Older FIV cat, new concerns

Hi all,

I am new here to the site but, have visited here frequently for answers.  After going through various threads on here and other sites, I have almost become overwhelmed with information and need some more direct help.  

I have a 16 year old boy named Sully that was diagnosed 9 years ago with FIV.  He wasn't showing symptoms at the time; I just had heard about the disease for the first time and wanted to test all my little ones.  He was the only one that came back positive.  He's been mostly healthy for the last nine years, with only occasional bumps that were easily managed by vet trips.  This last winter, he started to catch more viruses than in the past and finally, in early spring, he became lethargic, lost weight but was still eating okay.  After a round of antibiotics, he did okay for a couple of weeks and then fell ill again to the point that he wasn't eating very well.  When blood work was completed, his numbers were all bad.  Practically nonexistent white count, irregular neutrophils and a PVC red count at only 9.  Wasn't sure he was going to make it through but, after only 6 weeks on Aranesp and a couple of iron shots, his red blood cell count was up to 41 and he was doing much better.  Since then, he has had periods of up and down.  He has been having stomach problems; not eating, along with straining to go to the bathroom that resulted in small stools with diarrhea and tinged with mucus.  The vet thought he might be suffering from colitis and gave him a shot of depo medrol and metronidazole.  I have also been giving him lactoferrin and acidophilus.  That worked for about 3 weeks.  Then, last week he began straining again and not producing hardly anything at all.  Again, he stopped eating.  We thought maybe he was constipated so, I spent the last week giving him various things to try to loosen up his stools.  I also was forcing nutracal down him because he would eat absolutely nothing.  In addition, he wouldn't drink water so I took him in three times to be given fluids.  Last Friday, I took him in and the vet noticed that his anal gland was impacted.  He cleaned that out and thought maybe that was the problem but, still no change.  Yesterday, I spoke to the vet and we decided to try the steroid shot again.  Gave that to him and finally, he has been taking a small interest in food.  Started with a spoonful of baby food and is now eating a little bit of canned tuna (low sodium).  It's the only thing that I have found that he will eat.  

My concern is that Sully has already lost so much weight by not eating the last week and from the periods of not eating in the last few months.  From reading the different threads and other sites, I wonder if he has IBD or lymphoma and if so, what the best course of treatment would be?  The vet in my small town is very caring but, we are a small farming community and that is their specialty.  That added to the fact that Sully is one of the oldest cats that they have seen in their office plus, he has FIV and it has always just been trial and error on how to treat him.  I also need to figure out what to feed him, that he will eat and that will not irritate his stomach even more.  He is an extremely picky eater.  I have been feeding him and his siblings Fancy Feast, but they also have Science Diet (dry form) down during the day.  I know that dry is not the best and most of the time, they eat the wet.  Sully has not shown an interest in either since he started eating again.  He is a tough old guy and just when we thought that this might be his time, he has always rallied.  But, I'm not sure if he can pull out of this one or not.  Even so, I'm not willing to give up on him until he shows me that his fighting is done.  Any suggestions would be greatly appreciated.

sulcal said:

 
Hi all,

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Hi and thanks for sharing.

This is a direct quote from basically all my vet colleagues "No cat should die without the benefits of steroids".  It has strong anti inflammatory properties and when we don't know exactly what is wrong, it can really help and it sounds like the steroid shot helped a bit.  I would ask my vet to consider putting your cat on a daily dose of steroids like Prednisolone (oral) or Dexamethasone (sub Q injection).  This may be a hail mary pass but imo its worth a try.  FYI, steroids is a primary treatment for IBD and small cell lymphoma.  An ultrasound may also be helpful if they have the ability to give him one.

I would also offer any type of food he may enjoy, anything  he will eat.  Human baby food.  Tuna (as you have tried) and most especially Hill's A/D, a prescription food that is extra tempting for cats and is packed with calories, fish oil etc.

And then i would watch your cat, and respect his approach to what may be the end of his life.  I wouldn't force feed him.  ANd if you can't tempt him to eat at all, before his organs all shut down i would consider letting him go.

Talk to your vet about daily steroids.

Thanks for your response Stephen.  The vet gave him DepoMedral two days ago.  Is that a lot different, as far as effects go, than the prednisone?  Also, do you happen to know if there is a waiting period between giving a steroid like Depo and prednisone?  The last time he received the Depo shot, he was really good for about 3 weeks.  Unfortunately, this time around, he has been eating some but, not to the same extent after the first round. 

sulcal said:

 
Thanks for your response Stephen.  The vet gave him DepoMedral two days ago.  Is that a lot different, as far as effects go, than the prednisone?  Also, do you happen to know if there is a waiting period between giving a steroid like Depo and prednisone?  The last time he received the Depo shot, he was really good for about 3 weeks.  Unfortunately, this time around, he has been eating some but, not to the same extent after the first round. 

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I don't really know the answer but cats who really need steroids usually get them daily.  Discuss with your vet.

I have been caring for FIV+ cats for awhile. I applaud Sully for staying healthy for so long it really is a great thing!! Unfortunately around this age the FIV can catch up with them. Over the years, the 5 I have lost, have succumbed to some sort of abdominal cancer. I wish I could tell you Sully's story is not sounding familiar but Sully sounds like a fighter so help him fight for as long as he can. At this point it's a matter of getting him to eat anything, have you tried the shredded versions of any of the can food? Friskies has worked in the past for my Kittys who have gone through this rough patch.

hexiesfriend said:

I have been caring for FIV+ cats for awhile. I applaud Sully for staying healthy for so long it really is a great thing!! Unfortunately around this age the FIV can catch up with them. Over the years, the 5 I have lost, have succumbed to some sort of abdominal cancer. I wish I could tell you Sully's story is not sounding familiar but Sully sounds like a fighter so help him fight for as long as he can. At this point it's a matter of getting him to eat anything, have you tried the shredded versions of any of the can food? Friskies has worked in the past for my Kittys who have gone through this rough patch.

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Hi hexiesfriend.  Thanks for sharing your information.  Cancer has definitely gone through my head as a real possibility.  Did you go the route of treating for IBD for awhile?

I gave Sully the Depo shot 5 days ago and it has worked for a few days.  He slowly started eating more of the same things he was eating before.  But, now this morning, I can tell he isn't feeling well and even though he came into the kitchen and looked like he wanted what I put down, he ended up not eating it.  I talked to the vet last night about getting him some Prednisone and treating him for IBD to see how that goes.  He agreed that the IBD route would be a good way to go.  He said that I could either do pills or a shot.  I am kind of concerned though because the way he talked, the shot would probably only be once or twice a month.  He said that if he needed a shot more than a week apart, that nothing would work.  From what I have been reading, steroids for IBD or lymphoma are given on a daily basis, like StephenQ stated.  

Well, I am kind of frustrated right now.  I talked to my vet again and he said that he couldn't give Sully Prednisone for at least 2 weeks since he just had a shot of the Depo 5 days ago.  His Depo shot was 1CC.  I am not sure if that that amount would be enough to normally treat the symptoms of a cat with IBD for a month or if his condition is such that whatever I give him isn't going to work.  

I just wish we had a small animal specialist closer by so I know what is realistic as far as treatment goes.  

I'm sorry if never treated any of mine for IBD I which I can provide some help on that subject. Is sully having digestive issues?

hexiesfriend, yes he has been having digestive issues.  For the past few months he strains a lot when going to the bathroom.  Most of the time, not much comes out and when it does, it is generally very loose or even just diarrhea.  We went back and forth trying to decide if he had diarrhea or was constipated or blocked.  Poor guy strains so hard and has been so weak from not eating at various times that he almost can't stay standing while he tries to go to the bathroom sometimes.  I thought it was probably diarrhea, given the fact that he has had so many different antibiotics over the last 4 months.  He goes in and out during the day, and I have to go to work, so it is difficult to always tell.  When the vet gave him a Depo shot last month, it seemed to help quite a bit but, it only lasted a few weeks.  

I still haven't heard back from the vet as far as getting him started sooner on prednisone.  But, I did get him some s. boulardii and gave him a dose yesterday afternoon. He hadn't eaten anything all day and just laid around and slept, showing no interest in food or water.  After some time of giving him the probiotic, he ate some food and went outside for the rest of the evening.  Then, he ate again this morning and even went outside, found a mouse, killed it and ate some of it .  I don't know if it was the boulardii or if he just was feeling better but, it was nice to see him eating something, even if it was a mouse.  Hopefully, this lasts until I am able to get him started on the predisone.  

Well that's good news that he has interest in average cat activities....

After being on predisolone for 8 days, my cat is still losing quite a bit of weight, becoming more lethargic,  and only producing small liquid drips in his stools.  He eats small bits here and there but, I have had to supplement his food with Nutri-cal to ensure he is getting what he needs.  I took him to the vet today to see what they thought regarding his diagnosis.  He never has been confirmed to have IBD or lymphoma but, symptoms point that direction.  I have been trying to decide if it is time to just let him go.  He is 16 and has FIV, in addition to this new problem.  They gave him fluids and some pain medicine and apparently, he ate quite a bit of food while there, which is encouraging.  As far as a diagnosis on his weight loss, the vet basically told me that his weight loss is just a symptom of his old age, which I do not agree with.  Just not real confident in what I am being told.

 I also have been researching on here and on the ibdkitty website and see that many vets prescribe 5 mg of predisolone twice a day for 2 weeks and then once a day for a week or more and then every other day.  My vet is using the routine of 5 mg twice a day for the first 5 days, then 5 mg once a day for 5 days and then every other day, 5 mg.  I do not think that is high enough but, not sure how I have that conversation with my vet without them thinking that I know more than they do.  The ibdkitty website states that one of the biggest mistakes made with steroids in treating IBD is that the dose is not strong enough at the beginning to combat the disease.

Also, I've been researching a diet for him and I see that many look at a raw diet but, with his FIV status, I do not think that is the best route to go.  Plus, I don't think I would be able to do that long term with my schedule.  Does anyone have suggestions on a diet for an FIV kitty, with possible IBD/lymphoma? I am currently feeding him Fancy Feast wet and just bought Nature's Variety in dry.   

I think at this point give him whatever he will eat and don't worry too much. I tried several canned foods before it looked like Friskies shredded was what mine ate the most of. I'd but several small cans and see what he'll eat the most of. I'm sorry you are having to go through this. This unfortunately sounds familiar but my FIV+ cat Tom lived about 4months in this stage. He did have watery stools as well coupled with constipation at times. He stuck in there still being alert for all that time until one day I woke up and almost overnight he lost his tomcat jowls, from his body being tasked. He was a tomcat that adopted me and my home Though he was loving and let me pet and snuggle he never let me pick him up to take him to the vet. So I just provided love and supportive care until he was so sick he didn't put up a fight with me by that time it was too late. Having gone through this with the other FIV cats I have had we just enjoyed what time was left. I couldn't pull him or give him any meds anyway. He died of a liver tumor in all likelihood. I'm not saying this is the same with your kitty now but I think you need some answers. You probably want to take your kitty to another vet or a cat specialist for a second opinion just so you are comfortable with the care instructions you are give and diagnosis. Vets don't take any offense. Any recent blood tests X-rays or ultrasounds? An ultrasound will tell you if there is a tumor so at least you know...,

Sorry about your kitty hexiesfriend.  It's hard to lose them.  I lost one of my cats about 2 years ago.  He was 16 and it was not easy. 

I had blood work done twice, in June and then again in July.  That's when they found that his red blood cell count had almost bottomed out.  Came back up to normal after 6 weeks with Aranesp.  White blood cell count was low but, that was to be expected with his FIV status.  Kidney's and liver results were good at both tests.  I thought they might do bloodwork today but, didn't.  Just the fluids, pain meds and food.  I have thought about a second opinion but, I live in a small town and would have to travel with him for quite a bit to get another opinion.  When I took him today, I was really just needing an answer whether or not it they thought it we had gone as far as we could with him.  He did seem to feel much better when he came home.  I'm trying to stay rational in my decisions and not be too selfish (definitely not an easy task to do).  But, I also want to be able to be doing what ever is practical and expected with his case.  I guess I am just not certain that that is being done when I think his predisolone dosage is too low.  We have not done an ultrasound and I doubt that the vet would suggest it as they still think some of his symptoms is from old age.  Plus, I'm not sure they even have the capabilities of doing an ultrasound...just x-rays.

I will have to look into the Friskies.  Believe me, I put down numerous items for him to eat to try and encourage his appetite, lol.  Sometimes my kitchen looks like a dinner plate war zone because there are so many plates covering the floor from different kinds of foods.  

Thank you for your response and suggestions.

Hi SulCal.I'm sorry your baby is struggling.Itis true dosage of pred for small cell as per the lymphoma group is 10mg per day as per my Internist's advice..It did help my boy who was not FIV  positive  but went off food and was diagnosed with small cell. Syringe fed him for 3 months & then he began on his own.He continued to eat over 200 calories per day for the last 9 months of his life.Do you belong to an FIV group? I know of an excellent smaller group.Very compassionate & knows pretty much everything.here is the link.pls join.Joel the owner is a super knowledgeable man & every one is so caring.Hugs to your babe.Chin up.

https://groups.yahoo.com/group/fiv-healthscience  hth C.

sulcal said:

 

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I feel your pain as I had a cat and my best friend finally succumb to complications (mast cell cancer) to severe IBD.  I work with vets and they love to say "No cat should be allowed to die without the benefit of steroids"

I agree your dose may be low, especially since its not working.  It may be a hail mary pass, but in this case at this stage in your cat's life, you have nothing to loose and everything to gain with a higher dose.  For your vets to do just fluids, pain meds and food sounds to me like hospice style supportive care until you decide its time to let him go.  I think they have given up.  In truth, clinically they may be correct, but i don't see any harm at this point in going to 10mg a day on the Pred, and i would simply discuss this with your vet, show the research and ask them basically "why not?" since the alternative seems to be a progression towards death.

Your cat has had a long happy life, and you cared for an FIV cat, and extra blessing on you.  It is very very hard to find the perfect time to euthanize, i believe the reality is people either do it a little early, or a little late (sometimes sadly a lot late).  Let him end his life with dignity. Give yourself memories that you will hold for the rest of your life that will comfort you, not haunt you.

Sully only knows today.  He can't project into the future.  So if today is bad, then life is bad, and unless we think we can give him a future that is better than today, then it may be time.  Yes, try the hail mary pass (higher pred with vet's consultation) consider a second opinion if you wish, but i would start prepping for the day that is coming.  You can even ask your vet a direct question, "Is it time to let him go"?  Vets are trained to say things like "I believe it is perfectly correct for you to euthanize him at this time, without guilt" when they believe it is time, and if they think its isn't time, that there are still things to try, they will offer an alternative.  I suspect your vets think its time.

You're vets protocol of tapering Pred in this instance does not seem to be correct and i would personally only do that if the cat at least first responded to the higher dose.

As to food, i agree with hexiesfriend.  Earlier in the disease you might have had some success with novel proteins, special diets etc but i think you're past that point. So i agree, whatever he will eat.  A very good food that is FILLED with nutrients and that many cats can't resist is a prescription food called Hill's A/D.

Having said all of this, it sounds like his only chance is to get him into some type of remission so that he can start absorbing nutrients again and i don't see that happening without Pred or Leukeran although it may be too late for Leukeran and may be ill advised at this point.

Vibes.

Thank you all for you replies.  It is so nice to be able to have someone to bounce ideas off of and receive support from with this situation.  

MomofMaxwell ~ thank you for that Yahoo link.  I will definitely check it out.  I am glad to hear that the increased dosage helped your kitten.  Even though he wasn't FIV positive, it is nice to see that something worked for someone and gave you more time with him.  It is definitely a hard situation to be in and it is so easy to be greedy with our pets by trying to keep them here longer than their time.  If only they could let us know what they want us to do. 

StephenQ~ Your post had a great deal of valuable information.  Your comment about the increased prednisone being a hail mary is exactly the way I think of it.  For me, this is his last shot and he has nothing to lose by increasing to what I would view as normal protocol in this situation; he only can gain.  If it works, even for a while, at least I know that I tried everything within reason.  Making that dreaded call has weighed on my mind for the last couple of weeks.  I was close to being there on Monday, but then when he got back from the vet yesterday, he seemed like he felt quite a bit better.  Makes one second guess oneself.  I do want my vet's opinion on it but, I also am not real confident in that opinion.  They're good people but, they're also used to treating farm animals and while they definitely care, I do not get the impression that they are used to going beyond what they believe is the "norm" regarding these situations.  I have worked with them long enough though that I believe if I asked to increase the dosage, they would be okay with it.  So, when I am able to get a hold of them, I will definitely be asking.  

Question, I'm not as familiar with this disease but, is it common to have to have fluids given frequently? Just wondering if it is something I need to watch for as it seems like he felt so much better after receiving them yesterday.  

sulcal said:

 
Question, I'm not as familiar with this disease but, is it common to have to have fluids given frequently? Just wondering if it is something I need to watch for as it seems like he felt so much better after receiving them yesterday.  

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Hi there

Severe IBD which is an inflammatory disease can progress into a multi organ inflammatory disease called trai-ditis (3 organs inflamed) and usually involves the pancreas.  Fluids given sub q can help relieve a lot of symptoms, as well as hydrate our cat.  It might not be a bad idea to test him for pancreatitis, the best test being Pancreatic Lipase Immunoreactivity (see http://www.2ndchance.info/pancreatitiscat.htm) and i would also consider an ultrasound.

Fluids generally given at this stage in life can help a lot.  You may want to talk to your vet about giving them at home on a frequent basis.

Hi sulcal.You hit the nail in the head.Fluid therapy.Myy Maxwell was on vit B12 monthly and when his condition worsened it became weekly.Cyanocolbalamin..25cc injected with a 25 guage diabetic needle.I boutht them by the box.Cheap.Cyanocobalamin from your vet around $20.00 for a bottle that will last you a 100 yrs.I only dealt with an Internist as i went through so many vets in my life.Her expertise was far superior to any vet i had ever met in over 30 yrs.If your boy is dehydrated he will feel like hell.If he is inappetant and is not getting the required calories per day ,dehydartion kicks in big time.Also you mentioned pain.At his age he will undoubtedly have some pain whether it be arthritic which vets are seeing kitties as young as 7 yrs old with arthritis.All these matters need to be addressed.I also now use a farm vet for my ferals.I TNR & have 68 in two colonies.He spays & neuters them & general health issues as he observes them while under.I would never had taken my Maxwell to him.That being said pred is nothing to play around with either.I really wish you would join joels fiv group.`Very compassionate & just a hard to find group who can relate to any FIV plus of course they deal with other kitty ailments too.His appetite can be addressed.Pain can cause inappetance & without a pain killer you wouldn't know if it would help or not.Fluid therapy at home I did for maxwell for 6 yrs nightly.Not for his small cell but he had mega Colon.You can google it.It was only for hydrating his bowels only.The vit b12 because he was also a CKD kitty with dilute urine ,Vit b's get peed out as they are a water soluble vitamin.Replenishing them in subq fluid therapy helped his appetite as well as B's are huge for everything else.Any excess gets excreted out so you don't over dose them.But I went by instructions of the specialist to a T.He was only on 60mls of LRS fluids nightly.You could talk to your vet about it.Ask when upon examination if your baby has a heart mumer.Sometimes they do and the vet doesn't mention it to the owner.But then kitties can have them stress related too.Then go home & be fine.A heart murmer is staged.like one ,two ,three.It goes by sound.The higher the sound the vet hears the higher the stage of murmer the kitty has.Everything in fact is blamed on old age.Just like people.The reason I  mention that is heart problem is in a cat you have to be extremely careful as per fluid inducing.But I belong to the heart group at yahoo & do see members giving like 50 mls per night.If he`s up for it it will not hurt him.For pain buprinex is highly used in the cat world & is tolerated well.It is a liquid drawn up in a syringe and NOT syringed into the mouth but rather just placed inside the cheek of your kit and plunged.It is not designed to be syringed down the throat but rather absorbed into the mucous in the mouth.Very tiny doses I would recommend.Tramadol is used as well but I never went that route.All going by the advice of a veterinarian.Bup your vet probably doesn`t know of either.I will give you a couple of links to read.But i do hope you will join the FIV group as i am not aware of all the symptomology they can have.But inappetance,lethergy etc can all be not have anything to do with FIV.Joel & his members will know.I also don`t believe in a cat being old & just blaming it all on that.You honestly don`t know how long he has got.I read of miracles & major turn arounds everyday.Unfortunately he cannot speak to you to tell you what hurts.His bones .His gut and dehydration being huge and just making them feel like heck.You can do a couple of tests as per hydration of your boy.You can rub your finger along his gums and see if they feel slippery or sticky.You want slippery.I never had much luck with that one.Also a scruff test.Grab your boy by the scruff like Momma cat would carrying the babe.Pull straight up his fur & flesh.Twist the skin etc to the  right & hold for a few seconds.Then release your grasp.His skin should somewhat bounce back into normal positon and not stay all wrinkled and then finally go back.Is he nauseous You won`t know as kitties that are nauseous do not have to be vomiting.In fact most don`t vomit.They will walk up to food,take a sniff then walk away.Basic symptomology for a cat that`s tummy isn`t right.Then an anti nausea med should be administered.Ondanestron is the one I like.It is human drug used for patients going through chemo & the nausea it can cause.4mg tabs.1/4 tab I believe once or twice a day.I can confirm dosing for you.It requires a script from your vet that you take to a human pharmacy to have filled.Cerenia can help with nausea but is more used for vomiting.You will not know if this will help him or not without actually trying it.Appetite stimulants are given but only if nausea has been addressed.A kitty should not be on an appetite stimulant without an anti nausea med first.This can cause learned food aversions.In other words this med if a human was taking an appetite stimulant they always tell you when you are sick never eat your favorite foods for they will no longer be your favorites anymore after you become well again.Almost like drinking a bottle of Gin & waking up to crane.Which I`ve done once in very days  of youth and can`t to this day ever smell it or I wiIl gag.An appetite stimulant mirtzapine I never used.We call it meowzapine.It can make cats very vocal ,have seritonin syndrome which the only anti dote is Ondanestron(Zofran) & other side affects.But is still used but I do find members I deal with going a way lower in dosing than what their vet recommends.Cyproheptadine is what is preferred.A human antihistamine available here in Canada over the counter.Mere shavings of this pill can entice a kitty to eat.BTW I would never recommend any med without your vets`s approval & also all the years of participating in groups & seeing the results.We are not vets.But i`m sure if you mentioned Ond & cypro heéshe would look at you like what is that.Joel will know all this tuff.Dosing etc.So here are a couple of links.As per fluid therapy.Most used is lactated ringers.Or LRS for short.It is the same for humans.Itis a human fluid therapy.There are places to get it a lot cheaper than what your vet will charge.My first bag i bought from my vet was $25.00.I then after found a human medicine supply company here who shipped everything to me needles,bags of LRS etc for $6.85 delivered OéN to my door.I was then when Maxwell was alive paying no more than $4 bag for the exact same fluids.Same brand everything.But they have gone up since.But for you starting out & just getting a bag from your vet would suffice to tell if your baby feels better from it.Also Joel & his members will know of needles.I used the terumo 21 guage ultra thin walled ones with my Maxwell.He never flinched ever.Some people use the 18 guage which to me are harpoons.I never used them.Not even in a pinch. So something to talk about to your vet & pls jon the FIV group .You will not regret it.Here are some links for you:

Sophia gets her sub-Q

hepatic lipidosis in Cats

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https://groups.yahoo.com/neo/groups/Feline-Assisted-Feeding/info

feline assisted feeding group.Excellent to give you ideas of how to get food into your babe and are well aware of app.stimulants & anti nausea meds.

HTH Honey & Hugs to the Babe.C.Sorry about the typos.I`m sure they are plentiful.I am a mechanic not a typist.lol

Hi SulCal.if your boy has triaditis.major inflammation like Stephen is talking about which is a hard diagnosis but is doable.Pls join this group it is superior to all the groups i belong to and they deal with this as well as any inflammation of major organs of the body.They will recommend fluids and stay away from metacam IMO.Ok Hugs C,.

https://groups.yahoo.com/neo/groups/Feline_Pancreatitis_Support/info

Hi SulCal.

If reading Stephen`s Link on triaditis,which I have as well, you will see notice of FIV.Please join Joel's group.Triaditis, your kitty will be in a lot of pain.Fluids can help but pain does have to be addressed.I don`t think your up to having an US.Depending on how well your baby is feeling.Have you used cyclosporine before.long term use of this med for FIV kitties can bring on lymphoma.So just wondering.the pancreatitis group is super but also joel`s FIV group.Meds for triaditis will be the pancreatitis dept.Pancreatitis alone is very painful & buprenorphine is often dosed (buprinex) which I spoke to you earlier about.If you get your vet to show you how to do fluids on your kitty make sure the vet doesn`t do it.Make your vet show you by handing you the line .You taking the skin etc.It`s fine to watch but actually doing it something else.I was personally shown by my Internist by me actually doing it and her observing me doing it.Many yrs ago.

Big difference.Hugs C.