Extenuating circumstances.
They affect just about everything in life, don’t they? Our pets are not exempt from extenuating circumstances, either.
Take Black, a sweet, middle-aged Labrador retriever. Black has a little lump on her right rear leg, down low, past the tibiotarsal joint, on the outside of the leg. The tibiotarsal joint corresponds to our ankle. The same joint is sometimes called a “hock.”
We first noticed a small lesion a couple of months ago, diagnosed a sebaceous cyst, made a note on the medical record to check it each time she came in and didn’t think much more about it. Sebaceous cysts usually don’t require treatment unless they become complicated. Black’s seems to now be complicated.
It is in a location that is prone to becoming irritated by everyday life: running in the woods, lying around, licking. Now the surface of the swollen area is raw and may be infected. The entire lesion is larger.
Here’s where the extenuating circumstances come in. If this same lesion were on the side of the chest, where there is plentiful skin to close a surgical excision, I would be satisfied to treat this mass conservatively. Conservative treatment might include systemic antibiotics such as Convenia, ointment and an Elizabethan collar to control licking.
The leg, however, has no “extra” skin to give us leeway. If we approach Black’s lesion with conservative treatment and it gets substantially bigger, we could “run out” of skin to close the resulting surgical site. Surgical lesions which cannot be closed conventionally may require Z-plasty, H-flaps or even skin grafts. None of these are particularly difficult for the accomplished surgeon, but certainly add to the length of the surgery and correspondingly to the cost.
Friday we will perform Black’s preanesthesia laboratory tests. A few days after that, if all of the results show her to be sufficiently healthy, we will schedule he surgery to remove the growth. We will then send the growth to a pathologist who will perform histopathology: section (slice) it, stain it and look at it under a microscope. In that process he will be able to tell us exactly what the mass is just in case it proves to be dangerous to Black’s health. Dangerous results would include cancer and unusual infections such as systemic fungi.
See you tomorrow, Dr. Randolph.
