Dr. Phil Zeltzman’s Blog
Ninja, my biggest surgical & ethical challenge in 2021
“I beg you for help.”
Such was the subject line of the email.
In the email, a pet owner explained:
“My dog Ninja, a 6 year old Siberian Husky, just had a CAT scan, then surgery to drain a cyst in his enlarged prostate” (17 cm long – about 7 inches).
“Because of the pressure on the colon and the bladder, Ninja couldn’t defecate or urinate!”
“His bladder has been so over-stretched, that it couldn’t contract and now Ninja still can’t urinate. A urinary catheter was placed temporarily… and the only option the surgeon gave us was euthanasia!”
“I don’t want to put him down. He is eating, drinking and (now) pooping. He acts normal but can’t pee. Please help me, I am very desperate.”
Desperate times call for desperate measures.
Ninja had a condition similar to unfortunate older gentlemen who struggle to pee because of an enlarged prostate. It is a frustrating & painful situation. But in a dog, it can be life-threatening.
There is a better solution than euthanasia. I suggested a surgery that involves placing a special tube in the bladder and allows draining the bladder on demand.
It’s certainly not for every pet owner, but Ninja’s owners were exactly the right people for the challenge: dedicated, attentive, and totally in tune with their dog. They had done their homework and found out about this option by reading my blog about Madeline, who had the same surgery for a different problem (a bladder tumor).
Chapter 1
Time was of the essence, so we quickly scheduled surgery at Brodheadvsille Vet Clinic.
Ninja had a “cystostomy” surgery, where a tube was placed to drain the bladder through an opening in the skin.
In addition, Ninja was neutered. After that necessary step, male hormones would decrease and cause the prostate to shrink. That would reduce the pressure on the urethra and allow Ninja to urinate.
Chapter 2
Everything went according to plan for about a month… until Ninja accidentally stepped on the tube.
The logical next step was to replace the life-saving drain. Unfortunately, preop bloodwork showed some concerning changes. Ninja’s immune system was attacking his own red blood cells (hemolytic anemia) and platelets (thrombocytopenia). This double condition is called Evans’ syndrome.
So we changed plans. Since it was too risky to perform surgery with such low numbers of red blood cells and platelets, we placed a traditional urinary catheter to allow Ninja to urinate.
We were able to do this thanks to the generosity of another practice owner near Allentown, PA.
The catheter had to be changed frequently to lower the risk of bladder infection (UTI).
His faithful owners would drain the bladder multiple times a day to allow it to stay small. Remember, the bladder was so over-stretched, that it couldn’t contract anymore…
Chapter 3
At that point, Ninja was referred to a board-certified internist (a medicine specialist) to manage his Evans syndrome.
Meanwhile, Ninja still couldn’t pee!
To make matters worse, an ultrasound showed that the prostate now had an abscess. Again, euthanasia was recommended.
Again, his owner called me to see if there were any other options.
After reaching out to multiple specialists, we found one willing to help. My amazing nurse and I suggested a completely crazy plan:
. An ICU specialist at a specialty hospital in NJ accepted to let us use the key to our problem: a special transfusion with platelets to help with clotting.
. We would drain the abscess at another practice in NJ, and place a new cystostomy tube to allow Ninja to pee.
. We would recover Ninja under the supervision the ICU specialist.
Amazingly, Ninja’s owners decided to go with surgery, about 2 months after the first one.
The procedure was uneventful, and after 2 days in ICU, Ninja went home.
Then came weeks and months of amazing dedication from Ninja’s owners.
Long story short, Ninja progressively got better and stronger.
Then out of the blue, to everybody’s surprise, he started to pee on his own!
After agonizing over the right time to remove the tube, we eventually did, once we were convinced that Ninja was emptying his bladder on his own sufficiently to survive.
Now you understand why Ninja was such a technical and mostly ethical dilemma for me.
When should a surgeon stop helping?
When should a pet owner stop hoping?
When should a pet to cross the rainbow bridge?
Why did I choose Ninja’s story…
… over so many other amazing pet stories I was fortunate to play a part in in 2021?
Because of the number of people who played a role in Ninja’s survival.
In the middle of the COVID crisis, it was an absolutely astonishing display of generosity, love and care, by multiple vets and nurses.
Across half a dozen practices.
And across 2 States (PA & NJ).
(trust me, I gave you the short version!!!)
Everybody rallied behind Ninja, led by his loving owners.
And the result is one happy, playful, fluffy Husky, whose only wish is to be comfortable, to be able to pee, and to return his owners’ love.
Ninja’s owner created an amazing video summary.
It’s a story about the love of a family pet.
A story about the power of dedication.
A story about not taking no for an answer.
You can watch it here: https://vm.tiktok.com/ZMRatj6Co/
Fair warning: it’s a tiny bit emotional…
What’s the moral of the story?
1. Neutering early in life decreases or eliminates the chances of having prostate issues in male dogs. There are many other good reasons, which you can read about here:
https://www.drphilzeltzman.com/blog/top-10-reasons-to-neuter-your-pet/
2. You are your pet’s best advocate. If something makes no sense to you, don’t give up. Sadly, there is not a solution or a cure for every condition. But at least, you should explore your options.
Don’t take no for an answer. Get a second opinion.
This is exactly what Madeline’s and Ninja’s owners did. They didn’t take no for an answer, and they saved their dogs’ lives.
Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified
Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!