Jimmy Is Sick Again This Month

immy presented this morning with diarrhea with blood and vomiting.

He was sick a month ago with blood in diarrhea and some vomiting and lethargy and poorly eating, and some weight loss (minor) which I posted back on April 11, 2017. Home treatment calmed the diarrhea but he was still lethargic so he saw the vet. His Cobalamin fasting and Folate fasting and Pancreatic Lipase tests were normal (no sign of pancreatitis; good absorption of nutrients, etc.) Blood work CBC/chem panel had questions but no definitive answers. He had high cholesterol; normal but edging up fructosamine test (for diabetes); high albumin; proteinuria of 30 in his urine. Diabetes? Cancer? Organ inflammation (like pancreatitis)? Kidney disease? Poor adrenal gland? Albumin is related to kidneys or dehydration. For cats it's typically dehydration but in humans, failing kidneys causes high level of albumin to be in the blood stream. High proteinuria means poorly functioning kidneys. Or it's a matter of how the urine was drawn with a needle. Vet had no concerns and said let's monitor and do a scan.

Next step was an ultrasound which he had Tuesday. They also took his weight. He dropped 11 oz in a month despite eating well and three times a day. What's the cause if he's eating as much as usual and if his Cobalamin and Folate tests were normal? The ultrasound showed no issues with heart, stomach, intestines, liver, pancreas, gall bladder, kidneys, or bladder. Again, vet said monitor.

Then today, we woke to find him sick with vomiting and diarrhea and blood in the stool. We scooped out samples; called the vet; and I took him in. They gave sub q fluids, a shot of Cerenia (calms stomachs after vomiting and helps cats feel better) and by the time we got home he was much better and has been eating. He is to take antibiotic Zeniquin for 30 days to cure any gastro issues. He is to eat a non-fish based food and we might try a hypoallergenic food. The vet thinks it may be a food allergy, including the weight loss but that there may be bacteria in the gastro system. For now I will stop all supplements except lysine and potassium just in case any are causing weight loss (however, he's been on them about a year with no issues.)

Jimmy at the vet

I think it's the herpes virus trying to come back stronger. When he was initially sick in 2009-2010 before we got it under control (with lysine and Forta Flora and vet trips every two months or so when he was too sick for home treatments) the virus would hit on schedule each month at the same time. It comes back under stress but there wasn't stress that we know of in March or early April. I think the virus has been appearing and I didn't take it seriously. He has had black discharge from his eyes-very slight-but it has always been a sign of the virus. While I've given him extra lysine, perhaps it was not enough. Perhaps he should have had antibiotics in April. Perhaps he had bacteria in his system that gets active with herpes or stress. Who knows. When he was given antibiotics in 2009-10 to fight the attacks, he presented with vomiting, diarrhea and a fever. No fever this time. But with blood in the stool, the belief is there might be bacteria. Luckily, stool samples were free of worms-hook, round, and something else (but not tapeworm: those you see from the rear not in the stool sample.)

And Jimmy is a sensitive boy. He was the one hit hardest and hit first with the herpes virus as he was the first sibling to be spayed/neutered (neutered of course.) He reacts strongly to smells and stress and changes and viruses and bacteria.

For now he is secluded where I can monitor if he's eating or has diarrhea and can seclude him from the other cats. I'll keep him secluded today and maybe tomorrow. I'll give him some rice water later to help bind up the stool.

And I researched glycerin (April 21, 2017 Facebook post) which is used in Jimmy's prozac. It has carbs-not good for prediabetic, diabetic cats. 1 gram of glycerin has 1 gram of carb. He receives one tenth of glycerin per dose so only one tenth of a carb. No need to change his medication.

New Drug Might Decrease Effects of HCM

http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0168407

http://science.sciencemag.org/content/351/6273/617

New drug might help cats with HCM: "The novel drug, MYK-461, proved effective in a study of five cats with a naturally occurring form of inherited hypertrophic cardiomyopathy (HCM)...eliminated left ventricular obstruction in five cats with HCM...MYK-461 was already shown to stop the thickening of the ventricle walls in mice."

Here's the paper about the new trial drug discovered for the treatment of HCM. Understand the drug treats obstruction, not something all HCM cats have; and it may not decrease the progression of the disease, just some physical issues of the disease. But only time will tell. Keep an eye on this drug. Let me know if you read more about future developments. I'll try to stay aware of it. "Treatment with MYK-461 reduced contractility, eliminated systolic anterior motion of the mitral valve and relieved LVOT pressure gradients in an exposure-dependent manner. Our findings provide proof of principle that acute reduction in contractility with MYK-461 is sufficient to relieve LVOT obstruction. Further, these studies suggest that feline HCM will be a valuable translational model for the study of disease pathology, particularly LVOT obstruction."

Jimmy Needs Prozac Adjustment

Once again, after about a month with the increased Prozac (I'm assuming because Prozac can cause aggression), Jimmy is once again attacking his sisters. Never sure of the cause but something happens in his head and he gets angry and attacks. This isn't just swiping and hissing but a full on attack. Fur flies, cats cry, and when two are fighting, they all get involved. And it happens in a flash. So, I will dial down the Prozac-this time to .18-and see if he improves. Problem is, with the lower dose, he then begins to have accidents which we've seen since about September (the last one being 11/26 when he went against a window.) Maybe I'll try a week of a low dose and a week of a high dose and alternate. I could tell a change was coming, though. He has always had these maniac/depressive mood swings when on Prozac. He would spend a couple weeks very happy and then begin to slow down and not be active or involved, and would seem lethargic and disinterested in his environment. So, I would adjust the Prozac. Since September, the depressive mood swing has led to attacks against his sisters (because those are the cats he's near) and going out of the box.

Echos Necessary Before All Surgeries to Detect Heart Health and Avoid Problems

When writing up a medical history list of Bette for the cardio visit, I came across her 2013 dental surgery record. It was written for her and Cooper's dental surgery record which they both had had the same day. I realized in reviewing it that I had not taken either Cooper or Bette to the cardio for a scan prior to surgery. I believe it was because at the time Myrna was so sick, and we were spending so much on her care, and now were faced with $1000 for two dental surgeries, that spending another $600 for cardio echos was going to be out of reach. And yet I wished that I had spent that money.

Cooper had had an echo summer of 2012 and was fine. He had dental surgery a year later in 2013 and afterwards, began to slowly exhibit symptoms of being ill but symptoms I attributed to his reoccurring hypercalcemia (high calcium rate) which we had battled the year before and which had not returned. Blood tests didn't show anything other than a minor increase in calcium. Months later, March of 2014, after another dental surgery, he did not bounce back and we took him to the vet two days later, only to discover he had CHF. We rushed him off to the cardio. He would be on heart meds March-July and die of CHF in July.

If I had taken him to the cardio in June 2013, we may have caught early signs of heart disease. And certainly, he had heart disease by March 2014 which an echo would have caught and we could have avoided dental surgery and the onset of that first CHF-even if the outcome would have been the same in the end.

From now on, every cat gets an echo before surgery.

Bette Davis Visits Cardiologist for a Checkup

Bette Davis yesterday, finally had a cardio check-up with the famous Dr. D that was Myrna's vet cardio. She was the last one Dr. D had not yet met. Bette passed with flying colors: no issues, and she was well behaved.

Going to the vet cardio's office brings back mixed feelings. First, apprehension over what will be found-the same feeling I had when I took Myrna. Then, memories of being there so many times over the six years with Myrna when she was seeing the cardio, coupled with that feeling of "I should be back in three months which was the routine with Myrna but that routine no longer exists." Then sadness because that building houses the ER where she died.

Assuming no one gets sick, I won't return to the cardio's for a few months. Late next summer, Katharine and Roxy will return for annual check-ups: Katharine has a heart murmur and Roxy has an anomaly that needs monitoring.

Despite the mixed memories and feelings, it is always great to see the staff and chat with Dr. D about her life and family; and talk to Julie, the much respected, talented vet tech who worked with Myrna and me for so many years. She recently and unexpectedly lost a pet dog to cancer. She brought him in for a scan; cancer was discovered in the stomach; and she put him down that day. But there was also joy-her son is now two and she showed me photos and a video.

Jimmy Stewart Update Urine and Frucotsamine

Jimmy update: doing well this week on .19 Prozac (up from .17.) The Solequin calming treats may have helped so we'll get more. Urine is free of bacteria, glucose, and crystals which is good. Fructosamine test for blood sugar was in the normal range at 208-although it could be lower. Kidney values-normal but ticking up. Need to keep an eye on him; hydrate more (albumin shows dehydration); and maybe some light kidney support vitamins if I can sneak them into his food.

Jimmy Accident Out of Box

Tuesday, Jimmy went out of the box against the living room window. Yes-the window, window sill, under the window to the foam insulation, behind that to the screen and sill on the outside; down the wall, under the baseboards, through the cracks between floor boards, down the chest, under the legs, etc. It took an hour to clean with my husband doing the outside work and me cleaning up the mess inside. And we both cleaned and moved the chest (in place because you don't want to inadvertently spread urine.)

Last week, he went against the wall at the top of the landing, a favorite place of Myrna's. That was easy. This was beyond difficult.

After wiping up the urine, I used cleanser, then bleach on the wood, window, screens, floor, chest, etc. Where it might actually bleach out color, I used sparingly. But the wood interior sill wouldn't stop smelling so I kept soaking it in bleach. Finally, I used a wet paste of baking soda and have left it soaking for a few days. I'll eventually wipe it up and vac and sweep and let it dry and make sure the smell is gone.

He has had accidents a few times this summer but on pads around litter boxes for the most part, nothing this horrifying since his issues first began in 2010. When he first began urinating out of the box in 2010, we tried everything-new boxes, new litter, calming sprays, changing placement of boxes, adding boxes, monitoring his use of and the time it took for him to go; monitoring behavioral cues; using behavioral training techniques; finally adding Prozac to the mix. We've titrated up Prozac as needed as time went by, all with success. He began to be normal by 2013, and only had one or two accidents against litter pads in the last two years. Then this summer he went about four times, and has gone three times since fall including this week. That's about seven accidents in six months, more than in the last three years put together.

I took him to the vet yesterday for blood work of CBC/chem panel and fructosamine to test his sugar levels as he is pre-diabetic (discovered a couple years ago.) If there is too much sugar in the urine, the bladder fills quickly and the body wants to "dump" it as soon as possible, and the cat feels it must go immediately. (And if there are reasons why they choose a certain site, it's difficult to discern as to why they chose that spot other than it might be cool or comforting-if they have a UTI for example. But why a window?) The CBC/chem panel shows some dehydration and some ticking up of kidney values. Those can be related but typically seen only in extreme cases of dehydration and a decline in electrolytes. And there are none. And his SDMA kidney value test was normal. We will get the fructosamine results in a few days.

Meanwhile, we are trying a calming treat solliquin the vet suggested. We add it to his food. http://www.solliquin.com/

The vet also suggested we increase the Prozac. We had in August but by late September, he began showing signs of anger management issues and fighting with his sisters (psychotropics can increase anger as well as increase feelings of happiness.) We decreased the dose. He was fine. But now he's had two accidents. We increased it again to .19 from .17. She suggested we get it over 2.0 and if he gets angry, increase dose to see if he becomes less angry.

What is difficult is that we started from zero in 2010 and built a successful approach that included training, boxes, litter, paying close attention to cues, and meds. There is no other successful med other than Prozac, that if Prozac stops working, there is nothing more effective. In fact, most other meds are less effective for controlling anxiety and litter box use. It was working. But if it is no longer working, and we have done all there is, what more do we do to solve the problem?

Pray of course. Increase Prozac if possible. Clean more thoroughly (the house is clean but I have not washed walls and baseboards in months and probably should since Roxanne has been running around the house and is no longer confined-not that she's had an accident but to make the place smell more neutral.)

I'll ask the vet about any concerns regarding his kidney values. May need to pay attention there. And he needs a urine test and he did not have a bladder on Friday.