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Wednesday, November 29, 2006

Thinking too much....

I'm trying to sit still and relax but a combination of genetics and good coffee precludes any capacity for me to do so.
There was a case of a cat with fatty liver disease that I saw a good four months ago or so. Fatty liver disease is a feline disease (more often obese cats that have rapidly lost weight) in which the liver essentially becomes 'pate de foie gras.' It may or may not be associated with a primary disease such as inflammatory bowel disease, pancreatitis, etc. The cure: calories - the cat must be fed. Often harder in practice. The cat was clinically ok besides being the same colour as Tony the Tiger. I thought for sure I'd cure him. After the placement of his feeding tube (an esophageal tube, placed in the lateral neck area directly through the skin and extending to just before entering the stomach) he did well for a few weeks then crashed and died at the local emergency clinic. I feel tremendously guilty.
Radiographs after the tube placement showed very good positioning. Was it the tube? Did the cat have a more serious primary illness? Theoretically, that's usually the case, however in real life vets often will not find a concurrent illness besides the "idiopathic hepatic lipidosis." For those who've never heard the word 'idiopathic,' it's a fancy word describing an illness for which a cause or etiology cannot be found. Very often, there is some stress in the history. For example, a change of environment: new house, addition of a baby, death of another pet, etc., etc.

These cases weigh heavily on me. The pet owners trust that I am doing the right thing and though many cases end happily, others do not. Thus is the world of (veterinary) medicine. Months down the road I still feel a sting of regret while telling myself, "What could I have done to prevent that outcome?"
For everyone who knows me, I am a harsh self-critic.......

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