Wednesday, October 29, 2008

Lookin' Good (the slideshow)

Lookin' Good!

(The slideshow above is of today's appointment. I can't figure out how to get it and the narrative together in the same post.)

Today was Scruffy's follow-up appointment with Dr. B. Three weeks after the laser surgery. He seems to be pretty much back to himself, although he's been off alone more than usual - for some reason, he's taken to huddling on the love seat downstairs, despite the cold.

So, Dr. B. was very happy with Scruffy's eye. There is a noticeable area - perhaps 1/4 of the size of the melanosis - of dark brown tissue at about 5:00 on his iris. This, the doctor felt, is most likely burned tissue left from the laser itself; he thinks that it may eventually be sloughed off. There is also - apparently invisible to the naked, non-professional eye - a small area of tan-ish tissue, which is the actual remains of the tumor, I believe he said. He was very happy with the "regression" of the melanosis, and said that it is somewhat likely/possible that it might regress even more over the next few weeks. It was a very good sign that the regression started during the procedure. He is convinced - though there's no way to prove it- that the growth was malignant, but doesn't feel that there is anything that needs to be done about it, unless the area would regrow rapidly or significantly; laser surgery could be done again, presumably. He felt that check-ups using xrays or MRI or whatever to search for more melanomas would be more risky to Puffer than helpful. A concern with iris melanosis is the possible development of glaucoma, and he again checked the pressure in Scruffy's eye(s) - 15 in the right eye, 16 in the left eye (where the melanosis was). Both are good numbers and indicative of no pressure problems. Dr. B did say that, had there been an indication of glaucoma at the previous appointment, he would not have done the surgery, but would have recommended enucleation. (And because of my awful experience with my beloved Black Kitty, I would have agreed, sadly - I would never want another cat to go through what Black did because I didn't understand the treatment options.) Dr. B. feels that Scruffy's procedure was very successful, and that the eye appears to be healing, although there is some inflammation still. "Mild uveitis"? (The directions they gave me only included medicating the eye for two weeks, and, instead of calling and asking if I should continue, I just quit using them. I feel really bad about that.) He has re-prescribed the flurbiprofen drops for 4 more weeks and as needed after that, and the atropine ointment every other day for 10 days. Contrary to their warnings, Scruffy had absolutely NO reaction to the atropine ointment, but he certainly hates the flurbiprofen. (Sounds like a cartoon name, doesn't it?) His pupil is a little distorted, which will probably not change, but isn't likely to cause him much trouble. And he is likely to be sensitive to light, which the atropine is supposed to help with - it will encourage the pupil to change sizes so that adhesions don't develop. He also said to watch for something like brown "glitter" floating around in the eye - it's a sign of something bad, but I don't remember what.

Other general information - the procedure took about 40 minutes. I thought that was a long time; the doctor thought it was pretty quick, considering how many times he had to apply the laser. (Five, I think he said.) And they did check his blood pressure during the surgery- 115, 90, and 80. Dr. B. said anything under 150 they regarded as being acceptable. They checked his glucose level, too, but I don't remember what it was - I think it's in the previous post, anyway. There was some discussion about the fact that he wasn't their most cooperative patient - I don't know what happened to my laid-back kitty who loved everybody and was so pleasant.

We slid him in and out of the carrier in his kitty pi - boy, that makes it so easy. He just sits in it while everybody does whatever to him. And then, after he slid back into the carrier, he hissed and spit three times at the technician standing beside the table. Just to let her know that her efforts were NOT appreciated, I guess.

I had taken my camera along because I wanted a picture of the doctor using this fascinating machine to look into Scruffy's eye. I hadn't said anything to Dr. B about taking a picture, because I was just going to take it without a flash, which wouldn't bother anyone. Only, the stupid camera - I pushed the button with the lightning bolt picture on it, which I believe is the Controller of the Flash, and when I took a picture - after they'd turned off the room lights so they could look at Scruffy's eyes - the stupid flash flashed. Dr. B and Scruffy and the two technicians all jumped. I felt so dumb. Haven't looked at the pictures yet - but I will put his picture here. I don't think I got a very good shot of the interesting eye machine, unfortunately, and it'll be quite a while, probably, before I take a picture of Scruffy's poor eye.

The next appointment, barring complications, is January 13 at 2:00. Now I won't have to worry about the appointment card falling off the fridge and disappearing forever.....

Monday, October 13, 2008

Great improvement!

Scruffy's doing very well. Moving around normally - although he seems to prefer to stay on the bed, eating as usual (like a horse!), peeing okay and has finally pooped (after 6 days and Miralax), and in general, being his old self. Headbutting and a hairball. He is not fussing with the eye, although I do believe that his face must hurt still, because he is cautious about, for example, laying down (without the cone on) on that side of his head, and he still does an odd thing - seems surprised, or something - when he yawns. There seems to be some swelling left around the eye, but it's hard to tell. The fur's been shaved there, and it could be that those bones have ALWAYS stuck out..... He has been incredibly cooperative with the medications - ten times a day, but several of them will be given less often after tomorrow - the 7th day since surgery. I've kept the bedroom blinds closed, which he seems to still need. There's good light from the bathroom window, but he never goes in there, which I interpret to mean that light is still uncomfortable. (`I moved the litter box into the bedroom.) His atropine eye ointment was reduced to every other day, so that may make a difference in his reaction to light. The only difficulty medically at this point seems to be the sinus infection, for which he's taking zithromax, but he's thrown up two days in a row within twenty minutes of taking the pills, so I don't know if he's gotten much benefit from them or not. (Yes, I did sickeningly poke around in the STUFF, which he very thoughtfully placed every single drop of in the food bowl, but I couldn't identify anything that looked like the pills.) He is very snorty and congested, although there does seem to have been minimal improvement.

I'm not sure what to do about letting him out of the bedroom. The last two mornings, he's been sitting at the screen door waiting for his breakfast, and I know he'd like to see what's going on in the living room. But, given Busy's propensity for gnawing on the other cats, and Toot the Brute's chasing habits, I just think he's better off being separated for another week or so. We'll see, I guess.

His pupil is still very enlarged (from the atropine, I assume.) I can't see the edges of his iris, where the melanosis/noma tissue is hopefully shrinking significantly. I am making up a list of questions I want to be sure to remember to ask when we go for his follow-up appointment on the 28th of October.

Forgot to add that his glucose levels have been very good. Highest I found was 102, yesterday was 63, today was 72 (but I had to poke him THREE times - I seem to have lost the knack. Well, it was a little dark to see the blood on his dark ear.....) What a relief.

It's so nice to have him back again. I've been spending a couple hours a day snuggling with him, and it's wonderful. (Okay, we've been napping for much of that time, but it's STILL nice!) He is truly a treasure.

Saturday, October 11, 2008

He's feeling better.

Got the little bounce back in his step, his ploofy tail's waving in the air, and - while he didn't eat much this morning after the Metacam-laced "teaser meal" - he enthusiastically gobbled down the treats where his antibiotics were hidden. This ordeal is turning me into a really deceitful person. My whole day is devoted to figuring out innocuous-seeming actions that will result in medication being delivered to his mouth or his eye without his expecting it.

I checked his bg level this morning - 91, after no food or water from 1:30 AM. Given the stress of the cone, the medication, the isolation, the presumed pain and everything else, 91's a pretty good number. I'll take it. The next problem to come up is that he hasn't pooped since Monday, the day before the surgery. I'm NOT accustomed to being interested in who's leaving what in the litter box, so this is a whole new world for me. I did get Miralax yesterday while I was out, but I'm hesitant to use the recommended 1/4 teaspoon because his water intake is restricted. I do squirt a little water in whenever I can, but he's not much interested in water in general, even when he isn't wearing a cone. I add water to his food, but..... He is peeing, so I supposed that's a good sign.

He looks brighter and happier this morning. He rarely gets off the bed, and he's chosen to spend most of his time in the kitty pi (there are two for him to use) that's on the heated cat mat, so I guess he's cold. I've been keeping the room dark and as calm as it can be with five other cats sitting at the door for vast quantities of time - everyone wants in, for a variety of reasons: The Girls think it's THEIR room and they want it back, and please fill up our bowls with Kitten Chow RIGHT NOW; Milk wants to snuggle up with the Puffer, which I considered letting him do, but I don't know if Puffy's up to it. Busy wants in because he's a pain in the neck and there's absolutely no reason he needs to be in there, and Burble would like to get the pi with the heated mat back again - he was using them last week. And Burble and Minnie have perfected a sort of harp duet - they sit at the screen door and pluck, plink with one claw, over and over, endlessly, until I want to scream. Or squirt someone.

Still no sign that Scruffy wants to scratch that eye, even when the cone's off. Yesterday, he groomed himself for almost an hour. (Hairball city is probably coming up.) But he never went anywhere near his eye. I am SO looking forward to taking the cone off on Tuesday, although I don't know if there's a criteria for doing it. The directions from the hospital just said to wear it 1 week and then "as needed." And I just reread the constipation part of the instructions; I guess I'm gonna have to get the miralax into him somehow. (When I gave him his actual "breakfast", he sniffed at it, and then went over, and climbed into his pi with his back to me. Wouldn't touch the stuff. I refilled with Tender Beef FF, and no Miralax, and he ate about 1/4 can.

All in all, feeling better as the days go on. I can't see anything around the edge of his eye yet, because the atropine makes the pupil so huge, so I can't tell if the tissue is "regressing" any more or not. I am going to take my camera to the follow-up appointment just for general purposes.

Thursday, October 9, 2008

Getting a grip...

on the medication schedule, and managing to feed him what's getting to be close to a normal amount of food. Unfortunately, through the night, he developed a really stuffy nose - whether it's from the passage of the medications through the eye to the mouth, or if it's leftover from the previous sinus infection before the surgery, or if it's a new herpes attack because of all the stress this week - WHATEVER the cause, the outcome is that he's absolutely miserable. He takes a bite, has to sniff to swallow it. It does not appear to be the customary herpes snorting. I called today and got a prescription for the same antibiotic they had given him prior to the surgery - zithromax. Unfortunately, I had them call it in to Walgreen's, not knowing that they 1) don't deliver and 2) close at 10:00. At 7:00, I went out and got in the car to go pick up the prescription and more Fancy Feast, because we're out of the last of Dian's Homemade Raw - and once again, got no further than the stop sign at the corner when the power steering started to shriek again. I made three right turns and ended up back in the driveway. Rege wasn't home, there was no way to contact him, and no one to go pick up the medicine. I looked in the garage, where there was no visible bottle of anything labeled power steering fluid. I SHOULD have taken the car somewhere on Wednesday. Well, yes, I SHOULD have, but I had other things on my mind and it never occurred to me. So what do I do with it tomorrow? I have to get the pills picked up, and we need milk and bread and light bulbs. Maybe I can borrow some fluid, drive to the drugstore and the grocery store and then to the Dodge dealership, and ask them to bring me and my groceries home? Why didn't it occur to me before Walgreen's closed to transfer the prescription to CVS, which is closer, cheaper, and open 24 hours? Well, WHY???

What I can't stand here is that I try so hard to do stuff right for the cats, and somehow, it never quite works out.

Okay, Mr. Wonderful came home. Had a little more power steering fluid, put it in the car, ranted about why I haven't gotten the stuff fixed in the last two days - SICK CAT! SICK CAT! - and now, the automotive shrieking is stopped, at least for tonight. The human shrieking also, thank goodness, lol. Now, as long as I can get down the road to the stores tomorrow morning, then maybe I can go and fling myself on the mercies of the Dodge dealership and they'll figure out what's wrong. (Is it odd that the oil and the power steering fluid have BOTH disappeared at the same time in a car with only 21,000 miles on it? Got me.)

Have to go and tell Jojo that I don't need her BF's "toe truck."

Wednesday, October 8, 2008

Over, but not done with.......

The laser surgery's over, and the sad little cat's tucked away in the bedroom with his awful plastic collar. Unfortunately, he's not eating or drinking or peeing or pooping, and the ophthalmologist feels certain that the no-longer-with-us tissue from his left eye was malignant. Not exactly what I'd expected to hear, somehow. And certainly not what I wanted to hear, or think about or see, or know, actually.

These are the medications he came home with: (nothing steroidal, to try to keep the OTJ status)

1) flurbiprofen - antibiotic/painkiller? - 1 drop 4x a day for 1 week, then 3x a day, I guess until the next appointment. I need to call them, I suppose.
2) BNP ointment - Bacitracin-neomycin-polymyxin veterinary ophthalmic ointment - Small amount 2x a day for 1 week, then 1x a day at night.
3) Atropine - Atropine Sulfate Ophthalmic ointment - 1x a day for 4 days, then every other day for 10 days.
4) Metacam - .05ml by mouth once a day for 14 days. Not to start until tomorrow because they gave him a shot of metacam today.
5) lysine - usual stuff to try to keep the herpes under control.

Here's the problem: most of this stuff travels down inside his little head from his eye through his nose and into his mouth. And most of it tastes really bad. And he won't eat. Also, none of it can be given at the same time as anything else, which pretty much guarantees that he's not gonna be able to eat much of anything the whole time he's using all this medication. Assuming that I can concoct and maintain a schedule of dosing for him, plus coordinate it with Milkshake's already time-consuming pilling schedule. And, please give me pills any day. In the mouth, wrapped in a pill pocket and gone. Ruining his sense of taste - what's the point? I was also warned to be sure to carefully wipe my hands after giving him the atropine because it could end up having a similar effect on me that it does on him, only very long lasting: drastically dilated pupils. I need to look that up, I guess. Whatever, it sounds like a threat for both of us.

They said not to feed him until 6:00 PM. Unfortunately, I hadn't noticed over the past five days that the Flurbiprofen must be one of those nasty tasting eye drops, because the minute I put it in his eyes, he started spitting and dripping and that was the end of eating or drinking anything at that attempt. After the first unfortunate experience, I waited until I could get at least a little food into him before trying one of the ointments. Which was a good thing, because that taste seemed to be the direct cause of the crying-with-whimpery-baby-noises. I did get maybe an ounce of canned EVO - with water and lysine and taurine into him with Milk's baby bottle. And a minimal amount - drops, maybe - of water with another bottle. Then, after I'd left to put the things in the kitchen, I noticed that he had tried to eat the little bit of Fancy Feast I'd left on a little china coaster from Old Economy. The stupid cone must have gotten hooked under the edge of the coaster, though, because it was backed up against the wall and the FF had slid off. I guess it was a good thing that he wanted to eat; too bad he didn't get to. I will make another stab at it again before I go to bed. The directions said that the horrible cone could be taken off if he was supervised, which seemed like the best way to entice him to eat later. Wasn't. And it's a pain. I couldn't figure out which way it needed to go to replace it. The good thing about it is that the directions say that, instead of making him wear it for 3 weeks, which is what the original instructions said, the new paper says "one week, then as needed." Hopefully, one week will be all that's needed.

Scruffy's miserable. I can't comfort him, I can't get him to eat, he can't sit or lay right because of the cone. I am debating trying to sleep in the extra bedroom with him - I hate to have him be alone, and he's slept on me every night for years, but he's not supposed to jump, and I don't think I'd survive the arthritic agony of a night on the floor. His eye is kind of distorted, and it's an odd color - bruised, I suppose, or burned - but it looked like the bottom part of the melanosis/melanoma was still there; a little triangular artifact. I remember that the ophthalmologist said that he was delighted to find that the tissue had started to "regress" while he was still working on it, and that that was good because some eyes take a couple weeks to see the regression. It didn't register that that may mean that the ugly thing is still going to be there in some form, threatening him, for an extended period of time. Actually, if the odds are only 65% of being able to remove the tissue, maybe it'll always be there. I hope not.

This was a horrible day, and a pretty horrible outcome. Not the actual outcome, I guess, of the laser surgery, but the idea that it could even have BEEN a melanoma is horrible. I spent four years trying to repair the damage I did to the poor cat by giving him diabetes, and now - cancer. My old refrain about his walking into the wrong garage springs to mind once again.

Last minute minutia:

- total cost (next follow-up visit is included) - $1051. Plus, $146 for Dr. B. appointment last week, $100 or so for Dr. K appointment the week before, $271 for xrays and bloodwork at Dr. G's. I hope that's enough money for the Universe to say , "Okay, cancer, out of there; Scruffy's covered."

- I have two kitty pi's and a heated electric pad for him to lay on. It's chilly tonight, although that room is usually the warmest place in the house. I want him to be comfortable and pain-free and to have a full-happy stomach. Probably not gonna happen tonight, any of it...

- checked his glucose level just before cramming him in the carrier this morning - 76. And at the hospital, after the surgery, they checked him and he was 80. It would be nice to be able to maintain that; the thought of having to start testing and shooting him again makes me sick. It's about time he gets a break.

-really not crazy about giving him metacam every day for the next two weeks. It's purpose was as an anti-inflammatory, not a painkiller. Still seems like an undesirable plan. I think I'll post and see what others think.

- the litter box was empty - not too suprising, although I would have thought that they'd have given him fluids during the procedure. I gave him the box with the Feline Pine Clumping in it - for a week now, he's been waiting to sneak in and pee in that stuff as soon as I open the door for The Girls to come out in the morning. Now he'll have it all to himself. I do hope he pees soon.

I love you, my sweet Puffer.

Thursday, October 2, 2008

Preparations for surgery continue....

Yesterday, Scruffy went to our regular vet for xrays of his lungs (to look for possible metastatic disease) and blood work. I couldn't imagine how they were going to get him to cooperate for the xrays, but was actually spared the agony of knowing - they took him off into the back room - which I don't remember Dr. G. ever doing before, but of course, the xray machine is back there somewhere..... I did hear a huge amount of hissing and spitting, but apparently they were able to do what needed to be done. He got the blood, too, at the same time.

Results were fine for both. He said there were some changes in something about the heart touching the sternum. (? I have no idea.) Blood work was fine. All in all, pretty good, I guess for a cat of uncertain age who was a totally uncontrolled diabetic for three and a half years.

We started the eye drops this morning. Flurbiprofen. (Doesn't that sound like something from a tv cartoon?) Every 8 hours, one drop in the left eye. Scruffy was NOT delighted. I assume he'll have all sorts of drops after the surgery, too, so he might as well give up and get used to it. Useless protest does seem to be a cat's most kneejerk response, though. After biting and scratching.....

I posted on FDMB last night about the cone, and learned, to my relief, that it's not the enormous plastic umbrella-sized thing I had in my mind. I couldn't even figure out how I was gonna get him in the carrier to bring him home with one on his head. But, I saw a picture of a cat cone, and it was small and manageable. Well, manageable for me; I'm sure Scruffy won't be thrilled. Anyway, that was one more thing I'm not going to stew about any more. The significant thing was that he has to have something to prevent him from being able to rub that eye against anything - furniture, the floor, the walls, his foot, whatever - until the tissue has healed. Three weeks. Gonna seem like a looong time, I'm afraid.

I'm worried about this whole thing, but hopefully, when it's over, that will be the end of our Iris Melanosis tale. (At least, until the one in the other eye does whatever it's going to do.) I hope that Scruffy's one of the cats who only needs to have the procedure done once.