Teeth Cleaning And Lump Removal - 2 X General Anesthetics?

[MattB]

Hi,

 

I just wanted to hear some opinions on this - I'm sure people know more than me.

 

I've just had both my greys to the vet for vaccination boosters + general check up. I mentioned that we'd recently found a very small lump under the skin on Daisy's leg. I was offered 3 options:

 

1) use a needle in clinic, aspirate and send to lab.

 

2) remove under GA

 

3) do nothing - just keep an eye on the lump - currently about 1/2 the size of a pea and just under the skin.

 

 

we were also advised that she could do with a scale and polish but this wasn't urgent.

 

The vet was really lovely but sat on the fence about what to do and I feel apprehensive about making the decision. My request was that we bring her in for a dental and they remove the lump then but they said it was practice policy to do dental treatments completely separately because of risk of infections when combined with other treatments. I asked if 2 x GAs was not also a risk. She said that was a good point and that she could try to persuade the practice to agree but it would depend on the vet on the day.

 

In the past when we've had dogs (usually needing wounds stitched or x-rays) have a GA the vet has always asked if we'd like a dental done at the same time so I thought this was standard practice.

 

I'm left not really sure what to do in the interests of Daisy - I obviously don't want any unnecessary surgery but my thoughts was that dental + lump removed would be the best treatment option - however I don't want Daisy to have a GA and find out that on the day they decided not to remove the lump.

 

Does this all make sense? Maybe I need some agreement from the vet that they will definitely remove the lump during the dental (or definitely not in which case we'll need to go with option 1 or 3).

 

Any advice much appreciated.

Edited April 10, 2015 by MattB

[Batmom]

For something that small, honestly don't see why they wouldn't remove it at the time of the dental.

[tbhounds]

For something that small, honestly don't see why they wouldn't remove it at the time of the dental.

 

Exactly. If you were performing an open abdominal surgery I would agree with your vet but, a small dermal growth would be perfectly safe to be done at the same time.

[NeylasMom]

Agree with above. I've had it done myself. I would not have the dental done with the lump removal open-ended. Either you agree to a plan with the vet or have it done somewhere else.

 

As for when to do it, I might watch and wait for the moment. If the lump grows (measure and/or take a photo so you will be able to tell) or the dental becomes necessary then I would do both at the same time.

[GeorgeofNE]

Simple answer to the risk of infection==the vets around here use antibiotics in advance of a dental cleaning just to prevent infection.

 

My choice would have been need aspiration. It's likely nothing at all, and it's a whole lot cheaper to pay for that than excising it and finding out it's nothing.

[MattB]

Thanks for the advice.

 

You're right Neylasmom - I definitely don't want Daisy to have the trauma of a GA if she's not definitely going to have them both done.

 

Good idea re: photos/measurements.

 

In terms of proceeding, it's difficult to talk to the vet that would be carrying out the procedure as I was told it depends who's on on the day - I suppose I need to make it clear to reception staff what I want to book and then to restate this when I take her in?

[NeylasMom]

I find that a bit odd. I suppose some don't mind and just see whatever vet is available at the practice when they need to get in, but although there are multiple vets at the practice I go to, I work with one vet primarily. It's not like I've never had a call with test results from another vet when mine was otu of the office for instance, and she doesn't do dentals anymore because another vet at the practice really enjoys doing them and has sort of "specialized" in it, but she is our vet and we make the decisions about the care of my dogs together, even if another vet carries them out as in teh case of the dental. I feel it's important to have a single person who knows my dogs' histories and who knows me to get the best care for my dogs.

 

But everyone is different so I'm sure there are people out there who don't feel the same way. Either way, you should certainly be able to establish a plan that whatever vet will stick to. I assume certain vets are there on certain days so I would just try to identify someone who will work with you and then schedule for their day when the time comes I guess. Or consider finding a smaller practice with someone who is more willing to meet your needs.

[greysmom]

If the dental isn't a thing you need to do "right now," I would probably hold off and see if the lump does grow and/or change rapidly. It could be a lot of things that would require it to be taken off, but it could also be something that might go away if left alone.

 

A needle biopsy may or may not tell you anything about it. Our Lilly had a 1/2 inch bump suddenly appear over one eye. We freaked out, and a needle aspiration showed some cells that were "concerning" to the vet and the technician who also looked at the them. Once we had it taken off, it turned out to be a bad contusion which would have gone away on its own.

 

I've never had a vet not want to do anything and everything they can during a dental. Bottom line? The vets, while extremely well-trained professionals, are still working for you.

[KF_in_Georgia]

You should be able to specify which vet you want to do the dental, but you might wind up with fewer choices about which day your appointment falls on.

 

My vet-of-choice does non-emergency surgery on Wednesdays, so I'm trying to find a Wednesday for Silver's dental. The problem is that I know she'll need extractions, and I have a bunch of therapy dog visits (with Tigger) scheduled for this month. I won't schedule a dental unless I'm sure I can be home with Silver that night and the next day, so her dental will wait until the therapy visits are less frequent. (It's exam time, and Tigger de-stresses college students...)

[PatricksMom]

I rearrange my schedule not only for my vet, but for the day my vet operates with her favorite vet tech, who is a greyhound mom, for what that's worth. I'm probably just inconveniencing myself, but it makes me feel better.

 

For a small lump, or anything comparable, I've never had a vet suggest anything other than pairing it with a dental. The small amount of added time under is nothing compared to the risk of knocking your dog out twice.

[XTRAWLD]

I've had leg x-rays done while under for a dental but that's about it.

 

Personally I agree with greysmom. if there isn't an immediate need for a dental, I'd like to gander and wait to see what becomes of this small lump. I can't tell you how many odd bumps and lumps Kasey has had for them just to disappear on their own. Ryder - not a one, Kasey - plenty.

[JJNg]

With a lump that is that small and just recently detected, I don't think there's anything wrong with watching it for a few weeks and seeing if it grows or changes.

 

If it's big enough to try to get a sample, I think it's a good idea to do an aspirate prior to planning surgery. Fine needle aspirates are relatively non-invasive and easily performed at a regular appointment. Some benign cysts can be identified on an aspirate, and if there are suspicious cells, sending it out to a lab for a pathologist to review the slide will often provide more useful information than if it is read in-house by the vet or tech. Some more concerning growths, like mast cell tumors, can be easily diagnosed on an aspirate too, and that will allow you to plan for a surgery to get wider margins.

 

If an aspirate is inconclusive, or if she will be put under for another procedure, like a dental cleaning, then the growth can be removed at the same time. As others have mentioned, most vets have no problems performing other minor or routine surgeries at the same time as a dental, and most will actually encourage it. IMO, the risk of 2 general anesthesia episodes is higher than the risk of infection from a combining the procedure with a dental. Most adoption groups routinely do spays and dentals under the same anesthetic episode, and I've never seen a case where that resulted in an infection.

[MattB]

Thanks for all your replies they are really helpful. To check my options I rang another vet (the one my mum has used for her greys and who I know had offered a scale and polish while they were stitching up her accident prone hound a few months ago!) to ask if they would do lump + teeth and was told that they 'don't anymore' as dental work is classed as a 'dirty procedure' which they sperate from other surgery and do at a different time of day to other ops. You're right I know that my two had dentals when they were spayed. It seems like I'm having a different experience to others with the vets I've talked to, both have implied this is new policy.

[JJNg]

My take on it is this... The risk of complications during anesthesia is very low, but when it happens, it is often life-threatening. Performing 2 anesthetic episodes doubles your risk. The risk of infection from combining a dental cleaning with another surgery is also very low, but the vast majority of infections are not life-threatening, especially when you're talking about a superficial surgery like a minor mass removal. I know what I will continue recommending for my patients.

 

There's another option if you decide to have the lump removed, and your vets refuse to do it at the same time as a dental cleaning, but then your vets may not be willing to do this either. Removing a small mass 1/2 the size of a pea is a quick and simple procedure that doesn't necessarily require general anesthesia. I often do them using sedation and a local block if that's the only procedure the dog needs.

Edited April 11, 2015 by JJNg

[Victor]

It might be helpful to do the needle aspiration first, just so you know what you're dealing with. If it's a mast cell tumor Daisy will likely need a separate surgery, since they'll want to get wide margins.

[GreytTerp]

We went through a similar situation this past January. Our hound developed this bump out of nowhere on the top of his head, but since he wasn't ready for a dental, our vet recommended just a 'benevolent negligence' approach to see if the bump changed. She did say that they would have removed it during his dental if he needed one. In our case, the bump did grow to almost a large pea over the next two months. Then, within the course of a week or so, it shrunk (naturally, just as we made him a special vet appointment to get it checked because it had grown...), and the bump is now completely gone and the hair grown back over. If the bump is large enough, I would go for the fine needle aspirate first before any GA. Good luck!

[MattB]

Thanks so much everyone. Feeling empowered, I contacted my mother's vet (I liked the fact that she couldn't remember my mum but knew her grey!) who would happily do both at once. Obviously still s decision to be made re watch and wait for a while/aspirate but at least I know there are options now. Thanks again. Much appreciated.