Monday, January 29, 2007

A difference in care

It is only 7 pm, but both kids are in bed, with dueling cases of strep throat. Colin actually has scarlet fever, the variety that gives him a lovely rash all over his chest and back. It sounds very serious, but fortunately with antibiotics, they are both on the mend.


When I worked on Saturday, I had a euthanasia of a 10 year old dog who looked sadly a lot older. The last time we saw her was 8 months ago, and at that time they declined much work up or treatment of her geriatric problems. She had hypothyroidism, the world's easiest disease to treat - just give your dog a little pill twice a day - but they never refilled the initial prescription. By the time I saw her on Saturday, she had scruffy skin and generalized muscle atrophy. The tartar on her teeth was so thick it made her little cheeks bulge out. The periodontitis had now caused a heart murmur (the bacteria in her gums had spread to her heart valves). She was incontinent and had difficulty rising due to osteoarthritis. Although there were treatments we could have done to help her, they would have been more effective months ago. Given her owners, I agreed that euthanasia was the most human solution. Her owners seemed very sad to see her go, but inside I could not help but question their devotion to her.

Quite a contrast to the day before, when I euthanized a favorite patient, a cat named Velcro. He was a very cool feline who presented to me yellow back in November. He had a combination of pancreatitis and hepatitis that initially responded to our treatment of fluids, antibiotics, and nutritional support. After a few days of hopitalization, he was ready to go home. I was surprised when he came back even yellower a few weeks later. He had stopped eating, too, although he was as amiable as ever. Our medical treatment was not improving him, so after conferring with an internal medicine specialist, we decided surgery was the next step. His owners had good queries about his case, but did not question my judgement, or balk at the cost of anything I suggested.

I stood, gowned and gloved up, over Velcro's yellow abdomen, and took a deep breath. "I might not be able to fix him," I thought, scalpel in hand as I made the long incision. I was expecting to find a cancer the ultrasound probe had missed. Instead I found a distended gall bladder and bile duct. He had developed an obstruction in the duct and the bile was backing up into his liver. With my boss's assistance, we flushed the bile duct and removed the gall bladder. I also biopsied everything. At this time, his pancreas looked normal, not at all inflammed.

The biopsies came back clear of cancer, and Velcro quickly improved. I was elated that I was able to "fix" him. On subsequent rechecks, his liver enzymes got better and better.

Then he came in because he'd stopped eating. He was yellower than ever. His bile duct was obstructed again. I referred him to a surgeon who said he could cannulate the duct, but that even with surgery, his prognosis was poor. His owner elected to take him home, and he actually started to eat again. They decided to manage him at home until he took a turn for the worse.

Unfortunately when I saw Velcro's name on my appointment book Friday, I knew that day had come. He had lost an entire pound, most of it muscle. He was so yellow, he looked like a green highlighter. I have never seen a patient so jaundiced. Everyone knew it was time to let him go. He purred, as usual, as I placed the IV catheter, but it was obvious he was ready.

Later that day, after I composed myself, I opened up Velcro's abdomen. His pancreas was terribly swollen and inflammed, with small abcesses all over it. He must've been miserable. Also, a band of scar tissue had formed over his bile duct, squeezing it off from his intestines. This was in the area of the pancreas, and the inflammation there must have caused this fibrotic band. His liver looked terrible compared to his surgery, just six weeks before. I hated that despite all our efforts, we could not fix such a great cat. He kept his dignity though, even up to the last moments, and thanks to his loving owner, we knew we had exhausted every course of treatment.


EdamameMommy said...

Wow. Here's to Velcro. Wouldn't the world be better if we could all manage to purr in the face of pain and death?

Leah said...

Velcro was a wonderful cat. He will be missed.

A.Norma said...

Awwwwww. :o( xx

Emily said...

Oh, I have tears in my eyes. You handle it all with such love and grace.

Hope Anna & Colin are better soon.

ColeBugsmommy said...

I also wish there would be some standard of care with pet owners, although I guess you could say the same about parents.

I hope the kids get better soon. We had to make another trip to the doctor tonight, because in addition to the strep, and ear infection, today Cole had a bright red rash on the right side of his face. Stay healthy!

Lisa said...

Emily said it all.