First Opinion Reproduction Cases

Question 1

Case 1

• Signalment: 2 year old, female entire, Miniature Schnauzer
• History: Molly had 5 puppies 3 weeks ago. Today vomiting, not able to stand & salivating. Is being fed a raw meat diet.
• Clinical exam: Upon presentation collapsed, panting, salivating and extension of limbs. Temp 41.5 C (HIGH), increased RR and HR. Brief physical examination was performed.

1. What is your initial thought(s) when presented with this history?

Blood profile shows decreased ionised calcium.

2. Is this anticipated?
3. What should we do next?

Answer 1

1. Low calcium? How would we diagnose or investigate this
   
   • Blood test – ionised calcium
2. As she is lactating, produced 5 puppies and feeding them
   
   • Diet – raw meat is low in calcium
   • In last trimester of a dog being pregnant it should be fed a puppy diet as its much higher in calcium
3. Hospitalisation with intravenous fluids and calcium supplementation. Discharged with oral calcium supplementation
   
   • Discussion with the client:
     
     • Explain what has happened
     • Back yard breeders and registered breeders
     • Recommendations when breeding

Question 2

Case 2 – Benji

• Signalment: Benji is a 10 year old, male entire Yorkshire terrier.
• History: Straining to urinate. Haematuria, constipation and seems sore in the back end. Eating ok. Fully vaccinated. Travels to France on a regular basis with a valid pet passport.
• Clinical exam: BAR, tartar/dental disease (surprise !!), thoracic auscultation unremarkable, abdomen tense (dog tries to bite you), back pain and sore when trying to manipulate the hip joints (you count your fingers afterwards ?!?) – temp normal - taken very carefully!

1. Remainder of the exam is unremarkable…..or is it? Have we forgotten something?
2. What is our problem list?
3. So lets say that the dog was prescribed a course of NSAIDs and owner was asked to bring in urine sample for analysis. Anything that we need to discuss with the owners when prescribing a NSAID?
4. The analysis of the urine (normal s.g., dip positive for blood & protein). Culture: E. Coli. Are we antecipating this? What antibiotic could we try?
5. So we try a week of your chosen antibiotic. The owner again comes back and indicate that Benji still is not quite right……..the owner now wants to do further investigations…..and now informs you that they are insured (happens all the time!!) What do we suggest?
6. Full blood profile:
   
   • CBC: Mild mature neutrophilia. Clumping of platelets
   • CHEM: Alkaline phosphatase mildy increased. Otherwise unremarkable
   • Imagine shows an enlarged prostate gland (homegenously enlarged).
   • Write a DD list
7. Treatment options for benign prostatic hyperplasia?

Answer 2

1. Havent examined his testicles – they are equal size, shape and in scrotum both of them. HR, RR – NAD
   
   • Forgot prostate – haven’t examined this. Might need to muzzle him!! In a male dog, entire, if we don’t do this, rather vital point to examine any time they come, but especially with clinical signs like this
2. Haematuria, stranguria, constipation
   
   • Prostate gland enlargement
     
     • Benign hyperplasia
     • Neoplasia
3. Meloxicam – can we prescribe to any pet? Dont want them to be on steroids, ask which medical treatment the animal is on. If they start to V+/D+ stop treatment. Bloods to check liver and kidney function as meloxicam is contraindicated if you have kidney disease, it isnt with liver disease but will get decrease metabolism with it. Always recomend bloods to check liver and kidney before we prescribe it. If they dont want to have the blood tested, just have to write that we are prescribing, but it is unknown about internals and owners aware of risks and informed decision they are making
4. E.coli could be an artefact or contamination.
   * Dipstick – not expecting to see blood or protein in a normal animal, may be expecting to see blood due to history but not protein. Parameter to test – specific gravity or UPC.
   * What antibiotic could we try? Amoxiclav – as long as we do not say marbofloxacins
5. Blood test? Imaging? Ultrasound or radiographs? Chemical restraint as he isn’t happy with us touching him! Full haem and biochem profile. US of prostate gland
6. Benign prostatic hyperplasia (BPH) and Prostatic tumours
7. Tardak injection

Implant (Suprelorin®)

A non-steroidal, peptide-based contraceptive implant containing the GnRH-agonist deslorelin

Castration (most efficient treatment of choice for BPH, not neoplasia)

Question 3

Case 3 – Ellie

Signalment: 4 year old, female entire Labrador

History: Had a season approximately a month ago. Been quiet at home. Minimal interest in food which is not normal for Ellie. Fixated with toys. Fully vaccinated. No travel history. New neighbour that has a male entire dog.

Clinical exam: QAR, mm: pk and crt approx 2 sec, temp normal, thoracic auscultation nad, abdomen tense (reluctant for you to palpate the abdomen), milk in mammary glands. No other abnormal findings.

1. What to do next?
2. How far along in a pregnancy can we terminate with Alizin?
3. On imaging, an US was unremarkable, no signs of pregnancy or uterus abnormalities. Diagnosis?
4. Treatment?

Answer 3

1. Ultrasound
2. Can terminate up to day 45? With alizin. If you say no way that female dog was caught by neighbours dog, then assuming pseudopregnancy? More happy to say its this if they are certain
3. –Pseudo pregnancy

• Seen normally as a respond to increased prolactin
• Abnormal behaviour (even aggression) can be seen
• Do NOT spay while in pseudo pregnancy

–What happens if you do? Increase risk of bleeding, she will also remain pseudopregnant, then behaviour will stay

–Nwgative feedback from progesterone not there, so prolactin continues to be produced – pseudopregnancy. Constant clinical signs

4. •Treatment Galastop (Cabergoline)

–I do only use this in severe cases as normally the condition is self-limiting and I have seen a lot of side effects.

Question 4

Case 4 – Sophie

• Signalment: 6 year old, female entire, Whippet.
• History: Owner noticed Sophie drinking and urinating more. Was in season two weeks ago. Not been properly eating for a couple days. Been quiet yesterday and vomiting this morning. Is a rescue dog and has in the past been suffering from kennel cough according to the owner.

Clinical exam: Quiet but alert and responsive, temp 39.4 C, crt approx 2 sec, mild watery ocular discharge, thoracic auscultation (grade 1/6 systolic heart murmur). Abdomen tense and resisting this. No discharge noted from the vulva. Blood profile:

–CBC: Mild mature neutrophilia, large clumps of platelets on the smear.

–CHEM: Unremarkable
Imaging shows enlarged uterus

1. What is the next step?
2. Can we medically manage if cervix open?

Answer 4

• Next step……..start fluids peri-operative for a couple of hours and then……
• Antibiotics……..what would you use (if any)?
• General anaesthesia and spay
• Would your decision making been different if the purulent discharge was noticeable at vulva inspection?

– surgery vs medical management?

–You could do medical management as the cervix is open, some clients will want this