HELP, Toney went into remission, now kidneys failing?

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Lunarstruck

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Toney went into remission and did not have any Lantus for 3 weeks. Today, he had worse hind-end neuropathy again, which usually signals in increase in glucose but he tested normal (112 on a ReliOn Micro that always tests 25 less than our vet's AlphaTrak meter). We took him him and his glucose was high at the vet at 257 on their AlphaTrak (and same high at home after, so our meter is working). Can cats get higher glucose from stress? His kidneys are failing, his bloodwork isn't good, vet has no clue. Kidney values all normal just a few months ago. I think kidney cancer or CKD? Vet doesn't know what to do and didn't say anything, boyfriend took him in, I wasn't there. This bloodwork is conflicting to me - anyone? These are the results from today 9-16-13 with my interpretations with help from the internet and my memory from pre-vet school. I hate not being able to figure this out. Should the vet have done a blood transfusion or do you think she thought it points to non-regenerative anemia and he's just not treatable? I don't know whether to ask for prednisolone or a transfusion or more testing. SO frustrating. No FLV/FIV ever in all the cats here (everyone tested neg., a few more than once, our oldest recently) and Toney has always been an indoor-only cat that tested neg. when we got him.

SUSAN/Toney
Riverside, CA

TONY’S BLOODWORK 9-16-13 (LaserCyte in-house)
Manual PCV = 34%

HIGH

TP 9.5g/dl (normal 5.7-8.9) = inflammation, Total protein can be increased if the dog or cat is dehydrated or if the pet's immune system is being stimulated to produce large amounts of antibody.
BUN 43 mg/dL (normal 16-36) = decreased kidney function
CREA 2.9 mg/dL (normal .8-2.4) = decreased kidney function
BUN/CREA 15
MCH 84.5pg (normal 12-20) = Immune-Mediated Hemolytic Anemia (IMHA) (cancer, parasites, infection, should we give prednisolone?)
RDW 23% (normal 17.3-22%) =
PLT 2500 K/ul (normal 175-600) =
Note: PLT abnormal distribution (RD)
GLOB 7 g/dL (normal 28.-5.1) = antibody protein that fights disease
GLUC 313mg/dL (normal 71-159) (using bloodwork)
GLUC 257 (using AlphaTrak meter at vet)

LOW

RBC 1.35M/ul (normal 5-10) = anemia, decreased oxygen-carrying capability of blood (heart?)
HCT 5.8% (normal 30-45) = anemia, decreased oxygen-carrying capability of blood (heart?)

NORMAL/LOW

WBC 7.56 K/ul (normal 5.50-19.50) = inflammation
RETIC 9 K/ul (normal 3-50) = decreases indicate few or no immature RBCs,
indicating the body is unable to respond to a demand for RBCs (nonregenerative anemia)
LYM 1.22 K/ul (normal .40-6.80) = responds to stress, chronic infection
MONO .39 K/ul (normal .15-1.70) = (responds to repair of tissue injury)
BASO .01 K/ul (normal 0 - .1) = (responds to parasites, allergies)
MCV 43 fL (normal 41-58) = increases indicate the presence of larger than normal cells, which
may be related to young cells during response to an anemia; decreases indicate the presence of
smaller than normal cells, which may be associated with chronic blood loss/iron deficiency
ALB 2.5 g/dL (normal 2.3-3.9) = Albumin is decreased if the liver is damaged and cannot produce an adequate amount of albumin or if albumin is lost through damaged intestine or in the urine due to kidney disease. The only cause of increased albumin is dehydration.
ALT 32 U/L (normal 12-130) =
K (potassium) 3.6 mmol/L (normal 3.5-5.8) = (increases with kidney disease)

NORMAL

EOS .54 K/ul (normal .10-.79) = (responds to parasites, allergies)
NEU 5.41 K/ul (normal 2.50-12.50) = (responds to infectious and non-infection diseases)
HGB 11.4 g/dl (normal 9-15.1) = (hemoglobin, increases in these
parameters may support dehydration or a disease of increased production of RBCs; decreases
indicate anemia and decreased oxygen-carrying capability of the blood)
 
I can't help with the kidney issues other than to say that kidney problems and diabetes seem to be closely related. We do have some members who are familiar with reading blood chemistry panels and hopefully one of them will be along to help you.

Can cats get higher glucose from stress?
Click to expand...

This I can help with. YES....the stress of going to the vet can raise the BG as much as 200 points. That's why glucose curves done at the vets are never a good idea because once the cat gets home, their BG comes down. It takes a little time once they are home to come back down, so it's quite possible the 257 was stress induced.

I'm sorry your kitty isn't doing well, and hope you can get some answers soon.
 
You said "K (potassium) 3.6 mmol/L (normal 3.5-5.8) = (increases with kidney disease)"
Frequently K decreases with kidney problems since the greater urination deplete the K. A low K can cause muscle weakness. Many kidney cats need K supplements.
I do not see a reading for phosphorous.

You also said "RBC 1.35M/ul (normal 5-10) = anemia, decreased oxygen-carrying capability of blood (heart?)
HCT 5.8% (normal 30-45) = anemia, decreased oxygen-carrying capability of blood (heart?)"
Yes kidney cats tend to have a low HCT. However, with a value of 5.8 a think a cats would be dead.

Do you have a value for urine specific gravity?
 
I'm so disgusted with this vet and she is our 2nd one for Toney. She didnt' recommend a transfusion or anything or even call me after the bloodwork. No U/A run, nothing else. These labs don't even make sense to me. I'm so frustrated and angry at both these vet's offices for just letting him die. I don't think my b/f will take him anywhere else now, we've spent so much money on bad labs and a bad vet now and he cannot go to a speciality clinic. This is awful. I placed a call to her and asked that the senior vet there call me back but they said she's too busy today. I'm pretty upset at this vet for not doing a transfusion or at least repeating these labs at IDEXX if they are wrong. She did NOTHING for him and I dont' think Hill's WD is going to be good for his diabetes - anyone? He was 257 this morning and we had to give .75 insulin again after a night on the dry WD. I'm SO frustrated, this is his 2nd vet already that was BAD, I don't know any other good vet out here we've had so many bad ones so far.

PS - I just called their sister office's office manager and begged her for help - I told her if this cat doesn't get treated today, he will most likely die and that this isn't the first time their other office has dropped the ball on him and he'd be dead if I'd listened to their insulin dose recommendations and they gave me the wrong B-12. She's going to have the vets there review his chart and call me back - I told her to please hurry, this cannot wait, he needs treatment and probably a transfusion quickly. If he dies and I autopsy him and he has babesia, bartonella or a UTI, I'm going to be one VERY unhappy, broken-hearted camper.
 
Hi again! (could you tell us your first name please?)

Sorry you're having so many problems with your vet, but I know how you feel. I had to go on a vet search myself after China's regular vet refused to even consider that he didn't know it all. The good news is you are in the right place and we can help you with Toney's diabetes.

To answer your question, NO....W/D is not a good choice. It is too high in carbs. Pretty much ALL dry foods are too high in carbs. We recommend you feed only wet food with a carb percentage of less than 10%. You should take the w/d back for a refund. Tell them Toney won't eat it. Here is a Food Chart that shows pretty much any kind of food available and the percentage of carbs (Column C) Look for foods 10% or less. Friskies and Fancy Feast pates are both cheap and readily available.

Changing over to a low carb diet can drop the blood glucose pretty quickly and for some cats, that's all they need to control their diabetes. Do NOT switch immediately over to only low carb since you are giving insulin. Do it gradually over about a weeks time.

What insulin are you using? Lantus, Levemir and Pro Zinc are the only ones that work well with cats.

It's also very important for you to learn how to home test. It's the only way to be sure that it's safe to give Toney insulin as well as finding the best dose for him. (as well as not having to deal with the vet or pay more for tests you can do at home)

Getting started shopping list for home testing:
1. Meter ie Walmart Relion Prime, Confirm or Micro. (about $15)
2. Matching strips (Prime $9 for 50....Confirm/Micro about $18 for 50 strips)
3. Lancets - little sticks to poke the ear to get blood . new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed. Optional - lancing tool. (about $5)
4. Cotton balls to stem the blood
5. Neosporin or Polysporin ointment with pain relief to heal the wound
6. Mini flashlight (optional) - useful to help see the ear veins in dark cats, and to press against
7. Ketone urine test strips ie ketodiastix - Important to check ketones when blood is high
8. Sharps container - to dispose of waste syringes and lancets.
9. Treats for the cat - like freeze dried chicken
10. Karo syrup/corn syrup or honey if you dont have it at home - for hypo emergencies to bring blood sugar up fast
11. A couple of cans of fancy feast gravy lovers or other high carb gravy food- for hypo emergencies to bring blood sugar up fast

There's a lot of information and tips we can give you to learn how to treat Toney's diabetes at home. The learning curve is steep, but we'll do our best to help you learn to control this at home. If we go too fast, PLEASE just tell us to slow down.
 
We already home test and Toney was in complete remission with zero Lantus given for almost three weeks. Then the neuropathy came back, his hind legs paralyzed again WHILE he was on the M-B-12 5000mcgs. So I think it might be a pinched nerve or worse. Well, the vet admitted today that their in-house lab machine is NOT working right and they have known this for awhile but she insists ONLY the HCV is wrong. I told her the labs are really screwy and that I was up half the night worried and almost took Toney twice to the ER for transfusions. She refused to re-run the labs at IDEXX and I ended up hanging up on her in mid-sentence. That office has misdiagnosed this cat way too many times and would have killed him with their insulin dose recommendations three times had we not gotten our own meter. Plus, they recommended the wrong cobalamin and he would have been severely permanently paralyzed had I not noticed and gotten the M-B-12.

We had to go to two other vets today before he got treated and had to use a lab I've never heard of and it cost us three times the amount we already spent for labs but I liked the new vet so far. He did find a heart murmur the other vets never mentioned and a retinal tear and high bp of 228 on three legs and seven tests, so he put him on Amlodipine. So we're waiting on the labs tomorrow and a U/A, this new vet said Toney doesn't appear anemic so he didn't do a transfusion, but we really don't know until we see the bloodwork. I'm just sick about this and have a bad feeling its not going to go well for Toney, who is hind-end paralyzed again even on the M-B-12 5000 mgs for the past month. I'm wondering now if it is a pinched nerve or thrombosis, he had an x-ray done that didn't show anything that would cause this according to the last vet who we will never return to again, but the M-B-12 could help a pinched nerve and he did recover, then got it again yesterday. I'm disgusted with that vet's office and the fact that she sent those labs home never doing anything for him when it shows starting renal failure and severe anemia and inflammation. She could have at least run a U/A.

SUSAN/Toney
Riverside, CA
 
Well, big surprise, almost ALL of the old vet's labs were totally wrong. He does not have kidney failure, nor anemia. I'm too tired to post them here but

NORMAL

HCT
WBC
RBC
HGB

HIGH
Neutrophils
TP
GLOB
BUN
GLUCOSE (normally high at vet but he was over 600 unless our meter batteries are already going out. (Gave Lantus again and took away dry W/D food bad vet gave him)

LOW
lymphocytes


New vet found a heart murmur can't tell how bad but put him on Amlodipine we pick up tomorrow - also found a retinal tear, poor guy. He was so damn stressed after being in the carrier 7 hours yesterday (long story) that his Bp was 228 on average. He's not feeling well but still eating. Walking a tiny bit better on one hind leg. Neg again for FIV/FLV. U/a pending and Free T-4 pending, T3 (RIA) normal. I'm worried. Any suggestions?

SUSAN/Toney
Riverside, CA
 
An important note: Lab work doesn't start showing problems until a significant number of nephrons no longer function.

If the blood pressure is high, there may be some sort of renal compromise. Going with the lower phosphorus foods may be prudent. Using distilled water for drinking or adding to food may slightly help as it has no solute for the kidneys to process.

If the hind end paralysis were due to a blood clot, he would most likely be in severe pain to the point of howling.
 
No pain, thinking it could be a pinched nerve now. The methylcobalamin would work on that, too. Poor guy, he's only 9 and my heart just breaks. I can't stand that his glucose is over 600 twice now, we'd better get it down tonight with more Lantus - we cut out the W/d the bad vet prescribed, now she's almost killed him 8 times now.

SUSAN/Toney
 
The new vet STILL has not called us with recommendations for Toney nor called in the Amlodipine they insisted he needed the next day and its been FOUR DAYS now. Today we got a faxed report stating his U/A was normal and a nasty report from the vet saying that now he won't prescribe the Amlodipine for fear we won't come back for a bp recheck - total lie. He lied in the report and I faxed a letter to the owner of the vet office and they promised he would call me two days ago, now I know they will never call us with any recommendations for Toney, nor give him the prescription. To top it off, the bad lab vet sent us a letter covering their butts stating they wont' treat our animals anymore and of course my pancreatitis cat and old dog are due for medication refills there. I cried all day long, because we spent so much money on vet bills for Toney with zero diagnosis and no meds and now we have to find yet another new vet? I just can't do this anymore, they were so mean and we did nothing to deserve this. I feel so bad.
 
And I called the CA Vet Medical Board to file a complaint today and was told due to budget cuts, they only have two people working now and there is a 1 - 1 1/2 year BACKLOG. I'm disgusted with these vets who care nothing about the animals, just money and don't know what to do now but cry.
 
On a pragmatic note, renal-sparing foods like the Friskies Special Diet pates may help reduce BP by reducing the workload on the kidneys, as will using distilled water (no extra solute to be filtered).

The krenal system is directly involved in blood pressure control, so reducing renal workload may reduce BP, which in turn will reduce the workload on the heart and reduce issues with a mild heart murmur.

Do what you can, one step at a time.
 
Brie had elevated kidney values in his yearly in 2012. In 2011 everything was perfectly normal. In 2012 his creat was 3.6. I was so concerned I took him to a radiologist and had an ultrasound done. He ended up having a kidney infection. I think his WBC's were normal at the time. I believe he had protein and blood in his urine. He never grew anything in his urine culture. The radiologist suggested taking a urine directly from his kidney and doing kidney biopsies if his kidney levels didn't come down using antibiotics and fluids. Luckily his kidney values did come down. I think we caught the kidney infection pretty early. As a result of the kidney infection Brie does have CRF. His creat stays under 2 as long as we give fluids every other day. His BUN is only slightly elevated. I can't remember his exact numbers. His urine specific gravity is always low.
Sandy
 
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