3224. Gigantic breast tumour with stalk

Dec 26, 2017
The young man's Silkie terrier I see today had a gigantic tumour with a stalk. This is the 2nd case I encounter and is rare in the sense that most  breast tumours in the dog are non-sessile and take a longer time to excise.


2017 CASE

 Owner wanted to bring the dog home after operation. Large skin wound. Asked him to wait till next day and get a cage to confine dog.

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2007 CASE
The first case I saw and operated in 2007 is taken from my Toa Payoh Vets website and shown below:

A bloodless surgery A DOG WITH A LARGE MAMMARY TUMOUR HANGING LOOSEDr Sing Kong Yuen, BVMS (Glasgow), MRCVS

E-MAIL TO DR SING DATED 4 DEC 2007 ----- Original Message ---- From: ...@yahoo.com> To: Dr Sing KY Sent: Tuesday, 4 December 2007 12:50:40 Subject: Re: Please help the dog Hi Dr. Sing, I am Ms Ng. So did you manage to talk to the dog's owner? How is it? Did she agree to let the dog does the op? If yes, please let me know the time can? Thanks. Regards, Ms Ng (Volunteer) Singapore Tzu Chi Foundation Tzu Chi volunteers brought the dog to Toa Payoh Vets for first consultation. Dog was sent home on antibiotics. Surgery was scheduled in 10 days' time E-MAIL REPLY FROM DR SING DATED 4 DEC 4, 2007 No telephone call from the owner although his friend who was present at the Surgery would have informed him of the high anaesthetic risk of surgery. I did not phone the owner to talk to him because he will only think of one thing: The vet (me) is a salesman trying to sell his services. Therefore I don't phone owners as they feel pressured to make a decision. If the tumour is not removed, the dog is likely to die a slow painful death due to bacterial infection of the big tumour and the bacterial toxins inside this huge tumour affecting his heart over some weeks. If surgery is performed, the 8-year-old dog may die on the operation table. The ill will created by a dog's death invariably harms a vet's reputation built up with great difficulty over the years. In my experience, when there is a death of a pet, the owner or his family and friends in Singapore usually blame only one person - the veterinary surgeon. They bad-mouth the vet for all who care to listen. Seldom do they blame themselves for the belated treatment. Some write malicious false allegations to the veterinary authorities to solicit and get an investigation. Some get lawyers to sue. Personally, I had never seen or talked to the dog owner in person. I assess that the 8-year-old dog with mammary carcinoma bigger than the feet of an adult man has less than 50% chance of not dying under general anaesthesia. Hence, I do not tel the owner to get the surgery done. This is a matter for the owner to decide as there is a very great anaesthetic risk of the 8-year-old dog dying on the operation table. Singapore does not have a charitable animal foundation like the PDSA (People's Dispensary for Small Animals) in the UK. In the PDSA, low-income dog owners can get their dogs treated at low fees. I distinctly remember the PDSA for one reason --- a Jaguar. No, they were not treating the big wild cat! I was seeing practice with an Englishman, a private vet. He offered his services once a fortnight as a volunteer. He drove me to the PDSA. I was a fourth-year vet student. That was in 1973. A big Jaguar car drove up to the PDSA clinic. The driver brought in a dog for treatment. The English vet told me that the PDSA was meant for disadvantaged families. Maybe your foundation may look into starting a similar project like the PDSA. If this 8-year-old dog had been spayed and her mammary tumour removed earlier, she would be living a better quality and pain-free life now. Best wishes Friday, January 25, 2008 after the follow-ups by Ms Ng from Tzu Chi Foundation, Singapore "Since the dog may die on the operating table, put the dog to sleep," the dog owner wiped tears from his face. Men usually don't cry at the veterinary surgery.  I had told him that the dog had less than 50% of surviving the anaesthesia and he felt it was better put to sleep with lethal injection rather than being operated on the table.  The dog had not been eating for the past few days after the first consultation. The dog had been given antibiotics and the owner had not phoned me to schedule the surgery some 10 days later. The surgery and transportation of the dog would be paid by the Tzu Chi Foundation. No financial burden for the family if the dog got her gigantic breast tumour removed by the vet. Yet there was just absolute silence from the family. The Singapore Tzu Chi Foundation Medical Secretary, Ms Ng had e-mailed to ask whether I had followed up on the case after the first consultation. She was the one who contacted me initially about this dog too. I told Ms Ng that the family had to decide themselves. I could not solicit the family. In the interest of the dog, I ought to. So, no response from the owner since I did not sell myself, I mean my services. Not a good businessman.  Ms Ng and her volunteers numbering more than 10 had helped to bring the dog to the surgery during the first consultation. She and her volunteers contacted the owner. The dog came in for surgery in a worse condition than during the first visit. Tzu Chi volunteers send the dog to Toa Payoh Vets for surgery The dog could barely stand up. "Are you sure that your over 70-year-old mother had agreed to euthanasia?" I asked the representative. This dog was close to his mum and there was no way I could verify that all family members consented since the mum was not present at the Surgery. On arrival, the dog was barely able to stand outside the Toa Payoh Vets "I represent the wishes of my family," the man in his fifties was decisive but his body was trembling. He wiped tears streaming down his face. The Tzu Chi Foundation volunteers were shocked at his decision. Though there was a high anaesthetic risk of dying on the operating table, there was a probability that the dog might survive. By electing for euthanasia by lethal injection straight away, this dog had zero chance of survival. As to why the decision to elect for death by lethal injection was made, I cannot understand to this day. Maybe it was economics.  One Tzu Chi volunteer, Ms Seow, a lady in her late thirties and working for an advertising agency sat beside the dog owner in the consultation room. She talked to him quietly for some time. She convinced me to go ahead to operate.  The representative signed the surgery consent form. This form informed the owner that he knew of the anaesthetic risks. This was a standard surgery form used in all hospitals to confirm in writing that the person had been aware of the risks. The clinical outcome of this case would be so poor that I would rather not risk my professional reputation to operate on this dog. But the Tzu Chi volunteers were now waiting. A death of a dog spreads like wildfire to all family members and friends and all Tzu Chi Foundation members. Why take risk of ruining my hard-earned reputation over the years? There was no turning back. To operate or not? I gave the 500 ml of 9% dog dextrose saline and amino acid drip overnight.  It was so difficult for the volunteers to get the dog for surgery. So, no delay is best for the dog.  I operated the next day. I dissected the skin carefully. Don't just snip off the tumour at the stalk as this will be the normal approach in a case of a very small skin tumour. There was a monstrous blood vessel bringing in nutrients to grow the tumour and this was ligated twice. The operating field was bloodless as if all blood vessels had been commandeered by the tumour warlord to nourish him only. Not a drip of bleeding in the big cut of the skin. Incredible. Usually there is lots of bleeding from the subcutaneous blood vessels.   The dog survived the anaesthesia which was just gas. No tranquiliser. Just straight gas.  A monstrous artery and vein in a sheath of over 3 cm in diameter is present at the stalk of the tumour at (X). They  supply nutrients to the breast tumour, enabling it to grow to such a large size. Be careful. Dissect the skin, undermine the skin with scissors. Identify, isolate and ligate the big blood vessel. Then cut off the tumour. No bleeding in this approach.  Not one drop of blood oozes in such a big skin wound during and after removal of the tumour. As if the tumour has had requisitioned 99% of the blood supply from the surrounding tissues. Or was it the power of the collective prayers of the Tzu Chi volunteers to ensure a safe surgery?  "Our volunteers prayed hard last night that the dog would live." Ms Seow told me later. Do prayers work?  Do you believe in miracles? Killing a life is never an option with the Buddhist volunteers. If there is a chance of survival, take the chance. Some 20 volunteers came to the Surgery to transport the dog back and forth and to see him. These volunteers were not paid by the Foundation. Their intervention save a dog from death by lethal injection or a horrible painful death from the infected breast tumour. Some 6 weeks passed. Did the dog survive after the surgery? I had not phone the owner. What if the dog had died after the surgery?  If the dog survived, she could live for a few more years keeping the aged grandmother company every day. Ms Ng reminded me that I had not billed the Foundation for the services. This Foundation is good at accounting and pays for services rendered promptly even to the extent of reminding the tardy veterinarian to send the invoice.    Did the dog survive? Is she fatter? I asked Ms Ng in the reminder e-mail. Ms Ng wrote: Jan 26, 2008 Hi Dr. Sing, I heard from those who paid visit to see the dog and the owner. The dog looks good and better now. Thanks for your concern. 黄燕芯 慈济新加坡分会 电话：65829958 分机：204 This incredible story is hard to believe. No bleeding during surgery. No death. The old dog just woke up after surgery and was able to walk normally. Freed at last from a 2.2 kg encumbrance. She wagged her tail and looked much younger when I put her on the table to take a picture. This was the first time she had wagged her tail. As if she was so glad to be free of a heavy burden. Was it her destiny to survive? When the vet thinks the dog that is emaciated, weak and has been sick for a long time has little chance of survival on the operating table, the dog proves the vet wrong. When the vet thinks the dog has no problem under anaesthesia and surgery is a piece of cake, the dog  dies on the operating table. If one believes in fate and prayers, this dog was destined to live. However, without the care and follow-ups of the numerous Tzu Chi Foundation volunteers, this dog had little chance of survival. Bacterial infection and sepsis would have killed her in the next 1-2 years as the ulcerated tumour starts rotting spreading toxins into her liver and kidneys.   DRAFT REPORTS AT DR SING'S BLOG 110. An 8-year-old dog's destiny 124. The dog that the Singapore Tzu Chi Foundation volunteers saved from lethal injection. Follow up to Case 110.

3223. A 1-year-old ragamuffin scavenges and ate chicken offals - diarrhoea for 2 days.

Dec 25, 2017
Christmas Day.

I was surprised to see a young lady with a ragamuffin that had diarrhoea for the past 2 days.
Abdominal palpation showed that the cat had abdominal pain. It was Christmas Eve yesterday and the lady had bought chicken to celebrate. Locals rarely eat turkey for this occasion.

The cat had upturned the garbage bin and ate some chicken liver or gizzard. "No chicken bones," the lady said.

"She also sat in a corner by himself," the young lady showed me the mobile phone image of the cat in an unsual position with the back laid on the corner of the wall and the belly upwards yesterday. "Was she in pain?"

"Possibly, " said. "Did she hide in a corner or under the table or bed?" I asked.
"Yes," she replied.

The cat was given the IV drip and pain-killers and one day of in-patient observation.

3221. Images of adverts/artwork in Singapore malls - Raffles City on Saturday 16, December 2017

Raffles City

3rd image is of advert of products of Reese Witherspoon who has started her own beauty and fashion business in addition to being a very successful actress


ART

PEOPLE

HEADWARE. Very few shops sell headwear in Singapore

3220. Images of birds

This mynah was on the grass with the financial district crowd in City Hall subway area. I used zoon lens. He was looking my way. The photo is cropped and photoshopped. 

3219. Images of flowers seen during my Japanese travel in Fukuoka in Oct 2017

3218. Itchy inflamed lower body skin in 2 dwarf hamsters

Early veterinary treatment prevents skin from degenerating into wet yellowish pus with bad smell.

3217. Toxic relationships are hard to severe

Dec 20, 2017

It is easy for me to advise a friend to severe toxic relationships.

The divorcee and single mother may wish to revive the toxic relationship although the man had told her bluntly and honestly that he preferred the other woman and has children by her.  She wanted a husband as she was past 45. She met this man in an online dating website.

Yet this man still kept messaging her after telling her she was not his priority in a long-term relationship. He had someone and had teenaged children to take care.

I advised letting go. She did not block his messages. Then she phoned him. He did not pick up the phone but texted to her that he is with the other woman. This text finally convinced her that there was no point in continuing this toxic relationship anymore.

I sent her the image below and hope she would let go.

3216. The poodle swallowed half a box of Difflam throat lozenges

Dec 18, 2017

"My dog just could not get up when called," the lady was worried that her dog was sick as he had loose stools after being fed a dog bone treat. "He just would not move yesterday. But now, at your clinic, he is active."

"He could have eaten other things like human medication," I asked.
"Yes, yes, he had swallowed half a box of Difflam lozenges which we use to relieve our sore throats," she said.

Difflam contains benzydamine hydrochloride. It has an anaesthetic, anti-inflammatory and analgesic effect in people. However, in dogs, it is a sedative and that explained why the dog could not get up when called.





Blood test showed slight liver impairment in that the ALT enzymes were higher than normal. The dog had IV drip and was OK the next day. The liver should recover.

3215. A 17-year-old cat is still much loved by this man

Dec 19, 2017

"My cat had hunted 5 rats," the gentleman in his 50s came to buy eye drops. "Now he is blind, but I can see his pupils". I asked him to take some images of the eye for me to see tomorrow.

"Stray cats are getting extinct," I told him.
"In my 3 blocks in Toa Payoh, there are only 2 cats out of 25 left," he said."The government had got rid of them and the rats are now increasing in numbers, as in the Bukit Batok hill. 5 pest control firms were paid $2 million to get rid of the rat nests in Bukit Batok!"

3214. A 13-year-old cat is still going strong

Dec 19, 2017

TP 44197
http://www.bekindtopets.com/stories/20130301cat_bladder_stones_toapayohvets.htm


This domestic short-haired male, neutered cat, born  2005 is now 13 years old. The owner loves him very much but has scarcely any time for himself, being in the software development industry.

In Feb 2013, he brought the cat to Vet 1 who advised "wait and see.". Vet 2 said she does not perform bladder stone surgery. His friend, a young vet working in Biopolis referred him to me.

A calcium oxalate & magnesium bladder stone was removed by me.  The cat survived the surgery and the busy owner did not come to see me.

"I come to buy feline k/D because I am in the Toa Payoh area," he usually go nearest vet to buy the feline prescription diet C/D. There are over 80 vet clinics and he should have a big supply.
 
"How is your enterprise now? Has it gone into IPO (Initial Public Offering?)," I asked him today.
"No, not yet," he came to buy feline K/D.

In Nov 17, 2017, he consulted me. His cat was overweight, ate and drank a lot. Blood test showed high creatinine of 200 (71-160) while blood urea was normal at 9.1 (7.2 to 10.8).

He did not want X-rays to check for kidney stones nor urinalysis. No yearly urine check up.  So this history taking will be most important.

3213. A 5-year-old cat has difficulty in urination for the 2nd time. Scattering sand onto rooms. TP 15006

Dec 19, 2017

TP 15006 as reference number indicated a very old client of some 30 years.
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I phoned the owner today. His cat, Tiger, male neutered, 5 years old had difficulty passing urine for the 2nd time. The first time was 3 months ago.
"Is he the only cat?" I asked the retiree father who brought the cat down.
"Yes."
"Is there a change of cat food or litter?" I asked.
"My son purchased the pelleted litter 1 week ago," the father said. "My cat keeps soiling the apartment rooms with sand litter from his paws and body. So, my son changed from sand to pelleted litter one week ago."

 "Changes may cause FUS (Feline Urological Syndrome) in male neutered cats being fed dry food," I explained. "The cat drinks less and had difficulty passing urine or passes small drops, soiling the sand."

No bladder swelling or inflammation of the penile area. No fever. This is likely a case of FUS and treatment is by removing the stress and painful urination medication.  I had a blood test done. Low platelet count was the finding as it was 261 (normal 300-800).

Today is 5 days later. I phoned.
"My cat is Ok," he said. "Eating and active!"
"Any urination difficulty?"
"No more on the 2nd day," he said.

As this is the 2nd time of urination difficulty, I advised feeding Hill's feline C/D diet which usually prevents FUS in most of such cases I had treated. He mixed a small portion of the C/D first and gradually increase. I don't expect to see this cat with FUS anymore.

The cat's paws must have been stuck with wet sand as he goes to the sand litter box to urinate many times with great difficulty and in small amounts. He walked into rooms, soiling the floor. So, the owner decided to replace sand with pelleted litter.

No need to return to the use of sand litter in this situation as the Tofu pelleted litter is satisfactory.

3212. Images. Advices on relationships

Dec 19, 2017

Toxic relationships. Some victims find it hard to let go and their emotions get manipulated and hurt. A card is created for them

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April 1, 2018
It takes 30 minutes to create this image, one second to read and forget.
Educational image for those who picks on small things in life - Don't sweat the small stuff!

3211. Images. Singapore apartments

3209. A 10-year-old Samoyed has occasional pain and "front limb" lameness

EXAMINATION FOR LAMENESS IN THE DOG
1. General examination - walk, trot, run
2. Detailed examination 
- palpation for limb swelling and manipulation of joints for pain.
    Extension, flexion, abduction, adduction
- manipulation of the spinal area for pain

Findings. Slight lameness on right hind limb, not bearing weight, tilt more to left hind limb when trotted (see video).  Slight pain on right hip joint and on thoracic-lumbar spinal area. 

3. X-raysNodules in the lungs suggestive of lung tumours
Osteophytes in right femoral necks suggestive of osteoarthritis

Wheezing - Heart is normal. Lung nodules and forced medication (sore throat)



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"Can you remember his brother?" the lady asked me.
"I cannot remember," I said as there are many Samoyed treated during the years.

However, this was a memorable case. The brother Samoyed died at 5 years of age from recurring fever one year after my successful treatment of high fever earlier.

The first fever was tick fever. It is possible that the recurrence of fever was due to tick fever again.
The first vet could not bring the fever down for the first few days. So the owner consulted me. I got the dog clipped bald and gave anti-fever injectons, IV drip and anti-tick medication and antibiotics. The fever  subsided and the dog was back to normal.


 The owner brought it to the nearby vet and later to me. The dog died despite treatment.