Strange Case Tales

Thought I'd take a moment to share one of my recent strange cases. Unfortunately, I don't have cool pictures to post but this was a doozy.

A client told me the other day that she didn't believe in all the fancy diagnostic tests that we often recommend because we should be able to see and feel a patient and thereby formulate a diagnosis. She further indicated that she thought things like bloodwork, x-rays, etc. were simply a means to generate more revenue. The case I'm about to relate is an excellent illustration of the inadequacy of that viewpoint...

I had a large breed dog present to me partially for a second opinion and partially because our clinic is less expensive than the first clinic that was visited. The previous veterinarian had run a CBC and chemistry panel and things had stopped there. It was a combination of money (as previously stated) and communication issues. Either the first vet did not explain well or the clients just chose not to hear the bitter truth.

On examining the dog, I saw pale pink, tacky mucous membranes and a distended, fluid-filled abdomen. Nothing else was extremely remarkable but when combined with the previously run bloodwork showing a hematocrit of 8.6% and panleukopenia, cancer was definitely screaming out as the most likely diagnosis. I added the exam and the anemia and figured that the dog was bleeding into its abdomen and probably had been for a while.

The owners and I had a long, very serious discussion about the limited options and poor prognosis facing their dog. They opted to give surgery a chance even though there was a good chance the dog would not survive. Further diagnostics were declined so that the little money available could be put into treatment.

I stabilized the dog as much as possible then began an exploratory fully expecting explosive bloody fluid from the abdomen as soon as I entered the cavity. This failed to materialize surprising me immensely. Instead, I found the urinary bladder distended all the way forward to the liver. I actually double checked the site of my initial incision thinking I had to be insane but, no, the bladder truly was that large and did not want to express. Additionally, a urinary catheter would not pass. Hmmmmm.....

The following summarizes my findings: Left kidney approximately 5 times normal size with irregular margins, blood clots within bladder lumen and presumptively within urethra creating obstruction (one was larger than my fist), retained right testicle within the abdominal cavity also having irregular margins, colon distended with fluid fecal material and bruised where in contact with the urinary bladder, multiple enlarged mesenteric lymph nodes.

The dog did not survive surgery....