Since I don’t have much time to write anything lately, I figured I’d steal this one from my classmate’s blog from her animal hospital in Belize:
It all started in April while I was out of town on vacation. Sasa, a 7 year old non-spayed Jack Russell terrier, was not eating well and listless. Since I was out of town she was presented to Saga Humane Society’s vet clinic. She had a fever and her symptoms were typical of “tick fever”, a common infectious disease here in Belize transmitted by ticks and caused by Ehrlichia canis. She received some pills, but a few days later there was no improvement. She went back to Saga. No fever now, received more pills. A few days later, still no improvement, back to Saga, received some subcutaneous fluids for dehydration, and yet more pills. Then I returned from vacation and Sasa’s owner brought her to me. Now Sasa was vomiting and not eating at all. I examined her and she had abdominal pain. Since she was not spayed I was concerned about a pyometra, an infection of her uterus, but she did not have the typical vaginal discharge associated with it. I recommended an abdominal xray. Here in San Pedro the only xray machine is at Clinica Los Pinos, a private medical office for people, not animals. However, the doctors there graciously help us by xraying animals as well. I went down with Sasa and her owners, showed them how to hold Sasa in position on the table, and Carlos, the xray technician, patiently worked out the settings on the machine until we obtained an xray of the quality you would see at any of the best veterinary hospitals in the U.S. The xray did not show what I had hoped, an enlarged uterus. Instead there was very little detail at all on the film of her abdomen, which can be an indication of free abdominal fluid, which is never normal. We took Sasa back to the clinic, and I “tapped” her abdomen, producing blood.
Now we were all very concerned. “Has she had any exposure to any rat poison?”, I asked her owner. “Well, actually, yes. We put some out a week ago. We never thought this was her problem because her symptoms actually started earlier.”
The owners brought in the box and it was indeed the type of poison that causes bleeding. We proceeded to treat Sasa with Vitamin K, and I cautioned the owners that this could be a life threatening situation. A blood transfusion could be necessary if we did not catch it in time, and San Pedro has never had the resources to perform them in dogs. We could attempt it if really necessary, but it would be difficult.
Wanting a definitive diagnosis, I called Irina at the San Pedro Central Lab, another human medical facility which helps us quite often. It was a Sunday, but Irina graciously offered to bring her machine down to the clinic to test Sasa’s blood for clotting ability, a test called a PT and used to confirm rat bait poisoning. Unfortunately, after repeated attempts, the machine only gave us an error response.
“Well, maybe it can’t read it because canine blood is different from human blood,” I reasoned. “We will have to just treat her and watch for a response.” Irina generously refused payment for her after-hours efforts. Reluctantly, I sent Sasa home on Vitamin K.
Over the next few weeks Sasa improved slowly. Repeated belly taps showed much less blood. We thought we were on the right track, but a little voice in my head kept telling me something wasn’t right. Even though she was eating small amounts now and not vomiting, she was losing more and more weight, and I was concerned there was something we were missing.
Then one day she came in for her recheck and I tapped her belly again. Black fluid came out. Lots of it.
“I have never seen anything like this before,” I told her worried owner. I took the sample down to the Central Lab, and called on Irina for help once again. I have a microscope in the clinic, but ironically had not been able to get the stain I needed for the sample into the country. Irina stained the sample for me and we looked at it together. No bacteria. The microscope field was full of white blood cells which appeared to be lymphocytes. “Something is leaking inside her,” Irina said.
I called the owner’s brother. Sasa’s owner, Simona, had left for Italy a few days prior. After giving Sasa a tearful goodbye she asked me if we we should put her down. I told her I thought we should keep trying. I didn’t feel it was time to give up. So I spoke to her brother and told him it was time to perform an abdominal exploratory surgery. We couldn’t let Sasa get any sicker and we needed to find what the problem was in her belly. What could be producing this black fluid? I explained that it could be something very bad and we may need to euthanize her. But our best hope was that it was her uterus or her spleen that was the problem. These organs can be surgically removed and patients will live a normal life.
Sasa’s “uncle” gave consent and agreed we should try the exploratory surgery. Because my anesthesia machine was still stuck in customs I was forced to create an anesthetic protocol out of the injectable drugs I had available. This would be the first time I had ever used these particular drug combinations, but I had been sent some information from a helpful vet in the U.S., and I adapted his protocols to the drugs that I had the best I could.
On the day of the surgery we placed an IV catheter and started IV fluids for Sasa. The anesthetics worked beautifully, and I nervously incised her belly, not sure what I would find. The first thing I touched was her bladder, normal enough. But next to it was a large, swollen, dark firm tube. Colon? No, it was a uterine horn! With great relief I performed the ovariohysterectomy, easily removing the large uterus and ovaries from her small body. The rest of her abdomen was completely normal. After the surgery, I made an incision in the thickened wall of the uterus I had removed. Black fluid poured out.
Amazingly, Sasa recovered quickly and smoothly, and a few hours later she was begging for food. I imagined her thinking, “Thank god they finally got that thing out of me!”
Now, after a month of tests and treatments, Sasa was finally cured. She went home and I imagine worked to gain back her lost weight by eating her family’s delicious Italian food.
So what did Sasa really have? Was it tick fever, rat poison, an infected uterus, or all three? We will never know, because that is life and veterinary medicine in Belize! Luckily for her, Sasa’s owners never gave up. Veterinary and medical professionals here and abroad worked together with me to save her.
As for me, I will use her story as a cautionary tale to the many, many pet owners who come to see me, wanting to breed their pets. PLEASE PLEASE PLEASE do not breed your beloved pet. HAVE YOUR PET SPAYED OR NEUTERED.
Laurie Droke, DVM