Mr. H's second surgery for re-excision of the scar and reconstruction
is scheduled for the 27th. His surgeon taught small animal surgery at
Purdue University for 5 years before coming to the animal hospital. I
was impressed with her and the way she described the operation to me; I
trust Mr. H will be in good hands.
During surgery, Dr. A
will remove the scar tissue and get better margins on the sides. For
the lower portion that did not have a clean margin, she will go in much
deeper and take out what she thinks is abnormal tissue. (She explained
that most of her work is done through palpitation not sight. The
tendrils of the tumor are microscopic. She relayed that studies prove
the hands and limbic systems of surgeons can determine if something is
abnormal before the conscious mind. In other words is tissue doesn't
feel right, she's taking it, whether or not it
looks weird.
Another example of how we don't know all that we know.) She will call
the pathologist to see what sarcoma's origin tissue was- . She will
take more of that type of tissue, unless it is a nerve sheath sarcoma.
If she takes the nerve, his leg would have to come off. He'll be in the
hospital for 3 days. Since the incision is so deep they'll use a
negative pressure wound vac on him. I suspect they'll keep him pretty
drugged up so he doesn't bite it off. Also, as much as I hate that he
will be away and in pain, I'm glad he is staying there so they can
manage his pain hour to hour, and as a bonus (!) and much as I love and
want to take care of him, I don't have to see the incision immediately after surgery.
I
asked for something that could increase the cost of the surgery by over
a third: reconstruction so that he will lose no range of motion and
maintain his ability to run and have fun. For me, a dog's whole point
in life is mobility. While a human can make do and even thrive confined
to a bed or wheelchair, a dog would not have a fulfilling life. At
least in my opinion.
The sarcoma is a skin cancer, so
they took of a good bit of skin in the first surgery and sewed it back
together. Mr. H has no problem with running now. In fact he acted like
he never had surgery. He and his sister made a jail break about 2 weeks
after his surgery and he was as fast as ever. The second surgery will
take more skin to increase the margins on the sides so there is less to
pull together without too much tightness. She offered a couple of
options, and I told her to do what she needed to do:
1) there may be enough skin to simply close the wound normally
2)
make a flap out of some skin lower on the leg and fold it over, she
drew a picture but I don't understand. Add four days more to
hospitalization
3) take skin from somewhere else on the body. Also add four more days.
Good
news through- a study of dogs with soft tissue sarcomas who had the
second surgery showed that there is only a 9% chance of recurrence.
The surgery estimate minus the $$ is below the fold. I'm embarrassed to say how much this will cost - approximately 6 mortgage payments.