Vitamin D for a Sick Cat; Too Much May Be Toxic-Proceed With Caution

The vet recommended a vitamin D blood test (last week during the scan) and the result came back that the level is very low. She recommends a supplement. PROBLEMS: too much and it's toxic. Giving too much of a supplement and causing toxicity would be easy since cats do not need that much vitamin D to increase their levels unless they were not eating or absorbing nutrients. In Katharine's case, she has IBD so her body was not absorbing nutrients effectively. She also was not eating well and not at all a few days prior to the test (although we were hand feeding her.) So, her level may have been temporarily low anyway. We will try it for a few days-next week as the vet needs to order it. I will give very little and we will retest her level in a month. She's eating better on her own so I'm expecting the level to improve.

Here's an article about vitamin D and cats. 

Katharine Struggles to Eat on Liquid Phenobarbital-Trip to Vet for Scan and Meds

Katharine update since 7/11: she had been eating well enough once I cut a small amount off of the phenobarbital pill half that she received in the morning. She ate well enough for a week. We had to hand feed in the evening but she did eat some in the evening. She had not lost weight during this time. But then 7/13, we switched to liquid pheno. Since I couldn't accurately cut the pills in half (not scored, easily fell apart) I never knew how much more or less of 7.5mg per dose she actually received. The liquid version was supposed to help us figure this out, titrate down as needed, and track efficacy. But she immediately lost her appetite. The script was 7.5mg/1ml-one dose was one ML liquid pheno. To decrease the dose, I began giving her .95, then .90, then .85, then .80. She would not eat. We had to keep hand feeding her. The goal was 150 calories a day which was difficult to do just because it required multiple feedings of 21 ml or more per feeding. Each ml was approx. one calorie.

Her gastro scan was already scheduled and that was this past Thursday. She's fine. No liver damage or disease; still no pancreatitis. But her small intestine, the mucosa, is a bit more thickened since May's scan. They suspect IBD-irritable bowel syndrome-because all blood work is normal, and there are no signs of disease or cancer. She is to ONLY eat hypo food-rabbit, venison, duck-and NO fish based foods. She is on steroids for a few weeks (which are tapered down over time.) She received a B12 shot and will receive them every 2 weeks until late August. (They sent the supplies home, expecting me to administer the shot since I learned how to give shots sub q when I had to inject lasix into Myrna. I declined to do this with KH and will take her back to the vet for each shot. I'm not up to it frankly and since it's not life saving such as lasix, it's not something I MUST do.) While she could take by mouth, vitamin B12, since she has IBD, she may not absorb the needed amount, so hence the shots. They also tested her vitamin D levels which-just like with humans-if low, creates all sorts of issues (I have been low on iron and vitamin D and both caused the same symptoms for me: muscle aches and weakness, inability to breathe/move, feeling as if a major disease is attacking your nerves, etc. I take supplements for both.)

I also switched back to pheno pills in case the liquid version has put off her appetite. By shaving a bit off the end, she returned to eating-but after beginning steroids (which can increase appetite) and receiving the B12 shot. She's not eating enough and we continue to hand feed as necessary. She has lost 3 oz. since last week and is down to a bony 10 lbs. So, we must make sure she reaches her caloric daily goals. We will try the pills for a few days, then switch back to the liquid version and see how she responds. If she looses her appetite again, then I'll have the pharmacy redo the formula.

Cure for Cat Car Sickness/Vomiting in the Car

Solution to no vomiting on the way to the vet: I finally hit on a plan to prevent Roxanne from vomiting in the car on the way to the vet. And I don't know why I didn't think of part of the solution beforehand. She vomits in the car regardless of duration of trip or if I give her Cerenia before we leave. So, it occurred to me today that perhaps if she ate very little in the morning and didn't eat at all for two hours before departure, that she wouldn't have food in her stomach to vomit. AND since giving Katharine Pepcid to stop stomach acid, I thought I would give it to Rox to see if that helped. Perhaps nerves creates acid; perhaps acid creates nausea; and nausea leads to vomiting. I gave Pepcid yesterday and this morning and 1/8 more before we left. I gave Cerenia before we left. And it worked. She only vomited up some foam. But she was calm on the way there and while there.

She saw the cardiologist today and all is well. No disease signs at all. So, she does not need to return annually. I will take her back if she needs dental or other surgery (which I hope we avoid) or if there are signs or other illnesses that require a full check-up.

Katharine's Appetite Improves with Less Phenobarbital

Today Katharine ate on her own all day long. And she has eaten nothing but AD in a bowl. And she demanded food every hour. By 3 p.m. she had had 115 calories. We weighed her last night and she's at 10.4, up one ounce from 7/3. So,no weight loss which is good. And maybe she only needs about 165 calories a day. She hasn't eaten since 3 and may need hand feeding a bit or maybe she'll eat again on her own. But titrating down the pheno seems to help her eat.

We had her pheno compounded but I think the vet got the script wrong. I'll call the pharmacist tomorrow first. We want to titrate down one dose and make the evening dose a regular 7.5mg dose. She receives a total of 15mg a day. The script compounded says 7.5mg/1ml-7.5mg is in one ML of concentration. That means one dose is 1ml which is a lot to syringe up and try to give her. That also means the TOTAL for the day is 2ml. If it were 15mg/1ml then I could easily give .5ml per dose and titrate down as needed. I need to use a syringe with hundredths measurements which I have but which is hard to read accurately and we are aiming for accuracy. We need to give the exact dose each time so that we can see how it affects her appetite as well as monitor for efficacy for seizure control. This should be more accurate than trying to cut pills that are not scored and that shatter easily.

However, the really confusing part is the script label says to give .9ml per dose. That would only be 13mg total instead of 15mg (.9+.9=1.80ml instead of 2ml.) That would really decrease her pheno which might be dangerous.

Hand Feeding Technique

Katharine isn't eating enough on her own so we are still hand feeding her. Saturday and today, she ate well throughout the morning and afternoon but then slowed down and then wouldn't eat at all. We are counting calories and on her own, she'll consume 100 in eight hours. She needs another 65-80 or more. So, we are supplementing.

Here are photos that somewhat show my towel technique to calm and contain her while I hand feed her. The towel is draped over her chest, under the neck, and the ends wrapped snuggly over her back. I hold the ends at her neck as if I'm holding her at the scruff. I hold the towel in one hand and syringe feed with the other. (No photo yet for that.)

Phenobarbital Adjusted to Help Cat Eat

Katharine is finally eating on her own. Not much but it is a start. She ate 1 tb of tuna and 1 tb of Hill's Venison for about 20 calories. And I had given her about 5ml of AD earlier. So, she's had 25 cals. this a.m. We will hand feed as necessary to get her up to 160-180 calories a day. But we will offer food every hour and a half to try to get her to eat on her own.

What might be helping-aside from finally getting up to about 165 calories yesterday which made her feel better-is that I shaved a corner off of Katharine's phenobarbital this a.m. And we decreased it a touch last night.

How did we know she wanted to eat on her own? After I had prepared breakfast for all of the cats, Katharine and the rest came into the kitchen, crying for food. Katharine has only sniffed the food for the last couple of days and acted as if she wanted to eat but never ate, and never cried for food. But today, when she cried for the food, we hoped that she would actually eat and she did. She took almost 15 minutes to eat but she ate almost all of it.

We weighed her last night and she weighs as much as she did Tuesday-10.3. So, no weight loss since Tuesday despite hand feeding, and despite not getting more into her than maybe 50 or so calories per day the first couple of days.

I will try to take photos of my feeding technique and post. She originally kept moving her head and refusing to take the food. And as it was liquid (AD with water), it flew everywhere. I tried draping a hand towel over her front like a bib but she was too difficult to hold that way. Finally, I wrapped her up in the kitchen hand towel and held the towel securely, tightly (but not too tightly) at the neck. This seemed to calm her. Maybe it felt as if I had grabbed her at the scruff of the neck as if she were a kitten. And the towel contained her body. She stopped shaking the food off and with minimal head movement, took in the food. This allowed us to feed her 18 or more mls (of 3ml syringe) at a time and allowed us to get 99% of it in instead of 40%.

I think I'll have the phenobarbital compounded so that I can better regulate how much she actually receives. The pills are not scored so are hard to accurately cut. Shaving off the corner of one dose, and the corner of another only helps if the halves are the same size but they are not. The pills cut unevenly. And maybe we'll add Kepra. I'll have to talk to the vet on Monday.

Phenobarbital and Kepra for Katharine

We will slightly decrease Katharine's phenobarbital in hope that it will be enough to restore her appetite. We can only wean over a matter of weeks, not days, unlike with steroids. Meanwhile, we might add Kepra, another seizure med, other wise known as Levetiracetam (the pronunciation of which sounds as if someone is HAVING a seizure.)

Today, we successfully fed her an entire can of AD by mouth, a total of approximately 186ml of water and AD. She finally perked up by 6 p.m. I'm assuming that it was about that time that she had had enough calories to make her feel better. We will need to push more food faster so that she feels better sooner. We are waiting for her to eat on her own. I do not want to try stimulants yet until she is eating on her own. The mirtazapine did not work for her the other day when she was not eating on her own.

Katharine-NO Pancreatitis but Still Struggling

Update on Katharine: NO pancreatitis. PPL came in at .09. Reference range is 0-3.5 for normal pancreas. Reference range increases up to 5.4 for severity. Despite calls to the neurologist from the vet and myself, they have yet to respond. So, we continue to give the med that may be causing her to be sick-phenobarbital. It is a drug that cannot be stopped. It must be weaned. But it also needs to be replaced with something else to keep seizures at bay.

We are hand feeding her. 3ml of baby food sweet potato now once a day just in case she might get diarrhea. It's also a good source of potassium-much needed since she's not eating; much needed by the body as it regulates the heart beat (ions of sodium, calcium, potassium cause the heart to beat;) and potassium is much needed for the kidneys to function.

We are also hand feeding her 186ml of a 5.5 oz can of AD (162.5ml) mixed with 24ml of water, using a 3ml syringe. That comes out to 62 syringes of food. If we do ten feedings of six syringes, we can get about 186 calories into her. So far, she's keeping it down. The Pepcid has taken care of the stomach acid we saw Tuesday and Wednesday.

She is not yet eating on her own but is sniffing food. We gave her tuna today and elevated it by using a large bowl inverted to create a stand. Elevating the food helps because a cat that is sick or has stomach acid will experience it more if they bend over to eat their food. Elevating it allows the food to be more a standing height for the cat, hopefully avoiding any stomach acid or reflux.

Here is an article from IDEXX about pancreatitis. It's a very good discussion paper.

http://www.idexx.de/pdf/de_de/smallanimal/education/client-education/feline_pancreatitis_roundtable_discussion_us.pdf

Katharine Not Eating-Due to Phenobarbital?

A cat that is not eating well enough or at all is creating a dangerous situation, a domino effect where the body lacks nutrients and fluids and goes into steep decline. Too many people think that it is ok to not let a cat eat enough or to skip a few days due to the false belief that the cat is just being finicky. A cat can be finicky but if a cat cries for food but won't eat; sniffs the food but won't eat; does not come for food at meal times; even takes a bite or two and leaves and never eats again that day, then it is a cat that is likely ill-not finicky. The lack of eating must be addressed immediately with the use of supplementation (feeding protein and liquids by mouth) and with medication to stimulate the appetite (Mirtazapine for example.)

Katharine has slowed down eating this month while on phenobarbital. She stopped eating on Monday. I gave food by mouth: tuna juice, juice from the can of cat food, and kitten formula (a great alternative because it has all the nutrients a cat needs.) Unfortunately, she vomited it up Monday night and this morning. She is down a pound in a month.

She had the weight to lose but the real concern is that if she loses too much, does not get any nutrients, hepatic lipidosis-an acidic condition of the liver that involves the release of bad enzymes-could be the result.

When a cat starves, the body begins to shut down and in a matter of hours and days, not months. Cats are not like dogs that will eat anything until they are too sick to want to eat. Cats tend to stop eating as soon as they do not feel well even if the illness is only slight. When a cat doesn't eat, the domino effect begins as the body begins to fall apart.
A lack of nutrients means a lack of electrolytes; lack of electrolytes means low blood pressure, which means a run down condition, which means a lack of oxygen that won't be circulated to the heart and kidneys and organs and brain, etc. all that need oxygen and electrolytes and nutrients in order to fully function.

Feeding her by mouth with a 3ml syringe, a mixture of potassium (baby food sweet potato), glucose (corn syrup), and some salt with tuna juice/juice from canned food; and the kitten formula kept her hydrated enough that she had pink, wet gums. She failed the skin tent test as her skin did not fall but stayed aloft when pulled which meant she was dehydrated. When feeding a cat by mouth, you must make sure not to force feed the cat. Doing so, only makes the the cat upset and creates acid in the gastric system which then makes the situation worse.

She received sub q fluids, a shot of Cerenia (to calm the stomach after vomiting; a good overall restoration medication to help the cat feel well enough to eat;) a shot of B12 (to help them feel better)-all of which are to help her feel better in hopes that she recovers enough to eat.

The CBC/chem panel showed no signs of liver or kidney issues; no infection or inflammation. They sent to IDEXX, the lab company, the PPL-the test for pancreatitis. We will schedule a gastric system scan. She had one in May that was normal so it's good that we have a baseline with which to compare.

She has been sleeping since being home. We have fed her by mouth twice and we aren't sure half of it go into her. She is spitting it out which she had not done before.

We will continue to feed by mouth every three hours during the day and evening; try to get her to eat on her own; and wait to hear from her neurologist, which should be Thursday, as to what to do with the phenobarbital-if that is what is causing the not eating. Also, on Thursday, we will get the PPL results.