[Lightning&Stomps]

My boy Stomps, who I guess is about 12 now (he was a rescue so age is not known), developed what appeared to be a liquid-filled lump right on his back knee. Although he's had fluid-filled lumps before (which I had surgically removed), the fact that this one was right over a joint worried me. So I took him to the vet. The vet said it was probably a lipoma and we might as well just take it out. No aspiration, no biopsy, just whisk him into surgery. At first I agreed, but the more I thought about it, the more bothered I became. While I am concerned about what these lumps are (he found something on Stomps' chest that I still can't feel), I think subjecting a dog of his age to general anesthesia without doing less invasive tests first--especially when the vet feels certain these are not life-threatening lumps--is not in the dog's best interest. The veterinarian is supposed to call me to discuss, and I'd like to be as educated on this as possible before I make a decision. What are your thoughts/opinions/experiences? Thanks!

 

[AmyB]

I'm no expert, but here's my opinion. Sadie & Spencer's vet has always held the belief that if a lump was not anything dangerous, was not growing rapidly & was causing no discomfort, then it should be left alone. I totally agree. Each time we visit the vet, he feels & measures all the lumps & bumps. He appears to be very good at telling what they are just by feeling them. Sadie lived to age 11 & had a few lumps. Only once did she have surgery to remove one. She had a lump on her elbow that started out pea size & grew to golf ball size in a month. Her vet was concerned about that, removed it & found it to be a benign tumor. Spencer is currently 11 & is covered in many lumps - mostly small cysts. He also has 3 fatty tumors on his chest that are large enough to be visible. However, all have been slow growing & he doesn't seem to even know they are there. I would never put him under general anesthesia unless it was absolutely necessary. I think at his age it would be too risky. Good luck with your decision.
Amy

 

[Betsy Iole]

Some information on anesthesia risks...

Mortality is higher among pets with known disease processes, a portion of whom are not resuscitated (due to knowledge of disease/poor prognosis) and at some university veterinary hospitals, possibly because they see the sickest pets. It's quite a bit lower in general community practice and among animals without known disease. The below discussion contains additional citations of primary sources.

From Jones RS. Comparative mortality in Anaesthesia. British Journal of Anaesthesia, 2001, Vol. 87, No. 6 813-81

Small animals

In 1990, a survey of 20 814 dogs and 20 103 cats undergoing general anaesthesia in the UK reported a mortality of 0.23% in dogs and 0.29% in cats.(20) However, when they were divided into two groups, on the basis of the absence or presence of pathology, a different situation was observed. In dogs, the figure was 3.12% with pathology and 0.11% without. In cats, a similar pattern was observed with a mortality of 3.33% with pathology and 0.29% without. There were few factors that could be highlighted as the main cause of death. However, the administration of xylazine was again associated with an exceptionally high mortality rate. Complications following tracheal intubation in the cats appeared to be associated with several deaths.

In a survey involving some 30 000 anaesthetics reported in 1992, a mortality rate of 0.11% was reported in dogs and 0.06% in cats.(21) The most common cause of death was cardiopulmonary arrest. A further single institution survey published in 1994 recorded a death rate of 0.43% in dogs and cats.(22) Most of the deaths were associated with cardiac arrest and, due to the nature of the surgical condition, resuscitation was not attempted in some of these animals. A more recent survey was published in 1998 on anaesthesia in the dog and cat.(23) Death occurred in 0.11% of 8087 dogs and in 0.1% of 8702 cats. Significant odds ratios were calculated for a number of factors including the association of cardiac arrest with xylazine administration in dogs. A modified ASA classification of patient status was adopted, and a classification of 3, 4, or 5 was also associated with an increased incidence of cardiac arrest in both species.

It would appear that the incidence of death associated with anaesthesia over a number of years has shown a reduction in most species. Whilst this may well have been associated with the development of ‘safer anaesthetic techniques’, it is most likely also to have been associated with attempts to reduce human error by improved training and wider use of sophisticated monitoring methods. However, with the developments in surgery, which have presented greater challenges to the anaesthetist, it remains to be seen whether further major improvements in mortality figures will occur in the foreseeable future.

References:

20 Clarke KC, Hall LW. A survey of anaesthesia in small animal practice. AVA/BSAVA report. J Ass Vet Anaesth 1990; 17: 4–10

21 Dodman NH, Lamb LA. Survey of small animal anesthetic practice in Vermont. J Anim Hosp Ass 1992; 28: 439–45[ISI]

22 Gaynor JS, Dunlop CI, Wagner AE, Wertz EM, Golden AE, Demme WC. Complications and mortality associated with anesthesia in dogs and cats. J Anim Hosp Ass 1994; 35: 13–7

23 Dyson DH, Maxi MG. Morbidity and mortality associated with anesthetic management in small animal veterinary practice in Ontario. J Anim Hosp Ass 1998; 35: 325–35[/b]

The 0.11% figure translates to 99.89% survival. Risk can be reduced by having dogs lab tested before surgery and monitored during surgery (these options may cost extra but are well worth the money) and by observing the "no food after midnight (or after whatever time your vet says)" rule.

I usually have lumps removed if they grow rapidly; if they burst, become infected and surgery seems the best option once infection is controlled; or if they're in the mammary chain.

 

[Lightning&Stomps]

Thanks Betsy and Amy. I think the reason why I'm so torn is because my last dog had a mammarian tumor that I didn't find until it was too late (she was a samoyed with a particularly thick coat, even the vet had a really hard time finding it, although I still should have felt it). So now I panic whenever I find a new lump on my boys. I think I'll have the lump on his stifle aspirated, since it seems to have appeared suddenly. If the aspiration shows that that lump needs to come out, I'll have the vet take the chest lump out as well (that one doesn't worry me so much). Thanks to both of you for your help.