"Do you remember you operated on his ears?" the mother and daughter brought in a white Schnauzer that had fits and collapsed just over one hour ago. The dog had white and cyanotic tongue and was breathing fast. I put him on oxygen therapy first as he had insufficient oxygen for his red blood cells, leading to purplish tongue and mucous membranes.
I reviewed the medical records and said: "Yes, he had very painful and itchy right ear and his ear canal was opened up. How's the ear?"
"No more problem," the mother said. "Could the dog be suffering from a stroke?"
"Hard to say at the moment, I need a blood test and examination. It is possible there is a brain abnormality e.g. tumours, infection or bleeding or a systemic infection. I advised a brain scan but that would be costly and so the owners wanted the basic treatment to be done. That included a blood and urine test.
The veins were collapsed too. Dr Daniel had to collect blood from the jugular vein. It was not a good sign. Despite intensive treatment with fluid intravenously, the dog passed away 2 hours later.
Significant findings are:
1. Total white cell count 18.3 (6-17). N 90% Absolute 16. L 9% Absolute 1.7
2. Red cell count 5 (5.5 - 8.5)
3. Haemoglobin 11 (12-18).
4. Platelets 108 (200-500). Few giant platelets present. No platelet clumps.
5. Uric acid 0.27 (<0 .13)
6. SGOT/AST 129 (<81)
7. Urea 3.4 (4.2 - 6.3). Creatinine levels were normal.
The blood was taken from the jugular vein. The dog had around 30 minutes of oxygen therapy by mask before the blood and urine were collected.
pH 5.0 (5-8), SG 1.020 (1.005-1.030), urobilinogen +, blood 4+, bacteria 3+, white blood cells >2250, red blood cells 315.
It is important to practise evidence-based medicine. In this case, the dog could have a septicaemia. There could be a pathogenic type of bacteria picked from sniffing the grass or consuming some poisonous food or treats.
The onset was "sudden" fits and recumbency. There could also be an internal bleeding and breakdown of capillaries. A post-mortem may give a definitive diagnosis as to the cause of death. As it would be costly, this was not advocated by me.
A simple blood and urine test provide some clues of illness at the most economic rates as compared to brain scanning and more tests. In any case, the dog was breathing fast and had white and purplish tongue, indicating a very poor prognosis. However, other tests like brain scan needs to be advised. This Schnauzer has been well cared for as evident by his good size and body condition as so the death was a "sudden" loss to the family. No poisonous food or drink was consumed according to the mother. If no blood or urine tests were done, the owners would not know why the dog died suddenly.
The dog's ears were normal after the surgery as there was no more intense and continuous ear scratching. The case study and lateral ear canal resection surgery is at:
The above case had
symptoms of shock as
the blood pressure
was very low. A
shock syndrome is
reviewed below as
this dog has similar
brain, liver and low
blood pressure and
as in the case
Saturday, June 15, 2013
Dengue haemorrhagic shock syndrome
A 20-year-old Singaporean, Mr Ang Yong Han was the first dengue death in Singapore in 2013 (Straits Times, Home B1, Jun 1, 2013). He died one week after falling ill. Another man died. 8,305 people were infected as at May 31, 2013 for the year.
Signs: fever, headache, muscle or eye pain, vomiting and diarrhoea - see a doctor
Don't take aspirin or non-steroidal anti-inflammatory drugs (Nsaids, e.g. Ibuprofen or Synflex) as they make the person more ill. Pannadol is said to be safe.
No drugs to cure. Must drink a lot of isotonic drinks as there is a loss of electrolytes in vomiting and diarrhoea. Patients given fluids intravenously, blood transfusion, plasma and platelet transfusion and pain killers (Pannadol). If blood pressure keeps dropping, goes into shock and die.
BLOOD TEST. Virus caused liver and brain inflammation.
Enyzme (AST) Aspartate transaminase levels are 10-40 units/litre of serum. 200-500 units are common in dengue patients. In Mr Ang's case, they were "way off the charts", being 1,000 and then 4,000.
Platelet counts are usually very low. Below a certain level, patient is hospitalised and given platelets. Blood test said to be useful only when the patient has fever for one week.
Brain inflammation (confused) - brain scan done. Patient complained about stomach pain.
HAEMORRHAGIC SHOCK SYNDROME
Blood pressure continued falling despite being given strong medication. Due to blood vessels leaking fluid. Blood becomes concentrated and pressure falls continuously leading to death.