More Than An Annual Exam
The case I am going to present will help you understand why it is important for veterinarians to do a thorough physical exam on every animal that is presented to them for any reason or condition.
At Milford Animal Hospital (MAH) all routine exams and annual exams are scheduled as thirty minute appointments. Thirty minutes allows us enough time to examine all animals from the tip of their nose to the tip of their tail. It provides our doctors time to explain our findings and answer all of our client’s questions. Veterinary hospitals that schedule less time, especially “vaccination clinics,” may not have adequate time to examine patients thoroughly, thereby missing important conditions such as the need to recommend dental care or missed heart murmurs.
“Casey” Monahan is a twelve year old neutered Tri-colored Beagle. Casey has been a wonderful long-term patient at MAH. In the past I have repaired torn ACL’s in both rear legs. When presented on 4/7/18 for his annual exam and vaccinations, Casey was his usual slightly apprehensive self. The only concern from his owner Diane was a swelling over the lateral aspect of his right stifle (knee). It turned out the swelling was a serum pocket caused by a piece of monofilament that was used to repair his ACL, which was rubbing against the tissues under the skin. Casey had mild calculus and gingivitis on some of his teeth and a slightly rapid heart rate of 140/BPM, probably anxiety related. His eyes, nose, ears, skin and auscultation of his chest were all normal. The last part of my exam was to palpate his abdomen. To my surprise I felt a mass in the anterior part of his abdomen. I asked permission to take a radiograph to confirm my finding and there was a grapefruit size abdominal mass. I explained to Diane that the most common mass in that position is a tumor of the spleen. I explained that if it was a splenic tumor there was a 50 to 60% chance it could be malignant and a 30 to 40% chance it could be a benign tumor or a hematoma.
We took radiographs of the chest to see if there were any metastatic tumors that could have spread if the mass was in fact a splenic tumor. The chest looked clean, no tumors. We performed blood tests and Casey had an elevated ALT, a liver enzyme, which had been elevated for many years on previous blood tests.
I discussed the guarded prognosis and Diane said she wanted me to operate on him with the understanding that if he had cancer that was spread throughout his abdomen, that we would put him to sleep. His exam was on a Saturday and I scheduled the surgery for the following Monday.
As Casey was being prepared for surgery I asked Dr. Chelsea Sluyter if she would ultrasound his abdomen. She did and said she didn’t think the mass was in his spleen.
Casey was taken to surgery and was on IV fluids, EKG, pulse oximeter, blood pressure and CO2 monitors with one of our veterinary technicians monitoring the anesthesia.
During the exploratory I soon discovered the tumor was in fact in one of the liver lobes and was six inches in diameter. I carefully ligated the blood vessels and removed the liver lobe that contained the large tumor. There were no other visible tumors in the abdomen so I closed the abdominal incision and allowed Casey to wake up. The tumor was submitted for histopathology. At the end of the day Casey was alert and was sent home on Gabapentin and Tramadol for pain and Diane were to take him to MedVet if his condition worsened. I called Diane around 9 pm and she said he was resting well.
The biopsy came back as a moderately differentiated hepatocellular carcinoma. These tumors are slow growing and have a long clinical course. They usually do no spread to other liver lobes or other parts of the body and if they do, it is in the late course of the disease. Removing the liver lobe with the tumor, on average, provides a disease free interval or survival time of 860 days with no chemotherapy necessary which is great for a 12 year old dog like Casey.
I called Diane on 4/23/2018 and she said Casey was back to his “old ornery self”, and feeling great. We hope Casey is cancer free for many years to come.
I am thankful Diane loved Casey so much that she allowed us to do exploratory surgery otherwise we would have missed a chance to extend a wonderful dog’s life.
Gary L Clemons DVM