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

From the Archives, one year ago

The Angry Awn

KATA Alumni

D. E. Larsen, DVM

“Doctor Larsen, I visited my therapist today, and she told me to find what motivates me and run with it,” Vicki said. “She said, ‘if that happens to be cats, then do cats.’ I am going to start a cat rescue, and I am wondering if I can get some support from you.”

“That sounds like a big project, and there is a definite need around here,” I said. “The County gives no help for cats, and the Humane Society is not much better. Cats definitely are relegated to the back seat.”

“Well, we are going change things,” Vicki said. “Doris is on board with me. We will start small, but we have big plans.”

“I would guess you are going to have to define your operations pretty well, or you are going to be overrun with demand. But I will give you all the support that I can afford. I don’t have real deep pockets, you know.”

Following the initial brief conversation, Vicki and Doris embarked on their project. They had lessons to learn along the way, sometimes they were hard lessons, and as I predicted, the job soon became more than two people could handle.

They started working with colonies of feral cats. Sweet Home had more than enough of those colonies. The life of a wild cat was difficult and short. 

Their goal was to capture, neuter and release. Once captured, they would test for feline leukemia and then vaccinate the negative cats for rabies and feline distemper. The cats would receive a broad spectrum dewormer and then have a trip to a low-cost surgery at the humane society in Salem. There they would be spayed or neutered, as determined by their plumbing.

Once treated and rendered sterile, they would be released back into the colony. With a distemper vaccine onboard, the cat’s survival was greatly enhanced. Distemper is one of nature’s mechanisms to control the population of the cat colonies. In young cats, it is a highly fatal disease. The colonies would experience periodic epidemics where the virus would eliminate a significant portion of the kittens. The feline distemper portion of the vaccine given to the captured cats is one of the best vaccines science has produced. With vaccination and periodic natural exposures to the virus, cats remained solidly immune. The average age of the colony indeed doubled.

The first significant attempt to provide primarily free neuter and spay surgeries locally were undertaken with the aid of the Feral Cat Coalition. The FCC operated a mobile truck set up with three surgery tables and a prep table. Caregivers could bring feral cats in for surgery and vaccinations done by volunteer veterinarians. There was no fee for the procedure. Although, a donation was expected.

My first experience volunteering for the day was when they had the truck at the Holley Grange. I found the day exhausting and the environment in the surgery room hot and lacking adequate ventilation. But we accomplished close to a hundred surgeries. I am sure that some of the cats were less than feral.

After that experience, the Kitty Angel Team took off like wildfire. They grew in numbers of volunteers helping them. The number of cats that they helped, actually saved, also increased. 

They arranged for periodic visits of the Feral Cat Coalition surgery truck. When that wasn’t enough, they would transport cats to low-cost clinics and the humane society for spays and neuters. They held adoption clinics in Petco’s in Albany and Corvallis. And with their tax-free organization status, they expanded their all-volunteer, no-kill cat and kitten rescue to serve the entire mid-Willamette Valley. Their name also extended to the Kitty Angel Team Adoption, KATA.

They were obviously the only choice for Sandy and me when we were tasked with finding kittens for our two California granddaughters, Addison and Olivia. We gave Vickie a call.

“Vickie, we are looking for a couple of kittens for Dee’s girls,” I said.

“You’re in luck,” Vickie said. “Doris has a bunch at her place that are just about ready to go. I would guess that we could release a couple of them early to your care. I will call Doris and tell her you are coming if you would like. Do you know where she lives?”

“Yes, we have been by her place often,” I said. “And it would be great if you could give her a call, that way I don’t have to know her phone number. I know you two try to protect your privacy as much as possible.

We can get up there this afternoon. We are not going to California until the end of the week. But we can hold the kittens at the clinic until we leave. That way, we can make sure they have all their shots and deworming.”

Doris was waiting for us when we pulled into her driveway.

“I have these kittens in the old chicken coop,” Doris said. “This spring has been pretty productive. We have almost twenty kittens in there. I have a few more isolated, just for that mild upper respiratory stuff they get sometimes.”

We followed Doris into the chicken coop, and we were immediately swarmed with kittens. I think they were expecting to be fed. There were all kinds and colors. They all looked to be six to eight weeks old, and I could only spot a couple with a bit of discharge in the corner of their eyes.

“We keep the younger ones with our foster caregivers,” Doris said. “Then, when they are about six weeks old, we move them in here, so they are a little better socialized to the ways of being a kitten.”

“Picking two out of twenty might be a little difficult,” I said.

I had no more than spoke those words when two kittens launched themselves onto my pant legs and started to climb up. They were a couple of tabby kittens, and they looked so much alike that they must have been littermates. 

“It looks like these two made a choice for me,” I said.

We gathered the two kittens up and made a generous donation to KATA. The kittens shared a kennel at the clinic. It was a couple of days before our trip, and they seemed to enjoy being away from the crowd.

***

The trip to South San Francisco proved to be uneventful. The kittens, in their carrier, had no issue with traveling. We stopped for a visit with cousins at Fortuna. We stayed in a motel, but the kittens stayed with the cousins. They were almost adopted by Lorrene and Jim. We could have easily left them there.

We picked up Addison and Olivia from school on our arrival at Dee’s. To say they were excited to see the new kittens would be a colossal understatement. 

It did not take long for Wishbone and Crystal to become fixtures in the family. They have individual personalities, but they also remain very close to each other in their daily routines.

And most of all, they remain a living testament to the great work done by Vicki and Doris and their cadre of volunteers.

Photo by DeLaine Larsen, PhD