There’s a saying that comes up a lot in vet school, and other areas of life I’m sure, “When you hear hoof steps, think horses not zebras.” In other words, common things happen commonly.
And then sometimes you get flattened by a herd of zebras. W.T.F. This is one of my zebra stories.
So, this geriatric yellow lab comes in – losing weight, not doing well, poor appetite, urging. The horse I’m thinking of? Cancer. This dog just looks like a tumour is hidden somewhere inside him, I just need to find it.
We start with blood work, and it’s fairly unremarkable. We do some radiographs… hello! What’s this? Some kind of shouldn’t-be-there object in the stomach? Bone? Rock? Other? The spleen looks pretty huge, and the liver seems a bit displaced… but nothing that would really be something to hang our hat on, except that foreign body.
Now, this dog hasn’t been right for a few weeks . . . so potentially this object has been bouncing around in there all this time, and maybe causing ulcers, and definitely causing discomfort. It fits. It’s a horse; Labradors are a breed known for eating things they shouldn’t. It is one problem to answer all the questions (that’s another thing we’re told a lot – try to find one problem that explains everything, rather than giving a patient multiple diseases at once.)
Owners opt to go to surgery to remove this item. Getting all ready to go, slice open his abdomen and HELLO MASSIVE SPLENIC MASS. Dear lord. The spleen wasn’t just ginormous, it had a huge giant spleenbaby growing on it. (On review of the radiographs afterwards, the mass was superimposed on the liver and you had to kind of squint to see it…).
So, we call the owners to get their okay for a splenectomy. Remove the spleen, and take a biopsy of the liver in case it’s a bad cancer and we want to know about metastases. Also, go into the stomach and remove that rock.
Histopathology comes back from the spleen… and it’s not cancer! It’s just necrosis (dying tissue), though we’re not really sure why. Still good to be gone, because that ‘mass’ was a large hemorrhage waiting to happen.
And here’s where the horse becomes a zebra: the liver biopsy? From the liver that looked normal, if a bit pale? Pretty much completely done. Pathologist was amazed we didn’t have abnormal values on our blood work, this liver is a moment away from being completely cirrhotic.
Nothing about this dog said he was in liver failure – no jaundice, no gross abnormalities on the liver, no abnormal values on the blood work. . . We never would have figured it out without a liver biopsy. We never would have taken a liver biopsy if the spleen didn’t have a mass on it. We wouldn’t have done the exploratory if we hadn’t seen the rock on the radiograph. Sometimes there’s a zebra hidden in amongst the horses.