The owner did not want the dog to be spayed nor the encrusted tartar in the teeth to be cleared when advised some 2 years ago.
The dog came to the clinic comatose and had fits (video). Blood test showed low glucose and extremely high total white cell count and neutrophils. The diagnosis was bacteraemia and sepsis. Based on the history of the dog having heat 4 weeks ago, a swollen vulval area with some discharge, a tentative diagnosis of pyometra was made by me.
On the 2nd day of IV drips and antibiotics, the dog could stand up. On the 3rd day, she did. Reddish brown pus leaked out from the vagina. This was a case of closed pyometra.
Time has run out for this 9-year-old Maltese. A spay at a young age of 1 year old would have permitted her to live much longer than the 9 years.
REFER TO POST NO. 2968.
Wednesday, August 26, 2015
2973. INTERN. An emaciated "anaemic" terrapin
This terrapin has loose flabs of skin in the thigh area and looks very pale compared to normal terrapins. The owner had confined him to a small plastic tank and he had stopped eating for some months. Antibiotics, tank hygiene, sunshine and a much bigger tank are advised.
Video
Video
2972. INTERN. Time is running out - Case 2. A female Pekinese passes foul-smelling vaginal discharge
August 25, 2015
Two years ago, I had this female Pekinese's breast tumour removed and advised spaying the dog as some breast tumours are more likely to develop in dogs not spayed. The dog's teeth were enveloped in thick tartar and I advised dental work to get rid of the bacteria inside the tartar. The lady owner did not accept my advices.
Today, the dog came with a dark brown vaginal discharge. The rotten meat smell of the discharge filled the consultation room. "I know she is suffering from uterine infections," the lady said. "I have researched the internet." The dog had a prominent spine, indicating a loss of weight but she did not have other breast tumours developed in the past two years.
Now a life-threatening condition of pyometra. This was one of the worst cases of open pyometra based on the bad odour and copious brownish vaginal discharge.
"The treatment is spay but she is so thin and will likely die under anaethesia," I prescribed oral antibiotics and gave an injection of antibiotics."So I will not advise surgery to remove the badly infected womb. She may die in the next few days despite antibiotics as she is not eating."
This Pekinese who strongly resisted swallowing the antibiotic capsule I gave to her through the mouth. She snapped at my fingers. I had put her on the consultation table. I decided to grasp the capsule with a pair of forceps and inserted the capsule into her snapping mouth, far back in the tongue and closed her mouth. She swallowed one capsule and there would be 13 more, at twice a day. The owner would have to hand feed her and give her water to drink.
Time is running out for this Pekinese. If the owner had at least spayed her 2 years ago, this dog would not have pyometra and causes so much emotional distress for the owner and the vet. Time has run out for this Pekinese as death from sepsis could be imminent. No blood test was taken to lower medical costs. This type of against medical advice to spay a dog after removal of a breast tumour is quite a common occurrence.
Pyometra that could have been avoided by a spay operation after breast tumour removal makes me feel sad for this Pekinese. She had lost a lot of weight but could still fight to avoid oral medication. If she is stable after 7 days, she could be spayed. But her emaciated body may not take anaesthesia well and she may die on the operating table. The stench of rotting uterine lining is an indicator that spaying cannot be delayed. Many owners will not accept their dog dying on the operating table and will blame the vet. So, it is best for the vet not to undertake such high risk surgeries.
Two years ago, I had this female Pekinese's breast tumour removed and advised spaying the dog as some breast tumours are more likely to develop in dogs not spayed. The dog's teeth were enveloped in thick tartar and I advised dental work to get rid of the bacteria inside the tartar. The lady owner did not accept my advices.
Today, the dog came with a dark brown vaginal discharge. The rotten meat smell of the discharge filled the consultation room. "I know she is suffering from uterine infections," the lady said. "I have researched the internet." The dog had a prominent spine, indicating a loss of weight but she did not have other breast tumours developed in the past two years.
Now a life-threatening condition of pyometra. This was one of the worst cases of open pyometra based on the bad odour and copious brownish vaginal discharge.
"The treatment is spay but she is so thin and will likely die under anaethesia," I prescribed oral antibiotics and gave an injection of antibiotics."So I will not advise surgery to remove the badly infected womb. She may die in the next few days despite antibiotics as she is not eating."
This Pekinese who strongly resisted swallowing the antibiotic capsule I gave to her through the mouth. She snapped at my fingers. I had put her on the consultation table. I decided to grasp the capsule with a pair of forceps and inserted the capsule into her snapping mouth, far back in the tongue and closed her mouth. She swallowed one capsule and there would be 13 more, at twice a day. The owner would have to hand feed her and give her water to drink.
Time is running out for this Pekinese. If the owner had at least spayed her 2 years ago, this dog would not have pyometra and causes so much emotional distress for the owner and the vet. Time has run out for this Pekinese as death from sepsis could be imminent. No blood test was taken to lower medical costs. This type of against medical advice to spay a dog after removal of a breast tumour is quite a common occurrence.
Pyometra that could have been avoided by a spay operation after breast tumour removal makes me feel sad for this Pekinese. She had lost a lot of weight but could still fight to avoid oral medication. If she is stable after 7 days, she could be spayed. But her emaciated body may not take anaesthesia well and she may die on the operating table. The stench of rotting uterine lining is an indicator that spaying cannot be delayed. Many owners will not accept their dog dying on the operating table and will blame the vet. So, it is best for the vet not to undertake such high risk surgeries.
Saturday, August 22, 2015
2971. INTERN Time is running out - case 1. An 11-year-old Jack Russell has false pregnancy and 4 breast tumours
Aug 21, 2015
TIME LINE
10 years ago, I advised spay 2 months after the end of the heat bleeding. The owner did not turn up.
5 years ago, the owner noticed a small breast lump in the dog. His son told him to seek veterinary attention. He did not want the dog to suffer post-op pain. The dog had surgery to remove a pebble in the intestines by another vet and his wife had to take leave to care for her. So no more operations.
TODAY Aug 21, 2015
The dog was not eating much. I examined her and found 4 breast lumps (video). I expressed some milk from one of the breasts. There was no vaginal discharge now. So, false pregnancy and/or pyometra is diagnosed. The hormonal changes of false pregnancy would affect the dog's appetite and behaviour.
"Did she carry a soft toy or blanket to a corner and was protective of it?" I asked. "As if she had a newborn puppy?"
"Yes," the owner said. "She carried a towel and went to a corner. What do you advise about the breast tumours? Do you advise euthanasia?"
"The decision for euthanasia is up to the owner," I said. "This dog is still active. She needs spay and breast tumour removal but at her age of 11 years old, you may want to think about her few remaining years, the medical costs and the post-op pain. Generally, most dogs do not suffer from post-op pain as they are given pain-killers."
The owner will decide with his wife.
Blood test, X-rays of the lungs, spay and breast tumour removal, high anaesthetic risks and post-operation complications and pain. Whether it is worth doing the operation as the dog is near the end of the life span. These must be considered.
Aug 25, 2015
Blood test showed high cholesterol and very high liver enzymes.
"This dog cannot be spayed now as the risk of anaesthetic death is very high," I said. Five years ago, the dog had a single breast tumour but the owner chose to ignore this growing tumour. He said that his wife had to take leave to take care of this dog after a pebble was removed from the intestine. So, he did not want the dog to suffer post-operation pain again, if she had her breast tumour surgery.
Time is running out now as the dog now has 4 growing and big breast tumours, 3 on the left side and 1 on the right side. Their sizes were more than 5 cm across. No biopsy was done to lower medical cost. So, it was not possible to state that these tumours were malignant or not. I had advised a spay to remove the ovaries which produce hormones encouraging breast tumour growth in some cases. Not every case as you can see in the case of the Pekinese that did not develop breast tumour after tumour removal and without the owner spaying her as advised.
"My dog recovered her energy and appetite after consulting you," the man said. On superficial appearance, the dog is normal, with good food like roasted pork pieces being fed when she had lost appetite a few days ago. A high cholesterol level and liver disorder now presented itself.
"My son noticed her elbows and her sternal area were yellowish," the man said.
"He is very observant young man," I told him I had noticed a yellowish strip of sternal skin on that day but had not pointed this to him. "I thought he had stained himself but this yellowish skin do look like jaundiced skin."
As the eye white was not yellowish, I ignored this finding and did not tell the owner. Usually jaundice presents itself as yellowish eye white. Now, the blood test had shown that this dog has a severe liver disease. The total white cell count was normal, but the neutrophils were higher. This could be a start of bacterial infection and my antibiotic medication had eliminated the bacteria based on the dog's rapid recovery of appetite.
"What can be done now?" the owner asked. Dr Daniel had advised him on a prescription liver diet for the next 1-2 weeks and he had come for the canned food. Unless the dog's health deteriorate, this would be the course of action. I agreed with him.
Time is running out for this dog. There is no point saying that she should have been spayed 5 years ago when she had only one breast tumour as in the case of the Pekinese with foul-smelling vaginal discharge.
TIME LINE
10 years ago, I advised spay 2 months after the end of the heat bleeding. The owner did not turn up.
5 years ago, the owner noticed a small breast lump in the dog. His son told him to seek veterinary attention. He did not want the dog to suffer post-op pain. The dog had surgery to remove a pebble in the intestines by another vet and his wife had to take leave to care for her. So no more operations.
TODAY Aug 21, 2015
The dog was not eating much. I examined her and found 4 breast lumps (video). I expressed some milk from one of the breasts. There was no vaginal discharge now. So, false pregnancy and/or pyometra is diagnosed. The hormonal changes of false pregnancy would affect the dog's appetite and behaviour.
"Did she carry a soft toy or blanket to a corner and was protective of it?" I asked. "As if she had a newborn puppy?"
"Yes," the owner said. "She carried a towel and went to a corner. What do you advise about the breast tumours? Do you advise euthanasia?"
"The decision for euthanasia is up to the owner," I said. "This dog is still active. She needs spay and breast tumour removal but at her age of 11 years old, you may want to think about her few remaining years, the medical costs and the post-op pain. Generally, most dogs do not suffer from post-op pain as they are given pain-killers."
The owner will decide with his wife.
Blood test, X-rays of the lungs, spay and breast tumour removal, high anaesthetic risks and post-operation complications and pain. Whether it is worth doing the operation as the dog is near the end of the life span. These must be considered.
Aug 25, 2015
Blood test showed high cholesterol and very high liver enzymes.
"This dog cannot be spayed now as the risk of anaesthetic death is very high," I said. Five years ago, the dog had a single breast tumour but the owner chose to ignore this growing tumour. He said that his wife had to take leave to take care of this dog after a pebble was removed from the intestine. So, he did not want the dog to suffer post-operation pain again, if she had her breast tumour surgery.
Time is running out now as the dog now has 4 growing and big breast tumours, 3 on the left side and 1 on the right side. Their sizes were more than 5 cm across. No biopsy was done to lower medical cost. So, it was not possible to state that these tumours were malignant or not. I had advised a spay to remove the ovaries which produce hormones encouraging breast tumour growth in some cases. Not every case as you can see in the case of the Pekinese that did not develop breast tumour after tumour removal and without the owner spaying her as advised.
"My dog recovered her energy and appetite after consulting you," the man said. On superficial appearance, the dog is normal, with good food like roasted pork pieces being fed when she had lost appetite a few days ago. A high cholesterol level and liver disorder now presented itself.
"My son noticed her elbows and her sternal area were yellowish," the man said.
"He is very observant young man," I told him I had noticed a yellowish strip of sternal skin on that day but had not pointed this to him. "I thought he had stained himself but this yellowish skin do look like jaundiced skin."
As the eye white was not yellowish, I ignored this finding and did not tell the owner. Usually jaundice presents itself as yellowish eye white. Now, the blood test had shown that this dog has a severe liver disease. The total white cell count was normal, but the neutrophils were higher. This could be a start of bacterial infection and my antibiotic medication had eliminated the bacteria based on the dog's rapid recovery of appetite.
"What can be done now?" the owner asked. Dr Daniel had advised him on a prescription liver diet for the next 1-2 weeks and he had come for the canned food. Unless the dog's health deteriorate, this would be the course of action. I agreed with him.
Time is running out for this dog. There is no point saying that she should have been spayed 5 years ago when she had only one breast tumour as in the case of the Pekinese with foul-smelling vaginal discharge.
Tuesday, August 18, 2015
2970. A 10-year-old Chihuahua sleeps curled up
Aug 13, 205
Suddenly the 10-year-old female spayed Chihuahua slept curled on the right side worrying the owners. Much loved by the couple, esp. the wife. Weight was 2.6 kg, looking rather plump. Has an excellent appetite.
I palpated pain behind the right side of the rib cage, around the right kidney.
X-rays
right 9th rib appeared fractured.
multiple lung nodules, liver enlarged? spleen OK.
Were the liver and spleen enlarged?
Blood test
Only the kidney profile is not normal
urea 3.5 (4.2-6.3)
creatinine 63 (89-177).
Platelets 578 (200-500)
Treatment was painkiller rimadyl for 4 days and antibiotics.
AUG 18, 2015
Follow up by tel. The dog sleeps in the usual sternal position since treatment and the husband was most happy. No more curled up in the foetal position when sleeping. He enquired about the W/D diet to reduce the weight. No jumping up and down.
Suddenly the 10-year-old female spayed Chihuahua slept curled on the right side worrying the owners. Much loved by the couple, esp. the wife. Weight was 2.6 kg, looking rather plump. Has an excellent appetite.
I palpated pain behind the right side of the rib cage, around the right kidney.
X-rays
right 9th rib appeared fractured.
multiple lung nodules, liver enlarged? spleen OK.
Were the liver and spleen enlarged?
Blood test
Only the kidney profile is not normal
urea 3.5 (4.2-6.3)
creatinine 63 (89-177).
Platelets 578 (200-500)
Treatment was painkiller rimadyl for 4 days and antibiotics.
AUG 18, 2015
Follow up by tel. The dog sleeps in the usual sternal position since treatment and the husband was most happy. No more curled up in the foetal position when sleeping. He enquired about the W/D diet to reduce the weight. No jumping up and down.
2969. INTERN The 7-year-old Silkie passes strong smelly urine
Saturday, August 15, 2015
An unusual feast of cases this Saturday morning and morning at Toa Payoh Vets.
Outstanding cases include:
A 7-year-old female Silkie X passes very smelly urine, blood and pus for many times and had been treated by vets. The lady had consulted 3 vets in a practice but the dog passes smelly urine after a course of antibiotics. Blood tests and X-rays were done.
So, she brought the urine sample in a bottle to consult me for a 2nd opinion. The ammonia smell was overpowering.
"Was urine test done?" I asked.
I palpated a "fish ball " sized bladder. It could be a thick-walled bladder which had been inflamed for many months or there could be bladder tumours and small stones.There was pain in the kidney area (video).
I got a urine test done.
pH 9, SG 1.03, Nitrite +, protein 4+, blood trace, bacteria nil, crystals triple phosphate +, amorphous phosphate 3+.
There was no bacteria as the owner had given a course of antibiotics from the other vet.
Blood test
Kidneys were OK. No abnormal blood cell count or numbers.
Treatment
IV drip with antibiotics and painkiller. Trimax tablets at 1/4 twice per day for 14 days.
Follow up on Aug 18, 2015
No smelly urine as the dog was on trimax.
The dog is advised to go on C/D
Ultrasound advised to check for bladder tumours
X-rays from the other vet needed although the vets said no stones.
A blood test 2 months later.
Advised spay as the vulval area and ventral skin area in the groin were hyperpigmented black since the dog had been licking it for many years. Possibly the dog had open pyometra leading to licking and bacteria entering the bladder causing infection. I explained to the lady that in female dogs, the urethral opening can be easily infected from the pus passed out from the uterus.
"I do not want my dog to suffer from pain (involving spay surgery)", the lady said. So this advice that could save the dog's life in later years was given but not accepted. Pyometra could worsen leading to septicaemia and death 2 years later.
An unusual feast of cases this Saturday morning and morning at Toa Payoh Vets.
Outstanding cases include:
A 7-year-old female Silkie X passes very smelly urine, blood and pus for many times and had been treated by vets. The lady had consulted 3 vets in a practice but the dog passes smelly urine after a course of antibiotics. Blood tests and X-rays were done.
So, she brought the urine sample in a bottle to consult me for a 2nd opinion. The ammonia smell was overpowering.
"Was urine test done?" I asked.
I palpated a "fish ball " sized bladder. It could be a thick-walled bladder which had been inflamed for many months or there could be bladder tumours and small stones.There was pain in the kidney area (video).
I got a urine test done.
pH 9, SG 1.03, Nitrite +, protein 4+, blood trace, bacteria nil, crystals triple phosphate +, amorphous phosphate 3+.
There was no bacteria as the owner had given a course of antibiotics from the other vet.
Blood test
Kidneys were OK. No abnormal blood cell count or numbers.
Treatment
IV drip with antibiotics and painkiller. Trimax tablets at 1/4 twice per day for 14 days.
Follow up on Aug 18, 2015
No smelly urine as the dog was on trimax.
The dog is advised to go on C/D
Ultrasound advised to check for bladder tumours
X-rays from the other vet needed although the vets said no stones.
A blood test 2 months later.
Advised spay as the vulval area and ventral skin area in the groin were hyperpigmented black since the dog had been licking it for many years. Possibly the dog had open pyometra leading to licking and bacteria entering the bladder causing infection. I explained to the lady that in female dogs, the urethral opening can be easily infected from the pus passed out from the uterus.
"I do not want my dog to suffer from pain (involving spay surgery)", the lady said. So this advice that could save the dog's life in later years was given but not accepted. Pyometra could worsen leading to septicaemia and death 2 years later.
2968. A 9-year-old not spayed Maltese became comatose
Aug 18, 2015
This morning, I went to the pet shop to buy hamster food. The aunty at the pet shop asked what caused her niece's Maltese to die? She had not asked the niece who was grieving over the death.
I told her that the Maltese was comatose and had fits when her niece brought the dog into my clinic 3 days ago. The dog had septicaemia as the total white cell count was 70 (5-17 being normal) and the neutrophil % was 98% (60-70% being normal). There was insufficient blood glucose.
The dog was recumbent and despite IV drip and glucose, the dog died after 2 days of in-patient. She was in heat 3-4 weeks ago and I suspected pyometra.
Brownish red blood oozed out from the vagina after she died and the niece saw it. The parents and the pre-teen children came to visit the dog. The niece got a man to cremate her.
This death could have been prevented by early treatment or by spaying the dog at 6 months of age. This dog would have lived much longer as her kidneys and liver were normal as shown in the blood test. Her teeth was encrusted with tons of tartar but the niece ignored my earlier advice to get dental work done.
Bacteria could have reached the blood stream via the mouth or infected uterus. It is hard to say where the bacteria in the blood originated.
I did not want to bring out this sad topic with the aunty as this was death that could have been prevented by spaying.
This morning, I went to the pet shop to buy hamster food. The aunty at the pet shop asked what caused her niece's Maltese to die? She had not asked the niece who was grieving over the death.
I told her that the Maltese was comatose and had fits when her niece brought the dog into my clinic 3 days ago. The dog had septicaemia as the total white cell count was 70 (5-17 being normal) and the neutrophil % was 98% (60-70% being normal). There was insufficient blood glucose.
The dog was recumbent and despite IV drip and glucose, the dog died after 2 days of in-patient. She was in heat 3-4 weeks ago and I suspected pyometra.
Brownish red blood oozed out from the vagina after she died and the niece saw it. The parents and the pre-teen children came to visit the dog. The niece got a man to cremate her.
This death could have been prevented by early treatment or by spaying the dog at 6 months of age. This dog would have lived much longer as her kidneys and liver were normal as shown in the blood test. Her teeth was encrusted with tons of tartar but the niece ignored my earlier advice to get dental work done.
Bacteria could have reached the blood stream via the mouth or infected uterus. It is hard to say where the bacteria in the blood originated.
I did not want to bring out this sad topic with the aunty as this was death that could have been prevented by spaying.
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