Dear Doctor: Pushing back on the diagnosis
Q. My beloved cat, Tigger, has died of cancer at the age of 19½, and his death has left me feeling somewhat guilty. He enjoyed going outdoors, and I would follow him around the yard to make sure he was okay. In December of 2018, he suffered terrible stomach pain, hunching up, crying loudly, and suffering from vomiting and diarrhea. I took him to the vet, who told me it was my fault for allowing him to go outside, where he had undoubtedly eaten something poisonous. I wasn’t confident enough to let him know that I kept my eye on him the entire time he was outdoors. I knew he hadn’t eaten something he shouldn’t have. The pain subsided with opioids, and I let it go. But the same thing happened again a few months later, when he had not even been outside for a couple of days. Again I was told that it was probably just something he had eaten. I continued to hold my tongue. But the third time it happened, he was diagnosed with chronic kidney failure, and I insisted that we investigate further. It turned out his bladder was riddled with cancer. Tigger died in October. I can’t help wondering whether, if Tigger had been examined more thoroughly when I first brought him in, the cancer would not have had the opportunity to spread and he wouldn’t have been in as much pain.
Is there any reasonable way to convince a veterinarian that someone who has lived with a cat for almost two decades is in a position to weigh in?
Virginia Benton Morris
Carol Stream, Illinois
Dear Ms. Morris,
A. In human medicine there is a phrase called “shared decision making.” It means that the patient is provided with the best available evidence about a medical situation and is encouraged to consider both the diagnostic and treatment options together with the doctor rather than have the physician make all the decisions in top-down fashion.
We believe strongly that the same should be true for animal medicine. Your knowledge about your pet should allow you to collaborate in the process of how best to get to the bottom of symptoms and treat them once their cause is found. It’s also appropriate to advocate for your cat and request further testing if you feel the veterinarian may be overlooking something or may not be considering the full history. In your case, the fact that your cat lived almost 20 years suggests that you — and your vet — did a pretty good job overall. You should not feel guilty, nor should you bow to pressure in the future if something feels wrong.