What evidence is there that the dog has pyometra? "This dog had no bleeding of heat during the past 3 years," the owner asserted and so, would not produce bleeding from the uterus.
On examining my records, the dog came in Jan 2015 for vaccination. I detected false pregnancy with milk seen in the mammary glands and swelling of the nipples. I advised spaying to prevent pyometra.
No news.
Today, July 4, 2016, the owner accepted the evidence of swollen uterus on X-rays and blood infection from blood test. His helper had shown blackish red vaginal discharge seen 2 days ago, snapped in her smartphone. Brownish-yellow discharge dribbled from the swollen private parts.
An 8-year-old female spayed poodle urinates a lot in the past 2 months. Polyuria is the medical word for this condition. It is abnormal. What's wrong with this dog? The owner brought the dog to Toa Payoh Vets.
This video is a case study of an 8-year-old female spayed poodle that urinates a lot
Dr Sing from Toa Payoh Vets enquired more and found that in addtion to polyuria, the dog has
Polydipsia (drinks a lot of water)
Polyphagia (eats a lot, always hungry)
Abdominal Distension
EXAMINATION The main finding is a large painless anterior abdominal swelling 50% the size of a tennis ball. Dr Sing needed further lab tests to provide evidence of what's wrong with the dog. These tests are as follows:.
X RAYS
BLOOD TESTS
High serum ALT indicate liver cell damage, enlargement and necrosis
ALT = 1054 u/L (normal: less than 59)
AST = 421 u/L (normal: less than 81) AnABDOMINAL ULTRASOUND was recommended to the owner and he agreed. The summary of the ultrasound report is as follows:
1. Liver is moderately to severely enlarged with no tumours
2. Left and right adrenal glands have a nodule each in the cranial pole
3. Other organs are normal
4. No fluid inside the abdomen
More details are as follows: THE ULTRASOUND OF LIVER AND ADRENAL GLANDS
LIVER - moderately to severely enlarged; borders are rounded but margins are smooth; echogenicity is diffusely increased; parenchyma is homogenous and no discrete masses or nodules are seen; vessel size is subjectively normal
Liver
Liver
ADRENAL GLANDS - one hyperechoic nodule present in cranial pole of both adrenal glands; margins are smooth and no signs of invasion of the blood vessels are seen.
Right Adrenal Gland - nodule size of 1cm x 1.4cm
Left Adrenal Gland - nodule size of 7.8mm x 9.7mm
Left Adrenal Gland - another view
THE OTHER ORGANS ARE NORMAL AS SHOWN BELOW.
Gall Bladder - has gall bladder sludge (cholestasis); gall bladder wall is thin and moderately distended with bile; small amount of echogenic material is seen on the dependent wall; material dot have distal acoustic shadowing or a stellate appearance; no masses or stones are seen; no dilation of the cystic or common bile duct
Right Kidney - normal; symmetrical in size; no cysts, masses, stones or dilations
4.1cm
Right Kidney - another view
Stomach- normal; wall layering normal without thickenings or masses
4.3mm
Duodenum - normal; wall layering normal without thickenings or masses
3.6mm
Jejunum: 2.6mm
Ileum: 2mm
Pancreas - both lobes appear normal with no edema, enlargement (1.4cm) or masses seen; no increase in echogenicity of the surrounding mesentery.
Spleen - size is subjectively normal; shape is normal with a smooth capsule; parechyma is fine, homogenous and bright; no masses
Left kidney - normal; symmetrical in size; no masses or stones present
4.5 cm
Left kidney - another view
Bladder - normal; no masses or stones present; thin-walled and moderately distended with anechoic urine
Bladder - another view
Urethra - normal; urethral wall normal; no dilation
Colon - normal; thin wall with no masses seen
1.8mm
Small Intestine - normal; wall layering normal with no thickenings or masses seen
COMMENTS ABOUT ULTRASOUND
1. Fluid: No free fluid.
2. Lymph Nodes: No enlarged lymph nodes
DIFFERENTIAL DIAGNOSIS
1. PDH - Pituitary-dependent hyperadrenocorticism. The pituritary gland inside the brain is abnormal
2. Adrenal glandnodular hyperplasia or neoplasia or both. e.g. adenocarcinoma, phaechromocytoma
3. PDH or adrenal tumours or both? Measurement of endogenous plasma ACTH concentration is the reliable way to differentiate between PDH and adrenal tumour. ACTH is low or undetectable in adrenal tumour while it is normal to high in PDH.
4. Steroid hepatopathy - Liver disorder and disease due to endogenous or exogenous steroids.
5. Liver infection - chronic active hepatitis
6. Liver abnormality e.g. diffuse infiltrative liver disease or tumours
7. Diabetes mellitus
8. Diabetes insipidus
9. Unknown cause of increase/decrease of serum cortisone
ADVICES TO OWNER
1. Adrenal testing. Hyperadrenocorticism e.g. ACTH, low dose dexamethosone suppression (LLDS) test or high dose dexamethosone suppression (HDDS) test.
2. Treatment of PDH is with mitotane or tilostane.
3. Surgical removal of adrenal nodules/tumours if present. Abdominal ultrasonography is a more sensitive way to identify adrenal tumours or nodules, including liver metastasis or invasion into the vena cava blood vessel.
4. Radiation
PROGNOSIS
The owner has not decided what to do with the poodle. It has been reported that the maximum number of years a dog with hyperadrenocorticism can live is 2 years
CREDITS
Roxanna Neo Yuan Xin - Narrator; video editor
Dr Sing Kong Yuen - Veterinary surgeon
BVMS (Glasgow), MRCVS
Toa Payoh Vets
Consultant Vet @ Royal Asia Veterinary Surgery
Dr Daniel Sing - Veterinary surgeon
Toa Payoh Vets
BSc, BVMS (Murdoch)
FOR MORE VIDEOS, VISIT www.toapayohvets.com/videos.htm
FOR MORE INFORMATION, VISIT www.toapayohvets.com
Tel. No.: +65 62543326, 96686468
E-mail: judy@toapayohvets.com
Date: 1/7/2016
A video is created with the help of Raffles Institution Intern Roxanna Neo:
4 days have passed. What happened to the puppy with the crooked tail and swollen umbilical cord?
This morning, I visited the C-section 634rd-day pregnant Dachshund. She's OK but was not permitted to nurse her own new born puppies. The poodle was the surrogate for the 3 puppies. The 4th with the crooked tail and swollen umbilicus had passed away the 2nd day although the umbilicus had dried up.
"I had tied up the intestine which was inside the swollen umbilical cord," the breeder said. "So the intestine was deprived of the blood supply, killing the puppy. I had a few of such cases."
Each breeder or vet has his or her own theories about medical conditions and so I did not say that this puppy had been severely stressed as the amniotic sac was filled with yellow meconium unlike the normal 3 siblings. In human medicine, ultrasound scans showing meconium in the baby will lead to an emergency Caesarean section to save the baby. But costs prohibit the breeder from spending on such ultrasounds.
The umbilical cord was twisted and so it swelled 4X. But I know the experienced breeder would not accept my theory and so I did not expound my theory. "Maybe, next time, I should check the swollen umbilical cord for any intestines inside and push them inwards before you tie the cord," I said.
"I should assist you during C-sections," he said as I usually asked him to be outside the operating room unlike one lady vet who had 100% no-death in puppies in C-sections with him and so she was an excellent vet. Unfortunately she had retired from doing C-sections for him and he had been to various vets throughout the past years. He advocated an assistant to elevate the lower body of the dam so that C-sections can be completed faster. Or the assistant holding part of the uterine horn while I take out the puppies faster.
The latter suggestion was preposterous as the gravid uterine horn is not that long unlike that of the cow's. There is just no space for another assistant to hold part of the uterus while the vet milk out the puppy.
Many sensitive younger vets may not be happy with his presence or suggestions of assistance or his criticism of puppy death being due to delay in pulling out the puppy and so the puppy had an overdose of the isoflurane and therefore die the next day. I don't permit outsiders into the op room during C-sections to keep the room as sterile as possible.
In this 63rd-day pregnant, the breeder had outsourced the 3 puppies to the poodle and is pleased with his decision as the puppies are thriving. He believed that the other Dachshund had toxic milk killing all the 3 puppies I delivered alive on C-section and so was not taking chances with this Dachshund. This Dachshund had snow-white milk whereas the other had no milk and the next day, produced thick yellowish milk deemed toxic to the 3 puppies.
Breeders have their beliefs. He even suggested that a longer incision bringing out the whole gravid uterus would compromise the milk production of the mammary gland and so vets who incise the abdomen from umbilicus to pelvis as stated in the vet books have had damaged the milk system, leading to poor quality milk production.
I had closed my surgery at 4 pm as usual on Saturdays. The breeder decided on a Caesarean section at 6.30pm since his 63rd-day pregnant Dachshund had not given birth and was starting to scratch. He did not want to wait till midnight. He could have the C-section at 3 pm as his worker had told him that his Dachshund's rectal temperature had dropped to 37.7 deg C in the morning. With a drop of temperature, the dog is ready to give birth and could have an elective C-section. The breeder decided to wait to "save money" paying the vet. But no puppy came out and without much delay, he phoned me.
4 puppies and dam are alive. Milk was present. The breeder was over the moon.
1 of the 4 had yellow stools (meconium) inside the amniotic sac. He had pooped a lot. His umbilical cord was swollen 4-6X and this would be due to his placenta being twisted.
In this operation, I made a larger cut to exteriorise the elongated uterine horns (Dachshunds have long bodies). This would speed up the taking out of the pups instead of my usual smaller cut without needing to exteriorise the uterine horns.
FOLLOW UP 24 HOURS LATER
I phoned the breeder 24 hours later. He said all 4 pups are OK. They were nursed by two surrogate poodles as he had a bad experience of the previous Dachshund providing "toxic" milk to the 3 large pups I had delivered by C-section. Those 3 pups died on the next 2 days, attributed by the breeder to the toxic milk. So he was not taking chances. He fostered the present Dachshund dam with older puppies as they would be stronger in case this Dachshund has toxic milk.
I was most surprised that the other Dachshund had all 3 puppies dead as they were alive and OK before they went home from C-section at Toa Payoh Vets. "Did you use anti-tick wash on the dam before C-section?" I asked this experienced breeder as yesterday's Dachshund had many small ticks. The breeder normally hand-picked the ticks and might use Frontline spot-on to get rid of the ticks. The breeder said he does not use tick insectides and so the mystery of the "toxic milk" remains.
The dog was limping in the hind for some years as the owner did not want to remove the urinary stones stuck inside the urethra and bladder. When he decided to do it at Toa Payoh Vets, the dog's lameness is much less and he looks better.
Terrapin, 5 year old, F was rescued from the pond 1 year ago. Goes for walk in playground. UVB light 1-3 hrs/day. Tank. No filter Overturned basket as basking area, not ramp.
Mar 12, 2016. Consulted Toa Payoh Vets New tank Bubbles from nose, open mouth breathing Why? Tank chemical likely cause resp. problem.
Jun 2016. Another Vet clinic. 7 injections alternate days of oxytet IM
Tobradex eye drops into eyes and nose "Yawns" or gasping returns after treatment course. Why?
