The pain was killing him loudly when the 4-year-old Shih Tzu was at home yesterday. But he was silent, looked normal and merely limped a bit on his left fore leg when he was brought to the Surgery by 3 distressed family members pacing impatiently in the waiting room for me to finish a case.

The Shih Tzu did not put much weight on his left fore occasionally. Therefore I assumed he had pain in his shoulder joint or somewhere in his left leg and cried for attention last night.

After observing him walking here and there in the 80 sq. ft consultation room now packed with 3 owners, myself and my assistant, there was little space for this little Shih Tzu to walk. But he walked and was as cool as a cucumber.

"Put him lying on his right side the examination table," I asked my assistant. The Shi Tzu did not struggle. When I flexed and extended all his joints from the paws to his shoulder a few times, he did not feel any pain and so he did not cry or move away. I abducted and adducted his shoulder joint. No pain. So, why was he limping so obviously to all? I pressed his paws and the rest of his leg. No pain at all.

"He kept crying and whimpering past midnight for some hours," Mum was stressed out by this incident and probably had no sleep. "He was OK the whole day and after dinner."

"No," the teenaged daughter contradicted. "He started whining for attention at 9 p.m" and then cried.

"He was crying as if in pain for the whole night," Dad said.

"Did you give him any medication or pain-killer?" I asked.

"We thought of giving him some pannadol but no, we did not."

The next stage of the examination would be palpation. I put the dog standing on the table and used my right hand to press his abdomen. Starting from the stomach area to his bladder usually. I asked the agitated Mum and the other 2 family members to listen to the reactions of the palpation for pain of this dog I had known since he was a puppy.

"Did you hear the "hiss" sound from the Shih Tzu?" I asked the family members. A slight hunching of the back and a soft hiss that could be easily missed when I palpated the stomach/pancreas area. A painful reaction that the family members missed as it was so quick and so soft.

There was something painful in this anterior abdomen.

I started the palpation a bit forward or cranial to the stomach, just below and midway near the rib cage. That would be the location of the liver and gall bladder. I pressed the fingers of my right hand together to where the gall bladder would be.
This time, the Shih Tzu grunted like an old man. Loud. Everybody could hear it. I did not reproduce the same pain reflex as that would not be good for the dog.

So, the cause of his pain was this gall bladder area. There was mild fever. Was the dog having gall bladder infection or gall bladder stones?
 

"What's the bright yellow discoloration of the front half of his white coat on his shoulder area?" I asked. "Is it urine on his white collar?". I doubted it was urine as this dog was well cared for. This Shih Tzu had a full white collar.

"Maybe turmeric powder?" the father said. I guessed turmeric powder referred to the chilli powder used for making curry.

"What do you use to shampoo the dog?" I asked. Yellow shampoo can discolor the white coat.

"He applied some brownish tick powder to kill the ticks as the dog had lots of ticks," the mother said. "He got the powder back from India."

"Tick powder is very poisonous if licked by the small dog," I said. "It is possible that the liver and gall bladder could be affected, causing the pain."

"Don't buy tick powder from India," the mother  ticked off Dad.

So the use of tick powder is now a prohibited substance in this dog as it might poison his liver when licked. Tick powder is seldom sold in Singapore but it was common some 10 years ago. One big tin could kill all ticks and it was inexpensive. Presently, some Singapore pet shops do stock potent anti-tick concentrate solutions but not much tick powder. Skin application of anti-tick liquid is the most common and more expensive anti-tick arsenal used in Singapore.

My safest and free advice is to get the groomer to clip the dog  bald and all ticks are removed and caught easily.   
 

"Does the dog jump a lot?" I asked.

"He jumps from sofa to the floor and from one piece of furniture to the next," the daughter said.

"It is possible he could have had strained his left shoulder when he missed a step on landing," I referred to the dog's limping left fore. "He could have felt the pain yesterday but now he had recovered."

If only dogs can talk. There was a slight fever and therefore infection of the gall bladder and liver could not be ruled out.

"We have a 5-month-old Shih Tzu who plays with him," the daughter said. "The new dog is a female and was bleeding being on heat, 5 days ago." I had presumed this dog was the sole pet in the house.

"Did he injure himself while trying to mate with the female?" Twists and turns as he would be inexperienced and the female dog was not receptive at this stage of her heat and so he injured himself, causing lots of pain to his anterior abdominal area. And at night when everybody wanted to sleep, the pain radiated out from the injured area near the gall bladder.

No family member was sure about his sexual activity. This was the first time they had a female dog who was also full of ticks. It is just possible that he was too vigorous in his pursuit of the female, slipping off when the female moved away and trying again. Climbing up and falling down, hurting his anterior abdomen. A sound hypothesis?

I got the Shih Tzu clipped bald to remove all ticks. He was all right when he went home. As for the gall bladder pain, no further blood tests or X-rays would be done for the time being. It would be good to do all the ancillary tests to confirm the diagnosis of gall bladder/liver infection.

However, from the owner's point of view, the less costly the veterinary fees are, the more appreciative they are. If there is a relapse, blood tests and X-rays would be done. It had been 3 days and there was no complaint from the family. The dog was back to normal. Today is Sunday Jun 15, 2008.

I hope the hard-working business man had a good father's day. I told him as he returned to pick the dog that sexual activities could be the possible cause of the Shih Tzu's acute abdominal pain. He did not say anything.

A systematic palpation of the internal organs do help in pin-pointing the source of pain. Practise on all dogs and the vet will be quite competent in locating the gall bladder. Just with his fingers. This takes lots of palpation. Practice makes perfect.