Gazette Vet: Keep Moving Forward

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I am writing this month’s column as 2018 is coming to a close. The year’s end is a natural time for us to ponder about…stuff. I don’t know about you, but for every fond memory or optimistic plan, there is typically an equal anxiety or regret. As I plan some upcoming family trips, I can’t help but look at the list of things I wanted to do in our house that never got done. As I think back on some of the great memories made this past year, I look forward to new tasks and longer lists and wonder how I’m ever going to get it all finished. I suspect we are all pondering this kind of stuff each year about this time and perhaps the take- home message is that we simply need to be grateful for where we have arrived, and each year, keep moving forward. 

Often I have moments in my job as a veterinarian that make me want to stop in my tracks, both big-picture metaphorically, as well as in-the-minute-live-action events. I thought I would share a moment when I wished I could just hit the pause button and check out for a while, but learned that I had to keep moving and not give up.

Many years ago, I was setting up to perform some dental work on an old cat with heart disease. The cat was very sweet, and the poor thing had horrible teeth. Several were broken and infected and she was clearly in pain. At the same time, she had some very significant heart disease, and these types of dental procedures need to be done under anesthesia. Fortunately, in our day, anesthesia is actually very safe, even in older pets with serious health conditions. So I approached this procedure with some anxiety, but also confident that we could get the bad teeth out, wake her up safely, and dramatically improve her quality of life. 

For about the first 15 minutes of her anesthesia, this kitty was doing great. She was intubated (we had a tube in her airway, controlling her breathing) and all of her vitals were great. However, as we were finishing up cleaning some of the teeth that were going to stay in her mouth, things started to change. Over just a few minutes, her vitals started to drop. She began to have difficulty oxygenating and started having heart arrhythmias. I listened to her lungs and could hear fluid building up. Crap. This is, in fact, the gamble of doing anesthesia in a pet with serious heart disease. Despite making some medical adjustments to her anesthesia, within just another few minutes things went from bad to worse: her heart simply stopped. My stethoscope confirmed what all my monitors were telling me. This cat was checking out. 

Even though this is something the owner and I had discussed as a possibility beforehand, it was still a horrible feeling. As the vet, I was the one who ultimately suggested that this would be a worthy risk to take and convinced the owner to follow my lead. Everything is somewhat more agreeable when you have an optimistic viewpoint. But when you are hovering over a dead animal, it is easy to feel regret.

So, as calmly as I could, I started CPR on this cat. Yes, we actually do little chest compressions, and we already had a tube in her airway and IV access. Many times we can bring them back, but after a few minutes of CPR, there was simply no response. As the support staff looks at you for guidance and you calmly just keep doing compressions and ordering drugs, you most certainly want to check out for a little bit. After about 10 minutes elapsed with zero signs of the ECG coming back to life, the chance for things to turn around start to diminish exponentially. Now it’s just a matter of “how long should I keep this up?” Envisioning the difficult conversation with the owner, I feel even more despair and continue CPR mostly because it’s the only thing I can do to avoid what I feel is almost a certainty. A few more minutes and still no response. Just keep moving forward. I am seconds away from just stopping, all the while thinking in my head how horrible this moment is and how horrible the rest of the day is going to be. 

And then, quite suddenly, there is a beautiful mostly-regular little rhythm on the ECG monitor. Somewhat in disbelief, I put my stethoscope to her chest and sure enough, this cat’s heart is actually beating on its own, even after being relatively traumatized by me squeezing its chest for the past 15 minutes. Wow, I was overjoyed that she might survive, as well as I surprised that I kept moving forward in what seemed like a rather hopeless scenario. 

The old cat’s heart kept on beating and we were able to wake her up and get her breathing on her own. Not only did she prove an incredibly resilient old girl, but she amazed me by gobbling up some food only a few hours later. 

Believe it or not, after she recovered and I let the owner know what a close call it was, we actually got that cat back in a month later to try again. She still had very painful teeth! And wouldn’t you know, second time was a charm (and of course a different protocol) and we were able to remove all of her painful teeth with minimal drama. She went on to live for several more years and all parties involved were glad we took some risk. 

Maybe I wanted to share a little battle story from the trenches for this column, or maybe this was the type of case that sticks with you for a while because you didn’t give up when perhaps others would have. But as we come to the end of a year and begin a new one and we feel as though we have proverbial fluid in our lungs, difficulty oxygenating, or that we have simply flatlined, don’t give up! Keep moving forward. Keep doing the things that you can do. And although it can be very difficult while you are in the middle of giving or receiving CPR, be grateful. 

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