Bella – Frightening kidney values

Bella started having problems with eating a week ago (pawing at her mouth and showing distress whole eating). Our vet found that she has numerous resorptive lesions and wanted to remove a few teeth. She was given an antibiotic injection at the vet and onsior pills to be taken at home, and it helped a bit. Her bloodwork was sent to an emergency hospital in another town (previous test were done in-house), and the results came back so bad that our vet is not recommending anesthesia and advised not to give her onsior pills. They are going to teach us tomorrow how to give subQ fluids. Bella’s only visible problems are with her mouth and the diminished food intake because of that (she wants to eat but it’s obviously uncomfortable). Still, she does eat wet food (1.5-2 cans per day). She doesn’t drink or urinate excessively. She behaves normally and is alert.

Is it possible that the results are botched because they were sent to the lab a day after the sample was taken? If the results are correct, should she be hospitalized? What to do with the teeth?

 

I’ll tag @Suzanne & Darcy for you.

 

I'm sorry for this difficult time... I don't have much information to provide, but since I also have doubts about the test results, so spoke with a specialist in laboratory analysis and he clarified that after 2 days the blood samples could lose some confidence , but that there are even analyzes that can be done weeks after the extraction of the sample. In addition, there are different factors such as blood extraction, the state of the tubes, sample transfers and temperature that can affect the results. I had doubts about the reliability of the Tuni tests (my dear friend), because the first biochemistry and t4 were with clotted blood (sampling problem) and the specialist told me that coagulation does not affect the blood analysis for biochemistry or t4, among others. That said, although it is likely that your results are reliable, if your kitty tolerates going out of the house and is at good weight, I would undoubtedly repeat the test in a center where they have a laboratory and deliver the results on the same day. I hope everything goes well and you can report his state of health.

 

Onisor and convenia shouldn't be given together. I have a case with the company open about the side effects of them given together. Idk if that could cause what your seeing here, or if the drugs were given before the blood work. In my case my cat had mild anemia that quickly progressed into moderate anemia and more issues. When the convenia wore off she was all better over a month later and weekly blood tests.

Sorry I'm not an admin or mod, this was just my experience and I can't really help or guide you with this.

 

A Convenia injection? I am not a fan unless there is no other choice like with a fully feral cat or a cat who will not eat pills in pill pockets, etc. The best treatment for the mouth antibiotic-wise is usually Antirobe (Clindamycin) as it is very specific to oral bacteria. I have had cats with bad teeth concurrent with kidney disease. They could not go under anesthesia. After the initial course of Antirobe, we did pulse dosing of the antibiotic to keep things under control. One week on the antibiotic and three weeks off. One week on and three weeks off….

For a cat with pain and kidney disease, Buprenorphine is the safest on the kidneys. Some vets these days won’t give it, but it’s the best for them and sometimes you need to push for it. After the teeth improve (or fall out) she may not need it so much. Having said that, you need to be able to insert the syringe just inside the buccal pocket outside of the teeth and squirt the tiny amount of Bupe onto the inner cheek/gums or it will not be properly absorbed. Vet can give a Buprenex/Simbadol injection too, but it will only last for 24 hours max. It takes effect quickly. I recently (last week) had to use it in one of my cats for post-operative pain and it took effect in no more than 15 minutes.

 

When this blood was drawn, was she dehydrated? It looks like she may have been dehydrated. Also, if the blood sample was handled incorrectly then the numbers could be skewed. I find it hard to believe that a cat with those high numbers (particularly that BUN) would even still be eating. The nausea would be very severe. Something is not adding up here.

 

I never even give Onsior any more. My cats kidneys have been hurt by this drug. I know some people have used it and nothing detectable happened, but I will not risk it. I’m sorry that you have had trouble with Convenia and Onsior together.

 

Was the bloodwork taken before or after the Onsior was started or before or after the Convenia injection?

 

Is she having any trouble walking/jumping or back leg weakness?

And she’s not drinking or urinating a lot you say?

She needs a urinalysis to check urine specific gravity (USG). That will give an idea of whether her kidneys are appropriately concentrating urine which indicates level of kidney function.

 

With regard to the dental issue, can you find a veterinary dental specialist? This is a link to a search.

 

So I'm thinking that if you find the Convenia does help and she does not have a reaction to it -- and it does last in their system for weeks, then you may be able to just get regular Convenia injections for the teeth. I'm really hoping for the best here. I'll check back in later today.

 

Smart move. I wish I new about it before I let a vet prescribe it but I was very desperate. Kitty had 105 fever completely uncontrollable. I didn't even bother looking it up when the vet said it'll lower the fever. It didn't lol, idk how I got her through that and the Anemia and uri and it was so difficult. She's alive, healty, and sassy these days lol

 

Suzanne, thank you so much. It’s hard to read on the paperwork but it seems that the antibiotic is Convenia. We’re told it is supposed to work for two weeks

Blood was taken no more than 15 min after the injection. We had given Bella onsior pills twice (every other day) and clindamycin liquid for 3 or 4 days before that visit. We gave her the last onsior pill after the visit.

Buprenorphine: my understanding is that they need some paperwork to be able to prescribe it, I asked in three clinics here and none is prescribing it. I may not understand the situation correctly.

Bella got 200 ml of subQ fluids at the clinic today. We’re told to give her fluids every other day. We’re going there tomorrow to recheck the blood and we are also going to try to collect a urine sample at home for urinalysis.

Bella is eating wet food with water added and she also drinks from the faucet. She isn’t showing any sign of nausea at all. We tried to switch to Wellness exclusively but sometimes she would only eat Fancy Feast. She hates renal food and Weruva. She’s urinating less than some time ago but regularly.

She seems to have some weakness in one of her back legs. I mean, she does have neuropathy in them and we’re giving her supplements and Adequan injection for that, but I recently noticed that one of her back legs is sort of slipping to the side a bit. She is able to jump on chairs and walk up and down the stairs.

I’m considering going for a consultation to the emergency hospital in a different town. I hope they can prescribe opioids there.
My main question for now is whether we should push for hospitalizing her for IV at the emergency hospital and then proceed with anesthesia and the teeth removal or just, as you say, think of pulse therapy with antibiotics. Our vet initially was against doing the dental, but I guess Bella’s teeth/gums now look so bad that the vet changed her mind.

 

When Sheba had neuropathy her back legs would slip to the side.

 

Convenia stays in the system for longer than two weeks. Perhaps it's at its peak for two weeks, but it does last longer. I saw your post on the tanyackd group and it's all good advice, similar to what I've said here. They're wonderful over there. Convenia is risky and a lot of people hate it, but I have seen some cats who do okay on it. We can link you to articles on Convenia here.

This is the part that I am not sure people on tanya's group are understanding. She isn't showing signs of nausea? Are you sure? Sorry for asking... but she is eating well? She isn't sniffing at food and walking away? Or licking the surface of the food and walking away? Or licking her lips a lot? Or making strange tooth grinding sounds?

This is definitely the question. If she's going to have a dental extraction, then I would definitely have her hydrated on IV fluids for a few days prior and afterwards for a day, and I would discuss the approach that they have to the dental procedure and particularly the anesthesia that will be used. Will they monitor blood pressure continuously during the procedure to prevent a significant drop in blood pressure that is damaging to the kidneys. I really feel for you. I know how scary this is. I really do.

 

Bron, do you think Diabetic Neuropathy is likely for Bella when she's in these numbers? I want your opinion.

 

I do hope that you can get a urinalysis done and get them to check her blood pressure... just because we can get a better idea of kidney function via urinalysis and high blood pressure can be caused by kidney disease and can also damage the kidneys further. I hope they actually have the ability to check blood pressure.

I saw what you said about the Buprenorphine. It is just the best pain relief that spares their kidneys. Do you think you could give it to her as I described above? I'm just not sure how fractious Bella is.

 

Oh my goodness. I am so sorry. I have read about cats getting hemolytic anemia from Convenia and then the Onsior too. I totally understand. We trust our vets to do the best. When we are really stressed and sometimes in shock when we take our cats to the vet when they are really sick... we just kind of take whatever they say at face value and do it. We also don't even have time to think through everything and even ask good questions. We are just hoping that our babies will get better if we follow the instructions we are given. Been there so many times! I'm really happy your sweetheart is okay now. Is this your diabetic kitty or a different one?

 

Oh, the reason I asked about potential problems jumping or hind leg weakness is because high phosphorus can interfere with nerve signals to the back legs and cause weakness. Darcy had this happen. When we did renal food and phosphate binders, it improved.

 

And usually fluids every day at this stage (if blood results are accurate) will be a lot more safe and beneficial than doing it every other day. They can usually absorb the fluids pretty quickly. The fluid "hump/bump" will usually disappear within a short period of time (if it does not then it's probably too much). So don't let them tell you to do 200 mL every other day. 100 mL every day will be best. I can help you with tips on how to give the fluids (in addition to the basics that the vet will hopefully show you.) Also, you need to consider if her heart is stable enough to handle the fluids (at least no murmur detected) and her weight is a consideration for how much fluid to give. You will see the same advice over on tanya's support group. They've walked with me through many a time of being given bad advice on how much fluid to give and through some pleural effusions resulting from too much fluid being given to cats whose hearts were not able to handle the fluid. But we don't want to go there... just make sure they check Bella. Do you think she will cooperate with you for fluids? Do you have a "helper" (husband? my daughter is my main helper.) A helper can keep them occupied (read: FOOD/treats/petting) during the fluid administration.

 

Suzanne, thanks for responding here and on the CKD forum. I will reply here because it's more "user friendly" to me.
Urine sample: the vet tech who was giving Bella the fluids today advised us to collect the sample at home. We know that her litterbox should be as clean as possible to prevent contamination. (I often write "we" because I try to have my husband present at all appointments. I just can't handle this amount of information alone!)
Fluids: we will try giving her 100 ml daily (not tomorrow though). Her weight is around 8 lbs. Bella is usually cooperative but that needle is scary. Will need to find a video with instructions somewhere.
She does have heart murmur.
Local clinic can't measure blood pressure. I hope the 24/7 hospital can do it if we get there.
I see that I misunderstood what nausea is.

Yes, but this often means that she wants different food.

Not lips, but she washing herself a lot these days.

I thought this is because of the teeth problems?
In any case, I will try asking our vet tomorrow if they could give us cerenia.
I would try phos binders but I'm afraid she wouldn't eat if she senses something added to her food.

 

Bella was in higher numbers up until the end of last year and in January this year. There was a sprinkling of blue and green BGs during some cycles, although there are not that many tests in the am cycles and almost none in the pm cycles, so it’s hard to say how low she dropped during the cycles.
It’s really only since the end of January that she has dropped into blue preshots. Still very few tests during the cycles but I would think that they are probably dropping into low blues or some greens so much better numbers.
So I do think it is possible she does have a bit of neuropathy. Sheba’s first sign of it was one of her legs sliding out to the side.

 

This was an abused and neglected kitty I had got that week. The owner said ill just take her out back and shoot her for you. The owner is my boss. I had to save her. She and jekyll are my most recent rescues and my most costly ones. She was afraid of people, other animals, loud noises. Now she and my og sugar cat live together in my master bedroom and she is doing amazing! She loves me and my husband and she can tolerate tuna! My hope is that she can enter the rest of the house with the other 15 cats confidently.

The company that owns onisor and convenia said "because onisor is new we haven't tested convenia with it for side effects" then maybe tell people that??? Wild. They can get away with murder I swear

 

Oh wow! I am glad you mentioned this because other people will hopefully read this and be warned about the Convenia/Onsior problems. I am glad you saved her. You and I have obviously got a lot in common (ummm… crazy cat ladies.)

Oh and neither Onsior and Convenia are very “new.”

 

Oh the tooth grinding and sometimes it seems like a chattering almost… it’s sometimes hard to describe… but definitely can be from nausea. I have seen it in different cats of mine several times. And she does have the added problem of the teeth and pain so that can cause pain and a lot of weird ways of eating and reluctance to eat, strange turns of the head when eating.

 

I find this fine aluminum hydroxide powder from Thriving Pets to be well tolerated. Starting with a small dose of Niacinamide (felinecrf.org has information on it) is an option as well - as someone on the tanyackd support group mentioned.

https://thrivingpets.com/products/thrivingpets-aluminum-hydroxide-powder-usp-50g-jar

 

I would not let the vet give you those giant Monoject “harpoon” needles that they like to use. Terumo needles are the sharpest and it really makes a difference. They are thin walled needles and so give a better flow rate as well. Again, I will link Thriving Pets below. I usually use Terumo 19 gauge and sometimes the 20 gauge needles that are a little smaller. The larger size gives a faster flow rate. I believe there’s a chart on the thriving pets site that shows flow rates of various types and sizes of needles. Warming the fluid bag in hot water before giving is an important step for Bella’s comfort. Just test on the inner part of your arm first and run the cold fluids out of the line first.

Over hydration is a concern and especially with a heart murmur. Just read the information on over hydration on felinecrf. She (Helen) also has a lot of information on how much fluid is too much. I believe there are links to videos on there. It is all so overwhelming, I know. I will stop now. You have a lot to process.
https://thrivingpets.com/products/t...f-100?_pos=1&_psq=terumo needles&_ss=e&_v=1.0

 

Update:
Went to the local clinic yesterday to recheck the chemistry panel at their lab, and the numbers are bad. Will post the pic later but phosphorus is 17! Our vet is supposed to call ne later today with urinalysis results. I remember urine specific gravity is important, what else should I ask the vet about?
Bella got cerenia injection and we took two pills home (I don't know why only two, our vet couldn't see us yesterday and someone else decided to only give us two).
Upon return, Bella started eating almost normally! No more pawing! Is it cerenia or convenia started working or both, I don't know.
But she also drinks more and pees more (not to be compared to the copious amounts she produced before we figured she is diabetic, just more than she did for the last couple weeks).
Will try subQ at home today, 100 ml max.
Ordered Terumo needles and the phos binder.
I'm under an enormous stress now at work and the next week is going to be insane, so I don't think I'll have time to deal with a new clinic and hospitalization right now. I had almost a blackout yesterday when I was driving to pick up Bella and go to the clinic, that was not fun.

 

Thank you so much for the update. I have been thinking of you and Bella. I’m sorry about the bad numbers. You are doing all you can right now it sounds like. This is hard on you and is a huge emotional drain, I know. I’m glad she ate food. Two Cerenia pills are definitely not enough. Although she probably only needs one-half of a 16 mg tablet. Since the dose is to give about 1 mg per pound of body weight.

 

Ask them to give you the bloodwork. Keep an eye on her HCT too.

 

Ask about giving her weekly B-12 injections if you already haven’t talked to them.

And be sure to please take care of yourself, and get some sleep. We can’t lose you! That is frightening that you almost blacked out.

 

FD is a learning curve.....your in great hands here

 

Chemistry panel and urinalysis Feb 9 (USG 1.016)

 

Thank you so much, Suzanne. I will post updates on the ckd board, too.
This clinic doesn't check blood pressure. And they didn't rechek hematology for whatever reason. Too bad I didn't know that HCT is important, I would insist on rechecking.
Bella started pawing at her mouth again, so I guess that cerenia injection worked a bit as a painkiller, too. Cerenia pills dosage is 1/2 pill per day. I'll ask for a refill.
Very hard to understand how much subQ we're giving because the main amount is at the bottom of the bag and the top part is too "thin". I need to check the instructins on Tanya's site again.
As I mentioned, none of the nearby clinics precribes or carries bupe. Our vet suggested ordering liquid tramadol from a compound pharmacy.
What are B-12 injections for and can we give them at home? Are they subq or intramuscular?

 

B-12 injections are just sub-q like an insulin shot. In fact you can use insulin syringes. More in a minute…

 

Anyway, cats with CKD are prone to B vitamin deficiency for a lot of reasons but one is because B vitamins are water soluble and CKD cats urinate so much that they lose a lot of these water soluble vitamins. B-vitamins also play an important role in red blood cell production and, since most CKD cats will eventually become anemic, it is a good idea to supplement with injections of B-12 and also a vitamin B, complex, like the Jarrow B Right capsule, which needs to be divided into 10 portions inside of size 4 gelatin capsules.

 

As for the fluid bags, just follow the lines on the bag. You will notice that the lines are not evenly spaced on the bag - some are further apart than others. This is to accommodate the way the bags are shaped and bulge out in the middle with the fluid and the way they get “thinner” as the amount in the bag is reduced.

 

Dod you ask them about the Leukocytes in her urine? Normal cat urine should contain no leukocytes. It is indicative of infection if they are present. I don’t know how they analyzed the urine. The dip stick method is inaccurate at detecting leukocytes for cats and it needs to be done manually. They take the urine and spin it in a centrifuge. They then take the various cells (the sediment) and redilute it in a little of the urine. Then they examine the cells to see what’s there. There should be no leukocytes. I see it looks like they did look at the urine under a microscope? I would ask them if any leukocytes were seen. I see it says 0-3 per high powered field.

 

It looks like the leukocytes you are talking about are from the urine dipstick determination. The handwritten "manual" on the UA says 0-3 WBCs (which are leukocytes) per high power field were observed and 0-3 is normal.

Also, I a wondering what OCC means in the "manual".

Edited to add:
The urine results tables references UA14. This is an automated device (Zoetis VETSCAN® UA Urine Analyzer) reader urine dipsticks. Thus the typed results are from a dipstick. Thus the "manual) would be a manual urinalysis of urine sediment under a microscope.
For info Zoetis also makes an automated urine microscopic analyzer (VETSCAN SA Sediment Analyzer).

 

Thank you, Suzanne! Something like this? https://www.chewy.com/vitamin-b12-generic-injectable/dp/219875
We used to give Bella B-12 supplement (powder) but stopped when her eating has become inperdictable. I'm curious why everyone says gelatine capsules should be size 4 , because size 5 is smaller? Probably because it's hard to fill the smaller ones?
Anyway, yesterday we gave Bella 1/2 cerenia pill without using a capsule and it went well.

I read this in the detailed instructions from Tanya's site: "There should be some air space above the fluid in the bag. The air in this space is very important. IF you forgot to close the valve on the IV set before you spiked the bag, it is possible you may have let the air escape from the bag. If this happens and there is not enough air remaining in the bag, then the sides of the bag will stick together as the fluid level goes down and you will NOT be able to read how much fluid is still in the bag. This makes it impossible to tell how much fluid you have put in the cat." This is precisely how our bag looks like. We used a measuring cap and a stopwatch to figure out how long does it take to give 100 ml (2 minutes).

No, I didn't ask when our vet called because I got a picture of the results much later, and I remember the vet commented on some cells present but like they're not a big deal and convenia should take care of them anyway.

 

Occasional, I believe.

 

Yes. Size 5 is smaller. It’s sort of too small for a Cerenia, although I have jammed them in, and is really hard to fill with the powdered B-Complex.

 

And yes, depending on how cooperative your “patient” is and also depending upon your pilling skills… it’s okay to give Cerenia with no gelcap. If you shoot it way back in the center of their throat they never taste it. But if you miss and it starts to dissolve then it can. be really bad as it’s a nasty tasting pill. With my cat Tabitha, I gave her Cerenia every day with no problems - no gelcap. But she was cooperative as well.

 

Oh right, I was forgetting about the fact that she’d had the Convenia injection. So hopefully no worries there at all - and the Convenia perhaps has already reduced the white cells IF there were any there at the time she had the shot. Shot was almost ten days ago now? February 3?

 

Oh my! That is not good about your fluid bag! It was clever of you to think of the stopwatch to time the fluids though The IV infusion set should have instructions on it for spiking the bag and getting it all set up.

 

Oh, and yes that bottle of Cyanocobalamin that you linked from Chewy is the stuff you need.

 

thank you, Suzanne!
Convenia shot was on Feb 2 (I know it was not a good idea to go to the vet on the Groundhog day...now we're stuck!)
IV bag was first spiked by a vet tech

 

I replied over on the group... but anyway, that vet tech should know better! They should give you a new bag. If you have time, I would take it back and show them and get them to give you a new bag! You could have done better yourself.

OBTW, I order my bags of fluid in multiples (usually from Chewy because it's just easier for me) and they're a lot cheaper than the vet prices. I've also ordered them from Thriving Pets. I have gotten used to using the Vetivex non-HDPE lactated ringers solution from Chewy.

 

Walgreens if I remember right was less than 4$ per bag(might be more now) and https://www.calvetsupply.com/ sells the lines for 3.99$ (I used the same line several times as it was the same 2 cats)
They also sell terumo needles and other types of syringes

The vet prices are so high

 

Okay, so I got this aluminium hydroxide powder from Thrivingpets.
It says 1 tsp=1200 mg, 1/4 tsp=300 mg
What's the dosage I need for a 8lbs cat?

 

Does this help?

 

Thank you, Suzanne! And I have a similar tablecloth

 

yes, it’s one of those cotton woven tablecloths … homespun they’re called, I think? My friend gave me that chart a few years back when I needed it, and she loaned me some aluminum hydroxide powder. She sometimes acts as a moderator on the felinecrf group.

 

Oh, I learned a new word!

Many thanks to you and your friend.
We're going to see a new vet on Saturday, I just posted on the ckd group with questions and a bit of freaking out.

 

I think, if there's a chance of her staying at the new vet, you should bring the ProZinc because they may not have it on hand. I always took Darcy's insulin with me when he had to stay. First it was ProZinc (which the ER vet did not have on hand) and then it was Lantus and then Levemir (neither of which did they have at the ER vet or at my regular vet.)

 

I'm not sure if I would repeat bloodwork either (as someone on the kidney group said.) I would bring the bloodwork that you had done with me. I would also bring her whole record from the other vets. They may insist on seeing new bloodwork, but it's probably too soon to see changes in it. Definitely get them to check the Blood Pressure to make sure (hopefully to rule out hypertension.) The part that bothers me is that you said she doesn't really even want to get up to eat? She's eating lying down? Is she eating a normal amount? No more mouth pawing? Any more teeth chattering? Did you start the phosphorus binders? And you are still giving Cerenia and Ondansetron? (can't remember actually if you started Ondansetron, but definitely you did give Cerenia and it seemed to help.) Is she still having problems walking? With a phosphorus of 17 (which it was before you said) that can cause hind leg weakness. I'm sure you are very nervous about tomorrow.

 

Thank you, Suzanne. We’ll take Prozinc and her favorite food with us tomorrow.

Yes, Bella is mostly eating lying down. I mean, if we try to make her stand to eat, she does stand for a bit. She eats ½ to 2/3 of her usual food intake. She’s paving and grinding her teeth after a few bites when eating pate without water added. As soon as she starts doing it, we switch to “pate soup” instead.

She walks to her litter box and then back to her den and this is it. On a sunny day (two days ago) she was more active and demanded to go outside and eat grass. A few days ago she made it to the second floor bedroom but then didn't seem to have strength to jump on the bed.

Today she was lying in her litter box. Twice. Produced a tiny poop once. Yes, we started the phos binder so I guess she’s now constipated. I’ve ordered Miralax, should arrive tomorrow.

Cerenia seemed to help for a few days but now I’m not sure if it’s working.

 

Hospitalized Bella today. Bloodwork looks rather hopeless.

SDMA 69.
Blood pressure: 105/86 (92)
95/42 (73)
88/59 (69)

We brought her upstairs for the night and that was a mistake because her litter box was too far away and she ended up peeing on the bed in the morning. Then we noticed that her back legs are barely holding her.
I choose this vet because she’s a dental specialist and two days ago things still looked like we might consider doing a dental. So the vet was surprised with Bella’s bad shape and it seemed at first she doesn’t know what to do. This vet does not think it make sense to give Bella antibiotics at this point.
Only IV (with vitamin B complex added).
Because of Bella’s heart murmur they can’t be too aggressive in treatment.
They promised oral bupe. Didn’t want to give her an injection because she never had it before. Does it make sense?

 

Were you able to bring a phos binder to the vet? I think it could help kitty feel a bit more comfortable

 

Did they measure the hematocrit? If the cat is dehydrated then HCT will be artificially high.

 

Yes

No, they only did the kidney panel. I guess she's dehydrated.

 

I checked in on you on the tanya ckd group. I do not think it's hopeless.

 

I do think they need to do full bloodwork, not just BUN, CREA, electrolytes.

 

Got a call from the hospital. Told them about rechecking the bloodwork and urinalysis. They say Bella is eating and alert. I'm going there soon to visit.
BUT
They put a Libre on her and she maintains numbers between 150 and 190 and they say she does not need insulin with these numbers because they're afraid she drops too low. What should I do? This hospital is the only emergency options around here. Her recent doses of Prozinc were 0.25 u under 200 and 0.5 units over 200 (because of her limited food intake).

 

A Libre sensor can be off quite a bit from ear pricks. I would check @home with ear prick and compare with the Libre. THe Libre reading can be higher orm lower than ear prick. I had one sensor that switched which one was higher about halfway through the sensor's 14 day life. Do you have a means of reading the Libre? Which Libre? The old 14 day, the newer Libre 2 or the newest Libre 3?

I myself would say 150-190 may need insulin depending upon how BG is over the day. If it drops lower then I would give a little insulin,n in your case a very little insulin.

 

So you are saying that they are not giving her insulin while she is there? Because they say she doesn’t need it? Well I do not agree that she doesn’t need it, but your priority for now is to get her stabilized so she can go home. If she’s really not getting out of blue numbers then maybe it will be okay for a few days. I have found that they really don’t check the cats BG as much as I would like while they’re in ER care. So maybe it’s just as well.

 

Visited Bella. We checked her BG with ReliOn and it's 164 , 30 hours after her injection yesterday morning. She's eating, but I suspect she's only doing it for us. I don't like that her third eyelids are visible (I kinda noticed it yesterday, before she was admitted, but today they're more visible.

 

Darcy’s third eyelid was visible when he had an infection and was hospitalized.

Are they just thinking she’s had a crash with the kidney disease? I’m so happy y’all got to see her. It must have been an encouragement to her. Although it’s so hard to leave them again.

 

Monday Feb.20 update:

So, now she has pancreatitis. Amylase 2685. Was 1156 in June and 1739 in October.

New test results:

https://drive.google.com/file/d/11cBptZx7adSqFXZWhfNpjJH2SsN4hLM5/view?usp=sharing

https://drive.google.com/file/d/1sRbg0mfAivMTboabRBC9_Fsz00og7X-G/view?usp=sharing

https://drive.google.com/file/d/1eXkhvcN_YU0EdVXdV8BP6niRQiyunbIH/view?usp=sharing

https://drive.google.com/file/d/1BQvHdrE4SM7mqX5mZt9JYR9qXWVUNzLV/view?usp=sharing

https://drive.google.com/file/d/1LztcAulJ6TnALNUZ2bqolzO4wbx3S7iq/view?usp=sharing

https://drive.google.com/file/d/1IEN9dKSyyYX3YD51_g7bN3HYS6esevI6/view?usp=sharing


No insulin shots since AM 2/18/2023. I was shown Freestyle Libre data: Bella’s BG maintains numbers between 150 and 200.

Bella gets Baytril, buprenorphine, Pepcid, vit B complex, phos binder. We gave her 1/8 tbsp of Miralax.

They had to decrease IV fluids to 5 ml/hr this morning because she had tachycardia (and 4/6 heart murmur). Because of this decrease, the emergency vet is not sure it makes lots of sense to keep Bella hospitalized even though her kindey values are a bit better. They will decide tomorrow morning (it will be 48 hours in the ICU). I think if you guys feel it would make sense to keep Bella there for another 24 hours I may push for that but honestly I am not sure.

The vet says that any dental work on our cat would “push her over the edge”, so best case scenario they send Bella home with some buprenorphine and we should feed her whatever she likes to.

She is alert but weak, wants to go around and explore the room, has difficulties walking but wants to do it anyway, jumped on the couch in the visitation room. Eats bit by bit but is interested in food (but not in the low-fat food they tried giving her).

This is my first experience ever with a critically ill cat. In terms of Bella’s life expectancy, are we looking at a few more weeks? We want her back home and will do anything to keep her comfortable but I’m not sure if another ICU visit will make sense.

 

I've heard that subqs are easier on the heart, and according to the advice I got here (for my cat) 100cc a day or every other day. I'd wait for a mod to be more clear on that though. You can do it at home too!

I'm really praying for the best for you guys. I'm sorry I don't have alot to add, I'm still semi new here. But, as a person that has had dozens of ICU and hospice pets, you are doing and have done a great job. You are an amazing pet parent do not ever doubt that.

 

I have made a few replies on the kidney group. I’m so sad for you having these results for Bella. Honestly, nobody knows how long she will be able to be happy with you at home. On the ckd group, there are many cats that have lived a long time with “bad kidney values”. Helen even mentions this on the felinecrf website. That is why we say to treat the cat and not the numbers. When you get her home, you can give her the treatment she needs to be comfortable. She may do well for a long time. Nobody can predict the future for her.

 

Saying prayers for your previous Bella

 

Thinking of you and Bella this morning. I’m praying for her and you. She will need some fluid support, just give her smaller amounts so she has time to absorb it. Why were they giving her low fat food? Because of pancreatitis? I think it’s encouraging that she is up and about and wants to explore, etc. That is a good sign.

 

Yes, but she dissmissed it right away. My question that I also asked at the ckd group is whether we indeed should feed her whatever she pleases (if we add phos binder)?

 

I think it’s paramount that she eats. It’s so hard on them losing weight. Honestly, there are people on the group with cats who would only eat “Party Mix” treats and that was it! So that’s what they got. I’m not recommending that, but it makes a point that eating is most important.

 

Oh, I thought that was “old school” thinking about feeding low fat food to cats with pancreatitis? Maybe somewhat reduced fat, but not ultra low fat? Is that what you have read?

 

♥♥

 

Yep, she also talked about low proteins for ckd cats...although she mentioned that this is debatable. In any case, Bella won't eat either of them, so I have to figure out her food. She hates Weruva, unfortunately.

 

Find something she likes and just use binder.

 

Hi everyone, we brought Bella back home. Her creatinine and phosphorus improved a little bit, BUN is higher today than yesterday. Check-out process took a while, and Bella was unusually active, trying to escape from the carrier all the time.
Once she got home, she decided stay in the carrier. She ate a bit, drank a tiny bit, but did not urinate since we got home (5 hours ago), I sure hope she will do it soon.
I have a few questions regarding medications dosage, please let me know if something does not look right to you guys:
1) Vit 12 injection: 0.25 ml subQ once a week
2) Buprenorphine (0.3 mg/ml): 0.25 ml by mouth every 8-12 hours [I thought that maybe too much for her 8 lbs, and I’m just cautious about this stuff so we gave her 0.1 ml for now, will wait for your guidance and her reactions]
3) Pepcid 10 mg: ¼ tab once daily [I realized I don’t have it; I have Omeprazole delayed release capsules 20 mg – but it may be difficult to deal with them for such small doses?]
4) Aluminum hydroxide: recommended increase to ½ tsp per day
5) Insulin: not recommended unless glucose is consistently above 250. Bella’s BG was 169 this evening, so we did not give her insulin, we have to work on a new strategy regarding insulin. Unfortunately, we had to ask the hospital to remove her Libre sensor because none of our cell phones is compatible with it.

 

Bupe dose is .01 to .04 mg. per kg for a cat. So anywhere between .03 and .14 would be okay. It's really a matter of how she's feeling and if the pancreatitis is causing her pain. But there's a wide range of safety with Buprenorphine so you often see prescribed. My cat Marcus who weighs 11.6 pounds and recently had surgery was prescribed a dose of .15 and it really did make him stop being in pain. So his dose was less than .25. Just try to get the liquid on her inner cheek/gums in that buccal pocket in the corner of her mouth. How did she do on the .10? Did her pupils get large?

 

Everything else seems okay. Is she getting Cerenia? Ondansetron? How many fluids will you give? Has Rekha or anybody given you any suggestions on that -- with her heart murmur? There are charts and such on the ckd site.

Are you going to try Niacinamide to help with the phosphorus. I did with Darcy and it seemed to help, of course I was also using binder.

 

Thank you, Suzanne. Bella did good on 0.1 bupe, I don't know about the pupils, will check next time. Rekha agreed that 75 ml of fluids should be okay in our case. Bella is getting Cerenia (1 divided pill per day). The hospital did not have ondansetron and I'm not totally sure I understand why she needs it. At check-out they said I can order everything from Chewy and they will approve it.
So, niacinamide should be in addition to the aluminum stuff? I thought it was just another option.
My main question for this board is insulin dosage. To give or not to give, that's here the question! We're debating this today, her BG was 202, so we decided to give 0.25 u and ended up with a fur shot! Crazy. I'm going to create a new topic, probably in Prozinc forum.

 

Okay. See you over on the ProZinc forum. That’s where I spend a lot of time. Let me look at her ss.

 

I was thinking today that it would be good to find a dose that will keep her in blue numbers.

 

Niacinamide can be used alone or in conjunction with phos binders. Just wait and see if her phosphorus comes down with the binders to about 4. If it remains high, you could add in some Niacinamide.

 

I did use phosphorus binders (AlOH) in Darcy and it actually drove his phosphorus down too low! Vet had me discontinue the binder due to it worsening his constipation (although Ondansetron did that too) and I used Niacinamide, starting at about 50 mg per day. I put it into a gelatin capsule since it tastes terrible and I could not risk him not eating and not getting the dose into him.

 

Did you give her any insulin today? I see that last night she didn't, and that looks fine. I don't see a preshot test for today so I was just wondering.

 

I've just updated Bella's spreadsheet, her AM preshot was 194 so we gave her 0.25 u, and right now she's 164 so we skip. I hope to have more time on the weekend to test her several times a day, but in general I think I would skip insulin if she's under 180 and give 0.25 if she's over. I wanted to consult about this on the Prozinc forum but now I'm just so dragging behind on many things.

 

I know that catch up circle you're in. Make sure you take a little bit of time for you. A hot bath is my go to.

 

Thank you, Katrina. Planning to catch up on work stuff during the weekend actually. No bathtub here But the weather today was very nice and warm, so I spent some time in the backyard together with Bella!

 

Aw I use to do that with my 1st diabetic cat! We would have bg curve picnics all day! Then I found out I'm highly allergic to trees lol! I was desperate for him to lose weight I hoped critters would make him run, it was being far from me that made him sprint back to me! I'm happy you guys had some nice weather for that and I hope it continues for yall

 

It looks like last night’s skip resulted in the yellow preshot this morning. Maybe you can try a drop dose when she’s borderline like that. Or a .10 dose is an option rather than a skip. There were no midcycle tests yesterday but it looks like she did fine since she had the blue PMPS. That is not a criticism as I know you are overwhelmed caring for her now. With my cat Ginger who is on a lot of meds, I have an Excel spreadsheet that I print out and I check off each medication as I give them- just so I don’t forget anything.

 

I barely see where is that 0.25 on the syringe, so the lowest dose we're giving so far was "0.25-"
We'll observe her ## for a couple of cycle, then I guess we'll figure out the new strategy. So many variables here.
Tomorrow she was active, eating a lot, wanting to jump on furniture, etc.
Today she's asleep and doesn't want to leave her den, so I had to feed her some "soup" right there and I will try mirataz.

I want to do the same and I've actually posted questions on Tanya's group about the right meds schedule. I haven't receive any replies so far so if you could respond here that would be so helpful :
1) is it true that no medications should be given two hours before and two hours after the phos binder? And no food or drink 30 min before and after buprenorphine? And should famotidine be given first and then antibiotics or vice versa?

She's on baytril, famotidine, buprenorphine, phos binder, subQ, cerenia, insulin, miralax, B12 injections.
2) If she's eating, does she need mirataz?
3) She used to get Adequan for arthritis every month or so, is it safe to give it now and does it make sense to give it?