Dr. Donnell Hansen joins The Cone of Shame Podcast with Dr. Andy Roark to discuss oral tumors in dog. Together they discuss how to recognize them, when to biopsy, and how to talk to pet owners about what comes next. Dr. Hansen breaks down the diagnostic process, explains when a fine needle aspirate won’t cut it, and shares best practices for pain management and treatment options. She also dives into the importance of setting client expectations and how to approach these cases with both confidence and compassion. Let’s get into this episode!
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ABOUT OUR GUEST
Dr. Donnell Hansen, a Minnesota native, and a small group of friends joined together to form the Moxie Center (which was the first hospital to be now known as BluePearl) in Minnesota’s twin cities of Minneapolis/Saint Paul. Although her daily life is spent in specialty care, in 2011, her and her husband, also a veterinarian, opened Rice Creek Animal Hospital which provides a little balance and perspective about life in family practice. In 2019, Donnell developed Four Legged Tooth Fairy, an interactive small group conference center for the veterinary community to enhance their patient health, practice health, and mental health through veterinary dentistry. Dr. Hansen’s special interest in maxillofacial surgery, however the truth is, she loves the whole darn gig… especially when she gets to share the fun of veterinary dentistry with others!
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. Guys, I am here with the one and only Dr. Donnell Hanson. She is a Minnesota dentist, veterinary dentist. She is, she’s what I love talking to. You will hear why as soon as you get into this episode. She is so down to earth and easy to talk to. I could just listen to her talk about dentistry all day. all day long. She tells wonderful stories and gives great examples.
And she makes me feel like dentistry is just not a big deal. Like I could just do it. And I just, I just, I always leave my conversations with her excited and wishing that I got to do more dentistry than I do in my current job. And so anyway, that’s how I feel here. This is a great one. It’s a great review of oral tumors, oral tumors and dogs specifically we get into. Again, it’s full of Donnell’s patented optimism and encouragement and yeah, we break down the diagnostic process. We walk through best practices around biopsies, things like that. We talk about language to the pet owner. Like how, optimistic or not optimistic should we be when we find a mass in the mouth?
So anyway, this is a great review quick to the point pack full of pearls. The way that Donnell does it is just fantastic. Anyway, let’s get into this episode.
Kelsey Beth Carpenter: This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast, Dr. Donnell Hanson. Thank you for being here.
Dr. Donnell Hansen: It’s my pleasure. Thanks for having me as always.
Dr. Andy Roark: It is my pleasure. You have been on this podcast a number of times at this point. One of your episodes is in the top three Cone of Shame episodes all time. It is the Should I Pull It, Should I Leave It episode. Like,
Dr. Donnell Hansen: Hey, that’s big.
Dr. Andy Roark: That’s something.
That’s like, it’s like 30,000 people have listened to that episode. It’s a lot. That’s a big, you know, feather in your cap. I, I always love talking to you. We’re coming into dental month, which always puts dentistry back in the top of my mind. I, I wanted to bounce something off of you cause I’m kicking it around and I’m kind of rolling through my brain basket.
And here’s what I got. So I’ve got a six month old mixed breed dog, sort of a large kind of a, we call them a South Carolina yellow dog. And there’s a lump between this dog’s sort of teeth, right? Right between, you know, sort of second and third premolar, you know, I’m looking at this, it’s sort of, it’s definitely there.
Like I keep, I want to not think that there’s a lump there, but it’s, but. But it’s, it’s, they are, it’s a six month old dog. And so the owners are kind of pressing me on this and they’re like, well, he’s six months old. And I’m like, yeah, I know. I, I, I thought that maybe if you don’t mind you and I could jump on real quick and you could one I’d like you to comment on this and kind of what I’m looking at and and but then two I was wondering if you could talk to me a little bit about oral tumors just in general. And so I I have to be honest, they scare me because it’s pretty. They’re not easy to deal with and they’re hard to get to, you know, I, I think a lot about oral melanoma and stuff like that. And I’m like, I know this is, this is, this is bad. When I look and I see something in a dog’s mouth, my thought immediately is, please God, let this be gingival hyperplasia.
Like that’s, that’s the, that’s what I think when I said fingers crossed to please let this be gingival hyperplasia. And if it’s not, I, part of me dies, like part of, part of my soul just dies in that moment. I used to have a much more optimistic view of oral tumors in general. So I’m going to, let me stop talking here.
Let me, let me serve you the six month old dog with a lump and sort of say, let’s start with that. What, what are you, what are your initial thoughts?
Dr. Donnell Hansen: You know, when you think about young things, whenever we talk about our rule outs and we talk about, you know, you put down your list of considerations when pets are young, most of us put cancer is low on the list or tumors low on the list. And that’s real. That makes perfect sense. But we all know, we know all too well at both in people and our pets that everybody can get cancers no matter what age you are.
And at a six month old dog, gosh, that sounds like you said, the part of you dies. You feel a little devastated to hear about that. First, you got to rule out the easy stuff, right? I mean, sometimes we get swellings and puppies and dogs who are erupting their teeth. They can get these big sort of eruption cysts that can happen.
Dr. Andy Roark: Yeah?
Dr. Donnell Hansen: That should be done by about six months, unless you’re a small breed dog, like A Maltese or a little white thing because those guys can have delayed eruption. So if you see swellings or enlargements there, count the teeth, see where you’re at. But if you’ve got a, the dentition’s in, you know, you’ve got this, you mentioned a larger breed dog.
And you don’t think it’s papilloma puppies and viral disease, you got to think about that. And of course those look like little cauliflowers. that are often white and
Dr. Andy Roark: Yeah. They’re fairly distinctive, right? I mean, like, like, yeah. When I see it, it says papilloma to me. Like, I just, it just looks like a papilloma. It whispers.
Dr. Donnell Hansen: If you’re not there, if those things don’t seem to fit the characteristics, then I’m always worried about there’s a certain type of tumor. And again, any tumor can happen at any age and any breed, but there’s one called papillary squamous cell carcinoma that happens in our young guys. And it’s, you know, of course I’m a dentist oral surgeon, so we, we see tumors more than maybe our average family vet would do but there’s one called papoid squamous cell carcinoma that’s fairly common in our young dogs, and I’ve seen them in old guys too, but the great news is, with that one specifically, especially it tends to be It’s not heard of to metastasize, so we won’t see other body parts.
And, gosh, if we can see it, if we can find it, so we’re doing our exams, if we can biopsy it, identify what it is, we can cut it out. The prognosis there is excellent. Excellent. We just need to be on the ball. Mm hmm. Correct.
Dr. Andy Roark: Okay. All right. That, that feels, that feels good in general. Talk, talk to me. Let’s talk a little bit more about, about sort of approaching these cases. So, I’m, I’m, I’m just gonna be really sort of, everyone listening has to be nice to me. I’m gonna be a little bit vulnerable here.
I, I look at this and I see this, a lump in their mouth and I’m like do I have to, am I aspirating that? Is that what I’m doing? They’re not gonna, they’re not gonna let me get in there and get a good sample. And so, so now we’re talking about, we have to do it. Like at some point you’re trying to get through your day and you’re seeing it and you’re like, I really wish that we would just hold still for a second and I could just poke this thing, but it’s not going to happen.
And so I just have to take a big breath. And put on my big boy pants, and I’m like, alright, now we’re, we need to get into this. And so we need to sedate. If I’m, if I’m going to take the time and I’m going to sedate this dog so that I can get into its mouth and actually get a sample of this. Donnell, are you okay with a fine needle aspirate?
Should I be, should I be, if I’m going this far, should I be taking more of a biopsy sample? Like, walk me through some diagnostic when I’m, when I’m finding an oral mass.
Dr. Donnell Hansen: You’re going to get some mixed messages because there are studies out there that show that aspirates can be helpful, and most of us think, no, they’re not going to be terribly helpful.
Dr. Andy Roark: Okay.
Dr. Donnell Hansen: So you’re right. It makes sense. You want to be as convenient, as practical, as accessible as possible, and aspirates sure feel good about that, especially when you’re doing skin masses and stuff.
But in the mouth, boy, I just have a hard time having aspirates be reflective of what I’m dealing with. And the last thing I want to do is spend their money and get that doomed, non diagnostic or inflammation, you get…
Dr. Andy Roark: Or just blood. Yeah.
Dr. Donnell Hansen: Yeah, it’s like I knew that. Thanks a bunch. I knew that already. So whenever we’re thinking about that, if we want to put our real big boy pants on, if a tumor hits my radar screen as a possibility it would be smart to do just a little bit of staging before we get going on biopsies.
I get it. There’s times I skip right to biopsy for costs, times, motions, whatever it might be that inspires me to skip these steps. But if I have a choice, I’m going to think about, well, maybe smart to do chest films before we anesthetize this dog. In my own dog’s experience, my own Ellie Mae Clampett, she had a tumor and I thought, well, geez, let’s just cut it out.
And then my surgeon friend, he reminded me, he’s like, We call him my big brother. Our big couple of us have Dr. Andrew Jackson as a big brother. And he says, Donnell hey, you should probably take films before we do surgery on that. And I said, oh, right. And there was a tumor everywhere. Right? So I paused.
I paused. Thankfully in the mouth, that’s relatively rare. Most of our oral tumors, not all, but most, really are slow to spread to other body parts. So, we often have good outcomes when we take chest films, but easy thing to do. Of course your labs, that’s easy enough. And that’s where I just have my basic screening before I do anesthesia or sedation for biopsies, if I have that option with this family.
Dr. Andy Roark: All right. So start with some chest loads. Okay makes sense.
Dr. Donnell Hansen: And then once we get there, if we’re going to go ahead and biopsy, can take them to anesthesia, whether you do a twilight, you know, you think about your propofol stuff. you’re going to do that, don’t be taking x rays, because you don’t want to ruin your film. So if you’re going to take x rays of a tumor, which is a great idea when you’re doing evaluation of oral masses, make sure you have full anesthesia, because you don’t want to ruin your sensor. Practice managers, people don’t like that particular.
Dr. Andy Roark: That sounds like the voice of experience is what that sounds like that sounds like to me like someone who’s who’s seen something expensive broken.
Dr. Donnell Hansen: As they say, ask me how I know, right?
Dr. Andy Roark: Okay, cool. Lesson learned. Like, that is a pearl I’m gonna take and hold on to. I really don’t want to go and tell the manager. Hey, I have to tell you something.
Dr. Donnell Hansen: $10,000 lesson.
Dr. Andy Roark: Yeah. Gotcha. All right, cool.
Dr. Donnell Hansen: So if we get there, then what we want to do before we touch it makes a lot of sense folks often are biopsying and they say, well, let’s just remove it while we’re at it. Like, cause if it’s removable, well, that’s lovely, but you know, with your own mast cell discussions and all other kinds of tumors, it’s super tempting to lop it off because what if it is hyperplasia.
Dr. Andy Roark: Yes.
Dr. Donnell Hansen: What if it is some of our friendlier ones, like those peripheral odontic fibromas that we talk about POFs that used to be called the epulises, right? Well, then lopping it off is the treatment and that’d be really nice. But my secret brain says, what if it’s not? And then it gets lopped off, if you will.
And then someone like me or you, future you has to come back and cut out a more definitive surgery. You don’t have to know where it was.
Dr. Andy Roark: That’s, that’s my, that’s my worry, right? Is like, what if I get in there and just, you know, half, halfway it and, and then make it a, it’s sometimes we intervene and we don’t, it’s not even that we fail to help the next person, it’s that we make their job actively harder because of our involvement.
And I really, I’m okay if I try something and it doesn’t work and the next person doesn’t benefit from it. I really don’t like to set other people back because of paths that I have chosen.
Dr. Donnell Hansen: and who’s ever confused right and left or one Oh four, two Oh four, who’s ever written that wrong in the record? You know? And so when you come back to, to do a more definitive surgery and you’re like, Oh shoot, was this left? Right. Trying to ask the family. Which side do you remember it on? That doesn’t work so well.
So, lots of pictures is step one. And then if you have those, I’m more content with whatever you do in terms of biopsy. Just get big pieces, like, big chunks. And we’re talking six, eight millimeter punches if I have that choice. Right? Or scalpel, that’s great. Or, yep, cut wedges. And the thing to make sure you do Is, you know, you’ve all gotten the report back.
We take a biopsy and it’s like, Oh, inflammation and your heart knows it’s not inflammation. Right. So if you can get mucosa tissue and bone, which means grab that Ranger and go in there and get new pieces too.
Dr. Andy Roark: Yeah. All right. We need to talk about that.
Dr. Andy Roark: All right So my you you touched on this a little bit. I want to clarify what you were saying. So I get in there, right?
Let’s just say And there’s a mass that’s around the size of my little fingertip, you know, so a pea sized, maybe a little bit bigger than a pea sized mass. I’m going to look at this and I’m going to say, well, I could just try to take this thing off, but then I’m worried, you know, I go, well, I don’t exactly know what it is.
And, and I don’t know, I don’t know if I’m going to leaving pieces of it or things like that. Would you encourage me to say, Andy, don’t try to take it off. Just get a big piece of it. Let’s find out what it is cause that way, if it is something, then you’ll be able to find it easily. We can go back.
Or would you say Andy? Go ahead and take it off and just document, document, document where it is, get good photos and things like that. So if we have to go back, it’s easier to go back. So how would you weigh in on that?
Dr. Donnell Hansen: Yeah. There’s an adage amongst the veterinary dentists that say, ask 10 dentists, get 10 answers.
Dr. Andy Roark: Yeah.
Dr. Donnell Hansen: So my friends might say other things. Here’s where I have discussions with a family and I really believe that disappointment is just expectations missed.
Dr. Andy Roark: Yes. Yes.
Dr. Donnell Hansen: If I can have, take a moment before I do all of this, not under anesthesia, it is not the time that I spend time talking to families about this, but if I know about it beforehand, I will say, here’s our benefits and risks.
If it’s one of those smooth pink from the gingiva, right, right from the gum line, kind of growths that look like a blueberry or half a blueberry. And I’ve taken photos, and I know where it was, and I’ve, you know, make my measurements. I can be convinced to say, Andy, just take it off. Like a gingivectomy, take it off.
As long as I’ve explained to the family, hey, listen, I’m going to submit this. And if this comes back more concerning, that’s not the solution. We have more surgery to do. But if it comes back as hyperplasia or again, maybe that POF, those guys have, can be a little friendlier and we can and if they behave differently, well then we’ll just watch it and see what happens.
And then success. The one procedure was the trick. But dear family, if it’s something more concerning, a budget plan, emotionally plan for surgery again in the future.
Dr. Andy Roark: Yeah, I like
Dr. Donnell Hansen: If they’re not going to be like flexible with me, then I’m more by the book. Like I just take a sample of it rather than to cut it off. But my practical self wants to cut it off sometimes too.
Dr. Andy Roark: but that, that, I love that. That, that is a wonderful approach. That totally makes sense to me. Jump, jumping back into this. Say I get into it and then say, okay, I’m gonna do this by the book. I’m gonna, I’m gonna, I’m gonna take this biopsy. I’m gonna sort of, you know, take some samples. I want to make sure that I try to get even some bone sample as we talked about.
Talk to me a little bit about pain management control, things like that. This is gonna, this is gonna hurt. I, you know, I’ve taken the dog I’ve, you know, I’ve done the chest rads. I put this dog on anesthesia. I’m, I’m in there and I’m getting it. Do you, do you have, so, so just talk to me about general pain control philosophy for something like this.
To me, I go, Ooh, that seems terrible. Yeah. What does, what does your pain control setup look like when you go to do these?
Dr. Donnell Hansen: Right. So just like for any other surgery, we’ve pre medded them if we’re going to do the anesthesia. So there’s pain control there, right? There’s obviously pain control in the gas coming through the machine. There’s pain control there. If my tumor is not in the area of my nerve block, my regional anesthesia, I’m willing to block these. Sometimes, there’s a mass in the way of my block, and I don’t want to stick needles where I don’t belong and drag things places. So, if there’s a large enough mass that’s like blocking our access to a good regional anesthesia, well then, I’m not using that resource.
Dr. Andy Roark: Okay.
Dr. Donnell Hansen: Instead you know, if it’s these soft tissue things, in my secret brain, I think this is no different than when you get a mole removed.
And I don’t go home with codeine after I get a mole removed, right? So, maybe some anti inflammatories or maybe it’s the tumor itself, the mass itself is painful. So, anti inflammatories, if you’re a gabapentin person all those things are things we can use to go home. Either for our biopsy purposes or because it’s a tumor and those hurt in the first place sometimes, just to help with that too.
Dr. Andy Roark: when you are talking to the pet owners, and you’re saying so all this is coming together into a nice little package, which I, which I love. So I’m talking to the pet owners, and I’m sort of setting those expectations, and I’m talking about the approach that we’re going to take, and I’m saying, I don’t really know what this is, but we’re going to go in and find out, and things like that, and they’re looking at me, and they’re saying, Well, Dr.
Roark, this sounds bad. It’s, it’s cancer, right? Is, is this cancer? This is, this is bad. Donnell, how do you frame that up so that you are honest with them? Like, how optimistic are you? What kind of, what kind of communication do you give to them before you really know what you’re looking at?
Dr. Donnell Hansen: Yeah. So, I really believe my one job is to build trust.
Dr. Andy Roark: Mm hmm.
Dr. Donnell Hansen: Like we got all the other jobs that we do, right? But the one job that I actually have is to build trust. And so, and I’m not the same as a family practitioner who they know them, right? And they’ve built trust over time. I have to do it in these 12 minutes or, in my case, 30 minutes, which my team just loves.
They love that I spend so much time. That was sarcasm, if you didn’t catch it. So here’s what I say to families. And right or wrong, you can come at me with questions or with critiques, but I really do sort of lay it out there and say, Hey, you guys, I know it’s hard to come see me when there’s this concern of a mass.
I’m sorry you have to meet with me in the first place. I say, I know it sounds super scary. And the word cancer, many families never even make it to me. They heard cancer and they don’t even come to the door. Right. But listen, I know it’s scary. There’s lots of steps to take here, I do let them know that there’s no right and wrong.
Like, we can go down the long road, we can go down the short road. All the options exist in front of us, and I’m not here to judge about that. So let’s walk through it. Are you up for that? And they say, Sure, of course, I’m up for that. Okay, we’ll walk through it and start moving forward. And then I do make sure I say, it’s important for me to say to you that many masses are treatable.
Right? And some of the things I’m going to say sound a little scary, but pause. We’ll come back around, I’ll bring it back around, and we’ll decide what feels right for you and your family and your pet. The reality, the cool thing is, if you can acknowledge the worry, and I’m sure you obviously know this already, but, and help guide them through it.
I am astounded at how much compliance we get with getting to move forward on surgeries, that people come in saying, they say the first thing out of their mouth, I’m not cutting bone out. I’m not cutting, I’m not doing that to him. I get it. Baby steps and many families take us up on it.
Dr. Andy Roark: That sounds good. No, I really appreciate it. Donnell, thank you so much for talking through this with me. Tell me more about the four legged tooth fairy.
Dr. Donnell Hansen: Four legged Tooth Fairy is a CE center. You can probably see it in the background here. You know, early in my career, folks would ask us to come out and teach at their places and we would do that. And we still sort of do that sometimes now, but it felt like maybe folks needed more than four hours of us blabbering in their spaces.
So we built this space so vets can come hang out with us for, this case is three days. We start tomorrow for this month. It’s negative 20 here today. Negative 20 people are coming from all over. So I feel some sort of grief for them, but I know.
Dr. Andy Roark: Boy, they’re invested. For me to come to where you are when it’s negative 20 is, I would have to really want
Dr. Donnell Hansen: Yes, we had a veterinarian from Alabama come last January and the snow was above her head. So she took pictures with her mittens that we gave her because she needed mittens, everyone needs mittens.
Dr. Andy Roark: She gave, you gave her mittens.
Dr. Donnell Hansen: We spent a few days talking about teeth and just kind of getting back to confidence. That’s our goal, confidence!
Dr. Andy Roark: That’s great. Where can people learn more about this? If they were like, I would like to participate in something like that. Maybe when it’s not negative 20, but at some point in the future. Yeah. Where would
Dr. Donnell Hansen: We have a webpage fourleggedtoothfairy.com
Dr. Andy Roark: I’ll put a link in the show notes. All right. Great. Donnell, thanks so much for being here, guys.
Thanks for tuning in and listening to everybody. Take care of yourselves, gang. I’ll talk to you later.
Dr. Donnell Hansen: My pleasure, guys. See ya.
Dr. Andy Roark: And that’s what I got guys. I hope you enjoyed it. I hope you got something out of it. Thanks to Dr. Donnell Hanson for being here. Thanks to you for being here. I hope this makes you feel more relaxed and comfortable and excited to do some dentistry. Gang, take care of yourselves. I’ll talk to you later on.
