Monday, November 2, 2009

Examining Cats: Sticking to the Routine

Interesting case the other day. A client came in with her 11 year-old cat. I was the third or fourth vet that she was consulting. Her cat Bobby had been losing some weight and had developed a weird cough that occurred when he tried to purr. Other vets had taken x-rays and tried antibiotics, but the cat never really responded. Now the cough was getting worse, and the cat was becoming more lethargic, less interested in food, less interested in life. I looked at the x-rays that she had brought from the other hospital, and it looked like a classic asthmatic pattern. I figured the cat had asthma and would probably benefit from a tapering course of steroids. After chatting with the client some more, we took the cat out of the carrier and I started my physical examination.

I've performed physical examinations on cats thousands of times. I do them the same way, over and over again, like a robot. I check the eyes. I check the ears. I check the teeth. I open the mouth. I check the lymph nodes under the jaw (the submandibular nodes). I check the lymph nodes deep in the neck (the prescapular nodes). I listen to the heart and lungs. I palpate the abdomen. I feel the femoral pulses. I check the lymph nodes in the back of the legs. I feel for lumps and bumps on the skin. Same way every time.

Of the thousands of times I've felt the pre-scapular lymph nodes, maybe once out of every 10,000 times, I'll discover something abnormal. It's not a high-yield procedure. You try to feel the nodes. You can't find them because they're too small to feel. This means they're normal. This is what happens, over and over again. So, why bother feeling for them, if the odds of feeling anything is so small? You do it because of that one time when you do feel something abnormal. Like I did with Bobby.

I got to the pre-scapular lymph node part of the exam on Bobby, and I was stunned to discover that the left lymph node was the size of a cherry tomato. A very firm cherry tomato. I pointed it out to the client. She was shocked. Shocked that she never felt this, given the fact that she's always patting and feeling her cat. And shocked that the three or four previous vets never detected it. I recommended a biopsy and she readily agreed. The result: high grade lymphosarcoma, a type of cancer. Today we began his chemotherapy. Let's see how well he does.

I guess the point I'm making here is this: you can have all of the fancy machines that money can buy, all of the high-tech toys, all of the fancy laboratory tests at your disposal. But nothing beats a good physical exam.
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