7/7 Doodle update (oldtimer) | Feline Diabetes Message Board - FDMB

7/7 Doodle update (oldtimer)

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Michelle and Doodle

Michelle and Doodle

Member since 2009
Doodle has been a bit "off" for the last week. I need to update his SS but his numbers have been okay and he remains on a 0.075 dose.
I had to double his dose of amlodipine, (he now gets 1.25mg) which has killed his appetite - so it's difficult (if not impossible) to get his now increased (and insanely high) dose of 15mEq potassium in him.
And honestly I don't know if he really needed the increase in blood pressure meds - though his number was 210.
He was so stresssed he was shaking when he was getting his BP checked and I'm sure it was unusually elevated.
I don't know... I just worry because too much amlodipine can be bad for his kidneys while of course too little can be as well.

Since his appy is down so much I am left with the choice of
1.)trying to mix in as much potassium as I possibly can with each meal. (which he is becoming increasingly grumpy about)
2.) trying to give him as much as possible as pill pocket wrapped treats. (but that can be up to 24 little treats and he won't eat more that 2 or 3 at a time)
or 3.) trying to syringe it in him - which is the messiest and least efficient, since now that he has all his teeth removed he is able to flail his tongue around and squish out whatever I am trying to syringe in him.

I'm manageing with a frustrating mix of these choices - hoping that he doesn't lose too much in the occasional vomit. :roll:

Since his magnesium level tested on the lower end a few weeks ago I had been supplementing with 1ml of Milk of Magnesia daily and his constipation issues had completely disappeared :smile:
But his magnesium level was high when we tested again last week and my vet is concerned that continuing the supplement might cause kidney stones. So, I've reduced the amount to 0.5ml and he's not quite as happy in the poop department.

I also began giving him sub-q fluids last week - every other day 100ml -- we are hoping that this doesn't further reduce his potassium levels... but since his creatinine was elevated my vet felt that the fluids would ultimately be a benefit.
I have to tell you I have always had major issues with giving sub-q's and this has been quite a big thing for me. seriously.
But thankfully this time I was given 22guage needles that were only 3/4 inch long -- and I have been able to give him his fluids with no trouble at all. :-D
He's such a good boy - he very patiently sits for about 10 minutes and never complains at all.

His last labs were:
BUN - 47 (15-34) ----- in house - 43 (15 - 34)
CREA - 3.3 (0.8 -2.3) ----- in house - 4.1 (0.8 -2.4)
Potassium - 3.7 (3.9- 5.3) ----- in house - 3.1 (3.5 -5.8)
Magnesium - 2.9 (1.8 - 2.4)
Blood Pressure - 210 -- with previous readings between 130 -220

We have an appt. this evening to recheck his blood pressure - I'll let you guys know what I find out.
 
Have you had Jess take a look at labs and meds?

I'm concerned if only because the more amlodipine you're giving, the more of an effect there is on lowering potassium levels.
 
Hey Doodle I'm sorry your not feeling good. :YMHUG: :YMHUG:
I haven't seen you in awhile. Sending you lots of hugs and healing vines for the Do :YMHUG: :YMHUG: :YMHUG:
 
Sienne and Gabby said:
Have you had Jess take a look at labs and meds?

I'm concerned if only because the more amlodipine you're giving, the more of an effect there is on lowering potassium levels.
Click to expand...

I haven't wanted to bother Jess since she's dealing with Elliott's illness... but I have the same concern.
It's sucky when you feel like you're fighting against yourself :roll:
 
(((Michelle and Doodle))) Sorry you guys are having a rough spell as of late and that Doodle doesn't feel good. Hopefully things will settle down some and you guys will have a little peace. The idea of adding the potassium in the sub q's sounds promising, Michelle. Maybe that will help???
Sending you guys lots of love and healthy vines! Glad you stopped in to give an update.
 
Hi Michelle. I'm so sorry for all of the issues you're going through. I have an idea, though. Since you have started subQ's you can have your vet add postassium to the fluids so you won't have to give so much in supplements. We did this for one of our cats several years ago and you just had to warm up the fluids so the potassium wouldn't sting going in. We just started Blackie on fluids last week and we are also using the 22g 3/4 needle. It takes a little longer, but its much less stressful. You might also check out Terumo needles - they are supposed to be even less painful due to their thin wall.

I hope Doodle is better soon.
 
(((Michelle))) You are doing a great job of juggling Doodle's issues and meds. Congrats on being brave enough to take on the sub Q fluids. Here are two sites that mention supplementing the sub Q fluids with potassium. I have no experience doing this, but the reading suggests that doing so may cause some stinging.

http://www.caninediabetes.org/pdorg/chr ... ailure.htm

http://www.felinecrf.com/managb.htm

Bear takes .625 mg of amlodipine twice daily. I wonder if Doodle would tolerate it better split in two doses. I also wonder if you want to discuss adding benazepril to the list of meds. You should probably test a urine protein creatinine ratio first, to see if he is spilling protein in his urine. Just a couple of thoughts on things you could consider asking your vet about.

Also, I know dry is probably not something you want to feed Doodle, but sometimes a bit of Temptations treat pressed into the Pill Pocket treat makes the whole thing more attractive.
 
Sending Healing vines to our dear friend Doodle--Hope you feel better real soon, no advice just, we care about you!!
HUgs to you Both!!!!
 
I think there are precautions in the human literature about the benazepril + amlodipine + potassium combination. There are warnings about using potassium supplements with these two meds in combination since combining an ACE inhibitor and a calcium channel blocker can raise potassium to dangerous levels.

Are you sure it's the amlodipine that effecting Doodle's appetite? Potassium can cause an upset stomach (to say nothing of tasting pretty foul).

Michelle -- I'd drop Jess a PM. I think if you acknowledge she has her hands full at the moment and give her the link to your condo, she can visit when she has a chance. It may be a welcome distraction, but you never know.
 
Hugs to you both. I'm glad your Doodlebutt is a model patient but I do wish he was feeling and eating better.
 
I'm sorry Michelle! I understand completely how you're feeling (cause I'm feeling the same :sad: ) But, it sounds like you have a good vet and that you're on top of things and remember that everybody loves you and Doodle-butt. Boo and I are sending "coping" vines.
 
Hi Michelle

Michelle and Doodle said:
I had to double his dose of amlodipine, (he now gets 1.25mg) which has killed his appetite - so it's difficult (if not impossible) to get his now increased (and insanely high) dose of 15mEq potassium in him.
Click to expand...

Are you sure it's the amlodipine? How exactly does his lack of appetite manifest? (Runs to bowl, but then doesn't want, appears repulsed by food, eats but doesn't eat enought, etc.)

Where are you with the spironolactone/another ultrasound debate?

1.)trying to mix in as much potassium as I possibly can with each meal. (which he is becoming increasingly grumpy about)
Click to expand...

This is a potent appetite-killer in cats, and can turn them off a particular food/flavor forever. One of the internists I work with doesn't want any of her clients to even try mixing meds in food, she feels they always go off their food eventually when you try that. I don't feel quite as strongly, but I would full-stop once a cat starts shying off the food.

What potassium are you mixing in? Have you considered using KCl ("No Salt" Salt)? It is much more concentrated, IIRC, than the K Gluc powder. Have you looked into other human supplement forms, which might be more concentrated than the vet ones?

I also began giving him sub-q fluids last week - every other day 100ml -- we are hoping that this doesn't further reduce his potassium levels... but since his creatinine was elevated my vet felt that the fluids would ultimately be a benefit.
Click to expand...

As others have mentioned, you can add potassium to the fluids. Most cats will tolerate up to 40meq/L.
 
Back from the vet.
His potassium is in the normal range!!! :-D 4.1 !! ....finally!!
Blood pressure was 170 so we are holding the dose - and I feel more comfortable now with the increase.
But I do plan to call back and ask if there is any reason why we can't split the dose and give it BID - that's an excellent idea Linda!
(especially since I have more than once had to dig thru a scarf and barf pile to salvage his amlodipine) :roll:
I normally wrap all his pills in pill pockets and then roll them in crushed temptations and honestly Linda I don't even have a rule against dry food anymore :shock:
My rule now is, do what you gotta do.
When Abbey wouldn't eat anything a few months ago I bought several bags of dry food trying to find something... anything... she would eat.
And today Doodle has had a few kibbles of crushed dry food on every meal - and I'm just glad he ate.

I did ask about adding the potassium to his fluids (thank you for the link Kristen) but my vet said that although she did suggest it for some cats that Doodle was not a good candidate. She said he needed such a large amount that it would sting a lot - and that a dose that large could also be potentially dangerous.
So we'll keep going with the pills and see how it goes.

I also asked her about adding benazepril - actually I asked her about it BECAUSE the combination can raise potassium... and I thought perhaps it might be helpful in reducing his need for so much potassium. But after discussing it... we decided not to, because it would mean we would have to continue this level of monitoring. And I hate to admit it, but I just can't afford to keep taking him in for bloodwork this often. It's draining us...

Anyway, tonight we celebrate a normal potassium level and a day of good blood glucose numbers ! His PM shot was 71 :-D
 
Jess & Earl said:
Hi Michelle
Are you sure it's the amlodipine? How exactly does his lack of appetite manifest? (Runs to bowl, but then doesn't want, appears repulsed by food, eats but doesn't eat enought, etc.)
Click to expand...

Hi Jess :) thanks for checking on us again!!
I don't suppose I am SURE it's the amlodipine - it just started the day I increased his dose so I assumed it was.
He just sits there and refuses to eat even if I put food right under his nose. He doesn't seem repulsed - just not interested. (except when there's crushed dry food on it) :roll:


Where are you with the spironolactone/another ultrasound debate?
Click to expand...
My vet says she is not comfortable giving him a "diuretic" since he has dehydration issues and she's not sure that we're not dealing with kidney disease. sigh...
I don't know if that makes sense or not - or if she's even knowledgable enough to be dealing with all of this. We're supposed to do another ultrasound in a couple of weeks after we do another aldosterone test.

This is a potent appetite-killer in cats, and can turn them off a particular food/flavor forever. One of the internists I work with doesn't want any of her clients to even try mixing meds in food, she feels they always go off their food eventually when you try that. I don't feel quite as strongly, but I would full-stop once a cat starts shying off the food.

What potassium are you mixing in? Have you considered using KCl ("No Salt" Salt)? It is much more concentrated, IIRC, than the K Gluc powder. Have you looked into other human supplement forms, which might be more concentrated than the vet ones?
Click to expand...

Interesting... maybe I should rethink the mixing it . I know a lot of people do... but I don't want him to start refusing his food altogether. I've been using GNC potassium gluconate for the last month - but I had never heard of the no salt type. Thanks for the idea!

As others have mentioned, you can add potassium to the fluids. Most cats will tolerate up to 40meq/L.
Click to expand...

ANd now I'm confused as to why my vet would say that 15mEq was such a huge amount. ?? It sounds like that wouldn't be a problem.
Hmm..
 
Hi, Michelle -- You're getting such great feedback from our scientists. I just wanted to send hugs and feel better vines! I hope Doodle responds to all the love and care you're giving. :YMHUG:
 
I'm guessing the vet said it would be a bad idea because you need to get 15mEq in him everyday, and are only giving him 100mL every other day, or 1/10th the bag of fluids. I think Jess mentioned 40mEq/L which would mean 40mEq goes in the whole bag, so if you did that, he'd only be getting 4 mEq every other day.

I hope things turn around...at least you had something to celebrate yesterday! Feel better Doodle!
 
Glad to hear the vet appointment went well with some good results. You're in the right place here with all the good advice and suggestions. All I can add is hugs, healing vines and snowflakes.
 
hi michelle,
hug to the handsome doodlebug.

I have NOT read through all the posts, so you might disregard the following...
question... how would you feel about 50ml SQ every day instead of 100ml SQ EOD? I think some messages from Jojo over the years explained to me that some SQs every day are better than EOD b/c you're trying to flush out stuff from kidneys and it's better to give a little every day than a lot every other.

I know you hate doing it, but really... I give Cosmo bonito flake treats afterwards and he LOVES SQ time now. He jumps up on my lap, and I pet him the whole time. Then, when we finish, he starts begging and meowing for the treats.

-C
 
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