Don’t Be So Sure

D. E. Larsen, DVM

I could smell the problem before I could see it. The entire front of the clinic reeked of the foul odor of rotten flesh.

Dixie was waiting outside of the exam room. The air inside was not something you wanted to breathe for too long.

“Mrs. Johnson is in the exam room with Bella,” Dixie said. “It is a real mess.”

Bella was a Great Dane and a great dog. Bella, at almost ten years of age, was ancient for a Great Dane.

The minute I entered the exam room, the problem was obvious. Bella had a massive mammary tumor hanging from the middle of her abdomen. By massive, I mean a tumor the size of a cantaloupe. This tumor had ruptured and was drain putrid fluid from its interior.

“Oh my,” I exclaimed as I knelt down to examine the tumor. “How long has this been here, Mrs. Johnson?”

“I know I have allowed it to go far too long,” Mrs. Johnson said. “But Bella is so old, I really didn’t want to put a lot of money into treatment. You know Dane’s don’t live too long.”

“I understand that,” I said as I stood up. “But at this point, there is not much that can be done.”

“She smells so bad, I would like to have the tumor removed,” Mrs. Johnson said. “I that something that can be done?”

“I can remove the tumor,” I said. “It will be a major surgery for an old dog, but it can be done. The thing is, we will definitely be closing the barn door after the horse is out, so to speak. We should take a chest x-ray before surgery to see what kind of shape her lungs are in. She probably has tumors in her lungs already. Removing this tumor may buy her only a short time. By that, I mean we get rid of this uncomfortable tumor and make Bella good company. But it does nothing for the cancer that has spread throughout her body. She could die in days, or weeks, or months. I won’t say years because I am almost certain that she won’t survive another year.”

“I understand that, but I would like to enjoy her company for whatever time she has left on this earth,” Mrs. Johnson said. “I hope you don’t think I am being selfish. I trust your opinion on her lungs, and I have read a bit about that. There again, I was hoping we could do this without an x-ray. I mean, we know she has little time. What good will come from having a picture to prove that point.”

“No, I think that’s valid thinking,” I said. “By removing this primary tumor at this point in time, it will definitely help Bella. These large tumors grow in an unorganized manner. When they get large, the center of the tumor loses its blood supply and dies. Eventually, the decayed center of the tumor ruptures to the outside. That is where we are at with Bella. I will do the surgery as long as you understand we are only buying Bella a short time. And if you promise to remember this conversation.”

So we scheduled Bella for surgery the following morning. We scheduled her to come into the clinic at ten in the morning so we could go right to surgery and not smell the clinic up too much.

***

When Mrs. Johnson came through the door with Bella, we left her to sign her paperwork, and we rushed Bella through a hasty exam. Then following a final goodby from Mrs. Johnson, Bella was pointed toward the surgery room.

“We are going to get her right now,” I said. “Everyone is going to feel better once we get this tumor off of her and get the odor contained. We didn’t discuss sending this tumor in for histopath. That will allow us to know just how aggressive this tumor happens to be. Is that something you would like to have done?”

“I haven’t thought that,” Mrs. Johnson said. “Is that something I need to decide right now?”

“I will save a sample in formalin, and you can make that decision later,” I said. “We can see how she is doing when we get the sutures out and make the decision at that time.”

“That’s good,” Mrs. Johnson said. “That way, if she is going to fade away rapidly, we’ll know that by then. Or at least, I hope we will know.”

“The problem with these old dogs is they are tough enough to hold out to the very end and act pretty normal until they fall off the cliff. She may very well be normal one night and near death in the morning. That is just the nature of the beast.”

In those early years, I had no mechanical assistance for lifting and moving these large dogs. I was strong enough that lifting a hundred and fifty-pound dog on and off the surgery table was not a big problem.

When we had Bella prepped, and on the surgery table, I draped the tumor. It was quite a sight. Bella was almost too long to fit on the table. Her large Dane chest rose into the air under the surgical drapes and then this rotten, melon-sized tumor sticking up out of the drape. 

I scrubbed and gowned and picked up the scalpel.

“This tumor probably has some large vessels feeding it,” I said. “I will try to isolate them before I cut them, but there is no guarantee. We could have a squirter or two.”

About that time, Sandy popped her head in the door.

“Boy, it smells in here,” She said.

“Yes, we are going as fast as we can,” I said. “I will feel better when this thing is bagged up in the back.”

“Dr. French is out front,” Sandy said. “I thought you might want to say hi or something.”

“Yes, have him step back here if he wants to see this,” I said. “But warn him about the odor.”

Al French has been a good friend since we came to town. He was an older Lebanon physician and an owner of Great Danes.

“Wow, that is some tumor,” Al said as he entered the surgery room. “And it stinks too.”

“I don’t see this type of thing too often, but I have had several of them since I came to town,” I said. “It’s always the same. They want something done when there is so little time left.”

“You are going to take that thing off?” Al asked.

“Not many options for the owner at this point,” I said. “Take it off so you can live with the dog or put her to sleep.” The problem is the owner seldom fully understands that we are not going to buy any time, short of removing the rotten mass that runs everyone out of the house.” 

“I would guess that the dog will feel better getting that rotten mass off of her,” Al said.

“Yes, I think so. And Bella here seems to be embarrassed by the odor. Like she knows she is not acceptable when she is around people.”

“Are you going to do anything else for this dog?” Al asked.

“This dog could be dead next week,” I said. “I will be surprised if she lives a couple of months. Chemotherapy would be a big waste of time at this point, and it is not available locally.”

“Metastasises are probably everywhere by now,” Al said.

“There is a money issue here with this dog, also,” I said. “You probably don’t get a chance to see this sort of thing.”

“Don’t be so sure about that,” Al said. “We see old grandma who doesn’t want to be a bother to anyone. She just straps the thing down, and nobody notices the problem until it is too late. Most of the time, the tumor is not this large, but sometimes it does rupture, and that is when it is found.”

“That must be a difficult problem to solve,” I said.

“I have the luxury of sending her to a specialist,” Al said. “It doesn’t change anything. The outcome is always the same, but I am not the one to deal with the ultimate problem. And we don’t have the option of putting the patient to sleep.”

When Al left, I hurried to remove the tumor. There were no squirting vessels as they were easily found in the trim Great Dane. The surgery room smelled better almost instantly when the tumor was removed to the back of the clinic.

Bella recovered well, and she did feel much better right away following surgery. The incision healed nicely, and Mrs. Johnson declined to send in any tissues. I am sure she thought that Bella was cured. But true to my guess, Bella returned to the clinic in severe respiratory distress some six weeks following surgery.

“At least we gave her a few good weeks at the end,” Mrs. Johnson said. “And you were right, Doc. She was maybe a little slow the last couple of days, but she ate her dinner last night and sat beside me as I watched the news. Then this is what we had in the morning.”

We put Bella to sleep, and Mrs. Johnson took her home to bury her.

“I have two grandsons at home. They have already dug the grave, and they will take care of her.”

Photo by Nick Freiling on Unsplash