I don't know about the rest of you, but I actually pause when someone asks me about my profession. Each and every time I'll wage a cerebral war with myself on the pros/cons of telling this complete stranger about what I do, because 75% of the time the next words will be, "So I have this dog...".

Wednesday, December 22, 2010

Rhinotillexomania (seriously, it's a word)

I've unfortunately diagnosed Mast Cell Tumors (MCTs) on dogs many many times, and the conversation that follows is NEVER a fun one.

(now stick with me on this one, I really will make the connection from MCTs to nose-picking)

You see, a MCT is considered a type of cancer and HAS to be surgically excised (at least in the opinion of most family-practice vets and veterinary dermatologists). Sure there are three different grades of MCTs, and many return as Grade 1s which are generally considered to be surgically cured when the margins are clean. But regardless, they're still considered a type of cancer that needs to be excised, and the discussion is usually very somber and serious.

For context, I'll explain that if the results of the pathology reveal the tumor to be a Grade 3, then it's expected to be very aggressive and most likely will return soon after surgery and metastasize. Really bad. Grade 2 is the "go-to" diagnosis for most pathologists these days (at least in my opinion). It's like the Goldilocks of MCTs, not too cold, not too hot, but just right. (...hmm, that analogy sounded better in my head...). Seriously, the pathologist was probably too scared for whatever reason to give the dog a clean bill of health with a Grade 1, but the cells didn't look nasty or dirty enough to be called a Grade 3. Thankfully though, somewhere in the range of 75% or so of Grade 2s end up being cancer free after 2 years (hey, I've got to admit that it's late and I'm too lazy to look up the EXACT numbers, but that's pretty close. So please don't pull out the studies and yell at me if it's closer to 23 months or something similar).

Then I have to explain the diagnostics we do prior to surgery such as bloodwork, a buffy coat analysis, thoracic radiographs, etc, and why we need to do them. Oh, and I also like to explain to the owners that sometimes the surgery isn't a complete success depending on the location and size of the mass, and what to expect in those situations. And man that post-op conversation really sucks! Regardless if the report shows a Grade 1 or worse, no one likes to tell the owner over the phone that the margins were dirty (meaning there are cancer cells extending to the edges of the sample) and a second surgery is needed.

Crap, I'm out of breath just typing this, and I've probably 5 minutes from diagnosis to my next appointment to explain all of this (AND give a surgery estimate).

Sooooo, imagine trying to have this conversation with an owner that doesn't stop picking his nose. Really. And I'm not talking about the casual but repetitive "nose-rub" that you might do when you think someone is watching, but "damnit there's just something up there!" Or the super fast "hit-and-run", the kind that's most likely seen in line at a store - you think you saw them pick their schnoz, but the finger was in and out so fast that you unfortunately blinked.

No, this was literally a "deep sea fishing" expedition. The finger just kept going! And when that failed, he turned to a kleenex that was rolled by his fingers at one end into this deadly spiked dagger-looking contraption that he persistently jabbed into his nostril and twisted it about. And yes, it really was that painful to watch.

Oddly though, I couldn't turn away either! It was just so weird that someone could possibly have such little social ineptness. But admittedly, I felt this need to keep score or something.

Thankfully, the fishing trip must have been a success because we were able to finish the discussion when I returned to the room after giving him some privacy (that wasn't asked for, mind you). And equally (or more so) thankfully, he didn't have his catch on display like some prized Swordfish.

You can be sure that it wasn't a coincidence that my hands were full when he tried to shake my hand as he left the room.

1 comment:

  1. Oh my...

    I just don't know what to say. It would be rude to laugh, given the nature of the circumstances but... Oh my.