Cat Liver Shunts

When new acquaintances ask about Newt, I try to give them my “elevator speech” (the quick, 30-second overview), and not overwhelm them with too many of the details which are routine to us, but might be mind-boggling for others.

So, here’s my personal version of the quick and dirty on liver shunts in cats:

A liver shunt is a condition where the blood is not properly purified, because it bypasses the liver. As a result, toxins can accumulate and cause “Very Bad Things” to happen. Liver shunts are even more rare in cats than in dogs, affecting approximately 1 in every 10,000 cats. However, there is Hope – many cats with liver shunts are able to live normal, happy lives!

Okay, that was one floor; if they haven’t gotten out of the elevator yet, and want more info, the next part goes like this:

A liver shunt may also be known as a portosystemic shunt (PSS), and be intra-hepatic, extra-hepatic, or some combination of both. Treatment options include surgery and/or medical management, using a combination of diet and medicine. More studies and statistics are available on surgical options, but we are now seeing more anecdotal evidence regarding successful medical management, both pre-operative, and in lieu of, surgical correction, as with our Newt.

Is the listener still on the elevator with me, or are they planning to jump out whether or not the next floor is theirs?

The “Very Bad Things” that can happen are a result of Hepatic Encephalopathy (HE), where the toxins have accumulated and start causing problems. Depending on the severity of the HE episode, signs can include, but are not limited to, lethargy, circling, head-pressing, drooling, blindness, seizures, and neurological impairments. However, many owners are able to control/minimize these episodes in their liver shunt cats through a combination of diet, medication, and/or surgery.

Which takes us back to the first (and most important) part of the whole elevator speech, which is simply …

“Cats with liver shunts – there is Hope.”

If It Ain’t Broke, Don’t Fix It, Part 2

How many minor annoyances do you endure before you call it a night, pack up your toys and go home? (or to shop elsewhere?)

am reminding myself how truly fortunate we are with Newt, for so many
reasons. His liver shunt was diagnosed early; we found protocols that
worked to stabilize him; we have an amazing team of caregivers and
service providers on Team Newt; we are in a position to be able to
afford his care; his care is not nearly as expensive and invasive as
that of other cats with more serious conditions; we live in an area
where products and services are readily available … the list goes on,
and on.

So why do these minor annoyances tend to send my blood
pressure skyrocketing, and my language far, far out of bounds from any
sort of propriety?

I arrived at 6:20 PM – well after the 4PM time
I was given as ready for pick up. My mood was only heightened by the
freezing rain pouring down, dampening my spirits, as well as my

I was greeted warmly, by friendly staff. My optimism rose a couple of notches, but it was short-lived.

No, they did NOT have a prescription on file for Newt. When was it
called it? I’m pretty sure I managed to NOT let my voice drip as icily as
the rain outside when I replied “last THURSDAY – four and a half days ago.”

chipper little pharmacist quickly stepped in to take over, and rummaged
thru paperwork, then politely informed me that it had just arrived, and they would prepare it right then, if I wanted to wait.

Great! How long could it possibly take? I was the only person in the shop.

Let’s just say that during the ensuing 40 minutes, I was really wishing
I’d brought a knitting project with me. Ah well. At least I did
remember to ask if they could put it in a dropper dispensing bottle. “No
problem!” they cheerfully replied.

When I was given the bag, I looked inside, and … no dropper dispensing bottle. Granted, it wasn’t a normal bottle; it had some sort of special lid, designed to fit the accompanying 1 ml syringe.

“I’m so sorry.” I apologized. “Is it not possible to obtain a dropper dispensing bottle?”

“Oh this is a dropper!” I was told.

no. “That is what I had in mind.  You know, small? Like an EYE dropper? A bottle
with a built-in dropper for dispensing the medication?”

“Ah. That’s okay. You can use the syringe!”

(If I had WANTED a syringe, I would have ASKED FOR a syringe!)

I tiredly replied that actually, no, the syringe was not as suitable as the eye dropper type of dispenser.

“No problem! I’ll get you one.”

“Great!” I think.

pharmacist goes over to a display and happily hands me a bigass dropper
– one that I already have in healthy quantities, thanks to it coming
with every bottle of Lactulose.

“You can use this one!”

“Uhm, no. No, I can’t, but thank you anyway.”

“No charge!”

“No, really, I don’t need it, but thank you.”

“Why not? It’s a dropper.”

Yes, it is a dropper, but it’s HUGE. It won’t fit in his mouth! Besides, I already have several of those, but thank you.”

I just wanted to get home, see if Newt would take the new med, and then curl up on a heating pad and have some NewtSnuggles.

“OH! You want a smaller one? Like an eye dropper?”

“YES! I practically sobbed. “Yes! That would be great!”

“Okay, if you have one of his old bottles, bring it in, and I’ll see what we can do.”

this time, I really wanted to simply escape before either bursting into
tears, or bursting forth with a string of colorful invectives – neither
of which would have helped solve anything.

Upon arrival at home, I
must have spilled half the bottle – on me, on Newt, on the counter, on
The Dog – trying to figure out how to use the fancy cap to draw the
correct dose into the syringe. Luckily, it smelled okay, and tasted not unpleasant. Certainly not as bad as some of the prior efforts of years’ past. 
Newt did not try to run away, and tolerated my awkward manipulation of
the syringe.

“Maybe this is going to be okay,” I thought.

Not seeing a “refrigerate” warning on the label as with his past version, I called to verify.

pharmacist first cheerfully asked if Newt had liked the taste, then
said he would check the paperwork. “No, not refrigerated. Just store in a
cool, dry place.”

Heating pad, here I come!

Nope, the
phone rang.  It was the chirpy pharmacist, calling to trill at me that I
needed to adjust Newt’s dose, as they had made an error in mixing the

“Excuuuuuuuuuuuuuuuuuuuuuuuuuuuse me, WHAT did you just say?!?!?!”

(Count to ten, count to ten, count to ten …. breeeeeeeeeeeaathe breeeeeeeeeeathe …)

just read the original instructions, and you need to adjust his dose.
It’s supposed to be mixed 100g/ml, and I mixed 50 g/ml. Just double his
dose and it will be fine. It’s no problem, just give him one ml instead of one-half ml.

At this point, I resorted to banging my head on the counter.

With a sore head, and smelling of some sort of powdery, flowery,
candy-coated chicken, I whimpered my way onto the couch, and mentally began to
count our blessings, to counter the frustration.

Newt is stable. Newt has protocols and medicine that work to KEEP him
stable. The new pharmacy has friendly, happy, cheerful staff, and is
conveniently located. They are inundated with unexpected new patients,
in the same boat as us.  They promised that they would make things
right, if we weren’t happy.

Well. I’m NOT happy. Nothing horrible is wrong – this time. The error
was discovered after only one dose, and it wasn’t an egregious error –
THIS time. Do I trust that this mistake will help ensure extra attention
to prevent future mistakes, or do I start the dance over again, with
another new partner, and hope that things go better?

If It Ain’t Broke, Don’t Fix It!

Things have been cruising along here in Newtopia. No major changes, no surprising new developments.

Until Thursday.

No, no, don’t panic. Newt is FINE. I, on the other hand, am a bit … unsettled.

I always used to pride myself on being an early adopter – eager for new technology, new experiences, new improvements.

And then I got old. And we got Newt.

I’d like to say it’s our steely determination to maintaining Newt’s protocols that has turned me cautious. Alas,  I’m pretty sure it’s just me turning into a hide-bound, crotchety old curmudgeon, thrown for six with any unplanned changes in my, or Newt’s, routines.

I’ll confess, I’ve been holding my breath since winter hit, as historically, some of Newt’s most challenging times seem to have occurred deep within winter’s icy grip. I dared to relax a bit, in that our winter so far has been pretty mild, and Newt has been doing so well. Everything has been going according to plan, in its comfortable, dull routine.

Until I called in the refill of his antibiotic and was shocked to find the local mom and pop shop is no longer a pharmacy.


Add into the shock the fact that they are – err, WERE – one of the few pharmacies in the area that can / will compound prescriptions.

A few years ago, Newt was switched from his previous Amoxicillin onto Neomycin, compounded in a chicken flavor. The pharmacist, Dr. Bob, was so kind and
patient and worked diligently to find a compound that Newt would
tolerate. (Tastes like chicken, my ass!)

And now, not only are the pharmacy staff involuntarily transferred, and/or looking for jobs, and an area  landmark hailed for its commitment to affordable prescription services is no longer offering its main service, patients like us are scrambling to find alternatives for the specialty compounding service that they provided. Normal patients had their prescriptions transferred to one of the big box pharmacy chains, and the helpline gave me the names of other compounding pharmacies in the area. They said it was all quite sudden, and everyone is still in a bit of shock.

So, I called the closest provider, and am not really a happy camper.  There seems to be some communication issues at play.  New pharmacy says of course they can compound, just have the vet call in the RX. Great! Initial questions are what flavor is needed; will I be picking it up;  my contact info, etc. I’m trying to find the silver lining here, and stress the fact the new pharmacy is so close, I can easily pick it up.

Next I’m told that they will be delivering it.  No, I don’t WANT delivery.  I said I was happy they were so close so I could PICK IT UP.

Next exchange is that of course they can MAIL it.

Mail it? What part of “I will pick it up” translates into “mail”?!

And then I get “No, it’s fine, they are happy to mail it to the post office box.”

This is a prescription that must be refrigerated – W. T. F. ?!?!

Final exchange had me growling and muttering very unladylike language when I hung up the phone. The discussion began Thursday morning, and by the last exchange, I was told they might have it ready after 4PM on Monday.

What!?!  Four working days to compound a chicken flavored antibiotic? This new relationship is not getting off to a very good start!

Luckily, he is not completely out of his Neomycin, and worst-case scenario, we could obtain a bit of Amoxy from the ER vet to tide him over. As it is, for Newt, we consider the antibiotic almost secondary to his Lactulose in terms of necessity. He can miss a few doses of his antibiotic with no major effects, but Lactulose is his “must have at all costs” medicine.

So. we shall see what happens tomorrow night. I am trying desperately to remain optimistic that 1) it will be ready on time, 2) the flavor they provide will be palatable to Pookie, and 3) there will be no months’-long adjustment period like we had the last time his meds got changed.

Wish us luck!