One of the things that I love about veterinary medicine is its breadth.
In a day I may examine a kitten, do a Csection on a dog, suture a laceration, pick through feces and help someone say goodbye to a beloved friend. It is emotionally and intellectually gratifying work. But it is also a huge challenge to do it all with mindfulness and competence....without getting alot of poop on me.

In human medicine, there are more specialists...people who have devoted their lives and learning to a specific area. In veterinary medicine, the number of specialists is rapidly increasing as the knowledge base and the percentage of people who view pets as family grows. Unfortunately, we have relatively few specialists in  Maine. There are 3 neurologists in Scarborough. There is a surgeon and an internal medicine specialist in Portland. There is a cardiologist and two ophthalmologists that visit Maine regularly.

So among the vets in the area we have focused on certain areas to go to the 'next level' to bridge the gap of availability. Since Vet school I have been interested in ophthalmology and regularly get referrals from area veterinarians. I am not an ophthalmologist, and this last week has reminded me that I never will be. Not because of a lack of passion, but because in addition to undergraduate and 4 years of vet school, these vets have gone onto a 3 year residency under the guidance of other ophthalmologists. Then they take a grueling exam.

Then they see exclusively ophthalmic cases.

They are smarter, more experienced and have developed skills that are amazing...seriously.
And fortunately for 12 of us, they gave their time to share their experience, wisdom and guidance.

5 years ago I had a life changing experience that reinforced how reassuring a specialist could be.

In the first year I started Kindred Spirits, my son was 13. He complained regularly of hip pain that spring and we brought him to the pediatrician. She in turn sent him to an orthopedist. The orthopedist ordered an xray. There were no significant findings.  He concluded that Daniel was having growing pains and sent him home with anti inflammatories. Daniel (unlike his father) is pretty stoic. He continued to complain of pain and was taking a large amount of anti-inflammatories on a daily basis. We went back to the orthopedist. He ordered an MRI of Dan's hip.
Again, no abnormalities.
More time went by, Daniel still was uncomfortable. He limped. His activity decreased. He mainly did homework and played video games. His pediatrician kept him out of gym class.
Finally, frustrated we went back to the orthopedist who ordered an MRI of Daniel's back.
His mother and I went to meet with him about the report.

When he called us in, he seemed eerily somber. He put the MRI on a view box and pointed out a lesion on the spine.
He said a few words that still make my breathing stop both then and now.
"Your son has a spinal cord tumor at his 5th Lumbar Vertebrae."

I did not see that coming. It felt like the oxygen had been sucked out of the room. My exwife (Daniel's mom) touched my shoulder. I glanced at Daniel. He looked kind of blank.
"Can you tell what kind?" I asked
"I can't tell for sure. I have shown this to a neurosurgeon who works on kids and she agrees that it is most likely a schwannoma. She said she feels comfortable with the surgery and is waiting for a call to set up an appointment. "

We left the little consultation room, both parent's hands on Daniel's shoulder. He stayed stoic. I'm not sure I ever felt more helpless than that first day after the diagnosis.
We called the neurosurgeon's office. The receptionist set us up an appointment in 2 weeks for a consult. I remember that seemed ridiculously long. I googled schwannoma...an action I often warn you guys about. I read about this tumor, the fact that it can be associated with genetic predisposition called neurofibromatosis. This could mean a lifetime of intermittent tumors.
We reviewed every relative we could think of. No one had weird neurological signs or anything other than the usual cast of characters in human death....heart disease, cancer, etc.
We asked the receptionist to call back if there were any openings earlier. If not, perhaps the neurosurgeon could give us a call to discuss Daniel's tumor.
She explained that the neurosurgeon was a busy woman and that we had an appointment in 2 weeks to discuss his case.

Ok, I'm going to ask for a witness on this one. Does 2 weeks sound like a really really long time to meet with the specialist if your child (or pet) has a spinal cord tumor?  Perhaps not, but it sure seemed like it at the time.
The next day I stood by patiently and checked in with everyone in the family. Day 3 I started calling out of state pediatric neurologists. I called several in Boston, one in Michigan. I figured we could fly. At that point had you given me a plane I would have figured out how to use it to get wherever I needed to go.

I spoke with a very accommodating nurse at the Children's Hospital in Boston. I told her the situation. I heard empathy in her voice and she said that they had a pediatric spinal cord specialist. She would see if she could touch base with him.

Within 1/2 hour he called me back. He asked if I was available to meet the next day and if I could get the MRI. I told him I had already hijacked a plane and was pretty sure I could use it. We went down with MRI images in hand the next day.

What happened next did change the way I look at specialists.

He patiently sat down after reviewing the MRI images and acknowledged that as a vet and an RN that we had some experience that we brought to the table in understanding his talk. He said to feel free to speed him up if it was too basic an explanation and slow him down if it was feeling over our heads. In his experience he said that his talk for parents is difficult to remember because there is so much emotion present during the information exchange.

"Wait...you mean you have a spinal cord tumor talk like I have a puppy talk?" I asked.
"Essentially yes" was all he said.

Now, stop at this part of the story to tell you that the relief I felt at that moment, before the discussion even started was enormous. This guy did 5 spinal cord surgeries in kids a week....in a friggin week!

He could schedule the surgery 10 days away, told us that he was confident he could remove it, and was also confident it was benign. He asked us to set up a time with a geneticist to make sure it wasn't heritable (it wasn't), and told us the only trick was that it was difficult to predict if there would be a neuro deficit after the surgery. The possibilities were many, and we couldn't know if he would have a deficit until after the surgery. Perhaps he would have a limp. Perhaps he would have mild continence issues. Perhaps his foot would drop when he walked. Perhaps there would be nothing. Hard to tell.

We arrived as an extended family 10 days later. My exwife and her partner. Daniel's grandfather. Mary and Becca were there as well. We nervously joked. He was admitted for surgery at Childrens Hospital in Boston.
The seperation immediately felt like a bad idea. The group did well.
I paced like a cat.
I chattered nervously.
I bothered the nurses.

The surgery was hours long. I had an ipod. I played the same songs incessantly. There is a Melissa Ethridge song called "I Run for Life" about her commitment to breast cancer research. I listened to that song 5 times at least.

I found a nurse.  "Any word on Daniel Hanks??"

"Mr Hanks, its only been 45 minutes."

  

Finally the  surgeon came out. He reported that the surgery was done and that Daniel was doing well. We could visit him in a little while. The mass looked like a schwannoma. He thought it came out well. He could find no neuro deficits. He had to submit it for a biopsy, but his experience said we were on the home stretch. Dan would have to stay in the hospital for a week or so to recover.

We went to visit Daniel as he woke up for anesthesia. He made a joke in his loopy state. I laughed, but the laugh turned into tears of relief. I didn't know you could have tears of relief.
He recovered fine and he is now 18 years old and 6 feet 3 inches. His hair is long and blond. Except for the emotional part, he has little to show for the surgery except a 4 inch scar on his back.
But I took so much more away.
Since then I  see the worried eyes of my clients before surgery a little differently.
Since then I appreciate a little more that life is best lived now, before a diagnosis that might change our lives
Since then I know that when someone drops their pet off to me that I have a trust put in me, just like I trusted that the anesthesiologist and neurosurgeon would be present  and focused on my son
Since then I have a renewed respect for the right specialist at the right time
Since then I realize the power that words have when your emotions are raw.

Life has a way of keeping us humble and if we are willing to go there, we can manifest a hell of alot more in our lives.
At the end of the day the patient's well being is the top priority. If the best outcome will work with me and the team, great...but otherwise I reserve the right to send you to a trusted colleague or a specialist. I understand that Anthem will not pay for your trip to the veterinary specialist...and if its any consolation, I will not send you unless your pet needs to go. But this week's experience for me reminded me of a very special vulnerability I experienced that made me see the bigger picture.  We all want the same thing...If that means I need to send you to Northern Florida to see a seal lens specialist....then you have to go.
..but only if you have a seal.
According to our records, none of you have a seal, which works out well because getting one of those on a plane to Northern Florida can be a bugger....