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.

I Don’t Have Fleas!

D. E. Larsen, DVM

The clouds were gathering in the sky, and everyone was hopeful that fall would finally be here. It had been a long summer. 

We were winding down for the day, and Sandy and I planned to take the kids to a movie. We had just switched the phone at the clinic over to the answering service when Sally came through the door with her Rottweiler pup.

“Doctor Larsen, I hope you have time to look at Brutus,” Sally said. “He is chewing a hole in his rump, and I have no idea what’s going on with him, but it looks bad.”

I looked over the counter at Brutus, a young Rottweiler. “Looks like fleas, Sally,” I said. “Do you want to try a shampoo and see if that works?”

“Doctor, this can’t be fleas. Brutus is never around other dogs,” Sally said. “And I don’t have fleas in the house. The other dogs look fine, and none of us ever have a flea bite. Besides, all the dogs have flea collars.”

“Okay, I will take a few minutes and look Brutus over, but we have plans this evening,” I said. “This might be a short visit.”

We took Brutus into an exam room, and I lifted him onto the table. He had an obvious sore on his tail-head where he had been chewing on himself. I parted the hair, and the fleas scattered.

I pulled Brutus close to me and held him while I pulled his legs off the table and laid him on his side. Then rolling him on his back, Brutus looked at me with his head held off the table. He wasn’t sure he liked what was going on.

“Now, Sally, watch his belly close,” I said as I scratched Brutus so he would relax and spread his hind legs.

Many fleas scattered, seeking cover in longer hair.

“Oh, my God, where did all of those come from?” Sally exclaimed.

“Sally, it is late August in the Willamette Valley,” I said. “Fleas are everywhere, and you can’t avoid them.”

“But he has a flea collar,” Sally said.

“Yes, that is better than nothing, but not much better,” I said. “Those flea collars do a good job controlling fleas around the head and neck. On a dog like Brutus, the little cloud of protection is about three feet behind him most of the time. I doubt if he spends a lot of quiet time.”

“The box says they work,” Sally said. “It said they would give total flea protection for six months.”

“Yes, I know what the box says,” I said. “But the box is talking about Denver. That is probably where they did all the testing. They don’t understand what fleas are in Denver. They don’t have fleas there. When I was in vet school at Colorado State, in four years, I never saw a dog that looked like Brutus. I never saw a case of flea allergy dermatitis.”

“That’s terrible. How do they get away with that kind of marketing?” Sally asked.

“I am sure they have the paperwork to back up their statements on the box,” I said. “It is just that things are different here.”

“Can we take care of his problem?” Sally asked.

“Sure, but it takes a lot of work to get fleas under control this time of the year,” I said. “We are told that there are products on the horizon that will work better, but I will believe it when I see it.”

“Why don’t I have any flea bites?” Sally asked.

“Fleas only like special people,” I said. “When we have fleas in our house, only me and one daughter will have flea bites. Nobody else will know there is a problem. If you watch when you drive around town, you will see a few dogs with little or no hair on their back half. Those dogs all have flea allergies. The other dogs probably have fleas also but are not bothered.”

“What are we going to do to help poor Brutus?” Sally asked.

“For this sore, we will give him some prednisone for a few days, along with a course of antibiotics,” I said. “For the fleas, I will send you home with a good shampoo, followed by some flea spray. Then, if you really want to get things under control, you need to use a flea bomb in the house and a yard spray for the outside. And then, hope for an early winter.” 

“I  really don’t want to do the flea bomb thing,” Sally said. “I had a friend that did all of that a couple of years ago. It seemed to take care of her problem, but it was a real hassle.”

“Some of these shampoos do a pretty good job at giving a week of protection,” I said. “It might work to just plan on giving Brutus a bath every Saturday morning for a while. We can always get more aggressive later if it doesn’t work.”

“Yes, that sounds good to me,” Sally said. “Just fix me up with the medication and the shampoo, and you can still make your plans for the evening.”

Sally and Brutus when out the door with a large bottle of shampoo, flea spray, and medication. 

As soon as Sally left, Sandy locked the front door.

“I bet she will be back next week or maybe in two weeks,” I said. “Giving Brutus a bath will probably be more of a chore than she thinks.

“Let’s get out of here before someone else catches us,” Sandy said. “If we don’t get to this Star Wars movie early, we won’t get a seat.”

Photo by Rachel Leibelt.

Blackjack and Newt, From the Archives

D. E. Larsen, DVM

“Joleen, are you still feeding that feral tomcat out the back door?” I asked.

“I don’t think he is really feral. I am going to catch him one of these days.”

“Catch him. If you get ahold of him, it will be a question mark as to who has caught who,” I said.

Our original clinic on Nandina Street had a large patch of berry vines across the alley from the clinic. That patch of briers was home to a sizable population of feral cats. Joleen had taken a liking to this young black tomcat. She was convinced she could catch him and tame him down.

A couple of weeks later, Joleen came out of the back and washed her hands at the front sink.

“I got him,” she said as if it was no big deal. “I threw him into the isolation ward. It wasn’t so hard. I didn’t even get scratched.”

“What are you going to do with him,” I asked.  

“I figure if we neuter, vaccinate and deworm him, then leave him in a kennel for a time, he should tame down just fine. Then I will either take him home, or we could make a clinic cat out of him.”

“I’m not sure about a clinic cat,” I said.

But, so began Blackjack’s sojourn in the clinic. 

Our first adventure was transferring him from the isolation room, a small bare room at the time, into a cage in the kennel room. He was not going to be fooled by Joleen’s gentle nature again. It took a capture pole and a lot of clawing and biting at the end of the rod to accomplish the transfer. 

Finally secured in a kennel, we made plans to secure his future.

“We are not going to have a tomcat in here for long,” I said. “There is nothing that will stink up a vet clinic worse than tomcat pee.”

“We have time; you can neuter him this afternoon,” Joleen said.

One more wrestling match, and I had an injection of Ketamine into Blackjack. Joleen took the opportunity to comb him out. Blackjack was a short-haired cat, black as could be, but he had been living in the briers for some time now and needed to be spruced up a bit.

Then we neutered, vaccinated, and dewormed him.

“He will be a new man in the morning after his brain surgery,” I said.

Blackjack tamed down in a surprisingly short time. In a couple of weeks, he was given a limited run of the clinic. It was not long that we recognized that he enjoyed people and the cats that were with them. Coming off the street, he was very dog-wise. He could greet a few of the dogs that came through the door. But most of them he avoided with the skills only learned by a feral lifestyle.

He was controlled by the smell of the canned food. Joleen would pop the seal on a can of cat food, and Blackjack would come running from anywhere. 

There came a day when Blackjack wanted out the door.

“Do we dare let him out,” Joleen asked, more to herself than to me.

“I think he knows where his home is by now. My guess is he will be back before closing time.”

That was the case. About 4:00, Joleen heard him meowing at the back door. He came in for his can of cat food and then headed to his kennel for the night.

It was not long, and he would come and go by the front door. He learned to scurry through the door as a client would come or go. Jumping up on the counter and almost scaring some lady who had not noticed him following her through the door.

Most clients loved Blackjack, and he loved to sit on the front counter and accept any pats handed out by clients. But unfortunately, not all clients. One of our ‘Cat Ladies’ thought we provided Blackjack a terrible existence. 

“It is not right for him to be cooped up in here all the time,” she would say. “He should be in a home, where he is loved.”

“Mary, he has the run of this place,” I said. “He can come and go as he pleases, and his life here is far better than his old life.”

“Well, that may be, but I think he deserves a real home,” Mary said.

It was some months after that conversation that Blackjack left by the front door of the clinic one afternoon and never returned. We looked on the neighborhood streets and through the feral cat colony. There was never a trace of him.

“I bet she took him,” Joleen said. “Poor Blackjack, his life here was far better than she will ever provide.”

“There is no way we will ever know. There are a hundred ways that a cat can meet his fate in this world. We gave him the best we could while he was in our care. And I doubt she would have been capable of catching him out on the street.”

We were still in a sort of grieving status over Blackjack’s loss when Kathy burst through the front door with a limp kitten in her hands.

“The highway crew found this guy in the ditch by our house,” Kathy said. “It looks like he has taken a big whack on the head, but he is alive.”

“If you guys can do something for him, that is fine,” Kathy said. “I can’t afford to do anything for him.”

“We will look him over and see if he is savable,” Joleen said. “If he recovers, we can maybe find him a home.”

This kitten was about 6 weeks old and had a patch of hair gone on the top of his head. Still unconscious, he must have been hit by a car. When I started handling the kitten, he began to stir a little. Other than the patch of missing hair on his head, he looked fine.

I gave him a dose of Dexamethasone, and Joleen went back to settle him in a kennel. Or so I thought. She carried him around in a towel for the rest of the morning. 

By noon, the little tabby kitten was back to normal function. We offered him some canned food, and he acted like he hadn’t eaten in a week.

“It looks to me like you have your next clinic cat,” Joleen said.

After devouring his lunch, he was screaming for more. And I did say screaming.

“He sounds like he would make a good Speaker of the House. Maybe we should name him Newt,” I said.

Newt grew up in the clinic. Will, he spent most of his first year in the clinic. The clinic was his domain, he had free run of the place during the day, and we would put him in a large kennel overnight. His voice was the first thing one heard when we came through the door in the morning. He knew he got his breakfast and that the kennel door would be left open.

Newt enjoyed people, and they loved him. He would often perch on the front counter, acting as a greeter. He seemed to have no interest in going through the front door.

He was close to a year old when Bill and Opal were in with Mucho for a check-up. When they completed their visit, they purchased a 25-pound bag of C/D cat food. We were a little surprised when Opal came back into the clinic with the bag of food.

“This bag has a hole in the corner,” Opal said. 

Sure enough, there was a small hole in the bag and evidence of scratch and bite marks.

“That looks like Newt has been helping himself to some free meals,” I said. “We will refund that money. Do you want to keep this bag, at no cost, or do you want another one?” 

“Oh,” Opal said. “We can keep this one if you can tape it up. We really don’t want our money back.” 

I grabbed some packing tape and closed the hole. “You really don’t have any choice, Opal,” I said. “Sandy has already reversed the charge. If I take it back, we will just throw it away. So you may as well get the use of it.”

When Opal left, I went back and inspected our inventory. Newt made good choices. The bland diet foods for liver or kidney failure were not touched. But every bag of C/D had a small hole in the corner.

“Newt, I think you just got canned,” I said. Newt looked at me in a very aloof manner. “I think you earned a trip to the house. I can’t afford to lose hundreds of dollars in inventory to a cat that doesn’t produce any income for the clinic.”

That night Newt went home with us. This transition to the house went off without a hitch. He was quick to stake out his corner on the foot of our bed as he settled into a long life in the Larsen household.

Photo by David Bartus from Pexels

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