02/21 J.D. PMPS 559

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Dyana

Dyana

Member Since 2009
Yesterday's Condo

Last Night:
135 PMPS
116 +2.25
86 +3
65 +5
87 +7
201 +9
Here's J.D.'s :mrgreen: for last night.

I'm surprised he didn't bounce further...knock on wood...
He didn't eat that much in the middle of the night, but I was sleep testing, and a couple of the cat bowls were licked clean when I got up so maybe he did.

He ate pretty good this morning, with encouragement.

I can't believe it's already past time to get ready for work. Where does the morning go?

I hope everyone has a good Friday.
 
Re: 02/21 J.D. AMPS 329

Hi Dyana,
Lovely cycle last night.
I'm glad J.D. ate good this morning. :-D
 
Re: 02/21 J.D. AMPS 329

Hi Dyana,
I just wanted to post a couple of thoughts about JD's blood work. I showed the numbers in his spreadsheet today to the vet who teaches my clinical pathology course. JD's RBC and HG (hemoglobin) are low, so that is anemia. You would expect to see a low HCT (hematocrit) with that, but JD was in the normal range. Dehydration can artificially increase the HCT and/or PCV (basically interchangeable) values, so that may or may not explain the higher than expected HCT. He does have reticulocytes (immature red blood cells) but they are in the normal range, so they don't suggest a strong regenerative response. On the other hand, anemia has to be quite advanced before a regenerative response is triggered, so the reticulocyte count may not be significant. Anemia related to renal failure tends to be non-regenerative (i.e. the cat is anemic not due to blood loss, but rather due to not being able to make enough red blood cells) in any case, but at this point you can't say for sure if it is regenerative or not. Also, a slow decline in RBC is less likely to set off a vigorous regenerative response than a sudden drop, and the cat also tends to cope better (feel better) with a slow decline than a sudden drop. His BUN is high, his CREA is getting toward the high end, his USG is low, and he has some protein in his urine, all suggesting renal issues. Was the urine specimen a free catch or done by cystocentesis? I see that there were some bacteria in his urine. The vet I spoke to feels his symptoms suggest a renal cause (i.e. not producing enough erythropoietin) to his anemia, and that he may have been dehydrated when his blood sample was taken. If possible, try to ensure he is well hydrated the next time you have his CBC rechecked, so that you can get a good idea of where his HCT really stands. The vet was confused about the suggestion to give a steroid shot and feed liver flavoured food. I would try to get more info about that.

Someone mentioned occult blood in your condo the other day. That is microscopic blood. You wouldn't see it. If he has upper GI bleeding (if one is trying to speculate on other causes of anemia that would lead a vet to suggest steroid treatment) then you may or may not see black stool.

This may or may not be helpful. I just wanted to pass it along. I think you are doing the right thing by monitoring it. Hopefully the vet will be able to give you more thoughts on what may be going on.
 
Thank you so much, Linda.

J.D. does drink a lot and pee a lot. I can try to make sure he's well hydrated next time, but it's at 9:00am Monday after next. How should I try to extra water in him besides giving him fluids?

The urine was drawn by cystocentesis.
 
Giving him fluids would be one good way, and adding water to his food would be another. I know it's difficult with a cat that pees a lot, and there is only so much you can do. It just might help you to get a more clear picture, but I know it's easier said than done.
 
I thought I read something about the steroid use in Tanya's Site. I'm looking for it now.
 
I can try to give him some fluids that morning. The appointment is at 9:00am. Should I give them at 7:00am? Would that be okay?

Tonight, he ate some of his dinner. We went for a medium sized walk, and then he ate some more FF.
 
I'm sure the vet would only want to give him steroids if it was absolutely necessary. I have enough problems dealing with his blood sugar as it is, without mixing steroids into the bunch.

4th dose of Orbax was given today. I thought it was his 5th, as he hates it. The receptionist said the doctor said to give them for 10 days, but his urinalysis paperwork says to give it for 5 days, so I'm going to call them again tomorrow to get a 3rd answer. :roll:

I am finally getting a doctor appointment for my arm tomorrow morning. :) Yay!
 
So, Linda, I'm sorry my brain doesn't function as well at night as it does in the morning.. because J.D. has reticulocytes that means he is anemic and is trying to make more RBC? I just looked through his last blood work tests, and he has had reticulocytes as long as they have tested for them.

Luckily, his blood type is AB, so if he needs a transfusion can take either type A or type B blood, correct?
 
Dyana said:
Anabolic Steroids is on this page about 2/3 of the way down.
Click to expand...

Hmm. I have never heard of a cat taking anabolic steroids. I think those are the ones that body builders use. The ones that are frequently used are the corticosteroids, like prednisolone, and it is pretty common for them to be prescribed for inflammatory bowel disease. Bear took these steroids, but they carry a lot of risk, and they caused many problems for him, and you will see in that article that they are not the best thing for diabetic cats or for renal cats. Sometimes medicine is a balancing act, though.

The part that I am trying to get a handle on is the link (if there is one) between anemia and treatment with steroids. I understood that JD's anemia was getting worse, and the vet was therefore considering treatment with steroids. That is how I got into a discussion of some of the different things (parasites, GI blood loss, kidney disease, etc) that can potentially cause anemia, and which ones on that list might respond to steroids and which ones would not. Keeping in mind that I am not a vet, and I am probably in over my head already, I was hoping the vet would be able to give you more info about:
1) Does he/she suspect anemia due to blood loss, for example from IBD, and wants to treat with steroids ..
2) Does he/she suspect anemia due to kidney disease, in which case I m not sure how steroids would help ..
3) all of the above
4) none of the above.

I am sure that your vet would only do what is in JD's best interest. I am just suggesting some areas where you might want to get more info from the vet as to what he thinks may be going on.

Yes, I think the fluids as you suggest might be helpful, and maybe for a day or two prior as well.
 
Dyana said:
So, Linda, I'm sorry my brain doesn't function as well at night as it does in the morning.. because J.D. has reticulocytes that means he is anemic and is trying to make more RBC? I just looked through his last blood work tests, and he has had reticulocytes as long as they have tested for them.

Luckily, his blood type is AB, so if he needs a transfusion can take either type A or type B blood, correct?
Click to expand...

Interpreting reticulocytes can get a bit complicated. There are different types of reticulocytes, and the counts have to be adjusted and so on. Unless the cat has been severely anemic for a several days, the reticulocyte count is meaningless, really. If the cat becomes very anemic, the body should try to build a lot of RBC's. In a normal response, you would see the reticulocytes (immature RBC's) increase. In a renal cat with inadequate erythropoietin, the reticulocyte count would probably stay flat. Bear had a HCT of .18, and his reticulocytes stayed in the low normal range, indicating that he was not making many new red blood cells. He was treated with an ESA (erythropoietin stimulating agent) called Aranesp (or Darbepoietin), and his HCT did go up. This treatment has a lot of potential very serious side effects, so it is not undertaken until the cat is quite anemic.

Cat transfusions are another complicated issue, and you don't really want to go there at this point. The blood typing is very different from human blood types, not to mention dog blood types. There are a lot of potential side effects from blood transfusions, which I don't think are routinely used for treating kidney-related anemia, and I think there is a limit on how many times in a lifetime a cat can be transfused, due to antibodies. You would have to talk to an expert about it. I think he ESA's are the way to go before transfusions, but before you go there, be looking at all the ways you can help renal cats (where Marje and many others I am sure) can give you all sorts of tips. I am not sure what you do with JD in that area now, so I will leave it at that for now.
 
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