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Life and Death Decisions Part IV: Caramel's Story

Posted May 01, 2013 in A Vet's Life

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

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

Caramel, a 13-year old Chihuahua, has had a very unusual story.

In 2008, she started to have sneezing fits. She eventually could only breathe with her mouth open.  Then a mass appeared near her left eye. She then had a nasal discharge. She had surgery at her family vet. The biopsy didn’t show much.

In 2009, the mass came back. Her vet did surgery again. This time the biopsy showed… brain tissue!

In 2010, the mass came back.  Caramel was referred to a specialty hospital to meet with a surgeon. A CT scan was recommended before surgery.  The results were consistent with a cancerous tumor.  Caramel had surgery, but again, the biopsy didn’t show much.

In 2011, the mass came back.  Her vet performed surgery again.  The biopsy didn’t show much.

In 2012, the mass came back.  That’s when I met Caramel… and her owner, a dry, demanding and “rough around the edges” lady in her early 70s.  Let’s call her Janet.

The poor lady (and her poor dog) certainly had been through a lot.  She had developed a profound distrust for vets in general and surgeons in particular. She was “sick and tired of getting the run around.”   She wanted answers.

So it is in that wonderful frame of mind that she came to my surgery consultation…

What would you do in my position? Could I ethically recommend a fifth surgery on Caramel?  She was breathing through her mouth – again. The slightest activity would lead to panting and sneezing fits – again.  She had a large mass near her left eye – again.  By now it was pushing her left eye forward, which caused a lot of pain.  And all I had to offer was surgery – again. Should I?  Would I?  What good would that do? Provide another “negative” biopsy?  I had no desire to be the subject this lady’s wrath.

But my job was more to focus on Caramel’s well-being than to worry about being yelled at by Janet. So we had a long heart-to-heart.  As a surgeon, all I could offer is another surgery to remove the mass… as long as

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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, and follow him at

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