Boots update - reaching the end of the road? plus nausea treatment questions - ondansetron dosing

[Mandy & Rex (GA)]

Hugs!! I think I'm starting to see the same issues with my civvie Tanner, who has already been diagnosed with pancreatitis. This thread reminds me of my plan I had in place - Cerenia, Ondansetron, Buprenex, and subq fluids (if needed). I worry - is it really time to intervene??

I hope you can pull Boots out of his funk.

 

[Megan and Boots (GA)]

Megan

I’m sorry I just got a chance to look at Boot’s Labs. Here are some things I’m seeing:

• His cobalamin is normal but his folate is elevated. This can potentially indicate proximal SIBO or small intestinal bacteria overgrowth unless he is getting a folate supplement.
• We know he’s got an elevated specfPL and that can be due to pancreatitis or the triaditis. His TLI is elevated and he’s sort of in that gray zone between high normal (82) and 100. Over 100, it would indicate CKD, pancreatitis, emaciation
• His phosphorus is too high. He needs to be below or as close to 4.5 as you can get it. If you aren’t feeding a low P food, it would really help him out if you started. Try to find a LC food that is less than 1.00% P on a dry matter basis or less than 200 mgP/100kcal on as fed basis. Controlling the P is absolutely essential for longevity and feeling well.
• His potassium is too low. Although it shows 3.4 as “normal”, anything below 4.0 is too low for a CKD cat. Ideally, it should be around 4.4. With CKD cats, if the serum level is 4.0, it’s less than that in the cells where he needs it. OTOH, insulin can cause the uptake of potassium into the cells and so the serum value will be lower. However, I don’t think it’s a good idea to assume that when a cat has CKD. I would talk to my vet about supplementation. You might want to read up about potassium levels on Tanya’s CKD site so you can discuss it with him.
• His urine MA is high. This can be part of the CKD but it’s not so common to see a kitty in such early stages have a high MA. Has your vet checked his blood pressure? I would be sure he/she does it every time you have him in. CKD cats are very prone to high BP. I would also consider obtaining a free catch urine sample and having your vet send it off to check the urine sediment unless the lab already did and it’s noted on his labs but you didn’t put it on the lab tab.

Let me know if you have questions.

Thank you so much for that analysis! I know I've read up on SIBO before but will check that info out again, as it's been a while. I suspect pancreatitis is the cause of a lot of his issues. His various numbers that indicate p'titis have been high for years now, and his ultrasound showed abnormalities, if memory serves. Heck, his ultrasounds have shown pretty much everything in his abdomen is a bit abnormal and enlarged which likely is the cause of his distended belly that he's carried around for 2+ years. The potassium info on Tanya's site is interesting. I see that also can impact BP. I don't think he's had a reading in ages, so we'll ask for that at the next visit and discuss the potassium levels. I try to do foods low(er) in phosphorus, but I totally admit to get him to eat, I'll bust out pretty much any crap. If we can get him eating well again, I'll try to be more diligent in keeping the choices lower in phos.