Pet Patients “C’mon, Doc, it ain’t brain surgery!” Well, sometimes it is…

This past Tuesday, I arrived at the specialist’s hospital with my little Vincent in tow, hoping to secure a fit-in appointment for the following day (which I managed, as you may already know). As a referring vet, I’m granted the privilege of standing in the treatment/ICU area while I wait. When I do this (often), I thoroughly enjoy reading the cage cards and treatment schedules. It gives me a heads up on new drugs I should be considering and fun procedures I’d never dreamed would be undertaken outside a University setting.

But on that day, I couldn’t help staring at one particular cage card in disbelief: “intracranial mass—surgery 11 AM.” The designated dog, an older black Lab, stared placidly out at me. She was apparently taking the news in stride, despite the CT image of her large brain tumor plainly visible from her in-kennel perch.

Wow! They’re going to take THAT out of her skull today! Someone’s got b----!

Of course, that someone turned out to be none other than my significant other. He hadn’t thought it sufficiently exciting to mention he’d be doing brain surgery that morning—so much for pillow talk.

When queried, he described this case as one where increasingly frequent, debilitating seizures had finally led the Lab’s owners to conclude that she would either be surgically attended to…or summarily euthanized.

He’d done his share of these brain tumor cases—though none since I’d met him—and described them as “easy compared to removing anal glands.” (He hates anal gland surgery, a deceptively difficult area to work in.) Still, I was impressed by his matter-of-factness. It’s brain surgery!

Perhaps I’m more awed by these situations than most. About ten years ago, my beloved Boxer, Bruno, had suffered the same variety of brain tumor-related seizures. One horrible middle-of-the-night found me euthanizing him—in spite of his normalcy between seizures. It was all I thought I could do for him.

But here, not even a decade later, sits this dog, ready to undergo what I couldn’t do for my boy.

A few hours later, brain tumor successfully extracted, this Lab was sniffing the grass behind the hospital, still clueless and comfortable—if slightly dopey. But no seizures. Less than forty-eight hours later she was resting comfortably at home. Still no seizures. Apart from the embarrassing bald headedness, she had left the hospital in perfectly Lab-like spirits. Saved.

I don’t know why but I get so misty-eyed over these cases—far more so when they’re not my own. Perhaps it’s because I don’t have the stress of watching over them like a buzzard looking for road kill—expecting the worst, hoping for the best, wondering which disaster could next befall my patient. As a fly on the wall, it’s infinitely more possible to revel veterinary medicine’s successes.

Hence the way my S.O. plays off his triumph: “Give me a brain tumor over a large breed dog spay any day.” As a big dog spay hater I’d readily agree. Still, it’s not like it’s brain surgery…

November 16th, 2007

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Sorry to hear about losing Bruno that way, it's a terrible thing to go through.

I lost my 16 year old lab/GSP mix, Sid, to the same thing earlier this year. I was working nights and I had left him laying comfortably on the couch when I went to bed. I woke up to my office space in shambles and a dog that was so tired he could not stand. I had a feeling it was a tumor that caused the seizures and an emergency visit to the vet rural vet that was on call confirmed my suspicions.
I said goodby that night, wishing that there was something that could have been done. Now I am sad to know that there was something that could have been done and this was never an option given to me. Perhaps the rural doctor didn't even know? If he had, I probably would have headed to Cornell with my mastercard in tow. Of course, he was 16 and his hips weren't what they used to be, so maybe everything happened the way it should, but one can't help but wonder.

Brian Hewitt November 16th, 2007 09:58:00 AM

I loved this post! I work as the imaging tech for a veterinary neurologist. All I do all day is MRI and CT dogs and cats like this lab. I'm amazed at how (seemingly) common brain tumors (and cysts, and malformations, and encephalitis...) actually are. Of course, my perception of the frequency is skewed since these patients are referred from several neighboring states. However, finding two or three of these in a day is not uncommon. Thinking back on it, I can name several pets of friends (and in one case, my own) that surely had a tumor that was never diagnosed. So many people don't realize how far technology has come. My job didn't exist 15 years ago. Just wanted to share. Thanks for your wonderful blog!

Sarah November 16th, 2007 11:02:00 AM

I also forgot to mention...we average about one craniotomy - brain tumor removal - per week. It's more common than it seems. :)

Sarah November 16th, 2007 11:04:00 AM

A question Dr Patty; how much does this miraculous surgery cost? can most of us afford it?

In Humans the problem with brain tumors is NOT if they are malignant or begnin, but where the tumor is.Removal causes so much damage, that the patient is not the same person after the surgery. Is this the case with our dogs?
A friend of mine just lost his beloved Frenchie to a brain lesion; the cost of the MRI alone was over $3000... surgery yes.. but at what cost..??

cl November 16th, 2007 11:30:00 AM

cl: I think Sarah might be in a better position to answer that. I think the bill was about $3000--without the CT.

Dr. Patty Khuly November 16th, 2007 02:48:00 PM

Sorry to hear about Bruno, that must have been awful.

I"m curious: What is the difficulty or particular stress of big-dog spays? How are they different than little to medium size dogs? I would think the little guys would be more stressful (cuz they're little).

Amy in Somerville November 16th, 2007 02:56:00 PM

Dr. Khuly: This is a bit of a digression, but why do you and your S.O. dislike large breed spays so much? Just curious.

Megan November 16th, 2007 03:52:00 PM

Off-topic questions, or rather old-topics:

1. did you ever get hold of suitable goat-sperm, and are you going to be a goat-granny sometime?

2. on the topic of euthanasing where there isn't a suitable vein. Was talking to my rehab boss about your post and the story about the vet giving heart-shots, and asking whether she ever sees any of the vets we refer to using that method (the answer is very seldom and always sedated) - but she reminded me that for birds, if the bird is too small or too flat to get a vein in either the wing or leg, our vet would then inject directly to the liver. Less painful and far more certain than trying for a heart that is hidden behind air-sacs etc. Is this something that you'd use or recommend, and if not, what would be the reasons?

jcat November 16th, 2007 03:52:00 PM

jcat: IP (intra-peritoneal) injection is advocated by a substantial group of exotic vets. Some feline and canine practitioners do it, too. Though it doesn't seem painful at all (perhaps even less so than with venipuncture (in the vein), it does take a pretty long time for the animals to succumb. It seems not unpleasant to them and perhaps more pleasant for some but it's a little disturbing to the owners, I think.

Dr. Patty Khuly November 16th, 2007 05:28:00 PM

Megan and Amy: With older, large breed, fat bitch spays, there's a lot of fat, a lot of vascularity, increased tissue friability (tendency to break and rip) and an overall higher degree of risk of potentially life-threatening bleeding. Small ones are a cinch. Fat ones are the worst.

See this post for more hand-wringing on the subject:
http://www.dolittler.com/index.cfm/2007/6/29/The-d...

Dr. Patty Khuly November 16th, 2007 05:33:00 PM

Oh......gosh. Now I am imagining all that fat.....eeewwwwww....... *feeling queasy*

Amy in Somerville November 16th, 2007 05:52:00 PM

Amen to your feelings about large dog spays. Today on my volunteer day assisting the vet in surgery at the shelter, we had not one, but two large-breed spays; both 80+ pounds and multiparous, and both somewhat overweight for their breeds (Lab- and Rottie-mixes). Makes for an interesting morning-- not only do they take forever to respond to sedation before they get prepped and tubed, but as you said "all that fat"!! Not to mention just the mechanics of lifting and moving a dog of that size who, once sedated, is 80 pounds of floppy dead weight. Give me 3 small dogs and 10 cat neuters any day!!!!

Shellie November 16th, 2007 11:21:00 PM

On the question of price...the total bill for a brain surgery patient at our specialty clinic is about $5,000 to $7,000 start to finish, including MRI ($1100), surgery and post-op care. It varies quite a bit due to location of the tumor, management of the patient (how critical they are before and after the surgery), and length of hospital stay required afterwards.