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Challenging Cases: Zippity's Story

Posted June 11, 2013 in A Vet's Life

Dr. Phil Zeltzman is a mobile, board-certified surgeon in Allentown, PA. Find him online at www.DrPhilZeltzman.com. He is the co-author of “Walk a Hound, Lose a Pound” (www.WalkaHound.com).

Kelly Serfas, a Certified Veterinary Technician in Bethlehem, PA, contributed to this article.

One afternoon, I received a frantic call from a colleague, requesting my immediate help for one of her patients.  Zippity, a 3 year old Bichon, had been having increased difficulty breathing over the past few months.  Today however, Zippity could hardly breathe.

She was gasping for air despite being kept in an “oxygen cage.” This is a special cage enriched in oxygen we use for patients who are suffocating.  Whereas room air contains 21% oxygen, an oxygen cage provides about 50% oxygen. That still wasn’t enough to help.

An X-ray of the neck revealed a large mass located in the larynx or voice box.  The suspicion was that the mass blocked most of the airway. Emergency surgery was likely her only hope.  
Zippity's owners agonized over what to do. As soon as they decided to proceed with surgery, I rushed to the clinic and we got to work.

There were a few challenges here, which I discussed with the owners. The first one was anesthesia, which requires placing a tube into Zippity’s trachea or wind-pipe. Normally, this is not a difficult procedure, but it turned out that the mass filled about 75% of the larynx. Inserting the tube took not one, but three doctors to accomplish.

The second challenge was the surgery itself.  The agreement with the owner is that we wouldn’t try anything heroic, such as removing the larynx. We would remove as much of the mass as we could, while preserving the nearby fragile structures such as the windpipe, the esophagus, the jugular vein, carotid artery and important nerves.

The golden rule of cancer surgery (we had to assume cancer in this case) is to remove 1 or 2 inches of healthy tissue in every direction: above the tumor, beneath it, to the left and to the right. Clearly, it was impossible in the vicinity of the larynx if we were to save it. When we can’t remove a tumor entirely, we call it “debulking,” i.e. we remove the bulk of the mass.

So we carefully debulked the mass. It did in fact block most of the larynx. When we got done with

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Dr. Phil Zeltzman is a board-certified veterinary surgeon and author. His traveling practice takes him all over Eastern Pennsylvania and Western New Jersey. You can visit his website at www.DrPhilZeltzman.com, and follow him at www.facebook.com/DrZeltzman.

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