Here's where it gets sticky:
My patient was very, very sick. He had a huge, huge tumor in his belly that was cavitated and horrible looking. He also had severe azotemia (elevated kidney enzymes) and significant anemia. One of his clotting times was very slightly elevated.
I was left with these questions:
1) Was the tumor causing the clinical signs, anemia, and azotemia? Was the tumor a red herring?
2) Which came first: the tumor or the kidney disease?
3) What should I do? Stabilize the patient with the hopes that the tumor could be taken out later? Or take the tumor out now?
What would you have done?
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I was thinking maybe another four years of vet school would better prepare me to answer a question like this... I'd go with my gut instinct, which is hard to do as I never saw the patient. Since I'm cautious and conservative, I'd most likely opt to wait until I felt the patient had improved somewhat-- but I'm not sure I'd wait until the patient was truly stable as it doesn't sound like that is necessarily going to happen ever. I'd at the very least want the patient rehydrated, and hope to see the kidney values start to come down with the fluids, and check to see if there was canine blood on hand before cutting.
When's the next installment? This is the suspenseful part!
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