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My kitten got treated for worms, but he's still very sick. What should I do?

Dear Siouxsie, Thomas and Dahlia:
I recently got two kittens, both about 8 weeks old. While one of them has been acting playful and healthy, the other has become very sick. He hasn't been able to hold anything down and just sleeps all the time. We took him to the vet and he got dewormed. The doctor agreed that it was worms and gave me Albon suspension and Val syrup to give to him daily. On the car ride home from the vet, he threw up a worm. Could he have thrown up the deworming medicine too? It's been five days and he hasn't improved at all. I'm starting to get very worried, considering he's very dehydrated and still not keeping anything down. How long do worms usually take to go away? He's scheduled to go back to the vet in three weeks, but that seems kind of long if he remains this sick. Is there anything else the vet could do to get him well quicker? Or is this something we just have to wait out? I'm just confused and need advice and want this kitten feeling better again. Thanks so much!
~Julia

Siouxsie: You're right, Julia. Three weeks is much too long to wait for a kitten this sick. You need to call your vet as soon as possible and explain what's going on.

Thomas: Although a heavy infestation of worms can cause some of these symptoms, such as nausea and fatigue, we suspect there's more going on than just worms.

Dahlia: Your vet gave you Albon, an antibiotic, and Val syrup, which we've never heard of. Presumably you're to give your kitty Albon in order to deal with any infection he has. We presume that Val syrup is a dewormer, but as I said, we're not familiar with it.

Siouxsie: Our vet used to give us Drontal, a broad-spectrum deworming medicine. Most recently, we've been given Cestex for tapeworms and Strongid for roundworms, hookworms, pinworms and other nasties. Strongid is a liquid, and Cestex is a tiny little pill. We didn't like the Drontal much because it's a huge pill and we had to take one and a half of them each time! Ew!

Thomas: Dewormers are generally given in two doses, two weeks apart. The first dose kills the adult and juvenile worms already alive in the intestines. The second dose kills any worms that have hatched out of eggs since the first dose.

Dahlia: But there are other intestinal diseases or parasites that can cause diarrhea and dehydration. Coccidia and giardia are two possibilities We suspect that when you call your vet, you'll be asked to bring in a fecal sample from the sick kitty. They'll examine it microscopically and see if they see any worms or other parasites in it.

Siouxsie: Whatever the case, the dehydration is definitely an urgent problem. This tiny kitten needs nutrition and enough fluid intake to keep his body fighting off whatever is going on and to keep his organs from shutting down. So please call your vet and get the kitten under treatment.

Thomas: Once your vet has the kitten stabilized and has figured out what the problem really is, she should give you a home care regimen including appropriate medication, instructions on its use and potential side effects.

Dahlia: We've decided to use the generic "she" when talking about vets, because Mama read in a recent issue of Cat Fancy that 75% of veterinarians practicing in the US are women! How cool is that?

Siouxsie: In our town and its immediate surroundings, we have eight vets, including one holistic practitioner with a veterinary medicine degree, working in five clinics. Four of those vets are women. So the average does vary from place to place.

Thomas: Anyway, back to your letter, Julia. It is very possible that your kitten threw up the deworming medicine when he threw up on the way home from the vet. In order for deworming medicine to be effective, it needs to go through the stomach and into the intestines, where the worms live.

Dahlia: If the poor little guy is so loaded with worms that he's throwing them up, he definitely needs deworming. You will have to re-dose him, though, because whatever medicine you gave him didn't reach the target area before it came back out.

Siouxsie: Another thing you're going to have to do in order to make sure that your kitty doesn't get reinfected with worms (and that your other healthy kitten doesn't get worms or whatever else is going on in your sick kitty) is to be religious about cleaning the litterbox. On a daily basis, scoop out feces as soon as you're aware of their presence and flush them.

Thomas: Then you need to clean and sanitize the litterbox. Dump out whatever litter you have in the box and clean and sanitize both the box and the scoop you're using to remove feces and other waste. Get yourself a pair of those yellow rubber gloves and a scrubber sponge that you're not going to want to use for anything else. Fill the litterbox about a third to halfway with very hot water to which you've added unscented dish detergent and a splash of bleach. Scrub the entire box, inside and out, making sure to get rid of any diarrhea that's stuck to the sides or bottom of the box. Soak and scrub the scooper, too.

Dahlia: Repeat this process one more time for good measure, then rinse the be-Bastis out of everything.

Siouxsie: Dahlia P. Kittenface! Don't you take the Goddess's name in vain!

Dahlia: I'm sorry. *sniffle* I got excited and forgot. Please don't make me wash my mouth out with dog food!

Siouxsie: It's okay. Even at my, ahem, advanced age, I do still have a vague recollection of what it's like to be a kitten. Just don't let it happen again.

Thomas: Anyway, Julia, what Dahlia meant was that when you're finished washing the litterbox and scooper, you need to rinse them very thoroughly in hot water. You want to make sure there's no detergent residue or bleach odor left on the box.

Dahlia: When you're done with this chore, you'll definitely want to soak the sponge in bleach water and set it aside where nobody can mistake it for, say, a dish sponge. Sanitize once a week (or more frequently if your vet recommends it) until kitty is feeling better, and then do a general litterbox cleaning on a more regular schedule.

Siouxsie: If your vet recommends other sanitary procedures, make sure you implement those as well.

Thomas: So, Julia, call your vet and explain that your sick kitten is not only not getting better, but is in fact getting worse. Describe the symptoms and get your kitty in before the three-week recheck. Then keep your litterbox scrupulously clean and give medication as needed.

Dahlia: We do have a little tip that might help your kitten start feeling better. Antibiotics tend to kill off not only bad germs, but the good bacteria that live in the intestines and help us digest food. When you give your kitty antibiotics, you can also give him a teaspoon or so of plain, lowfat yogurt per day. Make sure there is no sugar or artificial sweetener in the yogurt you give him.

Siouxsie: The active cultures in the yogurt will help restore the balance of the intestinal flora, and will help keep your kitten from getting diarrhea or constipation as a result of taking antibiotics. And it's yummy, too!

Thomas: Adult cats can have a tablespoon a day of yogurt if they get antibiotic-related diarrhea -- or even just as a preventive. You humans can eat plain yogurt for a similar salutary effect on your intestinal health, too. Add stuff like fruit, granola and maple syrup to make it taste good for you.

Dahlia: I don't know what you humans see in fruit. It's all sweet and sticky and stuff. Ew!

Siouxsie: We hope this helps, Julia. Please let us know how things turn out.

Got a question? Need some advice? E-mail us at advice@paws-and-effect.com. None of the material in this column is meant to be a substitute for regular veterinary care.