Smokey

Smokey Boy - our little boy kitty. He adopted us in June 2001, when he was probably about 8-12 months old. Before the neurological event which happened in July 2003, he was the sweetest, most playful kitty I've ever known. He remained so very sweet, but for a while, it was as if he has had a stroke, lost most of his eyesight, and had to re-learn how to do most everything. He was a fighter, and came back from the trauma amazingly. He never regained his sight, but that didn't stop him from being an independent, happy kitty. Unfortunately, he began deteriorating in late 2010 and 2011, and we lost him June 10, 2011. He will be missed, this sweet, darling boy.

Smokey in "his" chair, November 21, 2003

On Thursday, July 10, 2003, I took Smokey to the vet. We had thought that he had another UTI earlier in the week, and the doctor had put him on another course of antibiotics. But when I got home from work that evening, he seemed okay, then about an hour later started acting extremely agitated and uncoordinated. The vet gave him a cortisone shot and told me to check back in the morning if he was not any better. Well, I didn't wait to call Friday morning, I just took him back in, where he spent a week in the hospital with a variety of symptoms:  seemingly not able to see (although he had pupillary response), very uncoordinated, obviously very confused. The doctor could find no external cause, and his bloodwork came back normal. One day in the hospital, he had a borderline blood pressure, another day, he spiked a fever of 106, and another day his paws swelled up huge, and they were no closer to determining what was wrong, but they suspected something neurological. He had a good appetite when the food was put under his nose, so we were still very hopeful that he would be okay.

There seemed to be nothing additional that the vet could do for him that we couldn't do at home, so we brought him back home with us on Friday, July 18. Dr. McCormick gave us an antibiotic and more steroids for him, but he was still stymied as to the cause or whether or not he would get any better. That first night home was one of the longest nights of our lives. I rearranged my craft room so that he would be confined (he still couldn't see, would walk straight into the walls), and CC and I took turns staying/sleeping with him. Smokey was so weak and his breathing was so shallow when he was asleep that, at times, I couldn't see his chest rising and falling, and I had to wake him just to make sure he was still with us.

We spent the rest of the weekend completely focused on caring for Smokey - the doctors said we could take him to the University of Tennessee in Knoxville (a 3 hour drive), where they might be able to figure out what is wrong, but with neurological problems, there was no guarantee that they would be able to treat him, even if they did find out what it was. At first, he could only eat wet (canned) food. And it was almost as if he had forgotten how to chew. He slept a lot those first couple of days home. Sunday, he spent a little more time up and about, exploring a bit. His legs were very unsteady. Gradually, he was more often awake, and walking around exploring. He made it into the kitchen, found Candy's (one of our girl kitties) dry food bowl, and began eating (actually chewing!). It was almost as if he was having to learn how to do things all over again. But we have been taking these baby steps as positive moves forward.

He made little improvements almost daily. CC and I have been so encouraged by each improvement because it was like some connections that were broken were finally being mended - he started using the litterboxes again on a regular basis, and even when we let him out of his room to explore, he managed to find and use his litterbox. He seemed to be stronger, and he was walking around without much difficulty at all (except for the sight loss).

On August 7, we thought he might be getting worse again, because he was all of a sudden very anxious and kept "looking" upwards. However, we soon determined that he may be having periods of partial sight. When I took him in for his annual visit August 8, I got a referral to a veterinary ophthalmologist. He told me that there was obvious evidence of Smokey having had a parasitic infection of some sort in his left eye. It was not recent (meaning within the last couple of days), and he referred me to a neurologist in Knoxville (but not at the University of Tennessee).

On August 20, I took Smokey to Dr. Elizabeth Shull in Knoxville. I had no idea what to expect, but scheduled the appointment in the hopes that she would be able to figure out what has happened and help him get even better. He had already come such a long way in a month's time, in my opinion.

Unfortunately, things did not go well during the visit - Smokey is okay now, but he got so agitated/aggravated/stressed at the doctor's that they weren't able to complete all of the neurological and blood tests they wanted to do (mostly simple things, but blood pressure or echocardiogram would have been contaminated because of his state). Dr. Shull believes that he may have had toxoplasmosis and we decided to treat him for that with 2 weeks of clindamycin (they don't normally do that without the blood test, but she was so afraid that someone or he would get hurt if they tried to draw blood, she decided to go ahead and treat him for it anyway). This should get rid of any of the remaining parasite (if it exists). She also wanted to start weaning him off of the steroid he has been taking for a month. His diagnosis was definitely brain trauma, more pronounced on the right side of the brain because his left side of his body is more affected. What caused it is the unknown - most likely either the parasite or a blood clot or a combination of both. Kind of like a stroke. She said an MRI would be able to pinpoint how much damage was done, but it was unlikely that it would be able to help with determining the exact cause or treatment. And besides, the only MRI available is in Lexington, KY until the end of August, and then they are closing. They would have to sedate him if we wanted to do that, and with the brain trauma, she's not sure how adversely that sedation might affect him. So we are not going to do an MRI or spinal tap or CT scan unless he gets worse. He finally did calm down a bit during the afternoon drive back home. Dr. Shull said he may never return to his former self (bit of a personality change since the trauma), and he may never see well, but he's definitely getting better day by day.

I sent Dr. Shull a couple of updates by email, to keep her informed of his condition. She especially wanted to know if his condition declined any as we slowly weaned him off the steroids. The first one was a week after our visit:

After changing to the pills instead of the liquid, he is doing much better with the medication. I haven't noticed any decline in his behavior or condition so far in weaning him off of the steroid - so far, so good.

He did calm down quite a bit once we got him home. One new thing we noticed was that he started washing his face that evening - prior to that, he had only been able to wash his body because it seemed he didn't quite remember how, or maybe just didn't have the coordination, to clean his face with his paw. We took this as another positive baby step.

His general condition is about the same - he sleeps quite a bit (but what cat doesn't?). When he is awake, he finds his way to the food bowls and litter pans just fine. He does wander about aimlessly quite a bit, but I do notice that he follows me a bit more when I move from room to room. At night, when we go to bed, I've noticed he sleeps in near the doorway to our bedroom. He has been doing this for about a week. He still gets agitated if he thinks we are going to pick him up, but that may also be attributed to the fact that about half the time we do that, he gets to take a pill. He is still startled easily when he sees us moving towards him, and he turns and runs the other direction.

I am giving him the medicine at 6 a.m., 2 p.m., and 10 p.m., or as close as I can get to those times. He let me clean his ears the other day, so I was able to remove quite a bit of the junk that had built up.

Sincerely,
Melissa

The second update I sent on September 16:

Smokey is completely off of all medication now. I still haven't noticed any deterioration of his condition or general health, so that is very good.

About a week and a half ago, the weather was cool enough for us to open the windows in the house (we have screens, and the kitties have all loved in the past to sit on the windowsills when the windows are are open). Smokey was immediately drawn by the sounds and smells of the outside over to the windows. He tried, unsuccessfully, several times to climb onto the windowsill - they are not very high off the floor, but are not really wide. We piled pillows in front of the windows to see what he would do, and to give him some cushion in case he should make it up on the sill but fall off. I put him on one of the pillows, to help give him the idea that he COULD climb on them, and after several attempts, he managed to climb into the windowsill. He walked back and forth, fell off several times and got back up. Once he got to the right side, he would turn around and walk to the left side. Here we could see more evidence that his left side is still a bit weaker and maybe less-coordinated than his right, because if he back left leg came off the sill, he had a lot harder time trying to get it back up on the sill.

He seemed so excited to have learned something new (and of course, we were so excited for him too). Once he learned to climb a bit there, he began trying elsewhere - first the windowsill in our back bedroom, which has a box in front of it with a fuzzy "sill-extender" (for lack of a better description), which all of the kitties have sat and slept on at one time or another. He also climbed up onto my cedar chest (on top of which I keep a quilt, which he used to help "pull" himself up onto), and the other day he actually climbed up (more pulling himself with his front paws and scrambling with his back legs) on our couch in the living room. As long as he is doing the climbing, he seems to understand that he is UP and walks carefully so as not to fall off.

Yesterday morning, he actually jumped onto the futon in the back bedroom - he seems to be gaining confidence and strength in his back legs. For the most part, he slides down off of things that he gets up on. But he seems to be learning to better judge how far down the floor is from where he has climbed.

My husband has also played a little bit with him, where Smokey gently nips at his hand, the way they used to. He doesn't play for long, but it does seem as if he knows it IS play and not for-real-fighting or aggravating.

My two girl kitties are starting to settle back down now - they still occasionally swat and hiss at him, but that is a lot less frequent now. They might be starting to comprehend that he can't see them well, because they more frequently just avoid him when he comes close to them. He eats and drinks out of everyone's bowls, but the majority of the time I see him eating, it is out of his bowl. He doesn't seem to be over- or under-eating as far as I can tell.

It is nice to see him sleeping comfortably too - occasionally we even see him in the "upside-down-head" position as we call it - belly is a bit exposed, and his head is almost upside down, the way he is turned. He is getting better about being picked up, although he still occasionally tries to bolt away.

Sincerely,
Melissa

I received this response from Dr. Shull on September 19:

Thank you for the updates on Smokey. I am pleased that he has not deteriorated since the medication was withdrawn. This fact points away from a progressive neurological disease as the cause of his symptoms and supports the proposed diagnosis of parasite migration or vascular accident.

Please continue encouraging him to relearn things, in order to achieve the maximum functional recovery possible.

Dr. E. Shull

Another really neat thing he has been doing for CC when he goes home for lunch (about the last week or so), and which he did when I got home yesterday afternoon (September 18), was he ran from the dining room into the living room, and he seemed SO excited that I was home. We both so miss our boy's playful delight, but maybe it is returning, and anyway, we are SO grateful for how far he has come.

October 21, 2003: Just when I thought that he might be about as recovered as he could be, he surprised me again today.

Over the past week or so, my husband and I have tried play with him a little, like the "roughhousing" we used to do - tickle his belly, and he would grab on to our arms and give us very gentle bites. He could stand that tickling about three times before he would get up and be in an "okay, i've played enough" mode.

After I came in from work today, Smokey (who gets very excited and happy when we come home from work) started running and "attacking" a couple of cloth bags I have in our entryway. I found some of the jingle balls and the golf ball he used to love playing with before the trauma, and played with him for a good 15 minutes. He would run towards the sound of the balls, sometimes finding them, sometimes not, but actually playing!

I also noticed that while he was playing, he started scratching the rug, so I tried to direct him to the scratching pads/posts we have. He wasn't interested in them until I got some catnip out and put an amount on each one. Up until this point, when we have tried to see if he was interested in catnip, he has not been at all. He got all fired up this time! He was scratching at the large pad, then he located the post and scratched and rolled on it too.

He still has his bad times, sometimes during the early morning he will meow and meow, and nothing we do (except for getting out of bed) will quiet him. Occasionally he seems down in the morning, but he is fine by the afternoon, and he seems much better on the weekends, when of course, we are with him most of the day instead of having to go to work. And of course, he just loves it when we open the windows and the back door so that he can hear and smell the outside.

Here he is on one of our supervised outings in the front yard.
He doesn't go outside without one of us accompanying him, but he
thoroughly enjoys himself when he does get to go out.

This is where Smokey has been sleeping for the past several months - his
"night-night" bed. He's so cute when he sleeps.

And this is where he tends to sleep during the day - on a quilt that my great aunt
made, sitting atop the cedar chest my grandfather restored. Here, for most of the day,
there are great southern sunbeams coming through the picture window.

February 13. 2006 - still one of Smokey's favorite spots, and for good reason!

May 14, 2006 - still one of the handsomest cats I've ever seen. :)

September 3, 2006 - A boy on a box

November 30, 2006 - sitting atop the speaker

The "cool cat"