Lump on a dog’s foot, a saga of questions
(somewhat paraphrased from a series of conversations)
Me: When did you notice the lump?
Owner: Well my friend was over yesterday and said “What’s with the lump?”
Brain: Crap what the hell is this soft subcutaneous lump? It could be anything – abscess, haematoma (bruise), lipoma (a fatty lump), mast cell tumour, lymphoma, histocytoma, haemangiosarcoma etc etc etc.
Me: We should take an aspirate and have a look at it under the microscope, is that ok?
Brain (whist looking at the smear): Crap crap crap, all I can see is blood! Are those interesting looking lymphocyte type cells just from the blood that’s contaminating my smear or is this lymphoma?
Me (to owner): I think we should send this to the pathologist, are you happy with that?
Pathologist: Round cell tumour, likely lymphoma.
Brain: Crap! What the hell do I do next?
Me (to owner): Its bad, it looks like lymphoma.
Owner: What's lymphoma?
Me: Its a cancer made of white blood cells. Would you like a referral to a medicine specialist?
Owner: No I have had a bad experience, I don't trust specialists. What can you do?
Me (to specialist): There’s a lymphoma on this dog’s foot, what do I do next?
Medicine specialist: Can you refer it to me?
Me: No, the owner doesn’t want a referral, what do I do next?
Medicine specialist: Can you get a bigger sample from the lump and one from the lymph node?
Me (to owner): Can we spend lots of money to give your dog an anaesthetic and take a sample from the lump? Btw if the lymphoma has spread your dog will probably need chemotherapy, are you willing to do that?
Owner: Can’t we just cut the lump off? How long will she live? Will she get really sick with the chemo? How long will the chemo buy us? If we’re gonna knock her out to take the sample why can’t we just cut the lump off?
Me (to specialist): Can’t we just cut the lump off? How long will she live? Will she get really sick with the chemo? How long will the chemo buy us? If we’re gonna knock her out to take the sample why can’t we just cut the lump off?
Medicine specialist: If you don’t get the whole lump the first time/the tumour has spread you’ll need to do further surgery/chemo anyway, plus it will probably be a complicated surgery. No idea until we know more about the lump. Less sick than humans get. No idea until we know more about the lump. See first answer. Can you refer it to me?
Me: No
Me (to owner): See above
Owner: Ok, we’ll take the sample, what do we do then?
Me: Probably spend more money to do x-rays and an ultrasound to see if the lymphoma has spread anywhere else. Then we may be able to cut the lump off or we may need to do chemo.
Owner: I don’t really want to do chemo, can we just cut the lump off? How long will she have if we don’t?
Me: Don’t know until we know more about the lump.
The saga is ongoing....
(somewhat paraphrased from a series of conversations)
Me: When did you notice the lump?
Owner: Well my friend was over yesterday and said “What’s with the lump?”
Brain: Crap what the hell is this soft subcutaneous lump? It could be anything – abscess, haematoma (bruise), lipoma (a fatty lump), mast cell tumour, lymphoma, histocytoma, haemangiosarcoma etc etc etc.
Me: We should take an aspirate and have a look at it under the microscope, is that ok?
Brain (whist looking at the smear): Crap crap crap, all I can see is blood! Are those interesting looking lymphocyte type cells just from the blood that’s contaminating my smear or is this lymphoma?
Me (to owner): I think we should send this to the pathologist, are you happy with that?
Pathologist: Round cell tumour, likely lymphoma.
Brain: Crap! What the hell do I do next?
Me (to owner): Its bad, it looks like lymphoma.
Owner: What's lymphoma?
Me: Its a cancer made of white blood cells. Would you like a referral to a medicine specialist?
Owner: No I have had a bad experience, I don't trust specialists. What can you do?
Me (to specialist): There’s a lymphoma on this dog’s foot, what do I do next?
Medicine specialist: Can you refer it to me?
Me: No, the owner doesn’t want a referral, what do I do next?
Medicine specialist: Can you get a bigger sample from the lump and one from the lymph node?
Me (to owner): Can we spend lots of money to give your dog an anaesthetic and take a sample from the lump? Btw if the lymphoma has spread your dog will probably need chemotherapy, are you willing to do that?
Owner: Can’t we just cut the lump off? How long will she live? Will she get really sick with the chemo? How long will the chemo buy us? If we’re gonna knock her out to take the sample why can’t we just cut the lump off?
Me (to specialist): Can’t we just cut the lump off? How long will she live? Will she get really sick with the chemo? How long will the chemo buy us? If we’re gonna knock her out to take the sample why can’t we just cut the lump off?
Medicine specialist: If you don’t get the whole lump the first time/the tumour has spread you’ll need to do further surgery/chemo anyway, plus it will probably be a complicated surgery. No idea until we know more about the lump. Less sick than humans get. No idea until we know more about the lump. See first answer. Can you refer it to me?
Me: No
Me (to owner): See above
Owner: Ok, we’ll take the sample, what do we do then?
Me: Probably spend more money to do x-rays and an ultrasound to see if the lymphoma has spread anywhere else. Then we may be able to cut the lump off or we may need to do chemo.
Owner: I don’t really want to do chemo, can we just cut the lump off? How long will she have if we don’t?
Me: Don’t know until we know more about the lump.
The saga is ongoing....
Saga indeed..
ReplyDeleteThat's the most annoying thing about random lumps. Can't do surgery until we know about the lump. Do surgery to find out about the lump. Gah.
I usually find it is useful at this stage, with the prospect of further diagnostics to arrange for a prognostic dead-line. such as "if the lump has spread to the lungs, which we can see on x-rays, then the average lifespan would be about 3-6 months without chemo. But the length of life isn't as important as quality. If the x-rays are clear, I would recommend attempting to remove the lump. Otherwise, we probably won't be buying too much more time. In that case, we should just give it pain relief until her QOL deteriorates." Then choose a suitable marker for when QOL is too low to carry on.
ReplyDelete