1174. Intern Ng. Rare uterine serosal inclusion cysts in a pyometra Golden Retriever

The Golden Retriever had profuse dark brown vaginal discharge - open pyometra diagnosed by the other vet on 12.1.15. Heat was 1 month ago. Vulval discharge 34 days. Vomited once  days ago.

X-rays and blood tests done. Advised immediate surgery as antibiotics may stop the discharge but this infection will recur. Costs would be $3,000. No more vaginal discharge at consltation in Toa Payoh Vets on 14.1.15

"As the life span of a Golden Retriever is around 12 years and this dog is 13 years," I told Dr Daniel who was discussing about alternative medical treatment to surgery. "The owner was thinking of euthanasia rather than take the anaesthetic risk of surgery. The fees still have to be paid if the dog dies on the op table!"

Spaying the dog young would have prevented such anaesthetic worries and financial costs. The dog was given IV drips with amino acids and antibiotics overnight.  More dirty vaginal discharge passed overnight. Operated by Dr Daniel in the afternoon and went home in the evening. Low dosage of Domitor and Ketamine at 0.1 ml + 0.1 ml IV plus isoflurane gas.

"Only after 7 days do we know whether your dog is back to normal," I advised the couple. Surrpising, this case had a large number of uterine cysts, so rare that I had not seen in over 100 pyometra cases done over the last 30 years. This is the first case of uterine cysts seen by me. I don't know whether other vets have had seen such occurrences. Cystic endometrial hyperplasia is part of the pyometra disease but such cysts are usually inside the uterus.


CHANCES OF SURVIVAL FROM ANAESTHESIA AND SURGERY
1. Age. 13 years old - very old for a Golden Retriever.
2. Kidney impairment. Vomited once only.
3. Duration of illness. Vaginal discharge said to be for 3 days.
4. Health is poor - Lethargic. Not standing or eating.
Blood test showed bacterial infection and blood loss. No kidney impairment. Abnormal values are:

  RBC 5.1   (5.5-8.5).
  Hb    14.3 (12-18)
  PLT   556 (175-500)

WBC  22.8  (5.5-17)|
NEU  14.8  (2-12)
MONO  3.8 (0.3-2)
EOS  2.2  (0.1 - 1.5)

Peripheral blood smear - normocytic normochromic erythrocytes. Adequate platelets.
Leucocytosis with neutrophila. Babesia negative

3. Anaesthesia. Isoflurane gas is best.  In this case, very low dose of Domitor 0.1 ml + Ketamine 0.1 ml IV was given before maintenance with gas. I noted that the dog was still drowsy post op. For old dogs, it is best not to wait for her to recover. Antisedan 0.1 ml reversed the domitor sedation and the dog was alert after 15 minutes. Went home in the evening.

4. Follow up 16.1.14  10.15 am, 19 hours post-operation.  Owner said the dog was very weak and would not go to the bathroom by herself. She ate a bit and he had to syringe feed her. I advised feeding 6 X/day. 

5. The first vet had prescribed Clavet 500 mg 1 tab bid and Tramadol 50 mg 1.5 tablets bid

VIDEO

FOLLOW UP ON DAY 7 AFTER SURGERY.   Jan 20, 2015 5 pm. Managed to reach the husband by phone. I was expecting the worst as the dog was so thin and was unable to stand up and ate less on Day 2. Day 1 is surgery day on Jan 13, 2015.
"The dog does not need to be lifted up since yesterday," the husband had also said that the dog had passed bloody discharge after the pyometra surgery. "For the past 6 days, she could not stand up."

I was glad to know that the dog had recuperated well. She ate more and drank normal amounts. Her stools and urine were normal.

"She is so thin that I was worried that she would pass away," I told Intern Ng. "Since she can survive 7 days and is walking by herself, she will likely live."

The first 7 days are critical. I had phoned the owner to tell him that the dog must be fed 3 times a day, instead of once. She has poor appetite and so should be fed more times.  I also gave the owner a high energy vitamin supplement to be given a tablespoon a day and he had asked to buy another tube.

MAKING A VIDEO. These are the pointers I gave to Intern Ng. Whether she can create a good movie of this ordinary pyometra case, depends on her ability. There are at least 5 conflicts.

1. Old dog likely to die under anaesthesia.
2. Thin old dogs have higher risks. They may die after surgery within the first 7 days.
3. Medical and surgical costs over $3000 as quoted by the first vet. So, is it more pragmatic to euthanase the dog since the money spent still has to be paid even if she dies on the op table? This was considered.
4. Reputational risk of the vet. Why operate high risk dogs and risk ruining his reputation?
5. Experience of vet. Immediate surgery advised by first vet. I would not advise it. Stabilise the dog first. The dog had 2 days of antibiotics and this eliminated the bacteria and enhance her chances of survival. 3 bottles of drip. 2 before and 1 after surgery.

 
     

A different approach to cat spay - head downwards 45 degrees

https://www.youtube.com/watch?v=4I1wMYQU3k8

Video:
Cat spayed in upside down position.


https://www.youtube.com/watch?v=4I1wMYQU3k8
This slanting  head downwards position is said to be easier access to the ovaries and a quicker spay.

Video:
Cat spayed in upside down position.

1. The vet ligates the ovarian blood vessels separate from the uterine horns and and then cut it off. The ovary and uterine horns are clamped.  Traditionally, the vet ligates the combined ovarian blood vessels and uterine horns.


2. The vet clamps the uterine body. He ligates the uterine body cranial to the clamp. Then he cuts off the uterine body cranial to the ligation.

3. Injectable anaesthesia IM is used. Long recovery period.

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.