Cow Mau has been pawing a lot lately. His mouth pain has been getting worse. Yet, he tries his best to eat, which is really heart-breaking.
I’m at my wit’s end deciding on a suitable food because he paws even when I syringe liquid into his mouth. So I give him whatever he can tolerate, which ranges from Coco&Joe’s (not that I want to, but he wants it), Cindy’s canned food (with the meat broken up by a spoon – again, because he wants it), Cubgrub (he cannot tolerate this well for some reason though it has more water than Coco&Joe’s, so I don’t use this much for Cow), Cindy’s pureed food (even this makes him paw) and Aixia’s canned food (more liquid than Cindy’s).
This morning, I could not find Cow Mau at all in Bunny’s Place. I looked everywhere and feared the worst. Even calling him failed, I could not find him until I finally looked at the far end, covered by the big leafy plants – there he was, earthing himself on the soil. He didn’t come out to eat and when I did the pinch test, he was quite dehydrated.
So, a vet’s visit is definitely needed.
I also remember the senior vet preparing me when Cow was first diagnosed with congestive heart failure that eventually the heart condition will lead to kidney disease. There is no escaping it because when the heart does not pump sufficient blood to the kidneys, the nephrons will start to die. Cow Mau is already on Clopidogrel (a blood thinner).
I think his kidneys could be failing now, hence the dehydration.
I managed to get a 12noon appointment and off we went. I was lucky too because this vet on duty today is also a qualified acupuncturist. I think acupuncture helps in pain management too though it works slowly.
So the vet examined Cow Mau and I’m very grateful for her compassion. Based on Cow’s weight which is only 3.55kg today (he was previously 4kg), Cow has cachexia, which is muscle-wasting. This could be due to his heart condition, the FIV+ condition or even his kidneys. Or it could be old age as well.
For the dehydration, I am to do only 60ml per day (again, because of his heart condition, it cannot be more than this). So it’s daily for now, and if hydration improves, then it can be reduced to alternate day. I should also monitor is SRR (sleeping respiratory rate). So far it’s been find at around 20-24. The vet says as long as it is not 30 and above, it’s okay.
The vet explained that acupuncture can be done for pain management but it works slowly, so she normally couples the acupuncture with allopathic treatment which is a combination of 3 injections, ie. Vetacortyl (low dose steroids), Ketamine and Convenia (a long lasting antibiotic and this is for the infection in the mouth). I agreed. Anything to relief Cow Mau’s pain.
Vetacortyl is an aqueous suspension of 40mg/ml methylprednisolone acetate for injection. Methylprednisolone is a potent anti-inflammatory synthetic corticosteroid with prolonged systemic and local effects. It has marked gluconeogenic effects. The tendency to promote sodium/water retention is very weak.
The anaesthetic Ketamine is used to treat various chronic pain syndromes, especially those that have a neuropathic component. Low dose ketamine produces strong analgesia in neuropathic pain states, presumably by inhibition of the N-methyl-D-aspartate receptor although other mechanisms are possibly involved, including enhancement of descending inhibition and anti-inflammatory effects at central sites.
Cefovecin is an antibiotic of the cephalosporin class, licensed for the treatment of skin infections in cats and dogs. It is marketed by Zoetis under the trade name Convenia. It is used to treat skin infections caused by Pasteurella multocida in cats, and Staphylococcus intermedius and Streptococcus canis in dogs. Convenia is a fast-acting, safe, and effective treatment for common bacterial skin infections in dogs and cats. Just one injection, administered by a veterinarian, lasts up to 14 days. Convenia can be administered by a vet. The effect takes place as soon as 1-2 hours, but you may only see the outward effects after 1-2 days.
So Cow Mau started with the acupuncture. I was worried he would react by biting the vet, but he was quite under control today. The vet got the clinic’s best vet assistant to help too. The needles were all poked in the specific pressure points, even including the paws and face (surprisingly, Cow Mau allowed it all) and then we had to wait for 15 minutes.
That was a VERY long wait, but cats are extremely patient creatures so we must be too.
Two assistants were on hand to look after Cow. I was there too.
After the 15 minutes was up, all the needles were removed and counted, but of course three needles had already fallen off, which was fine as these were not in the “important” points.
Acupuncture treatment is quite holistic so it doesn’t just address the pain, but other wellness as well.
The vet explained that acupuncture must be done when the patient is awake as that’s when there is qi flow. The qi has to flow during acupuncture. For very fierce animals, it is sometimes done under sedation but this reduces the efficacy of the acupuncture treatment by a whopping 70%! This is because qi flow is drastically minimised when sedated.
Luckily Cow was okay with the needles and we survived the 15 minutes without any problems.
Spot the needles!
After the acupuncture, Cow was given the three injections. Only the Ketamine was a challenge as it’s acidic and a painful injection, but the pain was only during the injection and not after that. Just that 1 second.
The vet did not want to do any blood test as that might be too much or the day. I appreciate that very much. But I do have to collect Cow’s urine (if possible) so that proteinuria can be tested. If Cow is leaking protein, he needs to be started on Semintra. Then we know he has kidney disease. I requested for the urine SG to be tested as well when I manage to collect his urine. That should indicate if he has kidney problems too.
The vet added transdermal Tramadol to Cow Mau’s pain management regimen. The vet also asked me how I manage to feed him his Clopidogrel and Amlodipine; she could see how painful the mouth is. I said I just have to as these medications are important. I use a tiny bit of wet food to do it. He still paws, of course.
The vet also recommended 0.8ml of Vetri DMG daily to help boost Cow’s immunity (especially since he is FIV+).
So we came home after that and I still haven’t done his subcut yet. Will let him rest first, as the vet had advised.
One good thing is that Cow Mau immediately asked for food after coming back and he managed to almost finish his baby food.
I know the protein from the baby food is very low at 8%, but one thing at a time. The most important thing now is to manage his pain. Cow mau’s next acupuncture treatment is next week. It has to be done weekly.
I totally believe in pain management for palliative care. Why does anyone have to be in pain if modern medicine (or in this case, acupuncture) can reduce pain, right?
Even as far back as 2009 when the senior vet told me pointblank that our dog, Mac, was dying of multiple organ failure, he told me I could opt for painkillers but it might shorten his life. I said to do it. Mac didn’t have much time left, but let’s make that time as pain-free as possible. So Mac was given painkillers (I think it was morphine) and he remained happy and was eating well until he passed on peacefully many days later.
I was talking with a cat rescuer a few weeks ago and she disagreed with medication that can shorten lives during palliative care. Well, to each their own opinion. There is no right or wrong in palliative care. It’s just doing the best we can for the remaining time our loved ones have on this earth.
On the other hand, quite a number of people have written to me asking for suggestions on palliative care. I always recommend pain management. Eventually, they write back saying they are thankful they chose pain management too.