Care Standards & Case Studies
Why does the veterinarian recommend semi-annual examinations even though my dog or cat's vaccines are only due once a year? Isn't that a little excessive? The following cases exemplify instances in which a serious medical condition was detected during a "routine" semi-annual health exam. After detection, the first case was managed with the assistance of a specialist, with the majority of the care being coordinated by the doctors at Stream Valley. The second case was managed from start to finish solely in the hands of the Stream Valley general practitioners.
Brodie, a 10 year old male neutered black lab, presented in the summer of 2009 for his semi-annual health exam and vaccine update. The owner reported that Brodie was doing well at home but started "slowing down a bit," being generally less active and less tolerant of exercise. The owner wondered if this could be the result of aging or perhaps a sign of worsening chronic hip pain. On physical examination, Brodie appeared healthy with the exception of some fatty masses (previously biopsied) and worsening osteoarthritis of the hips as evidenced by Brodie's reluctance to fully flex or extend either hip joint. Notably, although Brodie had been in for an examination only seven months earlier, the doctor detected a loud heart murmur, which was not previously noted.
After discussing the murmur's significance as an indicator of underlying heart disease, Brodie was referred to the veterinary cardiologist in Leesburg for a more in-depth evaluation. Although Stream Valley can perform some preliminary diagnostics, such as chest radiographs and an electrocardiogram (EKG), the veterinary cardiologist has the ability to perform an ultrasound of the heart (an echocardiogram) which permits visualization of the inner heart muscle including its walls, chambers, and valves; this definitively determines the heart's overall function and ability to contract and pump blood. With the cardiologist's expertise and specialized imaging, heart function can be specifically analyzed to determine the best course of treatment to slow the progression of the disease.
Brodie's family budgeted for the specialist visit, and he was evaluated two months later. Based on his echocardiogram, Brodie was diagnosed with an acquired heart disease termed Dilated Cardiomyopathy. To manage this condition Brodie was placed on two oral medications to improve the contractility of his heart and overall cardiovascular status. The necessary monitoring of blood levels was performed at Stream Valley as needed over the next six months, and on his recheck with the cardiologist, Brodie's heart function improved from less than 30% to close to 60%. Brodie's owner noted that his energy level improved dramatically and he seemed more comfortable overall.
During the course of the next year, Brodie did well at home. He was started on an anti-inflammatory medication for his joint pain, and his doctors at Stream Valley were able to confer with the cardiologist to make sure that none of his medications conflicted with each other. After enjoying 10 months of stability with regards to his heart and overall health, Brodie developed a cough, which was evaluated at Stream Valley. Chest radiographs showed evidence of heart failure, so Brodie was referred again to the cardiologist for a more in-depth evaluation. His medications were adjusted, and Brodie maintained several more months of stability and a good quality of life.
This case illustrates the way in which the general practitioner and veterinary specialists work together to provide the best care for each patient. The specialist provides the expertise on certain health matters, but ultimately the general practitioner guides each case, managing the health of the entire patient, and assisting in follow-through recommendations from the specialist.
In our second case, a 6 year old domestic short hair tabby cat, Charlie, was presented in the winter of 2010 for his annual physical examination and vaccine update. His owner noted that he was doing well at home, though recently started vomiting and vocalizing shortly after eating. Although he had lost some weight in the past 12 months, Charlie appeared generally very healthy. Externally, he had a good coat condition, appropriate weight and muscle condition, and healthy eyes, ears, and mouth. His heart and lungs were clear and his lymphnodes were all normal size. In addition to assessing Charlie's external condition, heart, and lymphnodes, an abdominal palpation was performed to assess the general size and condition of his liver, kidneys, and intestinal tract. On palpating his abdomen, the veterinarian detected a large (3-4 inch) mass in his cranial abdomen. To confirm this finding, an abdominal radiograph was performed, which clearly showed the mass. To investigate further, an abdominal ultrasound was performed; ultrasound varies from radiographs in that it shows the texture and inner structure of internal organs whereas radiographs only show the general outline. Charlie's abdominal ultrasound revealed that the mass was associated with either his liver or his intestines.
Surgery was scheduled within the week at Stream Valley to explore Charlie's abdomen and remove the offending mass. During surgery it was revealed that the mass originated from the liver and was intimately associated with the gallbladder. With two doctors working together in surgery, the mass and adjoining gallbladder were removed. Charlie was kept in the hospital for several days afterwards for supportive care including IV fluids and pain medications. He was discharged after he started eating again. The mass was submitted to the lab and was shown to be a tumor called a biliary cystadenoma. Because the mass was benign and completely removed, a very good long-term prognosis was given to the patient.
This case demonstrates the full diagnostic and therapeutic capacity of the general veterinary practitioners at Stream Valley. From start to finish, each step was completed without the assistance of a specialist. Thanks to the early detection of the abdominal tumor on an annual physical exam and the diagnostic and surgical skills of the Stream Valley veterinarians, Charlie continues to live a happy, healthy life with his family.