The Vomiting Conundrum - Part 1

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Journal entry: September 2, 2009

Simone for several days was throwing up a dark liquid, mostly during the middle of the night; started her on 1/8 tablet of Zantac-75mg mixed in with the Hill's a/d.

Journal entry: September 6, 2009

Simone has eaten very little in last several days, acts stupefied, crouches in bedroom closet, and generally not very responsive; continued force feeding of meds, but cut back on epakatin to morning dose only and eliminated Zantac; did not give her fluid in the evening due to sullen condition.

Journal entry: September 7, 2009

Simone jumps on bed at 5am and starts meowing; she seems to be feeling better and she eats a little tuna in the morning.

Throwing up is nothing new for Simone.  I think that may be a common trait for the Siamese breed.  In Simone's case, she has always had a sensitive stomach.  But I think the CRF has made it worse, since her diet had changed.  She was getting new medicines and supplements that her tummy was not used to, plus she may have reacted to the CRF.   In the fall of 2009, Simone was spitting up daily, almost always in the middle of the night or very early in the morning.  Since she usually sleeps next to me, it was not uncommon to be aroused from a deep sleep to the fearsome sound of convulsions, followed by the liquid mess.  If I was lucky and alert, I had a few seconds between convulsions to lift her off the bed and gently place her on the floor.  If I was not, then I awoke to a wet mess in bed.  Yuck!!!!!  If lucky, I carefully tiptoed around the carpet in the morning.  In any event, there were plenty of messes to clean up.  Of course, that didn't make for a great start for the day.  Even now, I keep a can of carpet cleaner in the bedroom ready for action.

Under the advice of my vet, Dr. C., I started to treat Simone with Zantac (anti-refluxing) medication.  As the journey entry above indicated, Simone did not take to it well.  Thus began a long search for a solution to this problem.  There were many dead ends.  An answer was never found, but eventually the condition got better (lower frequency).  Next, I tried giving her 1 mL of a suspension of Pepcid AC (3 tabs per 30mL) by syringe before bed time.  This helped a little, but Simone hated being force fed the medicine and would spit it out.  The dose was increased to 2 mL but she continued to upchuck (sometimes dark or moist or hard or clear or yellow).  By late September, I was ready to try some alternative treatment.  I had read on-line that the herb, slippery elm, was beneficial for refluxing.  I started to give Simone 1/4 teaspoon with her supper meds/supplements.  For first few days on slippery elm, Simone stopped throwing up, but on third day and thereafter, she started to throw up in the middle of the night and in the morning.  But on only one morning was it really bad; on the other mornings there was a mixture of a clear fluid plus some of the Hill's CD. 

Journal Entry: October 1, 2009

However, Simone continues to feel well, is pretty lively, purrs, greets, has a good appetite, and is generally very responsive and alert.  Will continue with the herbal treatment but will increase the dose slightly.

That's all for now.  The next post will continue on this appetizing subject.  Purr on!!!

"When you give a personal lesson in meanness to a critter or to a person don't be surprised if they learn their lesson."

(Anonymous)

Smacking Lips & Other Signs

Continued treatment:  September 2009

A classic sign of a CRF cat is thirstiness due to dehydration (excessive whizzing).  I noticed early in the treatment process that Simone would frequently lick her lips.  Fortunately, it wasn't difficult to get her to drink large amounts of water.  However, I decided to make fresh water as available as possible.  At one of the CRF websites, a pet fountain was recommended, in particular the Drinkwell  brand.  [See picture above.]  This item comes in different flavors:  regular and platinum.  I opted for the regular kind and also ordered a 70-oz reservoir (also shown in the picture; essential for multiple cats) as well as a pack of filters.  I think the total cost was around $45 on sale at one of the on-line pet stores.  At Amazon (direct link) the cost of the main unit is $33, the reservoir is $15, and the filter pack is $6 for a total cost of around $54.

After setting the fountain up in her favorite room in the house, Simone took to it immediately.  She loved to sneak up behind it and sip water from the bowl for several minutes.  She really seemed to enjoy it, and I think it made a difference in her rebounding from CRF.  Note that not all cats will react similarly.  Pickles won't go near it ... I don't think she likes moving water or maybe it's the sound of the motor.  But Twinkles, really got into it.  He wasn't just drinking the water, but loved to bat it around and soak himself with it.  That's why you see a tray in the picture above with a towel underneath it.  Twinkles would throw water around the fountain soaking the carpet with it.  I couldn't tolerate those antics for very long, so the tray was employed as a suitable solution.  He stills throws water around, but most of it is captured in the tray.  Even yet, when walking in the area of the fountain, I can wind up with wet socks.

Besides careening water, there are several downsides to the fountain.  Periodically (1 to 2 weeks), depending on the quality of the water and the deposition of cat dander/fur, the unit has to be taken apart and thoroughly cleaned, the filter rinsed or replaced, the unit re-assembled, and fresh water added.  It takes a few trials to learn how to disassemble and re-assemble the fountain properly.  There are areas of the fountain that are difficult to clean.  I later ordered a brush kit (Amazon $9) which helped some, but cleaning the unit is not a whole lot of fun.  Also, the charcoal filter, which helps to purify the water, will eventually get exhausted, so it's best to have extras on hand.  I try to get at least a month, maybe 6 weeks, out of a filter, by rinsing it off good at cleaning times.  To remind myself, I place a label on the unit with the date of installation of the filter.

There are other pet fountains on the market, but I have no experience with them.  The Drinkwell unit has lasted for 15 months now, so, other than the cleaning issues, I have no complaint with it.  It really has helped in hydrating Simone.  Readers, if you have experience with other fountains, let me know.

In Simone's case, here are some other signs of CRF that were noted in the months following her diagnosis.  Most of these diminished over time as the treatment ensued.

• Foul breath (uremic odor)
• Listlessness
• Sitting sphinx-like for long periods
• Hiding in dark areas like a closet or under the bed
• Increased shedding (combing out her fur every few days helped a lot with this)
• Increased vomiting (see next post)
• Tremors (probably due to low potassium levels)
• Large urine output in litter

That's it for today.  The next post will be on my least favorite subject - upchucking.  Purr on!!!

   

"I simply can't resist a cat, particularly a purring one. They are the cleanest, cunningest, and most intelligent things I know, outside of the girl you love, of course."
(Mark Twain)

CRF Be Damned - The Cat Must Eat

Journal Entry:  September 12, 2009

Took Simone to the vet in the morning; she meowed, roared, and hissed the whole time that she was on the exam table.  Dr. C. was amazed at how well she was doing and said that she could be the poster cat for CRF; no tests today and next appointment will be in about 6 months.  Simone has really perked up: purrs, snuggles, follows me, occasionally greets me; grooms herself, good appetite, drinks from fountain regularly.  Estimate 80 to 85% comeback.

In addition to the right medications, the most important imperative for Simone was to get her to eat regularly.  After getting sick, she had lost several pounds.  From the time she was a kitten, she loved and craved tuna fish.  I knew she would go for it now.  Even though the tuna was not the healthiest food she could eat (high mercury, PCB's, etc.), it was the best choice for her at that time.  At the vet's suggestion, I also started her out with Purina NF.  I mixed about equal amounts together.  She got fed twice a day (about 2 oz. per meal) after administering the medicines, supplements, and sub-Q fluid.  Simone loved that breakfast and supper, usually downing each meal.  When she occasionally didn't eat, that was a tell-tale sign that she wasn't feeling well and something was wrong.  Over the months, there were times when she didn't eat much or threw up her meal.  The causes varied from reactions to supplements or medications, tainted/spoiled food, upset stomach, or food revulsion.  During those times, I adjusted or eliminated medicines, cutback on supplements, and paid closer attention to spoiled food or sanitation (cleaning her dishes, silverware, or syringes).  To be on the extra safe side, I started sanitizing the supplies used for force-feeding using ethyl alcohol.  But, and here's the big but, ethyl alcohol is toxic to cats!  So, it has to thoroughly be rinsed off any utensil used for a cat's food and medication to avoid ingesting it.  CRF is bad enough; you don't want to poison your cat at the same time!

Simone, the typical Siamese cat, unpredictably changes her taste in food.  After a few months of loving the Purina NF, one day she turned her nose up at it.  Then the next day she turned her nose up again.  Finally, I gave up and turned to IAMS white fish in a can.  She love it, again mixed with her absolute favorite, tuna.  But eventually the IAMS company changed its formula, so I switched to the much cheaper and more consistent Friskies ocean fish.  Simone didn't seem to notice the change and continued to eat well.

Next up, continued symptoms of CRF in Simone and the importance of fresh water.  Purr on!!!

Simone & Me

"Man is the only animal that blushes or needs to."

>< Mark Twain

Preparing Meds & Supplements Plus an Aborted Trial

August 2009 - The Treatment Plan

[First more info about prescribed supplies mentioned in the previous post.  Drs. Foster & Smith provides free shipping and handling on prescribed products.  That makes the cost of the Lactated Ringers Sub-Q fluid more reasonable since the weight of this item is substantial.  You may be able to find this product at a lower cost from another supplier, but the shipping and handling will hurt!]

I found out early on that Simone will not take medicines or supplements directly.  In her ornery way, she would just spit them out, even if I used a supposedly tasty pill pocket.   So, I decided to disguise all the medicines and supplements in some scrumptious, high-quality cat food recommended by the vet.  I used Hill's a/d prescription food, which she consistently likes.  This food is pretty mushy so it's easy to mix things in, and, even more important, it's syringeable (if that's a word!).  At my vet's office, a case of 24 8-oz cans costs $31.00 or $1.29 per can.  I don't think it can be ordered outside of a vet's office.  It's very important that this food be kept refrigerated between uses.  The downside is that the cat food, even when kept in the refrigerator, will go bad in 3 to 4 days as evidenced by some nasty aromas and the cat throwing up (yes, Simone taught me about food spoilage on several occasions).  However, so no food is wasted, after opening a can, I freeze one-half of it.  After using the first half in 3 to 4 days, I defrost the other half and get another 3 to 4 days out of it.  The usage equals about 1 can per week which is very reasonable.

We have 3 cats in our household, so, early on, it was important to isolate Simone from the other cats during her treatments and feedings.  Fortunately, we have a half-finished basement bathroom that did the trick.  In isolating Simone, I could make sure that Simone was properly fed and that the other cats would not get into her stuff or interfere with the treatments.  Simone spends anywhere from 1 to 1 1/2 hours in her treatment room for each session.  She has a cushion to sleep on plus a radiator for warmth.  She rarely complains about the situation and seems pretty content with the setup.

To prepare Simone's meds and supps, I add about a teaspoon of the Hill's a/d to a mixing cup.  Then I syringe 1/2 mL of the Alumi-Gel into the mixing cup.  Then about 1/4 to 1/2 teaspoon of Epakitin is added.  The solid pills (Rena-Kare, Rena Essentials, Rena Food, and Cypro) are crushed to a powder in a mortar, then added to the mixing cup.  Everything is incorporated together using a mixing stick.  Then the mixture is sucked into a 3cc syringe and fed in 7 to 9 doses to Simone, all the time giving her a positive reinforcement to accompany the forced feeding.  Surprisingly, Simone is usually very cooperative and takes it like a lady, only wasting a wee amount.  This is done twice daily, morning and evening.  The evening feeding does not include the Epakitin.  Each session takes from 15 to 20 minutes.  The evening session is longer since that's when Simone gets her sub-Q injection.  After this procedure, Simone gets a feeding of her favorites foods (more about that later).

Early on (August 10, 2009), I investigated another supplement that was getting positive reports on the internet.  It's called Azodyl.  It's a renal detoxifier that contains probiotic intestinal bacteria.  As a "live" supplement, the product must be shipped cold.  For about $21, I ordered a 60-dose bottle from Entirely Pets.  To be on the safe side, I requested my local post office to contact me as soon as it arrived so it could be kept refrigerated.  In short, they didn't.  It arrived warm, and I decided not to use it.  So I can't testify to the benefits of Azodyl.  Simone was responding very positively to the regimen described above and that was good enough.  If I had used Azodyl, the annual expense could have been $250.  I certainly didn't need additional expenses.   

From the journal - August 28, 2009:

Simone's behavior has returned to 80% of old time; she's following me around, snuggling, jumping on bed and food table, talking, snapping at other pets, and generally looking and acting better.

In the next blog, the topic of food will be discussed.  Purr on!!!

Simone & Me

"The greatness of a nation and its moral progress can be judged by the way its animals are treated."

<> Ghandi

Journaling, A New Supplement, Suppliers and $

August 2009 - Searching for Meds & Supplements

Before continuing with information about medicines and supplements, let's talk about journaling.  Soon after Simone was diagnosed with CRF, I decided to set up an Excel workbook to keep track of her treatment program.  I started a journal as part of that workbook.  The journal provided me with a record that I could look back at over time.  In the journal I recorded changes in (1) the treatment program, (2) diet, (3) behavior, and (4) miscellaneous signs and symptoms.  With the journal I didn't have to rely on my memory as to what was tried, what worked, or what failed.  Also, I was better able to spot trends in Simone's behavior, so I could make more timely decisions about her treatment.  The journal entries were made periodically, but only when a significant change needed to be recorded.  They were short and to the point. Additionally, the Excel workbook contained worksheets for lab work, expenses, suppliers, and the daily regimen.  Here is the journal entry for August 24, 2009:

Returned to daily sub-Q treatments using 75 mL starting on 8/27/09.  Added in 1/2 t. of epakatin twice per day to reduce toxins.

The epakitin, manufactured by Vetoquinol, was an additional supplement.  It's classified as a renal detoxifier and nutritional supplement.  The ingredients are lactose, calcium carbonate, chitosan, and hydrolyzed soy protein.  For some bizarre reason, this product is rather pricey although it contains cheap ingredients.

Of course, initially I got the meds like Cypro, Tumil-K, sub-cutaneous fluid, and injection paraphernalia from my vet.  But getting supplies from a vet can be costly, so I quickly turned to the internet to locate low-cost providers.  The overall cost to care and feed a cat with CRF can be daunting.  It's really a good idea to have some idea about the expenses as you go into it so you can be financially prepared.  In my case, I'm on a fixed income, so I needed to watch costs closely.  In the first year of treatment, the total cost of supplements, medicines, blood tests, and exams was $1408.  This sum excludes other costs like food and litter.  Before the CRF affair, Simone had been a very healthy and rarely visited a vet.  So, I justified the expense by averaging her health care over her lifetime.  Looking at it that way, the annual expense over a lifetime was less than $100.  That sounded fair to me.  We don't have pet insurance.  Could we have saved money if we had it?  I really don't know, because I never looked into it.  Readers, if you have experience with pet insurance, particularly as regards CRF, please comment.

Looking around for low-cost providers did ratchet the costs down, so the total expenses for year #2 should be much lower.  Please comment if you know of other low cost providers.  Currently, here are the suppliers and costs (includes S&H) for Simone's treatment program:

RenaKare (=Tumil-K)	2	100/btl	Thriving Pets	$36.55
Renafood	3	90/btl	Amazon	$46.01
Rena Essentials	3	60/btl	Amazon	$26.62
Cyproheptadine	1	60/btl	Drs. Foster & Smith	$22.20
Aluminum Hydroxide (Alumi-Gel)	3	12 oz/btl	Amazon	$20.89
Epakitin	2	150g/btl	Amazon	$55.88
Lactated Ringers + Delivery Kit	7	each	Drs. Foster & Smith	$57.13
Terumo Needles	2	100/bx	Thriving Pets	$18.30
3 cc Plastic Syringes (feeding)	30	each	Amazon	$8.60

Notes:

1. Some of these items require a vet's prescription such as RenaKare, cypro, and Lactated Ringers.  Both Thriving Pets and Drs. Foster & Smith will request prescriptions from the vet after placing the order.
2. The cypro tablets were broken into quarters for Simone's treatment, so the total units per bottle was actually 240.
3. The Alumi-Gel is mixed 1:1 with water which doubles the amount of the medicine; 3 bottles should last several years.
4. The two bottles of Epakitin should last at least 6 months.
5. Lactated Ringers, the sub-Q fluid bag, requires a delivery kit for each bag; after the bas is used up, both the bag and the delivery kit should be disposed of.
6. The Terumo needles for sub-Q delivery come highly recommended as they are easily inserted and removed from under the cat's skin; these are used once and disposed of.
7. The 3cc syringes are used to deliver the medicines and supplements via mouth feeding; typically a syringe will last 4 to 6 days if kept clean.

Coming up:  (1) Another supplement is considered but gets thumbs down and (2) supplement preparation.  Purr on!!!

Simone & Me

"Thousands of years ago, cats were worshipped as gods.  Cats have never forgotten this."

>< Anonymous