1289. Update: A hamburger tumour in a dog's mouth

TOA PAYOH VETS toapayohvets.com Date:   13 February, 2013   Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits Trust & Audit: A rare case of a hamburger tumour inside the mouth of an old dog  Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   13 February, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2013-0131 Blog 1286. Good dental hygiene is very important for people and dogs as some oral tumours form when the mouth is not clean. Yearly dental check ups will be ideal. In February 2013, I encountered a case of a dog with bleeding in the mouth and face. "Oro-nasal fistula also known as malar abscess or carnaissal abscess," I said to the two interns very confidently as this was a common problem in old dogs that seldom if ever was sent for dental check ups or scaling. I was 50% correct. There was a large oral tumour shaped like an oval elongated tumour! Veterinary medicine throws surprising oral tumours to me even after 40 years of practice! The dog was eating food under this tumour which expanded to fit the length and width and height of the oral cavity. The length of this tumour was estimated to be 10.5 cm long. I doubt I will ever see another case similar to this. Dr Daniel operated to remove this "hamburger" tumour using electro-surgery. I was present for a few seconds during surgery as this was his case and I had confidence he would be able to perform this surgery. "There was a lot of bleeding," he told me when I audited this case on Feb 12, 2013 (yesterday) and phoned the owner as well. He packed the back of the mouth with gauze swabs to prevent inhalation of blood into the lungs. Around 90% of the length of the tumour was excised electrically and then the remnants.  He electro-coagulated the bleeders in the remnants so that there would be no more bleeding.  Electro-cautery was effective in preventing bleeding.   The 50% calculated dosage of domitor and ketamine IV anaesthesia was just sufficient for surgery, with top up of isoflurane gas via the mask. This formula is now used by the vets for IV anaesthesia. It took some time to convince vets that this is a safe and effective formula as all vets have their own judgments and preferences of using various anaesthetics. Stocking a variety of anaesthetics is very costly as they expire and so I don't permit associate vets to order their favourite or their vet professors' choice. A veterinary surgery must be able to sustain its profitability and most associate vets don't bother with this aspect as they are not accountable for the bottom line.     Histology confirmed it is non-cancerous. It is known as a ossifying fibroma, originating from the soft palate according to the operating vet. There was also oro-nasal fistula which I diagnosed on first visual inspection and the rotten teeth black teeth as you can see from the image, were also extracted.  Blood test had not shown any abnormal findings and so this dog was fit for anaesthesia and survived without any problems.  In this case, the profuse bleeding from the excised tumour could be inhaled into the lungs and cause death by asphyxiation if electro-cautery had not been used to seal all bleeders successfully. From my phone call, the gentleman owner of this dog is most happy. As far as the dog owner is concerned, his old Chihuahua is OK and eating and that surgical outcome is what matters in the final analysis. "How long has this tumour exist?" I asked him. "I don't know as I don't look inside the mouth," he said. This is a very rare case of a "hamburger" oral tumour. Yearly dental check up of your dog over 3 years of age with your vet will prevent most oral tumours and rotten loose teeth. MY COMMENTS ON MANAGEMENT OF THIS CASE: 1.  Electro-surgery was the correct choice. 2.  IV anaesthesia with top up IV would be the choice in this case as isoflurane gas use by mask was not practical. However, the IV anaesthesia at 50% had lasted a sufficient amount of time to complete 90% of the surgery and isoflurane gas top up was effective in this case. IV anaesthesia top up, the drugs would be injected with the IV drip or the syringe with the drugs would be attached to the IV catheter.   This webpage: http://www.bekindtopets.com/dogs/20130214ossifying_fibroma_oral_dog_toapayohvets.htm Toa Payoh Vets Clinical Research

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All rights reserved. Revised: February 13, 2013
Toa Payoh Vets

1288. Follow up oro-nasal fistula 6 years later

TOA PAYOH VETS toapayohvets.com Date: 13 February, 2013 Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits A Facial Wound does not heal: Oro-nasal fistula follow up 6 years later Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Case written: November 15, 2007 Update: 13 February, 2013 toapayohvets.com Be Kind To Pets Veterinary Education Project 2013-0131 "Why didn't you come for the surgery?" I admonished the lady owner of the Pomeranian. "You wasted more money buying more antibiotic powder from the pet shop to dust onto the facial wound, hoping it would heal. "For ordinary skin wounds, the antibiotic powder would heal them, but I had already explained to you why the wound would never heal without dental extraction of the infected tooth." Her 4-year-old Pomeranian had a weeping wound of around 0.5 cm in diameter below the left eye, above the maxillary 4th premolar tooth. It did not heal over the past weeks despite various medications and powders she had sprinkled on. Some 14 days ago, I had patiently explained to her by illustration how the infection from the root of the maxillary 4th premolar spread into the nose from the diseased gums to the skin below the eye. The bacteria from the decayed roots of this premolar had dissolved the nasal bone area and made a hole. This condition is called an oro-nasal fistula. Dental surgery to remove the infected premolar would resolve her Pomeranian's non-healing wound problem once and for all. "The vet did a slick sales presentation to make me spend money unnecessarily" the husband of the dog owner must have told her. "How can a rotten tooth inside the mouth cause a hole on the skin below the left eye. This doctor is nuts and is desperate to make money. Mouth and nose. So far apart. How can there be a connection?" Back to the present, I said, "Surgery was to be done 7 days ago after 7 days of antibiotics. But you did not turn up till today --- 14 days later!" The middle-aged lady shook her head. I forgot my bedside manners by scolding her. The customer is king. The general anaesthesia and tooth surgery was affordable for her as I had discounted my fees but that money could buy another sari from Niven Road's sari shop. I was annoyed because there was an optimal time to do extraction of the infected and decayed tooth. It was after 7 days of antibiotics and she had not kept her appointment nor cancelled it. She just did not turn up as there was less weeping of the wound due to antibiotics. However after the course of antibiotics, the bacteria in the infected teeth had resumed their attack and the facial wound became wet again. The lady pulled up her fine and most colourful sari and smiled sheepishly, "My husband wanted to use the money for the dog's anaesthesia and surgery to go to India for holiday lah!" Now that the dog is no longer on antibiotics, should I operate? There was no urgency in the sense that it was an emergency. But it would be in the best interest of this poor dog to be cured as soon as possible. The Pomeranian's teeth were not brushed at all as this is a common practice in Singapore. Initially bacteria attacking the food debris on the tooth gum line would die in 3-5 days to form a plaque on the tooth surface. As the dog's teeth were not brushed daily or at all, more plaque accumulated on the surface of the teeth. Soon they become tartar (calculus). The gum became infected, leading to gingivitis. The root of the 4th premolar tooth of the upper jaw became abscessed due to bacterial attack. Abscess tracked upwards towards the nose and side of the face. Soon a facial wound appears to form a connection (oro-nasal fistula) between the tooth and the skin, discharging pus daily. As the pus and fluid from the mouth is discharged daily, the wound can never heal as it is always infected. The decayed 4th premolar and lst molar became loose as their roots had been exposed as the diseased gum diseased shrivelled. The supporting structure of the teeth was weakened by the bacterial attack, leading to a loose tooth that would fall out in time to come. At this time, there was no choice but to extract these two loose teeth. Otherwise the Pomeranian would suffer from daily toothache as the owner's husband might thwart her from doing the right thing for her dog. I put the Pomeranian under general anaesthesia gas and got the offending teeth extracted and scaled the other good teeth to remove the tartar. "How can a rotten tooth inside the mouth cause a hole on the skin below the left eye? So far away. This doctor is nuts and is desperate to make money." the husband must have had advised his wife. "The money is better spent travelling." So, at first, she did not heed my advice to do extract the infected premolar No. 4. The facial wound just would not heal and it cost her time and money to apply medication with no good outcome The facial wound closed after a few days when I phoned the lady owner to follow up after extraction of the infected teeth. "You are a good vet," the lady surprised me with her compliment especially after my admonishment. She needed not clean the wound daily and her dog was more active and has a livelier demeanour. And what more joy could a lady have than to see her companion having a higher quality of life? BLOOD TEST & OTHER PROCEDURES. There was no pre-anaesthetic blood tests to assess the liver and kidney functions and blood cells of this younger Pomeranian. Veterinary costs would be additional $150. Most likely the poor Pomeranian would not receive any veterinary attention if an increase of $150 was added to the veterinary expenses. Therefore I did not require blood tests and had reduced costs in not prescribing pain-killers and pre-op i/v drip and antibiotics. Physical examination of the Pomeranian indicated that there was no cardiac problem and there should be no death from general anaesthesia. The dog's anaesthesia was uneventful. He went home on the same day and had no more facial wound below the eye as the cause was removed. UPDATE IN FEB 2013 I have not seen the Pomeranian since 2007. He was 4 years old then. In Feb 2013, the owners came with the Pomeranian wanting to board the dog for Chinese New Year. I took the following image of him with a face that has no more oro-nasal fistulas for the benefit of readers. This webpage: http://www.bekindtopets.com/dogs/20080825Pomeranian_Oronasal_Fistula_Singapore_ToaPayohVets.htm More interesting cases of dental problems in Singapore dogs: Toa Payoh Vets Clinical Research: Mouth problems in Singapore's dogs Toa Payoh Vets Clinical Research

1286. Trust & Audit Case Study: A rare case of a hamburger tumour inside the mouth of an old dog

Good dental hygiene is very important for people and dogs as some oral tumours form when the mouth is not clean. Yearly dental check ups will be ideal. In February 2013, I encountered a case of a dog with bleeding in the mouth and face.

"Oro-nasal fistula also known as malar abscess or carnaissal abscess," I said to the two interns very confidently as this was a common problem in old dogs that seldom if ever was sent for dental check ups or scaling.

I was 50% correct. There was a large oral tumour shaped like an oval elongated tumour! Veterinary medicine throws surprising oral tumours to me even after 40 years of practice! The dog was eating food under this tumour which expanded to fit the length and width and height of the oral cavity.  I doubt I will ever see another case similar to this.

1285. Update: Toe warts in dwarf hamsters will not disappear

1283. Follow up: The tough hamster goes home

Feb 12, 2013 
3rd day of Chinese New Year

The young lady and her friend came at 10.13 am to bring the hamster home.

"She's panting," she noted.

"Yes," I said. "She is not well as she had bacteria in her upper nose and upper lips for a long time. When did you see the black ear in the right ear? The cut off ear is inside this shoe box brought by you earlier. "
It is sometimes good to provide evidence of surgery.

"I saw the ear tumours about one month ago," the lady said. "My hamster keeps scratching them off,"

"Most likely her right paw had damaged the right half of the nose skin and bacteria went in. There is now a bad smell from her as the nose is still infected."

In dogs and cats, it would be easy to give antibiotic injections and IV drips. In dwarf hamsters, there is a small amount acceptable owing to the small body area.

"This hamster can still eat after surgery," I parted the litter and the young lady could see at least 20 small stool pellets. At home, the lady had to peel off the shells and hand fed her. But after surgery, this hamster could crack the sunflower seeds and ate. The proof of good appetite is in the passage of the faecal pellets.

The white hamster said to be less than one year old, panted more whe

n handled. Her eyes were now open instead of sealed up as I had put eye drops.

"Is she still dehydrated?" the lady asked. "Shall I still peel the seeds and hand feed her?"

"She seems to be less dehydrated as you can see that the skin does not stand up when I pull the neck skin. She weights 25 g now. I am so surprised she has eaten."

"She is a greedy hamster. She has lost a lot of weight," the lady said.

This was one of those cases that I expected not to survive after surgery and yet she had eaten. 

"Medication for another 4 days and keep her in a very dark place for the next 7 days."
"Shall I cover her cage with newspapers?" the lady asked.
"Best to keep her in a dark room and take her out only for medication and clean the nose with warm water as it is still smelly. It is not so swollen but it still has bacteria."

Today is a bright sunshine day unlike the last 2 days which had showers and dark clouds. I hope this hamster will survive with proper nursing.

Never give up hope when there is no hope for a very ill hamster. Life is full of twists and turns.

1282. Chinese New Year Feb 10, 2013

TOA PAYOH VETS toapayohvets.com Date:   11 February, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits The hamster has a gangrenous ear and swollen nose  Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   11 February, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2013-0131 1281. Feb 10, 2013. Chinese New Year. 10 am to 1 pm I opened the clinic for half a day on this Chinese New Year so that I can check on the sick animals feed and clean up the kennels. Singapore is a developed country that is thriving and has low unemployment rates. So there are high rentals and high manpower and operating costs. The vet must be hands-on as it is costly to employ more and more inexperienced staff who will job hop after a few months of experience. Other vets poach experienced staff and that is part of life. The phone did not ring throughout the morning. I reviewed the severely dehydrated hamster with the ear gangrene and large nose abscesses operated yesterday at 4.30 pm. 17 hours after surgery. Would she be alive? She was less than one year old but from her hagged appearance with leg skin folds raised, I thought she was very aged. "Very little chance of surviving anaesthesia and surgery," I told the young lady who brought in this hamster on the eve of Chinese New Year. "You have two options," I said. "Euthanasia or surgery with a high possibility of death during or after surgery." The hamster was not eating or drinking as her upper lip was bursting with pus starting from the bridge of the nose towards the upper incisor teeth. In addition, two black gangrenous tumours filled up the right ear pinnae. "My mum said to operate," the young lady said on this last day of the old year. It was 4 pm and this would be my last case for the ear. "If there are bad news, can you phone us early in the morning on Chinese New Year?" "No news is good news," I dislike deaths on Chinese New Year and here, there was a very high risk patient that could not wait for surgery as she was downhill in her health, being scarcely awake. "I will give a 0.1 ml of dextrose saline under the skin now and operate soon." The images illustrated the surgery. I was surprised that the hamster was still alive 17 hours after the surgery. Not moving but alive. This was a very tough cookie. 5950 - 5956. Ear gangrene  Updates and follow up at webpage: http://www.sinpets.com/F6/20130211hamster_gangrene_ear_abscesses_nose_toapayohvets.htm Toa Payoh Vets Clinical Research

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1281. Adult dog sleeps on poo

	Inbox		x

C@yahoo.com.sg>	Feb 6 (5 days ago)
to judy

I have a poodle abt 9 mth old. Seem timid of human contact maybe abused by pet shop. Sleep on his own poo/pee. Paper train but somehow Forgotten abt it.

 

Any toilet training lesson and training for that. Wanted him to be active.

Best regards

C

REPLY FROM DR SING DATRED FEB 11, 2013

 

 

 

This dog has lost his cleanliness instinct. You will need to confine him to a small room/crate for a few weeks to get him to learn again his toilet habits but this takes a lot of patience and time. It will need your personal attention to train. Or you can take him outdoors to pee and poop daily twice a day at fixed times.