? 8-7 Djoko - pmps 94 - decreased appetite -shooted 0.5 - finger crossed

Marj & Djoko

Marj & Djoko

Member Since 2020
https://www.felinediabetes.com/FDMB...-with-decreased-appetite.249566/#post-2815912

This morning I gave him his shot 1.15hr later because he did not want to eat. He has eaten a bit during the day at odd times. He did not eat enough at pmps so cannot shoot.

I gave him Zofran 1mg around 2PM in preparation for tonight shot (which was supposed to be at 7h30PM). So he was given 2mg in the last 24 hours.

I elevated his bowl too but not a success. I am wondering if this will become the new normal and I will need to shoot when he eats or not shoot...it took a while to get him regulated and now that he is I cannot shoot. Bit disappointing...

Should I give him 0.25U when he eats just a bit or 0?

Thanks!

Marjorie
 
I checked for Zofran one tab is 4mg. Direction is to give 1/4tab every 8-12 hrs.
Should I go back to Cerenia? Seems less complicated re: dosage.

I was wondering if I should just feed him whatever he wants regardless of CKD or to adapt insulin in consequence.
Like tonight, options are (1) r shoot 0.25U (2) wait until he eats and shoot (3) no shoot and shoot earlier tomorrow morning (4) feed him whatever works - even if high carbs and not suitable for CKD.

Any ideas?
 
Marj & Djoko said:
https://www.felinediabetes.com/FDMB...-with-decreased-appetite.249566/#post-2815912

This morning I gave him his shot 1.15hr later because he did not want to eat. He has eaten a bit during the day at odd times. He did not eat enough at pmps so cannot shoot.

I gave him Zofran 1mg around 2PM in preparation for tonight shot (which was supposed to be at 7h30PM). So he was given 2mg in the last 24 hours.

I elevated his bowl too but not a success. I am wondering if this will become the new normal and I will need to shoot when he eats or not shoot...it took a while to get him regulated and now that he is I cannot shoot. Bit disappointing...

Should I give him 0.25U when he eats just a bit or 0?

Thanks!

Marjorie
Click to expand...
Hi Marj. Is it the pancreatitis that is causing decreased appetite or the CKD, what do you think? It sounds like you are underdosing the Ondansetron. He should probably get getting 4 mg. Tell me how much he weighs? Also, Cerenia is usually dosed at 1 mg per lb. of cat. Again, he may be getting underdosed. I would at least try 8 mg (one half of the 16 mg. tablet that is probably what you have at home) on a daily basis. Are you giving sub-q fluids at home? Has the vet discussed that yet, or is it too early to start.
 
Marj & Djoko said:
Like tonight, options are (1) r shoot 0.25U (2) wait until he eats and shoot (3) no shoot and shoot earlier tomorrow morning (4) feed him whatever works - even if high carbs and not suitable for CKD.
Click to expand...
This is my opinion. Feed him whatever he will eat. Eating is paramount. Are you a member on the tanyackd support group. This is what they will tell you. I would feed him anything he is willing to eat regardless of carbs and regardless of anything else. I fed Darcy the high carb renal food and he liked it for a while. It really did not affect his numbers -- of course, every cat is different! But you can adjust insulin, but he must eat. Once they start to lose weight it is VERY hard to get them to gain it back.
 
Just looked at your SS. When is the last time labs were done? May 2020 is the most recent I see. Is that the correct date? I thought they checked labs before his dental procedure? I'm just wondering if there's been any change in BUN, CREA, Phosphorus, etc. Big hug to you! And his numbers just look soooo good!
 
Suzanne & Darcy said:
This is my opinion. Feed him whatever he will eat. Eating is paramount. Are you a member on the tanyackd support group. This is what they will tell you. I would feed him anything he is willing to eat regardless of carbs and regardless of anything else. I fed Darcy the high carb renal food and he liked it for a while. It really did not affect his numbers -- of course, every cat is different! But you can adjust insulin, but he must eat. Once they start to lose weight it is VERY hard to get them to gain it back.
Click to expand...
He is 4.8kg - lost 0.2kg in the last two days or so. I think I will buy him many options of food. He seems fed up of royal canin (e and d). He was a bit overwight (body score 6.5/9 or so) but kept him that way knowing he would at some point start losing weight.
I do consult tanya CKD forum.
I am not sure if related to pancreatitis of CKD but because his BG is steady, I would say probably renal disease but the bloodwork will provide more guidance. I am wondering too but I think it is more likely to be CKD than pancreatitis. I may order more cerenia then and give him 8mg per day. Do you have something I could send to my vet? She wanted me to put him on appetite stimulant and for me this is a plaster. I want to address the cause. I did raise the fluids but she has not gotten back to me yet. If this is due to toxins cuased by elevated BUN and CRE, I think it could help him. She will be back Friday evening so Im hoping she will a address my question re: fluids.
Do you need to give fluids everyday?
 
Suzanne & Darcy said:
Just looked at your SS. When is the last time labs were done? May 2020 is the most recent I see. Is that the correct date? I thought they checked labs before his dental procedure? I'm just wondering if there's been any change in BUN, CREA, Phosphorus, etc. Big hug to you! And his numbers just look soooo good!
Click to expand...
No last labs were done May 5, 2021, before his dental.
CRE was at 206 umol/L (range is 80-203 umol/L), BUN at 13.5 (range is 5.7- 13.2 mmol/L), SDMA at 16 and Phosphorus at 1.7 (range 0.9-2.0 mmol/L). I have started phosphorus binders to decrease it to 1.3-1.4 but when he is not eating, it is more difficult to give him the same quantity everyday.
 
Marj & Djoko said:
He is 4.8kg - lost 0.2kg in the last two days or so. I think I will buy him many options of food. He seems fed up of royal canin (e and d). He was a bit overwight (body score 6.5/9 or so) but kept him that way knowing he would at some point start losing weight.
I do consult tanya CKD forum.
I am not sure if related to pancreatitis of CKD but because his BG is steady, I would say probably renal disease but the bloodwork will provide more guidance. I am wondering too but I think it is more likely to be CKD than pancreatitis. I may order more cerenia then and give him 8mg per day. Do you have something I could send to my vet? She wanted me to put him on appetite stimulant and for me this is a plaster. I want to address the cause. I did raise the fluids but she has not gotten back to me yet. If this is due to toxins cuased by elevated BUN and CRE, I think it could help him. She will be back Friday evening so Im hoping she will a address my question re: fluids.
Do you need to give fluids everyday?
Click to expand...
Whether to give fluids every day or not depends on the stage/hydration status of your cat (the labs should help the vet determine that as well as just a good old check of skin and gums, etc.) How many mL do you give and how often. The fluids can really help them feel better. Is Djoko's heart in good shape -- I mean nothing that would be of concern in giving fluids. The vet can address this. The amount of fluid to give depends on their weight as well.
 
Suzanne & Darcy said:
This is my opinion. Feed him whatever he will eat. Eating is paramount. Are you a member on the tanyackd support group. This is what they will tell you. I would feed him anything he is willing to eat regardless of carbs and regardless of anything else. I fed Darcy the high carb renal food and he liked it for a while. It really did not affect his numbers -- of course, every cat is different! But you can adjust insulin, but he must eat. Once they start to lose weight it is VERY hard to get them to gain it back.
Click to expand...
What is the high carb renal food you were feeding him? I will dress a list and buy many cans and make a rotation.
 
Suzanne & Darcy said:
Whether to give fluids every day or not depends on the stage/hydration status of your cat (the labs should help the vet determine that as well as just a good old check of skin and gums, etc.) How many mL do you give and how often. The fluids can really help them feel better. Is Djoko's heart in good shape -- I mean nothing that would be of concern in giving fluids. The vet can address this. The amount of fluid to give depends on their weight as well.
Click to expand...
He has a murmur stage 2 but nothing serious - probably due to his age. I did an ultrasound before the dental and he got cleared. I dont know how much experience my vet has with CKD but very difficult to find vets that accept new patients because of covid and increase of pets..
 
Marj & Djoko said:
No last labs were done May 5, 2021, before his dental.
CRE was at 206 umol/L (range is 80-203 umol/L), BUN at 13.5 (range is 5.7- 13.2 mmol/L), SDMA at 16 and Phosphorus at 1.7 (range 0.9-2.0 mmol/L). I have started phosphorus binders to decrease it to 1.3-1.4 but when he is not eating, it is more difficult to give him the same quantity everyday.
Click to expand...
Those labs do not seem bad at all really. They aren't that far outside the reference range. That's a relief, I think. As for appetite stimulants, they are usually necessary at some point for CKD kitties. A lot of people use either transdermal mirtazapine (Mirataz) or Cyproheptadine works for some people ... or some prefer the mirtazapine pills and think they are more effective than the transdermal. Of course, you do want to try to address the root cause as much as possible, but pretty much all you can do is fluids, nausea meds, phos. binders and the like.
 
Suzanne & Darcy said:
Just looked at your SS. When is the last time labs were done? May 2020 is the most recent I see. Is that the correct date? I thought they checked labs before his dental procedure? I'm just wondering if there's been any change in BUN, CREA, Phosphorus, etc. Big hug to you! And his numbers just look soooo good!
Click to expand...
I am concerned that the stupid long anesthesia may have worsen his kidneys... this is my fear. He is still a bit weird after all. It really shocked him.
 
Marj & Djoko said:
What is the high carb renal food you were feeding him? I will dress a list and buy many cans and make a rotation.
Click to expand...
Oh, it sounds like you already have tried it. I used Royal Canin D, T and E. Hills K/D Tuna and Vegetable Stew (or is it veg and tuna?) and the Chicken and Vegetable Stew. You probably would not need phos. binders with those ... especially since his phosphorus isn't that bad.
 
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Marj & Djoko said:
I am concerned that the stupid long anesthesia may have worsen his kidneys... this is my fear. He is still a bit weird after all. It really shocked him.
Click to expand...
Oh no. I know how you feel. I am so sorry. I hope there is no damage. The only way to know would be to repeat labs. You may not want to do that at this point. Poor boy!
 
Suzanne & Darcy said:
Oh, it sounds like you already have tried it. I used Royal Canin D, T and E. Hills K/D Tuna and Vegetable Stew (or is it veg and tuna?) and the Chicken and Vegetable St4ew. You probably would not need phos. binders with those ... especially since his phosphorus isn't that bad.
Click to expand...
According to IRIS guidelines, because he is stage (hopefully still is), his phosphorus should be a bit less than 1.7mmol but not that bad..

When I do blood test, should I get a better idea if he had not eaten before? rare that diabetic kitties do not eat but was wondering if results would be more accurate or the opposite
 
Marj & Djoko said:
He has a murmur stage 2 but nothing serious - probably due to his age. I did an ultrasound before the dental and he got cleared. I dont know how much experience my vet has with CKD but very difficult to find vets that accept new patients because of covid and increase of pets..
Click to expand...
Best resource is to go to the felinecrf.org site. It has all the backup needed to convince your vet... if the vet won't listen to begin with. The section on fluids is a bit daunting ... it seems like there are so many different opinions about it/formulas to calculate how much is safe. Did you say how much you were giving in another post? Let me look.
 
Suzanne & Darcy said:
Oh no. I know how you feel. I am so sorry. I hope there is no damage. The only way to know would be to repeat labs. You may not want to do that at this point. Poor boy!
Click to expand...
Well I will need to do it to understand but I already hate this dentist, if I witness a big difference, I will know this is the result of the dental and I will hate her even more....I used to do bloodwork every 2.5 months to see the progression and the progression was slow. If he is now stage 3, I will be very mad. Nice teeth but no appetite? not sure whats better or worse...
 
Marj & Djoko said:
According to IRIS guidelines, because he is stage (hopefully still is), his phosphorus should be a bit less than 1.7mmol but not that bad..

When I do blood test, should I get a better idea if he had not eaten before? rare that diabetic kitties do not eat but was wondering if results would be more accurate or the opposite
Click to expand...
stage 2! sorry one word missing.
 
Suzanne & Darcy said:
Best resource is to go to the felinecrf.org site. It has all the backup needed to convince your vet... if the vet won't listen to begin with. The section on fluids is a bit daunting ... it seems like there are so many different opinions about it/formulas to calculate how much is safe. Did you say how much you were giving in another post? Let me look.
Click to expand...
He never got fluids. I was reading Tanya ckd website and thought it could help if the nausea is caused by toxins.
 
Marj & Djoko said:
He never got fluids. I was reading Tanya ckd website and thought it could help if the nausea is caused by toxins.
Click to expand...
Oh! I definitely think it would be worth a try to see if sub-q fluids would help him to feel better. You could just start with like 50 mL daily. Some people will do every other day. Do you think he would sit still for you?
 
Marj & Djoko said:
Thank you for checking on Djoko. I will buy him many cans tomorrow and hopefully he will like one - perhaps for 2 days lol - but on day at the time.. very though combo ckd and diabetes.
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You are right. It is so tough. But you do a very good job! I will check in on you again! Hope I didn't overwhelm you!
 
Suzanne & Darcy said:
Oh! I definitely think it would be worth a try to see if sub-q fluids would help him to feel better. You could just start with like 50 mL daily. Some people will do every other day. Do you think he would sit still for you?
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He is a gentle cat. I do feel that he had enough manipulation lately. I brush his teeth everyday but sometimes I give him a break because he is unhappy. I only skip a day when he gets too grumpy. I think he could take it. Just need to learn how to do it. His USG is 0.016 (May 5, 2021). Does that mean he is dehydrated?
 
Suzanne & Darcy said:
You are right. It is so tough. But you do a very good job! I will check in on you again! Hope I didn't overwhelm you!
Click to expand...
Not at all. I do not post everyday although I like to see whats going on with other cats. But I am struggling with his decreased appetite these days so I appreciate the help!
 
When are you planning to get more labs to check his kidneys? I would not do it sooner than 3 months but wondering if he’s still stage 2. Does he seem dehydrated to you? I know some believe in starting fluids sooner than others but if not dehydrated I’m one that doesn’t rush due to the salt in fluids. If at all dehydrated and it makes him feel better I would not hesitate to start.
 
tiffmaxee said:
When are you planning to get more labs to check his kidneys? I would not do it sooner than 3 months but wondering if he’s still stage 2. Does he seem dehydrated to you? I know some believe in starting fluids sooner than others but if not dehydrated I’m one that doesn’t rush due to the salt in fluids. If at all dehydrated and it makes him feel better I would not hesitate to start.
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I did read that re: sodium in fluids. I was tempted to do the labs before than 3 months just because he is not eating well. I can try to wait. I will go buy renal disease cans with high carbs that he may like. Not like I am aiming at remission. Just want him to eat and not damage his kidneys. So you think I should wait more time re: labs? I dont know if he is dehydrated. I tried to check with his neck but tough to say. He drinks water and peed 4 times every 24 hours.
 
Feel his gums to see if moist or tacky. It’s a better way to check hydration for cats over 8 or 10. If his appetite doesn’t pick up getting labs will be a good idea sooner than 3 months. I like ondansetron better than cerenia unless vomiting or ondansetron doesn’t work. :bighug:
 
tiffmaxee said:
Feel his gums to see if moist or tacky. It’s a better way to check hydration for cats over 8 or 10. If his appetite doesn’t pick up getting labs will be a good idea sooner than 3 months. I like ondansetron better than cerenia unless vomiting or ondansetron doesn’t work. :bighug:
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is USG 0.1016 a sign that he is dehydrated. Not sure I understand this value correctly.
 
Marj & Djoko said:
He is a gentle cat. I do feel that he had enough manipulation lately. I brush his teeth everyday but sometimes I give him a break because he is unhappy. I only skip a day when he gets too grumpy. I think he could take it. Just need to learn how to do it. His USG is 0.016 (May 5, 2021). Does that mean he is dehydrated?
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The urine specific gravity is just a measure of how dilute or concentrated his urine is. CKD cats have more dilute urine.
 
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