It’s Only a Bump, Doc

D. E. Larsen, DVM

Chuck was waiting patiently in the reception area. He was preoccupied with keeping his old dog, Hank, calm. Hank was sitting beside Chuck’s chair, and Chuck had his hand on his back.

Hank was a Mastiff and an old one at that. I have been seeing Hank several times a since I came to town. He was over ten years old, ancient for a giant breed dog.

“Ruth, let’s get Chuck and Hank into an exam room,” I said. “Chuck looks pretty worried.”

Ruth showed them into an exam room, and I gave her a few minutes to set things up before going into the room.

“How are things going, Chuck,” I said as I shook hands.

“I’m doing okay, but Hank here has bumped his leg,” Chuck said. “I debated about having you look at it. I didn’t want to waste your time on a little bump.”

“You don’t have to worry about wasting my time, Chuck,” I said. “And Hank is no spring chicken. Sometimes it is important to look at those little bumps.”

Hank was sitting, trying to ignore my presence. I guess he figured if I was talking with Chuck, he was safe.

“Let’s get a look at this bump,” I said as I knelt down to look Hank in the eye. A long drool of saliva fell from the side of his mouth, almost reaching the floor before it broke free from his mouth. “Where is this bump?”

“It’s right there on the inside of his left front leg, Doc,” Chuck said. “Low on the leg, just above that lower joint.”

My heart sank as I picked up Hank’s left front leg. There was this boney swelling on the inside of the lower leg. All the odds, and all my experience, said this was a bone tumor. 

“What’s wrong, Doc?” Chuck asked as he noticed my change of expression.

Chuck’s wife had passed away five years ago. Since that time, Hank has been his sole companion. How am I going to tell him that Hank is on borrowed time?

“Chuck, I think we should get an x-ray of this bump,” I said.

“It’s only a bump, Doc. Right?” Chuck asked.

“That’s what an x-ray will tell us,” I said.

“Doc, this isn’t like you. You are always straightforward, almost to matter of fact, most of the time,” Chuck said. “What are you thinking?”

“Chuck, I’m thinking this might be a bad bump,” I said. “This is where a lot of bone cancers develop in old giant breed dogs.”

“Bone cancer doesn’t sound good,” Chuck said. “Is there anything that can be done?”

“Let’s not get ahead of ourselves, Chuck,” I said. “Let’s see what the x-ray looks like, and then we can talk about what needs to be done. This will take us a little time to get this film. We have several people to take care of first. Maybe if you go over to Mollie’s, have a cup of coffee, and check back in about an hour.”

“All you’re going to do is take an x-ray, right?” Chuck asked as he patted Hank on the head.

“That’s all we are going to do,” I said. “You go relax for a bit, and we will have a set of films to look at when you get back over here.”

We worked through the other patients and managed to get an x-ray of Hank.

“I want to make sure those films are dry when Chuck gets back,” I said as Ruth hung the films on the drying rack in the dark room.

When I got a chance to look at films on the viewer, my fears were confirmed. On the distal end of the radius, there was a boney swelling with a star-burst eruption starting at the surface.

“Is that a bone cancer?” Ruth asked.

“Yes, when I was in school, this film would confirm the diagnosis,” I said. “Today, I probably can’t find a radiologist that would make that diagnosis without a biopsy, or at least cytology.”

“Chuck isn’t going to want to hear this,” Ruth said. “This old dog has been his whole world since Marilyn died.”

I could see Chuck walking across the street, coming from Mollie’s. I met him at the door with Hank on a leash.

“Let’s step back to the surgery room, Chuck,” I said. “We had a better viewer back there.”

I placed the two x-rays on the viewer. 

“So, here is the bump,” I said as I pointed to the lesion on the bone. “Chuck, I don’t have any good news here. In my mind, this is a bone cancer until I prove otherwise.”

“What does that mean for Hank, Doc?” Chuck asked.

“If I’m right, Hank’s days are numbered,” I said. “There are a couple of things we can do to confirm the diagnosis. The radiologist is going to say we need to do a bone biopsy. We might be able to get a pathologist to confirm the diagnosis with cytology on a needle aspirate. But most of the time, they will also want a biopsy.”

Chuck looked at Hank, sitting at Chuck’s side, sort of pressed up against his leg. 

“I don’t want to put this old guy through a bunch of surgery or other stuff,” Chuck said. “You sound like you’re pretty confident in your diagnosis.”

“When I was in school, not too awful long ago, these x-rays would be considered diagnostic,” I said. “Time changes things for the experts.”

“You’re about the only expert Hank is going to see,” Chuck said. “If this is a bone tumor, is there any treatment that will cure it?”

“Cure is a big word,” I said. “No, Chuck, nothing is going to cure this. We can talk about buying some time, but that comes with some expense for Hank.”

“Hank does have many dollars,” Chuck said with a wry smile.

“I’m not talking about dollars. I’m talking about the quality of life for his final days,” I said. “There is good evidence that if we amputate this leg, we can buy some time by removing this primary tumor.”

“Doc, it’s just a little bump,” Chuck said. “You can’t mean you want to take his leg for that little bump, can you?”

“Chuck, this little bump is going to grow,” I said. “In a couple of months, give or take some, this bump will be much larger. Then it will do one or two things. It will break open and drain, and/or the bone will fracture. Taking the leg removes all of that and allows Hank to live a little longer. The problem is Hank is a big old dog. He isn’t going to be able to handle an amputation like a young dog. And this amputation only removes the primary tumor. Most of the time, these tumors have gone elsewhere in the body by this point, so the amputation is not curative.”

“Doc, we aren’t going to take his leg off,” Chuck said. “Let’s just make him comfortable and give the old guy whatever time he has left.”

“I can agree with that, Chuck,” I said. “The only problem is that most people go too long. If this tumor ruptures, that is not a big thing, but it will be very painful for Hank if the bone fractures.”

Chuck was quiet for a couple of minutes while he looked at Hank and petted his head.

“Doc, I think we will go camp on one of the high lakes for a couple of weeks,” Chuck said. “Hank used to love going camping up there and going fishing. I haven’t done that since Marilyn has been gone. Hank and I have just sat around and grown old. We will go fishing for a couple of weeks, and then we’ll come to see you again.”

“That will be good for both of you,” I said. “I will fix you up with some pain medication. And by then, there will be enough change in this little bump, so we will know for sure what’s going on with it.”

***

It was close to a month when Chuck returned with Hank. The little bump had grown into a large swelling, and Hank was in obvious pain.

“We had a great time,” Chuck said. “It wasn’t like old times, but we still had fun. We even caught a few fish. But Doc, I’m afraid that you were right on all counts. I noticed this swelling was draining a little last night. Hank and I think that it’s time for him to go sit by the fire with Marilyn in that great living room in the sky.”

“How do you want to do this, Chuck?” I asked.

“We talked about that a lot last night,” Chuck said. “Doc, I just can’t stay. Hank and I decided that we want you to take Hank and send him on his way, and then if I could come back in a week or two and pick up his ashes, that would be great.”

And that was the way it was done. With tears streaming down his face, Chuck said goodbye to Hank, stood up, did a military about-face, and marched out the clinic door. 

Hank looked at me, and I imagined a tear from him as he lifted his sore leg and waited.

Photo by Anil Sharma on Pexels.