Re: Thickened bladder wall + pupd in 12 yr old Springer

Hannah Wynne Richards — Fri, 10 Feb 2012 11:42:15 GMT

I'd go more with james herriot lied than roboxley other than that you come over as a good veterinary surgeon trying your best, and the owners-to put it bluntly-bad owners

Wynne

Re: Thickened bladder wall + pupd in 12 yr old Springer

Rob Loxley — Thu, 09 Feb 2012 23:55:50 GMT

[quote user="shanners"]I am uncertain how to proceed, as the owner doesn't want to pursue either the bladder or the pupd, in light of the mammary masses.[/quote]

If they don't want to pursue the bladder, the mammary tumors, the pupd or the blood results then I'd stick with making sure the dog is comfortable, trying not to come across too bluntly with them. I'd guess ultimately the mammary tumor will cause the demise of the dog well before Cushing's (if found) might?

Re: Thickened bladder wall + pupd in 12 yr old Springer

james herriot lied — Thu, 09 Feb 2012 22:51:27 GMT

[quote user="shanners"]

I am not great at prioritizing....

[/quote]

Beat yourself a little less: as the old adage goes, more things are missed by not looking than by not knowing. You've amassed a good amount of info here, and whilst making sense of it all may be difficult, your limiting factor is what the owners are allowing you to do, not what you know about the patient. You need to be fairly strong with the client and explain that there's little or nothing you can do with the waterworks without being allowed to go further.

Bladder masses can be confusing if you go off ultrasound appearance alone. The first question would be, was the bladder in a similar state of filling on the first two scans? Wall tumours often flex and flatten along with the bladder itself over a period of time, and focal thickening plus or minus diffuse thickening sounds awfully suspect, particularly the longer the issue goes on and a 'mass' is repeatably demonstrated.

Ex lap. By all means bargain with the owners if necessary, although that will allow their reluctance to look after their dog properly to rather win the day. Essentially, you have clients who didn't spay their dog, won't deal with the fall-out of that and have no wish to look into its other problems. The dog is a bit of a hostage, with which they're attempting to make you come up with a solution on their own terms (essentially, for free and without any effort on their part). Why either they - or you- should think that this is reasonable is beyond common sense.

Force their hand a little. Either of three things will happen: euthanasia (not great, but no suffering); proper investigation (better) or second opinion (less stress for you, and is surprisingly often the thing which will shame them into action).