Saturday, November 14, 2015

First Freeze

Overnight was the first freeze in Huntsville. The squirrels are out chasing each other around, looking for the last of the acorns for this season while the chipmunks are still asleep in their burrows because it's too damn cold to be out at the moment. No pictures of the squirrels since they wouldn't let me get close enough to snap a good photo.

When I took these pictures, the sun had not yet risen above the horizon and it was a chilly 32°F, or 0°C if you prefer. Now that the sun is up the temperature has risen to all of 34°F.

Frost limned leaves, dogwood and violet among the frosted grass.

The partially frozen birdbath is nearly empty from all the birds splashing around, and a few of the last dogwood leaves and seeds have found their way into it.

Friday Catblogging - Requiem In Pace

Since the last edition of Friday Catblogging, there has been a lot of change in the cats of the Oubliette. We have lost McCullough, Eep, and Noah due to age and illness. Callie went to live with a neighbor, who liked each other and where she would be an only cat, as she always wanted.

McCullough had hyperthyroidism, and was on medication for it. We had the option to have part of her thyroid removed. The procedure is to introduce a radio isotope that goes to the thyroid then perform a scan to see how much the thyroid absorbs, indicating how active it is and how much would need to be surgically removed. This requires a specialist, since the cat must be boarded at the clinic for about 3 days in isolation while the radio isotope is excreted in the urine, which is mildly radioactive. By the time we would have been able to send her to Georgia for the surgery, it was too late.

In February of 2013, I found McCullough lying on the floor one morning, gasping for breath. I immediately loaded her up and took her to the vet, who only works on cats. She was immediately put in an oxygen chamber before an x-ray was performed. She had a lot of fluid in her chest, making it hard for her to breathe. She had to have a needle decompression (inserting a needle into the chest cavity but not any organs to remove excess fluid) and it was all hands on deck. Usually, as the owner, I would not have been allowed in the procedure room, but since I let the doc and the techs know I had medical experience as an EMT, the allowed me to help. I gloved up and assisted in restraining her, keeping her calm, and after one side had been decompressed, placing my finger over the puncture to prevent air from entering her chest cavity until it sealed itself (the doc was using a small gauge butterfly needle, so the puncture was very small). In total, 300 milliliters of fluid was drained from her. The vet said she had never seen a cat have that much fluid removed and the cat living more than an hour.

We decided the best course of action was for me to take her home and nurse her there. I was given a prescription for oxygen so she could be in an oxygen chamber at home to ease her breathing. An oxygen chamber sounds elaborate, but it is simply a clear storage tub with a hole drilled in the lid for the tube from the cylinder to fit into and fill the tub with oxygen, and the cat is placed in the storage tub with the lid on. I made a larger one than the emergency chamber the vet had, since McCullough was going to be in it for several days.

I picked her up from the vet after I had assembled my own oxygen chamber, so McCullough would be as comfortable as possible for the ride home.

We nursed her for two weeks, keeping her on oxygen the entire time, but she did not respond to her medications. We decided to let her go instead of keeping her in a box for any longer. We gave her the best possible chance for recovery, but she was beyond saving. Her final resting place is in our back yard, in a small glade among the trees with wildflowers growing in the spring and a stone cairn marking her resting place, age of approximately 15.

In 2012 we discovered Eep had breast cancer. She had gone into heat before she had been spayed, which increases the chance of breast cancer in cats. The vet had to remove all 4 mammaries on her left side, plus two lymph nodes. It was thought we had caught it in time and she came home without needing chemotherapy or radiation.

In March of 2013, one month after McCullough's ordeal, Eep was lying on the floor gasping for breath herself. I loaded her into the smaller oxygen chamber I had and rushed her to the vet. My car was jokingly called the "Cat Ambulance", since I already had her on oxygen when she arrived.

An x-ray showed that the cancer had metastasized to her lungs, with a couple of tumors as large as a quarter. She was terminally ill at that point, so we (myself and Hubby) decided to have her put to sleep immediately. Her resting place is next to McCullough with her own stone cairn, age of 12.

Noah's story is both the longest and the shortest. In 2013 he was diagnosed with a serious heart murmur, initially rated at 4 of 6 in severity. There was no medications we could give him, no treatment available. His heart would eventually fail.

Over the two years after he was diagnosed with the murmur, we watched his behavior and patterns, looking for any sign he was in distress. He wasn't, although he slept more than usual, because of the murmur.

 By October of this year, his heart had grown significantly worse. He had no energy since his heart wasn't pumping blood properly. Hubby found him on the floor one morning, not moving, and thought Noah had passed in his sleep. When he touched him, Noah finally responded, but stayed lying on the floor. He stopped using the litter box and would spend the entire day and night sleeping on the floor. On 10/10/15 we had him put to sleep. He rests in the same glade with McCullough and Eep, age 18.5. We have not yet been to the nursery that sells decorative stone to pick out the stones for his cairn.

In 2014 Callie went to live two houses down the street. She and the owner liked each other, and with him she would be an only cat. I would see her occasionally wandering the neighborhood, and she still liked getting skritches from me, but she had chosen her new home.

Earlier this year, S asked me if I had seen Callie. I hadn't and he said she hadn't been home in a few days. We never saw her again. There is a pack of coyotes in the area that occasionally come into the neighborhood. I'm afraid she was killed by a coyote, since we never found any trace of her. Callie was approximately 12 years old.

Right now the Oubliette has only two cats, Freya and Freyr. Both have become more clingy towards Hubby and me. Right now Freyr has attached himself to my hip while I type this. Freya is probably asleep in the window in Hubby's room. Both are healthy and happy now that they've adjusted to Noah's passing. Freya is enjoying the peace of fewer cats and Freyr just wants a warm human to snuggle with without  having to compete with anyone.

The Oubliette is quieter now; no herd of cats running around. There's still the sound of the rats in the background, but the colony of rats in the Oubliette is another story.

For more cats and other critters, go visit The Friday Ark #545 at The Modulator. Or you can head over to the Catblogosphere to catch up on cat related news on the blogosphere.

Edit: I genuinely thought it was Friday when I posted this. I was a day behind, since the trash collection is on Thursday, trash collection happened today, so it must be late Thursday/early Friday when I started typing. I'd forgotten that the trash was a day late due to Veterans Day. So, Caturday then?

Monday, October 26, 2015

a lot of things happen in five years - medical

*removes spiderwebs*

It has been a long time since my last post. Why? It's called Major Depressive Disorder (MDD) that's been poorly managed. I become a hermit when my MDD is being poorly managed, online and real world. Don't feel bad, I was irrationally afraid to communicate with everyone, including my family. Living with MDD is a bitch.

First, it was trying to find a medication or combination of meds that would work. That didn't go so well and I ended up spending 3 days voluntarily inpatient in the psychiatric unit at a local hospital to get on different meds and somewhat stabilized. I was having a really bad day and leave it at that. Part of the problem was my insurance at the time, it didn't cover any psychiatrists in the Huntsville area, so my only choice for specialist care was inpatient admission. The doctors told me that if I needed any adjustment to my medications to just voluntarily admit myself again, since my insurance would cover inpatient psychiatric care 100%. No, it makes no sense at all; covering the more expensive care but not a physician in a local practice.

Had to change general practitioners (GP). Most of my meds had the "May cause drowsiness" warning on them, so I slept a lot. I asked my new GP if there was an anti-depressant that would not make me drowsy. Yes, there was a new one that fit the bill, that treated MDD and would not put me to sleep. Just the opposite, actually. Great, I'll take it. Which I have been for the past 2 years. One problem: no one told me that it should be taken with food or else 1/2 of the dose is lost in the digestive system. Oops. No wonder it stopped working so well, I was taking it on an empty stomach. I discovered this around 9/1/15, so almost two months ago now. So I spent most of September of this year adjusting to the effective doubling of my dose of meds. Yay, such fun when one's neurochemistry is being messed around with.

Then the first of this month rolls around and I'm dehydrated from having nausea and vomiting with a mild fever for 3 days and end up going to the ER on the October 1. What a way to break in my new insurance which went into effect that day. I was delirious at times, I was so low on fluids. A good friend/adopted family/neighbor (I'll call her Hera, in keeping with the Greek pseudonyms for people) took me to the ER since hubby was at work. Hera stayed with me until Evil Timmy (hubby, yeah, no Greek name for him) could get off work and meet me in the ER, then stayed a little longer to find out what the doctor said before she went home, despite how the chair had to be hurting her back (another story for another time). Long story short, yes, I was very dehydrated: 3 liters of fluid given in the ER  and I couldn't keep anything down, despite all the Zofran I was given. Reglan finally stopped the vomiting, so if it took that drug, I was going to be admitted.

So testing for C. diff, which was negative, but landed me in contact isolation for about 24 hours while the test was being run. Contact isolation protocols mean that I was restricted to my room and anyone who entered first had to put on a paper gown and gloves before entering since C. diff is transmitted by touch. I was allowed out of my room once, at 5am for a CT scan, and I had to wear the gown and gloves outside my room. I was given two lap blankets to cover myself with in the wheelchair, and I got to keep those since they were potentially infected. I ended up with a lot of blankets by the end of my stay. 

The morning I was scheduled for discharge I began to have double vision, vertically, which is pretty odd to see. The doctor on call was an ass, he dismissed my concerns about optic neuritis by telling me I needed to go see my optometrist (not ophthalmologist, who is a medical doctor specializing in the eye, but just get my glasses prescription adjusted). Now, I've had optic neuritis twice before so I know the symptoms, which include a sudden change in vision as the optic nerve becomes inflamed. The first time I wrote it off as needing a new prescription for my glasses, waited 4 days until my appointment with my neurologist, and got my butt chewed on for waiting so long since if the inflammation isn't immediately treated then there can be permanent damage and partial blindness. Lesson learned, don't screw around when my vision suddenly becomes abnormal.

The ass of a doctor wanted to send me home, and I'll admit, I became a bit emotional at the prospect of re-admission for IV medication treatment for my eyes. It was a Sunday and he said there weren't any specialists at Madison Hospital on the weekend. I said that Huntsville Hospital (HH, both are in the same hospital system) had neurologists on staff on the weekends and would he please call one of the neurologists and see what they wanted to do. Well, a HEMSI ambulance was called for me to be transferred to HH's Neurological Progressive Care Unit (NPCU, and doesn't that sound impressive). Screw you Dr. Asshole. Well, out of spite or something he ordered a psych consult for me while I was in HH because I was "overly emotional" or something like that. The psychiatrist said that it's perfectly normal to be terrified of going blind, especially for a visual artist. In other words, I had a normal, human reaction. Take that, Dr. Asshole, no I wasn't wanting to stay in the hospital just because I'm a hypochondriac or something like that. I just wanted to be sure I wasn't going to end up partially blind. No, I'm not bitter or anything.

An MRI of my brain and cervical spinal cord (neck) didn't show any lesions at this time, but that doesn't rule out the possibility of microscopic lesions that wouldn't show up. Another MRI of my eyes and optic nerves revealed no inflammation. The diagnosis? Multiple Sclerosis. Yep, back to MS as the source of my neurological problems. I'm going to be seeing a specialist in MS at Vanderbilt Medical Center in Nashville to try to figure out what's going on. I'll go up for an exam, then the doctors at Vanderbilt will coordinate with my neurologist in Huntsville so I don't have to keep going to Nashville for treatment. It will be January before I can get an appointment; they're booked that far out.

On the up side, a diagnosis of MS guarantees I'll receive disability benefits, which I'm in the middle of re-applying for. Hopefully I won't have to get a lawyer involved and I can keep all of my disability back-pay.

Next update - more of what's been going on, moving on from medical.

The photos show much better than I can describe what edema (retained water) from 19.8 liters of saline given over the course of a week when input > output looks like. That's 19.8 kilograms or 43.5 pounds of water, mostly accumulated in my legs. I'm wearing thigh-high anti-embolism stockings to provide compression for the edema, both to reduce the pain and the edema itself. After 4 days of not being able to eat and dehydration landed me in the ER in the first place. The same pen is used for scale.

Then I was given Lasix by my GP and I lost 40 pounds in 5 days! Wanna guess how? You probably guessed right. Ugh. And I had to keep my oral fluid intake at normal so I wouldn't get dehydrated again...