Updates on Myrna, Cooper, and Katharine

Some recent changes for our cats:

Cooper's vet from Michigan State, whom we've been seeing for his hypercalcemia, wanted him off of Buprenex-a narcotic that cats tolerate very well, which he's been on for a year for litter box issues with no physical complications or issues in his blood work.  She and his regular vet discussed the options and we all eventually decided to try Valium. We had already tried Amitriptaline prior to Buprenex and the Amitriptaline had caused complications.  We decided to begin Valium this week.  We had his blood work updated Monday to make sure he was healthy and could begin Valium.  Valium can cause liver and kidney issues so we had to make sure he was healthy enough to begin it. We must retest in two weeks to make sure there are no sudden changes in blood chemistry levels and then retest a month later to make sure things are still going well.  We learned from Myrna's cardiologist, when we began her on Valium, that if there were any issues, they would show up very quickly in the blood work and physically-if the cat eats, vomits, develops lethargy, etc. His blood work proved to be fine.  We began just yesterday, Saturday, and have begun Valium at 1 mg a day-1/2 tab twice a day. We will titrate up from there as needed.  So far, he eats very well on Valium and in fact, cleans the bowl whereas before, he only ate about half.   This is great news because he's so bony at 11.6 lbs because of his size-he's twice or more bigger than the other cats.  The best news from his blood work-his calcium continues to fall and is now in high normal range at 11.7, down from 13.8 earlier in the summer!!!  This is great news as hypercalc can cause damage to the heart and kidneys as well as other complications.  His BUN however is up at 34, the top end of high normal. But all other values are normal and neither vet is concerned.  We should try to do urine test next time if he has a bladder which he did not this week at the vet's. 

Katharine Hepburn, on the other hand, may or may not have an issue with her liver.  Her ALT level was high last summer but the vet said to ignore it. In September, she began to eat more and to demand food more often whereas before she would eat a few bites and leave and not eat again until her next meal. I was concerned that she had developed diabetes so I had her blood tested.  Now her ALT value has climbed to 197 when high normal is 100.  Her AST, the other liver value, is normal at 37.  Her albumin is high end normal at 3.7 but all other values are normal.  But her blood RBC is 10.51, HGB is 17.1, HCT 53.4, all extremely high and above normal.  Her lymphocytes are 59.3, just over high normal.  The vet said to retest the blood in a month but nothing else.  When I researched the blood chemistry, I found that they can indicate either that she's dehydrated or that there's an infection or issues with her liver, bone marrow, or she could be eating things she shouldn’t-and she does chew on everything, or a dental issue, or thyroid, etc.  So, I decided we’ll try to combat the dehydration if that’s the issue.  We will give her more water in her food-she was already receiving ½ cc of water; she will receive 3 ccs of water by mouth three times a day at meal time.  She isn’t externally dehydrated.  Her gums are not pale and her skin seems to bounce back normally.  If next month when we retest the blood it is still high, then I will need to take her to a specialist at MSU or have the regular vet call MSU for guidance and to what is next for tests and procedures.  She seems fine except for always eating.

Now, the only thing to mention about Myrna, our HCM cat, is that she’s urinating quite often and no one knows why. She drinks a lot, probably due to her meds which is normal. Only this September she seemed to go from urinating 3-4 hrs to urinating around 1 ½ to 2 hrs and sometimes every hour for two or three hours. But then she’ll return midday to going every 3 hours.  Blood work and urine are normal. If this continues, I may have to take her to MSU to see a renal or nephrology specialist or have her vet call MSU for a consultation.  Other than that, she’s a joy to be with, such a sweet little girl, even when she wakes me two or three times a night to use the litter box.

Cooper

Katharine Hepburn

Myrna Loy

Myrna Loy Update and a Visit to the Cardiologist

Myrna Update:

Last month, Myrna’s urine test showed a level of Ph 6. In September, the potassium level was high at 5.1. Because I gave her a potassium supplement to help her body maintain a decent potassium level, (the kidneys need potassium but lasix and other drugs tend to cause the body to excrete potassium and the other electrolytes causing a shortage) I ceased administrating the supplement.  Obviously, the body was maintaining a high level of potassium and not excreting it and that could be due to Valium that she takes which slows down the urge to urinate.  Within a few days, she began going out of the box about three times a week.  Going out of the box has been a problem for her since spring 2011. Due to that, she’s been on Valium since January ’12 (the only safe psychotrophic for HCM.)  It took a few months of behavioral training and Valium to get it under control. 

We had the blood and urine retested October 5.  The urine Ph was up to 8.  The potassium level was down to 4.1-low normal.  So, I once again administered potassium but 1/8 of a tablet instead of ¼.  Within days, she stopped going out of the box.  

Neither her vet nor her cardiologist knows of a correlation between potassium levels and using the litter box nor between potassium and urine Ph levels.  Her blood chemistry report shows normal BUN and creatinine and all other blood levels.  So, there’s no physical reason present to indicate any issues with normal kidney or bladder function nor are there any crystals, blood, or bacteria in her urine. Why if she’s given potassium, does she use her litter box but when it is ceased, she goes out of the box? Is giving her potassium the reason the Ph level returned to normal and ceasing it drove it up?   I think that potassium plays a part and I can only go by what I see, by the cause and effect of what I see.  So, I will continue with the potassium supplement.

Myrna also received a daily dose of Methigel during the last few weeks. I have suspended it for now even though it is suppose to bring down the urine Ph. I want to see if she returns to going out of the box which would indicate it’s the Methigel that affects her box use. If she continues to use her litter box, and then next month we retest the urine, I will see if her Ph is lower or not. If it is, then it’s due to potassium. If it is not, then it’s the Methigel that is lowering the Ph level. And all of this might indicate that the potassium keeps her using the litter box and the Methigel keeps the Ph low and that it’s not a combination of both that effect her box use.  We will continue to experiment and see.

She has been drinking a lot of water and urinating a lot since early September.  She goes approximately every 2 ½ hours after spending weeks going every 3-4 hours.  But she excretes a lot where as before she was excreting a small amount but the same amount (size in the litter box) as she always had.  But again, there is no indication regarding a decrease of renal function to explain the change.  It could be that all of the meds and the introduction of aspirin in July have contributed to a need-as well as the heat coming on in the house in mid September due to cold weather-to drink which leads to increased urination.  We will need to keep an eye on this.

As for her heart, she saw her cardiologist this past Thursday.  Everything seems fine. Her lungs are clear, the blood veins are good, and the heart number decreased from 186 to 184-a minor change but a decrease in heart size by any number is a good thing. 

We discussed some issues. She’s tolerated aspirin very well. She’s never vomited and her blood work continues to show that her liver and kidneys are able to filter it.  I noted that with aspirin, her energy levels seemed to be higher in July. Her platelet count is low at 164 but that is due in part to the aspirin which affects platelets.  But it could also be to how the test is run. Blood will begin to coagulate once drawn if not handled properly.   We will need to keep an eye out for bleeding and bruising that can occur with a low platelet count.

Lately, she has shown signs of extreme exhaustion. There is usually a day on a weekend where she seems to need not only a lot of sleep but seems as if she’s been up all night, can’t get up in the morning, and just looks and acts exhausted for the rest of the day. I explained her behavior by saying she acts like she’s in college and partied all night and now needs to sleep in the next day.  The cardiologist says that she has seen that before but in cats whose hearts are getting weaker but we don’t see any real issues in her heart. She also said that human seniors with bad hearts will have days of great energy followed by days of exhaustion as their bodies need to rest.  The cardiologist said that if this begins to happen more often or if it happens a couple days in a row, to bring her in, especially if we can bring her in when she seems to be more exhausted than usual.  We will need to keep an eye on this.

I did note that her breathing seems to from time to time to be at a fast sustained level before leveling off.  But it’s not constant and it has not made her anxious as if to say CHF is coming on.  She said that if it happens again, to give her ¼  lasix in the afternoon instead of 1/16. And if it happens again, to call her and bring her in.  Again, we will need to keep an eye on this.

I love to talk to Myrna’s cardiologist and to tell her Myrna stories and updates. We also discuss the other cats and sometimes she gives me feedback and suggestions.  We laughed at my current escapades with various cat issues and the many vet visits these last few weeks that we’ve had.  I also ask about her children and we talked about her new born son.  She gives me time to discuss everything that might be on my mind and sometimes there is a lot to go over regarding Myrna.  I always keep a list of questions and concerns and observations that I type up that we review at the visit.  It’s so good to have someone that listens about Myrna. When looking for a specialist that you’ll be depending on and visiting often, you must find someone who listens to you and takes the time with you that is needed and of course, someone you trust to do the job correctly.  We thank God, have it in Dr. DeSana.

She jokes but it is true-Myrna is a special little girl. She’s unique because she has a bad heart, and what should go wrong doesn’t like negative interactions with meds regarding her digestive system, her liver or her kidneys; and what should not go wrong does.  She will present with unique symptoms that the doctor has never encountered before like needing Valium (I think Myrna’s the only patient on a psychotropic) and the relationship between potassium and using the box and the urine Ph.  And Myrna’s had other odd issues with reactions to meds or her environment or other odd things that if they cause a typical negative reaction to most cats, never does in Myrna and yet if they are of no consequence to most cats, will be to Myrna. 

Here are the vet’s notes from the visit:

Myrna watching the leaves fall

“Today’s echocardiogram revealed that Myrna Loy’s cardiovascular status is currently stable. There has been no progressive enlargement of the left atrium or thickening of the left ventricle. There is no evidence of active or impending congestive heart failure. Further, there were no visible precursors to blood clot formation during today’s echocardiogram.”

Short Bette Davis Update

Bette Davis Update:

Bette Davis keeping warm

With the increase amount of Buprenex since her September going out of the box, we have not seen any issues. She didn't have any blood, crystals, or bacteria in her urine in September.  But it could have been that her idiopathic cystitis was beginning to flare up and to cause pain.  We have been giving her Buprenex .20 in the a.m., .15 at lunch, and .20 at bedtime.  When we decreased the amount over last weekend due to a shortage of the prescription, she did go out of the box by Tuesday.  But now things are back to normal with a resuming of the appropriate medication levels. We will continue with the higher levels of Buprenex, and giving water in the food and by mouth. 

Baby Update-Box Use, Teeth Issues, Etc.

Baby Updates:

Last week, Baby went to the vet for an annual checkup and to have her urine retested after the September visit for going out of the litter box which showed she had blood in the urine but no other indication of crystals or a UTI.  There was no cause given other than behavioral for her problem. 

After a few days of Buprenex at .15 BID (twice a day) she began to use the box without fail.  We also gave her water by mouth-3ccs at three times a day and added water in her food and fed her only wet food. 

She has also had issues with constipation/loose stool that didn’t want to come out completely (not to be too gross or too detailed about it-let’s just say it left a mess when she walked away from the box.)  So, we gave her Laxatone and Forta Flora. Laxatone is great for hairballs which she is prone to having since she has long, fluffy fur.  Forta Flora introduces good probiotics into the digestive system.  Since there was no cause that could be found for any digestion/colon issues, we didn’t do a scan since the blood work was normal. But if this continues we might need to do a scan.  She’s negative for worms, and the stool sample didn’t reveal anything abnormal at the time except for the amount of hair in it that hadn’t been digested in the colon-hair shouldn’t come out in strands in a bm.

The physical at that time, revealed that Baby had lost a tooth and was losing another one to resorption-when the tooth disappears into the gum and is gone, disintegrates.  I think it’s possible that the pain caused by her teeth-and the doctor said the teeth that are being resorbed would be painful-may have caused her enough pain to not use the litter box.  But who knows for sure and she can’t tell us.

After her check-up last week, she had no more blood in the urine.  She has had no issues with passing stool. She has used her litter box without any accidents (actually we should refer to them as on purposes out of the box-OPOB or OPOOTB or simply OP-what acronym would work best?)  But instead of needing dental surgery to remove a second tooth that was disappearing, it had already left her body. 

So, Baby will need a dental cleaning and xrays soon to see if other teeth are going to disappear.  We will keep up the water by mouth, in the food, the Forta Flora, the Laxatone, and the Buprenex.  Her blood work is normal for all glucose, calcium, electrolytes, BUN, creatinine, etc.

I also wonder and I can’t find an answer do cats need fluoride?  We have been giving them bottled water since last winter because our tap water has too much chlorine (you can smell it.)  Maybe without fluoride, the resorption was hastened. So, now I mix bottled and some tap into each water bowl.  Just in case.

Baby

Cooper and Hypercalcemia Update

Cooper Update:

Cooper chillin' out

The vet from Michigan State, who is handling his hypercalcemia, said that we do not need to have him tested monthly for calcium and other blood chemistry levels since she is positive that his hypercalc is idiopathic. So, we won’t retest his parathyroid or his blood and urine for a few months unless it seems his condition worsens.

With more water by mouth-6ccs TID (three times a day), 3ccs of water in his food TID; with inulin fiber added to his food; and by allowing him to eat between meals when he indicates he’s hungry, we believe those are the reasons his calcium levels are beginning to decline-which is a great thing since they are too high.  The increase water helps the kidneys flush out the calcium while the fiber and the extra food helps the body bind the calcium in the gut and to excrete it.  And eating more keeps up his weight.  

We give Buprenex at .35 TID which allows him to sit more when using the litter box.  We do not know why he might feel discomfort when using the litter box but we do know that we see an increase of him standing and going in the box (but the urine actually shoots out of the box) when he has lower amounts of Buprenex.  We haven’t had his urine retested for October but since he only had crystals last time, the only way to get rid of them is to give more water which we are doing.  And we were giving him Methigel-an acidifier that will lower the PH of the urine and help get rid of and prevent crystals.

We will continue the water, the fiber, the daily vitamin paste, the Methigel, and the Buprenex.

And Now Bette Davis

I took Bette Davis to the vet last week because she was going out of the box. She has idiopathic cystisis for which she takes Buprenex and water by mouth.  All of my usual tricks for managing her issue failed: no dry food, no Fancy Feast and only SO, and a reduction of treats, and an increase in Buprenex.  So, off to the vet we went to make sure she wasn't sick.  She's fine of course.  She had no glucose, crystals, blood, or bacteria in her urine. Blood work and temp, etc. all normal. So, that must mean that it's behavioral or her cystisis could be bothering her but a lack of blood in the urine means that it's not flared up really enough to be detected.  The vet suggested a psychotrophic but I'm hesitant.  Her weight is up to 10 lbs from a low of 9.12 last spring.  We increased the Buprenex last week from .15 q12 to .2 in the a.m.; .15 at lunch; and .2 at dinner.  After a few days it seems to be helping.  Perhaps if we bring down her weight we can also reduce the Buprenex.  Perhaps her weight is causing stress.  Perhaps the weather changes to a colder temp is causing stress on her system.  Can't be sure.  For now, aside from the increase in Buprenex, we make sure she only eats SO with little dry CD and few treats.

Bette Davis

So, that makes a total of three cats-Bette, Baby, Cooper-with bladder issues, two of which saw the vet last week because they were going out of the box.  And I cannot find a correlation as of yet.

Cooper Hypercalcemia Update

Cooper

Cooper was in for a blood and urine recheck on Sept. 8.  His urine for whatever reason shows a Ph of 8 with crystals in the urine.  I'm not sure how that can happen as we give him water by mouth, water in his food, and he drinks from a bowl.  His albumin was high which indicates dehydration, which in turns explains a high Ph and crystals in the urine. But why is he dehydrated if he's getting a lot of water? No one's sure. His BUN and creatinine-two blood chemistry values that indicate kidney function-are normal.  There's no indication of kidney disease or a lack of normal functioning.   For now, he's receiving more water by mouth, in his food and Methigel to bring down the Ph level.  He will have his blood and urine rechecked at the beginning of October.

The good news is that his weight is steady at 11.7 and his calcium is down from 12.8 to 12.3.  His phosphorous is steady at 3.4

Next month we will test for PTH, the parathyroid hormone which is currently not registering in the blood work. It should be at a normal level, neither zero nor high. His has been at zero because the calcium level is high and body, due to the high calcium, is telling the parathyroid that it's not needed at the moment.  When it does begin to be active, the calcium should be normal. If not, the activity of the parathyroid could indicate a disease with the parathyroid, something that tests rule out so far.  So far, his hypercalcemia is idiopathic-no real cause can be found.   For now, we are managing to decrease the calcium with food, fiber, and water.