Monday, January 26, 2015

The Bump That Gets Too Big. (Warning; Surgery Scenes). Why a team approach will always tilt the odds in your favor.

This is Cody's story.

He is an older Springer Spaniel who has been visiting me for the last four years. He came to me seeking a second opinion because his primary veterinarian had given him a very poor prognosis and no plan.

Now, I am a realist. Medicine is about statistics... (by the way, I loathe statistics, numbers; boring, scenarios; boring, population studies; boring, math..well, you get the picture), but as much as it is boring it is a factor in guiding our decisions and our recommendations. Veterinarians look at the physical exam findings, lab work, and then decide which diagnosis fits your pets billet. From there we discuss treatment options and  their corresponding most likely prognosis. To many clients it is a difficult wad of information to chew on and digest, never mind to try to make a decision upon.

My job, as your vet, is to help you all understand your pets ailments, options, and decide where to go with them.

Some vets do this better than others. If your vet, (who I will almost guarantee is one smart cookie), cannot adequately articulate and help you understand which direction to head in, or even worse, if they cannot give you any options, or sign of hope, it's time to rethink the value they add to that relationship.


Cody's parents did not want to give up on him. At eight years old he was their kid and they felt he had a few years left ahead of him. They came to visit me and we laid out a plan this included a change in diet, a nutritional supplement, carefully planned scheduled monitoring (which includes a plan for Best AND Worst case scenarios), and access to me, or any of the other veterinarians at the clinic to help when the plan changed, as it inevitably will.

Cody has a plan, a clear written list of items for his family to do at home, a schedule to follow and a support network to utilize if anything comes up along the way that his family needs assistance with.

That was over four years ago.

Over those four years Cody has blown two cruciates, had them surgically corrected. He has beaten the odds at every challenge. He has an army fighting for him, and we all know that the odds always shift in your favor when you have a team approach to your problems.

Cody was visiting this time because one of his many bumps had gotten rather large and worrisome.

Like many dogs Cody has gotten a little lumpy as he aged. We have kept track of all of them, monitored them closely and none have changed size, shape, or texture. Well, that was until this one. Cody's previously thought to be a lipoma (benign fatty tumor) had all of the sudden gotten much bigger. It had evolved from golf ball sized to bigger than softball.

Cody's mass is on his lower neck/upper chest area. It is firm, round, and felt as if it was adherent to the underlying tissues (in other words I was not able to get my fingers underneath it and pull it away from the muscle). The skin covering the mass was very red, had visible blood vessels and the hair was beginning to wear off. This is a sign of the mass being either abraded by the surfaces that he is laying on (thereby wearing off of the hair and causing the skin to thin), and/or the skin is being stretched to the point of beginning to tear). Either scenario is a problem.

We discussed Cody's current predicament.

His family had come in because they understood that something had to be done.

Their options were;
1. Do nothing. Not a good one, because unless we thought Cody had only a few weeks left that mass was going to open and we would have a heck of a time (I used the word "impossible") keeping it from bleeding continuously, and/or it could become a source of infection. It is impossible to keep these kinds of masses bandaged, and even keeping as bandage on does not prevent infection. Chronic bleeding will lead to anemia and there is no permanent way to treat this without stopping the source of the bleed. You will end up with your back against a wall deciding whether to euthanize your pet because you cannot manage an open and non-healable mass. Don't wait for this. don't euthanize your pet without trying to heal them.
2. Take it off, cross your fingers that you can close your incision and remove the cancer in total just in case it is a tumor that can spread. to other parts of the body. Plan and hope for excision to be curative.
3. Perform a fine needle aspirate and/or biopsy.  We do these to try to identify what the mass is before deciding which step to take next. Sometimes we classify this as "de-bulking" because we feel that we cannot get the whole mass removed cleanly.

Cody's family opted to take off the mass before it opened up and became a big messy problem.

That same evening in addition to Cody's physical examination we checked a CBC, full chemistry, urinalysis, and three view chest x-rays. 

Thankfully, everything was normal. Cody was scheduled for surgery the following week.

I have to admit that I was pretty nervous. None of us want to admit to being paranoid, but I was afraid that I had pushed my luck too far with Cody already. This was the sixth "older dog not really sure what I am going to find mass removal surgery" in about as many weeks. Could I really be so lucky to not have one of these guys NOT make it through surgery?  And, damn it, I liked these clients a lot,, we had been through too much together already.. weight of the world on my shoulders we went into surgery.

They always look waay more ominous when they are shaved.

The first big sigh of relief. The preliminary exploration of the mass and it all appears to be fat!

Now all I have to do is get my fingers all the way around the big ball of fat, hope that they don't encounter any big angry blood vessels and get this thing off.

The lipoma is off, and I have enough skin (always think about this before you place scalpel to skin) to close the incision. Almost nothing is worse than having a bigger problem after surgery than you did before because there is too much tension, or, it takes months and months to heal because you didn't have a good exit strategy.

A big mass always leaves you a big hole.

Starting to close is more technically challenging than any other part of this surgery..

In the end there is a large incision. It always looks worse after than it does before,prepare your clients for this.


A closed incision must be able to maintain function. Expect some pocketing, some bruising, and monitor very closely for any signs of infection. Some pets need to be hobbled. We bandage the front legs together so they cannot splay open accidentally, or otherwise, and put excessive stress on the incision.

Cody recovered well and seems to have once again proven that if you have a team behind you, and you face the challenges life throws you head on with them, anything is possible!

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If you would like to follow me on Twitter I am @FreePetAdvice. Or find me at the clinic Jarrettsville Vet, in Jarrettsville Maryland.

This is my team.. resting for the challenges life might throw them..later.


  1. This comment has been removed by the author.

    1. Hello,
      I think that all of the US schools are very good and the only slight differences lie in what your plans for after vet school might be. Each school has their own nuances and strengths, for instance, large animal surgery, research, welfare, oncology, etc.. If you are certain that you want to specialize after vet school this may be important to you. If not, I would strongly suggest you choose the most affordable school amongst those you are accepted into.
      Knowing someone there is not going to help you much. The application process is rigorous and unbiased wrt "who you know". Spend some time at each of the schools and know that you will get a very good education and meet people you form life long relationships with. This is irrespective of location or school.
      Good Luck.. Read my blogs on vet school.. this is a terribly difficult job where you will likely never be paid what you deserve, work yourself into burnout, struggle to pay back a debt that has a very poor return on its investment, and face the highest suicide rate for any profession. There are are many women who leave, struggle, and regret being so determined to becoming a vet. It's hard..and it's a decision to not take lightly.
      I'm sorry, I have to be honest.
      Best of luck in whatever you decide to do.