This week was a rough one for one of my clients. Last Monday morning dawned to the recognition that her middle-aged Lab mix had a lump on her leg. She’d been in and out of the car several times on Sunday and her owner assumed one of these ungainly maneuvers had occasioned a bruise. She made an appointment to see the vet on Wednesday, her day off, hoping it would improve by then and she’d have to cancel it. No such luck.

On Wednesday morning, two hours before appointment time, the bump blew up like a balloon. So she arrived early, alarmed by the appearance of this big bad ball of flesh.

By the time I examined her, the mass was the size of a large grapefruit. It was losing hair over its now-weepy surface and sported a bright pink patch of skin over half of it. When I clipped and cleansed it for a fine-needle aspirate (sticking a needle into it with a syringe to grab a few exemplary cells) it seemed to get redder by the second. So I stopped my ablutions and carefully stuck in the needle.

What I got out of the mass looked like blood, but under the microscope, everything looked way different. As far as the aided eye could see was an ocean of nasty-looking mast cells, (histamine-releasing cells found primarily in the skin). These tumors can be horrific, and this one was rapidly proving its worth as the worst one I’d ever seen.

When things like this happen I take lots of pictures and I get on the phone with a specialist. An oncologist, preferably, but a surgeon will do. So I called my friendly neighborhood surgeon (far more reachable and just across the street). I emailed him the pics and voilá—bad news, as I knew it would be.

Patiently hearing him describe different reconstructive techniques for removing a tumor so entrenched on an extremity, I knew this tumor was going to come down to two things: amputation and/or reconstruction with radiation.

How was I going to tell this devoted owner that her active, happy dog should have her leg lopped off by week’s end? Her response, as I knew it would be, was to reply in the negative on all counts. No amputation and definitely no radiation. But she did agree to a biopsy and I intuited some room to maneuver on the amputation issue. In the meantime she went home with instructions to buy Pepcid AC and Benadryl to ward off the effects of rapid histamine release from the tumor.

The next day I sampled the site with a biopsy punch to help us determine the tumor’s grade (a measure of severity). This would hopefully identify the tumor as one that could be removed (with serious reconstruction, skin flaps, the whole nine yards). Thankfully, the tumor looked no worse at this point. Still, I ordered a STAT on the biopsy.

The next day, however, the tumor was in a rage. The whole leg, she said, looked like it had been beaten with a baseball bat. She feared a car ride would make it worse so I went to see it for myself. So much for my gentle tissue handling, I thought when I saw the grotesque swelling. I urged her to reconsider amputation, discussed it at length and directed her to some three-legged websites for inspiration.

She relented. But it was Friday. I called the surgeon in a panic, begging him to fit her in for an amputation. Good thing he had the sense not to respond to my alarmist entreaties. It would be far worse to amputate under these conditions, he pointed out.

So I ordered strict cage rest, a light massage on the unaffected part of the limb for lymphatic drainage and an increase in the Benadryl dose (for sedation as much for it’s anti-histaminic effects). Next up, a Monday morning amputation.

It’s these unusually aggressive masses that keep me up at night. How would I feel if my previously healthy, non-geriatric went from sixty to almost zero in one week? I’d be in rough shape right about now. And I imagine that’s just how she feels.

I’ll keep you posted.