spiral

Coolidge, my companion cat of 15-1/2 years: we’ve gone through some rough diagnoses together. We’ve kept each other comfortable. I’ve treated his diabetes since 2006, and he’s purred at my side and diminished my discouragement since my diagnosis with Addison’s disease in 2007. Now he has also developed hyperthyroid. It seemed a simple thing to regulate—just a very small half-pill, morning and evening.

But the methimazole was treacherous. My cat stopped eating. The pill form of the drug can cause inappetence. He refused any and all low-carbohydrate canned foods he had eaten before the hyperthyroidism arrived. This was especially frustrating because kibbles jack up his glucose so much. I fought back with gradual increases in his insulin. Untreated, his thyroid would blow up his heart. Surgery and radiation aren’t thinkable at his age. Better to stay with methimazole and chase down the glucose numbers.

My vet and I decided it was worth the additional complexity to ditch the pills and go with transdermal methimazole, which doesn’t have the liabilities of the pill form, but it doesn’t have the simplicity, either. This formulation is prepared by a compounding pharmacy. I have to syringe a small amount of the medication into my cat’s ear. It resolves inappetence and GI issues in most cases, but the pills are normally prescribed first because they’re so much simpler to administer. If this would resolve his increased glucose levels, and even more critically, restore his appetite, it would be worth everything.

Inappetence in a diabetic cat can quickly bring on hepatic lipidosis—it took Coolidge only four days back in 2006— and a feeding tube was necessary for nine horrible weeks that summer. Pancreatitis also menaces the inappetent diabetic. And, obviously, so does starvation. So initially we fed him kibbles and the most wholesome treats we could find. They were like junk food, full of carbs, but they were the best food in the world, because my cat would eat them.

I broke into sobs the next morning when the heartless glucose meter read 372. It was 365 the previous evening, after Coolidge’s first transdermal dose. I have a low tolerance for slow progress.

My vet wanted me to try a diabetes management kibble, Purina D/M. I picked up a bag this morning, along with two cans of D/M, in case he might still transition back to the lower-carb canned form. Coolidge is finicky, but by God’s merciful grace, he tucked into the D/M kibbles with renewed alacrity. He snubbed the canned D/M, but at least he can get off the high-carb kibbles. Not only did he eat a small but sustaining portion, which in itself was enthralling, but his evening glucose was only 95!

There’s a reason this chow costs $34 for a six-pound bag. It’s the only Hail Mary trick I have left. Time—I hope not much time—will tell whether the transdermal formulation will restore Coolidge’s appetite and lower his glucose to more tenable levels on the diabetic spectrum.

My cat’s diseases are necessarily complicated because they interact. You can’t treat any of them as a discrete circle, stack the circles, and celebrate a series of victories; you have to chase them through a pernicious spiral formation. You always end up in a broken ring. It’s like Mutually Assured Destruction, only it’s Assured Destruction of Patient. That is because all patients are mortal beings; there was a Fall, remember? And now all creation groans under the sentence of death. It sucks, but it is what it is, and for the very most part it is very beautiful and very wonderful. Still, there are snakes in every paradise.

I can’t know how long Coolidge or I or anyone else has to live in our unique assigned spirals. All I can know is that I’m throwing metaphorical hail Mary passes and we’re keeping each other comfortable, as long as there’s a goal post left standing.

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