Observations: Post Feeding Tube Session 1

Varr helped me administer fluids to Flower via the feeding tube. I was really nervous on this, but I got the food mixed and made sure it was warm. Because I have to mix the meds with two separate portions of food, I had some food ready in the syringe and another portion of food in a bowl. I started with 10 mL of water and then followed with the first portion of food, which was about 15 mL. Flower was pretty calm through most of this; she started to get a little unsettled toward the end of the first portion of food. After this portion was done I had to cap the tube and refill my syringe with the second portion. I administered this, but she was definitely getting more agitated at this point. After the second portion of food, I flushed the tube with just 5 mL of water. Finally, I administerd the amoxicillin via the tube and flushed with the last 10 mL of water. Varr sat with her and pet her while I cleaned up the supplies and she is still resting soundly. Her eyes are finally closed now, they seem to be often stuck in a half open state with an empty gaze straight ahead that is uninterested in the world. Sometimes, like this morning when she was up, I see that she is still full of life. And other times, like now, I wonder how much pain she really is in. Maybe I should just let her go. I hope more than anything right now that this feeding tube works and that she begins to regain some strength and lust for life (and food). I can't tell if she's so somber this evening because of the procedure today, but she just seems sick of everything and so dejected. I want to turn this around for her, but I can't let it take forever; this needs to happen soon, for her sake.

Something for Flower

I would like to give Flower something to help keep her occupied and give her something to focus her attention on. I thought that I might get some fish. She spends so much time looking outside, as so many cats do, and considering that right now we really can't try to play with her much, I think that fish might be a good idea. They could give her something to watch, to give her a focus that might entertain her and stimulate her postively. They are low maintenance, and they're colorful; everybody likes looking at fish, not just Flower. The ones that I liked, however, are little more expensive than I thought. Or rather the fish tank/filter/etc. is more expensive than I thought. Not quite sure what to do here but all I know is I can't just let Flower sit and waste away; I've got to do something to keep her motivated and active.

Status Report: Feeding Tube

Last night Ashley and I tried the Valium/Diazepam without success. Flower hated the medicine and she yelled and jerked away from it. At this point I really feel that I am belying her trust because she can't understand why I'm doing the things I'm doing to her. Especially after today. I spoke with Dr. Ikeda on this morning and given the lack of feeding even with additional medication, he and I decided that the feeding tube would be the best option to give Flower the greatest chance at getting healthy or at least maintaining. The feeding tube allows us to provide her with water, nutrition, and medication without injections or force feeding or forcing pills. Right now I just hope this works.

Ashley and I went to the vet's office to pick up Flower this afternoon and to learn how to administer food via the feeding tube. Although it doesn't seem difficult, it was not something that Flower especially enjoyed. They gave her one feeding before we got there and then demonstrated how with a small amount of food so that we could learn. The food must be mixed with water to make it soupy. About a quarter of a can should fill a volume of 35 mL (and maybe a little extra) when mixed with water. This food is drawn into a syringe to be fed to her via the tube. Another syringe is used for water. We have two medications and a supplement that need to be mixed in with the food. The food should be mixed with warm water so that it does not shock her system when it hits the esophagus and stomach, which can cause vomiting. Ever since we gave her this food earlier, she has been making rather odd sounds: some gurgling in the stomach and intestines, some burping, and some odd breathing sounds (which the doctor said is likely from the tube in her trachea used during the surgery). The most disheartening, however, was when she vomited a small amount this evening. This came right before Ashley and I were to administer her nightly feeding/medication. Afterward she didn't want to stay in my room. She sat in front of Varr's door for nearly 10 minutes and then even went to Ev's door to try to get in. Finally, unsuccessful, she came back to my room and sat in the doorway. I had to pick her up and place her on the bed and she is now sleeping and snoring oddly. I hate to wake her but I have to do the feeding for this evening. I'm waiting, hoping that Varr might come home soon because I'll need some help to make it as easy as possible on Flower.

At the vet's office today, we found out that Flower is becoming anemic. Her red cell volume on a PCV was about 29% yesterday and then 27% today. At the time of the surgery the doctor was pretty worried; having done a PCV with the blood taken while under anesthesia, Flower's red cell volume was at only 14%. But he double checked it after surgery, and returned with the 27% value I just mentioned. Her gums are pale, which is not good. He gave us a supplement (see above) that we will give her with food that contains iron and some other components to help with red cell development.

Status Report: A Second Opinion

Ashley and I met with Dr. Ikeda this morning in order to get a second opinion. I brought Flower and all of the paper work from the previous visits and we sat and talked with the doctor and with the nurse for about an hour and a half about Flower. He was pretty puzzled by her condition also and didn't yet have any clear answers. His assessment was more optimistic, however, than what I've been hearing lately. Her symptom's all point to some kind of gastro-intestinal disorder and he suggested that this be the first place we look. Having already had x-rays done about a week ago, we need to next get an ultrasound done; we just need to decide whether to go to the specialist or have it done at the vet's office. He also suggested a feeding tube for her, which at first I was very reluctant toward. Ashley has mentioned this to me before, but I didn't think it was something to consider in Flower's case. The fact remains, however, that all we know right now is that she won't eat on her own, and that she seems to feel better (although not 100%) after returning from the vet when she has recieved IV fluids and she has eaten. After talking with Mom and with Ashley about it I decided that the feeding tube gives us the best chance to help Flower until we can find out what's going on. The doctor called me back later in the afternoon, however, and told me that Flower had started eating some dry food on her own after only having been on the IV for a short time. He felt that we should wait and see how she'll do on her own with a new prescription of diazepam*. So we'll administer it this evening and again tomorrow evening in the hopes that she'll eat on her own. With so many ups and downs in the last week I'm ready for some answers but it appears that I will have to wait awhile longer to find anything out for sure. Tonight Flower is sleeping again, curled up in a little ball; I've taken off her cone and she has her paw with IV catheter installed draped over her head, not quite sure what to do with it. I'm anxious for Flower to give me the sign that she feels better but for now it seems that she still wants mainly to sleep; I'm always worried when she's sleeping. I want her to wake up and pester me in the kitchen and beg for treats. But she's not quite ready for that. In the meantime I am focused on giving Flower the best chance and on giving her as much of my time as I can afford.

Status Report

Today I started with a positive outlook but had some hard ups and downs during the day. I gave Flower her sub-q fluids and Valium this morning before school and then Ashley came over later and gave Flower her dose of amoxicillin. When I came home this evening Flower still hadn't eaten anything and so I began to worry. Ashley and I played with her for 15 or 20 minutes even though she was barely interested. Finally, I decided to try re-dosing her with cyproheptadine. This did not go well. I tried hard to get her to take the tablet but after 2 or 3 attempts she began to foam at the mouth and finally threw up. Watching her throw up is painful. I don't think that I've seen a cat wretch quite so violently as Flower does. She threw up twice: the first was mostly green and brown and included the little food that she had eaten and then again within a couple minutes, this time mostly yellowish in color. She continued flicking her tongue, and I was worried about letting her go a full 24 hours with virtually no food, so I decided that we should go to urgent care again to try to get some answers and hopefully a little help. Dr. Crook was very nice and she suggested that in order to find what was wrong we would start back at the beginning with testing. Since I already have an appointment to see Dr. Ikeda in the morning, I decided to wait on more testing. I did have them give her some anti-vomiting medication and something to help decrease acidity in her stomach as well as show me how to properly give her the tablets. Jeff was really helpful here and explained how he does it. I can use two fingers behind Flower's head and the thumb and index finger on the upper jaw to hold her mouth open and head back and then use the other hand to pull the lower jaw down and deliver the dosage. Hopefully I can do this more deftly than I have been. He went ahead and gave Flower the dosage of Valium and now we're at home in bed. As I was getting ready for bed, Flower came to find me a couple times and seemed to not want to go to bed without me, which I appreciate. I just hope I can do some good for her. Over the last six months I have worked to build her trust and I don't want to let her down. I want to be able to keep her safe and healthy. She is sleeping now, but I hope that she will wake me up tonight with loud chomping; I left about a third of a can of the A/D food for her and some water.

Also, as a side note, the past 2 days I have recorded about 25 mL of water gone from her bowl by the front window each day. I hope that this is because she is drinking it and not because it is evaporating. I make sure that the water stays out of the sun, but I still wonder.

Observations

Cleaned Flower's littler box this morning. I used bleach this time, which I did not do last time. I was sure to rinse thoroughly using the hose in the back yard. I think I just cleaned her litter box right before school started which would have been about a week before her symptoms began. Flower slept through the night in my room. I tried to play with her this morning, but she was only barely interested. Varr helped me with sub-q fluids and Valium, which is getting easier. She still really hates taking the Valium and flicks her tongue to try to keep it out of her mouth. I set out about a third of a can of Hill's A/D but she hasn't touched it yet. She's sleeping in the sun and spent a little time grooming herself this morning. 

Status Report

This morning I was awoken at 5 AM to the sound of Flower eating out of the food dish that I left at the foot of the bed. The relief that I felt then was tremendous. I didn't get up then; I just went back to sleep and checked in the morning. This was a good change from the day before. I haven't checked her litter today or changed her water yet this evening; I'm anticipating that she hasn't used the water dishes I've been keeping out. The good news is that she was more active today than she has been by Ashley's account. She has been pretty sedentary during the times that I've been home but Ashley said that she was playful this afternoon. I gave her the Valium and amoxicillin this morning (7 AM) and I need to give her the evening dose of amoxicillin for tonight still. She hasn't eaten since I've been home, but I did find some salmon at the pet store that she ate earlier in the afternoon (~4 PM). I also picked up some catnip and some Kitty Kaviar, which she was somewhat responsive to this afternoon, and I tried to play with her again this evening (8:15 PM) but with little success. Only a couple pats and bites. The goal right now is to stimulate her and give her about 30 minutes of playtime everyday or at least the opportunity for at least 30 minutes of playtime. Ashley and I are dividing playtime into 3 sessions of 10 minutes in the morning, afternoon, and evening. With no clinical findings (the urine culture and stool came back today: both negative) we have to assume that she may have simply had a virus or other infection or that she may be depressed or bored. So the meds should help make sure that she's not sick and we will spend the time to make sure that she has something to do during the day. Tomorrow I will also administer sub-q fluids.

This morning when I checked her litter box, there seemed to be about the same amount of both stool and urine as yesterday.

Status Report

Today was a stressful one: for me and for Flower. This morning, Varr helped me administer sub-q fluids to Flower, which, again, she hated. We did manage to get about 50 mL (cc) of fluid in her though. I also tried to get her to take a Valium. She really hates this. I thought I got her to take it but then found it on the couch about an hour later. I had to get her to take another one by myself which was incredibly difficult. I went to class afterward (about 9:30 AM) and left some food out, and when I came home (at about 3:30 PM) she had eaten all of the Hill's A/D and several treats that I left out for her but she seemed very tired and didn't get up from my bed. On my way to class, I stopped by the vet's office and dropped off a stool sample. The urine culture was still in progress but both should be done by tomorrow (Tuesday 1/27). While I was home in between classes I played with Flower until she got tired of it, for a total of about 10 minutes.

Without any clear sign of what is actually wrong with her, I think it might be something as simple as depression. So much of her behavior just seems inexplicable at this point. She eats very little and drinks hardly anything on her own. She sleeps a lot and doesn't follow me around much anymore. She didn't wake me up this morning and she hasn't come to get me at bed time in at least a weak either. It's worth noting that yesterday morning, Sunday, she did wake me up by pawing at my face. I gave her no meds on Sunday other than the amoxicillin.

Tomorrow I intend to pick up some more different types of food. She seems to consistently eat the "gravy" from wet food and does enjoy treats periodically. I'm not sure, but I'm considering that she may have some food allergy. Or simply some other aversion to foods; she has had a gag reflex to some foods for as long as she has been here, but the list of foods to which she gags may be increasing. Today, also, she barely drank any tuna water even though I left it out all morning. I refilled all of her food and water bowls and made sure that were wide and shallow. She has not had any of the water I have been leaving out. Also, I have been trying to use Pedialyte with her instead of tap water.

And just to remind myself: don't forget that she threw up back on Thursday, which you might have forgotten to tell the doctor. The vomit was yellow and frothy.

Sub-q fluids, Valium, food, and 10 minutes of playtime

Status Report

Flower woke me up this morning: a good sign as this is something she has always tended to do with me. I woke up and offered her a very small amount of no-salt-added tuna in plenty of its own water, which she did not eat or drink but only tasted. She did eat some cat treats: the kind from Grandma Mary and some that Ashley just got yesterday. I offered her some of the A/D food several times through the day, warming it up and not warming it up, which she did not eat. She ate some more treats again later from Ashley. We went to the store to get a couple toys for her to try to get her active a little bit and also picked up another kind of food that Ashley recommended. Flower only ate the "gravy" from the food and did not eat any of the solid portion. Also, this evening, after checking her water in the kitchen, I found that she has not had any of it to drink in the past 24 hours. I changed the bowl to a ceramic one, refilled the water with bottled water, and placed a couple small pieces of her dry food in the water in order to facilitate her depth perception. I also replaced her dry food (which I saturated with water), and provided some Pedialyte for her to drink in the living room (also with a couple pieces of dry food added). She began this morning more active than before and last night I scooped a lot of urine out of her litter box, but as the day has progressed, she has become more sedentary. Tomorrow I will administer sub-q fluids in the morning and try giving her a dose of Valium to stimulate her appetite, as well as continue her course of amoxicillin. I go back and forth between being worried and hopeful, but ultimately, Flower simply seems depressed. I don't know how else to characterize her behavior.

Another thought: I offered her food this morning and then, even though she hadn't eaten, I went ahead with her amoxicillin dose. It's possible that this might have upset her stomache in such a way that she didn't feel well for most of the morning or afternoon.

Final comment: I have left a veritable smörgåsbord out for Flower and just now she got up off of the couch to take a look around. She passed by some tuna-water and the Pedialyte I decided to try but she did go for some of the food that Ashley got this afternoon. It appears that she mostly licked off the remaining gravy and I cannot tell whether she actually ate much of the food or not.

Flower's fur is soft and dander-free - I can tell she's been grooming herself. This is different from how she was before. She was flaky and her fur was a little clumpy. Thinking back now, I'm sure she hadn't been grooming herself normally in the past few days. It's nice to have Flower back.

Status Report

I worked most of the day and missed Flower. Toward the end of the day I was pretty anxious, not knowing for sure what was going on with her. I read another blog post last night recommending tuna-water for cats that won't drink. Apparently this is a common problem. Ashely was understandably concerned about giving Flower so much sodium, so I decided to get low-sodium tuna. At the store, on the way home, I picked up tuna-in-water, Pedialyte, and some Gerber veal and lamb. I got ordinary canned tuna at Ralph's but I also went to Trader Joe's to get tuna with no salt added. When I got home Flower was sitting in the window, a normal spot. I came in and opened the no-salt-tuna and poured the watery "juice" from the can. As soon as Flower saw me pick up the can, her eyes opened wide, and when she heard the can opener, she came immediately. I poured the tuna-water into a bowl and placed it in front of her on the floor, with hope but also apprehension. She smelled it momentarily and then lapped the approximately half of the tuna-water down. When she was done drinking, I fed her some tuna from the can, but she ate only a small portion. She laid in my bed for awhile afterward, and then, when she heard me in the kitchen, came to investigate. I gave her some more of Hill's A/D food, and again, she ate only a small portion. But at least she is eating consistently.

Status Report

Ashley helped me administer sub-q fluids this morning. Flower did not like it. I only managed to get a very little amount of fluid in her. She did not like the way that I stuck her and she continued to growl and moan as the fluid went in. I may not have stuck her correctly or in the right place. She drank some chicken broth (that I made from chicken gizzards) last night: about 5 tbsps. And then she drank some more of that this morning. She also ate some of her dry food to which I added water last night. She was slightly more energetic this morning but that might have been simply because she did not like the needle.

Observations

Flower has been sedentary most of this evening. She visited the litter box once immediately after arriving home and probably once more later. I have not checked to see if she urinated or passed stool. Oddly, she sat on the blue couch most of the evening; she even went back there herself when no one was there. She stayed there through the evening until I brought her to bed about 15 minutes ago. She stayed here shortly and then got up and went into the hall: a farily normal habit. She has just gotten up again, suddenly. Although it is not unusual for her to leave my room to go to the bathroom or to sit in the hall for some time, her behavior does not seem to quite fit normal. She scratched at the rug vigorously, another common habit and she gave it a good show of vigor. However, when I picked her up from the couch to bring her to bed earlier, she was extremely docile.

Status Report

I just picked Flower up from the vet. She was anxious and ready to leave I think. Once home she walked around and checked her usually spaces, including her litter box. She smelled her food but ate nothing yet. She was just sitting with me, and she seems tired: like normal at the end of the day. I filled her bowl with 25o mL of water and will wait to see how long it takes her to drink it. The tech showed me how to administer sub-q fluids using a towel in order to prevent Flower from scratching or fighting. The technique is simple; the skin on the back of the neck is pulled away and the needle simply goes in through the folded skin. I should administer 50 cc every other day with otherwise normal fluid intake. I may administer as much as 150 cc if she is not drinking but I should call the vet to check Flower's other symptoms first. I also now have Valium for Flower; I am supposed to give her one-half of a tablet once daily in order to stimulate appetite. I also have amoxyicillin to give her: 1 mL twice daily. This will probably last for the duration of the next week and then some. I hope this works.

Flower, Lateral View

Progress Continues...

I spoke with Dr. Smith from VCA Animal Hospital on the phone after work this morning. She and the doctor from last night still have little conclusive evidence for what is actually wrong with Flower right now. All we seem to know is that she won't drink much on her own. Last night, apparently, she urinated copiously with the IV although I'm not sure whether she ate or not. We also had the veterinarian at the urgent care take x-rays which came up with no significan findings. When I spoke to Dr. Smith this morning Flower still didn't seem to be eating much and so she wanted to try using Valium in order to increase Flower's appetite. I don't know yet if that has happened. The doctor last night began a course of antibiotics that will be continued today at VCA. I may go in today to learn how to administer sub-q fluids to Flower in the event that she not begin eating and drinking again on her own. I asked Dr. Smith several questions today, and from our conversation I learned many things. The A/D food is high in both protein and fat and has antioxidants and is designed to be highly palatable for animals. I may give some low-sodium chicken broth, milk, soy-milk, or lactose-free milk to her to try to keep her drinking if she still does not want to drink water. Milk can be hard on cats intestinally, although there is little difference between the effects of dairy on humans and cats. But it may help Flower get the fluids that she needs. The best way for me to monitor her fluid level is simply from urine output. I asked also if there were some way to assist in grooming other than brushing and the doctor said that that was about it. She had no other recommendations to assist Flower in grooming herself.

Ashley made a good point today; why did we not start her on antibiotics in the first place? I don't recall now whether the vet recommended this in the initial consultation or not. I was definitely confused after receiveing the bill and then trying to go over each item individually, and I just hope that I did not make an error in judgment and decide to postpone antibiotic treatment should it prove effective at this point. Ashley is concerned that the veterinarian may not have presented this initially and that we have gone on a wild-goose chase with so many tests, x-rays, etc.

Hope

I picked Flower up from urgent care about 45 minutes ago and she's doing fantastic. She's lively and energetic and active, although she hasn't groomed herself. She was started on antibiotics last night and will continue them at the vet today. She and I are waiting right now; it's my desire to spend some time with her this morning before leaving her, again, in someone else's care.

Waiting

Flower is now at the Urgent Care Clinic overnight. This is the first night in the past 6 months or so that she has been living with me that she has not slept in my bed. I keep looking down; there's a sweater at the foot of my bed where she might often sleep that I see from the corner of my eye. I think that it's her but then I look and it's not. She's not here right now. After spending so much time in the shelter, I don't think that she has forgotten what that place was. And although I think they were kind and loving to her, I think she must have been lonely. I hope she has not been lonely with me here. There are many days where I am at work or at school or both and I am gone for many hours. Sometimes Varr is here and sometimes not. I just wish I could let her know somehow that they can take care of her and I cannot. I wish she could understand me when I say that I'm coming back for her. But she doesn't know.