Erik’s Story – Soft Tissue Sarcoma

Erik is an 11-year-old Chihuahua Jack Russell Terrier cross, whose mum Inge works as a veterinary nurse at Fitzpatrick Referrals Oncology and Soft Tissue hospital in Guildford.

Earlier this year, she found a lump on Erik’s chest and has kindly shared his story from diagnosis to recovery, giving an interesting and very personal insight into the care he received from a veterinary nursing perspective.

Name: Inge

Job title: Senior Nurse Clinician

I’ve worked at Fitzpatrick Referrals Oncology and Soft Tissue hospital since 2015 and was lucky to be one of the first nurses employed who wasn’t already working for Fitzpatrick Referrals.

At the moment I work closely with Specialist Surgeon Professor Nick Bacon and ensure that his patients and their families are looked after, whether that means scheduling surgery, communicating regarding medications or advice, or performing anaesthesia on surgical cases. My job is to make sure the patient gets everything they need when they are with us in hospital, and that if needed we are on hand once they go home too.

It’s really rewarding, and means I get to think about the patient’s care as a whole, not just the surgery, but every part of their stay with us, including the best part…home time! I love building a relationship with owners and rarely forget one of ‘our’ patients once they’ve been in with us.

About Erik

Soft tissue sarcoma patient in wards wearing a soft cone

Erik came to me as a rescue five years ago when I worked in a practice in Ireland; he belonged to an elderly lady who sadly could not take him to the care home she moved to. He was a scared little soul, but somehow we took to each other straight away. He is quite a stubborn boy and definitely lets me know what he does or doesn’t like. He is also extremely clever, when I got him he wouldn’t even sit, but he now knows many tricks and recognises words such as ‘treat’, ‘chicken’ and ‘cheese’! He is a little suspicious of new people but extremely loyal once he gets to know you.

 

Finding a suspicious lump

30th May 2019

I got up that morning, and Erik, as normal for him, rolled over for a tummy rub. I immediately noticed something new, a small pea-sized lump on the right-hand side just under his leg. I couldn’t see anything, but I knew the lump hadn’t been there before, as I check him regularly for anything new or strange. I felt a sinking feeling in the pit of my stomach, I spend my life seeing lumps and bumps on other pets, and I knew how important it was to figure out what we were dealing with.

Although I was worried, I repeated to myself what we often tell clients; ‘when we know what we’re dealing with, we can make a plan to deal with it’. Erik, of course, had no idea what was going on, he was bright as ever and was just happy he was coming on an unscheduled walk with me, albeit to work! Luckily pets live very much in the present, they don’t worry as much as their owners do!

I contacted Erik’s vet, who was happy to refer Erik to have his lump investigated and treated at Fitzpatrick Referrals Oncology and Soft Tissue. The reason we need a referral from the patient’s own vet is so that we have any relevant clinical history, as well as making sure the referring vet is kept up to date so they can help once the patient goes home. It’s a team effort.

Veterinary nurse holding patient after coming round from surgery

Senior Nurse Clinician Inge with her dog Erik.

One of our oncologists braved a very nervous Erik and took some fine needle samples from the mass with a syringe and small needle. This involved Erik wearing a small muzzle and getting lots of reassurance from me, but actually the procedure didn’t hurt him at all, it was just the indignity of being at the vets that he resented! The tiny needle was inserted into the lump to take some samples of the cells to look at under the microscope.

Depending on the type of mass, sometimes these samples need to go to the lab for analysis, and sometimes the vet can tell what they are in-house straightaway. It’s important to get a diagnosis however, as it’s impossible to tell what lumps are without getting them properly tested.

The cells found on Erik’s samples were suggestive of a type of cancer called sarcoma, and probably low grade, so we decided to remove it the next day and then to plan any further staging if needed once we knew definitely what grade the mass was. The grade tells us how aggressive the tumour is, how it might behave in the future, and this then determines what further treatment we might give. Sometimes this involves chemotherapy or what we call further ‘staging’, which is usually a CT scan, x-ray or ultrasound to check whether the cancer has spread to internal organs. Again this depends on the tumour type, as different tumours behave differently.

Preparing Erik for surgery

31st May 2019

I brought Erik in to work on the morning of surgery, having fed him his dinner but no food after midnight, to prevent regurgitation under anaesthesia, which can add to surgery risks. He was allowed water, although he was not impressed that there was no breakfast available!

In hospital, we placed an IV catheter (I held him because I didn’t want my colleagues getting bitten by a scared Chihuahua) and we took some bloods to check his organ function, for example, his liver, kidneys and blood glucose. This is again to reduce anaesthetic risk, but also because he’s an older boy!

Canine patient in prep with his IV catheter fitted

Erik in prep with his IV catheter fitted.

My colleague listened to his heart and gave him the all-clear, and we checked his lungs and temperature to make sure there was nothing strange or unexpected going on. From an owner point of view, I signed a consent form and gave the finance team Erik’s insurance details. Even though I work in the veterinary field, I would always keep Erik insured as I want to be able to offer him all the options in terms of treatment, without worrying about money when it’s already so stressful.

Once we were all set up for surgery I weighed him and calculated his drugs (I had a plan from Nick for his medications), I checked the anaesthetic machines and theatre and made sure everything was ready and safe. We then administered some sedation to make him sleepy and give some pain relief before surgery too. We then placed a breathing tube down his throat and connected it to oxygen and anaesthetic gas. Then we placed ECG leads, pulse ox, capnograph, blood pressure monitoring, spirometry and temperature, to monitor him under anaesthetic. This allowed us to track and record all his vital signs, and make sure his anaesthetic was deep enough, but also safe. He had intravenous fluids too to support his body under anaesthesia, to keep him hydrated, and to make sure his blood pressure was good.

Soft tissue sarcoma following clipping and cleaning in preparation for surgery

Image showing Erik’s soft tissue sarcoma following clipping and cleaning, in preparation for surgery to remove the lump at Fitzpatrick Referrals Soft Tissue and Oncology.

Once asleep, the auxiliary nurse on surgery prepared him, so we clipped a large margin around the lump, and cleaned it with a disinfectant soap and surgically prepared it. Then we moved into theatre for surgery.

Erik’s surgery went as planned, his clipping and preparation took about half an hour, and the surgery itself a little over an hour. Professor Nick Bacon performed his surgery as he is the specialist I work closest with, he was the obvious choice for me, although I trust all our amazing surgeons fully.

I monitored Erik’s anaesthetic myself, as it can be quite daunting for someone else to monitor a fellow nurse’s pet! Also because Erik can be nervous, I wanted to be there when he woke up to reassure him. He had some apnoea, which is when they temporarily stop breathing in surgery, this is usually due to the anaesthetic drugs and we can ventilate them throughout, so I wasn’t that worried.

How did you feel during surgery?

I was actually super focused during surgery, he was treated the same as any of my patients! Wake up was the hardest, he woke confused with a whimper, but when he saw me just snuggled in and was quiet. I set aside all worry for his procedure, as it was important to me to approach his surgery with full focus and make sure everything was done according to plan. Obviously, once I reflected on it, I’m surprised how well I was able to separate my emotions from his procedure and I was just relieved that evening that all had gone so well.

After surgery, Erik woke up nice and slowly, with warm air machines keeping him cosy and some good pain relief on board. The lump was sent away to the lab for testing to find out exactly what it was and how aggressive it might be. Then once we have that information, we can think about whether he needs further treatment, such as anti-cancer drugs.

Recovery

Erik was moved to our wards for recovery, where the ward team monitored him closely to make sure he was waking up, comfortable and then offered him some food when he was awake enough. He had some really good pain relief on board and was quite happy to have some freshly cooked chicken when he woke up.

Usually, patients who have this procedure stay with us at least overnight, so that we can make sure someone is watching them at all times and ensure they have good intravenous pain relief and a good anaesthetic recovery. However, as I am a trained veterinary nurse, I was able to provide his care at home, knowing that if I needed support I could bring him back at any time. I left Erik with the wards team until later that evening, before bringing him home for the night and gave him his overnight pain relief – I barely slept worrying about him!

Small dog wearing a baby grow after surgery to stop him from licking or scratching his stitches.

Covering Erik’s stitches with a baby grow worked well to stop him from licking or scratching his stitches.

I had to restrict Erik quite a lot at home, so no jumping and no walks for the first few days and definitely no licking his stitches! This meant he wore a soft blue cone when I wasn’t there or at night, and then also had a baby grow on to cover the stitches. He looked incredibly cute in this, but it worked to protect the stitches, as Erik is a small dog and low to the ground, so I wanted to make sure he didn’t pick up any dirt or mud.

It was incredibly hard to restrict his walks, but I had to be strict as I didn’t want him to get any sort of post-operative infection from over-movement. He got used to being carried out to a patch of grass on lead, so he could toilet, and then after a week or so he was allowed to go on slow short walks, which was a little easier for him.

Medications wise, as well as pain relief, Erik had some antibiotics and some gut protectants, as he often gets an upset stomach when he has painkillers. He had these morning and evening in some cheese or chicken, so got very used to looking forward to his treats, even if he sometimes tried to eat the treat and spit the tablet out!

Erik’s results

I knew his lab results could take 5-10 working days to come back, and waiting is always difficult when we think of cancer. However, we wouldn’t do anything in terms of chemotherapy or further treatment until stitches were out anyway, so having the results sooner wouldn’t make much difference to the plan. His stitches were removed after 14 days and luckily his wound was all clean and well-healed, even if he was a bit bald for a few months.

We were very lucky with Erik that his mass came back as a low grade soft tissue sarcoma, which means once removed fully it is unlikely to return. Nick had removed good margins of tissue, so we knew he had probably removed it all, and the lab result confirmed this, so even though a lot of flesh was removed, it was for a good reason. This means that, although I will continue to monitor the site, hopefully, it will not return and it will not limit Erik’s life at all. We also do not need to give any additional chemotherapy drugs, which I was prepared to do if needed, as I see how well animals do here on chemotherapy.

Senior Nurse Clinician pictured with oncology patient and surgeon Professor Nick Bacon

Senior Nurse Clinician Inge pictured with her dog Erik and his surgeon, Professor Nick Bacon.

It’s now been 6 months since Erik’s surgery and thankfully he’s back to his happy old self, with no further lumps found.

My advice – check your pets for lumps and bumps

It is really important to check your pets for any lumps and bumps regularly, this can be during a grooming session or as part of a game, so it becomes normal and not scary for them. If you find anything strange, don’t panic! Ask your vet to have a look – taking a fine needle sample is always a good idea to be sure what cells are involved. Without testing lumps, there’s no way to know what they are and it’s such a small procedure it absolutely makes sense to do so!

If your pet is diagnosed with cancer, again, try not to panic. Speak to your vet and ask them all the questions you need to (it’s good to make a list sometimes to make sure you don’t miss anything). It’s also important that you get the treatment that best suits you and your pet, as we are all individual!

Be careful with online information, as there’s a lot of misinformation out there, but there are some reputable veterinary sites too. Fitzpatrick Referrals has handy information pages for clients on some of the common cancers found in animals such as mast cell tumours, soft tissue sarcoma, osteosarcoma and prostate cancer.

The team of clinicians at Fitzpatrick Referrals Oncology and Soft Tissue are happy to offer advice to your local vet about your pet’s cancer diagnosis and the options available. If you wish for them to be treated by a cancer specialist you can ask your vet to make a referral.

Read more about soft tissue sarcoma

Read more about our oncology service

Fitzpatrick Referrals