Don’t Forget Your Dog at the Veterinarian

When booking a new consultation with me, pet Guardians often ask if it is necessary to bring their dog to the appointment. From their point of view, they are often concerned about the stress of the visit on their pet, or maybe the travel itself.

But from my point of view, a consultation without the pet is like a visit to the pediatrician without your toddler. So, yes, you should bring your dog!

In some ways I am happy that someone wants to meet me and listen to the overview of their pet’s cancer and ask questions. Educating yourself about your pet’s cancer is important. But the visit is so much more than hearing about an overview of the how the cancer presents, behaves, treatment options, and prognosis. I also review your pet’s medical record; including previous history, previous tests and the cancer cytology or biopsy report.

But a critical part of the consult is my personal evaluation of your dog.

For example, if a mast cell tumor has already been removed, but the surgical margins are narrow or incomplete, I can only discover if a second surgery is possible with a physical exam. I need to see the previous scar on your dog. I may lift the scar, and see if we can remove more tissue.  I may even show the dog to our surgeon so see what she thinks and decide if surgery is even an option. If she says no, I just saved you the time and cost of a consult with the boarded surgeon.

Or, I may feel a small mass already coming back at a scar. If the tumor is back, it changes the recommendations. I only can determine that if I examine and feel the dog in person.

Measuring Is Key

I’ve also had cases where the biopsy report lists a soft tissue sarcoma (STS) as completely removed, but the vet notes the mass was 2 cm and the scar is 3 cm. Well, we need 2 to 3 centimeter margins AROUND the tumor … so a 2 cm STS should have an 8 cm scar. I will literally measure scars to make sure that they are actually as complete as reported on lab reports. If not, it’s unlikely the margins are clean and recurrence may be likely. And if that’s true, we need to know, so we can make the best plan.

I may also need follow up tests, like an ultrasound to monitor progression of an abdominal mass or to get a baseline.

Finding Other Tumors

Just last week, I saw a dog with a mass in the bladder, most likely a tumor called transitional cell carcinoma (TCC), based on the ultrasound at the primary vet. Penelope had the classic signs of TCC – straining to urinate and blood in the urine. The vet said the mass was not in the trigone area, which is great, because then we could remove the tumor with surgery before starting chemo. (Many tumors are in the trigone where all the nerves and the urinary tubes that connect from the kidneys and out the urethra. This area is usually inoperable.)

From the ultrasound at the primary vet, it looked like Penelope was a surgery candidate.

To be safe, I recommended a repeat ultrasound. This time the boarded internist not only saw the mass in the non-trigone area but also a larger mass in the urethra, the tube through which urine flows from the bladder to the outside.

Unfortunately, that discovery meant surgery was definitely not an option. With this new info, I changed my recommendations and we discussed medical management like NSAIDs, chemotherapy, and even a stent to keep her peeing if she gets blocked.

So Penelope’s prognosis and treatment options all changed based on the exam and tests. If she hadn’t been physically present, we might have gone ahead with a surgery that would be unnecessary and not even treat the larger mass.

Finding Metastasis

I may also discover something new on the exam, like an enlarged lymph node. If we aspirate that lymph node and find the cancer has metastasized (spread), it may change the prognosis and recommended diagnostics and treatments. If a cancer has spread to the lymph node, we may need to have it removed, radiated, or it may be the reason we add chemo.

Finding Other Problems

Without the patient, we could also miss other problems, like a fever, an infection, a heart murmur, or a lameness so severe that it changes recommendations.

Just yesterday, I had an appointment with Lady, a 11-year-old Russian Blue Terrier. She came to discuss CyberKnife radiation for her recently discovered aggressive bone lesion in her humerus (shoulder), consistent with osteosarcoma.

CyberKnife is an alternative to amputation, and we typically start with a CT scan of the leg to make sure the bone is structurally strong enough to be a good candidate for it. If the tumor has already destroyed too much bone, it puts the dog at increased risk for fracture even if we kill the tumor cells with high doses of radiation.

But looking at Lady (not her X-rays), I saw that she could barely get up and walk. The family was lifting the 100 lb dog to get up and go outside to relieve herself.

I was worried that her limping and disability wasn’t just because of tumor pain. It could also be neuromuscular disease, orthopedic issues, or worse, bone metastasis. I wasn’t going to do a CT scan (very expensive) and recommend CyberKnife radiation if there was some other major underlying medical issue that prevented her from walking. We had to figure this out, first.

So, during that appointment, I consulted with my surgeon, who looked at Lady and isolated the severe pain to her knees and hips, not just the shoulder with the tumor. X-rays confirmed severe degenerative joint disease and arthritis. Unless that can be helped, removing the tumor with radiation would not help her to walk. Even amputation was out, because a dog with this severe pain wouldn’t be able to recover easily.

This information was really helpful, because now we knew a few things:

1. We can add pain meds, specifically non-steroidal anti-inflammatory drugs (NSAIDs) to her treatment to help bring her some relief.
2. Her underlying arthritis is too severe for an amputation.
3. By treating her arthritis we can improve her comfort and mobility.

Once she is feeling better, THEN we can do a CT scan to see if she is a CyberKnife candidate. She may still be!

Bottom Line: Bring Your Dog

So … will I occasionally do a consult without the dog? Yes I do make exceptions, but it really limits what I can do for the pet and the family if the pet is not there to be evaluated.

Live longer, live well,

Dr. Sue