Sunday, June 10, 2012

1022. Sunday June 10, 2012 interesting cases

Sunday June 10, 2012
Bright sunshine, blue skies.

Case 1. Golden Retriever shakes and trembles after Antisedan IM injection.
As the electricity supply to Toa Payoh Vets and nearby tenants was cut off due to the need to maintenance by the Landlord, it was too dark to do 3rd eyelid irrigation and right elbow granuloma injection.

So I did it outside. This was not ideal but the lighting from the morning sun was good.

At 10.15 am, the 28kg GR was given Dom + Ket at 50% IV by Dr Daniel. The dog fell asleep fast. I got the table outside the surgery where there was bright sunshine. Time was of the essence and I hurried my assistant Min, intern Sally and Dr Daniel to move on with the preparations. There was no isoflurane gas back up now as we were outside the surgery and the couple (owners) were watching.|

The GR was still asleep. So I decided to give Antisedan 1.0 ml IV. But Dr Daniel and then I could not locate the cephalic vein. Around 4 clients with barking dogs and a cat came and there was no time to waste. I gave the Antisedan IM. Nothing happened for 2 minutes. "It takes a longer time to wake up when IM injection is given," I said to the concerned wife. Then the dog inside the waiting room held his head up. There was much barking from other dogs. A contractor across the block was using his machine to drill something.

The GR started to shake and tremble non-stop. He panted. He could not get up to walk. "He is excited by the barking and the machine noises," I said. I rushed into the Surgery to get the atropine injection and gave him IM. Still his whole body was trembling.
"Put the dog inside the boot of the SUV," I said. "He needs to be far away from the barking dogs." The owner drove the dog to the other end of the block and parked the car there. The dog was still trembling but much less. I brought a bowl of water. He did not want it, as if afraid of water. "His head keeps turning right and left," the wife said. "It is part of the excitation effects of the ketamine," I explained. "Normally, the dog should wake up in a quiet place at the back of my surgery, but this morning was unusual in that there was so much barking from the other dogs." 

After 30 minutes, the dog had stopped trembling, drank his water and was sent home. This side effect of excitation by ketamine after Antisedan reverses domitor, during recovery is rare but does occur. The vet must know what to do as it can be quite stressful to the owner. It is best to let the dog wake up in the back of the Surgery, away from the crowds and barking dogs.

Case 2. "The Westie's skin disease is much better due to a change of diet," the man in his early 30s said to me as he did not want any steroid injection. He had been to Vet 1 to treat the Westie's lacerated interdigital D3-D4 left hindpaw. Vet 1 had given injections and the paw wound is much less inflamed. "What injection did Vet 1 give?" I asked. "I don't know," he said. "My Westie has much steroid to cure his skin disease (lower body) and I don't want him to have any."
"It is because of the steroid that his skin disease is under control," I said.
"No," the man said. "It is due to a change of diet."
"If it is due to the change of diet, then the Westie should not have any steroids for the last 6 months. Just purely the diet. Has he got the steroid in the last 6 months?"
"Yes," the man said. "But not much."

"I am just trying to educate pet owners. Steroids are to be used carefully and they help to relieve the dog of itchiness and injuries due to licking and scratching. Many owners and younger vets seem to think that steroids are to be avoided at all cost as they suppress the immune system. Many diseases, even in people, need careful dosage of steroids to live a normal life."    

As he just wanted antibiotics for the lacerated wound and washes, I gave him what he wanted and a wash. The dog had an e-collar and should recover after many days. However, the lacerated wound between Digits 3 and 4 was long and between the digits, stitching up would be best option but it was declined. Healing by granulation could work.

Case 3. The 5-year-old Jack Russell passed fresh blood copiously yesterday. The owners wanted Dr Vanessa but she was off duty on Saturday. So it was Dr Jason Teo and myself. Anyway, I got them to see Dr Vanessa in the consultation room since she was present. "Dr Vanessa would not know anything about this case," I said. "The dog is more active and has not passed blood due to the drug injection. Blood test and stool test results would be known tomorrow. I did not feel any abdominal pain or foreign body and so no X-ray is done. It will take 3-5 days to know whether the dog has recovered from ulcerative colitis (bleeding from the colon).

"Did the dog eat chicken bones?" I asked again.
"No," the wife said. The husband and young adult daughter came.
"He eats wood, plastic and anything," the husband said. "Could this be the cause of the bleeding?" The dog had vomited once and passed stools followed by red fresh blood yesterday. This seemed to indicate that there was a foreign body lacerating the rectal area, causing large amounts of bleeding at the anus. Parvovirus test was negative and that was good news.

We had 2 or 3 cases of dogs passing blood in the stools recently.  My ideal treatment would be IV drip with IV to prevent dehydration and antibiotics and anti-spasmogesic in the drip to give more effective and prompt cure. Other vets may prefer antibitoic and anti-spamogesic SC as in this case. "The dog bites," the owner had warned Dr Jason Teo and I on Saturday (yesterday).

"Muzzle the dog and give IV glucose saline 500 ml as it is more effective," I said when Dr Jason suggested drip SC.  The dog was quite lethargic and would not bite when muzzled. The dog had stayed overnight. "I am worried that the dog may feel home-sick," the wife had told me as she wanted an injection and take the dog home. But the mucus and tissue from the rectum had red blood and we collected a sample to send to the lab for check up of parasites and abnormal cancer cells.

"Well, it is not the dog that is worried. He is already so sick and will prefer to rest quietly. It is the owner who feels it. If the dog goes home after the drip and wanders around the apartment, he cannot rest and recover fast. Worse of all, he may pass more blood and then there will be extra after-hours emergency costs."  So, it is best to hospitalise the dog with bloody stools at least overnight.  This dog was much active today on Sunday and the wife had great difficulty in muzzling him so that my assistant Min could remove the IV cathether. The dog had been eating all wood and other things from a young age. So, there could be chronic damage to the colon and ulcers form, leading to ulcerative colitis with profuse bleeding on Saturday yesterday.  

UPDATE Jun 15, 2012. 6 days later.
"My dog is passing black stools, once a day instead of twice a day," the daughter said today. "He doesn't poop more than twice a day as before. The stools are black. Why?"
"Your dad says your dog eats wood, chews wood and any plastic. Some of the big chewed pieces would have cut the small and large intestines. The small intestines bleed and the blood becomes black when it arrived at the anus. Hence you can see black stools."

"But my dog was passing lots of red blood," she said. "So scary. What is the cause of this red blood?"
"Most likely the rectum or the area near the anus had been injured by a large piece of wood or object. So the bleeding is fresh red blood and lots of it."

The dog had recovered from anal bleeding. "Stool sample showed RBC and WBC. That means there is infection in the intestines." I said.

The dog had been chewing wood from young. How to stop him is a problem. Lifestyle changes are needed. The owner bought canned food for the dog for the time being.


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