I Don’t Understand

D. E. Larsen, DVM

We were still getting settled into our house and I was busy trying to light a fire under the contractor building the clinic. That project was months behind schedule. Sandy and I were laying awake, in bed, on Sunday morning. Hoping we could get a little more time before the kids woke up. And then the phone rang.

“Hello, this is John, I live up the creek from you,” John said as soon as I picked up the phone. “I was hoping I could get you to look at my dog this morning.”

“It’s Sunday morning, you know,” I said. “What kind of an emergency do you have?”

“She is an old Golden Retriver and the vet in Lebanon took a mammary cancer off of her a couple of months ago,” John said. “She gets fluid on her chest now and he has had to drain that fluid about once a week. We had her over there on Friday and she is already having trouble breathing.”

“That doesn’t sound very good for her,” I said. “Has he taken a chest x-ray?”

“Yes, but he couldn’t see anything but fluid,” John said.

“Well, you have to take the x-ray after you draw the fluid off her chest,” I said. “If the fluid accumulates this fast, she likely has cancer all through her lungs. You are just buying her a short time and one of these days, in the near future, you are going to be up with her a three in the morning and she will be in a respiratory crisis. Has he talked to you about that possibility?”

“No, he just says as long as we keep the fluid drained, she will be okay,” John said.

“Well, I think you should call him this morning and let him draw the fluid off her chest,” I said. “If you can’t get ahold of him, I will do it. But if I do it, we will take an x-ray following the procedure and with the emergency fee, it will probably cost you more than you will spend over there.”

***

John went to the vet in Lebanon that Sunday but he was back at my door on Tuesday morning.

“John, I will take care of Sally for you but after I draw the fluid off her lungs, we are going to take an x-ray,” I said. 

“I don’t understand why you think she is so bad,” John said. “You act like she is going to die or something.”

“Are you telling me that the vet in Lebanon hasn’t talked to you about why the fluid is building up and what the prognosis is for Sally,” I said.

“No, he just says this is just a complication of the cancer,” John said.

“I shouldn’t say anything until we get an x-ray,” I said. “But if I was in Reno, all my money would be on Sally being dead before the end of the month.”

“Maybe I should stay with the vet in Lebanon, at least he is more optimistic than you are.”

“That is fine, John,” I said. “I think I would encourage you to do that. If he makes you feel better, that is what you need to do.”

***

It was the following Sunday when the scene repeated itself. The phone rang. I looked at Sandy, and she just smiled.

“No rest for the wicked,” Sandy said as Derek started to cry.

It was John on phone. He was so excited, he could hardly talk.

“Doc, this is John, Sally is laying on floor gasping. She can hardly breathe. Can I bring her down and have you draw some fluid off her chest.

“Okay, John, but be careful handling her. She is probably hanging onto life by a thread.”

We got up and dressed quickly. Sandy started taking care of the kids and I went out to meet John who had just pulled into the driveway.

“She is dead, I think,” John said. “It was terrible to watch. I just don’t understand how it happened.”

“John, when the dog has an aggressive mammary tumor, it spread throughout the body. We usually see it show up in the lungs first. When fluid is building up in the chest as fast as it was with Sally, that say the lungs are full of cancer. In the dog today, there is not much we can do at that point. You have a couple of choices. You can do what you did and keep drawing it off, but that is a short term fix. The other choice is to put her to sleep before you put her through a death like you witnessed this morning.”

“Well, why didn’t you tell me all of that before when I was here?” John asked in a stern voice.

“If you remember well enough, you would remember that I tried, but you were not prepared to listen,” I said. “You made the election to stay with your vet in Lebanon. It would be inappropriate for me to change his course of treatment at that point.”

“So, why didn’t he tell me that? Surely, if you know all of that, he would know it also.”

“I can’t speak to what went on in your conversations with him, John,” I said. “A lot of times, we will tell clients something, and if they are stressed by the situation, they just don’t hear. That is why I try to write things down for folks.”

“Why didn’t the surgery solve the problem in the first place?” John asked.

“It is sort of the luck of the draw,” I said. “We remove a lot of mammary tumors that never cause a problem. Some of that is because the tumor is benign and sometimes it is because the dog’s lifespan following surgery is short enough that we don’t see a problem. But when the tumor is a hot tumor, it has gone elsewhere in the body before we remove it. Then there is not much we can do. There is only very limited chemotherapy and radiation available and that is with high price tag. That usually means sending the dog to a Vet School Hospital for treatment.”

“If I was with you, you would have just put her to sleep then?” John asked.

“That is always a hard decision, and it is different for everyone,” I said. “I would have definitely offered you that option, up front. But when the fluid draws started happening every couple of days, I would have encouraged you to make that decision. Just because it was not fair to Sally to have her die in respiratory distress.”

“I want to be mad at someone, but you make it sound like it was just going to happen,” John said. “So now, what do I do with her?”

“Right now, I don’t have a lot to offer you,” I said. “You can take her home to bury or I can have that county dog control pick her up.”

“And what happens to her if the county picks her up?” John asked.

“If the county picks her up, they send her to a rendering plant and she ends up in fertilizer,” I said.

“An odd ending for good dog,” John said. “I guess I will call the grandkids to help me dig a hole. They will be upset with her passing.”

“Losing a pet, even a pet of the grandparent, is a good lesson for kids,” I said. “I think it is one of last gifts that pets provide. They teach young people how to grieve.”

Photo by Anthony Maina on Unsplash