Marvin Labs Update - Previous thread in post

https://www.felinediabetes.com/FDMB...in-dosing-advice-please.262465/?_params=Array

Just returned from the Vet and the news is much better than previously thought.

He does have Stage 2 chronic kidney disease and a slight heart murmur was detected.

Sent out a urine culture test to check for any infections and will get results in 3-4 days.

As for his diabetes, I showed her his spreadsheet and the picture of the weirdly colored ketone test strip. She couldn't explain the color but suspects he didn't really have any ketones because of how quickly he got a negative result. We are going to stop insulin and see if he is truly in remission. If he isn't we are going to switch to Lantus and go from there.
~ Blood Glucose was 97

She recommended to continue with his high protein low carb diet and sub-q fluids. Suggested getting urine test strips that detect both ketones and glucose. Re-check appointment in 1-2 weeks.

As far as how he is doing today, he freaked me out when he leapt off the bed across to the dresser that I was standing in front of. I think he is feeling better

Not sure if I inserted these photos correctly , please let me know if I need to make them bigger.
If you have any advice or opinions on anything I should do differently please let me know.

Thank you again for all your support and help!
Kwyn & Marvin

 

Well I like this one much better already! I do agree Lantus would be better, it's much better at these lower doses and numbers. There are pretty cheap generics out now, but you would need U100 syringes.

I'm a little concerned (perplexed is perhaps a better word) the kidney numbers changed that drastically...perhaps all the fluids helped, perhaps old vets machine is way off, who knows.

The only thing I disagree with is the urine glucose strips (and the AlphaTrak note I saw). Those only detect glucose when the cats BG is over renal threshold, which for most cats is in the 200 range. I would just continue to spot check him with your regular meter 2-3 times a day.

Some of the hematology hints at anemia, did she say anything about that?

 

@Suzanne & Darcy

 

I definitely liked this vet much better! She was a locum so I may not see her again but I have been happy in the past with the vets that I have seen at this clinic.

She did mention that the dehydration could be the cause of the high numbers. I don't recall that she mentioned anemia, she mentioned a lot of stuff I will check back with her on that.

I have no plans to get an AlphaTrak and won't worry about the ketone glucose strips. I definitely will spot check glucose throughout the day.

He has improved so much thanks to you wonderful people! I am so grateful!!

 

There's a lot to be happy about in these new labs. Did she say she thought the phosphorus could be a little lower? I would like to see 4 (but he's almost there now.) However, I think at the level where he is now that you would be good with Epakitin probably once a day. What changes did you make to his diet since the much higher phosphorus reading (was it just the Epakitin?) I would not even change to the renal foods at this point. He needs the protein for lean muscle mass. Save those for later.

I can already tell that this vet was way better than the other one. I would continue with the sub-q fluids. Did she say to do that? You can cut it back to 50 mL if you want to as long as he is still eating well and doesn't seem nauseated (remember the tooth grinding thing.) Honestly, his BUN is only a little out of range. His Creatinine is still within range. I'm glad they're culturing the urine. I don't like the white cells in there. That will negatively affect blood results as well (if there's a UTI.) I see a star by the HCT. She is noting, I suppose that it's on the lower end of normal. At this point, it would be a good idea to start giving Marvin one gelcap of B-Complex each day. I used Jarrow B-Right B Complex capsules (it's the most popular B-Complex among the people on the tanyackd support group.) Now you have to divide up the B-Right capsule to get cat sized doses. So you need to buy gelcaps (size 4 - available on Amazon) and buy some super tiny spoons (also on Amazon.) My son made me a little stand for the gelcaps out of Lego (snapped four flat strips of Lego together to make a kind of rectangle). The back side of the Lego holds size 4 gelcaps nicely. I divide the large gelcap up into ten size 4 gelgaps using the tiny spoons. That can help with anemia until it gets to the point where ESAs are needed (erythropoietin stimulating agents).

 

Also, a weekly injection of methylcobalamin (B-12) is very important for cats with CKD (to ward off anemia.) You can get a vial from your vet. I just use insulin syringes to draw it up.

 

I'm linking the page on Anemia so you won't think it's just my "idea" about the B-Complex, etc. I'd say he's good for now, but I don't want to see that HCT drop.
http://felinecrf.org/anaemia.htm

 

Thank you for all this information.

In terms of food change I have been trying to transfer him to low carb low phosphorus food but he has not been interested in it and I have just been using the Epakitin but for maybe only the last week. She was starring and underling as she was showing me the numbers. I really should have taken notes myself, it was a lot of information. I will continue with the Epakitin.

I did mention the tooth grinding to her as a potential sign of nausea and she said he also has some dental disease which could be the cause of it. She said to go ahead and use the appetite stimulant that I have and see how he does with it.

She did say to continue with sub-q fluids. She said 100 mL but I can do 50 mL. that's what he seems to tolerate per session.

I will get the B-Complex Gell caps and call about the B-12 injections.

Thank you again for all your help!

 

Sometimes dental problems can cause them to not want to eat. Pain can make them sometimes do the tooth grinding thing. I worry now that he has kidney disease that they won't be able to put him under anesthesia and so the dental problems are probably something he will have to live with so as not to risk further damage to the kidneys.

I'm so happy that Marvin is leaping onto dressers! You should let him out of his room now. Get those other cats on a feeding schedule. It would be better for them, too. (sorry, you don't want to hear that... I'm just thinking it would be nice for Marvin, too.)

I think the Epakitin could have helped even just for a week. Plus I think he was having a kind of "crash" when he had that bloodwork done.

 

I absolutely agree that I need to get them all switched over to better food and on a schedule, it will be better for all of them for sure!

 

I will come up with my plan of action for a schedule for the others and get this boy out of the bedroom tomorrow.

It has been a while since I have seen him sleeping all sprawled out instead of in a tight little ball.

 

That is one happy cozy kitty!

 

Oh, I'm going to call my daughter to see this picture of Marvin. She's been rooting for him. She's going to be really happy when I tell her about his better kidney numers (she's my nurse assistant for caring for the sick kitties... well... and the well kitties too... she does so much!) But that photograph says a LOT! He's comfortable and feeling well. This is sooooo good!

 

Tell your daughter thank you for rooting for him. She sounds like she is just as wonderful as her Mom!

 

I would do the 50 mls of subQ fluids a time, not the 100 mls if he has a heart murmur.
Also can you test daily for ketones while he’s off the insulin please…….
Beautiful photo!

 

Yes I will do 50 mL at a time and test for ketones daily.

Thank you so much for all your help!

 

@FrostD @Suzanne & Darcy @Bron and Sheba (GA)

Hi,

Just a little update, Marvin's urine culture came back negative, yay!

Picking up Methylcobalamin tomorrow and the Jarrow B-right B complex arrived, just waiting on the size 4 capsules and miniature spoons and we are good to go.
That being said, pilling a cat is not one of my skills if I can't get it to work can I just dissolve it in a syringe and give it that way?

Also his appetite is getting better and I haven't noticed any teeth grinding today.

Thank you so much!!

 

That is excellent news... especially that part about his appetite! I love it. Do you have a piller... aka pill shooter/pill gun? Here's a link to the one I use. It's wonderful. The tip is a flexible silicone tip that holds the pill and then you open their mouth (lots of youtube videos on this)... I kind of hold the top of their head and tilt back a little and use the piller tip to coax the mouth open... stick the piller to the back of the throat and shoot the pill in.

 

https://www.amazon.com/H-bar-s-10655-Pet-Piller-by/dp/B00GYA1I1K

oops... forgot to attach the link. I like these, but there's another kind that some people find easier... I'll link that one too. I see Amazon is out of stock right now, but a tone of places sell this model of pill (and a lot of vets have them) ... oh... here's a similar one. I just don't want to jam a hard plastic thing into their mouth... so I look for one with a soft/flexible tip... because sometimes it touches the back of their throat.
https://www.amazon.com/Pet-Piller-Dogs-Cats/dp/B00061MOGG/ref=dp_prsubs_1?pd_rd_i=B00061MOGG&psc=1

 

Did any other labs come back? Or did the holistic vet only check the urinalysis? I think that's what she did, right?

 

You could... but Marvin is not going to like it. B vitamins are notoriously yucky tasting. I actually hate taking them myself.... Not as bitter as some meds, but just kind of nasty.

 

I see he's doing just great in the blood glucose department with no insulin. This makes me happy. Don't forget to keep updating us as you can on his progress (even though he's not right now on any insulin.) I often think of people and cats who have disappeared and wonder how they are doing.

 

Yes just the urinalysis, she wasn't a holistic vet as far as I know, just a locum filling in.

I will do my very best to get these pills in him.

I will absolutely keep you updated. I have to keep myself from bothering you all everyday since I am so incredibly happy that he is doing so much better thanks to you all!!!

 

It’s never a bother! My “reward” is to hear about Marvin doing better!

 

On the contrary! It's nice to open threads with happy reports

 

Just popping in with an update on Marvin. @FrostD @Suzanne & Darcy @Bron and Sheba (GA)

Saw the vet this morning who confirmed remission (not that I really needed him to ) 14 days OTJ

What should my BG testing look like going forward? Still a few times a day? Once a day? Once a week? Should I still monitor for ketones daily?

Did kidney value lab with a slight improvement in his BUN and Creatinine from 2 weeks ago. Attached labs. This is a different vet at the same clinic and he suggested reducing his sub-q fluids to every other day which I don't think I am comfortable with. I am not looking to change something that seems to be helping.

Also I have switched all the other cats to wet food and on a feeding schedule so Marvin now has free rein of the house again. He is a happy boy

Next check up in 3 months.


Thank you all again to much for all your help and advice, we wouldn't be where we are without you!