Update on Puddy; she's gone*9/29* see post #421

[pomtzu]

I don't like that Medusa isn't around to give us Puddy updates!

I'm right there with you! I keep checking for a "Puddy Post". I hope it's good news.

[krazyaboutkatz]

Mary said that her computer was being worked on so she wouldn't be able to update us for a while. I hope that everything is okay. Puddy remains in my thoughts and prayers.

[Medusa]

Finally got my pc back; I was w/out it for nearly 3 days and now I'm really behind on my work, so I'll try to make this as succinct as possible. It's still giving me problems, so I may have to be w/out it again.

As soon as Dr. Lee saw Puddy yesterday he said "Oh boy, this isn't the Puddy I know". She was just lying there in a ball; she usually is hissing like mad. When he petted her, she didn't make a sound. So he petted her a little harder to see if he could get her to respond and she did hiss but she never even lifted her head. Dr. Lee, whom I've always said is a genius but, by his own admission, is not warm and fuzzy, stroked her so tenderly. I could tell that he really likes her; his eyes curl up at the corners and he grins when he sees her. He leaned down and talked to her at her level, which ordinarily would be a dangerous thing to do because she goes for the face when she's really mad, and he said "Puddy, what's going on w/you, little girl?" And she let out the most pathetic cry. That's when I lost it and started crying, too. Poor Dr. Lee, I could tell that he wanted to comfort me but he didn't know what to do. He asked "How long has she been lying in a ball like this?" I said "Almost two weeks. She stays on the corner of the bathroom sink countertop 24/7". I filled him in on everything, how she eats fine, uses the litterbox fine but just will not socialize at all, not even w/me.

He said that it could be one of a couple of things: senility could be setting in and/or she could be having an auto immune response to the Epogen. He said that he's never heard of cats responding to Epogen in that way, dogs yes, cats no, but then he said "Puddy has defied all the odds so far, so why should this be any different?" He said that cutting her back to once a week would neither help nor hurt her and her numbers all came back the same so he said to continue w/once a week injections and to really watch and see how she responds after next Saturday's shot.

Of course, when we got home yesterday, she went upstairs so I figured she was headed for the countertop but she ate first, then went to the countertop to drink her water, then she went in her carrier for the first time in two weeks and she slept there all night. So. Now I don't know if it's because she's doing better or if it's because the weather turned cold and rainy (it went down to 50 yesterday) and it's warmer in her carrier. Dr. Lee said that Epogen only stays in the system for about 4 days, so if she's having an auto immune response to it, the 4 days would have been past and thus she went into her carrier. (Are you tracking w/me on all this? I know it's difficult; I have a problem w/it myself.) If she goes back to the countertop and stays there again after her shot on Saturday, then I'll probably have my answer. I'm trying to take a friend's advice to stop analyzing everything and just take this as a positive sign because I'm exhausting myself.

Dr. Lee also said "I'm a numbers guy. Her numbers say she's improving but this is not the normal Puddy behavior. I'm not w/her all day, so only you can say whether or not her quality of life is non-existent. If you're asking me, though, if this is the end for Puddy, I'd have to say 'NO'. Her gums are pink and if a cat is anemic, the gums are white. Her appetite is good, her litterbox habits are fine. I think she needs to be observed a little longer." I asked him the question I always ask "If she was your cat, what would you do?" He said "Again, I'm a numbers guy. I'd wait. But if her numbers go down after a while, then I'd have to sit myself down and say 'Mike, you have a decision to make'."

I hope I haven't forgotten anything. Yesterday I cried until I was spent. I came home, laid down and cried til I fell asleep and I did sleep for about an hour and a half. I guess I needed the cry and I definitely needed the sleep because I felt better afterwards and Puddy slept through the night, too. This has been one strange experience. I've had to help animals to the Bridge but there was never any doubt then that I was doing the right thing. Just when I think it may be time to let Puddy go, she rallies, so I've been in a state of confusion for weeks. Dr. Lee told me to keep him informed of any changes, good or bad, and I'll let all my PT friends know, too, unless I have to part w/my computer again. If you don't see an update or if I don't reply to your posts, that's why.

Thanx again for all your thoughts and prayers and I apologize for the long post. I just wanted to make sure I covered everything.

[pomtzu]

And I'm sitting here crying with you! What a difficult and confusing time this is for you and Puddy also. Just hang in there and take it a day at a time and hopefully eventually you will see even more of an improvement. It does seem tho like it may be an issue with becoming senile since she just doesn't seem to be really "sick". Prayers for you and Puddy!

[Catty1]

RIGHT! I forgot that your pooter was going to the vet also.

Puddy does defy the odds! I loved how Dr Lee was so sweet with her...and she KNOWS him, and just cried at him! With her not feeling well, it's so sweet that she would 'ask for help'.

Mary - don't drive yourself crazy with details, but I did find a couple of bits of information on Epogen. Just have a look and then check the link if you want to. Epogen is made from a human protein, which is why autoimmune can happen...but if her counts stay up, that is good. There's another drug mentioned here also.

http://www.marvistavet.com/html/erythropoietin.html

SIDE EFFECTS

The main adverse event to be concerned about is antibody production. Antibodies are generated in response to an alien protein in the body. The problem is that antibodies that are generated not just against the alien (human) erythropoietin but also against the patient’s natural erythorpoietin. This makes for a profound anemia which can only be treated with blood transfusions. Regular monitoring to check for a sudden drop in red cell count, is crucial as this is the sign that a problem is incipient and the product can be stopped while there is still time. It has been proposed that darbepoetin (Aranesp ®) is less likely to cause this reaction than other recombinant erythropoietins since it differs from the human product the most.

INTERACTIONS WITH OTHER DRUGS

It is very important to administer an iron supplement in conjunction with the erythropoietin injections so that the bone marrow will have all the necessary “supplies” with which to make red blood cells. A multivitamin with iron is typically used as this will also provide the B vitamins needed in red cell production as well.

In humans, carnitine administration improves the response to erythropoietin in some individuals. Carnitine is a nutritional supplement available at most vitamin stores.

Also...is she on any meds that Epogen might interfere with?

HUGS to you and Puddy. I hope you get some much-needed rest.

[Medusa]

RIGHT! I forgot that your pooter was going to the vet also.

Puddy does defy the odds! I loved how Dr Lee was so sweet with her...and she KNOWS him, and just cried at him! With her not feeling well, it's so sweet that she would 'ask for help'.

Mary - don't drive yourself crazy with details, but I did find a couple of bits of information on Epogen. Just have a look and then check the link if you want to. Epogen is made from a human protein, which is why autoimmune can happen...but if her counts stay up, that is good. There's another drug mentioned here also.

http://www.marvistavet.com/html/erythropoietin.html





Also...is she on any meds that Epogen might interfere with?

HUGS to you and Puddy. I hope you get some much-needed rest.

Thanx for the info, Candace. Dr. Lee did mention that possibly down the line if the Epogen isn't working as it should that I could consider a blood transfusion. He also mentioned a monthly iron injection but at the time, Puddy was so sick and frail that he didn't want to do it to her because he said it's painful and my little girl is only 5 lbs. To give her a painful injection right now just wouldn't sit well w/me and he said that it isn't essential at the moment, so I'll wait until he gives me the green light. She isn't on any meds other than aluminum hydroxide gel, which is a phosphorous binder and an antacid which helps w/nausea. Dr. Lee said that nausea is a big problem in kidney patients and he should know; he said he's had kidney stones, nausea, back pain, the works. He's been a kidney patient for quite some time, I guess, so he can really empathize w/Puddy.

[Catty1]

Could she take an oral (even liquid) form of the vitamins and iron?

Maybe just ask about darbepoetin (Aranesp ®). Carnitine is supposed to help the response to Epogen...it's made by the liver and kidneys, so Puddy might be low in it.

I an wondering what Dr Lee thinks of this stuff. HUGS!

[Medusa]

Could she take an oral (even liquid) form of the vitamins and iron?

Maybe just ask about darbepoetin (Aranesp ®). Carnitine is supposed to help the response to Epogen...it's made by the liver and kidneys, so Puddy might be low in it.

I an wondering what Dr Lee thinks of this stuff. HUGS!

I asked him about an oral iron supplement and he said "Oh, the Geritol effect. I'm of the opinion that it doesn't do a bit of good" and he proceeded w/a lengthy explanation that I've since forgotten. Long story short, he feels that studies have shown that iron supplements are fairly useless. Whether or not he's right is up for debate but seeing that he is of that opinion, I won't bother w/the oral supplements. I want to see how Puddy does after this Saturdays' Epogen shot, then I'll go from there and maybe take her in to my local vet for the iron shot unless she's not doing well, then of course, I want Dr. Lee to see her. I will ask him about Darbepoetin, though.