Sunday, September 9, 2018

3268. INTERN. The 12-year-old emaciated red-eared slider is "constipated", the owner said.







Title. A constipated and emaciated red-eared slider. What to do?


INTRODUCTION
All healthy red-eared sliders love to eat and swim. They poo inside the water daily. 
This slider eats but no stools for over 7 days. The owner was worried. "Whenever she is submerged in the water, she would swim to the surface for air," the owner told the vet.


Day 3 of in-patient.
Complaint of constipation for "one week".
Surface quickly when he submerged her in the tank.




DIAGNOSIS - X-RAYS










TREATMENT
Syringe feed critical care
Antibiotic
Laxative oil for the past 3 days. Still no stools.

OBSERVATIONS  DAY 3
Not moving towards pellets --- lethargy
Ate around 70 pellets when pellets were close enough
NO STOOLS
1 ml of laxative oil was given.

OBSERVATIONS  DAY 4
Moving
Ate 10 pellets  
Medication given yesterday




OBSERVATIONS ON DAY 7

Day 7.

Constipated slider still had not passed stools on her own for the past 5 days.  We gave oil laxative daily for the past 5 days. 

What a relief to see loose oily stools were seen in the swollen anal area on Day 5. (video).









These were removed by forceps. Gastric impaction should be cleared by today.

















Swims lop-sided to the left after stool clearance from inside the cloaca











OUTCOME
After 7 days of in-patient treatment with antibiotics, critical care and pellet syringe feeding and laxative oil, the slider pooped and was sent home.  No more complaints from the owner on follow-up 7 days later.


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Original unedited images. Do not use for video production







3267. INTERN. The male cat cannot pee again. Urethral obstruction











Sunday Sep 9, 2018. DSH, MN, 8 years old



Sole cat in household. Stressed by new litter box and litter? Also moved house in Aug 2017.
Past 2 days, dysuria and pollakiuria (abnormal frequent urination). Today, I palpated distended bladder, the size of an orange. Need urinary catherisation. Does not want X-ray and blood test today. Urine test is mandatory this time to check for crystals.

Normal saline syringed to dislodge sand in mid-urethra. Irrigated bladder with 20 ml saline 5 x.
IV drip. Baytril antibiotics.


HISTORY
Dec 14, 2017 for dysuria. Blood test - low platelet. Recovered next day.


Sep 19, 2016. Urinary catherisation. Recovered. Blood test - low platelet. Advised feline C/D but not
X-rays






















                                            Urinary catheterisation to irrigate the bladder and suck out the sand


EVIDENCE
Dipstick evidence - pH 8, alkaline urine favours bacterial growth as compared to acidic urine.

Owner did not want blood test or X-ray

Explain X-ray of 2 years ago - no urinary stones
Blood test done on 2nd visit - pH alkaline





CONCLUSION
Prevent alkaline urine production. This alkalinity favours bacterial growth as compared to acidic urine. Special diet Feline C/D or feed canned food only. NO other dry pellets other than C/D.

Friday, September 7, 2018

3266. Clouds with faces - Scandinavia, Denmark, Norway. Judith, Giddeon

June 2018
Sunset. Cloud with a face seen from hotel room


Mall of Scandinavia



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3265. A dwarf hamster with the head tilted to the right had neck and leg tumour and armpit warts

An Indian mother and her small boy brought in this beloved hamster. She had come some months ago for treatment of the right head tilt which still exists but the hamster leads a normal life.

Surgery to remove the lumps were done by Dr Daniel










Thursday, September 6, 2018

3264. A 13-year-old cat vomits for 3 days. She has Stage 4 chronic kidney disease (severe azotemia)

Sep 6, 2018

The 13-year-old cat had never been sick since young and so, there was no visit to the vet.
She vomited 3 days in a row and so the owner brought her to consult me.
Blood test provides evidence of Stage 4 chronic kidney disease with very high creatinine levels above 5 mg/dL.

Tongue ulcers on the right and left sides of the tongue is a sign of kidney disease in cats.





  

X-rays show severely enlarged kidneys.
Blood test on Sep 5, 2018

Haemoglobin 7  (8-15)
Red cell count 3.8  (5-10)
Total white cell count 4.5   (5.5 - 19.5)
    N = 88%  Absolute 3.95
    L=5%  Abs  0.25
   M=6.3%  Abs 0.28
   E=0.8%   Abs  0.04
   B=0.1%   Abs  0.01


 Haematocrit  0.22  (0.25-0.45)
MCV  60                 (39-55)
Platelets 185    (300-800)

 Urea 72.5  (7.2-10.8)
Creatinine  1142  (71-160) umol/L
                  =12.9mg/dL
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umol/L x 88.42 = mg/dL

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Creatinine  mg/dL   Feline

Stage 1              Stage 2                  Stage 3                           Stage 4
No azotemia      Mild                      Moderate                        Severe
Less than 1.6      1,6-2.8                 2.9-5                             More than 5

This case, creatinine level  is 12.9mg/dL,   = severe azotemia

         








Day 2. The cat has been given 2 bottles of IV drips.