Last September, my cat Sam wasn't eating one weekend, so I took him to the (one) veterinary hospital in the city. They did an exam, noted how skinny he was, then asked to do an x-ray. Here he is relaxing a few weeks before that visit:
So, the x-rays come back, and the vet was quite shocked.
"All Sam's organs are in the wrong place," she told me. She took me in to see the pictures in question. All his important bits (stomach, kidney, liver etc.) were all up in his chest, compressing his lungs. As best she could tell, he had only one partial lung working at all.
This was quite a shock to me, as the lounging guy above was a seemingly healthy cat who loved to run around outside. She sent me home promising that a radiologist would review, but it didn't look good. The condition he had is called a Diaphragmatic Hernia, and he'd probably had it for quite some time. I think I know when it happened. There was a time when he was a kitten when he stopped eating. I took him to the vet (we lived up island then), and she poked and prodded him, and thought maybe it was worms from being in the SPCA. I fed him the de-worming meds, and he started to eat again, but after that he was always extremely skinny.
Back to last fall, I got a call from the vet the next day. The specialist had looked at the x-rays, and the diagnosis confirmed. In the meantime, I'd booked a consult with my own vet. The clinic vet was quite pushy, wanting me to bring him in for surgery immediately, which seemed like the only option. But after I took him home he was eating again, so I thought it unlikely he would die in the next few days.
At my vet, I heard that the x-rays had been making the rounds locally. Apparently most viewers were shocked that this was a living cat. During the exam, I felt horrible as he pointed out all the cute behaviours Sam had, like lying on his stomach with his chin out, were not so much cute as ways to breathe more easily.
He outlined the options. He was strongly recommending surgery, but I knew that would be quite expensive. Apparently without treatment, Sam could keel over dead quite quickly, as something could shift internally. In the meantime, the specialist surgeon who was apparently quite good was going on vacation. I had three options: wait a week for him to return, have one of the clinic vets perform the operation, or do nothing.
I picked option 2, figuring my best chance was with the specialist. Thankfully Sam was fine for the week we waited. So the week before Thanksgiving (Canadian, that is), I took him to the hospital on the Monday morning and met the surgeon. He told me the surgery was risky, given the age of the injury, but that if everything went well Sam could live a normal life. I left him there, and went to work.
The surgery seemed to go well, and I got a good report from the vet that night. When I went to see him, he was pretty beaten up, but otherwise OK.
But the next day he did not improve. He couldn't keep any food down, he just regurgitated everything they gave him. He stayed on the IV fluids. On Wednesday, the surgeon put a camera down his throat to see what was going on. His esophagus had slid back up through the diaghram opening and into the chest. They recommended another surgery. When I went to see him that night, this is what I found:
That is the face of a cat without many resources left. He kept snapping awake at every sound which happened often in a busy vet hospital. He couldn't seem to get comfortable, so I tried propping the blanket up underneath him, but nothing made him happy. He barely responded to me. I left the clinic and cried all the way home.
The next morning, my Mom came down to meet with the surgeon with me, and he convinced us that Sam could live through another surgery, and that he could fix him. We went home to wait. (There was no way I could work that day.) She and I sat and sorted a giant button container while we waited for news.
Around noon, the surgeon called. He was in the middle of the operation, and he was concerned that Sam's stomach seemed dead, that it completely lacked motility. If the nerves were completely gone, he would not be able to survive. Did I want him to continue with the operation? I had a minute to make the decision, but I figured I had to pay for the operation anyway, we may as well keep going.
He went back to the operating room, and Mom and I went back to waiting. During the surgery, as planned, the vet put in a feeding tube right into his stomach, to bypass the throat and esophagus. He also needed a blood transfusion, as he'd lost too much during the operation.
That night I went to see him again, and amazingly, he seemed improved.
The next day, they told me he'd managed to keep some food down, fed through the tube. I might be able to take him home that night. A few hours later, they called me at work to tell me that I should pick him up that evening. When I went to get him, they showed me how to feed him through the tube, which was pretty stressful. Then they sent me home. I later learned they put his chances at 50/50, but figured they could do nothing more for him. It was the Friday of the long weekend.
He looked pretty worse for wear, but happy to be home. I set him up in the living room to heal, as I didn't want him trying to jump up on the bed. I slept on the couch the first few nights with him, for comfort. That first night, after I fed him through the tube, he was so tired that as soon as I lay down he climbed on me, shoved his back under my chin, and fell deeply asleep.
In the morning he looked a little better.
That day I kept feeding him through the tube, but he was hungrier and hungrier. By the end of the day, it was hard to feed him through the tube, as he kept twisting around trying to get at the food. I started giving him some in a little bowl at the same time, even though that was days ahead of schedule.
Close up of the feeding tube, which snakes under the tape, around his body, and out of the side of the stomach. The little snuggy is to keep everything from shifting around.
The next night he was much improved already.
Tuesday I had to go back to work, and left him alone. When I got home he'd ripped his little snuggy off, and I had to take him back to the hospital to get it replaced, since I couldn't let the feeding tube hang on the ground. By then he was eating like a champ, and the vet's assistant thought we could maybe take the tube out earlier than later. The week saw great improvement, and he was eating more and more each day. Friday came and the surgeon agreed to take the tube out, which he did, and I think both of us breathed a sigh of relief.
After that, he healed really well. I kept him in another few weeks, but eventually I started letting him go outside. He started slowly, only staying out 20 mins or so at a time, but his stamina has gradually improved. Even better, he's gained almost 4 lbs. He was just over 7 at the time of the surgery, and he's nearly 11 now.
His fur is growing back nicely, but he is always interested in snuggling by the fire.
So why is he worth his weight in gold? Because OH MY GOD that was expensive. Like, wiped out most of my savings expensive. More then my car is worth expensive. But it's hard to know when to stop. I had my own grumbles when things went way over even maximum estimates, but once I'd started, it was pretty much impossible to say stop if there was still a chance he could live through it.
I can live without a ski trip this year. I can replace my savings. And when I look at that happy face, I guess it was worth it.
Anyway. Related musings on the economics of it all:
Worthwhile Canadian Initiative: The economics of health care: lessons from the animal hospital