1172. An 11-year-old Shih Tzu passes blood in the urine again

Jan 8, 2015
Two dry eyes, right eye has irritating upper eyelid conjunctival growths. Passing blood in the urine for the past years. Generalised skin diseases.

 

"My dog had passed blood in the urine but had recovered," the lady owner said. "Now, he dribbles blood in the urine again!"

The dog peed fresh blood on the mat of the weighing machine. He weighs 9.3 kg and has dry eyes as well as a row of right upper eyelid tumours. He had a very itchy body and a painful right ear.
"Shih Tzus need regular grooming and are high maintenance dogs." I said to the owner.

I placed him on the consultation table and palpated his abdomen. There was a golf-ball sized lump in his bladder area. No pain. It was lower down and could also be an enlarged prostate since he had haematuria and dribbling of urine.



X-rays. It is important to have 2 views. The V/D view shows gas inside the almost empty bladder while the lateral view showed an opaque bladder.

So, is it a bladder neoplasia or chronic cystitis? There appeared to be no radio-dense bladder stones
but in a previous urine test done several weeks ago, there was calcium oxalate crystals in the urine.

The eyelid conjuntival growths on the right eye were electro-excised by Dr Daniel and medication for the generalised skin infections were prescribed. The bladder was empty and no urine could be collected. Antibiotics cleared the bladder infections as no blood was passed in the urine on follow up 2 days later.

CONCLUSION
Based on the clear contrast of the ventral-dorsal X-ray showing the thickened bladder wall and air, this is likely to be a chronic cystitis rather than a bladder tumour. Some bladder stones are not radio-dense and hence not visible on X-rays. The prostate enlargement may not be large and is not visible on X-ray. An ultrasound of the prostate to check for prostatic cysts or abscesses cannot be done owing to the need to reduce medical costs.  

A urine test is needed but no urine was available when the dog's bladder was catheterised. The owner wanted only the eyelid tumours to be removed. Electro-excision  was done by Dr Daniel. 


 

1171. SCRIPT. Prostatic enlargement inside a perineal hernia

http://www.halifaxvet.co.nz/assets/Pet-Info/Paws-For-Thought/PAWS-35-Prostate-disease.pdf

Prostatic problems in the older male dog.

The prostate is a small gland enclosing the urethra at the neck of the bladder. It produces semen to transport sperm.

Many Singaporean male dog owners deem it cruel to get the dog neutered. In the older male dog, prostatic problems do occur but the signs and symptoms may indicate that the dog had difficulty standing up due to "hip arthritis". Perineal hernia is more common in the non-neutered male dogs than in neutered ones.

In this case, the prostatic problems of benign protatic hypertrophy was present with the perineal hernia in a 10-year-old male non-neutered Pomeranian.

 

1170. The red-eared slider has a gigantic middle ear abscess

Otitis media in a red-eared slider. Biggest abscess seen so far. Yet the terrapin continues to eat and drink normally and does not have head tilt.

Abscess was curetted (dug out), under physical restraint or isoflurane gas anaethesia.
The pus is not the usual liquid type. It is inspissated (dried thick type).
The terrapin went home after a few days of in-patient treatment with antibiotics

1169. SCRIPT - A chelonian love triangle

Jan 6, 2015

JANUARY 4, 2015

"The two bigger terrapins were living peacefully together," the lady then introduced the younger one into the small tank. "They attacked the younger one and the tank was filled with blood. I had changed water and the reddish-brown water you saw in the tank was a second change of water!"

The small terrapin, 4 years old, male was bleeding and the owner brought him to consult me. "He had a swollen grey erect penis of more than 8 cm long by 1 cm wide. Most likely he tried to mate with one of the bigger terrapins in the small tank and he was badly attached in his penis.  

Dr Daniel pushed back the penis with a pair of forceps.
"A purse-string suture 3/0 nylon is best used to prevent the penis from coming out of the cloaca," I said.


JANUARY 5, 2015
Sutures taken out 24 hours after stitching. No more penis coming out.

JANUARY 6, 2015
Back to normal. The terrapin goes home. Overcrowding had caused shell injuries. This male terrapin would find a new owner. Readers interested, pl email judy@toapayohvets.com or tel 9668 6468



 CONCLUSION
This was the first case of traumatic penile injury. Love triangles in people can sometimes result in beatings or murder of the rival. It looked like the red-eared slider had been a victim in this love triangle too.

Rectal prolapse is more common. See images or videos.

1168. Perineal hernia or right hip dislocation surgery?

Perineal hernia repair is more important as the intestines and bladder may get twisted inside the hernia. The dog can still survive on a right hip dislocation.

1167. Sunday's interesting case. A 16-year-old cat has a left facial swelling

Sunday Jan 4, 2015

"My cat is not eating. Blood dripping from the left side of the mouth", the gentleman said.
16-year-old cat is over a hundred years old in human age. What to do?

1166. Final Video: An elbow wart in a dwarf hamster

Jan 3, 2015.

A vet missed seeing the lower elbow wart based on general examination without lifting up the hamster to examine the lower side and diagnosed the itchy hamster as suffering from environmental causes.

I noted a right sided scratching, a circular right- sided flank wound and right-sided ear area inflammation. When I examined the dwarrf hamster upside down, there was a large hidden wart just in front of the lower side of the elbow. Inflamed and bitten. This would be the cause of the tichiness.

Electro-excision of the wart should resolve the problem. No more sand bath or deep food bowls to irritate the elbow.

It is best to examine every part of the itchy dwarf hamster as the cause may likely be just an irritating lower elbow wart. 

Every hamster owner expects no anaethetic death on the operating table. In this case, isoflrurane gas is given in just sufficient amount with the hamster in a container. The wart was
excised in a split second. The hamster went home the next day.

No bleeding if you use electro-surgery.

1165. The aggressive female Silkie Terrier has false pregnancy

January 2, 2015

This thin shivering, female, 17-month-old Silkie of 2 kg bodyweight came in for vaccination and a veterinary check-up . She vomits "gas" suddenly, as if there was gas inside the stomach.

"She bites my fingers with her back teeth nowadays, but not my daughter's," the owner said. "She pants with her tongue out for the past few months. I am worried about her health!"

"When was her last heat period of vaginal bleeding?" I asked. 
"6 months ago," the working lady owner said.

"The heart and lungs are normal," I had checked with my stethoscope (video). "No swollen uterus indicating pyometra and no vaginal discharge."
"Was there any vulval licking 2 months ago?" I expressed white milk and light brown fluid from the breasts. "Your dog has false pregnancy which occurs around 2 months after the heat period. The aggressive behaviour is due to the hormones of false pregnancy."

A blood test is taken and the dog will come back next week for spay.

CONCLUSION
Some busy owners may mistakenly report that the female dog was on heat 6 months ago. Actually it was 2 months ago as milk was present without the owner's knowledge. This was false pregnancy. Spaying and dental scaling will be done in 7 days' time. The dog was vaccinated and dewormed and went home.
   
 

1164. Last case of 2014 - a Netherland dwarf suddenly stopped eating

Dec 31, 2014

I was still in the surgery at around 5 pm. The rabbit had suddenly stopped eating and the lady owner came as her vet must have closed shop on this last day of New Year. Enjoyment was in the air and so many shop owners close early.

This was a new owner who had given critical care to this anorexic rabbit as I noticed some wetness in his mouth. She did not want any injection and this is a mindset of some of the younger generation pet owners and vets as regards injections of rabbits and guinea pigs, thinking they will suffer death.

They would dictate the type of treatment and had researched the internet..

"I am a doctor," she said when I explained that the rabbit would recover faster from injection.
"You heard a squeak when I palpated the abdomen," I explained that the rabbit had a swollen stomach which was painful on palpation. "As a doctor, you would know that it is best not to give oral medication to an upset stomach whenever possible. The stomach would get further irritated."

She reluctantly agreed to the injections which were 0.1 ml of baytril and 0.1 ml of painkiller meloxicam added to 0.4 ml of saline and given subcutaneously via fine needles. There was no painful squeal from the rabbit on injection.

"I want some antibiotics," she said.
"Be patient," I said. "Tomorrow morning, New Year's Day, I will be working in the morning. Giveme a phone call if the rabbit has not started eating. Antibiotics may irritate the stomach and intestines now inflamed."

Now it is 10.30 am on New Year's Day and no news from her.

This is a strange case in the sense that she lives in Toa Payoh but had never come to Toa Payoh Vets. So proximity was not her concern. She liked the service of the other vet south of Toa Payoh. This rabbit has a habit of licking wall paint and biting things compared to the other two roaming ones. So, the stomach could be upset by chemicals from the paint.

"Strict monitoring of the rabbit outside the crate would prevent a 4th occurrence," I said.

------------

I was at the pet shop to buy hamster food and had a chat with the operator. Her Primary 6 daughter had helped her in the shop. "I listened to what you said about having my children learn about the pet shop business," she told me. "So this 2nd daughter is here. The one in Seconday 1 will come another day."

"If you shield your 5 children from working in the shop, thinking that they better stay at home, you are bringing up your children to dislike the pet shop business and succeeding you later. You think you are protecting them from the smells and dirt of the pet shop animals. But this is a mistake. They will grow up self-centered and not assisting you at all, to keep their hands clean."

1163. INTERN. SCRIPT. A dwarf hamster has an itchy lower elbow wart

The mother and pre-teen daughter complained that this 2-year-old dwarf hamster had a red bald patch on the right backside area and was itch scratching continually. I observed the hamster and saw the scratching (video) mainly on the right side.

Some vets perform physical examination which does not involve picking up the hamster to examine his lower body. After all, this is such a small creature and everything can be seen at one look.

I picked up this hamster. Surprisingly, there was a hidden lower elbow wart! This could be the irritating inflamed growing wart that caused the right sided itchiness including right ear scratching and the left backside biting wound. Biting and scratching provide instant temporary relief of pain. This was my hypothesis.

If my hypothesis is correct, electro-excision of this ventral wart would resolve the problem.

Now how to excise this wart which extends the whole width of the lower elbow? It is a gigantic wart if you imagine your lower elbow's width being occupied by a large wart. Should the vet use scissors to excise it and how to control the post-op profuse bleeding?

The hamster is aged, being 2 years old and has around 6 months of life generally. Would the hamster die under anaesthesia and therefore damage the vet's reputation?

What to do to resolve this problem without killing the hamster? Reputational risks are more important for a private vet. Nobody will refer cases to him if he or she has hamsters dead on the operating table.

I decided to give the hamster only isoflurane gas anaesthesia. I used the circular electric loop wire to electro-excise the wart in a split second when the hamster was just anaesthesized by the gas. I used forceps to lift up the wart and excise under it. There was some normal skin. The wart came off and there was just a 3 mm wound. Blood-less. See video.

The hamster went home on the same day and the mother and daughter were happy and satisfied.

In conclusion, if the vet does not examine the underside of the hamster, he or she would mis-diagnose as environmental cause of itchiness and this would not resolve the itchiness problem.

TIPS

Always examine the underside of the dwarf hamster by picking up the hamster and turning him upside down. This elbow wart would have been missed as it was not protruding. A correct diagnosis resolves the client's problem and bring in more referrals than slick advertising. Vets have to deliver results and perform like any service provider.


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Jan 3, 2015

COMMENTS ON VIDEO PRODUCED BY INTERN JIA LING

1. A fast-paced concise video

To improve the quality of production
1. Not to publish the title of video as this is unnecessary
2. Subtitles to be on white text on a black band. White text not easily read in this video.
3. Subtitles are too rapid to be read
4. The BKTP image is flashed by too quick to be read
5. Weak concluding frames - same videos of hamster still scratching. Should have a post-op video or something similar rather than repeat the opening
6. The backside wound - main complaint was not emphasized.
7. Credits --  more videos at www.toapayohvets.com/videos.htm