5/3 Hamilton: fluids and vet problems

[Elizabeth B]

Hamilton has been on fluids for a few days and we’re not seeing much improvement. He’s still well controlled on diabetes and eating great. Started phosphate binder and B12 arrives tomorrow.

Our vet, however, wanted to switch him to a renal diet with 40% carbs. He is currently eating 4% and on 8u twice a day. The vet knows he’s carb sensitive and while it would help his kidneys, we’d be in DKA in a week’s time. Instead, transitioning to weruva steak frites which is 0.57% phos and 7% carbs. Should match both needs. When I asked the vet how much and how to administer his phosphate binder, he said just to read the bottle. They were also supposed to culture his UA and they never sent it in. I feel like I’m the only one actually managing his case.

He’s currently on my lap and purring. He doesn’t really move at all during the day. Fingers crossed the phosphate binder and B12 will give him a bit of a boost.

Good news is that his appetite is still fierce, so I’m holding onto that right now.

 

[Phoebes (GA)]

He's Soooo handsome! It's sad that your vet is not more enthusiastic about his care. You just wanna shake them sometimes. The B12 really makes a difference with Phoebe and her energy levels. How much fluid are you giving him daily? Or did I miss that?

 

[Elizabeth B]

Right now, we’re doing 100ml once per day. I’ve asked the vet to check BP, redo creatinine/BUN and sdma next Friday to see if his heart is tolerating the fluids and if they’re making any difference in his kidneys. Sad part, is that I asked for the follow up. He didn’t.

 

[Carol in Chicago]

Sorry vet is not helpful. Just wanted to probe more on renal failure DX. If this is the assessment of the vet you have been working with, it might be worth it to post recent labs for further assessment by experienced eyes here. If you are just starting fluids, there may be some room for improvement. Kidney values especially can look really bad if there is dehydration.

IMHO regardless of any lab values, it is a very good thing that he has a strong appetite! In my opinion, renal diet is "old school". Better guidance is higher quality protein with lower phosphorus.

Best to you and the handsome Mr. Hamilton!

 

[tiffmaxee]

Here is suggested dosing for phosphorus binders on Tanya’s site in case you don’t have it.
http://www.felinecrf.org/phosphorus.htm

And here’s a good crf group

https://groups.yahoo.com/neo/groups...Ec2VjA3Z0bARzbGsDdmdocARzdGltZQMxNTI1MjcwOTQw

 

[Stacy & Asia]

Please do post his lab values if you can. How high is his phosphorous? That can make them feel really bad even in the high end of the “normal” range, ideally you want it below 5, what kind of phosphate binder are you using? A lot of numbers can look worse on than they are if something acute is going on like: dehydration, UTI/kidney infection, etc.

Steak frites is a great choice! Low carb and low P.

What kind of b12 is it? Methyl or cyano? Is it a pill or injectable?

 

[Elizabeth B]

Okay, here’s his plan:

Right now, we’re doing half steak frites and half fowl bowl. About cycle 4 of the diet change his glucose hit the roof, so I upped him to 10u and that is keeping him under the renal threshold. I will keep upping insulin until I can get enough cushion to transition him further on the steak frites. His glucose curve has shifted from the carb increase and his nadir is no longer +6, but more like +10. So, sleep isn’t an option for now.

He is on epakitin for his binder and that has really changed his mood. He’s much happier.

His B12 is cyano and injections.

He is currently getting 100ml of fluid.

He has a BP and follow up labs on Friday, so we’ll adjust after those lab results.

When he was diagnosed with CKD in August of last year, I did all my research on IRIS and treating renal disease, so at least I was well prepared for putting this together.

 

[Elizabeth B]

And his phosphorus was 9.9!!! Which is why he was feeling so crummy. I do think the binder is working well.

And his appetite is still ravenous!!! I could not be happier about that!

 

[Juliet]

And his phosphorus was 9.9!!! Which is why he was feeling so crummy. I do think the binder is working well.

And his appetite is still ravenous!!! I could not be happier about that!

So pleased he's doing well. I just pm'd you ss I hadn't seen a post lately.

 

[Elizabeth B]

Yeah, I have a meter that posts it into his app, so I’m working off that. If I feel I need input on the glucose/insulin side, I’ll take the time to update. But for now, I’m having to prioritize where I spend time and effort.

I promise it’s not a cop out. I have two geriatric labs with their own high maintenance treatment plans at the same time I’m running my own consulting firm. Time is my greatest enemy at this point.

 

[Stacy & Asia]

Okay, here’s his plan:

Right now, we’re doing half steak frites and half fowl bowl. About cycle 4 of the diet change his glucose hit the roof, so I upped him to 10u and that is keeping him under the renal threshold. I will keep upping insulin until I can get enough cushion to transition him further on the steak frites. His glucose curve has shifted from the carb increase and his nadir is no longer +6, but more like +10. So, sleep isn’t an option for now.

He is on epakitin for his binder and that has really changed his mood. He’s much happier.

His B12 is cyano and injections.

He is currently getting 100ml of fluid.

He has a BP and follow up labs on Friday, so we’ll adjust after those lab results.

When he was diagnosed with CKD in August of last year, I did all my research on IRIS and treating renal disease, so at least I was well prepared for putting this together.

Sounds a lot more hopeful! Yes, the high phosphorous will make them feel like crud! Do you know what his last calcium value was? I ask because the epaktin is calcium based and you have to be careful with the phos/calcium ratio, especially using a calcium based binder, there’s a formula you can do with the phos and calcium numbers to determine if things are getting dangerous there. Aluminum hydroxide is another option for p binder and it works very well. Do you know what his HCT is? If it’s low and he anemic or close to anemic that can also make them feel bad. I started b multi’s and methyl b12 to help that andgot Asia’s hematocrit back up in a good range. I hope the p binders show so progress in the labs on Friday, may be a little soon depending when you started them, but you should see some movement.

 

[Elizabeth B]

Please do post his lab values if you can. How high is his phosphorous? That can make them feel really bad even in the high end of the “normal” range, ideally you want it below 5, what kind of phosphate binder are you using? A lot of numbers can look worse on than they are if something acute is going on like: dehydration, UTI/kidney infection, etc.

Steak frites is a great choice! Low carb and low P.

What kind of b12 is it? Methyl or cyano? Is it a pill or injectable?

He was quite dehydrated for his last labs, so we’re hoping the fluid therapy will give us better results Friday.

 

[Elizabeth B]

Sounds a lot more hopeful! Yes, the high phosphorous will make them feel like crud! Do you know what his last calcium value was? I ask because the epaktin is calcium based and you have to be careful with the phos/calcium ratio, especially using a calcium based binder, there’s a formula you can do with the phos and calcium numbers to determine if things are getting dangerous there. Aluminum hydroxide is another option for p binder and it works very well. Do you know what his HCT is? If it’s low and he anemic or close to anemic that can also make them feel bad. I started b multi’s and methyl b12 to help that andgot Asia’s hematocrit back up in a good range. I hope the p binders show so progress in the labs on Friday, may be a little soon depending when you started them, but you should see some movement.

Calcium was in the normal range and we’re watching it closely. I should probably disclose that I actually consult for veterinary practices all across the nation. I have my 3 best cat vets watching his labs with me, so I am spoiled in that regard. I wish everyone had those kind of resources.

 

[Stacy & Asia]

Calcium was in the normal range and we’re watching it closely. I should probably disclose that I actually consult for veterinary practices all across the nation. I have my 3 best cat vets watching his labs with me, so I am spoiled in that regard. I wish everyone had those kind of resources.

Well that’s amazing! It sounds like Hamilton is getting the royal treatment! I really hope BUN and creatinine are down a lot because of the fluids, odds are good for that.

My vets dismissed that the b vitamins could do much for the HCT, but seeing is believing, Asia’s labs are in my SS.

 

[Elizabeth B]

I’m always intrigued by things that trip vets up. I wholeheartedly believe in B12 injections. He was just slightly anemic, but B12 will not only help with HCT, but can encourage recovery from infection (as he is also fighting mild pneumonia).

 

[Elizabeth B]

The biggest frustration I have at this point is the vets insistance that we ultrasound and even BIOPSY his pancreas!!!? That is crazy, absolutely crazy. If we find a tumor, cancerous or benign, we are not doing chemo, nor are we doing surgery. There is nothing to gain in treatment plan adjustment, but instead, the risk of pancreatitis would great. And that would be a very quick end for our little prince. I have flat out refused the U/S. I cannot imagine putting him through an invasive procedure at this point.

 

[Stacy & Asia]

The biggest frustration I have at this point is the vets insistance that we ultrasound and even BIOPSY his pancreas!!!? That is crazy, absolutely crazy. If we find a tumor, cancerous or benign, we are not doing chemo, nor are we doing surgery. There is nothing to gain in treatment plan adjustment, but instead, the risk of pancreatitis would great. And that would be a very quick end for our little prince. I have flat out refused the U/S. I cannot imagine putting him through an invasive procedure at this point.

Good on you! I always clearly communicate those things to my vet, if getting the diagnostic does not change the treatment plan, I’m not interested in doing it. Especially if it’s that invasive, what exactly is the upside besides satisfying curiosity? The only way sometimes to actually confirm a kidney infection is to get a sample from the kidney. Very invasive, painful and dangerous. I’m so thankful my vet was willing to treat based on labs and ultrasound confirming dilation of the renal pelvis. There’s no way I’d let them take urine from her kidney!

Advanced vetty vines for Hamilton, sounds like he has many great beans in his corner!

 

[tiffmaxee]

Can you get aluminum hydroxide where you live? It’s a better phosphorus binder I think. I always got mine from thrivingpets.com. It’s also available on amazon but I didn’t trust it would be the same. Otherwise sounds like a plan.

 

[Carol in Chicago]

I love Thriving Pets! I must buy too much from them. Free shipping and discount code "Tanya" still works. This is a good thing because it looks like everything I order has had a price increase in the last couple of months.

 

[Sienne and Gabby (GA)]

If you are concerned about Hamilton's heart, please ask the vet to get a feline proBNP. If you're wanting the vet to send out blood for an SDMA, then the vet is using IDEXX and they are the lab that runs the BNP. The test will tell you if there is any damage to the heart.