Alley in trouble

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Pam & Alley

Pam & Alley

Member Since 2010
My once healthy guy with a toothache had complete bloodwork and I was waiting for the results to ask for help. His creatinine level went from 2.6 last Dec to 3.5 . His BUN is 55. My vet did not suggest any fluids and she scheduled an EKG & to check his blood pressure on Monday. He is eating just fine, his bg levels are very high, obviously we thought it was due to the toothache.
The EKG is to see if he has heart problems before the tooth extraction. My vet wants me to go on Hills K-D again, as she recommended last December but Alley did not like it and it is 27% carbs! Now I am paying for not staying on it I guess. He eats great, drinks fine (always has been a drinker, especially with the diabetes) and his urine is not too excessive. The vet said that anything over the size of a plum in the litterbox is too much. My guy does not get up in the middle of the night to use the litterbox, he has always has one large pee in the morning, about nectarine size? Anyway, white cell count normal, CBC normal, potassium normal. Liver is 117 and 100 is normal, so the vet said she wasn't overly concerned about that.
Now, his bg numbers have been high, though we would increase to .40 next since going down was a disaster so far. Then what do I do with the high carb K-D she insists I use?
Is there something I could give him with low carbs and low phosphorous? Also, is it high protein or low protein? Reading all I can here and that part is confusing.
All suggestions are welcome! I guess I just need to take a deep breath and stop crying, my keyboard may short out!
Thanks as always...
 
Hi Pam,
I'm very sorry that Alley is putting you through such stress! As if diabetes isn't enough. However, this isn't the disaster that the vet may have made it sound. Remember, knowledge is power.

We used to have a periodic information post posted on Health about CRF and diabetes. But here are most important links :

Most comprehensive site:http://www.felinecrf.org/

Food charts: http://www.felinecrf.org/canned_food_usa.htm scroll down, there's a lot of info/reading on the page prior to the food chart though, so read it when you can, but the food is listed with level of phosphorus first. You don't have to get the lowest protein - I noticed that EVO's 95% chicken & turkey is only about 40% calories from protein, less than other quality brands. There is debate about the protein issue. Some feel it's not necessary to cut back on it until bloodwork values for kidneys are higher.

I also would recommend starting lactated ringers fluid therapy NOW. It will definitely help the BUN value. It's easy to do once you get a routine. Please do some reading at the following sites and ask your vet again if you can start fluids. If she's against it, frankly, you might consider another vet. Dehydration is a disaster for both diabetes and CRF and because he's diabetic, at poor numbers, he's more likely to be dehydrated. Gandalf was when I was first told to start fluid therapy by a university vet 3 years ago and I didn't even realize it.

There is also a Yahoo support group you should consider joining. http://pets.groups.yahoo.com/group/Feline-CRF-Support/ There is a CRF/diabetes one, I'm on it, but activity on it is very light. This one is very active. The nice thing is they will have folders at the group home where you can learn more info, besides asking questions of the members. You may have to be approved to join by a moderator. Don't know if you've ever joined an email list before. You get the emails right to your inbox.

You are not "paying for" not going on the K/D! My thing about the K/D food is that not only is it high carb and low protein, it's probably not very good quality overall. Just like with diabetes foods, the "prescription" brands for CRF aren't the best. I didn't listen to my vet who told me at least 2 years ago I should put Gandalf on a low protein diet. I give him fluids, I give him good quality food, treat his diabetes and his kidneys are stable for now. His values are considered "renal insufficient." They have been at those levels for 3 years now. It doesn't mean he won't go in to CRF, but I've managed to hold it off for a long time.

The food chart form the CRF site doesn't list carbs. You could reference the foods on Janet & Binky's chart, but it looks like the CRF site is more up-to-date so there's probably foods on it which aren't on the carb charts.

It's probably a good idea to increase the insulin dose even to .5U. I am concerned he has an infection in that tooth. Is he getting any ABs right now? I would definitely recommend Clindamycin AB before the extraction and after.

Hang in there. There are a lot of CRF sites online, with lots of info, just like FD.

I think checking the BP and EKG before doing dental work is good. His BGs sure took a sudden turn and I think it's possible the resulting dehydration from so much sugar in his urine could have affected his kidneys negatively. So with some fluid therapy and resolution of the tooth issue, he may get through this rough patch fine.
:YMHUG: Pam :YMHUG:
 
I also would recommend starting lactated ringers fluid therapy NOW. It will definitely help the BUN value. It's easy to do once you get a routine.

Vicky, Is this Sub-Q? I asked the vet about this and she said if he is drinking he is fine. I have had problems with this vet, but she is the only good one near me, and that is 30 miles away! I do not have a problem going elsewhere in the state, but when the weather turns and I get snowed in, that would be a problem getting him back to a long distance vet. I ASKED her if the high numbers meant CRF and she said it did. She did not tell me, I had to ask! She also sells Science diet only, so you see my predicament.
Thank you so much for the reassurance, I know I can help Alley with all this help and support. He feels just fine for now, running, eating, pooping etc. Switching to .40 tonite, then I am sure to .50 in a few days.
thanks again Vicky.
 
(((Pam & Alley))) I have no experience with CRF. I'm glad Vicky was able to give you some great links and advice. Keeping Alley in my thoughts.
 
Vicky, Is this Sub-Q?
Click to expand...

Yes it is. Unfortunately to get the supplies you need a prescription, I don't know if it matters by state like it does with syringe needles or not though. probably, as this is a little different.

Here's a page from the CRF site about convincing your vet about fluid therapy: http://www.felinecrf.org/subcutaneous_fluids_vet_support.htm. Given your location it's probably best if you try to work with her. Unfortunately I disagree that a cat who is dehydrated gets enough water through drinking. Being a dry climate type animal, the very fact they are drinking suggests they are dehydrated! A normal healthy cat rarely drinks if it's on canned food, because they get their moisture from their food. Here is some info on kidney disease from Dr. Lisa http://www.catinfo.org/#Kidney_Failure As you will read, she is totally against the k/d food, because of the poor ingredients as I mentioned. I wish she would write more about kidney disease, as she states it the #1 cause for mortality in cats. Even though Alley is not on dry food, with a BUN of 55, he is dehydrated. Here's her section about cats needing water with their food http://www.catinfo.org/#Cats_Need_Plenty_of_Water_With_Their_Food

here's the CRF site's page on fluids http://www.felinecrf.org/fluid_therapy.htm
And where it states that a Creatinine at 3.5 or higher may need fluid support. http://www.felinecrf.org/subcutaneous_fluids.htm It's in the section "When To Use Sub-Cutaneous Fluids"

You will have a better leg to stand on about the fluids if his heart comes back with a clean bill of health. Fluids can affect the heart and should be used with caution in cats with diagnosed heart problems. But it's also best to see a cardiologist if a vet suspects a heart problem. If he is found to have a heart problem, PM Jess & Earl. She is a veterinary cardiologist tech and can point you in the right direction for further care in that area.

How far are you from a veterinary teaching hospital/school? Or Denver? I used to watch Emergency Vets on Animal Planet! It's an ER hospital, which Alley doesn't need, but there may be a teaching hospital at a University in Denver, but I don't know.

Oh, one thing your vet should do is a urinary specific gravity test of his urine to see how well his kidneys are concentrating it. My vet says values below 1.010 mean very dilute urine where the kidneys aren't working well at all. For example, Gandalf's last USG was 1.016, so that is more diluted than a normal healthy cat's would be, but he's not below the danger level.

I know it's a lot to take in. Tanya's site is wonderful. I hope I helped give you the pertinent links so you can find this info quickly.
 
I have researched most every one of those links already! Saw Dr. Lisa's opinion on K-D, very good. Signed up for the Yahoo link to CRF. My vet said if his blood pressure was elevated, that would be another reason he has high numbers. My head is spinning, I feel I just read WAR & PEACE in the last 5 hours. My vet seems upset with me when I ask her questions that I have learned from this forum. My list I have now after reading all these links should throw her into a tizzy! I asked about a raw diet because it is low in carbs and phosphates, she said she does not have time to thoroughly investigate such findings and I need to buy K-D or G-d (I think?) from her.
I live 4 - 1/2 hours from Denver, over Monarch pass, which is not for wimps in the winter! But in an emergency I will need this vet. The dehydration makes so much sense, we are all dehydrated here, from Indiana just 1 year ago! Now at 8500 feet! The good thing is he shows no signs of weakness anything. Acting normal, at least for him.
 
My advice is to ask why she does not want you to try the things you want to try - the fluids, the food? Where is the harm? If you try them and he gets better, that's a plus, regardless whether it was her advice or not. I cannot understand a doctor or a vet not allowing a patient or a caregiver to try things which they do not have empirical evidence are in and of themselves harmful. The jury is out on the protein for early stage CRF and his is early stage, especially if his phosphorus is still low and USG not too bad.

We've got your back, just sorry we can't be there to offer support and more arguments. CRF is pretty much the same as diabetes - there is a lot of great, practical info online, but it seems some vets are years behind in heeding it.
 
Sometimes my vet is open to suggestions, and sometimes shut. She said I did not work with her in the insulin issue. She does not understand high numbers could also mean too much insulin.
For right now, I need her, and after all I have read from those links, I understand he is not in that bad of shape. But I am not fooling myself either. I have seen posts here with higher creatinine levels and higher BUN numbers. But for her to say he is getting enough water from his bowl is just plain crazy. I will wait until Monday for the EKG and blood pressure tests, then suggest (more like insist) that he get Sub-Q fluids. If he has high blood pressure, and it is then controlled, his BUN will go down, according to her, so are we at possible high blood pressure or early stages of CRF? Geez...
As always, thanks for the links and opinions, and good thoughts, I am determined to do everything I can for Alley no matter what.
 
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