A Veterinary Journal by Claire Poole
Chapter 1
Page 6
Chapter 1
Sunday 4th January
Monday 5th January
Thursday 8th January
Thursday 14th January
Thursday 21st January
Monday 25th January
Tuesday 26th January
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Thursday 21st January
At last the sun has come back today - a mere half an hour’s worth flooding the back garden, but a good omen of times to come. Living as we do at the bottom of a large hill, the sun does not clear the horizon between the end of November and the end of January. We have to climb the hill or go down to the river to get a welcome boost of sunlight. Drying household and surgery washing becomes a chore during this time with much of it draped in front of the woodburner most of the time. The fire stays alight continuously from early autumn till late spring – except when we have a locum! Keeping it going is easy with a little experience, but it is like one of the mysteries of the universe to our regular locum, Linda. Her record so far has been 4 days - then she resorts to 24-hour central heating, a hot-water bottle and a duvet!
Apart from the return of the sun, today has been rather dismal. Last week, I removed a small growth from Bonnie the collie’s neck. The lab report came through today - a very malignant tumour. Bonnie might be lucky, or deadly cells may already be multiplying elsewhere in her body – none are detectable to us, but this is no guarantee that she will survive. Bonnie’s poor owners are now doomed to a tense future ever watchful for signs that the cancer has returned. Sometimes, just when owners and vet think that we have ‘got away with it’, more symptoms appear. Jay and I went through this with our old cat and know what a miserable time it is. It is so hard to handle the uncertainty.
Buzby MacTavish was a similar case. He was a bad-tempered, middle-aged collie brought to the surgery with a hind-leg lameness. It was necessary to examine him under sedative and take an x-ray to confirm the diagnosis - a ruptured cruciate ligament in his stifle (knee) joint. This ligament keeps the two bones in the joint correctly aligned; when it ruptures (breaks), the bones can be moved relative to one another, giving what we call a ‘drawer forward’ sign, unmistakable in Buzby’s leg. The damaged ligament needs to be repaired, using a graft fashioned from surrounding connective tissue. And so, Buzby received an initial anaesthetic injection which allows me to pass a tube directly into his windpipe - this tube is known as an endotracheal tube. It is then connected to the anaesthetic machine which administers anaesthetic gas to the patient – a routine procedure repeated several times a day during an operating session. But in this patient, something unexpected was seen when his mouth was opened to insert the tube. (Buzby’s temperament was such that no one ever attempted to open his mouth when he was conscious!)
A sinister ulcerated lump lay attached to the gumline - obscured by his hairy lips when he was awake. It is not generally possible to tell what type of growth is present just by looking, although certain guidelines can sometimes give vets a rough idea. If the growth is round or oval, painless, slow growing and distinct from surrounding tissue, then it is likely to be benign. If it is rapidly growing, tender, ulcerated and growing into nearby tissue, then the chances are that it is malignant. Buzby’s lump had features of both. We fixed the dog’s leg then removed the lump and sent it to the lab for histopathology, the discipline where tissue is examined under the microscope. It is important to get an accurate diagnosis of the type of growth as this influences treatment and outlook. The results appeared several days later – ‘malignant melanoma; evidence of lymphatic spread; prognosis very guarded’. Not good news.
Unlike in humans, malignant melanoma of the skin in cats and dogs is relatively uncommon, and usually follows a benign course. Not so in the mouth - these are usually highly malignant and carry a poor outlook. They spread via the blood and lymphatic circulation to organs such as the liver or lungs. Although the primary tumour can be managed by surgery or even radiotherapy, invariably the patient dies within 6 months from secondaries. Chemotherapy is not effective for this type of tumour in dogs. As luck would have it, Buzby’s knee surgery healed exceptionally well, and for 3 months, he lived a normal life. During this period of respite, both vet and owner hope that we have got lucky, or even that a mistake has been made, but inevitably, the cancer begins to bite. Buzby began to have trouble swallowing and developed a soft cough. The lymph nodes by his throat were the size of tennis balls, and through the stethoscope, his chest sounded harsh. He was put on a high dose of corticosteroids which had an initial near magical effect - his glands reduced in size and he felt well and full of life. However, the outcome was inevitable, we were just buying him a few extra weeks. Owners will generally know when the time has come, and so it was with Buzby’s. He deteriorated rapidly over 2 days - stopped eating, and became restless and miserable, panting continually. We put him to sleep on his settee in his kitchen - the first and last time I was able to do anything to him without a muzzle.
Copyright Claire Poole 2005
