Monday, December 29, 2008

Elvis Update (or There's More Than One Way to Torture Your Poor Old Cat)

Some of you may be wondering what's going on with Elvis. Well, quite a lot actually. It became apparent by Saturday that he wasn't doing much in the way of improving. Although the extreme swelling around his face was beginning to abate, I was beginning to have serious worries that he wasn't going to survive this. He still had copious amounts of gunk coming out of his one nostril and he sounded like he was breathing through water. All this time, I'm trying to get all sorts of stuff into him--Nutrical, water, canned cat food thinned with water so that it could be sucked up into a syringe, antibiotics--and each time I dosed him with something I could tell that I was risking choking him, or worse, aspiration. His lymph node on that side was HUGE. I started thinking that maybe the amoxicillin just wasn't doing the job. Clindamycin was the first choice antibiotic, but it messes up his GI tract so badly that we had tried to avoid it. So by Saturday night I was thinking about just switching him to the Clindamycin and seeing if it made a difference. To be safe, I e-mailed my trusted vet friend, who suggested just adding the Clindamycin on top of the amoxicillin, at least for the weekend, so that's what I did starting Saturday night.

That's where we were this morning. I think the Clindamycin had helped Elvis to improve marginally, but of course he now had diarrhea--not a great situation for a cat who is also becoming dehydrated. Since Dr. Redding isn't available at Chatham except on Wednesdays, I called Tri-County to see if could catch him there. He was off today, but I went ahead and made an appointment with them because they could get me in fairly early. (Chatham and Tri-County share some, but not all, vets between them. I go to Chatham usually because it's about 10 miles closer, but will use whichever practice as needed.)

When I showed up there, Dr. Redding just happened to have stopped in for something, and when he realized I had Elvis with me, he asked what was going on. When I got in to see Dr. Eads, Dr. Redding stopped in to consult, which was very nice of him considering it was his day off. Vets who truly care are priceless in my book (I have worked for vets who weren't so caring, so this is something that's very important to me).

Anyway, Elvis had lost another half a pound or so and was clearly dehydrated, despite my best efforts at gettig fluids into him orally. We discussed a number of options and finally settled on giving him a long-term injectable antibiotic known as Convenia (to try to avoid some of the swallowing issues he's having) and inserting a catheter so I could give him IV fluids at home. They initially wanted to keep him at the hospital for IV fluids, but I honestly believe that cats, especially, are way less stressed if they can stay in a familiar environment, and of course I am willing and able to keep an eye on him 24/7 (since he's been sleeping curled up next to me), and am willing to deal with giving fluids, etc., so that's the route we chose to take. It turns out, though, that Tri-County didn't have any Convenia on hand, so we decided to leave him on the Clavamox and just add metronidazole to cover anaerobic bacteria. Oh, and he's to continue on the Metacam for pain relief. Gah! I need a notebook and calendar to keep straight all the meds that I'm giving (an aside: I actually bought one of those seven-day, twice-a-day pill boxes for Willow so that Jimmy could easily keep Willow's meds straight when I'm out of town). Dr. Eads seemed a bit surprised when he suggested things and I'm like "I already have that at home." Yes, I am a regular veterinary pharmacy here. That's how it goes when you have a bunch of geriatrics at home (not to mention a sheep flock, which for most folks means learning to do a lot of medicating on your own since veterinary care for sheep is hard to come by--I got lucky in that Dr. Redding and his wife used to raise sheep, so he is familiar and willing to help with issues I face in that regard)....

I know Dr. Eads must think I'm a few short of a load, because he mentioned something about Elvis' heart and did he have a murmur or congestive heart failure, and my response was pretty much "God, no, don't even mention a heart murmur to me!" Of course the poor man had no way of knowing that half my animals (okay, so that's a slight exaggeration) seem to have heart murmurs. For a while, it seems every time I took someone to the vet, there was a heart murmur to be had. Fortunately, Elvis' heart sounded just fine, and his lungs also sounded pretty clear, so at least I hadn't succeeded in drowing him with kindness.

Oh, and I should mention that Dr. Eads, who is pretty new to Tri-County was astounded by Elvis' lymph node. He commented that it would make the lives of vet students at NC State much easier if they could have cases like Elvis whose lymph node was so swollen as to make it very easy to distinguish from everything else (i.e., the salivary gland). Of course all I can think of is Si and how his swollen lymph nodes ended up being a death sentence. But Elvis isn't Si, and I have to hope that the course of treatment we're going with now will do the trick.

Elvis got his first round of fluids while at the hospital. Because his temperature is abnormally low (96 point something), they suggested that I lay the extra IV tubing in a bowl of warm water while giving him his fluids. Easier said than done. If I had the IV bag hanging from the towel rack so that the extra tubing could rest in warm water, it wasn't high enough for gravity to help with getting the fluids in him, and if I put it on the shower curtain rod (which from past experience seems to be the ideal height) and sat on the toilet (lid down, naturally!) holding Elvis there was no place to set a bowl of warm water. So I opted for the shower rod and instead microwaved a towel to make it nice and warm and wrapped Elvis in that while he was getting his fluids, for which he was very patient. I also want to note that the vet made a point of getting me the "fish flavored" metronidazole for Elvis, but of course it's a liquid that has to be given orally. All I can say is that Elvis foamed at the mouth after getting his first dose, which doesn't say much for the supposed fish flavor that was intended to mask the actual nasty taste of the stuff.

I was hoping to get away from having to get so much into him via his mouth because of course to get stuff down a cat's throat, you don't have much choice but to hold it by its head and then use a finger on your free hand to pry the jaw down and then use that same hand to dispense whatever it is you're giving. All the while, even the sickest cat (at least in Elvis' case) isn't just sitting there placidly allowing all this to happen. I felt awful (still do, actually) about doing all that when he had just had a tooth removed, had a swollen face, and a huge lymph node that had to make swallowing painful. Imagine being held essentially by your face--pretty much on the spot where an infected tooth was just removed--while having various noxious substances shoved into your mouth. Nothing like torturing your cat trying to make him feel better....

Anyway, that's where we are right now. I have to go give him his next round of fluids, so I'll end this here and tell you about tonight's adventures in knitting (yes, I'm learning to knit because I have so much spare time for stuff like that) another time. Hmmmm...I probably shouldn't have had all that wine with dinner.

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