2. Java, elder cat

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You can fudge the time a little bit with Prozinc. When Sam gets really insistent about the food, I'll test him and feed him, and then just hold the shot up to 15-20 minutes longer. That way his shot ends up at about the same time, but he gets a little relief from the hunger. I've heard as long as the shot is within 30 minutes of the test it's okay. Hopefully someone else can confirm if that's right though.
 
Oh, and if you want Rachel, you can type the @ sign in front of her name to get her attention. Although it doesn't look like she's on right now. Just in case... @Rachel
 
He was glad to have both YA and FF and I went outside with him so he could drink some rainwater, which apparently is far superior to filtered tap water.

His BG has been crazy high all day. I get really nervous anytime I increase it, so I'm going to look at his SS again, but I'm thinking 1.75 is probably good for tonight.

I'll report back on what the vet says about the NaCl versus ringers fluids. I'm wondering if 1.75 with NaCl fluid is too much.
 
Lois and Java said:
It seems like the sodium chloride fluid helps him, and helps bring his BG down, but the ringer solution does the opposite, it makes it as if there's no insulin at all. I'll call the vet tomorrow and find out why, but I think Ringers is out of the equation from this point on.

I plan to do the NaCl fluid tomorrow, and he had blues before with that. Which makes me wonder about 1.75.
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It's your call on the 1.75 u, Lois. It was suggestion only. :)
 
Hooray! Kris is here!

I love that Java gets to go outside and drink rain water. I wonder if my kitties would like that better? You take such good care of Java!
 
Kris & Teasel said:
Not for long I'm afraid! It's my bed time. Just doing my before bed check in. :)
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But mooooooom!
You know how nervous I get. But it has been crazy high. Here's the thing though, I have just been so tired.... I don't want to have to wake up and test him during the night.
On the other hand, Kris, your suggestions are so good.
argh.
 
Lois and Java said:
But mooooooom!
You know how nervous I get. But it has been crazy high. Here's the thing though, I have just been so tired.... I don't want to have to wake up and test him during the night.
On the other hand, Kris, your suggestions are so good.
argh.
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I really don't like setting an alarm for overnight tests either. My sleep is poor as it is and that interruption can really do a number on me. :confused:
 
Yong was talking about fat and skinny doses, so I think what I'll do is go with a fat 1.5.
I'll talk to the vet tomorrow about what's going re fluids.
Java's been an indoor outdoor cat most of his life. Greater controls were implemented immediately when coyotes expanded into the area. It makes him happy to go outside and drink outside water.
I wonder if any of the outside water could affect his BG. Sometimes he ignores the bowls of clean water. Tonight he was drinking from a watering can full of rainwater with some oak leaves and oak pollen in it.
Id better get some insulin in him.
 
Djamila said:
Hooray! Kris is here!

I love that Java gets to go outside and drink rain water. I wonder if my kitties would like that better? You take such good care of Java!
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Java is a (probably) once in a lifetime special cat. It isn't just me, everyone who meets him sees it. He's my 6th cat, Lily's my seventh, and I've loved them all, but this guy just has a combination of confidence, curiosity, intelligence, skill, good sense, and affection that's rare and delightful. Boy am I going to miss him; he's such a good companion. And he's so resilient! Look at those #s and his age! If there's such a thing as reincarnation, he's moving up.
 
Lois and Java said:
Does he?
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I don't know. Both times he went hypo I was already awake.

Lois and Java said:
Java is a (probably) once in a lifetime special cat. It isn't just me, everyone who meets him sees it. He's my 6th cat, Lily's my seventh, and I've loved them all, but this guy just has a combination of confidence, curiosity, intelligence, skill, good sense, and affection that's rare and delightful. Boy am I going to miss him; he's such a good companion. And he's so resilient! Look at those #s and his age! If there's such a thing as reincarnation, he's moving up.
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I love this! Ive never seen a 20-year-old kitty before. I think that's testimony to how special he is, and to how well he's been loved.
 
Whoops hey Lois! I was fast asleep last night...2 nights ago, Oreo decided to sing the song of his people...for an hour...at midnight...only stopped when I got up and scolded him. So I was asleep early last night!

I live in Alabama...lord it's hot here! I was a military brat, so I grew up all over and this is about my least favorite place...so naturally I ended up here! :rolleyes:
 
Rachel said:
Whoops hey Lois! I was fast asleep last night...2 nights ago, Oreo decided to sing the song of his people...for an hour...at midnight...only stopped when I got up and scolded him. So I was asleep early last night!

I live in Alabama...lord it's hot here! I was a military brat, so I grew up all over and this is about my least favorite place...so naturally I ended up here! :rolleyes:
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You could come live here in Ottawa, Canada, Rachel. It can be 90+F in the summer with humidity and -20+ F in the winter! I think we're the second coldest capital city in the world after Moscow. ;)
 
I used to live in South Dakota and Germany, Kris, so I'm no stranger to cold weather! That's my problem here in the winter...it's . never really that cold but I dress like it is...and then boil!:smuggrin:
 
My brother went through basic training in Alabama, Vietnam. We visited him once, I was still in middle school. I just remember being scared all the time because of the South's reaction to civil rights, To Kill A Mockingbird, etc. PA is more like Ottawa. I keep nagging my high school peeps who stayed there to have high school reunions sometime other than muggy overcast hot hot Augusts. I do miss the green though. It's what I love about this time of year here. Droughts aside, it's natural to have zero rain from May to November -- it's a textbook Mediterranean climate. In SF area, we're lucky to have regular summer fog that acts as natural air conditioning. It's a function of the underwater dropoff in the Pacific, the seasons of the ocean currents, and upwelling.
 
Kris & Teasel said:
Faulty premise. A diet of low carb food shouldn't drive BG into a crazy range. Yes, food does influence BG which is why we say no food at least 2 hours before AM and PMPS. Those tests give an idea of the effectiveness of the dose. If you feed scheduled meals and avoid food 2 hours before a nadir test, that also gives good non food influenced info
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Still pondering this. I had concluded that his hypo or near hypos were in large part because I didn't take him enough food, follow him and urge him to eat more. If I don't do that, his #s do drop, but he really won't get enough food, I think. He's so thin now.
I'm waiting on dose to talk to vet, wonder if I should continue on that line. I am giving him NaCl this morning. It does seem to affect dose.
 
Lois and Java said:
Still pondering this. I had concluded that his hypo or near hypos were in large part because I didn't take him enough food, follow him and urge him to eat more. If I don't do that, his #s do drop, but he really won't get enough food, I think. He's so thin now.
I'm waiting on dose to talk to vet, wonder if I should continue on that line. I am giving him NaCl this morning. It does seem to affect dose.
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On 18 March, Maury's lime greens were also influenced him not eating his "lunch" that day.
 
Vet and i keep missing each other in phone calls. Meanwhile, finally gave him 125 ml NaCl fluid.
Edit, test strips for AT2 that I ordered in plenty of time? Hung up for days in Burlingame, wrong zip code. I won't get them until this Sat., when should've arrived last Sat. Grr. Prob have to switch to HS meter tomorrow.
 
Does Maury actually have cardiomyopathy? I mean I guess he does or you wouldn't put it down. Java has had a 2, 4 heart murmur his whole life. Echo tests etcetera when he was younger. He's been one of the lucky ones where it's never turned into anything.
 
Both vets detected the heart murmur but I can't afford to get him to a cardiologist for an ultrasound to find out what type :(. I'm just pretty sure he was not born with it. I check his Respiratory rate, he's slightly higher. Plan to start checking his heart rate too.
 
I'm guessing this is a classic bounce from the blue last night?
AT2-680,. HS-634.
1.75 this am.
Never did connect with vet yesterday, try again today.
 
So the vet said that the lactated part of lactated ringers = lactose. Java seems to be as sensitive to carbs and sugars as he is to insulin.
 
Ahh well they are both types of sugars; carbs and lactose. So can the NaCl do just as good as Ringers? Hopefully, with less effects on his BG :)
 
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Lois and Java said:
Me either. Of course I could have Googled it and I didn't until just now. It's sodium lactate.
https://en.m.wikipedia.org/wiki/Ringer's_solution

This entry says it's dextrose.
http://pets.thenest.com/sodium-chloride-vs-lactated-ringers-cats-10987.html

I have to go to help someone out with a ride, but I just found this at Tanyas kidney Cat website. To read later.
http://www.felinecrf.org/subcutaneous_fluids_tips.htm
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If it's lactate that's not lactose, rather it's salt of lactic acid. Dextrose is definitely a sugar, an alternate form of glucose.
 
Kris & Teasel said:
If it's lactate that's not lactose, rather it's salt of lactic acid. Dextrose is definitely a sugar, an alternate form of glucose.
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Kris, I remember reading somewhere that you said you used to be a teacher....were you a science teacher, by any chance? :)
 
This doesn't sound good.


Saline Solution (Sodium Chloride or NaCl) 0.9%

Saline solution (sometimes referred to in human medicine as "normal saline") may be suggested by some vets, but it tends not to be the best choice for a CKD cat because:

  • it is usually too acidic

  • it lacks the buffer contained in lactated ringers

  • it does not have added potassium, which many CKD cats need.

  • the higher sodium load is additional work for already damaged kidneys to process

  • it is not usually suitable for cats with hypertension or liver problems.

  • it can sting when injected subcutaneously which may make the cat resist sub-Qs
However, it is sometimes appropriate for:

  • cats with high calcium levels (though Normosol-R may be a better choice); or

  • cats with hyperkalaemia (high levels of potassium), who may initially be placed on intravenous sodium chloride in hospital
Fluid Sodium Chloride pH Buffer
Sodium Chloride 0.9% 154 154 4.5 - 7.0
None


One possible compromise would be to use half strength (0.45%) sodium chloride fluids. ISFM consensus guidelines on the diagnosis and management of feline chronic kidney disease(2016) Sparkes AH, Caney S, Chalhoub S, Elliott J, Finch N, Gajanayake I, Langston C, Lefebvre H, White J & Quimby J Journal of Feline Medicine & Surgery 18 pp219-239 state "although a balanced electrolyte solution such as lactated Ringer's solution is often used, a hypotonic solution (half-strength lactated Ringer's or 0.45% saline, with added potassium as needed) may be preferable to reduce the sodium load."
 
Kris & Teasel said:
If it's lactate that's not lactose, rather it's salt of lactic acid. Dextrose is definitely a sugar, an alternate form of glucose.
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It's lactate. Duh Lois. The ingredients are on the bag.
Each 100 milliliters contains sodium chloride 600 milligrams; sodium lactate, ANYHD 310 mg.; Potassium chloride 30 mg; calcium chloride, dihydrate 20 mg in water four injection may contain HCL or NaOH for pH adjustment.
Electrolytes per 1000 ml, not including pH adjustment: sodium 130 meq; potassium 4 mEq; calcium 3 meq; chloride 109 meq; Lactate 28 meq.
 
I'm sorry I'm just getting here to give you a lab report review. My kitten had two surgeries on Monday and I've been focused on her all week.

I'm glad you found the discussion on Tanya's on subcutaneous fluids. My preferred fluid is lactated ringers and, no it does not have lactose in it. It is a sodium salt from lactic acid. There may be reasons to use a different type of,fluid like Normosol but the latter does sting.

You obviously are already starting to treat the CKD. Just a few things I see on his labs:

Potassium is at 3.9 and ideally should be at 4.0 or a bit higher. If the serum level is 3.9, then the cellular level is less than that and the cellular level is where it is needed. You might want to discuss with your vet potassium supplementation with potassium gluconate. Keep in mind that giving a potassium supplement needs to be under the supervision of a vet and it does have to be monitored as you can go too much in the other direction which is just as bad.

His phosphorus is also higher than it should be. I've found that the number one predictor of how a cat does with CKD is the P level. The more you can get it down towards 4.5 using low P foods, the better. Binders se not usually started u til the P gets to 6.

His hematocrit is creeping towards 30. I don't think it is too early to start vitamin B12 supplementation to help co troll the anemia. The more you can keep it in the high 20s, the better. Usually cats are given 250 mg of methylcobalamin twice a day as well as a multi B vitamin like Jarrows B Right. If you use the latter, the dose is 1/10 a capsule a day but divided into two doses. I bought the #4 gel caps and would put the 250 mg of methylB 12 and the small amount of the multi B into one capsule and then gave one of my homemade capsules twice a day.

I'm not too worried about his other values that are in the high category although the Precision PSL is out of the normal range. This test is not as good as the specfPL for determining pancreatitis. Please let me know if you have any questions.
 
Marje and Gracie said:
Please let me know if you have any questions
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Marje, thank you so very much. I hope your kitten is doing well after surgery?

It's late, and this might be unanswerable without more patient info, history, yet my immediate query is - should I give him fluids tomorrow, and if yes, Ringers or NaCl? I have both.

Can do Longer history tomorrow, more immediate history is Java wasn't seeming to feel well a week ago, took him to vet, he was dehydrated despite 125 Ringers day before. Vet gave NaCl and Vit B shot. Java did much better after, including insulin worked. After Ringers, it is as if he'd had no insulin, high #s for 12 hrs.

Talk to vet and relayed improvement. He suggested Java get Fluids daily, Ringers one day, NaCl the next. [It could have been the Vit B] Tried it, same thing again with Ringers, as if no insulin. Back to vet today to talk, he said Ringers had sugar, just give NaCl daily.

I decided to wait, no subq today/ Fri. He had NaCl at 4 pm Thurs/2 days ago.

He's getting Zobaline daily. I have Jarrow's, tried, bitter in food, didn't want any reason for Java to not eat his FF classic. He's getting so skinny.

He's 20 yrs, 4 months mine; prob 20 yrs 8 month old.
 
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Marje and Gracie said:
I'm sorry I'm just getting here to give you a lab report review. My kitten had two surgeries on Monday and I've been focused on her all week.

I'm glad you found the discussion on Tanya's on subcutaneous fluids. My preferred fluid is lactated ringers and, no it does not have lactose in it. It is a sodium salt from lactic acid. There may be reasons to use a different type of,fluid like Normosol but the latter does sting.

You obviously are already starting to treat the CKD. Just a few things I see on his labs:

Potassium is at 3.9 and ideally should be at 4.0 or a bit higher. If the serum level is 3.9, then the cellular level is less than that and the cellular level is where it is needed. You might want to discuss with your vet potassium supplementation with potassium gluconate. Keep in mind that giving a potassium supplement needs to be under the supervision of a vet and it does have to be monitored as you can go too much in the other direction which is just as bad.

His phosphorus is also higher than it should be. I've found that the number one predictor of how a cat does with CKD is the P level. The more you can get it down towards 4.5 using low P foods, the better. Binders se not usually started u til the P gets to 6.

His hematocrit is creeping towards 30. I don't think it is too early to start vitamin B12 supplementation to help co troll the anemia. The more you can keep it in the high 20s, the better. Usually cats are given 250 mg of methylcobalamin twice a day as well as a multi B vitamin like Jarrows B Right. If you use the latter, the dose is 1/10 a capsule a day but divided into two doses. I bought the #4 gel caps and would put the 250 mg of methylB 12 and the small amount of the multi B into one capsule and then gave one of my homemade capsules twice a day.

I'm not too worried about his other values that are in the high category although the Precision PSL is out of the normal range. This test is not as good as the specfPL for determining pancreatitis. Please let me know if you have any questions.
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@Marje and Gracie
Hi Marje,
I hope your little girl is recovering well from her surgeries. So worrying for kitty parents ... :bighug:
 
Hey Marje! I hope your baby is doing well...those surgeries can be very scary, but I know she's getting the best care possible with you. Thank you again and again for your wisdom and expertise. You've always been a blessing to this board!
 
@Kris & Teasel
(Ah! That's how that works!)
He's at 324 this morning, surprise because he had so much FF last night. He must've not eaten at all during night.
1.75 seems like a lot. It's similar to a week ago (3/26) when I was heading out to event in Sonoma and he dipped down to 70s around +4, +5. Back off to 1.5? He had 1.5 then, go to 1.25?

Edit, going with flat 1.5, will test, watch, here today.
Found a diff food chart (diff from LP, DVM) at FD FB page. Says FF classics changed, ones I feed Java are too high carb now. Will update, query to main board. After I go outside with him.
 
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Thank you all. Livvie is doing quite well from her spay and a rhinoplasty to open her tiny nostrils. It's a blessing that she can breathe like a normal kitty now!

Lois: I really don't think the LRS is causing the issue with his numbers. I've given LRS to my Gracie and many other members have also given it to their cats and what we typically see is that the BG tends to drop with any subq fluids and, in some cats, it is quite dramatic. It might seem like the LRS is raising his BG but I think he's bouncing so it looks like LRS might be the culprit (see analysis below). There is no lactose in LRS. There is a difference between sodium lactate, lactic acid, and lactose.

One of the reasons I like LRS for CKD kitties is it has potassium in it. I also like it because the lactate is converted to bicarbonate which may help to prevent and can address mild metabolic acidosis (common in CKD cats).

NaCl is really not a good choice for cats with CKD. It has no potassium, it is too acidic, it isn't buffered like LRS, it can sting, it has sodium which is not something that CKD cats need since they are prone to high blood pressure. I feel that perhaps your vet does not know how to treat CKD.

When I look at his SS, I am not seeing any effect on his BG that I would attribute to LRS:
3/15 LRS given, BG came down
3/23 BG already high, LRS given, BG came down
3/29 LRS given, BG increased but it increased from bouncing
3/30 NaCl given, BG increased again due to bouncing

Vitamin B12 injections as usually given to help support the intestines and it will not increase the BG. The Jarrows is bitter and that's why it needs to go into a gel cap. I've never given any B vitamins orally that weren't in a gel cap because I don't like tomrosk my cats not eating.

You've done an amazing job taking care of him for him to make it to 20+ years! Please let me know how I can help.
 
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Thank you very much @Marje and Gracie, for all the information and benefit of your expertise. I really appreciate it.

I take good care of him, except when I don't. Ran off to my class today without testing him first, shouldn't have done any errands after. He had food, but didn't eat it. Low to acceptable in 20 minutes luckily.
 
We have to live our lives too, Lois. Considering his numbers lately, I would have NEVER expected to see that low of a number, so I would have felt comfortable running errands too. Bright side? Those are good, healing numbers mid cycle today!
 
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