Ninja: Why Specialists Are So Fabulous (Part II)
Dr. Allison Cannon is one of those idealistic, hard-working super-women we’d all love to be. Young and energetic, she just completed her internal medicine residency at the University of California at Davis (a top-tier vet school and an impressively grueling program) and has just started her real-work career at Miami Veterinary Specialists. When she talks about her patients she has that bright-eyed, I’m-going-to-save-the-world look you hope to see when your pet becomes dangerously ill. `Nuff said. She’s just the bomb.
So it happened that when Ninja came to see me last week I immediately thought I’d have to engage her skills.
Ninja is a seven-year-old kitty cat who had stopped eating and started hiding under furniture—most un-Ninja-like. No jumping out at his mother’s legs or playing with his brother. He was feeling pretty sickly.
When I first examined him I was initially alarmed by the size of his internal organs. Palpating a cat’s belly, we vets can often tell a lot. With practice we can even get good enough to distinguish one organ from the other just by feel. In this case I could feel a huge spleen and what I thought might be a big liver.
Cats and dogs have bigger spleens than people. The organ is there as an immunological filter for the blood and to manufacture new blood cells. While it sounds like a critical piece of machinery, spleens are redundant with other mechanisms in the body. So if we take it out it’s usually no big deal. But the liver? Now that’s a much trickier organ.
X-rays confirmed my findings. Big spleen and liver. Is there a mass in that liver as well? I sent out a blood sample, initiated antibiotic therapy, and offered to hospitalize Ninja for fluids, feedings and observation until my I had some solid results in hand. But his owner was, alas, unused to me as her vet (her usual vet, my colleague, was out of town) so she respectfully demurred. Oh well. Not much I can do. She’ll be back.
The next day, armed with some alarming bloodwork results, I called Ninja’s mom to let her know we would have to see him again. But he feels so much better! I pleaded my case to no effect. Oh well. Not much I can do. She’ll be back.
Three days later, Ninja is in my exam room again. He won’t eat. He’s been vomiting. He looks skinnier. He’s hiding again. His spleen? Gigantic! His skin? Yellow. To the client’s obvious satisfaction (I guess I didn’t exactly gain her trust), I recommended she take Ninja across the street to Dr. Cannon.
Dr. Cannon confirmed my suspicions: lymphoma. Lymphoma is a blood cancer that increases the size of the organs or creates tumors within them by stuffing them with a specific kind of white blood cell (lymphocytes).
To make the diagnosis, she used an ultrasound machine to identify the affected organs. She then inserted a needle into both the liver and spleen, extracting a small sample of the tissue to view under the microscope and send to a pathologist. To my wry amusement, she characterized the spleen as ginormous (!). The liver? It had a huge, fluid-filled mass within it.
To my relief, she had no difficulty having the client agree to hospitalization and a course of chemotherapy. Ninja’s probably going to be fine. For how long? Twelve to eighteen months, on average. Maybe more. Maybe less. Who knows? The most important outcome is that Dr. Cannon was able to secure this client’s compliance.
Sometimes we vets have to suffer the stabbing rejection of our clients` trust. Maybe it’s a personality thing. Maybe it’s that I still look the irresponsible party girl I once was. Maybe I said something wrong. Who knows?
Regardless, specialists are always there to provide a second opinion in cases where clients are just not ready to accept our medical opinions—for whatever reason. Sometimes specialists` obvious command as members of a special breed of vets makes all the difference. Either way, as long as Dr. Cannon has the ability to make things happen for my patients I’ll me more than happy to suffer the slings and arrows aimed squarely at this vet’s ego.