Negrito: Why Specialists Are So Fabulous (Part I)
I adore my neighborhood specialists. Not only do they make my life more pleasant and educational with their open-door policy, they also make me look like a rock star when a client receives a special procedure or amazing, state-of-the-art care. I love that.
The heartfelt thanks my clients shower me with when I send them away to a specialist seems a little odd considering I did none of the hard work. I guess I can take some of the credit given that deciding when to refer a client elsewhere can get a little tricky.
Some clients are dismayed when I explain they will receive better treatment elsewhere. Does this vet not know what she’s doing? Is she just trying to get rid of me? Yes to both, with reservations. When a case becomes too complicated for my hospital’s staff, equipment, facilities and me, I’m obligated to send them to a specialist.
Because there are no hard and fast rules on what constitutes generalist vs. specialist level of care, I usually call the specialists to see what they might do in my place. If it involves heavy-duty, high-tech work and 24-hour care I usually refer the patient.
I`ve written about specialists and their role in veterinary medicine on a couple previous occasions. By popular demand, here’s another great story about how much they do for us generalists, as we regular vets call ourselves.
Negrito (Blackie, in Spanish) is a ten-year-old German Shepherd mix who came in two weeks ago with a limp. His right front leg was ouchy everywhere but when I touched one little spot on the ulna (analogous to the smaller of the two bones in our human forearm), Negrito howled in pain.
The X-ray I took did not make me happy. The bone in that painful section looked like it was being eaten away by something nasty. The angry lesion looked like a bone cancer to me. An odd spot for it but there it was.
After taking full-body X-rays and confirming that his bloodwork was normal, I felt more confident that this was an isolated bone tumor. A terrible diagnosis, no matter how you slice it. So I carted off my folder of findings across the street to my favorite slicer, Dr. Marc Wosar at Miami Veterinary Specialists.
Dr. Wosar is one of those rare veterinary surgeons who manages to have a soothing bedside manner to match his amazing surgical skills. With less than four years out his residency program at North Carolina State and a frequent lecturer on cancers, orthopedics and surgical pain, this guy really knows what he’s doing. (He’s not hard on the eyes, either.)
Dr. Wosar agreed that the bone lesion looked cancerous. So when he saw Negrito (that afternoon!) he anesthetized him to biopsy the affected bone. Three days later the results from the pathologist confirmed the presence of an osteosarcoma (an aggressive bone cancer).
Most cases like Negrito`s are dealt with by amputating the affected limb. But Negrito`s other limbs were arthritic and painful, as any ten-year-old`s might be. He had been taking glucosamine and chondroitin sulfate along with his daily NSAID (Rimadyl). So amputation seemed an excessively stressful procedure and, in this particular case, unnecessary.
Dr. Wosar suggested a procedure called a limb spare. To accomplish this he planned to cut out the tumorous bone, leaving the remainder of the limb unaltered. Rarely undertaken, this surgery would allow Negrito the use of all four limbs with minimal trauma and maximum pain control.
Once the tumor was gone, Negrito seemed as comfortable as ever he had been. He was back to his old self, jumping on beds and doing all the things a post-surgical case shouldn’t be doing. His owners were so elated they sent me a basket of goodies. I sure hope Dr. Wosar got one as well.
Negrito still has a ways to go. A biopsy of the removed segment of bone reported clean margins—not a bit of the cancerous tissue remained on the rest of the bone. But because the ulna is so close to its forelimb partner, the radius, the possibility still exists that cancerous bone might have started to invade it.
Just in case, Negrito will receive a few doses of a chemotherapy drug, adriamycin. This should help stave off cancerous development should any cancer cells still remain within the limb.
The upshot? Negrito will live a normal life, as long as the cancer has been fully removed. So far it looks good, but time will have to tell. In the meantime, he can walk, jump and run like he always did. Amputation in his case would have been a serious hit to his quality of life. It took a high-tech procedure the rest of us would never attempt (or even consider) to make his comfort possible. And that’s how it was that (without lifting a finger) I got to look like a rock star. I love that. Thanks Dr. Wosar!