D. E. Larsen, DVM
Edith was an older lady who you would see walking down the street in Sweet Home daily. I don’t think she drove, but maybe she just preferred to walk. Her hair was always curled but not what you would call well kept. Some would call her petite, and I am sure she was at one time, but I would say she was matronly petite. In any case, the most important thing about Edith was she was always happy. We would notice that happiness in the clinic, and when you saw her walking, she always had a smile on her face. She could definitely enjoy the simple things in life.
For the first 5 years that we were in Sweet Home, Edith visited the clinic often. In fact, there was not a single month without a transaction on her account. This was unusual in that the average client might have three to five transactions per year. She would come into the clinic with Coco always in tow. Coco was a mutt, many people would call him an ugly mutt. He weighed about 20 pounds and had a gray, straggly coat. His lower jaw protruded well past his upper jaw, and when you looked at him, he would often smile, but it looked like a snarl.
Coco’s monthly trips to the clinic were more of a social event than a medical one. Coco was healthy as a horse, but there was always something that Edith wanted to be checked. I can’t remember finding anything wrong with Coco.
One Saturday morning, we were planning our day and hoped to take the kids to a movie in Albany, when the phone rang. It was Edith, and she was sure Coco had a problem. My initial thinking was Coco never has a “real” problem. This was going to disrupt our entire weekend to go to the clinic and reassure Edith that everything was fine with Coco.
“Edith, are you sure this couldn’t wait until Monday?”
But Edith persisted.
“Doctor, I know there is somewhat dreadfully wrong. Coco is just not himself this morning!” she replied.
I was stuck, but it should only be a brief visit. I arranged to meet Edith at the clinic in 15 minutes. Paul was home and could drive her and Coco to the clinic, so that would work.
Edith was smiling but concerned when she came through the clinic door. She thanked me profusely and reassured me that there was indeed some wrong with Coco. Coco groaned a little when I picked him up and put him on the table. Maybe he has hurt his back, I thought to myself. His temperature was normal, but Coco was not wagging his tail and was not acting his usual happy self on the table. His heart and lungs were normal, and the oral exam was normal. Then I got to the abdominal palpation. Coco tensed his abdomen from discomfort. His bladder was distended and uncomfortable.
I had almost made Edith and Coco wait until Monday. And here we have Coco with a urinary tract obstruction. He could have been dead by Monday
“Edith, when was the last time you saw Coco pee?” I asked.
“Well, he was outside this morning and lifted his leg several times, but nothing happened.”
“Edith, Coco can’t pee. Most likely, he has a stone blocking his urethra. If so, I will have to do surgery to remove the stone. I need to do some x-rays first to see if there are stones, how many stones, and where they are located. Most of the time, there is just one stone blocking the urethra, the tube from the bladder to the outside, and the surgery involves opening the urethra and removing the stone. If there are more stones in the bladder, we will need to do abdominal surgery to remove them also.” I explained.
“Surgery!” She exclaimed. “Shouldn’t that wait until Monday?”
“No, we can’t wait that long. Coco might be dead by Monday if we don’t do surgery now. At the very least, he would have some major complications by then.”
“You do whatever you need to do, Doctor,” she said. “We have the money in the bank to pay for it, and we can’t give Coco up.”
“I will get some x-rays and call if anything changes in my thinking after the x-rays. Otherwise, I will call following surgery, and we will arrange to send Coco home sometime this weekend.” I said.
We were going to have to get lucky to able to take the kids to a movie today. I took the x-rays, and sure enough, there was a stone stuck at the base of the os penis. The dog, like many animals, has a bone in his penis called the os penis. The urethra narrows slightly as it passes through a groove on the underside of the os penis. Most stones that cause obstruction are lodged in this location. Coco had no other stones visible in his bladder or elsewhere in his urethra. This would be an easy surgery.
I called Sandy and had her get the kids ready and come down to give me a hand. All the kids had observed many surgeries, so this would just be one more. I started getting Coco and the surgery suite ready, so we would be prepared to go the minute Sandy and kids arrived. The plan was to do the surgery, recovery Coco and then run to the movie while he was resting in the kennel. We should be able to send him home when we return from Albany.
When Sandy arrived, we got started with the surgery. I induced anesthesia with IV Pentathol and then put Coco on gas anesthesia. With him on his back, I clipped and prepped his posterior ventral abdomen. I could feel the stone. This should be a brief procedure.
I inserted an 8 French urinary catheter. It came to a stop at the stone. I made a one-inch incision in the skin of the prepuce over the stone. Then I dissected through the soft tissues to the urethra. I pushed a forceps through the tissues on the dorsal surface of the penis to stabilize the area. Then with a careful incision, I opened the urethra over the stone. This incision was just long enough for me to grasp the stone with forceps and remove it. I immediately plugged the hole with finger pressure. I advanced the catheter into the bladder to empty it and avoid leakage of urine into the surgery site.
After emptying the bladder, I left the catheter in place to ensure my closure did not narrow the urethra. I closed the urethra with interrupted 4-0 Maxon sutures. Then with the same suture material, I closed the subcutaneous tissue with a continuous suture pattern. Finally, I closed the skin with 4-0 nylon interrupted sutures. I infused a small amount of Lidocaine for pain control and turned off the gas to start waking up Coco. Maybe 15 minutes had elapsed. Since he would be unattended in a kennel after he was awake, I gave him fluid under his skin on his back rather than IV.
Recovery was pretty rapid, and Coco was up and about. He would be fine and should be able to go home when we got back from Albany. I gave Edith a call and reported favorable results. We arranged to meet her and Paul at the clinic when we returned from the movie.
The kids enjoyed the movie, Indiana Jones in Raiders of the Lost Ark. Sandy had tried to cover Derek’s eyes in the spider scene, but he was able to fight her off. The kids had been worried they would miss the movie because they had seen family plans set aside more than once by a phone call.
When we pulled up to the clinic, Edith and Paul were waiting out front in their car. They were talking and laughing. Here was our happy little gray-haired lady who adored Coco, sitting in the car outside the clinic, passing a whiskey bottle back and forth between her and her husband. Now my only concern was them driving home.
Photo by Julian Hauffe on Unsplash.