2/12 Theodore +3 572

NadineTheodore

NadineTheodore

Active Member
Hi,

I am struggling, I lowered Theodore to 4.5 after his super lows on 5 units and now his numbers are really high and not making much sense to me. Should I increase or wait a full 7 days?

Also secondary question, I am really struggling with his diet. I was told to put him on a kidney diet due to his high protein to creatitine ratio as a precaution even though his kidney values are FINE minus creatinine which was LOW. He hates BFF, he hates Weruva, I am struggling with what I can feed him that's actually acceptable. I also give him freeze dried chicken breast (PureBites) which is around 74% protein. Am I supposed to be focusing on low protein or low phosphorus? Sorry this is all becoming overwhelming as everything I do contradicts the other. It's very saddening for me as I am trying my hardest to help him and every time I go forward, I go three steps backward.

Previous Post:

https://felinediabetes.com/FDMB/threads/2-10-theodore-amps-95-3-43.286533/#post-3151903
 
Could you share his latest labs? What stage CKD is he at?

Many vets jump to prescription food even when there's really no need – both with diabetes and CKD. The only time a cat might need K/D is when they're in stage 4 or end stage CKD. Otherwise, you want to feed foods that are both low carb (for the diabetes) and low phosphorus (for the CKD). It used to be thought that a low protein diet is beneficial for cats with kidney disease but newer research shows that it's much more important to restrict phosphorus. That restricting protein at low levels of CKD just leads to muscle wasting. For cats with both diabetes and CKD (early stages), you want to feed low carb low phosphorus food but there are very few options and most of the are Weruva! :(

On the dosing front, he seems to be bouncing from the low on 2/10. It's also possible he went lower last night. Even if one were to assume he is bouncing from the 43, bounces can take 6 cycles to clear and some cats go high before they clear the bounce. So lets wait and see what he does tomorrow.

Normally with SLGS, you hold doses for a week - but given his history of DKA, we don't want him hanging around in higher numbers if it is clearly a failed reduction. Let's see what he does tomorrow?

@Wendy&Neko
 
Hello @Bandit's Mom,

So latest appt with internalist:
https://drive.google.com/file/d/1dfuhdFqJdLLMqzY1RhcQBebvj6oeKNp6/view?usp=sharing

Bloodwork that shows creatitine to protein being high (5) here:

https://drive.google.com/file/d/1fbQtGwDWQOA91_4mT7iVVot1fJ3NmqRo/view?usp=sharing

I am thinking the hounds and Gatos food is ok? I found it on here and I tried it before for Theodore which he didn't mind it.

https://www.bizave.com/foodlists/starter-list.html#note5

Is PureBites (freeze dried chicken okay? I will call tomorrow to ask about phosphorus but shows 74% protein..)


His numbers are so strange as they doubled so quickly tonight it's putting me on edge

I hope to get his results for acro soon although they were just submitted last week.
 
I'm going to tag a few others to look at his labs: @Marje and Gracie @Suzanne & Darcy @tiffmaxee

His SDMA and USG are okay but he has significant proteinuria. The Internalist's report you shared says "renal lymphoma most concerning as a cause of large kidneys and proteinuria. Future: aspiration of kidneys would be warranted if kidneys increase in size".

You might want to give him B complex for his anemia. I see that he gets B12 twice a week? Is that methyl B12 or cyano B12, do you know?
 
I have looked over the notes and the labs. I don’t find them that alarming - only because I have had ultrasound reports with similar findings and they ended up being nothing (like my cats liver which we biopsied.) Ultrasounds note everything when they’re done correctly, and all this hypoechoic and hyperechoic… and saying possible this diagnosis and possible that disease…. can be very scary. It’s great that his USG is very good. I doubt if he has kidney disease. Has his blood pressure been checked? That can cause proteinuria. With the proteinuria, it’s recommended to do further investigation. I will send you a really comprehensive article about proteinuria. It will help you to ask good questions of your vet. What did the vet say about the protein?

They only do the acromegaly testing on Wednesdays so, depending upon when the blood was submitted, it may have been tested last Wednesday or will be tested tomorrow. I hope Theodore doesn’t have Acro, but if he does it could account for the slightly enlarged kidneys (report said they were on the upper end of normal, so maybe that’s even normal for him. We don’t know unless you have previous ultrasounds to compare it to, right? My boy was Acro. I also have three FIV+ cats.

About the food, you should focus on low phosphorus and not low protein (and obviously low carb.) The vet report indicates that he has already lost muscle mass so you don’t want to withhold protein. I’m sorry he’s not liking Weruva. I feed the Weruva BFF pates that are around 140-145 on the diabetic CKD food list. What was his phosphorus level? If it is high, you could add an aluminum hydroxide powder to his food to reduce blood phosphorus — if you are feeding a high phosphorus food. He must eat. That’s most important.
 
Bandit's Mom said:
You might want to give him B complex for his anemia. I see that he gets B12 twice a week? Is that methyl B12 or cyano B12, do you know?
Click to expand...
Vitamine B12

Cyanocobalamine injection USP

1000 mcg/ml

10 000 mcg/10 mL

is this the right one???


Regarding lymphoma , his kidneys were ultrasound 6 months ago and one was slightly bigger than and one was very slightly smaller. I have no interest in aspirating them as he has a lot of known issues I need solved and these often come back inconclusive. My husband had his thyroid done when he had thyroid cancer and every time it came back inconclusive and he said hurt a lot. I feel vets just write lymphoma on everything when they hear he’s FIV. Renal lymphoma is also very fast acting so I’m not sold on this but more Acro yet they keep telling me it’s unlikely given he responded to low units of insulin. I did order the acro test....just waiting on results....


Also he was 183.6 this morning:bighug:
 
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Oh yes. About the mild anemia and the B-Complex. I have had several cats with “anemia of chronic disease” as the vets call it. I have great luck with using B-Complex given daily. It has increased my Ginger’s hematocrit and she has heart disease but not kidney disease. I take one Jarrow B-Right
B-Complex capsule and divide it into ten small gelatin capsules and give daily. I use number 4 capsules because I can actually just pour a little into each capsule and give it to her every night with other meds before her dinner. Other people use an even smaller capsule (number 5) and use tiny spoons (a drop spoon) that you can order from Amazon. I use a capsule “stand” made out of four flat strips of Lego put together into a square (my son’s invention years ago.) It holds the capsules for me while I pour an approximately equal portion into each gelcap. I believe that you can also buy capsule holders for filling capsules on Amazon. This is the recommended procedure that you will find on Tanya’s support group for CKD (group associated with felinecrf.org) but, as I said, I have used it in other non-CKD cats and it has raised their hematocrit.
 
Suzanne & Darcy said:
. It’s great that his USG is very good. I doubt if he has kidney disease. Has his blood pressure been checked? That can cause proteinuria. With the proteinuria, it’s recommended to do further investigation. I will send you a really comprehensive article about proteinuria. It will help you to ask good questions of your vet. What did the vet say about the protein?
Click to expand...

hi @Suzanne & Darcy! His blood pressure was 140 when he had DKA, 190 at the specialist but keep in mind it was stressful with a 45 drive one way and then 20-30 minute wait then having her assess him without me, my family vet took a look at him and did his blood pressure last week which on average she said it was 160 which wasn't scary high considering he was at the vet. She also had a heart health blood test done back in January which came back great. We are looking at finding a blood pressure monitor, just waiting to hear from my vet if they can advise where we can buy one that works but if anyone here has suggestions, I am open to it.

His phosphorus level was 1.2 on his January bloodwork which is within normal range.

Have you heard of Purebites and if they are safe to feed? I am feeding Dr. Esleys which he likes but I am thinking now I have to change that as the protein and phosphorus are too high according to these charts. He wasn't a fan of Young Again as it caused him terrible gas.

I love that you have FIV kitties, they're so sweet. Most vets previously have made it seem like a death sentence
 
NadineTheodore said:
hi @Suzanne & Darcy! His blood pressure was 140 when he had DKA, 190 at the specialist but keep in mind it was stressful with a 45 drive one way and then 20-30 minute wait then having her assess him without me, my family vet took a look at him and did his blood pressure last week which on average she said it was 160 which wasn't scary high considering he was at the vet. She also had a heart health blood test done back in January which came back great. We are looking at finding a blood pressure monitor, just waiting to hear from my vet if they can advise where we can buy one that works but if anyone here has suggestions, I am open to it.

His phosphorus level was 1.2 on his January bloodwork which is within normal range.

Have you heard of Purebites and if they are safe to feed? I am feeding Dr. Esleys which he likes but I am thinking now I have to change that as the protein and phosphorus are too high according to these charts. He wasn't a fan of Young Again as it caused him terrible gas.

I love that you have FIV kitties, they're so sweet. Most vets previously have made it seem like a death sentence
Click to expand...
That’s good. It sounds like his BP isn’t an issue. I agree about the stress. And it sounds like he had the NT-ProBNP test or similar test — and it came back good. So that’s great to know since a murmur was noted (not uncommon but always worth checking out.)

I love my FIV+ boys! So far they’ve lived long and pretty healthy lives. Sometimes we’ve hit a bump in the road, but they’ve gotten back on track.
 
Many people here feed PureBites to their cats. I do too, as I discovered them when Mr. Darcy was diagnosed. I don’t know what the phosphorus content is though.
 
Suzanne & Darcy said:
Many people here feed PureBites to their cats. I do too, as I discovered them when Mr. Darcy was diagnosed. I don’t know what the phosphorus content is though.
Click to expand...

I just finally found nutritional information for it after much digging. They don't list it on their nutriotnal value but I found it in the help section, I also emailed them but haven't heard back yet! Looks safe to me?

https://www.chewy.com/purebites-chi... not add anything,breast provided by the USDA.

and their actual website:

https://help.purebites.com/kb/freez...information-for-purebites-freeze-dried-treats

Looks like Theodore's favourite chicken is ~0.8% which is under he recommended 1% ? Woo hoo. I was worried as my vet told me not to give this due to the high protein.
 
That’s good news. I would think it’s okay because it’s boneless pieces of freeze dried chicken. Thanks for sharing that info. I give these to my FIV cats. I have a friend though whose vet told her not to feed them to her FIV cat (well.. or any of her cats but especially her FIV boy) because they are not cooked but are freeze dried (so raw and then freeze dried.) I never had any problems with them.
 
I’m glad Suzanne linked some info on the proteinuria because you can’t determine it just by blood and urine. You have to do the urine protein:creatinine ratio which involves several urinalyses within a defined time frame.

Insofar as using B vitamins for CKD-related anemia for HCT between 20-30%, you must also give methylB12 with the multi-B. I believe the recommendation, unless it has changed, is 500 mg daily split into two doses. Like Suzanne, I always made my own gel caps using the multiB and the methylB12 caps. I’d combine the appropriate dose of each into one #3 gel cap and give twice daily.
 
Previous discussion about Theodore and proteinuria here. His UPCR was 5 which is well above the limit of 0.5. But so far it's just one test, and you need a couple more to definitively diagnose proteinuria.

Neko had high proteinuria, but controlled with medication. I fed her a low phosphorus raw diet and her IM vet called it the best food for him. She also got freeze dried meat treats. When she could no longer eat raw (mouth issues) then low phosphorus canned.

Nice AMPS today. :cool:
 
@Wendy&Neko Thank you :) He likes to put me on rollercoasters clearly. My vet asked me to bring in his pee in a clean container to re-test. I believe you said it had to be cysto right?
 
The answer is maybe, it depends what type of proteinuria it is. If not post renal (which we don't know type yet), then looks like there is a paper that said either is OK. There are issues with both methods. Blood in cysto can contaminate the sample. Free catch also has potential issues. My vet(s) always wanted to do cysto and the UPCR was way off when they did a free catch (not on purpose). More information here: https://felinecrf.org/proteinuria.htm#diagnosis
 
Wendy&Neko said:
It's on the same page: https://felinecrf.org/proteinuria.htm#types
Click to expand...
@Wendy&Neko Sorry I mean how do we identify what type it is...like if it's kidney, inflammation, etc. Because if I redo the test and it's the same or higher...how do we say where it is coming from? When I look at my kidney values in January they were fine aside from creatinine so does that mean it's not kidney? Apologies this is confusing. I feel like I will be a vet soon
 
Pre-renal cause can by hypertension, so blood pressure testing is done. Kidney, as you said can be determined by blood work/urinalysis. Creatinine is a key kidney value. It's really up to the vet to figure out the cause and treatment.
 
Wendy&Neko said:
Pre-renal cause can by hypertension, so blood pressure testing is done. Kidney, as you said can be determined by blood work/urinalysis. Creatinine is a key kidney value. It's really up to the vet to figure out the cause and treatment.
Click to expand...
@Wendy&Neko Thank you:bighug:, it seems I have more information here than I did with my Internal Medicine Specialist. She never even suggested re-checking the protein to creatinine ratio ..o_O They just wanted to put him straight away on the hypertension meds but my family vet was not sold on him having hypertension that's why we re-checked it. On a side note, I am trying to find a blood pressure monitor to purchase, do you have any suggestions? Amazon has some but not many reviews and not sure how accurate they would be...
 
Wendy&Neko said:
Pre-renal cause can by hypertension, so blood pressure testing is done. Kidney, as you said can be determined by blood work/urinalysis. Creatinine is a key kidney value. It's really up to the vet to figure out the cause and treatment.
Click to expand...
@Wendy&Neko I spoke to the vet, I got his second results for protein to creatinine results and it was around 2 (lower) which still requires treatment. In terms of cause, it could be various things, she believes it's something called diabetic glomerulonephritis :D I had to ask her to spell this for me. Anyways it's where your kidneys get inflamed and blood vessels get damaged. She said it can happen to diabetic cats but she is hopefully the treatment will help him. I also changed his food to Hounds and Gatos (he rejected the Weruva), I think because of his dental extractions pates are easier and Hounds and Gatos was "OK" according to these food charts although there were better options. I am looking at changing his dry food now to a lower phosphorus option as Dr. Esleys is not really great in that respect. Young again I know he is not a fan of. It looks like the food change at least helped a little. I know my husband this morning forgot and gave him fancy feast and his glucose was high so I am not sure if the two are related but anyways it looks like hounds and gatos is working well for him. :cat:
 
Ideally you'd like the UPCR under 0.5, so would treat if above that. Hope he likes the new food.

Some interesting reading on glomerulonephritis, which apparently can also be caused by FIV. The article also talks about treating proteinuria.
 
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