3400. Eyelid tumour in a Golden Retriever

Sedated. Pre-operation  Eyelid tumour close-up

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ORIGINAL FILES

3399. 3 successive cases of 12-year-old dogs today Jan 17, 2018

Jan 17, 2018
Three clients



1. Open pyometra surgery. T= 37.7C. Anaemic. No surgery today. Owner did not want to operate when the 12-year-old dog was advised last year. No anaemia then.

"Why didn't you operate when the dog had no anaemia?" I asked the beer selling lady. She sells beer to customers at the food court.

"My mum said she was too old to be operated!"
This time, the dog passed brownish red vaginal discharge.






2.  Right elbow and shoulder pain. No X-rays to save costs.  Indonesian maid from tsunami area Krakakata volcano. Her family is Ok.




3.  Big open sore above the right elbow. Blood test. Anti-inflammatory.  E-collar prevented licking.

3398. Rabbit sneezes over 2 years. 3rd opinion. x-Rays

Rabbit, lop-eared, M, 5 yrs   1.31 kg

Adopted as 4-year-old last year. Sneezing intermittently. "Snoring sound". No discharge. 

lst opinion.  Vet 1.  Eye discharge treatment. No nasal scope to check nasal passages.
2nd opinion for sneezing and   eye 'gunk'.  X rays - mineralisation in nasal cavities.  Blood test - low basophil count.  (0.26 x 10^9/L).   Normal  0.56 -2.12

The left eye is smaller in size than the right eye

Frequent sneezing and lethargy but eats

Blood test  - low basophils suggestive of allergies
X-rays - each nose has "mineralisation" masses near to both nares suggestive of foreign bodies

Soft tissue mineralisation should possibly be present in kidneys if it exists.

Rabbit was adopted one year ago when he was 4 yrs old. Had sneezing before adoption and in the past year, but not serious. Owner had given some medication or supplement. Seen 2 vets. No nasal scope able to remove the nasal masses inside both nares

Low basophil count suggestive of  "allergies" or reaction to masses inside the nostrils since a younger age.

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FILES POSTED TO toapayohvets.com

VIDEO

https://www.youtube.com/watch?v=TRJvTiYm0Gw

3397. Rabbit respiratory diseases - article

Rabbit Respiratory Disease

Atlantic Coast Veterinary Conference 2001

Heidi L. Hoefer, DVM, Dipl ABVP

Long Island Veterinary Specialists
West Hills Animal Hospital
Huntington, New York

Upper Respiratory Tract Disease

Because rabbits are obligate nasal breathers, any obstruction of the nasal cavity will result in respiratory compromise. Open-mouth breathing in a rabbit is a very poor prognostic sign and is most often seen in the agonal patient.
The most common cause of upper respiratory disease (URD) in the rabbit is pasteurellosis. P. multocida is a gram-negative, coccobacillus that varies in serotypes and virulence. Other bacteria like Moraxella catarrhalis, Bordetella bronchiseptica, and Staphylococcus aureus may also be present in the nasal cavity.
Clinical signs of upper respiratory infection or "snuffles" in rabbits include rhinitis with sneezing and conjunctivitis, and is the most common form of pasteurellosis. Nasal discharge can be serous or mucopurulent. Rabbits are fastidious groomers and use the forepaws to remove debris from the nares, resulting in matted fur and exudate on the medial aspect of these paws.
Conjunctivitis is common with upper respiratory tract infection in rabbits and results in epiphora, discharge, and periorbital alopecia. Inflammation of the nasolacrimal duct is common and the duct may become obstructed. Because rabbits only have one lacrimal puncta and duct in each eye, occlusion results in chronic epiphora.
There are other causes of upper respiratory disease in rabbits. Maxillary tooth root overgrowth can inpinge on the nasal cavity and result in partial obstruction and inspiratory rales. Ocular discharge and a retrobulbar mass-effect can also be produced with tooth root overgrowth, abscesses, and odontomas of the caudal maxillary teeth. This resembles "snuffles" (pasteurellosis) in some cases.
Diagnosis of upper respiratory tract disease in rabbits is based on clinical signs and physical examination initially, followed by laboratory testing and diagnostic imaging. Auscultation of the trachea and nares may help to distinguish upper airway from lower airway disease. Deep nasal cuture is performed by placing a small-tipped sterile culture swab (Mini-tip culturette^®) 2-4 cm. into the medial aspect of each nare. Some rabbits may violently resist this procedure and may need to be sedated prior to culture using this technique. Innoculation of the swab onto a blood agar plate as soon as possible will enhance recovery of Pasteurella multocida. False negatives are possible and several attempts can maximize isolation of the organism. Of course, other bacteria may be involved as well.
Routine blood testing in affected patients may not show any abnormalities, even with abscessation. It is important to check the hemogram for subtle changes. It is unusual for total white blood cell count elevations to occur with infection in bunnies but changes in the lymphocyte:heterophil ratio may be seen. An elevated heterophil count and lymphopenia may be the only CBC abnormality and may be difficult to differentiate from a "stress leukogram".
Serology testing for Pasteurella multocida is available as an ELISA (enzyme-linked immunosorbent assay). Antibody detection has been used to screen colonies of rabbits for pasteurellosis. There are inherent problems with interpreting serologic tests; false negatives may be present in an immune-suppressed individual and positive tests may indicate exposure and not necessarily active infection. As with other antibody tests, paired sera samples taken 3 weeks apart can help in evaluating a rabbit's immunoglobulin response.
Skull radiographs are an important diagnostic tool in cases of chronic, non-responsive upper respiratory disease. Erosion of the nasal turbinates occurs with chronic Pasteurella rhinitis in some rabbits. Concurrent otitis externa and media may be seen radiographically as an increased opacity in the external ear canal and in the tympanic bulla. Tooth root evaluation can also be made from a series of skull films. For a more detailed study, computed tomography (CT) scanning can be performed.
Treatment of respiratory tract disease is dependent on etiology, if identifiable. Bacterial infection can be assumed until otherwise proven, and therapy directed against Pasteurella multocida should be initiated. Without culture and sensitivity results, antibiotic therapy may have to be on a "hit or miss" basis. Antibiotics with a known sensitivity towards Pasteurella include the quinolones (enrofloxacin and ciprofloxacin), chloramphenicol, the aminoglycosides, penicillin G (parenteral only), and trimethoprim-sulfa drugs. The use of antibiotics that induce bacterial dysbiosis (the beta-lactams, and the macrolides e.g.) should be avoided regardless of sensitivity results. Therapy should be for a minimum of 14 days and in some cases, 2-3 months is indicated.
Removal of potential environmental irritants like dusty bedding and moldy hay and increasing ventilation is helpful. Nebulizing with sterile saline and antibiotics can be done by most owners at home using a store-bought nebulizer (PulmoAide^®, Devilbiss Health Care, Somerset PA). Antihistamines rarely work because allergies are uncommonly identified in the rabbit but can be used if an allergic component is strongly suspected. Avoid the use of steroids.
Conjunctivitis must also be addressed. Good choices for topical therapy include gentamicin, ciprofloxacin opthalmic drops (Ciloxan^®, Alcon Laboratories, Fort Worth), chloramphenicol, and tetracycline. Nasolacrimal ducts should be flushed in all cases of epiphora or ocular discharge.
Prognosis is variable and depends on the bacterial virulence, host response, and therapeutic modality chosen. With Pasteurella, infections can be life-long and treatment may be for control and not elimination of the organism. Deep sinus infections and abscesses are the most difficult to control. There are generally several courses Pasteurella UTI can take in the rabbit: infection and spontaneous elimination, infection with response to antibiotics, infection with initial antibiotic response and subsequent recurrence, and chronic infection non-responsive to treatment. Which course an individual takes is unpredictable but an informed owner is best equipped to deal with chronic upper respiratory disease in their rabbit.

Lower Respiratory Tract Disease

Because rabbits are obligate nasal breathers, it may be difficult on initial presentation to determine if a dyspneic rabbit is suffering from upper or lower airway disease. Careful auscultation of the upper (trachea) and lower airways (lungs) can help differentiate between an upper airway obstruction and lung disease in most cases. Nervous or overheated rabbits will present with an increased respiratory rate and may be panting. This can also obscure normal pulmonary sounds. Ultimately, radiographs may be the only way to confirm thoracic disease and this differentiation is vital to diagnosis, treatment, and prognosis.
Bacterial infections account for the majority of bronchopneumonias in rabbits and once again, Pasteurella multocida tops the list of pathogens. Because pasteurella can spread hematogenously, rabbits with respiratory disease can subsequently develop pneumonia, lung abscesses, and infection essentially anywhere in the body. Other bacterial pathogens include Moraxella catarrhalis, Bordetella bronchiseptica, and Staphylococcus aureus. Other pathogens like Mycoplasma, and Chlamydia, and viruses in general, are not considered significant.
Noninfectious causes of lower respiratory diseases are common in the rabbit and must be differentiated from the bacterial etiologies. Environmental irritants and allergans may play a role as a primary etiology or as a predisposing factor to bacterial opportunists. Rabbit urine is particularly irritating and in poorly ventilated areas may be a problem. Proving an allergic response is difficult; a transtracheal wash may provide a cytological diagnosis. Avoid the use of steroids in the respiratory rabbit and consider antihistamines and bronchodilators if allergies are strongly suspected.
Neoplasia is an important differential in the dyspneic rabbit. Primary pulmonary tumors are uncommon but thymomas are reported and lymphosarcoma is a possibility. More common is metastatic uterine adenocarcinoma. Some of these affected intact females only present when metastasis developes.
Cardiovascular disease can be seen in the rabbit. Most rabbits with clinically identifiable heart disease present in heart failure (the other subset suffers from acute death). Dilated cardiomyopathies have been seen and can produce pulmonary edema and pleural effusion. Arteriosclerosis and aortic mineralization are not uncommon in geriatric rabbits and may contribute to cardiovascular compromise.
Diagnosis of lower airway disease is based on clinical examination and radiographic imaging. Thoracic ultrasound or echocardiography can determine if lung consolidation or abscesses are present, and give important cardiac parameters. In general, blood tests are not as helpful in elucidating etiologies but should always be performed for metabolic profiling and the realistic possibility of concurrent disease. Serodiagnosis of P. multocida can be performed but it has it's limitations and like other serological tests, is subject to interpretation.
Treatment of lower respiratory disease is based on etiology. There is no therapy for neoplasia, so once that has been eliminated as a cause, antimicrobials are the first line of defense (see above). It may be difficult initially to distinguish heart failure from bacterial pneumonia; these bunnies should be stabilized in oxygen and treated with antibiotics until thoracic films can be taken. It is difficult to auscult murmurs in rabbits with heart disease but arrhythmias are detectable in some cases. Heart failure with effusions are approached much like any other animal: pleural effusions can be tapped, diuretics (furosemide) administered, and oxygen provided for the acute crisis. Long term therapy follows that for a dog, cat, or ferret and would ideally be based upon results of echocardiographic studies.
Prognosis for lower airway disease is often poor. Most affected rabbits do not show early signs of disease and are often in the advanced stages of respiratory compromise when presented clinically.

Managing The Dyspneic Rabbit

Rabbits, as prey species, are particularly sensitive to stressful environments and situations. It is vital that these sick cases be handled quickly, efficiently, and with a minimum of stress. In hospital situations, rabbits must not be placed near dogs, or loud noises, and all rabbit cases should be discharged for home care as soon as it is medically safe to do so.
Respiratory cases can be pre-treated with oxygen and stabilized with fluids and antibiotics for 24 hours prior to diagnostic testing. Sedation may be needed for radiographs; this author prefers to administer midazolam (Versed^® @ .5 mg/kg IM) to calm dyspneic or panicky rabbits and add oxygen and isoflurane by facemask as needed.

Recommended Reading

Deeb, BJ: Respiratory disease and the Pasteurella complex. In E. V. Hillyer and K. E. Quesenberry (eds): Ferrets, Rabbits, and Rodents: Clinical Medicine and Surgery. Philadelphia, WB Saunders, 1997, 189-201.

Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker) Heidi L Hoefer
Long Island Veterinary Specialists, Plainview, New York
West Hills Animal Hospital, Huntington, New York

3396. Interpreting rabbit blood values. A Shih Tzu has a painful neck abscess

INTERPRETING LAB TEST RESULTS ON RABBITS

by Lucile Moore

Understanding those emailed or printed results we get after our rabbit’s lab test can be difficult. I hope that the following explanations of two commonly‐ordered tests will help readers interpret their rabbit’s test results.

Printed results of the tests may be presented in graphical or numerical form. They usually include the test name and/or abbreviation, results, and the low and high ends of the normal range for that test.

Results that fall outside the normal range may be noted in some way. It is important to compare the results to the range provided by the laboratory rather than ranges published in texts or online as different methodologies used for the test will result in slightly different ranges.

Rarely, errors in taking, handling or analyzing the sample will cause erroneous results, particularly if the sample is not stored correctly or is not analyzed soon enough after taking it. If you have concerns about the validity of a test result discuss it with your vet. In some cases a new test may be warranted.

Haematology.
In a CBC, or complete blood cell count, the amounts of the different kinds of blood cells present are tested.

Red blood cell (RBC or erythrocyte) count: Male rabbits and older rabbits tend to have higher counts than female and younger rabbits. Dehydration and stress from cold temperatures can cause high RBC counts. High counts of nucleated RBCs can be a sign of a bacterial infection; a very high count of nucleated RBCs can be a sign of a bad flea infestation or internal bleeding.

Slightly elevated counts of nucleated RBCs are not an abnormal finding in rabbits. The HCT (Hct, haematocrit) is a test in which the percent of red blood cells is calculated. A low value may be a sign of anemia. Hb, or hemoglobin concentration, can be used to help diagnose anaemia (low Hb) and its origin. Female rabbits tend to have much lower HB and Hct than males. Rabbits that get a lot of exercise may have elevated RBC, HB, and Hct values.

Platelets: High counts may be associated with iron‐deficiency anaemia and chronic bleeding. Cold stress can also cause elevated platelet values, as may drugs such as glucocorticoids and epinephrine. 

Low levels may be a sign of a severe allergic reaction, massive bleeding, aplastic anaemia, and systemic bacterial or fungal infections. Low values can also be caused by storing the sample for too long before it is analyzed.

White blood cells (WBC, leukocytes): White blood cell counts vary depending upon the age,  sex, breed and season of the year. 

WBC counts may include counts for specific types, such as monocytes, lymphocytes, neutrophils/heterophils and basophils. 

In rabbits it is often the proportion of the differing kinds rather than the total WBC count that helps determine the presence of an infectious disease. The proportion of neutrophils to lymphocytes should be 1:1; in a rabbit with an acute infection the proportion will often be nearer 2:1. 

A high value for monocytes can be a sign of chronic infection and a high value for eosinophils and/or basophils can be a sign of a parasitical infection.

Serum/blood chemistry. The focus on these tests is on parameters of blood other than cell counts.

Serum glucose: Although high glucose can be a sign of kidney disease, it is often caused by stress, including the stress of the trip to the vet and having blood drawn. High glucose values can also occur in rabbits with acute intestinal obstruction, hepatic lipidosis, hyperthermia, and shock. 

Some drugs can also cause elevated glucose levels, as can diabetes, but diabetes is extremely rare in rabbits. Low glucose levels can be caused by anorexia, digestive tract problems, liver disease, and septicaemia.

BUN (blood urea nitrogen): A key test used to assess kidney function. Urea levels depend upon a wide variety of factors, including the time of day, the amount of protein in the diet and how hydrated the rabbit is. Slightly high values are not uncommon in healthy rabbits. 

High values may indicate there is some kind of kidney disease. Elevated values can also be a sign of encephalitozoonosis (EC). Low levels may be caused by anabolic steroids or liver damage.

Rabbits on corticosteroids, tetracycline, or aminoglycosides may have elevated levels; rabbits on chloramphenicol can have either low or high levels.

Creatinine: High values are often a sign of severe kidney or muscle damage. This test is less influenced by external factors than the BUN. However, levels may be high in rabbits that have gone a few hours without drinking water. A disadvantage of this test is that it does not show high levels until there has been substantial loss of kidney function (excepting temporarily high levels caused by dehydration, which do not involve such loss of function).

 Cholesterol and triglycerides: To obtain accurate values for cholesterol the animal must be fasting. Since it is unsafe to fast rabbits for more than a couple of hours, not to mention that it is essentially impossible to fast most rabbits because of consumption of cecotrophs, results from this test should be considered only in conjunction with other tests. 

High cholesterol values can be caused by obesity, a diet high in fats, pancreatitis and chronic kidney failure. Values also be high if the rabbit is not eating enough, but this is a sign of advanced hepatic lipidosis and has a poor prognosis. High triglyceride levels may be a sign of chronic kidney failure.

Calcium and phosphorus: Calcium levels are primarily influenced by the calcium content of the diet. High blood calcium levels in conjunction with clear urine (showing it is not being excreted as it should) are a sign of kidney failure. 

Low calcium levels are rare but can occur in rabbits with poor nutrition. High phosphorus levels can be a sign of chronic kidney failure or soft tissue trauma.

Serum protein: Total protein levels may be high in rabbits that are dehydrated, whether from gastrointestinal hypomotility (stasis) or other reasons. Low levels can be caused by malnutrition or liver disease. Low levels of albumin (a specific protein) can be a sign of a heavy infestation of parasites, and high levels are a sign of advanced liver disease.

Bilirubin: High serum bilirubin levels in young rabbits are often caused by hepatic coccidiosis; in older rabbits they are more likely to be caused by an obstruction of the bile duct by neoplasia (cancer) or an abscess.

AP (ALP, alkaline phosphatase): The normal range for this test is wide and varies with age (young rabbits have higher levels) and breed. A high value may be a sign of diseases affecting liver function such as hepatic coccidiosis, liver abscesses, and neoplasia.

 ALT (alanine aminotransferase), also called GPT and SGPT: Another test that helps the vet assess whether there has been any liver damage. Mildly high levels may be found in rabbits that appear healthy and it is thought they may be caused by low concentrations of toxins such as aflatoxins in food or compounds in wood‐based litters. 

High levels may be a sign of hepatic lipidosis or liver damage from hepatic coccidiosis.

AST (aspartate aminotransferase), formerly called SGOT: High values in conjunction with high ALT, AP, or protein may be a sign of liver damage. High levels may also be caused by the rabbit struggling during collection of the sample.

Urinalysis
The urinalysis is another lab test that is ordered fairly frequently. More so than in blood work the normal value is often “negative,” or the absence of the tested‐for compound.

 Protein: The normal finding is negative to trace amounts. High amounts can be a result of kidney damage/disease. High levels can also be caused by dehydration, strenuous exercise or stress, and for this reason protein is best looked at in conjunction with the specific gravity and the ratio of protein to creatinine. Dilute urine with a high protein value is more likely to be a sign of kidney damage/disease than concentrated urine with a similar protein value. Low protein levels can be a sign of malnutrition.

SG (specific gravity): An SG level at the lower end of the normal range when combined with high creatinine and BUN is a sign of poor kidney function.

pH: Normal rabbit urine has a high pH (7.5‐9). Lower pH can be caused by high‐protein diets, severe
anorexia, and fever.

Glucose: The normal finding for glucose is negative, although trace amounts may be found in healthy rabbits. Higher amounts can be caused by stress, including pain or any experience which is frightening to the rabbit.

Ketones: The normal finding is negative. The presence of ketones indicates starvation or severe anorexia. Ketones may be seen in rabbits with severe dental disease that prevents them from eating or in rabbits on hay‐only diets that have severely impacted cecums. Rarely, ketones in the urine may be caused by diabetes mellitus.

Bilirubin: High levels of bilirubin in rabbit urine are unusual but elevated levels may be caused by poisoning from aflatoxins in contaminated food, hepatic coccidiosis, or neoplasia.

 Haematuria: Normally there is no blood present in rabbit urine. A positive result may be caused by inflammation and/or a urinary tract infection, crystals, or, less often, neoplasia.

Sediment: Calcium carbonate sediment is a normal finding in rabbit urine. Other crystals can be caused by drugs the rabbit is taking, and struvite crystals can be a sign of bacterial infection.

Urobilinogen: The finding for a healthy rabbit is negative. High levels may be caused by liver damage or drugs such as sulfonamides; low levels can be caused by long exposure to light.

Nitrate and nitrite: Urine normally contains nitrates, but some bacteria convert nitrate to nitrite. The normal result for nitrite is negative; a positive result is caused by bacteria in the urine. However, not all bacteria are able to convert nitrates to nitrite, so a negative result does not mean a UTI is not present.

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10 Dec 2010.

CHUBBY – DOG – Shih Tzu 9 Y/O Male. A very painful encapsulated neck abscess  

 CBC interpretation: Haematology Profile: Description: The CBC is commonly performed on an automated haematology analyzer using well mixed whole blood that is added to a chemical (EDTA – Ethylenediaminetetraacetic Acid) to prevent clotting.

 A CBC is a group of tests used to quantify the number of RBCs, WBCs and platelets, provide information about their size and shape, measure the haemoglobin content of RBCs, determine the percentage and absolute number of the five white blood cell types, and identify early and abnormal blood cells.

These tests are performed simultaneously. Analysis (Haematology): Haematology Result Unit Ref. Range Haemoglobin 18.4 g/dL 12.0 – 18.0 Red Cell Count 7.7 X10^12 / L 5.5-8.5 Total White cell count 8.3 X10^9 / L 6.0 – 17.0 Differential Count % Absolute V. Unit Neutrophils 68.19 5.66 X10^9 / L Lymphocytes 21.08 1.75 X10^9 / L Monocytes 6.14 0.51 X10^9 / L 

 Eosinophils 3.49 0.29 X10^9 / L 

 Basophils 0.96 0.08 X10^9 / L PCV 0.48 0.37 – 0.55 MCV 63 fL 60 – 77 MCH 24 Pg 20 – 25 MCHC 38 g / dL 32 - 36 RDW 15.7 % Platelets 491 X10^9 / L 200 - 500 

 Haemoglobin: 18.4 g/dL • This value is lightly above reference range but it should not be of much significance as the red blood cell count, PCV, MCV, MCH, RDW are all within normal limits. 

• Haemoglobin concentration is normally used to diagnose anaemia, which can be caused by microcytic RBCs, which are smaller than usual in size and unable to carry sufficient Oxygen. Macrocytic anaemia usually occurs when the division of RBC precursor cells in the bone marrow is impaired. The most common cause of macrocytic anaemia are vitamin B12 deficiency, folate deficiency and liver disease. Normocytic anaemia may be caused by decreased production of RBCs (any cause of bone marrow failure), increased destruction of RBCs (haemolytic anaemia) or loss of blood. 

 Total White Cell Count: 8.3 x 10^9 / L (within normal limits) • 

Normal white cell count usually indicates that the animal is not in any threat of infectious diseases and foreign bodies. • An elevated white cell count usually occurs in infection, allergy, systemic illness, inflammation, tissue injury and leukemia.

 • A depressed white cell count may occur in some viral infections, immunodeficiency states and bone marrow failure.

 • The white blood cell differential count will reveal which WBCs are affected the most • Neutrophils are the most abundant granulocytic cells and are phagocytic cells that aid in the removal of bacteria and antibody-coated antigens • Lymphocytes are the 2nd most abundant monocytic WBCs and originate from the lymphoid tissues and are NOT phagocytic. They are responsible for initiating and regulating the immune response by the production of antibodies and cytokines.

 • Monocytes are the largest monocytic WBCs and are phagocytic cells that process and present antigens to lymphocytes, an event required for lymphocyte activation 

• Eosinophils are granulocytic WBCs that have cytoplasms filled with granules that contain peroxidise, hydrolases and basic proteins that aid in the destruction of phagocytised cells. They are increased in allergic and parasitic infections

 • Basophils are granulocytic WBCs that contain large amounts of histamine, heparin and acid mucopolysaccharides. They mediate the allergic response by releasing histamine.

 Platelets: 149 x 10^9 / L (Below reference range of 200-500) • Platelets are disc-shaped structures formed from the detachment of cytoplasm from megakaryocytes. They aid in the coagulation process by attaching or adhering to the walls of injured blood vessels, where they stick together to form the initial platelet plug. 

• A low platelet count may occur in patients with viral infections, lymphoma or animals taking certain drugs such as quinine and quinidine. • Decreased platelet production is also a cause of thrombocytopenia, and may be due to aplastic anaemia, leukemia, lymphoma or bone marrow fibrosis. • 

A low platelet count can occur due to increased destruction and can result in antibody production that is often drug-induced (heparin treatment being a prominent cause)

 • In relation to this case, Chubby’s decreased platelet count might be auto-immune, resulting in platelet destruction and decreasing his ability to clot blood and predisposing him to conditions such as TTP (Thrombotic thrombocytopenic purpura) and DIC (Disseminated intravascular coagulation). 

BIOCHEMISTRY RESULTS: BIOCHEMISTRY RESULT UNIT REF. RANGE Total Cholesterol 4.75 Mmol / L HDL Cholesterol 3.72 Mmol / L LDL Cholesterol 0.20 Mmol / L Cholesterol / HDL Ratio 1.28 Mmol / L Triglycerides 1.83 Mmol / L Glucose 4.1 Mmol / L 3.9 – 6.0 SGPT / ALT 59 U / L < 59 SGOT / AST 41 U / L < 81 Calcium 2.06 Mmol / L 1.50 – 3.60 Uric acid 0.01 Mmol / L

3395. The perineal hernia started to bulge much more.

Jan 11, 2019.

"The bulge is much bigger than last week," I asked the owner if the dog had passed motion. If not, the stools could be trapped inside the rectum which had bulged out on the right perineal hernia.
An emergency hernia repair instead of neuter is done today.

Swelling right perineum seen

Stitch breakdown at home. 2 other dogs licking and playing

Day 2 of inpatient

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ORIGINAL FILES

HOOK

3394. A 13-year-old Jack Russell has fits

HOOK



SETTING
Singapore Toa Payoh township. One of the first townships built. Around 1950s? (research).
New apartments. Central location. High demand.

Jan 3, 2019. Fits

FOLLOW UP ON JAN 10, 2019

Now stabilised at 1.5 tab bid. Tends to be sleepy.
Appetite
Ask vet about euthanasia if recurrence or because dog is old and sleepy.

Proper dosage and 12-hourly
Can live past 13 years old.