Even more blood

The last story was one of internal hemorrhage.  This following one is a story of external hemorrhage.

A geriatric 40# mixed breed dog presented two weeks ago for severe blood loss.  The owner noted that there was a great deal of blood in the yard, and that the dog was covered in blood.  She was in a fenced yard, with no other dogs, and no history of trauma. Typically, calls about "severe blood loss" are minimal amounts of bloody diarrhea or the like that scare owners, and not actually a severe amount.  This was different.

When our patient, Mickey, arrived, her pelvic limbs were literally soaked red with blood.  Overall, her general appearance was poor, with matted fur all over her body, feces caked into her feet and toenails curling and overgrown nearly into her pads.  She had not seen a veterinarian for at least 8 years, they family reported, because she had been "so healthy."  Her teeth were nearly falling out of her head with a smell that could knock you over from two rooms away. The smell of blood, her breath, and feces was overwhelming, even for ER veterans like myself.

We jumped into action; her gums were still pink, but locating the source of the hemorrhage and stopping it was the first priority.  I gently rolled her onto her side, and started clipping away matted, blood soaked fur, until finally, I saw it -- a 4 inch, circular, necrotic mass in her groin that was gushing blood.  Not just gushing, but actually shooting blood up to 3 feet (hitting my technicians shoulder when she was at arms length).  This only occurs when an artery is the source of bleeding.  The arterial blood vessels are a high-pressure system powered by the strength of the heart's contractions.  Arterial bleeds are severe, and can result in death from blood loss quite quickly.  My staff applied direct pressure while I went to speak to the client and explain the situation.

Unfortunately, the mass was quite large and in a difficult area with many important structures; the chance of a cure with surgical removal alone was poor.  If left alone, the mass would begin to bleed when bumped even slightly; and due to the arterial nature of the bleeding, could quickly result in death.  Along with her other age-related illnesses and changes, her owners ultimately elected euthanasia.  Despite her outward appearance, they loved her very much and were grateful to have spent the last ~10 years with her as a part of their family.

(In order to help other pets, it is important to note that this tragedy could have been potentially avoided with annual or semi-annual complete physical exams by a veterinarian.  Physical exams are important in our veterinary patients as they obviously do not have the capability to tell their family member or neighbor, "hey, look at this mass growing here!  What do you think that is?" By performing an exam, a veterinarian would have had a chance to identify the mass when it was small and surgically removable, also allowing time for the family to discuss options, prepare for outcomes and make decisions in a less critical situation.)