Canine clinical cases (Proceedings)

Case #1

History

• 18 month old female intact Plott hound, "Donna"

• Bloody discharge that started approx. 4 ½ weeks ago

• Discharge has increased and decreased during this time

• This is the first heat, and the owner would like to breed her

Clinical Findings

• HR, RR, temperature normal

• Weight: 57 pounds

• Bloody vulvar discharge

Differentials

• Proestrus

• Estrus

• Endocrine Producing Ovarian Tumor

• Cystic Ovaries

• Exogenous Estrogens

• What diagnostic tests would you want to perform?

Possible Diagnostics

• Vaginal Cytology

o Is the reproductive tract normal?

• Progesterone Assay

o Has progesterone started to elevate?

• LH concentration

o No Value!

• Estradiol

o No more value than cytology!

• Ultrasound of the reproductive tract

o Rarely of value, except to locate follicular like structures or tumors on the ovaries

• Karyotyping

• Not indicated

• CBC, profile, urinalysis

• May be performed if indicated

• Thyroid panel

• Radiographs

o Unnecessary

• Laparoscopic examination or exploratory laparotomy may be considered

• Rarely of value in a bitch with these signs!

Diagnostic Test Findings

• Vaginal Cytology

• Normal proestrous/estrous cytology

Differential Diagnoses

• Proestrus - Too long for normal proestrus

• Estrus - Not typical of normal estrus

• Endocrine Producing Ovarian Tumor - Rare

• Exogenous Estrogens - Watch the clover and birth control pills!

Diagnosis?

• Cystic Ovaries

• Diagnosis based on history (proestrus should not last over 18 days), and vaginal cytology

• History must rule out exogenous estrogens!

Treatment

• Miberolone

• 18 mcg/lb for 5 to 10 days

• Testosterone

• 2 mg/kg up to 30 mg?

• Ovaban - Megestrol acetate

• hCG - 500 to 1000 units/animal

• PREFERRED

• GnRH

Expected Results

• Our treatment with hCG is 95% successful

• Signs decrease within 5 days and should be gone by 14 days

• Two treatments are 100% successful

Case #2

History

• 20 month old female intact Chinese Crested, "Tina"

• Tina was mated to a male Beagle by accident

• One previous litter, no problems

• Owner wishes to terminate pregnancy

Clinical Findings

• HR, RR, and temperature is normal

• Weight: 6 pounds

• Slight serous discharge from the vulva

Differential Diagnoses

• Proestrus

• Estrus

• Pregnant from Mismating

• Non Pregnant from Mismating

• What diagnostic tests do you want to perform?

Possible Diagnostic Tests

• CBC, Profile, U/A

o No Value

• Vaginal cytology

o Look for presence of sperm and evidence of estrus

• LH Assay

o No Value

• Ultrasound

o Little to no value

• Radiograph

o No Value

• Progesterone Assay

Diagnostic Test Findings

• Vaginal Cytology

o Sperm Present on Cytology

o Signs of estrus present

• Progesterone Assay

o 11 ng/ml

Differential Diagnoses

• Proestrus

• Progesterone indicates estrus

• Estrus

• In estrus and had ovulated when bred!

• Pregnant

• Wait and See

• Non Pregnant

• Wait and See

Diagnosis – Mismated

Treatment

• Recommended ultrasound exam of Tina at 25 to 30 days from suspected time of ovulation based on progesterone concentrations

• If pregnant

o ECP?

o NO, NO, NO

• Prostaglandin F2Alpha

o Excellent, inexpensive

• Ovariohysterectomy

o Best for nonbreeders

• Ergots

• ???????????????

Expected Results

• 100% effective

• Just continue treatment until fetuses disappear!

Case #3

History

• 4 ½ month old intact Yellow Labrador Retriever, "Lady

• Vulvar discharge with duration of one month

• Dog licks the vulvar area

• Appears to go outside to urinate more often

• Discharge is mucoid

Clinical Findings

• HR, RR, temperature are all normal

• Weight: 35 pounds

• Physical exam within normal limits except slight vulvar discharge

Differential Diagnosis

• Metritis

• Pyometra

• Vaginitis

• Cervicitis

• Vaginal Tumors

Possible Diagnostic Tests

• Vaginal cytology

o Determine if inflammatory or infectious process is present

• Vaginal culture

o Only if cytology deems it is warranted

• CBC/profile

o Limited value

• Brucella screening test?

• Ultrasound

o Limited value

• Radiographs

o Limited value

Diagnostic Test Findings

• Cytology

o Numerous WBC

• Culture

o Streptococcus sp. Sensitive to ampicillin

Differentials

• Metritis

o Too young

• Pyometra

o Has not had a heat

• Vaginitis

o Possible and common

• Cervicitis

o Rare in the bitch and rarer in the young non-bred bitch

• Vaginal tumors

o Rare in a dog this young

Diagnosis

• Vaginitis-prepubertal

Treatment

• Local antibiotic therapy

• Premarin-weak estrogen

o 20ug/kg

o 0.625 mg tab/60 lbs twice a week

Expected Results

• Recovery is approximately 95%

• Stubborn cases may require retreatment or reculturing and using a different antibiotic

• May disappear after a normal estrus

Case #4

History

• 9 ½ year old coon hound, "Seeker"

• Blood in urine and ejaculate

• Used for breeding since he was 2 and up until he was 8

• Few other health problems

• Owners wish to use him again

Clinical Findings

• HR, RR, temperature were all normal

• Weight: 48 pounds

• Prostate is enlarged and normal division between lobes is absent

• No pain on palpation

• Blood in ejaculate appears during the middle portion of collection

Differentials

• Prostatitis

o Hypertrophy of the prostate

o Acute Infectious Prostatitis

o Chronic Infectious Prostatitis

o Prostatic Cancer (?)

Possible Diagnostic Tests

• Examination of ejaculate

o Possible testicular degeneration

• CBC/Profile

o Little value since little systemic signs

• Brucella

o Always a good idea since he is a breeder

• Testosterone concentration

o Little value

• Culture of prostate

o Limited value initially

• Urine culture

o Probably no value

• Ultrasound of prostate

o May be of value

Diagnostic Findings

• Examination of the ejaculate

o 12% primary abnormalities

o 35% secondary abnormalities

o Total number of cells within normal limits

Differentials

• Hypertrophy of the prostate

o Fits the history of blood without systemic signs or pain

• Acute Infections Prostatitis

o No increased temperature or pain

• Chronic Infectious Prostatitis

o No recurrent epidsodes of pain, or other indications of a chronic infectious condition

Diagnosis

• Benign Prostatic Hypertrophy

Treatment

• Castration?

o Only true treatment

• Ovaban (magestrol acetate)

o 0.25 mg/lb/day for at least 45 days

• Proscar

o 1 mg/kg/day for at least 4 months

• Estrogens

o NO, NO, NO dog will not be a breeder with this treatment, so why not casterate?!?!

Expected Results

• Dependent upon age and involvement of prostate. However over 90% of dogs with prostatic hypertrophy will respond to Ovaban or Proscar. Remember, these are designed to be for relatively short periods of time! Longer treatment should be advised only after informing owner of possible decrease in fertility or libido