Wednesday, February 1, 2012

856. Persistent coughing in a young shih tzu - a 2nd opinion

"My other dog has been treated by Vet 1 for the past 12 years," the owner said he had no veterinary report from the vet who had treated the dog for coughing. "I feel bad to ask Vet 1 for the medical records and X-rays for this Shih Tzu."

"How long has this Shih Tzu been coughing?" I asked.
"5 months. My domestic worker says the dog has a tongue ulcer."

"There should be no problem with Vet 1 sending over your dog's records as this is a common practice. Shall I phone on your behalf?". The owner agreed and Vet 1 sent his report over. The coughing started 3 months ago and blood test and X-rays of the chest and abdomen were normal.

What's the cause of this persistent coughing? There was a tongue ulcer at the tip and one on the hard palate. I shone my torchlight at the ulcers to show the owner. The dog just would not cooperate, but the owner already knew of the existence of the ulcer. I palpated the dog's throat. It was very painful.

"My dog sometimes throw up liquid," the owner said. This is quite a complicated case as the heart and lungs were normal on auscultation using my stethoscope. What is the cause of this persistent coughing?

To complicate diagnosis, the right and left submandibular and popliteal lymph nodes were much enlarged. I let the owner feel the lumps. Could this be a concurrent case of lymphoma or lymphosarcoma?

"Did your tongue lick some poison?" I asked. "Tongue ulcer at the tip of a normal tongue usually indicated something corrosive had burnt the tongue. Like insecticide."

"Well my dog has licked shampoo used to treat his dandruff."
Blood, urine and X-rays of the throat, chest and abdomen are being done as this are necessary to aid in the diagnosis of persistent coughing even though some tests were done earlier by Vet 1. Throat X-ray was not done and is usually not done in cases of coughing. However, this must be done as there may be a piece of bone stuck inside the throat, leading to persistent coughing and weight loss as the dog ate little. The tongue ulcer could be due to licking of the shampoo over the last 3 months. Wait for the new X-rays to be done today.

"Dog owners may want to be loyal but the vet must be able to get the dog's problem resolved within two visits," I said to my associate vet. "Good bedside manners are great but repeat visits cost the owner money and time. So they go for 2nd opinions if the family vet can't come to a correct diagnosis and treatment."

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