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)

Leaving Simone in Good Hands

In March and July of this year, we went on vacation and had to leave Simone for a week each time.  The cost of boarding her plus the concern of placing a sick cat in a strange, and possibly unhealthy, environment caused us to look for a local pet sitter.  The best source of information about pet sitters is your local vet.  Dr. C.'s office recommended a professional pet sitter who turned out to be just the ticket.  Ms. Susan was very professional in explaining her services, prices, and policies.  We arranged to have her come out every day to take care of the 3 kitties.  We were particularly fortunate in finding someone who was willing to administer sub-Q fluids and Simone's medicines and supplements.  She came every day that we were gone.  Ms. Susan took care of the litter boxes, food and water containers, spent time with the cats (if they weren't hiding!), and even brought in the mail.  Even better yet, Ms. Susan gave me her personal cell phone number, so I could check on Simone's condition while we were gone.  That helped to relieve quite a bit of anxiety.   When we returned from vacation, we found that the cats were just fine ... but lonely as hell and very glad to see us.  And Simone was doing very well.  We didn't hesitate to use the services of Ms. Susan for our second vacation.

Now if can't get a good reference for a pet sitter from your vet, you can try the National Association of Professional Pet Sitters (NAPPS).  Ms. Susan is a member of that organization.  They actually train and certify people who aspire to be professional pet sitters.  Their website is:

http://www.petsitters.org/

On their home page, you can search for certified pet sitters in your area by entering a zip code in the search field.  For example, the zip code 63106 for St. Louis yielded 3 possible candidates.  Contact information is provided.

That's it for this week.  The next post is very special, so stay tuned.  Purr on cat lovers!!!!!

"I care not for a man's religion whose dog or cat are not better for it.  I am in favor of animal rights as well as human rights. That is the way of the whole human being."

(Abraham Lincoln)

Simone: A Look Back

Today I'm taking a break from discussing Simone's life with CRF.  Instead, this post is a retrospective trip to an earlier time in Simone's life when she was frisky, healthy, and alive with possibilities.

In 1990, an amazing Siamese male cat by the name of Cupid died rather quickly of feline leukemia at the age of 8.  He was my first Siamese cat, and he introduced me to the unique, playful, talkative, and intelligent world of the Siamese.  He left a big hole in the family, so in February 1991 my ex and I decided to get another one.  We saw a classified ad in a local newspaper listing Siamese kittens.  We went to a small, nondescript house in a nearby city and discovered Simone.  We purchased her right away.  She was to be my ex's cat and a replacement for Cupid, but, from the moment we arrived home, Simone clung to me and followed me wherever I went.  She would attach her sharp, front claws to my pant leg and hoist herself up into my arms or onto my shoulder.  She slept curled up next to me under the bed covers purring incessantly.  She made it abundantly clear that I was her human, paying little attention to the other humans in the house.  Initially, I found her very obnoxious, not being used to a cat clinging to me constantly ... I thought that she had some kind of brain disorder.  Eventually, I warmed up to her and accepted the extraordinary attention that she had bestowed on me.  We became pals.  She acquired nicknames like mowny, mownster, and Queen Siamese.  The picture above is Simone at the age of 8 weeks.

In order for Simone to have some company as an indoor-only cat, we decided to get a second kitten.  In March 1991, Dorian Gray arrived by airplane.  He was a special order Honey Bear Persian kitty ... the breeder claimed that he had some skunk genes in him and that these cats were extra smart and extra big.  He didn't look or smell like a skunk and never got to be huge, but he was super intelligent (later he learned about 8 dog tricks), and he was good company for Simone ... they were like brother and sister.  At the end of 1991, I received both Simone and Dorian in a custody settlement.   The first photo below shows them at 6 months.  Notice that Sealpoint Siamese are pretty white as kittens.    Dorian lived for 7 years and then he died of liver disease.  In the second photo below, you see him and Simone at 4-years of age.

Apart from clinginess, Simone developed some wonderful traits over the years.  She greeted me at the door whenever I came home.    When I picked her up and held her in my arms, she would place one paw on my shoulder in characteristic fashion ... she still does this today.  At a very young age, Simone created a greeting routine with me which she kept up for many years.  After picking her up, I would lay her upside down in my hands, hold her out, and then she would do a back flip onto the floor.  Amazing!  Sometime after she turned ten, she would hide under the bed when I came home.  Eventually, I learned what she was trying to tell me ... she was no longer comfortable with the backward flip.  After that, she returned to greeting me at the door.

People who know Siamese cats are familiar with their "talking."  Simone is no exception.  She speaks her mind all the time letting me know how things are with her or she readily communicates her feelings to other cats and dogs.  Simone always had a gentle and friendly nature with humans, but if she didn't like another animal, she made it very clear with a growl and a cry.  Little Simone at 6 lbs sometimes faced down the ferocious 40-lb American Eskimo dog in the house, and he always backed away from her.

From the time of kitten hood, Simone has always slept with me at night.  She would crawl up on my chest, nose-to-nose, and stretch out.  Then she would lay down by my side always placing a paw on one of my hands, and then purr herself to sleep.  At the time she became sick and to the present, that routine has changed somewhat, and she often likes to sleep by herself.  But every once in a while she'll walk up the cat ramp by the bed and join me for the night ... and I know that, in her old age, she still remembers.

Until recent years, Simone was always a great lap cat.  If I sat down anywhere, she would find my lap.  If anybody visited the house, she would soon find their lap ... always friendly, always sociable, and always curious.  Here's Simone at age 10.

Simone has had numerous cat roommates over the years.  She has outlived several of them.  Presently, she shares the house with Twinkle Toes, a 10-year old tuxedo cat, and Pickles, a 6-year old perennial kitten.  The pictures below show them sharing space together.

 

All for now.  Next week I'll address the subject of leaving a sick cat to take a vacation.  Purr on cat lovers!!!!!

"When a man wants to murder a tiger, it`s called sport;  when a tiger wants to murder him, it`s called ferocity."

George Bernard Shaw

Simone's Supplement Regimen

In the blog posted October 21, 2010 entitled "Blood Signs and Starting Treatment - Part I", I listed the medications and supplements that I give Simone on a daily basis.  She gets a slightly different treatment in the evening compared to the morning, but the video above shows the basic procedure that I use.  If you're treating your cat for CRF, I have found that this procedure works wonderfully.  I have used it for 18 months now, Simone is used to it, and she doesn't really mind getting syringe fed this stuff.  I thinks she really likes the Hill's Prescription Diet a/d food, so that makes the medicated-baby-food mixture palatable to her.  I know this protocol looks pretty involved, but it doesn't take long to develop a routine.  Preparing and administering the mixture takes maybe 10 minutes after some practice.  If your cat has its own special needs for medications and supplements, I definitely recommend this procedure to assure that your cat gets the required nutrients and medicines.

By the way, in consideration of the last few posts on retching, if anyone has any suggestions for vomit control, please post them as comments.  Thanks.

That's all for today.  Next week I'll take a break from the subject of CRF and chat about Simone's youthful kitty days.  Purr on cat lovers!!!!!

"If man could be crossed with the cat it would improve man, but it would deteriorate the cat."

Mark Twain

The Vomiting Conundrum - Part 2

Journal Entry:  October 17, 2009

Simone continues to throw up during the night and in the morning, but the amount has decreased and also looks more normal; occasionally she will have a bad day and throw up an earlier meal in liquid form; her behavior continues to return to improve and she is more like her former self; there is no uremic odor these days, she has a bit of a skip in her step, and she talks/complains more.  All-in-all she has made a great comeback and it's wonderful having my friend back.

Journal Entry:  November 28, 2009

Simone is back to her old self again; vomiting in mornings continues.

Journal Entry:  December 19, 2009

Simone has been on a Pet-Tinic concoction for the last week prepared from 3 tablets (30 mg) of Pepcid AC crushed and dispersed in a 1 oz bottle of Pet-Tinic.  I have increased the nightly dosage to 12 drops added to the other meds; the slippery elm was discontinued.  At that dose, she has nearly stopped vomiting in the mornings.  However, she does eat a smaller amount of the cat/tuna food.  The rest of her condition is unchanged and she continues to act like her old self.  She is heading for her 19th birthday on December 29.

Journal Entry:  February 5, 2010

Simone has started to vomit in the early mornings again, maybe every other day.  The Pet-Tinic dosage has been increased to 14 drops in the evening.  A new bottle of Pet-Tinic has been prepared using 4 tabs of Pepcid AC per ounce.  She will be given 10 drops of this medicine initially.  Otherwise, Simone is doing fine, continues to eat well, and still shows attitude.

Journal Entry:  February 26, 2010

Simone had a very bad night/morning with major vomiting.  I didn't feed her or give her fluids during the day.  She stayed in bed most of the time.  The next day she was feeling better and I resumed the usual feeding/fluids.  After several days, she was back to normal, but the vomiting continued, even with an increase in the petinic/pepcid dose (up to 14 drops).  Will be looking into an alternative anti-emetic or begin combining the slippery elm with the pepcid treatment.  Otherwise, she is doing fine as of 3/5/10.

Journal Entry:  April 3, 2010

Administered a single dose (1/2 mL) of Metaclopramide in the evening for several days in a row; this drug didn't work … the vomiting continued.  We started using a white sheet over the bed covers to catch the vomit so it wouldn't stain the cover.  Tried feeding Simone earlier (before 5:30 pm) and stopped the Petinic treatment with the Pepcid AC.  This worked better and now Simone vomits less often, less copiously, and on the carpet instead of the bed.  Also, I started removing the regular cat food in the evening, as well as the dog food.  Simone's behavior is great (very normal) and the involuntary shudders have almost disappeared.

Vomiting continued to be Simone's biggest medical challenge.  The prescription drug metaclopramide was administered at the vet's suggestion, but, like the other anti-vomiting medicines, it was not effective.  I finally decided that Simone responded better to non-drug treatments.  Personally, I occasionally took the homeopathic preparation called Nux Vomica (apt name, hey?) to treat light bouts of reflux esophagitis.  I decided to try it with Simone.  I mixed up 10 tablets (30X strength) in about 1/2 cup of water and divvied the solution into 3 dropper bottles.  I used this liquid to mix up Simone's meds/supplements with Hill's a/d soft food.  Also, I went back to giving her 1/8 to 1/4 teaspoon of the slippery elm as part of the evening supplements.  Finally, I decided to give her a sparing amount of food in the evening.  She got a big breakfast, but the evening meal was just a small amount (< 1 ounce) of Friskies Ocean Fish.  [Of course, the other cats had to tolerate the situation as their food was put up through the night ... poor beings!]  This is the current regimen, and, although Simone continues to toss her cookies every once in a while, that condition has improved greatly.  To my spouse's great relief, she rarely vomits in bed.  More often than not, the vomit is white and a liquid.

That's it for this gruesome tale of retching.  I had to get that off my chest (or esophagus!).  Now I can get on to more pleasant things.

"If you are worthy of its affection, a cat will be your friend, but never your slave."

Theophile Gautier

The Vomiting Conundrum - Part 1

[As a side bar, please take a few minutes to sign my Care 2 petition at the bottom of this blog.  It concerns the Physicians Committee for Responsible Medicine (PCRM) campaign to end NASA's testing of monkeys in irradiation experiments.  As of today, the signature list is less than 4% of the desired number, so please sign and help spread the word.  The deadline for this petition is 2/10/11.  Thanks!]

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

Blood Signs and Starting Treatment - Part 2

July 2009 - Tests & Treatment

Before continuing with Simone's treatment facts and figures, I want to write a few words about this business of taking care of cat with a potentially fatal illness.  Why bother?  Why take the time and incur the expenses?  Good grief, this cat is almost 20 years old!  

First of all, Simone is not just a cat.  She's a companion animal and a friend.  She has been with me for all but a few months of her life.  She has been with me for a third of my life.  With the exception of a few months cumulatively, we have spent over 19 years together sharing sleeping quarters.  She has been with me through the best and worst of times, always faithful and attentive, always there.  I cannot abandon her through her time of need.  Until this last year, she was always a healthy cat, never needing a vet.  As long as she responds to the CRF treatment and as long as she enjoys a quality of life with a measure of happiness and comfort, I will do all I can to help her.  I'm sure she would do the same if we could trade places.

From July 25 to August 10, 2009, we fought to restore Simone's kidney function.  During that time she was getting twice daily:  1/2 tab Tumil-K, 1/2 mL aluminum hydroxide suspension, 1/4 tab of cypro.  Each evening she received 50-mL of the sub-Q fluid to flush toxins out.  She received a second blood panel with the following results: 

BUN:  116 mg/dL  (36% reduction!  Yeah!)

Creatinine:  6.4 mg/dL (49% reduction!  Yeah!)

Phosphorus:  6.2 mg/dL (60% reduction!  Yeah!)

Calcium:  12.6 mg/dL (good balance with the phosphorus)

Potassium:  3.2 mg/dL (12% increase!  Yeah!)

It looked like Simone was on the rebound although she was still very low energy.  She had a uremic breath, a sign that her kidneys were still not functioning properly.  Based on the internet research, I found some supplements that were recommended for cats with CRF.  I started her on the following:

Renafood (from Standard Process Inc.):  This is an herbal supplement touted as a renal detoxifier and helps to maximize kidney function.  This product is actually for humans, but it is supposed to be very effective in treating CRF.  The supplement contains kidney bean plant extract, bovine kidney PMG extract, bovine kidney, enzymatically processed tillandsia and beet root, lactoxe, defatted wheat, oat flour, carrot root, Vit C, and Vit A.  Simone was given two tablets a day mixed in with the Hill's A/D food.

Renal Essentials (Vetri Science Labs):  This is a nutritional supplement for kidney support in cats.  It is like a vitamin pill.  It contains EPA, DHA, astragalus, lecithin, rehmannia, arginine, nettle seed, crdyceps sinensis, DMG, potassium gluconate, Vit B6, inositol, Vit B1, Vit B2, Choline, Folic Acid, and Vit B12.  Simone was given two tablets a day mixed in with the Hill's A/D food.

Here was the daily regimen early on:

[The medicines and supplements were mixed in with roughly a teaspoon of Hill's A/D cat food twice daily, morning and evening.]

One tablet of Tumil-K each meal.

One tablet of Renafood each meal.

One tablet of Rena Essentials each meal.

1/4 tablet of Cypro each meal.

1/2 mL aluminum hydroxide each meal.

50 mL of sub-Q fluids administered in the evening.

With the new treatment, Simone perked up considerably and some of her old behaviors were coming back, like following us around the house, wanting stroked, sleeping with us in bed, talking some, and eating her favorite food, tuna (eventually mixed it with Purina NF).

Next time I'll write about suppliers, costs, other supplements, and continued changes in Simone's health.  Purr on!!!

Simone & Me

“The soul is the same in all living creatures, although the body of each is different.”

>< Hippocrates

Blood Signs and Starting Treatment - Part 1

July 2009 - Tests

When I took Simone to get examined for the first time near the end of July 2009, the vet surmised that kidney failure could be the cause of her illness.  However, the final determination was made using a blood panel.  The vet labored intensively to get enough blood from an underweight, dehydrated, and crying Simone.  After several tries in several places, she finally got the bare minimum.  I took Simone home and waited for the hospital lab results.  Of course, when the results came in, it was confirmed that Simone had an advance case of CRF, with some numbers off the chart.  Here are the key blood factors that were tested for:

Blood Urea Nitrogen

This measure is often called BUN for short.  It measures the amount of urea formed from the breakdown of protein.  This is a waste product which with good kidneys should be flushed out in the urine.  The normal range is 12 to 34 mg/dl (milligrams per deciliter).  Simone's result was 181 mg/dl.  Ouch!  Obviously, the higher the number the worse the kidneys are functioning.

Creatinine

This measure is for another waste product.  If both the BUN and creatinine values are high, then that is a sure sign of chronic renal failure.  The normal range is 0.00 to 1.50 mg/dl.  Simone's result was 12.6 mg/dl.  Ouch!

Phosphorus

A cat with chronic renal failure (CRF) will have trouble excreting phosphorus (as phosphate).  A buildup of phosphorus can lead to calcium depletion.  The normal range is 4.0 to 7.0 mg/dl.  Simone's result was 15.5 mg/dl.  Ouch!

Calcium

As mentioned above, calcium is tied to phosphate.  Normally, the calcium level should be 100 to 200% of the phosphorus.  The normal range is 8.4 to 10.8 mg/dl.  Simone's result was 11.9 mg/dl.  Her little body was trying to keep up with the high phosphorus content.

Potassium

This electrolyte in cells is needed to keep muscles functioning properly.  An imbalance causes weakness, twitching, and possibly seizures.  A cat with CRF is subject to increased urination and vomiting, which can lower potassium levels.  The normal range is 3.8 to 5.0 mg/dl.  Simone's result was 2.9 mg/dl.  Ouch!

Other factors were measured, but the ones mentioned above were the most critical for diagnosing CRF.  First and foremost, Simone was dehydrated and not eating well, so we had to correct those conditions right away as her body was not properly eliminating waste products and she wasn't getting enough nourishment.  The only way to adequately hydrate Simone was to give her subcutaneous fluids, i.e. hypodermic needle injections of an electrolyte solution under the skin several times a day.  The vet's assistant showed me how to do it.  It was my choice:  either have them do it at great expense or administer the fluids myself.  I reluctantly chose the latter.  Ugh!  I had no medical training and no clinical experience, but I resolved that Simone and I could do this together.

Next, Simone had to start eating more food.  The vet prescribed cyproheptadine (cypro) as an appetite enhancer.  Then we had to get the phosphorus (phosphate) and electrolytes under control.  Aluminum hydroxide (found in some antacids) is a good phosphate binder, so that was added to her regimen.  To get her potassium up, Tumil-K (or RenaKare), a potassium gluconate supplement, was added.  To help with her diet, the supplements were given to Simone with Hills Prescription Diet a/d which is described as a critical care food.  It's a meat and fish based product packed with minerals and vitamins.  The soft consistency of this food allows for syringe feeding.

That's it for today.  In part 2 of this post, I'll talk more about supplements, the daily regimen, and the results of the second blood panel.   Purr on!

Simone & Me

"There are two means of refuge from the miseries of life: music and cats."
><Albert Schweitzer

Educate thyself! Learning About Simone's Illness

July 2009 - Research

Dang!  I can't believe it.  There was a technical error in my very first blog.  I mentioned that kidney cells lose function ... that's strictly not correct.  The part of the kidney that fails are the functional units called nephrons, which regulate the concentration of water and soluble substances by filtering the blood, taking out what is needed and eliminating the remainder as urine.  The nephron eliminates waste, regulates blood volume and blood pressure, controls levels of electrolytes (salts) and body metabolites, and controls blood pH.  Nephrons are the key operating units of the kidney and, without them, your cat, or you, could not survive.  The good news for cats and for us is that there are hundreds of thousands of nephrons, so, even if we lose a large percentage of them, the kidneys can continue to function with proper care assuming the continued death of nephrons is stymied.  Don't despair ... even with a loss of 75% kidney function, your cat can still survive and live normally.

Having noted my first technical error, it would be a good idea in this post to point you towards more knowledgeable folks.  I do not have a background in veterinary care, animal physiology, or animal science, so, as a word of caution, don't read this blog for technical and scientific accuracy.  If you're new to the topic of CRF, I recommend a few excellent websites.  When I learned about Simone's condition and the dangers of it, I was shocked.  She could die very soon.  I felt compelled to learn as much as I could about the disease and how to care for a cat with CRF.  I cruised the world wide web for several days, jumping from site to site.  Here are some of the best sources of information that I found:

Tanya's Comprehensive Guide to Feline Chronic Renal Failure

http://www.felinecrf.org/what_is_crf.htm

A cat lover by the name of Helen created this fantastic, extremely organized website that covers pretty much any question you might have about CRF.  It's fraught with hyperlinks to take you to other pages with additional information.  The name of the site comes from the author's first kitty who died from the disease.  Although she is self-taught, she has put together an encyclopedia of knowledge concerning CRF.  Look down the left-hand side of the home page to see all the topics that are covered.  Clicking on any topic will take you to a detailed description or discussion.

Living with a CRF Cat

http://cats.about.com/gi/dynamic/offsite.htm?zi=1/XJ/Ya&sdn=cats&zu=http%3A%2F%2Fwww.judysworld.net%2FCRF%2F

A woman by the name of Judy has created a website to address both the psychological and technical sides of CRF.  She kept a journal about her experience with a cat with kidney disease.  There is also a page with Frequently Asked Questions that may be helpful.

Feline CRF Information Center

http://cats.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=cats&cdn=homegarden&tm=259&f=10&tt=14&bt=1&bts=0&zu=http%3A//www.felinecrf.com/what0.htm

This site is co-authored by David DiFiori and Sandy Carr, but I could not find out any information regarding their background.  Their website has the usual information about CRF with an emphasis on scientific studies.  Also, owners of cats who have died from the disease can post a tribute to their cat.

Feline CRF Support Group

http://cats.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=cats&cdn=homegarden&tm=709&f=10&tt=14&bt=1&bts=0&zu=http%3A//groups.yahoo.com/group/Feline-CRF-Support/

Maintained since 1997, this service provides cat owners with a place to share their stories, get information, and contribute ideas.  A Yahoo ID is required.

Home Management of Cat with CRF

http://cats.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=cats&cdn=homegarden&tm=84&f=10&tt=14&bt=1&bts=0&zu=http%3A//www.fabcats.org/owners/kidney/crfhomemanagement.html

This is a short article by Dr. Sarah Caney about CRF, the ideal diet, and treatments of related problems.

That's it for today.  In the next post, I'll write about blood analysis and starting Simone's treatment.   Purr on!

Simone & Me

"Most of the shadows of this life are caused by our standing in our own sunshine."
>< Ralph Waldo Emerson