Recurrent Intestinal Stricture

Kikaioh

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Hello again. I actually wrote to this forum about 4 months ago about my cat Swirly, who was going through starvation at the time seemingly related to her chemotherapy treatment. I was grateful for the help at that time, but was unable to follow up because life has admittedly been a sleepless, exhaustive nightmare since then, and even now I'm fighting against sleep to try and find help for her online.

For months Swirly was experiencing chronic vomiting, in spite of the chemotherapy seemingly having cleared her intestines of cancer since the start of her treatment. We were able to get past her food aversion via syringe-feeding, which thankfully seemed to help her realize that food wasn't the problem behind her vomiting. But the question remained why she was still vomiting, without any signs of cancer in her body. At a certain point, an attempt to change her chemo medications wound up making the vomiting even worse and landed her in a near-death experience with acute kidney failure, completely stumping the emergency hospital and her oncologist as to an explanation.

Finally, though, after two months of being off of the chemotherapy (and still cancer-free) the hospital was able to find on her ultrasound that she had a stricture in her small intestine. They figured it might have been caused by scar tissue building up from her chemotherapy. About two weeks ago Swirly successfully went through a surgical removal of the stricture (3 inches of her small intestine), which turned out to be non-cancerous scarred tissue on biopsy.

We really thought that was going to solve all of her vomiting problems. But it didn't. Just a couple of days ago she started vomiting again, had another acute kidney infection, and wound up hospitalized. On a subsequent ultrasound, they found to their surprise that there was a new stricture seemingly at the site of the surgery. It was a baffling development, since strictures alone apparently aren't all that often seen, and strictures after intestinal surgery were also apparently rare. More surprising was that they expected the cancer to complicate the healing process and potentially cause a dehiscence (separation), but the opposite seems to have happened, where either the healing was too strong and wound up constricting the flow of ingesta, or possibly healed with a lot of excess scar tissue.

The doctors all seem to be at a loss for an explanation, and seem to feel like the situation is outside of general medical knowledge to explain, short of another surgery to see what happened.

The doctors are hesitant to try another surgery, and we're currently trying to figure out ideas or possible alternatives to explain and possibly prevent another stricture if another surgery is performed. The question is, what could have caused the recurrent stricture, and how can it be prevented again?

Two thoughts that had come up so far are:
  1. Swirly has been taking 5mg Prednisolone tablets every day since her chemo started. Usually it's supposed to be tapered off to an every-other-day schedule when used chronically, though in Swirly's case because of her cancer it was done on a daily basis. A side effect of long-term high-dose Prednisolone use, though, appears to be gastric irritation, bleeding and ulceration. Given that Swirly had an obstruction prior to her surgery, maybe the Prednisolone was concentrating in her gut at a high and long enough level to irritate the wound and causes ulcers, leading to a stenosis of the wound.
  2. Swirly may have a food allergy or IBD that somehow exacerbated healing of the surgical site. There has been some suspicion that a protein allergy (from eaiting Dr. Elsey's cleanprotein) may have caused her initial IBD/cancer, and that her newest current diet (NF early kidney care) may also have a similar/same protein that has irritated her intestinal lining.
Does anyone here possibly have ideas on what could be causing a recurrent stricture? Her surgeons don't feel like a second surgery would be successful, and seem to be leaning towards euthanasia, but I'd like to give Swirly a chance, since she's currently normal and healthy in the hospital, but this one complication is ruining her chances at a healthy life.

Any help is very much appreciated, and thank you all.
 
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Kikaioh

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I should have also mentioned, as it unfortunately might be getting too late. But the doctors are hoping that I can decide on whether Swirly will go through another surgery before lunchtime today, as they don't feel comfortable discharging her for the weekend. I'm pressured to make a decision soon, which has me worried to pieces. Given Swirly's weird circumstances, I can also understand if there might not be any experience around it, but thanks to anyone who might have any thoughts. It's an alarming and deeply worrying situation to be in. We haven't been able to have a normal life for so long now, but it's even harder for Swirly, so I'm trying whatever I can.
 

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Hi. I would ask the vets to consult with a vet university to see if they can shed any light on Swirly's situation. These universities often study rare cases in their training that sometimes a vet will never see again during their entire practice. There are also internal medicine specialists that your vet could also consult with, I don't think this warrants euthanasia at this time, IMO.

How old is Swirly?
 
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cat nap

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I should have also mentioned, as it unfortunately might be getting too late. But the doctors are hoping that I can decide on whether Swirly will go through another surgery before lunchtime today, as they don't feel comfortable discharging her for the weekend. I'm pressured to make a decision soon, which has me worried to pieces. Given Swirly's weird circumstances, I can also understand if there might not be any experience around it, but thanks to anyone who might have any thoughts. It's an alarming and deeply worrying situation to be in. We haven't been able to have a normal life for so long now, but it's even harder for Swirly, so I'm trying whatever I can.
I'm so sorry Kikaioh Kikaioh ...that none of us can answer your initial question....of what could be causing a recurrent stricture.
I was so hoping that someone would see your thread...who could possibly answer your question...or had a somewhat similar experience with their cats...as critical as it is.

From what I have only briefly read...is there any way that they can put in a type of balloon or stent to open up the bowels...in that part of the stricture?
Can a liquid only diet sustain your Swirly? or is this not even an option.
Do you have pet insurance, and is this covering the costs? ...or are you going into further debt? I know you didn't mention finances at all...but it is important not to put yourself...into too much debt...seeing as surgery costs may well be into four or five digit figures.

If it were me, and I had pet insurance...and saw that my cat was still alert, engaged in life...and had quality of life...then I would go for the second surgery...if they could somehow know that the second one would improve or open up the stricture that was created...and give my cat a chance at eating normally.
If the only other option were surgery or euthanasia...then I would definitely go for the surgery...if I could afford it...but is there a third option....that would give her any quality of life? Tube feeding, liquid diet..as a temporary measure.
 
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Kikaioh

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Hello, and thank you FeebysOwner FeebysOwner and cat nap cat nap for the responses.

Swirly's oncologist has actually tried to reach out to a state vet university to see if they have any thoughts on possible causes. The issue is that they're not sure when we might hear a response --- the oncologist mentioned that the university has been deluged with requests in the past year and switched from phone to email-only consultation to manage the volume, and that oftentimes they have to schedule appointments months with them in advance. I feel like this pressure to jump into surgery so soon without getting some experienced feedback is daunting, and I'm hoping I can discuss with the oncologist to see if the surgery can be delayed to next week while we wait for a response.

Swirly is about 9 years old. Her doctors seemed to feel that she was young to be experiencing cancer, which is partially why I'm wondering if she may have been suffering IBD or some persistent digestive irritation that wound up causing her to get cancer.

It's unfortunate but understandable if there isn't a lot of experience here with Swirly's situation. My oncologist asked everyone in the hospital (surgeons, critical care specialists, etc.) for their thoughts on her case, and they largely seemed to be stumped too.

Swirly's stricture seems to be backing up food and water in her digestive tract, so I don't think a liquid only diet would work out (every time she vomits it's mostly liquid), though I can try to ask. I also don't think a stent would be possible, as they had previously ruled out endoscopic imaging for investigating the obstruction area, because it was too far down in her intestines, but I can try to ask as well.

I unfortunately haven't had pet insurance for Swirly since she was diagnosed with cancer, and haven't gotten any yet still since it seemed like it wouldn't cover all of her current conditions, though I'm starting to look into it, just in case some other unexpected wildcard pops up for Swirly. I'm somewhat fortunately a software developer, and I've had enough savings to cover all of her treatment out-of-pocket so far, but I'm admittedly starting to run low, and may need to dip into my retirement accounts soon (which is worrisome).

I'm also leaning towards the surgery, assuming her doctors are on-board with trying different approaches despite the uncertain outcome (hypoallergenic diet change, reduced prednisolone) to see if it helps her this time around, but I'm unsure.

Thanks again for the thoughts and feedback. I can only hope some of these questions and thoughts can help guide Swirly to a positive outcome.
 

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Swirly is about 9 years old. Her doctors seemed to feel that she was young to be experiencing cancer, which is partially why I'm wondering if she may have been suffering IBD or some persistent digestive irritation that wound up causing her to get cancer.

It's unfortunate but understandable if there isn't a lot of experience here with Swirly's situation. My oncologist asked everyone in the hospital (surgeons, critical care specialists, etc.) for their thoughts on her case, and they largely seemed to be stumped too.

Swirly's stricture seems to be backing up food and water in her digestive tract, so I don't think a liquid only diet would work out (every time she vomits it's mostly liquid), though I can try to ask. I also don't think a stent would be possible, as they had previously ruled out endoscopic imaging for investigating the obstruction area, because it was too far down in her intestines, but I can try to ask as well.

I unfortunately haven't had pet insurance for Swirly since she was diagnosed with cancer, and haven't gotten any yet still since it seemed like it wouldn't cover all of her current conditions, though I'm starting to look into it, just in case some other unexpected wildcard pops up for Swirly. I'm somewhat fortunately a software developer, and I've had enough savings to cover all of her treatment out-of-pocket so far, but I'm admittedly starting to run low, and may need to dip into my retirement accounts soon (which is worrisome).

I'm also leaning towards the surgery, assuming her doctors are on-board with trying different approaches despite the uncertain outcome (hypoallergenic diet change, reduced prednisolone) to see if it helps her this time around, but I'm unsure.

Thanks again for the thoughts and feedback. I can only hope some of these questions and thoughts can help guide Swirly to a positive outcome.
You're in such a difficult position, seeing that Swirly had her initial stricture surgery about two weeks ago, and then the post surgery complication of another stricture forming.

So is that what would cause the acute kidney infection ...two days ago.?
The malabsorption of nutrients....or are the doctors thinking that the medications caused increased toxicity in the blood?

(I don't think that pet insurance would actually cover anything useful, now, because they would probably deem everything to be a pre-existing condition,...but I really don't know. And I wouldn't want you to dip into your retirement savings...unless you were so young to be able to put all that back in. Anyhow...I'm not helping you any...in getting you more worried. Just want you to be realistic, ...and think rationally, ...and not with only your heart or emotions...and the huge Love you have for your cat Swirly. That Love is totally clear to anyone reading your posts.)

Was there a reason that an E-tube was also not an option?
Is it the location of the stricture, within the intestines,....or is it the acute kidney infection?
Or because it would only be a temporary measure?

I do like your reasoning of waiting until the Vets hear from the university vets.
But only if it does not interfere with Swirly's chance of having a better outcome...in doing a second surgery sooner...rather than later.

If your oncologist thinks that a second surgery would be able to remove the stricture, sew up the intestines...and somehow the placement of the intestines would be better...or a different method of suturing...would prevent another stricture forming...then I would go for the surgery.
I'm still a bit baffled about the acute kidney infection, though....and what caused it.
 
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Kikaioh

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Thank you for the additional reply cat nap cat nap . I don't think the doctors are 100% sure why she had an acute kidney infection. I may be remembering incorrectly, but I think they believed her sudden acute vomiting (4 separate incidents where she threw up a lot of liquid) may have significantly dehydrated her to a level that her kidney couldn't function properly.

I'm not as young as I wish I were (late 30s) to be draining all of my spendings, and admittedly haven't saved for the future as well as I could have, from my failed attempts at following my passions in life. I owe Swirly the best I can give her, though. For all the mistakes I've made, but also for being the one creature in this world that's ever shown me unconditional love, from the moment she first walked onto my lap.

From my understanding, the feeding tube normally goes into the stomach, and her stricture may be too far down in her intestines to bypass. There was some thought about whether there may be a way to somehow set up a feeding tube that goes into her small intestines directly through the side of her belly, but apparently the surgeons mentioned they'd never done or heard of it being done before, and that it would more likely be something the university vets would have any potential familiarity with.

I spoke with the oncologist today, and she thinks that it's okay to wait until Monday to try the surgery again, and the timing may even give Swirly a chance to recuperate more fully before then.

However, I don't think she, or any of the surgeons, believe that the second surgery will be of any help to Swirly, unless the university vets have some insight that could potentially help. I was told that the surgery would be about the same as before (though with potentially less leeway, since the area may be close to where some difficult to handle ducts are located along the intestine), and that there didn't seem to be any significantly helpful improvements for adjusting the sutures for it to potentially heal better this time around. By going forward, it's mainly to give her a second chance that it may, through some adjustments to her Prednisolone and her feeding, and maybe just by chance, allow her to heal better this time around.

Unless we can hear some helpful feedback that could give an idea for what's causing her issues or help prevent them during a second surgery, there seems to be a likeliness that she'll end up with the same stricture again. And it just tears me apart to think of that, because at that point, I would likely need to consider euthanization, which is such a horrible tragedy when she's seems like she would be healthy otherwise. It's just unbearably heartbreaking to think one small problem in her body could ruin her life so terribly.
 

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Forgive me if my brain didn't process it, but why is she still being given steroids? Could that have any bearing on the development of such a stricture? An IV drip that they do with humans who are unable to eat, to provide basic nutrients, would most likely be released through the urine would it not? Is there any reason that the vets can't reach out to multiple universities incase there are others that could be more responsive? I'm sorry, just grasping at straws...
 
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Kikaioh

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From my understanding, usually cats with Swirly's type of cancer (large cell lymphoma) are kept on steroids until they either reach a state of usually temporary remission, or for the rest of their life. Swirly was unable to finish her chemotherapy schedule because of her persistent vomiting issues, but remained on Prednisolone, I think not just because of it being an anti-inflammatory, but also because of its anti-cancer properties. I think only recently was the oncologist willing to consider Swirly to be in remission, as she hadn't shown signs of cancer in her ultrasounds for over two months since she stopped the full chemotherapy.

It seemed like from the oncologist's perspective, the steroids (being anti-inflammatory) ought to have reduced the likelihood of a stricture. I tried to theory-craft if there might have been a cumulating effect of the Prednisolone due to her intestinal obstruction from the stricture, but the doctor reasoned that the medication's absorption would normally occur in the intestines, and if it was pooling in the stomach because of the obstruction, it would have actually been absorbed less as a result, particularly after vomiting, and not in a concentrated way that could have had strong side effects (which she would have also thought would be noticeably occurring elsewhere in the intestines).

I'm not sure if they have IV drips for cats. I know Swirly's currently on a fluid therapy that has various nutrients and calcium, and they mentioned that they're going to try a nasogastric feeding tube today to see if a slow-drip feeding could work for Swirly.

The oncologist mentioned that she would try reaching out to her colleagues to see if they knew of any gastrointestinal specialists that might be able to help. She said that she could try to reach out to other universities, but that there was a low likelihood that they would respond, as there sounded to be politics involved where universities give consultation precedence to practices that transfer special case clients to them (which is why she was mainly reaching out to Texas A&M, which her hospital is partnered with). I don't really know if that's the case, but in searching different universities online, I didn't have much of a clue on who to reach out to that could help Swirly on such short notice. The oncologist also explained that she didn't want to give me a false sense of hope, in that she actually doubts that Texas A&M would have any more helpful insights at all into Swirly's case, though she was open to the possibility that there could have been one unique similar case where they might have an idea for how to address her issues.

It's admittedly very frustrating, because all of the hospital's medical experience seems to point away from there being any helpful options for Swirly besides just trying the surgery again. I feel helpless, and I wish I could have more helpful information for Swirly if she goes into a second surgery, but it's been difficult finding anyone with any sort of experience with her issues.
 

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Thank you for the additional reply cat nap cat nap . I don't think the doctors are 100% sure why she had an acute kidney infection. I may be remembering incorrectly, but I think they believed her sudden acute vomiting (4 separate incidents where she threw up a lot of liquid) may have significantly dehydrated her to a level that her kidney couldn't function properly.

I'm not as young as I wish I were (late 30s) to be draining all of my spendings, and admittedly haven't saved for the future as well as I could have, from my failed attempts at following my passions in life. I owe Swirly the best I can give her, though. For all the mistakes I've made, but also for being the one creature in this world that's ever shown me unconditional love, from the moment she first walked onto my lap.
Kikaioh Kikaioh ...that last part you wrote above brings tears to my eyes, but not strictly tears of sadness,...but rather a mixture of all sorts of emotions, hope, contemplative, a bit of sadness, joy....because yeah, most of us who have animals in our lives...know exactly what you are talking about...that pure unconditional love, that our animals show us, every day. You said it beautifully.

You're actually fairly young, (late 30's), and true you shouldn't be spending all your savings, but following your passions in life is something to later look back on...and be able to say at least you did them. You still have time to put away savings for the future.
(I hate to say that I'm 51 years old, and only in my late 40's, actually thought that saving for retirement would be good. smh. I kind of wish I was back in my late twenties or early thirties...and kind of saved more too, but when I think about it...I probably wouldn't have.)

So the acute vomiting means that her first stricture developed a while back.
Causing kidney problems afterwards.🤔
From my understanding, the feeding tube normally goes into the stomach, and her stricture may be too far down in her intestines to bypass. There was some thought about whether there may be a way to somehow set up a feeding tube that goes into her small intestines directly through the side of her belly, but apparently the surgeons mentioned they'd never done or heard of it being done before, and that it would more likely be something the university vets would have any potential familiarity with.

I spoke with the oncologist today, and she thinks that it's okay to wait until Monday to try the surgery again, and the timing may even give Swirly a chance to recuperate more fully before then.
Sorry about that, yeah, that was kind of dumb of me...for some reason I thought the feeding tube could bypass the stomach...but now that I think about it...it doesn't make sense. (I think I'm also grabbing at straws...trying to find ways...where you can get more time...to make decisions. I don't make good decisions on the spot, or under pressure at all. I always need more time to think, read, absorb and then think some more.)

I'm so glad that your oncologist said it was okay to wait until Monday.:)
However, I don't think she, or any of the surgeons, believe that the second surgery will be of any help to Swirly, unless the university vets have some insight that could potentially help. I was told that the surgery would be about the same as before (though with potentially less leeway, since the area may be close to where some difficult to handle ducts are located along the intestine), and that there didn't seem to be any significantly helpful improvements for adjusting the sutures for it to potentially heal better this time around. By going forward, it's mainly to give her a second chance that it may, through some adjustments to her Prednisolone and her feeding, and maybe just by chance, allow her to heal better this time around.

Unless we can hear some helpful feedback that could give an idea for what's causing her issues or help prevent them during a second surgery, there seems to be a likeliness that she'll end up with the same stricture again. And it just tears me apart to think of that, because at that point, I would likely need to consider euthanization, which is such a horrible tragedy when she's seems like she would be healthy otherwise. It's just unbearably heartbreaking to think one small problem in her body could ruin her life so terribly.
Yeah, I know I'm doing wishful thinking...but I was somehow hoping that the surgeon...would have some sort of different sutures in mind, or cut the resection differently...so that both sides somehow line up better.
(in my mind I was thinking of the surgeon as a sort of seamstress...where different stitches and joinings were made.
I know that's not realistic, though.)

I just don't understand how these type of strictures, or stenosis, could happen...but hardly any online literature even mentions it.
I mean, cats swallow foreign objects...all the time...and Vets do surgeries to remove them...but I guess it's not the same type of surgery where a complete resection is taking place.

If it's scar tissue, or caused by inflammation, ...then why wouldn't anti-inflammatory drugs help.
Prednisolone is an anti-inflammatory, but it also suppresses the immune system, and like you mentioned before causes all sorts of gastric problems...with acidity. (With human prednisone, I had to take a sulcrafate type of medication to protect the stomach lining, when I was a kid. I can't remember which one, milky and awful tasting, though.)

This website is somewhat useful, to us regular laypeople, because it shows some pictures...of an Anastomosis procedure...towards the bottom of the page. Under Enterectomy.
How to Perform a Safe Gastrointestinal Surgery - WSAVA 2015 Congress - VIN

And this one is what I would wish they could do for the stricture..use a cutting balloon....but like you said before...because of it's location...it's not possible to get to it. (I wish medicine were more advanced, even though I do think it's better than it used to be. I just kind of wish they could do everything with laprascopes, and such.)
The Use of a Cutting Balloon for Dilation of a Fibrous Esophageal Stricture in a Cat
I'm not sure if they have IV drips for cats. I know Swirly's currently on a fluid therapy that has various nutrients and calcium, and they mentioned that they're going to try a nasogastric feeding tube today to see if a slow-drip feeding could work for Swirly.

The oncologist mentioned that she would try reaching out to her colleagues to see if they knew of any gastrointestinal specialists that might be able to help. She said that she could try to reach out to other universities, but that there was a low likelihood that they would respond, as there sounded to be politics involved where universities give consultation precedence to practices that transfer special case clients to them (which is why she was mainly reaching out to Texas A&M, which her hospital is partnered with). I don't really know if that's the case, but in searching different universities online, I didn't have much of a clue on who to reach out to that could help Swirly on such short notice. The oncologist also explained that she didn't want to give me a false sense of hope, in that she actually doubts that Texas A&M would have any more helpful insights at all into Swirly's case, though she was open to the possibility that there could have been one unique similar case where they might have an idea for how to address her issues.

It's admittedly very frustrating, because all of the hospital's medical experience seems to point away from there being any helpful options for Swirly besides just trying the surgery again. I feel helpless, and I wish I could have more helpful information for Swirly if she goes into a second surgery, but it's been difficult finding anyone with any sort of experience with her issues.
It is very frustrating...when all I could find online was a golden retriever dog with a stricture...where they think that NSAIDS might have caused it. (It's not even the proper species... and no help whatsoever, except for more photos.)
Benign Duodenal Stricture Treated with Surgical Correction and Dietary Therapy in a Golden Retriever

I totally feel for you, Kikaioh. Please stay strong, and do try to get some rest, too.:alright: :grouphug::hugs:
I'm going to be saying some prayers for your Swirly this weekend, and sending you both Mega Health Vibes, too. :vibes::vibes::bicolorcat:
 
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Kikaioh

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Thank you cat nap cat nap for the reply. I agree with your sympathies about animals. I love my cats more than anything in the world.

I'm also glad my oncologist gave me a chance to wait until Monday. It's given me more time to think about Swirly's situation, come up with different thoughts/explanations for her stricture, and to also reach out to an online vet, a gastrointestinal veterinary surgeon, that had some possibly helpful thoughts (though he admittedly didn't think there was much more that could be done to improve the sutures or reduce the chance of a stricture in a second surgery, unfortunately).

I was also told that strictures tend to happen after a surgery either as a progression of cancer, or due to the surgery reattaching a diseased piece of intestine back to a healthy one. In Swirly's case, though, the surgery was supposedly clean between the reconnected parts of her intestine, and the biopsy of the removed intestine showed no signs of lymphoma or cancer, so neither seemed feasible.

One potential idea that came up was that maybe Swirly could have consumed a foreign object sometime after her surgery. It doesn't seem entirely likely, since she was monitored and restricted (I kept her in a dog crate, which was recommended), though she did admittedly have some opportunities to wander the apartment a bit while I cleaned her cage. She at times would sit on the mat at my front door, which does have plastic fibers on it that she could have chewed at. She and my other cat, Milo, do also at times chew at and tear apart a scratching board in my living room as well, though it maybe sounds less likely that small bits of cardboard paper could be a problem.

Related to that, it may be possible that she consumed a foreign object a long time ago, that might somehow be stuck in her stomach, and maybe occasionally squirms its way down to where the surgery site is, and gets stuck for some reason, then gets dislodged from the vomiting, and winds up back in the stomach. Maybe it's a bit far-fetched sounding, but there was a time early on in her vomiting episodes that she seemed to have thrown up a Greenie, which is a treat I hadn't fed her for months --- she had also been prescribed Purina EN, a digestive food with bits of rice in it, and over the course of a week of eating it, wound up throwing up a big handful of rice, which seemed to suggest a lot of it had been stuck. More recently, when she threw up several days after her surgery, she also threw up several bits of rice, which made me think perhaps she still has some of that rice in her stomach (though, it's also possible the hospital staff fed her Purina EN after her surgery, which I wasn't able to confirm).

The oncologist and the veterinary surgeon I spoke to did also seem to feel as though her Prednisolone wouldn't likely be a cause, and in some senses, maybe ought to have been helping to prevent inflammation at the site of her surgery.

Thank you for the surgery links as well, I do also wish medicine was advanced to where they could better look inside cats' bodies, it would help so much more in diagnosing and figuring out what's going on.

Thank you for the prayers and good vibes. Today was a lot of talking with doctors, researching, and figuring things out for Monday. I can only hope things will work out more successfully for Swirly in a second surgery.
 

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I find a lot of the things you wrote above very informative and interesting....especially the throwing up of the Greenie treat and food that was previously eaten...and was sitting inside of her G.I. tract for a while.

Still a bit frustrated that I cannot find any useful scientific papers online, or websites, that mention actual strictures in cats...within the small intestines. (There are many that deal with esophageal strictures, and also anal strictures,...but not ones in the small intestines.)

The key words I'm using are:"prevention of feline stenosis, anastomosis, stricture formation, or abnormal narrowing in cat intestine"
But I think that I'm going to try to narrow it down to: "actual scarring...or scar formation...within the feline small intestines"...and see if I get any better hits.

-------------------------------------------------------------------------------------------------------------------------
**So far I did find these two sites...which are semi useful....(because unfortunately they only mention esophageal strictures and a dog in the second one)...but they do at least mention...the use of steroid injections placed into the lesions to reduce further scarring or strictures.

***(I'm sure that your oncologist already knows all this info,...but at least discussing if they do place some sort of injection into the surgery site...to prevent further strictures...might be worthwhile.)
But the troubling thing I found was that these meds are very, very strong with a lot of side effects...so really don't know if they are in use at all.

I'm so hoping that your oncologist will be able to get useful info and tips from any of her gastrointestinal specialist colleagues.:crossfingers:

VetFolio
Interest has turned from systemic steroid therapy to local injection of steroids into the stricture using endoscopic guidance. In keloids and dermal scars, intralesional steroid injections have been shown to reduce scar formation. The procedure involves the use of an endoscopic sclerotherapy needle to inject triamcinolone acetonide or dexamethasone at three or four sites around the stricture before or immediately after the dilation procedure....

Endoscopy – Vets on the Balkans - an online journal for veterinarians from the Balkans
Through the scope balloon dilatation of post-traumatic esophageal stricture in dog – case report
below:
Management and Outcome :
Dog was put under general anesthesia and intubated. Olympus GIF Q10 flexible gastroscope with 2.8 mm working channel was introduced into esophagus. After this, Olympus SWIFT balloon catheter (model BE – 6 ) was introduced through the working channel into the stricture ( through the scope method ). To generate force for stricture dilatation, catheter was expanded using saline and hand held Swift pump, two times for duration of two minutes. Steroid ( tramcinolone 40 mg / ml ) diluted with saline 1 : 2 was injected submucosally in three places around the stricture ( Pictures 1 to 5 ). After procedure, we prescribed omeprazole ( 1 mg / kg PO q24h ) for 7 days. After three weeks whole procedure was repeated. On next check-up dog regained normal body weight and was eating solid food without any problems.

....
Steroid injection prior or after dilatation improves outcome because it’s decreasing scar formation and need for repeated dilatations. Most cases will need repeated procedure in three weeks. If the dog is eating normally after 3-4 weeks it probably wont need new dilatation procedure.
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...She and my other cat, Milo, do also at times chew at and tear apart a scratching board in my living room as well, though it maybe sounds less likely that small bits of cardboard paper could be a problem.
I think she would have had a major blockage if plastic or paper would have accumulated...and you would have definitely seen that in her vomitus.
I'm glad that you have another cat, too. :)
Maybe it helps that Swirly has another cat friend, even if she's not feeling her best, but he's just laying around, and she knows he's there. :bluepaw:
 
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cat nap

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The oncologist mentioned that she would try reaching out to her colleagues to see if they knew of any gastrointestinal specialists that might be able to help. She said that she could try to reach out to other universities, but that there was a low likelihood that they would respond, as there sounded to be politics involved where universities give consultation precedence to practices that transfer special case clients to them (which is why she was mainly reaching out to Texas A&M, which her hospital is partnered with). I don't really know if that's the case, but in searching different universities online, I didn't have much of a clue on who to reach out to that could help Swirly on such short notice. The oncologist also explained that she didn't want to give me a false sense of hope, in that she actually doubts that Texas A&M would have any more helpful insights at all into Swirly's case, though she was open to the possibility that there could have been one unique similar case where they might have an idea for how to address her issues.
....
I'm also glad my oncologist gave me a chance to wait until Monday. It's given me more time to think about Swirly's situation, come up with different thoughts/explanations for her stricture, and to also reach out to an online vet, a gastrointestinal veterinary surgeon, that had some possibly helpful thoughts (though he admittedly didn't think there was much more that could be done to improve the sutures or reduce the chance of a stricture in a second surgery, unfortunately).
Kikaioh Kikaioh ...I guess I didn't ask about how Swirly's 'quality of life' has been these last few months...or the exhaustive nightmare you mentioned...in having to go through with all the treatment's lows and highs.

I think it's good that your oncologist...does not want to give you a false sense of hope...and to kind of prepare you ...if the outcome is not what we all want...for your beautiful Swirly. :greenpaw:
And I can only imagine that it is so difficult to face the realities of Swirly's situation, ...and still feel conflicted as to what to do.

I'm still glad that you got to talk to the online vet, gastrointestinal vet surgeon,...and in so doing you were able to find some more avenues of information...even if he could not offer any different ideas than the ones already presented by your oncologist. :read:

I know in thinking about 'quality of life' for our animals....we often have to think about things like, "are they suffering?", "are we keeping them around for us,...and not them?"..."how long?"...."and can we be sure we tried all we possibly could, to give them the best chance at recovery?"

(My biggest problem is that I don't want you to have any future regrets...no matter what course of action you choose.
I think that is why I said I would go for the surgery...but really, when I give it more thought...I have absolutely no idea of how hard, difficult, or exhaustive,...all the last four months have been for you.):frown: :grouphug: :hugs:

And I've never placed myself in a similar situation to you...in pursuing chemo treatment for one of my animals...over an extended period of time...so would not know the amount of Strength that a person must have to do this, for their companions.:hugs:

(Back in 2012, my previous 11year old, black lab dog did have what the Vets suspected to be liver cancer, a tumour was seen on x-ray, and he was vomiting what looked like coffee grounds. At the time, from doing online research, the things I read gave a 50% chance of success, with chemo, and didn't add as many years or months as I would have thought. So I did choose euthanasia. I don't regret it, now. Though there is always second guessing, but at the time, with the info available to me, that is what I chose.)

So I guess what I really just wanted to say, ...it that whatever you choose to do...just know that we all here, will be backing you up, and supporting you throughout.
Still be sending you and Swirly,...the best Health vibes...and thoughts for clarity, peace, strength, in decision making, too. :vibes::vibes::bicolorcat: :goodluck:
 
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Kikaioh

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Thank you again cat nap cat nap for the extra thoughts, comforting words and good vibes, it's much appreciated.

The mention about the injection into the strictures is a promising thought, and I've sent an email to her oncologist to see if that might be a possibility for her surgery tomorrow.

I wish I could say that Milo was Swirly's cat-friend, as they're admittedly more like begrudging roommates. Swirly's closest cat-friend, Lucky, actually passed away last year, at the start of the pandemic. It's been rough times since then, as my childhood cat at my parent's house, Tabitha, also passed away later that year. And of course, Swirly's cancer was an unexpected new tragedy that's run me over like a truck, as she's the closest and most loving cat I've ever had. It's been emotionally difficult for me, but I'm pushing through as best I can, to fulfill the responsibilities I chose to take on.

Swirly's quality of life is difficult to read at times. Right now in the hospital, they say she's feeling very well, walking around her cage, passing stools/urine normally, and acting alert and normal. In recent weeks (prior to her vomiting episodes) she acted and seemed to feel well at home too. There's a thought that she may have chronic kidney disease that gets pushed over the edge whenever she vomits, which might have led her to her acute incidents and her need for hospitalization (talking with the online vet, there may be hope that those situations could be mitigated with subcutaneous fluid therapy, though we'll see). Outside of those emergencies, though, she seems to act normally and happily at home. That's part of what makes her situation so complicated, even for her oncologist to make strong recommendations on the path forward --- Swirly seems like she could have a somewhat normal quality of life, if it weren't for these strictures and the dangerous vomiting incidents.

Your decision for your dog makes sense, especially for what you were aware of. I was told that Swirly would likely only get 9 months at the most to live on average, and she's already at 6 months, so I do worry that I may be putting her through a lot of turmoil when she may not even have that much time left. But my situation with Swirly might be unique in the debt I owe to her... there was definitely tragedy in her past that was my fault.... and so I owe her the best chances I can give her for happiness. I do regularly ask her veterinarians for their thoughts on what they would do if it were their pet in the same situation, and so if they ever seemed to think she didn't have a chance for some period of normalcy and happiness... I would very likely start looking into end-of-life considerations.

Thank you again for the encouraging thoughts and kind words. You've all been wonderfully helpful, and I'm grateful for the support. I'm crossing my fingers that tomorrow will go well for her, though we'll see.
 

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I wish I could say that Milo was Swirly's cat-friend, as they're admittedly more like begrudging roommates. Swirly's closest cat-friend, Lucky, actually passed away last year, at the start of the pandemic. It's been rough times since then, as my childhood cat at my parent's house, Tabitha, also passed away later that year. And of course, Swirly's cancer was an unexpected new tragedy that's run me over like a truck, as she's the closest and most loving cat I've ever had. It's been emotionally difficult for me, but I'm pushing through as best I can, to fulfill the responsibilities I chose to take on.
(Haha...Milo and your Swirly...being "more like begrudging roommates"...sounds exactly like my two 6 year old cats who are in fact brother and sister siblings, tripp and tepaul. But actually for some strange reason, my two cats started to get along better from last winter and this year,...which means they can sleep in the same room together...without getting into any quarrelsome playfights. Hopefully that will last, but who knows.🤷‍♀️)

Ahh, it is so hard that you lost Lucky and Tabitha in the same year. That is never easy.:rbheart:
I know our cats teach us to be strong,...yet to have them leave us in the same year...is both painful or numbing.
And then to get Swirly's cancer diagnosis...would flatten anyone. :hugs: :grouphug:
Swirly's quality of life is difficult to read at times. Right now in the hospital, they say she's feeling very well, walking around her cage, passing stools/urine normally, and acting alert and normal. In recent weeks (prior to her vomiting episodes) she acted and seemed to feel well at home too. There's a thought that she may have chronic kidney disease that gets pushed over the edge whenever she vomits, which might have led her to her acute incidents and her need for hospitalization (talking with the online vet, there may be hope that those situations could be mitigated with subcutaneous fluid therapy, though we'll see). Outside of those emergencies, though, she seems to act normally and happily at home. That's part of what makes her situation so complicated, even for her oncologist to make strong recommendations on the path forward --- Swirly seems like she could have a somewhat normal quality of life, if it weren't for these strictures and the dangerous vomiting incidents.
Wow. Swirly is way stronger than I thought. :bluepaw:

(I pictured it so wrong...thinking of a cat that was weak, frail, and lethargic. That is no where near what your Swirly is like, now.)
And yes, chronic kidney disease can be helped with a special diet, and sub-q fluids given at home.
I did also read about the 'acute kidney incidents' being caused by, like you said, acute dehydration...in relation to strictures...so perhaps once the stricture is gone...then the kidneys will be able to function as usual. I'm so hoping for this. :greenpaw:
Your decision for your dog makes sense, especially for what you were aware of. I was told that Swirly would likely only get 9 months at the most to live on average, and she's already at 6 months, so I do worry that I may be putting her through a lot of turmoil when she may not even have that much time left. But my situation with Swirly might be unique in the debt I owe to her... there was definitely tragedy in her past that was my fault.... and so I owe her the best chances I can give her for happiness. I do regularly ask her veterinarians for their thoughts on what they would do if it were their pet in the same situation, and so if they ever seemed to think she didn't have a chance for some period of normalcy and happiness... I would very likely start looking into end-of-life considerations.
I don't know, ...but that's a lot of extra time you gave her...with the help of the vets...and since you say you owe her a debt...then naturally...the decision is easier made.
Plus the fact that Swirly is no where near having a bad quality of life, either.

I think that hope is also...always a good thing to have in mind.
Luck, another chance, hope,...whatever is needed for a successful surgery outcome.:greenpaw:
Asking her veterinarians what they would do...if it were their cat...is another excellent idea.
Thank you again for the encouraging thoughts and kind words. You've all been wonderfully helpful, and I'm grateful for the support. I'm crossing my fingers that tomorrow will go well for her, though we'll see.
Will be crossing all fingers, toes,....and extra paws here, as well.:crossfingers: :greenpaw::bluepaw:
All the Luck...and prayers...that will guide the oncologist surgeon's hands, too.
Thinking only good thoughts for Swirly and you all there, too. :vibes:
:yeah:.....times ten. :vibes::vibes::bicolorcat:
 
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Kikaioh

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Thank you for the encouraging words, thoughts, and good vibes cat nap cat nap , it's very much appreciated. It makes me hopeful about humanity encountering such kind-hearted support online. In such an emotionally difficult year, it's uplifting to hear, and I'm really grateful.

It was nice to hear that your sibling cats are getting along well enough. My parents also have a brother and sister cat who were born in their backyard, though they're very fond of each other. There's also another older sister of theirs, though, who left their family for a while to roam the neighborhood, and when she came back some months later, she strangely didn't seem to recognize her siblings anymore, and always hisses at them now. Hopefully someday they'll realize how close they used to be with each other when they were kittens.

I woke up very early this morning to finally see Swirly again before her surgery. She acted like her normal self, much to my relief, wagging her tail, purring, and curiously wanting to explore out of the enclosed room we were in. She had lost a lot of weight, though, since she hadn't eaten for several days while she was hospitalized, which was really worrisome (though I was thankfully told that she had started eating on her own again earlier in the weekend).

After a lot of phone calls, planning, and discussions with the surgeon and various hospital staff members, her surgery was started and completed, with some drawbacks and success mixed together. The results admittedly are a bit mixed and confusing, still without a clear explanation on the source of the stricture, though the surgeon was at least able to work out something of a workaround solution, and Swirly was able to wake up safely from the anesthesia.

The surgeon explained that the stricture was something he'd never seen in all his years of veterinary practice. Apparently it was strangely dense and almost as hard as a rock, almost like some bio-chemical process had caused it to calcify and harden. And unfortunately, the way it formed didn't leave any room for an actual resection or even a removal of the stricture, which when I first heard it, seemed like a very worrisome thought. However, the surgeon tried thinking on his feet, and decided to perform something called a side-to-side anastomosis, which if I understood correctly, cuts the intestine in half, lines the openings up like barrels of a shotgun and sutures them together, cuts out a hole in the sutured sides, and then sutures up the barrels until they're closed. That weird-sounding approach apparently allowed him to make a hole about 3 times larger than what her original resection had allowed for, and his hope was that if this inexplicable scar formation of the tissue somehow occurs again in the same spot for some reason, even if the hole wound up narrowing to half it's size, it would still hopefully allow for the normal passage of food. It's an unexpected compromise, since the scarred tissue is still there, but at least there's hope in addressing the central problem by having a larger passage for food to finally start getting through normally again.

One interesting note that the surgeon mentioned was that he didn't see any signs of cancer, enlarged lymph nodes or inflammation anywhere in the digestive tract during the surgery, which he thought was puzzling, given that Swirly was diagnosed with large cell lymphoma, yet never finished the treatment program and hasn't been on chemotherapy for almost three months. He mentioned that the possibility that the initial diagnosis may have misinterpreted high grade IBD with low grade large cell lymphoma, which would be a really, really frustrating reality after half a year of chemotherapy.

The medical bill turned out to be surprisingly high too, and I wish they'd been more proactive communicating about the costs ahead of time. Hopefully the coming weeks don't see more difficult incidents for Swirly, or else I'll start having to dip into my retirement funds, which is a point I never thought I'd wind up reaching.

All worries and fears and unknowns aside, though... I'm trying my best to be hopeful that Swirly will start recovering well into tomorrow. It would be a miracle if she stopped experiencing any more bizarre strictures that defy medical expectations. I'm crossing my fingers and toes too that she'll finally get over this hurdle in returning to normalcy.
 

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Thank you for the encouraging words, thoughts, and good vibes cat nap cat nap , it's very much appreciated. It makes me hopeful about humanity encountering such kind-hearted support online. In such an emotionally difficult year, it's uplifting to hear, and I'm really grateful.
You are so welcome, Kikaioh Kikaioh . Honestly, though, it's really you I have to thank ...and give a lot of credit to, because my hope is that by you posting this thread, and such a unique and rare case...with your Swirly...that somehow in the future,...it may also help some other person, who is experiencing something similar.
And thank you so much for your very detailed reply. (I wanted to respond yesterday night, but I could not keep my eyes open. I'm on eastern standard time, in ontario canada,...and in my younger days could stay up well past midnight...now, not so much.)

I totally agree with you...about this part, that you wrote, "It makes me hopeful about humanity encountering such kind-hearted support online. In such an emotionally difficult year, it's uplifting to hear, and I'm really grateful."
With me, what I find grateful and amazing about the Cat Site community, are both the regular members ..who are able to answer so many threads...and also the members who drop in and add more knowledge, enrichment, and support, too.

It's exactly what you said...about encountering such kind-hearted support online.
I never actually thought about it quite in these terms, and I guess I took it for granted...but you're absolutely right.
It was nice to hear that your sibling cats are getting along well enough. My parents also have a brother and sister cat who were born in their backyard, though they're very fond of each other. There's also another older sister of theirs, though, who left their family for a while to roam the neighborhood, and when she came back some months later, she strangely didn't seem to recognize her siblings anymore, and always hisses at them now. Hopefully someday they'll realize how close they used to be with each other when they were kittens.
(Maybe the older sister figures that the younger ones should always listen to her...or have more respect for her...so she hisses to get her point across...loud and clear. Yes, hopefully with time, she will settle down, and not need to use her hiss, as much.)

Not sure how long cats remember for,...or if it's just basic biological hard-wiring in that they use their survival instincts, scent, and personalities to try and dominate, or co-exist with one another.

Cats are such interesting creatures, in their Behaviour.
I love how no two personalities are ever alike, and basically with our animal companions, there really is never a dull day.
Even when we humans are having a bad day, our animals can just lift our spirits, too.
I woke up very early this morning to finally see Swirly again before her surgery. She acted like her normal self, much to my relief, wagging her tail, purring, and curiously wanting to explore out of the enclosed room we were in. She had lost a lot of weight, though, since she hadn't eaten for several days while she was hospitalized, which was really worrisome (though I was thankfully told that she had started eating on her own again earlier in the weekend).

After a lot of phone calls, planning, and discussions with the surgeon and various hospital staff members, her surgery was started and completed, with some drawbacks and success mixed together. The results admittedly are a bit mixed and confusing, still without a clear explanation on the source of the stricture, though the surgeon was at least able to work out something of a workaround solution, and Swirly was able to wake up safely from the anesthesia.
So glad that you were able to spend extra time with your Swirly before her surgery.
Ha, I wonder if Swirly just wanted to leave the place...(much like we humans act when we go to the hospital, or medical procedures)

Yeah, I hope that now that her surgery is over,...that she will be able to absorb the proper nutrients. Also so good to hear that she was eating on her own, at that point in time. (That to me would be a good sign, that she will, again, return to eating on her own.)
The surgeon explained that the stricture was something he'd never seen in all his years of veterinary practice. Apparently it was strangely dense and almost as hard as a rock, almost like some bio-chemical process had caused it to calcify and harden. And unfortunately, the way it formed didn't leave any room for an actual resection or even a removal of the stricture, which when I first heard it, seemed like a very worrisome thought. However, the surgeon tried thinking on his feet, and decided to perform something called a side-to-side anastomosis, which if I understood correctly, cuts the intestine in half, lines the openings up like barrels of a shotgun and sutures them together, cuts out a hole in the sutured sides, and then sutures up the barrels until they're closed. That weird-sounding approach apparently allowed him to make a hole about 3 times larger than what her original resection had allowed for, and his hope was that if this inexplicable scar formation of the tissue somehow occurs again in the same spot for some reason, even if the hole wound up narrowing to half it's size, it would still hopefully allow for the normal passage of food. It's an unexpected compromise, since the scarred tissue is still there, but at least there's hope in addressing the central problem by having a larger passage for food to finally start getting through normally again.
This is amazing to hear.
And the way you explain, the side-to-side anastomosis...with using the barrels of a shotgun analogy/visual...is really helpful...to understand how the intestines were lined up, and sutured.
(I did see a diagram, somewhere, when I was reading through some online articles...but cannot seem to find it again, so maybe I had not bookmarked it.)

Since this means that the circumference of the inner walls of the intestines is larger...(like you mentioned the hole being 3 times larger)...then yes...that sounds amazing...and very promising...that IF more scarring does develop...that the larger passage would still allow more room for food to get through. :yess:
I'm still going to be hoping and praying...for no scarring, though. (even as unrealistic as this sounds..since I guess scars are a part of healing...let's just keep it to a minimum of scar tissue.)

You mentioned that the surgeon could not remove the stricture...
Does that also mean, that he could not get a sample to be biopsied, either?
(I suppose it does not really matter, though, since as long as the initial goal...of getting a larger passage...for food to go through...was achieved.)
One interesting note that the surgeon mentioned was that he didn't see any signs of cancer, enlarged lymph nodes or inflammation anywhere in the digestive tract during the surgery, which he thought was puzzling, given that Swirly was diagnosed with large cell lymphoma, yet never finished the treatment program and hasn't been on chemotherapy for almost three months. He mentioned that the possibility that the initial diagnosis may have misinterpreted high grade IBD with low grade large cell lymphoma, which would be a really, really frustrating reality after half a year of chemotherapy.
That last part of..."misinterpreting" high grade IBD...with low grade...large cell lymphoma...is rather worrisome to me.
Huh.
So Prednisolone is given for IBD
But yeah...what would the chemo drugs have done, here,...if no large cell lymphoma was detected.?
Don't they diagnose...the large cell lymphoma with an ultrasound, and then a biopsy?

(yeah, I'm totally confused now...but will do some more reading...this coming weekend.)
The medical bill turned out to be surprisingly high too, and I wish they'd been more proactive communicating about the costs ahead of time. Hopefully the coming weeks don't see more difficult incidents for Swirly, or else I'll start having to dip into my retirement funds, which is a point I never thought I'd wind up reaching.
I know american members have mentioned using Care Credit...but from my understanding...it seems to be a type of credit...where it can be useful...but then you have to pay off high interest fees...if you don't manage to pay off the care credit within a certain timeframe. (I actually don't really know all the specifics...or remember what the member actually had to do.)
I'm not really sure...if trying to get a lower line of credit from a bank...with lower interest rates would be available, either.

(Your thread actually makes me realize that I may also have not put away enough money to treat my animals, if something like cancer...or surprise surgeries are needed. I have two cats and a dog, and figured that ten grand each, would be adequate, in case of serious illnesses...but now I see that this may not be so. I am lucky, though, that I have a younger sister who I know would help me out, too,...but still it really does make me think about the rising costs of everything...and how prepared or unprepared, I would be.)
All worries and fears and unknowns aside, though... I'm trying my best to be hopeful that Swirly will start recovering well into tomorrow. It would be a miracle if she stopped experiencing any more bizarre strictures that defy medical expectations. I'm crossing my fingers and toes too that she'll finally get over this hurdle in returning to normalcy.
You sound like such a level headed, and calm person. A person that gets things done.
(I wish I could be more like that.)

I, too, will always remain hopeful that your Swirly's recovery goes extremely well. :)
And yeah, it does sound like some miracles are needed...but I kind of do believe in those, at times,...even next to science, and what it can do.

All we need now is for Swirly's body to heal well...and say "no"...to "any more bizarre strictures that defy medical expectations" from forming.
All paws, fingers and toes...crossed here, as well. :crossfingers::crossfingers::greenpaw::bluepaw:
More mega Health vibes...being sent to Swirly and you. :vibes::vibes::bicolorcat:
Hoping in the coming days,...that Swirly gets better and stronger, every day. :bluepaw:
 
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Kikaioh

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Hello again. And thank you so much again cat nap cat nap for the thoughts, encouraging words, and mega health vibes, it's all been very much appreciated. It has been sleepless and exhausting this past week monitoring and caring for Swirly since her surgery, and on top of my regular 8-to-5 job, it's unfortunately been difficult to give a meaningful reply/update until today.

I'm thankful to say that Swirly so far has been doing well after her surgery, especially compared to her first one. She seems to be putting on weight, has a voracious appetite, hasn't vomited, hasn't experienced diarrhea, and hasn't had any noticeably adverse issues so far. The only quirky thing is that she's been licking her lips at an infrequent but noticeable regularity, albeit not continuously like she had in the past when she was vomiting. She's still on a variety of medications that may be discontinued soon, and has an appointment for removing her stitches and for some follow-up diagnostic testing with her oncologist this coming Wednesday, so I'm hopeful she'll continue to do well until then, and not show any further signs of potential cancer as well.

To answer, unfortunately it seems like the surgeon wasn't able to get a biopsy with this recent surgery. I think he'd mentioned that there wasn't enough intestine in the space to get a proper biopsy sample, though I do agree that I'm glad at least the main goal of allowing more food to go through so far seems to have been successful.

Also to answer, it seems like the oncologist may have proceeded with treatment for Swirly largely based on her primary vet's conclusion that she had large cell lymphoma. However, that conclusion was based on an ultrasound and an aspirate sample, and not a proper biopsy of her intestines, which different GI surgeons have told me is usually how a definitive conclusion is reached. My guess atm is that Swirly's oncologist may have taken her initial positive reaction to emergency chemotherapy treatment as a confirmation that she had cancer (the emergency treatment was done early on due to Swirly seemingly dying from starvation and vomiting at the time). I'm not sure, but it may be that her chemotherapy (perhaps even the switch from prednisone to prednisolone at the time) could have been inadvertently treating severe IBD and not cancer. At which point, the treatment regimen may have snowballed into progressively more dangerous problems for Swirly as her underlying larger problem with the intestinal stricture could have been going unnoticed. It's all speculation at the moment, though it does generally seem likelier as more time passes by since her last chemotherapy treatment, especially if she continues to show no further signs of cancer.

Her expenses for her recent hospitalization and surgery came out to $10,000 USD. On top of her previous surgery and medical expenses, it's been a pretty expensive half year, likely in the $20k+ range. I think with Swirly doing better now, though, that hopefully I won't have to worry about taking out credit or pulling money from my retirement accounts in the near future (knock on wood, though).

Thank you for the kind words about my seeming to be calm and level-headed, though unfortunately that may actually be more in how I communicate with people in general (I try to limit my writing to dispassionate information as much as possible, since I would write a novel of text if I didn't restrict myself). In my day-to-day life I've actually spent quite a lot of time pacing about, worrying, and crying at home over Swirly's situation. I do think it's healthy to have an outlet for those emotions, though, but I do also try to keep my head afloat enough to live up to my responsibility to Swirly as best I can.

Assuming that things work out with Swirly's recent surgery, I thought it might be helpful to mention some of the things that were done differently this time around for Swirly's post-operative care, in case anyone in the future runs into a similar problem and in case it may be of help.
  • I cleared out my study to have a larger space for Swirly to recover in this time, since the dog crate I used after her previous surgery had seemed really uncomfortable for her (especially having to sleep so close to a litter box), and I figured a little more room to relax in might help relieve her stress this time around. I made sure there weren't any higher areas that she could jump to, just enough room for her to walk around a bit.
  • Because there was a fear that she may have experienced a complication of rebound acid hypersecretion after abruptly stopping her Omeprazole in her first surgery, this time around she was kept on Omeprazole both before and after her surgery.
  • Because her cancer seemed to be in remission, she was reduced to a biological level of Prednisolone medication prior to her surgery until it seemed likely that her Adrenal glands were working again (in case the long-term use of Prednisolone may have been causing her issues), and the smaller dosage was continued after her surgery as well, to prevent potential complications from discontinuing it altogether.
  • This time around she was given two new antibiotics medications, Clavamox and Veraflox, to take at home. She's also been taking a low dosage of Cisapride to help food move through her system as well.
Thank you again for having helped so much along the way with thoughts and words of encouragement. I'm grateful to have met such kind people, and I'm hopeful that Swirly will continue to do well in the weeks ahead.
 
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