( Jan. 3rd, 2015 08:57 pm)
Dr. Lehal did not give us good news when I spoke to him this morning after my last post. Everything that could be done medically for Ra was already being done. There were no "hail Marys" to dig out of the playbook--the playbook was all already in play. There was brief talk of trying to limp Ra through another weekend, but Dr. Lehal was pretty sure we were looking at the end, and very soon...

Wanting to avoid the trauma for all parties involved of going to an emergency vet in the middle of the night over this weekend, J decided that it would be best to send Ra over The Bridge today while Brookville Animal Hospital was still open. While saying our goodbyes at home would've been best, it was not really an option, so we got an appointment for 1340, scheduled near the close of business so we all could take our time saying goodbye with minimal fuss and bother.

We'd been taking Ra to his myriad vet visits in Jazz's old carrier, but J wanted Ra to go out in the carrier he originally came home in so we dug out Ra's old soft-side carrier and its fleece liner. We had Weather today, so the roads were a little greasy from the wintry mix so it took slightly longer for us to get to the animal hospital than normal, and long enough where Ra soiled his carrier with a soft poop that he managed to get all over his right leg. We spent the first ten minutes of our time in the exam room gently cleaning Ra and the fleece liner in the carrier. It was a somewhat welcome distraction from all the barking dogs that were still being looked at. Ra was so out of it the barking dogs didn't even make him flinch. J tried to hold Ra on his lap, but Ra wanted little to nothing to do with either of us. He wanted the cool tile of the floor. Eventually J sat on the floor with Ra, giving much pettins and lovins. I largely left the boys to say their final goodbyes...

Around 1415, Dr. Lehal was done with all his other appointments and could devote his full attention to us. J asked him questions--was there absolutely anything else we could do to keep Ra more comfortable and in better control of his bodily functions. No, everything was being done at its maximum dose already. Would re-adding the correct dose of Atopica make a difference--we'd been giving half the normal dose because we'd run low and the hospital was having trouble getting the liquid name brand Rx of the med for us--no, it would not likely make a difference, and if it did, not for long.

J made the final decision to let Ra go over The Bridge around 1430. Ra's veins were so bad from dehydration and his ongoing renal failure it was decided a port would be installed for his comfort for the impending injections. He officially Went Over The Bridge around 1440. We lingered for about another half hour more after that with Ra, continuing to love and pet him til we were sure his spirit was gone on its way.

Ra and J were best buds for over 14 years, almost 15. He was about 18 months old when Ra picked out J at Strays Halfway House back in '00. J is bereft, devastated and heartbroken and misses his friend dearly. I was a part of Ra's daily life since August of '07 and I, too, am heartbroken and miss my buddy. He was a joy and a frustration, feisty and loving. He was our Buddy Cat. We will miss him so very much...

Rest well, Ra Buddy. You are loved and will be dearly missed...

Ra adjusting daddy's glasses
I haven't posted in awhile because things have been pretty solidly status quo with him--mostly good days followed by A Bad Day or two filled with vomiting and diarrhea. Dr. L reckoned it could be because Ra's Leukeran doses were spaced too far apart at every four days, thus making his IBD symptoms flare up. So we went back to every three days right after Christmas and everything seemed to be going pretty well. His Good Days were really good and the Bad Day he had wasn't nearly as bad...

He had a pretty damn good day yesterday, but, come nightfall, things went to shit. Literally. He became quite lethargic mid evening and started drooling as if vomiting was imminent. This went on for at least an hour or so. We finally gave him a dose of his pain med buprenorphine in hopes it would ease his discomfort and perhaps perk him up. No love. He moved slowly from room to room, resting in between wanderings, drooling and making chewing sounds with his mouth. Not long after that he hid under J's desk and it took us awhile to find him to give him his meds and feed him.

Came time for the rest of his meds and attempts to get at least a little something in his belly and right after J gave him his meds he had a diarrhea on the guest bath floor right in front of the litter box. I wasn't in there with them, but based on where it was in the corner of the room, I would surmise that Ra crawled over there from J's lap and couldn't make it the short distance to the litter box...Poor ol' fella.

Cleaned up the mess (and Ra--he stepped in his own mess, of course, and his paws were dirty) and waited a short while before feeding Ra a quarter of a can of A/D, which we knew he would likely inevitably vomit back up, but we went for it in vain attempts to get something in his tummy...We were lucky--he kept it down for about 2 hours before vomiting it back up again.

When he's not attempting to avoid us and the other cats he sits quietly loafed on the tile floors, looking a bit dazed and out of it. I did a spot check around the house for diarrhea accidents or barfs that we didn't hear in the middle of the night first thing this morning and the house is clear--he's not been sick out of either end since late last night, so the Metoclopramide and the Metronidazole must be doing their jobs to keep him comfortable.

J is worried Ra is trying to tell him that he's Had Enough and that it's time to let him go over The Bridge. I am worried that's what he's trying to tell us, too, especially after last night. :( The good days aren't nearly as good, and the bad days are getting worse, even with med adjustments. J's still trying to sleep after being up late with Ra last night, but I've put in a call to Dr. L to see if we should bring Ra in for a looksee or if we should try to keep his demons at bay on our own here at home. So we wait...

Sigh. I know it's so goddamned hard because we love him so, but...Jesus...What a way to start the new year, eh? :/
I haven't updated on Ra in awhile because things have largely been the same--a mixed bag of good days and temporary set backs that have kinda slid into each other and turned into a bit of a blur.

He'll be good for a few days to a week, then he'll start randomly vomiting despite being on two anti-nausea meds. We've learned how to care for him when this happens--hydrate him a bit more with the sub-q fluids, feed a bit less so there's less to vomit up, and perhaps give him a dribble of the pain med we've got for him every now and again to ease any possible discomfort.

His blood work, which is now due again actually, remains largely the same, which is good in some ways and bad in others. His Red Blood Cells remain quite low at around 20% despite giving him the $expensive Aranesp med that's supposed to help increase same. The two iron supplement shots he got didn't do shit, either. :(

We've managed to somehow maintain his weight at around 8 pounds, which is Way Too Skinny for a cat his frame size, but at least we're maintaining that much. He's managing to do pretty well most days at his now 3/4 can of A/D syringe feedings and actually putting on an ounce or two! We're pleased with every ounce we can get.

There have been some changes to his medication regimen. He's off the Aranesp for his RBC; since it really wasn't doing any more to increase same, Dr. M at the VCA decided it was time to take him off it. We're a little bit concerned this might not be the wisest of moves--what if it's actually helping to maintain the RBC percentage he's currently at and being off it causes the number to plummet again? All that can be done is to take him off it temporarily and see what happens.

Additionally, we're tapering him off the "chemo" drug Chlorambucil--he's getting it every fourth day for the next six weeks, then every fifth day for six weeks after that and it'll be reevaluated after that. So far that's a mixed bag--when he gets it now he tends to be "off" and a bit more likely to be barfy on the day he gets it and the day after. This makes both J and I sad and there's not a whole helluva lot we can do about that, either, save for what I mentioned earlier.

While it's good that he's being taken off of or tapered down off of certain meds, I can't help but feel as though Dr. M. (his specialist from the VCA who Ra's regular vet is in constant contact with) is sorta winding down on Ra's active care in favor of a more palliative/hospice care. We've yet to confirm that's what's actually going on; I want to ask about that, but it's J's cat and he needs to ask the tough questions like that and he's so far not had the time or heart to ask. I can't say as though I blame him for avoiding that topic--I know I avoided talk like that with my two girls as much as possible when they were still alive...

Regardless, on more days than not, Ra is still pretty bright eyed and a relatively active part of our household. We give him our best lovins, pettins, and whatever else we can give him every day. He's slowing down, obviously, but not giving up on life just yet, so we keep going with more assertive treatment of what's ailing him. We take it as it comes, a day at a time when we can, smaller increments when we can't go as long as a day. Still, it's very difficult to watch him struggle on the bad days. Poor ol' fella...
It started again last Sunday afternoon when he somehow got ahold of some tape from somewhere in the house, which he likely promptly barfed up on our kitchen throw rugs in front of the sink. That's his usual M.O., so we weren't terribly concerned until he barfed forcefully twice more that night. We were concerned enough about his tummy troubles that we decided to forego feeding him Sunday night and to forego his Ursodiol which can also upset the tummy.

When he barfed right after getting his AM meds on Monday morning we decided it was time to bring him in for a looksee. Because it was known that he'd ingested tape, x-rays were taken to make sure there was no blockages or obstructions or obviously seeable pieces of more tape. The only thing of significance on his x-rays was a lot of gas in his upper intestine, which is common with GI affected kitties. Otherwise everything looked fine. Ra got a shot of Cerenia to help stop the vomit reflex that he was having and he was sent home.

Monday went along and I noticed that Ra was a bit more quiet than normal. J noticed the same thing, and especially got worried about how Ra reacted to him in the early morning before work when he came out to the kitchen to take his vitamins--as in there was no reaction, Ra just kept laying on the floor quietly and didn't come out to the kitchen from the den where he was laying on the floor as he would normally do. J laid down with Ra for awhile in the den and he still didn't move for awhile after that. Something Was Not Right--time for another call to the vet.

Brought him back in on Tuesday afternoon. He was warm but not running a temp. His belly was tender upon palpation, moreso than it was on Monday morning. Blood work was drawn--chemistry, CBC and in-house pancreatitis test. We got the call a few hours later--it came back positive for pancreatitis...Later on we also found out he was a bit more anemic again--his RBC went down from 22% to 20%, which doesn't seem like much of a change, but when it's thought about in the context that he should be closer to 30%...yeah...

There's not much to do for pancreatitis save for pain management and appetite stimulus. Ra was prescribed a pain med and put back on the dreaded Mirtazepine (appetite stimulant) and to get 100ccs of sub-q fluids vs. the 50ccs he was typically getting for a handful of days to rehydrate him.

He's responded pretty well to treatment so far. Meds and fluids are back to normal now as he's not vomited since Monday morning. He's acting his old self for the most part, which is A Good Thing.

Thank Sweet Bast he bounced back again--we were both afraid he was starting to circle the proverbial drain for the final time this time; things were pretty bad for the poor fella. Whew...
The vomiting stopped after the AM pill barf on Tuesday morning, thanks to the shots of Cerenia and Metoclopramide. The only problem with the Metoclopramide is it gives Ra the most nasty pure liquid diarrhea. :/ We were originally at 3x daily for that drug, but Dr. Lehal cut it down to 2x daily, and finally down to 1x daily. So far, so good with the low dose. I made an executive decision to take him completely off the Metoclopramide this morning--if he barfs, then he goes back on it, simple as that. We simply cannot have him liquid pooping every damned time he does a # 2. It's got to be hard on his system, and I know he *hates* me following him around to wipe the remnants off his (likely) sore ass once he's done if I catch him in the box dropping a watery deuce.

Because of the "liquipoo" situation, Dr. Lehal suggested we start Ra on a kitty probiotic, which we were able to pick up at PetSmart. It's a once weekly thing, though we gave him his weekly dose and a small amount more yesterday in hopes of calming his stomach. Don't know if we should've done that, but it was a mutually made executive decision, so we'll see what happens. The worst that could happen would be that his bowel movements would go the opposite direction and he'd get a bit constipated, but hey--we've got the Lactulose for that if that comes to (not) pass.

So, yeah. I think we're on the right track. Please keep your fingers crossed and keep on sending that oh-so-necessary healing energy! :)
He went for his now bi-weekly blood draw on Thursday morning. We considered doing a chem panel, too, but we decided that since Ra seems to be feeling a bit better lately to put that off til next time.

Dr. L called J last night with the results--no change in his RBC which is still at 22 percent. I'm disappointed that it didn't go up a little bit again, but am ever so happy it didn't go down! :) Stable is okay, too, and he's almost at the 25 percent "okay" mark still, so...yeah. There was one value in the test that went up, a value that could indicate some infection activity, but not high enough to justify bringing Ra back into the vet or to change any of his medications. Something to keep an eye on.

Other than that, he's slowly returning to his old, feisty self. I have to chase after him more often than not when it comes time to give him his meds, especially the Atopica, which has a sort of rubbing alcohol smell to it and must taste awful.

We've made a couple of executive decisions regarding his food. He's off the hypoallergenic kibble in favor of the food he used to like best--Science Diet regular adult in original flavor. He's not eating much of it yet, but he's eating a LOT more of it than he was of the hypoallergenic. He's being syringe fed every day on an alternating schedule of the supposed to feed Royal Canin hypoallergenic and the not supposed to feed Science Diet A/D. We're giving him the A/D not only to try to get some much-needed weight back on him, but also to give him a break from the nasty hypoallergenic food that he definitely doesn't care for.

He's still on daily doses of the anti-nausea med Cerenia and there are no plans to wean him back to every other day any time soon. We figure if it ain't broke, don't try to fix it. Our goal is to keep Ra as happy and comfortable as possible; if that means keeping him on a med that virtually guarantees he keeps down whatever food we feed him, then so be it and the vets tend to agree. I know VCA Aurora gets a bit salty about the diet we're feeding him, but Dr. L understands our feelings/plan for Ra and he's fine with Ra eating whatever it is he'll eat and keep down.

So that's that--this week's update on Ra. As annoying as it is, I'm really glad he's getting feisty with me when I take care of him... ;)
I spent Thursday night in Kenosha with my cousin, so when J told me Ra's blood draw results I wasn't home or near a computer I could use to give an update...

...Things largely remain the same: kidney values, same; liver values, ever so slightly improved; RBC: 22% from 21%, so not much improvement. Gained about four ounces, too...Meds all to remain the same, and I don't have to bring him in for another routine blood draw to check his values until the morning of the 21st, which is kind of nice I must say...

While I'm bummed that there's been little change in the serum blood values department, nothing has gotten worse, so there's that going for us, which is nice.

In the food department, some interesting developments. He's eating more kibble on his own again, especially early in the day. As far as syringe feedings go, that's *very* interesting! He's now waiting in the guest bath when hungry for us to pass by the door, and when we do he meows loudly to let us know he's hungry and expecting to be fed! Weird, eh? Even weirder, he's showed some interest in what we're putting down him with the syringe, be it either the hypoallergenic shit he's been prescribed and we're supposed to feed him, or A/D we aren't really supposed to be feeding him but feed him every third day or so in attempts to put some much needed weight back on him. If J pushes a small amount out of the syringe, a good share of the time, regardless of food type, Ra will eat the small amount of food at the end of the syringe on his own. We thought this might mean he's getting more interested in eating the wet foods on his own, but when we put the bowl of it in front of him he'll sniff at it, but won't eat any of it. Only from the syringe, which, again, is weird, but hey! He's interested.

In addition to that, he's stopped fighting the syringe and eagerly takes the food when it's syringed into his mouth/down his throat. This has made syringe feeding less of a daunting task and I daresay if it could be considered enjoyable in any way, a little more easy to bear. He still needs to sit on J's lap to be fed, but not braced against J's chest with his face held steady to syringe the food in--a welcome development for every living being involved. Ra's also learned "You're free to go" after he's done being fed means he can leave the room, though we still keep the door to the guest bath closed when we're in there feeding him so he doesn't wander off in the middle of the proceedings.

That's what's going on in Ra Land right now. Not good, but not bad, either. We'll take it...
His RBC is back up a little: from 17 percent to 21 percent. Small, but still an improvement! We'll take it!! His Aranesp dose remains at .07ml for now.

While at the vet I noticed in the bright lights of the exam room that Ra's inner ears seemed to be ever so slightly yellow tinged, so I brought this to Dr. Lehal's attention. Further exam of the whites of Ra's eyes and his mouth tissue confirmed my suspicions and a blood chemistry was added to the mix to check his liver values.

The results? kidney values are stable and remained unchanged, which was good. ALT (one liver enzyme) went down from 950 to 835, which was also good. Bilrubin, the liver enzyme that, when elevated, causes jaundice is up: from .5 to 1.5. This explains the slight jaundice Ra had. And one of his other liver enzymes, which Dr. Lehal said really fast and I didn't get the name or numbers for, also went up. So yeah, liver not doing so well. :/ It's a good thing he's on both the Atopica and the Ursodiol--both of which are to support and assist with liver function.

It was decided to keep all of his meds at the same doses and not to add anything. Thank Bast for that--poor fool cat takes enough meds as it is, I daresay we can't really add more without causing him undue trauma, poor guy. He's just on SO MUCH medication right now. He usually takes it like a champ, too, though, so that's a blessing, and it's only twice a day for 95 percent of them (he gets the Atopica first thing and before his PM meds and he gets his Cerenia as a stand alone dose once in the afternoon every day outside his AM and PM meds and his Ursodiol after he gets his PM syringe feed), so...yeah...

Also? While in the exam room, Ra made a mess--he shat on the floor in one of the corners of the room! :( I was MORTIFIED!! :( I should've asked for a small litter box when he started crouching and pawing at the floor as if to scratch at litter about five minutes before he pooed, but I didn't so...yeah...It was a messy one, too, of course, so a lot of fun for me to clean up. Ugh. Poor fella tried to warn me, though, so I can't really bitch all that much.

If all goes well we don't go back in for a vet appointment until his scheduled Thursday morning RBC blood draw in the coming week. Let's hope he continues to remain stable enough so that's all we have to worry about... :/
In the Pam's A Klutz move this morning...

Ra and I were in the kitchen together, which was most fortuitous because it was time for his Atopica, usually his first med of the day. It's a liquid and dispensed with its own special syringe. He HATES the stuff and has been running away from me and fighting me when I finally catch him to give him the dose as of late.

Today was no exception. We were both in the kitchen and he saw me with the syringe and booked it, so I ran after him. Caught him by the stove and had him by one hand, syringe in the other and I tripped over my own feet, hit the floor HARD on my right knee, and (for good measure) slid same knee into the bottom of the stove. OUCH!! :(

It doesn't appear that I've caused any grievous damage to my knee, but the middle of my knee cap bruised instantly and the skin on my knee remains red even about an hour after this happened. No noticeable deformity and it doesn't hurt terribly, although it aches pretty darn good. :/ Hopefully my usual achy body cocktail of two extra strength tylenol, 600mg of ibuprofen, and a Flexeril will squash any pain I might end up feeling. I'll be keeping an appropriate eye on things as the day progresses, and assess again tomorrow before I decide whether I'll test that knee for yoga tomorrow afternoon.

As for Ra? Poor fucker still got all of his Atopica--I didn't spill a drop of the stuff as I fell, and though he fought the good fight I managed to get it all down his gullet. ;)
J took care of Ra while I was away for the weekend at a dear friend's bachelorette party weekend and he says all went well, so that made for a nice fun and relaxing weekend away from everything.

Ra was eating pretty well when I left Friday and J says he was eating well enough on his own to only need one syringe feeding in the evening the two nights I was gone. But that all pretty much went to hell once I got home. Makes me wonder if I've got something to do with things... :/

So, yeah. He's back to not eating much on his own, and we should really be back to syringe feeding him twice a day again, but with J working so much and being the one who does the syringe feeding...yeah. I've been desperately trying to get Ra to eat any and all kibble on his own, though, and I think he's eating enough where only one syringe feed is enough to wiggle him through without worry about his liver getting worse.

I did call VCA internal medicine to ask if we could try to dial back on his anti-nausea med Cerenia to every other day because that drug is somewhat notorious for causing lack of appetite. It's got a good half life in the system, so I would think every other day would be enough now that his vomiting has been under great control for a few weeks now. They agreed and also suggested that the Atopica for his liver could also be causing some upset with his tummy and thus causing lack of appetite. They suggested we draw up a dose of the med and stick it in the fridge for about 15 minutes before administering the dose--they dispense it as a capsule and they recommend that folks do that for the capsule and allegedly that makes it cause less stomach upset. Hell, it's worth a try, but since the box says to keep at room temperature I have to get in touch with Dr. Lehal so I can ask if it's okay for us to put it in the fridge for that short amount of time to see if it helps...

In other news, Ra goes for his first weekly CBC in conjunction with the Aranesp injection he's taking for his severe anemia. We're both hoping that his RBC will have a better percentage than last week, but aren't expecting any miracles in just one dose. His results will determine what amount of the med we give him tomorrow night for the week. The med information says that it takes 2-6 weeks for it to start working, so...yeah...

More news tomorrow night...
( Jul. 23rd, 2014 09:48 pm)
It is with a heavy heart, indeed, that I report the latest news on Ra. The severe anemia is being caused by both kidney and liver failure. With his current med and food regimen, Dr. Medinger at VCA internal medicine gives Ra three to four more months at best. We're adding Aranesp for the anemia and Ursodiol for the liver. Fortunately we were able to get the Aranesp through Costco Pharmacy; I understand it's somewhat hard to come by. It'll be here tomorrow afternoon. Our poor, sweet old man...Our hearts are breaking...
Ra went for post VCA internal medicine follow up this morning with Dr. Lehal at Brookville primarily for a blood draw to check his blood chemistry to check his kidneys and liver and CBC to check his anemia...

From my Facebook post on the matter:

Ra's blood work has come back from earlier today. His liver enzyme ALT has gone down from 1390 down to 950, so going in a good direction. His potassium is normal at 4.4. His creatinine is okay at 2.4. The rest? Not so good. Bilrubin (another liver value) went up from .4 to .5 which is high normal. His BUN (kidney value) went up from 35 to 56, which Is Bad. The most concerning is his anemia is worsening--was at 31% red cell count last week, now at 17%. That's a serious drop and an indication that something is seriously wrong. Dr. Lehal suspects it's in the GI tract (ulcers), or in the bone marrow (related to the Chlorambucil). It could also be related to the worsening state of his kidneys, too, though, so... Sigh.

While the blood's still at the lab, Dr. Lehal is going to have them run a more concrete test for what type of anemia Ra has--there are two types to be concerned with, and Dr. L spoke of them so fast I couldn't keep up notes wise, but whichever type it's determined to be determines what sort of treatment Ra will get for it. Dr. Lehal is generally of the opinion Ra needs a blood transfusion for the quickest rectification of the anemia, but is waiting for more counsel from Dr. Medinger from VCA Aurora. We're both really scared for our boy--severe anemia and worsening kidney disease is what took our Diva kitty from us last summer, so...yeah...Shit. Shit. Shit! This so totally sucks. Will know more tomorrow after Dr. Lehal talks to Dr. Medinger...

If you're of the praying sort, please include our Ra into your rituals. He's gonna need all the help he can get, methinks...
...and none of us, particularly J (who does the actual syringe feeding) and Ra, are enjoying it. Ra simply will NOT eat much kibble on his own, as much and as often as I try. I don't think it's because he doesn't like it, but because it must set heavily in his tummy or something. I just don't know what to do. He seems to want to eat Lars' and Dorene's kibbles, but since their food isn't hypoallergenic...yeah...Even then, he loses interest in it fairly quickly after starting to eat it.

Ra's random feverishness seems to be getting under control--when I pick him up for his meds/feedings, his bare belly still feels a bit warmer than normal, but not nearly as hot as it was last week. I did buy an 8-second timed thermometer especially for kitty use so that we could monitor Ra's temperature, but since neither of us know exactly how to take a cat's temp rectally properly without perforating anything, we've not yet tried taking his temp here at home. I think when we're at the vet tomorrow I'll have Dr. Lehal show me how to do it.

Over the course of last week, Ra went from loose stools to straining to go and not actually achieving download; constipated once again, so putting him back on lactulose was in order. Dr. Lehal told me to start small--only 1cc--and that was plenty enough. Sent Ra right back into loose stool land. :( We simply must figure out a good way to regulate that particular bodily function. Poor fella. :( He seems a bit embarrassed when he inevitably ends up with poo on his feet after a particularly bad one while he's trying to bury his business. Either J or I end up chasing after him to clean him up if we notice him post-download, something Ra REALLY doesn't like. Hey, gotta keep the house from getting all gunked up with cat shit, ya know?

So it goes. We've got a pretty solid routine as far as giving the myriad of meds and timing of the two syringe feedings in between all of that. It's a still a lot of stress and work, but Ra is seeming to be doing ever so slightly better, so we keep going. I even caught him hanging out on the cat fort in the den on Saturday! Took him some effort to get up onto the shelf he was hanging out on, so that's a good sign that he's getting a bit stronger and feeling a bit better.
It's a mouthful, and I daresay I still have to do some Google-Fu to learn more about the diagnosis. It came back as moderate neutrophilic lymphocytic plasmacytic cholangiohepatitis. "This diagnosis in conjunction with Ra's IBD and pancreatitis consistent with Triaditis." I have NO real idea what it all means just yet, but I do know it's not infectious hepatitis, but rather a sort of inflammatory disease mechanism that he did not "catch" from somewhere/something that's somehow related, as stated to his IBD and his Pancreatitis.

He's on two new meds, sigh. One is a liquid called Atopica which is on-label used for skin conditions but off-label used for liver disease. Also, because he'd been running an unexplained fever for about a week, he got put on another antibiotic--pill form Clavamox--because they think the fever is from some sort of secondary infection in addition to the "small H" hepatitis condition he's now afflicted with.

The Atopica is interesting in that it's a tiny brown glass bottle with a special bottle adapter for the special syringe. The syringe isn't marked by MLs or CCs, but rather with the cat's weight. Ra's dose is for a six pound cat, even though he's just over eight pounds. The special adapter is a sort of tube mechanism that goes down all the way to the bottom of the bottle and there's a hole in which to stick the special syringe in to draw up the med. Interesting!

In other news.

Though perkier--he actually played and wallered with the new catnip toys we purchased on Friday night both Friday night and yesterday--he's still not eating enough on his own to avoid the syringe feedings twice per day. He (and we) pretty much hate the syringe feedings, largely because the hypoallergenic food is disgusting. We've decided it smells rather like rancid bacon, and its texture is both dense and grainy all at once, making adding water to it to make a sort of mash of the stuff to fill the syringe a pain in the ass. Both Ra and J usually end up wearing some of each feeding, which is frustrating for both of them. We all did so much better on the A/D, but it's been decreed as "too rich" for Ra's IBD to handle, even though he ate it with almost a bit of gusto when syringe fed and even though he kept it all down. Sigh. We do what we have to do. Or, rather, J does what he has to do and I help out where I can in the feeding department.

And so it goes. Medications throughout the day, attempts at feeding kibble throughout the day, two syringe feedings a day, and 50mls of sub-cutaneous fluids every night. It's a lot of work, but it's seemingly paying off--Ra does seem to be getting ever so slightly better a little bit each day...What we do for our critters... :/
With Ra being largely nourished with syringe feedings, it was decided that Dr. L should see him yesterday morning for a re-check. So I took him in. Exam done. Ra was running a temp of 103!! That's pretty hot for a cat, not a good sign since he's been on that antibiotic for about a week now. Did a thorough physical exam and noted that Ra complained most incredibly when Dr. L palpated a certain part of his tummy. Dr. L also thought he felt something abnormal in that spot, so x-rays were done.

It took him FOREVER to come back with the x-ray results, largely because he was scrutinizing them so hard. He came back into the exam room and re-palpated Ra's tummy, which caused a minor uproar. Showed me the x-rays and explained his concerns--the area where Ra complained about palpation showed an area of either food pocket or a possible mass and his colon was FULL of gas--just totally bloated with it. So Ra was diagnosed with colitis and Dr. L wanted us to follow up ASAP with VCA Aurora and Dr. M. about the possible problem area in Ra's tummy--located at the juncture between his colon and his small intestine. He recommended another ultrasound of the belly at the very least, and whatever tests Dr. M thought were necessary.

Got a 1300 appointment with VCA. J went with me. A partner vet of Dr. M's gave him his first exam. We talked about a lot of stuff--how Ra's not been getting around very well as of the last week or so--weak on his feet, uncoordinated, scared to jump, etc., Dr. L's observations about Ra's tummy and his x-rays. Partner vet palpated Ra again and felt nothing unusual and asked if Ra had perhaps had a bowel movement from the time he was seen by Dr. L and before we took him into VCA--we didn't know, so we were of no help. He tested Ra's leg's range of motion and made him walk back and forth in the room. Took him a good 40 minutes! He was THOROUGH!! Then he went to talk to Dr. M to see about next steps.

About 20 minutes later Dr. M personally examined Ra, again very thorough, again many questions about Ra and his behavior and his visit with Dr. L earlier that morning. Dr. M ordered a follow-up belly ultrasound, a neurological consult, and some blood work. We got the estimate for the treatment plan and were told it would take about two hours for what was planned. We went off to eat and came back just about around the time he was done...

Ultrasound: was negative for anything abnormal in the belly and showed basically the same as the one taken back in early June. Neurology: normal. The coordination/movement problems are largely caused by bodily weakness likely from the potassium deficiency the blood work uncovered and from lack of eating enough, and same would rectify when both of those issue were taken care of.

Blood work: Came back with the aforementioned potassium deficiency, stage II renal failure, mild anemia and VERY elevated ALT liver enzyme. Ra's ALT liver enzyme was shown to be elevated last week--went from 158 back in early June to 300 last week. Yesterday they were skyrocketed up to 1390! Holy Shit!! The first thing we asked about regarding the blood work was what about fatty liver disease?!?! Dr. M reassured us that Ra's liver showed no signs of fatty liver disease on the ultrasound, that it looked normal, and that ALT was not necessarily an indicator of fatty liver disease.

That being said--Dr. M felt it was necessary to aspirate some of Ra's liver tissue in order to find out just what might be upsetting his liver. So J approved that procedure and we waited in the very noisy and busy waiting area while that was being done. We should get the results for that test as early as Thursday night or Friday morning.

Dr. M took Ra off the antibiotic (good, as it wasn't seeming to be of much benefit anyway). He increased the prednisone for his PM dose to 5mg from 2.5mg. Put him back on potassium supplements; half a 468mg pill every twelve hours. Rest of med regimen remains the same. Encouraged us to really try to get Ra to eat the proper hypoallergenic diet, but if he wouldn't, obviously any food he'll eat is the way to go. So we picked up ten cans of hypoallergenic Royal Canin to syringe feed vs. the really rich and not hypoallergenic A/D crisis food. See Dr. L in 5-7 business days for the lab results and further treatment.

So, yeah. Ra and J and I had ourselves a day yesterday! Poor Ra--his belly fur had just sorta started growing back from the last time they shaved it for an ultrasound and they had to shave it again yesterday! :/ Tried the new canned food this morning and that went over like a brick--what a mess--he seems to prefer the A/D over the hypoallergenic; at least he doesn't try to spit out the A/D whereas he was trying to spit out the hypoallergenic this morning. Hopefully he'll get used to the new food, as it's definitely better for his guts...Sigh, let's hope!!
Finally got in touch with Dr L. followed by VCA internal medicine earlier this afternoon. Turns out we've not quite been feeding Ra enough via syringe as we should be--Dr. L wants to see at least a full can and we'd been feeding 2/3 to 3/4 of a can each day over the weekend. Whoops. At least Ra's been eating some kibble on his own to offset what we've not been giving him via syringe so I don't feel terribly mortified, just slightly mortified. :/ As if we could know without counsel from a vet how much Ra needed to be fed via syringe, right? So I shouldn't be so hard on myself, dammit, but I feel bad... :/ We're also supposed to keep an eye on his weight closely, so we'll be pulling out the good ol' postal scale later to weigh him to see if he's inevitably lost more weight...

Ra has a follow-up appointment and possibly lab work tomorrow with Dr. L at 0900 tomorrow. This is good enough for VCA internal medicine, at least according to Sandy the tech, so it's looking like we won't have to make the trek all the way out to Aurora, too, after all...All they want are all of Dr. L's observation notes and any labs he does for their records so Dr. M over at VCA internal medicine can go over everything and advise accordingly. At least, so far, VCA agrees with the current treatment regimen Dr. L has formulated for Ra over the weekend with us. I was dreading a lecture about taking Ra off the strict hypoallergenic diet, but it didn't happen--they just want to see Ra eating ANYTHING, too, so...yeah...

Speaking of feeding Ra, it's time to give him some more kibble...Wish me luck!!
I've been trying to get him to eat his kibbles on his own, but no love. So, we continue with the A/D syringe feedings. We've been doing 32ml twice a day, and are probably going to increase that to 32ml three times a day.

Got up at the ass-crack of dawn today to get his metoclopramide (one of his anti-nausea meds) into him so we could wait a half hour before we fed him before J had to get ready to leave for work. He's getting feistier with each feed, which is probably a good sign that he's feeling a bit better, but it's hard to know if that's the case or if he's Had Enough of the syringe feeding. Still, he generally took it like a champ. I'm ever so glad J is so good at doing it, and that I can help where ever I can--it's really a two person job to make things go as smoothly as possible.

I think the liver supplement did a number on him, poor fella. That's when the liquid/pudding poops started, when the lethargy got worse, when the appetite went into the crapper. Far too coincidental for it not to be that.

Our big concern right now is that his liver function will continue to falter and/or worsen. Fatty liver disease is an all-too-real possibility right now. I lost my Smudge kitty to that damned disease back in '06 when she was only six years old, I'll be damned if I'll lose another kitty to it without a fucking good fight. :(

Calls are in to both Dr. L. and to VCA Aurora internal medicine to give them both updates on Ra's condition. I fear a trip out to Aurora is probably in order given Ra's anorexia as of late, but perhaps they'll defer to Dr. L to do the work to spare Ra the trauma of the long car ride. He *Hates* that car ride, and I hate to do it to him if I don't have to.

Sigh. Our poor, poor kitteh...
Gave Ra his appetite stimulant around 1800, then around 1900 we tried feeding him some of Lars' and Dorene's food which he formerly ate and liked; ate a few bites, then no love. Baked him up some chicken--his all-time favorite food--and he ate a few bites and walked away. Sigh.

Nothing else left to do but syringe feed the poor ol' bastard...


I helped J syringe feed Ra 32ml of A/D crisis food mixed with a smidge of water around 2100. That's about a quarter of a regular sized (not small) sized can of cat food. For not having done it since the last time Ra was so desperately sick back in 2004, J did a spectacular job! Minimal mess, got most of the food into Ra without any aspiration. And, so far, Ra is keeping it all down! Yay!!

Put in a voice mail to Dr. L. at around 2200 to let him know Ra's having to be syringe fed for his nutrition right now. Perhaps he'll have some sage words of advice for us to do more for Ra than we're already doing, perhaps not, but I wanted to update him regardless, as he told me to do. We'll see if I get a call sometime tomorrow...

Have yet to look at Ra for signs of jaundice--will do that when we give him his 50ml of sub-q fluids in a little bit. I'm pretty worried about how poorly he's been getting around--he'll walk a few steps, then lay down for a bit, then wobble a few more steps...lather, rinse, repeat. So he's pretty weak right now. Because of that, I feel even worse for having to give him all the meds I'm giving him. :( Sigh...Poor Ra!
( Jul. 12th, 2014 08:12 pm)
...back in April of 2012, back when he was the healthiest cat in the household. My, how things have changed. :(

Ra and me April 2012
He was doing pretty well for the bulk of yesterday, but then petered out for dinner and, then again, at breakfast this morning.

Because two big meals went south on him, I put in a call to Dr. L. this morning first thing. He told me to take Ra off the liver supplement and give him his Mirtazepine (the appetite stimulant) early--this evening vs. tomorrow morning. He also said to feed him whatever it is he'll manage to eat--be it people or kitteh food. Additionally, if things continued to go south for Ra appetite wise, I am to call and leave him a voice mail and he will respond as soon as he checks it after hours.

As for the rest of the day, Ra's not eaten but a small amount of any kibble we give him, and that's about all he'll eat. I gave him his Mirtazepine probably a little earlier than Dr. L. intended at around 1830; it has yet to kick in and do its thing. We picked up some fresh chicken breast to bake for Ra, which just came out of the oven, in fact...Hoping he'll want to eat that up big time.

We'll have to check Ra for signs of jaundice later on, I'm afraid. He's simply not eating enough and I'm, personally, desperately afraid of fatty liver disease setting in. I lost my Smudge to that back in '06--it was a horrible way to go. :(

Things continue to go poorly for our boy. We're both so desperately afraid we're going to lose him. It's just one thing after another, dammit! I just hope it's not too much for him to take...