Thursday, September 22, 2011

626. Vulval leiomyoma

Today, Sep 23, 2011, I was reviewing some medical records today as part of my performance assessment of myself and my associates. What went wrong and what could be improved? Reviews improve operational efficiency and productivity as much can be learnt from the past case experiences. Such reviews add up, providing real life experiences as the vet ages.

In a histopathology report dated May 12, 2011, the age of a Jack Russell's nodule at the dorsal vulval lips was stated to be 5 years old. It had a leiomyoma, 2x1.3x1.2 cm.

The histopathology report:
Dermal circumscribed nodule. Whorled fascicles of bland smooth muscle cells. No necrosis, cytological atypia or increased mitotic activity. No evidence of malignancy.

Why did the lab report state the dog as 5 years old? I checked my records. In 2006, 3 Jack Russell pups came in for tail docking. The dam did not come till 2009 when I excised 3 breast tumours. She was said to be 14 years old then. The owner did not want to spay the dog in her younger days as he believed that she would become fat when spayed.

With this big growing vulval tumour, he agreed to the dog being operated to excise the tumour and spayed in May 2011. This was done by my associate vet. The vulval tumour was sent to the laboratory for histopathology by my assistant who wrote 5 years as the age.

So, I phoned the gentleman who is in his mid 60s today. He said the dog would be more than 14 years old. Definitely not 5 years old. This dog could not be 5 years old and I informed my assistant and the vet to check with the owner every time. In the Singapore General Hospital, the nurse will ask the patient going for surgery, several times his name and what operation he or she would be going for on the way to the operating room. I know this because I went for an operation. Sometimes, they even took a picture of the area to be operated.
"Is she OK after the surgery (to spay and remove leiomyoma)?" I asked. "Yes," he said. If the dog is more than 14 years old, it still had false pregnancy before the spay. How old should a female dog be before they go into "menopause"? Do dogs go into menopause?

Sometimes clients cannot remember the exact age of their dogs or they may have more than one of the same breed. It is best practice for the vet to ask the client at EVERY consultation what is the age of the dog patient. Some practices take one facial image of the dog patient. In my opinion, there needs to be front and two side views in order to identify the dog. If there are markings and the dog is of one colour, it will be wise to ask the owner to identify the dog.


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