A Veterinary Journal by Claire Poole
March
Chapter 3 - Page 9
Chapter 1
Chapter 2
Chapter 3
Saturday 21st March
Saturday 21st March
We have been on holiday for a short break and are steeling ourselves for a return to work this morning. It is a blissfully mild day, and the valley seems to be suddenly wakening up. Most fields are now green and tractors are much in evidence - ploughing, seeding, fertilising; sometimes working late into the night guided by their powerful headlights. This looks quite spooky from a distance - disembodied lights moving slowly across the fields. We are sitting with a coffee by the back door listening to the morning sounds. The farm cockerel has been crowing since first light and ought to be hoarse by now. Like the crashing of a car’s gears, a pheasant is chirr-chirring in the field, and for the first time this year, we hear the falsetto giggle of the green woodpecker. Elsewhere in the wood, greater spotted woodpeckers are drumming loudly on their chosen trees. The wood now appears variegated, the coconut-mat colour of winter trees now mottled with the lime green of budding larch, and deeper shades of evergreen pines. After the inactivity of winter, suddenly so much is going on. A large dog fox trots purposefully up the field, probably heading home to newly dug holes amongst the trees. Much of the wonder of living here is through the changing seasons. Half-forgotten sights, sounds and smells come round each year like old friends, stimulating anticipation of the following season’s delights. Now we look forward to long days spent outside - gardening, playing tennis, taking trips to the seaside and holding social barbecues lasting late into the evening. And in autumn, we anticipate brisk walks in chill weather, warm woolly clothes, winter sports and comforting stews and soups on dark evenings spent in front of the fire.
It would be pleasant to spend the day in peaceful contemplation of nature, but there is work to do. First, morning surgery in Clayfern, then a major operation on a dog seen yesterday by Linda. Moss the collie was rushed to the surgery after collapsing suddenly. He was a fit, active working sheepdog until a mere 15 minutes previously. On arrival at the surgery, he was deep in shock - pale and cold, and unable to stand unaided. His owners were mystified, but Linda soon had her suspicions as to a diagnosis. After stabilising the dog on intravenous fluids and oxygen, she continued with a thorough examination. Moss’s abdomen appeared enlarged and tender and an x-ray confirmed the presence of a large mass at the front end of the abdomen. This was most likely to be liver or spleen. Next, Linda inserted a small catheter into the abdomen under local anaesthetic and was able to collect free blood, confirming her suspicion that Moss was bleeding intra-abdominally. A biochemistry screen showed no evidence of liver damage or malfunction. The most likely diagnosis at this stage was a ruptured splenic tumour. The scenario was fairly typical - sudden collapse of a previously healthy animal with no history of trauma, showing signs of severe shock. Sometimes the dog may recover on its own from such an incident, but invariably a fatal bleed will occur if no treatment is given.
After an hour of intensive treatment, Moss had improved. As long as he remained stable, the next step is scheduled for today. He has been checked regularly throughout the night, and is in much better shape than he was.The plan for today is to open into Moss’s abdomen, and if the diagnosis is correct, remove his spleen. Fortunately, it is possible to survive without a spleen. Although off duty, Linda volunteers her help which is gratefully accepted, and with Gillian monitoring the anaesthetised dog, we begin our exploratory surgery. Linda’s diagnosis is confirmed within minutes. Large, fist-sized clots of blood are seen through the abdominal incision, free blood glistens round the organs and a massive spleen is soon in view. One end contains a ruptured tumour - like a squashed tomato - which oozes ominously as we manipulate the spleen towards the surgical site. Our next task is to tie off all the blood vessels leading to and from the massive organ before removing it completely. Care must be taken as the spleen shares a blood supply with the pancreas and stomach, and it is vital not to damage their supply. We start at opposite ends with the tedious process of dissecting out, then tying off, all vessels leading solely to the spleen. Finally the job is done and the damaged organ is lifted free of the abdomen - a good 2 pounds in weight and floppy like a dead fish. A sample of the growth will be sent to the lab for identification. After checking the other organs for tumour spread, we flush the abdomen with saline then close the large wound. At last, Moss is installed in a warm, recovery kennel. He is still not out of the woods yet - he has to recover from the anaesthetic and surgery, and regain his strength, but at least he is safely over the first hurdle. Once the tumour type is known, we will have an idea whether it is likely to have spread elsewhere.
After such major surgery, the operating room resembles a slaughter house - even a little blood goes a long way, and there has been plenty around today. The tumour behaved like a soft jelly, spontaneously falling apart with even minimal handling - the dog is really very lucky to be alive after the initial bleed. There is a good feeling of cameraderie amongst the surgical team as we begin to clear up the mess. Although cautious, we all feel fairly elated; the anaesthetic and surgery have gone smoothly and Moss is coming round according to plan. Finally, we adjourn to the house for richly deserved coffee and doughnuts, and that golden time after a job well done when we can relax and swap reminiscences of similar cases. Like fishermen comparing their ‘catches’, I’m sure a certain amount of exaggeration creeps into the discussion!
I am in and out of the surgery like a yoyo over the next few hours checking and comforting our patient. Overnight, he accepts some recovery diet and a drink. He stays with us until Sunday night when he is discharged with instructions for strict rest and a collapsible kennel with which to enforce this. He has a lot of blood loss to make up and is weak - like an anaemic person. I’m sure he will be only too happy to spend the next few days being waited on hand and foot - sounds wonderful to me!
Copyright Claire Poole 2005
