1122. An old Miniature Schnauzer has a tail lump. What to do?

Feb 22, 2015. 4th day of Chinese New Year.

A tail lump in an old Miniature Schnauzer - what to do?

When faced with a skin lump, veterinary opinions differ. Some vets will advise "wait and see", prescribing some antibiotics. I will advise excision as it may or may not be cancerous. It will be up to the owner to make the final decision.

The vet should NOT advise "wait and see". Give the owner the option to excise or not to do it as the lump may be pre-cancerous or cancerous.

In this case, the old dog had a circular skin lump 8 mm x 8 mm x 3 mm. It looked very much like a ringworm. Dr Daniel said it could possibly by a result of licking or biting as the old dog had anal sacculitis, with thick brown oil expressed by me earlier.

I advise the owner to get the lump taken out by excision with a 1-cm resection margin ideally. A 1-cm skin margin would permit any present cancerous cells, if any, be removed, leaving little chance of recurrence.

This was not possible as there was insufficient skin and the tail would have to be taken out. The owner wanted to keep the tail stump. She gave informed consent to excise the lump without the margin. Histology was approved.

Dr Daniel operated. The lump was not cancerous based on histology. Dr Daniel's opinion was that this could be due to the dog's anal sacculitis itchiness and licking and that the lump could be inflammatory.

In an old dog, it is best NOT to wait and see. If the dog's lump is cancerous or turn cancerous later, there will be no good words for the vet's competence from family members.      

In this case, the skin lump was not cancerous. Everybody is happy. This could be a case of tail gland tumour based on its location. I had seen one in a Siberian Husky some years ago.

1121. Born free

Feb 21, 2015
6.30 am exercise


Feb 21, 2015. 6.30 am
3rd day of Chinese New Year

I exercised in a public fitness area
The Bar Bender burned my upper arm muscles as I bent the two bars inwards and counted 1, 2, 3
Could do 10 now.
The Standing Push ups - could do 20
The Abdominal muscle bender - could do 100
The cycling machine - too creaky and noisy. would upset residents and so I did less cycling.
Daily workout, one at 6 am and one in the evening
Better than going to the air-conditioned gym once a while.
Self discipline needed. Fresh air.

Can see dawn breaking. Black sky to dark blue to light blue.
Today, a bird high up in the tree "tweet, tweet, tweet..." 10 times for some time. Born free. Shorter life.
Like some men. Addicted to coffee and late night online gaming to 4 am. Every night if possible.
Unable to wake up. A mean-looking grumpy face at the office.
Can never function normally or be kind to any one when deprived of coffee in the morning.

A bird in the nearby terraced house sang a melody every time. Caged. No freedom. Safety. But no worries of predators or hunger.
Like some women. Cannot survive without air-conditioning.
Unable to appreciate the wild flowers and flitting butterflies in the hot and humid countryside
Admonition on travel to undeveloped areas with no electricity and with no air conditioning     



 

1199. Three Chinese New Year inpatients.

Chinese New Year, Feb 20, 2015 is a cloudy day.

There will definitely be no cases as the owners celebrate.

I came to check on the Jack Russell that had recovered from vomiting and diarrhoea, the terrapin that swam sideways and the kitten that had diarrhoea for over a week.

1. The terrapin had been here for 2 days. Had lost 2 grams but is more active and no longer gasping as evident by the rapid throat movements of rapid panting. I noted the shell has had become greener instead of yellow green 2 days ago. He had not put on much weight as his two siblings, all originated from Florida, USA and sold by Pet Lovers' Centre. This batch looked good when I saw them some weeks ago at the pet shop. Now, the owner had a hideout which is a dome-shaped porcelain. Only 2 terrapins could hide inside as there is insufficient space now. Probably they bullied this 3rd one who is yellowish green in shell colour while the other two are dark green (see video).

Today, I tested this patient. He could swim with less frequency of right sided tilting after 2 days of inpatient treatment. He was exposed to sunlight as he never had ultraviolet light at home. The owner did phone yesterday but it takes time to recover from respiratory disease.

2. The Jack Russell had recovered from vomiting and diarrhoea some 2 days ago. The owner is very busy going all round Singapore to fix fibre-optic problems. He appeared on his bike at around 11.30 am and I saw him while I was monitoring this terrapin outside. He loves this Jack Russell and I offered to send the dog and him home in my car since he was riding his motorbike. He said he would drive his car here tomorrow. After much persuasion, he took the dog home on his motorbike (video). Some people work very hard for a living and I could see his weariness and bloodshot eyes. For the long hours he put in, he had no time to relax, let alone pick up his dog. Anyway, the dog went home today, on his bike.

4. The diarrhoeic kitten was still lethargy but still alive. Had drank water but did not want to eat. Handfeeding is done although he rejected after a few mouthfuls. Multivit, water and antibiotics are given.

Follow Up: A 7-year-old Shih Tzu 2 months post surgery to remove bladder stones. (Video)

Today, the Shih Tzu came in as he was limping from his left fore foot. A stitch still remains from his bladder surgery done on Dec 20, 2014 and I removed it.

This dog had blood in the urine in 2012 but the owner did not want surgery. The dog started vomiting once a month. X-ray showed numerous struvite stones inside the bladder and os penis. 

Now today, Feb 17, 2015, the dog is perfectly normal. Only home-cooked food.

Follow Up: A 7-year-old Shih Tzu 2 months post surgery to remove bladder stones. (Video)

Today, the Shih Tzu came in as he was limping from his left fore foot. A stitch still remains from his bladder surgery done on Dec 20, 2014 and I removed it.

This dog had blood in the urine in 2012 but the owner did not want surgery. The dog started vomiting once a month. X-ray showed numerous struvite stones inside the bladder and os penis. 

Now today, Feb 17, 2015, the dog is perfectly normal. Only home-cooked food.

Feb 2015 Video interview 2 months after urinary stone removal by Dr Daniel Sing
http://youtu.be/YYH6wQctLWk

1196. An apartment cat's lifestyle -obsturction of LI or torsion as seen on X rays?

Today, Feb  17, 2015, 2 days before Chinese New Year, I phoned the owner of this 6-year-old female spayed cat that was warded for vomiting frothy yellow stuff and passing watery reddish brown stools on 3 days earlier. The cat lived on the 2nd floor and would go outdoors every day for around 15 minutes. This was her routine but on Feb 5, 2015, her owner had to bring her for treatment of acute gastroenteritis.

"She has recovered  fully," the lady said. "What is the cause of her vomiting and diarrhoea? Dr Daniel did not give me the reasons."

"It is not easy to pinpoint the exact cause," I said. "The blood test was normal. The stools analysed did not show ova, cysts parasites, leucocytes and erythrocytes. The urine had some bacteria and blood.

"X-rays cannot show the cause. But I suspect large intestine obstruction as evident by the transverse colon showing lots of gas. Dr Daniel thinks it may be a torsion."

I had given the dog IV drip, baytril and spasmogesic SC and warded her overnight from Feb 4 to Feb 5, 2015.  Today, I phoned the owner and received the good news that the cat had recovered within 2-3 days of going home.

As to the cause of the gastro-eneritis, it would be related to the outdoor lifestyle of this cat. Perhaps she had eaten something poisonous or had cleaned her chemical contaminated paws. "Now she is kept at home and she is not happy," the lady told me that the cat would want ro go out whenever she opened the door.

"Best to keep her inside the apartment," I advised.  

1195. Sunday's interesting case - The dwarf hamster has an everted pouch

Unbelievable vet stories: Three couplets of Golden Retrievers with connected links

Sunday Feb 15, 2015

Some of my cases come in twos within a short period of time?

In the first couplet, two 13-year-old  Golden Retrievers passing dark red vaginal discharge in December 2014 and January 2015. Both suffered from  the same diseases called open pyometra.

Then yesterday, a second incident of timing occurred. Two Golden Retrievers came in one after another, one with lameness and the other with gigantic swollen anal sac areas.  Being uncommon in urbanized Singapore where over 90% of the residents live in apartments, meaning that big breeds like Golden Retrievers are rare, I was surprised to see 2 goldies as my first 2 cases.

In addition, there are around 70 small animal practices and so this makes the chances of seeing 2 goldies in a row much less.

In the 3rd instance of couplets, it was as if some Divine powers gave me an opportunity to take images for my comparative anatomy of anal sacculities. The Golden Retriever in the 2nd incident has two bulbous anal sac areas - a very rare situation which I am sure most small animal vets would not have encountered came in. It was like finding treasure in medical research. I took images and a video to document this situation.

I was wondering how I could compare this dual swelling with another Golden Retriever with anal sac impaction but not with such a gigantic swelling. The next day, a Golden Retriever came in came in with anal and tail end skin inflammation.

This was a case of anal sac impaction as the smelly brown oil expressed by me from the anal sacs shot out with a buzzing sound. This presence of oil astounded the owner and splattered onto my white polo shirt sleeve. I had used tissue papers to cover up the anal area before expression of the sacs but still, the volume of dark brown thick smelly oil was copious and explosive. This Golden Retriever permitted me to take an image of anal sac impaction without the gigantic swelling as in the other Golden Retriever in the second occurrence of couplets.

These are true but unbelievable vet stories of Golden Retrievers cases in Toa Payoh Vets. I have the images and the videos to substantiate my findings.

Two Golden Retrievers in a row

Friday, Feb 13, 2015

This morning, I had two Golden Retriever patients one after another. This is rare for me as Golden Retrievers are rare in Singapore, with the vast majority of dogs, about 99% being small breeds.

GOLDEN RETRIEVER NO. 1
The backside had two large swellings below and on the sides of the anus. "They appeared overnight," the owner said. "These are anal sac impaction with pus," I expressed yellow pus out from one side. "This case needs a finger to be inserted into the anus to expel the anal sac oil and pus. The dog needed to be sedated."

Dr Daniel expressed the pus digitally and the swellings shrunk. "No more anal sac oil," he said to me. "Flabby swellings now!" 

"It is best to incise at the lowest point to release any remnants of the pus and dead cells," I said.

Dr Daniel excised 1 cm at the ventral area of both swellings. Blood oozed out for several minutes.
"Let the contents flow out," I said. Later, Dr Daniel would stitch up the two incisions and the dog went home.


GOLDEN RETRIEVER NO. 2
"He is lame again on the back leg. I think it is the left one. Or is it the right?"
I had the dog trotted outside the clinic. His right hind leg was up while his left hind leg was down as he was trotted by the maid who did not wear slippers.
"Looks like he is not bearing weight on his right hind," I said. "The only way to tell is to flex and extend the joints on the consultation table. The dog refused to trot anymore.


My medical records showed the dog had a spinal pain at one time and a left medial thigh swelling and pain at another time.

Now he had spinal pain and very painful left hip. "He wrinkled his muzzle and that is a warning that he would bite." I flexed and extended his left hip twice. The dog did wrinkled his muzzle and turned to face me. So the dog was in pain.

"He would go under the sofa every day," the owner said. Such a big breed would injure his back and sprain his hips on getting out.  The sofa had a hollow just sufficient to squeeze in this dog.

"The solution is in your hands," I said. to the owner. "Close the gap or get worse hip pain next time!"

The second 13-year-old Golden Retriever with open pyometra

I had 2 Golden Retrievers with open pyometra recently. Both were very thin and in poor health, but the second dog was panting a lot for the duration of more than 15 minutes of consultation.

"She's frightened at the vet," the man said. "That is why she panted a lot."

"It is unusual for a dog to have such a fast respiratory rate, as if she had sprinted ," I said. "Such panting is a sign of very poor health.  Her heart is failing. There is also the blackish-red vaginal discharge. She has open pyometra and should be operated the next day, after one day of IV drip and antibiotics."

"She is too old for anaesthesia," the man did not want any surgery and I prescribed some antibiotics for the dog. "Feed her 6 times per day to let her regain her weight."

But the dog shut her mouth tightly and it was extremely difficult to hand feed her. The vaginal discharge came out every day for the next 7 days and the owner texted me. "The solution is to remove the bleeding womb," I texted back. "But she is unfit for anaesthesia and would likely die on the op table."

The dog was not panting so fast but she would not want to eat. Her vaginal discharge came out thick and dark red, soiling the floor. The owner decided to get her operated. I told them that the chances of survival are slim as she had heart disease causing the continuous panting. She also would not want to eat.

The dog kept passing vaginal blood. The couple decided on the operation. The dog was inpatient for 2 nights and given SC and IV drip for 2 days. "Her pulse was not palpable," I told the owner. "That means she has very low blood pressure and should not be operated. Her gums are purplish and so there was some difficulty in getting oxygenated blood into the gums. Are you sure you wanted the operation?" He gave his informed consent by texting me.

The dog was operated using just isoflurane gas. The uterus had a big sac around 20 cm x 10 cm of darkish red blood. This reservoir released the dark red blood every day out of the vagina.

The surgery was done by Dr Daniel who had warned that the dog was unfit for anaesthesia. "The owner had given his informed consent," I said.  I texted the owner that she had been operated but was panting a lot after surgery and sent him an image of the uterus with the cysts and the sac of dark red blood. Around one hour later, the dog panted much fasted and suddenly the dog passed away. There was heart failure. I informed the owner.

The parents and two daughters aged 10 years and 4 years came promptly. The 10-year-old felt the loss badly but the 4-year-old still could not understand that death was a permanent loss. "This dog is very old," I said to the 10-year-old. "Around 91 years in human age. She had lived a long life much loved by all in the family. Most Golden Retrievers don't live up to such an old age.. Many men alos die before they reach 70 years, not 91 years."  

"Would it make any difference if she was operated on the first consultation?" the man asked me. "I don't know," I said. "She was already having heavy panting then."

"I doubt it would make any difference if my dog was operated earlier on the first consultation," he replied. "But the solution to this heavy vaginal bleeding and reluctance to eat was surgery and I told my wife." 

If the dog survived the surgery, like the other 13-year-old Golden Retriever, she would live longer although she would need heart disease medication..  

In conclusion, this dog was likely to live longer if she had been spayed at one year of age. There would be no pyometra leading to dirty continuous vaginal discharge. There was also a swelling of the left posterior two mammary glands, possibly a sign of breast tumours. Early spaying might have prevented such tumours from developing.