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When Clients Twist My Arm

Posted: June 21, 2010

Mass on the left cheek of an 8-year-old Sheltie.

Fecchi, an 8-year-old Sheltie, had a firm, golf ball-sized mass in his left cheek. It was hard to be more specific since we couldn’t even open his jaw. Upon further exam, it looked like the mass was coming from the maxilla and/or the mandible. Clearly, a major reconstructive and possibly disfiguring surgery was necessary to remove the mass.

Fecchi’s owner had consulted with three veterinarians, who all had told her that this mass was some horrible cancer that couldn’t be removed. Given the poor prognosis and Fecchi’s anorexia, he should be humanely put to sleep. That option wasn’t good enough for this client.

And that’s when we met. During the surgery consultation, the owner insisted on removing the mass. I wasn’t so sure it was in the patient’s best interest. Fecchi had lost weight and wasn’t in very good health because of his tumor.

So we compromised and agreed on taking a biopsy first. A week later, my favorite pathologist read the biopsy as osteochondroma--a benign tumor.

Intraoperative view of the maxillary tumor.

Of course, I didn’t believe it. More convinced than ever about her decision, the owner insisted on removing the mass. I finally gave in and accepted to “explore the area and see what I could do to help.”

Granted, we perform mandibulectomies and maxillectomies all the time. In fact, I performed one of each in the past week. So why the hesitation? 

Cancer surgeons like Stephen Withrow, DVM, DACVS, at the Colorado State University vet school routinely perform what I poetically call “half face-ectomies.” With the numerous pain management modalities available, we can make these patients comfortable despite aggressive resections.

Anyway, we ended up taking Fecchi to surgery. It turned out that the mass stemmed from the maxilla, on both sides of the jaw. As the tumor grew bigger and bigger, the teeth of the mandible dug sort of a gutter into it 

Surgery was nothing more than a fancy maxillectomy, followed by reconstruction of the surgery site to make it look as cosmetic as possible.

Postop view of the mass after a maxillectomy.

Of course, the entire mass was submitted to the lab. As you can imagine, the histopathology report concluded … osteochondroma, still a benign tumor!

Almost one year later, Fecchi is reportedly doing great at home.  “The surgical site looks great,” the owner says. “You can’t even tell that he ever had surgery.”

So what’s the moral of the story? Fecchi’s owner kind of twisted my arm–in a nice way–and she was totally right. Should we always do what clients require? Of course not.  Otherwise, we would do ear crops, declaws and orchiopexies* all day.

The moral of the story may be that it is perfectly acceptable to perform a procedure, invasive or not, as long as client and practitioner are on the same page, and the procedure is acceptable and ethical.

Sometimes, it’s good to be pushed out of one’s comfort zone.

Would you agree?

* An orchiopexy is a procedure designed to tack an undescended testicle in the scrotum. It is considered unethical.

06/07/2010 - We Have Met the Enemy and He is Us

05/24/2010 - Do You Want to Retire Someday?

05/11/2010Despite Odd Requests, the Client Is Always Right

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When Clients Twist My Arm

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