1121. Fits in a 12-year-old Silkie Terrier - what is the cause?

A Silkie Terrier had fits at around 6 am yesterday and today Sep 27, 2012. First episode. What is the cause?

"There are many causes," I said to the owner who told me that the old dog had a dental scaling 1.5 months ago at Vet 1's place and the right submandibular lymph node would be due to bacterial infection from the bad teeth.

"The lump is nodular and quite large and painful," I said. "The dog reacted to the palpation and coughed a bit. One possible cause of this early morning fit could be the sharp pain in this lump," I said. "If only dogs can talk."

I advised an X-ray. "It is best not to operate now as the lump appeared to have spread inwards," I said. "This is an inoperable tumour, likely cancerous."
"Please forgive me for asking. How do you know it is cancerous?"
"I do not know for sure, unless it has grown aggressively since 1.5 months ago. If Vet 1 had recorded the size of the lump and it is now 2 or 4X bigger, then it is likely to be cancerous." He would try to get the report from Vet 1.

"If it is just an inflamed right submandibular lymph node, then medication will reduce it considerably," I said. "We have to review in 2 weeks time. Blood test did reveal liver disorder as the enzymes are increased. However, some vets will say that the liver enzymes must be considerablv higher than today to cause fits in your dog. I mean, you ask 10 vets and you get 10 different opinions."

 

 

 

 

 

I will be working with this owner to monitor the fits after taking medication, but no fits medication for the time being. X-rays are as follows:




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A kind Buddhist teacher

TOA PAYOH VETS toapayohvets.com   Blk 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074   Tel: 6254-3326, 9668-6469, 9668-6468.  judy@toapayohvets.com   22 May, 2015   Focus: Small animals - dogs, cats, guinea pigs, hamsters, turtles & rabbits

Mammary adenomas in an American Cocker Spaniel Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First written: 21 September, 2012 Update:  22 May, 2015  "Why did you  delay seeking surgery till the breast lump is gigantic in size, like two tennis balls combined?" I asked the Buddhist temple teacher who taught Buddhism and morals to over 800 children of devotees. "The breast lumps grow very fast in the last 2 weeks," she replied. "Nobody in the family wants to bring the dog for surgery. My brother said to let her die." The solution was surgical removal but the family did not want to pay the medical costs. She was kind to enough to bring in this old dog for surgery at Toa Payoh Vets. Breast adenomas grow rapidly to sizes of 4 large oranges in this American Cocker Spaniel. After mastectomy, the dog was eating and normal "Walk-in" sutures holding the skin edges tightly and the haematoma on the left MG5 was treated by opening up the area via removal of 2 stitches. Healing by granulation was uneventful.  The 8-year-old dog was not spayed.  Mammary adenoma was diagnosed. No malignancy, according to the histology report. I was surprised as it was a massive tumour. Dr Daniel and I operated. I took over the stitching to ensure that the stitches were tight. I tacked in "walk-in sutures" through the muscle layer and then the skin,  using 2/0 sutures to ensure that the large long wound would not break down.. The dog came back 4 days later. There was a swelling at one end of the tumour. " "There's seepage at the left Mammary Gland 5 area," I said to Dr Daniel who is in charge of the case. "Just cut off two stitches," I said to him. "In this way, the serum can drain out. No need to re-stitch." After that, we had no more visit from the Buddhist teacher. I was glad that this dog was not abandoned when she had the tumours. Such incidents do occur in Singapore. It is best to spay the female dog when she is young as breast tumours are less likely to develop in spayed dogs. BE KIND TO OLDER DOGS & CATS --- GET TUMOURS REMOVED EARLY --- WHEN THEY ARE SMALLER.  More case studies, go to: Cats  or  Dogs Make an appointment with your vet. Or tel 6254-3326, 9668-6469 for an appointment to discuss health screening for your senior companion. Or e-mail judy@toapayohvets.com your requirements.  Copyright © Asiahomes Internet All rights reserved. Revised: May 22, 2015 Toa Payoh Vets

1119. Two surgeries, 10-year-old Cocker Spaniel. Urinary Stone analysis by NUH

 

Inbox x A case of two surgeries for bladder stone removal in a 10-year-old Cocker Spaniel done by an associate vet is reviewed by Dr Sing today Sep 26, 2012 April 4, 2011 blood in the urine. Did not want more tests. May 23, 2011 dysuria - blocked bladder May 26, 2011 blood test, x-ray, UA, cystostomy. calcium oxalate Sep 4, 2012 dysuria - blocked bladder. x-ray, cystostomy, stone analysis LAB TESTS May 24, 2011 UA pH 7.0, SG 1.028, Protein 2+ Blood 4+, WBC 10, RBC >2250, Bacteria 3+, Crystals calcium oxalate occasional Aug 28, 2011 UA pH 7.0, SG 1.029, Protein 3+ Blood 4+, WBC >2250, RBC >2250, Bacteria 3+, Crystals Nil May 24, 2011 Blood test. ALT 629 (<59 132="132" 23="23" ast="ast" n="90%</div" total="total" wcc="wcc"> Sep 4, 2012 Stone analysis by Dept of Lab Medicine, NUH I spoke to the lab people about the approximate % Calcium stone Trace (10%) Phosphate stone Trace (5%) Oxalate stone Trace (10%) Urate stone Positive (40%) Magnesium stone Trace (1%) Cystine stone negative Ammonia stone Positive (10%) Bicarbonate stone negative The stone is crushed and analysed using the colorimetric method. Trace = light color. Positive = intense colour. A semi-quantitative method. I asked my associate vet whether there were any recommendations about diet and was told Urate Diet was recommended. U/D FOR UROLITHIASIS, non-struvite urinary tract health Indications: calcium oxalate, urate and cystine urolithiasis; end stage kidney disease. This is a low protein food exhibit unusual lab vales such as USG<1 .020=".020" and="and" are="are" br="br" bun="bun" compliance.="compliance." dl.="dl." effectiveness="effectiveness" food="food" methods="methods" mg="mg" monitor="monitor" monitoring="monitoring" owner="owner" ph="ph" s="s" serum="serum" the="the" to="to" uirinary="uirinary" usg="usg"> Target urinary pH 7.1 to 7.11 increases solubility of non-struvite crystals. Every 6 months, do a fasting serum chemistry profile and echocardiogram for underlying metaboic abnormalities OWNER COMPLIANCE Two cystotomies were done. Owner does not comply with instructions on using prescription calculytic diets and this is their own wish.

1118. Bladder stones in a 13-year-old dog

 "Is an operation needed to remove the bladder stones?" the lady asked me over the phone. "Much depends on the size and composition of the stones," I said. "If they were small struvite stones, they may be dissolved by eating a special diet."

The dog was a Golden Retriver X, medium sized, 13 years old and lethargic. A high anaesthetic risk. So I did not advise surgery. Catherised urethra 2 days. Today, could pee normally but vomited canned food.

The dog could pee normally and had a good appetite today. So I did not operate as he is very old and thin. Will S/D diet help? But his urinary pH is 6.0 and not alkaline. The urine crystals are nil and so the only way to know what composition of the urinary stones in his bladder would be to do surgery. But the dog may die on the operating table since he is 13 years old. So, this is the difficulty. The dog was given K/D diet by Vet 1 before I was handling the case. Could K/D bring down the urinary pH to below 7.0?

A trial of S/D may not be effective since the composition of the urinary stone is not known. It may be calcium oxalate but it may also be struvite. S/D diet dissolves struvite stones. The dog had antibiotics and a can of S/D diet with informed consent from the owner. For the past 2 days, he was urinating normally and had excellent appetite. I dare not do any cystotomy surgery as the risks outweigh the benefits. An S/D trial is one alternative and it may be worth a trial. It is not evidence-based, I informed the young lady owner. She understood.   

1117. Acute respiratory distress in a pug

 

 

 

The pug keeps panting non-stop. X-rays show gastric distension. What's the cause? Is there a gastric torsion? Panting slowed when lasix is given.

 

As I gave a high anaesthetic risk assessment if surgery is to be done, the owners lost confidence in me and decided to seek another vet. This is a common occurrence to all vets.

1116. Another edited version of struvite bladder stones to the editor

What are bladder stones?

Bladder stones or uroliths are common in domesticated animals. There are many types of bladder stones depending on their composition.

Struvite bladder stones

Struvite bladder stones are most commonly seen in canine cases at Toa Payoh Vets and this article is to educate dog owners regarding their diagnosis and treatment. They can be formed anywhere along the urinary tract in the kidneys, the urethra and the bladder when the urine is supersaturated with magnesium, ammonium and phosphate (MAP). MAP supersaturation may be associated with several factors, including urinary tract infections, alkaline urine, genetic predisposition and diet. Breeds usually affected by struvite bladder stones include the Miniature Schnauzer, Shih Tzu, Bichon Frise, Miniature Poodle, Cocker Spaniel and Lhasa Apso, but any breed can be affected. Female dogs are said to form approximately 85% of bladder stone cases.

Symptoms of bladder stones

Some dogs may not show clinical signs such as blood in the urine, difficulty in urination, or inability to urinate, until much later in the disease with severity of signs depending on the location, size, and number of uroliths formed. Your vet will take a comprehensive history to determine the start and severity of the disease. Physical examination includes bladder palpation to feel the crepitus (sounds of gas and stones rubbing against each other) inside the bladder or the solid stones if they are large.

Diagnosis

Urine analysis is the most useful and a sterile sample is taken by catheterisation or cystocentesis (straight from the bladder). The pH of your dog’s urine will also give a good idea of the nature of the stone. The urine sample will show the presence of bacteria, which is usually cultured to find out the type of bacteria causing the urinary tract infection. Antibiotic sensitivity tests are needed to figure out what appropriate antibiotics can be prescribed.

Uroliths need to be of a certain size before they are evident. The number and size of urinary stones seen in the x-ray may not correlate with the severity of clinical signs. A radiograph is highly recommended to find out the number and size of stones and where they are located prior to surgical removal, if surgery is required. In spite of all the tests above, the composition of the actual stone cannot be determined unless a stone sample (from the surgery or that has been urinated out) is sent for analysis.

Treatment

There are two types of treatment for struvite bladder stones; surgery or medical dissolution of the stones. The benefits of surgery include a shorter recovery period and the ability to identify the actual type of stone involved. Surgery is needed if the stones are too large as they may not dissolve by medical dissolution. Disadvantages of surgery are that it is more invasive and there are risks of death during or post operation, associated with general anaesthesia in a sick and/or older dog.

Medical dissolution takes a much longer time (about three months on average) to take effect and large stones may not dissolve at all. It revolves around three main concepts – to acidify urine, reduce the intake of MAP such that it does not saturate in the urine and dilute urine so struvite crystals do not have a chance to form. Affected dogs are usually prescribed calculytic diets and appropriate antibiotics to treat the bacterial infections. No other food or treats should be given and plenty of water drinking should be encouraged.

Most importantly, your dog’s health should be reviewed every three months with urine tests and X-rays to ensure that no new stones or crystals are formed. Be alert as to the urination pattern of your older dog and seek veterinary advice promptly if there are signs of blood in the urine, urinary difficulty or inability to pee.
 
Dr Sing Kong Yuen

BVMS (Glasgow), MRCVS

Toa Payoh Vets

 

Sep 25, 2012. Edited version for the editor

My opinion. A technical report. Quite a boring article without pictures for the layman but has most of the important facts.   

Urgent Question About Duration of Surgery For Roborovskii Dwarf Hamster

Inbox

x

	Sep 20 (3 days ago)
to judy

Hello,

I’m in the U.S. and I have an 18 month old male Roborovskii hamster who has two medium size abdominal “fatty tumors”. The hamster is still active and eating normally and in otherwise apparently good health, but I would like to have the tumors removed and start him on an anti-tumor/anti-aging diet.  Thus I would like to do this before the tumors become any bigger.

I love this little hamster very much.

Anyway, from the information you’ve kindly made available on your web site, and from talking to other people, I am under the impression that surgery on dwarf hamsters and Roborovskii dwarf hamsters in particular, is a very delicate operation, and the time duration must be limited, otherwise the risk of death during surgery – especially from the anesthesia exposure - becomes unacceptably high.

I know your office has had many years of experience doing all kinds of surgery on dwarf hamsters (I think Dr. Sing mentioned he’s done this for 40 years or so).

Generally speaking, based on your considerable experience, can you please give me some general idea as to the maximum length of time surgery that would be considered “safe” to a “reasonable” person under the circumstances? Thank you very much.

Regards,

Nelson

 EMAIL REPLY FROM DR SING DATED SEP 23, 2012

Thank you for your email. The general principle for all animals in good health is that the shorter the anaesthesia, the higher the chances of survival. Therefore, some surgeries in high risk cases (like old age, poor health and very small creatures like hamsters) have a good chance of survival if anaesthesia is short. In hamsters, the period of time is preferably less than 5 minutes but this is just a guideline. Much also depends on the skills and experience of the vet and therefore, there are many factors to take into account.

It is best you find a vet experienced in hamster anaesthesia and surgery.