Effort vs. skill: Who wins?

Some cases you knock out of the park.

You remove three feet of perforated intestines from a dog, and he pulls through. You diagnose an atypical Addison's patient. You discover a testicle left in the abdomen of a neutered rescue cat from some other doctor's surgery years ago. These are cases that make you feel good when you go home at night, the ones you brag about to your colleagues.

What I've always found odd, however, are the connections I make with clients over cases that don't go right.

The presentation gave me a lump in my throat.

That's what happened with a 5-year-old neutered male cat I saw recently. He'd gotten a rabies vaccine somewhere else and four months later, I was feeling a firm mass at the site of the injection. I hadn't seen vaccine-associated fibrosarcoma in years, but the presentation gave me a lump in my throat.

The owners were well educated on cats and had come to the same conclusion. But they had strong opinions about next steps. They were clear they didn't want to anesthetize the cat twice for the same thing. And they told me they wouldn't agree to amputate the leg if a diagnosis was confirmed. We decided on surgery for a biopsy, and they said again that they wanted this to be the only time the cat would go under anesthesia. I was as aggressive as possible, taking wide surgical margins in removing the suspicious mass.

They didn't want to anesthetize the cat twice for the same thing.

Thankfully, everything went well. The clients were thrilled when I told them the biopsy results showed that the growth was just a lipoma. They reported the cat was doing well, and the incision looked fine except for a small amount of serous discharge from the incision. I thought that was a little odd a week out, but we were at the point where tissue was already growing stronger, so I told them to monitor and come in a week later to remove the sutures. Instead, I saw them two days later due to dehiscence of the middle half of the incision.

There was a chance the cat was getting at the incision, but I figured it was tension on the incision. I used a dextrose wet-to-dry bandage instead of making a bigger mess by trying to resuture. Because of the tricky location on the triangular leg, I needed to anesthetize the cat to debride the necrotic tissue and place stay sutures around the opening to hold the gauze in place. The bandage held, but the cat was not happy with the excess bandaging. He hissed at the owners and his eating declined. Hepatic lipidosis became a new concern for us.

At this point, looking back just a couple short weeks earlier, I couldn't believe we were going through all of this for a lipoma. Should I have recommended a punch biopsy first before proceeding with an aggressive approach? Probably, but we just never have all the information at the time.

The owner once joked he was spending more on his cat than his Porsche. We both had an awkward laugh. The tension was then broken with his, “You're the best!”

Regardless of their frustration over the cat's decline, my clients were very nice and grateful for my help. One of them joked that he was spending more on his cat than his Porsche; we both had an awkward laugh. The tension was then broken with a, “you're the best!”

Fortunately, the wound healed nicely, the occasional diazepam IV helped with the appetite and anxiety, and we all pulled through. This wasn't a case I'm particularly proud of, but I developed a deeper bond with these clients than most. It goes to show that having good skill is great, but what owners really appreciate is effort.

Dr. Andy Rollo is an associate at Madison Veterinary Hospital outside of Detroit, Michigan. He is also a Veterinary Economics Editorial Advisory Board member.