The rest of the story

Dear Readers,

Remember last September when I recounted my misadventures in hospitalization, surgeries, hyperbaric treatments and pain?  As more and more of my right breast disappeared with each progressive surgery, I worried that I had the dreaded FLESH-EATING BACTERIA.  Through the full course of my treatment I contracted practically every bacterial infection known, some of them more than once.  I was under the impression, source forgotten, that it was MRSA that was the medical term for the flesh-eating bacteria (and in some cases it is).  MRSA stands for methicillin-resistant Staphylococcus aureus.  Now, I knew from my college days that staph aureus is one of the most common bacterium known – it’s almost always present nearly everywhere.  Normally it’s relatively harmless.  When the culture results were finally reported, I think it came back as a strain of Streptococcus.  Little did I know at the time….

The biggest concerns that the nurses and doctors had for my recovery were due to the fact that I’m diabetic and a smoker.  Neither of those is conducive for healing.  Fortunately, my blood sugar levels remained quite low, under 100, nearly each time they were checked.  I was on the “patch” while in the hospital for 23 days, so that helped as well. 

The nurses and doctors assured me that I didn’t have MRSA while I was in the hospital.  My surgeon told me that the reason for the multiple surgeries was that I had necrotizing fasciitis.  His delivery was cool, calm and collected.  No problem, we’ll just cut off more skin and tissue and I will live happily ever after.  Nothing to worry about.  After 4 surgeries and what would result in half of my right breast being sliced off, I was sent home.

Following my release, my hyperbaric treatments continued daily for several months.  In between I contracted more infections, one of which was MRSA.  A co-worker’s husband is a nurse and he told her to assure me that MRSA was nothing to worry about.  Knowing it was staph aureus coupled with his reassurance, I didn’t worry and after several more rounds of various and sundry antibiotics, the MRSA was gone.  I think it was around October that the infections were gone, and I got the rollicking opportunity for a skin graft.  I’ve detailed just how not fun that was in an earlier blog post, so I won’t bore you with more details.  The graft took on about 60% of the wound, leaving a decent size open area yet to heal.  I had about 12 derma grafts to promote skin growth.  Derma grafts are pieces of skin grown in a lab…..grown from the foreskin of some anonymous penis.  Those grafts were working until, once again, I contracted another infection.  That was cleared up with more antibiotics and the wound was allowed to heal on its own.  Finally, after just over 10 months, there is a good chance that my final appointment with the wound care staff will be this coming Wednesday.  It looks, to me, as if the skin has finally covered the entire wound.  All is nearly right with the world, or is it?

So USA is running promos for their show Royal Pains and in one spot the doctor says something like, “I’m sure it’s NOT necrotizing fasciitis.”  Well, after hearing that spot several times, I decided to Google necrotizing fasciitis.  Guess what I found?  DRUM ROLL, please.  Necrotizing fasciitis is none other than………. FLESH-EATING BACTERIA, and the culprit is Streptococcus pyogenes.  I read on and discovered that, left untreated, about 70% of people who contract this DIE!  Those who survive have lost appendages or limbs, depending upon the location of the infection.  Guess I was lucky it was my breast.  After all I just look lop-sided in my shirts.  No one checks out the breasts of a 61 year woman, so for all intents and purposes, it’s not noticeable.  Only the occasional curious cat sees my half eaten breast if they decide to check out what I’m doing in the shower.  They just think I’m weird for standing under running water. 

If I’m able to get copies of my medical records and ya’ll have really strong stomachs, I’ll share the wonderful photos of the deterioration and recovery of the “wound.”  I got a slide show about 2 weeks ago and it brought back all those painful memories.  I hadn’t seen just how bad it was in the early stages.  From its worst to where I am today is an amazing transformation.  If I believed in them, I would count my blessings.  

If you're interested in more info on necrotizing fasciitis, check out these links:

http://en.wikipedia.org/wiki/Necrotizing_fasciitis and http://www.nnff.org/

Charlie, Cissy & Cagney……and HAIR

I finally decided it was time to let Charlie go.  I took him to my vet on Monday, June 13^th and put him down.  He and I had struggled off and on since May, 2010 with his drastic weight loss.  All of the recriminations were and are there.  It’s tough, but rarely have I lost one of my critters and not questioned myself and what I could have done better.  Losing them brings me face to face with the fact that I do not have all of the answers, I do not have super powers and DEATH is a fact of life.  Death is too powerful an adversary for any of us.  We may win some victories, but we can’t win in the end.  Even though it is inevitable that Death always has the final victory, I will continue to fight for as much time as I can salvage.  I did that with Cissy.  I took her to the vet on Tuesday, June 14^th and again on Thursday, June 16^th, prepared to put her down.  My guilty conscience over not giving her as much attention as I should have while treating Charlie overruled all else.  I tried treating her chronic renal failure and for a few days, she responded, but by Friday,  June 24^th it was obvious she was not going to make it.  I had her put down Friday morning. 

In between this, on Wednesday morning, June 22^nd, Cagney the new kitten, wasn’t able to walk on her left front leg.  She was lethargic and not eating.  She was very hot to the touch, so I knew she had a fever.  I took her to the vet early Wednesday morning and her temp was nearly 105 degrees.  Normal for a cat is between 101 & 102.  Although she had her first vaccine about 2 ½ weeks earlier, I felt certain she had limping kitten syndrome from calicivirus.  Calici is hard to eradicate in a multi-cat household.  It first appeared here in 1999 after bringing kittens home from surgery at animal services.  One kitten, Chaz, presented with symptoms.  He didn’t get sick with it, but Clark, Charlise and Catherine got deathly ill from it.  My vet pulled them through, but the ramifications from this disease caused a plague of plasma cell stomatitis to hit my cats, who included Chase, Carly, Bob, Charlie, Chaz, Colt and Courtney.  All of them had most or all of their teeth removed.  Of those cats only Bob, Colt and Courtney are still with me.  I have also lost Clark and Catherine in the past few years.  Needless to say, I was seriously concerned about little Cagney. 

Limping kitten syndrome was seen several years ago and was attributed to vaccinations.  Most kittens showed symptoms within 48 – 72 hours following their vaccination.  They limped, had inflamed joints and fevers.  In many cases, the symptoms went away within a few days.  Since Cagney’s vaccination was over 2 weeks earlier, my fear was she had contracted calici from a carrier in the house and her recovery wouldn’t take the normal route.  With some fluids, to reduce her fever, and force feeding she started showing improvement within a few days and by yesterday she was more active and walking and eating normally.   I can only hope this incident won’t have long term ramifications for Cagney.  It’s to be expected to lose older cats, but it’s devastating for me to lose a kitten.  So much potential never realized. 

The one bright spot this past week was seeing the road company of HAIR at the Bob Carr.  OMGoddess!  This show has been such a big part of my life since college.  I played and played and played the soundtrack to the Broadway play in my dorm room.  I saw the road show at the Coconut Grove Playhouse in 1970.  Yes, I tend to be “a bit” obsessive and HAIR has been an ongoing obsession.  And, if you aren’t familiar with it or haven’t seen it, please DO NOT see the movie.  It’s a complete bastardization of the original play.  If the road show is coming to a town near you, run – do not walk – and buy a ticket.  You won’t regret it.  Most of the road show company has been a part of this play since its revival on Broadway a few years ago and the London company following its run on Broadway.  Although the play dates back to 1967 and is about the Viet Nam war, it is still relevant today.  Some things stay the same:  calls for peace, freedom & clean air. 

PEACE

Life with a kitten

Cagney is getting bored in my bathroom.  She really wants someone to play with.  While the dogs and other cats were eating tonight, she was in the bathroom SCREAMING.  Please release me, now!  When everyone was done and the dogs had licked the cat bowls clean, I put the dogs outside.  I then opened the bathroom door, and out Cagney dashed.  FREEDOM.  

Chow-Li, my gorgeous, but gigantic, long-haired Siamese mix was  lounging on the other side of the wrought iron gate between the living room and the hallway.  Cagney proceeded through the gate and started swatting Chow-Li.  I cannot begin to describe the ensuing “play/fight” session, but I’m going to try. 

Chow-Li  is easily 10 times the size of Cagney, however that did not deter Cagney from going on the offensive.  Cagney batted Chow-Li’s paws and Chow-Li returned the attack.  She kept her claws sheathed.  She rolled onto her side and Cagney tried to bite her tummy.  Chow-Li rolled back onto her stomach and Cagney swiped at Chow-Li’s face.  After several thrusts and parries, much like sword play, Chow-Li finally put her front paw on Cagney’s head (her paw being the size of Cagney’s head) and pinned her to the ground.  That didn’t stop Cagney.  She escaped the paw and ran behind the nearby bins.  She apparently decided on a sneak attack and approached from the rear, thinking she would catch Chow-Li off guard.  It didn’t work.  Chow-Li turned around and continued the play.  All I could do was stand there and watch the exchange, finding myself laughing out loud at times.  It was, seriously, such a cute and funny spectacle.  There is nothing like a kitten to make me smile. 

The dogs were barking to come inside, so I had to track Cagney down.  She had stopped the play and decided to venture further into the living room.  New territory to discover, other cats to bother.  They, however, weren’t interested in having anything to do with her.  I didn’t see her at first, so I called her name.  Don’t let anyone tell you that cats don’t know their name – she came running out of her hiding place and raced back into the hallway.  I managed to corner her and put her back into the bathroom.  I can’t wait until she’s a bit bigger and I won’t worry about her being around the dogs.  At this point my concern is that they won’t understand that she’s nothing more than a smaller version of the very same cats they ignore day in and day out.  When that day arrives, she’ll have all the company she could want and I’ll be able to reclaim my bathroom and clean it up.  For such a teeny thing, she can certainly make a mess.

Charlie Redux

The adventure (?) continues.  Charlie has failed to make any remarkable improvement since I began treatment for exonic pancreatic insufficiency, although he did put on 4 ounces in 2 weeks.  He's still under 5 pounds and in the past two days has required me to force feed him.  He's also developed a serious herpes eye infection, which is limiting his vision.  I've been debating (with myself) whether I should just give up and put him to sleep.  I've vacillated, with nights being when I say yes and daylight brings new hope. 

This morning I decided to check a blog I hadn't visited in nearly a year.  Jane Garrison had caught my attention during the animal rescues following Katrina.  She tirelessly saved so many animals as a volunteer.  She started Animal Rescue New Orleans, which is still operating today, run by local residents.  The post I read, I had read before.  One of her cats had been diagnosed with hemobartonellosis. It's now known of as Mycoplasma Haemofelis.  Maybe this is what has been afflicting Charlie for this past year.  I called my vet's office and asked if we could start him on doxycycline & prednisolone, the meds used to treat this disease.  To find out more about it, go here:  http://www.marvistavet.com/html/body_feline_infectious_anemia.html

After checking with the vet, I got the okay to proceed.  Unfortunately, due to Charlie's weight loss, the doxycycline would need to be compounded at a pharmacy.  After speaking to the pharmacist, and relaying my frantic concern, she agreed to have it ready today.  I'll be meeting my friend from the vet's office in another hour to pick up the pred and then, hopefully, the pharmacy will have his antibiotics ready.  Keep your fingers crossed that this is what he needs to improve.  I just hope it's not too late to make a difference for him. 

This ordeal has taken its toll on both of us.  My emotional state has been out of control.  His struggles and confusion have left me in anguish, and feeling nearly helpless.  I'll keep you posted on any and all progress.

As requested..............pictures of Cagney

I took Charlie back to the vet on Friday and brought Cagney with us.  She has gained 6 ounces since Saturday.  She also likes to sit on shoulders.  So here are the pictures taken by one of the folks at the vet's office.

Isn't she adorable?

 Charlie had finally gained some weight, although not much - 3.5 ounces.  He has a raging herpes infection in both eyes so - yay! - not so much - even more daily meds for him.

I thought I'd found a home for Cagney with my assistant and his girlfriend.  Both of them fell in love with her.  Why not?  She's adorable.  Unfortunately, their cat Bella wanted nothing - but bloodletting - to do with Cagney.  So, Cagney just came back to me a few minutes ago.  Que sera, sera, whatever will be, will be......

I lied!

As of yesterday, there is a new addition to the household.  A teeny, itsy bitsy, black & white kitten, gender undetermined.  Weight, only 1 pound and 4 ounces.  The baby's name is Cagney, although Screamer might be more appropriate.  She/he has very definite opinions and doesn't mind expressing them loudly and often.  I love vocal cats....................probably not very surprising.  I swore no more critters - I don't want them to outlive me.

She/he was most probably dumped at or next to my vet's office.  A man found the other kitten in the street a week ago Saturday.  He brought the kitten to the vet where the kitten was euthanized.  From what I was told, the kitten was suffering from heat exhaustion and appeared to have been hit by a vehicle.  I spotted Cagney on Tuesday, under a car in the driveway of a house next to the vet's office.  A few employees knew the kitten was there, but no one attempted to catch the kitten.  I was finally able to get a trap and dropped it off on Friday.  The young woman who lives in the house caught Cagney Saturday morning and I picked her/him up and brought her/him home.  Cagney is residing in my bathroom for the time being.  Prefers being held and will try to climb my legs if I don't pick her/him up.  Sharp, dagger like claws digging into bare legs - not a pleasant experience but, somehow, endearing. 

I'll post a picture once I get my camera operational again.

Charlie, Claudia and Cissy are hanging in.  Cissy had 4 teeth pulled on Tuesday and finally started eating normally today.  It's been a chore running a MASH unit for 3 cats lately.  I really am way too old for this!

For the Cat Lovers out there…….

With a house full of cats I usually can’t always react immediately when I notice something slightly wrong with one of the cats.  Last May I decided to take Charlie to my cat vet.  My previous vet, who treated both my cats and dogs, did not have a good track record when diagnosing or treating my cats, so I went back to the exclusively cat practice I had used years before.  PERSONAL OPINION – in my experience most vets know more about dogs than they do about cats.  Most of the vets I’ve used over the years have personal dogs, rarely do they have a cat or cats.  I don’t know if vet schools focus primarily on treating dogs or if dog “owners” comprise a higher percentage of veterinary clients than do cat “owners.”  Personally, I think that the veterinarians who specialize only in cats generally have a better track record when diagnosing and treating cats.  Unfortunately, that wasn’t the case this time with Charlie.

This is Charlie last Friday, after his last vet visit.  Thanks Carla for the photos.

Charlie was always the first face in the food bowl, but he was losing weight.  My first thought was hyperthyroidism, possibly even diabetes.  His blood panel said no to both.  In fact, his blood work didn’t point to anything wrong.  He had some teeth extracted several years earlier due to plasma cell stomatitis.  The vet said he needed the rest of his teeth removed and felt this was the reason he was losing weight.  Although he was severely under weight, I agreed to the surgery, and he came through it quite well.  In fact, he started doing a bit better…..for a while.  Fortunately, he stayed stable while I was in the hospital in August and September.  Focusing primarily on my slow recovery, I didn’t take him back to the vet until February.   He had lost even more weight.  His blood work did show elevated levels for his kidneys, but not renal failure.  Nothing else appeared to be troubling with this second blood panel.  I continued to feed him 4, 5, 6 times a day, whenever he wanted to eat.  I gave him from 60cc to 100cc of fluids daily.  He was seriously dehydrated in addition to the weight loss.  I lost his brother Chaz in March and my eldest dog, Caleb, and another cat, Colin, in the ensuing months.  I took Charlie, Cissy and Claudia to the vet.  Cissy’s kidneys weren’t in great shape and Claudia had developed hyperthyroidism.  Charlie remained undiagnosed – his problem was a mystery.

Back in May, 2010 I had suggested to the vet that I thought Charlie had a malabsorption problem.  Basically, I felt that although he ate well enough, he simply wasn’t absorbing the nutrients from the food.  I was told that definitely could not be the problem.  During the past year, with the loss of so many animals and my health at its lowest ebb, I was frustrated and depressed.  I was watching Charlie struggle to stay alive and depending upon me to make him feel better.  I had declined a sonogram and the TLI/PLI test (which requires fasting – something I didn’t think he could or should be subjected to).  I had continued, throughout this treatment period, to ask about malabsorption.  The vet felt that he could have IBS, irritable bowel syndrome, although he had none of the typical symptoms.  I asked to try the treatment for IBS – steroids – but they failed to produce positive results. 

I took him back to the vet last week and asked to have a T4 test, for thyroid, run.  The vet ran a full blood panel and the T4 came back normal.  His kidney values had decreased somewhat, which was a good thing.  We talked for an hour after the results were in.   Malabsorption and IBS were discussed again.  I explained that I had suffered from IBS several years ago and I was/am convinced that was not his problem.  I don’t remember how she finally told me about exocrine pancreatic insufficiency.  This occurs when the pancreas does not produce the normal digestive enzymes.  Needless to say, I latched onto that.  It was the answer I had been searching for since last May.  I feel certain this is what has plagued him for all this time.  I’m also convinced that this is what killed Clark last year.  He wasted away until he simply no longer had the strength to eat.  I am, at least, hopeful now that Charlie has a chance to recover.  He’s on medication that gives him the pancreatic enzymes needed to digest his food.  He’s had a shot to bolster his production of red blood cells as well as a B-12 shot.  He also has to take folic acid tabs to help boost the iron he needs. 

The moral of this story:  don’t take “I don’t know” for an answer.  No vet has all of the answers and your cats/dogs are depending upon you to be their advocate, to search for the cause of whatever is causing their illness.  It’s okay to question a vet.  If your vet won’t listen to you – FIND ANOTHER VET!  Your animal’s life depends upon it. 

NOTE:  my favorite veterinary website online is - http://marvistavet.com/html/the_pet_web_library.html  It was this site where I discovered plasma cell stomatitis, which affected so many of cats several years ago, and nearly killed Chase.  My vet, at the time, was not concerned that I had so many 5-6 year old cats who needed multiple tooth extractions.  Even though I frequently expressed my concern that there was some root cause, she did not bother to dig any deeper to find what could be causing this.  My cats had been exposed to calicivirus years before, with only some of them getting sick from it.  Calici is a known cause of plasma cell stomatitis.   

BTW, according to the internet, exocrine pancreatic insufficiency is RARE in cats.  It is most commonly seen in dogs.  Personally, I don’t think it’s rare.  Instead I think it is misdiagnosed.  I doubt that most people request a necropsy to determine cause of death.  If they did, I think the incidence of this disease would show that cats suffer from it much more frequently than veterinarians believe.  

Charlie & me last Friday