Angel the Maltese Wins a New Lease on Life
To recap: Angel, the 10-year-old Maltese dog had been vomiting and refusing to eat for days. Bloodwork and X-rays suggested he might have cancer in the stomach, or maybe a foreign object stuck in the stomach. His parents had NEVER seen him chew up a toy and they had NEVER given him rawhide. They had, however, adopted hm from Maltese rescue 5 months before he got sick. Plus, by the way, Angel seemed to be a picky eater who sometimes had vomiting or diarrhea, ever since his parents adopted him.
After a phone call in which dad said he wanted to wait and see, Doc Truli offered to show him the X-rays in person, and then everything changed.
It Can Be Difficult to Decide Whether or Not to Authorize Surgery for Your Pet
This X-Ray here is what did it for Angel.
Angel’s dad said, “Oh, I had no idea from our conversation that the lumps actually looked like that. That’s huge! He should have surgery, don’t you think?”
Doc Truli said, “Yes, I recommend emergency stomach surgery this afternoon.”
But dad said, “What if it’s cancer? Will we lose him this afternoon, and then will be it?”
“You have the option of a non-recovery surgery if it looks like awful cancer,” said Doc Truli.
Then Angel’s mom sealed his recovery by saying, “Honey, if it were me facing surgery, you wouldn’t hesitate for a second.”
Angel’s dad said, “That’s true. Let’s do the surgery.”
“If you think about your dog as if he were any human family member, it can clarify your doubts and help you decide what to do,” says Doc Truli. “Most people get advice from their physicians, and since insurance pays the bulk of the bill, and the issues are so complicated, and a human life is at stake, you just follow whatever the doctor says. In veterinary medicine, people pay their own bills, they are deciding for an animal who is unable to talk or weigh in on the decision. It is a tremendous, potentially confusing responsibility. Deciding about controversial or invasive surgery for your pet may be the biggest decision you have made in your life. It is normal to feel the weight of that responsibility.”
Angel’s Stomach Surgery
Angel underwent a standard gastrotomy. In a gastrotomy, the stomach is identified, brought close to the body wall, held in place by “stay” sutures which will be removed after surgery. An incision in the stomach wall exposes the inside. The inside lining of the stomach is examined., Angel had some red, sore ulcerated areas. Ulceration means the normal surface is eaten away, forming an unprotected raw area that hurts.
What is an Ulcer?
Ulceration means the normal surface is eaten away, forming an unprotected raw area that hurts.
If a person or pet has a bleeding ulcer, the ulcerated raw area bleeds spontaneuosly. If a person or dog has a perforating ulcer, then the raw area has worn all the way through all of the layers of the stomach and there is a hole in the stomach! Obviously, this is bad! The stomach makes hydrochloric acid, which is a string acid that digests and melts even metal. Leaking acid, food, and bacteria into the abdomen is fatal. If someone has a perforating ulcer, they need surgery to save their life!
Exporatory Gastrotomy Surgery Found the Object
Angel had small ulcers in the first mucosal lining layer of the stomach. Very painful. Doc Truli had to explore the stomach to find the problem. There was a 2 inch by 1 inch (4cm x 2 cm) irregular, roughly triangular shaped object in the stomach. It had pointy edges and it seemed to be made of plastic or cartilage and broke apart with light finger pressure. It trapped food and made it stay in the stomach for too long and it also scraped at the stomach lining.
“Have you ever eaten a potato chip (a crisp, for you UK readers), and felt it scrape in your esophagus as it went down? (Then you feel a little stupid that you ate it so greedily?),” says Doc Truli, “Now imagine you can feel that pointy thing up under the left side of your ribs. For 5 months. Maybe you wouldn’t eat every day, just like Angel.”
A Good Veterinarian Ensures Surgical Success
Be on Alert for Comorbidity
Doc Truli sewed Angels’s stomach shut. Doc examined the pancreas and intestines to make sure there were no other surprises, and took a post-operative x-ray to ensure success.
“I can’t tell you how many doctors find one big problem, fix it, and the patient dies from a second problem that was there at the same time. Doctors are taught to ‘give a patient one disease.’ It’s a principle that helps a doctor learn how to bring symptoms and test results together and figure out the one thing that is wrong. But, in my experience, once you know how to diagnose a patient, you have to realize that a patient who has one thing go wrong is in a life situation, or energy pattern, or whatever you call it, in which they could easily have 2 or 3 things go wrong.
It’s like the first thing wrong is proof that the patient is vulnerable in a certain way. A physician should be on higher alert. For example, if I see a dog with skin irritation, I should look for otitis ear problems. Or of a dog has storm phobis, 85% of these dogs will also have separation anxiety. It’s called comorbidity in medicine.”
Why Did We Need a Post-Op X-Ray?
Now, you may be wondering why the extra x-ray? If it were your dog, you would look at the invoice after surgery and think,“Why did they take another x-ray when they were right in there during surgery?” Right? Logical question.
Here’s why: the doctor cannot actually see inside the whole stomach, even during gastrotomy surgery. The incision to do this would be enormous and cross major blood vessels. Instead, we see most of the lining, we feel the rest with our gloved finger, and we take an x-ray to be certain there are no lingering surprises.
Another way to accomplish an internal stomach exam would be a camera videoscope. The surgery could have be performed endoscopically, with a scope going down Angel’s throat to the stomach. Or a scope could have been used to search the stomach at the time of gastrotomy. Combining a scope with surgery works: Research shows scoping at the time of joint surgery increases post-op success considerably.
In Angel’s case, the scoping would have cost several thousand dollars, and we couldn’t be sure we could remove the object through the throat, so we also would have had to perform surgery anyway. So basically, the endoscopy technology was left on the shelf in order to save $2,000. Doc Truli felt it was an acceptable trade-off! $75 x-ray or $2,000 scope? Hmmm… Which would you choose?
Angel the Maltese Comes Off all Medications
Angel made a full recovery, and after several months of post-op medications to be sure his ulcers healed 100%, he is drug-free and eats well, for the first time since he was adopted!