Lumps and bumps part 2: lump-be-gone

In part one I talked mostly about benign lumps such as lipomas, fatty tumors, that can often be left alone unless they are causing a specific problem.  This blog is dedicated to lumps that should not be left alone.  As a veterinarian, it makes me sad when I see a pet brought into the clinic with a tumor that has grown too large to be removed.  Usually the history given to me is that the growth showed up about a year ago and didn't look too bad.  Then it suddenly started to grow over the last week or two and by the time the pet is brought in for an exam it is either too late to do anything or if surgery is possible it would be so extensive that a referral to a board certified surgeon is necessary.  This is especially true of lumps and bumps on legs.  Remember that when a surgeon cuts a lump off an animal almost always they will have to remove the skin over the lump as well.  On legs especially, there is just not enough loose skin available to cover the surgical wound at least without using some special techniques. It is so much easier to just remove a leg lump when it is small.

As I mentioned in Part 1, I think part of the hesitation about bringing a pet in for an exam to have a lump checked is that we as humans are all afraid of getting a bad diagnosis.  But the good thing about lumps on the outside of the body where they can be seen is that we can do something about them early and that can lead to a good outcome.  Within the past year, I said goodbye to two of patients that will always remind me of what is possible by taking care of cancerous lumps earlier rather than later.  Both patients were diagnosed with cancer.  Buddy had a fairly aggressive mast cell tumor diagnosed in 2008.  Buddy actually had two surgeries to remove his cancer.  Daisy Mae had mammary gland (breast) cancer in 2007 and had a partial mastectomy.  Buddy and Daisy Mae both lived to around 16 years of age which is a fine lifetime for a dog.  I have no doubt that both their lives would have been considerably shorter if they had not had surgery early on to remove their cancerous tumors.

Buddy at age 16  

Gosh I love old dogs.

Unfortunately I don't have a picture of Daisy Mae, but I do want to discuss mammary cancer in dogs for just a bit.  There are many things unknown in our lives, but one thing that has been proven is that if you get a dog spayed before she is two years old, you can really decrease the risk of mammary cancer later in life.  Because of a dog's anatomy, a female dog has on average 10 mammary glands or a chain of 5 on each side, plus or minus.  Sometimes dogs will develop mammary cancer in multiple glands and when that happens, a complete mastectomy is done.  First one side and then the other if appropriate.  A female dog's mammary chain runs from the "armpit" area under the front leg all the back to the groin under the rear leg.  That means to get all the cancer, a surgeon has to make a VERY long incision.  It looks like this.

This little dog was 8 years old, not spayed and never used for breeding.  All this pain and suffering, and nearly always preventable by spaying while young.  Fortunately for this dog, she had an owner that was willing to treat her disease before it became inoperable.  If she makes it one year, she has a very good chance of her mammary cancer being gone for good.

The moral of Part 1 and Part 2 of the lumps and bumps blog?  If your pet  has a lump and you don't know what it is, please have it checked out sooner rather than later.  Time is ticking.

Lumps and bumps part 1: Do you want to see a one pound lipoma?

I have learned a couple of things from blogging.  Number one, the first picture contained in a blog post is often the thumbnail that is used by other web sites when a linked back to the blog.  Number two is that some people don't enjoy looking at gross pictures of tumors and body parts.  I can't quite figure out why someone wouldn't want to look at something as fascinating as a one pound lipoma, but I accept that some people really do feel that way whenever I show someone a recently removed tumor and they turn white as a ghost and leave the room.  Oh well.  I guess the fact that I am fascinated by how things look underneath that covering of skin makes me well suited to being a surgeon.  And so to kick off this blog about tumors and lumps and bumps, I give you a picture of my dog Buddy.  He is lot cuter than a one pound lipoma anyway.

Onward to the blog about lumps.  I decided to write this blog because I have seen a few tumors lately where owners ignored a lump on their dog until the lump was so big or so aggressive that nothing could be done to save the dog's life.  I don't know quite why people wait so long, but it is not uncommon.  Sometimes it is money, but many times it is not.  Maybe it's that we all get busy with other things in our lives or there is some underlying fear that the lump may be something bad, but it is a common human reaction to put things off until they jump up and bite us.  So I thought I would share some examples of when lumps can be ignored and when they can't and how some lumps can be prevented and how some cancers in our pets can truly be cured.  Part 1 will be dedicated to benign lumps that can sometimes be left alone except when they are in bad locations or get really large.

Lumps and bumps are really common especially in dogs.  Lumps can be caused by infections (e.g. abscesses) or irritations (e.g. lick granulomas - that's a good one to type into a Google Image search) or lumps can be caused by abnormal growth of cells (tumors).  Tumors can be either benign or cancerous.

The case of the one pound lipoma

definition of lipoma = a benign tumor made of fatty tissue

Lipomas are one of the most common tumors we see in dogs.  They are benign although there is a cancerous counterpart called a liposarcoma, but those are relatively rare.  Most lipomas occur along the side or the lower part of the chest or the belly, but I have seen them on legs or the head on occasion.  One time I removed a lipoma from the side of a Labrador Retriever's head that was literally as big as the lab's head.  It looked like the dog had two heads.  This dog had been adopted from the local shelter with this growth and his new owners were kind enough to have this monstrous growth removed.  I just want to give people a big hug when they take on a senior dog from a shelter with a problem.

Some dogs get so many lipomas during their middle age to senior years that it would be impossible to remove them all.  Retrievers are especially noted for getting lots of lots of these growths as they get older. These growths are not painful, but if they grow in a bad spot, they can cause difficulty walking or moving.  Because lipomas are common growths that don't bother dogs very much, they are one type of tumor that is often left alone.  They can however get quite large.  My personal record was an 11 pound lipoma that I removed off the side of the flank of a dog.  The dog weighed (after surgery) 17 pounds.  That tumor was nearly 2/3rds of the dog's post-surgery weight.  Holy lipoma batman!

Some lipomas are soft and others have a more firm feel to them.  Some of them are quite easy to determine where they stop and where normal tissue starts.  Others "infiltrate" into normal surrounding body fat.  Through experience, most veterinarians can tell you whether they think a lump is a lipoma or not and most of the time they will be right.  But the truth is that none of us can truly know what kind of lump your pet may have without a biopsy (taking a sample of the cells from a growth and looking at them under a microscope).  And the other truth is that there are some cancerous growths that can feel identical to lipomas.  Hemangiopericytomas and mast cell tumors are two examples and those two growths can be very difficult to deal with especially if you let them get big.  I will say that I don't necessarily recommend a biopsy of every single "lipoma-like" lump, but there are times when I think it is a very good idea.

Teddy was a retriever that came to see me because his owners noticed a swelling in his upper thigh on the inside.  By feeling it I could tell it was a mass of some sort so the next step was to do a needle biopsy.  A needle biopsy (fine needle aspirate) is done by sticking a small needle into the lump and sucking out some of the cells with a syringe.  The cells can then be put on a slide and looked at under a microscope.  Needle biopsies are not nearly as accurate as taking a whole slice out of  a lump, but the nice thing is that most dogs don't need any sedation to get a needle biopsy sample.   Some tumors are really hard to diagnose with a needle biopsy but lipomas are pretty easy most of the time.  I did a needle biopsy on Teddy's lump and the report came back it was a lipoma. We decided to leave it alone for several reasons.  It was in kind of a bad spot to remove, it wasn't causing him any symptoms and because I knew it was a lipoma, I also knew that if it got a little bigger it would not be much harder to remove than it already was.

Teddy did just fine, but about 10 months later, his owners noticed that the lipoma was getting bigger and it was starting to affect how Teddy was using his rear leg.  We decided to remove the lipoma.  I was happy that this lipoma was one of the non-invasive kind and even though it was in a really bad location, it came out relatively easily.  As is typical of growths that are a little larger than average, I like to get them weighed and photographed.  And so here is a one pound lipoma hanging out next to a regular sized Sharpie for size comparison.

Even though lipomas are abnormal growths of fat cells, they are fat cells none the less. If you are carrying a little extra weight, just think about 10, 20, 30 or more of these little buggers hiding out under your skin.  I know I think about it every time I have that extra slice (or two or three) of pizza on a Saturday night.  Certainly gives me some motivation to get out and ride my bike.

Enough about lipomas.  Next blog is part 2 about lumps that should not be left alone.

What were they thinking?

I am sitting here writing this blog entry on the night before a meeting of the Safety Council of the largest city in the county where I live.  That would be the city of Ashtabula in Ashtabula County, Ohio in case you are curious.  The city of Ashtabula currently has a law in place that bans ownership of "pit bull" dogs within the city.  According to my sources, one of the topics that will be discussed at tomorrow's meeting of the Safety Council is the fate of this law.  There are some very good people who are trying to get the ban against pit bulls abolished and I applaud their efforts.  This topic is especially relevant because of what happened yesterday during my work day at the clinic.  I had one of those moments in life where you think about a particular law that is in place and say to yourself "What were they thinking?".


I walked into the clinic yesterday morning and my surgery case I had scheduled for the day had already been admitted to the hospital.  The dog's owners are very nice people.  The dog I am sorry to say is not so nice.  Oh it may be nice to people that it knows, but it is not so nice when it is around the strange workings of a veterinary hospital.  Some dogs come to the vet office and are what I call "eternally happy".  This is the majority of dogs we see.  They wag their tails and love being petted.  Some dogs come to the vet office and are fearful, but even though they are scared, they sit still and just wait for the horrible experience to be over.  These dogs will often warm up to us if we are slow and take time to get to know them.  Then there are the fearful dogs that do not back down.  These dogs are a small minority, but they do present certain challenges.  They have learned that if they are scared of strangers and if they attack then the strange people will go away.  These dogs are dangerous and such was the case with the dog that was in for surgery yesterday morning.  This dog would just as soon eat my face, my technician's face or any other face of a strange person at a vet hospital.  It didn't help that the dog weighed about 100 pounds to boot.  Fortunately I work with some of the most talented animal handlers on the planet and we were able to get a muzzle on and treat this dog with what I call "no muss, no fuss".  The dog did not freak out at all and no one got bit.  But in spite of an uneventful visit to the vet, this dog is dangerous.  It is not however a pit bull so anyone that lives in the city of Ashtabula, Ohio could legally own this 100 pounds of accident waiting to happen.


My last appointment of the day was a stray dog that was rescued off the streets of Cleveland.  The dog was pregnant at the time of rescue and a wonderful woman who lives in my neighborhood took her in.  This woman has rescued many dogs and is very good at placing rescued dogs in good homes.  The dog had her puppies and Momma dog and her pups are being cared for until the puppies are old enough to be placed into new homes.  Then momma dog will be spayed and she too will find a new home.  Anyway, momma dog came to the clinic to get her vaccinations.  I walked in the exam room and she immediately walked over to me, wagging her tail and wanted to be petted.  I sat on the floor with her and she licked my face.  Then she rolled over next to me so I could rub her belly.  This dog was in that first category of dog that I talked about.  She was "eternally happy".  I did a physical exam while avoiding the slurping tongue.  I administered three vaccinations while she happily ate treats out of my assistant's hand and without any restraint at all.  Momma dog was one of the friendliest dogs I have ever met and I have met a lot of dogs.  Momma dog is a pit bull.  She cannot be adopted by anyone  who lives in the city of Ashtabula.


And so there is my "What were they thinking moment?".  If I lived in a city neighborhood and had a choice between my neighbor owning the 100# accident waiting to happen or the friendly pit bull, is there any question what I would choose?  Or what any sane person would choose?


I always wonder how a city council votes for a breed specific ban in the first place.  If I were on a city council and I was getting ready to make a new law, I would consult with people who were experts on the topic.  If I were making a law concerning, let's say, safety of drinking water, I would consult with people who have degrees and work in the field of water quality and public health.  If I were making a law concerning education, I would consult teachers and other educators.  Who would I contact if I were considering enacting a law concerning dogs?  Well, that would be dog experts such as veterinarians, trainers and those who run animal shelters to name a few.  I would not ask the public.  I would not ask the police department.  They are not experts on dogs.  And the funny thing is that almost across the board, dog experts are against banning specific breeds of dogs.  So how do these laws get passed in the first place?  Someone is obviously not listening to experts on the subject.


Things that have happened in the past though are just that: in the past.  Wrongs can be righted.  The State of Ohio just recently removed the words "pit bull" from the state's dangerous dog law.  It is time for local communities to step up and do the same.  You don't ban cars because some people are dangerous drivers and you don't ban specific breeds because some people own dangerous dogs.

Outdoor dogs: Oh what that fur coat may be hiding

This is the story about a hot spot.  It's about a hot spot that started off small and grew up big and bad.  But at least this story has a happy ending because they do not all turn out that way.

"Hot Spot" is a fairly common term used mostly to describe a moist area of skin infection and most of the time we use the term when we are talking about this skin lesion on dogs.  If you haven't heard the phrase "hot spot" before, here is a nice article "Hot Spots in Dogs: What are they? How to cool them down!" that talks all about them.  Veterinarians see hot spots all year-round but they are certainly more common in the summer because the underlying causes (fleas, insect bites, scratches from thorns, allergies, etc.) are more common in summer.  But the "hot" in hot spot is not because we see them in hot weather, it is because the skin is "hot" and inflamed.  And while most hot spots are indeed a "spot" on the skin, as you will see from this next case, they can become very large and do so very quickly.

Except in some cases of working breeds of dogs (Alaskan Huskies come to mind and sheep/cattle guarding dogs as another), I never quite understand why someone would have a pet dog and leave them tied outside 24/7.   But I have seen it work well many times for both dog and owner so I am not judgemental as to say it should never be done. (There are those who would criticize me for all my outdoor barn cats too.)  However, if you have an outside dog, there are some particular hazards that you need to watch such as heat related issues in the summer and cold related issues in the winter.  And in the summertime, you need to pay particular attention to the health of your dog's coat and SKIN!  That is SKIN capitalized with an exclamation point!  Most of our dogs are very very furry and that fur can hide a lot of problems. 

This is a picture of Big Red (not his real name) the Saint Bernard.  He is sedated and lying on a treatment room table.  Red came to the clinic because his owner had been trying to clear up a skin infection for about a week and things were getting worse and getting worse quickly.  I fully believe that all of this happened in about a week because I know how fast a small hot spot can turn into a big hot spot.

Doesn't look too bad does it?  You can tell the fur is a little matted up along his back, but most of this is because the owner had been using Kopertox to try and treat the skin infection.  For those who don't know, Kopertox is a green liquid that is used to treat a condition called "Thrush" that occurs on the bottom of hooves in horses and cows.

Now here is a little side note and a heads up for all dog owners.  If you want to make your veterinarian or veterinary technician thoroughly disgusted and upset with you, go ahead and treat your dog's wounds with anything sticky or gooey.  This means BAG BALM or VASELINE or CORONA OINTMENT or KOPERTOX or the list goes on and on and on.  Gooey ointments are not meant for animals with thick fur coats and all they do is make everything worse.  They attract dirt and they keep wounds moist when wounds really need to dry out.  They gum up clipper blades when fur is needed to be shaved from a skin wound and makes the job 300% harder.  Enough said.

Now back to Big Red.  Big Red was an outside dog.  He had a hot spot start on his back.  He lived outside.  It is summertime.  Can you think of what might make this whole situation worse?  I'll give you a minute to think.  Times up.  Think flies.  Think maggots.  To give Red's owner credit, he was trying to work on this problem.  He had been hosing Red off with water every day.  He saw that every time he hosed the dog, maggots would be flushed out of the wound area.  He tried fly spray, but the hot spot had already started to spread and was like a runaway train.  Other than the Kopertox (which I think was just applied in a moment of frustration), the owner was doing everything right, but he did not know the first basic principle of treating a hot spot.  You HAVE to shave the fur off the infected area of skin.  Oh, you can sometimes get by without this step in an inside dog with a half dollar or small sized hot spot.  But if you have a big dog with a wound and it lives outside and it is summertime, you HAVE to shave the fur.  And so that is what we did and this is a picture of Red after having his hot spot shaved.

And then one more picture after his skin has been cleaned and scrubbed and he is sleeping on the big blue furry blanket in the clinic kennel area.

This looks awful and it is, but this is not a case of abuse.  This is just ignorance.  Ignorance can be cured through education.  And thus the purpose of this blog.  Red's story has a happy ending.  His owner brought him in early enough that Red walked into the clinic with a wagging tail and left with a wagging tail.  Not all maggot infested dogs are as lucky.  I've seen many that have to be carried into the clinic on a stretcher.  Some live, but some get to go home in a body bag.

And so the lesson to be learned from this little adventure is if you have a dog and especially an outdoor dog, you need to be DAILY checking your dog over for what might be hiding under that fur coat.  Your dog's life could depend on it.

Does this tooth hurt? You betcha!

I get asked all the time by pet owners if I think their dog or cat is in pain.  The simple answer is that if it is something that would cause pain to a person, it will cause pain in a dog or cat.  What is different is how dogs and cats in pain behave compared to people.  The signs can sometimes be very very subtle.  Of course most of us would not miss a dog that just had its foot stepped on and is delivering an ear piercing cry that can be heard halfway down the block.  Puppies are particularly good at this and if anyone has a husky or a beagle, then you KNOW how loud they can be when they are hurt.  But this is a case of sudden onset of pain.  What about chronic pain?  How about an example.

Very early in my veterinary career, I treated a beautiful Golden Retriever whose name escapes me.  I'll call him Max.  Max lived on a farm and like a lot of farm dogs, he would occasionally go exploring in the woods.  One day Max went missing and didn't come home for 3 days.  When he finally showed up at the farm house, he was badly injured and his owner brought him into the clinic for me to examine.  Max's left rear leg had been shot with a high powered rifle.  The tibia leg bone below the knee had been shattered.  No, more like evaporated into nothingness.  Most of the skin and muscle was gone too.  There was a 1" wide strip of skin still there and that was all that was holding Max's lower leg and paw to the upper part of the leg.  So I walk in the examine room and here is this beautiful, happy, tail wagging, bouncing around on three legs, Golden Retriever.  He was so excited to see me and as he was bouncing around the exam room, the lower part of his left leg that was dangling by a strip of skin was twirling around every which way.  He never cried out.  He never slowed down.  Was he in pain?  I guarantee he was.  What happened was that he had just spent the last 3 days out in the woods adjusting to living with his pain.  Life goes onward in a dog's mind.  The end of the story was that I amputated Max's leg and he went on to live his happy Golden Retriever life.

The point of that story is two fold.  First, dogs and cats have nerve endings that send pain signals to the brain.  I am 110% absolutely positively you can't convince me otherwise sure that our pets feel pain.  Second, you cannot always tell if an animal is in pain by its behavior alone.  Sometimes you can, but sometimes you can't.  If there is something that you can see or feel that looks like it should be painful, then it is painful.

On to a tooth story.  Yesterday a regular client brought in her dog for me to check a tooth.  She had heard a story on the radio about dental health in pets and decided to look at her dog's teeth and a back tooth didn't look quite right.  Here is a picture of the tooth:

Do you see that pink spot on the tooth?  That is where the outer enamel has broken off the tooth and is exposing the pulp cavity of the tooth and yes, exposing the nerve.  Does that not make you cringe seeing that raw tissue exposed?  It makes me cringe.  I just wanted to rush over and give this client a big hug for being so observant and knowing when something didn't look right.  But I did restrain myself because, well, you know, it's probably not proper exam room etiquette to rush into someone's personal space and give them a big bear hug.  *grin*  I do just love it though when pet owners are really in tune with their animals.  Now this dog was not showing a bit of behavior that would make you think it was in pain.  I can guarantee this tooth was painful.  There are two choices for treating a broken tooth: extraction or root canal with a crown needed in some cases. In this case, the owner chose extraction which we did today.  This dog will go home with oral pain medicine for 4 or 5 days and then should be on her way to a painfree mouth.

Now I don't think that all pain needs treated in all animals (although we probably should be treating pain more often then we do).  If I bang my knee and it turns all black and blue and sore, I don't go reaching for the bottle of Advil right off the bat.  But I do think that animals hurt the same way you and I hurt.  I think different individuals have different pain tolerances too just like in people.  So while not 100% of pain needs treated, just know that even if they an animal is not acting painful, if you see something or feel something on your pet that looks like it should hurt, well, then it does hurt.  If you have any doubts, ask your veterinarian.

A dog is a dog is a dog

I was going to start off this blog with the statement "I love animals". Well that's probably obvious, but I don't think it says enough. I could say I love life, which is also true. But more what I want to say is that I am amazed by life. Perhaps that is why I am in medicine. Just thinking of all the chemical reactions and electrical impulses that occur in every living thing fascinates me. So as time goes by, I'm sure you will see me celebrate everything from elephants to amoebas, but today I am celebrating dogs.

Why dogs and why now? Well get ready folks because the Last Great Race on Earth starts this Saturday. The Iditarod! I love this event. It intrigues me to no end. And this thing we call the internet makes it entirely too easy to follow the journey. Nothing like sitting snug in a warm house reading about the Alaskan wilderness. If I had better cold tolerance, I would really consider being part of the volunteer veterinary team. Instead, I'll just follow along from home.


http://www.flickr.com/photos/mcmorgan/ / CC BY-SA 2.0

The race pairs a human being with a team of dogs. It requires great athleticism from both (the closet athlete inside me loves this!). It requires physical and mental toughness. And to do it well and succeed, it requires a musher that is so in tune with the needs of his or her dogs that they are almost one.

Unfortunately, the race is not without its critics mostly in the form of animal rights groups talking about inhumane treatment of sled dogs. Does this happen? Yes it does. Does that mean that those who do it right should have their pastime, their livelihood, their passion taken away from them. I think not. Not any more than driving a car being banned because of the few who drive drunk. These comparisons are endless.

Instead I choose to celebrate the working dog. There is nothing I enjoy more than watching and reading and hearing about dogs at work. The dog is a remarkable animal. In only 10,000 years give or take, man has created such diversity in the dog through selective breeding. From the sled dog to the hunting hound to the herding shepherd to the retriever and on and on. The bond between man and dog runs deep. And dogs seem to be at their happiest when they are at work. They are happiest when they have a "job". I think that is where we fail our dogs sometimes. We don't give them something to do. We don't let them do what they are bred to do. We don't let them be dogs.

http://www.flickr.com/photos/tonysphotos/ / CC BY-SA 2.0

So go hug your dog today. Let him or her snuggle in your bed if you wish. Spoil them. Love them. But please give them something to do with their life. Take them for a long walk. Play Frisbee. Find an agility class. Enter a dog show. Hunt. Herd. Retrieve. The list is endless. Celebrate your dog's life.

And I hope you enjoy following along online on the Iditarod Trail for the next two weeks as much as I am going to enjoy it. The stories. The journey. The wilderness. Dogs and man together. As it should be.