I was recently sent an interesting question from a reader about the right way to deal with a lump.
The question revolved around standard veterinary practices upon finding an external mass in a dog. Is it correct to simply monitor and wait for a cancer to grow before doing something about it?
The first point I’d like to make is, in many cases, veterinary medicine is still art and not science. Because of the still-present legal precedents viewing animals as property instead of beings, the protocols for veterinary care are neither truly standardized nor enforced by the AVMA, unless there is true negligence.
So there is no published standard of care when dealing with a mass on the outside of a dog. Some vets will try to get a history of growth rate, as most malignancies (but not all) tend to grow at the site they are found.
Many vets will note the appearance or the feel of a mass on palpation. This can often yield information as well.
However, the truth is that neither is 100% reliable. Far from it.
Now we get to the juicy bits. Suppose I am a veterinarian who advises a fine needle aspirate on a soft mass under the skin. I tell the owners it is better to be safe. While it is true that soft masses are most often benign fatty tumors (lipomas), they also can be mast cell tumors, hemangiopericytomas, subcutaneous hemangiosarcomas and others.
The dog’s guardian declines, and gets a second opinion from another vet, who states it is silly to aspirate a “lipoma” (without actually knowing it is one). True, 80% or so, in my estimation, of these tumors are lipomas, But what about the remainder?
So now this person is angry with me. Why? Because I tried to sell something that “was not needed”. Emphasis on “sell”. The perspective is that I attempted to gouge someone and take their money. Now I have alienated another human and I am worried they will hurt my professional reputation.
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The financial aspects of the scenario explain why some vets do not always recommend the safest options to owners. We enter the unpleasant land of money, guilt, business, and catering to the needs of the client but not the patient.
The financial aspect of the vet-client-patient bond makes things very messy!
The way that I most often deal with this quandary is to do my best to give odds and percentages, based on my clinical experience or data if I am aware of it. That way the guardian of the dog is empowered and responsible for the outcome.
On top of that, I will give my opinion, which is not the same as simply giving the facts as I see them. Many times people are not aware of the reality of some consequences, and I have a responsibility to try to guide a decision in the best interest of the dog.
Not getting a diagnosis is always a gamble. While it is true that, practically speaking, one may get away with a dice roll if the odds are high enough, this is not always the case.
The safest option is always to try to get a diagnosis on a mass, whether by fine needle aspirate or by surgical biopsy. And that cannot be disputed.
Best to all
Dr. Demian Dressler is internationally recognized as “the dog cancer vet” because of his innovations in the field of dog cancer management, and the popularity of his blog here at Dog Cancer Blog. The owner of South Shore Veterinary Care, a full-service veterinary hospital in Maui, Hawaii, Dr. Dressler studied Animal Physiology and received a Bachelor of Science degree from the University of California at Davis before earning his Doctorate in Veterinary Medicine from Cornell University. After practicing at Killewald Animal Hospital in Amherst, New York, he returned to his home state, Hawaii, to practice at the East Honolulu Pet Hospital before heading home to Maui to open his own hospital. Dr. Dressler consults both dog lovers and veterinary professionals, and is sought after as a speaker on topics ranging from the links between lifestyle choices and disease, nutrition and cancer, and animal ethics. His television appearances include “Ask the Vet” segments on local news programs. He is the author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. He is a member of the American Veterinary Medical Association, the Hawaii Veterinary Medical Association, the American Association of Avian Veterinarians, the National Animal Supplement Council and CORE (Comparative Orthopedic Research Evaluation). He is also an advisory board member for Pacific Primate Sanctuary.
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