? 3/26 Petey's Blood Work Results Review

Laurie&Petey

Laurie&Petey

Very Active Member
I just got Petey's blood work back here is a link to the results these results also compares to his last blood work. I will get it on the spreadsheet but hoping for some thoughts.

My concern is his Reticulocytes keep getting worse (none present this time)... yet she said he's not anemic. Anyone have experience with this? Of course she pushed a drug that might help.

Second concern is she said his kidney values have increased and considered him Stage 1 CKD. What values should I be concerned with? Of course she pushed prescription diets for this and said we can increase his insulin if carbs are high.

Anything else of concern here? Thank you!

EDIT: I have updated his SS with all the numbers I have.
 
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Laurie&Petey said:
I just got Petey's blood work back here is a link to the results these results also compares to his last blood work. I will get it on the spreadsheet but hoping for some thoughts.

My concern is his Reticulocytes keep getting worse (none present this time)... yet she said he's not anemic. Anyone have experience with this? Of course she pushed a drug that might help.

Second concern is she said his kidney values have increased and considered him Stage 1 CKD. What values should I be concerned with? Of course she pushed prescription diets for this and said we can increase his insulin if carbs are high.

Anything else of concern here? Thank you!
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@Bron and Sheba (GA)
@Sienne and Gabby (GA)
@Diane Tyler's Mom GA
 
Okay. I am in the process of reviewing your labs. First, his phosphorus is too high for a cat who looks like he could be borderline kidney disease. It’s gone up a lot since the last labs. You want the phosphorus to be about 4-4.5 in order to reduce the workload on his kidneys. That’s very important. I will look some more and comment further. My meat timer is beeping (meat in the oven. )
 
Those low reticulocytes are concerning. What did the vet say? Did she just suggest ESAs? Or what? The ESA medications (Epogen, Darbepoeitin, which are injectable, or the newer oral med called Varenzin which is for non-regenerative anemia in cats with chronic kidney disease.). Those meds can help the bone marrow to produce more red blood cells, but I don’t know if they would really be appropriate in this instance since his HCT is not really very low. It could be dangerous. I would not do ot without consulting an IM vet or a hematologist perhaps.
 
I would not go immediately to the renal prescription foods. If he’s stage 1 then you need to focus on phosphorus control and I would not worry about going with a low protein food which is likely to result in muscle wasting.

Regarding the low reticulocytes (and possible future anemia since the HCT is dropping) I would start Petey on an iron supplement and a B-Vitamin supplement. I am surprised that your vet didn’t recommend this. For B-Complex, I have had good results treating anemia using the Jarrow B-Right, which is a B-Complex. It’s a capsule for humans that you take and divide into ten smaller (size 4 because size 5 is just too small for this) gelatin capsules. It’s a little messy doing this. You kind of need a little capsule holding rack. My son made me one years ago out of 4 Legos strips snapped together into a square — I still use it. The size 4 gelcaps (which I order from Amazon and use for many different medications) fit into the back side of the Lego. Anyway, the B-Complex vitamins are very important in helping the production of red blood cells — as is iron.

Does Petey have any other diagnoses? Thyroid? Inflammatory Bowel Disease? Anything else?

Edit: I see his thyroid looks okay.
 
Suzanne & Darcy said:
Does Petey have any other diagnoses? Thyroid? Inflammatory Bowel Disease? Anything else?
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He has suspected chronic pancreatitis and no official IBD diagnosis. But he had a lot of inflammation when he got an ultrasound upon hospitalization.

I switched him to a novel protein cause he always seemed to get unwell and require a regular cycling of food when using chicken/fish... not sure what he's sensitive too, but knock on wood we haven't had any issues with the rabbit....

I see this is going to be challenging to find a novel protein, low carb, low phos.... at first glance I'd like to get more info on Ziwi Peak options. I'll try contacting them tomorrow.

I'll start him on the supplements, I did just start him on Zobaline but it's not a complete B supplement.

I realllllly appreciate you taking the time to look at his test results and offering your advice, I can't thank you enough. :bighug::bighug:

Edit: until I can make a full food switch, should I use a phos binder? And is it possible for a diet change to get the phos level lower?
 
Laurie&Petey said:
She just shrugged it off, just said he's not anemic and mentioned using the Varenzin... I'd like to understand what's causing it to get worse.
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Yes. It seems premature to me. If he had advanced CKD I would expect that. Of course, if he’s not producing the retics then he will have a dropping HCT before too long. It sounds like you need an IM doctor. How long has this been going on? I see from the prior bloodwork that it’s gotten a lot worse.
 
Laurie&Petey said:
I see this is going to be challenging to find a novel protein, low carb, low phos.... at first glance I'd like to get more info on Ziwi Peak options. I'll try contacting them tomorrow.
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It sure is going to be a challenge. I haven’t found one yet for my IBD boy. If there’s a food that he does really well on then you can just add Aluminum Hydroxide phosphorus binder to his food to help bind the phosphorus and keep it from damaging his kidneys any further. Rabbit is inherently higher in phosphorus than most other meats, but if he does well on it and you cannot find an alternative food, then you should add a binder.

did any of this stuff (low retics and declining hemoglobin and HCT start around the time of the food change?)
 
Suzanne & Darcy said:
Yes. It seems premature to me. If he had advanced CKD I would expect that. Of course, if he’s not producing the retics then he will have a dropping HCT before too long. It sounds like you need an IM doctor. How long has this been going on? I see from the prior bloodwork that it’s gotten a lot worse.
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Since December, that I know about. That IM said it was likely due to the diabetes crisis he was in. Next set of blood test was just a few weeks later.... so wasn't surprised it hadn't changed much and that vet wasn't concerned either.
 
Laurie&Petey said:
inflammation when he got an ultrasound upon hospitalization.
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Has he ever had the Texas A&M GI panel done for IBD? Folate tested? Cobalamin levels (B-12) levels checked? Your vet should give you a bottle of B-12 to do injections as well! That can help a lot. They’re super easy to give— just like an insulin injection. I actually use an insulin syringe to give B-12 injections to my IBD cat. With a lot of intestinal inflammation, it can be difficult for nutrients to be absorbed so supplementation is necessary.
Also, keep an eye on his potassium. It’s okay now, but it frequently gets too low in CKD. It’s easy to supplement if you end up needing to.
 
But I did add results I had for 2022 when I first adopted him, and it looks like maybe the numbers were low then too.

Just curious, is FeLV a possibility with these numbers? I don't know much about it accept it has something to do with RBC.
 
Laurie&Petey said:
But I did add results I had for 2022 when I first adopted him, and it looks like maybe the numbers were low then too.

Just curious, is FeLV a possibility with these numbers? I don't know much about it accept it has something to do with RBC.
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Yes. feline Leukemia can cause this (low reticulocytes.) I didn’t want to mention that because it’s less likely to be the case …. Unless you know he has it? Has he ever been tested?
 
Suzanne & Darcy said:
Yes. feline Leukemia can cause this (low reticulocytes.) I didn’t want to mention that because it’s less likely to be the case …. Unless you know he has it? Has he ever been tested?
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I'm not 100% sure he was tested, I know upon adoption they had not been able to get blood from him cause he is extra spicy. Then they said they got it and he was good. But it may be worth rechecking to be 100%.

Aside from high phos what other kidney values am I watching? BUN, Creatine?

I'm not sure I can do vitamin B shots right now, he has been giving me a hard time for insulin shots and I can't lose the very small edge I have with that. Will supplementation make any difference?

Hope you have a good day! :bighug:
 
Yes. BUN and Creatinine. Making sure the electrolytes stay balanced. Low phosphorus is frequently seen as I said earlier. I use Renal-K powder mixed in food and the cats seem to like it.
I was looking at his urinalysis. I guess they could not do one. I was hoping to see his urine specific gravity. That tells you how well he’s concentrating urine and so is another measure of kidney function to look at.
 
I think it would be worth checking his FIV/FeLV status. All they need is an ear prick just like a BG test to do the test. They drop the blood onto this special test kit to get the result.
 
Suzanne & Darcy said:
He hasn’t had any Convenia injections has he? For an infection?
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Nope no convenia injections -when diagnosed in December they gave antibiotics just in case... at that time I was told his urine was great -you can see those numbers in his SS labs.

I will request a FIV/FeLV test next time we are in.

I have started my quest for some food options as well.
 
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