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Thursday, April 21, 2011

The Frustration Of Not Knowing

I wish that we as doctors knew everything and could figure everything out.  Unfortunately, we can't.  And it bugs us to no end!

Yesterday I saw a cat for the first time.  The cat wasn't eating, and over a month or two had gone from around 24lbs to 17lbs.  On physical exam he was purring and happy with no obvious physical abnormalities other than an abnormally unkempt coat and some mild dehydration.  We ran a full battery of tests:  blood chemistry panel, CBC, thyroid screen, heartworm test, leukeima test, and AIDS test.  I was expecting to find a leukemia infection, hyperthyroidism, or kidney problems.  When all of the test results were in, my jaw dropped a bit.  There really weren't any significant abnormalities!  The ONLY problem I found was a mild increase in the white blood cells and an analysis of these cells leaned me towards inflammation.  That's pretty non-specific.  So this cat was losing weight rapidly, wasn't eating, and the only thing we could find wrong was some signs of inflammation hiding somewhere inside the body.  All of my normal possibilities went right out the window!  And unfortunately I was left with a thought of "I really don't know what the heck is going on here."

Thankfully this doesn't happen very often.  But it's also not the first time I've been faced with this (in fact, I may have blogged about it previously).  And it never gets easier to deal with.  As doctors we like to be able to find a problem and therefore be able to either fix it or relieve the pet's suffering.  When we know a pet is sick but can't figure out why, it can drive us crazy!  I mean, we know there's SOMETHING wrong, but for the life of us we can't figure out where or why.  With all of our skills, knowledge, and fancy equipment, sometimes easy answers simply elude us.  Not only is this extremely frustrating to us personally and intellectually, but it's bad for the patient as we can't effectively discuss a treatment plan without having a decent idea of what the problem is.

In this particular case I'm worried about cancer hiding somewhere in the body, especially the digestive tract, and have sent the cat to an internal medicine specialist for ultrasound and consultation.  Hopefully they will be able to figure out what is wrong and give the client more specific advice.

Honeslty, this is one of the reasons I really like surgery.  In most surgical cases you have a pretty straightforward situation.  Sure, you can be surprised sometimes and the unexpected does happen when you're exploring the abdomen.  But in most cases you're either cutting something out, sewing something closed, or a combination of the two.  Rarely is there the ambiguity you'll find with internal medicine cases.  It's often said by surgeons, "A chance to cut is a chance to cure."

Any veterinary students reading this, take the lesson to heart.  You simply can't figure out and fix anything.  That WILL happen to you, and you have to learn how to handle it.  Once you learn how to deal with this frustration, be sure and let me know so I can learn from you!