Whether a pet must have surgery, such as Caitlyn, who was treated after being found with her mouth taped shut, or have a medical condition that requires long-term care, surgeons and internists have the same goal: the best health possible for the patient.


As most of our readers know, Dr. Perry Jameson is a veterinary internist, and I (Dr. Henri Bianucci) am a surgeon. We are both board certified in our respective specialties, treating dogs and cats that are referred to us by our colleagues in general practice.
Our jobs are similar in many ways. Cases come to us with a range of medical problems, and we diagnose and treat them with advanced diagnostic and treatment methods. Our clients are both the referring veterinarian and the pet owner. The patient is brought to us by its “parent” so, in that way, we are like pediatricians.
The obvious difference is that most of the diseases I treat are handled surgically, while Dr. Jameson’s cases are generally treated with medications. His practice also is heavily weighted toward diagnostics, as many of the conditions he sees are not as easily diagnosed as those that need surgery.
Although our techniques and case management differ greatly, the greatest difference between our practices is psychological, not procedural.

For example, last week I received a call from Dr. Ashley Williams at our Mount Pleasant Emergency Clinic. It was about midnight, and she told me that a 3-month-old doberman pinscher had arrived in severe respiratory distress.  Minutes after arrival, the puppy went into respiratory and cardiac arrest. Dr. Williams and her team immediately intubated her and performed CPR. They got her back, and determined that she had a diaphragmatic hernia. This means the diaphragm was torn and the contents of the abdomen were occupying the chest cavity. This can cause difficulty breathing, but generally, patients don’t die immediately. That is, unless the stomach gets into the chest, as it did in this case. While the patient struggles to breathe, it swallows large quantities of air. Because of the stomach’s abnormal position, the air cannot easily escape, and as the stomach enlarges, it severely restricts lung capacity.  This puppy would not last the night without surgery. So Dr. Williams woke me up, briefed me and urged me to move it. I snapped to attention like a sleeper cell in a spy movie after being activated by a cryptic code word. My code here was “cardiac arrest.” That always gets our attention. I assembled our on-call team, and within 40 minutes we were in surgery.  We removed the stomach, pancreas, spleen, intestines and liver lobe from the chest, which successfully corrected the problem.

As I updated these clients on the phone the following day, and after having made a series of other calls to clients updating them about their cases, who also had been essentially cured surgically, Dr. Jameson expressed frustration.  “You always get to be the hero! Fluffy is doing great, Duke is cured; I can’t stand it. I should have been a surgeon,” he said.
He was joking of course, but in jest there is a truth, and he did have a point.

Most of my patients’ problems are essentially eliminated surgically. Some cases are not cured, some can’t be saved and some don’t even make it out of the hospital. Fortunately, these cases are the vast minority, but they are definitely the most stressful and sad cases. And, they take the most out of us.
As I listened to Dr. Jameson making his update calls, I realized the equation for him is the inverse. Many more of his cases have medical conditions that require long-term management, are terminal or in a steady state of decline. It is actually the minority of his cases that are completely cured.
I supposed that he is used to it and more immune than I am to the sadness and stress that accompanies these cases.
He assures me, however, that I am incorrect. Of course the impact of each of these situations upon pet owners is far greater than what an internist like Dr. Jameson feels, but they, too, become emotionally invested in these cases, and the cumulative effect can be tough to bear.
These professionals appreciate the special place that each of these pets occupies in their families, and the irreplaceable bond their owners feel. They understand the emotional impact on the owners of having a beloved pet who is sick or dying, and the effect of the void that will be left when they are gone. This is the majority of their cases, and the psychological toll it takes is very real.
Surgeons crave immediate gratification. The in-and-out case that recovers well, is cured, has no complications and the owners are happy is ideal and, fortunately, not unusual. These cases are our source of affirmation. So, what is the source of satisfaction for an internist? I have asked this over the years, and find their answer a bit more refined and cerebral than that of the surgeon.  I posed this question to Dr. Jameson. He said there is great satisfaction in the hunt for and attainment of a definitive diagnosis. This allows him to provide an answer to the owner of a suffering pet. The answer may point to a cure, but more frequently, it leads to medical therapy with the goal of extending length and quality of life. Sadly, sometimes the answer leads to an end-of-life decision.  In any case the owner is given the peace of mind of a defined situation, and whatever that is, it allows them to move toward an end to the suffering of both the patient and the owner.  Ultimately, that this is what surgeons are striving for as well. So, though we measure success differently, our goals really are the same.

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


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