Sunday, April 18, 2010

31. A Puppy & Old Dog with Itchy Backsides

Today is the second Sunday I came back from a break in Perth Australia. Last Sunday, I wrote about 2 related cases of house-breaking in two Cocker spaniels. Today, I saw two cases related to the anus of the dog. One in a 4-month-old Silkie and one in a 5-year-old Pomeranian.

CASE 1. OLD DOG. ANAL SQUAMOUS CELL CARCINOMA

History
Around 3 weeks before the surgery on March 23, 2010, Vet 1 diagnosed anal sacculitis, expressed the anal sacs and sent the dog home. As the dog was still licking the anal area, the owner came to me for a second opinion. "Vet 1 said it is anal sac infection," the personable lady in her 30s said. A wound that does not heal would need review.

KNOWLEDGE OF ANATOMY
In 99% of the cases, it will be anal sacculitis. But in this case, the lump was vertically below the anus, not at 4 or 8 o'clock position. This is where the vet student will find need to apply their knowledge of anatomy, a dull subject. Could this Pom be suffering from a chronic anal sacculitis?











Perianal (circum-anal) tumour resection in a Pomeranian. The anal sacs were normal. A lot of yellow oil was expressed out prior to surgery

Follow-up on Sunday, April 18, 2010
The daughter in her 30s together with her dad, came for a review, 3 weeks after the anal surgery of her male Pom, 5 years old. Many Singapore owners don't bother to come in for reviews as the dog's problems had resolved by surgical excision. The culture of Singaporeans is to be frugal and so they do not go for reviews of their dogs. But this attitude is at the expense of the older dog with tumours, some of which can be prevented.

"What's the result of the pathology report on the tumour?" she asked after I took out the stitches. The details of the histopathology report are as follows:
GROSS DESCRIPTION
The ellipse of skin measures 1.2 cm x 1.0 cm. It has a darkish lesion measures 0.7 cm x 0.6 cm. The underlying subcutaneous fat measures 0.4 cm thick.

MICROSCOPIC EXAMINATION.
The skin sections show ulceration of the epidermis. Beneath the ulcer is an infiltrative squamous cell carcinoma which is composed of irregular, closely-packed nests of atypical squamous cells. There is focal keratin pearl formation. Other areas show irregular anastomosing trabeculae of tumour cells. Most of the atypical squamous cells have voluminous eosinophilic calcification. There is surrounding desmoplasia and focal dystrophic calcification. The tumour reaches the resection margin. No lymphovascular tumour embolus is seen.

DIAGNOSIS
ANAL LESION, EXCISION BIOPSY. Well to moderately-differentiated squamous cell carcinoma.
ADVICES TO OWNER
1. Inspect anal region weekly for any hard lump as the tumour has spread past the resection margins. I explained that it was not possible to cut bigger as the wound will have difficulty in healing.
2. Get lump excised when it is small.
3. Get two retained testicles removed as soon as possible.

CONCLUSION
Many Singapore dog owners don't bother with the dog's backside tumours and so they grow larger. If this circum anal tumour was excised at 0.5cm x 0.5 cm when it was very small and Tardak (androgen inhibition drug) the prognosis is said to be good, according to the Tardak manufacturer.

A red ulcerated bleeding hard lump? I suspected it was a circum anal tumour due to its position. In my 30 years in practice, I had not seen anal sac discharge at the 6 o'clock position, ventral to the anus. This does not mean it will never happen. The probability is rare. So, the owner accepted my advice to get the tumour excised and sent for histopathology. It was a squamous cell carcinoma.

Circum anal tumours occur in old dogs. Dogs are said to be old when they are over 5 years of age. Hard swollen lumps even at the 4 and 8 o'clock position can still be circum anal tumours or perianal tumours. So, be vigilant and not be sued for misdiagnosis in this litigious age.


CASE 2. PUPPY - Clipper Burns. Silkie X, 4 months, male


"Do you think that the groomer was did not do a professional job?" the father of a 5-year-old daughter with big curious eyes asked me. "Before going to the groomer yesterday, he was normal. Today, he would rub his backside and lick it all the time. He was sleepy and did not want to eat. I felt that he has a fever."

The puppy had fever. His anal area had been shaved. His anus had a raised, reddish ring. His scrotal area was brownish for 75% of the area. 3 small brown patches of skin looked as if they were clipper burns.

"Talk to the groomer," I said. "Was the puppy having itchy backside prior to grooming?"

"This will be the last time I send my dog to her," he said. "Where do you find certified dog groomers?"

"Some groomers don't express anal sacs," I said to the groomer when the owner phoned her. "This is because some dogs feel the pain and the owner blames the groomer."

"But the course tells us to express anal sacs as part of the grooming services," the groomer said. "You know about this compulsory course conducted in the Temasek polytechnic?"

"I am only saying that some groomers learn from experiences similar to what has happened know and so, to avoid bad complaints, do not express the anal sac." I said to the young lady who must be a newbie.

"Does it mean groomers don't operate on the anal sac?"

"No, no," I answered. The owner was listening. "It is just that some dogs will experience intense pain after the groomer had expressed the anal sac. You may have to let the owner know after grooming, next time."

In this case, I suspected it was the clipper burns around the shaved anal area and near the scrotal area and subsequent application of a anti-bleeding purplish black potassium permanganate or iodine powder that burned the anal area and scrotum and caused the intense itchiness. The puppy just had to rub her backside to relieve herself of the itch.

The groomer's clipper had nicked the superficial skin of the anal area and below it and the groomer had dabbled he powder onto the wound, as this is the common practice in Singapore. I expressed the anal sacs. There was a very small amount of brown oil plus numerous specks of blackish powder which would be the potassium permanganate or iodine. But to prove it would require money and time.

So I better not instigate the owner who was already angry and would then had a big ugly fight with the poor groomer.

"Will you let me know how much it costs?" the groomer said. "OK," I asked my assistant to phone her after the owner had paid the bill.

This was a case where the vet could pour oil into the fire and made the owner extremely angry. Puppies are like babies. They are especially loved. This could lead to litigation and complaints to the veterinary authorities if the vet or his assistants played the game of running down other professions.

As for the fever, it could be a bacterial infection caused by clipper wounds. Or a viral infection as the dog vaccines protect against the major diseases. In any case, this puppy's primary complaint was an itchy backside and the problem needed to be resolved promptly with medication.

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