I have not had the time nor inclination to make blog posts since the last one of May 2024. I thought I had kept up with this but no. I have posted items to the cat Facebook pages, however.
There has been a lot going on. As of March 23, 2025, Jimmy and Elizabeth and Roxanne are still with us.
Roxanne and Elizabeth developed CKD.
Elizabeth developed it in March 2024 and we struggled through most of 2024 with stabilizing her issues. She would not eat. We used cyprohepatidine and mirtazapine and Mirataz ear gel to stimulate her eating. When she was feeling sick, neither medication would work to make her eat. The Mirataz ear gel did not really work well but it did greatly irritate her ears. They became red, dry, scaly and we had to stop using it by the end of the summer. We began hand feeding her and continue to do so as needed. We struggled to keep her weight above 11 lbs. I put her on numerous supplements and vitamins as I did for Myrna Loy for her heart and for kidney support (see Vitamins and Supplements and Goop mixture here at the blog in word searches, Medication tab, etc.) The vet started her on once a week fluids from March to June. Then we began twice a week fluids. We also put her on Zenequin antibiotics because the fall ultrasound showed that her kidneys were inflamed. Finally, by November, she began to eat something on her own, and 1/4 of Mirtazapine pill helped her begin to eat on her own. Blood work from the fall and currently shows slight improvement in kidney blood values. She is more of a CKD stage 2/3 than stage 3/4 now. She continued to do well until late January when she stopped eating on her own. We fed her by hand four times a day-40ml per time because only 30ml or so makes it into her mouth. Her weight remained stable. In March she began eating something on her own and began responding again to Mirtazapine which helps her eat enough on her own that we hand feed her 20ml four times a day-as long as her weight remains over 11.10 lbs. I give her 1/4 Mirtazapine once a week. It tends to wind her up a bit but eventually she settles down and eats. We do not want her to lose weight and fat and muscle mass. We have seen cats before lose weight and get below 10lbs and get very sick and go into end stages of life, and pass away once they begin to lose fat and muscle mass. She is also on Zenequin (originally Baytril which she did not tolerate)-first for one month, then two weeks on, and two weeks off. This was recommended for her inflamed kidneys and gastro issues. Elizabeth has a leaky tricuspid valve that appeared in 2024 and we continue to monitor. But she has no CHF or HCM issues.
Roxanne: She has had a difficult few months. She was showing early signs of something-CKD stage 1; gastro issues; she had been tested positive for FIV in 2023 but subsequent tests in 2024 showed no infection. We ran the ELISA and PCR tests three different times. She saw the internist at a hospital in October because of questionable blood values, possible FIV, and how she seemed run down at home.
(Hospital report:)
"DIAGNOSIS:
1. Chronic hyporexia, vomiting, lethargy, weight loss r/o chronic inflammatory enteropathy, IBD, small cell GI
lymphoma, infectious (toxoplasmosis, less likely fungal, other), less likley EPI
• Diffuse small intestinal muscularis thickening
Low normal to mild neutropenia r/o individual variant, spurious, contributing FIV, less likley immune mediated,
consumptive
Biliary cystadenomas
Chronic kidney disease (stage 2)
• Left pyelectasia (3.2 mm)-suspect CKD, less likely pyelonephritis, partial obstruction
Discordant FIV positive results
Focal thickening base of L interventricular septum (heart murmur
"She was seen 7/3/24 for weight loss and hyporexia, with an ongoing history of intermittent vomiting that would respond to cerenia. CBC was normal (Neut 3976). Chemistry showed azotemia (Creat 2.3, BUN 33, SDMA 17, otherwise normal (P 4.2, K 4, Alb 3.3, Glob 4.7, ALT 29, gluc 88, choles 244, spec cpl 1.3 ug/dL, T4 2.3 ug/dL). UA cysto USG 1.028, pH 6.5, 30 mg/dl protein, no glucose, ketones, bili, quite sedi. BP was normal (130-162). Baytril was prescribed for one month though lead to anorexia after about two weeks and was stopped, then appetite returned after also receiving an unmeasured amount of mirtazapine.
...9/11 she was seen for report blood work and was noted that she overall was doing better than the prior month, with main concerns including intermittent hyporexia, lethargy, and weight loss. CBC showed mild neutropenia 2147, lymphopenia 8742, WBC 3.2, otherwise normal. Chemistry showed creat 2.1, SDMA 17, otherwise normal including T4 2.4 ug/dL. Owner requested aldosterone level due to concerns with prior pets which was low 90 pmol/L (194-388) with normal K 4.8.
She is struggling with lethargy and inappetance, though that has improved somewhat. Owner is providing supplements to address her high potassium (see above). Owner is handfeeding...This week she has needed hand feeding at night, her appetite is intermittently decreased. She is fed in the morning and she will graze all day, then offered at night time, usually hand fed, and food is always available overnight. If she doesn't eat her breakfast than the hand feeding will start. She comes right away to the bowl, but walks away. Owner had tried Cyproheptadine but didn't see much response for appetite stimulation. The mirtazapine isn't working as dramatically for her as it does their other cat. Her weight is stable (around 10.6 lbs). She used to vomit frequently, but owner started her Cerenia 1/2 tab SID almost a year ago and vomiting has resolved.
Biliary cystadenomas. Chronic kidney remodeling. Left pyelectasia associated with pyelonephritis or CKD. Ureteral distention was not visible to evaluate for a ureteral calculus. Abdominal radiographs could be performed to evaluate for a ureteral calculus not visible sonographically (Radiographic images are not available to me).Altered small intestinal wall layering. Rule out IBD, neoplasia.
... ASSESSMENT: Based upon Roxanne's chronic gastrointestinal localizing signs it is suspected that she has primary intestinal disease...revealed stable biliary cystadenomas, chronic kidney remodeling, mild dilation of the left renal pelvis, and diffuse small intestinal muscularis thickening. The renal pelvis (outflow of kidney) dilation is suspected to be secondary to chronic kidney disease (CKD), though can be seen with infection, and is less likely secondary to partial obstruction and given the degree as well as lack of ureteral dilation.
...It is common for cats to have intermittently mildly decreased to low normal neutrophil counts that doesn't necessarily represent pathology. Severely decreased neutrophil counts can be seen secondary to overwhelming infection and immune mediated conditions, as well as primary bone marrow disease. Roxanne's neutrophil count has not been low enough for this and may be within her normal fluctuation, though if she does have FIV this could be a contributing factor...we have submitted toxoplasmosis levels (which can rarely cause decreased neutrophils and can infect the GI tract) as well as a GI panel (to assess for decreased vitamins supporting a malabsorptive process, pancreatitis, or issues producing digestive enzymes), both are pending...
That being said with her chronic GI signs and intestinal thickening primary intestinal disease is likely. The most common processes are chronic inflammatory enteropathy or small cell GI lymphoma. The causes of chronic enteropathy are not well known but are suspected to be a result of an abnormal response by the body to certain intestinal bacterial (uncommon) or dietary antigens/proteins (common), or immune driven inflammation (common). Treatment often employs diet (hydrolyzed, novel) and for some steroids or immunomodulatory medication and supplements if deficiencies are present based on the GI panel. While small cell GI lymphoma is cancerous, it is typically a slower advancing process, causes signs, blood work changes (often none), low B12, and intestinal thickening very similar to inflammatory bowel disease. However this process can only be distinguished from chronic enteropathy based on biopsies +/- additional tests performed on biopsy samples. Cats with therapy for small cell GI lymphoma (which in part overlap with inflammatory disease), if they have a positive response often have a median survival time (50% do better, 50% less) of ~2 years. Treatment mainly involves steroids and (generally oral) chemotherapy if tolerated..."
RESULT:
Roxanne was given steroids for her gastro issues and seemed to do well on steroids in October and into November. She began eating a lot due to steroids and drinking a lot. Then she began to drink excessively into November and getting her chest wet (from putting herself into the water bowl) and began to seem tired and was not moving around the house as much as normal. Then she began to not eat as well as she had been and her weight began to slowly drop. There were many signs that she was not doing well. In early December I took her to the vet for blood work updates. Her formerly NORMAL blood work was sky high off the charts, showing CKD stage FOUR and diabetes, and internal damage. Her body could no longer handle the steroids and the steroids had damaged her kidneys.
Glucose: 403-September was 93, normal high is 175.
Creatinine: 1.9-normal is below 1.6.
BUN: 44-normal is below 35.
Cholesterol: 504-normal below 276.
Triglycerides: 3308-normal is below 90.
Urine had glucose and protein indicating that the kidneys could not filter properly and items were spilling into the bloodwork, and that her body had so much glucose that it was not being filtered by the kidneys but spilling over.
We quickly titrated the steroids down for the next two weeks. I increased her fiber source to help absorb the cholesterol and triglycerides (high cholesterol and triglycerides are due to kidney/liver/diabetes/steroids.) And I increased the fish oil which was also recommended to help.
We fed her Royal Canin glycol balance diabetic food as well as Hill's KD and other renal diets until February when her glucose levels appeared normal again. Now she is fed renal diets only.
When she stopped eating in January, we began hand feeding her four times a day-and continue to do so. Hill's KD is easily syringed up to hand feed.
She began receiving fluids twice a week with Elizabeth and continues.
She was also put on Zenequin (could not tolerate Baytril) and received it for a month, then two weeks on and two weeks off. She continues to follow this regime.
Finally, in March her blood work improved and she now seems to be at CKD stage one. BUT she will not eat on her own. She still seems lethargic at times. She does not always choose to roam the house as she used to prior to steroids making her ill in late November. We can only continue hand feeding, giving supplements, etc. and monitoring. Her latest gastro ultrasound shows no issues.
VARIOUS OTHER ISSUES:
Ears-all three have had ear issues. We use Tresaderm or Animax. I use this when the ears feel hot or look hot, when the cat reacts by shaking their head when petted, or is found scratching at them. Since the girls are in enough, the vet has checked their ears often. There are no mites in any of the three AND we use Revolution (Revolution Plus, also) for monthly flea/tick/worm/mites protection.
All three have had eye issues. We use Tobramycin for conjunctivitis, running eyes, redness and irritation.
AS FOR JIMMY STEWART: that will be a separate post update.
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| Elizabeth |
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| Jimmy |
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| Roxanne |
