I was told a while back that I needed to give an update on Jack. Life has been busy, so here is how it all turned for him:
When I decided to share Jack’s story, everything was going pretty well. I thought he was out of the woods by then, and there wouldn’t really be more to say. Jack and his wounds had other thoughts on that matter. Twelve days after putting him back together, he got his e-collar off and started licking his incision. His mom brought him into work the next morning to have him assessed. I wasn’t there, so my colleague sent me the update that there was a large piece of dead skin on his side and that he needed a second surgery. She sent out a new culture of the incision and added him to my surgery schedule for the following day.
The second surgery went well. At first I was concerned that I wouldn’t be able to close the second wound after removing the dead tissue, but the site came together beautifully in the end. Jack started another full two weeks of strict rest and sweatshirt/cone-wearing. His second culture came back resistant to just about everything. I had to treat him with an injectable antibiotic that had the potential to kill his kidney function, which made me very nervous. It’s definitely not anything that has been my only choice before.
Thankfully, Jack’s kidneys tolerated the amikacin well, and he tolerated the injections well-enough to get them in daily for 10 days. He was out of his cone and able to have free run of the apartment by Easter Sunday. At one point, he had a small area near his incision that seemed to be taking a tiny bit longer to fully heal than the rest of it, but I haven’t heard that he’s had any misadventures since.
In other cat news, the little cat that I had surrendered from a client back in November continues to keep life interesting. She has now seen more specialists than any other animal in my personal care to date (may no one take that statement as a challenge they must take up), as she went to the dermatologist in December, saw a cardiologist last month followed by our radiologist later that week for an abdominal ultrasound. Overall, she’s doing well, but she’s a medical mystery that I can’t seem to tie neatly together.
The wound at her shoulders is no longer red or crusty, but she got her sweater unzippered at some point on Easter Sunday, ripped out a bunch of hair from the area and created two small, superficial ulcers that healed quickly. I had tried to decrease one of her medications from daily to every other day a little over a week prior to that. Obviously, that idea failed miserably, and her dermatologist said that she wants to do skin allergy testing on her next. She had told me back in December that she wouldn’t do it without an echocardiogram because of her heart murmur and the elevated proBNP test from November.
The cardiologist I contacted was just as wonderful as my colleague and the reports I have gotten from him regarding other patients had built him up to be in my mind. He made time to see Ferne (that’s the cat’s official name, and I can write it now that Justin knows she does have a name that is not just “Caaaaaattt!”) within a business day of my contacting him. He allowed me to come in and watch the echo and EKG and ask questions in real time. The good news is that her heart function is good, and it’s mostly structurally normal. He said her murmur is benign, caused by those likely age-related structural changes. (She may also be older than 7.5 years, given that finding.) HOWEVER… when he listened to her heart, he thought that he heard an occasional ectopic beat. We were all surprised when he hooked up her to the EKG leads and saw, not ectopic beats, but a ventricular arrhythmia that alternated back and forth with the normal sinus rhythm that she should have. Neither of us knows why she’s doing that. He said to look for something systemically inflammatory and that if Ferne was a dog, he would suspect splenic disease.
This leads us to the radiologist. Ferne’s abdominal ultrasound was 100% normal. On her chest x-rays, she may have some subclinical asthma. We also sent out a tick/vector panel, as many tickborne diseases can cause endocarditis (inflammation of the heart) and could be the cause of the arrhythmia. Unhelpfully, that panel was negative. Currently, Ferne is scheduled for a dental with me on Wednesday to address her resorptive lesion (of which I sincerely hope there is only one; please cross your fingers for us all) and clean her teeth. Her allergy testing with the dermatologist is set for May 24th. I have to send a follow-up EKG to her cardiologist in June sometime and recheck her proBNP in October. If the proBNP further elevated/above 800, he wants her to have another echo at that time.
If this isn’t enough for Ferne, she’s had 3 instances of randomly swollen body parts in the past month or so. I have no idea if these swellings are related to one another or to any of her other problems. The week before Easter, I noticed that her right front paw was about 2.5-3 times the size that it should be. She was not limping and had nothing else obviously wrong with the paw. It resolved 100% in about 2-3 days without any intervention. I assumed she had somehow done something while jumping in or out of one of the windows she’s always sitting in. Then about 10 days ago, I went to feed her breakfast and saw that her left front paw was swollen, although not to the extent that her right front had been several weeks prior. This also resolved without treatment in about 2 days. Last Wednesday, I came home from work and went to feed Ferne, when I noted that below her right eye was puffy, she was squinting and maybe had a little clear discharge at the corner of it. I put some acupuncture needles around the eye, which she allowed very nicely for 10 minutes before taking her paw and swiping them all out. The following morning, she was looking much better, and by Friday morning, she looked completely normal again.
One of my colleagues suggested that her sweater caused an impingement of some kind and subsequent back up of her lymphatics causing the paw swellings. I can’t remember if she was wearing the same sweater both times or not, but she hasn’t worn the sweater from the second instance again since. After the eye swelling, one of my former colleagues suggested calicivirus. I have a PCR test pending for that, although it would be strange. Her dermatologist theorized an allergic flare of some kind and wants me to let her know if it happens again before her allergy testing. Her cardiologist does not believe that if her swelling events have anything to do with calicivirus that the virus would be causing her arrhythmia, as he has not heard of this virus causing cardiac problems, and he feels that she would be more clinically sick. I rechecked full blood work on her at work Thursday too, and it’s mostly normal. Her urine is a little dilute, so just another thing to watch for now, I guess.
None of these recent events were at all the plan for Ferne when she was signed over. She was *supposed* to just have some severe eosinophilic plaques that would heal in 2-3 months and a benign heart murmur and go off and find a new home for herself. The more things she adds to her ever-growing list of maladies, the less likely anyone else would ever consider taking her on. She is sweet though (except to my techs trying to steal her blood on Thursday- sorry, guys!), and she most definitely loves me, if no one else. She shows it by sleeping on top of me every night for last 2+ weeks. When this one cat is done with me, I’ll probably be more of a cat medicine expert than my colleagues that LOVE cats. Maybe I’m a little honored that she and fate chose me to try and figure her out, but at the same time, it was not my intent to still have her with me, trying to sort her out, six months later.
“Cats choose us; we don’t own them.” ~ Kristin Cast
