Help/support. CKD sugar cat not doing well.

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Heytherr

Member Since 2019
Hello all. I took my kitty to the vet today. He isn't feeling good. The past day or so he hasn't been eating and I'm not sure that he's been drinking so he went to the vet to get fluids he got cerenia and an appetite stimulant it's been a couple hours now and my kitty just seems completely exhausted from the vet trip and he's still not interested in eating. I did a curve yesterday and my rely on prime reader has acted up and I can't retrieve the info. I should have recorded it but I was hoping that the meter would have saved the info for later as it has in the past. the vet also took blood so that if he's not doing any better we can run a blood panel he just had one in July. I'm just trying not to freak out and hope that he feels better soon the vet says that usually when CKD cats get fluids and some meds they usually perk up but he has not perked up yet. I'm just really not sure what I'm supposed to be doing for him I hate that he feels like crap.
 
I'm sorry to hear Felix isn't feeling so well at the moment, Heytherr. :(

Questions:

* Which appetite stimulant did your vet prescribe?

* Which IRIS CKD stage is Felix at?


Mogs
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More questions:

* Is Felix pooping OK? How long is it since he last pooped?

* How much time has passed since Felix got the Cerenia and appy stimulant?

* Did the vet give you more of the Cerenia and appy stimulant to take home?

If you have the lab results from Felix's last round of bloodwork it may help members replying to this thread if you could post them under the LABS tab in Felix's spreadsheet.


Mogs
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Critter Mom said:
More questions:

* Is Felix pooping OK? How long is it since he last pooped?

* How much time has passed since Felix got the Cerenia and appy stimulant?

* Did the vet give you more of the Cerenia and appy stimulant to take home?

If you have the lab results from Felix's last round of bloodwork it may help members replying to this thread if you could post them under the LABS tab in Felix's spreadsheet.


Mogs
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I have not seen him poop.there's his brother here too but the boxes have been filled with both poop and pee I thought he might be constipated but the vet didn't feel that he was constipated when she palpated him. I think he's stage 3. She only gave me mirtazapine to take home I didn't ask for the cerenia as they injected that. I forgot that it comes in a pill form too. But I'm not trying to fight him right now. He got the meds around 8:30 9am this morning.
 
The vet said we could send out blood work tomorrow but I don't know what all that would tell me other than he's failing and I don't want him to suffer the only thing I can think of is that maybe his UTI has not gone away but we were unable to get urine because his bladder was small. I think I'd rather opt for getting his urine than getting more blood work done to tell me he's dying.
 
Heytherr said:
The vet said we could send out blood work tomorrow but I don't know what all that would tell me other than he's failing and I don't want him to suffer the only thing I can think of is that maybe his UTI has not gone away but we were unable to get urine because his bladder was small. I think I'd rather opt for getting his urine than getting more blood work done to tell me he's dying.
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:bighug::bighug::bighug:

The blood work could give you an idea of where his phosphorus levels are at. If too high that can make a cat feel cruddy but you can give phosphorus binders to help with that. The blood work would tell you a lot more about his status and possibly point to treatments that could help him feel better. If there is a UTI that could be making Felix feel icky too.

Did the vet check Felix's blood pressure today?


Mogs
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Critter Mom said:
:bighug::bighug::bighug:

The blood work could give you an idea of where his phosphorus levels are at. If too high that can make a cat feel cruddy but you can give phosphorus binders to help with that. The blood work would tell you a lot more about his status and possibly point to treatments that could help him feel better. If there is a UTI that could be making Felix feel icky too.

Did the vet check Felix's blood pressure today?


Mogs
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I didn't think to check his BP. He hasn't had a reading in some time but I believe it was hi previously and they said it could be a sign of stress from being at the vet so they weren't concerned.
 
When you offer him food how does he react? (See the nausea symptom checklist for guidance on what to look for.)

Does Felix have any recent history of vomiting either when he eats or when he hasn't eaten for a few hours?

Mogs
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Heytherr said:
I didn't think to check his BP. He hasn't had a reading in some time but I believe it was hi previously and they said it could be a sign of stress from being at the vet so they weren't concerned.
Click to expand...
High blood pressure can be an issue for CKD cats as they go through the stages. It can be tricky trying to determine it when vet stress might be in play but it's not impossible. High BP can make a cat feel off, but again there are treatments available if required.

One thing that the bloodwork might show is whether there is any anaemia. That can affect the appetite. Again there are things that may help with anaemia.

Trying to eliminate the simple things, did you give Felix a new type of food in the last day or two? Or a new batch of his regular food?


Mogs
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Critter Mom said:
When you offer him food how does he react? (See the nausea symptom checklist for guidance on what to look for.)

Does Felix have any recent history of vomiting either when he eats or when he hasn't eaten for a few hours?

Mogs
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Click to expand...
He has is loss of appetite, maybe vomited and possibly nausea. there was vomit on the floor when I came home but my other cat will eat too fast and then vomit his food and the vomit had food. He doesn't act excited for food he just looks at the food and then looks away.
 
Critter Mom said:
High blood pressure can be an issue for CKD cats as they go through the stages. It can be tricky trying to determine it when vet stress might be in play but it's not impossible. High BP can make a cat feel off, but again there are treatments available if required.

One thing that the bloodwork might show is whether there is any anaemia. That can affect the appetite. Again there are things that may help with anaemia.

Trying to eliminate the simple things, did you give Felix a new type of food in the last day or two? Or a new batch of his regular food?


Mogs
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Click to expand...
I've been trying different flavors of weruva wet cat food to see which ones he likes low carb low phos. So at first I thought it was the flavors he didn't like but he had been eating them previously I had tried the flavors that he usually been eating and he doesn't even want that.
 
Heytherr said:
we tried to start fluid therapy this week but I've been unsuccessful..he got fluids at the vet but hasn't drank anything in a day or so that I've seen he might be drinking at night I'm not sure.
Click to expand...
The only way to do that is to measure out water every day and check how much is left after 24 hours. With more than one kitty in the house you obviously can't tell exactly who had what but the overall volume should give you some idea if both boys are drinking enough. Also if you feed wet food, by tracking the amount eaten you can work out how much fluid they're getting from that using the 'as fed' moisture content on the labels.

My civvie, Lúnasa, is stage III, on a dry diet (I know! but she has a very sensitive digestive system and I've not been able to find a wet food she can tolerate. :( ) She normally drinks c. 180ml a day, helped by adding some of the liquid from commercially available 'cat soup' but that's high in carbs so probably not a help in this situation. Sometimes adding a teaspoon of the juice from tuna tinned in spring water to flavour the drinking water added to about 30ml water can encourage them to drink a little extra. Adding a little water used to poach a chicken breast can similarly help, but I'm not sure of the suitability of this for a CKD kitty. I know that poaching water when the chicken is boned is not good for them because of the phosphorus content. Perhaps other members might be able to advise better on this.

(@jayla-n-Drevon - can you suggest something when you're online next?)


Mogs
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Hi I'm sorry to hear Felix isn't feeling well, CKD cats do have their ups and downs once in a while, If you could can you post the last blood work that you have even if it was in july it may help a bit to at least have an idea of how he was not so long ago specially what was his creatine, BUN, phosphorus and calcium

The vet gave him fluids but are you going to be giving subcutaneus fluids regularly?

It Is really not so terrible as it may seem at first once you get the hang of it.

What is he currently eating what is wet fd ( sorry I'm not in the US so not sure what food is it?) Is he getting any other supplements like B vitamin complex, B12 , omegas, probiotics or something?
 
Try warming it first. Make sure there are no hot spots if you are warming it in the microwave. Also see if he might eat from your hand.

If that doesn't work I suggest you pop out and grab some of those baby foods recommended on Tanya's Site.

Fingers, paws, eyes, legs, arms and anything else I can think of well and truly crossed in the Shire... :nailbiting:


Mogs
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Bloodwork and urine results from July

UA/Microscopy results from Antech Diagnostics
(East) Requisition ID: 15082-3 Posted Fin al
Test Result Reference Range
U PRO/CREA 1.0 H <0.5 - 0.5
Ascn: MEEB23684784 Profile: Urine Protein Creatinine Reflex
RE: 422 Protein 168.4 mg/dL RE: 304 Creatinine 172.5 mg/dL
----------------- URINE P:C RATIO INTERPRETATION
---------------------
The urine P:C ratio must be evaluated in conjunction with
urine
sediment findings as gross hematuria or inflammation can
cause
elevated ratios.
Urine P:C ratios >/= 0.5 in dogs & cats indicate overt
proteinuria and are evidence of persistent renal proteinuria
when
found repeatedly (3 or more samples obtained 2 or more weeks
apart)
and are unable to be attributed to a pre-renal or post-renal
cause.
The urine microalbumin test is a more sensitive test and will
be
positive before overt proteinuria is detected.
In dogs, persistent renal proteinuria with urine P:C ratios
>/= 2.0 is
usually due to glomerular disease.
-------------------------------------------------------------
--------
7/2/2020 L 13 Chemistry results from Antech Diagnostics (East) Req uisition
ID: 15082-3 Posted Final
Test Result Reference Range
ALB 4.1 g/dL H 2.5 - 3.9
ALKP 44 IU/L 6 - 102
ALT 33 IU/L 10 - 100
AMYL 1407 IU/L H 100 - 1200
AST 32 IU/L 10 - 100
BUN/UREA 41 mg/dL H 14 - 36
Ca 9.7 mg/dL 8.2 - 10.8
Chloride 107 mEq/L 104 - 128
CHOL 306 mg/dL H 75 - 220
CREA 2.2 mg/dL 0.6 - 2.4
GGT 1 IU/L 1 - 10
GLU 424 mg/dL H 64 - 170
Mg 2.2 mEq/L 1.5 - 2.5
PHOS 3.7 mg/dL 2.4 - 8.2


Potassium 3.8 mEq/L 3.4 - 5.6
TBIL 0.2 mg/dL 0.1 - 0.4
TP 7.6 g/dL 5.2 - 8.8
TRIG 119 mg/dL 25 - 160
Sodium 141 mEq/L L 145 - 158
A/G Ratio 1.2 0.35 - 1.5
B/C Ratio 19 4 - 33
Na/K Ratio 37 32 - 41
GLOB 3.5 g/dL 2.3 - 5.3
CK 86 IU/L 56 - 529
PSL LIPA 12 U/L 8 - 26
Ascn: MEEB23684784 Profile: Superchem
The glucose concentration in this cat is >170 mg/dl. A
fructosamine
level may be helpful in differentiating stress hyperglycemia
from
early or sub-clinical diabetes mellitus. If you would like
to add on
this test please call Customer Service. Please use test code
500016
for this additional testing.
Acute pancreatitis is unlikely. Chronic pancreatitis is not
excluded by a normal PrecisionPSL.
7/2/2020 L 13 Endocrinology results from Antech Diagnostics
(East) Requisition ID: 15082-3 Posted Fin al
Test Result Reference Range
T4 1.5 ug/dL 0.8 - 4.0
Ascn: MEEB23684784 Profile: T4
7/2/2020 L 13 Hematology results from Antech Diagnostics (East) Re quisition
ID: 15082-3 Posted Final
Test Result Reference Range
BLOOD PARA None Seen
HCT 49 % H 29 - 48
HGB 13.4 g/dL 9.3 - 15.9
MCH 17.4 pg 11 - 21
MCHC 28 g/dL L 30 - 38
MCV 63 fL H 37 - 61
POLY Slight
RBC 7.7 10^6/uL 5.92 - 9.93
WBC 10.0 10^3/uL 3.5 - 16.0
ABS BASO 0 /uL 0 - 150
Bands 0 % 0 - 3
Platelet C 188 10^3/uL L 200 - 500
Platelet E Adequate

Neutrophil 70 % 35 - 75
Lymphocyte 20 % 20 - 45
Monocytes 5 % H 1 - 4
Eosinophil 5 % 2 - 12
Basophils 0 % 0 - 1
Comment SEE COMMENTS
Absolute N 7000 /uL 2500 - 8500
Absolute L 2000 /uL 1200 - 8000
Absolute M 500 /uL 0 - 600
Absolute E 500 /uL 0 - 1000
Ascn: MEEB23684784 Profile: Complete Blood Count
Platelet count reflects the minimum number due to platelet
clumping.
Blood smear reviewed by technologist.
7/2/2020 L 13 UA/Microscopy results from Antech Diagnostics
(East) Requisition ID: 15082-3 Posted Fin al
Test Result Reference Range
APPEAR Turbid
BACTERIA Rods >100 HPF H
BILIRUBIN Negative
BLOOD Trace H
CASTS None Seen LPF Hyaline 0 - 3
COLOR Yellow
GLUCOSE Trace H
KETONES Negative
PH 6.0 5.5 - 7.0
PROTEIN 2+ H
RBC None HPF 0 - 3
SP GRAVITY 1.020 1.015 - 1.060
WBC 21-50 HPF H 0 - 3
SQUAM 2-3 HPF 0 - 3
Ascn: MEEB23684784 Profile: Urinalysis-Complete RE: 2133
COLLECTION METHOD Not Stated RE: 2146 Crystals None Seen HPF
 
I was hoping that you'd say that otherwise I'd feel really bad about my next request...

When you're suitably in a position to, could you actually enter the test results on the LABS tab in Felix's spreadsheet. It would make it much, much easier to read and we could ask members who are good at interpreting lab results to have a look and give you some feedback.

(It would have been awful if I'd had to ask you for the above if you had already had to type all that info into your previous post. :( )

Question: Is your vet open tomorrow (Saturday)?


Mogs
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If you look in Felix's spreadsheet, at the bottom you'll see 3 tabs labelled:

Sheet1
TEMPLATE
LABS

If you click on the LABS tab, it will bring you to a page in the spreadsheet ready for you to enter lab results. All you need to do is to work your way down the list of tests and enter the results from the email sent to you by your vets (e.g. CREA, BUN, HCT, PHOS, etc).

If I haven't explained this properly this time, please let me know and I'll try to do better. :)


Mogs
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Heytherr, I was just running my eye over the test results quickly and I noticed a mention of pancreatitis on the email but couldn't see what it related to. Does Felix have any history of pancreatitis, or did your vet mention it today? (Just brainstorming again here.)


Mogs
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He has protein in his urine and tge ratio is high indicating proteineria. Did you vet suggest medication for that ? I suspect he very well could have high blood pressure. When was it last checked? Amlodipine is the best drug and works well in cats. If it his high and u treated it could lead to blindness. Not meant to scare you because high BP is easily treated. The creatinine isn’t that high nor is the phosphorus so that is good. He could very well be nauseous. I would call your vet and ask about all this and ask if you can get medication for nausea just in case. I dint know where you live but in the US we have a holiday weekend and much that isn’t already closed because of Covid will be closed.
 
Taking a look at his labs nothing strikes me as terrybly off other than he was probably a bit dehydrated back then and that it appears he had UTI with some kind of bacteria, was a culture made? What meds did the vet gave him? The UTI could be coming back

In diabetic and CKD cats UTI's are hard to clear and usually need more than one round of antibiotics to really work, normally you will give a first round of antibiotics, then wait 10-15 days and do another urinalysis with culture and if it comes clean you are lucky and very happy but if not you give another round of antibiotics and keep repeating until he comes clean, and when that happens you wait a month and again do and urinalysis just to check it hasn't come back

Regarding his kidneys with dose numbers he would be stage 2 which doesn't mean he's ok but is a very manageable stage, and CKD usually does not change that much in a month time unless some other issue or illness causes some sort of crash

With his phosphorus and creatinine levels i wouldn't think he needs subcutaneous fluids regularly yet, those are usually recommended with creatinine levels over 3.5 or if phosphorus is very high and his isn't
 
Heytherr, please try to test Felix for ketones as soon as you can (as an important safety precaution because he's off his food and may still have an infection).

Also, my best suggestion is to see whether you could get in to see the vet again tomorrow to ask for ondansetron for nausea and also cyproheptadine for appetite stimulation instead of the mirtazapine. You can give cyproheptadine a couple of times a day if needed and ondansetron might work better than the Cerenia for nausea (it works differently to Cerenia). I'd also ask the vet about whether he could do an on-the-spot Snap fPL test for pancreatitis, if only to rule it out. In the event that pancreatitis was in play, Felix would also need pain relief (bupe) alongside the appy stimulant and anti-nausea meds. Just in case you might need more information, here's a helpful resource:

IDEXX Pancreatitis Treatment Guidelines


Mogs
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When the blood pressure was taken did your vet get 5 readings? Max had primary HBP well before he had CKD. It happens. My vet took it as a baseline and we were both surprised. I dint know why more vets don’t bother.
 
He went over to litter box and cried out in pain but the vet doesn't seem to think he's constipated because he hasn't eaten anything. Don't know if it's a good idea to give him lactulose. He's so weak already.
 
Cat trying to urinate:

iu




Cat trying to poop:


iu




Which position was Felix adopting in the litter box, Heytherr? (((Felix)))



Mogs
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I'm probably going to go with the comprehensive blood work if they can run it in house I want it back ASAP but also I'm worried I might miss something if they can only do the baseline. Ughh
 
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