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Krista's Care

daftcat75

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I thought I'd start her own super-thread rather than the individual concerns I've been having. This way those who want updates only need to follow one thread.

This is Krista.
EC45174C-61AB-47DB-8F21-645C70FC9664.jpeg


Over Christmas, her eating went way down. I thought it was her displeasure that we were running out of Rad Cat and I was transitioning her to homemade. After a week of struggling over the holidays with her appetite and fussiness, I finally got her into the vet's office on Jan 2. We took blood to screen her for anesthesia and made her a dental appointment for this Monday. I knew her teeth were bothering her but until Christmas, she was still eating very healthily and I figured it could wait.

Bloodwork came back last Thurs and her liver enzymes (not GGT though, normally associated with choleoangiohepatitis) and bilirubin were elevated. Terrible news! Poor candidate for anesthesia. The dental appointment was changed to an ultrasound and some fasting blood tests (bile acid test and B-12 because we've never measured that before.) I don't have the bile acid test results in front of me but that came back abnormal. The B-12 is good. Krista, my girl, she threw a fit during the ultrasound and got herself sedated. Once sedated, her wonderful vet performed the dental after all. One broken canine, two (one of those being the broken one) with deep pockets, trapped food, and roots dissolving. She had those canines extracted and has just one left now. She had one extracted last year. Whew! So she should be feeling a lot better once her mouth heals.

Except she still hasn't eaten since Sunday. She's been on IV fluids since Monday. She had a bupe SR shot on Monday and by Tuesday night she was still in a lot of pain. So I asked for something else for her. She got a gabapentin shot which seemed to help a lot with her pain but it gave her nystagmus (involuntary eye movements.) When I visited last night, her pain was returning so I asked for another gabapentin but at a lower dose. This morning she seems in far less pain. The nystagmus, if present at all, is only so slight that I'm not sure that's even what I'm seeing.

However, she's now showing some signs of Horner's Syndrome. Her right ear had waxy build up and possibly a mass. The vet cleaned as much as she could and inserted antibiotic. The other vet (there are two cat vets who split the week's hours) thinks it could be the first vet "stirred the pot" (my words, not hers) and that her eardrum may have ruptured putting this stuff in her middle ear. She has a right-side tilt to her head, her right pupil is constricted, and her right eyelid droops a little. Aside from this, she looks so much more comfortable and alert this morning than she has all week. But she also has ataxia from the ear (or the GBP?) And she's still not eating. She did eat a couple of fish flakes but no mousse topper. If she doesn't want the topper, there's no point in offering her food.

So....

The vets finally agree with me that, risky a patient she may be, a feeding tube is the best next action in her recovery. This allows us to finally start the liver and gallbladder medicine. We can also shift from the bupe SR to something shorter so that we can give her more if she needs it. Today she will get the feeding tube and I will pick up her prescriptions for denamarin and ursodiol. The ultrasound and aspirate are pointing more towards bile duct obstruction than liver disease. Though given her history with IBD and pancreatitis, it would seem likely that she would develop liver dysfunction at some point. I've taken to calling her Hat Trick. Also on the plan for today is to recheck the blood chemistry to see whether her liver enzymes/bilirubin got any worse or better being on IV fluids this week.

We may still need some exploratory, a biopsy, or bile duct stents. But I've made it clear to the vet that we take this in order of least invasive, least radical diagnostics and treatments first and escalate only as needed. But for the first time since she got the teeth extracted, I feel like we'll be moving forward again.

If anyone has questions, suggestions, experiences they can share with me to help direct her care from here, it would make this a lot easier than going it alone with Dr Google and the vets. The vets are great but they have their protocols, decision trees, and expectations. Sometimes, while thorough, they can get to be a bit much. For instance, I don't want to start with bile duct stents when we haven't even tried the ursodiol yet.

I've been visiting with her twice a day in the morning and at night. I have an iPod with her "cat rock" (Music For Cats) that she listens to at home. I've been picking up the iPod in the morning visit, charging it up during the day, and dropping it off for her for the overnight to play until it runs out of battery. The staff says she really appreciates it as I know she does. I've seen her laying next to the soundbar at home when one of the more purr-y tracks is on. Day by day she's getting better. She won't eat the mousse yet but she did eat the couple of fish flakes I offered her. Small victories. She also gave me a couple of weak trills last night. But most encouraging, she has found her voice when the staff lift her out of and into her cage again. "You tell 'em! Tell them how much fight you still have left in you!"

Tonight I will hopefully come back to her with a feeding tube inserted and probably her first real calories since Sunday night. I never thought I'd be excited about getting a feeding tube inserted into my cat. But now she can get the food and medicine she needs to eventually make her way back home once more. It's been too quiet at home this week.
 

FeebysOwner

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Hi, and oh my!! Krista is such a pretty, sweet looking girl!! I have nothing but support and comfort to offer you. I am not sure, based on how knowledgeable you are and how you are handling all the circumstances that you will find many here that can you give you additional insight. As far as I can tell the plan you have seems to be, to me, heading the right direction.

I know other members will come along soon and hopefully have some insight that I cannot give. Don't give up, but if you ask me, you seem to have it covered!! :rock::worship:
 
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daftcat75

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Just got a call from the vet. She came out of the feeding tube surgery and is doing well. They did xrays and had to take another couple of teeth. Poor girl. I wish they could just take them all so we don’t have to wait for her mouth to slowly go bad. But I’ve been told that they could break her jaw trying to extract healthy teeth. The other piece of good news is that her liver values look much better. I’m just sitting at the pharmacy waiting on her prescriptions. I’ll have just enough time here to go for a beer at a taproom before I head back to the vet’s office for a visit and a consult with the doctor.
 

mrsgreenjeens

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I can't give you any advise on what to do here, just to tell you that I feel a feeding tube is definitely the way to go here. It makes it SO much easier to get things that need to be done done! I had a cat years ago with Hepatic Lipidosis, and the feeding tube was an absolute must. Now Krista is a thin cat to begin with, so her chances of getting HL are less than if she were overweight, but going too long without food for any cat can eventually result in HL. I would strongly suggest you check into the Kitty Kollar (Kitty Kollar-Special Hugs for special kitties (Kanine Kollars too)) to help with the E-tube. I didn't have a choice with using it with our guy because he actually had his tube installed directly into his tummy, not into his esophagus, but things have greatly improved now.

I'm sure your Vets will give you instructions, but when feeding her into the tube, go slowly. My first couple of times I went too fast and the food came right back out. Of course, I panicked, not realizing this was actually regergitation, not vomiting.

Krista is a beautiful girl. Hoping the E-tube does it's magic, and that the Horner's goes away with the antibiotics.

We do have lots of threads on Bile Duct Obstruction AND on Horners if you haven't already done a search for them.

:vibes::vibes::vibes:for your precious Krista :hugs:
 
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daftcat75

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I will ask the vet tonight about the Kitty Kollar. That sounds lovely if I don’t have to dress and redress this. Especially as she perks up again with food and medicine.

I really don’t even know what to feed her yet. She is still an IBD kitty. Let’s see what the vet has and how she does with that. I guess the one good thing about her not being out of the woods yet is that the vet and vet staff can get her used to the tube before I have to worry about it. I’m sure tomorrow they’ll help me tube feed her once or twice before she’s released back to me. Between the tube and the latest round of extractions, I’d be surprised if she comes home before next week.
 

mrsgreenjeens

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Yes, I don't know about putting raw food into a feeding tube. You can't disconnect it to steralize it, you just put a little water thru it before and after to make sure it doesn't clog. Maybe something like Hounds and Gatos? (Hound & Gatos Original Paleolithic Diet Cat Food) I would think it might be ok for an IBD cat. Just blend it with some water or even goats milk to thin it out so it'll go into a syringe.
 
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daftcat75

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At least I can bypass her fussiness. She doesn’t like goats milk or bone broth but now I may give her both to cut the consistency without sacrificing the nutrition. I don’t know how thin the food needs to be. Maybe FF, Rawz, or Stella and Chewy’s can be made thin enough. I wouldn’t give her S&C exclusively because of the bone content. But a little would be nice just to keep some raw in her diet. I also have duck patties I pick up from the raw food coop. I can and have made a very soupy food for her from that back when her teeth were bothering her before she stopped eating. I could maybe give her a little soupy duck and flush the line with some goat’s milk. I don’t know. I’ll talk to the vet. We’ll work this out.

She beat Ibd and pancreatitis (as much as either of these can be beat.). I’ve taken to calling her Hat Trick. She’s got this!
 
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daftcat75

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I like the ingredient list for the Rabbit Recipe in the H&G. The others are an IBD nightmare with the four or five proteins in the beef recipe. Chicken is a no-go with Krista. And salmon may be too.

I’d rather just go with Rawz if that can be made liquid enough. At least I already know that agrees with her.
 

FeebysOwner

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Just ask the vet about what you want to feed her and how to create the proper consistency, etc. There may be other things they want you to start with, but if you have doubts about any of them, tell them what you normally feed her and ask for help in administering those foods via feeding tube.

She beat Ibd and pancreatitis (as much as either of these can be beat.). I’ve taken to calling her Hat Trick. She’s got this!
No, you BOTH have got this - together!! Hat trick and her rabbit (you)!!!
 

sidneykitty

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You've been so helpful in my thread I wanted to come say hi and "meet" Krista. She is so beautiful and it sounds like she is very strong :)

Unfortunately, I don't have any advice to offer, but I do want to say the feeding tube was a great choice. They can sound a bit scary, but man do they save lives and can drastically help with recovery.

You are doing such an amazing job looking after your girl, I want to say I love your positive energy, its inspiring! I am sure Krista can feel it when you visit.

Wishing you both the best and hoping the meds can help without needing the stents put in!
 
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daftcat75

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Dr said she did great and the tube is exactly where it needs to be. She put a little water in it but hasn’t started on the food yet. We agreed to put her back on Cerenia to prevent vomiting now that we don’t need to rely on her appetite. Krista seems to be anorexic on Cerenia making it counterproductive. But with the tube, that’s no longer a concern. Dr will try 10cc of food tonight after Cerenia.

Dr also found some tooth root fragments from previous extractions that could be removed so she did.

But that means I got a heavily sedated, swollen, and sore Krista on the evening visit. I should have told them that I preferred she stay in the cage to recover but Krista was happy to see me. As happy as she can muster after more dental procedures and a tube in her neck.

The chemistry came back really good. Liver numbers are much improved! Her ALT was 1400 last week. It’s at 230 now. I think high end of normal range is half that. Her other liver enzymes have come back into range except GGT. That went high for the first time (10? I don’t remember. They keep forgetting to email me the results.) Her bilirubin is back to normal. Dr thinks maybe liver infection that’s being addressed with the antibiotics given for her mouth. She will also begin ursodiol via tube tonight.

Inner ear is something that needs to be watched. They’ve done what they want to do now and they’ll just let it be for now. Eardrum is perforated and there’s something angry down there but it could be blood and gunk from previous clean up attempts. She’s getting antibiotics anyway for her dental extractions and now the tube insertion.

Dr said Krista may go home this weekend or early next week. We just have to see how she takes to the feedings and the medicine and how she recovers from all the procedures.

My exit criteria and I’ll run this past the Dr tomorrow:

1. She’s off IV fluids. If possible, she’s been off them long enough for Dr or staff to remove bandage because she’s a real fighter about letting me remove those self-adhesive leg bandages despite how much she hates having one on. Shake, shake, shake, “I’ll cut you if you come near me!”

2. She’s been fed by tube long enough to poop at least once. I don’t want to be the one that’s cleaning up that first one if the food isn’t agreeing with her.

3. She can walk well enough to get to a litterbox. I may have to get her a different one if her ataxia hasn’t resolved because of her ear.

4. I’ve fed her and administered medicine by tube with guidance from the staff at least a few times. Enough to feel confident I can do it at home.

5. The staff have shown me how to re-dress her tube site and I feel confident enough to do this on my own.

In short, if there are going to be any complications with the tube, the teeth, the medicine, or the recovery, I’d rather the vet office encounter them than me.
 

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daftcat75

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One of the techs said her brother’s dog stayed in the cage beneath Krista’s last night and seemed much more relaxed than they expected him to be. They attribute it to the “cat rock” that I leave for Krista. I remember this dog from yesterday’s evening visit. He did seem to be chillaxing to the Music For Cats.
 
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daftcat75

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The drool is yesterday’s dental procedure. It may be another day or two before that clears up. The eye is her inner ear thing. She looks rougher than she was acting. The techs set her on the exam table for a visit and this time, instead of just bedding down on the towel, she made an unsteady bee line straight for my lap.

The morning staff was busy with other patients so I’ll talk to them on the evening visit about how she’s doing with the food they’re giving her now. I’d like her to be steadier on her feet, a little less drool, and at least one stinky poop at the vet’s to see what we’re dealing with before I take her home. She’s on Cerenia so it’s going to be the “back 9” that tells the story.

No trills this time but she did give me a couple of licks. Very sweet!

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mrsgreenjeens

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What are they feeding her there at the Vet's office? Hopefully something that is compatible with her IBD issues. My guess is that unless you took them something, they are feeding her some type of recovery diet, which usually has some "no-no" ingredients in it for an IBD cat :sigh:.

As to food for her tube once you're home, basically ANY food can be blended well enough to go into the tube with a powerful enough blender and enough liquid. I used to use a Magic Bullet and could even use a chunky food, because that machine could make it into a nice puree. I would sometimes add in egg whites (unseasoned from the carton) for added protein and to help emulsify it all. Then it's just a matter of adding the liquid of your choice to get it thin enough to be able to pull up into the syringe. I think bone broth would be ideal as it has such nutitional qualities. You could always switch it up between goats milk and bone broth, etc.

So glad that H & G rabbit looks like a winner. I think it's fairly caloric too. 182 calories per 5.5 oz can.
 
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daftcat75

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I don't like the idea of conducting food trials with a feeding tube. If she's stable on the A/D (what I believe they are feeding her), and we'll come to learn that after a day or two of feedings, I'll keep feeding her that. Otherwise, I know she has no issues with Rawz. The rabbit comes in at 172 per 5.5 oz but the turkey is 199 cal per 5.5 oz. The Hills is 180. I'll probably just feed her the Rawz once I get the hang of it.

She's never had the H&G. I may offer that by mouth when she's ready to eat by mouth again. But if I get a direct line to the stomach (esophagus), I'd like to feed a known good food.
 
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