Acute Common Bile Duct Obstruction in 12yo Cat

[alrsto]

<strong>My goals:</strong>
(1) Immediate term: to quickly, but gently cure my cat Wilhelm’s blocked common bile duct (acute condition) that is causing him pain and dangerously affecting his health.
(2) Longer term: to cure what has been a long-standing pattern of digestive upset—one that I suspect was a long-simmering precursor to the new acute condition.

<strong>The chief complaint: </strong>obstructed common bile duct (the duct that carries bile from the liver, through the gallbladder, and to the small intestine).

<strong>When did it start?</strong> First symptoms manifested at 3 am on Thursday, 6/28.

<strong>How often does it happen? </strong>This is a newly identified dis-ease for Wilhelm. However, the first set of symptoms he exhibited was recognizable to me, because I had seen him exhibit them and had treated them three times previously in the last two years. The second set of symptoms was brand new. (See below.)

<strong>What else was going on when it started? </strong>I had been having an extraordinarily stressful (emotionally stressful) days before his first symptom appeared.

<strong>What’s changed? What’s new? </strong>Relevant background: Since 2012, Wilhelm has frequently vomited hairballs and regurgitated undigested food. He is also frequently constipated, and he has food sensitivities.

A change to a homemade diet in 2015 has reduced the vomiting and regurgitation episodes where he vomits multiple hairballs and undigested food a few to many times over the course one to ten days. He frequently goes for months without vomiting or regurgitation at all.

He also still experiences constipation from time to time, and eating anything other than his normal diet will trigger severe itching in his ears and head.

My veterinarian says this collection of symptoms suggests he has irritable bowel syndrome (IBS) or irritable bowel disorder (IBD).

When he's his usual self, Wilhelm is a very easygoing, affectionate, cuddly, sweet cat who is very bonded with me. He is usually shy of new people, but warms up quickly. He can be vocal when he wants something. He likes to be warm, seeking sunbeams and heating vents and sleeping under the bedcovers with me in cold weather.

He loves to chew on plastic bags. He also will seek out and chew on cardboard when he is hungry or his stomach is upset. He is prone to vomiting more often in March and November, when he tends to shed more than usual.

Wilhelm is a white and gray domestic shorthair mix. I adopted him from an animal shelter in early July 2010. A stray, he was estimated to be four years old.

<em><strong>First set of symptoms for this new acute dis-ease:</strong> </em>
At 3 am, Wilhelm vomited up a small hairball and a lot of undigested food from the meal he ate around 10:30 pm the night before. After that he ate a bit of food, then regurgitated undigested food and plain bile five times before 6 am.

Between barfing episodes he was restless and pacing throughout the house. When he tried to sit or meatloaf, he did so in places that were not his usual sleeping/resting spots. He also sought out cardboard boxes to bite and gnaw on.

He was not vocalizing, which is atypical for him. He did not want to be touched—also atypical. He was not interested in the heating disc I warmed up and offered to him. He stayed on the floor and did not want to jump on the bed or chairs.

This is a symptom pattern he has previously exhibited on three different occasions in late 2016 and 2017. Each time, he was given Cerenia (maropitant citrate), which successfully stop the vomiting and allowed him to rest.

Recognizing this symptom pattern from previous occasions, at 6 am I gave him a 12 mg pill of Cerenia, which my vet had previously supplied. My goal was to stop the vomiting before he became dehydrated, which would mean needing to go to the vet for sub-cutaneous fluids.

I also gave him some energy therapy.

(Addressing the recurring pattern of vomiting/regurgitation episodes with homeopathy was something I intended to explore after taking the “Vitality, Balance and Homeopathy” course.)

<em><strong>Second set of symptoms for this new acute dis-ease:</strong></em>
Wilhelm’s vomiting stopped after he received the Cerenia tablet, and he was able to lie down and rest for about 45 minutes.

But then, around 7 am, he began visiting and revisiting the litter box—four times in 30 minutes. After one visit, I found a single small, hard poop nugget. After another, I found what looked like a thick, yellowish liquid; I couldn’t tell if it was atypical urine or very weirdly colored diarrhea.

He was also breathing through an open mouth, with his tongue sticking out, off and on. His tongue looked to be a darker, purplish hue instead of its usual pale pink.

<strong>Veterinary details:</strong>
Wilhelm’s physical exam suggested he had pain in his belly. He received a painkiller (buprenorphine, a narcotic) and an ultrasound.

The painkiller made him glassy-eyed, subdued, and very droolly.

I gave him energy therapy while we were waiting for the ultrasound vet. I could discern no physical response to the energy therapy, because Wilhelm was very subdued after receiving the painkiller. But I detected that a few of his major energy centers were compromised before the energy therapy, and open and balanced after the energy therapy.

The ultrasound revealed that his common bile duct (in the gallbladder, bringing bile from the liver to the small intestine) contained what the vet called “small, mineralized sludge.” That sludge was extending up into the corresponding liver duct. The bile duct was also enlarged to twice its size.

However, the ultrasound did not show any of the classic bowel signs of IBD.

The vet also ran blood work. Results:
RBC: 11.10 M/uL
HCT: 54.1% (high)
HGB: 17.7 g/dL (high)
MCV: 48.7 fL
MCH: 15.9 pg
MCHC: 32.7 g/dL
RDW: 26.4%
%RETIC: 0.1%
RETIC: 5.6 K/uL
WBC: 6.74 K/uL
%NEU: 60.9%
%LYM: 37.5%
%MONO: 0.7%
%EOS: 0.6%
%BASO: 0.3%
NEU: 4.10 K/uL
LYM: 2.53 K/uL
MONO: 0.05 K/uL
EOS: 0.04 K/uL (low)
BASO: 0.02 K/uL
PLT: 267 K/uL
MPV: 14.2 fL
PCT: 0.38%

GLU: 213 mg/dL (high)
CREA: 1.4 mg/dL
BUN: 22 mg/dL
BUN/CREA: 16
PHOS: 3.9 mg/dL
CA: 8.5 mg/dL
TP: 8.0 g/dL
ALB: 3.4 g/dL
GLOB: 4.6 g/dL
ALB/GLOG: 0.7
ALT: 2770 U/L (dangerously high)
ALKP: 122 U/L (high)
GGT: 0 U/L
TBIL: 1.6 mg/dL (high)
CHOL: 277 mg/dL (high)
AMYL: 1073 U/L
LIPA: 3069 U/L (high)
Na: 165 mmol/L
K: 3.5 mmol/L
Na/K: 47
Cl: 120 mmol/L
Osm Calc: 333 mmol/kg

The general vet said the next step would be to see a veterinary internist. The internist recommended to me could not see him until the next day (Friday, 6/29).

I chose to have Wilhelm spend last night (Thursday, 6/28) at a veterinary ER.

At the ER, he was given painkillers again and, using a feeding tube, they ensured that he got some food/nutrients. By doing this, they hoped that his metabolic system would naturally begin to start moving some of the built-up sediment out of the common bile duct. They also gave him subcutaneous fluids to maintain his hydration.

The internist’s first step will be to get an ultrasound focusing just on the gallbladder and liver, to see how much sediment there is in the bile duct today, after his treatment overnight. She will suggest next treatment steps based on the findings of that ultrasound.

 

[alrsto]

UPDATE: The second ultrasound, focusing on just the gallbladder, liver, and pancreas, shows that there are stones in the gallbladder and dilated ducts in the same area. The internist says that the stones are not obstructing the ducts, but could move to do so.

The liver is darker than usual, plus the pancreas is darker and a little bigger than usual. These details, along with the gallbladder having stones and debris, indicates inflammation.

They don't know whether or not the inflammation is a product of a bacterial infection and can't tell for sure without doing more invasive tests.

The internist's recommendation: assume that the inflammation is caused by a bacterial infection and treat with antibiotics.

She'd like to keep Wilhelm in the hospital to receive injectable antibiotics every eight hours until the staff sees how he responds. They could also ensure that he continues to eat.

One more test finding: a urinalysis shows that there is no UTI. There is protein and bilirubin in the urine, and the kidneys seem to to be concentrating just fine.

 

[Dr. Jeff]

Wow Amy! Thanks for your great posts. I'm so sorry for your own life stress.

Wilhelm sure has a lot going on, but I'm confident that his body can heal from it.

It sounds like he's in good (albeit allopathic) hands.

Your HMDM goals 1 and 2 are both achievable. In general, curative treatment for acute flare-ups like this (which is actually not a new acute dis-ease), will help both resolve the acute problem as well as help the underlying internal imbalance.

Health challenges like this are a fantastic ways to get even better than before!

A few questions:

Were there any vet visits with vaccines (or other interventions) in the past few months?

How was Wilhelm doing for the week before 6/28? Any subtle symptoms changes (which would be awesome clues to a remedy)?

With his currently being in the hospital, would you be able to dose him with homeopathic remedies?

If so, how frequently could you visit him there?

I wonder what the vet meant by "dangerously high" ALT? This test just reflects secondary and usually temporary leakage of enzymes from within his liver cells.

It's also very interesting that his ALKP (or SAP=serum alkaline phosphatase) is not much higher. Same is true for the GGT. These tests are typically more reflective of problems with the gall bladder and biliary system.

However, internal symptoms measured with tests can be as individual as the external visible ones so interesting but not surprising.

Yes, bacteria are often considered to be the "cause" in situations like this.

However, as you know, they may be associated with the condition or even a trigger for it, but they are not the underlying  cause.

I typically don't advise using anti-biotics.

However, in situations like this, it's also important to work well with the  vets who are currently caring for Wilhelm.

They're doing the best that they know how to do. And that is by using the IV meds.

Once Wilhelm is home and you can begin minimizing them and other drugs so you can focus on building and preserving his Vitality.  Then you caan most effectively mitigate damage from disruption of his microbiome.

You can do this with more varied (yes, you'll eventually be able to do this) fresh food feeding and even DNA analysis of his intestinal flora.

Once off any anti-biotics, test his stool through the <a href="https://www.animalbiome.com/" target="_blank" rel="noopener">Animal Biome</a> company.

Very importantly, do you have a holistic vet or homeopath on Wilhelm's healing team?

When does he next have any other tests or repeat ultrasound?

Do you have any homeopathic medicines at home or readily available?

Was Wilhelm ever treated with homeopathy?

Good luck and let us know how he's doing.

Dr. Jeff

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[alrsto]

Thank you, Dr. Jeff! I am confident that Wilhelm's vital force can heal his body. But I think it will need a lot of support, probably over a long time frame, because it has been compromised for so long. What he experienced the last few days is, I believe, a severe flare-up of a longstanding chronic dis-ease pattern.

First, an update: Wilhelm is now back home with me. This morning (6/30) at the vet hospital, he was eating readily and acting “perkier.” A follow-up blood test showed that his liver enzyme values were decreasing back into normal range. Based on these results, the vets felt it was safe for him to be discharged.

The discharge papers give their official diagnosis: cholangiohepatitis of unknown origin. The papers explain, “Wilhelm has inflammation in his liver and gall bladder which is consistent with cholangitis/cholangiohepatitis syndrome (CCHS), the most common acquired inflammatory liver disease in domestic cats."

They’ve given me four medications for him:

1. Clavamox (oral antibiotic), to be given every 12 hours for two weeks.
2. Mirtazapine (appetite stimulant), to be given every two days.
3. Ursodiol, (for the liver and to dissolve gallstones), to be given every 24 hours.
4. Buprenorphine (painkiller), to be given if needed.

He has had diarrhea since the vets started the antibiotics at the hospital. He has not yet had to poop since he’s been home.

Right now, having been home for about five hours, he is subdued and doesn't want to cuddle or be petted. He doesn't seem to be in pain or discomfort when he's moving, sitting, or lying down. He seems to be just resting, either just sitting quietly or dozing. He has gotten up and moved between a few different spots in the house, but now he's made his way to one of his favorite spots. He has eaten the food I put out for him.

Second, to respond to your questions and notes—

<strong>Dr. J: “I typically don't advise using anti-biotics. However, in situations like this, it's also important to work well with the vets who are currently caring for Wilhelm. They're doing the best that they know how to do. And that is by using the IV meds.”</strong>

I agree with you about the antibiotics. I decided to accept the vets’ recommendation allow their use in this case (as part of Step 3 of the HMDM Protocol) because I felt that, as Dr. Chambreau said in the workshop, “Sometimes it is worth it to introduce the ‘poison’ to attack the symptom (e.g., the fleas, the heartworm, the bacteria) and then work extra to support and stimulate the energy field/vital force.”

Now that he is home, I can focus on our long-term goal: To strengthen and balance Wilhelm’s vital force in order to cure what has been a long-standing pattern of digestive upset and skin sensitivity issues.

<strong>Once Wilhelm is home and you can begin minimizing them and other drugs so you can focus on building and preserving his Vitality. </strong>

Q: Can I begin giving Wilhelm a homeopathic remedies while he is still on the antibiotics and other medications, in order to begin building his vitality?

<strong>Then you can most effectively mitigate damage from disruption of his microbiome. You can do this with more varied (yes, you'll eventually be able to do this) fresh food feeding and even DNA analysis of his intestinal flora. Once off any antibiotics, test his stool through the Animal Biome company.</strong>

Wow! I had no idea I could have my cats’ stool tested to see exactly what is going on in their guts. I can definitely do this after Wilhelm is off his antibiotics.

I am also willing to review his current diet and move into more fresh-food feeding.

<strong>Were there any vet visits with vaccines (or other interventions) in the past few months? </strong>No. His last vaccine was a three-year FVRCP vaccine on 6/2/2011. Before that, he had a one-year rabies vaccine on 6/17/2010, when he came into an animal shelter as a stray.

But please also see the answer to “Was Wilhelm ever treated with homeopathy?” below.

<strong>How was Wilhelm doing for the week before 6/28? Any subtle symptoms changes (which would be awesome clues to a remedy)?</strong>

The only subtle symptom change I remember from the week before 6/28 was that Wilhelm burped a couple of times. I remember thinking, “Have I ever seen you burp like that before? I don’t think so.”

Here are the “non-subtle” symptoms I recorded in the weeks before this event.

Between 4/29 and 6/27 (~9 weeks), Wilhelm had 14 vomiting/regurgitation episodes. He brought up . . .
<ul>
<li>just undigested food = 7 times</li>
<li>hairballs = 2 times (once with some undigested food)</li>
<li>mainly fluid (clear, yellowish, or the same brown as his food) = 4 times</li>
</ul>
The vomiting up of fluid (bile?) is new within this time frame. In the past, for most of his vomit/regurgitation episodes, he has regurgitated wet food—usually within 30 minutes of eating. He also sometimes vomits up hairballs, but less often than he regurgitates undigested food.

<strong>Very importantly, do you have a holistic vet or homeopath on Wilhelm's healing team?</strong> Not yet, but I want to find one. It was actually the unsuccessful search for a veterinary homeopath that brought me to Holistic Actions.

Q: Can you recommend a homeopathic vet—someone you and Dr. Chambreau trust?

My regular vet office uses homeopathic remedies in a limited way, such as giving animals Arnica after a dental. They also have a TCM practitioner/acupuncturist on staff and use flower essences in their practice. I am confident that they will support my use of homeopathy with Wilhelm. They just aren't geared to do the full case-taking and unique remedy selection that a full-time homeopathic vet can.

<strong>When does he next have any other tests or repeat ultrasound?</strong> The vets have asked for a follow-up ultrasound of the liver and gallbladder, plus another round of blood work, in one week.

<strong>Do you have any homeopathic medicines at home or readily available?</strong> I have Nux Vomica (6C and 30C), Calcarea Carbonica (30C), and a “for gas” combination from Hyland’s containing Asafoetida (6X HPUS), Ignatia Amara (6X HPUS), Lycopodium Clavatum (6X HPUS), and Nux Moschata (3 HPUS).

<strong>Was Wilhelm ever treated with homeopathy? </strong>Okay, I am embarrassed and slightly scared to admit this now, given what I have since learned in your “Vitality, Balance and Homeopathy” workshop. But I had been giving Wilhelm a series of combination remedies from a Canadian company called HomeoAnimal (homeoanimal.com).

I had been searching unsuccessfully for a homeopathic vet when I found HomeoAnimal online. I contacted the company about getting a single, custom remedy for Wilhelm. After I described Wilhelm’s skin-itching symptoms and digestive symptoms to them, they recommended their “General Detoxification” protocol, which includes four combination remedies plus probiotics.

You can read about the protocol and see exactly what each of the combo remedies it contains here: https://www.homeoanimal.com/collections/digestive-and-endocrine-diseases/products/natural-remedies-for-general-detoxification.

Wilhelm was two weeks in to the five-week protocol when this serious gallbladder/liver event manifested. (I'd begun it before I knew that taking your "Vitality, Balance, and Homeopathy" workshop was a possibility.)

When you said in the “Vitality” workshop that “any combination remedy is not homeopathy,” and explained why, I realized that this whole “General Detoxification” series of remedies was likely not supporting Wilhelm, because (1) it wasn’t made to address <em>his</em> unique collection of symptoms, (2) it contained multiple remedies, given all at the same time, and (3) it wasn't designed to see what effects one remedy (or combo remedy) had before adding another.

Now I actually worry that this protocol contributed to or triggered the whole gallbladder/liver condition Wilhelm as experienced. I can only say that I was trying to do the right thing for my animal friend, and, frustrated that I couldn’t find an experienced homeopathic vet, I had decided to try a product from a company that seemed to offer the next best thing. :-(

I am ready now to learn and work differently with homeopathy, and I'd very much appreciate a recommendation for a homeopathic vet.

Thank you!

Amy

 

[Dr. Jeff]

Thanks for your thorough follow-up Amy.

Fantastic news that Wilhelm is home with you!

It sounds like his body is re-balancing itself.

No more "dangerous" high liver values.

This is direct evidence of his Vital Force doing some good work.

No worries about the combination homeopathically-prepared medicines being the trigger.

Their use has helped you take the next step on his health-care journey.

They served their purpose.

However what you experienced with Wilhelm may indeed be related to the non-homeopathic stimulation of his Vitality.

But it allowed  his body to better express his internal symptoms.

As seen with the acute flare-up and the newly found diagnostic test findings.

I suspect that an earlier ultrasound of his  liver/gall bladder would have revealed similar changes. Things that would have been used to explain his IBD symptoms.

When in reality his GI symptoms were external managing manifestations of the same internal imbalance that led to the cholangitis diagnosis.

Yes, homeopathy can be used alongside drug treatment! Absolutely start treating him with homeopathy as soon as you are able.

Fantastic that your local vet should be open-minded enough to work as part of Wilhelm's healing team.

Whenever you're ready to proceed, we'll find someone for you to work with (the Academy of Vet Homeopathy at theavh.org is a great place to start).

Or feel free to fill out my new client form at: https://www.homevet.com/new-client-questionaire/

Very important is to continue building Wilhelm's Vitality with fresh meats, lots of positive energy and through mental and physical stimulation.

Now that he's been home for the day (7/1) how are his BEAM symptoms?

Is he interacting with you as usual?

Also, what did you observe when he vomited in the past? Things like were the vomits usually forceful (did he cry, retch, etc.), did you observe his regurgitations and if so, what did they look like, other details, etc.

Enjoy the day with him!

Dr. Jeff

 

[alrsto]

Thank you, Dr. Jeff! I really appreciate what you said about the homeopathic combo remedies I had been giving him. Knowing that they likely caused his underlying vitality imbalance to express itself more dramatically is reassuring.

7/1 BEAM Update (evening), changes I've noticed in the last 24 hours—

<strong>Behavior</strong>:

• I've noticed that Wilhelm has not used his scratching post since he has been home.

• He also went and sat in his cat carrier twice this afternoon; this is <em>very</em> unusual for him. (He usually avoids the carrier and won't go in on his own voluntarily.)

• He seems to be spending more time than usual crouching, sitting, or lying on his belly. He seems to be making a point of putting his belly on the ground.

• He is still eating, but he is making fewer trips to the food bowl than he did in the first 24 hours after he was home.

• At 2 am the first night he was home, he woke me up demanding that I pet his head, face, and jaw. He wanted stronger-than-usual petting in those places; he was pressing hard into my hand and fingers. At the same time, he was getting almost overstimulated—giving me "love bites" and pawing at me when I stopped. This demand for heavy head petting has happened twice more since then—once during the day and again around 2 am this morning. He has also tried to wedge his head into the crook of my elbow.

Side note: In TCM, the hours between 1 and 3 am are when the liver meridian is most active.

• He tried to hide his face underneath a pillow he was lying next to.

• Since he's been home, he's been vocalizing much less than he usually does. He also hasn't gotten any "zoomies" or gotten excited to chase a fly zipping through the house or a beam of car headlights moving across the wall—things he normally would be stimulated by.

<strong>Energy:</strong> His energy seems a bit lower than the first 24 hours after he was home. He was at a 7 out of 10 in the first 24 hours after coming home. Today I'd say he's at a 5 out of 10.

<strong>Appetite:</strong> His appetite seems to have decreased in the last 24 hours. Though he is still eating, he seems to be visiting the food bowl less often and eating smaller bits when he does. (He is due to receive another dose of his appetite stimulant tonight.)

<strong>Mood:</strong> He seems a little bit down or subdued to me. It seems to me like he is seeking attention for comfort, since he isn't feeling 100 percent, instead of seeking attention just for the sake of getting and expressing affection. He seems tired, rather than perky.

<strong>Answers to the questions you asked:</strong>

<em>Is he interacting with me as usual?</em> Yes, for the most part. Again, I sense that right now, he wants to cuddle with me and be on my lap because he wants comfort, rather than wanting attention and affection. He's also less vocal and demanding than usual.

<em>What did I observe when he vomited in the past?</em>

• When he's going to do a true, from the stomach vomit—like with a hairball—he will jump down onto the floor (or sit upright, if he was lying the floor) and sit on his haunches. His stomach will start pumping, and his tongue will stick out slightly. After several stomach pumps, he'll forceful expel the hairball (sometimes with bile or undigested food) with a "blach" sound. Then he usually walks away calmly.

• Regurgitation usually begins one of two ways: (1) Wilhelm gets restless. He paces and looks for cardboard boxes to chew on for several minutes, then he stops and regurgitates. (2) He'll be lying down, dozing, and then he'll begin smacking his lips for a minute or two. Then he'll get up from his position, jump down onto the floor (or move to a new spot on the floor), and regurgitate.

When he regurgitates, there's usually one main regurge, immediately followed by one or two smaller ones a short distance away. Sometimes he gives a little leap and zips away from the regurgitated food. He usually makes a sharp retching sound as the food comes up. There may be stomach pumping, but not as much or as forceful as with his vomiting.

Wilhelm has been known to regurgitate undigested food very soon after a meal if he hadn't been fed for a while before the meal and then ate his food too quickly once it was served.

<strong>One noteworthy pre-event symptom that is still occurring: </strong>

For two or three months before now, I've noticed that when Wilhelm is relaxed, his body will suddenly give a single, sharp, full-body twitch or jolt—sometimes little ones, sometimes really big, startling ones. They remind me of how when we humans start to fall deeply asleep, and one of our legs suddenly gives a sudden, sharp kick, or how we might awaken from a dream with a start.

I've felt the smaller twitches when Wilhelm is sitting on my lap. It's like his body is giving a strong shudder once or twice as it begins to relax and settle.

Other times, I've seen one of these twitches/spasms hit while Wilhelm is lying in a chair across the room or sleeping next to me in bed. He'll be sleeping, still and peaceful, and then just his body suddenly just jolts violently, as if an electric shock is passing through him. Once or twice, I've heard him give a little cry as he's woken up by it.

In all cases, the twitch/spasm feels and looks akin to the twitches cats get when they're deeply asleep and dreaming, except it isn't a series of small twitches, but one big jolt. And it isn't preceded by the series of tiny or small twitches like we see when cats are actively dreaming.

*****

I will continue to post more details if/when I notice them.

Thank you!

Amy

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[Dr. Jeff]

Thanks Amy! These more detailed symptom descriptions are great.

Overall, and even before repertorizing or consulting the materia medica, I'd say that Wilhelm's dis-ease can be characterized by his being slightly weaker (gall bladder not contracting normally, belly on the ground , lower energy) and  having little spasms  (skin twitching, retching, bile ducts, etc.).

And he is isolating himself (in his carrier) more than usual.

In order to start helping him rebalance and feel better right away, I'd suggest reading Nux vomica in any materia medica that you have. <a href="http://www.homeoint.org/hering/n/nux-v.htm" target="_blank" rel="noopener">Hering's Guiding Symptoms</a> online is a good start.

You may also want to buy a copy of Boericke's materia medica/repertory and Clarke's Dictionary.

Then evaluate and continue to define his symptoms and put them all together in a repertorization.

And continue to read and study symptoms associated with similar symptoms. Especially if they have known liver and gall bladder symptoms like Lycopodium, Chelidonium, and Carduus marianus.

This Boger rubric adds 14 more medicines to read in the materia medica:

L - LIVER AND GALL BLADDER: (17) bell. berb. Bry. calc. CHEL. Chin. lach. lept. LYC. Mag-m. Merc. Nat-s. NUX-V. phos. podo. sang. sep.

Dr. Jeff

PS-This is jumping ahead of where I'd ordinarily advise starting your homeopathic education journey. However, as you said, Wilhelm's body is making it clear that he needs more help right now. And the body always tells you what it needs.

 

[alrsto]

UPDATE, 7/4, 4:20 pm: Wilhelm had a seizure, and we are currently at urgent care.

He hadn’t displayed any new symptoms between my last update and this one. The only treatment change was that I’d given him his first dose of Urididol (prescribed for gallstones) at 10 pm on 7/3.

He was sitting next to me on the floor as I was in the kitchen. He suddenly fell over, with his eyes tightly closed and his whole body tense. His back feet began scrabbling on the floor, claws out, moving his body in a circle. He was shaking violently. His fur was raised.

The shaking and scrabbling lasted more than 60 seconds, but less than 2 minutes, by my estimation.

I put my hands on him and sent him energy until the trembling stopped.

Immediately afterward, his pupils were dilated. He got up, walked a short distance, and laid down on his side, head raised. He did not seem scared or confused, but bewildered—like, “What just happened?”

As I called the urgent care and got us ready to leave, he began meowing. He continued meowing as we were in the car. (This is typical behavior when he’s feeling well: he usually meows continuously when he’s in the carrier and in the car.)

 

[alrsto]

UPDATE, 7/4, 8 pm: Wilhelm and I are back at home after our trip to the ER vet. Since Wilhelm was acting normally both before and after the seizure, the vet felt comfortable letting me bring him home.

No anti-seizure meds were given. But I am to immediately bring him back to the ER vet if he has another seizure.

The ER vet said that this seizure may be related to his liver-gallbladder-pancreas condition or it might be completely separate. (That is, of course, the allopathic medicine point of view. From a homeopathic point of view, this seizure is another symptom of/clue to his overall dis-ease.)

The internal specialist vets will contact me tomorrow morning after they've had a chance to review the new notes about the seizure. Until then, I am to keep administering his current medicines on schedule and keep a close eye on him.

<strong>New symptoms: </strong>

• A grand mal seizure lasting about a minute and a half.

• A heart murmur, detected by the ER vet post-seizure.

<strong>Other notes:</strong>

• The ER vet checked Wilhelm's blood-glucose level and found it to be normal.

• The vet also checked his blood pressure and found it to be normal.

<strong>What has not changed: </strong>Wilhelm's overall BEAM.

• Both before and after the seizure, he has been eating and using the litter box as usual. He was also sleeping and seeking attention and affection as usual.

• At the vet (post-seizure), he was squirmy and meowing as the vet tech took his vitals, which is how he typically behaves at the vet when he's feeling well. He also meowed in the car to and from the vet, which is also typical for him.

• He used his scratching post yesterday (pre-seizure).

• Yesterday (pre-seizure) he stole a tortilla chip from my bowl and crunched it down before I could stop him. This "snack stealing" is a typical behavior when he's healthy.

• Post-seizure and ER vet trip, he is isolating himself in a back bedroom; however, he did this same thing after coming home from his tw0-day stay in the ICU, so I am not worried and don't consider this a new symptom.

• One note about him spending time in the cat carrier: I don't know if he's really isolating himself by do this, because the carrier lives in the middle of my living room/office area. When he's in it, he's not too far away from where I'm usually sitting. The carrier simply provides another, slightly enclosed sleeping space for the cats in this open area. That said, Wilhelm usually avoids sitting or sleeping in it (though my other cat, Luna, frequently sleeps in it).

*****

Thank you, Dr. Jeff, for you latest notes.

I spent the afternoon downloading various sources in the "Vitality, Balance and Homeopathy" toolkit, and I ordered copies of Kent's repertory and Boericke's materia media.

I will be reading up on Nux Vomica in Hering's "Guiding Symptoms" tonight. I will also be looking up seizure-related rubrics in an online repertory.

I will also give him an energy therapy session tonight.

 

[alrsto]

After reviewing the mini materia medica in your "Acute Homeopathy for Animals (toolkit)," I'm wondering if <strong>Belladonna</strong> would be a good fit for Wilhelm's current collection of strongest, most-noteworthy symptoms.

Not only does he have "Grand mal and petit mal seizures. Twitches and jerking," but he is exhibiting a "Desire to strike, bite" when demanding that his head and face be petted and rubbed—and with a lot of pressure—between 2 and 4 am. At these times, he frequently tries to put his teeth on my hand, arm, or face, and he frequently reaches out his paw and flexes his claws against my skin. I get the sense he's making these moves not out of anger, but reflexively. And he's holding back—trying not to hurt me.

I've been wondering if the reason he wants his head and face petted this way is that his head or mouth are hurting or aching or just feel funny somehow at these times.

(Side note: I am an animal communicator, but given how worried I've been about Wilhelm, it's been difficult for me to find the mental neutrality to communicate telepathically with him. I'm just not sure whether what I'm picking up is accurate or not.)

 

[Dr. Jeff]

Hi Amy-

I'm sorry to hear about Wilhelm's seizure.

It is indeed a rare side-effect (in people) of the ursodiol. However any drug can have different side-effects depending on the sensitivity of the individual.

Much more likely is exactly what you said about the seizure being a clue to his underlying imbalance.

Belladonna may indeed be indicated if he seizures again. However, you might still want to learn more about it and compare it to the Nux before you use it. Using the Hering's Guiding Symptoms link I sent for Nux.

Yes,  it can be very hard to communicate with (and treat) your own pets.

Last note for now is that the seizure may also be a type of "discharge" which his body is using to resolve the internal liver/gall bladder issue.

Time will tell..

In the meantime I'm very happy to hear about some of his typical behaviors returning! Especially using his scratching post.

Dr. Jeff

 

[Dr. Christina]

Amy, you are doing an amazing job of observing and evaluating his symptoms, even the scary ones. Congrats.

I strongly suggest, if you have not, to  fill out Dr. Jeff's new client form at: https://www.homevet.com/new-client-questionaire/ and begin to work with him. I think you can understand that an expert veterinary homeopath is needed at this point.

Dr. Christina

 

[Dr. Christina]

Amy, you are doing an amazing job of observing and evaluating his symptoms, even the scary ones. Congrats.

I strongly suggest, if you have not, to  fill out Dr. Jeff's new client form at: https://www.homevet.com/new-client-questionaire/ and begin to work with him. I think you can understand that an expert veterinary homeopath is needed at this point.

Dr. Christina

 

[alrsto]

Thank you, Dr. Christina! I have submitted my new-patient form to Dr. Jeff, and now I'm doing the next steps: writing Wilhelm's personality profile, gathering Wilhelm's medical records, filling out a treatment form. Dr. Jeff and I will be working together soon.

My regular vet is thrilled that I will be working with Dr. Jeff on Wilhelm's case.

<strong>UPDATE on Wilhelm, 7/7:</strong> He had a follow-up ultrasound and blood work on 7/6. The internal-medicine vets report:

• The inflammation in his liver is largely resolved. The ALT, which was extra high on his first vet visit on 6/28, is now almost normal. All other liver values are in normal range.

• The inflammation in his gallbladder has improved, but there is still some inflammation there. Gallstones and mineralized sediment are still present.

• There is still inflammation in his pancreas, but this is not unexpected, because pancreatitis typically takes longer to respond.

• Blood work says his cholesterol is high. BUN is a little high, but creatinine is normal.

None of these results suggest an (allopathic) explanation for the grand mal seizure he had on 7/4.

I suspect Dr. Jeff is right when he said, "[T]he seizure may . . . be a type of 'discharge,' which his body is using to resolve the internal liver/gall bladder issue." I could also see it as his vital force/energy system sort of hitting the reset button in general or on his nervous system specifically in response to the stress of the illness, hospitalization, and treatment he's had.

The internal medicine vets want Wilhelm to continue taking antibiotics and Urididol for three more weeks.

Both before and after his follow-up vet visit (for the ultrasound and blood work) on 7/6, Wilhelm's BEAM has been consistent. He is largely acting like his usual self, although he hasn't engaged in any vigorous play sessions, run-and-chase sessions with my other cat, or "zoomies" (sprinting around with little or no trigger). However, right now the weather is hot here in Colorado, and both of my cats are spending much of the day stretched out and snoozing in the heat.

*****

Meanwhile, I'm reading up on Nux Vomica and checking out the other rubrics Dr. Jeff suggested, in preparation for working with him. My Kent's repertory just arrived, and my materia medica is on the way.

Thank you, Drs. Christina and Jeff, for your support!

 

[Dr. Jeff]

Our pleasure Amy!

As Dr. Christina said, keep up the great work with putting Wilhelm's symptoms in context and interpreting them holistically.

We're here to help.

Dr. Jeff

 

[alrsto]

<strong>UPDATE, 7/8</strong>

1. Wilhelm has been seeking out cardboard—such as boxes and book covers—to chew on.

This is an interesting development, because before his dis-ease flared up as a liver-gallbladder-pancreas ("triad disease") episode, this chewing on things was one of Wilhelm's characteristic quirks—a behavior that I would now call an early warning sign of dis-ease.

Usually this type of restlessness and chewing on cardboard signals to me that he is hungry, needs to use the litter box (to pee and/or poop), or both. I believe he seeks to chew on things when something in his stomach or intestines feels funny to him.

2. Early this morning he was aggravating my other cat, Luna, by not letting her past him to see out one of the bedroom windows. Starting fights with Luna and annoying her or picking on her in ways like this is another behavior that I haven't seen this week since he's been home from the hospital.

I consider this behavior too to be one of the early warning signs of his dis-ease, because he is usually easygoing and respectful of Luna.

3. He is also restless today. He keeps getting up and moving between his favorite relaxation spots around the house. He'll lay down for a while in one spot, but can't seem to settle, and he sleeping as he normally would be this time of day. It's like he's relaxed, but can't quite get comfortable enough to fall asleep.

This little behaviors coming back now suggest to me that his longstanding dis-ease is still simmering, even though the allopathic medicine is addressing the more dramatic symptoms that manifested as the dis-ease boiled up (or boiled over) last week.

Two other characteristic behaviors have also returned, although I don't consider them to be early warning signs of dis-ease:

1. He is showing more interest in sitting by and looking out windows.

2. He stretching up the full length of his scratching posts.

 

[alrsto]

<strong>UPDATE 2, 7/8: </strong>

Not two minutes after I hit "submit" to post my last update, Wilhelm regurgitated undigested wet food that he'd eaten 25 to 25 minutes prior. Just before the regurgitation, I saw him flicking his tongue and licking his lips repeatedly for about 60 seconds; this is a classic Wilhelm pre-regurgitation signal.

His is definitely exhibiting the early (or earlier) warning signs of his dis-ease now.

 

[Dr. Jeff]

Fantastic assessment of EWS Amy!

I fully agree that the last two behaviors you mentioned are not Problematic and indicative of an early internal imbalance.

Rather, they are important observable clues that tell you about his BEAM and balance.

His body is becoming healthier and better able to express its symptoms!

Keep observing and recording them. They are the best clues about what to do next.

Go Wilhelm!

Dr. Jeff

 

[alrsto]

<strong>UPDATE from Sunday, 7/8: </strong>

After Wilhelm regurgitated undigested wet food, I asked myself, "How would I employ the HMDM here if Wilhelm hadn't had his triad dis-ease episode?"

I set my <strong>goal:</strong> To keep support Wilhelm's vitality so that it can keep him from further vomiting/regurgitation and associated symptoms of stomach upset (restlessness, desire to chew on cardboard).

My <strong>research:</strong>

Behavior: Between 4 am and 2 pm, Wilhelm was picking on Luna, my other cat; exhibiting restlessness by moving from spot to spot, lying down but unable to fully relax or fall asleep; chewing on cardboard boxes and book covers.

Energy: Stable to a little riled up.

Appetite: He ate a little bit of wet food when I offered it.

Mood: Restless, agitated.

Dr. Jeff had previously suggested that I read up on Nux Vomica. Wilhelm's current symptoms seemed well represented in the NV description. I also had it on hand (both 6C and 30 C).

The <strong>action</strong> I took: I decided to give Wilhelm NV 6C and watch to see how he responded.

3:15 pm: I dissolved three 6C NV pellets in one cup (8 fl oz) water. I gave Wilhelm 1 ml of the solution with a syringe. After smacking his lips a bit, Wilhelm laid down and went to sleep. I noticed the tips of his ears trembling just slightly.

4:30 pm: Wilhelm jumped onto my lap and tried to chew on the covers of the notebooks I was writing in. I gave him another dose of NV. He then jumped onto one of his living room sleeping spots, laid down, and dozed off. Again I noticed that his ears trembled slightly as he fell asleep.

5:20 pm: Wilhelm began following me around and meowing. I gave him another dose of NV. Again, immediately after, he laid down and relaxed, though this time his head was raised. Again I saw his ears tremble slightly, and I saw his muzzle twitch a couple times. Otherwise, his eyes were soft or closed.

6:30 pm: I gave Wilhelm a fourth dose of NV. This time, instead of relaxing, he wanted to go outside. I took him outside on his harness and leash, and he spent about getting some "earth therapy" (sitting on the earth).

<strong>UPDATE from Tuesday, 7/10: </strong>

2:55 pm: Wilhelm was again awake and restless, moving around from sleeping spot to sleeping spot and seeking cardboard to chew on. He declined food when I offered it.

3 pm: I gave Wilhelm a 1 ml dose of Nux Vomica (6C). Five minutes later, he regurgitated clear bile or slightly foamy saliva. Then he laid down on his side and relaxed for a few minutes, but by 3:15, he was up and moving around, seeking cardboard to chew on again. He still had no interest in food.

Behavior: restless. Appetite: none. Energy: a little elevated. He did respond a bit when I got out toys and invited him to play. Mood: restless physically, but not irritable.

3:20 pm: He was able to relax and doze.

3:30 pm: He ate a little bit of food, then laid down and began grooming himself. Fifteen minutes later, he was curled up and dozing in one of his favorite sleeping spots in front of the front picture window.

*****

Since Tuesday, Wilhelm has been keen to spend time outside (behavior). His playfulness has come out a couple of times (behavior, energy, mood), and he has begun actively dodging and squirming when I need to give him his antibiotics and gallstone medication (behavior, energy, mood).

I've noticed that instead of needing/wanting to be fed several times throughout the day, as he had been before his triad episode, he is going several hours between meals. After his morning meal, he isn't asking for food all day and is able to go without eating or distress until his evening meal.

He's not eating a lot at his meals. But temperatures have been hot here in Denver, and I've noticed that both he and Luna eat more lightly in hot weather. So I'm not concerned about the amount he's eating.

He seems to be visiting the litter box fewer times throughout the day, but he is urinating daily and defecating every 36 to 48 hours.

&nbsp;

 

[Dr. Christina]

Great job reporting Amy, and even better carefully observing, giving what he needs/asks for.

Keep us all posted.

 

[alrsto]

UPDATE: Wilhelm had two vomiting episodes two days in a row. Here's what happened each day.

<strong>Sunday, 7/15:</strong>

2:15 pm: Wilhelm vomited a huge hairball that also contained some pieces of undigested cat treat that he'd eaten at 8:30 am. Then he vomited up yellowish brown bile in four small areas. Immediately after this, he went to the litter box and delivered a stool that was smelly, brown, and fully formed, but soft—all of which is atypical for a Wilhelm stool.

2:23 pm: Wilhelm began chewing on cardboard—and early warning sign that his stomach is upset and he might well vomit soon.

2:30 pm: I gave Wilhelm a dose of Nux Vomica 30C, with the goal of quickly resetting his disturbed vital force before it could erupt in a full-blown vomiting/regurgitation episode. I chose Nux Vomica because Wilhelm seemed to respond to it well (at 6C) on 7/8 and 7/10, and I chose to try the 30C potency because I wanted to stop the episode early on.

2:41 pm: Wilhelm vomited up a large quantity of what I now am calling "Nux Vomica bile": yellowish or clear, very foamy bile that comes up after giving Nux Vomica.

Between 2:50 and 4 pm, Wilhelm was itching/scratching his face and ears frequently, and when he wasn't itching, he was grooming himself. I presumed that this was a reaction to the Nux Vomica. Itching/scratching is another early warning sign or symptom of Wilhelm chronic dis-ease.

Between 4 and 4:15 pm, Wilhelm vomited white foamy bile three times. I was very concerned about him becoming dehydrated. It seemed to me that the 30C potency of the Nux Vomica was having a too-strong effect.

I also had Arsenicum Album 6C on hand, and when I quickly looked up its profile in the Boricke matter medica, I saw that it was an antidote to Nux-v. So I gave Wilhelm a dose of Ars. at 4:15 pm. I followed up with two more doses between 4:30 and 5 pm. After receiving the Ars., Wilhelm stopped vomiting and eventually was able to rest, relax, and sleep.

At 8 pm, Wilhelm was able to eat and keep down some food. I gave him an energy therapy session around 10 pm.

<strong>Monday, 7/16: </strong>

2:20 pm: Wilhelm woke up, licking his lips repeatedly, and then vomited up a huge, very wet hairball, which again seemed to contain some bits of undigested cat treats he'd eaten early this morning.

2:26 pm: He visited the litter box and, like yesterday, left a moist, smelly, but fully formed brown stool.

2:30–2:45 pm: He looked for cardboard to chew on. He ate a little bit of wet food. At this point, I'd decided not to try any homeopathic remedies, but wait and see whether his vital force would rebalance and stem the escalation of symptoms on its own.

Between 3 and 4 pm, he was able to rest and sleep.

4:15 pm: He woke up, licked his lips repeatedly, and then violently regurgitated all the wet food he'd eaten 1.5 hours earlier. (I say "violently" because he retched a lot and the regurgitation spewed out a great distance.)

4:25 pm: Since his digestive upset was continuing, I gave Wilhelm a dose of 6C Nux-v, because his vomiting had subsided after receiving it on 7/8 and 7/10. I presumed that Nux-v was still the right (or closest) remedy that he needed, but the 30C was too strong. So a 6C dose would be gentler.

Between 4:30 and 5 pm, Wilhelm was able to rest and relax.

At 5:10 pm, he vomited up a large amount of the characteristic white, foamy Nux-v bile. After, he retreated to my guest bedroom and couched on the bed. When I approached him, he meowed loudly and did not want to be touched. I thought the Nux-v might again be causing this distress (even at the lower potency). So at 5:15 pm, I gave him a dose of 6C Arsenicum Album, since that had worked to make him feel better and calm his symptoms yesterday.

I gave him a second dose of Ars. at 5:30. Just before 6 pm, he vomited up yellowish white bile. Then he hid behind the guest bed and sat, belly down on the floor.

At 6:30, I saw him take a drink from his water bowl, which is unusual for him, but was encouraging to see under the circumstances. He moved to be with me in the living room. I gave him a little energy therapy during our HA empower hour meeting.

7:45 pm: He was resting and sleeping, and he seemed  more comfortable.

7:55–10:20 pm: Wilhelm continued drinking often from his water bowl, which I'd added Rescue Remedy to.

10:30 pm: I successes the Ars. 6C 10x, as Dr. Jeff directed, and gave Wilhelm a Q-Tip dose.

11:15 pm: Wilhelm moved from lying on my bed to lying on a chest of drawers—a harder surface.

11:25 pm: I gave Wilhelm another Q-Tip dose of Ars. 6C.

Other notes:

• He is still receiving a dose of Clavamox antibiotics every 12 hours.

• He is still receiving Ursodial for his gallstones every 24 hours.

• Early in the morning on both Sunday and Monday, Wilhelm showed two other early warning signs of vitality disturbance: he was walking around and meowing loudly, and he started fights with Luna, my other cat.

 

[alrsto]

UPDATE, Tuesday, 7/17: Wilhelm had another rounds of vomiting today.

Sometime between 9:20 am and 12:45 pm, he vomited up a small hairball and tan bile. (I wasn't home at the time, so I don't know precisely when he vomited or what other symptoms he exhibited at the time.)

6 pm: He woke up and began trying to chew on cardboard. I gave him a Q-Tip dose of Ars. 6C. After receiving it, he laid down, meat-loafing on his stomach, and was calm and still. Eventually he crawled onto my lap.

6:15 pm: He started licking his lips and jumped down from my lap. I gave him a second Q-Tip dose of Ars. 6C. Two minutes later, he vomited up foamy, yellowish-white bile.

6:20 pm: I put Rescue Remedy on Wilhelm's ears and gave him a little bit of energy therapy. He began looking for cardboard to chew again. I gave him a third dose of Ars. 6C.

7:15 pm: Wilhelm laid down on my chest, but after only a couple minutes, he meowed. Then he meowed twice more. Then he began licking his lips repeatedly.

7:20 pm: He jumped down onto the floor and vomited up yellowish white foamy bile.

7:25 pm: He went to the litter box and left a fully formed, slightly soft, slightly smelly stool. Afterward, I gave him a fourth Q-Tip dose of Ars. 6C.

7:55 pm: He is now lying on the floor on his belly, dozing.

I intend to continue giving him Q-Tip doses of Ars. 6C every 15 to 30 minutes until we go to bed.

<strong>Other notes:</strong>

• I noticed today that Wilhelm has developed a raw, red sore on the edge of the right side of his mouth. I'd noticed him scratching this spot over the last few days, and how it seems to be larger and more red and tender than when I first noticed it.

• Wilhelm and I spent some time outside in the afternoon. He got to have some earth-energy therapy (i.e., put his paws directly on the earth) for 20 to 30 minutes.

 

[Dr. Jeff]

<blockquote>• I noticed today that Wilhelm has developed a raw, red sore on the edge of the right side of his mouth. I’d noticed him scratching this spot over the last few days, and how it seems to be larger and more red and tender than when I first noticed it.</blockquote>
FACE - ERUPTIONS - red: (24)alum.ant-c.aur.calc.calc-p.carb-an.carbn-s.carc.caust.cham.cic.euphr.fago.hyper.Lac-c.Led.nit-ac.olib-sac.par.Petr.phos.psor.sep.sulph.

FACE - ERUPTIONS - rash: (35)Acon.Ail.anan.Ant-c.ant-t.Ars.ars-s-f.BELL.Bry.carbn-s.caust.Cham.coff.con.Euphr.Graph.Hep.hydr.Ip.jab.kali-br.lach.Merc.Mez.Nat-m.nit-ac.phos.PULS.RHUS-T.Stram.SULPH.tab.tarent.teucr.verat.

Hey Amy-

This may be your clue to hold off on dosing for awhile.

At least until you see if this symptom persists.

It also doesn't sound like the Ars is helping him.

Dr. Jeff

 

[alrsto]

<strong>Wednesday, 7/18:</strong>

After spending much of 7/17 vomiting, Wilhelm spent a lot of scratching and grooming himself, especially his face, between 12 and 1 am.

Between 4:45 and 6:30, he drank from the water bowl a few times, but only nibbled at food. He continued to groom himself frequently, especially licking the inside of his left leg quite a bit.

After that, he settled down spent most of the day sleeping on a blanket-covered table (harder surface). He ate nothing until the evening, when he nibbled at food and drank water again.

<strong>Thursday, 7/19</strong>

Wilhelm ate a little food during the day. Between 4 and 6:35 pm, he vomited yellow-green, foamy bile four times. In between, he was restless, looking for cardboard to chew on, crouching with his belly to the floor, and lying on hard surfaces.

I gave him some energy therapy and allowed him to smell some essential oils between 5:45 and 6:20 pm. He relaxed and dozed throughout much of the session, but vomited immediately after.

He ate little if anything that night.

<strong>Friday, 7/20</strong>

I took Wilhelm to the animal hospital for a follow-up ultrasound and blood work. (These were originally scheduled for 7/27, but the internist suggested coming in a week early, given how frequently he was vomiting.)

The ultrasound showed that his liver inflammation was completely resolved and his liver now looks normal. His gallbladder and bile duct are now normal, though there is still some mineralized grit in the bile duct. No gallstones.

His pancreas is still "a little plump" and the "muscular layer of small intestine continues to be thick."

The internal medicine vet has "chronic enteropathy." Her notes say, "To reduce the chance of this situation [the inflammation of the liver, gallbladder, and pancreas] happening again we need to address the source of the inflammation. Food is the most likely culprit and specifically protein. Suspect that Wilhelm is developing/has beef intolerance."

She has instructed me to continue giving Wilhelm Clavamox (antibiotic) for one more week. Then I am to bring him in for a blood work recheck (no ultrasound) on 8/10.

She proposes to address the chronic enteropathy with a diet change and probiotics. For food, she recommends either (1) a prescription diet food made with hydrolyzed protein, available only as dry kibble, or (2) a prescription novel-protein canned food, made with venison. For the probiotics, she recommends a prescription product called Visbiome.

But she suggests not making the diet changes or adding the probiotic until after the blood work recheck on 8/10. She wants to two weeks between the end of the antibiotics and the beginning of a new food, so Wilhelm doesn't link latter and the former and develop a food aversion.

I've told her that I want to follow up with my own holistic vet before I decide what steps to take next.

<strong>Saturday, 7/21</strong>

After an uneventful day, Wilhelm had a grand mal seizure at approximate 6:10 pm. This one seemed to last slightly longer than the first one he had on 7/4, but I don't know for sure because I couldn't see a clock it was happening.

But he also seemed to recover faster from this second seizure. His pupils were dilated, but he was able to stand and walk normally just five minutes after the seizure ended.

I called the animal hospital ER and was told I didn't need to bring him in unless he has another seizure within an hour or two of this latest one.

6:45 pm: He ate a plate of wet food. It was a healthy amount, and he licked the plate clean. I gave him some more, and he ate the equivalent of about another half can of wet food.

7:05 pm: Wilhelm was roaming restlessly, then went to the litter box and left a large, moist, brown, slightly smelly stool.

<strong>Other notes: </strong>

• I unexpectedly found a local homeopathic veterinarian. She's not just in the Denver area; her office is only two miles from where I live. I've scheduled Wilhelm for a case-taking appointment with her on Tuesday, 7/31.

• I called the animal hospital's neurology department this morning (Monday, 7/23). They said they would be happy to schedule an exam/consult for him, but since the two seizures Wilhelm has had were almost three weeks apart, I could just continue to observe him and keep a record of the seizure activity.

I should bring him in to the ER immediately if he has another seizure that lasts more than five minutes or if he has three seizures within 24 hours.

I have decided not to schedule a neurology consult for now.

&nbsp;

 

[Dr. Jeff]

Sorry about Wilhelm's second seizure Amy, but his body is healing the best that he is able.

That is until he sees Dr. Facinelli and she starts curative homeopathic treatment!

Good work!

Dr. Jeff

 

[alrsto]

Thank you for emailing me to ask about Wilhelm, Dr. Jeff.

His case-taking appointment with Dr. Facinelli was on 7/31, and I picked up the remedy she prepared for him (Calcarea Carbonicum) on 8/2. But before I could give him the first dose of Calc Carb on 8/3, he began exhibiting symptoms of the triad disease again, including repeated vomiting, chewing on cardboard, and open-mouth panting, plus showing signs that he was feeling a lot of stomach discomfort and/or nausea.

After consulting with Dr. Facinelli, I decided to take Wilhelm back to the ER at the animal hospital the afternoon of 8/3. He was quickly seen by the same internal medicine vet who had previously worked on his case.

An ultrasound showed that there was little inflammation in his liver, pancreas, and gallbladder, but his liver values were elevated. The vet's diagnosis was "recurrence of cholangiohepatitis."

He is now back on Clavamox and will continue taking it through the end of the month. He is also taking Ursodial again, because the ultrasound showed there was still some mineralized sludge in his gallbladder.

Fortunately, he did not need to be hospitalized. He received an appetite stimulant to keep him eating and Cerenia to help him feel comfortable and to help him get some rest. He was uncomfortable for the first 36 to 48 hours after we came back from the ER vet, but since then, his BEAM has been good. He seems to be doing well.  He is scheduled to have follow-up blood work this Thursday, 8/16.

The internal medicine vet suspects that we didn't continue the first course of antibiotics long enough. (We had stopped the Clavamox and Ursodial after four weeks. The internist would have liked to continue for two more weeks, but we stopped at four because the ultrasounds and blood work, plus Wilhelm's BEAM, all indicated he was doing well. Plus, because he was beginning to vigorously protest getting meds three times a day.) I think the internist may have been right about the antibiotics.

I also think he was affected by all the stress and anxiety I was experiencing because of his vet bills and as I was prepping for his case-taking with Dr. Facinelli. Even though his BEAM was pretty good, his inner healing was still in progress, and his vital force was still recharging after being compromised for so long.

Dr. Facinelli and I have mutually agreed to put homeopathic treatment on hold until Wilhelm has finished his latest course of allopathic medicines and his health has completely stabilized and then stayed stable for several weeks to a few months.

One of her concerns is that homeopathic treatment will not and cannot be curative for him because his dis-ease has been going on for so long, and that the best homeopathy can provide at this point is palliation.

That's the scoop. Thank you again for checking in with me about him.

 

[Dr. Jeff]

I'm very sorry to hear about Wilhelm's dis-ease recurrence Amy.

Please keep us updated, and continue to support his body.

Homeopathy can still help.

&nbsp;

 

[alrsto]

UPDATE, 8/22

Wilhelm had blood tests done on 8/16, and the results show that he is responding well to his current course of antibiotics. His liver values, specifically his ALT, had dropped significantly from their high levels found on 8/3.

He continues to take antibiotics. The internist in charge of his case would like to recheck his blood work in late September. She wants to keep him on the antibiotics for at least a few months.

He is also taking Ursidol again, because his ultrasound on 8/3 showed that there was still sludge in his gallbladder bile ducts. The internist elected to not do an ultrasound on 8/3, but will likely want to do one in late September, the next time he has blood work.

Since 8/3, his BEAM has also been steadily improving and staying well overall.

<strong>Behavior:</strong> He is sleeping, interacting with me and Luna, and acting normally most days. He is using the litter box regularly, and on average, he is pooping every other day, which is typical for him.

<strong>Energy:</strong> His energy was low on 8/4 and 8/5, the weekend after I'd taken him to the animal hospital when symptoms of triad disease showed themselves again. Since then, his energy has been increasing steadily. He regularly has high energy times when he wants and is able to play and run around.

<strong>Appetite:</strong> He seems to be eating lightly but consistently. He seldom eats a lot at once, but he cruises by the food bowl several times throughout the day and eats a little each time.

<strong>Mood:</strong> Overall, his mood is what I consider to be normal for him. Sometimes he's very cuddly. Sometimes he's wide awake and playful. Sometimes he's a sidekick, just dozing or sleeping near me as I'm working. Sometimes he's "little dictator kitty," demanding to go outside on his leash and harness, or otherwise pay attention to him or interact with him.

Two symptoms of his chronic dis-ease have manifested over the past three days (8/19–21):

<strong>1.</strong> He vomited white bile once and medium-sized hairballs + gooey, grayish tan bile twice. He has also sought out cardboard to chew on immediately afterward.

These vomits are not preceded by the usual lip-licking and other symptoms that signal he's feeling queasy/nauseated. They also don't continue with repeated vomiting, nor does he show signs of feeling poorly afterward. He just wakes up, jumps down from his sleeping spot, vomits, and walks away calmly.

<strong>2.</strong> He has woken up between 4 and 5 am and spent about an hour awake, alert, and active (i.e., zooming around, wrestling with Luna), plus occasionally yowling. He usually visits the litter box during this time, usually just urinating. He usually eats during this time too. By 6 am, he has usually settled back down enough to be able to sleep.

 

[Dr. Jeff]

Thanks for the update Amy.

I'm glad that he is responding to treatment.

Keep a close eye on his BEAM and let  us know how he's doing.