Q: I need help treating an impossible patient. Phoebe, 16 yrs, has been called fractious, but I prefer my sweet wild child - trips to the vet are heart wrenching and she has to be sedated to get any labs done. Watching her recover after sedation equally as heart wrenching. She has hairballs so a little vomit now and then is not uncommon but when it was just clear liquid I knew she needed to go. Her BUN was 45 creat 3.5, Na, K, Phos, Ca, H&H, WBC, RBC and all other labs WNL only choles 278 and glucose 183 where high. No personality changes, no problems eating, I do know now she does not drink enough. She has some slight wobbles in her back legs but still makes it to the top of her favorite perch 10 feet up with no problems. We are on 1/4 tsp miralax bid and I tried sub-qs - traumatic but I want to keep trying. I like your shebang method, my vet is not amenable to this method, can I get the supplies on my own? How would you structure at home treatment for her? It is not going to be easy to recheck her, any advice there? Should she get more protein than a kidney diet to keep her muscle? Is miralax ok to use daily? I also wonder about famotidine or if I would know if she was in pain…. On a side note, Phoebe has a sister (Molly, 16) I am treating for pyelonephritis/ckd but Phoebe does not recognize her when we come home from the vet - I've tried suggestions like rubbing Molly with common scents but still it takes weeks to reintegrate them - Phoebe does her best bruce lee / dracula combo - so far it's just noise but stressful, any thoughts there? It has been a rough month... Thank you for your advice!!

There are so many great things going on here that I don’t know where to start.  We can all learn from little Phoebe here...let’s go through a few things.

On being fractious:

Pheobe is fractious. BUT...how we respond to fractious cat is much to do with our state of mind. Pheobe’s person calls her the sweet wild child. This is all kind’s of awesome. Because we accept her the way she is - yet we hold out hope that things can change for the better. And with some time and effort, then can!


Vet trips can suck:

The vet trips are heart wrenching. Stressful. So of course people give up on bringing their cats into the vet. But Phoebe's person has a goal. Has a value system that says that going to the clinic is a bunch of lemon’s for my cat, but i'm planning on making the best lemonade ever. It’s completely possible when you start asking your cat the right questions about what they need during events like this. Cat’s like Phoebe get a trial run of gabapentin (night before and morning of their appointment) combined with a thundershirt if they are a responder to it. Very happy with that combo (always use more than one thing if possible) if our cats agree to it. It also helps if folks bring their cat in a carrier. Yes they might hate it. But some cats dislike open spaces and the uncertainty that brings even more. So you are picking your battles, and choosing the lesser of evils. But it’s ok if you decide not to come to the clinic. Lemonade isn't for everyone.  


On puking:

Pheobes person knows that puke isn't puke, isn't puke. After explaining why a puking cat could have a certain issue, many people I meet say “well she always pukes so thats not really a problem”. Ughhhhhhhhh. In my experience, cat puking isnt like math. It’s not like addition, so you do your normal puke, then your medical issue makes you puke, equals just more puke. Not at all. Sometimes, you puke the same amount, just for a different reason. And cat’s are full of these reasons, right? Sometimes the puke changes qualitatively. As Phoebe’s person is aware of.


On structuring the shebang SQ fluids (but your vet doesn't like it):

We vet’s are often conservative and creatures of habit. I once worked at a clinic and I asked to order 60cc syringes. The owner says “ahhhh..no”. Even before he knew what they were for. Because if he didn’t use them, then why on earth would anyone need them right? Cause the way I do things is fine after all. And I ain’t gonna change it. If it ain't broke, don’t fix it. Or maybe he was just really busy and preoccupied with something else. Or getting divorced. Or stressed out as a small business owner, which many vets are. I don’t know.

But I do know there is something called the D to C principle. And this will benefit our cats. People who have done my course (Stress to Success) will know this principle. It simply means you pivot from Dismissive to Curious (D to C). When your first instinct is to dismiss something, that is your cue to acknowledge it, and then get curious instead. When you get curious, you are going to discover the reason - the real underlying problem that needs to be solved for your cat. When you know this, you will understand if something is truly applicable for your cat or not.

Pheobe's person, even in an environment where something has been dismissed, is still curious on how she can make this work. This will give her cat the best chance that she is finding the way to give SQ fluids that her cat will agree too. The way to do it is to first put down the SQ fluids needle, and re-evaluate Pheobe. Like a lion or tiger trainer would. You can take wild child cats, figure out what makes them tick. Figure out what you would need to do if Phoebe was 400lb’s heavier, with wicked ninja skills. A true tigress. What you would do is figure out just her handling technique first. We would never stick her with the needle first. We want to know her preferences. What are her core requirements to allow her to become flexible with her behaviour, so she could learn new behaviours. We want to induce and promote flexibility and acceptance. And we want to do it in a way so a bond forms between the cat and the trainer.

This all might sound abstract, but it’s not. It’s just a learned skill set that most people can do for their domestic cats. Once you get their handling technique down, only then does a capped needle get picked up...and your not quite poking them yet. There are a few more questions to ask Phoebe before you get there. You can study handling and counterconditioning techniques but who has time for that - you can just follow the instructions on video # 14 found within my video series: http://iwillhelpyourcatcourses.com/stresstosuccess/

Most people can get off to the races in a few days, but even if it took you weeks, you are doing things in a way that respects the bond you have with your wild child.

In terms of where to get the syringes etc. - maybe your clinic will order you the equipment. Also check with online distributors.


On rechecking a cat who is hard to take to the vet:

Body weight. Get a baby scale. It can be inexpensive; it just needs to be accurate in the range of small babies and cats. If you cat’s body weight is trending downward, it’s recheck at the clinic time. Yes, as they get to grandma or grandpa stage, their body weight can naturally decrease, but just like puking, you need to know what is normal life stage weight loss, and when it’s not right. Declining body weight gives us less longevity. We know that for sure. So it’s something not to miss.

Then, try the gabapentin / thundershirt (insert your cat’s opinion about that in here with alternatives) technique to get your kitty into the hospital.


On protein in Phoebe's diet:

I call this “Phoebes’ choice”. She is a carnivore. She needs protein to build and repair her kidneys and body. I don’t protein restrict stage II CKD cats. When they are in stage three, we talk about it (as in me, the client, and the cat - we are all equal partners in this decision, right?). As protein goes up, phosphorous in the diet goes up. They are linked. She doesn't need the phosphorus, but she needs the protein. Some would argue that it’s really the phosphorus that is most damaging to them (and not protein per se). So I keep the protein moderate, but decrease the phosphorous. There are several ways to do this. Including the use of whole foods and phosphate binders that you add to the food. This is ideal.

If phoebe lost weight on a protein restricted food, but gained weight on a non-protein restricted food, then, I'm all about that bass, no treble. For me, body weight is a priority...so non restricted food it is. If her body weight was the same on both, and she ate the restricted food with gusto (especially if it had lower phosphorous levels), then it’s on the menu.


On famotidine:

Here is the test. You get it from your vet. If you give it for atleast a week. If appetite goes up or vomiting goes down, you have conclusive proof that it’s the right thing for your cat. If nothing much changes, then you keep it in your toolkit, because the day will come when you need to use it...because their body changes over time. If nothing much changes, some people still give it, because they like giving their cat the benefit of the doubt, if everything else about their cat supports it’s use.


On pain:

I am so overdue on writing about that. It will be a multi-part post. It’ll help out your wild child Phoebe.


Dr. Kris