692. Sunday Oct 16, 2011's interesting cases

Last Sunday, Oct 9, 2011, I took the day off. Yesterday, I was present.

Case 1.
A young man came with a newly purchased English Cocker Spaniel that had passed blood in the loose stools since yesterday. The puppy had loose stools since purchase 9 days ago from a pet shop in Pasir Ris. No stools sample was available. I palpated the puppy's stomach. There was some discomfort. Other signs were normal.

This was a case study for Kim who wanted to study vet medicine and I asked her to write up the process and procedures in the diagnosis and treatment of this case. "Some vets will just give a jab for gastroenteritis and send the puppy home with medicine," I said to Kim. "However, a newly purchased puppy from a breeder or pet shop needs more thorough investigation as parvoviral infection of the gut is the first of the differential diagnosis. Parvoviruses are very common in breeding farms and pet shops.

"The puppy looks all right today but if the vet fails to check for parvovirus, he or she is actually professionally incompetent if the puppy dies a few days later of bloody diarrhoea and vomiting."

Parvovirus check -ve. Blood test taken for haematology. The puppy was warded. Will report further.

Case 2
"I don't want my 5-year-old Miniature Schnauzer to be under anaesthesia for dental scaling," the mother of a young adult daughter repeated her concern when I told her that her dog would need dental scaling. I had written on the case sheet since she came for vaccination booster last year.

"It is a vet's duty to advise," I said. "It is the owner's choice not to do it. If the vet does not advise dental check up during vaccination and the dog develops oral tumours or bad teeth or ulcers later, the owner will say that the vet has not advised me, just give vaccination only."

"In any case," the mother said, "the groomer had charged me and did the dental scaling."

"I don't see how the groomer can do it," I said as the Schnauzer moved his head here and there to prevent me and the owner from opening his mouth. "I have heard of groomers grabbing the dog and pinning it down to do dental scaling. There is one pet shop providing this service for around $120. I hear that the grooming assistant who left this pet shop was very unhappy about forcing the dog down to do the dental scaling."

"I will do it next time," the mother must be thinking I am desperate and soliciting for business.

"How much did your groomer charge?" I asked as this groomer was from a well-known chain of pet shops that has branches all over Singapore.

"$70.00" the mother said.
"$70.00 for dental work or for grooming + dental work?" I asked.
"Grooming included. I can see that the front teeth are whiter now."
"In this case, the dental work is $20 as grooming of the Schnauzer will be $50.00. It certainly is much cheaper than a vet's job."

"And no anaesthesia death. Or the dog becoming groogy after anaesthesia and can't walk properly as that is what the groomer told me!" the mother said.

"Anaesthesia is very safe in most dogs nowadays. But the vet must know what to do to ensure safe anaesthesia," I said.

It so happened that there was a Shih Tzu with his tongue protruding. That Shih Tzu had domitor 0.1 ml IV and isoflurane gas given for stitching up of the cut in the interdigit of one front paw. This was done by Vet 1 and the dog was now outside as the owner dialed for a taxi.

So the mother saw a "groogy" dog as she asked the owner what happened.
I said to my assistant, "Get me the Antisedan and bring the Shih Tzu back to the Surgery Room. I got 0.2 ml of Antisedan, added 0.2 ml of normal saline and asked Vet 1 to give it to the dog IV. The dog was alert and awake.

"As you can see," I told the mother. "There is the antidote a vet may use to wake up the dog after anaesthesia. It is up to the vet's judgment as to whether he or she wants to use it. As for me, I usually do it but not all the time as that depends on each case."

I got the Schnauzer's mother opened up finally. Thick tartar in all back teeth and some gum inflammation. The mother saw it. This is just an education for the dog owner, not a desperate hard sell to get her business. Each owner has to decide as to anaesthetic risks of dental scaling. The groomer now goes into dental scaling to take advantage of such fears and well, this is the real world.

As for the Shih Tzu, the owner wanted the interdigital wound stitched up. But Vet 1 decided to give injection, medication and wash. I intervened and told Vet 1: "The interdigital wound is not easy to heal when opened up. The dog will lick it and if a granuloma forms, the owner will be most happy. He will curse and go to another vet who will stitch up the wound belatedly. You did not advise the owner that surgery is an option. Actually the owner wanted surgery."

This Shih Tzu case showed that every vet or doctor has his or her own ideas in handling a case and no two vets will do the same thing. "Some vets advise surgery, some advise no surgery and some have no advices," I said to the Shih Tzu and Schnauzer owner. "This is the judgment of each vet."

Well, the Shih Tzu owner, being well read, wanted surgery. The Schnauzer owner agreed with him. So, you can see that a vet in private practice must give all the treatment options. Not just his or her own recommendation of conservative treatment which will be much less costly. But will it be effective in a interdigital wound recovering early and not degenerate into a interdigital granuloma or worse?