Sunday, May 5, 2013

When You Only Have One Chance Left To Get It Right

Sometimes you get it right the first time. Sometimes your client wants you to just get it done right now and right cheap. Sometimes these things are not feasible to do together.

The "real-world" of veterinary medicine is often one of listening to the clues your client gives you, looking, listening, feeling, and smelling for the ones your patient gives you, and then the tricky scenario of recommending diagnostics, summarizing the costs of the items involved in your plan, and the statistics for recovery.

It's a sort of dance, a courtship in a way. The pet that needs help, the advice of the specialist, and the willingness of the client. The complexities of the process dictated by the findings, the answers, and the resources.

This is the tale of Cali. A barn cat. (Argh, how I hate that label. Like, they are some subclass of feline). Cali was accompanied by a young sweet girl. Seems Cali had been in a few months ago for a wound to the right side of her face. It was along her neck and under the base of her ear. Her family had tried to treat the wound at home for a few weeks before she was brought to us the first time. After trying ointments of varying sorts she remained itching the wound and it remained open.

A few weeks back Cali was brought in by the young girls mom. She had been insistent on not spending much time or money on figuring out the root cause of the wound, she just wanted it fixed. Cali was on a budget, a tight budget. 

Cali was scheduled the next day for a wound debridement and drain placement. The plan was to freshen (our veterinary terminology for livening up the stagnant tissue to try to coerce it to start healing like it is supposed to). A chronic wound sometimes has a residual nidus (a sort of thorn that won't let the wound close). Often a non-healing wound has a source of infection that precludes the body from healing normally. For these wounds we often recommend and exploratory surgery to look for the source, freshen the tissue, place a drain to allow a flushing agent, or good old air, to motivate final resolution to the wound. 

With that plan went four weeks. The drain had been removed one week post op, and things were looking like they were officially, and finally, on the mend.

Then Cali came to see me with the daughter. Cali is a three year old outdoor cat. She is sweet, gentle, purrs at a glance and loves any tiny bit of attention she can get. 

Cali had returned with the same wound and the same budget. Second times around are a whole lot harder to resolve. Our first guesses and first chances of getting a cure are usually the best case scenario's and the cheapest options. The more times we swing at the bat the less likely we are to get it done "quick and easy."

Cali's wound looked just like it had from the time her family started treating it. A fleshy subcutaneous wound without any hair surrounding it.

After a thorough examination I found the following; Cali had dirty itchy ears. Because she is an outside cat I suspected some of the dirt, debris, itchiness, and ear problems might be due to ear mites.

I suspected that the source of her wound was her chronic itching at her ear. I hoped that I was right..I was on a very tight budget, a family that was getting a little frustrated by the clinic, a cat with any already exhausted slim chance.

After a topical flea preventative, (that treats intestinal worms and ear mites), an injectable antibiotic, a thirty day steroid shot to stop the itch.

I also gave that bearer of her parents barn cat a small promise. I won't give up on you or your kitty. If I don't get this right this time we will get it right the next time, or the next time, until we get it right together.

That's what being a vet is about.

Ear mites are tiny ectoparasites (live on the outside of the body) that live in the ears of a host. The hosts are usually young cats and kittens. They can occur in many other species like dogs and rabbits but seem to be the biggest problem in cats.

Cats with ear mites have dirty black debris in the ears (I think it looks like very fine coffee grounds). They also scratch, sometimes to the point of causing wounds to the sides of their face. The mites are transmitted to other pets that they are in close contact with. The scientific name for ear mites is Otodectes cynotis in dogs and cats, and Psoroptes cuniculi in rabbits. For a definitive diagnosis your veterinarian can take a sample of the ear debris and examine it under the microscope.

Luckily, there are many treatment options available. Some are more expensive and very convenient, (like a one time topical), others are very inexpensive but need to be done daily for three weeks.

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