Tag Archives: surgery

Heat…

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Anya is scheduled for spay surgery in two weeks. It was the first available appointment with my regular vet. I could possibly had it done sooner if I’d have gone back through the shelter and used their choice of vet, but my bigger focus for the last two months has been making sure her eye issues were resolved, so I didn’t especially mind the delay. 

Now that we’re four days in to her first heat, let me be the very first to say that I wish I had been focused on both things simultaneously. She’s eight months old now, so this turn of events is not exactly unexpected. As we drew closer to her appointment, I mostly hoped that the natural course of things would just hold off a bit longer. It didn’t, of course, so I’ve been treated to a solid weekend of caterwauling and sweet Aud being an enormous pain in the ass.

All the other rescue animals who have made their way home with me have either arrived after neutering or had standing appointments to have the operation shortly after they got here. These last few days have certainly made the case in my mind for animals to be neutered before they’re placed in a home. For someone who was less tolerant of animal peculiarities or who doesn’t sleep quite as deeply as I do, I can see where the story might not end well.

At least with Anya there’s light at the end of the tunnel – or at the end of May, whichever comes first. I have to wonder, though, how many other intact animals the shelter has sent out into the world who will end up “unfixed” and contributing to the next wave of unwanted cats. I’m fully aware of the resource limitations they’re contending with, but I have to strongly recommend that Cecil County Animal Services revisit their policy of placing intact cats in the community. At some point it becomes a self-licking ice cream cone.

With Anya’s path more or less laid out, now I’m focused on getting Cordelia caught up with her vaccinations and on someone’s schedule for her own surgery. Whether that will be my regular vet or someone else, remains to be determined. Now that she has emerged from her reclusive, under bed period, I’m cautiously optimistic I’ll be able to get her contained and into a crate without tearing the entire house down in the process. Probably. Maybe.

What we’ve learned…

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After three days with Anya closeted away under medical supervision, we’ve learned a couple of things:

My girl is a perfectly happy cat, doing normal cat stuff, right up until the point where it’s time to take her medicine. Drops, pills, or even just generally being held result in adverse consequences for those attempting to make her do what she doesn’t want to do. Otherwise, though, she’s happy to receive the attention of her temporary keepers.

She’s eating, and drinking, and pooping, and getting the meds she needs to get over the hump following her eye surgery. It’s as good a result as I could hope for a few days after surgery.

I’d be lying if I said part of me doesn’t feel just a little vindicated after claiming so many struggles trying to get her through the first 30 days of treatment. I honestly was starting to wonder if I was somehow gaslighting myself about how hard it was to get this animal to take her meds. The professionals, however, have confirmed that she can, indeed, get spicy.

I’m glad to have confirmation that it wasn’t just me somehow being ragingly incompetent. However, it raises other issues. Unless Anya learns a bit more tolerance to handling and being medicated as she gets older, it could be well near impossible for me to single handedly deliver any kind of even slightly involved or complex home care. Sooner or later, it feels like we’ll inevitably run into a situation where following the best possible medical advice simply isn’t feasible because the patient refuses to cooperate.

That’s not an ideal scenario in a cat with FHV who is likely to need some level of treatment periodically throughout her life. In my more pessimistic moments, I foresee a series of hard decisions where we have to weigh treating the illness versus treating the patient. At some point there has to be a compromise between the best possible treatment and what’s physically possible. Now that we’ve addressed what I hope will be her biggest medical problem, I think we’ll be making future decisions based on quality of life overall versus the often simpler calculus of what’s medically possible.

When the time comes, someone please remind me that sometimes the best action is no action at all. I always find that hard to remember when I’m in the moment.

A good report…

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Anya got a good report from her surgeon. They were able to break down all of the adhesions and resect “a lot” of conjunctive material that has been hooding her eye for months. They laid in dissolvable stitches in a few spots to, hopefully, keep everything retracted as it heals. 

There’s a chance, they say, that the issue could reoccur over time. The ophthalmologist recommends this be a “one and done” shot at correcting it. If it reoccurs, the chances that it will continue to do so is apparently high no matter how many times we go after it. At that point, the course of action is to leave well enough alone since it’s not life threatening. I don’t think he or I have the appetite to chase diminishing returns.

Doc says the eye will probably end up looking “a little wonky” because of how much material they cut out. We’ll see how things look when the swelling comes down. Not that it matters. We may also have to revisit her third eyelid. He’s optimistic it will retract more on its own when the swelling goes down, but if it doesn’t, we’ll figure out what the right approach is – somewhere between do nothing and a follow-up surgery.

Our girl checked out with a bag of pills and drops to administer over the next few weeks. I’m (mostly) happy to be leaving that part of the recovery process in the hands of professionals. I’ll hate not having her here, but that’s entirely outweighed by the benefit of making sure she’s getting her meds in a more timely and less traumatic way than I could possibly manage on my own. I’d be lying if I said I wasn’t happy to have a proper medical staff watching for infection or any other potential post-operative issues… and I’m obviously thrilled that I’m not going to be the bad guy chasing her down and forcing meds on her for this stage of things. 

For now, Anya is a temporary resident of Pennsylvania. How long that lasts remains to be determined. I’m satisfied that the surgery went well and we’ve hopefully improved her quality of life in spite of whatever short term trauma we might have caused… I’ll be happier, tough, when she’s back home bouncing off every wall and flat surface in the place.

Not for the faint of heart…

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Anya is scheduled for eye surgery next Tuesday. The plan is to remove some of the conjunctive material currently obstructing her left eye as a result of the repeated eye infections she went through early in life. The underlying eye is mostly undamaged and this operation is intended to remove the existing trouble areas in order to prevent them from eventually adhering to the eye itself. It’s not inexpensive, but it’s work that needs done that should improve both her long term health and her ongoing quality of life.

She’s expected to be discharged Tuesday afternoon with a new round of oral medication and eye drops. Some of these could need to be given as often as every six hours for the first several weeks as she recovers. How a normal person who has a job or any other commitments can arrange to do such a thing is entirely beyond me. I get that the discharge instructions present the optimal course of action, but expecting an owner to be able to pin down a cat and deliver these meds on 16 separate occasions every 24 hours strikes me as perfectly absurd. Each drop, after all, should be followed by a 5-10 minute waiting period, so it’s not as if you could grab her up just 4 times a day and apply everything in a single go. I’m not embarrassed to say that I may have hit the panic button when I caught wind of what the coming weeks could look like. There’s simply no way I could sustain that level of post-operative care for any length of time.

Over the last four or five days, Anya has gotten increasingly combative and has started running away any time I walk into a room. She’s actively avoiding me, cowering, and essentially seeing me as an enemy. With most shelter cats, the advice and expectation is that they’re going to have some amount of time – weeks or months – to decompress and acclimate themselves into their new home. Anya never got that time. Three days after her arrival, I had to start holding her down and pouring meds into and onto her. It’s little wonder she’s losing whatever little bit of trust we may have developed.

Mercifully, I’ve got a friend who helps run a large veterinary practice outside Philadelphia. She’s going to arrange medical boarding for this poor gray fur ball for the duration of multi-time a day treatment. There, the techs will be doing the heavy lifting of keeping up with the schedule seven days a week and the on-staff vets will be around should something need to be addressed immediately. So, as soon as she’s released from surgery, we’ll be taking a short road trip through southeastern Pennsylvania to her temporary home.

Since Anya’s particular flavor of eye infection is often triggered by increased stress, boarding isn’t entirely ideal. It does, however, feel like a better option than having this poor animal at home with me stressing her out and inevitably missing doses of the medication she needs to recover from the surgery in a timely manner. It’s a real devil’s bargain.

I asked the doc yesterday if waiting until Anya was more settled here at home and more comfortable being handled was a reasonable option. He was of the opinion that although the eye isn’t currently an emergency, addressing it was something better done sooner rather than later as it created less overall risk to her sight in that eye.

I absolutely hate the thought of her being gone for two weeks or more, but I hate the thought of irreparably damaging what needs to be a trusting relationship with her even more. I’ve never shied away from getting my animals the best possible medical treatment I could find, but damnit, this one is hard because I don’t have the skills, nor the ability to learn them fast enough, to even be a part of the recovery process. Even if I did, Anya isn’t in the right headspace with me yet to give me the benefit of the doubt.

I know she’s going to be in good hands. The friend who’s helping me by arranging all this for Anya was also responsible for bottle raising Hershel before he came to live with Winston, Maggie, and I. I couldn’t possibly trust anyone more to keep a proverbial eye on my girl and make sure she’s getting everything she needs to get well. Still. The next weeks are going to be tough in a whole different way than the last month was hard. There’s a mile of difference between knowing what’s best and actually wanting to do it. It’s one of those times when the best interests of the animal have to be pressed well above my own selfish desires.

When all this is over, I’ll be putting on a masterclass about the hazards of taking on “project animals” from the shelter. She’s mine now. I’ll see it through. But Jesus, it’s not for the faint of heart.

Diagnosis and the way ahead…

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Anyanka had her follow-up exam with the ophthalmologist today and we’ve arrived at several conclusions. 

First, Anya is a carrier for feline viral rhinotracheitis (FVR), often called “cat flu” or less popularly known as kitty herpes. Odds are the virus was transmitted by her mother at or shortly after birth. The virus often presents as a standard upper respiratory infection with the expected coughing, sneezing, and watery eyes, but it can also cause a nasty infection of one or both eyes – in Anya’s case, her left. 

There’s no “cure.” Barring a breakthrough treatment, Anya will be a carrier for the rest of her life and may or may not experience further flare ups. One of the most common causes for these flares is stress – things like living in a shelter environment or suddenly finding herself thrown in a crate and taken to a new home. Given how little I enjoy change myself, I’m optimistic that as things settle into a routine here, we’ll be able to minimize whatever stress she may experience going forward.

Second, most likely as a result of ongoing infection in her eye from a very young age, Anya has conjunctival symblepharon. For lack of a proper veterinary explanation, this is a condition where her third eyelid and portions of her inner eyelid are adhered. It’s why even now that the infection is controlled, you can really only see about 1/3 of her eye. Fortunately, the eye itself doesn’t appear to be damaged. Assuming no further issues, we’ll schedule surgery in about a month to correct the adhesion and try to get her a wider field of view in that eye.

Even with surgery, it’s never likely to look “perfectly normal.” That, of course, is an issue I’m perfectly indifferent about so long as it improves her overall health and quality of life. The vet’s recommendation is that this is a “one and done” effort. If for some reason the surgery doesn’t take, it’s better to leave well enough alone than try repeatedly.

I had a hunch I was getting into something when I decided on this little gray kitten hunkered down in the back of her cage at the shelter, though admittedly this has gotten more involved than I planned for originally. Whatever. Everyone wants an “ideal” kitten. After already spending three months getting passed over, there’s no telling how much longer “the cat with the weird eye” would have lingered there or worse, been returned or dumped somewhere, once they realized the cost and level of effort required to get her fixed up. She’s in no danger of that fate here.

On the good news front, the cone of shame is now tucked in the cabinet and we’re down from four medications three times a day to two medications twice a day. That level of treatment feels much more manageable, especially since the two meds we’re continuing are basic eye drops rather than the ointment that stuck to everything or the oral suspension that she disliked mightily.

Now that we have Anya on the mend, it’s probably time to shift a little focus towards helping Cordy come out of her shell a bit. Given her background as having been “caught in the wild” just a few days before I brought her home, I can’t help but feel like this is going to be a whole different kind of project. But at this point, what’s one more thing to do?

A bloody mess…

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The morning feeding here starts most every morning at 5:30. It’s usually a completely uneventful part of the day. Today it wasn’t, of course. It was a bloodbath.

For the prior 24 hours Maggie had been growing a fearsome looking lump under her incision. It was worrying enough that I changed her follow up appointment to this afternoon rather than waiting for Thursday, when it was originally scheduled. We fell seven hours short of that appointment when she dove into her breakfast and the dam broke – leaving a trail of blood tinged fluid dripping down her shoulder and quickly spattering the floor.

“Not good,” my initial early morning response. Maggie didn’t seem bothered at all. She didn’t even slow up on inhaling her breakfast.

Over the next three hours, what I’ve now learned is a common post operative condition called a seroma, steadily grew smaller as the fluid continued to drain – mostly into the kitchen floor. I’ve mopped today. A lot.

Our vet assured me this is all fairly normal. He was happy enough with her progress to take her sutures out, and advising “just let it drain” while handing over another 10 days worth of antibiotics just to ward off any future issues.

So here we all are, confined once again to the kitchen in an effort to keep random canine bodily fluids from soaking in to more sensitive parts of the house. I can only hope this iteration won’t take nine months.

I’m happy my girl is on the mend… though I wish it would involve just a little less oozing.

What Annoys Jeff this Week?

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1. Numbers. This blog is my own little catharsis and never really intended as clickbait, but sometimes I really do wonder what sorcery is behind the numbers. My view and visitor numbers have been all over the map for the last few weeks. There’s no seeming rhyme or reason for days that are up or down. Posts that I think should be a hit end up idle and those that I thought fairly bland rack up visits. After fourteen years of doing this, you might be tempted to think I’d have a clue. If you thought that, however, you’d be 100% wrong.

2. Incredulity. The number of times in the last six weeks that I’ve been asked some version of “Aren’t you starting to go stir crazy?” is telling… if only because it reveals how many people don’t really “get” me at all. I’ve got books, critters, ready access to food and liquor, the ability to have almost anything on earth delivered to my front door, and can leave at any time for goods and services that need to be sourced locally. I feel no fear of missing out. Staying home isn’t punishment for me. It’s the life I thought I was going to have to wait another 15 years to have for myself… and after sampling it, I can assure you going stir crazy is the very least of my worries.

3. Persistence. Maggie has been quite a trooper, never so much as attempting to lick or scratch her enormous incision. Keeping a certain white and brown young canine sibling from trying to lick it all the time has been my other full-time job this week. Seven days into healing and he’s mostly stopped – though not before a few full-blown screaming fits on my part. I can sense him still searching for an opportunity. I usually appreciate and even respect that kind if persistence, but in this one case, I’m going to need him to knock it the hell off.

Do not resuscitate…

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One of the convenient features of the Great Plague is that more places will just email you things that usually have to be filled out in their office so you can take care of them at home. Anything that removes that human to human interface is a net good overall in my book. Look, I know some of you out there thrive on this human contact foolishness, but in a lot of ways I feel like I’m over here living my best life in a world finally designed for avoiding people.

The joy of being able to dispense with a bit of one-on-one human interaction this morning was tempered somewhat because I was filling out Maggie’s pre-surgery paperwork. The 4-page packet included basics like my contact information, what medication she’s currently on, and a summary of the procedure and expected costs for my initials.

This particular pre-surgical packet also included, what I can only think of as “advance directive for dogs.” The vet wants to know just how heroic the measures should get if something goes horrendously wrong during the procedure. The forms I’ve seen in the past include everything from the standard do not resuscitate, to providing CPR, to using electrical defibrillators and even more invasive options. Since this surgery is being taken care of at the local vet’s office rather than one of the big emergency clinics we frequent, we were limited to DNR or performing basic CPR.

I’ve probably filled out a dozen or two of these forms over the years – mostly for myself, but more than a few for the animals. My own advanced directive is relatively straight forward and I’ve passed it out to a slew of doctors over the years – CPR is fine. Machines are fine. But the moment we hit the point where my big beautiful brain is damaged or I’m alive only by virtue of the machines, go ahead and pull the plug. I’d like to hold out for the point where the techies can download my consciousness into a computer, but if that’s not an option feel free to let me go. 

With the animals, though, the temptation for me is to keep them with me at all costs using whatever tools veterinary medicine can bring to bear. I always resist the strong temptation to tell the vet to be heroic, though. It’s not the easy choice, but it’s the right one. 

My life with dogs…

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I was talking with a friend of mine last night – and by talking, I mean keeping up a decade old text conversation – and mentioned if I ever write another book I’m pretty sure its title is going to be My Life with Dogs and Other Things that will Fucking Bankrupt You.

Here’s the backstory:

Maggie has had a fatty lipoma on her shoulder for the last five years. We’ve treated it as a cosmetic thing up to now, but it’s finally grown to the point where the medicos tell me it needs to come out – or at the very least be “de-bulked.” For the last year or so I’ve been rolling the dice in determining if we’d go to surgery or if an old dog with Cushing Syndrome would make it to the point where surgery was necessary. Doc tells me where at that point now. The good news is that means my girl is relatively healthy. The bad news is it means we’re putting her under the knife fairly soon.

I talked to Maggie’s vet last night. Given her age and the general presentation of Cushing, I was prepared to hear that the results of her bloodwork were all over the map. They weren’t. Everything was basically where it should be for a dog whose disease is well controlled. So, small mercies there. In trying to decide how to approach the lipoma on her neck/shoulder, we also did a series of chest x-rays – mostly a due diligence to see if benign had become something more problematic or infiltrated her chest wall. The pictures show that it hasn’t.

The only minor pre-surgical issue we have was a slight presence of bacteria in her urine. It could easily be something that was introduced during the collection process, but in an abundance of caution prior to putting a decent incision into my girl, we’re starting a course of antibiotics to make sure all is clear before she heads in for surgery.

The doc did give me the option of taking Maggie in for an MRI – which would give a far more detailed view of the mass than simple, old fashioned x-rays. If I thought we were looking at something more involved than removing a large, but reasonably simple lipoma, I’d have probably given it more consideration, even knowing it would end up being a $2,000+ bill. I appreciate that this vet walks me through all available options, but doesn’t attempt to push in the direction of the more expensive tests. Even as he was discussing the MRI, he was clear that level of diagnostic testing was probably overkill in Maggie’s case.

I’m working with the scheduler to get a time for surgery and Maggie is getting an extra ration of cheese to hide her enormous antibiotic capsule. All that’s left to do now is wait and see how it goes. I’m sure that won’t cause any gnashing to teeth because I’m well known for my patience and low key approach to animal care.

Lumps and bumps…

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Having an old dog means there’s really no end to the lumps and bumps you’re going to find on them today that weren’t there yesterday. I’m told fatty lipomas are particularly common in old Labrador’s – and Maggie has more than her share of those. As long as we confirm that they’re not malignant, I’m more or less happy to leave them be rather than subject her to an invasive surgery to correct something that’s basically cosmetic.

The story is a little different when it comes to the most recent tumor. This one is growing under her right eyelid and if left unchecked could cause damage to her eye. That falls well into the category of “not cosmetic.”

We schlepped over to the most local of the region’s specialty vet’s offices this morning to meet with the veterinary ophthalmologist for the first of what’s likely to be several consultative visits. They ran a few tests, poked and prodded, and looked deeply into her eyes… and confirmed that “yep, that’s a tumor and we should probably cut it off.” At least that part wasn’t a surprise.

Maggie’s overall prognosis is good. The procedure is fairly straightforward, so we’re not breaking new ground in veterinary medicine. That’s not to say the procedure is inexpensive, of course. It’s not the kind of vet’s office you ever walk into thinking that the visit is going to be budget friendly. It’s the price of progress. At least that’s what I keep telling myself.

The only question now is whether I want to get another consult with the surgeons to see if taking off one of the large fatty masses on her shoulder is something we should think about adding in to the surgery. On a younger dog in my mind the decision would be a no brainer. With my girl pushing 12 now, I’m hesitant to take on anything invasive that isn’t strictly necessary.

At least I know what I’ll be spending the weekend pondering.