Thursday, June 27, 2013

Taffy's Tongue Tumor. Part Three of the Mass Removal Series.

Taffy is a 13 year old long haired orange tabby. He has been struggling with a decreasing appetite for months. His mom has been trying every kind of food and every kind of texture to try to convince him to eat. It has been a roller coaster ride that has been full of frustration and worry.

His first visit to the vet revealed an irregular ulcerative red spot under his tongue. Despite trying antibiotics and watching to wait and see over time the mass had grown to cover over half of his tongue. Taffy's tongue was swollen making ti hard to hold in his mouth. The mass was painful and the pain made Taffy reluctant to eat, and he was now drooling constantly. The decreased food intake was causing weight loss and muscle loss. The muscle loss was causing him to have more and more difficulty in getting up and walking. (Quick cat tip: cats often show weakness in their back legs. They will walk plantigrade (with the hocks (ankles) dropped. So instead of walking on their back toes they walk on the foot from the toes to the ankle. If you notice this in your cat go to the vet. This is also one of the first signs we see in diabetic cats). He needed relief quickly or he was going to continue to slip downhill and that down hill slope will get progressively steeper as you slide into the abyss. At some point your pet will not be able to crawl out of that abyss.

I saw Taffy for his surgery a few days later. Before surgery I gave him another thorough examination, reviewed his pre-op history and diagnostics and took some x-rays to make sure that there wasn't any evidence of cancer. We thought that the lesion under the tongue might be cancer so we look very hard everywhere else to see if it has spread. IF the cancer had spread his prognosis would be much worse and the surgery might be done just for de-bulking, temporary relief purposes, instead of getting clear margins. All of these thing are vitally important points to discuss before surgery.

My point is to be proactive and not wait until that mass is your pets death sentence.

Induction agent being delivered to put Taffy under anesthesia.

After Taffy was sedated to be intubated we could see for the first time the complete source of his pain.

Intubating for inhalant anesthesia.

Looking down the throat to see where to put the endotracheal tube.

Looking to check before placing the endotracheal tube.

My very good friend, and fellow veterinarian, referred Taffy to me specifically because at our clinic we have a laser that we can use to remove masses. The laser reduces the bleeding and surgical time and she believed was the best tool to try to remove Taffy's tumor.

Taffy's tumor was in a tough spot. All the way in the back half of the underside of the tongue. Until he was under anesthesia completely we weren't really sure how big or how deep it was. Many times in surgery it is as much discovery and examination as it is attempt to surgically correct and/or remove. (That's why it is sometimes very hard to give a definitive estimate for services). I was not sure I was going to be able to remove this with even the laser, and I was not sure what "IT" was to begin with.

We began surgery with the laser. Removing the mass was made much easier with the laser but there is only so much tissue that you can remove at the base of the tongue and it is a fine line between enough to get Taffy comfortable and able to eat again and too much tissue removed and the tongue becomes non-functional.

Ready to be draped in for surgery.


Ready for surgery!

Begin lasering.

After the mass was lasered off the tongue was sutured closed. The tongue is essentially one large muscle, and muscle bleeds readily. In order to reduce the normal trauma that the tongue encounters as it moves in the mouth and rubs against the teeth I had to close the surrounding tissue.

The tongue is sutured and the mouth should be much more comfortable. I expect that with a few days of antibiotics and pain management that he will be back to eating voraciously.

The tissue should be sent out for a biopsy to diagnose the lesion and help treat it appropriately. The biopsy will also assist in prognosis and future treatment should it recur.

To adress the chance that the lesion might be related to dental disease we cleaned and polished the teeth. Taffy's owners will also be instructed on how to brush them and be advised to do this daily.

Taffy is part three of the "wait until the last minute" mass removal. This series was written to remind us all that medicine is often a juggling act. We are always juggling risk versus consequence. The important thing to remember is that the plan will change as the patient changes. Don't be afraid to re-assess, re-think, and change course.

Be proactive and try not to use age as a reason to deny possible life saving treatment.

If you have any questions or comments about this blog, or any aspect of veterinary care please leave me a comment. You can also find me, and a whole bunch of other pet experts at We are happy to help you and your pet live a long healthy life together.

No comments:

Post a Comment