Sunday, November 13, 2011

Libby. A lesson in why we spay cats

A very nice woman came into the clinic yesterday with her very very sick cat, Libby. She was a new client for us and she said she come in because she "heard good things about us." As much as I hoped this to be true, I am not sure she didn't exchange "good" with "compassionate."

As she carried in her very ill cat, she explained to the receptionists that she "knew her cat was ill but she only had $100 to care for her." Unfortunately, "$100" and "very sick" are mutually exclusive. For $100 we can't do anything other than an examination, (by far the most important part of the whole process) and maybe a limited bloodwork panel. It really isn't enough money in almost ALL cases to give you a diagnosis without your "reasonable doubt" being the size of the planet.

Fortunately for Libby, a 6 year old female unspayed tabbly cat, her condition, history, and physical exam were all we needed to make her diagnosis. Unfortunately, these weren't enough to know just how advanced her condition was.

Her physical examination read as follows; "recumbent, (unable to stand upright/laying down), severely dehydrated, weak rapid heart beat, short shallow breathing, and palpable large "doughy" (we Vets always related physical exam findings to food, gross, but true) tubular mass in the abdomen, thick, fetid purulent (pus) discharge from the vulva." Based on these findings her diagnosis was easy; she had a pyometra, (infection of the uterus). It is one of the many reasons we spay pets. A spayed pet does not have ovaries or a uterus, and therefore, will not have a pyometra. Of all of the diseases I have seen, the pets with a pyometra are the sickest animals. They are in almost every case, completely down and out, not eating, reluctant to move, very painful in the abdomen, intact, and will die if not treated quickly, (they look like death warmed over, and they feel like it too).

There is an old saying every Vet student learns in Vet school. The motto is easy (so we won't forget it, but truer words are seldom ever uttered); "Don't ever let the sun set on a pyo!" Meaning if you think you are looking at a pyo(metra) you go in and take out that uterus (spay) ASAP! It is not something you can wait and think about. It is a now or there will be a never soon. Dr. C went into to tell Libby's mom that she was in a terrible state, and that her prognosis was grave, (that's the worst kind). Her recommendation was that we surgically remove her uterus now. The diagnosis and the treatment plan for Libby were both easy, but the topic of finances was not. Dr. C came back to find me and delivered Libby's news. I told Dr. C that I didn't feel right about euthanizing for a pyometra. I told her that I would spay her and expected that the rescue would help pay for her care, IF SHE LIVED. I went to go meet Libby's mom and talk to her about our proposed plan.

I told her that if Libby didn't have this surgery now that she would be dead by tomorrow. I also told her that Libby was so ill that she might not live through surgery. I didn't think we had much of a choice. And I told her that I wanted to give Libby a chance, and she agreed. An hour later (because we had to put an i.v. catheter in, run some fluids, and give an antibiotic), Libby was under general anesthesia. Her surgery revealed that she did indeed have a pyometra. But to my dismay she had the worst infection I have ever seen. Her uterus was infected, but it was so advanced that the pus in her uterus was solid, like cheese solid. The infection had been in her uterus for so long that she had pulled all of the fluid out of the infection, (because she was so terrribly dehydrated). It was dreadful, and it was also very difficult to surgically remove.

To my surprise Libby survived her surgery. When she woke up I was almost hopeful. I called her mom and gave her the news. As I left that evening I made sure that she was comfortable and quiet and on pain medications to keep her sleeping over night. Her temperature was improving, but her heart still sounded bad. I had given her about a 25% chance before surgery, but now I was leaning more towards 50:50.

The next morning we found Libby dead in her cage. I was sad to hear it, but not surprised. For the first time in a long time I told myself that maybe I should have just put her down and used the lack of funds as an excuse to do so. I remembered standing infront of her cage just before we started her surgery, and that little voice inside of me told me to just let her go. Then I argued with myself, I had told Libby's mom that I would try, and I wanted to give her a chance.

When I called Libby's mom she just said "Thank-You for giving her a chance." I had, and in the end I am ok with that.

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