This is Mal Purrcino (the white slash across his face = Scarface = Al Pacino). One summer day, this loud-mouthed orange cat walked onto our property and demanded to be adopted, and we obeyed. This formerly feral cat (now fixed and vaccinated, you’re welcome, Bob Barker) has had nonstop health issues. In fact, we have spent most of this year dealing with a painful skin issue that causes oozing, baldness, and nodules. He had skin scrapes, biopsies, and bloodwork. We don’t have a definitive diagnosis, but a solid working diagnosis.
His health recently escalated when he started exhibiting limb stiffness and weakness. First, his back legs, but he recovered rather quickly. But then his front right leg went full pirate peg leg. Wobbling around and barely using it. We put him on pain and inflammation medication, but he continued to decline. We were sure he had a fracture, so I rushed him to the emergency vet.
I told the staff that he is a wild boy who still spends a lot of time outside (we live in the woods in the country) and probably landed wrong while jumping from a tree. I asked for X-rays, and after a 30-second exam where they poked and prodded his leg (and nowhere else), they got him radiographs and more pain meds. X-rays were totally normal. They said it was a sprain and to keep him inside. Mal looked at me and mindspoke, “Try to make me a full-time housecat and you’ll find a squirrel head in your bed.”
Despite his threats, we kept Malley Cat in the house for the rest of that day and night. By morning, he was a million times worse. He was barely moving. With tears streaming down my face, I reached out to my regular vet in a panic. Mal acted like every bone in his body was broken. He could barely get up, let alone walk. My amazing vet rushed over.
After a thorough body exam, plus her intimate knowledge of his crazy clinical history, the most likely answer was immune-mediated polyarthritis. Every joint was reactive for him. He was having a flare, which so many of us spoonies can relate to. I was heartbroken for him. But we have a plan, and I’m confident this tough-as-nails cat will pull through.
What Did I Do Wrong?
I’ll test your patient advocacy skills here – did you catch what I could have done better at the emergency vet? I made two mistakes, actually. One, I was too leading. I walked in and said he was a rough and tough boy, and I just needed X-rays. I didn’t really leave room for a discussion. Two, I didn’t give them his clinical history. Sure, they didn’t ask, but…
You Have to Take Ownership Even in the Face of Leadership
We want to go to the doctor and be 100% taken care of. We want them to ask all the questions and do the detective work. Because medical providers are often viewed as authority figures—the ones leading the appointment. However, when you give a provider complete ownership of the appointment while maintaining a very passive role, things can be overlooked or rushed. On the other hand, if you try to take full ownership and guide the outcome, as I did with Mal, you can mislead the provider.
Aim for a Patient-Provider Partnership
In an effort to make Mal’s appointment more of a collaboration, I could have said that he has a complex medical history with ongoing health issues that may or may not be related to front limb weakness. I could have asked questions like, “Do you feel his pain could be related to his chronic health issues?” When the x-ray came back normal, I could have politely asked for a more full-body exam. Instead, I really stayed on the extremes of both ends, versus trying to be in the middle where the collaboration sweet spot is. I was either way too leading (just give him an x-ray) or way too uninvolved (giving no clinical history).
While Mal is seriously questioning my patient advocacy skills at the moment, I told him that we all need reminders from time to time on how to best advocate when you have a chronic illness, and to please forgive me (insert bribe with stinky wet food).
Dr. Sarah Schafer and I discuss various aspects of patient advocacy in our course Streamlining Sjogren’s: How to Navigate a Path to Diagnosis and Treatment. As patients, we have to be proactive in understanding our suspected or confirmed diagnosis, but also need to strive for a collaborative relationship once we find those great doctors (yes, we give tips on how to find them, too!). You can check out a free video preview of the course here (with no commitment!).
Little Engine Patient Advocacy 
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