Date:   10 August, 2012  

Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits.

Squamous papilloma in an older Cavalier King Charles   
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
10 August, 2012  
Be Kind To Pets
Veterinary Education
Project 2010-0129

1026. How to make a compelling photo essay in the internet age - Michael Freeman

Ref: Digital photopro  Feb 2012

A photo essay or picture essay is a sequence of photos telling a story. It has:
1. A theme and the following fundamental structure
2. The Opener - The opening shot
3. The Body
4. The Closer
5. The Key Shots ( = climax or climaxes in short stories)
The Opener is the "hook" or attention grabber of the reader. Openers are not where you place the key shots.

The Body has a definite storyline.

The Closer - end with a bang or whimper? Ending with a bang is better choice.

The Key Shot. Not all images are fantastic. Be ruthless in weeding out images that do not make a photo essay strong. A high impact or key shot need to be part of a paced rhythmic photo essay. Earlier images need to build toward it.

The internet.
The future is in the form of the online slideshow. The tools are almost cinematographic, including strictly linear sequencing, transitions like cross-fades, audio, pans and zooms and more.


Title sequence
Opener (Opening image)
Establishment, setup
Buildup (= minor climax?)
Counter story, Second situation
Climax, Key Shot
Closer (Closing Image)

e.g. LIFE magazine 1948  "The Country Doctor"
show young dedicated smart doctors like Dr Ceriani can handle everything without federal interference. Opening image -  rural doctor walk down a road, doctor's bag to house call.
Closing image - modern surgeon exhausted after a late-night op but completely dedicated.


My draft script for this photo-essay


1. Opening shot - TUMOUR
2. Middle - Contents - Diagnosis and treatment
3. Closing Shot -  NO TUMOUR
4. Key Shots x 2
5. Theme - Be Kind To Older Pets - Examine her mouth weekly

The older dog is a family member. Externally groomed, eats and drinks normally

Mouth seldom examined

A lump appears. It grows bigger and bigger

Is it cancerous? Doubles in size within a week. Likely to be cancerous.

How to find out?

Anaesthetic risks in old dogs. Blood test to screen health. Health OK. Take the risk. Yes.

Biopsy as recommended by the vet professors during undergraduate studies. This is the usual practice.

No. Fast growing tumour may be malignant.

Anaesthesia. What type? Intubation normally. But this endotracheal tube blocks the view.

IV Anaesthesia. Effective? Yes if you know the dosage. 50% will do.

Electro-surgical excision including extraction of teeth

Send to lab for histopathology  -  Squamous papilloma. So not an epulis.
Good news. Not cancerous.

Goes home happy owner.

Examine your older dog's mouth weekly for oral tumours


The older dog is a family member for most Singaporeans nowadays. Visits to groomers regularly, good food, dog treats of various brands and plenty of water available at all times.
The dog's mouth is seldom examined by most dog owners and bad breath is usually tolerated.  Dental check ups are not usually done and the rotten teeth drop out and oral tumours develop in many dogs that are now not so much cared for as they are much older.  The older dog is always happy to greet the owner and is a good companion to the senior citizen parents and retirees.
  PROBLEM.  One day, the owners of a male, 10-year-old Cavalier King Charles saw a pinkish lump appearing on the front of the lower jaw covering two of the front teeth. It grows bigger and bigger. "Is it cancerous?" the owners asked Dr Daniel and me.  "If it doubles in size within a week, it is likely to be cancerous," the vet said. How to find out whether it is cancerous? What can I do to resolve the dog's oral tumour problem?
  CONFLICTS NO. 1. Biopsy as recommended by the vet professors during undergraduate studies will be adopted by most vets especially the recent graduates. This is the standard practice as taught in the University. A small piece of the oral tumour is cut out and send to the laboratory for analysis of its type - cancerous or benign? If the biopsy shows that it is not cancerous, then, there is "no" need to do any surgery.

But biopsy takes time and involves anaesthesia. Sometimes as long as 7 - 14 days.
Not much time is available in this case as the tumour was said to be fast growing. It may be malignant and must be excised within 24 hours.
  CONFLICTS NO. 2. Anaesthetic risks are much higher in old dogs. There is always the possibility that the older dog may die on the operating table. "I advise a blood test to screen the health of the Cavalier King Charles," Dr Daniel said. "OK," the patriarch said. The owners must consent to take the anaesthetic risk and they gave permission for the surgery.  

Anaesthesia. What type? Intubation is normally done as there will be dental scaling after surgery. This will take up to 30 minutes of operating time.

CONFLICTS NO. 3.  But this endotracheal tube blocks the operating view. "IV Anaesthesia is the best," I said to Dr Daniel. Will this be effective? Yes if you know how to use the appropriate drugs. The dosage must be just sufficient for surgery but safe for the older dog.  50% of the Domitor & Ketamine IV formula was used in this case
SOLUTION - Electro-surgical excision including extraction of 3 incisor teeth enclosed by the papilloma.

The owner consented for the gum tumour to be sent to lab for histopathology  - a microscopic examination of the tumour to check its cells as to whether the tumour is cancerous or note.

Lab Report:  Squamous papilloma. So it is not an epulis as I thought it would be except that it had various finger-like projections as in a wart. The owner was happy with the good news. Not cancerous.
  Cavalier_Squamous_Papilloma_mouth_toapayohvets CONCLUSION.  The dog goes home 24 hours after surgery on the next day. There was no more gum bleeding.  BE KIND TO YOUR OLDER DOG.  EXAMINE YOUR OLDER DOG'S MOUTH WEEKLY FOR ORAL TUMOURS. SMALL TUMOURS ARE EASIER TO REMOVE AND THERE IS A MUCH LOWER ANAESTHETIC RISK.

Wednesday, August 1, 2012

Blog No. 1022. The Cavalier King Charles has a gum tumour that grows very fast

Aug 1, 2012

Cavalier King Charles, Male, 10 years

"Most likely cancerous," I said to the owners of a gentle distinguished-looking Cavalier King Charles . "If a gum tumour doubles in size every week, it is cancerous and needs early removal."

Blood tests were not normal. Surgery was done the next day. Unlike the Lab Retriever's epulis which is usually not cancerous unless it is an acanthomatous epulis. This case seems to be poor prognosis. Electro-surgery by Dr Daniel. "Transect at least 2 mm from the tumour and remove the entombed incisors," I said. The owner agreed to sending the tumour to the lab for check whether it is cancerous or not.

Total WCC  17.8 (6-17)
N 81%, L 15%, M 3.2%, E 0%, B 0.4%. Indicative of a bacterial infection going on.

RBC 5.6 (5.5 - 8.5)
Platelets 81 (200-500). No platelet clumps seen but few giant platelets present.

Squamous papilloma with reactive atypia and chronic inflammation. No definite dysplasia or malignancy. Good news for the owner. However, the papilloma may return as it is extremely difficult to completely excise it.

The old dog survived the anaesthesia and that was what counted for the owners. Dom + Ket at 25% was sufficient for electro-surgical excision. "No intubation, as we need good access to the gingival tumour and to excise all, if possible. It is growing fast."  Dental scaling was done too.

Older dogs must be checked by the owner daily and any mouth tumour be removed when it is small. In this case, the tongue covered the papilloma till it became chronically infected and swollen. It could have existed for some weeks without the owner seeing it.

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All rights reserved. Revised: August 10, 2012

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