Wednesday, January 25, 2012

The Finish Line

I think that I have shared with you all already that one of the things I love most about this job is learning why people name their pets what they name them. I get some funny names and some even funnier explanations. (For those of you new vets out there, this is a great "ice-breaker" for a new client, or a new pet, and it's also a great way to help you remember a client and your patient).

One day I received a call from a very good vet friend of mine who doesn't particularly enjoy surgery. Her clinic is very close to my home and we have been very good friends for as long as I have lived in my home. She has a beautiful clinic on her in-laws farm and it is the quintessential picture perfect rural small animal practice. But not all vets love surgery, so for those that work in a 1 doctor practice they have to "farm" out some of the things that they cannot do in-house. For her it is the big surgeries. She called me and said that there was a very nice family who had an older lab mix dog who had a bone cancer and that the dog needed her right hind leg amputated.

Dogs with advanced bone cancers most often are recommended to have their affected leg amputated to prevent the cancer from spreading and also to stop the chronic terrible pain associated with a bone tumor. Bone tumors are aggressive bone eating cancers that will spread to other organs and other places in the body if not excised completely. I have seen many bone tumors over the years and seen many owners try many different kinds of treatments for them. Veterinary oncologists and surgeons have tried many kinds of operations, radiation, and chemotherapy's to try to treat this devastating kind of tumor. I will say that for the bone tumors I have seen I still stand by the choice of amputating that chronically uncontrollably painful leg and the care of a vet oncologist. The difference in a pet when you take off that broken bone that never heals, is like light and day. I actually have discussions with owners and say to them "I am happy to give you the numbers of some of my clients who have done this surgery and actually said "Thank-you," after we amputate the leg. These dogs are soo much happier because they are finally pain free." I fully understand how hard it is to decide to amputate a leg, but in all cases these dogs aren't using the leg anymore. They are just dragging around a broken crumbled bone that hurts them every second of everyday.

When I met the owners that my friend was referring to me I knew I did not have to convince them that doing this surgery was the right thing to do. When I met this dog I had to ask if her name was correct as it was written on her chart. "Finish Line? Is that correct?" "Yes," was returned with a smile and a bob of blonde Shirley Temple curls. Finish Line's mom is a cheerful, always smiling kind, thoughtful, gentle woman. She never speaks without a smile and direct eye contact. She has the aura of pure sunshine. I liked her from the starting line. She explained to me that her husband is a race car driver, (we live in the middle of nowhere between Baltimore MD and Philadelphia PA, so I can't imagine where he is a race car driver at, but I am sure it is a drive to get there. Someday I will ask). She has two dogs, Finish Line and Checkered Flag. (Maybe I will move from naming my dogs after southern cities, what I currently do, to veterinary instruments? "Here hemostat," "Heel thumb forceps," "Sic needle driver," Umm? I guess I'll stick to southern cities.

It was grossly apparent that Finish needed her right leg to go away. She would barely walk at all, because even placing her toe on the ground sent shooting pains up her leg. So she would just lay still and growl or threaten to bite if you even thought of approaching her to touch her. We checked her blood work, (all normal), took x-rays of her body, (we check the lungs to make sure we don't see any evidence of metastatic lesions) and decided that everything looked very normal except for that wretched leg.

Finish Line was scheduled for surgery on the next day and successfully had her right rear leg amputated. Within 2 days she was up, walking, and feeling like the dog she hadn't been in months. Her mom and dad were thrilled by how happy she was, and how good she felt. At 13 she was playing, jumping, running, taking the stairs to spend the night in the kids room, and in general doing things that they had not seen her do in a long time.

Two weeks later I got a phone call that haunts me to this day. I was at the front desk when the phone rang and I saw the receptionist answer and then heard nothing but blood curdling screams. I immediatley took the phone from the receptionist and tried to understand what was happening on the other end of the line. It took me a few times to understand who I was talking to, and what they were talking about. I clearly remember hearing "SHE'S BLEEDING OUT!"

"What? How can that be, it's been 2 weeks?" I said to her.

She replied, "I heard a yelp from her in the kitchen, and I ran in, and there was blood squirting out of her leg. It's everywhere! So I just took a towel and put pressure on the incison where her leg was."

"Ummmm, OK,,,,Umm, well,,,keep pressure on it." I sounded like a fool as my brain tried to digest, comprehend and process what she was telling me. And my heart was breaking hearing her sound so desperate and so scared. She said to me, "I called **** (the vet who had referred her to me, and lived much closer to her than my practice was) and they told me if I brought her there they could only euthanize her." I knew that that clinic was equipped to do an exploratory on poor Finish Line.

I said "can you get her here?"

"It's only me here, with the kids, and if I take my hand off of her leg it starts gushing blood again."

Damn It! I thought, "I will send someone to get you."

"No, I can drive 1 handed I will get there faster if I go." She hung up and I waited the longest 15 minutes ever. I was certain that Finish would arrive at our clinic dead. And I grappled with the thought of "How can this have happened? Because I couldn't imagine how this could have happened.

I am so careful with my surgeries. I dissect out everything. I put ligatures on every vessel, and the big ones I put at least four ligatures on. I thought that she must have fallen or bumped something and punctured an artery? Or avulsed (pulled the blood vessel away from its attachment) the artery. Any scenario I could come up with were all very very bad based on her owners description of how much blood was coming out of Finish.

Finish's mom arrived covered in blood and clutching a black mass of frantic fur. Sometimes (actually quite often) owners significantly exxagerate how much blood they are seeing. But in this case she was right on. It was an incredible volume of blood. And she was right by saying that if you took your hand off of the gusher it would pump out blood like a geyser. I took one look at her, and one look at Finish, and took her hand off of the place where her right rear leg used to be and I knew I was going into surgery NOW! The clients in the waiting room also took one look at her and her dog and they all volunteered to come back another day. Within minutes Finish was on the OR table and I was dissecting out a huge hematoma to try to find the tiny coffee stirrer sized straw that was the remnent of her femoral artery. Only this little monster could produce this much blood at this fast of a pace. I was determined to find it before it pumped its last remaining drop of her blood.

What an incredible mess that almost completely healed leg was. Within 5 minutes I had found a tiny nubbin' of the femoral artery and I was lassoing to save her life. Where my first surgery was pretty and precise, this one was sloppy, immediate and vengeful. I didn't care about how it was going to look when I was done (which is how I approach every other surgery, I think about how I am going to finish before I start), I just tied and tied and tied again. I didn't have much rope to strangulate but I was going to put as much suture as I could around that artery to get it to stop spewing, and I was serious about how angry I was at it.

It was the quickest life-saving surgery I have ever done. I got in, got my revenge, and got out.

Finish walked out of our hospital from her second leg surgery the next day. I spent the next three weeks as worried as her parents were. But she did great. I don't know what slipped, or how it could have slipped, but I am sure that it was her femoral artery and I am also sure she is one lucky pup.

It has been 23 months since that day. I saw Finish last night. She has a recurrence of the melanoma tumor that we surgically removed 2-1/2 months ago. She is now 15.5 years old. She is every bit the happy, playful, companion to her family that she has always been.

But we know her time is near, and this tumor is too aggressive and invasive to treat. Her parents are trying a new melanoma vaccine, because it is all we have left to offer.

We will all hold out for one last miracle, if anyone can catch one it is Finish Line.

"Fini," as her mom called her, was euthanized tonight. She had some moments of running and playing with the kids, but yesterday and today was unable to stand and refused to eat or drink. When she arrived at JVC it was evident to us all that it was her time. She was unable to move and her eyes were all any of us needed to know that her struggle was too  much to bear for anyone anymore. Her mom cried and told me that Fini had been with her for 16 years, long before her children were born. And that she had never had to have a pet put down before. Fini passed gently, quietly, and peacefully. We send her family our deepest sympathies, and hope that they always remember how much she loved all of them.

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