Coated With Fur: A Vet's Life Page 17

  Now that granulation tissue covered the wound, Jennifer had a decision to make. At this stage we could continue to bandage the wound and let it heal on its own, or it could be covered with a skin graft. The graft would speed up healing time, but it required putting Captain under anesthesia, something that made Jennifer uncomfortable. The final cost of each would be about the same.

  “I’d rather keep bandaging the leg,” Jennifer replied without hesitation. “Now that we only have to come every other day, it’s not so bad.”

  “Actually, I think we can go to every third day now. The wound isn’t oozing much anymore.”

  “Fantastic!” Jennifer exclaimed. She bent down and rubbed her face in Captain’s fur. After flushing the wound with saline, I covered it with a non-stick pad and applied a thick layer of cotton cast padding followed by stretch gauze. Per Blake’s selection, bright yellow vet wrap topped it all off. I ripped a small piece of medical tape from the roll and used it to hold the end of the vet wrap in place. I wrote the date on the tape with a black marker.

  “OK, you’re all set.” Captain sprang to his feet. He knew the word OK meant treat time. He watched me get a dog biscuit out of the jar. Just as Pavlov commanded, a drop of saliva dripped onto the table, and the pup’s tail beat back and forth. I handed Captain the biscuit. When he finished, I hugged him for a long time relishing the moment. Eventually, I placed him gently on the floor. Standing up, I realized I was coated with fur, Captain’s fur. It made me smile.

  “I’ll see you in three days,” I said. Jennifer beamed with delight. For the first time since the accident, she knew in her heart that Captain would be all right. She had a twinkle in her eye, finally free of worry and guilt.

  Chapter 21

  Rusty the Blood Donor

  Over the next two days, Sugar’s PCV declined again. Her body destroyed her own red blood cells and Lulu’s too. She stopped eating. She seemed to be unaware of the animals and activities around her. The act of breathing exhausted her. She needed another transfusion.

  Ben and Spice entered the clinic at their normal time to visit Sugar. Instead of her custom of bringing Sugar out to the waiting room, Allie ushered them to an exam room. As I entered, Ben sat on a chair in the corner with Spice on his lap. He clung tight to Spice and looked at me with a drawn, hollow face. His eyes were red. Sadness and concern hung over him; he knew the news was bad and was bracing for the worst.

  “I’m afraid Sugar’s PCV fell into the critical range again,” I told him. I placed my hand on his arm. “She needs another transfusion.” Ben leaned back in the chair, all hope and optimism draining from his body. The strong drugs I used were no match for Sugar’s immune system. Her spleen destroyed the red blood cells faster than her body could make them. Her only hope was to remove her spleen to stop the destruction. I planned to give her another transfusion, then let her rest awhile before performing surgery.

  Ben stared at the floor. Spice glanced at me for a second, then licked his face. “Do you think she can handle surgery?” he whispered.

  “Not in her current condition,” I paused. “But after a transfusion ... yes.” I stepped back and waited for Ben to respond. Dark circles lined his eyes. Like Sugar, he looked exhausted.

  He hugged Spice. “I ... I want to do whatever it takes to save her.”

  “That’s the right decision, Ben.” I opened the door. “All right, I’m going to make arrangements for the transfusion. Allie will get you in a minute. She’s busy preparing for surgery on a dog that ate a bolt. Hang in there for me … promise?”

  I had met Rusty, the golden retriever, and Melanie Baylor last fall for a second opinion. Rusty experienced episodes of vomiting that worsened with time. Their veterinarian took X-rays but didn’t see a problem. The films were “within normal limits,” as radiologists like to say. The veterinarian sent Rusty home on conservative medical therapy. Unfortunately, the dog continued to vomit. Over the next 24 hours, the vomitus included blood. Melanie brought him back for more care, but once again, the vet could find no cause. After the third unsuccessful visit, the owner decided to try a new veterinarian. She brought Rusty to us, desperate for a cure.

  During the exam, Rusty bounced off the walls. The young golden retriever had energy to burn. I agreed with my colleague; Rusty did not look sick. But Melanie said he was. Somewhere in my medical upbringing, I learned to listen to owners. They truly know what’s normal for their pets.

  During the first week of my internship at the Animal Medical Center in New York City, I examined a cat for lethargy. The owner said at home he barely moved. Yet the cat rubbed and purred throughout my examination. I thought he was the picture of health, but his owner insisted that something was wrong. I offered to perform blood tests and a urinalysis just to be sure. Lo and behold, the cat suffered from diabetes. From that moment on, I adhere to a healthy respect for owner intuition.

  In young dogs, especially hunting dogs, the most common cause of vomiting is dietary indiscretion. That is a fancy term for eating the wrong thing. Unfortunately, not all foreign bodies show up on regular X-rays. I offered to perform a barium series to diagnose cloth and other non-mineral items. When the series was done, the diagnosis was easy. Rusty had a foreign body. I surgically removed about a foot of quilt batting from his small intestine.

  Now, six months after the first surgery, Melanie brought Rusty in with the same symptoms. Again, he bounced off the walls during my examination. Allie and I struggled to hold him still for the X-rays. This time, the plain films made the diagnosis. Rusty had eaten a bolt, a big one with a washer attached.

  As I changed into a set of scrubs, an idea popped into my head. Maybe I could use Rusty as a blood donor. His medical costs put a strain on his family’s budget, and I could give them a credit for a blood donation. I grabbed Rusty’s chart and headed for the phone.

  “Hello, Baylor residence,” a woman answered.

  “Hi, Melanie, I’m calling to ask for your permission to use Rusty as a blood donor. I have a sick little Maltese here that desperately needs blood. If Rusty donates, I will credit your account for the donation.”

  “His eating habits have cost us a small fortune,” she replied. She thought for a moment. “As long as it’s safe for Rusty, I’m all for it.”

  “I won’t draw from him until he’s recovered from anesthesia and I know his blood is a match.”

  “Could you put a zipper in him, just in case he does this again?” Melanie asked, part in jest and part in earnest.

  “Tempting, but not recommended.” We both laughed. “Someone must have done it, though,” I said. “Some of the zipper packets actually state, ‘Not for internal use.’” We laughed again.

  Fifteen minutes later, I finished the surgical scrub and stood before the operating table dressed in cap, mask, gown and gloves. Rusty lay on his back with all four feet secured to the table with cords. Surgical instruments sat on a Mayo stand. I placed a series of small drapes on the dog’s abdomen, leaving the center section open. Next, I covered his entire body with a blue paper drape. Allie sat by his head. As she reached under the drape to get his vitals, the EKG beeped in regular rhythm. I cut a hole in the drape to expose Rusty’s abdomen.

  The first surgery had left him with a long thin scar right down the middle. I followed the line with the scalpel blade. First skin, then subcutaneous tissues until the linea alba glistened under the bright O.R. lights. I punctured through with the tip of the scalpel, creating a hole big enough for my finger. I slid one inside for a quick feel. Because Rusty had surgery before, I had to be careful of adhesion between the incision and an internal organ. Feeling none, I methodically extended the incision with a scissors, using my finger to protect the vital organs below.

  As surgeons, the natural tendency is to go directly to the problem and address it. In veterinary school, the instructors drilled into our heads the need to perform a thorough examination of the entire abdomen before undertaking anything else. I started at the diaphragm, reaching deep int
o Rusty’s abdomen to feel its smooth surface. I slowly worked my way back past the spleen, kidneys and urinary bladder and finished by running the entire bowel from the stomach to the descending colon. The bolt in the stomach was the only abnormality.

  Using lap sponges to isolate the stomach from the rest of the abdomen, I attached two pieces of suture to the outer wall and used them to pull the stomach up and out of the abdomen. I stabbed the area between the stay sutures with the scalpel blade. Blood oozed from the incision. I wiped it away before enlarging the incision with a scissors. Through the two-inch opening, I saw the bolt resting in the folds of the stomach. It had done a number on the stomach: the lining bled in places from denuded areas. I inserted a forceps through the incision and grabbed the bolt. I checked one more time for additional foreign bodies, then closed with a double layer of suture.

  I changed into fresh gloves and got a new sterile set of instruments to avoid contaminating Rusty’s abdomen. I removed the lap sponges and flushed the area with two liters of saline. The suction pump sputtered and squeaked as it vacuumed the fluid. Blood-tinged, it accumulated in the glass jar attached to the pump. I closed the abdominal incision one layer at a time. I knew from experience that Rusty would gnaw anything in his skin with his mouth. So this lucky dog was treated to the time-honored plastic surgeon closure. I buried the suture within the dermis, out of his reach.

  Rusty shivered on the table as I pulled the drapes away. We moved him onto a thick quilt on the floor with a tracheal tube protruding from his mouth. Allie sat next to him, her hand on his back leg. She looked at her watch, counted his pulse and gently tapped the corner of his eyelid with a finger. When he blinked and coughed, she pulled out the trach tube. Rusty lifted his head and flicked his tongue from side to side.

  An hour later, the dog stood in his run, ready to be a hero with his tongue hanging happily out the side of his mouth. His eyes sparkled with excitement. I could hear him barking from my office. Allie poked her head in the door.

  “Hear that?” she asked.

  “Is that who I think it is?”

  “Yes. He’s standing back there begging for dinner.” Allie rolled her eyes. “I wish I had his energy.”

  “Me too.” I smiled. “Let me give him a quick physical, and then he’s all yours.” I stood and stretched my arms. “And no food until tomorrow morning.”

  The next morning, I could hear Rusty’s stomach rumble when I listened to his chest. He jumped up and down in the run while I prepared a small meal for him. I opened his door just enough to slide the stainless steel bowl inside. He grabbed all the food in his mouth and swallowed it with one loud gulp. Standing on his back legs with his front feet resting on the wire gate, he looked at me with a grin on his face and wagged his tail.

  “Woof, woof.” The bark came from deep within.

  “Nice try, Rusty.” I reached over the gate to pet his head. “Begging won’t work with me. Remember, I’m the mean old vet.”

  “Woof, woof,” he barked again, wagging his tail so hard his entire body swayed from side to side. I smiled. I smiled big. It’s hard to resist the charms of a happy dog.

  Meanwhile, Sugar looked like a new dog with Rusty’s blood coursing through her veins. The blood carried much-needed oxygen throughout her little body. She ate breakfast and for the first time in two days, walked outside under her own power. She looked great.

  At noon, Rusty went home on a strict diet and medication to help his stomach ulcers. The top item on the go-home sheet instructed Melanie to get a basket muzzle for the dog. While Rusty could drink through the wire or plastic mesh, he could not eat anything.

  At 3:30 p.m., Ben and Spice arrived for their daily visit. Ben sat in the same lobby chair with Sugar in his lap while Spice pranced on the floor, winding her leash around his legs. When she ran out of room, she stood on her back legs with her paws on Ben’s knee. “Wrrrr, wrrr,” she whined.

  “What’s wrong, Spice?” Ben cooed. “Did you tie yourself up in knots?” He unhooked the leash, picked her up and placed her next to Sugar. They watched other animals come and go from the safety of Ben’s lap.

  “Hi, Ben.” I extended my right hand. “What do you think of her today?”

  “She seems much better,” he replied. He patted Sugar on the head. “Maybe she won’t need the splenectomy.”

  “It’s possible,” I said. I took a seat next to him. “It will depend on what her PCV is tomorrow morning. If it stays the same, she doesn’t need surgery. If it drops, surgery is at 11 a.m.”

  “How is the dog who donated the blood? Is he OK?”

  “Rusty is great. He didn’t miss that blood at all. He went home at noon.” I sat back into the chair with both hands on the armrests. My legs ached from walking the hard floors all day. “Rusty is a hyper dog. Sugar should be chasing Spice around in no time.” Ben laughed at the thought with a zest he had not exhibited for some time.

  “What do you think, Spice?” She looked into his eyes upon hearing her name. She had been watching a miniature pincher on the other side of the room. The small black-and-tan dog lay in his owner’s lap with his ears perked up, looking like a regal sphinx. “Would you like it if Sugar chased you?” Spice put her paws on Ben’s shoulder and licked his chin. “I think that’s a yes.”

  “Well, I better get back to work,” I said. “I’ve got a stack of medical records to finish.” I stood and patted Sugar on the head. I extended my hand toward Spice, who leaned into Ben and hid her face in his jacket.

  “Still shy after all this time,” I said, shaking my head as I walked over to the counter for a medical record. “I’ll call you tomorrow morning with the PCV. Keep your fingers crossed. Maybe we’ll get lucky and she won’t need surgery after all.”

  Chapter 22

  Sugar’s PCV Falls

  Morning arrived with a cold drizzle. Sugar’s body shivered against the chill as I took her outside. Her morning PCV fell six points from the day before. Ben was terrified at the thought of anesthesia, but he also knew it was Sugar’s only hope. Reluctantly, he consented to a splenectomy.

  “Dr. Nelson, will you do a favor for me?” he asked before we hung up.

  “Certainly,” I said.

  “Tell her I love her.” He paused and sniffled. “Tell her to hang on, and we’ll be there to visit as soon as she’s ready.”

  Allie set up the operating room while I saw the last appointment of the morning. She placed the water heating pad on the table, covered it with two towels and positioned the EKG machine at the head of the table. The cords wound around themselves into one big knot. She carefully detangled them according to color –̶ green and white on one side and red and black on the other.

  A splenectomy requires many forceps to clamp off blood vessels. Allie opened the surgical instrument cabinet. Blue and green packs of instruments closed by a piece of tape with black stripes lined the shelves. The tape looked like normal masking tape before it was autoclaved. Allie shifted around a few packs labeled “small” or “large spay” until she spotted a big one in the corner. From the size and weight, she knew it was the general surgery pack. She placed it on the Mayo stand along with sponges, suction equipment, drapes and a scalpel blade.

  “Are you ready?” I asked when she returned to the treatment room. Allie handed me a cap and mask and nodded. She picked up Sugar and put her on the treatment room table. I picked up a syringe filled with clear liquid.

  “Are you ready, Sugar?” I patted her head. She glanced up at me and licked her lips. I removed the cap and inserted the needle into a rubber catheter plug. Allie shut off the fluids to prevent backflow. “Ben loves you, Sugar.” Sugar blinked her eyes a couple times, opened her mouth in a wide yawn and then sank into Allie’s arms.

  Repositioning the dog on the table, Allie held Sugar’s mouth wide open with both hands. I grabbed the dog’s tongue with a piece of gauze, pulled it forward and waited for her to take a breath. On inhalation, I pushed the tip of a tracheal tube down her airway. Sugar sp
uttered and coughed. Allie connected the tube to the anesthesia machine, turned a valve for oxygen and flipped another switch for the isoflurane. The black bag attached to the machine moved with each of Sugar’s breaths. After three more inhalations, the sputtering stopped.

  “How’s she doing?” I asked. Allie and I had worked together for over a year. I trusted her, something vital in the O.R. Allie held up her thumb as she listened with the stethoscope. Sugar’s pulses were strong, and she breathed on her own. I gathered her limp body into my arms and carried her to the O.R., her head bouncing with every step I took. Allie followed with the anesthesia machine and I.V. pole.

  Ten minutes later, I backed through the O.R. The EKG beeped in a regular, almost hypnotic, rhythm. Sugar rested on her back with a multitude of cords attached to her; her pink skin glistened under the bright O.R. lights.

  Allie placed a headlamp on my head and tightened the headband. She tied the cord into the back of my gown to keep it out of the way. I placed drapes on Sugar in much less time than it took for Rusty –̶ girls are easier to drape. Next, I incised her skin one layer at a time until the internal organs sparkled under the headlamp.

  “Wow, look at the size of the spleen,” I remarked. Allie stood on her tiptoes to get a peek. She kept her hands behind her back to avoid the sterile field.

  “It’s enormous,” she said from under her mask. “It looks like the spleen that ate Minneapolis.”