Got some plain yogurt from the Meijer last night; of course they only had the McLargeHuge size, so that's what I bought. Thankfully it was cheap at about 2 bucks for the McLargeHuge container of the stuff. Stir it up well, dish out a couple of tablespoons of it into Lars' gushy fud bowl and present it to The Prince...

...and he licks at it like three times, rejects it and walks away! :/ Mkay. I try a taste of it. Okay, it does taste kinda flat and gross. Perhaps if I doctor it a bit with some of the handy dandy bottle of clam juice I've got. A few more sniffs, a few more licks, then rejection and walking away.

Harlow, on the other hand? He LOVES both versions of the stuff--plain or doctored with juice, he's totally down with the yogurt. Figures, right? ;) That knowledge could come in handy if he ever encounters any tummy troubles, LOL.

So...

I had one unopened jar of chicken baby food left over, so I dished out about two tablespoons of that and mixed in 1/8 of a teaspoon of benefiber very well into that to see if Lars would deign eat same with that tiny amount of benefiber added to it. At first he was reluctant to eat it, but grew more enthusiastic after he got going and he finished the portion, licking the bowl clean as a whistle! So at least I might have that trick up my sleeve...

Another trick I'm contemplating trying in the dairy department is vanilla ice cream. I've yet to meet a kitteh in my life who did NOT enjoy a bit of vanilla ice cream. Every single cat I grew up with loved the stuff, as did every cat that owned me that came before the cats that own me currently. So I'm hoping the trend continues with Lars! That, and if he doesn't like it at least J and I can enjoy some vanilla ice cream, LOL.

Sweet Bast, this whole special food thing with Lars is SO VEXING!!! :( But hey--He's my Special Snowflake, my Floofy Floofy Little Prince, LOL. I expect nothing less from His Royal Highness... ;)
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His personality is back full-tilt boogie--he's gone back to hanging out on the cat forts and to ripping ass down the hallway after his "siblings", two things I was really waiting to see before I declared him out of the woods. I still have him on the Mirtazipine for appetite every 96 hours, but his appetite doesn't seem to wane at the end of the dose, so I think I'm going to start tapering him off that med and see what happens.

So, the vexing part...

He's decided to reject any gushy fud that has the probiotics and/or the benefiber in it. Flat out, stone cold reject any of it, regardless of type, regardless of how I doctor it up, regardless of how hungry he acts. Tested the theory by offering him gushy fud without anything added to it and he gobbled it down with no issues. Little fucker. :/ Fortunately he's still downloading okay with the 5-6ccs of Lactulose we give him daily, so it's not totally an issue, but...yeah. He still needs at least something else to keep his guts moving...

Called VCA internal medicine about this new conundrum, and was told to try plain yogurt for its natural probiotic effects, or, if that fails, anything else dairy based that he'll deign eat. Alrighty then, we can do that. I know he likes milk a lot from my past learnings, so there's that at least. Was also told to try to try to at least try to sneak in one dose of the benefiber a day if I can manage it. I know the probiotic's straight away right out--he always rejected his feeds with it in it, but sometimes ate his feeds with just the benefiber, so that's pretty telling right there.

Sigh. Finicky cat is fucking finicky. Little shit. :/ Oh wells, a cat mama will do what a cat mama's gotta do...
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Well, my thoughts on the repetition causing food apathy came true--this morning's helping of Spot's Turkey Stew was largely a big old bust. He barely touched the stuff, at least the first go at it. I even left the can out on the counter for over an hour to warm up a bit before serving it to him. He showed some initial interest, but it waned quickly. Sigh.

In a little while I'm going to try zapping it in the microwave for a few seconds to see if a little bit of warmth will coax him into eating more of it. If not, then I'll have to dig into the selection of other gushy fuds I've got stashed and see if he'll eat some of one of those. He's definitely hungry--he ate all of his breakfast allotment of kibble with great enthusiasm, so it's not that his appetite is faltering at all. It's him being A Finicky Bastard.

Yay me? Yay us? :/

Sigh...again...

Back to the drawing board...
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Got a wide variety of gravy and broth heavy gushy fud selections between Petsmart and Pet Supplies Plus yesterday. Petsmart yielded Fancy Feast Gravy Lovers flavors I've not yet tried with Lars just yet (beefy ones) and some of the "classic" line of broth based packets of food they offer in fishy and chickeny flavors. Pet Supplies Plus had the Halo brand, which came highly recommended by a good cat owning friend, so I picked up some cans of Spot's Stew in a couple of different flavors, largely because the Stew part of the name seems to infer that it'll have a stew/gravy like quality to it...

Tried the Turkey flavor of Spot's Stew this morning and was surprised to find the consistency of the bulk of it was like a very thick gravy to a thin pate'. :/ Additionally, it came complete with a complement of vegetable matter mixed in with the gravy and meaty pieces as well, which I'd read on the ingredients on the can, but somehow pictured they'd be diced smaller or something. Lars isn't known to prefer pate' type food, and he's never had food with veg in it before, so I was sorta wary of giving it to him, but I figured since I opened the can and didn't want to just throw it away without giving it a good go, I mixed in the probiotics and the benefiber and set the bowl of the stuff down in front of him...

He absolutely shocked me by totally scarfing that stuff down like a mad man! :) He snarfed down the gravy/pate' and meat and even some of the smaller veggie bits and ate the gravy/pate' off the bigger veggie pieces that he left behind! It was a sight to behold! I haven't seen that sort of enthusiasm for gushy fud in at least a few weeks! It was a miracle!

Tonight for his dinner I served up more of the same; he didn't quite have the same enthusiasm but he still ate with pretty good gusto despite there being more and larger veggie bits in with this particular batch of chow. He, again, ate all the gravy/pate' and meaty bits for the most part. There were more leavings tonight, but I think that had more to do with the extra veg getting in the way than any problem with the bulk of the gravy/pate' medication vehicle.

He'll get the rest of the turkey can tomorrow morning. Hopefully his enthusiasm for it won't wane at all with the repetition. Next up after this can will be one of the brothy packets. Will keep you posted on how things go!
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He's now decided to, one by one, reject his formerly favorite flavors of Gravy Lovers gushy food. The other day he vetoed the turkey, and today he rejected the chicken. At least he's still seeming to want to bother with the salmon, which is good, but...yeah.

I need a gravy/broth laden gushy fud as a vehicle to deploy the powdered probiotics and the powdered benefiber that he'll at least eat the gravy/broth off of. I tried Friskies but theirs is woefully low on gravy/sauce, making mixing the powder(s) in a bit difficult. I know either Friskies or Fancy Feast has a line of broth oriented gushy fuds that I'm going to look into later today, so that's my next line of attack.

Internet Cat Hivemind--any ideas for gravy/sauce/broth bountiful gushy fuds I can look for??? Any and all ideas are welcome, and damn the cost!

Otherwise he's doing about the same. Still not quite back to normal either in personality or in the downloads department, kinda maintaining a status quo of sorts in the middle ground of things. This leaves us both hopeful for further improvement and frustrated that it's not forthcoming more quickly.

Sigh. He *had* to reject the Gravy Lovers shit. He just *Had To*...
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He's turning into a finicky eater, the big dumb floof. He's seemingly growing tired of his Gravy Lovers gushy fud, eating only the gravy off the top of the many meaty bits (which, frankly, is fine since that's where all the benefiber and probiotics live), so I decided to go out on a limb and try Friskies gushy fud "with sauce and gravy" type foods. Tried one can of ocean whitefish in sauce, which barely had any sauce whatsoever; I did manage to mix in the supplements and he did eat the gravy off the meaty bits, but very few meaty bits. Sigh. Damned cat--at least he's still eating a goodly amount of kibble so he won't completely waste away...

Downloads have been a bit dicey as of late; yesterday he took his time again and waited just over 24 hours to give me some litter box love. It was A Good One, though, so that was a good thing to see. It's just frustrating that I'm giving so much medication/supplements to get him to go and he's barely producing. I know, I know--Dr. M says it can take a few to several weeks for things to right themselves, but...yeah, mama's getting antsy.

His personality/affect is steadily coming back still, which is also nice to see. He's been a bit more feisty than we'd like to see as a result of the not-so-positive side effects of the Mirtazepine, but he still needs that for the appetite boost, so we'll keep giving it to him every 96 hours. His feistyness manifests itself in wanting to argue and promote fisticuffs with his other "sibling" cats, which is maddening to say the least. We've had to keep the water squirt bottle handy to break up the squabbles.

He's also picked up a new, rather annoying habit--kitchen counter surfing. He's up on the counters virtually every damned night, probably looking for food scraps which aren't there. Ra used to do that a lot throughout his life, so we think Lars learned that habit from Ra. It would be fine if our counters were clear of random stuff, but we get lazy and stash our recyclable cans and bottles on the one counter throughout the week rather than just bring in the recycling bin and put them outside, so when dumbass jumps up onto the counter, something inevitably falls off same, clattering to the floor. That's our bad, of course, so we should work on clearing our counters.

So yeah, about the same, really. Wish there was something more definitively positive to report...
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He's been a total dickhead this morning, jumping back and forth from my hope chest starting before 0800, which is early even for him. He kept swatting/attacking Ulysses in the hallway, too, while he waited for his breakfast--that was more concerning and aggravating, as Ulysses was just hanging out in the hallway being himself and doing nothing wrong to Lars to deserve the fisticuffs. Lars be a jackass!

No downloads yesterday or overnight, so we're back up to 6ccs of Lactulose tonight. Getting the digestive tract regulated again is going to be a Big Old Bitch, methinks. I caught him in the open hallway box a couple of times yesterday afternoon, squatting for a minute or two, then leaving the box. He wasn't seeming to be straining, but no action, either, so...yeah. He still needs that extra 1cc of Lactulose to kick his guts into gear.

At least he calmed down after breakfast. He's chilling out somewhere, probably in his kitchen window or on Cat Fort Bravo. He ate alright--not as much of the meaty bits in the gushy fud as I would've liked, but at least he ate all the gravy off the meaty bits and that's where the meds live, so it's all good. I'll give him back the remaining meaty bits in a little while to see if he'll eat more of them before I toss it away. He ate his morning allotment of kibble like a boss, though, so that was good to see. He's so conditioned--he's so used to getting his gushy fud first, followed by a helping of kibble, that he'll eat less gushy fud so he's got room for his kibble, at least that's what I think that's how he's operating, LOL.

So, yeah--excitement a'poppin' in our house this morning! :/ Damned jackass cat, drivin' us nuts! Ever so glad to see the nutty behaviour, but it's still maddening as all hell!
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Lars' digestive tract finally went into overdrive yesterday with all the tummy meds he's on to make him download--after breakfast he had a regular download followed by a somewhat squishy one, then followed by a liquipoo. /TMI This is exactly what we were trying to achieve with the max dose of Lactulose and we finally reached maximum velocity! This means dialing back Lars' Lactulose dose to 5cc per day (3cc in the morning, 2cc at night) and see how that goes. If we achieve standard soft poos we're golden again; if we still have maximum velocity ick then I'm to call back to see if we dial back the Lactulose some more.

The trial at 96 hours' interval on the Mirtazepine went pretty well--his appetite didn't flag until yesterday morning when he was due for his next dose, and picked right back up again once yesterday morning's dose kicked in a few hours after dosing. So that's going to be our go-to dose for the coming while. The goal is to see if he can eventually go without the Mirtazepine and still have an appetite without it, but for now...yeah...

This morning marked a very happy and somewhat aggravating milestone! Before he got sick, Lars would agitate me to get up to feed him his breakfast by jumping atop my hope chest, which is stacked with a goodly part of my tee-shirt collection. I hate it when he jumps up there because the stacks are not the most stable and, occasionally, his jumps upon them cause some of them to fall off the stack and also destabilize the rest of the stack(s) that remain. Yeah, I know--get another dresser, but there's no room in the master bedroom for another dresser, so that's where they live...Anyway, this morning Lars jumped onto my hope chest/tee-shirts' stacks like three times!! :) I was both annoyed and incredibly happy all at once!! A great sign that he's really starting to feel better!

He's also been a bit of a dick to the other kittehs in the house this morning--agitating and causing what we call "fisticuffs"--boxing at the other three kids and posturing and a bit of hissing. He's been corrected several times so far this morning. I think he was agitating because he was hungry, LOL, and the Mirtazepine's giving him the Cat Crazies in full force now that he's feeling a bit better. Gotta keep an eye and an ear out for fighting today and in the coming days...

The Monday update with VCA was a good one--Dr. M was pleased to hear that Lars was able to get through the 96 hour interval with the Mirtazepine, that his personality continues to return, and that he's continued to download on a regular basis (or even moreso as he found out after the call from Cindy the tech, LOL) As long as Lars maintains status quo or improves we're golden--no need for another evaluation visit or any more testing/endoscopy. If Lars starts heading backwards into illness again, then we'll have to re-evaluate at the very least. It could take 3-4 weeks for him to completely return back to normal from this bout of illness, so I'm trying to be a patient mama; daddy's perfectly patient, but not me, LOL. I want my boy back, dammit! :/ At least now things are slowly returning to normalcy! :)

Yay! :D
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Once the Mirtazepine kicked in later this morning, Lars was a bit closer to acting himself. Still a little flat, still a little lethargic, but the "cat crazies" that I anticipate him getting from the med were almost there full force by afternoon time. :)

He even downloaded a good one for me early afternoon instead of waiting all day and into the night to do so! :) Mama's a bit more of a happy camper.

I finally did get an answer regarding the ongoing lethargy; Dr. M attributes it to possible side effects from the Mirtazepine. Given that Mirtazepine is an antidepressant, lethargy could legitimately be a side effect. Thing is, though, it usually ISN'T with any of our cats who've taken it. They all have usually gotten the "cat crazies" and acted manic as all fuck while on it, at least for the first 24 hours of the dosing interval. So, sort of a non-answer. The solution is to give Lars 1/8 of a tab vs. 1/4 of a tab every 72 hours or to go to 1/4 tab every 96 hours. Here's the thing: the 1/4 tab starts to crap out and his appetite starts to wane about 12 hours before the next dose is due, so lengthening the dosing interval is probably not a wise idea. Nor, would I think, would cutting the dose in half be a wise idea, but I guess we'll try it the next time he's due for a dose, if anything to appease the folks at VCA, to show we're listening to and following their counsel.

So recap: more active and vocal and "Cat Crazy" today, even perching on the cat fort in the den for awhile for the first time in over a week that I've noticed. Eating pretty darn good, downloading earlier in the day. All and all A Good Day so far. Here's to hoping his days continue to improve!! :)
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He was quite lethargic most of the day yesterday and he didn't beg for food as much. The food thing didn't surprise me much as he was on the tail end of his most recent Mirtazepine dose, but the increased lethargy was quite worrisome. :/ All he really did was lay around, all meh, sleeping or just kinda staring into space when he wasn't sleeping.

Called VCA with the latest update--the concern about the increased lethargy, the finally achieved download from Tuesday, the somewhat not surprising lag in appetite. Was told by the tech that I need to expect to some degree that Lars will be "off" for awhile because his body is healing from the intestinal problem, that he's still behaviorally within the range of what a "normal" cat would be acting like--maybe not close to normal for Lars, but "normal" for cats in general, so to try not to fret too much but to keep them updated on any changes. Cindy the tech said she would let Dr. M know about the increased lethargy and get back to me, but she never called back last night so...yeah...

As far as downloads go, he was *really* late with his daily present yesterday--didn't deposit kids in the pool until around 2230. Thank Bast it was a sizable one, which put my mind at ease. I keep looking around the house at his old errant shitting haunts and find nothing, so he's using the boxes exclusively now, so...yeah...unless he's picked new places to deposit his shits, which is entirely possible. I simply do NOT think he's downloading enough for the amount of Lactulose, Benefiber, and probiotics we're giving him daily. Cindy from VCA says as long as he's giving one good download per 24 hour period we're pretty good, but...yeah, I worry big-time!

This morning was a Mirtazepine morning, so his appetite and affect should pick up a little bit in a few hours or so. He half-heartedly woke me for his breakfast again this morning, and ate alright for me in both gushy fud and kibble, so there's that at least. He's currently asleep in his usual post-breakfast spot. Another thing that concerns me is I've not caught him on either of the cat forts in at least a week, probably longer. That's unusual for him, as he's all about being up high and looking out the window. Sigh. Another thing to bring to VCA's attention.

The stress of him being sick is really getting to me. I'd just gotten past the stress of Ra illness and passing, long since gotten past the stress of Jazz's and Diva's illnesses and passings, and was coasting along, all blissed out that I finally had two healthy cats in my life. Now I'm back to sick kitty land and I'm a wreck... :( Sweet Bast, please watch over my precious boy...
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He was a bit more lethargic yesterday than I would like to have seen, but on the up side his appetite was pretty darn good, so there's that at least. Another day of mixed bag behaviors.

He put a bit of a scare into me by waiting to download until late afternoon around 1700 rather than his somewhat usual noonish he'd been doing in the several days before. I did put in another call to VCA regarding his lack o' poo, but they weren't terribly concerned as he'd had good output 24 hours earlier and even better output 48 hours before. So at least he *did* download for me, damned cat. :/

This morning he woke me up for breakfast, more politely than his normal, but he still woke me up for his breakfast so that's a good thing. J wasn't up at the same time as I was feeding so Lars got his half scoop of kibble to tide him over rather than his usual first being served his gushy fud with all the stuff in it because I'm not able to corral Lars to give him his Lactulose (tried that one time with only 1.5 cc, couldn't control him, and got bitten to boot, as you might recall). Lars was Unhappy about this development, but he managed to survive. ;) He's actually grudgingly getting a bit more easy for J to dispense with the Lactulose, which is very nice for everyone involved.

Once the Lactulose was down the hatch, I waited a few minutes and fed him his half can of Gravy Lovers gushy fud with the probiotic and the benefiber mixed in. Predictably, he scarfed down all of the gravy (which is where all the meds are, which is a great thing) but only ate about 2/3 of the meaty bits today. This could indicate that the Mirtazepine is starting to wear off as his next dose is tomorrow morning. :/ So...yeah. Mixed bag food wise this morning.

Doesn't seem to be nauseated, has not vomited at all since going on the Cerenia course last Thursday. But...I *know* he's not feeling well because he's so lethargic and extra sleepy. I worry that he's not improving quickly enough to avoid the endoscopy procedure. J says "don't borrow from tomorrow" and to take every day as it comes and wait and see, but I'm an overly anxious mama who just intrinsically knows when her best boy is Not Well. I know it takes time for the meds to do their thing, but on top of being overly anxious I'm an impatient mama, too. I want him back to his old self NOW. I want my peace of mind back that my beloved boy is alright.

Sigh. And so it goes... :/
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Talked to Julie at VCA and she was kind enough to break down what's going on. Basically Lars has too much bacterial flora in his intestinal tract, for as now unknown reasons, which caused his serum folate levels to elevate on the one test. It's likely to be controlled with daily Lactulose, Benefiber, and probiotics. Found out during the call that I'm to give Lars the probiotics daily vs. once a week, so he got a second serving of wet food with the probiotics mixed in after the phone call.

He's been lethargic all day save for when he thinks he might be fed something and he hasn't downloaded yet today or since yesterday morning around 1145. Called VCA back and talked to Cindy about that--she's going to let Dr. M know and if need be get back to me with further instructions. Sigh. He's got me stressed out, he does...

Basically we're to do the probiotics, the Benefiber, the Lactulose, and the Miratezipine regimen for the next week. Little to no change and it's the scope for Lars...So send all good well-wishes our way if you would...

I think he's going to be headed for the scope/biopsies. I just don't currently see him improving enough for them to say he's enough out of the woods to forego that procedure...Sigh... :(

My poor, sweet boy... :(
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And it's a mixed bag...

Urinalysis, CBC, chem panel, and T4 all came back normal. All of the special digestive testing ones came back normal save for one--serum folate came back elevated. I'm still not sure what this means and I'm going to have to both call back and ask more questions and also do some google fu on my own and see what I can find out. Evidently it can be a sign of underlying disease in the digestive tract, probably the pancreas. That was unclear, and I need more clarity on that. The phrase "Small Intestinal Dysbiosis" was bandied about and I did a little google fu on that one this morning and all it served to do was confuse me more with all the veterinary medical jargon.

Next steps if Lars either doesn't improve or gets worse on his current medication regimen within the next week or so is re-evaluation followed quickly by an endoscopy of the belly. His current medication regimen, as you might recall from days' past, no longer contains the anti-nausea medication Cerenia--it's a 4-day run for that one typically, according to the tech I spoke with, unless the nausea/vomiting returns again. Again, my understanding is its blood serum levels remain high in the system for several days after the last dose of the regimen, so we've got some time before we need to worry about the nausea/vomiting possibly returning.

So far he's on 3cc of Lactulose every 12 hours, a half teaspoon of Benefiber on his food every morning, probiotic powder on his food every Saturday, and Mirtazepine for appetite stimulation every third morning. I asked about the Ursodiol in regards to his inflamed gall bladder and was told the inflammation is relatively minor and they do not want to add an additional med at this time, that they're hoping the inflammation will go down on its own. We shall see...

As for his affect/appetite--both are improving. He's still a bit lethargic and "flat"--no chasing the other cats down the hallways, mostly sitting quietly when he's not begging for food by the laundry room door. He's downloading on about a every 24 hours schedule right now, which is at least predictable the last few days. I expect to see some "action" around noon if his recent schedule remains intact. He should be downloading more and more often than he is, which leaves me concerned, but the folks at VCA don't seem too terribly concerned, so I'm trying to not be terribly concerned myself...

So yeah...mixed bag...Will post when I learn more about the specifics of the blood work...
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As I said yesterday, there was one for sure, possibly two others that were ambiguous but could have been his from over the course of Saturday night into Sunday morning. Then there was nothing all day yesterday. This morning's litter box check yielded three smallish hard pebbles, which could've been his or could've been Dorene's...This, mind, is on a max of 6cc of Lactulose, a half teaspoon of Benefiber in his gushy fud every morning and he's eating almost his regular diet worth of food. I've scoured the house for errant shitting and found nothing, so...yeah. Something seems to be afoot at the Circle K, as they say.

He got another dose of Mirtazepine (appetite stimulant) before breakfast, but got fed before it kicked in. He ate like a champ, though--both pretty much finishing his gushy fud and his small allotment of kibble. No problems with vomiting since being on the Cerenia. I'm concerned, but waiting a little while for this morning's Lactulose and Benefiber doses to kick in and work in his gut before calling VCA for advice. I fear our Lars is starting to be impacted...

Personality wise he's almost back to normal. He was all for wanting breakfast, although he wasn't his usual overly enthusiastic self just yet. He spent most of the night sleeping on me last night--I know because I was up on and off with seasonal allergies kicking my arse and whenever I woke up he was there on me...So...I just don't know! Quite obviously something has gone sideways with my boy's digestive tract, but what? I really, sincerely hope the blood work they did comes up with some answers...and we'll get those answers in the next couple of days from my understanding...
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He's generally less lethargic and a bit more himself, but still Not Quite Right. He's eating small meals more times a day vs his usual larger twice a day, but it all ends up equaling about the same amount of food so I'm relatively pleased over all. Cerenia and Mirtazepine seem to be working in concert with each other--the Cerenia is controlling the nausea/vomiting which is finally allowing the appetite stimulant component of the Mirtazepine to do its thing. Yay!

In the downloads department, he didn't all day yesterday, but left me at least one good present overnight. I say at least because there were two "questionable" ones that I could not totally verify if they were Lars' or if they were Harlow's. Looked suspiciously like Lars' but didn't pass the sniff test /TMI. Regardless, glad I got the one definitely his good one; it's a sign the max dose of Lactulose isn't for naught, though I wish it was doing a better job... :/

This afternoon marks the last officially prescribed dose of Cerenia, which makes me a bit nervous for Lars' tummy state. The good news, though, is after 4 or 5 doses the blood serum level of the med remains a bit constant for a few days before slowly leaving the system. The way the med is typically prescribed is 4-5 days on, then every other day for a week, then every 3 days. Don't know if that's how they'll end up doing it for ol' Lars, but that's how it was prescribed for Jazz when she was on it. Poor Ra was on it daily, his nausea was so bad, along with another drug who's name escapes me right now that he was on three times daily as well. So far it doesn't look like it's going to come down to that for Lars, as Cerenia alone so far is controlling things, but...yeah, Ra's experience is definitely on my mind.

So, all and all...Better, but not fabulous. I'll take it, though! :/
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His personality is still a bit flat, but is coming back somewhat. He's eating a bit better and keeping it all down. He's downloading well, clearing out all the backlog he had in his colon, so we're keeping up on the 6cc of Lactulose. He's remaining quite clingy to his mommy today--wanting pettins and lovins whenever I was sitting still for any amount of time in the den. He's definitely got the tell-tale "cat crazies" from the Mirtazepine, but the appetite stimulant component isn't quite there yet so I think he's still feeling a bit nauseated. It does usually take a couple of doses for the Cerenia to really kick in and control nausea consistently and effectively, so I expect that Lars will start to be feeling more like eating as more time passes.

It's interesting--he'll beg to be fed and hang around the laundry room door where we keep the food constantly, but we'll offer him food and he doesn't end up finishing the small offerings we give him. That being said, he'll ask for small offerings frequently, so whenever he asks we offer up something for him. He's got a variety of Fancy Feast Gravy Lovers waiting for him starting tomorrow morning, so that should make him a happy boy as he's ALL about the gravy/broth, LOL.

Dr. B called earlier this evening before the clinic closed to check on how Lars was doing. I told him about how he's got some of the "cat crazies" from the Mirtazepine but it's not stimulating his appetite as strongly as we're expecting it to, that we're hoping once the Cerenia really kicks in and takes better care of the nausea so that will greatly improve his appetite. Dr. B told me he received his copy of the patient discharge summary from Dr. M at VCA from yesterday, and he said he thinks he might have some idea of what they might do to help Lars out with his enlarged gall bladder; to his knowledge, it's typically treated with Ursodiol, a drug I'm somewhat familiar with from Ra being on it for a short while before he really fell ill. That being said, Dr. B also said he was definitely not getting ahead of the treatment protocol that Dr. M and VCA internal medicine will eventually recommend we follow. He let me know he was not going to be in the office tomorrow or Monday, but that he would have substitute vets available if we needed Lars to be seen for any reason, and that he'll be back in the office on Tuesday when he expects to hear back from Dr. M. I did not expect to hear from him, so it was a welcome phone call! :) He's good people, that's for sure.

Anyhoo, that's the latest scoop on ol' Lars. Sorta doing a bit better (hopefully). Got a lot of people thinking of us and sending prayers and healing energy his way... :)
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With the maximum 6cc dose of Lactulose, we've managed to get some action in the downloads department; overnight he left us a present and he left us another good one after he ate his breakfast/got his AM 3cc dose. Very good news, indeed. Wish it was there was an easier way, though--Lars (like Ra, Diva, and Jazz before him) HATES getting dosed with Lactulose with a passion and fights J like a little tiger. Scratched up J a pretty good one this morning, in fact, which sucked. :/

Mirtazepine day today (that's the appetite stimulant that's dosed every third day), and it'll take awhile to kick in. Again, All Hail Pill Pockets! So easy to pill a willing cat with those things! :) Again, Lars just gobbled his pill down, no muss no fuss. :) Fed him his breakfast before it kicked in, though, so lackluster breakfast eatings were to be had. :/ Oh wells, just means we'll have to try feeding him again later in the day after it's kicked in and he's started acting all buggy from the med. He ate enough of his wet food to get the 1/2 teaspoon of Benefiber down the hatch and that's my bigger concern right now, so...yeah...

Called VCA Aurora internal medicine with a few questions I had; some were about the patient summary I got for Lars yesterday, most were surrounding how much I should do to entice him to eat. I asked about the kidney data on the ultrasound section of the report; was told the findings could be of congenital nature, something that he's always lived with and that he functions fine with how they're formed, or that they degenerated for some reason and it's something to be of concern. The good news is the blood flow to the kidneys had to be good, otherwise it would've been noted in the summary and it would've been investigated further, so that's a good sign right there. Basically to know more we have to wait for the blood work to come back to see if he's got impaired kidney function; thus far with his past chemistry panels he's had done his kidney values have always come back normal, so I'm not terribly worried about that changing.

Next we talked about diet. Lars' appetite remains lackluster, largely we think because he's still fighting off nausea, so we talked about conservative and safe ways to entice Lars to eat more. Got told the standards--tuna in water, boiled chicken, senior and adult gushy fud. Lars used to get and LOVE Fancy Feast Gravy Lovers fud, but we stopped giving it to him because 1) it tended to give him the trots and 2) Dorene wouldn't touch the stuff and we were looking for a gushy fud that both of them would like so they could share tins of the stuff. Tech said to go ahead and try the Gravy Lovers with him again, so it'll be off to the PetSmart for us for a gushy fud run later today.

So, doing marginally better or at least holding his own and not getting any worse. That's about all we can ask for, and take things as they come...a day at a time...

Sigh. Poor fuzzy fella! :/
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...in fact, yesterday afternoon he vomited his breakfast largely undigested and was lethargic so I called Dr. B to see if we should add any urgency to our intended treatment plan. The answer was yes--Dr. B suggested I reach out to Dr. Medinger and the Internal Medicine team at VCA Aurora that helped treat Ra for his tummy troubles, as now there were just too many digestive tract variables in play that they were beyond his general practitioner scope of practice comfort level. I called VCA Aurora and was able to get Lars an appointment right away; another Friday appointment so J could help with the Cat Wranglings.

Then last night happened; he vomited a kibble snack J fed him while I was at bowling shortly after I got home, and then around 2100 we found a LARGE errant shit in the den by the TV stand. He did keep his very small kibble allotment for dinner down, though, as far as we know; if he did vomit it, Harlow likely found it and ate it, piggy that Harlow is...

Anyway, I figured it was probably A Good Idea to call VCA Aurora to see if they wanted me to move up Lars' appointment to today because of the new developments. They did, and he was seen at 1100.

Intern went over our pre-appointment paperwork (which was about 3 long pages worth of questions long) very thoroughly with us, gave Lars a preliminary exam (temp, weight, etc) and then it was wait to see Dr. Medinger.

Right out of the gate, Dr. Medinger is listening to Lars' heart and he says "Did you know your boy has a grade 3 1/2 to grade 4 heart mumur? That's out of 6 grades, in case you didn't know." !!!! What the everlasting fuck, do you say?!?! Sweet Jesus!! :( He didn't have much more to add to that observation at this time, just let me know about it as of right now. So I don't know what, if anything, this could mean for my boy on its own...

Dr. M determined that, yes, something is definitely afoot at the Circle K, and worth much more investigation. First plan of attack was an abdominal ultrasound, a full blood chemistry panel, and a special blood panel to test digestive tract and pancreatic function which would be overnighted to a special place in Texas for the test. This all took about 1 1/2 hours.

Ultrasound was largely...inconclusive is not a good word, but ambiguous? Nothing relating to his digestive tract, per se, but he does seem to have something going on physically with his kidneys (his one is severely undersized and the other is slightly enlarged with an infarct of some sort) and his gall bladder is enlarged. That's what the prelim report I got says anyway--when Dr. M came out to talk to me he told me the ultrasound came back "relatively okay, nothing significant." We have a few questions we want to ask someone in Internal Medicine tomorrow about the ultrasound in particular...Blood work will all be back sometime early next week.

Meds: we're to start Lars back on Lactulose at max dose until he's downloading decently again; 1/2 teaspoon of Benefiber added to his wet food every morning; add 8mg of Cerenia daily for four days for the nausea/vomiting; and continue the Mirtazepine every 3 days for appetite stimulation. No changes to diet save stopping the Science Diet kibble which Lars doesn't like anyway. We'll see what, if any, changes come from the blood panels...

Got Lars home and gave him the Cerenia for the nausea right away, then fed him about 3 hours later. So far he's not eaten much, but he's kept down what he's eaten. He's gotten 3 of the 6cc of Lactulose he's due--the other 3 are due around bedtime. Hopefully this will produce some download results.

Sigh...

So, yeah. That's what Lars and I did today. :/ So very worried about my boy.
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He's not been truly right for awhile now. Mostly on and off lack of enthusiasm with eating, smallish and hard downloads, lethargy that comes and goes. He otherwise acts normally, but goes through these bothersome periods of meh.

He went into boarding with constipation and came home with it still going strong. Dr. B told us to give him probiotics every other day for two weeks upon his return home, which helped a bit, along with mixing his grain free kibble with a bit of science diet regular kibble to see if that didn't help get things moving along in the downloads department. It did--sorta...

Lars got done with the probiotics about a week ago now. Potty problems returned, le sigh. Weird lack of appetite returned, albeit intermittently and inconsistently--eating 3/4 of his breakfast, but then eating everything for dinner for a few days in a row. Was really clingy yesterday, but I attributed it to his realizing that Ulysses was in the house. Then last night he struggled to finish his dinner; he did, but with lots of coaxing. After dinner settled, I gave him an inch strip of Petro Malt in the hopes it would produce some download results as he'd not produced one in a day or so; he gobbled it right down.

Woke this AM to a goodly sized download in the hallway box from him, but his breakfast eating performance was very lackluster. Didn't finish his wet food, which is like The Holy Grail to him, and only ate about half of his grain free only kibble. Time to go to the vet. Got an 1115 appointment.

Dr. B gave him the good looksee. Said there was probably still about 4-5 inches of stool left in his lower intestine/colon, but it wasn't hard or impacted just yet. Everything checked out fine physically. He asked a lot of questions about downloads--how often, consistency, etc. Told him how the Petro Malt really helped things move along, much better than the Lactulose ever did.

Dr. B thinks there's something chronically off with something in Lars' gut--be it narrowing of upper or lower intestine/slow gut motility/pancreas issues/chronic consitpation. Too many variables to consider. Told us to give Lars at least an inch strip of Petro Malt for the next seven days and to save Lars' downloads in baggies so Dr. B can examine them for any blood, check their consistency, etc. He wants to do a specialized blood draw related to pancreas function and also an ultrasound of Lars' abdomen. Our appointment for both is on Friday morning at 0945. Dr. B may also want to do a barium series of x-rays to check Lars' gut motility, but we don't know when that will happen.

We're pretty worried about our boy right now. He's Just Not Right, and he's too young at 5 1/2 to Not Be Right. I know we'll get it figured out, but...yeah...want answers now!
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...when I went into the kitchen for a cuppa coffee.

Lars and Dorene 22 March 15.jpg

Ded from the kyute...
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