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post #1 of 12 (permalink) Old 08-21-2015, 05:47 PM Thread Starter
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Tim's Not Blinking After Ear Surgery

So it's been just over a week since Timmy had a polyp removed from his ear canal, he was doing well until 2 days after surgery, his faced swelled really badly on the side he had surgery. The vet wasn't massively worried but wasn't sure why it had happened, she said it was almost like he took a knock to his face, the swelling wasn't fluid, it was like swollen tissue.
On that day we also noticed he wasn't blinking his left eye, same side as his ear surgery too, his third eyelid was protruding at times but no other symptoms of Horner's Syndrome as far as I can tell (I know Horner's Syndrome is common after that surgery). At the minute the vet isn't too worried about the eye, he's kind of glossing over it when I ask. Does anyone have any experience of this? I suppose I'm wanting to know if this is likely to get better
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post #2 of 12 (permalink) Old 08-21-2015, 07:47 PM
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I can't believe your vet isn't doing anything about this obvious complication to his surgery. At the very least, he should have supplied you with eye drops and instructions to administer them to keep Tim's eye moistened. If his eye dries out, he could go permanently blind. You need to get your vet on the phone immediately and insist on eye drops to protect Tim's eye. If the problem doesn't resolve quickly, you need to get Tim to another vet who isn't invested in avoiding responsibility for this complication like your current vet.

Laurie
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post #3 of 12 (permalink) Old 08-21-2015, 07:54 PM
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Hi Leanne2112 !

Right off the bat, the first thing that hit me was 'I wonder if there's an infection going on in there?'

I've never had a cat have a polyp removed but I did extensive 'reading up' on polyps and their removal when I suspected and the Vet wondered about Stryker of having one. I don't remember all the details now except that these are not simple surgeries and that the removal process sounded almost barbaric to me....basically, the polyp is just pulled out ! It just seems to me that the trauma of that could well produce swelling in the surrounding tissue. Now, given that and adding in what you're seeing, then, if swelling is a natural outcome of the removal, I would expect the Vet to have told you - to allay your fears by providing a logical explanation.

It is not difficult to determine whether/not an infection is at play...a simple temperature-taking and a minor blood test will do it in most cases.

Because this area is so close to the brain, I wouldn't be leaving things any longer.......on the face of it, things are NOT improving and, in fact, you're seeing signs of a worsening, imo.

Because you're in the UK, I want to mention a couple of cautions for you. There are two medications that are given like candy there: one, an injectable antibiotic and, the second, an 'anti-inflammatory'. Each has significant risks for cats and worse, given together, they are most often fatal.

The antibiotic is called "Convenia" - you can read about it here: Convenia: Worth the Risk? by Lisa A. Pierson, DVM :: Long-acting antibiotic for cats that can have serious side effects

The 'anti-inflammatory' comes in each of "Metacam" (oral & injectable) and "Onsior" (tablets). We humans rely heavily on non-steroidal anti-inflammatories (NSAIDs) for pain relief.....cats are really different, though and are unique in their inability to metabolize them...a cat's liver does not have the requisite enzymes to deal with them - so, it's the kidneys that must deal with them 'on the front line'...and, these substances destroy kidney tissue. Some degree of kidney damage is the invariable result.

Naturally occurring swelling from surgery (not the result of infection) will self-resolve without anti-inflammatories, it will 'simply' take a little longer.

Now, if pain is a factor, there are other (opiod) drugs that are very safe for cats...best to use those.

If Timmy were here, I would be having him seen as quickly as possible and reassessed....by a different, competent Vet. If you have the resources for an after-hours examination, I'd recommend it.

Out of curiosity, are you within accessible range of UCD Veterinary Hospital ? Here's their webpage: UCD Veterinary Hospital, UVH Because it's part of the Veterinary school, there'll be a full range of certified specialists there. It may be a resource that you'll need to insist on being referred to, although I hope not. (I see that people can 'book themselves in', though it seems to be a deliberately difficult admission process that they've set up....quite differential to the Veterinary 'community' if you ask me ! [Quelle surprise !])

I'm really bothered by (what sounds like, to me) the cavalier 'attitude' of the Vet and the immediate conclusion that the cat 'MUST HAVE' sustained a facial injury.....

(This part's opinion only: I find, from reading personal experiences with UK Vets, that many do not feel the need to explain anything to the "owner"....it's an attitude of 'I'm the Vet, you are ONLY the uneducated owner....you have no need to meddle with medical information, just do the aftercare as you are told'.)

Now, I don't know if any of that is involved in your situation or not. I DO know that I wouldn't be leaving this any longer by taking a wait-and-see approach.

Hope something there helps...and, post back about any of it.
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post #4 of 12 (permalink) Old 08-21-2015, 08:50 PM
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I just noticed Laurie's post.

When I read your story, I didn't 'read into' it as she has......and, of course, she's rightly concerned if Timmy isn't closing his eye at all - and, the eye isn't being lubricated normally.

Now, I spoke about your ability to access after-hours emergency services. IF you're unable to get him in (perhaps they have 'regular' Saturday hours ?), I'd recommend that you (at the very least) speak with your pharmacist and get some over-the-counter artificial tears product.

You can read about these here: Artificial Tear Solutions - PetPlace.com (just say 'no thanks' to the pop-up window there)

These lubricants are available in gel format as well....that might reduce the number of applications for you and certainly cover the overnights better.

You'll probably need help to get anything into his eye...I've found that with one person doing the holding and a second doing the applying, it works well. With a couple of treat rewards and snuggles afterwards and, once Timmy learns the routine...who knows, he might even like it - which two of mine did !
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post #5 of 12 (permalink) Old 08-22-2015, 12:00 AM Thread Starter
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Thanks so much for the replies! I left out whole chunks of what happened trying to be brief but the vet isn't as bad as he sounds! Tim is on Convenia, he got it two weeks before surgery on the off chance that it was just an infection and not a reoccurrence of the polyp, he also got it post op so shoimd be covered until next week. The vet has also given me lubricating drops which Tim is an absolute trooper for and I have managed to put in on my own when I have to, he'd definitely our only cat I could do this with.

He didn't have the 'pulling it out' type of surgery, the polyp was too far down to grab so there's an incision under his ear, reoccurrence is supposed to be a lot less likely with this type but this is his second time having this surgery. He had no complications the first time. My poor boy is lying here with me, his eye slightly open while he sleeps, I so hope it's not permanent, he's really good to take the drops but I hate to do it to him
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post #6 of 12 (permalink) Old 08-22-2015, 12:59 PM
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Leanne, no need to apologize ! You did cover the basics of your concerns...

Just on the 'Vet culture' piece, I've certainly developed a jaundiced view of the 'state of Vet medicine' on your side of the pond and I have no problem stating that. It's developed after seeing time after time after time again, examples of poor outcomes as the result of poor/incompetent practices. It has jaded me.

I'm relieved to hear that you're not (quite) feeling left 'out-of-the-loop' on the treatment front....though it's clear you're unhappy that some of your concerns haven't been satisfactorily responded to....is my 'take' on that right ?

On the use of Convenia....personally, I wouldn't be having any more of it. This drug stays in a cat's system for about 65 days after administration, so, while it's at it's 'peak' during the first ten to fourteen days, it's not eliminated until long afterwards. It has as one of its typical characteristics the effect of seeming to 'zap' all the energy from a cat...they're frequently lethargic in the early period after receiving it and certainly "not themselves". Again, the coverage of Convenia in the article I offered describes the common observable side effects.

Now, just because he's had Convenia doesn't preclude that he might still have developed an internal infection. Convenia is a "broad spectrum" antibiotic - but, that doesn't mean it's equally effective against all bacteria. So...I wouldn't automatically be dismissing the possibility that there could be something nasty brewing in there. Again, a simple temperature measurement (as simple as that can ever be with a cat), to me, is a "no-brainer"....if that's raised at all, then a simple blood test will reveal whether/not he's fighting an infection. Does his head feel unusually warm? Is his nose cold to touch?

You happened to mention recurrence of a previous polyp...one of the points about polyps that I distinctly remember is that they frequently recur....it's "in the nature of the beastie' !

On the method of removal (again, from my memory), pulling is the standard operating procedure with these growths....the incision you speak of is 'just' the doorway/entry point to the location of the growth.

One point in your original post that's lingering for me: the third eyelid. Is that protrusion still happening ? If so, (and if I were you) I would want an explanation.....and, if one were not forthcoming (or, not making sense/satisfying my concerns) I would be insisting on a referral to specialty services at the Vet College. You can read about some of the causes of third eyelid issues here (carefully read the bullet-point section just after the intro): Protrusion of Third Eyelid in Cats - PetPlace.com

As you'll see there (well, at least I did) there are a number of possible factors that can be intuited as connected to 'nearby surgery'.....and, even local pain alone can cause the TE to appear.....was/is he receiving pain meds ?

I think that just about covers off my thoughts..........if I get a chance later on I'll see if I can run over the stuff on polyps I bookmarked when we were dealing with Stryker's issues.

Last edited by Stryker; 08-22-2015 at 01:03 PM. Reason: typo
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post #7 of 12 (permalink) Old 08-22-2015, 03:14 PM Thread Starter
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Thanks so much His third eyelid isn't appearing much at all now, I only see it when he sleeps and his eye doesn't close fully, also when I put the dropper for his drops near his eye his third eyelid will flicker across. If he had the other symptoms of Horner's Syndrome (the sunken eye, fixed pupil etc) I'd almost feel a bit bit better because I'd know what it was and that it was likely temporary. The vet is usually great, he's very honest about what he's doing and thorough in explaining what's going on so it's unusual for him to not really want to explain something, I don't know if he's maybe worried that I might blame him if nerve damage is mentioned or something, like he's being defensive, it's odd.

He was on Metacam for a few days after surgery as he was for his last surgery, I'm really surprised that Metacam and Convenia together are thought to be so dangerous, it does seem to be common practice here to use them, not just my own vet either so it's a shock that the risks aren't known here, I'll definitely talk to him about it.

My vet had actually mentioned referring Tim to UCD if the polyp reoccurs, it's about 2.5hours away. We'll definitely take him if we need to but Tim gets massively anxious in the car and I worry about how he'd handle such a long journey but it's something we're preparing for as a possibility, the vet is definitely in favour of this which is good.

Thanks again for the answers
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post #8 of 12 (permalink) Old 08-22-2015, 03:49 PM
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Just keep an eye on the boy while he gets better. Does he still like to play in the sink?
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post #9 of 12 (permalink) Old 08-22-2015, 08:42 PM
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You may be spot on about your Vet's out-of-character response...this surgery has more inherent risk than other more common procedures. It might also be a touch of self-doubt/what-if's that he's dealing with.

I pulled out three references I used when Stryker was having issues. I re-read through them (~) today and, because each has some unique tidbits, I'll pass on all three. Combined, they should provide an in-depth understanding including the risks and the expected post-op results/observations with prognoses for all. I have a feeling they will be reassuring for you.
Well, I suspected the Metacam was used...I think it's good that you can bring it up with him. I've sent you some links to the UK regulator's site which I'm sure will have more resonance than the word of 'someone on an Internet site'...'twill be interesting to hear his response.

I'm glad to hear that he brought up the UCD resources....I'm beginning to think that you should 'hang on' to this guy after all
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post #10 of 12 (permalink) Old 08-23-2015, 08:40 PM
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I've had a personal experience with a polyp removal in a cat as my previous cat, Masha, had a polyp removed when she was about 10 months old, so here is what I know and my experience:
Was it a simple polyp removal i.e. they pulled the polyp out without cutting into the ear bone or was it bulla osteotomy - when they cut into the middle ear and remove not just the polyp, but also the area in the middle ear the polyp was growing from? With the former, there is a high risk of regrowth, with the latter, the risk of regrowth is small, but the surgery is more complicated. My cat had the latter surgery. As you know, Horner Syndrome is very common complication of polyp removal, especially bulla osteotomy.

If your cat had Bulla osteotomy, it is a very complicated surgery. In my cat's case, the clinic invited a specialist surgeon from the city to do it to minimize the risk of complications. Even with that they did warn me of some inevitable complications. Basically, the way they explained it to me, the area is very small with a lot of nerves there, and just to cut into the ear bone, they need to cut several nerves, some of which control the eye.

After surgery, Mashka's third eyelid covered the eye on the side of the surgery completely. She didn't have any other complications, no swelling at all. She did have to wear the cone collar for a week. They did give her antibiotics post surgery to prevent infection, pain meds for 5 days (if I remember correctly).

Her third eyelid gradually disappeared, but it took a while, I think a month, maybe longer. I didn't notice any blinking issue, but one permanent complication was that her pupil on that eye has remained constricted for her whole life. It was dilating a little, but not as much as the other eye.

I google for "not blinking after bulla osteotomy" and I found two things. First, this can be caused by facial nerve damage and is a common symptom of long standing ear infection. One place said it can happen after the bulla osteotomy as well. Here it says that it can happen - due to possible damage to the facial nerve, but it's usually transient, but the cat does need some lubricant drops in the meantime.

She's lived for 14.5 years with no recurrence.
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