Patient Stories

 

 An Unlikely Success Story

Ozzy, a 10 year old male neutered cat belonging to a local elementary school teacher, came to us for the first time in September 2015 because of a 2 week history of sneezing and excess discharge from his right eye.  He had also lost a fair amount of weight over the past few months. He had been drinking more than usual during the summer but Dee attributed that to the heat. Because he was petrified in a car and because his owner, Dee’s budget was very tight, he had not been to a vet for many years.   

On physical exam it was clear that Ozzy had lost a large amount of weight – though we had no way of knowing exactly how much, given that there was no “baseline” to work with.  In addition he had an almost closed right nostril.  From this nostril a bit of red tissue was bulging out and when he sneezed the discharge was bloody.  His left nostril appeared open and normal.  

Sneezing is a common issue in cats.  It can be caused by upper respiratory infections, tumors, fungal infections, allergies, polyps, bad teeth and if left untreated, chronic sinus infections. Unilateral (one-sided) discharge makes an upper respiratory infection or allergies much less likely.  Because of the tissue visible from the nostril, our first concern was cancer or a polyp – the first having a much poorer prognosis then the second.  The fastest way to find out what was really going on was to anesthetize the cat and take a sample of the mass protruding from his nostril for pathology examination.  

A diagnostic workup was begun on Ozzy including blood work and a urinalysis in preparation for the procedure, scheduled later in the week. Chest and abdominal x-rays were in order but because of financial constraints, were postponed for the time being.  Initial lab results showed that Ozzy was diabetic, thus explaining his recent weight loss and the increased urination pattern. Now, along with the sneezing, we had another major disease going on.   

The nasal biopsy came back, not as cancer but as a fungal infection by an insidious organism called Cryptococcus neoformans.  Although treatable, it requires a very expensive anti-fungal agent, Itraconazole, given by mouth daily for 11-13 months! Not a small feat for even the most dedicated of owners!  On top of that, diabetes in the cat is a very difficult disease to treat, as cats show variable response to Insulin so their regulation takes time and multiple visits. Ozzy would also need to change his diet for life.  

In addition, his overall long-term prognosis due to both diseases going on was poor. However, this was a very special cat. It was clear that he was about as sweet and cooperative as a cat could be and that his owner was not only dedicated but adored and needed him in her life. Dee had already contributed a fair amount of her limited income by this time to Ozzy’s workup and it would have been difficult or impossible for her to continue long term to care for him. So we turned to our McDuff Fund for help.  

As most of you know, here at AAAH we started the McDuff Fund into which we and many of our generous clients donate small or large amounts of money to be used at our discretion to help patients whose owners cannot afford the cost of their veterinary care.  Many of our previous recipients, add small amounts of money back into the fund when their circumstances improve – thus “paying it forward”.   

So, with monies from the McDuff Fund, Ozzy began treatment with Dee bringing him repeatedly for blood glucose curves and rechecks.  After only a month, the sneezing had subsided and slowly the tissue that had been visible at the end of his nostrils disappeared. His breathing is almost normal now.  We were able to get a formulation of the Itraconazole that was a bit less expensive than the human drug -made into a chicken flavored tablet which is easier for Dee to give him daily. His diabetes is still being regulated but he’s gained weight, is moving around more comfortably and is clearly a much happier cat.  Luckily, he’s not the typical finicky cat and eats his diabetic diet food with enthusiasm.  So… we’re hoping to keep this boy around for a while.   

We thank all of our McDuff Fund contributors once again for their generosity in continuing to help us provide the best of care even to those of our clients who cannot afford it. And of course, we welcome any new contributors who want to be part of this process at any time of the year.

Max


On a Sunday afternoon in June 2015, Duni got a call  from a very distraught client whose 3 year old cat, Max, had been dragging his rear end along the ground and leaving large streaks of blood across the floor.   She brought him right over for an examination and he was discovered to have a prolapsed rectum.   This is when an animal strains to defecate and while straining, the last portions of the intestines i.e. the rectum is pushed outside of the body. Max’s rectum was gently pushed back inside and for a time, he seemed much more comfortable.  

There are many reasons why an animal might prolapse his or her rectum. These include megacolon, constipation, intestinal parasites, cancer, foreign bodies, obstructions higher up in the bowel and intussusceptions.  X-rays, blood work and fecal analysis were performed on Max and all were normal.  He was dewormed prophylactically because a single fecal check misses parasite eggs about 25 % of the time.  His diet was also changed and pumpkin was added to the new food to be sure his bowel movements would be a bit softer and easier to pass.  Despite all this, Max continued to have intermittent recurrences of straining and occasionally prolapses. 
Diagnostically, the next step should have been an abdominal exploratory or endoscopic exam under anesthesia but Max’s owners simply could not afford to continue working up the diagnosis and, because of other serious family circumstances opted to give Max up for adoption.  But who would adopt a sick cat? 
So… for a short time, Max became our newest “Clinic Cat”.  He was scheduled for an abdominal exploratory surgery here.  Once in surgery, it was immediately apparent that the cause of his repeated prolapses and straining was due to an intussusception.   This is where loops of small bowel telescope into the large bowel – making the passing of stool impossible.  It was just coincidental that at the time we initially took x-rays, the bowel loops had returned to their normal position and so the diagnosis was not made.    Although biopsies of upper and lower bowel were sent in for pathological review and a number of blood tests were performed to determine what had originally caused Max to repeatedly intussuscept, everything came back normal.  Surgery consisted of removing his entire damaged colon and after a few weeks of recovery, Max became a normal cat again. We suspect that chronic roundworms (which he’d had as a kitten) may have caused abnormal bowel movement (peristalsis) and megacolon in this boy leading to his condition. 

Just before Thanksgiving, with help from the dedicated staff at the MSPCA, Max found his forever home!


Savannah’s Story

Or, Why Kids Should Clean Up Their Rooms!

Savannah, a Sheltie Savannah, a nine year old, sweet and (usually) intelligent Sheltie with a calm but playful personality is typically full of herself and of life in general.  So, when her owner, Barbara Willis, noticed her lying around, salivating and refusing food for 2 meals in a row, she knew that something must be seriously wrong.  She called Ark Angel and Dr. Schutzengel had her come in as an emergency before morning appointments.

Her physical exam was pretty unremarkable except for the fact that palpation of her abdomen revealed a “full stomach” despite the fact that she hadn’t been eating.  X-rays were taken and sure enough there was something in her stomach.  Once she was anesthetized and her mouth could be more readily examined, it became clear that not only was there something in her stomach but that a thin piece of  cloth or string had looped itself under her tongue, tearing her frenulum  (the attachment of the tongue to the base of the mouth) and contributing to her discomfort.

Four hours later, Savannah was waking up feeling much better, having undergone an emergency gastrotomy and had her tongue sutured back together.  Out of her stomach, Duni removed a part of a colorful sock and a sports bra (both apparently gone A.W.O.L.  from the floor of a family member’s bedroom. We won’t divulge who had the messy room)!

Unfortunately, dogs don’t have the most discriminating palates. Underwear, sweaty, stinky socks, corncobs, sanitary napkins and even rotten food from the compost pile or garbage pail often end up in their stomachs and can have serious, expensive and often fatal consequences.

Savannah was lucky that Barb knew very quickly that something was wrong and was willing and able to put her through an expensive and risky surgery to save her life.  

 

A Tale of Two Cats

Emilie didn't know what was wrong but she knew Zak was in trouble. Seconds before she heard his cry, she had heard a crash in the living room.  She ran towards the sound and found Zak, a handsome, 18-year old silver colored cat, lying on the floor next to his usual hang out on the back of the couch and he seemed unable to use his hind limbs. Emilie was 2 hours away from her regular vet in Boston and it was a Sunday!  Desperate, she called a neighbor and was told to try AAAH.  Twenty minutes later, she was at the office frantic, leery of entrusting her “son” to a stranger and sure this was the end of the road for him.

Zak

After a physical examination and X-rays it was determined that he had an old, but apparently healed pelvic fracture and a lot of arthritis in his spinal vertebrae.  This alone could not account for the extent of his pain.  It soon became apparent that he had neurologic damage that not only affected his ability to use his hind limbs but more significantly, his ability to defecate and urinate on his own.  These symptoms could all be explained by an injury at the lower (lumbar) portion of his spine.  Although he had clearly fallen and was severely bruised around his rear end, with no evidence of a spinal cord or pelvic fracture or a slipped disc,  it was most likely that he had an embolic episode (either a blood clot or a piece of fibro-cartilage) that had acutely reduced the blood supply and nerves affecting that region causing him to fall and further injure himself in the process. His kidney function, blood pressure and heart were all amazingly normal for such an old guy so his prognosis was very guarded but not hopeless.  Most importantly neither he nor his Mom were willing to give up and we decided to take it a few days at a time with supportive care, pain medication and anti-inflammatories. 

At first, Emilie brought him from Provincetown to our clinic in Wellfleet daily.  For the first 2 weeks, Duni had to express his bladder, give him enemas and other treatments.  But neither Emilie nor Zak was going to give up. Despite debilitating arthritis in her own hands, Emilie was a fast and willing learner. She made the decision to stay on Cape for as long as it took to get Zak to walk, defecate and urinate on his own. She was gradually able to express his bladder on her own and give him suppositories as necessary – necessitating fewer trips to the clinic.  With patience and a lot of TLC, multiple medications to give orally (stool softeners; meds to release the pressure on the lower part of his urinary tract, the urethra) and still others to increase the ability of his bladder muscle (detrusor) to push; medication to help his bowel with peristalsis and of course pain meds) and above all lots of love, Emilie brought that cat around. 

Over the next 2 months the two of them, and Zak’s other Mom, Nancy, became "family" at the clinic.  Sometimes they just stopped by for espresso and a social visit.

Zak seemed to know that Emilie and the staff at Ark Angel just wanted him to get better and he went along with all the treatment with never a complaint. He took his meds – never once scratched or bit anyone during any of the painful and embarrassing procedures we inflicted upon him.  It was a day for celebration when Emilie reported his first normal bm outside and a short walk in the grass with no support!

Zak, cat with flowers

But, the story would not be complete without another cat. 

Each time Emilie came in, she added donations to our McDuff Fund.  For those of you who are not familiar with this Fund, it was started in 2012 by Ark Angel and a couple who owned a sweet cat named McDuff.  As donations increase we use them to help other Ark Angel patients who otherwise could not afford treatments.

Lola

Just a few weeks before Zak and Emilie’s emergency visit to the clinic, another cat, Lola, came for the first time into Ark Angel with symptoms of acute onset of blindness and inability to use her limbs on one side of her body. She too was diagnosed with an embolus, but unlike Zak’s, hers was due to heart and kidney failure which in turn, led to high blood pressures. 

 

Lola cozy

With very high blood pressure, many patients (especially cats) will have bleeding issues.  If bleeding happens in the eye, we see retinal hemorrhages and subsequent detachment of the retina - which causes the patient to go suddenly blind. If bleeding happens elsewhere, there may be a stroke (a blood clot in the brain) or sometimes a clot along other vessels, causing weakness, paralysis, seizures and other neurologic signs depending on where the clot lands.  Poor Lola had all of these sequelae. Her kidney failure and hypertension had gone undiagnosed and over the course of a few days she started falling over, circling and flopping around like a fish. She lost her vision due to retinal detachment in one of her eyes.  Unlike Zak, Lola was a typical girl cat!  She had strong opinions about everything and was difficult to medicate.   But, as in Zak’s case, her Mom, Tracy, was not going to give up. She quickly taught herself how to give Lola all her medications. She massaged her limbs and rotated the cat to increase circulation to her affected limbs.  She hung in there with Lola despite hearing from others that it was time to give up and despite the financial hardship of all this veterinary care. We used what we had in the existing McDuff Fund to offset these expenses. 

Emilie and Nancy, being frequent visitors to the clinic, soon got wind of the situation and insisted on sharing their better financial circumstances by additional large contributions via the McDuff Fund directly to Lola’s account.  Together, over the same two months, the two cats got better.  Today, they are both walking on their own.  Lola retains vision in one eye and her kidney, heart disease and hypertension are stable. And Tracy, at first a recipient is now a contributor to the McDuff Fund, hoping that one day, her contributions will help someone else’s cat or dog in need of support.

Patience and Persistance

Pelvic fractures X-ray

On the 4th of July last summer, a very distraught gentleman came rushing in with his little poodle.  Phoebe had been accidentally too near the road and was hit by a car.  Phoebe was 2 and ½ years old and aside from her present injuries had been in good health. Her owners were prepared to go as far as necessary financially to save her life.   It was immediately clear that this was one special dog. 

Although she was very painful with, as it turned out, multiple pelvic fractures, a hip fracture and dislocation as well as skin injuries, she allowed us to do her full exam, draw blood, place a catheter and take X-rays without a muzzle or a complaint.  Due to her serious injuries and need for orthopedic surgery, Phoebe was stabilized here for the night with fluids and lots of pain medications and then sent on to Angell Animal Medical Center in Boston for surgery the following day. 

If repairing her fractures was the extent of her problems, then that would be the end of her story.  Unfortunately for Phoebe, her injuries involved so much trauma to nerves and muscles and so much internal swelling and bruising that in addition to the fractures she’d endured, she was semi-paralyzed on one of her hind limbs and had lost her ability to control bowel movements and urination.  It would take time, intensive physical therapy and TLC to determine whether these more serious issues would resolve.  And, there was a chance that she might never return to normal function.

Luckily for Phoebe, her mom is a nurse and her dad has the patience of a Saint. They learned to express her bladder manually, borrowed rubber grates from Ark Angel so she didn’t have to lie in her own urine, kept her back end shaved and coated with ointments to prevent urine scalding.  They gave her massages several times each day and had her swimming daily to build up her muscles.  Over the course of months, as her strength increased and the fractures healed, she started to show signs of improvement.   First, was the report that she’d had her first BM on her own.  Then the call telling us that she was no longer urinating where she lay and could support herself just long enough to squat.

post surgical X-RAY

Finally came the day in October – almost 3 months from the day she was hit, when Arthur and Phoebe walked into the clinic to return our cage grates - one on two legs and the other on four!

Phobe

 Finances and the length of time that it often takes to recover from serious injuries involving nerve function are the 2 main reasons that owners give up on a pet that is paralyzed and incontinent.  But, for those, like Phoebe’s parents, who are willing to dedicate their time and patience the rewards are amazing.   Phoebe is a daily reminder that miracles can happen.

Oh My Darling, Clementine

Cat with a broken tail

As they say, accidents happen – even to the best loved and pampered pets.   Just such a pet was Clementine, a sweet 15 year old calico cat.  Her only problem is she didn’t move quite fast enough following her mom, Eleanor, through a heavy wooden door.  As the door slammed behind her, it caught the tip of her tail, pulling the skin right off and leaving about 4 inches of exposed bone and surrounding tissues.

You would think with that kind of an injury, Clementine would be miserable.  To the contrary, she sauntered into Ark Angel as if she had not a care in the world, waving her poor naked tail behind her – allowing us to perform a full exam, place an IV catheter, do blood work in preparation for anesthesia and start her on pain medication and antibiotics. Surgery was scheduled for the following morning.

By the next morning, Clementine had decided that sleeping in a cage was not her cup of tea – tail or no tail she wanted to go home and told us so in no uncertain terms.  Nonetheless, she came through her tail tip amputation with flying colors and, because tails are prone to knocking into things and not healing well, Dr. Schutzengel concocted a protective lightweight splint using a syringe case and bandage material.  Amazingly, once back home, Clementine flaunted that bandage and continued to prance around with a “cone of shame” for the 2 weeks until it was safe for her sutures to come out.  By then, she’d forgiven us enough to let us remove the bandage and sutures with no anesthesia – back to being her compliant, sweet self.  Today, she sports a perfectly beautiful tail, minus 4 inches!

 

Sadie Is Strong

SadieSadie is a strong, energetic and happy 3 and ½ year old Akita belonging to a young landscaper in Truro.  One day in late January, Sadie’s owner noticed that she seemed to be breathing with a bit more effort than usual and had begun to cough occasionally.  She had not been anywhere that might have exposed her to kennel cough or canine influenza and so the owner made an appointment to have her seen at Ark Angel.  Although her energy level was normal and her tail and body continued to wiggle with joy throughout the exam, it became clear that there was something really not right with her breathing pattern.  Her lung sounds were overly quiet and she was working a bit too hard on expiration. 

Xrays revealed “pneumothorax”.  Thorax refers to the chest cavity which encloses the lungs, heart and other organs passing through the diaphragm to the abdomen.  When we (or other mammals) breathe in to fill our lungs with air, that air fills tiny sacs called alveoli within the lung tissue and passes oxygen from those alveoli into blood capillaries and through arteries to theChest X-ray cells of our body.  Between the ribcage and the diaphragm there is normally “negative pressure” allowing our lungs to expand and contract easily.  If however, one or more of the alveoli in the lungs are injured, air leaks out of those sacs and starts to fill the space around the lungs within the thoracic cavity.  As more and more air fills that space, a “positive pressure” develops that causes the lungs to collapse.  This process is called pneumothorax.  The most common cause of pneumothorax is some sort of trauma – e.g broken ribs that puncture a lung lobe; a chest wound from a bullet or knife.  More rarely, both people and dogs can have what’s called “Spontaneous Pneumothorax”.   These alveoli rupture with no known cause. It is seen most often in young, tall, thin athletic men and young, athletic large breed dogs.

Once the diagnosis was made, Sadie was stabilized here at Ark Angel and sent immediately down to Bourne to the emergency clinic there (Cape Cod Veterinary Specialists) for a CT scan, placing a chest tube to allow round the clock withdrawal of the air in her chest and 24 hours monitoring.  Spontaneous pneumothorax was confirmed with the CT scan and luckily, she was found to have the type of lesions that could be corrected by surgery. 

                                                 Sadie was lucky in a lot of respects.  First, she was lucky to have astute owners who realized something was wrong anSadied brought her within hours to Ark Angel as an evening emergency. She was lucky to be healthy and fit and to have had her diagnosis made quickly. But more than anything, she was lucky to have a “dad” and “grandma” who were willing to remortgage their home to pay the $13,000 bill to CCVS for the CT scan, 7 days hospitalization and finally open chest surgery to repair her lungs.  They were just not willing to give up on a 3 year old dog! 

Sadie is doing great, but we’re guessing that the owners are eating Top Ramen every night.  Anyone willing or able to make a small donation in her name to help recuperate some of their CCVS bill can contact us on the owner’s behalf.  We are calling our fund “the Sadie Fund”.


All’s Well That Ends Well

MiloRecently, Dr. Schutzengel was presented with a young patient with a lameness issue.   Milo, a very sweet and active mixed breed male canine had been licking his left hind limb for several days.

It was after hours and as is usual here, Duni let him check out the clinic while talking to his mom and getting information into the computer.   Milo took full advantage of Ark Angel’s  “open door policy”, exploring every nook and cranny.  He wandered around , first checking out the kitchen  (nope no forgotten dog food), then played for a while  with toys on the dog beds  and finally decided it was time to delve a bit deeper into the back room of the clinic which houses cages and the xray machine.   As he meandered into the treatment room, sniffing the cart where clean bowls and litter pans are stored, out of the corner of her eye, Duni noticed that he’d grabbed a cat toy from the same shelf.  As soon as she jumped up to trade him the cat toy for something more appropriate for his size – Milo took one look at her and down the hatch the toy went!

So….instead of immediately dealing with the problem at hand (or rather, foot), Milo, his mom and dad and Duni headed out to the back yard with the bottle of peroxide and a syringe.  Peroxide is a quick and easy way to induce vomiting (used only when it’s safe to vomit back up something that’s been swallowed).  Several doses of peroxide later and a lot of retching yielded up first that morning’s breakfast and finally the mouse- only slightly worse for wear.   See photo of “cleaned up mouse”! (Breakfast content not included due to graphic nature!)mouse

 Milo thought that was the end of it but unfortunately…now...it was time for his exam!  

 

 

 

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