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.

OUCH!

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 Pawbly.com. We are happy to help you and your pet live a long healthy life together.

Puppy Mills Cruelty

Puppy Mills

I got a call from Grace at Animal Rescue asking me if I would look at a 7 year old Golden Retriever that they had rescued from a shelter. Animal Rrescue takes in so many dogs abnd cats that they provide spays and neuters to all of the pets that they adopt out at their shelter. When they were preparing to spay this dog they injected her anesthetic and proceeded to try to pass an endotracheal tube into her esophagus to provide her the oxygen and anesthetic gas to keep her under general inhalant anesthesia. For the Veterinarian we approximate what size endotracheal tube to use on the pet based on their size, weight, and breed. I have seen some toy breed dogs take a tube used routinely for cats. And I have had to use a tube three sizes smaller than I estimated on a bulldog.

As a side note: There are a lot of helpful anesthesia tips for brachycephalic dogs. I always have a long discussion with these owners prior to placing these guys under sedation or anesthesia. You should expect to pay more and be asking questions if you are not.

In the process of trying to pass the endotracheal tube the Veterinarian noticed that her vocal cords were abnormal. She also noticed that the size of the lumen (the opening of her airway) was significantly smaller than it should have been. As I have said before your body will respond to an insult (fancy medical term for damage) by scarring. Scarring in a tubular structure is called stricture. A stricture causes the tube to narrow. Her vocal cords were unable to open normally, (they open like drapes around a window) because she had been brutally de-barked.

When Grace called to ask me about this dog she was calling to ask if I could use our laser to try to remove the scar tissue that was like a webbing holding her vocal cords together. It is always very difficult to give an opinion on a case over the phone. I need to see a pet and understand not only the condition about which they have come in, for but also assess the pet, and in many cases the owners ability to follow through with any post operative care. I told Grace that I needed to better understand this dog’s condition by seeing her. I also told Grace that I wasn’t sure what she was talking about when she explained to me that she had a 7 year old dog that had been de-barked at the puppy mill. I had never heard of a de-bark being done by anyone other than a veterinarian. (This is a procedure that used to be done pretty routinely in the “old days,” thankfully it has fallen out of fashion).  Grace sent me a drawing of the dogs larynx as the Vet had described. She also went on to say that the way puppy mills de-barked was to “shove a pipe down their throat, to break the vocal cords.” I wanted to vomit. I couldn’t believe that people could be so cruel. I also couldn’t believe that I had been doing this for as long as I had and never heard of this. (Something about ignorance being bliss ran through my head).  I told her that I was appalled to hear about this girl but I would be happy to see her.

Thankfully she did well under anesthesia and recovered without any problems. It was decided that based on her age, her lack of clinical signs and how well she seemed to be doing that we would take a “watch and wait and see” approach.

My hope is that she will never need another surgery and that she will be with a family that loves her. She may have started out with a terrible cruel person who didn’t care about her, but hopefully she will end up with the exact opposite.

Puppy mills only stay in business because there are people willing to buy a pet from them. If you don’t know the breeder and you haven’t met and visited their facility personally please don’t support them by buying a pet from them. They will only stop abusing when there isn’t someone buying their product.

There is not much information available on de barking, but here is an interesting debate;
http://tinyurl.com/3rdfugb