A Jack Russell has a large liver tumour

A 12-year-old Jack Russell came with a much swollen abdomen.

She was not spayed and so I thought she could have closed pyometra. This is a common problem of unspayed old female dogs. Yet the dog was active and could even walk 30 minutes to the Surgery. She had a very good appetite and drank a lot of water. She peed a lot. So, closed pyometra was ruled out.


Could there be an abdominal tumour since a vet had removed a breast tumour (MG 5 left side) some 8 months ago? Or metastasis of this breast tumour?

Could there be an ovarian tumour?

Next was ascites. On percussion of the abdomen, there was no tympany of gas or fluid thrill when I tap the right side of the abdomen and let my fingers of the other hand feel the other side.

I gave fruesemide to bring down any abdominal fluid and took an X-ray 12 hours later. There was the classical splenic neoplasia as diagnosed by Dr Daniel. This image was similar to the image in the Vet Surgery book which showed the lateral abdomen with the tail of the spleen being a globular shape.

According to an experienced older vet, an ovarian cyst would be higher up in the anterior abdomen.

So, the X-ray diagnosis is a splenic tumour. Could it have metastasized to the atrium causing an atrial tumour?

Exploratory surgery showed that the abdominal mass was a liver tumour, not a splenic tumour. Blood test showed liver hepatitis. The dog had a mammary tumour by another vet 8 months ago. No histopathology was done. It is likely that this liver tumour was a metastatic tumour from the breast. Prevention of this liver tumour might or might not be possible if the dog had been spayed at a young age. Spayed dogs seldom develop breast tumours. Primary malignant liver tumours (hepatocellular carcinoma) are rare in dogs and they are usually due to the spread from other organs with tumours. In this case, histopathology is in progress as at Oct 24, 2014.  

OCT 20, 2014. Exploratory laparotomy. Low dose of domitor + ketamine IV and isoflurane gas.

SURGERY
The large globular tumour was at one end of the lobe. The lobe was taken out. A scalpel blade cut one side of the lobe like "fracturing" the liver.  That meant that the liver was incised on one side while the assistant could hold up the liver for ligation of the parenchyma blood vessels.

Bleeding inside the parenchyma area where the one side was cut was profused. The suture needle is put inside the parenchyma and ligation was carried out..

3/0 absorbable "gullotine" ligatures were placed inside the parenchyma to ligate the blood vessels and bile ducts. Electro-coagulation was done. "Gullotine" ligatures were put on the other side of the lobe 2 cm below the tumour to control bleeding.

The liver tumour was then excised, using electro-excision needle to cut and coagulate the stump. Surprisingly, there was no bleeding after this electro-excision.

HISTOPATHOLOGY. Malignant tumour composed of anastomosing traeculae, nests and pseudoacinar structures. The tumour cells are plyonal with mildly enlarged round nuclei, vesicular chromatin and small round nucleoli. Areas of tumour necrosis are seen. The uninvolved liver shows evidence of steatosis.
Diagnosis: Malignant tumour, favour heptocellular carcinoma  

Liver neoplasia with multiple abscesses.
One 70% size of a tennis-ball-tumour in one lobe. Abscesses have spread all over the liver.
Another ping pong ball tumour in a smaller lobe.  Histopathology in progress - whether it is simply abscesses or abscessed tumours.

24 hours post-op, the dog was eating and very active. I advised in-patient for 10 days as the other dog at home would play with this dog, causing suture breakdown.

The owner asked about prognosis.

Poor prognosis.
1. Locally advanced stage of liver neoplasia with abscesses. This is to be confirmed on histopathology of samples sent..

BLOOD TEST.
No leucocytosis. No "neutrophilia",  but neutrophils % was 92%. (60-70% normal).
Liver enzymes SGOT and SGPT were raised.

TREATMENT IN DOGS.
In people, a combination of chemotherapy or radiation therapy to down-stage the cancer to a more early stage so that surgical resection can be done to provide a long-term survival or cure.

CONCLUSION
8 months ago, another vet had excised a breast tumour but did not send it for histology. This tumour was large and could have spread to the liver.  No lung X-rays were done to lower medical costs. If the dog had been spayed young, it is possible that she would not have breast tumours which could have spread to the liver, now at 12 years of age.

SEVEN DAYS POST OP.
The dog is presently eating and drinking and is active as at Oct 28, 2014. But she panted a lot when taken out for a short walk. Will go home on Day 14 when stitches are removed. As to life span, it is unlikely to be more than 6 months.    

--------------------------
NOTES

In people, liver cancer (HCC or hepatocellular carcinoma) is the 6th most,  important cancer in the world and the 3rd most important cause of cancer mortality. 80% of all HCC patients are found in the Asia Pacific region because of the high incidence of viral hepatitis. In Singapore, it is the 4th most important cancer and the second cause of cancer death after lung cancer.


Reference; Down-staging of liver cancer to allow curative surgery: An emerging paradigm. Prof Pierce Chow, Pg. 2, Salubris Issue No. 30, Jul - Sep 2014

A hamster in Africa

Hello,

My name is XXX and I need help with with hamster.

My girlfriend currently live in Mozambique is taking care of hamsters from a school there. Looks like one of them, L has the wet tail. I'm attaching the photos, that she send me.

She is asking for a favour - its almost impossible to get veterinarian help for small animals in Mozambique.

L (the hamster from the photos) doesn't seem to have wet tail disease, as she doesn't have diarrhoea. Also her wet back was from the spilled water. The problems with her that require treatment are :

- red mole or a tumour that is visible on the photos

- left eye irritation (infection?) - also visible on photos

- her bum is quite dirty - she doesn't seem to groom her butt area

If there is medicine or antibiotics needed to treat the problems,then I can pass it to her.

The drops for the wet tail, would be needed rather to prevent the disease, as there are multiple hamster under her care and it could be useful. 

Thanks,
XXX









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

Oct 16, 2014
REPLY FROM DR SING
Hamster appears to have skin infections and abscesses, possibly from bite wounds. She is unable to groom her backside. Some images are not clear.  Pl tel me for further discussion.

1078. A stray cat welfare activist

Today, an elderly lady who rescued stray cats and had 11 in her apartment brought in an old stray cat that had been vomiting yesterday. An old lady feeding this cat had asked her to help.

"I spent over a thousand dollars feeding the strays every day, twice a day," she said. "Yet the prices of canned food keep increasing!"

"Rentals have had shot up considerably as there is a grave shortfall of commercial properties," I explained to her. "So, the cost of doing business keeps going up. The Landlords keep increasing the rentals."

As to her view on stray cat activism, she said she would operate alone and not get into problems with the other activists.

There is a vet who used to charge male cat neuter at $40. Female cat spay at $50, on heat at $55 and pregnant one at $60. "The vet is a butcher," she was referring to the thicker sutures used by one vet providing cheap sterilisation, as compared to another vet who hides her sutures under the skin.

"Prices are different for the vet who used the fine sutures," I said. "Definitely she would not be charging $50 to spay a female cat."

"She charges high," the activist said. "But those cats spayed by her are my personal cats, not the strays. I have to get somebody to queue at SPCA fo.r the free spay vouchers"

She gave some cost figures:

Stray cat trapping $70
Cat transport to vet $35/cat or $30 by a lady.
Boarding after spay for 3 days and neuter for 1 day  $5.00/day

"Do you know about this person who was fined heavily for sterilising cats? I had sent over 100 stray cats to him over the past 3 years. Fortunately, none died. Well, except a pregnant one."

"Yes," I said. "I know the incident. He did not sterilise cats. He was transporting cats to a lady who sterilised them."

    

1077. What makes a wedding dinner interesting?

aSunday Oct 12, 2014

I attended a unique wedding dinner on Sunday Oct 12, 2014.

A wedding dinner can be interesting if there are some elements of entertainment and audience education. It is like a movie with a compelling story.

USUAL ROUTINE
1. A bride in white with bridegroom enters the hotel and walk in the central walkway.
2. Stage - cage cutting action
3. Couple returns to stage for champagne pouring.
4. Later, bride in red gown with groom enters the hotel and walks the central walkway
5. Family on stage to say "cheers" once or "yam sing" 3 times.
6. Walk round tables and photography of each group by couple. The photographer was not present for my table for some unknown reason. I don't get to see the couple too. There were 70 tables and I was was the bridegroom father's friend.

At the end of dinner, photos of diners were printed on the spot and handed out to the guests. This was unique service not present in other weddings.

SCREENS on the left and right showed the history of the couple. Unfortunately, the screen does not show the actions on the stage when there is "cheers" as there seem to be no projection from this top hotel in Singapore. The screens display the slides which had already been viewed.

STORY TELLING BY COUPLE AND THE BRIDE'S FRIEND. At least 5 minutes per person. Interesting anecdotes of the couple's life. Public declaration of love and thanks to parents.



 

2014 Bodley Head/Finaicial Times esssay prize

http://www.ft.com/cms/s/2/f1c7d1f6-3f53-11e4-a5f5-00144feabdc0.html#axzz3GAQCSUZL

Script for Phyllis. Sunday's 4 interesting cases Oct 12, 2014

1. The blinded Siamese cat, male, 2 years old.
The other male cat clawed him. 3 male cats. 5 female cats.
"The females don't like him," the breeder said to me.
"He has stronger competitors and so the female cats usually prefer the stronger males."
"The males start to bully him nowadays and that is why his right eye was injured by claws."
The owner decided on the removal of the badly damaged eyeball but wanted to wait for 2 days.


VIDEO OF CAT'S EYE 

"The house wives who buy my cats are cheapskates. They want instalments, " the home breeder said. " Should I breed dogs instead? What breeds will you recommend?" the lady asked me.

"Breeding of cats and dogs are not a profitable business as the AVA will penalise anybody who tries to sell kittens and puppies without a licence to sell," I said.
"Yes, yes," the lady said. "My friend's HDB flat was raided as she was selling puppies through the Straits Times Advertisements." 
"How do you advertise without the AVA officers coming hard on you and knocking on your doors to investigate?"
"I use the internet or place the kittens in the pet shops but now I cannot even produce one kitten."

"Shih Tzus appear to be a very popular breed in Singapore," I replied to her queries. "Since you work long hours and leave the operation to your helper, the breeding will never be successful," I said. "There is much more knowledge and expertise required with the management of 3 male cats and 5 female cats and you have not produced any kitten.  Normally 1 male cat will do."

"The first male cat had become fat and lazy," the woman said. "So I got the second male. Somebody gave me this 3rd male Persian cat whose right eye was injured by the second male."

"A fat cat could be due to over-feeding," I said. "In any case, 3 male cats will not live peacefully and so they fight to become dominant and cause injury."

The couple decided that breeding was not profitable and would not do it.  They were busy with their meditation exercises in their spare time. So, they have no time for this breeding business. Every venture needs full attention to even have a chance of success and in this case, asking a helper to do it is the surest way to financial ruin.  Helpers are never passionate nor knowledgeable about the art of breeding dogs and cats.

CONCLUSION
A friend of the owner wanted to take over the cat and seek a second veterinary opinion on the eye problem.


2. A black dwarf hamster has an impacted cheek pouch.



HOOK with subtitles
"His right cheek pouch is swollen again," the lady owner placed her beloved hamster on the palm of her hand (video footage). "Her mouth is becoming smelly."

A BKTP VET EDU ....... TITLE ..IMPACTED CHEEK POUCH AGAIN



HISTORY AND EXAMINATION

"5 months ago, his right cheek pouch was packed to the maximum and I had evacuated the thick grass-like material," I showed the medical illustrations (IMAGE OF ACTUAL ILLUSTRATION IN CASE SHEET) in my case sheet to the lady teacher. 


"Yes, her cheek pouch was back to normal size for the first few weeks but become filled up again," the lady said. "I emptied the cheek pouch for her but now I could not do it. This time, her mouth had become smelly." (VIDEO VERY ACTIVE HAMSTER OBJECTING TO POUCH EMPTYING WITHOUT SEDATION)

I weighed the hamster. She was 41 g as she wass 5 months ago. I checked that the cheek pouch area in the face was inflamed and some areas were hairless owing to scratching (VIDEO).

ANAESTHESIA AND SURGERY
I sedated the hamster with Zoletil 50 IM (VIDEO). When she was less active, I emptied the cheek pouch. There was an ulcer at the lip commissure (VIDEO) causing the bad smell.

POST OP
The hamster recovered fast 15 minutes  after the sedation. She was very active. (VIDEO). She would be given the oral antibiotics and painkillers for the next 7 days. 


TIPS AND ADVICES TO PREVENT RECURRENCES

"Some hamsters prefer the right cheek pouch to store food," I said to the owner. "Just like some people who grind food more frequently with one side of the mouth."

 CHEEK POUCH IMPACTED

CHEEK POUCH EVACUATED

"What should I do to prevent recurrence?" the teacher used her handphone to photograph the "grass-like" roll of soft material of around 5 cm lodged taken out from the right cheek pouch (VIDEO). This was similar to the greenish roll removed 5 months ago. 

"You can empty the cheek pouch every 2 days. Give her just sufficient amount of food in the bowl. In that way she has not sufficient amount to store." 


CONCLUSION
Impacted cheek pouches can become infected causing pain, infection and loss of appetite. Some hamsters try to clear the food inside by hand. Sometimes they evert their cheek pouches as shown in the images below. These everted cheek pouches need to be put back inside the cheek by the vet.  Always consult the vet early when your hamster has impacted cheek pouches for more than 3 days.


PAST CASES OF CHEEK POUCH IMPACTION AT TOA PAYOH VETS



VIDEO
http://www.youtube.com/watch?v=pzL_tjwv0g0&feature=youtu.be

IMAGES FROM CASE STUDIES AT TOA PAYOH VETS
http://www.toapayohvets.com/surgery/050609hamsters_ToaPayohVets.htm

IMPACTED CHEEK POUCH

EVERTED CHEEK POUCH DUE TO IMPACTION

EVERTED CHEEK POUCH DUE TO IMPACTION

IMPACTED CHEEK POUCH

3. BKTP......        TITLE: A CAT HAS BUMBLE FEET

"A very rare case in Singapore cats, similar to the condition of bumble foot in rabbits" I said to the young couple who was present at 9 am on this fine Sunday Oct 12, 2014 morning.

"Do you house your cat on  a wired-floored cage with no bedding or pads?" I asked.
"No, no, she has the freedom to run around the apartment!"

"Was there something sharp she stepped upon?" I asked.
"No, no," the couple said.
Yet the underside of both hind feet showed one swollen wound each (VIDEO). There was bleeding and pus oozed out in one of the feet. What was the cause? The cat's hind feet were injured by something sharp but the couple could not feedback any possible cause.

"We did buy an anti-cat mat from the $2-Daiso store," the wife showed me her phone image (IMAGE). "It has sharp ends to prevent a cat from accessing the area behind the sofa. But the cat persisted in getting under the sofa!"   

"This mat would be the cause of traumatic injury to the underside of the hind feet," I said. "The cat was careful with her front feet but the hind feet would be pricked as she walked over the mat to hide under the sofa. Parts of the spike could have penetrated the underside of the two hocks of the hind feet. This resulted in inflammaton and infection with pus formation.

"The treatment is to sedate the cat and drain the infected skin wounds (CLIPPER, CLEANING VIDEO CLIPS). The cat was sedated with xylazine and ketamine IM and a thorough irrigation of the leg wounds was done. The cat's ears were cleaned. The anal sacs were expressed with lots of foul-smelling oil oozing out from the right anal sac (VIDEO). 
 


OTHER PROBLEMS IN THIS CAT
1. Hair shedding is more frequent nowadays. No more soft coat
2. Loose stools now and then in the past 2 months
3. A hairless brownish nose tip is not normal for any cat.

SOLUTIONS
PROBLEM NO. 1 - MORE HAIR SHEDDING. The cat may be stressed by the bumbled feet pain and infections and the stomach upset. The cause of bumbled feet was finally found to be the sharp ended mat bought from the $2-store Daiso. This mat was meant to prevent the cat from stepping onto the area behind and below the sofa. (IMAGE FROM OWNER'S HANDPHONE).

The cat would step over the mat but his hind feet were injured by the sharp ends. Over time, part of the plastic spikes entered the lower feet causing abscess. Treatment was to clip the hair and express the pus and foreign bodies. (VIDEO)

2. Stop using perfumed spray over the cat litter to keep it "clean" and to stop using perfumed shampoo very two weeks for the next 4 weeks. Use a mild shampoo or just brush the cat. The cat could have licked off the perfume, causing gastroenteritis now and then after the young couple had used the spray or shampoo. This is another form of stress leading to more hair shedding.

PROBLEM NO. 2 - LOOSE STOOLS
I advised the feeding of W/D, a high fibre prescription diet (canned) to be introduced slowly at 90% of old food and 10% of W/D initially till 100% for the next 4 weeks to stabilise the intestines and producing solid stools to clear the anal sacs. The right anal sac was impacted with black anal anal oil and infected. I expressed and around 1 ml of foul-smelling thick grey oil was taken out (IMAGE & VIDEO).

A high fibre diet which produces solid stools will help in evacuation of the anal sac oil daily during pooping.

PROBLEM NO. 3. The cat purred whenever the husband stimulated the nose tip for the past year. Daily rubbing caused friction and led to hair loss and brown pigmentation. The wife would tickle the neck area and the cat would purr with happiness. The husband would cease this nasal rubbing and hair would likely regrow some months later. (VIDEO CLIP OF NOSE). A review in 4 weeks time.

CONCLUSION
This was a rare case of bumble foot but the cat had other health problems like anal sacculities and management issues like spiked mat injury.

It was great that the other problems were discovered during this bright Sunday morning and the cat would live a happier pain free life after treatment of the pododermatitis with drainage, antibiotics and pain-killers.

The outcome of treatment should be good as the couple had not delayed seeking veterinary treatment. Delays would have led to tendon and bone infections of the hock resulting in poor prognosis. 


CASE NO. 4. A LABRADOR RETRIEVER HAS OPEN PYOMETRA
Infection of the womb in the older female dog is a common condition in Singapore. The owners came to Toa Payoh Vets as the first vet had prescribed antibiotics but the dog was still passing sticky brown red vaginal discharge during the past 2 days. IV drips and antibiotics were given. The dog was spayed the next day. Image of pyometra uterus. Follow up on Day 3.  VIDEO BEFORE AND AFTER SURGERY.    

1074. Travel Images - Spain - dogs - tail docking

A tail-docked Doberman Pinscher, Sergovia, Spain

Tourists love taking pics of Dalmatian in the Royal Palace, Madrid, Spain

Play ball retrieving, German Shepherd, Toledo, Spain

A Westie in Sergovia, Spain

1073. Travel images - Portugual and Spain

Toledo - Posing travellers do not wait too long. One shot.
Should have excluded tower on left. Original image. Zoom 55mm - 250mm
"P" Mode. Autofocus, Auto ISO. 

Image has been rotated 1 degree CCW, cropped and photoshopped as seen below

Always sharpen your image, using "Unsharp Mask"

1072. Travel images - good composition of two people being photographed

Sometimes, a fellow tourist can give good tips on posing for a good photograph.
The Portugese tour guide in Lisbon is used to being asked for photographs.
"Sometimes, my left eye will see left while my right eye will see right," she said as she posed for several tourists.
It is good to have a sense of humour. My tour manager is high energy as she stretches her left hand and smiled

   Selfie by the younger lady with fellow tourist in winery
I was opposite. Used zooms lens. "P" Mode, Autofocus, Auto ISO and high speed continuous clicking

Oct 7, 2014
Holiday Inn, Madrid
Watched NHK World on a programme about a company being entrusted with items for safe keeping. It takes photos of items inside the box. A big white sheet is clamped on a stand and the item is photographed against a white background. Tripod. The items are posted online in this portal to be shown to others in the "fun" community. Probably same category and an auction of items for sale.   

Travel images - Spain and Portugal using Canon EOS 55-250mm lens

A dog is a man's best friend. No complaint about over-time work in downtown Portugual at 9 pm .
Zoom lens 55-250 mm, "P" Mode. Fast clicking as the basker packed up.

This zoom lens produces quite sharp portraits if there is good sunlight.

10 am sunlight brings out sharp images. Need to click fast as eyes may close.

In downtown Lisbon.
A waiter is happy to pose for me, sitting from my chair, in low evening light,
using zoom lens 55-250mm
and the usual "P" Mode. No waste of time. Click the three adverts on his T-shirt. Focus on eyes.

Moving coach. Zoom lens focus on "castle".  "P" Mode and high speed continuous clicking. 

A "gypsy" sells stalks of flowers to 2 male tourists in Spain.
If you accept her offer, she will read your palm and asks you for money. As much as 20 euros. You can give her one or two euros, the local guide said to me or walk away. My tour leader warns not to accept any offer or communicate with "gypsies" who are also present in other parts of Europe.  Notice foreground, a tourist is clicking the tool used in "Flamenco" step dancing.

A Canon EOS 55-250mm lens and a Canon EOS 70D camera are used. Photoshopped images compared to original ones. 

"P" Mode, Autofocus, AutoISO, high speed continuous shooting -- produce above images.
No need to miss shoots due to the need for setting aperture and shutter