The Bull Terrier has
whistling lung sounds and bilateral cryptorchidism
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date: 30 July, 2011 |
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Be Kind To Pets
Veterinary Education
Project 2010-0129 |
On this bright Sunday, July 24, 2011 morning, I was preparing to
operate on the Silkie Terrier with "the mother of all perineal
hernias" as described in
Perineal hernias in a Silkie
Terrier repair pictures. Update on a Boston Terrier's perineal
hernia. The dog had his hernias repaired 11 days ago. However,
the skin where his herniated bladder and intestines had crushed had
little blood supply and the cells started dying. This is called
gangrene.
A young couple arrived promptly at 9.30 am as they had made an
appointment with me. They wanted to neuter a good looking solidly
built miniature 2-year-old "miniature" Bull Terrier.
A hyperexcitable dog, resisting handling and turning upside down to
examine his testicles which were not present inside the scrotum as
in normal male dogs.
"Listen to the whistling sounds," I handed the hearing piece of the
stethoscope to the husband so that he could listen to the whistles.
I could hear the heart sounds separately but the continuous
whistling sounds blocked out the heart sounds. This sounds reminded
me of a condition similar to the racehorse - laryngeal hemiplegia.
"They are heart sounds," the husband declared. I asked if he had
medical training but he had none. He heard loud distinct whistles in
the stethoscope and therefore deemed them to be heart sounds.
"Well, they are lung sounds," I said. The heart sounds were muffled
and he could not hear them since he had no experience with dog heart
auscultation.
SYNCOPE
It was in 1974 when I was in my 5th year of veterinary studies at
Glasgow but I still remember the word "Syncope" mentioned in my
veterinary lectures. At that time, syncope was a word meant to be
remembered for the examinations. I seldom encountered this transient
fainting and spontaneous recovery after a short while in dogs in my
over 30 years of practice. This miniature Bull Terrier appeared to
be suffering from this condition and more detailed heart
examinations including the ECG will be needed.
The dog has a history of fainting when over-exerted. "When he plays
vigorously with the bigger and younger 8-month-old standard Bull
Terrier, he could just simply collapse, as if out of breath and lie
down for a while. Then he would recover completely. As if he has
caught his breath and behaves normally."
This bit of information from the husband is valuable. It indicates
that this dog has a cardio-pulmonary problem. He is a highly risky
candidate for anaesthesia. I checked the gums. Excellent pink
colour. However, the left inside lip had a yellow ulcer and several
holes. "Bitten by the other bull terrier?" I asked. "Probably," the
husband said. "They bite each other."
Two undescended testicles. With the dog upside down, I could palpate
the left one. The right one was barely felt as it slipped inside the
body. "My advice is to prepare for general anaesthesia rather than
just take out one. When the dog is down, his right testicle may just
disappear inside. Under anaesthesia, I can open up the abdomen and
locate and get it out. (Undescended testicle can become cancerous
years later). Neutering was to reduce his hyperexcitability.
BLOOD TEST
The couple agreed to the complete blood test. The liver enzymes were
high while the platelets were below normal.
"Why?" the husband asked.
"Did you feed herbal or other supplements?"
"Yes," he said. "One iodine capsule per day since he was a puppy."
"Is the dosage recommended for the dog?" I asked.
"I gave one capsule as recommended for adult people," he said.
HIGH ANAESTHETIC RISKS
Based on his history of syncope, the liver disorders and low
platelet count, I advised against surgery for the time being.
Another blood test can be taken 4-12 weeks later. Definitely, no
more iodine or other supplements and wait one month for another
blood test.
The liver could have had been damaged by the iodine and its other
ingredients consumed over the past 2 years. "It is not just iodine
alone inside the capsule," I said to the husband. "The manufacturer
will add other substances. Over the years, the liver could have been
damaged. As to why the dog was given iodine, I did not ask the
owner. It was good that he agreed to a blood test.
UNDESCENDED TESTICLES if normally felt under the skin can be
easily removed via skin incisions as shown in the case of the poodle
below. In this miniature Bull Terrier, one testicle is barely felt.
To save on veterinary cost and the need for another operation to
open up the abdomen to remove the hidden testicle, it is best to put
the dog under general anaesthesia, open up the abdomen, locate and
remove the abdominal testicle inside as well as to remove the
inguinal testicle under the skin.
INFORMED CONSENT
If the dog is healthy, there should be no anaesthetic risk but this
miniature bull terrier has some health problems. So, the owner has
to take the risk and be given proper information of the risks and
options (informed consent). It is best that this be recorded in the
case files, in case of litigation and complaint when the dog dies on
the operating table.
NEGLIGENCE AND REMOVAL OF THE HIDDEN ABDOMINAL TESTICLE NEEDS A
LONGER SURGERY
In some practices, since the dog has only one undescended testicle
felt under the skin, this is only one that will be removed during
the traditional neuter while the abdominal one is not as that
necessitates opening up the abdomen, prolonging anaesthesia and
increasing the risks of dying on the operating table. This is not in
the interest of the dog or owner as the hidden testicle inside the
abdomen can become cancerous in old age and I had seen some cases
(revealed by X-ray). A negligence litigation suit may result.
Therefore, the owner must be well advised and both testicles must be
removed. Not just the one under the skin. The hidden testicle is
usually seen located just below the mid-penile area and can be
hooked up to be tied and taken off.
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Cryptorchidism can be
either bilateral or unilateral, and inguinal or abdominal (or
both). This poodle has bilateral inguinal cryptorchidism. Therefore you can see both
undescended testicles under the skin. In abdominal
cryptorchidism, the testicles are inside and there is a need
to open up the abdomen to take out the "hidden testicle." |
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In the case of the
miniature bull terrier, one testicle is in the inguinal and
one is retracted into the abdomen when the dog is held upside
down. Neutering or castration is strongly advised as there is
a high chance of the undescended testicle becoming cancerous
in older dogs. |
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