Friday, November 23, 2012

Blue Pearl Veterinary Partners: Malignant Sarcoma Misdiagnosis and UNNECESSARY Amputation by Dr. Jennifer Huck, DVM

This is Charlotte's story and I am here to share the EXTREME level of oversight and inattentiveness demonstrated by the doctors at Blue Pearl Veterinary Partners NYC. Because of oversights and neglectful actions, Charlotte's front left leg was AMPUTATED to cure her from a cancer that it turned out she never had.  

I’m from Brooklyn, NY and so is my cat, Charlotte. We met about 10 years ago at a nearby veterinarian’s office, when I adopted her. Charlotte and I have been through so much together and she is honestly one of my best friends. 

Monday, September 24nd, 2012. 
I had noticed Charlotte limping for a few days and decided to monitor it to see if it would subside on its own. She continued to limp intermittently and then began keeping weight off of one her paws. I took a closer look and felt a bump on her left front leg. I thought perhaps she had jumped off of something while playing and had hurt herself.  I called my regular veterinarian and made an appointment. 

Tuesday, September 25, 2012.
Went to the vet to have Charlotte’s leg looked at and x-rayed. At the vet’s office, Dr. ____ observed Charlotte walking, but she wasn’t limping. Dr. ____ did a physical examination and was able to feel a bump. 

She then did 2 different x-ray views of Charlotte's front left leg and was able to see a small mass in the images. Dr. ____ explained that the machine at her office was not the clearest lately and that to get a more definitive answer, I should have it looked at by a specialist. She gave me a referral to see Dr. Jennifer Huck at Blue Pearl Veterinary Specialists (NYC Veterinary Partners) to have an aspirate and cytology done. The next day, I made an appointment with Dr. Jennifer Huck at Blue Pearl.

Thursday, September 27th, 2012
My first visit to Blue Pearl Veterinary. I wish, now, that I could turn back time. 

My mom and I took Charlotte to see Dr. Jennifer Huck at Blue Pearl to have the mass looked at, get an FNA (fine needle aspirate), and cytology done. First, Dr. Jennifer Huck did a physical examination, during which she felt a mass in Charlotte’s left front leg. Dr. Huck manipulated it to see if it could be moved around…she said that it was not fixed in place that it was movable. After this part of the exam, Dr. Huck and a vet tech took Charlotte upstairs to do the fine needle aspirate in order to have the cytology done. The cytology, as Dr. Huck told us, would give us a definite answer as to what the mass was.  The aspirate was completed and I was told that I would have the results within the next couple of days. Later that afternoon, Dr. Huck called and left a message saying, in a cheerful tone, “by some miracle I did get back Charlotte’s cytology report this afternoon.” I immediately called Dr. Huck back. 

The news she gave was the complete opposite of what her tone of voice had suggested in the message. I was obviously hoping to hear that Charlotte was fine, but instead, Dr. Huck told me that the mass WAS indeed malignant. She said she had consulted with a veterinary oncologist at Blue Pearl, Dr. Joshua Lachowicz, on the results of Charlotte's cytology report.  She then explained the treatment options that the two doctors had discussed regarding Charlotte’s case: removal of the mass followed by chemotherapy OR amputation. Amputation? My entire body became numb and began to tremble the second Dr. Huck had said that word. She stressed that based on the findings she felt the BEST curative action would be amputation. I was shocked, shaking.....and completely speechless. Dr. Huck said the next step, before any treatment action was taken, was to get x-rays of Charlotte’s lungs and chest to be sure that the cancer had not spread. After this, Dr. Huck said, surgery could take place. Dr. Huck never mentioned biopsy and presented the cytology report as a DEFINITE CANCER DIAGNOSIS. I made an appointment for Charlotte’s chest x-rays for that Saturday September 29th at the Blue Pearl Brooklyn location.

I got off the phone and tried to process the news that my sweet Charlotte had cancer and that Dr. Huck had said amputation was the best treatment. I called my regular vet and told her what was going on. She agreed that the next step should be chest imaging to check for any signs of spreading. My regular vet suggested setting up a consultation with Dr. Joshua Lachowicz, the oncologist with whom Dr. Huck had involved regarding Charlotte’s cytology.

Friday, September 28th , 2012.
I called Blue Pearl to set up an appointment with Dr. Lachowicz at the Forest Hills office, for Tuesday October 2nd. 

Saturday, September 29th, 2012.
On this day we went to Blue Pearl in Brooklyn to have chest x-rays done. Did not meet with any doctor. Charlotte was taken in her carrier to have x-rays done and was brought back out to waiting room when the x-rays were done. The vet tech said that Dr. Huck would call on Monday with the findings of the x-rays. 

Monday, October 1st, 2012. 
Dr. Huck called and said that the x-rays showed no evidence of metastasis in Charlotte’s chest.  She said that this meant that the cancer was localized to the mass her leg. Dr. Huck talked about the treatment options again (removal or de-bulking the mass, followed by chemotherapy OR the alternative, which was amputation). She said that amputation would be the best option. I told her that I had made an appointment with veterinary oncologist Dr. Lachowicz to discuss options in more depth and have him involved in the treatment process, as he was already familiar with Charlotte’s case.

Tuesday, October 2nd, 2012. 

Blue Pearl Appointment in Forest Hills with Dr. Lachowicz. This appointment began with a physical exam.  Dr. Lachowicz then examined Charlotte more closely checking for any other bumps. He said that he had been reviewing Charlotte’s chest x-rays and saw a small “area of concern” that may need to be rechecked at some point. That alarmed me a bit, as Dr. Huck had not mentioned this at all. She had specifically told me that the x-rays were clear. We then discussed the treatment options. Dr. Lachowicz then said that there was a very minuscule chance that the mass was not malignant.    Dr. Lachowicz did not give me a basis for that.  I asked him how can cancer cells show up and be present in a mass that isn’t malignant. He quickly answered by saying that pathologists don't usually over interpret results. DR. LACHOWICZ ALSO DID NOT DISCLOSE TO ME THAT THE PATHOLOGIST REPORT STATED THAT "reactive fibroplasma" CAN MIMIC A MALIGNANT SARCOMA. He said that the best way to know what the mass was, would be to do a CT scan followed by biopsy of the mass, to see if it could be removed. Dr. Lachowicz told me the cost for CT scan, mass removal and radiation therapy was significantly higher than any other option, but I would do anything within my means to help my Charlotte, SO I PLANNED TO GO FORWARD WITH BIOPSY. It seemed as though having the CT scan and biopsy was a more sound path, instead of rushing into the severe amputation surgery as Dr. Huck had proposed.

Dr. Lachowicz then suggested that we set up the appointment for the CT scan and biopsy at the Blue Pearl Veterinary office in Manhattan on a day that BOTH he and Dr. Huck would be there. I was relieved that the two doctors would be involved the day of the scan to assess and suggest the best course of action. The soonest date was Monday, October 15th, 2012. I felt as though I was definitely making the best choice for Charlotte by having more tests done to get a conclusive answer. 

Later that afternoon, I received an email from Dr. Lachowicz summarizing the appointment and restating his treatment advise. In the closure of his email, Dr. Lachowicz wrote," The more aggressive the treatment, the better the opportunity for long-term control.  If no further therapy is planned, then treatment is largely palliative and may only keep Charlotte comfortable for a few months."  The doctor's words emphasized the severity of Charlotte's situation.

Wednesday, October 10th, 2012. 
I had some questions about the upcoming appointment, so I called Blue Pearl to speak with Dr. Huck and touch base before the CT scan and removal. The receptionist told me that Dr. Huck was not working that week, but an email message would be sent to her and she would call me back. 

I left a message, but still felt anxious about the upcoming appointment, so I emailed Dr. Lachowicz. He explained again, the treatment plan for Monday; which involved the CT scan, removal (or partial removal) and again said the best way to know what the mass was, was to biopsy it, which was my plan for the October 15th appointment.  In his second email to me, Dr. Lachowicz specifically said, he would "have to see something "extreme" on the CT scan to forego biopsy of the mass itself and proceed right to amputation considering the findings and our discussions thus far." This clearly stated that only in THE MOST EXTREME CASE, would they consider amputation as the next step.

After getting the doctor's reply, I felt a little more prepared to go in on Monday to Blue Pearl, for the CT scan, which, I was told, would inform the two doctors as to whether or not the mass could be removed. If the mass could be removed, they would and it would be biopsied. If it couldn’t be removed because of the location, a small portion of the mass would be removed for biopsy. Dr. Huck never called back or reached out before the October 15th appointment, the day of the procedure. Based on my conversations and emails with Dr. Lachowicz, I felt assured that the correct steps were going to be taken based on what he and Dr. Huck found in the CT scans on Monday. 

Monday, October 15th, 2012. 
Looking back, I can honestly say this was one of the worst days of my life, having to make the decisions that I was forced to make in such a rushed and insensitive way.

We got to the Blue Pearl Veterinary Specialists in Manhattan around 8:00 am and were told to take a seat in the waiting room. After about twenty minutes, a vet tech came out to the waiting room with some papers to fill out. She went over the procedures for the day and then showed me a long and complicated itemized invoice with a “low” and “high” estimate of the procedures to be done that day. I was then given a form to fill out about resuscitation and life support. Once everything was signed, the vet tech took Charlotte to be prepped for the CT scan. She grabbed the carrier and proceeded to walk away. I stopped her to  give my girl a kiss before she went under anesthesia for the CT scan and possible mass removal procedure. I paid in full the "low" estimate on the invoice and was told that Dr. Huck would call me in a few hours when the results of the CT scan had been viewed and discussed. 

I walked around, waiting for the phone call that the CT scan results were in. Dr. Huck called about an hour later asking me to return to the office to go over the findings of the scans.I returned and Dr. Huck brought up the CT images on a computer screen in the reception area. She told me that the situation was more serious than they had thought and that mass was closely associated with a bone near it. Possibly, Dr. Huck said, the only way to remove it would be to take a small portion of the bone. She again stated that the best course of treatment would be amputation and that cats adjust well and that she would still be able to get around. My mother, who was with me, asked if the mass would be removed for biopsy. Dr. Huck was adamant and said the mass should not be disturbed at all and the entire limb would need to be removed and sent for biopsy/histopathology. To hear Dr. Huck say that amputation was the best course of action and that the mass should "not be disturbed" was alarming and devastating. Biopsy was not mentioned at all by Dr. Huck.  She had said the mass should not be disturbed. As Dr. Lachowicz had told me, they would “have to see something "extreme" on the CT scan to forego biopsy of the mass itself and proceed right to amputation.” This seemed to be that "extreme" situation as evidenced by Dr. Huck’s reluctance to touch the mass. 

Dr. Huck said she would give me some time to think about it. Still in the waiting room, I was completely stunned, thinking about the options that Dr. Huck had presented, and what Dr. Lachowicz had said to me about this situation. I sat there sobbing at the fact that I had gone there simply to have a CT scan and removal of the mass followed by biopsy and it had come to this. I was putting my trust in these two veterinary specialists, taking their advice as to the best treatment plan, which Dr. Huck unequivocally said would be amputation. 

Dr. Huck came back out to the waiting room about fifteen minutes later to see if I had made a decision. I asked her what she would do if it were her cat. She hesitated for a second and then clearly told me that she would amputate. I then made one the hardest decisions of my entire life and decided that the best way to save Charlotte’s life from this malignant tumor, was to follow the advice of the doctors at Blue Pearl and amputate. As soon as I said it, Dr. Huck rushed away.  I felt like she had just left me hanging.  She came back into the waiting room a couple of minutes later and said she was being paged because Charlotte was being kept anesthetized through all of this.  She again said that this was the right decision and rushed away again. The receptionist told me that I would get a phone call from the doctor when the procedure was over. I again left and just walked around waiting to know how Charlotte was doing. The whole time, I thought about Charlotte lying on the operating table. I comforted myself that Dr. Huck and Dr. Lachowicz had been guiding me toward what they said was the best treatment plan. 
Dr. Huck called a few hours later, saying that the surgery was successful. Charlotte was in the “ICU”, area and would be monitored overnight. I was told I would be called later that evening with an update of how she was doing. I got a call later that night saying that Charlotte was doing well, breathing well and curled up in her cage. 

It was so lonely that night not being with her, thinking that she was waking up in a cold hospital cage, realizing that something was very different about her body. 
Tuesday, October 16th, 2012.

I called Blue Pearl in the morning and spoke to a vet tech who had gone in to check on Charlotte. She said her vitals were good, she was doing well, and had eaten a bit. I was relieved that she seemed to be doing okay considering everything she had been through.
  Later in the afternoon, the doctor who was on rotation at Blue Pearl called and left a message saying Charlotte could be picked up that day. When Charlotte was admitted the day before on Monday, they had said she would be there until Wednesday in order to monitor her heart murmur. I felt more comfortable having her closely monitored at the hospital, so I called Blue Pearl to have her remain over night and be picked up on Wednesday afternoon. That night I spent rearranging my apartment. I knew that the healing and adjustment process would be hard and painful for Charlotte, so I took all of the tall furniture out of my bedroom and made everything low so she wouldn’t be tempted to jump up.
 It was another lonely sleepless night without my girl. 

Wednesday October 17th, 2012. 
I called Blue Pearl in the morning and she was doing well and eaten some more. I couldn’t wait to have Charlotte come home, but was nervous about seeing her.

I got to Blue Pearl NYC at around 4:30 to pick Charlotte up . After waiting anxiously for about an hour in the waiting room, I was given another invoice with the remaining balance to pay before they would even bring Charlotte out.

We waited another hour and finally a vet tech brought her out swaddled in a blanket under one arm with her carrier in his other hand. He said that she was doing well and had "used the litter box". The vet tech explained how we should take care of her sutures, the medications to give her, and other hospital discharge instructions. At no time during that visit did a doctor see us and we were once again, only seen in the waiting room. At the time, I didn’t even think of that it was odd we were not in an exam room. I was just happy my girl did well and was on her way to recovery. 

All I could think was that she was a survivor. We went home and began the first day of a new chapter in our life together. When we got there, I brought Charlotte into the bedroom where she would be confined until she was healed.  She found the little “bed” I had made for her out of a fluff of blankets on the floor and went right to it. That night, I left the light on and watched her. I drifted in and out of sleep on the floor next to her, staying close to keep her warm and make her feel safe.

Thursday October 18th, 2012.

Woke up in the morning and Charlotte was up on the bed, which is only six inches off the ground, but still an accomplishment for a cat who had just undergone such an invasive surgery. That first full day was hard...I didn’t want to leave her alone even for a second. She just seemed shocked and traumatized, her eyes huge as saucers from the pain meds. She flinched and twitched at every sound. The night before, I had looked at the incision site the, but when I looked on this day, her skin was even more discolored. Charlotte’s entire “torso” area was severely bruised and red. 

Friday, October 19th, 2012. 
I slept next to Charlotte on the floor again and woke up to her straining to urinate in the litter box. Called Blue Pearl at 5:30 am in Manhattan. I explained that she hadn’t urinated in over 24 hours and was going to the box but not producing urine. The doctor on duty said that there was no emergency or it could be a blockage (which is actually serious) and that I could either wait for my regular vet to be open or go to the Brooklyn Blue Pearl location. 

I decided to go to Blue Pearl Brooklyn. Got there at about 6:30 a.m. and was seen by a vet tech who examined Charlotte and said that her bladder didn’t feel full and that she probably just didn’t have any urine. He said he could spare me the emergency visit fee instead of seeing the doctor and that maybe I should just wait for my regular vet. I said no and opted to see the doctor on duty at that hour. The doctor came in and examined Charlotte listened to our concerns, slightly dismissing them as we spoke. She looked at the severe red bruising all down Charlotte’s side, down away from where the incision was. She said that it was normal. Then, the doctor brought Charlotte into a room with a litter box to see if she would go. Ten minutes later, the doctor came back to the waiting room holding a little container with a reddish liquid. She said there was blood in Charlotte’s urine, which could have been caused by an infection or possibly stones. Had urinalysis and culture done. 

Tuesday,October 30, 2012. 
Suture removal day. Brought Charlotte to Blue Pearl Brooklyn to have Dr. Jennifer Huck remove the sutures. She was brought upstairs to have the stitches taken out. About 15 minutes later, Dr. Huck came out with Charlotte in her carrier. She said everything looked good, the incision was healed, and the sutures had been removed. Dr. Huck said that the histopathology report has not come back yet, but her lymph nodes showed no signs metastasis.  At the time, I didn't even think to ask how she knew there was no sign of spreading if the histopathology report had not come back yet. 

I expressed my gratitude to her for everything she and Dr. Lachowicz had done.

I wish I could take that back now. 

Tuesday, November 6, 2012. 
4:28 p.m. Dr. Huck called with the findings of the histopathology. I picked up and her voice was very upbeat and cheerful as she told me the report had finally come in. I thought, by the tone of her voice, that the treatment path she strongly advised had cured Charlotte of this malignant sarcoma. The same “malignant” mass Dr. Huck had said she did not want to disturb, on the day of Charlotte’s surgery.

But that was wrong. 

Dr. Huck began by saying that the report showed that there was “NO EVIDENCE OF SPREAD”. She continued in the chipper voice, saying that it was actually something called OSTEOCHONDROMA, "which is more of a BENIGN process and not a malignant process." She went on, saying that she was definitely frustrated by this. I was frozen. I felt completely sick. Sick that I had trusted and put faith in Dr. Huck and Dr. Lachowicz. I believe all I said to her was, “Wow, thanks.” And I hung up. I paced back and forth, crying. 

My girl was changed for life...mutilated...for no reason at all? No cancer? How was this possible? I had followed the treatment advice that these two veterinary specialists had given me on the day of the CT scan.  My mind still cannot wrap itself around the fact on the day of the scan, I was told that the situation was more serious than they had thought.  Even if Dr. Huck thought that the mass was more difficult to remove because of the location, biopsy should still have been presented on the day of the procedure, which it most definitely was not. Dr. Lachowicz specifically said that, he'd “have to see something "extreme" on the CT scan to forego biopsy of the mass itself and proceed right to amputation".  Both doctors were present at Blue Pearl NYC on this date, as that was the plan laid out in my appointment with Dr. Lachowicz, and I was advised on that day that amputation was the best course of action. After viewing the CT results, I asked Dr. Huck what she would do if it were her cat.  She quite clearly told me that she would AMPUTATE if it were her cat.  My appointment on October 15th had only been for the CT scan and a biopsy. My plan after that was to have the mass removed for biopsy, or a portion of it.

Wednesday, November 7th, 2012. 
Called Blue Pearl to have Charlotte’s entire medical record mailed to me. 

Friday, November 9th, 2012. 
Called Blue Pearl back to see if records had been sent. They had not, so I decided to pick them up. 

Saturday, November 10th, 2012. 
Went to Blue Pearl in Brooklyn to pick up Charlotte’s records. The receptionist handed me the package. I walked out to my car and opened it, my hands shaking, wondering where these two veterinary professionals had gone wrong This just should not have happened. I began reading the medical file that was given to me; from the initial appointment all the way through.  I WAS SHOCKED. There was information missing. But not only was information missing, but there there was VITAL INFORMATION NOT DISCLOSED BY DR. HUCK from the original cytology report. Although one email correspondence from Dr. Lachowicz was present in the record, the email in which he stated that he to proceed with amputation he would need to see something "extreme" on the day of October 15th was nowhere to be seen. I happen to have ALL emails and correspondences saved. 

Wednesday, November 21st, 2012.
I've had some to begin to digest this and recount all of the occurrences of the past few months.  I've spent time adjusting to Charlotte's new needs and she's doing very well adapting. I've been through every emotion; anger, sadness, doubt, bitterness....and realize that regretting having gone to Blue Pearl is pointless, because, bottom line happened.

Replaying the past two months in my mind, I am just completely devastated. Piecing together Charlotte's medical file, some written by Dr. Jennifer Huck and some written by Dr. Joshua Lachowicz.  IF DR. HUCK HAD RELAYED THE ENTIRE ORIGINAL CYTOLOGY report to me, my course of action as to Charlotte's treatment would have been have significantly different.  On September 27th, when Dr. Huck gave the results to me over the phone she NEVER REVEALED THIS MAJOR detail that was written by the pathologist in the report.  In the medical file, Dr. Huck did NOT NOTE THIS MAJOR DETAIL.

I've wondered whether or not Dr. Huck and Dr. Lachowicz care at all that they "dropped the ball" on Charlotte's case.  There was no sense of sadness, empathy, feeling, or caring at all in Dr. Huck's voice when she gave me the results of the histopathology telling me the mass was BENIGN.  To not take any sort of accountability or even exhibit some common human decency by saying, "Sorry, that this happened." completely beyond me.
(charlotte one week before the amputation)