What strikes one person as gross can be another person’s lunchtime entertainment.
That’s certainly true for veterinarians, whose social media news feeds are filled with X-rays of bizarre things animals eat, mango worms, and weird animal/owner memes.
A friend who is a veterinary surgeon in the military recently sent me a video of the removal of an ear polyp from a cat. The cat is under anesthesia. A pair of hemostats (those are fancy grabbers) go down into the cat’s mouth and pull out a giant polyp from the back of the throat.
I know always to look for this condition in cats, especially young cats who are struggling to breathe. But I have never actually found one. I have had some very satisfying veterinary moments removing things from animals — extracting an enormous plastic eyeball from the intestines of a dog, scoping out a massive clump of grass from a cat’s nose, pulling a huge splinter from a paw. But I’ve never experienced what must be the extraordinary satisfaction of grasping such a big piece of tissue, yanking it out, and effectively remedying a cat’s inability to breathe instantly.
That ear polyp video satisfied my desire to have my own case like it. At the same time, it reminded me of my own white whale of animal diseases.
When I was in veterinary school, we were given brief lectures on various oddball conditions. One of them was pheochromocytoma. This is a tumor of the adrenal gland, which is the organ in the abdomen that produces all kinds of hormones, including epinephrine, cortisol, aldosterone, and the sex hormones. These tumors are mostly found in dogs.
Most of the signs of pheochromocytoma are vague, such as drinking more water than normal, panting, and heart arrhythmias, and they can wax and wane. Moreover, the signs can very closely mimic a common condition in dogs called Cushing’s disease (hyperadrenocorticism).
Apparently, I just loved writing and saying the word pheochromocytoma. Since so many canine problems have symptoms that mimic the signs of that condition, I found myself including it on my differential list for probably every dog with a sickness that even remotely matched it, starting in my second year of vet school.
Flash forward to eight years after graduation. At this point I have written the word pheochromocytoma countless times as the possible underlying cause of a problem. One day a very sweet older neutered male spaniel mix I had known for several years came in to be evaluated because he had been urinating in the house. His belly appeared a bit bigger than at the last visit, he had a lost a little muscle mass, and he looked like he had aged faster than I was expecting him to. We did the lab tests, which showed changes we would expect in an older dog with Cushing’s disease (or, yes, with a pheochromocytoma). But the numbers were more extreme and had changed faster than expected. We scheduled an ultrasound.
The day arrived. The ultrasonographer arrived. The dog arrived. And on that fall day, I found my white whale. A large mass was visible on the adrenal gland, invading along the very large blood vessel, the vena cava. It could be only one thing: my long-sought pheochromocytoma.
Unfortunately, there were multiple nodules elsewhere in this dog’s abdomen, and his clinical signs were rapidly progressing. Because surgical excision was not an option, and because of the increasing severity of his disease, this very sweet senior gentleman was euthanized several weeks later, with his family surrounding him.
His owners very graciously allowed us to perform a necropsy to sample the mass so that we could establish what it was. The biopsy confirmed it: an invasive pheochromocytoma. I keep that biopsy report next to my desk.
The death of a beloved animal is always sad, but science can help lessen the pain. Many people are willing to donate their animals after death so that, at my vet school, for example, we could learn anatomy from them. And with the knowledge gained from necropsies, we can help people make difficult decisions about treatment.
It helps people to know what has caused their pet’s death, and to know that they can help another animal in the future.
Sadie Hutchings is a veterinarian who lives in Wellfleet.
