June 13, 2013  7.35 pm review

I may or may not work in the evenings as Dr Daniel would be present. However, on June 13, 2013,. Dr Daniel had gone to a "Dirty Dancing" concert at Marina Bay Sands and so I handled the cases after 6 pm. Surprisingly two dogs had intense ear and skin itchiness were brought in by two couples in their 30s. I used the UVL to show and tell. One dog was an aggressive Jack Russell. The other was a Shih Tzu.

Both ringworm-infested hair shafts fluoresce apple-green while the normal hair showed plain lighting. This was quite impressive to the owner. I asked intern Ms Toh to video the UVL procedure but I know it is difficult to capture the real images owing to our lack of experience in videography.

 "Lots of hard rubbing of the skin and ear irrigation and medication is needed," I emphasized to the two couples. "Review in 3 weeks."

Case 1. The ferocious Jack Russell that all vets avoid
The first couple had seen a few vets and skin scrapings were negative. "The main problem is the painful itchy left ear," I said. "There is a red circular skin patch in front of the left ear of 4 cm across. It would be ringworm . Also, the left inguinal area is extremely red while the right is normal white. Therefore, I can say that this is not a case of contact dermatitis although some vets will say it is ventral contact dermatitis. In such cases, both the left and right inguinal areas are inflamed. Your dog only has the left side blood red, now obvious after clipping the whole body bald." The couple had brought the dog in the morning. I gave him immediately a Dom + Ket 0.1 ml + 0.11 ml IM and the dog was sedated for dental scaling and hair clipping without biting my assistant and me.  The owner came in the evening after work to take the dog home and I had a lengthy discussion with them as generalised skin diseases are not so easily treated by owners despite seeing several vets.

"If you see 10 vets, you will have 10 different opinions as to the cause of the skin disease.

"From my observation, the dog uses his left hind paws to scratch vigorously the left inguinal area because the left ear is extremely painful. Most owners will wonder what the left inguinal area's itchiness has to do with the left ear being infected? There is a nerve connection and you will see the dog's hind leg moving whenever the same sided ear is itchy. Only in this dog, the leg scratches the inguinal area. Normally it scratches the flank and belly area."

The Jack Russell shook his head sideways and this was a clue that he has ear problems. As to which ear he scratches more, the couple did not know. "I saw both ears being scratched," the husband said. I would say it is the left ear as the inflamed skin was present mainly on the left ear base and the left inguinal area. Only the dog knows and he cannot talk!

Case 2. The timid Shih Tzu is a tiger at home.
As for the Shih Tzu, he bites the owners but was docile at the consultation table. He did not bite me or my assistant.

I advised: "Feed the anti-fungal and antibiotic medication tablets inside cheese balls when he is hungry. Irrigate his ears with ear drops downstairs away from his home base as he may be more docile.

"Do you sell muzzles?" the wife asked me.
"This Shih Tzu is hard to muzzle as he has a flat face," I said. "Use the net from the oranges for sale to cover his face but I doubt it will work."  I muzzled the dog with my muzzle but it was too long. "More for a Jack Russell with long nose," the wife laughed. Still the owner must work hard on the ear to resolve the problem.

Going downstairs to clean the ears may be successful as the dog appears timid in the clinic but ferocious at home. 

In the Jack Russell, it is unusual as the left inguinal and scrotal area were very red. Neck skin and paws also were red. One paw showed fluorescence at the pad junction but the dog wanted to bite me when I tried to lift the paw up to shine the UV light. The wife was convinced.

In the Shih Tzu, the neck showed a large circular patch of 5 x 4 cm which fluroesce green in certain parts, confirming ringworm. The wife was quite impressed with this show and tell. The chin was inflamed too. Ear surface were rough but not much pain when I pressed both ears. In this case, the main area of itchiness was inflamed by ringworm and the belly, flank and inguinal area were OK.     
 

THREE URINARY STONE CASES IN A ROW.

Case 1. Urine crystals 3+ but no stones in the X-rays.
This morning, I got a 2-year-old female cross X-rayed as her urine test showed triple phosphate 3+ crystals. X-rays did not show any stones.  S/D diet for 2 months advised by Dr Daniel.

Case 2. 10 little bladder stones
Yesterday's X-ray of the male, overweight older Jack Russell, emptied bladder and catherised showed at least 6 bladder stones of 3 mm across. Dr Daniel operated today and removed 10 stones. Urine test showed calcium oxalate crystals.

The dog is resting as I typed this report and is given IV drip. "His bladder bleeds and tears whenever I stitch the tissues," Dr Daniel says. "His bladder wall is thin as he is not badly infected for some time. There is little inflammation and so there is a difficulty in stitching with 3/0 monosyn."   As for me, I used 3/0 absorbable braided with smaller needle but the monosyn comes with a bigger needle. Each vet has his or her own preferences.


Case 3. Update on blood in the urine in a female poodle with bladder and kidney stones.

Female Poodle with one big bladder stone and small kidney stones. The owner phoned for appointment tomorrow Friday for surgery. I will be operating. This case was infected as the total WCC was high at 25 but now the dog is OK and active. Case is at: Against Medical Advices. So, my operation can proceed tomorrow, Jun 14, 2013.

Update on Jun 26, 2013: The dog went home on the 3rd day after surgery and has no post-op problems other than bruising her inguinal area with the e-collar. The bruises disappeared with time. The owner was advised to give S/D diet to dissolve the kidney stones.