From:
ELNRRGBY1@aol.com
Date: 2004-05-03 06:59:26 UTC
Subject: Postop complications
To: ferrethealth@smartgroups.com
Message-ID: <d7.9770bd6.2dc747ce@aol.com>
Hi everyone,
I have a 6-year-old MF male who just underwent a pretty involved exploratory
on Thursday. He ended up having a splenectomy, left adrenalectomy, liver and
intestinal biopsies, a large mammary tumor removal and a mast cell tumor
removal (for those wondering, I just took him in a week prior to surgery as a
permanent foster). I don't have a lot of the surgery details but was told that
the left adrenal was "gigantic" and was somewhat adherent to the left kidney.
The spleen was also huge, but wasn't weighed unfortunately. There were also a
few small white foci on the liver and a spot on the intestines that didn't
look right and these areas were all biopsied (don't even know where on the
intestines though).
He was doing fairly well immediately postop and had begun eating on his own
almost immediately after surgery and continued to eat and do well all day
Friday but by Friday night/very early Saturday morning he started to decline and
stopped eating unless finger fed. By Saturday afternoon food/meds were being
vomited back up immediately after being given and he was having severe mucousy
diarrhea. He also had become rapidly dehydrated, was very depressed, had a
temp of only 98.7 and had some mild jaundice.
Blood work was done at my clinic and showed a PCV of 39%. Preop it had been
in the mid 50 range I believe. The chemistry results were albumin 0.7
(Vetscan machine couldn't read it first time due to being so low), ALP 31, ALT 954,
AMY 8, TBIL 0.6, BUN 115, CA++ 8.9, PHOS 18.1 (unreadable first time because so
high), CRE 1.3, GLU 182, NA+ 131, K+ 4.8, TP 6.6, GLOB 0.0 (unable to be read
first time). Also worth noting is that this glucose reading was with at
least a 4 hour fast.
I was advised to basically make him NPO for 24 hours due to the vomiting as
he has no issues with low glucose and to push subcu fluids - as much as I could
get in him basically. I was told by the surgeon that I could also try
cimetidine if I was sure there was no bowel obstruction but to date I have not
attempted this, mainly out of fear since I'm not exactly sure what is going on with
him. There definitely isn't a complete blockage, but there is also
definitely something going on with his GI tract.
He has had about 350 cc of subcu fluids in the past 36 hours but there has
been only very minor improvement in his overall condition. The vomiting and
pawing at the mouth/gagging did stop with his NPO status and he was willing/able
to take some Nutrical earlier today with no problem, but the gagging/pawing
are back now with any attempt to give him anything orally, including water, and
occasionally even when not being given anything. I have been able to keep
him from actually vomiting by doing only very small amounts at any given time,
but he definitely appears to be very nauseaus still.
The only meds he is on at this point are Pet Tinic, Clavamox, Carafate, and
the subcu fluids. I do have Torb on hand for pain control if needed but have
been reluctant to use it as he is already so depressed.
He is urinating frequently with the added fluids, but I can't quantify
exactly how much urine output there has been. Stools are frequent, but scant due
to limited oral intake, and they are primarily green/yellow mucus and he does
appear to have some intestinal cramping going on with sudden "urges" to
defecate. The jaundice seen yesterday appears to have resolved and his postop
bruising on his abdomen is also resolving. Mucus membranes are pale but moist. CRT
is normal. Turgor is normal again. Eyes, nose, mouth/throat are clear but
there is a pinpoint ulceration starting on the roof of his mouth tonight.
Heart rate has been semi-normal and is currently in the 200 bpm range. Breathing
is somewhat labored at times, but lungs are clear. His abdomen seems to be
nonpainful for the most part and is not distended but it does feel doughy to me.
No sign of infection, seeping or oozing at the incision sites. He also can
and does get up and walk around at times but tires after only a few steps
most of the time. Other than that, he has no interest in anything going on
around him and makes no effort to move away from me when I put him on my lap or lay
him on the floor while I clean his cage.
So, at this point, I'm just not sure what else to do for him or what else to
try other than a second emergency surgery to see what is actually going on in
his belly. At the very least, I would like to hold out for the pathology
report to get back before even considering a second surgery since lymphoma is high
on the list of possibilites, but while I'm waiting I feel like I need to do
something else or try something else. I will at least be rechecking lab values
tomorrow and will hopefully be able to get a CBC done this time as well as a
UA, but other than that I'm just not sure.
Anyone have any other suggestions? Any chance of this being some kind of
Addison's crisis? I know the chem results don't really support it and he does
have his right gland, but I'm grasping at straws here trying to figure it out.
Thanks!
Stacia