I’ve just returned from the annual forum for the American College of Veterinary Internal Medicine (ACVIM), held in Nashville Tennessee. For those not familiar, the ACVIM (www.ACVIM.org) is the non-profit organization dedicated to the education, training, and certification of veterinary specialists in the fields of small and large animal internal medicine, as well as cardiology, neurology, and oncology.
This was the third conference I’ve attended this year. Each time, I’ve returned feeling renewed and invigorated about being an oncologist. I’ve felt more confident in my career path and my knowledge base. I’ve felt assured I’m doing the best job I can do, and that I have been adequately adhering to my responsibility to keep current in my field. Sadly, within just a few short days of arriving home from each occasion, I’ve found my enthusiasm become re-routed as I tackle events that completely question my faith in the public’s perception of veterinary specialty medicine.
I’d barely arrived home when my husband excitedly told me the wine store near where we lived was having it’s grand opening that afternoon. Though I am an avid lover of animals, I also really enjoy wine, so I was equally enthusiastic about the event.
Within a few minutes of our arrival at the store, we met two gentlemen who struck up a conversation with us about a baseball game we all were watching on the large flat-screen TV. My husband and I have an unwritten rule that we will not voluntarily bring up our profession in social situations unless asked directly, as inevitably the tides of conversation will change and then simply become monopolized by animal talk. So we happily discussed the game, the wine store, and things to do around the area with our newfound friends.
But, as is so often the case, it somehow came up in conversation that we were both vets, and immediately the topics shifted from discussing pitching stats and the merits of beer flavored with Old Bay to questions about our new friends' pets, breed specific illnesses, and then once they found out I was an oncologist, stories of their dogs who were previously diagnosed with various tumors and their outcomes.
I listened intently as one owner recounted the events surrounding the death of his older Golden retriever. He accurately recounted how his dog became acutely weak and inappetant one morning, with no premonitory signs of illness. His owner knew enough to know the behavior wasn’t normal, but figured his dog had contracted a stomach bug or ate something he shouldn’t have. He diligently brought him to his primary care veterinarian for evaluation that same day. That’s when the story took a disheartening turn for me.
Turns out his dog’s signs were not due to a simple virus, but rather a bleeding tumor along his spleen. Given the age, breed, and presentation of his pet, the most likely diagnosis was an aggressive tumor called hemangiosarcoma (see Cancer: Imagining the Worst, and the Best). However, other possibilities existed. The only way to know would be to perform an immediate life-saving surgery and remove the spleen and submit the tissue for biopsy.
The owner recalled the story with the following chain of events: 1) The primary care veterinarian diagnosed his dog with a bleeding tumor that had a > 90% chance of being a type of cancer; 2) The dog would live only three months with an immediate life saving surgery; 3) The life saving surgery needed to be done at a specialty veterinary hospital and would cost no less than $10,000; and 4) The dog had a less than 50% chance of surviving the surgery. He ultimately elected for humane euthanasia.
As he told the events of his pet’s death to me, I could feel myself struggling between a strong sense of sadness over the sudden loss of his beloved companion and a growing sense of frustration and anger towards the misconceptions he had about what may have been the outcome for his dog.
Yes, there is a strong likelihood of a diagnosis of splenic hemangiosarcoma, but I will stand by my conviction that so many dogs are euthanized prior to surgery that we actually do not know the true prevalence of benign vs. malignant splenic tumors.
Yes, if the diagnosis is splenic hemangiosarcoma, the prognosis is considered very guarded with surgery alone, but chemotherapy following surgery can be effective in prolonging survival.
Yes, the surgery is expensive, but the cost likely would range between about one-third to half the amount quoted by the primary veterinarian.
And yes, though the dog was quite ill at the time of diagnosis, the survival rate for splenectomy surgery is far higher than 50%.
At the time, I silently agreed with the owner as he told the story, as nothing I would say or do could change the events of what transpired with his dog. But I made a mental note that although I am only one small voice for my profession, I have the potential to be a proverbially powerful one. Therefore I put forth two main suggestions for our profession at this time:
1) I sincerely urge owners to seek referral to a specialist when offered, but also consider asking for a referral when they want to learn more about their pet's health.
2) Likewise, I urge primary care veterinarians to discuss cases with your local specialists to be sure, as frontline consultants, you are providing the most accurate information to owners.
In the triad of owner, primary care veterinarian, and specialists, don’t we owe to it to the one thing we all share in common? The voiceless companions dependent on our care would never ask for anything more than this.
Dr. Joanne Intile