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On Vets, Competence, Attention, Trust and Misdiagnoses: Cookie's Lumpectomy - The Unpublished Bit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

52 comments

  1. I hear you. Although I like my vet, and have had her for 6 years... I also have a holistic vet I see. I try and get both their views and go with my gut. they are almost always on opposite sides of treatment options. But recently my little one had an anal gland rupture. The pain killers and antibiotics they pumped into his tiny 3.5 pound frame cause way more grief than the gland had. in the end my holistic vet suggested taking him off all chemicals and just to apply warm compresses and then corn starch to the "wound" within 24 hours my little dude was back. It's so hard to know who to trust!

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    1. I always try to opt for least invasive, and medicate conservatively. But this was a lump, getting out was most likely the best thing to do. But how do you find something that "isn't there" and completely miss something that is?

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  2. Oh my! Wow... that is heartwrenching to read. And then to send a dog hold with no pain management?!?! Who does that?? I'm sorry you had to go through dealing with such incompetence.

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    1. Here is the thing, I don't feel she's incompetent. I think her head might have been some place else ... or who knows.

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  3. My faith in that vet would have absolutely been shaken. Plus, what an ordeal for you all. Sometimes I know they all get super crazy busy but I agree with you about the lump - they weren't looking at the right one until you had to point it out a second time... I'm glad it was benign. Sorry you had to go through that...

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    1. I have no clue what was going on through her head - she missed the actual bump twice. Somehow. Took a third try. It wasn't THAT little as you can see on the photo.

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  4. I'm glad the surgery went ok, but sorry to hear about the stress you had to deal with through the process.

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  5. Wow, that's pretty crazy and stressful. Can't believe the vet was confusing the lumps. Glad all worked out OK in the end.

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    1. Somehow she was confusing the real one for some imaginary one. Quite a trick.

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  6. The feline Tribe of Five have regular wellness visits to the vet and this helps to deal with problems early!

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    1. This WAS early. Cookie has been in for physio or laser 3x a week, always having,hands all over her. And my hands all over her. While it's not likely that it literally grew over night, it must have been pretty close,to it.

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  7. Oh my goodness!! It would be so terrifying to have to see a completely new vet for something that had the potential to be so serious anyway....but how confusing that was for you!! It would definitely shake my own confidence about what they were seeing. Glad you had a happy ending!

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    1. It was not a good experience. And there is even more to the story which I'm contemplating whether I should publish or not.

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  8. Well that's enough to make you lose faith in a Vet! I'm glad it all worked out ok with Cookie but I'm sure you won't be returning to that particular Vet. I haven't had any negative experiences like that, thankfully, just minor stuff.
    Love & Biscuits,
    Dogs Luv Us and We Luv Them

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    1. Fortunately, we won't have to. I hope.

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  9. So scary. I always do lots of research with doctors or vets. They are human and make mistakes or may not be experts on many things (even though some can be a bit arrogant). I have had to change from a vet who was great with Nala and Isabelle because Kilo hates him and he was unhelpful on Kilo's issues.

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    1. We had some knowledge about this vet and what we knew was positive. SO I don't know what happened there. You didn't need to be an expert to find that lump - it was sticking out like a sore thumb.

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  10. Scary story! That an example of why we haven't gone to a new vet since we moved here and mom had my stomatitis surgery done at my old vet when we went to BlogPaws.

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    1. Selecting a new vet after we moved was scary for me too. We still keep in touch with Jasmine's vet.

      In this case things got complicated by our trip for hubby's work. It was for three weeks and I didn't want to leave that bump undiagnosed for that long. You'd think that finding a bump is not rocket science.

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  11. okay I would change vets right away. Actually i've been through a few different vets in the past few years. I want the honest truth and I want my vet to give me options but to also tell me what they would do to their pet. We hope that vets love their dogs as much as us anyways. Man I am sorry. And thats sooooo scary. I am just dumfounded that they acted like they knew what the lump was, but then admitting later that they were looking at another one. UGH. Change vets!

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    1. They weren't looking at any lump at all but somehow and normal fat tissue on the belly. I would switch vets but this was just one time deal because of our travels.

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  12. Wow! What an ordeal. I am so glad you were able to get everything figured out. We have to be our pet's advocate. Way to go Mom and Dad.

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    1. Thank you, I don't know where her head was at to miss the thing TWICE while trying to removing something that belonged.

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  13. Glad to hear it was benign. You must have confidence in your vet and that's one reason I switched vets when Truffle and Brulee came to live with me.

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    1. Even the greatest vet can make a mistake but this one made too many - three mistakes over one little lump ...? Too much.

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  14. That would be very frustrating. I'm glad that Cookie got the correct lump removed and is doing well. Hopefully, this veterinarian was just having a rough day and is normally more careful in her work.

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    1. I'm hoping too. We knew off her before and she seems to have a good head on her shoulders ... perhaps she left it home that day.

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  15. OMD what an ordeal, I check Layla for lumps and bumps all the time as I am paranoid here. Thank goodness all Layla's medical records are online so its easier to access and check all if I would have to take her to a vet somewhere else.

    Good for you that you did not let it go

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    1. Yeah, I love web-based records; Jasmine's vet uses them. Unfortunately he's too far now. Though we still drove down to see him for Cookie's knee assessment and PRP treatment.

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  16. That would shake me I confess. If the vet couldn't find out what I had pointed out to them!!

    I once asked our vet if he was OK with us getting a second opinion and we got lymphoma treatment for Sooty at the veteriinary hospital but I still like and trust our vet.

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    1. You almost always want a second opinion with cancer. This was just question of finding the damn thing. Ugh.

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  17. We had a bad experience at the vet recently (but more with the techs) and I ended up writing an email. They apologized and sent a gift certificate.

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    1. Since this was a temporary location, the odds we'd have to use them again are very low.

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  18. Oh, my gosh! Sorry you went through that traumatic experience. It is very scary that we depend so much on these 'experts.'

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    1. All is well what ends well. But damn.

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  19. It is always unnerving when you have to deal with a medical expert who seems less than the best. I'm glad that lumpectomy went well and that you were able to give Cookie some relief for her pain. I feel sorry for the other dogs who receive the same surgery and have less knowledgeable humans to help them with the pain.

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    1. Apparently there are still enough vets out there who underappreciate the importance of pain management.

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  20. Gosh, how concerning for you. Just goes to show we need to be as present as much as we can when our pets are at the vet.

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    1. Makes you think back to X-Files - TRUST NO ONE

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  21. I do believe I would switch vets. I had to switch vets after 15 or more years at the same way. A misdiagnosis like that is a no go. I hope all improves and it sounds like you are on top of things!

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    1. Well, even the best vet can screw up. Either way, fortunately it was a temporary location so it doesn't affect anything long term.

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  22. Poor Cookie. We hope future vet visits go much better.

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    1. The whole thing didn't really affect Cookie other than the lack of pain management post-op which we resolved.

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  23. Oh wow...that's cray! I'm glad everything worked out just fine though. I haven't had a bad experience with the vet yet, but definitely have had one with a doctor and I switched ASAP.

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    1. I think the number of wild experiences with vets depends on how many and how complex issues is one dealing with. I think it's a question of percentages and sooner or later you ought to run into problems.

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  24. SO happy to hear Cookie's surgery went well, but...wow! Talk about a fast descent into having no confidence in the vet! I know these little lumps well...and it's good it is gone. My boy Wolf had one about that size and it grew and "cauliflowered" to twice that size. Went in for surgery and sneakily growing beneath was something my seasoned had never seen in his 30 years of practice - the grown underneath, unseen to the naked eye, had the look of a baby's foot, with the "toe" being the very small growth up on the surface. When I saw the photos from the surgery, I could not believe something that large could be lurking down in there just under the surface, and positioned so that we could not even feel it. He's had another removed, and it was a clean removal (whew)! Even though Cookie's surgery went well, I so agree that the whole situation is just unbelievable...and once that faith in a vet is shaken, it's very hard to not question every that follows...

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    1. Yes, even benign bumps can hide naughty things underneath.

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  25. Wow, that sounds stressful, but glad Cookie is doing better.

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    1. Cookie is doing fine and the ordeal didn't really affect her. But it surely did affect us.

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  26. Oh my dog! So hard to trust vets these days

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    1. One has to keep looking over their shoulder.

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