Thursday, June 29, 2017

3091. A 13-year-old cat had sudden onset bloody diarrhoea

Fresh red blood passed with watery stools. Why?
Apartment cat loves to eat lizards.

Blood test - thrombocytopenia.
Sudden onset bleeding inside the stomach and intestines. Not clotting.
Bit own tongue inside crate - lots of bleeding.

Cause of death - owner did not want autopsy. Unable to confirm cause.

Thursday, June 22, 2017

3089. A Maltese has a gigantic perineal hernia - synthetic mesh

June 21, 2017

"Very rarely do we get such a gigantic hernia measuring over 10 cm across," I said to the owner who came to me as the 3rd vet. The 2nd vet had quoted some $3,000 to insert a synthetic mesh to close up the big gap of the width of 2 fingers. Ordinary apposition will not be effective.  The first vet had referred her to the 2nd vet who did not want to operate as she had no mesh but had inserted a urinary catheter as the dog could not pee.  The two vets had done X-rays and advised mesh to cover the defect in the pelvic diaphragm. So, the owner searched for a vet who was more affordable. 

"Can you guarantee 100% successful outcome?" the owner asked me.
The dog was a male not neutered dog as frisky as a young puppy despite his age of over 10 years.
"I cannot guarantee 100%," I replied. "The dog needs to be crated for at least 14 days and preferably 30 days."
"He will bark and bark," the owner said. So the dog was my inpatient for the 3 days post-op.

The dog stopped breathing at an early stage and was revived with emergency adrenallin and resuscitation.  He survived the lengthy anaesthesia as the mesh surgery took over 1 hour. The next day, he was normal and would be crated for 2 days.

Excess skin to be trimmed to prevent haematoma swelling. To neuter 14 days later.
Hernia repair took over 1 hour. Not advisable to prolong anaesthesia to neuter resulting in increased anaesthetic risk of dying on operating table.


Normal except monocytosis

1. Hernia reduced.  Hernial ring dissection.
2. Check muscular weakness and size of defect. Hernia is lateral to the external anal sphincter muscle. The herniated contents are between the sphincter and the levator ani muscle. Often the levator ani is atrophied, making a big opening for abdominal contents between the anal sphincter and the coccygeus muscles.
The herniated contents include intestines, bladder, prostate and rectum are pushed into the abdomen.

3. Identify pudendal arteries, veins and nerves. Also note sciatic nerves and sacrotuberous ligament.

4. (Video in Youtube). In one big dog, a vet drill 4 holes into the caudal ischial border to insert sutures to anchor mesh to internal obturator muscles. This was not done in this case.

4.1 Mesh folded diagonally and cut.

5. Cone formed from one half.
6. Place cone over the defect and size adjusted until the base of the cone covers the hernial ring.
7. Take out mesh. Suture the ends with 3 interrupted sutures.
8. Stitch horizontal mattress sutures (muscles of anal sphincter to mesh).
9. Inside the cone, stitch mesh to muscles.
10. (Video in Youtube).  Ischial border holes - stitches tied onto ventral cone via holes attaching internal obturator muscles. This was not done in this case.

11. Trim excess cone off the top.
12. Suture subcutaneous skin.
13. Suture skin.

MESH IMPLANT for Large Perineal Hernial Repair
Dr Sing Kong Yuen, BVMS (Glasgow)

  1. VIDEO: MESH IMPLANT FOR Large Perineal Hernial Repair

  2. BLOG: MESH IMPLANT for Large Perineal Hernial Repair.



Thursday, June 15, 2017

3088. A 6-year-old cat vomits for the past 10 days

Blood test shows liver disorder and low platelet count.
Possibly the cat had stepped on something toxic and/or licked the chemicals.
So, vomiting for 10 days.
Owner was able to give antibiotics with brown sugary paste now.
Cat has recovered fully today.

I suspect some chemicals ingested by the cat had caused liver damage and low platelet count.

3087. A 13-year-old Jack Russell has a right facial swelling - carnassial tooth abscess

Facial swelling below the right eye, 5 cm x 5 cm x 3 cm
Slight pain on palpation. Black spot seen between the crown spaces of right carnassial. Bad breath. Dog disliked showing it and would bite if I continued.
Could it be a tumour or cyst or carnassial tooth abscess?
Dog not happy to be X-rayed another view after lateral views.
X-rays as follows shows the roots of the right carnassial tooth are black instead of white. This indicated bone loss around the roots, confirming this is a case of carnassial tooth abscess.

Treatment is by extraction of the carnassial tooth under anaesthesia. The dog recovered fully after the dental surgery.

3086. An 11-year-old Miniature Schnauzer vomits for 2 days

11 years old, male neutered.
A beloved jogging companion vomited greenish black stuff 2 x
"Did he eat grass?" I asked as dogs do eat grass.
"Yes," the master said.

Blood test
kidney failure

Left kidney enlarged 3X - tumour or hydronephrosis?
kidney (left and right) and bladder stones

biopsy of left kidney?

Thursday, June 8, 2017

3085. Water bag ruptured over 12 hours. No puppy born. Will puppies still be alive?

Dachshund 3 years, 2nd litter.
lst litter 1 year ago - one pup by Caesarean section
Now, the breeder had waited over 12 hours after the water bag had burst. "I can hear very faint heart beat," he told me. "Be quick in your Caesarean section to save the puppies!"
He explained: "The dam was running around and was active."
I did not ask why he took such a long time to come for surgery as the best advice is less than 2 hours after the water bag had ruptured.

Caesarean section using only isoflurane gas anaesthesia.
2 black stained puppies covered by muddy liquid of decomposed placentas.
Both had died a long time ago.

Footage of Caesarean section.
2 dead pups. .

The dam survived the surgery and went home.

Do not wait over 2 hours after the water bag had ruptured to get an emergency
Caesarean section if you want to save the pups. Images of past C-sections, water bags and normal placentas.

Delays over 12 hours lead to dead pups and black liquid of decomposed placental cells. The normal placenta is green black (images). 

Wednesday, June 7, 2017

3083. A 12-year-old Chihuahua had a large facial wound

Jun 8, 2017

The lady surfed the net as her 12-year-old Chihuahua, weighing 1.78 kg and of good bodily condition had foul breath. She drools and has poor appetite. She came to Toa Payoh Vets.

"I had dental work done by the vet twice in 2015 and 2017. She showed two images of her dog's skin disease. One was an inflamed neck area and the other were a large circular patch of wet skin wound. This circular patch of cellulitis occurred 5 months ago but her vet did not look inside the mouth to check the right upper premolar 4 which was loose and decayed.

"The dog had fully recovered from her vet's treatment of the skin disease," I told the owner. But she suspected dental work is needed as the dog has lost appetite and had bad breath. .

"It could be some teeth infection causing bad breath," she requested dental work and accepted the anaesthetic risk of the old dog dying. I checked the heart and lungs. They were normal and so the dog should be able to withstand gas. No injected sedatives.

12 teeth extracted.

There was the loose right upper premolar 4 which was not extracted by her vet when the dog came for treatment of the right facial wound below the eye. "That wound could be tooth root abscess rupturing into the skin below the eye," I said. "The dog rubbed it to relieve her itchiness and so it became very extensive. Some vets may diagnose it as an insect bite wound."

The left upper premolar 4 was extracted by her vet but one of the 3 roots remained as I could palpate it using my finger. I extracted the 3rd root. The premolar 4 has 3 roots.

So this dog should live a normal life and regain her appetite after the pain and infection in the gums are now gone.

A long tongue and drooling saliva. "The tongue hung out as the dog has a longer tongue as a puppy," I asked the owner. She confirmed, "But the dog manage to keep the tongue inside the mouth earlier!"
I informed her that the right lower jaw was fractured or broken in the back 1/3 but I would not know
when it had happened as no X-rays were taken as advised by me.

According to the owner, the tongue hung out to one side after dental work by the first vet. "Now it hangs out centrally," she observed. "That is because the rotten teeth on the right upper and lower jaws had been extracted. Around 7 of the decayed teeth were from the right maxilla and mandible."

A much-loved Chihuahua and a knowledgeable owner who surfed the net for information regarding her pet dog and rabbit.  The dog should stop drooling now that the oral pain and ulcers should have disappeared after this dental work.


Monday, June 5, 2017

3082. A pet rat has a large mammary tumour. What to do?

It is best to get the pet rat's tumour removed by your vet when it is much smaller.

A case study is shown.

A large tumour requires more anaesthetic and takes a longer time for surgery. This increases the risk of anaesthetic death. In this case, the pet rat survives and is OK at home.  

Thursday, June 1, 2017

3081. Slipped disc in a 9-year-old, female intact Miniature Schnauzer

Jun 1, 2017

Miniature Schnauzer became paralysed on hind legs yesterday. Vet 1 did X-rays (below) and showed "slipped disc". Prescribed meloxicam for 4 days.

Owner was a vet nurse and consulted me for second opinion. I did the spinal palpation (pain from between shoulder blade area to middle of back) , placing and pedal reflexes and pinched the toes.

Prognosis is not so good as there is no reaction to the pinching of toes of the back legs and needle pricking of skin behind the groin to the paws of back area. Poor reflex seen on left front paw. .

IVDD at lumber 4 and 5.
Spurs seen in these 2 vertebrae.

June 2, 2017.
1. No bacterial infection as total white cell count and neutrophils ae within normal range.
2, No anaemia. Platelet count  1852 (200-500) is very high with platelet clumping noted and large platelets seen.
Large platelets are abnormal and the cause may be genetic, traumatic or auto-immune disease such as immune thrombocytopenic purpura (in this case, platelet count is low and not high as in this case).

3. Glucose 2.5 (3.9-6) is low. May be due to stress and painful slipped disc.
4. Kidney and bone/joint function normal
5. Liver has elevated AST but normal ALT. May be due to stress and pain.

Blood test to be done 4 weeks later.

Fracture, dislocation in the spinal area, neoplasia, bony spurs, herniated disc (slipped disc).

IVDD L4-L5 causing paraplegia

1. Surgery and MRI. In USA, MRI $2,500.Surgery US $5.000-7,500. Surgery to be done within first few days as early as possible. It is doubtful there are experienced vet surgeons in Singapore with sufficient number of cases to refer to.

2. Conservative treatment in this case
2.1 Cage rest 3 months and pain medication.
2.2 Therapy - sling to walk on front legs and try standing on hind legs. Owner will purchase online a wheelchair from China, arriving on Jun 13, 2017.
2.3  Carry to grass as dog will not eliminate indoors. Dog pees and poops on Jun 3, 2017.
2.4  Clean back area after urination and defeacation.
2.5  Turn him on sides every 4 hours to prevent bed sores. Sternal recumbency (rest on chest area instead of lying sideway) means recovering well.
2.6. Painkillers when needed esp. first week.
2.7. Lactulose to loosen stools and prevent constipation.
2.8. Good quality food with high fibres and neurobion.  

It is possible that the dog had fallen down from the steps as the painful area is extensive, from behind the shoulder blades to mid-lumbar area. The bony spurs may or may not cause IVDD.