More Pippin - overwhelmed and upset

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kelthulu

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Hi, all. Yet another update on my Pippin.

We took him to our vet yesterday to have his renal values rechecked. Today, his BUN and creatinine are slightly elevated (42/2.5); they were normal Monday. :( The good news is he's eating well, active, and quite perky, and he maintained his weight for the first time in a really long time for a whole week (he was the same yesterday as he was last Thursday, instead of losing). I spoke with our internal medicine vet, and she reminded me that a) they're just numbers and b) since he's had a kidney infection for more than a month, his kidneys may very well need more time to recover and heal as he responds to the antibiotics. She wants us to recheck them the week after next, in addition to starting blood sugars again and continuing to watch his appetite and behavior closely.

I'm so disappointed. I had hoped that the worst of this was over, and Pippin was on the mend. I can't stop crying. I'm trying to be positive and hopeful, but it's just not working. I know that if he ends up having a little chronic kidney disease, it isn't the end of the world but I just feel so badly for my little guy. I feel like we're up to three strikes against him: diabetes, kidney disease and probable heart disease. Can't someone cut my little guy some slack? I'm freaking out, and of COURSE I'm going to do everything I can for Pippin, but I'm at the completely overwhelmed stage again. I'd like off the rollercoaster, please and thank you. I'm scared that none of this is ever going to be manageable.

My logic tells me Pippin IS better, and we're treating the cause of the kidney issues. My heart tells me OHGODHESGOINGTODIE and itsallmyfault. My logic tells me this isn't actually a setback, but my heart is telling me it's the end of the world.

Update - as I was writing this, the covering vet for our primary vet called, and she feels he might benefit from subQ fluids a couple times a week for now. I talked to the specialist about this, and she feels it won't hurt, but it isn't necessary. I talked to Pippin about this, and now he's hiding under the bed. (Ha. Well, I think he's generally feeling picked on right now, with the antibiotics and insulin and blood sugars.) I had been waffling, but I think since Pippin's feeling so picked on, the IM vet says we can cut him some slack, and his values aren't overly high, we'll hold off.

Just... still feeling very overwhelmed, still, and trying not to see this as a setback. :(
 
Hi sorry, I don't know your full story, but here is the bottom line - you are doing everything you can for Pippin. Sadly, things happen to our loved ones and it can be very overwhelming. The good news is, you are doing everything you can for Pippin.

As I've told another friend, please check the bottom of his paws - all of them. Tell me what you see... I'll wait. What's that you say, you see paws, fur, paw pads, nails....is that all you see? Tell me what you don't see -- you don't know - ok I'll tell you what you don't see, you don't see an expiration date on there do you.

Well do you?

so, let's regroup, stop the tears, put on the big girl pants and deal with the situation with a positive outlook.

And if the vet is recommending fluids, that may not be a bad thing. ask them to teach you how to do it, so you can administer it at home. And it's a great skill to learn when you don't have to be panicked about it.

Hope this helps.
 
I haven't been around much in many days as life has been crazy along with I have one that is sick right now too so I too am not familiar with what's been going on with Pippin.

I just wanted to add my $0.02 about the kidney numbers and the subq's etc.....

I thought I was losing my 17 year old LePew yesterday. He went blind a little over a year ago because of high blood pressure and he was soon thereafter diagnosed with very early kidney disease. Recently his numbers started to climb and the vet recommended starting him on subq fluids. Unfortunately we have been dealing with a perinephric cyst around his right kidney since about February this year and there was concern that the subq's could increase the speed at which his cyst fills up and the frequency at which we have to have it drained for him. Well, I can tell you this, in October his BUN was 51, and his Creatinine was 3.9. We started him on subq fluids about that time I believe. Right away, and very oddly, we noticed the fluids actually slowed down the filling of his cyst. a big plus :smile:

Wednesday night this week we were convinced his kidneys were shutting down. He was fine tuesday night, and pretty much non-responsive wednesday night, wouldn't drink, eat, or barely move. Something we had seen with another of our elder cats 2 years ago. We got him to the vet early thursday morning and laid out a plan. We were gonna test his kidneys and if the BUN was over 150, yes, his kidneys were done and we would let him go. If they were not that high, we'd proceed with further testing to see what else was going on.

His BUN was 30 and his Creatinine was 3.5. BETTER than they were in October. The only change was the addition of the subq fluids. WOOOOOOHOOOOOOOO!! I would get to take my boy home again!

Last night when I picked him up from the vet, he gave me some attitude momentarily, hissing his smelly cat breath at me, and then talked to me all the way home. Once home he got himself to the water bowl several times, without his legs giving out on him, and he climbed up on the couch and sat there with his head held high like nothing had happened. Turns out he had a raging fever and an infection.

My point is I guess, don't be afraid of the fluids. Your kitties kidney numbers aren't really that bad yet and fluids can and will help, whether you start them now or a month from now. You just don't want to wait too long. I think of it as dialysis for kitties. Without it, we'd lose our loved ones alot earlier.

(fwiw, the reference ranges for my vet is BUN 16-36 and Creatinine .8-2.4)
 
Thank you both for the replies.

The issue I'm having with the fluids is not doing them; I had them show me how at the vet this afternoon. The issue I'm having is that I have two vets telling me different things. One is the relief vet sitting in for Pippin's usual vet, and the other is the internal medicine specialist who has been managing Pippin's case starting last Friday when he went into the hospital. The relief vet says to do the fluids. The IM vet says doing the fluids won't hurt, if it doesn't stress Pippin out, but it's not necessary right now. She feels his kidney function may continue to recover as we treat the pyelonephritis. So... I'm sort of torn. Pippin is acting stressed today, so I may wait and see what tomorrow brings.

The truth is, if we hadn't gotten the labs back, I would think Pippin is continuing to improve every day. His appetite is great, he didn't lose weight this week (seriously, I think it's been > 6 weeks since that's been the case), he's active and perky (except when he's mad at me) and his coat looks great. I am reminding myself to treat the patient, not the number, and to have some patience.

That being said, I have a call out to the vet who knows Pippin best, his primary vet (not the relief one). I left him a 'this isn't urgent, but this is the situation, if you can give me a call when you have a minute' voicemail, which he has invited me to do throughout this process. I'm hoping he can give me some guidance, but like I said... I'm going to see how Pippin looks tomorrow and go from there.

In other news, his pre-shot BG at noon was 433, and his 6-hour post was 315. It's not great, but I'm glad to see the Lantus doing something. Again, the IM vet doesn't anticipate we'll see those really start to improve for another week or two, given the infection is likely causing insulin resistance.

Again, thank you for the support and words of wisdom. What I most need to know is that this can be done, and Pippin can still have a good quality of life, even if it ends up being life with insulin, blood sugars and SQ fluids. I'm hoping he won't need all that, but I'm afraid if he does, he'll be miserable and hate us.
 
What you might be able to do is select foods that are both low carb AND low phosphorus, to help rest the kidneys a bit. Binkys Page will list some of these, as well as the CRF links that have been posted in Feline Health several times.
 
BJM said:
What you might be able to do is select foods that are both low carb AND low phosphorus, to help rest the kidneys a bit. Binkys Page will list some of these, as well as the CRF links that have been posted in Feline Health several times.
Click to expand...

What do we consider a low phosphorus content, appropriate for renal kitties? (I'll take a look at the CRF links, while I'm at it...)
Thank you! Good news is so far, Pippin's phosphorus has been okay. I hope to keep it that way.
 
i aim for as close to 200 or under on the phosphorous. fwiw, Friskies Special Diet foods have a few flavors that are both low carb (diabetes) and low phosphorous (crf)
 
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