The Downward Spiral Continues

On Friday, I took Simone to the vet's office to get a weighing, hoping against my darkest thoughts, that Simone's weight had stabilized since the last visit about one-and-a-half weeks ago.  But she lost even more weight ... about 4 ounces.  She was looking more and more emaciated and frail.  The vet's assistant looked inside her mouth since I was wondering if she might have mouth ulcers, which would cause her to stop eating.  There were no obvious problems inside her mouth.  I listened to the vet's assistant describe the ravages of old age --- the loss of muscle tissue, the inability to chew, the depletion of energy, and so on and so on.  Shit!  I know she was hinting about giving up the struggle, but Simone was still alert, still purring, still talking, still climbing, still jumping, and still sleeping paw-to-paw with me at night.  Simone and I had had the "talk" on several occasions in the last month; I asked her to let me know when she was ready to depart.  Since she had not revealed that to me yet, I remained intent on getting her to eat again and gain some weight.

On Friday, Simone was given the first full dose of mirtazapine.  I had mixed feelings about giving her this medicine since it has been reported in CRF discussion groups that some cats react badly to it and some die from it.  I started her on a half-dose and she seemed to take it okay.  This drug, also used in humans, is a tetracyclic anti-depressant, but the side effects include a reduction in nausea and an increase in appetite.  Also, it can adversely affect heart rate and blood pressure.  On Friday, Simone certainly reacted to the medication as evidenced by her increased energy, dilated eyes, and restlessness, but there was nothing alarming in her reactions.  On the plus side, she followed me around the house, purred excessively, and generally demanded attention.  The drug seemed to elevate her mood.  At the evening meal, she ate about one-third of the food that was set out ... a positive sign.  Of course, that amount of food would not sustain her, so I continued with assisted feeding.

Simone has been getting food by syringe for a few weeks now.  I'm trying to pack as many calories in her as possible at each feeding.  I've experimented with several formulas, but have settled on a combination of Purina NF (very high calorie), tuna with oil, and Gerber chicken or beef baby food.  Using an immersion blender, I combine 8 T. of the Purina NF, 8 T. of tuna, 1 bottle of baby food, and 4 T. of water.  The resultant pudding makes a good mixture for syringing and lasts 3 to 4 days in the fridge.  I estimate that I'm getting about 115 calories in Simone per day, which is a combination of the food blend and Hill's a/d, used to administer the supplements.   Now she's getting a few more calories, maybe 10 to 20, eating food on her own.  That's not bad if she is truly getting about 135 calories per day.  Based on her original weight, Simone should be getting around 180 to 190 calories per day, so I'm hoping with this regimen that Simone's weight loss can be stymied and reversed.

Stay with me cat lovers ... the story continues.  Purr on!!!

"I have studied many philosophers and many cats. The wisdom of cats is infinitely superior."
(Hippolyte Taine)

AT THE BEGINNING OF THIS BLOG, I MENTIONED THAT I WOULD PROVIDE THE HISTORY OF SIMONE'S STORY OF HER STRUGGLE WITH CHRONIC RENAL FAILURE.  AND THAT AT THE END OF THAT STORY, I WOULD START A SEPARATE BLOG CHRONICLING HER LIFE WITH CRF IN REAL TIME.  RECENT EVENTS HAVE CHANGED THAT PLAN.  AT THIS POINT, I WILL END THE HISTORICAL CHRONICLE AND BEGIN THE REAL TIME ONE.  IN LIGHT OF SIMONE'S RECENT HEALTH DECLINE, I FIND IT NECESSARY, IF NOT IMPERATIVE, TO PICK UP HER CURRENT STORY AND FOLLOW IT TO THE END. 

Simone's Condition Nosedives

Sunday, January 23, 2011

Because of recent events, this post will focus on what's happening in the last few months. 

Journal Entry:  November 21, 2010

The vomiting has decreased a little.  Simone vacillates between spending time in the basement and the bedroom.  The basement couch was covered in cheap sheets to keep it from getting stained from vomit if she spends the night there.  Overall, she seems pretty alert and affectionate.  She spends most nights with me in bed.  She still growls and cries for food.  She's not eating as much as usual though, either morning (big meal) or evening, so Twinkles is enjoying the leftovers.  [He's even demanding them now!]

The loss of appetite was a bad sign, but I didn't catch it early on, because the amount of food Simone was eating was decreasing slowly.  She went from gobbling all the food down to three-fourths to one-half to one-quarter, and recently she stopped eating altogether.  I didn't take it as a serious sign because, throughout the treatment for CRF, she had frequently had days when she didn't want to eat much, but she would bounce back a few days later.  By mid-December, I could tell she had lost considerable weight.

I made an appointment with the vet to have her blood checked and to get a physical exam.  As expected, Simone had lost a full pound.  That may not sound like much, but for a 6 1/2 pound cat, that's 15% of her body weight.  The rest of the exam went fine and there weren't any obvious signs why she wasn't eating.  Dr. C. suggested that I give Simone a supplemental food called NutriCal.  This dietary supplement adds calories via corn syrup as well as provides vitamins.  I tried mixing it with Hill's a/d, which was used for the other supplements.  I quickly learned not to like it.  It's a hell of a sticky mess!  It got caught up in Simone's whiskers and other places on her face, where it dried into a nasty crust.  She didn't seem to care for it and that made it easier to stop using it.  After a week, I abandoned the NutriCal.  I particularly didn't like the fact that the extra calories were coming from sugar, as opposed to protein or fat.

There was some good news during this period.  The blood panel showed a strong rebound from the worst signs of CRF.      

Test	Aug  2009 Reading	Norm	Dec 2010 Reading
BUN (mg/dL)	116	12 - 34	42
Creatinine (mg/dL)	6.4	0 - 1.5	2.9
Phosphorus (mg/dL)	6.2	4.0 - 7.0	5.0
Calcium (mg/dL)	12.6	8.4 - 10.8	8.8
Potassium (mg/dL)	3.2	3.8 - 5.0	4.3

Apparently, Simone was not reacting to the CRF ... there was something else wrong.  But Simone continued not to eat much and lost more weight.  The vet suggested trying Purina Fancy Feast kibbles, which she described as "kitty crack."  But Simone took a sniff of the stuff and turned away.  Also, other foods were tried and rejected.  By the second week of January, I was getting extremely concerned.  At that point, I decided to start an assisted feeding program, the details of which will be provided in the next blog.  The goal was to stem the weight loss until a cause could be found.  The vet recommended starting Simone on another appetite stimulant called mirtazapine, and it was ordered from a pharmacy.

One evening, when I was about to give a sub-Q injection of fluid to Simone, she walked over to a nearby litter box and just sat there for several minutes.  Obviously, she was straining to urinate.  Concerned about a bladder infection or blockage, I took her to the vet.  The vet ruled out a blockage but thought she might have a bladder infection.  Also, Simone was frequently sniffling like she had a cold and shaking her head in an odd way.   Simone got a shot of penicillin and, a few days later (Wednesday of this week), she received a more potent antibiotic.  The really bad news was that Simone had lost even more weight ... now she was down to 4.5 lbs (a 31% loss of weight), and she was looking rather gaunt.  I increased the caloric content of the food that she was getting by syringe, and, as of today, I'm keeping my fingers crossed.  Maybe with the elimination of the infection and cold virus, she will start eating again.  On the bright side, Simone continues to move around, purr, and seek attention.  She's still with me!  Stay tuned, cat lovers and purr on!

 "The squirrel that you kill in jest, dies in earnest." (Henry David Thoreau)

Hydration Part 2: Needling Simone

This will be a short post today.  Simone is experiencing some health issues right now ... more about that next week.

It's very important to keep a CRF cat hydrated to flush the kidneys of toxins.  I was lucky to have a cat that stayed calm, cool, and collected during the injection of fluids.  She rarely complained or struggled or ran away, even with my bungling efforts early on.  If you have a cat with CRF, don't be intimidated by this business.  I have no clinical experience, but it didn't take me long to get reasonably adept with the process.  Sure, there were times that I pushed the needle straight through her skin, punctured a vein (blood, yech!), failed to pushed the needle far enough in or pushed it too far in, or needed multiple insertions to get a stick that didn't leak.  Fortunately, these were rare incidents, but I did get frustrated ... some evenings I just gave up.  But that was okay because I'd bounce back the next day and skipping a day really didn't matter that much.  The important thing is to hang in there and stay persistent to provide the best chance for your CRF cat. 

The video above shows a typical sub-cutaneous fluid injection session with Simone.  It's not very instructive, but there are some good websites that explain the process with more clarity and detail.  Here are a few of them:

http://www.pawswhiskersandclaws.com/articles.htm 

(pdf article)

http://www.youtube.com/watch?v=-4Ta537YEOU

(video)

http://www.youtube.com/watch?v=zmaNe1YaUrk

(video)

http://www.ehow.com/video_4945235_give-cats-subcutaneous-fluids.html

(video)

http://animalstemcells.com/videos-administering-subcutaneous-fluids-%5B-4Ta537YEOU%5D.cfm

(video)

http://www.youtube.com/watch?v=1LSppGcrQ3Y

(video)

That's all for today cat lovers.  In the next post, there will be an update on Simone's health.  Purr on cat lovers!

"I began to wonder why we cuddle some animals and put a fork in others.”  (Henry Spira)

Hydration Part 1: Preparing a Sub-Q Bag

Since Simone gets sub-cutaneous fluids every day, I thought that it would be a good idea to show how this is done.  Of course, there are several demonstrations of this procedure on the web, e.g. http://www.fabcats.org/owners/kidney/subcutaneous/info.html.

When my vet's assistant showed me how to administer fluids, they used a demo cat that lived at the clinic.  They assured that the cat would not mind, and, as far as I could tell, it was rather unfazed by the procedure.  I thought to myself that I hoped that the cat didn't have to earn its keep that way.  After the demo, I thought, "Yeah, I can do this.  Looks easy."  When I tried it on Simone, the poor kitty had to endure my clumsiness and ineptitude, and she got overly poked the first few times.  Eventually, with continued practice, I got the hang of it, but there were times when the needle hit a muscle, poked through a fold a skin, or drew blood and I humbly asked Simone's forgiveness.  Occasionally, for some reason, I could not get a good insertion even after 3 tries, and I would give up until the next day.  The point is that, even after learning the technique of sub-Q injections, there are going to be some bad days.  Just hang in there.  Don't beat yourself up.  It will be better the next day.  Fortunately, I was blessed with an easy-going cat, so Simone rarely made a fuzz during my bungling times.  She is very forgiving.

The first part of administering sub-Q fluids is to prepare the bag and delivery pack.  I was hoping that the above video would clearly show this procedure, but it was a shoddy shooting job and the object of interest is sometimes off camera.  So, I will also verbally describe the procedure with some photographic illustrations.  As stated in an earlier blog, I use Lactated Ringers Solution (1 liter) and the delivery kit from Drs. Foster & Smith.

 

#1:  Rip open the outer bag containing the fluids bag and remove it.

#2:  Invert the fluids bag and remove the white, plastic plug.

#3:  Rip open the bag containing the delivery kit.

#4:  Close the thumb-wheel valve by turning the wheel towards the end of the delivery tube.

#5:  Remove the protective cover from the plastic spike at the upper end of the delivery tube.

#6:  Insert the spike into the bottom of the fluids bag.

#7:  Lift the fluids bag upright (no fluid should flow), and squeeze the clear, plastic tube until it half fills with fluid.

#8:  Hang the bag with the delivery tube in a convenient location for administering fluids.

#9:  Remove the cap at the end of the delivery tube and attach a sterile syringe.

That's it feline fanciers.  In the next post, I'll publish part 2 of hydration.  Purr on cat lovers!

 

"A cat has absolute emotional honesty: human beings, for one reason or another, may hide their feelings, but a cat does not."  (Ernest Hemingway)

Simone Achieves a Lifetime Milestone

Today I jump to present time.  On December 29, 2010, Simone attained her twentieth birthday.  Who-hoo!  It's really hard to believe that I have lived with a nonhuman animal for almost 20 years.  That blows my mind!  That's over 7000 days that we have spent together, through good and bad times, through 5 homes, and through several significant others, humans that is.  For most of those days, she has slept faithfully by my side at night, her paw on my paw.  Through that score of years, Simone has been the only living constant in my home life.

The picture above was taken on her birthday.

I could never have imagined having a companion animal for such a long time.  With one exception, I was not allowed pets while I was growing up.  After my mother died in my early teens, my father granted permission to have a kitten, but it disappeared after several months.  I would not have another companion animal for 20 years.  After being introduced to Siamese cats, I was sold on them.  I was captivated by their intelligence, playfulness, attentiveness, gregariousness, and their non-stop chatter.  But my first Siamese cat, a male by the name of Cupid, only lived to be about 8.  Until recently I had no idea that Siamese cats are known for their longevity, particularly females.  I have read on-line that Siamese cats can live into their mid-twenties or longer. 

When Simone was diagnosed with CRF in July 2009, I thought she had only weeks or months to live.  I mentally prepared for the worst, but also got busy learning about her illness.  Even more amazing is the fact that Simone has contended with a potentially mortal disease during the last year and a half.  She is a very feisty and determined cat.  She has endured the indignities of daily syringe feedings and sub-cutaneous injections with tolerance, patience, and courage.  Today she shows her age:  underweight, slow moving, cognitive loss.  But she still retains her finest traits:  talking, socializing, and deep purring.  Human-equivalent age calculators show her to be around 96 in human years (cf. calculator at bottom of blog).  Wow!  

For Simone's birthday, a decorated cake was made.  The picture on the cake shown above is Simone at 8 weeks of age.  Of course, she didn't eat any cake, but she did have some special food for her birthday.  Below is a granddaughter, Madeline, and I at Simone's birthday party.

Happy new year to all!  In the next post there will be a video about one aspect of Simone's daily treatment.  Purr on cat lovers!

"The cat could very well be man's best friend but would never stoop to admitting it." (Doug Larson)