It’s Not A Tumor: Dr. Val Lacks Veterinary Savvy
As 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?
Wow! You & Ona live the life, Val!
$300 for a single vet ER visit!
I'll have you know that I could have done a complete Coronary CT angiogram for you for exactly that amount in my department.
Wow! You & Ona live the life, Val!
$300 for a single vet ER visit!
I'll have you know that I could have done a complete Coronary CT angiogram for you for exactly that amount in my department.
I know, prices are crazy in this country. Maybe I should engage in veterinary tourism? If I flew to India could someone fix Ona's patella issue? Might cost a heck of lot less than doing it here. 🙂
I've had two dogs in the last year die of cancer. Actually my ex had custody of them and footed the bills. He got ripped off by UF Shands and several vets and I don't think it did anything improve the dog's life, although his life was extended several months. By the time the second dog was diagnosed later, he kind of let things run their course with pain control and ultimately dog was put to sleep. So two beloved dogs gone and about 10,000.00 poorer. I think much of veterinaray practice is a racket. With your cat, it's different. If she's got a long life ahead of her, then I say get another opinion or two and get her knee fixed. There is pet health insurance out there. Maybe take a look, but she probably has a pre-existing condition. Good luck.
Is it painful for her to have this problem? Seems like it happens kind of often regardless. I'd get a second opinion. If the 2nd opinion is surgery, I'd seriously consider it. They depend on us to give them what they need, ya know? Or maybe she could wear some kind of brace?
As for the rabies shot – both of my cats are indoor cats and neither have had a rabies shot in YEARS. My vet fully supports my decision not to vaccinate them.
Val,
Great story. Reminds me of the time my Maltese didn't look so good to me. I counted her breaths per minute and was alarmed to find it was about 60 – about 5 times normal breaths per minute for humans. I called the vet and was gently informed that dogs aren't humans and that they do a little something called “panting.” Oh, yeah. Forgot about that. My dog was fine.
Jon
Do nothing unless it starts happening more frequently, or if the cat seems progressively more uncomfortable. It's your darling little snoog-a-book kitty, but it is just a cat after all.
And yeah, those cash-only vet practices are lucrative as hell.
(I think we used to take our animals to that place in Friendship Heights when I was growing up in DC a million years ago.)
Ona update: ok, this is going to sound kinda gross, but I have learned how to pop her patella back into place. It's really easy and she doesn't mind. Any time I see her pause with her leg lifted I just pop it back in. She's generally not uncomfortable. I suppose the inevitable outcome could be a grade 4 subluxation (where it stays dislocated permanently) or development of knee arthritis. I'll try some “watchful waiting” – what's the more modern term? “Active surveillance” and see if she needs ortho.