Dam Quail

I'm glad to report that Mungo continues to improve. He's been getting neem bark tea once every other day, slippery elm gruel with water chasers two or three times a day, and is eating the Merrick Thanksgiving Day Dinner and Grammy's Pot Pie in turns, with good appetite. He has not been tolerating sub-cutaneous fluids very well, though; he's been bolting on me mid-drip and complaining a lot before and during. I don't know if it's scar tissue at the needle site or irritation around his torso from where the fluid collects under his skin, but I made him a deal that if he kept eating and going twosies and generally lookin' good, I'd tentatively reduce his fluids to every other day... in exchange, he'd have to sit still for two entire units each time and also put up with me giving him extra water by mouth on off days. Dr. M doesn't know about this blog and he'd tear me a new one if he saw that I was easing up on the fluids, but this has become a quality of life compromise. Let's just keep it between us, shall we? And I promise you and Dr. M and the surly orange cat himself that I'll start sticking him every day again as soon as he starts to lag.

Cats with kidney disease need special diets, and while there is an ongoing debate about low-protein vs. regular levels of high quality protein, it's generally agreed upon that the KD diet must have reduced phosphorus, which the kats can't eliminate properly. Generally, this means little to no fish and mostly chicken or turkey formulas of wet food, which are typically lower in phosphorus. Ultimately, it's a balance between what is within the acceptable range of nutrients and what the cat will eat, since inappetance is one of the major problems with feline KD. After Mungo stopped eating the one brand of prescription kidney food he'd been tolerating (Royal Canin LP), I went to a local pet boutique several weeks ago in search of premium foods to try enticing him with, which is how I discovered the Merrick. I'd heard about the grain-free theory for cats, and picked up an assortment of grain-free cans, including Evanger's Turkey and Butternut Squash (which we'll be trying again), Merrick's Grammy's Pot Pie and Turducken (former popular, latter Not So Much), and the Merrick Before Grain foods, which contain nothing but the meat listed on the label; I got the BG turkey and quail, and Mungo seemed to go for the quail in such a big way I ordered piles more of it for him from PetFoodDirect. Only basic fat/protein info is listed on the label but I assumed that quail, being poultry, must be like chicken and turkey and thus a good low-phosphorus choice. And you know what they say about assuming... though in my defense, most of you would have thought that too, right? Turns out all squab is not the same.

Last week I requested nutritional data from Merrick on all their foods, hoping to find more suitable entrees to broaden Mungo's culinary horizons so he wouldn't get bored with the few things he was gladly eating. I got a great spreadsheet-style summary of the nutrient breakdown back from Merrick customer service today, and lo and behold the quail is THE highest-phosphorous food in the list! Far and away, too, much worse than the salmon and tuna. I hadn't looked into quail but apparently they have some sort of special need for calcium and phosphorous and have evolved a system that metabolizes these two minerals with high efficiency. Quail breeders feed their stock a diet high in C and P, and the meat and eggs are high in both.

I am still learning how to read all this stuff... the calcium to phosphorus ratio is also important, and you sometimes have to convert As Fed values to Dry Matter using the moisture percentages, and when I get a handle on what the numbers mean (with the help of a slide rule and a box of NoDoz) I'll be sure to share it here. But one thing's for sure, the levels of calcium and phosphorus in the quail are simply way too high for a kidney cat, and really any older cat, to be eating.

Anyway, Mungo started shirking the quail on his own recently so I guess that's good. Maybe his instincts told him he felt crappy after eating it, maybe he just got tired of it. Now I have to find someone locally who's maybe fostering kittens and lactating momma cats, since according to this article the quail would probably be excellent nutrition for those stages of cat life.

Speaking of kitten fostering, lalalaurie over at The Itty Bitty Kitty Committee made my day by posting about poo. Which means I'm not an isolated nut case for writing about Mungo's poo the other day! Still a nut case, just not an isolated one. Small blessings etc. etc. If you haven't visited the IBKC you should do so with all haste. It's one of the few things in life that restores my faith in my own species while completely gratifying my love for Felis Catus. Plus, she has a fantastic eye. The color and composition alone are worth the price of admission, even if you were not subject to incapacitation by a need to Keeeees Eeeeeeet! when you see photos of adorable smalls. And if you're not, what the hell is the matter with you?!? Is freon coursing through your veins?

Tomorrow, Manwich hits the scales. Stay tuned.

Water Boy

Last month, I got sick for a couple of weeks and Mungo went almost five whole days without getting subcutaneous fluids, which he was supposed to be getting about every other day. I almost coralled him up to do it a couple of times but he was eating well and seemed comfortable, and at that point we were still having trouble making ourselves do it at all. The idea of stabbing him in the back with a needle made us both so anxious it made Mungo anxious too, and that made him very vocal about the needle insertion, much more so than I'd seen him be when getting fluids at the vet. I supposed I was doing a bad job of it, my husband felt it was cruel (even if it does make Mungo feel better), and so we were both avoidant of the duty.

Then he started having severe trouble pooing, as mentioned, and also started vomiting again, which had not been much of a problem since the thyroidectomy. He had been eating Royal Canin Feline LP packets (wet kidney diet) with relish, but had stopped eating those altogether and become very picky just before this. Poor Mawich got an enema at the vet that didn't help much, and after a day or two with dark stools and vomiting he was diagnosed with a GI bleed. Dr. M recommended Pepsid AC but I knew that neem worked well for Mungo's acid stomach in the past, so I went that route, with quick results. I also started giving him slippery elm gruel, which is not as strange as it sounds; a good page on its use for cats can be found here. Mungo gets a large dropper of each daily, neem bark in the AM and slippery elm in the PM, with a delay after both before giving food to allow it into his system. Though it was a rough week or so poo-wise for everyone concerned, he gradually improved.

He also had to start getting sub-cutaneous fluids every day at this point, and for about three weeks did very well on this routine. We started warming up the bags and wrapping him in a warm towel out of the dryer and it got so I could even give him fluids by myself. In fact, to save money I ordered several sets of lactated ringer solution and lines and needles from Drs. Foster and Smith. I realize now how much faith I had that Mungo would live at least a few more weeks. Today I'm not so sure, but then we've been here before, and Mungo has so often surprised us in the past.

He has not been eating much these last two days and seems quite pained by the fluids now. I'm trying a smaller gauge needle (20 instead of 18) and it hurts him a little less going in but takes longer to get 2 units into him, and he seems to find the 'water-boob' that collects on his side uncomfortable, which is new. I guess I'd be getting tired of it too. We thought maybe he would require fluids less often if he put a little weight back on, but without eating enough that won't happen. Nothing appeals to him now except fish, which he isn't supposed to have anymore as it's high in phosphorous. And he is allowing only limited petting and cuddling.

He seems to be in pain, and that is the line I drew for myself on whether or not it was getting close to time for the final vet visit. So this may end up being a short-lived blog, after all.

Let's hope not, though.

Captain Neem-O

I am something of an herbal geek, and get excited when I find something particularly useful or interesting. I confess to being a spazz when it comes to neem. For years I had a vague notion of it as an agricultural product but had no further information on it until several months ago. Although many topical products, like creams and shampoos, containing neem have become more common, this very useful tree is still not well understood, at least in the US or maybe in the west period.

It bears repeating that I am not a health or veterinary professional and am not dispensing medical advice in this blog. I am only sharing my own usage experiences and relaying information about herbs and nutrition according to my own understanding.

Neem is an evergreen tree native to India and the surrounding region. It can thrive despite difficult and dry conditions, and resists pests, which begins to hint at its uses. One source of confusion about neem is that the three most commonly used parts are used differently.

Neem oil comes from the fruits and seeds of the tree. It is used agriculturally as a natural pesticide and on people (and animals) usually as a topical (not usually orally ingested) treatment for healing irritated skin and also repelling and killing pests, like lice and mosquitoes. It is also, like the other parts of the tree, antifungal and antibacterial. For these reasons, it is included in soaps and lotions for lice, acne, eczema and other skin irritations. It smells absolutely awful in its pure form, but I have found it very useful for cats who have irritable skin in the summer from fleas or have bad skin reactions to the pharmaceutical flea drops that are usually applied between the shoulders. I put a few drops of neem oil in the same place on two of my cats about once a week, with good results.

Neem leaf also has pest repelling properties, and the dry ground leaves can be sprinkled in the garden to inhibit pests and fungus. It is also used for stomach upsets and to calm hypertension and racing heartbeats. Neem leaf is available in capsule and gelcap form and I personally discovered that it was as effective as omeprazole (generic Prilosec) without side effects and is less expensive to boot, for my acid reflux. Whole dried leave are available, which can be boiled for a tea, which can be used internally or externally. The tea is bitter tasting, but I've used it as an eye wash for cats and as a way to administer it orally to cats, for example Mungo (who cannot be pilled in the same way that Houdini could not be held by chains. I would give him the miniscule gelcaps and rub his throat and chase it with dropperfuls of water and still I would find the thing an hour or so later by the food dish or on the floor, all earning him an additional nickname of "McMurphy".). Neem leaf extract is also available in an alcohol tincture but these are, I learned the hard way, not a good idea for animals More on this as I describe Mungo's experiences below. Acording to the literature, an additional benefit of neem leaf is stabilization of glucose levels, which makes it a benefit to diabetics-however none of my human or feline family members suffer from this problem, so I cannot attest personally to its effects in this area.

Neem bark can be used internally the way neem leaf can, but has properties more specific to digestive disorders (with research demonstrating benefits to ulcers) and also has shown , in lab rats, the ability to inhibit thyroid function, which does not heal the cause of hyperthyroidism but can help treat the symptoms. Neem bark is also useful in dental hygeine, specifically for gum disease. Neem bark is harder to come by than the leaf and oil, but it is possible to order the powder in bulk and make tea or capsules from it. I have been giving it to Mungo lately instead of the neem leaf tea as it is more helpful for the stomach while being less objectionable in taste. I hope that neem bark will soon become more widely available in capsule form, like neem leaf.

When Mungo was having "Freakout Times" during his hyperthyroidism, I found that neem leaf invariably helped him calm down and reduced his vomiting. Trial and error taught me that making a tea of neem leaf and giving it by dropper was the easiest and safest way to get it into his system. He was never able to tolerate the thyroid pills (methimazole) Dr. M prescribed, fighting them violently and often choking them back up. The neem leaf alcohol tinctures also helped the hyperactive attacks but caused him to salivate horribly, and of course the alcohol was terrible for the latent kidney disease. The best treatment was the tiny gelcaps of 'supercritical' neem leaf extract, which did not need to be given as often as teas or tinctures. I didn't discover neem bark until later, after his thyroidectomy.

When Mungo's kidney problems resulted in a GI bleed recently, with dark vomiting and dark stools and constipation, I started giving him neem tea again, first neem leaf but then switching to the bark after a little more reading. It quickly reduced his stomach acids and his stools were back to normal in about four days. Neem bark seems to work very well for feline GI support and, though I didn't know it, is more suited to hyperthyroid problems as well. If I had it to do over again I would have used neem bark tea from the beginning with Mungo, instead of neem leaf. I certainly don't know that it would have made the thyroidectomy unnecessary but there's a chance it might have delayed the need for it, and been more tolerable for him to take flavor-wise.

For the last few weeks, Mungo gets about a 1-ml dropper of neem bark tea a day, and his eyes are washed once or twice a day with neem leaf tea warmed in the microwave for five seconds on a well-dampened tissue. The severe weight loss that accompanies thyroid and kidney disease can make a cat's eyes to get sunken and not drain properly, causing irritation and mucous buildup. The eye cleaning helps keep him comfortable, and since it no doubt reminds him of a maternal kitty tongue-cleaning he also seems to find it comforting.

Mungo also gets slippery elm these days, which will be part of another post. And he also took some proprietary herbal blends for cancer and hyperthyroidism early on, which I will discuss in yet another post. I wanted to talk about neem's various forms and properties in this particular post, as I have found it so useful and cost-effective for myself and for our cats, especially Mungo.

In Which an Improbably Resilient Feline is Diarized

This is my first blog, and yes, it is about a cat. Knowing my habits it will likely end up being about other things too, but primarily it is designed to share the history and status of Mungo, a neutered orange tabby now 18 years old and living with kidney disease.

Mungo has lived through so many health problems now it's hard to fathom how he's made it this far, except that he is too annoying (and it is to be admitted, Too Beloved) to pass quietly. Three or four years ago he had two tumors removed, one on his shoulderblade that was a benign but infiltrative lipoma, and a small, hard granular one on the top of his head that he obtained a somewhat indecent thrill from when rolled between the fingers (which came to be known as "The Erogenous B-B"). The B-B was malignant, but easy to remove. The surgeon believed the infiltrative lipoma would probably return, as it was difficult to excise, but it never did.

Last year, in spring 2008, I felt a sort of lump under his chin, and after a painful biopsy Mungo was diagnosed with lymphoma. Our wonderful and talented vet offered to treat him with chemotherapy out of the vet's office, an option that was significantly more affordable than driving him out of town for radiation therapy and easier to live with than doing nothing to treat it. Through treating Mungo in this manner, with a rotation of chemo injections and pills, he was actually blazing a bit of a trail and maybe helping other cats and vets form a treatment strategy for lymphoma. In truth, Dr. M's hopes for Mungo's recovery were probably not great--he was already 16 going on 17 and had signs of hyperthyrodism and impaired kidney function. And due to some scheduling delays a few months into treatment his chemo ended early, which almost certainly meant the cancer would return. But, like the infiltrative lipoma, it has not.

In spring 2009 when the hyperthyroidism became unmanageable, Mungo got a thyroidectomy, and as is often the case with older cats this caused his kidney function to worsen. Hyperthyroidism causes increased blood flow to the kidneys and other organs, masking and somewhat ameliorating any disease there. So, after the thyroidectomy he felt better for about a week and then began to decline again as the kidney disease took hold, and now he is in his own assisted living facility in the basement where I check on him several times a day and minister to his fuzzy needs. I give him subcutaneous fluids (something I thought I'd never do), wash his eyes, keep fresh towels for him, and smooch his poor deaf head whenever he will let me.

This caretaking has become a big part of my day, and so I blog.

Having always been interested in natural and alterative therapies, I have augmented Dr. M's excellent care over the last couple of years with herbal supplements, with varying degrees of success. I've learned a lot, tried a lot, and hope that my experiences taking care of this kitty might come in handy for others. I am not a health or veterinary professional and do not intend to dispense advice on this blog! This is just Mungo's story, and what has worked, or not, for him may not apply to your cat.

Manwich is but one of Mungo's many nicknames (it seems that most cats, like dieties and devils, are known by multiple epithets), and now that he lives on his own in the basement, separate by his own choice, he is sort of an island. So that's what that's about.

I know it must sound to some as if we are constantly reanimating a lifeless bag of cat bones, and I am sure most people would not have done what we have. It has been expensive, but not as expensive as some might think; it has been difficult, and I wonder now if I would have done it all over the same way, being wiser. We are childless, yes, by choice, but we are not the kinds of people who dress our cats up (Mungo is one of four) and plan to leave them control of our meager estate when we die. We have come close to asking Dr. M to make the sad pilgrimmage to our home and put Mungo down, it just hasn't seemed right. Maybe it never will, but I trust my own compassion to know when he is suffering too much to keep him with us any longer, and maybe knowing that time might not be far off is Why This Blog. Nothing like spreading the cheer of the heartrending decision to euthanize a beloved companion.

Mungo is not the sweetest cat, and that too may raise the question of why we go to these lengths. All I can say is; when he came to live with us, he had never been a lap cat, but (and forgive me being maudlin) one day he decided to let me be his mommy. He put his trust in me, and soon slept on the bed with us and nuzzled my hair with the barest purr. He tells me when something is wrong, though I can't always decipher what the problem is. But he trusts me to help him, to be his advocate and his voice.

Our other cats are much freer with their love, and that is not unappreciated. But Mungo's trust is rare, and hard-won. And I just don't want to betray it.

So let this be a tribute to Manwich, the brave and tough orange tabby, and maybe also a comfort to others who are caring for ailing pets. I will strive to keep the posts not-too-frequent, not-too-sappy, and substantive.

Manwich welcomes you to his island. Now go get him some grain-free quail, and be quick about it.