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.
CBC IN- HOUSE
|
|||||||||
CHEM 10- IN HOUSE
|
|||||||||
ANESTHESIA- HYDRO/DIAZEPAM
|
|||||||||
IV CATHETER GROUP
|
|||||||||
IV CATHETER PLACEMENT
|
|||||||||
IVCATH 18GX 1.16
|
|||||||||
T-SET
|
|||||||||
INJECTION CAP
|
|||||||||
IV FLUIDS GROUP
|
|||||||||
IV FLUIDS SET-UP
|
|||||||||
IV ADMIN SET
(CLEARLINK)
|
|||||||||
EXTENSION SET 42"
|
|||||||||
NORMOSOL R 1OOOmL (IV FLUIDS)
|
|||||||||
POTASSIUM CL
|
|||||||||
HYDROMORPHONE 2MG/ML
|
|||||||||
DIAZEPAM 5MG/ML
|
|||||||||
ATROPINE 1/120GR
|
|||||||||
PROPOFOL 28- 20 ML
|
|||||||||
ANESTHESIA ISO 1ST HOUR
|
|||||||||
ANESTHESIA ISO ADDTL PER 15 MIN
|
|||||||||
ANESTHESIA MONITORING
|
|||||||||
MASS EXCISION
|
|||||||||
OR FEE
|
|||||||||
SPONGES 4X4 XRAY
DETECTABLE
|
|||||||||
SURGICAL MARKER W/RULER
|
|||||||||
MASS REMOVAL
|
|||||||||
SKIN RECONSTRUCTION
|
|||||||||
SUTURE PDS II SZ 2-0 TAPER CT-1
|
|||||||||
SUTURE PDS II SZ
3-0 CUT FS-1
|
|||||||||
SKIN STAPLER 35 WIDE
|
|||||||||
PACKED CELL VOL/TOTAL SOLIDS
|
|||||||||
LACTATE PRO TEST
|
|||||||||
GLUCOSE ALPHATRAK TEST STRIP
|
|||||||||
TRAMADOL HCL 50MG
|
|||||||||
FLK GROUP
|
|||||||||
FENTANYL 0.05MG/ML INJECTION
|
|||||||||
IV FLUIDS GROUP
|
|||||||||
IV FLUIDS SET-UP
|
|||||||||
IV ADMIN SET
(CLEARLINK)
|
|||||||||
EXTENSION SET 42"
|
|||||||||
NaCI 0.9% 500mL
|
|||||||||
HISTOPATHOLOGY COLORADO
|
|||||||||
SHIPPING COLORADO
|
|||||||||
CEFAZOLIN
|
