Wednesday, June 26, 2013

The Rule of Three. Casey's Catastrophic Cyst

This is part two of three of the "wait til the last minute" mass removal series.

One of the most common surgeries that veterinarians perform (outside of the spays and neuters) is mass removals. What we term as 'masses' are any abnormal growth of tissue. They can, and in most cases, are usually benign growths that are usually nothing more than cosmetic annoyances. This is not stated to diminish or negate the importance of having your veterinarian look at any growth that your pet might have. It is essential to have a strong bond built on trust with your veterinarian. They should be able to help you make decisions that are in the best interest of your pet when deciding which growths to remove and which to let alone for now with a "watch closely and keep us posted" attitude.

All three of the pets in this series were pets whose growths were watched for extended periods of time. Each case and each mass is different, but each client was very very concerned about the age of their pet and the effects of the needed anesthesia to be able to remove their masses. Deciding to put your elderly pet under general anesthesia is incredibly stressful and gut-wrenching for many owners.

I remember the turmoil and fear I had each time I had to spay, neuter, or do a dental on my own pets. I had to clear my whole day, and warn all of the staff that I was a nervous wreck about putting them under. For my beloved Wren I almost cracked. I get the stress and the fear, I do. I admit it to my clients and I only recommend anesthesia if it is necessary.

Casey is a 14 year old black lab. She is a smiling, wagging, happy girl. She has no idea she is old, she lives in the moment. We should all so lucky, and we should all have that outlook. (Oh, the lessons we learn from our dogs). She lives for her daily walks and her parents adore her.

She has been coming to see me for years. Every year we discussed the mass on her back and every year we decided that it was not bothering her and that the risk of general anesthesia to remove it did not warrant the ugliness of having to look at it.

That was until we got a frantic call from Casey's parents last week. They called panic stricken and asking for an emergency office visit because the mass had "burst." The receptionist tried to convince them to wait until the next day, as we were already booked, but they decided that they were headed over and we would fit them in. They were afraid that Casey's bleeding was too severe and that it would be dangerous to wait.

Our policy is to see every patient that needs us, and in all cases IF the owner thinks it is a big deal AND needs to be seen immediately it is a big deal AND it will be seen immediately.

Casey and parents arrived in very quick order. Casey wagging and happy and parents obviously concerned.

The mass had been simmering and festering for years. But at this point the previously quiet mass had reached critical mass and it was spewing its contents all over Casey's back. They wanted me to bandage it and they were here to talk long term options with respect to maintaining that bandage.

The cold hard reality is that this mass was not going to be bandaged. This mass on the top of his back was about the size of a baseball. When a tumor (in reality every mass is a tumor) gets large enough that there is no longer any normal healthy tissue to allow it to heal it will bleed and not stop. It is impossible to close a tumor with any kind of suture, or bandage, or staple. A tumor will turn into a festering pile of hamburger, and that tissue is friable and unyielding to healing.

I slowly and calmly told Casey's parents that we were at a fork in the road. It was time to talk about surgery or trying to manage a wound that would never shut up for very long.

They listened and listened and tried only twice to convince me to try a bandage.

Scrubbed and ready for surgery.
After a quiet discussion it was decided that the only way to have a hope for a long term manageable solution was to surgically remove the mass.

After a thorough examination, radiographs of the chest (to look for metastasis) and abdomen and a full blood work and urine we decided to go forward with the surgery.

The day of Casey's surgery she was brought in and left behind by some very very worried parents.

For Casey's surgery we placed an i.v. catheter and gave i.v. fluids for the few hours before her surgery. She also received an NSAID for pain and inflammation and an antibiotic.

Casey's surgery only took about 20 minutes. She did great under anesthesia and it was a relief to see her so calm and steady. She had a strong regular heart beat and breathing pattern. I was so relieved to hear the monitors beeping steadily and the breathing bag full and rhythmic.

Removing the last piece of subcuticular fat to take the cyst off.

The removal of the mass left a large elliptical shaped hole.
Thankfully, Casey has more than enough extra skin to close the incision.

Starting to close the incision.

The post-op product is a 6 inch incision, sutures, and a few staples. After care involved warm antibiotic compresses and antibiotics.

The mass is gone and Casey is wagging and walking within a few hours.

I know it was a very hard decision for Casey's parents to make, and I know that we were very lucky that Casey did so well. But, there was no good option other than to try.

With a significant amount of pre-op preparation and planning we went into Casey's surgery with as many favorable indicators as was possible.

Casey is still the happy beautiful girl she always has been, bit now she doesn't have to have a draining open wound prone to recurrent or chronic infection.

I wish them all the very best of luck!

If you have any questions for me, or any pet questions at all, please visit me, or the bunch of us, at Pawbly is free to use and open to anyone and everyone! Or find me on Twitter @FreePetAdvice, or on Facebook.

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