5/13 Asia AMPS 171 AHA! An important observation

Click here to read about a frustrating vet visit that simultaneously gave me no answers while punching me in the wallet and making me feel some kind of way.

First of all, HAPPY MOTHER’S DAY to all you human and cat mamas! Your sweet kitty may not send you flowers or take you to brunch, but take a moment to pat yourself on the back for giving and loving and caring and all you do for all of your babies, cat/human/drooler/growing or grown.

I was reading some posts last night and came across one by @Tasha & Darwin where she was telling Karen there is light at the end of the tunnel with FME because Darwin eats more enthusiastically now than ever in his life.

ZING! I don’t know why it never occurred to me before, but I had a thought just then. What if Asia’s piggy eating was related to when antibiotics were started? I was happy when she started doing it, but it was so unusual I was convinced it was a symptom of something (like hyper T) rather than the resolution of a very long standing symptom. Mental note to self and said dig through old condos and investigate timing of Piggy Poof against timing of abx in the morning.

Well I investigated. Piggy Poof came on the scene on around 2/2/2018 according to my condos. Prior to that time, she ate little bits over several hours and even had some brief periods of inappetence. 2/2/18 was 9 days after starting Zeniquin for the kidney infection. When we finished the Zeniquin, guess who went on vacation? Piggy Poof. According to 4/20/2018 condo, I mentioned she wasn’t piggy eating but was more like the old Asia recently. That’s the time she was off Zeniquin for a bit and her BG started to go out of sorts and she was back on it but not for long enough to see results. I don’t know when Piggy Poof returned, but sometime after the new round of Zeniquin was started.

I wonder if the Zeniquin killed enough of the baddies in her mouth that she could eat pain free? And it’s obviously started to do so again, but she now has other issues and her BG is still crazy. Are the other issues from her mouth dumping more bacteria into her system and creating widespread issue? Doesn’t seem like a crazy assumption to me.

Can she stay on antibiotics indefinitely, or can I convince my vet to pulse abx, or is surgery our only hope? These are things to ponder, but this was a huge lightbulb moment and puts a ton of weight in the teeth part of the equation since there is nothing to see there and a dental X-ray can be done without anesthesia. I don’t know if I have THE answer regarding what’s going on with her right now, but I have a big part of it, that’s for sure! Ah sleep, it does a body good and solves problems with less effort!

 

When was the last time Asia had a dental? Not that it really matters, I know infections can arise not too long after a dental anyway. Due to her age is her heart the concern during anesthesia? I wonder if you could ask Dr Goodman. Its not a procedure a regular vet should do but I believe you mention a board certified anesthesiologist on the island. I just checked Cornell's website and they had a specialist there but apparently not at the moment.
I mean otherwise Asia is one tough cookie could she manage a dental?? I don't know but if the root of the problem..

I'm glad you got some much needed rest!

Have a very Happy Mothers Day

 

You may be on to something.

10days of ab is about what it's taken to stop having to coax bfg to eat.

 

Nodding my head. Exact same observation here with Gizmo. I am not convinced (with Gizmo) that it is his teeth but it could be. I think it is kidney infection or infection from the pancreatitis.

I am researching Texas A&M vet hospital (thanks for your post here @Sienne and Gabby (GA) ) as possible place to take Gizmo. It is only 1-1/2 hours away which is just a bit farther than other options outside the close Blue Pearl where he has his appt on 05/29.

 

If they could only talk! Think @Amy&TrixieCat used AB's long term. I'm not much help in assessing as it could be so many things. Thanks for the support with Leo...I'm feeling very defeated at the moment.

 

When Olive's echo was done besides finding out about the arrhythmia it was to clear her for anesthesia for a cat scan. He listed anesthesia meds she should not be given. Did Dr Goodwin do that for Asia?

 

She’s never had a dental for cleanings, she’s only had the extractions when she was 13. Her heart isn’t a concern as far as I can tell and the fact I had the echo so recently makes for great pre op workup. If the issues are known in advance: diabetes, pancreatitis, etc. they choose the best anesthetics to work with the conditions. That’s why I asked the vet yesterday what would kill her? If she has an active infection, yes, bad idea. If the Zeniquin is controlling that (which according to Asia’s eating her kidney values) all the better. It’s super risky, as of course is any procedure and surgery on elderly cats (or people) with dieseases. But, unlike some other things you might treat or have surgery for, her teeth coming out could solve some problems. AMC is a big to do hospital here and they have many clinical trials and things, I would likely use them if I could and pay extra to have the anesthesiologist oversee her during surgery rather than just select the drugs and leave the monitoring to a tech.

But before I can even consider it, I have to figure out what is causing her pain and is it an acute thing, or is this her new normal. If it’s pancreatitis, it may pass? I really don’t understand enough about it and she has none of the classic symptoms other than pain. Just pain. I upped her bupe dose to 1.5 mL (every 8) and she is suffiently out of pain and not sedated or loopy. Crazy, considering a few weeks ago she was .o75mL every 12 and was doing great.

 

It’s so painfully obvious now that I’m looking at the dates I feel stupid for not making the connection before. I should have listened to @Marje and Gracie instead of my vets and done this months ago!

 

I know Asia has other things going on, one being a UTI or kidney infection, but let me tell you, we went through this when she was 13. It was widespread and systemic, she was fading and shutting down, lethargic and couldn’t keep her head up, we tried so many things trying to figure out what the problem was! The day I said this is enough, she’s not going to get better and we can’t help her, the day I called my vet and she came to give the pink shot, that’s when she saw blood drip from her mouth and said it’s her teeth, I think it’s her teeth. So it doesn’t mean other things aren’t the problem, but it does mean a mouth infection can trigger a whole host of systemic issues from dumping bacteria constantly into their body.

I think the Texas A&M resource is exactly where you need to be! I hope you can work something out for Gizmo and I hope someone tries antibiotics for him.

 

He did not, but I will email him, I’m sure he would oblige and than you so much for recommending him!

 

It looks like it might be a really good option. I posted on a local (fishing) forum as I know there were others there that have taken their dogs. Really good input/feedback and everyone has nothing but good things to say. Doesn't look (from the posts) that there would be a wait time but I just have to figure out how to get him there and get off work. Friday may be a possibility (drive up Thursday after work and have appt Friday AM and drive back Saturday AM).

 

We used ABs somewhat long-term, but not extensively. Trixie had terrible teeth, too, but because of her kidneys a dental was out of the question. When she had a mystery infection in January 2016, the ABs were a miracle for her. We think the infection was actually an anal gland, but the AB (simplicef) cleared up her mouth beautifully and she ate like a pig. After the ABs, things reverted back to a so-so appy and I could see the yuckies returning to her mouth. She then did a couple 6-week courses of Zeniquin, but it really was a stab in the dark sort of thing (possible UTI, etc). She did pass away that June, so it really was somewhat of a pulse AB thing (but not in the "traditional" sense) over the course of 5 months.

 

I’m guessing they don’t do weekend appointments? I hope you can figure out how to work it. Why wouldn’t you just make it a day trip? 90 minutes used to be my work commute, that’s nothing.

 

I could I just worry about the stress on Gizmo and the heat. It would be great if it would be overcast and raining. It is already hot here - going to be 90* today. If it is his teeth - they would more than likely (from the info I am getting) and they think his heart can take the anesthesia, they would do the procedure the same day. Just worried that a day trip (+++ the visit) might be too much for him.

Are you giving any B12 shots?

 

I think you are on to something. I hope you can find a vet who will listen. Sending prayers.

 

Ah yes, I went to Houston once for a June wedding, the heat was worse than being in the Caribbean for some reason. I guess A/C doesn’t do much in a car with that level of heat kicking outside. I like your other plan, drive after the sun sets and make a mini trip of it.

I am giving Asia the methyl b12 shots every other week. Compounded from diamondback pharmacy.

 

Thanks, Carla. I’m tenacious, so I have that going for me!

 

I was going to do every 2 weeks but went ahead and gave another shot today (so giving every week). Mine is Cyanocobalamin.

 

Asia got weekly shots of Cyanocobalamin before, I think that’s pretty standard. I’m not sure why the methyl is every other week, there’s not a ton of info on it, unfortunately, and it isn’t widely available as must be compounded.

 

My two cents on a comment you made on your other thread about the vet saying the mouth infection wouldn't affect her systemically. That's nonsense. One of the many risks of not treating serious dental disease in cats - and humans - is that the bacteria can go into systemic circulation and set up shop elsewhere like in the kidneys or the heart, as two examples. One of my brothers who has since passed had very serious heart problems that involved valve replacement among other things. He needed a whopping dose of antibiotics before any dental work because of the risk of bacteria infecting the valve site.

 

Wow, good detective work! You could be on to something and I hope that she will be a candidate to do long term antibiotics for if this is a tooth issue.

One cat owner friend of mine in AZ, her vet uses a "gas box" to put her kitty in to sedate her enough to do what has to be done. Wonder if gassing her would be enough to do any dental? I don't really know enough about it. Just throwing that out that.

 

FYI: We did a pulse therapy using clindamycin for several years for recurring gingivitis. Started with 5 days then soon went to 7 days every month. My vet didn't think it would help, but I asked him to humor me. I also asked him what did we have to lose? We didn't want to anesthetize her any more than we had to because of other health issues and there were other abs available for oral use if she happened to become resistant. My vet was pleasantly surprised at how well pulse therapy worked for Alex.

 

I know! I thought this was common knowledge, or at least would be to a vet. I don’t know how to convince her, I already told her what it did to Asia at 13.

I’m sorry to hear about your brother.

 

Would it do, is the question. If you look at Asia’s SS from the time she stopped Zeniquin until her BG started going crazy wacky, it’s less than a month. I know she could have pancreatitis or something else going on, but her lack of enthusiastic eating also tells me it became painful to eat and it also likely allowed the bacteria to come back and potentially go elsewhere. I don’t know how gingivitis stacks up to FORLS or whatever they call it these days.

I wonder if there is any way to swab her mouth and culture to see what abx would target it? Is that a thing? This vet refused to do pulse antibiotics and the one that suggested it is from where we moved from last year. I’ve asked her to humor me about the kidney infection and antibiotics, I’ve had to literally beg for every extra week past two weeks to treat it.

 

I don't know. When my vet and I were discussing abs we were mostly talking about clindamycin and possibly the use of clavamox. We decided on clindamycin because she did well with it in the past.

I get not wanting to build up resistance to abs, but when cats are older and/or with multiple health issues they're usually not going to live long enough for it to become a problem... at least that was my argument with my vet.

 

That was my arguement too, but I don’t think that’s the real issue.

It hasn’t been researched very much, but I think the concern is less that one animal would become resistant, and more that an animal would become resistant and potentially transmit the resistant bacteria to other animals or particularly to a human. Breeding so called superbugs. It’s conjecture at this point (transmitting it to humans, which the inverse is far more likely), but that is more the concern.

 

On our first consult with Dr M, when he asked why George had not had his mouth seen to and I said it was because previous vet said it was to dangerous for him to undergo the procedure, and then he asked
Why hasn't he had AB's to manage it then?
Apparently it's something he does, but obviously not what George's previous vet does.

I think that because there is concern and evidence is not clear cut one way or the other it just ends up coming down to individual vets opinion as to whether it works or not or if there is a real risk in breeding a 'Superbug'.

 

Sadly, yes, I think that’s exactly it. Only because we moved, twice, and Asia got diabetes, I have had exposure to many more vets than normally I would have. I always ask about her teeth and what to do because I’ve been paranoid about the resorptive disease coming back since the last time. The dentist that did her extractions said to come back every year for cleanings, my long term vet’s take was having her go under anesthesia every year for a dental was too risky as she was a senior. It was hard to know what to believe there because wouldn’t every dentist say come back every year, and my vet knew Asia for a long time. She said we just need to keep an eye on it (apparently they can do some jaw chattering test in the absence of X-rays) and deal with it when it presents. She’s the only vet that’s ever been able to get in Asia’s mouth (and not without getting peed on). Every other vet had their own thoughts: pulse antibiotics, don’t get the teeth out too dangerous, it could go either way the surgery is risky but the dental disease is risky too, pulse antibiotics don’t work and mouth infection stays local, and finally “you’ll kill her” (well guess what, so will her teeth if I don’t do anything).

Not one of them said yes, go do it, get those teeth out! All said too risky with the exception of one who said it’s a tough call and there’s no wrong answer. With all the things she has going on now, it sucks, but from all I’ve read about anesthesia, age has nothing to do with risk. The risk comes from the general health of the cat and disease processes present. So many regrets here.

I’m so, so, so glad you found Dr. M! It really sounds like he is on top of things and it’s a huge win there is a vet that awesome in your area, period. George is going to do great!

 

@Stacy & Asia
Look what I just found.. I am going to pick up some generic tonight. Looks like it could be a win-win on the appy/mouth issue. The way I figure it - it is worth a try.

Why I Love Zyrtec for Cats

Moderate dog success notwithstanding, where Zyrtec really shines is in my kitty patients. Though it doesn’t work for all itchy cats, it does seem to help quite a bit — far more than Benadryl’s diphenhydramine and significantly more than chlorpheniramine (my former go-to antihistamine for cats).

The dermatologists on VIN (the Veterinary Information Network) seem to agree: Good, safe stuff for cats, this Zyrtec. Probably more effective than the alternatives. And definitely easier because, for cats, we now know that once-a day dosing is perfectly appropriate.

The best news for felines, however, is not just that Zyrtec seems to help for their itchiness, but also that it may help treat eosinophilic diseases.

What’s that, you ask? They’re a collection of (typically) skin, airway and intestinal diseases cats suffer much more frequently than dogs. They can cause stomatitis (oral inflammation), rodent ulcers (unsightly upper lip lesions), eosinophilic plaques (crusty sores), intestinal ulceration and diarrhea, and bronchitis, tracheitis and asthma, among other problems.

Lately, it’s been determined that a significant percentage of cats affected by these eosinophilic diseases respond well to Zyrtec. Complete remission of symptoms is actually possible for some once this drug is initiated. So far, this seems to be true for all eosinophilic cases, save those of the respiratory variety (Who knows why?).

 

That’s really interesting! I am going to ask my vet about it, not sure if/how it may interact with other things she’s on. I hope it helps Gizmo! Side note, I’m sure this doesn’t relate to cats at all, but I used to take Zyrtec for seasonal allergies and I switched to Allegra because it had a very weird side effect on me that took a couple months to figure out it was Zyrtec...it made me angry, like all day, for no reason. Very odd!

I wonder if this would be a good thing for @Sean & Rufus to try!

 

Oh, Stacy, thank you so much for thinking of me and Rufus He actually was on Zyrtec last year for about 4 months and we didn't see any improvement unfortunately. We were hoping that some of his allergies could be seasonal and be relieved by it, but no.

 

It says it can help with skin and intestinal allergies, not just seasonal. But that’s too bad you already tried it and it didn’t work.

 

I ended up getting Zyrtec (not generic) the inactive ingredients in the generic included corn starch and blue coloring and some other stuff so I just got a 5 pack of the 10mg. Not sure when I will give it. It has been 4 days tomorrow AM since his last Mirtz and I was thinking about giving up the Z instead but I am not comfortable giving it and leaving not knowing how he will react. I am getting about 4 days of fair to good appy on 1/2 Mirtz so I may give him Mirtz tomorrow and give the Z Saturday.

 

Hav

Have you tried Cyproheptadine? I am not familiar with Rufus' issues so I don't know what you are dealing with. They give cypro for appy enhancer and asthma but it is an antihistamine.

https://www.vetinfo.com/cyproheptadine-for-cats.html

 

Rufus has food allergies that have turned into food intolerance/IBD?/SCL?. He is constantly licking himself and gnaws at himself. He licks himself bare in some places. His story is a long one since last year, but we tried Zrytec and that didn't change anything. Then he started eating less so we thought prednilsione would help with the itching and appetite. He was on a lower dosage and didn't do much for his appetite but it did help with the itching. But then he developed diabetes so off the pred. Now he is eating whatever we can get him to eat, so the inflamed GI remains which make him have bad nausea. We tried Atopica which helps with the itching and theoretically with the GI inflammation, and that helping with the itching but made him even more nauseous, and it it exacerbated his kidney numbers. So we took him off of that.

As of right now, no allergy meds. We are going to a new IM vet on Wednesday. I'm hoping to get him bude for his GI. Hopefully that will calm him enough to switch to a novel diet, and then hopefully be able to take off the bude. Current IM vet will not allow any steroids as she is more concerned with him being kept in diabetic remission then anything, which is becoming a huge sticking point withe me.