Archive for March, 2013

What was Your Best Moment in Medicine?

Saturday, March 16th, 2013

My new client lifted her sweet little Maltese onto the exam table.  “You’ll have to excuse my gardening hands,” she said.

I gasped.  “You’ll have to excuse MY gardening hands!” I said.  We smiled.

www.j-hokkaido.com

(I examined her dog.  She was healthy.)

The Quality of Life Discussion: A Short Story

Wednesday, March 13th, 2013

Mom wants to discuss the quality of life of her old Lab.  My heart sinks.

“Doesn’t he look great?” Mom asks.

“Yeah,” I say softly.

“This season of life has been a really good one.   I thought you should know. “

The memory still makes my eyes teary.  In a good way.

 

Max the Cat Loses Weight

Thursday, March 7th, 2013

Max the Cat is our 16 year old kitty.

The Incredible Max the Cat

I may have mentioned before what an incredible cat he is.

Max was in for his wellness care the other day.  He had lost ANOTHER pound.  He used to be twelve pounds.  Now he is 6.6 pounds.  This most recent pound was lost in the past nine months.  At Max’s age, that’s scary fast to lose weight that is not lost on purpose.

A sixteen year old cat losing weight with no explanation on examination, urinalysis or blood work is a strong suspect for cancer hiding somewhere.  Look at me being objective and doctor-y about my own cat.  I can (usually) do it when needed.

I called Dr. Krapfl, who does ultrasounds for most of Omaha and whom I work with at Gentle Doctor (one of my many favorite things about Gentle Doctor – blog post idea – write THAT list).  “No rush…” I said calmly.  (Calm AND objective!  You know this can’t last through the whole case.  This is MAX!)  What Dr. Krapfl heard was “my cat”…”16″…”weight loss” and within SECONDS (a couple days) Max was upside down with his tummy shaved having his first abdominal ultrasound/cancer search – me praying for no cancer and Dr. Krapfl probably praying I would not cry.

I’d Love to Go to Work with You, But I am Washing My Ankle. Sorry.

In those couple days between weighing Max and reviewing his lab work and his ultrasound, I went through all the possible emotions associated with all the possible outcomes.

I diagnosed a ten year old (SO YOUNG) cat who was feeling great, eating great and losing weight with probable intestinal lymphoma, and bawled.  You are right, I would have bawled anyways.  But he is six years younger than Max!

At the doctors’ meeting, we discussed the most recent AVMA euthanasia guidelines.  Every time someone said “euthanasia,” I sniffled.

I tried to dwell on the fact that Max has been too skinny for almost a decade…and the 25 year old cat I once knew…and how great Max felt…and I spent the time I was not sleeping at night petting Max, and telling him things would be okay.  He didn’t really seem interested in what the future held, but loved the attention.  Cats are awesome like that.

Today came.  I packed Max up and headed to work.

Noodle Wanted to Know Why Max was in His Fort

The entire team rallied to support me.  Dr. Thomassen said she was going to have me help with a detail of a case but she would get it in case Max’s appointment ended sad – “Then you can just get home with him.”

Dr. Belfiore came into the appointment with me.  “I’m going to hold him so you can just be the Mom.”

And Dr. Krapfl said my favorite thing of all.  “Well, you could have done this on a work day after all.  I have no sad news for you.”  “I might still cry, Bob,” I said.  “Oh,” he said.

“I can’t promise you ten more years,” he said.  “26!” I thought.  “I was hoping for 25!”  And then I did cry.

Clearly, I was no longer being calm or objective, so I thanked Dr. Krapfl, tucked my cat under my arm, and ran to the corner of the doctor office, set my kitty on the desk, and wrote down all the things Dr. Krapfl ACTUALLY said, and my thoughts on follow up care.

When You are Overwhelmed, Write a List!

We tested Max for feline leukemia (negative – yes!) and feline immunodeficiency virus (negative – yes!)  Over the next few weeks, we will run a few more tests, but the Big Scary Stuff that was keeping me up at night has been ruled out.  My day is TOTALLY made.

Max Contemplating…

Max Being Awesome

Max Back at Home, Resting with his Poodle – Don’t Tell Anyone He has a Poodle Friend! 

Thank you, Dr. Krapfl!  

*Mental Hugs*