Wednesday, January 07, 2009

Do it right the first time.

My last appointment of the day was with a new client with a sick cat. She told me she'd had the cat spayed last year, but ever since then she acted like she was going into heat every few months. She thought that the vet did a bad job, so she consulted another vet who told her that cats with a bladder infection act like they are in heat. He diagnosed a bladder infection and put her on antibiotics. She got a little better, but now was much worse - hiding and not eating.

I frowned. "Bladder infections don't make cats act like they are in heat, but they can make them urinate outside the litter box." She'd been doing that, too, but now she had vaginal discharge. I explained to the owner that remaining ovarian tissue is what causes "in heat" behavior. Prolonged exposure to estrogen from the ovaries can hypertrophy the uterine remnant left behind after a spay, which then can become infected.

This girl was sick - dehydrated, listless, and weak. I took her back for an ultrasound. I could see two black fluid filled shapes: one was the bladder, and another mass was behind it. I tapped the bladder with my needle and got urine. I tapped the second one and got pure pus. My suspicion was correct - uterine stump pyometra.

I explained to the owner her sick kitty needed surgery immediately to remove the infection that was killing her. "You do this surgery?" she asked. I assured her I could do it; I would call home and say I was staying late to do it - she needed it now. "Don't worry," her nice sister, who brought her to our clinic said, "You are at a REAL animal hospital now."

I was hoping I would be able to find the offending ovarian tissue. Sometimes if the patient is not at the height of estrus, the tissue is small and quiet and easy to miss when its no longer attached to the uterus. Or sometimes some small cells can drop from the ovary into the abdominal fat and set up shop - that too can be hard to find. Fortunately for me, this was not the case. My patient had at least half an ovary ON BOTH SIDES, covered with follicles, right where they should be.

The previous vet had also left quite a uterine remnant, which was now swollen with pus. It was at least 15 times normal size. After aspirating the infection out, I cut it short and closed it with an inverting suture pattern so the infection would not leak into the abdomen.

We took lots of pictures and saved the tissue to prove the problem. The owner said she would go back to the first vet and at least get the cost of the original spay back. She told me which clinic it was, and unfortunately this is not their first mess that I have had to clean up. As tactfully as possible, I let her know that she absolutely should go back to them and ask for payment. I saw the patient the next day and she looked perky and hydrated. Finally.

8 comments:

get2eric said...

Wow. Some poor surgery going on there.
What can be done about this kind of ineffective practice?

Emily said...

Amazing. Way to go on your diagnostic and surgical intervention!

EdamameMommy said...

Are you bound to report them? Have them brought before the review board? Sounds like they are completely inept. So glad she came to see our VetMommy. Great save-the-day story!

Laura said...

I don't understand how hypertrophy of the remnant leads to infection. Got a ref you can recommend?

Sounds to me like the other vet is either inept or that they just don't care enough to do a good job.

Anonymous said...

Jennifer that is an amazing story and as usual you came to the rescue of that poor Cat and her Owner..you did well,Girl! xx
A.Norma.

premenopaws said...

*Boggle*

Leigh-Ann said...

I'm so glad the owner persisted and ended up with a caring, competent vet. I'm sure both owner and cat are having a wonderful weekend and looking forward to better days ahead!

taryn said...

Hi,

As someone who has applied to vet school, I've been lurking on your blog for awhile now. I decided to stop lurking when I read this post. I am getting ready to start interviewing at vet schools, and in some of the practice interview questions I've read online this topic (sloppy care by other vets) has come up. I was wondering if in your opinion, it is appropriate/necessary to take some other action, other than telling the client they should demand their money back. Is this something one should report to the state veterinary board, etc? If you wouldn't mind answering some other ethical questions, I'd love your advice as I prepare for my interviews. You can email me at dlop at aol dot com. Thanks!