? 12May2020/Maxi/Labs from Hospital - PLEASE CHECK

bambinaki

Member Since 2010
Last thread: http://www.felinediabetes.com/FDMB/...-24-hours-spoke-too-soon.229470/#post-2569221

Hello-

If you are able, please check Maxi's labs (attached) from his hospitalization. He has an appointment tomorrow at the same clinic, so I would like to know today if you see anything I should ask about at the appointment.

I also have lots of ultrasound and x-ray images that I can e-mail to you.

Thank you.

PS: He had diarrhea again this morning. His last Clavamox was yesterday morning. Do you think it might still be in his system and still causing diarrhea?

@Wendy&Neko @Marje and Gracie
 

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Can you enter this information on the Labs tab of the spreadsheet. Seeing how these compare to previous labs is helpful.

Are you still giving s. Boullardii?
 
It's possible the clavamox could still be causing a problem. I hope the diarrhea clears up soon. Sending prayers.
 
I see two things that raises a red flag to me: his phosphorus and his folate. We’ve discussed P before. Here is info about high folate from Dr. Karen Becker:

Sometimes, folate levels can be high on your pet’s blood work. What happens with high folate levels most of the time is that there’s a small amount of bacteria in your pet’s small intestine that can actually produce some B vitamins. When these B vitamin-producing bacteria bloom into an overgrowth, you can end up with high folate levels. This condition is called SIBO or Small Intestinal Bacterial Overgrowth. The clinical diagnosis is made with an elevated folate level.

Did the vet mention this to you or address the elevated folate? I’m wondering if they are exacerbating this with the clavamox. I’d ask. I’m glad you could rule out EPI as that can be a nasty booger but can be addressed.

One suggestion: Be sure you are giving the clavamox and probiotics several hours apart.

I’m glad you have him home and his kidney values have improved.
 
his phosphorus

Thank you, Marje.

...but his phosphorus was normal, at least according to that last test. Do you mean that even in their normal range, his number is too high?
This vet said he doesn’t need binder.
Do you think he should be getting binder?
 
...but his phosphorus was normal, at least according to that last test.
As Elise said above, his P needs to be closer to 4.5. The normal ranges include kittens which is why you see the upper limit of it so high but a cat with a P over 6 has too high of a P. His levels have been pretty consistent. Personally, I would try a small amount of binder and see how that helps. I linked the info from Tanya’s on binders and dosing back a week or so ago. Be sure you have his labs rechecked after a few weeks using the binder.

One of the main things to control with CKD is P levels because they are a good indicator of longevity. High P levels can cause so many other cascading events with CKD that you really want to focus on keeping it under control.

https://www.vin.com/apputil/content/defaultadv1.aspx?id=7054720&pid=12886

What do you think of this treatment, @Marje and Gracie ?

Could you please, if you know, let me know how to deal with SIBO?

Thank you
That’s a great article. I’ve never had a cat with SIBO but since Gracie has IBD, I am familiar with SIBO. This link provides you with good info from a CG standpoint and what they did. I am familiar with this CG as she helps out a lot on the IBDKitties FB group. She’s really knowledgeable about SIBO as well as IBD. I would read her information and references and then discuss with your vet.

I’ve never used Tylosin. I believe @Sienne and Gabby (GA) has friends whose kittens had raging diarrhea and they might have used it so she might be able to offer you some thoughts. I have used Metronidazole long ago only one cat just for colitis. My vet stays away from antibiotics as much as possible. But....you are dealing with an entirely different issue that you need to figure out with your vet and do what Maxi needs.

You might also want to discuss giving him digestive enzymes (not pancreatic enzymes). Pancreatic enzymes are for cats diagnosed with EPI which he was not. They are very expensive and can be caustic if not given correctly. I use Mercola (at the direction of my vet). While my Tobey does not have any intestinal issues at this time (paws crossed), he had coccidia as a kitten and that can put kitties at a disadvantage GI-wise so we give him good supplements and feed a balanced raw diet to support his intestines. Since you are giving S boulardi, you can just add the Mercola (if you’re vet agrees with giving it) to the S boulardi, add water, and syringe. What would be even better and help him with motility and GI Health, in general, is to add in with those supplements some egg yolk powder. I would go very, very slow with the dosing on that. Egg yolk powder is great for constipation so you don’t want to go overboard with a cat that has diarrhea but since SIBO can be a motility-issue problem, a small amount of egg yolk powder might help. It’s an excellent nutrient. I use this also with both my cats just because it has so many benefits.

Word of caution: for anything you try, do one thing at a time. In other words, if you decide to try the above things, don’t start digestive enzymes and egg yolk powder at the same time. Anything you add, whether it’s from the vet or a supplement, do one at a time so you know what is or is not addressing the issue.

Lastly, if those things don’t work or help, I know a lot of people that have had great success with fecal implants from Animal Biome. I’d just keep that info in my back pocket if nothing else helps. I wouldn’t start there but it’s an option down the road, if need be.

And here’s the thread that discussed why we don’t recommend using Entyce.

I hope that helps you with things to discuss with your vet. Good luck!
 
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@Wendy&Neko @Marje and Gracie @Sienne and Gabby (GA)

I am anticipating struggling to get Maxi to eat, so I am looking again for tasty low phosphorus and low carb.
And I am again confused about percent of calories (Dr. Lisa Pierson catinfo.org) VS dry matter analysis basis (Tanya).
I think Maxi likes Fancy Feast so I'd like to start there. But I'm at a loss as to how to choose the lowest carb and lowest phos.

Low phos is less than 0.5% dry matter analysis. Low carb is less than 10% of calories. But I can't figure how to balance those 2 elements measured in 2 different ways. Dr. Lisa uses calorie percentages and Tanya uses DMA. With Tanya's chart, I know to look for as close to 0.5 % phos in her way of measuring as possible, but I don't know what is considered low carb measured by DMA. Wth Dr. Lisa's chart, I know to look for under 10% carb calories, but I don't know what is considered low phos in her way of measuring. I don't know what number to look for in phos in Dr. Lisa's chart, and I don't know what number to look for in carbs in Tanya's chart.

Can you help, please?
 
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@Wendy&Neko @Marje and Gracie @Sienne and Gabby (GA)

I am anticipating struggling to get Maxi to eat, so I am looking again for tasty low phosphorus and low carb.
And I am again confused about percent of calories (Dr. Lisa Pierson catinfo.org) VS dry matter analysis basis (Tanya).
I think Maxi likes Fancy Feast so I'd like to start there. But I'm at a loss as to how to choose the lowest carb and lowest phos.

Low phos is less than 0.5% dry matter analysis. Low carb is less than 10% of calories. But I can't figure how to balance those 2 elements measured in 2 different ways.

Can you help, please?
Well it’s apples and oranges so you don’t need to make it harder than it needs to be :) First, about the only low P food you will find that is 0.5% or lower on a DMB are the prescription renal diets. There might be one or two that are not.

Here’s what is confusing you (and everyone). Tanya’s charts are done on a DMB. But for finding out % calories from carbs, you have to insert those DMB numbers into a calculator (Q2, you can download the Excel SS to your computer and then you will always have that calculator) to come up with the actual % calories from carbs that we use and that Dr. Lisa has already done for you. You have a couple options:
  • find the food on Tanya’s for the P you want in DMB and then look for it on Dr. Lisa’s page to see what the actual % calorie from carbs is.
  • find the food on Tanya’s for the P you want in DMB and then use the calculator linked above to enter the DMB for protein, fat, carbs so you can see what the % of each of these macronutrients from calories is.
  • just use Dr. Lisa’s page and try to find the foods that are lower in P based on as-fed values that she uses. For P, you absolutely want less than 200 mgP/100 kcal but the lower you can find it, the better.
  • check out this 2017 SS put together by a member for lower P and LC foods; I’m sure there have been changes so you might need to do some research but it can narrow the list for you.
Does that help?
 
  • find the food on Tanya’s for the P you want in DMB and then look for it on Dr. Lisa’s page to see what the actual % calorie from carbs is.
  • find the food on Tanya’s for the P you want in DMB and then use the calculator linked above to enter the DMB for protein, fat, carbs so you can see what the % of each of these macronutrients from calories is.
  • just use Dr. Lisa’s page and try to find the foods that are lower in P based on as-fed values that she uses. For P, you absolutely want less than 200 mgP/100 kcal but the lower you can find it, the better.
  • check out this 2017 SS put together by a member for lower P and LC foods; I’m sure there have been changes so you might need to do some research but it can narrow the list for you.
Does that help?

I have of course been attempting your first suggestion but was hoping to simply get the right number for carb to look for in Tanya's chart or the right number for phos to look for in Dr. Lisa's chart, and you have done the latter, and that DOES help! Thank you!!
 
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I have of course been attempting your first suggestion but was hoping to simply get the right number for carb to look for in Tanya's chart or the right number for phos to look for in Dr. Lisa's chart, and you have done the latter, and the DOES help! Thank you!!
You’re very welcome!!! Hope you get good news today.
 
His TLI was normal on his GI Panel. You didn’t list it on the lab tab on the SS but it was on the labs dated 1-5 May.

Thank you very much for taking the time to look for that.

I've added it as well as B-12 to his SS.
B-12 was normal, so doesn't that indicate that SIBO is less likely than just high folate alone?
 
Metronidazole

The vet said this is what she would prescribe if diarrhea doesn't stop and SIBO is more suspected.

I read about neurotoxicity and got scared. But the great majority of users are fine with it, aren't they?

I'm against (over)use of antibiotics too, and I'm not in favor of pumping drugs in without careful consideration. But I do want to make Maxi better. I would like to know more about what you think of trying Metronidazole.
 
@Wendy&Neko @Marje and Gracie @Sienne and Gabby (GA)

I am anticipating struggling to get Maxi to eat, so I am looking again for tasty low phosphorus and low carb.
And I am again confused about percent of calories (Dr. Lisa Pierson catinfo.org) VS dry matter analysis basis (Tanya).
I think Maxi likes Fancy Feast so I'd like to start there. But I'm at a loss as to how to choose the lowest carb and lowest phos.

Low phos is less than 0.5% dry matter analysis. Low carb is less than 10% of calories. But I can't figure how to balance those 2 elements measured in 2 different ways. Dr. Lisa uses calorie percentages and Tanya uses DMA. With Tanya's chart, I know to look for as close to 0.5 % phos in her way of measuring as possible, but I don't know what is considered low carb measured by DMA. Wth Dr. Lisa's chart, I know to look for under 10% carb calories, but I don't know what is considered low phos in her way of measuring. I don't know what number to look for in phos in Dr. Lisa's chart, and I don't know what number to look for in carbs in Tanya's chart.

Can you help, please?



I didn't find Fancy Feast on any of the lists, by the way.
 
I am familiar with SIBO. This link provides you with good info from a CG standpoint and what they did. I am familiar with this CG as she helps out a lot on the IBDKitties FB group. She’s really knowledgeable about SIBO as well as IBD. I would read her information and references and then discuss with your vet.

I would like to ask her advice. I Googled her, but couldn't find her. Would you happen to be able to put me in contact with her?
 
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She said she's not familiar with it so advises not to use it. (I will post elsewhere about the way this vet rolls.)
:confused::confused::confused::rolleyes::rolleyes: Good grief. My vet wasn’t familiar with Levemir insulin either but she took the time to check it out and then prescribed it. Just sayin’.

B-12 was normal, so doesn't that indicate that SIBO is less likely than just high folate alone?
His B12 was in the low end of normal. If you read through the link I gave you that Rebecca wrote, you’ll see cobalamin can be normal, folate elevated, and SIBO be the dx.

In regard to metronidazole, that’s between you and your vet. If it is SIBO, hopefully it will respond to the metronidazole. He probably also needs B12 as those levels should be in the “upper mid-range”. Your vet would have to be on board with him having B12 shots.

Rebecca is an admin on the IBDKitties Facebook page and that is where I am familiar with her. If you have FB, you could ask to join that group and then do a post and ask about SIBO. You could tag Rebecca there. That is really the Bret place to get info about this, about whether he could have it, and the best way to treat it. Again, I was giving you info to discuss with your vet but I’ve never dealt with it so it’s best to work with those that have.
 
In regard to metronidazole, that’s between you and your vet. If it is SIBO, hopefully it will respond to the metronidazole. He probably also needs B12 as those levels should be in the “upper mid-range”. Your vet would have to be on board with him having B12 shots.

Rebecca is an admin on the IBDKitties Facebook page and that is where I am familiar with her. If you have FB, you could ask to join that group and then do a post and ask about SIBO. You could tag Rebecca there. That is really the Bret place to get info about this, about whether he could have it, and the best way to treat it. Again, I was giving you info to discuss with your vet but I’ve never dealt with it so it’s best to work with those that have.

Thank you for this!
 
Thank you for this!
You’re welcome.

You know you can put more than one quote in the text box, right? So if you are answering a bunch of info I’ve put in a post, you can answer back all in the same post so it keeps your condo from being so long. :)
 
When Max was a kitten he had Coccidia. I was given Tylan powder but he wouldn’t eat. I’ve had luck with metronidazole at the very low end of dosing but never gave it more than a week.
 
I didn't find Fancy Feast on any of the lists, by the way.
You won't, it's fairly high phosphorus. See if there are other brands he likes.

As for tylosin, aka Tylan, it's incredibly bitter. I gave it to a civvie for a while but had to put it in a gel cap and put that in a pill pocket. It's didn't help him, but he wasn't having diarrhea. Metronidazole at a low dose worked better for him.

You also bumped up an older post where you asked about dosing of aluminum hydroxide. That should be done in conjunction with your vet.
 
Yes, and I got the usual kind of response: The binder she prescribes is Epatikin; she has found it works well.
That doesn’t mean you have to use it. You are his advocate. She works for you. Use what’s best for him not what is convenient for her because she doesn’t want to learn about something new.

And Epakitin “can” raise Ca levels in CKD cats. That’s an issue especially if you are dealing with high P levels. Anytime the Ca x P is greater than 70, kitty is at risk for tissue calcification.

It’s time to start a new condo.....one per cat per day. Thank you and I hope Maxi is better.
 
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That doesn’t mean you have to use it. You are his advocate. She works for you. Use what’s best for him not what is convenient for her because she doesn’t want to learn about something new.

Based on what I have read on the message board, aluminum hydroxide is best for him. Because the vet has not advised me on dosing, I was hoping to get some help with dosing here. I'm having trouble reconciling the dosing info I have read from IRIS with the info on the label of the aluminum hydroxide from Thriving Pets.

It’s time to start a new condo.....one per cat per day.

Create a new thread with the same question?
 
Based on what I have read on the message board, aluminum hydroxide is best for him. Because the vet has not advised me on dosing, I was hoping to get some help with dosing here. I'm having trouble reconciling the dosing info I have read from IRIS with the info on the label of the aluminum hydroxide from Thriving Pets.



Create a new thread with the same question?
Yes pls. Thx.
 
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