How Many Specialists Does It Take?

Photo: Ann Hohenhaus
One of my favorite set of dog jokes is the series “How many dogs does it take to change a light bulb?” The author of these jokes hit the nail on the head with the characterizations of each individual breed. Since today’s blog is about a Labrador retriever named Ajax, here’s the one about Labs.
How many Labrador retrievers does it take to change a light bulb?
And the Lab answers: Only one. Oh, me, me!!!!! Pleeeeeeeeeze let me change the light bulb! Can I? Can I? Huh? Huh? Huh? Can I? Pleeeeeeeeeze, please, please, please!
If you want to read the rest of the series here is a link.
I thought of this series of jokes in regard to Ajax, not because his case is funny in any way, but because his case was so complicated; it required many more veterinary specialists than would be required to change a light bulb. Ajax had five Animal Medical Center (AMC) specialists contributing to the management of his case, a good example of the many diagnostic and therapeutic challenges faced everyday by veterinarians at AMC.
Ajax was referred to me, a dog and cat cancer specialist, because he had a tumor on the inside of his back leg. The biopsy of the tumor done by his primary care veterinarian showed a tumor best controlled by surgery. Ajax also came with an x-ray of his lungs — standard procedure with a cancer patient. AMC’s radiologist reviewed the films and was worried about the possible spread of the tumor to Ajax’s lungs. He also identified a small growth in front of the heart. He recommended a CT scan. One of the AMC’s surgery specialists looked at the tumor on Ajax’s leg and the CT scan of the tumor and felt it could not successfully be removed from the leg.
We then called in the AMC’s radiation oncologist to discuss how we might incorporate radiation therapy into a treatment plan for Ajax. Ultimately, the CT scan and the radiologist determined there was only a small growth in front of the heart and nothing in the lungs. After much soul searching on the part of Ajax’s family and dozens of conversations between Ajax’s specialists, the small mass in front of his heart was removed via thoracoscopy (the insertion of an endoscope, a narrow-diameter tube with a viewing mirror or camera attachment, through a very small incision in the chest wall).
Unfortunately, the leg mass required amputation. Ajax’s fifth AMC specialist, a pathologist, performed biopsy interpretation of both the small growth in front of the heart and the leg mass. The biopsy results indicated the small mass in front of the heart and the leg mass were successfully removed and were types of tumors which are unlikely to come back anytime in the near future. Just shows what good teamwork and a lucky dog can accomplish.
As you can see from the family’s photograph of Ajax 2 weeks after surgery, he is doing very well and enjoying a cancer free life.

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