It's Only a Cat

Many people get this response from others when they find out that someone is treating a chronically ill cat. It's quite all right to take the high road even when you want to say, "Well, you're only a jerk and I still would treat you." But until a person has their own experience with pets, it's wasted breath to give them any return. Smile politely and move on.

I'll confess something. I didn't want Pearl. I had two cats. It was plenty. Taking in another would mean a long integration, difficult in my small apartment. Pearl was unlike any cat I'd ever had. More independent, more snooty than any cat I've ever lived with. I took her because who would adopt a 6 year old, black, gimpy legged cat? And she really was a handful. She was not happy with Sugar at all. She took months to integrate. I didn't understand her. She was definitely more like a roommate than a pet. But she was smart. She swore like a sailor when I could eventually just say "NO" to chasing Sugar and not put her in time out. She stopped, but she chuntered under her breath as she walked away from the hunt as if to say, "You always take her side. Boy, some friend YOU are. You don't understand me. I don't know why I stay here." *huff*. But she was a character and she was her own being. And I began to really appreciate her for being herself and not for cuddling and being "cute". She was like a naughty little sister by then.

For many people like me and you, who are taking time to read this blog, it isn't just a pet. It's a family member. It's SOMEONE. They make US someone. They teach us things.

Then, she got ill. And iller. And she let me poke her ears and stick things on her face to breath and stick things in to her neck (well, OK, shots are probably not even felt, so maybe it doesn't count). She sits when I say "Sit" for her blood tests. She teaches me patience. She comes for cuddles even though it's rare that I am not DOING something to her to control an issue. How can you not love that? And how can you think "it's only a cat"?

Now she is 15 and arthritic and she walks a bit like the drunken sailor she once swore like. She is grayer and allergies make her itch. The arthritis makes it hard for her to groom regions I'd rather not go, but have to so she can stay tidy. But she's still funny and seems happy enough and still occasionally chases Sugar and Sugar actually likes it. I know the day will come when I will have to part with this irascible character but I will always be thankful to her. I will always be glad she was "just" a cat.

Recently I read the most beautiful article. "With Pets as 'part of the family', grief hits hard when they pass" by Anthony Breznican of USA Today. It's well worth the look and definitely view the video. It begins "I didn't want this cat".

I totally understand. Updated link: Updated link Pet Grief
Video Sinatra's Good-bye

Diagnosis can be Overwhelming

I'm not insisting that we be brimming with hope. It is ok not to be optimistic. Buddhist teaching says a feeling that you have to maintain hope can wear you out. The biggest gift that you can give is just to be absolutely present. Whether your worrying about being hopeful or hopeless, pessimistic or optimistic; who cares, the main thing is showing up. That you're here and finding ever more capacity to love this world, because it will not be able to be healed without that. That is what is going to unleash our intelligence and ingenuity. And our solidarity for healing the world. -- Joanna Macy in an Interview with Krista Tippett on Being (Episode - A Wild Love of the World - September 16, 2010) Blog entry

I was driving along listening to Krista Tippet on Being last week when I heard this. I thought, "Everyone needs to know this. It's so true. THIS is how you keep from being overwhelmed." It applies to so many things but I realized this was what changed for me when I was so overwhelmed when Pearl was first diagnosed.

At the time, I was in deep grief over my loss of my cat Grant who I'd suddenly lost to stomach cancer in February of that year. My perfectly healthy boy suddenly began vomiting blood one night. Within two weeks, he was gone. One Sunday in April, Pearl, who had always had occasional coughing spells had several in one day and began wheezing. An ER trip later, we had x-rays and a diagnosis of asthma. She was given prednisone and the next day I took her and the x-rays to her own vet, who agreed there was classic donut signs in the lungs of asthma, but also, her vet thought the heart looked enlarged. Thursday of that week brought an ultrasound and the diagnosis of mitral regurgitation of the left ventricle. Prognosis "two weeks, two years, who knows?" Oh boy. OK, OK, a couple of more pills a day, we can do that.

One month later, Pearl acted awful. Especially after getting her prednisone. She lagged around. She had dandruff and just acted like she just felt plain awful. I really didn't know what to think. She had asthma and a bad ticker, of course she felt awful, right? But when it became more clear to me that she definitely got worse after having prednisone, I decided another vet visit was in order. Dx? Diabetes.

Another chronic but treatable condition. Now, switched to flovent for the asthma, dealing with diabetes and worried about some future heart event, I was overwhelmed. Actually, overwhelmed doesn't even cover how I felt. I began to think "this was it". Everyday I'd come home from work expecting to find my cat dead. I was exhausted, depressed, I worried over everything. After four months though, I realized, she wasn't dead. And I needed to stop living like she was. She acted better so why was I acting worse? I had kept showing up but with constant living in some non-existant future. Future by it's nature is non-existent, but I let it be real. I gave her meds everyday. We puffed, pilled and poked. She seemed completely oblivious to this being a trial. While I was busy worrying and pestering her over everything she did, waking her up, touching her in sleep to make sure she was breathing, agonizing over what ifs, she just showed up. She existed.

It's something animals do by nature of not being contemplative beings. They show up. They just do. They accept. They live in the world. Snore, snore, snore...BIRDS! Snore. Eat...CHASE OTHER CAT. Snore snore .... SCRATCH! No sitting around saying "Gee, I wish I didn't have to have shots, or pills or puffing." Once I gave up worrying that I'd open the door and find she was curled up lifeless somewhere, I began letting go. I started being in the world again instead of living in some made up future where a terrible thing happens. Terrible things can happen anytime, everyday and we will waste our lives worrying about something that doesn't yet, or may not ever exist.

God speaks to each of us as he makes us,
then walks with us silently out of the night.

These are the words we dimly hear:

You, sent out beyond your recall,
go to the limits of your longing.
Embody me.

Flare up like flame
and make big shadows I can move in.

Let everything happen to you: beauty and terror.
Just keep going. No feeling is final.
Don’t let yourself lose me.

Nearby is the country they call life.
You will know it by its seriousness.

Give me your hand.
—Rilke’s Book of Hours, I, 59

Hear Joanna Macy read this

Cats do that naturally. We can learn from them. It took me hearing Joanna Macy to put it into words. But I know one thing. It is truth. So as diabetic cat parents, lets just show up. Let's gather data through testing, give our shots, feed the best we can and be present. Let's keep showing up and letting go of living in some possible future in order to live today.

Dear Mom

Sometimes, you have to let your cat be a cat. One of my favorite things off the Feline Diabetes site.

Dear Mom,

I know it's only been a couple of days, but there are a few things I'd like to tell you.

First of all, you really do have to calm down, because you're stressing me out.

Please at least let me get all the way out of the litter box before you start to inspect it.

Don't stare at me while I'm eating. It makes me nervous. I need a little privacy please.

You really don't have to follow me from one room to the next. I'm not doing anything that I haven't done a million times before. I'm still trying to catch those pesky fish that live behind the glass. I'm chasing the dust bunnies under your desk. I'm waiting to catch Libby (drooler) off guard so I can smack her and run. I'm doing all those catly things I've always done. I don't need a perpetual audience.

Just because I'm sleeping, doesn't mean that you need to wake me up and check on me every five minutes. I'm a cat. I sleep.

I feel hot because I've been lying in my favorite sunny spot in the office. Yes, that really is the only reason.

I know it would make you feel better if I slept in your bed with you, but it wouldn't make me feel better. I've never done that before, so it would feel funny to start doing it now. Besides, I really like my bed. I've had it a long time, you know.

It doesn't mean that something is wrong with me just because I don't want to play. Don't you remember the rules? When you want to play with me, I want to ignore you and treat you with disdain. I want to play with you when you are reading the newspaper or attempting to drink your first cup of coffee. This has always worked for us, so why would I want to
change that now? So if I don't want to play with you, it doesn't necessarily mean that I don't feel good. It means that I'm just being the Rainbow I've always been.

Stop lecturing (boyfriend) every time you leave the house for five minutes. He has read everything you have. He was there at the vet's when you picked me up. He knows all the signals/symptoms of hypo, and he knows what to do. He knows where the syrup is. How could he not, since it's now in every room in the house. Remember when you told me that you would trust him with your life? Well trust him with mine. He loves you, and he won't let anything happen to me.

You know that pounding headache you've had since last Sunday? It might go away if you'd chill out just a little bit.

And lastly, every single sound I make need not be analyzed for meaning. Just because I speak to you, it doesn't mean I'm sick or hurting or getting ready to go hypo. I've always been a very vocal kitty. Sometimes a meow really is just a meow.

Love,

Your Sugar Cat

---

Written by Laura and Rainbow. We couldn't agree more with its sentiment.

Insulin Primer

Confused?

I don't blame you.

There are several types of insulins that may be prescribed by a vet for your cat's diabetes. On FDMB we sometimes see really strange advice from vets and we see newly diagnosed cat's parents confused about what they just brought home. You can find a more involved primer on Feline Diabetes which I highly recommend you read when you are calmer. But for a short, sweet rundown, here is a short, sweet primer:

Humulin R - Extremely fast acting insulin. Used usually only as a bolster for a cat with unusually high hard to drop numbers in conjunction with another insulin or for ketone cases AT the veterinary's in an effort to get a drop as one part of helping with ketones in DKA. EXTREME CAUTION. Experienced and RARE, CAUTIOUS use only. Only active for about 3 hours but causes FAST drops. Any vet prescribing this should be considered extremely suspect in their experience of feline diabetes (or any diabetes). Use as a bolus should ONLY be undertaken by an extremely experience user and extremely carefully. Very rare need. There, did that scare you? Good.

If the vet gave you this I cannot emphasize enough to find a new vet. This is NOT an insulin that should be prescribed to a new owner. Or actually for anything other than the rarest of circumstances.

Pearl says you may proceed now.

Humulin N (u100)- Often prescribed by vets who may not be used to using newer synthetic insulins or used to treating feline diabetes. Longer lasting than R but tricky for cats. Cats process insulin pretty quickly so this insulin usually has a quick onset and hits the nadir in about 4 hours. MUST be given after feeding because it is fast. Some cats do well on it, usually when a cat parent can really test, monitor and get to know how the cat eats and processes it with the food. Can be used but it's, I think, finicky to use in a cat.

Here is a good primer on how to use with your cat's diabetes. Many cats, it's just not enough. Since it is out of the system eight hours or less, even twice a day dosing is probably going to leave your cat without enough coverage at least half of a day. Also, if you have a vomiter, can be really tricky and leave you worrying about hypo if you can't get the cat to eat again. Or if the cat vomits and you've left for work, again you risk hypo with no one at home to help. Would not ever be my choice of insulin but it works for some.

Vetsulin (u40)- This insulin had some major manufacturing problems several months ago and even the manufacturer sent notices to all vets to change to other insulins. I don't know if they fixed it but it was never great for cats as it was a dog insulin. Vets used it for lack of other insulins but honestly, almost no cat did well on it. If a vet has some lying around and gives it to you, insist on another insulin or find a new vet.

PZI (varying strengths - check with vet and vial) (Protamine Zinc Insulin)- There are only two sources now that I am aware of that produce this insulin. There is BCP PZI by a compounding pharmacy out of Texas. We used this a while. It works better in some cats than others. I didn't find it to be the best for Pearl. Longer lasting than N, probably 5 to 6 hours to nadir, so around a 12 hour cycle. Many vets are leary of it because it is pounded in their heads that compounded insulin is inconsistant. I don't know for sure that is true, but this insulin is more affordable than the other PZI and some cats do great on it. Service in our experience was terrific and fast fast fast. May be worth a try for some. There is also the new ProZinc that replace the Idexx PZI (which was, indeed, a very consistant, good manufactured PZI but was discontinued by the manufacturer for .... well, reasons that are debated). I don't know much about it. Never used it. More people are coming home with it. I'm sure it's pricey but probably works fine. Again, testing and knowing your cat will be key to success as with all insulins. If a cat is not doing well on it, a switch to one of the following insulins should be considered.

Lantus (glargine) (u100)- An excellent long last insulin. This insulin is often great to use, especially in newly diagnosed cats. This insulin, with careful blood monitoring at home with a glucometer and a switch to low carb we food can often result in remission for many many cats. IMO, some vets do not realize that the Queensland protocol says to dose by ideal weight, not the current weight of the cat, resulting in beginning doses that are too high. Nothing against them. Vets are not all versed in specialties, but they do miss this. Not only does beginning with a too high dose risk a hypo of a cat under a new, inexperienced parent but it could also cause chronic rebound which the vet then sees as "not enough" reaction from the insulin and they increase the does, compounding the problem until one day a crisis point is reached and the cat bottoms out and hypos or has other problems from the high blood glucose numbers. In my opinion, the *best* starting dose for any insulin is to begin on the low side and increase. This protocol is very good at describing how and when to change doses in conjunction with home testing.

The awesome thing about lantus and the following insulin, levemir, is that they have a long, slow effect on blood glucose numbers. Instead of the sharper V shaped curves of the shorter insulin there are nice gradual lowerings, in more of a shallow U form. This means, once you get experienced at using this, you can often get a cat on nice mid normal range numbers form most or even all of the day. This is also probably why remission can happen so well on it. It gives the pancreas the rest it needs to repair. The flip side of that is you MUST be testing or one day you could come home to a hypoing cat. Pearl did fantastically on this for over a year, but then did begin to have trouble. I don't know why, but I've heard of this happening with some cats. Others use it fine for years. We switched to the PZIs but then when levemir began being used and people had great results I finally switched to that. Lantus can be purchased in pens or cartridges

that can be used like vials but bring the cost way down because it is much more efficacious for longer.

Levemir (u100)- Uses the same protocol as glargine. Works similarly. I find it is more stable (I never have a vial poop out on me like I did with Lantus). Everything said above about how Lantus works applies here to. I love it. We get the pens:

(only pens, not cartridges, are available in the U.S. but they all can be used with syringes, just like a vial so it's all good), which while it is a higher cost outlay to do, lasts well over 5 months (unless you have a big gulp kitty (rare) or an acromegaly cat rare but less rare than vets have been saying. If your cat is needing ever higher doses of an insulin and the vets are puzzled, even if they say it's too rare to check out, check it out. Make them test. Especially if you have a cat that looks like it has kind of oversized features. It's just not as rare as many believe.) This brings the cost down to probably the most affordable insulin. In my opinion, also the best.

All insulins really require home blood glucose monitoring to get the best results. There is just no doubt about that. Even if your cat has been on insulin 10 years, test. Just the other day a cat who had been getting flat normal numbers on a certain dose of Lantus for YEARs had a hypo. The owner had grown lax in testing because numbers just stayed the same. The cat was in dire shape, her meter was dead and by the time she found batteries and tested the cat was down to a 19 mg/dl reading. That is DEADLY. She caught it in time and using the tools from a Hypo Kit and knowing how to treat a hypo her kitty recovered. Mostly a cat with that number and those symptoms needs the ER immediately!!! So, never doubt testing before shots, even when you get the same ol' same ol'. Treating your cat with insulin and not testing is not unlike, as some have said, driving with a paper sack over your head that has a couple of slits cut out. You may get along but you sure can't see any approaching dangers and your luck could run out very quickly and tragically.

I hope this helps some newly diagnosed parents figure out the mysteries of what the heck the vet just handed you and what it means.

Pancreatitis Sucks

It really does. Pearl has had bouts off and on for years, but they seem to get more chronic as she gets older. She has issues, as you know from the blog and I think we can add teeth to that, which doesn't help.

Major things to know about pancreatitis in cats is that 1) it's really common. Probably more common than is diagnosed and 2) vets are beginning to agree that pain management is probably a key thing in controlling it. Here are some GREAT reads to share with your vet if you are facing this issue. Yes, I know, Idexx has interests here, but the roundtable link is I think particularly frank and good. I'm always at war with my distaste for Big Pharma and my need for some of their products.

I keep pepcid a/c on hand too as it seems to help. (NOTE: ONLY regular pepcic/famotodine, NOT the complete or advanced kinds). This is one case where it is actually a good reason to use it for a cat. Some people jump on it too quickly but I don't think you can for panc attacks (or as I accidentally texted to my sis "pancake attack").

Luckily, the last bad attack, my vet gave me two little vials of buprenex for pain so I had some on hand which was great at 3 a.m. when she was yowling from discomfort. It's easy to give, tasteless and seems to provide great comfort quickly. Sometimes vets are very cagey about giving that out though. Some don't even have it. If you have a pancreatitis prone kitty, see if you can get your vet on board with having a little vial on hand for emergencies. I can only offer luck there on your relationship with your vet.

One thing I have learned from many people with pancreatitis prone kitties is that food is in the category of "Each Cat Is Different" or ECID. What works for one may not work for another. For Pearl, w/d by Hills works pretty well. It's not a great food, IMO, as many but when she gets poopy and pukey it usually helps. I also like to get her Earth's Best Chicken and Brown rice or Chicken and Squash baby food. For her low fat, high fiber helps. But you may have to experiment. You can find lots of info in the FANTASTIC JANET AND BINKY'S FOOD PAGE.

Water, water, water. De-hydration makes you feel YUCK anyway. It will add to the situation here, so try to get them that water anyway possible.

Well, for what it is worth, there are some tips. Good luck to anyone searching "cats" and "pancreatitis". I feel for you and your kitty.