Dr. Phil Zeltzman’s Blog

Clearly today’s topic is sensitive and it will ruffle some feathers… but please hold the hate mail.

It never ceases to amaze me the number of cats and dogs who end up on my surgery table because they were not neutered. Many end up hit by a car. Many end up with a specific type of hernia (more below).

Then there are all the non-surgical reasons, starting with behavior problems.

Are you wondering whether you should neuter your cat or your dog? Here is a non-exhaustive list of 10 reasons to do it.

1. Unwanted pregnancies

Ah… Love at first sight… It’s really difficult for an intact male to resist a female in heat! An intact male classically runs away and can follow the smell of a pretty female in heat located miles away. And keep in mind that one single incident can lead to 4, 8 or 10 puppies or kittens!

Incidentally, you may be liable if your male procreates with somebody’s prized female. Suddenly, the miracle of life has a bittersweet taste, doesn’t it?

2. Pet overpopulation

Meanwhile, 3 to 4 million of unwanted pets are euthanized each year. What a tragedy… This is called “pet overpopulation”.

Many of these deaths could have been avoided by neutering males (and spaying females).

So sterilizing your pet ultimately makes the world a better place.

3. Behavior

Unneutered pets have all kinds of behavioral problems. In male dogs, the most common behavior is an aggressive temper. Of course, there are many intact pets who are perfectly sweet. Neutering, when done early in life, can reduce aggressiveness and improve behavior overall. For example, it decreases the always-awkward “mounting” behavior in dogs.

4. Marking

Few things smell worse than intact male cat urine. Some people make their indoor cat an outdoor cat when they can’t tolerate the smell anymore. This increases the risk of being hit by a car or getting into a fight. Neutering, when done early enough in life, virtually eliminates the odor of male cat urine and should prevent marking in male dogs.

5. Roaming and getting in trouble

Pets are rarely taught how to cross the street safely. So when they roam, searching for trouble or looking for a partner, they might get hit by a car.

In fact, many pets I treat for a fracture are intact. Neutering reduces the urge to roam or run away from home.

In addition, neutering decreases the risk of getting into a fight, especially in tom cats. They commonly get nasty abscesses from these fights.

Family and emergency vets regularly see wounds from dog bites, and I assure you that it’s rarely pretty. I’ve seen many dogs die after getting attacked by another dog.

6. Roaming and getting lost

Every year, millions of pets get lost. Some are returned to their owner. Most are not. To decrease the risk of such a tragedy happening in your family, neuter your pet, pet-proof the fence in your backyard and always keep your pet on a leash during walks.

In addition, talk to your vet about the benefits of tattoos and microchips.

7. Prostate disease

Intact male dogs can have a number of diseases of the prostate including cysts, abscesses and enlargement. The latter is called “benign prostatic hyperplasia,” just as in older men. Neutering (of dogs!) prevents these problems.

8. Perineal hernia

A perineal hernia is a fixable but annoying problem mostly seen in intact male dogs. Organs from the belly can slip or herniate through weakened muscles in the pelvis. The consequence is a bulge on one or both sides of the anus. The hernia can contain fat, fluid or even the bladder. These hernias frequently cause constipation.

This condition is believed to be due to testosterone (from the testicles). Neutering dramatically reduces the risk of these hernias.

9. Testicular tumors

Neutering eliminates the risk of testicular cancer. This condition, mostly seen in intact male dogs, is believed to be due to testosterone (from the testicles). It’s simple, really: no testicles, no testicular cancer.

One more reason to neuter is when a male is cryptorchid, i.e. when a testicle does not come down and remains in the belly. The testicle left in the belly has a much higher risk of becoming cancerous. So this may require 2 surgeries: 1 to remove the “outside” testicle, and 1 in the belly to find and remove the other one. Occasionally, both testicles are in the abdomen.

10. Genetics

Yet another reason to neuter is to prevent spreading bad genes. Pets with hip dysplasia, eye diseases, heart conditions and many other genetic conditions should not be allowed to breed.

It seems, however, that neutering does not decrease, and in fact may increase, the risk of prostate cancer. Luckily, this is a very rare tumor. Therefore, the combined benefits of neutering vastly outweigh the risk of prostate cancer as you can see from this top 10 list.

The next controversy is when to neuter your pet. Again, hold the hate mail: most reasonable vets recommend neutering at 6 months of age.

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

As you can imagine, some conditions are more severe and urgent than others.

Removing a small lump that’s been there for 3 months is logically less urgent than a C-section.

Still, how do you, how does your family vet, how does a surgeon, decide what surgery is urgent and what is not?

A simple way to decide is to consider that a surgery is urgent if not performing it would cause irreversible harm. This can include:

. Threat to the patient’s life (e.g. severe internal bleeding, “bloat” or a “twisted stomach”, pyometra aka an infected uterus, some C-sections)

. Risk of irreversible damage to the patient’s physical health (e.g. difficulty breathing, risk of paralysis of the legs)

. Threat of permanent harm of an extremity or an organ (e.g. urinary blockage that can cause kidney damage, intestinal blockage that can damage the intestine)

. Risk of rapid worsening of severe symptoms (e.g. a pet hit by a car with open wounds).

. Severe pain that can be solved with surgery (e.g. a severely broken bone that cannot be stabilized)

On the opposite, some surgeries are not urgent: most lumps and bumps, a torn ACL, some fractures that can be stabilized (e.g. with a splint), bladder stones, etc.

Now, just because these surgeries are not considered urgent, doesn’t mean that you should procrastinate for months!

. Delaying the removal of bladder stones can lead to a blockage (of the urethra) that can in turn cause kidney damage and heart problems.

. Removing a small tumor is obviously less invasive than removing a huge one.

. Delaying the repair of a torn ACL for months means that there will be much more arthritis and muscle loss (and pain).

Even though some of the above examples are sometimes debatable, these are pretty good guidelines.

Everything is relative, even in the surgery world…

Basically, urgent or emergency surgery is recommended when it provides relief to the patient or to an organ, and a non-surgery option is not available or practical.

Importantly, as you read these examples, please remember that I am only talking about surgical conditions. There are countless other conditions that are medical, i.e. that are not treated with surgery. Those are beyond the scope of this blog.

Bottom line: when in doubt about a specific condition in your pet, the best thing you can do is ask your family vet, an emergency vet, or ideally, a surgeon.

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

Nestle, a 6 year old pit bull, started limping on her left hind leg. Her owner took her to her family vet to figure out what was wrong.

The vet took one X-ray of the leg and gave the owner some devastating news: Nestle had bone cancer – most likely osteosarcoma. He recommended that she been seen by a surgeon to discuss what options were available.

Nestle’s dedicated owner immediately took her to see the surgeon. He reviewed the X-ray taken by the family vet and agreed with the diagnosis. Then he recommended to take her to surgery right away to have her leg amputated. Amputation is indeed the standard of care for bone cancer.

But Nestle’s owner didn’t feel right about the whole situation. He couldn’t explain it. It just didn’t sit right with him. “I knew we had to get a second opinion. When I looked at Nestle, something just told me I wasn’t getting the most accurate information.”

Trusting his gut, he reached out to me for a second opinion about his dog’s unfortunate situation. I asked him to send me the X-ray his vet had taken for me to review. After looking it over thoroughly, and with all due respect, I didn’t see anything convincing on the X-ray.

That put me in a diplomatically tricky position…

I told him that I would not feel comfortable amputating Nestle based on that X-ray only.

Instead, I recommended doing a full “workup” – by the book.

X-rays of the bone in question, in addition to the knees and the hips to be thorough. I also recommended chest X-rays since bone cancer readily spreads to the lungs. And full blood work for good measure, to make sure Nestle was a good candidate for anesthesia.

That was a big leap of faith, and a significant expense, but Nestle’s owner trusted me enough to follow my advice.

Once I received the X-rays from the clinic I referred him to, there was no question in my mind. Nestle did not have bone cancer. To be extra safe, I even emailed the X-rays to several surgeon friends. They all agreed with my opinion: no sign of bone cancer.

So what did Nestle have? A torn ACL.

Rather than an amputation, she needed a TPLO (Tibial Plateau Leveling Osteotomy).

Both happy and a bit uneasy (i.e. going against a family vet’s and another surgeon’s opinion), I delivered the news to Nestle’s owner. He was beyond grateful for the amazing news.

Can you imagine the emotional roller coaster?

We set up surgery for her TPLO procedure the following week. She had a successful surgery and recovered uneventfully.

The owner and his family were so happy. They were relieved that they trusted their gut and pursued a second opinion for their dog.

What’s the moral of the story? My point is certainly not to pretend that I am smarter than the other surgeon.

Here are a few points to never forget if you get in a similar situation:

. A thorough vet will always do specific things rather than cut corners. For example, we almost always need “2 views” or 2 X-rays, to get a better idea of the anatomy in 3D: one from the front and one from the side. Nestle’s vet, with all due respect, only took a view from the side. I always ask for “2 views” of the bone.

. When cancer is suspected, we usually take chest X-rays to make sure the cancer hasn’t spread to the lung (I say usually because in some cases we need to look inside the belly for spreading). Can you imagine amputating a dog’s leg, and then later realizing that the lungs are full of metastasis?

Incidentally, a thorough vet will take not 2 but 3 views of the chest: one of the front, and one from each side. Again, don’t cut corners.

. And of course, we always perform full blood work before putting a patient under anesthesia, to ensure they are a good candidate, ie internal organs such as the kidneys and the liver, are healthy enough.

. And here is my final and most important point: whenever something doesn’t seem or feel right about a practice, a vet or a treatment recommendation, you should trust your gut. It is your absolute right to get a second opinion if you aren’t comfortable.

You should never feel embarrassed or ashamed to seek a second opinion. You need to be your pet’s best advocate.

The diagnosis and the outcome may not be any different, but at least you can rest assured that you will make the best possible decision for your pet.

“The initial thought of losing Nestle to bone cancer absolutely crushed my family and I. Nestle is a rescue & since the day I rescued her, I vowed to do everything in my power to keep her safe and comfortable throughout her life after a rough beginning. After her initial diagnosis, I felt like I had failed her. But there was something about Nestle’s demeanor, I can’t explain it, I knew there was more to the initial diagnosis. And I knew I wanted a second opinion, especially after such a serious diagnosis.”

And he concludes:

“Without a doubt, Dr. Zeltzman and the staff at the clinic changed Nestle‘s life for the absolute best, and they gave me back my best friend when I thought I’d lost her for good.”

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

I met Oliver, a 9 year old Yorkie, in late January of 2019.

His family vet had incompletely removed a mass on the gum of the lower jaw (aka mandible). It turned out to be malignant melanoma, an aggressive type of cancer (you may have heard of it in the skin of people or pets).

An aggressive cancer requires an aggressive treatment…

Therefore, more tissue, i.e. part of the jaw bone, had to be removed. This is called a partial mandibulectomy.

Below is an X-ray that shows the extent of the surgery (between the red arrows).

Surgery was uneventful and Oliver recovered smoothly.

Just a few hours after this invasive surgery, Oliver ate!

His nurse wrote: “Oliver is awake and walking around in his cage. I offered him small amounts of his own blenderized dog food and he ate it when I hand fed him. He also ate a little of the boiled chicken that his owner brought.”

Would you have believed that a dog would eat a few hours after a big part of the jaw is removed?

His super dedicated owner then chose to give Oliver the melanoma vaccine.

This is a very rare situation. We actually have a vaccine… against cancer!

It’s definitely not cheap, but it’s very effective.

About 4 months after surgery, Oliver’s owner wrote:

“He had his checkup exam today and chest radiographs. I am extremely happy to report everything looks good.

X-rays are clear and he is running around like a puppy, playing, eating and is unaffected after his surgery.

He is back to eating his kibble (not softened) and chewing on his toys.

I cannot thank you enough for your patience, professional advice on how to proceed, and your amazing skills as a surgeon.

Forever indebted.”

Then I didn’t hear much about Oliver, now 10 years old, until early May 2020.

His owner reached out to me because he started gagging, coughing and having difficulty breathing while awake, and making weird sounds while sleeping. He also couldn’t bark anymore…

His family vet did an exam of the mouth, and found a big mass, apparently attached to the roof of the mouth. Clearly, it was blocking his airway.

We performed emergency surgery the very next day.

The mass was the size of a walnut, which is huge for such a small dog. Upon further exam, under anesthesia, the mass was actually not attached to the roof of the mouth, but to the right tonsil.

Here is a picture of Oliver just before surgery – you can vaguely see the mass inside the mouth. You can also see the plastic tube which delivers oxygen and anesthesia gas.

WARNING – what follows is graphic, read further at your own risk !!!

Here is a close up of the evil mass – I don’t think you need an arrow to see it…

Surgery was rather tricky, but we were able to remove the mass safely.

Here is a postop picture. At the end of the red arrow are the stitches.

And this is the actual mass, just before we sent it to the lab for a biopsy.

About a week later, the biopsy confirmed the suspicion: the mass was the same as last year, a malignant melanoma of the right tonsil. The only good news: we got it all.

The tonsil really behaves like a lymph node.

Since the initial cancer was in the right lower jaw, the theory is that this second mass could have spread from the initial mass, even though it had been removed completely at the time. Of course, it’s hard to prove, which is why it’s only a theory.

Shortly after surgery, Oliver could breathe much better.

Oliver is now recovering and we wish this cancer survivor the very best.

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

Emmie, a 9 year old Golden Retriever, had a small mass on her left thigh.

For weeks, it waxed and waned.

A needle test (a Fine Needle Aspirate or FNA) suggested a mast cell tumor, a very common skin tumor.

Eventually, it almost disappeared. Instead of brushing it off, her amazing owner reached out to me and asked me to remove it regardless.

This is how tiny the mass was at the time of surgery: less than 1 cm, or less than half an inch. It was basically flat. It would have been impossible to see or feel under a Golden retriever’s hair!

How many pet owners do you think would have requested surgery to remove it?

Well, Emmie’s owner sure did!

Because of the behavior of a mast cell tumor, and without knowing how aggressive it was (ie without knowing it’s “grade”), the surgery had to be aggressive.

With a special pen, a 3 cm in diameter circle (a bit over 1 inch) was drawn around the mass.

However, we cannot remove a circular area of the skin (the scar would be tight and ugly). We can however remove an oval area. So the shape was changed to this:

Then the mass was removed along those purple lines (OK, OK, for the purists, this is a fusiform shape, not oval).

One week later, the biopsy came back. A mast cell tumor was confirmed – a grade 2, which is considered “intermediate.”

(Grade 1 is low grade or least aggressive, grade 2 is intermediate grade, and grade 3 is high grade or most aggressive)

The good news however is that being aggressive to remove the mass (and not wishy-washy) allowed us to “get it all.” Here is a picture of the incision:

Now, Emmie has fully recovered and can enjoy her walks again.

Her owner simply commented: Emmie “looks great!! I’m very happy with my decision!”

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