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Tuesday, March 31, 2009

When It Gets Personal

It's hard to be a doctor. There are a lot of decisions you have to make that affect your patient's life and well-being. Test results can sometimes be interpreted in different ways, and different combinations of results can mean different things. Not every case is clear-cut, and many are difficult to figure out. Many decisions have to be made on the path to a proper diagnosis and treatment. It's never an easy thing to do. It's even harder when its your own pet.

My oldest cat, Perceval, is 16. The summer before I started vet school I was working for a veterinarian in my home town. A litter of three kittens was dropped off for routine leukemia testing and vaccinations, and we did those services. The "owners" never came back for the kittens, and we quickly discovered that all of the information they provided was completely bogus. I ended up keeping one of those kittens, and he's been with me ever since. He has moved with me across the country several times, and has lived with me in seven homes in five states. In his 16 years he has seen us add two cats, two dogs, two kids, and a wife (not in that order!) to the family. He has taken these changes with quiet grace, and is older than any pet I have ever had.

Over the last couple of months he has started vomiting with increasing frequency, beyond what a cat normally will do. In the last several weeks we've started noticing that he has seemed very thin, quickly getting worse. He's always been a thin, lean cat, but this has been much worse. He is normally around 9 pounds, and last year was as low as just over 8. Today he weighed in at 6.6 pounds.

I took him with me to work today and ran a battery of tests. I ruled out kidney and liver failure, heartworm disease, hyperthyroidism, and several other diseases. Unfortunately, I wasn't able to make a specific diagnosis, and am still scratching my head. I have it narrowed down to two likely possibilities, and a host of lesser possibilities. One is inflammatory bowel disease (IBD), which is very treatable with steroids and diet. The other is cancer, especially intestinal lymphoma, which will require surgical biopsies for a definitive diagnosis. I'm beginning treatment for IBD and will see how he responds before taking the next step.

Situations like this are very difficult for a vet. No matter how close I am to a patient or a client, there is always a clinical objectivity that I can maintain. That's much harder when it's my own pet, especially one that has been my friend for a decade and a half. I'm faced with the prospect of possibly only having a few months with him or even less depending on what happens in the next few weeks. That's not easy, and it makes any decisions even harder. I've been faced with this on my own pets in the past, and it's never easy. At times like this, a vet is more of a client than a doctor, but has to play both roles. Vets can definitely sympathize with our clients because we are faced with the same decisions with their own pets. As I make choices about Perceval, I will have to weight the chances of successful treatment versus the cost. And yes, I do have to pay for services and medicines even if it's discounted, and I'm far from wealthy, so I do have to worry about money.

When it's personal like this, it's not easy. But I also don't want to turn over his care to anyone else, even though I completely trust my associate. I just need to go through the diagnostic process, try various treatments, and pray.

4 comments:

  1. Ooh sorry to hear this. I lost my Sydney cat six months ago, after a year of giving insulin every day, his little heart just gave up.
    Then out of the blue my Lily cat became sick. Thinking it was because she missed Sydney, I wasn't alarmed at first, but noticed her vommiting and starting to lose weight. Doc, did tests, and finally ended up doing exploratory surgery. Poor Lily, never made it out of surgery, she was diagnosed with stomach cancer..
    I wish i had taken her to her vet much sooner :(
    I hope it's nothing that serious.

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  2. I'm sorry to hear about your kitty. It makes me think of my dog who has been with me since I was 16. Arthritis and chronic renal disease slow him down but thankfully he's pretty stable and still plays ball a little. I know that it's super hard to maintain your professional composure with your own pet. I generally freak out and lose all sense of reason when one of mine is sick. I will definately be thinking about you-keep us updated.

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  3. You have captured our vet dilemna perfectly.... and I have been there twice. I have many pets, but only two of them have been really special for me. The ones I truly grieved for. One 16 yr old dog, one younger cat with nephrosis. They both declined slowly, they both required decisions from me - no quick or sudden leaving. I put both of them to sleep at home. Myself. When I was ready. No fear, no stress, and they trusted me to the end.
    All I can say - although I agonised over it, and dreaded the day, and grieved in advance, when the time came, there was no problem. All my years of vet training and experience told me when the moment arrived, that this was the last thing I could do, that to continue was selfish on my part, and that I could let them go in this way. I had the knowledge, the power and the ability...and I have never regretted it!
    I do feel for you - it never gets easier....

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  4. Thanks for the comments, everyone. I had to do this about 7 years ago with another cat, and it definitely doesn't get easier. I'll post updates on his condition.

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