Thursday, March 24, 2016

A 40th day pregnant Corgi vomits twice and has no appetite - acute kidney failure

Mar 18  2016
I got a tel call at 8am from the breeder. The 2-year-old Corgi is heavily pregnant. Vomited once yesterday and today  yellow vomitus. No appetite. Why?

Blood test.
High blood urea and creatinine. Leucocytosis - a higher than normal number of total white cell count indicating a possible bacterial infection.

"Acute kidney failure," I gave the breeder the bad news. The sudden onset of uraemia causing vomiting led me to diagnose acute kidney failure in contrast to chronic kidney failure. 

"Why and how the Corgi suffers from kidney failure?" the breeder asked. "She is only 2 years old and this is her first litter."

"There are many causes," I explained. "Infections, dietary management, toxicity, kidney injury, kidney pressure on the ureters due to too many foetus (the Corgi was later found to have 10 foetuses). It is possible that there is a kidney infection based on leucocytosis."

I gave IV therapy and antibiotic. The IV therapy was continued at the farm for the next 3 days. The dog still vomited after drinking and had no appetite for the next 3 days.

Mar 20, 2016
The dog miscarriaged with 2 premature puppies born. I gave oxytocin as the others would be dead too. There were 10 puppies in total. Most of the 10 placentas came out the next day. The dam was more alert but had no appetite. "The IV drip for the next 3 days is critical. It is for dialysis to clear out the waste products of urea by the functioning glomerulus cells of the kideys to filter the toxic waste.  It provides the dextrose energy and fluid to prevent dehydration," I explained to the breeder. 

Mar 23, 2016
I phoned the breeder. He said that the dam started eating yesterday and is ok.  He was most happy. "Breeders will not be happy with the vet if the dam dies during Caesarean or treatment as they tend to blame the vet for being incompetent for achieving a poor outcome," I said.
"Well," he replied. "If the factory is shut down, there will be no production."
I had never thought of the dam as being a factory but this analogy is realistic.

Tuesday, March 15, 2016

2947. First vaccination of 11 pups - one good image out of over 20

8.5x11 in 300 ppi    16.67% 31.5M/42.3M

8.5x11 in 300 ppi    16.67% 28.9M/32.9M

Bright sunny 9.30 am   Breeder's farm one day after vaccination of 11 puppies.
Puppies put inside a styroform box but difficult to get all to pose together.

A greenish-black Caesarean section - Breeder could hear only one puppy's heart sounds

March 15, 2016


Visit to Farm to check whether my Dachshund patient had given birth naturally. She had not been eating on Mar 8, 2016 and recovered on Mar 10, 2016 being very active. Had visited on Mar 11 (video, very active running about, eating)

Dachshund in whelping crate. The Dachshund looked at me. She was quiet with slight increase in respiratory rate.  I noticed a greenish-black vaginal discharge on the towels.
Temperature 37.9C was below normal. Breeder showed that she had milk Plenty of it.

But she looked bad. "The big abdomen had shrunk," I had seen her since 10 days ago. "That is not good".  In retrospect, this meant that the two puppies had died and the water bag had ruptured. Shrinkage of the abdomen.

He decided on an emergency Caesarean section saying: "I can only hear one loud heart beat of one puppy," the breeder said. "The others have had died."

10 am
The way she responded to anaesthesia showed she was very weak.

Masked and given isoflurane gas + O2 gas. Intubated. Tongue pale. Eyeball rotated downwards, pupils dilated - very deep anaesthesia. Surveillance. No gas at all unlike normal procedure of connection to gas directly. Dog took around 1 minute to recover. 

Thick greenish-black liquid flowed out from incision instead of the usual colourless water bag. 2 dead pups drowned in melted placental material pulled out.

Third pup at the brink of death. Still in the normal water bag with the clear colourless fluid. Placenta had separated and not wholesome. Melting. No sound. Gave to the experienced breeder.

Closed up the dog as fast as possible.
Dog only on 0.5% isoflurane gas  + O2. (normal strong dam needs at least 2% to be painfree)
Death on the operating table - not good for the vet's reputation no matter what is the cause.

Recovered. Cleaned up. Given IV drip (baytril, vitamins, amino acids). Puppy went home first. 

8pm  tel breeder. Dam and puppy OK.

Monday, March 14, 2016

2945. An 11-month-old poodle has hind limbs rotated outwards - medial patellar luxation

Mar 14, 2016

While jumping up the playpen 2 months ago, this poodle's right back leg was caught inside the fencing. Now the poodle is unable to walk upright, with both lower legs pointed at right angles to his body. He would paddle on his hind legs.

I flex and extend the knees. The gentle poodle wanted to bite me when I extended his right knee. He also reacted in pain to extension of his left knee. Could there be fracture of the tibial growth plate leading to patellar luxation (bilateral) or just lateral patellar luxation and what to do to cure this dog?

X rays Mar 14, 2016

                                          BILATERAL MEDIAL PATELLAR LUXATION

X-rays on Mar 24, 2016

The above X-rays shows the patellas in the groove as the vet had manipulated them. Hence there is no patellar luxation.

                                          BILATERAL LATERAL PATELLAR LUXATION                                        

 The above mentioned x ray showed clearly that the patellas have had luxated laterally
and there appear to be no tibial growth plate fracture from this general view. On close up, there appears to be growth plate fracture

April 15, 2016
The owner brought in the dog for surgery. Need to check for cruciate ligament rupture.

Saturday, March 12, 2016

2944. A cat vomits more hairballs than usual

In March 2016, a young lady consulted the vet as her cat had been vomiting hair balls more frequently.

Video clip of consultation

This is a Be Kind To Pets Veterinary Educational Video
sponsored by Queens Vets


The cat grooms excessively and ingested more hairs. Why does the cat groom excessively?
1.  Usually it is due to an environment that is not clean. The cat walks and lie down in this environment, getting contaminated with the dirt or floor cleaning chemicals.
The cat is naturally a clean creature. So he grooms his contaminated paws and body more times to get rid of the contaminants. He swallows the hairs, leading to more hair balls filling his intestines.

2.  The other cause is impacted and inflamed anal sacs. The anal sac oil accumulates and cause pain and discomfort. The cat licks the anal area more frequently to relieve himself of the pain, ingesting more hairs.

1.  In this case, the cat lives with other cats and all share a common bathroom floor. There is no litter box used. The cats pee and poop on the toilet floor. The owner  may be very busy, being a working lady. She may have clean the floor with stronger detergents and may have forgotten to rinse the floor thoroughly. The owner is advised to keep the toilet floor well rinsed with water after disinfection. 

2.  This cat also has anal sac impaction and infection (video clip). Expressing the anal sacs remove the thick oil.

No more complaint from the owner for the past two weeks.

Wednesday, March 9, 2016

2943. Three Shih Tzus with different diseases

March 10, 2016

2 Shih Tzus today.

Case 1. Male, Neutered, 5 yrs, 10 kg (good bodily condition as judged from the well-groomed coat, ear hair plucking and the weight). Came for annual vaccination and check up. Many Singapore owners do not bother after puppy vaccination.  Left ear painful. Right ear occasionally painful but no foul smell or discharge. Lady owner is a hair-dresser proprietor who told me she worked 7 days a week when she first started her saloon. But she had clientele and referrals. "Young Singaporeans will never work 7 days a week," I said. "They want a work-life balance."
The itchy ears could be due to commercial ear drops.

"After plucking the ear hairs, the groomer will put some ear drops and the dog would scratch and scratch," the owner said. So, the solution is ear surgery called lateral ear canal resection which opens up the side wall of the ear, permitting ventilation and drainage. "I have near heard of it," she said. So, a change of ear drops.  

Case 2.  
Male, Not neutered. 14 years. Serious ear infections with crusty edges. Complaint of itchy skin. Large amount of scales. Thin. Around 7 kg. Front and back legs are wet due to licking. In Oct 2015 and May 2015, same ear problems.  Ear surgery would have prevented recurring ear infections as Shih Tzus have floppy ears which cover up he ear canals 

Case 3 on March 9, 2016.
Female, Not spayed. 11 years. Very thin.
Dirty vaginal discharge. Cloudy reddish brown vaginal discharge. Open pyometra is easily diagnosed. Owner did not want blood test or spay surgery as the dog is old. She had applied Ectopic skin wash for the hairless areas.

3 Shih Tzus. Different fates.

Tuesday, March 8, 2016

2942. A young terrapin with swollen closed eyes. A young terrapin with extended neck

March 8, 2016

Toa Payoh Vets do see at least one terrapin or turtle per week for the past 3 years. I find them interesting.

Terrapins, the size of 50-cent coins, would be around 1-3 months old. They are sold at around $5.00 in the pet shops. Some pet shops have some good quality terrapins imported from the USA for sale but some are sickly.

These two cases are typical of diseases seen at Toa Payoh Vets

2941. A 1-year-old Cavapoo vomited many times for 2 days, with blood today. X-rays of throat.

March 8, 2016

The owners were concerned that the 1-year-old male neutered cavapoo vomited out blood this morning but had started vomiting yesterday.

No abdominal pain or foreign body. The throat was painful, probably due to vomiting.
X-rays did not show any abnormality or foreign body in the throat or stomach. Only painful throat but no abdominal pain on my palpation (video).

On further discussion with the two ladies, the dog did bite a hard toy to pieces.  He probably tried to swallow the pieces, injuring his throat. He vomited many times, including blood-tinged vomit this morning. 

Blood test done.
Conclusion. The dog vomited lots of water during the IV drip and baytril and spasmogesic injections. The cause of vomiting could be the hard toy pieces that the owners saw the dog chewing and swallowing. These are non-fabric toys for dogs to play. 

Monday, March 7, 2016

Post-op complications after umbilical hernia repair

The swelling appeared around 10 days after an inguinal hernia repair by Dr Daniel who was now in Vietnam.

The young couple WhatsApp the image on Feb 26, 2016   "Hi, my dog jux went for the hernia ops at the tummy wif ur vet and the plaster drop off a while alrdy den the tummy starts dropping like dat. Is it OK?"

I replied: "Pl bring in for check up tmrow" in an inexpert way of texting unlike the younger generation. 

At the consultation, I said: "It could be a blood collection called a haematoma or a hernia due to a stitch breakdown. These are post-op complications due to the dog being too active and not confined to a small area."

Apparently Dr Daniel did not give such instructions to confine the dog in a small area and so the dog had this large swelling. I told the owner that the vet was in Vietnam and so he could not reply. Post-operation complications do occur as the dog is very active.

"He could have licked the wound," I said.
"No," the owners said. "He had worn a large E-collar."
"There are bruised purplish areas towards the end of the stitching nearer the tail area," I said. "This is evidence of the e-collar's edges traumatising the skin."

The dog was anaesthesized and over 300 ml of unclotted blood was taken out by syringe.

This unclotted blood showed that bleeding was recent, probably yesterday. The stitches did not break down and so there was no umbilical hernia.

Evidence of the bruised area is important. The dog had been hitting the back area of the wound, damaging the subcutaneous blood vessels, leaking blood under the skin, causing a large swelling which the couple thought was bigger than the original hernia.