2924. INTERN. Breeder's perception of heavy anaesthetic dose - respiratory distress of puppies

Jan 20, 2016

HOOK (Video)
Breeder:  "The puppies were overdosed with anaesthesia. That is why the puppies are not crying after delivery."

What is the answer to this question?


MEDICAL HISTORY
On the 6lst day, the Dachshund, female, 3 years was not active as on the day before. She stopped walking although she ate. The breeder decided on Caesarean section at 8 pm.

C-section. 3 large pups. 2/3 distressed as they were not crying till more than 10 minutes after delivery.  61st day (average 59-63 days)


PHYSICAL EXAMINATION
Alert, no fever. Uterine inertia
No uterine contraction

SURGERY

SURGERY

Education of the breeder is very important. This was his 6th Caesarean section in the last 3 months. He had various vets in the past 30 years performing C-sections for him and had acquired knowledge of anaesthesia and outcomes from the vets.  

Isoflurane gas
1. A very safe anaesthesia for caesarean section compared to other injectable anesthetics.  Puppies would cry on delivery provided there is no delay in getting the Caesarean done and the dam is healthy. 

Evidence: I had done over 100 caesarean section for various dog breeders in Pasir Ris. There was no complaint about puppy deaths attributed to isoflurane anaesthesia.

2. No pre-op sedation injections were given and so the puppies could not be sedated on delivery. 
3. Others

2923. An active 1.5-year-old blue-merle Shetland limps on the left fore leg

Jan 19, 2016

The mum and her young adult daughter made an appointment to see me.
"His lameness was in the back last time," the daughter said. "Now, it is on the front leg. Limping around now and then for the past 2 weeks. My brother surfed the net and thinks the cause is a sprain or genetic."

As if to confirm the owner's complaint, the 1.5-year-old Sheltie would walk around my consultation room, stood at the corner near the door and lifted up his left fore limb. When he walked, this happened too.

The mum held the dog down by putting her hand on his shoulder area while the daughter held his backside down. Not without a struggle. I muzzled the gentle dog in case he bites anyone while I manipulated the left front limb from toe to shoulder. Safety of people is important.

The dog yelped in pain when I flexed and extend the left elbow and shoulder.
"This is acute pain," I said.
"Should we X-ray the joints?" the mum thinks this could be genetic in cause.
"This is a young dog. Did he jump up and down inside the apartment and run down the flight of stairs?" I noted the owner lived on the 22nd floor.

"No," the daughter said. "We take the lift. However he does jump from the car floor to the road, play roughly with other dogs downstairs and runs down the ramp."

"Young dogs, like young men and women think they are invincible and take risks to their lives," I said. "Some suffer injuries or deaths because of this type of life-style."

No x-rays for the time being. The dog was given painkillers and to avoid jumping on or off the car, run down and up the ramp and play rough with the other dogs for one month. If not, the joint pain will worsen.

This is the third of 3 recent cases where the mum and young daughter brings the pet to the vet. The other. The other case was the chronic coughing cat and the tattoeed hand girl with her mum bringing the Schnauzer with strangulated uterus.

2922. An eosinophilic cat has a "lungworm"?

Has the chronic coughing cat a lungworm?

This is a strange case. The much beloved old Himalayan cat has chronic coughing for the past 6 months. Yet the heart and lung sounds were normal when examined by Vet 1 earlier and myself on Jan 18, 2016. I could hear rapid breathing which could be due to this cat being unhappy at the vet.
The cat had good appetite but now had a sore throat owing to daily coughing nowadays. 

MEDICAL HISTORY.
Oct 2015. Went to Vet 1.  Occasional cough. Cough medicine did not banish the coughing.
Dec 2015. Went to Vet 1.  Coughing more often. Vet 1 wrapped cat around towel to examine the cat in a room away from the owner. Vet 1 prescribed antibiotics and steroids but the owner did not give them to the cat as there was no definitive diagnosis. Vet 1 did advise X-rays.Vet 1 noted that the heart and lungs sounds were normal.

On Jan 18, 2016, a mother and young adult daughter brought the cat to consult me. I confirmed the heart and lung sounds were normal. There was a rapid breathing rate which I attributed to the cat being unhappy with examination by any vet as he tried to claw me now and then. He did not like his head area touched. I palpated his enlarged left submandibular lymph node when the owners were distracting him, but he would not permit opening of his mouth. Was there a tumour in his painful throat?

"X-rays of the throat and lungs are needed to check for tumours or other abnormalities," I advised as simply giving antibiotics would not be useful in chronic coughing. "A blood test is needed to check for blood-borne infection and diseases of the liver and kidneys." 

The owners agreed and the results are as follows:


X-RAYS

The cat was stressed when isoflurane gas was given via the carrier and bag. As an alternative, he was given a lowest dosage of IM injection - xylazine 0.3 + ketamine 0.2 ml IM to enable a thorough physical examination of the mouth, throat and abdomen.

Reversin 0.15 Im woke up the cat in less than 15 minutes.


 
 

 

BLOOD TEST
Leucocytois with neutrophilia and thrombocytopenia suggest a septicaemia on Jan 18, 2016.
Eosinophilia suggests allergy, parasitic or tumour condition. 
No liver or kidney disorders.

COMMENTS
Close up of the X-ray appeared to show a donut-shaped object looking like a lung worm swallowed inside the left lower lung. This would account for the eosinophilia. Tumours would also cause eosinophilia. Eosinophilic granuloma is a possibility although the lesions manifest in the mouth and skin usually.

The X-ray shows a full stomach, suggesting that the cat has a good appetite. The throat was very painful due to daily coughing. Antibiotics and anti-inflammatory medication was given. Review in 10 days. May need deworming (Panacur, ivomectin or Revolution).

PHYSICAL EXAMINATION UNDER SEDATION
Tonsils are enlarged. The owner said they had been enlarged for some time. No tartar or calculus in all snow white teeth as if they were brushed daily. 

 

CONCLUSION

Follow up by tel on Jan 19, 2016. 
"The cat eats and is more active," the young lady said. "Less coughing."
"If the lung lesion is not a tumour or lungworm, we will see complete recovery in a month," I said. 

Chronic coughing of 6 months' duration and old age suggests a high probability of a pulmonary tumour.  A review is needed in 2-4 weeks' time by telephone.

   

2921. A much loved 13-year-old Sheltie has a right head tilt - vestibular disease

Jan 16, 2016

The 13-year-old Sheltie has a right head tilt, became off-balance. What is the cause and solution?
Some old dogs suffer from chronic ear infections. The infections rupture the ear drum and affect the middle ear where the organs of balance are located. Many old dogs suffer from vestibular disease.

In this Sheltie, the first vet did not resolve the loss of appetite and balance to the owner's satisfaction. The owner consulted me on Jan 2, 2016.  I anaesthesized the dog and irrigated the right ear and did a dental scaling. There was fresh blood deep inside the right ear.

Around a week later, the lady owner phoned me saying that she cleaned the pus discharging from the right ear every day.  I checked the dog's right ear on Saturday Jan 16, 2016. There were thick plugs of brownish yellow purulent exudate. These were flushed out. X-rays of the ear showed some masses at the horizontal canal area.

   

2920. Saving an old Silkie Terrier's eyeball

Jan 17, 2016

After one month of intense eye pain and rubbing, the first vet advised enucleation (removal of the eyeball) to resolve the problem. This was a deep corneal ulcer. The owner asked me for a second opinion. He was an old client but had gone to the other vet.

It was already one month and the tarsorrhaphy works very well with injuries sustained within 24 hours. He was agreeable to the surgery. Outcome was excellent. The dog did not need enucleation and has his eyeball and eyesight back. Images are shown below but not in order. There is a video at:
https://www.youtube.com/watch?v=aUEC5WmmJ-s

  

2919. Top 10 most common bird blogs

1.  10000birds.com
2. blog.aba.org
3. leesbird.com
4. birdingblogs.com

5. birdchick.com/blog.htm
6. nemesisbird.com

7. billofthebirds.blogspot.com
8. birdingisfun.com

9. urbanhawks.blogs.com
10. besgroup.org    Bird Ecology Study Group

2918. X-ray interpretation website - ear x-rays

http://www.acvr.org/node/335 used to provide case interpretations of x-rays  in 2015 but now no more.

Cat