Saturday, March 23, 2013

1338. The old Sheltie has a red oral lump


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

Date:   23 March, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
The old Sheltie has a cauliflower lump 
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   23 March, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129
Sunday Mar 10, 2013

I was reviewing this Sheltie X's case, operated by Dr Daniel 3 days ago, using electro-surgery to excise the large gingival mass.

In this surgery, intubation is compulsory as it takes a longer time to excise this lump. Electro-cautery to seal the bleeders. Monosyn 2/0 sutures were used to close the large wound after electro-excision. I asked Dr Daniel what was the post-op situation 3 days after op now?

"Any stitch breakdown or complaint from the owner?"
"No news," he said. He phoned the owner but the line was busy.
"You can text to her," I advised.
After 10 minutes, I phoned the owner. The mother said: "I have not checked the mouth, but the dog is OK." She asked the daughter to check the mouth but she would not want to do it.

"I will check for you," she replied. "The stitches are still there."
"Give soft food or dry food with water for the next 14 days," I advised.
"My Sheltie is eating dry food with water all the time," she said.
"How long was the gum tumour there?"
"I don't know. Four months probably."
"One month," the daughter said.
"If the tumour grows so fast and so large within one month, it is likely to be cancerous and will recur," I advised.

This is an cauliflower-type gingival lump. Could it be malignant? Since the owner did not want histology, there is no way to know its nature.

It is good practice to build up client loyalty in this competitive world. Getting feedback from the owner after surgery is one excellent way to show you care.

But many of us don't do it often esp. if the vet has 40 cases a day to handle and is mentally exhausted at the end of the day.  Too many customers/vet does not mean it is a good thing as each case becomes a bottom-line figure rather than a personal involvement and continued education through follow up on the clinical or surgical outcomes. Follow ups make a vet hone his skill and become better at the next case as no vet knows everything and every case is so much different. .

In Singapore, busy owners may need repeated dialing or to phone their residence number just to communicate with them. Some don't return calls and some don't have time to talk! Sometimes I just text the message to them and we never talked at all since text messages are so convenient.
 
   
     

Update will be on this webpage: www.bekindtopets.com/stories/20130323gingival_tumour_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: March 23, 2013

Toa Payoh Vets

1337. An 18-gram leg tumour in a dwarf hamster

TOA PAYOH VETS
toapayohvets.com

Date:   07 April, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
A gigantic 18-g leg tumour in a dwarf hamster
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   07 April, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

1412. An 18-gram leg tumour

 
Yesterday Mar 22, 2013, I strongly advised the young couple that their one-year-old male white hamster with a large swollen right hind leg with only the foot seen. I said it would unlikely survive the anaesthesia and surgery. The right hind leg was the size of a firm fish ball - the type eaten in fish bowl noodles in Singapore. I got a ruler and show that it measured 3.5 cm x 3.5 cm x 3 cm. The hamster weighed 64 g but he was much heavier some 4 weeks ago.

The couple had consulted Vet 1 who prescribed baytril and prednisolone (pred) for 2 weeks and advised surgery if the drugs were ineffective. Apparently Vet 1 did a biopsy which showed cells were not normal. According to the owner, pus and blood seeped out when Vet 1 put in a needle. A blood test was also done by Vet 1. The details of the procedure were a bit vague.

"Such a large tumour will not disappear with medication," I said. "An early operation without taking medication would give the hamster a higher chance. Pred relieved pain and inflammation but it weakens the immune system and adversely affect surgery. In any case, the hamster is unlikely to survive the anaesthesia as the lump is massive and involves the hip joint as well as the right groin area. If this large leg tumour is removed, the hamster will lose around 20% of his blood and that could be fatal.  The blood supply in this lump has increased to feed the tumour. There is no blood transfusion in the hamster to replace this blood loss as this is not practical.

"This large leg lump would probably be a bone tumour which has spread.   Go home and think about the surgery. The alternative is let the hamster enjoy his life till the lump starts getting infected and bleeding more." However, there was some purplish area and an open wound on the extreme right of the lump. The hamster would lick this lump but the owners had tied a band of tissue paper like a ribbon around his waist, preventing him from attacking this lump.

It appeared that the tissue paper tie was effective but actually it was the pred that stopped the itchiness and pain as the overall appearance of the lump was not highly inflamed or itchy. The hamster would still lick the lump if the paper ribbon tie was taken off.

"Is he still eating?" I asked.
"He eats a lot," the young man said. The young lady showed me a Handphone image of this hamster 4 weeks ago. It was a plump as can be, at 77 grams for a dwarf hamster. So the right leg swelling which would begin as a small tumour was not obvious. 
"He looks thin," I said. "If he is eating a lot, his weight would not have dropped from 77 grams to 64 grams now. How many faecal pellets does he pass out a day? "  
"We don't count them," the young man showed me 2 small faecal pellets in the cage.
I asked the couple to think again as regards the highly risky surgery. "This may be the last time you see the hamster before he goes to the operation room. He will lose around 20% of his blood supply based on this large tumour having cornered this amount, when the whole right hind leg is amputated at the right hip level."
They wanted a few minutes at the reception area to discuss further. 
"Take your time," I had asked them to take 2 days to think about it. This was the type of high risk anaesthesia that I would rather not do. The alternative is let the hamster be euthanased when the tumour had become necrotic and smelly.
"How much time has my hamster to live?" the young man asked.
"Around 4 weeks," I said. "Your medication will have to be taken off as it can't be given for a longer time. It may cause wet tail diarrhoea and the hamster would die from that condition."

It was a hard situation for the owner and for the operating vet. In some cases, I would tell the owner that the condition is inoperable but in this hamster, a right hind leg amputation was operable if the hamster would survive the anaesthesia.

The couple decided on the surgery.

At 6.42 pm I injected 3 drops of zoletil 50 IM. At 7.08 pm, the stitching was done. The hamster was well sedated without the need of isoflurane gas top up. The right hind leg muscles were clamped at the right hip area. I excised the whole leg, cutting off the femoral bone below the hip. I used a transfixing ligature to tie up the muscle remnant. There was no bleeding surprisingly after removal of the clamp and excision of the tumour. I stitched the big skin wound of 5 cm long displaying the right-sided abdominal intestines under the thin peritoneal covering with absorbable 6/0 simple interrupted sutures. 
 
tpvets_logo.jpg (2726 bytes)6078 - 6081. Malignant leg tumour grows more aggressively in younger dwarf hamsters

The hamster was still breathing at the end of the long surgery taking around 26 minutes But he did not bounce back. I phoned the couple who arrived within a few minutes. The hamster was still. Motionless. "Normally I can see chest movements or whisker movements within 30 minutes after surgery," I said to the couple. I checked the hamster's heart. There was no heart beat. The hamster's eyes were open. He had passed away. This was a very sad moment.

The hamster now weighed 45grams. The left hind leg and tumour weighed 18 grams. I expressed my condolences to the owner. It was difficult for them as the alternative was a dehydrated hamster with a necrotic right hind leg. The skin of this hamster was folded up when I pulled it, showing a moderate degree of dehydration.

This type of high risk cases may best be rejected as the chances of survival are very low. In many cases, I don't operate in cases with very low survival rates but this was a younger hamster, being one-year-old and so I agreed to operate at this late stage.

An informed consent was given but at the end of the day, the surgical outcome of death after the surgery was not too emotional for everyone. Yet no operating surgeon can have a 100% no-death surgical and anaesthetic outcome but it still affects the veterinary surgeon.
  
Update will be on this webpage:
www.sinpets.com/F6/20130407malignant_tumour_leg_hamster_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: April 07, 2013

Toa Payoh Vets

Friday, March 22, 2013

1336. The young Sheltie is very thin

The 1-year-old Sheltie came in for diarrhoea for more then 3 days..

She was bought as she was the runt of the litter. A very thin dog who would just eat the bare minimum. Previously I had her puppy canine teeth extracted but now I noted that the left upper premolar 4 had a puppy premolar 4 lodged inside.This was a surprising finding since most retained puppy teeth are canine teeth. The others just dropped off in time.

I put the dog on the IV drip for 2 days. The dog went home on Day 3. She was on I/D canned food + rice which was fine for the past 4 weeks till the diarrhoea came in. As to the cause, it is hard to say. Stool analysis revealed no parasitic ova but red blood cell +.

The dog went back on I/D canned and dry for the next 8 weeks to stabilise the intestines.

1335. The majestic looking 14-year-old Sheltie

The 14-year-old Sheltie has a full luxurious bloom of hair and a thick white collar  He looked much younger and would be mistaken for a younger dog. No hair loss. No skin disease. No tick infestations. The Bishan owners vaccinated him every year and he would have his physical examination. Very few Singaporean dog owners bother with this annual examination after puppyhood.

Dr Daniel vaccinated him. I said hello to the family as I was the puppyhood vet. "It is best to check his urine for any urinary crystals," I said and gave them a urine collection bottle. The dog went out of the surgery and the owner returned with a bottle of yellow slightly turbid urine.


Significant urine test reslts

pH 7.0 (5-8), SG 1.036 (1.005-1.030)., Nitrite +v, Bacteria 2+, Crystals Nil.  No red or white blood cells in the urine.

"There seems to be some Urinary Tract Infection," I phoned the owner. "Does the dog lick his private parts?"
"No," the owner said. "He licked his paws only."  Sometimes, the owner may not be aware of the other aspects of licking.

Advices

1. Antibiotics for 10 days.
2. Drink more water or add water to dry food as the SG is high. This would lead to urine staying inside the bladder for a long time and bacteria infection of the bladder. Maybe the dog did not go out to urinate often. .
3.Urine test 3 months later. 

Health screening annually should include the blood and urine test. But many vets don't advise any health screening but just give the vaccination.

Thursday, March 21, 2013

1334. Neutering a 9-year-old male Chihuahua X

"He is still a virgin," the fair lady tutor of English, Maths and Science full-time said. "All these years, he was not naughty. Then yesterday, he started mounting the neighbour's female dog."

"He didn't do it before," I said. "The other neighbours would have female dogs but they would be spayed and therefore do not produce a pheromone that attracted him. Is the female dog he is interested spayed?"

"No," she said.
"The other female dogs had been spayed and so didn't attract him!"
"Will he still mount now he is neutered?" she asked. "He is a virgin and in the pas 7 years, he never did this."
"Yes, for a while as his testosterone hormones are still present. After a few weeks, he will not be susceptible to female dogs on heat."   

I reviewed the medical record. The dog came in Oct 30, 2012 as he had a right malar abscess. He was a healthy normal dog. Dr Daniel neutered him and the owner came at 6 pm to take him home.  She is a private tutor. "I enjoy my job very much," she said. "The free lancers give up as the syllabus is too difficult for them. . I have job security!"

"The Maths is so advanced that even well educated parents cannot tutor their own children," I said. So there is a great demand for full-time and passionate professional private tutors like her. Private tutors coaching small groups can earn more than an average employee if she puts in the hours and perform since there are fewer of such experienced tutors nowadays.

1333. A rabbit grows a "horn" above the left eye

"The rabbit grows a horn," I said to Julia.
"Why would a rabbit grow a horn?"
"Because he is horny."
Seriously, I had a case of an 8-year-old rabbit growing a prominent "horn" in around 2 weeks.
Dr Daniel was thinking it could be a sarcoma. My advice would be to excise it. X-rays showed a growth. Dr Daniel and I operated. Histology indicated a sarcoma.
"It grows big very fast," the neurology nurse said to me. "One week ago, it was a small lump."
"It is likely to recur," I said. "It was too big to completely excise all tissues. The bony skull would have remnants of the cells.  

1332. Follow up on Sharpei with oily skin & blood in the urine

March 21, 2013  12.45pm
Phoned the mother but she could talk very briefly that the dog was not passing blood in the urine and that the skin was less "waxy". The dog vomited food + tablets 2 days ago but is now OK. Will call me back later.


REVIEW OF THE HISTORY
This is probably a Chow Chow X Sharpei, F, not spayed, 4 years old.

Mar 13, 2013
Presented for oily skin disease and 6-month haematuria (blood in the urine). Vet 1 had taken X-ray and found no bladder stones. After antibiotics, blood is seen during urination. This occurred for at least 6 months.

I had taken bladder and kidney X-rays and found no radio-dense urinary stones. However I saw  bright red blood peed out in the midst of urination and also bloody vaginal discharge.
Bladder palpation was a solid firm bladder (thickened wall). Little pain. No crepitus. I thought there was a large stone and told the owner on the first visit and palpation.


Skin scraping +ve demodex, fungi, yeast
Blood test - elevated total white cell count
Urine test - pH 9.0, bacteria +, struvite crystals +, blood +
X-rays - no obvious stones in urinary tract

S/D to dissolve struvites + antibiotics.  2 weeks to review.

1331. Images used for "Caring For Your Terrapins" video











1330. Descemetocoele - deep corneal ulcer in a Shih Tzu's eye




















1329. How to write a copy that sells

March 21, 2013


All sales pages should have the following 5 points.
1. Headline
2. Problem description. Why it is important to solve the problem or alleviate it.
3. How your product or service will solve the problem - accurate & descriptive content.
4. Proof that it works.
5. A way to take immediate action - online or phone 

 ---------------------------------------------------------------------------------------

Reference: Web Marketing All-in-one For Dummies 2012 Edition - Pg 111

Writing a copy that sells, using the C.O.N.V.E.R.T. M.E Formula

1.  Captivate visitors - Headline with a hook
2.  Offer just one testimonial - under the headline
3.  Now address your visitors
4.  Validate some facts - show industry % to reinforce the problem
5.  Expose your solution - describe how it works
6.  Recapture attention - don't let visitors leave now that you unveil your secret
7.  Test for action -  determine whether they are ready to buy now
8.  Motivate with value and urgency.
9.  Energise visitors to buy - Give assurance it is a good deal.