Saturday, October 02, 2010
I just got back from three and a half hours at the Animal Emergency Center, where Harley will remain overnight. The short version: we're not sure what's going on, but whatever it is, it's definitely not normal recovery from anesthesia.
He didn't eat all day. I gave him his scheduled pain meds, but around six -- after my speaking gig, which went fine -- I started to worry about his once-a-day antibiotic dose, which I wasn't supposed to give him unless he'd eaten. Also, his hindquarters still weren't working right, and he'd started a terrible yowling, the same noise I've had other cats make when they're dying, although I wasn't that worried because it's also the noise Harley makes when he's trying to hawk up a hairball. I wasn't worried about the hindquarters because of what my sister told me about her cat's nerve damage from an injection.
So I called AEC, figuring they'd tell me to bring him in for more fluids and maybe some force-feeding so he could take his antibiotics. They indeed told me to bring him in, but when I got there, the doctor -- the same one we saw last night, a very nice and supersmart guy who looks like he's in third grade -- said that the howling plus the dragging back end was a classic symptom of blood clots. Even though Harley had good pulses last night, he could be throwing small clots, possibly secondary to heart disease, which could cause pain without completely blocking circulation. I asked about the injection theory, and the doctor said that the kinds of shots Harley got for his dental work (I brought his records with me yesterday) wouldn't cause that kind of nerve damage.
I gave him permission to take an x-ray and give poor howling Harley stronger pain meds. While all that was happening, I went across the street to Whole Foods for a quick dinner, and then came back and listened to other people's tales of woe. A couple of dogs got to go home after mishaps like choking on a piece of steak, but a pet ferret had to be euthanized.
Periodically, techs came out to update me. Harley had been given superstrong pain meds, kitty morphine, and was much more comfortable now; Harley's x-ray was finished and they were waiting for the radiologist to read it; the radiologist's report wasn't back yet. (The radiologist was looking at digital images in, I kid you not, New Zealand, and may have been interrupted by other emergencies.) Finally the nice young vet called me into an exam room and showed me the x-ray; he still didn't have the radiologist's report, but he could tell me some of what we were dealing with.
First of all, Harley has kidney stones. Even I could see them. In fact, I pointed to them before the vet even said anything and said, "What are those?" These might account for the blood in his urine, but the doctor can tell from physical exam that they aren't the cause of Harley's current pain. Furthermore, they're too large to pass.
The current pain is most consistent with blood clots, and the escalation of the pain over several days is consistent with a series of blood clots. Cats can be given low-dose aspirin, but there's really no treatment for clots, no kitty coumadin, and cats with this condition don't have a good prognosis. They usually six to eight months, with sudden death always possible if a clot travels to the heart or lungs.
The vet told me that clotting problems can actually be caused by dental issues, which makes me wonder if Harley should have had the surgery sooner . . . but the last time we saw our vet, she said he should have it done in the fall, which started, like, last week.
He emphasized that Harley was indeed much happier on kitty morphine. I got to visit him in his large, clean, comfy cage, which would have made me feel better if the other large, clean, comfy cages in the room hadn't been filled with moaning animals. I patted him until I started crying -- which took about thirty seconds -- and then went back to the waiting room, since I didn't want to upset him more by being upset.
The NZ guy weighed in: kidney stones, yes, but no obvious heart problems (which doesn't mean there aren't any) and no spinal abnormalities to account for the dragging rump. There was some suggestion of pancreatitis, though, which could cause some of these symptoms, although blood clots are still more likely. It's also possible that the kidney stones are causing a blockage.
So, the nice young doctor said, he wanted to keep Harley overnight and do some bloodwork and an ultrasound to look for things he could treat. He didn't think he'd find anything, since blood clots are still the most likely suspect, but it would be good news if he did.
He showed me the estimate for one night of hospitalization plus the tests: minimum of $950, and probably more like $1,100. I told him I had to call my husband. He said, "Of course."
Gary wanted to know if we could hold off on some of the tests or do them at our regular vet office, where they might be less expensive. The ultrasound's the biggie, though, and although our vet does do that, I suspect these guys are more skilled, and if the cat's already miserable in the hospital, I want to get everything done at once.
So this is the game plan. If Harley's the same or better tomorrow morning, the doctor will go ahead and do the ultrasound. If he's worse tomorrow morning, the doctor will call us to recommend euthanasia.