Lisa -
There are plenty of humans who have less than ideal BG levels and need major surgeries. I see lots of humans who need coronary artery by-pass surgery and it's typically more on the emergency situation than an elective procedure. The wound healing may take more time but the wound should heal. Make sure that Angel will eat and get sufficient protein in her diet.
Hi Gabby,
Thank you for commenting! Maybe I should elaborate a bit.
In 2021, Angel had a (what turned out to be benign) lump removed, from her shoulder/flank area. The vet did not do a great job, quite frankly. They left a huge suture line (we called her "frankencat" for a while) and removed so much skin and tissue that the remaining skin was pulled so incredibly tight that she couldn't even reach down to clean her bum. But she healed, and she was fine, or so we thought.
About 8 months after the procedure, she began having attacks that looked like feline hyperesthesia, always aimed at her surgical scar. After lots of treatments, trials and error and LOTS of vets, we found out that she was suffering from persistant post-surgical nerve pain. The pain is progressive; the attacks/episodes became longer and longer until it was just constant with periodic flareups with more intensity, and the severity continues to increase. It started as twitching and licking, then gnawing, then biting, then biting and tearing at her skin causing actual wounds. She wore a t-shirt for about a year to prevent her from injuring herself.
Disregarding all the meds that
didn't help, she was on gabapentin first. Worked for a while, then the progressive pain progressed and the med became ineffective. We started the merry-go-round of increasing the dose for a couple months, until she was on a massive dose 3 times a day. Then we switched to pregabalin. Same story here, effective until the pain gets worse again. Then we increase. Currently she's on approx. 62.5mg 2 times a day (the max. recommended dose for a cat her size is 12mg).
In november 2023 we saw a chronic pain specialist as my vet was out of options. She was taking 85mg pregabalin twice daily at the time. He laid out some options for us, including surgery, but said we could treat conservatively with additional meds first to see if that'd be enough to bring down her pregabalin dose. We started her on tramadol; this worked well, but had too many side effects (she would spend most of the day laying with her head on the rim of the water bowl staring out into space). She had a ketamine IV on december 7th that also worked well at reducing her central sensitisation, but didn't fully resolve the pain that came from within. We started her on memantine after that, and that combo has worked best of all the things we've tried so far. She has not needed to wear her t-shirt since the ketamine IV.
Right now, we're out of options for additional meds, and even the pregabalin + memantine + ketamine IV treatment protocol is not enough to keep her stable and comfortable. The pain is getting worse again, but we don't want to have to increase the pregabalin any more as she's already on such a high dose, and every increase results in explosive diarrhea for some time. So, we're facing the surgery.
The surgery: major resection of the entire initial surgical scar and all the misfiring nervous tissue within, with a skin flap taken from her belly to cover the wound. She will receive maximum pain relief before, during and after the surgery. It's absolutely vital that the tissue then heals as optimally as possible to prevent a recurrance of the nerve pain. We're worried that if her diabetes isn't tightly regulated, it's gonna interfere and render this whole process useless. So it's a delicate dance between wanting to get it done ASAP, but wanting to give it the best possible shot of working as well.
To note, this has been and still is a very difficult decision for me. The people around me think I'm nuts to do this, even my regular vet. We don't know if it'll work, if the pain will be cured or even come back, and it's a big (and expensive) surgery. But the alternative is putting her down, and I just don't think I can bring myself to do that when there's still a chance we haven't taken.
One thought may be to ask if the pain specialist would be comfortable talking with a veterinary endocrinologist or internal medicine vet who has experience with feline diabetes and post-surgical recovery. Some of the things that I would think about are how the post-surgical pain and overall stress from surgery will affect blood glucose numbers.
Thank you, I'll be sure to ask that! I know he's got an internal medicine colleague as he's mentioned them before. He is of the belief that Angel's diabetes is being exacerbated by her chronic pain, and once that's gone, she should be much easier to regulate, to say the least. I agree with that, as her numbers have been affected by how well her pain has been controlled in the past. I worry sometimes that we won't even get her regulated until she's pain-free, tbh.
