1812. Epulis - Vet 1 advised no need surgery, not malignant

Friday, July 27, 2012 Today, I left home at 7.19 am, missed the feeder bus and walked to the Yio Chu Kang subway as the next bus will be 9 min. A breezy bright morning with sunshine and blue skies. I reached Toa Payoh subway at 7.50 am and walked to Toa Payoh Vets reaching at 8.41 am. A slow walk for exercise. Quite breezy but still sweating at the end. A father and son came with a Labrador, Male, 12 years, bleeding from a large gum tumour. He had consulted "3 vets" but they did not advise surgical excision. According to Vet 1's medical report- biopsy of gingival mass which was a fibromatous epulis of periodontal origin. According to the owner, Vet 1 did not advise surgical excision as it was "generally benign". Neither did another 2 vets from the same practice. The lump grew and grew and started to bleed at times. He was bleeding spots of blood outside the surgery at 9.15 am when the owners came. I asked them to wait as Dr Daniel was not here yet. More bleeding. I decided to take over the surgical case as this is an old dog. Should be 14 years as he was stated 12 years in 2009 in Vet 1's record. Blood test by Dr Daniel showed normal results except slightly below the low range of RBC and PCV Domitor + Ketamine at 25% instead of 50% as the dog is really old. Electro-excision is OK at this dosage if not delayed. Needed some isoflurane gas. Also for dental scaling. Strong teeth. Implemented new anaesthetic recording system. Today I used my first Anaesthesia & surgery record No. 151. 27.7.12, Lab Retriever, Male, 12 years, 36.3 kg, 39.1C A   *Inj Domitor (0.4 ml) +K (0.5ml) IV at 25% calculated dose   10.06 am B   Isoflurane gas first given                          10.18 am for dental scaling. Good teeth. C   Isoflurane gas stopped                              10.51 am. End of dental scaling D   Electro-excision of epulis started               10.10 am E   End of excision                                         10.18 am Antisedan IV to reverse domitor                      11.02 am. Dog wakes up in 1 minute In 2009, Vet 1 said half the jaw had to be cut off, so the owner did not want surgery. Another of the 3 vets said that since the epulis was not cancerous as checked by biopsy, there was no need to remove it. But this epulis grew to twice the size and blood dripped from this tumour whenever it was injured, soiling the floor. He did some internet surfing and consulted Toa Payoh Vets' Dr Daniel as 2nd opinion. As the dog is old, I took over the case as I had more experience and could perform a shorter surgery, minimising risks of death on the op table.  The likely reason that the other 3 vets didn't recommend surgery would be that the dog is old and they don't want to bear the high risk of anaesthetic death ruining their reputation. I took 8 minutes to excise the epulis 2x2x1.5 cm under Domitor and Ketamine at 25%. A vet must be quick and know what to do during surgery, as the analgesia would wear off 8 minutes after injection. The dog started to move around the 8th minute. The incisor tooth might be entombed but I did not think of slicing the epulis to check and gave it to the owner. The owner threw it away.  Isoflurane and intubation were done for dental scaling. Solid teeth in general except for the tartar and plaque. The dog was given carrots and apples and had good food. 5508 -5517. A gigantic epulis Control of bleeding. Electro-excised more of the periodontal ligament inside the hole. I used cotton to plug the hole after removal of the epulis to stop bleeding. The bleeding was profuse but stopped after 5 minutes of plugging with cotton.   UPDATE  July 30, 2012  12.50pm. 3 days post surgery, I phoned the owner to ask about the health status of his dog. "On the first day at home, he was not able to walk on his left hind leg and we had to carry him outdoors for him to pee," he said. This dog has a left hind pain before surgery, possibly a bad hip. "However, today he could go to the lift himself." "Has he got a good appetite?" I asked. "He is eating soft food and wants to eat more. He has no problem eating." "You can continue your usual dry food and others now," I said. "Is he more active?" "I can see that he is overall well," the gentleman thanked me for following up. It was good to know that this old dog is OK. It is not guaranteed that all old dogs operated by me survive anaesthesia and so surgery must be short to lessen any risk of death. Oral tumours are best removed when they are small in size, even though they may not be cancerous. This is because they cause oral pain as they ulcerated and become infected. They interfere with the joy of eating too as an ulcerated infected mouth is very painful.   Blogger.com has some problems displaying the width of the page. Toa Payoh Vets webpage is: http://www.sinpets.com/F5/2012072gigantic_epulis_labrador_toapayohvets.htm