alternative to or experiences with canine thoracotomy?
May 23, 2012 7:10 AM   Subscribe

My dog (obligatory pictures) has a mass in his lung. The vet specialist explains that it could be an abscess, tumor, or lung lobe torsion, but regardless of which it is, it'll have to come out. His usual vet agrees. I trust the veterinarians, and I'll schedule surgery soon. Two questions: any alternatives I should consider? And have you had experience with small dog thoracotomy?

Excerpt from specialist's letter:
Samson presented to [specialist vet] today for a consultation with the Internal Medicine Service. He has a six month history of cough and a one week history of vomiting, that has improved with famotidine. There has been no improvement in the cough with antibiotics, and a minor improvement with Hydrocodone. A thoracic radiograph at [home vet] showed a right caudal lung lobe mass.

On presentation Samson was bright, alert, and in good body condition. During today's appointment we performed a thoracic ultrasound and repeat thoracic radiographs. The right caudal lung lobe mass was confirmed. Radiographs were submitted for a radiology consultation with [radiologist]. The thoracic sonogram showed a 4.6 by 4.7 cm mixed echogenic mass in the right caudal lung field. The current possiblities for this mass include abscess, neoplasia, or lung lobe torsion. We have recommended that you make an appointment with [surgeon] to discuss a thoracotomy to remove the mass.
Samson is 12 years old and otherwise in pretty good health. The vets I've asked have said that his age isn't a particular risk factor for the surgery.
posted by moonmilk to Pets & Animals (8 answers total)
 
Be wary of being swept up in the tide because your veterinary team has a plan and you do not. That tends to make their plan look awesome. I would be having a very serious discussion with my primary vet about the prognosis for no surgical treatment at all. I'm not saying that's what I would do, but I'd want to know a lot more about this course of action. If, for example, the vet says "if you do nothing he'll be dead in 2 years" that is a very different outlook for a 6 year old dog than a 12 year old dog, because he's not likely to live past 14 regardless. In that case, be very clear what this surgery is buying your friend - comfort? Mobility? Lifespan? You need to know for sure.

For what it's worth, I feel the same about myself and am not a "life at any cost" person. I will not be treating cancer at 85, for example.
posted by DarlingBri at 7:30 AM on May 23, 2012 [5 favorites]


I agree with DarlingBri, I would also inquire about the quality of life without surgery. If Samson doesn't get surgery, is there a treatment to prevent vomiting and cough? A second opinion is worth to try as well.
posted by 3dd at 7:46 AM on May 23, 2012 [1 favorite]


Ask what happens if you wait. Can you see if the mass grows in a few weeks, or a few months? Or will he suffer in the meantime? Sometimes "do nothing and wait" is actually a viable plan.
posted by barnone at 11:35 AM on May 23, 2012


Aw. Lyle and I send our best to Samson.

Obviously the cough is of concern to you, or you wouldn't have spent the time consulting with multiple vets to determine what's going on. I think it's worth asking about waiting, but you also sound pretty clear that you trust the vets and want to proceed with the surgery. I think it's worth running through the expected outcomes in your head ahead of time - what will do you do if it's an abscess, what will you do if it's a tumor, what will you do if it's torsion? How many more procedures are you willing to consider for what quality of life?

If you don't go through the thought exercise ahead of time, it can be easy to fall into a sunk cost thing where you say "well, we already did this, so we might as well do that", etc.

I wish you both the best as you go through this!
posted by judith at 5:20 PM on May 23, 2012


Oh this makes me so angry. I'm a vet, but not your vet, so this isn't medical advice. And this is probably my biggest issue with where veterinary medicine is going these days.

What your RDVM or specialist should be doing here is going through all the options.
-You need to know what Samson is probably feeling in terms of discomfort.
-You need to know what will happen with less aggressive treatment.
-You need to know how you could support him if you decide not to treat surgically.
-You need to know the expected prognosis depending on each outcome if you do treat surgically.

Your vets should be helping you decide how to go forward, not simply planning the most aggressive (and profitable) treatment without the whole conversation. If this is a specialist that your RDVM doesn't usually refer to, please let him or her know so that they are aware that the specialist has this tendency, ESPECIALLY if the surgeon is in the same specialty practice.
posted by Nickel Pickle at 6:09 PM on May 23, 2012 [3 favorites]


Response by poster: Thanks for the input. It was helpful for my meeting with the surgeon, when I got good answers to the questions you all recommended.

Nickel Pickle, you may have read too much into my very quick summary of my previous interactions with the vets, but your "need to know" list is very much on point.
posted by moonmilk at 11:19 AM on May 24, 2012


Response by poster: Update: post-operation biopsy says it was a carcinoma. I'll talk to an oncologist next week to see if we need to do anything else to follow up. Meanwhile, the pup is recovering at home and doing well.
posted by moonmilk at 10:10 AM on June 6, 2012


Response by poster: Update: 4 months after the operation and ten weeks of chemotherapy, Samson is doing very well, with much more energy and appetite than he'd had for a long time. He's remarkably peppy for a 13 year old dog with 1.5 lungs.
posted by moonmilk at 6:45 PM on November 8, 2012 [2 favorites]


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