Wednesday, November 18, 2009

A Difficult Call

Dr Bollenbeck found a mass growing inside this dog's eye (the pink circular mass in the center of the picture). This 10 year old is a great companion and belongs to one of our best clients. The location of the mass was a little unusual but the appearance strongly suggested cancer. After an extensive search to make sure that there were no other tumors elsewhere, a decision had to be made about surgery. Should the tumor be removed (which means removing the eye), or should we watch the mass to see if it grows? Fearing that further growth might cause it to spread outside the eye, the decision was made to remove it. Good thing we did, as the biopsy revealed a carcinoma. A difficult decision but the right one for this dog's long term health.
This case highlights a unique aspect of veterinary medicine. Our patients experience little psychological stress from the loss of eyes, ears, limbs, teeth, testicles or ovaries. As dog and cat lovers, we are often affected more by the resulting change than they are. Pets, if they are pain-free and can function socially within the family, live pretty contentedly regardless of their appearance. Just look how happy Pugs are!


Believe it or not, these are just some of the bladder stones from one dog. I've only seen 2 dogs in 20 years of practice with this particular type of stone. Most stones are made of calcium-oxalate, magnesium-ammonium-phosphate or urate. These unique stones are silica and have a "jackstone" appearance. Noone knows why some dogs get them. This patient had several lodged in his urethra and was quite painful. Fortunately, I was able to use a technique called urethrohydropulsion to flush them back into the bladder where they were easily removed. Without this technique, they have to be removed by an incision into the urethra with a resulting painful, complicated recovery. Few men wouild have trouble sympathizing with this dog, but the good news is that he was feeling great within a few days!


One of the reasons to wait until 6 months to spay or neuter a dog or cat is shown above. The upper canine tooth (fang) has come in, but the baby fang behind it never fell out. This is an extremely common problem, especially in toy breed dogs, and will be apparent by 6 months of age. This is when most dogs would have had the permanent canine teeth erupt. While pets are under anesthesia, the baby teeth can be extracted, eliminating the crowding of the teeth. This is a delicate procedure since the baby teeth enamel is very thin, but one that pets recover from very quickly. Neutering or spaying can be done as early as 12 weeks of age, but if retained baby teeth have to be removed later, there is the additional cost of a second anesthetic procedure. Worse, pet owners may not notice the retained teeth, and the problem may not be addressed until the next exam. By that time, damage to the teeth and gums may have occurred.
The orange tube delivers oxygen (see the nice pink gums!) and anesthetic and allows us to "breathe" for our patient as need. The rubber bands help to gently hold the tube in place while being easily repositioned during the extraction. A nerve block has been done (hidden by the upper lip) to minimize any discomfort from the extraction.

So that's a lipoma!

Many who have had a dog with a few extra pounds around the waist have seen lipomas develop under the skin. These are benign, slow growing tumors. Ususally we recommend leaving them alone, but occasionally we'll remove lipomas that are in awkward locations like the axilla (armpit). Frequently, these lipomas are encapsulated and come out in one large "glob". This is an example of such a lipoma. It was fist size and probably weighed 2 pounds. It is surprising how little blood supply there is to these tumors. In fact, the major surgical challenge is eliminating all the space that the lipoma took up so that the space doesn't fill up with fluid after surgery. There is no liposuction done in dogs, but this comes close!


This was a satisfying surgery on a rat with an ear tumor. Fortunately, the mass was attached to the margin of the ear, so I was able to remove part of the ear without having to compromise the canal or any major blood vessels or nerves. The black device is a mask that delivers the anesthetic gas. A little lidocaine cream on the surgery site kept this rat from scratching at the ear when it woke up. Total time: 10 minutes! (The length of anesthesia is critical--small critters cool off and can get dehydrated pretty quickly.)