Vit B12 was added to his Normosol bag. Note on the bag says 5000mcg, and we give him 50ml. I'm awful at math and even though that should he simple math, I'm not going to pretend I know what that amounts to. Is a multi B something I should get and give without consulting my vet? I can call to speak with them Monday morning.
It is very likely that what you are adding to his bag (I prefer lactated ringers over Normosol and the reason why he might not let you do more than 50 ml is that Normosol stings), is cyanocobalamin, not methylcobalamin. Cyanocobalamin is great for intestinal issues and just to help the cat feel better but it does not address anemia. You do not have to consult with your vet. While there are some places where you can get methylcobalamin in a liquid to inject, typically, it is a capsule. Again, without the multi-B, the methyl B12 will not help his HCT. Please read the link I gave you on B Vitamins.
It really concerns me that your vet does not have a good handle on treating CKD. That’s not unusual. You absolutely must be addressing the BP and the proteinuria. Giving fluids is actually secondary to getting P under control, addressing any potential high BP, addressing developing anemia, and also proteinuria. Those are the things that are tied to longevity more than an elevated creatinine.
Rec #1 was 5-7 days in hospital with IV at a rough estimate of $2k.
His creatinine is not high enough for this. That is usually done with cats whose creatinine is almost double where Toasty is.
Rec #2 is to bring him in 2x/wk for fluids at a cost of $35 per visit.
I read in another condo that you watched the video I linked and it was the same as what they taught you. I’d be extremely surprised if it’s the same as what they taught you because I’ve not only seen at numerous vets how they teach how to give fluids, I’ve had my vet ask me to go out to other clients’ homes and teach them how to do it so the cat will be ok with it. In the description of the video, I also give a link for getting a little vest that helps because the needle can be inserted and the cat not sequestered after that. Again, I would ask for Lactated Ringers Soln and see if that helps. My video description also tells you how to get less expensive LRS than the vet (if they even carry LRS) and also where to get 21g needles instead of the harpoons they use at the vet’s office. If you are using 18g needles, that might also be something he doesn’t like.
The problem with mirtazapine is two-fold. One is that you can only give it every three days (although some vets seem to be using a daily option for it). The bigger issue is that high P levels make a cat nauseous. Therefore, you need something for nausea before you give an appetite stimulant. This is another thing I just can’t understand why vets don’t “get”. Why stimulate the appetite of a cat who is nauseous without first addressing the nausea? You need cerenia and ondansetron to help with those. In case your vet isn’t up on the ability to use cerenia long-term, you can. It’s dosed once a day. Ondansetron is a human drug which, IMHO, works best for nausea but the two together are great because they address nausea from different modalities. Ondansetron can be given 2-3 times a day based on the strength and the need.
Slippery elm bark syrup is also good to help with acid tummy caused by CKD and high P. You just want to be sure it’s given separated by two hours from meds.
I doubt that the pet stores have the B Vitamins you need. I got mine through VitaCost but a health food store might have them. Again, please read the link on Tanya’s as she goes through those. You don’t have to rush out and get it tonight. Although he is considered to be anemic, the big guns for anemia are not brought out until the HCT is below 20%. Your goal is to keep it from doing that.
