"I thought he had died," the mum said. The Shih Tzu, male, neutered, 8 years old was motionless. He had a right perineal hernia repair and then neutering 2 weeks ago and was Ok for a few days. Then he stopped eating for a few days and collapsed as if he had died. |
23.8.10
On examination, he on 23.8.10, I found that he had a high fever and was pale.
Palpation: Bladder felt firm and enlarged. Urine by catherisation.
Urine test: Urinary Tract Infection. The dog went home the next day. 3 days later, he came back as he was licking his private parts and urine kept leaking out. Cloudy urine.
Palpation: Bladder felt firm and painful. It could be an enlarged bladder wall, bladder tumour or prostrate enlargement.
2. Empty bladder using cathether. 15 ml of urine came out. Palpated the bladder. A little amount of urine came out but a rounded lump of 3 cm x 3 cm. This was the enlarged prostate.
3. Rectal digital palpation when the bladder is emptied. This confirmed that the prostate was enlarged.
To check the prostate:
1. Palpation. There was painful reaction. I diagnosed this as prostratitis and enlargement. Also epithelial cells seen in urine test.
BLOOD TEST
23.8.10 Creatinine was below normal. Red cell below normal. Total White Cell above normal. Neutrophils 97% (Absolute 17.2 x 10^9/L), Lymphocytes 2.5% (Absolute 0.45X 10^9/L).
URINE TEST
Colourless, slightly turbid. pH 6.5 (5-8), SG 1.005 (1.005 - 1.030). Protein - trace. Blood 4+, White blood cells >2250, Red blood cells 20, epithelial cells 0, Mucus Threads Occasional, Bacterial Occasional. Possible haemolysis of RBC in urine.
24.8.10
Vomited white froth overnight
"Tongue colour pinker," the mother told me. "At 7 pm yesterday when I saw him, his tongue was very pale."
Another urine test was taken. Owner was advised that an X-ray or ultrasound scan might be required. "The dog had never been sick for the last 7 years," she said. Now there were some veterinary expenses and worries. The dog is still incontinent and more work need to be done.
CONCLUSION
"Can a dog die of UTI?" the mother asked me.
"A dog can die of UTI or any infection if he is not treated," I replied. "Older dogs are more likely to die when they are sick as they have lower immune system. Your dog is 8 years old and is considered an old dog."
Neutering the dog when he was young would have prevented the worries but many owners feel it cruel to sterilise dogs. Annual vet examination and health check may be advised. Statistically, male dogs that are not neutered are likely to get perineal hernia and prostrate enlargement.
Tuesday, August 24, 2010
176. E-mail discussions to client (toilet training)
As the dog grows older, it is harder to change. Below is my plan for you
Pom, Female, 15-month-old. Came for vaccination (8-in-one and proheart). Vomited after injection, so kept in the Surgery fo 2 hours..
Will pee and poop on the newspapers when left home alone in the balcony.
Pees everywhere in the apartment when left alone.
PLAN
1. Confine to balcony and adjoining living room.
2. Neutralise all urine smell inside the apartment. Put white vinegar 1 part and 3 parts water in a spray bottle and spray clean the whole apartment.
3. Close all bedroom and kitchen doors for the next 2-4 weeks.
4. Newspapers to be placed in the living area too. Preferably with urine smell (2nd piece of newspapers from the balcony.)
5. No dry food for the whole day. Give with canned food. Dog is not skinny anyway. No water after 8 pm so she can control her bladder.
6. Feed 2x/day.
7. Remove all soiled newspapers (in the balcony and living room) immediately as dogs don't like to eliminate in soiled papers.
8. Praise when the dog pees on newspapers in the living area. Dog treats if the dog is motivated by treats.
9. Same routine for 2-4 weeks and let me know by e-mail 99pups@gmail.com
Pom, Female, 15-month-old. Came for vaccination (8-in-one and proheart). Vomited after injection, so kept in the Surgery fo 2 hours..
Will pee and poop on the newspapers when left home alone in the balcony.
Pees everywhere in the apartment when left alone.
PLAN
1. Confine to balcony and adjoining living room.
2. Neutralise all urine smell inside the apartment. Put white vinegar 1 part and 3 parts water in a spray bottle and spray clean the whole apartment.
3. Close all bedroom and kitchen doors for the next 2-4 weeks.
4. Newspapers to be placed in the living area too. Preferably with urine smell (2nd piece of newspapers from the balcony.)
5. No dry food for the whole day. Give with canned food. Dog is not skinny anyway. No water after 8 pm so she can control her bladder.
6. Feed 2x/day.
7. Remove all soiled newspapers (in the balcony and living room) immediately as dogs don't like to eliminate in soiled papers.
8. Praise when the dog pees on newspapers in the living area. Dog treats if the dog is motivated by treats.
9. Same routine for 2-4 weeks and let me know by e-mail 99pups@gmail.com
Monday, August 23, 2010
175. Urine and blood tests important - 2 mum and daughter cases
"A vet cannot predict whether the dog will die or not." I said.
"Blood tests and urine tests are important in the aid to diagnosis."
Coincidental cases. Mum and young adult daughter
CASE 1
Mum brought in the dog. Daughter messaged while she was in clinic.
Shih Tzu keeps licking penile area. Urine incontinence. Had been treated for UTI and right perineal hernia repair. Yet he is not OK. Why? Needs blood test and urine test.
Urine - light yellow
CASE 2
Miniature Schnauzer, 2 years male, shivers for 1 hour yesterday. Working daughter brought in the dog. Why? Had a history of shivering after tick wash. A home groomer had come 2 weeks ago to the apartment as the dog had ticks. But the groomer refused to let the mum and daughter watch.
"He never humps or climbed our legs when we are around," the daughter said. I noted that the penile tip is red and inflamed. Pain in right ear horizontal canal, L/S spinal area (slight pain). Allergy to shampoo or environment? Excessive ear hairs trapping dirt and "ticks" inside the ear canal?. Head shaking for past 3 months, the daughter volunteered the new info.
Fits of unknown cause? Distemper encephalitis? So what is he problem?
Urine - orange yellow
I took pictures as they were contrasting.
"Blood tests and urine tests are important in the aid to diagnosis."
Coincidental cases. Mum and young adult daughter
CASE 1
Mum brought in the dog. Daughter messaged while she was in clinic.
Shih Tzu keeps licking penile area. Urine incontinence. Had been treated for UTI and right perineal hernia repair. Yet he is not OK. Why? Needs blood test and urine test.
Urine - light yellow
CASE 2
Miniature Schnauzer, 2 years male, shivers for 1 hour yesterday. Working daughter brought in the dog. Why? Had a history of shivering after tick wash. A home groomer had come 2 weeks ago to the apartment as the dog had ticks. But the groomer refused to let the mum and daughter watch.
"He never humps or climbed our legs when we are around," the daughter said. I noted that the penile tip is red and inflamed. Pain in right ear horizontal canal, L/S spinal area (slight pain). Allergy to shampoo or environment? Excessive ear hairs trapping dirt and "ticks" inside the ear canal?. Head shaking for past 3 months, the daughter volunteered the new info.
Fits of unknown cause? Distemper encephalitis? So what is he problem?
Urine - orange yellow
I took pictures as they were contrasting.
Sunday, August 22, 2010
174. SUNDAY CASE. Hamster wart - what is the cause?
2 big brothers in their early 30s and one younger teenaged brother tanned and solid build e-mailed me a blurred picture. "Looks like a wart," I replied. Appointment by e-mail on today Sunday at 11 am. So they came. Sire hamster was 1.5 years old, the two sons were 1 year old. One had developed a wart but the other two were OK. All 3 in top shape weighting around 65 gm.
Took some pictures of the hamster with a wart.
"What's the cause of warts and should I use disinfectant to spray the cages?" the big brother asked me.
"Unknown causes," I said. " Disinfectants will not help stop wart formation. Warts are viral papillomas. They develop when the hamster's immune system is not normal. It could be due to stress with 3 male hamsters living together."
"He does not like bathing in the sand," the youngest brother said when I said that this hamster also suffered from ear infections with scabs and possibly small warts seen in the right ear canal opening. "He just went in and came out of the sand, unlike the sibling."
I need to anaesthesize the hamster, check for more warts and clean the ears. The hamter was warded for 2 days.
.
CASE OF THE SPAYING OF STRAY CAT.
2.7 kg. Gave 0.15ml xylazine and 0.6 ml ketamine IM.
Insufficient analgesia if spay is delayed >20 minutes. Top up with isoflurane gas in gas mask to effect very effective. I was delayed by spaying a stray cat that was showing abdominal fat coming out of the midline incision
Surgery was started 10 minutes post injection, but
I asked Mr Saw to give some isoflurane gas. He checked the eyelids. "Cat does not need the gas," he advised. Being a cautious assistant. However, the omental gut spilled out of the midline incision. I said: "You need to give 30 seconds of isoflurane gas as I can't hook out the uterus. I can see the bladder."
"The bladder is full," Mr Saw said. I manually massaged the bladder and urine squirted out. After a few more seconds, I hooked out the left uterine horn. It was easy after that.
INTERESTING DOG OWNER FROM TAMPENIS
"I need to bring in my dog for vaccination," Mr Lee who had worked in watch rep;air in the last 30 years as a happy employee persuaded me to wait for him. "The Pasir Ris groomer called Sam said that I must vaccinate the dog first, otherwise it will be risky."
Pasir Ris is the place full of dog kennels and viruses. So the groomer Sam was careful that his client's dogs don't die of viral disease. "OK," I said. "I will wait." Busy watch repairer in his 50s. High end watches but prefer to be an employee. "Less headaches," he said to me. "I can take leave unlike boss who had to entertain a government lawyer yesterday."
I asked him about a fellow tenant in the famous Orchard shopping mall. "Avoid him at all cost," he said. "Those who said they make millions of dollars and dress up well are to to be avoided," he advised me.
"Your specialty in fixing broken watches is rare," I said. "There are few competitors."
"Around 16. Golden Mile has many. I can dissemble the watch for repair but don't know how to put them back again. My boss's son does that." His boss was the founder who is now 86 years old.
"You know, I find great difficulty communicating with your receptionist James."
"James is 75 years old, but he should speak slowly. It seems that his brain is not so good."
HEARING IMPAIRED YOUNG LADY IN HER EARLY 30S suddenly appeared with a rescued a kitten with a hole in the belly.
We wrote in English on a piece of paper. I could not understand sign language. She could write English and so we communicated this way.
"Can save?" she wrote on a piece of pager and on "hearing impaired in her case card.
"Yes," I said.
"Can live?"
"You have to feed her," I wrote.
"How?"
"I can buy a ilk bottle plus kitten milk from the pet shop."
"Goat's milk?" she penned.
"OK," I said.
She drew a syringe," I said "OK".
"You have to go to the library to read on how to feed every 4 hourly." She nodded her head.
Took some pictures of the hamster with a wart.
"What's the cause of warts and should I use disinfectant to spray the cages?" the big brother asked me.
"Unknown causes," I said. " Disinfectants will not help stop wart formation. Warts are viral papillomas. They develop when the hamster's immune system is not normal. It could be due to stress with 3 male hamsters living together."
"He does not like bathing in the sand," the youngest brother said when I said that this hamster also suffered from ear infections with scabs and possibly small warts seen in the right ear canal opening. "He just went in and came out of the sand, unlike the sibling."
I need to anaesthesize the hamster, check for more warts and clean the ears. The hamter was warded for 2 days.
.
CASE OF THE SPAYING OF STRAY CAT.
2.7 kg. Gave 0.15ml xylazine and 0.6 ml ketamine IM.
Insufficient analgesia if spay is delayed >20 minutes. Top up with isoflurane gas in gas mask to effect very effective. I was delayed by spaying a stray cat that was showing abdominal fat coming out of the midline incision
Surgery was started 10 minutes post injection, but
I asked Mr Saw to give some isoflurane gas. He checked the eyelids. "Cat does not need the gas," he advised. Being a cautious assistant. However, the omental gut spilled out of the midline incision. I said: "You need to give 30 seconds of isoflurane gas as I can't hook out the uterus. I can see the bladder."
"The bladder is full," Mr Saw said. I manually massaged the bladder and urine squirted out. After a few more seconds, I hooked out the left uterine horn. It was easy after that.
INTERESTING DOG OWNER FROM TAMPENIS
"I need to bring in my dog for vaccination," Mr Lee who had worked in watch rep;air in the last 30 years as a happy employee persuaded me to wait for him. "The Pasir Ris groomer called Sam said that I must vaccinate the dog first, otherwise it will be risky."
Pasir Ris is the place full of dog kennels and viruses. So the groomer Sam was careful that his client's dogs don't die of viral disease. "OK," I said. "I will wait." Busy watch repairer in his 50s. High end watches but prefer to be an employee. "Less headaches," he said to me. "I can take leave unlike boss who had to entertain a government lawyer yesterday."
I asked him about a fellow tenant in the famous Orchard shopping mall. "Avoid him at all cost," he said. "Those who said they make millions of dollars and dress up well are to to be avoided," he advised me.
"Your specialty in fixing broken watches is rare," I said. "There are few competitors."
"Around 16. Golden Mile has many. I can dissemble the watch for repair but don't know how to put them back again. My boss's son does that." His boss was the founder who is now 86 years old.
"You know, I find great difficulty communicating with your receptionist James."
"James is 75 years old, but he should speak slowly. It seems that his brain is not so good."
HEARING IMPAIRED YOUNG LADY IN HER EARLY 30S suddenly appeared with a rescued a kitten with a hole in the belly.
We wrote in English on a piece of paper. I could not understand sign language. She could write English and so we communicated this way.
"Can save?" she wrote on a piece of pager and on "hearing impaired in her case card.
"Yes," I said.
"Can live?"
"You have to feed her," I wrote.
"How?"
"I can buy a ilk bottle plus kitten milk from the pet shop."
"Goat's milk?" she penned.
"OK," I said.
She drew a syringe," I said "OK".
"You have to go to the library to read on how to feed every 4 hourly." She nodded her head.
Friday, August 20, 2010
Old shih tzu with multiple warts
Blood test was useful as it showed a kidney disorder with high blood urea. Advised k/d diet for one month.
owner phoned as to whether can give dog treats and food as the dog keeps looking for more food to eat. A can of k/d is insufficient. I advised not to. Give some apples/carrots instead.
One month later, will check blood and urine.
owner phoned as to whether can give dog treats and food as the dog keeps looking for more food to eat. A can of k/d is insufficient. I advised not to. Give some apples/carrots instead.
One month later, will check blood and urine.
172. Faucitis-Stomatitis cat goes home
Cat, 3.8kg. Eating. Ulcers in both fauces, base of tongue and midline of tongue is seen.
Advices to owner:
1. Immune disease with no permanent cure. Lifespan may be around one year if the steroidal drugs become ineffective.
2. Blood test taken on 17.8.10 shows high glucose and high liver enzymes (SGPT/ALT 642 compared to <121 and SGOT/AST of 309 compared to <67. Other blood results normal. Eosionophils is lower at 4.07%$ or absolute 0.37 x 10^9/L.
3. Canned food or fresh fish diet mainly. Multivitamin.
4. No stress but must interact with the other 2 cats.
5. Now to give immunosuppressive dose at 3 mg/kg every 48 hours from today. total should be 11.4 mg pred. Give 2 tablets of 5 mg every Friday, Monday and Wednesday for 1 month and observe. Increase pred when the cat is not eating.
6. To follow up 1 month later.
Advices to owner:
1. Immune disease with no permanent cure. Lifespan may be around one year if the steroidal drugs become ineffective.
2. Blood test taken on 17.8.10 shows high glucose and high liver enzymes (SGPT/ALT 642 compared to <121 and SGOT/AST of 309 compared to <67. Other blood results normal. Eosionophils is lower at 4.07%$ or absolute 0.37 x 10^9/L.
3. Canned food or fresh fish diet mainly. Multivitamin.
4. No stress but must interact with the other 2 cats.
5. Now to give immunosuppressive dose at 3 mg/kg every 48 hours from today. total should be 11.4 mg pred. Give 2 tablets of 5 mg every Friday, Monday and Wednesday for 1 month and observe. Increase pred when the cat is not eating.
6. To follow up 1 month later.
Thursday, August 19, 2010
171. Top 10 medical insurance claims for dogs in 2009
Veterinary Pet Insurance Co (VPI), the oldest and largest pet health insurance in the USA received >1 million claims from pet owners each year. For 2009, the top 10 canine conditions are:
1. Ear infection
2. Skin allergy
3. Skin inection/hot spot
4. Gastritis/vomiting
5. Intestinal inflammation/diarrhoea
6. Bladder infection
7. Arthritis
8. Soft tissue trauma
9. Non-cancerous tumour
10. Eye infection
Most of the conditions affect all dogs, regardless of age.
1. Ear infection
2. Skin allergy
3. Skin inection/hot spot
4. Gastritis/vomiting
5. Intestinal inflammation/diarrhoea
6. Bladder infection
7. Arthritis
8. Soft tissue trauma
9. Non-cancerous tumour
10. Eye infection
Most of the conditions affect all dogs, regardless of age.
Wednesday, August 18, 2010
Swollen lump in the belly area of a Retriever
First report is at toapayohvets.com: Tumours in 3 male dogs - Sertoli cell tumour, circum-anal tumour and oral tumour
FOLLOW-UP
"The young intern has no experience in dealing with the submission of specimens for histopathology," I explained to the Laboratory girl who phoned me to tell me that the 7 testicular specimens must be correctly labelled as "right" and "left" testicle when I queried the report's findings. My histopathological samples are sent to a commercial laboratory that specialises in this subject.
How come there was a blunder? It was my policy of letting interns be more hands-on.
I had instructed my assistant, Mr Saw, to let vet interns have some hands-on experience rather than being an observer. In that way, they will learn from experience and mistakes. We all learn every day as we can't be perfect people.
Ms Lai, the intern, would be studying veterinary medicine next year and so we gave her the task of submission and filling out the forms. She had been with us for around 2 weeks and had seen submission of blood samples.
Well, the undescended testicle of this 6-year-old Retriever was enormous (half the size of a tennis ball) and would not fit into the usual container we used to submit samples for histopathology. So, I advised cutting it into 3 smaller pieces for the larger testicle (left) and 4 smaller pieces for the descended atrophied testicle (right).
I ought to have advised getting a bigger container. I did that eventually. Next time I asked my assistant to check before submission of the samples. Usually we submit one sample and it fits nicely inside the Lab-provided bottles.
Everybody learns from being hands-on. Young interns can't be spoon-fed all the time and will make some mistakes. It is part of growing up in life.
I was fortunate to have worked in the Vet Diagnostic Lab at Kampong Java Road (now the new Kandang Kerbau Hospital) as a new graduate in 1977 and so knew a bit about the work of histopathology. What had happened was that the intern put 7 pieces 1 big bottle and submitted the bottle and form without separation of the left and right testicle.
After receiving the histopathology reports, I phoned to clarify that there were two testicles submitted as the report had presumed I had submitted 7 pieces of one testicle. The report was then corrected as follows:
Specimens 1-4 are left undescended testicle. Specimen 5-7 are the atrophied descended right testicle. The histopathology results are as follows:
Takes a long time to pee. Painful enlarged prostrate when digital examined via rectum during light anaesthesia. Could this be purulent prostatitis as mentioned in: www.vet.uga.edu/vpp/clerk_anat
/sabatino/index.php.
Hyperpigmentation in the preputial area
Follow up 7 days later: Owner is happy. "No more limping now. We thought he had hip dysplasia."
I asked" Was the dog attracting other dogs during exercise outdoors?" The owner recalled that many dogs wanted to make friends with him (the effects of hyperestrogenism).
Left testis - Sertoli cell tumour (see comments below).
Right testis - Atrophy of the contra-lateral scrotal testicle resulting in aspermatogenesis.
Comments from the Histopathology Lab:
1. The left testis is extensively replaced by a tumour which is composed of closely packed tubules, trabeculae and nests of elongated spindly cells. A second interstitial (Leydig) cell tumour component cannot be excluded. Most primary testicular neoplasm in dogs are benign. The rare malignant Sertoli cell tumours have no good cytological or histological markers of malignancy. The vet needs to identify metastases in lymphatics, spermatic cord, lymph node or distant sites. Please correlate with clinical features.
Dr Sing's comments: The left testis will likely be a mixed tumour with Sertoli and interstitial cells involved). Much more details of the types of testicular tumour in the dog are in an excellent report at:
www.vet.uga.edu/vpp/clerk_anat/sabatino/index.php.
2. In the right testis, the parenchyma shows closely packed seminiferous tubes composed solely of Sertoli cells without spermatogonia, spermatocytes or spermatids. This is common in cryptorchid (undescended) testis. There is no tumour involvement.
CLINICAL FEATURES OF INTEREST TO VET UNDERGRADUATES
1. As the histopathologist is an independent service provider, he or she had not seen the real dog. The right testis was assumed to be an undescended or cryptorchid testis. It was a descended testicle, much shrunken.
2. Hyperestrogenism. The reason the descended right testes was atrophied and had no sperm production was due to the excessive production of estrogen by the large left testicular tumour. Estrogen is anti-androgenic and therefore cause the atrophy of the scrotal right scrotal testes.
3. Blood test results as shown below indicated a thrombocytopenia which can be a cause of death in the dog if the tumour had not been detected early and removed.
Golden Retriever, Male, 6 years. Left undescended testicular tumour and atrophied right scrotal testicle removed 5 days ago. Greyish-white, large sized and multi-nodular suggestive of a Sertoli cell tumour.
The owner asked about post-op management. This depended on blood test results.
Blood tests:
1. No disorders of liver and kidney function. Glucose is normal.
2. Haematology: Low haemoglobin and red cell count. Low PCV. Very low platelet count. Platelet clumping noted. (This indicated bone marrow depression). Effects are well written in:
www.vet.uga.edu/vpp/clerk_anat/sabatino/index.php.
Urine results
1. pH=7.0, SG 1.027.
2. Abnormal findings: Protein 2+, Glucose 1+, Blood 4+, WCC >2250/uL, RBC 900/uL, epithelial cells 1053/uL. Bacteria 3+
This indicated a severe bacterial infection of the bladder and prostate (painful and enlarged during rectal palpation). The infection is probably localised to the urinary tract as the total blood White Cell Count was OK. The dog had been given IV Vit K1 in drip earlier and appeared much more energetic the next day.
Advice to owner:
1. Had been fed meat, rice 1X/day in the past. Very thin. Increase feed to 2x/day.
2. Good quality premium dog food dry to be added. 1 egg/day for 14 days.
3. Antibiotics for next 14 - 20 days. UTI + prostatitis + bone marrow depression.
4. Review in 14 days.
4. More info of this case has been recorded at:
Tumours in 3 male dogs - Sertoli cell tumour, circum-anal tumour and oral tumour
5. An excellent veterinary report on canine testicular tumours is at: www.vet.uga.edu/vpp/clerk_anat/sabatino/index.php.
I note that the "Summary" stated that "the Sertoli cell tumour is the only known testicular tumour that commonly produces hormones with clinical effects." Some vet reports I read on the internet claim that estrogen is produced by two of the 3 common testicular tumours, namely the Sertoli cell tumours and Seminomas. In the "Introduction", there was this statement that "testicular neoplasms other than Sertoli cell tumours are rarely hormonal productive. Testicular neoplasms are often mixed-origin especially in cryptorchid testes". In this case, the histopathologist indicated that the undescended testicle could be a mixed type with Sertoli cell tumour and interstitial (Leydig) cell tumour.
Cryptorchidism in the dog can be unilateral or bilateral
Note that the report said that testicular tumour in the above-mentioned dog is found as early as 6 years of age (this case) but the median age is 10 years (photo of one of my cases, left).
Testicular Tumour in an undescended testicle of a 10-year-old Spitz in my 2001 case when I was new into digital photography. This picture is acceptable by me nowadays.
In 2010, many younger dog owners do not wish to have their male dogs neutered as they perceive the surgery to be cruel. However, undescended testicles may develop testicular tumours. Weekly check up of the dog's belly will detect their presence
Testicular Tumour in the undescended testicle of an 8-year-old Jack Russell.
Check the belly of your older dog every week if you do not wish to have your male dog neutered. Testicular tumours are seldom malignant but they do cause death due to bone marrow depression and thrombocytopenia and consequent overwhelming bacterial infections.
updates and pictures at www.toapayohvets.com
FOLLOW-UP
"The young intern has no experience in dealing with the submission of specimens for histopathology," I explained to the Laboratory girl who phoned me to tell me that the 7 testicular specimens must be correctly labelled as "right" and "left" testicle when I queried the report's findings. My histopathological samples are sent to a commercial laboratory that specialises in this subject.
How come there was a blunder? It was my policy of letting interns be more hands-on.
I had instructed my assistant, Mr Saw, to let vet interns have some hands-on experience rather than being an observer. In that way, they will learn from experience and mistakes. We all learn every day as we can't be perfect people.
Ms Lai, the intern, would be studying veterinary medicine next year and so we gave her the task of submission and filling out the forms. She had been with us for around 2 weeks and had seen submission of blood samples.
Well, the undescended testicle of this 6-year-old Retriever was enormous (half the size of a tennis ball) and would not fit into the usual container we used to submit samples for histopathology. So, I advised cutting it into 3 smaller pieces for the larger testicle (left) and 4 smaller pieces for the descended atrophied testicle (right).
I ought to have advised getting a bigger container. I did that eventually. Next time I asked my assistant to check before submission of the samples. Usually we submit one sample and it fits nicely inside the Lab-provided bottles.
Everybody learns from being hands-on. Young interns can't be spoon-fed all the time and will make some mistakes. It is part of growing up in life.
I was fortunate to have worked in the Vet Diagnostic Lab at Kampong Java Road (now the new Kandang Kerbau Hospital) as a new graduate in 1977 and so knew a bit about the work of histopathology. What had happened was that the intern put 7 pieces 1 big bottle and submitted the bottle and form without separation of the left and right testicle.
After receiving the histopathology reports, I phoned to clarify that there were two testicles submitted as the report had presumed I had submitted 7 pieces of one testicle. The report was then corrected as follows:
Specimens 1-4 are left undescended testicle. Specimen 5-7 are the atrophied descended right testicle. The histopathology results are as follows:
Takes a long time to pee. Painful enlarged prostrate when digital examined via rectum during light anaesthesia. Could this be purulent prostatitis as mentioned in: www.vet.uga.edu/vpp/clerk_anat
/sabatino/index.php.
Hyperpigmentation in the preputial area
Follow up 7 days later: Owner is happy. "No more limping now. We thought he had hip dysplasia."
I asked" Was the dog attracting other dogs during exercise outdoors?" The owner recalled that many dogs wanted to make friends with him (the effects of hyperestrogenism).
Left testis - Sertoli cell tumour (see comments below).
Right testis - Atrophy of the contra-lateral scrotal testicle resulting in aspermatogenesis.
Comments from the Histopathology Lab:
1. The left testis is extensively replaced by a tumour which is composed of closely packed tubules, trabeculae and nests of elongated spindly cells. A second interstitial (Leydig) cell tumour component cannot be excluded. Most primary testicular neoplasm in dogs are benign. The rare malignant Sertoli cell tumours have no good cytological or histological markers of malignancy. The vet needs to identify metastases in lymphatics, spermatic cord, lymph node or distant sites. Please correlate with clinical features.
Dr Sing's comments: The left testis will likely be a mixed tumour with Sertoli and interstitial cells involved). Much more details of the types of testicular tumour in the dog are in an excellent report at:
www.vet.uga.edu/vpp/clerk_anat/sabatino/index.php.
2. In the right testis, the parenchyma shows closely packed seminiferous tubes composed solely of Sertoli cells without spermatogonia, spermatocytes or spermatids. This is common in cryptorchid (undescended) testis. There is no tumour involvement.
CLINICAL FEATURES OF INTEREST TO VET UNDERGRADUATES
1. As the histopathologist is an independent service provider, he or she had not seen the real dog. The right testis was assumed to be an undescended or cryptorchid testis. It was a descended testicle, much shrunken.
2. Hyperestrogenism. The reason the descended right testes was atrophied and had no sperm production was due to the excessive production of estrogen by the large left testicular tumour. Estrogen is anti-androgenic and therefore cause the atrophy of the scrotal right scrotal testes.
3. Blood test results as shown below indicated a thrombocytopenia which can be a cause of death in the dog if the tumour had not been detected early and removed.
Golden Retriever, Male, 6 years. Left undescended testicular tumour and atrophied right scrotal testicle removed 5 days ago. Greyish-white, large sized and multi-nodular suggestive of a Sertoli cell tumour.
The owner asked about post-op management. This depended on blood test results.
Blood tests:
1. No disorders of liver and kidney function. Glucose is normal.
2. Haematology: Low haemoglobin and red cell count. Low PCV. Very low platelet count. Platelet clumping noted. (This indicated bone marrow depression). Effects are well written in:
www.vet.uga.edu/vpp/clerk_anat/sabatino/index.php.
Urine results
1. pH=7.0, SG 1.027.
2. Abnormal findings: Protein 2+, Glucose 1+, Blood 4+, WCC >2250/uL, RBC 900/uL, epithelial cells 1053/uL. Bacteria 3+
This indicated a severe bacterial infection of the bladder and prostate (painful and enlarged during rectal palpation). The infection is probably localised to the urinary tract as the total blood White Cell Count was OK. The dog had been given IV Vit K1 in drip earlier and appeared much more energetic the next day.
Advice to owner:
1. Had been fed meat, rice 1X/day in the past. Very thin. Increase feed to 2x/day.
2. Good quality premium dog food dry to be added. 1 egg/day for 14 days.
3. Antibiotics for next 14 - 20 days. UTI + prostatitis + bone marrow depression.
4. Review in 14 days.
4. More info of this case has been recorded at:
Tumours in 3 male dogs - Sertoli cell tumour, circum-anal tumour and oral tumour
5. An excellent veterinary report on canine testicular tumours is at: www.vet.uga.edu/vpp/clerk_anat/sabatino/index.php.
I note that the "Summary" stated that "the Sertoli cell tumour is the only known testicular tumour that commonly produces hormones with clinical effects." Some vet reports I read on the internet claim that estrogen is produced by two of the 3 common testicular tumours, namely the Sertoli cell tumours and Seminomas. In the "Introduction", there was this statement that "testicular neoplasms other than Sertoli cell tumours are rarely hormonal productive. Testicular neoplasms are often mixed-origin especially in cryptorchid testes". In this case, the histopathologist indicated that the undescended testicle could be a mixed type with Sertoli cell tumour and interstitial (Leydig) cell tumour.
Cryptorchidism in the dog can be unilateral or bilateral
Note that the report said that testicular tumour in the above-mentioned dog is found as early as 6 years of age (this case) but the median age is 10 years (photo of one of my cases, left).
Testicular Tumour in an undescended testicle of a 10-year-old Spitz in my 2001 case when I was new into digital photography. This picture is acceptable by me nowadays.
In 2010, many younger dog owners do not wish to have their male dogs neutered as they perceive the surgery to be cruel. However, undescended testicles may develop testicular tumours. Weekly check up of the dog's belly will detect their presence
Testicular Tumour in the undescended testicle of an 8-year-old Jack Russell.
Check the belly of your older dog every week if you do not wish to have your male dog neutered. Testicular tumours are seldom malignant but they do cause death due to bone marrow depression and thrombocytopenia and consequent overwhelming bacterial infections.
updates and pictures at www.toapayohvets.com
169. *Common toilet-peeing-everywhere situation in Singapore's apartment
HOW A VET WILL DISCUSS ABOUT TOILET TRAINING
Date: August 18, 2010. Came for annual vaccination and heartworm vaccination. Ate at 10 am but vomited canned food during vaccination at 3.30 pm. Surprising. Dog is nervous of vets, owner said. I kept the dog in the Surgery for one hour to observe. No problem.
Dog: Pom, red, 17 months, female, not spayed
Problem: Pees everywhere inside all the rooms of the HDB apartment when let loose. Pees on newspapers when confined to the balcony when the family is not at home. Family lives with this situation of having to clean up after her peeing.
Look at the routine and my explanation:
Sleeping area - balcony by herself. So she has an incentive not to soil her "den".
Feeding - 8 am & 7 pm. Canned food. However dry dog food is left available all the time. This is a mistake. Dog should be given food for 15 minutes as a puppy and food removed.
Drinking - Water anytime. I advised no water after 8 pm so she can control her bladder. Eating dry dog food anytime may make the dog thirsty too.
Pooping - 1-2x per day.
Poops after breakfast - Yes, usually around 30 minutes after eating.
2nd pooping time variable. Sometimes overnight in the balcony.
Peeing - 4-5X/day including overnight. Is this urine spraying? "Female dogs do urine-mark to stake out their territory inside the apartment," I said to the young lady. "To let the other family members know."
As the location of peeing was all over the apartment, this seemed to be a case of urine-marking. "Spaying at a young age may stop urine-marking," I said.
I will e-mail to the owner the proposed plan and hope she will provide feedback to me in 2 months' time.
PLAN
1. Confine to balcony and adjoining living room.
2. Neutralise all urine smell inside the apartment. Put white vinegar 1 part and 3 parts water in a spray bottle and spray clean the whole apartment.
3. Close all bedroom and kitchen doors for the next 2-4 weeks.
4. Newspapers to be placed in the living area too. Preferably with urine smell (2nd piece of newspapers from the balcony.)
5. No dry food for the whole day. Give with canned food. Dog is not skinny anyway. No water after 8 pm so she can control her bladder.
6. Feed 2x/day.
7. Remove all soiled newspapers (in the balcony and living room) immediately as dogs don't like to eliminate in soiled papers.
8. Praise when the dog pees on newspapers in the living area. Dog treats if the dog is motivated by treats.
9. Same routine for 2-4 weeks and let me know by e-mail 99pups@gmail.com
I advised for the next 2 weeks, confine dog to living area and balcony. Put newspapers on tray
Date: August 18, 2010. Came for annual vaccination and heartworm vaccination. Ate at 10 am but vomited canned food during vaccination at 3.30 pm. Surprising. Dog is nervous of vets, owner said. I kept the dog in the Surgery for one hour to observe. No problem.
Dog: Pom, red, 17 months, female, not spayed
Problem: Pees everywhere inside all the rooms of the HDB apartment when let loose. Pees on newspapers when confined to the balcony when the family is not at home. Family lives with this situation of having to clean up after her peeing.
Look at the routine and my explanation:
Sleeping area - balcony by herself. So she has an incentive not to soil her "den".
Feeding - 8 am & 7 pm. Canned food. However dry dog food is left available all the time. This is a mistake. Dog should be given food for 15 minutes as a puppy and food removed.
Drinking - Water anytime. I advised no water after 8 pm so she can control her bladder. Eating dry dog food anytime may make the dog thirsty too.
Pooping - 1-2x per day.
Poops after breakfast - Yes, usually around 30 minutes after eating.
2nd pooping time variable. Sometimes overnight in the balcony.
Peeing - 4-5X/day including overnight. Is this urine spraying? "Female dogs do urine-mark to stake out their territory inside the apartment," I said to the young lady. "To let the other family members know."
As the location of peeing was all over the apartment, this seemed to be a case of urine-marking. "Spaying at a young age may stop urine-marking," I said.
I will e-mail to the owner the proposed plan and hope she will provide feedback to me in 2 months' time.
PLAN
1. Confine to balcony and adjoining living room.
2. Neutralise all urine smell inside the apartment. Put white vinegar 1 part and 3 parts water in a spray bottle and spray clean the whole apartment.
3. Close all bedroom and kitchen doors for the next 2-4 weeks.
4. Newspapers to be placed in the living area too. Preferably with urine smell (2nd piece of newspapers from the balcony.)
5. No dry food for the whole day. Give with canned food. Dog is not skinny anyway. No water after 8 pm so she can control her bladder.
6. Feed 2x/day.
7. Remove all soiled newspapers (in the balcony and living room) immediately as dogs don't like to eliminate in soiled papers.
8. Praise when the dog pees on newspapers in the living area. Dog treats if the dog is motivated by treats.
9. Same routine for 2-4 weeks and let me know by e-mail 99pups@gmail.com
I advised for the next 2 weeks, confine dog to living area and balcony. Put newspapers on tray
Tuesday, August 17, 2010
Faucitis in a stray cat
August 17, 2010
Stray cat can eat as ulcers heal 80% as evident from digital photography taken today. Midline tongue ulcer re-appears. Ulcers at base of right side of tongue seen in one of the images.
Cat was more cooperative but he got fed up after I took over 50 images. It was difficult to take his inner mouth from a table in the waiting room with outside sunlight at 11 am. I did not shine a strong light into the mouth.
HISTORY:
Tuesday, August 10, 2010
Faucitis stray cat
August 10, 2010 review of eosinophilia in a stray cat.
Salivation is the presenting sign. Ulcers in fauces and lower tongue 2 weeks ago. Treated and went home. Came back again as the cat started to salivate.
Ulcers at fauces reduced by 80% today. Cat gentle but dislikes mouth being opened. Wanted to scratch intern Ms Lai. Will the condition relapses? Is there a permanent cure? Not according to the cat experts.
Stray cat can eat as ulcers heal 80% as evident from digital photography taken today. Midline tongue ulcer re-appears. Ulcers at base of right side of tongue seen in one of the images.
Cat was more cooperative but he got fed up after I took over 50 images. It was difficult to take his inner mouth from a table in the waiting room with outside sunlight at 11 am. I did not shine a strong light into the mouth.
HISTORY:
Tuesday, August 10, 2010
Faucitis stray cat
August 10, 2010 review of eosinophilia in a stray cat.
Salivation is the presenting sign. Ulcers in fauces and lower tongue 2 weeks ago. Treated and went home. Came back again as the cat started to salivate.
Ulcers at fauces reduced by 80% today. Cat gentle but dislikes mouth being opened. Wanted to scratch intern Ms Lai. Will the condition relapses? Is there a permanent cure? Not according to the cat experts.
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