My Nipo is getting some intensive care

My sweet and precious 11 y/o feline companion has had a severe decline in appetite since a stressful event in early January. She's had quite a few diagnostic tests run recently and there has been no conclusion of any underlying condition (besides the stressful event). However, today Dr. C thought lymphoma was a possibility.

She is currently under observation at the clinic where I work part-time. She is being force fed and given fluids as needed. She is also on medication for appetite stimulation and anti-nausea. I was in denial for a period and thought that I could avoid force feeding. I was tempting her with every food I could think of and trying to maintain baseline calorie intake with Nutri-Cal. When I posted my first thread about this I stayed up waiting for the first reply (at like 2:45a Hawaii time) and Jen L told me exactly what I needed to hear - force feeding was the next step and now was the time to take it. For that I want to thank her!! :)

I work with an amazing veterinarian - Dr. A. I trust her completely with Nipo and truly believe that if full recovery is possible, then it will happen under her guidance. She does not work on Tuesdays, so today I had the clinic's other two doctors look at Nipo's case and give me some feedback. Dr. C suspects possible lymphoma (Dr. A mentioned the "C" word yesterday as well). He couldn't pin down what it was, but when he palpated her abdomen it felt a bit "funny." We could aspirate and try to get some cells to test for cancer, but I'm not feeling ready for that yet. I just want to see how she responds to a few days of force feedings. We also took an abdomen x-ray and nothing looked abnormal. Well, except she was gassy – but that happens when you meow piteously every 4 seconds for the 2.5 hours Mommy visits. *sigh* :p

Dr. Z expressed some concern that her right kidney felt a little asymmetric or something – but this was something very subtle. I know an ultrasound would tell us more, but I want to wait on that. It is much more stressful procedure than quick force feedings, blood draws or sub-q fluids. It takes a long time and she has to be held on her back. She will also probably need her tummy shaved. That ordeal is more than I want to put her through for now, and it won't give us a definitive diagnosis since it is unlikely she has any LARGE masses.

I helped with her afternoon feeding and we administered her anti-nausea medication a full 45 minutes before her force feeding this time. Hopefully she will keep down today’s feedings. She had kept down the morning feeding as far as I know, but early this morning there was vomit everywhere in her cage and it's likely she threw up most of yesterday's feedings last night. I will probably go in daily to help with her afternoon feeding, she seems to be better when I hold (although she's not GOOD by any means) and she also calms down faster if I'm there. She's actually happier up on the exam table with me petting her than in the cage with me petting her. She was purring up a storm on the exam table! Very odd cat I tell you. :p

She still has a lot of things going for her...even if she is down to 7 lbs. from 9. She's FULL of spunk, life and indignation, LOL. She still has a LOT to say!! I look into her eyes, and I do not see sad, glossy or lifeless eyes- I see NIPO. I am hopeful that after a few more days of force feeding she will start gaining a bit of weight and may become more interested in food. Today when I offered her some treats she would smack her mouth distastefully after sniffing them. She'd also give me that "icky smell" expression that cats give, wrinkling up her nose and everything.

We'll probably run some more diagnostics with Dr. A tomorrow. Probably at least a urinalysis to get some quick feedback on her basic kidney function and we'll also likely send some blood off for an abbreviated panel.

Please keep Nipo in your prayers and pray that I make the right choices so that whatever time she has left with us is the best that it can be. :)

Also thanks for reading. Yeeesh, I wrote a novel!

Kater, I experienced the same problem with my Auggie twice and each time she bounced back. I’m defiantly keeping your Nipo in my prayers.
Has your vet ruled out gastric problems? Is she getting her medication orally?
You might want to discuss an anti nausea shot instead oral medication with you vet.
Some appetite stimulants can cause stomach upset. The reason I’m asking is because of the vomiting.
If she has to have an ultrasound and her belly shaved, would she be given a mild sedative or full anesthesia?

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Originally Posted by auggie

Has your vet ruled out gastric problems? Is she getting her medication orally?
You might want to discuss an anti nausea shot instead oral medication with you vet.
Some appetite stimulants can cause stomach upset. The reason I’m asking is because of the vomiting.
If she has to have an ultrasound and her belly shaved, would she be given a mild sedative or full anesthesia?

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Well, I know the vets considered IBS- but to suddenly start showing symptoms at 11 y/o would be highly unusual. I don't know that they have actively ruled out other possible gastric problems... let's see...a blockage would probably have showed up on the x-rays. Did you have certain conditions in mind? I can't really think of anything else at the moment.

She had not vomited at all until getting all that food. Yesterday was the first time she had a full tummy in quite some time - so I'm not extremely concerned by it. However, if I find out that she did not keep today's food down, then I will start asking Dr. A what we can do differently. I know just by not eating she is most likely making herself nauseous - all those gastric juices are being produced, but they have very little to break down.

She is getting the appetite stimulant orally and the anti-nausea med as a shot. The appetite stimulant does not come in any other form, unless we go to a compounding pharmacy and get it made into a cream - do you think that would be preferrable? Dr. A mentioned it, but I didn't see any major advantage since the pill is small and easy to administer.

In terms of the u/s - I would prefer to not sedate/aneth her at all. I certainly won't consider it until we know exactly where her liver values are. I don't doubt that we could do it without sedating her...it would just be very stressful judging how she handled the x-rays taken today with her on her back. And that was only maintaining the restraint position for around 15 seconds at most!

Thanks much for your post, auggie! I am heartened to hear that Miss Auggie has pulled herself out of this place twice before!

Prayers for Nipo. And I am glad that I was helpful. I wish you both all the best.

Kater I'm still keeping Nipo in my thoughts.

Nipo in our thoughts and prayers

There are Pet Angels now with Nipo,so that he is being comforted.
And Prayers are coming for Nipo,that he will be all right,and that he will be Your Companion,for Many Years to come!!

Blessings to you Nipo

I will be praying for your Nipo.. . ((hugs))

Keeping Nipo in our thoughts and prayers.

Prayers and positive thoughts on the way for your Nipo.

Prayers for you and Nipo.

I'll be keeping Nipo in my thoughts and prayers. I hope she'll get better soon.

Nipo is in my thoughts

Please get feeling better soon sweet Nipo!

Oh, I didn't know. :( I hate that I am so distant from PT Cats these days. Full speed prayers on the way for Nipo.

Nothing good to report. We got her blood work back and her liver values are much worse, which I expected. However I thought the change would be assumed to be a RESULT of not eating (and thus the damage would conceivably be "reversible"), Dr. T says it's probably not.

Woah. That's when my heart got stomped into the floor. :( :( :( We are still waiting on the liver aspirate results.

I hate to ask this, but I really must. Are there any PTers I could talk to over the phone about this? I feel so frustrated, unsupported and alone right now. I would be glad to make the call (& pay for it). If anyone is willing, please PM me and we can set it up. I should say that because of the time zone difference, it will probably have to be someone who stays up late.
I'm not up to writing more right now. Thanks so much for your prayers, they are deeply appreciated. :(

I can imagine how devastating this news must be to you, it's happened to me several times and it never gets easier.

While the news is bad, is it truly immediately hopeless? I ask because I had a cat, Simka, who stopped eating and became nauseous, and was diagnosed with both liver cancer (the results from her aspirate said it was a very aggresive type of cancer, but that must have been wrong) and chronic renal failure. I thought I would lose her very quickly and it was hopeless. However, like Nipo, Simka was still full of life and so, with the vet's approval, I decided to try treating her for a while. She was on anti-nausea medication and I force fed her for two weeks. After a few days, she kept most of her meals down and became stronger. I treated the CRT with daily sub-q fluids. After two weeks, she began eating by herself though it was always difficult to find out what she wanted to eat each day. She remained on the anti-nausea medications and I offered her a wide range of foods, both wet and dry, cat and human, each morning and evening. She lived for 2 years and 3 months past that terrible diagnosis. Good years, playing with her toys, demanding attention, lolling around in the sun on the deck. The mass did become larger and larger, but apart from making it harder for her to get up on the bed, didn't seem to bother her. When it did bother her, she was euthanized.

It was a great deal of work to take care of her. But when I remember how much she loved walking around talking to her felt mice, laying them in turn in front of the heat vent until there were three in a row when she would like down next to them, I'm very glad I was able to give her that time. I tucked three of the mice into the blanket I wrapped her in when I handed her body over for private cremation.

I've no desire to encourage you to prolong a life that has become painful and miserable, only to suggest you query your vet.

:( Oh Kater. I've been so scarce on PT lately I had no idea. I'm so sorry for not knowing about precious Nipo sooner.

I know how very dear Nipo is to you, and will keep her in my prayers. May your precious kitty have a speedy recovery, and come through this quickly. {{{hugs}}}

I losrt my RB gigi January 05 from Lymphoma. She declined very rapidly, one day being fine to one day I thought "she hasn't moved from that spot all day" and completely quite eating. No vomiting at all, I took her in a she had quite a large mass.

I am not trying to scare you just saying it doesn't sound like they have felt a large mass so I am hoping it is not cancer.

I feel so badly for you. Most of us have gone through this at one time or other (even if not with the exact same problem).

I'd be happy to PM with you, but I am phone-shy, so talking to me would certainly not help you cope. :(

Prayers for Nipo and prayers for you as well. Prayers that you have the strength to do whatever is needed.

Darling Nipo - sending you some positive blessings (and a few for meowmie)

Sending many prayers to your precious Nipo. I hope she recovers and feels better very soon.

Kater I sent you a PM. You know my phone line is always open to you, no matter what time it is! If you want you can always try sending me an IM and if I respond that means I'm home.

*deep sigh* The liver aspirate came back and she has "marked hepatic lipidosis." This is really the best diagnosis I could hope for after seeing the blood work. "Marked" refers to the severity; I think its one level below the most severe.

I brought her back home today as well. I will have to force feed her myself now, but she was pretty good for her afternoon feeding today. She is happy to home, that is very clear. Now comes thrice daily feedings for a minimum of three weeks...I hope she doesn't make it too difficult!!

I will talk to Dr. A about specifics tomorrow. She may put Nipo on more herbs (she's on milk thistle now) and/or other supplements (vitamins, minerals, etc). For tonight and tomorrow morning I'll go with the A/D, water and Nutri-Cal in a blender.

Whew, I am feeling so relieved!! I know her condition is serious - but to know that the liver damage is reversible lifts a huge weight from my shoulders. :)

I want to thank you all so much for your support. Thank you thank you thank you!! Sorry I got a bit hysterical, but I'm sure you all understand.

I'll work on getting some pictures up sometime soon.

Thanks again! Mahalo Nui Loa!!! :)

Kater, I'm glad to hear that Nipo's liver aspirate results weren't as bad as you had expected. My RB Pepper also had hepatic lipidosis and was jaundiced. He was able to bounce back but also had to be force fed and it took a while before he was well again. Many more prayers and positive thoughts are being sent your way. Please take care. (((HUGS)))

It is good to know that her condition can allow her to bounce back. Your 3 weeks of forcefeeding will be over before you know it.

Praying for Nipo to come back from her illness. She must be very happy to be home; that in itself will benefit her a great deal.

Hugs to you and gentle scritches to Nipo.

I’m so happy that Nipo’s liver damage is reversible.
Sounds like you’re doing everything possible to make her well again.
I’m also glad that Dr.A believes in some alternative treatments like herbs and supplements. I wish we could buy Gimpet vitamin paste over here. My cats absolutely love it, while they dislike Nutrical. Being at home in your loving care should make her feel so much better.
Prayers continue for Nipo’s recovery.

Nipo is doing pretty well. She pooped over the weekend, for the first time in a long while, and I was just ecstatic! :D :D

The force feeding is quite stressful...but I know I'm getting a good amount into her. I still may have the feeding tube put in. I want to see how she is doing after a week. If she is pooping, active, and I'm still able to feed at least 100 cc at each meal, then I feel that this is the less stressful option. I know weight gain will be slow, but I hope to see some when I next take her in. If everything continues on this course, I think I will wait until Saturday for a recheck.

I ordered some tempting treaties through Pet Food Direct today. I have searched for websites & communities related to HP and/or CRF kitties since both conditions cause decreased appetite. Many of them have reported success with the two products I purchased. The rosedust in particular seems to get rave reviews and one person claimed NO cat would ever turn it down. I would love to find a product that can jumpstart Nipo's appetite - since she is eating some (a very limited amount) on her own, I know she does have SOME appetite.

Kitty Kaviar
Rosie's Rosedust

I will let you all know how everything goes with these. For now, Nipo is doing as well as can be expected. Continued prayers would be much appreciated.

Love and Aloha,
Kate & Nipo

I am very glad to hear that there is progress.

I'm so glad that Nipo is getting better! :D

She is still in my prayers . . .

:( Oh, Kate. You can ALWAYS call me, sweetie. God forbid something like this occurs and you need to talk, I'm here, OK??

Poor sweetie Nipo! That Rosie's Rosedust stuff sounds neat! I hope it'll work to get her to eat on her own.

How is she doing today?

Quote:

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Originally Posted by NoahsMommy

Poor sweetie Nipo! That Rosie's Rosedust stuff sounds neat! I hope it'll work to get her to eat on her own.

How is she doing today?

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Today was a good day. Another poop!! Yay!! She also had some nice lappie-time with my Dad. :) Unfortunately I eventually had to snatch her up for her evening feeding. I am definitely improving my syringe technique and increasing the amount of food that actually gets into her. She is so good - hardly struggles and complains less and less now. Bless her for that - I feel guilty enough as it is.

I cannot wait until that rosedust stuff gets here! I have a very good feeling about it. After trying so many 'fishy' things...beef might be just what tickles her hungry bone, LOL!

One thing I am having trouble with is cleaning the food off of her neck, chin and scruff area. I want to do it quickly because after I unroll her from her kitty burrito she wants to bolt to the door and get as far away from me as possible. I considered using a shampoo product, but that will take longer, especially the rinsing. I have been using a washcloth and plain water, but her fur still retains some food matter and dries all spiky and hard in places. :( Any ideas for how to better clean her up after mealtimes?

Much thanks for the thoughts & sweet posts. This treatment schedule is consuming my life right now so I apologize that I do not have time to post elsewhere on PT.

xoxo Kate & Nipo

Although I haven't taken any recent pictures, this shot is similar to the scene tonight.
Lappie-time
http://img.photobucket.com/albums/v8...o/2442e557.jpg

Good for Nipo. :D
As for cleaning her, they make "no-rinse" shampoo. It is wet, but you put it on, rub it in but do not rinse out. Just make sure it is safe for cats (not all of them are).

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Originally Posted by jenluckenbach

Good for Nipo. :D
As for cleaning her, they make "no-rinse" shampoo. It is wet, but you put it on, rub it in but do not rinse out. Just make sure it is safe for cats (not all of them are).

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Oh, I already have some of that 'waterless' type cat shampoo! I totally forgot about it oops...I will have to look for it. Thanks Jen!!

I talked to Dr. A at work today about Nipo's progress. She seemed impressed that I am able to feed her two cans of A/D daily. We agreed that I should bring her in Saturday for a basic exam and to get a precise weight. I really think she is gaining :eek:...it may only be a few ounces, but I am starting to notice positive changes!!! :D :D Yaaaaay!!

She is still grazing here and there...I noticed she ate most of the Greenies (8-12ish) off of the plate with her dry cat food. She is also eating most of the soft cat treats which I leave under the sofa for her.

I will definitely update after Saturday, if not sooner.

Mucho Mahalos for the advice and prayers,
Kate & the Nipopotamus

Saturday's appointment went okay. She looks and acts like she is in a better place, but the weight gain is hardly significant. When I first weighed her the gain was 5 oz., but after Dr. A palpated her tummy she said her bladder was very full. So I put her into a cage with a litterbox and later in my shift checked on her and weighed her again after she had voided her bladder. After urinating the gain was only a few ounces. :(

She is still doing some nibbling here and there. This morning I put out two kinds of wet food, lots of kibble and a pile of 20 or so greenies. I also decided to hold off on the morning feeding to see if she would eat more than usual if allowed to get 'hungry.' I will be driving home before going to work today and if she hasn't eaten 'enough' then she'll get a late breakfast.

I also keep meaning to get some grocery store type brands of dry kibble. I just wish I could get samples or something instead of buying full-sized bags...the wet food purchases are already breaking the bank! Especially since 95% of it is wasted. :( *sigh* I'm just frustrated, since I really expected more weight gain. Well, all in all I think she looks *better* physically, so that is something significant. She is also staying pretty well hydrated (between liquidy force feedings, her new fountain, and the numerous water bowls I have set up) and that is better and less stressful than administering sub-q. I think I might bump the feedings up to 1.5 cans of A/D twice daily...if she can keep that much down.

Still haven't gotten the 'food enhancers' in the mail yet....Pet Food Direct isn't known for the quickest shipping and being in Hawaii won't help any.

Thanks for reading.
Kate & Nipo

I'm so glad she is doing better; remember, any food that you get into her will do her a world of good.

Keep up the good work, and Nipo. do what your meowmie says! :)

Checking for an update on Nipo. I've been following your progress. Don't be discouraged if the weight gain is minimal, best thing is that no weight is being lost!! Holding steady is ok. Continued good thoughts and wishes for you both.

Nipo is finally stepping her nibbing up a notch...she is eating more kibble (after carefully eating ALL the Greenies off the top, that is). :D I am soooo happy with this progress!! Happy enough to take pictures... :p

I am using the plates temporarily since I think they make eating easier. You can see her regular food bowl empty in the back.
http://img.photobucket.com/albums/v8...ecovery001.jpg

A close up of the nibbled leftovers...:D
http://img.photobucket.com/albums/v8...ecovery007.jpg

hehe....my favorite 'flavor' of kitty burrito http://www.smileys.ws/smls/grinning/00000020.gif
http://img.photobucket.com/albums/v8...ecovery010.jpg

I love this girl SOOO much...
http://img.photobucket.com/albums/v8...ecovery021.jpg

The evil syringe...
http://img.photobucket.com/albums/v8...ecovery023.jpg

Thank you from the bottom of my heart for your prayers, guidance and good thoughts. I appreciate each and every one SO MUCH!! :)

We will probably run follow-up blood work in about another week. Things are certainly looking up!!

...still waiting on PFD, heh.

xoxo
Kate & Nipo