amputation – Freya's tale

Day 3 AA

Well, last night wasn’t quite as easy as the night before. Not necessarily because of the amputation but because when I went to go to sleep Freya had somehow managed to extend herself across almost the full width of the mattress. So I was mostly contorted, but that is something we cat owners know about. She made some small growling noises in her sleep, which is not usual and I’ve noticed she has been making a few noises like that as she snoozes/sleeps. Not necessarily alarming but different. She was also wandering a bit and I notice it takes some time from when she wakes up to be confident getting around. I also find that I pretty much follow her everywhere she goes, even in the middle of the night, just to be sure she’s OK. And you know what? She seems to be.

As for getting around, well, she has made the choice it seems. I think I was saying that I was thinking of opening the entire lower floor to her today? I went into the kitchen area and then back to where I have set her up and the door to the other room was opn – the room in which I have stored all the stuff she shouldn’t be near yet – like the cat tree and so on. It is a rabbit warren of boxes and stuff and there she was, lying in the spot of sun in the little bit of clear floor space there was.

Then a little bit later on I was again in the kitchen (which was still off limits), and she navigated the barriers I had set, which must have involved her jumping on the bottom stair, and sauntered in as pleased as she could be into the kitchen. She went into the loungeroom and found a place to hide so I just let her do that. I had to leave for an hour or so (dropping off that feral kitten) and so I contained her within that room leaving water, food and litter tray in there.

When I got back (verdict of kitten – definitely feral and too late for socialisation and we know what that means) she was on the lounge itself, curled up as cute as could be. I had left a little step to the lounge and wondered if she had used it, especially as she jumped down in one go a little while later. Well, I soon saw first hand that she did not. I was so pleased. The couch is one of our favourite places to be together and so when I was curled up there and she jumped up to join me, well I’m not ashamed to say I had a little moisture in my eyes (allergies? no, happiness). And a little while later she clambered up the long way (ie over the arm) and after a little bit of a ‘will she, won’t she’ balancing act, she was there!! I am so so proud of my little trooper.

Freya snuggling on the couch with her human

She has also tackled her favourite cat chair but it wobbled a bit and so she didn’t stay there long. I’ve fixed the wobble so her next attempt should be better.

Freya on top of the world - or at least her favourite viewing platform — Freya on top of the world – or at least her favourite viewing platform

As for the ongoing battle for antibiotics, she ate most (most is good) of the antibiotic laced liquid this morning so I’m quite pleased. I’ve gone and bought some straight tuna in springwater and I take the liquid from that and mix it with a broth you can buy in individual sachets. to make a liquid and smelly concoction within which an antibiotic liquid can hide. This evening she again managed to eat most of the antibiotic mix, although I have to follow her around with the bowl, which must look a bit funny. But only 3 more days of antibiotics to go and then I can relax about her food (and start tackling her weight as tripods need to be reasonably svelte and Freya will need to lose some weight).

Pain does not seem to be an issue at the moment. Of course that is with all the caveats of cats being good at hiding pain. The dose seems to be right (once a day liquid dose) and she is moving around quite freely.

Her incision is looking fine, no discharge, no swelling and so far no worries. Fingers crossed and double crossed that all is well there (she is a good healer – her recovery from the biopsy was a source of some joy to the vet) and continues well. I just compared it to the photo from Day 1 and it already looks better, marginally better of course, but hopefully not my imagination.

I think I might leave the e-collar on until tomorrow afternoon as I will be going to work in the morning for a few hours. But she is OK with it for the most part although she bumps it when wants to rub against things – but she can sleep in it quite well and eat in it so I’m pretty fine with that. It’s a bit pathetic when she wants to lick her side but she forgets shortly (I read somewhere that cats are very much of the now and that seems to be very true).

And so Day 3 after amputation draws to a close and Freya is with me on the couch as I type away with a movie on in the background (Seabiscuit for those who may want to know). It’s so like the way things normally are that the tight feeling in my chest that has been there since her diagnosis is beginning to relax. Not gone you understand, it probably won’t be gone until her incision is healed, and possibly only then minimised, as I know I need to remain vigilant, but it will be so much better.

ETA: A word on elimination. Freya has been weeing no worries and her balance is fine (the e-collar is the greater hindrance I think) and she did a solid elimination on Day 2 ie yesterday. Nothing so far today but I’ve mostly been giving her liquid food to hide the pain killer and more importantly the antibiotics so possibly that is the cause. I’ll give her some more solid food before bed.

Day 2 AA

Today Freya managed to get around some more, she had a solid movement (oh joy) and has taken her required doses of painkiller and antibiotics. The antibiotics in particular feel like a win – she doesn’t take them orally at all well and so I sneak them into some of her food (strong smelling fish broth) and for the most part she eats it. She sometimes stops and there is still food there and so I follow her around with the bowl, tilting it for her and after several impassioned pleas to be a good girl, she eats it all. I just hope that it continues this way for the next four days.

She slept well last night, sharing the mattress I moved downstairs into the room she is recuperating in. I managed to sleep quite well too. She has stuck quite close and usually is lying next to me as I read or type. I just had to move then to avoid having her sit on the laptop, or walk across it, as is her wont. I kept an eye on movements to see when I should give the next dose of painkiller – once a day is the recommendation but if need be I would move it up a few hours, but she did well. When I did notice the start of some discomfort I dosed her up (in food) and she settled.

She really doesn’t like the Cone of Shame and that almost causes as much trouble for her moving around as the loss of her leg does. It came off the first day and I did keep a watch and unfortunately she did start to lick the incision site so I put it back on. She just them managed to remove the soft cloth at the back of it, but it has stayed put. I think I might remove it tomorrow afternoon and observe her actions again. I would remove it tomorrow morning but I have to take a feral kitten in to the RSPCA and she will have to be left alone for the hour or two that will take.

That’s a whole other story. Suffice to say that on top of worrying and caring for Freya, a mother cat and six kittens turned up in my yard four days ago and after some feeding I got one of the kittens tonight and have placed it in a cage. It was not pleasant and I’m thinking that I might see if I can get a humane trap from the RSPCA but it seems like such an unnecessary complication in my life right now. I want to be focusing on Freya and her recovery but instead I’m having to spend time trying to work out how to deal with a feral cat situation! Part of me wants to just ignore it but I know someone has to take responsibility at some time.

I’ve also been doing some thinking about the incision as I got feedback that internal sutures without any external ones is a bit unusual. I know most of the photos I’ve seen are of staples and the length of the incision seem so long but Freya’s is about the length of my hand and looks quite … well, smart isn’t the word, but quite neat I think. I’m not sure if this is an Australian thing but my vet said he was old fashioned and didn’t use staples. He also made the call to make them internal and I’m guessing that was so she didn’t need to go back to get stitches out – she would probably have to be sedated and that would be unnecessarily harsh for her so soon after this procedure. He’s been a brilliant vet, and I feel quite lucky.

There also appears to be a different approach to amputation overall here (or at least at my vet) as Freya was only in overnight and back home the next day (the vet said I could have taken her home the next morning and that would have been less than 24 hours) and she is only taking pain killers once a day. I know from some of the other blogs that it can be days at the vet and the pain management regime seems quite intensive. But Freya doesn’t appear to be in pain (no head to floor posture, etc that can sometimes be the only indicator) and she is currently lying on the incision, so I am making an assumption she is not in pain.

Freya has begun to want to investigate more and it was all I could to stop her sneaking in to try the stairs! I’m glad she’s feeling that way, but I’d like her a bit more stable before she tries the stairs. I am however thinking that I might open the bottom of the house to her tomorrow. I’ll have to go through and shift some of her favourite jumping places, and place some assists (small boxes) to the couch but that should be fine.

So, Day 2 is drawing to a close and it has been a good day.

Photos and more photos

I’ve gone and inserted photos into my earlier posts. Now for some reason they are too big on the post to see all of the photo but if you click on the photo it will take you to a full size version.

I hope they convey a little of the lovely cat she is. I know many people ask if she is Russian Blue or similar but she was a kitten in a litter from a stray cat – albeit a lovely all black cat (no markings) and very bright green eyes, father unknown but possibly a feline mercenary for hire – see discussion on her personality below! And with yellow eyes I understand that she is not a true blue (hah, Australian joke there). However her coat while short in length is very thick and lovely (eek – she’s missing so much of her lovely thick fur over her butt right now – so I do have to tell her that her butt looks big in that!)

Freya has tuxedo markings of white, and a little white moustache that is very cute. So many people remark how lovely she looks and her little face is very sweet (little! My friends are laughing here as she is rather …. rubenesque). But it hides an attitude of ‘don’t mess with me’. She has also become very much a one person cat over the last few years and while she will wander up to and sniff at your belongings and even you, woe betide if you (as in not me) take that as an invitation to pet or stroke – prepare to be swatted away, with claws if you are persistent.

Freya contemplatingl ife — Freya contemplating life

So, not a cuddly princess but a haughty goddess shares my home. And after nearly nine years, I wouldn’t have it any other way.

And for those interested, she has been an indoor cat all her life. A pampered, environment enriched indoor cat.

Cat tree – tick.
Cat chair – tick.
Scratching posts – tick.
Cat grass – tick.
Toys and boxes of all kinds – tick.
Sleeps on the bed – tick.
Sleeps in the bed when cold outside – tick.
Does pretty much whatever she likes – tick.

LOL. No wonder she carries on like a goddess – I do nothing to dissuade her of that notion.

Freya Date – Day 1 AA (After Amputation)

Well, I’m calling it Day One. Day One After Amputation.

Today, 21 December 2012, I picked Freya up at the vet’s in the afternoon. After a hefty bill was paid (come on down pet insurance people!! Show me the money!! Wait – mixed metaphors there – who cares!) and pain killer prepared and antibiotics obtained (liquid form please) I see her.

She’s in a cage. She has a Cone of Shame. She is so pleased to see me!! I am so pleased to see her too! She’s moving around. Woops, bit unsteady there. Oh no, there it is. Not so bad really. Feel relieved. FYI, my vet used internal sutures, no staples, immeasurably less confronting.

I pick her up – it’s so quick there’s no time to wonder about right way and wrong way, she’s just in my arms. Then carry her to the carrier, she practically lunges at the thing. I think I actually got a face full of absent leg as she clambours in.

Back home and out she gets, weaving and listing, into the luxuriously appointed recuperation room (the front room I use as a sort of library). I spent the last two nights clearing out obstacles and moving in a mattress for me and boxes for her, and decorating it appropriately.

It’s also Xmas and instead of heading home to Taree to my Mum’s, I’ll be here with the cat (don’t worry, I will be temporarily adopted for Xmas dinner). So I made the house a bit more festive and the recuperation room positively glows with candles (battery operated tea lights), crystals, flowers, colourful throws and beautiful pictures. It’s to be my home too for a few days (possibly longer as my bedroom is upstairs and that is where she normally sleeps, and I’m not sure how long until stairs are OK) and it needs to be beautiful and uplifting. The stuff I’ve read said make it dark and quiet and calm, keep her confined and all that, but I also chose to make it beautiful and inspiring.

She wanders slowly, listing to one side, staggering almost. Her front paws are a bit awkward as she lies down then gets up again. But lying down seems to cause no concern. Of dear, the Cone of Shame came off. Watch and observe if she licks the wound …. back goes the cone of shame (not agreeable to Freya at all).

She sees me prepare some food, lots of miaowing in agreement. Woofs it down, liquid pain killer and all – cone a challenge. The vet said she hadn’t eaten while she was with them, so really pleased to see that. She hasn’t gone to the kitty litter tray yet, which may pose a challenge.

Realise I need to give her some anitbiotics. Prepare the syringe and rapidly find out the ‘arrangement’ she and I had come to after her first surgery is null and void as the cone prevents me grabbing her by the scruff on the neck and prising open her mouth. Dang. Darn. Drat. Review her known eating habits (all food fair game) and think if I hide it in some smelly tuna/broth then she might take it that way. Successs!!!

Right now? I’m creating posts on my laptop while lying stomach down on the mattress and Freya has taken up one of her favourite positions, curled up between my legs. Euphoria. Bliss. Contentment. Hope.

Close up of internal suture incision - no exterior sutures or staples — Close up of internal suture incision – no exterior sutures or staples

Freya at her food bowl on Day 1 after amputation

Bring on Day Two.

Surgery and Survival

We lay on the bed together that morning. I was reading – Freya was sleeping.

I turned a page and Freya scratched an ear … with a left hind foot. I stared. Part of me, the flippant ‘hide your pain’ part of me was all ‘enjoy that while it lasts’. Another part was quietly weeping inside.

Not all tears are an evil? (Take refuge in Tolkien) But I felt so bad.

I placed her in her carrier and off we went to the vet’s.

I took deep calming breaths. Did absolutely no good. Tears were a constant pressure behind my eyes.

Hold it together!! You’re a professional person. You know it is the only option. Hey, there are people who are having much worse days than you. You have the money for the operation (your heart bleeds a little for those posts and pages you’ve seen in your frantic scouring of the internet for all the information you can find where they know their finances cannot give them a choice). You take another breath. Still no good.

The vet is lovely and warm. He smiles. He explains the best of care will be taken. X-rays will be taken. That new lump I think I found the other day (all of a sudden amputation is a preferred option to ‘I’m sorry it’s no use’) will be checked.

All I know is that my little Freya will soon be on a table and not all of her will go back in her cage.

Tears. Fears. Composure gone. Tissues essential. Small talk and then no talk. Small talk again.

Leave. Now.

The call came. All clear. No additional lumps found. Surgery clean. Out from anaesthetic. All good.

More tears.

Not all tears are an evil.

Specialists and Speculation

So, all seemed fine. The way ahead was clear. Observe and then act.

But my vet said he’d like to consult with a veterinary specialist oncologist on management of Freya. OK thought I. No worries. Probably really good to get a specialist to give a second opinion. So, we took a lymph node sample, which came back clear ie no cancer cells (yay!). And off to the specialist all the information went.

Freya paying attention to her leg after biopsy

The report came back from the specialist on 12 December 2012. Remember, since 21 November 2012 we had been having bandage changes every four days and so much was going well. The raw patch was brilliantly healing and the vet was really pleased. And then there it was.

Written down (and forwarded in full by my vet).

Preferred treatment – Amputation

I suppose it wasn’t so much of a shock as I’d had some time to get used to the fact that this was the way it would eventually go. It was good to see in the report that amputation for her likely type of tumour “could potentially be curative”. There was however a note that “reports are mixed regarding survival for cats with these intermediate grade tumours” (Freya has a likely Grade 2 tumour ie intermediate) so it is of course no guarantee, but I think it is preferable to both radiation and chemo which were raised in the report (both lesser treatment options).

It was also sobering to see that if no action apart from surgery was taken that “Depending on the study…, median survival would be expected to be 4 to 9 months”.

The report also directed me to http://www.fabcats.org/owners/disabled/amputee.html for some stats about owners of amputee cats, with the salient points as follows:

The only differences noted by owners were that amputee cats tended to be less active and moved slower – in all other aspects the cats were generally no different following amputation.
Pain after the operation was noted in 36% of cases and recovery time seemed to be 2 weeks for those in no to little pain and up to one month for those perceived to have been in pain
When asked if they thought their cat had a normal quality of life, over 90% of owners believed that they did.
When asked whether they would make the same decision if they knew then what they knew now, 95% of owners said they would.

So, I sent an email back:

Message understood.

Let’s pick a date.

How does 20 December 2012 suit you?

Good.

Book it in.

Discovery and Diagnosis

You know how it is. Things seem fine and then out of the blue something catches the corner of your eye.

But a brief trip down memory lane first. I first met Freya when she was three weeks old and brought into my workplace with her mother and the rest of her litter. She was the only grey kitten in the litter and I took to her straight away. So, after some research into a potential name and an internal confirmation that I was ready to take on a serious feline commitment, she moved in. That was nearly nine years ago. Since then she has terrorised geckos in Rockhampton, been aloof to visitors, made the move from Queensland to Sydney with me, and surveyed her world with justified disdain. When people meet her for the first time I remind them that cats used to be worshiped as gods in Ancient Egypt, and Freya remembers, so treat her like a goddess and you’ll be fine: hands off, approach with caution and provide offerings at regular intervals. What did I expect, after naming her for the goddess of the Valkyries?

Anyway, to the present. On 7 November 2012 I noticed a lump on Freya’s rear left leg (her hock for those who know, which didn’t include me until now). And then I looked more closely and saw it was quite a large, raised, solid, hairless lump which actually went around the inside of her leg as well, although that area still had hair. More than a bit alarming. So, I rang the vet for advice and ended up taking Freya in the next morning for some tests. Freya wasn’t limping, wasn’t in pain (touching the area did not elicit a cranky reaction) and her food intake hadn’t not been affected, so I took some heart from that……

Then the vet said it was definitely a tumour of some kind and the tests would tell us more. So, started the emotional roller coaster for me as you’d imagine, with many visions running through my head and feeling pretty gutted that I’d missed such an obvious lump.

Anyway, they took a fine needle aspirate and the results seemed to show the tumour was borderline benign/cancerous. The vet also said that he thought the tumour was located in a place that was not readily visible and so it could easily have been overlooked for a while – so feel a little bit better about that aspect of it.

The upshot was, Freya was booked in for surgery on 21 November 2012 when the growth was removed as an excision biopsy and the mass sent off for further testing. Well, once they had a look, the news wasn’t good. The tumour was quite entwined with the muscles and tendons in her leg and so not all of it was able to be removed. Further, that type of growth pattern is apparently associated with malignancy.

And that was when the word was first mentioned …. amputation.

The vet said it is ‘better’ to have a rear leg amputated than a front – I say surely it is better not to have it removed at all … but I get what he is saying.

Well, the results of the biopsy were available 24 November 2012 when I took Freya in for a bandage change. And they were not good. A soft tissue sarcoma – and whilst ‘locally invasive’ (code for whopping great lump I suppose) they ‘generally do not undergo metastic spread’. So, for bad news it wasn’t as bad as it could have been. Nonetheless, the advice from the vet, was to reconfirm amputation and so it was booked in for 28 November 2012.

Then, the day before the operation, Freya managed to remove the bandage on her leg and so I had to take her to the vets to get a replacement one (she had a skin graft and an open wound so even a day with that exposed would not be good). Anyway, the vet was impressed by her calm demeanour with the bandage change (they had called her a cat with ‘personality’ when she was at the vets’ – we know what they mean). He also commented that her skin graft was healing really well and that the open wound was beginning to granulate over (apparently that’s a good thing) and she was in no pain. So, he looked at me and said, I think we might let this leg heal and just keep an eye on the regrowth of the sarcoma and when that happens, that’s when the leg will be removed. He couldn’t put an estimate on that of course, it could be weeks, months or more.

So, that seemed all for the good. Amputation off the agenda for the moment. Sure, a delaying tactic only, but hey, I was good with it.

But of course, why have this blog if that was the end of the story…..