Visiting Veterinarian : What if?
For several weeks Ketch, a cocker spaniel, had a small patch of thickened skin on her neck. Right around Christmas, the lesion began increasing in size. When it ruptured, her owner brought Ketch in for me to take a peek. The area in question was red, relatively flat but firm, with a central open sore discharging a little fluid. "She's running a low-grade fever," I said. "Could be infection or an allergic reaction to something like a spider bite." I paused. "Or it could be a tumor. We would need a biopsy to know for sure."
Her owner hesitated. "Ketch is almost 14. I don't want to put her through a lot." We agreed to treat the lesion empirically, and consider further diagnostics if it didn't resolve.
Two months later, the surface sore had healed, but what had been a small, flat lesion was now a very large, irregular mass. "It's probably cancerous," I said, sighing. The location could make surgery difficult, with all the blood vessels and nerves that run close to the neck's surface. On the other hand, the lump felt well circumscribed and not attached to the underlying structures. "We could remove it surgically," I offered. "Either here or by referral to a specialist."
Ketch's owner hesitated. What was the long-term prognosis? Would she also need chemotherapy or radiation? Did that make sense considering Ketch's age?
"For some types of cancer, surgery can be curative," I continued. "But it makes sense to gather more information before proceeding." I suggested getting a small biopsy using a local anesthetic. With a definitive diagnosis, we could make an informed decision about our next steps. It was Tuesday. I had a light schedule. "We could take the sample today," I offered. "The sooner we get an answer, the better."
"I need to go away in a few days," the owner responded. "Will that be a problem?" I assured her complications were rare as I walked her to the door.
Once Mom had left, I prepped the lump and injected a local anesthetic. I made a tiny nick with a scalpel, then inserted a Tru-Cut Needle into the mass. Unlike a "fine needle aspirate," which sucks a few cells out via hypodermic needle, the Tru-Cut Needle actually cuts a little tissue core, preserving the architecture. These biopsies are much more accurate than aspirates.
My first attempt yielded nothing but blood. "Hmmm, pretty vascular," I muttered and tried again. My third attempt yielded a decent sample. A drop of blood bubbled from the incision. I applied pressure. Blood continued to well up slowly. I packed the area with special hemostatic surgical material. No more bleeding. One suture and we were done. Ketch stayed the rest of the day for observation. I released her as we closed for the evening, her tail wagging happily. I was in a good mood, too - happy we had moved promptly toward definitive diagnosis - and happy tomorrow was my day off. My 11-year-old and I were taking an early morning ferry for a long-awaited mother-daughter outing.
Our Wednesday trip was a huge success. We went to Build-A-Bear, bought new clothes, ate Chinese food. My daughter actually talked to me. We took a late boat home.
The next morning, I awoke early and went into the office, as I often do, to organize my day. A fax from the night before sat in the machine. I read the report, sitting down slowly in dismay. Ketch had been fine all night Tuesday but on Wednesday morning had started to bleed again - a lot. The veterinarian on emergency call ran tests and treated her with fluids, medications, and bandages. Ketch began having seizures. It was suggested she go immediately to a 24-hour emergency facility with an ICU and specialists on staff, but in keeping with her earlier decision not to pursue "heroics," Ketch's mom opted to take her dog home for the night and hope for the best. I glanced at the clock as I finished reading - not yet 7 am. I decided to wait a few hours before calling for an update.