May 29, 2013
"Do you remember you
operated on his
ears?" the mother
and daughter brought
in a white Schnauzer
that had fits and
collapsed just over
one hour ago. The
dog had white and
cyanotic tongue and
was breathing fast.
I put him on oxygen
therapy first as he
had insufficient
oxygen for his red
blood cells, leading
to purplish tongue
and mucous
membranes.
I reviewed the
medical records and
said: "Yes, he had
very painful and
itchy right ear and
his ear canal was
opened up. How's the
ear?"
"No more problem,"
the mother said.
"Could the dog be
suffering from a
stroke?"
"Hard to say at the
moment, I need a
blood test and
examination. It is
possible there is a
brain abnormality
e.g. tumours,
infection or
bleeding or a
systemic infection.
I advised a brain
scan but that would
be costly and so the
owners wanted the
basic treatment to
be done. That
included a blood and
urine test.
The veins were
collapsed too. Dr
Daniel had to
collect blood from
the jugular vein. It
was not a good sign.
Despite intensive
treatment with fluid
intravenously, the dog
passed away 2 hours
later.
BLOOD TEST
Significant findings
are:
1. Total white cell
count 18.3 (6-17). N
90% Absolute 16. L
9% Absolute 1.7
2.
Red cell count
5 (5.5 - 8.5)
3.
Haemoglobin 11
(12-18).
4.
Platelets 108
(200-500). Few
giant platelets
present. No platelet
clumps.
5. Uric acid 0.27
(<0 .13="" br="">
6. SGOT/AST 129
(<81 br="">
7. Urea 3.4 (4.2 -
6.3). Creatinine
levels were normal.
The blood was taken
from the jugular
vein. The dog had
around 30 minutes of
oxygen therapy by
mask before the
blood and urine were
collected.
URINE TEST
pH 5.0 (5-8), SG
1.020 (1.005-1.030),
urobilinogen +,
blood 4+,
bacteria 3+,
white blood cells
>2250, red blood
cells 315.
It is important to
practise
evidence-based
medicine. In this
case, the dog could
have a septicaemia.
There could be a
pathogenic type of
bacteria picked from
sniffing the grass
or consuming some
poisonous food or
treats.
The onset was
"sudden" fits and
recumbency. There
could also be an
internal bleeding
and breakdown of
capillaries. A
post-mortem may give
a definitive
diagnosis as to the
cause of death. As
it would be costly,
this was not
advocated by me.
A simple blood and
urine test provide
some clues of
illness at the most
economic rates as
compared to brain
scanning and more
tests. In any case,
the dog was
breathing fast and
had white and
purplish tongue,
indicating a very
poor prognosis.
However, other tests
like brain scan
needs to be advised.
This Schnauzer has
been well cared for
as evident by his
good size and body
condition as so the
death was a "sudden"
loss to the family.
No poisonous food or
drink was consumed
according to the
mother. If no
blood or urine tests
were done, the
owners would not
know why the dog
died suddenly.
The dog's ears were
normal after the
surgery as there was
no more intense and
continuous ear
scratching. The case
study and lateral
ear canal resection
surgery is at:
http://www.asiahomes.com/singaporetpvet/dogs/
0750Schnauzer_lateral_ear_resection_Singapore.htm
The above case had
symptoms of shock as
the blood pressure
was very low. A
dengue haemorrhagic
shock syndrome is
reviewed below as
this dog has similar
brain, liver and low
blood pressure and
platelet disorders
as in the case
below.
Dengue
haemorrhagic
shock
syndrome
A
20-year-old
Singaporean,
Mr Ang
Yong
Han
was
the
first
dengue
death
in
Singapore
in
2013
(Straits
Times,
Home
B1,
Jun 1,
2013).
He
died
one
week
after
falling
ill.
Another
man
died.
8,305
people
were
infected
as at
May
31,
2013
for
the
year.
Signs:
fever,
headache,
muscle
or eye
pain,
vomiting
and
diarrhoea
- see
a
doctor
Don't
take
aspirin
or
non-steroidal
anti-inflammatory
drugs
(Nsaids,
e.g.
Ibuprofen
or
Synflex)
as
they
make
the
person
more
ill.
Pannadol
is
said
to be
safe.
No
drugs
to
cure.
Must
drink
a lot
of
isotonic
drinks
as
there
is a
loss
of
electrolytes
in
vomiting
and
diarrhoea.
Patients
given
fluids
intravenously,
blood
transfusion,
plasma
and
platelet
transfusion
and
pain
killers
(Pannadol).
If
blood
pressure
keeps
dropping,
goes
into
shock
and
die.
BLOOD
TEST.
Virus
caused
liver
and
brain
inflammation.
Liver
inflammation.
Enyzme
(AST)
Aspartate
transaminase
levels
are
10-40
units/litre
of
serum.
200-500
units
are
common
in
dengue
patients.
In Mr
Ang's
case,
they
were "way
off
the
charts",
being
1,000
and
then
4,000.
Platelet
counts
are
usually
very
low.
Below
a
certain
level,
patient
is
hospitalised
and
given
platelets.
Blood
test
said
to be
useful
only
when
the
patient
has
fever
for
one
week.
BRAIN
SCAN
Brain
inflammation
(confused)
-
brain
scan
done.
Patient
complained
about
stomach
pain.
HAEMORRHAGIC
SHOCK
SYNDROME
Blood
pressure
continued
falling
despite
being
given
strong
medication.
Due to
blood
vessels
leaking
fluid.
Blood
becomes
concentrated
and
pressure
falls
continuously
leading
to
death.
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