Monday, November 30, 2009
Lucy was normally a feisty and trouble-making tortiose shell kitten. Well, yesterday she had the trouble-maker part down pat. Her feisty personality was toned way down, though. She had vomited the day before, a piece of what looked like gift-wrapping ribbon. And there was blood in the vomitus. If that had been all, and she had gone back to eating and tormenting her brother and all, well, that would have been that. But Lucy's mom just had a feeling about her, and I have learned never to dismiss a mother's intuition. She brought her in first thing in the morning-and I am glad she did. Lucy's usual glossy hair coat was oily and rough-she wasn't grooming herself. Her gums were tacky and dry-she was dehydrated. And when I palpated or felt her abdomen, she became very tense and painful-different from the normal-"don't do that, I don't like it" reaction most cats will give me. It might be a subtle difference, but like her mom, I knew it when I saw it.
Because of her history of vomiting up what looked like ribbon, we decided to take some radiographs of her abdomen right away. Now, for most patients with a little vomiting or gi upset, I don't usually jump right to x-rays. They are expensive, and by far most pets are going to get better with a little tender loving care, maybe a fast, some fluids, bland food, etc. But remember her mother's intuition? And remember her painful abdomen? And remember she vomited blood and ribbon? Those symptoms all added up to trouble-and I wanted to be ahead of the game with Lucy's diagnosis. I'm glad we took the pictures.
Lucy's radiographs showed a whole lot of "stuff" in her stomach-lots of very distinct lines all packed together-nothing readily identifiable. Her owner said she hadn't been fed since the night before, (and she didn't know if she ate then or not-she does have another kitten in the household.) Lucy hadn't had any breakfast, so she shouldn't have had anything in her stomach at that time. Since I couldn't identify just what it was, but knew it shouldn't be there, and because that meant a pretty big next step-surgery-I wanted a second opinion on the films.
We have all of our x-rays read by a board certified radiologist-I learn a lot from him and it is a lot of comfort to have that second set of eyes when I'm just not sure of what I'm seeing. Our local veterinary reference laboratory provides a courier service for the films themselves, (I haven't made the 70+ thousand dollar investment in a digital system yet...) picking them up and delivering them to the radiologist's office where he interprets the films, faxes us a copy of his results, and sends the films back via the same courier service. This is a very handy and speedy service, but still takes a day or two at best. We can occasionally arrange for "stat" pick up and delivery of films, but there is a considerable extra fee involved, and still some delay. Since I was worried about the liklihood of imminent surgery for little Lucy, I asked her owner to hand carry the films to the radiologist's office herself, saving the fee and resulting in much faster results. Lucy stayed with us, and so did George, her big brother-more for moral support for HIM. He couldn't bear being seperated from her!
All this worked out very well. In about an hour the radiologist gave me a call and concurred: the radiograph findings suggested we should do a "peek and shriek" surgery. In proper medical terms, an exploratory laparotomy. I like "peek and shriek" just fine. They are usually quick and we usually find some pretty impressive things to "shriek" about in these surgeries-and Lucy's was no exception.
We called Lucy's mom and told her what she was already suspecting-Lucy would be going to surgery right away. We called a few other owners to rearrange the schedule-those with "routine" appointments for things like vaccinations had no problem resceduling for another day. Others with ill pets, just not as critical, got moved to a little later-all knew that if it were their pet needing the emergency attention, they would be first in line. That's just how we do things here, and everyone is usually very understanding.
I have to mention here how very lucky Lucy is to be owned by such good humans. Not only did they recognize her signs of illness and bring her right in, they also accepted the responsibility and need to care for her, making big sacrifices during this holiday season so they could provide the care she required. We all know that isn't the case with all of our animal friends, especially in these difficult economic times. Hurray for Lucy's humans!!!
Schedules were rearranged, the staff swallowed some pizza I got for their lunch and off we went to surgery. Lucy did great, and so did her team. She was anesthetized and prepped for surgery, and I was in the surgery room with her in record time. It didn't take long to find her problem. Her stomach was the size of my fist, (That's pretty darned big for a 9 pound cat!) and although outwardly it looked just fine (no signs of perforations or necrosis, thank goodness) it was rock hard. I ran through the rest of the gastrointestinal tract and found it was completely empty-whatever was in the stomach had prevented anything from entering her intestines for quite some time.
After ensuring that the stomach was the sole problem area, I performed a gastrotomy-an incison into the stomach wall.
The contents were pretty impressive-wads of what appeared to be plastic strips and elastic bands-hair bands and maybe even a small bungee cord. And yes, there were many pieces of colorful ribbons, too. Lucy had been collecting these goodies for quite some time.
We saved all these treasures to show her owners-after all, they were paying good money for retrieving them! Hopefully they would be able to identify them-and then be able to "Lucy-proof" their home a little better than they thought they were. Her incisions were closed up, Lucy was given some good pain medication, and she was tucked into her recovery kennel, nice and toasty warm. She was a bit slow to wake up, but there was no rush. We monitored her carefully, and by the end of the day, she was doing just fine. She even ate a couple fingers full of food! We set up some nurse checks and I put my web cam on her so I could monitor remotely. She got a little over heated with all the heat lamps, heated kennel and heated rice bags, so those were removed during the night, but otherwise, everything went smoothly. Lucy had another dose of pain medication this morning, and soon after she began eating like a pig! She wouldn't let poor George any where near the food dishes. She must have been starving for actual real food-hair bands don't have much nutritional value.
Lucy's owners came this morning to pick up her and her brother-the house must have been awfully quiet without those two last night. We went over her care instructions-I don't usually consider gastrotomy patients "out of the woods" until about 10 days or so post-op. That would give the stomach incision plenty of time to heal and digestion to start up again. If any leakages were to occur, infection would become obvious during this time. All in all, I was quite pleased with how she did, and expect her to recover just fine. Now it is up to her humans to keep her away from those darn enticing stringy things. My own cat, Stella, has an addiction to curly ribbon-she can just smell a package wrapped with the stuff when it enters the house and is immediately drawn to it, chewing frantically unless I intervene. It is weird just how much certain cats love to chew on things like this-ribbon, string, yarn, tinsel, dental floss, and yes, hair ties. If you don't know what your cat's predilection is for these things, don't take a chance! Keep them in drawers or cabinets or in covered bins. Surgery is no fun for any one. (Well, I actually DO like these types of surgeries :) "A chance to cut is a chance to cure." In Lucy's case this adage is particularly true.
Wow! Lucy's story makes 100 blog entries! That is quite a milestone, especially since I took the last 3 months or so off. I hope you have had some fun reading about the various patients that have come and gone in our busy little hospital-maybe were grossed out by a few stories, laughed at some, shed a tear or two at others. I tried to always add a little "educational" aspect to most of my blogs-hopefully teaching fellow pet lovers some new things about their friends, reminding you of situations to be aware of or just exposing you to an aspect of veterinary medicine that you might never have considered before. Some veterinarians are called upon to do some pretty amazing things-from realigning the broken bones in the leg of a puppy accidentally stepped on by the playing children, to stuffing the intestines of a "broken" spider back in his body and super-gluing him closed. Some of us who enjoy surgery might get to repair a torn ACL on a rambunctious lab or pull hair ties out of a kittens packed stomach. We occasionally get to diagnose rare or exotic illnesses, and the outcomes may not be good-but hopefully we learn from them, too. With all this knowledge and technology at our hands, we still have a "few" limitations. (Ha ha! I wish it were ONLY a few!) But I was referring in this instance to a limitation I have often wished we didn't have-we still aren't capable of installing zippers into the bellies of patients who repeatedly eat things they shouldn't eat.