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Dr. Karing
Dr. Karing, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 286
Experience:  General veterinarian with a special interest in internal medicine and emphasis on individualized care.
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Karing only. here are all tests for the past year on Eva,

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For Dr. Karing only. Hello, here are all tests for the past year on Eva, except for an ultrasound in August that was normal. She has always been obsessed with water. We have two fountains in the house and bowls of filtered water everywhere for our four cats. Eva started drinking even more than usual in the early summer, and started peeing every three hours by July. The April tests were because of bloody/mucous diarhea. She has suffered from constipation since we found her( or she found us) in October of 2007. We thought she was about 4 years old, but not sure. She had been spayed. She is extremely affectionate and delicate. Her extreme long silky hair is the cause of constant GI problems and huge daily hairballs. I gave her temptations hairball treats every day for years to avoid painful constipation episodes. She would have to be given laxatone for several days every so often. Since starting fluid therapy, she has had soft or runny stool. The vet wants her on 200ml every day. We tried but could not do it ourselves. We did it for a stray several years ago, but we just can't. I am taking her twice a week to have the vet tech do it. I really think Eva does better on 150ml. One time the tech doubled the amount to 300ml accidentally and Eva was very sick for several days. At 200 she breaths rapidly and coughs a little the first night. She stopped drinking and peeing quite as often. She eats the KD dry food but still eats a regular wet food with .8 phosphorous-the lowest I could find that she will eat. She is slowly losing a little weight. She lies by her fountain a lot and has some days when she is obviously having tummy trouble. She has had bright red blood in her stool in the past but now there is black. Stool was checked the other day and had trace blood. That's when we got the Flagyl. Her blood pressure was checked in August and was 130. We just got that one number. The vet said it was low normal. The vet is insisting on benazepril for two weeks before she will do any more bloodwork, stating that it will not be if any use to check her levels again if we are not treating her. I'm reluctant to throw more medicine at a sensitive cat and upset her emotionally and physically if it is not going to help. I read that benazepril helps after there is protein in the blood, but not really before. My vet says it protects the kidneys. It's like a cat hospice here. So depressing.

Hi Catherine,

The lab results are not attached for some reason. If you could try again to do that, it would be very helpful. Unless Eva has hypertension (her last blood pressure measurement was normal) OR protein in her urine in the absence of infection, then benazepril is not indicated per current recommendations by the International Renal Interest Society (i.e. IRIS). http://www.iris-kidney.com/pdf/treatment-recommendation-cats.pdf

I do really want to see Eva's lab work to be sure she really has stage 2 chronic renal failure (i.e. CRF). Stage 2 cats rarely experience weight loss, nausea or require daily subcutaneous fluids. Also, diarrhea is not typically associated with renal disease. Eva's long history of hairballs and constipation suggest an underlying gastrointestinal disorder: dietary intolerance/food allergy and inflammatory bowel disease are VERY common in cats. Studies have shown that 90% of hairball vomiting is the result of an underlying disorder and NOT caused by ingesting excess hair. So while hairballs are very common in cats and often disregarded as typical, this is not the case. There is much speculation that cats experience more GI (and renal) problems due to dry food diets that are too high in carbohydrates (not GI friendly for carnivores) and low in moisture (not kidney friendly for cats).

All that being said, I'd like to know how much Eva weighs now versus prior to her diagnosis of kidney disease? How often does she vomit/what time of day and what is in her vomit? How many bowel movements she has per day? Also, what else does she eat besides k/d dry food (i.e. which specific wet food are you giving her)? Does she have any other abnormal exam findings such as a heart murmur? Was Eva's ultrasound done by a veterinary radiologist? Did the ultrasound reveal her kidneys to be normal in appearance? Again, please send her lab results including recent urine culture results if at all possible.

Lastly, does your vet know that Eva coughs and breathes rapidly after fluids? That is unusual and concerning. Until I have more information, I can't say the fluids are a bad idea, BUT it is very unusual for her to have that kind of response. How long do the fluids take to be absorbed my her body? Does she have any remaining after 24 hours (i.e. pooling under the skin at her front legs?

Thanks so much,

Dr. Karing

Customer: replied 1 month ago.
I will try to send lab results again soon as I can. I have an early meeting at work. Her urine was dilute in July but bun and creatinine were in normal range. Creatinine crept up out of normal range in August. I feel so bad for her constant GI issues and so bad that nothing was ever done. She has eaten Purina Pro Plan lamb for sensative skin and stomach for 9 years along with Fancy Feast white meat chicken florentine with garden greens in a delicate sauce. That's her favorite. I have always tried to get them all to eat raw food or Paul Newman, bone broth or anything healthy but they just want that darn fancy feast. In July I started buying all kinds of "healthier" canned foods like Earthborne, Holistics, Ziwi Peak, and many others but she would only eat an Iams tuna topia. (I got the others on some of the healthier stuff and on Halo spots stew dry. I wonder if the food change caused Calleigh's cancer. It was about the time I was trying to give new food and omega chewy treats that Calleigh got sick.) Eva began the KD dry too. She immediately got over the constipation with that and it is much lower phosphorous than the delicate sauce, so I thought it was good but now I suspect it (tuna topia) is causing problems with blood. I also started putting Life Extension vitamin mix for cats in her food, which she loves, but I have to wonder if it caused tummy problems. I have stopped it. She has been vomiting hairballs several times a week since we got her. She also sometimes vomits clear foam and water. She had allergies for years until we discovered that revolution would take care of her skin itch. It seems that even one flea causes problems for her. She had some sinus issues before we moved here five years ago. She had to take a round of Zenequin to get rid of a sinus infection when we moved here. The vet had us giving her the chlorpheneramine for humans for her itching and allergies for a long while back five and six years ago. I suspect that, along with a shot of prednisone one time in 2010 that almost killed her, may be why her kidneys are in trouble now. The shot put her into a long night of breathing 100 times a minute and trying to climb the walls and stretch out as far as she could. Awful. I have written all over her charts not to give any steroids!! She still has watery eyes most of the time but doesn't sneeze. She was hospitalized right before we moved for severe constipation. They wanted to do surgery, but I kept insisting on fluids, laxatone and repeat X-rays for several days while the mass in her stomach slowly moved out. The day after she came home from the hospital she had the biggest hairball I've ever seen. 8 inches long and more than an inch and a half in diameter. She has vomited almost every other day her whole time with me. At least every few days. She gets very affectionate, usually in the morning in bed, and then has a hairball. I can tell by how affectionate she is, when she is getting sick. She usually pooped every other day or every three days. We would walk her around the house outside and out in the yard when she was getting constipated. She would get hyper with discomfort and try to climb on things and walk all over with a driven purpose. She would also walk to the corners of different rooms in the house to try to "go". She would ask to get in the shower and "go" in there. Since the new diet she has been in discomfort but it's different. Not constipated but gas and pain. She will lie beside the toilet sometimes and then "go" there or get back in her box. She has always intermittently run out of her box like she was shot out of a cannon -pooping and peeing both. That would be due to all the poop not getting out when it was poo-related. Not sure why she would run after urinating. We have three litter boxes on different floors. They are always clean. She Never goes anywhere but in the box or in the shower when I let her in there if she's in distress-now sometimes beside the toilet. She's not always in distress but it comes and goes often. There has been no protein in her urine. Her SDMA was 14 in April and I wish we were told that it might be pointing to a problem. We were told "normal". We didn't do a urine culture then. The urine was finally cultured in August and was positive for enterococcus. That's when we did Clavamox. I have to wonder how long the infection had been there and if it caused the kidney damage. She has no heart murmur. Another vet at the clinic where her vet is did the utrasound-not a radiologist. She said everything was normal. Kidneys looked normal. Her weight went steadily down for several months but I have to check the records. She has an extreme pot belly and has had for years. I think she was around 13lbs and is now 10-something. I'll try sending the records again. I feel like such a failure. I can't seem to take care of all of them. Jammie is obese. William Henry almost died of toxoplasmosis five years ago and has to take phenobarb now. Sorry. More later.
Customer: replied 1 month ago.
Jammie and Eva. Let me know if you can see the lab results now. Thanks.
Customer: replied 1 month ago.
I forgot to mention two things: Eva has always struggled with mucous in her throat and that is in the liquid and hairballs when she throws up. Also Eva is very itchy now. It might be kidney related or it might just be that she has picked up a flea of two. I'm going to have Scott comb her today. I want to ask vet about giving her revolution in her state but it's hard to get my vet to call me back. I have a message in to her but they said it would be several days. They said I could give revolution to Calleigh. I hate yo but since we are taking her out we are seeing some flea dirt. I slept on the floor with Eva last night while she slept in her plush bed but she scratched and scratched. Calleigh did not get pain meds this morning. She's barely eating and just cries all the time to go out. She's strong but losing weight. I'm trying to be there for all of them and work too. I hope you got Eva's tests. They were attached in 13 pictures. I don't know how else to do it. I have them all in an email as 13 attachments. I just took pictures of each one and attached for you. Thanks.

I got the pic of Jammie and Eva eating but no other attachments. Make sure the attachments that you are trying to send are jpeg images and check the file size to make sure it isn't extremely large. If the files are over 1 Mb, then you might try decreasing the resolution. Alternatively, you can carefully type out the results but that is tedious.

It is fine to apply Revolution to Eva (as well as Calleigh and Jammie) despite her history of kidney disease and recent diarrhea: no need to wait several days to do that. I agree that holding off on Calleigh's buprenorphine is wise today since she hasn't yet returned to herself. She was eating fine before that, right? Did you give her the prednisolone today?

Customer: replied 1 month ago.
I can't open the email you sent around 11:30 this morning so I hope this is the latest correspondence from you. Calleigh's vet wants her on Metacam and would not give me more prednisolone. He says to wait until tomorrow night to start it. He did not want to provide Tramadol either. Got kind of cross with me and said Bupronorphine is best. I can ask another vet for it and get it today. Calleigh has been eating less and less over the last week. She went from 12 pounds on August 16 to 10 last Monday. She's always been a big talker but her cries are more frantic now. Jammie is upset by them and tries to comfort her and meows at me the way he does when Scott and I argue, which is rare. I ordered the vetriscience capsules today and will call about carafate. I wish I had done something all along besides occasional Fortiflora. I also ordered "Renafood". It's a human supplement that is given to cats. Do you know if it is ok for her? I'll wait to see how she does on the vetriscience probiotic. Scott clipped her nails today because she is sticking to everything. She is definitely feeling better but I fear she has lost some more weight. I'll get you a history of her weight. She is eating a lot yesterday and today. Too bad it's mostly fancy feast. I'll attach the first couple of lab result pictures now and see how that goes. I'll try sending a few at a time.
Customer: replied 1 month ago.
Here are two more labs
Customer: replied 1 month ago.
Two more
Customer: replied 1 month ago.
Two more...
Customer: replied 1 month ago.
Some more
Customer: replied 1 month ago.
These are in order from recent to oldest.
Customer: replied 1 month ago.
Last one. She has angel wings on her back. She's my angora bunny. Thanks for helping us.

Hi Catherine,

I got all Eva's lab results. I will review them carefully and get back to you later this morning. I did expect to see a urine culture report but that was not included. The doctor's notes from 8-24-2016 simply state the urine culture grew enterococcus (i.e. no actual lab report). If the sample was submitted to the lab, then they would report the number of bacterial colonies (i.e. helps confirm this was a true infection and not a contaminanted sample). It's always nice to have an antibiotic sensitivity report as well but most labs don't perform sensitivity panel on that bacteria because they find them inaccurate. In any case, I will get back to you before noon today.

Thanks,

Dr. Karing

Customer: replied 1 month ago.
I had to make a Sophie's Choice last night re which one to stay beside. I chose to let Calleigh stay by herself downstairs and I stayed by Eva upstairs. She is lying beside her water fountain a lot and is itchy. The alarming thing is that she has pooped several times in the last 24 hours and it is a light putty gray color. She has had some putty color frequently over the years but mostly at the end. This is gray all the way. I don't know if this is an emergency but it's hard to get ahold of my vet.
Customer: replied 1 month ago.
Also she went beside the toilet a moment ago instead of in her box. I'm afraid she ate some Iams kitten chow last week that I had out for Calleigh, and that may have upset her.
Customer: replied 1 month ago.
Her eyes are dialated and she is trying to get up on the dresser, desk, etc the way she does when in pain. I didn't do the Fortiflora last night. I'm just so fearful of everything-afraid of making things worse or if she's allergic to it...
Customer: replied 1 month ago.
I don't have info on the urine culture other than it was done by needle through the bladder and sent off for a week or so. I had them run a free catch a couple of weeks prior that grew high E. coli. Enterroccocus was not mentioned then. Paid $200 for the free catch culture before they told me it didn't mean anything and had to be done over with the needle. The needle culture did not mention E. coli.
Customer: replied 1 month ago.
Eva's guts are gurgling and I can tell she feels bad. She ate Fortiflora for me just now. I'm working from home today. Poor Calleigh is being ignored as usual. Eva has gotten all the attention for the 9 years because she's always having issues.
Customer: replied 1 month ago.
Is this what you recommend?

Just a moment. I'm typing you a lengthy response now.

Thanks for your patience. I took some time and looked everything over carefully. So it is clear that Eva has suffered from GI upset since you've had her (i.e. vomiting hairballs, troubles with constipation and more recently diarrhea). In addition, she has developed kidney disease over the last 6 months based on her lab work. Please note that in April of 2016 Eva's creatinine was normal at 1.5, her SDMA was normal at 13 and her BUN (which had to be calculated from the BUN/Crea ratio) was elevated at 58.5. The mismatch of normal creatinine and elevated BUN suggests dehydration and likely GI ulceration/bleeding which raises BUN. At that time, her thyroid level was 2.3 which is in the grey zone for hyperthyroidism. For cats with ANY symptoms of hyperthyroidism, it would be appropriate to run a Free T4 by Equilibrium dialysis to rule-out thyroid disease. Symptoms include but are not limited to weight loss with good appetite, increased thirst/urination, vomiting, diarrhea, anxious/restless, etc. Not all cats exhibit all symptoms so I'll generally act on the side of caution and rule-out hyperthyroidism in any cat that has a grey zone value unless they are 100% healthy or have been definitively diagnosed with another disease that explains all their symptoms in which case I simply recheck the Total T4 in 3 months to assess for emerging hyperthyroidism. Hyperthyroidism is the most common endocrine disease among cats so it should really never go undetected. Please note that while hyperthyroidism generally decreases kidney values I have seen the values decrease after treatment for hyperthyroidism.

In July, her BUN was 48 and her creatinine was 1.8 with a low urine specific gravity of 1.018 which is the first time she is officially diagnosed with renal failure (i.e. stage 2). She had no protein in her urine at this time. In August, Eva's kidney values increased. On Aug 19th her kidney values revealed her BUN was 41 and her creatinine was 2.5 (no SDMA). Values over 2.0 are considered stage 3 renal disease. However, she was diagnosed with a urinary tract infection on August 24th which was likely present on August 19th and may have played some role in elevation of her kidney values (i.e. kidney infection present?). Her urine protein creatinine ratio (UPC) was 0.19 at this time but the significance of this cannot be determined in the presence of infection.

My recommendations for additional diagnostics would be to repeat renal values (BUN, Crea, SDMA, Phos & potassium)and repeat a urinalysis with UPC as well as a urine culture. You need to see that the enterococcus infection resolved and learn what the kidney values/urine protein levels are since that has been achieved. This is the only way to know if Benazepril is needed or not. Conversely, if the infection persists, then obviously further treatment will be necessary. The lab work should be ideally performed just before you are due to give fluids again: in that way, you see the worst case scenario without the fluids diluting the values. In addition, Eva needs a repeat Total T4 test and if the value falls in the grey zone again, then she needs a Free T4 by Equilibrium Dialysis (a plain Free T4 test is less accurate).

I did check on Renafood supplement: there are no studies regarding its use. However, various veterinary specialists state that it is very safe and I have never seen it harm any patient. Since it is a food supplement, allergies are a possiblity but not commonly encountered.

Gray stool can be the result of constipation (i.e. the gut has extra time to remove the urobilinogen from the stool which usually provides the brown color OR increased fat in the feces. It is not an emergency at all but suggests some intestinal disorder is ongoing. The increased frequency of bowel movements that you have observed recently suggests her large bowel is inflamed and of course the borborygmi (i.e. increased gut sounds) suggest inflammation further up in the stomach/small intestine. Based on Eva's history of GI issues well before any kidney disease developed, I believe this is a separate issue that needs to be addressed apart from her kidney disease. Again, hyperthyoridism if present or emerging would complicate any underlying GI issue so this must be ruled out.

For cats with chronic GI issues, the first step I take is dietary modification. I recommend chicken and turkey canned diets only: no beef and absolutely no fish. The diets should be at least 50% protein and preferably less than 10% carbohydrate. Sometimes it is necessary to find diets that eliminate guar gum and carrageenan as some cats are sensitive to these additives that are used to thicken the canned food, but I usually don't start out on that type of diet because it may not be necessary and those are harder to find, more expensive, etc. A few cats are senstive to chicken and turkey and require a more novel protein like rabbit: again, I don't start out on a rabbit diet but consider it if the initial changes don't help. Grains can also be eliminated but in general the idea is less than 10% carbohydrates. Cats are obligate carnivores and protein is what their GI tracts are made to digest. This kind of diet is directly opposed to what k/d is trying to accomplish. However, when you are dealing with cats that have multiple issues, prescription kidney diets are not always possible. Less than 10% of my feline renal failure cats eat prescription renal food. This is not because they all have other special diet needs BUT rather because cats don't like renal diets very much and older cats tend to lose muscle mass anyway. So if you feed an elderly cat with kidney disease a food low in protein, they lose weight and it is mostly muscle. Sarcopenia in geriatric cats is a big issue and hard to reverse. I like my patients with renal disease to eat well and maintain their weight: maybe even be chubby. Remember, the low protein renal diet doesn't stop or reverse renal disease, but it simply aims to decrease the BUN (by product of protein metabolism). It has less phosphorus too, but lower phosphorus and BUN can be achieved through other means. These include using subcutaneous fluids, phosphate binders and supplements like Azodyl. I don't recommend those for Eva at this time because she needs the recheck lab work to assess her post-urinary tract infection values first.

In addition, for Eva's GI issues, I'd recommend Pepcid AC (i.e. generic name famotidine) at 5mg once daily. This is a very safe antacid medication used for cats with GI issues and also commonly used for cats with renal issues. An alternative to Pepcid, in the event Eva doesn't like to take Pepcid or it is difficult to give her, is Prilosec (i.e. generic name omeprazole) at 5mg every 12 hours. Sucralfate tablets at 1/8 tablet every 12 hours can be very helpful in resolving diarrhea in cat: it is not absorbed by the body but simply coats the intestinal mucosa and binds toxins as well. It is important to monitor for constipation and decrease the Sucralfate dose if needed. Sucralfate should be given 1-2 hours before or after other medications to prevent decreased absorption of of other drugs. I'd also advise a probiotic. Fortiflora is a great choice (i.e. is said to be hypoallergenic) but it has to be mixed with food and some cats don't like that. You may be able to increase its acceptance by dissolving it in 1/4 teaspoon of water and make a gravy to mix with food. I have trended toward Vetri Science GI Balance Pro since most cats take it as a treat: http://vetriproline.com/gi-balance-pro/ The Mega Probiotic that you sent an image of is fine to but then the gritty texture could be an issue as with Fortiflora. All these probiotics are available on Amazon.com and as a bonus they are one means of preventing urinary tract infection.

As far as the diets go, I like Fancy Feast Chunky Chicken Feast or Chunky Turkey Feast for cats with a sensitive GI tract.

https://www.fancyfeast.com/gourmet-cat-products/wet-cat-food/chunky/chicken-feast

https://www.fancyfeast.com/gourmet-cat-products/wet-cat-food/chunky/turkey-feast

If you decide to pursue that, then change slowly over the course of a week and be proactive about treating for diarrhea at the same time (i.e. probiotic and Sucralfate). It takes anywhere from 2 days to 4 weeks to see the effects such a diet change will have, but in general if things haven't improved in 2 weeks, then I'd move on to something different. Wild Callings Rabbit Burrow is a good choice for a grain free novel protein diet without carrageenan or guar gum

http://wildcalling.com/products/rabbit-burrow/

Instincts makes some fine options too:

http://www.instinctpetfood.com/product/instinct-grain-free-canned-cat-food-rabbit

Your veterinarian is likely to have a melt down if you present all this information at once. It is pretty commonplace these days for clients to do their own online research, but involving another veterinarian who has not even examined the patient is an entirely different issue. I would suggest diplomatically raising the issues that I've presented to open a dialogue. If your vet will not listen, refuses to even run the diagnostics you request or becomes defensive, then it is your option to find a new vet.

In summary, this is what I advise:

1. Repeat renal values (i.e. BUN, Crea, SDMA, phosphorus, potassium), urinalysis with UPC (urine protein creatinine ratio) and urine culture AND take the samples just before Eva is due for her next subcutaneous fluid treatment. In this way, you see the worst case kidney values. You will also learn if her infection resolved with after using Clavamox (i.e. some infections require longer courses of antibiotic treatment) and if that resulted in lower renal values and resolve the mild increased UPC (urine protein creatinine ratio that has your vet recommending Benazepril).

2. Check a total T4 test and run a Free T4 by equilibrium dialysis if it is in the grey zone

3. Start daily probiotic (of Eva's choice), Pepcid AC and Sucralfate for her GI upset

4. Consider a change to a high protein, low carbohydrate canned diet for long term management of GI issues which is best pursued after rechecking lab work to avoid making too many changes at once and to learn if hyperthyroidism needs to be addressed. I do believe Eva would benefit from a GI friendly diet based on her LONG history of GI issues.

Your vet should have no problem whatsoever with recommendations #1 and 2: these are simply diagnostics and she will profit from them even if she doesn't find them necessary. She may not agree with Sucralfate but point out IT IS BENIGN. Hopefully she will prescribe it, if not, see what happens without it and find another vet if Eva continues to have diarrhea/frequent defecation. I hope all of this is helpful. Please let me know if you have questions

Customer: replied 1 month ago.
Thank you thank you thank you. I am going to make an appointment with her vet and will be very careful how I proceed with presenting my requests. Eva did have a urine culture after the Clavamox which came back clear. Sorry, I forgot about that and didn't ask for a copy of it. I have the food you talk about here and will start offering it to her. She's been scarfing down fancy feast chicken in a delicate sauce for the last few days since I suspected that the Iams tuna was causing trouble. The Iams was great at first because of the water content and seemed to help the constipation but now we have the opposite problem. YES in April Eva had a very runny bloody stool with jelly like mucouse. Everything you say makes perfect sense. I have suspected hyperthyroid lately but was told she is normal. I will get the tests done. She has been on a slow slide down for over a year. She had a front tooth hanging one day when I got home from work four years ago and they pulled on it at the ER vet for over a half hour with pliers before I said stop. She had surgery to remove it the next day and became ill with a UTI. She's never fully recovered from that event. Anyway, I'm taking way too much if your time. I'll get her in for these tests and follow your suggestions very carefully and will not ruffle any feathers at the vet. I think they are doing a good job, they just don't communicate well enough. I was told the SDMA and specific gravity would not tell us anything now that we started fluids?? I was told there was no protein in her urine. I've been doing fluids twice a week and she had them on Saturday and I was going to take her this afternoon but was thinking of waiting until tomorrow. If I can't get the appointment for bloodwork until Friday, should I wait that long for more fluids? I'm so grateful for you. You are helping me and my family so much.

You're welcome. I'm glad to hear Eva has had a negative culture since she was treated for a UTI in August. I do think it is worthwhile to see what her renal values are since the infection has resolved. Yes, the fluids play a role in what the lab results are, but you can factor that in to your interpretation. I usually run a total protein or albumin as well as a hematocrit (HCT) if I am concerned that fluid therapy will be playing a major role in the results. Waiting at least 48 hours after the last fluids were administered really eliminates the issue completely as the body will rid itself of excess water (from the fluids administered) easily within that time. If Eva is eating well and not having a lot of diarrhea, then I think it is fine to wait until Friday to have her lab work done and get her next fluids. It would be great if the values look a lot better, then maybe she won't need subcutaneous fluids as often. The protein in her urine was from the report dated 8-19-2016 (see values UPro, UCrea and UPC which are urine protein, urine creatinine and urine protein creatinine ratio). Lastly, make sure the Fancy Feast you have is the "Chunky Chicken Feast" just like the link I sent. They have many varieties that sound similar but are very different in nutritional content. Best of luck at the vet: please do let me know how it goes and if I can help further.

Take care,

Dr. Karing

Customer: replied 1 month ago.
Thank you! I'm intimately familiar with the fancy feast flavors lol. I could open a pet supply store right now with all the stuff I have stockpiled. I'll let you know how this goes. I really hope she's not hyperthyroid.

Yes, I hope she isn't hyperthyroid too. Let me know how things are go at your visit.

Customer: replied 1 month ago.
Appointment is at 3:45 tomorrow. I talked to Dr.Dascoli today and she will run the tests. I'll try to catch urine so we don't have to take it with a needle. She says no need to culture again so free catch should be good. It's just so hard watching Calleigh deteriorate. She is trying to do her normal activities. I have not given Matacam yet today. She's asleep beside me now and I got so spooked by the product insert info. I have to do it though. I'm very worried about how she shares the water with the other cats. I'm afraid of infection or this dangerous medicine getting into the water and harming the others. Any thoughts?

I disagree a little about the free catch sample being okay. There will be bacterial contamination: how much just depends on the individual. Cats with dilute urine (i.e. like those with kidney disease that do not concentrate their urine well) may have no other evidence of infection (i.e. protein, white or red blood cells, etc.) except for the presence of bacteria. In fact, sometimes you have to culture just to find bacteria in these cases. That being said, unless it is extremely difficult to perform a cystocentesis on Eva, then I believe that provides the best information. Otherwise, if bacteria are present in the sample without indicators of infection present, then you will be left wondering if they represent a problem or not. Some veterinarians do not treat urinary tract infections in the absence of these other indicators but I find that a risky practice for patients with kidney disease.

I understand your concern about Metacam, but I would not be worried about giving Eva Metacam and having her contaminate the water supply with it. It is a very tiny dose and even if she drank water immediately after that, any trace of medication would be diluted to the extent that it would have no effect on your other cats. At the correct doses, studies show daily metacam can be given safely to cats for up to 6 months. The studies did not follow cats beyond that time so it is hard to say if there are any long term side effect (i.e. kidney damage). That being said, I know many elderly cats with arthritis that take metacam daily for months on end without any problems. It is my last choice for daily pain control in cats, but since buprenorhpine was not well accepted and your vet will not prescribe tramadol, I think it is okay to use metacam for Eva's cancer related pain.

Customer: replied 1 month ago.
Calleigh is the one with cancer. Eva has the GI/kidney disease. I know you probably just typed it wrong. Thanks. We are at the vet now getting bloodwork for Eva. She doesn't want to run another culture. Just tests on the free catch for protein and whatever else they run without culturing. The culture was clear following Clavamox August 24-31. I'll ask again about it though. Thanks!

I'm sorry, I don't know why I typed Eva when I meant Calleigh. My apologies.

I'll look forward to hearing how Eva's visit at the vet goes (i.e. lab results, etc.) and I hope Calleigh feels more herself after starting metacam.

Customer: replied 1 month ago.
Ok so here are the results. They sent the T 4 away and should have those results Wednesday. Vet said she is now back in stage 1 and high BUN is not indicative of kidney problem necessarily. I wonder how high it is?? It looks bad! The vet did not want me to have Carafate. Eva pooped a formed soft stool that was very gray paste today and an hour later she got in the bathtub and cried and then went beside the toilet and had runny stool that was very light gray with hair in it. She ran like a shot afterward and seemed agitated and in pain. The vet said she likes Fortiflora best. She said to feed her whatever she will eat but try to get her to eat the KD dry. Bring her back in two months for more bloodwork and urinalysis. She said to give her some of Calleigh's buprenorphine tonight. Eva seems comfortable now so I haven't done that. She weighed 10lbs 3oz today and so she lost 5oz from two months ago. Here are the test results. I hope you can read them. She did not do Potassium even though I had asked. She said it was ok last time. Blood pressure was 140 and she said not to do benazepril now. I'm getting my nerve up to give Calleigh the metacam. She's so clingy and it's tearing me to pieces. Eva had her vetriscience probiotic in the chunky chicken food. Calleigh loves the flavor of the probiotic so I gave her some too. Thanks so much for your opinions and help. It's scary to be responsible for these sensative, trusting creatures.
Customer: replied 1 month ago.
4am and more gray soft poop in the bathtub and Eva seems miserable. I think she might be allergic to the fluids or maybe it's because she ate some kitten dry food that I had down for Calleigh last week. Whatever it is I've never seen her this bad. I wish the vet had run a full screen bloodwork. Something is going on. Maybe her liver.
Customer: replied 1 month ago.
we are in the box again. Nothing. Now she is hiding behind the bed in the bedroom across the hall. Not good. I'm exhausted.
Customer: replied 1 month ago.
Now she's throwing up. Just a little food. Guts are gurgling. She's belching. She's moved back to the other upstairs guest room. Poor Eva. I forgot to get the Pepcid. I'll send Scott out now. We have the master bedroom downstairs with two litter boxes and a water fountain. Upstairs we have two bedrooms and a bathroom with a litter box and fountain. Eva has been hanging out upstairs. I usually stay close to her unless she is feeling well and Scott is with her. Jammie will come to stay with us for a while and then goes back to Calleigh who is usually downstairs. We supervise all night to make sure Eva isn't harassed by William Henry. It's hard to separate him. Calleigh had her metacam at 10pm and is doing ok with it. She and Jammie are cuddled on the couch. Scott and William are in the master bed. And I wonder why I'm going crazy. I don't know what else to do though when they are up sick all night, which has been going on for years with Eva. This is the first time I've seen this gray diarhea though. It bothers me that the vet acted like she didn't know what Eva's stool sample looked like. She took her temperature to see what her poo would look like on the thermometer. We took it in a few hours before her appointment along with the urine. I wonder if she even looked at it.

Hi Catherine,

Thanks for your patience. I was in appointments all day and then emergency surgery so unable to respond until now. I've reviewed Eva's lab results. She is actually technically in stage 2 disease per this reference that is the standard among veterinarians at this time: http://iris-kidney.com/pdf/staging-of-ckd.pdf#page=7

I'm still very pleased that her creatinine has improved this much and your vet is right that the elevation in BUN may not be entirely due to kidney disease. Dehydration, gastrointestinal ulceration and a recent high protein me can all increase BUN. For Eva that GI ulceration is a strong consideration. You may or may not see dark stools: obviously now stools are grey so there is no evidence of bleeding into the GI tract but it is a consideration for any cat with GI symptoms and high BUN. I did notice that Eva's phosphorus has come up from 4.9 in August to 6.1 at this time. I don't want to obsess over that value at this time (i.e. with a history of recent diarrhea), but this needs to be rechecked.

Did the vet tell you to continue subcutaneous fluids? If so, how much and how often?

I don't see how buprenorphine is going to help Eva except to sedate her. I don't generally recommend pain medication unless I know the source of the pain and am taking reasonable measures to resolve it in addition to the pain medication itself. Fortiflora is great as long as Eva eats well with it in her food. As far as k/d dry food, I would very much disagree that is an appropriate diet since Eva has been eating that and is still having GI issues. I do not believe Fortiflora alone added to her k/d is going to change the scenario very much.

It's not a bad idea to run complete lab work since Eva is worse. The vet might be able to add a chemistry panel to the serum the lab has now for thyroid testing provided there is enough serum left over (i.e. it doesn't take very much). Aside from thyroid disease contributing to GI upset (i.e. really something that just needs to be ruled out since Eva's last lab work revealed a thyroid level in the grey zone), dietary intolerance, food allergy, inflammatory bowel disease, pancreatitis which sometimes coincides with cholangiohepatitis are considerations. An fPLI test is necessary to assess for pancreatitis. Cobalamin and foltate levels can be evaluted for evidence of intestinal disease as well as abdominal ultrasound. Ultimately endoscopic or surgical biopsies are needed to definitively diagnose IBD, but often the diagnosis is presumptive in older cats when doing invasive procedures is not desired. The decision to pursue these diagnostics should be based on the severity of symtpoms and response to benign presumptive treatments (i.e. those below).

All that being said, based on Eva's long history of vomiting and constipation, I am VERY suspicious of inflammatory bowel disease. I would take a dietary approach along with medical therapy to control symptoms while allowing a diet change time to work. Controlling vomiting is very important so you may request Cerenia tablets from your vet to use once daily if the vomiting persists or just to have on hand should it occur when you can't immediately access the vet's office (i.e. after hours). As a bonus, Cerenia has antiinflammatory properties (at 2mg per kilogram) and it is very safe even for cats with kidney disease. It can be used five consecutive days, take two days off and then use twice weekly.

Continue Pepcid & Fortiflora. You can cook chicken breast (i.e. white meat only with no skin or fat) to feed temporarily (i.e. for 2-3 days) if you just want to give Eva something super easy to digest. You can also use Little Tummies (i.e. simethicone drops) and give 1 mL orally every 12 hours which will help with gas. Since your vet will not prescribe Carafate or Sucralfate, then you can try fiber such as Benefiber (i.e. tasteless odorless powder) at 1/8 teaspoon in meals every 12 hours OR Metamucil unflavored powder at 1/8 teaspoon in meals every 12 hours OR 1 teaspoon of canned pumpkin (i.e. no spices, just plain pumpkin) in food every 12 hours. Sometimes large bowel inflammation is fiber responsive: it depends on the individual which of those options work the best but the important issue is that appetite remains good when the fiber is added. We don't want to start a food aversion.

If the above fails to provide some improvement, then I would pursue other diagnostics up to the point you are comfortable. There are many other presumptive treatments for intestinal disease, but it is usually wise to start out with benign things as above before moving on to medications that may have negative side effects.

I hope this additional information helps. Please let me know if you have questions and send an update when you have a chance. I should be available to respond much more promptly tomorrow and Monday.

Customer: replied 1 month ago.
Please don't apologize. I don't know how you are finding the time to spend on this and am so happy to have your input whenever you are able. Eva had her first normal looking and comfortable poop in weeks this morning. She's been on the chunky chicken and the probiotic you recommended, with no dry food (except a couple of bites of her old pro plan for sensative skin and stomach this morning). I slept with her on my chest and Calleigh on my legs last night. William and Jammie slept with Scott. I got a little sleep, but may throw a blood clot from not moving my legs all night lol. I'm so frustrated with both Eva's current and former vet. I don't know why I have this problem of not being able to get the tests or medicines I need - and why I am even in the position of having to ask for them. The T4 test was not going to be run until I mentioned it at the end of our appointment even though we had talked about it the day before. At first she said she would have to take more blood for it, and I said to just forget it because Eva was already growling(which she never does). Then she said she had enough blood, so she would send it off. I'll call her Monday morning and ask her to call the lab and add on the Chem panel if they can. I know this will make her mad. Yes, Eva has had bright red blood and then black in her stool since April and has always had mucous and slight blood and all kinds of misery since we got her. I've never been informed of these drugs to help her. I wish I had known about the simethicone and Pepcid a long time ago. She has had severe gas from time to time. Cerenia sounds like something that would have benefitted her all along. I'll ask my vet about those too. There aren't very many options for changing vets here. The current vet and her coworker that saw Calleigh are supposed to be the best. The vet we have in Charleston that still sees William Henry is now a half hour away and it's hard to take Eva there for fluids two or three times week. If I switch to the vet who saw Calleigh I don't know how awkward that would be. I want to trust the current vet but I have to wonder why she isn't doing something more than buprenorphine, which I didn't give) and why she is staging her kidney disease wrong... She says to continue fluids twice a week at 175-200ml. We will do that and keep her on the canned food and try to get her to gain weight. I'll use the OTC meds you mentioned as needed. I'll ask for the bloodwork and other medicine. I'll also give Eva A dose of Revolution. This household went from joyous romping to sad suffering really quick. It's hard. Eva's vet is also the one who saw Jammie. She warned me again on Friday that he will soon get sick. Calleigh's vet thought he was fine and just has chronic bronchitis. It's just so stressful. I've attached a picture or two of our peacock. He loves to play hide and seek with the cats.
Customer: replied 1 month ago.
I forgot to mention that Eva has been grinding her teeth when she eats for several years and I t has gotten a lot worse in the last few days. My vet said she's never heard of that. I had another cat years ago who did it. I've heard my friends talk about their cats doing it. I looked it up and found that it can be related to kidney disease and irritable bowel. She has been grinding constantly while eating her wet food for a few days.

Wow!! I love your peacock: he is gorgeous. It's amazing that he plays with the cats. Are they afraid of him? I guess he seems pretty big when he puts his feathers on display!

I'm glad to hear Eva's stool was pretty normal this morning. Chronic GI issues are very common in cats but I believe many vets are less comfortable treating cats than they are dogs. Regardless, I understand your frustration. I would simply suggest going to the vet in Charleston for anything serious. It's not going to surprise me if your current vet is not familiar with using Cerenia as an antiinflammatory for routine use in cats: most vets are not. This is a link to an article on feline IBD that lists cerenia and comments on its antiinflammatory benefits: http://www.allfelinehospital.com/inflammatory-bowel-disease.pml Unfortunately, I can't find a journal reference on that topic to provide at the moment.

The fluids aren't harmful, but if GI ulceration is playing a major role in BUN levels, then they may not be necessary. It is a situation that just needs to be rechecked after the GI issues are under better control. Grinding of the teeth (i.e. bruxism) is relatively non-specific but can be related to GI disease: of course ruling out dental or TMJ issues is important as well.

I'm sorry that you've had way more than your share of cat health issues lately. Hopefully things will slow down and you'll have some normalcy again soon.

Customer: replied 1 month ago.
Tonight we are sitting up with William Henry who has been acting like his back end hurts for a few days. He was constipated and tried to poop over and over for several hours and then started vomiting. We took him to the emergency clinic at 8:00pm but he pooped a good amount that was full of hair while we were waiting. We decided he was ok and brought him home. He has done this before. When we got home he had runny poop in the living room and later vomited upstairs and hid behind a chair. Then he tried to poop again with nothing coming out. He then went downstairs and threw up again yellowey mucous. The first vomit was yellow with mucous and hair. He's been grooming a lot. We are trying to decide if we should go back to the ER. I think the KD food that he has been getting into for a few weeks and the kitten food we had down for Calleigh have made him sick. Unlike all our other cats, he never throws up, which is good since he has to have phenobarb twice a day. I think he has lost a little weight in the last couple of months and have an appointment with his vet to take a phenobarb level at peak and run a full bloodwork. I will not try to give the phenobarb tonight because of his nausea. If you see this maybe you could advise me on that. He almost died of toxo five years ago. He has asthma yearly in June and sometimes in September but not for the last two years. He has always had what I think are tummy aches from time to time and he acts clingy when he is not feeling well. He has been very clingy the last couple of weeks. I hope it's just the change in food. Eva had a small runny poop again today. She also had an enormous hairball that was about the size of a quarter in diameter and about 9 inches long. We brush her all the time but nothing comes off in the brush or with the furminator. It sure comes off with her tongue, though. I'm so exhausted. All I do is clean puke and poo and fix food plates and give medicine and sleep here and there between going to work. Jammie threw up water and food this morning. Don't know what that was about. I feel so bad that I must be doing something wrong for them all to be sick. The vet wants me to give Calleigh the metacam every other day and the buprenorphine every 12 hours. I'm not giving the buprenorphine because she is spending most of the day outside acting surprisingly normal and loving it so much. I'm trying to give her the last sunny days while Scott can watch her since he's not working. I wonder if I should ask my vet if she should have metacam daily in lieu of buprenorphine. Metacam is not making her unsteady or out of it. She's chasing birds and climbing trees. I'm sorry I'm such a pain. If you don't answer I will understand.
Customer: replied 1 month ago.
William Henry and Jammie and me.
Customer: replied 1 month ago.
William Henry is throwing up bright yellow. He threw up his phenobarb pill just now. He's trembling sometimes. He is in the litter box now and trying to poop. I think we were off to the emergency clinic.
I'm sorry that William Henry is sick. Did the ER think he was simply constipated or are there complicating factors? I hope he is doing better now. If you share more details, I'd be happy to help.I'd suggest checking with Calleighs vet about the Metacam usage. The drug doesn't cause sedation but must be dosed very carefully. Impaired kidney function, if any, must be considered carefully too. If you tell me the strength of the Mwtacam medication (there is more than mg/mL) and dose, I can try to advise you. I'all need to look through the posts and find Calleigh's lab results. I think I have those.My Uverse is out until tomorrow and I can only respond using the phone app which is limited to say the least. I can't easily search through our previous discussions until I get internet service again.Please do let me know how William Henry and the gang are doing as well as the details of Calliegh's Metacam dose. Hopefully I can get online tomorrow.Thanks,
Dr Karing
Dr. Karing and 5 other Cat Veterinary Specialists are ready to help you
Customer: replied 1 month ago.
Metacam is .4 ml every other day. I want to ask about a drug called piroxicam. I read that it might cause tumors to regress. I want to give her T factor for immune boost but can't figure a way to get it down her. It's a capsule full of powder. I mixed it with nutri cal gel but it seems cruel to try to put that in her mouth when she is struggling to swallow. I don't even know if it's worth it to try to get a little nutri cal down her. This is the worst thing I've had to witness, and I've seen some sad things. William Henry's vet -our old vet in town- squeezed his anal glands and got a whole lot of gunk out. She said his left hip seems sore. I noticed he has been sitting gingerly for a couple of weeks. She gave him two shots: Zofran and Pepcid. He has lost 3/4 pound since he saw her last 6 months ago. She thought it might be the KD dry food of Eva's that he keeps eating. His temperature was 102.1. He seems better tonight. He last threw up and stopped straining in the box with no results at 7:30am. The vet said his abdomen felt normal. He's not very hungry though. I wonder if he needs a dose of Clindamycin to keep the toxo in check. He has had a couple of courses in the past five years. Once when he started having seizures again after a year and once last year when he had an infected toenail that was persistent. Eva seems more comfortable. William Henry's vet made a comment that It's not normal how worried I get about my cats. Yes, I do. Since I was 7 years old and my first one got FIP. I worry because things tend to go so wrong with them. I would like to give another cat a home, but it seems so much harder for me to keep them than for most people. I've also spent thousands of dollars since July on relatively young cats. William was just five when he got toxo. He's 10 now. Someone dumped him in my yard when he was about 6 months old. he and Calleigh were fast friends when she got dumped in my driveway a few months later. I already had Jammie and Eva. Thanks so much.
Customer: replied 1 month ago.
Eva and Pea.
Customer: replied 1 month ago.
Hello. Eva's vet called me yesterday and said her thyroid was normal and no worries. I asked for a copy of the test today when I took Eva for her fluids. I have attached the results because it's in the gray zone. Eva's vet said we do not need to instigate further. Sigh...

Hi Catherine,

I'm finally back online!! Eva's thyroid value has gone up and it is appropriate to run a Free T4 by equilbrium dialysis (Free T4ed) to rule-out hyperthyroidism. Vomiting, diarrhea and weight loss are symptoms of hyperthyroidism AND cats that are ill with other problems usually don't have increasing thyroid values (i.e. up to 3.8 now from 2.3 earlier this year). Now if the Free T4 is not run by equilibrium dialysis, then it can be falsely elevated due to concurrent illness and not very helpful in this situation. So it is very important that your vet run the Free T4ed. When your vet doesn't recommend runnning a Free T4ed test to rule out an ever increasing Total T4 in a symptomatic cat, you really have to wonder why? Did she even recommend a follow-up Total T4 at some point to learn if the upward trend continues ( 2.3, 3.8 ....????)

On Calleigh's Metacam, is the Metacam strength 0.5mg/mL? This is most likely but I'd like to be certain. Also, what does she weigh currently?

It has not been established that Piroxicam has any anti-cancer benefits against oral squamous cell carcinoma in cats. This particular NSAID can be more likely to cause GI upset than Meloxicam and Piroxicam must be compounded for cats. I'd personally be reluctant to recommend use of Piroxicam for fear of causing loss of appetite, vomiting or diarrhea and that would be unfortunate especially without much anticipation that the drug would help more than Metacam.

For William Henry, I would not use Clindamycin unless there is clinical evidence of toxoplasmosis and a high titer to support its use. Based on his history, repeating titers isn't a bad idea if he continues to be ill. Did they run any lab work on him?

It's really inappropriate for your vet to tell you that you worry too much about your cats!! You have had several with serious illness recently as she well knows. My cats are like to children to me. Not all cat owners feel so passionately about their cats (pets), BUT it is very important that a veterinarian approach every case in such a way that the absolute best care is offered. If a vet devalues pets and allows that to influence their recommendations, then they will ultimately be doing a disservice to their clients.

Customer: replied 1 month ago.
Oh boy. I'm getting kind of emotional. You are the first to validate my feelings regarding the vets dismissing my worries. I worry because things are going so wrong so quickly here. I have no children, so it's hard not to have these feelings. I am responsible for their wellbeing. I always feel like I'm walking a tightrope trying not to make the vets mad at me. Eva's vet did not recommend anything further on her thyroid. I will ask again but I think I need to search another vet. Problem is every one seems to be lax in looking at the history charts. For instance, Eva's vet said her blood pressure had never been taken until the other day when it had been taken months ago. William's vet said he had lost a half to 3/4 pound since last time she saw him. I called for the weight history and found that he has lost from 12.2 to 10.07. The tech could not tell me the conversion so I don't know if that is ounces, but at any rate he has lost two pounds since June. They have no record of him being there between June and Tuesday. He was there in September because he has intermittent limping on his ftont legs after rough play sometimes. First it was the right leg in June and the left in September. X ray of foot only was done in June. No X Ray in September but he quickly recovered. His temp was 102.1 Tuesday. High for him. He felt terrible yesterday until evening and still isn't quite himself. He usually tears up cardboard boxes all day but doesn't want to do that. He doesn't want to eat much. He still sits gingerly. She did not look in his mouth that I recall, and I forgot to ask her to. The Metacam is what you said-0.5mg/ml. She weighed about 10lbs a couple of weeks ago, but is losing. She plays and acts normal. It's so frustrating. I hope William is losing weight because he was eating KD a lot for two months now, but I think I noticed him looking thinner before-not sure. My mind is playing tricks. He will be seen by his vet on Monday for a peak phenobarb level and full bloodotk and toxo titer at my insistence. I'll take some urine and poo. I'll ask for the works. I wonder what his last thyroid level was. We had full bloodwork run on him in February because the vet filled his phenobarb prescription at double his dose of 1/4 grain. He was so drunk and weak and I thought he was dying. Scott gives him the pills and didn't notice until he had two weeks of the double dose. We took him twice to the vet during that time and he had all kinds of tests. The phenobarb levels were sky high. The vet called a specialist and they just couldn't figure it out. I finally looked at the pill and noticed it was bigger than normal. Ughhhh. I called Cornell Feline Hotline and asked if he would have any permanent damage and they said they didn't think so. Thank you.

Calleigh is on the correct dose of Metacam for her weight. She could be given that dose daily BUT I would only advise that if her kidney values were normal the last time they were checked. There is also an argument for remaining at the every other day dose if Calliegh is doing great now. You could increase to once daily later if needed. For some reason, I can't access Calleigh's original post right now to see her lab work/kidney values. It may be a computer glitch that will resolve or you can attach the values here if you like.

Your frustrations with your vet are well founded: there is no question about it. Mistakes and oversights happen here and there but what you have shared with me is unacceptable. I checked The American Association of Feline Practitioners website and these are the results: http://www.catvets.com/cat-owners/find-vets-and-practices

There aren't any feline specialists near you but these are vets in your area that are AAFP members and have a special interest in cats. Looks like one is your vet now. However, check out Dr. Amy Keith. Her hospital has some good reviews and here is her bio: http://valleywestvets.com/our-team/amy-keith

Here are some reviews: https://www.facebook.com/Valley-West-Veterinary-Hospital-251123141604246/reviews/?ref=page_internal

Alternatively, you could consider Animal Care Associates which appears to the be only animal hospital accredited by the American Animal Hospital Association in your area:

https://www.aaha.org/pet_owner/about_aaha/hospital_search/hospital_detail.aspx?record_id=4259&hospital_name=animal_care_associates_inc

http://acawv.com/hospital-tour.html

They seem to have some good reviews too. There is definitely something to be said for AAHA accreditation: while it is possible to meet all the standards they require but choose to remain unaccredited, that is unlikely. As a veterinarian, I would not consider employment by an unaccredited hospital.

Obviously, I'm not sure you can find someone better to care for your cats but I think you should investigate. I'd suggest calling the hospitals above and asking which vet in the practice is best with cats. If you are lucky, you will get some good info. Friends and family may be a good source of info as well. I'd even consider asking boarding facilities and/or groomers who they recommend to see cats. If you ask enough people, I believe you should start to see a pattern to help you decide who you might consider. Eva and William Henry might have the greatest needs at the moment. Remember, seeking a second opinion is commonplace (aka testing the waters at another vet office) and doesn't mean you can never go back to your regular vet. You can simply get a copy of your cats records "for yourself" and take the records and your cat anywhere you like for one visit or on a regular basis.

Customer: replied 1 month ago.
Thank you so much for all this research and info. William Henry's vet is in the practice at Valley West with Dr. Kieth. Animal Care Associates is where we used to go. They are good. It's further away for Eva's fluids, but we could probably make it work. The doctor we saw there retired but there is another one-Dr. Patton-that is good. William is still not feeling well and acts like his back end hurts. He hasn't pooped since the ordeal Tuesday night. He's not interested in food. He just walks around. It just occurred to me that with that much weight loss he might have been getting overdosed for a long time on the 1/4 grain phenobarb. I don't want to wait until Monday for the level to be taken. It has to be sent off and will take several days. I'll try to call his vet in the morning but I don't know if she can see him. About an hour after the dose of Metacam tonight Calleigh ate and drank a whole lot and then threw it all up on my guest room carpet. I'm so exhausted. If Scott were working we would really be in trouble. I have to be out of town from November 13 to late on November 18. It's going to be bad.

Thanks very much for the generous bonus: you are very kind.

I think it is unlikely that William Henry's problem is the result of the incident with his phenobarbital from February. However, I would be concerned about the weight loss and that he isn't eating much. A repeat exam and full blood work (with thyroid/phenobarb and consider a fPLI test for pancreatitis) are in order, and since he hasn't had a bowel movement, taking abdominal x-rays isn't a bad idea. Perhaps he needs an enema. The x-rays would also be a way to evaluate his hip/pelvis since he seems uncomfortable. Adequan is a very safe treatment for cats with arthritis if that turns out to be a factor. It is VERY important that he start to eat so I would sugggest an appetite stimulant (i.e. mirtazapine) to help get him going.

I'm sorry to hear Calleigh has vomited. I still can't access your previous post about her that I believe has her lab work attached. It's important to check and see that her kidney values were totally normal before starting Metacam: I believe they were. In any case, do not give her Metacam again if she is vomiting, having diarrhea or isn't eating and drinking normally. Regardless of what caused GI upset (i.e. may or may not be a side effect of Metacam), the drug cannot be used in cats if there is any chance of dehydration (and it is likely to contribute to continued GI upset if there is already some). Hopefully, the vomiting was an isolated incident and everything with be fine with Calleigh today.

Customer: replied 1 month ago.
Thank you! Calleigh has often vomited after eating very fast throughout her life. She is very good today. In fact, she was out most of the day and I just got her in. She caught two mice and a mole today and chased birds and climbed trees all day. I forgot how much she loves it outside. This is not going to be quick like I thought. She is acting so normal. She even ate the mice. It's so painful not to be able to fix her tongue. William had a bowel movement today. Half of it was very dark and shaped like a tootsie rolls. The other half was peanut butter color and consistency and pencil thin. He ate a little here and there today according to Scott. I was at work all day. He ate a few petrolatum treats for me when I got home, but not very enthusiastically. I put some NutriCal gel in his mouth and he didn't seem to mind. About a half teaspoon. It was prescribed for Calleigh. Do you think that was ok? I couldn't get an appointment for him any sooner than the one we have Monday. He acts like his back end is sore. I'm not sure if it's his hip or both hips or his bottom. He just doesn't sit all the way down without stopping and going slow. I'll give him some laxatone tonight. His vet said a teaspoon a day for several days. I'll open a new question on him. Hate to keep bothering you but I couldn't have gotten through these last awful weeks without your help. I wish you were in our area! I'll be sure and get all the tests on William on Monday. His phenobarb level was 38 after he got over the overdose. I still think that is too high, and I bet it's higher now with a two pound weight loss. I also wonder why I'm seeing almost black poop in the box from every one of the cats at different times lately. Eva's tested positive for blood and was very black a couple of weeks ago. I attached a picture of what Wiiliam did today here. Sorry if that's too gross. Nothing phases me anymore.