Sunday, December 1, 2013

1232. Sunday's interesting cases. The woman who had "shingles", a Roborovski had a big swelling.

Sunday Dec 1, 2013's interesting cases.

Case 1. The woman who had shingles.
"You can still remember my shingles?" the woman in her late 50s had brought in her older Miniature Schnauzer that had been scratching her right cheek area below the right eye. A circular patch of around 3 cm x 3 cm, with yellow pus appeared.

"I remember because not many of my clients had suffered from shingles," I read about shingles when my sister had them. "Those snake-like tracks in your skin are caused by the virus. You consulted a specialist skin doctor who had mis-diagnosed it or something. Have you recovered?" I remembered her interesting story of her Jack Russell who avoided her as he was dying. I need to search for this story written some years ago.
"Yes, yes,'" she replied. "Now my Schnauzer had this skin problem. A few months ago, she had dental done at any clinic."
"Why didn't you send the dog here?" I asked since we could communicate as friends and I had treated her dogs several times.
"The vet was nearby my house," she said. I could understand that Singaporeans prefer proximity of service providers.

I examined this dog. I noted that Vet 1 had done an excellent dental scaling job as the teeth were all shiny snow white in this 8-year-old. It was done recently anyway.

"The roots of this right upper premolar 4 are exposed and this tooth is shaky. The dog could have rubbed his right cheek which is located near this tooth as it may be painful. Extraction will resolve this problem.

"I don't want any tooth extraction," she said as many owners have the misperception that it is better to have loose teeth causing tooth ache rather than no tooth in an old dog. "I will be going to Japan soon anyway."

"OK, I will prescribe antibiotics and if the skin disease recur, then you may wish to consider this option.

"My domineering loud barking Jack Russell kept licking it," she said.
"Dogs do help to groom each other, to lick the other's wounds," I said.
"Did the Jack Russell bite her?" I asked.
"It is possible."
Some itchy skin wounds don't heal when licked or scratched frequently. This could be a ringworm lesion but it was hard to tell. Skin scrapings and microscopic examination was negative.  
"Did the dog keep scratching it like mad, with her right hind legs many times a day?" I asked the Filipino maid. The owner was surprised when she affirmed.. 

The dog was given medication and an injection and I would see what happens in 2 weeks.

Case 2. The Roborovski has a big globular swelling below her right ear.
"I discovered this lump around 2 days ago," the young slim lady in her late 20s said.
"You are sure it was not around longer than that?" I asked.
"Maybe," she replied and held up a maize seed. "I could have ignored it as she likes to hide all the seeds inside her pouch. She eats only  maize seeds in my presence."
"Did she eat the same amount as usual?" I asked.
"I don't know as I fill her feed bowl to the full every day and there is always some seeds and pellets left behind."
Hamster owners tend to over-fill the feed bowl.
"How many faecal pellets she passed a day? Did she pass the same amount?"
"I don't know but you can see a few in this plastic container I carried the hamster to the clinic. She has her own cage."

So it is hard to know whether the hamster had been eating or not. She is still active and her big black eyes were bright against her light yellow face. I could not assess the anaesthetic risks but the owner was aware and consented to the surgery of this firm lump which could be an abscess or tumour.

Dr Daniel gave Zoletil 50 IM and pus oozed out. He stitched up the wound. The hamster was lively and so this was a happy ending. I asked Intern Daniel and Clara to do some videoing.  

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