Bette's necropsy report came in two weeks ago and I have only been able to post about it now. A necropsy report-if you've never seen one-drills down into the cellular level of tissues. Samples are taken from all major organs and tissues and any areas noted as a concern or involved in the demise of the animal. They also look at all organs and give a physical description.
Basically, Bette died of brain cancer. The Nerve Sheath Tumor was gone from her spine. BUT it had spread through the nervous system into her brain. The SYMPTOMS of TRIGEMINAL NERVE damage that we thought we saw: open mouth breathing, excessive drooling, tongue out, difficulty swallowing, combined with her right eye not blinking or closing, and the eye ulcer (from not closing the eye all the way) that hit her two weeks before she died, were signs of brain cancer.
Likely it was spreading before radiation treatment. Possibly could have been seen if another MRI had been done as she began radiation treatment. Definitely would have been seen if we had been able to convince anyone to do one in the last week or so when she was struggling to breathe and no one would listen (the vet school ER for example.) I would have wanted to do palliative care and to be more aware of her demise and spend the time accordingly (not that I wasn't with her that last week) instead of trying so many things to fix whatever ailed her, only to be ignored by almost anyone I approached. (Her regular vet was wonderful as was her dentist-see previous posts.)
Her increased breathing issues were also related to decreasing brain function.
She also had ASPIRATION PNEUMONIA. When she went immediately into respiratory distress at 6 p.m. that Thursday night 5/18/23 was because she aspirated food into her lungs. Likely, she regurgitated and inhaled it. Aspiration pneumonia quickly happens when something is inhaled into the lungs and quickly causes respiratory distress and death.
She had declining cranial responses-the eyes weren't closing, she couldn't move her limbs-over night Thursday and when we put her to sleep Friday, all from brain cancer.
She also had mild HCM-not detected in January-but seen in pathology report in the left vent and in the cells. It was not drastic and is likely radiation/cancer change related. However that works. She wasn't presenting "clinically" meaning there were no outward or vital signs indicating heart disease.
She also had lymphoma in her cells-cancer-that cats do not recover from.
She had a small tumor/nodule on her thyroid that would have become an issue if the rest of the cancers hadn't happened.
NO MASS in the body; NOTHING wrong with the esophagus or larynx causing breathing issues. The ER doctor that Thursday 5/18 thought something was pressing down on the esophagus causing the breathing issues because the xray showed gas in the opening and at the end but the airway suppressed in the center. The vet school radiologist for the pathology report looked at the xray and said it was normal. The way she was laying for the xray made it look as if it were pushed down; and the pathology did not find a mass in that area.
There are terms in the necropsy such as:
*heart myofiber disarray and fibrosis
*Lipofuscin granules
*hepatic parenchyma small nodular aggregates listiocytes
*pancreas nodule of hyperplastic exocrine pancreatic epithelial cells
*proliferations of thryoid epithelial cells
*fibrin hemorrhate viable and degenerate neutrophils
*infiltrates of a momomorphic medium round cell population
etc.
I did complain this week to the owner of the ER about the rudeness of the clerk on that Thursday when she said "The doctor already told you we can't fix this. Whatever's wrong with her we can't fix this." as we are standing there with Bette in severe respiratory distress. I calmly discussed my concerns, as well as shared the necropsy. She apologized and seemed concerned about the interaction and said she'd address it. I can only hope changes are made because they have been a wonderful ER that we have almost exclusively used since 2009 despite being 40+ minutes away. (The cardio is in the same building and can run over to see a sick cat as needed.)
I also calmly complained to the vet school about the over reliance in my view, of the ER staff on VITALS to determine if a patient is fine, while IGNORING how the patient presents with difficulty breathing. I said that the resident in the ER had said that Bette on 5/16 was fine, while they ignored that she looked awful, wasn't breathing well, and made horrible noises. I wanted her admitted so that the hospital staff could see her the next day but was refused. Possibly they could have done an MRI or made further determination that she was failing so that again, we could have done palliative care. I told the manager that she crashed two days later in respiratory distress and died that Friday. So CLEARLY she was NOT FINE on Tuesday. I'm not sure a practice manager can change how vet school students are taught and how the residents handle cases. AND it was just a voice message that I left after getting the manager's number. But I told him that she was a rad/onc patient and the pathology report was on file there.
We fight the signs of illness as we see them. That's what I encourage you to do-always. Monitor your pets especially those with a chronic condition such as HCM. They need meds, regular schedules; they need monitoring for breathing; they need help eating; they need all symptoms addressed even if in the end they will die of HCM or cancer. And fight-complain-when vets are not helping or solving or searching; or clerks are rude. Fight your panic that prevents you from thinking of what to do. Get organized for pet care-we did even more of this for Bette's care than we already do for the cats.
What did I learn from Bette's ordeal:
*to get the MRI earlier than later as soon as it seems necessary; to get it again weeks later if the pet seems worse (as she lost the use of her rear left leg in April maybe? When she first had trouble breathing in May?)
*to keep oxygen on hand always
*to check the cats' faces for ability to blink-if you get half way to their face and they blink that's a good sign; if you get up to them before they blink, that's not a good sign.
*That I was able to force myself to think as I panicked about her breathing issues and to act quickly, to overcome the panic and to act. I hadn't been in this situation since Myrna died in 2015. It all came back and is now registered in my brain.
*That I did more for Bette than for Baby when she was sick in the ER struggling for a week in 2021 before we had to put her to sleep. We put her to sleep too soon and I'll never know what I could have done. But I panicked. (Baby was breathing on her own unlike Bette who could never have come back home.)
So, there was nothing that we could do to cure Bette while we were doing everything we could think of doing to help her. She was slipping away the moment she got sick in January because that was the first sign.
