Diabetic Cats, Geriatric Clients, and the Mystery Malady
In the veterinary world, the pets are the patients we treat. Their caretakers are the clients who pay our bills. But sometimes it seems as if we play nursemaid and doctor to both our pet patients and their people.
Nowhere has this become more obvious to me than in a recent example provided by one cat, two very elderly clients, the disease of diabetes, and a telltale bottle of insulin.
Here’s the story:
Groucho is a cat I’ve known for almost a decade. In his day, he was a very fat and happy feline whose weight was always a struggle. Now he’s a cranky old man of a cat with grey in his whiskers, Metamucil in his crunchies, and diabetes in his system (don’t make fun, we’ll all be there soon enough).
Thankfully, Groucho’s been doing great on insulin for all six of the years I’ve been treating his diabetes — that is, until the past four months. Over that period of time he’s encountered three diabetic crises. Every single time he’s come in droopy, dehydrated, and in full-on disintegration mode. In other words, his diabetes was no longer under control … for seemingly no good reason.
Over this past weekend, Groucho suffered the third of these aforementioned episodes. During this period of time, he managed to display all of the following symptoms: vomiting, anorexia, weight loss, increased urination, and extreme listlessness. They were the exact same signs we saw the previous two times. What's up with that?
So you know, Groucho's getting old. Very old. He's about fifteen years old, and I know that's quite a ways for any cat, much less one who's suffered through diabetes for the past six years. I hold out no odd hopes, nor do his owners operate under any delusions. I have, however, been frustrated by Groucho's inexplicable decline. After all, nothing has changed over the past few months — nothing I can put my finger on, anyway.
But something's amiss. This I can feel with the sixth sense all veterinarians cultivate as part of their practice. I can always tell when something doesn't smell right. In this case, my money was on my clients, not on my patient's body (though I'm not delusional about his fundamentally unsound condition). Somehow, I expected a very human issue to be at the root of this mystery, especially since everything had come up negative on Groucho's tests. Sure, his liver wasn't doing what it should, but that's been an issue for years … so what's different now?
After much investigation, I decided to have his elderly owners in for a conversation. How are you feeding him? How are you administering the insulin? Can I see how you do it? Do you feel comfortable doing it? How do you make sure that it's being given twice a day, like you're supposed to?
OK, so this might seem like micromanagement, but what else was I supposed to do? Everything else checked out. As did this test. His owners, though undoubtedly aged, were handling Groucho's diabetes better than I might've expected for the average pet owner. How idiotic of me to have assumed that my heretofore trusted clients might now lapse on the basis of their geriatrically addled brains. In short, I felt like a schmuck for selling them out to the gods of lowest common denominator thinking. I'm more considerate than that, am I not?
Sure I am. That is, until they arrived the next day with the bottle of insulin they kept for Groucho at home. In this case, I had asked them to bring it in to spare them some of the costs of hospitalization. Unfortunately, the bottle arrived as if it had just emerged from the bowels of a Saharan tent. "Why so hot?" I asked, when alerted by an intrepid receptionist. "Well, he jumped at the injection whenever it was too cold. He just likes it better this way," Dad explained with a faraway look in his eyes.
Sure he does. Too bad this insulin no longer works now that they store it atop their dryer. No wonder Groucho's been suffering a diabetic's recurrent nightmare over the past few months. And you know what the worst thing is? His geriatric owners are diabetic, too. Which makes me think the human medical system's awash with cases like Groucho's; cases where everyone is willing to do what it takes to fix the ills in question … but where they don't always have the tools to know how to tinker with the nitpicky minutia involved in treating said ills –– especially when clear signs of dementia are starting to set in.
All of which makes me want to ponder the following: We know pets are great for the aged, but we also know the aged aren't always best equipped to handle them. How do we reconcile these two realities? It's a conundrum I've been increasingly treated to now that more adult children are looking for new ways to keep their geriatric parents stimulated and happy. And the solution is shockingly simple (aren't they all?): When the owners come to need a nursemaid, it should be obvious their pets will need one, too.
Dr. Patty Khuly