The Wrah-Wrah goes to the E.R. (and proves once again that he has more lives than the average cat.)

Well, that was a night.

Ronnie James is back in the hospital. After a few days of observing him, calling the hospital, making appointments and then canceling them as he’d seem not-fine one minute and then much better the next, not knowing what his new “normal” is supposed to look like after his surgery (like all cats, Ronnie James is incredibly skilled at hiding the extent of his discomfort), we knew last night that he needed to go to the E.R.

A technician triaged Ronnie James the minute we got there, then immediately took him to the ICU and put him on oxygen. It was scary – scary enough for the doctor to come in and warn us that the Wrah-Wrah might not survive the thoracentesis that had to be done – but the little guy made it through. He was looking much better when we kissed him goodnight before coming home. He was alert and active in his oxygen chamber, being his usual flirty, affectionate self. He’s unbelievable! We were cautioned that he’s not “out of the woods” yet, but he’s looking just as spry as ever!

We shouldn’t have been surprised by this development, as Dr. M. had clearly warned us that Ronnie James would likely require one or two more thoracentesis (chest tap/draining) procedures following his surgery. We were prepared for this likelihood. We just weren’t prepared for the situation to arise in such a dramatic and scary way. I mean, we truly almost lost him last night.

The E.R. doctor, who was wonderful, showed us Ronnie James’ x-rays and said, “Look at this… I don’t know how he was still alive!”

The Wrah-Wrah is a miracle kitty, that’s how.

His x-rays showed nothing but white. On a normal chest x-ray, dark areas of a healthy size and shape would be visible. Those would be the lungs with air in them.

In this one view of Ronnie James’ chest, there’s no dark area to be seen at all:

 

Thursday, 4/23/2015 - Wrah-Wrah's chest cavity is completely filled with fluid. No lung is visible.

Thursday, 4/23/2015 – Wrah-Wrah’s chest cavity is completely filled with fluid. No lung is visible.

 

And in this view, the side view, you can see a small, grayish area with rounded edges “just kind of floating there.” That’s the Wrah-Wrah’s lung. It was surrounded by so much fluid that it was barely functioning. It’s like a ghost lung.

 

Thursday, 4/23/2015 - That faint, ghostly dark roundish area in the center, just below his spine? That's his "lung." That's all he has left, and with all the fluid crowding it, it was barely working.

Thursday, 4/23/2015 – That faint, darker gray area in the center, just below his spine? That’s his lung.

 

The doctor talked to us carefully and made sure that we understood the precariousness of the situation before he performed the thoracentesis. The procedure was extremely high-risk because Ronnie James’ condition was life-threatening. But everything went well. 300 ml of chyle was aspirated, and that wasn’t even all of it!

 

Thursday, 4/23/2015 - This is the fluid that was taken from Ronnie James' chest cavity. It's 300 ml (a cup and a quarter), and it's not even all that was in there. The doctor didn't want to try to drain all of it, because it would have been too risky. The fluid is chyle (chyle can either be cloudy or pink).

Thursday, 4/23/2015 – This is the fluid that was taken from Ronnie James’ chest cavity. It’s 300 ml (a cup and a quarter), and that was just some of it. The fluid is chyle (chyle can either be cloudy or pink).

 

There’s still “quite a bit” of chyle left in the Wrah-Wrah’s pleural cavity. The doctor said that it was too dangerous to try to get it all, but enough was removed to allow for more normal breathing. They might try to remove a little more sometime this morning.

Now, we wait to hear from Dr. M. when he comes in, examines Ronnie James, and reviews the whole situation. We don’t know what’s going to happen next. It’s at least comforting to know that what has happened so far had been anticipated… and the E.R. doctor said that he’s hopeful. Also, most importantly, the Wrah-Wrah isn’t suffering continuously.

 

Thursday, 4/23/2015 - Ronnie James felt better after his thorocentesis. He was wide-eyed, active and heart-meltingly lovey-dovey when we went to visit him in his oxygen chamber before we left.

Thursday, 4/23/2015 – Ronnie James felt better after his thoracentesis. He was wide-eyed, active and heart-meltingly lovey when we went to visit him in his oxygen chamber before we left.

 

Look at those wide, bright eyes!

We’re keeping our thoughts positive.

Ronnie James has a new nickname: Cat Squared (he has 81 lives, apparently)

I wanted to thank you all again for thinking of us and taking part in our journey to better health for Ronnie James with your kind well-wishes and interest in his story. I didn’t mean to tease in my last post. I just didn’t have much time for writing last week! Also, I wanted to talk to our doctor again before I sat down to scribble this out.

This is the short story:  Ronnie James was sick and gradually dying when we rescued him in the fall of 2012, but we didn’t know anything was wrong until he started coughing about 11 months ago. We now know that he’s been evading death for years, somehow surviving a thing that would have killed most mammals. We are in awe of him.

 

Ronnie James, Sunday night, 4/12/2015. Angel kitty with his halo of lights!

Ronnie James, Sunday night, 4/12/2015. Angel kitty with his halo of lights!

 

The detailed story goes like this:

In the operating room on Friday, April 3, Dr. M, our surgeon, opened up Ronnie James and found his left cranial lung lobe in a state of semi-decay; he said it almost looked like it was “rotting” in his chest. The mysterious mass seen on the CT scan turned out to be a mushroom-shaped (“pedunculated”) object that oozed a “weird, thick mucus-like material” when the stem broke off.

Dr. M tried to describe what he saw in the center of the mass, but he couldn’t quite find the words. I got the impression that he’d never seen anything like it before.

He told me, “It looks like it might be something of an infectious nature,” but he seemed to be baffled. He suggested that the mass might be a remnant of an old infection that Ronnie James’ body had tried to wall off. As he spoke, I envisioned an oyster protecting itself from grains of sand by coating the foreign material with its own bodily secretions.

But the bulbous, sickly pearl inside Ronnie James almost killed him. At first, its point of origin wasn’t obvious; it appeared to be attached to the bottom of the left cranial lung lobe. Actually, it seems to have grown off of one of the bronchi, clogging it and causing the lobe to collapse and consolidate. It’s possible that the mass ultimately caused blockage of Ronnie James’ thoracic duct, either directly or indirectly, as it was on the same (left) side. We’re hoping that this was the case, because if it was, then it answers the question of “What caused his chylothorax?”

Chylothorax, the filling up of the chest cavity with chyle, was the chronic issue we were aiming to fix, the problem we had to solve in order to save Ronnie James’ life. If the mass was causing it, well, problem solved! The mass is gone now.

Our surgeon said, “Until the labs come back, we can’t rule out cancer. I’ll tell you what, though… this doesn’t look like any cancer I’ve ever seen. I don’t know what this is.”

All along, Ronnie James’ labs have consistently tested negative for cancer. Dr. M had to say that he couldn’t rule out cancer until the labs came back, but the fact was, no one really thought that it was cancer.

Whatever it was, it was weird.

The weirdest thing was that standing before our kitty’s exposed insides, Dr. M and his team were still more or less flummoxed. Nothing was adding up or making sense, but he went ahead with the planned lung lobectomy, which was absolutely what had to be done, and removed “the entire mass and left cranial lung lobe as well as a small amount of an adherent adjacent lung lobe.” Samples of everything were sent to the lab for analyses and cultures.

While Dr. M was working in Ronnie James’ chest cavity, he also did an ultrasound on the second, smaller mass the CT scan had detected in Ronnie James’ neck.

 

Ronnie James' left cranial lung lobe, part of an adjacent lobe, and the mass were removed. The mass seemed to stem from one of his bronchi.

Ronnie James’ left cranial lung lobe, part of an adjacent lobe, and the mass were removed. The mass seemed to stem from one of his bronchi.

 

When the lab results came back a few days later, they showed that the inside of the lung mass was comprised of fat necrosis (dead fat). Necrotizing tissues and edema were also found throughout the lung lobe. There was “scattered mineralization.” We were indeed looking at decaying organic matter and an old infection, an infection with a history… and it was chronic.

Considering all of this, it’s miraculous that we didn’t lose Ronnie James to something like sepsis or cardiac arrest. Other than his intermittent episodes of coughing and his more recent bouts of prolonged lethargy, he had seemed just fine. He’d initially been diagnosed with asthma, which he may or may not actually have.

But what could have caused Ronnie James’ ancient infection? He’d tested negative for Valley Fever. He’s been an indoor cat since we’ve had him, anyway. We couldn’t stop thinking about it… we were faced with a medical mystery that had to be solved so we could take the best next steps toward complete recovery. It was maddening. What could have wreaked all this havoc in Ronnie James’ pleural cavity?

Then we thought back to the first time we ever took Ronnie James to the vet, when we were still living in France, and we remembered the cause of that problem. It was the Chenille Processionnaire, and it explains everything.

 

Chenille Processionnaire, or Pine Processionary.

Chenille Processionnaire, or Pine Processionary.

 

In October 2012, soon after we adopted 8-year-old Ronnie James from an impoverished woman in Montélimar in southeastern France, we noticed that he was having trouble eating. We took him to the veterinary clinic closest to us, which was down in Bourg de Péage. (In France, our home-base was in the Alpes, about 100 miles from the recent plane crash. I’m sorry to be able to use the location of that awful event as a point of reference, but there it is.) We thought that dental problems might be causing him pain, but when the vet opened his mouth, he simply remarked that Ronnie James had experienced some sort of contact with a Chenille Processionnaire (“Pine Processionary” in English), a venomous caterpillar common in southern France. The tip of Ronnie James’ tongue had been “burnt off,” and it was this disability that impeded his eating. Our vet immediately recognized the characteristic chenille processionnaire damage to Ronnie James’ tongue; there was no question about it.

I’d never heard of anything like it. The Pine Processionary doesn’t exist in the United States. According to Wikipedia, it’s only found in southern Europe and in parts of Asia and Africa.

From what we can understand, animals such as dogs and cats are harmed by this caterpillar either because of poisoning from its venom, or because of an allergic reaction to it, or both, in any case being potentially – even often – fatal. Incidentally, I found some disturbing images of dog and cat tongues either burned, like Ronnie James’ tongue, or amputated at the tip (due to contact with this caterpillar).

 

Les Chenilles Processionnaires (Pine Processionary caterpillars) are often seen traveling end-to-end. They're common where we lived in the Alpes and all over the French Riviera.

Les Chenilles Processionnaires (Pine Processionary caterpillars) are often seen traveling end-to-end. They’re common where we lived in the Alpes and all over the French Riviera.

 

The caterpillar’s venom is released when its tiny hairs break off, or when the caterpillar ejects the hairs in self-defense. The toxins are in the hairs. Dogs and cats suffer when they have direct interaction with the caterpillar, or when they come into contact with pine needles or other organic matter on which the caterpillar’s hairs had fallen. Ronnie James could have licked the caterpillar, or he could have stepped on the hairs while walking around outside, or, more likely, knowing him, he might have played with the caterpillar with his paws, batting it around. Whether he walked on the hairs or played with the caterpillar, the toxic hairs would have stuck to his paws (they stick to whatever they touch), and Ronnie James’ tongue would have been burned when he went to lick his paws, as cats do.

At the same time, a venomous hair or two could have traveled down into Ronnie James’ lungs.

It happens. It happens to dogs and cats who roam outside in areas infested with the Pine Processionary.

Dr. M, who had (along with the rest of his surgical team) noticed the unusual damage to Ronnie James’ tongue when they were prepping him for surgery, agrees that more than likely, this is what happened to him. Though we didn’t witness the caterpillar encounter, we can all look at the evidence before us and do the math. In this case, 2 + 2 = Pine Processionary caterpillar damage in the Wrah-Wrah’s lungs. It would also account for the smaller mass found in his neck, lodged in his throat area, as the way that was presenting also matched the type of damage that could be done by the Pine Processionary.

Everything we can see points to this caterpillar.

Two things are for sure: Ronnie James survived an inordinately long time after his encounter with the caterpillar, and he was certainly dying by the time the surgeon removed the dead lung and surrounding infected areas. And we’re not finished yet. One of his lab cultures came back positive; the infection is alive.

 

thatasianlookingchick.com-pineprocessionarycaterpillar

 

One for the “WTF, Nature?” archives, if you ask me.

We’re so proud of Ronnie James. He’s been such a good sport throughout this ordeal, and he did extremely well in surgery. Everyone was surprised when he didn’t need oxygen therapy to transition out of anesthesia, as dogs and cats typically do after surgery. He started breathing on his own again as soon as they unhooked him! We credit this bit of badassery to the fact that the Wrah-Wrah had long since learned to get along without that nasty old lung.

So that’s what happened. Years ago, Ronnie James inhaled or ingested toxins from a caterpillar. And to think that I’d blamed myself for bringing him here, back when we thought he’d developed asthma from being in the dusty desert! The whole time, he’d been suffering the effects of an environmental hazard that doesn’t even exist in North America. I can’t believe we brought this demon caterpillar venom back from France with us, embedded in the Wrah-Wrah’s lungs. That was more baggage from France than we’d bargained for.

Now that we know the root of the problem, we have a better idea of what to do for Ronnie James. We’re going after the remaining infection with an aggressive, extended course of antibiotics. We’re also continuing him on his asthma treatments, as he’d shown slight improvement on them (the steroid inhaler was helping to hold the infection at bay, and the bronchial dilator inhaler was helping to open up his airways).

Tomorrow, the Wrah-Wrah goes back to Dr. M to have his stitches removed, and he’ll be checked for need of further thoracentesis (chest tapping/draining). We were cautioned that it wouldn’t be unusual for him to need to have his chest drained one or two more times following the surgery. Our hope is that after a month or so, he’ll no longer have to deal with chylothorax and all the treatments it necessitates.

We’ve had a couple of scary episodes with coughing and vomiting in the last few days, but he checked out fine at the hospital; the episodes aren’t surprising given that his insides are adjusting to the changes, and he’s still recovering. Overall, the Wrah-Wrah continues to do much better. He’s happy and more active now than we’ve ever seen him. He is exponentially better, in fact. He’s next-level Wrah-Wrah!

A happy kitty is a kitty without dead lung tissue rotting in his chest with a weird, bulbous, rotting-fat-filled mass. We still have a long road ahead of us; Ronnie James’ long-term prognosis depends on how he responds to treatment from this point on. Anything can happen, but we’re optimistic!

 

Sleepy Ronnie James. He just woke up from his evening nap. (4/13/15)

Sleepy Ronnie James. He just woke up from his evening nap. (4/13/15)

Frankenkitty Comes Home!

Or, shall we say, the FrankenWrahWrah.

Ronnie James, one week post-op. (4/10/2015)

Ronnie James, one week post-op. (4/10/2015)

The results of Ronnie James’ surgery are unbelievable, better than anyone thought possible.

Friday, 4/3/2015, Day Zero: Our first sight of Ronnie James after his surgery, about five hours post-op. Still coming out of anesthesia, heavily medicated.

Friday, 4/3/2015, Day Zero: Our first sight of Ronnie James after his surgery, about five hours post-op… still coming out of anesthesia, heavily medicated.

Hello, Wrah-Wrah!

Hello, Wrah-Wrah!

He’s half hairless. He’s got a five-inch-long incision with about 20 stitches, plus a few stitches closing up the hole where his chest tube had been. He’s minus his left cranial lung lobe, part of an adjacent lung lobe, and a mysterious mass, and he’s breathing much easier now!

Poor Nounours missed his brother so much, he literally waited at the door for him to come home (when he wasn't wandering around the house crying).

Poor Nounours missed his brother so much, he literally waited at the door for him to come home (when he wasn’t wandering around the house crying).

We were all kind of confused going in, but the truest story of the Wrah-Wrah could be seen when our surgeon opened him up and looked inside. The phone call I received at work after the surgery was bizarre because what the surgeon found was bizarre. It fact, it was so bizarre, I have to save the story for the next post.

Meanwhile, here are some pics of our little warrior!

Saturday, 4/4/2015, Day One: The day after his surgery, we went from the gym directly to the hospital to visit Ronnie James. We were allowed to hold him. He was so out of it and scared!

Saturday, 4/4/2015, Day One: The day after his surgery, we went from the gym directly to the hospital to visit Ronnie James. We were allowed to hold him. He was so out of it and scared!

Sunday, 4/5/2015, Day Two: When we brought him home on Sunday night, Wrah-Wrah went straight to my office to rest, relaxed on his pain meds.

Sunday, 4/5/2015, Day Two: When we brought him home on Sunday night, Wrah-Wrah went straight to my office to rest, relaxed on his pain meds.

His fur had been shaved so precisely for the surgery, it looks like he's wearing half a coat! That spot in the center is where his chest tube had been.

His fur had been shaved so precisely for the surgery, it looks like he’s wearing half a coat! That spot in the center is where his chest tube (for drainage) had been.

That is quite an incision there, little guy.

That is quite an incision there, little guy.

Monday, 4/6/2015, Day Three: Pain-killers in full effect! The kitties' toy area in the living-room has been one of Ronnie James' favorite hang-out spots since he's been home.

Monday, 4/6/2015, Day Three: Pain-killers in full effect! The kitties’ toy area in the living-room has been one of Ronnie James’ favorite hang-out spots since he’s been home.

So many toys! Too many decisions.

So many toys! Too many decisions.

Tuesday, 4/7/2015, Day Four: We had a rhythm going with Ronnie James' after-care. Between his different meds and his compress treatments, there's something to be done six times each day. He's doing so well!

Tuesday, 4/7/2015, Day Four: We had a rhythm going with Ronnie James’ after-care. Between his different meds and compress treatments, there’s something to be done six times each day.

He's spent a lot of time snuggling up to me in my office at home.

He’s spent a lot of time snuggling up to me in my office at home.

Thursday, 4/9/2015, Day Six: Breathing so much easier now!

Thursday, 4/9/2015, Day Six: Breathing so much easier now!

We’re so grateful to everyone involved in the Wrah-Wrah’s medical journey (which isn’t quite over, but we’re certainly off to a great start!) and well-being, from the doctors and staff at our two clinics to all of you who’ve been keeping him in your thoughts and prayers. Next week I’ll fill you in on What the Heck the Surgeon Found. 

Happy Friday, All!

Ronnie James update Number 2 – Out, damned mass!

Sorry… I couldn’t resist the Shakespeare reference.

I’m postponing my March Favorites post until Tuesday, since this morning we had to take Ronnie James (Wrah-Wrah!) to the hospital super early. A lot more has happened since my last post about the Wrah-Wrah… that post, you know, in which we were so relieved and optimistic. In fact, since that very day I updated you guys, something else happened (as you know if we’re Facebook friends), and it’s continued to be an up-and-down kind of situation. The new developments have been relentless, and now, this morning, Ronnie James is going into surgery. The surgeon is going to perform a lung lobectomy to remove one Ronnie James’ lung lobes – the one with the mass, which may or may not be cancer, and which may or may not be causing his chylothorax, either because it’s cancer, or because structurally, it’s creating a blockage of his thoracic duct. In any case, the mass has to go. We consulted with several doctors at two different places, and everyone agrees that we can’t not take a serious measure at this point. He had to have another 150 ml of fluid removed from his pleural cavity the other day. We have to at least try to stop the flow of lymphatic fluid into his chest.

Because other than this, Ronnie James is very healthy, happy and active. He has a great appetite. He’s not at death’s door, so to speak. He’s not saying, Mommy and Daddy, I’m ready to go. He’s just saying, Mommy and Daddy, please stop the coughing. And so we’re going to try. Here are some pre-op pics, starting from late last night:

Ronnie James the night before his big surgery adventure! (4/3/2015)

Ronnie James the night before his big surgery adventure! (4/3/2015)

We've arrived at the hospital. Ronnie James is snug in his carrier, reassured under Daddy's touch. (4/3/2015)

We’ve arrived at the hospital. Ronnie James is snug in his carrier, reassured under Daddy’s touch. (4/3/2015)

Off to get tucked into his cozy hospital bed! Jordan loves the Wrah-Wrah, too. (4/3/2015)

Off to get tucked into his cozy hospital bed! Jordan loves the Wrah-Wrah, too. (4/3/2015)

Ronnie James will likely remain in the hospital under 24/7 care through Sunday. With the exception of the gym on Saturday morning, we’ve canceled our weekend plans so we can spend lots of time visiting him.

Thank you for your kind thoughts, prayers and well-wishes! I’ll post an update next week.

Happy Friday! =)