7/7 Jake AMPS 321 - still here!

[Lydia & Sid & Jake(GA)]

Jake is still here and about the same - not eating and very lethargic. He can barely walk. However, he definitely has a little bit of spark left
Last night he meowed at me at the front door so I carried him outside and then we walked around (I carried him). I set him down in the grass and he nibbled a little. He purrs very loudly sometimes, usually when he is being given his fluid treatment.

I have received so much good advice from this forum. When I posted on the regular health forum, Wendy suggested I join a Feline Assisted Feeding Yahoo group, which I did. There is a wealth of information there if anyone ever needs any advice at all related to assisted feeding. After reading all the advice on this group and that group, I feel so much better informed. However, one worry I have right now is about anti-nausea medicine for Jake. My vet will only prescribe Cerenia, which is injectable only and costs $30/injection. So if he needs that daily, that is a little pricey. Plus I have to run to the vet every day to get the syringe because I have been giving him the injection at home. So I am debating about checking with another vet though I have to say I have been to every vet in my area (practically). Another option is to the veterinary teaching hospital (which is 1.5 hours away). I feel they will want to run a lot of tests and I'm not sure that is best for Jake. My vet has not run any xrays or ultrasounds because he said he isn't sure what we would do with the results. Jake won't survive a surgery if he has an obstruction in his gall bladder or bile duct. He is currently syringe fed 3-4 times per day, on baytril, pred, denamarin, and 100u sub Q fluids/2x per day and still yellow.

I'm thankful for many things right now. One of them of course is all of you and the other is that at least Jake's BG levels haven't skyrocketed like I expected.

last condo: viewtopic.php?f=9&t=19002

 

[Pat+Raja+Shadow (GA)]

Morning Lydia....so sweet to hear about your adventures in the garden with Jake. You are doing so much to help him...
I know nothing of the meds...but I was wondering what would happen if you told them at the teaching hospital that you didn't really want him to go through a lot of tests. Certainly they would understand that. They might help you without additional testings. OR they might suggest one or two that were acceptable to you if need be....to help with the course of action. The very least, you would get the meds you needed. (that is a super expensive shot!! WOW!)
Sending you and Jake a million hugs... :YMHUG:

 

[Kelly & Logan]

It sounds like Jake is hanging in there and is pretty content. I'm sure he loved your time in the garden. I used Cerenia with Logan and it's really only for severe vomiting. It doesn't really help with nausea. So, it might be worth trying to get another medication for the nausea. I've used Anzemet (also injectible - don't think it was as expensive as the cerenia) and metoclopramide. The metoclopramide helped with Logan's motility issues which helped the nausea. Carolyn and Latte have used several kinds of anti-nausea meds so they could give you some advice on what to ask for.

 

[Lisa and Do Lou (GA)]

So Happy to hear about Jake purring away as you two walked outside :mrgreen: I am no help with advice but sending feel better vines to Jake

 

[Deb & Spot]

I don't have any suggestions as far as meds are concerned, but I'm stopping in to say that you are such a wonderful mum to Jake! Sounds like he enjoyed his time out in the garden and you two are enjoying life together. Sweet

 

[Michelle and Mannie (GA)]

Hi - I can't help with any of the med questions, just wanted to say it's nice to hear that Jake is still hanging in there. It's great you can spend time with him in the garden. I had a cat once that I used to do that with - it made such a difference for him. Take care!

 

[Jess & Earl]

Hi Lydia

You sent me this info in a PM but I'm responding here, if you don't mind, because I prefer to have open responses when possible.

However, one worry I have right now is about anti-nausea medicine for Jake. My vet will only prescribe Cerenia, which is injectable only and costs $30/injection. So if he needs that daily, that is a little pricey.

Cerenia is a temporary nausea drug--shouldn't be used for more than a few days in a row, and as it is metabolized by the liver it is not the first choice for animals whose liver function is questionable. Cerenia was a third-choice drug for my dog even when he had stable chronic hepatitis and good liver function. Based on some of your other comments, I think it's time for a second opinion, but for future reference or if you choose to stay with this vet, the wonder-drug is dolasetron (Anzemet). A proton-pump inhibitor like omeprazole isn't a bad idea either, but for nausea dolasetron is king. Reglan is a crappy option when given at home (it works really only as a constant infusion, if an animal is getting fluids); mirtazepine has some anti-nausea action and is starting to be used for this but I don't know how well it works (jury is still out).

My vet has not run any xrays or ultrasounds because he said he isn't sure what we would do with the results.

How about make some treatment decisions? Lydia, would your own decision-making be influenced if you found out:
--he has a gigantic gallstone (stones can cause a great deal of pain; decide if you want to stabilize for surgery, or decide to let go) OR
--he has a belly full of fluid (can be a sign of end-stage liver failure, may be very tough to impossible to recover from this) OR
--classic for hepatic lipidosis, everything else looks good (go all out and get a feeding tube) OR
--there is evidence of cancer (can start palliative treatment, stop all treatments he doesn't like, etc. or go for chemo) OR
--liver looks mildly irritated, pancreas looks angry (treatable, hang in there, def start pain meds)
etc.

Personally, prognosis makes all the difference to my decisions about whether to treat my animals. If I do the force-feedings, force pills, etc. , is there a reasonable chance my animal will get past this and have some quality time? (No guarantees, of course, but is there a chance?) Ok, I'll go forward. If things look end-stage? I'm stopping potentially uncomfortable treatments *now* and starting all the palliative care I can, and getting my family and myself ready for what is to come. Is this a surgery-or-euthanasia situation? I want to know that. Is the condition painful? I want to know that too.

I'll be honest, Lydia, your cat's age (which I was unaware of) makes this more likely to be cancer-related although it's by no means for certain. It's still quite possible that this is hepatic lipidosis that snowballed from pancreatitis -- that is always possible esp in diabetic cats. Again, speaking personally, I'd want to know what I was looking at so that I could decide to try to treat or to let go if there is no real chance of recovery.

Jake won't survive a surgery if he has an obstruction in his gall bladder or bile duct.

I don't understand your vet's thoughts here either. An obstruction can be painful (from what humans tell us) and is a surgical emergency; this is a case where you need to know whether to let him go very soon or to check him into the nearest hospital for rapid stabilization and surgery.

I guess I'm turned off by your vet's apparent shrug-off that Jake is old so it's hopeless. There is always something to do, whether it is intervention or helping to make a sick patient's last days as comfortable and dignified as possible.

I'm sorry, I hope I've not been too blunt. As you may know, I have recently had to deal with some dire results in one of my own animals and had to make some of the same decisions on whether to do further diagnostics, how far to go with treatments, what type of treatment to choose, etc. and having the 'big picture' makes a huge difference.

 

[Lydia & Sid & Jake(GA)]

This is fine! I sent the PM in the hope that you might see it more quickly because we had a vet appt yesterday. I took Jake to a different vet. This one told me his liver was enlarged and his kidneys were not functioning. I got the distinct impression that she felt I should just euthanize him. She did send him home on an IV drip and so he received about 500 ml. I really did not like her at all. She withdrew some urine from his bladder and said that she didn't even have to test it to tell he was able to concentrate it. Then I said that maybe she should run the test anyway. So she did and saw that he was not able to concentrate it and it was dark yellow because he is so jaundiced. This vet also ran a blood test that said his potassium level was low.

This morning his blood glucose is at 43 so I am taking him over to the vet he has been seeing regularly to get more IV fluids and I will discuss with him an ultrasound (again). I mean he is pretty much at end stage here. He is in very bad shape. I'm beginning to feel very guilty that I can't just euthanize him. His pet sitter who is a vet tech told me yesterday that she didn't think he would survive the night and I should take him right over to the emergency clinic to be euthanized. (She came over to help me with the IV fluids.)

He is still here. Last night for the first time in 2 weeks he acted hungry and ate 4 small pieces of cheese and licked baby food off a spoon (about 1 tsp). I have started syringe feeding him I/D.

At the vet today I will find out about doing an ultrasound or an xray. I guess I don't understand why this vet would suggest putting in a feeding tube but not feel it was helpful to run some xrays or ultrasounds. The thing about the feeding tube is that I can syringe feed him really well. Jake is so dehydrated that he really needed IV fluids. Why didn't a vet suggest that? Why did I have to go in and insist they give him some. Why did I have to insist on the Denamarin for liver support and then I tried to get an anti nausea pill for him ( anzemet) but the vet had never heard of it so she wouldn't prescribe it. Then on top of that, Jake has received Cerenia but that isn't even recommended for cats with liver failure. Maybe it is me because I am stressed and so not understanding what they are telling me very clearly, but I don't feel any of these vets are being straightforward or communicating in a way that I am getting what they are talking about. I do appreciate your being blunt. At least I can understand you then. I appreciate everything - thank you so much!

 

[Ella & Rusty & Stu(GA)]

Dear Lydia, This is such a hard time for Jake and you. I hope that you will be able to get the information you need to make the right decisions. I don't know anything about those medications, but I do know that the best thing to do until you are able to sort through the answers to your questions is to keep doing what you are doing: being with your kitty and telling him how much you love him.
Many hugs to you and Jake,

Ella & Stu

 

[Nina and KB]

(( Lydia )) Kudos to you for wanting the best for Jake. The walk in the garden sounds beautiful.

These are tough times for sure and as pet owners many of us may some day face some portion of what you and Jake are going through. What a blessing to be able to sound out your thoughts and frustrations here, and the advice you've gotten is worth bookmarking.