Coincidence

I work in an emergency practice and things come in fits and starts. If I see a blocked cat on the first day of my week, I know I’ll see at least two more by the end. Then I might not see any more for a couple of months. It’s weird like that when you consider the catchment area of the practice. That said, most nights have the same “rhythm” and when nights follow the rhythm it’s good for predicting when we’ll be able to do surgery.

One week I saw four gastric dilations, with volvulus, in one day – and the weird thing was they descended in size and probability through the day: the first was in a great Dane, the next in a setter, then a cavalier (I kid you not; x-rays proved it) and then – I couldn’t believe it – in the evening, a dachshund was all swollen, hard and retching… but no x-ray forthcoming for that one, euthanasia elected.

That day, and the cases, should really have been written up as a short communication, because I find it all hard to believe as well.

Not too long after that I had a week where I saw four GDVs in more “typical” breeds throughout the course of one week. All of them went to surgery and, by the fourth on the Friday morning, we had a good routine going – the dog came in at 0600h, and we were operating at something like 0700h. The day vets are due in at 0830h.

Having already done three earlier in the week, everything just went brilliantly – the stomach derotated with little effort, and the incisional gastropexy was apposed without much problem. Indeed, we timed it as 20 minutes from cutting to being ready for closing.

So… with the time approaching 0730h, what I should have done was close the dog up and count my lucky stars I’d be going home on time despite what “fate” had thrown my way at the last minute.

But no…

Just the previous week I’d been talking on an e-mail discussion group about whether we should do “exploratories” on all animals we open up, whether it be for neutering or other purposes (I was playing Devil’s advocate and pushing it to see where the discussion went). So in this case, because it had all been so quick, I decided I’d have a quick look around.

Liver, kidneys and spleen were all OK, but the intestines had a two-inch-long thickening about the level of the jejuno-ileal junction, which extended into the mesentery – so the nurse phoned the owners while I got ready to take a biopsy.

The report form the biopsy was lymphoma. I communicated this to the dog’s regular practice and, I have to admit, forgot about the case until a few months later when I received a lovely card from the owners thanking me for doing that exploratory. They had decided not to pursue chemotherapy, instead opting to “spoil our little boy as much as possible for as long as possible” – which still brings a lump to my throat!

I am just writing up a remarkable case; I don’t do exploratories as standard and am not suggesting anyone starts. It was just a conjunction of coincidences and good luck that the surgery took an incredibly short time due to having a cluster of them and I had been discussing the very topic a few days before this and had the time to “have a quick look around”.