Monday, August 2, 2010

The Caring Claras of Our World

Just 6 weeks ago, Clara was walking in her neighborhood when she found a German shepherd with a note attached to her collar: "My name is Bear, please take me home." In this area, close to Fort Bragg, many pets are abandoned when troops are deployed. They're often purebred, beautiful dogs, like Bear.

Clara took Bear to her veterinarian and had her vaccinated, a heartworm test done, and had her treated for internal parasites. Bear, renamed Sofie, was positive for heartworms and so, a couple of weeks after joining Clara's family, she was treated with two painful injections into her back muscles to kill the heartworms. After the treatment, Sofie didn't seem quite right. She had good days and bad days, and just didn't seem as spry as she had for the two weeks prior to her heartworm treatment.

When I met Sofie, two weeks after the completion of her heartworm treatment, I was taken with how gentle and attentive this young German shepherd was. She clearly loved her new family, and was devoted to Clara. All Clara could tell me was that something wasn't quite right ever since her heartworm treatment. Some days she was restless or didn't want to eat. Other days, she would vomit and had no energy.

When I did my physical exam, I could feel a very large lump near where Sofie's kidney should be. An ultrasound exam revealed that the lump was indeed Sofie's kidney, which had a large area of swelling covering most of one side of the organ. It could be a hematoma (like a large blood blister), an abscess, or cancer. An ultrasound exam can't distinguish those diseases, so we needed to get a sample of the tissue. After anesthetizing Sofie so she wouldn't feel anything, I passed a long, thin needle, with the guidance of the ultrasound probe, into the tissue surrounding Sofie's kidney. Based on the sample, an abscess was unlikely and cancer didn't seem probable either. A hematoma as a result of some type of trauma was most likely. The problem was, it was large enough that it was a ticking time-bomb, waiting to rupture. She was going to need surgery to remove the kidney and the associated hematoma.

The morning after we collected our sample, Sofie's condition worsened. She was painful, weak, and dehydrated. Within a couple of hours, she went into shock. I was sure she was bleeding internally and I suspected that the mass around her kidney had ruptured. We stabilized her with fluids and pain medications, started a blood transfusion, and took her to emergency surgery. The surgery took a grueling three hours of painstakingly careful work. Sofie's body had surrounded part of the hematoma with thick, fibrous tissue that had to be slowly peeled away and severed to release the kidney and the hematoma. The mass had bled into the cavity where the kidney lies and a significant amount of fluid and blood was lost into that space which was the cause of Sofie's life-threatening shock. My colleague did the surgery while I assisted and simultaneously ran the team supporting Sofie with fluids, medications, and a blood transfusion. Her situation was critical throughout much of the surgery, but the team of veterinary technicians worked continuously to ensure her stability while Dr. Williams teased her offending kidney free of all of its adhesions.

Finally the surgery was completed and Sofie was carried to recovery, where I hovered, on and off, for the rest of the day, until she could raise her head to look at me through her morphine-glazed eyes. She took a deep breath and seemed awake and comfortable for the first time all day. When Clara came to see her, she raised her head and managed a little tail wag. Next came the waiting -- we'd have to see if her other kidney was up to the task of taking over the function of two kidneys. She had intensive care and monitoring for 36 hours after surgery. As we weaned her off of her medications, she was able to stand and walk and urinate normally. Seeing that urine on our hospital floor, I did a little jig of joy.

Three days after surgery, she went home with Clara. We both cried. Sofie wagged her tail and leaned against the veterinary technicians, giving them liberal canine kisses.

Sofie almost died. And, but for the caring of a kind woman who adopted her and took responsibility for all of her medical conditions, she would have. I'm so very grateful for the Claras of our world.