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. 

Bette Davis Died of Radiation Side Effects

May 19:

Bette’s life is now done. We chose to put her to sleep. I don’t know what happened but she’s so quickly declined. She wasn’t lucid. She was in and out of it. She wasn’t really aware of her surroundings. Because she would physically panic If off oxygen, they arranged for us to go back to the room and see her in the oxygen cage and talk to her and say goodbye. Then they brought her out so that we could hold her and pet her and she started to struggle a little bit but she was so out of it also because of the pain meds, but in a different way that when they gave her the first medication that usually puts them to sleep, and usually stings, and a cat who is conscious enough reacts, she did not react. And then she was quickly gone with the next medication. We are now dropping her off for a necropsy, so that we get an idea as to what happened.

Feline Trigeminal Nerve Damaged When Aggressively Intubated

Bette Sees Dentist Who Rules Jaw Issues are Likely Trigeminal Nerve Damage  

From Aggressive Jaw Opening When Intubated

I know it looks scary that her tongue is hanging out. But the photo from last Wednesday when I took her to the ER and her tongue was really hanging out and her mouth was really wide open and she was breathing hard is scarier. 

But we saw her dentist today and he observed and checked her and he said that she is actually doing much better than what I described that she was doing a week ago and then last Saturday and last Wednesday at the ER. She’s no longer holding her mouth all the way open, she’s no longer sticking her tongue all the way out, not moving it. She’s able to close her jaw even if it is somewhat still open. She can move her tongue which he said is a good sign even if it still hangs out a wee little bit. He believes that someone once, or more than once got aggressive, not in a mean way, but in a “they aren’t paying attention” way when they opened up her mouth, opened her jaw wide for intubation. That damaged or inflamed her trigeminal nerve. It’s a nerve that connects throughout the face, the jaw, the eyes as in the outside of the eyes not the optic nerves. That is why he suspects her right eye is not responding, that’s why she was drooling, had open mouth, her tongue sticking out while she was swallowing hard a few days ago. He believes that she’s on the mend. He said to give it another 7 to 10 days. If after 10 days it hasn’t completely improved then maybe something else needs to be done but right now he thinks she’s on the mend. She may not be perfectly healed, because once the damage is done, depending on how severe it is, it may not heal all the way. He said he doesn’t think there’s a reason to get an urgent MRI either. And don’t intubate her for the next two weeks. Just let her rest. So we will not go ahead with the last two radiation treatments. We do have to see them and go over whatever. But we’re going to skip the last two treatments so that she’s not intubated and I called her neurologist, and I said we will no longer need an urgent MRI but we would like to get one sooner than the one that we have five weeks from now if possible. So we are back to at least she’s no longer drooling. That is a major improvement over this this past week and she’s able to not drool and spit out her food or medications. Now we just need to eventually get her to eat on her own, and hopefully that will happen when she’s more comfortable, licking or chewing and swallowing more solid food. So better news, good news, etc.

He also gave her a shot of the antibiotic Convenia. He suspects that there’s an infection and given that she supposedly had a UTI and then her radiologist said she didn’t he suspects, she probably did, and Zenequin can be too strong. It gets the job done but it’s too strong and so he said Convenia is nice and slow and quiet will work its way through a system and fight off anything.

Bette at home head on counter

Bette May 9 before ER visit-mouth opened, tongue out, fast breathing.

 

Bette Has Had Many Issues Since Beginning Radiation

Bette began the process of radiation treatment without any issues. The first few days she was home, used the litter box, ate well, then slept but was also up later in the day, moving about, being taken from room to room. But quickly small issues emerged-litter box use and ability to eliminate, lameness, exhaustion, fast breathing, inappetence, drooling, open mouth, weak front legs, weak side of face. No one knows the cause. We are going to the dentist on Monday 5/15/23 because he's an expert and will be able to evaluate and offer suggestions as to cause and treatment. We are to hear from her neurologist about setting up an MRI recheck on Monday and hopefully we can get her in sooner than the June appointment we already had set. The following are notes from the notebook I have kept about her treatment. I tried to clean them up so that they make sense, replaced person and place names. The grammar or sentence structure is not always correct. 

4/19  Began radiation treatments Wednesday-Friday. Never sick, tired, ate well at home. Restless at night. Used litter box without issue. Good 4/19-21. Looked and acted normally. But quickly lost use of left leg, no weight on it.

4/22 Signs of difficulty eliminating. Increased Miralax and Cisipride and Forta Flora. Smaller bowel movements. Began difficulty getting into the box as leg got weaker. Began urinating periodically on pads and not in box. Still looked normal. Eating ok.

4/24 High amount of blood in urine. Not using box, urinating over box onto pad or on pad. Dark red. vet school checked urine and no bacteria. Red blood cells they thought from stress. Increased Buprenex, Methigel, water by mouth. Ate ok but not as much.

4/25 Vet school prescribed Gabapentin at bedtime-50mg/1ml; we gave .75ml. That settled her down at night to sleep. 

4/26-4/28 Better, using box, restful, slept well at night. Could move up and down basement stairs on her own. 

4/29 Urine out of box, restless at night. Gave more Buprenex, water by mouth, Methigel. 

Weight was 11.11. 

4/30-5/1 normal, weaker legs, unable to move as much, box use getting difficult. Eats well enough. 

In May-begins squinting eyes, slight drooling and wetness around mouth. This increases daily.

5/1-Monday-normal day, fine post treatment. Good evening. Ate well.

5/2 Evening-can’t get into litter box, puts legs in but butt is out and urinates onto pads. Can still slide her body and drag left leg and use front legs to move around. Is drooling.

5/3 Came home from vet school dirty and wet around mouth, chest, legs because the drooling has increased greatly. The gunk on her is food she tried to eat after treatment. 

5/4 Thursday vet school radiologist sees ulcer in right eye. Gave antibiotic gel cream for eye bacitracin neomycin polymyxin. She is now very lame, harder to move around but she can move herself. Continued drooling out of mouth all day into next. Could still eat. Began urinating laying on pad and it got all over her. Got urine sample from pad into vet. Eye gel glues eyes closed, makes a mess on face. 

5/5 Friday BD urine on pad laying down, on herself 5:30 a.m. Her vet said Thursday's urine sample has high amount of bacteria although not sterile sample. Dr gave Zenequin. Seems tired and not able to get into box easily. Drooling is worse, very wet. Eats only some. Eyes closing more, gel on face. Afternoon and evening-used the box by getting into it and only got a little wet with urine. 

5/6 Saturday -Was fine in the a.m. and ate but by the afternoon was clearly run down. Wouldn’t eat all day. Gave water PO often and she rejected it. Difficult getting food into her with syringe. Eyes squinting, second eyelids out on both eyes, drooling, open mouth, weak, tired. She hadn’t had a BM or urinated since Friday 5:30 a.m. Was afraid she was crashing or had blockage or fistula. Seemed cool, less pink. But BR was normal at home. Took her to vet school ER. Tested-despite clinical signs nothing tested positive. BR/HR/temp/BP normal. ER doesn’t know why she’s drooling. Or why feeling/looking miserable. She hates having her mouth touched. Bladder at ER was small but she wasn’t dehydrated in skin test nor in blood work so did not give fluids. Urine tested positive for bacteria so continue Zenequin. Left leg has good blood pressure but less muscle mass. Gave Onedansetron for nausea, suspect drooling nausea related. She ate very well for them-although a drooling mess. They cleaned her face and she looked perfect.

5/7 Sunday-finally urinated on a pad 2:30 pm as she lay and had to be cleaned. She perked up afterwards and ate and drank for five minutes. Then slept. Then by 6 pm. seemed run down again. Never urinated all day or night. Looks miserable. Ate little. Gave water PO. Drooling increasing, even more wet on body. Eyes squinting closed more. 

5/8 Monday Dr. Radiologist said tumor may not be shrinking, litter box issues related. Discussed Saturday ER. Needs followup MRI. Left leg has no feeling-blood and good pressure (ER) but wasting muscle tone. Mouth is held open slightly, drooling is excessive, tongue is out. Eyes squint more. Vet school radiologist doesn’t know why. Sort of dismissed it as mouth soreness. *They’ve never had a mouth injury during intubation. Bette looks miserable. *On Monday Dr. Radiologist said ER urine sample was not bacteria but would not say why the ER said bacteria other than ER doctor misread it. Said to end Zenequin. Said to end Buprenex, give Gaba 1ml BID and not just at bedtime. Decided to do 1ml Gaba post treatment, ½ ml dinner, ½ ml bedtime. Evening heard jaw click noise, open mouth more, tongue out, not comfortable. NO urine or BM since Sunday.

Finally urinated 3:30 a.m. Tues. on pad.

5/9 Tuesday-Drooling is worse. She’s wet, hard to hold down meds, jaw makes noise, heavy breathing, open mouth. BR was 80 in the morning when we arrived at vet school. It did not fluctuate while we waited for treatment. Dr. Radiologist said it was normal BR when in treatment. She later said she did not react when mouth and face touched-but then said that was done under anesthesia (so not a good indicator.) She was drooling post treatment and was dirty from struggling to eat and keep it down. Mouth was opened, tongue out. BR was excessive. They still released her. And it got worse in the car going home. Decided to go to local AEC. They put her on oxygen and that calmed her immediately. Blood work shows some iffy-most to do with breathing fast; and some white blood cell counts are low. Lungs clear, eyes irritated. Gave Optimax eye drops. Don’t know why mouth is opened, drooling, fast breathing. May be signs of pain or injury or anxiety. Took xrays of body and nothing is wrong internally-no fistulas, no blockages. 

5/10 Wednesday Gave Valium in a.m. before treatment instead of post treatment to help with anxiety if drooling is related. Radiologist concerned that radiation causing breathing issues but denies mouth soreness still. Finally urinated 2:30 pm on pad at home. We then saw Dr. Vet to review issues. She checked mouth, teeth and said it’s pain reflex but cause is unknown. Might be TMJ or nerve damage. Related to intubation likely. Said to give Buprenex post treatment to help with jaw pain and to use it as break through pain control as needed. Checked eyes-irritated, no ulcer. Said to use Topamycin for eyes post treatment, lube pre treatment. Bette BM 10 p.m.; urine by midnight pads and on her. Her mouth is opened, slack, drooling excessive, tongue out still. Gave buprenex at home. Can’t keep down Gaba with drooling and bitterness of med. AEC bloodwork-showed low WBC count, off RBC counts; and off CO2 counts due to fast breathing. And low potassium. Give Renal K. Kidneys normal. Decided to stop Onedansetron except as needed since drooling isn’t nausea related but likely pain. Giving more water by mouth. Eyes squinting closed. 

5/11 Thursday radiology treatment; said they will compound Gaba into pills (ordered from NJ pharmacy) because drooling is excessive and with bitter Gaba she can’t keep it down. She came home DIRTY from spitting up her food at vet school post treatment. Giving Renal k potassium and buprenex post treatment. She cannot CHEW today, can’t eat her dry food or treats. Drooling is worse ever. Decide to give only Buprenex because she can keep that down; Gaba at bedtime. Must be gentle with mouth, hold it partially closed to help her swallow. Careful not to choke on meds or aspirate liquids. Giving water by mouth.  Slept rest of day. No urine/BM. Eyes-especially right-keeps closing. Mouth still open/drooling.

5/12 Friday BM 3:45 a.m.; front legs seem weak-especially RIGHT front leg. And vet school called and said they suspect drooling now is from TMJ or trigeminal nerve damage. Could be inflammation or a tumor or damage. They say this has never happened before. 

Urine in crate by 1 pm. Once home. Giving tuna juice, water by mouth, buprenex. Decide to syringe feed AD. Renal K, etc. Right eye is not opening up as much, right side of mouth NOT sore but left is. We suspect her right side of face nerve damage. Eye does not respond to touch. Pupils look the same. Hard to lift herself and move with weak front legs. 

5/13 Saturday less drooling, less opened mouth, tongue only out a little. Must be careful when syringe feeding-hold mouth closed, go slowly, and with meds. She is eating some on her own. Clean her, protect catheter paw. Right side of face not responding as left to touch or pain. Suspect weak front right leg, doesn’t seem to resist as front left. Hard for her to move around. Right eye not blinking when touched. 

Urine and bm in box 9:45 a.m. A little wet. Eating on own in late day/evening and syringe feeding. 

5/14 Sunday Weight down to 10.13 from 11.11 a month ago, and 11.3 a week ago. Not eating on her own. Careful with syringe feeding. Mouth not as opened. Does open it and breathes fast but can mostly close it, especially when sleeping, or tongue is out a little bit. Urine/bm 9 a.m. in box and only a little wet.  Slept well over night. 

Pet Oxygen Masks

If you wanted various sizes of masks for oxygen for pets, Amazon sells many.

Pet Oxygen Tent/Chambers

If you wanted an oxygen tent-and learned how to use them-here is just one on Amazon; $319 for a small.

Pawprint Oxygen Cannister Kit for Pets

II don't think this was available-certainly wasn't recommended-when Myrna was alive or it would have been in our house. It's easy to use, safe to use; doesn't require a chamber. About $210 for a kit.

Pawprint Oxygen kits for dogs or cats.

Bette Has Evening Trip to ER after Radiation Weakens Her System

Saturday May 6:

So-despite doing better, today Bette decided she was not. She seemed fine this morning and ate. But hasn’t eaten, nor had water-except for the 9ml we gave every three hours-hasn’t eliminated, and both eyes are closing, she hates being touched, hated her mouth touched, was drooling. This happened over the course of the day. By 4 pm I thought something was wrong. I reread the information from her radiologist about how certain symptoms can appear and be normal; how others are life threatening. By 7pm I thought she was worse and since the drive to the vet school is an hour-they have emergency also, have her records, nothing needs to be explained except about what happened today-I took her then instead of waiting even later and risk coming up here with her at midnight. (We are not strangers to midnight visits to our regular ER.) 

They believe she is exhausted from treatment, and is dehydrated; she is not crashing-radiation can cause fistula-a hole-in the colon or bladder leading to death and those signs would appear quickly after occurrence, she would vomit and be lethargic and be unresponsive. Her eyes are closing and they will check both. They will do another urine test. They may change the antibiotic. They will do an ultrasound to make sure her bladder and colon are fine. She doesn’t have a fever. Breathing and heart rate are normal. 

She arrived very weak but once in the examination area, tried to bolt very fast on three legs anytime they let go of her.

She presented clinically with issues but NOT when tested. She had normal temp/breathing rate/heart rate/pulse; was not congested nor wheezy as I thought; and was not dehydrated-not in the blood work, not in the skin test. Her right eye no longer has an ulcer but both are irritated. Her kidney/liver/electrolytes were normal. The ultrasound showed no fistulas or blockages. She does have a UTI with a high level of bacteria, no crystals, normal pH. 

They thought the drooling and not wanting to be touched in the mouth was from nausea. Similar to humans with indigestion and burping, the mouth can get irritated and uncomfortable. They gave her a new med Ondansetron. Cerenia is to stop vomiting and helps with nausea, also. But when a cat presents with strong nausea that causes drooling and mouth aversion, this med is necessary. 

They will do a urine culture to see if we need to change the antibiotic. 

They did not give fluids since she was fine. 

They cleaned her eyes and face (the eye gel gets messy.) We are to continue use of the eye gel but we don't need to use as much and only twice a day (so far.) 

But why had she not eliminated? They don't know why. She had a small bladder and they withdrew some for the test. 

She ate very well for them after not eating all day at home and BEFORE she received the Ondansetron. She left looking more chipper for no reason other than having ate finally. She was perfectly fine once home. She received the new med and her bedtime Gabapentin and ate some more. BUT she still did not eliminate. 

Sunday May 7:

We got up this morning and was fine. We seculded her in the dining room on her own so that I knew if she was the one using the litter box. She ate, etc. She was tired but alert. She slept a lot. I could not express her bladder (I'll need to learn how.)

Then at 2:30 she got into the litter box, and finally urinated-in the box, over the box, on the pad; then moved out of the box, laid down and finished urinating on a pad. She was soaking wet with urine on her backside, legs, and tail. I used a pad to wrap her up so that I could carry her to the laundry room without dropping urine all over. The pad also soaked up a lot of it from her. I gave her a bath in our blessedly very deep laundry room sink from which she could not jump. It also has a hose. I sprayed her down while holding her up in one arm because the bandaged port line in the front left leg cannot get wet. I shampooed and rinsed. Then I wrapped her up in a large towel to dry her, took her outside and sat on the deck in the sun for about 15 minutes, turning her over every so often to dry her. Then I brought her back inside, and she laid on the blankets while we finished cleaning up the pads. 

She also eventually began this afternoon to drink water out of the bowl on her own again after not drinking all of Saturday. 

I'm not sure what happened yesterday. Is it possible she did not get enough of her prednisolone? Maybe I didn't see an air gap that can occur which decreases the amount in the syringe. (Wedgwood sends orange syringes to go with their orange bottles.)

We continue to take this one day at a time. 

Bette Has Issues This Week with Radiation Treatment

Bette: developed an ulcer on the eye due to being under anesthesia each day. That can happen because the eyes don't close and can dry out. They are supposedly using drops to keep the eyes wet during treatments but I guess it can still happen. They gave us a eye gel to use for a couple weeks. They do a full physical check each day before treatment and that's how they discovered the ulcer.

She's had trouble using the litter box this week, stepping in but not getting her butt into the box, then urinating out of the box. I thought it was due to treatment, the tumor weakening her rear legs, etc. I captured a sample and took it into the regular vet on Thursday. The results showed high level of bacteria, some blood (not seen visually this time unlike two weeks ago) no crystals, high WBC. So, she's now on Zenequin for ten days. BUT today after treatment (before Zenequin) she blessedly used the box twice by getting into the box, butt and all. She did get a touch of urine on her rear leg so we will continue to have to clean her. 

Bette Radiation Treatment Update Last Two Weeks

May 2-3

Bette is doing well. She is having trouble urinating in the litter box but we have pads around the box so she has gone on those. But it seems she still has no blood in the urine or a UTI but we will continue 9ml water PO (by mouth), Buprenex .25 or so, and Methigel 2x a day. She has not yet gained use of her lame rear left leg but is able to quickly get around and up and down furniture. She is eating well, maintaining weight after losing 9oz in late March-April. We continue to put her in different rooms so that she is not shut up in just one (she usually spends the day post treatment in the enclosed dining room although the French doors allow her to see us; and her siblings hang out with her after she has rested.)

May 1

My husband drove Bette to the vet school for treatment today and will drive her up on Friday as well.

I gave him notes on the drive-time it takes, when it's boring (long, flat section), the dead animals he should try to ignore (there are so many!), where the police hide in their HUGE blue SUVs, the scenery (long, flat, boring), exactly when he'll be tired, exactly where and when there will be traffic. I even told him which gas station to stop at, the blond cows at the yellow house, and the geese and goslings in the marsh along a road. I told him which left turn to take to get to the vet school, to stay in the left lane and not the right when going down that street, and how to hand her off to the attendants. All of which he rolled his eyes and scoffed at until I told him rather forcibly to PAY ATTENTION! And then when he got home he said that I was right about almost all of it, but did I mention this one spot? Yes, I had but he must have still been scoffing.

April 27

A good day for Bette. She is over the obvious blood in urine but we continue to treat it as if still there. She didn’t sleep well Tuesday night so we increased the Gabapentin from .50ml to .75ml (the script calls for 1ml) and she slept well and used the litter box without crying or being disturbed. And she was able to get around (too much med and it makes cats wobbly.) She did well at today’s treatment.

The drive is now becoming automatic. And the wait from 8:30 to 11 or so (today we left at 12) is flying by. I read the news, my book or magazine, and suddenly she’s done.

But I still need a break. My husband will take her Monday and Friday next week.

April 26

So far this morning, Bette is doing much better. Her urine does not appear to be showing any signs of blood. And she used her litter box. We will continue to do the water by mouth every 2 to 3 hours, the extra Buprenex, and the Methigel. And, if it happens again, then I will contact her regular vet who will give her Zenequin . But I think right now everything is going in the right direction and that her bladder is going to hopefully calm down.

April 25

Bette possibly has bloody urine. I saved the pad to take today to treatment. She went at bedtime 10:30 pm in the box but over it onto the pad. It was light red orange. She had an accident in the crate on the way home and it was very dark orange and her urine has been stinking since Friday. So I didn’t know if yesterday it was the radiation treatment but last night it was rather dark looking. But since she only went one time, I didn’t think it was necessary to take her to the ER. She received her bedtime pain med which may have helped. We’ll know more later.

So-The vet school checked and thought she had no bacteria in the urine and suggested not giving antibiotics. They didn’t give sub q fluids to wash out the bladder and any irritants or bacteria that might be there but did give the regular amount of fluid she receives each day with her treatment. They did not offer me guidelines to address the issue. I’ve never had a vet dismiss this problem. They thought it was just stress since she does have a history of idiopathic cystitis. So I called her vet office once home and left a message with them asking her to call me Wednesday when she’s in. And that wonderful woman called me on her day off!! She said if this continues, she’ll prescribe Zenequin antibiotic because there could be bacteria and the pad wasn’t showing it. If it clears up, then Zenequin worked. Meanwhile, give more Buprenex (pain relief/inflammation reducing), water by mouth (we do 9ml a few times), and Methigel to improve the ph level of the urine. The radiologist did finally prescribe Gabapentin for night time.

I would have taken her to the ER last night had she continued to urinate and was in pain when urinating. We have had to do that years ago with Baby, Bette, Elizabeth; and Myrna-with HCM-was frequently in the ER after 8 pm.

April 24

Bette-good Sunday day. Slept well overnight. Good Monday so far. My husband and I changed my schedule since getting up at 4 am was exhausting for me. It’s amazing how one more hour and a half of sleep can feel great! Up at 5:30; shower and dressed; downstairs to make my breakfast and tea-now to go-and her meds; give her meds, crate her, finish gathering whatever; go to car. By 7:25-five minutes late but still ok-in the car.

He will medicate and feed other four cats, clean boxes, do waters. When I’m home I’ll empty dishwasher/put in dishes, sweep; feed and medicate Bette (as soon as we are home). Then do my list of things to do.

He has hours of vacation he can use that allows him to take off an hour or so in the morning to care for the cats. He will be up earlier to take care of the cats for the days when he has an 8 am call.

Granted, I’m not a wash and go person. If I were, I suppose I could roll out of bed, shower and dress, etc at 6:30. But that’s never been me. Not that I put on makeup for over an hour but it’s not five minutes either.

April 23

Bette had a good Saturday of moving around or being moved and resting. Last night she slept very well. Not sure why compared to a restless Friday night. She used the litter box. We didn’t give her extra Valium. She slept on the bed and then the floor. So-I slept well for the first time in days, including a restless Friday night. The weekend break has been good for both of us. After she urinated in the cat house Friday night, and the urine got on the floor, and after cleaning the floor three times, I covered the floor with pads, even under blankets. You can see her sleeping under the rocker and see how small is the room.