Today, I left home at 7.19 am, missed the feeder bus and
walked to the Yio Chu Kang subway as the next bus will be 9
min. A breezy bright morning with sunshine and blue skies. I
reached Toa Payoh subway at 7.50 am and walked to Toa Payoh
Vets reaching at 8.41 am. A slow walk for exercise. Quite
breezy but still sweating at the end.
A father and son came with a Labrador, Male, 12 years,
bleeding from a large gum tumour. He had consulted "3 vets"
but they did not advise surgical excision.
According to Vet 1's medical report- biopsy of gingival mass
which was a fibromatous epulis of periodontal origin.
According to the owner, Vet 1 did not advise surgical excision
as it was "generally benign". Neither did another 2 vets from
the same practice. The lump grew and grew and started to
bleed at times. He was bleeding spots of blood outside the
surgery at 9.15 am when the owners came. I asked them to
wait as Dr Daniel was not here yet. More bleeding.
I decided to take over the surgical case as this is an old
dog. Should be 14 years as he was stated 12 years in 2009 in
Vet 1's record.
Blood test by Dr Daniel showed normal results except slightly
below the low range of RBC and PCV
Domitor + Ketamine at 25% instead of 50% as the dog is really
old.
Electro-excision is OK at this dosage if not delayed. Needed
some isoflurane gas. Also for dental scaling. Strong teeth.
Implemented new anaesthetic recording system.
Today I used my first Anaesthesia & surgery record No. 151.
27.7.12, Lab Retriever, Male, 12 years, 36.3 kg, 39.1C
A *Inj Domitor (0.4 ml) +K (0.5ml) IV at 25% calculated
dose 10.06 am
B Isoflurane gas first given 10.18
am for dental scaling. Good teeth.
C Isoflurane gas stopped 10.51
am. End of dental scaling
D Electro-excision of epulis started
10.10 am E End of excision
10.18 am
Antisedan IV to reverse domitor
11.02 am. Dog wakes up in 1 minute
In 2009, Vet 1 said half the jaw had to be cut off, so the
owner did not want surgery. Another of the 3 vets said that
since the epulis was not cancerous as checked by biopsy, there
was no need to remove it. But this epulis grew to twice the
size and blood dripped from this tumour whenever it was
injured, soiling the floor.
He did some internet surfing and consulted Toa Payoh Vets' Dr
Daniel as 2nd opinion.
As the dog is old, I took over the case as I had more
experience and could perform a shorter surgery, minimising
risks of death on the op table. The likely reason that the
other 3 vets didn't recommend surgery would be that the dog is
old and they don't want to
bear the high risk of anaesthetic death ruining their
reputation.
I took 8 minutes to excise the epulis 2x2x1.5 cm under Domitor
and Ketamine at 25%. A vet must be quick and know what to do
during surgery, as the analgesia would wear off 8 minutes
after injection. The dog started to move around the 8th
minute. The incisor tooth might be entombed but I did not
think of slicing the epulis to check and gave it to the owner.
The owner threw it away. Isoflurane and intubation were done
for dental scaling. Solid teeth in general except for the
tartar and plaque. The dog was given carrots and apples and
had good food.
Control of bleeding.
Electro-excised more of the periodontal ligament inside the
hole. I used cotton to plug the hole after removal of the
epulis to stop bleeding. The bleeding was profuse but stopped
after 5 minutes of plugging with cotton.
UPDATE July 30,
2012 12.50pm. 3 days post surgery, I phoned the
owner to ask about the health status of his dog.
"On the first day at home, he was not able to walk on
his left hind leg and we had to carry him outdoors for
him to pee," he said. This dog has a left hind pain
before surgery, possibly a bad hip. "However, today he
could go to the lift himself."
"Has he got a good appetite?" I asked.
"He is eating soft food and wants to eat more. He has no
problem eating."
"You can continue your usual dry food and others now," I
said. "Is he more active?"
"I can see that he is overall well," the gentleman
thanked me for following up. It was good to know that
this old dog is OK. It is not guaranteed that all old
dogs operated by me survive anaesthesia and so surgery
must be short to lessen any risk of death.
Oral
tumours are best removed when they are small in size,
even though they may not be cancerous. This is because
they cause oral pain as they ulcerated and become
infected. They interfere with the joy of eating too as
an ulcerated infected mouth is very painful.
Toa
Payoh Vets