Eeyore: blood work, kidney issues, anemia

[Michele and Esse]

hi, everyone.

I just got off the phone with the vet. She's a dear. Eeyore's kinda sick, aside from the diabetes.

1. She is worried because there is no glucose in his blood. I need to research this to figure out why that's a concern, but it worries her. I'd think it was a good thing, but she is concerned we're ODing him on insulin. If anyone has any ideas about that, I'd love to hear them.

2. RBC 5.6 range 5.92-9.93. They did find a blood clot in his tube at the test place, so they want to repeat it. He'll get that done tomorrow. His hemoglobin is 8.8 (9.0-15.1), and his hematocrit is 25% (30.0-45.0). If it's not a blood clot and he really is anemic, it could be a result of the kidney issues.

2. His BUN is 57. Normal range: 16-36. So this is pretty high...she is recommending 100 ml subq 2x weekly to see if the fx improves. I will be shown how tomorrow. Sigh. She also wants him to have a lower protein diet, but with this many mouths and the length of time I'm out all day, I can't go there. He'd be sequestered for 12 hours a day, 4-5 days a week, and I just can't do that to him, or the others. So I need to find a different method...

3. Creatnine: 2.6 normal range: 0.8-2.4. No terribly high, but enough to be concerning to her.

So, here's what I'm thinking is going on.
His diabetes issue - no glucose in urine - is a good thing, and we're not ODing him. I've done a curve, and some spot checks overnight, and the lowest I've seen is 172 (midnight last Saturday). To me, this means we're on the right track...if there is no glucose, then he's not "spilling" any, and the insulin is working to control things. He's only been on high protein and regular insulin (Lantus) for just over one week (and exactly one week at the time of testing), so if we have no glucose, I'm thinking this is good. She thinks it's bad, because all diabetic kitties should have glucose (should they??) and the absence of glu in the urine means they're getting a too high dose of insulin.

His kidney issues may be a direct result of non-treated diabetes. Hopefully, as things progress and we get some more fluid into him, his fx will improve, that BUN will come down, and his tubules will clear out and he may come 'round. We're going to give the SQ fluids a shot, but he may be tough to do, because he's a squirmer. And hopefully, as his diabetes gets better controlled, he will have a better kidney panel.

Nothing's wrong with his liver, which is good. At least one of the major organs doesn't have an issue. LOL. And the rest of his bloodwork came back right in line with normal ranges, which is really good - no infection anywhere. And, I keep catching him playing, and he loves to snuggle, so hey, he's feeling pretty good right now, and that's what counts.

She said that his kidney disease will kill him very fast; she thinks that will kill him, not the diabetes. Of course, this is not what I wanted to hear...but he's got a good home as long as he lives, and as much love as he can tolerate.

I'm just sad...I had hoped to have Eeyore around for many years...but if God calls him to the Rainbow Bridge, at least Eeyore will know he was loved (and not stuck in a closet eating dog food) and loved and loved again when he leaves here. For whatever time Eeyore is in my life, he will be adored, cherished, well treated, and snuggled. And it may be years yet before anything happens, but still, I'm pretty sad right now.

Anyone have any ideas/tips/hints/thoughts? I'd love to hear them...

best-
Michele

 

[CD and BigMac]

Oh Michele. I am so sorry to hear this about Eeyore and his kidneys. I am so glad you are there for him to love and be loved. Maybe as you said, treating the diabetes will help as will the fluids. I sure hope and pray that it is possible.

My heart goes out to you and Eeyore. This is so very sad.

 

[Deanie and Boo (GA) and Scout]

2. RBC 5.6 range 5.92-9.93. They did find a blood clot in his tube at the test place, so they want to repeat it. He'll get that done tomorrow. His hemoglobin is 8.8 (9.0-15.1), and his hematocrit is 25% (30.0-45.0). If it's not a blood clot and he really is anemic, it could be a result of the kidney issues.

Clotted samples do not give valid answers. They shouldn't have even reported any numbers from that sample. It should have just gone in the garbage.

 

[OptOut]

I'm so sorry to hear this Michelle. Talk to Choy-Foong (WFC & Meowzi) - she has lots of knowledge and experience with kidney disease and should be able to help you out.

 

[Lisa and Merlyn (GA)]

I am sorry Eeyore has more stuff going on but dont let a little CRD (chronic renal disease) make you think hes going anywhere too soon LOL. His creatinine is early CRI..not major at this point and in the condition hes been in. Did they get a urinalysis and/or urine specific gravity?

Sub Q fluids may help him overall at this point but I would not overdo them unless hes actually dehydrated. It is said (http://www.felinecrf.org for more info) that giving fluids too soon can make the kidneys work harder, earlier than they need to.

Do not forget that BUN is going to be higher if he is dehydrated, and also if he is eating higher carb food.

Even if you could do lower protein foods, dont go there. You know cats are obligate carnivores. They need protein. Newer recommendations are to wait for low protein diets until "end stage"

Talk to vettybean about Calcitriol...http://members.verizon.net/~vze2r6qt/calcitriol/

I think Eeyore will suprise you!
Just so you know... Merlyn was on insulin for 11 months, dxed with early renal insufficiency a month after going off insulin, and a heart condition (HCM) almost a year and half later. His kidneys were relatively stable even during the tightrope of kidney TX vs Heart TX. it was his heart that got him.

 

[Michele and Esse]

Thank you, guys. I wouldn't have reported any number from a compromised sample, but then again, I don't rule the world...sigh.

Lisa, I can't help but think that somehow, this is all tied together. Given that Eeyore has been (literally) out of the closet, on a good diet, and having insulin regularly for only 10 days (the vet visit was day 7), I really want to just give it some time, get those sugars under some better control, and see where he is in a month.

I am pretty puzzled as to the vet's concern that there is no glucose in his urine...I mean, that's a good thing, right? But perhaps it's an unexpected finding, where his condition should have some sugar; but he was "only" 241 when at the vets (and he's been as high as 577 with me), so maybe that's below the threshold. Not sure.

I will have to think about all this over the next few days...but I still can't help but think this is all connected somehow. Maybe it's too late to reverse everything, but still...maybe I can put a stop to things with good control. And no, I'm not heading to a low protein diet anytime soon; obligate carnivores do not do well on low protein stuff; and I'll see how the fluids go tomorrow, and what his specific grav and other urine stuff shows...

I'm just a bit sad. Poor guy...but, love is plentiful here, and he will get all he can stand. Right now, he's tormenting the kitty racer and playing tag with Malachi...no s/s of anything wrong with him at all.

Best-
Michele

 

[Sienne and Gabby (GA)]

((Michele))

Hang in there. I tend to agree with your taking a longer view. A better diet, regular insulin, squids, etc along with a good number of people experienced with dealing with renal issues can mean a lot.

 

[Lisa and Merlyn (GA)]

Unfortunately, some vets still think being in the 300s is acceptable, its safe. Thats because they are not dealing with many clients who hometest. If there was no hometesting going on, they would rather that the cat not hypo than to have high BGs.. which makes sense.

The shelter vet was like oh no, when I took Carly in for her dental (when she was still a foster) because her fructosamine was LOW! and I had to remind him that she was off insulin.

And I lost count of how many times I would tell the shelter vet her BG and he would do a mini freak until he remembered she was off insulin LOL.

I definitely agree that in the shape he is in, the labs hopefully will get better.

 

[Jen and Oreo (GA)]

(((Michelle and Eeyore))) I too hope as he gets better in your care the issues will resolve themselves.

Hang in there girl!! You are doing a good thing for that critter :smile:

 

[Larry and Kitties]

What is the phosphorous level in the blood? Kidney problems cause the kidneys not being able to keep the level down and a high level cause problems. In addition the specific gravity of the urine should be measure since that is very good indicator of kidney problems.

 

[Hillary & Maui (GA)]

My Sydney was diagnosed with early kidney disease and she doesn't think anything is wrong. The vet told me low protein, high fiber and I looked at her and said that doesn't make sense.

So, I'm feeding her the way I feed everyone, with the good FD diet. I also introduced raw food, even learned how to make it and am mixing that with the canned, until they learn to eat it on its own. Maybe something to consider for your group.

I discussed fluids with the vet, but it's too soon for Sydney, so I'm adding more water to the food and keeping the kidneys working naturally. The vet said, this is a gradual deterioration and eventually squids and other things will be needed to help Sydney.

As we all know, our loves can't live forever, however Eeyore is not distressed, his kidneys aren't shutting down, so with preventative measures - I'm sure he has many years of loving left in him.

Regarding urine sugar - I would think not having this is a good thing, not a bad thing. But what do I know.....

hey got pics to share???? you know we want to see him in his new home. And so glad he's getting all the lovin he deserves - no more closets or dog food for this guy.

 

[HollyandSpader(GA)]

Michelle, I am late for work so this is going to be quick.

Spader lived with CRF for years. Honestly, those kidney numbers are not bad at all.

I have several CRF links and tips for dealing with CF and FD in my signature here.

Not having sugar in the urine is a good thing.

 

[Dale]

My thoughts, FWIW.

I wouldn't be concerned about the BUN since the creat isn't that terribly high. Higher BUN can be from high protein food, dehydration, and even if there is a blood loss in the body the kidneys have to process it and is considered to the kideys as protein = higher BUN.

Ask if the lowered hematocrit is because of a GI blood loss (may need to think about some carafate), parasites, haemobart, anything other than the kidneys. Has a fecal been done?

Michelle I think with time, a good diet, control of the diabetes that Eeyore can recoup. I found a cat once that had so many fleas and ticks on her she had licked all her hair off (I was gonna call her Fluffy in hopes that she'd live up to the name...eventually! LOL). Her hematocrit was very low, wbc high...well just basically everything on her bloodwork was messed up. Vet started treatments but what he said was to take her home, feed her well, love on her and we'll see what happens. Had her for another 10 years! So I ditto the vets advise to you for Eeyore.

Here's some sites to read.
http://www.peteducation.com/article.cfm ... 44&aid=989 CBC
http://petdiabetes.wikia.com/wiki/Renal_threshold

 

[Karen & Smokey(GA)]

I am pretty puzzled as to the vet's concern that there is no glucose in his urine...I mean, that's a good thing, right? But perhaps it's an unexpected finding, where his condition should have some sugar; but he was "only" 241 when at the vets (and he's been as high as 577 with me), so maybe that's below the threshold. Not sure.

Some vets use 'glucose in urine' as a check that insulin is not being over-dosed. They don't expect or even
encourage their clients to home-test.

You might re-emphasize to your vet that you are home testing...which tells a better story than urine testing.

 

[Michele and Esse]

Thanks, everyone. I had a good cry last night, and feel much better this morning. **HE** is not suffering, and he's still the same skin-and-bones bag of snuggles he was yesterday...so...well...there you go. I really appreciate the support - I really do. Bless him, he's a trooper, to have survived what he has, and maybe, if I can stop the sugar issues, things will hold steady.

My vet knows I hometest, and has access to the spreadsheets. My vet also doesn't like that I hometest - says it stresses the kitties which raises the sugars; but if that were so, as I've pointed out, it's an easy cure to a hypo event - just test a lot, stress the kitty, sugar gets dumped, and voila, hypo is over. Doesn't quite work that way, though, so...we're at an impasse. She also knows I won't shoot blind...no insulin unless I have a number...so she just is doing what she's taught. I'm working on her, though...it's a process.

I've been reading, and I don't believe we should start fluids right away. Yes, the BUN is high; but the cre is not so very high. I'm more concerned with his sugars right now, and making sure he does get enough fluids naturally (meaning from the bowl), and we'll repeat the blood soon. I was going to take him in today, but have decided to wait until tomorrow; I need a day to go ride my horse, let this settle in, and do some more learning so I can discuss this intelligently with the vet. And I will definitely ask about the phosphorus, too.

Someone upthread made the comment about raw. I have some raw food, and leave that out as a snack sometimes. I'm thinking I'll be doing more of that as time goes on...

This info is still new to me, so...I need time to digest this all. Know what I mean?

Best-
Michele

 

[Karen & Smokey(GA)]

If you DO start Sub-Q fluids, I would suggest 50ml every other day, rather than 100ml 2x/week.

 

[Sheila & Beau GA & Jeddie GA]

Wow, Michele, I just see so many red flags in that vet report from the "no glucose in urine" is bad to "he's going to die fast from CRF"....

Honestly, dehydration, even slight can cause those renal values and if he was eating dry food, dry dog food at that, I would imagine that things could take several weeks to straighten out. Ditto, unregulated diabetes. Beau's renal values were higher at the beginning and my vet was totally unconcerned about it. When retested after I got him regulated they were fine - and Beau is a cardio kitty, so she would not be overly dismissive of something that was a real concern.

I think "stay the course" with what you are doing and KNOW is the right thing to do for an FD and retest him in a month or something.

It might be worth getting a fecal done - and you can just drop that off and save Eeyore the stress of a vet trip - to check for parasites. God knows with the conditions he was living in what he might have been exposed to.

All of that aside, you are right that you will give him the love he deserves for as long as he is here. You can do nothing more - and have already done so much. (((hugs)))

 

[Venita]

2. RBC 5.6 range 5.92-9.93. They did find a blood clot in his tube at the test place, so they want to repeat it. He'll get that done tomorrow. His hemoglobin is 8.8 (9.0-15.1), and his hematocrit is 25% (30.0-45.0). If it's not a blood clot and he really is anemic, it could be a result of the kidney issues.

Clotted samples do not give valid answers. They shouldn't have even reported any numbers from that sample. It should have just gone in the garbage.

I agree with Deanie. And I would insist that they redo the test without charge.

 

[Michele and Esse]

Wow, Michele, I just see so many red flags in that vet report from the "no glucose in urine" is bad to "he's going to die fast from CRF"....

Oh, I see issues, too...if I saw this on a human patient, I wouldn't run screaming into the hills...I just had to step back and think about it, you know? Put it into perspective. His diabetes is so uncontrolled right now, and I know that uncontrolled FD *and human* can cause so many different "side issues" that this isn't much of a surprise. I think she's doing what she's been taught, and bless her, I'll just have to teach her more. LOL.

For example, she tested the Alpha track side by side with both meters (UOT and Relion), and they both read 10-20 points higher than the Alphatrack. Problem is...she still doesn't believe that Esse can be at 34, totally asymptomatic, and not need a glucose drip - that HC will bring her through it (as long as she's asymptomatic), as I've shown several times. And if the Alphatrack was correct and the trend held true, that would mean Esse was at 24 or so...still asymptomatic, still treated (successfully) with HC...so she has some learning to do, I think, but I'm even more convinced that my meters are just fine...

It's a process.

Honestly, dehydration, even slight can cause those renal values and if he was eating dry food, dry dog food at that, I would imagine that things could take several weeks to straighten out. Ditto, unregulated diabetes. Beau's renal values were higher at the beginning and my vet was totally unconcerned about it. When retested after I got him regulated they were fine - and Beau is a cardio kitty, so she would not be overly dismissive of something that was a real concern.

I think "stay the course" with what you are doing and KNOW is the right thing to do for an FD and retest him in a month or something.

I think that's a great idea...and will probably do exactly that. It took Esse a while after starting a wet diet only before she got decently controlled, and I bet if I took a peek at her chart at diagnosis, she'd have some wonky numbers, too. And Eeyore is still drinking like a fiend...

They also had to give him fluids to get a sample while at the vets; his bladder was "dry"...I wonder how much of that affected things, like no sugars and high BUN...

It might be worth getting a fecal done - and you can just drop that off and save Eeyore the stress of a vet trip - to check for parasites. God knows with the conditions he was living in what he might have been exposed to.

We did have a fecal done...I don't know the results, but if there was something wrong, I think she'd've told me...I will be getting a copy of the chart, though, at the next visit.

All of that aside, you are right that you will give him the love he deserves for as long as he is here. You can do nothing more - and have already done so much. (((hugs)))

Shiela, thanks...the hug was needed. He's such a darned sweetheart...loves nothing more than to be held and snuggled...just loves being picked up and kissed. He kisses back, and holds onto my neck like a kid will. It's like his body was starved, and so was his soul. I'm doing my best to feed both his body and soul...and in the meantime, being blessed by him a thousand times over.

At the moment, he's discovering the joys of sweaty, horse-stinky clothes and a fuzzy saddle pad I brought home to wash. He is reveling on that pad like it was stuffed with catnip or something. LOLOL...

Venita, noted and will do. No reason the sample should've clotted if handled properly.

Best-
Michele

 

[Sheila & Beau GA & Jeddie GA]

Bless his heart! We all know that he could have become so scared and withdrawn that no amount of love and attention could have gotten him out of his funk, but this little guy seems to have never lost hope!