Monday, October 27, 2008

MEET the FAMILY : SPANKY (pt 3.)

Spanky on sentry duty in Buddy's castle.
Seems Spanky has stormed the castle and has laid claim.

This next post is to truly bring Spanky's medical history up to date.
I have to bring him in for specialist / surgical consultation and testing (with possible surgery) tomorrow at the Animal Medical Center in NYC, and I need to get my head together.

It's been a whirlwind and a lot of it is mixed up in my mind, so I have to resort to looking at his records to help me piece together the events.

When I last posted, we were on our way to the vet for Spanky's FIRST visit on August 11, 2008.

That first bout of illness was:
- possible upper respiratory infection
- congestion
- infestation of strange tick aphids
- tapeworms
- gooey eye(s)

Some antibiotics, de-wormer, flea & tick ointment, a warm place to sleep and round-the-clock love brought him out of that.
But we were still so very worried about his passing his blood tests.
What if he had some contagious illness?
We couldn't bear to put him back outdoors.
Even if he did have a loving family out there, he might spread it to them, if they didn't have it too.
If he DID have a blood-borne illness, like leukemia or FIV, we'd have to try to find a special home for cats like that.
Some special people open their homes (or facilities) to JUST cats who are infected, so they can all live together, without fear of passing on the illnesses to healthy cats.
They live their life-spans out there as best as can be.

We prayed, however that he'd be fine.

Soon he was doing very well, and the big day had come...(August, 23, 2008). He had his FeLV/FIV blood-tests (passed!) and had his Rabies shot.
Things were looking good.

So, I took him home and proceeded feeding him soft food mixed with hard kitten-food (I was told to start weening him off the soft food, so mixing in the hard food is step # 1).
His sneezing lasted a little longer, so we got some more Baytril, but otherwise, he was looking good.

Within a few weeks afterwards, he started to show some very strange signs of distress;

- lack of bowel movement
- staring into space
- tremors
- lack of energy
- tongue sticking out a tiny bit
- drooling

They didn't happen all at once.
The lack of bowel-movement was our first sign. Then, the lack of energy, then the minor drooling. We looked these up online, and they all seemed to be fairly common kitten-things, so we just monitored him closely. Even our vet had said that one or two days with no bowel movement isn't out of the ordinary, but to keep watch. Drooling, we had heard could be anything from teething to happiness.

Within a couple of days, the drooling and tremors got so bad that we knew it wasn't anything run-of-the-mill.

So, of course, this was late at night, after the vet's hours of business and we rushed to the Emergency clinic (Sept. 16, 2008).

After they took a urine sample (and since he was "holding it in", they had to forcibly squeeze his abdomen!) and saw that it was chocolate-brown in color (like a liquified tootsie-roll), the vet surmised that it was acetaminophen (Tylenol) poisoning.

Normally, I'd have dismissed that as impossible, since I'm hyper-vigilant about dropping stuff on the floor, but there was a chance, since I had asked my wife for a few pills just the day before, and one might have dropped.

I couldn't be 100% sure.

So, they had me drive about 35 minutes away (on the highway) to go to the only 24-hour drug store around) to pick up a special medicine that was the antidote.

A series of one-way streets, road-construction, bad-directions and 18-wheelers-of-death doing well over the speed limit in the post-midnight hours, and I finally arrived.
I got the meds and drove like I was in a race against chariots from hell to get back to the emergency clinic.

They treated Spanky with that, and kept him overnight.
I stayed with him until well after 3am, before going home for a few hours sleep.

He had a LOT of backed up stool in his colon, and was a bit toxic from everything, but he seemed to be out of danger.

The next morning, he was released and I took him to our normal vet for an early am drop-off appointment where they continued testing and monitoring him.

Later that day, I was told that he was doing well, and that there might be some damage to his liver, but with medicines, he should recover.

We could only hope.


However, not a day or two afterwards, after I had administered some Clavamox and gave him a good, hefty amount of food that he started showing more signs of distress;

- vacuous staring
- lack of coordination and fine motor skills
(would walk in tight counter-clockwise circles or circumnavigate the room only clockwise.)
- tremors
- he missed the litter box for a urination
- couldn't drink properly

I figured it was all because of the meds (because, coincidentally, it happened after I gave them) - although, I would later find out it was the FOOD that he was reacting to. His illness is supposedly food-triggered.

Once more, due to it occurring during off-hours, I rushed him to the Emergency vet again (while I had my wife monitor the phone for a call from our regular vet, whom I had left a message on their machine).
Of course, right after I arrived at the emergency clinic (and found that they were booked solid for the day) my wife called me on my cell to let me know that our vet was open and expecting Spanky as soon as I could get there.

So... back I drove to our vet (which is only 5 minutes away from our house, but a good 30+ minutes from the clinic).

The vets posited that it might be high levels of ammonia in his bloodstream, and that I would need to drive to a different Emergency Clinic, an hour away, for a special ammonia test.
But first, I had to quickly drive to the local pharmacy.
Our vets prescribed Laculose to remove the ammonia from his bloodstream & metronidazole (instead of the Clavamox).

Then, Spanky and I made the hour-long drive to the Emergency clinic (which, oddly enough, is when I first started writing about Spanky for the blog, but never had a chance to wrap that up).

Right then and there, within minutes, they confirmed that his ammonia levels were quite high.

On the way back home, I passed our vet again and went in to bring them up to speed. The results were exactly what she expected, and we were told to keep up the meds for about 10 to 12 days.

Within a day or two, Spanky seemed to be perfect.

So, it was hoped that he may have had some minor liver malfunctioning, but that the meds would give him time to heal.

2 weeks later, I stopped the meds and he was AOK.


THEN... almost 2 weeks after that (October 10, 2008), he had a major relapse.

- lack of energy
- loss of stability (you could knock him over with one finger)
- loss of ability to eat or drink properly
- drooling

This time, I recognized the symptoms and brought him to our vet for a refill of meds and a recheck.

Our local vet examined him and concluded that it seemed to be a fairly classic looking case of hepatic encephalopathy, but she wanted to know what the ammonia levels were at this time.
So, back to the emergency clinic an hour away for a recheck on the ammonia levels.
And again, the test results came back high.

So, we then made an appointment to have a consultation at the Emergency Clinic in two day's time (Oct. 13, 2008), and hopefully with testing, they'd be able to determine the exact nature of his possible liver damage.

- How severe was the progression of his condition?
- Was it due to toxicity (the acetaminophen)?
- Congenital defect?
- Shunts?
- Damage Induced by trauma?
(Spanky's balance was off and he'd often fall flat on his back. Sometimes from moderate heights).

We needed to know.

However, this is where everything started to go off the rails.

When we arrived at the clinic, we found that he should have been kept from eating the night before (even though I DID call to ask, and was told that he could eat normally). Then, the resident who was to perform the test informed me that he probably shouldn't have been the one to have been scheduled for this, as he was more of a post-op Dr. and that he also has a zero batting average at being able to find shunts on an ultrasound and would probably just have to hand the case over to the surgeon who would have to go in blind and perform an exploratory.
He stated that she "felt confident" about her ability, as she does this procedure.

However, by that point, I had zero faith in their ability and opted to find another place to have it done.

Of course, I still had to pay his consultation fee (for him telling me nothing that I didn't already know, except that he isn't confident in his track record for this particular thing).

Then, while once again stopping at my local vet on the way home, I asked them to see who else performed this test, and where could we be ready for the best chances for surgery should he need it.
Somewhere where it's all under one roof.
We were told for where we were, the "closest" places were University of Cornell (in Ithica NY) or U. of Penn (near Philadelphia).

We were also allowed to bring Spanky in the next day for proper "bile acid" tests, and that he'd need to NOT eat the night before.
Unfortunately, BOTH tests were high.
PRE test levels were: 43.6
POST levels were: 110.4

As I understand it, Pre should be around 10 or so, Post around 20.
He was at 5X the proper levels.

We were told to keep Spanky on his meds until we could get him properly treated.

I spent that day calling and researching both Cornell and U of Penn, but only became more frustrated.

It was at THAT point that I called the one man whom I trusted to give me the straight answer; our old veterinarian from when we lived back on Long Island, NY.
We had gone to him for several years and he was always spot on with his diagnosis and was so obviously caring about all of his patients, that we knew he'd be able to steer us in the right direction.

Calling him, he definitely set me more at ease, because while I was detailing the course of previous events, he was able to consistently jump ahead to the test or situation that I was building towards, obviously knowing what was next.
After he did this three times, I realized that he knows exactly what I'm leading to and we got the the current situation.

I mentioned to him, that I didn't have to pick either Cornell or U of Penn, that I'd be ready, willing and able to head back to Long Island for someone there, if they were qualified.

He recommended someone,while also mentioning the NYC-based Animal Medical Center.
I first called his L.I. based referral, who, in turn made mention of tests done at A.M.C. (where his radiologist comes from), and so, right then and there, it made sense to go to the one place that has it all under one roof.

I then called A.M.C. and made an appointment for Oct 23, 2008, but as it turns out, there was a medical conference most of that week, and the Doctor whom I was to see, after getting the information from me about Spanky's situation thus far, agreed with me that a normal consultation isn't what we need.
We were past that, and now NEED to know WHAT it is.
So she made an appointment for us to see a Surgical consult and testing a few days later (the medical convention was playing havok with schedules) the next Tuesday (Oct 28, 2008).

So, here I sit, wrapping up Spanky's 2-month saga up to this point.
(I can't believe that's all it's been since he came in the door. Just a week or so past 2 months - it seems like a year.)
My wife and I are crazed. The delays, especially these last 3 weeks are killing us.


Spanky, however, is feeling FINE.
The medications are keeping things in stasis, and he's growing by leaps and bounds.
He's much bigger than he was (for the longest time, it seemed like his growth was stunted) and has energy to burn.

Unfortunately, he's also teething AND needs to be neutered (his hormones must have kicked in because he's performing flying-tackles on BUDDY who easily outweighs him by almost 10 pounds).

I can only hope that this newfound strength aids him in this next step.

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