Up Against A Wall. (Warning this blog contains graphic surgical slides).

For some odd reason that the universe refuses to make clear to me I have found myself week after week sitting in an examination room with some ancient old pet and a couple in tears torn to pieces about what to do next.

It is a deja vu I cannot seem to escape from.

How do these situations keep recurring...well, that I actually know the answer to. These old guys are walking the tight rope of time versus disease.

They have all had some small seemingly insignificant thing show up months ago. We examined, discussed it upon its arrival, and collectively decided to wait and watch. After all surgery requires genrral anesthesia and the older you are the harder it is to recover from and the riskier it is. I understood their reservations, concerns and conservative reasoning. I have a seventeen year old dog Savannah, and I am not sure that there could be any reason that I would consent to putting her under..(Oh, Krista, don't tempt fate).

At the onset all of these mysterious bumps were little and unassuming.

Kayla is a fourteen year old lab. She is big but gentle. She lives with a retired couple and they have mutual adoration for each other. They schedule their day around Kayla's walks, naps, breakfast and dinner. They need each other and they are very emotional about the idea of Kayla aging.

Kayla came in about 6 months ago with a small bump on her knee. At her first appointment we decided to wait and watch. Now half a year later, Kayla is fourteen and a half and her little bump is a big softball sized mass that precludes her from walking comfortably. Her mom had called me half a dozen times to schedule the dreaded surgery and had cancelled it about as many. I knew how nervous they were to bring her in and leave her with us.

After the third surgery cancellation I called then and said to just come in with her to talk about a plan.

Kayla's mass was big. It was burdening her old stiff joints, and most troubling for me it was about to wear through the stretched  thin skin covering it. I discussed how imposibly difficult it would be to manage this open wound once it ruptured.

We were up against a wall. None of us wanted to be there, but a decision had to be made.

Plain and simply if they didn't do the surgery they would be putting her down because of a chronically bleeding open to infection wound.

With tears streaming and unable to speak they agreed that something had to be done. We had avoided this and now the decision was inevitable.

Argh, how I hate the pressure of this. This is why so many vets hate surgery..You try to carry the burden of someones love on your shoulders..all I can ever tell them is that "I will do the best I can to send their beloved pet back home at the end of the day."

Kayla pre-op.
She doesn't look nervous, does she?
I was for her, and her mom, well, she was in the reception area sobbing.
I gave her a quick hug, tried to re-assure her and ducked out.
Crying, emotional parents don't make a tough, stressful surgery easier.

The mass is starting to wear through the skin.

Under anesthesia and beginning the surgical clip and sterile prep.

In preparing for Kayla's surgery there were a few important things to address before we decided surgery was her next best option. She had a complete blood work done. THIS ALWAYS includes urine. Turns out Kayla had a urinary tract infection. She was placed on antibiotics for two weeks before we did her surgery.

Kayla also had pre-op full thoracic radiographs. IF she had evidence of metastasis to her lungs her prognosis would have been affected negatively. We take thoracic radiographs to look for the soft tissue structures that indicate a presence of a structure that should not be in the lungs. The lungs are supposed to be black (air filled) and if we see patches of round white areas it can be evidence of the cancer spreading. There is also a belief that the anesthesia is immuno-suppressive and can also "turn on" the cancer cells, and therefore, speed up the spread and/or growth of the tumor cells. All of these are critical discussions to have with your vet.

 I like to use the laser because it cuts very quickly, has minimal bleeding and gives me a quicker recovery. It is more expensive but between the cost of the laser and the decreased surgical time they about balance each other out.

TAH-DAH! Removed!

Thankfully Kayla had enough skin to close the incision after the mass was removed.
For pets with large masses, or in areas with little extra skin this can be a huge problem.
ALWAYS have an exit strategy when you start your surgeries!

Waking up.

One week post-op..
Incision healing well, very happy parents.

And still Kayla doesn't look worried.

And me, well, I go home, go for long walks with the kids,, the dogs,, and the cats, drink a glass of wine, and then worry about my family ruining my profile pictures.