I asked: "Does he go to the Bishan Dog Park and dig the soil and eat grass and lick soil?"

Yes," she said. "He loves to do that when we take off the lease at the park."

"Why do you bring her to the Bishan Dog Park since you live in Punggol?"

"The Bishan Dog Park is the place where the dog can run around without a lease," she replied.

"Any construction nearby?" Dr Daniel asked.

"Yes," she said. There are new HDB flats being built in this pretty new town with waterfronting views, so there was dust all around.

"The soil bacteria could have gone into the eyes, nose and mouth and then the submandibular lymph nodes," I said. " A blood test will be important to help in the diagnosis."  I got permission for a blood test.

BLOOD TEST RESULTS - Significant findings were:
Total white cell count 17.4 (6-17)
N=71%, L=23%, M=6%, E=0.2%, B=0.6%
Urea 10.5 (4.2-6.3)

Use evidence-based medicine to come to a diagnosis if the owner can afford the blood test as it tells a lot of causes but the vet must know how to interpret them in relation to the clinical signs. In this case, glanders was confirmed by the increase in total white cell count in the blood test as a result of a systemic bacterial infection. 

What is the significance of increase in monocytes? This could mean a long-standing chronic infection and well, this young dog had an active outdoor digging and eating soil and so, the infection from the soil had been going on for some months. Hence, an increase in monocytes.

Based on clinical signs, blood test helps in coming to a correct diagnosis of "glanders". The owner would know simply that her dog had a bacterial infection.

I tried phoning the owner again to close the case by giving her the blood test results.  As I typed, the happy owner phoned me and said that the dog was still eating and drinking as before and had the following improvements as compared to 2 days before treatment

"Both eyes are still tearing but much less," she said. "No more redness in the eyes."  She was referring to the acute conjunctivitis which she saw when I pulled down the eye lids.

"How about the size of the submandibular lymph nodes?" I asked.

"I don't know whether it is psychological but I feel them as being much smaller than on that day."
"You are correct in finding that the size had gone down considerably due to the injection," I said. "Continue the antibiotics and change his life-style". 

So, no more soil digging and eating grass for the active pet as the soil bacteria had infected her. 

P.S The owner got the dog treated early and so the total white cell count had not reached a much higher level and the young dog was still eating and drinking. The submandibular lymph nodes could have expanded bigger and ulcerate.

The owner was worried about the dog having pus in both eyes for the last 4 days and made an appointment to see me. The bacteria had gone to the eyes as well but  antibiotics and anti-inflammatory injections I gave had nipped the infection in the bud. So, the owner was happy with the recovery when I phoned 2 days later. This was good news for everyone. Except for the Schnauzer as he has to change his free soil digging and eating life-style.

P.S "Glanders" is more a disease of horses in the older days. It is rare to get a case in the young Singapore dogs and puppies nowadays as the standard of hygiene is much higher in Singapore kennels. I remember my professor's lecture about this disease and that was in 1973 as a final year vet undergraduate. I did see a few puppy cases from breeders some years ago but no more.  This is not just a case of acute conjunctivitis. Just prescribing some eye drops will not help to resolve the problem. 

P.S It is best to follow up on the owner 2 days and do a blood test.