Atenolol Drug Shortage-You May Need a Compounding Pharmacy

There is a drug shortage for Atenolol, a very important medication. Atenolol is often prescribed for HCM cats. It works to lower the heart rate and blood pressure by working on the heart muscle. It is vitally important that the heart rate and blood pressure come under control for an HCM cat. Most cats with HCM have a high heart rate. A damaged heart should not be overworked and stressed. Lowering the heart rate also helps to lower blood pressure, although Atenolol is only one drug that the cat might need to lower blood pressure. 

Our vet cardio released this statement:

"Some of you may already be aware that there is a nationwide shortage of this medication due to a production issue. Many pharmacies are running low, which is becoming an issue for our cardiac patients who are receiving it.

There are a couple of options:
1) Continue calling around to pharmacies in your area since some pharmacies still have it in stock.
2) Get it compounded at a specialty compounding pharmacy. We prefer to use Wedgewood for our compounding needs. Atenolol can be made into tablets, capsules or liquid suspension. See the link below for more info..."

If you or your vet are unable to find Atenolol locally, here are two reputable pharmacies you can try:

http://www.wedgewoodpetrx.com/search/atenolol.html

https://www.roadrunnerpharmacy.com/

Also, Google "compounding pharmacy" for your area. You may find one locally. Your vet would call in a script for them to fill. 

Protect Wires and Stop Cats From Chewing By Using Various Items

I'm using various items to protect wires and cords throughout the house from the one cat in the house-Roxanne-that likes to chew on them when she's anxious. I ordered the black coiled wire covers from Amazon to cover all cords and wires. It comes in different width sizes. My husband ordered the Power ADD metal phone cord from Amazon. They also sell laptop cords. It's supposed to be chew proof. Let's hope.

There are various types of materials one can find at Amazon (and other online sites) to protect pets from chewing. Simply do a word search at Amazon or Google for cord protectors or chew proof cords.

Here are the links:
Coil cord: https://www.amazon.com/…/B00…/ref=oh_aui_detailpage_o03_s00…

Power ADD cord: https://www.amazon.com/Certified-Lightning-3-…/…/ref=sr_1_7…

Bette Develops Diarrhea Due to Antibiotics; Problem Resolved with Sweet Potato

Bette is doing much better (see September 7 post.) She has developed diarrhea since Monday after a few days on the antibiotic. She is already getting Forta Flora in her food. I have added a teaspoon of baby sweet potato and that seems to have helped firm up her stool enough. For diarrhea, as long as it is not more than once a day-sweet potato, mashed banana, rice, rice water-are good home remedies. Add these to the food or give by mouth with a syringe if using baby sweet potato/banana. Forta Flora mixed into the food adds a probiotic which is suppose to help make a better gastro system (this is a really good product to use for any cat even if there are no gastro issues.) Had it been watery and or constant-more than once a day-these methods and maybe anti-nausea, anti-diarrhea medication from the vet, or IV fluids from the vet (to replace lost fluids) would help firm up the stool. There was a time when Kaopectate could be used safely (do not use Pepto Bismol) but I've since read that the formula changed and can be deadly for pets. The products have an aspirin related product which is toxic or can be if given in large or frequent doses. It's due to how a cat's body processes the aspirin. (And HCM cats may already be on aspirin for blood thinning therapy.) And some vets may not be aware of the change in Kaopectate. Be wary of any online/store anti-diarrhea medication. Check the ingredients to make sure the list does not include salicylates or bismuth subsalicylates.

Here's a Cornell University vet link about diarrhea:
http://www.vet.cornell.edu/…/Health_Information/diarrhea.cfm

(From the link below:)
"Bismuth subsalicylate is the active ingredient in Pepto-Bismol. Aspirin is also known as acetylsalicylate. In other words, both kaopectate and Pepto-Bismol contain aspirin derivatives...salicylate itself can cause toxicity, which is a special problem in cats, who clear the drug from their systems very slowly. This makes them susceptible to buildup of the drug to toxic levels...can interfere with other drugs that are commonly administered to pets. These include nonsteroidal anti-inflammatory drugs (NSAIDs) such as Rimadyl, Metacam, and Deramaxx as well as steroids such as prednisolone, prednisone, and dexamethasone...dogs also can suffer toxicity. Of significant concern is the risk of seemingly paradoxical exacerbation of gastrointestinal signs for which Pepto Bismol or Kaopectate might used, since salicylates can cause upset stomach in both dogs and cats."

Does Pepto-Bismol Work for Cats and Dogs? | Catster

A few weeks ago, a client at the emergency clinic where I work mentioned that she frequently gave her cat Pepto-Bismol to prevent gastrointestinal upset....

CATSTER.COM

Bette Going Out of the Box and Vomiting Up Clavamox; Replenishing Lost Electrolytes

Bette became very ill last night after seeing the vet and I almost took her to the ER but was able to resolve it at home. Bette's been going out of the box on occasion this summer. But she's gone out of the box seven times since the beginning of August, four of them in the last week and a half. And this weekend, she was sleeping a lot but with a tired look on her face. And she's not been eating as much-although she's not lost weight. Due to her cystitis, whenever she eats cat food she shouldn't eat, she has bladder issues and goes out of the box. And it's hard to keep her out of other cats' food when we are feeding six of them at the same time, even if two are in another room. And usually, I give Methigel to acidify her urine, going on the assumption that it's not acidic enough, that the pH is off, that her bladder could be irritated, and that she may have crystals (having been prone to them when younger.) And we have increased her valium as needed in the past. But Methigel, a bit more Valium, and keeping her out of the other food, didn't lead to any changes in behavior. So, then I wondered if the cats were fighting overnight when she used the litterbox, something Jimmy is prone to do when he's in a mood. We actually bought a camera this summer (a post from June or July) to put in the laundry room because that's where she keeps going. We have pads covering the washer and dryer which she targets. (This has been going on since 2010 when a few of the cats got the idea to use the washer and dryer as a litterbox. Because it's cool to the touch? Now it's just Bette.)

So, we saw the vet yesterday. Her urine showed high WBC so that shows an infection. There were no crystals. Still waiting on blood work to see if there are any other issues. Scan looked fine. But when the vet palpated the bladder area, Bette winced and tightened up. That's an indication that the area is uncomfortable. They drew the urine via needle with the scan and drew blood. But when it came time to give sub-q fluids, she revolted and bucked like a horse and tried to bite the vet techs. They couldn't control her. I heard the commotion and went to the back room and tried to assist. That didn't change her. So, I suggested we go back to the exam room which for some reason, maybe because it's smaller, calms the cats when they are upset. And yes, Bette was quieter. But I also held her. I wrapped the towel around her front; they put a hard collar on around her head; and I wrapped my arms and body around her and held her tight. She couldn't move when they put the needle in for the fluids. And she gave up trying to move. The vet prescribed Clavamox liquid as the antibiotic.

When we got home, she ate and I gave her Clavamox. But them vomited up almost immediately. Then slept. Then when we gave her valium in the evening, she vomited that up. Then I gave her Cerenia to quiet the vomiting and she vomited that up. Each time it sounded as if she were choking. It's a horrible sound for such small amounts of fluid that she gave up. At 10 p.m. we tried the Clavamox again. She then spent the next hour and a half vomiting up small and large amounts of fluid. By this time, she was not moving, was only sleeping, and refused to eat. The Clavamox also made her foam so much that there is no way she was keeping any of it down.

So, I don't know if the vomiting was caused by the Clavamox but I do know that once they begin to vomit, they can continue just because their gastro systems become upset. And the more they vomit, the more electrolytes they lose. And the more of those they lose, the more they may continue to vomit. So, I gave her 9mls of water by mouth at 1 a.m. and she kept it down. Then I made up sugar water (usually corn syrup but I was out and used maple syrup mixed with water.) I added a pinch of salt to the sugar water (sodium and glucose are electrolytes) and gave her 6mls. She kept it down. We went to bed. She got me up at 4 a.m. and seemed to want to eat. So I gave her some food. She ate. I gave 6mls of water, and 3mls of sugar water. She kept it all down. She ate again at 9 a.m.. I gave her valium and Clavamox at 9:30 and she kept it down. And I gave more water and sugar water. I chased the Clavamox with sugar water which decreased the foaming.

So, she has kept it down all day and she's up and almost normal in disposition. Which is good. But we will change the antibiotic since Clavamox makes her foam too much and might be the reason for the gastro upset.

From experience I know that a cat cannot go too long-as in hours-without replenishing the lost electrolytes from vomiting; and that sugar water is a good source of energy when a cat is not eating. Giving her water, sugar and salt helped to replace a bit of what was lost and helped her regain some strength and ability to feel better and to eat. Had she continued to vomit last night, I would have gone to the ER where she would have been given sub-q fluids with electrolytes and possibly an anti-nausea shot which some cats have received before. Had she vomited today after Clavamox, I would have gone to the vet or ER and she likely would have received the same treatment.

So, so far she's on the mend. As for the infection, we are awaiting blood results. We will do antibiotics for 14 days and then retest the urine and she how she seems to respond to the exam. And then monitor going forward.