Jasper's Story, Part II
Linda, the clinic’s office manager, caught me in the hallway coming into work this morning. She gave me a rundown of the patients that had been dropped off before I came into work that morning. “Jasper is back for the weekend -- but his owner wants you to check him out,” Linda explained. My heart was suddenly beginning to sink as Linda continued, “He has been vomiting the past several days again.” The day had begun on such a positive note, the sun was shining: I was at work on time, and no major catastrophes had occurred until now.
The clinic staff as well as Jasper’s owner all knew that there was a good chance that his vomiting would be a result of the return of the fungal Pythium infection previously removed from his intestinal tract. An Auburn pathologist had warned me that regardless of the treatment given Jasper, we would likely see the Pythium infection back in six months. It had been seven months since his surgery and only around 5 ½ months since Jasper had finished his series of pythium vaccinations. Were the pathologist’s words of warning ringing true? I hoped not, and yet there was a sickening feeling in the pit in my stomach that I was trying to deny the obvious.
Reluctantly I headed for the phone. “Just how bad was Jasper vomiting and did he have any other gastrointestinal signs of trouble?” I inquired of his owner. I was told that it had been going on for the past couple of days and was getting worse. Like us, Jasper’s owner tried to make excuses for the vomiting but did fully realize the gravity of the situation and what might be at stake.
On physical examination Jasper was down a couple of pounds but his hydration appeared normal. Palpating his abdomen I could imagine a thickening of the intestinal tract, but tried to rationalize that thickening as scar tissue from his previous abdominal surgery.
Trying hard not to jump to conclusions, I administered Jasper an anti-vomiting drug, took a blood sample for a Pythium titer, and privately prayed for the best. By the afternoon Jasper appeared brighter and felt well enough to eat a can of I/D food. By 7:00 PM when the clinic closed we had not received any of the I/D food back. Since Jasper had kept down his lunch, I had at least a glimmer of hope that a further crisis could be averted.
I had the weekend off but couldn’t help but check on my special patient. I knew he was in good hands with my associates but I had to know if we still had the vomiting under control. A quick conversation with Dr. Vaught the following morning confirmed my worst fears. Jasper was vomiting again! After talking with his owner, Dr. Vaught was going to take Jasper back to surgery that afternoon. We all realized that Jasper could not afford to lose further intestinal tract footage. He already suffered from chronic diarrhea problem following the first surgery. I wasn’t sure about the minimum length of intestinal tract a dog could live with and I was not anxious to find out the answer.
“Do you need any help?” I inquired of Dr. Vaught. “No, we have it under control but will let you know what we find out,” Dr. Vaught answered. Now it would be a waiting game until Jasper went to surgery. I truly did not believe that he would ever come out of surgery. If the Pythium fungus spread throughout the abdomen, then it would be kindest to euthanize him on the surgery table rather than see him starve to death.
Jasper received an IV catheter and was carried into the surgical prep area. The entire staff was fighting back tears. Everyone had become quite attached the friendly yellow lab. With his tail wagging he was quickly sedated, prepped for surgery, and Dr. Vaught soon found herself exploring his abdomen. She efficiently grabbed the colon and traced the entire intestinal tract forward to the stomach. Passing over the old surgery site there was not a proliferative lesion indicating a return of the fungus.
Instead, to Dr. Vaught’s amazement, there was an impaction of the cecum and adjacent intestinal areas. Isolating the area, that portion of the intestinal tract was opened and the sludge was removed. The impaction was dark, greasy, and extremely gritty. The material resembled motor oil, with a texture reminiscent of sand paper. Once the impaction was removed the surgical site was closed in two layers preventing any leakage.
Being the patient person that I am I was unable to wait for information and called the clinic asking them to connect me to the speaker phone in surgery. “How is everything going?” I inquired of Dr. Vaught and her surgery team. To my amazement the surgery had gone well and they were closing Jasper’s abdomen. What a relief! We all thought the fungus had returned but instead we received one of those rare medical miracles. Dr. Vaught could hardly wait to talk to his owner with the great news! She wasn’t sure what the origin of the blockage was, but she felt hopeful that Jasper’s owner could help her out. Regardless, Jasper had a new lease on life.
We had one excited and happy owner on our hands. He was quickly able to shed some light on our gritty, greasy blockage material. Jasper’s owner often spent weekends as a pit master. Is there a better way to spend the weekend than in the pursuit of the perfect barbecued pork, beef, and chicken? Jasper’s owner had a huge portable barbecue pit to take on the road behind his truck for BBQ contests and weekend events. In returning home he had cleaned the barbecue pit, which included draining the grease that had collected from a weekend of intensive smoking of various meats. The barbecue drippings were then covered with sand.
Jasper had a great nose and decided a short dig for a delectable snack was just fine with him. The sand had been flavored perfectly and he didn’t seem to mind the extra grit. Unfortunately his intestinal tract did not appreciate the sand, for it all collected near the old intestinal anastomosis site where it decided to stay. The diagnosis turned out to be our first case ever of sand impaction ever in the dog. Horses grazing on sandy pasture or lizards on sandy substrate are prone to sand impaction, but before Jasper I had never heard of sand impaction in the dog. It just goes to show you that anything flavored with southern BBQ is palatable!
Jasper had just gotten his sutures out. His weight was returning. I had all but forgotten the Pythium titer we had pulled when Jasper first got sick again. The results were in from Auburn and the news was good. The Pythium titer had dropped to half of what it was before the first surgery. The next titer we run will come in 3 to 6 months and we fully expect it to be lower still, since we saw no indication of fungal regrowth on surgery. Now we just have to get Jasper over his thunderstorm phobia.