After reading my title I’ll bet you thought this was going to be a how-to kind of a blog post. But it’s not. This bump-y entry is going to be more like a rant than a prescription. And why? Because nothing calls out for greater disparity in veterinary decision-making than the lowly lump.
Take the new client’s long-haired Chihuahua from Saturday morning: Batman was an un-neutered male with a lump just to the left and downward of his anus (nice spot, right?). "It came up so suddenly!" his owner claimed. But then, "that’s not a spot I try to look at on a regular basis," she admitted. (Nor, I confess, would I.)
Here’s more background: Butt-lumpy Batman had gone to see his regular veterinarian the morning before and gotten the "watch and wait" spiel. Another vet that afternoon said, "Let’s do everything!"
For the record, I was the third-opinion vet. Along the way, Batman had been treated to antibiotics and steroids, along with X-rays, ultrasounds and fine needle aspirates, all of which confirmed the presence of … well … nothing.
OK, so it wasn’t air in there, much less a space-sucking black hole, but it was, I ultimately deciphered, just a pouch of fat with maybe some swollen subcutaneous tissues. Nothing much, really. But that nothing much could have come up as a result of a variety of causes: trauma, lipoma (fatty tumor), or even a perineal hernia (intact males can experience a weakening of the muscular wall that separates the pelvic contents from the outside world, which leads to a hernia in this area).
"I don’t know for sure," I said, "because it doesn’t look like much, but it can’t hurt to have a surgeon take a look-see just to be sure it’s not worth exploring." But by the time Monday rolled around, the lump was almost gone. Good thing, too. It might’ve easily been subjected to a biopsy by an inquisitive surgeon.
So what’s the moral of the story? Stick to your first vet?
Not at all. Here’s mine: There are at least as many ways of dealing with a simple lump as there are veterinarians. Some will make you watch and wait (for what?) while others will slice and dice before you can say "Boo!"
Sure, this time the mass was an innocuous collection of swollen tissues (knowing Batman, he probably humped his toy too vigorously), but what if it had been a perineal hernia … or a Grade III mast cell tumor? Either of these would have been treated as a medical condition well worth every possible intervention.
And yet, "watch and wait" would have been best in this case.
Nonetheless, if it were my pet, I’d have yanked Batman out of his first veterinarian’s arms as quickly as this client had done. Because there are times when what an owner obviously needs — choices, at the very least — is worth more than the price of the relationship.
Dr. Patty Khuly