Sunday, March 20, 2011

Not your average laceration.

Client arrived for me to evaluate a wound on her cat's neck, which occurred just prior to arrival.  A tech gathered vitals and a brief history in the exam room, as is typical for any patient who presents at our hospital.  The patient (Reeba) was 2 years old, and the client did not note any other health concerns.    When I entered the exam room, I was not expecting this case: Reeba weighed about 4 lbs, was emaciated, very weak, and icteric (a yellow tint to the skin).

I started to ask questions to figure out the real story with Reeba; her appearance suggested a very chronic, long term illness that the client did not seem to recognize.  The client reported that her kitty was totally normal prior to this wound, did not go outside, and was not any medications.  I asked specifically what Reeba had been eating and commented on her emaciated figure.  The client paused for a minute ....  and finally admited that maybe Reeba hadn't been eating well for a few weeks.  The client had been out of town for 2 weeks, and she thought maybe the other cat in the household ate ALL the food.

Me: "Are you sure it's only been a few weeks?  She's extremely thin.  Do you know how much weighed before she started to look thin?"

Client: "About 16 pounds.  She was obese and my vet told me to help her to lose weight at her last checkup."

Me: "When was that, specifically? Did you have her seen by your veterinarian, so perhaps you have an exam date or some records? A few weeks seems like too short of a time to lose 75% of her mass."

The client shuffled through her paperwork, and found the exam dated THREE MONTHS prior.   Reeba's mom reflected on the history, and realized maybe it had been more like 2-3 months that her appetite had seemed poor.   While the client was out of town, Reeba had eaten NOTHING.  The client returned home about a week ago, and started syringe feeding Reeba several days ago.  The wound happened today, accidentally, when she tried to hold on to Reeba for a feeding.

Regardless of the initial cause of Reeba's illness, at this point, she was likely suffering from hepatic lipidosis, or accumulation of fat into the liver during starvation. Very simply stated, hepatic lipidosis causes kitties who were already sick to have a worsened appetite, causes nausea, and also results in liver dysfunction and icterus, as in Reeba's case.  She was a very sick cat, and having lost nearly 75% of her body weight, required intensive care and diagnostics.

The client authorized bloodwork and hospitalization, which provided further evidence for severe liver dysfunction.  Over the next 5 days, Reeba stayed in the hospital for rehydration, placement of a feeding tube, and careful monitoring.  Reeba suffered from multiple complications of starvation, including re-feeding syndrome and skin fragility syndrome.  Re-feeding syndrome is a potential consequence of eating after long periods of starvation.  Reinitiating normal nutrition results in massive electrolyte changes, which can be life threatening and severe, including hypophosphatemia, hypokalemia, and hypomagnesemia resulting in weakeness, cardiac arrythmias, destruction of red blood cells, or death.

Unfortunately, due to Reeba's starved condition, she also suffered from acquired skin fragility syndrome -- which caused the initial wound and the original presenting complaint.  Her skin tore with normal activity, resulting in wounds over large portions of her body.  Despite careful handling, Reeba acquired new open wounds almost daily.

Reeba was discharged after about a week from our hospital, and over the following month, continued to suffer from complications related to her starvation.  Eventually we lost contact with Reeba's owner.  I hope Reeba had a full recovery, but I believe it is more likely that she eventually succumbed to her illness.

All of this could have been avoided if the owner had not waited THREE months to see a veterinarian about her cat's lack of appetite.  I still can't grasp what she was thinking -- watching each day, as her cat skipped meal after meal and lost every ounce of muscle on her body.   Imagine an average, physically fit, six-foot adult male going from 180lbs to 72 lbs over several months, and not consulting a physician.   To this day, I still just don't understand if she wasn't smart enough, was in denial, was concerned about finding out bad news, or.... ?????  It's beyond my comprehension.

1 comment:

  1. Wow. Nice. Very nice. Sometimes I think owners must be... I don't even know, honestly. There is nothing to say about that other than I am very sad for the (now likely dead) kitty.