And then you save one...

All is restored in the veterinary career of Ang...why??...because I recently had a great success story, a case I handled all on my own...made the correct diagnosis, set up treatments, and really did save a life!! Here's my story. It was during my am shift last week...got a call from a referring veterinarian about a cat that they were sending over that was in respiratory distress - immediately flags went off in my head and I was thinking lung or heart disease. rDVM says they saw the cat a couple days earlier and took rads that were normal but thought hairball and so gave some anti-inflammatories...I can't say anything but am banging my head against the wall on the other end of the line. Why? Well if it is heart failure then the kidneys already are not perfused and are not getting the blood they need - add on an anti-inflammatory (Meloxicam) and poof..goodbye kidneys! Oh crap! So anyhow...cat comes over...beautiful male neurtered rusty orange Himalayan named Meiko!! Ok..first look and I fall in love with this cat who is open-mouth breathing yet still purring and trying to rub on me. I listen quick and confirm my thoughts...harsh lung sounds, gallop rhythm on heart auscultation, poor pulses, open mouth breathing...I place cat into oxygen cage and go to break the news to the owner....So your cat is in heart failure...no it's not a hairball...here's what we need to do...$1200-1500. They take a minute to discuss and decide they want to at least confirm heart failure - if it is they say they will likely euthanize...sign estimate...ok start diagnostics. Full blood work looks beautiful...good it is not due to other underlying disease but damn this just supports heart failure. I look at radiographs that rDVM called normal - NOT NORMAL!!! Lungs look horrible - large amount of pulmonary edema, heart enlarged -- shoot! Get catheter placed and get cat started onto lasix (diuretic), nitroglycerin (venodilator), and torb to calm. Later able to get a VD radiograph of lungs - yup--still fluid in lungs, still huge heart, huge cardiac veins. Ok...echocardiogram confirms cat has hypertrophic cardiomyopathy. Start benazepril and later atenolol because HR elevated. End up placing onto lasix CRI. Call owners and convince them to give cat overnight to see how he responds to the lasix - owners agree to this. So I hand cat over to Dr. Green for overnight care. I come in am, cat is out of oxygen and breathing normally, lungs sound great!! Yay!!!! I check bloodwork and as expected electrolytes are up and BUN (kidney value) is up - likely due to the diuretic. I start a maintenance rate of fluids and tell owner I would like to keep overnight again - they ok. They come in to visit and are so happy...they thank-me so many times...then comes the question I knew was coming...owner says " so I think our vet may have misdiagnosed the cat and we are thinking we should get all our money back from them" I think quick knowing I want to say - yay they did!! almost killed your cat by telling you it had a hairball and that was why it was breathing heaviy...come on even I didn't have to go to school to know that sounds like quakery. But instead...as I have to keep up good relations and not get others into trouble..say the following : "I cannot say what Meiko looked like when your vet examined him 3 days ago. We are sending over records of his visit here so your vet will have them. What I would do is just go in or call your vet and discuss it". The bad thing for that vet is their physical exam that is written in the record practically screams heart failure along with the radiographs they took!!! Good luck with that one! SO...that was my happy case. For one it was a cat and I love love love them...for two he was the friendliest smoosh faced Himalayan around...and I saved his life...so that his people can enjoy him...even if it is only for a few more months. Maybe I do like this job!