Tuesday, August 23, 2016

On Vets, Competence, Attention, Trust and Misdiagnoses: Cookie's Lumpectomy - The Unpublished Bit

When I wrote the article about Cookie's lumpectomy, I left out some stuff because it was irrelevant to the point I was trying to get across. It is a lesson in itself, and it deserves its own article.


Out of the blue, Cookie grew a lump on her belly.


I'm not saying it popped-up over night, but it as well might have. Cookie's belly almost always has somebody's hands on it. One of those hands would have to have felt it.

After our evening walk, there is always a lot of petting and rubbing going on. There is always a lot of petting and rubbing going on. As I ran my hand over her stomach, I felt a lump. I don't know anybody who doesn't hate finding lumps or bumps on their dog. I was not happy about that.

We examined it and didn't like it the least bit.


So it happened that this was the night just before we were leaving town so we couldn't make an appointment with our vet. The only thing we could do was to make an appointment with a local vet at our destination, and that's what we did. The plan was to have it aspirated to find out what it was.

Hubby drove Cookie to the appointment while I stayed home with JD. JD doesn't like being alone, and all of us in a small exam room just complicates things. Unless we feel that I really have to be present, hubby is the one who drives the patient, and the rest of us stay at home. This problem seemed straightforward enough.

The vet looked and sounded seasoned and competent.


Hubby had a good feeling about her. She examined Cookie and advised against cytology. "It's going to take two weeks to get the results, and I don't like this lump the least bit," she said. She strongly recommended making an appointment for removal instead.

We discussed it all and decided to go with the advice.


The vet didn't like the location - neither did I. The vet didn't like that it seemed highly proliferative (growing fast) - neither did I.

We had a long phone discussion on the issue of clear margins. The ideal process is to identify the lump, then treat/remove it. That way you know how much extra tissue you need or don't need to remove.

We decided to treat it as cancerous and remove enough.

While I didn't like the idea of cutting out a bunch of healthy tissue, it was the better strategy under circumstances.

The morning of the surgery, hubby drove fasted Cookie to the hospital.

And then I got the confusing phone call.

"I examined Cookie once again, and it turns out it's just a fat pad. It is symmetrical to the other side. So we are not doing any surgery today."

Ugh.


I mean I was happy to hear that. Or, more accurately, I would be happy to hear that if it made any sense. What we found could by no means be a fat pad, nor it was symmetrical to anything. It was a single lump.

Are we talking about the same lump???



I don't know what exactly the vet found when she was examining Cookie but I was starting to get a good idea she did not find what was the reason for the visit in the first place! I got her to go back and take another look, this time searching for the actual lump that was on Cookie's belly.

"Oh, this one."


The vet finally found the lump in question. "Oh, this one doesn't look good, it seems highly proliferative; it  needs to come out."

So Cookie did have surgery after all, but now with my faith in the vet seriously damaged. Fortunately, the surgery was done well. I'm gonna leave the fact that Cookie was sent home with zero pain management alone for the purpose of this article. We worked that out with the help of Jasmine's vet and the fact I still had some Deramaxx on hand.

You know how people who are going to have an amputation have somebody write "Not this one" all over the healthy limb? Tough luck that both legs or arms look the same, huh?

How does one find a non-existing lump while missing one that is right in their face?


All is well what ends well, I suppose. The lump was removed. It turned out to have been a benign histiocytoma. Knowing that, could we have left it alone? Perhaps, perhaps not. According to the pathology report it was already ulcerating. So it was just as well that it got cut out. Cookie got through the ordeal without complications. But still ... seriously?

Related articles:
See Something, Do Something: Cookie's Lumpectomy


From The End Of A Lead Line To Casa Jasmine: Meet Cookie, Our New Adoptee
And So It Begins Again(?) Our First Health-Related Heart Attack With Cookie 
I Didn't Know I Could Fly: Why Cookie Wears A Harness Instead Of A Collar
C.E.T. Oral Hygiene Chews For Dogs CAN Be A Choking Hazzard 
Our First Health-Related Heart Attack With Cookie: The Knee Or The Foot? 
Creative Solutions And An Incidental Product Review
Too Young For Pot: Cookie's Snack With A Side Of Hydrogen Peroxide  
Taming Of The Wild Beast: Cookie's Transition To Civilization  
Staying On Top Of The Ears: Cookie Is Not Impressed  
Putting The Easy Back Into Walking
Cookie's Ears Are Still Not Happy 
The Threat Of The Bulge Is Always Lurking 
Today Is Cookie's Three-Months Adoptoversary  
Cookie Meets The Electric Horse Fence And Her First Chiropractic Adjustment  
Why Examine Your Dog's Vomit? 
Why Is That Leg Still Not Happy? Cookie's Leg Keeps Getting Sore 
Cookie Too Is Insured With Trupanion
Does Being Insured Mean Being Covered? Our First Claim With Trupanion
Is Cookie's Leg Finally Getting Better?
Is Cookie Going To Be Another Medical Challenge Or Are We Looking To Closely? 
The Project That Is Cookie: Pancreatitis Up Close And Personal  
Pancreatitis: Cookie’s Blood Work   
Another Belly Upset: Pancreatitis Again Or Not?  
Happy Birthday, Cookie 
Incontinence? Cookie's Mysterious Leaks 
Who's Training Whom? Stick And Treat 
Don't Just Stand There, Do Something? Cookie's Mysterious Bumps 
Cookie's Mysterious Bumps Update
One Vomit, No Vomit 
Happy One-Year Adoptoversary, Cookie!
Cookie's Leaks Are Back: Garden Variety Incontinence Or Not?
Cookie's Leaks Update 
Don't Panic, Don't Panic: Know What Your Job Is 
The Continuing Saga Of Cookie's Leeks: Trying Chiropractic Approach 
Cookie's Minor Eye Irritation
Regular Wellness Exam: Cookie's ALT Was Elevated 
Cookie's Plantar Paw Pad Injury 
How Far To Take It When The Dog Isn't Sick?
Cookie Has Tapeworm Infection 
Cookie's Elevated ALT: The Ultrasound and Cytology  
Cookie's ALT Update
The Importance of Observation: Cookie's Chiropractic Adjustment
Sometimes You Don't Even Know What You're Looking at: Cookie's Scary "We Have No Idea What that Was" 
Living with an Incontinent Dog 
Summer Dangers: Cookie Gets Stung by a Bald-faced Hornet 
To Breathe or Not To Breathe: Cookie's Hind Legs Transiently Fail to Work (Again)
Figuring out What Might Be Going on with Cookie's Legs: The Process 
Figuring out What Might Be Going on with Cookie's Legs: The Diagnosis 
Cookie's Iliopsoas Injury Treatment: Trazodone  
Cookie's Iliopsoas Injury Treatment: Other Medications 
Cookie's Iliopsoas Injury Treatment: Laser, Hydrotherapy and Chiropractic 
Cookie's Recovery from Iliopsoas Injury: ToeGrips 
It Never Rains ... Cookie's New Injury 
Mixed Emotions: When What You Should Do Might Not Be What You Should Do for Your Dog 
Cookie's New Injury Update 
Cookie's Iliopsoas Injury: The Symptoms 
Cookie's Iliopsoas Injury: Battling the Zoomies 
Cookie's Muscle Injuries: What Else Is Going On?
Theory and Actual Decisions for an Actual Dog Aren't the Same Thing: Cookie's Knee Injury
Does Your Vet Listen to You? Cookie's Post-Sedation Complications
Would I Ever Treat a Symptom Directly? 
Platelet-Rich Plasma (PRP) Treatment for Cookie's Bad Knee(s)
Platelet-Rich Plasma (PRP) for Cookie's Bad Cruciate Update 
Injury or Surgery Recovery: Mishaps versus Setbacks 
See Something, Do Something: Cookie's Lumpectomy 
Cookie's Lumpectomy Update 
Using Pressure Pads to Evaluate Lameness in Dogs: My Observations
Cookie's Musculoskeletal Challenges: What Supplements Am I Using?
Cookie's Musculoskeletal Challenges: Restricted Activity and Weight Management
Cookie's PRP Treatment for Partial Cruciate Tear: Update
Has Your Dog's Physical Therapist Taken Dog Training Classes?  
Cookie's PRP Treatment for Partial Cruciate (CCL/ACL) Tear Update and Considering the Future 
Still Confused About Cookie's Incontinence 
 

Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

Email me, to have your story heard.
 

Monday, August 22, 2016

Adoption Monday: Bama, Labrador Retriever, Southington, CT

Bama was pulled into rescue from a southern high kill shelter and placed into a wonderful foster home where she has learned lots of new things.


Her foster mom says she has excelled with her house training and manners

Bama is completely crate trained, which has been utilized as a training tool. She does well on leash and continues to improve as time goes by. Foster mom says she is currently learning some basic commands and doing a great job!

Bama is great with other dogs, cats, and kids (big people too!). Like most youngsters, loves to run around and play hard working off some of her puppy energy. Afterwards she settles in nicely for a well deserved nap.


This sweet little girl also loves playing in the water which is no surprise with those lab genes she's showing off. Of course she loves lots of toys, chew ones are a particular favorite.

Bama is already spayed, up to date on all vaccinations, current on preventatives, and micro chipped. She is ready to go home with her forever family and enjoy blue skies wherever home ends up being. Time to carry our Bama off to meet her new kin. Is she coming home to you?

***

Best Friends For Life is a privately run, 501 c3 non profit organization, privately funded NO KILL dog rescue. They operate on a strictly volunteer basis out of foster homes.

Sunday, August 21, 2016

Teaching Your Dog Take Treats Gently

Another awesome video from Donna Hill's channel.

With many dogs, you really have to watch your fingers when trying to give them a treat. 


Our guys do quite well being gentle taking treats; perhaps partially because they get a lot of practice. Only when she's very excited, Cookie gets grabby, trying to quickly take the treat and get back to whatever she's been focused on. It becomes particularly obvious when I try to use the "Look a that" game to teach her to ignore a squirrel, for example.

Level of arousal is certainly one criteria to keep in mind when trying to get your dog take treats gently.



***

Donna Hill, Donna Hill B.Sc. B.Ed., has a degree in zoology and a teaching degree. She has 20 years experience in adult and child education and enjoyed teaching people how to observe animals in nature as a nature interpreter, field biologist and train-the-trainer for presentation skills and now applies her knowledge and skills to help people and their dogs. She helps people with disabilities to train their own service dogs and has experience working with autistic and developmentally delayed teens. She uses plain English to explain what you are doing and why and also provides analogies you can relate to. She was also a Girl Guide and earned the highest honor as well as worked in the Tourism industry as a information counselor. She loves to share key information with people!

Visit her blog at Online Clicker Training Tutorials & Coaching.

Check out her two Youtube channels supernaturalbc2009 and supernatural 2008 for more awesome videos. Her motto is "Yard by Yard, Life is hard. Inch by Inch, It's a Cinch!" Break everything down into it's simplest parts and it's achievable!

Don't forget to visit Donna's FB group Observation Skills for Training Dogs or connect with Donna on Twitter.

Saturday, August 20, 2016

Top Veterinary Articles of the Week: Toxic Bugs, Helpful Honey, and more ...

Will My Dog Get Sick If He Eats Bugs?

Dr. Marty Becker/vetStreet

Bugs. We certainly get our share of them. Fortunately, apart from grasshoppers, our guys show no interest in eating them.

Does your dog eat bugs? Cookie prefers hunting mice. JD is just a copycat, trying to do what Cookie does. He hasn't caught a mouse yet. Or found one. But he does catch the odd deer fly if they are bugging him too much.

Most bugs make a harmless snack. Some, though are toxic. The rule of thumb is, the more colorful the bug, the more likely it is toxic. And, of course, too many of them can cause a problem from the sheer volume.

Saddleback caterpillar. Pretty, huh? Pretty nasty.
Photo Featured Creatures

Puss moth caterpillar. Photo True Wild Life

Find out which bugs you should keep your dog away from in Dr. Becker's article.


How Honey Can Help Dogs with Allergies

Dr. Ernie Ward/Petplan


So far I've used honey only for wound care. But I have heard of the use of raw honey to help with allergies and it does sound interesting and logical as a form of immunotherapy. For such purpose, obviously, it needs to be local honey as it contains the same pollen spores the dog is subjected to.

Same as immunotherapy, local raw honey introduces these spores in small amounts helping the body to get used to their presence.

It might not be a magic cure but it can help. If my dogs had problems with seasonal allergies, I'd give it consideration.

Find out what Dr. Ward recommends.


Cruciate Ligament Disease: A Comparison of Surgical and Nonsurgical Treatment Outcomes

Dr. Nancy Kay/Spot Speaks

I'm always interested in any new information about cruciate ligament disease and its treatments. You never want to think you know it all. Because you moment you do that, something really important slips through the cracks.

In this article, Dr. Kay highlights results of a recently published study focusing on evaluating owner satisfaction with outcomes of surgical repair as opposed to orthosis (brace). Just as Dr. Kay, I'm surprised that in spite of less impressive objective outcomes, there was a higher level of satisfaction with the brace option.

When Jasmine was diagnosed with partial tears, we too found the brace option attractive and gave it a lot of consideration. At the end, though, we decided we wanted to fix, rather than manage the problem.

Check out Dr. Kay's thoughts and review of the study results.


Friday, August 19, 2016

Veterinary Highlights: Optical Coherence Tomography (OCT) in Cancer Treatment

Optical Coherence Tomography (OCT) is a new imaging approach to improve accuracy of surgical treatment of cancer.


It works similarly to ultrasound, except instead of sound it uses light waves to visualize tissue in real time. Small Animal Clinic at the University of Illinois is the first one in the US to use it.


The advantage is knowing exactly which tissue needs to be extracted.


If you can see the cancer, you can take it out and leave healthy tissue alone. Some other techniques for identifying cancerous tissue had been tested. Otherwise two things can happen. Without being able to see which tissue is bad and which isn't, either not enough tissue is removed, which results in second surgery, or a bunch of extra tissue needs to be removed in hopes for getting all of the cancer.

That can be tricky, such as in JD's case, where his mast cell tumor was in such a location where there wasn't much tissue to begin with. We decided to take enough even at a cost of having to use a graft, rather than worry about closing the wound and leaving some cancer behind.


More precision would mean more healthy tissue preserved and no cancerous cells left in the body.


Technology being able to extend beyond our the ability of our senses is always great. I'll be watching this one.

Source article:
New Medical Tech Now Saving Local Pets Battling Cancer

Further reading:
Optical Coherence Tomography Advances Veterinary Cancer Treatment

Thursday, August 18, 2016

Veterinary Visit Checklist: Part 2 Before You Leave the Office

Don't ever leave the vet's office unless you're fully satisfied that you understand what is going on with your dog. You should be walking out either with a diagnosis and a treatment plan or at least a plan of action and further diagnostics.


Don't leave the vet's office unless you got all your concerns addressed and questions answered.


When I prepare my list before hand, I make two copies. One for the vet to keep, one for me to make sure nothing gets forgotten. I don't leave until all my points had been checked off.

Make sure you understood everything your vet told you and that you're comfortable with the treatment.


Are there more than one treatment option? Did you discuss them all?

If it's complex, write it down or ask them to write it down so you can research it later. If your dog is sick and needs treatment, it's up to you to comply properly. For that, you need to understand what to do as well as why do it. Because if you don't have faith in the treatment, you're much less likely to go through with it. And no treatment, however great, will work unless it's actually administered.

If you're concerned about your ability to follow through with the plan, let your vet know.

Jasmine's vet always includes a note to contact him if for any reason the treatment plan cannot be followed. He'll then work to find a plan that will work.

Here is one thing I have ever seen only one vet ever do - provide an outline of expected treatment progress.


Should your dog feel better after the first pill? Should they get better by the next day? Is it going to take a week? A month? What should you expect to happen?

Such estimate cannot always be accurate, but it provides a guideline by which to assess whether the treatment is working or not. If your vet doesn't provide this, ask for it. Jasmine's expected progress estimate looks like this:

25 % improvement by day 4
50% by day 6
75% by day 10
100% by day 21

The actual outline, of course, depends on what is being treated. This particular outline was given after Jasmine's neck issues.

Ask not only what the treatment should do, but also what it might do and it shouldn't - side effects.


This is so important and yet with most vets getting this information is like pulling teeth. What side effects you might run into? And even more importantly, what should you do?

How should you give the medications?

Most of the time, the label will include how many pills and how often you should give. However, some medications, such as NSAIDs, have to be given with food. Others should be given on empty stomach. Yet, this is not always indicated. If you give NSAIDs on an empty stomach, you might run into stomach problems. If you give other medications, such as some antibiotics or thyroid supplement with food, it might significantly lower their effectiveness. Ask what is the best way to give them.

Ask about any contra-indications and interactions.

If you got a prescription for more than one medication, or your dog is already on other treatments, will there be some negative interactions? Can they be given together or should they be given apart? Should one follow a certain amount of time after another (such as if you're getting stomach protectant with NSAIDs)?

Same applies if you're giving any supplements. Ask whether any of them could negatively interact with the new meds.

What should you do if you miss a dose?

Find out what you should do if you forget a dose. Also find out what to do if you did give the medication and your dog happened to throw up shortly after.

When should you come for a follow-up?

I many cases, it is wise to schedule a follow-up appointment. You might be able to tell whether the treatment work or you might not. Your vet might need to get their hands on your dog again to evaluate progress or results. You might need to run a follow-up blood work or other labs.

What information do you expect to come home with from a veterinary visit?


Related articles:
Veterinary Visit Checklist: Part 1 Before the Visit
Before Getting a Second Opinion: Something Not Right? Speak Up 
Thinking Outside The Box: Solutions Tailored To Your Dog's Needs 
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