The test results from the prior day showed a slightly low packed-cell volume (PCV) and some problems with the morphology of the red blood cells. Specifically, the pathologist observed cells shaped like little targets, a tell-tale sign of autoimmune disease. Her PCV dropped to 18 percent on the sample we analyzed this morning. If it dropped much further, she would need a blood transfusion. Although donor red blood cells would carry oxygen throughout Sugar’s body, they also would contain antigens foreign to Sugar’s immune system. Even with a cross-match, the donor red blood cells would make it more difficult to get her under control with steroids. I administered large doses of steroids and hoped to keep her PCV out of the critical range.
The sun shone brightly as Ben drove to the clinic after work. Areas of dormant grass appeared between piles of dirty snow. Green buds lined barren tree branches. After months of cold and snow, the promise of spring was in the air, but Ben was oblivious. He thought only of Sugar. What would he do if she didn’t make it? He tried to push those thoughts out of his mind.
Allie escorted him to the treatment room as soon as he arrived. In the pharmacy, he noticed Genny in front of the refrigerator. She stood on her one back leg and tried to reach a homemade card with her front paws. Two magnets kept it firmly out of reach. A hand-drawn guinea pig adorned the cover with “Emily” scribbled below. Inside, a stick-figure family shouted “Thank you.”
“Who’s this little fellow?” Ben asked.
“That’s Genny, our clinic cat. Dr. Nelson rescued her last summer,” Allie said as Genny gave up on the card and sat down.
Ben stopped for a better look. “What happened to her leg?”
“We’re not really sure,” Allie explained. “The foot was missing when Dr. Nelson adopted her.”
“Poor little thing,” Ben said in amazement. Genny sauntered over to Ben and sniffed his pants and shoes. Ben bent down and scratched the little tortoiseshell under the chin. She let out an annoyed meow and swatted his hand with her front paw. Ben jumped back, shocked by her behavior. He clearly was uninitiated in the ways of Genny.
“She’s pretty spoiled,” Allie commented. “Everything has to be on her terms or else.”
“Sounds like some of the people I work with,” Ben replied.
Sugar rested in one of the middle cages, about waist high off the ground. She lay on her chest like a sphinx, her head resting on a rolled-up towel across her front legs. This position made it easier for her to breathe. A bag of Lactated Ringer’s solution hung on the front of her cage with the clear fluid dripping into the attached line at a slow rate.
Ben winced at the sight of his beloved pet. “Sugar, Sugar,” he whispered. She opened her eyes, and her tail moved back and forth slowly. Allie opened the cage door and rearranged the I.V. line. Ben froze in place about two feet from the cage, not sure what to do next. Allie motioned for him to come closer. He moved forward two steps and placed his hand on Sugar’s head. She licked it with her pale pink tongue. Ben swallowed hard, his eyes glistening with tears. He reached into the cage and cuddled his dog’s head with both of his hands. Sugar closed her eyes again, her chest continuing to heave with every breath. She used most of her energy for breathing.
Allie walked into the office. I looked at her with the phone pressed between my shoulder and ear. “Yes, Stacy Davenport, please, may I speak to Stacy Davenport? This is Dr. Nelson calling with lab results.” Allie pulled a piece of scrap paper from her pocket and scribbled a note. She laid it on the desk. I heard a loud click on the phone and the elevator music ended.
“Hello, this is Stacy,” a female voice said.
“Stacy, I’ve got great news for you,” I blurted into the phone. “Cleopatra’s lumps are benign.”
“Benign,” she repeated.
“That’s right Stacy,” I paused. “And the margins are clean.” Silence filled the space between us. After all of Stacy’s sleepless nights, it seemed surreal.
“That’s wonderful,” she finally answered. Her voice quivered as spoke. “I was so worried.”
“Me too,” I echoed. “But it was benign, so now I want you to check her once a week for lumps. Other than that, you are under strict orders to spoil her rotten.”
“I can do that,” Stacy replied with joy. “I can definitely do that.”
I hung up the phone, still filled with elation over the news. Sometimes misdiagnosing is wonderful. I stood up and headed back to the treatment room. Ben remained in the same position with Sugar’s head in his hands. I stood by his side in silence, not wanting to interrupt the moment of pure love.
“She doesn’t look too good,” Ben said without looking at me. “Is she going to make it?” Tears streamed down his face.
“Her PCV continues to drop. It was 29 percent yesterday, 18 percent this morning and 16 percent at the last check.” I moved closer to Ben. The orange cat in the next cage stuck his paw through the bars and meowed. “I’m hoping the steroids will kick in soon so she can avoid a blood transfusion.”
“She’s breathing so hard,” Ben whispered. “She barely wagged her tail to greet me.”
“That’s because she’s trying to conserve oxygen,” I replied. She has about one-fourth her normal blood capacity to carry oxygen.” I managed a small smile. “She’s doing exactly what she should be.”
Ben nodded his head and continued to stroke her head. “Do you think seeing Spice might perk her up?” For the first time, he looked at me with a glimmer of hope shining in his eyes. “I would be happy to run home and get her.”
“I don’t think she’s ready for that yet.” Ben looked down at Sugar again, deflated. “But that’s a great idea for when she’s better. I think it would do her and Spice a world of good.” The glimmer evaporated from Ben. He kissed Sugar and wiped the tears from his cheeks before leaving. I know Ben wondered if he would ever see his old girl alive again.
By 10:30 that night, Sugar’s PCV fell to 10 percent. The massive doses of steroids had failed to stop the disease. Her spleen continued to destroy the few remaining red blood cells. Sugar needed a blood transfusion, and she needed it now. Where was I going to find a donor at this hour? Steve and I thought through our family and friends. My sister was always a good sport about helping me out, even in the middle of the night. Unfortunately, her shit tsu, Tai Paws, tipped the scale at a whopping 14 pounds. Sugar needed more blood than Tai Paws could safely donate.
“How about one of the Harris dogs?” Steve suggested. One by one, I ticked off their pets in my mind. Ivan has too many health issues. I wouldn’t want to stress his immune system. Bonnie and Clyde are too old, but Lulu ... she would be perfect. Now I just had to convince them to bring her in.
Linda and her husband, Rich, love animals. When Linda was young, she used to carry turtles across the road to keep them safe. Rich rescued their Saint Bernard, Lulu, from a horrific situation. The kennel used her as a bait dog to train pit bulls to fight. They taped her mouth closed and then let the puppies attack her. The tips of her ears were shredded and frayed from the abuse she suffered.
“Hello, Harris residence,” Linda answered. I could hear the TV in the background.
“Hi, Linda, I’m sorry to call so late, but I need your help,” I said. “I’ve got a sick dog at the clinic that needs a transfusion. I was wondering if I could draw some blood from Lulu?” Linda agreed without hesitation.
Rich arrived at the clinic with Lulu 15 minutes later. I crossmatched a small sample of her blood with Sugar’s. Lulu nosed around the clinic chasing a syringe case, a Scruffy leftover. I gave her a mild tranquilizer and placed an I.V. catheter in her front leg. While I drew blood from Lulu’s neck, clear fluid dripped into her veins to keep her blood pressure up. She passed the time watching Genny play with Rich’s shoelaces. I locked his leather jacket in a safe place.
Forty-five minutes later, Lulu’s blood dripped into Sugar’s veins. With each burgundy drop, Sugar’s condition improved. Her breathing became less labored, and a faint pink color returned to her gums.
When half the bag was gone, Steve laid out two sleeping bags on the floor and put Genny back in her room. She meowed and stuck her paw under the door. We took turns throughout the night napping and watching Sugar.
The next day, when Ben arrived for his afternoon visit, Sugar looked much better. Her gums were pink, her respirations normal and her murmur was gone.
The clinic buzzed with animals and people. Spring meant heartworm season in Minnesota. Dogs need an annual heartworm test and preventative for summer. In addition, the animals that had undergone surgery in the morning were ready to go home.
Instead of having Ben sit in the treatment room, Allie decided to bring Sugar up to the reception area. She capped off her fluid line and covered it with a pink bandage. Sugar wagged her tail every time Allie talked to her.
“Now it’s time to go see Daddy.” Sugar’s tail thumped again.
Ben jumped to his feet when he saw his beloved pet in Allie’s arms. Sugar squirmed and tried to get away from her. She wanted her Daddy. Allie directed Ben back into a chair and placed her on his lap. He wrapped his arms around her in a loving embrace. She snuggled into his side and licked him. She stared into his eyes as if memorizing his face. She adored him, and he adored her right back.
In between appointments, I headed up front to check on Sugar. She looked so happy in his lap. “Hi, Ben,” I said, taking the seat next to him. “Doesn’t she look good?” I patted her on the head.
“Yes, she has more energy today.” He hugged her again. “That was awfully nice of those people to donate their dog’s blood. Please thank them for me.” I nodded. “Spice really misses Sugar. Last night she wouldn’t get in bed with me. She paced around the house, looking for her buddy.” Ben looked into Sugar’s eyes. “Yes, Spice misses you, old girl.”
“Bring her with you tomorrow,” I replied. “I think it would be good for both of them.” We chatted about the next 24 hours of Sugar’s care. The transfusion had raised Sugar’s PCV to 30 percent. We would check her PCV twice a day. As soon as it stabilized, the dog could go home.
Sugar raised her head with an expectant look on her face when she heard her name. We both gazed at her and chuckled. “You are too smart, Miss Sugar,” I said, patting her head. The expectant look disappeared. I stood to leave.
“Just one last thing before you go, Dr. Nelson.” Ben cleared his throat before he continued. “I want you to call no matter what time of day or night if you think she’s going to ...” He paused. “If you think she’s going to...” Tears welled up in his eyes.
I placed my hand on his shoulder. “You will be the first to know if her condition changes. But hang in there, Ben. My money’s on Sugar.” Ben forced a smile in response. I only hoped I was right.
Chapter 20
Butch Revisited
Butch the Great Dane arrived with the entire family for his last set of puppy shots. Dan Arnold’s wife, Joy, was a petite woman with sandy brown hair. She stood next to her husband, looking anxiously around the exam room. Butch sat at their feet listening to the activity in the waiting room. His head almost reached Dan’s waist. The dog cocked his head back and forth, raising his ears occasionally.
A boy sat on a chair, his feet dangling. With his blond hair and blue eyes, he looked like a poster child for a Minnesotan of Scandinavian descent. He took off his jacket, placed it over his legs and kicked it for fun until Joy stopped him.
Dan interrupted me as I tried to introduce myself to his wife and son. He told me to make this quick as he needed to get home right away. Joy smiled briefly at me and mumbled hello before introducing her son, Dan Jr. I leaned over the exam table and stretched my arm out to the child.
“Can we get on with this?” Dan asked impatiently. As the child extended his hand toward me, I noticed scratches covered his arm. On closer inspection, I noted two deep puncture wounds. “He likes to play hard with Butch,” Dan answered before I could ask. He hoisted Butch onto the table. “Whew, I think this will be his last time on the table.”
During the last month, Butch’s body transformed itself from pudgy puppy to awkward teenager. The parts of his body grew at different rates, making him look like he was comprised of spare parts from another animal. His broad head with its massive lips reminded me of the manatees I saw in Florida. His paws looked like they should be on a wolf. What impressed me the most was the growth of his torso. It was almost as long as my table. This pup was going to be a huge dog, even for a Great Dane.
Butch squirmed when I inserted the otoscope in his ear. “Would you mind putting a hand on him?” I asked Dan. He motioned for his wife to do it. She shuffled toward the table and gingerly placed her hands on the pup’s neck. When I lifted his ear, he continued to squirm.
“Butch, no,” she commanded with as stern a voice as she could muster. Butch ignored her. “Honey, he won’t listen to me. Would you please hold him?” Dan smirked and rolled his eyes before exchanging places with his wife.
With Dan’s assistance, I completed the rest of the exam in record time. Butch stood like a statue for his vaccinations. The pup stared at me after I completed the shots, but didn’t make a sound. Due to my earlier work, he considered me superior, at least for now. Dan clipped a leather leash onto the ring of his collar and handed the other end to his wife. He grunted as he placed Butch on the ground.
“Take him to the car while I pay.” Joy obediently opened the door, ushered Dan Jr. through it and started out. But Butch remained at Dan’s feet. She pulled on the leash. Butch ignored her and continued to sit by Dan. “Butch, come!” she commanded. She walked over to the pup and attempted to raise his rear end off the ground. A low growl rumbled from his throat. She jerked her hands away from him. “Honey, will you take him?” she pleaded. Butch looked up at Dan and stopped growling. His ears perked and his tail waved back and forth.
“You go with her,” he responded. Butch stopped wagging his tail and slowly followed Joy out of the room.
I thought for a moment before addressing Dan. How could I make him understand what was happening? I must choose my words carefully. “Dan, it looks like Butch will only obey you.” I pulled a manila folder from the drawer. “I’m also concerned about the marks on your son’s arms. Butch should never, ever be allowed to bite a human.” Dan ignored me as he pulled his wallet from his pocket. “Even in play, it’s too dangerous to let a big dog like Butch bite.” Dan stared at me blankly. “Are you taking him to obedience classes?” He stood silently with his hands on his hips and turned toward the door without answering.
“Listen, Dan,” I tried desperately to get his attention. “I’m concerned that Butch is an alpha dog. That means he wants to be the leader of the pack.” He froze in his tracks.
“That’s want I want.” Dan turned toward me with a smile on his face. “Don’t want no wusses at my house.”
“But you don’t understand,” I continued undaunted. “Butch considers your family his pack. When he gets bigger, he will challenge you for that role. You need to get control of him now before it’s too late and he hurts someone.” Dan turned away from me again.
“See you in a year,” he said as he left the room.
Back in the treatment room, Captain Thomas waited with Jennifer by his side. Blake stood in front of the cages, looking at the animals. A black cat rubbed back and forth on the bars in front of him. He scratched the cat’s neck through the bars. Sugar slept in the cage next to him, snoring loudly, much to Blake’s delight.
With school out for spring break, Jennifer took the week off of work. They planned a trip to The Minnesota Zoo when we finished the bandage change. I collected bandages from under the counter and retrieved a new box of vet wrap from the closet. “Blake, would you like to pick the color?” I opened the lid and bent over to show the variety of colors to the little boy. He pulled on his ear with one hand while pointing to a yellow roll with the other.
“You want yellow? I thought green was your favorite color,” I said, pulling out the yellow roll and placing it next
to the other bandages.
“Yellow is Grandma’s favorite color,” Blake replied.
“My Mom is coming to visit today,” Jennifer explained. She tried to smooth the unruly hair on Captain’s back. Allie usually held Captain for the bandage change because blood makes Jennifer queasy, but today Jennifer wanted to hold him. She promised to keep her eyes on me instead of Captain’s wound.
I put Captain on the table and pushed his front legs out in front of him until his elbows rested on the table. Jennifer and I rolled him onto his left side. Captain squirmed, then quieted. Holding still was tough for him. I inserted the tips of a heavy-duty bandage scissors into the wrap over Captain’s toes. The blades cut through the layers of padding one small bite at a time. By the time I reached the top, the handles left impression marks over my knuckles.
“OK, I’m going to take the bandage off. Don’t look,” I said. Jennifer turned her head away. “How in the world did you manage to get him in here after the accident with all that blood? I am amazed you did not pass out.”
“I almost did after I got to the clinic. All that blood,” she shrugged her shoulders. “I kept thinking about Captain.”
I peeled the bandage off from top to bottom, following the direction of hair growth. Captain cried when I pulled the tape stirrups off his skin. The wound had made remarkable progress since the accident; it was about half its original size, and healthy pink granulation tissue covered the bone and tendons.
I explained my observations to Jennifer. Since the bone was covered, she felt she could look at the wound without passing out. She turned her head for a quick peek. Her face flashed white, and she swallowed hard. My own stomach jumped to my throat. I am comfortable with sick animals, but sick people are another story. Jennifer leaned forward and cleared her throat. When she straightened up, her color was back to normal. I would never trust her near open wounds again.
Coated With Fur: A Vet's Life Page 16
