Monday, April 11, 2011

Miracles can happen, folks

First off, this was a great weekend. We were busy, clients were compliant, and we were able to do good medicine. Further, we saved a patient that had absolutely no business living - none whatsoever.

On Saturday night, we were presented with an older cat in severe respiratory distress. As Alyssa the cat sat there, her abdomen puffed in and out as she tried to breathe. She was demonstrating a "restrictive" breathing pattern, indicating to the naked eye that she had something in her chest, compressing her lungs. Given her age, I suspected heart failure and pleural effusion (fluid around her lungs). We gave her a dose of Lasix (a diuretic) to promote urination (although this arguably does not help with pleural effusion) and a mild sedative of fentanyl and midazolam. We placed her in oxygen and waited. Trying intervention with this cat would have likely lead to her death. After about 20 minutes, she seemed improved. We took her to xray (a mistake, I later decided) for a quick snap of her chest. Really, what I should have done was tapped her chest to remove the fluid. At any rate, she did fine with the xray, we placed her back in oxygen, and then she died.

Her gums turned blue, she stopped breathing, and her heart rate dropped to 20. We snatched her out of the cage, intubated her, and started breathing for her. Bloody fluid from her lungs (pulmonary edema) came frothing out of the tube. Her pupils became fixed and dilated. She lost all responsiveness to us. She was a dead cat other than a slow heartbeat. The owner was there for this, and she begged us to do everything and not to give up on her cat. Privately, I thought this was insanity. The cat was dead for pete's sake, but we went at it with the fervor of the optimistic.

We gave her atropine and epinephrine to stimulate her heart beat, we manually ventilated her to supply her brain with oxygen. I grabbed 2 large bore chest tubes and punched them through into her chest cavity, removing 1/4th of a liter of fluid from around Alyssa's lungs. The owner was standing by for all of this, alternately praying and asking questions - which I mostly ignored.
She wanted us to do anything, and she didn't want us to give up, no matter what. I'll admit, I thought the cat was a goner, but we persevered.

After 30 minutes of emptying her chest, breathing for her, administering drugs to stimulate her heart, careful fluids to get her blood pressure up some, and hoping, Alyssa amazingly began to breathe on her own! Her pupils remained fixed and dilated, but she was breathing. I still thought there was no way this cat could possibly pull through, but at the owners request, we continued.

After an hour of supplemental manual ventilation, 2 chest tubes, and a polypharmacy of drugs, the cat was breathing steadily and normally on her own. The bloody froth from her lungs had stopped. She was still absolutely neurologically absent, but she was breathing, her heart rate was normal, and her blood pressure was hanging close enough to normal for me.

We moved her to the oxygen cage (still intubated) and waited for her to die. I told the owner the chances of this cat surviving were last than 5%. 2 hours later, we pulled her endotracheal tube and moved her to a sternal position. Her pupils were still fixed and dilated, but she began to make noises - muted meows.

3 hours later, she was able to hold herself upright and meow, although she was blind. 8 hours later, she was visual again. Her respiratory rate was almost normal, and her breathing was no longer labored. I started her on pimobendan (the cardiac wonder drug of dogs, while tested extensively in them, has never been tested in cats - but many cardiologists are recommending trying it). We continued her Lasix to remove any pulmonary edema and started enalapril.

After 12 hours, we removed her chest tubes due to discomfort and the likelihood that we would not need them again (heart failure fluid tends to accumulate very slowly).

This morning, when I sent her to the cardiologist for her echocardiogram, she was a "normal" cat - eating, drinking, meowing, and soliciting head rubs in the oxygen cage. She was 100% neurologically normal, no residual effects from her near death experience. If you saw this cat on the street, you'd think nothing was wrong with her (well, other than her shaved chest and stitches from her chest tubes).

It's rare that I can look at an animal and say that I saved it for sure. In this case, if we hadn't intervened, the cat would have undoubtedly died. My team did an excellent job getting this cat back - unparalleled in my 3 years of experience. It was one of the most satisfying experiences of my veterinary career thus far.

On top of that, we had a cat with a pyothorax ("pus chest") - and the owner elected to treat instead of euthanasia. We saved a kitty that was dying from severe electrolyte imbalances and sent her home a happy, healthier, eating kitty. We took a 2 year old parvo dog with a 106 temperature and turned him into an eating, tail wagging machine. It was a great, great weekend with many successes to make it memorable. It restored my faith in my ability to love my job.


Karen Whiddon said...

I'm so glad to hear all this good news! You ROCK!

Mary said...

Great job! Sounds like you had exactly the weekend you needed!

HP said...

Congratulations! What an amazing weekend! I can't imagine how satisfying that must feel to have a patient on the brink of death (or just dead, really) and bringing them back to life. Great job :)

The Homeless Parrot said...

We decided that the cat was only "mostly dead" rather than fully dead.

LetMeTellYouATale said...

What a great post :) Thanks for sharing it.

clairesmum said...

is kitty's new nickname "Lazarus"? good work and a lovely antidote to the more usual outcomes.

Nicki said...

Awesome. Amaizing about the cat-they really are amazing creatures. Feels good to have really saved one doesn't it?