"I got worms in me"

Before sitting down to write my previous post, I turned on the TV and started channel surfing to find something to watch as I typed. I came across "Untold Stories of the ER" on TLC. I had missed the beginning, but became intrigued with the story about a woman who kept repeating "I got worms in me".

I watched as the perplexed ER physician tried to make sense of what this meant...she had intestinal parasites? how did she know? she swallowed worms? why?....and I, like him, was surprised as he discovered that his patient had actually placed earthworms under her skin in several locations. No doubt, this was the last thing on his mind as he ran though his differential list for a patient telling him she had worms in her!

It reminded me of the day a client had called our clinic saying that her cat had worms coming out of his abdomen. With the client still on the phone, the same process the ER physician went through was begun. What could "worms coming out of the abdomen" mean?

Knowing that tapeworm segments can be passed out of the intestinal tract in stool or on their own, and knowing they can move like inch worms once out of the body, we asked if there might be a small worm or worms moving on her cats fur....no, these were coming out of the skin. Having seen only 2 cases of maggots (and hoping never to see another case) we asked if the cat had cuts or sores on the abdomen...no, just the worms coming out of the skin. Might these be something other than worms...no the worm heads were sticking out of the skin. Unable to determine what we were dealing with without seeing the cat, an appointmet was made.

The worried owner and her nervous-at-being-at-the-vet but otherwise happy & healthy appearing cat arrived. Wishing to end the suspense, I eagerly began my exam. Several minutes later I happily reported to the concerned owner that I saw no evidence of worms coming out of the abdomen, her cat was fine. Skeptical, she proceeded to point out 8 "worms" evenly spaced, 4 in a row each on the left and right sides of her cats abdomen.

Have you guessed it by now? Sure you have. I let her know not to worry, these were nipples and very normal looking ones at that. She was quite surprised to hear my diagnosis, and skeptical of my diagnosis, pointed out to me that this was a MALE cat. Seeing that she was wearing a wedding ring, I gently asked "have you ever seen your husband with his shirt off?" and waited for her to make the connection.

A sheepish owner left the clinic with an anatomy lesson that will never be forgotten. A cat left the clinic with a diagnosis of good health and nothing more than a good "massage". And I reaffirmed my belief that a diagnosis can't be made over the phone, the patient needs to be seen.