My dog has a lump

RE: My dog has a lump

Julian Earl — Thu, 07 Nov 2019 15:46:50 GMT

Anthony... Surely not?!!

I was concerned that someone had hit the dog with a shovel!

RE: My dog has a lump

Anthony Dennison — Thu, 07 Nov 2019 15:37:16 GMT

[quote user="Anthony Todd"]

[quote user="Anthony Dennison"]Bob was talking about radiographs. You have used the example of CT which is more sensitive so will pick up smaller lesions. Not really comparable.[/quote]

I do realise that which was the sole point of my anecdote! And it can be done without a GA while you wait [in animals]

[/quote]

Are you saying humans to have no GA or animals have no GA? For diagnostic thoracic radiographs as a met check you need inflated views, which requires sedation at least, preferably GA

[quote user="Arlo Guthrie"]having also been spaded at the same time.[/quote]

*shudder* Arlo, are you being provocative on purpose?

RE: My dog has a lump

Arlo Guthrie — Thu, 07 Nov 2019 11:43:05 GMT

Turns out that Daisy had a couple of other small lumps, but nothing on the liver ... back home now having also been spaded at the same time. Fingers crossed now!

RE: My dog has a lump

Richard Carter — Mon, 04 Nov 2019 18:40:50 GMT

my understanding is the first paper dealt with dogs with low grade or first stage mammary tumour (ie hormone responsive/ dependent tumours) which therefore showed less new tumour growth in the spayed bitches whereas the second paper deals with malignant carcinomas which as I understand grow independent of hormone stimulation.

RE: My dog has a lump

Sarah Keir — Mon, 04 Nov 2019 15:07:24 GMT

The evidence regarding OHE at the time of mammary mass removal is not clear cut.

https://www.ncbi.nlm.nih.gov/pubmed/26687731 this paper is newer than the above linked one

RE: My dog has a lump

Anthony Todd — Mon, 04 Nov 2019 11:01:02 GMT

[quote user="Anthony Dennison"]Bob was talking about radiographs. You have used the example of CT which is more sensitive so will pick up smaller lesions. Not really comparable.[/quote]

I do realise that which was the sole point of my anecdote! And it can be done without a GA while you wait [in animals]

RE: My dog has a lump

Julie Innes — Mon, 04 Nov 2019 10:16:04 GMT

I've seen a lot of these too- where they present the dog again months down the line, the lump is now virtually inoperable and it feels like they feel it is somehow your fault, for not forcing them to go ahead with op. Sometimes you really cant win!

RE: My dog has a lump

Julian Earl — Mon, 04 Nov 2019 01:01:38 GMT

[quote user="Francisco Gomez"]The problem comes when the owner brings the dog back a few months later. The previously small mass is now a tennis ball sized stinking ulcerated lump of nastiness. Yes, really.[/quote]

Or worse, it hasnot just grown massively but what was a mobile easily removable mass is now vcovered by skin stretching taut over a large mass. the lump could be excised but the skin cannot be repaired or at least not without great risk of break-dpown. I had a Border collie presented with a small manageable ulcerated mass, about 10cm x 5cm that never attended for removal but required further attentionabout six months later now being the size at least twice as deep with the skin thin and taut over the mass. Is this painful for a dog now? But it was now inoperable in the poor fifteen years-old patient. I think that he had her euthanased if I recall correctly. What a waste?! These are the annoying cases, the " I told you so six months ago"-ones! Maybe it was a financial decision I csanot remember that. But I do thik of/ remember the dog every time we drive by the house!

RE: My dog has a lump

Mark Hedberg — Fri, 01 Nov 2019 18:16:33 GMT

[quote user="Evelyn Barbour-Hill"]

Merciful heavens. I'm agreeing with everything said by both Francisco and Gillian.

[/quote]

There, there, a damp towel on the forehead, feet up, it'll soon pass. ;)

RE: My dog has a lump

vs0u — Fri, 01 Nov 2019 13:42:45 GMT

[quote user="robloxley"]

[quote user="vs0u "]

[quote user="David Mills"]

[quote user="vs0u "]- won't have any effect on mammary masses at this stage,[/quote]

It will.

[/quote]

I was taught that you need to spay before the 3rd season to affect mammary tumours, as after that the hormones have been around long enough to have their adverse effect. Has this changed?

[/quote]

There is newer evidence e.g. https://www.ncbi.nlm.nih.gov/pubmed/23701181

[/quote]

Thanks - that's really useful

RE: My dog has a lump

vs0u — Fri, 01 Nov 2019 13:40:20 GMT

[quote user="Arlo Guthrie"]Secondly, I question whether it would be wrong if more people did decide to 'watch and wait'?[/quote]

Yes. If it's a mammary lump, a good proportion will either spread to the lungs/elsewhere (if malignant), or spread locally, grow and start rotting (if benign). It could be some other kind of mass, but you can't tell without removing it. Watch and wait until welfare is compromised and then euthanasia might be a reasonable choice for a very old dog or one with other health problems, but wouldn't be advisable for a healthy 8 year old crossbreed.

Imagine it was a female relative with a lump in their breast - would you want to leave the lump, or get it removed and find out what is it and whether it's spread? I understand that some people may not want to pay for histology and chest xray, but there clearly is value in them for many owners.

RE: My dog has a lump

Rob Loxley — Fri, 01 Nov 2019 13:38:58 GMT

[quote user="vs0u "]

[quote user="David Mills"]

[quote user="vs0u "]- won't have any effect on mammary masses at this stage,[/quote]

It will.

[/quote]

I was taught that you need to spay before the 3rd season to affect mammary tumours, as after that the hormones have been around long enough to have their adverse effect. Has this changed?

[/quote]

There is newer evidence e.g. https://www.ncbi.nlm.nih.gov/pubmed/23701181

RE: My dog has a lump

Anthony Dennison — Fri, 01 Nov 2019 11:12:45 GMT

[quote user="Anthony Todd"]

[quote user="Bob Russell"]It is not sensitive enough to pick up lesions until they are fairly sizeable. [/quote]

By the way

A friend had a scan post bowel cancer resection and they are concerned about a 5mm!! mass that has appeared on the chest post-op 3 months CT scan........................

[/quote]

Bob was talking about radiographs. You have used the example of CT which is more sensitive so will pick up smaller lesions. Not really comparable.

RE: My dog has a lump

Beats — Fri, 01 Nov 2019 08:32:49 GMT

You would be typical of 95% of clients here Arlo, not wanting to spend money on something that your vet cannot convince you is anything other than purely, or principally, "prognostic".

"Would you consider further surgery or other treatment if I felt that was indicated by the results of sending the lump to the lab?"

"No."

"Would you like to pay xxGBP to send it off anyway to find out what it was?"

"No."

RE: My dog has a lump

Evelyn Barbour-Hill — Thu, 31 Oct 2019 20:19:21 GMT

[quote user="Gillian Mostyn"]They then say 'It is now horrid so I've decided to get it removed. And I expect the previous estimate to stand.'[/quote]

. I don't get the second part of that, I'm glad to say. What I do sometimes get is the reproachful look as if it's my fault the lump is now big and horrid.

RE: My dog has a lump

Francisco Gomez — Thu, 31 Oct 2019 20:01:35 GMT

[quote user="Gillian Mostyn"]

[quote user="Arlo Guthrie"]In my case, my dog is clearly not suffering, so 'watch and wait' would not be wrong, would it? [/quote]

The problem comes when the owner brings the dog back a few months later. The previously small mass is now a tennis ball sized stinking ulcerated lump of nastiness. Yes, really.

[/quote]

It brings up the problem where by the time the dog is perceived as suffering, the surgery is less safe (or impossible).

On the other hand, not all masses grow to cause problems.

RE: My dog has a lump

Gillian Mostyn — Thu, 31 Oct 2019 19:20:04 GMT

[quote user="Arlo Guthrie"]In my case, my dog is clearly not suffering, so 'watch and wait' would not be wrong, would it? [/quote]

The problem comes when the owner brings the dog back a few months later. The previously small mass is now a tennis ball sized stinking ulcerated lump of nastiness. Yes, really.

They then say 'It is now horrid so I've decided to get it removed. And I expect the previous estimate to stand.'

A significant number of clients are looking for a way to avoid spending their money whilst remaining guilt free. And even when warned about the possible outcome, they assume worst case scenario is unlikely. If you give them the option of doing nothing, against your better judgement, then you have to be prepared for the fall out when worst case scenario happens.

RE: My dog has a lump

Anthony Todd — Thu, 31 Oct 2019 16:23:58 GMT

Glad we agree on something

RE: My dog has a lump

Kate Richardson — Thu, 31 Oct 2019 16:14:41 GMT

I would advise excising the mass and sending for histo. If the dog is clinically well otherwise, I would wait and see what it was before suggesting any further assessments such as chest xrays as these may not be necessary. But if the client did not want to send the mass for histo, I would pop it in a pot and sit it on the shelf in the future if indicated.

RE: My dog has a lump

Anthony Todd — Thu, 31 Oct 2019 16:04:43 GMT

[quote user="Kate Richardson"] Regardless of the budget available, a logical stepwise approach should be taken with all cases and each tests or treatment should be able to be justified.[/quote]

So, in this case [and I think this is the point of the thread] following your above quote, what would you do?

I agree with your quote BTW.

RE: My dog has a lump

Kate Richardson — Thu, 31 Oct 2019 15:33:27 GMT

[quote user="Arlo Guthrie"]And of course, as someone else said, most people who are insured are going to throw the kitchen sink at it regardless.[/quote]

I really take issue with this and any vet who has this attitude, (not saying that any one who has commented on here has got that attitude), but it suggests that unnecessary things are done. Insurance doesn't mean there is an infinite pot of money available. It still has a limit and many policies require the owner to pay a percentage of the total costs as well, particularly as the animal ages. Regardless of the budget available, a logical stepwise approach should be taken with all cases and each tests or treatment should be able to be justified.

RE: My dog has a lump

Anthony Todd — Thu, 31 Oct 2019 15:32:47 GMT

[quote user="Bob Russell"]It is not sensitive enough to pick up lesions until they are fairly sizeable. [/quote]

By the way

A friend had a scan post bowel cancer resection and they are concerned about a 5mm!! mass that has appeared on the chest post-op 3 months CT scan........................

RE: My dog has a lump

Sarah Keir — Thu, 31 Oct 2019 15:23:20 GMT

[quote user="Anthony Todd"]

[quote user="Sarah Keir"]Shared decision-making.[/quote]

Try that when your Merc. goes in to investigate a failure to start........

And here it's the same!.

[/quote]

Because mammals are way more complicated than machines and often them or their carer would like some degree of input into the decision making process. My mechanic discusses options for fixing said broken car with me, checking how I would like to proceed and I what outcome I would like (as working car or a perfectly fixed one that much less likely for that part to fail again in the future) and how much I will pay for this.

RE: My dog has a lump

Bob Russell — Thu, 31 Oct 2019 14:17:18 GMT

A chest X-ray may tell you that it has already spread. It is not sensitive enough to pick up lesions until they are fairly sizeable.

I have to say many owners of elderly dogs leave them alone. Most owners with younger dogs go for surgery +- pathology. Early removal can increase survival time significantly but these patients often develop further masses later on in life.

Insurance does not particularly change my recommendations.

A small lump is likely to get bigger and surgery can be curative at that site.

RE: My dog has a lump

Anthony Todd — Thu, 31 Oct 2019 14:05:17 GMT

Just think of the saved time and energy saved, even on here, if it had been removed at op. 1 with histo in a bottle TBA.

As it is the mass wil be, hourly, prodded and poked by all the family, friends, and medicos, and Google will be repeatedly scanned, and quoted, usually totally out of context, strange curative vegetables will be fed to the poor animal and weird curative chemicals given too......