Not ALL Of Your Clients Are Crazy!
Despite seemingly odd requests, find out why not every client should be considered a little out there.
Joshua's MRI reveals a mass between L5 and L6.
It’s easy to dismiss "unusual” clients as "different.” They may have strange requests or describe bizarre signs in their pets. They may seem extravagant or eccentric. But sometimes, just sometimes, their description is perfectly truthful.
Such was the case with Ms. Smith, who brought Joshua for a consultation. The 3-year-old male beagle has some strange neurological signs. Or so Ms. Smith said. She had been dismissed as "crazy” by three previous colleagues.
Ms. Smith main complaint was that Joshua could not wag or lift his tail. That seemed hardly an issue. But Ms. Smith wasn’t happy with that situation and wanted an explanation.
After quizzing the owner at length, a few interesting facts came up:
• Joshua sometimes had difficulty urinating and/or defecating.
• He occasionally would bite his right hind leg.
• At times, he would have tremors "because he is in pain,” the owner insisted.
• Despite tramadol and prednisone, and in spite of seeing three different vets, Joshua kept getting worse over time.
Ms. Smith became increasingly frustrated that nobody took her seriously. And then we met. Joshua was a happy, healthy, 3-year-old beagle. His physical exam was unremarkable. The neurological exam revealed pain on tail extension, as well as pain on lumbar spine palpation. That’s it. He was walking strongly with no conscious proprioception deficits. Hind leg reflexes appeared normal.
A spinal lesion was suspect and an MRI was recommended.
Amazingly, the MRI showed an intradural, extramedullary mass at L5-L6. Now things were starting to make sense. Despite a questionable prognosis, decompressive surgery was discussed… and approved. A dorsal laminectomy revealed a 2 cm long mass dorsal to the spinal cord.
The mass couldn’t be excised entirely, so it was debulked and biopsied. Fortunately, Joshua was still able to walk a few hours after surgery.
Proprioception was normal, and he was sent home two days after surgery.
Histopathology revealed that the mass was a chondrosarcoma, i.e. cancer stemming from cartilage. Since the mass was intradural, the pathologist believed that it was a "de novo” tumor, as opposed to a tumor derived from the vertebra.
Ironically, it was a slow-growing tumor, which is good for Joshua, but bad because neither chemotherapy nor radiotherapy were great options, since they target rapidly dividing cells. Two weeks later, at suture removal, our beagle was doing great, with normal CP and no pain, and most importantly, he could lift and wag his tail.
Five months postop, Joshua was still doing well, with occasional pain controlled with tramadol.
What is the moral of this story?
Thanks to advanced imaging, such as MRI, a motivated pet owner can enable us to perform high level procedure (not limited to surgery).
It can be difficult to decipher clients who have strange complaints. Three colleagues had judged Ms. Smith as "high maintenance” with a dog with nebulous signs, yet Joshua had a real (and treatable) problem.