Consulting with Specialists

We had a horse come in with a runny eye on one side.  He didn’t seem to be bothered much by it, but his face was wet and a little gooky (scientific term: things with gook on them are gooky).  Now it just so happens that your tears are made in glands around your eye, they wash over your eye and they then drain into your nose and throat.  If you were a horse (Why the long face, buddy?), they would drain through a long tube (the nasolacrimal duct) that exits in the nostril.  You can actually see the hole about the size of a pencil lead.  When the tube gets stopped up, tears and mucus spill out of the eyelids instead, resulting in "gookiness" of the face.

Usually, you can put a little tube in the hole in the nostril and back-flush the duct to remove the blockage, thereby ending the gooky condition.  This horse was different, though.  I used different tubes and more pressure and nothing was working.  This is NOT a "use a bigger hammer" situation.  Now, admittedly I’m mostly a dog and cat repairman, but horses were once my primary interest and I’ve done this quite a few times in the last twenty-eight years.  Things were not going according to plan, so I decided to call a specialist at the University teaching hospital. 

See, I’m a general practitioner.  I’ve got to be a little bit of everything: eye doctor, dentist, pharmacist, surgeon, radiologist, dermatologist, internist, lab technician, groomer, janitor, baby-sitter, you name it.  This means that I can’t be a specialist expert in every one of those fields, to say nothing of being an expert in every field and every species.  That’s why it’s great to have access to people who are highly specialized, who see nothing but the weird, difficult cases in their narrow field of interest and expertise.  Few of my clients can afford to take their dog out of town to a veterinary oncologist (cancer specialist), but that doesn’t mean they don’t want the best possible treatment that they can afford.

I spend a fair amount of time on the phone with the faculty at the College of Veterinary Medicine.  In the last four years, we have had a specialty group in Memphis, Tennessee.  This group has an eye specialist, two internal medicine specialists, a top-notch surgeon, and a cancer specialist.  I also make use of top specialists across the country through the resources of VIN (Veterinary Information Network).  For a pretty significant fee, I post my cases over the internet with their history and labwork and pictures, and several nationally known specialists help me out when I need it.

In the early years, there were many things that I just hadn’t seen yet.  They really weren’t that tough. I’d get the consultation and they would tell me the answer that was so simple for them and so elusive for me.  I’d feel dumb, but happy that I had the answer to fix my patient.  That doesn’t happen so much anymore.  Oh, I still have lots of questions, but now they aren’t so easy to answer.  My signature line on VIN is "I’m lost, but I’m making good time."  By this I mean that I’ve done lots of diagnostic testing and investigation, but I still don’t have the answer.  This means that there are no simple answers for my case.   The specialists often compliment me on the thoroughness of my workup, and comment on what a challenging case it is.  I’d much rather have them  make me feel dumb and fix things for me. At least things would be fixed instead of "challenging".  (You don’t want to be a "challenging" case when you go to the doctor.  You want to be boring, dull, every-day ordinary.)

Back to the gooky-faced horse.  I told the Equine Center receptionist the general nature of my problem and they put an intern on to speak with me. Interns are very sharp young veterinarians who have graduated in the past year and are at the vet school for intensive training to become specialists.  I told her all that I had done and she replied, a little crestfallen, "I thought this would be an easier question… I’ll have one of the ophthalmologists get back to you." 

Twenty-eight years or one year twenty-eight times: I can do the simple stuff (and some not so simple).  It is nice to have specialists available when I need them.

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