Surgical options

[MPbandmom]

Sky has an odd swelling on her left rear leg on the inside. It is as if the muscle doubled in size. A dead tick was found in the middle of the swollen area. Anti-inflammatory, antihistamines, and antibiotics don't seem to have made any difference. She was seen by the local after hours vet service around here because our regular vet is a mobile vet clinic and mainly does maintenance type of services and is normally booked up a couple of weeks in advance. The after hours vet prescribed the Anti-inflammatory and antihistamines and the regular vet prescribed the antibiotics a couple of days later when I contacted her to be certain she had received the report from the emergency vet. (She reported that she had not received a report.)

After 5 days, I again contacted the regular vet to see about how long to continue the antihistamines, the anti-inflammatory were only for 5 days. There was no change and I wondered who should do a recheck and when? Regular vet advised a return to emergency vet as she had still not received anything from emergency vet on the case.

I returned to the emergency vet who collaborated with a couple of "referral only" surgery vets located in a trauma and surgery center next door to the emergency vet's office. Their conclusion was that the swelling is a mass that I have missed and only now discovered and that the antibiotics are unnecessary because her white blood cell count is normal. I have continued the antibiotics because it just seems strange to me that there was a tick smack dab in the middle of the swollen area and since I have the medicine already, it might as well be utilized for it's intended purpose.

The recommendation is that I wait a couple of weeks and then have a surgical biopsy conducted using one of the board certified vets at the referral center. A friend from the samoyed club has referred me to a practice about 30 to 45 minutes away that is a combination of vets with a variety of specialties including oncology. So this is likely someone of similar or perhaps superior training and experience with removing masses from dog's back legs.

Every test they have run so far has come back perfectly normal, blood work, x-ray, 4 needle biopsies. There is no pain nor fever associated with the swelling. I know there can be benign masses and I have to say that I am reluctant to go the surgical route when I have yet to be shown any evidence of some disease process at play. Other than the swelling of the leg of course. I have been told that a biopsy won't just be a little take part of the mass or muscle for testing. That if there is a mass, it will be removed in its entirety if possible to avoid having to go back and do it all again. Which makes sense. I have also been told that I want to go with a board certified surgeon because of the large number of nerves and the blood vessel being right on top of the muscle, and "you never know what they will find once they get in there."

OH has been doing internet research. Mr doom and gloom has discovered that labs are prone to growths. That they are impossible to remove in their entirety, and they repeatedly come back. That the only way they will be able to resolve this issue is to amputate her leg and we aren't going there. He has also said, "You know it's cancer don't you?" Well, no I don't. As I said so far everything has come back normal.

While I certainly want to remove something such as a cancer, I don't want to remove something unnecessarily that isn't a cancer. If this were your dog, what would you want to know before scheduling surgery? If this were your dog, would you have scheduled surgery already?

[Nettle]

What I'd do isn't necessarily what's right or what anyone else would do, but having done all the preliminary stuff with no diagnosis and assuming the dog is acting normally, I wouldn't do anything apart from finish the meds.

Reason being you do not have a diagnosis, you do have a middle-aged dog, she doesn't seem distressed by it so it's only the humans who are, and it will either stay the same or get better in time (in which case why put her through so much stress?) or it will get worse until you have a diagnosis.

I think your professional medics don't know what to think of the tick contribution and are therefore going back to what they feel happy with as a normal procedure (back into their comfort zone). But it does sound as if the tick is important.

What's the worst thing it can be? Cancer. If it is, there is nothing you can do. If it isn't, chances are it is more cosmetic than serious.

But please be clear I am NOT recommending to you what you should do. Simply that it is what I would do. "Wait and see" is always an option.

[JudyN]

I would be asking what the downsides to surgery are. There's the risks inherent in anaesthetics of course, but what are the risks of nerve damage? And if the mass turned out to need removal, what are the chances that it would come back again meaning that the surgery had little benefit? Also how long would recovery take and how stressful/painful would it be for Sky?

To me it's a case of weighing up the probabilities and the costs/benefits, but that's never as simple as it sounds.

Don't pay too much attention to Mr Doom and Gloom - it's amazing how minor symptoms can turn into terminal illnesses with a bit of googling

[Ari_RR]

I am with Nettle.

[MPbandmom]

I feel definitely inclined to wait the recommended two weeks even though the emergency vet's office called on Monday asking if we had considered the surgery yet and contacted the recommended surgeons. I am leaning towards contacting the vet recommended by my friend for a second opinion or recommendation. I also plan on contacting another friend and discussing with her. I am mainly trying to acquire as much knowledge as I can from experienced dog people as to what things I should ask and know before I commit to surgery should I decide to go that route. I forgot to mention that emergency vet also ran a couple of quick sonograms on the leg and like everything else, those showed nothing abnormal.

I am certain the referral center has quality doctors, but I know absolutely nothing about them. The only way I even know of the referral center's existence and a little bit of what they do there is a result of a friend of my son's committing suicide in the home of another friend during a party and the mother of yet another friend pulled together a bio-hazard cleaning crew to clean up the friends house. She was able to do this because she worked at the referral center and had the knowledge and availability of the appropriate chemicals and technique to accomplish the job. She commented that they get the really bad cases like the dogs hit by cars and the building was pointed out to me. If any building wanted to blend into the background and be invisible, that is one.

I could potentially ask her for her opinions on the doctors there, but unfortunately she isn't one I would consider amongst my friends and to be honest there were moments when I gave serious consideration to calling and reporting her to the police. In her mind she was doing the right thing and was being a very caring parent and watching out for all of her children's friends. The only reason I didn't call the police was that I felt there was some element of reason to her thinking and I figured if I could attend parties as a teenager and not join in the boozing it up, my son was also capable of making that decision for himself especially in light of him having been told to avoid alcohol because of a strong potential genetic predisposition to become an alcoholic.

I don't know anybody who has taken their pets to these doctors at the referral center. One is only referred there by another vet. While they have seen Sky, I haven't seen them. I just have two names, one with a bunch of initials behind the name and another with just the usual DVM, where it was my understanding that I was being given referrals for board certified vets.

Then there is the vet referred by my friend. If I am correct, I have met this vet at a scootering clinic and helped her get set up to do some scootering with her terrier. A larger terrier, don't laugh, I think that terrier was the best beginning scooter dog there. So instead of faceless names in an email referred by a vet I have only seen a couple of times, I would be going to someone I have met, whom I believe provides services for several members of the samoyed club, not just the one friend. I could be wrong, the vet I met could be a reproductive specialist which wouldn't be what I was looking for, but I have time to chat some more with club members and get that part figured out. There is conveniently a club walk this weekend. Sky and I plan on attending.

I just really hate the idea of putting Sky through surgery just because the vet's can't figure out what is wrong and want to get a closer look to see if they can figure it out. At least that is what I feel like the surgery recommendation comes down to. There is obviously an enlarged area on the leg defined by the muscle boarders and every other test they have run has given no indication as to why.

[MPbandmom]

https://www.facebook.com/photo.php?fbid ... 065&type=1
https://www.facebook.com/photo.php?fbid ... 079&type=1
https://www.facebook.com/photo.php?fbid ... 079&type=1

Pictures of Sky's leg before and after shaving if anyone wants to see.

[Nettle]

I'm thinking of questions you could ask, and I'm sure others will have some too. What a sensible dogmama you are.

What information would surgery give you?
What are the various possibilities of what it could be?
Might this be an extreme reaction to the tick bite?
What are the treatment options for these possibilities? The risks?
What if we keep the lump under observation for now?

[MPbandmom]

Thanks Nettle,

That gives me a good start and a few more questions have popped to mind.

I have been researching the two possible treatment centers online. The local center that I have been referred to has 2 surgeons, one board certified and also has a linked internal medicine practice in addition to the emergency practice. There was also mention of holistic medicine, but that link didn't work.

The center referred by my friend has vets boarded in about 10 different fields of specialty, dental, surgical, internal medicine, oncology, physical rehab, emergency, and more. One also has to be referred there by one's regular vet except for the emergency practice.

This difference could in part be due to the affluence level of the two different areas. Our area would rank as a lower income less populated area in comparison to where the other practice is located.

It looks like if I were to take Sky to the local surgeon, I would get just that, a surgery. If I took her to the other center, I would possibly also get a surgery, but depending on how invasive the surgery was and what the prognosis was, there would be other specialists to take up her care after the surgery. Of course, I also envision spending much more time and money at the center recommended by my friend. I do have concerns as to just how much time and money. While I certainly want to do what is best for Sky, I do still need to be able to feed her and pay the bills when this is all over with. We are also heading into warmer weather and I wonder how many long road trips in a potentially hot van stuck in traffic will be required. At the same time, I am not one to say "what if" and not seek the answers.

After hopefully having a chance to learn more from my friend this weekend. I may next be checking with my regular vet to see if she would have a preference as to which center Sky might go to. I have to admit that now that a week has passed with no real apparent reduction in size of the area, I am wondering more and more if it has really been growing for an extended period of time and I just didn't see it. She has a few more days of the antibiotics.

[MPbandmom]

Today I had a couple of "dog" people look at Sky's leg during a club walk. One of these people was a "human" doctor. I got a very quick lesson in what things should be done as far as some of the procedures that have been done on Sky and what types of results I should be receiving from those procedures. I also learned what things to ask for to take along to seek a second opinion. It was confirmed that I should be seeking a second opinion and someone more familiar with such conditions. I also learned some anatomy of masses. I am fairly certain at this point that surgery will be in Sky's future, but I am armed with more questions to ask the emergency vet before I make a decision on when and where the surgery occurs.

I am not totally closing the door on the local surgeon yet. There are positives about the local surgeon like their location being a mile away from home as opposed to 30 miles away from home. If there are rehab and oncology services available elsewhere in the local area if necessary, then there may be less reason to travel to the other center. Travel to the other center may end up falling strictly to OH to do as things would likely have to be done while I was at work. I think I might want to be more closely involved.

[Nettle]

Good work! Sky is lucky to have you batting for her. The closer surgery sounds a good bit of thinking. Fingers crossed for you.

[MPbandmom]

We have surgical consult appointments set up. I was rather surprised to find that one fasts one's dog before seeing the surgeon and having the surgeon tell one what s/he thinks, would recommend/do. A morning appointment leads to afternoon surgery. An afternoon appointment leads to morning surgery the next day. Assuming the surgeon determines surgery is indeed necessary.

We are altering that schedule a bit. We have an appointment with the local surgeon on Tuesday and the further away center with the greater variety of specialists on Wednesday. OH and I will both go to the Tuesday appt. OH will have to take Sky by himself to the Wednesday appt.

The local center says fast for 14 hours and no water for 10 hours. The further away center says fast for 12 hours and water is okay. Sky is likely to not be very happy with us not feeding her breakfast two days in a row. Keeping her away from water will likely require crating since the other dog and cat will need access to water. It has been rather warm this week and due to continue, so I am glad that the further away consult allows water consumption.

I have my questions prepared on index cards. I have Nettles suggestions, a few of my own, and some suggestions from a friend from the club.

I will update after the consults.

[Erica]

Good luck for all of you!

[Nettle]

I would not fast/withold water. You don't need to be shanghaid into surgery that day. You need your questions answered, options offered, prognoses discussed and then you need time to think it over. IF you go for surgery, it has waited long enough that another few days won't make any difference. This smacks of hard sell to me.

[MPbandmom]

I wondered if the fasting would still be desired. I don't know if they would want to conduct some test that hasn't been done yet that may require anesthesia. So far she has been wide awake while they did the x-ray, needle biopsies and sonogram.

The local center specifically said, appointment and meeting with doctor in morning dog has surgery in afternoon. When I called back and said we would just be doing the consult, I didn't think to ask if the fasting was still necessary. I was more concerned about with holding water with the warm temperatures. Because of her anxiety, she tends to pant quite a bit while out and about and thus makes herself quite thirsty.

I specifically stated that I was calling to schedule a consultation when I contacted the further away center. They said nothing about surgery.

The fasting will be trickier with the local appointment, but if I take her over to the park to play some fetch and have a walk about, she should be contented and we can feed her when we get back home. OH will have to leave fairly early for the further away appointment, most likely before Sirius has breakfast.

I think I will still do the fast just in case, but still give her access to water.

[MPbandmom]

Two surgical consultations completed. After the first one OH was dead set against surgery. Asked to order a supplement he had found online containing alfalfa and other such ingredients that was said to shrink lymphomas such as what this has been diagnosed to be.

Today OH took Sky to the second consult and came away with a much different opinion. He felt the second surgery center put much more effort into identifying the mass and explaining to him that diet changes or supplements will have no impact on it whatsoever as it has nothing to do with diet.

Sky is scheduled for surgery at the further away location next week. We are to keep her confined to one level of the house and no jumping and such for 2 weeks. This should be fun. My plan is to remove the couch from the "den" and put a couple of mattresses on the floor from daughter's room and then put a baby gate in the doorway. That way I can sleep down there with her to be certain she is doing okay and there won't be any furniture for her to try and climb up on. Sky believes couches and chairs are placed around for her comfort. We refer to both of our upholstered living room chairs as "Sky's chairs." She won't climb up into the rocker though.

Keeping her in and on reduced activity once she is feeling fine will likely be a challenge. She isn't big on brain work. She will lick peanut butter out of kong toys for an extended period of time. So we will have to keep a supply of those in the freezer. We will likely have a very pouty husky though.