Trusting in your vet’s gut feelings
I had a feeling standing in the room.
I was looking at a young terrier type dog. The owner was a young, very smart elementary school student.
She disliked the poster on parvovirus in my room.
I calmly explained that all owners didn’t understand like she did, so I had to have a poster.
I knew I should say this because I was looking at an extremely positive parvovirus test.
There is a lot of science that goes into veterinary medicine.
Savannah had been sick for a couple of days.
Parvo often comes with vomiting and diarrhea, but Savannah’s main complaint was not eating. A highly specific test performed a series of complex ELISA (enzyme-linked immunosorbent assay) reactions and the test spot was way more blue than the control spot.
Meanwhile, the stool sample was placed in a special solution to allow the lighter density fecal eggs (ova) to float to the top of the sample where they are collected and examined under the microscope.
When faced with the economics of IV fluids, IV antibiotics and intensive care, the single father thought that euthanasia was for the best.
Not only economics, he cared very much about his daughter not having to stress about the uncertainty of the family pet for days.
He sent his daughter out and requested euthanasia.
But, looking at Savannah, I had a feeling. I argued a little, listened a lot and bargained.
That is a dangerous thing for me to do.
As a vet, I can make them feel good about the decision and collect the money and everyone is happy.
If I suggest a different course of action, I risk being wrong and loss of reputation.
But that feeling was there.
I thought if we could help just a little, Savannah would probably be okay and do well for not much cost.
In the end, we went with my gut feeling and kept Savannah on minimal treatment.
I was clear that we had a cap on expenditures and he knew I could not promise.
That feeling is not always good.
I walked into the cat room with an eight-year-old cat. Katie was very thin.
Her gums were grayish pink, I could feel nothing but doughtiness in the abdomen and her walk was weak.
Her temperature was three to four degrees lower than it should be. Katie’s owners were convinced that this just happened in the last couple of days, but I had a feeling that it was otherwise.
I explained that cats are very good at hiding signs of disease, but when they decompensated it was tough to get them back.
The weight loss was a sign of chronic disease, not acute failure. My gut feeling was that this was very bad news and the cat was dying.
If the physical exam and history taking is the art, the tests are the scientific portion.
We did the scientific ELISA for feline leukemia, feline aides and feline heartworm disease. Statistically, in an eight-year-old cat, one of these diseases is most likely.
These tests were negative. Because I knew this was a possibility, I had gotten enough blood to do some more tests.
A CBC is a complete blood count or red blood cells, white blood cells and platelets.
When I graduated, we learned to count the cells manually under the microscope.
Now we have machines that we have paid thousands of dollars for that count them for us.
The science of the CBC showed a stress response and a borderline anemia.
Nothing specific enough.
The chemistry is a snapshot of internal organs and some electrolytes. It includes Alanine aminotransferase (Liver diseases, including viral hepatitis and cirrhosis; heart diseases); Albumin (Liver and kidney diseases); Alkaline phosphatase (Liver, bone, parathyroid, and intestinal diseases); Amylase (Kidney and pancreatic disease); Calcium (Parathyroid, bone and chronic renal disease, tetany); Creatinine (Renal disease); Globulin (goes up with dehydration and usually with antigenic stimulation); Glucose (Diabetes, hyperglycemia, hypoglycemia, and liver disease); Phosphorus (Kidney disease, hypoparathyroidism and nutritional disorders); Potassium (Malnutrition and renal disease and this electrolyte is used to diagnose the causes of vomiting, diarrhea and cardiac symptoms); Sodium (Dehydration, and diabetes and this electrolyte is used to diagnose the causes of vomiting, diarrhea and cardiac symptoms); Total bilirubin (Hepatic disorders and blood damage); Total protein (Dehydration, kidney, liver disease, metabolic and nutritional disorders); and finally Blood Urea Nitrogen (Liver and kidney diseases).
That is a whole lot of complex science. There were several increases on Katie’s profile.
Her total protein, amylase and calcium were off, but her BUN, creatinine and phosphorus were off the charts.
Katie was in renal failure.
The abnormal walking was because of high blood ammonia levels that her kidneys could not get rid of.
It was like she was drunk, but on a different chemical.
Unfortunately, my gut feeling was right.
Being a good veterinarian is a lot of important science, the practiced art of examining well and listening and a bit of trusting you gut feelings sometimes.
It meant that Savannah is home with her little girl and Katie was no longer suffering with a disease that is not curable.
It also meant both owners spent their money wisely.
MJ Wixsom, DVM MS is a best-selling Amazon author who practices at Guardian Animal Medical Center in Flatwoods, Ky. GuardianAnimal.com 606-928-6566