Mass Removal On The Foot, and Neuter, German Shepherd Dog

 

This is Apollo. He is a recent rescue. He, like almost all of the rescues we see has a checkered past with more holes than answers. We know what we see in front of us.. male, young, intact and jittery with all of the newness of everything in his life.

He is in foster care as the rescue gets him caught up on vaccines, allows for time to decompress, acclimate and show his true colors. Let his fear assuage to his personality. 

This is the story of Apollo's neuter and mass removal.

I mention both as he was in need of neutering before he found a home of his own, and he had a mass on his wrist that had no accompanying information.

When dealing with a neuter the options are fairly straightforward and simple;

1. neutering is the removal of the testicles from the scrotum. It can be done as an open or closed technique. I  decide which based on size of the blood vessels needing ligatures. There shouldn't be a change in price and the preference is based on the surgeons 

2. scrotal ablation with the neuter. For dogs with excessive scrotal tissue (older dogs tend to have larger and more sagging skin). It's a cosmetic thing in almost all cases. In the trade we call it preventing "the flapjack."

This is Apollo's mass. Firm, raised, irregular and without any evidence of what it might be, or, what might have caused it. 

As with all masses on pets the only way to identify what it actually is, is to send in a piece of tissue of that mass to a pathologist. There is only guessing outside of tissue. If you are looking for more information on this please read this blog; When a Bump Causes You Concern, Slay It With A Diagnosis.

There are so many factors that go into a successful surgery. For Apollo's case we did a thorough pre-op physical examination. We also made sure his vaccines were up to date. I prefer that each patient be as calm and stable as possible. This includes physically (healthy based on exam and blood work), emotionally (all rescue pets need time to acclimate and adapt to their new surroundings). Too often these rescues are rushed in and out and back and forth to find placement as quickly as possible. It costs the pet terribly. Stress and its detrimental affects on the body are underestimated and too often overlooked. If at all possible give a pet time to go into surgery in the best possible place, happy, calm, relaxed and healthy.

The next part of a successful surgery is surgical planning. I start every surgery with the plan in my head. The order to which I will execute the surgery, the amount of tissue I want to remove, and the plan for how I will close the area after. You need to know where you are ending before you begin, and then you also need to be prepared for plan B, C, D, etc if the previous doesn't go as planned/hoped for/expected.

Apollo's surgery was a challenge because there is not much room on the wrist. I can't cut too deep, or wide, or have any extra tissue to close after I removed his mass. The mass extended both wide and deep. No room was left over to let me close the sides after I removed the mass.

The goal for every mass removal surgery should be discussed with the pet parents before the anesthesia is turned on. 

Ideally every surgical event is what we call a "one and done." Once surgical expense and event solves the problem. It provides both the diagnosis (meaning we removed a large enough tissue sample that the pathologists feels exceptionally confident in their diagnosis. AND, there are clean margins that prohibit the mass from being able to return. 

In all but the most exceptional cases we should never place our patients under repeated anesthetic events, NOR, require additional financial investments from our clients.

Too often I see veterinarians offering surgical services and NOT attempting to remove the mass in its entirety. It is a financial and emotional burden that is placed on patients and clients. 

What happens if the mass is malignant? Or, invasive/destructive over time? Do we require clients pay for surgery twice? Put our pets at an anesthetic risk twice, or more? Many clients cannot afford twice? Or, feel the case is not worth the diagnosis the partial mass removal has provided. 

Many of the cases that I see have been told the "mass is probably bad" i.e. likely cancerous, or, the pet is too old to put under general anesthesia. People are essentially discouraged from surgical excision of a mass for reasons that too often ;eave them at a place where they are euthanizing their otherwise happy older pet because the mass is now so large it is open, draining, and painful. 

I cannot even tell you how many dozens of older pets that we have given extra enjoyed months of time to because we just tried.. we tried, and SUCCEEDED, in the mass removal. See Spencer's story here.

Apollo's mass was in a tough spot: the lower leg. It was the size of an acorn on the outside of his wrist. 

I had to remove the mass and then make a large flap of skin above where I had removed the mass to close the hole the mass left behind. It is commonplace to close the sides of the site and leave a linear incision, but, the legs don't leave enough skin to do this.

The fear with an advancement flap is that everything you cut will die. Instead of a quarter sized hole of non healing tissue we have an area three times larger than the mass was.

After Apollo's surgery I placed a bandage. It serves a few functions;

1. Protects the incision.

2. Allows a few days for the incision to have very little stress on it with movement of the leg.

This is Apollo one week post op. The tissue is looking perfect! 

Here is the histopath results for Apollo;

Calcinosis circumscripta refers to a non-neoplastic nodular focus of

mineralization and is considered to be a localized subgroup of

calcinosis cutis. The cause of calcinosis circumscripta is currently

unknown, but the majority of cases most likely involve trauma followed

by dystrophic mineralization. In some cases it may be an incidental

finding in young rapidly-growing large breed dogs (especially German

Shepherd dogs). This lesion most commonly occurs at sites of previous

trauma (bite wounds, ear crops), over pressure points (footpad) and

other bony prominences (spine, elbow), and occasionally in the tongue.

There is no evidence of neoplasia, and etiologic infectious agents are

not observed in the examined tissue sections. The lesion appears

narrowly excised.

What makes this case so notable?

1. The rescue made decisions based on what Apollo needed first and foremost. Not cost, but care. His adoptive family knows what his mass was. They don't have to worry about what it might be. How it will affect his lifespan, and the cost of all of this as a new family member.

2. His mass removal BOTH diagnostic AND curative. Every case in every surgeons hands should start with this as the goal.

3. Apollo has the best chance at success for a future with known information. He's not a mystery of unknowns. We are filling in answers for him as we discover who he is. He has a solid foundation to succeed!

The cost of care for Apollo's case included;

i.v catheter $40

i.v. fluids $50

i.v. fluid pump $25

anesthesia $250 for 2 hours, it is based on surgical time

castration $150

nail trim $0

analgesics post op $50

laser for mass removal $220

mass removal $250

sutures $30

SQ fluids $35

biopsy $150

antibiotics $30

total $1280. Apollo received a rescue discount (not shown here).

Investing Too Much. When, and Where Do You Draw The Line?

Perhaps I went into this for all of the wrong reason(s)?

Maybe not the wrong reasons, but, perhaps the expectations were unrealistic? Maybe there was too much of me in this endeavor for others? Maybe it's the other way around?

These are the questions I ask myself as I muck through the maze of my daily life as a veterinarian in general practice.

One of the many delightful faces of my vet life day

Yesterday I spent a long time, (to be honest 20-30 minutes), with a sobbing client as she dropped off her dog, Brunswick, for a forelimb amputation. She was, (as every single other amputation pet parent has ever been), reluctant to consent to this surgery. Of all the procedures that we do, and, for all of the many indications this procedure is recommend for, there is no other life-saving, pain alleviating surgery that is met with such pet parent reluctance and resistance. In my clinic over the last 15 years that I have been practicing, I would say that only about 1/4 of the pets who need this procedure, and, I believe would benefit immensely from, actually get it. Most pet parents will sacrifice the pet to spare the removal of a limb. There is this incredibly difficult and deeply rooted mental block on consenting to limb removal as a treatment option. We were at this place; sitting in the front office, debating whether to consent to cutting off the leg of her otherwise perfectly healthy and happy pup.

Brunswick is a timid 7 year old, 50 pound, mixed breed dog. She is a tawny brown with big erect triangular ears, a wide faced and her soft white body is liver spotted from neck to tail. She has a history of a mass removal from this leg that yielded a diagnosis of "lipoma" many years ago. That mass has returned, slowly growing within the armpit of her front leg. It is now pushing the limb out and away from her torso. It has gotten so large that it has exceeded her skins ability to further contain it. The underside of the arm was red, raw and ulcerating. The mass that has been slowly growing for years now is outgrowing her. The cold cruel eventuality of Brunswick's leg was lose the leg or lose her as she would soon have an open wound that would never heal but instead continue to erode her leg, cause her increasing pain, and chew its way up her neck and across her sternum. 

Brunswick walks front legged short stepped, cowboy style. It manifests as a limp. The mass is hidden from obvious view by her bushy hair. The dappled coat hides the magnitude of the mass until you pet her. The diameter of the upper part of her left front leg is easily twice that of her slender athletic right leg. Her demeanor is always stand-offish for a few moments, but, if you are patient, quiet, and gentle in allowing those few moments to pass she will warm up to you to flounder flop on her "good" side for a full belly reveal. It is her not so subtle invitation to focus your affectionate rubs on the tender fleshy part of her belly. She is easy to fall in love with. Her handicap simply reinforces her charm. Her mom adores her. She will tell you that "Brunswick is her first child." 

And, now,,, here we are. Sobbing. Crippled with fear and doubt, and stuck about what to do with it all.

Many conversations get to this point. That critical pivot point where biology, disease and prognosis has met the timetable of limited options. That juncture in a pets life where you have to choose? Are you a proactive parent seeking to gain as much time with your pet as medicine is able to provide? Or, do belong to the crowd that does not believe in surgical procedures for pets? Do you choose to invest multiple thousands of dollars, hours, and caregiving requirements to gain the precious commodity of more time with your companion. Do you value your pet as a member of your family? Are they one of your kids? Can anyone possibly speculate all of the twists and turns that lie ahead if you do, or don't, take action? 

Most pre-op surgical discussions go like this. 

In Brunswick's case we had already done multiple examinations. Two with me, one with the surgeon. At each time we (the "professionals") agreed the best resolution to this tumor was to remove the leg. There were about a dozen emails back and forth to discuss every possible question and concern. And,, yet,, here we were, crying at drop off. 

I sat with her and said; "I know how hard this is. Please do what you think is right. Not what anyone else tells you to do." I firmly believe that this needs to be said to every parent. The road ahead is too full of twists, turns, and potentially even life-threatening landmines. I should add the cost of care, but, for me it is not a part of the equation I will let decide options. If we believe a treatment option is needed we will find a way to make it accessible. (Note: we use multiple payment plan options to help people not let the financial burden be the deciding factor).

I try to ask myself who will benefit from these decisions? Who am I looking after? These are huge weighty decisions with dire consequences. I try to be unbiased, neutral, indifferent. I try to present facts, argue all sides. I soo often feel that I fail miserably at this. I am not ever able to remain indifferent. I am not on anyone's team outside of my patients and their family. It is the dark force that grips my soul surrenders my conscious heart at midnight.

Brunswick post op

Here's where the muck meets the sole. Brunswick needs this operation. She will die within a year from the mass if she doesn't have it. How do I advocate for that? A: I just have to be honest. Then I have to accept the consequences. But, I know Brunswick is loved and I know her mom is making this decision based on that. Seems silly to some, maybe? But that is always enough for me. I am not the vet for indifferent people who don't value pets. That I cannot do. That would kill me.

My pups; Frippie and Storm

These are the elephants I carry on my back all day every day. They remain cumbersome, consuming and catabolic even after I get home at night.

I didn't sleep much after midnight. That mystical witching hour.  My typical work day has me arriving home after 9 pm, a 12 hour day of work without breaks, meals or niceties logged in the record books.  My shear exhaustion leads me to literally passing out on a pillow having foregone the obligatory teeth brushing, face washing, moisturizing and evening medical supplement regimen. They are all tossed out the window for the sake of sparing my legs the 80 paces they would require. There are loads of nights like this. Wrung out dry. I enter home as this zombie-eyed shell. I sleep for 3 hours and the death cipher lets go her grip for the anxiety ridden stressed-out-Suzie to take claim. Its always this exchange of custody each night between the hours of midnight and 2 am. A shared custody battle as the sun sleeps. 

My Frippie always brings me a gift

Why does the day weigh so hard? Brunswick is one example.. this is another. This one happens too often these days. COVID has created a huge demand for puppies. None of them are being socialized appropriately and for some (often breed specific) it is causing potentially disastrous consequences.

The other emotional dilemma of my day was an 11 month old German Shepherd, (let's call her GS), who visited for a pre-spay exam with bloodwork. Her mom had brought her inside the clinic vestibule on a one foot leash to a tight prong collar. Even with moms double fisted grip she could not get GS to remain with four feet on the floor nor have any kind of focus. She had no control of her adolescent puppy, and, she knew it. She told me that she "doubted I would be able to get her blood." She passed my technician the one foot lead and watched us all as we struggled to lead her to the treatment area. All GS needed was a 5 minute physical exam and 30 seconds to pull a blood sample. These appointments are not charged for as they should only take 6 minutes to complete. That didn't happen.

GS was a happy, outgoing 75 pound determined to party firecracker. She was elated to be around people, and in absolute resolve in not sitting for longer than one split second for anything. She knew commands, and she knew how to decide to avoid them. She surged, jumped, boxed, and thrashed. She twisted arms, crashed heads, and started to lunge and bite to have her demands heard.

Our dinnertime excitement

I always stop here...... The three of us; myself, my technician, and GS. We all looked at each other. What to do now? Take a breath? Try a different tactic? All of the above? We took breaks. We tried treats. We tried calm quietness. I tried a large muzzle, just to see if that would settle her. Fifteen minutes into the endeavor and one thing was clear; Nothing worked. We were at the place where one of three things was going to happen;

    1. I lose my patience and I hog tie, muzzle and we pig-pile on her to attempt to bruticaine (brute-force-paralysis vet lingo), and see if she is so shocked by this she gives in.  I just turn into a cold hearted drill sergeant. Bark orders. Intimidate. Force her to be what I want her to be. Force her to hold this command until I feel she has learned who is in charge. Quickly restrain GS and get it done. Get the blood. Skip the exam. Smile and return her to mom. After all what she doesn't know isn't my problem. She can't claim naivete when she already admitted unruliness. Make friends with the owners, even if it  is at the patients expense. A lot of vets have learned this trick. Two faced. Sweet to people, not so much to patients. A bite will likely follow at some point. What the real consequence of this is; To hell with the next guy who has to deal with her.  Might work for some dogs, never works for shepherds. Shepherds are too intelligent, they cement resentment like dolphins. If I do this to her she will never again come happily into our doors.. She will start every future interaction with fear and aggression. A bite will follow at some point soon.

    2. I give up knowing the short game loss is worth the long term gain and we have a family meeting to try to find a way to make her appointments more enjoyable and productive. Her mom had already expected that today wouldn't go well. We come up with a plan for next time. This should include training at home with the family to allow others to handle her. Working with a trainer to help her focus on commands and execution of them with focus and safety. And medications to help bridge the gap as we work on training. 

    3. I just get bitten. No chance to compromise, or convince her that we are not trying to hurt her. She just explodes and bites as fast as she  can. She is done with us and she will remind us she is in charge. 

What happens when a "bite" happens? Paperwork, fear, and almost always the pet parents compounds the tragedy by isolating their dogs in an attempt to avoid future potential bite provocations. Muzzles, prong collars, yelling, over protecting orders and mounting anxiety across all fronts. It's a snowball. Attempt to avoid situations leads to a lowering of estimation of the pets perceived threats. They used to like everyone. They were puppies meeting a world of new sights, sounds and smells. Now they are guardians that bark at the door knocking, or, strangers. You can't take them out in public anymore because now they bark at everyone. Everyone is a perceived threat. They are 100 pounds and you cannot restrain that amount of determined muscle. They become isolated. We reinforce the idea that everyone is a stranger. I used to see them every two to three weeks. We had fun visits. Now I am the stranger. I ask for unreasonable acts of discipline and focus. They don't know me and they certainly can't see a reason to obey me. Hence the bruticaine and indifference. 

Buster

Who's fault is a bite? Well, for the huge majority of clients vets see daily they would say it is our fault. For every time I have handed back a shepherd to say "we need a different plan to make this visit enjoyable." I almost always get, "well, you don't know how to hold her. She is fine with me." Oh, how I long to reply; "Ok then you do the bloodwork and  the spay. I like my fingers and face." Or, "she would never bite me, therefore, you are the problem." 

Here's my advice; it is the advice that every seasoned pet care professional will give you. Train your dog to accept a muzzle. It is NOT a reflection of a persons failure. Nor the pets. It is a tool to provide assistance as we transition out of anxiety based fear laden actions and reactions. Every pet parent should openly and provide permission for a muzzle to be used if deemed necessary. Man-handling, bruticaine, that is not permissible.. ever (unless a pet is endangering another's life). How do we insure this? Trust. If you don't trust your pet care professionals ask to be present for all possible procedures. Ask, demand, insist that pre-anxiety medications be given. Set ground rules for care. Resistance is a flag for scrutiny. Leaving a practice because a person intervenes on your pets behalf is only going to hurt your pet. 

About 30 minutes after I aborted pushing GS any further I sent her home with a training plan and sedatives to try at the next vet visit. I chose to not push her, not exacerbate a bite, and not make it impossible for the next time. Here's what I got for that, a call from the husband saying "they had a bad experience with us and they are going elsewhere." I doubt I will ever see GS again. There is pride before a fall. There are Shepherds relinquished everyday because no one intervened on their behalf at this critical development time. And, worst of fall there are vets who get court orders to put animals down after a "bite" history deems them a danger to the public. Will the next vet push her so hard she bites? Or becomes passive aggressive? Or fears people so much she reacts with defensive aggression to everyone outside of her family? In my opinion she needs help. Will she  get it? It's one of the reasons I awaken at midnight with elephants.

Tex. His first puppy visit. My goal is to have every patients visit look like this.

The truth is that people pine as much as I do, if not more, on what to do for their companions. What is the right/best/safest/compassionate course of action to take? What will consequences for that looks like? Will I hate/berate/beat up/chastise myself for the action, or lack there of, I take? I have been in these shoes. At every moment of my professional life I remind myself that I am still that devoted pet parent who is in turmoil about what to do? Do I trust my own judgement? Do I have enough pertinent information to base my judgements upon? Is there trust here. Maybe GS's parents lack that? They just don't trust my call? The reality is that she is being set up to fail, not flourish, and her "bite" won't be on my account of failing her. 

Brunswick. One week post-op forelimb amputation

What these two cases have in common is that I did my best to make decisions, present options that were in the  best interest of my patients. period. I can fall asleep knowing that. The rest, the worry, the grief, the elephant on my shoulders that I failed them, their parents, or the relationships we have is the midnight hour that clutches my throat and drags me into the abyss of self-doubt of avenues from that first decision to "do no harm."

Magpie helps me motivate for another morning.

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Cryptorchid Neuter Canine. What Happens When Your Dog Doesn't Have His Testicles In The Scrotum?

This is Cash. He is an 11 month old German Shepherd.

He was purchased from a private breeder at 8 weeks old. At his first examination I, his veterinarian, found that only one of his testicles was in the scrotal sac where it belonged. He also has a small umbilical hernia.

Umbilical hernia in the center, shaving the scrotal area for the neuter.

An umbilical hernia can be a very dangerous finding in puppies. If the hernia (a hole the communicates with another adjacent body cavity, in this case the abdomen), doesn't close like it is supposed to then the contents of one space can possibly move between them. In Cash's case his intestines could slip out the open umbilical (belly button) hole. If a piece of intestine slips out we worry that it can twist and strangulate, therefore, inhibiting gut function. This can be fatal. All hernias should be checked by a veterinarian frequently to decide if, or when, surgical intervention is needed. Not all need to be closed, or require surgery, but all need to be monitored very closely and if the hole is big enough to let abdominal contents slip through surgery should be planned as quickly as possible.

Correcting the umbilical hernia

My bigger concern for Cash was his undescended, unpalpable testicle.

The testicle in the abdomen.

Abnormally small (the retained, intra-abdmoninal testicle) on the left,
and, the normal testicle (one in the scrotum) on the right.

Cash was seen by me every 3 weeks for his puppy examinations and vaccines. His missing testicle never made an appearance. At his 6 month exam we discussed giving him another few months to let gravity and maturity see if it could coax anatomy into its correct position. At 10 months old he still didn't have two palpable testes so his family elected to neuter him, correct his umbilical hernia, and perform an exploratory surgery to look for the missing goods.

Pre-op bloodwork ($60 for a partial chemistry and CBC) was done and returned normal.

Surgery included; umbilical hernia repair.
pre-scrotal neuter of the left teste.
abdominal exploratory surgery to find and excise the retained left testicle.

Cash did very well under anesthesia and his testicle was quickly and easily found in the caudal part of his abdomen by his urinary bladder.

cost for surgical care was;
anesthesia, $215, approx 90 minutes
medical pet shirt; $28
suture material; $150
NSAID, for analgesia; $20
antibiotic $$30
hernia repair $75
e-collar $15
castration cryptorchid $300
total about $930

Related Blogs;

Retained Testicle In A Dog.

If you are interested in help for your pet and don't know where to go please find us here at Pawbly.com. It is a free online community dedicated to educating and inspiring pet people everywhere. It is free to use and open to everyone.

I can also be found at Jarrettsville Vet in Harford County Maryland. Visit our Facebook page here, or see our online Price Guide at our website jarrettsvillevet.com

Pawbly Question."Based on the latest research, at what age would you recommend to spay a German Shepherd?"

This is CC, who was spayed last week.
She is a 6 month old shepherd (and lots of other stuff) mix.

Pawbly has been aflutter with questions lately..here's one I haven't talked much about.. 

"at what age do I recommend spaying?"

Always a smile..

Ready for surgery.

 Here is my answer;

There have been a few studies done that have altered our old perceptions of "ideal time to spay."

Certainly some breeds of dogs seem to be predisposed to some diseases, so we looked for ways to alter the statistics of incidence to see if anything (other than diluting out the gene pool,,a subject for another debate), might influence the incidence of disease. Of note is the study done on Golden Retrievers and a lower incidence of many diseases like hip dysplasia, cranial cruciate ligament tears, and even cancer IF the age of neutering was delayed. This study sent shock waves through the veterinary community who is now re-thinking our previously held belief that ALL dogs should be spayed/neutered at 6 months old.

Unfortunately, the decision is not so simple. As awful as watching a pet suffer from one of these diseases is, it is even more awful to deal with the other end of the spectrum of this debate. It has been decades of trying to convince pet parents to spay and neuter their pets in an effort to curb the unwanted pet population. In this country alone we euthanize upwards of 10 million pets a year. And we are sometimes forced to euthanize puppies and kittens because we do not have homes for them.

If my clients did not spay/neuter this number would be larger. Most of my clients do not want to have an unwanted pregnancy, or deal with a pet that goes into heat so they spay at about 6 months old.

The other thing I have seen all too often is aggression. I see more anxiety, fear, and aggression related problems in un-spayed/neutered dogs than those that are fixed. Of all of the breeds of dogs that have the worst fear aggression and most devastating consequences German Shepherds have been the most horrible cases.

No one wants to admit it but medicine is all about statistics. I know that statistically as a population GSD suffer from aggression, fear, hip dysplasia, allergies, and immune mediated diseases. Whatever I can do to help avoid these I will do..But starting your dog on the best path can only be done by understanding the client, their abilities, restrictions, lifestyle, the pets bloodlines, genetic markers, parental diagnostics, and then deciding with as much information as possible what age is best to spay.

If I have to give an age without knowing any of these I say 6 months old, (before the first heat cycle).

I hope this helps..As always every pet is a unique individual who should be treated as such. After that the rest of the guidelines are based on statistics, they are the best guide we have to go on for now.

Surgery is done,, cleaning up the incision.

Waking up.

To find the Golden Retriever study please visit;
AVMA JAVMA News.

A little snack before heading home with dad.

If you have a question about anything pet related you can ask the community on Pawbly.com. Pawbly is dedicated to providing a safe, credible place to help people and pets the wide world over. Pawbly is free for everyone to use. We are also on Facebook..

You can also find me at the clinic, Jarrettsville Vet, or on Twitter @FreePetAdvice.

Thanks to Jana Rade for this question. Jana is the amazing woman behind Dawg Business, a blog to help people take care of their dogs, dedicated to the memory of her Rottweiler, Jasmine. 

Happy Spring Everyone!

P.S. Nina's Not a German Shepherd

At my clinic, Jarrettsville Vet Center, do a lot of work with rescues.

It comes from my roots in pursuing veterinary medicine and my deep belief that you should use your talents and abilities to pay it forward. I strongly believe that we are all responsible for the world in which we live in. The more you contribute the better all our lives will collectively all be. I rarely look inward, it makes you jealous, bitter, and defeats any productive purpose. It's not about what I take with me, for me, it’s about what I leave behind.  So if I can help I jump in.


Very early on in the ownership of JVC I was approached by the former owner, the beloved, Dr. Wilson, and asked if I was interested in meeting with a German Shepherd Rescue volunteer? 

I remember him muttering something to the effect of “the smell of new meat”. I was sure that he was referring to me, and the rescue was the predator in his inaudible euphemism. 

I was excited about the opportunity to join forces with a rescue group. I thought it would be a marriage of the best of both worlds. I could help pets who really needed me, feel like I was giving back, and at the end of the day I didn't have to look for a home for them. After all, I had already come to a resolve that this job isn't about the money. 

I met with a few of the Mid-Atlantic German Shepherd Rescue volunteers later that week.

Now that I recall that first meeting I remember Dr. Wilson also passing on a few other pointers to me. He said such things as; “You know German Shepherds can be aggressive, you might want to think about whether the staff can handle them?” and, “You know you are opening the hospital up to disease if they come from a shelter,” and lastly “Why wouldn't you pick a breed like labs?”. 

Well, I thought, I guess because Lab Rescue didn't come to me? And, besides, I grew up with a great sweet protective German Shepherd, and I am not afraid of German Shepherds. (Ahh, ignorance is bliss).

A few days after our meeting, (which really consisted of nothing more than a handshake, and introduction, a tour of the facilities, and some quick jots of prices), the first German Shepherd arrived at JVC. Actually the first two dogs arrived at JVC. One qualified as a German Shepherd, the other was clearly using the definition very, very loosely. 

This second dog is the point of this blog.  That second dog was a Rottweiler. Albeit, a mangey, hairless, scabby, emaciated Rottie. She was found in the same home as the GS, in Puerto Rico, and by the grace of the goodness of the saviors who found her, given a companion departing plane ticket. Her name was Nina. 

Now lets go and review our geography; JVC is in Northern MD. Maryland is far, like really far, away from Peurto Rico. About 2000 miles far. (I didn't put it in the navigator, this is a guess. But you get the point). I don’t really understand how they landed at our facility? But, there they were. Our first rescues. 

I was shocked and appalled when I saw them.

I am always amazed at how resilient and forgiving a dog is. They will lift their head and wag to greet you, even at the precipice of doom, despair, and death.  She was the poster child for the t.v. info-mercials about animal cruelty and neglect that I still can't sit through. Actually all of those mangey, hairless, crusty dogs almost always have the same problem. You, (yes, you), can diagnose them on sight. Feed them, apply flea and tick control, treat for superficial mange, (aka scabies), skin scrape for Demodex, look at the poop, and control the itch without destroying the gut. Remember, that a dog that is fragile on the outside is also fragile on the inside, (but now I am giving away part of the story).  

We started our treatment plan. It included multiple medicated baths per week, oral antibiotics, oral gastro-protectants, ear cleanings, and a high quality recovery diet. 

Everyone got really attached to Nina quickly. Being a veterinary care provider for many of us is a maternal calling that evolves and takes over the most primitive part of our brain. It is soo deeply seeded in human beings that it can convince us to make irrational decisions. The DVM inside of me placed her odds on survival at less than 50%, but the staff was rooting for her and I was afraid to publicly admit my defeatist odds.

One of the reasons I believe that the rescue groups are an important part of our JVC family is that we get to spend long periods of time with these rescued pets. It reminds us on a daily basis that every animal is an individual.  It keeps us from putting up a justifiable, all too common defensive mechanism that becomes a shielding emotional shell and just seeing them as a “thing”. I don’t ever want any staff member to see our patients as just a 'dog', 'cat', etc. Should you ever  become the patient confined to a hospital bed at the mercy of being cared for by someone else, you will want to feel like an individual. A unique complex person who matters. 

About 1 week into Ninas treatment and stay with us, she became very depressed. Her belly was very tender and she was reluctant to eat. If you could coax her into eating she vomited it all back a short time later. 

"Crap," I thought, "here it is, the consequence of having hit her hard with all of the medications she needed to fight all the disease she was carrying." 

I took an x-ray and my fears were confirmed. She had fluid in her abdomen! 

I looked around at my staff. They were now crying and cuddling with her on the floor. I told them that I had to open her up to see why she had fluid in a place it didn't belong. I knew that she probably had perforated something organ somewhere. 

They asked me what I was hoping they wouldn't. “Will she live?” 

I was honest and told them that "I didn't know?" 

I knew she had been just barely holding on since she had arrived. I knew that if I didn't open her up she would be dead by morning. Within a few minutes she was under general anesthesia belly up on the surgery table and I was gloved, gowned and taking deep breaths. Under that gloved, gowned green shroud I whispered that "I wanted to be doing this in another  zip code." I didn't want all of those teary eyes watching me,,, as if I wasn't worried enough? So much for building bonds with the animals, now I have to feel responsible for breaking hearts too?  

I made a ventral mid-line incision into her abdomen. In the laymen’s terms we call it a stem to stern incision. Or, medically, from xyphoid to pelvis. It is essentially the longest abdominal incision that one can make so that you can really get your hands in there and inspect everything completely. The leak can be a pinpoint and there is a lot of stuff in the belly to root through. Ever try to find a hole in a tire? How about a hole, in a hole, in the dark, while your patient is rhythmically heaving up and down as they breathe?

When I opened up her belly the first thing that I saw was free floating ingesta, (or her stomach food and juices). We suctioned out the fluid and started our tedious inspection of her internal contents. 

Sure enough the stomach had a large perforation in it by the pylorus (bottom of the stomach). A few layers of suture and the hole was closed. I moved on to check the rest of her abdomen. Everything else looked remarkably good. She was doing well through the anesthesia and the inquiring heads stopped poking in with worried tear stained faces. She was almost out of the woods and the clinic was returning to its normal busy day hum. 

Like every veterinary hospital the staff has its own internal public announcement system. The surgical technicians are very good at keeping the news wires flashing, which I much prefer that they provide than me. I need to concentrate when I am in surgery. It is the only time I am not talking and multi-tasking.

Nina made it through surgery and she recovered quickly. We had to taper her medications back significantly. Which let her remaining scabies residents have a little fiesta again. We whacked them hard a month later when her body had healed enough to go back on her mite killing meds. She stayed with us at the clinic for about 6 months. It took her scarred over taxed body that long to recover. Needless to say over that time she became an integral consistent part of our team. Many of our clients got to witness her recovery first hand. She was a fixture behind the receptionists area. When it came time to place her in foster care one of our receptionists applied to adopt her. She had nursed her, cared for her, walked her and hugged her through 6 months of treatment, recovery and care, and she was attached. We all were.

Nina lived for 5 more years and thrived. She was loved every day. She reminded all of us that life is full of miracles.

I want to thank MAGSR for bringing Nina home from Puerto Rico even though she was obviously not a German Shepherd. They brought her to us, paid for 6 months of care and then let her go home with the person who loves her most in the world. Amazing things happen everyday,  and sometimes they happen right under our roof.


Nina in the early days of recovery:

At the clinic keeping a dog recovering from surgery company.

Nina at her new home;

Nina and her mom.

Nina smiling a big Thanks!

If you would Like more information on the Mid-Atlantic German Shepherd Rescue 

If you would like to learn more about Jarrettsville Vet 

If you have any pet related questions you can find a whole bunch of helpful people to answer them at Pawbly, or follow me on Twitter @FreePetAdvice.