Canadian Medical Association Journal 1995; 153: 621-622
[résumé]
Like most of you, I've been watching Canada's agonizing debate on how to fix our ailing health care system. As both patient and doctor, I've been raised on universal health care. At the same time, I've also wondered whether we need some private funding to keep the system afloat. It took a couple of very expensive encounters with our veterinary colleagues to crystallize my opinion.
My wife and I have two cats. Buster is around 8 years old -- we're not exactly sure of the age because he arrived on our doorstep as a fully grown tomcat. Except for a mild skin rash and halitosis that could stop an army, he's enjoyed excellent health and a huge appetite.
Scout is a different story. We adopted this 3-year-old long-haired tabby 2 years ago, and her medical history started out innocently enough. About 18 months ago she developed a urinary tract infection, and obviously needed a confirmatory urine culture.
I don't know if you've ever waited for an indignant cat to pee, but I don't recommend the experience. In the end, we decided to take Scout to the veterinarian so he could get the sample. Two days in the clinic passed, but no urine did. It was only on the third day of incarceration that Scout finally consented to produce a sample. Along with her urinalysis and culture, she had examinations, antibiotics, and what's known in the trade as a "flea-eradication program." The bill came to $439. That was a bargain compared with what was to come.
In October 1994 Scout developed a second urinary tract infection, which was also treated successfully with antibiotics. Because she was a tad anorexic, the veterinarian decided to do some blood tests. All of her tests came back normal except for an alanine transaminase (ALT) level of 72 U/L. The veterinary technician told me that the result was slightly elevated for a cat. A second result was somewhat lower, and Scout was discharged home with instructions for follow-up. The bill came to $500.
Then disaster struck. On Nov. 21, 1994, Scout was readmitted to the veterinary clinic with a 3-day history of lethargy and anorexia. On her initial blood tests, Scout's ALT had shot up to 553 U/L. Over the next 3 days our poor tabby was subjected to daily blood and urine tests, a chest x-ray and a flat plate of the abdomen. These all came back normal. With injections of antibiotics and steroids, not to mention subcutaneous saline infusions, Scout perked up considerably.
But, my veterinary colleague pointed out, we still didn't know what was wrong with Scout. One general anesthetic, one abdominal ultrasound and two liver biopsies later, we still didn't know. The only abnormality picked up on the ultrasound was some medullary scarring of both kidneys, an incidental finding. The total bill came to $1050.
It was only after this admission that I saw Scout nibbling at the leaves from a fern that had been brought into the house just prior to her illness. Out went the fern. Scout took about 6 months to recover completely from her ordeal and to grow back the abdominal fur that was shaved for the ultrasound.
In early May 1995, we brought Scout back to the clinic for her annual physical and immunizations. The staff clucked over how well she had recovered from her toxic hepatitis. As I think back, I'm reminded of the proverbial executive who drops dead of a heart attack the day after getting a clean bill of health on an annual physical. I knew it was too good to be true.
Exactly 1 week later, she started vomiting rather violently. After a couple of nights of this we took her, reluctantly, back to the clinic. The veterinarian thought Scout looked a bit cyanosed, so he ordered a chest x-ray and an electrocardiogram. Both showed evidence of left atrial enlargement.
Scout's urine was concentrated, and her creatinine and urea levels were both quite elevated. The veterinarian also mentioned that he thought he could palpate a mass in Scout's abdomen, but concluded that the finding was incidental. His diagnosis: severe vomiting brought on by renal failure. As he explained to me, the "proof" was the abnormal ultrasound from the previous admission, which showed scarred kidneys. Two views of the abdomen that showed a rectangular object in the gastrointestinal tract failed to change his opinion.
After a night of saline infusions Scout was better hydrated, but still vomiting. The veterinarian was puzzled. Scout had evidence of left atrial enlargement but no pulmonary edema. And, he could still palpate that darned mass in the abdomen. As my wife was going to the clinic to pick up some food for Buster, I suggested that she look at the abdominal x-ray and describe the object. "Brian," she said when she got home, "it looks a lot like one of your ear plugs."
As soon as she said it, I knew she was right. I called the veterinarian with the news. He wouldn't be completely convinced until 24 hours later, when a barium enema -- you read that correctly -- demonstrated a bowel obstruction in the precise location of the rectangular foreign object. My earplug.
At this point, the gods were smiling upon Scout and my wallet. Before the veterinarian could book Scout for a laparotomy, she passed a large bolus of barium, an even larger clump of her long hair, and one foam ear plug. Scout was gratefully discharged from the clinic the next day. The total bill came to $1112.
Altogether, Scout has cost me $3101, not including food, vitamins, her annual physicals and immunizations. She has had more tests than my entire family put together. I think the only test she has not had to date is a CT scan.
I may have briefly entertained the idea of joining the camp that favours private health care for Canada, but after Scout's misadventures I decided to stick with universal health care. I know there are a lot of cat owners who would have euthanatized Scout by now. If there was no hope of helping her, I would have done the same thing. I'm just glad that the cost of health care never entered my deliberations.
For the time being, Scout is doing well. As a reminder of her proclivity for medical care, I've had the obstructing ear plug bronzed.
And there's another happy ending to the story: I've just signed Scout up for cat health insurance. I'll sleep much more soundly knowing that the next barium enema won't be on me.