9/4 Bear Man Old Timer Update

Last week: viewtopic.php?f=9&t=23528&p=234739#p234739

Bear Man is not doing well. Over the last couple of weeks he has been slowly declining, and in the last five days he has been refusing most food. He is weak and unsteady on his feet. He won't eat canned food or his usual renal dry k/d. I have been offering him a smorgasbad of every food in the house, and he will nibble on a bit of HC gravy, Temptations, warmed baby food, and a dry kitten food called Babycat 34. I shudder to think of the phosphorus content, but my biggest fear in him is weight loss, and I want to keep something going in at all cost. He will take a nibble of this and a lick of that here and there. He has managed to maintain his weight since last Tuesday. His BG's are all over the place, and I am dose hopping like crazy. There is no way of telling if he will eat enough to offset the insulin, and I do not want him going too low, so I am flying by the seat of my pants.

Last week his PCV was still holding steady, and he skipped his Aranesp shot for a third week in a row. We gave a shot of iron to see if that would perk him up (it didn't). His magnesium level was tested, and came back low normal. His other recent bloodwork has been unremarkable. We did not test fPLI, as it is always elevated in him. Yesterday we started treatment for a suspected IBD/CP flare: injectable Dexamethasone rather than oral Pred, Bupe twice daily, and Cerenia shots daily. He was up and around a bit last night and was purry, but his appetite is still poor today. We will continue this plan through the weekend and hope for some improvement. I have the week off work, so I will be able to keep an eye on him.

Since I am sticking close to home, I am doing some cooking. This is not one of my stronger skills. Last night I made meat sauce and cooked the end of my finger by putting it on the hot burner. Today I am about to attempt my very first slow cooker beef stew in an old Crockpot that someone gave me. My goal is to not burn the house down. Wish me luck.



Aranesp history:
July 15 PCV=.18 Shot of iron dextran and Aranesp 6.25 mcg given.
July 22 PCV= .20 Shot of Aranesp 6.25 mcg given. BP stable.
July 29 PCV = .28 Aranesp shot skipped. BP stable.
Aug 3 PCV = .28 Aranesp shot skipped. BP stable. Bloodwork done and hematocrit = .33!
Aug 10 PCV = .26 -.27 Aranesp 6.25 mcg given. BP a bit lower than last week.
Aug 17 PCV = .29 BP higher than last week. Aranesp shot skipped.
Aug 24 PCV = .28 BP higher than 8/17. Aranesp shot skipped.
Aug 31 PCV = .27 BP 140/95 Aranesp shot skipped. Iron dextran shot given.

I'm sorry to hear Bear Man is not feeling well still. Healing vines being sent your way this moment.

Please don't burn the house down, though. You have enough to think about and a fire would definitely make Bear Man po'd.

Hey Bear Man - hope you perk up soon. Good thing your Ma will be home to look after you. Sure seems like she is the BEST Mom in the whole wide world & we can tell how much she loves you! Get better buddy 'cuz we love you too! -- Lanky

Linda - since you are home & love to cook, thought you might like to try this bread recipe. I got it off the Board in spring & have made it several times, it is delicious & would go wonderfully with your stew or fixed up as hot garlic toast with your meat sauce. You are doing a great job so hang in there & take care.
Susan

I am sorry to hear he is not feeling as well sending snowflakes to help this week and ((((((HUGS)))) to you both love the pic as always

Bear Man, I am sending you better appetite and feel better vines.
Linda, I am glad you have the week off. That will make both you and the Bear Man happy , provided you don't burn the house down. Hope you both have a good week.

Here is the snowbunny with "eat-up" snowflake vines.


I'm sure he'll feel better after some good'ol home, slow cookin!
Just a tip....go heavy on the spices and flavoring....slow cookers seem to suck the taste out of the fuds. Oh, and you're not supposed to cook your finger on the burner, it hurts.

Bear Man is just cute as cute can be, I hope he feels better.

Sending snowflakes and healing vines to Bear Man...I hope he starts to eat ...hey, maybe the aroma of your slow cooking beef stew will stimulate his appetite. I hope so....it is good that you are off this week. What are you cooking tomorrow? Hope your finger is healing too...ouch...that hurts...silly you...(I got hot oil from chicken plopped on my right hand...it didn't hurt so much at first, but what a burn I got...!!!) Cooking can be dangerous to your health so be careful!
Feel better soon Bear Man...we love you and send hugs and kisses to you... :YMHUG:

((((((((((linda and bear man))))))))))
eating vines and positive thoughts on the way...

Sending snowflakes and vines for Bear's appetite.

Its so worrisome when they dont eat. Send tons of vines and snowflakes for a big appy.

sending eating vines for my beloved Bear Man. Beef stew sounds yummy, why don't you try some, Bear?

I have a great deal of confidence that you can accomplish your goal of not burning the house down.

Feel better Bear. Happy cooking Linda. Please don't burn the house down but a little too much smoke and some hunky firemen, well...
(I've done that, just a few weeks ago...) :roll:

oh dear. (((bear))) (((linda)))
what's his phos?
does he seem dehydrated?
can he get SQ fluids at all, or is that a bad idea?

ahh, cooking. i had 40 lbs of tomatoes to work with a couple of weeks ago, and that got me looking online for recipes, and i got lost clicking away in recipe-land. it was .... oooh that looks interesting ... click ... this one looks good... click ... click ... click .... click ... i have no idea where the last two weeks went ohmygod_smile

cooked-finger meat sauce sounds a little too exotic, suggest you don't make it too often, fingers are not easy to come by :razz: did bear taste it, what did he think of the added ingredient?

So sorry to hear Bear Man is feeling under the weather. Hopefully, your being home this week will be good for Bear Man.
Have fun with the cooking!

Hi Linda, We sure hope that Bear Man will perk up this week. If you are going to be home all week, that will help. Sending feel better, eat better vines to Bear. And a note to you that the no-knead bread recipe in the NY Times is fantastic and really easy. My DH makes it every week. (and hasn't yet burned his fingers).

Hope this coming week is better than last,

Ella & Stu

WCF and Meowzi said:

oh dear. (((bear))) (((linda)))
what's his phos?
does he seem dehydrated?
can he get SQ fluids at all, or is that a bad idea?

Click to expand...

His phosphorus on Aug 3 was 2.5 mmol/L (= 7.74 mg/dL), at the top of the ref range (0.8 - 2.5) and the highest he has ever tested. That was up from 2.1 on July 8. His best was 1.9 in March. Calcium on Aug 3 was 2.65 mmol/L (=10.6 mg/dL). That's a horrible CA X Phos of 82.

The vet still doesn't want him to have sub Q fluids, even administered by her. I don't think he is dehydrated.

hey Big Bear...heard you were feeling poorly, so i'm sending you some of my appetite, and a bushel basket of healing thoughts!

feel better soon-

binks

Hey Bear man - I hope you are feeling better today. I miss you buddy! Maybe i can come and visit you a little? That would be really cool. It is nice that your bean has some time now to spend with you - it's so great when they can be home with us. Take care buddy - you are the best! See you! ~~ Mannie, your look-alike twin.

Mannie and I send many positive thoughts, snowflakes, healing vines. I hope Bear Man perks up for you. it is so nice that you have some time at home this week. Take care.

linda -- am late to caturday....

sorry to hear bear is not eating or feeling very well.
sending healing wishes......

( for your fingers too ;-) )

Linda and Bear Man said:

His phosphorus on Aug 3 was 2.5 mmol/L (= 7.74 mg/dL), at the top of the ref range (0.8 - 2.5) and the highest he has ever tested. That was up from 2.1 on July 8. His best was 1.9 in March. Calcium on Aug 3 was 2.65 mmol/L (=10.6 mg/dL). That's a horrible CA X Phos of 82.

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that's not pretty at all. you've never tested his ionized calcium, have you?

remind me again, what dose binder - just ALOH3, right? how is it given, and when in relation to food? has it affected his appetite? and what's his weight?

I'm very sorry to hear that Bear Man is not feeling well and not eating well. When Blackie stopped eating it was high creatinine and BUN and the subQ fluids had him eating again within a few days. ECID - I don't know if it would help Bear Man, though. I'm sending healing and eating vines to Bear Man. Feel better, Bear Man.

Shoveling snowflakes and healing vines your way! I hope Bear Man starts to get his appetite back quickly. What a cutie!

WCF and Meowzi said:

Linda and Bear Man said:

His phosphorus on Aug 3 was 2.5 mmol/L (= 7.74 mg/dL), at the top of the ref range (0.8 - 2.5) and the highest he has ever tested. That was up from 2.1 on July 8. His best was 1.9 in March. Calcium on Aug 3 was 2.65 mmol/L (=10.6 mg/dL). That's a horrible CA X Phos of 82.

Click to expand...

that's not pretty at all. you've never tested his ionized calcium, have you?

remind me again, what dose binder - just ALOH3, right? how is it given, and when in relation to food? has it affected his appetite? and what's his weight?

Click to expand...

No we never tested the ionized calcium or PTH. Partially due to the expense, and partially because I don't think I would do anything with the info. I don't think Calcitriol is an option for him.

ALOH3 cap$ules are 120 mg, given twice daily with an a.m. meal and a p.m. meal, though the "meal" may only be nibbles. Food is available to him throughout the day, so other "meals" are not being bound. He would not eat food containing the binder, and is at the moment not eating canned food at all. Even if I dusted binder on his dry food that is left out, he may unpredictably eat a lot of, or none of, a food, and the same food is available to Teddy. Again, at the moment, his appy is so tenuous that I am not willing to put him off the last one or two dry foods he will touch. My work schedule rarely allows tid dosing (the vet's instructions were to give no more frequently than every 8 hours), but in the past, more frequent dosing seemed to make him feel ill. Weight is 3.75 kg.

Tuesday update: he is off Dex and back to Pred, off the Bupe and the Cerenia. Last night and this morning he ate some k/d kibble (huge progress)!

Curry is sending kitty kisses, hugs, snowflakes, healing vines and prayers to Bear Man.

Good to hear that he ate some kibble....Come on big guy....eat a little more for ya momma bean.

Another beautiful picture of your handsome guy. Great that he ate a little last night and this morning, I do hope he's feeling better today.

third attempt at posting ... let's see if i can finish it before break ends again. here goes :razz:

good news that he's eating, i hope his appetite has continued to improve

Linda and Bear Man said:

No we never tested the ionized calcium or PTH. Partially due to the expense, and partially because I don't think I would do anything with the info. I don't think Calcitriol is an option for him.

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i wasn't thinking of calcitriol. i asked about ionized calcium because iCa is the active portion of calcium and that's what we're concerned with. see http://animalhealth.msu.edu/Sections/En ... ium.php#09

but you're right, i'm not sure what you would do with the info anyway, since the general rule of thumb (and i don't know why that is so) is to use serum total calcium x phos. the problem with total calcium is that it's not always a good estimate, esp in disease states like CKD. eg, meowzi has had several instances of high total serum calcium, but normal iCa.

just fyi: if you're ever interested in checking iCa (without PTH), regular labs - antech, idexx - should be able to run it. we had it done by antech a few years ago, when meowzi had that hypercalcemia cancer scare. i don't remember how much it cost, but the MSU charge for the iCa single test is under $10, so it's not like it uses expensive reagents or anything.

interestingly, i've seen a reference that pred may lower iCa and tCa. http://animalhealth.msu.edu/Sections/En ... ium.php#06

ALOH3 cap$ules are 120 mg, given twice daily with an a.m. meal and a p.m. meal, though the "meal" may only be nibbles. Food is available to him throughout the day, so other "meals" are not being bound. He would not eat food containing the binder, and is at the moment not eating canned food at all. Even if I dusted binder on his dry food that is left out, he may unpredictably eat a lot of, or none of, a food, and the same food is available to Teddy. Again, at the moment, his appy is so tenuous that I am not willing to put him off the last one or two dry foods he will touch. My work schedule rarely allows tid dosing (the vet's instructions were to give no more frequently than every 8 hours), but in the past, more frequent dosing seemed to make him feel ill. Weight is 3.75 kg.

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it's not clear to me if you're dosing enough ALOH3. we're giving 100 mg/lb/day, or 200 mg/kg/day, which is the max. we can't safely go any higher ; hence the use of a second binder. admittedly, we have an easier time with meowzi, since she's syringe-fed.

btw, there is some thought that ALOH3 may still do some good even if not given with meals, albeit it's not as effective as when given with meals. but every little bit helps. you're already doing the best you can, if he won't eat food with binder, and your priorities are right; he must eat.

re: timing of the cap$ules, i hope i'm not imagining this but i haven't been able to find it again - i think there was a discussion on the crf support group on giving the binder in cap$ules a little before food, so the gelcap has time to dissolve and release the binder, before food hits the digestive tract. i didn't pay much attention to it probably because 1) we don't use gelcaps and 2) i was probably doing a search for something else when i came across it. try doing a search for it?

just made it, break's about to end let me know if you need clarification, had to type that all in a hurry.

Sending Giant Snowflakes and Healing Vines, to dear Bear Man--Linda you have been an inspiration to me & I pray for Bear Man to come back as he has done so many times with your unbelieveable treatment!! You are my Hero Momma Bean & I just know he will get better yet again--Newbies dont know your devotion to your kitties, above & beyond all things!!
Praying for him on this eve of the Jewish New Year fo good health! Love & Hugs from Us!!

((Linda))
I"m sure someone has suggested, but is it possible to try a bit of mirtazapine? I love that stuff. I don't know if it's contra-indicated with any of the other meds Bear man is on though. It's relatively cheap, so if your vet thinks it is ok, i would give it a shot. Maybe Bear man has a cold or something.

(((((((Linda))))))) scritches for Bear man.

I'm sure I can't find the words to say what I feel. Maybe you know. This Bear Man is a love kitty and you are the love bean.
I wish he would eat and am sending you clouds of snowflakes.
((((((((((((Linda and Bear)))))))))))))))))

cyn, bear doesn't respond well to mirtz. i think linda has a video of what happened.

Thyank you Choy-Foong, for typing up all of that info on Ca and ALOH3. I have printed it out so that I can sit down and go over it thoroughly. I was very interested in the part where you said that binder has some efficacy even if not given with food. I had not heard that. I should try increasing his binder, once he is feeling better, and see how it goes.

Thanks to everyone for the recipes, hugs, vines, suggestions, and support. I can't tell you how much I appreciate it.Two notes: Bear can't take sub Q fluids because he has very fragile skin that is vulnerable to tearing, and he has had a bad reaction to Mirtz in the past. I should repost my link to the "Bear on Mirtz" video.

Update: he is continuing to improve. He is off his extra meds and is eating his renal kibble again, and also some nibbles of FF canned food. Last night he sat for a long time purring and enjoying the breeze from an open window, and he washed his face a little bit. I love seeing him just being a cat.

I guess we have missed a lot of beach parties recently. He should be feeling up to partying again soon. He can't wait to meet Duchess.

Linda and Bear Man said:

I was very interested in the part where you said that binder has some efficacy even if not given with food. I had not heard that. I should try increasing his binder, once he is feeling better, and see how it goes.

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linda, i don't want to raise false hopes on this. the person who wrote it is ian of thriving pets, and i haven't seen much in reference to it otherwise. i do not know how credible his information is; afaik he didn't cite a source. but if bear is underdosed, and there is no other way to get more binder into him in conjunction with food, this is worth a shot. i should note that it is a desperate shot, though, given the limitations in his, and only his, situation. the gold standard approach has been, and still is, to give phos binders in conjunction with food.

Linda and Bear Man said:

Last night he sat for a long time purring and enjoying the breeze from an open window, and he washed his face a little bit. I love seeing him just being a cat.

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This is a wonderful WCR for Bear Man.

Im sorry to hear Bear Man did not have the best of weeks. From the sounds of it, he is coming around. That up /down... So hard, isnt it? :YMSIGH: I agree, I like watching a cat be a cat! ;-) No, really...playing is fun and fine. But, What I have always enjoyed is watching them eat, clean, sleep, and look out the windows. Something about all of those things is calming and reassuring that they are happy.

I hope bear man's week continues to improve. He deserves it! And you deserve a smile on your face, along with some calm.

Hows the cooking going? ;-)