Pooey kitten!

RE: Pooey kitten!

Anthony Todd — Thu, 15 Dec 2016 20:04:34 GMT

[quote user="Clive Ansell"]If folk don't sometimes take on difficult cases and have a go, we cannot push or redefine the boundaries, maintain or improve our skills, or progress veterinary science.[/quote]

Of course not but you've got to play percentages!

Really smashed up long bone, major orthopaedic procedure, pins. plates screws etc; chances got to be better than 50% of a good functional recovery.

This, (megacolon) in adults [I assume] judging by the review article I cited, er, not very good at all.

Then you've got to factor in the discomfit, or worse, of the procedure and sequelae.

In this case I don't think the percentages are good enough.

Finances, BTW, don't feature anywhere in these decisions; they come after.

RE: Pooey kitten!

Anthony Dennison — Thu, 15 Dec 2016 12:03:11 GMT

I've had a couple of kittens like this at the RSPCA Shelter I visit - both of them were quite bunged up and producing really hard stools - as finances were limited I started them on liquid paraffin and then lactulose at quite high doses.

It took a while but as the kittens grew this issues resolved. A bit like their colon had grown big enough to cope with the stools. One case was over 2 years ago, and hasn't had any problems since.

RE: Pooey kitten!

Clive Ansell — Thu, 15 Dec 2016 07:48:49 GMT

[quote user="Anthony Todd"]

PS [and as an aside] you've got to admire, or I do, the skill and ancillary expertises [plural] getting a kitten that small through a major procedure like that.

My hat off to your boss and his support staff!

[/quote]

I agree, and in a way I admire Busybee and colleagues for having a go and giving it their best shot.

I know the prognosis was always going to be poor, but there was a very slim chance of success. As long as the client was made fully aware of the prognosis and likely complications and outcomes, I cannot see that it is an more or less unethical than many other things we do.

If folk don't sometimes take on difficult cases and have a go, we cannot push or redefine the boundaries, maintain or improve our skills, or progress veterinary science.

Or do people think that difficult, unusual or ground breaking cases and procedures should be the sole preserve of referral centres and recognised specialists?

RE: Pooey kitten!

Virginia Campbell — Wed, 14 Dec 2016 22:27:33 GMT

[quote user="Anthony Todd"] the long list of future complications makes me come to the conclusion that the journey should have been terminated long before, independent of the money spent.[/quote]

I understand this. Just was thinking if Busybee wrote the original post hoping there was some wonderdrug that they didn't know about that makes colons work, the "finances are declining" is relevant because it would rule out any further diagnostics and treatment if they happened to be very expensive, like sending a test off to a genetic lab in the USA then getting a special import license to bring the expensive wonderdrug in from France, or whatever. Whereas if the wonderdrug wasn't overly expensive - I dunno, like the equivalent of using Bravecto for Demodex or something - then it would be worth suggestions.

My first thought in this case would be "I don't know of anything that makes congenital megacolon colons work- euth it, it's probably not going to do". But I don't know about all the wonderdrugs that exist. I don't know that it's definitely not going to do, because I haven't read the papers about whether congenital megacolon cats will realistically ever do or not. If somebody else had done a subtotal colectomy and I was called on to manage the case I would give it the drugs I knew about, see what happened, mean to ask questions on VIN and vetsurgeon that night, and probably eventually get around to asking the questions on the forums about a week later when I haven't returned home at 11pm/to a stroppy baby and husband wanting to talk rather than bury my head in the computer/to research more pressing cases like the adrenalectomy I did today (first ever, read Fossum yesterday lunchtime and skimmed again this morning, it went OK thanks for asking).

So the kitten, in my hands, might have been left cantering about after its toys in the back for longer than necessary before I did enough research to realise that the prognosis was hopeless, and tell the owner that we needed to stop the bus and euth it.

RE: Pooey kitten!

Anthony Todd — Wed, 14 Dec 2016 20:00:59 GMT

[quote user="Virginia Campbell"]In case somebody was going to suggest some sooper dooper expensive only performed in one lab in the USA test for something rare and genetic that is beautifully controlled by some sooper dooper drug that costs £200/month?[/quote]

You'll have to explain this in the context of a consult in a vet's surgery in the UK and relevance to the post.....

I suppose we''ll never know what had been spent so far but a glance at the paper I cited and the long list of future complications makes me come to the conclusion that the journey should have been terminated long before, independent of the money spent.

Although this is always easier in hindsight, in a case like this the odds of a smooth return to a normal existence for ever, and all the suffering in between, are not good enough for me to change my opinion.

And the chances of rehoming a one-eyed kitten are good/average/poor??

RE: Pooey kitten!

Virginia Campbell — Wed, 14 Dec 2016 19:03:10 GMT

[quote user="Anthony Todd"]So why, pray, mention that "Finances and the kitten's quality of life are declining".[/quote]

In case somebody was going to suggest some sooper dooper expensive only performed in one lab in the USA test for something rare and genetic that is beautifully controlled by some sooper dooper drug that costs £200/month?

RE: Pooey kitten!

Lucy Fleming — Wed, 14 Dec 2016 18:56:27 GMT

[quote user="Robin Grimmer"]Not in this case. This is purely an ethical decision. Is it fair to put a 2 month old kitten through all this surgery with a poor prognosis? I don't think so. Money is irrelevant.[/quote]

Equally, you could argue that an animal that young, with a potentially long life if the surgery is successful, should be given the chance, however slight. I'm not saying that is the decision I would or wouldn't have made if it was my pet, or my case, but I don't necessarily think that performing the surgery is innately unethical.

RE: Pooey kitten!

Anthony Todd — Wed, 14 Dec 2016 17:43:50 GMT

PS [and as an aside] you've got to admire, or I do, the skill and ancillary expertises [plural] getting a kitten that small through a major procedure like that.

My hat off to your boss and his support staff!

RE: Pooey kitten!

Anthony Todd — Wed, 14 Dec 2016 17:32:58 GMT

[quote user="Clive Ansell"]I think those comments are a tad unfair. there was never any suggestion or implication in Busybee's OP whatever that this was financially motivated in any way.[/quote]

So why, pray, mention that "Finances and the kitten's quality of life are declining".

As I have said many times this is the major change in approach between modvets and dinovets.

i don't think I, or any dinovet, have ever euthanised a pet because of money, although, to be fair, the charities were usually happy to take these sort of cases on,

Either a pet needed an endomaxipectomy [with all the add-ons that now are mandatory] or it didn't, if it did, then that was the recommendation, if it needed bloods, same, if it needed what-ever, same, finances came at the end!!

I just wish the owners of that kitten had run out of money sooner!!

RE: Pooey kitten!

Robin Grimmer — Wed, 14 Dec 2016 13:26:39 GMT

[quote user="Clive Ansell"]

[quote user="Anthony Todd"]

I do hope it wasn't just "declining finances" that were influential and would not support the "expected outcome".

I suppose the final straw was "Finances and the kitten's quality of life are declining ".

[/quote]

I think those comments are a tad unfair. there was never any suggestion or implication in Busybee's OP whatever that this was financially motivated in any way.

Finances are a key factor, often the limiting factor, in the decision process for many euthanasia cases. Often treatment can not proceed because of "no money"

[/quote]

Not in this case. This is purely an ethical decision. Is it fair to put a 2 month old kitten through all this surgery with a poor prognosis? I don't think so. Money is irrelevant.

RE: Pooey kitten!

Martin Atkinson — Wed, 14 Dec 2016 09:45:16 GMT

[quote user="Busybee"]A bit harsh Martin, especially when you don't know the client's circumstances. I asked for ideas to help with a difficult case, not a judgement from a pedestal. [/quote]Considering your response: 'Thanks Martin, this is what we are thinking but just wondered if there was any light at the end of the tunnel', to my first post: 'Sorry Busybee but I think this is one its best to call time on and euthanase on welfare grounds. I'm amazed it got as far as such drastic surgery in such a young kitten, I would certainly not have been party to it', this is a bit of a turnaround.

No pedestal, no judgement, no insinuation of financial motivation, just an opinion that this was ill-conceived, unnecessary and the outcome predictable - something I suspect you are also aware of if you were to admit it.

RE: Pooey kitten!

Clive Ansell — Wed, 14 Dec 2016 09:29:08 GMT

[quote user="Anthony Todd"]

I do hope it wasn't just "declining finances" that were influential and would not support the "expected outcome".

I suppose the final straw was "Finances and the kitten's quality of life are declining ".

[/quote]

I think those comments are a tad unfair. there was never any suggestion or implication in Busybee's OP whatever that this was financially motivated in any way.

Finances are a key factor, often the limiting factor, in the decision process for many euthanasia cases. Often treatment can not proceed because of "no money"

RE: Pooey kitten!

Anthony Todd — Tue, 13 Dec 2016 22:32:03 GMT

[quote user="Busybee"]Would you not operate on any kitten/puppy with megacolon?[/quote]

Definitely not on a 2mo kitten(!) or puppy, but depending on age and age of onset, and response to non-surgical intervention.

[see reference below]

[quote user="Busybee"]especially when you don't know the client's circumstances.[/quote]

I can't see how this has anything whatsoever to do with an animal's atonic bowel.

[quote user="Busybee"]managed by my senior colleague, who I suppose would be classed as a said 'dinovet'[/quote]

In this case I'd disagree with him and pretty early on too.

[see reference below]

[quote user="Busybee"] the case was discussed at length, options and expected outcomes were given throughout the process.[/quote]

We can only differ I guess.

I do hope it wasn't just "declining finances" that were influential and would not support the "expected outcome".

[quote user="Busybee"]He had been hospitalised with us for the whole period of treatment, given food, fluids, pain relief, laxatives not to mention a whole host of toys![/quote]

He can't have been over the moon though, and unless you can produce some evidence that kittens with this degree of, let's call it "gut problems" do well, even if eventually, I don't think anything would ever justify the effort in this case, based on what you have described.

[quote user="Busybee"]not a judgement from a pedestal.[/quote]

Not a pedestal, but just as I said " I just wonder where the profession's compassion compass is " and I suppose the final straw was "Finances and the kitten's quality of life are declining ".

Not many dinovets I know, or knew, ever mentioned or considered money when making this sort of critical decision!

However in the interests of EBVM this seems to be the most comprehensive survey, and from the UK:

Journal of Feline Medicine and Surgery (2002) 4, 129–138 doi:10.1053/jfms.2002.0171, available online at http://www.idealibrary.com

but if you look at the tables [sideways], consider that this was a kitten, and read the number of of complications in the 118 cases reported and all the different complications, repeated surgery etc. etc.I still think an early euthanasia would be the correct advice.

RE: Pooey kitten!

Busybee — Tue, 13 Dec 2016 21:28:15 GMT

[quote user="Anthony Todd"]some permanent congenital neurological bowel deficiency, is allowed to go on.[/quote]

In which cases would a colonectomy be appropriate then? Would you not operate on any kitten/puppy with megacolon?

[quote user="Martin Atkinson"]You don't have to be a dinovet to see what a waste of time and resources this was let alone considering the suffering the kitten went through and the false expectation the client was given. Common sense should have prevailed but maybe that is a bit lacking in 'modvets'![/quote]

A bit harsh Martin, especially when you don't know the client's circumstances. In fact, the case was initiated and managed by my senior colleague, who I suppose would be classed as a said 'dinovet'. The client was never given any false hope; the case was discussed at length, options and expected outcomes were given throughout the process.

I would like to think as a vet, I have a pretty good grasp of animal welfare and feel offended that someone who hasn't seen the animal is accusing me and my colleagues of leaving an animal to suffer. I know the kitten (who, incidentally has now been put to sleep) was obviously not normal and had a severe illness, but I genuinely believe his welfare was not unacceptably compromised. He had been hospitalised with us for the whole period of treatment, given food, fluids, pain relief, laxatives not to mention a whole host of toys! He was not just stuck in a kennel or given to the owner to manage.

I asked for ideas to help with a difficult case, not a judgement from a pedestal.

RE: Pooey kitten!

Robin Grimmer — Tue, 13 Dec 2016 14:12:17 GMT

For once Anthony, I am in complete agreement with you!

RE: Pooey kitten!

Martin Atkinson — Tue, 13 Dec 2016 09:38:46 GMT

[quote user="Anthony Todd"]I just wonder where the profession's compassion compass is when the euphoric effects of phenobarb are regarded as cruel, yet this poor kitten which has, to a dinovet, some permanent congenital neurological bowel deficiency, is allowed to go on.[/quote]You don't have to be a dinovet to see what a waste of time and resources this was let alone considering the suffering the kitten went through and the false expectation the client was given. Common sense should have prevailed but maybe that is a bit lacking in 'modvets'!

RE: Pooey kitten!

Anthony Todd — Tue, 13 Dec 2016 01:24:25 GMT

[quote user="Martin Atkinson"]

Sorry Busybee but I think this is one its best to call time on and euthanase on welfare grounds. I'm amazed it got as far as such drastic surgery in such a young kitten, I would certainly not have been party to it.

[/quote]

+1 and I can't believe it has been allowed to suffer for so long.

Finances shouldn't even warrant a mention, they're not a symptom or a treatment but seem now to be a sort of diagnostic exclusion or treatment inclusion.

I just wonder where the profession's compassion compass is when the euphoric effects of phenobarb are regarded as cruel, yet this poor kitten which has, to a dinovet, some permanent congenital neurological bowel deficiency, is allowed to go on.

RE: Pooey kitten!

Busybee — Fri, 09 Dec 2016 21:48:28 GMT

Thanks all.

No, David, the ileocaeocal junction was left in.

I've had the kitten under GA again today to further evaluate it. It was still straining very frequently and a large bulge was developing behind the anus. Unfortunately, there is continued dilation of the remaining bowel, which feels very flaccid, almost like a bladder, on abdominal palpation. The faeces is forming fine but just backing up and up so the kitten cannot easily pass it. It took 20mins to unblock him again.

Finances and the kitten's quality of life are declining and unless he starts to improve over the weekend, euthanasia seems likely. Very sad case as he's such a lovely little guy.

RE: Pooey kitten!

David Mills — Thu, 08 Dec 2016 21:56:40 GMT

Was the ileocaecal junction removed? If it was, I find these do worse than if its left in place in terms of producing normalish faeces in the future.

You could try erythomycin paediatric liquid, dose is 1-2mg/kg TID, fairly easy to give and can stimulate intestinal motility so the kitten when it wants to go, can. Sounds as if there may be some dyssynergia between colon (if any left) and rectum.

Feeding a low residue diet is useful - you could try changing to a pure meat/protein diet rather than RC for a couple of weeks.

Tough case.

RE: Pooey kitten!

Glenn Hodgson — Thu, 08 Dec 2016 21:50:44 GMT

I'd add in peridale if id gone this far. Could perineal stimulation help like in younger kittens? Would probablly just make it angry tough.

RE: Pooey kitten!

Busybee — Thu, 08 Dec 2016 20:36:11 GMT

Thanks Martin, this is what we are thinking but just wondered if there was any light at the end of the tunnel.

RE: Pooey kitten!

Martin Atkinson — Thu, 08 Dec 2016 18:08:22 GMT