Sometimes you can be right, even when you’re wrong.

Sometimes it seems that your patient’s history is rigged to fool you.  Of course, you don’t know that when you start the case.  At that point, everything seems so logical.

Sassy is a 7-years old Maine Coon cat.  We had her in for dental cleaning a few weeks ago.  Her pre-op blood-work was fine.  No problems noted at home other than an occasional hairball.  When we cleaned her teeth, we found that she had a bad tooth which needed to be extracted.  We removed the bum tooth and sutured the gums.   Since she had something a bit out of the ordinary, we sent home pain medication, and antibiotics.  She’s a big girl (17 pounds) and not so easy to medicate, so we decided on one BIG capsule once a day, instead of a small one twice a day.  This usually works okay in a case like this.

Shortly after her dental procedures, Sassy began having vomiting troubles.  She could keep down liquids, and soft foods, but dry food came back up pronto.  I feared she might have some irritation to her esophagus from those big antibiotic capsules.  We started her on sucralfate in slurry form three times a day. Sucralfate forms a gel that will temporarily patch into small ulcers and help them heal.

She seemed to be doing better, eating better, but still had trouble with hard cat food.  I feard that she was developing a stricture (a narrow place in the esophagus, caused by the shrinkage of scar tissue in a damaged area).  When I found that she had lost a pound, I was really worried about her.  We mixed some barium into some soft food, which her owner hand-fed her.  An X-ray showed that it all got to her stomach, nothing left in the esophagus.  What she really needed was an endoscopic examination to actually look at that esophagus. 

I have a fiber-optic endoscope, but it’s a bit too large to put down a cat’s throat, even a 17-pound cat.  Plus, I’m not really experienced in the techniques of dilating a damaged esophagus.  I called the nearest referral specialists and discussed the case.  They agreed with my assessment, and scheduled Sassy for endoscopic examination.

Imagine their surprise to find a normal esophagus, and the pylorus (the stomach’s exit valve) pretty much plugged with this gigantic hair-ball. It was hard, not soft, and hooked around into the intestine, so it didn’t move much.  Soft stuff gets around it, but no hard chunks need apply.  They were able to remove it by cutting it into pieces [reassembled for the photo here] and retrieving it with the scope — no surgery required.

Why did this vomiting not start until two days after the dental procedure?  We don’t know.  If the vomiting had come out of the blue, would I have sent the cat to a specialist for endoscopy? Probably not.  If I had made the hairball-of-the-decade diagnosis here, the cat would have had exploratory surgery to remove it.

So, I felt bad that I might have caused the problem with the big antibiotic capsules, but that’s not what happened, so I feel better about that.  I felt bad that I referred a case of hairball to a specialist, but having it retrieved with an endoscope was so much easier than surgery for the cat and her owner.  It was the absolute best way for the cat’s problem to have been handled, so I feel better about that, too.

Despite the fact that I was on the wrong track, we did exactly what the cat needed for the best possible resolution of her problem.  So, sometimes you can be right, even when you’re wrong.