Another Case of Unexpected Bad News

I'm hoping you don't get tired of these stories and cases from the "front lines." Sometimes, being IN this world all time, I lose perspective on what those outside don't know about or would be interested in - which is why I always say (and mean) - I am open to suggestions, comment, questions, and criticisms!


I find no better or more "real" topic than what I see in day to day practice. There is always a chance to educate in these stories (even if to ME, they can be repetitive, old hat, etc.)


Today I had a 12 yr old chocolate Lab arrive that was in lateral recumbency (flat out on his side) and not moving. He was minimally responsive. Yesterday he was fine! He ate dinner and overnight, vomited a large amount of food/fluid. The major sign that alerted this owner early on that something was wrong was his refusal to eat this morning (most Lab owners know a Lab NEVER turns down food!) and his increasing lethargy as the day wore on.


When he got to us, he had to be carried in on a stretcher. His gums were a pale pink but not too bad (I was expecting white gums) and his abdomen was definitely distended with either a mass or a bloated/twisted stomach. We ran a full blood panel and did two radiographs (chest and abdomen). 


Why both? 


An older patient like this can have more than one problem or a problem with more involvement (ie, a mass in the abdomen and spread to the chest) which will influence OUR recommendations to the client, costs and the client's decision. 


This dog's chest radiograph was fine but he had a very large splenic mass in his abdomen which was slowly bleeding but had gotten to the point that NOW the owner noticed. We know this mass was in there yesterday - even probably a few weeks or months ago. The dog just dealt with it until it reached a critical size, putting pressure on the stomach AND until the red blood cell count got to the point that this dog was very weak. 


There were only 2 options here - surgery or euthanasia. Surgery is not inexpensive AND there are important considerations even if we went ahead with the splenectomy:
1. It may be malignant (we wouldn't know for sure until we got the pathology report the following week) - in which case, most of these dogs don't live past 2 months post op 
2. When we get in there we could find it involves other organs (liver, etc)


Based on the patient's age, the above considerations and the expense, the owner very understandably chose euthanasia. 


The hard thing about cases like this is that the owners are not really "prepared" for this. The animal did not have a previously diagnosed terminal illness or some chronic disease to which we knew he'd eventually succumb. There wasn't time to say "goodbye."