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Date:   10 March, 2011  
Focus: Small animals - dogs, cats, hamsters, guinea pig & rabbits.

Toa Payoh Vets Clinical Research
Making veterinary surgery alive
to a veterinary student studying in Australia
using real case studies and pictures

 
Perineal hernia in dogs - 2005 case
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS 
Case written: July 5, 2005
Updated: 10 March, 2011
Toa Payoh Vets
Be Kind To Pets
Veterinary Education
Project 2010-0005
Perineal Hernia.  13-year old Pomeranian with big swelling near Rt side of anus. Pom, 13 years old, male, irritated by big lump right side of the anus (see photo). Keeps licking it, hence colour of skin changed to black (see bottom right quarter of photo).

Diagnosis: Right perineal hernia.

Implications: A defect in the muscle layer means that the "intestinal fat, intestines and bladder" falls through the hole and cause a large swelling under the skin. What tissues get through depends on the size of the hole. Some cases are fatal especially if the intestines and bladders get twisted, leading to intense pain, shock and death. Dogs do die when the hernia gets strangulated or infected.  The older boomer-generation of Singaporeans may not bother as long as the dog eats but the younger generation is more sophisticated and caring and so more cases are seen. Seek prompt veterinary treatment when there are small swellings in the perineal or anal areas. In many cases, neutering the male dog will enable the dog to live longer and cost the owner much less when the dog needs treatment for perineal hernia, testicular tumours, prostate enlargement and circum-anal tumours during old age.
 
A rabbit cannot eat
properly
  - 2005 case
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS 
Updated: 10 March, 2011                                         
Toa Payoh Vets
Be Kind To Pets
Veterinary Education
Project 2010-0005
Rabbit with overgrown front teeth, going into nostrils. toapayohvets, singaporeLower front teeth overgrowing into the rabbit's nostril.

Malocclusion means that the front teeth of the lower and upper jaws do not meet. Therefore, they do not wear out when the rabbit eats the carrots. They tend to overgrow. Regular trimming by the vet may be needed.

 
An angry English Bulldog nearly bit off my face - 2011 case
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS 
Updated: 10 March, 2011
Toa Payoh Vets
Be Kind To Pets
Veterinary Education
Project 2010-0005

On March 9, 2011, the owner made an 11am appointment to consult me. Normally, I don't consult after 11 am as I have another vet on duty. Sometimes I hang around to manage the cases and supervise the staff and interns.

It is seldom possible to leave a surgery alone and expect it to function well in terms of quality of client services and standards of service. Empowerment of employees and delegation is good in theory but the owner of the Surgery has to be pro-active as life is full of challenges and surprises as in this case of an angry English bulldog that nearly bit off parts of my face.

The lady owner who had consulted me some 15 years ago brought in a 4-year-old male English Bulldog that was "limping."  This was the 3rd case of lameness in a short period of less than 7 days fulfilling a theory that some related incidents occur in threes.

Two recent incidents were paraparesis in a Chihuahua which puzzled the first vet and a Shih Tzu that had weakness in the hind legs too. The cases were drafted in my blog, Draft Case Studies:  2010vets. I really have no time to document properly for the time being. This 3rd case had no paraparesis but is linked by "lameness" common to all 3 dogs.

"My dog bites," the lady warned when the dog, on the examination table, suddenly turned his head and opened his mouth aiming for my face as I put the stethoscope on his right chest to examine his heart. "But he does not bite children."    
        
Before that, I had the dog outside the surgery and asked my assistant to trot him. The Bulldog refused to move initially. I asked the owner to do it after the dog walked and ran on a loose leash. I had checked his spinal area and there was one reaction of the dog sinking to his haunches when I pressed the lumbo-sacral area. However, the pain could not be reproduced and so there was no definitive proof of paraparesis.

Most owners give conflicting signs and symptoms to the vet. Many times, the one who brings the dog to the vet is not the caregiver. The caregiver could be the domestic worker (maid) or the aged parents. So it was not surprising that the first vet was puzzled by the case of the Chihuahua "not eating and lethargic with swollen abdomen" which I diagnosed as having paraparesis due to spinal pain which was reproduced repeatedly.

In this English bulldog, the maid was the one caring for the dog. After trotting 4 times up and down the outside corridor of the Surgery at the side, the dog panted and was quite fed up. He just went on strike and laid down while we were all wary of him. Being bitten by a big hunky English bulldog is no joke and so I told my assistants to be careful and forbade my intern Michelle from handling this breed.

After the 4th trot, I saw the dog dipping  on his left hind leg and hopping on hind legs. So, he really had lameness, most likely the left hind. The next step was to put the dog on the examination table. I seldom muzzle dogs as I would be more alert. After pressing the spinal area, checking the ears and general examination, the dog was quite restless. I lifted up the left hind paw. The whole lower part of the paw was reddish and wet. I pinched the interdigital space. The dog yelped and turned suddenly towards me. This was a warning that he would bite if I persisted. Unfortunately, I had to check the right hind paw which suffered similarly. The dog was really not happy now. While the owner held on to the leash, I checked the two front paws. Not so red. My assistant took hair samples for microscopic examination for ringworm as the dog had been licking the underside of the paws raw.

I was going to check the heart and as I put the stethoscope on the right chest, the dog suddenly turned and opened his mouth aimed at my face. I swerved a bit and missed being bitten. This dog ought to be muzzled.

My assistants went around looking for an appropriate cloth muzzle. But they could not find one. "Just use a string and tie around the muzzle," I said. Sometimes, the assistants are so fixated on the cloth muzzle that they forget alternatives.

I had the dog muzzled and my associate gave Domitor 0.3 ml IV. The dog was sedated for around 10 minutes while my assistant irrigated his wax-filled ears and scrubbed his under paws. "Take off the string," I had to tell my assistant. "The dog may vomit." Domitor does sometimes cause vomiting after injection, even on IV injection. If the dog is muzzled, he can't vomit properly and may get inhalation pneumonia.

From this report, readers can see that there are so many risks and challenges in veterinary medicine every day. There was recently a groomer whose face was bitten off by a fierce dog and she was hospitalised. "It would never happen to me" attitude creates complacency as vets and groomers sometimes don't muzzle dogs out of expediency and efficiency. We may not want the owner to think we are cowards and we may be over confident of our lion-taming skills.

But once bitten, the person is dis-figured and traumatised. So, it is best to be alert and to muzzle. I was fortunate this time as I got no bites on my face. It is best to be safe than sorry. As for this English bulldog, I advised neutering to reduce aggression and also that he kept licking his scrotal area. He could be suffering from dry food allergy (itchy middle ears and paws) but the owner disputed my hypothesis as she had changed to sea food diet which she said had no grains. We will have to wait and see as it is not easy to just say "dry food allergy" or "contact dermatitis" without proof to convince the owner!
 
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