I'm fine hearing that I'm just a crazy cat lady

May 3, 2011 7:35 AM

We had to put one of our cats to sleep on Saturday. Now that I've had a couple of days to think over some of the things that the vet at the emergency clinic said, I'm wondering if our regular vet is giving our pets the best care.

Sweet Jane was 14 and a half, and about two years ago, she was diagnosed with hyperthyroidism, which was controlled through medication. A few months ago, she started scratching at a spot over her eye and wouldn't leave it alone. My boyfriend took her in to see the vet, who thought it might be from an ear infection and sent her home with ear drops (which ended up making her deaf, a usually rare side effect of the medicine which is more common in geriatric animals) and an antibiotic ointment. The wound healed, but then she started scratching again and it came back. My boyfriend took her in again, and this time they gave her an antibiotic shot and a steroid shot.

Later, we noticed that she was breathing really rapidly, and since the vet was closed, we took her into the emergency clinic. The vet took one look at the cut above her eye and said, "That is not normal, that will need to be biopsied." As soon as she saw that Jane had been given a steroid shot, she said that most likely the hyperthyroidism had led to a heart condition, and then the steroid shot sent her into congestive heart failure. X-rays then confirmed heart failure.

After weighing her age, existing health problems, and the cost of treatment, we made the very difficult decision to have her put to sleep. When we were talking to the emergency clinic vet about it, she reiterated that even if we treated her and she made it through the weekend, once she was stable, the sore above her eye would have to be biopsied and that her hyperthyroidism most likely led to a heart condition that would need further treatment. Now I'm wondering why my vet didn't seem as concerned about the sore after having seen it twice, and why she decided to give a steroid shot knowing that Sweet Jane had a condition that often causes heart problems. This isn't as serious, but I also wonder why she would prescribe Jane a medicine that could cause deafness in geriatric animals. She never told us the possible side effects of the shot or the ear drops. She's been our vet for 14 and a half years (since Jane was just a tiny kitten), and her practice is very state of the art and very expensive. She is wonderfully warm and I've always liked her personally.

Am I over-reacting because I'm distraught and looking for someone to blame, or should we be looking into going to another vet? Is it crazy and completely inappropriate to contact the vet at the emergency clinic and ask her if she's comfortable giving her opinion of our vet?

posted by amarynth to pets & animals (14 answers total)

I would avoid making a decision at the moment, as long as your other pets are currently healthy.

I'm really sorry about the loss of your beautiful kitty :(
posted by you're a kitty! at 7:40 AM on May 3, 2011 [1 favorite]

I'm sorry for the loss of your lovely Sweet Jane.

The original treatment of the spot over her eye seems odd. Was Sweet Jane on Tapazole (methimazole) for the hyperthyroidism? A side effect of this drug is serious facial itching, which can cause wounds over time (rather than the spot being the reason for the itching). The vet should have been well aware of the facial itching side effect of the drug. Was there any mention of this or did the vet go straight to the ear infection idea? If that's the case (Tapazole w/no mention of facial itching side effect), I would personally switch vets.

Either way, I don't think I'd get the emergency vet involved in offering an opinion. At most, after you've had time to grieve and approach the situation calmly, I would just ask the original vet about the decisions surrounding the treatment of the eye spot. The vet's response may help you decide whether or not to keep going there.

Best of luck in whatever you decide.
posted by dayintoday at 7:48 AM on May 3, 2011

We put down our lovely 18 year old cat a few months ago, so I feel for you.

I have to say, though, that it sounds like Sweet Jane would have developed serious problems that would have impacted her quality of life pretty soon. I think you could ask your vet why she went with the steroid shot treatment, but note that the emergency vet didn't say--at least as you describe it--that the steroid shot was a "wrong" choice. Sometimes when animals get that old and their bodies start to break down, lots of things that would usually heal start to harm, and there may not be better alternatives. I don't know--I'm not a vet--but this was a very elderly animal with a weak constitution who lived a rich, well-loved life. I would hold off for now.
posted by liketitanic at 7:50 AM on May 3, 2011 [3 favorites]

I've dealt with pets with serious problems. I think that there is a "third way" to look at this.

"Normal" vets are really good at doing the basics, but they're not always so great at dealing with more serious medical issues.

"Emergency" vets deal with emergencies well, but in my experience, there is an urgency in their care, having dealt with emergency cases on a day-to-day basis for years, that makes them not always the best source for information. Some emergency clinics also (based on what people in my pet's disease's list serv say) are money generators and encourage people to take drastic measures.

The third way, in my opinion, is working with a good internal medicine specialist vet that is a bit more skilled than regular vet.
posted by k8t at 7:53 AM on May 3, 2011 [1 favorite]

Keep in mind, you have no idea if the emergency vet was correct about their split-second diagnosis or not. I have found that emergency vets (especially ones who have done nothing but emergency work for a long time) can tend to overreact to chronic conditions, treating every minor ailment as a life-or-death crisis. When the vast majority of the things you see are crashing, it can be easy to assuming everything is dire.

I suspect it will be largely pointless to ask the ER vet their opinion of your regular vet. Emergency hospitals depend on referrals from regular vets to stay in business and (if they know what they are doing) they will be very careful to not badmouth their colleagues.

I would have a talk with your regular vet about it. You might ask to set up an appointment with her just to talk about what happened with Sweet Jane, and see how she reacts to the emergency vet's comments. She may have known that the sore was more serious than it appeared, and that the steroid shot had the possibility of side effects, but in weighing those risks and everything else she knew about Sweet Jane, decided that her course of treatment was more prudent. If she gets defensive and argumentative, well, sometimes vets that have been in general practice for years can get a bit medically conservative and set in their ways (just the opposite of long-time ER vets, actually). It may be that the current best practices in veterinary medicine have passed them by.

The bottom line is that if you do not trust your vet, you need to find another one. At least give them the chance to earn back your trust with a conversation.
posted by Rock Steady at 8:00 AM on May 3, 2011

Some vets are great cat vets and some vets are not. It doesn't make your vet a bad vet - s/he may be a great DOG vet, and just an okay cat vet. Also, older animals are different than spring chickens.

So long as your remaining animals are in good health, I think you are okay and justified if you feel like the vet may have, for whatever reason, been unable to provide the best care for your friend. Personally, I would research vets in the area and try a new one out when it comes time for your cats' annual exams. Interview them, get client feedback, etc. Do what you have to do to feel good about your cats' care.
posted by Medieval Maven at 8:15 AM on May 3, 2011

I do think it's reasonable to question the quality of care your regular vet has been giving you. My wife and I have used three vets between us. One was extremely laissez-faire. One would aggressively prescribe treatments that they admitted upfront probably wouldn't do much good (and, we later learned, would fail to explore productive options). In hindsight, I feel that we did our cats a disservice by sticking with those vets as long as we did. We're now on vet #3, which we like a lot better—the vet was recommended to us by a rescue organization from which we adopted two cats.
posted by adamrice at 8:16 AM on May 3, 2011

Find a new day practice vet- there are alot of really bad RDVMs out there. Unfortunately vet schools only require 1 year (their 4th year) of rotations seeing real cases. What this means is that alot of DVMs are released onto the world with just enough knowledge to be dangerous. Not all RDVMs are dangerous- in fact there are alot of really good ones. Without getting on a soapbox, new DVMs would greatly benefit from a 5th year in school of rotations.

I don't know where you are, but if there's a vet school near you, I'd suggest going in to be seen by their day practice (most will have teaching a day practice teaching hospital). Not only will you have all the regular vets there, but they will have a large network of great diagnosticians to oversee any complications that may arise.

If this is not an option for you, then vca hospitals usually hold their vets to a higher standard and are connected to a great network of veterinarians and vet services around the country.

The thing that is so painful about animals is that they can't advocate for themselves. If something hurts or is wrong, we can only go on what we can see. I'm sorry you had to go through this.
posted by TheBones at 8:47 AM on May 3, 2011 [3 favorites]

Some emergency clinics also (based on what people in my pet's disease's list serv say) are money generators and encourage people to take drastic measures

I don't want to start a fight here, and that is not my intention by bringing these to light, but emergency medicine, whether it be vets or humans, cost more money. The doctors are more experienced (sometimes board certified) and there are usually more tests to run. While the above statement isn't false, it isn't true either.

Any good vet (regardless of specialty) is there to provide the best treatment for your animal, if you don't fee like you are getting the best treatment, please find a new vet- you are the only advocate your animal has.
posted by TheBones at 8:53 AM on May 3, 2011 [3 favorites]

I know from several firsthand experiences how it's almost impossible to avoid second-, third-, fourth-guessing your vet and yourself after having had to make the awful decision to euthanize a pet. You have my deep sympathy.

I personally think the emergency vet might have been acting unprofessionally in insinuating so strongly bad care from your regular vet, without having your cat's full medical records to review. On that basis I would not involve the emergency vet in the situation any further.

As far as your regular vet goes, I think I would have a long conversation with them about the factors that led to your cat's death, ideally to reassure myself in their skills. They may have made a mistake with the steroids. A responsible vet should be able to put risks into perspective and admit when a treatment did not work out as they anticipated.

But it's also possible that, even if your vet made no major errors in your pet's care, the death of your pet and the strong comments from the other vet may have permanently damaged your faith in them (emotionally).

Best of luck and so sorry.
posted by aught at 8:59 AM on May 3, 2011 [2 favorites]

I am so, so, sorry.
posted by angrycat at 1:38 PM on May 3, 2011

I'm sorry to hear about the loss of your pretty cat.

I can't speak to the specifics of your case, but I can make a comparison to human medicine. My mother was afraid of my grandfather taking a medication that could have side effects that might harm him. However, the possible (very good) benefits of the medication outweighed its potential (very serious) side effects. As we age and/or as our conditions become more complicated, more risk is required to gain the best result. It's also worth noting that (at least in my experience) it happens frequently that doctors have opinions that differ from those of their colleagues, which is possibly the case with the two veterinarians you encountered.

Yes, it's possible that your vet could have used better judgment. However, it's also possible that she made a more than reasonable clinical decision. So although I would advise you to talk to your vet about it, I would avoid jumping to conclusions.
posted by analog at 3:58 PM on May 3, 2011

From my vet friend who specializes in cats:

"It's difficult to really comment on because it involves a lot of variables and I have not seen this cat. Bottom line is that if you are not comfortable with your vet, then you should find another vet, or you should talk to your current vet to see if that resolves any of your issues with them. We (vets) have all made mistakes, of varying degrees of known and unknown risk, and faced the consequences.

The head lesion, the ear meds, the heart failure--anything I say about that is purely conjecture. However, IF the steroid injection was Depo Medrol (a long-acting steroid that stays in the system for at least 2 weeks), it was poor form to not warn the owner that if the cat has side effects (including pulmonary edema), you cannot take the drug away: thus, you offer the alternative of pills, which that cat could clearly receive. I RARELY use Depo and ALWAYS warn owners of that very side effect. In all likelihood, I would not have given it to this cat.

A quote I like is, "There are no good vets or bad vets: there are only vets that care and vets that don't care." This lady has to decide if her vet truly cared and made an honest mistake, or if the vet did not care enough to do the right thing for this cat."
posted by nile_red at 7:21 PM on May 3, 2011

I just wanted to thank everyone for their responses. We probably won't make a decision until Miles is due for his next annual, and maybe by then I'll have some more prespective and be able to think more rationally. Right now, I'm also upset that they haven't even called us about Sweet Jane, though the emergency clinic told us that they would send our vet her file on Monday.

Just to follow up on some comments in the thread -- Sweet Jane was on tapazole, so I'll ask if that might have caused the itching that led to the lesion. And the emergency clinic that treated Jane was a VCA hospital, and there's another nearby. If we do decide to switch, we'll probably try them first.
posted by amarynth at 7:10 AM on May 4, 2011