Bette began the process of radiation treatment without any issues. The first few days she was home, used the litter box, ate well, then slept but was also up later in the day, moving about, being taken from room to room. But quickly small issues emerged-litter box use and ability to eliminate, lameness, exhaustion, fast breathing, inappetence, drooling, open mouth, weak front legs, weak side of face. No one knows the cause. We are going to the dentist on Monday 5/15/23 because he's an expert and will be able to evaluate and offer suggestions as to cause and treatment. We are to hear from her neurologist about setting up an MRI recheck on Monday and hopefully we can get her in sooner than the June appointment we already had set. The following are notes from the notebook I have kept about her treatment. I tried to clean them up so that they make sense, replaced person and place names. The grammar or sentence structure is not always correct.
4/19 Began radiation treatments Wednesday-Friday. Never sick, tired, ate well at home. Restless at night. Used litter box without issue. Good 4/19-21. Looked and acted normally. But quickly lost use of left leg, no weight on it.
4/22 Signs of difficulty eliminating. Increased Miralax and Cisipride and Forta Flora. Smaller bowel movements. Began difficulty getting into the box as leg got weaker. Began urinating periodically on pads and not in box. Still looked normal. Eating ok.
4/24 High amount of blood in urine. Not using box, urinating over box onto pad or on pad. Dark red. vet school checked urine and no bacteria. Red blood cells they thought from stress. Increased Buprenex, Methigel, water by mouth. Ate ok but not as much.
4/25 Vet school prescribed Gabapentin at bedtime-50mg/1ml; we gave .75ml. That settled her down at night to sleep.
4/26-4/28 Better, using box, restful, slept well at night. Could move up and down basement stairs on her own.
4/29 Urine out of box, restless at night. Gave more Buprenex, water by mouth, Methigel.
Weight was 11.11.
4/30-5/1 normal, weaker legs, unable to move as much, box use getting difficult. Eats well enough.
In May-begins squinting eyes, slight drooling and wetness around mouth. This increases daily.
5/1-Monday-normal day, fine post treatment. Good evening. Ate well.
5/2 Evening-can’t get into litter box, puts legs in but butt is out and urinates onto pads. Can still slide her body and drag left leg and use front legs to move around. Is drooling.
5/3 Came home from vet school dirty and wet around mouth, chest, legs because the drooling has increased greatly. The gunk on her is food she tried to eat after treatment.
5/4 Thursday vet school radiologist sees ulcer in right eye. Gave antibiotic gel cream for eye bacitracin neomycin polymyxin. She is now very lame, harder to move around but she can move herself. Continued drooling out of mouth all day into next. Could still eat. Began urinating laying on pad and it got all over her. Got urine sample from pad into vet. Eye gel glues eyes closed, makes a mess on face.
5/5 Friday BD urine on pad laying down, on herself 5:30 a.m. Her vet said Thursday's urine sample has high amount of bacteria although not sterile sample. Dr gave Zenequin. Seems tired and not able to get into box easily. Drooling is worse, very wet. Eats only some. Eyes closing more, gel on face. Afternoon and evening-used the box by getting into it and only got a little wet with urine.
5/6 Saturday -Was fine in the a.m. and ate but by the afternoon was clearly run down. Wouldn’t eat all day. Gave water PO often and she rejected it. Difficult getting food into her with syringe. Eyes squinting, second eyelids out on both eyes, drooling, open mouth, weak, tired. She hadn’t had a BM or urinated since Friday 5:30 a.m. Was afraid she was crashing or had blockage or fistula. Seemed cool, less pink. But BR was normal at home. Took her to vet school ER. Tested-despite clinical signs nothing tested positive. BR/HR/temp/BP normal. ER doesn’t know why she’s drooling. Or why feeling/looking miserable. She hates having her mouth touched. Bladder at ER was small but she wasn’t dehydrated in skin test nor in blood work so did not give fluids. Urine tested positive for bacteria so continue Zenequin. Left leg has good blood pressure but less muscle mass. Gave Onedansetron for nausea, suspect drooling nausea related. She ate very well for them-although a drooling mess. They cleaned her face and she looked perfect.
5/7 Sunday-finally urinated on a pad 2:30 pm as she lay and had to be cleaned. She perked up afterwards and ate and drank for five minutes. Then slept. Then by 6 pm. seemed run down again. Never urinated all day or night. Looks miserable. Ate little. Gave water PO. Drooling increasing, even more wet on body. Eyes squinting closed more.
5/8 Monday Dr. Radiologist said tumor may not be shrinking, litter box issues related. Discussed Saturday ER. Needs followup MRI. Left leg has no feeling-blood and good pressure (ER) but wasting muscle tone. Mouth is held open slightly, drooling is excessive, tongue is out. Eyes squint more. Vet school radiologist doesn’t know why. Sort of dismissed it as mouth soreness. *They’ve never had a mouth injury during intubation. Bette looks miserable. *On Monday Dr. Radiologist said ER urine sample was not bacteria but would not say why the ER said bacteria other than ER doctor misread it. Said to end Zenequin. Said to end Buprenex, give Gaba 1ml BID and not just at bedtime. Decided to do 1ml Gaba post treatment, ½ ml dinner, ½ ml bedtime. Evening heard jaw click noise, open mouth more, tongue out, not comfortable. NO urine or BM since Sunday.
Finally urinated 3:30 a.m. Tues. on pad.
5/9 Tuesday-Drooling is worse. She’s wet, hard to hold down meds, jaw makes noise, heavy breathing, open mouth. BR was 80 in the morning when we arrived at vet school. It did not fluctuate while we waited for treatment. Dr. Radiologist said it was normal BR when in treatment. She later said she did not react when mouth and face touched-but then said that was done under anesthesia (so not a good indicator.) She was drooling post treatment and was dirty from struggling to eat and keep it down. Mouth was opened, tongue out. BR was excessive. They still released her. And it got worse in the car going home. Decided to go to local AEC. They put her on oxygen and that calmed her immediately. Blood work shows some iffy-most to do with breathing fast; and some white blood cell counts are low. Lungs clear, eyes irritated. Gave Optimax eye drops. Don’t know why mouth is opened, drooling, fast breathing. May be signs of pain or injury or anxiety. Took xrays of body and nothing is wrong internally-no fistulas, no blockages.
5/10 Wednesday Gave Valium in a.m. before treatment instead of post treatment to help with anxiety if drooling is related. Radiologist concerned that radiation causing breathing issues but denies mouth soreness still. Finally urinated 2:30 pm on pad at home. We then saw Dr. Vet to review issues. She checked mouth, teeth and said it’s pain reflex but cause is unknown. Might be TMJ or nerve damage. Related to intubation likely. Said to give Buprenex post treatment to help with jaw pain and to use it as break through pain control as needed. Checked eyes-irritated, no ulcer. Said to use Topamycin for eyes post treatment, lube pre treatment. Bette BM 10 p.m.; urine by midnight pads and on her. Her mouth is opened, slack, drooling excessive, tongue out still. Gave buprenex at home. Can’t keep down Gaba with drooling and bitterness of med. AEC bloodwork-showed low WBC count, off RBC counts; and off CO2 counts due to fast breathing. And low potassium. Give Renal K. Kidneys normal. Decided to stop Onedansetron except as needed since drooling isn’t nausea related but likely pain. Giving more water by mouth. Eyes squinting closed.
5/11 Thursday radiology treatment; said they will compound Gaba into pills (ordered from NJ pharmacy) because drooling is excessive and with bitter Gaba she can’t keep it down. She came home DIRTY from spitting up her food at vet school post treatment. Giving Renal k potassium and buprenex post treatment. She cannot CHEW today, can’t eat her dry food or treats. Drooling is worse ever. Decide to give only Buprenex because she can keep that down; Gaba at bedtime. Must be gentle with mouth, hold it partially closed to help her swallow. Careful not to choke on meds or aspirate liquids. Giving water by mouth. Slept rest of day. No urine/BM. Eyes-especially right-keeps closing. Mouth still open/drooling.
5/12 Friday BM 3:45 a.m.; front legs seem weak-especially RIGHT front leg. And vet school called and said they suspect drooling now is from TMJ or trigeminal nerve damage. Could be inflammation or a tumor or damage. They say this has never happened before.
Urine in crate by 1 pm. Once home. Giving tuna juice, water by mouth, buprenex. Decide to syringe feed AD. Renal K, etc. Right eye is not opening up as much, right side of mouth NOT sore but left is. We suspect her right side of face nerve damage. Eye does not respond to touch. Pupils look the same. Hard to lift herself and move with weak front legs.
5/13 Saturday less drooling, less opened mouth, tongue only out a little. Must be careful when syringe feeding-hold mouth closed, go slowly, and with meds. She is eating some on her own. Clean her, protect catheter paw. Right side of face not responding as left to touch or pain. Suspect weak front right leg, doesn’t seem to resist as front left. Hard for her to move around. Right eye not blinking when touched.
Urine and bm in box 9:45 a.m. A little wet. Eating on own in late day/evening and syringe feeding.
5/14 Sunday Weight down to 10.13 from 11.11 a month ago, and 11.3 a week ago. Not eating on her own. Careful with syringe feeding. Mouth not as opened. Does open it and breathes fast but can mostly close it, especially when sleeping, or tongue is out a little bit. Urine/bm 9 a.m. in box and only a little wet. Slept well over night.
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