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.

The Rule of Three. Casey's Catastrophic Cyst

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

Casey.

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!

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