Am I overreacting?

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So this is day five of Twyla’s treatment plan. My overall observance is that she seems to be feeling pretty well. She ate great the first three days (eating about 220 calories) but has slowed down since. I don’t know if the methimazole is making her feel “punky” and thus low appetite or if It is the impact of the medication starting to work on her thyroid.
Did you go with the 'smaller dosage route...then increasing it...slowly'...as FeebysOwner had mentioned?
Or are you and your Vet initialing starting at a 'higher dosage'...of the methimazole...then doing a re-check?

I guess it would depend on the numbers...and also the 'normal values'...from the hyperthyroid tests.
(I know that you had posted values for numbers, before, but without the 'normal ranges'...I really could not tell how Twyla was trending.)
As long as you know, though,...that is the main thing. :)

She has been up and down with her appetite for months so It is really hard to judge. She is eating half dry and half wet because she actually likes the dry kidney food (Purina Pro Plan Early Care). The dry is high calorie so even eating a little helps meet calorie goals. Turns up her nose at the wet kidney foods so she is eating Fancy Feast pate with a Phosphorus binder mixed in. Giving 1/16 in each meal up to three meals. Being conservative to start because I have concerns about constipation. I always add water to wet meals but may need to begin Miralax. I had been adding pumpkin to her food, but she stopped eating meals that had pumpkin in it. But that has kept her regular in the past.
Is this the one that Twyla likes: PURINA PRO PLAN VETERINARY DIETS NF Kidney Function Early Care Dry Cat Food, 8-lb bag - Chewy.com
Great that your Twyla likes the food. :thumbsup:

If you can get her to enjoy eating more wet, then that may be better,...yet I know that at at certain age...when you don't want them to lose any more weight,.. it's mainly important that our cats eat...and also enjoy it, too.

***Have you tried mixing in some of her fave Fancy Feast pate foods,...and adding a tiny portion of the kidney wet foods...to the side of the plate?
Or does this 'tiny portion' not smell right to Twyla...and throw her off...her fave wet food, as well?

This video shows some 'tips'...on how to introduce some 'new foods'...or 'new meds'...by mixing it up in creating a 'parfait'...by Fundamentally Feline.


Fundamentally Feline has many helpful 'how to videos with cats'.
I think she is excellent for explaining things in detailed ways.
How-To Videos - Fundamentally Feline

(This one is also good, but probably more for your Hooper, in training him with a clicker.
I know that Twyla is smart, but I figure she would be more stubborn, and just walk away, from the clicker sound,...leaving you standing there, clicking away. :blush: :wink: That's just my take on Twyla.)
(I picture her more like my female cat, Tepaul.)

(PS. If you watch the whole video, near the end there is a 'cat wheel'. I cannot remember why Furballsmom and I, had suggested a 'cat wheel' for Hooper, in the intro thread,...I think it had to do with him chasing Twyla...but the wheel made me think of him, anyhow.)
I hope that Twyla is still...chasing him. :cool2:


On another thread, their cat is not liking a particular 'phosphorus binder'...epakitin,...so if Twyla does not like hers...then your Vet could also try some other types.

Keeping an eye on her poops,
and consistency is a good thing.
Constipation can also cause cats to feel full, and not want to eat as much.

So Hoping that your Twyla,...with still being active,...and getting good hydration,...plus using the Miralax...will help her to get a proper Balance,..along with her body getting used to the new meds/new foods, too. :crossfingers:
I think I am partly to blame for the appetite issues - if she doesn’t eat a meal I will try something else a little while later so she is eating tiny amounts at a time but then isn’t hungry at mealtime. I think I need to do better with keeping to a schedule (I have summers off from work so I tend to get fixated on her eating because I am home so much more). On a bad day she is still eating some but not enough.
(I could understand that, since I also 'try different flavours'...all the time, too.
Except that I usually give smaller amounts, now,...say a quarter of a 'perfect portion' size...which is like a 1/4 can...and if they like it...then I will give them more, at the next meal.)

(They always seem to leave a slight amount, though, but as long as it is not a quarter size, from when feeding them 'half a can'...then I'm okay with it. Still throw out some, depending on the days,...but mine are 7 yrs old, and obviously a bit fussy. More the female than the male cat.)

I think you will probably notice some days will be 'down days'...and not quite enough...but as long as she picks up the calories...on other days...and is not losing weight weekly...then you're probably doing fine.
Schedules are definitely good, if your cat is able to get used to them,...and does not get too much stomach acid build up,...or depending on the times that you have to give her meds, also.

I guess it also depends on how you feel about it, and if you feel that..more times per day...with smaller amounts...is doable for you.
Or if you think that trying a schedule would get her to eat more.
Hard to say, without experimenting.

As long as you don't become too fixated, on the bad days,...and take it day by day...since that's basically how our cats do it. :catrub:
You are doing really well, in taking care of Twyla...so just remember that, too. :bluepaw: :hugs::grouphug: :tabbycat::bigeyes:
 
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Did you go with the 'smaller dosage route...then increasing it...slowly'...as FeebysOwner had mentioned?
Or are you and your Vet initialing starting at a 'higher dosage'...of the methimazole...then doing a re-check?

I guess it would depend on the numbers...and also the 'normal values'...from the hyperthyroid tests.
(I know that you had posted values for numbers, before, but without the 'normal ranges'...I really could not tell how Twyla was trending.)
As long as you know, though,...that is the main thing. :)

Is this the one that Twyla likes
: PURINA PRO PLAN VETERINARY DIETS NF Kidney Function Early Care Dry Cat Food, 8-lb bag - Chewy.com
Great that your Twyla likes the food. :thumbsup:

If you can get her to enjoy eating more wet, then that may be better,...yet I know that at at certain age...when you don't want them to lose any more weight,.. it's mainly important that our cats eat...and also enjoy it, too.

***Have you tried mixing in some of her fave Fancy Feast pate foods,...and adding a tiny portion of the kidney wet foods...to the side of the plate?
Or does this 'tiny portion' not smell right to Twyla...and throw her off...her fave wet food, as well?

This video shows some 'tips'...on how to introduce some 'new foods'...or 'new meds'...by mixing it up in creating a 'parfait'...by Fundamentally Feline.


Fundamentally Feline has many helpful 'how to videos with cats'.
I think she is excellent for explaining things in detailed ways.
How-To Videos - Fundamentally Feline

(This one is also good, but probably more for your Hooper, in training him with a clicker.
I know that Twyla is smart, but I figure she would be more stubborn, and just walk away, from the clicker sound,...leaving you standing there, clicking away. :blush: :wink: That's just my take on Twyla.)
(I picture her more like my female cat, Tepaul.)

(PS. If you watch the whole video, near the end there is a 'cat wheel'. I cannot remember why Furballsmom and I, had suggested a 'cat wheel' for Hooper, in the intro thread,...I think it had to do with him chasing Twyla...but the wheel made me think of him, anyhow.)
I hope that Twyla is still...chasing him. :cool2:


On another thread, their cat is not liking a particular 'phosphorus binder'...epakitin,...so if Twyla does not like hers...then your Vet could also try some other types.

Keeping an eye on her poops,
and consistency is a good thing.
Constipation can also cause cats to feel full, and not want to eat as much.

So Hoping that your Twyla,...with still being active,...and getting good hydration,...plus using the Miralax...will help her to get a proper Balance,..along with her body getting used to the new meds/new foods, too. :crossfingers:

(I could understand that, since I also 'try different flavours'...all the time, too.
Except that I usually give smaller amounts, now,...say a quarter of a 'perfect portion' size...which is like a 1/4 can...and if they like it...then I will give them more, at the next meal.)

(They always seem to leave a slight amount, though, but as long as it is not a quarter size, from when feeding them 'half a can'...then I'm okay with it. Still throw out some, depending on the days,...but mine are 7 yrs old, and obviously a bit fussy. More the female than the male cat.)

I think you will probably notice some days will be 'down days'...and not quite enough...but as long as she picks up the calories...on other days...and is not losing weight weekly...then you're probably doing fine.
Schedules are definitely good, if your cat is able to get used to them,...and does not get too much stomach acid build up,...or depending on the times that you have to give her meds, also.

I guess it also depends on how you feel about it, and if you feel that..more times per day...with smaller amounts...is doable for you.
Or if you think that trying a schedule would get her to eat more.
Hard to say, without experimenting.

As long as you don't become too fixated, on the bad days,...and take it day by day...since that's basically how our cats do it. :catrub:
You are doing really well, in taking care of Twyla...so just remember that, too. :bluepaw: :hugs::grouphug: :tabbycat::bigeyes:
With reservations, I started with the vet recommended dose - 2.5mg once a day for four days and then twice a day, with a recheck in two weeks. Appetite dropped sharply once the twice a day was started on Saturday. Yesterday was also the first day off Cerenia as she transitioned to taking it every other day. As of this morning she is basically refusing food, even though she does her usual “it’s time to eat” behavior. She maybe ate a bite of wet food, a bite of kibble and two Temptations I gave her just to see if she would eat at all. My plan is to skip her morning dose and call the vet about reducing her dosage to see if that helps. I hope she will agree.Transdermal would be my next step. I don’t think the phosphorus binder is causing the not eating issue. She is taking aluminum hydroxide which is supposedly odorless and tasteless. So I’m not even going to try the kidney wet food again until she is back to eating. It is so frustrating when the medication designed to help makes things worse (hopefully temporarily).

Her T4 was 5.6 (4.7 is the high reference for “normal”) so not extreme. Her phosphorus level was 6.1 which is high normal, but too high for a CKD kitty.
 
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Update: My vet is strongly opposed to lowering the dose because her thyroid level is so high. They suggested I go back to giving Twyla Cerenia everyday, instead of every other, especially since she still has interest in mealtime, just not eating. I am fine with that, because it does seem to help. They also said to go ahead and stop giving the phosphorus binder for now, since that could be causing the food aversion, so constipation at least shouldn’t be an issue for now.

She did eat a little about 2 hours after her Cerenia dose this morning - wet mixed with dry and she mostly ate the dry. I am also going to pick up some Fortiflora today to use as a topper as needed.

If her appetite still doesn’t improve than we will discuss transitioning to transdermal. I understand the rationale for wanting to get the values down so the dose can then be adjusted at the recheck (scheduled for July 1).

Not what I wanted to hear, but I will try it for the next two weeks.
 
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Hi - I just thought I'd mention that fortiflora has calcium iodate in it, which could be a possible issue for her thyroid.
Sigh…I am feeling overwhelmed and like I am doing a bad job taking care of Twyla. If something is good for one thing it’s bad for another. I am feeding mostly Fancy Feast pates because that is what she will eat, but the phosphorus level isn’t good. But for now I am discontinuing phosphorus binders because they may be deterring her from eating wet food. Fortiflora might stimulate her to eat but may not be good for her thyroid. If I can get her thyroid stabilized that will likely show that her kidney function is even worse than labs are currently showing. I thought I was prepared for all of this to be happening but I am struggling at the moment.

She needs to eat. If she doesn’t I’m afraid I’ll be dealing with hepatic lipidosis next. So do I try Fortiflora to get her eating better? Won’t the methimazole mitigate the possible issue with the calcium iodate? It would be a fraction of a packet as a topper. She doesn’t like Churu style treats or freeze dried treats. A couple of crushed Temptations are my only other proven option.
 

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I thought I was prepared for all of this to be happening but I am struggling at the moment.
I'm in much the same situation with my Poppycat, it's an incredible thing. Maybe a different probiotic, with a prebiotic, that doesn't have any iodine in it? (calcium iodate, kelp, kale, potassium iodide). I thought I'd found one but it's way too strong to begin with :(

You're probably right, since you've gone the route of the Methimazole, that fortiflora would be ok. I feel bad now, I probably shouldn't have said anything about the iodine ingredient.

Can you handfeed her, even a little bit?
 
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I'm in much the same situation with my Poppycat, it's an incredible thing. Maybe a different probiotic, with a prebiotic, that doesn't have any iodine in it? (calcium iodate, kelp, kale, potassium iodide). I thought I'd found one but it's way too strong to begin with :(

You're probably right, since you've gone the route of the Methimazole, that fortiflora would be ok. I feel bad now, I probably shouldn't have said anything about the iodine ingredient.

Can you handfeed her, even a little bit?
Don’t feel bad, I was already spiraling about everything anyway. I’ve never really tried hand feeding her, since eating has always been one of her favorite activities! I have to say that she is an incredibly easy cat to medicate - she gets two to three pills each morning and two pills and her inhaler in the evening, with a treat reward. My other cat Hooper comes and sits with her as support (he gets a treat, too). I may have to experiment with hand feeding if her appetite doesn’t improve soon. We’ll see how the rest of the day goes.
 

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You don't have to use a whole packet of Forti Flora each time - I think you said that, yes? I have had success with just a partial packet in getting Feeby to eat more. She also has a favorite dry treat that I ground up to a fine crumble and will use that interchangeably, for the change of pace and hoping not to get her tired of either. I personally would not worry about Forti Flora affecting her thyroid to any real degree.

I can't speak to your other issues, as I am fighting similar battles with Feeby. Her last blood work showed a T4 of 3.9 - with the top of the range being 4.0, so she is 'right there'. I just raised her dosage to 1.875mg twice a day (from 1.875mg AM/1.2mg PM), despite one vet saying to leave it where it was, and the other vet wanting me to increase it to 2.5mg twice a day. So, it just all depends on the vet.

Feeby's phosphorus level was 6.0 as of 4/19 - both vets said it is fine, but one of them did say I could try phosphorus binders if I wanted to. However, Feeby's eating is so sporadic, that I have no idea how much phosphorus binder she actually gets. I use Phos-Bind which is also supposed to be flavorless and odorless. And I agree with you - it isn't the phosphorus binder causing the inappetence.

Excuse me for not remembering, does Twyla take an appetite stimulant?
 
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Excuse me for not remembering, does Twyla take an appetite stimulant?
No appetite stimulant yet, but if her eating doesn’t improve that is the next thing on my list.

For those who followed Twyla and Hooper’s introduction, here is a picture of them from last week and one of Twyla from 2 weeks ago. They are best buddies.
5D689431-EA7D-4585-8EF4-489AC4A44F49.jpeg
A54086A0-E95C-43F1-A8DA-04B0173E2367.jpeg
 
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Last anxious cat mom post of the day - I was able to get Twyla to eat almost half a can of pate. She ate a little by herself and then I literally “hand fed“ her by scooping food up with my fingers and she enthusiastically licked it right off. She then ate a little more on her own afterwards. Going to try this again for her evening meal, but going to put a towel down first, it was pretty messy!
 

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Her T4 was 5.6 (4.7 is the high reference for “normal) so not extreme. Her phosphorus level was 6.1 which is high normal, but too high for a CKD kitty.
Update: My vet is strongly opposed to lowering the dose because her thyroid level is so high. They suggested I go back to giving Twyla Cerenia everyday, instead of every other, especially since she still has interest in mealtime, just not eating. I am fine with that, because it does seem to help. They also said to go ahead and stop giving the phosphorus binder for now, since that could be causing the food aversion, so constipation at least shouldn’t be an issue for now.

She did eat a little about 2 hours after her Cerenia dose this morning - wet mixed with dry and she mostly ate the dry. I am also going to pick up some Fortiflora today to use as a topper as needed.

If her appetite still doesn’t improve than we will discuss transitioning to transdermal. I understand the rationale for wanting to get the values down so the dose can then be adjusted at the recheck (scheduled for July 1).

Not what I wanted to hear, but I will try it for the next two weeks.
Vets do follow some type of formula or 'treatment plan notes'...so it does make sense, that the Vet would want to concentrate on getting the H-T numbers lower...to get her body's metabolism in the right range.
With July 1st... being just another week and a half...then it also makes sense,...to see how Twyla's numbers, and response to the meds will be. :crossfingers:
...You're probably right, since you've gone the route of the Methimazole, that fortiflora would be ok. I feel bad now, I probably shouldn't have said anything about the iodine ingredient.

Can you handfeed her, even a little bit?
I am so glad that you did mention the iodine ingredient, Furballsmom Furballsmom . :thumbsup:
You should never feel bad...for sharing extra information that you've found, read about, or experienced,...since that is really the only way...any of us...will ever Learn...about different issues that may arise...that our own Vets...do not have the time to comment on, or explain.

(I do understand the 'not wanting to make Twylasmom, worry more' with her treatment journey with Twyla, though. :hugs::grouphug:

If anything, it's me, that is asking a 'whole load of questions'...which then leads to other extra ideas or different 'brainstorm moments'.
Not all of them will necessarily be good 'brainstorms', and most will probably not apply,..but as long as we are all Learning,...I think it's still a good thing.) :cloud9:

I for one, really appreciate...when members 'share their knowledge'...since,...even if it does not necessarily apply to my own cats, or their own particular health status...it still enables me...to go on...and do some more research. :read:

For instance, with you mentioning the Hill's Y/D food...it had me curious. So I looked it up, and just read a few articles, about why they prescribe it, and of any studies where they used it. It's something 'new' that I have never heard about before, so again, I appreciate knowing a little about it. :)

Another thing, was about how 'fish flavours'...contain more iodine...and therefore are not totally recommended for hyperthyroid cats.
Having said this, though, I would also think that 'as long as the thyroid meds' are doing their job...and somehow reducing the T4 numbers...that this would also somehow negate the added iodine in the fish flavour wet cat foods. 🤔
At least I hope so. Would have to read up some more...to learn how the hyperthyroid meds work. :idea:

So there you go, I probably have now added 'more worry to Twylasmom'...not intentionally, but just by reading some articles, and posting. (when someone else reads this thread, though, they will also have some good info.)

Plus, the main thing is that our cats eat,...and then try to get to a healthy stable state...where we can actually try different foods, treatments, etc.

Hyperthyroidism in Animals - Endocrine System - Merck Veterinary Manual
My cat's hyperthyroidism is successfully treated with a low-iodine diet.

Managing Hyperthyroidism with Diet in Cats
In this last article, above, it was written by a 'board certified veterinary nutritionist'...which had me wondering...if having a Consultation, with an actual Vet Nutritionist Specialist...would be possible...and helpful...once the numbers get stable.
I wonder how that would work, if our cat's are only liking one type of food, or have a particular favourite? :hmmm:
Anyhow, it just seemed like an okay thing to ask our own Vets, if they actually ever consult with the Vet Nutritionists. :dunno:
If I can get her thyroid stabilized that will likely show that her kidney function is even worse than labs are currently showing. I thought I was prepared for all of this to be happening but I am struggling at the moment.
:hugs::grouphug: I think it's just the initial shock,...of finding out that our beloved animals have new Health issues,...that will be on-going,...and need different treatments...and that now...we have to alter what they eat, when, medication schedules, etc...until it becomes a 'new Routine' for them, and for us, too.

Change is never easy,...so just remember,...take it day by day.
And do things 'non cat health related'...like just enjoying the brushing, cuddling, playing.
Which I kind of know, you already do, just by looking at those beautiful photos. :greenpaw:

I bet our cats don't even worry about their own heath issues, and look at their humans like, "hmm, I wonder why there's suddenly all this fuss, surrounding food, and me walking away. My human must be strange, but other 'internet humans' are just as strange, so there you go. Plus, the humans at the vet clinics, seem to be similar, too." :catlove::lovecat2:
Thankfully, our cats cannot type, or write their diaries. :bluepaw::winkcat:
I can't speak to your other issues, as I am fighting similar battles with Feeby. Her last blood work showed a T4 of 3.9 - with the top of the range being 4.0, so she is 'right there'. I just raised her dosage to 1.875mg twice a day (from 1.875mg AM/1.2mg PM), despite one vet saying to leave it where it was, and the other vet wanting me to increase it to 2.5mg twice a day. So, it just all depends on the vet.
FeebysOwner FeebysOwner ...how do you decide which Vet to listen to?

When you get two differing professional Vet opinions,...but they differ,...then I usually choose the one that 'explains the most to me'...and also the Vet that seems to explain things well,...either on the phone,....or through email.
Yet, sometimes, it does feel 'like rolling the dice'.
Last anxious cat mom post of the day - I was able to get Twyla to eat almost half a can of pate. She ate a little by herself and then I literally “hand fed“ her by scooping food up with my fingers and she enthusiastically licked it right off. She then ate a little more on her own afterwards. Going to try this again for her evening meal, but going to put a towel down first, it was pretty messy!
Yay!! :cheerleader:
For 'hand feeding her'...and it worked. :yess:

I didn't know if I should put a 'laughing emoji' down for that post...or a 'hugging one'.
I bet is was messy. :spew::crackup:

Twyla is now probably thinking, "hmm, my human is suddenly going to try and eat MY FOOD, with her own hands,...so I better lap it all up."
LOL...I just love our cats.
(I wonder what your Hooper is thinking...with Twyla getting the 'royal hand feeding treatment') :cool2::jive: :blackcat: :eek2:
 
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Today has been somewhat better. Twyla ate her entire daily ration of kidney care dry food. I mixed it with 1/8 of a teaspoon of Fortiflora which seemed to make it enticing. She has eaten about 1/4 of a can of Fancy Feast without me hand feeding her, and we’ll see if she comes back for the rest. I usually do another half a can right before bed. Last night she ate the whole half of a can, with my help. I put a towel down and she was even licking the food off the towel. You could tell she was hungry, but needed encouragement to eat. She wasn’t receptive to my helping her with eating this afternoon so I let it go as I don’t want mealtime to be associated with stress. Even in normal times she often doesn’t eat that meal all in one go and she obviously isn’t as hungry today since she has already had a good amount to eat.

Fingers crossed that this continues! I wish that there was a lower phosphorus wet food she would eat, but right now I’ll take eating.
 
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Looking over this thread it is apparent to me that the feeding issues have been going on for a while and will likely continue. Last night she didn’t want her wet food but ate more dry. This morning she was picky about the dry food that she loved the day before. She eventually ate some and also would lick baby food off my fingers but not eat it out of the bowl. I am trying to focus on the dry food since it is calorie dense (so less to eat) and low in phosphorus. That may help her to feel better in the long run and improve her appetite. Her hydration seems OK. Her urine output has decreased a bit since starting the methimazole (hopefully because it’s working) but still going several times a day and drinking water. No vomiting but maybe still some nausea, even with the Cerenia. Not large poops but seem to be in line with how much she is eating. Her attitude is good - she just finished batting her favorite ball around and instigated a wrestling match with Hooper, much like this…
CB431D9B-0236-4306-9F37-66CF721C627C.jpeg
 
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Not much to report here. Twyla is eating well! She is eating almost 1/2 a cup of the ProPlan NF Early Care every day. It takes about 24 hours but she gets it done. I measure it out into a sealed container every night and add 1/8 of a teaspoon of Fortiflora and shake it together. If she is being finicky I break up a couple of Temptations and hide them in the dry food. A half a cup is 245 calories so measuring out 1/2 a cup and doling it out in small portions allows for waste if some sits in the bowl too long (245 calories is more than she needs)- and she is getting more calories a day than she has in weeks. When I leave it out she often circles back and finishes it off later. She is showing zero interest in her regular wet foods but likes a little chicken baby food as a treat as long as she can lick it off my fingers. I wish she would eat wet food for hydration - but I see her drinking pretty regularly and her skin snaps back quickly. May get a few more cans of wet kidney food to try those again when we are at her checkup on Friday. I also got the Advita probiotic if it looks like the Calcium iodate might be an issue in the Fortiflora.

I am still giving her Cerenia every day but am thinking about trying every other day. I just hate to jeopardize her apparent progress, but it would be great if she didn’t need to take it every day. Thoughts? I am also still monitoring for constipation. She produces a 3 to 4 inch well formed poop about every 24-36 hours (that’s normal timing for her) and it has enough moisture for litter to stick to it. Would like to see a little more volume but it is not hard dry balls like she has had in the past.

She seems very content as well. Playing, asking for pets, and purring and making air biscuits when I give her a massage in her sunbeam.
 
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