tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS

Date:   22 March, 2010  
Focus: Small animals - dogs, cats, hamsters, guinea pig & rabbits.

Toa Payoh Vets Clinical Research
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to a veterinary student studying in Australia
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Breast tumours and inguinal hernia   
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written: 23 March 2002.
ated:  22 March, 2010 
Be Kind To Pets
Veterinary Education
Project 2010-0129
The heavy-breathing bitch

"Huh, huh, huh, huh, huh, huh, huh, huh".  It was like Def Leppard playing Pour Some Sugar on Me heavy and hard rock music. 

Singapore. Bitch with breast tumour and inguinal hernia, tranquilised for surgery.Heavy panting at regular intervals, non-stop for what seemed like an eternity although it lasted less than sixty seconds.  These sounds evoked fear in me.  No, it was not one of the stalkers on the telephone making obscene calls at midnight. 

It was the bitch in the middle of general anaesthesia.  She was stablised at 2% gas but now she was hyperventilating as I extracted the huge breast tumour. 

A huge mass of body fat called omental fat and intestines shot out of a three-centimeter hole in the muscle area below the breast tumour as I pulled out half of the gigantic hard breast tumour, one and a half times bigger than a golf ball.  

Was the bitch going to die of heart failure?  Should the gas concentration be increased to 5%?  This increase might cause heart failure. I pushed the fat and intestines into the abdomen and blocked the hole with gauze and stopped operating.

The bitch's tongue was not purplish although it had turned into a shade of pale pink.  The blinking reflexes were absent indicating that the bitch was in deep anaesthesia.  There was no other movement of the limbs, as would be expected in cases where the patient was about to wake up.  Just the "huh huh huh huh" sounds which you would hear from the boy bands.

Was the dog feeling the deeper pain as I removed the breast tumour?  I increased the gas to 3% and waited for the anaesthetic to take effect. I should have waited a few days before surgery but time was of the essence.  Sunday was not good for surgery. Blood tests should be done to assess the health of this bitch but this would increase the costs and delayed surgery.  

The inguinal hernia was unexpected. I anticipated a simple removal of a breast
tumour - a hard core and a cyst. This should be a simple procedure although it would be bloody, with small arteries spurting blood at you as you remove the breast tumour.

But now, there was this big gap where the intestines were disgorged. 

Would the bitch die?  Mrs Lam was one of those rare clients who had said that she would want back half the fees should the dog die. A matronly woman with a sun tan face and fuzzy hair and wearing thick black butterfly-shaped spectacle frames.  She had driven a hard bargain.  Two hundred dollars for the breast tumour surgery, general anaesthesia and medication and one hundred dollars for post-operative care of fourteen days. Don't ask for more money. 

"Can you reduce the fees by half?" Mrs Tan asked in Mandarin.  I said it was the lowest. I would have to close down and seek employment if fees were lowered.   "Why not check out the costs with the other veterinary surgeries?" I suggested. 

The cost varies and depends on the complications involved. Singapore was in recession again in 2002 and more than ten thousand people living in the heart lands had lost their jobs. Expatriates had been sent home in large numbers too.        

She waved and said "bye bye" to the bitch as she pondered over the cost of treatment. versus euthanasia. Maybe she was teasing her two young daughters. The elder one, a teenager girl was in silent tears.  She had wanted the bitch to be treated when the breast tumour was smaller. She said the tumour increased to a very large size in the last seven days.  A malignant breast tumour doubles in size every week, so I expected this to be a malignant breast tumour.  

"I would pay the three hundred dollars this time" she said decisively and firmly. The bitch was now not eating and it was certain death if nothing was done. 

Under the operating table, the reason for the sudden massive increase in size was this inguinal hernia which had spilled out the omental fat and intestines under the skin.  I had not expected that this inguinal hernia to co-exist and prolong the operating time.   

This was no way for a veterinarian to operate. Under duress of money back if the patient dies.  I waited. The emergency drugs were ready in case the dog went into cardiac and respiratory failure. 

Around sixty seconds, the patient abruptly stopped panting. She was in deep anaesthesia. I removed the gauze. I noted a huge pudendal vein and artery of around 3 mm in diameter, coming out of the inguinal hernia hole.  At the edge of the hole nearer the vulval area, just under the breast tumour.  If they rupture, there would be massive bleeding and probably death. 

Singapore bitch just after surgery. Breast tumour removed.  I ligated the blood vessels and then cut off the end near the breast tumour. I stitched up the inguinal ring so that the intestines would not prolapse.  Now that the bitch was in deep general anaesthesia, it was a not stressful. There was no spurting arterioles as I removed the breast tumour, unlike other cases. The tumour might have stifled all good blood vessels.       

This was an unusual case of anaesthesia and surgery. The inguinal hernia repair prolonged the whole procedure by at least twenty minutes. It was still bright at 6 p.m on this sky blue March Sunday evening.  Fluid therapy was given to maximise her survival rate.

Mastectomy - Singapore bitch recovering from anaesthesia and surgery.I had commenced the mastectomy at 4 p.m and expected it to be a simple one-hour surgery and be in time for the cinema show. Man proposes, God disposes.  

 Mrs Lam was happy to see that the bitch had survived the operation and brought chicken rice and the favourite Pedigree dog pellets. The patient should be able to go home in fourteen days to the elder sister who loves her very much.  I felt joy in seeing the patient recovering every day.  She took her revenge by spraying urine onto the floor from her cage the second day after surgery.  And I thought only male dogs spray urine.   

Singapore bitch with large breast tumour - mammary tumourBE KIND TO OLDER DOGS & CATS --- GET TUMOURS REMOVED EARLY --- WHEN THEY ARE SMALLER
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