Sammy – The Power of Fundamentals
Jul 02, 2013
Sammy, a middle-aged Golden Retriever, had no prior medical problems before being brought into the emergency service of one of our partner hospitals for a severely swollen left rear leg. On initial examination, the board-certified criticalist noted the leg was swollen from the tip of the toes all the way to the hip, among the most severe cases he had ever seen. Sammy had no prior history of leg trauma, no chance the dog was hit by a car, motorcycle or even bicycle. Physical examination revealed no evidence of a fracture, insect bite, snakebite or other diagnosis indicated by such severe swelling. Sammy’s swollen leg was a mystery symptom.
Sammy’s mom, faced with inconclusive results and growing financial concerns, began to considering having Sammy humanely euthanized. The criticalist asked mom if she would consent to one fine needle aspirate of the swelling in hope that the sample would yield the information needed to save Sammy’s life. Luckily, mom said yes. After thoroughly checking the entire leg, the veterinary criticalist prepared a small area that was very slightly firmer than the rest of the leg for a fine needle aspirate.
The aspirate revealed mast cells on cytology, so the criticalist referred Sammy’s case to me. Initially, Sammy’s mom was devastated to learn that her beloved dog had cancer and she, again, considered euthanasia. She believed that Sammy’s quality of life would be affected by treatment and that the financial burden would be too much for the family. I asked her to consider one week of treatment with prednisone before she made that final decision. This treatment is inexpensive and can be very effective at decreasing inflammation caused by mast cell tumors. By the following week, Sammy was a new dog. The swelling in his left rear leg had completely resolved—except for an area the size of a quarter right near his knee (stifle).
Because Sammy was enjoying life once again and the massive swelling had been reduced to a small area, his mom could now elect to have the mass surgically removed. Sammy and his mom hit the “Trifecta”—the surgeon was able to excise the entire mass and the biopsy revealed a low-grade mast cell tumor. Sammy was cured!
Sammy’s story illustrates the power of fundamentals in the treatment of pet patients: thorough physical exam, clear communication between pet guardian and veterinary professional, and hope on everyone’s part for the best possible outcome even in the face of a cancer diagnosis.
Case Notes by Dr. Gerlad Post