When in Doubt, Cut it Out (or at least part of it)

As the owner of multiple rescue animals and a continual stream of fosters, it seems like I am in my veterinarian’s office weekly.  During a recent vaccine appointment (categorized as “tech visit” as the DVM is not involved), I showed the vet tech a lump on Gemma’s right hind leg. For those who are interested, Gemma is a 3-year-old “Sato” which means mixed breed “mutt” that I took home with me from a yoga retreat in Puerto Rico when she was just 8 weeks old.

After the vet tech gave Gemma her vaccine (and a treat), she looked at and felt the lump (without commenting) and told me that the doctor had a full schedule, but she would ask him to “stick his head in for a minute.” A few moments later, the doctor came in, palpated the lump, and told me to make an appointment soon for him to aspirate fluid and look at it under a microscope.  I thanked him for taking the time to come in and scheduled the soonest appointment which wasn’t for another 2 weeks. During that time, the lump began to drain (bleed) on its own but did not decrease in size. Gemma did not seem to be bothered by it.

When it came time for the appointment, the vet carefully aspirated fluid from the lump, placed it on a slide and took it into another room to view under a microscope. A few moments later he returned and explained that he was clearly able to see “mast cells” meaning that Gemma’s lump could be defined as a “mast cell tumor” (cancer). He then went into a brief explanation about these types of tumors, recurrence rate, the recommended surgical procedure and how an excision site larger than the tumor itself would be required for best chances of “clean margins.”

I nodded as I understood from years of experience watching lesion excisions that required substantial elliptical cuts. The difference here was that following the procedure Gemma would have to wear a cone around her neck (in order not to lick the sutures or incision site) instead of a surgical shoe or walking boot.

We are now in the process of scheduling her procedure and I am hopeful that the outcome will be positive. I am glad that I mentioned Gemma’s “lump” to the vet tech and that she made it a priority to bring it to the DVM’s attention right away. I will keep you informed once Gemma has her procedure and pathology results are reviewed.

In the meantime, please have ALL your patients remove both shoes and socks and roll up their pant legs no matter the reason for visit. I urge you and your staff to respond quickly (without alarming patients) if you notice any type of “lump, bump, or discoloration” during an exam or if a patient asks you to “take a look at something” unrelated to the chief complaint. Make the time and provide patients with a definitive diagnosis rather than an educated guess. Many of my doctors have been following this “when in doubt, cut it out (or at least part of it) philosophy for years and have saved the lives of countless patients. Please do the same in your practice.

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