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Thursday, September 3, 2009

A Bit Twisted

I think that most medical professionals have a slightly twisted sense of humor and idea of what is cool and exciting. Veterinarians are no exception.

I am currently mentoring a new graduate veterinarian, and today she had an interesting case. A five year-old cat came in with a large mass in her abdomen and was acting lethargic. After blood tests and x-rays we determined that she was overall in good condition, though thin and dehydrated, with an unknown mass involving the spleen, kidney, or something else in the belly. The owner agreed to do exploratory surgery and try to remove the mass.

We got in and quickly discovered that the very large mass was actually the right kidney. All of the other abdominal organs appeared fine and the left kidney looked good. But the right one was about 3-4 times the size it should be and was slightly irregular. Having more experience, I was the primary surgeon but she was also scrubbed in and assisting. Both of us had wide eyes and were excitedly trying to determine what it might be attached to and how we could get it out. There was definitely a sense of excitement as well as some slight anxiety. In the end everything else looked good, we were able to tie off all vessels without causing any other problems, and the affected kidney was removed.

When we closed her up and had a chance to examine the kidney better post-operatively we noted that it had a relatively normal general anatomy and structure, but was diffusely enlarged with a loss of the distinction between the different parts of the kidney tissue. For my vet readers, the renal pelvis was normal, there were no cysts or abscesses, and there was no obvious difference between the renal medulla and cortex (the rest of you get that?). The tissue was white and slightly irregular. We're pretty certain that it's cancerous and have submitted tissue samples to our diagnostic lab for analysis.

Now the twisted part of this was how excited we were. "Woah, that's a huge kidney!" "Oh, my gosh, I can't believe how big it is!" "Wow, that was a really cool surgery." "Man, I wish we could do more things like that." "I can't wait to see what the biopsy shows!" Here we were, having finished an hour-long complicated surgery, with a critical (though stable) patient who was going to have a long recovery and likely had cancer, and we were acting like kids in a candy store! I was practically giddy at the same time that I was worrying about the kitty. My entire staff was taking turns looking through the surgery window, and then while we were sectioning the kidney after surgery there were at least three cell phones being used to take pictures!

Please understand that we still have compassion and understanding, but this is a common attitude among vets and others in the medical field. We go into these professions because we have a great interest in anatomy, physiology, and disease processes. Most of what we see is pretty routine, and we could do many of these cases in our sleep. For example, I will see at least 3-5 ear infections almost every day, especially during the warm, humid months. We we see something different, it's very interesting to us. It makes us remember why we wanted to do this job in the first place. Sure, we might be a little twisted, but it's a GOOD kind of strange.

Oh, and the kitty recovered well and went home tonight for observation at home. She will come back tomorrow morning for fluids and further monitoring. Her prognosis is guarded to fair pending her biopsy results. We're hopeful, though.


  1. Cool. I had a neoplastic kidney I tried to remove awhile back, but it was so invasive and the prognosis got so much worse as we looked around we ended up euthanizing on the table. Also my staff loves when I do quick necropies from interesting cases. And nothing looks cooler than a mast cell tumor cytology and...well you get it!

  2. If the kidney was malignant, is there anything that can be done for the cat?

  3. The biopsy came back as lymphosarcoma, a rather aggressive form of cancer. We consulted with a local oncologist, and he said that with proper chemotherapy, there is a 70-75% chance of remission and a good outcome. I believe that the client is going to do the referral.


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