If you have read this blog for a while, you know that our job is interesting for many reasons.  One is that we have cool patients – let’s face it – I get to play with dogs and cats at work.  But another reason is that we are all scientists, and the challenge of the medicine gets us going too.

But a fact is that some our most interesting cases can also be some of our most challenging and also some of our saddest cases. It’s an odd feeling to feel exhilarated by making a diagnosis of something uncommon, when the outcome is not good.

A case I had this weekend is an example of just that.

A five year old Lab came in collapsed.  He was fine with the owners left early that morning, and he had been outside in a fenced yard during the day.  When they came home, they found him unable to stand, and this normally happy guy could only give a weak wag of his tail.  They lifted the big boy into the car and brought him in.

When he got to us, he was laying on his side, unable to get up.  His limbs were cold, he was in shock.  He was very painful when I felt his belly.  Even though he was so tense, I thought I could feel a large mass in his abdomen.  “Uh oh,” I thought.  This didn’t look good.

Then I noticed a couple more things on my exam.  His nipples were inordinately large for a male dog.  And he only had one very small testicle in his scrotum.  This means he was a cryptorchid, or that only one testicle had properly descended into his scrotum during his development.  The other testicle was retained in the abdomen.  

So I started putting the pieces together:  

• I suspected the mass I felt in his abdomen was the retained testicle.  A retained testicle is about 13 times more likely to develop cancer than the descended testicle.  The most common type of cancer in a retained testicle is something called a Sertoli Cell Tumor, which secretes too much estrogen.  This caused his nipples to enlarge, and caused the descended testicle to decrease in size.
• I suspected this handsome boy’s collapsed was caused by the large, cancerous testicle twisting (a testicular torsion).  I have seen this once previously, and the symptoms were very similar, especially the shock and extreme abdominal pain.
• The estrogen secreted by the tumor can also cause severe problems with the bone marrow, meaning the marrow does not produce enough blood cells.  Anemia, a low white cell count and a low platelet count can ensue.  Sometimes this is reversible with treatment (and removal of the tumor) and sometimes it cannot be reversed.  At this time I did not know if blood count problems were part of this boy’s illness (I did not have bloodwork on him at this point).

This dog needed aggressive stabilization, a bunch of diagnostics, then surgery to explore his abdomen to see if my guess at his problem was correct.  Unfortunately, his owner just could not afford any of this, and the prognosis was up in the air until we understood the tumor’s effect on the bone marrow (if removing the tumor did not reverse the effects of the estrogen on the blood counts, he would not survive).  The owner decided not to let the boy suffer, and I euthanized him.  It’s hard for me to euthanize any 5 year old dog, but not as hard as the decision that owner had to make that day.

The owner did let me do an autopsy (in animals we call it a necropsy).  The necropsy confirmed my suspicions – a torsed, cancerous testicle was the cause of the big Lab’s problems.

This is a very uncommon problem, so for me it was very interesting – ‘a cool case’.  Why do the cool cases have to be so sad?

PS.  This is why it’s important to have a cryptorchid dog neutered.  Had this Lab been neutered (which would have involved opening his abdomen to get the retained testicle), this problem could have been prevented.  It’s not a common problem, but it can be devastating when it happens.

• Induce vomiting. With this option, there is a small risk of perforating the esophagus if the stick presents itself at the wrong angle. With this option, the staff and owners would need to be prepared to quickly make a decision and act on it if the stick perforates the esophagus.
• Endoscopy. With this option the internist would attempt to scope out the stick with Codi anesthetized. This could be difficult because there is food in the stomach; the stick could be tough to find. We also gave the option of waiting until the next day in hopes that the food would have passed through and the stick would have remained in the stomach.
• Surgery tonight or tomorrow to remove the stick
• Wait to see if Codi can pass the stick. With this option, there would be significant risk of GI perforation, which would cause Codi to become extremely ill.

The owners elected to induce vomiting. We fed Codi a can of dog food that was well smashed and crumbled. The extra food in her stomach would help cushion the stick and decrease the chances of it perforating the esophagus. Then we walked her around and around the treatment room to help mix it all up in her stomach.  Codi then received an injection in her vein of a drug called Apomorphine. This is for the induction of vomiting. Within minutes she was drooling and giving us that sad look that says, "Oh my, what have you done to me?!" Shortly there after, an eruption of cheers was heard throughout the hospital as the treasure was hurled onto the floor.... the corn dog stick, complete with the WHOLE corndog (see the picture below)! (Okay, we are medical people who are fascinated by gross things, but, surely, anyone would think this was very cool... Right?!) We promptly scooped up the corn dog and ran it out to Codi's family to show them the exciting results. They were equally happy. Pictures of Codi's forbidden snack were then taken by Dr. Susan and by Codi's family with their camera phone. Never has there been so much celebration over a soggy corn dog.

In the end, Codi and her family went home happy and relieved. The decision to induce vomiting was the correct one. Dr. Susan and her team have a great case story to share. Codi's family was able to quickly solve their dilemma, and they have a unique addition to their collection of camera phone photos. And Codi the Dog triumped over Corn Dog.

Note from Susan:  Do NOT try making your dog vomit something like this at home.  There are serious risks if the stick embeds in or punctures the esophagus.  Codi's family and I had a long converation about risk/benefit.  It all worked out for the best in this case, but every case must be individually evaluated by your veterinarian.