Page 29 - Sonoma County Gazette - June 2018

Something New Every Day
June 12th marks the 36th anniversary of my graduation from veterinary school. Experience has its perks, and my profession is filled with puzzles. Over the years, I thought I’d seen quite a few. Until yesterday, that is.
Enter Daisy, a yellow Labrador retriever of a certain age. She lives on a dairy with her cows and her peeps. She enjoys hanging out, doing her job, and an occasional hunting trip. She is the epitome of a ranch dog and has a really great life. But things aren’t so great today. Daisy’s belly is distended and she’s having trouble getting around. To top things off, she’s not interested in food. That just ain’t right.
We check her out: No fever. Her hydration is not great but not terrible.
Her chest sounds OK: There’s no heart murmur, but she’s not breathing very deeply and her pulses are weak. Her tummy isn’t just distended, it’s under pressure, and when we tap on one side of her stomach, a fluid wave is felt
on the opposite side. Daisy’s abdomen feels like an overfilled water ballon. A quick ultrasound exam verifies the presence of fluid, but also reveals that the fluid is full of... something. In fact, there is so much something in the fluid that the ultrasound waves echo back, making it difficult for us to visualize Daisy’s internal organs. It’s as if we’re doing ultrasound though a jug of cottage cheese.
But fluid is fluid and that means we can obtain a sample for analysis, and the characteristics of the fluid will define the characteristics of Daisy’s disease. Cytology is a quick and reliable test that we perform in the office, so a fine needle aspiration is performed and within minutes we know that the fluid in Daisy’s abdomen is pus—a thick soup of white blood cells. We see no bacteria, so the severe inflammation inside Daisy’s abdomen appears to be sterile. The simplest explanation for Daisy’s problem is that she has developed a sterile pyometra (a condition where the uterus fills with sometimes massive amounts of inflammatory fluid), and that her uterus has ruptured, releasing all that muck into Daisy’s abdominal cavity.
It’s not a bad theory, and it might even be correct. The old doctor has seen this puzzle before. One thing is certain: Daisy needs to go to surgery and fast. We have no faith in her ability to survive even a few hours.
But there is no way Daisy is going to be able to breath with so much fluid in her abdomen, so we dose her with morphine and pump over a gallon of nasty fluid from her belly. Daisy is breathing better and her pulses improve, so we induce anesthesia and take her into surgery. Our plan is to open her abdomen and take a look around. Then, when we find the source of her infection, we’ll repair whatever it is and wash her out. The procedure is called an “Exploratory Laparotomy.” It’s nerve wracking to not know what we’ll find, but there’s nothing else to do and we’ve seen this puzzle before. To hesitate is to squander Daisy’s small remaining chance of survival.
But within seconds, our Weird Stuff O’meter goes from “Strange But Understandable” to “Are You Kidding Me?” As soon as the abdomen is opened, a tapioca-like gel of fluid begins to flow from the wound. That red fluid we so carefully analyzed contains literally millions of 1/8” diameter, clear, “gawd knows what,” thingies that were too large to pass through the fine needle used to sample. We collect a few, scrub out of surgery, and place some of these thingies on the microscope.
That’s when 36 years of “I’ve seen this puzzle before” becomes a “once-in- a-career mystery.” I don’t know what the things are, but I know that they are alive, and that they are animals, and that no parasitology textbook I’ve ever read has ever described anything like them. They are little moving blobs of protoplasm, with little arm-like pseudopods, and some kind of round, central organ that makes them appear similar to a fluke, except that they are too small and too poorly developed and not flukes at all. They certainly are not tapeworms. Whatever they are is inconsistent with any canine parasite. We even Googled it. Nothing.
You know the ending: Daisy does not survive, even though we removed over 16 pounds of stuff from her tummy. Her abdomen is just too severely inflamed for her to live. We’ve spoken to several other veterinarians, but no one has
seen anything quite like this. Samples have been sent to the pathology lab in hope that one of the specialists there will recognize these things, or will know someone at the University who might know.
I just want to find out how to help the next Daisy. Next time I want to be able to say, “I’ve seen this puzzle before.”
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