As the eight month mark has come and gone, I can finally start to let myself feel that it was worth it. What was worth it? Often as a vet I am asked, what would you do if it was your pet? Now I have a better answer for that question.
This past summer my 15 year old cat, Meg Ryan (named for the incredible actress,) started to show signs of weight loss despite having a great appetite. She was also throwing up her food a bit more than usual and having occasional diarrhea. I figured it was probably one of the big three for older cats. Hyperthyroidism, Diabetes or Kidney failure. I was a little concerned she might have Feline Leukemia or FIV but knew she didn't really have any exposure and was negative as a kitten.
In order to save her a trip to the clinic, and I I have done with hundreds of house call patients, I took a blood sample on my kitchen table. The lab does pick ups of the samples from my home so I called them then waited until the next day for the results.
Normal. Not just normal normal but perfectly normal. In most patients you expect to see one or two values slightly out of the normal range, but not Meg. Glucose NORMAL. Thyroid hormone NORMAL. BUN NORMAL. Creatinine NORMAL - everything was NORMAL.
Okay, that just changed by differential diagnosis list a little. Inflammatory Bowel Disease or IBD moved up to the top. The definitive way to diagnose that is with stomach and intestinal biopsies. I decided to do a trial of corticosteroids. If it worked I had a presumptie diagnosis. I checked her weight, gave her a shot of long acting cortisone and waited to see what happened.
She seemed a little better. The vomiting was still happening but not as much. The stools were almost back to normal. But she still kept losing weight. After 2 weeks she was down another half pound.
What I had tried not to think about was now starting to gnaw at me.
I had her stand up on my lap and grasped around her belly with my right hand. At her body condition it was pretty easy to feel every internal organ. Kidneys, nice and smooth, normal size. Spleen, no enlargement. Liver, normal. Intestines...lots of intestines to check...small bowel normal. Large intestines...
I wondered why I didn't notice it two weeks before. A mass the size of a walnut was present in her colon. My heart sank. It all fit. Meg had cancer.
She was fifteen. What could I do for her? I talked it over with my wife and it seemed that putting her to sleep was an option. We were getting ready to leave on vacation in 10 days and if she continued as she had been she might end up dying while I was out of town.
The kids said their goodbyes just in case and I took her into the clinic. Radiographs confirmed the mass in the large intestines but no signs of metastatic lesions in the lungs or liver. I decided I would do an exploratory surgery to have a peek and if it was as bad as I thought it was, she would never wake up from the anesthesia.
I thought about whether I would even be doing this if it wasn't my cat. The cost for surgery and recovery would likely end up in the $1,000 to $2,000 range. Would I even suggest the exploratory as an option?
But Meg was my cat and friend and family member. She was always there to keep my lap warm and curl up next to me in bed each night. I had to try.
I anesthetized her and clipped the hair from her belly, prepping her for the surgery. Her body was so thin I could see the organs under her skin. I made the incision, expecting a quick confirmation of terminal cancer and a quick injection to end her life.
I was a little surprised to see a normal liver. No unusual fluid or blood in the abdomen. These were good signs. I did find the tumor. It had almost totally obstructed her large intestine and the lymph node next to it was the size of a peanut, way too big. It had spread if just locally. I looked at her insides, considering the options.
I was considering options. No longer was putting her to sleep the only outcome available. I could remove it. If most of her problems were from the obstruction I should be able to make her better. Not cure her but keep her going a while. There was also the chance that it wasn't cancer. Maybe an infection or a foreign body that caused some severe inflammation.
I decided to remove it. I excised the mass and a few inches of normal bowel on either side along with the lymph node. I sutured the two ends of the intestines together then closed her abdomen, carefully putting her back together. Then I sutured up her skin, gave her a dose of pain meds and let her wake up.
Then the second thoughts came. What had I done? What sort of arrogant, self-serving, lover of animals was I? What sort of pain and discomfort had I set her up for? Would she even wake up? What made me think I could cure this creature and give her back the quality of life that had seeped away from her over the last month?
She did wake up. She was tired and worn out. I tooke her home and settle her into her cat bed. The boys had made a nice recovery area for her. But despite our attempts to ease her recovery while we waited for the lab results, all she wanted to do was hide in the basement.
The biopsy came back two days later. Adenocarcinoma. Cancer. Prognosis poor. Even though the margins were clean the lymph node was affected and it was likely to recur.
I tried to get her to eat. I bought every flavor of canned food they had at the Jewel. I gave her fluids under her skin to keep up her hydration. I gave her pain medication to keep her comfortable. Most of the time I had to find her hiding in the basement. The cat who had always managed to find my lap within seconds of me sitting down didn't want to be near me. Each day I expected it to be her last.
But it wasn't. She licked the gravy from the food. She put up with the subcutaneous fluids. She even purred, but she didn't seem to be getting better. She was just in a holding pattern and in a couple of days we would leave on vacation.
I suggested to my wife that we take her with but that didn't seem practical. I didn't want to leave her with the cat sitter. I could imagine her hiding and slowly dying of dehydration. My vet assistant, Amara, at the animal hospital offered to care for her. I seriously considered that it was time to put her to sleep. That I had put her through enough already.
But I guess I wasn't ready. I decided to give her another week. If she still wasn't eating by the time we came back that was it. If she got worse, the other vets at the clinic would do what I couldn't. The morning it came for us to leave she was nowhere to be found. Her normal spot in the basement was empty. I spent an hour looking for her. It was my son Trevor who finally did spot her on a chair that was partially covered with boxes.
She sat in my lap on the way to the clinic as we headed out of town. This might me the last time she sat on my lap. We set her up in the clinic and I said goodbye.
The week went by quickly as vacations tend to do. A mid-week update reported that Meg was eating. Not only the canned food but dry. There was no vomiting. No diarrhea.
We stopped by the clinic on the way home. I put her on the scale before taking her home. She had gained half a pound. Hope? That night she sat on my lap. She crawled into bed with me. The cat that had been scratching at death's door was now back to her normal self.
Her recovery has continued. She is back to her pre-illness weight. Still vomits the ocassional hairball on the dining room floor, but the diarrhea is gone and her appetite is normal. Every month or so I palpate her abdomen. Nothing abnormal. She chases our other cat. She tries to hurry me to the food bowl in the morning.
It has been eight months. She made it past my birthday. Past Christmas. Two gifts I never imagined that summer day I stared at the tumor in her abdomen.
I don't know how many more months she has. If the pathologist is right the tumor with come back. At that time there will be no surgery. She will have her dignified end.
I wonder what the odds are. One in ten? One in a hundred that a cat with her condition would not only survive the surgery but make a full recovery? So far Meg has beaten the odds. I like to think it was my great surgical skill that got her this far but I know there is more.
Would I recommend surgery to a client in the same situation? Would I be selling them false hope?
Yet if I were the client. If my cat had a less than 10 percent chance of waking up from the surgery let alone living eight months, would I do it? I don't think I can answer it. I'd like to think I would. I'd like to think that odds are just that, odds. In reality, the animals live or die. We can only hope to do the best for them.
Yes, Meg had the advantage of adopting a veterinarian as her human. A human who wasn't ready to give up on her when it looked like she had given up herself.
But in the end, all we have is hope. Hope we are making the right decision, no matter what. Hope that the promise to do no harm is fulfilled. Hope that the time we have with our four-legged companions will never end.
I will have to say good-bye for real to Meg someday. Maybe not for another 8 months. Maybe in less time than that, maybe more. But I have her friendship and companionship now. I have the last eight months.
I still have hope.
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