Dr. Phil Zeltzman’s Blog

NOTE: This is a free excerpt from my upcoming book about cancer in pets!

Fecchi, an 8-year-old Sheltie, had a firm, golf ball-sized mass in his left cheek. It was hard to be more specific since I couldn’t even open his jaw during the exam.

Note: I have pictures of the entire surgery, but I decided some were too graphic. So I will only show a few relatively “tame” pictures.

Upon further exam, it looked like the mass was coming from the upper jaw (maxilla) and/or the the lower jaw (mandible).

Clearly, a major reconstructive and possibly disfiguring surgery was necessary to remove the mass.

Fecchi’s owner had consulted with 3 surgery colleagues, who all had told her that this mass was some horrible cancer that couldn’t be removed.

Given the poor outcome and Fecchi’s lack of appetite, they all told her she should humanely put him to sleep. Yet that option wasn’t good enough for this client.

And that’s when we met. During the surgery consultation, she insisted on removing the mass.

I wasn’t so sure it was in the patient’s best interest. 

Fecchi had lost weight and wasn’t in very good health because of the tumor.

So we compromised and agreed on taking a biopsy first. A week later, the biopsy came back as osteo-chondroma – a benign tumor of both bone and cartilage.

Of course, I didn’t believe it. More convinced than ever about her decision, the owner insisted on removing the mass.

After a lot of soul-searching, I finally gave in. I accepted to “explore the area and see what I could do to help.”

Granted, removing jaw tumors is not an uncommon procedure. So why the hesitation? 

After all, with the numerous pain management modalities available, we can make these patients comfortable despite aggressive surgery.

Anyway, we ended up taking Fecchi to surgery. 

It turned out that the mass came from the upper jaw, but on both sides of the jaw.

As the tumor grew bigger and bigger, the teeth of the lower jaw dug sort of a “gutter” into it.

Surgery was long and challenging. It was followed by reconstruction of the surgery site to make it look as cosmetic as possible.

To make sure Fecchi would get enough nutrition after surgery, we placed a feeding tube to inject a special liquid diet directly into the stomach (see the red tube coming out of the skin).

The entire mass was submitted to the lab.

Fecchi recovered smoothly from anesthesia.

He stayed in ICU overnight, on IV fluids, pain medications, and antibiotics.

10 days later, the biopsy report came back. As you can imagine, it concluded… osteochondroma – still a benign tumor!

So what’s the moral of the story?

Fecchi’s owner kind of twisted my arm – in a nice way – and she was totally right.

Should we always do what clients require? 

Of course not. 

Otherwise, we would do ear crops, declaws, and tail docks all day long.

What’s the moral of the story? It is perfectly acceptable to perform a procedure, invasive or not, as long as client and practitioner are on the same page, and the procedure is acceptable and ethical.

Sometimes, it’s good to be pushed out of one’s comfort zone.

Almost one year later, Fecchi was reportedly doing great at home.

“The surgical site looks great,” the owner says. “You can’t even tell that he ever had surgery.”

If you would like to learn how we can help your pet with safe surgery and anesthesia, please contact us through www.DrPhilZeltzman.com 

Never miss a blog by subscribing here: www.DrPhilZeltzman.com/blog 

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Toast, a 4-year-old kitty, was sleeping on the couch when he was suddenly woken up by a porcelain vase that fell and broke into a million pieces. Spooked, he jumped from the couch and hid in another room.

Later that evening, the owner found his poor kitty crying out in pain and unable to use the left back leg.

The next day, he took Toast to his family vet. An exam revealed severe pain in the left knee. X-rays under sedation showed pretty drastic findings.

After reviewing the X-rays, I realized that the knee was completely dislocated (luxated). This is called a “deranged knee.”

I suspected that Toast’s leg got caught during the escape from the couch and the evil vase. While Toast was running for his life, he pulled on the leg, and that presumably caused the damage.

What’s a deranged knee?

Toast’s owner asked what this condition with a weird name was about. I explained that there are four ligaments in the knee: two inside the knee (anterior and posterior cruciate ligaments) and two outside the knee (collateral ligaments). When more than one ligament is torn, the knee is so severely affected, that the condition is called a deranged knee.

Most of the time, both cruciate ligaments and one collateral are torn. Occasionally, with very violent trauma, all four ligaments are torn.

How is a deranged knee treated?

A deranged knee is so unstable (wobbly) that the only hope for a good recovery is surgery. The goal is to make the knee more stable. Post-op care involves a combination of strict rest, pain medications and physical therapy.

During surgery, I confirmed that Toast had 3 torn ligaments (one collateral and both cruciate ligaments). They were repaired with heavy nylon sutures to mimic or imitate the original ligaments.

Toast recovered smoothly from anesthesia and went home the day after surgery.

Recovering from a deranged knee

After 2 weeks of strict confinement and physical therapy, Toast had his stitches removed. At that point he was “toe-touching,” which means that he was starting to put gentle pressure on the foot. After another 6 weeks of continued rest and physical therapy, he had another follow-up exam: he was using the leg very well.

It was time to progressively increase his activity level. We designed a program to help him rebuild muscle and regain flexibility in the surgery knee. By using toys and food, Toast’s owner managed to convince him to follow him around.

Long-term outcome of a deranged knee

Although patients can do well after surgery to repair a deranged knee, they will get arthritis.

We managed Toast’s arthritis by maintaining a healthy weight, and giving joint supplements (aka arthritis supplements) such as glucosamine and fish oil (omega 3 fatty acids) – for life.

In the end, Toast’s owner was happy with the outcome, and promised not to break fragile objects anymore!

If you would like to learn how we can help your pet with safe surgery and anesthesia, please contact us through www.DrPhilZeltzman.com

Never miss a blog by subscribing here: www.DrPhilZeltzman.com/blog

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified
Pete Baia, DVM, MS, DACVS

Trusting your vet or a surgeon with doing surgery on your beloved pet is not as easy as it sounds.

It requires a lot of trust.

To help you establish that trust, here are some questions I feel are reasonable to ask your vet or your surgeon.

• Are you a board-certified surgeon, i.e. a true specialist?
• What’s my pet’s exact diagnosis?
• What are ALL of the treatment options?
• What is the specific surgery you recommend?
• What is the purpose of the surgery?
• Why do you think this surgery is a better option than the other ones?
• Is my pet a good candidate for this surgery?
• Who is the best person to do the surgery?
• How many of these surgeries have you done in your career?
• How many of them have you done in the last year?
• What are the possible risks and complications?
• How common are they in general?
• How common are they in your patients, in your hands?
• What is your success rate?
• Are there additional tests required before surgery?
• How will my pet be monitored during and especially after surgery?
• How long will the surgery take, and how long will my pet need to stay at the clinic?
• If there is an overnight stay, who will supervise my pet?
• How will pain be assessed and addressed?
• What is the expected recovery like?
• How long will it take for my pet to fully recover?
• What are the postop care instructions and restrictions?

Even though this list looks long, and seems like it would take hours to answer, a good surgeon should answer many of these questions during the consultation anyway.

So check those questions off as they go, and ask the remaining questions after that.

It’s critical to have open and transparent communication with your surgeon to ensure you make an informed decision about your pet’s surgery.

If you would like to learn how we can help your pet with safe surgery and anesthesia, please contact us through www.DrPhilZeltzman.com

Never miss a blog by subscribing here: www.DrPhilZeltzman.com/blog

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

NOTE: This is a free excerpt from my upcoming book about cancer in pets!

Many pet owners think we can diagnose cancer by looking at routine blood work, when that is very rare.

Exceptions include liver and thyroid cancer.

So how might you suspect your pet has cancer?

Here are 7 findings that should put you on alert.

1. Skin mass

The most common type of mass is directly visible on or under the skin. Sometimes, the mass can burst open and bleed, or ooze.

Don’t make the classic mistake of thinking “It’s just a cyst” or “It’s just a fatty tumor.”

Never procrastinate in those situations. Early intervention can make the difference between success and failure. Removing a small mass is understandably less invasive and cheaper than removing a big mass.

In some cases, removal of a mass has become impossible and the best option is to amputate a leg.

2. A big belly

Of course not every cat or dog with a big belly has cancer!

Rather, it’s about a belly that becomes big quickly.

That can be a sign that a mass has grown inside an organ (for example the spleen).

Occasionally, such a mass can rupture and cause internal bleeding, which can also cause a big belly.

3. Unexplained weight loss or gain

A mass in the spleen can weigh several pounds, so it would make sense that the pet would gain weight despite having the same appetite.

In other cases, it’s the other way around. Cancer can cause weight loss.

Why? Because cancer cells need specific nutrients to grow and thrive, so they rob them from the patient.

4. Bleeding

Bleeding from anywhere in the body should be a cause for concern – and a veterinary consultation.

• Bleeding from a mass or a wound as mentioned above.
• Bleeding from the mouth, the ear, the bladder, or the rectum.
• Internal bleeding, causing an enlarged belly as mentioned above, which may be difficult to tell.

5. Difficulty breathing, eating, walking

Any mass can affect a body part, and its function.

A mass in the throat can cause difficulty breathing.

A mass in the jaw, the gum, or around the tongue can cause pain and difficulty eating.

A mass in a leg or the armpit can cause difficulty walking.

6. Stubborn vomiting or diarrhea

Tumors in the stomach or the intestines can cause vomiting or diarrhea.

They typically don’t stop after the usual treatments provided by your family vet.

As they grow, these tumors affect the lining or the thickness of the stomach or the intestines, which can affect the way they work.

This can cause bleeding, so vomit or poop/diarrhea can contain blood, either red (“fresh”) or blackish (“digested”).

Sometimes, a mass grows so big, that it can cause a blockage of the stomach or the intestines.

7. Something just doesn’t make sense

A bladder infection that keeps coming back despite multiple rounds of antibiotics may very well be masking a bladder tumor.

And then sometimes, my experience shows that when something just doesn’t make any sense, or defies a logical explanation, cancer should be considered as a possibility.

If you ever notice any of the signs above, please get an appointment with your family ASAP.

If cancer is suspected, time is of the essence.

The sooner we intervene, the better off your pet will be.

Procrastination never helps.

Quite the opposite. Procrastination may mean there is no hope to help your pet.

So the sooner you act, the better it will be for your pet.

If you would like to learn how we can help your pet with safe cancer surgery and anesthesia, please contact us through www.DrPhilZeltzman.com

Never miss a blog by subscribing here: www.DrPhilZeltzman.com/blog

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Surgery is a big deal, and we want you to be fully prepared and comfortable with the plan.

Here are 6 simple steps to be ready for the big day.

1. Blood work

We always recommend pre-anesthetic blood work to make anesthesia and surgery as safe as possible. Seemingly healthy pets on the outside can have serious problems on the inside. They could cause complications during anesthesia and surgery.

Pre-anesthetic blood work will confirm:

• Liver and kidney health
• Red and white blood cell count
• Enough platelets for proper clotting
• Enough protein to ensure healing and clotting
• Balanced electrolytes, which can affect the stability of the heart under anesthesia.

Discovery of a small imbalance will allow us to adjust drugs or IV fluids before, during, and after your pet’s anesthesia and surgery.

Unless it’s an emergency and we don’t have the luxury of time, detection of a serious problem may lead us to postpone surgery until the pet’s condition is stable.

This can happen with high liver values, which could justify an ultrasound to make sure we’re not missing something important.

2. Medications

We will let you know which medications to continue or stop before anesthesia. And we’ll tell you when to resume them.

Other drugs are given to reduce stress and the risk of vomiting around anesthesia time.

An added benefit is that it will allow us to give less anesthesia to your pet.

3. Rest

Anesthesia and surgery can take a toll on the body, so let your pet chill the day before surgery.

It’s just like a human: provide plenty of rest the day before surgery.

Plan on a relaxed day, full of TLC.

4. Instructions

Follow the instructions you are given verbally and in writing.

Failing to do that could potentially prevent your pet from having safe anesthesia and surgery.

Following them will increase the chances of success.

Also make sure you fully understand postop instructions, i.e. what you will need to do as far as confinement, feeding, medications, supplements, activity, physical therapy, wound care, leash walks, etc.

5. Preparation

Prepare your home for your pet’s return.

We will explain in great detail how to confine your pet, which type of flooring is ideal, which toys are allowed, how to feed your pet etc.

Depending on the type of surgery, we may also recommend:

• getting a harness for your dog
• changing the litter for your cat
• using soft food only

Again, this all depends on the surgery, and we will help you get fully prepared.

6. Feeding

An empty stomach is important to decrease the risk of vomiting before, during, and after anesthesia.

With a few exceptions, we recommend taking food away at 8 pm the night before surgery.

Water however is important to prevent your pet from getting dehydrated.

So water is allowed until you leave home, the morning of surgery.

If you ever have a question about your pet’s care, before or after surgery, never hesitate to call.

Our only goal is a happy outcome for you and your pet.

If you would like to learn how we can help your pet with safe surgery and anesthesia, please contact us through www.DrPhilZeltzman.com

Never miss a blog by subscribing here: www.DrPhilZeltzman.com/blog

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified