Saturday, November 2, 2013

1145. Saturday Nov 2, 2013 - Deepavali - interesting cases

Nov 2, 2013  Deepavali

I believe many vet practices close today as Deepavali is a public holiday. Toa Payoh Vets opens during public holidays since some 30 years ago. Some new interesting cases are seen.

Case 1. The Golden Retriever with enamel hypoplasia.
"Did Dr Daniel receive my sms asking whether your clinic is opened during Deepavali?" he asked me. His message was present on the clinic's phone but no on Dr Daniel and so he did not receive any reply.

His sms at 8.45 pm & 9.24 pm said:
"Dear dr Daniel   
Is your clinic open tomorrow as my dog .... - golden retriever 19 months old, vomited a white liquid 2 days back and eats very little only - hardly 20% of his normal diet and just sleeps around the whole day."

I said to the gentleman in his late 40s: "It is best to phone rather than sms as sometimes I don't read sms in the clinic phone."

I put the dog on the table and examined him. I found nothing wrong with him generally. However, this dog was slightly hunched back. It was a slight hunch easily missed. I put my two fingers to press down on the spinal area from the neck to the tail. At the cervical/thoracic junction behind the ribs, the dog suddenly swung his head attempting to bite me. The owner saw this action. But he was not convinced when I said that the dog had a severe back ache and that would be why he was not moving much.
"Really?" he repeatedly said when I reproduced the behaviour, nearly getting bitten by the dog.

I put the dog on the floor and asked him to press on his spinal area.
"No pain, no pain!" he commented.
"You pressed on the wrong area or you did not press hard," I replied.
He pressed on the painful area. The dog turned his head, curled up his lips and bared his teeth. This time he was convinced.
"It is his active lifestyle," I said as the dog had sprained his left hip last month. "Did he fall down from the staircase or some heavy object fell on his back?"
"He is always dashing here and there inside the house," the owner could not confirm any fall or trauma.
However, now he knows why his dog was not active for the past 2 days and vomiting would be due to the extreme pain.

I got the blood test done and gave the dog the IV drip and painkillers. Confinement is necessary.

Case 2
An old Roboroskvi had two large globular tumours and was no longer as active as a young one. He did not attempt to escape when held.. "The only solution is surgery but the risks are very high since the hamster is old."
The lady had consulted another vet who said that these were fatty tumours and best left alone. However, the hamster's leg tumour obstructed his movement. Yet there needs to be surgery to enable him to live a good quality of life. Surgery would be done tomorrow. "One tumour at a time," I advised as the dwarf hamster will die of stress under prolonged surgery to remove 2 tumours.
This case illustrates that some clients do not go to the nearest vet practice owing to proximity. Sometimes it is the brand name.  She lives a short walk from Toa Payoh Vets. However the other vet did not want to operate on this hamster and now two large ones have developed!
The hamster will be operated on one tumour today.

Case 3
The old Silkie Terrier still would not eat and had loose bloody stools for the past 7 days, despite blood tests,  X-rays and ultrasound being done at another practice. "Nothing wrong with the dog," the owners said. However the clinic was closed and so no medical report was possible.
Owners go to another practice when their dog does not recover. This happens to all vet practices.
I palpated the throat and the dog winced.
"There is intense pain in the throat area," I said. "There may be a piece of chicken bone stuck there."
I could understand that the owners did not want to spend more money when I suggested X-ray of the throat area.
"The dog had X-rays," the owners said a family member who was not present had brought the dog to the first vet. They would seek medical records the next day as the clinic was closed for Deepavali.
This was an easy case to diagnose as the dog had eaten chicken bones before being sick. Chances are that this dog had injured his throat and intestines. "The pulse is weak," I said. The owners did not want another blood test and so evidence-based medicine could not be practised.

I hospitalised the dog to give IV drip and medication as this would be the cheapest method of treatment rather than X-rays.

Case 4
The Pom had bloody diarrhoea 1 day ago. His pulse is normal and strong. So this was a case likely to recover after an IV drip and medication and went home at 4 pm today. No need for hospitalisation.

Case 5.
The 12-year-old Silkie had a large painful lump below the right armpit. "It is a large breast tumour between MG 1 and MG2 on the right side," I said. Since the owner claimed that the large mass appeared rapidly, it would likely to be malignant. The dog had dental scaling done by another vet 3 months ago and there was no mention of the mammary gland tumours, now scattered on the right and left side.
"Is the dog spayed?" I asked.
"No," the couple said.
"Chances of getting breast tumours are very slim if the dog had been spayed young," I said. "As the dog is very old and the tumour is likely to recur soon after surgery, please think about surgery."
The dog had fever and would not be operated immediately. The owners decided on operation which will be done next week. Detailed explanation on the possibility of recurrence and spread to the lungs were given. The dog may die under anaesthesia. The owner had to decide and they wanted surgery. If only this dog had been spayed some 11 years ago, this situation would be unlikely to be presented. 


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