Wednesday, July 4, 2012

TRANSITIONS: BEGINNINGS AND ENDINGS


Spring brings rain, sun and lots of work.  This spring is no different, but with an added element.   My oldest and dearest, first rescued cat Vinny, was diagnosed with Hyper thyroid last July.  Hyper Thyroid is an over active thyroid gland. Symptoms are increase thirst, weight loss, restlessness, increased appetite, rapid heart rate, hyperactivity, irritability and an unkempt coat of fur, along with mild to moderate diarrhea and vomiting. Also some do not tolerate the heat and seek cool places. Vinny no longer tolerates the heat. He went from a weight of 13lbs to 10 lbs before he was diagnosed with Hyper Thyroid.   Dr. John put him on the standard thyroid dose of medicine for cats.  Within a month, Vinny went from Hyper to Hypo thyroid.  This surprised Dr. John. Symptoms of Hypo Thyroid are: lethargy, increased sleep, weight gain to obesity, cold intolerant, constipation, decreased appetite, excessive hair loss and decreased interest in anything. This is not good.  This is caused by too much thyroid medicine.  We took him off the thyroid medication for one month to clean out his system and get him back to Hyper thyroid.  
 This is Vinny at his normal weight of 13lbs. He is at his correct weight.

Vinny is very sensitive to the thyroid medication.  We played with his dosing for months trying to find the right dose to get him into a normal range and not make him Hypo Thyroid again. 

In December we went through this big scare that one of the cats had Feline leukemia, which turned out to be false.  Well, come January things began to slow down and mellow out. Vinny got really ill, with a fever, vomiting, diarrhea the whole works.  I rushed him in as an emergency patient.  Dr. John did a chem. Panel on him and all was good.  The Vet drew blood and sent it off for thyroid testing.  In the meantime, Vinny received shots to lower the fever, calm his tummy and antibiotics.   The next day his thyroid test indicated his levels were extremely high, 8.1. This is extremely dangerous as it can lead to heart failure, high blood pressure and damage to several organs including the eyes, kidneys, heart and brain. Normal Thyroid range is 0.8 to 4. ug/dL.  Again we changed his dose to bring his thyroid levels down to normal range. 

Instead of testing his thyroid levels every month we test him every two weeks.   Each visit is promising; we are getting closer to normal range.  However, I am seeing some changes happening with Vinny as we approach the normal thyroid range.  I begin mentioning these changes in passing.  Finally, in March his reading is 2.8. Yippee!  Dr. John, however, wants his levels to 2.3 since he is on medication. How exciting, right?  


 I now mention, again, Vinny is acting as if he is in Hypo mode again….Check him out.  Faithful Dr. John reminds me that Vinny is 14 years old.  Dr. John examines him and he looks okay, but he does a blood draw and a complete blood work up.  Yes, I know what you are thinking, $$$$$.  Again, my oldest and dearest baby, need I say more?

As we wait for the blood work, Dr. John mentions Vinny’s thyroid gland is swollen, which it is, and I should consider having it removed and letting the other thyroid gland take over and get him off his medication.  Hmmm….O k a y……..the results print out……Now to know Dr. John is to see a face you cannot read when he brings in the results.…I ask him, “good news or bad news?”  Answer: bad news.  Vinny is in renal failure………………of course my eyes fill with tears as I look at Vinny.   I suck it up and put on my business face.  Renal failure symptoms; increased water intake, increased urination, weight loss, lethargy, vomiting, loss of appetite, weakness and the most significant problem is the build up of blood toxins and anemia.  Vinny is slightly anemic at this time. The controversy is whether a high protein diet is good or bad, the research is not complete. In humans and dogs with kidney failure, high protein diets worsen the disease.  To error on the side of caution, I keep high protein out of Vinny’s diet.  By the way, Hyper thyroid masks renal failure.  Renal failure is considered an old cat disease, but it does happen to young cats as well.  The excitement of Vinny being in normal thyroid range transitions to the end of life stage. 
 This is Vinny June of this year.

What do I do for him? Dr. John’s options:

One we can leave his thyroid in normal range and Vinny will be gone in a matter of weeks or a couple of months. Two, we put him back into Hyper thyroid, the low end, between 5. and 6.  This will improve his kidney functions and give him a little better quality of life.

I opt for two, put him back into hyper thyroid.  The tightrope here is keeping him in the low range of Hyper and not going too high, Why? As you read above, it can kill him. We decide to check his thyroid in 2 months instead of every two weeks.

Here we are in June. Vinny is holding his own.  But symptoms began to creep up causing concern. Back to Dr. John for thyroid test.  He is too high again! This time his reading is 9.1.  We kick up the dose of his thyroid medicine to bring his numbers back down to 6 or 5.  The only good thing about this high reading is he is eating everything I put in front of him.  Did I mention he is a picky eater?

Here is an example of just how picky the boy is.  When I first brought him home, as a kitten, I asked about the best cat food for him.  I get brand “A” for him.  He eats it for three days then refuses to eat it.  I stop at the pet store and check labels and find brand “B” bring it home and he eats it for two days…..Okay, I go back to the store and read more labels and bring home brand “C.”  He eats it.  The third morning I put his dry food down, along with some wet food...  I am getting ready for work so, not paying close attention to the boy.  I notice he is playing with his dish, whatever.  Next I see him pushing his dish around, okay.  When I checked again, he was sitting scooping litter out of the litter box onto his dry food dish where he left a fresh stool.  I got it! You hate this food!  I stop once again at the pet store and bring home brand “X” he has eaten it since! Now you know how picky the boy can be.

Weekly I go to the pet store and pick up 50, 3 oz cans of assorted cat food. There is pate, chunk, minced, bits and shredded.  He prefers the pate.  It is really the same stuff, chicken, fish, beef and turkey just put together in weird combinations.  Each time I come home with his 50 cans he is determined that I open all 50 cans that day for him to sample.  Also royal Canin has 10 to 12 oz bags of their food for $4.99, which works great for Vinny. I know, I know, $$$$$, once again, oldest and dearest baby, enough said. If I was caring for you on your march to death and you requested chili cheese fries with gravy, I would not deny your request.

He has narrowed the food choices down for me. He no longer likes any of the expensive exotic foods.  Now he only likes the cheap foods. Why?  The expensive food is like eating cardboard with salad dressing on it.  The cheap food is like eating French fries and cheeseburgers; better taste because of the high fat content.  Not to worry he is not gaining any weight. In fact, he has lost weight and will continue to. He went from 13lbs to present weight of 7lbs 9 oz.  This is the renal disease now.

I feed Vinny nearly every hour on the hour, or every time I walk into the kitchen. He eats half and ounce of food and water per serving. He won't eat anymore at one serving. He eats a sampling from 4 to 8 combinations of food.  This takes half an hour to forty five minutes to get about 3 to 4 oz down him. He is also being supplemented with baby food, only Gerber’s; chicken, beef and turkey, which I mix together in combos and sometimes, mix it with his cat food. Why baby food? It is bland which is good for his tummy.  

Our regiment now is I get up at 3:30 to 4:00A and feed him some food, then I go back to bed, then we start over again at 6:30A, then he gets thyroid medicine, followed with a ½ of a 10mg of pepcid.  This keeps the ulcers from forming in his tummy and working up his esophagus to his mouth.  I feed him ALL DAY AND EVENING LONG.  At night he gets thyroid medicine and twice a week he gets calcium supplement. Of all of the cats, he is the easiest to give medicine.

When I go outside to work, I am usually out for a couple of hours. I come in to cool off and drink lots of fluid, water, Gatorade and ice tea.  Vinny is usually sitting in front of the kitchen door tapping his foot and talking at me as I walk up to the door.  I can only imagine what he is saying. “Where have you been? I am starving to death with no food in the house to eat!”  Of course, we do have a dish of dry food that the other cats eat, but no not for him unless he absolutely has to!

This is how my mornings begin; at 3:00 AM, Vinny usually stands on my face talking to me. He wants food. He passed the big plate of dry food on his way to wake me. I get up, stumble to the kitchen, mix some warm water with can food and serve.  I feed him enough, I think, and then I go back to bed.  This takes half an hour. I bought an inexpensive 12 cup coffee maker to keep warm water on hand for feeding Vinny. It saves a bit of time and money on the water bill. He eats, he sleeps and when he is having a good day, he plays.  Mostly his thoughts are about his next meal, which is usually in an hour or so.  He reminds me of the movie Ice Age 2, where the vultures sing a song about food. “Food glorious food, I am going to get some…”  If you have not seen the movie, check it out. It is a funny skit.  Hey, I have to have some humor in this or I would be a blob of emotional goo all the time!

The other thing we can do for him is hydrate him subcutaneously.  This involves an IV needle setup along with a bag of saline.  This is a two person job. One holds the intended, the other inserts needle just into the skin, careful not to prick yourself, as I have done more than once, or go through and through the skin, again did this,  then open the IV line fully and hold it until you put 250 cc of saline in the intended.  The saline bag holds 500 cc. This is not an easy task.   My husband has tried to assist me twice but finally said, “No more.”  He feels this is the Vet’s job. Yes, but to save money we can do it. Well, not happening.  My husband feels we are not qualified or trained to do this.  In place of hydrating subcutaneously, I do my best to make sure he gets lots of fluids in his wet food by mixing enough water in the wet food to make it  a gravy for him to eat. I am trying to push as much fluid as I can onto him.

The other transition in all of this is Oreo.  You may remember Oreo and his ordeal with food, then his exploratory surgery to find, thankfully, nothing.  Oreo and his brother Scamp (deceased) adopted Vinny as their mom.  I brought Oreo and Scamp home when they were a month old. Vinny has been Mr. Mom since.  Oreo is losing his Mr. Mom.  Oreo sleeps with or actually on Vinny. See the pictures below.  When these pictures were taken, Vinny weighed 13lbs and Oreo weighed 16lbs but slowly gaining to 19lbs.  


The 3 amigos




Vinny sleeps in the cat crate by the kitchen door now, Oreo is feeling the loss. He first began stress eating.  Not good for the boy.  Oreo slowly began to accept the loss of Mr. Mom by substituting ME in Vinny’s place!   Oreo is just a loving cat, who wants nothing more than lots and lots of love in return.  Oreo insists on having some part of him on you. He likes to lie on my chest and demands I pet him. He uses one tiny little claw to tap on my chin. Or if I won’t go for that, he will lay his paws and upper body on my arm, my shoulder or my hip and sleep.  He has stopped his stress eating now that he knows I will be his “Vinny.”

Vinny is still Mr. Mom to the older group of cats. When he hears one of them meowing and carrying on, he gets up to investigate. Vinny has good and bad days.  At this point, mostly good days.  On his bad days, I am afraid this is the day the buzzard death is coming for him.  Here is a quote that fits my feelings on his bad days, from The Wind in the Willows where Rat and Mole approach Pan on the island. “Rat,” he found breath to whisper, shaking, “Are you afraid?” “Afraid?” murmured the Rat, his eyes shinning with unutterable love. “Afraid? of Him? O, never, never. And yet—and yet—O Mole, I am afraid.”



In mid July, Vinny goes back for a full blood work up and thyroid check.  Now that we are getting his thyroid back down to 5 or 6 he is happier and a little more active.  The beginning, get his thyroid in check.  Today, we are progressing toward the end of his life.  I sometimes refer to his time as being on death row, without hope of pardon.

 I see the buzzard death floating weightlessly in large lazy circles above, casting its shadow on the landscape below.  It circles, slowly, slowly descending, to pluck the life of animal and human a like.  The shadow it casts loams large over our landscape.  Vinny has maybe a month possibly up to three months, but it can change over night.


I take you onto part 3, Transition: The Big C.

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