Tag Archives: Surgery

Should I Take My Dog The Vet Appointment?

mosey-ft collins 1.9.14

Honestly, this question never occurred to me. A vet appointment without the pet? But the following article from the Dog Cancer Blog poses some interesting thoughts? What if you just need advice? What if your dog is too sick to travel? Our oncologist is a three hour drive from home so Mosey is in the car for six hours on visit days. Do the benefits outweigh the inconvenience? Read below for the reasons your vet really needs to examine your pet in person. And, as always, thank you to the folks at Dog Cancer Blog for their very valuable information:

Don’t Forget Your Dog at the Veterinarian

When booking a new consultation with me, pet Guardians often ask if it is necessary to bring their dog to the appointment. From their point of view, they are often concerned about the stress of the visit on their pet, or maybe the travel itself.

But from my point of view, a consultation without the pet is like a visit to the pediatrician without your toddler. So, yes, you should bring your dog!

In some ways I am happy that someone wants to meet me and listen to the overview of their pet’s cancer and ask questions. Educating yourself about your pet’s cancer is important. But the visit is so much more than hearing about an overview of the how the cancer presents, behaves, treatment options, and prognosis. I also review your pet’s medical record; including previous history, previous tests and the cancer cytology or biopsy report.

But a critical part of the consult is my personal evaluation of your dog.

vet-with-dogFor example, if a mast cell tumor has already been removed, but the surgical margins are narrow or incomplete, I can only discover if a second surgery is possible with a physical exam. I need to see the previous scar on your dog. I may lift the scar, and see if we can remove more tissue.  I may even show the dog to our surgeon so see what she thinks and decide if surgery is even an option. If she says no, I just saved you the time and cost of a consult with the boarded surgeon.

Or, I may feel a small mass already coming back at a scar. If the tumor is back, it changes the recommendations. I only can determine that if I examine and feel the dog in person.

Measuring Is Key

I’ve also had cases where the biopsy report lists a soft tissue sarcoma (STS) as completely removed, but the vet notes the mass was 2 cm and the scar is 3 cm. Well, we need 2 to 3 centimeter margins AROUND the tumor … so a 2 cm STS should have an 8 cm scar. I will literally measure scars to make sure that they are actually as complete as reported on lab reports. If not, it’s unlikely the margins are clean and recurrence may be likely. And if that’s true, we need to know, so we can make the best plan.

I may also need follow up tests, like an ultrasound to monitor progression of an abdominal mass or to get a baseline.

Finding Other Tumors

Just last week, I saw a dog with a mass in the bladder, most likely a tumor called transitional cell carcinoma (TCC), based on the ultrasound at the primary vet. Penelope had the classic signs of TCC – straining to urinate and blood in the urine. The vet said the mass was not in the trigone area, which is great, because then we could remove the tumor with surgery before starting chemo. (Many tumors are in the trigone where all the nerves and the urinary tubes that connect from the kidneys and out the urethra. This area is usually inoperable.)

From the ultrasound at the primary vet, it looked like Penelope was a surgery candidate.

To be safe, I recommended a repeat ultrasound. This time the boarded internist not only saw the mass in the non-trigone area but also a larger mass in the urethra, the tube through which urine flows from the bladder to the outside.

Unfortunately, that discovery meant surgery was definitely not an option. With this new info, I changed my recommendations and we discussed medical management like NSAIDs, chemotherapy, and even a stent to keep her peeing if she gets blocked.

So Penelope’s prognosis and treatment options all changed based on the exam and tests. If she hadn’t been physically present, we might have gone ahead with a surgery that would be unnecessary and not even treat the larger mass.

Finding Metastasis

I may also discover something new on the exam, like an enlarged lymph node. If we aspirate that lymph node and find the cancer has metastasized (spread), it may change the prognosis and recommended diagnostics and treatments. If a cancer has spread to the lymph node, we may need to have it removed, radiated, or it may be the reason we add chemo.

Finding Other Problems

Without the patient, we could also miss other problems, like a fever, an infection, a heart murmur, or a lameness so severe that it changes recommendations.

Just yesterday, I had an appointment with Lady, a 11-year-old Russian Blue Terrier. She came to discuss CyberKnife radiation for her recently discovered aggressive bone lesion in her humerus (shoulder), consistent with osteosarcoma.

CyberKnife is an alternative to amputation, and we typically start with a CT scan of the leg to make sure the bone is structurally strong enough to be a good candidate for it. If the tumor has already destroyed too much bone, it puts the dog at increased risk for fracture even if we kill the tumor cells with high doses of radiation.

But looking at Lady (not her X-rays), I saw that she could barely get up and walk. The family was lifting the 100 lb dog to get up and go outside to relieve herself.

I was worried that her limping and disability wasn’t just because of tumor pain. It could also be neuromuscular disease, orthopedic issues, or worse, bone metastasis. I wasn’t going to do a CT scan (very expensive) and recommend CyberKnife radiation if there was some other major underlying medical issue that prevented her from walking. We had to figure this out, first.

So, during that appointment, I consulted with my surgeon, who looked at Lady and isolated the severe pain to her knees and hips, not just the shoulder with the tumor. X-rays confirmed severe degenerative joint disease and arthritis. Unless that can be helped, removing the tumor with radiation would not help her to walk. Even amputation was out, because a dog with this severe pain wouldn’t be able to recover easily.

This information was really helpful, because now we knew a few things:

  1. We can add pain meds, specifically non-steroidal anti-inflammatory drugs (NSAIDs) to her treatment to help bring her some relief.
  2. Her underlying arthritis is too severe for an amputation.
  3. By treating her arthritis we can improve her comfort and mobility.

Once she is feeling better, THEN we can do a CT scan to see if she is a CyberKnife candidate. She may still be!

Bottom Line: Bring Your Dog

So … will I occasionally do a consult without the dog? Yes I do make exceptions, but it really limits what I can do for the pet and the family if the pet is not there to be evaluated.

Live longer, live well,

Dr. Sue

About the Author: Susan Ettinger, DVM, Dip. ACVIM (Oncology)

Susan Ettinger, DVM. Dip. ACVIM (Oncology) is a veterinarian oncologist at Animal Specialty Center in New York and the co-author of Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. She blogs about dog cancer at http://DogCancerBlog.com.

MoseyLove!

Diane and Mose

4.6.14

mosey and me

Diagnosis

Mosey at 3 1/2 months

Mosey at 3 1/2 months

Mosey is a happy, goofy, beautiful golden retriever with a voracious appetite, very treat motivated, and a total love bug. His energy level is excellent for a 10 1/2 year old so nothing prepared me for the cancer diagnosis. Here is our story:

Mose has slept for years on a big, puffy, pillow type bed. One night, a few days before Thanksgiving, he woke up and started breathing very heavily…almost panting. He moved off his bed and onto the floor. I got up, sat beside him and started petting him to relax him. He stopped the panting after a few minutes, went to sleep and was fine the rest of the night. This happened a few nights in a row. I thought it was odd, but I didn’t panic as he was fine the rest of the time. A few days later I noticed he was breathing a bit harder than usual during the day…not after any activity, just as he was lying around the house.  Again, this was so slight that it didn’t raise any concerns but, after a week of the 5 minutes of heavy panting at night business, I decided to take him to our vet. I honestly expected them to tell me he had allergies or something similar.

Our local vet checked him out and asked if she could take some x-rays. The first shock was when she told me he had a mass surrounding his heart and that there was nothing they could do here in Taos. She referred me to specialists in Albuquerque and told me “Keep him very calm, don’t go on any walks or any other activity and call me on my cell in an emergency…like if he collapses.” What? OK, so now the panicking started.

This was on a Thursday afternoon and our appointment with the specialist was not until the following Tuesday morning. My husband and I spent a very long, tense and sad few days, lots of crying and frustration with the wait. It didn’t help matters that we had a big snowstorm and sub-zero temperatures forecasted the day of the appointment. Taos is 2 1/2 to 3 hours from Albuquerque and we had an early morning appointment so Mose and I left Monday mid-day to beat the weather. Let me tell you…sitting in the hotel room waiting for the next day was one of the longest nights of my life.

We first met with a cardiologist who, after an ultrasound, told us that the mass had not gone into his heart and that, for his age, his heart was very strong. Some good news! Then she referred us to the oncologist who had us do an abdominal ultrasound which revealed no major abnormalities. They aspirated some of the mass for analysis which showed degenerating cells…probably cancerous. The oncologist created a report for me which states:

“Mose has been diagnosed with an intrathoracic mass that extends to the heart base (also called heart based mass).  There are generally four common differentials for a tumor in this location.  They are lymphoma, thymoma, ectopic thyroid carcinoma and chemodectoma.  The aspirate results have ruled out lymphoma. These other three potential cancers are all epithelial which is what the pathologist thought the cancerous cells were most consistent with.  Thymoma is a cancer of the thymus, an organ involved in development of white blood cells in embryos and babies.  When cancerous, it is most often treated surgically although it is also responsive to radiation therapy.  Ectopic thyroid carcinoma is when a remnant of thyroid in the chest becomes cancerous.  These tumors are best treated with surgery although many are non-surgical.  If non-surgical, they can be treated with either radiation therapy (if site is appropriate) or chemotherapy.  Chemodectoma is a cancer of the cells at the base of the heart involved in sensing blood pressure and position. Chemodectomas are generally slow growing cancers and have not been particularly responsive to most therapies.  If possible, they are removed surgically but they are only rarely surgical.”

I met with the surgeon Wednesday evening to determine the next steps. First was to have a CT scan to get additional info.  We had the CT scan performed on Thursday morning. The results showed the cancer was inoperable. They ruled out 2 of the 4 potential cancers. The oncologist said, based on the CT scan findings, that she believes it is an ectopic thyroid carcinoma but it could also be chemodectoma. They also found 2 lung nodules which makes them think it is also a metastatic disease.

You can imagine my week of crying, bargaining with God, and researching everything in sight. Mose has always eaten healthily, but I am amping up his diet by starting an anti-cancer holistic program. He started taking an anti-cancer drug called Palladia last Friday. We are waiting to hear from  Colorado State University, Ft Collins to find out if he is a candidate for radiation therapy. If not, the oncologist recommends we watch what the Palladia does (or doesn’t do) and then discuss chemo.

The only good news is that, except for a little bit of panting once in a while, he is symptom free. Great appetite, energy appropriate for a 10 yr old, no pain…his normal goofy self. This is the hardest thing I have ever gone through. My friends and family have been amazing…listening to every detail and offering support and guidance…but, especially now during the holidays, I don’t want to continue to bum them out with my sadness.

These blog posts are designed to help me keep track of Mosey’s situation. It is such an overwhelming and confusing time. I want everything I learn, try and experience to be organized. I hope our story helps others on the same journey.

MoseyLove!

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