April 8, 2011
"My uncle was so surprised and said: 'Your dog is so young
and active," the wife said to me
over the phone today when I asked what happened since 76
warts were excised by me 8 months ago. See:
http://www.asiahomes.com/real_estate_tips/0816bluff.htm
"He is like a brand new dog a few days after the surgery.
He behaved as if he was 6 years younger. Full of
energy! It was not just my uncle who commented. Many
friends
were so surprised that my dog had become energised after
the wart surgery!"
Today, the husband made an appointment specifically to
consult me about the dog's
right ear.
His first remark was that the 13-year-old male neutered
Shih Tzu was a new dog after the warts were removed. I
expected a half-dead lethargic old Shih Tzu but I was also
surprised at the full coat and alertness.
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The old Shih Tzu has been
stressed by the painful eyes
and right ear canal (filled
with stinking pus) for at
least 8 months. 10 viral
skin warts came back and
were frozen.
The couple will need to be
diligent and educated to
eliminate the stresses if
his old companion is to live
to a ripe old age in comfort
and free from pain and
itchiness. Follow up with
the vet is advised after one
month and subsequently.
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The dog came in for
a smelly right ear. I put a cotton bud and got a smear of
dark brown
 pus
at one end. The Shih Tzu winced in pain when the cotton
bud touched the junction of the horizontal and vertical
canal. He did not bite me. I smelt the brownish-yellow tip
to check what type of bacteria or yeast infection it could
be. This is not scientific as an ear discharge smear to
check for yeast and bacteria would be done soon.
The smell was like some rotten flesh kept for some time. I
asked my assistant and the owner to smell the tip as I
waved it in front of their nose. The left ear was
perfectly normal. "I ran out of your ear drops," the
husband said.
There were 10 warts on the back spinal area (after I had
the dog clipped bald. We thought it was 3 warts before
clipping). 10/76 warts. Yet Vet 1 had told the owner: "The
dog is old already. The warts are not serious. No point
removing the warts. They will return back." I did say
there is a possibility of recurrence too. The dog was 12
years old and a very high anaesthetic risk.
WHY DID THE OWNER SEEK A SECOND OPINION?
I asked the wife over the phone as Vet 1 had been their
regular vet and they were a loyal client. "The dog was
bleeding every day," the wife said. "A lot of blood. The
dog was in pain. He was sleepy most of the day. I had to
do something." In other words, the wife was very concerned
and went into the internet to do research. Then the couple
came to consult me.
WHAT DID I DO
8 MONTHS AGO?
Admitted: August 8, 2011, 2011, 9.3 kg, 38.1 C.
76 warts from head to toe literally.
R ear - rotten smelly skin. L eye - dry eye.
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8 months ago, 76 warts were
electro-excised under
general anaesthesia |
HIGH
ANAESTHETIC RISK
It is not surprising that the family vet (Vet 1) did
not want to perform surgery to excise the warts. He
probably did not relish the blame and hassles if the
old dog died on the operating table. So, over the 5-
6 years, the warts multiplied to number 76! The dog
was lethargic most of the day. "What do you expect?"
you would say. "He is an old dog!"
Anaesthesia & Surgery on Day 1 - August 11, 2011 and
goes home on Day 2.
IV saline drip with Baytril 0.5 ml and Tolfedine 0.5
ml IV
Domitor 0.1 ml IV. Isoflurane gas maintenance.
Electro-surgery. Excised 76 warts (a packet of warts
given to the owner is still remembered).
2/0 absorbable stitches.
Baytril x 3 tablets, Trimethoprim and multivitamin
for home.
The owner came 2 weeks later for antibiotics and no
more news from the owner till today to consult about
the smelly right ear. The wife was knowledgeable and
had agreed that it was too risky to get the lateral
ear canal resection surgery done. This surgery would
have eliminated this recurring right ear infection
(since 8 months ago, if you referred to my notes
dated August 2010 (image below).
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Procedures
used to excise 76 warts |
BLOOD TEST
ON AUGUST 11, 2011
Liver enzymes high, urea high, creatinine low.
White Cell Count 19.8 (6-17)
Neutrophils 88%
Abs 17.55
Lymphocytes 9.6%
1.90
Monocytes 1.1%
0.22
Eosinophils 0.71%
0.14
Basophils 0%
0
PCV, platelets, haemoglobin and RC etc - normal.
URINE TEST ON AUGUST 11, 2011
pH 6.5 (5-8)
SG 1.038 (1.005-1.030)
Protein trace
Blood negative
White blood cells 8
Bacteria Occasional
Crystal Calcium oxalate+ |
TODAY'S TREATMENT
Clipped bald. 10 warts. 2 most prominent between eyes and
behind midline of eyes.
1. Right ear discharge sample. Stained exudate (fixative,
air dry, S1, air dry, S2, air dry) to check for yeast and
bacteria. Bacteria present. The owner had been giving his
own ear drops for the past 8 months from some sources.
2. Irrigated the ear and bathed the dog after clipping the
coat.
3. Froze 10 warts seen after clipping coat, 1
minute. Prominent one between eye. biggest cauliflower
shaped at 4 mm x 4 mm. Others were much smaller appearing
as small lumps under the skin. No need for sedative or
anaesthesia.
PERFORMANCE COUNTS
This is a rare case of generalised warts in Singapore. The
warts multiplied and spread over a period of 5-6 years.
Why?
Food fed - home-cooked chicken and dog treats and canned
Caesar. Sometimes diarrhoea, the wife said.
Given k/d canned and dry (last 2 months). Stools well
formed and no diarrhoea.
OVERALL
Need to treat right ear infection and dry eyes if the dog
is going to live longer with no pain and discomfort. Warts
must be frozen when they are small. 10 very small warts
were frozen without the need for anaesthetic and sedative
as this dog was OK with the freezing. The biggest one was
around 4mm x 5 mm between and above the eyes in the
midline as shown below.
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8 months ago.
Under general anaesthesia and for around one hour,
the 76 warts were excised by electro-surgery! |
8 months later.
The wart above and between the eye has recurred but
was hidden by the hairs. Clipping exposed this wart.
This was deep frozen. |
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Small warts <4mm x 4mm can
be frozen and usually they
will disappear 7-14 days
later. Note that the large
wart above the left ear (as
in 8 months ago) has not
recurred! So, the
owner was happy with the
outcome. But the war
can be lost if one battle is
won if the owner is not
vigilant to get small warts
excised. |
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PHONE ADVICE TO THE
WIFE - REDUCE STRESS AS WARTS ARE SAID TO BE VIRAL AND
GROW WHEN IMMUNE SYSTEM IS DONE.
A very busy working couple. I told them I do consult on
Sundays and other days by appointment only. Fortunately,
the dog's 10 warts discovered early - can be frozen. Only
10 small ones. The husband did not want a blood test as
advised. Here are instructions given for this dog:
1. EYE CARE TO BE DONE DAILY (2 types of eye drops and
Atopica) to prevent dog going blind with dry eyes 2 years
later. Put dog on table. Teach mum how to do it if couple
goes overseas for 2 weeks.
2. NO DIRECT WIPING OF EYEBALL by husband to clear
pus around eyelids. Close the eyelids first after applying
eye drops, I advised.
3. RIGHT EAR INFECTION MUST BE DILIGENTLY CONTROLLED AND
FOLLOWED UP WITH THE VET. Rotten flesh smelly pus. Should
be able to cure this one soon. Should review with the vet
(me) 4 weeks later.
Warts do come back and can be frozen if detected early.
Warts had caused pain and infection if left for several
years (WCC high in Day 1). Owners are happy with the
outcome. If the dog had died
under anaesthesia, it would be bad for the vet. So, it is
understandable that Vet 1 was reluctant to do surgery. Too
many large warts, deep freezing is impractical.
A rare case in Singapore. Many older dogs have a few skin
warts but this old Shih Tzu had 76 warts. The warts
started with a few over the back area some 5 years ago,
according to the wife. Then more and more appeared. The
family vet would not want to excise them saying that the
warts would come back again. So, no point removing them.
The dog started rubbing his infected warts onto the floor
and bloodied the apartment. "The Shih Tzu just could not
stop scratching the large wart above his left ear. I have
to do something," the wife checked the internet and
contacted me.
What causes these warts? They are believed to be caused by
papilloma viruses. Poor immune system in very young and
old dogs lead to wart formation. What is the cure? Reduce
the stresses.
PERFORMANCE counts
in the veterinary practice. This case needs the owner to
take care and follow up with the vet monthly or regularly.
It had been 8 months since I saw the dog. I said
diplomatically to the wife that an old dog needs more care
than a young one and that stress due to pain and infection
must be reduced considerably to prevent wart formation in
old age. Also, good nutrition and no dry feed (urine
crystals). The dog has a very good coat and skin and I
presume k/d diet and some home-cooked food were
sufficient.
RETROSPECTIVE REVIEW. In hindsight, I should have
operated the dog after 24 hours as he was lethargic.
Sometimes I want to save the owner some money by doing a
same-day operation as in closed pyometra and urinary stone
cases. It may not be wise to take such a risk as many dog
owners never really forgive and never forget if the dog
passes away on the operating table. Deaths of pets on the
operating table are very highly emotional events even for
the vet and his or her staff.
GET YOUR DOG WARTS EXCISED BY YOUR VET WHEN THE WARTS
ARE SMALLER.
This case has a happy ending but owners are advised that
skin warts in their dogs are best removed when they are
few in number and are smaller. Happy endings are not
always the case in high anaesthetic risky old and sick
dogs with warts!
A YOUNG MAN
WITH FOOT WARTS
Skin warts occur mainly in very young and old dogs
as both groups have a much lower immune system. What
about young people?
Do people get the cauliflower skin warts? I remember
this young man in his early 20s in National Service.
His shoes were damp from military training.
At first he had one and then more foot warts
presented below his feet as he had to wear his boots
for military service. Moe warts kept appearing on
his hand as well. I can't remember how many he had.
I advised him to see the doctor who made him an
appointment with the surgeon as these warts seem to
thrive and spread.
Like many young Singaporean males hooked onto the
online gaming, he did not have sufficient rest. He
would go online gaming till past 3 am every day.
He ate noodles most of the time. He saw the doctor
who removed some warts. He reduced his online gaming
of WOW II and other games. Slept more hours and
earlier. I got him a freezing solution. He applied
on the remaining two warts. Now he has no warts
recurring. It seems that the warts are best excised
early as they seem to spread to nearby skin areas.
How he got the skin warts, I don't know. Now he has
no warts at all and that is a relief for him as such
warts can be quite painful. |
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TOA
PAYOH VETS
