Visiting Vet: What a day

Phones on the fritz, a surprise tick find, and a sad diagnosis.

A pet can remain healthy with routine veterinary appointments. — Joseph Sollitto

I should have known it was too good to be true. My Thursday 24-hour shift on call had been exceptionally quiet. Friday looked to be a busy day, but mostly wellness exams, vaccinations, and minor health concerns. Morning appointments began. Rosie got her annual check up. I clipped Daisy’s ingrown toenail and pulled an infected loose tooth. Bronco arrived for an introductory exam and first Lyme shot. Moose, his rabies and kennel cough vaccines. Feisty feline Nikki wasn’t happy about his nail trim but I convinced him he would survive. Same goes for Bella. My assistant Fawn and I kept reminding each other of the mantra we are using to keep ourselves focused on our work in a positive way through the ongoing pandemic stressors. “Today we are helping pets and people.”

The morning went smoothly, except for the telephones. In between pet visits, I was on the phone fighting with Comcast. Clients calling my office number were suddenly being forwarded to a nonexistent voicemail box. Caller ID block was randomly appearing, then disappearing. Call waiting had been mysteriously added when we didn’t want it, while call forwarding, which we needed, had been shut off. What a headache! No matter how many times Comcast said it was fixed, it never was. Finally an actual repair person arrived (masked and vaccinated) at my door as the afternoon began.

Now things got a bit bumpier, with extra appointments we had squeezed in for sick animals. When the telephone worked, one person called to cancel, another needed to change times. “I’m helping pets and people,” I reminded myself, moving around this Rubik’s Cube of appointments. We spent time working up a cat with a complicated problem with inappropriate urination. Next came Sugar, a dog with a “mass” on her side. I had emailed back and forth several times with Sugar’s owner earlier. What would be involved in removing the mass? Could I do it at today’s appointment? Should we biopsy? It turned out to be a very short visit, however. “It was a tick,” I said as we handed Sugar back to her owner. “Yes, a big, bloated tick. Yes, we see ticks this big all the time. Next time, pull it off at home. No charge.”

My next client had a combination of challenges. In March I had told her that her cat, Lady, was seriously overweight and at risk for diabetes. We had discussed weight loss and set up direct delivery of a prescription low-calorie food. All went well until, due to pandemic issues, she could no longer get that specific brand. The owner had been trying various substitutes but, although Lady was not a picky eater, certain foods seemed to make her vomit. In addition, the owner is a musical, artistic, right-brain sort of person, and calculating caloric content and portion sizes is a left-brain sort of activity. After multiple phone calls and emails, with all of us increasingly frustrated, I had suggested bringing  Lady back for a recheck. Guess what? She had actually gained weight, rather than losing. “Helping pets and people,” I reminded myself as I went online to find another appropriate diet food that was definitely in stock, then did the math, and gave the owner a precise menu plan in writing.

Next came Aslan, an older dog I had seen in December for a limp. The lameness had now very suddenly gotten worse and his owner had noticed a bit of swelling of the leg. Expecting to find progressing arthritis, or maybe Lyme disease, we put Aslan on the table and I started to examine the affected limb. Oh no. My heart sank. The leg was clearly broken just above the hock. Considering Aslan’s age and history, and the nature of the break and swelling, this was almost certainly a “pathological fracture.” A quick radiograph confirmed my suspicions. Aslan had some form of cancer that had eaten away the bone until it was so weakened that it had fractured spontaneously.

The most common form of bone cancer in dogs is osteosarcoma (OSA), an aggressive malignancy. In Aslan’s case the location of his tumor is not the most common site for osteosarcoma, but OSA is still the most likely diagnosis. Definitive confirmation would require biopsy, but how, when, and whether to biopsy depends on many factors. With OSA, the cancer usually has metastasized by the time of initial diagnosis. We took a chest X-ray looking for tumors in Aslan’s lungs. Even though he has no visible evidence of metastasis at this time, unfortunately in the majority of OSA cases there is often microscopic spread, too small to see initially.

The prognosis with bone cancer in dogs is not good. I went outside and broke the news to Aslan’s dad. The family would have to absorb this difficult information but then would have many decisions to make — the first being whether to pursue treatment at all. Treatment has two goals: reducing pain, and keeping the cancer from spreading. The first step (after additional diagnostics) would be to amputate the leg and biopsy the tumor. Median survival time for OSA with amputation alone is four months. Add chemotherapy post-amputation and that might go up to 10 to 12 months, with a small number surviving two years. It’s a huge commitment with an uncertain outcome. Much depends on the dog’s temperament and the owner’s risk tolerance. For those that want to proceed, I refer them to board-certified surgeons and veterinary oncologists. But for many families, palliative hospice care and, eventually, euthanasia are the most feasible and humane options.

Aslan’s dad said the dog is still playful, active, and eating well, despite the pathological fracture. I gave him a handout about bone cancer, prescribed pain medications to give while the family considers what to do next, and went back inside to try, once again, to fix the telephones. “I am helping pets and people,” I told myself sadly as they drove away. Sometimes there are simply not enough ways to help.