We all rely on doctors, nurses and many other medical staff who work in human-based medicine to help care and assist in what are often the most difficult of times. In the same way; we rely on the professional skills of veterinarians for the care of our non-human family. We hope that their expertise is combined with an understanding of the animal they are seeing, compassion towards them and clarity in explaining a diagnosis and treatment.
Unfortunately just like the terrible, shocking stories we read or hear relating to medical care of people that goes tragically wrong, this can also apply to animal medicine.
It doesn’t need to be a case of gross negligence or incompetence or a deliberate malicious act. A certain mindset or attitude that to a distressed, bewildered human trying to make a decision about an ill and highly stressed animal can do the greatest damage of all: the irrevocable decision to euthanise.
This story is about our cat, Bod, a British shorthair who, until a sudden, seemingly trivial urinary infection seemed healthy and happy.
Bod had only one instance of a urinary problem in the previous eleven years. He was diagnosed as being prone to a build up of struvite crystals in his urine when he was five, which after being initially treated for a blockage, was completely controlled by diet.
Then he had the first treatment for the appearance of a urinary tract infection in May this year. And this is where we started encountering problems. The infection appeared to clear up with antibiotics. Then, only a week later, it returned. Initially it seemed less painful than the first time but it resulted in a bladder blockage requiring catheterisation. Stronger antibiotics were given, but this time his recovery just didn’t seem quite normal once he returned home. Over a five day period Bod’s vocalisations changed in pitch and tone, his back legs became weakened, he remained bladder incontinent when his urination should have returned to normal, his eyes were often unfocused and he became prone to hunching over his water bowls. Worst of all; he stopped eating.
I could write about all the details of his illness at extreme length but these were just the most noticeable.
The essential thing is that Bod had, unknown to us, developed Feline Chronic Kidney Disease. Chronic Kidney Disease (CKD) is not unusual in cats, although it is more often diagnosed in older ones. If you’ve never even heard of it, please don’t be embarrassed or feel ignorant reading this, it’s not something I had ever read about before either.
As the symptoms built up for a week, all we knew was that Bod wasn’t recovering in the way he should be. We’d taken him to the vet and phoned several times but no-one, at that point, seemed to pick up on the need for immediate treatment. Like many others before me; I took to the internet to try and find information. After some false starts I found an amazingly detailed resource: Tanya’s Guide to Feline Chronic Kidney Disease, created and managed by Helen Fitzsimons. I cannot recommend this website strongly enough. It basically saved Bod’s life.
Knowing that Bod was showing signs of what is called a ‘crash’ we finally got through to a vet at the practice, someone we hadn’t met before, who did know what he was seeing and listened to our litany of symptoms. And this is where it could have taken an absolutely disastrous turn.
If I hadn’t read the relevant advice on Tanya’s CKD pages, I would’ve been inclined to just listen to the vet and take his assessment at its professional face value. Bod looked in a bad state by now, but we knew he was still trying to move around, to urinate in his litter box and drink water.
Both myself and Mr Other Half were upset and mentally and physically tired from the stress of watching Bod’s condition worsen despite our efforts to help. We were reassured, at first, as the vet was thorough in his physical examinations and seemed engaged, friendly and concerned about Bod’s health. Then the initial blood test results were processed and this seemed to take over his focus entirely. Some of the chemical levels were apparently off the scale of their lab equipment to even measure.
He instantly emphasised how seriously ill Bod was, that his kidney functions were likely to be failing completely but without once mentioning CKD. Before he had discussed what possible stabilising treatments could be given, the euthanising option was clearly being stated. Bear in mind that having a vet say; “Optimistically he has a 50/50 chance” and then, in the same sentence, that we should think about ending his life it would appear to be a very contradictory situation. Without being aggressive; the vet was trying to steer us towards euthanising, as though we should decide at that very instant without attempting any treatment.
If that sounds extreme then, in reading Helen Fitzsimon’s guide and contributors’ stories, you will find that, sadly, this is a common reaction from some vets when faced with a cat that has CKD.
Despite our exhaustion we were determined not to give in. If Bod had a 50% chance of recovery then he wasn’t going to get that chance if we had him euthanised. We rejected that and said we wanted him admitted for treatment.
This was not the last time the vet attempted to push towards that choice; in a phone conversation later that day he strongly resisted my suggestion that there should be at least a week of treatment, if Bod appeared to be only slowly improving, with the answer that it would only be unnecessarily painful and that it would be best to consider sparing him that. This was after just a few hours of treatment when Bod’s very high potassium levels were already beginning to drop as he responded to being on an IV drip.
I’m sure the vet sincerely believed that it was the only realistic option and perhaps he had particularly strong grounds, in his view, why that was the correct choice to make. I cannot say what his motivations might have been for certain. But he was wrong in making that particular judgement and he was especially wrong to press for euthanising without allowing basic treatment to be tried.
Thankfully, it was the last time we had to see that particular vet during the next two and a half days of treatment and his care was handed over to a different person. Bod did respond and stabilise extremely quickly through being rehydrated and receiving two of the standard medicines for managing CKD. I also cannot fault the dedicated levels of care from the practice’s veterinary nurses. He was released to come home two and a bit days after taking him in and was excited at being able to move around freely in his home environment. He was not completely healed physically, but he was back to showing the happy and affectionate behaviour that we hadn’t seen in some time.
Bod, for now, continues to improve from his sudden crash and we both decided to look for another veterinary practice that is willing to work with us on actively managing his CKD for as long as is reasonably possible for a pain-free and happy life.
The reason I’ve shared this experience is because if we had fully trusted in the few, extreme, details we were told by the vet of his condition we would have never seen our cat be himself again. We would have never seen him alive again, full stop.
This isn’t to say ignore or challenge all veterinary advice at every instance. Many vets are fully supportive of cats with various stages of CKD and work very hard with clients to ensure the correct balance of care is achieved. This is not meant as an anti-euthanasia stance either. I think it is right to be able to decide on euthanising when there are levels of suffering that cannot be relieved by other means, but, it should be as part of an overall plan of care and support and it should be discussed when it is appropriate for the individual animal. It should not to be used as a first instance response in all cases, at all times.
Read, learn and ask questions and remember that, like any other professional, vets can make the wrong choices too. Being informed about the disease and knowing your own cat’s behaviour means you don’t always have to agree with them.