Too Much of a Good Thing
Opening up my own veterinary clinic was a challenging proposition. One of the nicer aspects of being an associate was the availability of a second opinion—often whether you wanted it or not. When you are a single practitioner faced with a complicated case, it’s sometimes frustrating not having another colleague to bounce things off of.
In veterinary school you are taught many uncommon, rarely seen disease processes, fondly referred to as "zebra diagnoses." In a university setting you may need to know the obscure disease for a question on a national board question, but they rarely—if ever—come up in practice. Little did I know that one day I would come up against one of those obscure diagnoses.
A wiry older gentleman with a gruff manor burst forth into the exam room. “I have been to every veterinarian in the damn town and no one can fix my cat!” he bellowed. “You’re the new gal in the neighborhood, so see what you can do for him. Dr. Meadows told me he has a shoulder problem and it’s not going to get any better. Tell me what you think!”
This cat was not too keen on being examined, and looked rather gruff himself. Ivan was a six-year-old male neutered cat, but he looked ancient. He had a medium length, black and white coat that was badly matted, especially above the tail along the back and sides, as well as on the feathers of the back end. He had a distinct odor of litter box about him. Ivan’s personality matched his appearance. When you moved in near him or tried to touch him, Ivan would let loose a screech, like a cross between a scream and a hiss. This screech resounded across the clinic and sounded like an animal being tortured.
After being in practice for a few years, and receiving my share of cat scratches and bites, my reflexes have become almost automatic, and I jerked backward involuntarily. “Is he always this painful and guarded?” I asked. I hadn’t even placed a hand on him and yet he was complaining with vigor. The man claimed Ivan had a great personality but did not appreciate veterinarians, especially since no vet was able to help him.
I inched ever closer to the cat. Ivan screamed again, and this time appeared to move his entire body at once to face me. He did not strike out with a paw and claws drawn in a customary defensive stance, but moved stiffly in one piece, while trying to intimidate me from coming ever closer through his screeching. Ivan did not hiss or spat but continued his blood-curdling scream. Despite his objection, I reached out and finally touched the matted fur on the back of his neck. He discontinued his screaming and had moved to deep throated growls. I finally decided he was more talk than action, and tried to manipulate the joints on the nearest front leg. Ivan exhibited a hard swelling of the joints and a rather limited range of motion. I asked the owner for permission to radiograph his front end. Ivan was scooped up and the technician and I quickly headed to radiology. He wasn’t quiet about the change in venue, but at least he had toned down his rhetoric a few decibels.
Lateral pictures of Ivan laying flat on his side were relatively easy to obtain; he even kept his head and neck area straight for us. Getting a VD (ventral/dorsal) view proved to be much more problematic. When we placed Ivan on his back, the blood-curdling scream returned. We had an extreme problem trying to move the legs forward, and could only move them slightly. We decided to get the best picture we could and snapped the radiograph.
While Ivan and I were coming to a testy ceasefire, I anxiously awaited the radiographs. The lateral radiograph of Ivan’s was very insightful. The previous veterinarian had diagnosed an unknown shoulder problem, and yet the left shoulder was about the only joint in the front legs not fused by extensive arthritic changes. Now I knew why the cat appeared to move in one piece—he was literally fused together.
I had been in practice for well over two years and I had never seen a case of arthritis so extensive. Ivan was like a statue, frozen in position. The cat had some movement in the left shoulder and the hip area but precious little else. No wonder Ivan had such an intense personality. I would be pretty miserable myself if I had joints like that. It made sense why he never raised a claw at us or turned his head to bite. The poor cat could not turn around or extend his leg far enough to reach us in retaliation. As for his smelling like a litter box, forget turning around to groom himself: he couldn’t flex his back at all.
I loaded up the radiographs with Ivan in tow to show the owner what we had found. I could not understand why the arthritis was so extensive but suggested we should consider running some tests for rheumatoid arthritis. I knew dogs were susceptible but had never heard of a cat being diagnosed with rheumatoid arthritis. Of course we could always get a referral to an orthopedic specialist. When faced with an impossible case we could also contact an expert in the field. There was always a way to find that second opinion.
The owner became a little less defensive and slightly more talkative himself. He then decided to relate his life story. Since his wife had died three years previous and this was her cat, he had tried to do his utmost to care for him. In fact, Ivan was so spoiled that the owner went daily to Kentucky Fried Chicken to purchase chicken livers for Ivan. In fact, Ivan would not eat anything other than chicken liver. The owner would either cook chicken livers for him at home, or would pick them up from the Colonel on his way home from work.
Then I remembered one of those zebra diagnoses, and realized the symptoms poor Ivan was exhibiting were related to his unusual diet. There is an obscure disease called Hypervitaminosis A, in which the consumption of too much vitamin A can actually cause a severe arthritis of sorts. Years of only feeding chicken livers had literally fused approximately 2/3 of Ivan’s joints. I had my diagnosis, and now came the hard part: I had to break it to the owner that in being overzealous with the chicken liver, he had actually caused Ivan’s joints to fuse. I told the owner he had to find a good quality cat food that was nutritionally balanced—and above all else did not contain liver in any shape of form. Recovery would be guarded at best, but we could prevent any further joint deteriation. After a short protest fast, Ivan did learn to eat cat food.
Ivan never gained much additional joint flexibility, but was able to salvage some quality of life. At the clinic we would see Ivan on a 4 to 6 week basis for a back end trim, and even more frequently for a bath. Since Ivan could not groom himself, we became his grooming substitute.
Ivan would always frighten new employees with his blood-curdling screams and deep-throated growls. At our clinic it became almost a right of passage that each new bather would get their opportunity to bathe Ivan. Although intimided, these new employees would quickly learn that he could not strike out at you or swing around quickly. With him being stiff, washing the cat was not a problem—although he would try to through out every dirty word he could think of in the way of growls and screams. Ivan threatened each new employee; in fact, he appeared to enjoy the response he provoked. I’m sure some clients thought we were killing a cat in the back of the hospital when it was time for Ivan’s bath. Ivan never learned to appreciate water, but he lived a long and fulfilled life.