Pet Docs 8-19-18

Perry Jameson (left) and Henri Bianucci. 

Charlie is a 6-year-old Lab, who had knee surgery performed, by me (Henri Bianucci), two years ago, to treat a ruptured anterior cruciate ligament (ACL). Surgery was successful and his function on the leg has been good.

Charlie, and his owners, have now moved a few hours away from Charleston, and there have been signs that the other knee may be in the early stages of the same problem, so, it was not a surprise when the family reached out to me to say that they thought things had gotten worse. What was strange was that they were contacting me on the eve of Thanksgiving. ACL tears are not emergencies, and since they have recently dealt with this issue, they knew this. I took their call, and it was immediately clear that this was not a simple matter of a ligament injury.

Charlie had stopped eating, and was vomiting. He was depressed, and lethargic, and his leg was extremely swollen from the knee to the toes. The affected leg was the one that had been operated on two years prior. Since they can’t re-tear an ACL, and because an orthopedic injury would not create systemic illness, I advised them to immediately take him their nearest veterinary emergency clinic.

Radiographs were taken, which I viewed from out of town on my cell phone. They showed a lot of soft tissue swelling, and what appeared to be fluid in the joint. I recommended that they aspirate fluid from the joint to determine if it is infected, but there was not a doctor available who felt comfortable with this procedure.

Charlie was looking worse, as the leg continued to swell. He was in severe pain, and could no longer walk. If his joint was infected, the local effect of the bacteria, and the inflammatory response, can literally melt the cartilage away, and it does not grow back. Furthermore, the toxins were making him systemically ill. So, in addition to the likelihood of irreversible joint damage, there was also a real possibility of dying from septic shock. Charlie was in trouble, and there was no other choice; they had to make the drive to Mount Pleasant.

Almost upon arrival, things went from bad to worse. Another set of radiographs were taken and then submitted to a radiology service for review. Their conclusion was that the radiographs were consistent with cancer.

The owners were devastated. He was really suffering, and given his other leg problems, surgery was not an option.

They were seriously considering euthanasia.

They reached out to me again, to discuss the situation, and asked that I review the new X-rays.

I disagreed with the Radiologist, explaining that what was being described as a sign of cancer, was actually a normal change in the bones after a surgery like the one he had.

Moving forward with the tap, an infection was confirmed. The joint was drained, flushed out and I.V. antibiotics were started.

Once the necessary diagnostics and treatment were started, Charlie’s recovery was dramatic. The swelling and pain quickly subsided, and function returned to the leg. His appetite and attitude resumed to normal Labrador levels.

As with human medicine, the sources of medical care for pets are increasingly diverse. Charlie had been seen by his family veterinarian, a surgeon, and two emergency hospitals. Additionally, his X-rays were interpreted by someone who never laid an eye or a hand on him.

This case illustrated the importance of coordinating these sources, especially when crises occur. The radiologist was not wrong in describing the changes as having been consistent with cancer. But I have seen literally hundreds of cases of this surgery, and I am familiar with the post-surgical appearance of the bones. It was this input alone that stopped the decision to euthanize, or to pursue an unnecessary diagnostic course.

This case is a dramatic illustration of the importance of comprehensive, and coordinated medical records, and the need to cross consult when problems develop, especially in an area with a medical or surgical history, such as the knee in this case. Whether to prevent adverse drug interactions, unnecessary procedures or misdiagnoses, getting all of your pet’s health providers on the same page may be the key to receiving the best care that modern veterinary medicine can provide.

Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to petdocs@postandcourier.com.