Tiny’s Swollen Belly 

D. E. Larsen, DVM

I watched as Dixie showed Mr. Johnson into the exam room. He ducked his head as he went through the door. I don’t know if he needed to duck, but it was close. Mr. Johnson was a large old man. Not fat, just tall and solidly built. In his later years, he lost some muscle mass, making his pot belly a little more prominent. 

“What’s going on with Tiny today, Don?” I asked as I entered the exam room. 

One of the things that I always found interesting was how the biggest men seemed to be attached to the smallest dogs.

“I don’t know what’s going on, Doc,” Don said. “Tiny is all swollen up in the belly the last few days. I guess it has been going on for some time now, but it has been really bad these last few days.”

I took Tiny from Don’s arms. He was always reluctant to place her on the steel exam table. Dixie brought a blanket in for the table, and we carefully placed Tiny in the middle of the table.

Tiny fit her name. She was a small Chihuahua. When I finally got a good look at her, it looked like her little belly was going pop. It was so distended that I couldn’t compress it enough to feel anything inside.

“She was uncomfortable this morning, Doc,” Don said. “I figured I better get you to look at her before she popped. What do you figure is going on with her?”

I listened to Tiny’s heart, and it sounded normal. I could bounce any enlarged organ off the distended belly wall.

“I am probably going have to hang on to her for a bit to find out what’s going on,” I said. “Can you leave her with us for a few hours?”

“You know I don’t like to leave her, Doc,” Don said. “It’s not that I don’t trust you. It is just that we are never apart. She is all I have, Doc.”

“Okay, I will start with just a little needle poke,” I said. “That way, I can maybe figure out what kind of fluid is in Tiny’s belly. Depending on what that looks like, I may need to drain a lot of this fluid so I can get an X-ray. If I take an X-ray with all this fluid, we won’t be able to see much.”

“You can do that right here?” Don asked.

“Yes, you sit down in the chair,” I said. “You have a long way to fall if you faint. I will grab some things, and we can do this right here.”

“I’m not going to faint,” Don said with a bit of a frown. “During the war, I saw a lot more than a needle poke.”

We laid Tiny on her side and clipped a small area on her lower abdomen. After a prep, I used a sixty cc syringe to draw some fluid off her belly.

“You said a little needle poke,” Don said. “That looks like a horse needle.”

“I figure if we are going to poke her, we may as well draw off enough fluid to make her more comfortable,” I said.

The fluid was ugly. It was a dark straw color with small white flecks all through it. This was not going to be good news for Don. With a full syringe of fluid removed, Tiny’s belly was relaxed enough now that I felt her liver and spleen were not enlarged.

We returned Tiny to Don so he could hold her while we took the fluid syringe to the lab.

“We are going to get a look at this fluid. It will only take a few minutes,” I said.

The white flecks in the syringe were quick to settle to the bottom of the fluid. I squeezed a drop on several slides, making sure I had a slide with a lot of flecks.

My heart sank as soon as I looked at the slide. The slide was covered with large aggregates of tumor cells. The only tumor that I knew of that would put this much debris into the abdominal fluid was an ovarian tumor. This was not good news for Tiny, and I had no idea how Don could cope with the pending crisis.

“Don, that slide that I just looked at from the fluid looks like bad news,” I said. “It looks like Tiny has a tumor in her abdomen. It might be a bad tumor, Don.”

“Can you remove it?” Don asked.

“We need to confirm what type of tumor it is first, but if it is what I think it is, we can remove the tumor, but it will have already spread elsewhere in the abdomen.”

“Are you trying to tell me that you think Tiny is going to die?” Don asked.

“I don’t know that for certain at this point, Don,” I said. “But we need to find out as fast as we can.”

“I don’t have a money tree in the backyard, Doc,” Don said. “I want to help Tiny if I can, but we have to do it without spending a lot of money.”

“When there are limited funds, and we are dealing with an abdominal tumor, I think the best approach is to do an exploratory surgery,” I said. “That shortcuts a lot of the diagnostic work. If I find something I can deal with, we take care of it right there. If it can’t be fixed, then we have decisions to make.”

“When can you do this surgery?” Don asked.

“I can move things around on the schedule and do the surgery in the morning,” I said. “Now, Don, if this is an ovarian tumor, there might not be much to be done. Looking at this fluid, this tumor has probably spread all across the abdomen. If that is the case, Tiny will die, and all the money in the world will not help her.”

“But if it is something else, you could maybe fix it,” Don said.

“Yes, but you are grasping at straws now,” I said. “My guess is there will not be much I can do to help Tiny. I may be able to remove the primary tumor, but looking at this fluid, that will be closing the barn door after the horse is out. The other option would be to send this fluid into the lab and get an opinion from a pathologist. I could draw the fluid off Tiny’s belly so she would be more comfortable while we wait for the results from the lab. That should only be a couple of days.”

“And I suppose that just adds another hundred bucks to the bill,” Don said.

“If the pathologist agrees with me, we might want to rethink doing a surgery,” I said. “If there is not going to be anything that will help Tiny, we might want to just make her comfortable for the time she has left instead of doing a surgery.”

Don sat quietly for several minutes, cuddling Tiny and looking at her.

“You really think I’m going to lose her, don’t you, Doc,” Don said. 

“That’s what I’m afraid of, Don,” I said. “Why don’t we draw some fluid off Tiny’s belly, and I will send those slides and the fluid to the lab. It will only take a couple of days to get results. Then we can talk again about the best thing we can do for Tiny.”

With another few minutes of thought, Don agreed. We drew another two large syringes of fluid off Tiny’s abdomen. The fluid didn’t look any better this time, but Tiny felt much better.

“Now she is going to feel pretty good with all that fluid off her belly,” I said. “But don’t think that she is well. I will call you as soon as I get results from the lab, and we can decide what we want to do.”

***

“Dave, I don’t like to make a diagnosis with just cytology, but looking at this fluid you sent and the slide, this has to be an ovarian tumor,” the pathologist said. “With all these tumor cells floating in this fluid, this tumor has spread all over the abdomen. There is nothing you can do for this dog.”

“Would removing the primary tumor be any benefit?” I asked.

“In ovarian cancer, the primary tumor seldom causes any problem,” Doctor Hedstrom said. “It just spreads to every corner of the abdomen. There is nothing we can do for this dog at this point.”

I had Sandy call Don to make an appointment for a consultation. I didn’t look forward to the conversation. 

Don was in the exam room with Tiny when I entered.

“Just like you said, Doc, she felt great after you took the fluid off her belly,” Don said. “I thought you had to be wrong. She was feeling so good. But it seemed to all come back almost overnight, and now she feels worse than before.”

“The pathologist agrees that this is an ovarian tumor,” I said. “He says that surgery won’t be helpful for Tiny.”

“If you can take this fluid off one more time,” Don said. “Give me one more day with her. That is all I ask.”

And that is what we did. I drew off another three syringes of fluid, and Don went home with Tiny.

It was three days later when he returned to have Tiny put to sleep. It was hard, but she was weak and miserable. It was the best thing for her.”

Photo by Stephanie Yolanda on Pexels.