One of the things that I love about my job is the wide variety of patients and cases that I see.
This is not the case in most of human medicine.
Although my job includes many species (last Tuesday included a pot belly pig, unweened hedgehog, pygmy goat, two Amazons and a flying squirrel in addition to more usual pets), it also includes many fields of medicine.
A veterinarian is also a radiologist, cardiologist, ophthalmologist, nutritionist, allergist, internist, soft tissue and orthopedic surgeon, neurologist, emergency and critical care medicalist, pediatrician, dermatologist, gastroenterologist, urologist, pulmonologist, theriogenologist (OB/GYN), a dentist, an oncologist, behaviourist, endocrinologist, an anesthesiologist, pathologist, groomer and more.
In addition, cats are not little dogs, birds have their own physiology and reptiles are even more different.
Different medicines for different conditions and the medicines may react differently in different species or even under different disease conditions.
Then in their spare time, they are the business manager, office manager, supply manager, legal experts, plumber and more. Most of the time their office staff is only a couple of techs or trained assistants and a front desk person or two.
Veterinarians are used to handling it all.
But sometimes there are cases that need to see a specialist. Even if it were possible to know all of the knowledge in individual fields, it is not possible to stay current in all of the fields.
So, when I send Brutus, the black lab, to the oncologist at Ohio State for his mast cell tumor, it is not that I do not know about mast cell tumors and the prognosis, but rather that I am hoping that there is a new, cutting edge treatment that will save Brutus’s toes so that he can be a functional service dog and companion.
Sometimes, the referral is made to see someone with more knowledge or experience.
Mopessa, an older black lab who presented for eye swelling went to an ophthalmologist in Dayton. The ophthalmologist knows a lot more about eyes and eye diseases than I do, but the ophthalmologist still needed to refer Mopie to another specialist for cancer. She knew a tremendous amount about eyes, but not as much about Mopie’s cancer.
There are things that I know how to do, but haven’t done for a long time.
We learned in vet school to read bone marrow aspirates. Classmates would complain that there were no definite rules to catagorize the cells, but I was very good at putting the maturing cells into the proper categories. But when Tyson needed his bone marrow evaluated to see if it would ever create blood cells again, I knew that the reading of precursor blood cells was an art and there were others better at it than me.
Specialists tend to see more cases like the few that I am seeing.
Peaches is a cockatoo with a bleeding vent. I have done the surgery before, but believe that being honest is the only way. A specialist who does the surgery every week is going to be better and quicker than I who only does them occasionally.
Some cases need a specialist because of the time frame.
Lenore’s cancer was caught extremely early, but squamous cell tumors are highly malignant and spread rapidly. A CT scan or computerized axial tomography is needed to determine the extent of the tumor growth. A CT machine can cost $265,000 up to 2.5 million dollars. An MRI or magnetic resonance imaging machine can cost up to three million dollars. Both are a tad too expensive to have around Guardian Animal.
The safety equipment to safely handle the chemo drugs is not inexpensive either although because of a rising number of cases, we are working on getting set up to do chemotherapy.
The chemotherapy protocols are complex and ever improving, so we may always need to have a specialist on the team.
The best treatment for mast cell tumors that cannot be resected (cut out) is radiation.
Guardian Animal Medical Center does not have a radiation machine because they cost three million dollars, but Ohio State University and some other specialty hospitals do.
So, when Harley’s tumor came back with dirty margins (the tumor had spread beyond the cut tissue), I know Harley needs to have radiation which is another good reason for a specialist.
There are cases where the owners need to hear from a specialist.
Bully has bitten four or five people. I suggested several solutions to allow Bully to stay in his home. The owners have reasons why none of those things can be done. Since they must be done or someone can be killed, I feel this is a great reason for a specialist. The veterinary behavior specialist will set up a two hour appointment and go over things in detail.
The owners will pay two to three hundred for the appointment and that will encourage them to listen.
Exotic pets that have been to another vet are also good candidates for referral.
The two things that are always limited with exotic pet care are time and money.
If the time has already been spent somewhere else, it is time for a specialist, before it is too late.
I try very hard to teach proper care and do good medicine.
When owners ask me why a veterinarian did something that is not standard of care, it stresses me.
I will not throw them under the bus, and to be very fair, I am not seeing the patient that they saw at this time, but it bothers me.
This is often the case with second opinion exotics, but also happened in Grizzly’s case. Grizzly had gone to a local clinic instead of a specialist for orthopedic surgery. When I saw him back, he couldn’t hardly walk.
The owners had been told this was normal. A trip to the specialist, corrective surgery and Grizzly walks normally now. Best for the specialist to handle that conversation.
Most of the time, I handle cases here, but some cases need a specialist and some cases are better at the specialist.
Sometimes owners need to be reassured by the specialist or need to listen to the specialist.
Sometimes the stakes are too high not to go to the specialist. Occasionally, I need for the client to go to the specialist.
There is a wide variety of specialists that complement our practice and the care for our patients.
Sometimes in human medicine, I feel that I am shunted from a specialist to specialist and nobody understands me or how my medicines interact.
One of the things that I love about veterinary medicine is that at the center of all of veterinary medicine there is a veterinarian who cares about the patient, their family and the whole care.
At least at Guardian Animal there is.

MJ Wixsom, DVM MS is a best-selling Amazon author who practices at Guardian Animal Medical Center in Flatwoods, Ky. GuardianAnimal.com 606-928-6566