Losing the Battle - Or So We Thought

I don’t know at what point that I decided to look upon cancer in my dog and cat patients as the ultimate enemy. As the general in the little veterinary clinic whereI worked, I wanted to be on the offensive with cancer just one time. Instead, I always seemed to be on the defense, and about three steps behind the enemy. Cancer is simply uncontrolled growth of abnormal cells, and it always amazes me how such a tiny force can wreck so much havoc. For a 8 year old friendly Pitt Bull named Tyson that lived just two doors down, that force was now a large cutaneous hemangiosarcoma that started as a small red lump just under his skin. Over the months, it had become gnarly and already burst open more than once. My weapons were steroids to help reduce the size, medications to keep the pain at bay, and freezing of the edges to help portions die off over time. I had watched Tyson grow up with two other Pitt Bulls, as well as the Riley’s three children. His human mom, Renee, had asked me a few months earlier in the check out line at the Dollar Tree store, if I thought we could easily remove this tumor. Another veterinarian had told her it was a bad prognosis. I had let her know as gently as I could, that the odds were not in our favor. So today, with weeks of preparation, I was ready to stare this evil cancer right into the face, as I let his human dad know what my plans were for the day. I put on my game face before I entered the room for Tyson’s pre-operative exam. “James, Tyson’s gums still look pretty pale to me. The first thing I need to do is check Tyson’s blood to make sure he has enough platelets to clot his blood during surgery and enough red blood cells to efficiently carry oxygen. If the levels are not high enough, I will need to give him a blood transfusion, and the best candidate would be one of his littermates,” I stated. While the blood was processing in the lab machine, I had to see two other patients just to keep up with my morning schedule. When Stacey handed me the results, I took a quick look, and let out a long sigh as I headed back into Tyson’s room. “Ok, James, are you able to go get Po back at your house?” I asked. Po was fifty pounds of pure energy, and I had already warned James that we might need to sedate him just to get the much needed blood transfusion. “I’ll be back in about twenty minutes,” he said. This would give us enough time to get an intravenous (IV) catheter inserted and some fluids running to give him a boost. As I came back to the pharmacy area and noticed that every exam room was full. Kaitlin pointed to which one was first, and I said a quick prayer for strength and wisdom. Mrs. Crabtree wanted full exams, bloodwork, and an explanation of the results as soon as possible. In Room 2, Bosco, the Labrador Retriever, had yet another ear infection. In Room 3, was an euthanasia on a cat that was not allowing his owners to give him medicine to lower his high thyroid levels. I had already given him two sets of sedation, but his adrenaline and high rate stopped any chance of calm without the big drugs. So I went back in the room again to give him the best happy drug combination I could find before we could even think of trying to hit a vein with the euthanasia solution. These are the moments when my thirty years of veterinary experience sends me into the zone of slowing down to speed up the pace. I had Kaitlin and Stacey clean and treat Bosco’s ears, while I started the exams for Mrs. Crabtree’s cat and dog. Shilo stayed in the back with Tyson to monitor his IV fluids. I could hear the front doorbell ring as James and Po entered and went to the corner of the lobby until one of us could help them. I extracted myself out of Mrs. Crabtree’s room, which was no easy task because she was deep in the tale of her late husband’s rescue of their fluffy cat. I was able to give Po a sedative injection right away. Stacey appeared to grab Po’s leash and lead James around the back way to Room 2 as Kaitlin led Bosco out to the front so that his owner could pay the bill. Shilo was able to use her inner strength to lift Tyson off the back table and into a comfortable cage. I met Shilo and Stacey in Room 2 to start the blood donation. I inserted the needle into Po’s large jugular vein, and blood began to flow into the transfusion bag. Back in Room 3, Kaitlin held off a leg vein on the now serene Wally cat, so that I could administer the final injection. We could hear his sigh as the euthanasia solution took its effect, and felt both the owner and Wally relax as I gently removed the tiny needle from the vein. We let Wally’s owners spend a few last minutes with him so that they could begin to process all that had happened. As I went back to check on Po, I could see Mrs. Crabtree came to the door and cleared her throat loudly. “If we are going to do bloodwork it better happen soon because I have a hair appointment in a half hour,” she announced. Before I could respond, the door to the treatment room opened. “Dr. Fran, we need you in here now, there is a clot in the vein and blood line,” Shilo said in even a louder voice. I gave Mrs. Crabtree a sympathetic nod, and went in to solve the blood clot issue. I knew at that point, it was time to go to the old fashioned technique of drawing up individual syringes lined with the anticoagulant, heparin. I was able to get three 20 ml syringes filled before the jugular veins were blown. I explained to James that we would need to get as much of the blood as possible into Tyson before the surgery. I quickly checked to see if there was a reaction between Tyson’s and Po’s blood on a glass slide to make sure the transfusion would not be rejected by Tyson. No reaction occurred, so I let James know it would take about 1 ½ hours of slowly dripping in 1 ml of blood every thirty seconds, so the best plan was to take Po home and wait. Back in Mrs. Crabtree’s room, we easily drew blood for analysis from her little Sasha’s leg. Raymond her cat was going to be a whole other story. “I just see how you can’t seem to find a vein on Raymond. He is so thin and practically hairless, it should be easy,” she sniped. I felt like she laid down the gauntlet, and by no means was I going to let Mrs. Evelyn Crabtree win. It took me three more tries because of my arthritic thumbs, and I only got just enough blood in the syringe for a minimal amount of bloodwork. “Mrs. Crabtree, I will have to call you later with the bloodwork results,” I mentioned. “Well, I can text my hairdresser and tell her I will be a few minutes late. I am sure she won’t mind waiting for a Gold card client like myself,” she firmly stated. I let Stacey handle this situation while I raced to the back to make sure that Tyson wasn’t having a transfusion reaction. After listening to his heart and breathing with a stethoscope, I finally took a deep breath. Shilo and Kaitlin, ever the professionals, gave me a smile to let me know they could handle it. The blood machine had just given its “Bloodwork complete” ding, when Stacey came to tell me that our client with dementia was here to euthanize her old Chihuahua named Chip. She said someone had told her on the phone last week to come in at 10:30 am today. It’s hard to argue with dementia, and you should always tread lightly around a broken heart, so we guided her into Room 2. I went back to make copies of the bloodwork, but the copier wasn’t working. “Mrs. Crabtree, Raymond has non-significant changes in his bloodwork, but I will text you a copy and an explanation in a few hours,” I said. “I just don’t understand the slow service here today. What is going on?” she asked. “We have a dog in the back with cancer who is getting an emergency blood transfusion before we can surgically remove a large tumor,” I succinctly stated. “Why didn’t you say so in the first place. I will have Stacey check me out and I will leave you to your work,” she said with a gentler voice. With that, she gathered up her pet’s and headed to the front desk, so that I could attend to the euthanasia at hand. Meanwhile in the back, I had a decision to make about when exactly to do the surgery on Tyson. Should I let it wait a day, for the blood transfusion to have a full effect, or should I take the chance and get the surgery done today. My gut told me to look for a secondary bleed inside of his tired body. When I put my portable ultrasound probe on his abdomen, I received the answer to my question. “Only about one in five hemangiosarcomas under the skin metastasize to the spleen. Since the spleen is the cleaning house of blood in the body, it can be life threatening if a cyst or tumor in it ruptures,” I told Shilo and Kaitlin. Why don’t you give him some oxygen and warm him up while I call the owner to see how they wanted to proceed. I sat down at my small desk, and took a deep breath before I dialed the Riley’s number. This time, Renee picked up the phone when I called. “Renee, I want to let you know that Tyson has recently had a bleed from a cyst on his spleen in his abdomen, and that is why he is so pale. To go ahead with surgery, may not be the best option as he may not recover,” I let her know. “Dr. Fran, what would you do if it were your dog?” she tentatively asked. “My beloved deaf and blind Australian Shepherd named Sprite had hemangiosarcoma in his heart. We elected not to do any heroic treatments with him. My one regret was that I was not home when he passed away, but he had so much fun on his walk that morning. I feel that euthanasia would be the best solution in this situation,” I said as I felt my strong woman facade starting to slip. “It will take about thirty minutes for the whole family to get there. Tyson is my stepson’s dog, and he will want to say goodbye,” she said with tears in her voice. I let Shilo and Kaitlin know the change in plans. Tyson enjoyed the cheese whiz, peanut butter and turkey we gave him since he no longer needed to be fasting for surgery. I administered an injection of pain medications to him, as he licked up the treats. We kept him up on the table in the treatment room with the warm winter sun coming through the window, and oldies rock playing on the radio. There were many tears that flowed in the next hour. The euthanasia went smoothly as I used the one remaining undamaged vein on his back leg to slowly inject the euthanasia solution. There were many tears when he passed, but an overwhelming sense of peace. To do my job effectively, I have to be like a general, and not get emotional in the thick of things. On that day, I performed three euthanasias on beloved pets before 11:30 am. There were moments when I wanted to get angry, be sad, or even joke to bring any type of levity to the situations at hand. I knew I would do all three when I went home that day to evening to stare at the sunset and tell my own dogs all that had happened. . You see, sometimes our patients will lose the battle with their disease, but that prepares us for the next battle, by giving us experience. In the heat of the moment, I tend to suppress my emotions knowing that sometimes death is the ultimate healer by giving the patient and the owner peace.