“And I give her lots of joint supplements as well,” she continued. “I think she has a pretty good life.” Lady closed her eyes and let her tongue fall out of her mouth as Stacy continued to pet her.
Steve escorted the Davenports to the dog room, but Lady spotted the aquarium in the cat room. She lunged toward the glass, pulling the leash out of Stacy’s hand. A few inches from the tank, Lady screeched to a halt, mesmerized by the fish inside. Since Lady wanted to watch the fish, we accommodated her and moved into the cat room.
Cleopatra stood with all four legs perfectly aligned on the exam table as if she were at Madison Square Garden for Westminster. One by one, I checked each mammary gland. Mammary tumors come in all sizes and shapes. Aggressive carcinomas often break through the skin. Owners see blood, then notice the lump. A common benign tumor often occurs under the nipples and feels like a hard BB.
“What do you think, Dr. Nelson?” Stacy asked in a nervous voice.
Between my fingers, I held a firm mass. The edges felt irregular. The top felt pitted like a cobblestone street missing a stone here and there. Red streaks radiated out from the mass into the surrounding skin. Beside the first lump, I felt another smaller one. In dogs, 50 percent of mammary gland tumors are malignant. The odds are far worse in cats –̶ breast tumors are almost always malignant.
“I’m afraid I found two lumps,” I finally responded. Stacy’s eyes widened. “Cleo needs to have them removed as soon as your schedule allows.” I pointed to the bigger mass. “This one worries me.” I have a duty to be honest with each client about the pet’s medical condition. But I felt horrible giving this news to Stacy. “We’ll send the lumps to the lab and it will take about a week to get a diagnosis from the pathologist. I’ll also have them check the borders to see if I got clean margins during the surgery.” Stacy held Cleo to her chest and stroked the little dog.
“But you really don’t know what kind of cancer it is. I mean,” her voice cracked, “it could be benign, right?” I nodded, but something told me not to be optimistic. Stacy kissed Cleo’s forehead. Her eyes glistened with tears. Lady appeared by Stacy’s side with her tail tucked between her legs. She knew something was wrong. We scheduled Cleo’s surgery for Monday. Stacy put the leather jacket back on Cleo and left without saying a word.
“What’s wrong with Cleo?” Steve asked as her van pulled away.
“She has two lumps in her breasts,” I replied quietly. Steve stood in silence. Just saying those words cast a shadow over the clinic. We both hoped surgery would cure the little fashion plate.
“Anything good in the mail?” I asked, trying to change the subject. He shook his head and handed me a stack of envelopes.
“I keep forgetting to ask if you heard any more from the clinic that sent you the nasty letter,” he said.
“No, I guess our attorney wrote a good poison-pen response.” I smiled and thumbed through the mail. “So what’s next on the books?”
“Nothing, except Ivan Harris is coming in at noon. Rich thinks he has another hotspot, and it’s time to recheck his thyroid level.” Steve spun around in the desk chair. “Jennifer and her son are in back visiting Captain. Good job on the green. The bandage matches the boy’s mittens, scarf and hat –̶ green is his favorite color.”
I winked at Steve. Steve’s favorite color was also green. Besides gloves, he had a green winter jacket, a green car and lots of green ties for work. I, on the other hand, liked purple. My childhood bedroom was purple from top to bottom with purple carpeting, purple drapes and vinyl jungle wallpaper in shades of purple, blue and lemon yellow. It was extreme purple.
Ivan arrived at the clinic just as Jennifer and Blake finished their visit. Blake clung to his mother when he saw the large Doberman. Rich kept Ivan by his side. When the coast was clear, he unclipped the leather leash from Ivan’s silver choke collar, which sparkled next to his black coat. Ivan sniffed the chairs Genny had marked earlier in the day and started to lift his leg on one.
“Ivan, no,” Rich ordered. The dog gave him a look that said, “What? I wasn’t going to do anything.” Steve ushered Rich and Ivan into the pharmacy area where there was more room to work on the large dog. Ivan strutted in with his head held high. Lack of confidence was not his problem.
“Hello, hello,” Bongo called out. Ivan’s head jerked toward the mechanical voice. He trotted to her cage with Rich trailing behind and stood like a statue in front of the cages. His eyes darted from one bird to another.
“Hey, Dobermans aren’t supposed to be bird dogs,” I called out. “Ivan, come.” Ivan looked at me for a second, wagged his little stump of a tail but failed to move his feet. He returned his attention to the birds.
“Come on, boy,” Rich said as he slid his hand under the collar. “Sorry, Kris, sometimes he’s such a butthead.” Rich pulled Ivan to me. He removed his leather jacket and tried to hang it on the office doorknob, but for some reason, it kept falling to the floor. I took it from him, brushed off some dog fur and laid it over a chair in the office.
Ivan stood facing the birds for the entire exam. He didn’t move a muscle unless I blocked his view. On the inner side of his back left leg, I found a quarter-sized area of moist pink skin. Rich noticed the spot in the morning and called right away. I gathered supplies from the cabinet and laid them on the floor next to Ivan.
“Ivan, platz,” Rich ordered in German. Ivan looked at Rich but did not lie down. The owner stared at him with a look that said, “I’m not kidding,” and with that, Ivan sank. With Rich’s help, I treated the hotspot and drew blood from a small vein in Ivan’s back leg.
“OK, we’re done,” I announced as I filled a test tube with bright red blood. Ivan sprang to his feet. He knew what OK meant. Rich grabbed his collar before he could run back to the birds and reattached the leash. “I’ll call with the thyroid results on Monday,” I told him.
While I was busy with Ivan, Genny noticed the strange jacket on the chair and came out of the closet to inspect. She stood below it, sniffing the hem. After several minutes, she jumped onto the chair and buried her face it. Rich had purchased the jacket in Italy during a recent business trip. Made of high-quality leather and soft as butter, the jacket emitted that wonderful new leather smell. Genny, however, was entranced by the tactile sensation. She pushed her paws into the jacket’s folds, shifting her weight back and forth. Before long, she was lost in the world of forbidden pleasure.
I opened the door to find Genny holding the collar in her mouth, kneading the leather with her front paws and a glassy look on her face. When I picked her up and placed her on the floor, she protested with a loud “waa, waa.” I picked up the jacket and inspected it for damage. “Rich, Genny was on your jacket. I’m really sorry about that. I didn’t know she liked leather.”
“Oh, that’s alright,” Rich replied. “She can sleep on it.”
“That’s not what she was doing. Genny was, ah, she was, ah, ah ... well, let’s just say she loves your leather jacket.” I raised my hands and wiggled the first two fingers on each hand in quotes as I uttered the word “loves.” Rich looked at me quizzically. I paused for a moment as I searched for a nice way to say what Genny was doing. “She loves your jacket ... in a sexual way.”
“You mean she did the wild thing on my jacket?”
I nodded. Rich started to chuckle, which grew to a full laugh. The more he thought about what Genny was doing, the harder he laughed. His face turned red.
Steve walked into the room, wondering what was taking so long. “We just got a walk-in, Kris, a guinea pig with an injured leg. The owners think it might be broken.” Rich continued to laugh. He put on his jacket and coiled Ivan’s leash in his hand. “Come on, Ivan, let’s get out of here.” Ivan reluctantly turned his attention from the birds and followed him out the door.
Earlier in the day, Jeff and Laurie Shultz had stopped by the local Humane Society with their children. They wanted to adopt a small pet that would be comfortable in their apartment. After looking at ma
ny animals, they selected a beautiful young guinea pig with a bright white coat and pink eyes. Their daughter, Maria, named the precious snowball Emily. On the way home, they stopped at a pet store and purchased the necessary accessories including food, litter, a bright pink harness and matching leash. Three hours later, Emily caught her back leg in the leash. She limped around after that without touching the injured foot to the ground.
I examined Emily just like every other pet, starting at her head and finishing with her injured right rear leg. The foot was normal, but just above the hock I noticed a swollen area. Emily jerked her leg back and tried to escape when I touched it. Further inspection revealed a puncture wound on the inner side of her leg.
“I’m worried that Emily has an open fracture,” I announced to the family with the guinea pig perched in one hand. “See this hole in her skin?” I pointed to the puncture wound. “I’m worried that her bone popped through the skin when it broke. Infection is a big problem in wounds like this.” Silence fell over the family. Tears rolled down the daughter’s cheeks. She hid her face in her mother’s coat.
X-rays confirmed what I already knew. Emily’s fracture occurred through the growth plate of her tibia. Technically, it is called a Salter II fracture. The entire family followed me into the treatment room to view the film.
“Can you fix it?” Jeff asked.
I took a deep breath before answering. Fractures like this can be tough to repair for several reasons. First, the fracture went right through the growth plate. As the name suggests, it’s the area where bone lengthens during growth. If the cells in that area were badly damaged, her leg would not grow properly. Second, guinea pig bones are like chicken bones, thin and fragile. I would have to be careful not to damage it further during surgery. Third, the bone was contaminated with bacteria and dirt. Infection was a big issue. To make matters worse, guinea pigs don’t respond well to anesthesia. With her young age and small size, I warned the family that she might not make it through the anesthesia.
“But she needs the leg fixed, right?” Laurie stated. “I mean, she can’t live with a broken leg.”
“Yes,” I answered. “I will put a wrap on the leg to stabilize the fracture. Once it stops moving, she will feel a lot better.” I smiled at the girl, who was still upset. “The bandage will make it feel better just like when you put a bandage on an owie,” I told her. I flipped off the light box. “I can fix the fracture on Monday.”
“Dr. Nelson,” Maria whispered. “Emily needs to be home for Easter. Take good care of her.”
“I’ll do my best,” I replied.
After the family left, Steve held little Emily for me. I clipped the hair from her leg and flushed the wound with saline. Once the leg was dry, I applied a soft padded bandage. I cut a tongue depressor to the perfect size for her little leg and wrapped it into the bandage for support.
Emily felt a lot better with the leg stabilized. She hopped around the incubator, leaving a long noseprint along the glass. Her limp was slight. She ate a teaspoon of pellets, sipped a little water and settled into the corner for a nap.
“Poor little thing,” I said as we stood observing her. “She’s had quite a day.”
“Yeah, but she got a good home with people who care,” Steve replied. He took my hand in his. “I have a good feeling about Emily. I think she’s going to do just fine. Let’s follow her lead and get some lunch. I’m starving.”
Chapter 19
Sugar and Spice, Maltese Sisters
Ben O’Brian returned home from a frustrating day at work. He opened the front door expecting a warm welcome from Sugar and Spice, his two Maltese. At 10, Sugar was the calm, friendly dog. When she stood, her legs bowed into abnormal positions. Her wrists caved forward onto her front paws while her hocks bent backwards almost to the ground. But what she lacked in physical beauty, she made up for in personality. She was Miss Congeniality with a capital C.
Spice lived up to her name. She zipped from place to place. Her motto was “Why walk when you can run?” The muscles on her body bulged beneath curly white fur. Because Ben rescued Spice from an abusive situation, she was shy and nervous around strangers. She let Sugar meet them first while she watched from the safety of Ben’s arms.
Ben opened the door to an empty foyer. His voice echoed down the hall as he called for his girls. “Sugar, Spice, where are you?” Silence greeted him. Without removing his coat, he walked down the hallway in search of his dogs. Spice met him at the doorway to the kitchen. Instead of jumping into his arms for a hug, she touched his hand with her nose and ran toward the back of the house. Ben knew something was terribly wrong. Spice never left Sugar’s side.
When he reached the bedroom, his concern became panic. Sugar lay on her side in the middle of the floor with her legs stretched outward. Her nostrils flared with each breath. Spice stood by her side and whimpered.
“Sugar,” Ben cried. “What’s wrong?” Sugar raised her head one inch off the ground. She looked at him for two seconds, moved her tail once and collapsed. Ben knelt beside her and put his hand on her chest. He felt it rise and fall with each breath. Sugar closed her eyes. It was as if she used her last bit of energy to greet Ben. She fought to stay alive long enough to say goodbye.
Snatching a blanket from the hall closet, Ben wrapped it around Sugar, grabbed his car keys and headed for the front door with the dog’s limp body in his arms. “Hang on, Sugar,” he whispered as tears spilled down his cheeks. “Please don’t die.” Spice followed, whining. She knew her friend was in serious trouble. When Ben got to the car, he could hear Spice howling as he laid Sugar on the front seat. Spice’s cries sounded like the frantic wails of someone losing her best friend.
At the clinic, squealing brakes caused Allie to look up from her paperwork. Through the clinic window, she watched Ben slam his car into park in front of the clinic. He threw open the door, ran to the passenger side and scooped up his beloved pet. Allie ran to the front door and held it open.
“This is Sugar,” Ben said as he walked inside. “I got home from work and found her on the floor.” He spoke in staccato bursts. Allie pointed to the cat room with one arm and nudged Ben’s elbow with the other.
“She was just laying there.” Ben lowered his voice. “She ... she even peed on the floor.” Allie flipped on the lights and motioned for Ben to place Sugar on the table. “That’s not like her. She never would do that.” Beads of sweat formed on his forehead. His fair skin flushed to a bright pink.
Allie lifted Sugar’s lip and pressed on the gum above the big canine tooth. The color returned in a second, but her gums were slightly pale. Next, Allie took the stethoscope from her scrub pocket. She placed the bell of the instrument on Sugar’s chest. Allie stood watching the second hand circle the Starship Enterprise for one minute as she counted Sugar’s heart rate. Ben stood close to his dog, watching every move Allie made. Finally, she stuck a thermometer in Sugar’s rear end. Sugar did not resist; she just lay there and panted.
“101.8,” she said smiling. Ben’s facial expression did not change. “That’s normal for a dog.” She opened Sugar’s record and recorded her findings on a new physical exam sheet. “Dr. Nelson will be in right away.” She patted Sugar’s head and left.
When I entered the room, Ben was sitting next to Sugar with his arm across her back. He positioned the exam room chair tight to the exam table. His gray-white hair matched Sugar’s snowy white coat. They looked like a match made in heaven.
Ben cuddled his pet as he recounted the events of the day. Nothing was out of the ordinary when he left for work. Sugar and Spice got a biscuit and went to their beds as usual. He hadn’t changed their diets. No exposure to any kind of poison. Ben kept all the chemicals he used for cleaning in a locked cabinet. She was not on any kind of medication and did not have any drug allergies as far as he knew.
“Any coughing, sneezing, vomiting or diarrhea?” I asked. Ben shook his head no. I closed the cover of Sugar’s record. “Well, let’s take a look at you, pu
mpkin.” Sugar looked up at me and tried to jump off the table. When that failed, she tried to jump into Ben’s arms. I performed the physical exam with her sitting in Ben’s lap. Other than her bowed legs and slightly pale gums, I couldn’t find anything to explain what happened.
Fortunately, her breathing had improved dramatically since arriving at the clinic. I suspected that Sugar suffered a seizure but was unsure of the cause. I sent blood and urine off to the lab for tests. Ben took Sugar home while we waited for the results. He placed my pager number in his wallet just in case Sugar had problems during the night.
The next day Ben brought Sugar back for observation while he was at work. Her condition had deteriorated overnight. When I called her name, she thumped her tail a few times but kept her head on the table. Her gums were now a faint pink. I pulled the stethoscope from around my neck and positioned the bell over her chest. “Whoosh, whoosh, whoosh” echoed in my ears. I feared Sugar had autoimmune hemolytic anemia –̶ a lack of red blood cells causing her murmur.
I held Sugar as Allie drew blood. We mixed one drop with saline and placed the rest in a purple-top tube. The red bloods cells clumped into pieces the size of pepper.
“Her blood just agglutinated,” I said holding up the slide for Allie to view.
“It’s clumped in here, too.” Allie inverted the blood tube in her hand. Clumps of cells floated from one side to the other like an inverted snow globe. “I’ve never seen one this bad.”
As Allie helped me place an IV catheter in Sugar’s malformed leg, I thought about the other dogs I had treated with this condition. Autoimmune hemolytic anemia is a life-threatening disease. The patient makes antibodies against its own red blood cells. The antibodies attach to these cells and signal the spleen to discard them. It destroys the red blood cells, causing a life-threatening anemia. If the process is not stopped, the patient will die. We had to end this process now to save Sugar. The textbooks in my office made it sound so easy. Combine massive doses of steroids with good nursing care, and the patient recovers. In practice, I learned that textbooks seldom tell the whole story.
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