Sunday, January 17, 2021

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. 


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