What is wrong with people?

This case was particularly heartbreaking and tragic. It took me 3 hours to figure out what was going on with the patient, and by then, it was too late. It was likely too late from the moment the dog walked (or rather, was carried) through our doors.

She was presented to me, a 27 pound, morbidly obese small breed dog named "Small Fry". Her history was odd. Her owner had let her outside before leaving for lunch. It was 80 degrees today, and she was a brachycephalic breed (like Pugs, Boston terriers, Shih-Tzus, and bulldogs) with a weight problem. That was a recipe for a heat stroke. At any rate, the owner - a small, frail, elderly woman - was gone for an hour. When she came home, the dog was in the house, let inside by the workers that were fixing the siding on the house. The owner was concerned that "Small Fry" had either suffered a heat stroke or that someone had deliberately hurt her.

She found Small Fry on the floor, extremely lethargic with bloody diarrhea. The owner decided to wait to see if her condition improved. Over the next 4 hours, it deteriorated. So, the owner brought her to us.

Small Fry was extremely lethargic, cold (temperature was 94 degrees!), her blood pressure was too low to read, and her gums were grayish white - all signs of a dog in profound shock. My initial thoughts were a heat stroke, anaphylaxis of some sort, a toxin in the yard, or a pyometra (she was not spayed). My bloodwork did not support any of those suspicions very specifically, so I was left treating aggressively with IV fluids and monitoring.

Over the next 2 hours, her condition would improve with aggressive fluids given IV. As soon as we backed off however, her blood pressure dropped, her heart rate sky-rocketed, and her gum color became grayish again. She also developed a heart murmur. I began to suspect heavily that she was bleeding somewhere internally. But where? And WHY?

At that point, we rolled her onto her back for an abdominal ultrasound and that is when the clue hit us smack in the face. Along her belly were 2 horrific, very large hemorrhagic bruises. There were also scrapes and scratches. It looked like something might have hit her in the abdomen - extremely hard. Xrays confirmed free blood in her abdomen, concentrated on the right side of the body (where the worst bruising was located).

A growing suspicion nagged at me, but I didn't have time to gnaw much at it. Small Fry started to demonstrate signs of impending cardiac arrest. We called the owner, who rushed to be by her side. Moments later, she died. The owner did not want resuscitation, but she did want a post-mortem exam.

We opened her up to find horrific hemorrhage and bruising under the skin, an abdomen full of blood, and a kidney that had been bluntly traumatized. The kidney itself was normal, but it had hemorrhaged severely. There was no tumor, no nothing to explain why the sudden bleeding. Coupled with the presence of the external bruising, it seems all too obvious that a blunt force trauma was applied to the abdomen. It looked - for all the world - like she had taken a kick to the abdomen. A very, very hard kick.

We documented everything with pictures, should the owners decide to proceed with legal action. I am not a pathologist, but I am fairly certain given the external bruising, the bruising in the subcutaneous fat, and the hemoabdomen that this was blunt force trauma. The only likely explanation is that someone kicked this poor little dog. Such a sad case with such a sad outcome.