Whispers health part 4
Night after receiving the diagnosis was hard but I manager to fall asleep. Rest of the weekend was mostly spending time with Whisper. I was slowly getting used to the thought we will undergo a 6 month long treatment. I had hopes that it will make her live a few more years with us. I was looking for positive sides. Experience gathered while taking care of my own cat, would help me in similar cases with my patients. Break in the cattery was forced in a way, but I was hoping to use this situation as well. At first I was thinking about catching up with cat shows for Elma and Helen, but we gave up that idea in the end. We didn’t want to bring anything home that could have threatened Whispers health. It was enough that we take the time to clean up other cats teeth and general rest from the litters.
On Monday we collected Whispers blood sample for control hematology and biochemistry. She was still receiving antibiotics because of renal biopsy and cystitis. Usually for urinary infections it was recommended to treat for at least 14 days.
With introducing chemotherapy we wanted to wait until Wednesday. We wanted to plan therapy in the way that fits our schedule for next 6 months as well. We had Whispers baths to consider, cleaning up, desinfection after administering chemo. Regarding my work I wanted to avoid the risk of getting her sick. It was easier to do all that during weekends but on some of them I had my postgraduate studies. It had to be properly arrange for me to be home on time.
On Wednesday I’ve noticed enlarged pupils in Whisper. There was no proper reaction to light. I didn’t know what was going on. She had trouble seeing properly. First I took her blood pressure, as this kind of symptoms go along with hyperthension. But her BP was within normal range. So was her eye pressure as well. In clinical exam and repeated blood test there was no other abnormalities. At first I was connecting this with diagnosed lymphoma but dr Estera Zawłocka – Hutny, that I contacted about this case, didn’t confirmed this kind of symptoms come along.
What’s good of this horribile situation was that I haven’t given her chemo yet. Otherwise I would think this is due to medicines. But since she didn’t get it, it souldn’t be it. It helped me avoid a mistake and find the real cause.
Digging through interned articles, medical data etc. took me the whole day. I found few more reasons for Whispers eye problem but the one that fit most was hardly possible. There was data about rare cases (one in 270 thousand! Patients) enrofloxacine may damage the retina in animals. Few of my colleague vets said I was thinking to much and it wasn’t possible I had such a rare case. They’ve been using this antibiotic very often and never have heard of such a problem. But my intuition and publications that I found were saying otherwise. Although I wish I was wrong. Mechanisms of this condition are not well known yet and most of the cases is irreversible causing blindness.
I decided to verify my worries on veterinary ophthalmologist group. Unfortunately many doctors confirmed, that this problem doesn’t occur very often, but it takes place. One of the Universities even does research on this case of side effects. There are reports about restoring partial sight in some patiens. But most of the prognosis were not optimistic.
From what I read in few sources, the cause are disorders in the retina that make it more sensitive to light. Additionally there is problem with blood circulation in the retina and blood vessel atrophy. Worsening blood supply to the retina makes it loose it’s properities what results in blindness. Few days after first symptoms are crucial for further prognosis.
I was on the edge of breakdown. Few days earlier I was trying to settle after diagnosis of lymphoma. Now I was forced to face the fact that Whisper may be blind. I was blaming myself because I set her on antibiotic for urinary infection. Most of my fellow doctors never have had such a case while using enrofloxacine, or even heard this may happen. Despite the fact I couldn’t predict this would happen, I was feeling awful. In this kind of situation I was having doubts in myself and undermine my job as a vet. I was seriously considering changing career. If I can’t keep my cats safe from this kind of situations, maybe I’m not good enough to be a doctor…
The only thing that I could do, was to minimize the side effects. Enrofloxacine was taken away immediately when I started suspecting it may be causing it. Whisper received specially ordered supplement, prepared to help improve proper eye vision. Additionally she was receiving meds to improve retinal blood circulation. Considering increased sensitivity to light we decided to separate her in cat room with no light for the next week. What’s more we also functioned practically without light. We turned off led light by the floor in the hallway. In the morning we used selfphone light to get dresses and we kept blinds closed during the day. Whispers litter box was cleaned in the dark, as well as her food and water bowls. It wasn’t easy but it was at least we could have done. Luckily it was January so days were quite short. Other cats spent their time in the living room as it was far enough for cat rooms, to keep the window uncovered for them. We postponed chemotherapy untill the situation resolves or settles.
After around 10 days (we made it a bit longer just in case), we got back to normal step by step when it comes to light. Whisper was still received her supplements and blood circulation meds. From what we were able to notice, she didn’t lose her sight completely. But it didn’t get back to normal either.
Opthalmological exam showed blood vessel atrophy. Unfortunately it didn’t improve despite the meds Whisper was getting. We’ve consulted dr Garncarz, who left us no hope. In his opinion Whisper was completely blind. But from her, we couldn’t tell that. Around the house she functions like before the incydent. Probably other senses compensate lack of vision in some part. Smell, air movement sensed with her whiskers, hearing and memory help her find herself at home. We try not to change anything too much. But in our opinion Whisper has kept partial vision. When she was in the cat room, behind glass door, she cannot feel air movement with her whiskers. Waving a hand or toy (that doesn’t make a sound) behind the glass doesn’t make noise, and still she follows the movement as she sees it.
With much difficulty (because I was still blaming myself) I was coming to terms with the fact that Whisper lost her sight. Whats good about it – she’s doing pretty well. Despite postponing chemotherapy I was glad she didn’t got it as it was planned. Otherwise I would probably missed the real cause and this is side effect from chemo. After this situation I also verified antibiotics that I use in everyday practice at work with my patients. Even if this kind of side effect happens in 1 on 270 000patients and helps 269 000 others, I would stop using it for that one. Luckily in case of fluoroquinolones, enrofloxacin can be replaced with marbofloxacin, that doesn’t cause such side effects.
