Wednesday, June 25, 2008

On the mend

Two surgeries in three weeks, and two good outcomes. I couldn't be more pleased with Dr. Davis' work--she took good care of both cats in the run-up to surgery, and did a great job in the actual surgery. Both Izzy and Cleo were not in the best of health before surgery--Izzy because of chronic ear infections, and Cleo suddenly became incapable of feeding herself, and went from mesomorph to wasting. So we had to build both of them up for surgery, while at the same time, not putting off the surgery so long that we missed the best window for each kitty.

Anyway, still crazy busy with second shift cat care + crunch time at the day job, but it's definitely starting to wind down. Cleo's feeding herself now, and Izzy's ear isn't oozing nearly the amount of crud it was in the beginning. There is the problem of getting antibiotics down non-compliant patients, but it's not as bad as syringe-feeding someone who doesn't want it.

So there's light at the end of the tunnel. And there's good news, too--in addition to inferring that the teeth and stomatitis (inflamed mouth) was Cleo's sole obstacle to eating because of the beeline she made for the food on returning home, as groggy from the anesthesia as she still was, the biopsy seems to back it up. No cancer--yay! The patho report said "severe stomatitis", which the steroid injections and the removal of her teeth should fix, and we'll keep an eye on for recurrence. In the meantime, the little feral rescue from my last weeks at Microsoft looks better than she has in a while. No more wheezing that you can hear from the next room, no more weepy eyes, and she's chowing down like there's no tomorrow.

As always, I'm a day late and a dollar short on getting all my deadlines caught up with. But really, I couldn't be happier with Cleo's and Izzy's outcomes, and if it took sublimating every thing else for a month to play second shift intensive care cat nurse, I don't begrudge it.

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Friday, June 20, 2008

Raven plans, and God laughs

Originally, June was going to look very different. I had wanted to go to Evolution 2008, and today is a workshop on ontologies and evolutionary biology that I was especially interested in attending, as it ties tightly into the work I'm doing to continue my dissertation research.

Instead, I'm playing intensive-care cat nurse x 2: Isadora's amputated ear wound site is healing nicely, and Cleo is having surgery today. She has stopped eating on her own, so I've been hand- and syringe-feeding her. She's not so sick, though, that she can't fight back against the syringe-feeding; we both hate it.

It's not quite clear what's going on with her, but there's something wrong with her mouth--whether or not that's the whole story, we don't know at this point. We do know that she has bad teeth, and a lesion in her mouth. But she's so compromised at this point--and she went downhill so quickly from being fine at the end of May--that we've been putting off anesthetising her because of the risk.

Best-case scenario: the lesion in her mouth is just inflammation from bad teeth and gums, and the dental work will alleviate it, and she'll go back to eating on her own, once the dental surgery's in her rear-view mirror.

Worst-case scenario #1: the biopsy comes back malignant from pathology. In that case, we'll euthanize her--keeping her around while a facial tumor takes its toll is not doing her any favors. We lost our cat Momo to a facial tumor in 2002, and to this day, I am not quite sure that we didn't keep her around just a little too long for Momo's quality of life because we were reluctant to let her go. We won't do that to Cleo.

Worst-case scenario #2: the biopsy comes back benign, but Cleo continues to decline after the surgery, and we never figure out what the problem is.

Sad, but not worst-case, scenario: Cleo is a very poor anesthetic risk at this point, but it's clear that this is her only chance, and we're going to take it. She may well die under the anesthesia. If she does, we'll be sad, and we'll miss her, but we won't regret going forward with the surgery. If she has a chance for any future life with any degree of quality of life, this is it. But she's DNR (do not resuscitate) if she dies in surgery.

In her favor, we've temporarily gained a little ground with steroids and antibiotics--it's not a permanent gain, but we're hoping it's enough to get her safely through dental surgery this morning. She's alert, her eyes are clear, and she's looking around for the food I normally give her by hand in the morning (she's been NPO, or nothing by mouth, since midnight).

Carpe diem. I'll let you know how it turns out.

UPDATE, Friday AM: Leaving for the vet now. Cleo is awake, alert, and the talkiest I've seen her in weeks. I love you, Cleo, and we're hoping for the best. Whatever happens in surgery, I'll remember how your old self showed itself this morning.

UPDATE, Friday night: Cleo came through the surgery fine, much better than we were expecting. Yay, Cleo! I brought her home, and she headed right for the food bowl. I think we've found and fixed the problem! I didn't let her stuff herself, because she's had quite the shock to her system today, but clearly she wants to eat.

She had about half her teeth extracted, and the biopsy is sent out, but the vet thinks it's stomatitis, or inflammation of the mouth, rather than cancer. Her canines were abcessed, and their proximity to her sinuses may account for her chronic respiratory issues--so we just may have solved another problem in addition.

Good Cleo! I'm glad you came through so well.

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Saturday, June 07, 2008

Izzy's home!

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Tuesday, June 03, 2008

Izzy's big day

Today is the day Isadora's finally going to have her ear amputated. The chronic infections have gotten to be so bad that her quality of life is severely impacted, and continuing along the same path has become untenable.

The vets are going to begin by amputating her pinna (outer ear), and performing a lateral resection, or cutting away that portion around the ear canal on the outside. Once they get the deformed pinna out of the way, they will actually be able to see down inside and get a better idea of what is going on, something that's been impossible until now because of the extent of deformity of the cauliflower ear.

The vet expects that once she gets in, she is going to find damage all the way down into the inner ear. She expects that the eardrum is ruptured, and that evaluation at that point will indicate that the best course is to make the surgery even more radical, proceeding from the vertical canal into the horizontal canal, and removing the entire middle and inner ear as well.

I'm worried about Izzy--she's currently at a local maximum healthwise, which is why we've decided to go ahead and seize the day surgically--but even with the anemia and elevated white blood count under control at the moment, no one thinks she's an outstanding surgical candidate. They're going to take extra precautions, like putting a catheter in in advance, so if there's an emergency and they need to give her drugs to get her heart rate up, they don't lose minutes looking for a vein. But she's an old cat, with chronic health problems, and she's got the pug nose of a Maine coon cat, so there are just some realities we can't do anything about. I'm worried about the anesthetic risk, and I'm going to be on pins and needles all day until I get the word that she came through surgery ok.

I'm worried that she's going to die on the table, and I so do not want that to happen. I'm really nervous about putting her through surgery. But Mr. thalarctos and I have discussed this at length with both vets, and everyone sees it this way: the only chance for Izzy to have any quality of life at all in her remaining years is to get rid of the source of chronic infection that is causing her such distress. Her ear is so bad, and causing her so many problems, that--as drastic as this surgery is--it is the right thing to do.

I love you, Isadora, and I hope this is going to be all right.

UPDATE, Tuesday evening. It was a long day, with running errands, work, and a project management class at the end. I got the news right before going into class that Isadora had done well in surgery and is recovering. They're keeping her sedated because of the pain from the amputated ear. Once the vet got in, she found that, past the pinna, things were better than she expected, so rather than fully ablating the ear, she just took off the pinna, then cleaned up the ear inside. Izzy considerately spared them the trouble of having to take out her IV by removing it herself. After that long day, I came home and fell asleep. More later about the anatomical details, but it looks like Izzy has set out on a long road to recovery.

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