June 14, 2010 4.30 pm.
Completion of a mouth tumour surgery in a fat old dog with purplish tongue.
Dog: Schnauzer X, Male, Not neutered, 11 years old. Born: 1999
Complaint: Bad breath.
June 8, 2010 Admitted
12.6 kg, 38.9 deg C.
Blood test, Grooming, Baytril and drip.
Liver SGOT/AST above normal.
Urea and Creatinine below normal.
Jun 9, 2010 Dental
Anaesthesia Domitor 0.2 ml IV. Isoflurane gas. Extracted 15 rotten teeth
Jun 14, 2010 Right cheek tumour excision - bigger than 50 cent coin size.
IV drip
For Old Dog
Domitor 0.2 ml IV
Wait
Zoletil 100 0.1 ml IV
I saw dog trembling slightly
Atropine 0.65 mg/ml given 0.5 ml IV
No tremors.
Surgical Anaesthesia last around 30 minutes
Electro-surgery
Lots of bleeding.
2/0 stitch up mucous membranes of hard palate to cheek.
Tumour is much less swollen and rounded due to antibiotics. More disc-shaped. Easier to excise now than if done on Jun 8, 2010.
Antisedan 0.2 ml IV. Dog woke up as if nothing had happened.
Monday, June 14, 2010
Sunday, June 13, 2010
99. A bi-sexual toy poodle
YOUNG PEOPLE DOING INTERNET RESEARCH AND DIAGNOSIS
Sunday's Unusual Case Highlighted:
Toy poodle, female, spayed at 6th month, 6 years old. 3.9 kg (trim).
Neck had 3 itchy patches of ringworm infestation. Very itchy.
Complaint:
For the past few weeks, she would stretch her front legs forward, lower her body and maintain this posture for several seconds.
"My poodle is suffering from pancreatitis," the young man phoned me. "Do you do blood test to check this condition?"
Sometimes the young people diagnose their own dogs.
The couple whipped out the handphone and showed me the picture of the poodle in this pose. Seeing is believing.
"Is the dog eating well?" I asked today. "Very well," the owners said. I palpated the abdomen. There was not a touch of pain. So, I advised them to wait as the dog was being treated for ringworm and the results would not be accurate.
If owners request a blood test, it should be done. How does the vet know what is occurring inside the body system but a dog with good appetite is unlikely to have any medical problems. If the vet does not do a blood test on request and the dog becomes ill some days later, he may be liable for professional misconduct. So it is wiser to do the blood test.
In this poodle, my examination discovered an unusually large clitoris. It was about 4 mm in diameter. I asked the couple to hold the poodle. The dog had been spayed in Hong Kong at 6 months of age. On further detailed examination of the vulval area, there was an unmistakeable miniature structure resembling a male organ with the body of the penile organ being 1 cm long and 5 mm in diameter. The whole mucosa was a deep red suggestive of inflammation.
It was difficult explaining to the lady in Mandarin. She could get the idea of what I was trying to explain. As for treatment of the posture, there was none. As for the large bald patches on the neck between the shoulders, anti-ringworm medication would take several weeks to work. This must be explained to the owners.
Sunday's Unusual Case Highlighted:
Toy poodle, female, spayed at 6th month, 6 years old. 3.9 kg (trim).
Neck had 3 itchy patches of ringworm infestation. Very itchy.
Complaint:
For the past few weeks, she would stretch her front legs forward, lower her body and maintain this posture for several seconds.
"My poodle is suffering from pancreatitis," the young man phoned me. "Do you do blood test to check this condition?"
Sometimes the young people diagnose their own dogs.
The couple whipped out the handphone and showed me the picture of the poodle in this pose. Seeing is believing.
"Is the dog eating well?" I asked today. "Very well," the owners said. I palpated the abdomen. There was not a touch of pain. So, I advised them to wait as the dog was being treated for ringworm and the results would not be accurate.
If owners request a blood test, it should be done. How does the vet know what is occurring inside the body system but a dog with good appetite is unlikely to have any medical problems. If the vet does not do a blood test on request and the dog becomes ill some days later, he may be liable for professional misconduct. So it is wiser to do the blood test.
In this poodle, my examination discovered an unusually large clitoris. It was about 4 mm in diameter. I asked the couple to hold the poodle. The dog had been spayed in Hong Kong at 6 months of age. On further detailed examination of the vulval area, there was an unmistakeable miniature structure resembling a male organ with the body of the penile organ being 1 cm long and 5 mm in diameter. The whole mucosa was a deep red suggestive of inflammation.
It was difficult explaining to the lady in Mandarin. She could get the idea of what I was trying to explain. As for treatment of the posture, there was none. As for the large bald patches on the neck between the shoulders, anti-ringworm medication would take several weeks to work. This must be explained to the owners.
99. Sunday's highlighted case: Oro-nasal fistula 15 years old
Date: Sunday, Jun 13, 2010
Case on a Sunday: Maltese X, Female, Not Spayed, Weight 5.5 kg. 37.9 deg C. Active and eating.
Complaint: Pus below right eye. Rubs right side of face onto bed sometimes.
3 Owners: 2 young men and a lady all around late 20s.
History: Had consulted Vet 1 who prescribed oral Baytril 50 mg antibiotics 1/2 tablet two times a day from May 16, 2010. But the owners gave the dog 1/2 tablet one time a day as they deemed that the dog would be overdosed. The pus in the facial wound disappeared after 2 days. However the medication finished after 20 days and pus re-appeared in the wound below right eye during last 2 days.
Diagnosis: Owners knew the diagnosis of oro-nasal fistula as they had researched the internet.
Prognosis: "It is very high risk and the dog may die on the operating table," I advised the owners to get a blood test done to screen her health. The vet must inform the owner and the owner is free to reject the advice. Since the owners did not want a blood test, it was hard to estimate the anaesthetic risk. In any case, such an old dog would be very high risk.
I checked the dog's heart. It was OK. The dog was in good bodily condition and had good body weight. So I gave a 50:50 chance of success. Usually the chances are less than 50%.
Pre-op:
1. Antibiotics IV with the drip or return after 5 days of antibiotics for surgery.
The owners chose the IV drip.
Anaesthesia:
1. Isoflurane gas by mask. Intubate. This dog was not able to sleep fully. When a loose tooth was extracted, he would wake up partially and moved. So, I took out the endotracheal tube, put on gas by mask and repeat the intubation. After 3 episodes, I decided just to give isoflurane by gas mask. 6 teeth extracted including the right and left premolars. Dental scaling done. If the dog had been sedated, he would have a smoother anaesthesia. However, sedation may cause low blood pressure or kill the dog and so in this case, I used isoflurane gas only as it is much safer for an old dog. This would also take a longer time to anaesthesize the dog.
Surgery:
1. IV drip with antibiotics baytril was given before surgery. The dog bit off the drip line before surgery.
2. Loose teeth were extracted. I was surprised to see thick pus actually lodged in the roots of the right upper pre-molar. Like a wallet full of cheese. I used the forceps to scrape out the light yellowish pus.
Post-Surgery :
1. Two hours later, the owners came to bring her home.
2. No solid food for the next 3 days so that the big holes from the extracted teeth would close . Just give soup, milk or honey water for 3 days.
3. Antibiotics for 20 days.
This dog should live to a ripe old age of 20 years. "No more white coat," the young man said. "As she grows older, her coat colour became brown." I asked: "Did you use yellowish shampoo?" "Yes," the owner said. "The shampoo colours the coat over the years," I explained. "If you use a "white-dog shampoo", the coat will not become stained yellowish brown for a white coated dog."
All ended well for this well loved dog. I asked the young man to sit on a chair and hold the dog and opened her mouth. The dog kept moving her head. After 15 minutes, he could open the mouth and was surprised to see a bleeding hole over 1 cm in size where the right upper premolar was extracted. "I thought the pus come from the front teeth or the fangs," the young man was indeed surprised that the source was from the root of the premolar 4. Fortunately, he could open the dog's mouth so that he could see the hole and I could snap a picture to educate readers.
This must be one of the oldest dogs in Singapore to have an oro-nasal fistula. At this age, most teeth had dropped off.
UPDATE ON JUNE 14, 2010
The owner phoned to say that the dog was coughing. "This coughing was due to the irritation of the throat during the many times of intubation, " I said. "It should clear up within 2 days. Continue giving the antibiotics." No further news from the owner after this.
VET PHARMACOLOGY FOR VET STUDENTS
Baytril 50 mg (5mg enrofloxacin/kg bodyweight) is advised by the manufacturer to be 1 tablet per 10 kg bodyweight once daily or as a divided dose twice daily for 3 to 10 days with or without food.
For this dog weighing 5.5 kg, the dosage should be 1/2 tablet once daily or 1/4 tablet 2x/day. It seems that Vet 1 advised double dosage at 1/2 tablet 2x/day.
In any case, the owners felt that the dog did not need so much antibiotics. So they gave 1/2 tablet 1x/day (which is what the manufacturer recommended) from May 16 for 20 days till Jun 4, 2010.
Baytril was effective as the pus discharge occurred only on Jun 11, 2010 (2 days ago). "What did Vet 1 advised?" I asked the owner. "Vet 1 said that the wound would not be going to heal and would come back again. She advised dental work after the antibiotics."
In this case, the owner was informed about the need for "dental work" and that the wound would return again. They were also informed about the high risk of anaesthetics and had cancelled a dental scaling one year ago. However, in the case of oro-nasal fistula, they had no choice. They were fortunate that the old fawn coloured Maltese X survived.
What is an oro-nasal fistula?
It seems that the internet had much information for the young owners, and so I did not need to elaborate. Basically, it is a wound in the face connecting the sinus to the roots of the pre-molar 4 tooth. It is also known as carnaissal tooth abscess.
A non-healing facial wound below the eye
Extraction of the carnaissal tooth is the only solution to cure the condition known as oro-nasal fistula or carnaissal tooth abscess
Case on a Sunday: Maltese X, Female, Not Spayed, Weight 5.5 kg. 37.9 deg C. Active and eating.
Complaint: Pus below right eye. Rubs right side of face onto bed sometimes.
3 Owners: 2 young men and a lady all around late 20s.
History: Had consulted Vet 1 who prescribed oral Baytril 50 mg antibiotics 1/2 tablet two times a day from May 16, 2010. But the owners gave the dog 1/2 tablet one time a day as they deemed that the dog would be overdosed. The pus in the facial wound disappeared after 2 days. However the medication finished after 20 days and pus re-appeared in the wound below right eye during last 2 days.
Diagnosis: Owners knew the diagnosis of oro-nasal fistula as they had researched the internet.
Prognosis: "It is very high risk and the dog may die on the operating table," I advised the owners to get a blood test done to screen her health. The vet must inform the owner and the owner is free to reject the advice. Since the owners did not want a blood test, it was hard to estimate the anaesthetic risk. In any case, such an old dog would be very high risk.
I checked the dog's heart. It was OK. The dog was in good bodily condition and had good body weight. So I gave a 50:50 chance of success. Usually the chances are less than 50%.
Pre-op:
1. Antibiotics IV with the drip or return after 5 days of antibiotics for surgery.
The owners chose the IV drip.
Anaesthesia:
1. Isoflurane gas by mask. Intubate. This dog was not able to sleep fully. When a loose tooth was extracted, he would wake up partially and moved. So, I took out the endotracheal tube, put on gas by mask and repeat the intubation. After 3 episodes, I decided just to give isoflurane by gas mask. 6 teeth extracted including the right and left premolars. Dental scaling done. If the dog had been sedated, he would have a smoother anaesthesia. However, sedation may cause low blood pressure or kill the dog and so in this case, I used isoflurane gas only as it is much safer for an old dog. This would also take a longer time to anaesthesize the dog.
Surgery:
1. IV drip with antibiotics baytril was given before surgery. The dog bit off the drip line before surgery.
2. Loose teeth were extracted. I was surprised to see thick pus actually lodged in the roots of the right upper pre-molar. Like a wallet full of cheese. I used the forceps to scrape out the light yellowish pus.
Post-Surgery :
1. Two hours later, the owners came to bring her home.
2. No solid food for the next 3 days so that the big holes from the extracted teeth would close . Just give soup, milk or honey water for 3 days.
3. Antibiotics for 20 days.
This dog should live to a ripe old age of 20 years. "No more white coat," the young man said. "As she grows older, her coat colour became brown." I asked: "Did you use yellowish shampoo?" "Yes," the owner said. "The shampoo colours the coat over the years," I explained. "If you use a "white-dog shampoo", the coat will not become stained yellowish brown for a white coated dog."
All ended well for this well loved dog. I asked the young man to sit on a chair and hold the dog and opened her mouth. The dog kept moving her head. After 15 minutes, he could open the mouth and was surprised to see a bleeding hole over 1 cm in size where the right upper premolar was extracted. "I thought the pus come from the front teeth or the fangs," the young man was indeed surprised that the source was from the root of the premolar 4. Fortunately, he could open the dog's mouth so that he could see the hole and I could snap a picture to educate readers.
This must be one of the oldest dogs in Singapore to have an oro-nasal fistula. At this age, most teeth had dropped off.
UPDATE ON JUNE 14, 2010
The owner phoned to say that the dog was coughing. "This coughing was due to the irritation of the throat during the many times of intubation, " I said. "It should clear up within 2 days. Continue giving the antibiotics." No further news from the owner after this.
VET PHARMACOLOGY FOR VET STUDENTS
Baytril 50 mg (5mg enrofloxacin/kg bodyweight) is advised by the manufacturer to be 1 tablet per 10 kg bodyweight once daily or as a divided dose twice daily for 3 to 10 days with or without food.
For this dog weighing 5.5 kg, the dosage should be 1/2 tablet once daily or 1/4 tablet 2x/day. It seems that Vet 1 advised double dosage at 1/2 tablet 2x/day.
In any case, the owners felt that the dog did not need so much antibiotics. So they gave 1/2 tablet 1x/day (which is what the manufacturer recommended) from May 16 for 20 days till Jun 4, 2010.
Baytril was effective as the pus discharge occurred only on Jun 11, 2010 (2 days ago). "What did Vet 1 advised?" I asked the owner. "Vet 1 said that the wound would not be going to heal and would come back again. She advised dental work after the antibiotics."
In this case, the owner was informed about the need for "dental work" and that the wound would return again. They were also informed about the high risk of anaesthetics and had cancelled a dental scaling one year ago. However, in the case of oro-nasal fistula, they had no choice. They were fortunate that the old fawn coloured Maltese X survived.
What is an oro-nasal fistula?
It seems that the internet had much information for the young owners, and so I did not need to elaborate. Basically, it is a wound in the face connecting the sinus to the roots of the pre-molar 4 tooth. It is also known as carnaissal tooth abscess.
A non-healing facial wound below the eye
Extraction of the carnaissal tooth is the only solution to cure the condition known as oro-nasal fistula or carnaissal tooth abscess
Saturday, June 12, 2010
97. Puppy shreds papers and soiling herself
E-MAIL TO DR SING DATED JUN 11, 2010
Dear Judy,
I juz got a cockapoo for 1 wk. She is 2mths old now. Currently we
placed her in a big playpen w toys, hanging water bottle & a security
towel. There is also a corner in e pen where she pees n poops
successfully on everytime. I bring her out in short intervals abt 3
times a day, allowin her to play ard the living room. Her pen is in a
corner of the living room by the way. After playin, when I put her
back to the pen, she will pee on the papers. The problem is, she also
likes to lie on the papers, clean or soiled, when she is playin alone
w her toys, n when she starts to shred and eat the papers when bored.
I've given her toys n pushed her away when I c her on e papers. But
without supervision, she ends up on it again. When we wake up in e
morning, e soiled papers will be shredded, her toys on her urine, n
her body reeks of urine smell. What should we do? Why does she do
that? Should I expand her pen furthur? I await your kind advice. Thank
you!
Thanks & regards
Name of Owner
Sent from my iPhone
E-MAIL REPLY FROM DR SING DATED JUN 12, 2010
I am Dr Sing for Toa Payoh Vets. Thank you for your e-mail.
From your description, the puppy pees on the papers at a corner of the playpen. But she also shreds the papers. Paper shredding is a common complaint of confined puppies. As to why they do it, it is likely to be fun.
Here are some suggestions:
1. Just do not make a fuss when you see the puppy shredding papers
2. Change the soiled papers without scolding the puppy or making any comments. Your reaction makes the puppy repeat her paper shredding to get you to pay more attention.
3. Tape the 4 sides of the newspapers onto the floor (the corner of the playpen). This may not be fool-proof.
4. I saw an invention by some people at a Singapore pet shop some time ago. It is a clip-on rectangle to hold the papers tightly so that the puppy cannot shred them (in theory). This invention was not marketed well and is hard to find. Maybe you can make one with 4 pieces of wood or metal rods (which holds newspapers in the library).
5. Some owners buy the "puppy diapers or pads" which have tapes to stick it onto the floor. The puppy may or may not shred it.
6. Paper training takes a lot of time. When the owner pays a lot of vocal attention to this misdeed, it is hard to stop the puppy shredding. The puppy just loves attention and the owner keeps scolding. This is attention to the puppy. Therefore be silent.
7. Soiling herself overnight. This puppy has no "clean" instinct. Check how she was housed in the previous place (seller). Was she housed in a grate + pee pan. If that is the case, don't expect her NOT to enjoy shredding papers as she had no previous paper experience.
8. Please e-mail me 3 pictures of top views and side views of the playpen and puppy (newspapers in the corner) as sometimes, I can provide advices better after seeing the housing floor plan.
Dear Judy,
I juz got a cockapoo for 1 wk. She is 2mths old now. Currently we
placed her in a big playpen w toys, hanging water bottle & a security
towel. There is also a corner in e pen where she pees n poops
successfully on everytime. I bring her out in short intervals abt 3
times a day, allowin her to play ard the living room. Her pen is in a
corner of the living room by the way. After playin, when I put her
back to the pen, she will pee on the papers. The problem is, she also
likes to lie on the papers, clean or soiled, when she is playin alone
w her toys, n when she starts to shred and eat the papers when bored.
I've given her toys n pushed her away when I c her on e papers. But
without supervision, she ends up on it again. When we wake up in e
morning, e soiled papers will be shredded, her toys on her urine, n
her body reeks of urine smell. What should we do? Why does she do
that? Should I expand her pen furthur? I await your kind advice. Thank
you!
Thanks & regards
Name of Owner
Sent from my iPhone
E-MAIL REPLY FROM DR SING DATED JUN 12, 2010
I am Dr Sing for Toa Payoh Vets. Thank you for your e-mail.
From your description, the puppy pees on the papers at a corner of the playpen. But she also shreds the papers. Paper shredding is a common complaint of confined puppies. As to why they do it, it is likely to be fun.
Here are some suggestions:
1. Just do not make a fuss when you see the puppy shredding papers
2. Change the soiled papers without scolding the puppy or making any comments. Your reaction makes the puppy repeat her paper shredding to get you to pay more attention.
3. Tape the 4 sides of the newspapers onto the floor (the corner of the playpen). This may not be fool-proof.
4. I saw an invention by some people at a Singapore pet shop some time ago. It is a clip-on rectangle to hold the papers tightly so that the puppy cannot shred them (in theory). This invention was not marketed well and is hard to find. Maybe you can make one with 4 pieces of wood or metal rods (which holds newspapers in the library).
5. Some owners buy the "puppy diapers or pads" which have tapes to stick it onto the floor. The puppy may or may not shred it.
6. Paper training takes a lot of time. When the owner pays a lot of vocal attention to this misdeed, it is hard to stop the puppy shredding. The puppy just loves attention and the owner keeps scolding. This is attention to the puppy. Therefore be silent.
7. Soiling herself overnight. This puppy has no "clean" instinct. Check how she was housed in the previous place (seller). Was she housed in a grate + pee pan. If that is the case, don't expect her NOT to enjoy shredding papers as she had no previous paper experience.
8. Please e-mail me 3 pictures of top views and side views of the playpen and puppy (newspapers in the corner) as sometimes, I can provide advices better after seeing the housing floor plan.
Thursday, June 10, 2010
96. Treatment of canine perianal (circum-anal) gland tumours
INTRODUCTION
Certain breeds (e.g. Siberian Husky), old dogs and intact (not neutered) males are more prone to perianal (circum-anal) gland tumours. The majority of tumours are benign and are called perianal (circum-anal) adenomas. The malignant ones are called adenocarcinomas. They can't be differentiated by visual inspection. A histopathology of the excised tumour is needed to check whether it is cancerous.
TREATMENT - 3 OPTIONS
1. Surgical excision. Most perianal gland tumours are benign but only histopathology can determine whether they are benign adenomas or malignant adenocarcinomas. Some vets don't perform this surgery as there may be worries of the wound not being able to heal and close. The client may get very angry as the dog will keep licking the open wound. Old dogs may die under general anaesthesia on the operating table leading to highly emotional scenes and potential litigation.
These are two main reasons why some vets don't want to operate. It may be kinder to pets for such vets to ask the owner to seek a vet who will operate as the dog licks the infected tumours to relieve its pain. Blood dripping from the backside can be quite inconvenient to the owner. Owners may need to be proactive in seeking early surgical removal.
2. Neutering. Perianal gland tumours are most common in male dogs that are not neutered. Seldom occur in female dogs. In this case, a female spayed Siberian Husky had one such tumour.
3. Hormone treatment.
Tardak is an anti-androgenic hormone. Injections may be effective but need to be given regularly when tumours occur.
Tardak is for use in male dogs and cats in the following indications:
3.1 The treatment of hypersexuality (humping, wanting to stray).
3.2 The relief of prostatic hypertrophy whether benign, carcinomatous or when due to chronic inflammatory processes. In inflammation, antibiotics and anti-inflammatory drugs are used too.
3.3 For the treatment of circum-anal (perianal) gland tumours.
3.4 For the treatment of certain forms of aggressiveness, nervousness, epileptiform seizures and corticoid-resistant pruritus (developing into dermatoses and accompanied by alopecia).
4. Chemotherapy and radiation for cancerous types. This is not normally available for Singapore dogs.
INTERESTING CASE STUDY
Female spayed Siberian Husky, 11 years old suffered from blood dripping from her perianal tumour for over 4 months. Tumour ulcerates and become infected. If you see the black spot below and to the right of the anus, there were early signs of perianal gland irritation, as the black spot is due to continual licking over several weeks.
CHALLENGES
1. High anaesthetic risk as in all old dogs. The owner did not wish to have a blood test. The vet must inform the owner of the need for such a test to screen the health of the dog before anaesthesia and surgery.
2. Large tumour over 3 cm x 3 cm very close to the anus. That meant a large wound after removal of the tumour and difficulty in achieving normal closure.
3. The dog passes soft stools during surgery, resulting in possible contamination during surgery and after.
4. If the dog rubs her backside on the floor after surgery, the stitches may break down. A large e-collar prevents licking of the wound.
PLAN AHEAD
I advised the owner to get her vet who did not want to operate, to do full grooming esp. of the tail area, ensure no maggot wounds and prescribe oral Baytril antibiotics for 6 days.
PRE-ANAESTHESIA
On the 6th day, the wound was not infected. The dog's rectal temperature could not be taken as the dog struggled and leaked out urine whenever her tail was to be held up for the insertion of the thermometer into the rectum. She was in great pain in the anal area and tried to bite to defend herself. More urine leaked out as she struggled. I got her muzzled for the IV drip and the injection via the IV catheter of Domitor 0.15 ml.
ANAESTHESIA
Dog got shaved. Isoflurane gas was given by mask. I intubated the dog and isoflurane at 1-2% ensured surgical anaesthesia. I got a towel to cover the metallic operating table to prevent electrical shock when I used electro-surgery to excise the perianal tumour. A swab with saline was placed on the indifferent plate and the dog's belly for the conduct of electricity during electro-incision and cautery.
ACTUAL SURGERY, JUNE 9, 2010 FROM 2.17 PM - 3.15PM
1. I used electro-incision to cut off the tumour. The dorsal part has a dark red mass of 0.5 cm x 0.5 cm. The main mass was hard, nodular and ulcerated. It was 2.5 cm x 2.5 cm. The shorter the surgery, the better the chances of survival.
2. A small artery at the ventro-lateral area nearer and below the anus spurted out red blood. I ligated 3 times. Coagulated the bleeding point. Finally, there was not much bleeding.
3. As the elliptical gap was large and under high tension, I had to reduce the tension in order to enable good wound healing. I extended the skin incision to the left at the dorsal and ventral edges above and below the anus respectively (see illustration). The wound was stitched with 3/0 sutures.
4. During closing, this dog kept passing out the loose stools despite her rectum being plugged by a 3-ml syringe. I replaced this syringe with a 5-ml syringe but the stools kept pouring out. This was be possibly due to the minimal isoflurane gas being used and therefore the dog's defaecation reflex was present. The dog's tongue was not a healthy pink and sometimes it turned cyanotic. Since the owner did not want a health screening blood test, it would be difficult to know if this dog had anaemia, hypercalcaemia, kidney or liver disorders.
POST SURGERY
The dog woke up within 10 minutes as if she had a good nap of over 30 minutes.
I gave 2.5 ml of anti-spasmogesic IV to prevent more loose stools coming out to contaminate the wound. She wore an e-collar. I phoned the owner to take the dog home. They came to visit her in the evening.
HISTOPATHOLOGY
The vet must inform the owner that there is histopathology to verify whether the tumour is cancerous or benign. In this case, the owner did not want it.
CONCLUSION
Neutering and surgical excision are recommended. Tumours are best removed when they are very small. I advise two anti-androgenic injections post surgery at 2-weekly intervals. Neutering your male dogs when they are young and/or weekly examination of the anal area will ensure that your dog live longer. This case has a happy ending. However, vets are not Gods and there will be deaths of old dogs on the operating table. It is best that the owner gets the tumours excised when they are very small in size.
Latest info at www.toapayohvets.com
Certain breeds (e.g. Siberian Husky), old dogs and intact (not neutered) males are more prone to perianal (circum-anal) gland tumours. The majority of tumours are benign and are called perianal (circum-anal) adenomas. The malignant ones are called adenocarcinomas. They can't be differentiated by visual inspection. A histopathology of the excised tumour is needed to check whether it is cancerous.
TREATMENT - 3 OPTIONS
1. Surgical excision. Most perianal gland tumours are benign but only histopathology can determine whether they are benign adenomas or malignant adenocarcinomas. Some vets don't perform this surgery as there may be worries of the wound not being able to heal and close. The client may get very angry as the dog will keep licking the open wound. Old dogs may die under general anaesthesia on the operating table leading to highly emotional scenes and potential litigation.
These are two main reasons why some vets don't want to operate. It may be kinder to pets for such vets to ask the owner to seek a vet who will operate as the dog licks the infected tumours to relieve its pain. Blood dripping from the backside can be quite inconvenient to the owner. Owners may need to be proactive in seeking early surgical removal.
2. Neutering. Perianal gland tumours are most common in male dogs that are not neutered. Seldom occur in female dogs. In this case, a female spayed Siberian Husky had one such tumour.
3. Hormone treatment.
Tardak is an anti-androgenic hormone. Injections may be effective but need to be given regularly when tumours occur.
Tardak is for use in male dogs and cats in the following indications:
3.1 The treatment of hypersexuality (humping, wanting to stray).
3.2 The relief of prostatic hypertrophy whether benign, carcinomatous or when due to chronic inflammatory processes. In inflammation, antibiotics and anti-inflammatory drugs are used too.
3.3 For the treatment of circum-anal (perianal) gland tumours.
3.4 For the treatment of certain forms of aggressiveness, nervousness, epileptiform seizures and corticoid-resistant pruritus (developing into dermatoses and accompanied by alopecia).
4. Chemotherapy and radiation for cancerous types. This is not normally available for Singapore dogs.
INTERESTING CASE STUDY
Female spayed Siberian Husky, 11 years old suffered from blood dripping from her perianal tumour for over 4 months. Tumour ulcerates and become infected. If you see the black spot below and to the right of the anus, there were early signs of perianal gland irritation, as the black spot is due to continual licking over several weeks.
CHALLENGES
1. High anaesthetic risk as in all old dogs. The owner did not wish to have a blood test. The vet must inform the owner of the need for such a test to screen the health of the dog before anaesthesia and surgery.
2. Large tumour over 3 cm x 3 cm very close to the anus. That meant a large wound after removal of the tumour and difficulty in achieving normal closure.
3. The dog passes soft stools during surgery, resulting in possible contamination during surgery and after.
4. If the dog rubs her backside on the floor after surgery, the stitches may break down. A large e-collar prevents licking of the wound.
PLAN AHEAD
I advised the owner to get her vet who did not want to operate, to do full grooming esp. of the tail area, ensure no maggot wounds and prescribe oral Baytril antibiotics for 6 days.
PRE-ANAESTHESIA
On the 6th day, the wound was not infected. The dog's rectal temperature could not be taken as the dog struggled and leaked out urine whenever her tail was to be held up for the insertion of the thermometer into the rectum. She was in great pain in the anal area and tried to bite to defend herself. More urine leaked out as she struggled. I got her muzzled for the IV drip and the injection via the IV catheter of Domitor 0.15 ml.
ANAESTHESIA
Dog got shaved. Isoflurane gas was given by mask. I intubated the dog and isoflurane at 1-2% ensured surgical anaesthesia. I got a towel to cover the metallic operating table to prevent electrical shock when I used electro-surgery to excise the perianal tumour. A swab with saline was placed on the indifferent plate and the dog's belly for the conduct of electricity during electro-incision and cautery.
ACTUAL SURGERY, JUNE 9, 2010 FROM 2.17 PM - 3.15PM
1. I used electro-incision to cut off the tumour. The dorsal part has a dark red mass of 0.5 cm x 0.5 cm. The main mass was hard, nodular and ulcerated. It was 2.5 cm x 2.5 cm. The shorter the surgery, the better the chances of survival.
2. A small artery at the ventro-lateral area nearer and below the anus spurted out red blood. I ligated 3 times. Coagulated the bleeding point. Finally, there was not much bleeding.
3. As the elliptical gap was large and under high tension, I had to reduce the tension in order to enable good wound healing. I extended the skin incision to the left at the dorsal and ventral edges above and below the anus respectively (see illustration). The wound was stitched with 3/0 sutures.
4. During closing, this dog kept passing out the loose stools despite her rectum being plugged by a 3-ml syringe. I replaced this syringe with a 5-ml syringe but the stools kept pouring out. This was be possibly due to the minimal isoflurane gas being used and therefore the dog's defaecation reflex was present. The dog's tongue was not a healthy pink and sometimes it turned cyanotic. Since the owner did not want a health screening blood test, it would be difficult to know if this dog had anaemia, hypercalcaemia, kidney or liver disorders.
POST SURGERY
The dog woke up within 10 minutes as if she had a good nap of over 30 minutes.
I gave 2.5 ml of anti-spasmogesic IV to prevent more loose stools coming out to contaminate the wound. She wore an e-collar. I phoned the owner to take the dog home. They came to visit her in the evening.
HISTOPATHOLOGY
The vet must inform the owner that there is histopathology to verify whether the tumour is cancerous or benign. In this case, the owner did not want it.
CONCLUSION
Neutering and surgical excision are recommended. Tumours are best removed when they are very small. I advise two anti-androgenic injections post surgery at 2-weekly intervals. Neutering your male dogs when they are young and/or weekly examination of the anal area will ensure that your dog live longer. This case has a happy ending. However, vets are not Gods and there will be deaths of old dogs on the operating table. It is best that the owner gets the tumours excised when they are very small in size.
Latest info at www.toapayohvets.com
Saturday, June 5, 2010
95. Perianal tumours in the dog
In the afternoon of June 3, 2010, I had taken out the files of the old Shih Tzu with gigantic perianal tumours and gave a review of this case to a new intern who was a Junior College Year 2 student from Raffles Institution.
I had driven back to the surgery with an old Shih Tzu that had large perianal tumours excised by me four months ago. However his tumours had not recurred, so the old illustrations in my case sheets would be the only way to educate her. I do illustrate my surgical cases for review and to give to my clientele to educate them and their families.
For the benefit of readers, the tumour case is described at:
Buying Time For An Old Companion - Cicum-anal (perianal) tumours in a male Shih Tzu
http://www.sinpets.com/dogs/20100533perianal_circum_anal_tumours_dogs_ToaPayohVets.htm
Jun 2009. Surgery aborted as the dog went into cardiac failure. Only the largest tumour was excised.
To continue surgery would be very foolish as no owner wants a dead dog with a completed surgery
Feb 2010. Dog came with larger tumours
Jun 2010. No recurrence of circum-anal tumours for the past 4 months after excision, neutering and an anti-androgenic injection. So is he fully cured?
Weekly monitoring of the anal area during bath-time will be ideal and any small tumours be resected or reduced by an anti-androgenic injection. But which owner would remember to do the weekly checking for perianal tumours?
"I have not seen many cases of perianal tumours as they predominantly occur in male un-neutered dogs," I said to the intern. The old Shih Tzu I drove back in my car now had a normal backside and so I could not show her the real thing. "Perianal tumours, also know as circum-anal tumours seldom present themselves in neutered male dogs or female dogs. Many Singapore dogs are sterilised as dog licence fees are much lower. This is why there are so few cases."
In the evening, I visited a veterinary surgery whose founder is an old colleague of mine during our employment by the Primary Production Department (PPD), Singapore. The PPD is now called the AVA (Agri-Food and Veterinary Authority.
"How many cases of perianal tumours have you seen?" I asked the founder's son who was on duty. His mum had not been in good health and was not in the practice.
The son would be at least 30 years old. I could remember him as a 10-year-old running around in his mum's surgery when I was doing locum some two decades ago. Now he is a young father and have to bear the responsibilities of taking over the practice.
On this fine evening, I was shocked to see that he had both sides of his head shaved bald, leaving a central high turf of hair bleached brown. I could never imagine he would be this fashionable when he was half my height during his childhood days.
The son said: "I don't see many cases. There is one 10-year-old Alsatian in the Army having this anal problem. The Army would not send it for treatment and I donated some of my cream for the dog."
"Is the dog suffering from anal fistulas? Or circum-anal tumours? Why don't you get him treated?" I asked.
"The Army takes a long time to decide on treatment," the son said. "There are many considerations before a sick dog can be sent to the vet for treatment. The Army sends their dogs to two veterinary practices if necessary."
"Why don't you ask the Army to send the old dog to me for surgery?" I asked him. "I will charge $100 for everything to be done." The son who was doing reservist duties in the Singapore Armed Forces Provost Unit's Dog Company. I was a veterinarian in charge of the health of guard dogs and tracker dogs in this Dog Company when I was doing my National Service in the early 1970s and am concerned about the health of this old guard dog.
"It is not so easy to send a sick dog to the vet for treatment," the son said. "The Army has to be careful of expenditure and has to justify."
This is a sad state of affairs as Singapore is a developed country and a retired guard dog's painful backside does not get treatment.
One can be idealistic but in reality, any complaint from me to the Commanding Officer would likely lead to euthanasia of the old dog. For $100, a retired dog's life is terminated by the bureaucracy. But which is worse? Suffering from a painful backside daily but being alive or death by lethal injection? Has the dog any choices? Is there public funding for such cases for retired army dogs? There must be a fund to treat retired military dogs. In the meantime, I have to store away my idealism by keeping quiet. Rocking the boat will mean death of this dog as I doubt that the Army would even organise transport to get the dog treated for free.
At the surgery, I borrowed the son's new thick cat medicine book "Problem-based Feline Medicine" by Jacquie Rand, Edition 2007. I wanted to read more about a condition in cat where the mucous membranes of the cat's fauces are swollen and edematous. This surgery had many stray cat cases and this was why I came to ask the founder and her son about one case I encountered recently. It was an immune disease as prednisolone reduced the swelling by 50% the next day.
The name of the condition is plasmacytic-lymphocytic stomatitis/faucitis. My case was severe faucitis as the cat did not have inflammation of the tongue or gums. What a name for vet students or even vets to remember.
"Where's Dr Sing?" the receptionist said in a loud voice. I was sitting on the sole chair at the waiting area to her left but she could not see me. She had phoned a young couple to come to the surgery me after asking me how much I charged for surgery to excise the circum-anal tumours.
The couple had been to another vet since this surgery did not provide this service. The fees quoted was over a $1,000 and the couple must have sought the advice of the receptionist who asked me about my fees since I was present.
"Didn't you talk to the vet about the cost of over $1,000 perianal surgery?" I asked the couple.
"No," the young-looking wife whom I estimated to be in her 30s said. "A driver sent our dog to the vet." She looked young as contrasted to her husband who has many silvery grey hairs.
"Veterinary costs are now higher as many younger vets are more careful about litigation and demand blood testing prior to surgery." I said. "My generation appears backwards as we would have simply operated. However, nowadays, in a litigious society, there is no strong defence against professional negligence if the dog dies under anaesthesia if blood tests have not been done."
I asked the wife about the size of the tumour and to illustrate on a piece of paper. It was around 2-cm in diameter and was located below the tail and above the anus. This is a very difficult area to do surgery as there will be insufficient skin to stitch up. No wonder the founder did not want to perform this challenging task.
The continuous dripping of blood from the backside of their old Husky had caused the couple much distress. "Did you talk to the vet about the breakdown costs of over $1,000 for the surgery?" I asked the couple.
"No blood test will be done for the fee quoted by Dr Sing," the receptionist interjected. "I will not send the excised tumour for histopathology to check whether it is cancerous," I said to the couple. "That would bring down a few hundred dollars of veterinary costs."
"Blood test is important to screen the health of the dog before surgery. If the dog dies under anaesthesia, the owner may complain that the blood tests ought to have been done so that they would know the risks involved before surgery. The owner may sue the vet." I explained to the couple.
Blood tests would be useful as they can tell the vet that the dog is having a serious bacterial or viral infection or a liver or kidney disorder. Treatment would be done first if the health screening showed abnormality. A complete blood test would normally cost around $200.
"Is the Husky neutered?" I asked. "She has been spayed," the wife said. I had been presumptuous. This was a female dog. Perianal tumours are rare in females dogs but this was one of them. The world of veterinary medicine and surgery is full of surprises everyday.
"Get your dog's infected backside treated at this surgery first," I advised grooming, clipping of the backside and Baytril antibiotics for 6 days. "Otherwise the wounds will not heal well." The receptionist took out the case card and recorded what needed to be done. She calculated the cost and gave a fee estimate. This was the most efficient veterinary receptionist I had met and was definitely an asset to the founder of this practice. Knowing what to do and not wasting time is rare in many young receptionists. This receptionist was able to create loyalty in the founder's clientele from the way she cared about this customer by solving their problem. She must have overheard my conversation about perianal tumours with the founder's son as the door of the consultation room was open to the reception and knew what to do.
Sometimes the chemistry between a new vet and the prospective clientele is good and this was the case after several minutes of discussion and preparation for the surgery. This is important. The wife offered to shake my hands with me before she left.
There was a young girl in pink overalls working in this surgery. Her pink apron was unusual as I seldom see veterinary receptionist in pink. A slim quiet girl who would be learning from this receptionist on how to do things. I was introduced to her after her Miniature Schnauzer's bladder stone were removed by the son at my surgery (Toa Payoh Vets) some three years ago.
The son had operated on the dog. This was his first urinary stone removal surgery and his mum had asked me for assistance. So I was his mentor. See:
Mentoring a younger vet
Now three years later, the Schnauzer is OK and has no bladder stones although he has been eating dry dog food. "Are you feeding dry dog food to your dog?" I asked the girl in pink in a serious voice. She nodded: "Dr ... said it was OK." I was surprised that this Miniature Schnauzer did not get a recurrence of urinary stones despite being fed dry dog food after surgery and for the past three years.
"It is best not to as the bladder stones may recur unless the dry food is meant for dogs with urinary stones," I said to the young graduate.
There seems to be a high staff retention rate in this surgery. "Girls who left to work in banks would come back during Saturdays to work," the receptionist announced to me with maternal pride and to say that the founder was very caring about her staff.
I was most impressed with the management of the founder. It is hard to retain staff nowadays as many Singaporeans have lots of choices and are picky.
Good service helps to retain and grow clientele too. I was most impressed with this receptionist as she knows what to do to solve a client's problem on behalf of her employer without the need of prompting and reminders. She is worth her weight in gold. Gold prices are high and she is worth at least 80 kg worth of gold.
Photos and updates at:
http://www.sinpets.com/dogs/20100533perianal_circum_anal_tumours_dogs_ToaPayohVets.htm
I had driven back to the surgery with an old Shih Tzu that had large perianal tumours excised by me four months ago. However his tumours had not recurred, so the old illustrations in my case sheets would be the only way to educate her. I do illustrate my surgical cases for review and to give to my clientele to educate them and their families.
For the benefit of readers, the tumour case is described at:
Buying Time For An Old Companion - Cicum-anal (perianal) tumours in a male Shih Tzu
http://www.sinpets.com/dogs/20100533perianal_circum_anal_tumours_dogs_ToaPayohVets.htm
Jun 2009. Surgery aborted as the dog went into cardiac failure. Only the largest tumour was excised.
To continue surgery would be very foolish as no owner wants a dead dog with a completed surgery
Feb 2010. Dog came with larger tumours
Jun 2010. No recurrence of circum-anal tumours for the past 4 months after excision, neutering and an anti-androgenic injection. So is he fully cured?
Weekly monitoring of the anal area during bath-time will be ideal and any small tumours be resected or reduced by an anti-androgenic injection. But which owner would remember to do the weekly checking for perianal tumours?
"I have not seen many cases of perianal tumours as they predominantly occur in male un-neutered dogs," I said to the intern. The old Shih Tzu I drove back in my car now had a normal backside and so I could not show her the real thing. "Perianal tumours, also know as circum-anal tumours seldom present themselves in neutered male dogs or female dogs. Many Singapore dogs are sterilised as dog licence fees are much lower. This is why there are so few cases."
In the evening, I visited a veterinary surgery whose founder is an old colleague of mine during our employment by the Primary Production Department (PPD), Singapore. The PPD is now called the AVA (Agri-Food and Veterinary Authority.
"How many cases of perianal tumours have you seen?" I asked the founder's son who was on duty. His mum had not been in good health and was not in the practice.
The son would be at least 30 years old. I could remember him as a 10-year-old running around in his mum's surgery when I was doing locum some two decades ago. Now he is a young father and have to bear the responsibilities of taking over the practice.
On this fine evening, I was shocked to see that he had both sides of his head shaved bald, leaving a central high turf of hair bleached brown. I could never imagine he would be this fashionable when he was half my height during his childhood days.
The son said: "I don't see many cases. There is one 10-year-old Alsatian in the Army having this anal problem. The Army would not send it for treatment and I donated some of my cream for the dog."
"Is the dog suffering from anal fistulas? Or circum-anal tumours? Why don't you get him treated?" I asked.
"The Army takes a long time to decide on treatment," the son said. "There are many considerations before a sick dog can be sent to the vet for treatment. The Army sends their dogs to two veterinary practices if necessary."
"Why don't you ask the Army to send the old dog to me for surgery?" I asked him. "I will charge $100 for everything to be done." The son who was doing reservist duties in the Singapore Armed Forces Provost Unit's Dog Company. I was a veterinarian in charge of the health of guard dogs and tracker dogs in this Dog Company when I was doing my National Service in the early 1970s and am concerned about the health of this old guard dog.
"It is not so easy to send a sick dog to the vet for treatment," the son said. "The Army has to be careful of expenditure and has to justify."
This is a sad state of affairs as Singapore is a developed country and a retired guard dog's painful backside does not get treatment.
One can be idealistic but in reality, any complaint from me to the Commanding Officer would likely lead to euthanasia of the old dog. For $100, a retired dog's life is terminated by the bureaucracy. But which is worse? Suffering from a painful backside daily but being alive or death by lethal injection? Has the dog any choices? Is there public funding for such cases for retired army dogs? There must be a fund to treat retired military dogs. In the meantime, I have to store away my idealism by keeping quiet. Rocking the boat will mean death of this dog as I doubt that the Army would even organise transport to get the dog treated for free.
At the surgery, I borrowed the son's new thick cat medicine book "Problem-based Feline Medicine" by Jacquie Rand, Edition 2007. I wanted to read more about a condition in cat where the mucous membranes of the cat's fauces are swollen and edematous. This surgery had many stray cat cases and this was why I came to ask the founder and her son about one case I encountered recently. It was an immune disease as prednisolone reduced the swelling by 50% the next day.
The name of the condition is plasmacytic-lymphocytic stomatitis/faucitis. My case was severe faucitis as the cat did not have inflammation of the tongue or gums. What a name for vet students or even vets to remember.
"Where's Dr Sing?" the receptionist said in a loud voice. I was sitting on the sole chair at the waiting area to her left but she could not see me. She had phoned a young couple to come to the surgery me after asking me how much I charged for surgery to excise the circum-anal tumours.
The couple had been to another vet since this surgery did not provide this service. The fees quoted was over a $1,000 and the couple must have sought the advice of the receptionist who asked me about my fees since I was present.
"Didn't you talk to the vet about the cost of over $1,000 perianal surgery?" I asked the couple.
"No," the young-looking wife whom I estimated to be in her 30s said. "A driver sent our dog to the vet." She looked young as contrasted to her husband who has many silvery grey hairs.
"Veterinary costs are now higher as many younger vets are more careful about litigation and demand blood testing prior to surgery." I said. "My generation appears backwards as we would have simply operated. However, nowadays, in a litigious society, there is no strong defence against professional negligence if the dog dies under anaesthesia if blood tests have not been done."
I asked the wife about the size of the tumour and to illustrate on a piece of paper. It was around 2-cm in diameter and was located below the tail and above the anus. This is a very difficult area to do surgery as there will be insufficient skin to stitch up. No wonder the founder did not want to perform this challenging task.
The continuous dripping of blood from the backside of their old Husky had caused the couple much distress. "Did you talk to the vet about the breakdown costs of over $1,000 for the surgery?" I asked the couple.
"No blood test will be done for the fee quoted by Dr Sing," the receptionist interjected. "I will not send the excised tumour for histopathology to check whether it is cancerous," I said to the couple. "That would bring down a few hundred dollars of veterinary costs."
"Blood test is important to screen the health of the dog before surgery. If the dog dies under anaesthesia, the owner may complain that the blood tests ought to have been done so that they would know the risks involved before surgery. The owner may sue the vet." I explained to the couple.
Blood tests would be useful as they can tell the vet that the dog is having a serious bacterial or viral infection or a liver or kidney disorder. Treatment would be done first if the health screening showed abnormality. A complete blood test would normally cost around $200.
"Is the Husky neutered?" I asked. "She has been spayed," the wife said. I had been presumptuous. This was a female dog. Perianal tumours are rare in females dogs but this was one of them. The world of veterinary medicine and surgery is full of surprises everyday.
"Get your dog's infected backside treated at this surgery first," I advised grooming, clipping of the backside and Baytril antibiotics for 6 days. "Otherwise the wounds will not heal well." The receptionist took out the case card and recorded what needed to be done. She calculated the cost and gave a fee estimate. This was the most efficient veterinary receptionist I had met and was definitely an asset to the founder of this practice. Knowing what to do and not wasting time is rare in many young receptionists. This receptionist was able to create loyalty in the founder's clientele from the way she cared about this customer by solving their problem. She must have overheard my conversation about perianal tumours with the founder's son as the door of the consultation room was open to the reception and knew what to do.
Sometimes the chemistry between a new vet and the prospective clientele is good and this was the case after several minutes of discussion and preparation for the surgery. This is important. The wife offered to shake my hands with me before she left.
There was a young girl in pink overalls working in this surgery. Her pink apron was unusual as I seldom see veterinary receptionist in pink. A slim quiet girl who would be learning from this receptionist on how to do things. I was introduced to her after her Miniature Schnauzer's bladder stone were removed by the son at my surgery (Toa Payoh Vets) some three years ago.
The son had operated on the dog. This was his first urinary stone removal surgery and his mum had asked me for assistance. So I was his mentor. See:
Mentoring a younger vet
Now three years later, the Schnauzer is OK and has no bladder stones although he has been eating dry dog food. "Are you feeding dry dog food to your dog?" I asked the girl in pink in a serious voice. She nodded: "Dr ... said it was OK." I was surprised that this Miniature Schnauzer did not get a recurrence of urinary stones despite being fed dry dog food after surgery and for the past three years.
"It is best not to as the bladder stones may recur unless the dry food is meant for dogs with urinary stones," I said to the young graduate.
There seems to be a high staff retention rate in this surgery. "Girls who left to work in banks would come back during Saturdays to work," the receptionist announced to me with maternal pride and to say that the founder was very caring about her staff.
I was most impressed with the management of the founder. It is hard to retain staff nowadays as many Singaporeans have lots of choices and are picky.
Good service helps to retain and grow clientele too. I was most impressed with this receptionist as she knows what to do to solve a client's problem on behalf of her employer without the need of prompting and reminders. She is worth her weight in gold. Gold prices are high and she is worth at least 80 kg worth of gold.
Photos and updates at:
http://www.sinpets.com/dogs/20100533perianal_circum_anal_tumours_dogs_ToaPayohVets.htm
Friday, June 4, 2010
Blood tests and pyometra
Many owners don't want blood tests prior to dental scaling or operations to save on costs. Here is a case where blood tests must be done to prevent litigation.
Sep 8, 2008
Chihuahu, female, 8 years
Not eating past 2 weeks. Sleepy. Big blod clots fom vagina passed 2 weeks ago.
Exam
395 fever
Enlarged uterus palpated 1 cm in diameer.
abdominal pain moderate lower half.
Closed Pyometra
Haemoglobin below normal. Total WBC 72 (4.5 - 13.5).
Neutrophils 97% Absolute 70 (1.8 - 7)
Lymphocyes 2.6 % Absolute 1.84 (2 - 7,8)
Platelts 2 9 (150 - 600)
Numerous giant plateles seen.
Bacteraemia and toxaemia.
Liver SGOT/AST 53 (<41)
Kidney urea and creatinine normal
Operated. Survived. OK as at Jun 2010.
Sep 8, 2008
Chihuahu, female, 8 years
Not eating past 2 weeks. Sleepy. Big blod clots fom vagina passed 2 weeks ago.
Exam
395 fever
Enlarged uterus palpated 1 cm in diameer.
abdominal pain moderate lower half.
Closed Pyometra
Haemoglobin below normal. Total WBC 72 (4.5 - 13.5).
Neutrophils 97% Absolute 70 (1.8 - 7)
Lymphocyes 2.6 % Absolute 1.84 (2 - 7,8)
Platelts 2 9 (150 - 600)
Numerous giant plateles seen.
Bacteraemia and toxaemia.
Liver SGOT/AST 53 (<41)
Kidney urea and creatinine normal
Operated. Survived. OK as at Jun 2010.
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