Thursday, March 28, 2013

1341. Follow up on the rat with a nose "tumour"

The owner went to a 2nd vet for a second opinion. The vet  had a smear of the cells of the nose tumour done. The tumour was growing bigger over time. I had proposed surgical excision earlier on. The owner wanted a second opinion and investigation of the cells by another vet.

Nose "tumours" that keep growing bigger, in my opinion, are based excised when they are smaller. No delays and waiting for biopsy and giving antibioitcs to see if they will reduce in size. Some of them may be abscesses and antibiotics may work.  

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

On Wed, Mar 27, 2013 at 5:45 PM, ,,,@gmail.com> wrote:

Dear Dr Sing,

The tumour ruptured and we had to put XXX to sleep today. The tests came back inconclusive.

From the smears examined there is a moderate accumulation of intact erythroytes and rare hyperplastic epithelial (round to ovoid) central nucleu with mild amphophilic cytoplasm) and small round cells with no discernible mitoses or evidence of inflammation; the findings are not specific for any particular etiology. If lesion persists then if clinically allowable a representative tissue biopsy should be evaluated via histopathology. Clinical surveillance is warranted.

Thank you for everything that you and your staff have done for Moo.

Regards,
Jasmine Lim


 EMAIL REPLY FROM DR SING DATED MAR 28, 2013
 Thank you for your feedback. Please accept my condolences. Best wishes

Monday, March 25, 2013

Ringworm in a Labrador's puppy forehead






Ringworm infestation a 3-month-old puppy or kitten can take a long time to heal despite medications and washes. There are many reasons. One is that the immune system in the puppy is not as developed. The other reason may be that the owners or their maids have not been able to clear the infections through non-compliance with drug dosage or times. There may be re-infection from the surrounding area.

I spotted this case of ringworm in the black Labrador puppy given anti-ringworm medication and sent home during the first consultation by my associate vet. He had lots of scales. All over his body especially his forehead and backbone area from the neck to the tail. As if the skin was sprouting dandruff on the 2nd day after bathing.

I retained the puppy for a more thorough treatment as I know the average Singaporean owner would not be able to treat it as it was full of dandruff. Scales big and small fall from the body. Not just fine scales as in some chronic dog diseases. The puppy's skin was not dry nor oily. Did the breeder or seller give some medication or apply some wash that cause such a condition? Nobody knows. The owner just brought the dog as it was. A lively puppy that would never stop jumping on anybody and straining on the leash like a racehorse in prime condition to win a race. 

I had the puppy clipped bald. Scrubbed the forehead with anti-fungal shampoo and sent the puppy home after 4 days. The owners wanted the dog hospitalised as Chinese New Year was round the corner. So the dog was boarded and treated for more than 10 days. The forehead recovered as new hair grew. The whole body has a new shiny coat about 8 cm long. The puppy went home a week or two after Chinese New Year.

The owners sent him back again as dandruff sprouted from the backbone area, the sides of the thigh and the belly. "It could be due to too much bathing and loss of oil," Dr Daniel gave his opinion. "The owners bathe the dog and scales appear two days later."

OK. Too much bathing? Loss of skin oil. So dandruff forms. If this is the case, don't bathe the puppy often. But the dandruff keeps forming more and more. What is the solution?  The vet is the expert.

Dandruff along the spinal area. It indicated that the puppy had been rubbing his backbone area or somebody had applied strong medication on this area. Some friction on the skin. No hair loss unlike the usual ringworm infestation. Just lots of skin flakes in snow white colour and of various sizes. As if the skin is peeling off.

I checked the anal sacs. Dark brown oil of over 5 ml were expressed. Surprisingly so much oil in a 4-month-old puppy. Then I gave a Vitamin ADE IM and anti-inflammatory injection as well as got the puppy in a bath tub and scrubbed by myself and my assistant. A strong bristle brush. Red papules were seen in the skin after bathing. I started the puppy on the Z/D anti-allergic dog food.

4 days later, I noted that the dandruff did not form on the backbone area from the neck to the pelvis. "Good news," I said to Dr Daniel. "The anal sacs were impacted fully and expressed. The Vitamin ADE seemed to do a good job. Was it the Z/D? Or was it the anti-inflammatory or the scrubbing?"

A few flakes appeared around the tail area. It would take time to recover. I sent the boisterous puppy home and told the owner that recovery of the skin was around 80-90%  and the puppy was to be put on Z/D, anti-fungal medication and multi-vitamins. 

From my experience, it is difficult for owners to treat generalised ringworm in the puppy or kitten. It takes more than a month to recover and require clipping of the coat to remove the contaminated hairs.

I may produce an educational video about this case. An image of the puppy with the forehead ringworm is shown:











Sunday, March 24, 2013

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), MRCVSDate: 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

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.