Sometimes the very best care is not enough.

We can do so many wonderful things with medicine and surgery that we begin to think we can fix anything.  If we just do the right thing, make the right choices, do the right tests, perform the right treatments, we can make the patient well again.

Well, doing the right thing is certainly better than doing the wrong thing.  It makes me think of the Mad Hatter and the March Hare in "Alice in
Wonderland"
.  They have used butter in an attempt to lubricate a
pocket-watch.  Their results are not good, even though "it was the best butter".  They did their best, but it was the wrong thing to do.

Then we have cases like the one I had this week.  We did everything right, but it wasn't good enough.

The kitten came in just not acting right, not wanting to eat much.  He had shown no specific signs of illness, but hadn't felt well for two days.  His temperature was slightly elevated, but nothing to write home about.  Then I felt what I was sure must be the problem: a mass in the middle of his abdomen.  It was nearly two inches thick, and it was in a place where there shouldn't have been any big lumps.

An X-ray confirmed that all the normal stuff was in the normal places, so this was definitely something that shouldn't be there.  With a kitten at Christmas time, and such vague symptoms, and not wanting to eat, and an abnormal "thing" in the belly, I thought I had it figured out.  He must have eaten some non-food item (tinsel, anyone?) and developed an intestinal blockage.  Nothing for it now but an exploratory surgery to fix things.

The thing about an exploratory surgery is this: by definition, you are going exploring, which is to say you are going into unknown territory to find out what is there.  The exploratory was definitely the right thing to do, but I didn't find what I expected.

The big lump was a hugely swollen lymph node.  It was as big as as a hen's egg, when it should have been about the size of a black-eyed pea.  It appeared to be reacting to a marble-sized, angry-looking red lump on a section of small intestine.  There was no way to peel off the lump and be sure to get it all without making a hole in the intestine.

So, I removed a short section of intestine, and I also took a biopsy of the lymph node.  We put the intestine back together and put the cat back together, and started on some heavy-duty antibiotics and supportive therapy.  The lumps went to the pathology laboratory via FedEx within two hours.

The next day, the kitty had some fever, but was eating and looking better and acting better.  Sweet.  We don't want to get in a hurry to send him home, yet, though.  Got to be sure he keeps eating and keeps it down.  AND we want to know what the lump was.

I'm thinking that a six-months old kitten is unlikely to have cancer (though St. Jude's Hospital is full of kids with cancer).  Maybe there was some tiny perforation of the bowel, and the body was trying to wall it off.  That ought to be fixed.

The kitten seemed to continue his recovery over the next couple of days. The fever came down, and the lump in the belly was getting smaller.  I'm feeling great about this.  Then the pathology results come back.

The pathologist says that the most likely diagnosis is FIP.  That's bad, no treatment, gonna die.  Could it be something else?  The internist says, yes, it might be just what I had suspected… or not.  A more definitive test can be done on the tissue, so I order it.

The kitten goes home with mom and dad. He ought to feel better, but he doesn't.  The next morning they call to tell me kitty took a nose-dive during the night.  On presentation, he's starting to turn yellow – liver failing.  He's breathing hard.  X-rays show pneumonia.  He didn't have those problems before, but he's got them now. 

His immune system is shot.  It was FIP after all, and it was killing him.

If you clicked on the FIP link, you know that there's not much we can do to prevent it, treat it, or even detect it accurately (while the patient is still alive, that is).

The owners didn't waste any time, we didn't waste any time here, the kitten would have had the same treatment at a referral institution.  We did everything right, and the patient was still lost.

We can do so much, but sometimes, the best we have is not enough.

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