Sunday, November 7, 2010

Old dog with cheek tumour

The skin wound did not close entirely. This is a complication of surgery of the cheek tumour excised from outside the cheek. The Miniature Schnauzer of 11 years of age,10 kg bodyweight drooled saliva out of two gaps in the cheek. The young lady owner wanted surgery to close the holes as the right cheek keeps getting wet.

"It is lymph," my first assistant speculated. "Do you think so?" I asked him again. "It is possible as the surrounding area had a type of wetness that looked oily. Like melted butter. However, there was saliva from inside the mouth flowing out of the two gaps.

The old dog had 3 general anaesthesias and I did not look forward to a 4th. Try not to be complacent as deaths on the operating table of an old dog are always a possibility.

INJECTABLE IV ANAESTHESIA
This time, I do not use isoflurane gas as in the previous 3 operations as the endotracheal tube would get in the way of the surgical procedure of debridement.

For 10 kg, the formula for a safe dosage of injectable IV is 0.5 ml diazepam 5 mg/ml and 0.5 ml ketamine 100 mg/ml by slow IV injection.

I used 0.4 ml + 0.4 ml respectively. It was insufficient. As the needle was in the vein in case of the need for top up, my first assistant injected 0.02 ml Zoletil 100 mg/ml diluted in 0.18 ml saline to make it 0.2 ml. The dog was sedated but his eye reflexes were present.

6 DAYS PRE-OP.
Dog was on Baytril oral for the past 6 days. The young lady remembered the appointment as I do not phone or text message unlike the Singapore General Hospital staff of some medical departments. I ought to do it and will do it.

SURGERY
Snip off granulated edges, debride. Undermine skin to separate some areas from the underlying cheek muscles. New raw bleeding edges. I used simple interrupted sutures 3/0 at 0.3 mm apart. 1.0 ml atropine SC was given to reduce salivation as Zoletil does cause salivation as a side effect. Sent dog home to reduce vet cost as this young lady had used her savings for the operations.

Only time will tell whether the old companion finally has a healed intact right side of the cheek.

OBSERVATION
It was too early to see whether the cheek tumour had recurred again. For readers, it is best to get your dog over 3 years of age, annual dental check up for mouth tumours rather than not do it. Some do develop into cheek or gum tumours as in this old Schnauzer and would then cost a lot of worries and money.

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