May 24: Full story and why so concerning
Today is the first day without my left hand hurting. There is still some tenderness at the first and second knuckles, hurts with pressure. But the right thumb, which didn't seem to be improving, is now almost completely normal. The skin looks slightly different but, again, is almost normal. Of the various cat wounds there are only faint traces.
Explanation: Oreo had been more stressed of late, pooping outside of litter box for the previous 2 weeks, which is always behavioral. I'd increased pressure on Eileen for help, was doubting at this point that John and all should take her in case the nine months of unhappiness left her personality changed. Chester's consistent bullying probably didn't help, although I've never witnessed more than rough play on his part with her screeching like a wimp. On Saturday, after picking up her poop (which is easily disposed of and cleaned up after) I noticed the towel on the top of my favorite antique upholstered stool was bunched up. Oreo had defecated there before and, as is natural for cats with a burying instinct, then pulled the towel over it. On going over to inspect this was not the case, instead she had urinated right smack in the middle of the fabric then pulled the towel over. I went ballistic. Anyone who has smelled cat urine will totally understand. She was calmly sitting on the porch. I grabbed her by the scruff of her neck and carried her, dangling and complaining, to the stool, then rubbed her nose in it. Her protests became louder, screeching and screaming, Tabitha and Chester came running in, getting right up in Oreo's face. She lashed out. I tried to hold her down, still wanting to punish her, as Tabitha really got in her face. Oreo bit and scratched both hands and the right wrist. It went through my head "Let her go, it isn't worth it.", at which point I threw her away from me towards the open window, Tabitha hot on her heels. I closed off both windows, then went to the porch to find Tabitha (the only cat who has been declawed!) being so ferocious that Oreo was cowering in the corner. I picked Tabitha up, brought her into the house and left Oreo out on the porch to calm down.
My hands were bleeding a fair amount at this point. On testing my INR the night before it was perfectly in range at 3.1 (my range is 3.0-3.5) which is substantially thinner than most people on coumadin. The biggest danger with puncture wounds is infection, because of the penetration into the skin and tissues. So I held my hands in the bathroom sink and let them bleed. After several washings I then put on a strong antibiotic cream and bandaids, called my primary care doctor's office for an antibiotic. Cat's mouths are more bacteria-laden than either a human's or dog's bite. While cat scratches occasionally get infected, almost every cat bite will become infected.
For those who are not aware, there are two major issues for people with mechanical valves. The most common problem is the formation of clots on the valve, which then flip off and get lodged in nasty places like kidneys, eyes and--most common--the brain, leading to a stroke. For this reason, every person who has a mechanical valve has to be on coumadin and aspirin to decrease the chance of clot formation. With the blood thin come other problems: injuries, trauma, surgery. Anything that causes bleeding then becomes a risk for more blood loss and uncontollable bleeding is a significant factor in death and disability in coumadin patients. So a fairly minor accident takes on a whole new set of fears, any surgery has to be delayed while coumadin and aspirin are stopped and another drug, heparin, is started. Heparin can only be administered by needle,has a much shorter action in thinning the blood and can be timed very precisely. Surgery is then timed for when the blood is normal. After the surgery the blood thinners are re-started with the hope that no clots formed during the time of surgery but also taking the risk that any place that was cut during the surgery doesn't start bleeding uncontrollably. It's a delicate balance. But uncontrollable bleeding is a high cause of death and disability in coumadin patients.
As if that wasn't enough to worry about, the other major risk is infection. Anytime a person has any foreign material in their body they have an increased chance of it getting infected. But, obviously, an infection in the middle of your heart is more severe than in your knee replacement. If any bacteria travel through the bloodstream to the mechanical heart valve things go very, very badly. Infective endocarditis on a mechanical valve is critical. Untreated, the mortality is 100%. Treated, mortality drops to 40-50%, which obviously still not great. Not infrequently antibiotics aren't enough and the valve needs to be re-replaced. I'm at greater risk because of the number of surgeries and resulting scar tissue, which attracts bacteria because it's different. Additionally, there is the repaired tricuspid valve as another site of bacterial seeding.
For the record, the above issues are the reason why the goal was to repair the valve rather than replace. This is why they tried three times during the first surgery and Cohn's first time in (my second surgery) was again a repair. Especially in a younger patient who will have more years to develop serious problems.
So, rapidly starting on antibiotics is critical for me. After the call to the primary's answering service was returned the next call was to the vet. My wish was taking Oreo to the SPCA for euthanasia but the vet tech talked me into bringing her to the office and boarding her for 24 hrs to calm down. I chose the latter if for no other reason than the vet office is less than 5 mins away and the SPCA , which I've never been to, about 30 minutes drive.
I started the pills within about two and a half hours of the bites. My hands were very swollen and painful. My thumb on the left was OK, the fingers on the right weren't bad, but then one on the right wrist was pretty painful. The pills were prescribed for 3/day, 1 very 8 hrs but I took 3 in a 12 hour period. When I went to bed there was discoloration, which I was hoping was blood collection since bruising is a way of life with any trauma while on coumadin. But when I woke Sunday morning the areas that were bad eight hours before were all worse, red and hot. While it appeared to be cellulitis (infection of the layers of skin) and wasn't streaking up the veins (much worse) there was no doubting IV antibiotics were needed. Off to the hospital.
Eileen took me; she had told me the day before she was available to help and the two other people I called weren't able to help. Just in the first two hours she was with me the redness moved almost 2 inches further up my left wrist. With the above information you now understand the conversation with the ER doctor. Fortunately the infection was contained and responded to the stronger IV antibiotics, there was no infection in the blood.
The danger is over, things are fine. I now go back to living my 'new' normal life of the last few years. But it's a reminder--for everyone in my life--how quickly things can change.
By the way, Eileen's ex-boyfriend took Oreo. She had sent out a feeler to him through mutual friends and he had gotten back to her Friday night. She couldn't find my phone number to let me know. Oreo is now an only cat and reportedly very happy. My four and I are happy to have a spat-free house back. But the stool will probably need to be re-upholstered, which there isn't money for right now.
Time to start typing and rest my hands. Will update other things later. Besides, the Flyers are leading 3:1 and a win will mean going to the Cup Playoffs.
Thanks for checking in, Laurie
Explanation: Oreo had been more stressed of late, pooping outside of litter box for the previous 2 weeks, which is always behavioral. I'd increased pressure on Eileen for help, was doubting at this point that John and all should take her in case the nine months of unhappiness left her personality changed. Chester's consistent bullying probably didn't help, although I've never witnessed more than rough play on his part with her screeching like a wimp. On Saturday, after picking up her poop (which is easily disposed of and cleaned up after) I noticed the towel on the top of my favorite antique upholstered stool was bunched up. Oreo had defecated there before and, as is natural for cats with a burying instinct, then pulled the towel over it. On going over to inspect this was not the case, instead she had urinated right smack in the middle of the fabric then pulled the towel over. I went ballistic. Anyone who has smelled cat urine will totally understand. She was calmly sitting on the porch. I grabbed her by the scruff of her neck and carried her, dangling and complaining, to the stool, then rubbed her nose in it. Her protests became louder, screeching and screaming, Tabitha and Chester came running in, getting right up in Oreo's face. She lashed out. I tried to hold her down, still wanting to punish her, as Tabitha really got in her face. Oreo bit and scratched both hands and the right wrist. It went through my head "Let her go, it isn't worth it.", at which point I threw her away from me towards the open window, Tabitha hot on her heels. I closed off both windows, then went to the porch to find Tabitha (the only cat who has been declawed!) being so ferocious that Oreo was cowering in the corner. I picked Tabitha up, brought her into the house and left Oreo out on the porch to calm down.
My hands were bleeding a fair amount at this point. On testing my INR the night before it was perfectly in range at 3.1 (my range is 3.0-3.5) which is substantially thinner than most people on coumadin. The biggest danger with puncture wounds is infection, because of the penetration into the skin and tissues. So I held my hands in the bathroom sink and let them bleed. After several washings I then put on a strong antibiotic cream and bandaids, called my primary care doctor's office for an antibiotic. Cat's mouths are more bacteria-laden than either a human's or dog's bite. While cat scratches occasionally get infected, almost every cat bite will become infected.
For those who are not aware, there are two major issues for people with mechanical valves. The most common problem is the formation of clots on the valve, which then flip off and get lodged in nasty places like kidneys, eyes and--most common--the brain, leading to a stroke. For this reason, every person who has a mechanical valve has to be on coumadin and aspirin to decrease the chance of clot formation. With the blood thin come other problems: injuries, trauma, surgery. Anything that causes bleeding then becomes a risk for more blood loss and uncontollable bleeding is a significant factor in death and disability in coumadin patients. So a fairly minor accident takes on a whole new set of fears, any surgery has to be delayed while coumadin and aspirin are stopped and another drug, heparin, is started. Heparin can only be administered by needle,has a much shorter action in thinning the blood and can be timed very precisely. Surgery is then timed for when the blood is normal. After the surgery the blood thinners are re-started with the hope that no clots formed during the time of surgery but also taking the risk that any place that was cut during the surgery doesn't start bleeding uncontrollably. It's a delicate balance. But uncontrollable bleeding is a high cause of death and disability in coumadin patients.
As if that wasn't enough to worry about, the other major risk is infection. Anytime a person has any foreign material in their body they have an increased chance of it getting infected. But, obviously, an infection in the middle of your heart is more severe than in your knee replacement. If any bacteria travel through the bloodstream to the mechanical heart valve things go very, very badly. Infective endocarditis on a mechanical valve is critical. Untreated, the mortality is 100%. Treated, mortality drops to 40-50%, which obviously still not great. Not infrequently antibiotics aren't enough and the valve needs to be re-replaced. I'm at greater risk because of the number of surgeries and resulting scar tissue, which attracts bacteria because it's different. Additionally, there is the repaired tricuspid valve as another site of bacterial seeding.
For the record, the above issues are the reason why the goal was to repair the valve rather than replace. This is why they tried three times during the first surgery and Cohn's first time in (my second surgery) was again a repair. Especially in a younger patient who will have more years to develop serious problems.
So, rapidly starting on antibiotics is critical for me. After the call to the primary's answering service was returned the next call was to the vet. My wish was taking Oreo to the SPCA for euthanasia but the vet tech talked me into bringing her to the office and boarding her for 24 hrs to calm down. I chose the latter if for no other reason than the vet office is less than 5 mins away and the SPCA , which I've never been to, about 30 minutes drive.
I started the pills within about two and a half hours of the bites. My hands were very swollen and painful. My thumb on the left was OK, the fingers on the right weren't bad, but then one on the right wrist was pretty painful. The pills were prescribed for 3/day, 1 very 8 hrs but I took 3 in a 12 hour period. When I went to bed there was discoloration, which I was hoping was blood collection since bruising is a way of life with any trauma while on coumadin. But when I woke Sunday morning the areas that were bad eight hours before were all worse, red and hot. While it appeared to be cellulitis (infection of the layers of skin) and wasn't streaking up the veins (much worse) there was no doubting IV antibiotics were needed. Off to the hospital.
Eileen took me; she had told me the day before she was available to help and the two other people I called weren't able to help. Just in the first two hours she was with me the redness moved almost 2 inches further up my left wrist. With the above information you now understand the conversation with the ER doctor. Fortunately the infection was contained and responded to the stronger IV antibiotics, there was no infection in the blood.
The danger is over, things are fine. I now go back to living my 'new' normal life of the last few years. But it's a reminder--for everyone in my life--how quickly things can change.
By the way, Eileen's ex-boyfriend took Oreo. She had sent out a feeler to him through mutual friends and he had gotten back to her Friday night. She couldn't find my phone number to let me know. Oreo is now an only cat and reportedly very happy. My four and I are happy to have a spat-free house back. But the stool will probably need to be re-upholstered, which there isn't money for right now.
Time to start typing and rest my hands. Will update other things later. Besides, the Flyers are leading 3:1 and a win will mean going to the Cup Playoffs.
Thanks for checking in, Laurie
posted by Laurie @ 6:42 PM
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