Blocked! When Being More Aggressive About Surgery Makes All the Difference ... to the Kitty
Last week I saw a cat who arrived near-dead following a urinary obstruction. His owners hadn’t noticed he couldn’t urinate. And because they explained that he was vomiting but stable at the time of intake (not that he was recumbent, poorly responsive and, essentially, on death’s doorstep), it took me 45 minutes more to finally take a look-see (we’re not an ER so we have no triage nurse).
Yes, these owners are — in the words of yesterday’s post — shiny but not too bright. At least when it comes to their cat, which is all I happen to care about, seeing as I’m his doc and he’s my patient and it’s my job to make sure he gets along all right in the world after I get my chance to fix him.
So yes, I fixed him; temporarily, anyway. I passed a catheter, flushed out his bladder, kept him for a few days, and sent him home on special food in the hopes that his nasty crystal-making problem could be tamed sufficiently enough that he’d never suffer another episode of complete urinary obstruction. (Wishful thinking, I know.)
Then yesterday, he came back; same thing. The complaint? Vomiting. The finding? Blocked. Death’s doorstep and everything.
On the one hand, I feel terribly sympathetic. It’s especially frustrating when the owners, who clearly have a really hard time identifying a pet’s distress (time pressures, work schedule, general cluelessness), are the ones stuck with the tough cases. But it happens.
On the other hand, I just want to take my two hands and make a ring around their necks (figuratively, I mean). It makes me crazy that they would let him get like that all over again. Especially after (a) what he’s already gone through, and (b) what I’d repeatedly advised them to look out for in the week following the initial incident. But I guess they have crazy lives and aren’t able to observe their cat as carefully as I wish they could.
The last of which is a common occurrence. Sometimes owners are simply incapable of noticing things about their pets. I’m sure it happens among humans, too. They’re just not the noticing kind. Or more likely, they’re too busy raising a family and trying to put food on the table to notice that Grandma’s having an adverse reaction to her new medication.
And while these cases might make you want to make your two hands into a figurative neck-shaped ring, too, the truth is they’re inevitable. Recognizing owners who cannot for the life of them care for a cat with this condition — or a grandma with polypharmacy issues — is part of being a general practitioner, human or animal.
So it was that I got to pushing for surgery. Hard. Because in cases like this, pets who don’t get surgery tend to die for one of two reasons: (1) Their owners come home late one night and find Kitty’s long gone; dead this time; or (2) Their owners eventually get to thinking euthanasia is a great idea.
Now, normally surgery is mentioned right up front. We’ll always mention that surgery is necessary for a certain percentage of our patients. But it’s no small undertaking, this surgery. We remove the penis, which means the urethra gets bigger so things like crystals and fleshy swellings won’t occlude it. But it's expensive, recovery can take weeks and complications are common unless a boarded surgeon takes over. So we tend to hold off until we know whether our patient is truly a good candidate.
Unfortunately, I should’ve known this cat was a good candidate from the start. Busy owners who haven’t brought Boris in for two years? Didn’t notice he was sick until he was almost gone? Can’t tell a dying cat from an urpy one? I dunno … this should have been a surgery from the word go.
But then, who’s going to tell the client they need to cough up three times as much on day one because their lifestyles are clearly unsuited to keeping a cat like this?
In this case, it’ll be the same person who’s getting ready to hand them the very same news just one week later. Wish I’d’ve done it then…
Dr. Patty Khuly