Baby Struggled a Week in the ER Before Her Life Ended

                                            Below are a compilation of posts to the Facebook page regarding the week         Baby struggled in the ER before we had to choose to put her to sleep.

Baby Jan 18, 2021

    Baby had gone to a local vet hospital for an upper and lower GI ultrasound        biopsy which required anesthesia. She went in strong and normal; came out         weak, lame, severely dehydrated, anorexic, etc. Her temperature and blood        pressure had fallen during the procedure so she had to remain one more             night at the hospital. When she was brought to me on Saturday, no one said        that she was weak, or lame, or severely dehydrated. When I got her home,         she presented as weak and lame, barely able to move to the litter box, barely     able to drink, and after a bite of tuna, refused all other foods. I took her to the     ER on Monday. She died the following Saturday.

Baby Jan 23 2021

    

January 18, 2021 (Sunday-Monday 12:08 a.m.)

Baby isn't doing well and has not recovered from procedures under anesthesia on Friday. We have been mitigating the issues and I will call the vet tomorrow. I may need the ER if they can't see her.

Monday morning and Baby hasn’t improved. She’ll have to go to the vet or the ER. But I won’t know until about 9-930 when I can speak to someone somewhere. It’s been very difficult for me-as if I’m important. I’m not. It’s been difficult for Baby. But that feeling returned of being overwhelmed and not knowing what to do and having to go back and think about what I did when Myrna was sick. First, the feeling of trying to figure out what is wrong and what does she need. Not eating? Feed her by hand. Every two hours. Not drinking? Give water by mouth. How much? As much as she’ll tolerate. Then, that feeling of uncertainty returned-is this enough? What else does she need? Paralyzed by fear can happen. It’s panic and fear that arises in difficult situations that can cause us to not think. Our brains go spinning and the clogs don’t land on clear thoughts and solutions. We stand there saying over and over “What to do!??” Experience finally pops up and reminds us we’ve been here before and we know what she needs-food, water; check paws for warmth or cold; check breathing rate; urinating even if out of the box? What symptoms can wait for the regular vet the next day as long as I continue to feed and water by hand? What can’t wait and requires the ER-breathing rate is key, and passing urine are key, pain level is key. Depends on what procedures or issues occurred. Then experience tells us what is working but that she hasn’t recovered as she should have. A sense of determination and calm and focus set in. She will need the vet .

Baby-turns out she’s not recovering from her three day hospital stay and I took her to an ER today. Not eating, drinking, and barely mobile. We’ve hand fed her via syringe since Saturday night. But it wasn’t enough. She’s severely dehydrated and weighs over a pound less than she did a week ago. No updates yet.

Baby will remain in the ER overnight for IV fluids and diagnostic tests. X-rays possibly, an ultrasound, blood pressure check for rear legs, x-rays for rear legs and x-rays also to show if there’s any internal blockage or leaking of blood into her system. They said that sometimes with anesthesia kidney patients because she has CKD, can develop clots or issues regarding kidneys and that can cause the kidneys to go into decline.

The ultrasound and x-rays for Baby show nothing is wrong per se with her kidneys. Severe dehydration has increased the blood values. No clots are seen. Putting in feeding tube via the nose, giving pain meds and nausea meds, and IV fluids. But the lymph nodes and pancreas are inflamed. They were not on Friday. It’s possible the lameness, weakness, are caused by severe dehydration and anorexia. But what caused those? What happened during the procedure Friday? Why was she released Saturday in this condition? She will be in the ER until Wednesday or so.

I'm concerned that Baby may have or might develop hepatic lipidosis-liver failure where the liver converts body fat into energy and expends it. Hand feeding her helped provide some fat and nutrients. As the liver burns off fat, there's not enough to send to the brain to allow the brain to function. As the brain declines, so does the body. This is why you cannot let a cat, regardless of how sick from HCM complications, or any cat sick from any complication, go longer than a few hours without eating. You must begin hand feeding to keep up nutrients.

Wikipedia: Hepatic Lipidosis

January 19, 2021:

Baby has been on a feeding tube since last night and is receiving supportive care. She hasn't yet improved. They said it will take time. I allowed myself to be pressured into getting more extensive biopsies, which meant longer anesthesia period, which the hospital wanted to do when they saw her last April and did minimal biopsies (which did not show cancer).

I was against it for the cost (which ended up being $1000 more than estimated in April), and for the fact that regular biopsies didn't show cancer-and Praise the Lord I refused to have her opened up which they wanted to do.

I knew we had to give her care and feed and water by hand when she came home weak on Saturday. This wasn't the quick recovery she has shown before. And she had lost weight since Thursday.

Lessons learned: One-extensive anesthesia may not be well tolerated in cats. Two-if regular biopsies don't show cancer, do what you can for your cat with antibiotics, and steroids (for non HCM cats and after the cardiologist has cleared the cat.) Don't worry about getting larger biopsies. DO NOT be pressured by vets for procedures that might help "prove" they are sick when other procedures or tests show they are fine or fine enough or sick. Blood work is one thing, surgery another. If you feel it's not right for your cat, maybe it's not. Sure-it depends. And I'm not ruling out surgery or larger biopsies in general. But I wasn't sure about this for Baby and I wish I had listened to my concerns. Sure-we DO NOT always know what's best for our cats. We do not always understand what is necessary for the vet to make a determination. But we had all of the previous blood tests and simple biopsy information for Baby already. That should have been enough especially since the vet on Friday said everything looked fine. Of course-the biopsy results might come back differently. But look where Baby is now-struggling for her life. If I hadn't had the biopsy done, she would be at home now, safe and healthy.

Baby-steroids started last night; will give additional meds to help stomach digest food to absorb nutrients because the food isn’t moving along; her cardiologist-shocked by her appearance-said heart is fine, no changes that caused any issues or decline or clots. They still think dehydration caused many issues. But she’s not yet recovering despite fluids. But she is keeping down food.

And they will watch for hepatic lipidosis but her liver values are normal; ultrasound normal; bilirubin is 7 and normal is 5 so tiny elevated; kidney values are better with hydration and still higher than normal but within normal CKD range that shows kidney function.

January 20, 2021:

Baby showing signs of improvement overnight-she got up and drank water. Next step-eating on her own enough for the feeding tube to come out. But also, the food in her stomach must move along more than it is.

They suggested transferring her to MSU when more stable. I don't care to transfer at this time. Is there anything more only MSU can do for her? And it's a bit further away.

The vet hospital where Baby was Thursday-Saturday called me back and yelled at me for leaving messages demanding answers. FIRST they said voice messages were rude (I was firm in my wording, questions about care, not rude) and that they "don't appreciate it"; then they were condescending and unhelpful and claimed THEY are not the problem, that Baby with multiple issues-despite leaving the house perfectly fine on Thursday-is just too sick. And that she left them perfectly fine. She's in the ER because of that and NOT because they did anything wrong or neglected her-per the spokesperson. He did not diffuse the situation by being understanding or compassionate. Nor are they willing to take something off of the bill to help cover some ER costs (I thought it wouldn't hurt to ask.) Instead, he was angry and scornful. He said I wasn't being civil. And that I need to seek care elsewhere-NO PROBLEM THERE.

Baby update: more alert and still drinking water. Sitting up while all four legs are down-not up on her feet-and they move her from time to time if she hasn't moved. But there's some crackling in her lungs so keeping an eye on her asthma. And blood in her urine and bladder. Doing ultrasound checks for what's going on and will know more later. They'll call me tomorrow morning or this evening if it's serious. Could be an infection or stress or...? Anything. Food in her stomach is moving along, digesting which is good news. Still on IV fluids and pain meds and such of all sorts.

January 21, 2021:

Baby-unchanged. I can’t visit due to COVID restrictions they have. I asked if I could visit since she’s been in so long and they said no. If I could visit daily she might perk up. They want us to transfer her to the State vet school hospital (not the one from last week.) I’m waiting until the biopsy results come back. They also said we need to think of end of life care and when it might be time to put her to sleep. I’m waiting for biopsy results before thinking about that but I do know I want her home for either palliative care we can give or to spend time with her. I might be able to make visiting vet arrangements with her normal vet practice, even for end of life. For now, she can’t come off of fluids and such and be home.

January 22, 2021:

There is no improvement for Baby. Still stable and drinking but not eating and described as very depressed. She has more gurgling noises in her lungs, possibly due to her asthma-which they are treating-but she doesn't have any signs of CHF.

We called the State vet hospital and they said-given that it is getting late today (almost 1 p.m.)-that we transfer her on Sunday night and then she'll be transferred to the hospital Monday. Or we bring her into the hospital first thing Monday morning.

Yes, their ER is open 24/7 but not the specialists or diagnostics outside of xrays and simple ultrasounds. There's no reason to move her from one ER to the next for the entire weekend. I'm taking her Vitamin D supplement up to the ER since she's not had it for a week now. She's insufficient-last reading was in November at 68-should be about 100. It's grasping at straws to think it might fix her but it is a vital component for her overall health.

Did I say this already? When I took Baby to the hospital on Thursday expecting she would be back Friday, I spent two days at home without her. And during that time and then of course going into the weekend because Baby stayed until Saturday, I missed Myrna our former HCM cat the most that I have in the last five years since she died, except for the months following her death. Not sure why and not a good omen. I was worried about Baby before I knew I should have been.

January 23, 2021:

Today at 12:35 am Baby girl died after a week in the ER. We chose to end her life because she was declining and today her platelets dropped too far. She never really improved although there were some good signs. But not enough. A necropsy will be performed and maybe answers will be found. She was feisty, demanding, particular, ornery, intelligent, funny, playful, sweet, loving, and a guard cat ready to attack all dogs and squirrels. 2005-2021.

January 25, 2021:

The initial gross anatomy report from the necropsy for Baby has been released. They saw left ventricular thickening and say she had HCM. They also noted severe pancreatitis. The remainder of the report will take a week.

This is confusing. She saw her regular cardio in July and had no changes, no heart disease, no HCM. She had dental surgery in November and had no issues.

When the cardio at the vet hospital for the biopsy said they heard a murmur and saw myocardial changes, why did they say she was ok to go ahead with the biopsy? Her cardio on Tuesday said the pushed fluids into Baby's body made it difficult to assess the heart completely but that she hadn't seen any troubling areas.

Did Baby's severe and sudden pancreatitis likely caused the body to fail and be unresponsive to treatment? Her heart rate, etc. was normal, and none of the classic symptoms of HCM presented and called for medications such as ACE inhibitors, beta blockers, etc. Nor does this explain the drop in platelets as far as I know.

No more biopsies for any of our cats regardless of age or condition. They are too dangerous when done by unscrupulous vets. We'll treat the symptoms of whatever comes up and do xrays and ultrasounds but no biopsies. You try to find out all that you can to beat an issue, to stay ahead of the possible issues, to meet something head on and it doesn't stop someone from killing your cat.

I don't mean not to do all that we can for our HCM cats. But they don't have invasive procedures for HCM. It's the other diseases that we apparently try to do all we can to prevent, to decrease, to stop and in the end, to no avail when we think they are safe and it turns out they are not.

Baby Dental Surgery November vs Upper/Lower GI ultrasound January-She's Not Doing Well

We've had a busy summer and fall into winter with the cats. Either there were some minor health issues or they spent the summer and fall going to the vet for annual check-ups and shots. 

Bette had a bladder cystitis blowup this fall which meant a trip to the vet. I could tell she didn't seem well. Sure enough, her urine and blood work showed the inflammation. The vet prescribed antibiotics.  She's done well since.

Jimmy was at the vet this summer for box accidents. He continues to be monitored for diabetes and still has out of the box accidents once a month, sometimes two. We have him on a special low carb diabetic diet, Royal Canine Glycol Balance, mixed with Tiki Shredded Chicken, mixed with a bit of canned CD (to help the bladder that has seen some minor inflammation). No dry food (carbs). His accidents are in the oddest of places: against the washer, on the linoleum, against a dining room chair (which are covered in plastic, which is covered over with pads, which is covered with a cloth chair cover. First the chairs were covered to keep them clean. Then he began going on them so that prompted the plastic covered by cloth. Only, the urine would run through the cloth, down the plastic, onto the floor. Now it's plastic, pads, cloth.) He'll have one accident, then be fine for two to three weeks or a month before the next. And typically in a new spot. He's on Prozac which is compounded with a sugar free substance. We developed a behavioral technique where we praise him when we see him use the box (if we see him use the one on the first floor) and then let him have access to the second floor bedrooms or into the living room. He's not allowed into either spaces unless he's used the box. 

Katharine has spent months now on steroids for IBD. She wasn't eating well enough this summer and began to lose weight. Blood work PLI/Cobal/Folate test showed inflammation, possible IBD. Steroid prednisolone was prescribed for a period of time before we titrated down her dose. But we have been allowed to go slowly. I decrease the dose by .005ml every two weeks or so depending on how well she maintains eating after the dosage is decreased. She has gone from .4ml to now .1. She has been at .1ml for a month because she has not been eating well and has lost weight after going from .15 to .1ml. This week I had to give her Miratz-Mirtazapine in a gel form-the appetite stimulant because she lost weight and was not eating. We may need to increase her dose again. 

Baby-Baby sees the vet every few months for blood pressure checks due to hypertension caused by CKD-kidney disease. In 2019 and in April 2020, she saw specialists to review her many issues: CKD, hypertension, hyperaldosteronism, mast cells, lymphoma/IBD/pancreatitis, Bowenoid in situ sarcoma skin lesions. She had her annual check up in November and dental surgery in November to remove two teeth. The small front tooth was broken, and a molar had a cavity. She recovered from anesthesia without issue. She ate and drank and used the litter box once home and only seemed to need the one day to bounce back. 

HOWEVER-the specialist at the animal hospital wanted to do a larger biopsy of her lymph node that was enlarged, as well as get more samples of her intestines to test for lymphoma vs IBD/pancreatitis. That was scheduled for last Thursday/Friday January 14-15. 

Upon initial exam, they discovered a heart murmur and did a cardio echo which showed mild changes in the heart but no heart disease. They did a regular ultrasound. The enlarged lymph node was no longer enlarged so it is unlikely that she has cancer. Also, the mast cells found in 2019 are likely not cancerous because that is an aggressive cancer and she would have died by now. Mast cells can also appear with severe/chronic inflammation like IBD. The rest of her appeared almost the same in 2021 as in April 2020. They kept her overnight and did the biopsy on Friday. They took samples to test but they do not believe she has cancer of her intestines. 

BUT-the anesthesia was not well tolerated. Baby's blood pressure dropped during surgery to 90-normal is 120 or more. Her body temperature dropped during surgery and had not returned to normal by 4 p.m. when they called to say she could not come home. Her body temperature returned by Saturday and she was released in the afternoon. They also performed an enema-water solution pushed into the butt with a hose and up into the intestinal tract-under anesthesia. When they released her, they said she was in stable and good condition but that she hadn't eaten. 

HOWEVER-when I got her home, she was NOT in good shape. She was LAME in the rear legs, gurgling out of her nose, wouldn't eat, kept crying in pain, etc. I removed the bandage on her leg and that helped her walk better but she still had trouble walking and she was also walking in a curved line. Eventually, I administered her Buprenex at .2ml (up from .15) which eventually helped her sleep; and gave her blood pressure med which they have failed to give her; and after trying to get her to eat, began giving her tuna juice by mouth. She had not eaten for them and had not eaten a full meal since Wednesday. Subsequently, she has lost one pound since a week ago. She kept going to the water bowl and trying to drink. 

On Sunday, today, she was going to the water bowl and NOT able to drink but has been laying there instead. She is not using her box but is going on soft surfaces. She appears unable to climb into a box. We have set up a flat box which she was able to use. She is walking better than she was Saturday night. We have been feeding her A/D mixed with a bit of water, fed to her with a 3ml syringe, for 12ml total every 2-3 hours. We have also given water by mouth. She is not active; she appears uncomfortable; she does seem restless although Buprenex helps calm her. Her breathing rate is about 36 which is normal. But WHY isn't she bouncing back from this as she so easily did after dental surgery in November? WHY isn't she eating despite Cerenia, cyproheptadine, and Mirataz? WHY is she in pain or uncomfortable? WHY is she having trouble with her rear legs and is unable to climb? 

The notes from the vet said she presented on Thursday with rear leg lameness and pain at the initial exam. She did NOT have any trouble with her legs at home or at the regular vet a week ago when she went in for blood tests. IF she had rear leg lameness, they failed to tell me, and then failed to try to figure it out and fix it. What if something happened during the surgery to cause leg pain or lameness? Did they cut off blood supply-although her paws were warm to the touch. Did they damage a nerve? Did they cause pain when they inserted the tubes for the enema and lower GI? 

I will call her regular vet tomorrow, Monday, to see if they can see her. If they can't, I may need to take her to the ER but that's a tough call to make. She isn't well but nothing appears life threatening. Except that she isn't eating and drinking and with the sudden weight loss, she could be low on electrolytes and nutrients; she could have internal damage that I can't see and may need xrays or an ultrasound. But she should have bounced back by now. As for the changes in her heart, I will call the cardiologist to see if they can see her sooner than the February appointment she already has.