Monday, June 21, 2010

Tragic twists and turns

Last week one of my best clients said he was sending his dad's cats in to see me.  One of the cats had teeth trouble, and his parents' regular vet just kept giving steroids and antibiotics with no improvement, stating he was unwilling to anesthetize and take care of the cats teeth.  Since I am unafraid of anesthetizing older cats with our very safe protocol, and I love taking care of teeth, I encouraged him to send them in.

His sister ended up bringing in her very elderly father to the appointment, with the old cat, and the old cat's mother.  The cats had belonged to some neighbors who moved about 2 years ago, leaving the cats behind.  The old man had the cat in question sitting on his lap, and seemed delighted to meet me.  He grabbed my hand with both of his and smiled warmly when I introduced myself.  He was terribly hard of hearing, and seemed not to know exactly what was going on, but still enjoyed meeting people and connecting with them, especially if they were interested in his cats.

The cat in question was very friendly, but dried drool was all around his mouth.  His teeth weren't terrible, but there was a large mass under his tongue, with a necrotic center.  I relayed this information to the man and his daughter, continuing my exam.  The old man said, "Oh,"  and the daughter came close to me, and whispered, "His wife just died two weeks ago.  I don't know if he can handle this."

I finished my exam, reeling from this information.  Well, I'd better examine the cat's even older mother.  She weighed only 4 lbs (!), and had a pronounced heart murmur.  She seemed to have some labored breathing.  Oh, great.   The daughter and I left the old man with his cats to confer in the adjacent exam room.

"I am 95% sure that is a tumor under the cat's tongue," I told her.  "The only way I can be 100% sure is if we do a biopsy, but it will come back something bad like squamous cell carcinoma."  How I wished it was just a dental infection, something I could fix!  After conferring with me and her brother, we decided to euthanize the cat.  We sent off labwork on the older mother cat, and took a chest Xray, which showed an enlarged heart but no problems in the lungs.

The daughter thought it would be best to just leave the cat with us for euthanasia, and she would take her dad and the mother cat home, and let him know later what happened.  I brought her the permission form for euthanasia.  "Just initial here that he hasn't bitten anyone in the last 10 days," I said.

"But he has!" she said.  "He bit my dad last week, really bad, on the arm."

Oh no.  I checked the records faxed from their previous vet.  No history of a rabies vaccinations.  This was not good.

"Could you just look at his arm, and tell me what you think?" she asked.

"No," I said, "but here's what we're going to do.  After the euthanasia, I'll have to send the head to the state lab for rabies testing.  We can send the rest of the body for cremation."  Truly, since I am not a physician, I cannot give my opinion on a human's condition, and no one can tell by looking whether a bite has rabies or not.  But I do have to help protect public health, and by law this cat's brain had to be tested.

"What will I tell my father?" she asked.  I told her not to say anything; likely this cat had been vaccinated at some point in his lifetime, and in 24 hours we would have the rabies testing results.  If it came back positive, we'd let him know and deal with it then.

While the poor overwhelmed daughter finished the paperwork (remember, she'd just lost her mother two weeks ago, too), I went back into the room with the old man.  "You're going to go home with L. (the mama cat), and I'm going to take care of this one here," I told him.  "Okay," he said, "what was your name again?"  "I'm Jennifer," I said, dispensing with the dr. title, and we shook hands again.  He was so sweet and kind, and I felt terrible for him, but I knew it was the right thing for his poor cat.

Then, I humanely euthanized the cat and had the gruesome task of cutting off its head, and double bagging it for the lab.  Fortunately for us the lab is here in Austin; other parts of the state have to put it on  ice and send it via Greyhound.

The next day the results came back negative, and the mom's bloodwork showed some hyperthyroidism, a disease that is relatively easy to control with oral medication.  And there is talk of getting the old man a new cat, perhaps an adult cat from the shelter, one that also likes to sit in laps.


Lisa said...

Wow, what a day for everyone involved. At least it sounds like this family appreciated all you were doing for them. And your wonderful way with patients (animal & human) is the reason I tracked you down all those years ago. I'm so glad we are still friends!


Emily said...

What an emotional visit! I'm glad at least one of his cats was treatable.

And glad you were able to help them.

Krispy said...

WOOF! what a day!

Anonymous said...

You never cease to amaze me! So very proud of you. Love, M

get2eric said...

Great job!

Fratella likes laps......

Just kidding.

Angie said...

I'm training on rabies testing right now. Interestingly (and sadly) enough, some people do not seem to understand (or be told?) what has to happen to their pet to accomplish this. We have gotten calls asking us for results, followed up with asking when they could come pick up their cat/dog.

EdamameMommy said...

I shudder at the thought of being the lab tech or vet who gets picked to sever the head and package it up for testing. Eeerrrrr.