2978. A cat has dislocated left hip

Aug 28, 2015. Yesterday, one 3-month-old rabbit dislocated his right hip. The owner wanted closed reduction rather than doing nothing as Vet 1 suggested. Vet 1 had said he could not reduce the hip joint and suggested doing nothing. The rabbit has a right hip sling after putting the femoral head into the hip joint. The owner did not want any surgery as the rabbit is only 3 months old.


Then another case of dislocation of the hip in a cat abused by somebody. He was missing and found to be lame.

The left hind leg was shorter than the right on extension. X-rays to confirm and taken today.
Sedation is necessary for proper X-rays as the hind legs must be extended.

In this cat, 4.4 kg bodyweight:

xyla 0.5+Ket 0.3 IM
Reverzin 0.05 ml IV (or IM) given to reverse xylazine.

The owner wanted closed reduction and a sling was applied. The cat stained his bandage after peeing. I asked the owner to wash it off. For other "looseness" of bandage or hairs stuck, I asked the owner to bring the cat down as it is impossible to "diagnose" and "advise" over the phone. So far, the Cavalier King Charles and the rabbit, both given slings, had no complaints.

X-rays for this cat are as follows:

Rabbit hip dislocation 3 months old

Closed reduction may be possible if done early.

Follow up: A 9-month-old Miniature Schnauzer cannot pee

Aug 26, 2015.

This case illustrates the typical challenges many Singaporean dog owners face.
Most vets have no time to follow up as it is time-consuming. Today, I followed up to find out whether this brown male Schnauzer stlll has difficulty in peeing. (Video done July 2015) since he was given dry Canine C/D, no dog treats and other food after 4 days of in-patient and catheterisation for urethral obstruction (small bladder stones around 4 mm across was flushed out). The owner did not want blood test or X-rays, but the clinic did a blood test free of charge.   

"He pees a lot now," the mother of 2 boys, 10 and 11 years old was happy. "Neighbours said he has put on weight."  That was good news. The stools are "nice" in a continuous roll when the dog was fed C/D.

FINDINGS
1. Jan 2015. Dog was purchased at 3 months of age. Fed dry food from pet shop.

2. May 2015. Changed to a different brand of dry food called Osbourne as pet shop operator said it is better, more protein. Dog vomited often after eating this dry food and the earlier brand. So added canned food. Owner thought the dog ate too fast, so vomiting occurred. 

3. Jul 2015. Dysuria. Blocked bladder. Catheterised. Small bladder stones sucked out.
    4 days of inpatient. Did not want x-rays or blood test.

4. Aug 26 2015. Follow up on dysuria and C/D diet.  No more problems. He peed a lot for the last 2-3 weeks. Stools are well formed and in a roll

5. Urine test
pH 7, SG 1.020. Nitre +, Protein 4+, Ketones +, Blood 4+. White blood cells 576/uL. Bacteria +. No crystals. Yet around 3 small crystals were sucked out during catheterisation.

6. Blood test
Liver enzymes ALT/AST  159/102   (<59 br="">Urea 49.5   (4.2-6.5)
Creatinine 691  (89-177)

Total WCC  37.3  (6-17)
N 83% (60-70)
N absolute 90.96 (6-11)
Platelets  78 (200-500).  The dog has sepsis and kidney failure.

DOG PYSCHOLOGY
1. The mother is the disciplinarian of the dog.  Would crate him for most of the do. He will bite things in the apartment including the crate playpen and the younger son.
 
2. The younger son, 10 years old is bullied by this dog. He complained to his mum that his leg is painful from the dog's bite. There are bruises. The son would run when the dog is let out. The dog would chase him as a prey and bite him. The boy is encouraging this attack bite behaviour.

I advise:

1. grip the dog's muzzle and say "no biting" when he chases the younger boy.
2. place him into the play pen when he starts "bullying" the boy in Primary 4 class. .
 
3. Now the dog is nearly 11 months old. Not neutered as the owner did not want to do it.
He pees many x a day, every 20 minutes. The mother will estimate the 20-minute interval and placed him inside the playpen bought 2nd hand from the pet shop. It has a pee tray which she lined with pee pad. This routine is still present as other family members feel that the mother is too strict on this young dog.

CONCLUSION

No recurrence on C/D diet. Strictly no other food or dog treasts.  Schnauzers are prone to urinary stone formation.
 
Early neuter will have prevented this need of the dog to urine mark. The owner has to place him into the play pen to pee every 20 minutes. She did not realise that he is urine marking.

2975. INTERN. A 17-year-old Shih Tzu barks all night long

Aug 25, 2015

The parents and the young adult son came in to euthanase this 17-year-old Shih Tzu who barks all night long. The parents have to work and have no rest. They used to bring the dog down the apartment to the grass to pee at 5 am and 10 pm but now, they had to do it at 2 am.. The dog would not pee at home even at 17 years of age. He was kept in a very good condition although he had difficulty standing up.

Vet 1 had prescribed heart, liver and joint disease medication. Most likely, Vet 1 did not want to put the dog to sleep.  The frequent night barking led to this decision to euthanase as the parents have to work.

"Take time to think about euthanasia," I do not advocate euthanasia for dogs that can eat. Is there another solution?

I advised:
1. No water after 6 pm so that the dog does not need to go downstairs.
2. Antibiotics for possible bladder infection due to holding of urine for long periods of time. No urine test is done to lower medical costs. 
3. Medication. Sleeping tablets adjusted for effect at 10 pm.

The owners decided to accept the medication and the dog barks less. The dosage is being adjusted and it is only 3 days since I saw the dog. This family loves this old dog very much to undertake this solution. 

2974. INTERN. . Time is running out - Case 3. A Maltese became comatose and had pyometra

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.

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

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.