By Dr. Amanda Rainey
Lethargy is a symptom for an enormously wide variety of diseases and conditions. So when we received the call that a dog with a several week history of lethargy would be arriving soon at the UTVMC that Sunday afternoon, none of us were very alarmed. The students wondered why an owner would bring their dog in to an emergency service for something that seemed so benign, but I gently reminded them that sometimes people are so busy during the week that our hours are the only time they find available to do so, and that possibly the owners had just become very worried about their pet’s state.
Blue was waiting up front a few minutes later, and one of our students went up to triage him. She quickly returned with the dog, and I saw the worry on her face as she walked him into our ER area.
“His gums looked pale to me, so I brought him straight back. And his heart rate is pretty fast.” She told me as she went about finishing her physical exam on the large, black mixed breed dog. I jumped in behind her, doing my own check of Blue’s vitals and assessing his stability. His fluffy hair coat hid the appearance of a fluid filled abdomen, which I soon discovered as I continued my examination. He definitely had a rapid heartbeat, and a quick assessment of his red cell count revealed a significant anemia. Blue’s blood pressure was also low, and all these things paired together left me with one major differential. Dogs can develop a tumor on their spleen that fills with blood, and often they show very non-specific signs, as the tumor grows larger. If the tumor ruptures, they suddenly become obviously ill, often presenting very weak and lethargic due to the acute loss of blood.
I discussed my concerns with the student and demonstrated how to appropriately sample the fluid, first shaving and scrubbing the area of the abdomen where we would obtain our answer. I carefully plunged the needle of the syringe in and pulled back the plunger, revealing hemorrhage. Blue seemed to know he was in trouble, as he let out a sigh and looked up at me with tired brown eyes. While I went up to talk with his owners, my technician placed an intravenous catheter in his forelimb and provided him with warm fluids, in order to temporarily increase his vascular volume and bring up his blood pressure. I explained to them that more than half of these cases are cancerous, but surgery could remove the offending growth and possibly allow Blue to have a good quality of life for a few months after the procedure. It is certainly not without risks however, and some animals require very intensive care during and following the operation, including blood transfusions and days in ICU. Prior to any surgery we would perform radiographs to search for spread of the disease, because often this type of cancer quickly travels to the lungs.
Blue’s owners wanted to give him the best chance possible, so we went forward with our imaging and had our surgery team on standby pending the results. Unfortunately, Blue’s chest radiographs showed extensive metastasis to his lungs, and surgery was not an option for him. The owners faced suddenly saying goodbye to their family pet with an admirable grace and thankfulness for the love he gave them over his 10 years. It was a tough blow for our team, but we were glad we could be there to help Blue and his family that day.
(Dr. Amanda Rainey, DVM, is a clinical assistant professor in the small animal clinical sciences department at the University of Tennessee Veterinary Medical Center in Knoxville.).