Tag Archives: Coolidge
Coolidge isn’t easily impressed, and he’s really pretty indifferent to all other creatures, except the two of us in his immediate household whom he has graciously retained in his service these past 16 years. Notwithstanding his noblesse oblige, I was surprised he refused to give even a token glance to a 3-inch grasshopper who came calling, waiting to be greeted on the screen through which Coolidge surveys his holdings from his window hammock.
Moral of the tale: It’s not always that easy to make friends in friendly places.
It’s been a while since I’ve updated the Chronicles with a snapshot of how Coolidge (and his keepers) are faring as his diabetes and hyperthyroid conditions battle not only against my poor cat’s well-being, but appear to be engaged in a struggle for supremacy over his endocrine system. I suppose it could be compared to wars between nations. One side tries to wipe out another, never considering the disadvantage of mutual annihilation.
Coo’s thyroid came down to a glowing normal 3.3, using locally compounded methimazole transdermal formula I smear in his ear twice daily. My delirious joy was not durable. His glucose revived a trend we had believed defeated. He launched a new high-wire act. He was again capable of 12-hour glucose swings from 52 to 420. You can’t treat this sort of thing with any predictability. You stay the course. You email your vet a quick “any ideas?” with means and ranges. You are thrilled with relief to learn that a normalizing thyroid can up-end glucose values in a diabetic cat, that you are doing everything possible, and even to reduce the insulin a bit when he needs it, even when the number on the meter is huge and terrible (HAT). Sometimes Coolidge’s glucose is too low to give him any insulin. That almost always leads to a HAT number at the next check point. I don’t treat that number. I treat the condition. Eventually his numbers begin again to hover around his average. But my cat is not average.
I am thankful my vet has access to top-line experts at the College of Veterinary Medicine at WSU, and that she will confer with them when Coolidge throws an implacable turn.
He is a Cat, I need to remember, and Cats will duck predictability, dodge rules, and be quite cavalier toward your sleep rhythms, even if they have food, water, and everything they need, but simply feel like broadcasting at 1:28 AM, and again at 4:10 AM, in a nerve-frazzling yowl at 141 db. . .which, ultimately, must be what we adore about them.
If our embarrassed government decided to inaugurate Obamacare for pets, it could only aspire to operate on the caliber of the megapharmacy I’m now dealing with to procure Coolidge’s new prescription.
My veterinarian has researched thyroid formulations for Coolidge’s sensitive skin, and, based on past experience, decided to use an out-of town compounding pharmacy that features free overnight shipping. It’s an online megapharmacy serving humans and pets nationwide. All I had to do was call in my payment info so the pharmacy could have Coolidge’s prescription to us tomorrow.
I dutifully called the pharmacy this morning. I listened to the recorded menu instructions until finally I qualified to do something. I pressed “0” because I am a Pet Owner.
Twelve minutes of obnoxious wait music later, I began to wonder whether I was going to be making a free overnight call. But finally a friendly human voice displaced the muzak. The sequence is universal. First, the cat’s name, always. No one seems to worry about duplicates. Then our vet’s name, and lastly, my name. The friendly human voice belonged to Dominique. She found our vet’s name, but not Coolidge’s name or mine. This was not seeming to go well.
Ah, but our vet called in our prescription on Friday. The megapharmacy was closed Friday. They probably didn’t want customers to expect Black Friday discounts on their prescriptions. So the order would be among their voicemails, voicemails from all over the country, which, Dominique told me with some (but, I thought, not quite full) confidence, they would get to by the end of the day. Someone would call me for my payment info, and Coolidge’s new skin-safe thyroid meds would be in tomorrow’s mail.
Before heaving a sigh of phone fatigue, I realized I had said my vet “called” in our prescription. In point of technical fact, she faxed it. I use “called” interchangeably, but I suspect Dominique is more particular. Faxes are not voicemails, and I had led Dominique on the entirely wrong trail. In a nationwide megapharmacy, for all I know, voicemails and faxes are in separate buildings. Or it could operate out of some guy’s basement.
In my state of gumption depletion, I called my vet’s can-do person and asked her to please relay the correct information to Dominique. Doctors and their people get to press a number that by-passes the wait music and gets a knowledgeable human specialist on the phone right away. Mere pet owners must wait, and while they wait, they should be comporting their thoughts to the specialized language of megathings.
I have so much yet to learn, not only in treating my cat’s illnesses, but even how to give and receive information to and from entities the likes of which I have never dealt with before. It can be frustrating and discouraging, but it has come into my life.
Isn’t that part of what sanctification is—seeing that a customary way of doing things has been just wrong all along, and no longer works in a new life?
So now the patch of skin between Coolidge’s shoulder blades is ulcerated. I can no longer dose him there with the transdermal thyroid medication. There isn’t anyplace else he can’t reach.
He had been snuggling up for his insulin and the simple application of his thyroid medication to the skin on his back, but this morning he tried to bolt. I could see why. I dabbed the stuff around the perimeter of the shaved area. The center is a cluster of raised sores. I can’t stand it.
The compounding pharmacist will have to reformulate the delivery substrate. I thought of other possibilities: grind up pills and put them in a capsule so maybe the taste doesn’t make him inappetent again? Sugar water for the transdermal application? —it’s the carrier, not the drug, that’s causing the ulcers. A homeopathic remedy? Just to brighten the moment, my husband mentioned the anecdotal cure-all, mercury pills.
I’m not ready to concede that it’s checkmate. My all-time favorite scene in American cinema is the one in which Indiana Jones is confronted by a saber-swirling guy in harem pants. He watches the saber whirring around at eye-blink speed, gets bored, and finally takes out his gun and shoots the guy dead.
There just has to be another way through this, Chewie. . . .
I remain a denizen of the Coolidge Nebula, a place rife with cause and effect explosions. My vet has deployed her receptionist to call various compounding pharmacies including mail order, since options aren’t a significant industry in our corner of the universe. But it does seem that no one but a major pharmaceutical company is likely to make injectable formulations, because special sterility conditions are required. This keeps us stuck with transdermal administration. But I should be thankful–and I am thankful–that there are thyroid remedies besides radiation and surgery.
I brought Coolidge to the vet to shave a patch of hair on his back between his shoulder blades. I’ll be able to shave him myself next time he needs a trim. The skin isn’t so thin there, and a light fuzz of hair is left. The hope is that I can use the stuff we have without irritation, at least until a kinder-gentler formula can be found. The location on his back is the one place he can’t get at with his paws or his tongue.
I’m whooshed; my pain meds are no match for the day. Coffee. . .
My poor cat: he’s been so patient with all these annoying things: poking his ears to take a blood drop to test his glucose level all these years, and now, syringing irritating thyroid medicine in his precious ears. . .this morning he articulated that it was just too much. I agreed.
I called my vet through her amazing competent and compassionate answering service, and by kindly providence, at 7:30 Sunday morning she was still on call for another 20 minutes. I told her messenger I needed something to heal Coolidge’s ears before he began to hate me for compounding his misery. The messenger understood everything perfectly. My vet called me right back. I heard her unbelievably cute two-year old in the background; the baby must have been asleep.
She asked whether Coolidge’s ears were “just red” (they could stop a train in the fog) or actually ulcerated. I hadn’t thought to make this obvious distinction. “They’re ulcerated, I see little sores.” Good God, how much they must hurt, and I just dosed him and added to his agony. . .I was fighting tears, but strong women have to kick into reserve around stronger women. I knew the vet wasn’t going to cry, so I couldn’t either.
She instructed me to apply some hydrocortisone cream to his ears. Tomorrow she would research the problem—she hadn’t seen it before, probably because hardly anyone presses on this far–and call me. In the meantime, we’re excused from methimazole duty.
I know my vet will follow through; I also know that she will not walk into her office on Monday morning with the luxury of time to do research. Her all-women office will be insane with emergencies, calls from cat finders seeking cat owners, calls from cat owners seeking cat finders, and the whole gamut of complications of human-animal relationships we’ve been trying to fix since the Fall.
In a quick search, my husband found that methimazole is available in injectable form. I hope that means injectable as in, with a needle, into his skin, the way I have administered his insulin for seven years. I hope it doesn’t mean poured into his ear with a syringe; in other words, I hope it means intradermal, as opposed to transdermal. That would be simple; it would resolve the thyroid issue and its nebula of cause-and-effect explosions.
As I soothed the mean little medicine sores in his ears with hydrocortisone cream, Coolidge gave me to know that he liked me again. And he’s still eating consistently, which gives me to know that he remains under God’s gracious protection.
Thankful tidings! A certain resilient cat has resumed eating his canned food—the low-carb, grain-free, gluten-free food that keeps him from gaining excessive weight and has made his diabetes management possible.
He accepted some Beast (< Fancy Beast < Fancy Feast) via handfeeding, and then tucked into it on his own. I have never been happier to be wakened at 4 AM to replenish his food than I was this morning. What a relief!
We have no way to know whether Coolidge’s restored appetite is due to the antibiotic injection kicking in, or to switching the delivery system of his thyroid meds from oral to transdermal. He’ll have another u/a next week to check the status of his UTI, and a blood test to check his thyroid level. He is definitely a much happier and brighter-eyed fellow than he was two days ago.
Of course, we remain vigilant, given Coolidge’s age and health status. But one more time, the emergency is deferred. I’m grateful for the meaningful support of true friends when my apprehension was coming close to despair. Murphy, Maddy, and Lily know whom I mean.
Coolidge’s u/a revealed a UTI, which could be the troubler that robbed him of his appetite. The thyroid pills he took for a couple of weeks also remain suspects. We have since replaced the bitter-tasting pills with transdermal medication administered by syringe to his ear. I wear nitrile gloves so an errant dribble of the stuff won’t kill my thyroid.
The fix for the UTI was supposed to be oral cephalexin twice daily for 14 days. It’s the swift and sure cure for the 50% of cats who can tolerate it. Not surprisingly, Coolidge is in the other 50%.
I spritzed the entire content of the 3 ml syringe of pink liquid into his mouth at once, and cheered in amazement that he swallowed it. A few minutes later, he announced his cohort affiliation. I have never seen Coolidge vomit that much before. Thankfully it was only 4:20; my vet’s office was still open. As I cleaned up his trail (he has a knack for travel vomiting), I received instructions to bring him to the office in the morning for an injection of an antibiotic that is supposed to last for two weeks. My vet doesn’t quite trust its efficacy, but our trick bag is about depleted. She is going to consult with a WSU College of Veterinary Medicine professor, her longtime mentor.
Coolidge is eating enough kibbles for sustenance. The remaining problem spawned by his total inappetence is his continued rejection of canned food. The kibbles will pack weight on him and his diabetes is out of control. Endocrine and immune systems just don’t contain any isolated variables. They are the domains of the phantoms of the flesh.
All in all, we’re having a peaceful day at Rabbitbrush. The sun is shining, and it’s 29°, up from 19° this morning, when I took Coolidge in for his antibiotic shot.