Thursday, September 17, 2015

2298. Referral. A 13-year-old cross bred had a "water-melon" lump

Sep 18, 2015

I had laksa with this practising 76-yerar-old senior vet at Potong Pasir this morning. He would be opening a vet clinic in Johor and decided to focus on surgery.

"Many young vets do not want to perform complicated surgeries," he said. "So they will refer to others."

"That's true even in Yangon," I said. "One experienced vet who had worked in Singapore got all the surgeries referred to by the other vets. Even in Singapore too."

"Swee also wanted to refer one case of a dog with a very large cyst, as big as a water melon to other vets," he recounted a 13-year-old cross bred dog that the owner wanted him to treat. "I am an old vet and I refer to a young vet to do the surgery!"  This old vet practised vet surgery for over 50 years but this was the first time he encountered such a large abdominal cyst.

Once I saw him operating to remove a gigantic tumour on the submandibular area of an old dog. The tumour was the size of an orange. Electro-surgery and keeping a lookout for bleeders, he removed this tumour. But the abdominal tumour was a large water-melon size.

"Did you draw out any fluid after inserting a needle?" I asked.
"No fluid," he said. "There was a thick wall and it was enveloped by some lace-liked tissue (the mesentery).

"It is a matter of common sense. I dissect slowly using electro-surgery. I reached a drainage tube. Suddenly, thick viscous fluid shot out, deflating the lump!" 

"This would be an abdominal cyst that grows slowly over 10 years," I recalled my Taenia tapeworm from sheep to dog transmission lectures in Glasgow University some 50 years ago. "It could be a tapeworm cyst. Cysticercus species."

"There were many smaller cysts and it would be too risky to remove every one." he said. "The fluid inside the cyst was not clear but thick and cloudy."

"These would be the other younger cysts developing," I said.

"After the surgery, the dog was jumping and running normally," the vet laughed happily. "The owner was very happy!"

And to think that his senior nurse who had been with him for many years, asked him not to operated and to refer to other vets or the expatriate specialist. I just cannot understand. Some 50 years ago, when I was in National Service full time in 1977, this vet operated on a Patent Ductus Arteriosis in a SAF Provost Unit guard dog that would be put to sleep as it was lethargic and useless. There was no sophisticated hospital equipment like the automatic ventilator to prevent the lungs deflating when the chest is cut open.

I assisted by pressing the anaesthetic vet while he located the shunting blood vessel and ligated it. No young vet would do this surgery. He was 38 years old and had his own practice and at least 10 years of experience.  I was 27 years and doing my National Service, with no canine surgical experience.

A sound knowledge of anatomy is needed. The dog recovered and was back on guard dog duty.    


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