Sassy

10/2/1994 -- 3/17/2004

February 12, 2004

So, yesterday I get home from work early (my day off) and my wife says that the oldest of our three golden retrievers is a little "off" -- listless, not eating well. This worries me - my wife is very attuned to animals. If she's worried, I'm worried. I examine her and really find nothing, so my wife decides to take her to the vet - a friend of hers 30 miles north - our regular vet is out of town. She calls later to say that xrays show that Sassy has a fishhook in her stomach (damn ice fishermen) and found her to be pretty anemic. The vet is pretty sure that the fishhook has created some chronic bleeding which dropped her blood count. What she needs is an upper GI endoscopy, but there are only three small-animal veterinarians in Minnesota that can do that. So I go over to the hospital and scrounge up an old optical flexible endoscope that we only use for training and head up to the vet's office with the idea of retrieving the fishhook with the scope and sparing poor 'ol Sassy an operation. The OR staff here are animal-lovers and work hard to find the necessary equipment for me. I load it all into my truck and head up to Crosslake.

The vet sedates Sassy for me. I am impressed with their equipment - very sophisticated. I can see the inside of the stomach well with the scope, but find no fishhook, only a relatively small trichobezoar (hairball). We then assume that the fishhook is in the small intestine and now we have to operate to go get it since it is apparently causing bleeding. He asks me if I want to scrub with him (our regular vet is out of town, and he is younger and less experienced at major operations on dogs). At first I demurred, but he kept asking and I perceive that he really wants me there. I agree to do this, thinking it ought to be a relatively simple operation to find and retrieve the fishhook).

As I incise into the abdomen, I find a HUGE amount of blood. This is not good - the fishhook-as-main-problem idea goes out the window. I begin the typical methodical exploration of the abdomen, hampered by a very fuzzy concept of canine anatomy. The vet and his partner (she's doing the anesthesia) are fascinated by my operative skill :), but mostly amused by the fact that I had only a vague clue as to where anything was. As we pulled the spleen up, we found a golfball-sized hemangiosarcoma (tumor) that had ruptured the spleen and was causing really significant bleeding. Yikes! She wouldn't have survived the night with that amount of ongoing bleeding. So I took out the spleen (much easier than in a human, actually), and exploration found no evidence of spread of the tumor (don't know yet how malignant this thing is). As an afterthought, I opened the stomach, removed the hairball and found the fishhook encapsulated in it. The fishhook wasn't causing any problem, as it turns out.

Weird combination of circumstances that ultimately led to saving Sassy's life, at least for the time being. If she hadn't had the incidental fishhook in her stomach, we wouldn't have known where to go from there and wouldn't have operated. Or, if I had found and removed the fishhook with the scope, we wouldn't have operated, assuming the fishhook to be the problem. With the ruptured spleen, she would have then bled to death within 12 hours. Now she's home in our guest-room ICU with my wife (she's a nurse) in attendance. She just finished getting her second unit of blood. When I made rounds on her this morning along with the rest of my patients, Sassy looked pretty good.

I'll be fascinated to see the vet's bill. He did agree to split the surgeon's fee with me (heh)

February 19, 2004

Sassy's blood count is still pretty low (5.3) but some of that is dilution from all the IV fluids. And that level is after 2 units of synthetic dog blood. The vet thinks she probably doesn't need any more. Just as well -- that stuff costs $300 per unit and she got two units.

We got the bill $2220.43.....the vet and I apparently did split the surgeon's fee of $291. Sure saved me a lot of money..$145 out of $2220.43 :).

That's OK. I couldn't imagine letting a member of our family die over some $$$ (OK -- a LOT of $$$). What are ya gonna do?

It's good lesson in case any of you are thinking you can save some money by operating on your own pets :) 

That bill is very typical, and actually reasonable. In any set of medical bills, human or animal, the surgeon's fee pales in comparison to the hospital costs. Even though I did the surgery, the equipment, drugs etc still costs the vet money and they  have to recoup those costs. I can't expect them to lose money on my dog's operation. For example, they had a pretty sophisticated cardiac monitor system as well as automated blood pressure and pulse oximetry. Most vets don't use them because it represents a $5000+ investment. But it makes the operation much safer. And without the two units of Oxyglobin (synthetic blood) Sassy may very well have died. But that stuff costs about $300 per unit.

I am grateful that these vets had good equipment, the appropriate drugs, safe anesthesia monitoring. Without those things, human or veterinarian, the skill of the surgeon might very well be irrelevant.

February 21, 2004

Sassy is really making a great recovery. Her blood count is up toward normal, she's eating and drinking well.

The tumor that I found in her spleen really worries me, however, and we're still waiting for the pathology report. One of the more common tumors that affects the spleen is hemangiosarcoma and that's what I suspect this is, although I can't be sure since I've never seen one in a dog. The vet isn't sure either. In humans, sarcomas have varying degrees of malignancy, but apparently in dogs hemangiosarcomas tend to be much more aggressive and are almost uniformly fatal within a matter of weeks or months. Chemotherapy can prolong the life span by a only a few months, so I doubt we'll go that route if that's what it turns out to be.

Poor ol' Sass...

March 17, 2004

Well, we put poor ol' Sassy to sleep tonight.

She'd been doing really well since the operation a month ago, but the tumor in her spleen turned out to be a rather aggressive hemangiosarcoma - certainly metastatic. Last night Sassy lost the use of her right front and back legs. Couldn't get a CT scan, but I'm pretty certain of a metastasis to the brain. We gave her a blast of IV steroids and she got a lot better in that she could walk and felt much better, but the writing was on the wall and it was clear that her life was drawing to a close. We wanted her to go out with dignity rather than wait for the cancer to spread so far that it would cause her pain. She might have gone on for a few more days on the steroids, but we didn't want her to be in fear or in pain, nor did we want our last memories of her to be the seizures that were sure to come any day. There comes a point in the treatment of a fatal illness where you are no longer prolonging life, but prolonging death.

So, we took her to the vet tonight. She died peacefully and without fear, with the people that she loved and that loved her - in the arms of my son, who was always her special friend. Things are pretty glum around here tonight, but they'll get better as we begin to remember the joy of her friendship, and forget the pain of her death. Life goes on...

Howard McCollister