1413. Sunday May 12, 2013's interesting cases. The senior citizen man has a swollen foot

Sometimes, the vet has to care about the client's health although this is the domain of the medical doctor. The couple brought two Bichons with itchy necks and rashes all over the body for consultation. 

As there are over 50 vet practices now, I rarely get cases from Tampines which is near Changi Airport and is a half-hour's drive to Toa Payoh Vets and so I was surprised to see this couple. They wanted to buy a bottle of multivitamins in the belief that this would cure the itchiness. They had bought Neoderm cream which was effective.

"It is best to see the dogs," I explained to the couple. Times are hard for senior citizens and if the skin diseases cannot be cured after two consultations, then self-treattment is usually done by many Singaporean dog owners.

Both Bichons had extensive redness below the neck and on the face. Rashes scattered all over the body except the ventral part. The dogs wore clothing to prevent scratching but this was futile. From the signs, the main cause would be ear itchiness leading to continuous hind leg scratching and scratching of the flanks and self-inflected biting of the back and body. 

"The skin has been injured by the daily scratching. Skin wounds and rashes become infected over the months. To the owner, it seems that the skin is badly infected and he buys oil,cream and shampoo over the counter to treat the disease. Without success if it is a fungal and bacterial and yeast infection."

I had the dogs clipped bald, the excessive ear hairs plucked. As the gentleman was wearing slippers with straps over and across the foot, I noted that the left foot was much swollen. The swelling under the cross straps was absent due to the pressure. "I can't wear shoes and these sandals are useful as I can adjust the width as my foot swells."

"You will lose your foot if you continue," I said. "How long and have you seen a doctor?"
"Just 8 weeks. The doctor said I could have gout or arthritis and gave me some medication."
"I think it is likely a tumour - a nerve sheath tumour at the ankle growing and obstructing blood flow," I said. So, the fluid from the blood vessels of the obstructed area spills out and accumulate under the skin, leading to such a swollen foot. If you delay further, you lose this foot and will be hopping around on one foot. Have you got an MRI  or CT scan of the foot?"

He had not. He would go to the polyclinic to get an appointment to see the specialist. "By the time the specialist sees you under this system, it will be a few months. Your foot may become gangrenous and need to be amputated."

I advised him to see a private specialist at the Singapore General Hospital. "How long do you think you will live?" I asked this 65-year-old man.
"Men live up to 85 years."
"Men live shorter lives than women," I said. "Many have died before they reach 60 years of age, owing to poor health."
He agreed to see the private specialist next week as he said: "I believe the swelling has a more sinister cause." I guessed his wife was grateful for the advice. Men are inert when it comes to their health and in this case, an MRI would have detected the cause and he might save his foot.