Are we really as good as we think we are?

Re: Are we really as good as we think we are?

Gillian Mostyn — Wed, 19 Sep 2012 19:24:49 GMT

[quote user="plantagenet"]Ill animal + normal bloods always starts me worrying.[/quote]

Re: Are we really as good as we think we are?

plantagenet — Wed, 19 Sep 2012 12:55:24 GMT

Alas there is a grain of truth behind what the article has actually written.

There are cases (and this may not have been one of them) when you just know the animals stuffed, and the client probably knows it too, but it would cost a lot to find exactly what form the stuffing takes and you sure as hell aren't going to make it better.

With discussion with the owner about what course they want to take, sometimes early PTS is the answer.

I think sometimes it is we vets who want all the answers, perhaps self protection, perhaps professional curiosity, perhaps lack of experience.

Ill animal + normal bloods always starts me worrying.

Re: Are we really as good as we think we are?

patrick murphy — Tue, 18 Sep 2012 15:57:05 GMT

I once had a gp not even look at me from the computer terminal which was facing away. don't get me started. I was in the middle of chemo and having a terrible time of it. I say an opthoid who asked how I was doing, but interupted me during my reply re. chemo etc. to say, not how I was, he meant how was my eye! it was needless to say fairly low on my list of prioritis.

Re: Are we really as good as we think we are?

Rajat — Tue, 18 Sep 2012 00:33:00 GMT

Oh, and this comment made me smile,somewhat wryly - this is from one of the readers of the post:

Methavrio said... "My first port of call when it comes to feline ailments is the cat breeder who sold mine to me. They can be a good source of sensible advice on cat management. I'm fed up of vets opining your cat is 'allergic to fleas' and suggesting a series of ever more expensive and invasive tests. Seems to be a default position."

Re: Are we really as good as we think we are?

Rajat — Mon, 17 Sep 2012 23:40:47 GMT

[quote user="Martin Atkinson"]I do however believe that I can feel the very earliest thickening of intestines and millimetre enlargements of the lymph nodes and I've yet to find a cat so tense that I cannot confidently palpate its abdomen, but we are not likely to be talking fat cats here are we?[/quote]

You are a much better man than me at palpation then and I have no doubt the lack of US has honed your PE skills - incidentally fat cats do get gut cancer/lymphoma- last one I have had is from just 3 days ago with no obvious changes on abdo palp (under sedation)..US shows SI spasticity and mucosal prominence, overall there is SI thickening -0.42cm (normal upto 0.3 or 0.35 cm depending on who you read..)...enlarged LN upto 1.0cm, fnab of lymph nodes is pending but suspicious on in house microscopy for lymphoma..!

One great benefit of ultrasound is non invasive sampling of tissue- without it I believe disease may be picked up later in its course and also more exploratories are needed..but regardless of that, if it was malignant cancer sure the cat was buggered but the article just says the scan revealed cancer..which the scan can't really do - it can point towards it but it's not a microscope! And the author says after it revealed cancer, they decided to put the cat down..without biopsy/surgery/chemo which may have possibly shown it was not malignant or curable or was potentially.treatable..all a bit strange!

Re: Are we really as good as we think we are?

David Mills — Mon, 17 Sep 2012 22:45:44 GMT

[quote user="Michael Woodhouse"]

TBH the cat was buggered however you chose to look at it......

[/quote]

What a very silly article it is by someone who should be intelligent enough to know better. I'm always suspicious of bloggers of any ilk - Joe Inglis anyone? - especially when they trot out lazy misunderstood articles such as that claptrap. MRI scan? Do me a favour.

In any case, the cat was headed for an early grave, as above, which is sad, and perhaps the vet could have communicated better, who knows - what is it, people in human consultations remember - 11% or so?

As above gut cancer is terminal anyway, hardly ever shows up on bloods and I very much doubt anything more could have been done to change the outcome.

If she was that bloody bothered why didn't she try preds?

Re: Are we really as good as we think we are?

Michael Woodhouse — Mon, 17 Sep 2012 22:19:57 GMT

TBH the cat was buggered however you chose to look at it......

Re: Are we really as good as we think we are?

tess — Mon, 17 Sep 2012 21:00:42 GMT

The other thing is that we are all human, and we all make mistakes. I bet we can all recall a case where we've overlooked something, or missed something on exam. The main thing is that we learn from it!

Re: Are we really as good as we think we are?

Martin Atkinson — Mon, 17 Sep 2012 18:16:38 GMT

[quote user="Rajat"]Maybe by the time lymph nodes in the cat are palpable and guts are obviously thickened the disease has progressed a fair bit!![/quote] I believe the inference in this case was exactly this - it didn't present in the best of health, I doubt it went from the full bloom of health with slight anorexia and no discernible lesions to euthanasia due to bowel cancer in the space of a few days! I do however believe that I can feel the very earliest thickening of intestines and millimetre enlargements of the lymph nodes and I've yet to find a cat so tense that I cannot confidently palpate its abdomen, but we are not likely to be talking fat cats here are we?, by the time there are any symptoms they've already lost a lot of weight let alone at end stage this one allegedly was at. You see some of us were weaned as vets without the luxuries of ultrasound let alone MRI and we managed to diagnose things pretty well believe it or not.

Re: Are we really as good as we think we are?

Rajat — Mon, 17 Sep 2012 17:31:37 GMT

[quote user="Martin Atkinson"]

Mmmm...without the vet's side its difficult to judge but I have yet to come across a symtomatic cat with bowel cancer that I could not feel thickening of the gut or enlarged lymph nodes which would prompt me to investigate further. I would assume that the vet did an abdominal palpation but one thing it didn't say was the age of the vet. It seems to me sometimes that the modern generation has lost the use of the connection between its brain and it's hands and has come to rely on high tech equipent to make a diagnosis. Maybe there is more than a grain of truth in this account, I don't see an obviously detached owner here just a realistic one.

[/quote]

I see plenty of cats with early lymphoma with enlargement of lymph nodes on ultrasound and NO other changes..Now if you can feel them great (we are talking millimetres here) - but in many cases one cannot feel them due to a variety of reasons- size, tense abdomen/ painful abdomen and so on.Maybe by the time lymph nodes in the cat are palpable and guts are obviously thickened the disease has progressed a fair bit!!

Re: Are we really as good as we think we are?

Martin Atkinson — Mon, 17 Sep 2012 17:20:59 GMT

Re: Are we really as good as we think we are?

Robin Grimmer — Mon, 17 Sep 2012 17:04:20 GMT

This sometimes happens when an owner has an animal euthanased. They are often looking for someone to blame, and as the vet, it's all too easy to be in the firing line without doing anything particlarly wrong. In this case, perhaps it was guilt with the owner neglecting the cat and not taking it in early enough. Gut tumours are one of the commonest conditions we see in older cats and after ruling out hyperthroidism and other organic disease I am always suspicious if an older cat is losing weight and anorexic. This is the owner's perception of how events occurred, but I bet the vets concerned would tell a different tale. And the owner must be confusing MRI with an ultrasound scan.

As for GPs, when was the last time your GP performed a clinical examination when you went to see them?

Re: Are we really as good as we think we are?

Anthony Todd — Mon, 17 Sep 2012 16:21:59 GMT

[quote user="Joyce Whitehead"]I would also agree that vets generally have a better reputation for actual examination of the animal,[/quote]

Mmm, the writer accepted a tentative suspicion with alacrity I think. Too much trouble and money for an ex lap etc.

I remember shouting into a full waiting room that I had not said "there's nothing I can do" to an owner who wanted his "ill" cat euthanased.

In this case the owner got round his mild guilt by criticising vets in general and the testing philosophy.

Id love to read the vet's notes......

Re: Are we really as good as we think we are?

Joyce Whitehead — Mon, 17 Sep 2012 15:57:02 GMT

I would agree with Bob, I think it may well have been ultrasound that this cat had, and the owner made the jump from "scan" to MRI as that is what she knows about. I also think this was a slightly uninvolved owner, to call the cat "it" in the article says quite a bit to me. And who is to know what the vet said about the bloods. I'm sure many of us have spent time explaining to owners on the phone that the bloods were normal but that this does not rule out everything, etc etc, and that further tests or monitoring may be required, only to have the owner come back in and say "the vet/you didn't know what was wrong before" or "you said he was fine".

I would also agree that vets generally have a better reputation for actual examination of the animal, so many GPs don't actually touch the patient....

Re: Are we really as good as we think we are?

Bob Russell — Mon, 17 Sep 2012 15:31:34 GMT

Not really enough information to make any judgement on the case diagnostically. What is very sad is the perception that the vet(s) involved did not look at the cat.

Blood tests are not all seeing, all knowing especially for gut related pathology so I would not be particularly surprised to get a lot of normals. The owner got the message that because the blood tests were normal the cat was fine. If gut looked abnormal on MRI was the offer made to biopsy (MRI??). Was it MRI or ultrasound I wonder?

It sounds as if this was a disaster of communications. If an owner thinks there is something wrong with their pet then there usually is in my experience. Not always something major but this is a good wake up call for vets that think technology has all the answers.

Love the bit about the GP looking at the patient - usually the perception is that it is the vet that looks and the GP that does not!

Re: Are we really as good as we think we are?

Dagmar Steele — Mon, 17 Sep 2012 15:26:00 GMT

yes and no I'd say... A sick cat is a sick cat and if it's off it's food for some time there must be something wrong. The blood test was clear does not exactly equal the cat is healthy, right? To find out what is wrong with it, maybe the next step would have been a scan - do we know if this was declined? If no further diagnostics has been offered initially maybe the vet in question is to blame of overlooking the cat's suffering, if it has been offered it's another cup of tea. Without diagnostics it may have been difficult to tell what exactly was wrong with little cat, and putting it down without knowing why may not have been an option, too. Very speculative I know but it shows we're lacking vital parts of the story....

Re: Are we really as good as we think we are?

Rajat — Mon, 17 Sep 2012 15:22:38 GMT

From a consult to an MRI scan?

Doesn't sound very believable. Additionally, small bowel cancer may be tough to identify in a cat at first consult..who knows what happened here. Didn't sound like a particularly involved or 'animal' involved owner by the tone of her article, so I take this as a bit of a random un-informed moan more than anything else..

I do know as vets, we are good at one thing which GPs suck at - the physical exam...and our patients being non verbal has pushed us and our teaching to emphasize how important this bit is. I wonder, if this is still seen as the all important most basic and first 'test' in human medicine too.