Any advice before surgery? I'm scared

Musiaka

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We did an ultrasound today and our vet noticed something casting quite a strong shadow, looking almost like a foreign object. She took Musiaka in for an x-ray and saw that the gallbladder stones that were quite small in the autumn are now large and there's several of them. The time is up for Musiaka's gallbladder to be removed.

We have to stop prednisolone and because the dose is low (1,25 mg) she said we can just quit cold turkey.

Musiaka is eating well is generally in a good mood, but does seem to show some signs of pain, despite being playful.

Does anyone have any experiences of gallbladder removal surgery? Could your cat recover well and lead a normal life? Any tips on how to increase Musiaka's chances of a successfull surgery?
 

sivyaleah

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Sorry to hear this!

I think it's similar to humans in that they can live without the gallbladder. Watching fat intake might be necessary but your vet will advise on proper diet.

I had mine out years ago, no issues at all. Just had to be careful about eating certain foods for a while (nuts was one but cats don't eat them LOL). Your liver eventually takes over some of the work the gallbladder did. Again, probably similar in cats.

Musiaka will most likely feel SO much better afterwards - I know I did!
 

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I had mine out years ago, no issues at all. Just had to be careful about eating certain foods...
In humans, a gall bladder operation is fairly routine, these days.

I can't imagine that it would be any more difficult for cats.

The gall bladder is a storage organ. The liver produces bile then the gall bladder stores it until it's needed. The gall bladder delivers it to the digestive tract when we eat. This doesn't mean that the body won't have any bile. It only means that the body won't have a stockpile of it. The liver still excretes bile but only when needed and, obviously, more slowly.

You will have to adjust your cat's diet and you're going to have to experiment a little in order to decide what adjustments to make but, once things settle down, your cat will live almost the same as before.

It's good to be concerned about your cat having an operation. That means you care.
But it doesn't pay to fret about it. Instead, channel your concern into motivation to help you are take care of your cat the best way you know how.

This is the time to ask questions and learn what you can. It'll take some time to get used to things but, afterward, you'll hardly remember that your cat had an operation.

If your cat is otherwise healthy, I see no reason why she won't come through with flying colors. :)
 
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Musiaka

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In humans, a gall bladder operation is fairly routine, these days.

I can't imagine that it would be any more difficult for cats.

The gall bladder is a storage organ. The liver produces bile then the gall bladder stores it until it's needed. The gall bladder delivers it to the digestive tract when we eat. This doesn't mean that the body won't have any bile. It only means that the body won't have a stockpile of it. The liver still excretes bile but only when needed and, obviously, more slowly.

You will have to adjust your cat's diet and you're going to have to experiment a little in order to decide what adjustments to make but, once things settle down, your cat will live almost the same as before.

It's good to be concerned about your cat having an operation. That means you care.
But it doesn't pay to fret about it. Instead, channel your concern into motivation to help you are take care of your cat the best way you know how.

This is the time to ask questions and learn what you can. It'll take some time to get used to things but, afterward, you'll hardly remember that your cat had an operation.

If your cat is otherwise healthy, I see no reason why she won't come through with flying colors. :)
Musiaka has IBD, but in general he's in a good condition, eats well (although I suspect that his current food has something to do with how fast the gallstones grew in size cause it has a pretty high fat content, 8%!), is interested in life, doesn't lose weight so I hope his condition is good enough to at least not get worse after the surgery. I'm trying not to think about the possibility of death.

Although now when I think about it, his liver enzymes are on the higher side, vet said not to worry as it's common on pred, but if the liver will have to take over for his gallbladder, shouldn't it cause problems? His liver not being in perfect condition?

Also, should maybe getting some IV be helpfull for the operation? Musiaka had a bit of a flareup, he threw up 3 days in a row, maybe we should get his liquids restored before getting on with the surgery?

You're right, no point to fret, this is something we must do and there is no choice anymore. When the stones were small I thought maybe they're asymptomatic and he can live with them without going through the risk or surgery, but I was wrong. He also seems to have some discomfort in the gallbladder area and now when I think about it, has become much grumpier about me lifting him up. I thought he's just becoming a grumpy old man but it might be due to him experiencing pain.

I guess most cat mom's have to go through this fear of losing their babies, but still having to proceed with what's necessary...
 

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After my gall bladder surgery the surgeon visited me in the hospital to ask whether I needed any pain medications, and I said "No, I haven't had any pain at all since you took the nasty thing out." (All right, I didn't say "nasty," but this is a child friendly site.) And he looked doubtful and went to the nurse's station to order pain meds for me. The nurse came in about five minutes later to offer me a shot, which I turned down.
* * * * * * * * *
Sometimes after the gall bladder has been removed one of the bile ducts will expand a bit, to create a sort of pseudo gall bladder, but it isn't a big deal if that doesn't happen. I wouldn't say that the gall bladder is useless, but it isn't even close to essential.

Margret
 
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Musiaka

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I guess I'm not that scared about him losing a gallbladder, the whole surgery and anesthesia worries me the most. Should we check his heart before the surgery so that the anesthesia is adjusted in case he has a murmur or something? Should get some IV prior to that or maybe I could give him a special electrolyte drink for cats?

A good thing is that we will do the surgery probably at the best clinic in country, so I hope they really know how to handle cats on anesthesia and monitor them closely
 

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Any vet worth their salt will do all those checks before the surgery.

I know my vet uses isoflourane for anesthesia; it’s considered very safe, used on infants, as it leaves the system very quickly once it is no longer being administered. It’s a great option for geriatric and small animals.

They will also likely hook him up with fluids during and after the surgery to help with recovery. If you are feeling very brave and confident, you can ask if you need to do subcutaneous fluids at home. But I would probably just add some extra water to his food for a while before going that route.

I know surgery can be scary, but try to remember that veterinary care has come a long way over the years. Breathe and trust. ❤
 
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Musiaka

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Any vet worth their salt will do all those checks before the surgery.

I know my vet uses isoflourane for anesthesia; it’s considered very safe, used on infants, as it leaves the system very quickly once it is no longer being administered. It’s a great option for geriatric and small animals.

They will also likely hook him up with fluids during and after the surgery to help with recovery. If you are feeling very brave and confident, you can ask if you need to do subcutaneous fluids at home. But I would probably just add some extra water to his food for a while before going that route.

I know surgery can be scary, but try to remember that veterinary care has come a long way over the years. Breathe and trust. ❤
Yes, I have to finally learn to trust the vets. I didn't do much for his gallstones for over a year, except for trying Ursofalk and giving up shortly because Musiaka didn't react well to the taste. But even back then the vet recommended to just take the gallbladder out as it's even safer than trying to melt the stones and cats can live without it perfectly fine. But I was like noooo surgery is danger, I don't want to put him through surgery, let's see if he can just live with the stones as there were initially no signs of pain. But then again, cats are masters at hiding it...
 
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Musiaka

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Also, mortality rate during the surgery was 21,7%!!!!
 

furmonster mom

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Ok, that’s 23 cats in a 14 year period. That seems like a pretty low sample to me.

They say the cats were “client owned”. My question would be where/how did they obtain their sample?
Whose clients?
And is that a reflection of the cats’ health or the skill of the surgeon(s)?
What was the condition and prognosis of the cats to begin with?
Were the surgeries all performed by the same surgeon?
what was the skill level of the surgeon(s)?
If it was a single surgeons clients, did their skills improve over 14 years?

You see, when evaluating a “study”, there are many factors that are sometimes not accounted for.

Also, you need to take stock of your own situation.
This may seem calculating, but what is the current life expectancy if you do not get the surgery? What would make the risk worthwhile? Is an extra year acceptable? 1.5 years?
I know these are tough questions to consider, because we have so much love and attachment for our little companions. It’s sometimes hard to remember that their lives are inherently so much shorter. All we can do is try to give them the best life we can offer for as long as they stay with us. If a surgery will give them a better quality of life for a little while, and if it’s in our power to do it…. Then we hope and pray for the best outcome possible. 🙏
 
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Musiaka

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Ok, that’s 23 cats in a 14 year period. That seems like a pretty low sample to me.

They say the cats were “client owned”. My question would be where/how did they obtain their sample?
Whose clients?
And is that a reflection of the cats’ health or the skill of the surgeon(s)?
What was the condition and prognosis of the cats to begin with?
Were the surgeries all performed by the same surgeon?
what was the skill level of the surgeon(s)?
If it was a single surgeons clients, did their skills improve over 14 years?

You see, when evaluating a “study”, there are many factors that are sometimes not accounted for.

Also, you need to take stock of your own situation.
This may seem calculating, but what is the current life expectancy if you do not get the surgery? What would make the risk worthwhile? Is an extra year acceptable? 1.5 years?
I know these are tough questions to consider, because we have so much love and attachment for our little companions. It’s sometimes hard to remember that their lives are inherently so much shorter. All we can do is try to give them the best life we can offer for as long as they stay with us. If a surgery will give them a better quality of life for a little while, and if it’s in our power to do it…. Then we hope and pray for the best outcome possible. 🙏
The vet says he won't be living long with those gallstones which is currently hard to believe because Musiaka is generally in a good condition right now (he is playing and running at this very moment I'm writing this). But maybe it's only a matter of time until he becomes much more symptomatic, I don't know... He's currently not jaundiced and his blood results last month were ok, liver enzymes on the higher end but not over the top. He was vomiting less while on prednisolone but recently started to vomit more again, which coincides with me taking him outside more (he throws up bile). He has recently become more angry about me lifting him up, which makes me think that maybe he's in more pain then he lets on, but why running and having zoomies then?

I just don't know... if he dies during this surgery I'm never going to forgive myself. Especially because he's not doing too bad right now, he looks like he could live at least some years, he's chubby, interactive, eats well...
 

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I was going to say something similar to what furmonster mom furmonster mom said.

With 28 cats in the study, only six of them would have to have unsuccessful surgeries to make 21%.
If the study went on for fourteen years, that means that, on average, only one cat died every two years.

What if only one of those cats didn't make it because it was at death's door before the surgery even started.
What about old cats or young cats? What about cats with some other disease? Does the study make it clear and break patients' down into categories?

If just one of those bad outcomes happened in an already-sick cat, you should eliminate that one from the study. Because of that the rate drops from 21% to 18%.

Like furmonster mom furmonster mom says, you've got to be critical when reading studies.

That's why they are published... So that other people can criticize them.
If you don't criticize, you can't find the flaws in your theories. Isn't that what science is all about? Finding out what's true? :)
 
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Musiaka

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You guys are right about the study. I found another source that says that gallbladder removal is done at critical situations which is what may raise the mortality levels. But that raises a question if Musiaka is ceitical enough for the surgery?

I paid for an online chat with a vet from a different clinic and asked him this question. He asked if Musiaka is jaundiced and if he has biliary obstructions, doesn't eat etc. I answered no and he said that we could still go Ursodiol/antibiotics route to try and improve bile drainage and let him live with the stones for now. Or we could opt for removal of the stones alone, without removing the gallbladder. Gallbladder removal is much more complicated for cat than it is for humans as it's interconnected with the liver. Fatty food and parasites could cause gallstones. Pred can also cause them. I need to switch his diet to a low-fat one immediately and go back to giving liver support supplement. It's unclear which route will give him a longer lifespan but if there's no imminent danger to his health right now, the removal can be of a greater risk.

What do you think, which vet should I trust? Gallbladder removal is an extremely rare surgery!
 

furmonster mom

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You mentioned earlier that the stones have become quite large, and that he seems to be “grumpy” because of the pain. Putting it off means you have to manage his pain, which means meds, which will take a toll on his kidneys and liver.

Also, you said that your vet recommended the surgery earlier, but you put it off, and now things are worse. What makes you think things are going to get better if you put it off again?

If Musiaka is in good condition now, wouldn’t it be a better time to go through the surgery than waiting until he’s critical? If you wait until it’s more critical, he may have less chance to recover.
 
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Musiaka

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You mentioned earlier that the stones have become quite large, and that he seems to be “grumpy” because of the pain. Putting it off means you have to manage his pain, which means meds, which will take a toll on his kidneys and liver.

Also, you said that your vet recommended the surgery earlier, but you put it off, and now things are worse. What makes you think things are going to get better if you put it off again?

If Musiaka is in good condition now, wouldn’t it be a better time to go through the surgery than waiting until he’s critical? If you wait until it’s more critical, he may have less chance to recover.
I talked to the surgeon today. She says that the episodes of pain are usually so intense, that it's impossible not to notice - the cat won't eat, get letargic, won't let you touch it. Musiaka doesn't seem like that at all, often he just sits calmly and suddenly bolts through the apartment and jumps on the couch hanging on his nails lol. He does seem much more grumpy when I try to lift him up, but if I'm not trying to, he happily exposes his belly for rubs, so I don't know... The surgeon says they rarely perform this surgery (and this is one of the best clinics in the country) and it's usually when there's external signs of deterioration, hight GGT and ALT/ALP, but otherwise they try to treat it with Ursodiol and SAMe. So at the end of the convo we decided that I should bring Musiaka in for a second ultrasound + bloodwork and then we decide if surgery is needed
 
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Musiaka

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And we're starting to spiral out again.
This evening Musiaka started vomiting relentlessly. This is day two of no pred and new low fat food. Didn't have such vomiting since december.
This last visit spiraled us both out completely. That foolish vet took him off pred while knowing how great he was doing on it just to push for a surgery that's rarely even done for cats in his condition - aka no major side effects from the gallstones.

I'm so angry and sad. We had months of doing good and his vet singlehandly ruined it with her instructions and panic. We should have continued on Pred. I don't know what to do!! :(((( god I will never have a cat ever again, it's 6 years of agony and nothing else
 
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Musiaka

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Should I put him back on pred myself? There is no way we could do surgery on a flared up ibd cat even if it's needed...
 
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Musiaka

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Just vomited for the 5th time in a row! After months of only vomiting once or twice a month!! All that for nothing
 
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