From Dr. Lindmeier: Loki is one of my nicest patients — a friendly 2-year-old Siberian Husky that is always sweet and loving when he comes to my practice. But even sweet dogs can get into fights. Loki came to see me in September at the Chalfont Veterinary Clinic after his owner, Jesse Sinisi, said Loki had been fighting with another dog in the home.  

Loki did not have obvious puncture wounds, but I did find a small lump over the caudal area (toward the tail) of his rib cage which appeared painful. I treated him for a possible dog bite, prescribing antibiotics and a pain reliever.

It seemed pretty simple. Nothing made me suspect this case this was going to be one of the most puzzling of my 27-year veterinary career.

A week later, the swelling had gone down, but Jesse and I could tell Loki was still in pain. So I continued antibiotics.

By the end of the month, I again found a lump — but in a different place on Loki's chest. A bite wound should not move around the body. The plot was thickening.

X-rays of Loki's chest and abdomen showed two fractured ribs near the lump, but mostly the swelling was in soft tissue under the skin.

One possible explanation: during a dog bite, hair sometimes sinks into the wound and gets trapped there, decomposing and forming a lump.

But over the next several weeks, I continued examining Loki and saw that lumps seemed to form in different places. At one point I surgically opened a lump and removed about 20 hairs. More x-rays showed the ribs had healed normally. He never even had a fever, but was still in pain and wasn't getting better.

It had now been three months since the dog fight. We decided to try one more exploratory surgery.

Solution:

Five minutes into the exploratory operation, an unexpected answer popped right out of Loki's chest.

"Oh, my goodness, it's a stick," I said.

Actually, it was a wooden shish kebab skewer, poking three inches out of the incision I had just made.

My whole team started yelling: "Loki got shish kebabed!"

I repeated the X-ray but still didn't see the skewer, as wood does not show up well on X-rays. I suspected the skewer had been in Loki's stomach, but how did it move up toward his chest?

As I tried to remove the skewer, the whole story started fitting together, like pieces in a puzzle.  Loki had probably found a freshly cooked shish kebab and wolfed it down, meat, skewer and all. This might even have been what the dogs were fighting over in the first place. After swallowing the stick, it poked through Loki's stomach and against his inner chest wall — that's the sensitive lump I kept feeling from the outside. As Loki walked and moved around, the skewer moved.

Once I saw the skewer poking out of the incision, I carefully tugged on it. I twisted it.  I pulled harder. It wouldn't budge.

It was time to get some help. After all Loki had been through, I wanted to make sure this skewer was removed in the safest way possible.

After speaking with Jesse and Veterinary Specialty & Emergency Center we decided to transport Loki directly to the emergency room while he was still sedated. I put Loki in my car, brought a veterinary nurse to monitor him and drove to Levittown.

From Dr. Christ: Loki was admitted to our hospital as soon as he arrived. A CT scan was immediately ordered by Laura Tseng, our chief of emergency and critical care services, partly because it would do a much better job of imaging a wooden object.

The CT clearly showed the skewer in Loki's stomach, which was piercing the stomach wall and coming through the body wall to the outside. The thicker end of skewer was still inside the stomach, so it couldn't be pulled out.

I called Loki's owner and discussed the surgical procedure. After Loki was anesthetized, I made an incision in Loki's abdomen and then used a gastrotomy, a small incision in the stomach, to remove the skewer. After suturing his stomach incision, I carefully removed some infected tissue in Loki's chest, disinfected the wound and closed it.

Loki came through surgery wonderfully. I also have to salute Dr. Lindmeier's tireless work, which made all the difference.

From Dr. Lindmeier: I'm also thankful — and I know Loki is thankful — for Jesse Sinisi, who is the kind of pet owner veterinarians dream about working with. Jesse's persistence paid off and Loki is back to his happy, playful self. Loki was very lucky as the skewer passed through his stomach, under the skin of his body wall and through a rib but never entered his chest, which would have made this situation far more dangerous. As for the hair I removed, I think it probably came up from the stomach through the path made by the skewer, because dogs normally ingest some hair from grooming.

Eileen Lindmeier, VMD, owns Chalfont Veterinary Clinic in Bucks County; and Jeffrey Christ, DVM, practices at Veterinary Specialty & Emergency Center in Levittown.