Tuesday, April 9, 2013

1358. AUDIT & TRUST CASE. The 5-year-old Shih Tzu scratches and bites paws

April 9, 2013

As Shih Tzus are quite popular in Singapore, I get more of such patients. Today, a couple in their 40s and residing in Simei brought in the Shih Tzu at 8 pm. Sometimes I closed at 8 pm sharp or 10 minutes earlier as most clients would phone for appointments.

I had returned to the clinic at 7.30 pm to help out Dr Daniel if necessary. In addition, a man who drives a Lexus SUV and in his late 50s had phoned to say he would bring in 3 more stray cats for neutering and sometimes he would be late and Dr Daniel would have closed the clinic. He came around 7.55 pm and I told Dr Daniel to attend to him as there was a relationship of trust and he had done his previous stray cats which would be sterilised, left ear clipped and released back to the community. 

After this man, the couple from Simei turned up at 8 pm. They lived quite far away, in North-eastern Singapore and they had to rush here after work. There are other vet practices nearer to their home nowadays but skin diseases that have successful clinical outcomes after treatment get repeat visits from the owner.

This female spayed Shih Tzu was seen by me as a puppy in 2008 for vaccination and I spayed her as a one-year-old in 2009. Now she had all four paws itchy and infected, a circular bleeding patch of hair loss on top of her head and an area of skin infections above her neck. "I think oral ringworm tablets are needed," the wife said to me. "None was given in the past two treatments."

"Let me review the medical records and check for ringworm," I said. I noted that her dog had been treated by my associate vet first in September 17, 2012 for demodecosis. The skin scraping was positive for demodex mites.  The dog was clipped bald. Anti-mite injections were given on Sep 22 and 30, 2012 and on Oct 7, 2012. In Dec 30, 2012, Dr Daniel treated the skin disease for demodecois as her paws were red and swollen, the backside and below the neck skin were inflamed. In Jan 6 and 22, 2013, the owner came for anti-mite injection and now news from her till today, April 9, 2013.

Superficially, this would again be a recurrence of demodecosis and the usual injections would be given. The owner had requested for oral anti-fungal tablets as she must have done her internet research.
 The owner had stated unequivocally that the scratching of her head and chewing of her paws commenced only two weeks ago. The owner had done her own clipping of the coat and the dog wore an e-collar at all times and the whole body was no longer itchy.

"Did you change to a new brand of dog food?" I assessed there was a period of little or no skin inflammation from Jan 22, 2013 for the past 2 months.

This was a very important piece of clue. Some factors had caused a new occurrence of skin disease.

"Yes," she said. "I used to feed wet food but change to Alpo dry food 2 weeks ago. My old maid had gone back home and I have a new maid. My dog would not eat and so I bought trhe Alpo dry dog food for the new maid to feed her."

"Your dog is a one-man dog and missed the previous maid badly," I should have said a 'one-woman' dog.
So there was a possible cause of dry food allergy. It seemed to be obvious in this case. The dog would be on wet canned food for the next 3 months after treatment of the skin infections.

As to the oral anti-fungal medication requested by the owner, I showed the medical record that Dr Daniel had prescribed anti-fungal tablets for 15 days on December 31, 2012. During the review in Jan 6 and 22, 2013 by him when anti-mite injection was given, there was a slow improvement stated in the records but no anti-fungal medication was prescribed.

In retrospective analysis, would the fungal infection be still present in addition to demodecosis and skin infections?  Was this a pure case of dry dog food allergy as it seemed to be.

I warded the dog for clipping and full examination for the next day. The couple would come at around 8 pm to collect the dog. This case is a typical case of skin disease in the Shih Tzu. There were follow ups and there seemed to be a resolution in February. Till the dog was given dry dog food and started itching 2 weeks ago. Demodecosis could have returned as the immune system became suppressed. I need to review the whole dog thoroughly again. 


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