2497. INTERN. NOCTURNAL PANTING. The chihuahua pants at night and sits upright with her front legs straight and head pointed to the sky

"Panring and sits on backside with front legs straight up. Her head tilts upwards with eyes staring," the lady in her 30s said to me today, Hari Raya last day. A bright sunshine day. 


On Jun 10, 2015, she boarded the 3-year-old female spayed Chihuahua. On the 7th day of boarding in a home, the chihuahua vomited saliva and had a slight cough. The boarding owner fed her own vegetarian diet and so the owner presumed a change of diet caused this problem. She brought the dog home on Jun 25.

On Jun 25, consulted Vet 1 who diagnosed heart disease based on X-ray (see below) and wanted to prescribe heart medication. The owner rejected this.

On Jun 27, consulted Vet 2. Also another visit on Jul 12. Vet 2 diagnosed a dietary change as the boarder came to give the owner free vegetarian diet for the dog. The boarding operator came on Jul 9 and the dog was fed this vegetarian diet for 3 days. "Could there be toxicity in the diet?" the owner postulated. So Vet 2 diagnosed the problem as dietary based on blood liver enzymes slightly elevated and low white cell count. 

But the dog continued with the same behaviour of panting at night and upright front legs.

On Jul 14, consulted Vet 3 who diagnosed heart disease based on X-ray of Vet 1 and prescribed one medication called invoril 5 mg.

On Jul 15, consulted Vet 4 who did an abdominal ultrasound to scan for tumour and wanted to refer her to a French specialist to do ECG test for the heart. The heart murmurs were grade 1.

Today, Jul 17, I was on duty in the morning. I confirmed Vet 1's and Vet 3's diagnosis of heart disease.  Left heart enlargement for a 3-year-old dog is rare but does occur. There was throat pain due to the owner force-feeding medicine by grabbing the dog's throat and syringing medication with a 3-ml syringe.

I thought her to use a 1-ml syringe and be gentle. The dog should be placed on a table.  Panting at night stresses out the career lady as she has to have a sound sleep. The lady is happy with the final diagnosis from me.

"I am in denial," she said when I asked her why she did not believe the first vet. "It is better than I have more second opinions! Will she be cured and how long will she live?"

"Well, the 3rd vet is an experienced vet with over 30 years of practice," I said. "Yet you do not believe him."

I opened my website and showed her X-rays of a 1-year-Pom with severe heart disease and how heart enlargement look like.
http://www.bekindtopets.com/animals/20110201dog-heart-problems-x-rays-toapayohvets-singapore.htm

http://www.bekindtopets.com/dogs/20090923Heart_Failure_Young_Pomeranian_ToaPayohVets.htm

"Your dog has a Grade 1 left mitral murmur on the left heart, the left sided heart enlargement is not too large and is due to congenital origin, that is from birth problem. It is hard to predict how long she will live. Much depends on the control of the heart disease, restriction of strenuous exercise and diet."

The dog went home. The owner phoned. "My dog vomited, peed and her front legs are now stretched out straight!"  I asked her to be patient as it was only 1 hour since she left the clinic.

 
CONCLUSION
It is very difficult to convince some owners about heart disease in young dogs. I used the previous case of a one-year-old Pomeranian to illustrate the heart enlargement in X-rays as shown above.
As you can see, the left heart occupies more than 1/3 of the pleural cavity and is therefore enlarged. the right heart is normal. The X-rays from Vet 1 are slightly tilted but the clinical signs are the main factors in coming to a correct diagnosis of heart disease. It is just that client education is very important as there is a need to "show and tell" rather than just tell.

The owner just cannot believe that such a young dog can get heart disease during boarding. The boarding operator surprisingly offered more of her home cooked vegetarian diet after boarding, confusing the owner. As to the dog showing improvement after the first visit to Vet 1, I told her that it could be the pain-killer cartophen that temporarily stopped the pain in the heart. But proper heart medication is the solution.



UPDATE ON SAT JUL 18, 2015

Jul 18, 2015. My SMS as I could not contact her by mobile
                9.50am     "Any front leg being upright in Wawa now?"



              
                     Her SMS
               1.10 pm  Hi doc, sorry I was busy with housework earlier, so missed your call.  She is not in upright posture anymore, but kept sleeping and mostly in a daze-like expression.

I phoned her. The dog had the most restful sleep without panting on Jul 17, after treatment. So did the owner. The dog had eaten a little bit of the chicken meat but avoided the H/D diet prescribed for heart-diseased dogs.   I advised her to persevere in feeding H/D with 90% of the present diet until H/D replaces the diet. As for the lethargy, it was most llikely that the dog is recuperating for over a week of night panting and deprivation of sleep. I advised a small teaspoonful of honey in case the chihuahua suffered from hypoglycaemia as some do.

"I have researched the internet and saw similar X-rays of left heart enlargement," the lady said. "What is the cause of this heart disease?  Will she be cured? Should she have an ECG?"

"The cause is presently unknown. Heart enlargement could be due to infection,  heart valve disease or from birth. Wait one month before doing the ECG and to get another review."  No blood work was done by me on that day as the other vet had done it.

UPDATE - July 22, 2015
The owner phoned me saying that the French vet who did an ECG on her cat had said that the dog's heart did not have abnormalities as there was no heart murmur or abnormal ECG. "I had told you that the heart disease was due to a slightly enlarged left heart when you had seen the X-ray of a 1-year-old pomeranian with a extremely large heart enlargement. The heart murmur was not serious. I have advised to take the antibiotics and heart disease medication for one month and then review the heart, doing ECG when necessary."

But the owner had the ECG done anyway on this 3-year-old chihuahua and found nothing abnormal from the 5th vet. "It is hard to pinpoint as to cause your dog to have the upright posture, night panting and difficulty in sleeping based on one-time X-ray," I said. "The dog could have a chest or heart infection which leads to a slight enlargement of the left heart. How is he nowadays?"

"He is good and normal," she now can sleep peacefully at night as the dog no longer had nocturnal respiratory distress.  She would complete the medication and get the dog X-rayed and reviewed one month later.     

2496. INTERN Aug 2014 Thousands of ticks in my face - Rottweiler

Video like:
https://www.youtube.com/watch?v=VgQO9Kbdid0


HOOK

BKTP


INTRODUCTION

Settings - City


MIDDLE

Setback - economic depression, real estate crush, property values fall


CONCLUSION

2495. Angel the cat is admitted for dysuria

1. Monday, Jul 13, 2015. The cat was admitted as the owner said he had difficulty in peeing. Bladder and urethral stones were removed some 7 days ago. The cat was given IV drips on Jul 10 and 11 and I discharged him on Saturday Jul 11, 2015 since he was eating. I took out his stitched urinary catheter as it is not good for the cat to have it for more than 3 days, in my opinion, as it irritates the bladder.  However, he ate little at home, the owner said and was worried.

Dr Daniel and I discussed his treatment. Perineal urethrostomy will be the last resort.

"There is bound to be inflammation in his urethra as he had urethral stones stuck at the bend of the urethra," I said. "The bladder is not much swollen as before, not as big as an orange. Pain killers and antibiotics will be needed."
The cat was given gas anaesthesia. Dr Daniel lavaged the bladder by sucking out the bloody urine (video). An injection of painkiller and antibiotic was given.

2. Tues July 14, 2015. The cat meowed when he saw me. His bladder was not swollen. He preferred to sit inside the litter box where there is sand, than outside the box. He ate when my assistant hand- fed feline C/D with water. The owner came to visit around 6 pm and was happy to see him.

 
This is a case of the intense inflammation inside the bladder and urethra as the owner had delayed seeking treatment, base on blood test result showing kidney failure and the much swollen and red bladder (image).

HISTORY

Ju1 2, 2015    Cannot pee, blood in urine. Surgery. urethral stones and bladder stones removed.
Jul  5             Dr Daniel sent home 2 days after surgery.

Jul 8              Vomiting and dysuria. Had kidney failure based on blood test of high creatinine and urea. Given 2 days IV drips

Jul 11            I sent home as he was eating.

Jul 13          Warded. Bladder lavage. urine analysis. Catheter not stitched. 

Jul 15          Bladder swollen 1/3 size of orange. Cat eats when hand fed dry feline C/D + water. Bladder lavage. urine analysis. Catheter not stitched.  Alert.

Jul 16          Bladder small like ping pong ball, painful.

2494. The most loved cat in the block has difficulty peeing

Previously able to run down 16 floors and climb up 16 floors after going outdoors. Last 2 months, would wait for the owner to come to look for her, maybe at the 3rd floor.
"Why would a cat climb up and down 16 floors of the apartment?" I was surprised.  The slim lady owner in her late 50s do that. That was why.

Today, Jul 14, 2015, her busy son took her and the cat to me for treatment. The cat could not pee on the litter box, just squatting but could pee on the bed and blankets when lying down.

What was the problem?

1. Everybody loves this cat as he meows when fed and meows to "thank" the giver after eating. "Other cats would just eat and go silently," the woman had never stayed apart from this cat.

2. "This cat has a good memory of going to the vets," she told me. "He would avoid getting into the car."

2493. Animal Welfare. The smartest street dog in Singapore

Jun 11, 2015

"She gave birth to 2 litters," the woman who was active in trapping stray dogs and bringing them to SOSD showed me a cross-bred. "My husband and I just cannot get her! She will  run away at the first hint of suspicious activity to trap her with a collar.  Do you have the sleeping tablets? The last time you prescribed one was ineffective! "

"You did not stay long to see the effect," I said. "The effect starts 30 min to one hour after eating the tablet."
"Well, another stray dog barked. She was feeling drowsy after taking the tablet. On hearing this barking, she bolted into the dense forest!"
 
The couple wanted to catch this dog to spay her so that no litters would be born. 1/6 (a white one) of the puppies were adopted as they looked handsome, with the long nose of the bull terrier and the face of the Golden Retriever.
The wife stated that the shelter would not accept more sick dogs for medical treatment.
"There is a limit to the money any shelter will have," I said. "In any case, you sent one day at night for treatment. Heartworm was diagnosed". How much was the bill?"
"
"Your $1,250 bill from the vet could have paid for treatment of other strays." I admonished her.
 

2492. The daughter-in-law does not want the shih tzu in her HDB

Sat Jul 11, 2015

"The daughter in law does not want the shih tzu to be inside the apartment," the matronly lady brought her dog for vaccination and said that the dog demanded a lot of time to be cared for. "She does not want any dog hairs inside the apartment as she has a baby."  The son and his girlfriend bought the puppy but now leave him to mum.

"A bit fat but well cared for," I said in Hokkien as that was her dialect. "Some tartar in the back teeth. Next year, will need dental scaling." The dog was groomed regularly. Only that the groomer did not express the anal sac. Full of dark brown smelly oil.

2491. A kind family adopted a Beagle

Saturday, July 11, 2015.

As part of the adoption agreement, the family brought the neutered Beagle under the care of Voices For Dogs to Toa Payoh Vets for a check up. I showed Intern Gin the procedures involved as her 2nd semester in Melbourne Univ Animal Health course will have a module "Animal Welfare". 

If she gets straight As in the 2nd semester as in the first, she should have no problem being admitted to the Vet course.

2490. A kind cat owner with a caterwauling "spayed" cat.

Sunday Jul 7, 2015.


This lady was very kind as she did not sue the vet who spayed her cat. A few weeks after spaying, the cat caterwauled. The vet gave her a strip of Ovarid tablets to be given whenever the cat makes noises. This happened around 4 times per year and after 2 years of medication, the cat became fatter.

The lady was worried about prolonged use of hormones such as kidney failure.
"You have only one alternative to hormonal control of heat," I said. "Surgery to open and look for the ovary or ovarian tissues which are near the kidney or kidneys. When the cat is on heat, as she is now, it may be easier to spot the ovarian tissues and take them out."

"What if the cat still caterwauls?" the Sec 4 daughter asked.
"No more caterwauling, if the ovaries are removed entirely."  .

The mother signed the Informed Consent form and op will be done tomorrow

Dr Daniel advised ultrasound to see whether the ovarian tissues can be found and near which kidney. Op is delayed till next heat.


HISTORY

1.  Around Nov 2012, Vet 1 spayed this cat.  In 2013, consulted Vet 1 as caterwauling started a few months after spay. She prescribed some Ovarid tablets, to give 1/4 tablet when caterwaul on Day 1 and Day 3.


2. Cat caterwauls 4x/year and next 2 years. Given tablet. Cat puts on weight. Sometimes clear vaginal discharge.

3. Last Ovarid given some months ago. Cat on heat now, Jul 12, 2015

2489. A Rottweiler has a few thousand ticks - VIDEO FOR INTERNS

Sunday Jul 12, 2015

Unusual to see a young Rottweiler with a few thousand adult and  nymph ticks attached to the face and body.

Sedation needed. 35 kg. 4-year-old dog.
Given 1/3 formula ie. Dom + Ket at 0.4 ml + 0.5 ml IV. Able to clip bald.

The owner had applied Frontline Plus spot on. The pest control man applied a white insecticide wash yesterday. So, all ticks were dead but the mouth parts clamp to the face and body skin. Took over 2 hours to clip and remove the dead ticks. Goes home on same day. This dog had a left dislocated hip repaired by another vet (closed reduction) when he fell into a drain.  He is OK now but still, the vet must be careful in case the hip dislocates and the owner blames the vet.


DE-TICKING AT TOA PAYOH VETS.
Dog safety and staff safety.
This dog looked thin and was probably poisoned by both Frontline Plus and Pest control man's insecticide.  The owner wanted the dog's ticks extracted from  the face and body. Looked horrible. One groomer suggested that euthanasia.

SEDATION. Minimum yet sufficient. This is hard to assess in a weakened toxic dog.
Formula: I gave 30% of the calculated dosage for this 35kg Rott.   0.4 ml + 0.5 ml Dom + Ket IV.
No top up. Dog muzzle when ticks plucked from face as he tends to bite.
"Topping up may kill the dog," I explained to Naing who was not so happy with the dog trying to get up and bite him. "Just muzzle him."   



FOLLOW UP ON JUL 13, 2015
The dog ate but was not as active.
QUARANTINE FROM ANOTHER DOG (X-bred F, 7 years rescued as a puppy from the Defu Industrial Park with cement-covered body).
The lady owner said the Rott had a few small ticks seen and was told to remove them manually. I did the clipping but no further tick wash as the dog had Frontline Plus 7 days ago and the pest control had applied insecticide on his body the day before.

The Rottweiler was enclosed in a playpen of 7 fences in a circle (diagram) on the car porch.
"He could just push away the fences, being such a strong dog," I said.
"No, he dared not go near the play pen," the lady replied.  Probably he had a lasting imprint of fright as a puppy when the playpen fence collapsed on him. So he dared not go near. That was good for the owner to quarantine him.

The other dog was quarantine but had few dead ticks.

PEST CONTROL
Yesterday
1. Sprayed insecticide mist on grass, walls, floors of car porchs, play pens, perimeter of home, and not indoors as there was no ticks indoors.  Lady said about 95% effective as she saw few ticks.

2. Advised to tell the mum not to eat the papayas and pandan leaves in the garden as they will be contaminated with spray and from soil.

EPIDEMIOLOGY
Both dogs have no ticks for past 7 years.
Rott does not go outdoors except to the vet when he had right hip dislocation and surgery. On the follow up visit, the owner saw a large adult female tick which was removed.
X-bred, never visit vet since puppyhood 7 years ago. She goes out 3X/day by herself for 10 minutes. But no ticks for past 7 days. No more use of Frontline since 4 years ago for this X-bred. Rott never had any Frontline Plus. Both roam around the garden but the X-bred seemed immune. Given Frontline Plus on Jul 5 to both dogs, when Rott discovered to  have ticks from the Vet clinic. X-bred had dead ticks on inspection after Frontline Plus on
When Rott had ticks at 2nd follow up visit some 3 weeks ago, Frontline Plus given to both dogs. But Rott's face became infested with ticks. Whole body and neck area plugged with grey adult female ticks around 1 cm x 0.8 cm.

OWNER TREATMENT OF ROTT
1. Advantix 2 X at once a month after seeing ticks from Vet clinic.
2. Frontline Plus 1X
3. X-bred clear of ticks. Rott has some small ticks, now plucked off.

2488. 13-year-old cat has a recurring below right eye abscess -microbiological exam

Jul 3, 2015

Culture

Moderate growth of Lancefiled Group G Streptococcus
Susceptibility Results

Resistant to tetracycline
Sensitive to amoxycillin+clavulanic acid, erythromycine, penicillin, clinadmyain, azithromcyin, ampicillin, ofloxacin,clarithromycin.