Saturday, October 24, 2015

Date with your cat: vet visit

Michael was not impressed with her confinement but felt much better once the intravenous fluids kicked in.

Yesterday’s post was delayed due to an unforeseen feline health scare. Mike, a fifteen year old moggie I adopted way back when I was a veterinary student, had some spectacular vomiting and diarrhoea all night and looked pretty awful this morning. I have been monitoring her renal function as she’s had sub-optimally concentrated urine for a while (the beginning of chronic renal insufficiency?) so my worry was renal failure.

Over the last few months she has been drinking noticeably more (it’s kind of hard to ignore when you’re quietly reading in the bath and a cat jumps onto you, knocks whatever it is you’re reading out of your hand and drinks the bathwater).

But being a vet gives one plenty of ammunition for worry…lymphoma. Acute, fulminant, necrotising pancreatitis. Gastrointestinal obstruction. In the darkness of the night, when someone close to you is painting the bathroom with projectile fluids, you tend to skip over the common things and catastrophise. Like many others who live with a senior cat, when they become ill the big question is, is this the beginning of the end?

So yesterday Mike came into work, I ran a complete blood count, biochemistry panel, total T4 and pancreatic lipase and didn’t get a lot to write home about. Her creatinine was elevated a bit, her ALT was increased (it has been since I’ve known her, and a team of specialists have concluded: “meh”) and her lipase was high, but everything else was fine. This is consistent with early renal insufficiency although further monitoring needs to occur. Alas she had emptied her bladder so there was no opportunity to get a concurrent urine sample before putting her on a drip.

I organised imaging specialist Graeme Allan to pop in and perform an abdominal ultrasound so we could visualise the pancreas, monitor a renal cyst discovered by a colleague incidentally a few months ago, and measure the thickness her intestines. The verdict? The renal cyst remains but everything is within normal limits. Intestinal wall thickness: well below the biopsy threshold.

Michael's renal cyst. It is the dark circule in the middle of the pic with the + signs on either end and dots in the middle. LK means its the left kidney. Image courtesy Dr Graeme Allan, Veterinary Imaging Associates.
A better view of the left kidney. Itsthe thing in the middle of the screen that looks a bit like a knuckle duster. Image courtesy Dr Graeme Allan, Veterinary Imaging Associates.
Mike is a fairly extroverted character and spent the entire day reminding me (and everyone else) that she was there by vocalising quite assertively. As she rehydrated through the day she became brighter and brighter (and louder). Once the ultrasound was completed, she was allowed to eat at which point she threw her face into the food. After 12 hours on fluids, she’s home on a bland diet (she has already indicated she would prefer Fancy Feast, thanks very much) but skipping around the kitchen as if she were five years old again. So today we’re having a quiet one in. Well, I am having a quiet one in. Mike is having a ball.

When it comes to the animals I live with being ill, as a vet I try to keep two things in mind.

First, always do the very best I can for them. I’d rather be overzealous (within reason and ensuring no harm is done) than not, and ensure I treat them to the gold standard. If I am prepared to recommend it for a patient, I am prepared to recommend it to any patient, i.e. including those I live with.

Second, being in the shoes of the veterinary client is a good reminder of how stressful it can be, especially uncertainty about the severity of illness and prognosis (and lack of sleep). If you’ve not been there in a while it is easily forgotten. As a colleague emailed me only this week when she had to see another vet about her cat, “I was the crazy client all super worried about my pet. Interesting to be on the other side of that interaction for the first time.”

We have the benefit (sometimes more fuel for anxiety) of understanding terminology, of being able to ask the opinion of colleagues (“Hey, could you palpate this abdomen for me?) and of knowing what tests to do and what is involved, but it’s a good exercise in empathy. Being kept up all night, chasing a cat who has seen the cat carrier so you can get to the vet only for the cat to adopt the “starfish” position when you try to ease her into the carrier (no wonder some clients are late), and feeling awful because you can’t explain it to them is all part of the experience.

Right now the plan is to let Mike relax, keep her on a fairly bland diet then monitor her (urine, blood pressure and blood tests) for CRI. Right now HER plan is to break down my resistance and force me to feed her something a bit richer. No way, Mikester!!!

1 comment:

  1. Maybe some no salt chicken stock or spring water tuna juice to spice up I/d

    ReplyDelete

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