8/20: Update on Carter, and some bad news for civvie Simon... (CKD questions!)

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Erica & Carter

Member Since 2016
Hi everyone,

Just wanted to give an update on what has been going on with my kitty crew. I haven’t been active posting here but I do read threads from time to time, and I’m usually more active on a lot of the cat Facebook groups.I apologize if this is long, but I’d love any advice or opinions!

Re: Carter -

Back in May, Carter had a senior screen that revealed a few things:

ALT - 671 (5x the normal range)
Thyroid - 3.8

He had fur loss, a ravenous appetite (he loves food, but he literally broken into the pantry and bit through a can of Tiki Cat...), and had lost weight rapidly in the time span of a month - he was down to 10 pounds, and he had been hovering around 12 prior. He also had regurgitation/vomiting issues that had been on and off for about a year that were initially thought to be food intolerances but it would only be whenever he would have any type of raw, but not on canned. He’d also been battling some environment allergies.

Carter had an ultrasound that did not find an anything conclusive on the liver other than it appearing coarse, and IBD was ruled out, phew! We treated the liver with antibiotics (Amoxicillin and Metronidazole) for about a month, started Denamarin, and rechecked his bloodwork 6 week later and 2 weeks off antibiotics - his liver values were back to normal at 54! Which had we not seen improvement, a liver biopsy would have been the next course of action. Since then, he has gained about a pound and a half back, fur has grown back, not ravenously hungry, and has not vomited in 5 months - currently eating EZ Complete w/ boneless meat. He will remain on Denamarin daily and is also on Chlorpheniramine for allergies once to twice daily as well. Overall, he is doing great and we plan to retest his T4/liver panel in September - to see if he is a good candidate to do i131 at that time, or depending, start the transdermal methimazole gel if my finances are tight due to my civvie’s health issues that have come into light. Right now he’s not symptomatic and is still in grey-zone numbers, so we will see what the specialist says come September. 14 months in remission too, yay!!

Re: Simon -

Simon went for his senior screen this week, which revealed a few things:

BUN - 36
Creatine - 2.7
Thyroid - 2.5 (normal, but going to monitor annually…)
Cholesterol - 230 (was up from last year, but he also wasn’t fasted, which could contribute…)
USG - 1.020
Urine Culture - Positive
Blood Pressure - 199 (average, some readings were in the 200s…)

So, diagnoses is likely stage 1-2 CKD, severe hypertension, and he has some sort of bacterial infection either in his kidneys or bladder that could be elevating those numbers. I sent off an MIC to find out what bacteria it is, and started him on antibiotics for 14 days; MIC results can take up to 5 days. It was also recommended I do an ultrasound to take a look at his kidneys and ureters themselves, so that will be happening in the next 2 weeks. I took the blood pressure machine home to retest his BP in a calmer setting and see if I could get a different reading but my spouse was not comfortable holding him and it ended up stressing him out more - so I’m taking him back to work with me on Wednesday and we’re going to try it in a room and give him 10-15 minutes to calm down before hand. Unfortunately, his BP is much too high to be solely influenced by stress, so we will also be starting Benazeprill this week, retesting BP in 2 weeks, and possible adding in Amlodipine if he’s not responding. I also scheduled him for a dental on September 5th that may have to be post-poned until we can get his BP under control, which sucks because I feel like he's having some issues eating (nothing appeared out of place during his annual oral exam other than G2 calculus and tarter) but he definitely eats a lot slower than my other two boys, and he struggles to eat his ground meat unless it's super soupy.

Right now the plan is to have him on:

Clavamox (for 14 days, depending on MIC/ultrasound results…)
S. Boulardii (to off-set any GI issues from the Clavamox...)
Calcitriol
Benazepril
+/- Amlodipdine
EZ Complete w/ boneless meat or Rad Cat (both use eggshell calcium vs bone)
Krill Oil
Green Lipped Mussel powder

I brought him in because he was due for his annual senior screen anyways but also because I noticed him drinking more than my other two cats, and they are all raw fed so realistically I never really see them drink, and it wasn’t his glucose, so it makes sense now since his urine is so dilute - but I would have never expected him to have a positive urine culture, nothing has been out of the ordinary. His labwork looked great last year, super disappointing to see how much can change in 10 months. He is 13.5 half, and he is my heart cat; I’ve been crying on and off this past week because I’m so overwhelmed, and I know he is not bad off by any means - he appears totally outwardly healthy and happy, but he had gone almost 14 years without any health issues so I guess we are still lucky. I handle end stage CKD cats every day but when it comes to my own, it is a different story.

He is not at the point of needing SubQ fluids or a phosphorus binder, is there anything else I’m missing?

He has pet insurance that will cover 70% of his bills and I work for a specialty clinic so he has access to a lot of care at a fraction of the cost, sometimes no cost, which I am very thankful for - but I am still having to struggle a bit financially.

Also my cats are all being cats right now because they are bored of chicken as a protein w/ EZC (this batch has 10 days left on it until I can go to the butcher - so I’m having to add some Tiki Cat toppers, or in Simon’s case, some Weruva that is lower in phosphorus) ugh, cats!

Also, does anyone know how to manipulate the spreadsheet template so I can use something similar to keep track of Simon’s medication/feeding?
 
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So sorry to hear about your bad news! My 18 year old is also deciding whether to be CKD (although she's probably stage 2 already). She's my heart cat - I love that phrase. I just wanted to give you a hug as it sounds like you suddenly have an awful lot on your plate. :bighug::bighug::bighug::bighug::bighug:
 
So sorry to hear about your bad news! My 18 year old is also deciding whether to be CKD (although she's probably stage 2 already). She's my heart cat - I love that phrase. I just wanted to give you a hug as it sounds like you suddenly have an awful lot on your plate. :bighug::bighug::bighug::bighug::bighug:

Thank you for your support! Your kitty is beautiful!
 
Sorry you now need to deal with CKD. I just posted a pretty good article on it on tge main health forum.
 
Hi Erica.

Nice to hear from you, and to see that Carter is doing okay. I'm so sorry about Simon. I hope you are able to get things under control soon. It is very fortunate that you work in a specialty clinic, as the kind of care a CKD cat needs can get pretty expensive. It does sound like you're doing all the right things, but I'm going to tag @Marje and Gracie because she has a lot of experience with CKD and may be able to add something useful.

Also, if you haven't already, check out Tanya's site. It's a bible for people with CKD kitties.

Sending lots of vines for Simon and :bighug:s for you.
 
Erica

I'm glad Carter is doing so well! What a great recovery and I hope his ALT stays down.

Insofar as Simon, the dx of CKD can really be upsetting but once we step back and take a breath, we know we can handle it.

It looks like you are really on track. I would definitely get those kidneys ultrasounded because he could have pyelonephritis and, in that case, you'll need something more than clavamox and for much longer. If he does have a kidney infection, it could be the cause of his creatinine being higher. My Gussie, in four years of CKD, had two kidney infections and not only did he not have symptoms but his urine culture did not grow any bacteria, which is not uncommon since the infection is in the kidneys. An ultrasound is the best way to dx pyelonephritis.

What is his phosphorus level? I'd also be looking at potassium, calcium, HCT/PCV and monitoring those closely. Control of Phosphorus is crucial for QOL and longevity. I'm curious as to why you have him on calcitriol? Does he have secondary hyperparathyroidism? I would really be careful with that. It's not harmless as something like Azodyl would be and you have to stay on top of the labs. While he might need it at some point, I rarely see Stage 2 cats that need it but ECID. I know Laurie with the Raw Feeding for IBD Cats was extolling its virtues and it does have a place in the treatment of CKD...if it is warranted.

I would definitely get the BP again before starting meds. My Tobey has a left anterior fascicular block which does not seem to be indicative of any structural issues based on echocardiograms but we also keep an eye on his BP. The first time I took him in, the vet's office was loud, barking dogs, etc. They put us in the room and the techs came in to do the BP and it was way up there like Simon's. My vet was incredulous and so she told me to bring him back the next day, very last appt of the day, we sat in a dimly lighted room with zen music for 15 mins, they came in and took his BP and it was 130. So every time we check it, we always use that method and it's always been around 130.

I can fix the SS so you can track Simon's data or I can do a new one for you. I always keep lab SSs on all my cats. Just send me a PM.
 
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Hold those tears for your heart cat. It looks like he can be treated and stabilized.
 
Yum had her first BP test yesterday, at a cardiologist visit. It was 180. The cardiologist put her on 2.5 mg enalapril once a day. Marje copied me on her post to you about stress related measurements in the 200's for kitties whose blood pressure was 160 in more relaxed settings. Probably Yum and Simon both have high blood pressure, but there's a possibility that they don't. I will take Yum in tomorrow for a BP test with our regular vet. She had an enalapril dose last night; I will decide whether or not to give her one tonight. Yum's senior wellness exam also suggested stage 2 kidney disease, with numbers a tad worse than Simon's. Yum's mother lived a long time with early stage kidney disease, passing from something else. Good luck to you and Simon.
 
Hi Erica.

Nice to hear from you, and to see that Carter is doing okay. I'm so sorry about Simon. I hope you are able to get things under control soon. It is very fortunate that you work in a specialty clinic, as the kind of care a CKD cat needs can get pretty expensive. It does sound like you're doing all the right things, but I'm going to tag @Marje and Gracie because she has a lot of experience with CKD and may be able to add something useful.

Also, if you haven't already, check out Tanya's site. It's a bible for people with CKD kitties.

Sending lots of vines for Simon and :bighug:s for you.

Thank you Tricia. I've been reading over Tanya's site, a great resource for sure!
 
Erica

I'm glad Carter is doing so well! What a great recovery and I hope his ALT stays down.

Insofar as Simon, the dx of CKD can really be upsetting but once we step back and take a breath, we know we can handle it.

It looks like you are really on track. I would definitely get those kidneys ultrasounded because he could have pyelonephritis and, in that case, you'll need something more than clavamox and for much longer. If he does have a kidney infection, it could be the cause of his creatinine being higher. My Gussie, in four years of CKD, had two kidney infections and not only did he not have symptoms but his urine culture did not grow any bacteria, which is not uncommon since the infection is in the kidneys. An ultrasound is the best way to dx pyelonephritis.

What is his phosphorus level? I'd also be looking at potassium, calcium, HCT/PCV and monitoring those closely. Control of Phosphorus is crucial for QOL and longevity. I'm curious as to why you have him on calcitriol? Does he have secondary hyperparathyroidism? I would really be careful with that. It's not harmless as something like Azodyl would be and you have to stay on top of the labs. While he might need it at some point, I rarely see Stage 2 cats that need it but ECID. I know Laurie with the Raw Feeding for IBD Cats was extolling its virtues and it does have a place in the treatment of CKD...if it is warranted.

I would definitely get the BP again before starting meds. My Tobey has a left anterior fascicular block which does not seem to be indicative of any structural issues based on echocardiograms but we also keep an eye on his BP. The first time I took him in, the vet's office was loud, barking dogs, etc. They put us in the room and the techs came in to do the BP and it was way up there like Simon's. My vet was incredulous and so she told me to bring him back the next day, very last appt of the day, we sat in a dimly lighted room with zen music for 15 mins, they came in and took his BP and it was 130. So every time we check it, we always use that method and it's always been around 130.

I can fix the SS so you can track Simon's data or I can do a new one for you. I always keep lab SSs on all my cats. Just send me a PM.

Hi Marje!

Simon's PHOS was 3.6, everything else within normal range. The calcitrol was recommened through the DVM on his case but if his numbers come back down a bit after the infection is treated, then he may not need it. It was also recommened through the CKD group to start at stage 2 but I've been reading conflicting information. We are retesting a USG, kidney panel and UC in about a month so we will decide then.

We retested his BP after being calm and quite in a room for about 15 minutes, with feliway and playing with some string (his favourite thing) and the numbers were the same - so we started him Amlodipine.

I will post the results of the ultrasound below. Shockingly, he also appears to now be an IBD kitty, with no symptoms. I'm really shocked.
 

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Yum had her first BP test yesterday, at a cardiologist visit. It was 180. The cardiologist put her on 2.5 mg enalapril once a day. Marje copied me on her post to you about stress related measurements in the 200's for kitties whose blood pressure was 160 in more relaxed settings. Probably Yum and Simon both have high blood pressure, but there's a possibility that they don't. I will take Yum in tomorrow for a BP test with our regular vet. She had an enalapril dose last night; I will decide whether or not to give her one tonight. Yum's senior wellness exam also suggested stage 2 kidney disease, with numbers a tad worse than Simon's. Yum's mother lived a long time with early stage kidney disease, passing from something else. Good luck to you and Simon.

Thank you I appreciate it!
 
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