Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Army Searches For Rabid Animal That Infected And Killed A Soldier

Wow, that is awful beyond belief.

Army seeking troops bitten by stray animals following rabies death – Army – Stripes.

SEOUL – The Army is redoubling its search for anyone who might have been bitten by a wild animal in Iraq or Afghanistan following the Aug. 31 death of a soldier from rabies, the service’s public health command stated Wednesday.

“The death of this soldier is very tragic, and we are taking actions to Read more »

*This blog post was originally published at GruntDoc*

It’s Not A Tumor: Dr. Val Lacks Veterinary Savvy

onaoncomputerAs some of my Twitter friends already know, I had a bit of a scare a few days ago with my cat. I know that I more-or-less promised not to let this blog degenerate into cat talk (and for the record I love dogs too), but please indulge me because I think there’s a larger lesson to be learned.

A few days ago I was emailing away on my computer when I heard an odd thud behind me. I turned around to find my cat lying on her back with one leg fully extended, her pupils dilated, and a fine tremor in all four legs. This lasted for about 10 seconds and then she jumped back onto her feet and walked away as if nothing had happened.

My husband denied giving her any catnip, and since I hadn’t seen this odd behavior in her before I decided to keep a close eye on her. About an hour later she was walking across the floor when she suddenly raised her back rear leg, hopped a few steps, flopped onto her back and did the same weird leg extension, trembling, and let out a bizarre yowl.

That buys her a trip to the vet – and I started running my differential diagnosis through my head. It seemed to me that she was having some kind of focal seizures – and I wondered if she could be in renal failure (she had had a UTI earlier in the year) with metabolic encephalopathy, or perhaps a small tumor that had started to trigger some seizure activity. The episodes seemed to resolve completely in between episodes so I didn’t think she was having a stroke, she also wasn’t continuing to limp and when I pressed on her bones she didn’t flinch so I didn’t think she had broken anything. I called the vet and when asked for the “chief complaint” I was just as helpful as many ER patients:

Dr. Val: My cat’s ‘acting weird.

Receptionist: Could you be more specific?

Dr. Val: Well, she’s acting like she’s had catnip, but she hasn’t.

Receptionist: Uh huh… And what do you mean by that?

Dr. Val: She keeps falling on the floor and stiffening her rear leg. Then she gets up as if everything’s fine. This seems to be happening every hour or so.

Receptionist: I see. And is it possible that she could have eaten something toxic? Do you have poison lying around the house?

Dr. Val: Not that I’m aware of.

Receptionist: Well it sounds like you should bring her in. Can you be here in 15 minutes?

Dr. Val: Wow, that’s not much time. But I can try! I think she might be having seizures…

And so with the vet’s office being 15 minutes away, you can imagine the frenzied efforts that ensued – I managed (single handedly) to put together a cat carrier and stuff the “seizing” feline into it and hoist her onto a cart and push her down the city sidewalks, much to the amusement of onlookers, who probably fully believed that I was a cat-abuser, hearing the pitiful cries coming from inside the cage.

To make a long story short, I explained to the vet-on-call what I’d witnessed, and suggested that my cat might have a brain tumor. Luckily for me, the vet did not blindly take my diagnosis for granted, but performed her own physical exam.

The conclusion?

Vet: Dr. Jones I don’t believe your cat is having seizures. She has a subluxing patella.

Dr. Val: Um, so you’re saying that her knee cap popped out of place?

Vet: Pretty much, yes. That’s why she flops on the floor and stiffens her leg. She’s trying to get the knee cap to slide back into place. It’s a grade 3 subluxation, which means it pops out easily, but still goes back into place on its own.

Dr. Val: How do we fix it?

Vet: She’s a surgical candidate. We can create a divot in her femur to help keep the knee cap in the right groove.

Dr. Val: Wow, we don’t do that for humans. Are you sure that will work?

Vet: Well, you can try glucosamine. It will reduce the inflammation.

Dr. Val: Glucosamine doesn’t reduce inflammation in humans – and there’s no conclusive evidence that it improves joint health either. Isn’t this more of a mechanical problem that needs a mechanical solution?

Vet: [Becoming irritated] Yes, well you can see our orthopedic specialist. She’s not board certified though – but she has a lot of experience with these kinds of things.

Dr. Val: Well, is there a board-certified orthopedic veterinary surgeon that we could consult with? How much do you think that would cost?

Vet: There’s an animal hospital in Friendship Heights. I’m sure their surgeons are all equally well qualified. I guess the procedure would cost around $2000.

Dr. Val: Wow, $2000 to put a divot in a cat’s femur? Gee… I don’t know…

Vet: You should also know that your cat needs her rabies shot.

Dr. Val: She needs another one?

Vet: Yes, they need one every year.

Dr. Val: How likely is a house cat to get rabies? Are there rabid mice that could get into our condo?

Vet: [Scowling] It’s the law. All cats must get a rabies shot every year. There is one rabies shot that can be given every three years, but it’s been associated with osteosarcomas in cats. Would you like to give her that vaccine?

Dr. Val: Uh, no. But seriously, where is my cat going to catch rabies?

Vet: Maybe she’ll catch it from the other pets at the animal hospital when she goes for surgery?

Dr. Val: [Visions of Cujo dancing in her head] Well, that doesn’t sound like a very safe place to take her.

Vet: Would you like to buy some glucosamine?

Dr. Val: No thanks, I think I’ll go now.

***

I learned a few things from this amusing interaction:

1. People should try not to make diagnoses beyond their level of expertise. (Brain tumor versus subluxing patella? Yikes.)

2. Vets do not necessarily practice evidence-based medicine. (Glucosamine for a subluxing patella?)

3. There’s a lot of money in cat vaccines.

4. Cash-only practices are quite lucrative. My little visit cost $300.

What do you think I should do with/for my poor cat?

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »

Commented - Most Popular Articles