Info

November 14, 2011- Amount of fluid has increased... 700cc drawn this morning.   Dr. Hadley wants to discuss Bumble during rounds with the doctors to see what they think about sending him home.  Tentative plan to pick him up at 3pm but wait for call.

BUMBLE'S HOME- Peed at 7pm and pooped a 7:20pm.  Got a big drink of water but stopped him so he wouldn't drink too much.  Ate a full dinner.  Wanted to run but that's not happening.  The pack wanted to say hi... a few peeked over the top of the Dutch door and were then shooed away.  Now lying on his side and sleeping peacefully.  Respirations at 8:30pm - 23 while sleeping.

Sent home with enough huber needles, stopcocks and tubing to remove fluid 3 times. Asked vet to order supplies so we have enough on hand.  Appointments for draining on Wednesday at 9:40am and Friday at 12:40pm

Panting.

November 13, 2011- 400cc drawn this morning. The fluid's cloudy... they're going to run a test tomorrow to determine whether there's chyle present. Please no...

Still wondering about lung damage if this has been a chronic condition that was missed back in February.  When Dr. Hadley looked at his lungs, she did NOT note the fibrous scaring that can happen due to the irritating nature of the chyle. She said things could definitely be worse at this stage and to stay positive... it can take weeks or even months for him to "dry up". So cautious optimism.

He's starting to rub up against them and trying to kiss their faces... my lover boy. They're seeing the real Bumble when he feels well. Plan's still on for tomorrow. I may ask them whether it's advisable to lightly sedate him when we're reunited... I don't want any exuberance to dislodge that port.

November 12, 2011- They used a longer needle to get the port working and were able to draw off 1200cc of fluid.  (Just over 1/2 of a 2 liter bottle of soda/pop.) I worried about how much was in there and whether he was having any problems breathing through the night. It's a lot of fluid but Dr. Hadley said this was 2 days worth so he's doing ok for this stage of recovery. The fluid is blood tinged but there's no chyle so far.  Hopefully the new pathways are beginning to form so the lymph stuff can go where it should. Yeah, too much info but some day someone else may be going through this and want all the details when searching for chylothorax.

She said they'd like to keep him until Monday and I'm SO totally on board with that. Repeatedly tapping his chest could mean additional scaring so I really hope this port will continue to work. They expect to take him off IV fluids today. He's eating most of his daily quota of food. She had wondered how we fed him... one meal, two, etc. because he's leaving some. They said he's a sweet boy and he's been a trooper and tolerating procedures real well :') That's my buddy

November 11, 2011- Unfortunately, they were only able to draw off 25cc of fluid and there's some mild to moderate pleural effusion. The port could be kinked or out of position. Real disappointed it's not working properly but things don't always go quiet as planned.  Do they ever reopen?  I'm glad we didn't bring him home today.  They'll monitor him tonight to see if his breathing rate increases or becomes heavy and tap him again if necessary. They'll try the port again tomorrow morning to see if it might shift and allow for drainage again. Even with this "bump in the road" they'll always first try the port before doing a tap just in case it opens up again.

November 10, 2011- Still at home. As things stand right now, we plan to pick him up on Sunday. Drawing the fluid from the port is not something I can do here at home. We called at 8am to see who's handling calls in the GT area this weekend. Dr. J is out of town until Sunday... and the vet on call is the one we had a problem with. In all fairness, that vet may have just been having a bad day but she later admitted that Panda would not have had emergency surgery until the following day anyway. In other words, that vet was unable to provide the emergency care needed. That just isn't acceptable so hopefully we can avoid a situation like that again.

Stephanie said at 10am this morning that the last two times they drained him the level of fluid drawn had dropped dramatically. I can't remember the numbers but maybe 100ccs and then maybe 10ccs. They were getting 700cc. But... they're suspicious that the port might be plugged because it's uncommon for the fluid level to taper off that fast. They'll try to flush the line with saline to see if more can be drawn and if not, take another radiograph to see how much fluid in the chest cavity.

He's now eating about 1 cup of ostrich and potatoes every 6 hours so that's encouraging news.  Along with his beloved veggies too.

November 10, 2011- They postponed the decision on releasing him until tomorrow morning. Dr. Hadley had a late surgery and they want to see how much fluid they draw off in the morning. They don't want to send him home too soon... I told her that *I* don't want him to come home too soon. I need to call to see who's handling the weekend emergencies. Unfortunately my vet was on call last weekend so won't be on call this one. There is at least one vet I will not use... when Panda's bladder sutures failed and she was in so much pain, that particular vet said OESs just don't tolerate pain well and did not take us seriously. Never again. If there is any question about him being ready to come home, I'd rather he stay an extra day or two.

He did eat some green beans tonight. He's on oral pain meds only and it's controlling the pain. So... if he's released tomorrow, one option might be for us to rent a room and stay down there until Saturday night or Sunday morning and have fluid drawn off before before we leave just to be sure he'd be good until Monday morning. I need to talk this over with my vet and the vets there to see what's best.

November 9, 2011- He's been sitting up in his kennel this morning. Gone out to potty... Stephanie noticed he doesn't like the wet grass.  No diarrhea but he's not eating yet. Sending out cooked zucchini and green beans to see if it will help get him start eating. They aren't too concerned at this point saying the pain meds can cause this. They drew 500cc of fluid at 8 hours... it had been around 400cc at 4 hour intervals after surgery so the volume has decreased a bit. They may now be able to space out the times they remove fluid. The incision on his side/chest is the most painful. They'll try to drop his pain medication and transfer him over to oral pain meds possibly by tonight. Stephanie said she'll talk with Drs. Nelson and Hadley to see if a visit would be beneficial to him. So for now, he's about where they would expect him to be.

There are two 10cm incisions on his right side. If the fluid continues to decrease over the next couple of days and if the pain is managed with oral meds, AND all continues to go well, he may be able to come home as soon as Friday. :') They're moving toward drawing fluid every 12 hours now. I'll need to monitor respiration and also observe his breathing pattern for any signs that he needs to have fluid removed and any signs of infection. They'll be sending him home with supplies to drain the port but it will be done at Dr. J's office... hopefully just once week for 3 weeks and then the draining will stop.

Stephanie said he's brighter tonight. He has not started eating and I was told he may not until he gets home if it's due to stress. The diarrhea did stop but it may be because he's got no food going through. Keep your fingers crossed that he can come home by Friday and that we can get food going through him at a normal rate.

All 75 intradermal allergens and the RAST panel again came back negative on October 5th. As a last ditch effort on the allergy front, I sent saliva in for the Nutriscan food allergy testing back on October 24th and the results came back today. It's been almost impossible to tell what he might be allergic too (the reason I wonder if this condition has anything to do with the itching). I thought that if the Nutriscan didn't identify a food allergy, it might tell us what foods he could eat. If anyone wants to see what they send, it looks like this- http://oesusa.com/Bumble-Nutriscan102411.pdf He has medium IgA reaction to beef but maybe eggs will be okay? Might be a little something we can start with to entice him to eat.

Cisterna chyli ablation with thoracic duct ligation (CCA-TDL) and pericardectomy. 

http://www.vetmed.wisc.edu/dss/ChyloThoraxTrial/page3.php
http://www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/Chylothorax

The surgery has been completed and Bumble's in the critical care unit so he can be closely monitored. He's receiving good pain medication and will likely sleep the rest of the day. I was told he tolerated the anesthetic pretty well. They did not do the CT scan after all... it was decided that it wasn't as effective in locating the leakage.

They'll drain his chest cavity every 4 hours through the port they put in. The drainage will continue for a few weeks. The hope is that all the leaks have been sealed up.  We now have to wait and see how he does. Dr. Nelson or Dr. Hadley will call again this evening.

Dr. Hadley told me the surgery went well and there were no complications. Bumble's where they would expect him to be. They've drawn fluid through the port and it's working properly... there wasn't a lot and it looked normal... nothing unexpected. The way we'll come to know whether this surgery was successful is if the drainage gradually begins to taper off and eventually stop over the next few weeks. That will indicate that the leaks have been closed. That's what we'll be hoping for!

He wasn't eating well yesterday... they did get him to eat a little. But he's a boy that when we take him out in public or to the vet, he refuses all treats. When we're in the car heading home, he'll often eat again. Dr. Hadley said if he doesn't begin eating in the next day or so that they'll have to weigh the benefits/problems of having us come down to see if we can get him eating.

I asked the doctor whether she could tell if there had been any lung damage. She said that subjectively his lungs looked to be in good shape. I also asked whether lymph fluid in the chest cavity could in any way be related to the 2+ years of itching, physically hot areas on his skin and pyoderma. (Two intradermal allergy tests and three RAST tests over this period of time had been negative for every single thing.) She said it seems unlikely but it's something she'll discuss with Dr. Rosser, Bumble's dermatologist. She said there just isn't enough known about Chylothorax so it's something to look into a little further.

They want to do both the CT scan and surgery with one sedation so that will be tomorrow. The patient lineup depends on the severity of the cases that have come in over the weekend. Dr. Creighton said last night the success rate is up to 75%... one thing in Bumble's favor is that they haven't had to tap his chest again. There's still fluid in there but they didn't believe it's enough to cause discomfort.

The plan today is more x-rays, another ultrasound and he'll be spending time with cardio for a work up there to see if there are any heart problems.  Staying away is killing me...  He has diarrhea... likely due to the stress. Not eating well.  Put on antibiotics just in case and will add fluids if needed.  Will retest to be certain he doesn't have heartworms.

http://www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/Chylothorax
http://www.morrisanimalfoundation.org/our-research/completed-studies/comparative-clinical-trial.html
http://www.vetmed.wisc.edu/dss/ChyloThoraxTrial/page5.php
 

November 6, 2011- Back in February, his "discomfort" breathing and his recurring pyoderma were what sent us quickly down to MSU to see the dermatologist. Nothing has ever been picked up with a stethoscope until Nov. 4th. The odd breathing wasn't constant and his energy level increased. He has always had healthy looking pink gums. I could post a video of Halloween where the dude was chasing his purple pumpkin all over the living room. But there were times when he was exercise intolerant. But NOT in the past several months but over the past couple of weeks his energy has gone down a little. He's been so happy and playful. The local vet was shocked to see the x-rays on Friday.

Bumble's scheduled for a CT scan on Monday and surgery Monday or Tuesday IF they don't find a cause.  Wrote to Dr. Linder to ask her to touch base with MSU doctors about his diet.  I'd been monitoring his weight... 88 pounds was a good weight for him. He was 87 on Friday at the vet... he was 88.8 here in late October. So I would just boost his food a little. But they drew 2 liters of fluid from his chest cavity... so he's lost weight and is down to 83.3.

Diagnosis= Chylothorax. :'(  They removed 2 liters of chyle from his chest cavity.  Have to wait for tests to be done on Monday.  An uncommon condition... of course. OMG... was this the cause of his heavy breathing in February?????  We can't be so focused on ponies that stripes are missed...

Rented a room at 2am so I could boil potatoes and fry up his ostrich.  Back on the road heading home at 4:30am.  What a wretched night...

November 3rd, 2011- Something's wrong. 
 Labored breathing again. Making appointment
to specifically request a chest x-ray.

For the rest of the pack starting this evening...

Taste of the Wild- Sierra:
Lamb, lamb meal, sweet potatoes, potatoes, peas, canola oil, pea protein, roasted lamb, tomato pomace, natural flavor, salt, choline chloride, mixed tocopherols (a natural preservative and source of vitamin E), dried chicory root, taurine, tomatoes, blueberries, raspberries, yucca schidigera extract, dried Enterococcus faecium fermentation product, dried Lactobacillus acidophilus fermentation product, dried Lactobacillus casei fermentation product, dried Lactobacillus plantarum fermentation product, dried Trichoderma longibrachiatum fermentation extract, vitamin E supplement, iron proteinate, zinc proteinate, copper proteinate, ferrous sulfate, zinc sulfate, copper sulfate, potassium iodide, thiamine mononitrate (vitamin B1), manganese proteinate, manganous oxide, ascorbic acid, vitamin A supplement, biotin, niacin, calcium pantothenate, manganese sulfate, sodium selenite, pyridoxine hydrochloride (vitamin B6), vitamin B12 supplement, riboflavin (vitamin B2), vitamin D supplement, folic acid.

There's a small bump on the middle-back of his neck... no color to it.  Looks to be scar tissue or maybe a cyst?

Looks to be a comedone on his back right hock- inside.

Taste of the Wild High Prairie has chicken meal...

"Bison, lamb meal, chicken meal, egg product..."

 We were going to hold off on opening the bag for a week or so but opened anyway.  Picked up Taste of the Wild Sierra Mountain today and packed up the High Prairie to give to Chris.   Not sure what's in the natural flavor but we'll give it a try.

Bath today with Duoxo

Again tonight at 7:30pm.  Had been out to potty not long before... see video.  5 minutes later he was lying on his side breathing normally.

Sweet potatoes and 5 frozen green beans.