UT-VMC emergency room tails: Marley’s Decision

utvmc web headerBy Dr. Amanda Rainey

Sometimes it’s hard to know what the right thing to do is. This is true in life and in medicine, both human and veterinary. Marley was one such case that we experienced recently at the UT-VMC ER Service. Marley had been referred from her primary veterinarian for further workup, after she had been seen for not wanting to eat and seeming tired. A suspected abdominal mass had been identified on x-rays taken by her regular vet, so we were all concerned about an insidious process such as cancer rearing its ugly head.

Marley was a sweet, older mixed breed dog that came slowly shuffling back to our triage room. You could tell she didn’t feel well, but that didn’t stop her tail from wagging or her attempts to lick your face. Her physical was fairly normal, except her gums seemed a bit pale. We signed her up for blood work and some additional x-rays, as well as an abdominal ultrasound. Her blood work showed that she had some increased liver values, and that she was anemic, which fit with her pale gums. Her imaging demonstrated possible nodules in her chest, as well as definite liver and splenic masses. We attempted to take samples of the masses by performing a needle biopsy during her ultrasound, but unfortunately the samples were inconclusive. Through it all Marley was the perfect patient.

Marley’s owner was very unsure of what to do next. We were still quite concerned about cancer in Marley, and in order to diagnose this she would most likely need more testing, which would include a possible CT scan and maybe even surgery. Marley was like his shadow, always going wherever he went on their rural property, so the owner decided to take her home and think about how best to proceed. Her vital signs were stable so we agreed to discharge Marley for the time being.

She was back the next morning, feeling a bit worse than before. Her physical parameters were still normal however, although she was much weaker. Once again the owner decided to take her home rather than admitting her for more care. He was still on the fence about additional tests, which was understandable given her age and the significant costs involved. The following day Marley returned in much more serious condition. Her abdomen was filling with fluid and her blood work had worsened dramatically. She could barely lift her head. She was placed in ICU on supportive care including intravenous fluids, pain medication, and monitoring of her heart rate.  Despite all we were doing, Marley’s vitals continued to deteriorate.

The owner then faced a decision many of us have experienced before. Did he proceed with care and testing even while Marley seemed to grow sicker by the minute, or did he let her go? Knowing Marley wasn’t the dog she had been for some time and not wanting to prolong her discomfort, the owner decided to help her leave this world with dignity. He was thankful to be with her as she slipped away on her final journey, and we were honored to have cared for such a good and true companion.

 (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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