The first patient I saw this morning came in as an emergency. The presenting complaint was “not moving”. She turned out to be a 12-year old domestic shorthair. She usually follows her owner around everywhere, always wanting to cuddle, so her owner knew something was wrong last night when she just stayed in one spot and didn’t want to get up or even eat.
My exam revealed a quiet, lethargic, febrile (T = 104) senior kitty with a fairly distended abdomen, but I found it difficult to discern what I was palpating in her abdomen. Important question I should have asked at this point: Has your cat been spayed? (We had only seen the cat at our hospital one other time, almost a year ago, for a broken foot. We’d never seen the cat for routine wellness care where we tend to address the fundamentals a little more diligently. Another reason why routine wellness care is so important! So even though her record didn’t indicate spayed, I didn’t know if it was because she wasn’t spayed or we just forgot to ask her specifically.)
I put together a treatment plan, which included comprehensive in-house blood work, a UA, IV catheterization, fluids, antibiotics and hospitalization. The owner was clearly concerned as she looked at the total of $550 and heard me say, “This is a starting point for us.”
Blood work revealed marked neutrophilia (WBC 35,000 – though I don’t remember specifics off the top of my head), elevated BUN (moderate–likely due to dehydration), hyperglycemia, and some mildly elevated liver enzymes. When I placed our ultrasound probe on her belly to collect my cystocentesis urine sample, I was a little surprised by what I saw. At first, it just looked like a really large bladder. I mean realllly large–but the bladder isn’t supposed to extend up past the kidneys! And this was more of a tubular fluid-filled structure. I stuck it with my syringe and needle anyway and aspirated 3 cc of dark green, turbid nastiness. I had just (accidentally) expressed the cat’s bladder moments before and it looked like normal, yellow pee–so clearly this material was not from her bladder.
You’d think I should be starting to think pyometra by this point, but I’m a little dense (and I always assume my patients are spayed, because they almost always are–and what 12 year old cat wouldn’t be spayed?!). I had my associate come over and take a quick look and she immediately asked if the cat was spayed or not.
When I called the owner with an update on the blood work, I of course asked her this very important question. She said no, the cat had never been spayed. I could then confidently tell her that her cat had pyometra and needed immediate life-saving surgery. Naturally, she wanted to know how much it would cost and I told her it would be about another $1000-1500.
I was afraid she would call me back with a decision to end the cat’s life, but she applied for CareCredit and was approved, so we got the green light to do surgery. Thankfully, surgery went very smoothly–better than I could have ever hoped for, really. No bleeding, no tearing, no spillage. Pretty easy, actually. She weighed a half-pound less afterwards!
Calling the owner after surgery to tell her the good news felt rewarding. We had just saved the cat’s life! But what the owner said next moved me to tears, and reaffirmed why I love to help people and their animals. I can’t repeat what she said because, although some details have been changed to protect identity and this is posted semi-anonymously, it’s still too personal in nature to share. Needless to say, this cat has seen her through some dark times, times when she felt like she had no friends at all in the world. Her cat has always stayed by her side. She felt like she had to save her. And I’m so glad we did. The kitty may be “senior” but hopefully has many, many years ahead of her.