20. A 12-year-old Shih Tzu coughs and pants a lot - congestive heart failure

April 11, 2016

The 12-year-old Shih Tzu was coughing for some weeks but now the coughing and panting becomes too frequent.
"It could be the smoke from the praying to the dead," the husband said. "But my dog did not go to the graveyard." This is the period where graves are cleaned and food offerings are given at the graveyard.
 
The dog was heaving and the abdomen appeared swollen. The right heart had a loud systolic murmur.  X rays confirm congestive heart failure. Heart enlarged considerably and the lungs are filled with fluid (pulmonary edema).

Heart medication is given for 2 weeks and will be reviewed. Each vet has his or her own idea of treatment. I usually prescribe 3 types of heart disease drugs but my other vet prescribe Vetmedin only. I gave the dog an IV glucose, antibiotic and lasix to ease his pain and clear the lungs.  

The tongue was so cyanotic and the dog was panting so badly that I gave oxygen therapy. However, the owners had to go home as the therapy took more than 30 minutes.

I advised the Prescription Diet H/D but the owner does not want it.

Right sided heart enlarged and lots of fluid inside the lungs - difficulty in breathing for the dog. 

Nowadays, the Singaporean pet owner is better educated. He wants to know the prognosis. X-rays will show the severity of the heart disease, the shape, size and surrounding lung fluid. The vet must produce the X-ray or ultrasound evidence rather than prescribing medication trying to lower medical costs. 

19. Images of Singapore and others

Difficult to get the correct angle. It is good to have a person to show the dimensions.

18. VIDEO SCRIPT. A young poodle has severe anaema and thrombocytopenia due to Babesia canis tick fever

TP ..948

April 7, 2016
I got a 1-year-old poodle, lethargic and pale in the gums and tongue.

BLOOD TEST   Apr 7, 2016
                            Toa Payoh Vets  

Haemoglobin     5.2 (12-18)
Red cell count    1.9  (5.5 -8.5)
Platelets             <10   (200-500)

Total White Cell count  21.4 (6-17)
Neutrophils  81%  (60-70%)
Neutrophils absolute 17.3    (3-11.2)

Haematocrit  0.16  (0.37-0.55)
MCV  87  (60-77)
MCH   28 (20-25)
MCHC 32  (32-36)
RDW     24.1%
A regenerative anaemia based on increase in MCV and MCH
The owner did not accept my advice to get a blood transfusion.
No liver and kidney disorder

Blood smear     Babesia +ve

 
Imizol (imidocarb dipropionate 120mg/ml, SC  0.2 ml given at 3 pm
Dog ate 2 days later and has recovered.       

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RESULTS FROM ANOTHER VET (VET 1)  consulted earlier
The grown up children consulted Vet 1 although the father said he wanted them to bring the dog to me. The following are the tests done by Vet 1, an experienced vet.   

BLOOD TEST   Mar 26, 2016                          


Haemoglobin     low
Red cell count    low
Platelets             low


Peripheral blood smear, SNAP 4DX Plus Heartworm done.
Given Iron tablet, prednisolone, IV infusion, Ranitidine 50mg/2ml, Sucralfate 500mg tablets


BLOOD TEST   Mar 30, 2016.
                          

Haemoglobin     low
Red cell count    low
Platelets             low

Given doxycycline 100 mg tablets

The dog was still lethargic and not eating. The father brought him to Toa Payoh Vets on April 7, 2016 and the blood smear showed Babesia canis abundantly inside many red blood cells.


FOLLOW UP
Apr 21, 2016 (2 weeks after the first imizol linjection)
The parents who love this poodle very much brought him  to Toa Payoh Vets for blood test and blood smear 2 weeks after the first injection as advised. The dog had been prescribed Vit K1 10 mg per day but the owner gave 5 mg/day. Nutripet paste with iron and vitamins much loved by this dog but not the Vit K1.

Blood smear by Dr Daniel showed fewer red blood cells infected by Babesia canis compared to 2
weeks ago when almost 90% of the red cells are infected (see above image).

                              Apr 21                       Apr 7               Range

Haemoglobin         5.2                            8.9                    12-18
Red cell count        3.7                            1.9                    5.5 - 8.5
Platelet             less than 10                                             less than 10.              
                         large platelets present                             no platlet clumps seen
PCV                      0.27                           0.16


MCV                    74                                       87*                     (60-77)

MCH                    24                                     28*                       (20-77)

Blood test  show an increase in red cell count and haemoglobin but still below the normal limit. There was a regenerative anaemia (*) in Apr 7.



The platelet is still less than 10 (as 2 weeks ago) but the dog's gums are pink. (see video).  


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CONCLUSION

The father said that his poodle does not have any ticks.

Vet 1's peripheral blood smear did not show Babesia as not many red blood cells have been infected at that time on March 26, 2016. When the dog was seen by me on April 7, 2016, the blood smear showed the Babesia canis in large numbers.

So, I was at the right place and at the right time to produce the positive smear which had around 90% red blood cells infected by Babesia canis.

In conclusion, it may be better to treat a dog with severe anaemia and thrombocytopenia as tick fever although the blood smear is negative. Babesia may not be present in that smear and so the dog's medical condition deteriorates.  It has been reported that most Babesia infected dogs recovers rapidly with treatment and that they become carriers. A second injection should be given 2 weeks later and a blood smear should be done.  

This dog appeared to be recovering slowly but is still eating and active.

17. Amitraz tick wash poisoning twisted neck

"It is scary" the owner saw his old Westie suffering from a necked twisted to the right one hour after he bathed the old dog with Amitraz wash






When applying pesticides, always follow the label's instructions when you make the solution. High doses kill
2. Spraying when the dog is heavily infested can kill the dog as he is already ill ith tick fever.  Bld test x2  showed Westie was much badly infested n sick

GR

TWC  23  6-17
N        93%   Abs  21   3 -11.5

Westie

16. Images for future articles

Monday. April 11, 2016

An artist sketches things that inspires him or her to collect ideas for future paintings. I upload pictures.

Before Imizol injection

After Imizol injection. Tongue and gums pinker

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15. An 8-year-old carnivorous terrapin has 2 swollen eyes

April 5, 2016

"This terrapin eats only meat, mainly fish and prawns as she rejects the pellets," the woman said. "For the past 4 weeks, she has no appetite as my domestic worker sees the meat still present inside the tank.

In the past, the terrapin will eat all and be taken out of the tank after 2 hours to roam on the floor. But in the past 4 weeks, the domestic worker had retained the terrapin for 4 hours to ensure she will eat. But she had no appetite.

"When do the eyes become shut and the eyelids swollen?" I asked.
"I don't know," the mistress said. Neither did the domestic worker who mentioned that it could be the past 2 weeks. The water was very dirty with stools and meat during the 4 hours and this poor quality of water irritated the terrapin's eyes. So painful were the eyes that the terrapin shuts the eyelids and will not eat.
"How long will she recover?" the mistress asked.
"It is hard to tell. It depends on how badly infected the eyelids are," I could see the terrapin using his right fore hand to rub his right eye.

I hospitalised the terrapin for 2 days giving eye drops and medication and warm morning sunshine for 30 minutes. Her left eyelid started to open first showing a cloudy upper cornea. Then the right swollen eyelids opened. The next day, the eyelids were much less swollen.

So, on Day 3, the terrapin went home. I advised changing of water twice a day. Apply eye drops and give medication inside the prawns and fishes. Also to vary the diet and introduce pellets.

14. A 16-year-old Sheltie has left nasal discharge

April 4, 2016

"Nowadays, she will only eat when I hand-feed her," the mother said. "She used to be greedy for food."

The mother had adopted a 16-year-old Sheltie as a 12-year-old as her friend could not cope with 2 dogs.

"It is very kind of you to adopt such an old dog," I said. "Most people will not do it as there will be short life span and medical problems of aging."

The dog will not permit me to open her mouth. "There may be painful gums," I said. "The left nostril is dribbling with pus too. It is an upper respiratory tract infection since 2 months ago when you came in for examination and she needs a more effective antibiotics. "

Losing interest in food in an old dog could be due to many causes. One of them is tooth ache. Another could be cancer of the internal organs. A blood test is done.