3/22 Yum AMPS 486 +5 408 PMPS 550 +3 531

[MJW]

Well, at least it's not black. Maybe she will hold her ground on her latest dose increase.

Her regular vet visit yesterday could have been worse, but it wasn't great. Her creatinine came down to 3.2 from 3.8 on 3/15. Her BUN is worse at >130. Her phosphorus is down to 5.3 from 5.7. My vet is guiding me in reducing Yum's lasix dose. We halved it again yesterday: she is down to 3mg, twice a day. My vet didn't think these were huge doses, but I am hoping her kidney numbers will continue to drop with the lasix dose. She had proteinuria at 1+. I sure hope this is due to inflammation and not renal.

When I asked the IM vet about lasix and diabetes, she wrote "The diabetes may be dysregulated as a result of fluid imbalances in the kidneys and heart due to the Lasix.". I don't know what that means.

I put her on cabergoline every day again instead of every other day.

My vet said pimobendan can be hard on the kidneys as it lowers blood pressure, I guess because of vessel dilation. Maybe we will want to get Yum off pimobendan. She sees a cardiologist on 4/2.

My vet also said splitting her enrofloxacin dose in half and dosing twice a day makes it ineffective. Something about the area under a curve. The critical care folks did that, saying it would help prevent the side effect of blindness. The IM vet agreed it would not decrease the risk for blindness.

Her respiratory rate remains normal. She is eating more than 200 calories a day. She is enjoying life.

 

[Beth 73]

Sending prayers and hugs , that today Yum gives you a positive sign that she is improving beyond a vets observation .

 

[Bobbie And Bubba]

Wow, you are really juggling a lot of things for her. I can't help with any of the med questions not having gone through any heart and kidney issues. Maybe you could tag Doodles and Karen and or Wendy and Neko as they both have been through similar issues.

 

[Kathy and TiTi]

Well, at least it's not black. Maybe she will hold her ground on her latest dose increase.

Her regular vet visit yesterday could have been worse, but it wasn't great. Her creatinine came down to 3.2 from 3.8 on 3/15. Her BUN is worse at >130. Her phosphorus is down to 5.3 from 5.7. My vet is guiding me in reducing Yum's lasix dose. We halved it again yesterday: she is down to 3mg, twice a day. My vet didn't think these were huge doses, but I am hoping her kidney numbers will continue to drop with the lasix dose. She had proteinuria at 1+. I sure hope this is due to inflammation and not renal.

When I asked the IM vet about lasix and diabetes, she wrote "The diabetes may be dysregulated as a result of fluid imbalances in the kidneys and heart due to the Lasix.". I don't know what that means.

I put her on cabergoline every day again instead of every other day.

My vet said pimobendan can be hard on the kidneys as it lowers blood pressure, I guess because of vessel dilation. Maybe we will want to get Yum off pimobendan. She sees a cardiologist on 4/2.

My vet also said splitting her enrofloxacin dose in half and dosing twice a day makes it ineffective. Something about the area under a curve. The critical care folks did that, saying it would help prevent the side effect of blindness. The IM vet agreed it would not decrease the risk for blindness.

Her respiratory rate remains normal. She is eating more than 200 calories a day. She is enjoying life.

I think the diabetes being dysregulated is a fancy way to say, her diabetes will not be well controlled. Her creatinine is great. I never gave much credence to the BUN, because it can go thru' the roof after a cat eats, and then slide back down to normal a few hours later. BUN is volatile.

There is a way to usefully interpret BUN, and it has to do with taking percentages and ratios, and here I will call out @Marje and Gracie

 

[LuvinThisPig]

I would not worry overly much about the proteinuria. According to Merck, many Acro cats present with a "urinalysis [that] is unremarkable except for persistent proteinuria". In fact, Pig test positive for it on every single urinalysis that the Vet or I have ran. That fact was one of the biggest keys to me becoming suspicious of his simple dx of diabetes. Something was not right and this was a big piece of it.

Hugs! You have much to deal with, but I have seen your strength!

 

[Stacy & Asia]

I'm glad to hear she's eating, enjoying life and her breathing is normal! That must be such a relief, it sure freaked me out when Asia was breathing too fast. And yay for not black! We can celebrate these small BG successes, she has come a long way!

 

[Susan&Felix(GA)]

She is enjoying life.

This makes me so happy. She's been through so much--what a brave, joyful spirit she must have.

 

[Wendy&Neko]

It wasn't until Neko's urine protein was +3 when her vet thought she needed to do further testing. Pimomedin also did not have a negative effect on her BP. Remember, heart trumps kidneys. If Yum needs pimomedin, so be it.

Other secondary conditions, besides acromegaly, can cause insulin resistance. They include kidney and heart disease. Yeah for lower CREA and phosphorus.

Great Yum report today.

 

[MJW]

I'm glad to hear she's eating, enjoying life and her breathing is normal! That must be such a relief, it sure freaked me out when Asia was breathing too fast. And yay for not black! We can celebrate these small BG successes, she has come a long way!

When was Asia breathing too fast? How fast? During the kidney infection? Her profile says undiagnosed heart disease. Do you mean unclassified?
Poor Yum. I sit there with my cell phone timer and time her breaths over and over and over again. She twitches and I start over.
This morning's BG success is gone. Now I can only be glad she isn't over 600.

 

[MJW]

It wasn't until Neko's urine protein was +3 when her vet thought she needed to do further testing. Pimomedin also did not have a negative effect on her BP. Remember, heart trumps kidneys. If Yum needs pimomedin, so be it.

Other secondary conditions, besides acromegaly, can cause insulin resistance. They include kidney and heart disease. Yeah for lower CREA and phosphorus.

Great Yum report today.

I just worry the kidneys will give her a poor quality of life and a bad heart will take her quickly. I'm not thinking like that yet. I'm still trying to win on all fronts. Or optimize her situation on all fronts.
Heart disease causes insulin resistance? Her blood sugar did shoot up when she had CHF. But her chest is clear of fluids now. She doesn't currently have CHF.
Bad kidneys cause insulin resistance? Her kidneys were at their worst before and during her first ICU stay for the kidney infection. She was on a 0 to 1 unit insulin dose then.
Hmmm. Infection causes insulin resistance, but Yum's numbers did not go up with her kidney infection.
What is the mechanism? Inflammation? I did get her some omega3's today.
There's a lot to try to understand.

She is eating like a pig but has either stopped or slowed her weight gain. If it was the acromegaly flaring, she would be gaining weight maybe.

 

[Stacy & Asia]

When was Asia breathing too fast? How fast? During the kidney infection? Her profile says undiagnosed heart disease. Do you mean unclassified?
Poor Yum. I sit there with my cell phone timer and time her breaths over and over and over again. She twitches and I start over.
This morning's BG success is gone. Now I can only be glad she isn't over 600.

Before the kidney infection was diagnosed, it was right when we started giving fluids, probably around November? It happened the first time after giving her fluids and perisisted until I noticed the pattern was she would do it after I gave her fluids, it was rapid breathing whilst awake and labored breathing when sleeping. I cut fluids in half (100 mL down to 50 mL) and it still happened. I stopped giving fluids and it stopped happening, like a light switch turned off, she's still supposed to have fluids but my gut says don't do it, so I just soup up her food as much as possible. Asia had a snap bnp test (which is only a yes or no to indicate further studies are needed for heart disease) that came up positive. I have yet to have an echo or anything done on that end so we don't have an actual diagnosis, just a strong indication. At her age, all parts are past their expiration date, so it's not unexpected.

Yum's numbers will come down, I just know it. Hang in there.

 

[MJW]

At her age, all parts are past their expiration date, so it's not unexpected.

Asia is 25% older than Yum! Better genes I guess. Plus you are exceptionally thorough.
Yum has outlived her mother and sister and a half brother.

 

[Wendy&Neko]

What is the mechanism? Inflammation? I did get her some omega3's today.
There's a lot to try to understand.

At some point, there just becomes too many different things going on to figure out exactly what is causing the higher numbers. In Yum's case, it can be one or more of many things. I got to that point with Neko that I didn't bother trying to figure out the "why". Other than blood sugar, most of it was out of my control anyway. Just do what you can do, and let the BG be your guide in dosing.

 

[LizzieInTexas]

You are doing fantastic. You could send some of Yums appy and weight gain Gizmo's way .

 

[Stacy & Asia]

Asia is 25% older than Yum! Better genes I guess. Plus you are exceptionally thorough.
Yum has outlived her mother and sister and a half brother.

You're right, so much of this is luck, I credit her ripe old age to genetics and diet more than anything. I'm as supportive as I can be for as long as she still wants to be here and is acting like a cat, but I also have to weigh things like the cost (health and stress wise) of doing something like an echo or giving her fluids with the potential benefit... it's a balancing act and there are not always clear answers. Like you, I put out fires where I can, try to give her the best care nutritionally and hope her body handles the rest. You have done an amazing job with Yum and obviously she is thankful and doing as well as she is because of your care.

 

[MJW]

At some point, there just becomes too many different things going on to figure out exactly what is causing the higher numbers. In Yum's case, it can be one or more of many things. I got to that point with Neko that I didn't bother trying to figure out the "why". Other than blood sugar, most of it was out of my control anyway. Just do what you can do, and let the BG be your guide in dosing.

It's just if it is the acromegaly, I want to add the octreotide to the cabergoline. That should shut the tumor down for sure, if it has come back to life.
I can test her IGF-1 again, if her numbers and dose keep rising. The cabergoline is supposed to shut down the IGF-1 if it's working.

 

[Wendy&Neko]

The cabergoline is supposed to shut down the IGF-1 if it's working.

Unfortunately no. That was the goal of the research, but they found it wasn't true. @Chubba just had Gizmo retested and little change on the IGF-1, but he's just earned a reduction down to 0.25 units.

 

[MJW]

Unfortunately no. That was the goal of the research, but they found it wasn't true. @Chubba just had Gizmo retested and little change on the IGF-1, but he's just earned a reduction down to 0.25 units.

The cats in Argentina showed IGF-1 declining to normal levels on cabergoline (post #109 in acro cabergoline thread).
I believe RVC's cabergoline+octreotide tests did the same.

I stopped microwaving Yum's radcat meals, in case some food imbalance is driving up her BG. Her BG started ramping up when I started microwaving her food (post first ICU visit; delivered to the ICU for her second stay).

 

[MJW]

I just now googled how severe infection and kidney failure can cause hypoglycemia. I sure hope Yum really did respond to the cabergoline---that her insulin dose drop from 16.5u bid to < 1u bid wasn't due to her kidney infection. The vets didn't think so, but we didn't dwell on it. She is my complicated cat.