3/15 More on Max

Max & Lori

Max & Lori

Member Since 2021
Previous https://felinediabetes.com/FDMB/threads/3-6-maxs-follow-up.287428/#post-3159171

We are hanging on by a thread over here. I don’t think I have ever felt so stressed and hopeless, but I’m doing the best I can. First, Max’s BG’s are terrible. I was reducing at a pretty quick rate for safety when his appetite wasn’t good. Then he started eating a little better and the numbers started climbing back up. Not sure if that’s why or if it’s something else. I still have to give him Ondansetron and Cyproheptadine though. After that last visit to NCSU (see above) Max got constipated pretty bad. I thought it could have been from the Naraquin because it’s calcium based. I’m not even sure why she put him on that because his calcium was at the cutoff of being too high. I took Max to his primary vet who did x rays and determined he needed an enema, so she did that and it didn’t work. So she had to do a disimpaction on my poor cat. We stopped the Naraquin and the BMs finally got back to normal.
We went back to NCSU this past Tuesday for more lab work. For some reason this IM vet doesn’t like to give copies of his records, so I’m still trying to get the lab reports. Max’s creatinine had come down to 5.4 on the previous visit and went to 7.8 on this visit. She didn’t give me the BUN or phosphorus in the email. I mentioned before that I was very anxious for her to take him off of his blood pressure meds. Well without BP meds the kidney values went up that much. She didn’t check his UPC. She said she wasn’t concerned with the protein in his urine right now. Max has only gotten worse since we’ve been going to NCSU these last few weeks when they don’t seem to be suggesting anything to help. I’m have been upset all week about it. I talked to Max’s primary vet and she is going to be checking his labs from now on. She put him on a low dose of Benazepril and said we would recheck his labs in a week. His BP was 170 at the vet and 140 at home with my vets Doppler. I feel like everything has gotten out of control. I am not taking him back to NCSU. Not satisfied with what’s happening. I’m going to make sure he gets a UPC included in his labs next week. I understand that we have to be cautious because of his creatinine level and being on the Benazepril. He obviously got worse when taken off the Telmisartan and not put on anything, so we are just trying the Benazepril. At this point I don’t know what else to do. I am so tired and worried. I’m trying to get his BG’s straightened out again after all of the decreases and inappetence. I am posting to find out if anyone thinks I increased too fast and this is causing the high numbers. I know I didn’t follow the protocol when increasing, but I was second guessing myself. My question is, do we think the dose is too much? Or wait another couple of cycles and increase again. Could be some glucose toxicity or maybe even NDW, but I just want to make sure I am not overdosing him causing these unusual cycles. Please excuse my rambling. I’m really stressed out lately. I can tell Max hasn’t felt good since that visit to NCSU a couple of weeks ago. Not sure how much longer he’s going to hold on. I’m really not ready for him to leave me and these kidney values scare the daylights out of me. I guess we will see what happens next Wednesday when he goes to his primary vet. Can anyone answer my questions about his insulin dose? Thanks so much. I will tag you @Wendy&Neko and @Marje and Gracie thanks a bunch.
 
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Sorry to hear about the experiences at NCSU. :bighug::bighug::bighug: You own those lab records, you paid for them. Insist that they email them to you.

Yes, you increased too fast. Green nadirs means increases by 0.25 units and being patient. The increase to 2.25 units was justified as the greens were high.

Constipation can increase numbers by quite a bit. Hopefully all resolved now. I also found that Neko took a few days to properly adjust to a new med, and I could see some pretty harsh numbers while I waited that out.

How is his resting respiration rate?
 
I’m sorry you and Max are struggling so much. :(
Diabetes is hard, acro is harder, and pile on all of the other concurrent issues … of course you’re stressed. It’s a difficult path even on the best of days. :bighug:

I’ve done the “university experience” at at least 5 different vet schools. Not all vets are equal, even at what we like to think of as gold-standard universities. I’ve had stellar experiences and some not so much, sometimes at the same university. I hope your recent interactions don’t put you off NCSU permanently.

As for medical records, I usually told both the vet and the student up front that I’d like copies of everything before I left. Some records—such as ultrasound reports or urine C&S results—won’t be available until later, but you should be able to get at least a copy of bloodwork before you leave. I’ve never had pushback about that, although they or I have forgotten on occasion. I’d suggest you call the vet school and ask for the Medical Records department. They should be able to send you whatever you want, usually same day in my experience.

As Wendy mentioned, constipation/obstipation can significantly increase BG. I definitely saw that with Tubby. At one point he was so constipated he had to have surgery to resect the bowel and remove nearly a pound of fecal matter (per the vet). I sorted out the constipation with food and supplements, but later he developed motility (“sluggish bowel”) issues even though the stool was normal shape and consistency. His BG was a hint as to when he was stockpiling — even when he pooped, it wasn’t always enough. Then he’d drop the mother load and his BG would settle back down. It was much easier to see in hindsight than when it was happening, at least until I caught on. o_O

Is Max fully emptying his bladder? As time progressed, Tubby developed what was apparently bladder neuropathy, which meant he didn’t fully empty his bladder. It was deceptive, because he still urinated in the box but retained some urine nonetheless. That likely contributed to his worsening kidney function. I didn’t even realize it until late in the game after I started palpating his bladder just after he peed and found there was still urine in it. I don’t mention it to worry you, it’s just something I learned the hard way and so am mindful of, especially with acro cats (I lost Tubby to kidney failure). Even though his C&S came back clean, we treated empirically for kidney infection as a precaution.

Hopefully this is just a small glitch. I’ll be thinking of you both and sending positive vibes your way.
 
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Wendy&Neko said:
Sorry to hear about the experiences at NCSU. :bighug::bighug::bighug: You own those lab records, you paid for them. Insist that they email them to you.

Yes, you increased too fast. Green nadirs means increases by 0.25 units and being patient. The increase to 2.25 units was justified as the greens were high.

Constipation can increase numbers by quite a bit. Hopefully all resolved now. I also found that Neko took a few days to properly adjust to a new med, and I could see some pretty harsh numbers while I waited that out.

How is his resting respiration rate?
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Thank you Wendy, JL, Cecile and Jason. Max’s RR now is 26-28. That’s normal for Max. Yes constipation does affect Max’s BG, but that isn’t the problem this time because he’s been regular over the last few days. Doesn’t look like he’s coming down today either, so tomorrow what should I do with numbers like this? If he has or gets glucose toxicity, it will take a long time for that to resolve according to his past history. I don’t like him being dehydrated and numbers like these are only adding to the problem. Trying to be patient with this dose, but I can’t afford to wait too long. I was just wanting to make sure he wasn’t overdosed because I went too fast on the last increase.
I’ve never had a problem with NCSU until now. We’ve been going there since Max was 3 years old with asthma. It’s been an exceptional place until my recent experiences. The IM vet that’s there now is different. It’s difficult to get someone to return phone calls or emails. Medical records won’t release records until the vet okays. I’ve been round and round with that. It’s just added stress that I don’t need. I’ve never had problems getting his records before this vet came. He’s gotten a lot worse since they changed his meds and then took him off altogether. I told this IM vet I disagree with her plan of care, but I’ve done exactly what she says and now he’s in worse shape than ever. I am not happy with what we’ve gotten out of these latest visits, otherwise NCSU is a great place. They were excellent during Max’s SRT, and hospital stays before. I hope Max can get back on track, but it doesn’t look that way and I’m burning out fast. Max is the one who’s sick and I am the one who is falling apart, but I will just keep doing what I can for him.
 
JL and Chip said:
I’m sorry you and Max are struggling so much. :(
Diabetes is hard, acro is harder, and pile on all of the other concurrent issues … of course you’re stressed. It’s a difficult path even on the best of days. :bighug:

I’ve done the “university experience” at at least 5 different vet schools. Not all vets are equal, even at what we like to think of as gold-standard universities. I’ve had stellar experiences and some not so much, sometimes at the same university. I hope your recent interactions don’t put you off NCSU permanently.

As for medical records, I usually told both the vet and the student up front that I’d like copies of everything before I left. Some records—such as ultrasound reports or urine C&S results—won’t be available until later, but you should be able to get at least a copy of bloodwork before you leave. I’ve never had pushback about that, although they or I have forgotten on occasion. I’d suggest you call the vet school and ask for the Medical Records department. They should be able to send you whatever you want, usually same day in my experience.

As Wendy mentioned, constipation/obstipation can significantly increase BG. I definitely saw that with Tubby. At one point he was so constipated he had to have surgery to resect the bowel and remove nearly a pound of fecal matter (per the vet). I sorted out the constipation with food and supplements, but later he developed motility (“sluggish bowel”) issues even though the stool was normal shape and consistency. His BG was a hint as to when he was stockpiling — even when he pooped, it wasn’t always enough. Then he’d drop the mother load and his BG would settle back down. It was much easier to see in hindsight than when it was happening, at least until I caught on. o_O

Is Max fully emptying his bladder? As time progressed, Tubby developed what was apparently bladder neuropathy, which meant he didn’t fully empty his bladder. It was deceptive, because he still urinated in the box but retained some urine nonetheless. That likely contributed to his worsening kidney function. I didn’t even realize it until late in the game after I started palpating his bladder just after he peed and found there was still urine in it. I don’t mention it to worry you, it’s just something I learned the hard way and so am mindful of, especially with acro cats (I lost Tubby to kidney failure). Even though his C&S came back clean, we treated empirically for kidney infection as a precaution.

Hopefully this is just a small glitch. I’ll be thinking of you both and sending positive vibes your way.
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Thank you JL. I hope it’s a small glitch too. We’ve done a couple of ultrasounds. It looks like he is emptying his bladder okay. It doesn’t feel distended to me. We’ve also treated with Veraflox even though he had a negative culture. It hasn’t helped. Thanks for thinking of us and your ideas.
 
How long are you doing the Veraflox for? It it usually given for twice as long for a kidney infection.

As for dose, Max saw low/middle blues on this dose just two nights ago. I'd wait 8 cycles or for when he's definitely cleared the bounce before increasing. Which should be the same time if he takes 6 cycles. Today is cycle 5, so 3 more.
 
Wendy&Neko said:
How long are you doing the Veraflox for? It it usually given for twice as long for a kidney infection.

As for dose, Max saw low/middle blues on this dose just two nights ago. I'd wait 8 cycles or for when he's definitely cleared the bounce before increasing. Which should be the same time if he takes 6 cycles. Today is cycle 5, so 3 more.
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We were supposed to finish out the bottle according to the IM vet, even though there was no evidence of infection. She was treating just as precautionary measure after I suggested it multiple times. Today Max had blackish/bloody loose stools and his regular vet stopped the Veraflox and is now treating the diarrhea with Metronidazole. Max isn’t feeling well at all. I think it’s all catching up with him. I’m just treating symptoms now. I haven’t given him the Benazepril today because he hasn’t eaten that well today. Then the dark diarrhea happened. I read something that said cats with creatinine over 7 shouldn’t take ace inhibitors because it can worsen the creatinine and make anemia worse. His creatinine worsened when he was taken off of it so I’m not sure what to do about that. His primary vet gave us the RX because I was so upset about the IM vet taking him off his BP meds to begin with. She said try it for a week and we will recheck labs and BP. Now we have all of this GI stuff going on, so I don’t know if I should give it to him or not. I guess not because she said if he was not eating and drinking well to not give it. It’s one thing after another. Max can’t catch a break and I feel like I’m no good to him because I do not know what I am doing anymore. I want to do the right thing but one thing is always contraindicated in another thing. It’s too hard to think being so stressed also. Sorry, that was a lot more than what you asked about.
 
Ugh, poor Max. :bighug:

I'm not a fan of metronidazole, it can disrupt the gut biome. Sounds like his poor bowels are in sad shape.

Kidney infections don't always show up on urine culture.
 
Yes, you told me that before, and that’s why I kept asking for treatment for kidney infection. His tummy is probably some of the culprit of these high BGs too. I know he doesn’t feel good and the BGs make him feel worse. He’s getting his Bupe too and that helps him feel a little better. I’m giving his probiotics every day and l usually don’t give Metronidazole for long. I’m not really a fan either, but hopefully it will help.
 
(((Lori)))

I’m so sorry Max has all of this going on. I don’t have anything to add on insulin dosing because Wendy has already addressed it.

I will also add that I never let my cats have metronidazole. It does more harm than help to the gut and can cause nausea and diarrhea. I try to avoid all antibiotics but the exception would certainly be if there was an infection like kidneys. Cultures don’t always grow bacteria if it’s far up in the kidneys but if a kitty is being treated for a kidney infection, the treatment period is, as Wendy said, quite long (8 weeks is what my vet does).

I think we’ve discussed using Saccharomyces boulardi for diarrhea but it won’t work if B12 levels are low. I’ve also used an herb called Agastache but you have to get it through an holistic vet who has really done their homework on sourcing because it is a Chinese herb.

Insofar as his CKD issues, I hope you are posting to one of the CKD groups that are well-versed in all those issues.

Just know we all are sending much healing light and energy to you both.:bighug::bighug::):)
 
Marje and Gracie said:
Cultures don’t always grow bacteria if it’s far up in the kidneys but if a kitty is being treated for a kidney infection, the treatment period is, as Wendy said, quite long (8 weeks is what my vet does
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Thank you. It can be so frustrating dealing with some vets. It’s exhausting. The vet said that after over a week on the Veraflox, he should have shown some improvement in his kidney values if it were truly an infection and Max’s values got much worse. Also the side effects of the Veraflox are GI symptoms so she said since it wasn’t helping and possibly causing the GI symptoms, she stopped it.
 
Max & Lori said:
Thank you. It can be so frustrating dealing with some vets. It’s exhausting. The vet said that after over a week on the Veraflox, he should have shown some improvement in his kidney values if it were truly an infection and Max’s values got much worse. Also the side effects of the Veraflox are GI symptoms so she said since it wasn’t helping and possibly causing the GI symptoms, she stopped it.
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It’s been a while since my last CKD kitty crossed but, back then, they used Baytril. I know there are alot of new a/bs but I’m not familiar with them.
 
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