Thursday, February 28, 2013

Update: Feline S/D discontinued

UPDATE

The supplier told me today that Feline S/D had been discontinued by Hills since 9 months ago. I told him I saw a can being given by Vet 2 recently to the cat with bladder stones I operated on.

He said that feline C/D does dissolve struvites as well and is recommended for cats with calcium oxalate too, targeting the urine pH = 6.2-6.4.

Follow up: Stone analysis results for cat with bladder stone

Report received today.

Calcium, oxalate, magnesium positive.
Preventive diet will be C/D for life
Target urinary pH to be 6.2 to 6.4

1403. SOP - Urethral obstruction in a male cat

Written: Feb 28, 2013  10.49 am reviewing this case to compare to the cat with bladder stones operated.

Feb 28, 2013

Urethral obstruction in cats may be quite common. A lady phoned me near midnight about her cat's difficulty in urination 2 days ago but she did not want to go to the emergency clinic I referred her to. So, I presumed this 13-year-old male neutered black and white cat to be the owner who came on Feb 28, 2013 as he cat could not pass urine and had blood in the urine passed.

"No, I did not phone you," the lady in her late 40s said to me as I palpated a bladder the 50% the size of a Thai mango.

"How long had he been having this problem?" I asked.
"Two days."
"Did he vomit?" I wanted to ascertain the kidney involvement as owners seldom volunteer this info.
"He vomited 3 times yesterday."
"He must be eating dry cat food since young," I predicted.
"Yes," she said. I feed dry IAMS and ikan bilis since he was young."
"He seldom drinks water," I said.
"You are correct."

This was a gentle old cat. He did not like me massaging his penile area to loosen the urethral plug and hissed.

Standard Operating Procedure (SOP). Emergency treatment usually

1. Sedate the cat. Collect blood and urine if possible. Blood collected. No urine
2. I Injected SC baytril and tolfedine. I used xylazine 0.1 and ketamine 0.4 ml IM. Sufficient.
3. Collect urine via catheter. This was not possible as the urethra was severely blocked at the bend of the penile area.
4. Put saline into syringe and flush into catheter to unblock. This was successful. Do not force catheter inwards as this tramatise the urethra as I had seen a vet doing it. Sedate first.
5. Urine flows out. Collect for urine analysis.
6. Irrigate bladder with saline and suck out any sand and blood
7. Stitch 3 areas catheter with absorbable to anchor catheter for 2 days. Blood still flows out on Day 2 (today).
8. Hospitalised overnight and goes home next day.

BLOOD TEST RESULTS
Urea 59 (7-11)
Creatinine 1003  (7-160)
Platelets 93  (300-800). Cat's mucous membranes were pale. Nose looked pale as compared to normal cat.

URINE
pH 6.5  SG 1.012 (not reliable as saline was used to unblock obstruction)
Blood 4+, Bacteria 3+, no crystals
(No crystals does not mean no bladder stone. Palpation of bladder on Day 2 - no hard stones). No urethral obstruction as catheter is in place.

X-RAYS not done to reduce cost for this first occurrence. Will do if recur.

ADVICE
Change slowly to canned food. Urine analysis 1 month later. K/D for 10 days. Seldom gets followed up as most owners don't comply.    

1403. Update Key Performance Indicators for spay & SOP

tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
toapayohvets.com
01 March, 2013
Focus:
Small animals - dogs, cats, hamsters, turtles, guinea pigs & rabbits
Toa Payoh Vets Clinical Research
Standard Operating Procedures (SOP) & Key Performance Indicators (KPI)

For other cases, goto: Dogs
One of the effective management systems is to ensure consistency of process and to execute Key Performance Indicators. To maintain the highest standards of veterinary practice and productivity as well as sharing knowledge, the Standard Operating Procedures (SOP) and Key Performance Indicators (KPI) are being implemented in Toa Payoh Vets from 2011.
Good written records are a strong defence in the cases of litigation and complaints
Standard Operating Procedures (SOP)
http://www.kongyuensing.com/pic/20120711tn_chihuahua_open_pyometra_SOP_toapayohvets.jpg
5491 -5495. The internet connections open the doors...
Pekinese, first-time corneal ulcer, 3 days, toapayohvets, singapore deep ulcerative keratitis, corneal ulcer, pekinese, singapore toapayohvets Adenocarcinoma tumour in bladder,urinary incontinence, dripping copious reddish brown blood, toapayohvets, singapore, beagle, male, 13 years new puppy purchased has loose stools, now has blood in stools for 2 days, toapayohvets, singapore
5417. SOP: Eye corneal ulcer & tarsorrhaphy 5412. SOP: Veterinary Surgery
Report format
5413. SOP: Urinary Tract Infections and struvite stones SOP: A new puppy with blood in the stools
Key Performance Indicators (KPI) for an experienced vet
E-D = Time from first skin incision to skin stitched up
Spring time in Araluen Botanic Park, in 2010, Australia. Toa Payoh Vets
5991. Feb 2013. KPI spay Maltese on heat. E-D=27 min. Isoflurane gas top up needed.
maltese false pregnancy irregular heat periods spayed toapayohvet key performance indicator shih tzu first vaginal bleeding at 9th month, the day of spay
5448. KPI for spaying a dog with false pregnancy. E-D=19 min 5448. KPI for spaying a dog with pyometra.
E-D=26 min
5615. KPI: Spaying a fat dog. E-D=28 min KPI: Dog spay -
Chihuahua.
E-D=23 min
KPI: Dog spay - Fox Terrier E-D=26 min and Shih Tzu E-D=18 min
1/3 size of normal descended testicle - hard to locate, neuter, toapayohvets, singapore
5545. KPI for spaying a Miniature Schnauzer with closed pyometra. E-D=41 min. KPI: Neuter E-A=18 min and tarsorrhapy
Veterinary Management: Processes, Protocols, Procedures & Best Practices
Spring time in Araluen Botanic Park, in 2010, Australia. Toa Payoh Vets
5990. Best practices from a plastic surgeon
toa payoh vets, singapore Female dogs are seldom catheterised. toapayohvets.com, singapore Liang-Seah-Place-Street_Court-conservation-heritage-shophomes-rental-singapore-asiahomes Spring time in Araluen Botanic Park, in 2010, Australia. Toa Payoh Vets
5286. A vision for Toa Payoh Vets to be a top 3 veterinary surgery in Singapore 5385.
Procedure: Female dog urethral catherisation
5111. Pet grooming business success in Singapore 5288. Reversing
the decline in horse racing - Part 2
5212. Veterinary clinic inspection
Spring time in Araluen Botanic Park, in 2010, Australia. Toa Payoh Vets Beauty is enhanced by good grooming and uniform. toapayohvets, singapore Dubai Dec 2010 visit toapayohvets, attractive advertisement, singapore
5142. A neat and good spay suture pattern is important 4980. Dressing casually at Toa Payoh Vets 4981. Character and competence of interns and young employees
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets Clinical Research
Standard Operating Procedures (SOP) &
Key Performance Indicators (KPI)

For other cases, goto: Dogs

This webpage is:
www.bekindtopets.com/animals/20081201PG9standard-operating-procedures-vets_ToaPayohVets.htm
Copyright © Asiahomes
All rights reserved. Revised: March 01, 2013
Toa Payoh Vets

1402. Digital images of 83g hamster now 77g after surgery

Make use of digital photography to show tumours excised, hamster recovering etc as the owner will be educated and happier to know what had happened. This hamster of 83 g was not knocked down by 3 drops of Zoelietil 50 IM today. I thought it was too little. After 5 minutes, he became drowsy. Clipped and excised the large left inguinal tumours and left ear wart. Weighed him. He was 77 g and pooped a lot. Owner was pleased.

1401. Abdominal cryptorchid in a dog

"Is the vet competent?" the owner asked me. The young male dog had been sent in for neutering. Two undescended testicles. So, just get on with the operation. Many times, there is no problem locating the two undescended testicles under the skin.

However veterinary surgery throws the vet a surprise. In this dog, one testicle was located. The only was nowhere under the skin!

Be meticulous. Make a thorough examination before any surgery. If the undescended testicle cannot be felt under the skin while the dog is standing, don't expect to find it when he is on his back! There will be a lot of doubts from the owner when the vet can't find this testicle as it is inside the abdomen.
Have an examination procedure. Verify gender. Verify presence of both undescended testicles under the skin. If not, let the dog owner know immediately and open up the abdomen. The abdominal testicle usually is located next to the bladder at the side.
Be humble if you don't know and ask your senior vet what to do.    

Wednesday, February 27, 2013

1401. Update on KPI spay Maltese


tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
toapayohvets.com

Date:   28 February, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
KPI to spay a young Maltese  
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   28 February, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

1398. Domitor + Ketamine Anaesthesia for spay duration + KPI

 
Feb 27, 2013  I spayed a 7-month-old Maltese X., 4.3 kg. The happy couple took leave and made an appointment with me. Usually spays are done by Dr Daniel as they are routine surgeries. This dog had been vigorously licking her vulval lips such that the area above the vulva became black. "Much less licking after antibiotics last month," the lady in her late 20s said to me. I had advised spaying as there could be pyometra which leaked out vaginal discharge causing the need to lick. It could be a urinary tract infection too. The dog was on heat with uterine horns and ovaries very red and congested when I spayed her. 

ANAESTHESIA
Based on formula of 10 kg, young healthy dog Dom=0.4 and Ket=0.5, I gave this 4.3 kg dog IV Dom=0.2 + Ket = 0.17 totalling 0.37 ml IV one syringe with 0.13 ml Hartmann.

A: Injection of D+K IV  10.22 am
B: Isoflurane first given  10.43 am
C: Isoflurane stopped    10.53 am
D: First skin incision: 10.34 am
E: Completion of skin stitching: 11.01 am.

E-A = 39 minutes. This is because the dog started moving at 10.43 am (21 minutes after injecton) and the surgery was paused to give gas by mask to stabilise. This shows that duration of D + K is 21 minutes for this dog. Spay should be completed in 21 minutes but there was some delay as there was training of the new veterinary staff on gas anaesthesia.  Without traiining, spay should be completed in 30 minutes for this small breed.  

E-D= 27 minutes. Dog was on heat. More time was spent ensuring no bleeding and on speed on hooking out the ovaries.
Hooking left ovary took 3 trials and it was hooked out at 10.38 am. 4 minutes after incision. Right ovary was hooked out at 10.42 am, 8 minutes after skin incision.

Conclusion: Usually the above formula gives at least 20 minutes of surgical anaesthesia. If spay takes longer, isoflurane top up is needed. Efficiency and timing are important in productivity of a vet surgeon. Taking too long to spay a dog is not good.

Conclusion:
Much time was wasted between first skin incision and injection (D-A=12 minutes) as I was teaching a new assistant since Mr Min was poached. He had worked 2 years for me and I wished him well as he ought to move on for a better future and more income. Surgery should commence around 7 minutes around injection as IV effects would occur in 5 minutes usually. Check reflexes for surgical anaesthesia like eyelid blinking. 5 minutes extra off the E-D process would mean that I would take 22 minutes and would not need isoflurane top up. The planning and proper prompt process is essential in veterinary surgery procedures and process and in less wastage of resources.
More info at: Dogs or Cats
To make an appointment:
e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research
Copyright © Asiahomes
All rights reserved. Revised: February 28, 2013

Toa Payoh Vets

1400. Follow up on bladder stone cat 7 days after surgery

Feb 27, 2013 - I phoned the busy gentleman owner of the cat with the bladder stones as I was reviewing the past few days' cases. All cases done by associate vets and be me are reviewed by me as much can be learned from cases done. But this takes a lot of time and time is not much when there are many other things to do.

"My cat is back to as good as normal," he said that the cat was jumping and his stools and urine were normal. He had told me the day before that the cat drank less. I explained that the cat was fed canned K/D diet and canned food has a lot of water.

"Does he eat on his own?" I asked this important question.
"He eats a bit and does not mind spoon-feeding by my maid." This was a moment of great joy to know that a surgical patient who was having kidney disease based on blood test by Vet 2 had recovered almost fully. The stitched bladder with a 8-mm cut by me to extract the 8-mm diameter stone must have healed well, otherwise this cat would be dead.

Follow ups are much appreciated and great learning lessons for any vet but we seldom have much time to do it. It creates an excellent customer service experience.

This owner loves his grandmother as he did bring her to take the cat home the day after surgery. Grandmothers are most loved as they usually spend most time with the grand children while the parents are out working and surviving in the corporate jungle. His grandmother was over 80 years old and her mind was sharp and alert.

"Remember the S/D can of food given by Vet 2?" I asked the owner. "It may not be useful as the cat's urinary pH is acidic at pH=5.0. That means that the bladder stones are unlikely to be struvites as S/D is for prevention and dissolution of struvite stones. Most likely, they are calciuum oxalate stones but we have to wait for the results of the stone analysis."

This info was obtained when I collected urine before opening up the bladder for stone removal. It is important that the vet performs this procedure as it may not be possible to collect urine from an angry non-sedated cat earlier. That could be one reason Vet 2 did not do a urine analysis and just prescribed S/D of one can. It is best to practise evidence-based medicine by doing urine analysis. In this case, there were no crystals in the urine.

A 4th year vet student from the top Portugal Vet University was with me and I asked Catarina Mateu : "No crystals in the urine test means no bladder stones. Many vets will come to this conclusion. What about you?"
"Yes," she replied. "I also think this way."  She will be making a video for me. 

 



 

 

1399. Identification of patient and operation area



   
tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
toapayohvets.com

Date:   28 February, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
Best practices from a plastic surgeon  
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   28 February, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

1399. Identification of patient and operation area

 
Monday, Feb 25, 2013 was an eventful day for me. I had a facial lump of 1x0.5x0.5 cm cut off by Prof Foo C L from the Singapore General Hospital. He thought it was just a scratch tumour as I scratched it to try to get rid of it but it persisted. Sometimes, scratching causes a reaction and the pimple or inflammatory lump disappears. But this lump persisted and increased in size.

"How long has it been present?" he asked as I was on the operating table. "Months," I replied. After seeing this good-natured Syrian hamster with a malignant tumour excised at Toa Payoh Vets recently, I decided to get my skin lump on my face excised and checked for cancer.

"Will local anaesthesia be painful?" I asked Dr Foo.
"Only during injection," he said. He injected 3 areas but the pain was only a small ant bite. I guessed he had perfused the skin immediately on injection and the anaesthetic had numbed the area. He made a blue elliptical marker pen area and excised it. Marking the area to be excised is a good practice even for vets but not all vets do it.

The SGH also has a good practice of verifying the patient's identity and operation site. I was asked my name and identity card number at various points of admission on the day of surgery, outside the operating room and inside the operating room. This practice ensures that the right patient is being operated on. I got asked which area was to be operated. This ensured that no mistakes will be made, e.g. operating on the wrong side of the face. Such mistakes have been made in human surgery with horror stories of the wrong foot amputated.

For veterinary surgery, the patient can't communicate with us. The owner sometimes give incorrect information. For example, a rabbit or cat may be male but the owner says it is female. Trusting the owner who says her pet is female means just spaying the pet. The abdominal area will be shaved and the incision made. No uterus will be found after some time. The vet thinks that the pet had been spayed or worst of all, discovers it is a male.

It is the responsibility of the operating vet to do a full examination including the gender of the pet to be sterilised. Owners are trusted implicitly but some of them don't really know. Pets don't talk to vets and so mistakes have been and can be made by vets in operating on the wrong site.

As for my surgery, Dr Foo said general anaesthesia was unnecessary to remove my facial skin lump. "There is always a risk of death," he said. "You may be the unlucky millionth person to die under anaesthesia. Local anaesthesia will do. It takes around one hour in all."

So, I was strapped on the narrow operating table to prevent me falling off. Swabs covered my eyes to shield them from the 3 bright operating lights. I could not feel the cutting as the area was numbed by the local. Dr Foo had asked whether I felt any pain before excising. This is one part which vet surgeons can't get feedback from the animal patient under local anaesthesia. "6/0 vicryl and 4/0 ethicon," he said to the nurse. The wound was closed well subcuticularly by 6/0 but he stitched up the skin with 4/0 in case of stitch breakdown. This 2-row stitching could be the secret of success in a plastic surgeon in getting a small scar. I got some antibiotic ointment which I didn't use. I asked for plaster to cover my facial wound with a few stitches so that crowds would not stare at me when I attended Cliff Richard's concert in the evening at Marina Bay Sands Grand Theatre.

In any case, Cliff Richard who is 72 years old, gave such an energetic 3-hour-long performance that would put a younger singer to shame. His jokes were appreciated and the audience left much satisfied. One commented that he did not sing "Bachelor's Boy." I was waiting for him to sing "Fall In Love With You", but was disappointed. This was a song I heard at the 25th Baba & Nonya Anniversary in Malacca last year. I got a short video done. See:
https://www.youtube.com/watch?v=-G48MbWTu8c

Cliff Richard's "Fall In Love With you" song when he was very young is at:
https://www.youtube.com/watch?v=T0EHxaVJ0ok

Dr Foo sent my facial lump was sent for histology. It looked white and elliptical in the formalin bottle. There were some fine hairs of around 3 mm long on the skin of this lump as commented by Dr Foo. "Don't read too much into it," he said to me. I do not know why he commented on the presence of these fine hairs.

As for the Syrian hamster operated on Valentine's day, the fair lady owner brought the 2-year-old hamster to consult me 11 days after surgery. There were large reddish skin nodules on the body, under the armpits and on the left thigh. They were around 4 mm x 4 mm raised skin rashes. Could they be due to the "anti-mite" spray the young lady was spraying to "kill the skin mites"? She had diagnosed hair loss and brought the spray from the pet shop.

"Your hamster has a malignant skin tumour," I showed her the histology report which I had paid for since she did not want histology. "It is possible that these red lumps are the spread of the skin cancer which was 2.5 cm in diameter. I gave her the photo of the lump sent by the laboratory.

"Should I continue the spraying of the skin?" she asked me. "No," I said. "This hair loss of the hamster could be due to other reasons and not mites." A hamster with a large skin tumour could be scratching himself a lot and hair loss would be expected due to trauma. "Let the Syrian hamster enjoy his life since he is 2 years old and their lifespan around 3 years," I told her that the rashes could be either irritation of the spray or spread of the cancer. She was to give medication for 7 days and if he nodules disappear, it would be due to irritation.

"I adopted him from the SPCA," she said to me. "He is such a gentle hamster and does not bite me unlike some hamsters."

"Yes, he is very good-natured," I said. "He does not bite me too." Dr Daniel who had operated on him came by and had the stitches taken out. Stitches can be taken out on the 11th day with no problem of the skin breaking down. The wound had healed. Time will tell whether the skin cancer had spread. There was a black pigmented spot on the further back before the left hip area. It was not present before. So it is hard to say whether this was cancerous. I did not advise removal as there was not much skin and there was economics to consider.

Updates will be on this webpage:
http://www.asiahomes.com/petshotline/20130228syrian_tumour_follow_up_toapayohvets.htm
 
More info at: Dogs or Cats
To make an appointment:
e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research
Copyright © Asiahomes
All rights reserved. Revised: February 28, 2013

Toa Payoh Vets

Tuesday, February 26, 2013

1398. Domitor + Ketamine Anaesthesia for spay duration + KPI

Feb 27, 2013  I spayed a Maltese X., 4.3 kg

ANAESTHESIA
Based on formula of 10 kg, young healthy dog Dom=0.4 and Ket=0.5, I gave this 4.3 kg dog IV Dom=0.2 + Ket = 0.17 totalling 0.37 ml IV one syringe with 0.13 ml Hartmann.

A: Injection of D+K IV  10.22 am
B: Isoflurane first given  10.43 am
C: Isoflurane stopped    10.53 am
D: First skin incision: 10.34 am
E: Completion of skin stitching: 11.01 am.

E-A = 39 minutes. This is because the dog started moving at 10.43 am (21 minutes after injecton)and the surgery was paused to give gas by mask to stabilise. This shows that duration of D + K is 21 minutes for this dog. Spay should be completed in 21 minutes but there was some delay as there was training of the new veterinary staff on gas anaesthesia.  Without traiining, spay should be completed in 30 minutes for this small breed.   

E-D= 27 minutes. Dog was on heat. More time was spent ensuring no bleeding and on speed on hooking out the ovaries.
Hooking left ovary took 3 trials and it was hooked out at 10.38 am. 4 minutes after incision. Right ovary was hooked out at 10.42 am, 8 minutes after skin incision. 

Conclusion: Usually the above formula gives at least 20 minutes of surgical anaesthesia. If spay takes longer, isoflurane top up is needed. Efficiency and timing are important in productivity of a vet surgeon. Taking too long to spay a dog is not good.

1397. Follow up on the dog with a cancerous leg

 
TOA PAYOH VETS
toapayohvets.com

Date:   27 February, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
The old dog had a cancerous leg  
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   27 February, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

1397. Follow up on the dog with a cancerous leg

EMAIL FROM DR SING DATED FEB 27, 2013

It is very difficult to diagnose based on emails as what you write may not be what I think as regards "dead space." The "success of surgery" is not a guarantee in any surgery as there are many risks and complications involved especially in an older patient with poor health. Old age and poor health delay in wound healing in people as well as in animals.

Pl understand that some old aged patient undergoing surgeries have post-operation complications like bleeding and infections especially when the dog was not in good health (e.g old age, cancer, delay in seeking treatment, spreading of cancerous cells).

I will advise you bringing the dog to me or your vet for examination and treatment of the post-operation complications in your older dog which nearly did not survive the general anaesthesia during the amputation of the cancerous leg.

Best wishes.


EMAIL TO DR SING DATED FEB 26, 2013
On Tue, Feb 26, 2013 at 2:31 PM, S@hotmail.com> wrote:
 
Hi,
By the way, I read that with that dead space the dog's wound will heal much slower. Does this mean that the surgery was not successful? What can be done to increase the healing process?
 
Thanks.
 
EMAIL TO DR SING DATED FEB 25, 2013
Sent: Monday, February 25, 2013 10:23 PM
Subject: Re: X-rays and blood test report for xxx (Appt 15 Feb 2013, 9.30am)
 
Hi,
 
There seems to be a dead space as liquid keeps flowing out of the wound. I have cleaned the dog's wound and squeezed out the liquid in his leg. Other then that his wounds seems fine.
Thanks.
 
EMAIL FROM DR SING DATED FEB 25, 2013
 
Sent: Monday, February 25, 2013 6:10 AM
To: S
Subject: Re: X-rays and blood test report for bobby (Appt 15 Feb 2013, 9.30am)

How is the dog now? Is his wound healing well? 
BACKGROUND OF CASE

An old dog with a non-healing ulcerated skin wound on the left hind leg. Vet 1 diagnosed skin cancer. Vet 2 did an X-ray and skin biopsy and advised leg amputation but did not do it. The biopsy showed squamous cell carcinoma. The X-ray showed bone involvement around the hock area. The owner consulted me.
EMAIL TO DR SING DATED FEB 14, 2013
On Thu, Feb 14, 2013 at 6:42 PM, S@hotmail.com> wrote:
Hi,
 
I am S... I made an appointment for 15 Feb 2013 at 9.30am for my dog to undergo surgery to amputate his leg due to cancer. I have attached the relevant information to this email for your reference.
 
Thanks.
 
The dog was operated at Toa Payoh Vets and I followed up on Feb 25, 2013, around 10 days after the amputation of the left hind leg above the knee joint by Dr Daniel of Toa Payoh Vets. It was a very high anaesthetic risk case as the dog was not in good health.
tpvets_logo.jpg (2726 bytes)5965. Squamous cell carcinoma spreads to bones. Leg amputation is done Video: Squamous cell carcinoma (skin cancer)
 
Updates will be on this webpage:
www.bekindtopets.com/animals/20130227leg_bone_squamous
_cell_sarcoma_toapayohvets.htm

More info at:
Dogs or Cats
To make an appointment:
e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research
Copyright © Asiahomes
All rights reserved. Revised: February 27, 2013

Toa Payoh Vets