Your Pet's Best Friend

Fractured Jaws - Dizzy's Story - Part Five

Five weeks, and Dizzy ate on his own for the first time.  When he continued to do so for a few days, it was time to pull the feeding tube.

I've unwrapped the bandage (we've changed it weekly) and you can see the tube going into the side of his neck, into his esophagus, and going almost down to his stomach.  The hole where it was sutured in looks great -- no evidence of infection.  These usually do okay, though a patient with other disease processes affecting their healing can have a disaster here.  I once lost a patient and a client because of that. The cat was doomed from the start, but that didn't make it look any better when his neck disintegrated.

We clipped a couple of stitches and slid it right out.  The tube doesn't go all the way into the stomach, as that would cause gastric reflux.  You have to measure carefully when you insert it and sew it in place.

Here is the hole in Dizzy's neck. It will heal rapidly.  When his hair grows back, you won't be able to tell it was ever there.

Our only problem now is the partial facial paralysis.  When the left side of his skull was gull-winged away from the rest of it, it did some considerable nerve damage. His left upper lip is paralyzed and his left eyelids don't work so well, and his eye looks a little funky.

And this is where Dizzy's story came in on the KVC Facebook page.  Dr. Carol is still working with acupuncture and electro-acupuncture to try to rehabilitate some of that nerve function. 

When she feels like Dizzy has come as far as he can, he'll be heading home.  I'm not too sure how long that will be, so the next installment of Dizzy's story will be in the indefinite future. 

He feels good, he eats well, he has eight lives left... seven, anyway.

Fractured Jaws - Dizzy's Story - Part Four

Two more weeks of nursing care (four weeks total so far), and it looks like the infection is all under control.  I'm thinking it's time to try to repair that upper jaw, and try again to re-attach the inner cheek surfaces to the gums and cover up that naked mandible bone.  So, it's sleepy-time for Dizzy.

Here's where we get into that nine lives thing.  That red line in the roof of his mouth is all that's left of our horrendous open fracture line.  The maxilla has healed together.  No more "gull-wing".  No surgery, just tincture of time, the cat's remarkable healing ability, and the fact that we were giving him huge amounts of nursing care -- esophagostomy tube feeding three times a day, plus his meds.

The granulation tissue was nearly covering the naked bone, too.  So, now we've just got to keep supporting him until he is ready to start eating on his own.  The bones are healed together, and his lip is stuck back on.  No reason he couldn't eat, but he's probably still too sore. 

He could eat that soft A/D food and swallow it on his own, even though he still has his feeding tube in his esophagus.  The soft food would just flow around it.  Of course, if his mouth is still too sore, then it's still too sore.  So, we keep feeding him with his tube, three times a day.  His stomach will only hold so much, so you can't put a day's worth of food and water in one feeding.

It looks like we can see the light at the end of the tunnel, but we're not out of the woods tunnel  yet.

                                                                                    To Be Continued...

Fractured Jaws - Dizzy's Story - Part Three

So now we're a couple of weeks into this mess.  In this picture, you can see that his tongue is healing well.  Some of the stitches have already dissolved, but a couple of them are still hanging in there (the purple things).  You can also see the wire that is holding his mandibles together, and that was also used to help sling his lip back up on to his chin.  We are definitely making progress here.   Unfortunately, we do have some problems. 

 

There's that upper jaw that I didn't even want to think about.  Then we have the outer sides of his jawbones.  This isn't in focus very well (sorry), but that white stuff in front of my thumb, and between the red gum-line and lower lip, is bare bone.  On day #1 when I cleaned this up and sewed his cheek lining to what was left of his gums, it just didn't hold.  I can't say that I'm terribly surprised by this, since it was full of black sand.  I can say that I was disappointed.

I called the University of Missouri and talked to Dr. Meadows again. "Well, it may granulate in [fill in from side to side on its own], or you could try surgically reattaching things, now that the infection is controlled. I'm worried that the bone might just be dead from the trauma.  Then nothing will work."   Now there's a little ray of sunshine after all my hard work.

Speaking of all my hard work, there's another problem.  We still have a long way to go, and we have exceeded the owner's top-dollar budget.  Time to quit... but he's getting better! I can't quit now.  I mean I could, but I don't want to.  I want to see how this turns out.

So we made a deal with the owner.  She paid her top-dollar estimate, and Dizzy becomes our hobby.  When he gets well she can still have him back. 

With weeks to go before he's well (if he does get well), I can't afford too many hobbies like this one.

                                                                                        To Be Continued...

When the problem changes, re-evaluate the diagnosis.

And the diagnosis is:   I do not know.  One thing seems evident:  it wasn’t a hematoma (ruptured blood vessel).  

Things really changed in the next two days after I posted last on my poor hand.  The swelling became greater, the finger more red, and a spot near the first bend in my finger started turning white (i.e. dead –- white = no circulation).  It began to look like a hot-dog with two rubber bands around it.  It looked bad, and felt worse.

When I went to bed that Sunday night, I took a culturette swab in case it burst during the night.  I wanted to see what was growing in my finger.  It didn’t burst on its own, though.  This picture is the next morning on November 22, before I went to the doctor.  It had to be an abscess (pocket of pus).

That afternoon, the surgeon looked at it and said, “I think that is MRSA.”  [Methicillin Resistant Staph Aureus, a bad bacteria to have]  He split the swelling down both sides to drain “a lot of pus”.  I wasn’t looking --  just gritting my teeth, looking the other way and moaning softly. 

He took a swab to culture the mess, then irrigated the pocket to remove as much debris and dead tissue as possible.  I already knew this from my own patients, but local anesthetic doesn’t work in an abscess, so the process of opening and cleaning it out is pretty painful.

The wound was packed with Prisma, which is a cool material made of collagen (the body’s natural connective tissue) and treated cellulose.  This eliminates the dead space in the pocket and absorbs new crud that forms.  That is, it absorbs moderate amounts of drainage.  There was a little more than “moderate” draninage on the first day.  By the time I returned to the office, the bandage was already soaked.  I had to apply another layer to keep from contaminating other folks, and from wicking new bacteria in through the wet bandage.

He also prescribed antibiotics, pain meds, and suggested taking extra vitamin A, C, and zinc.  I complied.

The next day, the dressing was changed, the wound flushed, and the packing changed.  This feels a little like having a rasp up your nostril, pain-wise.

The next day, he had to remove some more dead tissue.  This time the local anesthetic did help a little.  Since I had experienced so much drainage before, he gave me a more impressive dressing.  It looked like a boxing glove.  The culture results were back: normal skin bacteria, no MRSA.  No MRSA is good, but (in the words of the surgeon, and I concur) “this makes no sense”.

Other than the weight-lifting a week before, I can recall no trauma of any kind: no splinter, no cut, no scrape, no nothing.  Was there some “micro-abrasion” during weight-lifting?  My weight-lifting gloves have open fingers.  I’ve ordered new ones that cover my whole hand.

Two days later, after Thanksgiving, another bandage change, new packing.  The pain is subsiding, and I can bend my finger, but things still don’t look good.  I made myself look this time, but no picture.

That packing was supposed to come out with a bandage change three days later, but the surgeon’s wife went into premature labor and had to have an emergency C-section.  The guy put his family ahead of my finger, so I had to wait an extra day, but things went okay [finger, momma , baby, everything]. 

Here’s a picture on December 1.  There’s enough improvement that I can change my dressings myself now.  The wounds from the lancing haven’t completely healed yet, but they are getting there.  The surgeon tells me that being a  non-smoker and a non-diabetic have been my saving grace.  I just wish I knew what the inciting cause was, so I could make a serious effort not to repeat the mistake.  At this point I am mystified.  It could be a spider bite, or maybe alien abduction.  I'm open to suggestions -- constructive suggestions, I mean.

Here is today's picture.  The finger continues to improve.   At least it feels better, though it still looks pretty rough.  It’s functional – I played the recorder for a Renaissance Feast last night, and I can do surgery (though my right hand needs a size 8 glove, instead of the usual size 7).

This is why I am pretty careful not to bad-mouth the previous doctor when I see a case for a second opinion.  Sometimes the problem looks  a LOT different  when I see it a week (or a month) later.