Wednesday, June 8, 2011

B is for bleeding

"Roscoe",  a 14 year old Akita mix, presented with a sudden onset of panting.  Roscoe's very attentive, loving family reported that he had been compeltely normal in the previous days and weeks; today he was suddenly different.  Unwilling to rise, panting, and they just felt that he was uncomfortable.

As I started my physical exam, it was clear that they were right.  His mucous membrane color was pale pink, his heart sounded muffled, and his pulses were poor.  Something was causing low cardiac output, and difficulty breathing.  That something was also causing me great difficulty in hearing heart sounds.

Ultrasound confirmed pericardial effusion.  The heart is actually contained in a fibrous sac, which has a small amount of fluid for lubrication and during the normal motion of the cardiac cycle.  This space had become over-full with fluid, therefore exceeding the normal pressures of the heart, and causing it to collapse.

We quickly prepped his chest for removal of the fluid, which I would perform by inserting a needle with catheter into this space.  The procedure went very well, and immediately Roscoe felt relief.

Unfortunately, as I re-ultrasounded his heart, the reason for the effusion became very clear.  Roscoe had a very gnarly looking mass on his right atrium; most likely a hemangiosarcoma.  This is a tumor of blood vessels, and the space was likely to fill up again, quickly, with fluid. 

His family visited, considered their options, and ultimately, elected to euthanize Roscoe while he was in relative comfort.  A very sad, difficult decision for them, but they could at least take comfort in knowing his diagnosis.  Death of our pets is always an awful time, but some little part of me feels just a bit better when I know, beyond a doubt, that they have a terminal disease and that there was no chance for a cure.  At least we really are preventing the invetable suffering.  I really do believe that dogs and cats don't understand length of life, only quality of life. 


The next case to walk through the doors was an very sick labrador.  He was unable to walk, had collapsed that morning, and was brought in on a stretcher.  His clients, who were not wearing shoes, noted that he had been the picture of health only a day before.

His physical exam was a classic ER presentation; white gums, elevated heart rate, poor pulses, and a distended, fluid filled abdomen.  He was bleeding into his belly, probably from a bleeding mass.  Most likely, this mass was cancerous. Ultrasound and abdominocentesis confirmed my presumptions.  The only way to know, definitively, would be to stabilize and proceed with exploratory surgery.  Unfortunately, he was euthanized as the clients could not afford, and furthermore, did not want to put their dog through surgery with the above knowledge.   I made them a clay impression of each paw, and expressed my extreme sadness for their loss.

Cancer sucks.

No comments:

Post a Comment