Recurrent Intestinal Stricture

[cat nap]

Hello again. And thank you so much again 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.

Hi Kikaioh ,
I'm so glad you posted Swirly's update.
You totally made my weekend.
(I knew you'd be busy and tired, so didn't know when I should ask about Swirly. I figured the first 3 to 5 days would be rough...and last week would be totally trying to get back to some sort of routine with Swirly...albeit still in recovery phase.)

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.

So glad that Swirly is putting on weight, and eating well.
Perhaps the quirky lip licking thing...has more to do with all the medications...she in on...and will go away after they are reduced, or discontinued. Those antibiotics might taste awful, too,...or change the way the saliva or taste in the mouth is...but so necessary to guard against any infections from surgery bacteria.

Hoping that Wednesday's appointment with Swirly's oncologist, also goes smoothly...and will still be thinking of Swirly, and sending more Mega Health Vibes her way.

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.

Thanks also for all those replies, in answering my questions.
I know that your write-up will definitely help me, in the future, if I ever have to face similar situations with my own animals.

(just knowing that there may be differences in the possible detection and analysis from fine needle aspirates, and biopsy samples...helps me tremendously...since my 9 year old retriever mix dog...has some lumps that I am concerned about. One of the three aspirate samples were conclusive for lipoma (fat cells), but the other two were inconclusive...and must be done again...at the end of May.)

I also definitely think this thread will help others, who may come across the 'intestinal stricture' problem.
In reading up all that you had done, will definitely help them, as well.

I don't necessarily think there is anything wrong with speculation, and thinking about possible theories, for us laypeople.
Even if we go off on tangents, and have certain thoughts...as long as we come back down...and deal with the realities of the situation right in front of us...and give adequate treatment to those...then I figure it's not all that bad...to question, and seek answers from Vet professionals, and Specialists...that have the experience and deal with the immediate situations right in front of them.
(For me, I'm a visual learner...so it takes me much more time...to understand and take things in.)

Your ideas and observations are so very helpful, because they offer a first hand account and extremely descriptive information...especially when trying to figure out...how a stricture may have gone unnoticed...or have been causing the initial vomiting and starvation, too.)

I'm just so appreciative, of the difficult decisions that you had to make...and that you were able to go forward with this surgery, for Swirly.

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).

(Not happy at all at the extremely high price of the hospitalization and surgery costs...and so wish that somehow...all our governments would somehow help out with costs associated with our companion animals...in either giving us breaks on our taxes, ..in seeing the value of companion animals as actually 'a different category of dependant'...but that is me...just dreaming of a caring world...that puts companion animals in a 'better able to find veterinary care...sort of light'...and more accessible to everyone, too.)

I will be "knocking on all wood, trees, tables, and floors"...for you and Swirly, too.

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.

Definitely healthy to have an outlet for all those emotions.

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.

This above list is so detailed and useful ...and thoughtful of you to do.
Helpful for anyone reading about post operative care.

Will still be sending more of those Mega Health Vibes...to Swirly and you.
For a continued and uneventful recovery...meaning that things go smoothly.