Penny And The Feeding Tube (hepatic Lipidosis)

Lotski

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Hey all,

The past two weeks were hell for us. Our cat Penny ended up with hepatic lipidosis after eating too little and in the end not eating at all. She needed new food for her bladder, but only ate the old food that was mixed with it. Our vet told us to leave the new food for her, because 'when a cat is hungry, she'll eat'. Well, not our Penny... She had to go to the vet clinic and ended up staying there for six days on an IV. On day two they placed the feeding tube. I could write down the whole story which involves a lot of crying and anxiety attacks (and I really mean A LOT), but I'm gonna focus on the post-clinic time. I have Asperger's, and everything that happened (and is still happening) was one of the biggest emotional rollercoaster rides I ever had.

There were moments I felt kinda okay, and the other moments I went into full panic mode. Most tube feedings are my responsability, because my boyfriend had too much work and couldn't take vacation days. We set up a schedule where there's always someone with me when she has to be fed, since I'm the panicky and anxious one. It's extremely exhausting, mentally and physically. I haven't slept well in two weeks and we're 'camping' in our living room and haven't seen our own bed in five days. I went to the doctor because I wasn't functioning anymore (when she was still in the clinic and we weren't sure if her picky eating was the cause alone), and wrote me a sick note for two weeks. A lot of ups and downs (I think a lot of cat owners who went through this with their furry friend can relate), sometimes in the extremes because well yeah... extreme anxiety because of my Asperger's.

I got a lot of support from my mom, my best friend and her boyfriend, my mother in law,... Without them, I'd be on a feeding tube myself I think (I lost more than 3 kilo's in less than a week because I couldn't eat). My best friend has cats too, is very calm and not afraid to handle/hurt Penny. She changed all her bandages because that freaks me out too, and found a much better way to wrap her up. The tube stays in place way longer, and the bandage survives longer too. We decided to buy a large dog bench and put it in our living room with blankets, a pillow, food, water and a litter box. When we leave the house for a while or go to bed (still in the living room for now), we put her in it. I was always very anxious she would fall, or her tube would get stuck when we weren't watching. This made me constantly alert, but in a way it wasn't healthy anymore.

But now for something positive... Since a day or four, Penny is really becoming her old self again (day 10 since she has the tube). She's purring again, meowing, asking for attention, grooming herself, lying on her back,... She still sleeps a lot (a bit away from us, but not too far away on some safe spots we provided), but we're noticing a BIG difference. This makes me feel a bit better, and I fully realize why we're doing this now. We were curious yesterday and fed her a little treat. My heart stopped when I saw she ate it. She ate a treat! The days before, she just sniffed her food (which made me happy too, because she showed interest), but now she ate. She even ate four treats. Today we tried it again with some treats, and she ate them too. I went to the store with my best friend, and before that we put her in her bench to see what she'd too with some food (and one treat in it). To my big surprise, she ate some of her food. I couldn't believe my eyes. We're trying to offer her a small amount of food now every few hours. I think this is really going in the right direction, although I realize we're not there yet. But eating is good. The vet from the clinic was very happy to hear that too.

I'm curious about your experiences in general, but specifically: how long did it take before your cat started to eat again? And when (s)he started eating, how soon did they eat 'normal' again? Some weeks before the tube could come out? Longer? I was really worried this would be a process of months, because I felt like I couldn't handle that, but I hope it won't be like that because she's already showing interest in food. Again, I realize this doesn't mean she will be off the tube soon, but it gives me hope. Finally I see a light at the end of the tunnel, and I really needed that after two weeks of absolute hell. I had monthly visits with my psychologist since I've been 'stable' for a long time, but I'll be going two times a month again after this experience.

Many thanks, and apologies for the wall of text. I'm not good at compact writing.
 

daftcat75

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Krista was already eating on her own again when I brought her home from the hospital. I used the tube primarily for medicine only.

A few bits of feedback:

1. Have you seen the Kitty Kollar? It makes keeping the site clean easier and the tube secured and out of the way.
Kitty Kollar - Special Hugs for special kitties & kanines

2. I found that she was perkier for eating on her own after she got a little food in her belly by tube. Maybe offer yours a bit of food after a couple of syringes. You can subtract whatever she eats by mouth from what needs to go down the tube.

3. Plan on keeping the tube in longer than needed. It’s easier to leave it in and not use it than to put it back in if you took it out too soon. You can discuss with vet and partner how long she should be eating on her own before you decide the tube is no longer needed.

4. When it is time to remove the tube, it heals up remarkably fast. Within a week.

5. Kudos to you for using feeding tube with her. Rest assured, it is far more stressful on you than it is on her. This is giving her an assist when she’s not well enough herself. It’s saving her life. And it’s only temporary. She will continue to get better and quickly and you probably won’t need the tube much longer than a month or two. My Krista didn’t have hepatic lipidosis but it took months for all the behaviors I hadn’t noticed she stopped doing to return. Cats are remarkable self-healers. I wouldn’t be surprised if you saw daily improvements.
 
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Lotski

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Krista was already eating on her own again when I brought her home from the hospital. I used the tube primarily for medicine only.

A few bits of feedback:

1. Have you seen the Kitty Kollar? It makes keeping the site clean easier and the tube secured and out of the way.
Kitty Kollar - Special Hugs for special kitties & kanines

2. I found that she was perkier for eating on her own after she got a little food in her belly by tube. Maybe offer yours a bit of food after a couple of syringes. You can subtract whatever she eats by mouth from what needs to go down the tube.

3. Plan on keeping the tube in longer than needed. It’s easier to leave it in and not use it than to put it back in if you took it out too soon. You can discuss with vet and partner how long she should be eating on her own before you decide the tube is no longer needed.

4. When it is time to remove the tube, it heals up remarkably fast. Within a week.

5. Kudos to you for using feeding tube with her. Rest assured, it is far more stressful on you than it is on her. This is giving her an assist when she’s not well enough herself. It’s saving her life. And it’s only temporary. She will continue to get better and quickly and you probably won’t need the tube much longer than a month or two. My Krista didn’t have hepatic lipidosis but it took months for all the behaviors I hadn’t noticed she stopped doing to return. Cats are remarkable self-healers. I wouldn’t be surprised if you saw daily improvements.
Hey daftcat75, thanks a lot for your reply! Good to hear that Krista recovered quite fast. :)

Yes, I've heard about the Kitty Kollar! I'm gonna check it this weekend with my boyfriend. I'm from Belgium, so I'm gonna inform about the delivery time. Do you have experience with the Kitty Kollar?

We could try that, yes. Thanks for the tip. She's not eating her regular food yet, but I'm already happy she's into treats. She stopped eating those too. We keep offering it to her. She licked the kibble I offered her half an hour ago. Still better than ignoring it!

I've heard about keeping the tube in long enough too. We're sure planning on doing that. That's also the advice we got from the vet (the one from the clinic). Our own vet doesn't have experience with feeding tubes, and is kinda 'negative' about it. He told us we had reasons to worry if she didn't eat on her own after two weeks. That made us decide to always return to the vet from the clinic the next few months, even though it's a longer drive. She's a lot more positive too. When we've seen her, I feel much better. When we went to our own vet this Monday when her bandage came loose, I left crying and had to take a Temesta to calm down and go to sleep.

The tube feeding is becoming a routine more and more. I admit I still have a little stress reaction right before, but when there's someone with we, I can stay calm. It's tiring since it has to go in so slow and has to be done four times a day, but she purred most of the time the last two days when we fed her. That relaxes me too. We see a daily progression. The interest in food is the best progression yet, ofcourse. She was a very good eater before all this. Picky, but she never skipped a meal or declined a treat.

Thanks for sharing your experience. :)
 

daftcat75

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I liked the Kitty Kollar because it made keeping the stoma site clean a lot easier. I don't think Krista would have been patient enough for bandage dressing and re-dressing. The only issue I had with the Kitty Kollar wasn't the kollar as much as the tube itself. The vet didn't leave me enough length for the tube to be secured in the strap on the kollar. Most of the time, the tube just stuck up and Krista paid it no mind. It was actually when the tube did lay flat into the kollar, those times I knew the tube sutures had come undone and the tube was coming out of Krista. Twice we were able to catch it, reseat it, and re-do the sutures. The third time, Krista yanked away at an inopportune time and left the doctor with the tube in her hand, not in the cat. When it comes out completely, it's apparently pretty hard to put it back in. Since I was only using it for meds at that time, it wasn't worth it to re-intubate her.

Maybe you can try some Fancy Feast Classic pates with Penny. These are moderate to high calories, simple species-appropriate recipes (only the Classic pates, the other lines have questionable ingredients), and most cats seem to go for them even when they don't go for anything else. I used to keep a few cans in case Krista stopped eating. But now she reacts to Fancy Feast because I guess the poultry giblets in the turkey recipe still have too much chicken for her IBD. Tiki Cat is another brand my Krista went for during her pancreatitis. Tiki Cat tends to be lower in calories but also easier to digest. Sometimes you need a bootstrap food to get them eating again. Once Penny is eating on her own again, you can fine tune her diet for "better" foods if you don't want to continue with FF or Tiki Cat.

Since she's already interested in treats again, you might crush up the treats and use them as topper on wet food to get her started.
 
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Lotski

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We had to do an 'emergency' bandage change yesterday. We were both invited for our friends' wedding a month ago, but since Penny got sick and needs to be fed every 4-5 hours now, we decided that my boyfriend would stay home. I went to the wedding a little later, and left on time for her last feed. Five minutes before I got home, she scratched the white bandage from underneath her outer bandage (which is stronger and sticks to itself). I got a little panicky, since my best friend really made a nice, strong bandage, and yet she managed to 'destroy' it the day before the next bandage check. We ended up doing two bandages, since the first one was too loose. Luckily, she remained calm, but giving her her meds afterwards (the last antibiotics pill), she was in the biggest grumpy mood and growled and hissed the whole time. Good for us she isn't the scratching or biting type... Seriously considering buying the Kitty Kollar now. I think the site isn't the easiest to order, at first sight. Gonna discuss it with our vet.

I'm gonna check the tips you gave me, thanks for that. She only ate a bit of her normal food when she was locked in her bench (we put her there when we both have to leave the house for a while). Whenever we give her a treat now, she eats it immediatly. But we really have to give it to her. We let her smell it and put the treat a little farther away: no interest. She just ignored the treat. Like she's lazy or something. My boyfriend told me yesterday that when I was gone, she woke up meowing and walked to the place her food bowls are. Before she got sick, we knew she'd go eat when she did that. Now she went to the bowl, licked her lips but didn't eat anything. My boyfriend tried stroking her (he did that a lot before she got sick because she likes eating that way, like she likes being motivated or something), but she ended up making a left turn and started scratching her scratching post (also a good sign).

Tomorrow's a holiday again, unfortunately, but we're gonna try to contact the vet for some sort of schedule to offer her food. We're giving her treats in between and try to let her eat her old food, but it feels random. Yesterday we had the feeling she was kinda full when giving her the tube feeding.
 

daftcat75

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Kitty Kollar will be much easier. Yes. They don’t have a modern web store. I print out their order form, fax it back to them, and then call them up and confirm they received my fax.

Sounds like Penny could use an anti-nausea medicine. Showing up to food bowl, licking lips, and walking away. That sounds like nausea.
 
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Lotski

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Even if she eats treats without hesitation?
 

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Those are treats. She’s not going to get through this on treats alone. You don’t want to do tube feedings forever. Try putting a little in her stomach by tube first—a half or quarter portion. Then flush the tube, seal her up, and offer the other half portion on a plate. Ask the vet if she should be having antinausea and appetite stimulant drugs yet or if there’s still more refeeding to do by tube first.
 
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Lotski

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Oh no, I meant that if she eats treats, she can still be nauseous? Since she didn’t eat treats when she was nauseous before all started.
 
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Little update: she started eating on her own this night. My boyfriend was still awake and heard her. She ate for more than a minute. This morning, not long after her first tube feed, she ate again. Not her treats (which we always offer to her), but the new food she had to eat before this misery started. It made us both excited, but we're trying to keep our cool. We're hoping she'll continue like this, eating small doses each day. I heard that some cats stop eating again. Fingers crossed...
 

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I'm sorry your vet did this to your cat. There are some vets who feel this way which means others have suffered as you and your cat have. I'm glad things are better. However, if I were you I'd be looking for a vet who knows a little bit more about cats.

Yes, I had one who starved herself to death despite offering her everything we could. I don't know why that vet didn't suggest a feeding tube, but he didn't.
 
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Lotski

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I'm sorry your vet did this to your cat. There are some vets who feel this way which means others have suffered as you and your cat have. I'm glad things are better. However, if I were you I'd be looking for a vet who knows a little bit more about cats.

Yes, I had one who starved herself to death despite offering her everything we could. I don't know why that vet didn't suggest a feeding tube, but he didn't.
Thanks for your reply, Kflowers. It’s a double feeling. He was always there for us and helped us lots of times, but this time it didn’t turn out good. My gut feeling told me it wasn’t right from the start, when she didn’t eat much. I still feel a lot of guilt because of that. I asked him about lipidosis, but told us it would be okay. Well, yeah... If I had just followed my gut feeling, she wouldn’t be on the tube.

Did your cat die of starvation?! Oh gosh... That’s horrible. :/

I’m also a bit down tonight since we changed her bandage. It seems like the stitches came loose, the tube was more loose and the wound seemed bigger/more open. There was some dried up blood too. We called the vet clinic, and they told us to pay them a visit tomorrow so they can check the tube, restitch it or put another one in. In case of that, we are not giving her her last two tube feedings today. We had to put away her food too. It feels weird that, now she finally started eating herself, we have to take it away from her. She was just walking around the house, looking for her food bowls. I’m afraid she’ll stop eating again after tomorrow’s stress of going to the vet clinic and potentially being put to sleep again for a new tube. I’m also ‘afraid’ they’re gonna give her a cone. She’s curious and active again, and a cone makes lots of animals less mobile. She keeps scratching her bandage on the spot where the tube’s inserted. I think it could be the reason why her stitches are loose. We checked the Kitty Kollar this weekend, but we’re from Belgium, and I’m afraid it’ll take several weeks before it arrives. Not sure if it is a good solution for all the scratching too.
 

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It is a terrible thing to have your trust and faith in some one betrayed in this awful manner. Remember you did nothing wrong. Use this to learn to believe in your instincts. Think carefully over what you just posted.

Since she is eating on her own, perhaps it's time to not have the feeding tube. When another of mine had recovered enough to want to eat and not want his medicine which went down the tube too, he would fling his head and send medicine every where. Same for tube food. I don't know what the difference was but he couldn't eat with his tube. The vet said that meant it was time to let him eat on his own.

could you talk to another vet before you take her back to this one? Maybe at least ask another vet clinic's tech some questions?
 

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It is safe to let her eat if the tube is coming loose or even out. With the cap on the tube, the tube is essentially pressurized and won't easily allow food or liquid to back up into it.

The tube enters the esophagus and continues on down into the stomach. There is a certain amount of leeway for the tube to come loose without being out. Go ahead and let her eat on her own until you can have the tube reseated. Have the vet mark the skin line with a Sharpie (permanent ink pen) where the tube and the skin meet. This will let you judge when the tube is coming loose. In fact, what I would suggest is marking the skin line and then crossing the skin line with a 1 or 2 cm line that runs the length of the tube. This way if the tube dips such that the skin line isn't visible, you can see how much it dipped by how much of the cross-line is still visible. If it's 1 cm in either direction, you can probably fix that at home without bringing her in as long as at least one of the sutures are still in place. In fact, you can even ask the vet to mark off how much in either direction you can gently push or pull the tube to get it back to the skin line vs. when it's too much to fix at home. The tube came loose on us three times. Twice we were able to fix with a simple visit to the vet. The third time, Krista said she was done, and basically yanked the tube out herself. I wasn't there but the Dr said she wigged out at an inopportune moment and left the Dr with the tube entirely in her hand and none in the cat.

Kitty Kollar is run by great people. They understand how stressful a time it is to have a cat on a feeding tube. If you called them up, I'm sure they have an express ship option, even for Belgium. I had them overnight Krista's first kollar directly to my vet's office because she was still an inpatient at the time.
 
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Lotski

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I’m sure I’ll absolutely follow my gut feeling now! The vet from the clinic (not our regular vet) has much more experience with ‘special’ cases like Penny. She’s a lot more positive, and takes everything we say seriously.

I think it’s a little too early for removing the tube. If she eats like before for a while, then it’s okay to be removed. Even if she doesn’t have to be tube fed anymore, it’s best that it stays in a little longer just in case. She’s getting a little more impatient with the feedings now, which is also a good sign I think. But it’s not that it’s not doable anymore.

We’re going to the vet clinic tomorrow, so it’ll be someone else than our regular vet! The vet from the clinic who looked after Penny is on a vacation this week, but there are a lot of other awesome vets in the clinic to follow her up this week. We decided to go there as long as this tube feeding thingy is going on. We’ll see afterwards. I love the staff at the clinic, but it’s a 30 minute drive (extra stressy for Penny).
 

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Lotski Lotski you have no idea how much of a relief it is to me to read your last post. good energy to both you and Penny.
Listening to yourself over others is really hard, but it's important. It's really really hard and life will keep trying to teach you this lesson.
 
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Lotski

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It is safe to let her eat if the tube is coming loose or even out. With the cap on the tube, the tube is essentially pressurized and won't easily allow food or liquid to back up into it.

The tube enters the esophagus and continues on down into the stomach. There is a certain amount of leeway for the tube to come loose without being out. Go ahead and let her eat on her own until you can have the tube reseated. Have the vet mark the skin line with a Sharpie (permanent ink pen) where the tube and the skin meet. This will let you judge when the tube is coming loose. In fact, what I would suggest is marking the skin line and then crossing the skin line with a 1 or 2 cm line that runs the length of the tube. This way if the tube dips such that the skin line isn't visible, you can see how much it dipped by how much of the cross-line is still visible. If it's 1 cm in either direction, you can probably fix that at home without bringing her in as long as at least one of the sutures are still in place. In fact, you can even ask the vet to mark off how much in either direction you can gently push or pull the tube to get it back to the skin line vs. when it's too much to fix at home. The tube came loose on us three times. Twice we were able to fix with a simple visit to the vet. The third time, Krista said she was done, and basically yanked the tube out herself. I wasn't there but the Dr said she wigged out at an inopportune moment and left the Dr with the tube entirely in her hand and none in the cat.

Kitty Kollar is run by great people. They understand how stressful a time it is to have a cat on a feeding tube. If you called them up, I'm sure they have an express ship option, even for Belgium. I had them overnight Krista's first kollar directly to my vet's office because she was still an inpatient at the time.
I read your comment after commenting (think we were commenting at the same time). Thanks for your advice. I’m gonna see what the vet says tomorrow. I wrote all my questions down, and my best friend is going with me.

Also: Krista is one determined kitty. Damn! Did she scratch the Kitty Kollar?
 
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Lotski

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Lotski Lotski you have no idea how much of a relief it is to me to read your last post. good energy to both you and Penny.
Listening to yourself over others is really hard, but it's important. It's really really hard and life will keep trying to teach you this lesson.
Thank you. <3
 

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Krista probably scratched at the kollar. But that's why I had the kollar.

If you want to simulate the kitty kollar, take a round cotton pad like the kind for washing off makeup. Fold it in half and make a tiny diamond cut so that when you unfold it, it has a tube sized hole to slide down the tube and against her neck. The smaller the opening the more coverage and protection of the stoma. Maybe even ask the vet tomorrow for a short length of tubing so you can create a number of these pads ahead of time without having to use the cat's tube to measure and test. Slide this pad over the tube and flush against her stoma. This you'll change out every day or every other day. For the collar, you can use a bandana (or a small square of cloth folded like one) and just cut a slit into it for the tube to slide through. Then if you have sewing skills, you can attach velcro to the bandana to make it easier to secure and take off.

The kitty kollar is thicker than a bandana so you may want to fold it a couple of times if you can (or cut up a t-shirt for this to have more fabric to fold.) The thicker you can fold this, the more protection against her claws. But also balance that against her comfort. The thicker it is, the more she will notice it and scratch at it. It's a balancing act for sure. But that's cats for you. It's always a balancing act between their personal quirks and preferences and what's best for them.
 
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Lotski

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The tube was still in place. The vet (another one because our vet is on a vacation) gave her one extra stitch to be sure. It was still okay, but I felt better with the extra stitch.

She talked about possibly removing the tube already today since she eats on her own again. Another cat that was hospitalised at the same time (and dismissed the same day) as Penny had a feeding tube too. The owners had problems with tube feeding her, and the cat pulled the tube almost out completely. The vet removed the tube, and she started eating again because of it. It didn’t feel good to already remove it today, but we have an appointment on Monday with the vet who treated Penny for a check-up and to draw some blood.

I decided to wait until Monday. My boyfriend and I are going together, so we can ask all the questions we have. I’m still scared she’ll stop eating and we’re back where we started. Since she eats, we went from 4 to 3 feedings.

Since she scratched her bandage a lot and potentially damaged the stitches because of it, she has a cone. Pro: she doesn’t scratch. Con: she’s a lot more immobile. She’s just lying on the floor, looking a bit sad and depressed, bumping into everything, walking backwards, tripping, eats less on her own, we have to block our (stupid open) stairs again,... The vet told us we could remove the cone if we wanted, but she’ll just start scratching again. Since we’re discussing the tube and the possibility of removing it on Monday, I’m not yet buying the Kitty Kollar. But I’m really thinking about removing the cone on Friday, when my friend comes to change the bandage. She was so active! I’m less comfortable too again since I’m constantly alert about where she is, scared she’ll get stuck somewhere because of the cone.

My best friend drove us to the clinic today. While we waited for the vet to take a photo of Penny’s tube and stitch her up, we started talking about our regular vet. Last week, when we were very panicky, a friend of my best friend (who was a vet before) called the vet clinic for us to get more information (which I still think is incredibly sweet). Our regular vet talked about putting Penny down on the phone with the vet from the clinic. My friend didn’t want to tell me before, but since I am doing a lot better the past few days she told me. I was in shock. How different can opinions be?! Regular vet: talking about euthanasia. Vet from the clinic: very positive Penny will recover fine and will soon be okay again. Really frustrating... This makes me think even more about our regular vet (how many pets did he gave up without getting second opinions?). Something to discuss with my boyfriend... He doesn’t know yet, but I’m not telling it today since he’s exhausted from a lack of sleep and has a lot of stress at work.

Almost there, but not there yet.
 
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