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18. Is This Lump a Problem? · Senior Pet Talk | for dogs + cats

• Amanda Steffen: You are listening to Senior Pet Talk, the show where we combine Western and Chinese medicine to give senior dog and cat parents the knowledge, the clarity, and the confidence to make sure that your pets' senior years are their best years yet. I'm Dr. Amanda Stefan. Let's get started. Welcome back, pet parrot, to another episode of Senior Pet Talk. Today I want to talk to you about skin masses or lumps and bumps that you find on your dog and cat. I really want to get down into the nitty gritty of what we're looking for when we look at these, how you would know whether it needs to be tested or not, how to monitor this at home, and how to bring that information to your vet visits, okay? This is extremely important. I feel like there's a very large percentage of senior dogs that especially that get some skin tags here and there. And a lot of times they can be benign or not cancerous, but there is a statistic that says that about 20 to 40% of skin masses that are sent in are actually cancerous. So it is very important for us to make sure we're differentiating those things. Okay. To start off, if you are new here, welcome. I am Dr. Amanda Stefan. I run an in-home integrative senior dog and cat facility in the Cincinnati area. And I am now here online to talk to you and give you that knowledge that I like to give my clients in person. And if you have not already, I would love if you would be able to subscribe and comment and do all those wonderful. Clicky things for me so that I can get more people in to see these episodes and helps me from having to run any sort of like ads from other companies and keep it just focused on you and your senior pet. Okay. If you are tuning in from a watchable platform, I do have my sweet senior dog Mabel here with me today. So she may or may not have some snoring that happens. And I hope you enjoy it. Okay. So When we are talking about finding a mass on our pets, it always scares people when we say tumor or mass or all of those words are going to be a little scary. But tumor does not mean cancerous. Mass does not mean cancerous. It could be just like a skin tag or a wart or a lipoma, which is like a fatty mass or something like that. So it doesn't always mean it's something scary. It just is like the wording that we use with it. Okay. So please keep that in mind and don't freak out too much when your doctor uses that word. I want to go through a couple different criteria with you on the things that we look for so that you can do a little bit of looking for these things at home and be able to keep an eye on these things. If you do not already have my age and gracefully checklist, that is a really good thing to have for this. If you go to my website, senior petconnection.com and you go to the Freebies tab, you just enter your email address there and I send you this six-page checklist. And it seems more daunting than it is. There's a lot of pictures in there. So I promise it's not super scary. But one of the pictures that it has is a dog and then a cat. And it has a couple of different angles. So you can go on there and mark where you see a lumber bump on your pet. And you can put some notes down there about like how how big is it. What does it look like? What does it feel like? Those types of things that we're going cover today. And that will really help your vet when you do go in to be able to differentiate, well, is it growing? Is it changing? You know, what do we need to do about this? Right. So I will link that again below. But if you don't already, please go get that. It'll be a nice thing to have at home and follow along with. So by the end of this episode, I want you to have a really good system on how to check these lumps and bumps and then how to discuss them. Okay. Someone I have had the privilege of getting to know and meeting is Dr. Sue Ettinger. She is one of, I think, 400 ish veterinary oncologists in the US. She is a wonderful human and she's a fantastic oncologist. So she has a lot of information on this, and she talks about how almost every pet parent has been told at some point by their veterinarian. to just keep an eye on something. And that may not exactly be the right answer going forward. So if that is something you've been told before, it is not that your veterinarian was wrong in any way. It's just that sometimes we need to say, okay, well it hasn't gone away and it's gotten a little bigger and all these things have changed. And like I really want to check this, right? I want to really want test it and see what's going on. So why this like wait and watch can backfire sometimes, it can go into a couple of different reasons here. Cancerous tumors, so something that could spread to other places or could get larger in the area that it's in and spread cancer cells other places is going to need wide surgical margins. And that basically means that when we take that skin tumor off, we are going to need to go pretty far around to, you know, you see the bump. But we're gonna need to go a few inches around that bump to actually make sure that we're not getting any cancerous cells in that in the middle area. We can't just touch up to the bump because a lot of times these masses, if they're cancerous, basically have these little like finger projections of cancer cells that are microscopic and we can't see and they're spreading under the skin to these farther away areas. That's how it continues to grow. That's kind of the first stages of it growing. So it's important for us to make sure that we get really far around this mass when we do take it off to make sure that we're getting all the potential cancer cells. The bigger that tumor gets, the wider the margins are going to be. And potentially the harder this is gonna be to take off, right? Especially if we're talking about an extremity like the tail or a foot or something like that. There's not a lot of extra skin in that area, right? So when we're thinking about, How are we going to take off all of the cancer and still be able to close this area back together without potentially tourniqueting the leg and cutting off circulation or, you know, having it open back up because there's too much tension on it? That can get really difficult and can mean that sometimes we need multiple surgeries. Sometimes we're doing bandages over like an open wound and having to change those a couple of times a week. It just gets a lot more in-depth physically and financially, a lot of times. So the smaller it is, the easier it's going to be to take off and the better everything's going to be, right? There's also a health center that I will reference here. It's called Cornell's Rhiney Canine Health Center. And they basically say that tumors that have been monitored for too long can grow to a size that requires a far more invasive surgery. And in areas with less surrounding tissue, the cells are going to get left behind. And that's gonna again lead to those like projections and this potential regrowth. And then the other side of that too is a second larger surgery and longer surgery because we've already taken some skin from that area and made that skin more taut and made it more difficult. So now what if we have to go back and do a second surgery and get even wider margins? Then we're gonna have even more problems being able to close that back up, right? All right. So This is why we don't always wait and see. This is why a lot of times when they're smaller, I preferred let's just take them off if we can, while they're small and they're easy to take off and your pet is younger and it's gonna be easier the younger that they are, even if they're still a senior, it's still going to be better to do it now than it would be to do it later. All right. As far as integrative medicine goes in this, essentially the integrative medicine component for me, everyone's gonna be a little bit different. Some people treat purely Chinese, I treat integrative. So I wanna do the surgery, take it off. I wanna find out what it is. And then I from there, we're gonna talk about is there a mushroom complex we can add on to this? Is there an herb that we can add on to this? Is there a certain regimen that's gonna help us from this coming back or to help regulate whatever's going on in the body that caused this cancer to show up in the first place? You know, what can we do from here from an integrated perspective? Other vets may choose other methods and they are not wrong or right. It is just what I choose to do, and that's what you're gonna learn here. So back to Dr. Sue Edinger. She has this thing called the rule of ones. And this basically says that if a lump is one centimeter or larger, which is essentially the size of a P or like the eraser on a pencil, or it has been present for one month or longer, then it should be tested. Not watched, truly tested. Okay. The Cornell's Rhiney Canine Health Center also has some red flags, and these are all kind of independent of each other. They don't go together. But any one of these would mean, you know, call your bet as opposed to waiting and see. If the size of it is a P or larger, if it's been present for one month or longer, if it is growing or changing in appearance, or if it's like irritating your pet. So if they're like licking, scratching, chewing at it, those types of things, or if we notice any like redness, any bleeding, any oozing, any ulceration, or a foul odor associated with it, right? Again, 20 to 40% of skin tumors that are sent in are cancerous tumors. So it is very important to get these guys checked and to get ahead of the game. The other thing with potential cancerous tumors is they can spread to other parts of the body. So we can have a mast cell tumor that happens on the skin. And that can my dog here, Mabel, she's had two. If we take them off quickly, then we don't usually have any spread to other parts of the body. However, if we wait too long, that mast cell tumor can actually spread to the inside of her body and to her organs internally and things like that, potentially to her lungs, different lymph nodes, those types of things. So the faster we get that taken off, the quicker we stop that potential spread of cancer cells to those other organs. For cats, the rules, there's a three, two, one rule that we like to use for cats. Okay. So if there's a bump that is showing up, cats do have a risk for something called an injection site sarcoma. That doesn't always have to be from a vaccine. I have seen it happen from a microchip insertion. I've seen it happen from You know, some other sub Q injection that they get. Cats are just very funny. And sometimes their body says, I hate that. I'm going to wall it off and create a cancer. They're just a little funny that way. So it is important to specifically with cats. I don't see a lot of masses that happen that are not something I want to check for a cat. So typically I'm going to want to check most of those guys that happen. They don't get as many of the like fatty masses and things like that as our dogs do. So Our three two run one rule says that we want to biopsy it, which I will explain in a little bit later, if the lump has been present for more than three months, if it is larger than two centimeters, so two pencil erasers or two B's, or is still growing one month after it was first noticed. That's our three, two, one rule. This is going to exist because feline injection side sarcomas, those guys have a lot of those little finger projections I was talking about. They are really bad about it. They're very aggressive. They're usually adhered to the underlying skin. They're going to be hard to get out. And again, our cats are smaller. They're going to have less surface area for us to close up things. They can also spread to other parts of the body pretty aggressively. So we want to make sure that we are getting on top of that as quickly as possible. If you notice a bump on your cat, I would recommend getting them seen and keeping a close eye on that. So note what day it is. Take a picture of it, you know, get some information about it, say what it looks like, all those types of things. And then in a month, if you do get to your vet or don't, in a month, if you notice that it has changed, then you definitely need to get into your vet clinic and get that evaluated, probably get it sampled and potentially get it taken off, right? With cats, you know, they can get a little bit more stressed easily with us doing samples and things like that. So I always recommend having some like feel-away spray or pheromone spray that you spray in their carrier and on their stuff, as long as they don't have an allergen to it, and potentially asking your veterinarian about like a a medication that they could have before coming in to help with calming and sedation. So with Mabel, she had a mask that popped up one day. And I was one month after having my daughter. So I was still very much postpartum and dealing with all those things of waking up all throughout the middle of night. And she had this little bump that popped up and it almost looks like a bug bite. Right. And I was like, huh. She's got boxer in her, she's got Pipple in her, she's got Mastiff in her. She has a lot of breeds that are predisposed to mast cell tumors. So I quickly watched this for about a week. And I actually noticed that it would get smaller and then would actually come back and be a lot bigger. She didn't have any other clinical signs or anything like that, but I know with my education that mast cell tumors tend to do this thing with a histamine release where they'll come and then they'll get really big and angry and then they can ulcerate and then they can actually get smaller and then they can kind of cycle. So it could look like a simple bug bite, a little red bump, but it actually can get pretty substantial pretty quickly. So I was able to get her in within about two weeks of noticing it. We did test it, and then we found out it was a mast cell tumor. And then we took it off within a couple of days. She did great. She's, like I said, had two now and has no signs of spread anywhere to her body because we got it taken care of very aggressively and very quickly, right? So how do we do that? All right. I want to make things as easy as possible for you. And I want you to understand what's gonna happen when you go in for that bed visit. Because The most scary part is gonna be when you don't know what's going on, right? I notice this bump and I'm gonna go in and ⁓ my gosh, are they gonna recommend that they sedate my pet or like are they gonna have to get surgery today? And like, what what's gonna happen? And you get really nervous. And that's valid. When my pets go under anesthesia or go get sedated, I still get stressed out too. And I I'm often the one doing it. So I get it. But I want to give you some information so that hopefully it's a little bit easier and less stressful. Okay. There's a couple steps that we take when we see a new mess. Sometimes your vet may think, ⁓ well, maybe it has a ⁓ abscess or maybe it's something that's not cancerous at all. Okay. Cool thing about most of these guys is there's a very easy test we can do, often in-house and look at the sample and be able to determine if it is something that we need to. send out to be evaluated by a specialist, or if we need to do something more in depth. So that first test is a fine needle aspirate or an FNA. So an FNA basically means taking a small needle like we would give an injection with, and we're going to poke it into that mass. And then we're going to either pull back on the plunger on the needle or we're going to kind of stab that little needle around in that mass. Typically, this is not a painful process for these guys. They don't actually feel anything inside of that mask. There's not usually like nerves and things inside of it. So it doesn't usually cause any pain. There may be some bleeding that happens if we make it angry or we hit a skin bleed or something like that, a skin vessel, but nothing crazy. Okay. So this is a procedure we typically do awake. If it's somewhere on the face, sometimes we need to do a little bit of light sedation so that we do not get worried about poking them anywhere scary. But it just depends. Sometimes I've done it where I don't need to do that for patients that are, you know, fairly well behaved or easily distracted by treats and things like that. So is this usually relatively inexpensive? Typically, same day results. If there are some scary cells when they look at it, sometimes they do recommend sending it out to a pathologist. Okay. So We are going to take the little stuff that we get under that skin sample. So basically we're gonna take the needle, we're gonna poke around in there, and what we're trying to get in the inside that needle hub are cells. So we're looking at the microscopic version of these little cells that are inside of this bump. And we're seeing, do they look like they're rapidly growing like cancer cells? Do they look more like fat cells? You know, there's different types of cells. There's round cells, there's fat cells, there's, you know, all these different versions of sarcoma type cells and all these different things that we're looking for when we're checking cells under a microscope. It's actually really beautiful a lot of times to see certain masses. If they've if you stain them, they stain these beautiful colors. So not that it's a it's a good thing in any way, but if you're interested in what it looks like when we look under a microscope, you can always go to microscopic mass images. And a lot of times you will see these pretty like shades of purple and blue and pink. And you can kind of see these different little like round bits that are in there. And those are different cells. They're actually very beautiful sometimes. Not always things that we enjoy. However, so that is going to be usually a very easy way for us to get somewhat of an answer. However, We do have to think about the fact that I am taking a tiny very tiny needle and I'm trying to get some cells in the hub of that needle. If I don't get a lot of cells, if those cells kind of break when I poke it, and then when I put them on the slide, they don't what we call exfoliate or show up very well, then we may not get a definitive answer there. So I usually tell people I get an answer on a skin FNA forty to sixty percent of the time. I can usually get an answer of whether like, at least is it scary and we need to take it off, or is it benign and not scary? So it's not foolproof, but it is usually the cheapest, easiest answer for us to get a first step. If that doesn't work, then oftentimes the next step is a biopsy. Even if that does work, sometimes depending on the concern for the type of cancer, we recommend a biopsy to grade that cancer first before we take it off. It just depends. So a biopsy is taking like a big round punch hole thing. And basically it goes in and it is like a a spoon with more razors on it. That sounds scary, but basically we're taking like a little chunk of tissue, very minimal. It's going to be smaller than the end of an eraser head, probably low at half that size. And we're going to basically get a little scoop of that tissue. We're going to put it inside of a tube. And then we're going to send that out to a lab to have them evaluate it. And they're going to be able to look at those cells a little bit more in depth and tell us whether those cells are something to be of concern or not. A biopsy is going to be better than an FNA because we're getting a bigger chunk of tissue, right? We're getting an actual like chunk of tissue to evaluate. They can get better samples out of that. They can do a couple different ways that they check it. So that is typically sent out to a pathologist to be graded, evaluated, those types of things. And again, we like to do an FNA and a biopsy and or first because it's important for us to know what type of tumor this is and is it cancerous or not. If we jump straight into taking it off, then sometimes we may take bigger margins than we need to because it wasn't a cancerous tumor. Or sometimes we're not going to take a big enough margin and then we're going to send it off and then we're going to realize that the cancer spreads all the way to the edge of where we took it off at. And now we have to go back in and do a second surgery. And nobody wants to do that. Right. So it is rather important. And I much prefer to be able to do that stepwise approach where we actually go in and take a sample of it first and then we try and take it off, depending on what that shows us. Right. So From a TCM perspective, I know there are a lot of people who may say that certain things in TCM like mushroom complex can like shrink lipomas and things like that. I have not experienced that. I have had clients who have tried that. I have not experienced that. I had one doctor who's holistic doctor who told me that happened that it did shrink her dog's masses. However, she discontinued it and they came back. So I don't know that that's really helpful. So just keep that in mind. There are some studies showing that mushroom complex and certain herbs and certain different remedies and integrated medicine can help with like mast cell tumor, histamine release and those types of things, but typically not going to make it go away, just going to kind of help to support that from getting bigger and changing and then potentially coming back if we take it off, right? So just remember that Little needle aspirate is not usually painful. Sometimes for a biopsy, we will put a little bit of a topical anesthetic around the area because it is a bigger chunk of tissue that we're taking out. And we do have the skin that's overlying this tumor, a lot of times can be sensitive. So, you know, depending on what's going on will depend on what they recommend. And sometimes with a biopsy, we do have to put like one little stitch or suture in that area to close it back up afterwards. Okay. All right. So when we're looking at the mass itself, these are things that you can do at home, but this is something your that your vet will do when you go in. One thing that we're going to be looking at is the growth rate. So is it growing very rapidly in days to weeks? Is it sitting unchanged for a period of time, or is it having these like basal tumors where it has these waxing and waning things where it will like ulcerate, get really big, and then it like shrinks and almost looks like it's gone, and then does that again. That is to me a red flag that this could be a mast cell tumor, which is a very scary type of tumor. Just a caveat. I know I kind of touched on this, but mast cell tumors are more common in like boxers, potentially labradors, pipples, mastiffs, a lot of those types of breeds. So if you have a breed that is more prone to mast cells, make sure you are definitely keep an eye on it. Anything that looks like a bug bite, right? The second thing, so girth rate is one, firmness is the second. So if we are seeing something that is like hard or it's ulcerating or it's got some redness to it, if it's very firm when you feel it, that is a little bit more scary to me. If it's really soft and squishy, sometimes that can indicate more of like a lipoma. But I will tell you right now. No one should ever say, I know what this tumor is based on looking at it. I don't even think oncologists can do that. They can guess, but they don't always know. And they still get tricked sometimes. So you can't look at something and say, this is a lipoma, this is a mastal tumor, whatever. I can say it, it seems like it's gonna be, but I've also been tricked. So you never know. Cancer is kind of the great pretender sometimes, especially like mast cell tumors. So they can look like a lot of things and then, you know, trick us. Okay. Have you ever left the vet with more questions than answers? And then you drive home and you go straight on to Google. Yeah, I hear that a lot. And honestly, is exactly why I created my senior pet virtual consultations. Imagine we have 45 minutes where we go through everything, your pet's full history, their specific challenges, their daily life, no rushing. We're gonna cover nutrition, integrative options, whole modifications, and quality of life. And I send you a personalized plan after so that nothing slips through the cracks here. But don't just take my word for it. Chelsea called it a senior pup therapy session and said she felt so much better afterwards. Adiba got recommendations her own vet had never thought to suggest, and Denise said that the consult was incredibly informative and helpful, giving her many options to help her dog Loki feel better. This is the conversation that your senior pet deserves. And honestly, The one you deserve too. The link is in the description. I'd love to help you. The third thing is fixed or not, is it adhered to underlying tissue. So a if you can kind of grab it and get your fingers kind of under the area and kind of move it around a little bit, that is a less scary indication than if it feels like it's stuck to the muscle or the bone underneath that area. If it feels very adhered to the underlying tissue, then I would be even more apt to say it needs to get. Checked out sooner rather than later. The fourth thing is ulceration and size. So if you're finding that there's ulceration, which means like opening, redness, oozing, that type of stuff, this can often be five times higher odds that it has metastasis if this is something like a mast cell tumor. And mast cells that are larger than three centimeters were also associated with some more shorter survival times, right? So when we're having these like ulcerated areas, these red oozing open areas, first of all, it's just uncomfortable for our pets, usually. They usually don't like it. They're chewing at it, they're making things worse. And secondly, it can be a sign of a more malignant or cancerous type of tumor. All right. So this is why we should always do a skin check. We should always keep up with lumps and bumps, keep up with their changes, those types of things. I would love if that's always had like a chart. And oncologists usually do, but I will say general practitioners don't always have or take the time for that. So it's not always done on every patient. So if possible, that's something you can do at home. I have faith in you and I you can do it. And then you can take that to your vet and it makes it so much easier for them to be able to look through these things and then get you a plan together. And hopefully maybe save you some money that way. Okay. If you're watching this live. You may notice that my Frenchie is over here laying on top of my pity. He's kind of laying on the back of the actual dog bed. I know this may be like, ⁓ we're concerned about her. And, you know, is she comfortable? Is she okay? She's perfectly comfortable, I promise you. Interestingly enough, they have slept like this. I brought my Frenchie home at three days old because he had a cleft palate and we tube fed him. And he's been with my pit bull since that time frame. And they have just been the best of friends. And he has always done this thing where he just lays like actually on top of her back. And if she didn't want him there, I promise she could get him off. But it's also really precious to see what happens. So there's that. All right. From an integrated perspective, again, as we get these things taken care of, then we can look into herbs and supplements and other things like that. I treat a dog named Sammy. Sammy is a almost 15-year-old golden retriever. She's amazing. She has bladder cancer and she has a some tumors on her liver. And she was diagnosed with those, ⁓ probably like nine months ago now. It's been a minute. And when she was diagnosed, her parents said, Well, she's doing okay. They were incidental findings. They just happened to do an ultrasound and found them. And they said, We really don't want to do chemo or anything like that with her or any like surgeries. We're just gonna kinda keep her comfortable. So I said, Well, let's do some herbs. And we started around some herbs. And I will tell you that her Western oncologist is amazed at the slow growth of these masses. At the first checkup at three months, they had actually gotten smaller. And at the six month mark, they had gotten a little bit bigger, but definitely not what she had anticipated. So the power of herbs and Chinese medicine can be pretty amazing. Just something to keep in mind. Okay. Sometimes we cannot do surgery, whether that's like late kidney disease, late heart disease, you know, there's every patient's gonna be different on how we approach these situations. So it is gonna be a conversation that you have to have with your vet. And if that is the case, then I do recommend going to a Chinese practitioner and seeing are there other things we can do to lengthen time and comfort that are not invasive, right? Ozone therapy is another thing that's very interesting now. There's like low dose now traxone, which is an option. There's a lot of different modalities, mistletoe that can be used from an integrative Chinese perspective to help with these things, right? Okay. So the rules of one. If it's one centimeter or bigger or present for one month or longer, it should be tested. Cats 321 rule. FA. And then we go to a biopsy and then potentially surgery, depending on how it's going. Watching for things like rapid growth, firmness, fixation to underlying skin, ulceration, or like this on and off type of signs. And then doing a monthly at-home lump check. Make sure that you get my aging gracefully checklist and You can use that as a beautiful little map and you can put sizes, you can color code it, you can do whatever you want to it. Your vet will be amazed when you bring that little piece of paper in because it's the same chart that they use in the hospital. So you'll seem extra smart, a plus student, and that's what you are if you are in my world. Okay. You are all amazing. You are doing such a good job with your senior pet. I just want you to know. How wonderful of a job that you're doing. And I know this is very hard. And I know all of this is always on. You're always doing something. But I just want you to know that you're doing a good job and they love you and they're happy to have you. And I know you're happy for any moments that you get with them. So give your senior pet a cuddle for me. Have a beautiful day or night, whatever it is for you. And please don't forget to subscribe and rate the podcast if you love it. And tell me what you want to hear next. Thank you. Have a good day. That's it for today. If this episode helped you, please leave a review or rate this podcast so we can get the word out to more pet parents who need to hear that they are doing a good job. And if you're interested in working more with me, you can find me on social media or at senior petconnection.com because we all need to stay connected. Remember that you are doing a great job with the information that you have in this moment. And I am just here to give you more of it. See you next week.