UT-VMC emergency room tails: lucky Lucy

UTVMC COLUMN HEADER  2By Dr. Amanda Rainey

It was a busy Sunday afternoon at the UT-VMC ER when the overhead page from the front desk alerted us that another patient had arrived to be seen. The fourth year student on duty ventured up front yet again and soon returned with a tiny black and tan dachshund cradled in her arms. The petite dog appeared quiet and alert, peering at me with curious chocolate eyes.

“This is Lucy. She has been losing weight over the last few months and recently had diarrhea. Lucy is here because she didn’t want to eat this morning, which is very strange for her.” My student quickly relayed the history to me as we set about examining our calm little patient.

Her gums appeared pale and she had mild heart murmur. I wasn’t overly concerned until I palpated her abdomen. In the mid-abdominal region where I should feel only soft loops of bowel, my hand found a firm, baseball-sized structure. I immediately knew this was most likely the cause of Lucy’s clinical signs. I also knew something that it was most likely cancer. A quick bedside test of her red blood cell count determined that she was indeed anemic, which made sense with her pale gums. I suspected that tumor was bleeding into her intestinal tract, causing the diarrhea and weight loss.

Lucy was a very loved pet as I was soon to find out. When I entered the exam room to speak with her owner, not only was she there but her sister and mother had also made the trip in to find out what was wrong. I introduced myself and then gently told them about what I had discovered on my physical exam. They were shocked and quite upset, but maintained their composure and immediately asked what needed to be done.

I discussed that we needed to perform a full diagnostic workup in order to get a better idea of her overall condition. The bottom line remained that the growth was abnormal and would need to be surgically excised if this was even possible. But first we had to determine how sick she really was.

We performed blood work, radiographs and an abdominal ultrasound, which helped us to figure out the exact location of the growth. It was definitely in her small intestinal tract and a fine needle aspirate confirmed that the tumor was cancerous. Lucy received a blood transfusion that evening due to her anemia and after consultation with the surgery specialists she was slated for an abdominal exploratory procedure the next day. Through it all, Lucy’s owner and family were holding fast to the hope that the growth could be successfully removed.

Fortunately, Lucy was a tough little girl and sailed through what was a serious and potentially life-threatening surgery. The mass was removable and she spent the next few days recovering in ICU. The pathology report that came in confirmed that the growth was completely excised. Once sure that her repaired intestines were healing appropriately, she was discharged.

This case is particularly memorable to me because I was able to follow her care and see her through all stages of the process. I watched as Lucy trotted out the door to continue her recovery at home. Her happily wagging tail waving me a cheerful goodbye as well as what felt like a thank you.

(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.)

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