Keeva face

Do you believe in karma?

By complete accident, I stumbled upon an old email sent by a vet student who was shadowing me during surgery.

The email contained a picture she had taken during surgery.

I still remembered the student, the patient, and the challenging surgery.

So I wondered what happened to the patient.

She was still alive, 2 years after surgery!

Below is the surprising story of Keeva, a 9-year-old Pitbull.

How did we find out about Keeva’s intestinal cancer?

Her owner recalls: “Life was pretty good until one hot August day. Keeva and I were lying in bed in the air-conditioned bedroom and she panted for about 2 hours. Something wasn’t right. It hit me that she was panting from pain and NOT heat. So I took her to the emergency clinic.”

In hindsight, Keeva had also been a bit lethargic and not eating as well as usual.

Her owner continues: “The ER vet took X-rays and shockingly, found a big mass in Keeva’s belly.”

Keeva VD

Here is the X-ray of Keeva’s belly, from the front. Can you see the mass?

Here is the same X-ray with a red circle around the mass.

Keeva VD with arrow

The vet suggested getting an ultrasound to find more information about the mass.

The next morning, the family vet – miracle #1 according to the owner – had a mobile ultrasound person come in that same day!

The ultrasound revealed a 10 cm (5 inch) in diameter mass somewhere in the intestine. That’s about the size of your fist.

Keeva ultrasound
The ultrasound showed a 10 cm (5 inch) in diameter mass in the intestine

Keeva’s surgery to treat cancer of the intestine

Surgery was recommended to remove the mass, and find out what it was.

The owner remembers: “I was extremely impressed with the time that you took to talk to me prior to the surgery, informing me of what the procedure would entail, how you and your team work, when you would call me and you emailed me lots of detailed information as well (right up my alley). So I was comfortable with the decision to have the surgery.”

We were able to perform surgery the very next day.

Keeva’s owner calls this miracle #2.

After opening Keeva’s belly, we found a 20 cm (9 inches) in diameter mass, so twice as big as expected…

Worse: it was attached to the appendix (cecum).

The appendix is a very important structure in the intestine.

It acts as a one-way valve between the small and the large intestines.

Food (errr… or poop) goes down, from the small intestine into the large intestine.

Thanks to the one-way valve (the cecum or appendix). it cannot go back up.

More importantly, it prevents evil bacteria from the large intestine from backing up into the small intestine.

If they do, they multiply and cause a condition called Small Intestine Bacterial Overgrowth (SIBO). In turn, SIBO can lead to ongoing (chronic) diarrhea.

To remove the mass, which was attached to the appendix (or coming from it), we would have to cut and reconnect the small and the large intestines.

Given the risk of life-long diarrhea, I had to have a heart-to-heart with Keeva’s owner.

A nurse called her and put her on speakerphone in the OR.

I explained the risk of SIBO and diarrhea. And the fact that this was a bigger and riskier surgery than expected.

She recalls: “You explained that due to the intertwining and location of the tumor, you were going to remove the cecum/appendix and that this could mean chronic diarrhea post-surgery. My thought was: I can live with that, if it gives Keeva a chance at life. You also explained that from the looks of the tumor, you were fairly certain it was cancerous. Your comment was a reality check, although not a surprise, and absolutely appreciated.”

Despite the risks, she loved Keeva and wanted to do everything to help her dog, and she elected to pursue surgery.

WARNING – the next picture is very graphic !!!

So we removed the mass. Despite sticking to every organ in the area, the tumor was well-contained (the owner calls this miracle #3).

Keeva mass

The intestine is held by the 2 metal instruments. In between is the big mass…

Keeva recovered smoothly from anesthesia and surgery, and spent the night in ICU.

She went home the next morning.

“Within a week, she was almost back to normal, eating and pooping… and she did NOT have diarrhea!!!”

About a week later, the biopsy report came back and confirmed a type of cancer called leio-myo-sarcoma, which is a cancerous tumor of the muscle around the intestine.

The only good news was that the pathologist thought we got it all, which was surprising since the mass was attached to so many organs in the belly.

After talking to her family vet about the pros and cons of chemo, Keeva’s owner elected against further treatment, besides a special food to keep the intestines happy.

2 years later, when I found that email and picture by accident, Keeva was still cancer-free and thriving – at 12 years of age.

In hindsight, her owner’s lesson is: “I feel that I am much more attuned to Keeva’s body language, barks, and behavior. It is always in the back of my mind that she may get cancer again, but that only makes me appreciate the time we have now!”

And very kindly, she concluded: “You saved Keeva’s life. I am very happy you gave her more good quality years! I can’t thank you enough for saving her.”

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Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Pete Baia, DVM, MS, DACVS