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When Clients Twist My Arm

By Phil Zeltzman, DVM, Dipl. ACVS

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

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.

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.

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.

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When Clients Twist My Arm

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I found your stories very interesting, maybe you need to come to Atlanta and try to figure out more poor dog that has been going through everything and around in circles, meaning no one can tell me an answer. He is a 9 year old Maltese, started to bi-lateral go bald, had hot spots everywhere, moaned when you picked him up, shall I say the list goes on. He had 2 urinary tract infections, ultrasounds that said he has his testicles still in him, while in fact the other Dr. took them out when he was 4 months old,(I was there and have the papers to prove it). His prostate was aspirated (no cancer was saw). He was x-rayed, nothing. Has an enlarged prostate now, which he is on medication for. He has had 3 days of inections to see where his hormones are. He went into surgery because they said there was testicles there, but she came to me after surgery with a UTERUS, yes, you are reading this right. To this day, no answers, but they want to cut him open to explore more...... I seach on the internet day and night for answers. Seen 5 vets, talked to the head of the sonogram Dr., which to me did not give me a straight answer, so I thought maybe I am in the wrong state for my poor little male maltese. valerie, atlanta, GA Posted: 6/27/2010 7:37:47 PM Congratulations Dr. Zeltzman for this very intersting case and aproach. I beleive there are some points where we need to give second (and mostly third and fourth) thoughts about euthanising a living creature. I beleive we only should "do it" if we are %100 sure of it... Guessing is one thing testing is another. One of my teachers once said "If I could diagnose only with my eyes I would be rich!" Diagnosis of the tumor with the first biopsy and confirming it with the postop material is the key point of this case I beleive. When it comes to tumors (I see them like aliens in the film MIB) although they may look ugly and huge they may be good inside but the ones that look cute can be very dangerous... It's the eye that fools the heart. I'm sure this cute dog will live out the rest of it's life thanking you and it's owner. Thank you again; Efe ONUR, DVM Efe, Istanbul, TX Posted: 6/26/2010 5:12:03 AM