Monday, February 29, 2016

2939. The Sheltie swallows an "aluminum foil wrapper of sweets" but it is actually an ankle sock

Feb 29, 2016

"No way he had swallowed the aluminium wrapper. It appears like a disc in the X rays

Tues March 8, 2016

The couple had promised to provide feedback to me although they had gone to another vet for the operation.Total cost of surgery (removal of ankle sock) and hospitalisation was around $2,500 as compared to another vet practice (Vet 3) that quoted $6,000. Some bruising in the gut but nothing serious.

The wife phoned me to say that her dog had recovered from the intestinal surgery done by Vet 4.
The dog went home last Saturday.

The dog had swallowed an ankle sock. That was how I palpated a hard golf-ball lump in the mid-abdomen as the sock must have had bunched up. I had advised surgery but the dog had a blood bacterial infection on that day. Surgery was postponed to the next day after IV antibiotics and drip. However the owner went to Vet 4 who did the surgery.

The dog is OK now and had not passed much stools yet. "He had not eaten for the past few days and so no stools were formed," I explained. The owner fed porridge and chicken. The big skin wound was necessary to open up the abdomen to take out the intestines.

Video of dog pre-op in You Tube.

2 ultrasounds
2 x-rays
Several vet consultations

In my opinion, a painless hard golf-ball lump in the mid abdomen and the first ultrasound stating possible foreign body would have been sufficient evidence to go for exploratory surgery. Barium meal contrast X-ray is another option but all these cost money.

2938. A golden retriever fell into a drain and hurt his back and right hip

March 1, 2016

The Golden Retriever from Marine Parade, East Singapore, fell into a deep drain yesterday and was all right after being taken up.
"He even walked several km," the owner said. "Without any lameness."
Later in the evening, he limped on his right hind.
"I tried palpating the back spinal area," the owner saw me doing it before. "He growled when I felt part above his hip."

X-rays show slight dislocation of the right hip joint.

Sunday, February 28, 2016

2937. A 9-year-old Jack Russell bites himself sore

Sunday Jan 27, 2016

It has been several years since I saw this Jack Russll.  Now he has bigger bleeding sore on his elbows, chest, back perineal area and all 4 paws.

Never been to the groomer or pet shop for the past 9 yars

I checked right elbow hair which is full of raw skin sores. Anal sac almost empty of anal sac oil but both perineal areas were bald and hair loss.   

Saturday, February 27, 2016

2936. Vetoryl 60 mg for Cushing Disease

Sunday Feb 28, 2016

In 2014, his 15-year-old Shih Tzu kept looking for food every hour and drank a lot. Her body hairs did not grow back after clipping. Her belly became pot-bellied. She passed blood in the urine.

The vet diagnosed 5 bladder stones, the biggest being 0.5 cm on X-rays. However, he advised not operating as the wound would not heal well as the dog had abnormal cortisol levels from Cushing Disease.

So the ACTH stimulation test was done for half a day, costing him $200. 10mg Vetoryl was given orally for one week, then 15 mg twice a day for one month. After several months, the effective dose was 30 mg once a day. 

The dog no longer has Cushing Disease. He came to Toa Payoh Vets to get prescription of 2 boxes of 60 mg as it is less expensive.  One capsule content is divided into two. Carefully he apportioned the alloted portion to an empty capsule. The dog has a little pot-belly but would eat and drink normally.

Brain and adrenal glands. His dog's was the brain.

Cushing's Syndrome - dogs 

SYNETHIN  15 BOXES PER MONTH - goes fast.  250 I U of per ml

Tuesday, February 23, 2016

2935. A 6-year-old Shih Tzu panted continuously after swallowing a large chicken treat

Feb 23, 2016

History is very important in the diagnosis of this case. To the observer, this Shih Tzu panted furiously, pulse pressure shot up, tongue became cyanotic and rectal temperature became very high.

"A heart failure," the X-ray assistant observed the cyanotic tongue and palpated the high pulse pressure. "Check the heart!"

The history was that this morning at 10 am, the Shih Tzu that loves to swallow any object, took in a large piece of dog treat made of chicken. The domestic worker said he had swallowed a bone, the length of a man's forefinger. So, the dog started to gag and panted furiously as you can hear from the video. The wife was most concerned and so the husband phoned me and another vet for a quotation

"I will check the mouth and if there is a bone, I will see whether I can pull it out." I said. Later the husband texted me to say that the dog had swallowed a large dog treat made from chicken.

X-rays showed some pieces of dog treat inside the pharynx but no chicken bone. So the domestic worker had given the incorrect info.

What to do now? The dog kept panting and panting, becoming feverish.

I gave an IV drip, with painkiller spasmogesic 1.2 ml IV and baytril 0.7 ml IV. After one hour, the dog relaxed and no longer panted furiously. He was back to almost normal and coughed a bit. So he went home.

Sunday, February 14, 2016

2934. Better to put the hamster to sleep since pus flowed from the right eye?

Feb 14, 2016
The last case in this dark clouded sky evening at 4.15 pm was a hamster with both eyelids glued tightly. Liquid pus oozed out from the right eye, as if a dam had ruptured. The young man saw it and asked whether it is better to euthanize this hamster.

"I need to examine the eyes first," I told him that the left eye was still open partly. Examination of the right eye showed sticky pus which I removed with a wet cotton bud. The eyeballs were intact. "How long had the hamster not been eating?" I asked. "The lower front teeth have overgrown. I will clip them shorter"

"Don't know," the man said.        
The hamster is an in-patient on this Valentine's Day. Will see how she goes.

2933. Two-of-a-kind cases - rabbit feet, dog abdominal tumour, dog swollen tummy

Sunday  Feb 14, 2016

It is very unusual for me to receive two similar medical conditions within 3 days.

1. Case of sore feet in 2 rabbits.
    Today, Feb 14, 2016, a young man came with his rabbit having no hairs and wounds on the underside of the front and back feet. "I researched the internet and got the diagnosis," he could not recall. "It is sore something...Yes, it is sore hocks!". He was spot on for the hind feet and hocks. Only that 4 feet had the similar problem.
"I have an in-patient rabbit with large sores only on the back limbs but your rabbit has 4 legs affected!", I was surprised to see two-of-a-kind cases, known as pododermatitis in rabbits.    
Videos are shown.

2. Case of abdominal tumours in a Miniature Schnauzer and a Fox Terrier. I was talking to the owner just 3 days ago as regards the importance of taking out the bladder stones (seen in X-rays) as the dog had an emergency urethral obstruction resolved some months ago after midnight by an emergency vet. I had diagnosed bladder stones for him earlier but his lady friend did not want an operation. "No more blood in the urine," the man in his 50s said. "Maybe the stone had disappeared."  

Then yesterday, he phoned me distressed as his Schnauzer had passed away from a ruptured tumour spilling blood inside the swollen abdomen. Vet 1 had given this dog a series of anti-heartworm injections but in the last injection, the dog's abdomen became swollen. Vet 1 quickly referred to Vet 2 who said that the dog's abdominal tumour had ruptured spilling blood into the abdomen. The dog died soon after admission by Vet 2. So the owner wanted me to do an autopsy to find out whether Vet 1 had been negligent in not discovering the tumour earlier and before anti-heartworm injection. I have a conflict of interest, being a competitor and so I advised that he contact AVA or A-Star vets. It was Saturday and he had taken the body back from Vet 2. "Put the body in a freezer," I advised. "Otherwise it is not possible to do an autopsy properly."  He said he put it inside a fridge.

"The disadvantage of autopsy by the AVA is that we will not get back the dog's body for creamtion," he told me today. "As for A-star autopsy, the vet wanted a referral from another vet."

"It will be costly to do autopsies and engage lawyers," I told him that the burden of proof on negligence is on him, not the veterinarian. He would think about his next step after getting all the medical records from Vets 1 and 2.  The Fox Terrier came in for consultation as he always leaves a puddle of urine after lying down to sleep. The owner thought he was naughty, urine marking at this old age of 8 years and so had him neutered.
"There are 4 abdominal tumours, one of which is a gigantic one I could feel on palpation," I said and got the dog X-rayed. Dr Daniel had the tumours confirmed by ultrasound.

What to do?  Chemotherapy is too expensive. The neutered dog still leaks urine when lying down to sleep overnight but otherwise could control his bladder. 

"One large tumour is said to be near a major blood vessel," I said. "The descending aorta and so there is a risk of bleeding to death during removal of this large golf-ball tumour." The owners could not decide what to do. "The dog is still young, at 8 years," the wife said.

Case 3. An old Pomeranian and a Maltese had swollen abdomen. Both had dirty vaginal discharge a few days ago. Both were very ill and were unlikely to survive anaesthesia.  Closed pyometra in both cases. The Pom owner brought the dog to Vet 1 but she died on arrival.  The owner of the Maltese did not want any surgery as the dog would "die" anyway during the operation to remove the pus-filled uterus. I could not help feeling sad that the two old female dogs would have been alive if they had been spayed at 6-12 months of age. Both were in good bodily condition but time had run out for them.

The above are the twin cases appearing within a day or two and this was such a coincidence.

Thursday, February 4, 2016

2929. A gentle 8-year-old Fox Terrier has a gigantic abdominal tumour

The Fox Terrier, M, Not neutered, was peeing more nowadays, esp. after exercise. He will drink more after exercise and pees overnight, unlike previously. He could control his bladder.

Ultrasound showed:
An abdominal tumour or lymphoma. The liver, spleen, kidneys and intestines were normal. There were 4 separate tumours, next to the descending aorta. So, these are inoperable.

4 separate tumours might be visible.

Tuesday, February 2, 2016

2928. Wishing friends good luck in their endeavours with images

Create greeting images for friends who venture to a new job or business meeting.
A picture is worth a thousand words.