tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
toapayohvets.com

Date:   19 December, 2011  

Focus:
 Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
Internship and hyperestrogenism in an old Sheltie
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS

19 December, 2011  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129
2011/12/18 lim ..@hotmail.com>

Dear Dr Sing

I have attached a document on the case studies I have seen on the 2nd day of internship, 18 December 2011. Is this what you want of the daily case studies or does it have to be more detailed?

Yours Sincerely
Name of Intern


REPLY FROM DR SING DATED DEC 19, 2011

Thanks for email. During internship, one case study per day is to be recorded for me to review and discussed with you. Otherwise, being a bystander standing around the vet will not enable you to appreciate the diverse aspects of vet medicine and surgery and its varied clinical presentations and challenges to a correct diagnosis.

Evidence-based medicine and knowing how to arrive at a correct diagnosis is not so easy in some rare cases as in this Sheltie whose condition may be mis-diagnosed as ringworm when the actual cause of the hair loss is due to hormonal factors.

One Case study should be written with the following format using the Sheltie you saw yesterday Sunday as an example. You re-write your case study with as much info of the case under the following headings:

CASE NO. 1 DATE:

1. Description of patient - breed, gender, age, colour. Not spayed.
2. Chief complaint - hair loss. Other complaints -
3. History - Hair loss for the last 5 years. Hair grows back after the heat and problem of hair loss recurs. Not fully recovered. Seen 2 vets.
4. Presenting sign: Vulval enlarged over 20X normal. Hyperpigmented black.
5. Examination and tests (blood, urine, skin etc).
6. Diagnosis
7. Treatment/Advice
8. Review/Outcome/Follow up - 2 weeks later. Date to be written on medical record.
8. Against Medical Advices - to be written down

As reviewed by me, what should have been included in this case were:
1. Where were the medical records of other vets? This should be recorded if the owner does not bring them. If owner said "Blood test of other vet is OK," the vet should not take the owner's word for it and ask for the blood test results. Some owners do NOT want to pay for another blood test and this should be recorded under "Against Medical Advices".
2. When was the last heat? This should be asked.

From my review of the above case, the main diagnosis would be a case of hyperestrogenism rather than fungal infections of the dog. Fungal infections are present but the dog's problem will not be cured even if the ringworm is eliminated. So, the owner goes to another vet later for a 4th opinion or just accept that nothing can be done. The dog was put on a hypo-allergic diet by the previous vet for one month. This would be too early to eliminate dry food allergy as a cause of the hair loss.
 
Hyperestrogenism, old Sheltie, hair loss for 5 years, toapayohvets, singapore Hyperestrogenism, old Sheltie, hair loss for 5 years, toapayohvets, singapore Hyperestrogenism, old Sheltie, hair loss for 5 years, toapayohvets, singapore
Record all observations in your medical record including enlargement of the vulva and the history of estrus.

The owner had given a clue for hyperestrogenism: "The Sheltie's hairs grow back after the end of heat but 6 months later, the hairs drop off again". This clue indicates that the hair loss is associated with the hormonal cycle of the female dog. Examination of the grossly enlarged vulva would be another clue. This time, the clue comes from the dog

Now, the Presenting Sign of a swollen vulva 3 months after the end of heat and its presence for over the last 5 years point to a high probability of hyperestrogenism. The solution for this owner is to spay his dog after the skin infections are resolved in around 4 weeks' time. However the dog is old and there are high anaesthetic risks. This case is quite rare. I had seen less than 10 cases over the past 30 years of small animal practice. So a mis-diagnosis can easily be made as the skin signs of recurring hair loss distracts from the PRESENTING SIGN. A blood test for hormonal levels should be advised in theory and as part of the practice of evidence-based medicine.

P.S
What the intern on his 2nd day of internship, wrote quite a good report considering the fact that he did not study Biology during his A levels:
 

Day 2 of internship at Tao Payoh Vets (18 December 2011)

Case 1

A 12 years old dog that has been having skin problems for the past 5 years. There is dandruff all over the dog’s body. The dog also has dry skin. Fungus is also growing on the skin of the dog and it gives off a bad odour. It is suspected that the dog’s hormones caused the skin problems. There is also a pressure sore in an area as the dog kept lying on one side. Medicated wash was given to reduce the fungus growth. Conditioner was given with the medicated wash as medicated wash tend to make the skin very dry. There will be a follow up in the case to determine the main cause of the problem.

3 Images: Two lateral views and the back view pictures were in his .png file which could not be downloaded. The mobile handphone pic were blurred. The intern will learn more about digital photography as he has more hands-on case writing.

Marina Bay Residences condo, singapore, asiahomes, above 40th floor

Advertisement:   Asia USA Realty (Singapore)
asiahomes.com Pte Ltd  

VARIOUS UNITS ARE FOR RENT AT VARIOUS TIMES:
Tel: +65 9668 6468, Email: judy@asiahomes.com
Asia USA Realty

red eared slider eyes closed and puffy for last 2 weeks, now open after 4 days of treatment, toapayohvets, singaporeMore info at: Dogs or Cats. To make an appointment: e-mail judy@toapayohvets.com
tel: +65 6254-3326 or 9668-6469

Be kind to dwarf hamsters. Don't wait till tumour becomes large to ask your vet to excise it. Toa Payoh VetsHamster anaesthesia at Toa Payoh Vets

To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326

toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research
 

Copyright © Asiahomes
All rights reserved. Revised: December 19, 2011

Toa Payoh Vets