Case of the Month - April 2025

Being a veterinarian means you help people with their pets, not just the animals themselves.  The other day, a close family member, Sue, texted me about her dog Ruby.  

Ruby with Sue

Ruby

Ruby is a 4 yo mixed female spayed dog adopted late last year from a rescue.  Since Ruby gets lots of attention and touch, Sue noticed soon after adoption that Ruby had a small (less than 1 inch) mass under the skin of her neck.  They monitored the mass, but it was not going away.  So the mass was tested, and it turns out the mass is a mast cell tumor. 

Ruby had surgery on Thursday 4/17.  Sue was mortified that the incision was so long.  Why does this have to be so f’ing big for that little mass?

About mast cell tumors

Ugh, I hate mast cell tumors.   They like to come to surprise parties when they are not invited.  Normal body functions depend on mast cells to help with digestion, inflammatory responses and mindfulness/staying awake.  But tumors can be a pain in the butt.   Sometimes they are well circumscribed, but I have run into a few that are very messy.  Like liquid goo or slime that has no boundaries.  To avoid the mess and possibility of leaving cells behind, us vets have to make wide, long incisions to take them out.  And if cells are left behind, they will grow back with a vengeance.

Ruby post-op

Ruby’s first night was hard for her.  She was crying, and the extra-long incision is in an area that makes it hard to put a leash on her or lay down.  She is currently taking Carprofen for pain, which is a non-steroidal anti-inflammatory often prescribed for surgical pain because it’s fast acting and inexpensive.  Is Ruby painful?  What if Carprofen is not strong enough for Ruby’s pain?  Why is she crying?

Dogs can cry for many reasons, not just pain.  In Ruby’s case, since she just had surgery and a pain injection hours prior, I think some of the crying might have been from the drugs of anesthesia wearing off.  I think anesthetics and injections we give in the hospital can affect a pet’s perception and they don’t like it.   It can take up to 48 hours for those drugs to get metabolized completely, depending on what was used.  Since Ruby is still pretty young, I think the drugs will be gone by morning.  But what does she need now to make her more comfortable?   Let’s try and figure it out. 

I suggested to Sue that Ruby get taken out for a walk.  Sometimes the pet patients need to use the restroom from all the fluids they had during surgery.   And I think walking helps return the pet’s perception of normalcy sooner, like a creature comfort that anyone would enjoy when they are not feeling 100%.   If she was still crying after a walk, I suggested to Sue that she could have Gabapentin in addition to the Carpfofen.  Gabapentin is sort of the soup-du-jour for pain these days, and in Ruby’s case I think it would be helpful.  Gabapentin does take a few hours to kick in though, so the effects will not be immediate.  Thankfully, after Ruby’s walk she was more comfortable and the extra pain nullifier was not necessary. 

We will wait and see what Ruby’s mass results are, probably not until next week.  Until then, I prescribe lots of love and pats, tasty food, and all medications as prescribed.  

Update 5/8/25

Ruby’s mast cell tumor came back as low grade, Patniak grade 2. The margins were clean, with no hints of the tumor stretching beyond what was cut out. The grade of tumor, low grade, means that there is a favorable prognosis that this tumor was not likely to spread when it was still in her body. The location of where the mass was is also a good area, under the skin in the neck region; if the mast cell tumor was located say in her mouth or at the base of a toenail, then those areas are considered not so great and have a higher likelihood of spreading.

Healing Time

As Ruby’s incision heals, she wants to scratch it. This has slowed the healing process a little bit, and the incision started to ooze. Why is it oozing? Sometimes surgery sites ooze due to the suture material under the skin. With the size of Ruby’s incision, there are not only sutures on top of the skin, but there are tons of sutures under the skin holding it all together. And so the body is trying to mop up the wound but can’t really get rid of the sutures. So the body oozes as a method of sponging out the material. That doesn’t really work either, but the fluid probably does weaken the area and sutures to some extent. Anyways, with time those sutures will finally dissolve and Ruby will be as good as new!