Sunday, March 4, 2012

Good owner, good cat = bad disease

It's an axiom of veterinary medicine. Good owners with sweet pets is always going to equate to something bad when they are ill. This past weeknight was no exception. I was presented with a sweet, older cat (11 years old). She'd been fine up until about a week prior to coming to seem me. The owner noticed that she'd been hiding frequently and less social than usual. Then, a couple days prior to seeing me, her appetite had dropped off. Then she'd stopped eating completely. She wasn't vomiting or having diarrhea, but had no interest in food, and she was becoming increasingly anti-social.

The owner was distraught. He explained he had a young child at home (15 months). He wasn't sure when his cat's appetite had dropped off, and he felt badly that he hadn't been "paying enough attention." He immediately stated that whatever testing was necessary, he would do.

I examined kitty and found a cat in good body condition. Her heart and lungs sounded good. She was mildly dehydrated. Her lymph nodes were normal in size, her skin was dry and free of ectoparasites. Her oral exam was unremarkable. Her gums were nice and pink, she had no string at the base of her tongue, no significant halitosis, no oral ulcers. Then I palpated her abdomen. Right in the middle, I held in my hand something lemon-sized and firm. I wasn't sure what I was holding, but I knew it wasn't good.

I hoped against hope that it was a colon filled with stool, although it really didn't feel like that. Or maybe an enlarged kidney compensating for a previously failed kidney. In my heart of hearts though, I knew what it was.

Xrays and ultrasound confirmed my suspicion. The kitty had a large mid-abdominal mass. It didn't appear to be associated with the spleen, liver, or kidneys, and I suspected it was growing from her gastrointestinal system. Gastrointestinal lymphoma is a very common cancer of cats.

I delivered the grim news to the owner and discussed options - exploratory surgery with removal if possible, histopathology if not (or euthanasia on the table, if appropriate), palliative care for a suspected cancer, or euthanasia.

He struggled with the decision, as he really, really loved his cat. In the end, he asked me my opinion quite bluntly. Without knowing what exactly the mass was, I couldn't give him an accurate prognosis. So I told him what my gut said. It was bad. After much deliberation, he elected euthanasia. With tears in his eyes, he held his kitty and said good-bye.

Afterwards, he kindly allowed me to necropsy his cat so that I could see what exactly I was feeling. I found this.

I aspirated cells just to confirm my diagnosis, and it was indeed a GI lymphoma. It was satisfying to know that I was absolutely right. It was a bitter satisfaction though, given the outcome for a kind father and his sweet cat.


Anonymous said...

The clinic I work at seems to have a similar rule, except ours is clients who bring their kids in with them. 95% of the time a client comes in with a kid in tow, especially new clients, their pet either has cancer or some other horrible malady. It's gotten to the point that I cringe every time I see a small child at work.

On a side note, I've just discovered your blog and have really enjoyed reading it ( not sure enjoyed is the right word for some of the stories, but you get my meaning). Please keep doing what you're doing, from what I've read you're one of the good ones =)

Nicki said...

Cool pics. Bummer situation.

foffmom said...

Forgive me for this may offend. As a physician, I am so envious that you can get diagnostic confirmation. Wow. I know, "we" get fancy scans and needle biopsies. But autopsies are rare things outside of forensics, and sometimes there are questions after a patient dies. And of course, a pathologist would do the autopsy.
One of many reasons I envy veterinarians.

WeldrBrat said...

11 years... difficult, but somehow fathomable. Odd, for me to be reading this right now. We have a male Persian mix, that just happened to end up with that nasty Cryptorchidism. (Took 3 years and an examination of his left rear leg after a bath to figure this out! lol) But...I don't get it. He behaves like a 3 year old, even today. And lately - I have that nagging bug in the back of my ear, trying to make me worry about him dropping dead in a moment's notice, without any warning. Your post is a perfect reason why. But he seems to enjoy the poking and prodding I keep doing around his gut. LOL