Dec 29, 2017
by Dr. Michael Trapani
“It Don’t Matter To Me” is an awesome song by Bread, but other than these five words, has absolutely nothing to do with this story. That is completely fitting.
This is the story of Eva. Eva is a 14 year old lady Pit Bull and one of the sweetest little dogs you could ever meet. And Eva is sick.
She isn’t only merely sick. She’s really most sincerely sick - with a 104.5º fever and a big lump under her shoulder blade that looks like a cancer. The lump was first seen about a year ago, but went away. Now it’s back and Eva has been in a hospital for three days with a 104.5º fever. And the people taking care of her think she has “paraneoplastic syndrome” caused by the death of cells within her tumor.
Oh. And she’s old and really, really sick. And did I mention that she’s had a 104.5º fever? For three days? And no one wants to do anything invasive, like remove the tumor, because, well, she’s old and really, really sick. But Eva is just a poor little old lady dog and the fever is killing her. A little old lady can only take so much. What to do?
We looked her over. The old girl is surprisingly tough and has been receiving the best of care, even though it’s clear that she’s about at the end of her rope. The lump is six inches across and situated beneath the heavy muscles of her left shoulder. This is a lump with poor edges, like a malignancy. When we looked at it with ultrasound, we could see that the lump’s interior was a gooey mess, as we might find with a necrotic tumor.
It’s time to look more deeply, so we introduce a fine needle into the mass and obtain some cells for examination. Under the microscope, all we find are pus cells, and nothing that can be identified as a cancer cell. We look for bacteria, but find only a few “maybes.” What’s clear is that the center of the lump is a liquified mess of dead and dying tissue - just the sort of thing that causes a persistent high fever. What to do?
Let’s consider Eva’s dilemma: She’s old and really, really sick, but is doing OK for now. She probably has a cancer, and it’s too deep and too extensive to remove. BUT, the tumor isn’t Eva’s real problem, is it?. Her real problem is the fever, which is killing her, and the fever is being caused by all the dead crud Eva is absorbing from inside her tumor. Eva’s tumor is behaving just like an abscess. If we can drain the fluid, we might eliminate the cause of Eva’s fever, and she might be just as good as old.
But she’ll still have cancer, won’t she?
It Don’t Matter To Me (you knew I’d get back to that). And It Don’t Matter To Eva. Before the fever developed, Eva was a pretty happy old lady dog, cancer or no. Taking Eva to surgery is a risk, sure, but when you’re actively dying, you have a different view of the term “risk.” Besides, if Eva’s tough enough to get through three days with a 104.5º fever, she can handle a brief anesthetic. It Don’t Matter To Me whether the toxic fluid inside Eva’s mass is caused by cancer or any other process. That fluid needs to be out of her body. Everything else is a detail.
Under anesthesia, Eva is fine. We clip and scrub her skin, and Lo! There is a suspicious scar found at the point of her shoulder, right at the lowest edge of her tumor. A small incision is made right through the scar (when the patient provides a road map, it’s wise to follow it). We separated the muscle fibers before popping through into the tumor cavity.
And… SPLOOSH! Out comes a cup of stinky fluid. It’s pus, of course, and there’s a ton of it under there. Once emptied, the hollow cavity has a smooth lining. It’s clear that there is no neoplastic process taking place: Eva is suffering from a plain old garden variety infection, which just happens to be very deep. We place a drain and flush the cavity with antibiotic, then wake her up. Total surgery time: 20 minutes.
The term “tumor” in it’s most archaic usage, means “lump.” Although we have come to define the word as “malignancy,” not all tumors are malignant and some are not neoplastic at all. In Eva’s case, her tumor was the result of a non-cancerous process. We think the scar on her shoulder was a puncture wound that led to an infection deep beneath her shoulder muscles. It looked just like a malignancy, but her real problem was the dead tissue material inside the tumor, which caused a life-threatening fever. That fluid had to be removed and It Don’t Matter to Me - or to Eva - how it got there.
Eva’s fever disappeared before she woke up. She went home that evening. She’s still old, but now miraculously cancer free! Her infection resolved with antibiotic treatment, and she’s back to her little old lady self.Happy New Year!
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