"When you consult 10 vets, you will get 10 different opinions in most cases," I said to the mother and daughter who consulted me on this fine Sunday morning, August 28, 2011. The daughter said the internet recommended me. My surgery was relatively far away for them. "The first vet said she would cut away the "three" mouth growths," the daughter said angrily. "She cut one and sent it to the laboratory. The report said it was not a cancerous growth. So she told me to apply the cream onto the growths in the mouth as they were infections. She said the growths would then disappear."
Well, I had no comment. The histopathological report did not confirm that the growth was cancerous or not.
But the "three" oral tumours have grown much bigger. So they consulted Vet 2 nearby their home. But Vet 2 did not care to excise the growths and so the internet lead them to me on this fine Sunday morning when I was interviewing a fair young lady graduate with first class honours in an Australian University. She wanted to volunteer on weekend to see practice to know whether she would like to study veterinary science.
"These oral tumours are likely to be cancerous," I stated on the fact that the growths grew fast over the last 3 months and the spread to the submandibular lymph nodes and down to the nearby ones.
"Feel this thick cord of 8 cm x 3 cm x 2 cm on either side of the neck from the submandibular lymph nodes," I asked the daughter and mother to place their thumb and forefinger onto the cord. "These are likely to be spread of the cancerous cells from the mouth to the lymph nodes."
"What do you advise about the mouth tumours? Vet 1 should have removed them as promised." the daughter was quite unhappy as the tumours had metastasized and she had already spent $2,000.
I said: "Each vet has his or her own way of handling a case of mouth tumours. Vet schools may teach the vet to do a biopsy first. If the lab results find that the growths are not cancerous, then the owner is informed as to the next step. By then, some cancerous ones will have grown much bigger due to the delay.
"Unfortunately, tumours don't disappear even if they are not cancerous. In practice, it is best to cut them off when they are small. They interfere with the dog eating, being painful and ulcerated. And smelly. However anaesthesia in old dogs is highly risky and the dog may just die on the operating table. So the vet may not want to operate as deaths of dogs under his or her care badly damage his or her reputation."
The daughter asked: "What are the chances of survival?"
I said: "I estimated around 40% as your dog is emaciated. All skin and bones now. You can see the spine protruding."
The daughter said: "My dog eats a lot and will even eat the other dog's food. The vets don't believe when I say that."
"It is hard to believe. Any dog or person that eats a lot will put on weight. What do you feed?"
"Brown rice and potatoes," she said. "The vet advised against dry dog food as she has skin problems. Her foot pads are licked red and so the vet thinks that my dog is allergic to dry dog food."
This is surprisingly the second emaciated dog I was presented on this fine Sunday morning. I had just hospitalised an emaciated poodle who had a painful mouth and screamed when I touched the mouth. Blood tests were taken to find out why. The lady owner had another dog with urinary stones. So no dry dog food for that dog. And similarly for this poodle. Skin and bones and protruding spines.
Back to the old Shih Tzu. What to do?
"Do you advise euthanasia?" the daughter asked me since I said that the Shih Tzu was at the end of his life-span of 10 years. Healthy ones may live up to 15 years but they usually live to 10-15 years in Singapore.
"The decision to euthanase is up to the owner," I advised. In advising euthanasia, some owners deem the vet to be a good for nothing. Only know how to advise euthanasia.
I said: "In many cases, it is a matter of economics too. These tumours can be cut off by electro-surgery. You may buy some time for the old dog."
"If they are cancerous, the tumours will recur around 2 months."
"What to do then?"
"It is best you and your mum take 3 or 4 days to think what to do," I said. "If surgery is your option, I will operate but you know the chances of survival are around 40% and I have not done any blood test to know the dog's health, to save some money, since you had spent $2000 at the other vets."
"How much is the surgery?"
"I can only estimate. Around $500 - $1,000"
"My dog barks at me when I tell him that he will be put to sleep," the daughter said. "So, I do not want to do it."
The owners went home to feed the dog on a good diet for the next 3-4 days, multivitamins and antibiotics. Surgery will be scheduled on Thursday morning at 10 am if she wants surgery. This is the type of high-risk surgery where fools go in where angels feel to tread. But is there any other choices? Chemotherapy will not work and I don't want the owners to get false hopes. Neither will surgery if there is recurrence. But there is no other choice. It was Hobson's choice.