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Angel the Maltese Wins a New Lease on Life

July 17, 2011

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Angel, a 10-year-old male neutered Maltese

Angel waits for a decision about his 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.

Close up of barium sticking to rounded objects in the stomach

Close up of rounded objects in the stomach highlighted by barium

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!

Angel's inner stomach lining showed reddish-purple ulcers

The top edge shows a darker red blotch. That's an ulcer.

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.

Pointy pain-causing gastric foriegn object brown and slimey from stomach acid

The offending object and a kibble

“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!

7 Comments leave one →
  1. August 13, 2013 9:35 pm

    Hi., i just read your post. Mind if i ask some question?
    I hv a dog. Pom.female. 4Y.o/ she’s been throwing up on & off for these whole 5months. start in early March ’13, she suddenly vomiting alot of white sticky foamy liquid and sometimes yellow bile, which i thought it’s kinda “ok”, she might hv a bad temporary upset tummy. i did what most of the article said, “hold food for atleast 12H & give bland food like boilled chicken and extra fresh water”. i did that, but the boilled chicken thing is nothing new, as my girl always and only wants to eat the boilled chicken as her food (been traveling from one brand to another, but nothing fits her taste). the next day, she felt better and eat like a champ. but the next day, the vomiting is back. i checked her physical appearance, pressed her stomach, no tense and no abdominal pain. after the throwing up, she’ll lied down for a moment just to play and running again. this on & off thing was happened for a week. felt something was goin wrong, i took her to the vet. took an xrays, the vet saw some narrowed part on her intestinal part, the vet then said this is an intestinal blocage. So we did the barium test, but it was all fine. no foreign object, no twisted intestinal, we got home with no medication prescribed. 2 days at home after the barium test, she thrown up again, too her to a different vet, show the vet her barium xrays. the vet said her spleen is enlarged. and offered me to do the laparotomy as fast as i can. afraid of this sudden diagnosed, i refused and said to “let’s wait and see”. the vet gave us Raniditine and pimperan. My girl doin just fine without the throwin up for almost 4 days after i gave her ranitidine & pimperan. but on the 5th day, here cames the massive diarrhea. she poops like 7-8 times in 1 day. the next day, the stools became black tarry formed. i brought her again to dif vet (3rd vets), he just tought it might be an upset tummy and sent us home w/Ranitidine. no antibiotics. he want us to prolonged the ranitidine then wait and see. i insist for a blood test. everything came normal. we then stick around just w/rantinidine. but the diarrhea wont stop. took her back to the vet. he then gave us Sulcrafate. i told him, that my girl was passing out alot of gasses lately. her stomach is make a sound, she’s burping and farting. but the vet said, its ok. after a week, nothing is changed. i search for another clinic, found 1 who seems profesional and can lead us and wants to hear my oppinion, my girl did the CBC & biochemistry and also giardia test. averything came back normal. her liver, pancreas, kidney are all fine. the vet gave us famotidine, sulcrafate, flagyl, and probiotics. for 3 weeks. all was fine for 3 weeks. but when the medicine is over, the vomitting and the black stools was comeback again. the vet decided to prolonged the drugs. so my girl was once again on 3 weks of famotidine, sulcrafate n flagyl. we doing fine for 1 month. but then she vomiting again. i made an appointement to do the ultrasound. we took it and the sonographer said, it seems to be like a thickening waal in her stomach wall, which indicating a Gastritis. the sonogrpaher told us to keep sticking in w/rantin & sulcrafte, for 6-8 weeks straight. then do the ulrasound again. i told him, we already feed her these drugs for 4 months, but it keeps return. we then start to give her rantin & sulcrafate for 6-8 weeks. but on her 5 weeks range, my girls was throwing up Blood. a real red bloody liquid smells like metal. that was happened on 30 july’13, after that, she keeps on throwing up another white foamy liquid. i rush her to the nearest clinic, which unfortunately this clinic doesnt hv an xray equipment and no blood checking. the vet then put my girl on IV, i ask them todo the boold test, they did it and will sent it to another clinic, so we only can get the result bu tom morning, when the vet drawn my girl’s blood it wont flow. the blood was so thick. bcoz of dehydration. i told the vet about my girl’s historical record and what we’ve been through, including what drugs we’ve already given to her for these past 5 months. i show her my girl’s xrays and barium test and also her previous blood check. but the vet seems not taking it too serious. she told me, she will give my girl a zantac, which she claimed it’s a different drug from ranitidine, i snap out, and told her that zantac IS ranitidine. both are the same drugs, but different comercial names. but she insist it was different. tired from yelling, i came home. my girl stayed for 4 days at her clinics. i told the vet todo the barium test. let me transfered my girl into another clinics and did the barium test there. but the vet didnt allowed it. she said, she personally that will do the barium test. turns out this vet has another branch clinic, but it’s located for 3 hours long. i dont want my girl to be on the road for that long and on top of that in our country we just entered a long holiday week (Idul fitri, for moslem people. i live in Indonesia jakarta), so most of clinics and her clinics will likely to be closed for about 1 week. so the barium test will be done in another week. i dont like this vet, she viewed my girl case a sif its just a simple case, while she has nothing to back up her opinion ( i mean no xrays, cant do the barium). so i told her, let me take my girl home. and we will back to you asap for the barium test after the holiday sesion is over. but for now, let me take her home. I took my girl, on her 4th day at home, my girl was throwing up blood again. twice. im scarred to death. but no clinics was opened for a whole week. no ER vet, i keep giving her pedialyte, i cant sleep, and the next morning, i trid to give her a small portion of hill’s i/d (been giving her this for a week), she was fine for days. And as early as i could get up, this monday morning, i rush her to a dif clnics, i ask for barium test, i told the vet all of the stories, the barium test show that my girl has an erosive Gastritis. the barium should be clearly out of her gastric/stomach area in 6 H. but some still stayed on her stomach. which means, her stomach area has this folded/wrinkled mucosa cell or what we called as having an ulceration. that;s why she was throwing up blood. The vet gave us Omeprazole and sulcrafate. and will do the endoscopy, if they can borrowed the equipment from singaporean vetcare. i dont knw how much this will cost me. as i already spent soo much money for the past 5 months. really alot.
    i ned to ask, what was you vet told you when your vet found out about the ulceration on angel’s tummy? was the ulceration spread in all over her stomach lining? or it was just in some part of area? and did your vet took an act? like, maybe scrapping the ulceration area and thrwn out the bad cell? or it was pure left it like that and treating it w/drugs? and what drugs did you vet gave for angel’s ulceration problem?

    Thank you.
    from desperate mom 😦

    • August 14, 2013 5:42 pm

      Dear adensanti,
      I am the vet that took care of angel. I cannot advise you about meds, etc because I have not examined your dog. I do sympathize with the tough road you have had going from one vet to another. What a horrible experience for you and your dog.

      The endoscopy or exploratory laparotomy may be your best bet. Good luck. I hope they find and fix your dog’s problem.

      Yours truly,

      • August 15, 2013 6:45 am

        oh, my bad. i thought you bring angel to a dif vet, and you are the owner’s friend. im so sorry. 🙂
        I just want to knw, did angel’s ulceration is a mild ulceration when you did the surgery?, and for how many months did angel fully heal from her ulcer? and how to make sure? did angel was having another test done? like the secnd barium test to knw her heal ulcer?
        thats all i want to knw. at least i knw there’s some hope that my girl ulcer can heal. i knw what it felt having this gastric ulcer as i hv the same illness. but unlike her, i can speak up and said what’s hurt. i also can yelled and whinned to my mom. but all my girl did is just endured it. she really is a strong girl.

        Thank u !

      • August 16, 2013 8:08 pm

        It was a medium ulceration. We kept her on ulcer medication for 6 months. We did not scope her again. But if the family could have afforded it, it would have been ideal.

      • August 16, 2013 9:36 pm

        6months for mild ulceration? mind will take more, i guess. my girl is on Omeprazole for 1 month now. but nothing change, she kept puking at night. although i already give her primperan.
        How i wish i had a doctor like u, where you can freely discuss about the finance situation & how to manage what need to be done first (like between endoscopy or surgery) i did many tests here, and my vet cant even focus and make 1 final decisoin on what we should investigated further. i spend soo much money these 5 months, but my girl still sick. i need 1 vet that i can trust to spend my money on. and who i can freely talk about my situation. always thought that a doctor and a client should always be a partner. but i dont feel it here.
        well, doctor, thank you for your time and kindly answer. please do saving many lives 🙂

  2. July 19, 2011 2:21 am

    Wow, this was a cliff-hanger! Poor Angel! And you have no idea what that thing in his stomach was? It was just in there for all those months (or longer)?

    • July 22, 2011 2:08 pm

      Yes, Sharon, I believe the thing was in there since before the family adopted Angel. I still have no idea what it was. It seemed to be shaped like rawhide, but it cracked apart like old soft plastic. It will remain a mystery.

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