Thursday, April 3, 2008

goonies anyone?

we euthanized a sad little kitty today. it was an interesting case. "one-eyed willy" (as i called her in obvious homage to the greatest teen flick ever) presented last week. she was previously diagnosed with hypertrophic cardiomyopathy (kitty heart disease), chronic renal failure, and retrobulbar lymphosarcoma (big cancer mass behind the eye - in layman's terms). the cancerous mass and its associated eye were removed. the remaining eye later developed a raging cataract (hypermature). a hypermature cataract happens when the lens of the eye has become so diseased that it ruptures and spills lens material out into the eye.

poor willy weighed a mere 4 pounds. she had an esophagostomy tube in her neck so that she could be fed (a tube that comes out of the side of the neck, so her mom could feed her slushy food). when she came in, mom mentioned that in the last 2 days she had begun dragging her rear legs.


first off - in a cat with heart disease - you start thinking that kitty threw a clot to the aorta and now there's no blood flow to the rear limbs. however - on physical exam - kitty's rear limbs were warm, there were pulses present, and the nailbeds were pink and oxygenated looking. yay!! right?

wrong. very wrong. if kitty's paresis (weakness) was not due to a clot...then what caused it? in a kitty with a history of lymphoma (cancer) and a cataract...the diagnosis couldn't be good. see - cats - unlike dogs and people - don't develop cataracts secondary to diabetes. when you see a cataract in cat - you look for anterior uveitis and chorioretinitis (inflammation of the deep structures of the eye). AU and CR almost ALWAYS represent systemic disease -- especially cancer in an older animal (other diseases are also possible). so we had a cat suddenly down in the rear end, with a history of lymphoma, and a cataract. our suspicion was that the lymphoma was back and it was in the spinal cord.

we stabilized willy, replaced her e-tube, and sent her home so that mom could say goodbye (last week). she came back this morning. a tiny, soft, sweet, blind little grey tabby - i had fallen in love with her in the brief day she was my patient. when she came back this morning, i was sad to see her go, but i knew it was the right thing for her.

necropsy confirmed the presence of a large mass in her spinal cord - exactly where our neuro exam localized it. pending histopathology, we hypothesize lymphoma. it was gratifying that the owner was very pro-necropsy - agreeing that examining her kitty's body was important for research and learning. and it was fantastic to see that our diagnosis was bang-on.

it was still very sad to see one-eyed willy leave us.

otherwise, i am very very sad that in 3 days, i will pass through the gateway to hell. there lies madness. i

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