TWO 2002 CASES: BAD BREATH & SWOLLEN EYES
2010 CASE: EYEBALL POPS OUT
Dr
Sing Kong Yuen, BVMS (Glasgow), MRCVS
First Written: 22 January, 2002
29 July, 2010 |
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2002 Case: Bad breath at first sight
Nurse Ann felt nauseated and asked to be excused from helping me as the
terrier cross entered the examination room with its owner.
She was new to the world of halitosis or bad breadth as this was her first day of work. It was smell at first
sight in the small examination room of around 100 sq. feet as the air conditioner
directed the air into her nostrils. It was an unusual case of very bad breadth preceding the dog at the door.
"My dog is having a yellowish white discharge and have not been eating for a few
days," said Mrs Collins as she put the 7-year old bitch on the examination table. I
guessed she was used to the bad breadth after living with her pet for so
many years.
I palpated the abdomen which indicated two long swollen tubes on its lower half.
This was a case of an open pyometra, an infection of the womb in older bitches, not
spayed. The dog was pyrexic.
"Mrs Collins, you have two options," I said. "Immediate surgery to remove
the infected womb and take the risk that she may die after the surgery due to its weak
health or wait 20 days while your bitch had its antibiotics and would be stronger for
surgery."
Sick dogs do die after anaesthesia and surgery and this must be communicated to the Owner
although death was not certain.
This bitch had discharged pus from its womb, licked the creamy stuff off
as most pets do to clean themselves. The toxins
of the bacteria inside the vaginal discharge was too copious for her to be
able to lick them off and had adversely affected her energy and vitality.
It would have been some time.
"In addition, your bitch would need to have some decayed teeth removed, but this
would be done another time so as not to contaminate the inside of its abdomen when the
uterine horns of the womb are removed," I advised.
"Antibiotics for 20 days would get rid of the bad breadth and reduce the
vaginal discharge. However, the discharge would recur again as the womb becomes
infected later,"
Mrs Collins was told.
I did not expect to see the terrier again as many owners don't follow up or might have
gone for a second opinion. The terrier was presented in 20 days' time. Not
a whiff of bad breadth, but now Nurse Ann had been accustomed to the bad
odours. She sprayed the perfumed air fresheners to counter any
foul smell. The
vaginal discharge was minimal. |
The owner opted to have her teeth checked but no surgery. This female dog had
several good teeth as there were only two decayed molars on the right upper jaw, far back
in.
Two of the three roots of the bigger molar had rotted and
shrivelled and I extracted it out easily. Normal molars with 3 strong
roots will never be strongly anchored into the bone tissue and would not
be extracted as one tooth.
At least, the female dog would not be having tooth ache anymore. This
was a rather strange outcome as the bitch came in
for consultation of a purulent vaginal discharge
and returned for dental surgery!
2002 Case: Eye swollen
From afar, this Pomeranian looked normal. A very handsome dog indeed attracting
you to notice him.
"No complaints and no change of behaviour," said Mr Lau.
But this sharp eyed owner noticed a swelling on the left eye and immediately made an
appointment with the veterinarian.
On examination, the eye ball and cornea were all right and free from ulcers or
tears.
The tissue or conjunctiva of the upper eye lid was swollen but not excessively
inflamed. What could be the cause? Most likely a spilling of the detergent
while the owner's mother was mopping the floor.
An Elizabeth collar was applied so that it would not scratch its eye. Eye
drops were given. It should recover within 7 days.
Any eye injury will need prompt attention, within 24 hours in order to save the eye sight
of the dog. Unless the owner is aware of the nature of the injury. There are no
replacement for eyes and the dog tends to rub or injure its eye more if left to tend to
its eye injuries. |
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2010 CASE: A SHIH TZU'S EYEBALL POPS OUT |
Tue July 27,
2010. Back to work after visiting Penang yesterday
to talk to a swiftlet farm consultancy with my
mentor who is interested in this cloak-and-dagger
business. I presume the underworld has a hand in
the swiftlet and bird nest production business but
then where there is money to be made, the triads
will be there.
At 3 pm after finishing perineal hernia in a Shih
Tzu that cried during defaecation, I was
surprised to see a lady in her 30s waiting in my
reception. She was early for her appointment. She
showed me her female Shih Tzu with a green left
eye.
"Her left eyeball popped out after 5 pm yesterday
as I saw her at that time and she was OK," lady
owner said. Another dog had jumped onto this Shih
Tzu. The eyeball pops out <24 hours. I could see
that the dog had been rubbing eye vigorously till
the upper area above the eyelid was a purplish red
and the sclera (eye white) was as blood shot as it
could ever be.
The lady consulted Vet 1 who had instilled green
ophthalmic fluoroescein. This dye showed that >
80% of the eye cornea is ulcerated. She wanted a
second quotation and Clara, a dog groomer
and friend had referred her to my surgery where
charges are apparently lower. Groomers sometimes
play a great role in referrals according to the
Penang vet I visited in Penang yesterday. The
Penang vet showed me the pet shop whose owner
regularly sent him cases. Well, I don't have such
good connections as pet shop owners in Singapore
tend to be promiscuous in veterinary referrals.
"The Shih Tzu has a high fever," I warned the lady
of the risk of death on the operating table for an
old dog. An old dog with a high fever too
aggravated the risk. "However, eye injuries are
emergencies and cannot wait another 24 hours." The
lady had no choice and left the decision to me.
I gave the anti-fever and painkiller tolfedine and
antibiotics baytril injection subcutaneous around
5 minutes before I used Isoflurane gas to
anaesthesize the dog. There was no sedation as
this would be riskier.
Surgery: Lateral canthoplasty increases the
space for this enlarged injured popped out eye.
The prolapsed eyeball was too large for a simple
stitching up of the eyelids (tarsorraphy).
"But I had a previous Shih Tzu whose eyes popped
out bigger and the vet did not do that," the young
lady said.
"Each case is different," I said. "If you don't
want the side of the eyelid to be cut to enlarge
the eye socket to accommodate the eyeball, please
don't blame me if the stitching of the upper and
lower eyelids break down before 7 days."
The lady consented to leave the technical matters
to me. Many owners want to voice their opinions on
treatments and in some cases, they are more
knowledgeable than he vet who has to treat several
thousands of various cases and may not be an
expert in a particular condition.
The following is a summary for vet students of
what I did.
1. "Clip both eye area and eyelid lashes," I said
to Mr Saw as he presented me with the dog. "Take
out the 3rd eyelid and wash off any hairs and
debris. Also rinse the eyeball thoroughly."
2. I note an embedded foreign body inside the
eye-white. I used a scalpel blade cut off.
3. I ensured that all green dye and hairs are
washed away.
4. Sub conj gentamycin and prednisolone
subconjuctiva.
5. 3rd eyelid flap, use tension tubes and stitch
lateral canthus.
6. For old dogs with fever, reduce the fever and
stablised the dog first in normal situations. This
will take 24 hours. Eye injuries are emergencies
and so the vet has to decide whether to operate
soon or not.
The beloved
Shih Tzu recovered well from anaesthesia as if
from a nap. I phoned the worried lady to let her
know that her dog was OK. The eyeball should
shrink back to normal in 7-14 days. The lady
wanted her dog back and took her home the next
morning. |
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