Egg binding is most probable cause of lethargy and not eating for over 10 days.
Owner took home and provided a sand box for egg laying for the next 6 days, but no eggs were laid.
The slider usually laid eggs in batches of 3 in the water in a tank shared with a male slider, during the past years, but this year, she had not laid any eggs.
X rays show around 13 eggs.
The vet advised oxytocin injections for the next few days but the owner wanted the slider home.
Feeding orally the Critical Care from Ox bow 6 times a day. "She was able to walk a while, after
eating, but soon became lethargic," the lady owner told me yesterday, Mar 7, 2017.
I advised warm water and putting her back to the tank in which she used to lay eggs in the water durng the previous years.
As at March 8, 2017, the slider had not laid any eggs in the sand box. So
The complaint was a big lump in the hind leg of this 3-year-old cat that was limping. Blood test showed high blood glucose. Urine test showed glucose. The lump would be due to hind limb neuropathy which is a symptom in diabetes mellitus in cat.
On further questioning, the owner said that the cat was always looking for food, drank and peed a lot.
After insulin injections, the cat's lump disappeared and she was no longer ravenous, thirsty or urinating a lot.
Chronic skin disease
Old dog with poor immune status
Under new drug for skin disease for the past 2 weeks
Seen by Vet 1 on Feb 26, 2017
X-rays Spiral fracture of tibia and fracture of fibula - Right hind.
Seen by Toa Payoh Vets on Feb 28, 2017.
Proximal tibial fracture from fall
Closed fracture
TIBIAL SHAFT FRACTURES
Haematoma
Blood supply to diaphysis.
Open fractures are surgical emergencies.
Debridement of necrotic tissues and irrigation to remove bacteria and prophylactic IV antibiotics to be done within 6 hours of open fractures to decrease infection rates.
1. Cast treatment is non-operative method. Most closed tibial fractures can be treated without surgery with good results. Wait 3 days to let swelling go down. 6 weeks. X-rays. Non-displaced fractured tibial shaft ideal.
2. Surgery. Open reduction and internal fixation (ORIF) e.g. intramedullary nailing, external fixation, plating
and in some cases, amputation.
3. Intramedullary rod therapy.
Cast treatment has fewer infections than ORIF
ORIF has a higher union rate as there is more fracture stability.
Fracture stability and infection risk must be considered..
Surgical fixation is required when fractures are unstable.
Cast treatment isbest in a young patient with a non-displaced fracture.
OPEN FRACTURES
Outcome
No union
Mal union
Intramedullary nailing is generally used to treat many types of tibial shaft fractures.
Infections
IN THIS CASE
This Westie has chronic dermatitis for many years with no resolution when given steroids and coconut oil. However, in the last 2 weeks, he was given Oclacitinib (Apoquel by Zoetis) 16 mg divided into 4 parts. For the first 2 weeks, he took 1/4 tablet twice a day. He will be taking 1/4 tablet once per week for the next 2 weeks.
The owner was happy that the Westie responded very well with no itchy scratching just within the 2 weeks of Oclaitinib.
Oclacitinib, an immune suppressant drug is used for the control of pruritus associated with allergic dermatitis. The healing of the fractured tibial shaft fractures will be adversely affected if this drug is to be used as it suppresses the immune system.
Owner warned that open reduction will result in bacteria from skin infections getting into the fractured bones resulting in osteomyelitis, pain and possible loss of leg via amputation. Also the
high financial costs and worries if infections occur after open reduction using intramedullary nailing surgery.
The dog is old and his immune system is poorer than a young one. He had been on Oclacitinib for the past 2 weeks and this further depress his immune system.
Cast treatment is advised as the proximal tibial shaft fractures are minimally displaced and look stable on X-rays. Wait another 2 days for the swelling to go down. Antibiotics are given. No more Oclacitinib for the next 6 weeks when on cast. The dog may feel itchy and scratch again, including the right hind leg skin!
UPDATE ON JAN 22, 2019
The Westie came in as he had a gigantic lick wound above his right elbow. Pus and raw flesh and fat were seen. Blood test showed high total white cell count indicating bacteraemia. The dog is an inpatient for 7 days to get the infection under control and cleaning of the wound. He was clipped bald and given anti-inflammatory injection of pred. He need apoquel 3.6 mg two times per day for 14 days and then 1 time per day for another 28 days, together with antibiotics. Not possible to close the wound.
"I tried changing diets and shampoos for the past 1 year," the young man could not resolve the continuous scratching and itchiness of the old dog. "Bad body odour," he told Dr Daniel. The skin is full of pustules, rashes and ringworm-like lesions. Paws are licked red and limbs are pigmented from constant licking.
Generalised dermatitis with ringworm, bacteria and yeast are the main cause. Whether there is food allergy or not, is another possiblity. Neck alopecia and inflammation. Anal sac area hyperpigmented.
Otitis externa and anal sacculitis compounded the severity of the skin disease.
After clipping bald and around 10-16 days later, the owner came back for a review. He was relieved that the dog's skin had improved.
10-16 days after treatment
The owner is satisfied with the outcome. It will take at least 2 months to know whether the Schnauzer has fully recovered. Monthly reviews with the vet are important.
A young couple visited Vet 1 near their home. Vet 1 inserted a needle into the soft golf-ball sized swelling behind the left ear and above the left shoulder. Clear fluid was aspirated. "It is a salivary cyst," Vet 1 said.
The swelling did not disappear. The couple surfed the internet and came to Toa Payoh Vets. "We saw a Youtube of a guinea pig with a swelling done by Toa Payoh Vets," the gentleman said.
"This looks more like an ordinary cyst rather than a salivary cyst," I noted that the location of this large swelling is distant from the sublingual and submandibular salivary glands. "It is possible to be a salivary cyst but unlikely. Fluid need to be sent for laboratory examination to check for cells," I advised.
Dr Daniel operated. The cyst was large (see picture) but ruptured, spilling clear fluid.
