Thursday, April 4, 2019

3477. VIDEO CREATION BY INTERN. The 4-year-old Silkie Terrier vomited for 21 days - cloudy X-rays

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The vomiting  4-year-old Silkie Terrier had been examined by 2 vets as he had swallowed numerous chicken ribs, according to the owner.

Chicken thigh bones at the supermarket are fried at home. Bones in the garbage bin are sometimes scavenged by the dog


Vet 2 was consulted as the dog still vomited after consulting Vet 1 two days earlier.

"Vet 2 had X-rays and ultrasound done and reported no chicken bones inside my dog" the owner was not happy with my suggestion to X-ray check for stuck bones inside the throat and chest. "Vet 2 told me there were no chicken bones seen. Why do you still want to X-ray to find chicken bones in my dog?"

Day 3 of vomiting. Vet 2's X-ray report says "no bone" inside the dog. He confirmed by ultrasound scan.


 "X-rays by Vet 2 were done on Day 3 of vomiting," I understood the owner's worries about high veterinary medical costs of the aids to diagnostic tests.  "The dog has daily vomiting for the past 16 days!"

The owner sought Toa Payoh Vets as the 3rd opinion. He was adamant that no X-rays be done. After treatment, the dog went home. But the dog persisted in vomiting. What should the owner do now?

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




CLOUDY X-RAYS in veterinary practice





The vomiting 4-year-old male Silkie Terrier was seen by Vet 1. As he continued vomiting, Vet 2 was consulted and performed X-ray and ultrasound examination. He stated that there were no chicken bones swallowed.

The dog had already vomited after eating for the past 19 days. The owner agreed to pay for further X-rays.

X-RAYS
X-RAYS BY TOA PAYOH VETS on Nov 6, 2013 (Day 21) showed distinctly a chicken thigh bone (femur).

Looks more like a chicken thigh bone (femur)

Intern:  To narrate the history as shown in the  text in the above X-rays shown in the video

Ventro-dorsal view is not useful in seeing chicken bone lodged in the oesophageal/stomach junction
as the heart and diagphragm obstruct the view of the junction




X-RAYS BY VET 2 on Oct 21, 2013 (Day 3 of vomiting). 
The cloudy X-rays were not clear leading to a misdiagnosis by Vet 2 of "no chicken bones". 



Day 3 of vomiting. If you view or enlarge the X-ray, a chicken bone stuck in the oesophagus/stomach junction can be seen

Cloudy X-ray indicates incorrect exposure settings

Ventro-dorsal view is not useful in looking for chicken bones in the oesophageal/stomach junction



SURGERY at Toa Payoh Vets

Gastrotomy by Dr Daniel Sing and Dr Sing Kong Yuen

Dr Daniel incised a 1-cm stomach incision.  He inserted a long tissue forceps into the stomach towards the oesophagus to to grasp the chicken bone. He could not grasp the intact chicken thigh bone as seen in the X-ray. . 

I passed a stomach tube from the mouth into the stomach. Copious amount of fluid filled with bubbles shot out of the tube. I withdrew it to clear the froth. A second stomach tubing encountered some obstruction in the caudal oesophagus and was withdrawn. The third stomach tubing pushed small pieces of bone fragments into the stomach. The small and large intestines had no bones but were inflamed. The stomach was stitched up.   

The dog recovered fully after 10 days. He was still trying to scavenge the garbage bins for chicken bones. 


VETERINARY TIPS AND ADVICES

1. IMAGE-EDITING
Vet 1's X-ray image needs to show better contrast. 




In retrospective study, I could see a chicken bone in Vet 2's image on Day 3 of vomiting, after image-editing using Photoshop. However, a recent X-ray needs to be performed to get the update of the situation before surgery. This must be explained to the owner before surgery.


Compared to Toa Payoh Vets' X-ray on Day 21 of vomiting





2. CHICKEN OR PORK BONE OBSTRUCTION.

If the chicken bone is stuck in the oesophageal-gastric area, the gastric acid may dissolve the bones over time. This depends on the size and amount. Vomiting for 21 days could have killed the dog due to malnutrition, dehydration and oesophageal ulceration and infections.

Pork bones in the similar situation will not be dissolved by gastric juices according to one senior veterinarian with over 50 years of small animal practice.

CONCLUSION

 Cloudy X-rays are caused by incorrect exposure settings. Some images can be photoshopped to increase the contrast as in the image of Vet 1 on Day 3 of vomiting.

However, an updated X-ray needs to be performed on Day 16 of vomiting to assess the position of the chicken bones in the oesophageal/stomach junction as the gastric acid reflux from vomiting could have dissolved the chicken bone. In this case, the chicken bone which was a thigh bone was clearly visible and the solution was surgical removal.

Cloudy X-rays lead to a misdiagnosis. The owner can sue or complain to the veterinary authorities. 
Vets will need to be careful as litigation for negligence is costly and time-consuming. In this case, the owner demanded compensation from Vet 2 and got some money to settle the case.
 


3. REFERENCES: ORIGINAL VETERINARY REPORT

 http://www.sinpets.com/dogs/20131107chicken_rib_bone_oesophagus_dog.htm

 https://2010vets.blogspot.com/2013/11/1154-why-is-dog-still-vomiting-19-days.html

CREDITS
include Intern's name

vet assistants x 2






FOR MORE INFORMATION






6254-3326 etc.
www.toapayohvets.com/videos.htm



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Show text on slides and narrate as a lecture. See example at:


Wait for me to locate the video. thanks.



   

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