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Toa Payoh
Vets Clinical Research
Making veterinary surgery alive
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Breast tumours
and inguinal hernia
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written: 23 March 2002.
Updated:
22 March, 2010 |
 toapayohvets.com
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.
 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.
 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.
 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.
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 BE
KIND TO OLDER DOGS & CATS ---
GET TUMOURS REMOVED EARLY ---
WHEN THEY ARE SMALLER
More case studies, goto:
Cats or
Dogs |
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tel: +65 9668-6469, 6254-3326 |
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Be Kind To Pets
Veterinary Education
Project 2010-0129 |
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