Visiting Vet: The call of the lily

Coral takes a walk on the horticultural wild side.

Lillies are toxic to cats, but not dogs. — Thomas Williams

The call came in around 7 pm from a longtime seasonal resident who had recently moved here year-round with her cat, Coral. Coral enjoyed exploring the garden outside, but tonight she had done more than sniff around. She had eaten a few leaves. “I think they were lilies,” her owner said. I took a deep breath. This person was not my regular client. I didn’t know her. More importantly, she didn’t know me, and what I was about to tell her was upsetting.

Lilies. Whether in a vase on your table, a pot on the porch, or planted outside, lilies are highly toxic to cats. Not dogs. Just cats. The flowers are the most toxic portion, but all parts are dangerous, including leaves, blossoms, pollen, even water from the vase. Ingestion of any of these can lead to acute, irreversible kidney failure. It doesn’t take much. A nibble of a leaf. Perhaps a dusting of pollen groomed off a paw. Even minor exposures can be deadly.

I looked at the clock. Mortality rates for cats who ingest lilies range from 50 to 100 percent, but early intervention can make a huge difference in survival rates. Optimum treatment would include trying to induce vomiting, followed by two to three days of constant intravenous fluid and monitoring. None of the Island veterinary practices, self included, can provide round-the-clock intensive care. Coral needed the 24-hour emergency facility on the Cape. I was conflicted, Should I have her come to me first so I could try to make Coral vomit? It’s surprisingly hard to get a cat to throw up, and I didn’t want them to risk missing the last ferry.

I explained the situation to Coral’s mom. Her first reaction was understandable. Denial. Maybe they weren’t lilies. Maybe they were tulip leaves or daffodils? Not being a botanist, I could not personally identify the leaves. The Liliaceae family contains more than 160 genera. The ones of concern are the genera Lilium (true lilies) and Hemerocallis (daylilies), including Easter, Asiatic, day, Stargazer, tiger, and wood lilies. If there was any chance Coral ate one of these, the situation was dire. Her owner then faced the facts. The plants in question were undoubtedly lilies.

Now the bargaining stage. Coral didn’t seem sick. Did she really need such aggressive intervention? Although occasionally lily ingestion causes death within hours, usually it takes a day or so for the kidneys to fail, and three to five days before a cat dies. Once symptoms appear, which may include depression, loss of appetite, drooling, crying, vomiting, excessive drinking and urination, incoordination, tremors, and seizures, it is often too late to save Kitty. I offered Coral’s owner the number for the animal poison control hotline so she could consult a toxicologist. Wanting a second opinion made complete sense, especially since she had never met me and had no reason to trust my advice.

By the time the toxicologist confirmed my recommendations, it was getting late. I Googled the Steamship Authority website. Luckily, there were openings on the last boat. “Make your ferry reservation and get packed,” I told her. “I’ll call Cape Cod Veterinary Specialists and let them know you’re coming.” I hung up, then emailed her directions, and names of a few affordable hotels near CCVS. Then I went to bed. (Yeah, I go to bed early. I’m old … and tired.) At 9:45, the phone rang again. A mix-up about the ferry reservation. Despite a valiant effort by Mom to get Coral promptly to CCVS that night, the last boat had left the Vineyard without them on board. The owner was distraught. What should she do?

Twenty years ago, I might have told her to come over. I might have tried to locate my assistant, or get a family member to help me place a catheter for intravenous fluids. I might have stayed up all night to monitor her. But I can no longer manage working all day, staying up all night, then working all day the next. As a little one-doc country practice, I simply can’t provide the level of care available at a big, state-of-the-art place like CCVS, especially during a pandemic. What I could do tonight would be one big dose of fluids under the skin as an outpatient, then she could head to CCVS in the morning. That would be far from ideal. But there was another option.

“Don’t panic,” I said. “I’ll call Captain Jim. If you’re game, you can get over to the Cape tonight on the Patriot.” For those who don’t know, Patriot Party Boats is a family-owned business that has been around these waters for 40 years, offering fishing and other kinds of charters. They also provide 24-hr water taxi service. Over the years they’ve transported many sick pets and worried owners. Captain Jim called me right back. I connected him with Coral’s owner. Falmouth Taxi would meet them on the other side, and take them to CCVS. The specialists there could decide whether to start with inducing vomiting or performing gastric lavage, followed by administration of activated charcoal to prevent further toxin absorption, but the mainstay of her therapy would be carefully monitored intravenous fluids, balancing intake and output. Sometimes diuretics are necessary to stimulate urine production, or anticonvulsants for seizures. Luckily Coral did not need these medications. She received 50 hours of continuous fluids, and had regular assessment of her kidney function, blood pressure, and other vital parameters. After 72 hours, she was declared out of the woods, and was able to go home.

No one knows exactly why lilies are so toxic to cats, but for some reason, kitties are attracted to these beautiful but deadly plants. I do know that as I went back to bed that night, old and tired, but confident Coral was on her way to receive the best possible care, I was very grateful for Captain Jim. I also know Coral’s owner loves her a lot, having overcome so many challenges to make it happen.