From Neglect to Shame

Willowy

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Comfortis is danged expensive. But it's probably cheaper than throwing money at ineffective treatments. And definitely less frustrating.
 
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jefferd18

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Comfortis is danged expensive. But it's probably cheaper than throwing money at ineffective treatments. And definitely less frustrating.

Probably just a few cats would get it- the ones most dangerously affected by the fleas. Love the soft paws website. :)
 
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jefferd18

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I am so sorry. Is there nothing that can help? I know she is an older kitty and I also know you are giving her giant doses of love.


I don't know if there is anything that can help an 18 year old kitty. She has ear mites that are giving her fits so I got some medicine to get rid of the little buggers but she also has pain in her hips which makes it hard for her to stand long enough to even eat. I administered pain meds to her last week and usually the relief last longer than one week.
 

Jcatbird

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Ear mites do drive them to distraction. It can take awhile to get rid of them and they can have some inner ear issues that make them not want to stand. Perhaps she is woozy instead of in pain? That might explain why the pain med didn’t last as long. If it’s arthritis there are meds specific for that which might be helpful.
 
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jefferd18

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Ear mites do drive them to distraction. It can take awhile to get rid of them and they can have some inner ear issues that make them not want to stand. Perhaps she is woozy instead of in pain? That might explain why the pain med didn’t last as long. If it’s arthritis there are meds specific for that which might be helpful.
Thank you for responding, Jcatbird.

My vet told me that metacam was as good as it got when it came to pain meds for cats. I am sure she has arthritis in her hips- at her age- how could she not? I know she kind of squats when she eats her food- like her hips aren't able to hold her up. I will work the mite solution into her ears when I get home and see if that makes a difference.
 

jen

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I also would suggest Revolution from the vet to get rid of the ear mites. That way you aren't shoving a solution into her ears which can throw off her balance and possibly affect her hearing, aside from just being generally uncomfortable. Are you sure it is mites and not bacteria or yeast or anything else in there? Did the vet look under a microscope for all the other stuff that can be in the ears?
 
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jefferd18

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jefferd18

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I also would suggest Revolution from the vet to get rid of the ear mites. That way you aren't shoving a solution into her ears which can throw off her balance and possibly affect her hearing, aside from just being generally uncomfortable. Are you sure it is mites and not bacteria or yeast or anything else in there? Did the vet look under a microscope for all the other stuff that can be in the ears?


No, he hasn't seen Vale since her last visit a few months ago, but she had black stuff in her ears at that time too. Thank you for the tip!- I will try Revolution. When I put the solution in her ears last night I could tell that she was distressed- she was breathing hard.
 
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mentat

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Thank you, Indyjones :)

He didn't say it was not without danger, in fact, he hesitates to use it more than four times withr a cat. But what else is there, what else can ease her pain?
Proven safety and efficacy of meloxicam in cats in placebo-controlled, double blind studies of small to large sample populations, for over 20 years in EU, over 15 years in USA/CAN.
Efficacy and safety of 3 versus 5 days of meloxicam as an analgesic for feline onychectomy and sterilization
"Meloxicam’s efficacy and safety have also been extensively studied in cats, both through the regulatory requirements inherent in licensing meloxicam as a veterinary pharmaceutical, and in the published literature assessing perioperative and chronic use efficacy and renal/gastrointestinal safety (1526). Meloxicam has also been recommended as part of preventative and/or therapeutic protocols for “chronic pain syndrome,” which has been associated with feline onychectomy and theorized to be a manifestation of neuropathic pain."
"Earlier authors had postulated that suspect NSAID-mediated renal adverse events in the perioperative period may be primarily or partially a result of inadequate patient supportive care, including the lack of proper monitoring or IV fluid support (24,9). Hypotension plays a significant, if not primary, role in the incidence of postoperative NSAID-associated acute renal failure, and this has been cited as a stand-alone risk factor and can be mitigated by proper perioperative supportive care (including IV fluid support, blood pressure monitoring, and anesthetic dosing to effect) as was employed in this study (35,36). These supportive procedures have now become the foundation for standards governing the perioperative care of the anesthetized veterinary patient"
https://catvets.com/public/PDFs/PracticeGuidelines/NSAIDsGLS.pdf
This is from 2010, yet still has modern approach to cat NSAIDs long term use.
Acute Pain In Cats: Treatment With NSAIDs | Today's Veterinary Practice
  • In addition to standard dosing protocols (Table 2), meloxicam has also been recommended at lower doses, such as 0.02 mg/kg/daily.18 At this dose, it is well tolerated, but there is currently no information on whether it is efficacious.19 However, a recent masked, placebo-controlled clinical study found a dose of 0.035 mg/kg to be efficacious over a 3-week period.15
Table 2. Recommended Doses: NSAIDs for Acute Pain Management in Cats
NSAIDRECOMMENDATION SOURCERECOMMENDED DOSE
RobenacoxibRecommended dose from manufacturer (FDA-approved)1 mg/kg PO Q 24 H for 3 doses
Dose range, 1–2.4 mg/kg Q 24 H
Meloxicam
(injection)
Recommended dose from manufacturer (FDA-approved)0.3 mg/kg SC (single injection)
Meloxicam
(oral suspension)*
Recommended dose from ISFM/AAFP for daily use140.1 mg/kg PO for 1 day;
then 0.05 mg/kg PO Q 24 H
Meloxicam
(oral suspension)*
Other recommendations180.05 mg/kg PO every other day or 0.025 mg/kg PO Q 24 H

Meloxicam administered under supervision and monitoring of a veterinarian, including regular bloodwork monitoring if chronic use, and ensuring euhydration, is very safe, effective feline medicine. All of mine, as well as thousands of others in Europe, US, and Canada for over a decade, benefited from meloxicam and, more recently, robenacoxib, in youth and hospice at end of life. Vets achieve the lowest effective dose, usually as low as 0.025mg/kg daily to 0.05mg/kg every other day, meloxicam in oral liquid or injectable form. Even my CKD cats did well on it, as we compensated for reduced function by fluid therapy daily to every other day, in addition to moist, water-rich food; without meloxicam, they weren't mobile, didn't eat/drink with reduced mobility and pronounced pain/inflammation, and were depressed. They also had inappropriate elimination, as getting to the boxes, lifting limbs to navigate box edges, and squatting, were all impaired without meloxicam. We added gabapentin, Cosequin, and as needed buprenorphine. Microdose of ketamine every 2-3mo also reset their pain pathway; if my lymphoma girl now hadn't been prescribed prednisolone for life, she'd still be on meloxicam, but her higher dose gabapentin, Adequan twice weekly, and ketamine in her cocktail prior to rechecking her labs/imaging every 2-3mo is working in its place (more costly and invasive than meloxicam, which she'd still be on, as she has for many years of her DJD, if she weren't now on a steroid). We used Onsior at first, but low dose meloxicam liquid was easier to get in her without stress, just as effective, and was safe up to the last day she had it last year; poor bony union after trauma had us using it in her case alone for 9 years, kidneys beautiful on last ultrasound last year. Just to reassure you your cat isn't suffering silently on this NSAID, and your vet isn't neglecting or harming her by choosing it. Quality of life takes precedence in seniors with chronic pain, even with comorbid existing diseases. If anything, multimodal analgesia, with additional treatments atop the meloxicam, will bode well for her comfort in the future.
 

mentat

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Regarding her increased respiratory effort you noted while medicating her, if after handling her, she may have been excited and anxious while ears treated, combined with age-related lung changes, may not be alarming. If she was calm, such increased effort breathing could be underlying weakness due to a number of diagnoses, including anemia, lung disease, or pain associated with DJD. Hopefully, your vet communicates well digitally and you can request additional pain management if this sign persists. As she still has a great appetite, there are options to add to her regime, that can be mixed into her food. My last medical foster senior I had until euthanized harbored an abdominal mass missed by her shelter vet until presenting for euthanasia, but man, her pain was controlled on multimodal therapy, that was affordable, easy to administer, and effective. Cat cancer is weird, so no wonder we missed it up to the day; she was a "hell cat" in a cage at the shelter, stressed with change after her owner died and she was abandoned, but also mindless with pain due to DJD, IVDD, and, likely, that abdominal mass. Vale may just need a little more supportive care and pain management. While asking about it, you could inquire about fluid therapy for her while she's on NSAIDs, to preserve her kidney health and blood pressure as much as possible. Our home kits are $10-15, with 10+ sessions of SQ fluids per liter bag.
 
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jefferd18

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"

Meloxicam administered under supervision and monitoring of a veterinarian, including regular bloodwork monitoring if chronic use, and ensuring euhydration, is very safe, effective feline medicine. Just to reassure you your cat isn't suffering silently on this NSAID, and your vet isn't neglecting or harming her by choosing it. Quality of life takes precedence in seniors with chronic pain, even with comorbid existing diseases. If anything, multimodal analgesia, with additional treatments atop the meloxicam, will bode well for her comfort in the future.
[/QUOTE]


Thank you,mentat, that makes me feel a whole lot better. I certainly don't want to make her condition any worse. And you are right, at her age, its all about comfort.
 
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jefferd18

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Regarding her increased respiratory effort you noted while medicating her, if after handling her, she may have been excited and anxious while ears treated, combined with age-related lung changes, may not be alarming. If she was calm, such increased effort breathing could be underlying weakness due to a number of diagnoses, including anemia, lung disease, or pain associated with DJD. Hopefully, your vet communicates well digitally and you can request additional pain management if this sign persists. As she still has a great appetite, there are options to add to her regime, that can be mixed into her food. My last medical foster senior I had until euthanized harbored an abdominal mass missed by her shelter vet until presenting for euthanasia, but man, her pain was controlled on multimodal therapy, that was affordable, easy to administer, and effective. Cat cancer is weird, so no wonder we missed it up to the day; she was a "hell cat" in a cage at the shelter, stressed with change after her owner died and she was abandoned, but also mindless with pain due to DJD, IVDD, and, likely, that abdominal mass. Vale may just need a little more supportive care and pain management. While asking about it, you could inquire about fluid therapy for her while she's on NSAIDs, to preserve her kidney health and blood pressure as much as possible. Our home kits are $10-15, with 10+ sessions of SQ fluids per liter bag.


Oh, I wish I had read this before I took her in this morning- I would have inquired about fluid therapy. She was attacked last week by another cat in the house which resulted in a large abscess in her shoulder. The vet felt that was making her not want to eat, feverish, and generally not feeling good. He drained the abscess and then put her on antibiotics. It is now basically a 'wait and see' mission.
 
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jefferd18

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I am conflicted- I wanted the vet to help Vale and he did- but I wonder if I am just putting off the inevitable. It bothers me that her hips still hurt and that there is nothing more that can be done. Who wants a life of chronic pain.
 
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