Page 548 - WSAVA2018
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R. Koh1
1Veterinary Teaching Hospital, Louisiana State University School of Veterinary Medicine, Baton Rouge, USA
2Veterinary Medical Center, University of Florida College of Veterinary Medicine, Gainesville, USA
Cancer is a common disease in small animal practice; it has been estimated that 1 in 4 dogs and 1 in 6 cats will develop a form of neoplasia at some point during their life.1,2 It has been reported that almost 50% of dogs over 10 years old die of cancer-related problems, and cancer is the most common cause of natural death in dogs
and cats in the United States.1 However, treatment of cancer remains a challenge for both veterinarians and caretakers.
Conventional medicine understands neoplasia to arise due to a decrease in anti-tumor defenses, increased mutations and silencing of tumor suppressor genes such as p53 through methylation and deacetylation, along with exposure to carcinogens and a decrease in immune defenses and therefore DNA repair mechanisms. While we are beginning to unravel the complex biochemistry of cancer development and have begun to understand how DNA is damaged and repaired, we still have a long way to go before the cure for cancer will be found.
Traditional Chinese Medicine (TCM) has been used successfully in the treatment of cancer for thousands
of years, long before we understood the basic pathobiology of tumors in Western medicine. Traditional Chinese Veterinary Medicine (TCVM) shares the similar philosophy and treatment of cancer in TCM. TCVM is
not a replacement for Western diagnosis and therapy, but may be used with Western approaches to help heal patients. When the option for Western therapy is lacking, there are TCVM therapies which can be employed to help the patient live a quality life, reducing the rate to cancer expansion or, in some cases, leading to remission of the cancer. TCVM may be best suited to prevention
of the development of cancer through healthy living. On the other hand, Chinese herbal medications have been shown to lead to spontaneous remissions of cancer.
In some cases, these herbal products can be used in conjunction with traditional Western therapies, improving the outcome and reducing the side-effects from Western therapy alone. An integrative approach combining the best of both Western medicine and TCVM seems to be the only sensible course of action, providing the best overall care for the patient.
25-28 September, 2018 | Singapore
operative CT will assist in determining the extent of middle ear involvement however a bulla osteotomy
is almost invariably required in cases of severe otitis. The placement of a drain following surgery remains controversial and is not considered mandatory. In instances of subsequent abscessation this is more likely associated with inadequate debridement of the epithelial lining of the bulla rather than the lack of drain placement.
Post-operative care is based around providing adequate analgesia. Management of facial nerve paralysis
in hospital is required in some cases with reports describing up to 36% of dogs developing transient facial nerve paralysis and up to 13% permanent paralysis (these numbers are expected to be higher in cats).
Pinnectomy is performed most often for neoplastic lesions, commonly squamous cell carcinoma in the cat. Margins should be 1-2cm and skin is brought over the cut edge of the cartilage (usually from the convex surface) and then sutured.
Ventral bulla osteotomy is a common management option for cats with inflammatory polyps and those
with disease limited to the tympanic bulla. The true middle ear is separated from the larger hypotympanic cavity and must be concurrently accessed. Cats are positioned in dorsal recumbency and incision centred over the tympanic bulla. Relevant anatomical structures encountered during the approach include the salivary gland, bifurcation of the linguofacial and maxillary veins, hypoglossal nerve, and lingual artery.
The incidence of neurological deficits following otic surgery is higher in cats than in dogs however attempts to avoid excessive curettage of the promontory can help reduce the risk of Horner Syndrome when performing the ventral bulla osteotomy.

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