"My other dog has
been treated by Vet 1 for the past 12 years," the owner
said he had no veterinary report from the vet who had
treated the presented Shih Tzu of 4 years old for
coughing. "I feel bad to ask Vet 1 for the medical
records and X-rays for this Shih Tzu."
"How long has this Shih Tzu been coughing?" I asked.
"5 months. My domestic worker says the dog has a tongue
ulcer."
"There should be no problem with Vet 1 sending over your
dog's records as this is a common practice. Shall I
phone on your behalf?". The owner agreed and Vet 1 sent
his report over. The coughing started 3 months ago and
blood test and X-rays of the chest and abdomen were
normal.
What's the cause of this persistent coughing? There was
a tongue ulcer at the tip and one on the hard palate. I
shone my torchlight at the ulcers to show the owner. The
dog just would not cooperate, but the owner already knew
of the existence of the ulcer. I palpated the dog's
throat. It was very painful.
"My dog sometimes throw up liquid," the owner said. This
is quite a complicated case as the heart and lungs were
normal on auscultation using my stethoscope. What is the
cause of this persistent coughing?
To complicate diagnosis, the right and left
submandibular and popliteal lymph nodes were much
enlarged. I let the owner feel the lumps. Could this be
a concurrent case of lymphoma or lymphosarcoma?
"Did your tongue lick some poison?" I asked. "Tongue
ulcer at the tip of a normal tongue usually indicated
something corrosive had burnt the tongue. Like
insecticide."
"Well my dog has licked shampoo used to treat his
dandruff."
Blood, urine and X-rays of the throat, chest and abdomen
are being done as this are necessary to aid in the
diagnosis of persistent coughing even though some tests
were done earlier by Vet 1. Throat X-ray was not done
and is usually not done in cases of coughing.
However,
this must be done as there may be a piece of bone stuck
inside the throat, leading to persistent coughing and
weight loss as the dog ate little. The tongue ulcer
could be due to licking of the shampoo over the last 3
months. Wait for the new X-rays to be done today.
"Dog owners may want to be loyal but the vet must be
able to get the dog's problem resolved within two
visits," I said to my associate vet. "Good bedside
manners are great but repeat visits cost the owner money
and time. So they go for 2nd opinions if the family vet
can't come to a correct diagnosis and treatment."
"Why did Vet 1 not able to diagnose the case?" the man
asked me twice after I had shown him the X-rays and
asked him and his wife to palpate the enlarged
submandibular and popliteal lymph nodes. It is show, not
tell nowadays.
"Vet 1 is an experienced vet," I said. "The lung X-ray
was normal and the lymph nodes have probably just
enlarged in the last month. He did blood test and the
result was normal as he had told you."
The second opinion vet has the benefit of the
progression of the disease. I warded the thin dog. He
did vomit white frothy mucus around 3 times per day and
ate little. So, what is the diagnosis and what is the
cure?
Use evidence-based medicine and do a thorough physical
examination including turning the dog upside down and
checking all lymph nodes and doing abdominal palpation.
There was no fever, increased respiratory rate or
anaemia or other abnormal signs other than the enlarged
lymph nodes and tongue ulcers and severe weight loss.
The X-rays were useful but the vet must take more than
one X-ray. Vet 1 did one X-ray, the quality of which was
not so good.
Take more than
one view of a site but some vets just do one view
to reduce veterinary costs to the client. This may
not be in the interest of the canine patient.
Study the X-rays again in the privacy of your home
and review your case again and do research on
similar cases, discuss with peers. This will make
you a better vet over the years. There is no
short-cut to be a better vet and veterinary
medicine and surgery cannot be mastered even with
a life-time of practice as the subject of the
whole canine body has too many diverse medical and
surgical conditions. Human medical or surgical
specialists just focus on one area of the human
body. Vets have to be know it all!
This is likely a
case of canine lymphoma at an earlier stage. Late stage
would show images as described in:
http://www.sinpets.com/F5/20110319canine-lymphoma-eye-bleeding-toapayohvets.htm.
Due to economic reasons, more detailed tests cannot be
done. As to the cure, chemotherapy is needed. Prognosis
is not good and the owner knows it. He and his wife were
quite satisfied with the diagnosis using evidence-based
medicine.
TOA
PAYOH VETS
