Operation: Spoil Wrah-Wrah Wrotten

Ronnie James stayed in the hospital for three more days after I last updated here. We brought him home yesterday, after work.

It was a long weekend of worry and wait. We continued to visit the little guy twice a day, and we called the hospital every four hours to ask about the status of his pleural effusion. The volume of the fluid in his chest did decrease significantly from where it’d been earlier in the week, but hovering around the 8-10 ml range (down from 20-30!), it was still too much to warrant removing his chest tube.

So yesterday afternoon, Ronnie James underwent anesthesia again, and Dr. M. and the radiologist performed a lymphangiography. This procedure allowed Dr. M. to see whether we’d have a shot at the one last surgical option available for chylothorax: cisterna chyli ablation. The study results showed that the surgery would be irrelevant, since the problem was not leakage from the thoracic duct. The thoracic duct ligation surgery had been effective. The fluids were coming from somewhere else, likely from the pleura, as a result of pleural fibrosis. We are out of options.

The good thing about being out of options, though, is that the Wrah-Wrah is now home with us. He’s home, and we’re enjoying him, loving him and spoiling him with attention while we’re waiting for the next thing to happen.

Ronnie James is just the toughest little guy! His spirits are high. He’s happy and active, eating and drinking. But his little body is showing signs of wearing down. For one thing, despite eating well, he’s losing weight. We’ve stopped feeding him the prescribed low-fat diet. We’ve halted attempts to force him to take the loathed rutin. There’s no longer any point to these chylothorax medical management strategies. We’ve more or less entered a hospice phase here at home, and in this phase, we’re going to give him anything and everything he wants.

Dr. M. sent Ronnie James home with us last night so we could spend a good few days with him while he’s happy and alert. Freshly tapped, it will take maybe 48-72 hours for the increasing volume of fluid in his chest to slow him down again. I’m staying home with him today and tomorrow, because it’s out of the question that I’m not here to spend his last few days with him.

On Thursday, we’ll take him back to Dr. M. for an x-ray to see where we are with the fluids. We’ll probably have to make The Decision at that time… for real, this time.

Of course, I’ve got a slew of pics from the weekend.

From Friday:

 

Ronnie James got all the cuddles!

Ronnie James got all the cuddles!

 

Sleepy Wrah-Wrah.

Sleepy Wrah-Wrah.

 

"I can't even with this long underwear!" ~Ronnie James

“I can’t even with this long underwear!” ~Ronnie James

 

Ronnie James, our little dragon.

Ronnie James, our little dragon.

 

The Wrah-Wrah can chill with the best of them.

The Wrah-Wrah can chill with the best of them.

 

The Dude Abides.

The Dude Abides.

 

Here’s me on Saturday wearing my paw earrings just for the Wrah-Wrah:

 

Going to see my baby! Paw earrings required.

Going to see my baby! Paw earrings required.

 

On Sunday, many pictures were taken:

 

Mother's Day at the hospital!

Mother’s Day at the hospital!

 

"Happy Mother's Day, Mommy!" ~Ronnie James

“Happy Mother’s Day, Mommy!” ~Ronnie James

 

Ronnie James moved into a larger kennel on Saturday. More room for rolling around!

Ronnie James moved into a larger kennel on Saturday. More room for rolling around!

 

I got to hold him!

I got to hold him!

 

Daddy scritches are the best.

Daddy scritches are the best.

 

And on Sunday night, we got to spend an hour with him in a private room.

 

Wrah-Wrah cuddles in progress!

Wrah-Wrah cuddles in progress!

 

"I can spend forever in Daddy's arms." ~Ronnie James

“I can spend forever in Daddy’s arms.” ~Ronnie James

 

Snuggling with my baby on Mother's Day. Gratitude.

Snuggling with my baby on Mother’s Day. Gratitude.

 

A miracle could still happen, right? A miracle, an inexplicable turn-around, whatever you want to call it… it could still happen. But Ronnie James will tell us. He’ll tell us what he wants to do, and when he wants to do it. Our job is to listen. At the moment, I’m only hearing his happy “I see birdies!!” sounds as he watches the front yard through the living room window, and I’ve never heard anything more precious.

Ronnie James’ complicated case.

Ronnie James did not come home yesterday, as planned. He’s still in the hospital.

 

Ronnie James recovering in the oxygen chamber the evening of his surgery. (Thoracic duct ligation and pericardectomy)

Ronnie James recovering in the oxygen chamber the evening of his surgery.
(Thoracic duct ligation and pericardectomy)

 

His surgery went well, and he did well, like last time. Dr. M. said that once again, he came through it “like a champion”! The chylothorax seems to be resolved – there’s no more chyle leaking where it doesn’t belong. The Wrah-Wrah is happy and alert, loving all the cuddles and pets he’s getting. He’s eating with good appetite. His disposition and attitude are fantastic!

So what’s the problem?

His chest cavity just keeps filling up with fluid.

As I said, it’s not chyle. Rather, we’re looking at some sort of nondescript, inflammatory-ish fluid, and at this point, no one can say with certainty what it’s all about. A little bit of such fluid could be normal following a surgery. It could be caused by the chest tube, itself, even. But the amount of fluid we’re talking about here is well out of range. Ronnie James’ case is a complicated one, and it’s tough. We’re still battling the ripple effect of his contact with that venomous Pine Processionary caterpillar.

This current iteration of pleural effusion could be a fluke, as in, maybe a “pocket” of fluid resulting from the surgery just released all at once over the night (that was Wednesday night). Or, it could be something scarier, such as his pleura lingering in a self-perpetuating cycle of emitting fluid. Whatever the case, we can’t bring him home until the pleural effusion stops, since his chest tube needs to stay in place in order to drain the excessive fluids.

On his part, Ronnie James is totally oblivious to the danger he’s in, as he’s been busy in pursuit of Dr. M.’s heart (which he successfully captured, might I add). During morning rounds yesterday, Dr. M. found himself engaged in a Wrah-Wrah love fest. The Wrah-Wrah had been rolling around, asking for belly rubs, until he ended up on his back in Dr. M.’s arms, purring furiously as he got his belly rubs with two hands.

“Isn’t he cute?!” I asked Dr. M. when he told me about this.

“Oh, he’s adorable!” he answered the same second the question was out of my mouth. Exact words. Then, later, he said, “He HAS stolen my heart!”

Dr. M. has been Wrah-Wrahed. It happens.

Several other doctors and some of the technicians and staff have also fallen in love with the little guy. This is what the Wrah-Wrah does best, just being himself… his affectionate, smart, happy, interactive, funny, sweet, sweet self. Everyone who spends any time with him at all loves him!

Because Ronnie James’ two-part modus operandi in life is:

  1. Find all the hearts.
  2. Stealz them.

 

Ronnie James the day after surgery, off oxygen and resting in a kennel in the ICU.

Ronnie James the day after surgery, off oxygen and resting in a kennel in the ICU.

 

As I write this, we don’t know what today will bring. I’m going to work, as usual. But will Ronnie James come home tonight? We can’t say. We don’t know. We hope so. We miss him, and so does his Nounours.

 

Poor Nounours! He misses his brother.

Poor Nounours! He misses his brother.

 

I’ll keep you posted. Thank you for reading, and for keeping Ronnie James in your thoughts and prayers.

Happy Friday, All! =)

The Wrah-Wrah Wrollercoaster (or, the WrahWrahCoaster).

Ronnie James goes in for another surgery today. We’re dropping him off in about two hours, at 7:30am.

This development resulted from yesterday’s trip to the vet, when it was found that fluid has filled his pleural cavity again. His chylothorax persists with an aggression that’s frightening. A chylothorax-specific surgery might be able to stop the process; it’s actually a combination of procedures: Thoracic duct ligation plus pericardectomy. This is our next step, and it’s our last.

We were told that the success rate for this surgery is 80% for cats, which is encouraging… but we’re not sure if the Wrah-Wrah will have a chance to try for those odds. We won’t know until Dr. M. opens him up today and examines him. If the developing pleural fibrosis (a complication of chylothorax) is still mild enough to be survivable, Dr. M. will move forward with the surgery. If the pleural fibrosis turns out to be beyond-hope bad, on the other hand, he’ll drain Ronnie James’ chest for the last time and close him up. We’ll have the “end of life” discussion. It will be time to address the details of The End.

 

Callaghan with Ronnie James at yesterday's appointment.

Callaghan with Ronnie James at yesterday’s appointment.

 

Thing is, Ronnie James has been doing so well outside of his bizarre, catastrophic emergencies. You literally only know half of it, because I haven’t yet written about the other half. I will, at some point soon. It’s just… the other day, I joked to Callaghan that “Wrah-Wrah is going to outlive us both long after he sends us into cardiac arrest with his near-death episodes.”

We’ve been on the WrahWrahCoaster going 500 miles per hour for months, and sometimes, it’s like we’re barely strapped in. The relentless and extreme ups and downs have been exhausting.

 

With the Wrah-Wrah at home, after our appointment.

With the Wrah-Wrah at home, after our appointment.

 

So today, we’re trying for this final possible solution.

We’re glad that Ronnie James had such a good weekend this last weekend. He looked better and seemed to feel better than we’d seen him since, well, maybe ever. All weekend, we enjoyed an unusually alert and active Wrah-Wrah, who was everything a healthy Wrah-Wrah should be – he was hungry and thirsty, playful and talkative, and just as flirty and affectionate as ever. He stayed close to us, wherever we were. He’s our bright little lovebug, and we’re going to give him every chance at survival we’re able to give him… and we’re so grateful that we’re able to give him these chances.

Here are some pics from the weekend:

 

The Wrah-Wrah looking so alert! You can see the wheels turning in his head, too.

The Wrah-Wrah looking so alert! You can see the wheels turning in his head, too.

 

The Wrah-Wrah's poodle-like cut is growing out. When the fur on his back is ruffled, it looks like a mohawk from this angle.

The Wrah-Wrah’s poodle-like cut is growing out. When the fur on his back is ruffled, it looks like a mohawk from this angle.

 

Now that his fur is growing out from his last surgery, he’s cultivating kind of a faux-hawk on his left side. Depending on where they shave him this time, we might bring him home with a full-blown ‘hawk!