TOA
PAYOH VETS
toapayohvets.com
Date:
13 February, 2012
Focus: Small
animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
The Jack Russell coughs fresh blood and white mucus for
the past 2 days and had been coughing for the past year
Dr
Sing Kong Yuen, BVMS (Glasgow), MRCVS
13 February, 2012
This case illustrates
the importance of using relevant evidence-based medicine
to provide a standard of veterinary care affordable and
expected by the sophisticated younger generation of
Singaporeans. This google generation knows much more
than the baby-boomer generation and wants answers
quickly as to what is the cause of the problem with
their sick pet. Not more than one visit will be the best
as Singaporeans are time-pressed.
Yesterday morning, I was the vet on duty. A young man
came with his 12-year-old Jack Russell which was in
excellent body condition. "He coughs blood in the last
two days."
The dog's gums were slightly pale. Rat bait poisoning?
Unlikely as the dog was supervised when outdoors and
there were no rat baits used in the apartment. This was
a much loved dog as he would try and attack the
newspaper delivery man every morning but not his family
members and the family's friends. He was a puppy when
the young man was in Primary 5 or Primary 6 and now 12
years or more had flown by.
"Is he a scavenger?" I asked as the Jack Russell started
coughing when I palpated his throat from the larynx
downwards. The dog coughed and retched. Fresh red blood
with white mucous came out from his mouth onto the floor
of the consultation room.
"Yes, he swallows any food he would find in the house."
the young man asked me for tissue to clear the mess.
"Is he like my son's Bichon who waits for some chairs
not pushed inside the dining table to jump onto the
table to eat the chicken bones?"
"Yes, yes, he is like that!" the man said.
"As the throat is so painful, it is possible that there
is a chicken bone poking the throat and causing coughing
and bleeding. I will need to X-ray the throat, lungs and
stomach area."
The owner must be given the advice and if he does not
want the X-rays, this must be recorded in the case
sheet. He wanted the X-rays and complete blood test.
"My dog had a fierce cancerous lump removed from his
neck skin at another vet clinic," the owner said to me.
He phoned the vet and they faxed over the report in the
afternoon. It was a sebaceous gland carcinoma which had
grown red and fast on the dog's lower neck 2 years ago.
The skin in that neck area was hairless but no
recurrence of tumour was seen.
So, was this a case of chicken bone trauma or not? I got
the X-rays done. "Pleural effusion," commented two vets
as the X-ray of the lung showed radio-opacity instead of
black spaces as for normal lungs. Based on clinical
signs and the history of a cancer as well as diffuse
nodules seen on the X-ray, I advised the owner that it
was most likely metastases of cancer cells to the lungs.
Bronchoscopy and lung biopsy could be done but this
would add to the cost.
Pleural effusion is likely
to be caused by bleeding
from the metastases in the
lungs
The owner decided on euthanasia and was present when I
administered the injection. It was sadness in the
evening but he was satisfied with the evidence-based
medicine done. If the vet had just given some injections
and drips without advising X-ray, this coughing of blood
would continue and the owner would become much unhappy
with another visit. Therefore, the vet must know what to
do in a case of coughing blood. In retrospect, this dog
had been coughing for the past year but had not coughed
blood till the last 2 days.
Blood test revealed an increase in total white cell
count suggesting a bacterial infection, red blood cells
and haemoglobin in the lowest range of normal values,
suggesting blood loss probably from the lung bleeding. I
explained the findings to the owner. He had to decide
what to do further.
The diagnosis of tumours in the lung due to metastases
from the sebaceous gland carcinoma is quite possible.
Veterinary costs need to be minimal so I did not suggest
Bronchoscopy and lung biopsy to confirm the lung tumours
as this would prolong suffering in this dog. Coughing of
fresh blood was very likely from the lungs as the amount
was much more and persistent.
TOA
PAYOH VETS
