Castiel Comes Home from Hospital

We had a  good check-up this morning.  Aside from taking out his medicine catheter last night and fussing with his cone, Castiel did well overnight. The nurse said he was trying to ambulate, although he was not doing too well at balancing yet.  She said he ate three small plates of food and peed, although he wasn’t able to get to the box yet. He is still on some very strong pain relievers. She said he was doing as well as could be expected after such a major surgery. The doctor said he could come home this afternoon.

We finished setting up his recovery rooms in the morning. We moved the furniture out of our guest room and took the futon mattress off the bed and placed it on the floor so that one of us could sleep with him in the room and the other upstairs with  his tiger siblings so no one would feel lonely. We figure we’ll rotate nightly. We also have a large soft crate with lots of padding that we can move him around in so he can be wherever we are.  He likes that.  We have tons of wee wee pads and a low litter box. We also have a nice soft sofa style cat/dog bed that is very low in front that he can nap in when we bring him out of the soft crate and can supervise him. All the beds and bedding are machine washable.

At 2 pm, the nurse carried Castiel out in his carrier. He was so happy to see us! He immediately gave us happy meows and combo purr-meows. We told him how much we loved him and petted him and cooed over him as we loaded him into the truck to head home. We thanked the nurse and asked her to please tell the doctors and all the staff thank you and let them know that we were very grateful for the excellent care Castiel received.

We brought Castiel to his recovery room and he was so happy to be out of the carrier.  He immediately wanted to try and walk around. He kind of hopped about. He is working on the balance thing and the drugs were not helping with the that, but he wanted to try. We had to settle him on some soft blankets. He tried to use his litterbox – he was a bit wobbly and it took a few tries. He wasn’t good at lifting his rear but he did use his box.

Eventually he snuggled into a fluffy comforter we placed on the floor for him and rolled around in the sunshine waiting for belly rubs. He is so happy to be home and he seems like Castiel. He’s making happy meows and purrs and he is enjoying chin and bum scratches, and lots and lots of belly rubs.

He has some frustration that he has vocalized with learning to walk and balance but he keeps wanting to try. The litterbox balancing act seems to be the most frustrating. We  have a low box with an even lower front entrance and supports on the side of the box to use for balance — he’s trying to get the hang of this but mostly sits in the box when he has to go. We have wipes to help with cleaning. He also needs a little help with the digging, but we got that.  I think he’ll figure it out, it will just take practice.

He is also a bit frustrated with his large crate.  He wants to move around. If he would sit still more we could let him out under observation but he wants to roam so he is sitting in the crate — enforced rest. He finds this frustrating and spent a good amount of time telling us all about it.

We’re feeling a little better. Most importantly, he still loves us. He was happy to see us, and he still seems like Castiel. Silly, goofy, parlor panther. Both his siblings checked in on him. We let them into his recovery room and observed them closely. They mostly sniffed everything and him, but no one hissed, ran away, or acted out. They seemed glad to have him home too. The nurse said Castiel might not want to eat much. He came home and gobbled down his food (small portion so he didn’t get sick). He had another small plate for supper. He is snoozed out in his crate now. It’s been an exhausting day.

Castiel has been given three medicines (1) Robenacoxib 6mg tablets, which we give 1 once a day to reduce inflammation. He has to take that with food; (2) Buprenorphine 0.3 mg/mL oral. He will take 0.2 to 0.3 ML on the gums every 8 to 12 hours as needed for pain.  However, he doesn’t start this until drug until 6+ hours after he has completed the fentanyl patch (so, Monday night/Tuesday morning). We are to give one of these by mouth every 8 to 12 hours as needed  for pain;  and (3) Gabapentin 50 mg Tiny Tablets. He takes one tablet by mouth every 8 to 12 hours as needed to control discomfort.  The nurse explained the side effects to watch for and what to do if we were concerned about a reaction.

We were told to carefully watch his incision for any signs of infection, and report any signs to his doctors immediately. He is also not to lick or scratch his incision, and it is not to be cleaned by us or his siblings. We were told to watch for a seroma. This is a fluid filled sac that sometimes happens after these kinds of surgeries. We were told they could swell for several days. If he gets one, we are to place a warm compress on it 3-4 times a day for 5-10 minutes at a time.

We’ve also been directed to treat his incision site with a cold compress 3-4 times daily for 5-10 minutes for the first five days.  The compress is wrapped in a towel so the cold pack is not right against the skin. Castiel hates this. We got 6 minutes in before some major fussing. Working on this.

The doctor said Castiel should be confined to a small room without furniture or a large crate for the next three weeks. We’re doing a bit of both so he can join us in the rooms where we are — he likes this, although he fusses for a while in the crate before settling down. He is not to have free access to the house or furniture. He doesn’t go outdoors; but if he did, that would be strictly prohibited. He is also not to run, jump, play, tackle stairs, etc. during this initial recovery period of 14-17 days. His body needs time to heal and we want to keep his sutures in place. The instructions we were provided have a note that says, “Cats are notoriously difficult to rehabilitate with exercise restrictions, but every attempt should be made to minimize activity which may stress the surgical repair.” Yeah, no kidding.

He has a follow-up appointment in two weeks on November 10. We hope to get the pathology results sometime next week. Hopefully, he will have a good rest tonight knowing he is safe in his home with his siblings and hoomans who love him. Our vet friend called to check up on him too — we thought that was super sweet and were very grateful.  Castiel has also received lots of love, support, and prayers from our friends and from the parishioners of St. Paul’s Episcopal Church here in town. We are so grateful to everyone — and especially to those in this community.

Castiel after surgery

 

 

Surgery Day

This morning, we woke up with Castiel snuggled between the two of us. He was purry and lovey. We nuzzled him and kissed him all over. In fact, we kissed him so much that he had that look that said, “blech… too much hooman kissing.”  He quickly caught on that this wasn’t going to be a normal morning when breakfast didn’t arrive on time. He’s naturally suspicious of any change in meal times and quickly sought out a hiding place behind the wicker chair.

At 7 a.m, we scooped him up and into the carrier and headed to the vet hospital.  We were told he had to be there by 7:45 am and with rush hour traffic this meant an early start. On arrival, we sat in the car and phoned in our check-in. While we were waiting for the nurse to take him in, I wrote out a little message to be sent in with him. “Please take good care of our parlor panther Castiel. He is our sun, our moon, our stars — our everything. We love him so much! Thank you, Michelle and Brian.”

When the nurse came to pick up Castiel, we petted him through the carrier, told him we loved him so much, and gave the note to the nurse to show the doctor and others. I was crying  and heaving uncontrollably and trying to catch my breath between sobs. The nurse said she would give Castiel a sedative when he went in, and she said that, she wished she had one for me too. I wished she could give me one too.

At home, we collapsed on the couch physically and mentally exhausted, committed to this path, but still unsure if we were doing the right thing or if it would work out. We just hoped right now that he would do well during the surgery. One step at a time.

The surgeon called around 11 am. Castiel was in recovery. He said the surgery had gone well but taken longer than he thought it would originally take due to the need to avoid the previous surgical suture. The surgeon said he normally would have made a Y-shaped incision but because of the previous suture and the need to get wide margins, Castiel had a crescent moon shaped incision.  I guess, he didn’t want us to be shocked, although I’m sure we will be anyway.  Castiel’s vitals stayed well throughout the surgery, including his temperature. The surgeon said it didn’t drop below 100 (Cats have higher normal temperature than humans). He said that during the surgery and afterward that Castiel was placed on a warming pad. He told us that he was resting and that he was receiving injectable pain medicine (Fentanyl and Ketamine) and fluids.  He said that Castiel was being monitored closely. He said when Castiel went home, that he’d have a Fentanyl patch for a few days, followed by Buprenex and Gabapentin for pain control.

We called again later in the afternoon for an update. The nurse said that Castiel was recovering well. She said that  he was a bit groggy when he came out of surgery and that this was to be expected. She said that his vitals were good and that he was warm and comfortable. He was receiving pain medicine and fluids. She said that he had moved around in his recovery cubicle napping here and then elsewhere. She said he was napping now, which was normal after a big surgery. Normal for him regardless. I reckon he naps about 16 hours a day on a regular day. She said he would be monitored 24/7.  She said that he would be offered food this evening, but not to be concerned if he didn’t eat because sometimes cats don’t feel hungry after the anesthesia and pain medications or because they are nervous.  She said he was a little hissy before the surgery and that he had some diarrhea.  Apparently, he gave her the flattened ear look.  We told her, he was scared and both the hissing and pooing were typical of a nervous Castiel. She said she understood and that the nurses and doctors were used to nervous and scared patients. She said that he hadn’t peed yet but explained that this is something cats are often hesitant to do at vet hospitals. She said if he was well enough, he could go home tomorrow afternoon. She said the nurses and doctors had shared the note I wrote asking them to take good care of Castiel.  She said it was now taped to his cubicle. This brought a smile to my face.

The nurse said that we should call again for an update tonight before we went to bed so that we wouldn’t worry and could get some rest. We’ll worry anyway. It’s what we do.  We will definitely call though. We hope he has a good night. Fingers crossed.

In the interim, we did what someone suggested – we got everything set up. We received a new ramp today and assembled it and placed it by the bed. We moved another ramp down by the sofa and set up a step so he can get on his favorite chair.  We have two low wide litter boxes, a balancing step, two onesies, several raised dishes and two cat calming diffuser plug-ins. I don’t know if we are ready but we did prepare for his return home. Much of the house is now ADA-cat accessible.

Now, if I could just get his tiger (adopted) siblings to eat. They are looking for him. I wish I could explain and prepare them.

Castiel and his siblings. Our lovely black cat is undergoing surgery this morning. He has cancer, and unfortunately the only real treatment is amputation. We’re going to bring our lovely three-legged cat home tomorrow.

Castiel has a Surgical Consult

Once again, we handed over our little panther to a vet technician who carried him into the vet hospital. We were relegated to the parking lot  for the next hour and a half.  COVID regulations make what is already impossibly difficult worse. We understand the need to keep the medical staff safe and disease-free but separating us from Castiel at this time was so difficult. We wanted to be there to reassure him, to comfort him, to pat his little head. We wanted to see the doctors, see the facility, be reassured that he was in good hands. We wondered what was happening behind the curtain.

About an hour after handing him over to the technician, the surgeon called us. We put him on speaker phone so we could both hear. He wanted to know we were sure of what we were asking. He said, ” I can take it off but I can’t put it back on.”  We weren’t sure… we weren’t sure of anything. We wanted to scream that. I’m sure we sounded a complete mess. We tried to breathe.  We had a list of questions prepared ahead of time. We asked him about his experience with amputation. We asked about his experience with front leg amputation. Did he follow up with patients — how did they do? Did he think Castiel would adapt despite his age and tubbiness? He thought he would. He said it would be harder for Castiel with a front leg amputation because cats place most of their weight on the front. But he thought he would figure it out. He said he thought Castiel was otherwise healthy and that he would do okay during the surgery. He  described the pain medicines that he would give and how we could manage Castiel’s pain. He said he would help us to make sure Castiel was not in pain. The surgery sounded incredibly scary – the removal of the whole leg and the scapula. Why aren’t there good prosthetic options. Why doesn’t Science know how to kill the cancer and save his limb? Why didn’t we study oncology. We felt useless.

We know we shouldn’t ask the question but we had to — you know the question. We all ask it. “What would you do if it was your cat?” What he said gave us pause. He said he would wait… he might assume more risk and gamble that he could wait a little longer until the cancer started growing and then maybe remove the leg. We didn’t know what to think. Was it like the stock market — some people are comfortable with more risk where others are more risk averse or did he maybe think Castiel wasn’t a good candidate and didn’t want to say so directly. We asked for clarification. He said it was like the stock market. He would gamble a bit more — take on more risk for perhaps quality of life, or at least that is how we understood it.  But he also cautioned “that when the pathologist says the cancer will come back, in his experience, 99 percent of the time, it does.” He didn’t think removing the leg was the wrong thing to do. He left the decision with us. He explained that if the cancer spreads, it would shorten his life.  He said the recommendation for this kind of cancer was usually  to treat it with surgery, radiation, and chemotherapy. He said he wasn’t an oncologist so he couldn’t speak to what was best for a particular cancer. We understood also that he was a surgeon, confident in his skills, possibly able to detect changes earlier and easier than us in his cat, and perhaps this went into his decision-making tree in answering our question.

We were uncertain. It is easier to make a decision when everyone agrees on what is best but that wasn’t what we were hearing.  We had heard sometimes that vets try to get a feel for where the patient’s guardians want to go with treatment and then advise along those lines. We don’t know if this is true.  We felt like we had received an independent opinion and we were grateful for it, even if it gave us pause. We were reminded of a friend who shared her experience with amputating the leg of her cat to try and beat cancer. In her case, however, the cancer had unknowingly already spread to the lungs and her cat only survived a year and a half. She said she was “haunted” by the experience. She said her cat didn’t adapt well and that “he was never the same.”  We appreciated her honesty.  Perhaps her cat didn’t do well because the cancer had already spread at the time of amputation or perhaps her cat was depressed by the loss of the limb.  We can’t know, but we felt her pain and despair, and it was real and palatable — and it scared us.

A family member who had been a vet tech for several years said she wouldn’t do it. She said she had never seen a good outcome. She said she would let him live out his life as is and let him go. We were horrified.

We went back and forth…we read more journal articles. We read books about how fibrosarcomas are treated in humans (much of it sounded similar). Should we rely on science and the information from the veterinary and oncology professionals or should we listen to family and friends who advocated for quality of life (no amputation) or letting him go. We couldn’t give up on him so it was between palliative care and surgery (and possibly adjuvant radiation). We changed our minds a million times a day. Emotionally, I can’t imagine him without his beautiful black paw that I have kissed countless times. I had nightmares imagining seeing it separated from him lying on a table. It was too much to bear. I wished I was the kind of person who could do something with stress — exercise more, throw myself at my work, drink like a fish, whatever — but I’m not.  I just lie awake agonizing in the dark. I think we know that the science suggests that the best likelihood for prolonged life  is to do the surgery and follow it with radiation. But science deals in likelihoods and medicine is not an exact science and never will be.  There are too many variables — too many unknowns. This is the biggest decision we have ever had to make. What if we get it wrong? What if the naysayers are right? My husband tells me that we will know that we did our best. Is that enough? I don’t know.  He’s our baby panther and we love him so much. He just can’t be sick.

Here is Castiel as a baby. This is my husband holding him on the day we brought him home

 

 

A Consult with the Veterinary Oncologist and More Tests

The COVID has made receiving veterinary care so much more difficult. We  had to hand off Castiel to a technician who brought him into the SAGE Vet Hospital, while we waited in the car. All our contact with the doctors was through a telephone call.  We weren’t allowed to meet them in person – even masked.  How do you know if you can trust someone you can’t see.  Cancer is serious — life or death stuff — and we were talking to someone we couldn’t see – whose reactions we could not judge. It felt like an impossible situation. The oncologist did not inspire confidence. I’m sure she is probably well educated — much more than us — but she didn’t answer questions well on the phone.  She paused a lot. She sounded uncomfortable and as a result, we were uncomfortable. We didn’t know what to think, maybe if we could have seen her — but we couldn’t.

The medical oncologist conducted a CT scan (a CAT scan of our cat, ha ha!) and an ultrasound to try to determine if the cancer had spread. They didn’t see any signs of spread. However, the CT showed a cyst or lump in one of his thyroid glands. This might be cancer or it might not.  Malignant thyroid cysts in cats appear to be rare in the literature but in reality, we didn’t know. Fibrosarcomas are supposed to be 1 in 10,000 — we were already unlucky. Could we be unlucky again?  Worse, the oncologist didn’t mention this finding to us — a vet friend who we phoned one night out of the blue, probably breaking all protocols, pointed it out to us and recommended we check it.  Why hadn’t the oncologist mentioned it? We asked her… she didn’t think it was anything to worry about. It could be but maybe it wasn’t. Ugh! So much uncertainty! We didn’t want to remove his leg if the cancer had already spread but none of the tests claimed to be 100 percent. How could we make this decision? How could we even consider it… we could hardly bring ourselves to even say the word “amputation” never mind visualize it or consider doing it.

We saw our local vet to test the thyroid — it was normal. No hyperthyroidism. At 18.3 lbs he was still a big cat and well-groomed despite his now Frankenstein suture and funny haircut from all the tests and anesthesia monitoring.

The oncologist recommended we remove his left leg and scapula to give him the best chance of survival and a prolonged life. She said radiation and chemotherapy alone wouldn’t likely work. She thought the cancer would eventually spread, and that the cells on the edges might be more aggressive. She also recommended radiation and chemotherapy.

Our mostly retired veterinary friend (Castiel’s first doctor ) — the man we called out of the blue, offered to review the medical results and help us understand what it all meant. He has probably had more years as a practicing veterinarian than we’ve been  alive.  We wanted a second opinion from someone we trusted and who had no money in the game.  We trust our local vet but we didn’t know about these strangers at the vet hospital who we couldn’t see and whose reactions we couldn’t gauge over the phone.  Cancer treatment is expensive and while we believed everyone was telling us what they truly thought was best for Castiel, we weren’t sure. Family suggested vets were in the money making business, and this led to doubt.   And worse, family members voiced that we should do nothing and  “just let him go.” They told us we were being cruel. We felt like monsters.  Our vet friend helped calm us. He told us that he thought amputation was the best chance for a longer life. He assured us that he thought Castiel would adapt. He said he wasn’t sure if he would do radiation and that it would depend on if we got clean margins.  He said he didn’t think cats had the same psychological reaction as humans did to the loss of a limb. But how could we really know?  I think we were already grieving for Castiel’s affected limb. Our vet friend listened to us and we felt a little calmer. Another friend from church brought us a hot meal that night and a bag of groceries – easy to prepare things.  These things made the hard things a little easier.  People on this website reached out to us — they gave us tips and advice, they shared their stories, and they listened to our fears.  We were grateful and felt less alone.