This story truly breaks my heart.

Isn't it fairly standard for veterinary clinic employees who handle animals to have rabies vaccinations? That would have avoided the additional heartbreak entirely.

In some clinics in some states, it is standard. On the East Coast, for example, the hospital I worked in (a big referral practice in Pennsylvania) paid for half the cost of my getting the vaccines ($600 total cost, of which they paid $300). The general practitioner I worked for on a relief basis did not have any vaccinated techs.

In other states, where rabies is not so endemic, it is not only not the standard, but prohibitively expensive ($1000 for the series in southern California, IF you can find a doctor who carries it, which not all do). Very few technicians I know on the West Coast have been vaccinated, and if they have it's due to school help (the two major RVT programs in SoCal give both financial and location help in getting the vaccines) or, again, being from a different state.

I agree that it would be a benefit to have all your animal-handling employees vaccinated for rabies, and in an ideal world they would be. But then all the costs at the hospitals would rise as well, to help cover the cost of vaccinating all the employees--or there would be very few employees, as if they were required to pay for it themselves I doubt many would do so, and if it was a requirement for being hired or staying employed, I think many would go elsewhere.

>>Isn't it fairly standard for veterinary clinic employees who handle animals to have rabies vaccinations? That would have avoided the additional heartbreak entirely.>>

Pre-exposure vaccination for rabies does NOT eliminate the need for post-exposure treatment. The kitten would have been sent for testing regardless of whether the tech was vaccinated.

As for the catheter, the kitten could have bitten just as easily while the veterinarian was locating a vein with a needle... and it would have been more likely to bite the owner (who would have been present). The owner would then have grounds to sue the veterinarian responsible for human injury.

At least small animal owners are spared the necessity of decapitating the pet on the farm. That's gruesome, and it's no fun transporting horse heads. Is this a difficult conversation? Of course, but most owners prefer the disturbing mental picture to a human loved one (or even me, though I'm vaccinated) dying of rabies.

Rabies is a fatal zoonotic disease. People's lives are more important than feelings about dead animals, beloved as those animals might have been in life. "It was on them to watch themselves" - people with attitudes like that are the reason the rabies testing laws exist, and grounds for being refused care by my practice.

...a whole horse head. What a difficult task. I do not envy you that. It does lend some additional perspective on why public health departments and state labs do not accept entire cadavers. For a tiny kitten, btw, my local public health department did take the whole body. But then, I drove it there myself and appealed personally. It's not reasonable to expect that veterinarians always do this.

Is there any possiblity that a cure for rabies would be found in the future? I know that the Pasteur Institute in Paris is the only manufacturer of the vaccine and the subsequent antidote therapy (they were undergoing rennovation about 1.5 years ago and the vaccine was low in supply).
Why has no progress been made in erradicating this disease after nearly 200 years?

"of course the test came back negative."

I've seen lots of animals tested for rabies and "of course" the test comes back negative 99% of the time... but there is that surprising one percent that comes back positive which leads to people getting the appropriate post-exposure prophylaxis and completely justifies all the testing. If we never tested animals that "of course" should have tested negative, we would miss the rare but real few cases of rabies that we see.

Hey Doc, I did submit to you a rather long commentary on Mallo and the whole mess! I hate to make it more about the rabies debacle; I am concerned about this disease and how he suffered. I will have to try to find out about the other cat, whom I believe was older, being treated for this. Another note I thought of for what it's worth; I don't believe many people seem aware of the rabies test as far as the laws and what it actually is! Just from telling a brief story of Mallo to a few, they just look at you when you talk about the rabies thing and probably wonder why your are beside yourself. Then you tell them what the test is! Anyway, I feel almost as drained as when this all happened, and shed a few more tears too. I do understand all you had said in your post; I am not ignorant, as I feel the EquineDVM may have assumed. He/she insulted me! I read all the time about cat issues, some say I should have been a vet or tech!(not!) I've had plenty of cat-mom experiences too. Just sayin'... Have a great day and I thank you again and enjoy your site and blog - straight up no nonsense~!

>>Is there any possiblity that a cure for rabies would be found in the future?>>

Supportive care and prophylaxis are still the most effective weapons against viruses. Consider other diseases caused by viruses - influenza, herpes (all of 'em), hepatitis B, AIDs - all of which are challenging to treat even with antivirals.

>>Why has no progress been made in erradicating this disease after nearly 200 years?>>

What do you mean by "no progress"? According to the CDC's rabies page (well worth a visit) human rabies cases in the U.S. declined from around 100/year in the early 20th century to 1-2/year today. We've come a long way since Ole Yeller! Rabies vaccination of domestic animals is VERY effective in reducing human exposure. Most cases of human rabies in the U.S. are as a result of exposure while visiting countries where vaccination is uncommon or nonexistent (India, China). U.S. mandatory rabies testing programs are highly successful at identifying possible domestic exposures, which are rare but real and frequently unexpected (as Megan said).

When I'm presented with a neurological patient, I always discuss rabies as a possible differential when appropriate. I care about my patients, but I also care about the safety of my clients, who routinely come in contact with their horses' saliva.

Re: eradication, consider smallpox, the only disease humans have managed to eradicate. Smallpox was limited to a single host (humans) with no reservoir in wildlife (unlike rabies). Some regions are attempting to vaccinate wildlife with oral (bait) vaccine, but I'm afraid it's difficult to convince every skunk, raccoon, fox, etc. to take its medicine.

The incubation period for rabies is at least as long as one year. The sick kitten in question most certainly could have been incubating rabies. Testing should have been done even if the kitten hadn't bitten anyone because of the possibility of exposure via saliva.

Dr. Khuly: it is no fun to disarticulate a horse's head in the field. The potential for lacerating oneself is considerable. If I could send the whole works to the laboratory, I'd be a happy girl. ;-)

First I am very sorry for that person’s loss. It is heartbreaking when our beloved friends pass on and even more so when the pet is so young.

I feel this hospital and Vets really dropped the ball and made the situation worse. They should really have explained everything including what would happen if the cat bit someone while showing neurological signs. The also should have explained why it is more humane to use an IV catheter. Instead they left the owner at a loss, no way to cope with what could/was and did happen.

I have been to my share of bad vets and in some cases some sensitivity and discussion would have left me with an idea of what could happen.

There is absolutely no reason this person should be as confused as to why/how and what happened and to have left her out in the dark makes a sad situation even worse.

It is important that this pet owner knows she did all that she could, she just wound up with a Vet that did not take the time to explain or give her some closure to what happened to her best friend
.

My empathy & sympathy to Mallo's owners to lose their pet young, with a horrible disease.

I also agree with rockjdog, a sad situation was made worse by not calmly & kindly informing options for all procedures. I spoke to another well-seasoned pet owner the other day, regarding procedures.

The "taking away" for catheterizing has to be stressful for the pet & human, I sure wouldn't like it. And the 1 shot or 2--this clearly could have used a pre-tranquilizer IM. For the old & physically ill pets? Give me the confident, experienced vet that will do the one shot. I think the "2 shot" procedure is for the benefit of the humans anyways, not the pet.

I meant to say 1 injection directly into leg vein, no IV tube

One blown vein during a euthanasia, with subsequent infusion of the euthanasia agent outside the vein...you only need to see that once to change your mind about the importance catheters. It happens, even to the most experienced, and it's NOT pretty. If the pet is struggling or is so stressed that catheter placement becomes inhumane, then that pet needed a tranquilizer to begin with, IMO.

Thanks for the understanding comments. I am indeed a seasoned pet owner and Mallo's mom. I had commented here yesterday, twice, but the first one didn't come thru and the second one was more to Dr. Patty. I understand the catheter and have had cats put down with either that or the shots to the leg veins. To be clear, Mallo was starting to seize again in his carrier as we turned him over to the emergency vet and tech. After some time he did come into the room where we waited very relaxed and sedated but I saw the bandaged front paws, and the catheter finally in the back leg. After they told me he had bitten. So I can only wonder what the heck they were doing with him; was he seizing, as they are not themselves of course when seizing, while they were trying to catheter front legs? Lots of people aren't but I was well aware of what had to be done to the body for the rabies test, and I had told them I wanted his ashes - the first time I ever requested that for one of my cats. So of course the horror of what that meant I no longer could bear to have only 'part' of his ashes. The law is the law, some vets aren't thrilled with it in cases like this, he was tested for rabies by the state and not for any other medical condition. Anyway, I hope something more can come to light in researching this strange brain disease, 'death of tissue'. It is more prevalent, so far, in Europe oddly enough. We still miss our little buddy and pray no more animals have to suffer.
I appreciate all of the comments and knowledge passed on here. Thanks.

For an interesting human medical perspective on pediatric seizures and the interaction of a family's culture vs. the culture of medicine, I recommend: The Spirit Catches You and You Fall Down, by Anne Fadiman. Harrowing descriptions of the technical difficulties the docs faced in attempting to treat a little girl with a rare seizure disorder who presented repeatedly to their ED in status epilepticus.

>>Mallo was starting to seize again in his carrier as we turned him over to the emergency vet and tech. After some time he did come into the room where we waited very relaxed and sedated but I saw the bandaged front paws, and the catheter finally in the back leg. After they told me he had bitten. So I can only wonder what the heck they were doing with him; was he seizing, as they are not themselves of course when seizing, while they were trying to catheter front legs?>>

He probably was seizuring.

As for "what the heck they were doing with him", it is incredibly difficult to hit a vein on a patient that is seizing. It's even more challenging if the patient is a difficult stick, and in my experience patients with a history of multiple blood draws, catheter placements and/or IV injections fall into this category. Your cat had an MRI and a spinal tap; I assume he was anesthetized for these procedures, likely with a catheter placed. Furthermore, one of the workhorse emergency drugs for controlling seizures is diazepam aka Valium, which is ineffective when administered IM. Finally, also in my experience, many of the IM sedatives don't work well in a seizuring patient, or are contraindicated. (Practice tip: one-tenth the lethal dose of pentobarbital aka blue juice IV may control seizures diazepam won't touch. Don't do this without informed consent.)

>>The law is the law, some vets aren't thrilled with it

I have never met a veterinarian who enjoys submitting heads for testing. OTOH, I've also never met a veterinarian practicing in a rabies-endemic area who would fail to submit the head of a neurological animal that bit any human.

I do not think it is reasonable to be angry at the emergency veterinarian OR the technical staff. Honestly, your blaming the tech for allegedly not "watching herself" and questioning "what the heck they were doing" horrifies me. You're a "seasoned pet owner", but even in the face of education you seem to consider your personal feelings about your pet's remains more important than the safety and peace of mind of the staff of the veterinary emergency hospital. They were trying to help your pet. They knew he was dying, because they've seen status epilepticus (believe me, those techs know "they are not themselves of course when seizing"). They wanted your cat to stop seizuring long enough to be able to euthanize him with you present, because they knew that was important to you. In my experience, seizuring animals do not die peacefully without first stopping the seizures.

>>in cases like this, he was tested for rabies by the state and not for any other medical condition.>>

My state laboratory happily examined the last brain I sent after testing for rabies and found the cause of neuro signs (abscess, FWIW). My clients, whose teenage daughter had been in close contact with the horse's saliva, were enormously relieved by the negative rabies test, even though the horse was vaccinated.

Your veterinary neurologist certainly could have requested that the brain be examined by a veterinary pathologist after ruling out rabies. A PM exam might have confirmed the neurologist's presumptive diagnosis, since the antemortem tests did not. IOW, maybe your cat really did have hippocampal necrosis, but it doesn't sound like your neurologist had made a definitive diagnosis. That happens.

I work as a vet tech and had an incident where a young woman brought in a foster kitten to be euthanized due to undiagnosed neurological issues. While I was getting him out of the carrier the vet yelled at me to not get bit, which startled the kitten and made me lose my concentration and as a result, yes, I got bit. Barely enough to bleed, but that was enough.

What was already a harrowing, painful experience for this young woman was made worse by the fact of what needed to happen to protect me. I felt horrible, the vet felt horrible, and I know the woman felt horrible.

I am so sorry for the pet owner in the post, but you'd better believe I am 100% behind getting that and EVERY animal who is a possible rabies carrier tested if they bite, so that those of us who put ourselves on the line every day can have at least that small measure of protection.

My heartfelt sympathy goes out to Mallo's owner. I do agree however, that getting bitten is often just part of the job for a tech. We don't want to get bitten, it hurts. Sometimes no matter how hard you try to (humanely) restrain an animal you can still get injured. Also, a note on the IV catheter, it is often considered good practice to place a catheter before euthanasia so that a sedative can be administered before the euthanasia drug is given. This is especially true if Mallo's owner was going to be present for the euthanasia. The sedative allows the animal to be more relaxed and often decreases the potential of reflex muscle reactions and vocalization of the animal. These noises and movements can be horribly painful when observed by a grieving pet owner. It seems like the vet and the tech had not only Mallo's best interests at heart, but also the owner's.

Hey Equine DVM

I don't think she was being unreasonable. She had to ask another vet what happened. That means that they did not explain what was happening or could happen to her satisfaction.



Compassion takes very skilled thinking. I know it is hard to do but very rewarding. Give it a try sometime.

What is the name of your practice by the way?

I work at an animal shelter- we have 5 sites, and probably send an animal to the DLAB at least once a week for rabies testing. I was not aware that some labs only accept the head- we always send whole animals (granted, no livestock that i'm aware of). But i did tour the lab once, and they were preparing a giraffe for necropsy the next day (had died at the local zoo) and had just finished a necropsy on a horse, so they're apparently equipped to take whole bodies of even the largest animals.

In the five years i've worked here, we've only had 1 cat come back positive (even that was incredibly shocking). All the other positive results have been from bats (not suprisingly)

What a tough situation for Mallo's owners. But also what a tough situation for the Vet clinic. They of course didn't get bitten on purpose and were probably trying very hard to deal with a difficult situation humanely and with compassion. They probably felt terrible as to the end result.

As to rockjdog's assertion that the vet clinic should have explained what would happen if the animal bit... well i just feel that you're asking the vet to play the part of a psychic. Are they supposed to warn every owner as to every possibility of what might happen to their animal while it's in their care? Sounds slightly unreasonable to me, IMHO

A bite is always a crap situation. Our state requires that animals either be on a Bite Quarantine for 10 days, or be submitted for rabies testing (i believe, regardless of vaccination history for the pet or the person). obviously, in this case a 10 BQ was not possible since the animal was suffering

just read the symptoms of Feline Hippocampal Necrosis- i would have also been very concerned about rabies

>>I don't think she was being unreasonable. She had to ask another vet what happened. That means that they did not explain what was happening or could happen to her satisfaction.>>

"To her satisfaction" is probably the key phrase here.

When a pet dies young despite all efforts to diagnose and treat the problem, some owners simply want someone to blame and a target for their anger. It's also human nature to resent being told: you have no choice, because _____ authority says you must do _____.

>>Compassion takes very skilled thinking. I know it is hard to do but very rewarding. Give it a try sometime.>>

Perhaps you should try having some compassion for the emergency veterinary technician bitten by this person's neurological cat, who practices in a rabies-endemic area. As multiple veterinary technicians have commented in this discussion, bites are a workplace hazard.

Even after explanations by Dr. Khuly, myself, several veterinary technicians, (and the emergency veterinary personnel, and perhaps other veterinarians - we don't know) this owner continues to blame the technician for being bitten ("I can only wonder what the heck they were doing with him"). It's misplaced anger with no constructive outlet for resolution, IMO.

We don't know anything about the cat's illness, initial presentation to veterinarian(s), or what the veterinary neurologist (NOT the emergency veterinarian; they're two different people) actually said to this owner. All we have is the story of the seizuring cat being presented to the emergency hospital, and the knowledge the cat had seen a neurologist at least once, on a separate occasion. The veterinary neurologist involved works out of a practice that also has an emergency department. If the cat presented to that same hospital (we don't know), the emergency veterinarians would have had the cat's medical records available, including records of any discussions between the owner and the neurologist. That would explain minimal time spent by the emergency veterinarian on educating this owner. IOW, I don't think the emergency veterinarian was necessarily a "bad vet" lacking communication skills, though the emergency veterinarian may have (wrongly) assumed the neurologist had successfully educated the owner prior to the cat's presentation to the emergency hospital.

If the neurologist thought hippocampal necrosis was a strong possibility after an extensive workup, I think the neurologist should have told her the cat's prognosis was grim. I also think the neurologist should have discussed a PM at this time, especially without a definitive antemortem diagnosis. Believe it or not, I'd have recommended a PM out of compassion because in my experience, clients can derive comfort from knowing their pet may help others by contributing to veterinary education. The owner herself mentions "researching this strange brain disease". Well, research of hippocampal necrosis = PM of brain.

If the neurologist did discuss a PM and the owner refused for personal reasons then found out (after the bite at the emergency hospital) it was no longer her choice to refuse, well, no wonder she's upset. Under these circumstances, however, it would be illogical that she is now protesting "I hate to make it more about the rabies debacle; I am concerned about this disease and how he suffered". To reiterate, the neurologist could have requested additional tissue studies after ruling out rabies - actually, if "this disease" were her uppermost concern the owner herself could have contacted the neurologist to find out if this was still a possibility. It's a reasonable request. If the neurologist had previously presented the PM option to the owner and been strongly rebuffed, however, no wonder the neurologist didn't suggest a full neuro PM to this owner after the cat's death. Neurologists are human, too.

FWIW, veterinary pathologists are capable of performing cosmetic PMs (betcha didn't know that); a brain would have been challenging but not impossible.

Again, we were given scant information re: the cat's course of illness, but if the cat had had neurological signs for less than a week prior to his death the neurologist should have informed the owner the cat should be tested for rabies, regardless of vaccination status or human exposures. As Versinn commented, the symptoms of hippocampal necrosis are very similar to the symptoms of rabies.

>>What is the name of your practice by the way?

Irrelevant, as my practice is at capacity and closed to new clients.

Equine DVM, you don't know me at all; I don't appreciate the unpleasant remarks.
Mallo had his first seizure in March and was euthanized in April, dates in the subject. He would have turned a year old in May. The main vet hospital and the smaller hospital are members of the 5 or so in my state, so the records of any pet going to any of the hospitals show up on their computers. He was at the smaller 24hr hospital for his first seizure, treated at the specialty 24hr hospital, and then later euthanized at the smaller hospital. Let me just say that at one point the vet at the smaller hospital when he first went in thought it amusing how he went in circles during seizing. The vet there on the next shift seemed annoyed with the first vet's choice of drugs and treatment to stabilize him to get him to his neuro at the main hospital. So I shouldn't be wondering what the hell is going on? And when I did talk with a rep at the main hospital about some of my concerns, the woman's comment was something like 'it's not gonna change anything now'. What about for other patients? I guess alot of people are automatically on the defensive, and I was wanting to talk with someone, NOT place blame, nor did I. I worried everyday what I'd find coming home from work, or waking up - if I slept at all - the next day.
I know what the rabies tests entails; I know any bite from a patient, neuro or not, will be quarantined or tested. I know vets and techs get bitten, scratched, peed on, pooped on, sneezed and coughed and bled on. I know why catheters are used. I know they flush the catheter a bit with saline to be sure it's open, before they administer the sedation and then the heart-stopping med. Or they just do the two injections in the leg vein. Mallo was for sure sedated first, as he was sleeping so quietly bundled in his towels as I held him before he received his final shots. I don't have to be told when all the drugs he was on weren't working that things are grim. I knew exactly that he needed to be put down when he did. This was most obvious in his case, but I have experienced more than a few times when a pet 'tells' you they are ready, and they always do. His neuro and the partners were all wonderful and explained everything and answered all our questions. We were well aware of the lack of presentation of this disease in the US and the lack of any positive diagnosis of it or any other disease or virus like FIP from Mallo's tests. So then we were well aware of trying to see if any of the drugs would help him. I don't know why they didn't do a post-mortem, with or without the rabies test having to be done. Yes I hoped that something might be learned from a necropsy. The main hospital called to tell the partner hospital we were bringing him in to be put down. I'm sorry if I didn't seemed so 'concerned' about the disease itself because I didn't think of all these other things I 'could' have done and said. I guess that cancels everything out that we did for my little guy and all we do and have done for all our pets. Well, HARDLY.

>>The vet there on the next shift seemed annoyed with the first vet's choice of drugs and treatment to stabilize him to get him to his neuro at the main hospital. So I shouldn't be wondering what the hell is going on?>>

This was a different occasion, not the final episode at the emergency hospital during which the tech was bitten, correct?

>>His neuro and the partners were all wonderful and explained everything and answered all our questions...I don't know why they didn't do a post-mortem, with or without the rabies test having to be done.>>

Okay, so the neurologist did explain that a PM might be helpful on an occasion prior to your cat's final presentation to the affiliated emergency veterinarian, and you agreed with his recommendation?

If you had planned and requested a PM, and this was in the record available to the emergency veterinarian, I don't know why a full PM wasn't done, either. It should have been the ultimate responsibility of the neurologist (not necessarily your personal responsibility - read what I wrote) to make those arrangements because he would have been aware of your pet's case, your wishes, and known how to arrange a PM. A PM wouldn't be done automatically without prior discussion, however, no matter how unusual the pet's illness. There is a fee associated with a full PM which would have been billed to you, and this would have required your permission, of course.

>>Yes I hoped that something might be learned from a necropsy.>>

So you knew what was involved in a neuro PM and wished to have this done nonetheless?

This is not consistent with your initial statements re: "the horror" of rabies testing. A full neuro PM generally includes gross and microscopic examination of the brain.

Don't even begin to apologize or feel badly of what could have or could not have happened!

YOU are the client, Mallo was the patient, the vet clinic & staff are the so-called "experts"!

"Perhaps you should try having some compassion for the emergency veterinary technician bitten by this person's neurological cat, who practices in a rabies-endemic area. As multiple veterinary technicians have commented in this discussion, bites are a workplace hazard."....

What??? A rabies endemic area where vet support staff is not already pre-treated with rabies vaccine for humans? Part of the JOB, isn't it??

rockjdog:
I guess common sense isn't as widespread as we would hope~~

"Expert" does not equal "infallible." I have decades of experience working with animals and here's the truth - BITES HAPPEN. You can take every possible precaution but it comes down to the fact that you are dealing with a creature who is frightened, in pain and not acting in a predictable manner.

We do our best, do everything we can to keep both the animal and ourselves safe, but bites do happen. Staff are essentially cannon fodder in most cases (I worked for a vet who very pointedly told me "Owners do not get bit, I do not get bit, if it comes down to it you feed your arm to the animal").

I can understand ashmom's anger - she was not allowed to have her beloved cat's remains because of what she believed to be a preventable mistake on the part of the staff. What happened is a tragedy, but my point, and I believe, the point of Dr. Khuly's article, is that the steps taken as a precautionary measure, while heart-rending, are a necessary sacrifice to ensure the safety of the pet's family and the veterinary staff.

>>What??? A rabies endemic area where vet support staff is not already pre-treated with rabies vaccine for humans? Part of the JOB, isn't it??>>

As I mentioned much, much earlier in this discussion, I highly recommend a visit to the CDC's Rabies Homepage: http://www.cdc.gov/rabies/index.html

I learned about post-exposure rabies prophylaxis in veterinary school, when I elected to receive pre-exposure prophylaxis (i.e., I've been vaccinated for rabies). I suspect the veterinary technicians and shelter workers commenting in this thread may have received a similar education at some point. For those who are not aware of post-exposure protocols (Barbara A, etc.), here is a direct quote from the CDC's website:

"Pre-exposure vaccination does not eliminate the need for additional therapy after a rabies exposure, but it simplifies therapy by eliminating the need for RIG and decreasing the number of doses of vaccine needed..." (CDC Rabies Homepage/ Rabies information for veterinarians/ Protecting your staff/ Should my staff and I be vaccinated?)

This cat was tested for rabies because vaccination status of the person bitten is IRRELEVANT. Similarly, vaccination status of a deceased pet that bit a person is also IRRELEVANT, because a deceased pet cannot be quarantined.

I may have mentioned in a post that didn't get thru here, vets and techs are innoculated. A comment to me was it's not 100%, the rabies and other shots for the animals and people. So some of the comments here may assume any shots would preclude any rabies or other testing. Not so. Again I understand all of the precautions and laws and such for all involved. There is nothing more to read into the fact that the 'horror' of the rabies test, meaning what they had to do to the body, was something one cannot just get out of the head so easily. Combined with all the grief of the experience with the baby's suffering and putting him down, that part surely was a haunting recurring thought especially as you are initially grieving. No I couldn't bear to have 'part' ashes and told them so - the first time I ever asked for ashes. Also no one said anything about a way to have all of him cremated after testing was done. We did all this paperwork before we were told he bit, so I changed my mind on the ashes, got little ink pawprints on paper mailed later. (Was not sure they do the clay paw print. I have gotten that from my regular vet upon euthanization that they give as a small token for the difficult situation. But clay paws can be ordered online for any remembrance, living or deceased.)
The initial emergency vet visit (small hospital), and Mallo stayed a few days, was when I was in contact with the two vets on the different shifts; the final episode was with the first evening vet who saw him that first time in emergency and had commented on the amusing circling. That first vet wound up being the one who euthanized the baby. I am aware of what a post mortem of the brain for research could entail, but again this procedure was not brought up during treatment or planned for when he was euthanized. The last day happened so fast. We were working on drug doses and had planned for another hospital stay at the main treating hospital, after all his inconclusive tests. But the one night after coming home from work Mallo was a mess and I called the closer to us (small) hospital to say we needed to come in. I did call the main hospital first and got one of the neuros on the phone to tell him Mallo was a mess and to make sure I could just rush him to the small hospital, plus to see what more medicine dose I could give him to try to stabilize him for the brief ride. When we got to the small hospital the main had called anyway to let them know about us coming in.
I will certainly try to catch one of the neuro vets at the main hospital the next time I can make the trip, rather than a phone call, to ask more of the post mortem and why it might have been overlooked. They may still be treating another cat they had with similar problems. My husband is the one doing the trips to the main hospital - an hour away - because he works nearby. Thanks for all comments and concerns.

>>I will certainly try to catch one of the neuro vets at the main hospital the next time I can make the trip, rather than a phone call, to ask more of the post mortem and why it might have been overlooked.>>

Good. I think you should, because I think your neurologist could have done better here.

Knowing your cat's prognosis was uncertain, I think the neurologist should have discussed your wishes for your pet with you, including whether or not you wanted a PM exam should treatment prove unsuccessful. Your speaking up now may help the neurologist remember that part of being a good veterinarian is discussing end-of-life issues with clients. These are not fun conversations (physicians don't enjoy this, either) but I think clients prefer to have a plan because the last day can, as you said, happen so fast. Having a plan improves your chances of having your wishes honored.

End-of-life planning is important for pets and humans. I'm a fan of living wills for both. Many of my clients ask me about burial and cremation options, criteria for euthanasia, and permission to treat or euthanize letters, sometimes years in advance.

As for the first veterinarian you saw, I do NOT think it was appropriate for that veterinarian to laugh at your cat's seizure activity. A word to your neurologist (who likely outranks the emergency veterinarian in the practice food chain) may help that veterinarian grow up and learn more appropriate behavior.

Good luck.

ashmom: Everyone was so focused on the "rabies hysteria", it seemed as if the insensitivity to the way you & Mallo were treated was completely lost for most.

If I am reading the comments correctly, it seems like pre-rabies human vaccines is a waste and every single time a human is bitten, they should rush for post-rabies treatment (just in case). We know this doesn't happen, but it sounds like it would be the conservative & 100% safe thing to do.

I really don't understand the hysteria though, since Mallo was clearly diagnosed earlier with a seizure (circling) disorder, and not suspected of having rabies?

It went badly, but I hope you take comfort in knowing Mallo was "humanely euthanized" and you DO know what happened with his remains. Some clients have not been as fortunate with their beloved pets.

>>If I am reading the comments correctly

You are NOT reading the comments correctly. Did you visit the CDC's Rabies Homepage? Actually, did you read and understand the quote I provided from the CDC's Rabies Homepage?

>>it seems like pre-rabies human vaccines is a waste

Not at all, for those who work in high-risk occupations.

>>every single time a human is bitten, they should rush for post-rabies treatment (just in case)>>

Definitely not, as there are risks involved with post-exposure treatment. It's not inexpensive and the treatment has associated risks and side effects.

>>We know this doesn't happen, but it sounds like it would be the conservative & 100% safe thing to do.>>

Quarantine of live animals and testing deceased animals is sufficient for identifying those people who do require post-exposure treatment for rabies.

As for people who are bitten but cannot locate the animal that bit (example: wild animal exposures), those people usually are treated for rabies exposure even if they've been previously vaccinated. Being vaccinated simplifies treatment, though.

>>I really don't understand the hysteria, since Mallo was clearly diagnosed earlier with a seizure (circling) disorder, and not suspected of having rabies?>>

Any neurological animal is suspected to have rabies until proven otherwise by testing or quarantine. Any deceased animal that recently bit a human is tested for rabies because it cannot be quarantined and the symptoms of rabies vary, especially early in the disease process.

In this case, the cat was not definitively diagnosed with anything, despite an extensive workup and attempts to treat his symptoms. A PM might have confirmed the neurologist's suspicions or revealed a surprise diagnosis. Testing for rabies is part of a standard neuro PM.

>>Everyone was so focused on the "rabies hysteria", it seemed as if the insensitivity to the way you & Mallo were treated was completely lost for most.>>

Actually, with the exception of the emergency veterinarian finding inappropriate humor in seizure activity during the first visit to the emergency department (which is NOT acceptable), I don't recall Mallo's owner offering or alluding to examples of insensitive behavior by any other veterinarians or technicians. This emergency veterinarian subsequently euthanized her cat and probably delivered the news that her cat must be tested for rabies. Given that Mallo's owner seems to agree testing was inevitable given the cat had bitten a human, she may have reacted differently to this news had she and this veterinarian not had a previous unpleasant encounter.

Mallo's owner actually praised her neurologist for taking time to explain her cat's condition. I'm the one who thinks the neurologist also should have taken a few moments to explain the options should her pet not respond to treatment. I don't think he was insensitive, merely busy, hopeful and perhaps uncomfortable with the topic.

Through her candid comments to the neurologist, I hope Mallo's owner is able to help change the things she may be able to influence: the emergency veterinarian's maturity level, and the neurologist's approach to providing end-of-life counseling for owners of catastrophically ill pets. Rabies testing protocols aren't nearly as amenable to change.

No other insensitive behaviour except for the first emerg vet. Yes that vet told me about Mallo having to be tested because he bit, while he was still in the other room being prepped - she didn't have him with her yet when she told me. I do see the neuro should have done more to explain options, just that we didn't quite get there. Mallo had an appointment for another check and stay at the treating hospital but had the 'meltdown' just a few days before -as I said happens so fast. So perhaps if he had made it to that app't that may have been when the 'end of life' issues would have been addressed. The neuro was quite the 'sensitive' and caring vet, great 'bedside manner' you might say. And such a tough case especially involving a youngster. So it would certainly be prudent that I bring some of these points to his attention to benefit future clients and patients.