Sunday, April 22, 2012

Sunday's interesting cases Sunday April 22, 2012

Case 1: The hot dog farted on abdominal palpation again! The two young ladies came with the hot dog for a review and blood test. "The Miniature Schnauzer bites," one young lady held the dog's head with both hands as I palpated the abdomen with my left hand. "No more vomiting. Normal now." Suddenly the dog farted as I palpated the back half of the abdomen.

This was a loud cracking sound. It was a reproduction of the same incident when I saw him on April 8, 2012. Scientific experiments are valid if others can reproduce the outcome and in this case, I was able to do it again. It is not a common occurrence and so I was much surprised with this loud puffing crack from his backside. "Something wrong with the intestines producing too much gas," I said. The dog was on LD prescription diet and some dog treats, but he still farted. I asked the owners to wait 4 weeks from the first blood test to take blood to check whether the liver has recovered.

I gave the young lady a bottle to collect the dog's urine in the morning as he pees a lot and then dribbles with difficulty (I suspect urine marking as some male non-neutered dogs will try their best even to pee nothing!). In any case, the first urine test show struvite + and spermatozoa 2+ and so we need to review again. The male dog had no more urine and so I did not bother to catherise to collect the urine.

Case 2: Two shrivelled front teeth in a 5-year-old Maltese. The marketing books say "Give what the owner wants." Well, the wife did not want the teeth to be extracted and had been to Vet 1 who did recommend that. "It is not good for the dog," I showed that the gum had receded considerably. "The dog does feel the pain and bacteria will continue to grow after antibiotics.

The teeth may then crack." After much discussion, the wife agreed one bent front tooth to be extracted. Giving what the customer wants is good marketing. I asked the couple to think about it as the dog would need another anaesthesia if the other tooth fracture due to shrivelled root and instability. "It is not stable anymore," I said. "Like tree with rotten roots. During thunderstorms, the tree topples. This root will break and part remains in."

Much time was spent in discussion. It was up to the wife. Much time would have been saved and more fees earned if the vet just do what the customer wants as there will be two anaesthesias involved. The first to do dental scaling of the two front teeth. The later one to extract. However, this cost the owner money and the dog more pain in the delay. Finally, the wife agreed to extraction of the two front teeth and dental scaling.

During anaesthesia, another right upper molar tooth was loose after tartar removal. I did not extract it, knowing the wife's preference to have teeth present in this 5-year-old Maltese. It was loose but not that unstable. Yet all the other teeth were quite strong and relatively clean. The two loose front teeth were a surprising revelation as the other teeth were solid. Veterinary dentistry can be full of surprises. Domitor + Ketamine 50% and isoflurane was safe and fast. Owner wanted a blood test which was done.

Case 3. Phone review of the Maltese with acute bacterial meningitis 10 days ago. I phoned the owner. She said the Maltese was OK and she would come for a blood test later.

Case is written in:
Signficant blood test results at time of stiff neck is as follows:
April 12, 2012 Maltese, 5 years, Male

Glucose **. Specimen grossly haemolsed. Query glycolysis, suggest to repeat.
Plasma glucose = 20mg/dL Liver Profile. ALT/SGPT normal. AST/SGOT 95 (normal = 81)
Total WCC 19.3 (6-17)
Neutrophils 94% 18.16 Lymphocytes 5.4% 1.04
Monocystes 0.4% 0.08
Eosinophils 0% 0 Basophils 0% 0

Based on sudden onset clinical signs and the total tal WCC and very high Neutrophils, this would be a case of acute bacterial meningitis.

Case 4. The spayed cat caterwauling loudly for the past 4 weeks, starting from first month after being spayed by Vet 1. The young couple showed me their phone video of the cat rolling over, tail up, backside up as if ready for mating. However, no audio. "Most likely, there is a bit of ovarian tissue left behind by Vet 1," I said. "It will be very difficult to find this tissue even if there is a repeat spay." What to do?

Case 5. A 2.5-year-old dwarf hamster had a much swollen right eye. The lower eyelid was as round as a ball, around 4 mm X 4 mm. Squeezing out the pus with fingers had been done by Vet 1 but the swelling remains as solid as ever. A small hole released the pus if you press the lower eyelid. "The best way is to cut a big cut and release the pus," I said to the mother who said this was her favourite "Small White" hamster and was concerned that the hamster would die under anaesthesia. "The hamster is at the end of his lifespan," she said.

"If he dies on the operating table, there is no more." "He will die if he does not eat or drink. Within 2 weeks," I predicted."No antibiotics and eyedrops will help. This is a large conjuntival abscess that needs to be cut around 3 mm to let the thick pus out. Anaesthesia is needed. The hamster may just die during surgery."

So, the 40-year-old mother with a small boy did not know what to do. The older man who could be her father was more aware of the no chance with eye drop and antibiotic treatment. Finally, she decided. I got it done.

A big cut. The hamster survived with a much normal sized lower eyelid and went home.

UPDATE: APRIL 26, 2012. No complaint from the owner

Case 6.  The previous blog is below: 939. The hot dog growls at the vet Tuesday, April 10, 2012 "More active, no more vomiting," the lady said. "The dog has not recovered fully from hepatitis yet," I said. I prescribed some liver supplements and anitbiotics. Every family member is happy. The dog was warded 4 days for lethargy and recurring fever.

10 days ago, I had operated on him and removed a big epidermal cyst. The dog was rubbing his back area where the cyst had been removed. So, the grandpa applied bright yellow powder onto the wound. It looked like yellow sulphur, which is toxic. Saturday, April 8, 2012 The owner had brought the dog to see me last Wednesday with complaint of lethargy and fever.

I boarded him for observation and on Saturday, the whole family of 2 ladies, their husbands and grandparents came to visit this miniature schnauzer of 5 years, male. Saturday was my day off, but I went back to Toa Payoh Vets to see this dog. That was how I met the group outside. The dog growled when I approached him to palpate his abdomen to see whether it was still tense and hard. "That is a good sign of recovery to health," I said.

 "Yesterday, Dr Daniel said he stood like a statute for a few minutes when let out." "Maybe he is frightened," the young lady said. "Possibly," I asked the owner to hold his muzzle while I palpated his abdomen. Not tense as before.

So,I decided to let him go home. He would recover faster at home. Well, he did recover. As to the cause of his tense stomach area, I can only sketch this scenario as follows: 1. The wound was contaminated by the yellow powder. Toxins and bacteria entered the wound.

Blood test showed high liver enzymes. Low red cell count. The stomach was full. Impaction. I had given anti-spasmodic inj to cool him down. The tense anterior abdomen was due to his liver inflammation.

APRIL 26, 2011Urine test did not reveal any struvite crystals.
This morning, the owner phoned to say the dog had 4 partly swollen paws and red eyes. Yesterday, he had fever and was treated by me with one anti-fever injection. Eating and drinking normally this morning.  Had vomited once on going home and after eating the AD canned food.
I asked her to wait and see. Could the liver be inflamed again?

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