Wednesday, April 21, 2010

35. Looks can be deceiving. Circum-anal tumour

How to make internship interesting and entertaining? Young people can get bored easily. The following case had some elements of humour for the quiet and serious vet intern whom I tested her on her powers of observation. A 9-year-old male black Labrador Retriever was limping on right fore and walking on 3 legs yesterday. So the careful groomer brought him for consultation. He was to shave this dog bald every 2 months and was worried that if he lifted the leg to clip, the dog would get worse. Possibly he could be blamed for a lame dog after grooming. So, he pre-empted blame by consulting the vet first. This was smart of him.

EXAMINATION OF LAMENESS
How to make internship for Tanya interesting? One method is to ask her what the problem was and to ensure she is hands-on. In this case, I asked the groomer to walk the dog outside the surgery and then trotted as I would do as a racehorse veterinarian. The dog moved normally but suddenly collapsed on her left fore during running. This should make an unforgettable impression on Tanya as the dog was OK now, according to the groomer who had seconds thoughts of consulting me. He was busy and had many grooming cases and therefore he would prefer not to come.

To save time, I got the dog to lie down on the floor, muzzled her and palpated each digit and toe to the shoulder of the right fore. I flexed and extended all joints of the right fore limb, as I did when I was a racehorse veterinarian some 20 years ago.

LOCATION OF PAIN
Palpation at right fore, 4th digit, between phalanx 2 and 3. The dog reacted by withdrawing and whining in pain. So this was the pain location and the diagnosis was sprain of the ligaments in this area. Not a serious problem.

OBSERVATION
"Is that the dog's testicle near the tail?" I queried Tanya as the dog had a big swelling below the tail and near the anus. "Yes," she said immediately. The powers of observation need to be enhanced with age and experience and so Tanya's answer was expected.

"Are you sure?" I asked again. From general observation, it sure looked like one to the lay person. Tanya was sure. "It is in the wrong position," I told Tanya. She had just passed Junior College and so could not be expected to know dog anatomy. On first impressions, this looked very much like the scrotum. This was one of nature's tricks on interns who will be starting first year vet. Looks can be deceiving. A detailed hands-on examination on the table should be done in many cases. The vet or intern must be hands-on.



"The normal testicle is nowhere near the anus or tail in the male dog," I said. "Where is the anus actually? Please push the large spherical swelling to reveal the anus." Tanya used her hand to move the circum-anal tumour to the right as the dog was trying to sit down. There it was. "Is the tumour very near to the anal opening?" I asked. "Yes," she was convinced that this was no testicle.

IS THE MALE DOG NEUTERED?
The vet must be thorough in checking. This dog has no scrotal sacs. "This dog has been neutered," the groomer stated. This is another trick of nature. No scrotal sac does not mean that the dog is neutered. The vet has to be hands-on..

The dog was reluctant to stand for long. However, I had to get him standing and showed Tanya where to locate the two undescended testicles under the skin near the penile area. The groomer tried and felt nothing. The testicles had swollen in size but not excessively. These could be the start of testicular cancer. The only signs of a feminising testicular tumour were that this dog had put on weight and had a very shiny coat. I did not pursue the matter further as the owner was not interested. Undescended testicles do become cancerous and circum-anal tumours are best removed when they are small. But each dog has his own destiny. This dog had interesting teaching material for the vet intern but I don't know she will remember this case during her 4th year which will be in 2015.

CONCLUSION
Neutering of the 9-year-old male dog, especially removal of the two undescended testicles in this dog when he was young would have prevented testicular tumours and circum-anal tumours to develop, in most probability. It is not a guaranteed thing but removal of undescended testicles early will have been best for the older dog as no testicular cancers will be present in old age. Dog owners all over the world seldom give old dogs much notice or time unlike puppies and therefore neutering young ones may avoid much of the hormonal or gender-related tumours in our companion dogs. The vet's responsibility is to inform the owner via the groomer about the circum-anal tumour and a few black ones below the anus. The owner did not want any surgery.

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