dveterinarian

Muki part 1

2010-08-30T02:07:00.011+08:00

Last year, Muki was presented at early in the morning due to limping of both hindlimbs. He was practically dragging his hindlimbs similar to dogs with hindlimb paralysis due to vertebral dislocation.

The owners are uncertain how things came to be and palpation of the limbs and back showed no signs of swelling, pain or possible dislocation. however, something caught my eye: there was a blood clot forming at the end of the prepuce. Retracting the prepuce revealed an excoriated glans penis with the bone os penis exposed. This might also explained his "lameness". Since his os penis is causing trauma to his prepuce and due to pain during walking, Muki is minimizing the use of his hindlimbs in order to decrease pain and further trauma.

Now in cases like this, there are several possible and questionable scenarios how the penis turned out to be like this: 1) self trauma or mutilation, 2) someone hit him 3) dog fight (?), 4) infection, 5) and any other possible accident. I haven't really found the real cause since there were no other wound or lesions to point to violence or accident.

There were several recommendations I gave: 1) Penile amputation: The Penis will be amputated more proximal to the body with the os penis as the distal reference. 2) scrotal ablation: muki will have no use for his testicles and scrotum so we might as well remove them and also to give was to 3) urethrostomy at the scrotal area where Muki's urine will go out.

Muki was then sent to the Main branch for Surgery and after 48 hrs, he was back with us.

Now, since I am unable to locate the pictures post surgery, I will make a new entry for that later. Muki had a quality life after the surgery until He came down with Leptospirosis and Kidney failure earlier this month.

VETERINARIAN VS. MD

2010-08-17T00:30:00.004+08:00

Watch this link: This is entitled VETERINARIAN VS. MD. This was shared through Facebook from xtranormal.com

This goes beyond what this blog should be about but I just want to share this.

http://www.xtranormal.com/watch/6868901

2010-08-09T09:17:00.001+08:00

Is it me or do i see her smile?

poor whippet!!!

2010-08-09T00:56:00.004+08:00

Thursday Morning: May 27, 2010. A limping Whippet (forgot his name) was presented for check up. Apparently this dog was run over by a car (theirs) on monday and was presented to another practitioner for initial treatment. He was then taken home and was put on medications.

Radiography was recommended to further investigate the damage to the bones and the surrounding soft tissues. Fracture of the 2nd phalanx of the 2nd digit of the right limb was emminent, damage to the carpal bones were also seen (not clear on photograph), with too much tissue inflammation.

The bandage covering the damaged limb was removed to check the status of the limb (Apparently, the first and last time that the wound was cleaned was on Monday) Here's a few of those pictures:

There is severe damage to the soft tissues of the limb as well as the bones and they are not viable anymore. Putrefying stench also filled the room during the examination. The fractured phalanx is sticking out of the damaged tissues, carpal bones are visible as well as the tendons.

Amputation of the affected limb was recommended but they never returned. I wonder what happened...

In trauma cases like this, the wounds should always be kept clean. The trauma, aside from inflicting severe physical damage, may cause for the inoculation of contaminants and bacteria that can further cause damage and complicate the case. Some limbs may be saved from amputation if the affected area is still viable/living and may require intensive care and time to recover. Some may be recommended with amputation. Still others, even if the area is still viable but management of the wound is poor, may still result to amputation.

Accidents do happen, but sometimes, they can be prevented.

Remembering Barnie.

2010-08-03T04:42:00.006+08:00

A few months back, Barnie, a 13-year-old Basset Hound was presented due to sudden enlargement of the abdomen. I suddenly remembered Lucy (one of my earlier posts). Bloat was my diagnosis.

I had to pass a stomach tube in order to release the trapped gas and then flush the stomach with saline solution. Blood results were unremarkable and she was declined for surgical treatment, thus we had to modify her diet and keep her under confinement. A week later, she was discharged but was returned due to the same condition three days after her release. Her recovery this time was slower but we were able to keep her stable. Days later, she went home.

I haven't heard from her owner until last month when we bumped into each other inside a mall. Barney never had another bloat episode after her 2nd release. However, since she was old and her liver was compromised, she deteriorated about 2 weeks after.

Reminder!!!

2010-08-03T04:36:00.001+08:00

ALL SHOULD KNOW THAT COMMON PESTICIDES AND PETS DO NOT MIX.

ON TO BLOOD GROUP DETERMINATION

2010-05-09T04:24:00.005+08:00

the following texts are taken from the package insert of RAPIDVET-H Blood Group Determination System for Identifying DEA 1.1 Positive and DEA 1.1 Negative Dogs.

"While it is broadly true that dogs do not posses isoantibodies to incompatible blood groups and thus will generally tolerate well an initial incompatible transfusion, sound practice of veterinary dictates that transfusions be avoided. The half life of the transfused incompatible cells will be quite short and, thus, the intended therapeutic result may not even be attained. also the potential future needs of the canine patient must be considered. Antiboides arising from a transfusion of incompatible blood may form in only 5-7 days and will have long-term viability. This eliminates the option of using incompatible blood in a future emergency situation.

Eight specific antigens have bee indentified on the surface of canine erythrocytes. The internationally accepted canine blood group system, the DEA (Dog Erythrocyte Antigen) is based on these antigens. It currently characterizes eight common blood groups, the antigens DEA 1.1, 1,2, 3, 4, 5, 6, 7 and 8.

DEA 1.1 and 1.2 are the most significant blood factors in the dog. Both are highly antigenic but DEA 1.1 is the primary lytic factor in canine transfusion medicine. Although all of the blood group antigens are capable of stimulating formation of isoantibodies, DEA 1.1 has the greatest stimulation potential. Thus most reactions resulting from the transfusion of incompatible cells occur when DEA 1.1 positive blood is given to a DEA 1.1 negative recipient. Clinically significant reactions to DEA 1.2 may occur but are less severe that reactions to DEA 1.1. DEA 7 may be a factor in transfusion reactions, but since it is a cold agglutinin and a naturally occuring isoantibody, it is considered to have very low clinical significance. The remaining antigens are considered to cause clinically insignificant transfusion problems."

Recently, I had a visitor. Troy, a previous patient of mine was brought not as a patient but to accompany another dog that showed signs of Blood parasitism during pregnancy. But this is not about her but Troy.

Troy was presented july of 2009 due to severe lethargy and weakness, bleeding from the mouth and inappetence. Further investigation revealed Ehrlichiosis and severe anemia. we were able to stabilize him but blood transfusion was needed.

On testing Troy's blood, we found out that he is DEA 1.1 positive. Our donor Diego is DEA 1.1 negative. Upon these findings, we prepared both the recipient and donor for the procedure.

Troy recovered swiftly and was discharged a few days later. I haven't seen him for follow up (grrr!) until today. He is now very healthy and is very active. The owners even joked that, he must be like this due to the Doberman blood.

Diego the donor

2010-04-30T02:45:00.003+08:00

I am way beyond schedule in posting new articles... Though while I was checking my files, I have a number of cases to be written and posted, my mind doesn't seem to synchronize with what I want. I'll just reorganize my thoughts and cases and probably be back blogging in time...

dveterinarian

BATTERY INGESTION

2010-03-08T05:40:00.005+08:00

The chewed up battery was presented to me by the client together with the dog

Batteries will not power-up your dogs as compared to your remote control or other battery-run gadgets and appliances. Instead, they might suffer toxicity, muscosal and gastric burns- to a more severe note, gastric perforation and death.

It is our pet's nature to discover things around them. In contrast to us using our hands and other senses to discover things, dogs do use their mouth (by chewing), olfaction and sight. however, as owners, it is our responsibility to screen out things and even food that may cause problems to our pets, batteries being one of them. (You may also be familiar with my previous posts on rodenticides, needles, foreign objects, firecrackers and the like)

Discussing the components and the different types batteries can become too geeky and nerdy for this site and you may search for it somewhere.

Going back, batteries contain chemicals that may cause mucosal burns when in contact with the skin. Most dogs brought into the clinic that are suspected for battery ingestion may have oral burns and may have a recent history of chewing on a battery powered gadget. The owners may report a missing battery or will bring with them the chewed up battery. Doing a radiograph may reveal the location of the battery if swallowed.

If the incident happened very recently, emesis may be done, however it should only be done if the battery was swallowed whole without chewing especially button batteries. The leakage of the battery components and its contact with the mucosa may further cause chemical burns. In some cases, surgery may be warranted and in others, oral medications may work. However, It all depends on the case presented. If you knew you pet has ingested a battery, do not wait for several days as it may more be difficult to manage by this time and toxicity or poisoning may have occured.

Prevention is still better than cure. So be very careful with your things if you have a pet as you would be if there is a child in the house.

OVARIOHYSTERCTOMY

2010-03-05T01:30:00.006+08:00

Uterus and ovaries of a cat that underwent ovariohysterectomy.
Note that this is not a normal uterus of a pregnant and a non pregnant cat.

I apparently forgot her name since this case was dated October 2008. However, this kitty came in for elective ovariohysterectomy or spaying. Her owner doesn't want her to get pregnant anymore since she is already old. Her one and only pregnancy was about 5 years ago and the owner was actually almost complaining of the monthly visitors = the tomcats looking for a mate and the kitty calling out for one.

Since her blood results were all normal, we then scheduled the next day for surgery.

During the surgery, i thought i was looking at a pregnant uterus, however, upon exteriorization, it does not appear to be normal at all. We then proceeded with the ligation and the cutting of the uterine horns with the ovaries and the uterine body.

Out of curiosity, I decided to open up the uterus to check what is inside. FLUIDS.

Ovariohysterectomy is usually done as an Animal Birth Control (ABC) measure. Aside from this, other reasons for ovariohysterectomy are prevention of mammary tumors, and ovarian and uterine neoplasia, treatment of choice for pyometra and metritis, and may be recommended for other conditions such as uterine cysts, torsion, uterine prolapse, endocrine abnormalities and dermatoses.

The cat went home after recovery and is in good condition.

BYE BYE BALLS

2010-03-04T23:49:00.004+08:00

What the ...???

You are now staring at two testicles from a castrated cat.

Castration or orchiectomy is the surgical removal of the male gonads or testicles. This surgical procedure is done for both dogs and cats and is also performed in other species like rabbits, laboratory rats, goats, etc.

Most owners and enthusiasts have their pets castrated in order to prevent overpopulation (ABC=Animal Birth Control) and its possible effect on the male behavior, which is to decrease aggressiveness, marking of a territory by urination, roaming to look for a mate, and the like. However, castration is also beneficial to prevent and correct androgen-related diseases like prostatic diseases, perianal adenomas, and perianal hernias. Other than those mentioned, castration is also indicated for congenital abnormalities of the testicles, epididymis, neoplasia, abscesses, and trauma of the testicles, herniorrhaphy, scrotal urethrostomy, epilepsy control and control of endocrine abnormalities.

for further information regarding castration, ask your vet about it. ; D

REMINDER

2009-11-05T03:43:00.003+08:00

Sales of firecrackers will increase in the days to come.
These firecrackers are readily available and anyone can get access to them.
Thus, firecracker poisoning may be a concern.
It is advised to check whatever you pet ingests especially when walked.
Please also educate your children or young siblings not to offer them to your pets.
Firecrackers can cause poisoning.
It's better to be cautious and avoid accidental ingestion.

2009-10-26T07:34:00.004+08:00

If you are not comfortable with me as your veterinarian and do not trust my judgement, I think it's better to look for another veterinarian.

As a veterinarian, aside from the skills learned during college days and day to day training in the small animal practice, it is also important to develop people skills. You may see us talking to dogs and cats in order to calm them down during check ups but mostly, we are speaking with their owners and caretakers, explaining to them the different options for treatment, health management, vaccinations and other things necessary. That is called the client-veterinarian-pet relationship. this can further be simplified to the veterinarian-clent realtionship, client-pet relationship and the veterinarian-pet realtionship.

In order for these relationships to work properly, each individual should be able to communicate well, understand each other and respect one another. One must know their limitations and boundaries. In most cases, these relationships are going well. But if it becomes a roller-coaster ride, and the relationship gets bumpy, then you know there's something wrong.

Just like any other service, a client can choose their veterinarian and a veterinarian can choose whom to serve. Though as vetetinarians we have a noble duty to these dogs and cats (and other pets), their owners will still decide for them. Lucky are the pets with responsible owners. Thus, if a client is not satisfied with one veterinarian's service, he can go to another and another until he finds the one (and hopefully the pet is still alive by then). And us vets can decline to treat a patient if we think that the owners doesn't trust us, does not believe us and disrespects us.

Remembering Doodie (aka Phoozie)

2009-09-14T08:32:00.006+08:00

She was known as Phoozie when she was presented at the clinic. Not eating, inactive and basically not herself.

She was diagnosed with chronic renal failure.

Checking Phoozie's real gender, it turns out that she is a castrated male, (a HE)!!! Yes, for the longest time that Phoozie was with his real owners, they didn't know that since they only got Phoozie from the streets and adopted his as thier own. Upon knowing this, they changed his name to Doodie.

For several weeks, Doodie was hospitalized and blood counts, chemistries and electrolytes were monitored. He got well eventually and this video is the first time he started eating again.

She went home a few days later.

Yet after a few months, since kidney disease continually progresses, she was back at the clinic.

After a few days, it was time to say goodbye.

Goodbye Doodie. We will always remember you as one of the good tempered and sweet siamese we cared for in the clinic with such loving and caring owners.

Remembering Yoji...

2009-09-08T02:59:00.000+08:00

Warfarin rodenticide

2009-07-05T02:44:00.007+08:00

I am not against rodenticides. I fact, these, can help control rodent overpopulation which can serve as vectors for communicable diseases and destroy household and work stuff. However, I am against irresposible usage of these products. These products are poisons and should be strategically placed to bait target species and not our beloved pets, especially dogs and cats.

FYI: Warfarin is also used as a medication, however, it may cause toxicity in large amounts.
Warfarin and warfarin-based rodenticides are not the only rat poisons available commercially but also zinc phosphide and bromethalin.

There are different ways employed to treat and decontaminate a patient that ingested warfarin-based rodenticide, so if your pet ingests one, immediately seek veterinary service and don't forget to bring with you the package of the poison.

Again, be a responsible pet owner. Dog proof your household.

Princess

2009-06-24T07:07:00.011+08:00

One early morning, Princess, a female shih-tzu was taken to me. Apparently she was vomiting with decreased appetite on the day of presentation, feverish and unable to defecate about 4 days after surgery. She was subjected to a cesarian section from another clinic 4 days prior. The owner also noticed dehiscence of the wound area and decided to put a bandage around to prevent Princess from licking the area or further dehiscence. The area upon my inspection is wet and the sutures are slowly eating through the skin.
I took a radiograph to check for continuity of the abdominal muscle area. It seemed dehisced though i was doubtful since she was just subjected to surgery which means the area would still be cloudy, hazy and probably in diasrray due to healing and inflammatory reaction.

In the meantime, we stabilized her through fluids and medications and blood profiling was done revealing elevated wbc, slightly decreased rbc, normal kidney and liver functions. Cleaning of the area and changing the dressing was done to avoid contamination and further infection.

Further assesment and repair of the area should be done deemed necessary and a night after, we have a go signal.

Since the sutures were already cutting through the skin, I decided to first remove it and here's how it looks... (by the way she also has an umbilical hernia)

With the owner's consent, we prepared Princess for her surgical repair.
When we parted the skin and subcutis, we noticed a suture from which I am still unable too see where it came from. Aside from that, a fleshy material or organ is staring directly at me. At first i thought it was the subcutaneous fat but it wasn't.
It was the intestine! Thus this also means that the abdominal muscle sutures were also dehisced. Abdominal fluids were also seeping out. I am worried that infection can or could have entered the dehiscence.

Thankfully, the intestinal loop is still normal and vital. Careful examination of other organs was done and were replaced with care.

I decided to close the muscle only on that night leaving the subcutaneous area and skin open but with a wet-antibiotic treated bandage to keep the wound from infection.

After 24 hours, I was sure that there are no signs of infection on the outside, closure of the subcutis and skin was done.

Ten days later, Princess is back but for sutre removal only. See it on the next two pictures. one still with the suture and the next after removal.

You may also noticed that her left eye (she has no right eye due to trauma years ago) is cloudy. Antibiotic treatment plus cyclosporine was prescribed and positive change is noticed. Could be keratoconjunctivitis sicca (KCS) but that's another story.

Roundworms!

2009-06-22T10:53:00.005+08:00

THESE ARE NOT NOODLES!

These are roundworms.

Three cute little puppies defecated worms one Sunday morning at the clinic. Gross! Right! Though I am used these parasites all the way from parasitology class, I almost puked that morning- concerning that I already had a headache that same day.

Going back, wow! these puppies also have pets of their own. Well, actually they have parasites!!! Roundworms are one of the many parasites that can affect dogs and cats and also humans. Yup, you read it correctly: FYI roundworms can also affect us.

Basics: These roundworms can be trasmitted from dog to dog in different modes.
1. Feco-oral route: ingestion of feces with eggs.
2. Transplacental route: larvae migrate from the mother to the fetus while during pregnancy.
3. Transmammary/transcolostral: larvae migrate from the mother to the young through the milk.
4. Ingestion of transport hosts such as rodents.

Thus, regular deworming or pets is recommended at 3-6 months interval or actually depending on your pet's lifestyle and your veterinarian's recommendations. Pups can be dewormed starting at 3 weeks of age.

So, see to it you that if you have dogs, bring them to your vets.

Scabies

2009-06-18T05:20:00.002+08:00

Sacrcoptes scabiei var. canis

PANIC AND SCRATCH ALL YOU WANT YOU INFECTED HUMANS! most likely, you got it from cuddling your previously fluffy now alopecic (balding), pruritic and crusty pets.

Generally known as scabies or mite infestation or by its scientific name, this organism is NOT a normal resident of the skin, both pets and humans but a PARASITE, which causes severe itching that you'll be scratching until you bleed. These mites burrow under the skin and reside on the stratum corneum - a layer of the skin. The irritation is due to body's reaction against these invaders and just imagine a mite eating you up!

Basically, this is detected by you veterinary staff during skin check ups. If your pet has it, you are also at risk of contracting it. Your veterinarian treats your pet while you should go to a dermatologist...

yeast!!!

2009-06-09T03:58:00.004+08:00

DON'T PANIC!(unless you have to)

I don't think this is the cause of human yeast infections ( You unhygienic people! LOL).

Meet Malassezia pachydermatis, one of the common residents of your doggie's or kitty's skin. In normal pets, they can be seen in small numbers though may greatly increase in number if your dog contracts skin infections. This may also be found in ear infections of your pets. Usually this organism likes the warm, wet and unexposed areas of the skin; talk about axilla, ingunals, chin, skin folds and the ears.

And do humans have to panic?

If you are immunocompromised then maybe you should. Recent studies revealed that neonates and those with poor immune status may be affected with M. pachydermatis. Though humans also have a normal skin commensal of the Malassezia genus, the M. furfur, M. pachydermatis was also implicated especially in humans exposed to pets like me. (waaaah!!! panic! panic! LOLz)

I guess, it's just about health. Once you are immunocompromised, then you should atleast takeprecautions. If you are constantly exposed to pets, then hygiene comes. Consciousness helps.

Got to go now. I still have to to a self check!!! LOL

ALI

2009-06-05T14:06:00.007+08:00

Ali was actually a colleague's case. He was admitted due to a non-healing and infected wound. Prior to admittance, he underwent umbilical hernial repair from another establishment. Yet, days after the surgery, the owners noted that the surgical incision was swollen with pus and fluid oozing and is actually not healing. Upon assessment and repair, it appears that the whole wound is actually infected and there's more pus and necrotic tissues underneath. We cleaned the area and resutured the dehisced internal layers. We left the wound open covered with wet sterile bandages with antibacterial dressing to help keep the wound clean and for new granulation tissues to form prior to closure. A few days after presentation, we also noticed something: Ali is unable to stand up. Though actually responsive and with appetite, her limbs are stiff and extended. Is this tetanus? Concerning that he had a prior history of an infected wound, we assumed that this could be the T thing. Medications against tetanus were given and Ali was monitored for a few more days - three weeks total more or less.

The picture above was taken a few days prior to Ali's release. Slowly, she was able to gain back control of her limbs and was able to stand up on her own.

Clostridium tetani, the bacteria responsible for the production of the toxin causing tetanus is actually found in the soil. It can gain entry and cause infection in pets through wounds especially deep puncture wounds or those that have been in contact with the soil or area with the bacteria. Dogs and cats are actually pretty resistant to tetanus, however, predisposing factors may make them susceptible to the disease.

2009-06-05T14:00:00.002+08:00

It has been quite a while since I posted something in my blog.
Though I always have an interesting case to share, I often forget to take a picture prior during and after the procedures and/or treatments done...
I was also a bit busy these past few days...

lucy

2009-04-11T12:49:00.004+08:00

Lucy, a six-month old basset hound, is very unlucky. Her humans found her barely conscious, drowning in the pool one Sunday morning. At presentation, she was almost blue, dyspneic, weak and recumbent. At the same time, her stomach appears bloated. We took a radiograph and saw a very dilated stomach filled with gas and most likely also fluids. The lung area is also very hazy as the pool water may have accumulated with the respiratory lining most likely compromised.

Oxygen was provided yet since Lucy was conscious she was constantly shying away from the oxygen hood. Since bloating is also an emergency condition then it also has to be corrected thus, blood profile and baseline blood tests were done which were actually normal.

the radiograph on the left was taken before gastric intubation. notice the dilated stomach filled with gas and fluid. also notice the hazy lungfield (on both radiographs). the radiograph on the right was taken after the stomach was relieved of the gases and fluids.

During intubation for gas anesthesia, blood came out of lucy’s trachea, an indication that severe bleeding from the lungs has taken place. Blood accumulation will further compromise gas exchange. However, endotracheal intubation will also be beneficial to provide almost 100% oxygen. Then we did gastric intubation to release gases from the stomach. Aside from air, mixture of gastric fluid, pool water and blood was also recovered. Another x-ray was also taken check and there we saw that the stomach is already relieved of gases and fluids. Now we are back to the lungs… the blood+fluid filled lungs.

me and my assistant during gastric intubation. Lucy is on gas.

When Lucy was taken off the endotracheal tube, hood oxygenation was provided, she was actually pink as compared to the bluish color she was earlier. She also received all medications however, she still left us that same day…

2009-04-11T12:32:00.004+08:00

Max’s new owner rescued him from the streets. He was apparently in(?) a plastic bag by the street of an actually rich village when he was found.

Max was presented due to limping and at presentation, the left forelimb was swollen, painful to touch and has a wound with pus oozing. Radiograph revealed no fractures and/or dislocations but is suspicious for periosteitis.

Max during one of our would cleaning nights

Medications, wound management and removal of pus was the main goal. Increasing the appetite is also included. 4 days later, Max was ready to go home.

he's having his ears cleaned - earmites...

wound has actually improved from a swollen one with oozing pus to this one with granulation tissue forming.

The funny thing was Max was only given his name on the day of his discharge, about 4 days after presentation. During his stay at the clinic he doesn’t have a name and is identified only as Siamese kitten.

A few days later, Max’s owner called up that Max is actually a lot better. He’s walking, though still limping, and is more playful than ever. Aside from that he is also more demanding now… hehehe. Siamese.

As of posting of this blog, max has not visited the clinic yet but I got spoke with the owner just the other night. Apparently, Max is very very active now, the wound healed though with slight limping and he has a very good appetite. He'll be visiting this coming week.

I asked the owner if she's still willing to give up max for adoption, she said "not anymore", she loves max and intends to keep him.

Pregnancy termination and Metritis

2009-04-10T00:47:00.002+08:00

Bubbles is a 6-year-old female shih tzu at presentation (now she's 7) with fishy-smelling brown vaginal discharge. She is 6 weeks pregnant: positive for fetal forms and activity at ultrasound earlier (from a sister clinic). Is she terminating her pregnancy? Is she aborting? Why?

Rechecking her status: Active at presentation, pale mucous membranes, shivering, normal body temperature, tick infested!!! 1st time to breed.

Things to consider: Age, presence of ticks, Ultrasound: about 2 fetal balls in vesicles still with activity and heartbeat. Another 2 vesicles containing non-moving fetal balls.

Bloodworks were also taken into consideration: Increasing white counts, and lymphocyte counts with decreasing hemoglobin concentration...
Ehrlichia testing resulted positive, Brucella testing however was not done.

For several days, Bubbles was monitored at the clinic for further discharges and daily ultrasound from day 1

Day 5 of confinement revealed no fetal activity is all the vesicles. The vesicles were also in disarray and the boundaries were not as defined as it was days ago. Blood count revealed increasing white counts, lymphocytes, monocytes ang granulocytes... But we have a happy dog but without vaginal discharge and contractions...

Now, if she terminated her pregnancy, will it still be reabsorbed? at 6 weeks not really. It should be expelled. We waited for her to expel the fetuses while giving medications with caution.

Two days later, there was nothing. We opted for ovariohysterectomy. Here's what we saw.

Enlarged uterus with a closed cervix!

I decided to open up the uterus to see what it contains...

Brown mucoid material surrounding the fetuses which are not viable and are already decomposing.

I asked several colleagues prior to surgery including the referring doctor. Some were actually gave a GO signal for the surgery, others a NO.

But the important thing for me is Bubbles leaving the clinic alive, happy and healthy.