I had seen this problem before – a cute West Highland White Terrier, getting on in years, a bit more sedentary than he had been, but adept at persuading his doting owners to donate extra morsels in his direction.
However, once Duffy was on my consulting room table, it became evident that the cause of his problem was not so benign. I could feel a large mass in the front part of his abdomen. I tried to relay the serious news as gently as I could.
This was anything but a Westie with a fat tummy. We agreed that I should take some X-rays that afternoon so we could formulate a plan. I explain to all the vet students that come my way that there are seven ‘Fs’ of abdominal distension (and one other, which doesn’t begin with ‘F’).
Only the best students can crack this list. It seemed likely that the reason for Duffy’s abdominal distension was the one that didn’t begin with an ‘F’.
The X-rays and scan confirmed the presence of a melon-sized mass, although it was not clear what it was attached to. Surgery would be required, but I would need reinforcements. I arranged for Duffy to come back on Thursday, when my wife and fellow vet, Anne ,would be around to help.
Breakfast was rather tense that morning. We knew we would be up against it to sort out little Duffy. He arrived at the surgery, waddling along beside his owner, who squeezed my arm as she handed him over.
“I know you’ll do your best, Julian, but if it’s too bad, if there’s no hope, then do what is right for my little man.” Her parting words were tearful, but sincere.
I nodded, understanding exactly what was inferred.
I took Duffy to theatre and set up his drip. Once he was anaesthetised and on the table, the full extent of his abdominal distension was even more marked. While it looked dramatic, the outcome depended more upon what the mass was attached to than its size. In general terms if a mass is associated with the spleen, the outcome can be favourable – although not necessarily.
If the mass is on the liver, the outcome is usually terrible, as it is often inoperable. Whilst surgeons like to know exactly what they are dealing with, using scans, X-rays and blood tests help make a diagnosis, it is only when we reach for the scalpel that we can really see exactly what is going on. So much as we like to work everything out beforehand, surgery is very often the answer.
And it was today. As soon as we could see inside the abdomen, it became evident that the poor little Westie had an enormous tumour invading his liver. Despair was soon followed by a glimmer of hope – it was attached to just one lobe. Would it be possible to remove the lobe and the mass together?
We thought we could.
Two painstaking hours later, Duffy was waking up from his anaesthetic, while part of his liver and the huge tumour were sitting in a kidney dish. His tummy was a fraction of its former self and I picked up the phone to relay the cautiously happy news to his owner. It was the start of what was sure to be a long recovery, but so far so good.
If you want the answer to the seven ‘Fs’ of abdominal distention, then you’ll need to get a copy of my next book, On Call with a Yorkshire Vet, published by Great Northern Books, out soon. The riddle will be revealed!
The new series of The Yorkshire Vet continues this Tuesday at 8pm on Channel 5.