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Question – When is a lump not a lump?
Answer – When it’s a mass, or a bump, or a growth, or a skin-tag, or a cyst…
O.K., so that’s not even a joke but the point is, no matter how much we’d like to think otherwise, there is no way of telling exactly what a lump is just by looking at it or feeling it. Lumps come in various shapes and sizes and are caused by different things.
A cyst is a thin walled lump which is filled with fluid. This is usually as a result of the abnormal activity of a skin gland which usually produces only tiny amounts of a secretion, often as part of the normal make up of the skin for instance. Often the little tube (or duct) down which the secretion is supposed to travel to get to the surface becomes blocked and, as a result, the gland starts to fill up with the secretion until it becomes many times its intended size.
Most cysts are pretty harmless in and of themselves and, if slow growing, are pretty painless too. They usually appear as tiny skin-tags or smooth swellings of a centimetre or two in diameter within the skin itself. Occasionally they can cause problems if growing in a difficult area, such as an eyelid, or if they get particularly large or infected. In these cases they may need treatment such as antibiotics or surgical removal.
Bruising (or “haematoma”) is another cause of lumps. Often in these cases there is a history of trauma such as a fall or a collision with a car which would explain the lump but equally often there isn’t and we are left with a diagnosis of hindsight. If a painful lump arose quickly then disappeared of its own accord, it may have been a simple bruise.
One problematic area to have a bruise is the ear flap – a condition known as an “Aural Haematoma”. Here the inside of the ear flap of a dog or a cat swells up, balloon-like, until the whole inner surface is involved. Often, despite what you might imagine, these are non-painful. They are presumed to be caused by shaking or scratching the ear and are often associated with disease of the ear canals, which can lead to such “self-trauma”. A leaflet giving more details of this condition (often treated surgically) can be found by clicking this link.
The lump that most of us are worried about is generally referred to as “Cancer”. Unfortunately this word has become overlaid with all sorts of hidden connotations and pre-conceptions meaning different people will often have a completely different impression of what it means. Similarly, the term “tumour”, although it literally means nothing more than “swelling” has very emotive overtones.
It is generally more helpful to use the medical term “neoplasia” rather than cancer or tumour. This word translates simply as “new growth” which, in a nutshell, is exactly what these lumps are. Put simply, all that happens in neoplasia is that cells, in pretty much any body tissue, forget when they are supposed to stop growing.
Knowing when to stop growing or multiplying is normally one of the most import and and clever things a cell can do. Take the skin for example – our skin cells are constantly wearing out and falling off and need to be replaced from underneath in a continuous process of repair, otherwise the skin would wear out. To do this the cells deep in the skin divide and move upwards to the surface to form new layers. But the wonderful thing is that they know when enough skin cells have been produced to do the repair, and stop dividing when no more are needed.
Some cells however, have undergone an accidental change – a mutation – which means they are unable to stop dividing and multiplying. These cells, with their unchecked growth, go on to form other cells, each one of which exhibits the same excessive behaviour, and the whole thing will eventually be noticed as a lump.
The big question is, how worried should we be about such a lump? There is a spectrum of activity which is seen with neoplasia and various ways of categorising it. At one end of the spectrum we have completely harmless lumps which are known as “benign”. These would include such things as simple warts and fatty lumps (or lipomas) which are generally “well behaved” and will not invade nearby tissues or spread in the blood stream to other areas. These lumps occasionally cause problems if they are in a difficult site or they get to an excessive size but they are generally pretty simple to deal with if this happens.
At the other end of the spectrum we have the real nasties – these are known as “malignant” and are what most people probably mean when they talk about “cancer”. These include some skin neoplasias such as the melanoma; the bone cancer, osteosarcoma; the blood cancer, lymphoma (sometimes referred to as “leukaemia”); and the mast cell tumour.
These are far from “well behaved” unfortunately and will grow vigorously into surrounding tissues and spread, by various means, to different parts of the body causing lumps (known as secondaries) to appear elsewhere. Because of their habit of spreading into surrounding tissues they are difficult to treat with surgery alone as removing the visible lump isn’t enough – the surgeon has to cut deep into healthy tissue too in order to make sure that all the tendrils of growth which can’t be seen are removed as well. Once the tumour has spread to other areas (a process known as metastasis) it is difficult or impossible to physically remove the secondary growths and we have to consider something which will selectively target the neoplastic cells and kill them, such as chemo- or radio-therapy.
So it is of vital importance that we know what a lump is in advance of treating it. If we know a lump is, say, a fatty lump then the sensible course of action would be not to operate, but to keep an eye on the situation and only operate if it started to cause problems. On the other hand, if we are dealing with a mast cell tumour or a mammary tumour, it would make sense to operate early, before it has had a chance to spread, at a stage when surgery alone would be more likely to produce a cure.
Proper diagnostic tests are essential in the fight against malignancies so that we know what we are dealing with and can make a fully informed decision about a treatment plan. Blood tests are generally unhelpful on their own when it comes to this sort of diagnosis. What is needed, is to obtain a small portion of the lump itself which can be analysed at a laboratory.
Broadly speaking this is done one of two ways. The simplest is to do what is called a “fine needle aspirate biopsy” (or FNAB). This involves popping a thin needle into the lump, withdrawing a few cells and examining them. This has the virtue of being simple, quick, minimally painful and not requiring a sedative or anaesthetic. The drawbacks of the FNAB are that they can only be used in lumps which are large enough to position the needle accurately, they are not 100% accurate (occasionally the sample may come from nearby cells, not the lump itself) and it is only possible to look at individual cells, not how they relate to one another in the actual lump (the “architecture”) which can make interpretation difficult.
A more accurate way of making a diagnosis is to actually cut a small piece of the lump out and send that for testing. This is known as performing an “incisional biopsy” and can be done by taking a core of the lump via a large “Trucut” needle or performing a surgical procedure and physically removing a section of the lump. This method is almost 100% accurate, as the laboratory can look at the “architecture” of the lump as well as the cells, but often requires at least a sedative, if not a full anaesthetic.
Once we have the results from the biopsy we can discuss a treatment plan with you. At one extreme this may simply be to keep an eye on a lump now known to be benign. At the other extreme, if it is malignant, we may be advising repeat surgery to remove the entire lump with wide margins and occasionally may need to discuss whether or not you would like to opt for follow up treatment with a cancer specialist (or oncologist).
In many cases it is possible to treat even malignant lumps successfully. Many dogs who have had mammary tumours, mast cell tumours or so-called “spindle-cell” tumours are alive today, years after initial diagnosis, thanks to prompt intervention. But the vital thing is to make an early diagnosis. If we can get to a “cancer” when it is still small and before it has had a chance to spread, then we can usually do a good job. If, on the other hand, a lump is left then, in some instances, by the time the diagnosis is made it can be too late and the condition will inevitably deteriorate no matter what treatment is attempted.
“Cancer” is by no means a death sentence, particularly these days with our improved understanding of how it develops and progresses, but to give the best chance of a successful outcome you must act promptly.
Niall Taylor MRCVS 18 March 2013
It turned out Bailey was a little more agile than his owners had realised. At the age of 8 weeks, he managed to scramble onto a coffee table they didn’t think he could reach, and chewed up three ibuprofen tablets – more than the standard dose for an adult human, let alone an five kilogram Labrador puppy.
So, it was a trip down to the surgery for all of us. Bailey got an injection to make him sick, and the poor little chap brought up his breakfast with, hopefully, at least some of the ibuprofen. Unfortunately, ibuprofen can be absorbed within 30 minutes, so Bailey was going to have to stay with us. Ibuprofen is never a suitable painkiller for a dog, even in a very small dose, but Bailey had eaten so much there was a real danger he might go into kidney failure as a result. He was also very likely to develop an irritated gut, possibly even a gastric ulcer.
With the help of one of the nurses, we hooked Bailey up to a drip to administer intravenous fluid, which is the best way to try to ensure that his kidneys aren’t damaged. We took a blood sample as well – it would be too early to see signs of kidney damage in the results, but it was important to know where we were starting from, so we could respond quickly to any changes. He also got several meals of dog food mixed with activated charcoal, to prevent any ibuprofen which was still in his digestive tract from being absorbed into his body; and doses of anti-ulcer medication three times a day.
Bailey stayed with us for two nights and three days. Luckily for him, he wasn’t feeling unwell at all, as his owners had contacted us straight away, rather than waiting until he showed signs of illness. Unfortunately for us, that meant trying to keep him out of trouble was a 24-hour-a-day job; particularly when he was treating his IV drip line as a chew toy!
Luckily for Bailey, his second blood sample showed no sign of kidney damage. It was time to take him off the drip, as staying on it for longer wouldn’t help further. However, it would be some time before we could say he was out of the woods. He went home, but came back in three days later for another blood test – fortunately all was well, and Bailey is still a bouncing bundle of trouble at four months old. Thankfully, he has managed not to eat anything else that he shouldn’t.
At Christmas time we hear lots about foods, such as chocolate and raisins, which you shouldn’t feed your pets; but it’s important to be sure that anything dangerous is safely out of reach – from medications on hand to nurse a Christmas hangover, to electrical cords from Christmas lights that a curious pet might chew on. Even medications that are commonly and safely used in humans can be dangerous for pets – a tiny dose of paracetamol can be fatal for a cat for instance – so never dose a pet with medication at home unless specifically advised by your own vet. If you are worried your pets are unwell over the festive season, please contact the clinic for advice.
Lucy Fleming MRCVS 13 December 2012
(With grateful thanks to Bailey’s owners for kindly allowing us to share his story)
Vaccine manufacturer Virbac has recently launched a unique infectious disease alert system, running through Twitter, known as ParvoAlert. Vets will be able to alert Virbac of a confirmed case of canine parvoviral enteritis by tweeting the postcode to @parvoalert, and Virbac will retweet the location. Pet owners can follow the @parvoalert twitter feed to learn of outbreaks of canine parvovirus (CPV) in their area.
Whilst I must admit to being a bit of a luddite when it comes to Twitter, I do think the idea is a good one, as it is always worth knowing when extra disease challenge is about. Tracking outbreaks of disease through the internet and even social media isn’t a new concept, but as far as I am aware this is the first of its kind aimed at pet owners.
However, I would never, ever, ever recommend that pet owners wait until there is an outbreak of parvovirus nearby to think about vaccinating puppies and adult dogs. Canine parvovirus is a real killer, just like distemper, infectious hepatitis and leptospirosis, which is why these diseases are included in core vaccinations. Moreover, any age of dog can catch parvovirus if they have never been vaccinated or if their vaccination has lapsed for a significant length of time.
There is no cure for parvovirus, all we can do is nurse the animal while its body fights the virus. I’ve previously worked in an area where very few dogs were vaccinated, and seeing puppies with parvoviral enteritis was not uncommon. Sadly, despite intravenous fluid therapy and medication to support them, around half the pups we saw weren’t strong enough to survive the dehydration and shock that the vomiting and severe bloody diarrhoea caused. Worse was knowing that each puppy probably had several littermates that would be seen in the next few days – if they made it to the vets at all. I can certainly say that working here at Orchard, where most puppies are fully vaccinated, is a breath of fresh air in comparison!
So, if you know someone with a young puppy, or even an older dog that hasn’t been vaccinated, I hope you’ll remind them of the importance of vaccinations. After all, prevention is always better than cure!
Lucy Fleming MRCVS 3rd December 2012
As a general practice we see quite a mixture of animal species including more than a few reptiles. While we are in no way reptile specialists we are able to help with a variety of problems in this class of animals including parasite control, trauma, skin and mouth infections. For more serious problems we will usually advise referral to a Royal College of Veterinary Surgeons registered specialist for a greater level of expertise and facilities.
There is one particular problem that we see with regular monotony in lizard species, and that is Nutritional Osteodystrophy or metabolic bone disease. This is caused by an imbalance in the correct ratio of calcium, phosphorous and vitamin D in the lizard’s system and results in extremely weak, soft bones which, when x-rayed, can hardly be distinguished from surrounding muscle and ligament. Eventually the bones get so soft that they start to fracture following even normal movement and gentle handling.
This condition is particularly frustrating for us (and the lizards aren’t too happy about it either) because it is extremely easy to prevent – it is a condition that we should never need to see. So what follows is a ‘potted version’ of:
How To Avoid Metabolic Bone Disease in Your Lizard:
1/ Feed the right stuff
The basis of avoiding dietary problems is to have a good, balanced diet at the outset. Even a meat (including insect) eating reptile needs a source of vitamins and minerals in addition to just meat. Dark, leafy vegetables are best at providing these extras.
Do your research and find out what your particular pet needs and give it to them. That means give it ALL to them, not just the crickets because it doesn’t like the cabbage, not just the fruit because it doesn’t like the meal-worms – it needs everything, not just the stuff that is easy to give.
2/ Provide UV light
Vitamin D is one part of how you ensure good bone strength. The ingredients for vitamin D are contained in a balanced diet or supplements but diet alone is not enough. You also need a source of ultra-violet (UV) radiation to allow the reptile to make vitamin D proper from the nutrients you are providing. Without these UV rays your reptile will not get enough vitamin D no matter what you are giving in the diet.
To supply UV rays AT THE CORRECT FREQUENCY you need a proper strip lamp, specially manufactured for use in reptiles, in the vivarium. Using one designed simply to show up the colours of aquarium fish will not do the job. Once you have installed the reptile lamp you must change it every six months. Just because a lamp is giving out visible light doesn’t mean it is giving the correct wavelength to create vitamin D – you can’t tell by looking whether it’s still working.
Run the UV lamp along the length of the vivarium, with the heat (basking) lamp at one end. That way the reptile will get UV rays no matter what temperature zone it’s in.
3/ Give BALANCED supplements
The three dietary ingredients you need for strong bones are Calcium (Ca), Phosphorous (PO4) and Vitamin D. The ratio, or balance, between these ingredients is vital so pick a supplement with all 3 of these ingredients. If you give any one on their own or in the wrong balance you will do a lot of harm and will make soft bones worse, not better.
‘Straight’ supplements are available with just calcium or just phosphorous or just vitamin D but if you try to mix and match these yourself you will get it wrong (unless you have a qualification in reptile nutrition in which case I bow to your superior knowledge). It is much better to buy a supplement with all 3 ingredients already in it, in the correct balance. This type of supplement will tend to be more pricey than single ingredient supplements. “Calcium”, for instance is usually sold, on its own, in the form of powdered chalk (though it won’t say that on the tin!), really cheap but fatal if given on its own; vitamin D is available in the form of cod liver oil, again very cheap; but give it on its own and all you’ll get is rickets and soft bones.
If cheap or easy is your highest priority you should not be keeping reptiles.
4/ Do your research
There are some extremely good and helpful specialist pet-shops full of reptile enthusiasts desperate to go on at great length about the intricate details of husbandry – talk to these people. There are an even larger number of specialist web-sites in cyberspace – read this information.
Once you’ve read the information and taken advice FOLLOW IT. The advice won’t always be easy or cheap but, as I said, if you are looking for cheap and easy then you’ve got the wrong pet (in fact you probably shouldn’t have a pet of any description).
Lizard care for dummies – a summary
1/ Feed a BALANCED DIET. Bearded dragons need veggies and tortoises need a bit of meat occasionally.
2/ Provide a UV strip lamp and change it every 6 months even if it looks like it’s still working.
3/ Provide BALANCED supplements – don’t try to economise by buying cheap separates of calcium or phosphorous or vitamin D
4/ Be safe – be aware of the risk of catching Salmonella (a food poisoning bacteria) from reptiles of any sort – have a look at this leaflet from the Health Protection Agency for the full details.
Everything you ever needed to know about bearded dragons – colours, sizes, breeding tips, nutrition, health and much more – TheBeardedDragon.org has even got free badges and a secret manual!
Bearded dragon care
What to feed a bearded dragon
Stahl Exotic Animal Veterinary Specialists – excellent information on all sorts of exotic animals, including reptiles
Printable booklet on caring for a bearded dragon by KW Tosney
Niall Taylor 6th November 2012
So, firework night is nearly upon us once again. The problem is of course that it’s no longer just firework “night”, it is now firework “season”. And this season seems to last longer and longer every year. There’s the weekend before and the weekend after the 5th November as well, when the bonfire parties are held; oh, and not forgetting hallow-e’en the week before that. Then there’s those festivals and then Christmas and New Year. And the end of term celebrations at certain well-known local schools… The list seems endless, and the bangs ever louder.
While this is all wonderful for the pyrotechnics industry and young children, it is inevitably less so for our pets and probably has been since fireworks were first invented in Ancient China, undoubtedly causing aristocratic pooches to creep, quivering into the capacious sleeves of their exalted and inscrutable owners.
There are some measures which can be taken to reduce the stress to our pets at this time of year although, it has to be said, nothing is perfect and if a behavioural response is well established in an older dog, results can be disappointing.
The first thing is to physically reduce the impact of the sudden noises and flashes by manipulating the pet’s immediate environment. Keeping a pet indoors is an obvious start and here modern property improvements such as double glazing can be a boon. If you have a room with double glazing make sure your pet is used to going in there normally and that during the firework season this is where they go of an evening with doors and windows shut and the curtains drawn.
It can be helpful to try to mask some of the sounds with something more acceptible and which your pet might be more used to hearing such as the radio or some music. Bear in mind however that animals’ sense of hearing is far more acute than ours. They can hear noises which are far too high (ultra-sonic) or far too low (infra-sound) for us to detect and which will travel further and through more barriers than the limited range of sounds audible to us mere humans (we’ve got better eyesight, if that’s any consolation). Still, every little helps.
Sticking with “manipulating the environment” there is one other thing that you can do which will make a great deal of difference but which most people find difficult or even impossible to manage. That is, in a nutshell, to be “cool” yourself. One of the biggest mistakes people make is to try to console their pets with words and body language in the same way we might with another person. The problem here is although this would work well with a human who can understand our speech and gestures, to an animal who can only understand a limited number of signals from us, all this conveys to them is that their human companions are also extremely worried about something. They don’t know it’s them you’re worried about and not the fireworks, all they pick up on is there really is something to worry about. And that of course will just make things worse for them.
What you should be doing is being all nonchalant and casual – show your pet there is nothing to worry about – you’re fine and everything is well with the world. If they would rather hide under the table with a worried expression then let them; it’s their way of coping and they feel safe there. If you hook them out, give them an enormous cuddle and talk to them in high pitched, worried tones this unusual behaviour will unsettle them even further. What you should do is just to sit quietly, don’t ignore them completely but find a normal activity to do – read a book or watch telly. And if you do speak to them make sure you use a low voice and conversational tones.
There are a few “external” measures which you might like to try. The use of pheromones around the house can have a calming effect. Next time you visit your vet ask about Feliway in cats and DAP in dogs. By mimicking the natural scents (mercifully undetectible to humans) which animals leave in their home environment these products can create a sense of confidence and security in our pets if they are used in the correct way. There is another product called Zylkene which is claimed to have a similar effect, being itself a type of chemical associated by dogs and cats with the “nest” when they were young thereby encouraging them to relax.
Pharmacological sedatives or anxiolytics have been used in the past – older readers may remember the little yellow “ACP” tablets which used to be very popular. They have fallen out of favour in many cases these days with their mode of action being questioned. Some however still have a place in extreme cases of anxiety, diazepam probably being the most useful of this diverse group.
A herbal “sedative” is available in the form of Valerian based preparations which, for dogs, is often combined with another herb, Scullcap. Some owners report success with these products but there is little firm evidence in their favour. If you are going to try any herbal product you must make absolutely sure they are formulated by a commercial supplier specifically for animals. Contrary to popular belief not all things herbal or natural are safe by any means, and Valerian in particular has some extremely powerful chemicals in it which can be toxic if used incorrectly.
Homeopathy is something which has been suggested by some but a recent study conducted by the manufacturer of such a product found that although there was some improvement in the behaviour of dogs given the homeopathic remedy it was exactly the same as in those given a placebo sugar tablet. The effect was presumably as a result of a change in behaviour of the owners who, having given the tablets, were then more relaxed, feeling they had done something to help. Again, we come back to the most useful thing you can do which is to show your pet you aren’t worried, and they will respond in the same way.
Finally there are “desensitisation” techniques, the best known of which are the “sounds scary” CD’s. Put simply these work by exposing dogs, in a controlled environment and outside the firework season, to a variety of noises of increasing volume in the hope that by the time they get really loud they will no longer be concerned. Many people have reported success using this method but as you can imagine it takes a great deal of time, persistence and dedication from all parties.
There is no question that the best time to start following any of the above advice is from a young age, when the potential sufferers are still puppies and kittens. Once these patterns get firmly established, unfortunately, it appears almost anything we do seems to make things worse.
Niall Taylor 16-10-12
One of the most common neurological conditions we see in practice is known as Vestibular Syndrome. This condition, seen almost exclusively in older dogs, can be very distressing for both patient and owner. Often however, despite appearances, the prognosis can be surprisingly positive.
The condition usually comes on very quickly, with no previous symptoms being noted, and the presentation is generally dramatic. The most obvious sign is a loss of balance which causes the dog – in mild cases – to stumble with one leg appearing to give way, and – in more severe cases – to walk in tight circles, always in the same direction, or even fall over completely.
There will usually be a head tilt where the dog will have the appearence of having its head cocked to one side all the time. Occasionally the head may move from side to side as well, as if the dog was following a moving object crossing its path. If you look closely in these cases you might notice a condition called nystagmus where the eyes flick from one side to another; slowly in one direction and quickly in the other.
This loss of balance can be accompanied by a form of motion sickness and some owners will report that a dog has been sick following the onset of signs.
While these symptoms continue the dog will remain active, conscious and aware of their surroundings and can become quite distressed with rapid panting and an anxious expression.
Ideas about the cause of Vestibular Syndrome have changed over the years but current thinking suggests that it is most commonly due to a small “stroke” (i.e. a tiny blood vessel which has burst) in the vestibular apparatus of the central nervous system which is responsible for maintaining balance. Occasionally it can be as a result of other damage to this region including trauma, or even a tumour. These other causes are rare but on the occasions when they do occur the consequences for the patient unfortunately can be much more severe.
There is really nothing that can be done to prevent Vestibular Syndrome. Although obesity and certain other conditions may have a part to play because of increased blood pressure there is not a straightforward connection and dogs do not suffer from arterio-sclerosis, which can cause strokes in humans. As far as treatment is concerned, here too options are limited. When presented with such cases a veterinary surgeon may suggest blood tests or even x-rays to eliminate possible trigger factors but more often than not a provisional diagnosis is made on the basis of the clinical history and physical examination alone.
Many vets will treat affected dogs with anti-inflammatories such as glucocorticoids, on the basis that if the haemorrhage has an associated zone of inflammation around it these drugs will help limit the damage caused by that. But this is a supportive, not a specific, treatment and most cases will gradually improve spontaneously over a number of days. Most patients will go on to make pretty much a full recovery although some are left with a mild head tilt (often so subtle only the owner notices) and a slight tendency to stumble, especially when cornering.
So if you notice any of these distressing signs in your dog you should certainly take him or her to your vet for a thorough examination but don’t despair too much. In cases where there are no obvious complications, such as heart disease or other forms of neurological disorders such as epilepsy, it may well be that in a few days you find that things are greatly improved.
Niall Taylor September 2012
I’ve already mentioned in previous articles about the importance of keeping your pets vaccinations up to date. So many of the most serious, often life threatening diseases of dogs and cats which are still around can be prevented extremely easily by a simple vaccination. Distemper, hepatitis, parvovirus (all given every 3 years) and leptospirosis (given annually) can all be controlled in dogs while in cats the main concern is calici and herpes virus (cat flu) as well as feline enteritis and leukaemia are the core vaccines given.
Vaccination is extremely safe, highly effective and there are no suitable alternatives to it. They work by boosting the immune system and priming it to protect when an animal is exposed to disease by launching a rapid, ‘pre-emptive attack’ and neutralizing and harmful bacteria or viruses before they can gain a hold thus protecting both the individual and other animals in the vicinity.
In addition the health check and clinical examination which is carried out at the time of vaccination is absolutely vital for picking up all number or problems both minor and major which might require intervention before things develop to a more advanced stage. Dental disease, skin problems, allergies and even some cancers are just a few of the things which are regularly picked up at the annual health check.
Of course, with the busy lives we all lead these days it is easy to foget about the ‘annual jab’. Reminders occasionally go astray or appointments forgotten and before you know it the vaccine is so late that the advice is actually to start the primary course of two injections again. Well, the good news is that during the month of June we are offering a re-start coure for the price of a booster – so you literally have nothing to lose by starting again!
The offer is open to pets aged 18months or older and could save you up to £23.00 on the full cost of a primary course. So, if you’d like to get ‘back on track’ just contact the surgery (01458 832972) and make an appointment.
Niall Taylor MRCVS June 2012