Ventral bulla osteotomy

scoutandmaxine

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So on Tuesday, Maxine is going to the vet and we are going to discuss going through with the ventral bulla osteotomy. I'm hoping this will cure her chronic ear infection, once and for all. I have some questions about the surgery itself and also recovery. I was wondering if anyone else has any ideas as to what I should expect and also what other questions I should ask the vet beforehand. And how can I help her during recovery? What should I be doing to keep her happy and healthy? She is a very active kitty so keeping her confined will be difficult. Any insights will be appreciated and also well wishes bc I am an anxious mess! Thank you!
 
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scoutandmaxine

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daftcat75

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You can review Krista’s ordeal here.
Krista's Care

Stop reading when you get to August. Things take a very sad turn in August. 😿🌈

My understanding from my reading and experience with Krista is:

1. There may be a dietary component to her ear infections. I strongly believe it was tuna with Krista. I let her have all the tuna she wanted for a couple weeks after I had her teeth removed the prior October even though I knew it was one of her IBD triggers. I felt like she needed to eat and get through that recovery before she would return to her regularly fed Rawz rabbit. Then when we started steroids in January, I would wrap her nightly pred in my own homemade pill pockets of s. boulardii mixed with a tiny amount of food and a fish flake wrapped tightly around the tacky yeast. Since she was toothless there was no pulling the flake off the bite. So it all had to be swallowed if she wanted the fish flake. I called this our devil’s bargain because it allowed her to medicate herself rather than the wrestling matches we used to have before this trick. But that tiny amount of fish flake was still a trigger that kept her cancer simmering until the VBO surgery itself prompted a change in her medication procedures. I switched her to transdermal pred as she was on activity restriction for her surgery recovery. We used to do the nightly pred bites on the kitchen counter so I could easily prepare a new bite if she somehow managed to get the flake off without taking the pill. And it was a lot easier to verify she took the pill if she spit it out on the counter rather than the carpet. But anyway, the switch to transdermal pred finally cleared up the poop nonsense and got us to remission.

My point here is that while the VBO may be medically necessary with Maxine (and it’s better than the alternatives of intentionally puncturing her eardrum or months of antibiotics because the inner ear is technically outside the body and responds very inefficiently to oral antibiotics), the VBO may not be the end of her ear story. Does she shake her head and scratch at her ear? If you can see her symptoms than you’ll have an easier time continuing with food trials looking for what might be causing her ear infections. For starters, I would eliminate all fish.

2. For the recovery, I recommend a big dog crate with room enough for a litter box and food and water. She should remain in here for at least the first few days whenever you cannot 100% supervise her and make sure she won’t do run, climb, or jump.
Ruff 'n Ruffus Portable Foldable Pet Playpen + Free Carrying Case + Free Travel Bowl | Available in 3 Sizes Indoor/Outdoor Water-Resistant Removable Shade Cover https://www.amazon.com/dp/B07CZ3FNTD/?tag=thecatsite

I kept Krista in there for nights and the early morning. I was working from home so I would let her out for a couple hours over lunch. Longer if it could manage it with my workload. If I couldn’t watch her 100%, then back into the pen she went. I didn’t want her jumping onto my desk or into my lap or any other forbidden jumping and open up the stitches under her jaw. Same with the cone. I took the cone off her so she could eat. Otherwise she collected food inside the cone. 😹🤦🏼‍♂️ And when I could 100% supervise her, she could go without the cone. But at least for the first few days, I made her wear a soft cone whenever I couldn’t be right there to stop her from scratching.

3. Because the crate is a confined space, I got disposable litter boxes. When she used the box, I swapped in a new one and took care of the dirty one “offline.” I would only let her use a box a few times before I dumped and cleaned the box or tossed it and rotated a new disposable box in.

Krista wasn’t happy about the confinement. But she adapted. I think she knew it was for her own good. After two weeks, she got the thumbs up from the surgeon on our checkup to rejoin gen pop and be done with the crate. A little short term discomfort on everyone’s part (the sad meowing and scratching at the pen was tough to bear for me) was worth getting through it without any complications like tearing or scratching open the sutures.

4. You may still have to give an antibiotic for a long period of time. If you do, get it compounded with Wedgewood so you don’t have to wrestle your kitty who is supposed to be on activity restriction.

Krista in her pen:
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Also Krista in her pen:
View media item 423563
Finally an iPad, iPod, or portable speaker with Music For Cats playing on repeat will go a long way toward soothing a confined animal. Even a neighbors cat I trapped thinking he was a stray cooled off his captivity song once I got the “cat rock” playing for him.
Home | Music for Cats | David Teie
 
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scoutandmaxine

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Thank you! These are all very good ideas.
The vet doesn't seem to think its food related bc its mainly a bacterial infection. And bc she did see a mass in her ear in the ct scan. So she thinks that is probably the cause. And getting it removed will hopefully solve the issue. But I do still want to probably do a food trial just in case. The problem is, she can be particularly picky. She prefers her dry food. And when I tried to get her on wet only, she will refuse food to the point where she'll lose weight and she is small and tiny enough as it is, so I want her to eat whatever she wants. She prefers the nutrisource brand of dry food. For the past few months shes been eating the chicken and duck. She isn't overgrooming as much as she used to so thats good. But the only issue is this overproduction of very nasty, snotty exude in her right ear. I'm thinking, maybe bc there's that mass deep inside the ear, its causing her ear function to be all out of whack. I have to clean her ear every morning bc it drains out and she does shake her head often and scratch. After cleaning, she feels better and plays and eats and is totally fine. However what worries me most, is that she also squints her right eye a lot. Sometimes she can barely open the eye. It comes and goes though. There are moments when her looks completely fine. But it happens often enough that it scares me, that perhaps this mass is right up on the nerve of her eye and I'm worried about permanent damage during the surgery.
Anyway, all I know is she can't keep going on like this, so I think the vbo will be worth doing as I am all out of other options.
 

daftcat75

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And honestly, even the worst case scenario of losing her eye (which I don't think will happen) is still better than what could happen with an unchecked/untreated mass in her ear. That makes sense that it could be the mass itself that's causing the junk to build up in her ear. Hopefully this is a benign mass. I guess you won't know until she gets it out. But yeah, I believe proceeding with the VBO to remove the mass no matter what kind of mass it may be is your best next step. Let's just take it to there and see how she does before we make food changes. Because she will be confined, you don't want poop blowouts that can come from new foods and foods that don't agree with her in her tiny crateable litterbox.
 
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scoutandmaxine

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And honestly, even the worst case scenario of losing her eye (which I don't think will happen) is still better than what could happen with an unchecked/untreated mass in her ear. That makes sense that it could be the mass itself that's causing the junk to build up in her ear. Hopefully this is a benign mass. I guess you won't know until she gets it out. But yeah, I believe proceeding with the VBO to remove the mass no matter what kind of mass it may be is your best next step. Let's just take it to there and see how she does before we make food changes. Because she will be confined, you don't want poop blowouts that can come from new foods and foods that don't agree with her in her tiny crateable litterbox.
Yes, that is a good point about the food changes. I will hold off for now. And I am hopeful that the mass is benign bc the alternative is too scary to think about! But after nearly a year of this ordeal, I'm really really wanting this to be the solution.
Thank you for the insight! Krista was such a pretty kitty and I love her messy eating video lol, reminds me of my older cat, Scout. I have to clean the walls when she's done eating. 😄
 
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scoutandmaxine

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So the surgery has been scheduled and she will have it done on February 8th. I am so anxious! I really hope I'm doing the right thing and it'll go well. I just know she can't keep going on with so much nasty stuff in her ear. The vet was very thorough in explaining everything and how she'll likely end up with horner’s syndrome again. I hope it'll resolve quickly though. They also said that she'd be kept there overnight after the surgery and I'm wondering if I should insist that she comes home with me instead? The reason being, they are not a 24 hr vet so its not like she'll be monitored that night. Where as if she comes home with me, I will definitely be watching over her to make sure she's okay. Should I send them a message and let them know that I'd prefer that? It seems the only reason they want to keep her is bc she's going to have a lot of head shaking and yucky stuff coming out of her ear afterwards. But idc about that, I don't mind cleaning up, I just want her to feel safe at home. All night by herself in a kennel will probably be terrifying for her.
 

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I don't leave my animals overnight if no one is on duty. However, I did not know if you meant that the place is closed up at night with absolutely no one there (which is one scenario), or that there is an attendant who could call a vet if something did not look good....or if a vet tech mans the place during the night. In CA, if "services and staff" are not available "after hours" a sign has to be posted in the office and noted on statements or the like. That appears to be the difference and you could certainly send a message asking for clarification and voicing your concerns. What are the chances of immediate complications from this surgery? Does the head shaking mean that she could do damage to the surgery site or that the discharge is not manageable?

daftcat75 daftcat75 ?
 

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So the surgery has been scheduled and she will have it done on February 8th. I am so anxious! I really hope I'm doing the right thing and it'll go well. I just know she can't keep going on with so much nasty stuff in her ear. The vet was very thorough in explaining everything and how she'll likely end up with horner’s syndrome again. I hope it'll resolve quickly though. They also said that she'd be kept there overnight after the surgery and I'm wondering if I should insist that she comes home with me instead? The reason being, they are not a 24 hr vet so its not like she'll be monitored that night. Where as if she comes home with me, I will definitely be watching over her to make sure she's okay. Should I send them a message and let them know that I'd prefer that? It seems the only reason they want to keep her is bc she's going to have a lot of head shaking and yucky stuff coming out of her ear afterwards. But idc about that, I don't mind cleaning up, I just want her to feel safe at home. All night by herself in a kennel will probably be terrifying for her.
They usually have a night tech to watch over any animals staying overnight. The tech can call the doctor if there is a problem. She will be out of it from the surgery and the anesthesia. If they can keep her on IV fluids and IV pain relief, that’s two or three bupe doses you don’t have to worry about. If you have an iPod or old phone, I would load on Music For Cats and buy a USB battery pack for about $20. Between the iPod/phone battery and the battery pack, you can probably get her through the whole night with the soothing sounds of Music For Cats. When Krista had to stay for ten days due to her liver numbers, I’m told that even other animals in cages near her were uncharacteristically calm because of the Music For Cats I insisted they kept playing for her. Each day I visited, I simply traded them a spent battery pack for a charged one and they never had to unlock the iPod or charge it themselves. She’s going to be out of it. She’s going to be on activity restrictions. And she’ll likely need pain meds which will be easier to give via IV if they keep her overnight. My vote is let them keep her overnight.
 

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If you do insist on taking her home (and I would probably only insist if there was absolutely no one there overnight), I would keep her cone on and keep her in a kennel, crate, or pen to restrict her running, jumping, and climbing. Especially that first night where she still might have enough anesthesia or pain meds in her to not notice that she shouldn’t be doing what she might end up doing.
 
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scoutandmaxine

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They said no one will be there overnight. So thats why I want her to come home. And yes, I will definitely be keeping her cone on when I'm unable to keep an eye on her. I will set her up here in my room with me where she's most comfortable. I'm also going to get a disposable litter box to keep in here too. Should I keep my other cat Flint out of my room while she recovers? He sleeps in here too and I'll feel bad but I'm wondering if its best. He doesn't bother her at all, if anything she chases after him sometimes but idk if she'll be up for that after surgery. But during the day at least, while I'm working, I'll make sure she's alone with the cone on and everything she needs. I do have a good size crate to keep her in for those first few days.
 

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I was really thinking that there would be a night tech there, even as I read your initial post today. To me, the presence of absolutely no one would be worrisome. If you bring her home that first night, be very vigilant. Keep Flint at a safe distance so that there is no interaction, whatever that means for the layout of your house. I don't personally know what is entailed in the recovery from this surgery, but err on the side of caution in all cases.

It is true that, even with being highly sedated after surgery and recovering from the effects of anesthesia, some animals can move into a restless state where they move around or attempt to become active when they should not be.
 
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scoutandmaxine

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I was really thinking that there would be a night tech there, even as I read your initial post today. To me, the presence of absolutely no one would be worrisome. If you bring her home that first night, be very vigilant. Keep Flint at a safe distance so that there is no interaction, whatever that means for the layout of your house. I don't personally know what is entailed in the recovery from this surgery, but err on the side of caution in all cases.

It is true that, even with being highly sedated after surgery and recovering from the effects of anesthesia, some animals can move into a restless state where they move around or attempt to become active when they should not be.
Yes that happened to my cat Scout after her dental surgery. She was EXTREMELY restless. I had never seen her act that way. She would not stop or slow down. I was up all night with her bc she wouldn't stop moving around and trying to jump up everywhere.
Maxine was slightly out of it after they did her ct scan. She wandered around the house and became even more affectionate than her usually already affectionate self. But it passed pretty quickly. Since this is such an invasive surgery, I am so anxious about every little thing. That's why I'll have no problem being up all night keeping an eye on her. This vet is a small cats only place. And she did specify that no one would be there overnight so I don't see the point of Max staying there. If something were to go wrong, I'd rather have her home with the chance to take her to a 24hr vet if needed. I sent them an email to ask if that'd be okay but I probably won't hear back until Monday.
 
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Maxine had her surgery today. She did very well. The vet said that they found a pretty big polyp in there and some smaller ones too. The tympanic membrane was not intact. They took out the polyps and cleaned everything out. Maxie is going to stay overnight and the vet said she'll be going back there at midnight to check on her and give her more pain medication. They are going to try and get her to eat tonight and said she was already awake and looking around. She doesn't have horners syndrome but the vet said its still possible. I miss her sooo much. And going to bed without her tonight is going to be very tough. They are going to call me tomorrow around 9 or 10 and hopefully I'll be able to get her back. I have been a nervous wreck all day but I know I did the right thing going through with this surgery. Hopefully she recovers quickly. 🤍
 

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I am just seeing your posts now. You have been getting good advice from others, but just wanted to weigh in and give you some encouragement. First, I am glad Maxine had her surgery and all went well. My girl had the same surgery back in 2016 and all went well. She came home with a cone and although she did not like it, she adjusted quickly. It was surprising how fast she learned how to navigate around table legs, chairs and obstacles; how much distance she needed to clear the cone. I took the cone off her when she ate, but put it back on afterwards. She never developed Horner's syndrome, although that was a possibility. She was on antibiotics and pain medications for a while afterwards, but all healed up nicely within two weeks and no more problems. I wish your Maxine the same outcome and good recovery!
 
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Maxine is finally home! She is doing great. The vet was concerned about her not eating but we agreed that she would do better at home now. And sure enough, as soon as I got her home and set her down in my room, she made a beeline to her food bowl and chowed down. She was wandering around, a little out of it but she looks fantastic! You can barely see the incision. She had slight hornders syndrome but honestly its barely noticeable now. She has a soft cone on and doesn't seem too bothered by it. It's definitely going to stay on until next weeks appointment bc she does try to scratch. And she eats fine with it on so no need to take it off. I am just so happy to have her home! Hopefully she calms down a bit and gets some rest. Even the vet and all of the vet techs commented on her high energy and I told em that's just how she is lol. But I don't want her opening up the incision so am definitely doing my best to keep her calm and rested. Thanks everyone for your encouragement and advice!
Will update with her progress!
 

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daftcat75

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Maxine is finally home! She is doing great. The vet was concerned about her not eating but we agreed that she would do better at home now. And sure enough, as soon as I got her home and set her down in my room, she made a beeline to her food bowl and chowed down. She was wandering around, a little out of it but she looks fantastic! You can barely see the incision. She had slight hornders syndrome but honestly its barely noticeable now. She has a soft cone on and doesn't seem too bothered by it. It's definitely going to stay on until next weeks appointment bc she does try to scratch. And she eats fine with it on so no need to take it off. I am just so happy to have her home! Hopefully she calms down a bit and gets some rest. Even the vet and all of the vet techs commented on her high energy and I told em that's just how she is lol. But I don't want her opening up the incision so am definitely doing my best to keep her calm and rested. Thanks everyone for your encouragement and advice!
Will update with her progress!
I want to say that cone is inverted. But whatever works. I'm used to seeing it the other way like Lil Miss Lamp Shade here. 😹
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scoutandmaxine

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I want to say that cone is inverted. But whatever works. I'm used to seeing it the other way like Lil Miss Lamp Shade here. 😹
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The vet had it folded and said it was easier on her to have it that way. As long as she can't get to her incision its fine.
Shes finally calmed down some. Keeps getting up to go eat which is great and not surprising since she wasn't eating at the vet. Now I'm just feeling guilty keeping her brother Flint out of the room. Hes crying at the door. They do fine together but he just wants to eat all her food. And I don't want to keep putting it away bc she continues to go back to it. Poor boy, but he's such a glutton!
 

daftcat75

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The vet had it folded and said it was easier on her to have it that way. As long as she can't get to her incision its fine.
Shes finally calmed down some. Keeps getting up to go eat which is great and not surprising since she wasn't eating at the vet. Now I'm just feeling guilty keeping her brother Flint out of the room. Hes crying at the door. They do fine together but he just wants to eat all her food. And I don't want to keep putting it away bc she continues to go back to it. Poor boy, but he's such a glutton!
There will be a lot of short-term pains like this. One cat or the other will break your heart with cries for normalcy. Exceptional times require exceptional measures. Soon enough, everything will be back to normal for all of you.
 
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