Boreal B[l]og

My wife and I have devoted a significant portion of our lives to our many indoor cats.  We have given nineteen a home; each has taught us unconditional love—well, conditional on being fed promptly, perhaps.  We don’t expect others to understand that we need to line up good care for them should we travel:  it just can’t be “have the neighbor feed them,” which one person suggested, or “once a day stopping in,” as another thought.  The litter boxes need to be taken care of, and if one becomes ill, we need to have someone be willing to take the cat to the vet.

Veterinary care is expensive, and we don’t have insurance, because most of the conditions we would insure for are pre-existing.  Veterinary care is expensive, with key differences being usually getting called afterward to see how the animal is doing as well as being told upfront what the costs will be.  Also, people are expected to pay at the time of service.

Unfortunately, sometimes errors are made, which is something in common with human medicine.  

HC (Hors Categorie, from the cycling term of a very steep climb, “outside category”) was found abandoned in an apartment building in Tucson back in 2005 and arrived at our house a month after the sudden death of one of ours.  No cat “replaces” another, but when one dies, there is a vacancy, and there are far too many cats needing a home.  HC was a silver-gray guy, very quiet, and from day 1 never got along with Gryff, who lived to attack him.  So, he spent a decade in three different rooms, avoiding all other cats.  

After Gryff died a year ago, HC gradually started exploring the house, becoming a little more social.  He had almost no voice, so he just appeared, giving him the nickname “The Gray Ghost.”  

In 2015, he had an elevated SDMA suggesting the possibility of renal disease, and earlier this year he had an elevated creatinine of about 3.  We started giving him fluids and treating his associated hypertension.  In March, he started passing blood on the outside of his stool, which had become hard, suggesting maybe a fissure.  Then he stopped passing stool altogether.  We took him to an emergency center where an X-Ray was taken and he had a tap water enema, which didn’t do much.  We started Miralax and eventually he passed rock hard stools with some more bleeding.

He went back to emergency again, and the repeat X-Ray showed movement of the stool.  The radiologist’s report of the prior X-Ray showed was not told us. There was loss of serosal (outer membrane) detail and a suggestion of mucosal thickening consistent with possible colitis, pancreatitis, and even carcinomatosis.  An ultrasound was recommended.  We didn’t know any of this.

For the next two months, HC passed small caliber stools but was eating and comfortable.  He lost a little weight.  He again became obstipated in May and taken to our local vet, who also had received the first X-Ray report, but we didn’t know that, either.  HC received a stronger enema which led to full-blown diarrhea that night, constant leakage and exhaustion so bad that he fell asleep in his stool on the carpet.  Much later, we woke him and cleaned him with Dawn (it’s better for cats).  He then slept for another 12 hours.  He wasn’t eating.  

We were going on a trip across country which had been planned for several months.  We planned to have HC stay with a cat nurse, who had veterinary training, could board cats and give fluids and medication.  But the morning we were to leave, we were concerned enough about HC’s leakage that we took him to the emergency center.  I raised the possibility of a primary colon problem, but both the local vet and again the vet at the emergency center thought this was due to renal failure.  We thought that odd, since the creatinine elevation was modest; we have had several cats die from renal failure, and none had been obstipated.  But, we deferred to experts.  An ultrasound was not recommended, although had anyone looked at the chart they would have seen an X-Ray report from two months earlier recommending one.  HC’s colon continued to leak, and his renal function wasn’t quite as good, but he was thought to be able to be cared for at the cat nurse’s house.

We dropped HC off and left, not with a great feeling, but hoping things would gradually improve after the last enema.  They did for about three days, then he started having diarrhea again and was taken back to the emergency center.  For the next four days we had calls to the veterinary hospital.  Emails were occasional and difficult to download where we were at.  Replying was impossible.  Interspersed were cost estimates—well in four figures—as well as some frustration that each communication was with a different veterinarian.  

It wasn’t until the third day that we realized that the staff was treating HC as a renal failure cat, completely focused on that.  Only that day was an ultrasound performed that showed bowel mucosal thickening as well as pancreatitis.  A feeding tube was passed, and I was wondering how far we were going to take all of this.  It wasn’t the costs, but it was what we were doing to HC.  The final day started with a comment that he was a little better, barely eating, but HC wasn’t going to get better.  His numbers were not bad, but his condition was.  He could look forward—at best—to leaving there with a tube and tube feedings.  He would hate it and so would we.  And he would obstruct again, and that was assuming his pancreatitis could be treated. He also had a significant heart murmur.  

No, it was time to stop.  We both felt guilty about it, but not because we stopped but because we continued as long as we had. 

Perhaps had someone read the radiologist’s report—the two times we were at the hospital and the one time at the clinic—we would have realized what we were up against.  Or, I should say, they would have realized, since we felt all along that this was a primary bowel issue.

To those who know me well, it must be tiring to hear me rant about medical errors and the need to fix faulty systems.  Well, the errors have affected both me and my whole family.  I have ranted about poor communication in medicine, to stop important matters from falling through the cracks.  When my father was alive, he would tell me to calm down, saying “people are busy.”  Well, if people are busy, judging by the condition of medical care, too many are busy doing the wrong things.

I now am writing the vet hospital director, whom I know, to let her know what happened in hopes that somebody will learn from this issue without getting defensive.  I’m not optimistic. I don’t know what I will do with the veterinary clinic.  If they bring it up, I will mention it.  I just don’t want my care compromised because I spoke up.  I shouldn’t feel that way, but I do.  I’d like somebody to learn, including the young vet who got my wife’s call about the cat’s not eating and told the tech to tell her to wait another day.  That’s a recipe for Feline Hepatic Lipidosis.

I will meet HC at the Rainbow Bridge.  And he will probably wonder why I was so cruel to him in his final days.