10/24 Jack amps 90 +4 158

[saltycat]

last condo

Jack had another quick vetty visit today to take some blood for the SMDA test. While there I asked for the urinalysis results. I was quite surprised on the sheet I got back. It looks like they also did an inhouse mini blood panel. Results are updated in the SS, but are concerning to me. His urine SG was 1.005, creatine and bun are also up in just a few weeks. The ranges for the tests are slightly different so I am not sure how comparable the inhouse labs are with the Antech labs.

I'm reading up on Tanya's CRF site, always something new to learn with Jack. I've started using Reverse Osmosis water for him. I have even more pure RO/DI(near dialysis quality) water, but that can suck minerals out of their system and is generally not advised for drinking water. It looks like I can use my refractometer for USG measurements too which will let me monitor it a bit more.

Right now, just in a holding pattern until the SDMA comes back, but it sure looks like some renal issues are developing. It looks like if it is kidney issues, the numbers show it isn't too bad yet based on some reading on the crf site. They don't generally recommend sub-q fluids until creatine is over 3.5, Jack's is only 1.8 right now.

Hoping to get some direction soon and a treatment plan. I hate not knowing what to do next. On the plus side, he scored a 105bg and no glucose in the urine on the test, so he gets an A on that report card.

Vines for my boy and all the other kitties out there who could use some.

 

[carfurby (GA)]

 

[Sharon14]

Vines for Jack

 

[Wendy&Neko]

I'm reading up on Tanya's CRF site, always something new to learn with Jack.

Yup, I learned a lot about different things with Neko too. Jack's phosporus is also jumping up. I'd try to feed low phos fuds at this point if you can. Not sure the SDMA will tell you a lot that you don't already know. I just took a look at the labs and saw that HCT is dropping too. Might want to read the section on Tanya's site on B vitamins.

Tons of vines for Jack. are for you. I hope vetty has some recommendations soon - waiting is hard.

 

[Doodles & Karen]

Capt. Jack is a tough cookie. I don't have anything magical to add but give him extra scritches for me.

 

[LizzieInTexas]

If you want some low phosphorus/low carb suggestions take a look at the food tab on Gizmo's SS. Gizmo gets little to no fish based (I use it to give meds sometime). I also have costs and where I purchase there.

For the "B"'s see the meds tab (line 10&11). They should be hyperlinked to what I purchased. The B-Right was what Marje recommended. I open and dump the capsules into small plastic containers and use mini measuring spoons rather than messing with capsules on a daily basis.

 

[saltycat]

I wish I would have seen the 10/13 lab results when I spoke with the vet on Monday. She didn't mention anything about that b/w or urinalysis where he hit 1.005. With my limited knowledge I tend to agree on the SDMA being less useful now. At least it will give a little clearer picture on how bad the kidneys have gotten.

If I am reading into the numbers right, it doesn't bode well. weight loss despite lots of food, very dilute urine, with only mildly elevated bun/creatine/phos makes me think the kidneys are deteriorating quickly and the toxins haven't had a chance to buildup yet. Hopefully I'm wrong. The quick decline in his appearance and b/w means I am having to face the reality I knew would come one day.

He gets 3mg of methylcobalamine per day, but orally, which I suspect he is not absorbing well. He has been getting foods with ~200mg/100kcals. I'll need to look for ones a little lower.

Thanks @LizzieInTexas I'll go scour Gizmo's SS for some info. A little overwhelmed at the recent news and while I love Lisa's chart, it is a lot to look at then try to find in stores.

I bought out 2 different stores yesterday of wild callings cowabunga, and that will last less then a week. I've been buying food by the case, 25 cans is about a week of food for Jack.

Trying to do some research, but I think I'm going to have to take a break this evening, feeling a bit burnt out and discouraged at the recent test results. Letting the batteries recharge for a night should help with a clearer head tomorrow. Still not sure on the plan of action other then changing foods and adding a more complete b vitamin supplement. The CRF site mentioned fluids were hard on the kidneys and basically that his current numbers don't warrant fluids.

Thanks Karen, had to take a break writing this because Jack hopped up on the couch for some luvin, made sure to give him a couple scritches for you.

 

[LizzieInTexas]

feeling a bit burnt out and discouraged at the recent test results.

Don't feel discouraged.

Take a break. Then, when you are feeling better take a look at Gizmo's last labs. Comparative they are not that different. The numbers can and do change (up/down). Phosphorus looks good but I agree better to get ahead of that. Potassium looks good too.

I have given up trying to get food locally. Even if I gave to purchase a whole case and Gizmo doesn't like it it was worth the $30 to not spend an entire Saturday afternoon running all over to try and find food.

 

[Marje and Gracie]

Wes

I know it’s hard to not feel discouraged but I just have this weird feeling about his numbers because his creatinine and BUN are not bad so I, personally, do think the SDMA is crucial here.

I’ve seen cats with a mildly elevated BUN and creatinine and a normal SDMA. My own cats, with normal kidneys, might sometimes see a little bit higher creatinine and then next time, it has dropped. Yes, his trend is that’s it’s been increasing and his USG is so low.

While this seems indicative of CKD, looking at all other parameters, too, it is unusual to see such a low USG. I am wondering if he has pyelonephritis (kidney infection)as this will dip the USG unusually low and can also cause an increase in creatinine. The best way to diagnose this is via unltrasound. Quite often, a culture and sensitivity won’t grow bacteria if it’s a kidney infection. One of my CKD kitties had a kidney infection twice and there was no bacterial growth on his culture and sensitivity either time. But the C&S can help identify what antibiotics might work for him. BTW, dilute urine also puts him at risk for UTIs.

Just so you know, IMHO, in-house labs are never a good idea unless there is an emergency. With a kitty with ongoing issues, I would always opt for a Superchem and CBC. I know Antech, and I assume IDEXX, has a senior panel which includes a Superchem, CBC, urine, and T4 for a much more reasonable price than just an abbreviated Superchem and CBC. With a CKD cat, there are a lot of different parameters that’s you want to keep an eye on.

And, he is heading toward anemia so he will likely need some Multi B since you are already giving methylcobalamin.

However, the values that throw up a red flag to me are his cobalamin and folate levels. According to his GI Panel, he does not have EPI now, which is good. He had pancreatitis at the time of the test. There is really no significance to an elevated cobalamin but elevated folate is consistent with small intestine bacterial overgrowth (SIBO) (www.ibdkitties.net/SIBO/). Since both folate and cobalamin are elevated, it could be just due to vitamin supplementation but you said he continues to lose weight which is consistent with CKD or SIBO. Just something to read up about and be aware of.

His urine pH is really acidic, too. That puts him at risk for calcium oxalate stones.

Obviously, I’m not trying to be diagnostic but just have the goal of offering you some ideas to investigate.

Many vines for your sweet boy.

 

[saltycat]

Thank you for all the insight. Currently waiting to hear back on the SDMA results. I will definitely bring up a few of the points you mentioned with a little help from ibdkitties and felinecrf. I have been reading up and it slowly is starting to make more sense. I can see 1 number that is off, but taking the sum of the test values and seeing a bigger pattern is above my pay grade. I appreciate the extra set of eyes on the numbers, it gives me some better direction in what to research and bring up with the vet. I like that both the sites above cite references which will help when talking with the vet. It is nice to be able to cite certain studies instead of "somebody on the internet said...". Once again thanks.

in-house labs are never a good idea unless there is an emergency

Luckily that was a freebie. I questioned it when checking out and they took it off the bill, but must have still done the panel. I know it is also hard to compare labs from different sources.

Since both folate and cobalamin are elevated, it could be just due to vitamin supplementation

He is not getting any folate supplement currently, I am using a generic methylcobalamine supplement, not zobaline. I see it elevating the cobalamine test result, but not sure if it would have an impact on the folate levels.

I was surprised at the FPL results. Strangely, he is not showing any signs of pancreatitis like he has in previous episodes. Appy is A+, not lethargic, as perky as he normally is, not hiding, etc.

I need to read a little more on SIBO, but interestingly since switching foods he has been less gassy, stomach gurgly, and stools are less stinky and not as pale in color. I went with a red meat for protein thinking it might help with RBC production. I know it can in humans, not sure in cats. My main goal was just trying a different food/protein. It could also be the probiotic as well, he has been on that for about a month now.


Lizzie has some info I am going to read up on, including a B complex supplement you recommended to replace/complement the existing methylcobalamine. I am also planning on trying to get some lower phosphorous food to stay ahead of any kidney issues.

Thank you all again, I'd be SOOOOOO lost without this group.

 

[Marje and Gracie]

You’re very welcome. Just send me a PM when the SDMA comes back if you don’t mind. I need to start catching up on FDMB but it might take a while.

I was surprised at the FPL results. Strangely, he is not showing any signs of pancreatitis like he has in previous episodes. Appy is A+, not lethargic, as perky as he normally is, not hiding, etc.

Interestingly, anything else going on with the liver, gallbladder, intestines, etc can raise the specfPL. Gracie’s was always high and she never had pancreatitis and her pancreas always looked perfect on ultrasound. I notice Jack’s ALT goes up and down.

Lizzie has some info I am going to read up on, including a B complex supplement you recommended to replace/complement the existing methylcobalamine. I am also planning on trying to get some lower phosphorous food to stay ahead of any kidney issues.

To fight the anemia, you need to give the methylcobamin and the multiB both...it’s not an either/or. Oral methylB12 shouldn’t raise the folate level but never say never. Injected B12 can possibly raise it.