3478. A 2.5-year-old dwarf hamster becomes emaciated and hunched - overgrown tooth

"My dwarf hamster has not been eating much for the last few weeks and has lost a lot of weight," the father and son consulted me. "He has a hunched back. He eats only the soft seeds and very few of them. He could eat cooked rice."

"His tooth is overgrown!" said the young adult son who had researched the internet, like numerous young Singaporean pet owners.

"The overgrown right lower front tooth poked into the upper gum, causing oral pain and infection," I explained. "The hamster is emaciated and dehydrated. He is unable to crack the seeds with overgrown front tooth and drink properly." 

Treatment was by clipping short the overgrown right lower tooth to the same level as the left lower one, oral antibiotic, pain-killer and multi-vitamins.  He ate 20-30 sunflower seeds without the shells overnight and was active and not dehydrated by Day 7 of in-patient treatment. He was sent home.

"How long does the dwarf hamster live?" the mother asked when she and her husband picked up the hamster on Apr 6, 2019.

"Around 2.5 - 3 years if healthy," I replied. "Your hamster is aged. He has no tumours and should live to a ripe old age of 3 years." 

Successful outcomes in treating emaciated hamsters are not guaranteed as many are very ill.
Whenever your hamster loses appetite, examine his front teeth and consult your vet early as dehydration, infections and emaciation will lead to early death.

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FB post

Apr 7, 2019 - Overgrown tooth and long curved toe nails

Old dwarf hamsters that lose a lot of weight will die due to illness or malnutrition and dehydration. Some owners think the hamster is very old at 2.5 years of age and th erefore this appetite loss is natural. Why waste money in veterinary treatment when the dwarf hamster's life span is 2.5 - 3 years?

In this case, the young adult son must have researched the internet and correctly diagnosed "overgrown front tooth" as a cause of emaciation. But is it too late as inappetance occurred for the past few weeks?

The 2.5-year-old dwarf hamster ate little and only soft pieces of hamster food and cooked rice for the past few weeks.

His toe nails are very long as he is too weak to exercise in the wheel. The cause of his emaciation and dehydration can be treated by clipping his overgrown tooth short to level with the other tooth. After 6 days of in-patient treatment, his stool pellets have increased in number, indicating he has recovered. More details are at:

Blog

https://2010vets.blogspot.com/2019/04/3478-25-year-old-dwarf-hamster-becomes.html.

The Youtube videos of Day 1 and Day 7 of treatment are at:

Day 1 - admitted as an in-patient

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

Day 7 - goes home

https://www.youtube.com/watch?v=cOJJX9sllSo

3477. VIDEO CREATION BY INTERN. The 4-year-old Silkie Terrier vomited for 21 days - cloudy X-rays

HOOK

The vomiting  4-year-old Silkie Terrier had been examined by 2 vets as he had swallowed numerous chicken ribs, according to the owner.

Chicken thigh bones at the supermarket are fried at home. Bones in the garbage bin are sometimes scavenged by the dog

Vet 2 was consulted as the dog still vomited after consulting Vet 1 two days earlier.

"Vet 2 had X-rays and ultrasound done and reported no chicken bones inside my dog" the owner was not happy with my suggestion to X-ray check for stuck bones inside the throat and chest. "Vet 2 told me there were no chicken bones seen. Why do you still want to X-ray to find chicken bones in my dog?"

Day 3 of vomiting. Vet 2's X-ray report says "no bone" inside the dog. He confirmed by ultrasound scan.

 "X-rays by Vet 2 were done on Day 3 of vomiting," I understood the owner's worries about high veterinary medical costs of the aids to diagnostic tests.  "The dog has daily vomiting for the past 16 days!"

The owner sought Toa Payoh Vets as the 3rd opinion. He was adamant that no X-rays be done. After treatment, the dog went home. But the dog persisted in vomiting. What should the owner do now?

This is a Be Kind To Pets Veterinary Educational Video sponsored by Toa Payoh Vets

CLOUDY X-RAYS in veterinary practice

The vomiting 4-year-old male Silkie Terrier was seen by Vet 1. As he continued vomiting, Vet 2 was consulted and performed X-ray and ultrasound examination. He stated that there were no chicken bones swallowed.

The dog had already vomited after eating for the past 19 days. The owner agreed to pay for further X-rays.

X-RAYS
X-RAYS BY TOA PAYOH VETS on Nov 6, 2013 (Day 21) showed distinctly a chicken thigh bone (femur).

Looks more like a chicken thigh bone (femur)

Intern:  To narrate the history as shown in the  text in the above X-rays shown in the video

Ventro-dorsal view is not useful in seeing chicken bone lodged in the oesophageal/stomach junction
as the heart and diagphragm obstruct the view of the junction

X-RAYS BY VET 2 on Oct 21, 2013 (Day 3 of vomiting). 
The cloudy X-rays were not clear leading to a misdiagnosis by Vet 2 of "no chicken bones". 

Day 3 of vomiting. If you view or enlarge the X-ray, a chicken bone stuck in the oesophagus/stomach junction can be seen

Cloudy X-ray indicates incorrect exposure settings

Ventro-dorsal view is not useful in looking for chicken bones in the oesophageal/stomach junction

SURGERY at Toa Payoh Vets

Gastrotomy by Dr Daniel Sing and Dr Sing Kong Yuen

Dr Daniel incised a 1-cm stomach incision.  He inserted a long tissue forceps into the stomach towards the oesophagus to to grasp the chicken bone. He could not grasp the intact chicken thigh bone as seen in the X-ray. . 

I passed a stomach tube from the mouth into the stomach. Copious amount of fluid filled with bubbles shot out of the tube. I withdrew it to clear the froth. A second stomach tubing encountered some obstruction in the caudal oesophagus and was withdrawn. The third stomach tubing pushed small pieces of bone fragments into the stomach. The small and large intestines had no bones but were inflamed. The stomach was stitched up.   

The dog recovered fully after 10 days. He was still trying to scavenge the garbage bins for chicken bones. 


VETERINARY TIPS AND ADVICES

1. IMAGE-EDITING
Vet 1's X-ray image needs to show better contrast. 

In retrospective study, I could see a chicken bone in Vet 2's image on Day 3 of vomiting, after image-editing using Photoshop. However, a recent X-ray needs to be performed to get the update of the situation before surgery. This must be explained to the owner before surgery.

Compared to Toa Payoh Vets' X-ray on Day 21 of vomiting





2. CHICKEN OR PORK BONE OBSTRUCTION.

If the chicken bone is stuck in the oesophageal-gastric area, the gastric acid may dissolve the bones over time. This depends on the size and amount. Vomiting for 21 days could have killed the dog due to malnutrition, dehydration and oesophageal ulceration and infections.

Pork bones in the similar situation will not be dissolved by gastric juices according to one senior veterinarian with over 50 years of small animal practice.

CONCLUSION

 Cloudy X-rays are caused by incorrect exposure settings. Some images can be photoshopped to increase the contrast as in the image of Vet 1 on Day 3 of vomiting.

However, an updated X-ray needs to be performed on Day 16 of vomiting to assess the position of the chicken bones in the oesophageal/stomach junction as the gastric acid reflux from vomiting could have dissolved the chicken bone. In this case, the chicken bone which was a thigh bone was clearly visible and the solution was surgical removal.

Cloudy X-rays lead to a misdiagnosis. The owner can sue or complain to the veterinary authorities. 
Vets will need to be careful as litigation for negligence is costly and time-consuming. In this case, the owner demanded compensation from Vet 2 and got some money to settle the case.
 


3. REFERENCES: ORIGINAL VETERINARY REPORT

 http://www.sinpets.com/dogs/20131107chicken_rib_bone_oesophagus_dog.htm

 https://2010vets.blogspot.com/2013/11/1154-why-is-dog-still-vomiting-19-days.html

CREDITS
include Intern's name

vet assistants x 2

FOR MORE INFORMATION

6254-3326 etc.
www.toapayohvets.com/videos.htm



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Show text on slides and narrate as a lecture. See example at:


Wait for me to locate the video. thanks.



   

3476. Bad teeth and gum tumours (epulis) in an old Cairn Terrier

Epulis is a tumour or tumour-like mass growing from the gingiva. It may be caused by traumatic injury or be a growth.  .

3475. Nature stories: Exercise area - Pigeons on Thu Apr 4, 2019

April 4, 2019
Bright sunshine. Saw a black naped Oriole, one pink-necked green pigeon, brown pigeon and much smaller bird perched on the trees. Hidden by leaves. Difficult to capture sharp images.

Only this image is able to show the bird in full body.

The others show partly hidden birds.

.
Last 2 days, April 2 and 3 were drizzling and the sky was overcast. No birds.

3474. The 57-year-old vet has autoimmune disease!!!

April 3, 2019

"Auto-immune disease!!!" the vet's wife WhatsApp to me the diagnosis of the specialists who had the reports of blood tests, urine tests, ultrasounds, radiographs,  and MRI scan of the neck vertebra.

"Why do you say he has auto-immune disease?" I know this diagnosis  is not good for a longevity as the vet is only 57 years old.

"The dsDNA (DNA) antigen  is 28 meaning it is 2+ when it should be 0-5 i.e. negative", the wife replied. "Also the ASO (Anti-Streptolysin O) titre is very high at  477 when the normal is less than 200".

ASO is an antibody made by people to eliminate the the Streptooccus bacteria infecting them. The increase in ASO titres in the blood can cause damage to the heart and joints as well as other organs like the brain and skin. These antibodies attack mainly human antigens (mainly collagen). The husband recently suffered a very painful left neck pain and had stopped operating on many dogs daily over the past 20 years as he has a thriving practice.

Hence the vet's wife diagnosis of her husband suffering from auto-immune disease now.
"Your husband is not suffering from auto-immune disease," I explained that when the ASO titres are very high, it indicates exposure to Streptococcal bacteria. However it does not indicate disease if there are no clinical signs. A high ASO titre may be a false negative as false negatives rates are 20-30%. Hence a dsDNA antigen test needs to be done. If the DNA antigen is positive, it means that her husband has a recent Streptococcal bacterial infection, provided he has no rheumatoid fever or kidney disease (glomerulitis).

The husband's blood test showed normal blood urea and creatinine, phosphorus and sodium, normal thyroid stimulating hormone level, normal RA (Rheumatoid Factor). Urine test was normal with no proteinuria, bacteria, leucocytes and epithelial cells.

The ESR (Erythrocyte Sedimentation Rate)  is high at 16 (2-6). This is due to his suffering from hypochromic microcytic anaemia suspected to be thalassemia, a genetic blood disorder he has had inherited.

The X-rays showed a calcified lump in the lung and must be monitored for lung cancer.
The abdominal ultrasound showed a renal cyst.

The tumour marker test showed EBV Capsid Ag IgA AbIF positive, but EBV Early Ag IgA Ab IF negative. The vet has to monitor these values by repeating the test, the  as ear, nose and throat cancer is  common in Asian Chinese.  

Solutions:

1.  The vet loved surgeries and had hunched over the patient for long periods of time on a low operating table instead of one with hydraulic movement to elevate to his height. Bone fracture repairs in stray dogs knocked down by vehicles are common in his practice and such surgeries take a longer time to operate.

1.1. Physiotherapy relieves the pain and numbness in the left shoulder but is not a cure.
1.2. Invest in an operating table with hydraulic system. 
1.3  Best to stop operating. 
1.4. Stop texting for long periods of time

2.    The MRI scan of the cervical vertebra shows osteophytes and degenerative disc lesions at C3/4, C5/6, C6/7. The  disc spaces are narrowed. "The C6/7 space is severely narrowed," I said to the husband. "If you do not change your life-style (e.g  hunching on long operating table, texting, computer gaming for long hours, typing on low tables), you will be tetraplegic (paralysed from the neck downwards).  

3. Neurobion and folic acid for thalassemia. Good nutritious diet.

4. Penicillin for a year according to the Specialists to get rid of the Streptococcal bacteria in his blood. 

5. Be hygienic as regards treatment of diseased stray dogs, using gloves, masks and washing hands.

The specialist had given his opinion of a possible auto-immune disease but the wife took this to mean the husband already has it. Hence she WhatsApp message --- "Auto-immune disease !!!". The high ASO titres have to be taken seriously as it can lead to auto-immune disease of the heart and joints. 

3473. The dwarf hamster's leg is trapped inside the exercise wheel

April 2, 2019

2 days ago, at 5am, the hamster gave a shriek, waking up his lady owner. His right hind leg had been trapped inside the exercise wheel. She got the hamster to see me today. The hamster has recovered from the swelling of the leg.

He has no leg fracture and will recover in 7 days.
Discard the poorly designed unsafe exercise wheel

Video

An 11-year-old female spayed Jack Russell has itchy backside and lower body. Why?

Apr 2, 2019
The Jack Russell is obese and the back part of the body has been itchy for the past 3 months. Why?

(Youtube does not like the word "genital").



BLOOD TEST Mar 31, 2019

Significant result is the increase in liver enzymes.
 and high total cholesterol 8.8 mmol/L (3-6.6)


Trigylceride 3.0 mmol/L (0.3 - 3.3) is normal.


Liver
ALT/SGOT  169 U/L  is high (normal value is less than 59) 

Kidney has lower than normal values of:

Urea  3.3 mmol/L (4.2 - 6.3)
Creatinine 66 umol/L (89-117)