It’s Wonderful To Be Wrong
It’s Wonderful to be Wrong
Chynna, a 6-year-old Pit Bull mix, became acutely weak in the hind legs (paraparesis). She had no conscious proprioception (CP) in the right hind leg, decreased CP on the left side, and normal reflexes. This meant that her spinal lesion was localized between T3 and L3.
We discussed the differential diagnosis with the owner: disc hernia, tumor, infection, an inflammatory process, etc. Chynna had quickly become weaker, and time was of the essence. An MRI was recommended. The owner agreed to do that, despite her financial concerns.
The films were read by an experienced, board-certified radiologist. Here is part of the radiology report: “The most concerning lesion appears to be at T12-13 and spanning back caudally for the entire length of T13. This lesion appears right-sided and causes displacement of the cord. Following contrast enhancement, there is uptake along the right and dorsal aspects of the cord associated with the region of the suspected lesion. It is considered most likely this represents an extramedullary intradural lesion.
“Meningioma would be considered possible but other possibilities such as lymphoma or granulomatous disease cannot be completely ruled out. It is considered less likely that this represents herniated disc material with possible associated hemorrhage due to the suspected enhancement and the close association with the cord.”
Another discussion with the owner followed. Based on the MRI, a tumor was unfortunately more likely than a herniated disc. Decompressive surgery and a biopsy were recommended. And then, more money might be required if radiation therapy and/or chemotherapy were suggested, depending on the biopsy results.
The owner really wasn’t sure what to do. She wanted to talk with her husband—who she never did reach—and her grown up daughter.
After a lengthy discussion and many tissues, the women elected to give their beloved dog every chance, and we took Chynna to surgery. A standard, right-sided, T12-T13 hemilaminectomy was performed. Most of the mass, which was extradural and appeared friable and somewhat chalky, was removed safely. It was submitted for histopathology.
Chynna did well after surgery: She was comfortable, still had motor function, and went home two days after surgery.
One week later, the biopsy results arrived. Here is part of the histopathology report: “well-differentiated fibrocollagen, fat, and hyaline cartilage with mild reactive fibroplasia, epithelial proliferation, and partial stromal mineralization.”
In plain English, the mass turned out to be “compatible with an intervertebral disc.”
The owner was obviously relieved, and Chynna was getting stronger daily. Champagne for Chynna!
Of course, this blog is not about bragging. After rejoicing, I started wondering with horror about what could have happened.
* What if the owner had elected euthanasia based on the odds given by the radiologist?
* What if the owner had met anyone else but a “knife-happy” surgeon?
* What if another vet had suggested euthanasia, again based on the odds?
* What if the owner had reached her husband, and he had requested euthanasia?
* What if her teary daughter hadn’t insisted on performing surgery?
Sometimes, it’s wonderful to be wrong.