Friday, May 10, 2013

1411. Follow up: Cat with bladder stone surgery & owner's preferences of vets

tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS

Date:   11 May, 2013  
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
The vet said that the cat would die  
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   11 May, 2013 
Be Kind To Pets
Veterinary Education
Project 2010-0129

Friday, May 10, 2013

1411. Follow up: Cat with bladder stone surgery

Friday May 10, 2013

"Remember the cat? You said it would die under surgery!" the busy gentleman drove over to buy the C/D dry food and canned food for his cat after ensuring that these were available. He had ordered earlier and deliveries by the Science Diet supplier arrive only on Thursdays of the week. His cat had run out of the canned food.

"Yes, I remember your cat" I said. Cats with bladder stones are relatively a rare occurrence in Singapore and this was one with impending kidney failure according to the vet who had taken blood test. The owner wanted an immediate surgery since his vet who diagnosed the condition would not do it owing to lack of experience while the senior vet had a full schedule of surgery.

It is best not to operate on a cat with impending kidney failure as the cat would die. I waited one day so as to give antibiotics since the other vet did not do it. The cat die not die under surgery but the owner never forgets the "cat will die if operated upon" informed consent.

"How's the cat?" I asked.
"Put on weight. Back to his naughty pesky self now, as normal." he said.
"Can I keep the prescription diet inside my car as I cannot go home immediately?"
"No," I advised finding a covered car park.
He was such a busy person but he took time off to buy the special food for his cat before the stock runs out. His cat eats one can per day. Most Singaporean cat owners will not be bothered. He told me his cat will eat the canned food whether it was refrigerated and cold and also any brand of cat food. This is surely an unseal cat as most cats are fussy.

I am glad his cat is normal and there is the chance to follow up with him. I told him that the supplier will deliver to his home if he pays me first for the next order.  "The supplier does not want the hassle of collection," I said. He would transfer the money to my account electronically first. Actually he could have bought the food from the vet nearby but he did not do so. The vet was the one who diagnosed the bladder stone and I am sure she would just sell him the special diet.

Pet owners have their preferences of vets and it is up to the vet to build up the relationship of trust and goodwill as there is nowadays a vet round the corner. Owners have to make an extra effort just to go to a vet "far away" just to buy the special diet which is easily available at most vet practices in Singapore.

  An informed consent must be given prior to anaesthesia and surgery. It should be in writing but in this case, I emphasized orally the high risks of death since the cat has kidney disorders based on blood tests and surgery could not be postponed for a week. I suspected the cat could suffer from a bacterial nephritis based on high total white cell count so a pre-emptive antibiotic injection which the other vet did not administer would increased the chance of success.

In this case, the odds were in my favour after a Baytril antibiotic injection SC 24 hours ago. The cat survived the bladder stone removal surgery. Unfortunately for me, the owner never forgets my warning that "the cat will likely die during the anaesthesia and surgery" and will remind me whenever possible. Many vets will suffer my situation when the cat they say will die from a serious disease lives up to a ripe old age!

He had Hobson's choice and I had been fortunate that the cat did not die on the operating table and the fact that this owner detected loss of appetite in less than a week. Many cat owners wait and see for several weeks before they seek vet consultation.

No vet can predict the surgical outcome in taking on high-risk anaesthetic cases. Use evidence-based medicine always but sometimes the owner's financial situation prohibits blood testing and in this situation, it is difficult. In such situations, use minimal injectable sedatives, use IV drips and isoflurane only. 
Updates will be at: Calcium oxalate bladder stones in a much loved cat.
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