08/14 Blue AMPS 328 +2.5 194 +5.75 149 PMPS 218 +2.5 182 +3.5 167

I'm glad you increased last night. Looks like this dose might already have nudged him down from the high blues. :cool:

How's the pooping/eating situation?
 
One more question, is he really considered CKD at this point? I thought his latest labs showed not so much, or very early stage at worst case.
 
Wendy&Neko said:
I'm glad you increased last night. Looks like this dose might already have nudged him down from the high blues. :cool:

How's the pooping/eating situation?
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Yes, it's really good to see. Hoping that the high BGs were a function of eating that "special" diet for weeks. What I also noticed is something the IM vet seems to have missed during Blue's hospital visits between July 10th and August 4th:

TT4. 22 nmol/L. 10-60 (ref range) July 10/22
TT4. 77 nmol/L. 10-60 (ref range) August 4/22

Like WTH!~ I asked the IM vet about the newly compounded Levothyroxine (you may recall I got it so that Blue wouldn't have to take tablets with his dential issues) and he said "Based on your data [it was a lab report that he ought to have] the Total T4 (TT4) is too high and requires less thyroid supplementation. Just guessing, he should get 0.1cc BID, and retested in 3-4 weeks to see if that is correct or not."

Blue currently gets 1.5ml (=150MCG) Levothroxine BiD (this is the compounded prescription). he was getting 0.15mg BiD in tablet form. I asked the vet if compounding made a difference. He said, "It can play a role but for me there is no way to check for the concentration of the product. We use a pharmacy for that reason, quality control. If in doubt, the pharmacy is in a better position to answer that question." I'm going to call the pharmacy tomorrow but this doesn't explain why I had to be the one to notice the huge difference in Blue's TT4.

Anyway, I've decreased the dose to 1.2ml (seems the IM vet's "guess" to cut by 0.5mil BiD would be a bit drastic). Anyway, one thing I read was that hyperthyroid can be caused by too much Levothryoxine.

This has been a perfect storm for Blue to come back to DM. 39% carb "special" food, hyperthyroid and to answer your question below re: CKD, it would appear we've gone back to normal. Like what in the blue (!!) blazes has been going on...

Peeing and pooping are on the money with the PEG3350. Makes it much easier for him to go. No constipation. Good, no, great appetite and for the first time in ages (no really), Blue is coming to sit on my lap!! I've even taken him outside (they are indoor kitties with a catio but Blue hasn't been all that interested in going out the cat door). I'm hoping that getting his dental done will mean an ever better life for him.
 
Hyperthyroidism can mask kidney issues, so good on you catching that change in TT4. Sloppy work on the vet's part. :mad: What date did you start the compounded Levothyroxine? If you want some opinions from people who know quite a bit about feline thyroid issues, there is a groups.io group that specializes in it. If you aren't already on it. I had been asking about the CKD cause not sure it needs to be in the signature.

Regarding the PEG, are you getting a generic or just using Restoralax? Awesome report on Blue today. :)
 
Wendy&Neko said:
Hyperthyroidism can mask kidney issues, so good on you catching that change in TT4. Sloppy work on the vet's part. :mad: What date did you start the compounded Levothyroxine? If you want some opinions from people who know quite a bit about feline thyroid issues, there is a groups.io group that specializes in it. If you aren't already on it. I had been asking about the CKD cause not sure it needs to be in the signature.

Regarding the PEG, are you getting a generic or just using Restoralax? Awesome report on Blue today. :)
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I'm monitoring the hyperthyroidism. He has been on the compounded Levothyroxine just long enough for this to happen. You might recall, he went to hospital and his teeth were bad about four weeks ago. I got the compounded medication on July 12th....I don't know, smoking gun?
His lab reports show normal SDMA and normalized phosphorus, Bun, etc.
 
OK, TT4 of 22 on July 10, start new Levo July 14, TT4 out of whack at 77 August 4th. Hmmm...

Were his kidney numbers OK back on July 10 when he had a normal TT4? I knew he recently tested OK.
 
Wendy&Neko said:
OK, TT4 of 22 on July 10, start new Levo July 14, TT4 out of whack at 77 August 4th. Hmmm...

Were his kidney numbers OK back on July 10 when he had a normal TT4? I knew he recently tested OK.
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Just on my way out. Will get back here with those numbers. Thanks, Wendy.
 
Wendy&Neko said:
Were his kidney numbers OK back on July 10 when he had a normal TT4? I knew he recently tested OK.
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I’m curious about this too. If not, I’m questioning whether the hyperthyroidism has increased renal perfusion and masked the true kidney status.

I’ve read, and been cautioned, about switching from one brand of thyroid medicine to another. I don’t have the link handy, but the gist is that there can be a notable variation in the different brands (up to 10-20 percent in some studies, maybe??) and that follow up testing should be performed to verify the effect and titrate the dose if needed. That may be true with drugs in general, but thyroid can be a sensitive thing to regulate. Just musing out loud here. But the timing of the switch to compounded drug and the change in his thyroid values does make one ponder…
 
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JL and Chip said:
I’m curious about this too. If not, I’m questioning whether the hyperthyroidism has increased renal perfusion and masked the true kidney status.

I’ve read, and been cautioned, about switching from one brand of thyroid medicine to another. I don’t have the link handy, but the gist is that there can be a notable variation in the different brands (up to 10-20 percent in some studies, maybe??) and that follow up testing should be performed to verify the effect and titrate the dose if needed. That may be true with drugs in general, but thyroid can be a sensitive thing to regulate. Just musing out loud here. But the timing of the switch to compounded drug and the change in his thyroid values does make one ponder…
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I guess going from tablet to compounding is not exactly switching from one brand to another. Both are Levothyroxine; but in different form.
 
Jodey&Eddie&Blue said:
I guess going from tablet to compounding is not exactly switching from one brand to another. Both are Levothyroxine; but in different form.
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Same point though. It’s made in a different facility (I assume), might have different inactive ingredients… compounding in itself is a change, and thus a variable.
 
Wendy&Neko said:
OK, TT4 of 22 on July 10, start new Levo July 14, TT4 out of whack at 77 August 4th. Hmmm...

Were his kidney numbers OK back on July 10 when he had a normal TT4? I knew he recently tested OK.
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'Ok, back to July 10: TT4 22nmol/L ---10 60 ref range.

So, he was a little low on the scale, ie. "gray zone"; they recommend further test.

BUN/UREA 14.1 MMOL/L H 5.7-12.9 REF RANGE
CREA. 324 UMOL/L H. 71-212 REF RANGE
PHOS. 2.48 MMOL/L H 100-2.42 REF RANGE
SDMA. 24 UG/DL H. 24 ug/dL H 0-14 REF RANGE

They suggest treatment with methimazole: NOTHING from the IM Vet when we met to discuss Blue's test.

However, what led to all of this: on July 5th, I noticed Blue was having trouble eating: his teeth (you'l recall one vet had told me to expect resorption and that the bad tooth would just "fall out"). By the time I took Blue for the followup test with the primary vet (when they did an x-ray and said just go back to the hospital, he's really constipated), she looked at his mouth and said there was pus leaking out from one or more abscesses: one at hospital they put him on Clavamox and he's been on it since to keep infection under control in preparation for his dental, Sept 7th).

By July 9th, he did not want to eat and was lethargic. July 10th I brought him to hospital and they diagnosed CKD. He was there overnight and a full day (but hadn't had a bowel movement and when he came home he didn't have one for days, which ended up in going back to the hospital on July 29th after eating the special diet from July 11th-July 29th when he was lethargic and I tested his BG and it was 750.
 
JL and Chip said:
Same point though. It’s made in a different facility (I assume), might have different inactive ingredients… compounding in itself is a change, and thus a variable.
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No, I get it, JL. But, like all his medications are from one pharmacy. I'm calling them tomorrow to follow up on this.
 
So his kidney values were high when his TT4 was normal, and came into range when his TT4 was high. That's the thyroid masking the kidney issues, which it sounds like he does have after all.
 
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