1139. Two dogs with gas in the intestines and follow up

CASE 1

Chocolate Labrador Retriever
loose stools for past 2 months since purchase at 4th month of age.
Raw meat + knuckle slices + cheese + treats
Intestines are full of gas. Some bone fragment
Hunched back upwards when i palpated the abdomen.

 

Case 2. Chinhuahua Vomit and Diarrhoea 5 days.
X-ray  colitis
Recovered on Day 3.
Deworming Panacur prescribed.



Chihuahua passes watery stools for past 5 days.
Wanted to bite me when I palpated the abdomen

 

1138. How your dog can live longer? Two undescended testicles in a Pom

                       

TOA PAYOH VETS toapayohvets.com Date:   14 December, 2014     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits

How your dog can live longer? Two undescended testicles in a Pomeranian   Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   14 December, 2014

Dec 12, 2014 The Pom came in for vaccination. He is the daughter's dog but she had given him to the 68-year-old mother to take care as she had married and moved out. The mother had consulted me some 30 years ago and said: "You are still working," "Nowadays, the younger generation does not want to work hard," I replied. "They want to enjoy life as well, to achieve a work-life balance. Some do not want to work at all despite being highly and expensively educated!" "Yes, I know of a father who sent 3 children to Australia to study," the pioneer-generation woman said. "He found out that they were not attending classes and terminated his support. The two daughters married and are not working. The son finally realised that he had better get a University education and asked his father for a second chance to study in Australia. Now he is a Chief Executive Officer of a company."  . "In any case, it is better to work than stay at home, eat, watch TV and sleep all day," I said. "I work in the mornings. Are you still working?" "I work in the Changi Airport," she replied. "Some people die early when they don't work, but eat and sleep," I said. "I hear from a client who recruits young men for the flying club that they younger Singaporeans are generally in poor health as many cannot qualify to be pilots. Many young people are getting diabetes and high blood pressure at a young age." "Nowadays, people can die young," she recounted her recent experience. "There was a man around 30 years old who collapsed recently," she said. "The Airport Clinic at Terminal 2 referred him to the one in Terminal 3. At Terminal 3, he was rushed by ambulance to the hospital where he died." "Do you have to take medication for high blood pressure, diabetes and high cholesterol?" I asked this slim woman with grey hairs. "No, not at all," she replied. I sent her back to her home in Toa Payoh Lor 8, as she said it was difficult to get a taxi. "I can find a home for him if you "don't want him," I said to the mother. But the mum would not part with the dog. In an empty nest, the dog is the best companion for the elderly. The one-year-old had 2 undescended testicles and I advised neutering as they are prone to develop cancer. She said she would ask her daughter who had reminded her to get the dog vaccinated. That was why she came. Many Singapore owners do not want to neuter their male dogs as they consider it cruelty. However, they tend to forget about their dog's health when he grows older and cancerous testicles do kill the dog as the cancerous cells rot over time. Two undescended testicles are relatively rare as compared to one being undescended. I have made a video at http://youtu.be/0Br54ecbDFM  to educate pet owners and vet students. Blog: http://2010vets.blogspot.sg/2014/12/1138-how-your-dog-can-live-longer-two.html TIPS AND ADVICES EXPERIENCES IN THE TREATMENT OF CANINE CRYPTORCHIDSM (one or both testicles not in the scrotum) OR MONORCHIDISM (one testicle in the scrotum) AT TOA PAYOH VETS 1. Well informed dog owners in Singapore are worried that the undescended testicle or testicles will become cancerous and request neutering (orchiectomy). 2. Beside cancerous testicles, there is a possibility of testicular torsion in the undescended testicle. This can be an emergency as blood supply to the testicle is compromised leading to testicular gangrene. 2.1 Surgery (orchiopexy) involves sewing the testicle to the scrotum. 2.2 Manual rotation of the testicle (towards or away from the thigh) to untwist the torsion. Give painkillers.  Sometimes, this is successful and no surgery is needed. Orchiopexy or orchiectomy is seldom advised by some vets. The owner may not want surgery.  3. The locations of the undescended testicle can be below the kidney leading to the inguinal canal, the inguinal canal, ectopic (outside the inguinal canal e.g. under the skin of the thigh, perineum, femoral canal), undeveloped (hypoplastic), abnormal (dysgenetic) or absent (anorchia). The vet may have difficulty finding the undescended testicle in some of the locations. 3.1 For abdominal cryptorchids, the testicle can be found beside the bladder in many cases. 4  For professional dog shows, dogs must have 2 descended testicles. Some owners may request orchiopexy to qualify for dog shows. Inguinal based testicles can be pulled towards the scrotum and anchored there. 5. Orchiopexy prevents the development of testicular torsion. 6. I have seen a case of an old Rottweiler dying from a large cancerous abdominal retained testicle (seen from X-ray). I have seen inguinal testicular tumours necrotic as the owner did not seek early treatment.    7. It is expensive to use imaging to look for the undescended testicle in the dog. 8. In cases where the undescended testicle disappears into the abdomen when the dog is placed ventro-dorsal on the operation table, I advise putting the dog upright, locate and grasp the testicle under the skin before putting the dog on the ventro-dorsal position. This saves the trouble of opening up the abdomen to take out the disappeared testicle. 9. If no testicle is found inside the abdomen, it is possible that the dog has anorchia or ectopic testicle. Inform the owner accordingly and record in the medical records for the dog licensing application. Neutered dogs are charged cheaper licences in Singapore. More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326

1137. Make a person smile a day: Employment Agent has to meet bosses

Employment Agent Jonathan goes out to meet bosses asking if they need foreigner cooks etc. Vets still wait for clients to come. Which method is more effective?

I met him at Toa Payoh HDB Hub recently. His lady client, a Chinese National, complained that she had taken out too much money from the UOB bank. "Give Jonathan your excess," I said. "What nonsense," she replied. "He should give me some money!"


Jonathan smiled broadly and kept quiet..

1135. Left ear abscess recur in a terrapin with 2 ear abscesses

1134. Red eyes in a Filipino dog - email query on cause

4. Red eyes in dogs

Email from Philipines Dec 8, 2014

	Dec 8 (3 days ago)
to judy

My dog's sclera has bloodshots and turns red  specially at night. In the morning its not that red. I dont know whats causing it. :(

REPLY FROM DR SING  DEC 8, 2014

Pl send two images of the red sclera and eye involved..

3 IMAGES SENT

Sorry I couldn't get a clear photo. Attached are photos of his right eye. It started on his red eye May (2014) this year. He's been on different eye drops since then but nothing really helped. Now his left eye are showing signs of bloodshots too. At first i thought it was glaucoma but it's not. Vets here are also clueless as to whats causing it.

EMAIL FROM DR SING  DEC 9, 2014

Any image of lower half of sclera?

Im having a hard time taking pics of the lower part of his sclera but right now its not red but it has blood shots as well. Thin ones.

Are you a Vet? Where are u from? I just came across an article online so i decided to email you. Im hope im not so much of a bother. Its just that im worried about my dog I dont want him to go blind. Ive already brought him to an animal hospital here in my country but they also dont know whats causing it.

Thank you..

EMAIL REPLY FROM DR SING DEC 10, 2014

Yes, I am a vet, Dr Sing Kong Yuen from www.toapayohvets.com

Which article you saw online? Which animal hospital and which country you are in?

Good morning doctor!

I think its your rticle about red sclera. I've been searching the internet of anything that could help me figure out whats causing the redness and bloodshots in my dog's right eye when i came across your article.

I brought my dog to vip hospital (vets in practice) already and recently in Animal House hospital here in the Philippines. But they can't figure out whats causing it. Accdg to them his eyes seem normal other than the redness and bloodshots of the sclera.

He's been on diff eye drops, ointments, steroids.. His eye improved but the sclera is still the same. His blood test results are all okay. His blood pressure is high so but even after giving him meds for hypertension his eye didnt improve.

If you have any idea as to whats causing i hope you can help me.. Thank youuu so much. :)

Your article is at:

http://www.bekindtopets.com/dogs/200912003Shingles_Dog_Attack_ToaPayohVets.htm

-----------------------------------------------------------------------------------------------------------------

REPRINT OF THE ARTICLE

This dog owner in her 50s with 2 children is one of those natural story tellers. She not only could tell stories very well but the way she acted and told it was a master performance.

"I was alone in the house when the 2nd attack occurred," she said when I asked about her two domestic workers. "I rolled up a carpet,  pick up XXX (the dog being attacked). Yet TTT held onto the left ear and chin of her sibling till gravity pulled TTT down to earth.
"Did TTT bite you?" I asked.

"No, she growled at me." the woman said. "That is why I boarded TTT
at your Surgery after the attack." TTT sounded like a ferocious Jack Russell and I took precautions of muzzling TTT for examination after the attack. Today was some 2 weeks later. The lady had now diagnosed shingles infection linked to the dog attack, according to her diagnosis. This is what she said to me. 

"Two days after the attack, I saw a circle of 'insect bites' on my right lower elbow area." She displayed her wounds on the inner side of her elbow joint. They were now maroon red with a black centre in the bigger wound.

"Are you sure that the circular line of wounds were not caused by TTT biting you?"
This would be my first diagnosis although I am not a medical doctor.

"Well, TTT's teeth was sunk into XXX's left ear. I held XXX up till TTT had to let go as gravity pulled her downwards.  So, she could not have bitten me."
The lady waved her hand up and down to show that she had held XXX high up, until TTT gave up to the forces of gravity and dropped to the ground.   

"The next day, I felt tired," the lady continued. "Tingling sensations rippled from under the skin of my right elbow to my back shoulder", she pointed to her back. "More rashes appeared in the area. Watery blisters formed. The tingling sensation was unbearable. I quickly went to consult Dr Thiru, the famous skin specialist. Do you know him?"

"I don't know him nor have I met him," I said. "Is he the distinguished looking man with silvery grey hair and white sideburns?" I had attended a talk given by Attorney General Walter Woon's lecture "Criminal Aspects Of Medical Practice" to a full house of at least 1,000 doctors and lawyers in the Supreme Court Auditorium on Nov 30, 2009. The moderator was a doctor who is a skin specialist. "Yes," she confirmed my description of the good doctor.

"The doctor asked whether I had been to the vet?" the woman commented. "Probably my doctor was thinking that my right elbow I had been infected at your Veterinary Surgery."

I don't think the good doctor would have thought that she was infected by putting her elbow on the veterinary examination table and got infected by Shingles. I don't know why he asked whether she had visited the vet earlier.

"So, did he prescribe you the antiviral drug?" I was more interested on the cure.

"He said to wait 3 days," the woman replied. "Then more rashes appeared. They become watery and burst. I felt tingling, as if some snakes were travelling up my hand to behind my back and forth. I quickly went to see him. He was not available but his colleague gave me the medication. Now I feel so much better and have the time to quickly get my 2 dogs vaccinated."

"My sister had shingles." I said. "The viruses travelled along her nerves in her leg and the serpentine lesion manifested as snake-like in appearance."

This woman did not have the serpentine tracks as she had sought prompt medical treatment. "If the virus completes the travel from one end of the nerve, go round the body, the person will die," the lady told me about a common Chinese belief. "That is why the Chinese temple medium used incense to burn the shingles skin. To kill off the head of the snake."

"Some Singapore people don't know what is the cause of this serpentine skin problem," I said. "So, they seek the help of Chinese mediums."

The lady enlightened me: "Actually, shingles is the re-activation of the chicken pox virus due to stress. The virus lurks in the body for a lifetime. It is extremely painful, itchy and causes tingling sensations."

This lady is surely knowledgeable about shingles. I just could not believe that separating two dogs in a fight would lead to a shingle infection as this lady was definitely in good health.  I believe that there is a remote possibility that TTT had bitten her right elbow when the dog loosened her grip on XXX and was falling down to earth. I mean, how would the lady know since she was highly agitated and in that instant, TTT's bite would have resulted in what she first told me as "circular rashes" in a small area in the inner aspect of the skin of her right elbow. I remembered asking her to repeat what she said. She said "circular rashes".She meant that she had rashes clustered in a circle. Or semi-circle. The pain and tingling sensations could be due to the spread of micro-organisms along the nerve and tissues originating from the bite wounds. This condition is documented in the skin to owners owners who had been scratched by the cat. These bite rashes from the upper and lower incisor teeth of the attacking dog would become infected. That could be the reason that the first doctor did not think this was a shingles infection. As for the appearances of more rashes in the surrounding area, it could be due to the scratching of the infected skin. This is my hypothesis which I am sure the lady would not agree.  I have not seen shingle infections in human beings. Maybe they manifest as rashes clustered in the circle too.     Medicine is full of diagnostic mysteries. I asked to see the inner or medial aspect of the elbow again. I could see that the rashes covering an area of 10 X 10 cm of skin in the elbow. The biggest rash was 8 mm in diameter. It had a black centre. Other rashes were healing.This is an incredible but true story of an apparent shingles infection linked to dog assault.  Did the attacking dog get any shingles as well?  She had really blood shot eyes. Red sclera in both eyes after her ferocious lunge for the jugular of the sibling who garnered more attention at home. The redness in both sleras persisted for several days. So, would this be caused by a virus activated by the high stress of trying to get rid of the rival in love? A latent herpes zoster-equivalent virus in the dog, a canine type of chicken pox virus that gets reawakened in times of high stress? This dog was lunging for the jugular of the sibling with only one intention. To kill a rival in who is favoured more by family members.  But her attempt was thwarted and now she was "in the doghouse". Or to be precise, waiting to be rehomed (Re-homing picture must be attractive). 

P.S. 
1. Herpes zoster (Shingles). Anybody who has had chicken pox is at risk for developing shingles many years later. The chicken pox virus lies dormant in the person's body. Stress or a decreased immune system reawakens the virus, resulting in shingles infection. It appears as a rash. Rashes cluster around the eyes, face or body. The Shingles infection is also called herpes zoster. It is an extremely painful and itchy condition. Early aggressive treatment with antiviral drugs can lessen the length and severity of shingles attack.

2. Red scleras in the dog. I had encountered a few cases. Some are due to traumatic injuries. Some are a result of intense rubbing of the eye arising from some chemical spills. I note that there is a dog owner posting a picture of his dog with red sclera in a local website called Stomp.

I had 2 memorable cases of red scleras in Jack Russells.
2.1 This Jack Russell had a chew rope stuck inside its colon for some time.
2.2 This Jack Russell had intense abdominal pain and was vomiting. Exploratory laporatomy revealed petechial haemorrhages in the pancreas.
This present case would make it 3 memorable cases of Jack Russells with blood-shot eyes. E-mail tojudy@toapayohvets.com if you have seen more cases. 

1133. Just Keep Going - Persevere

1132. Happy New Year card from Toa Payoh Vets

1131. Perineal urethostomy in the male neutered cat

Dr Tun Thein Aung from Royal Asia Veterinary Surgery visited me today and explained how he performed the perineal urethrostomy in the male cat.

Basically,

1. Dissect between the anus and penis, taking care not to cut the anal area.  Lots of fat. No bleeding. 
2. Blunt dissection of the area to expose the roots of the penis and further below 2 muscle bands. These muscle bands are below the roots and must be used to stitch up the opened urethra after penile amputation.
3. Catheterise and elevate the penis high up.
4. Use scalpel to incise urethra at most ventral point (larger diameter). Take out the catheter and use eye scissors to cut the urethra towards the muscle bands.
5. Amputate the penis.
6. Suture skin edges after amputation dorsally lateral to lateral.
7. Stitch urethral opening to the lower and side of the muscle bands.

Cat no longer suffers from dysuria. An easy operation, he said.

An Australian CD of the op is available. 

1130. Threshold of death. A 14-year-old Maltipoo cannot breathe - a gigantic right submandibular abscess

2nd case within 2 weeks of a large submandibular swelling in the dog.
The other dog with similar swelling on the submandibular had no pain and a cytology revealed cyst.
In this 14-year-old male maltipoo, he was not eating for one day. Panting and breathless.
Bad breath. Drooling on right side of cheek. Large swelling  6" x 3" extending below neck. Very painful.T=39.4C. What's wrong?

X-ray of this maltipoo on first consultation on Dec 9, 2014

BLOOD TEST

Dec 9, 2014

Abnormal

Total white cell count 68.5 (6-17)

 N 98%  (60-70%)       N absolute 67.13  (3-11)

L  1.6%    L Absolute 1.10
M 0.1%  Absolute 0.07
E  0.3%   Absolute 0.21
B  0%

Platelets  142  (200-500). 

Several abnormal lecuocytes seen. Occasional nucleated red blood cells seen. Large platelets present. 

HISTOLOGY report from 2 biopsy punches on side of submandibular swelling.

No malignancy

URINE TEST
pH 6.5 SG 1.030. Protein 2+. Blood trace. Bacteria 3+.  White blood cells 288. Red blood cells 18. Epithelial cells 38.   Suspect UTI

During the IV drip on Dec 9, 2014, the dog with breathing difficulty started barking in response to another Spitz barking. Suddenly he collapsed with cyantoic tongue. This was surprising. I quickly punched his chest on the spot and massage vigorously, to stimulate the heart beat. I pulled his tongue out with forceps so that he could breathe. There was no time to waste as he was in the throes of death.

Fortunately he recovered and the owner was happy to see him alive. He went home in the evening with medication.

FOLLOW UP

on Dec 10, 2014, 10 am, I phoned the owner to discuss the blood test report and the possibility of a severe bacterial infection of the throat area.

"The dog is breathing better than yesterday," the wife said.."He eats a little egg yolk and meat and drinks water by himself."

"Any stools passed?" I asked.
"No."

I got another blood test done on Dec 15, 2014 

BLOOD TEST

Dec 15, 2014

Abnormal

Total white cell count 45.1 (6-17)

N 86%  (60-70%)       N absolute 39  (3-11)

L  9%    L Absolute 4.1
M 5%  Absolute 2.3
E  0%   Absolute 0
B  0%

Platelets  135  (200-500). 

No platelet clumps seen.

Liver disorder this 2nd test. Hepatitis.

SGPT/ALT  424  (below 59) SGOT/AST  106  (below 81)

FOLLOW UP on Dec 19, 2014 9.47 am

Dog is active, not breathless.  Eat, drinks and pees a lot. Advised resting, no serious exercise

FOLLOW UP ON JAN 5, 2015 at 3.45 pm

I first saw the breathlessness and painful right submandibular swelling, measuring 6" X 3" on Dec 9, 2014. Today is nearly one month later. The dog came in for a check up.  No more swelling at all. 

All are well with his appetite and drinking, peeing and pooping. He has the occasional coughing after eating. I advised dental scaling today, as the bad breath would return after all these antibiotic mediation.

The ears are no longer infected as the ear drop medication was applied. The dog actually put on weight and today, is 10.1 kg compared to 9.7 kg on Dec 9, 2014. 


CONCLUSION
The bacteria would be from the chronic ear infection of the past  6 months. The owner went to a vet who prescribed medication but the pus kept coming out from the ear. The owner did not seek further treatment. Then the dog became inactive and the next day, developed a right submandibular swelling. He could not breathe normally. The owners decided to come to Toa Payoh Vets.

This case is most likely a bacteria infection from the vertical canal going into the side of the ear and downwards. This bacteria was very fast growing and the 14-year-old dog's immune system could not fight it. Neutrophils went up to 98% (normally 60-70%) and the total white cell count shot up sky high.

I searched google and there is a similar submandibular swelling from a chronic ear abscess in another country. Another vet had operated but the pus persisted. Foreign body or tumour was suspected to be the cause of this pus which kept coming out of the ear as in my case. The bacteria cultured was psuedomonas. The case is at:
https://www.youtube.com/watch?v=OtjgriWDqCE

TIP.  The owner should not let ear infections esp. with pus linger on for months without seeking a second opinion from another vet.

1129. Script for RGS Intern. No excuses - The old Shih Tzu had big bladder stones

Dec 9, 2014

HOOK

The Shih Tzu has blood in the urine some days and "none" on other days for the past 4 years. What is the big deal? He could still eat his home-cooked food. Some dry food on stand-by. He goes to the newspapers to pee. On Dec 8, 2014, the dog stopped eating and vomited 3 times.


INTRODUCTION
Dr Daniel took the blood test and got the dog's abdomen X-rayed as he palpated bladder stones. His blood showed hepatitis and a high serum urea. The dog was given the I/V drip and was warded. He passed away in his sleep at around 9.30 am the next day. 



"Why did my dog die?" the husband asked me. His wife was grief-stricken. "Is it due to the I/V drip?"


MIDDLE
"No," I had the blood test evidence of hepatitis and high serum urea. "The dog was not well as he had vomiting. Vomiting is not a good sign in dogs with long-standing urinary stones inside the bladder. The 6 stones are large as you can see from the X-rays and must have caused bladder irritation and urinary tract infection over the past 4 years. Did the dog vomit during the past 4 years?

"Yes, yellow vomitus now and then," the husband recalled. "Do dogs not vomit now and then?"
"No," I said. "Unless they are not healthy. With blood in the urine, your dog could have suffered from urinary tract infections and hence vomiting."

   FLASH BACK (VIDEO OF SHIH TZU PUPPY)

I knew this male Shih Tzu as a puppy some 10 years ago. Gave him his puppy vaccination. A young couple with no children. The tricolour grew up and I have grown to become elderly.

The couple brought the Shih Tzu in for vaccination in 2013 and Dr Daniel gave him the jabs.
"Did Dr Daniel advise you to treat for blood in the urine?" I asked the husband. as I reviewed the medical records with a heavy heart. This dog was such a lovely tricolour puppy and now he had died.
after vomiting 3 X yesterday. Vomiting is not a good sign for an old dog.

The owner had switched to home-cooked food in the past   years. "Whenever he ate dry food, he passed blood in the urine," the husband told me when I asked him yesterday whether the dog had urine, blood tests or X-rays done by another vet.  He did not consult other vets although he lived
"far away" from Toa Payoh. There was a vet clinic in his neighbourhood. Presently, Singapore has over 60 veterinary clinics satisfying the proximity and convenience for the Singaporean pet owners.

 DEATH CERTIFICATE AND GRIEVING WIFE
I issued a death certificate today as the husband phoned me for one, to cancel his dog licensing by the authoritiies. "I cannot understand why you did not do further tests to remove the bladder stones last year when Dr Daniel advised you," I asked him. "This dog could have lived to a ripe old age. I mean you are not like those lowly educated Singapoean dog owners who would only feed the dog despite old rotten decayed teeth and bad breath. They would let the teeth drop off and would not seek veterinary treatment." 

His wife was badly affected by the death as women are closer to the companion than men, generally

I was most saddened by this loss as this was a puppy I had vaccinated over the earlier years. There was no complaint about blood in the urine which was present some 5 years ago.  I advised against immediate bladder stone removal surgery as the dog was not eating and was vomiting. Otherwise, he would have had died on the operation table as he was such a high risk candidate for anaesthesia and surgery..  

Dr Daniel advised blood tests and X-rays yesterday and there were around 6 big bladder stones. But vomiting was what brought the dog here yesterday.

X RAYS

VIDEO OF DR SING'S REMARKS ON X-RAYS


Conclusion
Regular blood and urine tests after the age of 7 years for small breeds and 5 years for big breeds are advised. X-rays must be taken when there is blood in the urine but most Singapore dog owners do not do it.