Whispers health – part 2
After previous tests and treatments (more about it HERE) it was time for checkup. Whisper was feeling pretty well and the only worrying sign was licking her belly. This type of behaviour is observed in patients with abdominal problems. It can be due to cystitis, gastroenteritis, ovarian cysts, tumors, or constipation, In rare cases it can also be related to stress (it can be compared to biting nails in people).
Unfortunately ultrasound showed that previously diagnosed changes were still there on a similar level. Additionally renal cortex was a bit brighter than it should, It could have been related to Whispers age but it already set a red light in my head – considering all the other problems. Mesentherical lymphonodes were also enlarged what may happen in inflammation proces of the intestines or in oncological proces.
We’ve decided to run further diagnostic test, but these required more invasive methods than ultrasound or blood samples. Confirming or ruling out IBD is based upon histopathology. And this means we had to get samples from changed organs. In this case it should be abdominal lymphonodes and small intestinal wall pieces.
Laparotomy was firstly planned for beginning of December. Unfortunately Whisper got runny nose few days earlier. We had to restore her health and raise her immunity so we decided to postpone the procedure. When she was feeling better after few days we wanted to give her a bit more time to fully recover.
On the beginning of January Sally & Sidney had their spay. We took Whisper along with them for blood collection. Some of the results came along quite fast, we had to wait for the rest. This time vitamin B12 level was within normal range. Yet it was still supplemented (which meant the dose was correct). Liver, pancreatic and intestinal parameters were ok as well. Urea – one of renal indicators was also within normal range. Creatinine seemed also ok as some labs give range up to 168. But according to IRIS (International Renal Interest Society) it shouldn’t be above 140. Whispers result was 148.
As I wrote before, while explaining Dziabąg’s results (TUTAJ), creatinine is a parameter that can be falsely elevated. That’s also why we ordered additional tests for phosphorus and SDMA. SDMA is a biomarker for renal function more independent than creatinine. High phosphorus can cause endocrinological changes (it influences parathyroid function) that force kidneys to work harder.
Whispers phosphorus was normal and on proper level (for nephrological patients it should be lower than for healthy cats). Unfortunately SDMA was a bit elevated. While normal rang eis between 0-14, Whisper’s was 17.
Sometimes being a doctor turns out to be bad for me, when it comes to my own cats. I always hope for the best, but I also know what is the worst that can happen. With my patients I try to save some distance to be more objective. But when it comes to our cats, it’s like I’m set in panic mode. In both cases I know what should be done, but with ours I have this fear all along. Fear for things that I have no influence on.
Inflammatory bowel disease can look very similar as early stage of lymphoma in ultrasound. In cats the second one can have many forms. For example alimentary lymphoma, multicentric or solitary form etc. There are two types when it comes to agressiveness and development. In calssification we have asympthomatical and sympthomatical form. The other one is much worse. Early detection is crutial when it comes to oncological problems. It allows to start treatment and prolonged good quality life. For ex. Chemotherapy with early stage type II gastrointestinal lymphoma can achieve remission up to 2-3 years, while with advanced stage is only around 3 months.
Considering such differential diagnosis we took a difficult – but I think – right decision. Despite a bit elevated renal parameters we planned the surgery. We didn’t know if the parameters wouldn’t worse in time, which may mean there will be no better moment for laparotomy. We took any precaution to make it as safe as possible. Even patients with chronic kidney disease (luckily Whisper was not in that group) undergo surgeries if there is a need for that. It requires special approach during pre and post- operative care as well as during surgery. It has to be assessed individually and may mean additional fluids, oxygen, different sedatives.
In Whispers case – risk of anesthesia was not that great. Although the procedure itself was invasive, there was no other way to make a diagnosis. We decided to get samples from changed abdominal lymphonodes and 1 or 2 pieces of intestinal wall. Additionally we’ve collected kidney biopsy due to blood tests abnormalities. It was also important to get an urine sample. Because she get’s stressed at the clinic, considering upcoming surgery, we decided to collect it while she is sedated.
Whispers preparation started even before the surgery itself. She had another blood pressure control, that came normal. On Thursday evening, right after our return from holiday, Whisper received antiemetics along with calming and painkiller – gabapentin. It’s recommended before vet visits for afraid or stressful cats.
On Friday morning she had some light breakfast regarding fasting time before anesthesia, which should be 5-6 hours. In cats longer withhold of food is not recommended as they are more sensitive for it than for ex. dogs.
Whisper is a cat that doesn’t take anesthesia easily. We got to learn this during her previous procedures like teeth cleaning or spay. Sometimes fully recovering took her even 48 hours. In comparison to kittens, that we spay before leaving, it’s quite long. Little ones behave like nothing ever happened just 1-2 hours later (and here’s another argument in favor of early spay).
We cared about least invasive anesthesia and smooth surgery. That’s why we went to Aura clinic in Łochowo near Bydgoszcz. They owe advanced equipment for inhalation anesthesia. Procedure was done by dr Rafał Bernacki, who is a qualified surgeon. He was assisted by one of my former students and last years absolvent – Agata Brożek. Whispers anesthesia was supervised by Agnieszka Wejna – a qualified veterinary nurse, graduate from Royal Veterinary Collage. We chose sedatives before together, considering their influence on kidneys. While premedication, Whisper was receiving oxygen (kidneys use a lot of it). While the surgery she was on a heating pad and all her functions were closely monitored. After sedation I was not present during the surgery itself. To save myself and the surgical team – that I know outside the clinic, some stress. I was called for the operating table only when organs were evaluated and decisions had to be made about collecting samples for further diagnostics.
When they opened the abdomen, it turned out that most of mesentherical lymphonodes is enlarged as well as those near ostium ileocaecocolicum (changes start usually at this place). From good news – there were no macroscopic changes abdominal organs (pancreas, spleen, intestines and kidneys) had no pathological signs. This may suggest not an advanced proces or remission of symptoms. We got to collect or the neccessery samples along with renal biopsy. A urine sample was also taken by cysthocentesis. Bladder punction is the best way to collect it for microbiological test as it doesn’t contain any bacteria from urethra and vulva. All that has remain was to suture the abdomin and put Whisper to the incubator sos he can easily wake up. There were no complications during surgery. Anesthesia itself also went smooth. Our goal was achieved. Theoretically the worst was behind us.
Why theoretically? Because despite our efforts, Whisper recovering was taking long time again. When we took her home she was already awake but not yet back to normal. It wasn’t due to pain as we took care of that. In the evening after laparotomy, she didn’t want to eat but we were prepared for that and gave a vitamin fluids instead. When she got she felt a bit better but still didn’t look for he bowl. I managed to convince her for few kibbles in the middle of the night. That was a sign she was getting better.
Another sign to look for was urine – first pee after surgery suggests that kidneys are functioning well. I was scared that there might be a problem after kidney biopsy. Blood in urine or nothing at all would be worrying. First litterbox was on Saturday afternoon. And only after bringing it to the Lady straight to… bed (we needed to get rid of the liter from sheets afterwards). There was a lot of urine – probably due to the fluids given. Luckily the color was yellow as it should be.
Whisper was a bit more active and interested, but she still didn’t want to go out from bedroom. On Sunday she decided to take a walk to the living room for the scratching post. But soon after she got back to bed (maybe because sick Tomek was staying in it). Another step was first poo (this is something that brings relief to pet owners and babies parents). Auscultating the abdomen gave me info that peristaltic is present. Although late appetite and not much of it, made me think that I will have to wait a while for it. She was staying in bed all day and so did we. Sometimes both of us, or we took turns so she’s not alone.
During weekend I had to go to Olsztyn for my specialization course. Considering that histopathology of Whispers samples, was suppose to be evaluated by my University, I took it with me for the classes. Although the department doesn’t work on weekends, but thanks to my friend, they were getting samples first thing in the Monday morning. Timing was perfect, because Monday was 3rd day after collecting it and that’s exactly how long it should stay in phormaline before further processing. Which ment they could go ahead with it right after taking it in.
For first results we had to wait for at least 7 days. That’s how lon git takes to prepare to specimen for microscopic evaluation. If the worst scenario was to confirm – lymphoma – I already asked tchem to run further tests to specify what kind of cells are involved. This may be crucial for further treatment. I was still hoping it turns out something else. Still I had a whole stressfull week. Whisper is our first thai cat, she was with us since the beginning of cattery. She was my only companion during my studies and I am most attached to her from all our cats. She is also the oldest one. I used to think she will live at least 20 years with us and I still hope so. But back then, waiting for results I was really afraid.
We’d like to than the whole team of Aura Veterinary Clinic in Łochowo, for understanding, patience and professional approach.
