{"id":1880,"date":"2022-01-11T11:55:00","date_gmt":"2022-01-11T15:55:00","guid":{"rendered":"https:\/\/www.drphilzeltzman.com\/blog\/?p=1880"},"modified":"2022-07-11T11:36:12","modified_gmt":"2022-07-11T15:36:12","slug":"ninja-my-biggest-surgical-ethical-challenge-in-2021","status":"publish","type":"post","link":"https:\/\/www.drphilzeltzman.com\/blog\/ninja-my-biggest-surgical-ethical-challenge-in-2021\/","title":{"rendered":"Ninja, my biggest surgical &#038; ethical challenge in 2021"},"content":{"rendered":"\n<p>\u201c<em>I beg you for help.\u201d<\/em><\/p>\n\n\n\n<p>Such was the subject line of the email.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"999\" height=\"1013\" src=\"https:\/\/www.drphilzeltzman.com\/blog\/wp-content\/uploads\/2022\/01\/Ninja-face.jpg\" alt=\"Nina\" class=\"wp-image-1882\" srcset=\"https:\/\/www.drphilzeltzman.com\/blog\/wp-content\/uploads\/2022\/01\/Ninja-face.jpg 999w, https:\/\/www.drphilzeltzman.com\/blog\/wp-content\/uploads\/2022\/01\/Ninja-face-768x779.jpg 768w\" sizes=\"auto, (max-width: 999px) 100vw, 999px\" \/><\/figure><\/div>\n\n\n\n<p>In the email, a pet owner explained:<\/p>\n\n\n\n<p>\u201cMy dog Ninja, a 6 year old Siberian Husky, just had a CAT scan, then surgery to drain a cyst in his enlarged prostate\u201d (17 cm long \u2013 about 7 inches).<\/p>\n\n\n\n<p>\u201cBecause of the pressure on the colon and the bladder, Ninja couldn\u2019t defecate or urinate!\u201d<\/p>\n\n\n\n<p>\u201cHis bladder has been so over-stretched, that it couldn\u2019t contract and now Ninja still can\u2019t urinate. A urinary catheter was placed temporarily\u2026 and the only option the surgeon gave us was euthanasia!\u201d<\/p>\n\n\n\n<p>\u201cI don&#8217;t want to put him down. He is eating, drinking and (now) pooping. He acts normal but can\u2019t pee. Please help me, I am very desperate.\u201d<\/p>\n\n\n\n<p>Desperate times call for desperate measures.<\/p>\n\n\n\n<p>Ninja had a condition similar to unfortunate older gentlemen who struggle to pee because of an enlarged prostate. It is a frustrating &amp; painful situation. But in a dog, it can be life-threatening.<\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>It\u2019s certainly not for every pet owner, but Ninja\u2019s 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).<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-wp-embed is-provider-dr-phil-zeltzmans-blog wp-block-embed-dr-phil-zeltzmans-blog\"><div class=\"wp-block-embed__wrapper\">\n<blockquote class=\"wp-embedded-content\" data-secret=\"IF13Kueo2k\"><a href=\"https:\/\/www.drphilzeltzman.com\/blog\/how-madeline-got-a-new-lease-on-life\/\">How Madeline got a new lease on life<\/a><\/blockquote><iframe loading=\"lazy\" class=\"wp-embedded-content\" sandbox=\"allow-scripts\" security=\"restricted\" style=\"position: absolute; clip: rect(1px, 1px, 1px, 1px);\" title=\"&#8220;How Madeline got a new lease on life&#8221; &#8212; Dr Phil Zeltzman\u2019s Blog\" src=\"https:\/\/www.drphilzeltzman.com\/blog\/how-madeline-got-a-new-lease-on-life\/embed\/#?secret=jJkOWhJzHG#?secret=IF13Kueo2k\" data-secret=\"IF13Kueo2k\" width=\"500\" height=\"282\" frameborder=\"0\" marginwidth=\"0\" marginheight=\"0\" scrolling=\"no\"><\/iframe>\n<\/div><\/figure>\n\n\n\n<p><strong>Chapter 1<\/strong><\/p>\n\n\n\n<p>Time was of the essence, so we quickly scheduled surgery at <a href=\"https:\/\/www.brodheadsvillevet.com\/\" target=\"_blank\" rel=\"noreferrer noopener\">Brodheadvsille Vet Clinic<\/a>.<\/p>\n\n\n\n<p>Ninja had a \u201ccystostomy\u201d surgery, where a tube was placed to drain the bladder through an opening in the skin.<\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<p><strong>Chapter 2<\/strong><\/p>\n\n\n\n<p>Everything went according to plan for about a month\u2026 until Ninja accidentally stepped on the tube.<\/p>\n\n\n\n<p>The logical next step was to replace the life-saving drain. Unfortunately, preop bloodwork showed some concerning changes. Ninja\u2019s immune system was attacking his own red blood cells (hemolytic anemia) and platelets (thrombocytopenia). This double condition is called Evans\u2019 syndrome.<\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>We were able to do this thanks to the generosity of another practice owner near Allentown, PA.<\/p>\n\n\n\n<p>The catheter had to be changed frequently to lower the risk of bladder infection (UTI).<\/p>\n\n\n\n<p>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\u2019t contract anymore\u2026<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"1535\" height=\"1166\" src=\"https:\/\/www.drphilzeltzman.com\/blog\/wp-content\/uploads\/2022\/01\/Ninja-body.jpg\" alt=\"Nina asleep\" class=\"wp-image-1881\" srcset=\"https:\/\/www.drphilzeltzman.com\/blog\/wp-content\/uploads\/2022\/01\/Ninja-body.jpg 1535w, https:\/\/www.drphilzeltzman.com\/blog\/wp-content\/uploads\/2022\/01\/Ninja-body-1100x836.jpg 1100w, https:\/\/www.drphilzeltzman.com\/blog\/wp-content\/uploads\/2022\/01\/Ninja-body-768x583.jpg 768w\" sizes=\"auto, (max-width: 1535px) 100vw, 1535px\" \/><\/figure><\/div>\n\n\n\n<p><strong>Chapter 3<\/strong><\/p>\n\n\n\n<p>At that point, Ninja was referred to a board-certified internist (a medicine specialist) to manage his Evans syndrome.<\/p>\n\n\n\n<p>Meanwhile, Ninja still couldn\u2019t pee!<\/p>\n\n\n\n<p>To make matters worse, an ultrasound showed that the prostate now had an abscess. Again, euthanasia was recommended.<\/p>\n\n\n\n<p>Again, his owner called me to see if there were any other options.<\/p>\n\n\n\n<p>After reaching out to multiple specialists, we found one willing to help. My amazing nurse and I suggested a completely crazy plan:<\/p>\n\n\n\n<p>. 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.<\/p>\n\n\n\n<p>. We would drain the abscess at another practice in NJ, and place a new cystostomy tube to allow Ninja to pee.<\/p>\n\n\n\n<p>. We would recover Ninja under the supervision the ICU specialist.<\/p>\n\n\n\n<p>Amazingly, Ninja\u2019s owners decided to go with surgery, about 2 months after the first one.<\/p>\n\n\n\n<p>The procedure was uneventful, and after 2 days in ICU, Ninja went home.<\/p>\n\n\n\n<p>Then came weeks and months of amazing dedication from Ninja\u2019s owners.<\/p>\n\n\n\n<p>Long story short, Ninja progressively got better and stronger.<\/p>\n\n\n\n<p>Then out of the blue, to everybody\u2019s surprise, he started to pee on his own!<\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>Now you understand why Ninja was such a technical and mostly ethical dilemma for me.<\/p>\n\n\n\n<p>When should a surgeon stop helping?<\/p>\n\n\n\n<p>When should a pet owner stop hoping?<\/p>\n\n\n\n<p>When should a pet to cross the rainbow bridge?<\/p>\n\n\n\n<p><strong>Why did I choose Ninja\u2019s story\u2026<\/strong><\/p>\n\n\n\n<p>\u2026 over so many other amazing pet stories I was fortunate to play a part in in 2021?<\/p>\n\n\n\n<p>Because of the number of people who played a role in Ninja\u2019s survival.<\/p>\n\n\n\n<p>In the middle of the COVID crisis, it was an absolutely astonishing display of generosity, love and care, by multiple vets and nurses.<\/p>\n\n\n\n<p>Across half a dozen practices.<\/p>\n\n\n\n<p>And across 2 States (PA &amp; NJ).<\/p>\n\n\n\n<p>(trust me, I gave you the short version!!!)<\/p>\n\n\n\n<p>Everybody rallied behind Ninja, led by his loving owners.<\/p>\n\n\n\n<p>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\u2019 love.<\/p>\n\n\n\n<p>Ninja\u2019s owner created an amazing video summary.<\/p>\n\n\n\n<p>It\u2019s a story about the love of a family pet.<\/p>\n\n\n\n<p>A story about the power of dedication.<\/p>\n\n\n\n<p>A story about not taking no for an answer.<\/p>\n\n\n\n<p>You can watch it here: <a href=\"https:\/\/l.facebook.com\/l.php?u=https%3A%2F%2Fvm.tiktok.com%2FZMRatj6Co%2F%3Ffbclid%3DIwAR2yOUs1QvMbUWgUh8Bq0iiXATATjl_BorjhYFUxGY_UzUhRshNzexHzEj0&amp;h=AT2ujVg6TIfR6429kWLyUj3PTdF9vQR-BLPeXxS7KFRHN4mK3W4qN2fjE7VTDCmbi1vUc3v-dAbtSjfrGaIDjBCEB6Bac018bXPAXku2e25k6Y3Ilpp8Q6d6vr5OiYYP_w&amp;__tn__=-UK-R&amp;c%5b0%5d=AT0x3Y6GF5eiS-yc-Gz9abZwlxcO1UXtlJmLwxILcC5HHOxy5_Q4nfXbZijvwKPGEWYTKj1wese3gyfOKYHBAe8-ZOPnKmxdX_JkpmPQaBrXWpDM7Lm80NcbLOlVJkzIGX2HYQHQ5ME4ZeLbKAMEQLBWjfjXy4ebhLlBTA\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/vm.tiktok.com\/ZMRatj6Co\/<\/a><\/p>\n\n\n\n<p>Fair warning: it\u2019s a tiny bit emotional\u2026<\/p>\n\n\n\n<p><strong>What\u2019s the moral of the story?<\/strong><\/p>\n\n\n\n<p>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:<\/p>\n\n\n\n<p><a href=\"https:\/\/www.drphilzeltzman.com\/blog\/top-10-reasons-to-neuter-your-pet\/\">https:\/\/www.drphilzeltzman.com\/blog\/top-10-reasons-to-neuter-your-pet\/<\/a><\/p>\n\n\n\n<p>2. You are your pet\u2019s best advocate. If something makes no sense to you, don\u2019t give up. Sadly, there is not a solution or a cure for every condition. But at least, you should explore your options.<\/p>\n\n\n\n<p>Don\u2019t take no for an answer. Get a second opinion.<\/p>\n\n\n\n<p>This is exactly what Madeline\u2019s and Ninja\u2019s owners did. They didn\u2019t take no for an answer, and they saved their dogs\u2019 lives.<\/p>\n\n\n\n<p>Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified<\/p>\n\n\n\n<p><a href=\"https:\/\/www.DrPhilZeltzman.com\">www.DrPhilZeltzman.com<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u201cI beg you for help.\u201d Such was the subject line of the email. In the email, a pet owner explained: \u201cMy dog Ninja, a 6 year old Siberian Husky, just had a CAT scan, then surgery to drain a cyst in his enlarged prostate\u201d (17 cm long \u2013 about 7 inches). \u201cBecause of the pressure [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[242,60,157,48,22,9,156,10],"class_list":["post-1880","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-cystostomy-tube","tag-cystotomy","tag-phil-zeltzman","tag-tumor","tag-veterinary-emergency","tag-veterinary-medicine","tag-veterinary-surgeon","tag-veterinary-surgery"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Ninja, my biggest surgical &amp; ethical challenge in 2021 | Dr Phil Zeltzman\u2019s Blog<\/title>\n<meta name=\"description\" content=\"Ninja had a condition similar to unfortunate older gentlemen who struggle to pee because of an enlarged prostate. 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