Toa Payoh Vets Clinical
Research Making veterinary surgery alive
to a veterinary student studying in Australia
using real case studies and pictures
After A Dog Attack?
Dr Sing Kong Yuen,
BVMS (Glasgow), MRCVS
First written: Dec 2, 2009.
This dog owner in her 50s with 2
children is one of those natural story tellers. She not
only could tell stories very well but the way she acted and told it
was a master performance.
"I was alone in the house when the 2nd attack occurred," she
said when I asked about her two domestic workers. "I
rolled up a carpet, pick up XXX (the dog being attacked). Yet
TTT held onto the left ear and chin of her sibling till gravity pulled TTT
down to earth.
"Did TTT bite you?" I asked.
"No, she growled at me." the woman said. "That is why I boarded TTT
at your Surgery after the attack." TTT sounded like a ferocious Jack
Russell and I took precautions of muzzling TTT for examination after
the attack. Today was some 2 weeks later. The lady had now diagnosed
shingles infection linked to the dog attack, according to her
diagnosis. This is what she said to me.
"Two days after the attack, I saw a circle of 'insect
bites' on my right lower elbow area." She displayed her
wounds on the inner side of her elbow joint. They were now maroon
red with a black centre in the bigger wound.
"Are you sure that the circular line of wounds were not caused by
TTT biting you?"
This would be my first diagnosis although I am not a medical doctor.
"Well, TTT's teeth was sunk into XXX's left ear. I held XXX up till
TTT had to let go as gravity pulled her downwards. So, she
could not have bitten me."
The lady waved her hand up and down to show that she had held XXX
high up, until TTT gave up to the forces of gravity and dropped to
"The next day, I felt tired," the lady continued. "Tingling
sensations rippled from under the skin of my right elbow to my back shoulder", she pointed to
her back. "More rashes appeared in the area. Watery blisters formed.
The tingling sensation was unbearable. I
quickly went to consult Dr Thiru, the
specialist. Do you know him?"
"I don't know him nor have I met him," I said. "Is he the distinguished
looking man with
silvery grey hair and white sideburns?" I had attended a talk
given by Attorney General Walter Woon's lecture "Criminal Aspects Of
Medical Practice" to a full house of at least 1,000 doctors and
lawyers in the
Supreme Court Auditorium on Nov 30, 2009. The moderator was a doctor
who is a skin specialist. "Yes," she confirmed my
description of the good doctor.
"The doctor asked
whether I had been to the vet?" the woman commented. "Probably my doctor was thinking that
my right elbow I had been infected at your
I don't think the good doctor would have thought that she was
infected by putting her elbow on the veterinary examination table
and got infected by Shingles. I don't know why he asked whether she
had visited the vet earlier.
"So, did he prescribe you the
antiviral drug?" I was more interested on the cure.
"He said to wait 3 days," the woman replied. "Then more rashes
appeared. They become watery and burst. I felt tingling, as if some
snakes were travelling up my hand to behind my back and forth. I
quickly went to see him. He was not available but his colleague gave
me the medication. Now I feel so much better and have the time to
quickly get my 2 dogs vaccinated."
"My sister had
shingles." I said. "The viruses travelled along her nerves in her leg
and the serpentine lesion manifested as snake-like in appearance."
This woman did not have the serpentine tracks as she had sought
prompt medical treatment. "If the virus completes the travel from
one end of the nerve, go round the body, the person will die," the
lady told me about a common Chinese belief. "That
is why the Chinese temple medium used incense to burn the shingles
skin. To kill off the head
of the snake."
"Some Singapore people don't know what is the cause of
this serpentine skin problem," I said. "So, they seek the help of
The lady enlightened me: "Actually, shingles is the re-activation of the
chicken pox virus due to stress. The virus lurks in the body for a
lifetime. It is extremely painful, itchy and causes tingling
This lady is surely knowledgeable about shingles. I just could not
believe that separating two dogs in a fight would lead to a shingle
infection as this lady was definitely in good health. I
believe that there is a remote possibility that TTT had bitten her
right elbow when the dog loosened her grip on XXX and was falling
down to earth. I mean, how would the lady know since she was highly
agitated and in that instant, TTT's bite would have resulted in what
she first told me as "circular rashes" in a small area in the inner
aspect of the skin of her right elbow. I remembered asking her to
repeat what she said. She said "circular rashes".
meant that she had rashes clustered in a circle. Or semi-circle. The
pain and tingling sensations could be due to the spread of
micro-organisms along the nerve and tissues originating from the
bite wounds. This condition is documented in the skin to owners
owners who had been scratched by the cat.
These bite rashes from the upper
and lower incisor teeth of the attacking dog would become infected.
That could be the reason that the first doctor did not think this
was a shingles infection. As for the appearances of more rashes in
the surrounding area, it could be due to the scratching of the
skin. This is my hypothesis which
I am sure the lady would not agree. I have not seen shingle
infections in human beings. Maybe they manifest as rashes clustered
in the circle too.
Medicine is full of diagnostic mysteries. I asked to
see the inner or medial aspect
of the elbow again.
I could see that the rashes covering an area of 10 X 10 cm of skin
in the elbow. The biggest rash was 8 mm in
diameter. It had a black centre. Other rashes were healing.
This is an incredible but true
story of an apparent shingles infection linked to dog assault. Did the attacking dog get any shingles
as well? She had really
blood shot eyes. Red sclera in both eyes after her ferocious lunge
for the jugular of the sibling who garnered more attention at home.
The redness in both sleras persisted for several days. So, would
this be caused by a virus activated by the high stress of trying to
get rid of the rival in love? A latent
zoster-equivalent virus in the dog, a canine type of chicken pox
virus that gets reawakened in times of high stress? This dog was
lunging for the jugular of the sibling with only one intention. To
kill a rival in who is favoured
more by family members. But her attempt was thwarted and
now she was "in the doghouse". Or to be precise, waiting to be
rehomed (Re-homing picture must be
1. Herpes zoster (Shingles). Anybody who has had chicken pox
is at risk for developing shingles many years later. The chicken pox
virus lies dormant in the person's body. Stress or a decreased
immune system reawakens the virus, resulting in shingles infection.
It appears as a rash. Rashes cluster around the eyes, face or body.
The Shingles infection is also called herpes zoster. It is an
extremely painful and itchy condition. Early aggressive treatment
with antiviral drugs can lessen the length and severity of shingles
2. Red scleras in the dog. I had encountered a few cases.
Some are due to traumatic injuries. Some are a result of intense
rubbing of the eye arising from some chemical spills. I note that
there is a dog owner posting a picture of his dog with red sclera in
a local website called Stomp.
I had 2 memorable cases of red scleras in Jack Russells.
2.1 This Jack Russell had a chew rope stuck inside its colon for
2.2 This Jack Russell had intense abdominal pain and was vomiting.
Exploratory laporatomy revealed petechial haemorrhages in the
This present case would make it 3 memorable cases of Jack Russells
with blood-shot eyes. E-mail to
you have seen more cases.