Saturday, March 10, 2012

Balancing act, continued

Whereas the previous story was a very gray zone, the following story is a little more black and white.

A 12 year old, male neutered lab presented to a colleague of mine for a second opinion.  Gus, a family pet, had experienced a sudden onset collapse, pale gums, and a distended abdomen.  I'd venture that the vast majority of veterinarians would start by looking for the most obvious condition; a hemoabdomen.  And they'd be right.  Hemoabdomen is when a large amount of blood pools in the belly; typically from a ruptured tumor (spleen is the most common culprit; it can also be a tumor on the liver).  (Hemoabdomen can also be caused by trauma, such as being hit by a car, but typically this sort of history is known, as well as there are other signs of injury on the pet which lead towards a trauma diagnosis).  This is a condition that must be treated quickly, or the pet will die from blood loss.  Unfortuantely, often the underlying cause is cancer, so many of these patients are euthanized as the prognosis is not very good. Regardless, some clients choose to proceed with therapy, which includes surgery (to remove the bleeding tumor), blood transfusion, supportive care, followed by chemotherapy once the specific type of tumor is known.

Gus presented for a second opinion because the first veterinarian who saw the case told the clients gave them no options; offered no diagnostics, and no therapy plan.  The vet gave them a bottle of prednisone (a steroid anti-inflammatory medication), sent them home, and told them that "he won't make it long enough to finish the bottle."

Again, I don't want to speak ill of others, but this is just plain wrong. There's nothing wrong with not knowing, but if you don't know, REFER. 

This didn't feel right to the clients. They left this office; presented to my friend and got the real diagnosis, treatment plan, and proceeded with care.

The bottom line; there's good and bad in every profession, including medicine.

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