My patients, My life

I was behind on my afternoon appointments but not by much.  I hate to make people wait beyond their appointment times but, because of the nature of my business, it is sometimes unavoidable for me, as a solo practitioner, to stay on schedule. 

This particular day was was going well but about to get turned upside down.  An appointment made the previous day by a new client for me to see a terrier who seemed “weak” to her owner was about to change my day and for that matter, my week.

Gia, a sweet eleven year old Jack Russell Terrier stood on my exam table and listlessly hung her head as her mom, Rita explained her situation. 

It was immediately obvious to me that Rita knew a good bit about dogs and was a down right expert on this one.  As the story unfolded, it was obvious that this little dog was seriously ill before I started my exam. 

Gia was not just another high energy Jack Russell Terrier. She was an accomplished competitor that had raced in the championship races at the National Jack Russell Terrier races in Baltimore. Although Gia had never won the big one, she was the first female to run in the championship heat. It seems that the “boys” dominate in terrier races just like the colts do at the Kentucky Derby. But this thirteen pound little bitch apparently had the body build, the heart and above all, the will, to run with the boys. 

She was one of several terriers that Rita and her friend Travis planned to enter in the nationals in Baltimore in just 2 weeks. Rita told me that Gia had fallen out of a training run a few days before.  To Gia and her kennelmates, the 10 mile run down sand roads behind an ATV was just a walk in the park. But this day, half way through she tired and then fell out of the run.  Even at 11 years of age, Gia could run with the best, but, no matter how much desire, her body could not make it that day. Travis picked her up and gave her a ride for the remainder of the workout thinking she was just having a bad day. 

The next day Rita found no smile on little Gia’s face.  Her bright eyes and happy demeanor were missing and Rita knew she needed help.  She called the office and we scheduled a visit which brought us to this meeting. 

Rita and I quickly exchanged pleasantries and she gave me a briefing about Gia’s history as a great performance dog and, how suddenly she had begun to fade.  She was concerned about Gia’s gums and ears appearing pale.  

I carefully listened and because of Rita’s intimate knowledge and closeness to this dog I gave great credence to her evaluation.  Indeed the little dog’s gums were a ghostly white. In most, but not all cases, this lack of perfusion means anemia or lack of adequate red blood cells. Her heart sounded great although beating more quickly than I would have expected for a dog in such excellent physical condition. 

We drew a blood sample from Gia and did a chemistry panel and a complete blood count.  As I read the report confirming her anemia I gave some thought as to why she could so suddenly be so anemic.  Rita would certainly notice a bleeding event to this extent as over 50% of Gia’s blood was unaccounted for. There was no history of trauma and she had seemed to feel OK up to the point of her training fatigue. We took her back and took a series of radiographs of her chest and abdomen looking specifically for an internal hemorrhage. 

While evaluating the abdominal radiographs I got a sick feeling that we had found the problem and the news was not good.  To confirm my diagnosis we prepped a small area on her belly and performed an abdominocentesis.  I carefully inserted a small needle into her abdomen and used a syringe to withdraw abdominal fluid to check for the presence of blood.  Frank blood rushed into the syringe on two separate areas of her abdominal wall.  Gia was bleeding into her abdomen, that much was certain, but why and from where? 

Rita wrung her hands in fear as I explained my findings.  She asked a plain and simple question.  Is my dog going to be alright?

I had to hedge my answer because the final diagnostic step would also be the single greatest chance to help her.  She needed an exploratory laparotomy to find the source of the bleeding and hopefully correct it at the same time.  Her life literally hung on the outcome of that surgery.

I always struggle with the goodbyes as a client hugs and kisses their pet before sending them into such a pivotal surgery.  I usually share the moment silently.  When I speak, after they release their loved one to my care, I almost always promise to treat their pet just as I would treat mine.  I mean that, of course, because I can’t make promises beyond doing the best I possibly can.  The unbelievable pressure that my heart feels during those next few moments strengthens my resolve to use every ounce of my skill and knowledge to earn the trust that person has so solemnly placed in me.  My focus is razor sharp and I am quite certain my techs feel it too. 

Our best hope was that Gia had a tumor on her spleen that had ruptured and begun to bleed. That is easy to fix.  If not the speen, I had told them that her liver was the next best possibility and rarely did we get a liver cancer that could be managed by surgery.  Most liver cancers involve multiple areas, if not all of the organ.  The prognosis is often grim when the liver is involved in any cancer. 

Gia struggles after surgery

Her surgery started as the bloodbath that we knew it would. Her abdomen was distended with the pressure of the hemorrhage and when I made my initial incision everything was immediately obscured by blood.  After a brief moment of sponging up some of the blood, I located the spleen and immediately externalized it for a thorough examination. Time elapsed was about 90 seconds.  Time was critical. I moaned to myself out loud as I examined a healthy spleen.  My midline incision was extended to the front of her abdomen and all of the blood from her abdominal cavity had to be removed in order for me to visualize the liver. 

It took only about 2 more minutes to find a golf ball size tumor on the right lobe of her liver.  This is bad, really bad I silently thought.  The tumor was covered by a large blood clot – her body’s futile effort to stop the blood loss.  The bleeding was continuing though, one drop after another.  With fear of what I would find, I began to carefully inspect the remainder of her liver, one lobe at a time.  I was almost sure, based on past experience that there would be other tumors. Perhaps they would not be bleeding yet but their presence would kill any chance for a complete recovery for this little champion. 

I found nothing but healthy liver. Beautifully healthy liver!  With newfound joy and optimism I began to assess the grim prospect of removing a sizable chunk of the sick part of her liver.  I was sweating bullets as I tightened to ligature which cut off the tumor and sealed the remaining lobe of her liver.  After gently teasing the, now free, tumor out of her abdomen I beamed a triumphant grin as I saw no sign of blood leaking from the liver stump. I began to close her abdomen as quickly as I could to get her to recovery. 

This anemic little dog recovered quickly but within an hour her incision began to leak blood; blood that she could not afford to lose.  I felt very strongly that the liver was not bleeding. The source of the bleeding was the skin and other tissue that we had to cut to get to her liver.  Gia’s body had desperately used all of her blood clotting factors and platelets over the past few days in a futile effort to try and stop the loss of blood from her liver.  She did not have enough left to keep from bleeding to death from the surgical wound itself.  I wrapped her belly in a large pressure bandage, told to girls to get ready for a blood transfusion and headed out the door in a sprint. 

If you are a long time reader of my blog you will probably remember the story of my dog Jack.  As I sped down our driveway he loped out to my truck to see what the hurry was all about.  He was wagging his tail as I snatched poor Jack up and tossed him into the passenger seat.  Jack really hates any kind of travel beyond walking or running. Nevertheless, he sensed something was up and decided to go along without complaint. 

Sleepy Jack the blood doner

I ran through the front door of the clinic carrying him like he was the one dying.  Jack’s not exactly brave when it comes to medical procedures.  I really don’t think that he believes that I am a veterinarian.  Therefore, we skipped all the coaxing and pleading and I just sedated him for the bloodletting that was about to take place. 

As Jack’s freshly collected blood dripped into Gia’s vein giving her life saving clotting factors, he lay watching in a head bobbing stupor. Gia indeed began to “pink up”. She began to return from her journey to the “light”.  For the first time I felt like I could breath again. I began to feel like we were in for a happy ending. 

Gia 1 week after surgery

Today, that “hard as rocks” little terrier (with a little splash of Jack) is back on the trail.  I am so proud of her and her grit.  Gia missed her trip to the nationals. However, I am very proud to report that her kennelmate “Heartbreaker”, another fine little female terrier did get to make the trip to Baltimore.  After their return from the races, Rita called to give me a great progress report on Gia and to share with me the old “by the way Heartbreaker won the national championship”.  Chalk up another one for the girls!

Although Gia, the little old lady with all the right stuff, had to stay home while Heartbreaker won the race, I know the real winner that day was little Gia. With guts, terrier attitude, and shear will to win, Gia had indeed finally won the big one. May she get many more chances.

The Greatest Win of All