Case of the Month

Colby

Colby is a 9 and 1/2 year old yellow Labrador retriever who presented to the Iowa Veterinary Specialties emergency service due to repeated collapsing episodes that occurred earlier that day. When Colby arrived at Iowa Veterinary Specialties, he would not walk, had very weak pulses and his heart rate was tremendously fast. X-rays revealed that his heart was enlarged. Dr. Portia Appel quickly suspected that Colby was suffering from a disease called pericardial effusion which occurs when fluid accumulates in the bag around the heart-putting pressure on the heart and preventing it from filling with blood to deliver to the body. Dr. Derek Nestor, Des Moines only Board Certified Veterinary Internal Medicine Specialist, was summoned to assist with Colby's diagnosis and treatment. Dr. Nestor performed an emergency ultrasound on Colby's heart and confirmed Dr. Appel's suspicion of pericardial effusion. He also noted that the fluid was being caused by a mass that was present on Colby's heart. The fluid was removed from the pericardial sac via a procedure called a pericardiocentesis which temporarily relieved his heart muscle from the pressure and allowed Colby's heart to function much more normally. In order to best prevent the fluid from returning, a surgery could be performed to remove the mass on the heart as well as the pericardial sac that surrounds the heart. Colby was discharged and the owners indicated that they were going to consider the surgery.

Colby then went to a midwestern Veterinary School's Teaching Hospital for surgical consultation. The surgical resident at the university felt that they were not comfortable removing mass due to its location, and Colby's owner was told that little could be done for Colby and his disease. Due to the discrepancy of information received, Colby's owner returned with him to IVS to see Dr. Brent Reimer, the only Board Certified Veterinary Surgeon in Des Moines. Fortunately for Colby and his owner, she knew of Dr. Reimer through her previous trip to IVS and discovered that Dr. Reimer had been trained during his residency to perform this intricate and difficult surgery. Dr. Reimer discussed the surgical procedure with Colby's owner as well as realistic expectations as the most common type of mass in this site in a dog is an aggressive malignancy called a hemangiosarcoma and treatment with surgery followed by chemotherapy results in an expected survival time of approximately six months. Colby's owners wished to pursue this avenue of treatment, and surgery was performed the same day to remove the mass from Colby's heart as well as his pericardium-the sack that surrounds his heart. The mass was a deep red color, raised and approximately 2.5 inches X 2 inches X 0.5 inches and associated with the left atrium, one of the chambers of the heart. The mass was carefully dissected from the underlying heart and a portion of Colby's own heart muscle was removed with the mass to completely remove the mass from the underlying heart. Surgery went well, and Colby recovered without incident. He remained hospitalized for 2 days, and was discharged when he was fully stable and comfortable. The biopsy report returned approximately 2 days later and confirmed the suspicion that the mass was indeed a hemangiosarcoma, but fortunately his lymph node and lung (which were also biopsied at the time of surgery) were free from the disease at this point in time.

Colby returned in approximately 2 weeks to assess his healing and begin his chemotherapeutic regimen with Dr. Nestor of the Internal Medicine department. Colby's surgical site had healed completely and the chemotherapeutic medication was given to him at that point in time. Since that time, Colby has completed his chemotherapeutic regime and repeat staging of his chest through x-rays and ultrasounds have revealed no return of his tumor at this point in time. Colby has returned to his normal activity level, and shows no signs of problems related to his disease or surgery at this point in time.

Colby's case demonstrates the superior care available to the patients of Iowa Veterinary Specialties. Through the interdisciplinary teamwork approach, Colby was expertly diagnosed and stabilized upon his initial presentation, ostensibly saving his life at that point in time. Due to this serendipitous visit, Colby's owners became aware of all the treatment options available to them-including advanced surgical expertise not available at regional teaching hospitals. With this knowledge, his owners were able to make an informed decision regarding all of his treatment options in a timely fashion. Without this knowledge, his owners were left to feel as though they had no options available to significantly increase his wonderful time with them and his life would have been cut tragically short. Through the hard work of the team members of Iowa Veterinary Specialties, Colby's owners , as well as Colby's referring veterinarian, Colby has survived his initial cancer crisis and has recovered the vigor for life that he deserves.

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