D. E. Larsen, DVM
It had been several years since I had seen Ayers when I noticed Sandy showing him and Nessie into the exam room. I knew he had a few tough years, as is always the case when an old man loses his wife.
Nessie was a rough-looking little miniature schnauzer. She wouldn’t win any contests at the dog shows, but she was one of the best little farm dogs I knew. She has been Ayers’ sidekick for many years, and now I would guess that she is his only companion.
“What’s up with Nessie?” I asked as I entered the exam room.
“I don’t rightly know, Doc,” Ayers said. “She has really slowed down the last week or two. And this morning, she wouldn’t even chase the squirrel out of the manger. You know she’s a tough little rascal, so when she quits doing her job, she has to be hurting.”
I leaned over and lifted Nessie onto the exam table. She tensed and groaned at the procedure.
“Something really hurts,” I said. “It is either her back or her abdomen. Has she been eating okay?”
“She ate a few bites yesterday, but she hasn’t touched her food today,” Ayers said.
I ran my finger down her spine, applying only moderate pressure, and Nessie showed no response. She tensed her abdomen with the slightest touch to her belly wall. I petted her and held her right side close to my body, and I lightly blotted her abdomen with the fingers of my left hand. I bounced off of a large abdominal mass.
“Ayers, she has a large mass in her abdomen,” I said.
“What does that mean for her?” Ayers asked.
“We need to investigate it a bit,” I said. “Abdominal masses can be anything. Location-wise, I would guess this is a splenic mass, but it could be her liver or something else. Sometimes we can define things with an abdominal x-ray. Still, it often requires surgery to determine if we can do anything with it. If it is on the spleen, we can remove the whole thing with surgery. Then it just depends on if it is malignant or not. If it is the liver, those are usually over my head here, and I send them to a guy in Eugene.”
“Doc, I have been bringing Nessie here since she would fit in my coffee cup,” Ayers said. “We will be here until she dies. I don’t want any discussion of going somewhere else. If you can’t get it done, it won’t be done.”
“Okay, I will need to get some blood out of her and do an x-ray,” I said. “Then we can talk about what needs to be done.”
“Whatever you think is okay,” Ayers said. “But it sounds to me like you just need to open her up and take a look. You are either going to be able to fix her or not. If her kidneys aren’t going to be able to take the surgery, so be it. And if she only has a short time to live, if she is out of pain, that is all I care about.”
“You’re right, of course,” I said. “A lot of the testing is just to generate dollars and cover my butt. In Nessie’s situation, if we aren’t going to be referring her, I just need to look and fix it if I can. I can do that surgery later this morning. I have some surgeries scheduled for this morning, but I can do those another day or do them this evening.”
With Nessie on prepped and on the surgery table, I draped her abdomen for a long ventral incision. I started the incision about an inch below her xiphoid process and extended it to an inch below her umbilicus. As soon as I entered the abdomen, I could see a massive splenic tumor.
I carefully worked the spleen out of the incision. I was worried that this tumor could easily rupture is I handled it roughly. When I had it out of the abdomen and laid on a moist towel, I could get a good look at the tumor.
This tumor looked like it had a mix of tissue in it, and it was unlike any splenic tumor I had seen before. That was probably not going to be good news for Nessie and Ayers.
The good thing was it was contained within the spleen, and by removing the spleen, we would be sure to get the entire tumor. The bad thing was if it was a malignant tumor, it had likely already spread elsewhere in the body at this size and appearance.
Starting at the tail end of the spleen, I started ligating the row of vessels, and I tied the ligatures close to the spleen. It was a tedious job, requiring over two dozen double ligatures. I severed the vessels between each double ligature as I progressed to the head of the spleen.
When the spleen was removed, and I double-checked all the ligatures, I returned everything remaining to the abdomen. I explored the abdomen for any other tumors. Finding none, I closed the incision in three layers, and we recovered Nessie.
Nessie recovered well and was bouncing around the kennel when Ayers came back to pick her up at five.
“Boy, that’s my Nessie” Ayers said. “She is back to her old self already. We can’t thank you enough, Doc.”
“Ayers, Nessie’s spleen had a large ugly tumor on it,” I said. “It will take several days, if not a week, to get results. But, Ayers, this tumor didn’t look good to me.”
“But you got it all, didn’t you?” Ayers asked.
“Yes, that is the good thing about a tumor in the spleen,” I said. “We just take the entire spleen out, so yes, I got it all. But if it is malignant and has already gone elsewhere in the body, we have probably only bought her a few months.”
“Well, like I said before surgery, Doc, if you can give her what time she has pain-free, we will be happy.”
The lab seemed to take forever, and I finally called them.
“This is Doctor Larsen in Sweet Home,” I said when the receptionist answered the phone. “I sent some tissues in over a week ago, and I haven’t heard a word out of you guys. I was just calling to check on the status of the tissues.”
“Yes, it has been a long time,” the receptionist said when she retrieved my file. “Let me connect you to the pathologist.”
“Doctor Larsen, this tumor is really unusual to see in a spleen,” the pathologist said. “I would say rare, in fact. I have been hitting the books on this one and doing some special stains, and I am just writing the report now. It looks like it is a schwannoma. These are rare tumors in the dog and exceeding rare in the spleen. Often a schwannoma is benign, but this one looks aggressive to me. I would give the owner a very cautious prognosis.”
“Is there anything else that can be done?” I asked.
“I don’t think there is a word written in the literature on the treatment,” the pathologist said. “There is scare little written period, only a couple of sentences that mention an occurrence.”
“Sort of the luck of the draw,” I said.
When Ayers was in with Nessie for suture removal, Nessie was still feeling great, and her incision was well healed.
“Boy, you should see her chase that squirrel out of the manger now,” Ayers said. “I think she is acting like she is five years younger.”
“These dogs are always amazing,” I said. “When I had my appendix out, I didn’t walk upright for three weeks. And Nessie is out there chasing squirrels before her sutures are out.”
“Have you heard anything from the lab?” Ayers asked.
“Yes, this was a very rare tumor,” I said. “It is a big word; it’s called a schwannoma. There is not much written about it being in the spleen. Often a schwannoma is benign, but you remember that I said it didn’t look good to me. The pathologist thinks it is likely an aggressive tumor.”
“How much time do you figure she has, Doc?” Ayers asked.
“I have no idea, Ayers,” I said. “When dogs have the most common malignant tumor in the spleen, they seldom live more than two months. But there is nothing written about this tumor. We just need to take things one day at a time. I like to tell people to count the good days and the bad days. When the bad days outnumber the good days, we should start thinking about putting her to sleep. But dogs are tough, Ayers. This tumor has probably been bothering her for some time, and she only slowed down in the last couple of days. She will probably go the same way, acting normal right up to the end until she can’t go another step.”
True to my words, Nessie lasted about six months following surgery. Ayers came in to tell me that he had found her dead in the manger that morning.
“I figure she was chasing that squirrel and just fell over dead,” Ayers said with a tear in his good eye. “I don’t know what I’m going to do now. I guess I will have to tame down that old tomcat that started living in the barn last winter. I have to have something to talk to, you know.”
“I know, Ayers,” I said. “You know, you can always come by here and spend some time telling stories here if you want. And I would bet that that old tomcat will think he is in heaven.”
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