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Update on Nikki (LONG, medical ramblings)

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Marina - 19 May 2005 05:23 GMT
Yesterday, Nikki had a violent coughing attack, then threw up and was
unsteady on her legs for a moment, then gasped for breath a few times
before she seemed back to normal. I called TED and talked about the
situation with her. I told her I'm not happy with giving Nikki
Prednisone every day. She called in a prescription for another drug with
the active ingredient theophylline (the brand name here in Finland is
Retafyllin, but it's manufactured by a Finnish company, so probably not
known by that name elsewhere). It's supposed to relax and open the air
passages into the lungs.

TED warned me that some cats can't take this drug, because they get
nauseous. It's been 12 hours now since I gave Nikki the first dose, and
she seems to be doing fine. I haven't heard a wheeze or cough out of
her. I talked to TED about inhaled meds instead of pills, but she didn't
seem to know very much about them. She recommended that I contact the
only cats-only TED's office in Helsinki, and that's what I've been
planning to do anyway. I'm going to wait and see what this new drug
does, and whether I can cut back the cortisone.

One problem with this pill is that you're not supposed to crush it. You
have to swallow it whole (or, in Nikki's case, half) to make the effect
last as long as possible. So, what I did was take Nikki in my arms, hold
her firmly, then pop the Retafyllin into her mouth and keep it shut for
a while. Then I popped in her Prednisone pill and held her mouth shut.
Then I gave her some turkeybird. ;o) I think she swallows both pills.

Both Frank and Nikki have stopped eating their meds mixed in sour cream
(they stopped shortly before Mere came to us). So lately I've mostly
mixed their hyperthyroidism meds into their gooshyfood. The drawback is,
of course, that I can't be quite sure that they get an equal amount of
their medicines, but I try to monitor their eating and make sure that
each eats about half of the food. They have separate bowls, but they
always have to check out the other bowl to see if the other one is
getting something better.

The pattern goes like this: I set down the two bowls. Frank comes and
eats from his own bowl, then from Nikki's bowl. Nikki sits off to the
side and watches him eat. When he's done, Nikki goes and eats out of her
own bowl. Then she eats out of Frank's bowl. Repeat until both bowls are
empty. They get the same dosage of the hyperthyroidism meds, so I'm
hoping they get about their fair share when they share the bowls like this.

Of course, now there's also Mere's plate to check out. Since Mere won't
eat catfood, but only fresh meat and fish, her food is usually veeeerry
interesting to the big cats. I try to keep them away but I can't be
there all the time to watch them. I give F&N their own share of fresh
meat every other day too, but somehow it just tastes better if it comes
from the 'baby's' plate.

Signature

Marina, Frank, Nikki, and Mere
marina (dot) kurten (at) pp (dot) inet (dot) fi
Pics at http://uk.pg.photos.yahoo.com/ph/frankiennikki/
and http://community.webshots.com/user/frankiennikki

Hopitus - 19 May 2005 05:50 GMT
Sincere purrs and meatloaf meditations for your two beloved companions to
get adjusted to revised pill/food
regimen. I know you love them dearly.

> Yesterday, Nikki had a violent coughing attack, then threw up and was
> unsteady on her legs for a moment, then gasped for breath a few times
[quoted text clipped - 44 lines]
> other day too, but somehow it just tastes better if it comes from the
> 'baby's' plate.
Karen - 19 May 2005 06:11 GMT
> Yesterday, Nikki had a violent coughing attack, then threw up and was
> unsteady on her legs for a moment, then gasped for breath a few times
[quoted text clipped - 44 lines]
> meat every other day too, but somehow it just tastes better if it comes
> from the 'baby's' plate.

Ohh. I hope that Nikki continues to do better. Poor girl :(
Jo Firey - 19 May 2005 08:23 GMT
I took theophyllin for my asthma for over twenty years.  Its much easier or
you than steroids.  The only real trick is getting the proper dose into a
cat. They used to check my blood levels fairly often.   Also it has a lot in
common with a good strong cup of coffee (which will treat a mild asthma
attack in a pinch) in that its a bit of a stimulant.

Jo
> Yesterday, Nikki had a violent coughing attack, then threw up and was
> unsteady on her legs for a moment, then gasped for breath a few times
[quoted text clipped - 44 lines]
> other day too, but somehow it just tastes better if it comes from the
> 'baby's' plate.
Howard Berkowitz - 19 May 2005 16:11 GMT
> I took theophyllin for my asthma for over twenty years.  Its much easier
> or
> you than steroids.  The only real trick is getting the proper dose into a
> cat. They used to check my blood levels fairly often.  

Yep. It has a lot of drug interactions that affect the level.  It can,
incidentally, interfere with the effectiveness of birth control pills
and anticonvulsants (well, they all can interact).

>Also it has a lot
> in
> common with a good strong cup of coffee (which will treat a mild asthma
> attack in a pinch) in that its a bit of a stimulant.

You are on the right track with coffee, since caffeine does have some
bronchodilating effects.  Tea, on the other hand, contains more
theophylline than caffeine. Strong tea is more likely to help asthma.
Victor Martinez - 19 May 2005 12:18 GMT
> Yesterday, Nikki had a violent coughing attack, then threw up and was
> unsteady on her legs for a moment, then gasped for breath a few times
> before she seemed back to normal. I called TED and talked about the

Lots of purrs for Nikki. I hope the new med works better and that the
new TED is able to help find a good solution.

Signature

Victor M. Martinez
Owned and operated by the Fantastic Seven (TM)
Send your spam here: uce@ftc.gov
Email me here: pistorLITTER@BOXaustin.rr.com

Howard Berkowitz - 19 May 2005 16:06 GMT
> Yesterday, Nikki had a violent coughing attack, then threw up and was
> unsteady on her legs for a moment, then gasped for breath a few times
[quoted text clipped - 5 lines]
> known by that name elsewhere). It's supposed to relax and open the air
> passages into the lungs.

First, hugs, regular purrs, and special purrs from Mr. Clark, who is
both head nurse and top sergeant around here.

Theophylline is an old asthma drug, but still useful. It probably makes
more sense in veterinary practice, since many of the best human meds are
inhaled, much more difficult to do with cats.  

Theophylline is of a chemical group called methylxanthines. Caffeine is
the best known of these, the other two naturally occurring ones being
theophylline and theobromine.  Tea, rather than coffee, contains a good
deal of theophylline. Theobromine is more found in chocolate.

> TED warned me that some cats can't take this drug, because they get
> nauseous. It's been 12 hours now since I gave Nikki the first dose, and
[quoted text clipped - 4 lines]
> planning to do anyway. I'm going to wait and see what this new drug
> does, and whether I can cut back the cortisone.

There are a couple of other things in human medicine that might be worth
considering -- but definitely get an opinion from a cat specialist.  
Sometimes, you can reduce the side effects of prednisone by giving it
every other day, doubling the dose but allowing the body more time to
recover. Another approach, which I don't know if it works in cats, is to
supplement prednisone with very low doses of the anticancer drug
methotrexate.  The combination uses lower doses of either than if done
alone.

Again not knowing if they are used in cats, another class of fairly
recently reduced oral drugs for asthma are leukotriene inhibitors, such
as zafirleukast.

> One problem with this pill is that you're not supposed to crush it. You
> have to swallow it whole (or, in Nikki's case, half) to make the effect
> last as long as possible.

It's usually given as a 12-hour time release tablet.

>So, what I did was take Nikki in my arms, hold
> her firmly, then pop the Retafyllin into her mouth and keep it shut for
[quoted text clipped - 24 lines]
> meat every other day too, but somehow it just tastes better if it comes
> from the 'baby's' plate.
Irulan - 19 May 2005 19:18 GMT
Poor Nikki, we will purr and pray that she starts feeling much better soon.
Jazz & his mama

Signature

Irulan
from the stars we come
to the stars we return
from now until the end of time

> Yesterday, Nikki had a violent coughing attack, then threw up and was
> unsteady on her legs for a moment, then gasped for breath a few times
[quoted text clipped - 44 lines]
> other day too, but somehow it just tastes better if it comes from the
> 'baby's' plate.
Kreisleriana - 19 May 2005 21:24 GMT
>Yesterday, Nikki had a violent coughing attack, then threw up and was
>unsteady on her legs for a moment, then gasped for breath a few times
[quoted text clipped - 44 lines]
>meat every other day too, but somehow it just tastes better if it comes
>from the 'baby's' plate.

It just almost stops your heart when this happens out of the blue, to
your healthy, *older* babies  Purrs that she feels better soon.

Theresa
Stinky Pictures: http://community.webshots.com/album/125591586JWEFwh
My Blog: http://www.humanitas.blogspot.com
Shiral - 20 May 2005 01:25 GMT
Marina wrote:  I try to keep them away but I can't be
there all the time to watch them. I give F&N their own share of fresh
meat every other day too, but somehow it just tastes better if it comes

from the 'baby's' plate.

EVERYTHING tastes better from the 'baby's' plate. ;o)  Except that for
Francesca and Nina, everything seems to taste better if they steal it
from Unka Pan.

I hope Nikki is soon back in form, and that the coughing and wheezing,
poor girl.  She has  a kitten to educate, after all.

Melissa
Sam Nash - 20 May 2005 03:32 GMT
<snipped>
No helpful advice I can offer, but purrs for all on the way across the Pond.
Sam, closely supervised by Misteltoe
Adrian - 20 May 2005 11:46 GMT
Purrs for Nikki, I hope the Retafyllin helps.
Signature

Adrian (Owned by Snoopy & Bagheera)
A house is not a home, without a cat.

Margaret Fine - 20 May 2005 20:37 GMT
> Yesterday, Nikki had a violent coughing attack, then threw up and was
> unsteady on her legs for a moment, then gasped for breath a few times
[quoted text clipped - 44 lines]
> meat every other day too, but somehow it just tastes better if it comes
> from the 'baby's' plate.

Purrs and tail wags that Nikki is feeling better soon.  I know the
routine of "it tastes better if it comes from HIS plate."  I've used it
against them when I really needed to.  Picture a big dog trying to eat
the cat food "accidently" left out in a teeny tiny kitty bowl.  :-)

Signature

Margaret Fine
mefine@mindspring.com

Christine Burel - 21 May 2005 00:32 GMT
{{{{Marina}}} Being the caregiver of older kitties can be so hard.  I'm
sorry for all the difficulties you're having with Nikki's meds (and Frank,
too).  Do any of their meds come in a liquid form or is there some
possibility of compounding them via a pet pharmacy?  Purrs for you and for
them.  Is Nikki on a high dose of Prednisone?  My RB cat Frodo had to take
prednisone for several years due to some liver problems but he wasn't on a
high dose and the only side effect he had was it made him thirstier.
Thinking of you,
Christine and Omar, Oreo, Midnight, Robin & Tucker
> Yesterday, Nikki had a violent coughing attack, then threw up and was
> unsteady on her legs for a moment, then gasped for breath a few times
[quoted text clipped - 44 lines]
> meat every other day too, but somehow it just tastes better if it comes
> from the 'baby's' plate.
Howard Berkowitz - 21 May 2005 02:25 GMT
> {{{{Marina}}} Being the caregiver of older kitties can be so hard.  I'm
> sorry for all the difficulties you're having with Nikki's meds (and Frank,
> too).  Do any of their meds come in a liquid form or is there some
> possibility of compounding them via a pet pharmacy?  Purrs for you and for
> them.  Is Nikki on a high dose of Prednisone?  

This is something I've wanted to research in more detail, but apparently
cats are more tolerant to corticosteroids (prednisone's family) than
humans.  With people, a two-week or so course of oral corticosteroids
usually has few side effects. Very often, the course with people starts
with a high dose and then gets reduced every 3 days or so.  In general,
however, long-term oral or injected corticosteroid therapy in humans has
risks. These risks are often very justified for any number of serious
diseases. One of the considerations, incidentally, for humans, and I
would expect cats, is that if the patient has been on long-term
corticosteroid therapy and needs surgery or is highly stressed, they
MUST get supplemental drugs.  One of the effects of long-term therapy is
that it suppresses the ability of the adrenal glands to make certain
hormones for dealing with stress.

Even a 5-10 mg daily oral dose needs care with people. One of the very
nice things is that corticosteroid asthma inhalers, which can deliver
huge concentrations to the lungs, simply have no significant absorption
in adults, and may have slight absorption in children.  To some extent,
the prednisone dose depends on body weight.

So, when a 5 kilogram (11 pound) cat gets 5 milligrams daily, it's
interesting to realize that 5 mg of prednisone would have noticeable
effects in a 100 kg human. 100 mg of prednisone is considered a high
dose in humans, and will likely have lots of other side effects.  Yet,
by weight, 5mg in a cat is equivalent to 100mg in a human.

Yes, you can get prednisone as a liquid. It may need to be compounded,
or it may be worth checking if the vet will give you a different
corticosteroid available in a pediatric liquid form. The latter would be
much cheaper.

You can't mix most drugs into the predisone solution, but what works
quite well with many drugs is to draw the first drug into the syringe
(assume you need 1 ml of each). Draw the prednisone solution up to the
1ml mark, and draw the next drug up to the 2ml mark.  That way, you can
squirt them in together.
Howard Berkowitz - 21 May 2005 02:26 GMT
Just one other thing about prednisone -- I've just taken it as a pill,
but when a little of it caught in my throat, it was EXTREMELY bitter.
Solutions really should be flavored. Clifford (RB) liked tuna, and, for
only cat reasons, the strawberry-cream flavor used for amoxicillin.
Marina - 21 May 2005 04:51 GMT
> {{{{Marina}}} Being the caregiver of older kitties can be so hard.  I'm
> sorry for all the difficulties you're having with Nikki's meds (and Frank,
[quoted text clipped - 4 lines]
> high dose and the only side effect he had was it made him thirstier.
> Thinking of you,

Thanks, Christine. Nikki gets half a pill of prednisone (2.5 mg) per
day. I think that's a pretty high dose. The thing is, it seems to me
that she feels a bit bloated, as if she's retaining fluid. AIUI, that's
a common side-effect with prednisone. Of course, it may feel that way
because I've become used to carrying skinny little Mere around, and
Nikki is so much 'fluffier' than her. I can't be quite sure. I'd be
happiest if I could just get her off the prednisone completely.

About the pilling; Dan has very kindly offered to send me some treats
that open up and you can put a pill inside. I've read about them before,
and looked for them here, but haven't found them. If Dan sends me a
packet, I could take it to a pet store and show it to them, and maybe
get them to order some for me. Or maybe even the vet would do it.

Signature

Marina, Frank, Nikki, and Mere
marina (dot) kurten (at) pp (dot) inet (dot) fi
Pics at http://uk.pg.photos.yahoo.com/ph/frankiennikki/
and http://community.webshots.com/user/frankiennikki

Howard Berkowitz - 21 May 2005 06:41 GMT
> > {{{{Marina}}} Being the caregiver of older kitties can be so hard.  I'm
> > sorry for all the difficulties you're having with Nikki's meds (and
[quoted text clipped - 16 lines]
> Nikki is so much 'fluffier' than her. I can't be quite sure. I'd be
> happiest if I could just get her off the prednisone completely.

Trying not to get too chemical, corticosteroids have two classes of
effect: glucocorticoid, or anti-inflammatory, and mineralocorticoid, or
water-and-salt retaining.  There are conditions where high
mineralocorticoid activity is useful, but generally, the drugs are used
more for inflammation.  

The drugs also vary in how much anti-inflammatory action they have per
unit of weight. With an oral drug, you can just give more pills, but in
a skin cream, an inhaler, or a joint injection, you are limited in the
volume you can physically apply, so the most potent drugs tend to be for
skin application.

As the anti-inflammatory potential goes up, and usually the potency per
weight, the water-retaining properties go down. If prednisone, a medium
potency and inexpensive drug causes water retention, ask your vet if you
might switch, say, to dexamethasone or beclamethasone. These are still
fairly cheap, but will cause less water retention.
polonca12000 - 21 May 2005 18:13 GMT
Lots of purrs and best wishes for the new medicine to work really well and
for both Nikki and Frank to take just the right amount of their thyroid
medicine,
Signature

Polonca & Soncek

> Yesterday, Nikki had a violent coughing attack, then threw up and was
> unsteady on her legs for a moment, then gasped for breath a few times
[quoted text clipped - 44 lines]
> meat every other day too, but somehow it just tastes better if it comes
> from the 'baby's' plate.
 
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