Re: Sassy - 19yr old (close to 20) - Not eating / Very Lethargic + losing balance

[fionasmom]

I think that you did get a number of answers from the vet, although I am sorry that this is not working itself out as you hoped. You are taking excellent care of Sassy where many would probably not have been so dilligent.

Let me just address low blood pressure. In the United States at least, we are all primed to worry about high blood pressure. Low blood pressure is almost universally viewed as desirable and healthier. It is not; in the extreme, someone can die from hypotension. In a human, the symptoms which include things like confusion, nausea, blurred vision, clamminess could be expressed in time for medical help to be found. A cat cannot tell you that any of those things are happening, so it is probably why your vets don't want to move her into sudden low blood pressure.

Call your vet and ask whatever questions you have. A vet tech could relay them to him and give you a response. You are doing so much for her that it is not unreasonable to think that they might take a minute or two on the phone with you. Don't mess with the BP meds on your own; however, now that you know how the monitor works and what its range is, you can use it whenever you see fit and that might be a good log to keep.

 

[iPappy]

miguel99nyc , how are things going?

 

[miguel99nyc]

Hi there.
Been busy monitoring with Sassy for past several days.

I don't really see any further changes. I've just taken a blood pressure check with machine here at home and it read 207 which is very high. And I just emailed off vet because now it just has me concern either A.) is the transdermal cream working or B.) if it isnt strong enough. Currently its at the 0.625 dose, wonder if she needs more?

My concern is that after 2 weeks on that cream, her BP even with stress at vet place, was nearly identical, only dropped from 242 to 235 I believe, or somwehere in 230's. For one as mentioned before, the frustration now I feel is that because of a lack of stronger dose initially, her BP could have been lower by now for one. Secondly, meanwhile I took her and she had some vision somwhat, that was the time to jump on it and attempt to have her heal and recover with this supposedly initial trial of Amlodipine of the 0.625mg dose and have any shot of her vision coming back. Now I fear that if her BP is still have after weeks, one, its at the point of no return for her vision sadly, but more importantly, have her blood pressure just go down to normal levels and stay there. That's the ultimate goal.

As for her eye, I don't see it improving. Her entire eye has the dark maroon/red tint now. On day 2 of the Ointment to apply to eye..but no difference. Definitely not worse either.

Another thing I noticed now she is sleeping a bit more. She's hardly walking out to her water bowl as frequently as before nor wandering around alot either as in the past week. In a way, she seems like her self where she would just wake up from bed, get fed near by in my room, and straight back to sleep. In the past week or so, she would be constantly going out of room after eating, wandering around, drinking water often as well and such. Hence, my previous posts on how she seemed resteless, vocal and such. Now she's hardly vocal, shes rather quiet and just goes to her bed to clean her face rigth after eating and then goes to sleep. she might just go drink water once or so, albeit be large amount of water I guess to make up from lack of frequent visits to her water bowl. But most of time she just wakes up and goes back to sleep. Eating I would say is fine as well.

Any thoughts?

 

[iPappy]

Hi there.
Been busy monitoring with Sassy for past several days.

I don't really see any further changes. I've just taken a blood pressure check with machine here at home and it read 207 which is very high. And I just emailed off vet because now it just has me concern either A.) is the transdermal cream working or B.) if it isnt strong enough. Currently its at the 0.625 dose, wonder if she needs more?

My concern is that after 2 weeks on that cream, her BP even with stress at vet place, was nearly identical, only dropped from 242 to 235 I believe, or somwehere in 230's. For one as mentioned before, the frustration now I feel is that because of a lack of stronger dose initially, her BP could have been lower by now for one. Secondly, meanwhile I took her and she had some vision somwhat, that was the time to jump on it and attempt to have her heal and recover with this supposedly initial trial of Amlodipine of the 0.625mg dose and have any shot of her vision coming back. Now I fear that if her BP is still have after weeks, one, its at the point of no return for her vision sadly, but more importantly, have her blood pressure just go down to normal levels and stay there. That's the ultimate goal.

As for her eye, I don't see it improving. Her entire eye has the dark maroon/red tint now. On day 2 of the Ointment to apply to eye..but no difference. Definitely not worse either.

Another thing I noticed now she is sleeping a bit more. She's hardly walking out to her water bowl as frequently as before nor wandering around alot either as in the past week. In a way, she seems like her self where she would just wake up from bed, get fed near by in my room, and straight back to sleep. In the past week or so, she would be constantly going out of room after eating, wandering around, drinking water often as well and such. Hence, my previous posts on how she seemed resteless, vocal and such. Now she's hardly vocal, shes rather quiet and just goes to her bed to clean her face rigth after eating and then goes to sleep. she might just go drink water once or so, albeit be large amount of water I guess to make up from lack of frequent visits to her water bowl. But most of time she just wakes up and goes back to sleep. Eating I would say is fine as well.

Any thoughts?

I know nothing about the BP issue and the dosage, but I'm wondering if she was vocalizing and pacing because she was losing her sight, and now she's adjusted and is feeling like her old self again, which is good as it sounds like she wasn't able to relax much before, and now she is. Even a slight drop in high blood pressures is a good thing. I don't know how quickly BP can be dropped (safely) with medication, but maybe the combination of those things are helping her feel better?

 

[fionasmom]

It is hard to tell, but possibly she is calmer and more adjusted to everything that has happened? A cat who is restless and vocal is usually upset about something as those are not positive behaviors generally speaking. While you need to observe her for signs of odd behaviors or health concerns, maybe this is good in the long run.

 

[miguel99nyc]

I just got emailed back by both vets. 1st vet was the one Sassy saw over this past Saturday with her eye issue. The other vet is the primary one from same clinic, who checked her eyes and BP initially 2 weeks ago.

1st vet says he would have to check with the other vet on alternating the dosage but he agreed it may not be high enough.

Primary vet emailed back too and said that yes, if she still has the eye issue and still getting high readings, especially the vet visit reading this past weekend being in 230's despite 2 weeks of medication, he said outright to increase dosage.

He went on to say the same med I have now with the clikpen, 0.625mg, but instead of 1 dose every 24hours, he's saying 1 dose every 12 hours now. Does that mean that's double dosage or any stronger? Not sure how that works. Like, by doing it now in intervals of 12 hours - does that mean its going to be more effective by doing less in between times of dosage as opposed to say getting another medication compounded to that higher dose - once a day?

 

[FeebysOwner]

You have to know how the med you are using is expected to work - specifically in terms of its longevity per dose in the body. I would imagine the vet thinks that advising to give the meds twice a day via the click pen is easier - and quicker - than waiting to have another medicine compounded at a higher dose for once a day. The odds are the overlap in two doses vs. one is not significant, at least for a short-term solution - strictly my layperson's opinion.

But you've brought up good points that you probably need to ask for clarification from the vet about.

 

[miguel99nyc]

Yes, have asked the vet.

He responded saying essentially, when increasing the total daily dose, he usually recommends splitting it to twice daily instead of doubling it once daily. I guess that's to potentially avoid if a stronger dose in 1 shot would possibly lower her BP too low as opposed to same lower dose but increasing it to twice daily?

 

[FeebysOwner]

Tbh, that makes sense to me!

 

[miguel99nyc]

Hello everyone,

So I've commenced with giving the double dosage as of yesterday morning to Sassy.

One issue I've encountered since Tuesday however, is her desire to sleep in more longer, not wait for me at the door for me to get home from work as she had been until this past Monday (vision or no vision), and lack of desire to get up for some time after I'd get home. Resulting in a later initial meal. Sure, I'd leave her some dry food while I go work, and she eats it, so its not like she's...ill...or sick to not eat. She maybe even stays awake for a certain time and just decides to just go back to bed. And once she does, she'd have some internal clock maybe to sleep 2-3 hours...regardless if she eats. It concerns me somewhat beacuse then as for amount of food she'd eat for the day, that would typically cause her to not have nearly as much as she would normally. I don't know what could be causing her to not want to wait by door as she had been for the past year and just go to sleep. Other times with her vision, she'd sleep rarely though when id get home, but as soon as I walked into my room, she'd feel my presence and then of course get right up from bed as she would see me of course. Then she'd eat just fine. Now of course with no vision, she won't be able to tell plus her hearing isn't the best. I've tried to wake her up..but she'd just be sooooo tired her eyes are still closed while her head is up. Then tucks her head back inside bed to sleep.

Happened Tuesday too, but I forced her to wake up then, as she needed to eat. Then she ate for the rest of the night like in 1.5 hour intervals, and made up for the amount she hadn't eaten entire day. So that was fine...she made up for it. And even last night, I had to force her to wake up, she got off bed cautiously, and then ate quite alot - again, to make up for her not eating for nearly maybe 8-10 hours. (That was typical of Sassy back in her younger years though, eating just twice or so a day). Seems like she no longer can remain awake or bother to try wait for me to get home. So its rather tricky situation - just want her to eat her normal amount, but I guess as long as she eats something? Overnight last night, I left her much more than normal amount of dry food to compensate her just eating twice last night. And turns out she ate most of it I'd assume while I slept. THen she had her canned food this morning like normal. I figured without vision, she must not know time of day and such, throwing her off...but she had been without vision for weeks? Not sure what difference this week has made or changed for that matter.

Lastly, As for her blood pressure and commencing the double dosage as per vet, I worry now if this Transdermal even works or if its even real? I took her blood pressure twice this morning, right before giving her dosage. One paw read 206, the other 232. I believe this is accurate because I purchased smaller cuffs universal, modified as instructed online, to fit my machine. How I can tell its more accurate? The original small cuff would give me "Normal BP" readings but yet her heart rate was at 78 or so. Too low. Now with this smaller cuffs, each reading shows her heart rate in 170's which is bit high but normal for a cat. I think the other cuff as the vet told me was a little too big, so I went to get smaller ones. And now with these smaller ones, I'm getting these 200+ readings for her pressure. So I just wonder, could it really be she would benefit from pills than this transdermal cream? because for it to be 200+ after now 3 weeks...even though the double dosage I just started yesterday, I don't understand why its high? She has CKD, for sure. ANd vet alluded that as the cause. And from what I read and saw online, seems like High Blood pressure is rather permanent, but of course controllable with meds. Amlodipine seems to be the right one but I just dont get why it hasn't worked. Prior to this double dosage, vet thought if it hadn't dropped it after this long, then it meant it was underdosage - hence now doing it every 12 hours. I just don't know what more to do. And im sure having High Blood pressure persistently will damage her organs, and Im sure in a way that would affect her behavior. Though back in previous posts, I would say she was vocal, restless, wandering around and such. But that has all stopped now and she is rather quiet like her old self. And now recently, mostly sleeps. Doesn't even drink as much water as she used to, or frequent trips to her water bowl, or urinate that often either...

Thoughts?

 

[catsknowme]

if you can tolerate to read it, the page on ESRF in Tanya's Guide to FCKD offers some good insights. It helped me delay my decision to release my Maine Coon JC when it seemed so dismal; instead, he was given extra hydration and did a good rebound which gave us a winter of cuddles, grooming, times of play before he had to leave in early spring. As a quintessential family cat, JC's passing had a profound impact on 4 generations of family and friends- he was truly a Prince of the Family and King of the Clowders, of both the inside tame kitties and the outside ferals. JC slept more and more but I knew from reports of CKD/ESRD human patients that lack of appetite and desire to sleep isn't always uncomfortable or miserable and they were/are content to live that way.
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - The Final Hours

 

[fionasmom]

I do think that the transdermal meds are medically correct; whether they are working better than a pill is something that you have to ask your vet. Possibly this answer may vary from medication to medication. I have heard both theories. One is that transdermal meds are more effective because they bypass the stomach acids and intestinal tract and all that can interfere with absorption in that area of the body; the other is that they may not be as effective as there can be a lot of variance in how and what is rubbed into the skin.

Blindness might have affected the daily rhythm of Sassy's world and you might be seeing this in her eating pattern.

 

[miguel99nyc]

See that's the thing, this uncertainty.

For one, to me, it concerns me that the medication appears to have not worked thus far. Again after a 2 weeks of use and her BP still being above 200 at vet visit, it shows her pressure probably remains high thus why back in mid September it seemed like her vision was going away gradually. If you see Sassy's picture now profile picture, that actually was taken maybe a 1 week after her diagnosis of loss of vision and high Blood pressure. Her right was still then very clear/normal appearance. It was only during 2nd week of medication that her eye developed a reddish spot. And since it has gotten worse than those pics I sent - to the point now its just a much darker eye overall. And again that's still with the once daily dosage of medication into her ear. Because her eye got worse, only one though, vet feels her pressure was still clearly high recently thus increasing dosage to once every 12 hours. Today was Day 2 of that two dosages/day. I guess i should re-test her blood in about a week or 5 days from now?

Vet also informed me today: " Blood in eye may take an extended period of time to resorb, consultation with a board certified ophthalmologist could be considered. Use eye ointment for one week only"

I thought using the ointment would improve her eye as other vet provided that ointment said it would, but that so far im on day 5 of 7. It seems that I must end this specific med into her eye after 7 days. But I'm certain the red eye got worse even during medication of Amlodpine once daily because it either doesn't work at all, or if it does, its short lived in her body somehow. Maybe she will need the pill form. Vet's belief on the transdermal vs pill is that pill gets absorbed in the gut he said, thus allowing a more direct absorption of medication into body overall thus ensuring blood pressure to drop over time. With Transdermal, it may not always work he said or not be enough because its entering to the skin. Pill goes right into the body I guess...quicker? I thought perhaps the ear/transdermal version would work wonders because I would put in the past summer months(due to food issues with Purina) a small strip of Mirataz (less than full amount strip required) and I would apply that small amount of Mirataz into Sassy's ear once a week and gave her alot of appetite then. So to me that meant her ears absorbed the medication just fine. Which now made me believe oh - this Amlodpine Transdermal should work and obviously for me initially thought was way to go as she's impossible to pill or syringe liquid form. I just wish her eye can improve and not get worse - but also hand in hand with wanting her blood pressure to drop and stablize just seems the transdermal version isn't working out...awaiting this double dosage.

 

[fionasmom]

Mirataz is known to be effective transdermally, so effective that TCS members who have gotten it on their own hands have experience increased appetite. It seems that the BP meds may be less effective in that application...certainly not your fault for trying it.

Blood in the eye does take time to reabsorb, even in humans.

 

[miguel99nyc]

Blood takes time to reabsorb I read up too elsewhere. I tried re-searching but can't see to find any timeframe. Vet says extended time, but no definite answer. Her eye looks worse sadly, don't think she's in pain and still been applying the Dexamethasone ointment to her eye as instructed for a week.

I don't know if this was the result of putting her on the Amlodpiine twice daily for now 3rd day, she was more active today by far, walking around again, drinking water several times and such. Even I had gone to grocery shopping and she waited by the door for me this evening when i returned. I don't know if something ailed her or what, but past yesterday and today she seemed more like her self, not with these extended periods of sleep. She'd been getting up every 2 hours like her self and eating too.

But for now, my main concern is her blood pressure lowering, and of course her red eye to just clear up....eventually which seems to be due to her high blood pressure.

Earlier I wrote to vet but I can't seem to get a response as of yet but its primarily trying to get an accurate reading of her BP here at home. Obviously this is critical to determine whether or not the med is working and if going in right direction with this double dosage. Problem initially was, vet thought the cuff I had originally with my machine was a little large. So managed to research - found cuffs smaller universal ones, and had to modify slightly for it to fit my machine - which is legit as there's videos on it and such. So now it seems a bit more accurate...but I ran into this issue earlier this morning.

I know Sassy's BP tends to rise to over 200 at some point before its time to apply transdermal (picture called BEFORE AMLODPINE). This time, I tried to get BP reading a few hours after, and I got these readings - one limb said 159 and other 120. I tried few times but got error message like Weak Readings or too much movement - which there wasnt. But the other thing that stood out was her Heart rate, one had it at 80 and other at 161. So it seemed way off in some way. But then I don't know if its how im applying the cuff, if too loose or too tight and such. But I know its not supposed to be too tight either. To me, those readings after med seemed in normal range...but how accurate it is I don't know. Machine would read 200's right before giving med too.So not sure what to make of it.

 

[Furballsmom]

Slightly off the subject, and I don't even know why exactly but I just love that photo of her sitting there, calm as can be, with the little cuff around her leg

 

[FeebysOwner]

Furballsmom 's comment made me think of something else you could ask about - using the cuff on Sassy's tail instead. Don't know if it is more - or less - accurate, but some vets take BP that way. Might be something to try.

Also, whenever Feeby's BP has been taken, they always have had her lay down for it. If that pic you shared is the way you take her pressure, you might see if laying down works better.

 

[catsknowme]

Slightly off the subject, and I don't even know why exactly but I just love that photo of her sitting there, calm as can be, with the little cuff around her leg

I was thinking the EXACT same thing!! That photo would make a great poster for a veterinary office! And for a pediatric office as well - frightened children would get great reassurance from seeing how calm and comfortable the kitty is with her own little b.p. cuff

 

[fionasmom]

I agree with trying to use her tail and with placing her in a different position if she will allow it. Home machines, including for humans, have a margin of error which is unavoidable and probably more so with a pet. Sometimes the manufacturer of the machine has a phone number you can call to ask for support, or a website. I apologize as I don't recall if that is or was a possibility.

Hugely different readings are probably inaccurate, but BP can have quite a range even in humans. It can vary from arm to arm as well.

Glad to hear that Sassy seems more like herself right now.

 

[iPappy]

miguel99nyc , nothing to add other than you are one dedicated and AWESOME cat owner!