Just keep an eye on it? The unseen raises questions about what is fair in life.

The following story is about one of my favorite patients ever: Jake

“My other vet told me to just keep an eye on it”

“It’s been there for a year and hasn’t changed so I have just been keeping an eye on it”

“I don’t have the money to do that microscope thing, I’ll just keep an eye on it”

Veterinarians and pet owners alike have been keeping a keen eye on lots of terrible things.  I personally have, against my will, kept an eye on torturous allergies, Cushing’s disease, probable mast cell tumors, ear infections, and a myriad of horrible and curable, illnesses, conditions, and cancers. But I can’t spend people’s money for them.  I can only educate them and hope (and often pray) that they make the move and the sacrifice.

The Egyptian Papyrus of Kahun (from approximately 1900 BCE) offered the first written record of veterinary medicine.  Ironically, The Eye of Horus (the ancient Egyptian hieroglyphic symbol) is the symbol of protection, royal power, and good health.  Maybe that’s where vets and pet owners got the expression, “keep an eye on it.”

But there are those pet owners that I really feel sorry for – the ones that wanted to do something and were told to keep an eye on it.  I have to change his name, but lets talk about the most wonderful Boxer I ever met, Jake.

I am biased since I grew up with boxers, but Jake was one of those boxers that when he looked at you, he looked into your soul.  He was that patient that when I got to work on a Monday at 6:30AM and saw that he was coming in, I knew it was going to be a good day.

I also liked Jake’s mom; she was a real class act, a working professional, and a nurse practitioner.  She had recently moved to our area for work because, at the time, the Lehigh Valley, PA was a thriving area.  She had a vet who had cared for Jake since he was a puppy.  He was overdue for his vaccines so she brought him in and I did a physical exam.  His first visit did not go well.

A cute regal boxer

This is not Jake. I never had a chance to get a picture of him. But he reminds me of him.

He had a small 3.5 cm raised red inflamed mass on his chest.  Knowing his breed, and the appearance of this mass, I suspected a mast cell tumor.  Yes, his mom was told to keep an eye on it – and I believed her.  We did the test that day and it proved to be a mast cell tumor.

Long story short, Jake’s surgical resection was very difficult.  He was a very lean guy and I had to get 2 cm margins in order to get all of the cancer.  This involved a rotational skin flap, which is a procedure where you “harvest” skin from another area and rotate it so it can cover the defect.  Days later, the pathology results were in and it seemed we finally had some good news!  The tumor was graded a grade II, which is better than a grade III, and honestly better than I could have anticipated. Further good news–I got clean borders on it’s removal, which means no microscopic tumor cells were left behind.

But Jake was an unlucky guy.  Months later, another red round button-like lesion popped up on his leg. Back to the OR we went, and soon again he was cured.  Not much time had passed before he grew another one on the same leg in a different place.  By now I was deep discounting the procedures and Jake’s mom opted out of pathology this time but we got it all.  I found myself saying to her, keep an eye on him for mast cell tumors, keep an eye on him.

About ten months later, a nurse came into the break room while I was eating lunch and told me that Jake’s mom was in the waiting area and she wanted to see me.  I didn’t recall him having an appointment…

As she walked in the room, I sensed something was wrong.  First of all, Jake was not there.  His mom seemed sad but she was not crying.  She started off by telling me she never regretted the three surgeries and the money it cost to save him from dying of cancer.  She told me she took Jake to the park two days ago, and he was having the most fun he ever had playing with three children for hours.  She told me how much Jake loved children and how tolerant he was.  She told me how she wished she had brought him to the park more. Then she told me that out of nowhere he suddenly fell to the ground — dead. She said she had no regrets.  He didn’t suffer and he died having fun and in no pain.  By then, we were both crying.

Like people, some of the best of them have the worst luck.  Like children with cancer, it doesn’t make sense and it certainly doesn’t seem fair.  Jake didn’t die from cancer despite his predisposition and his body being riddled with it.  Jake died of Type II Boxer Cardiomyopathy.  A disease where there are no overt clinical signs or physical exam findings–sudden death from an arrythmia was the only sign.

Rather than keeping an eye on the lumps, bumps and diseases we can see, I encourage you to think about Jake and address the problems in front of our eyes while we have the opportunity to do so.   This is a chance to help our loved ones live longer and get the most out of life, however long it is meant to be.

If you are interested in helping further the research that is being done on Boxer Cardiomyopathy, please consider making a donation to The American Boxer Charitable Foundation, an organization that funds studies in boxer cardiomyopathy, sub-aortic stenosis, thyroid disease, and various cancers that are overrepresented in the boxer breed.  For your convenience, there is a Paypal donation button below.

Dr. Jed

Dr. Jed Schaible Signature

Dr. Jed Schaible VMD

This post is part of the 2010 Blogathon Fund Raising Charity Initiative.

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November 14, 2010 at 12:32

Heartbreaking! But I suspect Jake had a great life full of love and caring, from his owner and his veterinarian :)

Kate Smith
November 14, 2010 at 15:47

I too grew up with boxers and this story touched my heart very deeply. You both are truly amazing people for all that you do for your patients :)

December 2, 2010 at 15:57

Thanks Kate. It makes me sad when I re-read it too!

November 9, 2011 at 03:23

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