6/18 Binx AMPS 243, +6 234 - Update

[Briana + Binx]

Last post

Happy Thursday!

I spent my night spiraling about Binx, considering both what was discussed and what wasn't. I ended up booking a last minute appointment back at my vet for 10am this morning, because I felt like Binx's treatment was getting left to "wait and see" and that hadn't worked for us for the last week.

I'm really glad I went and I think there's still more to be done but here's a "brief" update:
- His elevated creatinine level wasn't sitting well with me, so I requested some in clinic sub-q fluids. They were going to send me home with some as well for daily administering, but I wasn't yet comfortable with that before doing further research. Also, what's crazy to me is I saw my vet AND an internist and neither flagged his CKD as needing sub-q daily, but now that I've asked, they're telling me it's necessary? Plus, I know it's not good with heart disease and I need to dig more into heart/acro/etc.
- He had more bile last night and with his stomach issues, I requested some Cerenia. They provided 10 16mg tablets and have prescribed 1/4 tablets each day (4mg). For anyone that gives this to there cat, how does that compare to your dosage?
- I brought up his B12 again and requested a GI test including that. They're running it but the vet said they would be okay to give him an injection of this before knowing the results. I wanted oral, and I believe Tanya's website said the absorption has come along better for oral recently, but my vet suggested injectable had the best absorption outcome, so I opted for that. They sent me home with my own and I should hopefully get results tomorrow. From what I've read, this can help with absorption in the gut, so again not sure why there was no proactive approach for this before.
- In addition to the B12 test, they're running a spec fPL to identify any possible p-titis. I believe an ultrasound is the most accurate here, but his last labs had a elevated Lipase and if Bupe will help, I'd like to get him some.
- I asked about Budesonide. I know steroids are no good with diabetes, but I believe I've seen that this may be an option that sometimes doesn't react with a cat's FD (I believe Wendy's Neko was one). The vet didn't feel comfortable prescribing this, even after my mention, and suggested I speak to the internist about this (not my fave idea). The IM is supposed to be calling me this week after their report, so I'll bring it up.
- Lastly, finally got a script for the generic version of Felimazole.

I feel much better after the appointment, but still worried that there's something sinister happening and it may mean the worst. I know we all know how difficult it is not to worry.

Hugs and chin scratches to everyone's fur babies Thanks for all the support!

 

[Briana + Binx]

Ugh I’m sorry Briana. How frustrating! This is for the internist I really hope you can get it figured out soon I’ll be thinking of you two

Ugh!! Thanks, Tim Why is it so widespread and difficult to find good care for our cats

 

[Briana + Binx]

Hi Brianna! I'm so sorry Binx is still not 100% himself. Just a thought: I know that tightrope that you have to walk when a cat is suffering from CKD and FD is a challenge. Renal food is low-protein and high-carbohydrate, making it unsafe for Binx. Jude is in a similar dilemma with his FD and UTI issues--the UT food is also high carb, so I try to avoid it, but many cats do so well in terms of their UT issues when on it. What I've been trying to do is find some way to balance the two by isolating the ingredients or remedies in the UT food that make it good for the UT. For us, some of it is supplements that I've tried to introduce into his diet. Are you trying anything like this for Binx (and I'm sorry if you have written about this--I looked back a few posts, but I didn't see anything). I had a cat with CKD, and I remember trying fluids, a phosphorous binder, omega 3s, and we kept an eye on his potassium/b-vitamin levels and supplemented when necessary. I know you do such a good job being on top of everything, but I thought I'd mention it.

Thanks, Mary It's really helpful to hear your experience and approach (although I wish you weren't dealing with that difficult balancing act too). I did switch him to a low pho diet (although not "regulated"/specialty) and up until a couple weeks ago, it seemed to be holding his CKD steady at low Stage 3. I also finally got a water fountain, which I think has kept Binx better hydrated. His pho levels aren't too high yet, so when I spoke to the vet recently, they weren't quite at a point of pho binders but it's definitely something I've considered. Sub-q fluids is the next level we might hit, I need to consider this as a option now. And lastly, finally getting his B12 and GI panel tested from today and have a course of B12. I know there are many other B vitamins, so I'll be looking at how to supplement those once we (hopefully) get some clarity or improvement on his tummy issues.
It does make me think sometimes though, should I just opt for the renal diet and increase his insulin? What is worse?

 

[Mary & Jude]

Thanks, Mary It's really helpful to hear your experience and approach (although I wish you weren't dealing with that difficult balancing act too). I did switch him to a low pho diet (although not "regulated"/specialty) and up until a couple weeks ago, it seemed to be holding his CKD steady at low Stage 3. I also finally got a water fountain, which I think has kept Binx better hydrated. His pho levels aren't too high yet, so when I spoke to the vet recently, they weren't quite at a point of pho binders but it's definitely something I've considered. Sub-q fluids is the next level we might hit, I need to consider this as a option now. And lastly, finally getting his B12 and GI panel tested from today and have a course of B12. I know there are many other B vitamins, so I'll be looking at how to supplement those once we (hopefully) get some clarity or improvement on his tummy issues.
It does make me think sometimes though, should I just opt for the renal diet and increase his insulin? What is worse?

Do you know the carb value of the renal food?

 

[Mary & Jude]

Thanks, Mary It's really helpful to hear your experience and approach (although I wish you weren't dealing with that difficult balancing act too). I did switch him to a low pho diet (although not "regulated"/specialty) and up until a couple weeks ago, it seemed to be holding his CKD steady at low Stage 3. I also finally got a water fountain, which I think has kept Binx better hydrated. His pho levels aren't too high yet, so when I spoke to the vet recently, they weren't quite at a point of pho binders but it's definitely something I've considered. Sub-q fluids is the next level we might hit, I need to consider this as a option now. And lastly, finally getting his B12 and GI panel tested from today and have a course of B12. I know there are many other B vitamins, so I'll be looking at how to supplement those once we (hopefully) get some clarity or improvement on his tummy issues.
It does make me think sometimes though, should I just opt for the renal diet and increase his insulin? What is worse?

Also, you know that Yasmin and Pudge are battling CKD, right? She's giving Pudge several medicines/treatments for his CKD--she posted a list of them yesterday. She might be a good source for brands, dosages, etc.

 

[Mary & Jude]

Last post

Happy Thursday!

I spent my night spiraling about Binx, considering both what was discussed and what wasn't. I ended up booking a last minute appointment back at my vet for 10am this morning, because I felt like Binx's treatment was getting left to "wait and see" and that hadn't worked for us for the last week.

I'm really glad I went and I think there's still more to be done but here's a "brief" update:
- His elevated creatinine level wasn't sitting well with me, so I requested some in clinic sub-q fluids. They were going to send me home with some as well for daily administering, but I wasn't yet comfortable with that before doing further research. Also, what's crazy to me is I saw my vet AND an internist and neither flagged his CKD as needing sub-q daily, but now that I've asked, they're telling me it's necessary? Plus, I know it's not good with heart disease and I need to dig more into heart/acro/etc.
- He had more bile last night and with his stomach issues, I requested some Cerenia. They provided 10 16mg tablets and have prescribed 1/4 tablets each day (4mg). For anyone that gives this to there cat, how does that compare to your dosage?
- I brought up his B12 again and requested a GI test including that. They're running it but the vet said they would be okay to give him an injection of this before knowing the results. I wanted oral, and I believe Tanya's website said the absorption has come along better for oral recently, but my vet suggested injectable had the best absorption outcome, so I opted for that. They sent me home with my own and I should hopefully get results tomorrow. From what I've read, this can help with absorption in the gut, so again not sure why there was no proactive approach for this before.
- In addition to the B12 test, they're running a spec fPL to identify any possible p-titis. I believe an ultrasound is the most accurate here, but his last labs had a elevated Lipase and if Bupe will help, I'd like to get him some.
- I asked about Budesonide. I know steroids are no good with diabetes, but I believe I've seen that this may be an option that sometimes doesn't react with a cat's FD (I believe Wendy's Neko was one). The vet didn't feel comfortable prescribing this, even after my mention, and suggested I speak to the internist about this (not my fave idea). The IM is supposed to be calling me this week after their report, so I'll bring it up.
- Lastly, finally got a script for the generic version of Felimazole.

I feel much better after the appointment, but still worried that there's something sinister happening and it may mean the worst. I know we all know how difficult it is not to worry.

Hugs and chin scratches to everyone's fur babies Thanks for all the support!

I posted earlier before reading this update.

I'm glad you were proactive and went back to the vet to get a better plan of action. I'm a plan of action person, myself; "wait and see" can sometimes give me a feeling of torpor.

It's interesting that they are suddenly on the fluids page now that you've asked about it One would think that would be top of the list with CKD kitties.

Regarding his tummy and the bile, do you think an antacid might help?

Again, I'm glad you have some movement forward in Binx's treatment. I hope Wendy, etc., will jump in here soon with some medical advice--she and others are so knowledgeable.

Love and scritches to Binx!

 

[Christie & Maverick]

Cerenia is dosed by weight, oral pills generally are 2 mg/kg, so for Maverick I gave him half a 16 mg pill (8 mg) once a day. 4mg once a day would appear be a fairly small dose.

If the vet has an Idexx Catalyst One In-House Analyzer, they can add a separate pancreatic lipase test to the blood work and run it in house. Really good in that you don’t need to wait for blood work results to come back. Plus it gives you a number, not just a yes/no like the old SNAP fPL. Vets used to have to send the blood out for a spec fPL to get a diagnosis of pancreatitis.

tests come back okay.

 

[kitten68]

all sounding excellent.. sometimes you have to PUSH to get somewhere. hope things clear more and more. finding good medical care truly is a problem…

 

[Staci & Ivy]

Last post

Happy Thursday!

I spent my night spiraling about Binx, considering both what was discussed and what wasn't. I ended up booking a last minute appointment back at my vet for 10am this morning, because I felt like Binx's treatment was getting left to "wait and see" and that hadn't worked for us for the last week.

I'm really glad I went and I think there's still more to be done but here's a "brief" update:
- His elevated creatinine level wasn't sitting well with me, so I requested some in clinic sub-q fluids. They were going to send me home with some as well for daily administering, but I wasn't yet comfortable with that before doing further research. Also, what's crazy to me is I saw my vet AND an internist and neither flagged his CKD as needing sub-q daily, but now that I've asked, they're telling me it's necessary? Plus, I know it's not good with heart disease and I need to dig more into heart/acro/etc.
- He had more bile last night and with his stomach issues, I requested some Cerenia. They provided 10 16mg tablets and have prescribed 1/4 tablets each day (4mg). For anyone that gives this to there cat, how does that compare to your dosage?
- I brought up his B12 again and requested a GI test including that. They're running it but the vet said they would be okay to give him an injection of this before knowing the results. I wanted oral, and I believe Tanya's website said the absorption has come along better for oral recently, but my vet suggested injectable had the best absorption outcome, so I opted for that. They sent me home with my own and I should hopefully get results tomorrow. From what I've read, this can help with absorption in the gut, so again not sure why there was no proactive approach for this before.
- In addition to the B12 test, they're running a spec fPL to identify any possible p-titis. I believe an ultrasound is the most accurate here, but his last labs had a elevated Lipase and if Bupe will help, I'd like to get him some.
- I asked about Budesonide. I know steroids are no good with diabetes, but I believe I've seen that this may be an option that sometimes doesn't react with a cat's FD (I believe Wendy's Neko was one). The vet didn't feel comfortable prescribing this, even after my mention, and suggested I speak to the internist about this (not my fave idea). The IM is supposed to be calling me this week after their report, so I'll bring it up.
- Lastly, finally got a script for the generic version of Felimazole.

I feel much better after the appointment, but still worried that there's something sinister happening and it may mean the worst. I know we all know how difficult it is not to worry.

Hugs and chin scratches to everyone's fur babies Thanks for all the support!

Hi Briana, I’m glad you were seen today and they ran blood tests. It’s good you added a GI panel to see what they can find out.
I checked my spreadsheet notes for when Ivy had p-Titis last year and she was taking Cerenia 12 mg daily while she was not doing so well (she was around 14-15 pounds).

Then I noticed another time she had a flare for one or 2 days I gave her 4 mg dose.

I hope the new Methimazole will work out better for Binx.

I did give Ivy buprenorphine when she had p-titis. I’m sure it helped her to feel better. And I even fed her a can or 2 of A/D rescue food when she wouldn’t touch her normal homemade diet food.

Sending lots of love and hugs to both of you. Keep us posted. You do such a wonderful job with Binx

 

[Briana + Binx]

Do you know the carb value of the renal food?

I think it's 33% or something above 30% - no idea what that would do to insulin requirement, not good I bet.

Also, you know that Yasmin and Pudge are battling CKD, right? She's giving Pudge several medicines/treatments for his CKD--she posted a list of them yesterday. She might be a good source for brands, dosages, etc.

I was reading her posts, but I think I missed yesterday so I'll go back and have a look. Thanks!

I'm glad you were proactive and went back to the vet to get a better plan of action. I'm a plan of action person, myself; "wait and see" can sometimes give me a feeling of torpor.

It's interesting that they are suddenly on the fluids page now that you've asked about it One would think that would be top of the list with CKD kitties.

Regarding his tummy and the bile, do you think an antacid might help?

Again, I'm glad you have some movement forward in Binx's treatment. I hope Wendy, etc., will jump in here soon with some medical advice--she and others are so knowledgeable.

Love and scritches to Binx!

I'm the same way as you, Mary! I feel like all I could do was just sit and stare because my brain couldn't handle not knowing what the plan was.

Never thought about antacid, I'll look into it because I know in the past, his bile was coming from an empty stomach. Once I introduced the +9 snacks, the bile almost completely stopped. Whatever is going on has brought it back in some capacity.

Thanks for everything

 

[Briana + Binx]

Cerenia is dosed by weight, oral pills generally are 2 mg/kg, so for Maverick I gave him half a 16 mg pill (8 mg) once a day. 4mg once a day would appear be a fairly small dose.

If the vet has an Idexx Catalyst One In-House Analyzer, they can add a separate pancreatic lipase test to the blood work and run it in house. Really good in that you don’t need to wait for blood work results to come back. Plus it gives you a number, not just a yes/no like the old SNAP fPL. Vets used to have to send the blood out for a spec fPL to get a diagnosis of pancreatitis.

tests come back okay.

Thank you for this check point, Christie!! It did seem like a low dose, was wondering if it had to do with his liver values but I'm going to call them tomorrow to double check.

I believe they ended up going with the test you have to send out for, because it was the same for the GI panel and so they sent it all together. Hopefully back okay and quickly... always bad timing just before a weekend!

 

[Briana + Binx]

all sounding excellent.. sometimes you have to PUSH to get somewhere. hope things clear more and more. finding good medical care truly is a problem…

Truly truly, Yasmin I wish we didn't have to push so hard, but we will absolutely do it if it means they feel better.

 

[Briana + Binx]

Hi Briana, I’m glad you were seen today and they ran blood tests. It’s good you added a GI panel to see what they can find out.
I checked my spreadsheet notes for when Ivy had p-Titis last year and she was taking Cerenia 12 mg daily while she was not doing so well (she was around 14-15 pounds).

Then I noticed another time she had a flare for one or 2 days I gave her 4 mg dose.

I hope the new Methimazole will work out better for Binx.

I did give Ivy buprenorphine when she had p-titis. I’m sure it helped her to feel better. And I even fed her a can or 2 of A/D rescue food when she wouldn’t touch her normal homemade diet food.

Sending lots of love and hugs to both of you. Keep us posted. You do such a wonderful job with Binx

Thanks so much, Staci Excellent reference points on the Cerenia and Bupe. The vet seemed supportive of giving him some Bupe if the results came back with indications of p-titis, so whatever they may be, I just hope they come back quickly!

And yes, I hope the methimazole works better too. Can't believe it's a quarter of the cost!! Plus, would you believe it, the pharmacy offered to split all the pills for me! Incredible. He starts on it tomorrow.

 

[Staci & Ivy]

Thanks so much, Staci Excellent reference points on the Cerenia and Bupe. The vet seemed supportive of giving him some Bupe if the results came back with indications of p-titis, so whatever they may be, I just hope they come back quickly!

And yes, I hope the methimazole works better too. Can't believe it's a quarter of the cost!! Plus, would you believe it, the pharmacy offered to split all the pills for me! Incredible. He starts on it tomorrow.

Well that was lovely of the pharmacy! Yay for someone doing a little extra to help out
I hope the new Methimazole will be a better fit!

I hope Binx doesn’t need the BUPE but it’s great to know that at least the vet is willing to dispense it if needed. It seems like so many of the vets we hear about won’t give it to the patients to be used and it’s really just not good to make them suffer in pain

Paws crossed for good lab results!

 

[Wendy&Neko]

I'm glad Christie gave you the correct dosing for Cerenia. Neko was under dosed with 4 mg - that was before the paper came out showing what it should be. Vets used to dose the same as injectible, but oral needs to be twice as much.

Regarding fluids, Neko was getting fluids for her CKD and her heart couldn't take it and she went into CHF (congestive heart failure). So yes, I'm a little sensitive to this issue. Has Binx at least had a CardioPet BnP test? That's a blood test that can give you a heads up on heart issues. Having said that, Neko's CHF incident was about 6 months after a clean echocardiogram, which is gold standard for checking the heart. Neko did recover the first time, which additions of a couple heart meds. The second time the IM suggested just a tiny dose of fluids, and the heart said no again. Do whatever you can to give him fluids orally. In the battle of treating heart vs. treating kidneys, the heart wins. Treating kidneys can hurt the heart and vice versa.

GI issues are fairly common with acrokitties. An ultrasound is the next step towards figuring out what you are dealing with, but not the final step. Without an ultrasound, you can do a novel protein trial to see if that helps the problem. If so, IBD is part of the problem. I say part because I had a kitty with both IBD and small cell lymphoma. . She went into remission from the SCL, but IBD was forever. Neko likely had SCL, we couldn't do a biopsy to confirm because her heart wouldn't allow it. But once we treated her for very likely SCL, her bile acid stopped.

I wouldn't start a steroid unless you know it's needed. There are more potential downsides besides higher blood sugar. And you are correct it didn't impact Neko's BG. It was her IM who suggested budesonide. General practice vets don't have as much experience with it.

 

[Briana + Binx]

I'm glad Christie gave you the correct dosing for Cerenia. Neko was under dosed with 4 mg - that was before the paper came out showing what it should be. Vets used to dose the same as injectible, but oral needs to be twice as much.

Regarding fluids, Neko was getting fluids for her CKD and her heart couldn't take it and she went into CHF (congestive heart failure). So yes, I'm a little sensitive to this issue. Has Binx at least had a CardioPet BnP test? That's a blood test that can give you a heads up on heart issues. Having said that, Neko's CHF incident was about 6 months after a clean echocardiogram, which is gold standard for checking the heart. Neko did recover the first time, which additions of a couple heart meds. The second time the IM suggested just a tiny dose of fluids, and the heart said no again. Do whatever you can to give him fluids orally. In the battle of treating heart vs. treating kidneys, the heart wins. Treating kidneys can hurt the heart and vice versa.

GI issues are fairly common with acrokitties. An ultrasound is the next step towards figuring out what you are dealing with, but not the final step. Without an ultrasound, you can do a novel protein trial to see if that helps the problem. If so, IBD is part of the problem. I say part because I had a kitty with both IBD and small cell lymphoma. . She went into remission from the SCL, but IBD was forever. Neko likely had SCL, we couldn't do a biopsy to confirm because her heart wouldn't allow it. But once we treated her for very likely SCL, her bile acid stopped.

I wouldn't start a steroid unless you know it's needed. There are more potential downsides besides higher blood sugar. And you are correct it didn't impact Neko's BG. It was her IM who suggested budesonide. General practice vets don't have as much experience with it.

Thanks, Wendy

Binx has only had a cardiac ultrasound and that was exactly a year ago, but that was only to determine his heart murmur was physiological. Plus, I know a murmur doesn't equal heart disease. I'll see about a Cardio BnP. I mix in lots of water with his food and luckily he tolerates it. I also see him drinking a lot on his own too, but when I pull up his skin, he still seems dehydrated. I imagine without the diarrhea and occasional bile, he might be getting enough fluids but it's now just too much other stuff for his body.

Do you mind me asking how long from onset of symptoms to treatment to seeing improvements it was for any IBD/SCL kitty you've had? I know ECID but I'm really struggling with how much weight Binx has lost in such a short period of time and I feel like everything takes too long to become effective and he may just wither away in the process, plus he'll be uncomfortable with all the new meds/foods I throw at him

Good to know about the steroids.