We veterinarians are very familiar with the process of guiding our clients through the diagnosis and treatment of illnesses as a daily event in our veterinary practices. Yet, what happens when a veterinarian’s animal becomes sick? Do we choose to manage the case by ourselves or do we defer to others out of our lack of experience or ability to fully diagnose and treat the issue? Or, do we emotionally struggle with the concept of treating our own pets as patients?
In human medicine, there are restrictions surrounding the provision of care to our own family members. The American Medical Association (AMA) Opinion 8.19 - Self-Treatment or Treatment of Immediate Family Members states that “physicians generally should not treat themselves or members of their immediate families. Professional objectivity may be compromised when an immediate family member or the physician is the patient; the physician’s personal feelings may unduly influence his or her professional medical judgment, thereby interfering with the care being delivered.”
According to the American Veterinary Medical Association (AVMA), Principles of Veterinary Medical Ethics of the AVMA, such restrictions do not exist.
There are those of us who would prefer to direct all aspects of our own pet’s treatment. I am not one of those veterinarians, as I prefer to take a team approach in diagnosing and treating my pooch. I figure that if I engage the brains of my fellow colleagues, then we can have a more-thorough perspective on my own dog’s sensitive case.
I’ve sought help from other veterinarians many times before, as my Welsh Terrier Cardiff has overcome three bouts of typically fatal immune mediated hemolytic anemia (IMHA) in his almost nine years of life. The diagnostic workup and treatment of IMHA is very complicated, so I always seek guidance from other practitioners who are more experienced and educated than myself in treating Cardiff’s disease.
During all three episodes, I called upon the help of internal medicine specialists, geneticists, and other holistic practitioners to act as part of Cardiff's medical team.
It's been four years since Cardiff’s last IMHA episode and he’s been the picture of health during the times he’s not destroying his own red blood cells.
Just before our 2013 Thanksgiving trip to the East Coast, Cardiff started to again act somewhat unusual. With Thanksgiving 2009 being the event around which Cardiff last developed IMHA, I’m always extra wary during what’s actually my favorite holiday and give extra thanks for my dog’s ongoing good health.
Cardiff also has an infrequent history of petit mal seizures, with the first occurring around Thanksgiving 2011 (there’s that holiday again!). In the past six months, he’s had a total of four seizures. Each episodes never correlates with any known toxic exposure, infection, hypersensitivity reaction, or any disease that I would be able to diagnose through routine testing. The night before we left for our Thanksgiving holiday, Cardiff had another seizure and again recovered quickly and uneventfully. With his seizures becoming more frequent, suspicion that all may not be well inside my own dog’s body was developing.
Overall, Cardiff was acting energetically normal and showed no overt clinical signs of illness, but for a mild decreased appetite for certain varieties of his normal foods (Lucky Dog Cuisine and The Honest Kitchen, which contain only human-grade, whole-food ingredients). He then became mildly lethargic. Decreased appetite and lethargy always sends up a red flag in my mind, as they are clinical signs of IMHA. Could Cardiff be developing another IMHA episode? My mind started to race.
Cardiff then vomited partially-digested food on a few occasions. What came up were his meals from hours before, which appeared to barely be broken down in his digestive tract. As vomiting was not a clinical sign he showed during previous bouts of IMHA, I started becoming concerned that another form of mild to serious disease was brewing in his abdominal cavity.
I immediately started the diagnostic process, including blood, fecal and urine testing, and radiographs (X-rays). The good yet frustrating news was that no major abnormalities were discovered on these tests. With supportive care (fluid therapy, anti-nausea medication, probiotics, and antibiotics) Cardiff showed significant energetic improvement and resolution of his vomiting, but he still was not eating with a hearty appetite. At that point, I recognized the need to take a more investigative approach and arranged for him to have an abdominal ultrasound with Dr. Rachel Schochet at Southern California Veterinary Imaging (SCVI).
What was discovered via ultrasound did not overly surprised me, but changed Cardiff’s and my life forever. Please stay tuned for his ongoing story of diagnosis and treatment of one of the most severe forms of cancer afflicting our pets.
Dr. Patrick Mahaney
Image: Cardiff, by Dr. Patrick Mahaney
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