Thursday, January 10, 2013

Referral is best but the vet must deliver

tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
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Date: 11 January, 2013

Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
Referral is best but the vet must deliver Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written: 9 January 2013
Date: 11 January, 2013
toapayohvets.com
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Wednesday, January 9, 2013

The 14-year-old Burmese has 3 large abscessed mammary glands

Yesterday, Wednesday Jan 9, 2013, I phoned the gentleman to follow up on a hissing 14-year-old Burmese cat brought in on last Saturday and advised by Dr Jason Teo to operate.

So on Sunday, Jan 6, 2013, I phoned the owner to tell him the high risks involved. "Your cat may just die on the operating table," I said. "She has fever and infections of the ulcerated breast lumps - half as big as fish balls and very smelly."

"I will ask my mum first," he later phoned me to give consent. I decided to get the cat operated on Sunday, 24 hours after admission and after antibiotic injections given. The cat was angry and so she was still in good "health" for one with such smelly mammary ulcers. Dr Daniel would operate. This needed to be a fast operation. The problem was the dosage of anaesthesia. How much that would be effective and not kill the old dame?

"Give xylazine 0.1 and ketamine 0.4 ml IM," I said to Dr Daniel. Clip the hair and bathe the cat after sedation as this is an angry cat."

Dr Daniel had used electro-excision to remove the 3 tumours. I had one young lady intern with top academic results waiting to study vet in Australia. She put a finger to cover her nose. I was surprised. "My father is house-proud," she said when I asked whether she lived in a fragrant household with aromatherapy. Definitely no smells of infection and sick animals.

"Not cutting well," Dr Daniel said as the long elliptical incision of the skin to remove all 3 tumours by the needle electrode did not seem to be effective. "Well, the contact with the skin of the inguinal area is not there," I pressed the soaked saline gauze and folded the return plate so as to close the circuit for the electricity to cut through and return back to the equipment. Mr Min was monitoring the gaseous anaesthesia and he was good at this.

AN INTERN CAN'T STAND THE SMELLS

The young intern was really feeling nauseous as the wisps of smoke on flesh and the putrefying smell of the ulcerated mammary glands filled the operating room air.

"You better go outside," I wondered how she would be able to pass out as a vet. The next day she wore a mask. Another day, she wore one glove when she handled a skin-diseased dog so as not to infect her own cat. She would wash her hands after touching a dog and her mum would remind her. "I can be a hygienic vet," she said to me. Top grades from a top class in a top school and money of $300,000 or more to fund her veterinary studies- what more does a 19-year-old scholar desire?

I did not expect this 14-year-old cat to survive the anaesthesia. She was thin. She was bright 12 hours after surgery after fluid therapy and antibiotics and pain-killers. I phoned the son to take her home as cats usually don't eat at the surgery.

As a follow up with trepidation, expecting bad news, I phoned the owner yesterday which was Jan 8, 2013 at 5 pm. "My cat is very active. Eats a lot. Walk here and there! My mum is very happy as the cat was not eating."
"Did she lick the stitches?" I asked.
"She has an e-collar and could not lick." Actually it was the tolfedine pain-killers that made her so normal post op.
"How did you give her the tablet medicine?" I asked.
"Just crush the tablet and mix it inside her food - canned food. No problem."

CATERWAULING
As this cat was never spayed, I enquired how he coped with angry loud meowing which could be misconstrued as beating up the cat in some cases of caterwauling.
"No problem of noise nuisance due to her being 'bising' (noisy)," he said.
"Does she still do it? At this age? "
"She does it 3-4 X per year. But not nosily."

PRE-OP CONDITION
I asked about the cat before op as this was a first-timer and Dr Teo was consulted. I worked from 9 am to 11 am on Saturdays usually and the client came later.

"Day by day, she lost appetite," the son related the history of his cat during this follow-up call. "She became very weak. My mother wanted the cat to be cured but at the same time did not want to lose the cat (to death on the operating table). Yet my cat will suffer more if no operation is done."

"How long were the lumps present?'
"The lumps were small some weeks ago but started to grow bigger and bigger recently," the owner said.
According to the operating surgeon, these could be abscesses. To save money for the owner, no lumps were sent to the laboratory for histology to check whether they were breast cancers or not. The owner confirmed that he had this cat as a kitten and therefore she was 14 years old.

STITCH OUT IN 14 DAYS
I advised stitch out in 14 days as most cat owners don't come and the knots get buried into the skin and cause stitch abscess and irritation to the cat some months later. The Monosyn stitches used look like nylon and are absorbable..



REFERRAL
He lived in Tampines, near the Changi Airport. This is a 15-minute drive to Toa Payoh Vets and there are several vet clinics closer to him.

"Why did you come to Toa Payoh Vets when there are vets nearby?" I asked this filial son. "My friends in Bedok refer you to me."

I guess these friends were the two Malay ladies with cats that I had vaccinated some weeks ago as I seldom have any clients from Bedok. Proximity is the choice of pet owners as most Singaporeans are time-pressed and so the majority of clientele for me would be around a 5-minute drive to Toa Payoh Vets.

Referral is best as the client trust is there. But the veterinary surgeon must deliver. Nothing less than a live 14-year-old cat at the end of surgery and being alert and hungry at home after surgery. Essentially, this means assessing the anaesthetic risks such that the minimal dose is given without killing the cat. How do you do it? This depends on the good judgment of the individual vet.

In this case, Dr Daniel asked me and I judged that this 4-kg Burmese cat should be given xylazine 0.1 ml and Ketamine 0.4 ml IM and it was effective and safe. "Do a fast surgery in an old cat," I advised. "Electro-excise the 3 big lumps as fast as possible. Ligate the main vessels. There were no big blood vessels to ligate as I expected some from the caudal superficial blood vessels. Perhaps the tumours were necrotic and septic and the blood supply was being terminated or damaged.

UPDATE AS AT JAN 11, 2013
As at Friday, Jan 11, 2013, no news from the owner. In this case, no news is good news.  


Some problem with blogger.com's alignment of text. URL is at:
http://www.kongyuensing.com/folder7/20130110burmese_cat_breast_tumours_toapayohvets.htm
 

 

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