20% kidney function, high liver, high side thyroid

[cocheezie]

Update:

As mentioned in another thread, a couple of weeks ago, we tried the new drug Semintra for about two weeks without success. She vomited the med when given straight up, and she would vomit about 20 minutes later when mixed with food. This experience put her off food and we went back to square one trying to find something that she will eat. She's eating NV rabbit wet (new to her and may have made her first stool after the rabbit smell horribly, taking out the entire 2nd floor) and FF  chicken gravy lovers (because it is guaranteed that she'll lick the gravy which contains two meds and probiotics). She will sometimes eat FF beef. She will usually eat Merrick's Thanksgiving Dinner. Soon, we will try mixing k/d wet into her food. I also bought some venison but have yet to try it. But first we have to get to the bottom of her stomach acid problem.

A week after stopping Semintra: the last 2 days have seen a lot of stomach acid coming up. Two to four times a day. Sometimes on its own, sometimes with food, once after a bowel movement. She has been on Pepcid AC 1/4 tab for months. Obviously, the Pepcid is not working effectively for her anymore. She's also drinking a lot of water in an attempt to reduce the rawness of the stomach acid just before the throwing up. A signal to me that it's time to get the roll of paper towels at the ready. Immediately after throwing up, she feels great. Asking for more food, pets, interested in what's outside the window. There is no head hanging (which I see as a symptom of nausea). So it is a stomach acid problem only. We've been able to maintain her weight until recently. Since starting the Semintra and the current stomach acid tossing, she is losing about 2 ounces a week. It's time to switch to a different acid inhibitor. Today is a civic holiday. I could rush out and buy the other OTC med Zantac and try switching her over, but some websites say it takes a couple of days to start working, and I'd rather not put her through a foaming mouth experience if I can help it. Am awaiting an order of gel caps to have on hand for whatever comes our way.

She ate late last night and everything came back up at 12.30. At 4.30 am this morning, after a stomach acid throw-up, she wanted more food. I gave her some FF gravy lovers with a tiny bit of SEB mixed in. I also gave her some chicken baby food and it was still on the plate this morning. She has always rejected or vomited SEB in the past. This is the first time it has stayed down. She's been on the verge of vomiting all morning, but hasn't. She's taken on lots of water. I will attempt to sneak in a small amount of SEB later in the day. I've also been adding water to her food. Dehydration is not an issue.

It is not time. She still enjoys her walks by the river. She does not assume the meat loaf position. She sleeps on the bed ascribing to the cat standard "1/3+2/3" rule of sleeping with humans.

Calling the vet office tomorrow a.m. for an appointment asap. Hopefully my vet is back from holidays (the other vets aren't all that great, and one especially whom I wonder how she ever made it through vet school).

Question: 

Has anyone who has/had a cat on Pepcid AC long term (months) come to a point were Pepcid stops working for their cat?

 

[abbyntim]

I was sorry to read the Semintra did not work for Cocheezie and caused her nausea and vomiting. That is such a hard thing to see! I am glad you have found food she likes. Mine love the NV rabbit, although I can't say it causes stinky poops. In fact, Abby's are almost like raw food poops when on this food. Perhaps Cocheezie is still getting over the medication. Poor girl!

I did want to respond about the stomach acid and Pepcid AC. This (excess stomach acid) seems to be Tim's lingering issue and it's proving to be tough. Pepcid AC does not seem to be working for him, and neither does slippery elm bark syrup. He's been getting both (separated by two to three hours to minimize the possibility of the slippery elm interfering with absorption of Pepcid AC). Tim is not vomiting, thank goodness, but I can see he gets a mouthful of drool, which irritates him and causes him to vigorously shake his head and run off. It also causes his lower lip to become inflamed and swell. So right now it looks like someone socked him in the mouth.

I don't have a solution for Tim's stomach acid and I do wish the Pepcid AC would work. We are in the process of transitioning him to partial raw right now and all of us (holistic veterinarian, husband, and myself) are hoping this will resolve or at least improve this issue. If I don't see some improvement later this week, I'll be contacting the veterinarian for suggestions about other things we can do to provide relief. Meanwhile, today I started tapering the Pepcid AC, as it is not working, so why keep him on it?

One other thing I am working on is really watching the fat content of food I feed Tim. The mouthful of drool and swollen lip thing is relatively new; it started in February after I switched the cats to mostly NV and has happened two or three times since then. This brand is higher in fat than what they ate before and we suspect Tim does not tolerate high fat very well. In fact, what we think set off this latest episode is our feeding him a batch of the NV rabbit that was particularly fatty over a period of almost a week (it was very juicy and I thought it was just moisture until I refrigerated a can and the juice completely solidified).

Late last week, I read an article in the Wall Street Journal (from 2012) about a different type of heartburn that does not respond to traditional therapy. I filed it away in case this turns out to be Tim's problem and am posting the link: http://online.wsj.com/news/articles/SB10001424127887323894704578115031699278010.

Otherwise, it sounds like Cocheezie is getting along quite well considering everything that is happening with her. She sounds happy, you sound happy. I agree it's not her time.

 

[cocheezie]

The liver bile reflux makes sense (at least in part - who knows what's going on inside her - liver toxins, kidney toxins, misplaced internal organs). I'll slip it into the questions I have for the vet. Thank you. Most likely he'll treat for stomach acid, though.

Cocheezie has never had problems with high fat cat foods. She gobbled the rabbit. I probably should have introduced it slower, but she's a demanding little beast, and I'm just happy she's still eating.

I haven't fed raw (the old girl won't touch human food in any form), but it seems to me that monitoring Tim's fat intake will be easier on a raw diet rather than a diet that is dependent on what cat food companies put in their formulas; and becomes an issue for problem cats where you have to compromise and buy the closest you can get to meeting the cat's needs. Canned cat food is not perfect by any means.

And yes, we are doing are best to enjoy our time with her, occasionally hitting a home run in a hit-or-miss way with something on her "bucket list." This is nice to be a part of, and watch happening.

Sidenote: 

NERD? To rhyme with GERD?Surely, they could come up with a better name. It doesn't have to be an anachronism.

Edit: It is 9 days until Cocheezie's 17th birthday. It seems a lot of many humans and creatures always cross just before their birthdays.

 

[goholistic]

Sebastian is still on Pepcid AC for his chronic pancreatitis and so far it continues to help. I'm not sure what the possibility is of developing a tolerance to Pepcid, but I would imagine it could happen. This page on Tanya's site lists an order of things to try for excess stomach acid (see "Treatments"), and it does have Zantac next in line after Pepcid. If Pepcid no longer worked for Sebastian, or I wanted to ween him off of it, I would likely research some natural remedies (but not slippery elm).

You're taking such great care of Cocheezie. No doubt she wants to continue to be spoiled rotten and do more things on her bucket list! 

 

[cocheezie]

Yes, I'm familiar with the link. Thank you. This is what concerns me. The page lists links suggesting doses be lowered in cases of renal failure because the kidneys cannot process it efficiently and these drugs may accumulate in the kidneys.

The only thing I found so far is this: http://www.ncbi.nlm.nih.gov/pubmed/12753150

Why wouldn't you go with slippery elm. if I might ask? For me, it was 4.30 in the morning and it was the only thing I had on hand to try to soothe her stomach. I didn't want to give her more Pepcid in case she had absorbed some of the Pepcid before the 12.30 a.m. throw up. She's a tiny cat so giving a second dose is rarely an option.

 

[goholistic]

 
Yes, I'm familiar with the link. Thank you. This is what concerns me. The page lists links suggesting doses be lowered in cases of renal failure because the kidneys cannot process it efficiently and these drugs may accumulate in the kidneys.

The only thing I found so far is this: http://www.ncbi.nlm.nih.gov/pubmed/12753150

Why wouldn't you go with slippery elm. if I might ask? For me, it was 4.30 in the morning and it was the only thing I had on hand to try to soothe her stomach. I didn't want to give her more Pepcid in case she had absorbed some of the Pepcid before the 12.30 a.m. throw up. She's a tiny cat so giving a second dose is rarely an option.

I figured you were. 

  I've read that about the kidneys, too, and makes me want to try to ween Sebastian off the Pepcid or at least reduce it. Sometimes it may be a matter of weighing the pros and cons and choosing the lesser of two evils. 

Thanks for the link.

I'm not against slippery elm bark, by any means, nor am I saying that you shouldn't have given it. It's just that Sebastian is on too many medicines and supplements right now to control his chronic pancreatitis that I can't risk any of them not getting absorbed. (SEB can possibly interfere with the absorption of other things, which is why it is often recommended to give it separately / another time of day.) There's no good time to fit SEB into the schedule since Sebastian gets a myriad of things morning and night and just before bed for a total of 5 gel caps per day, each filled to capacity. I work full-time, so an afternoon dosing is not feasible. It's a logistical thing.

 

[cocheezie]

That makes sense. I don't know how you do all those meds. Kudos to you. Your experiences are part of the reason why I ordered gel caps to have on hand, just in case. I work from a home office, I'm lousy with time schedules. Don't "do mornings," and naps frequently interfere with my best intentions. But I think I could get at least one dose of SEB into her during the afternoon (cat willing) without it interfering with other meds (whenever I wake up and late evening). And maybe if I wake up during the night enough to function, I could get a second dose in.

 

[cocheezie]

Got an appointment with the good vet tomorrow morning. Ironically, Cocheezie had an easy night and is having a great morning. Two breakfasts, a romp down the corridor for no reason whatsoever, had a front claw session on the edge of the mattress (her favourite spot). Addition of SEB?

 

[goholistic]

 
That makes sense. I don't know how you do all those meds. Kudos to you. Your experiences are part of the reason why I ordered gel caps to have on hand, just in case. I work from a home office, I'm lousy with time schedules. Don't "do mornings," and naps frequently interfere with my best intentions. But I think I could get at least one dose of SEB into her during the afternoon (cat willing) without it interfering with other meds (whenever I wake up and late evening). And maybe if I wake up during the night enough to function, I could get a second dose in.

Thanks for the kudos. The actual pilling is easy, but I hate dividing things up into smaller portions, like when he only needs 1/4 capsule of something. LOL...you sound a lot like me. I don't do mornings either and it's a struggle to get up and keep the cats on schedule. A weekend doesn't go by without an afternoon nap. I have taken naps at work, too (ssshhh). 

Glad to hear she had a good night and a good morning! It certainly could be the SEB if that was the only thing that changed. 

 

[cocheezie]

So, we howled our way 10 miles to the vet this morning. Thank goodness she's deaf and I could turn the radio up.

He did a short physical exam and said that the tumour has grown twice its size since May. Since she is not nauseous, he's almost certain that the vomiting and excess stomach acid is being caused by the tumour squishing her intestines (pretty high up), and there isn't a whole lot to do about it. The problem is food and stomach acid backing up because it has to go through a much smaller space. Motility drugs, he said, would only try to push the food harder through the squished part of the intestine. I suggested antacids other than Pepcid, suggesting the next on the list in Zantac. He thought it was worth a try. He worked out the dosage to 3mg per dose and said it would take a couple of days to get a compounding company 100 miles away to make it up. I said that I was confident doing the compounding myself (and that my ancient car is going in on Friday and it never comes back the same day - or the next day - or sometimes the next week after that if they have to send to Europe for parts). So he gave me a small container of tuna flavoured suspension.

I picked up some Zantac at the local pharmacy and asked a few questions of the pharmacist. Is it soluble? Yes. How long is it stable. About two weeks. I'll try it tonight after I do the math over and over again to check. The vet said he usually leaves things like this to the compounding pharmacy and was a bit rusty.

I asked about using SEL to coat the stomach and intestines, and responded that it still doesn't solve the problem of getting the food past. I said that I thought maybe the SEL, while prevented some absorption, would at least lubricate. He didn't seem enthused. He was only focussed on "can't get the food past the obstruction." I did pick up some NutriCal on my way out the door in case it's helpful or needed.

I was going to ask for a panel to be done, but it all seemed secondary, so I left it.

If Cocheezie's liver, kidneys, or heart don't crash first, it will be this problem that takes her. She will start to vomit more and more, eventually refusing to eat altogether. According to the vet, this type of obstruction is not painful which explains why all these things are wrong with her, but she's feeling great. She ran from tree to tree last night on our walk. If she becomes wracked with vomiting, or refuses food for more than a day or two ...

 

[goholistic]

Your comment on the howling made me chuckle. Poor Cocheezie!

But the tumor is not funny. 

  How frustrating it is for her to be doing relatively okay except for whatever the tumor is doing to her. The only suggestions I have would be to try to make the wet food more mushy / liquidy and feed her small, frequent meals, but I think you already do this.

You're doing great. 

 

[cocheezie]

Yes, her food is pretty mushy. And you are right, small meals are key. Putting the Zantac off until tomorrow. I fell asleep and ended up having a 3+ hour nap, never quite woke up from it, and now it's almost bedtime. I need a clear head. We had a nice walk along the river tonight, and now she's ensconced in the window checking out a couple of kittens doing some exploring. The vet said the tumour is "pressing," but I guess I'll have to do some reading on internal gangrene so I'll know what to look for in case the intestine becomes incarcerated.

 

[abbyntim]

Sorry to hear about the tumor and what it's doing to her intestines. It's nice you work at home, though, so you can feed multiple smaller meals throughout the day. Have you tried the Zantac yet? How is it working?

 

[cocheezie]

I haven't tried the Zantac yet. I've been thinking through the process but I need a really clear head to do the math and some experimentation. The last few days have been hectic. I also have a medical condition that makes mornings and evenings fuzzy. I only have a short window of clear headedness each afternoon in which I would not doubt myself. Today, I have to be 5 different places (2 at the same time - 3 involve bbq), and I'm trying to watch my kid's sporting events on the web. Hopefully tomorrow for Zantac compounding. I worked as a pharmacy tech for 5 years, but that was over 20 years ago.

This is my thinking so far: I have to make sure that it is the smallest total amount possible, yet enough fluid to dissolve the drug, making sure I get the dosage right. The Zantac is 5-sided like a house, so if I split off "the roof", that would be 15mg. Crush that, and mix with tuna fluid from vet. Measure. Give slightly less than 1/5 of the total amount as a starting point. The vet suggested starting with 3 mg.

There was a hairball early this morning but otherwise she's been keeping food down for the last couple of days. Two huge bowel movements this morning and no vomiting afterwards. She's been eating a lot of small amounts and spending a lot of time with me on the upstairs balcony where she can observe without a window screen in the way and feel totally safe.