Spice Update 9/14/10

Hi everyone,

Spice did go to the vet. I have a lot of mixed emotions right now. First off they wanted to hospitalize her right away without bloodwork or x-rays at a cost of 629 dollars for one night. I did not go that option. I did decide on xrays and bloodwork at a cost of 325 dollars. The x-rays came out fine. Everything looked great, especially for her age. It did look like she had a stool in her system that was closer to the stomach and her stomach was empty. I asked the vet how long it takes to pass a stool from that point and he said 24 hours. At that point spicey had not eaten in 36 hours. She was dehydrated and they gave her fluids. I also decided on an antibotic called convenia, just be sure. Later on that nite I read the symptons for constipation and she had all the signs and after seeing the x-ray I thought that was more the case. I gave her some miralax and at one point in the nite she had a reall hard stool that came out. She has been eating and acting more normal. I still don't know if she had a bm since I had to work today.
I got the bloodwork back today and cdc normal,platent count normal, thyroid value normal, her bun and creatin values are elevated, creatin is at 2.6 and a year ago it was at 2.1 upper normal range is 2.4, bun value not so much due to hydration issue, So the vet thinks it is the start of kidney disease but is not sure because the blood draws are very hard on spice and the numbers could be inaccurate.. So at this point I think I am more confused because I really don't know what to think or is the vet just trying to get more money.
And I don't know what to do if it is the start of kidney disease and how much money is this issue going to run. And how do you care for your cat with kidney disease? Talk about an emotional wreck.

David

 

Hi David,

I can't help with the bloodwork, but I'm glad that Spice is eating, that's a step in the right direction! You might get more help with the kidney and BW questions if you change the title of the thread to include "BW/Kidney questions" or something along those lines to catch people's eyes who know about those things. I do remember reading that high protein diets cause elevation in some BW tests, but I don't remember which ones.

ETA: I thought I replied to the thread on Health....I would change the title of the thread on Health, not this one here....more eyes on Health, and you are more likely to get the help you need with these questions there.

 

Hi David,

I'm glad she's eating again.

There are people here treating both diabetes and kidney disease.

You may want to post on health for help with that. The few things I know are changing her food to low phospherous, using purified water so her kidneys don't have to work so hard (I have a water pitcher with a purifer in it and use that for all of us).

The vet techs on health can help you decipher her blood work numbers.

Hang in there.

 

Info on Convenia

I have no idea why that vet would have given Spice any antibiotic shot without knowing whether it was warranted or not. Please read about Convenia.

Subject: Convenia....2 week antibiotic shot....dangers and warnings


Below was posted by a vet that visits our diabetes board and has her own fantastic site www.catinfo.org Convenia is fairly new and warnings are coming out about it.


Convenia....aka....."the two week antibiotic"....which is being used far too often without considering if its administration is appropriate or not. It is becoming the 'easy fix' for people who don't want to
give antibiotics to their cat twice daily.

One of my favorite consulting patients became extremely ill post Convenia administration. Can it be absolutely proven that Convenia caused the severe anemia in this patient? No - but the evidence is very compelling.

The good news is that we are on Day 17 and the patient is still alive. The bad news is that the vet bill is now $5,000 and we are not done yet.

When I did a search on VIN, I found a post that discussed severe hemolytic anemia in two cats. Both cats died - 1 within 7 days of Convenia, the other one on Day 10. Both had normal HCTs prior to the Convenia administration.

This drug is known to wreak havoc on the bone marrow and, according to one source on VIN, anemia was seen in the patients post convenia in trials that were done outside of the US but no anemia in the patients involved in the US trials.

Please keep in mind that when you inject such a LONG ACTING drug into a body.....if that drug exerts a toxic effect on the body, you are in deep trouble because you can't retrieve the drug.

When a drug has a long half-life, you better be sure that it is a safe drug to be giving and that you have a very compelling reason to give it.

Please note that this patient was given Convenia for an off-label reason - ie - a dental. This is not an appropriate use for Convenia since there are much better choices for oral bacteria. Convenia is labled for skin infections.

Plus, this patient just had a *routine* dental - no extractions - no significant gingivitis. The patient did not even need antibiotics which makes this case even more heartbreaking.

It is interesting to read posts on the VIN dental boards that have the specialists speaking out about the abuse of antibiotics in dental patients. They frequently comment about the overuse of ABs in this area.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Patient: 9 year old neutered male. Healthy...goes in for pre-dental blood panel and CBC on 10/21/09. All is well - HCT = 41%.

Timeline:

1) healthy - normal full blood panel and CBC the day before a routine dental (Day 1 = dental day 10/22/09)

2) no gingivitis, no extractions - ie - no reason for post-dental antibiotics

3) my client picks up her cat and is asked to give clavamox…..why?....we don't know since there was no indication that abs were needed

4) client says patient is hard to orally medicate so they give a shot of Convenia

5) note that Convenia is NOT labeled for use for dental issues - it is labeled for skin issues - the spectrum of this drug is not targeted toward oral bacteria

Day 3 - 48 hours post dental/convenia - listless, ate half of normal amount

Day 4 -72 hours post dental/convenia – ate a little bit then vomited it up….later that day, vomited blood-tinged fluid

Day 5 - 96 hours post – HCT (the measure of the percentage of red blood cells in the serum) had gone from 41% pre-dental to 31%

client called me for a consultation on Day 7 and I did a search on VIN and found a post from last Feb that outlined the cases of 2 cats – separate practices – that had died within 10 days post Convenia – with severe anemia

Day 8 - patient was taken to a 24 hours critical care facility where his HCT was measured at 33%.

Day 9 – HCT down to 26%

Day 10 – HCT at 28%

Day 11 – IN HOUSE test showed 34% - most likely an error

Day 12 – HCT down to 22%

Day 13 – HCT down to 20%

Day 14 – HCTs were 18, 21, 24, 22 – Bone marrow results showed Panhyperplasia with relative erythroid hypoplasia meaning that RBCs were not being produced normally.

The patient was discharged on Day 14.

Day 16 - He is eating well but is a bit weak and tired. Today is HCT is 27%.

Day 17 (11/7/09) - HCT = 25%

For the past 25 years as a practicing veterinarian, I don't think that I have ever stuck a needle into a patient or given them a pill without stopping and thinking about it. Does the patient really need this drug? Is it the right drug for the situation? The correct dosage? etc..etc....

It has been frustrating to watch Convenia being reached for - in many instances - because it is *convenient*....NOT because it is actually the right thing to do for the patient. The drug does have its legitimate uses but I also see quite a bit of abuse involving this drug.

This patient did not even need antibiotics and, even if he did, Convenia was not appropriate for use with oral issues. Now the client has a bill that is over $5,000 and is hoping that her cat lives and has not had his life shortened.

I would suggest to your vet that she go on VIN and go to the Internal Medicine - Feline board and search "Convenia and anemia".

That way, she can read more detail about the case and participate in her colleagues' discussion.

(I posted far more detail on VIN than I did here.)

 

Everyone (feline and human) is heading toward kidney disease--the kidneys do not regenerate like other organs. FWIW, Lucy was diagnosed with CRF (chronic renal failure) before she was diagnosed with diabetes 6 years ago. The only thing I do is add water to her food. Her kidney values are getting worse but only slightly and in relation to her age, they haven't changed significantly over the 6 years.

 

Oh I am so glad she is eating again! That is great that poop came out and without needing any "procedures" (ewwwww). Hopefully she will be back to normal pretty soon. I don't know much about kidney stuff, but there are many cats here who have problems and do well for ages, so I wouldn't stress yourself out about it too much. Hopefully it's nothing too serious at this point, or like you said even the test might not be definitive.

 

When H was on a high[er] protein diet he had slightly elevated BUN levels - the rest of the liver kidney levels were within range. The N in BUN stands for nitrogen which is a metabolite of protein. So I chose to ignore the elevated BUN.

A tangent: the melamine scare was caused by the fact that the test for protein levels in wheat gluten were for actually for nitrogen not protein. And melamine is very high in nitrogen, so that's why it was surreptitiously added to the wheat gluten [and later water downed milk in China].

Constipation can be helped by proper hydration. As Terri points out adding water to the wet food is probably a good idea, not only for CRF but also for constipation. At some point [for any CRF] you may need to start with SubQ LRS. One way to tell if they need it is to give it to them and see if they perk up. Ask if you need LRS equip and supplies sourcing info. Adding water to the food is also important if you are giving miralax or lactulose as they draw water in from the body into the intestine and can further dehydrate the kitty.