Alex’s story

cropped-alex261.jpgAlex P. – New Alex articleHampshire
Female, tortoise shell Tabby
August, 1996 – July 10, 2008
Diagnosed with IBD in February 2008
Diagnosed with hepatic lipidosis in April 2008
Diagnosed with pancreatitis in May 2008
Diagnosed with triaditis in May 2008

Alex always vomited, at least from the time that she became mine. She was severely overweight due to her previous owner free feeding her junk (I got her at 6 years old). I had gotten her to lose some weight but she was already so sick her weight loss became too fast and entered the danger zone. In the fall of 2006 I took her in for a checkup because of her vomiting and at 17 pounds, I learned of the severe consequences of her being overweight. She needed to be on a strict diet and monitored very carefully. I bought a baby scale and agreed to email the vet weekly with updates on Alex’s weight and progress. It was a difficult process but it was going okay (or so I thought). In the spring of 2007 Alex seemed to be gaining weight again and had a small, two day bout with vomiting. I took her to the vet where she was given the proper tests and checked over well. I was told to give her Pepcid A/C to calm her stomach and see how the tests came back. When everything came back normal she seemed to be doing alright again and we kept going with her diet the way it was. Keep in mind that I was oblivious to the damage that certain ingredients in pet food could do to their systems and to proper feline nutrition. This was all new to me and even though she was eating less, she was still gaining weight due to high amounts of carbs in the food. So even though I thought I was feeding her better food, she was never going to lose that weight as long as she was eating it. Of course by the time I figured this out, the damage was done. This was also at the time of the massive pet food recall due to melamine poisoning and we could never be sure if that was a contributing factor to her getting so sick, this quickly.

All was fine for many months and she hadn’t vomited in quite awhile. But in late February of 2008 everything changed. She had a severe bout of vomiting that lasted three days, and because she couldn’t hold her food down any longer, she stopped eating almost completely (handfed boiled chicken was all she’d eat). I took her to the vet and after running the normal blood and glucose tests to check for diabetes, parasites, etc., she was given some fluids and mirtazapine as an appetite stimulant. At first she reacted well to it and came home to eat a hardy meal for the first time in days. I thought this was wonderful and felt pretty relieved. Within hours that changed to hysterics as Alex began to have a bad reaction to the drug and I ended up bringing her to the ER. Mirtazapine is a human anti-depressant and tends to make people crave food and eat voraciously. One possible side effect of the drug is called seratonin syndrome and Alex had it. Her heart rate was up, she was restless, pacing and crying, hiding in the corner of the room. Her pupils were huge, she looked like she was stoned and her breathing was rapid. I brought her to the ER where she was given the antidote, which happens to be another appetite stimulant, cyproheptadine (Periactin). It turned out that one dose wasn’t enough and I had to take her back to the vet the very next morning for more and to be checked over. She was okay but I was given a prescription for the cyproheptadine in place of the mirtazapine. I was told that this was a rare reaction, but it scared me so much it was the beginning of my desire to research and ask a million questions about every little thing we did for her. Even that turned out to not be enough as there were more problems to come. As the years have gone by we’ve seen more of this reaction to mirtazapine in other cats, mostly due to prescribing too high of a dose. Mirataz, the transdermal version of mirtazapine is now used widely and carries far less side effects. What I like about it is you can control the dose much more easily. For instance, the kitties I have now are Maine Coons. Although large kitties they are EXTREMELY sensitive. Instead of giving the recommended 1 1/2 inch ribbon of Mirataz prescribed, I give a small dot and that itself does the trick nicely. Mirataz still has the same properties as mirtazapine and can cause rapid breathing, hypersensitivity etc. To me it’s always better to start out small with the knowledge you can always go up safely.

In early March they did an ultrasound and found her liver to be inflamed, but not yet hepatic. Her pancreas looked okay, all other organs and lymph nodes looked normal, but her small intestines showed thickening and she was diagnosed with IBD. She was immediately put on metoclopramide (Reglan) for motility and to stop vomiting (Cerenia was approved by the FDA in 2007 for use in dogs and in 2012 for cats. By that time she was long gone. If approved earlier it could have saved her life. Zofran was also never offered to us as a possible anti emetic). The Reglan and Pepcid (famotadine) helped greatly but she was now incredibly sensitive and would still vomit every couple of days. She was losing weight quicker now and by March 19, 2008 was down to 13½ pounds and was vomiting bile. We decided to try prednisolone and after the first dose she ate voraciously for a week or so. Then her appetite decreased again so we decided to try metronidazole (Flagyl) instead of the pred. I was taught how to give her lactated ringers (fluids) at home to help flush her everyday and keep her hydrated. I was also giving her Reglan and Pepcid through injections to avoid stomach upset.

Again, for the first few days, she seemed to be doing well on the Flagyl but on the night of April 7th, Alex had a seizure. I had never seen an animal have a seizure before and I was never so scared in my life. She was lying on the bed with me, her eyes were staring at me but she couldn’t seem to see or hear me. She was twitching all over the place and I didn’t know what to do. After she came out of it, I put her on the table and gave her some fluids to try and stabilize her. I never went to sleep that night, first thing in the morning I brought her to vet’s where Alex was now jaundice in her ears, eyes, throat, nose, her stomach, everywhere. She was now severely hepatic and needed hospitalization. The usual treatment for this is to hospitalize an animal for at least three days on a slow IV drip of fluids and antibiotics. Because this wasn’t an all night hospital I would have had to bring her there, pick her up, drop her off somewhere else, pick her up in the morning, bring her back to the vet, etc. etc. This would have been enormous stress on her and I couldn’t afford it. So I opted to drop her off at the vet in the morning and leave her for the day for three to four days. That first day I left her, I came home and prepared myself for the worst, I thought for sure I was going to lose her. When I went to pick her up that night she looked a lot better and she was actually talking up a storm in the back room. Everyone said she was snapping out of it and was giving them a lot of grief. Which in the vet’s eyes is always a good sign, it means they’re still fighting. By the end of the fourth day we had her back on prednisolone and now on amoxicillin (antibiotic) in addition to the Pepcid, Reglan and Cyproheptadine. I had to switch her food around constantly to try and find something that she either wouldn’t vomit back up or she liked and would come back for. The trouble is that if a cat vomits a particular food enough times they aren’t going to want to eat it again.

By May of 2008 she was eating Fancy Feast pates and Royal Canin Recovery. She was doing well on it but still losing weight and was now over-grooming herself. She was still jaundice and even though she wasn’t particularly constipated she began vomiting right after going to the bathroom. By June 2nd, 2008 she was vomiting so much that her weight was now at 9½ pounds. Instead of dragging her to the vet in the car I requested the vet do a home visit. But Alex was already vomiting enough and she threw up in the car every single time I brought her out. During the home visit I requested they do blood work for B12 deficiency and pancreatitis. They also suggested I start her on FortiFlora for probiotics (I didn’t realize at the time this was not the best choice). The new regimen was to be a .25 mgs B12 injection once per week, B complex, and Denosyl, which is used for the liver. When the results came back her liver enzymes were again elevated, she did have pancreatitis and even though her B12 came back normal I not only kept her on it but I increased the dose to .50 mgs per week. This was a mistake. I didn’t know then that her levels were actually a bit high. We’re now finding out that high levels of B12 and folic acid can indicate other health issues like cancer and hypercobalaminaemia (which is associated with hepatic and neoplastic disease in cats). These issues were never addressed properly which again, could have saved her life or given us a much more clear indication on where we were headed. Did she have cancer? We don’t know because I opted not to do a biopsy. And while this is a very individual choice, I wish personally I had done it while she was getting her feeding tube put in. We could have given her more targeted treatments, I could have made more informed decisions, etc. It’s hindsight now but important to bring up. So in my view, it’s absolutely not a good idea to oversupplement these vitamins without proper testing and vet guidance, regardless of the fact that they’re water soluble. Yes these tests are expensive, but sometimes there’s a valid reason for doing them. It’s just best to decide with your vet and to make sure to take these issues into account first. For more information on B12 please see this page:

Diagnosed with traiditis (IBD, liver disease and pancreatitis), on June 11th we decided it was best to insert a feeding tube into her stomach via her neck. I feared since she was already so thin and having problems that maybe she wouldn’t make it through the surgery. Not only did she make it through but she was doing great. Using the feeding tube took some getting used to on my part, but she was okay with it, doing very well. I wish then they’d had better dressings for the neck whereas now there’s a company called KittyKollars. These collars are invaluable and help keep the risk of infection low while keeping the tube in place much better. When I took her back into the vet for a recheck the vet showed me how to change the dressing on her neck and said that everything looked very good. After a couple of weeks she was still losing weight and at this point she was literally ripping her fur out all over her body. At first we thought maybe it was allergies or her immune system being compromised but the vet said it was most likely a sign of OCD (obsessive compulsive disorder) usually associated with pain. So on July 2nd I took her in and asked if we should put her on something called Actigall (ursodiol), which seemed to work well for other cats. The vet was so impressed with her coloring that she didn’t want to “rock the boat” and said in her opinion we shouldn’t do it. She said her jaundice was drastically improved, her coat was luxurious and soft and her eyes looked brighter. She had already taken on Buprenex for the pain after surgery so we put her back on that as needed.

After that she started vomiting once every day, mainly fluid and hair. Her stools were extremely large and pale (she never had diarrhea the entire time with her IBD. Her main symptom was vomiting and weight loss). On July 10th she woke up, ate her breakfast and seemed fine. Within four hours time she began to have rapid breathing, her third eyelid was visible (the filmy covering in their eyes), she was very much in pain and distressed. I raced her to the vets where she told me she didn’t look good. She was now down to 9 pounds and in a lot of pain. They put her on an IV hookup and she just lay there, she didn’t care anymore. The vet didn’t understand it either but she had a high fever and it looked as if she had developed an infection somehow. (I later found out a pancreatic infection can happen at any point and is very dangerous). The vet gave her a Baytril injection and within an hour her temperature dropped, she seemed to be stabilizing. The vet didn’t want to make any decisions about care or what was going to happen because she had bounced back so many times before. I was advised to bring her to the nearest animal hospital but that was over 50 miles away, she would never had made it. I promised to do what I could at home and then bring her back first thing in the morning. I brought her home and she continued to decline rapidly. As a last ditch effort I put her in the carrier and went to the ER. My worst fears happened. I got stuck in construction on the highway and she passed away in the back seat of my car in her carrier. I never forgave myself. The vet believes she died of sepsis as a result of the infection.

For a kitty who was so sick, she fought very, very hard and pulled through so many times before. When she passed it was a shock and it devastated me more than I can say. In hindsight there are many things I wished I’d done differently. Although all I did was research these diseases, at the time there wasn’t enough information about these conditions and it was incredibly confusing. I would have immediately put her on Denosyl at the first sign of the inflamed liver and got her enzymes levels down before it had gotten out of hand. By waiting to start the treatments almost six months later, the damage was already done. She was already hepatic and it was too much stress on her body to try and turn things around at that point. Her liver had affected her pancreas and she was producing too much bile. I also would have gone with my gut and given her the Actigall instead of waiting on that as well. It’s a drug that helps with liver enzyme levels and can also help alleviate some of the symptoms of pancreatitis. I would have tried giving her Entocort (budesonide) instead of Prednisolone or Flagyl but I didn’t know about that drug at the time. It takes much less processing through the liver and I think it would have been better suited for Alex than prednisolone (although it budesonide has the potential for less side effects it also works very differently than pred and other steorids so it may not work for every kitty). We didn’t have many options back then and these conditions were fairly new in cats. I would have liked to have had something like cerenia or Zofran for the nausea and vomiting but again those weren’t approved for cats yet. All drugs have side effects and she certainly had her share of problems with medications. My poor girl had so many reactions. I wouldn’t have give her B12 or folic acid per the real results of her tests. I’d have given her slippery elm bark orally to help coat her GI tract and calm the nausea. Her diet would have surely been different, all wet food, possibly homecooked if she would have eaten it. It’s hard to look back now and say what I would have or could have done. But the purpose of this is for others to understand how incredibly fast things can change.

Alex was my soul kitty, the love of my life. To this day it’s hard to look back on what happened with her, she deserved a longer life. She was the absolute sweetest kitty I’ve ever met. I hope someday to be reunited with her.

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