INTRODUCTION
Certain breeds (e.g. Siberian Husky), old dogs and intact (not neutered) males are more prone to perianal (circum-anal) gland tumours. The majority of tumours are benign and are called perianal (circum-anal) adenomas. The malignant ones are called adenocarcinomas. They can't be differentiated by visual inspection. A histopathology of the excised tumour is needed to check whether it is cancerous.
TREATMENT - 3 OPTIONS
1. Surgical excision. Most perianal gland tumours are benign but only histopathology can determine whether they are benign adenomas or malignant adenocarcinomas. Some vets don't perform this surgery as there may be worries of the wound not being able to heal and close. The client may get very angry as the dog will keep licking the open wound. Old dogs may die under general anaesthesia on the operating table leading to highly emotional scenes and potential litigation.
These are two main reasons why some vets don't want to operate. It may be kinder to pets for such vets to ask the owner to seek a vet who will operate as the dog licks the infected tumours to relieve its pain. Blood dripping from the backside can be quite inconvenient to the owner. Owners may need to be proactive in seeking early surgical removal.
2. Neutering. Perianal gland tumours are most common in male dogs that are not neutered. Seldom occur in female dogs. In this case, a female spayed Siberian Husky had one such tumour.
3. Hormone treatment.
Tardak is an anti-androgenic hormone. Injections may be effective but need to be given regularly when tumours occur.
Tardak is for use in male dogs and cats in the following indications:
3.1 The treatment of hypersexuality (humping, wanting to stray).
3.2 The relief of prostatic hypertrophy whether benign, carcinomatous or when due to chronic inflammatory processes. In inflammation, antibiotics and anti-inflammatory drugs are used too.
3.3 For the treatment of circum-anal (perianal) gland tumours.
3.4 For the treatment of certain forms of aggressiveness, nervousness, epileptiform seizures and corticoid-resistant pruritus (developing into dermatoses and accompanied by alopecia).
4. Chemotherapy and radiation for cancerous types. This is not normally available for Singapore dogs.
INTERESTING CASE STUDY
Female spayed Siberian Husky, 11 years old suffered from blood dripping from her perianal tumour for over 4 months. Tumour ulcerates and become infected. If you see the black spot below and to the right of the anus, there were early signs of perianal gland irritation, as the black spot is due to continual licking over several weeks.
CHALLENGES
1. High anaesthetic risk as in all old dogs. The owner did not wish to have a blood test. The vet must inform the owner of the need for such a test to screen the health of the dog before anaesthesia and surgery.
2. Large tumour over 3 cm x 3 cm very close to the anus. That meant a large wound after removal of the tumour and difficulty in achieving normal closure.
3. The dog passes soft stools during surgery, resulting in possible contamination during surgery and after.
4. If the dog rubs her backside on the floor after surgery, the stitches may break down. A large e-collar prevents licking of the wound.
PLAN AHEAD
I advised the owner to get her vet who did not want to operate, to do full grooming esp. of the tail area, ensure no maggot wounds and prescribe oral Baytril antibiotics for 6 days.
PRE-ANAESTHESIA
On the 6th day, the wound was not infected. The dog's rectal temperature could not be taken as the dog struggled and leaked out urine whenever her tail was to be held up for the insertion of the thermometer into the rectum. She was in great pain in the anal area and tried to bite to defend herself. More urine leaked out as she struggled. I got her muzzled for the IV drip and the injection via the IV catheter of Domitor 0.15 ml.
ANAESTHESIA
Dog got shaved. Isoflurane gas was given by mask. I intubated the dog and isoflurane at 1-2% ensured surgical anaesthesia. I got a towel to cover the metallic operating table to prevent electrical shock when I used electro-surgery to excise the perianal tumour. A swab with saline was placed on the indifferent plate and the dog's belly for the conduct of electricity during electro-incision and cautery.
ACTUAL SURGERY, JUNE 9, 2010 FROM 2.17 PM - 3.15PM
1. I used electro-incision to cut off the tumour. The dorsal part has a dark red mass of 0.5 cm x 0.5 cm. The main mass was hard, nodular and ulcerated. It was 2.5 cm x 2.5 cm. The shorter the surgery, the better the chances of survival.
2. A small artery at the ventro-lateral area nearer and below the anus spurted out red blood. I ligated 3 times. Coagulated the bleeding point. Finally, there was not much bleeding.
3. As the elliptical gap was large and under high tension, I had to reduce the tension in order to enable good wound healing. I extended the skin incision to the left at the dorsal and ventral edges above and below the anus respectively (see illustration). The wound was stitched with 3/0 sutures.
4. During closing, this dog kept passing out the loose stools despite her rectum being plugged by a 3-ml syringe. I replaced this syringe with a 5-ml syringe but the stools kept pouring out. This was be possibly due to the minimal isoflurane gas being used and therefore the dog's defaecation reflex was present. The dog's tongue was not a healthy pink and sometimes it turned cyanotic. Since the owner did not want a health screening blood test, it would be difficult to know if this dog had anaemia, hypercalcaemia, kidney or liver disorders.
POST SURGERY
The dog woke up within 10 minutes as if she had a good nap of over 30 minutes.
I gave 2.5 ml of anti-spasmogesic IV to prevent more loose stools coming out to contaminate the wound. She wore an e-collar. I phoned the owner to take the dog home. They came to visit her in the evening.
HISTOPATHOLOGY
The vet must inform the owner that there is histopathology to verify whether the tumour is cancerous or benign. In this case, the owner did not want it.
CONCLUSION
Neutering and surgical excision are recommended. Tumours are best removed when they are very small. I advise two anti-androgenic injections post surgery at 2-weekly intervals. Neutering your male dogs when they are young and/or weekly examination of the anal area will ensure that your dog live longer. This case has a happy ending. However, vets are not Gods and there will be deaths of old dogs on the operating table. It is best that the owner gets the tumours excised when they are very small in size.
Latest info at www.toapayohvets.com
Thursday, June 10, 2010
Saturday, June 5, 2010
95. Perianal tumours in the dog
In the afternoon of June 3, 2010, I had taken out the files of the old Shih Tzu with gigantic perianal tumours and gave a review of this case to a new intern who was a Junior College Year 2 student from Raffles Institution.
I had driven back to the surgery with an old Shih Tzu that had large perianal tumours excised by me four months ago. However his tumours had not recurred, so the old illustrations in my case sheets would be the only way to educate her. I do illustrate my surgical cases for review and to give to my clientele to educate them and their families.
For the benefit of readers, the tumour case is described at:
Buying Time For An Old Companion - Cicum-anal (perianal) tumours in a male Shih Tzu
http://www.sinpets.com/dogs/20100533perianal_circum_anal_tumours_dogs_ToaPayohVets.htm
Jun 2009. Surgery aborted as the dog went into cardiac failure. Only the largest tumour was excised.
To continue surgery would be very foolish as no owner wants a dead dog with a completed surgery
Feb 2010. Dog came with larger tumours
Jun 2010. No recurrence of circum-anal tumours for the past 4 months after excision, neutering and an anti-androgenic injection. So is he fully cured?
Weekly monitoring of the anal area during bath-time will be ideal and any small tumours be resected or reduced by an anti-androgenic injection. But which owner would remember to do the weekly checking for perianal tumours?
"I have not seen many cases of perianal tumours as they predominantly occur in male un-neutered dogs," I said to the intern. The old Shih Tzu I drove back in my car now had a normal backside and so I could not show her the real thing. "Perianal tumours, also know as circum-anal tumours seldom present themselves in neutered male dogs or female dogs. Many Singapore dogs are sterilised as dog licence fees are much lower. This is why there are so few cases."
In the evening, I visited a veterinary surgery whose founder is an old colleague of mine during our employment by the Primary Production Department (PPD), Singapore. The PPD is now called the AVA (Agri-Food and Veterinary Authority.
"How many cases of perianal tumours have you seen?" I asked the founder's son who was on duty. His mum had not been in good health and was not in the practice.
The son would be at least 30 years old. I could remember him as a 10-year-old running around in his mum's surgery when I was doing locum some two decades ago. Now he is a young father and have to bear the responsibilities of taking over the practice.
On this fine evening, I was shocked to see that he had both sides of his head shaved bald, leaving a central high turf of hair bleached brown. I could never imagine he would be this fashionable when he was half my height during his childhood days.
The son said: "I don't see many cases. There is one 10-year-old Alsatian in the Army having this anal problem. The Army would not send it for treatment and I donated some of my cream for the dog."
"Is the dog suffering from anal fistulas? Or circum-anal tumours? Why don't you get him treated?" I asked.
"The Army takes a long time to decide on treatment," the son said. "There are many considerations before a sick dog can be sent to the vet for treatment. The Army sends their dogs to two veterinary practices if necessary."
"Why don't you ask the Army to send the old dog to me for surgery?" I asked him. "I will charge $100 for everything to be done." The son who was doing reservist duties in the Singapore Armed Forces Provost Unit's Dog Company. I was a veterinarian in charge of the health of guard dogs and tracker dogs in this Dog Company when I was doing my National Service in the early 1970s and am concerned about the health of this old guard dog.
"It is not so easy to send a sick dog to the vet for treatment," the son said. "The Army has to be careful of expenditure and has to justify."
This is a sad state of affairs as Singapore is a developed country and a retired guard dog's painful backside does not get treatment.
One can be idealistic but in reality, any complaint from me to the Commanding Officer would likely lead to euthanasia of the old dog. For $100, a retired dog's life is terminated by the bureaucracy. But which is worse? Suffering from a painful backside daily but being alive or death by lethal injection? Has the dog any choices? Is there public funding for such cases for retired army dogs? There must be a fund to treat retired military dogs. In the meantime, I have to store away my idealism by keeping quiet. Rocking the boat will mean death of this dog as I doubt that the Army would even organise transport to get the dog treated for free.
At the surgery, I borrowed the son's new thick cat medicine book "Problem-based Feline Medicine" by Jacquie Rand, Edition 2007. I wanted to read more about a condition in cat where the mucous membranes of the cat's fauces are swollen and edematous. This surgery had many stray cat cases and this was why I came to ask the founder and her son about one case I encountered recently. It was an immune disease as prednisolone reduced the swelling by 50% the next day.
The name of the condition is plasmacytic-lymphocytic stomatitis/faucitis. My case was severe faucitis as the cat did not have inflammation of the tongue or gums. What a name for vet students or even vets to remember.
"Where's Dr Sing?" the receptionist said in a loud voice. I was sitting on the sole chair at the waiting area to her left but she could not see me. She had phoned a young couple to come to the surgery me after asking me how much I charged for surgery to excise the circum-anal tumours.
The couple had been to another vet since this surgery did not provide this service. The fees quoted was over a $1,000 and the couple must have sought the advice of the receptionist who asked me about my fees since I was present.
"Didn't you talk to the vet about the cost of over $1,000 perianal surgery?" I asked the couple.
"No," the young-looking wife whom I estimated to be in her 30s said. "A driver sent our dog to the vet." She looked young as contrasted to her husband who has many silvery grey hairs.
"Veterinary costs are now higher as many younger vets are more careful about litigation and demand blood testing prior to surgery." I said. "My generation appears backwards as we would have simply operated. However, nowadays, in a litigious society, there is no strong defence against professional negligence if the dog dies under anaesthesia if blood tests have not been done."
I asked the wife about the size of the tumour and to illustrate on a piece of paper. It was around 2-cm in diameter and was located below the tail and above the anus. This is a very difficult area to do surgery as there will be insufficient skin to stitch up. No wonder the founder did not want to perform this challenging task.
The continuous dripping of blood from the backside of their old Husky had caused the couple much distress. "Did you talk to the vet about the breakdown costs of over $1,000 for the surgery?" I asked the couple.
"No blood test will be done for the fee quoted by Dr Sing," the receptionist interjected. "I will not send the excised tumour for histopathology to check whether it is cancerous," I said to the couple. "That would bring down a few hundred dollars of veterinary costs."
"Blood test is important to screen the health of the dog before surgery. If the dog dies under anaesthesia, the owner may complain that the blood tests ought to have been done so that they would know the risks involved before surgery. The owner may sue the vet." I explained to the couple.
Blood tests would be useful as they can tell the vet that the dog is having a serious bacterial or viral infection or a liver or kidney disorder. Treatment would be done first if the health screening showed abnormality. A complete blood test would normally cost around $200.
"Is the Husky neutered?" I asked. "She has been spayed," the wife said. I had been presumptuous. This was a female dog. Perianal tumours are rare in females dogs but this was one of them. The world of veterinary medicine and surgery is full of surprises everyday.
"Get your dog's infected backside treated at this surgery first," I advised grooming, clipping of the backside and Baytril antibiotics for 6 days. "Otherwise the wounds will not heal well." The receptionist took out the case card and recorded what needed to be done. She calculated the cost and gave a fee estimate. This was the most efficient veterinary receptionist I had met and was definitely an asset to the founder of this practice. Knowing what to do and not wasting time is rare in many young receptionists. This receptionist was able to create loyalty in the founder's clientele from the way she cared about this customer by solving their problem. She must have overheard my conversation about perianal tumours with the founder's son as the door of the consultation room was open to the reception and knew what to do.
Sometimes the chemistry between a new vet and the prospective clientele is good and this was the case after several minutes of discussion and preparation for the surgery. This is important. The wife offered to shake my hands with me before she left.
There was a young girl in pink overalls working in this surgery. Her pink apron was unusual as I seldom see veterinary receptionist in pink. A slim quiet girl who would be learning from this receptionist on how to do things. I was introduced to her after her Miniature Schnauzer's bladder stone were removed by the son at my surgery (Toa Payoh Vets) some three years ago.
The son had operated on the dog. This was his first urinary stone removal surgery and his mum had asked me for assistance. So I was his mentor. See:
Mentoring a younger vet
Now three years later, the Schnauzer is OK and has no bladder stones although he has been eating dry dog food. "Are you feeding dry dog food to your dog?" I asked the girl in pink in a serious voice. She nodded: "Dr ... said it was OK." I was surprised that this Miniature Schnauzer did not get a recurrence of urinary stones despite being fed dry dog food after surgery and for the past three years.
"It is best not to as the bladder stones may recur unless the dry food is meant for dogs with urinary stones," I said to the young graduate.
There seems to be a high staff retention rate in this surgery. "Girls who left to work in banks would come back during Saturdays to work," the receptionist announced to me with maternal pride and to say that the founder was very caring about her staff.
I was most impressed with the management of the founder. It is hard to retain staff nowadays as many Singaporeans have lots of choices and are picky.
Good service helps to retain and grow clientele too. I was most impressed with this receptionist as she knows what to do to solve a client's problem on behalf of her employer without the need of prompting and reminders. She is worth her weight in gold. Gold prices are high and she is worth at least 80 kg worth of gold.
Photos and updates at:
http://www.sinpets.com/dogs/20100533perianal_circum_anal_tumours_dogs_ToaPayohVets.htm
I had driven back to the surgery with an old Shih Tzu that had large perianal tumours excised by me four months ago. However his tumours had not recurred, so the old illustrations in my case sheets would be the only way to educate her. I do illustrate my surgical cases for review and to give to my clientele to educate them and their families.
For the benefit of readers, the tumour case is described at:
Buying Time For An Old Companion - Cicum-anal (perianal) tumours in a male Shih Tzu
http://www.sinpets.com/dogs/20100533perianal_circum_anal_tumours_dogs_ToaPayohVets.htm
Jun 2009. Surgery aborted as the dog went into cardiac failure. Only the largest tumour was excised.
To continue surgery would be very foolish as no owner wants a dead dog with a completed surgery
Feb 2010. Dog came with larger tumours
Jun 2010. No recurrence of circum-anal tumours for the past 4 months after excision, neutering and an anti-androgenic injection. So is he fully cured?
Weekly monitoring of the anal area during bath-time will be ideal and any small tumours be resected or reduced by an anti-androgenic injection. But which owner would remember to do the weekly checking for perianal tumours?
"I have not seen many cases of perianal tumours as they predominantly occur in male un-neutered dogs," I said to the intern. The old Shih Tzu I drove back in my car now had a normal backside and so I could not show her the real thing. "Perianal tumours, also know as circum-anal tumours seldom present themselves in neutered male dogs or female dogs. Many Singapore dogs are sterilised as dog licence fees are much lower. This is why there are so few cases."
In the evening, I visited a veterinary surgery whose founder is an old colleague of mine during our employment by the Primary Production Department (PPD), Singapore. The PPD is now called the AVA (Agri-Food and Veterinary Authority.
"How many cases of perianal tumours have you seen?" I asked the founder's son who was on duty. His mum had not been in good health and was not in the practice.
The son would be at least 30 years old. I could remember him as a 10-year-old running around in his mum's surgery when I was doing locum some two decades ago. Now he is a young father and have to bear the responsibilities of taking over the practice.
On this fine evening, I was shocked to see that he had both sides of his head shaved bald, leaving a central high turf of hair bleached brown. I could never imagine he would be this fashionable when he was half my height during his childhood days.
The son said: "I don't see many cases. There is one 10-year-old Alsatian in the Army having this anal problem. The Army would not send it for treatment and I donated some of my cream for the dog."
"Is the dog suffering from anal fistulas? Or circum-anal tumours? Why don't you get him treated?" I asked.
"The Army takes a long time to decide on treatment," the son said. "There are many considerations before a sick dog can be sent to the vet for treatment. The Army sends their dogs to two veterinary practices if necessary."
"Why don't you ask the Army to send the old dog to me for surgery?" I asked him. "I will charge $100 for everything to be done." The son who was doing reservist duties in the Singapore Armed Forces Provost Unit's Dog Company. I was a veterinarian in charge of the health of guard dogs and tracker dogs in this Dog Company when I was doing my National Service in the early 1970s and am concerned about the health of this old guard dog.
"It is not so easy to send a sick dog to the vet for treatment," the son said. "The Army has to be careful of expenditure and has to justify."
This is a sad state of affairs as Singapore is a developed country and a retired guard dog's painful backside does not get treatment.
One can be idealistic but in reality, any complaint from me to the Commanding Officer would likely lead to euthanasia of the old dog. For $100, a retired dog's life is terminated by the bureaucracy. But which is worse? Suffering from a painful backside daily but being alive or death by lethal injection? Has the dog any choices? Is there public funding for such cases for retired army dogs? There must be a fund to treat retired military dogs. In the meantime, I have to store away my idealism by keeping quiet. Rocking the boat will mean death of this dog as I doubt that the Army would even organise transport to get the dog treated for free.
At the surgery, I borrowed the son's new thick cat medicine book "Problem-based Feline Medicine" by Jacquie Rand, Edition 2007. I wanted to read more about a condition in cat where the mucous membranes of the cat's fauces are swollen and edematous. This surgery had many stray cat cases and this was why I came to ask the founder and her son about one case I encountered recently. It was an immune disease as prednisolone reduced the swelling by 50% the next day.
The name of the condition is plasmacytic-lymphocytic stomatitis/faucitis. My case was severe faucitis as the cat did not have inflammation of the tongue or gums. What a name for vet students or even vets to remember.
"Where's Dr Sing?" the receptionist said in a loud voice. I was sitting on the sole chair at the waiting area to her left but she could not see me. She had phoned a young couple to come to the surgery me after asking me how much I charged for surgery to excise the circum-anal tumours.
The couple had been to another vet since this surgery did not provide this service. The fees quoted was over a $1,000 and the couple must have sought the advice of the receptionist who asked me about my fees since I was present.
"Didn't you talk to the vet about the cost of over $1,000 perianal surgery?" I asked the couple.
"No," the young-looking wife whom I estimated to be in her 30s said. "A driver sent our dog to the vet." She looked young as contrasted to her husband who has many silvery grey hairs.
"Veterinary costs are now higher as many younger vets are more careful about litigation and demand blood testing prior to surgery." I said. "My generation appears backwards as we would have simply operated. However, nowadays, in a litigious society, there is no strong defence against professional negligence if the dog dies under anaesthesia if blood tests have not been done."
I asked the wife about the size of the tumour and to illustrate on a piece of paper. It was around 2-cm in diameter and was located below the tail and above the anus. This is a very difficult area to do surgery as there will be insufficient skin to stitch up. No wonder the founder did not want to perform this challenging task.
The continuous dripping of blood from the backside of their old Husky had caused the couple much distress. "Did you talk to the vet about the breakdown costs of over $1,000 for the surgery?" I asked the couple.
"No blood test will be done for the fee quoted by Dr Sing," the receptionist interjected. "I will not send the excised tumour for histopathology to check whether it is cancerous," I said to the couple. "That would bring down a few hundred dollars of veterinary costs."
"Blood test is important to screen the health of the dog before surgery. If the dog dies under anaesthesia, the owner may complain that the blood tests ought to have been done so that they would know the risks involved before surgery. The owner may sue the vet." I explained to the couple.
Blood tests would be useful as they can tell the vet that the dog is having a serious bacterial or viral infection or a liver or kidney disorder. Treatment would be done first if the health screening showed abnormality. A complete blood test would normally cost around $200.
"Is the Husky neutered?" I asked. "She has been spayed," the wife said. I had been presumptuous. This was a female dog. Perianal tumours are rare in females dogs but this was one of them. The world of veterinary medicine and surgery is full of surprises everyday.
"Get your dog's infected backside treated at this surgery first," I advised grooming, clipping of the backside and Baytril antibiotics for 6 days. "Otherwise the wounds will not heal well." The receptionist took out the case card and recorded what needed to be done. She calculated the cost and gave a fee estimate. This was the most efficient veterinary receptionist I had met and was definitely an asset to the founder of this practice. Knowing what to do and not wasting time is rare in many young receptionists. This receptionist was able to create loyalty in the founder's clientele from the way she cared about this customer by solving their problem. She must have overheard my conversation about perianal tumours with the founder's son as the door of the consultation room was open to the reception and knew what to do.
Sometimes the chemistry between a new vet and the prospective clientele is good and this was the case after several minutes of discussion and preparation for the surgery. This is important. The wife offered to shake my hands with me before she left.
There was a young girl in pink overalls working in this surgery. Her pink apron was unusual as I seldom see veterinary receptionist in pink. A slim quiet girl who would be learning from this receptionist on how to do things. I was introduced to her after her Miniature Schnauzer's bladder stone were removed by the son at my surgery (Toa Payoh Vets) some three years ago.
The son had operated on the dog. This was his first urinary stone removal surgery and his mum had asked me for assistance. So I was his mentor. See:
Mentoring a younger vet
Now three years later, the Schnauzer is OK and has no bladder stones although he has been eating dry dog food. "Are you feeding dry dog food to your dog?" I asked the girl in pink in a serious voice. She nodded: "Dr ... said it was OK." I was surprised that this Miniature Schnauzer did not get a recurrence of urinary stones despite being fed dry dog food after surgery and for the past three years.
"It is best not to as the bladder stones may recur unless the dry food is meant for dogs with urinary stones," I said to the young graduate.
There seems to be a high staff retention rate in this surgery. "Girls who left to work in banks would come back during Saturdays to work," the receptionist announced to me with maternal pride and to say that the founder was very caring about her staff.
I was most impressed with the management of the founder. It is hard to retain staff nowadays as many Singaporeans have lots of choices and are picky.
Good service helps to retain and grow clientele too. I was most impressed with this receptionist as she knows what to do to solve a client's problem on behalf of her employer without the need of prompting and reminders. She is worth her weight in gold. Gold prices are high and she is worth at least 80 kg worth of gold.
Photos and updates at:
http://www.sinpets.com/dogs/20100533perianal_circum_anal_tumours_dogs_ToaPayohVets.htm
Friday, June 4, 2010
Blood tests and pyometra
Many owners don't want blood tests prior to dental scaling or operations to save on costs. Here is a case where blood tests must be done to prevent litigation.
Sep 8, 2008
Chihuahu, female, 8 years
Not eating past 2 weeks. Sleepy. Big blod clots fom vagina passed 2 weeks ago.
Exam
395 fever
Enlarged uterus palpated 1 cm in diameer.
abdominal pain moderate lower half.
Closed Pyometra
Haemoglobin below normal. Total WBC 72 (4.5 - 13.5).
Neutrophils 97% Absolute 70 (1.8 - 7)
Lymphocyes 2.6 % Absolute 1.84 (2 - 7,8)
Platelts 2 9 (150 - 600)
Numerous giant plateles seen.
Bacteraemia and toxaemia.
Liver SGOT/AST 53 (<41)
Kidney urea and creatinine normal
Operated. Survived. OK as at Jun 2010.
Sep 8, 2008
Chihuahu, female, 8 years
Not eating past 2 weeks. Sleepy. Big blod clots fom vagina passed 2 weeks ago.
Exam
395 fever
Enlarged uterus palpated 1 cm in diameer.
abdominal pain moderate lower half.
Closed Pyometra
Haemoglobin below normal. Total WBC 72 (4.5 - 13.5).
Neutrophils 97% Absolute 70 (1.8 - 7)
Lymphocyes 2.6 % Absolute 1.84 (2 - 7,8)
Platelts 2 9 (150 - 600)
Numerous giant plateles seen.
Bacteraemia and toxaemia.
Liver SGOT/AST 53 (<41)
Kidney urea and creatinine normal
Operated. Survived. OK as at Jun 2010.
Puppy with loose stools for a long time may get intussception
It is not normal.
Silkie was active and eating well, but passes loose stools since purchase 2 weeks ago and prior to purchase. When the puppy passes red blood, the parents and grown up childen consulted me.
Why and how to cure him?
1. It is not normal for the puppy to pass loose stools every day when fed dry food.
Causes:
1. Stress
2. Vaccination by the owner
3. Licking floors and objects
4. Given variety of puppy treats
"My puppy had diarrhoea for one month," my outspoken intern said. "He was OK after that. The breeder said it was due to vaccination."
"Loose stools is not normal," I inserted a cotton bud into the rectum to take stool sample. Fresh red blood stained the cotton bud.
"Now there is red blood. It may be parvoviral attack of the intestines. I got the parvoviral test done. It was negative. In this case, it would be professional negligent not to do the test in puppies having blood in the stools," I taught my assistant Mr Saw.
"Sometimes the vet does not think it is necessary," I said. "If the puppy dies a few days later when sen home, a complaint might be lodged with the authorities. The first question would be whether the puppy had parvoviral infection?"
As an example,I told him to test the 3 puppies sent in by the breeder. All breeders want the least veterinary cost and parvoviral tests cost money and some don't want parvoviral testing. Mr Saw did the 3 tests. One of them tested positive for puppies.
Later the intestines may telescope into each other resulting in lots of bloody stools and a need to operate. The condition is rare and is called intussception."
I had seen one case. Palpation of the abodomen can reveal a telescoped lump of small intestines. This puppy may have the start of intsussception. No X-rays are taken due to economic reasons. Puppy remained active.
Warded for 3 days.
IV drip, antibiotics and dry food.
Silkie was active and eating well, but passes loose stools since purchase 2 weeks ago and prior to purchase. When the puppy passes red blood, the parents and grown up childen consulted me.
Why and how to cure him?
1. It is not normal for the puppy to pass loose stools every day when fed dry food.
Causes:
1. Stress
2. Vaccination by the owner
3. Licking floors and objects
4. Given variety of puppy treats
"My puppy had diarrhoea for one month," my outspoken intern said. "He was OK after that. The breeder said it was due to vaccination."
"Loose stools is not normal," I inserted a cotton bud into the rectum to take stool sample. Fresh red blood stained the cotton bud.
"Now there is red blood. It may be parvoviral attack of the intestines. I got the parvoviral test done. It was negative. In this case, it would be professional negligent not to do the test in puppies having blood in the stools," I taught my assistant Mr Saw.
"Sometimes the vet does not think it is necessary," I said. "If the puppy dies a few days later when sen home, a complaint might be lodged with the authorities. The first question would be whether the puppy had parvoviral infection?"
As an example,I told him to test the 3 puppies sent in by the breeder. All breeders want the least veterinary cost and parvoviral tests cost money and some don't want parvoviral testing. Mr Saw did the 3 tests. One of them tested positive for puppies.
Later the intestines may telescope into each other resulting in lots of bloody stools and a need to operate. The condition is rare and is called intussception."
I had seen one case. Palpation of the abodomen can reveal a telescoped lump of small intestines. This puppy may have the start of intsussception. No X-rays are taken due to economic reasons. Puppy remained active.
Warded for 3 days.
IV drip, antibiotics and dry food.
92. Hypersexuality
Cocker Spaniel, Male, 5 years, Not neutered
Blood seen in the urine today
Eats OK, No fever
Why?
History: No previous occurrence
Urine test: Not possible as bladder is not full.
Examination: Penile tip is red and inflamed.
Traumatic injury. Does the dog hump people or objects?
"Yes" the owner said. "He has been humping pillows and the other dog frequently."
The diagnosis is traumatic injury to the penile tips due to hypersexuality.
This condition can be anti-social as visitors do not welcome their legs being gripped by the male dog.
TREATMENT
1. Neuter the male dog.
2. Anti-androgenic injections regularly has been shown to reduce the libido.
Blood seen in the urine today
Eats OK, No fever
Why?
History: No previous occurrence
Urine test: Not possible as bladder is not full.
Examination: Penile tip is red and inflamed.
Traumatic injury. Does the dog hump people or objects?
"Yes" the owner said. "He has been humping pillows and the other dog frequently."
The diagnosis is traumatic injury to the penile tips due to hypersexuality.
This condition can be anti-social as visitors do not welcome their legs being gripped by the male dog.
TREATMENT
1. Neuter the male dog.
2. Anti-androgenic injections regularly has been shown to reduce the libido.
Thursday, June 3, 2010
Left perineal tumour in a male intact old Shih Tzu
Case Study 1. Circum-anal tumours and Tardak injection
Jun 1, 2009
Shih Tzu, Male, Intact, 11 years old, 7.5 kg. Can't take rectal temp. painful backside
Large left perineal tumour 10 cm x 10 cm in 5 globular lumps
IV drip + antibiotics
Jun 3, 2009
Decided to operate.
No histopathology for economic reasons.
Jun 8, 2009 Went home.
Jun 3, 2010
Facial dermatitis and eye ulcerations
Owner said the tumour did not recur after 2nd surgery and neuter.
He had not wanted neuter after the first surgery
Feb 2, 2010.
Left perineal tumour 6"x5"
Shih Tzu, Male, 12 years, 7.5 kg
Treatment
Feb 2, 2010
Pre-op IV drip + baytril 24 hours.
Feb 3, 2010
Clipped bald
Blood test
1. Liver disorder. High SGPT/ALT, SGOT/AST
2. Kidney disorder. High urea 13.3 (4.2 - 6.3). Creatinine low (29 (89 - 177)
3. Total WBC 30.8 (6 - 17)
Platelets 528 (200 - 500)
Zoletil anaesthetic 0.2 ml IV
+ Isoflurane gas > 1 hour
Surgical excision
2 packets of stitching
e-collar + rimadyrl painkillers for 7 days
Feb 4, 2010
Post-op swelling. Baytril 4 days and trimaxazole syrup
Feb 7, 2010
Neuter - 2 testicles removed.
Domitor 0.5 ml IV Antisedan 0.5 ml IV & post-op painkillers and antibiotics.
Feb 9, 2010
Parts inflamed Stitch breakdown at 8 o'clock and 12 o'clock
lst Tardak 10mg/ml inj. Bodyweight 6.8 kg. Tardak given at 14 mg or 1.4 ml SC
Another one on Feb 17, 2010 advised.
Painkillers tolfedine 60 mg x 2 tab. Pred 5mg 1/4 tab/day x 20 days
Tremethoprim, medazole,
Goes home.
The owner did not return for a 2nd Tardak injection.
"What is Tardak used for?" the JC 1 intern asked.
Jun 3, 2010
7.8 kg 39 deg C. Ringworm in body spinal area and face. To shave bald.
No tumour seen
Case Study 2. Hypersexuality and Tardak injection
Tardak (delmadinone acetate) is a potent anti-androgen 17 to 40X
the potency of progesterone. It is used for 3 indications
1. To treat hypersexuality (inhibit intersitial cedll stimulating hormone -->reduced testosterone production --> decrease libido. So it will be effective for dogs that hump cushions daily. Tardak 1.9 ml SC
2. Prostrate hypertrophy - due to chronic inflammatory process, benign hypertrophy or carcinoma. In inflammations, need to give antibiotics and corticoid.
3. Circum-anal tumours
Respond favourably so long as they are small.the larger they are at first treatment, the less encouraging is the prognosis.
Jun 1, 2009
Shih Tzu, Male, Intact, 11 years old, 7.5 kg. Can't take rectal temp. painful backside
Large left perineal tumour 10 cm x 10 cm in 5 globular lumps
IV drip + antibiotics
Jun 3, 2009
Decided to operate.
No histopathology for economic reasons.
Jun 8, 2009 Went home.
Jun 3, 2010
Facial dermatitis and eye ulcerations
Owner said the tumour did not recur after 2nd surgery and neuter.
He had not wanted neuter after the first surgery
Feb 2, 2010.
Left perineal tumour 6"x5"
Shih Tzu, Male, 12 years, 7.5 kg
Treatment
Feb 2, 2010
Pre-op IV drip + baytril 24 hours.
Feb 3, 2010
Clipped bald
Blood test
1. Liver disorder. High SGPT/ALT, SGOT/AST
2. Kidney disorder. High urea 13.3 (4.2 - 6.3). Creatinine low (29 (89 - 177)
3. Total WBC 30.8 (6 - 17)
Platelets 528 (200 - 500)
Zoletil anaesthetic 0.2 ml IV
+ Isoflurane gas > 1 hour
Surgical excision
2 packets of stitching
e-collar + rimadyrl painkillers for 7 days
Feb 4, 2010
Post-op swelling. Baytril 4 days and trimaxazole syrup
Feb 7, 2010
Neuter - 2 testicles removed.
Domitor 0.5 ml IV Antisedan 0.5 ml IV & post-op painkillers and antibiotics.
Feb 9, 2010
Parts inflamed Stitch breakdown at 8 o'clock and 12 o'clock
lst Tardak 10mg/ml inj. Bodyweight 6.8 kg. Tardak given at 14 mg or 1.4 ml SC
Another one on Feb 17, 2010 advised.
Painkillers tolfedine 60 mg x 2 tab. Pred 5mg 1/4 tab/day x 20 days
Tremethoprim, medazole,
Goes home.
The owner did not return for a 2nd Tardak injection.
"What is Tardak used for?" the JC 1 intern asked.
Jun 3, 2010
7.8 kg 39 deg C. Ringworm in body spinal area and face. To shave bald.
No tumour seen
Case Study 2. Hypersexuality and Tardak injection
Tardak (delmadinone acetate) is a potent anti-androgen 17 to 40X
the potency of progesterone. It is used for 3 indications
1. To treat hypersexuality (inhibit intersitial cedll stimulating hormone -->reduced testosterone production --> decrease libido. So it will be effective for dogs that hump cushions daily. Tardak 1.9 ml SC
2. Prostrate hypertrophy - due to chronic inflammatory process, benign hypertrophy or carcinoma. In inflammations, need to give antibiotics and corticoid.
3. Circum-anal tumours
Respond favourably so long as they are small.the larger they are at first treatment, the less encouraging is the prognosis.
90. William Somerset Maugham fan
June 3, 2010 meeting at Toa Payoh Hub
I was surprised and happy to meet a Singaporean who keeps the whole set of William Somerset Maugham books. Such men are rare as Singaporeans don't read.
"The pages are yellowed," he lamented.
"Do your books face sunlight?" I asked.
"Yes," he replied.
"Sunlight has a strong effect on books. Keep them in a dehumidifier. Do
you have book
I was surprised and happy to meet a Singaporean who keeps the whole set of William Somerset Maugham books. Such men are rare as Singaporeans don't read.
"The pages are yellowed," he lamented.
"Do your books face sunlight?" I asked.
"Yes," he replied.
"Sunlight has a strong effect on books. Keep them in a dehumidifier. Do
you have book
89. Reverzine S.A (yohimbine)
Reverzine injection is an "antidote" for the reversal of xylazine-induced sedation and xylazine-ketamine anaesthesia in dogs and cats.
Active constituents: Yohimbine hydrochloride 1.25mg/ml
4-aminopyridine 2mg/ml
It must be given by IV. Not to be used for animals with cardiovascular, renal or hepatic disorders
Dogs: 1 ml/10 kg bodyweight
Cats: 0.25 ml/kg bodyweight
Parnell Laboratories (Aust) Pte Ltd
Active constituents: Yohimbine hydrochloride 1.25mg/ml
4-aminopyridine 2mg/ml
It must be given by IV. Not to be used for animals with cardiovascular, renal or hepatic disorders
Dogs: 1 ml/10 kg bodyweight
Cats: 0.25 ml/kg bodyweight
Parnell Laboratories (Aust) Pte Ltd
88. An independent contractor
REPLY TO AN EXPATRIATE VETERINARIAN WANTING TO WORK IN SINGAPORE
An independent contractor as a veterinarian means he does what he wants and just uses the facilities of service providers like veterinary surgeries. I hope you understand the concept and business model. It is lots of risks for you. But you cannot have the cake and eat it!
That is why I advise you (for your own good) to be an employee first if you really want to make your fortune in Singapore. There is no short cut to success as you will know by now. My real estate company, asiahomes.com started with zero income for around one year as I had to build it up. Same applies to toapayohvets.com. Vets are not supposed to advertise their presence in newspapers etc. So, it was tough, unless the vet is proactive giving seminars and doing charity.
I find employment agreements not good once the trust is gone as the employee sabotage begins since the employee cannot get out of employment. I think you need to write a business plan first. Ensure that your financial savings to last you at least one year as you will be an independent contractor.
Other things like accommodation can be found when you are here. An HDB apartment will suit your budget for at least the first year. Rental of whole 2-bedroom HDB apartment is around $1,500 - $2,000 per month. A car is essential if you want to do big house-call vet business. Taxis are not convenient. There is the car cooperative rentals. Wessex Estate houses are usually full as Caucasian expats love them.
Please note that I do NOT get involved in car purchases for independent contractors. In life, you need to do a business plan (income and expenses especially) even if you have lots of money. Otherwise the money just goes down the drain within one year. I know of rich and influential people who want to "invest" in veterinary facilities. For example, they provide land and buildings in Myanmar and I provide the rest. But I don't know them. So, I avoid them.
As for you, you need to think and think what you want to do in Singapore as you have to leave the comfort of your home to venture overseas to sell your services.
I met a young English vet who took over a practice from a German vet in Siem Reap. After 2 years, she gave up as business was not to her expectations. I visited her when during my travel to Siem Reap in January 2010. I thought there would be expatriate vets in Siem Reap and she was the only one. She was very frank with me about the business of veterinary medicine in Siem Reap. The difficulty in getting veterinary drugs and the culture of the locals. She decided to go back to England and my visit was her last day of practice. I learnt more from her failures and my other business failures. I can tell you it is very painful. Very costly and involved loss of huge amounts of monies.
So, I don't want you to suffer in Singapore if you are not into risk taking. Costs of accommodation, cars and other matters - if you earn money and have customers through referrals and excellent service and perform correct diagnoses - they are small change.
Best wishes
Dr Sing Kong Yuen
An independent contractor as a veterinarian means he does what he wants and just uses the facilities of service providers like veterinary surgeries. I hope you understand the concept and business model. It is lots of risks for you. But you cannot have the cake and eat it!
That is why I advise you (for your own good) to be an employee first if you really want to make your fortune in Singapore. There is no short cut to success as you will know by now. My real estate company, asiahomes.com started with zero income for around one year as I had to build it up. Same applies to toapayohvets.com. Vets are not supposed to advertise their presence in newspapers etc. So, it was tough, unless the vet is proactive giving seminars and doing charity.
I find employment agreements not good once the trust is gone as the employee sabotage begins since the employee cannot get out of employment. I think you need to write a business plan first. Ensure that your financial savings to last you at least one year as you will be an independent contractor.
Other things like accommodation can be found when you are here. An HDB apartment will suit your budget for at least the first year. Rental of whole 2-bedroom HDB apartment is around $1,500 - $2,000 per month. A car is essential if you want to do big house-call vet business. Taxis are not convenient. There is the car cooperative rentals. Wessex Estate houses are usually full as Caucasian expats love them.
Please note that I do NOT get involved in car purchases for independent contractors. In life, you need to do a business plan (income and expenses especially) even if you have lots of money. Otherwise the money just goes down the drain within one year. I know of rich and influential people who want to "invest" in veterinary facilities. For example, they provide land and buildings in Myanmar and I provide the rest. But I don't know them. So, I avoid them.
As for you, you need to think and think what you want to do in Singapore as you have to leave the comfort of your home to venture overseas to sell your services.
I met a young English vet who took over a practice from a German vet in Siem Reap. After 2 years, she gave up as business was not to her expectations. I visited her when during my travel to Siem Reap in January 2010. I thought there would be expatriate vets in Siem Reap and she was the only one. She was very frank with me about the business of veterinary medicine in Siem Reap. The difficulty in getting veterinary drugs and the culture of the locals. She decided to go back to England and my visit was her last day of practice. I learnt more from her failures and my other business failures. I can tell you it is very painful. Very costly and involved loss of huge amounts of monies.
So, I don't want you to suffer in Singapore if you are not into risk taking. Costs of accommodation, cars and other matters - if you earn money and have customers through referrals and excellent service and perform correct diagnoses - they are small change.
Best wishes
Dr Sing Kong Yuen
Wednesday, June 2, 2010
87. A biting dwarf hamster
At 2.5 years old, this dwarf hamster bites when touched. His lower body is deep red and he has a bare backside. So, he must be feeling painful. He scratches his ears all the time and sometimes his body. What is the cause of his itchiness?
Contact with rough pellets and water. He prefers to stay inside his feed bowl. Mum gave him tissue paper inside a yellowish bowl. He would drag the tissues out and place them on top of the pellets near the water bottle and sleeps there. The water bottle drips water. He gets wet. Being an aged hamster, his skin is no more as good as when he was young. With friction and dampness, his lower body gets irritated and inflamed. He becomes very itch.
I gave him clean paper litter and treatment for 5 days. He was much happier and his lower body became pink and not so red and itchy. He went home to the little girl who would look after him.
"How about his big lump on his right thigh area?" the mum asked. "It is better not to operate as he may just die under anaesthesia or after surgery," I said. "He is nearing the end of his life span." Hamster lives around 2.5 - 3 years.
Contact with rough pellets and water. He prefers to stay inside his feed bowl. Mum gave him tissue paper inside a yellowish bowl. He would drag the tissues out and place them on top of the pellets near the water bottle and sleeps there. The water bottle drips water. He gets wet. Being an aged hamster, his skin is no more as good as when he was young. With friction and dampness, his lower body gets irritated and inflamed. He becomes very itch.
I gave him clean paper litter and treatment for 5 days. He was much happier and his lower body became pink and not so red and itchy. He went home to the little girl who would look after him.
"How about his big lump on his right thigh area?" the mum asked. "It is better not to operate as he may just die under anaesthesia or after surgery," I said. "He is nearing the end of his life span." Hamster lives around 2.5 - 3 years.
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