It's been a long day

[from my friend Sue]

I read your blog about the Leptospirosis – are you going to see a doctor? John too? Secondly, do Lucky & Mack need to be tested? Thirdly – is there a chance that Kamira is the source and if so, does Amy need to see a doctor? And for that matter, to prevent re-infections, does Kamira? If nothing else, should Kamira be tested to be SURE she’s not the source to prevent re-infections? I don’t want to stir up a problem as I know the whole Kamira incident is a sore point, but I’m concerned that you two as well as Da Boyz be treated, are well, and there is no chance of a re-infection. Egads.

[my response(s)]

Thank you ... all those questions are spinning in my brain, too.

First thing this morning, I called my doctor to find out when / how I can get tested. I'm not certain anyone else (human) needs to worry, but that would be my next question.

After putting me on hold for 3 minutes, a receptionist came on the line to tell me my physician had retired in January. My message will be cycled to one of the 20 other doctors at the clinic. I don't know when I'll hear from anyone.

My next move is to call the new vet and find out whether they received the fax with the blood test results on March 22. If so, WHY we were not informed. I'm guessing the answer will be something like, "well, we put him on antibiotics, and that should take care of it." IF they got the fax at all.

My next call is to the animal emergency hospital to find out WHY the owners were NOT CALLED with positive test results.

I'm home because I woke up with a raging headache this morning and queasy. I had hoped to take a headache pill, take a shower, get tested, and go to work a little late. Now I'm waiting for any old physician to be unoccupied enough to call me (someone who is NOT their patient, and whom they have no vested interest in taking on) to consult on this problem.

I'm discouraged, to say the least.

[later, to Sue]

God this is a mess.

The staff at our vet's office says there is no fax in Mack's file, and so they have no record of having received the fax from the emergency care facility. The doctors knew the emergency care facility had sent the test out, and that the results were pending, but that's all.

By 10 a.m., I still hadn't heard anything from my doctor's office, so I finally just called the clinic and asked for an appointment today with ANY internal medicine physician who has time available. I get to see someone at 11:15. The receptionist put me on hold when I told her I was concerned about exposure to leptospirosis. I had to spell it for her. When she came back, she said she'd consulted with other people and they'd never heard of it, and is it supposed to be contagious? I told her it was something that cats and dogs can get, that can be passed to humans through contact with an infected animal's urine. "Urine, okay ... so the vet thinks you should be tested?" "No, *I* think I should be tested, since I know I had exposure to the urine of a cat whose test came back positive." "Oh, okay ... YOU think you should be tested ..." Geez.

I left a message for the hospital administrator of the animal emergency center, who hasn't returned my call yet. I called back an hour later to ask someone else which phone number they faxed the test results to. Turns out I was speaking with the very person who actually remembers (!) faxing the test results "by hand" to our vet's office. I asked her to tell me the number she faxed it to, and it's the same number ... so I just don't know what to think.

Meanwhile, a nurse from my clinic called me back and listened to my story. She's never heard of lepto, either. She's going to leave a message for the doc I'll be seeing at 11:15, to see whether he wants me to come in earlier for any kind of tests. Very sweet of her.

So, moving on, I called the regular vet's office again to find out what the implications of a positive lepto test are for the REST of the cats in the household. After consulting with the vet on duty, the receptionist tells me that since this is a test they don't ever run, and have never interpreted the result of before, I'm going to have to ask that question of the vets who DID order the test at the emergency place. Nice loop.

So ... I have a call in to have an emergency vet call me with that information, I'm seeing a people doctor at 11:15, and I need to get in the shower ... OH! And I ought to feed Mack, too, since I'm home.

Please send lots of calming and healing energy. My head is about to explode.

[update about PEOPLE doctor visit]

No one has heard of this as a people disease. The doc I saw (for the first time ever) says he's got a feeling that I'm going to be just fine, but he'd be willing to give me a prophylactic dose of antibiotics that I can take weekly, if it would make me feel better. No ... I want to know if I've got it, and if I do I want the equivalent of a napalm bomb's worth of antibiotics to wipe it out entirely, thank you!

He thinks that if I was going to manifest symptoms, I'd have done it by now because 10 days is a pretty good mean ... even though the symptoms can manifest between 2-25 days after exposure, and some patients are completely asymptomatic. So, pretty much, I'm being treated as if I'm over reacting. He wants to hear from me tomorrow, to find out what I learn from the vets, but recommends using latex gloves to protect ourselves at home. I think it's a little late for that, myself.

I did tell him I'd feel better if I had a blood test. Almost reluctantly, he agreed to order it. It's not something that's in their computer system. It will have to be sent out to another lab. He couldn't tell me when I could expect results. Neither could the technician who drew my blood, until I told her that -- before I leave the clinic -- I really need to know when to expect to hear about results of this blood test ... so she checked with her supervisor. The results should be back from the lab next Monday or Tuesday. Thank you.

[notes from the rest of the day, to present (2:50 p.m.)]

1:20 p.m. - no call yet from either the hospital administrator or a vet at the emergency veterinary facility. Guess I may as well feed Mack.

1:40 - emergency vet called - promises to take my call in 5-10 min if I call back, because I was in the middle of feeding Mack.

1:45 - called back

QUESTIONS:

A.1. IS THE TEST POSITIVE FOR ACTIVE LEPTO DISEASE, OR INDICATIVE THAT MACK WAS ONCE EXPOSED TO IT AT SOME INDETERMINATE TIME IN THE PAST?

The test says that he was exposed to leptospirosis at some point. At the time of the test, he didn't have the active clinical disease. According to the research this vet did in preparation for my call, cats are very resistant to the disease and don't get infected from exposure to it. They may build up antibodies, which are what showed up in the test results, but there's no indication Mack ever had the clinical disease.

She also said they don't ever test cats for lepto, and can't understand why the other vet tested him for this. She is asking the hospital administrator to follow up with the other vet, when he is back on duty next weekend, to find out why ... and if there was no clinical reason for the test, they will credit our account for the cost. I told her I was much less interested in the cost, and had no idea how much THIS test was (she said, in the grand scheme, it was a "drop in the bucket"), but I'm much more interested in the implications of the test results for me, Mack, and the rest of the cats in the household.

Of course, she told me that my own physician is the only source for answers to my own health questions, which I understand. She can't guarantee that a cat who has been exposed wouldn't at some point "shed the organism," but even so, it would be unlikely to survive in urine, since it needs moisture to survive. (What about a wet towel?!?!)

As for the implications for Mack and the rest of the cats -- she says they're pretty much nil -- because cats don't get the clinical disease. So I can just forget about it? Yup.

A.2. WAS HE TREATED FOR LEPTO? WITH WHAT? FULLY TREATED - I.E., FULL COURSE OF ANTIBIOTICS?

Not that she can see in the records, but the vet that won't be back on duty until next weekend will be a better source of information on this.


B. WHY WERE WE NOT CALLED WITH POSITIVE RESULTS?!?!

Test results come in via fax to the front desk. They fax them directly to the referring veterinarian, and put them into a "call back box." On April 2, the emergency vet I spoke with called our regular vet's office and spoke with a staff person who said Mack had been in, had a feeding tube put in, and was doing well. When the emergency vet asked if she needed to call the owners about test results, she was told our regular vet was in communication with the owners. The emergency vet apologized to me for interpreting that to mean that the fax of Lepto test had been received at the regular vet's office and had been reviewed with the owners.

The explanation for why the test results sat in the "call back box" until April 2: with the emergency schedule they keep, these are not normally high priority. There is no note that she could see in the file about our concern with exposure to the cat's urine, or our urgent request for notification.

Sigh.