Book Review

Dog Bilateral Rostral Mandibulectomy | Guillermo’s Journey

Before I start… I wanted to note the following:

Throughout Guillermo’s entire journey it has been so difficult to find anyone’s full account of their dog’s rostral bilateral mandibulecomy, other than Beamer’s Corner. I had a plethora of extremely scary and serious questions during the diagnosis and healing process after surgery, but couldn’t find any real answers or useful information on Google.

I am hoping this blog entry will find it’s way to the people who need this the most. Those of you who are suffering, just like my family was, and are trying to do the research on an extremely aggressive and horrifying surgery for your beloved furry friend.

I am going to do my best to detail every part of Guillermo’s journey with you here today and I hope that it can help you with the difficult decision you may be facing with your pet.

For those of you who are just reading this just because you care about me or Guillermo, I love and appreciate you.

The Discovery and Diagnosis

(Note: Guillermo is a 4 year old hound mix, turning 5 this July. I have been told that it is rare for a dog as young as Guillermo to go through a cancer like this, but it is not unheard of.)

On March 5th, when I arrived home on my lunch break from work, Guillermo brought me a toy smeared with blood. I immediately opened his mouth to discover a decent sized lump surrounding his front left canine tooth, which had a lesion on the top. (Hence the blood.) Photo below.

After one google search, my heart sank when I realized how serious this lump could be. I left work and took Guillermo to the vet as an “emergency,” where they performed a needle aspiration biopsy. It took 5-6 days to receive the results from this, which ended up being inconclusive.

In hindsight, knowing what I know now, I would’ve insisted we skip the needle biopsy entirely. Needle biopsies often return inconclusive results, and when it comes to a place as delicate and dangerous as the mouth, I wish I would’ve pushed for an actual biopsy where part of the lump is removed to be tested. Unfortunately, the needle biopsy ate up a week of precious time.

March 13th, Guillermo had an actual biopsy taken of the lump.

On March 18th, the vet called to tell me that Mo has Oral Squamous Cell Carcinoma, which is a mildly aggressive form of oral cancer.

My heart was shattered.

I was beside myself with pain and fear, as I slowly started to realize that partial jaw removal was essentially the only form of treatment for this type of cancer, as well as most other forms of canine oral cancer. (As long as they have not spread.)

The Research and Decision

Due to Coronavirus, an additional layer of complication was added to the mix for us. A lot of vet offices were shutting down and not taking any new clients.

A trustworthy and talented surgeon was corresponding with me via e-mail, and although he had to shut down due to COVID-19, he was able to walk me through the best options for Guillermo’s prognosis.

Rostral Bilateral Mandibulectomy was the only chance to cure him of the cancer, and I was told to act fast.

While waiting for other vets to return my calls for a consultation, I had some time to do research on the surgery. A lot of the results were veterinarian medical journals and, quite honestly, written in a way that no normal person could understand. I felt like every 3 words needed to be googled just for me to understand a sentence!

However, I did find a couple websites that were simplified and had some easy to understand statistics regarding the success rate of this surgery. (Here’s one, and here’s another.) These two websites, specifically regarding Squamous Cell Carcinoma, really helped me understand that dogs can live at least a few years after such a surgery, which is especially appealing since Guillermo is only 4 years old. I just wasn’t ready to lose him, and these statistics gave me real hope.

So then, I was concerned about his quality of life. How does a dog bounce back? Do they bounce back? I wouldn’t want to selfishly force Mo into a surgery where he couldn’t live a normal life afterwards.

That’s when I found Beamer’s Corner. Beamer has a different type of cancer, but still had a lot of extremely helpful details about the surgery and healing itself. Not to mention, the comments section is filled with other stories of canine mandibulectomy success.

So it was decided.

I wasn’t ready to lose my best friend.

After reading how so many dogs bounced back after the surgery and lived for several years, I wanted to give Guillermo that chance too.

The Surgery, Complications, & Healing

Surgery

Much to my surprise, on March 25th when we visited the vet for our consultation, they took a CT scan and then offered to perform the surgery immediately. While I was shocked, scared, and slightly unprepared, I was also thankful that the waiting was now over.

The vet told us they’d have to remove the front lower part of his jaw, directly across, up to premolar tooth #3. (If you count back 2 teeth from the canine tooth, that is where they made the cut across. In between #2 and #3.) This was better than I was anticipating, so I agreed to have the surgery immediately.

They kept Guillermo overnight. I was a little shocked that they didn’t want to keep him for longer, but the next morning we picked him up and brought him home.

The vet gave us these instructions:

  • Hand feed him only mushy canned dog food, or soak any hard food with water to turn it into a paste.
  • Leave the cone of shame on at all times.
  • Section him off to a small space in the house so he cannot run or overexert himself.
  • Because his jaw is no longer fused, the mandibles can now act separately.
    • This means that each jaw bone can move independently, and this can sometimes create a strange clicking sound. However, that sound is relatively normal.
  • No toys or hard food for 3-4 weeks.
  • A checkup in 14 days is mandatory.
    • More instruction will be given at this time about the re-introduction into hard food, toys, and resuming normal activity.
  • Don’t stretch the dog’s mouth or try to look at the wound.
  • The removed portion of the jaw will have a histopathology test, which is another type of biopsy that will determine if “clean margins” were made, meaning all of the cancer was removed.
  • Antibiotics, pain medicine, and inflammation medicine on a strict schedule.
  • Complications are rare, but include:
    • Dehiscence (the wound randomly re-opening): Rare, but can occur without reason
    • Infection: Be on the look out for a strange smell.
    • Blood: Anything outside of some light bleeding while eating or drinking. Normal light bleeding should stop within 5-7 days.
    • Excessive Drooling: It’s possible the dog may temporarily drool a lot, or permanently.

I will definitely tell you that seeing Guillermo for the first time with his newly shaped and much shorter jaw was very hard and sad.

Once we were home and I really got a chance to look at it, I cried a lot. But just try to tell yourself… Your dog doesn’t have a mirror or vanity, so they don’t really care how they look.

But I also cried a lot while trying to feed him for the first time, as he really struggled and seemed very confused by his lack of jaw. It just shattered my heart into a million pieces. It made me start questioning, “Did I do the right thing?” and “Oh my god, what if he can’t eat?”

Feeding

I was shocked and delighted to discover that Mo was really hungry! He has always been a very picky eater, so this was especially positive. I was very worried that he wouldn’t want to eat after the surgery for a long time, and wondered if that would cause any complications, but it really didn’t!

Just know, feeding will have a learning curve for both the dog and for you.

Guillermo was struggling to keep the food on his tongue and I was having trouble figuring out how to put it in his mouth in a way that wouldn’t hurt his wound, but also wouldn’t roll out onto the floor.

What I found to be easiest was to refrigerate the can of food for a little bit. That way, when it was feeding time, it was’t just a watery mushy mess. I could roll up the soft food in my hands and create little meat balls. That made it so much easier for him to take the food onto his tongue and work it back down.

We both caught onto things really quickly and there weren’t any issues after the first couple days of trial and error.

As far as water goes, my little boy is spoiled and would only receive water out of a syringe. It could’ve been due to the cone, but he just wouldn’t drink from the bowl. I didn’t mind this, however, and continued to use the syringe since that seemed to be easier for him.

Complications- Dehiscence

Five days after the mandibulectomy, he was acting chipper and more himself for the first time since the surgery! It was bright and early in the morning and he was very excited to be awake.

When my boyfriend and I were feeding him first thing, I could see the front of his newly formed jaw was hanging a bit slack. Thinking it was just settling in, I continued feeding him. Since they tell you specifically not to open the dog’s mouth to look at the wound, I wasn’t going to pry his jaw open.

But then he started shaking a little bit, like body tremors. He suddenly didn’t want any more food, and we were only 1/4 way through the can!

That’s when I held him still, got underneath him, and noticed that I could see the entire opening of his jaw.

It wasn’t bleeding, it wasn’t extremely noticeable, and there wasn’t really any obvious signs that something was wrong.

Although I wasn’t supposed to touch near the area, I lifted his upper jowls a bit and snapped a picture with the flash to get a better look at what was happening in there. Sure enough, I could see the bone staring back at me, and a lot of other graphic stuff I won’t detail.

I immediately sent the photo to my vet’s email and drove his furry ass on down. They took him in immediately and re-sutured him up. This time, they drilled small holes into his jaw bones to suture the flesh to the jaw, hoping that will deter this from happening again.

Later that day, we picked him up.

At this point I was really starting to fear that what I had done to my poor boy was not the right thing.

I was worried that he was never going to heal right, and that this was going to be a never ending and painful process. Not to mention, I still hadn’t heard back regarding his histo results and was even more worried that they didn’t remove all of the cancer. I was worried I was putting him through all of this for possibly nothing.

Recovering

Guillermo was miserable for days. He was tired from the pain medicine, he was confused as to why he was hurting and why his tongue was hanging out, and he was serving major side-eye at us every chance he got.

We continued to love him, be patient, be gentle. At night, we set up the couches in the living room to face one another, sort of like a sleepover boat. This way, I was on one couch and he was on the other, and he couldn’t jump down while I was sleeping. We were both forced to stay in the living room for weeks to ensure proper healing and rest.

After a few days, he began acting like himself again. There will be moments when you question if that’ll ever happen again, but for us (and most people) it did. He seems happy now, even without part of his lower jaw, and he is slowly recovering and acting more like himself every day.

He started growling at the mailman again, wagging his tail when we enter the room, and cuddling up to us when he wants attention.

He’s a little bit more drooly than he was before, especially when he’s sleeping, but that is okay with us. It appears to be okay for him too, it’s what dogs do after all isn’t it?

The Histo Results

Today, April 7th, we finally got some good news… The best news in a long time…

CLEAN MARGINS!

Thank. F*cking. God.

This means that all of the cancer was successfully removed and hopefully gone for good.

Now, of course, there is always a chance that it could come back, or spread to another place, but for now, I am taking this as good news and we’re celebrating this win.

The doctor is referring us to an Oncologist, who will call me to devise a plan for moving forward. For example, x-rays every few months to keep checking that it hasn’t returned, showing me how to check his lymph nodes for any abnormalities, and possible radiation therapy if the Oncologist thinks it is the best course of action.

Final Thoughts

This surgery is hard. It is aggressive. It is extreme.

But it can be life saving.

Today, hearing the “clean margins” results, I am so glad that I went through with the surgery and I am hoping we just bought my dog at least a few more healthy and happy years with the family.

To me, that is well worth the weeks of sleepless nights, sloppy hand feeding, drool puddles, and side-eye.

The surgery was expensive, roughly $5K-$6K all together, but luckily we have Guillermo covered by pet insurance and 90% of it was reimbursed to me. This was was extremely helpful, and I recommend pet insurance to anyone reading this because sh*t happens. And, yes, sh*t happens to young dogs too.

I sincerely hope Guillermo’s story can help anyone out there who unfortunately ended up in a similar situation.

If you have any questions, please feel free to comment and I’ll do my best to help you with anything I know.

Thank you for reading this and for all the people who read my previous entries (finding the lump and receiving the diagnosis,) and had kind and supportive words for us. I will forever appreciate the role y’all kept in keeping me sane.

xoxo,

Ande

1 thought on “Dog Bilateral Rostral Mandibulectomy | Guillermo’s Journey”

  1. This is an outstandingly heartfelt and helpful post to all of us who share our homes and our hearts with non-human animals.

    Several times you questioned whether you had done the right thing. To me, anything that comes from the heart is the right thing.

    Guillermo is beautiful. Period. He may not be whole, but he’s beautiful. That beauty comes from loving and being loved. Look at his eyes. You can tell you guys are everything to him. That’s love, and it is the natural byproduct of being loved.

    The most important thing we can learn from your post is that you and your boyfriend are good people; not too many of those around. You can indeed tell the beauty of a human spirit based solely on how you treat a non-human animal.

    I for one I’m grateful you shared Guillermo’s story.

    Like

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