Let’s stop to make note that the other vet did not necessarily do anything wrong. None of us can do a complete gastrointestinal work up on every pet that presents when the vast majority will get better with conservative treatment. Too be fair, I didn’t realize how sick Rusty was until we started to get some bloodwork results.
Rusty’s records came with a note to use a muzzle and that the results had come in over lunch and the clients were upset that the veterinarian would call later with results. (Hmm, lunch, that seems like it might be a good thing to add to our routine.) I explained that I wanted to do some blood work to see what was going on. CBC is a complete blood count with red blood cells, white blood cells and platelets. A chemistry is a snapshot of the internal organs: the liver, the kidneys, pancreas, blood glucose and a some other things.
Rusty’s total white blood cell count was 55-thousand. It is supposed to be between 6 and 17-thousand. 55,000 is high enough to be a closed cavity infection. His chemistry (liver, kidney, diabetes, pancreas) was all normal. That meant that peritonitis and pancreatitis were the most likely. The radiographs looked normal and the ultrasound was read as either pancreatitis or lymph node. There was no peritoneal fluid, so we treated him for pancreatitis.
Rusty’s owners did not really like my plan. They told me that he was a huge part of their life. They had been in a car wreck that had taken the life of their young child. The same wreck had taken the mom’s eye sight. Prior to the wreck, they had lost their first child. After the wreck, Rusty’s dad had gone through horrible chemotherapy. The couple have been through so much. I know what this dog must mean to their lives. Throughout all of that they remained gentle, devoted, grateful pet parents.
Rusty spent the next week on IV fluids and antibiotics. His white blood cell count dropped to 42-thousand and then bounced back up to 49-thousand. But Rusty looked much better. The bloody mucoid stool was normal and he was eating well. We decided he could go home.
We did chat with the owners about the danger of a boutique diet. Even if the company is donating some of the profits to a great charity, it can be making Rusty sick. Many of the popular heavily advertised diets have problems. Grain free diets have been proven to cause heart failure that can lead to death in dogs. The owners were committed to Rusty and promised to change.
At first Rusty was doing well on his new diet and home antibiotics, but two weeks later, he was back in the hospital. He had started a cough, was not eating and breathing rough. We redid a CBC and chemistry and radiographs. His white blood cell count was still very high and now his albumin was low and some liver enzymes were elevated. We started him back on fluids and antibiotics. Radiographs looked the same, but ultrasound looked more like a mass in the abdomen.
I don’t get to pick which pets with which owners get to live or die, but occasionally I wish I could. I did recommend a specialist. Referral was declined. The owners thought they would rather me do the surgery. On Wednesday, Sept 11th, we took Rusty to surgery. While the owners were at home praying, I very carefully removed a five by 3/4 inch cancerous lymph node. The entire blood supply for the small intestines were adhered to the tumor. That meant that I had to gently, but firmly remove the blood vessels from the tumor without tearing them. Five inches of vessels on all 360 degree sides of the tumor. I lack the words to explain the adrenalin surge that happens when you are playing with important blood vessels adhered to a tumor. Suffice it to say, I was covered in sweat and happy to do it on my day off when nothing would interrupt me.
The spleen had some discolored spots, but Rusty started having some irregular heartbeats. As I closed, his ECG returned to normal. Even though he had been through a bit of surgery and I told the owners that his prognosis was poor, I thought he might have looked a little brighter when he woke up compared to pre-op.
A couple of days later, Rusty was stronger, but he was leaking fluid from his abdomen. The tumor had disrupted his intestinal blood supply for so long that he lacked the proteins to heal. In other words, Rusty had to have surgery, but he couldn’t heal from surgery because of the effects of the tumor.
Late in the day, I directed a blood transfusion. Fresh frozen plasma probably would have been enough, but it is more expensive than fresh whole blood. After the surgery and tumor, he could use some blood. Lindsay started getting blood from Taz, my silver lab. Katie did blood typing. And Garrett and I tried to keep appointments on schedule. The blood helped and the oozing slowed and stopped.
Seven more days on IV fluids and antibiotics in the hospital and Rusty would eat for his owners. He was still quiet, lethargic, but would jump up when mom and dad came to visit. If everything goes well, Rusty will heal, we will get biopsy results back, start chemotherapy and get a few more years for Rusty. A lot is ahead of Rusty and he had already been through a lot. Nine bags of fluids, nine bottles of antibiotics, five IV lines, extensive surgery and eight different medicines.
Mid September, Rusty went home with his tail wagging. His owners have been extremely compliant, asked good questions and think I walk on water. I have told them many times, that I could have done exactly the same thing and they could have had a dead dog and a big bill and be unhappy with me. Today when we called to check on him, Rusty was eating and doing well. The owners are happy, but perhaps not as happy and grateful as I am. Sometimes in this job it is the animals that get to you. Sometimes it is the humans.
We all know Rusty still may not make it. His parents understand this and to be honest are a little afraid of chemotherapy, but they have some answers and understanding. And a few more days at least of tail wagging.