Being a veterinarian is like being on a rollercoaster ride of highs and lows.
Take yesterday, for example. One intriguing case gave me a feeling of professional satisfaction and yet a sinking feeling in my stomach.
Why the contrast? Because I’d narrowed down the diagnosis, but I didn’t like the direction the ride was heading.
To Fix a Problem…
Of course, it doesn’t matter if I don’t like the diagnosis. The important thing is to make it.
Only by recognizing the problem can we do something about it. It’s a bit like realizing your car has a frayed brake cable: You don’t welcome the expense of getting it sorted, but preventing the issue from getting worse can potentially save lives.
One of the many things we are taught at vet school is not to jump to conclusions. When presented with a symptom, we examine the pet, draw further clues, create a problem list and decide what other evidence we need to uncover the answer.
That is why, when presented with a skin lump, the vet takes a history and checks the animal over. By asking questions about how long the lump has been present, whether it’s bothering the pet and how quickly is it growing, we begin to discover if it could be potentially worrying or not.
Indeed, a lump can lead you to think that it looks and feels like a lipoma (fatty lump), but when removed, the lab results say it’s a mast cell tumor…with a completely different prognosis. Which brings me back to yesterday and that intriguing case. Let’s look at how a simple urine test narrowed down the diagnosis.
Charlie, the Golden Retriever
Charlie has seen my colleague 3 days earlier. His human rushed Charlie in after he started dripping blood from the tip of his penis — so much blood that he’d left bright-red puddles on the kitchen floor.
From this history, the vet’s mind starts ticking: “What could cause the bleeding?”
An idea of the problem list:
- A clotting problem: Such as a lungworm, a result of eating rat poison or a hemolytic anemia.
- Prostate problems: Male dogs who are not neutered are prone to prostate enlargement, one symptom of which is spots of blood from the sheath.
- Trauma: Such as a cut to the sheath or penis.
- Blood in the urine: Could it be the dog’s human mistook bloody urine for actual blood?
My colleague examined Charlie. His gums were a healthy pink with no telltale bruising, which could indicate a blood loss or clotting problems. The dog was de-sexed, and had a small, non-painful prostate, which meant glandular disorders or prostatic cancer were unlikely. She checked the dog’s genitals over for cuts, injuries and foreign bodies…again, all fine.
Which left the most likely explanation that the dog wasn’t bleeding as such but rather had bloodstained urine. Charlie was bright and alert, so he went home with a course of antibiotics (against a presumed urinary infection) and instructions to collect a urine sample.
I saw Charlie for the follow-up appointment. But guess what? His urine sample was clear of blood. However, when I dabbed the tip of his sheath with white cotton wool, it came away bloodstained.
What I now knew was the blood wasn’t coming from the urinary tract or the prostate. This meant the source of bleeding had to be within the sheath. Donning a glove with lots of lubrication, I was allowed by the brilliantly patient Charlie to gently pass my little finger inside the sheath and feel around.
And this is where the heart-sinking moment comes in: Just at the tip of my finger, I felt a cherry-sized lump—the source of the bleeding. What Charlie now needs is a sample of that lump to be sent away to find out what type of cells are there and if it’s a cancer.
Let’s Not Jump to Conclusions
I’m worried that the lump could be a mast cell tumor, which, although rare in this location, would fit with the presentation. These tumors aren’t pleasant, and in such a hard-to-reach place, surgical removal is not straightforward.
However, I’ve been taught not to jump to conclusions, so let’s wait for the histology report to come back.
Reaching a diagnosis is only part of the picture — there’s a real live pet attached to the result. Next comes the step of breaking whatever that news is to the dog’s family, explaining the implications and what treatment options are available.
Let’s just say I’m keeping everything crossed for Charlie and that the rollercoaster stops in a good place after all.
This pet health content was written by a veterinarian, Dr. Pippa Elliott, BVMS, MRCVS. It was last reviewed Dec. 16, 2016.