Exploring

The world "explore" typically brings to mind images of fun and adventure, or -- at the very least -- something interesting and new. Unfortunately, the word has a slightly different connotation in veterinary medicine.

An "exploratory surgery" is when we go into surgery in an attempt to investigate what is going on with a particular case. Sometimes, we have a fairly good idea of what we will find. Other times, we have no idea. Sometimes we do find something interesting. Other times, we don't find a thing which means the surgery ruled out a lot of possibilities, but didn't actually answer any of the questions we were hoping it would. Sometimes you find something you can fix. Sometimes, you find something that you don't.

I had an exploratory this week that was depressingly predictable. A dog had presented 2 months ago for one bout of diarrhea. The dog was an outdoor dog, so the owners weren't certain if he had gotten into anything, and didn't know if he was vomiting. When they brought the dog in, we found that he had lost 20 pounds over the last 4 months, a pretty substantial amount of weight for a dog that had been 80 lbs.

Long story short, he had some abnormalities in his bloodwork that was corrected by a night on IV fluids, but there was something not right. The dog would not eat (wasn't even interested), and had no other abnormalities on physical exam. Abdominal radiographs were unremarkable, and the owners did not want to spend the money on an ultrasound. They took him home to see what they could do.

Over the next two months, the owners called several times with reports that they had gotten the dog to eat some random thing, but it had promptly vomited it back up. We all encouraged them to return for more diagnostics, an exploratory surgery or -- at the very least -- an abdominal ultrasound, to no avail. Then, one day this week, the dog showed up for an explore.

He had lost an additional 10 pounds since his last weight, and looked like a rack of bones. However, his attitude was surprisingly bright, and his abdomen was not painful. I knew this would not be a fun explore. My prediction was a foreign body or an intussusception (where the intestine folds in onto itself) at this point.

It didn't take long to confirm that diagnosis...both parts. The dog had both a foreign body (some carpet impacted with grass) and an intussusception. And, so severe was the tissue damage, that as I handled the grossly swollen, dark intestine, I knew this dog would not be waking up from surgery. Best-case scenario: dog survives surgery, losing 4 feet of intestine along the way. The owner was called, and the decision was made to euthanize.

Looking back, I expect the carpet was there for awhile and the intussusception was a later development. Either way, the dog was definitely having problems for awhile.

That kind of exploring is not fun.