Femoral head incision

[Desley (booktigger)]

This weekend, Lucy has finally worked out how to jump on the worktops, for the first time since her op last March. Downside is that I've been able to leave things on there, so the first time she had her head in the bag of dreamies, the second time she took the closed bag of dreamies on the floor to chew through, and last night tried to rip through a paper bag containing a pasty for me!

[Desley (booktigger)]

Well, the first thing the vet said to me was ‘what did you do to your cat this morning, she was vile?’. I figured Lucy must have been bad as I was sent to get her out of the cage, normally I’m not allowed to do that – says something when the vet thinks Lucy is worse than her highly strung Bengal!! We have a new vet nurse, who hasn’t met Lucy yet, and clearly my comment that Lucy is difficult wasn’t the right words to use, they wound her up that much to get blood out of her, that the vet ended up having to give her a slight sedation – after she drew blood!! Last week she was good as gold, but she was really grumpy when I put her in the carrier, and obviously I wasn’t there to calm her down (not that that always stops her!!). Ionized calcium was 1.34 and the top end is 1.32, so practically normal, and she is obviously showing no symptoms, so we are wondering if the increase in renal food has skewed her calcium/phosphorus ratio. I’m going to reduce her back to 2 pouches of renal wet, and we are re-testing ionized calcium in a month – unfortunately that means she will be going twice next month too, I didn’t want to put her acupuncture back by a fortnight, we are already having to put it back a week as the vet is on holiday. Vet thinks her increased energy is just her feeling well, and wonders if the aggression towards the fosters is that after nearly 2 years, she is showing her true personality, we have always known she has issues with other cats. She has been quite affectionate since coming home, but as soon as I put my coat and shoes on this morning she raced up the stairs. 

[Desley (booktigger)]

Just done her 3 monthly bloods, her calcium levels are up to 3.09 (think the top end of normal is 2.9), the worrying thing is I expected them to come back normal, she is full of energy, and apart from a fur ball last week, she hasn’t been sick for over 2 weeks, although that could be why she is extra grumpy with the foster cats. So looks like I was right to be concerned, although yet again, I’m concerned about her kidneys and it’s really her calcium levels, although her calcium could have made the SDMA go up (was 13, now 16, top end of normal is 14) – I did mention my concern about calcified kidneys to the vet, and we are going to do SDMA every 3 months with her calcium levels. She is hopefully going for an ionized calcium test next Tue. I was concerned as I knew her behaviour meant something, but as it’s the opposite of last time (and the opposite of all the textbook symptoms), calcium didn’t come into my head, I had her T4 tested!! Being asymptomatic/opposite this time is a worry, I am going to be in the same position as Buster where we will have to do 3 monthly bloods to monitor things.  It just feels never ending at the moment.

[Desley (booktigger)]

Well, we haven't had a repeat of last week - at first I thought it might be the increase in renal food, but then realised that she hadn't eaten the third lot of it, and in hindsight, she was off her food on Fri, so I am wondering if it is connected to the cake she pinched out of my bag - although she often eats human food that she really shouldn't. I had cut out renal food this week, so will try it again next week and see if last week was just a one off or if that is the reason

[Desley (booktigger)]

Yes she Will, and for her that is all that matters

[Judecat (Paula)]

For whatever time she has left, she will be very well loved with you Desley. 

[Desley (booktigger)]

Yes, even the vet agreed at the moment we have the balance right and she is happy, but if we keep having weekends like last one, we have some tough decisions (in hindsight Fri was bad too) and I just want her to have years of love after such a rubbish start.

I do know she loves me, if she is feeling insecure she gets that close she stands on my feet, at the vet she even managed to get her paws on my leg!

[Sue P (Paddysmum)]

Insofar as Lucy can have a decent life Desley, you're giving her that already. 

I suspect that's something she recognises - whilst you may feel like an unloved and inadequate care-giver when Lucy is side-swiping or biting, I suspect you hold a better place in Lucy's life than you realise.   

[Desley (booktigger)]

I know, we've had such a bad year - when we first got her ckd diagnosis, as it was described as early stage, I hoped we'd be able to get 5 years, but this IHC diagnosis has thrown everything, I just hope that last weekend was a one off, we had only said on Thu that while she just needs two lots of meds a week it's fine, but more and it will impact on her quality of life. She's so intolerant of being messed with and her safe place is somewhere I can't get to her

[Judecat (Paula)]

Poor Lucy.

[Desley (booktigger)]

Had a bad weekend with Lucy, she was sick at 6.30 am on Sat - she isn't normally sick till the afternoon, so I give her Ranatadine about lunch time to make sure she isn't sick. I gave her some when I got up, gave it an hour and offered her some food, but she growled at me, which panicked me. She did eventually eat about 12.15, ate her tea, but not interested in supper, so had to give her another dose of Ranatidine, and got her to eat a small amount of biscuits 2 hours later. Gave her her calcium meds yesterday and she has been fine since, but I'm worried in case this means either the meds aren't working well enough, or that the renal food is affecting them. Will see what she is like next weekend before deciding whether to bring her blood test forward (currently booked for 30th)

[pandorawarlord]

you can never be right or wrong so go with what your heart tells you 

[Lyn (Slugsta)]

Hi Desley,

What a dilemma this is for you!  I completely understand your reluctance to put Lucy through more treatment but we are always worried that maybe we have not made the correct decision - we wouldn't be such devoted cat slaves otherwise! 

I would say, take your time over making this decision and go with your gut. Whatever decision you make will be based on love 

[Desley (booktigger)]

Thanks for the opinions, Sue, your comment about the surgery being beneficial is my neighbours viewpoint. I have to say, I certainly wasn't looking forward to being bit and scratched every day during recovery or the stress of it again - I'm not sure I'd have put her through the initial one if the vet had been honest.

[Rosella moggy]

If only we had cystal balls Desley    Can understand your decision either way. 

Surgery is always a risk that has to be balanced with likliehood of a sufficiently improved outcome esp where kidneys are not so good.  I really don't feel either decision is any better than the other.  Am sure you and your vet are best placed to decide.  Leaving things for a few more months to see how she is seems perfectly reasonable.

[Sue P (Paddysmum)]

It's a tough one, Desley and understand why you feel hesitant as to what to do.

My own feeling is that I'd leave her be, and see how matters progress.  Knowing how she is, and knowing how much she's already undergone, I think the quality of her life is the key thing, and there's no telling that the surgery would be hugely beneficial and worth the additional time being incapacitated again from Lucy's point of view. 

That said, if you decided you'd rather chance the surgery now, while her kidney function is still relatively good, then it would be understandable. 

[Desley (booktigger)]

Could do with some opinions please, not 100% sure I've made the right decision. I'm rather reluctant to put her through another operation, partly because she has already had 3 sedations since her CKD diagnosis, and partly due to the fact that it took nearly 4 months for her to be 'normal' enough after the first one for me to think that I'd done the right thing. I know part of that was the set back we had with the hypercalcaemia. She seems happy in herself, the only thing she can't do that she could pre-op is jump on my kitchen worktops, which I'm quite enjoying, I don't have to hide food like I used to!!    She obviously does have a limp, but that is always going to be the case as we've effectively shortened her leg, although it seems a lot less than it was. The vet thinks her funny stand is that the hip bothers her, and it does crunch on manipulation, so they do still feel she would benefit from surgery, but equally appreciate that she isn't an easy patient, so at the moment we are just going to keep with the acupuncture and monitor it, and if she shows signs of getting worse, we can re-evaluate. She does sometimes seem uncomfortable though and my main concern with waiting is that if her kidney values have then got worse and she can't tolerate either the anaesthetic, or the metacam after. Any thoughts?

[Desley (booktigger)]

Lucy has been sick the last two weeks after having her calcium meds, she has been given ranitidine to try and stop her being sick, but I've not been very good on remembering to do it before feeding her, and am on hol, my neighbour didn't relish the thought of medicating her once, so thought asking to syringe her twice a day as well was a bit much. Fingers crossed she keeps it down tomorrow, as she was a bit loose yesterday, and in hindsight, that was the first symptom, weeks before the rest. Not sure how this will affect her op

[Judecat (Paula)]

Bloomin typical.

[Desley (booktigger)]

No, the vet on Tue couldn't explain it, and obviously the vet who did the surgery has now left.

[tab]

I'm sorry she has to go through another surgery. I didn't really understand why they didn't remove that bit of bone at the same time but they must have had a reason.
I'm glad she's more settled though

[Desley (booktigger)]

Very disappointing, and especially because the vet who operated had done all her check ups and never once mentioned it. The specialist didn't think it would need operating on, but she just saw it on x-ray, she hadn't seen how she stands, and the aggression she still has with that hip. At least we are getting all the expense done in this policy year. I have said that if she develops any new health issues, I'd really have to think about what more I could put her through - especially as the 4 (if you include her weight) all work against each other at the moment

[Sue P (Paddysmum)]

Oh Desley.  I can just imagine how really disappointing that is for you both.     Lucy is a brave gal tho.  Sending gentle (respectful) snoozles for her x

[Desley (booktigger)]

Should still be covered by Petplan, vets aren't charging full price although it will be done by an ortho vet this time

[Judecat (Paula)]

Awww, poor Lucy. Bet your bank balance will suffer somewhat too! 

Will the insurance cover this Desley or will it come under pre-existing condition now? Poor Lucy indeed.

[Lyn (Slugsta)]

Awww, poor Lucy. Bet your bank balance will suffer somewhat too! 

[Desley (booktigger)]

Yes, it is a shame - at least she is allowed unsupervised access to the bedroom, so she is sleeping on the bed while I am lying on the sofa waiting for the Zooplus delivery!! 

[Dawn F]

oh poor lucy, glad that things are going in the right direction but shame about the operation 

[Desley (booktigger)]

We went for a repeat blood test yesterday, vet has rang back today to say that all her levels are within normal values - her calcium levels appear to be only just in normal levels, but they don't want to increase the dose, in case they reduce too much. She is still 5.13kg despite the reduction in her food. I spoke to the vet about diet, she agreed that renal food isn't ideal for hypercalcaemia, however renal failure is more likely to kill her than high calcium levels, so we are going to keep her on the renal food, and monitor via bloods. She has 10 other cats with IHC, only 4 are on the high fibre diet - while she agrees diet plays a big part, as no one can decide what, she thinks that as lack of appetite is a big part of the condition, eating something is ultimately better, and Lucy enjoys renal food. I am trying to get her back to eating 2 meals of wet and one dry, ironically she likes renal wet!!

Downside is that she can also feel the bone that was left behind, she still isn't up to full muscle mass (it was 18 weeks yesterday when she had the op), and when we were playing yesterday, she started elevating her paw in the air with her leg behind her - showed the vet a couple of pics, and she thinks that her stance is that bone is bothering her, so when I get back from holiday, I have to book her in for another operation 

[Desley (booktigger)]

Aww, thanks. I can't imagine doing anything different though

[Cloveart]

she is very lucky to have come to someone who will go the extra mile, although I'm sorry you have to 

[Judecat (Paula)]

I am pleased for you both, easier is good.

[Desley (booktigger)]

Thanks - an ironic statement as I drove over 100 miles yesterday alone, not to mention the rest of the trips! My bathroom is, warm, I thought she would be favouring the kitchen as its cooler, but she is still sleeping on the heated bed! She his behind the curtain from me tonight, I used the stronger Frusol so it was an easier dose

[Judecat (Paula)]

she is very lucky to have come to someone who will go the extra mile, although I'm sorry you have to 

I agree with Dawn on both counts. Maybe it is warmer there? That is why my cats vie for the bathroom, especially in Winter as the hot water pipes keep the floor warm. That or the top landing for the same reason.

[Dawn F]

she is very lucky to have come to someone who will go the extra mile, although I'm sorry you have to 

[Desley (booktigger)]

After sleeping on it, while I’m upset for Lucy that she has yet another condition for life that needs treatment, and one that could impact on one of her other conditions, it could have been a lot worse. I’m just going to try the medication first, as if we do both medication and food, we won’t know how effective the medication is. Plus, I don’t want to compromise her kidneys to treat her calcium levels, hopefully we can balance it by treating her calcium with medication and her kidneys with diet. I also woke up to find one of her toys on the landing, she hasn’t done that since before her op, so think she is feeling happier, and bless her, despite hating the medication, as soon as I’d done it this morning, she was more bothered by a fuss than the Dreamie she gets to take the taste away. She has been spending a lot of time sleeping on the bathroom floor since coming home though, which is odd. Hopefully it won’t take long to get the medication dosage right. She has put weight on again since last week, so we need to worry about that next.

[Sue P (Paddysmum)]

In terms of diet, I think you can only try to give her what she "should" have.  If she won't eat it, then no doubt you'll end up giving her what she will eat.  Quality of life is always the key with cats, I think. 

[Judecat (Paula)]

I know that it sounds horrible but if it's idiopathic and one tablet a week that may not be a bad thing, at least Lucy won't be being taken to the vets all the time.

[Desley (booktigger)]

The scan doesn’t show anything immediately obvious, but she is sending images off to be reviewed, hopefully we will get those by the time I pick her up tonight. She did say if it comes back idiopathic, she is likely to have it for life, but there is a treatment that just requires one tablet a week. She also brought up diet, and that renal diets aren’t always great for hypercalcemia – the worry there is that her kidney values have reduced since being on said diet, so helping one may make another worse. Plus, with all diets, it’s what they will tolerate, she won’t eat a purely wet diet, and she’s fussy with what wet she will eat.

[Desley (booktigger)]

Did a quick google search last night, looks like they think that certain ingredients in dry food that help with alkaline levels contribute to idiopathic hypercalcemia (IHC), which is quite interesting as she was changed to renal food in March, and it is also used for urinary issues. Since her operation she has been shunning wet food in favour of dry, which no-one can explain. Unfortunately, the way to manage it is to cut out dry food completely, but she doesn’t like wet food enough to only eat that. There is also a link between calcium levels and renal issues, they don’t know whether the calcium affects the kidneys or vice versa. I am going to ask if this could just be a weird reaction to the hip removal, and her body adjusting, in which case it might not be permanent.