Tuesday, November 1, 2011

More ophthalmology stuff

Another visit - apparently there was an eye-related emergency, because we had to wait almost an hour for Scruffy's appointment.  Dr. B. seemed rushed and stressed during the time we were there - although I notice that we were charged for the SST test, they didn't do it.  Only $17, I guess.

Anyway, eye pressures were very good again - 13 in the right and 14 in the left.  Under 20 is desirable.  I got refills of the Flurbiprofen, and of the ulcer solution, and a prescription to send to Canada to order Azopt.    A couple months ago, a woman that I knew from the EpiKitty Yahoo board posted on Facebook that she had some glaucoma drops that her father had purchased for his dog.  (The dog had died.)  Turned out, the drops were Azopt!  The bottles were only 5ml, as opposed to the 10ml that I've been buying at Costco, but I was paying $117 for one bottle - these were  $28 for two or three!  I just finished the second of these bonus bottles, and despite an article I read from Consumer Reports about the hazards of ordering from Canadian pharmacies, I had no problems with the anti-convulsants I was ordering for Milkshake, and I don't expect any problem in getting glaucoma medication from there.

General report - 1) no regrowth of the iris mass, ocular pressures controlled,   and 2) no change in the focal iris pigmentation

So, good news and no more appointments hopefully until January, 2012.


8/11/11  Animal Communication

(I forgot to post this months ago, and now, since it's somewhat lighthearted and I am definitely NOT, I'm just trying to figure out a way to tack it onto an older post, instead of having it show up on top with all of the cancer stuff.....)

By August of 2011,  Scruffy's "inappropriate elimination" was pushing me right over the edge.  I was cleaning the carpets downstairs every week, and crawling around with my black light at night; sniffing when I came in from the garage, and paddling around in my stocking feet to see if there were wet spots.  He was spending most of his time hiding.  A couple of times a week, he'd poop right beside the litter box downstairs.  I was so annoyed with him I could hardly bear to look at him.  He hadn't come to sleep with his little head in my hand for months.  He had also started what appeared to be an intentional technique for avoiding the prozac pill every morning - he would just go from dish to dish, vacuuming up the cat food, until he threw up.  Once the pill was disposed of, he'd eat some more.  I was feeling persecuted and angry and guilty about all the eye drops he hated and the pill-giving.   I mean, after all, who rescued him from a short and miserable life outside?  Who spent almost 4 years testing him and giving him insulin shots, and who got the tumor in his eye removed???  He OWED it to me to use the damned litter box.  Only, unfortunately, he didn't seem to feel the same way.

Someone from the Feline Diabetes Message Board mentioned that she had been in contact with a new "animal communicator."  It was a person who had been around the board for years and had been/is fostering a ton of diabetic cats.  I had positive feelings for both the communicator and the communicated-with.   And I was so desperate for help that I decided to try it.

My only other experience with animal communication was a couple of years ago, when Hope and Linda and Dale gave me an hour with a communicator in Ohio.  (It doesn't matter where the communicator is; location isn't significant.)  And it was very interesting.  The communicator said that both Milk and Scruffy had spinal issues; I took them to the holistic vet here, who does chiropracty, and sure enough, without even knowing what the communicator said, he diagnosed the exact same problem location she had for both cats. And she had suggested some herbals for Milk's uncontrollable seizures. (I actually bought them from her, but couldn't bring myself to give them to him.)  There were some other things she said that weren't particularly applicable, but......

So, I made the appointment on-line.  Very well set-up website, very easy to pick a time.  Kind of expensive - $30 for 15 minutes, one cat and $60 for 30 minutes, two cats.  But, well worth it if works, right?

I wanted to be very organized about what I needed to know from her. My concerns were,  well, of course, the Scruffy-peeing stuff, and Milkshake's weight loss.  When the time came for our appointment, she asked only for the name of the cat and the color of its coat.  (I think I was so desperate for help that I may have told her that Scruffy was making me crazy, but I'm not sure.)  At any rate, she went away and came back in a couple of minutes and said, "Scruffy thinks you're mad at him."    I said, "Well, DUH.  I'm enraged!"  She talked to him some more, and he told her that he didn't like the Prozac.  He didn't like the way it made him feel.  (And I had increased his dosage as his peeing got worse, which made me feel even more guilty.)  He said he'd use the litter box if he didn't have to take the Prozac.  I was VERY unsure about making such a deal.  (And thinking that I had to be NUTS!)  But, I agreed, as long as he actually was going to cooperate.  He had to understand though, that because he was having a herpes attack, I still needed to give him zeniquin.  She said he didn't have a problem with that.  And she had to tell him that there was no choice about the eye drops, either.   We talked about Milkshake, who she felt had something going on internally, but couldn't identify what the problem was, and then hung up.

That was at 2:00 PM on a Sunday afternoon.  At 7:00 PM, Scruffy wandered into the kitchen and for the first time in months, PEED in the box.  Right in front of me!  I was stunned.  That night, he turned up the minute I was ready to go to sleep, and snuggled into his old place.  He started following me around again, waiting for me to sit down so he could sit on my lap.  It was all amazing.  And for a good two weeks, he seemed to have gone back to his old diabetic pattern - he peed twice a day, at the same time, right in the middle of his meal.  I was ecstatic.  At the end of that time, I again talked to Claudia.  I wanted her to ask him how he thought he was doing with our little agreement.  I didn't get that she understood my question, or that he answered it, but anyway, I felt comforted.

And then, I discovered a puddle in the laundry room.  On the vinyl floor, and when I tried to get the smell out, it got worse and worse.  (That was when all the downstairs peeing started - I moved a nice big litter box to the laundry room, thinking that he'd be happy to have a box down there.  He wasn't, apparently; he peed all over the floor a dozen times and never hit the box once.)  Eye-wateringly stinking.  I tried talking to him.   It seemed more hit and miss; sometimes he'd use the box, sometimes he didn't.  I noticed, to my extreme dismay, that both Burble and Duncan were beginning to watch when Scruffy was in the litter box and to chase him afterwards.  Not exactly what we needed.

And then - this was about 3 weeks ago - he peed on the floor right in front of me, twice.  I was in a frenzy.  I rushed to the computer after the second episode and looked up Claudia's website.  And tried desperately to get an appointment to become available.  Which never happened - I finally noticed that she was on vacation.  So, I had time to calm down, and I "discussed" with Scruffy my annoyance and disappointment with his behavior.

The outcome of all this - well, in the end of November, 2011, or the beginning of December, I started him back on Prozac.  Half the dose he had been on before.  And it seems to have been successful.  Haven't found more than a couple puddles on the rug since then.  I hated doing it to him, but I just didn't feel like there was any choice.  One more thing that I will be eternally sorry happened to my poor cat....

6/14/11 - catching up on ophthalmology

We're still having the every-four-months-appointments.  And eyewise, things have been good.   The eye-dryness measure (I don't know what its actual name is - they put a small tab of treated paper in each eye and hold it closed for a few seconds; I posted a picture of it before) which is reported as "STTs" on the appointment record,  was 12 in the right eye, and 13 in the left eye.  The eye pressure,  which is how the glaucoma is monitored -  was very good - 11 in the right eye, 13 in the left.  (The melanoma and surgery were in the left eye.)  Although I haven't taken any pictures of his eyes to Dr. B. lately, he feels that there has been no change in the melanosis that remains in the right eye.   It always looks a little more spread out to me; I do need to photograph it, I think.  At any rate, if it's growing, it's doing it very slowly.

At the end of this appointment, the technician mentioned that I was to continue putting the Azopt in BOTH eyes.  I didn't know that.  I could swear that I never heard Dr. B. even say that he needed the drops in both eyes.  So, obviously, I hadn't been doing it.   And Scruffy's personality changes had not improved - adding even one more drop of that thick white stuff was just likely to make him even less cooperative.   The essence of it is, I am keeping two drops a day in the back of my mind, but the reality is, when there appears to be no problem with the pressure in the right eye, I just don't know if it's going to get done until it becomes medically unavoidable.

Aside from that, the appointment summary was:

OU (both eyes):  lens sclerosis
OD (right eye):  focal iris pigmentation site (ventral quadrant) 6:00 position
OS (left eye):  previous laser surgery (for iris mass) - no evidence of regrowth.

We had the usual discussion of Scruffy's presumptive age again - almost three years ago, Dr. B. said that he felt, judging from the condition of  his eyes, that he was between 10 and 13 years old.  So, that would make him somewhere between 13 and 16 now, I guess. And he continues to have adequate vision in the eye that had the tumor, which is good.  All in all, except for the spitting and hissing and biting that went on, a pretty good trip.  (Except for the guy in the waiting room with the enormous black dog with the ear-piercing barking.  One of the technicians said that he has three more of that same dog - can't remember the brand - at home.  I hope he wears a hearing aid that he can turn off.....)

Sunday, March 6, 2011

Well, this is distressing.

I just noticed that, of all the blogs for diabetic cats listed on the sidebar here, only Carolyn and Spot's "Sugar Babies" cats and Karen's Pearl  are still with us.  It makes me really grateful that - given Scruffy's unknown age, the melanoma in his eye, the unfortunately inexpert 3+ years of diabetes treatment by me, and now glaucoma - my fluffy boy is still up and kicking. 

Way behind on things here - my intention, last May (2010!)  was to list Scruffy's quite good blood work, and comment on his still diet-controlled diabetes status, his on-going need for a dental, and the continued non-cancerous situation of his left eye.  However.....  being a major procrastinator, I never quite got around to it.

And then, along toward June, for some reason, his eye started looking odd to me.  It's very difficult to explain, and given the fact that his iris is quite distorted as a result of the laser surgery, it has never actually looked "normal"  for the last two and a half years.  Anyway, I made an appointment with Dr. B, and sure enough - and there was absolutely NO way to "see" this - Scruffy now has glaucoma in his left eye.  (There are no visible symptoms of glaucoma.  I'm attributing my thinking there was something wrong to, well, I don't know to WHAT; maybe just the connection we have?  Anyway, I was right!)  The pressure was not terribly high - in the 20's - I need to go and look up the actual report, as I wasn't really intending to write here today.  Anyway, it was not totally unexpected, of course, given the tumor and the surgery.  Just distressing.  We were given a human glaucoma eye drop called Dorzolamide.  Tiny little 10ml bottle for around $55.  Two drops per day in the "affected eye."  And thus started a horrible period for poor Scruffy which I will forever regret.

From the first drop, Scruffy reacted terribly to the drops.  He snarled, he hissed, he hid, and worst of all, he went back to peeing all over the house with a vengeance.  He no longer slept with his little head cupped in my hand, which he had done for years.  I never saw him from one day to the next, except for the times when I tracked him down/grabbed him while he was eating in order to give him his prozac and the miserable eye drops.  I asked several times if there was an alternative glaucoma drop that we could try.  And there was, but it cost almost twice as much, and there didn't seem to be much point in trying it because the ingredients were essentially similar.  Dr. B never really said if the reaction Scruffy had to the drops was normal or not.  I never actually asked, I suppose.

We finally managed, in November, 2010, to get the dental done. It went well, and I requested xrays of Scruffy's lungs to try to make sure the melanoma hadn't metastasized.  (It's fairly common for the cancer cells in the eye to be spread through the tear glands and other pathways to other parts of the body.  Several melanosis cats that I am familiar with ultimately died of lung cancer.)  Dr. G said that the lungs were clear.  He also xrayed Scruffy's abdomen and hips, which he said were normal.  The Puffer doesn't jump very well any more - I was concerned about the possibility of arthritis. Must just be that he's getting old.)

The glaucoma was very well controlled by the Dorzolamide.  The cat, not so much.  In the meantime, we accumulated two more kittens (which Scruffy generally ignored; he's not very "cat-oriented".)  And my mother had a major heart attack, was hospitalized for a month, spent five weeks in a nursing home, returned to her apartment where she needed support and help, had another heart attack, two more hospitalizations.......the essence of it was - there were entire weeks when I was gone 15 hours a day and none of the cats got much attention, although I never missed the medications for Scruffy and Milkshake.  It all added up to Scruffy's turning into a rather sullen, isolated, unhappy cat; the laid-back, sociable kitty just disappeared.  My sweet cat, who had tolerated more than 7000 ear pokes and who-knows-how-many insulin shots over nearly four years without a single objection, became unhinged from the eye drops.  

Finally, at the end of January, 2011, I was running out of Dorzolamide again.  I decided that, regardless of the increased cost, I needed to try the other medication.  In addition to the behavioral reactions, Scruffy was plagued with a black crusty discharge from his left eye; when I wiped it off daily, it left a reddish color on the kleenex, like blood.  Dr. G had said  previously, that it wasn't blood, it was iron and was related to the medication.  He prescribed yet ANOTHER eye drop - I was supposed to be giving Scruffy the glaucoma drops twice a day, Flurbiprofen drops (to treat something or another about the surgical site) every other day, and now, a drop to treat the irritation and infection that was apparently caused by the glaucoma drop.  You think he was miserable before?  We had reached the point where, while I could get both glaucoma drops into his eye every day, there was no possibility of giving him either of the other drops on a regular basis.  So,  I requested a sample of the alternate glaucoma drop, and it was amazing!  It's a thick, gluey white stuff, unpleasant looking, but Scruffy doesn't object to it at all.  No more hissing, no disappearing all day, he's back to snuggling on the arm of my chair and sleeping wherever I am.  Most of the time, when I put the new drop - which is a medication called Azopt, and cost $117 at Costco for a 10ml bottle - he doesn't even bother to blink or close his eye.  The other drops had to have been causing him serious distress, and I am so full of regret for making him so miserable for the last nine months.

Two weeks after starting the Azopt, we had our regular appointment with Dr. B.  Scruffy's eye pressure was 12 in both eyes!  He was doing so well that the opthalmologist felt that it would be possible to decrease the glaucoma drops to once a day.  (Oh, it makes me nervous, but I do have faith in him!)  We've been having an appointment every three months to monitor the glaucoma (and a small melanosis in the right eye,  as well as the former surgical site) and I guess that will continue.   But so far, so good.  I've pretty much got my Scruffy back, with the exception of the occasional litter-box offense.  Although I will probably never be able to totally relax about sniffing and checking all Scruffy's favorite places to "express" himself......