Epilepsy - 7-year-old Miniature Bull Terrier
Baxter's History
May 14, 08. One fit. I asked the owner to consult the competition. He said that there was nothing abnormal in Baxter's blood test and examination. The vet prescribed phenobarb 30 mg and advised 2.5 tablets 2 times per day for 2 weeks. The owner was told that Baxter would need the drug for life. Baxter did not complete the 2 week of medication. As to the cause of this fit, it was not possible to pin point. The owner had antibiotics given. I advised dental examination under general anaesthesia some months before and even after the first fit to remove bacteria multiplying in Baxter's mouth. Baxter had objected to any mouth touch and always looked lethargic with his head down whenever I visited his owner at the office.
As there was the possibility of deaths under general anaesthesia, the owner was not keen on my recommendation. More than one year ago, I had extracted 9 decayed teeth from Baxter under general anaesthesia but the bad breath had returned in 2008. Baxter is fed mainly home-cooked food. His coat condition is normal. His weight is normal and he exercised with his owner by jogging every morning around Mount Sophia area. Therefore hypothyroidism as a cause of his lethargy was ruled out.
Aug 9 08. National Day, Singapore
Baxter At home
2.30 pm lst fit (Stesolid rectal tube with 5 mg diazepam gel given by owner) > 45 sec
10.30 pm 2nd fit (Stesolid rectal tube with 5 mg diazepam gel given by owner) > 45 sec
Aug 10 08. Sunday
Baxter At home
7am 3rd fit (toilet roll into mouth to prevent tongue biting). 8 am 4th fit
8.30 am 5th fit
10 am 6th fit
Shorter 15 sec. Massage his shoulder and talk to him
Sutffed thick towel into mouth to prevent tongue biting.
Owner wanted to observe duration of fits. Noted shorter duration of fits when he massaged the dog.
Aug 10, 08.
Baxter at Toa Payoh Vets at 2 pm
2.10 pm IV catheter inserted. Took blood samples. Took urine sample via catheter.
2.15 pm IV 5% dextrose saline 200 ml
3-4 pm General anaesthesia gas. Extracted 20 loose teeth.
6 pm 7th fit of <20 seconds
Aug 11, 08.
4 am 8th fit (rectal diazepam)
7 am 9th fit of <20 seconds
10 am 10th fit of <20 seconds
2 pm 11th fit (diazepam 15 mg IM).
Aug 12, 08.
No fits
3 pm Jaws chattering (diazepam 15 mg slow IV drip).
Aug 13, 08.
No fits
8 pm Goes home.
Thur Aug 14, 2008
9 am Phoned owner. No fits overnight.
1.30 pm Visited Baxter at owner's office in downtown
Baxter quiet under the table
Had phenobarb 30 mg x 1, KBr 200 mg tablet x1 at 3pm, 9.30 pm on Aug 13, and at 9.30 am on Aug 14.
No fits since discharge from surgery on Wed Aug 13, 2008 at 8 pm. Drowsy.
Polyphagia. Owner said: "Dog is very hungry. Tried to topple the food container last night. Followed me everywhere." "Hunger is a side effect of medication," I advised.
Less lethargic. Owner said: "I notice that Baxter looks more alert and not so sleepy after extraction of his 20 loose teeth." This was despite phenobarb medication which causes drowsiness. I had noticed Baxter being very tired looking for past months and had a foul breath and did not permit anyone to touch his mouth.
Cause of epilepsy. Owner wants to know what is the cause of Baxter's epilepsy.
"Many causes of epilepsy in dogs are unknown and the epilepsy is termed idiopathic epilepsy," I said.
"Various causes of epilepsy include hereditary causes in dogs less than 5 years old but Baxter is 7 years old, damage to the brain by injury, toxins and diseases. In Baxter's case, total white cell count from blood sample revealed higher than normal. I believe it would be that Baxter's brain was infected. Encephalitis caused by bacteria leading to high fever and convulsions on National Day. The most obvious location of bacteria would be from the mouth. 20 loose teeth with exposed roots were infected and extracted. Also, the extreme pain in his mouth may finally aggravate his fits."
One of the tips of Baxter suffering from severe mouth pain when the owner said: "Baxter cries every day when he opens his mouth." Ms Tan, the 2nd year Victoria College student did mention it in her report which I asked her to write.
Advised him to reduce dosage by half the amount from 9.30 pm on Aug 14, 2008 and wait and see if there are fits. Best is to give the least dosage that is effective as dog gets hungry and sedated with phenobarb.
AN INTERESTING REPORT ON BAXTER WRITTEN BY MS TAN XINRU,
A 2ND YEAR VICTORIA JUNIOR COLLEGE STUDENT
SEEING PRACTICE AT TOA PAYOH VETS
Sunday August 10, 2008
A bull terrier was brought in later in the afternoon for a blood test. His stomach hurt when touched and could only be carried at the shoulders and hind legs. It had suffered from fits in May and had a relapse yesterday. The previous blood test at Mount Pleasant showed no anomalies. The fits last around 30-45 seconds and subsided when some medicine was inserted through the anus. It lasts 8 hours before the fits return again. His spine was prodded and the dog whined when the middle back was pressed, indicating pain, as when the stomach was pressed. Blood samples were taken (3 tubes) and sent to the lab. Two samples were taken to verify the consistency of the results. The dog yelps in pain when it yawns, not surprising when you look at the state of its teeth. Most were rotting away. The teeth were extracted as quickly as possible, gassing the dog at intervals to minimise the pain. The pain from the decaying teeth could be cause of the fits. A urine sample was also taken, which hinted at a problem in the kidneys. After the majority of his teeth were removed, the remaining were scaled. The dog was then put on a drip and left to rest. However, he had a fit about an hour later.
Friday, August 15, 2008
Tuesday, July 1, 2008
3. Closed pyometra - thin Lhasa Apso
A very thin dog. Surprisingly, she was young enough and survived the surgery, much to the delight of the teenaged girl | |||||||||||||
1178. Mar 11, 2008. Tuesday. 5 pm. Went home. Active. Advised hand feeding of nutritious food in small amounts every 2 hour & good care. No scavenging. Family members are very happy and grateful. 
Friday, June 27, 2008
1. The Internet Grandmother
"Flies just would not go away when I swat them," the 65-year-old grandmother with a fair 5-year-old grandson came to the surgery. She was surprised at the tenacity of flies: "They just stick onto the dog's vaginal discharge."
This was not good news. Flies are attracted to decaying flesh. The 12-year-old Golden Retriever had some vaginal discharge 2 months ago. Recently she passed out thick glue-like mucus from her vagina. She stopped eating for 2 days and had vomited.
"Your dog had a severe womb infection. She vomited because toxins could have damaged her kidneys and internal organs, " I did not give much hope of survival for this dog. "Why didn't you spay the dog after the breast tumour operation?" My past procedure was to remove the breast tumour and get the dog spayed so that the female hormones feeding any new breast tumour would not be available after removal of the ovaries and uterus.
The slim and fair grandmother laughed: "You said that the dog would not survive 9 months. That there was no point getting the dog spayed. Her breast cancer was as large as a tennis ball!"
I checked my records. It was September 2005 when the large tumour was removed and nothing was heard from the grandmother. The dog had a small breast growth but nothing outstanding. It was now June 2007 and my 'prediction' of 9 months' life had been way off the mark. Why would I give a definite 9 months, I cannot remember. Why not 3 months or any other number? No vet can foresee the future. But I did not argue.
Now the dog was very sick. She had fever of 40.5 degrees C. She was not eating. She yelled in protest of great pain when I stretched her legs to see the long 15-cm scar of the tennis-ball-sized breast lump. The dog survived the surgery. But now, she was in poor health. If flies just zero into her vaginal discharge, it indicated that her womb tissues had rotted. Flies are not interested in less smelly tissues.
The grandmother understood the big risk in surgery. I boarded the dog one day to give her antibiotics, anti-fever and drips. She felt good the 24 hours later and ate a full meal. Now I had to decide. To operate 36 hours after admission or wait another day? The infected womb might rupture anytime as it was decaying. Her temperature had dropped to 37.5 degrees C, one degree below normal.
The dog was given just gas anaesthesia and intubated. Her large thin-walled uterus and ovaries were removed.
She survived the surgery done at noon. Before waking up, she vomited a big mass of food on the operating table after I had taken out the endotracheal tube. This was an abnormal event as she had been starved >12 hours prior to surgery and should not vomit anything. Another abnormal feature was the dark bluish black blood of her omental blood vessels. Normally they would be reddish.
I asked the grandmother to come to see the dog after surgery at around 3 p.m as I had a bad feeling that this dog would not make it. However her two sons needed her at the airport - one going abroad and one returning. At 7 p.m, the Golden Retriever just passed away due to heart failure. Her gums and tongue were cyanotic. The grandmother and her grandson came around midnight to see the dog. This dog was family.
5 days later, the grandmother came to pay the bills. We reminisced. Grandmother said that the dog behaved strangely the night before going to the vet. The dog went to the back garden to stroll. She also went to the daughter's bedroom to sit till the daughter gave her a second piece of Pokey biscuit. "Mommy will scold me," the daughter told the dog. But the dog would not go away till she got a second Pokey biscuit strip.
Was the dog saying good-bye to the family? It is hard to explain divine happening. Grandmother said to me: "My grandson keeps asking when Jesus will bring Joy back." Would spaying her when she was younger prevent pyometra and prolong her life? Without the womb, she would not have pyometra and therefore would live to a ripe old age of another year or two? It is hard to say. Anaesthesia in dogs older than 8 years are high risk.
No vet can be assured of 100% survival in such cases. Sometimes it is best to pass such high risk cases to other vets. The daughter still grieved her loss. Grandmother was stoic in my presence. This dog was adopted as a puppy when there was a newspaper advertisement. She saw the advertisement when the newspapers were delivered at 5 am, instead of at 7 am 12 years ago. She went with her two sons to adopt this dog.
At one time she had 8 dogs dumped onto her house from friends who asked her to rehome them. She had to manage 3 children. Not much time for herself. At 65 years of age, she looked much younger than a 55-year-old.
"I cured one terrapin with enlarged closed eyes just by researching the internet," the grandmother said to me. That was great news. Most Singapore women of her age would not touch the computer.
"I can remember important dates and do calculations fast," the grandmother said to me. "I would tell my children the price per kg for things they bought. But lately, I am not able to remember so well. I can't stay long to chat. I have to go to Hong Kong."
"Why do you have to rush to Hong Kong?" I asked.
"To look after my grandson for a week." she said. All grandsons must surely love her vey much.
This was not good news. Flies are attracted to decaying flesh. The 12-year-old Golden Retriever had some vaginal discharge 2 months ago. Recently she passed out thick glue-like mucus from her vagina. She stopped eating for 2 days and had vomited.
"Your dog had a severe womb infection. She vomited because toxins could have damaged her kidneys and internal organs, " I did not give much hope of survival for this dog. "Why didn't you spay the dog after the breast tumour operation?" My past procedure was to remove the breast tumour and get the dog spayed so that the female hormones feeding any new breast tumour would not be available after removal of the ovaries and uterus.
The slim and fair grandmother laughed: "You said that the dog would not survive 9 months. That there was no point getting the dog spayed. Her breast cancer was as large as a tennis ball!"
I checked my records. It was September 2005 when the large tumour was removed and nothing was heard from the grandmother. The dog had a small breast growth but nothing outstanding. It was now June 2007 and my 'prediction' of 9 months' life had been way off the mark. Why would I give a definite 9 months, I cannot remember. Why not 3 months or any other number? No vet can foresee the future. But I did not argue.
Now the dog was very sick. She had fever of 40.5 degrees C. She was not eating. She yelled in protest of great pain when I stretched her legs to see the long 15-cm scar of the tennis-ball-sized breast lump. The dog survived the surgery. But now, she was in poor health. If flies just zero into her vaginal discharge, it indicated that her womb tissues had rotted. Flies are not interested in less smelly tissues.
The grandmother understood the big risk in surgery. I boarded the dog one day to give her antibiotics, anti-fever and drips. She felt good the 24 hours later and ate a full meal. Now I had to decide. To operate 36 hours after admission or wait another day? The infected womb might rupture anytime as it was decaying. Her temperature had dropped to 37.5 degrees C, one degree below normal.
The dog was given just gas anaesthesia and intubated. Her large thin-walled uterus and ovaries were removed.
She survived the surgery done at noon. Before waking up, she vomited a big mass of food on the operating table after I had taken out the endotracheal tube. This was an abnormal event as she had been starved >12 hours prior to surgery and should not vomit anything. Another abnormal feature was the dark bluish black blood of her omental blood vessels. Normally they would be reddish.
I asked the grandmother to come to see the dog after surgery at around 3 p.m as I had a bad feeling that this dog would not make it. However her two sons needed her at the airport - one going abroad and one returning. At 7 p.m, the Golden Retriever just passed away due to heart failure. Her gums and tongue were cyanotic. The grandmother and her grandson came around midnight to see the dog. This dog was family.
5 days later, the grandmother came to pay the bills. We reminisced. Grandmother said that the dog behaved strangely the night before going to the vet. The dog went to the back garden to stroll. She also went to the daughter's bedroom to sit till the daughter gave her a second piece of Pokey biscuit. "Mommy will scold me," the daughter told the dog. But the dog would not go away till she got a second Pokey biscuit strip.
Was the dog saying good-bye to the family? It is hard to explain divine happening. Grandmother said to me: "My grandson keeps asking when Jesus will bring Joy back." Would spaying her when she was younger prevent pyometra and prolong her life? Without the womb, she would not have pyometra and therefore would live to a ripe old age of another year or two? It is hard to say. Anaesthesia in dogs older than 8 years are high risk.
No vet can be assured of 100% survival in such cases. Sometimes it is best to pass such high risk cases to other vets. The daughter still grieved her loss. Grandmother was stoic in my presence. This dog was adopted as a puppy when there was a newspaper advertisement. She saw the advertisement when the newspapers were delivered at 5 am, instead of at 7 am 12 years ago. She went with her two sons to adopt this dog.
At one time she had 8 dogs dumped onto her house from friends who asked her to rehome them. She had to manage 3 children. Not much time for herself. At 65 years of age, she looked much younger than a 55-year-old.
"I cured one terrapin with enlarged closed eyes just by researching the internet," the grandmother said to me. That was great news. Most Singapore women of her age would not touch the computer.
"I can remember important dates and do calculations fast," the grandmother said to me. "I would tell my children the price per kg for things they bought. But lately, I am not able to remember so well. I can't stay long to chat. I have to go to Hong Kong."
"Why do you have to rush to Hong Kong?" I asked.
"To look after my grandson for a week." she said. All grandsons must surely love her vey much.
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