Charlie and Betty, All Bad News

D. E. Larsen, DVM

 It was not long after this fishing expedition that we got the sad news. Lee called me at the clinic one afternoon. “I have some bad news,” Lee said, his voice almost breaking. “Charlie has prostate cancer. It is very advanced and has already metastasized. I am afraid he doesn’t have much time.”

  Not much time, everybody wants to know how much time they have when they get a cancer diagnosis for themselves or for their pets. I have never understood how doctors could be so blatant about the figures they hand out. Be it 1 year, 6 months, or 3 weeks, people always think they really know. As I veterinarian, I can read the book too, but the times are the best guess, at best, and complete BS, at worse. Charlie’s time went fast. In less than two weeks, he was on his death bed, and he was gone a few days later. Probably better that it went quickly, the end was pretty painful for him.

 Sandy and I closed the office and went to his funeral. We had lost Sandy’s mother a couple of months earlier, and we were starting to realize we had entered that age group where funerals seemed to be more common than weddings. Charlie’s service was small, mostly family. The preacher did an excellent job for having met Charlie on his death bed. Although we knew we were welcome, we almost felt like we were intruding. We both shed more than a few tears. Walking back to the clinic, we both decided, almost at the same time, that we should not be attending funerals for clients. We held that as a policy for many years until we started losing some good friends who just happened to be clients, sort of like Charlie.

 The week following Charlie’s funeral, Betty came to the clinic with her little dog, Taco. Taco was a little Chihuahua crossed with a Dachshund, black, short hair coat except with long hair on his ears.

 Betty puts Taco on the exam table and looks at me with great concern. “He can’t pee,” she says with tears in her eyes. “What am I going to do? I can’t lose him too, I just can’t.”

 “Let’s look first before we start worrying about something that maybe doesn’t exist,” I said.

 I start through an exam when his distended bladder jumps out at me. I can’t pee for sure, but there are a couple of drops on the exam table.

 Betty points to urine on the table, “that’s what he does everywhere, never more than a couple of drops.”

 I put an exam glove on and lube my left index finger. This will be a tight fit but should be no real problem. Dixie comes in and holds Taco as I insert my finger into his rectum. There are a lot of reasons for urinary obstruction, and some are quite simple to deal with. I reach the level of his prostate, and my heart sinks. Taco has been neutered for many years, and his prostate should be small and smooth on palpation.

 Taco’s prostate is grossly enlarged, solid, and hard, with extensions of this hard tissue in all directions. Both vas deferens are 4 times their normal diameter and hard and bumpy. This extends as for down each vas as I could reach. This was unlike anything I have ever palpated. Old intact male dogs often suffer from an infected prostate Their prostate may reach a massive size, maybe the size of a grapefruit in a large dog. Those cases resolve quickly with antibiotics and neutering. This is not an infected prostate. Prostatic cancer is now number one on my list, and there is no way I can say those words to Betty at this point in time.

 “Betty, he has a problem for sure,” I explain. “We need to get him under an anesthetic, pass a catheter, and drain his bladder. That is number one, then we can do some lab work and get some x-rays. We will also do a pneumocystogram, which is an x-ray where we fill the bladder with air. That allows us to see the lining of the bladder and the pelvic urethra. We should be able to get this done this morning. So if you set up an afternoon appointment, we can go over our findings.”

 After anesthesia, I pass a catheter quickly. I get x-rays, plain film and then a pneumocystogram. The prostate is large, and the urethra that passes through it is eroded and large with tissue hanging into the lumen. This urethral abnormality extends down the pelvic urethra for some distance. The neck of the bladder is also involved with an abnormal lining that extends into the prostate. This has to be prostatic cancer. Something I have not seen in a dog. Time to hit the books.

 It turns out that prostate cancer in the dog is rare. I know that already. It also seems to occur more commonly in neutered dogs. This is not well understood because prostate cancer is thought to be testosterone dependent. It could just be a numbers game. Veterinarians see many more old neutered male dogs than they see old intact male dogs. The pictures are disturbing, they look exactly like what I am feeling in Taco.

 At this time, there are few specialists to send Betty and Taco. She would not go anyway, she thinks I can do anything. The truth is, Taco is on borrowed time, just like Charlie was. My guess is we have very few options. Attempting to remove this prostate will be at the very edge of the ability of this clinic. And even with surgery, we probably will only buy a few weeks at best.

 Betty returns in the afternoon, and I reluctantly go over everything with her. The x-rays, the lab work, and the book findings. The diagnosis is prostate cancer, the only thing lacking to confirm that diagnosis is a tissue biopsy. The prognosis is grave, meaning I don’t expect Taco to survive this cancer.

 “How can this be happening?” Betty says with tears in her eyes.

 I can hardly talk. “We can find a specialist to send you to if you would like.”

 “No, no, Charlie would never allow that. If anything is going to be done, you are the one we want to do it.”

    “There is not much I can do, Betty. This surgery is at the very edge of my skill and equipment. And even if he comes through surgery, I may buy him only a short time, maybe a couple of weeks, maybe less.”

 “We have to try because it could be maybe more. I have seen some of the things you do. We have to try,” Betty says. “When do you want to do this?”

 “We will make time this afternoon,” I said.

  We had Taco under anesthesia and prepped for surgery, on a slow IV drip of Ringers Lactate, and we had passed an eight french urinary catheter into the bladder. His prepuce is reflected to the left side of his abdomen, and clamped in place with a towel forceps. 

 Then a posterior ventral abdominal incision is made, passing on the right side of the prepuce, ligating preputial vessels as they are encountered, the linea alba is exposed all the way to the pelvic brim. The linea alba is opened carefully, exposing the bladder and prostate. It looks far worse than it felt.

 The entire prostate is involved with cancer, and it extends down both vas, beyond my vision. I grasp each vas deferens and pull them free of any attachment. Then I thread a length of OB tape around the pelvic urethra and secure it approximately 1 cm distal to the abnormal tissue. I sever the pelvic urethra and telt the prostate and bladder up to allow me to pull the tip of the catheter out of the prostate. Next, I sever the prostate from any bladder attachment. Now I remove the entire prostate with both vas deferens attached. I ligate any bleeding vessels, examine the cut edge of the bladder carefully. I trim away any tissue that looked suspicious. Then, after reinserting the catheter into the bladder, and using 3-0 Maxon, I sutured the bladder to the pelvic urethra. We filled the bladder with saline and put it under pressure to check for any leakage. Everything was good.

   With a neutered male, we didn’t have to worry about sexual function, but I had to trim enough of the bladder that I was sure that Taco would leak urine. It probably wouldn’t bother Betty at this point, she will just have to find a diaper that fits.

   The closure was routine and recovery uneventful. Taco went home the next day. Betty was pleased, even though she knew that time was short. This would at least give her a short time to come to grips with the recent events of her life.

    Taco did live a couple of weeks longer than I had expected. Betty was sad but buried him out by the pond, near where Foster was buried. The horses were gone now, and the ranch was for sale. Betty planned to move east of the mountains to live with her sister. I am not sure what happened to Charlie’s fish.

 I could always deal with the death of a pet without a lot of emotion. I guess that is the farm boy in me. I still remember the calf that was born without a rectum. It was a perfectly healthy little calf but had no rectum. It did well for a few days, but it obviously had no future. I was in the seventh grade, and when I got off the bus on the calf’s 3rd day, Dad said, “I want you to go get the rifle and take that calf without a rectum up on the hill and shoot her.”

 Simple task, I got the rifle, an old Model 94 Winchester 25-35, pulled the calf out of the pen and tied a twin around her neck, and led her up on the hill for a couple of hundred yards. I sat down on a log with her at my feet. Her big brown jersey eyes looking at me, we talked a little about her problem. I must have sat there 10 minutes with her before I gathered enough strength to stand up, shoot her in the head, and, after ensuring that she was dead, returned to the barn to do my evening chores. 

 Pets and animals die at times, and they die sooner than people in the best of times. I could handle that in my mind. When we started to lose clients, often clients who were also friends, that became difficult, and that was something I never really was able to deal with satisfactorily. There was no family attachment, there was really no circle of friends in our friendship. They were sort of in that special place in our lives, business clients, but clients who we shared intimate facets of their life, and often cultured a special friendship. Their loss was just hard to deal with in our minds. 

Photo by Mylene 2401 from Pixabay