19. To publish*****: Veterinary stories. Head tilt in a rabbit

Report written at Toa Payoh Vets: Feb 16, 2010. Chinese New Year (CNY) 3rd day. Still a holiday. I wrote the following since I was quite free.

CNY reviews of interesting cases.
During Chinese New Year, almost all Singapore small animal vets close. Feb 14, 2010 was Chinese New Year and also Valentine's Day. Toa Payoh Vets do open half days during Chinese New Year. During last Chinese New Year, I had no cases and so I thought the same would happen this time. However, there were a few cases. Vomiting and diarrhoea in dogs accounted for 3 cases. The following were some interesting cases for dog lovers.

Case 1. Hypersexuality in the male dog.
The career lady was in charge of a regional publishing operation and had no time to take leave. She planned one month ahead and took several days' leave to care for her Miniature Schnauzer after neutering as advised by me. Her dog had inflamed areas in his groin region due to humping and licking.

The dog was groomed first. Multiple rashes on his lower body. Treatment for 4 days. Then I neutered him and sent him home 4 hours after neutering. He would be given Tolfedine 60 mg at 1 tablet per day. I phoned the lady and she said that the dog felt no pain and was just normal. I told her that the urine analysis showed that the dog has no urinary crystals unlike the previous test in which some triple phosphate crystals were found. The dog had spermatozoa in the test, as in previous test. Why? This male dog had an anti-social habit of humping onto legs and pillows, injuring his groin area. I hope neutering would help as he is already 4 years old. Neutering before 1 year of age would be best. This owner slims her dog down now as she cooks for him. No more dry dog food. She takes good care of him and I expect this dog to live up to 20 years. He is only 4 years now and may outlive me as I am 15 times older than him.

"You can't shout at him," the gentle lady boss told me. When I commanded the Schnauzer in a firm voice to be still on the examination table, the dog suddenly turned around and opened his mouth to bite me. I just withdrew my fingers in time. No tough love for this dog. But no gentle kind words from me. I muzzle him instead.

Case 2. Medial Entropion. Shih Tzu, 7 kg, Male, Neutered, 1 year, 39deg C. Persistent eye tearing since puppyhood.

The Shih Tzu is well known for medial entropion causing life-long tearing and irritation but few owners are aware of a simple surgery to resolve the problem. Seldom does the owner bother to take the surgery. A case is recorded below for the benefit of vet undergraduates. Name of surgery: Nasal fold excision. I didn't know there is such a surgery.

Admitted: Feb 2, 2010
Surgery 1: Feb 5, 2010
Surgery 2 (left eyelid tearing on day 6, right eyelid has no tearing): Feb 11, 2010. Excised a bigger elliptical skin area below and lateral to the medial canthus. Rolled out the left eyelid more. Took out stitches of right eye area to review. Wound opens up as the area is under tension and has not healed firmly as it was 6 days only. Has not healed 100%. Re-stitch. Tolfedine 60 mg (1/2 tab/day) x 10 days
Baytril 50 mg (1/2 tab/day) x 6 day
e-collar, eye drops
Daily cleaning of eyelid area is necessary for the next 10 days
Nylon 5/0 stitches to be taken out on Feb 25, 2010
Goes home on Feb 17, 2010 (pictures taken on Feb 16, 2010. Phoned owner at 10.30 am wakening him up.)

Case 3. Anal sacculitis or circum-anal tumour.
Miniature Pinscher, male, 5 years with hard lump on left anal sac area. Anal sacculitis/circum-anal tumour surgery. Heals well. Goes home on Feb 16, 2010. Is this a circum-anal tumour? Still Alive And Kicking - Circum-anal tumours. Should the dog get a second anti-androgenic injection and be neutered? Many owners are against neutering deeming it to be a cruel act.


Anal sacculitis (left)
Anal sac and surrounding tumour excised. Neuter advised
Or in this case, the dog is deemed too old and a anaesthetic risk. So I do not pursue the matter further as the owner may think that I am soliciting business from her and from the owner's point of view - this is patently obvious. Update: 2004 tips for young and older dogs

Case 4. Torticollis (head tilt) in a rabbit.
CNY 1st day. Rabbit, female, 2 years, 1.7kg
Feb 14, 2010 (Chinese New Year).
Head tilt to the right. Rolling and rolling as the rabbit could not stand up. Sudden onset at 1 am (loud noises heard). Left eyelid wide open. Nystagmus. Right eyelid injured as rabbit lies on right face. Keeps rolling to try to get up. Ear canal - A bit of blood stain was seen in the cotton bud seen from deep inside the ear canal. No ear pain. Irrigated ears. Prednisolone, Meloxicalm oral, Biolapis, Fiberplex. SC dextrose saline and baytril.

Sent home the 2nd day as she could stand but with head tilted. Less Nystagmus. The lady owner to nurse and hand feed at home as economics was a big concern. Floor mat. No blood test or X-rays for the time being as this would increase vet costs. Possible causes are: trauma (cage too low), otitis media or externa (X-rays needed), encephalitozoonosis, neoplasia, toxicity and cerebro-vascular diseases. Antibiotics given.
Vestibular Disease is common dogs and cats. Rabbits too. Clinical signs are NOT dependent on the localisation of the lesion within the peripheral or central pat of the vestibular system. The peripheral system is the balance organ (semicircular canals) and distal Cranial Nerve 8. The central is vestibular nuclei and proximal CN8 and part of cerebellum (flocculonodular node).
1. Head tilt, falling and rolling: peripheral and central and sometimes cerebellum affected.
2. Circling: peripheral (ipsilateral). central affected. cerebellum: not affected.
3. Nystagmus: yes for peripheral and central. eye oscillations (tremor) if cerebellum affected.
4. Nystagmus changes direction: no for peripheral. yes for central. N/A for cerebellum.
5. Vertical nystagmus: no for peripheral. yes for central. N/A for cerebellum.
6. CP and postural deficits: no for peripheral. yes for central. no for cerebellum.
7. Paresis: no for peripheral. yes for central. no for cerebellum.
8. Horner's syndrome & CN7/5 signs: often for peripheral. rare for central. no for cerebellum.
Horner's syndrome is caused by disruption of the sympathetic innervaton from the hypothalamus to the eye and periorbital region and clinical signs are miosis, ptosis, enopthalmos and 3rd eyelid prolapse. Causes usually idiopathic but common ones are brainstem disease, cervical spinal cord disease (disc prolapse, embolism, trauma), C8-T2 brachial nerve root avulsion, C8-T2 spinal nerve or brachial plexus nerve sheath tumour, large anterior mediastinal lesions (thymoma, lymphoma), neck injuries or disease, otitis interna/media, skull fractures, trauma, retrobulbar neoplasia or infection.


CNY 2nd day.
Case 5. Suspected high fever in a hamster.
White dwarf hamster, Male, 14 m,
Eyelids closed. Not eating 2 days. Sleepy for 2 days
Young teenaged boy was upset that his pet became sick when he was in China for 9 days.
SC dextrose and Baytril and eye drops.
Day 2 - conjunctivitis and tearing esp. right eye (photography) and dehydration - will need electrolytes. Eating. Stools passed but only a few pieces. Not a good prognosis.
Owner to disinfect hamster cage, feed bowl and water bottle.

CNY 3rd day. Still a public holiday.
Case 6. Deep ulcerative keratitis in a Chihuahua.
Chihuahua, 2.6 kg, 38.8. adopted for 2 months. Abandoned. Eye cataracts. Possibly >8 years old. Male. 2.65 kg. Heart disease.
Right corneal eye ulcer very deep. Blood spots. Past 2 weeks. Why the delay? The owner thought it was a small matter.
Anaesthesia is high risk as dog has heart disease. Bad teeth. Eats only wet food. Big right flank abscess > 4cm x1 cm. 3rd eyelid flap on day 2 planned. As the dog has serious heart disease and would die under general anaesthesia in 90% of probability, I decided not to operate and let the dog go home later.

Case 7. Poodle, Male, 2 years. Dental scaling. I was surprised that the lady owner made an appointment for dental scaling for a young dog. Rarely do Singapore owners bother at this age. Grooming 3-monthly and regularly yes. The external beauty is a priority.




Tartar in the back teeth
Dental scaling removed tartar and plaques
But teeth check up once a year? No. This young dog eats home-cooked food and no dry food. So plaque and tartar form in the back teeth. Daily brushing will resolve all problems. Some dogs don't like teeth cleaning. This lady may be one of those more sophisticated ones who know the importance of dental health to enable her dog to live longer.

Case 8. A tele-conversation with a pet owner. One owner complained that his dog had been losing weight since being warded. His vet prescribed many types and sizes of capsules containing nutrients and vitamins for his old dog to "prolong his life". Yet the dog lost weight while he was warded. He said he was not given progress reports. The dog would not eat when brought home as he was force-fed. I don't make comments in this case as I only get one side of the story. Just provide a listening ear as I am sure that there will be owners with grievances against me as a vet.

Case 9. A tele-conversation with a new vet undergraduate. Young people prefer texting. I prefer phoning to thank Daphne for her help in producing 2 educational videos for vet students recently. Creating educational videos to bring veterinary surgery alive. She had been an intern at Toa Payoh Vets. I gave her my very best wishes for her new adventure as a veterinary undergraduate in Australia. She saw 5 beautiful Miniature Schnauzer puppies at a practice and was saying how cute they were. New-born puppies always tug's a lady's heart strings. I told her I did not perform the Caesarean section but was taking pictures. Oxytocin injection and wait or an elective Caesarean section?

This 2010 CNY was not a quiet day unlike 2009 CNY. My main lesson is from the feedback in Case 8. It is important that the vet does daily rounds of in-patients and check records of weight loss and appetite as a routine no matter how busy they are. Phone the owner to update and to phone the owner to visit the pet if the pet is dying. Before the pet dies so that the owner can pay the last visit. I wonder whether this is taught at veterinary schools for the 5th year students.