Tuesday, August 19, 2014

Charlie's Life Saving Lipoma Surgery

by  Krista Magnifico, DVM

Helplessness is despair with a straight jacket on.

When you are in this place mercy is your only prayer. We saw it four times in four separate patients two weeks ago.

People can call me a sucker, a bleeding heart, a million things, and yet, each case was a miracle disguised as a pathetic plea, and every case walked out of Jarrettsville Vet's door with a second chance and a grateful parent.

It is what we do here. 

It is who we are, and it is part of the reason people drive from far and wide to get to us.

Am I tooting my own horn, absolutely! Why?, well because I believe that there is always hope and always a chance IF you try. And, there aren't many valid excuses as to why people don't at least try.

So here is the story of Charlie.

He arrived two weeks ago to be euthanized. 

I couldn't, well, that's not exactly true, I just didn't feel right about it. My gut couldn't accept that his only option was death. His story here.

I stuck my neck out, I donated my skills, and together the staff at JVC saved Charlie's life.

Charlie has been to three other vets. They were correct in warning his family about all of the possible outcomes of his condition. There were a ton of unknowns. That's what life and medicine is. That's why medical advances and the luxury of diagnostics came into existence. On the human side doctors have been beaten by angry, bitter, entitled, victims who have sued or harassed enough doctors that they now will only make a decision after appropriately covering their butts. It is a terrible trade-off. We get so frightened to allow ourselves to be vulnerable that other patients suffer. There are now well documented "minimal standards of care." These are the protocols and practices we are required to recommend, and they also give us the protective excuse to dodge our clients ability to pay for. The reality is that most people cannot afford all of the diagnostics we want to do before we assist a patient.

The decisions made from this point separate the mavericks from the meek, and save lives. 

It is that simple.

Have we lost the ability to practice the kind of medicine our forefathers did decades ago? When diagnostics were a rumored luxury, when medicine was half gut guesses, half attempts at swinging the bat to try to hit one out of the park, and attempt were the norm?

Charlie was a risk on almost every front. 

There were no funds to run diagnostics, (almost every vet with a lick of sense would draw their line here and walk away with a clear conscious). He also had no imaging for me to reference. He had an ENORMOUS tumor in his leg and I had to go by my gut and my skill set to determine if this surgery was likely to allow a possible improvement in his ability to function.

He was at the clinic to be euthanized. His parents believed there was no hope and he was losing his ability to walk, urinate, and defecate.

When it comes to basic life functions my list includes;

  • Ambulate. A pet must be able to ambulate, with or without assistance. Few pets are happy or content to simply remain paralyzed and lie in their own excrement.
  • Eat and Drink.
  • Pee and Poop.

If you can't do these, the question of quality of life needs to be discussed.

Charlie case was far from ideal. But, what had been done for him previously had led him to being at my door with two parents in deep despair feeling like there weren't any options and that he would be better off dead.

I called my surgery specialist friends for advice. What I got was a list of diagnostics to do, information to gather, and a pep talk about how to proceed based on a every possible scenario. They were incredibly helpful, supportive, and a bit envious that I could try to help when the facilities that they work for would never allow them to even try.

I had many conversations with Charlie's owners. They understood what might happen  and they were willing to try. It all starts with that.

You have to care enough to try.

Last Tuesday morning we tried. Charlie had the most successful outcome imaginable. His surgery was relatively easy and any first year grad could have successfully cured Charlie with his lipoma removal.

As the hair is shaved off the leg revealed itself.. and no one is left to wonder why he was having such a hard time walking, peeing, and pooping.

Veterinarians use their hands as they do our eyes. Your hands can feel size, texture, and tell your brain what your eyes can't see. To the normal by stander Charlie looked normal. If he was standing still there was a mildly detectable abduction (away from the body) of his back right leg. At a walk there was also a mild limp. Not until you put your hands on his thigh could you understand the magnitude of his dilemma. When I was palpating his leg my hands couldn't tell my brain what was under this pups skin. Clients often don't understand why the vet wants to run so many diagnostic tests, but it is a guessing game without them. Charlie was a whole bunch of unknowns for every single step we took with him..until we got him to surgery.
There has to be a plan for every treatment strategy. 

It should be discussed as best case AND worst case scenario. Everyone should understand the consequences, even the most remote, and the plan should always be agreed upon before the first swipe of the scalpel.

Charlie's surgery contained too many unknowns, (based on a lack of resources to run diagnostics, and the position of the husband), therefore, his pre-op plan was even more difficult to  address.

I knew that Charlie likely had one shot. 

One attempt to go under the knife, one chance for this dilemma to be resolved or he would be euthanized. I also knew that if this was NOT a simply removable lipoma that the next best option for palliative relief would be an amputation.

Amputations are fraught with emotionally charged discussions. 

Of all of the treatment options that I discuss with people this is by far the most reluctantly agreed upon option. Most clients will drag their feet, procrastinate this decision until the pet is about to be put to sleep. It is also my least favorite surgery to do. I hate them. They are long, exhausting, and cumbersome.

Charlie's mom did not want to talk about this. I needed her to. I needed to hear that she understood the case  had possible unforeseeable unwanted outcomes. I also told her that for me to try, on this first surgery was me getting myself emotionally invested. I did not care to stick my neck out to be told that there were no future options. I understand that this is a selfish thing to say, but I had to say it in the beginning. I had to be honest.

Charlie, like every case, was hope for the best, but plan for the worst.

Even with the fat being consolidated there are still numerous vital structures that reside deep in the thigh. Dissecting these out (think blood supply and nerve function to the foot) requires careful finger tips, (nothing sharp belongs in here!). I had warned Charlie's mom that there might be some decreased nerve function (often manifests in the form of dragging the foot, or not righting it normally to place the toes at the step/walk), but as long as you don't sever the nerve they often improve with time to a normal walk.


Almost 4 pounds of fat were removed from Charlie's (pre-op) 24 pound body.


At two weeks post-op Charlie's body perfectly reflects the demeanor he has never flickered from. He is a beaming bubbly boy with a long happy life left to live.


Some stories do have a "Happily Ever After." 

I wish Charlie and his family many happy wagging days to come.

Editor's note: for photos from the surgery, see Diary of a Real-Life Veterinarian blog.

If you have a question, concerns, or just want to share your pet knowledge with our pet enthusiasts please visit Pawbly.com. We are a free pet community with a big heart.

***

Krista Magnifico, DVM owns a small animal hospital in northern Maryland, where she practices everyday. She wants to make quality veterinary care available to everyone, everywhere at any time; trying to save the world 1 wet nose @ a time.  Her blog is a diary of he day-to-day life & the animals and people she meets. 

Dr. Krista is also the founder of pawbly.com, free pet advice and assistance.

To contact her, you may leave a comment on her blog, email her or catch her on Twitter or Facebook.

Articles by Dr. Magnifico:
Don't Make This Mistake: Ruby's Death To Heat Stroke 
Parvo: Cora's Story 
Jake's Laryngeal Paralysis
The Tip Of The Iceberg: The Unexpected Dental Dilemma
The Ear Ache That Wasn't Going Away: Tottsie's Story
Cody's Eyelid Tumor
Ruger's Mysterious Illness
The Day The Heart Stood Still: Timber's Story 
Different Definition Of Comfort Food: Levi's Story 
Savannah's Pancreatitis  
Histiocytoma: Rio's Mysterious Bump
Von Willebrand's Disease: Greta's Story 
Alice's Heart Murmur  
Jekyll Loses His Tail Mo-Jo 
Pale Gums Are An Emergency: Bailey's Story 
To Amputate Or Not To Amputate: Heidi's Story
Lessons From A Real-Life Veterinarian


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, I'll be happy to hear from you!

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