Will Weez need an amputation?

Weez, a cute 12 year old Cockapoo, had a swelling under her left armpit (aka the axilla).

 

No signs were present otherwise: she was eating, drinking and acting normally.

Since the swelling continued to grow, her owner wisely went to see his family vet. She diagnosed a mass of unknown origin.

The vet (again, wisely), recommended surgery to remove it and biopsy it.

The suspicion, based on experience, the location of the mass and its fast growth, suggested that it was likely a cancerous mass (soft tissue sarcoma, nerve sheath tumor, lymphoma etc.). In addition, there was a chance that it involved some important nerves in the armpit (aka the brachial plexus).

Since those nerves cannot be sacrificed, we discussed a small possibility of amputation.

A physical exam and blood work confirmed than Weez was a good candidate for anesthesia.

To my relief, my own exam revealed that there was no need to sacrifice the leg!

So we removed the mass uneventfully, and it as sent to the lab for analysis.

Weez recovered smoothly from anesthesia and surgery, and went home.

Her activity had to be restricted and she had to wear a cone (E-collar) around her beck for 3 weeks. She was also given oral antibiotics and pain medications.

One week later, the results of the biopsy were shocking – in a fantastic way!

Amazingly, the mass was benign! It is called a fibroma, which is a non-cancerous tumor, and very unusual in that location.

There is still a small risk that the tumor can come back, so I asked Weez’s owner to monitor the area by feeling it monthly.

Weez’s owner was ecstatic. He wrote: “Cannot be any happier and blessed to have had Dr. Zeltzman operate on our girl. He was able to remove a tumor and save her leg from being amputated.”

This story reminds me that board-certified cancer specialists (oncologists) and surgeons have 2 similar sayings:

* The 3 deadliest words in the English language are “Just watch it” and

* The 5 deadliest words in the English language are “Keep an eye on it.”

What we mean by that is size doesn’t matter when it comes to masses.

A tiny mass the size of a grain of rice can be cancer.

Bottom line: even though this mass was luckily benign, it is important to remove masses as soon as possible. Have your family vet check your cat or your dog as soon as you notice any lump or bump, so that they can guide you through the next steps.

So please don’t procrastinate. Removing a mass when it’s small is less invasive, less costly, and gives much better chances for a cure.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Sparky receives the gift of life

It’s lar par season!!!

As the weather gets warmer, I will see more and more dogs suffering from laryngeal paralysis.

This reminds me of a recent patient with lar par, Sparky, an 11 year old Labrador. He was suffocating and was diagnosed with laryngeal paralysis. This is a serious and stressful condition where the larynx (voice box) doesn’t allow enough oxygen to flow into the lungs.

His condition had been getting worse for about a year, then it suddenly got dramatically worse. When he arrived at Barton Heights Veterinary Hospital (www.bartonheights.com) in Stroudsburg, PA, Sparky had to be placed on oxygen. He was given tranquilizers to decrease the stress of suffocating.

Then something unusual happened. Because he was still struggling, he had to be placed under general anesthesia so that more oxygen could be delivered through a tube placed down the throat and into the windpipe.

This bought time until I was able to drive to the hospital and perform emergency surgery. The goal of surgery is to open up the larynx with permanent sutures (tie back surgery).

Despite a stressful start, Sparky’s surgery and recovery were uneventful.


And that was exactly 2 years ago,

His owner updated us after a year: “Sparky is still with us. We celebrated his one year anniversary last night with some vanilla ice cream. He has lost a lot of his muscle in his back end, but is still ambulatory and it hasn’t stopped him from trying to chase deer in the meadow (though he doesn’t get too far) or climbing up on the furniture (even though he has a comfy bed on the floor).”

How does his owner feel about doing the surgery on a senior dog (11 years of age), in spite of how severe his situation was a year ago?

“It really is miraculous! We are extremely happy – beyond words, really – that Sparky had the surgery and survived the ordeal. If he had lived only a week, or a month after surgery, we would not have regretted his having it, but the fact that he is here a year later certainly underscores why he should have had it. We are so grateful to you for the gift of his life!

You can watch a quick video of Sparky here: https://youtu.be/fy7dWlAVqnM

So Sparky is breathing well. Yet “He has lost a lot of his muscle in his back end.”

It is possible that he has another nerve condition, related to lar par, that leads to progressive weakness in the back end (visit http://www.cvm.msu.edu/scs/research-initiatives/golpp/living-with-golpp for more info).

Sadly, there is no treatment. Well, besides doing the opposite of what most dogs wants to do: these dogs should not be moping around all day. They should be taken on slow, steady leash walks to keep the muscles as strong as possible.

Few pet owners are as dedicated as Sparky’s owner. She wasn’t about to give up on him without a fight, and the reward is a happy, breathing, deer-chasing Labrador!

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Cartier and the giant surprise…

Cartier, a 12 year old, 10 pound Shih Tzu, was originally seen by her family vet for a walnut-sized mass on the right side of her chest. It looked like a simple skin mass.

But she soon developed some rather troubling symptoms that had her owners seriously worried. She became lethargic, had difficulty breathing, and even passed out on occasion. What was happening?

Cartier was taken back to her family vet, where X-rays and blood were taken to find out what was going on. The blood work was normal, but shockingly, X-rays revealed that Cartier’s skin mass extended deep into her chest. It was so large, that it crossed to the other side of the chest!

The X-ray below shows the skin mass (green arrow), the chest mass (red arrow) and the heart (blue arrow).

A cat scan of the chest was then performed to better understand what was going on inside the chest, and to make sure the mass had not spread anywhere. There was only one mass (between the colored arrows) but it was almost three times the size of her heart! This explained her symptoms. The only option to help Cartier was to remove the mass.

So I was called in to perform the surgery. On X-rays and on the cat scan, the mass appeared to involve a single rib, but that meant that several ribs would have to be removed in order to successfully remove the mass.

A total of 3 ribs had to be removed, along with the mass, without damaging the heart, the lungs, or any other vital structure. And remember, Cartier only weighed 10 lbs…

By the time we got done, the defect in the chest wall was so big, that it was not possible to put the remaining ribs back together. So the defect was reconstructed with nylon mesh in order to close the chest cavity.

Next, air from her chest had to be removed to allow her to breathe on her own once anesthesia was over. So we used a special plastic drain called a chest tube. Surgery was delicate, but it went well and Cartier bounced back remarkably quickly for an older lady. This is a video of her, walking around the day after surgery (chest tube still in place).

 

The chest tube was removed a few days after surgery and she went home safely.

The mass was sent to the lab to be biopsied. One week later, the results came back as bone cancer (osteosarcoma). This was one of the 2 most likely diagnoses. The other most likely possibility was cartilage cancer (chondrosarcoma).

One month after surgery, Cartier’s owners were happy to report that she had more energy, ran around, had bright eyes, and seemed to be back to normal. Her personality had come back, she had a hop in her step, seemed much more comfortable and no longer struggled to breathe.

Twelve year old Cartier now had a new lease on life.

Her owners said: “we couldn’t have asked for better results.”

Addendum:

I am thrilled to report that as of July 2019, Cartier, the now 13 year old, is still doing well.

This is 7 months after surgery.

 

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Luna, a happy ending despite an agonizing decision to amputate

Luna, an 11 year old shepherd mix, had a large mass (larger than a golf ball) between her toes in the left front leg.

WARNING – WHAT FOLLOWS IS GRAPHIC – YOU HAVE BEEN WARNED.

Actually, the mass got much smaller suddenly, after she literally chewed up half of it. That left a large open wound, which got infected, and caused a horrible smell.

Luna was limping because of the severe pain this mass caused.

Her family vet did a needle test (“fine needle aspirate”), which came back normal or as we say “inconclusive”. So there was nothing to worry about right? It was likely a benign mass after all.

Amputation was mentioned, but Luna’s loving owner could not accept the idea. She thought it was a horrible idea and Luna would be miserable. She found me through my website, reached out to me, and we had a little heart to heart. I explained my concern that this was not a benign mass at all, and that amputation was the only reasonable option.

After agonizing over this difficult decision, Luna’s owner eventually agreed to do the right thing for her beloved dog and scheduled the amputation.

But first, we needed to take chest X-rays, because the cancer I suspected typically spreads quickly to the lungs. Fortunately, no spreading was visible at that point.

 

We performed the amputation (let’s call it day 1) and surgery went smoothly. Luna went home that night – walking. Below is a summary of what happened after surgery, to give you a feel for the emotional roller-coaster Luna’s owner went through.

Day 1: surgery was performed. Luna went home and had a rough first night. Of course, Luna’s owner questioned her decision.

Day 2: I recommended adding a third pain medication.

Day 3: One of my nurses called to check in. Luna felt much better already.

Day 5: Luna’s owner wrote: “Hi Dr. Zeltzman, she seems to be doing great so far. She’s acting more like herself each day. She’s just sad she can’t get on the couch or bed.”

Day 6: The biopsy results came back. The news was not good. As expected, the mass was indeed cancerous. It’s called malignant melanoma.

In spite of the bad news, Luna’s owner was relieved that her dog was finally out of pain. She wrote: “Thanks again. We can’t thank you enough for the amazing work you did to her!”

Day 28: Four weeks after surgery, Luna’s owner wrote: “Hi Dr Zeltzman. Just wanted to thank you again for the wonderful care you gave to Luna. She is doing wonderful and living a happy pain free life. I wanted to share a picture of her because she looks so beautiful and happy!”

So what is the purpose of this blog? I’m not sharing this story to brag. And I am not here to try to convince you that amputation is a wonderful thing and a walk in the park (no pun intended) .

What I would like pet lovers to believe is that when we recommend sacrificing a leg, it’s never for fun. It’s always to help a cat or a dog feel better, once the source of the pain is removed.

The biggest obstacle is most often in the pet owner’s mind. They are often terrified that amputation is cruel. I suspect that, subconsciously, they think of themselves as an amputee, walking on one leg. Well, remember, pets walk on 3 legs after amputation and they adapt very well. And typically, they start walking a few hours after surgery!

Pets don’t even know they’re missing a leg, all they know if that they don’t feel the pain anymore.

In Luna’s owner’s own words: “She is doing wonderful and living a happy pain free life.”

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Would you know if your pet were in pain?

Your pet can experience pain and discomfort in multiple ways. Belly pain (e.g. pancreatitis), severe coughing, injuries and cancer, to name a few, are difficult for our furry friends.

Pain and its expression can vary dramatically from breed to breed, and from pet to pet.

Animals in general are very good at hiding when something is wrong. Remember, in the wild, if an animal acts sick, they get eaten. Sadly, our pets have kept this ability to hide pain until they can’t take it anymore.

Subtle symptoms that you may not think twice about but should include:

. Sleeping in spots they don’t usually go to

. Grooming less

. Grooming excessively and/or one particular spot

. Reluctance to play as long or at all

. “Accidents” in the house

. Less excited to see you, jumping less

. Panting for no obvious reason

. Seeming anxious

. Hiding

Sometimes our pets will be more obvious and show us symptoms such as:

. Vocalization but PLEASE do not count on that to decide your pet is in pain. Many pets who are in pain do not cry out!

. No longer wanting to be petted or picked up

. Limping

. Shaking or tremors

. Hunched position

. Guarding an area (e.g. not wanting to be touched on the head because of an ear infection)

. Aggression

. Not wanting to get up

. No interest in normal routine, such as going on a walk.

It’s hard to think of our loved ones in pain. The good news is there is something you can do about it.

The first thing you need to know is you SHOULD NOT give anything over the counter or any human medication unless directed by your veterinarian. Many human drugs are toxic to our pets, even fatal.

Bring your pet to be checked sooner rather than later. The sooner you figure out what is wrong with your pet, the more options you have.

Remember, age is not a disease. We can successfully treat countless ailments we were unable to help with before. You no longer have to accept your pet no longer playing or wanting to go on walks because he or she is old. It’s probably because they are painful.

Also keep in mind that there are many ways to decrease or stop the pain without medications, including: surgery, weight loss, cold therapy, heat therapy, joint supplements, environmental changes, improving traction, harnesses, rehab, massage etc.

In my world as a surgeon, surgery is a classic way to help painful patients. Fixing a broken leg, repairing a torn ACL or removing a cancerous mass are just a few examples.

We are here to help.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified