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A practitioner ponders

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As a veterinarian I pride myself on having empathy for clients, but becoming a ‘client’ recently gave me a new appreciation of the shear faith that owners place in us – and how powerless one might feel in their shoes.

My nine-year-old moggie had skipped breakfast and slept in one morning, which was quite a detour from her routine. Normally not one for physical affection (the usual response was a firm bite), she didn't object when I gave her a pat. Maybe it was her slightly unkempt appearance, but something made me take advantage of this newfound compliance and I palpated her abdomen.

My heart sank as I palpated an abdominal mass. I couldn't tell if it was the intestinal or mesenteric lymph nodes, or both. Lil was a long-term objector to veterinary intervention. She had eluded vaccination, worming and probably two out of three flea spot-ons for the majority of her adult life. However, she didn't object when I raced her into work.

I anaesthetised her to facilitate palpation, in the hope that once she relaxed I would determine that I had palpated a huge faecal mass, but in fact it was a large nodular mesenteric mass. Thoracic radiographs revealed a mediastinal mass.

I sobbed in the x-ray room. I speculated that it was a multicentric lymphoma, and I knew Lil would not tolerate weekly chemotherapy. Even venipuncture for a complete blood count would require a general anaesthetic.

I was blindsided. Should I euthanase her? Now? Later? Was it worth fighting her to administer steroids alone? How could I have missed the signs? I still didn't have a tissue diagnosis. Should I refer or work up myself? Was a treatment trial based on a presumptive diagnosis acceptable?

I felt paralysed and helpless. But, unlike most pet owners, I had a handful of colleagues I could call. I kept asking, ‘What would you do?’. I could treat Lil at my workplace and know absolutely, because I could see for myself, that she was receiving the most appropriate care and being treated with dignity. In the worst case, I could always sedate her at home for venipuncture and run samples in. At least I didn't have to hand her over to someone else's care.

A dear friend and feline specialist was able to attend the practice the next day. I didn't have to move Lil. We didn't have to wait. Aspirates of the masses were difficult to interpret. After some deliberation, we decided that Lil would receive a single dose of chemotherapy, with a 70 to 80 per cent chance that she would go into remission. I knew the risks, I knew my colleague's experience and I knew how he looked after his own cats – a fact which I realised was of critical importance to me as an owner. I needed to know that anyone treating my cat would care for their cat in the same way. I could trust him completely.

Lil recovered uneventfully from the anaesthetic, but died overnight. None of us had expected this. I rushed to the practice in tears. At least her suffering had been brief. At least I'd been able to give her pain relief. My colleague was devastated. A postmortem examination, which was conducted by a pathologist and friend, suggested acute tumour lysis syndrome.

I didn't regret the choices I had made. But I was lucky. The treating veterinarians were my friends. They helped me make decisions where I erred. I didn't doubt that the decisions made were the best for Lil because I had seen so many cats with multicentric lymphoma. I know how brutal a postmortem can be, but I also knew that my cat would be treated respectfully by my colleague. Knowing how much easier these elements made the process for me made me realise how tough it must be for owners who don't have a network of veterinarians in their immediate social circle. I know now how much my answers to the question ‘What would you do?’ are appreciated.

If you would like to contribute to ‘A practitioner ponders’, please e-mail inpractice{at}bva-edit.co.uk for further information. We pay a small honorarium for contributions that are published.

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