Tag Archives: Surgery

Epulis Tumors in Dogs

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Epulides in Dogs:

What is This Thing in my Dog’s Mouth?

Dogs can develop odd growths on any part of their bodies, and this includes the mouth. Epulides are (usually) benign, rather common growths that you can find in your dog’s mouth. Despite this, the growths can still create many problems for your dog, and it is important to take your pet to see a vet if you discover an abnormality of any sort in his mouth.

What Dogs are Most Likely to Get These?

Older dogs over the age of seven are also more prone to developing these as opposed to younger dogs. These tumors form in response to gum inflammation and trauma, which would lead one to believe that dogs with poor oral hygiene are affected more. Genetic predisposition can also play a large roll, as brachycephalic breeds are more likely to develop these, especially boxers. The shape of a brachycephalic dog’s jaw can allow for trauma to the gum to occur from misaligned teeth, and this is a likely cause of the increased incidence of theses breeds. A dog may develop only one or many of these tumors.

It is important to note that while brachycephalic dogs may be more likely to develop these, epulides can pop up in any dog’s mouth. My dog developed one, and she is not brachycephalic, and she has received good dental care since puppyhood.

Signs and Symptoms of Epulides:

The most obvious sign of an epulide is seeing one in the dog’s mouth. These tumors can cause many other signs though, including facial deformation, decrease in activity, bad breath, drooling, enlargement of the lymph nodes, bleeding from the mouth, difficulty eating, etc. The first sign my dog exhibited was repeatedly opening and closing her mouth as if she had something stuck to a tooth, but I didn’t discover it until she yawned one day when I was petting her.

When examining a dog with an epulis, the veterinarian will try to look at and may feel the growth. X-rays are helpful to see how large the tumor is and will also help the vet determine what kind of mass is present, but the only way to be sure of the type of growth is with biopsy.

Types of Epulides:

There are three types of Epulides that a dog may develop, and the only way to be sure what type an affected dog has is through biopsy.

Fibromatous epulis: This type of epulis often resembles a mushroom, as is grows as a tumor on a stalk. It can also be seen without a stalk. (www.veterinarypartner.com)

Peripheral odontogenic fibroma: These are very similar to fibromatous epulides, but these tumors have in osteoid matrix. While these can be more attached to the underlying bone, they normally don’t invade the bone of the dog’s jaw. (www.veterinarypartner.com)

Acanthomatous ameloblastoma: These are technically benign growths yet they are often described as have behaving “cancer-like.” This is because these tumors will invade the bone in the dog’s jaw. While it will not spread throughout the dog’s body, this invasion of the surrounding bone can be very damaging. While fibromatous epulides and peripheral odontogenic fibromas normally have smooth surfaces, acanthomatous ameloblastomas may be rougher in appearance and are often ulcerated. (www.veterinarypartner.com)

Treatment for Epulides:

Treatment for epulides is surgical removal. It is better to remove these growths when they are small to avoid them causing undo discomfort to the dog. If the epulis is an acanthomatous ameloblastoma, part of the surrounding jaw may also need to be removed if the growth has invaded the bone. Sometimes radiation is done if the mass can’t be removed, but this is not the treatment of choice.

Thankfully, tumors don’t usually come back as long as the entire tumor has been successfully removed.

If you are very lucky, your dog may take care of the problem herself. Raina had an appointment to surgically remove her tumor, but about a week before her appointment, I noticed the tumor was no longer in her mouth. She must have done some home surgery and bit it off herself. I took her to the vet just to make sure it was completely gone, and Raina was able to skip that surgery!

Conclusion:

Certain types of dogs are more likely to develop epulides than others, but any dog can end up with one. While only one of the three varieties of this tumor is likely to invade the surrounding bone, all of these tumors should be removed if possible so they can be correctly diagnosed. Prompt removal also prevents an epulis from becoming so large that it causes the dog unnecessary stress and discomfort, as even a small one can be very bothersome to a dog and large ones can interfere with eating, drinking, and stop the dog from closing his mouth.

Sources:

Dog Owner’s Home Veterinary Handbook, 4th Edition

https://veterinarypartner.vin.com/default.aspx?pid=19239&id=6017279

https://veterinarydentistry.net/peripheral-odontogenic-fibroma-and-epulis-in-dog/

Pain Management for Your Dog

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Pain Medication and Pets: Management of Pain was not always the Norm

Most people who take their pets in for a surgical procedure are sent home with pain medication of some sort to assure their pet’s comfort. This, surprisingly, was not always the norm. For years, veterinarians believed that pets did not experience pain the same way people do, because dogs (and cats, sometimes even more so) hide their pain. This is a left over protective mechanism from wild dogs, as weak, injured animals are much more of a target for predators. While the assumption previously was that dogs don’t feel pain like we do, the assumption now is that if it would hurt you, it will hurt your dog (https://vcahospitals.com/know-your-pet/pain-management-for-dogs).

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It is important to control pain that your pet may be experiencing, not only for humane reasons, but also to help your pet heal faster, as pain slows healing.

Pain slows healing:

It is important to control our pet’s pain because no one should have to needlessly suffer. Still, some people believe that a little pain is good, because if an animal is feeling sore, she may be less likely to over-exert herself and reinjure a sprained leg or tear out stitches from surgery. The thought process here seems to be logical and would lead one to believe that some pain will help the pet heal faster. This isn’t the case (http://www.caberfeidh.com/Pain1.htm).

Other than being uncomfortable by definition, pain also slows healing. It can also cause the animal to experience unnecessary anxiety and depression. Not only is pain after surgery detrimental, but pain caused from other sources can also severely hurt your pet’s health. For example, a disease such as arthritis makes movement hurt for your pet. This in turn causes your pet to move less, which causes deterioration of the muscles, which in turn puts more stress on the already diseased joints (https://wheatlandanimalclinic.com/services/veterinary-surgery.php).

If a dog needs to rest because of surgery or injury but she wants to move around too much, crates and leashes can help keep the dog from hurting herself. If absolutely necessary, a vet can always prescribe a mild sedative to calm a dog the needs to rest.

Signs of pain in dogs:

While your dog may try to hide his pain, he may also make his pain obvious, whether obviously or subtly. Always be aware of signs of pain, as they can be evidence of an underlying disease. Some signs, such as whimpering and limping are very obvious. Others that are not as evident are holding the ears back, odd reactions to being touched, and loss of appetite. Any change in personality can also indicate something is wrong with your pet, making it important to be aware of what is normal and what is abnormal for your dog (https://vcahospitals.com/know-your-pet/pain-management-for-dogs).

What pain medications are suitable for dogs:

There are a wide range of pain medications available for dogs that provide relief from acute or chronic pain. These include opioids, corticosteroids, and NSAIDs. Some drugs, such as opioids, may be used after a major medical procedure or in end of life pain relief. Medications such as NSAIDs are many times used for conditions such as arthritis.

As can be seen from the previous paragraphs, it is important to recognize and treat pain in dogs, but this does not mean that it is safe to give your dog the same pain medications that you take yourself. Only use pain medications that your vet prescribes. Also, never give medications intended for a cat to a dog, and vise versa. Many things that are safe for dogs are deadly to cats, and many medicines for cats were never meant to be given to dogs.

Even when giving your pet over-the-counter medications, veterinary consultation is needed. Doses for pets are very different from doses for humans. Drugs that seem as safe and common as Tylenol (acetaminophen) need to be carefully administered. While this drug may be a good choice of pain relief for a dog with kidney disease, it can be deadly for a dog with liver problems. Only blood work done be your veterinarian can show what medications are appropriate for your pet, and your vet is the best person to give information on the correct amount to give and how frequently to give it.

Another note:

If you are confused at all about how to administer your pet’s medication, don’t hesitate to contact your vet. Once, our one dog was sent home with a prescription that we picked up from the pharmacy. The instructions on the bottle were different from the instructions that our veterinarian had given us. We found out after a phone call to the vet that the pharmacy had printed the wrong information on the label. Such a mishap could be fatal with certain medications. It never hurts to be extra cautious when caring for your pet.

Dog with Kidney Disease needs surgery

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IMG_1604My Old Dog with Kidney Disease needed Surgery:

When Lady was 14 years old, I discovered a hard mass in one of her mammary glands. Lady has many lipomas that, while unsightly, are harmless; they bother us way more than they bother her! This newly discovered mass felt different, so when she was in for bloodwork I brought it to the attention of my vet. Upon inspection, the vet immediately recommended having it removed as it was a mammary tumor. Without a biopsy, we would not know whether the tumor was malignant or benign.

I wanted to have the mass removed as much as Lady’s vet did, but putting Lady through surgery scared me because of her advancing age and her chronic renal failure.

Before looking into what I did for my dog after discovering she had a mammary tumor, it is helpful to know more about what mammary tumors are, how they are treated, and what the prognosis is after treatment.

What are Mammary Tumors?

As their name suggest, mammary tumors are tumors that grow on the mammary glands. Interestingly, these tumors are actually very common in female dogs, with unspayed females having over a 25% chance of developing one in their lifetime. To put this in perspective, The Dog Owner’s Home Veterinary Handbook compares a dog’s chance of developing a breast tumor to a person’s chance. An unspayed female dog is 3 times more likely to develop a breast tumor than a woman. Mammary tumors in dogs have roughly a 50% chance of being benign (harmless) and a 50% chance of being cancerous. (The Dog Owner’s Home Veterinary Handbook, 4th edition).

Hormones appear to play a role in whether or not a female dog will get a mammary tumor in her lifetime. A female dog that is spayed before her first heat has a less than 1% chance of getting breast cancer (The Dog Owner’s Home Veterinary Handbook, 4th edition). Spaying after the first heat cycle but before her second puts her at an 8% risk, according to the same source. After two heat cycles, the above text states that there is no reduction in risk of a mammary tumor. I have read other sources that differ slightly in their statistics, but most fall around these numbers.

If the tumor is malignant, it can spread throughout the body as any cancer can given the chance. Tumors may have discharge and if allowed to continue growing may ulcerate. A tumor that breaks through the skin’s surface is considered an ulcerated tumor (“About Ulcerating Cancers”).

Note: There is another type of cancer called inflammatory cancer that can occur in the mammary glands. This isn’t what we are looking at here.

How to Prevent/Detect Mammary Tumors in my Female Dog:

As can be seen, the best way to prevent your female dog from developing a mammary tumor in her lifetime is to spay her before her first heat cycle. Lady was not spayed until she was an adult. Many shelter dogs like her aren’t spayed until they are adults, so it is important to check your female dog who is either unspayed or was spayed after going through a heat cycle regularly for breast tumors. This is especially important after the age of 6, although it never hurts to start keeping an eye out for issues at an earlier age. As with people, early detection is extremely important to improve chances of successful treatment. If you feel any lump or swelling, take your dog to the vet for a checkup.

How do I Know if my Dog’s Tumor is Benign or Malignant?

I have had pets get needle aspirations to check lumps and bumps many times. With mammary tumors a needle aspiration is not a reliable way to determine whether or not the tumor is malignant. The only way to determine this is to biopsy the mass and have it tested.

Treating Breast Tumors in Dogs:

As stated above, early detection is crucial to good prospects of recovery. If the tumor is malignant but is removed when it is an inch or smaller, the cure rates are favorable (The Dog Owner’s Home Veterinary Handbook, 4th edition). Benign tumors are completely taken care of by removing them. Chemotherapy generally doesn’t seem to be really beneficial for dogs with breast cancer, but every case is unique, and it may be recommended for your dog (“Mammary Tumors”).

Before getting surgery, I would recommend asking to have x-rays taken of your dog’s chest. Breast tumors often metastasize to the lungs. If there are visible signs of cancer having spread to the lungs, I don’t see the point in putting the dog through the stress of surgery since the cancer has already become invasive throughout other parts of the body.

Lady’s Experience:

Now, let’s look at Lady’s circumstances, and how I made the decision to have the surgery even though she was a senior dog with kidney disease.

Lady’s Signs and Symptoms:

  • Size of tumor – 2 cm (0.79 inches)
  • Discharge
  • Mammary tumors are generally not painful
  • Lady has a history of high blood pressure that medication failed to improve.
  • Kidney disease
    • Creatinine 1.9
    • BUN 33
    • Low urine specific gravity (meaning her kidneys cannot concentrate urine as much as they should. I did not know Lady’s exact number, but my vet said it put her in the category of late stage kidney disease. Her other numbers did not line up with this)
    • All other values, such as phosphorus, were normal at the time of her surgery

Other than her kidney disease, Lady was in good condition when we discovered her mammary tumor. I think it is truly important to look at an elderly dog’s physical condition and not just her age when deciding if surgery is a good option. Some 13-year-old dogs may handle surgery better than some 8-year-old dogs. Lady’s kidneys weren’t great, but they were not that bad either. If her creatinine and BUN were more elevated and she had high phosphorus or other issues, my decision may have been different. Both Lady’s vet and I agreed that Lady’s constitution was good, and that there was more risk in leaving the tumor than in removing it.

Before surgery x-rays were performed to check to see if there were signs of metastasis. We also had the x-rays to check Lady’s heart. She had began coughing in the previous months, and her cough sounded frighteningly like the cough of a dog with congestive heart failure. The x-rays showed no problems with her heart (had there been a problem, I would not have had the surgery because the risk would be too great).

Before, during, and after the surgery Lady received continuous IV fluids to help her kidneys as much as possible. Her vet only removed the mammary tumor. I mention this because Lady has a harmless cyst on her ear that is rather ugly, but removing it would mean longer time under anesthesia. For a dog with kidney disease, it is important to minimize the time the dog is under as much as possible, so purely cosmetic procedures should be skipped.

Lady stayed at the doctor’s office for several hours after the surgery. We brought her home that afternoon and followed the instructions for the medication she received. Her vet prescribed tramadol and Tylenol. Other drugs are often used for post-surgical pain, but we were limited because of her kidney problems. The after effects of anesthesia make Lady extremely restless, so I was up with her throughout the entire night, but by the morning her personality was back to normal.

After the results from the biopsy came back, our vet called us with the news that Lady’s tumor was indeed malignant. The vet believed all the cancer was removed during surgery, but we were given information on a veterinary oncologist who worked with chemotherapy in case we wanted to pursue such treatment. Chemotherapy hasn’t been shown to improve survival rates in dogs with mammary cancer. This, in addition to Lady’s problematic kidneys, made my decision not to pursue chemo easy. Over six months later, Lady is now 15 and doing quite well.

Conclusion:

Making the decision to have surgery on Lady was extremely stressful, but it came down to weighing the benefits against the risks. Leaving the tumor to grow, not knowing if it was cancerous or not, seemed more dangerous than putting her kidneys through anesthesia. If your dog has kidney disease and needs surgery, work closely with your vet to decide if surgery can be performed safely.

Works Cited:

https://www.acvs.org/small-animal/mammary-tumors

https://www.cancerresearchuk.org/about-cancer/coping/physically/ulcerating-cancers/what

The Dog Owner’s Home Veterinary Handbook, 4th edition

Good Articles on Kidney Disease and Surgery:

https://www.mypetsdoctor.com/neither-age-nor-kidney-failure-a-factor-in-anesthesia

https://www.vin.com/apputil/content/defaultadv1.aspx?pId=14365&catId=73673&id=7259246&ind=6&objTypeID=17&print=1