Urban Jungle
Despite having been a vet for more than a decade, I freely admit to not being able to predict the outcomes of all cases that come through my clinic. It is hard, and in some cases impossible, to give a perfectly accurate prognosis for every situation.
Some situations are fairly predictable - particularly with common diseases with typical symptoms - and respond to treatment in a typical and repeatable pattern. But there are times when making predictions is simply a game of risk management, and no matter how many variables you have covered, there will always be an element of the unknown. The more complex the disease, the less predictable it is. Unfortunately, it is the life-and-death situations that are often the most complex. This is where we veterinarians have to dig out all our predictive skills to give a prognosis on which clients can make further decisions.
In the animal world we have the option of euthanasia. Many of the issues surrounding the human version also apply to animals - not least of which is that euthanasia is an irreversible decision. So any decision needs to be thought through carefully with the best information to hand.
I am often presented with animals that face serious health battles. By assessing the combination and severity of symptoms, various test results and my experience of previous animals' responses to various forms of therapy, I have to decide on the likely prognosis.
There are lots of adjectives you can use to describe a prognosis, but fundamentally it can be good, guarded, poor or grave. Good speaks for itself; guarded means I'm not sure and things could go either way, so we need to be wary and cautious; poor and grave only leave room for miracles.
It is these occasional miracles that really make my day. I like to be proved wrong after giving a poor or grave prognosis.
Recently a cat was brought to me hypothermic and catatonic, meaning it was not responsive to any stimuli. It was just staring, unblinkingly. What was worse, one of its eyes was rolling up and down on its own. This is called vertical nystagmus and is a sign of brain damage. This symptom alone warrants a poor prognosis.
After some blood tests, I found the cat had severe uncontrolled diabetes. The owners had never had the cat checked on a regular basis, so the diabetes had gone undiscovered and untreated. That day the damage caused by the diabetes was becoming apparent.
The excess glucose in the blood, caused by the diabetes, was being metabolised into ketonuric acid, which turned the cat's blood acidic, which in turn caused damage to multiple organs, including the brain, kidneys and liver. What was worse, it had been two days since the cat first collapsed; it hadn't drunk any water in that time, which made it extremely dehydrated and meant it had a severe electrolyte imbalance.
There was enough evidence present to suggest the option of euthanasia, but the owners wanted to try to save the cat no matter what. We started an insulin drip and gave all the necessary supportive therapy. It stayed in our intensive care unit overnight, attended by me and my nurse all night.
The next morning we were pleased to see the cat's blood-glucose level back to normal, but it was still the same non-responsive dehydrated cat. It appeared the kidneys were not functioning properly and, given the number of organs apparently affected, the prognosis remained poor and euthanasia was still a valid option.
After another night in the hospital, the cat was showing no apparent improvement in its condition. The owners then made the surprising decision, which I argued against, to take the cat home. Despite my professional reluctance, it was their cat and their right to do with it what they wanted.
So they took their pet home knowing it would probably die. Like the cat, these owners were tenacious and determined, so I gave them all the treatment ideas I could think of to maximise the chances of their pet recovering from its seemingly hopeless situation.
Two days later the owners brought the cat back to the clinic for its scheduled check up - walking on all fours and apparently eating, its dehydration problems resolved.
It was an amazing turnaround, totally unexpected. Even though the diabetes, now controlled with daily injections of insulin, will eventually take the cat's life, it is enjoying a respite from the suffering caused by uncontrolled diabetes and life is back to normal. It is these moments - when the miracles happen - that make me glad to be a vet.
