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Date:   28 February, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
Best practices from a plastic surgeon  
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   28 February, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

1399. Identification of patient and operation area

 
Monday, Feb 25, 2013 was an eventful day for me. I had a facial lump of 1x0.5x0.5 cm cut off by Prof Foo C L from the Singapore General Hospital. He thought it was just a scratch tumour as I scratched it to try to get rid of it but it persisted. Sometimes, scratching causes a reaction and the pimple or inflammatory lump disappears. But this lump persisted and increased in size.

"How long has it been present?" he asked as I was on the operating table. "Months," I replied. After seeing this good-natured Syrian hamster with a malignant tumour excised at Toa Payoh Vets recently, I decided to get my skin lump on my face excised and checked for cancer.

"Will local anaesthesia be painful?" I asked Dr Foo.
"Only during injection," he said. He injected 3 areas but the pain was only a small ant bite. I guessed he had perfused the skin immediately on injection and the anaesthetic had numbed the area. He made a blue elliptical marker pen area and excised it. Marking the area to be excised is a good practice even for vets but not all vets do it.

The SGH also has a good practice of verifying the patient's identity and operation site. I was asked my name and identity card number at various points of admission on the day of surgery, outside the operating room and inside the operating room. This practice ensures that the right patient is being operated on. I got asked which area was to be operated. This ensured that no mistakes will be made, e.g. operating on the wrong side of the face. Such mistakes have been made in human surgery with horror stories of the wrong foot amputated.

For veterinary surgery, the patient can't communicate with us. The owner sometimes give incorrect information. For example, a rabbit or cat may be male but the owner says it is female. Trusting the owner who says her pet is female means just spaying the pet. The abdominal area will be shaved and the incision made. No uterus will be found after some time. The vet thinks that the pet had been spayed or worst of all, discovers it is a male.

It is the responsibility of the operating vet to do a full examination including the gender of the pet to be sterilised. Owners are trusted implicitly but some of them don't really know. Pets don't talk to vets and so mistakes have been and can be made by vets in operating on the wrong site.

As for my surgery, Dr Foo said general anaesthesia was unnecessary to remove my facial skin lump. "There is always a risk of death," he said. "You may be the unlucky millionth person to die under anaesthesia. Local anaesthesia will do. It takes around one hour in all."

So, I was strapped on the narrow operating table to prevent me falling off. Swabs covered my eyes to shield them from the 3 bright operating lights. I could not feel the cutting as the area was numbed by the local. Dr Foo had asked whether I felt any pain before excising. This is one part which vet surgeons can't get feedback from the animal patient under local anaesthesia. "6/0 vicryl and 4/0 ethicon," he said to the nurse. The wound was closed well subcuticularly by 6/0 but he stitched up the skin with 4/0 in case of stitch breakdown. This 2-row stitching could be the secret of success in a plastic surgeon in getting a small scar. I got some antibiotic ointment which I didn't use. I asked for plaster to cover my facial wound with a few stitches so that crowds would not stare at me when I attended Cliff Richard's concert in the evening at Marina Bay Sands Grand Theatre.

In any case, Cliff Richard who is 72 years old, gave such an energetic 3-hour-long performance that would put a younger singer to shame. His jokes were appreciated and the audience left much satisfied. One commented that he did not sing "Bachelor's Boy." I was waiting for him to sing "Fall In Love With You", but was disappointed. This was a song I heard at the 25th Baba & Nonya Anniversary in Malacca last year. I got a short video done. See:
https://www.youtube.com/watch?v=-G48MbWTu8c

Cliff Richard's "Fall In Love With you" song when he was very young is at:
https://www.youtube.com/watch?v=T0EHxaVJ0ok

Dr Foo sent my facial lump was sent for histology. It looked white and elliptical in the formalin bottle. There were some fine hairs of around 3 mm long on the skin of this lump as commented by Dr Foo. "Don't read too much into it," he said to me. I do not know why he commented on the presence of these fine hairs.

As for the Syrian hamster operated on Valentine's day, the fair lady owner brought the 2-year-old hamster to consult me 11 days after surgery. There were large reddish skin nodules on the body, under the armpits and on the left thigh. They were around 4 mm x 4 mm raised skin rashes. Could they be due to the "anti-mite" spray the young lady was spraying to "kill the skin mites"? She had diagnosed hair loss and brought the spray from the pet shop.

"Your hamster has a malignant skin tumour," I showed her the histology report which I had paid for since she did not want histology. "It is possible that these red lumps are the spread of the skin cancer which was 2.5 cm in diameter. I gave her the photo of the lump sent by the laboratory.

"Should I continue the spraying of the skin?" she asked me. "No," I said. "This hair loss of the hamster could be due to other reasons and not mites." A hamster with a large skin tumour could be scratching himself a lot and hair loss would be expected due to trauma. "Let the Syrian hamster enjoy his life since he is 2 years old and their lifespan around 3 years," I told her that the rashes could be either irritation of the spray or spread of the cancer. She was to give medication for 7 days and if he nodules disappear, it would be due to irritation.

"I adopted him from the SPCA," she said to me. "He is such a gentle hamster and does not bite me unlike some hamsters."

"Yes, he is very good-natured," I said. "He does not bite me too." Dr Daniel who had operated on him came by and had the stitches taken out. Stitches can be taken out on the 11th day with no problem of the skin breaking down. The wound had healed. Time will tell whether the skin cancer had spread. There was a black pigmented spot on the further back before the left hip area. It was not present before. So it is hard to say whether this was cancerous. I did not advise removal as there was not much skin and there was economics to consider.

Updates will be on this webpage:
http://www.asiahomes.com/petshotline/20130228syrian_tumour_follow_up_toapayohvets.htm
 
More info at: Dogs or Cats
To make an appointment:
e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
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