She had been all black in her youth, but now at the age of 14 she is showing some gray around her muzzle. She used to jump and romp and play. Now she walks sedately across the yard, a faint weakness in her hindquarters. But always, Bella has class. Always, the gentle tail wag to let you know that she’s listening, she’s here.

Two years ago, Bella exhibited marked signs of difficulty when she tried to stand up in the morning. Upon examination, it was obvious that she was losing feeling in her back feet. Our X-rays showed degeneration of the spine in her back. We discussed options and Bella’s owners decided to see a specialist, where Belle underwent laminectomy spinal surgery. She recovered beautifully and even though she needed to stay on arthritis medications she moved quite fluidly again. Bella enjoyed her people and her life.

Bella is a Labrador Retriever, and though I don’t believe she has ever retrieved anything more interesting than a goodie from her owners’ hands, she shares a fate common to many Labs. Bred to be high energy dogs, capable of hunting all day and swimming in frigid waters to retrieve ducks, these dogs seem to naturally have an extra layer of protective fat. Given snacks and a soft life in the suburbs, many a Lab will put on a few extra pounds.

As I surveyed Bella in the exam room on Tuesday, I felt a deep unease. By no means obese, Bella could have stood to “lose a few” but not like this – Bella had lost 10 pounds over a two month period of time. Nothing in her diet or routine had changed, though her owners noted that she frequently passed a soft stool. Given her weight loss, I recommended that we start with a blood panel for diagnostic tests. Her physical exam was unremarkable for her age and existing medical history.

When the lab tests returned, the “biggies” were all good. No sign of diabetes, liver and kidney function within normal limits. Her body proteins were low. Hmmm.

Bella’s body either wasn’t making proteins or it was losing protein. In this case, with further testing, we were able to verify that she wasn’t losing protein in her urine, and that her small intestine wasn’t absorbing nutrients properly (her cobalamin levels, or vitamin B12, was too low). Of course, we knew she had chronic diarrhea, so it was only a small step towards the diagnosis of a protein-losing enteropathy, or PLE. Plowing ahead, what was the underlying cause of THAT? We asked that Bella return for abdominal x-rays and ultrasound. While corroborating thickened bowel loops, we also found a mass on her spleen. We didn’t know if that mass might be cancerous or not, but we hadn’t found any other signs of cancer and dogs can get along without their spleens very nicely. If it wasn’t cancer but a hematoma on the spleen, there was a risk of it rupturing and Bella bleeding to death. After several talks, we scheduled Bella for surgery. She would undergo a splenectomy to remove the spleen and have her intestine biopsied to confirm the cause of her PLE.

This was a lot to ask of an old dog. Bella was in surgery for over an hour, requiring her to lay on her back, not a terrific position for a dog that had undergone major back surgery. Positioned in a foam support tray throughout, I still worried. Surgery was successful and her recovery from anesthesia rapid.

We kept her on intravenous pain meds, but there was no denying that Bella was slow to “bounce back”. Her owner cried that first day. Because of her IV fluids, Bella couldn’t move around easily. She struggled. We disconnected the fluids to take her outdoors to walk in the sunshine. Pain medication can cause a loss of appetite. I hand fed her. We slowly decreased the pain meds and upped her recreation. On Day four post-op, Bella met her owner in the parking lot. Moving slowly, she walked over to her, tail gently wagging. Bella went home. Her biopsy report diagnosed Inflammatory Bowel Disease (IBD) which responded well simply by feeding a specialty diet. The diarrhea disappeared. Her spleen was cancer free. Bella was on the road to a full recovery, as classy as ever.