A greenish-black Caesarean section - Breeder could hear only one puppy's heart sounds

March 15, 2016


9am 

Visit to Farm to check whether my Dachshund patient had given birth naturally. She had not been eating on Mar 8, 2016 and recovered on Mar 10, 2016 being very active. Had visited on Mar 11 (video, very active running about, eating)

Dachshund in whelping crate. The Dachshund looked at me. She was quiet with slight increase in respiratory rate.  I noticed a greenish-black vaginal discharge on the towels.
Temperature 37.9C was below normal. Breeder showed that she had milk Plenty of it.

But she looked bad. "The big abdomen had shrunk," I had seen her since 10 days ago. "That is not good".  In retrospect, this meant that the two puppies had died and the water bag had ruptured. Shrinkage of the abdomen.

He decided on an emergency Caesarean section saying: "I can only hear one loud heart beat of one puppy," the breeder said. "The others have had died."

10 am
The way she responded to anaesthesia showed she was very weak.

Masked and given isoflurane gas + O2 gas. Intubated. Tongue pale. Eyeball rotated downwards, pupils dilated - very deep anaesthesia. Surveillance. No gas at all unlike normal procedure of connection to gas directly. Dog took around 1 minute to recover. 

Thick greenish-black liquid flowed out from incision instead of the usual colourless water bag. 2 dead pups drowned in melted placental material pulled out.

Third pup at the brink of death. Still in the normal water bag with the clear colourless fluid. Placenta had separated and not wholesome. Melting. No sound. Gave to the experienced breeder.

Closed up the dog as fast as possible.
Dog only on 0.5% isoflurane gas  + O2. (normal strong dam needs at least 2% to be painfree)
Death on the operating table - not good for the vet's reputation no matter what is the cause.

Recovered. Cleaned up. Given IV drip (baytril, vitamins, amino acids). Puppy went home first. 





8pm  tel breeder. Dam and puppy OK.

2945. An 11-month-old poodle has hind limbs rotated outwards - medial patellar luxation

Mar 14, 2016

While jumping up the playpen 2 months ago, this poodle's right back leg was caught inside the fencing. Now the poodle is unable to walk upright, with both lower legs pointed at right angles to his body. He would paddle on his hind legs.

I flex and extend the knees. The gentle poodle wanted to bite me when I extended his right knee. He also reacted in pain to extension of his left knee. Could there be fracture of the tibial growth plate leading to patellar luxation (bilateral) or just lateral patellar luxation and what to do to cure this dog?

X rays Mar 14, 2016

                                          BILATERAL MEDIAL PATELLAR LUXATION


X-rays on Mar 24, 2016

The above X-rays shows the patellas in the groove as the vet had manipulated them. Hence there is no patellar luxation.

                                          BILATERAL LATERAL PATELLAR LUXATION                                        

 The above mentioned x ray showed clearly that the patellas have had luxated laterally
and there appear to be no tibial growth plate fracture from this general view. On close up, there appears to be growth plate fracture

April 15, 2016
The owner brought in the dog for surgery. Need to check for cruciate ligament rupture.

2944. A cat vomits more hairballs than usual

HOOK
In March 2016, a young lady consulted the vet as her cat had been vomiting hair balls more frequently.

Video clip of consultation


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

A CAT VOMITS MORE HAIR BALLS THAN USUAL

CAUSES
The cat grooms excessively and ingested more hairs. Why does the cat groom excessively?
1.  Usually it is due to an environment that is not clean. The cat walks and lie down in this environment, getting contaminated with the dirt or floor cleaning chemicals.
The cat is naturally a clean creature. So he grooms his contaminated paws and body more times to get rid of the contaminants. He swallows the hairs, leading to more hair balls filling his intestines.

2.  The other cause is impacted and inflamed anal sacs. The anal sac oil accumulates and cause pain and discomfort. The cat licks the anal area more frequently to relieve himself of the pain, ingesting more hairs.

SOLUTION
1.  In this case, the cat lives with other cats and all share a common bathroom floor. There is no litter box used. The cats pee and poop on the toilet floor. The owner  may be very busy, being a working lady. She may have clean the floor with stronger detergents and may have forgotten to rinse the floor thoroughly. The owner is advised to keep the toilet floor well rinsed with water after disinfection. 

2.  This cat also has anal sac impaction and infection (video clip). Expressing the anal sacs remove the thick oil.


FOLLOW UP
No more complaint from the owner for the past two weeks.

2943. Three Shih Tzus with different diseases

March 10, 2016


2 Shih Tzus today.

Case 1. Male, Neutered, 5 yrs, 10 kg (good bodily condition as judged from the well-groomed coat, ear hair plucking and the weight). Came for annual vaccination and check up. Many Singapore owners do not bother after puppy vaccination.  Left ear painful. Right ear occasionally painful but no foul smell or discharge. Lady owner is a hair-dresser proprietor who told me she worked 7 days a week when she first started her saloon. But she had clientele and referrals. "Young Singaporeans will never work 7 days a week," I said. "They want a work-life balance."
The itchy ears could be due to commercial ear drops.

"After plucking the ear hairs, the groomer will put some ear drops and the dog would scratch and scratch," the owner said. So, the solution is ear surgery called lateral ear canal resection which opens up the side wall of the ear, permitting ventilation and drainage. "I have near heard of it," she said. So, a change of ear drops.  


Case 2.  
Male, Not neutered. 14 years. Serious ear infections with crusty edges. Complaint of itchy skin. Large amount of scales. Thin. Around 7 kg. Front and back legs are wet due to licking. In Oct 2015 and May 2015, same ear problems.  Ear surgery would have prevented recurring ear infections as Shih Tzus have floppy ears which cover up he ear canals 

Case 3 on March 9, 2016.
Female, Not spayed. 11 years. Very thin.
Dirty vaginal discharge. Cloudy reddish brown vaginal discharge. Open pyometra is easily diagnosed. Owner did not want blood test or spay surgery as the dog is old. She had applied Ectopic skin wash for the hairless areas.

CONCLUSION
3 Shih Tzus. Different fates.

2942. A young terrapin with swollen closed eyes. A young terrapin with extended neck

March 8, 2016

Toa Payoh Vets do see at least one terrapin or turtle per week for the past 3 years. I find them interesting.

Terrapins, the size of 50-cent coins, would be around 1-3 months old. They are sold at around $5.00 in the pet shops. Some pet shops have some good quality terrapins imported from the USA for sale but some are sickly.


These two cases are typical of diseases seen at Toa Payoh Vets

2941. A 1-year-old Cavapoo vomited many times for 2 days, with blood today. X-rays of throat.

March 8, 2016

The owners were concerned that the 1-year-old male neutered cavapoo vomited out blood this morning but had started vomiting yesterday.

No abdominal pain or foreign body. The throat was painful, probably due to vomiting.
X-rays did not show any abnormality or foreign body in the throat or stomach. Only painful throat but no abdominal pain on my palpation (video).


On further discussion with the two ladies, the dog did bite a hard toy to pieces.  He probably tried to swallow the pieces, injuring his throat. He vomited many times, including blood-tinged vomit this morning. 

Blood test done.
Conclusion. The dog vomited lots of water during the IV drip and baytril and spasmogesic injections. The cause of vomiting could be the hard toy pieces that the owners saw the dog chewing and swallowing. These are non-fabric toys for dogs to play. 
    

Post-op complications after umbilical hernia repair

The swelling appeared around 10 days after an inguinal hernia repair by Dr Daniel who was now in Vietnam.

The young couple WhatsApp the image on Feb 26, 2016   "Hi, my dog jux went for the hernia ops at the tummy wif ur vet and the plaster drop off a while alrdy den the tummy starts dropping like dat. Is it OK?"

I replied: "Pl bring in for check up tmrow" in an inexpert way of texting unlike the younger generation. 








At the consultation, I said: "It could be a blood collection called a haematoma or a hernia due to a stitch breakdown. These are post-op complications due to the dog being too active and not confined to a small area."

Apparently Dr Daniel did not give such instructions to confine the dog in a small area and so the dog had this large swelling. I told the owner that the vet was in Vietnam and so he could not reply. Post-operation complications do occur as the dog is very active.

"He could have licked the wound," I said.
"No," the owners said. "He had worn a large E-collar."
"There are bruised purplish areas towards the end of the stitching nearer the tail area," I said. "This is evidence of the e-collar's edges traumatising the skin."

The dog was anaesthesized and over 300 ml of unclotted blood was taken out by syringe.

WHEN DID THE BLEEDING OCCU?
This unclotted blood showed that bleeding was recent, probably yesterday. The stitches did not break down and so there was no umbilical hernia.

Evidence of the bruised area is important. The dog had been hitting the back area of the wound, damaging the subcutaneous blood vessels, leaking blood under the skin, causing a large swelling which the couple thought was bigger than the original hernia.

  

2939. The Sheltie swallows an "aluminum foil wrapper of sweets" but it is actually an ankle sock

Feb 29, 2016

"No way he had swallowed the aluminium wrapper. It appears like a disc in the X rays

Tues March 8, 2016

The couple had promised to provide feedback to me although they had gone to another vet for the operation.Total cost of surgery (removal of ankle sock) and hospitalisation was around $2,500 as compared to another vet practice (Vet 3) that quoted $6,000. Some bruising in the gut but nothing serious.


The wife phoned me to say that her dog had recovered from the intestinal surgery done by Vet 4.
The dog went home last Saturday.

The dog had swallowed an ankle sock. That was how I palpated a hard golf-ball lump in the mid-abdomen as the sock must have had bunched up. I had advised surgery but the dog had a blood bacterial infection on that day. Surgery was postponed to the next day after IV antibiotics and drip. However the owner went to Vet 4 who did the surgery.

The dog is OK now and had not passed much stools yet. "He had not eaten for the past few days and so no stools were formed," I explained. The owner fed porridge and chicken. The big skin wound was necessary to open up the abdomen to take out the intestines.

Video of dog pre-op in You Tube.

EVIDENCE
2 ultrasounds
2 x-rays
Several vet consultations

In my opinion, a painless hard golf-ball lump in the mid abdomen and the first ultrasound stating possible foreign body would have been sufficient evidence to go for exploratory surgery. Barium meal contrast X-ray is another option but all these cost money.

2938. A golden retriever fell into a drain and hurt his back and right hip

March 1, 2016

The Golden Retriever from Marine Parade, East Singapore, fell into a deep drain yesterday and was all right after being taken up.
"He even walked several km," the owner said. "Without any lameness."
Later in the evening, he limped on his right hind.
"I tried palpating the back spinal area," the owner saw me doing it before. "He growled when I felt part above his hip."

X-rays show slight dislocation of the right hip joint.

2937. A 9-year-old Jack Russell bites himself sore

Sunday Jan 27, 2016

It has been several years since I saw this Jack Russll.  Now he has bigger bleeding sore on his elbows, chest, back perineal area and all 4 paws.

Never been to the groomer or pet shop for the past 9 yars

I checked right elbow hair which is full of raw skin sores. Anal sac almost empty of anal sac oil but both perineal areas were bald and hair loss.   

2936. Vetoryl 60 mg for Cushing Disease

Sunday Feb 28, 2016

In 2014, his 15-year-old Shih Tzu kept looking for food every hour and drank a lot. Her body hairs did not grow back after clipping. Her belly became pot-bellied. She passed blood in the urine.

The vet diagnosed 5 bladder stones, the biggest being 0.5 cm on X-rays. However, he advised not operating as the wound would not heal well as the dog had abnormal cortisol levels from Cushing Disease.

So the ACTH stimulation test was done for half a day, costing him $200. 10mg Vetoryl was given orally for one week, then 15 mg twice a day for one month. After several months, the effective dose was 30 mg once a day. 

The dog no longer has Cushing Disease. He came to Toa Payoh Vets to get prescription of 2 boxes of 60 mg as it is less expensive.  One capsule content is divided into two. Carefully he apportioned the alloted portion to an empty capsule. The dog has a little pot-belly but would eat and drink normally.

CUSHING DISEASE - 2 types.
Brain and adrenal glands. His dog's was the brain.

Cushing's Syndrome - dogs 

SYNETHIN  15 BOXES PER MONTH - goes fast.  250 I U of per ml

VETORYL TO TREAT

2935. A 6-year-old Shih Tzu panted continuously after swallowing a large chicken treat

Feb 23, 2016

History is very important in the diagnosis of this case. To the observer, this Shih Tzu panted furiously, pulse pressure shot up, tongue became cyanotic and rectal temperature became very high.

"A heart failure," the X-ray assistant observed the cyanotic tongue and palpated the high pulse pressure. "Check the heart!"

The history was that this morning at 10 am, the Shih Tzu that loves to swallow any object, took in a large piece of dog treat made of chicken. The domestic worker said he had swallowed a bone, the length of a man's forefinger. So, the dog started to gag and panted furiously as you can hear from the video. The wife was most concerned and so the husband phoned me and another vet for a quotation

"I will check the mouth and if there is a bone, I will see whether I can pull it out." I said. Later the husband texted me to say that the dog had swallowed a large dog treat made from chicken.

X-rays showed some pieces of dog treat inside the pharynx but no chicken bone. So the domestic worker had given the incorrect info.

What to do now? The dog kept panting and panting, becoming feverish.

I gave an IV drip, with painkiller spasmogesic 1.2 ml IV and baytril 0.7 ml IV. After one hour, the dog relaxed and no longer panted furiously. He was back to almost normal and coughed a bit. So he went home.

2934. Better to put the hamster to sleep since pus flowed from the right eye?

Feb 14, 2016
The last case in this dark clouded sky evening at 4.15 pm was a hamster with both eyelids glued tightly. Liquid pus oozed out from the right eye, as if a dam had ruptured. The young man saw it and asked whether it is better to euthanize this hamster.

"I need to examine the eyes first," I told him that the left eye was still open partly. Examination of the right eye showed sticky pus which I removed with a wet cotton bud. The eyeballs were intact. "How long had the hamster not been eating?" I asked. "The lower front teeth have overgrown. I will clip them shorter"

"Don't know," the man said.        
The hamster is an in-patient on this Valentine's Day. Will see how she goes.

2933. Two-of-a-kind cases - rabbit feet, dog abdominal tumour, dog swollen tummy

Sunday  Feb 14, 2016

It is very unusual for me to receive two similar medical conditions within 3 days.

1. Case of sore feet in 2 rabbits.
    Today, Feb 14, 2016, a young man came with his rabbit having no hairs and wounds on the underside of the front and back feet. "I researched the internet and got the diagnosis," he could not recall. "It is sore something...Yes, it is sore hocks!". He was spot on for the hind feet and hocks. Only that 4 feet had the similar problem.
"I have an in-patient rabbit with large sores only on the back limbs but your rabbit has 4 legs affected!", I was surprised to see two-of-a-kind cases, known as pododermatitis in rabbits.    
Videos are shown.

2. Case of abdominal tumours in a Miniature Schnauzer and a Fox Terrier. I was talking to the owner just 3 days ago as regards the importance of taking out the bladder stones (seen in X-rays) as the dog had an emergency urethral obstruction resolved some months ago after midnight by an emergency vet. I had diagnosed bladder stones for him earlier but his lady friend did not want an operation. "No more blood in the urine," the man in his 50s said. "Maybe the stone had disappeared."  

Then yesterday, he phoned me distressed as his Schnauzer had passed away from a ruptured tumour spilling blood inside the swollen abdomen. Vet 1 had given this dog a series of anti-heartworm injections but in the last injection, the dog's abdomen became swollen. Vet 1 quickly referred to Vet 2 who said that the dog's abdominal tumour had ruptured spilling blood into the abdomen. The dog died soon after admission by Vet 2. So the owner wanted me to do an autopsy to find out whether Vet 1 had been negligent in not discovering the tumour earlier and before anti-heartworm injection. I have a conflict of interest, being a competitor and so I advised that he contact AVA or A-Star vets. It was Saturday and he had taken the body back from Vet 2. "Put the body in a freezer," I advised. "Otherwise it is not possible to do an autopsy properly."  He said he put it inside a fridge.

"The disadvantage of autopsy by the AVA is that we will not get back the dog's body for creamtion," he told me today. "As for A-star autopsy, the vet wanted a referral from another vet."

"It will be costly to do autopsies and engage lawyers," I told him that the burden of proof on negligence is on him, not the veterinarian. He would think about his next step after getting all the medical records from Vets 1 and 2.  The Fox Terrier came in for consultation as he always leaves a puddle of urine after lying down to sleep. The owner thought he was naughty, urine marking at this old age of 8 years and so had him neutered.
"There are 4 abdominal tumours, one of which is a gigantic one I could feel on palpation," I said and got the dog X-rayed. Dr Daniel had the tumours confirmed by ultrasound.

What to do?  Chemotherapy is too expensive. The neutered dog still leaks urine when lying down to sleep overnight but otherwise could control his bladder. 

"One large tumour is said to be near a major blood vessel," I said. "The descending aorta and so there is a risk of bleeding to death during removal of this large golf-ball tumour." The owners could not decide what to do. "The dog is still young, at 8 years," the wife said.

Case 3. An old Pomeranian and a Maltese had swollen abdomen. Both had dirty vaginal discharge a few days ago. Both were very ill and were unlikely to survive anaesthesia.  Closed pyometra in both cases. The Pom owner brought the dog to Vet 1 but she died on arrival.  The owner of the Maltese did not want any surgery as the dog would "die" anyway during the operation to remove the pus-filled uterus. I could not help feeling sad that the two old female dogs would have been alive if they had been spayed at 6-12 months of age. Both were in good bodily condition but time had run out for them.

The above are the twin cases appearing within a day or two and this was such a coincidence.

2932. Dystocia injuries? Inward bent hocks of newborn Dachshund

2930. Supernumerary teeth in a dog

2929. A gentle 8-year-old Fox Terrier has a gigantic abdominal tumour

The Fox Terrier, M, Not neutered, was peeing more nowadays, esp. after exercise. He will drink more after exercise and pees overnight, unlike previously. He could control his bladder.

Ultrasound showed:
An abdominal tumour or lymphoma. The liver, spleen, kidneys and intestines were normal. There were 4 separate tumours, next to the descending aorta. So, these are inoperable.

X-rays
4 separate tumours might be visible.