Coated With Fur: A Vet's Life

by Kristen Nelson

  “Cancer,” Jill muttered.

  “I’m afraid so. Let me show you.” Billy and Jill stood in front of the lightbox. The top of Billy’s head barely reached my elbow. I pulled the film down to the bottom of the lightbox so he’d have a better view.

  “This is Chewy’s film. Here is her head,” I pointed to the skull. “This is her spine, which continues into this long tail.” I ran my finger down her back to the tail. “Now, this is her normal leg.” I traced the right back leg. “See all the bones in her ankle?” They both nodded. “Now compare that to the bones in the other leg. You can’t see them, can you?”

  “All I see is a big white lump,” Jill said.

  I nodded. “That’s the cancer.” Jill put her arm around her son and drew him close. Tears ran down the child’s face. He sniffled and buried his face in her side. I explained that bone tumors are very aggressive. Treatment starts with amputating the leg and then putting the patient on chemotherapy. Unfortunately, I’ve never had that cure a patient because this kind of tumor likes to metastasize. It’s a nasty cancer.

  “What should we do?” Jill asked. “We don’t want her to suffer.” Billy nodded but kept his face hidden in his mother’s side.

  “I recommend putting her on an analgesic to control the pain. Then you need to spoil her rotten.” I smiled at the pair. “Let her eat all her favorite foods and stay up past her bedtime. Make the most out of the time you have left with her.” Jill blinked her eyes several times. She kept one arm around Billy and reached for a tissue with the other.

  “How much longer do you think she’ll live?” she managed to ask after 20 seconds.

  “That’s hard to say. With bone cancer, she could have days to months left. It just depends on how quickly it grows and where it spreads.”

  Jill cleared her throat. She didn’t want to put Chewy through surgery and chemotherapy. With her active lifestyle, she felt Chewy would be miserable without her back foot. Instead, they would follow my advice and spoil her rotten. She would be the happiest gerbil on the planet. Billy nodded as tears spilled down his cheeks. They formed a wet spot where he clutched his mom.

  “We’ll stop at the grocery store on the way home and pick up her favorites,” Jill informed her son. I picked up the carrier and held it out to Billy. “Thank Dr. Nelson for helping us with Chewy,” Jill coached her son. She unwrapped the child’s arms from around her waist and turned him around.

  “Thank you, Dr. Nelson,” he mumbled, staring at the floor. I smiled down at the child and handed the carrier to him. Inside, I felt like a failure.

  “Chewy is a wonderful gerbil,” I told him, “and you have done a terrific job taking care of her. Please feel free to call me with any questions or concerns.” I put my hand on Jill’s shoulder. “I’m sorry it wasn’t better news. She really is a special gerbil.”

  “Thanks, Dr. Nelson,” she replied. “We’ll be in touch.”

  Chapter 25

  Trudy, U.S. Customs Canine Officer

  “Welcome to the Minneapolis/St. Paul International Airport,” the flight attendant announced after the plane touched down. Static sounded in the background. My legs ached from the lack of legroom. When we reached the gate, I grabbed my bag and stood in the aisle. Ten minutes later, I walked up the gangway into Steve’s arms. I couldn’t wait to get home.

  “Well, how about a ride to the clinic?” Steve asked. I froze in my tracks. A businessman with a large briefcase almost ran into me. “Trudy, the Customs dog, is sick,” Steve continued. “The relief vet doesn’t know why.” He ushered me through the crowded hallway to a quiet corner. “I got a frantic call from Allie this afternoon. I told her to hospitalize Trudy until you arrived.”

  Trudy, a Lab mix, worked as a drug sniffer for the U.S. Customs Service. Every morning, her handler, Frank Culbertson, picked her up from the boarding kennel next door on his way to work. On this day, Frank and Trudy searched a warehouse in the morning, took a break for lunch and then went back to work. Trudy lay down in the middle of a search and refused to get up no matter what Frank did.

  Sensing something was seriously wrong, Frank rushed her to the clinic. The veterinarian who covered for me examined her but couldn’t find a reason for her behavior. Trudy just lay there with a sad look on her face. She didn’t even try to sniff Genny.

  Thirty minutes later, we pulled into the clinic parking lot. A dandelion grew in a crack between the asphalt and the sidewalk. Steve unlocked the front door. I spotted a record with a large note lying on the front counter. Someone had scribbled “Dr. Nelson” on it in bright red ink. I opened Trudy’s chart and flipped through the pages. The history section did not give me much to go on. The words “ain’t doing right” filled the complaint line on the chart.

  “That wasn’t very helpful,” I said and replaced the record on the counter. Steve turned on the clinic lights even though the sun shone brilliantly through the window. In June, the sun did not set until after 8 p.m.. We Minnesotans view this as our just reward for the long, dark winter nights.

  Together, we walked into the treatment room. The stainless steel cages were empty. From the kennel, we heard a dog whimper. Trudy lay in the first kennel run, her black body silhouetted against the gray concrete floor. A rumpled blanket sat in the corner. A small card taped to the gate read “Trudy, U.S. Customs.”

  I took off my blazer and threw it over one of the empty incubators. Dressed in a business suit, I heard my high heels clip on the floor. I rolled up the sleeves on my silk blouse and donned a surgical gown to protect my clothes.

  “Alright, Trudy, time to figure out what’s wrong with you,” Steve announced. He flipped the latch and swung the gate wide open. Trudy remained on the floor. She thumped her tail a few times, but refused to move. Steve stepped into the run and knelt beside her. “Come on, Trudy, you need to get up now.” He put his arms under her chest. She moaned and smacked her lips together. Steve released his grip.

  “She won’t get up, Kris.” He petted her head. “Maybe you should examine her in here?”

  “No, the light is bad,” I replied. “I need her on the treatment room table.” I walked over to her run, hoisted my skirt and stepped into the kennel. “I’ll take her chest, and you take her rear end.”

  “How come I always get the rear end?” he whined.

  “Because you’re the man,” I smiled. I put my arms under Trudy’s chest, and on the count of three, we lifted her off the floor in one fluid motion. Trudy looked around sheepishly, her legs dangling as we carried her in our arms. She continued to smack her lips.

  Trudy had a long nose, floppy ears and the expressive tail typical of Lab mixes. When she worked, she held her tail straight out behind her. She arched it over her back when she played tug-of-war with her handler. At the clinic, her tail normally moved from side to side in big circular sweeps. Instead of wearing her emotions on her sleeve, Trudy wore them on her tail. Now it drooped behind her. She held her ears flat against her skull as she stood on the table.

  Overall, Trudy was depressed. Her hair coat looked dull and lifeless, lacking its normal luster. Her ribs and backbone felt more prominent than I remembered from prior examinations. Her heart rate and respiratory rate seemed higher. Taken together, these symptoms told me Trudy was sick, but not much more. So far, nothing pointed to a problem with any particular body system. She obviously felt horrible, but from what? I rubbed my hand against my forehead.

  “What do you think it is?” Steve asked.

  “I don’t know yet.” A frown spread across my face. “Normally, Trudy is a wild child. This is way too calm for her.” Hopefully, her blood and urine would tell me something. Before I drew her blood, I decided to perform a rectal examination. I grabbed a disposable glove from the shelf.

  Steve wrinkled his nose. “Better you than me.”

  I slid on the glove and squeezed a blob of lube on my pointer finger. As I slowly inserted my gloved finger, Trudy tried to sit on my hand. Steve placed one hand under her abdomen and hois
ted her rear end back into the air.

  Bummer, everything felt normal. I pulled my finger out and let go of her tail. Bright red blood mixed with feces covered my gloved finger. “Steve, look at this.” I opened a drawer with my other hand and retrieved a glass microscope slide. I pressed the slide against my glove, leaving an imprint of my finger in blood.

  Many things can cause bloody feces. I ran through the possibilities in my mind. Gastrointestinal parasites or worms, as many owners call them, damage the mucosa of the intestine. The damaged area bleeds, but usually not this much. She could have a foreign body stuck in her intestinal tract. She is a Lab, after all. I thought of Rusty and his propensity to swallow inanimate objects. Or it could be hemorrhagic gastroenteritis from stress? I pulled the glove inside out as I removed it.

  But my gut told me this was a primary bleeding problem; her blood would not clot. Perhaps she ate some rat bait from one of the warehouses. Dietary indiscretion, as we call it in veterinary school, is always at the top of the list with young dogs. I needed to make the diagnosis quickly, or she would bleed to death. I grabbed a syringe and several different blood tubes from the drawer. Steve held Trudy’s head up with her neck exposed for a jugular stick. I pointed to her leg instead. It was safer to draw from a smaller peripheral vessel instead of the large jugular vein. Poor Trudy might bleed for a long time.

  The dog stood like a statue for her blood draw. Steve held off the vein with one hand and hugged Trudy with the other. I quickly filled several tubes with different colored tops –̶ purple, red, blue and green. One by one, I pulled the rubber stopper out and let the blood trickle down the side of the tube to the bottom. When the red top was filled, I looked at my watch. It read 7:30.

  Every minute, I inverted the tube. With normal blood, a soft clot begins to form in two minutes, and all of the blood clots in less than five. If I was right about rat poison, Trudy’s blood would take much longer to clot – if it clotted at all.

  Steve held a gauze pad over the vein. “Any signs of clotting yet?” he asked. I shook my head back and forth but kept my eyes on my watch. When the second hand reached the two-minute mark, I slowly inverted the tube again. The blood sloshed from one side to the other.

  “Be sure and keep holding her leg,” I told Steve. “I don’t want her to bleed out through the venipuncture site.” He readjusted his grip on Trudy’s leg.

  The seconds continued to tick by. Three, four and then five minutes passed without any signs of clotting. Her blood continued to flow from one end of the tube to the other. I glanced at Steve and Trudy in between inverting the tube. She rested her head on his shoulder. Six, seven, eight, nine and finally 10 minutes ticked by without any clot, even a soft one. “It’s been 10 minutes.” I placed the tube on the shelf. “I don’t think it’s ever going to clot.”

  “Poor Trudy,” Steve said as he stroked her head. “What’s next? Do we have to make her vomit?”

  “No, it’s too late for that,” I answered. “By the time an animal shows clinical signs, the poison is already absorbed.” I searched through the cabinet for bandage material. “I’m going to put a pressure wrap on her leg to keep her from bleeding, and then we’ll give her the antidote.”

  Warfarin is the most common rodenticide in our area. It interferes with Vitamin K1, an important step in the activation of platelets. Without Vitamin K1, the platelets won’t aggregate into a clot. A poor animal that ingests this product bleeds to death –̶ a prolonged, awful death. I wish we would find another method for rodent control.

  Unfortunately, treating rat bait ingestion is pretty common in practice. The bait appeals to all kinds of animals, not just rats. Some animals come in with bruises all over their bodies. Others bleed from their mouths. In the winter, owners notice bloody urine on the snow. Trudy was the first case I diagnosed from a rectal exam. The bloody stool was her only visible sign of hemorrhage.

  The principle behind treatment is simple. Give the patient large doses of Vitamin K1 to out-compete the poison. I grabbed a large needle and syringe. The thick solution burns when injected. I drew Trudy’s dose from the brown glass bottle into the syringe.

  “Steve, this really hurts,” I said. “Let’s muzzle her.” I grabbed a medium blue one from the rack by the leashes and slipped it over her nose. Trudy did not resist. I injected the irritating solution in multiple sites to lessen the inflammatory reaction. After that, Steve helped me place a catheter for I.V. fluids.

  “Good girl, Trudy. You are a brave girl,” Steve soothed. “I’ll stay with her while you call the officer,” he said. I retrieved an office chair for him before heading back to the lobby. Trudy lay down on the table and rested her head on her paws. Steve settled back into the chair with the Wall Street Journal in his lap. He placed his arm around her and skimmed the front page.

  Frank was waiting for my call; he picked up the phone on the first ring. “Sorry to drag you to the clinic after your trip, Dr. Nelson. I’m sure that’s the last thing you wanted to do.”

  “It’s OK, Frank. I’ll gladly come in for Trudy.”

  “So what’s wrong with her?’

  “Well, I’m afraid she’s got a bleeding problem,” I replied. “She can’t clot. I found blood on the rectal exam, so I did a quick clotting test. In normal animals, the blood clots in five minutes or less. Trudy’s blood never clotted.”

  Silence filled the distance between us.

  “What causes it?” he asked.

  “Lots of things,” I replied. “But I would guess rat poison.”

  “That can’t be. She doesn’t have access to any poison.” He paused. “What are the other causes?”

  “Well, she could have been born with some kind of clotting problem. For example, I always screen Dobermans for von Willebrand’s disease. But Trudy is a mixed breed, which makes that unlikely.” I ticked off the causes of bleeding that I learned in school. “She could also have a problem with her bone marrow not making platelets or making platelets that are defective. The list goes on and on.” I transferred the phone to my other ear. “But with most of these causes, Trudy would have had problems long before now. She would have bled during her spay.” I paused.

  “To the best of my knowledge, Trudy has never had any problems like this before,” he responded.

  “Ever notice any blood on her toys or in her food bowl?”

  “No, never.”

  “That’s why I think she has an acquired problem rather than an inherited one. Poison is the most common cause of an acquired clotting problem. This is especially true with young dogs like Trudy. You would not believe some of the things they will eat.”

  “Is she going to make it?” Frank asked.

  “I think so, but of course, there are no guarantees. I’ve injected her with vitamin K1 and started her on fluids. It will take awhile for the medicine to work. The next 24 hours are critical. If the blood loss doesn’t slow down, she might need a transfusion.” Frank listened intently and promised to transmit the information to his supervisor.

  The next morning, Frank pulled up to the clinic in a new white panel van just as I got out of my car. The windows on the van’s back doors were tinted black, and a temporary paper license stuck to the glass. The license plate holder was empty.

  “Good morning, Frank,” I called from across the parking lot. He turned to face me. He wore a navy blue shirt with large U.S. Customs patches on the sleeve, and his metal name badge reflected the bright morning sunlight. A flashlight, handcuffs and empty holster hung from his black leather belt. He quickly snapped a handgun into the holster.

  “Hi, Dr. Nelson,” he replied. He grabbed a towel taped into a roll from under the seat and stuck it into the back pocket of his shorts. The seams stretched to accommodate Trudy’s favorite toy.

  “Did you get a new car?” I asked.

  “Yes, we got it in a drug bust last week,” he said with a smile. Vehicles and equipment used by drug traffickers became property of law enforcement. The van worked well for transporting Tr
udy, accommodating her crate as well as other equipment. Frank opened the back door to show off the crate, but the smile vanished from his face as he thought about his dog. He fingered her rolled-up towel in his back pocket. Maybe she would play a little today.

  I held the front door open for Frank, but he would have no part of it. He grabbed the door handle and motioned for me to enter first. “Ladies first,” he commanded. “Especially when they’re treating my partner.” I nodded and walked through the open door.

  “Good morning, Dr. Nelson; good morning, Frank,” Allie greeted us from behind the counter. She handed Trudy’s record to me. Trudy’s PCV dropped two percentage points overnight. I had hoped it would stay the same or increase slightly in textbook fashion. Unfortunately, Trudy had not read the book.

  We took a shortcut through the cat room to the back. The angelfish swam to the front of the aquarium and followed us as we passed. Genny froze against the wall when she saw Frank in the pharmacy area. She didn’t like the noise he made as he walked. The squeaky leather and clinking metal alarmed her. The fastest thing on three legs, she scampered into the closet in the office.

  “Hello, hello,” Bongo greeted us in her feminine voice.

  “Hello, Bongo bird,” I responded.

  “Hello,” she said again, this time using her masculine voice. She sounded just like my dad. Frank ignored the greeting. He focused entirely on Trudy.

  Trudy drank a little water but refused her breakfast. Saliva dripped from her lips, leaving dark spots on her blanket. She tossed and turned from side to side and occasionally smacked her lips. Her tail hung between her legs, limp and lifeless, she lay in the first run with a bag of I.V. fluids hung above her head. Resting with her eyes closed and her rear end elevated just above her head, she looked like she was praying. Frank’s face flashed white when he saw her.