Updates Katharine and Roxanne and Elizabeth-Gastro, Meds, Weakness, Inappetence and More!

So much has been going on this past month. In early October, blood work was done on Katharine and Roxanne; then Katharine and Elizabeth had their annual updates where more blood work was taken and more issues arose.

Roxanne is still testing high for potassium or HYPERkalemia at 5.3 (with 4.9 being high normal.) What does that mean? We need to consider testing for possible hypoaldosteronism which is rare. It may also indicate Addison's disease or diabetes. And is connected to possible renal failure or decline. For now, monitor. We might consider giving her a diuretic if she continues to test for hyperkalemia. Symptoms may cause muscle weakness, nausea, heart palpitations, irregular heartbeat, and abnormal blood pressure.

If a cat has HYPERaldosteronism which produces HYPOkalemia, that could indicate cancer. And low potassium disrupts the body's function, leads to racing heart, weakness, etc.

She also tested POSITIVE AGAIN FOR FIV virus antibodies. The vet is checking to see if there is a test to test for the actual vaccine so that we can determine if she received the vax as a kitten or if she was exposed to the disease since 2017 (somehow despite no other cat in the house having FIV.) We will monitor her for active disease and try to make sure she does not fight or bite or get bitten by any of our other cats.

Katharine developed weakness and inappetence after taking an ACE inhibitor Benazepril for two weeks-she began in mid September. Mirtazapine did not work to spur her appetite. She began losing weight. While her weight was fine around 9.12 or 9.14, when it fell in early October after one week to 9.7 after we thought she was eating well enough, we had to begin feeding her by hand using the trusty 3ml plastic syringe method. (We give her 9ml of Hill's AD in the morning before breakfast, 9ml if she is not eating dinner, and 9ml at bedtime.) We concluded that somehow the Benazepril was prohibiting the absorption or interaction of the Mirtazapine, although there is no known contra-indication. 

When Katharine had her annual exam October 19, her heart was racing at 260 (normal should be 140 and no lower than 135 and no higher than 200.) Given her heart rate was high, the cardiologist said to give her Atenolol twice a day; given that she was weak, to pull the Benazepril and to check her heart rate in a week. She recommended that we buy and try a mobile EKG Kardia to monitor the heart rate at home. When we tried it, we got a laughingly low rate of 77-which would indicate she was near death. Given that she was up and about, eating, walking, alert, we knew it was wrong. We took her to the vet the next day and compared the in house heart rate reading to the Kardia device and both ran about 177.  This means the Atenolol at BID (twice a day) is working. But she does need an ACE inhibitor if it can be tolerated. We will try Enalpril sometime in the future and monitor.  Follow the link to purchase the device if interested. Follow this YouTube video for more information on how it works. It took until almost the end of October for Katharine to stop appearing weak; and it wasn't until this week 11/5/23 that Mirtazapine began working normally to spur her to eat.

We also noticed her breathing rate had increased. But it was difficult to get a true reading. So, in late September, her cardiologist said that it was ok for her to take furosemide once a day every day of  1/4 of a 12.5mg tablet (3mg approx.) Since the tablets were small and crumbled when cut, we changed over to the 20mg tablet, cut that into quarters, and shave off a bit more to reach the same 3-4mg dose. 

Because she wasn't feeling well at her annual exam, Katharine hasn't yet had her annual rabies shot so we will soon return for that.

She had her PLI/Cobalmine/Folate panel tested for pancreatitis and gastro issues and she has a high folate. These blood tests are to test for metabolic function. Specifically, folate is B12 and indicates malabsortive issues in cats (or humans.) If the cat cannot absorb nutrients, health issues develop. AND the inability points to issues in the gastro metabolic system which could be disease, irritation, infection, etc. This goes along with the gastro scan she had in early October that showed she had a "smouldering" pancreas, an issue developing. She is already on steroids. The vet suggested we had a different probiotic Visbiome  She also received a shot of B12. We can take her monthly to receive them and/or supplement her diet with B12. The vet wants us to give her cobalamine tablets which is B12.  I ordered some from Amazon and am waiting on them to arrive. 

Elizabeth had her annual exam in October and her rabies shot. She is good. She also needs some probiotic and will take Visbiome three times a week and not daily. Her PLI/cobalamine/folate test was also good except the folate was high. She has the same sort of gastro issues as Katharine but does not present with symptoms (although she was sick in June.) 

I think that is up to date on the cats. Jimmy has had a few urine out of the box accidents but we keep at it encouraging him to use the litter box and doing treats and behavioral work. 

Roxanne and Katharine Updates-Xrays, Gastro Scans, CHF, Furosemide and More!

Updates:
Roxanne is still testing for FIV. Vet did Western Blot Test yesterday-Thursday 10/5. Did a urine test because urine wasn't available at her checkup last week. We rechecked for potassium because it was abnormally high at her checkup. And she got her first gastro ultrasound just because she's nine, never had one, senior years will begin to show changes, high potassium could be a sign of adrenal gland issues (although that would appear in other blood work and has not.)

Ultrasound showed normal adrenal glands so we will hold off doing any further blood work (there's an $800 gland panel) and we won't test aldosterone levels (high pot might mean HYPOaldosteronism and Addisons Disease) unless potassium remains high for the next couple of months or she gets sick and has other issues. Baby had HYPERaldosteronism with low potassium (can be signs of Cushings) and developed high blood pressure which was primarily caused by CKD (which showed up in urine Specific Gravity and SDMA, BUN, and creatinine tests.) [Baby's hyperaldosterone remained stable from 2018-2020 and was not a cause of her death in 2021.] We will check iron levels in the future if RBC and such hematocrit values change because iron can be a reason for blood values being off.

Ultrasound showed prominent pancreas but no inflammation; normal adrenal glands; but cysts on the liver-this can be normal in cats and becomes a problem if there are too many or they become enlarged. We will monitor for vomiting, diarrhea, poor appetite (symptoms of so many issues), RBC (red blood cell count), liver values. She also has mild kidney changes normal for her age. Again-we will monitor kidney values, BUN, creatinine, potassium, phos, SDMA, and urine.

Katharine-I have been concerned that she has had numerous possible CHF episodes since July, and four these past two weeks. Her xrays yesterday showed some hazing around the heart related to HCM but none in the lungs to indicate CHF. But her cardiologist said that it was fine to put her on 3mg furosemide once a day since she has possibly had CHF episodes because her breathing rate declined within an hour of being given furosemide. Given my experience with HCM, I know when I see fast breathing rate at 40 bpm or more that is sustained and unchanging and must be immediately treated.

Her ultrasound showed "smouldering pancreas" with cysts but no issues or concerns. She is already on a steroid for IBD but cannot increase the amount for the pancreas due to HCM. She otherwise has a normal gastro system and organs. She has some slight scarring on kidneys due to normal aging process but her SDMA and BUN, creatinine, potassium, and phosphorous are all normal. But we will continue to monitor those for signs of CKD, especially important to monitor since she has HCM. I must make sure she gets enough potassium to support her kidneys while on diuretics now as a daily dose and not just an emergency dose.

So, we await blood tests for Roxanne.

Katharine and Elizabeth go to the vet for annual checkups in two weeks (poor Katharine-she's been at the vet and cardio four times these last four weeks and one more to go.)

Katharine's HCM Advances, Adds New Drugs

Katharine saw the cardiologist 9/13/23 and her heart has increased in left atrial from 1.50 September 2022 to 1.76 a year later. If it continues to progress, she'll be at 2 or over 2 by April, and more potential issues might develop. For comparison, Myrna in her first year had a left atrial of 1.83, then 1.69 after a few weeks using COQ10 (see later paragraphs.) It would decrease again to 1.52 the next year and remain low until the disease took over in 2013 (almost four years into the disease) and the left atrial increased to 2.12. At this point, she began to develop a series of serious issues. In 2013 she had a heart attack; in 2014-15 she had increased serious CHF issues. And then she died in 2015 (I can't find what size was her left atrium in order to compare to Katharine but it was 2.20-2.30.)

She had two cases of possible CHF this summer after major storms-late July and late August. I had given her small doses of diuretics which worked almost immediately although she needed two more doses in August. With the heart size increasing, more CHF might occur if I do not stay on top of it and fight it immediately with furosemide (lasix.) She may need a daily dose to ward off CHF. I will continue to monitor and discuss it later with the cardiologist if more CHF occurs.

The cardiologist put her on Plavix-1/4 once a day; and an ACE inhibitor Benazepril-1/4 BID. She is also on Atenolol 1/4 once a day.

Myrna was on Enalapril for an ACE inhibitor. I don't know why Katharine is not. The cardiologist said something about it has a different approach given Katharine's early issues. ACE inhibitors stop the ACE process-the angiotesin converting enzyme-which shuts down the bodies' veins, constricts veins in the case of a heart attack or accident that causes the body to lose blood. When you inhibit the ACE process, you allow veins to be wide opened and fully functioning. This helps lower blood pressure, and increases the flow of oxygen to the blood and therefore to the heart. The ACE process also increases SALT so by stopping the ACE process using an inhibitor, the body's ability to retain salt is reduced, thereby lowering fluid due to less salt, and therefore reducing blood pressure.

I also bought from CHEWY, a bottle of Rx Vitamins 30# COQ10, a supplement that we used with Myrna that improved her heart condition for a few years. Each capsule has 30mg. With Myrna, I'm not sure pet formula COQ10 existed because I bought Nature Made and squirted each capsule into her food. She received 200mg per day. Then later, I put it into the goop mixture I devised of this and other supplements and vitamins to improve her kidney function when the amount of diuretics increased and the load on her kidneys was too much, and her kidney values declined. This pet specific COQ10 is small enough that she can swallow it. I will give it to her daily. It's a lesser amount that what Myrna was taking but then Myrna's heart was far worse at 8 months old than Katharine at 14 years old. 

So, if Katharine's heart is nearing 2.0 this next year, and Myrna had severe issues at 2.12, we must work hard to try to improve Katharine's heart function, keep her overall health stable, and monitor closely for CHF; and be aware that there is a chance we might lose her in the next two years. Given her age at 14 and a half, she has lived a long life and we have had her a very long time. I'm grateful that her other health issues-seizures, IBD-are under control and hopefully remain so. That leaves me time to concentrate on taking care of her heart. But I refuse to make any concessions, to give in the inevitable, and to treat her condition as a given. And I refuse to give up. I cannot plan for how I want her life to end or when. But I will help her fight; I will help her body stay strong in order to fight. 

Please read more at the blog's tabs: Myrna's Story, Meds, About HCM; and do a word and category search for further information.

Apps to Use for Feline HCM

Someone mentioned they use an app to track their cat's progress and breathing. Here are some apps that help with tracking breathing. You can also use the clock/counter/timer on your smart phone, your stove or microwave, a kitchen timer, etc. if watching a watch (very small hands) or your house clock is difficult or not available.

I have NOT used these. These are NOT paid sources. These are NOT things I recommend as products, just things I Googled. You and others might have even more apps to recommend. Please do so here in comments. Thanks.

https://apps.apple.com/us/app/count-my-breaths/id1513102381

https://apps.apple.com/us/app/my-pets-heart2heart/id1564965551

https://www.cavaliermatters.org/unique-hereditary-diseases-index/mvd-heart-disease/mvd-respiratory-app-cardalis/#:~:text=The%20Cardalis%20app%20is%20very,information%20is%20recorded%20and%20charted

https://apps.apple.com/us/app/srr-counter-for-dogs-cats/id1086456790

Cat Medications and Supplements-Where to Buy

Cat Meds:
Cat meds do not need to come from the vet but it does depend on if it is exclusively sold by the vet; or if the vet exclusively has the smaller dose made for pets while the human pharmacy may only have the larger doses for humans. You might need to get some meds from your vet or cardiologist to get started when your cat is first sick (be it HCM or other issues), and then take the time to comparison shop for a more affordable price. When a sick cat needs six or more meds as with HCM, you'll want meds that you can get for a month's worth that are only $10 or less (for example) or whatever is affordable and available.

Most meds a cat needs are human meds and likely can be purchased at the local human pharmacy and for less money than from the vet. Even if the tabs come in only large sizes, check to see if they can be cut down to the dose you need (using a good pill cutter) so that you can buy the cheaper human size and not the more expensive vet size (if applicable.) Ask the pharmacist about the possible various dose sizes and thencomparison shop. There are various variables to consider.

Target, Kroger have had $4.00 meds in the past when we needed so many for Myrna Loy. We now get the various meds from Kroger, and a local compounding pharmacy, and an online pharmacy Wedgewood; and we have used the online pharmacy Road Runner in the past.

Check for hours a pharmacy is opened. You'll want something that is convenient for you to access. You don't want the store to be opened until 10 p.m. but the pharmacy closed by 6 p.m.

Supplements: can often be purchased at pet stores, Amazon, 1800pets, Chewy, etc.-like Laxatone, Lysine, Renal K, cat vitamin paste, immune liquids, taurine, etc.

Vitamins like COQ10, vitamin E, iron, magnesium, potassium for humans, etc. can be purchased at Kroger or Target (comparison shop: Target, Kroger brands, vs Nature Made, Sundown and other brands-look price per pill count, pill size per mg; and specials on price: 2 bottles for one for example) or elsewhere for human supplements and then cut them up or pierce and mix into food (depending on the flavor of the gel cap.) [These supplements are only some a cat might need. See the blog Med tab for what we used for Myrna. Your cat might not need them or might need others. These are suggestions referencing what we used.]

Bette Davis Necropsy Report-Brain Cancer

Bette's necropsy report came in two weeks ago and I have only been able to post about it now. A necropsy report-if you've never seen one-drills down into the cellular level of tissues. Samples are taken from all major organs and tissues and any areas noted as a concern or involved in the demise of the animal. They also look at all organs and give a physical description. 

Basically, Bette died of brain cancer. The Nerve Sheath Tumor was gone from her spine. BUT it had spread through the nervous system into her brain. The SYMPTOMS of TRIGEMINAL NERVE damage that we thought we saw: open mouth breathing, excessive drooling, tongue out, difficulty swallowing, combined with her right eye not blinking or closing, and the eye ulcer (from not closing the eye all the way) that hit her two weeks before she died, were signs of brain cancer. 

Likely it was spreading before radiation treatment. Possibly could have been seen if another MRI had been done as she began radiation treatment. Definitely would have been seen if we had been able to convince anyone to do one in the last week or so when she was struggling to breathe and no one would listen (the vet school ER for example.) I would have wanted to do palliative care and to be more aware of her demise and spend the time accordingly (not that I wasn't with her that last week) instead of trying so many things to fix whatever ailed her, only to be ignored by almost anyone I approached. (Her regular vet was wonderful as was her dentist-see previous posts.)

Her increased breathing issues were also related to decreasing brain function. 

She also had ASPIRATION PNEUMONIA. When she went immediately into respiratory distress at 6 p.m. that Thursday night 5/18/23 was because she aspirated food into her lungs. Likely, she regurgitated and inhaled it. Aspiration pneumonia quickly happens when something is inhaled into the lungs and quickly causes respiratory distress and death. 

She had declining cranial responses-the eyes weren't closing, she couldn't move her limbs-over night Thursday and when we put her to sleep Friday, all from brain cancer.

She also had mild HCM-not detected in January-but seen in pathology report in the left vent and in the cells. It was not drastic and is likely radiation/cancer change related. However that works. She wasn't presenting "clinically" meaning there were no outward or vital signs indicating heart disease. 

She also had lymphoma in her cells-cancer-that cats do not recover from.

She had a small tumor/nodule on her thyroid that would have become an issue if the rest of the cancers hadn't happened.

NO MASS in the body; NOTHING wrong with the esophagus or larynx causing breathing issues. The ER doctor that Thursday 5/18 thought something was pressing down on the esophagus causing the breathing issues because the xray showed gas in the opening and at the end but the airway suppressed in the center. The vet school radiologist for the pathology report looked at the xray and said it was normal. The way she was laying for the xray made it look as if it were pushed down; and the pathology did not find a mass in that area. 

There are terms in the necropsy such as:

*heart myofiber disarray and fibrosis

*Lipofuscin granules 

*hepatic parenchyma small nodular aggregates listiocytes

*pancreas nodule of hyperplastic exocrine pancreatic epithelial cells

*proliferations of thryoid epithelial cells

*fibrin hemorrhate viable and degenerate neutrophils

*infiltrates of a momomorphic medium round cell population

etc.

I did complain this week to the owner of the ER about the rudeness of the clerk on that Thursday when she said "The doctor already told you we can't fix this. Whatever's wrong with her we can't fix this." as we are standing there with Bette in severe respiratory distress. I calmly discussed my concerns, as well as shared the necropsy. She apologized and seemed concerned about the interaction and said she'd address it. I can only hope changes are made because they have been a wonderful ER that we have almost exclusively used since 2009 despite being 40+ minutes away. (The cardio is in the same building and can run over to see a sick cat as needed.)

I also calmly complained to the vet school about the over reliance in my view, of the ER staff on VITALS to determine if a patient is fine, while IGNORING how the patient presents with difficulty breathing. I said that the resident in the ER had said that Bette on 5/16 was fine, while they ignored that she looked awful, wasn't breathing well, and made horrible noises. I wanted her admitted so that the hospital staff could see her the next day but was refused. Possibly they could have done an MRI or made further determination that she was failing so that again, we could have done palliative care. I told the manager that she crashed two days later in respiratory distress and died that Friday. So CLEARLY she was NOT FINE on Tuesday. I'm not sure a practice manager can change how vet school students are taught and how the residents handle cases. AND it was just a voice message that I left after getting the manager's number. But I told him that she was a rad/onc patient and the pathology report was on file there. 

We fight the signs of illness as we see them. That's what I encourage you to do-always. Monitor your pets especially those with a chronic condition such as HCM. They need meds, regular schedules; they need monitoring for breathing; they need help eating; they need all symptoms addressed even if in the end they will die of HCM or cancer. And fight-complain-when vets are not helping or solving or searching; or clerks are rude. Fight your panic that prevents you from thinking of what to do. Get organized for pet care-we did even more of this for Bette's care than we already do for the cats. 

What did I learn from Bette's ordeal: 

*to get the MRI earlier than later as soon as it seems necessary; to get it again weeks later if the pet seems worse (as she lost the use of her rear left leg in April maybe? When she first had trouble breathing in May?) 

*to keep oxygen on hand always

*to check the cats' faces for ability to blink-if you get half way to their face and they blink that's a good sign; if you get up to them before they blink, that's not a good sign.

*That I was able to force myself to think as I panicked about her breathing issues and to act quickly, to overcome the panic and to act. I hadn't been in this situation since Myrna died in 2015. It all came back and is now registered in my brain.

*That I did more for Bette than for Baby when she was sick in the ER struggling for a week in 2021 before we had to put her to sleep. We put her to sleep too soon and I'll never know what I could have done. But I panicked. (Baby was breathing on her own unlike Bette who could never have come back home.)

So, there was nothing that we could do to cure Bette while we were doing everything we could think of doing to help her. She was slipping away the moment she got sick in January because that was the first sign. 

Cat Virus Makes Cats Not Eat

UPDATES: So Jimmy wasn't eating last week; Elizabeth began not eating last 6/3 Saturday; and Katharine was a picky eater more than usual last week, also. 

We discovered that all of the meds we normally would use-Cerenia, Mirtazapine, stomach meds, nausea meds-were contraindicated with his Prozac. Either the Prozac made them not work, or the other meds had a possibility of running up a heart rate/blood pressure, or can make a cat weak-depending on interaction. Jimmy saw the vet for sub q fluids Friday and Saturday and a B12 shot Saturday and began to slowly eat on his own Saturday afternoon. He spent Saturday-Sunday slowly eating a couple bites every two hours; then eating more and more often Monday and Tuesday, until he was eating a full meal on his own by Wednesday. He was slow and "out of it" and would disappear for hours until ready to eat Saturday-Tuesday; by Wednesday was hanging out upstairs again. 

His CBC/chem panel blood work showed signs of inflammation and pain: neutrophils and monocytes were increased to HIGH, and the lymphocytes and eosinophils had decreased to LOW. Possible causes: anemic-he had lower red blood cells but normal reticulocytes so not likely; Bone Marrow disease-with low RBC, high others, possible but requires bone marrow testing so NO for now; kidney disease-his SDMA is increasing from 10 to 11 last time, to 12 this time. Combined with the increasing RBC it's possible. Urine test was clear, no protein, no glucose, SPG-specific gravity-was normal at 1.030. So no obvious signs but something to monitor especially as he is 14. As a cat ages, kidney disease can be a problem. His ALT, ALP, etc. were all normal-no liver issues, no dehydration, etc. Other causes with the blood results: gastro issues, pancreas issues. He had an ultrasound Thursday that showed some small intestinal thickening of the walls which indicates possible virus or possible IBD coming on. If he continues to improve-and given that Elizabeth and to some extent, Katharine, were also not eating-the vet thinks it is some sort of virus. We are to monitor, give extra lysine (herpes virus) they already take, and if further "intervention" such as sub q fluids or more B12 or other tests are warranted, we'll go from there. (Other tests-MRI? Other blood work? A steroid-although not Prednasolone because of his pre-diabetic history and Prozac.)

Elizabeth-suddenly wouldn't eat Saturday as much as usual. But given we were busy with Jimmy, we let her do her thing. Then Sunday she wouldn't eat at all. We began hand feeding her Hills AD by syringe every two hours Sunday and into Monday. Elizabeth can take Mirtazapine. She had some Sunday which took hours to kick in and let her eat very little Sunday night. She had it again Monday to no effect. We have been giving her Cerenia (anti-nausea/vomiting med) since Sunday. It might have helped but did not encourage eating. I called the vet Monday and they saw her on Tuesday. They gave sub q fluids, a B12 shot, checked CBC/chem panel, did a urine-all came out normal. Nothing like Jimmy's blood work to indicate any pain or inflammation. 

We continued to hand feed her as needed until she finally began eating a couple bites every two hours Tuesday night and Wednesday. She also had an ultrasound Thursday that showed she also has a small intestine wall thickening that indicates IBD. Again, the vet said that if she's eating on her own enough, to continue to monitor her recovery. Use Forta Flora in her food-and Jimmy's-but any further "intervention"-meds, tests-will be discussed if this happens again.

Katharine-she responds well to Mirtazapine and eats well on it for a few days before needing more. She has not yet seen the vet. BUT again, the vet thinks a virus of some sort hit them. It affected Elizabeth slowly over time when she was showing signs of being a picky eater; hit Jimmy hardest because of the dental procedure and anesthesia which makes the body slower and more apt for things that are working their way through the body, to suddenly emerge. This can happen with HCM-in the form of CHF after surgery/anesthesia-for example. AND it's because they all have chronic health issues of various sorts.

Roxanne? Not sick. Secluded in the a.m. so that she eats and isn't bothered by the others; is also younger and so far healthy with no chronic issues.

Feline Thrombosis/FATE-Feline Arterial Thromboembolism-the Affect of Blood Clots in Cats

When Bette first went lame, many readers thought it could be thrombosis. So, what is thrombosis? Thrombosis is when a clot forms in (typically) the heart and travels and cuts off blood supply to the affected region. It can be to the heart-heart attack, stomach-vomiting (typically a symptom), or front or rear legs (the rear legs are saddle thrombosis or FATE-feline arterial thromboembolism.) Clots can be formed due to injuries or disease but for cats, it's mostly due to heart disease.

We know it was not thrombosis because we eventually learned with an MRI that it was Nerve Sheath Tumor. The tumor damaged the nerves to the rear part of her body, especially the left leg. But it did not affect blood flow in the legs. (A tumor could of course, depending on location on the body.)

A clot that travels in a blood vein will damage the arteries to the legs and arterial blood pressure will not register. Hopefully, the normal blood veins in the leg will continue to work and supply blood to the legs and the leg will be healthy. This may not always be the case. Cats can be paralyzed by loss of blood flow to the legs. In January, Bette's leg weakness went away while on prednisolone. Thrombosis isn't cured with prednisolone. And she maintained normal arterial blood pressure.

A cardiac ultrasound by her cardiologist in January showed no signs of heart disease, or clots having formed in the heart. With thrombosis due to HCM, an ultrasound would show changes to the heart and clots. When the problem of weak legs returned in March, that is when she had an MRI that showed the tumor.

When a clot forms in the legs, this can happen over days even if the onset seems sudden. The PAWS of the affected leg will be pale, not pink (or pale gray), and the paws will feel cool or cold to the touch. This is why you should always check cat's paws for color and feel of temperature so that YOU know when the paw is normal and may not be normal. If you suspect the paws are getting cold, see the vet and cardio as soon as possible.

When the clot settles in the artery of the leg, the cat will be in pain-typically over time-a few hours, a day; may go weak, may not want to move around; may begin to breathe heavily due to the clot having formed in the heart and passed along the body; may begin to breathe heavily due to increasing pain as the clot forms in the legs until the artery is cut off; the cat eventually will likely scream out in pain, and panic, and try to move around, as if to get away from it. The cat will not be able to stand or move the affected leg or legs. The cat will need immediate attention at the ER, the cardiologist office, or from the regular vet (you should discuss with your regular vet if they have experience with thrombosis and what treatments they can offer in the way of emergency care so that you know if they can treat the cat or if the cat needs the ER.)

We went through this with Myrna Loy. She had a heart attack in 2013, and FATE in 2015. With her heart attack, it was difficult to assess what was happening. She had begun to breathe heavily that morning and I gave her extra diuretic. She then hid and I spent a couple of hours trying to get her out from under the bed. I monitored her but saw that her breathing was getting worse. I finally had to chase her out with the vacuum. She ran, then laid down in the hall. I gave more diuretic but that didn't change her breathing. I called the cardiologist and she suggested that Myrna was having a heart attack. I rushed her to the ER which the cardio shares, and she was treated and the ultrasound showed a heart attack. Luckily, she was on Enalapril so the blood veins were kept open in her body so that the heart rate wasn't driven up, damaging the heart even more. She received oxygen, diuretic, other ER drugs, and stayed overnight until stable; was put on a twice weekly dose of aspirin in addition to the Plavix she was already on.

When she had FATE in 2015, she woke up and began to have a difficult day. She seemed uncomfortable; she wasn't eating well; her breathing eventually increased. I remember her paws were cool to the touch, but it was May and the AC was on and she had been on the floor. I ignored a major first sign. I was with her upstairs all night as she didn't want to move, didn't want to be touched, didn't want to eat, and seemed more and more in discomfort. As her breathing increased, I increased the diuretic. Her breathing rate fluctuated. She had just settled down on the bed for awhile, resting, breathing comfortably when she suddenly raised up, seemed to look surprised, and then leapt up from the bed and cried out in pain. She jumped down onto the floor and her rear legs were not moving. I picked her up, placed her back on the floor to make sure, and saw she couldn't use them. I immediately took her to the ER. By the time we arrived, it had resolved itself. She was treated, kept overnight, and saw the cardio the next day. She luckily had lost only the use of the artery. The other blood veins in the legs had taken over and supplied the legs with blood so that she never lost the use of her legs.

There is more information at the blog about what we went through and there is this information from a conference I attended in 2011. You can do word/category searches at the blog to learn more about thrombosis and thromboembolism.

2011 Vet Conference Thrombosis

How to Feed a Sick Cat-the Art of Getting a Cat to Eat or Feeding It by Hand

When Bette would not eat on her own earlier in the week, I was trying to syringe feed her.

When you have a cat that cannot eat on its own, won’t eat enough because the cat is sick, has a disease, there are a variety of foods, medicines to try, and feeding methods.

One of the best foods to feed a cat is Hill’s AD. It blends very well with very little water-a couple drops-therefore allowing a lot of calories and nutrients to get into the cat. Take a fork to blend in the can and then you should be able to easily syringe it up. This is of course a little easier to do when you’ve taken some of it out of the can and placed into bowl like I did in the photo. Use a 3ml plastic syringe which is enough for each try. We feed 9ml or more as tolerated at a time.

We also tried various liquid cat foods or "soups" by Friskees, and Fancy Feast "Broths" to add to AD and to syringe feed to add flavor, nutrients, and to encourage her appetite, and liquids that we hoped would be easier for her to swallow (since she could not easily swallow.) You can also use "cat milk" typically for kittens-add some to AD, or syringe feed 3ml for hydration.

Other meat based items that you can use: jars of baby food-chicken, beef, sweet potatoes (great source of potassium and fiber for gastric issues). Tuna juice. And you can make up your own broth. You do not want to buy commercial broth because it has too much salt and onions both of which you want to avoid. But you can make your own and add a little bit of sugar as long as the cat is not diabetic, and a little bit of salt as long as the cat isn’t HCM. 

I was going to use these broths for Bette. I boiled chicken with chicken livers because I thought she might need some iron. Chicken livers are a great source of iron, but it’s impossible to syringe. And since she wasn’t at that point eating on her own, I didn’t think she would eat it. But assuming that some of the iron rich liver leaked iron into the broth, I boiled them together. I did add to both the beef and the chicken broth a little bit of salt because she does not have heart disease. And I added just a little bit of sugar because she’s not diabetic. And since she wasn’t eating, and since sodium and glucose are necessary electrolytes, I wanted to make sure that she got something of those into her. Yes, it’s just a guess as to how much to put in. And it’s a guess as to how much she actually would have needed. I used 1/16 of a teaspoon if that in both of sugar and salt. 

How much should you feed your cat by syringe? I would say to start with 9 mL every 2 to 3 hours. Yes it depends on how much you can you get in at a time so if your cat rejects being hand fed after one or two syringes, decrease the amount of time in between each feeding and then try to increase the number of syringes you can actually get into your cat. We wrap a small hand towel or a paper towel around the neck of a cat. The cat is usually sitting, but Bette was mostly laying down, sitting up. You wrap one free arm around the cat and hold its head while using the syringe and your fingers in the other hand, to pry the cats mouth and gently feed the cat. You’ll want to go very, very slowly. Especially if the cat is very sick and weak. You don’t want to get food or liquid into the lungs. That will lead to pneumonia-not to frighten you, but that’s not going to happen if you go slowly. And yes, it’s frightening if your cat rejects it because you’re thinking your cats going to waste away. (I was very worried about Betty. I was worried about her even Thursday night when she was in the ER and I asked them how will they feed her. I just had it in my head that she had not been eating well for the last few days even as she presented with so many other things that were life-threatening, and not eating wasn’t one of them.) Your cat won’t waste away as long as it is getting enough food and enough nutrients every day and as long as you can keep it hydrated and as long as you can keep a staple weight. If your cat is 12 pounds and it’s been sick and you’re struggling to feed it and it gets down to 11 pounds after a month it’s OK. Sure, you want to discuss with your vet the overall body condition because it’s not just about how much it weighs, but is it healthy. 

I probably forgot to mention something as to how to feed. It is a trial and error. Food gets everywhere. Have baby wipes handy. Don’t yell at the cat. Don’t yell at your spouse. Don’t yell at yourself.

There are meds that can help your cat eat on its own if the cat is capable and healthy enough to respond to the medication. There is Cerenia a good anti-nausea medication. There is onedansetron which is a good anti-vomiting medication. There is Cyproheptadine an allergy medication which stimulates appetite. And there is mirtazapine, which is a pill and Mirataz ear gel, appetite stimulatants. I think those are the top meds that doctors give to prevent issues or help stimulate appetite, so that the cat can eat more on its own.

I do suggest that you keep a notebook. Start with cats weight and write it down, and write down when you feed it and how much you feed and how much water you give. The best way to monitor how much a cat is eating is to measure it always. Measure how much wet food you put into a bowl-cup, tablespoon, teaspoon. Measure it accurately. Because cats are funny. You will feed a cat an ounce of cat food and you will swear that it ate most of it. But because it pushes it off the plate or around the plate, when you collect all of it and you measure it, you might find that 1 ounce is not mostly gone, but is mostly still on the plate. If you know how much you fed the cat and you know how much the cat ate, then you can measure the amount of calories that the cat is taking in. 

A cat should have on average 260-280 calories per day. A 5oz can has a range of 120-180; 3oz can 70-125. Dry food varies but a cup is usually 250-300 calories. But you might give less than a quarter cup at a time and the cat might eat less than a quarter of that at a time of 25 calories. So, always measure before and after and keep a note of amounts.

Good luck.

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Difficult Week for Bette Davis

Bette Davis died May 19, 2023 of radiation effects after one month to the day (4/19/23) of treatment for Nerve Sheath Tumor. We are getting a necropsy to know the exact cause but something was compressing her esophagus and larynx, and she could not swallow, then could not breathe. Below are notes from the Facebook page.

May 16:

Another late night trip to the ER. Bette suddenly is not doing well today unlike yesterday. Yesterday the dentist said she was doing great, she was improving. Yesterday she ate a bowl of food on her own. Yesterday she seem to be on the mend. Today she can’t swallow, she coughs, she chokes, she spits up most of her food. She won’t eat on her own. We have a hard time, we have to go very, very slowly feeding her. We have to make sure she takes her meds first and keeps them down, then wait and feed her. I took her to the ER, to the local one that we use and they were going to do x-rays and sub Q fluids, but they can’t do endoscopy to check to see if her throat is closing up. I called the vet school ER and they said they do endoscopy. I run her up to the vet school an hour drive only to be told they don’t do endoscopy. That’s an internal medicine appointment that I have to schedule and that’s a few weeks out. They claim she can breathe and was oxygenating. Therefore they can’t admit her and then have endoscopy see her as a hospital patient. I’ve decided I’m not going to go back to the vet school ER because they misdiagnosed her last week when they said, everything’s fine, we don’t know why she’s drooling, tongue hanging, out open mouth breathing. That turned out to be the trigeminal nerve damage that her personal vet thought it was when she saw her on Wednesday the day after the ER visit. So tomorrow I have to call a couple local specialized hospital animal clinics. They don’t have ERs and I have to see if they do endoscopy. I have to see if anyone can see her. She can’t eat, and we’re not getting enough into her.

May 18:

Not good news. Bette is currently in the local ER again and this time X-ray shows there’s a compression on her esophagus which is why today she’s been in increasing respiratory distress.

Earlier today I had her in at her vet. And the plan that we came up with was to have her get a shot of steroids because she’s not able to keep her medication down. And she got a shot of Cerenia. And we were not supposed to feed her. Just give her some water by mouth. But keep an eye on her. And we were going to take her back tomorrow to do the same thing again and discuss with the surgeon about doing a feeding tube through the esophagus. Then we were going to do sub q shots over the weekend and then on Monday back to the vet and see what the plan is to go forward and see how she’s doing. Her vet thought that if we just left the throat alone, then maybe it would heal assuming that it’s due to the Trigeminal nerve damage. But then, about 6 o’clock, she went into distress. She was panicking trying to get out of her box, trying to get out of the room. Just panicking. We got the oxygen. I contacted her vet. We started using the oxygen. And then I was texting with her vet, and the vet eventually said to get her to the ER, that she was in respiratory distress. We all assumed her larynx was collapsing. But it’s fine. It’s the esophagus that is partially closed. It’s always closed until used. But she’s gotten gas into it-the gagging, coughing are symptoms and causes-on both sides of the closed part. But something is closing the middle part which causes her to drool and gag back up anything we put down. And it has something to do with pressure on larynx. I can’t recall what’s causing breathing issues.

What is it? She needs an MRI to know. What do we want to do? Find out what it is. Because she wasn’t dying. Not from normal decline. But we need to know. And that’s if she can be stable enough to move her. We’re out of oxygen. We had two brand new cans that were nearly empty. We used all three to get her here. I’ll complain tomorrow. What did we expect? That she’d be worn out from radiation treatment. That when it was over, she’d rest and start therapy next month. That we’d get her through to the end of the year before maybe starting over. We didn’t expect nerve damage, excessive drooling from it, mouth, breathing issues, and a new tumor or something causing this complication.

May 19:

The only update is that the vet called around 1 o’clock in the morning to say that that she had woken herself up because she finally urinated-she hasn’t urinated since 1 AM Tuesday. She urinated and defecated, and then panicked and her breathing ramped up and she was struggling to breathe. So they had to increase the oxygen, increase the medication to relax her, etc. The vet at that time wasn’t sure if she would make it through the night. She is currently stable, but stable with oxygen and sedation. They’re not sure she can be transported for further evaluation. The neurologist is going to look at her labs and her x-rays to evaluate and let us know what is the next step. Of course if she can’t be transported without oxygen, and she can’t be intubated because she doesn’t have a proper airway, I’m not sure what that means so until we get there I’m not going to guess.

Here’s what I wish: I wish people had listened to me days ago, a week ago when I first had her at the vet school ER on that Saturday almost 2 weeks ago. They said she was stable. There’s no reason to take her. They thought she was fine. She wasn’t fine, but she wasn’t as bad as she was yesterday. When I took her to the ER on Tuesday and the vet school again dismissed her and said she’s stable, she’s fine we can’t find any reason for why she’s breathing the way she is and nothing is wrong. If they had just listened to me and kept her overnight then maybe internal med would have seen her Wednesday and they would’ve imaged her Wednesday or Thursday and maybe they would’ve found this obstruction and maybe by now she would’ve had surgery instead of crashing. And if her neurologist at the other place where she originally had her MRI when I called two weeks ago to get an appointment to see what was wrong, if they had only listen to me that something was wrong and she needed to be evaluated then we would’ve caught it early enough while she was stable enough and breathing well enough on her own before she was incapable of breathing. If only everyone had listen to me and done what I asked a week ago, days ago, two weeks ago we might still have her and yes she would’ve undergone surgery probably to remove the obstruction and maybe they would’ve said well it’s cancer or you know she needs more radiation-which I would not have done because she’s done with radiation-and maybe she would’ve only had a few more weeks or a few more months but at least she would be home, stable to breathe, comfortable at home. She’d still have a life instead of struggling. And that’s not being selfish. It’s being realistic. 

I would not have chosen to put Betty down, just because she got lame. I would not have chosen to put her down just because she got a tumor. I would not have put her down because she needed radiation. But the kicker is if she had not gone through radiation would she still have had this obstruction?

Without the radiation there is a chance that should would go lame in both legs and lose ability to eliminate on her own. Yet many cats wear diapers and need help and live. And use wheelchairs. Would that have caused other issues and would the nerve have metastasized? There’s so many possibilities that the only choice was to have radiation to try to treat the tumor.

And the outcome is basically the same sort of. It’s possible that one scenario would’ve been she would’ve just gone lame. She would have spent the last month post when she would have received radiation treatment not having received radiation treatment and she would be have been fine. Would she have otherwise been fine for the rest of the summer? Would we have put off these complications or avoided these complications? She would be perfectly fine at least for a while until the tumor got worse and infiltrated her body or metastasized. She would have had a good summer or a difficult summer. Maybe she would have lived risk free until fall? It’s hard to say. I know the CT and the MRI did not pick up whatever this obstruction is so it must be post radiation or during radiation unless it’s something else entirely like something has collapsed because of radiation. Or Something is lodged in the larynx because of radiation. Until she has surgery or a necropsy, we won’t know. I hope this doesn’t happen to another cat of ours. But I do know that we will seek whatever treatment we think a cat needs to prolong a cats life. To treat the problem. Because when this all began, she was perfectly fine. And she is perfectly fine. Her health isn’t failing. She wasn’t dying. Except that she can’t breathe. And when you can’t breathe, a whole host of chemical, physical, biological processes kick in and starts to shut down your body. If she can’t survive off oxygen, then she can’t survive. And that’s where we might be. But I do this again yes. Why? Because she was perfectly fine until she wasn’t.