Should I remove this lump?

Re: Should I remove this lump?

Charlotte Marshall — Sun, 13 Jan 2013 14:37:56 GMT

[quote user="Gerry Henry"]BTW, to whom if anyone should we report this ?[/quote]

There is a form for reporting adverse reactions to microchips it used to go to BSAVA, I am not sure if it still does or one would report to the manufacturer I suppose.

Re: Should I remove this lump?

Gerry Henry — Mon, 07 Jan 2013 21:52:13 GMT

[quote user="Charlotte Marshall"]

Stroking my cat yesterday I felt a pea sized lump in between his shoulderblades. Now normally I would wip this out in case it is an early fibrosarcoma. However I am pretty sure I can feel his microchip sticking out of one end of the lump. So is this just a reaction around the chip and should I still remove it? Has anyone come across fibrosarcomas at the site of chip insertion? I suppose it is possible that one of his vaccine injections could have gone in right next to the chip.

(I have had him only 3 months and naturally gave him a vaccination course but we use purevax which does not contain an adjuvant but I have no idea what he may have had in the past as he is a rescue cat.)

I am inclined still to remove it rather than monitor as the earlier the better if there is a risk of fibrosarcoma but wondered what anyone else thought.

He may be prone to forming reactions as I have already had to excise a lump of tissue from where he was castrated as it did not heal properly on one side - the first time I've ever seen a cat with a post castration reaction like that.

[/quote]

Yes. Nice cat, nice people, chipped by my own fair hand and presented last year with a horrible fibrosarc in the centre of which was our chip. I have a nasty feeling that this is going to become more of an issue.

BTW, to whom if anyone should we report this ?

Re: Should I remove this lump?

James Laidlaw — Mon, 07 Jan 2013 08:18:01 GMT

Quick X-ray would show you chip location too.

Re: Should I remove this lump?

sarah mason — Sun, 06 Jan 2013 21:48:36 GMT

Hi Charlotte

I would advise just taking a small biopsy as any disruption to the tissue planes will reduce the chance of a successful second surgery if it is an ISS. Hopefully not!

Re: Should I remove this lump?

Rob Loxley — Sun, 06 Jan 2013 20:00:24 GMT

[quote user="Charlotte Marshall"]What I was actually wondering was whether fibrosarcomas had been associated with chips[/quote]

There have been a few published case reports in dogs and cats and lab animals. I guess a difficulty would be knowing if an interscapular fibrosarcoma was due to the chip or due to s/c drug injection in the same area?

Re: Should I remove this lump?

Charlotte Marshall — Sun, 06 Jan 2013 19:39:21 GMT

What I was actually wondering was whether fibrosarcomas had been associated with chips as I have never seen that and thought an abcess perhaps more likely. Perhaps I should have phrased it that way! and I see someone has seen chips in fibrosarcomas. I have decided to have him in next week and remove it anyway to be on the safe side. In fact feeling it 48hrs later it also seems to be feel less like the chip is there but it may be engulfed in the lump now but I will see when I remove it.

Re: Should I remove this lump?

Arlo Guthrie — Fri, 04 Jan 2013 09:08:58 GMT

[quote user="J G Wray"]My first reply was brief and a direct answer to the question.[/quote]

Yes Mr W, it was.

[quote user="J G Wray"]My second to the hand wringing indulged in by others.[/quote]

OK - fair point, you were replying to someone other than the OP, but a) I still think you're taking the thread off-topic, and b) I think your second answer read as though it was directed at anyone and everyone. I thought the OP might have thought it was directed in part at her, and that isn't why she came to ask for everyone's opinion (I assume!)

[quote user="J G Wray"]As a matter of interest and as a non vet on this forum, what do you think is the most appropriate course of action for the generic point of how to deal with vets pets when they're ill? [/quote]

JGW, you should have posted this as a new thread. It is an interesting point. However, my point is that we need to try, in the clinical forum in particular, to keep more tightly focused on answering people's questions, and not just opening the floodgates to thousands of posts which question the OPs rationale!

Bottom line: ANSWER THE QUESTION!

I shall be back in a mo to add a link to a new thread to answer your question.

Re: Should I remove this lump?

J G Wray — Fri, 04 Jan 2013 07:45:01 GMT

[quote user="Arlo Guthrie"]

Could we try and stick to answering the OP:

Should I remove this lump?

[/quote]

Dear Mr G,

Please re read this thread. My first reply was brief and a direct answer to the question. My second to the hand wringing indulged in by others.

As a matter of interest and as a non vet on this forum, what do you think is the most appropriate course of action for the generic point of how to deal with vets pets when they're ill? Would you expect to see professional people behaving constently in their care for patients even if they were "family"? How would you feel if you came to know that a professional expected one thing of their clients' patients and another of their own?

Every day the vets on this forum who are at least in practice are asked "What would you do, if this were your pet?". The vets who are agonising here about the personal are answering this question in their consulting rooms at a time of difficulty for their clients and potential suffering of their patients. If any of them give an answer which does not match their actions if it were their own pet, then they are hypocrites. They have a professional training which provides clarity for their clients and should use this, consistently.

JGW

Re: Should I remove this lump?

Michael Woodhouse — Fri, 04 Jan 2013 00:33:08 GMT

[Idexx do half price lab fees for vets and staff's own animals]

Re: Should I remove this lump?

David Mills — Fri, 04 Jan 2013 00:03:42 GMT

[quote user="robloxley"]This is generally my experience as well, though you might get a positive diagnosis with a good sample and cytopathologist, and is cheap and easy to do, and if you stain a slide up and check for cellularity before you send them off is a little less likely to be equivocal.[/quote]

Yes, potentially, but a decent cytologist will normally set you back at least £20-5. Histo is around £35, no?

[quote user="robloxley"]Hmmm, most we deal with charge full price for the initial histo and a reduced rate for followup histo, YMMV[/quote]

It depends on the volumes you send them routinely, but speaking directly to them and telling them its your own animal will normally grease the wheels sufficiently.

Re: Should I remove this lump?

Rob Loxley — Thu, 03 Jan 2013 23:29:20 GMT

[quote user="David Mills"]Fibrosarcs exfoliate very poorly so FNA is likely a waste of time[/quote]

This is generally my experience as well, though you might get a positive diagnosis with a good sample and cytopathologist, and is cheap and easy to do, and if you stain a slide up and check for cellularity before you send them off is a little less likely to be equivocal.

[quote user="David Mills"]most labs worth their salt will only charge you the once for a biopsy histo followed by excision histo[/quote]

Hmmm, most we deal with charge full price for the initial histo and a reduced rate for followup histo, YMMV

Re: Should I remove this lump?

Louise6732 — Thu, 03 Jan 2013 22:30:23 GMT

[quote user="Marie Kubiak"]don't feel bad to be your cats owner, not his vet.[/quote]

Re: Should I remove this lump?

Marie Kubiak — Thu, 03 Jan 2013 22:15:40 GMT

I had a very similar situation with my own cat - felt a lump, panicked, lost all rational thought. Shamefully I presented him to a colleague (in my defence, I don't treat small cats so wanted an experienced as well as impartial opinion) who palpated it, felt it was just his chip with a tiny coat of tissue and that I was massively over-reacting as a paranoid owner who had just enough knowledge to think the worst. 5yrs on he still has a tiny amount of soft tissue around his chip but it hasn't changed so I feel happy having not gone for surgery.

Not really a clinical comment as one anecdote means nothing and doesn't transfer, but more to say don't feel bad to be your cats owner, not his vet.

Marie

Re: Should I remove this lump?

David Mills — Thu, 03 Jan 2013 21:33:42 GMT

Fibrosarcs exfoliate very poorly so FNA is likely a waste of time - because even if it comes back as fatty or inflammatory it does't rule out fibrosarc. You're far better biopsying then going from there - most labs worth their salt will only charge you the once for a biopsy histo followed by excision histo so it's a no-brainer really. With fibrosarc you need to biopsy first because if you haven't access to CT then you'll need very wide margins.

Re: Should I remove this lump?

Louise6732 — Thu, 03 Jan 2013 21:05:12 GMT

The only case of fibrosarcoma I have seen so far, in a 9yr FN DSH, had the microchip within the biopsy that we took, so it is possible for the chip to be in the same place. I firstly FNA'd that cat's lump, came back inconclusive, we biopsied, and came back as fibrosarc. Referral surgeon then did MRI (or CT can't remember) and took very wide margins.

My advice - if you're worried/wondering, do an FNA/biopsy.

Louise

Re: Should I remove this lump?

Bob Russell — Thu, 03 Jan 2013 19:11:04 GMT

I think the OP was answered as much as any of us could do. First get a diagnosis (eg: FNA) and make a decision based on that. The argument is quite easy to make that all lumps benefit from some degree of investigation.

Hopefully this will give a degree of confidence to the OP!

These lumps are not always sinister but I would want to know if it were my cat. Yes if in doubt I would remove it, preferably with an idea of what it was first.

You might be lucky - it may be an abscess!

Re: Should I remove this lump?

Arlo Guthrie — Thu, 03 Jan 2013 18:03:44 GMT

[quote user="J G Wray"]

In any other sphere of veterinary practice, having double standards could be seen as being reprehensible. Instead of dwelling on the emotional anguish of having your own pet susceptible to illness and consequent suffering, a profound self-indulgence, this is the very best time for an examination of your professional actions, when you have something at stake. Each of our clients is going through this each time they bring their animals in. If you fall apart, or become muddled in your decision making because it is your own pet then you are not "being human" (aaaaaah - bless), you are ditching your professional life and training . The science and rigour you have chosen and lived by will have no value, since you are defining your professional actions as a choice to be discarded when faced with a personal dilemma, whilst wanting to retain an informed professional status in society.

One of the few surveys around which defines what society, the public, regard as qualities which make a good vet placed knowledge about veterinary medicine and surgery above all else. You have it. Use it, but make a choice early. Take full responsibility for the diagnostics and choice of treatment as you would with a client or, abrogate your professional life and go to a colleague with your pet and behave like a client. Something in between is a betrayal of your professional life and worse, a hypocrisy.

[/quote]

Could we try and stick to answering the OP:

Should I remove this lump?

When someone poses a question like this, I think it is reasonable to assume that they are interested in whether or not you think YOU would remove the lump, not your in-depth analysis of the rights and wrongs of asking colleagues.

If you think the question raises a relevant issue, such as the ins and outs of seeking a professional opinion from a colleague about your own pet, then please, FEEL VERY WELCOME TO START A NEW THREAD, AND LINK TO IT FROM HERE.

As I have said before, this kind of tangential reply which questions the ability, motives, etc. of the OP doesn't help foster a collaborative environment in this forum. Especially when couched in such flowery language: 'betrayal', 'hypocrisy'.

Re: Should I remove this lump?

Chris Geddes — Thu, 03 Jan 2013 17:26:34 GMT

The GMC advises that it should be avoided, but it is most definitely allowed.

Re: Should I remove this lump?

mariette asselbergs — Thu, 03 Jan 2013 16:27:44 GMT

Medical doctors are not allowed to treat their own family according to their CoPC. It is no shame to not be able to think and decide "objectively" about your own family's sicknesses.

Mariette

Re: Should I remove this lump?

Bob Russell — Thu, 03 Jan 2013 16:05:47 GMT

[quote user="J G Wray"]

[quote user="Bob Russell"]

I was going to start a new thread about vets and their own pets as one of my dogs developed a swelling of the face and massively enlarged LN's on New Years day. Awaiting FNA results. Obviously lymphoma the most likely diagnosis.

At 11 years do we go for chemo? Which protocol? etc, etc!!

[/quote]

JGW

[/quote]

What a lot of bull!

I agree it is a time to reflect and see things from a clients point of view. A good learning experience especially for those vets that do not have pets or have learned to be extremely detached from the emotions of the human beings the other side of the consulting room table.

I have gone to a colleague, not to make a choice of whether to treat but to make use of their ultrasound machine and imager but also to run through the best treatment options in this situation.

My dog has started a modified Madison Wisconsin protocol. The decision to treat was mine alone and was made the minute I had a suspicion of the diagnosis.

There is nothing wrong with going to a colleague to discuss a case especially if it is one of your own pets and the colleague has far more experience of treatment options. I do it all the time with my clients pets!

No betrayal of my professional life nor hypocritical.

It is unlikely that I would be that interested in the clinical opinion of anyone with Mr Wray's attitude.

Re: Should I remove this lump?

Mark Hedberg — Thu, 03 Jan 2013 15:49:10 GMT

I've gone down the abrogation bit a few times myself; I simply don't feel I can be really disinterested with my own pets so I've gone to a colleague with my pets. Coward's way out? Probably, but I'll live with that. :p

Re: Should I remove this lump?

Catherine Williams — Thu, 03 Jan 2013 15:02:37 GMT

[quote user="J G Wray"]Take full responsibility for the diagnostics and choice of treatment as you would with a client or, abrogate your professional life and go to a colleague with your pet and behave like a client. Something in between is a betrayal of your professional life and worse, a hypocrisy.[/quote]

That seems a little unfair to me. As a vet when your pet is ill I think all of us know the diagnostic & treatment options that are available to us and can see the choices as clearly as if this is someone else's pet. But this is not just a clinical decision of what is the gold standard treatment. When dealing with most clients I will offer the gold standard treatment but that does not necessarily mean that I will push that as the most appropriate option that must be chosen. With every patient the client & I will discuss the balance between full work up & compromise; gold standard treatment v palliative. The gold standard is not always the most appropriate...I've often thought that if one of my cats became diabetic I would struggle with insulin treatment as my life is rarely settled enough to be consistent with treatment....does that mean I have double standards recommending to a client something that I would not do myself, I don't think so. Surely when one of our pets is ill we have to act like the client to a degree and decide between our various options as to what works best for both ourselves & our pet, and that is an emotional decision to some degree. For one it is very difficult to divorce our feelings and put emotion aside with a much loved pet - not to have those feelings is surely a failing, it is only if we let it paralyse us & fail to make a decision that we are betraying our professional life.

Personally I had this situation when my dog developed lymphoma, recognised the condition as soon as signs developed, the diagnostic course was clear. The dilemma was chemo or not, just because we are well informed does not mean it is an easy decision to make. For every case we have seen that has done well there have been others that haven't, we all know it is often the poorer outcomes that stick in your mind, we all know that the statistics offer averages, some do better, some do worse, that is hard to put aside. There is also the question of whether the treatment is appropriate for our pet. I know I researched my options as a vet but I'm sure I went through the same considerations as a client when agonising on what treatment to go for. In the end I decided that for that dog at that time chemotherapy was not the treatment of choice. I have no regrets about that decision. Do I recommend chemotherapy to clients? Definitely. I don't feel I am hypocritical in that situation. I think we have to balance the professional approach and being a pet owner if we want to do justice to our pets and comfortable with our decision. There is not a 1 treatment fits all answer for all conditions and I wouldn't consider it a failing for a vet to spend some time ensuring that they have made the right decision concerning their own pet.

It's only hypocritical if they dump their veterinary knowledge & go for reiki or homeopathy instead!

Re: Should I remove this lump?

J G Wray — Thu, 03 Jan 2013 14:30:53 GMT

[quote user="Bob Russell"]

At 11 years do we go for chemo? Which protocol? etc, etc!!

[/quote]

JGW

Re: Should I remove this lump?

Bob Russell — Thu, 03 Jan 2013 10:49:24 GMT

FNA a good start. It is not impossible for a chip to be related to a fibrosarcoma or may be involved as incidental.

At 11 years do we go for chemo? Which protocol? etc, etc!!

Amazing how common sense and clear thinking goes out of the window when it is one of your own pets!

Re: Should I remove this lump?

Rajat — Wed, 02 Jan 2013 19:04:07 GMT

How about starting with a fnab if it can 'hit' it with a needle? And then if it is something nasty you can take wider margins or do further imaging etc before diving in..? It is tough when its your own pet...hope its all ok in the end!