Sigmund G.

Sigmund2Sigmund Grab –  Madison, Wisconsin
Male, Siamese Mix
January 1996 – April 3, 2013
Diagnosed with bronchial disease in September 2001
Diagnosed with constipation in January 2002
Diagnosed with megacolon in September 2003
Diagnosed with subtotal colectomy in September 2003
Diagnosed with pancreatitis in August 2008
Diagnosed with IBD in September 2008
Diagnosed with hyperthyroidism, heart murmur, R renal infarct in June 2009
Diagnosed with osteoarthritis in August 2010Sigmund1
Diagnosed with kidney disease in December  2010
Diagnosed with bilateral proliferative mucosal lesions in July 2011
Diagnosed with decreased anal innervation in January 2012
Diagnosed with diabetes mellitus in July 2012
Diagnosed with cranial abdominal mass in August 2012

First Entry, April 5, 2012: I adopted Sigmund from the Humane Society where I had been working in September 2001. He had been adopted and returned again, treated for tapeworms and lung worms. On his first examination he was considered obese at 18 pounds, diagnosed with asthma, and put on theophylline and prednisolone. At the time he was eating Nutro and Purina dry food. In January 2002 he was diagnosed with constipation and started taking lactulose and Metamucil. He continued to have trouble defecating and received frequent enemas in the following months. I mentioned to the vet that I thought he might have megacolon, but was told he did not.

In fall of 2003 I took him to another clinic for a second opinion where he was then diagnosed with megacolon. He was started on cisapride. Siggy had lost almost 2 pounds and was having difficulty passing stool and still needed enemas. The medication was not working and it became very uncomfortable for him. In September 2003 he had a subtotal colectomy. He had a difficult recovery with frequent diarrhea and pain meds making him agitated. A few days after his surgery his incision was open and oozing, and he was put on antibiotics. To this day, he still needs his back end cleaned with baby wipes after each bowel movement. For the next 5 years he had frequent episodes of diarrhea (pale, smelly stools). It was treated with metronidazole and Fortiflora, and he often received up to 200 mls fluids. I changed his diet frequently as nothing seemed to help (Iams Low Residue, Hill’s m/d,  i/d, Wellness, ProPlan). In February 2008 he started B12 injections .5 cc every 2-3 weeks. He continued to have weight loss and diarrhea for the next 6 months and was frequently prescribed Baytril. In August 2008 he was diagnosed with pancreatitis. He was taking tramadol, Orbax and acidophilus supplements. His diarrhea worsened and his prednisolone dose was increased to 5 mg 2x day.

In September 2008 he had an abdominal exploratory with intestinal biopsies and was diagnosed with IBD (I was told his pancreas looked like bubble wrap). He had a difficult and painful recovery. He was treated with Metacam injections and 200-300 mls fluids daily for a week. He started Pancrezyme tablets and tramadol as needed. His diarrhea intensified for a couple months. His medications were: prednisolone 2.5 mg, Pancrezyme 1/2 tablet 3x daily, cisapride 5 mg 3x daily. He was eating mostly prescription food – Iams Low Residue or Hill’s i/d dry and canned. His prednisolone dose was often increased to help firm up his stool.

In January 2009 he was straining to defecate again. He had x-rays and an enema, was prescribed MiraLAX– 1/8 to 1/4 tsp 2x daily, and cisapride was reduced to 2.5 mg 2x daily. His diet was changed to canned Fancy Feast. His megacolon had returned, and he fluctuated between diarrhea and constipation for many months. It was very difficult to figure the correct dose of medications. His stool needed to be kept very soft or he couldn’t pass it on his own.

In June 2009 he had increased appetite and activity level, was losing weight, showing aggressive behavior towards a feline housemate, vomiting, passing small amounts of stool out of the box, and drinking more water. He had an ultrasound, blood work and urinalysis. He was diagnosed with hyperthyroidism and started on methimazole (theophylline was discontinued).

In July 2009 he was again straining to defecate, and had blood and mucus in his stool. His medications were: cisapride, methimazole, MiraLAX, lactulose, prednisolone, Pancrezyme, and B12 injection once monthly. He was eating RC Duck, Venison, and Lamb canned/dry.

In October 2009 he had another dental with extractions. He was eating better, but still smacked his lips, drooled and had GI upset. Four weeks later he had a fecal blockage and another enema. We discontinued the Pancrezyme temporarily as it was making his stool too firm to pass. A couple weeks later he was straining to defecate and had diarrhea. He was given metronidazole and started Cerenia.  Prednisolone was increased to 5 mg daily.

In February 2010, his eyes remained dilated for extended periods and his activity level was increased. Blood work suggested stress.

In August 2010 he was diagnosed with osteoarthritis. He was already taking Dasuquin, but I added a fish oil capsule daily.  In September 2010 I left my part-time job as it had become too stressful with the care required for my animals at home.

In December 2010 we took him to a “cats only” clinic. He was diagnosed with kidney disease and started on potassium gluconate. He had been straining to defecate, nauseous, gassy, and drooling. He had been eating Wellness canned and Evo dry, and his diet was changed to Hill’s i/d. His appetite improved temporarily, but he developed liquid diarrhea and stopped eating. He had a dental with extraction in January 2011. He was given mirtazapine and experienced shaking/tremors throughout most of the night. He was eating but passing small amounts of liquid stool frequently. He was given 100 mls fluids daily at home for the next few months.

In February 2011 he received another enema. He was on buprenorphine for a couple months and he looked drugged up and had no personality. He had inappetance, nausea, drooling, stomach sounds, and his front legs were bowing out.

In March 2011 he received another enema. He was eating some Stella & Chewy’s Freeze Dried Raw and his stools had improved (less odor, formed), but then he couldn’t pass the stool and needed more lactulose.

In July 2011 he had more pain in his front left leg. It trembled and he often couldn’t bear weight on it. He walked with a limp and it was usually bowed out. His weight was down to 12 pounds, his diet was mostly dry Evo, as he had no appetite for canned. He looked like he felt miserable and I wasn’t sure how much longer we could continue. I didn’t want to give up on him, so his vet said we could try gabapentin. This greatly helped to alleviate his arthritic pain. He continued to drool and was put on Clavamox. He lost his appetite, so the antibiotics were discontinued. He was referred to the UW Veterinary School to have his mouth examined. He had bilateral proliferative mucosal lesions in the lower buccal cavities. They were removed and biopsied (no cancer). His two upper back teeth were ground down as they had been poking into his lower jaw and causing the lesions to worsen (thus the drooling). Siggy was now considered pre-diabetic. We had been testing him at home and it had become quite stressful. We tried to wean him off prednisolone. Shortly thereafter he experienced diarrhea for 11 days, defecating up to 8 times a day with straining. He was getting 100 mls fluids at home daily. He was eating Natural Balance Chicken LID. He was given Zeniquin and prednisolone was increased and he improved. We had blood work done and his PLI was off the charts at 10.8 (normal .1 – 3.5). At this point I knew he was very sick and there probably wasn’t
much else we could do.

November 2011: another flare-up of pancreatitis. He looked painful and unwell. His gabapentin dose was increased to .25 mg 3x day, and we discontinued buprenorphine. We tried Viokase-V powder and he wouldn’t eat his food (and I had a severe allergic reaction to it and had to wear a filtered mask). I syringed it down him for a few days and he became constipated. The gabapentin dose was lowered to 2x day after a week because he was lethargic and not eating.

In January 2012 he was straining to defecate and had no appetite. I am now able to recognize the signs of not eating being associated with him being backed up with stool. We took him to the vet for another enema. It was suggested we give them at home in the future.  Four weeks later we give him an at-home enema; he vomited, had bloody stool, and became fecal incontinent. I called the vet and was told to confine him overnight and see how he was in the morning. I was concerned we had injured him administering the enema. The next morning he still had stool oozing from his rectum. He was examined and diagnosed with decreased anal innervation and was given metronidazole. He became urinary incontinent after we got home from the appointment. He improved after a few days, but continues to have fecal matter leak from his rectum when he fills up.

In spring of 2012, Siggy still enjoys carrying his wand toy up two flights of stairs, meowing the whole way. He demands lap time and loves to purr. However, he sleeps more and his legs won’t allow him to stand for very long. At night he is usually confined so he can have food available, and because of hygiene issues. His medications are adjusted daily, depending on his appetite and bowel movements.  Daily fluids, B12 injections, Cerenia, and the supplements I’ve added in the last couple years are giving him more quality time. I put multiple medications in capsules to reduce pilling and he’s always offered a treat afterward. I buy his long-term medications online, as it saves time and money. His main diet is By Nature, Evangers, Merrick, Evo canned, and Orijen dry. I would prefer not to feed him dry, however, with his inappetance it’s helping to keep weight on him. He has improved stools and less stomach rumbling on a grain-free diet. He is fed every 3 – 4 hours throughout the day, with enzymes, probiotics, and laxatives added as needed. His appetite fluctuates from not wanting to eat, to being ravenous and eating 6 oz or more of food if offered. Here is Sigmund’s medication schedule as of April 2012.

6:30 AM
methimazole 5 mg – 1/4 tablet
potassium gluconate 595 mg – 1/2 tablet
cisapride – 5 mg capsule
L-lysine – 400 mg

10:00 AM
gabapentin – 40 mg capsule
omega-3 fish oil capsule

3:00 PM
cisapride – 5 mg capsule (if needed)

6:00 PM
methimazole  5 mg – 1/2 tablet
potassium gluconate 595 mg – 1/2 tablet
prednisolone – 5 mg – 1/2 tablet
famotadine 10 mg – 1/4 tablet
Dasuquin – 1 capsule

10:00 PM
gabapentin – 40 mg capsule
cisapride – 5 mg capsule
lactulose – 1-2 cc (if needed)

SQ fluids as needed (usually 100-150 mls)
B12 inj. .25 – .5 cc every other week or as needed
Cerenia – 16 mg – 1/4 to 1/2 tablet as needed
probitics-enzymes/slippery elm/psyllium – as needed

May 31, 2012: I decided to try laser therapy to see if it would help with Siggy’s arthritis. It was offered at the cats only clinic only, so we switched his care back to them. Labs were normal except three elevated liver enzymes, one possibly due to his severe dental disease.  His kidney values improved, possibly due to his fluid therapy. It was suggested to do an echocardiogram before putting him under anesthesia, but I didn’t want to put him through another procedure and didn’t want him living with a painful mouth in addition to all his other issues. His heart murmur was grade 2-3, he was examined by another vet at the clinic and given the okay for the dental. On his next two visits, the heart murmur was nonexistent. Siggy had one tooth extracted and his recovery went well. I asked them to not give him ketamine, as he reacts adversely to it.  The area where the tooth was extracted was lasered to promote healing. He was on buprenorphine for three days after the dental, which caused a decrease in his appetite. Siggy did well for the first week after the procedure. He had received four laser treatments and was walking around more comfortably and jumping up onto things. He was also passing stool more easily. The following week his energy level was low and he spent more time resting. His appetite decreased and he drooled for a few days. At his post-op appointment his mouth was completely healed and the sutures had dissolved. He lost 7 oz. in 19 days. I was instructed to give Cerenia daily for 2 weeks to help with nausea. I decreased Dasuquin to once daily, instead of 2x daily. It was the only change in medication and I want to make sure it’s not causing the increased nausea. In the last 20 days Siggy had six treatments of laser therapy on multiple sites. It was applied to his left and right elbows, left and right knees and hips, and spine. He was a very good patient for all his treatments and procedures, and never needed restraint.  In a month we will evaluate to see if we will continue the laser therapy 1-2 times a month. He still appreciates daily lap time and petting, but I’m becoming more concerned as his lethargy continues.

July 10, 2012: On June 20, Siggy was lying outdoors and enjoying himself. When he attempted to get up he was unable to use his back legs.  I gave him fluids and a B12 injection, his blood glucose level was 267. I called his vet clinic, both his vets were unavailable but we brought him in to be examined by a fill-in vet. By the time we arrived he was able to stand and walk. He was examined and said to have proprioception deficit in the hind legs (knuckling his feet under). His heart sounded normal and his femoral pulses were strong and synchronous. No known cause was determined for the episode. His appetite has been low so I’ve expanded his diet to include some food with grains. He has had pale colored loose stools, with an occasional formed stool, for a couple weeks. I’ve tried pilling Viokase before meals, adding more enzymes and probiotics, but nothing seems to make much difference. I stopped giving propulsid for 10 days, but have started it again as he is having trouble defecating if the stool has any shape. Siggy is getting weaker and continues to have more difficulty walking, lying down, and standing. He is still able to jump up on the couch for lap time and attention, and also carries his wand toy upstairs while meowing. I’ve been in contact with his vet and she recommends having another exam and checking some blood values. I’ve decided to raise his gabapentin to 40 mg. every 8 hours to see if he improves.

August 13, 2012: Sigmund was drinking a lot of water, walking on his hocks, and had diarrhea for a month. He looked tired and couldn’t walk very far without resting. He lost another pound in the last month and weighed 11 lb. 5 oz. I took him to the vet and the following labs were performed: fecal cytology, PCV/TP, hepatic panel, and blood glucose. His glucose was 354, and his liver enzymes were elevated (ALT 813 – normal 26-128). Siggy was considered diabetic and was started on 1 unit of Lantus insulin twice daily. He had been eating Natural Balance Chicken dry and Evo 95% Chicken and Turkey canned. He was switched to Royal Canin Intestinal HE and his vet encouraged me to feed him as much dry food as possible as this would help firm up his stool. I was concerned about feeding him more dry food because he was diabetic. However, I had exhausted all my canned/dry food options. I increased his B12 injection to 1cc/week and added oral Zobaline – 3 mg methylcobalamin. Dasuquin was increased to twice daily because his joints were making a creaking sound when he walked. He readily ate the Intestinal HE, his stools improved, and he was able to walk better. We were given the wrong supplies for his insulin and were injecting him with a pen, and had difficulty making sure he got his insulin. After speaking with a technician we started giving the insulin with a syringe and needle, which was much easier. Siggy lost another 1/2 pound after being on insulin for two weeks and his diarrhea and low appetite had returned. We did two curves in a week and his glucose was stabilizing. It was recommended to do another curve in 5-7 days, but I decide to spot check him occasionally, as he doesn’t appreciate having his ear poked repeatedly
throughout the day.

On August 9, Siggy had an ultrasound. A large cranial abdominal mass was seen (36 x 40 mm). Fine needle aspirates were taken – the fluid was blood tinged, cloudy, with clumps, and foul smelling. Siggy was given two antibiotic injections – clindamycin and a long acting penicillin. It was a stressful day for Siggy as there was a scheduling conflict with the doctors so the procedure was postponed until later in the day. He went a long time without food and was ravenous when he got home. He still had low blood sugar that evening after two small meals. The next day he looked depressed and tired. At the vet’s request, I gave him .35 ml buprenorphine. I wondered if putting him through this was worth it, but I wanted to know if there was anything else we could do to help him. The fluid was sent to the veterinary school for pathology. It was found to have large numbers of mixed bacteria, with a mixture of rods and cocci. It was said to have marked septic neutrophilic inflammation (consistent with an abscess). His vet suggested laparoscopy or exploratory surgery at a specialty hospital to further assess the issue. Siggy was started on clindamycin 25 mg/2x day for two weeks. Two days after the procedure Siggy’s appetite is great, he is more alert, and his stools are improved. His activity level is excellent and he is grooming himself. I’m assuming the antibiotics are helping him. His glucose levels are fluctuating a lot, and I frequently test before giving insulin.  His main diet is Evo 95% Chicken and Turkey canned, supplemented with Royal Canin Intestinal HE. I also feed him Freshpet Vital, as this seems to help firm up his stools. I will enjoy Siggy while he is doing well, as I know it may be short lived.

September 8, 2012: I took Siggy back to his regular vet to have an ultrasound to evaluate his mass. The abscess was smaller but still present (1.5 x 2.5 cm). The abscess may have developed secondary to bacterial pancreatitis or a tumor. The serosal layer of the duodenum is missing consistent with the tumor or abscess invading or causing inflammation in the adjacent duodenum. Since Sigmund does not have a fever, and bacteria were confirmed to be present in the abscess, the pus is likely walled off with a lot of scar tissue. While this protects the rest of the abdomen, it also makes it difficult to get antibiotics to the bacteria and resolve the infection. There is significant risk of the abscess rupturing or the inflammation causing progressive damage to the duodenum and surrounding tissue. Sigmund showed a dramatic response to treatment with clindamycin. Clindamycin is typically used to treat anaerobic infections. Anaerobic bacteria tend to produce gas.  Rod shaped bacteria were also seen on cytology. This is suggestive of a gram negative infection, which would likely respond better to a combination of clindamycin and marbofloxacin. Surgery is generally recommended to remove intra-abdominal abscesses. This type of surgery carries a lot of risk of bacterial contamination of the abdomen and intra-operative or post-operative septic shock. It is possible that a section of the duodenum would also need to be re-sected. Depending on the location of the abscess, the common bile duct may need to be rerouted which is a difficult procedure. Sigmund is debilitated increasing his risk of intra-operative and post-operative complication or death. We decided to treat him with oral antibiotics and monitor his response by ultrasounding the abscess every 2-3 weeks, for 12 weeks or possibly longer. Sigmund was started on clindamycin 75 mg – 1/2 tablet 2x daily and Zenequin 25 mg 1x daily. His insulin was lowered to 3/4 unit twice daily as he is having episodes of hypoglycemia.

December 14, 2012: Sigmund had diarrhea for a few weeks. None of the previous medications or remedies had any effect on him. He was eating mostly canned Natural Planet Organics chicken or turkey. It was very difficult to keep him clean, as the stool pooled around his feet and he was also unstable. He was getting 1-3 baths a day, and although he didn’t put up much of a fight, this was very uncomfortable for him. I started putting dog pee pads over his heated bed and this is much easier, as I don’t have to wash his bedding multiple times a day. Since medication wasn’t working, I decided to change his diet. I started feeding him Stella & Chewy’s freeze-dried raw duck or turkey. I mixed it with a small amount of warm water and he readily ate it. Within one day he had formed, less odorous stool. Siggy’s left back leg had become very swollen at the joint. At times he would kick his leg repeatedly. He was still making daily trips up the stairs, but was becoming more sedentary as the days went by. I didn’t think this was going to get better and questioned his quality of life. I took Siggy to his vet for an exam. He weighed 11 pounds, 11.5 ounces (3 oz. loss since his last visit). He had a proliferative mucosal lesion in his left lower cheek (suspected recurrence) and cataracts in both eyes. His elbows were arthritic and his left hock was very swollen from fluid in the joint, and the right hock may be very slightly affected. His abdomen felt normal, and the pancreatic mass that was previously present was not palpable. He also had chronic intervertebral disk disease L4 – L6, L7 – S1 (noted from previous x-rays).

Possible causes for Sigmund’s joint swelling include progressive osteoarthritis, immune-mediated arthritis, infectious arthritis (Calicivirus, feline syncytium forming virus, bacterial, L-form bacterial, mycoplasma, rickettsial, fungal, and Lyme disease), and cancer. In addition to getting 40 mg gabapentin 3x daily, we add tramadol 50 mg, 1/8 – 1/4 tablet every 8 – 24 hours. If the swelling persists, and he seems uncomfortable, his vet recommends taking x-rays and aspirating it. She would make those procedures brief to minimize his stress. She assured me he was alright, and I didn’t need to euthanize him for this, as long as he continues to receive pain medication. I gave Siggy 1/4 tablet tramadol, and he became very anxious and his pupils remained dilated for more than 12 hours.  He did not pass any urine or stool for the entire day, which is uncommon for him. If I give it again I will try 1/16 tablet. I was also told we can increase his gabapentin up to 100 mg if necessary.  I will try giving him canned food for two of his five daily meals, as the raw food improved his stool so much that he’s having troubledefecating because of his megacolon.

April 3, 2013: Sigmund’s left hock had remained very swollen. I took him to the vet to have it drained, but was told it probably would not help. He was wobbly on his feet and sometimes lost his balance, especially while using the litter box.  It was difficult for him to lie down and stand up. He had been eating mostly raw food and his stools were the best they had ever been. He ate three times as much as my healthy cats did, just to maintain his weight. Siggy had a strange habit of circling. He looked sound asleep and would suddenly stand up and while in the same spot walk in a circle. After about 30 seconds he turned around and circled in the other direction. He usually ended up tripping over his tail or legs. He did the same thing in the litter box before using it. This was an unlikely thing for him to do considering his legs were so sore. He had been doing it for years and neither his vet nor I had any explanation.

On March 25, I put my cat Dexter to sleep. The two boys had been sharing a room when they ate and were together at night. The first time I put him in the room without Dexter, he wanted out. That night he barely touched his food and the litter boxes had not been used. He looked very depressed and as the day progressed, he refused to eat. I left Dexter’s empty bed next to his; he stepped in and sniffed it, and climbed out. I had to get him to eat, because he’s diabetic and on insulin. Later in the afternoon I offered him some dry food and he finally ate that. He then climbed up three flights of stairs to the third level and went into the room where Dexter spent his last moments. He sniffed the floor and looked under the bed and in the closet, and returned to the main level. Siggy had not climbed the stairs to the third floor in many months and never did again. I knew he was looking for his buddy. He was very clingy and sat on my lap every chance he got.

On March 30, Siggy remained very depressed and withdrawn. His appetite and activity level were low. He occasionally had a burst of energy and looked like he felt better, but it never lasted long. He didn’t like being cleaned up after using the litter box and started defecating behind the couch. He was smart enough to know that if I couldn’t see him I wouldn’t scoop him up and give him a bath. He didn’t have muscle control of his tail and it would often get covered in urine, feces, and litter. My attempts to keep him clean had become a dreaded job for both of us, as I felt it caused him pain. Siggy’s appetite continued to decline and he remained depressed. On April 3, my husband and I spent the morning saying our goodbyes to our sweet boy. The vet and tech came over to end his suffering. He was in his favorite sunspot, surrounded by love. He will be forever in our hearts.

I thank Lisa for all her hard work in keeping this wonderful website updated. It was very helpful in my care of Sigmund and Dexter in their last year.

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