One last try for answers

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Mariana

Mariana

Member Since 2020
Hello,

My Cat frank was diagnosed about two months ago and his diabetes pretty much never was regulated and his numbers never went below 350. In the past couple of weeks his health has declines significantly, he has stopped eating, lost weight and is overall in a very bad state. We took him to the vet on 12/11 where he got fluids and antibiotics and the Dr did blood work, she told us that it may be liver cancer, however on 12/12 she called to say that he was in complete kidney failure and that she was baffled b/c his blood work two months ago did not show any kidney issues and she did not know why this was happening. She again gave him fluids on Saturday and we brought him again this past Monday for a check and fluids. In the past four days he has barely eaten. He did eat one pack of food yesterday after she gave him famotidine. He is also still on Baytril, famotidine tablets, cerenia and a phosporus binder along with getting his regular insulin twice a day at 7 units. His sugar is still off the charts. The vet said during Mondays appointment that we should think about letting him go.

I'm just so confused how he could deteriorate so quickly and how two months ago his kidneys can be fine and now in failure and she doesnt even know what it means. We are considering making an appointment for end of the week to let him go but i'm praying for a miracle that somehow he improves by end of the week. We are in shock and completely destroyed over this to have him go from a normal healthy cat to having to let him go in under 3 months.

Any input is appreciated. Thank you.

BLOOD WORK: https://drive.google.com/file/d/1Sx0ilgwFwEPBYBebAz1TAXsjT5_OI2Ef/view?usp=drivesdk

Previous posts:

https://www.felinediabetes.com/FDMB/threads/new-diagnosis-need-input.236845/#post-2663390

https://www.felinediabetes.com/FDMB/threads/is-insulin-even-working-high-dose-but-no-change.237681/
 
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Mariana said:
Hello,

My Cat frank was diagnosed about two months ago and his diabetes pretty much never was regulated and his numbers never went below 350. In the past couple of weeks his health has declines significantly, he has stopped eating, lost weight and is overall in a very bad state. We took him to the vet on 12/11 where he got fluids and antibiotics and the Dr did blood work, she told us that it may be liver cancer, however on 12/12 she called to say that he was in complete kidney failure and that she was baffled b/c his blood work two months ago did not show any kidney issues and she did not know why this was happening. She again gave him fluids on Saturday and we brought him again this past Monday for a check and fluids. In the past four days he has barely eaten. He did eat one pack of food yesterday after she gave him famotidine. He is also still on Baytril, famotidine tablets, cerenia and a phosporus binder along with getting his regular insulin twice a day at 7 units. His sugar is still off the charts. The vet said during Mondays appointment that we should think about letting him go.

I'm just so confused how he could deteriorate so quickly and how two months ago his kidneys can be fine and now in failure and she doesnt even know what it means. We are considering making an appointment for end of the week to let him go but i'm praying for a miracle that somehow he improves by end of the week. We are in shock and completely destroyed over this to have him go from a normal healthy cat to having to let him go in under 3 months.

Any input is appreciated. Thank you.

Previous posts:

https://www.felinediabetes.com/FDMB/threads/new-diagnosis-need-input.236845/#post-2663390

https://www.felinediabetes.com/FDMB/threads/is-insulin-even-working-high-dose-but-no-change.237681/
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Do you have a copy of the lab reports you could post? You said she gave antibiotics. Does she think it's a kidney infection? That would also raise bg numbers. I'm so sorry he's doing so poorly.

Not to scare you but I had a cat who deteriorated quickly like this and it was kidney cancer.

The high bgs make me wonder if it's an infection. Id go ahead and raise that dose again. You don't need to hold it as long as you are. If you don't see movement id raise again in a few days.
 
Mariana said:
I'm just so confused how he could deteriorate so quickly and how two months ago his kidneys can be fine and now in failure and she doesnt even know what it means.
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I like Janet wouod like to see the bloodwork results.

A couple of years ago I adopted an untreated diabetic, Chyna, from a shelter. The shelter did bloodwork and her kidneys were so-so. However, in less than two weeks her kidneys went into failure with the same symptoms you described. Before that I had cats go into kidney failure not long after bloodwork said kidneys wer so-so but the time was greater than the 13 days for Chyna.

I am praying that you have more good time with Frank.
 
Mariana said:
I just edited the post to include blood work. Any input is appreciated.
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OK so I don't think it's as bad as you think. The MAJOR problem I see is the anemia, and there's an infection! The kidneys are high end stage 2. Actually exactly what my cat is right now. With a little supportive care, cats can live quite a while in stage two. My cat has been in stage two for a year so far. OK so since he's on antibiotics, the anemia is the next thing to address. Anemia will cause lack of appetite and very low energy (I SPEAK FROM PERSONAL EXPERIENCE!!!) Your cat's levels are kind of on the boarder between mild and moderate anemia... Right away get him on B12 Meth supplements, and possibly some iron too. Let me link you to a page that explains it in detail. http://felinecrf.org/anaemia.htm
 
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JanetNJ said:
OK so I don't think it's as bad as you think. The MAJOR problem I see is the anemia, and there's an infection! The kidneys are high end stage 2. Actually exactly what my cat is right now. With a little supportive care, cats can live quite a while in stage two. My cat has been in stage two for a year so far. OK so since he's on antibiotics, the anemia is the next thing to address. Anemia will cause lack of appetite and very low energy (I SPEAK FROM PERSONAL EXPERIENCE!!!) Your cat's levels are kind of on the boarder between mild and moderate anemia... Right away get him on B12 Meth supplements, and consider some iron too. Let me link you to a page that explains it in detail. http://felinecrf.org/anaemia.htm
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Do you really think there is hope? They scheduled him for euthanasia for Friday but I don’t know if we should go through with it. I keep thinking this is my fault and likely is, we hadn’t taken him to vet for a couple of years we probably could have prevented this and I’ll never forgive myself
 
Caution is required when it comes to iron supplementation. From the Tanya's Site anaemia page linked in Janet's earlier post:

Cats without infections can be given iron in any form. Cats with an infection should not be given iron except possibly in the form of iron from meat.

[...]

You should not give iron to cats with a bacterial infection because bacteria thrive on iron. Therefore if a cat has an infection or inflammation, the cat's body will sequester iron (i.e. iron is stored away rather than released into the bloodstream) so as not to feed the bacteria. This means that the cat's body will be unable to use any iron you give it, but it may build up in the cat's liver.


In most cases, the infection or inflammation will only be short-term, and the cat will be able to manage without a supplement. If your cat does need an iron supplement during this time, you could ask your vet about obtaining iron via meat, which appears to be processed somewhat differently by the body and which therefore may be suitable.
​
[Emphasis mine]

Given that the labs point to a possible infection perhaps that should be your kick-off point for addressing the anaemia (in the hope that treatment of the underlying cause may improve/resolve it). Also, I'd recommend working in close consultation with your vet with regard to determining which supplements are/are not indicated.

Note: It's possible that a free catch urine sample might not test positive for an infection (due to low numbers of bacteria) and yet for an infection to still be present. I suggest reading the section on pyelonephritis and UTIs at Tanya's Site for more info on correctly diagnosing these problems (including the importance of doing a cystocentesis with culture and sensitivity).


Mogs
.
 
Mariana said:
Do you really think there is hope? They scheduled him for euthanasia for Friday but I don’t know if we should go through with it.
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Should it be that, when you contact your current vet, they are hesitant about at least trying to treat the infection then perhaps it might be a good plan to ask for a second opinion or an urgent referral to a renal specialist.

FWIW, my civvie, Lúnasa, is IRIS CKD stage III. At the end of July this year she was diagnosed with anaemia. Her haematocrit (HCT/PCV) was 21% (i.e. borderline for non-regenerative anaemia - normal feline reference range is 26-47%), and the vets were worried that it might be non-regenerative. The vets also determined that she had a UTI at the time (diagnosed via cystocentesis with culture and sensitivity). She was put on a 4-week course of antibiotics. In the follow-up blood work her HCT had recovered to 34%, showing the anaemia to be regenerative (thankfully!). There's no way to know whether the same might be true for Frank. I just wanted to share a real-world example of how clearing the UTI can possibly help when it comes to anaemia.

JanetNJ said:
Anemia will cause lack of appetite and very low energy (I SPEAK FROM PERSONAL EXPERIENCE!!!)
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I second this. (Also from personal experience. At one stage I did worry that Lúnasa might not have long left... :( )

Another heads-up: antibiotics can cause GI upsets (e.g. Clavamox). This didn't do Lúnasa any favours in the already poor appetite department. After a bit of a false start I was able to secure an Rx for ondansetron (for nausea management) and an appetite stimulant from our vets and that helped me to keep her eating during the antibiotic treatment. (She also needed a probiotic for diarrhoea.) As soon as she was clear of the antibiotics she perked up greatly. Unfortunately poor Lúnasa then developed another UTI (different infection type) so had to have another 4-week course of antibiotics. Second time around I was able to manage the GI issues proactively because I already had the meds to hand.


Mogs
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Mariana said:
Do you think maybe hospitalizing him would give him the best chance?
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Yes if you can afford it.

I do not like the really high phosphorus and the high total protein. High phosphorus makes a cat feel terrible and not want to eat. The high total protein indicate likely dehydration, and if corrected would result in the hematocrit (indication of anemia) being worse.
Further, the Reticulocytes (immature red blood cells) is in the normal range. If the body was responding to the anemia, the Reticulocytes should be high indicating that the body is producing a lot of red blood cells to correct the problem. Anemia is normal with kidney degradation since:
"Your kidneys help your body make red blood cells. Healthy kidneys make a hormone called erythropoietin (EPO). EPO sends a signal to the body to make more red blood cells."
from: https://www.kidneyfund.org/anemia/#:~:text=Your kidneys help your body,make more red blood cells.
 
My Zimmy, not diabetic but ckd, was boarderline anemic. A bit higher than your cat at 29 hct. We started him right away on b12 methylcobalamin and a b complex and in four weeks it was resolved. We did sub q fluids at home several times a week for about a year. In the end a stroke or hemmorage got him, not the ckd. Up until two days before he died he was doing great!
Mariana said:
Do you really think there is hope? They scheduled him for euthanasia for Friday but I don’t know if we should go through with it. I keep thinking this is my fault and likely is, we hadn’t taken him to vet for a couple of years we probably could have prevented this and I’ll never forgive myself
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These labs were taken BEFORE the fluid iv's, correct? I think after that and with more fluids given the BUN will be lower, as will the creatinine. It looks like he was pretty dehydrated. Sub q's are fairly easy to do at home. I did it for a year for Zimmy, and actually just picked up a bag of them for CC this week but haven't started giving them to her yet. Let me tag @Marje and Gracie who is good at reading labs to take a look and give you her two cents. I would also ask for an appetite stimulant. The famodedine is like pepcid so it will help a bit, but an appetite stimulant such as Mirtazapine could really help. The B vitamins may help with appetite as well. https://www.felinecrf.org/persuading_cat_to_eat.htm#appetite_stimulants
 
OH! Speaking of phospherous... fancy feast is HIGH in phospherous. You want to get him on a low carb, lower phospherous food. I feed many weruva foods. Although if he will eat the ff with the binder, that's fine. My cat gets really constipated from binders... So I use them really sparingly.
 
Thank you we just took him in to get more fluids and she will do some more blood work. I forgot to ask about appetite stimulant but will email as he is barely eating at all.
 
JanetNJ said:
My Zimmy, not diabetic but ckd, was boarderline anemic. A bit higher than your cat at 29 hct. We started him right away on b12 methylcobalamin and a b complex and in four weeks it was resolved. We did sub q fluids at home several times a week for about a year. In the end a stroke or hemmorage got him, not the ckd. Up until two days before he died he was doing great!

These labs were taken BEFORE the fluid iv's, correct? I think after that and with more fluids given the BUN will be lower, as will the creatinine. It looks like he was pretty dehydrated. Sub q's are fairly easy to do at home. I did it for a year for Zimmy, and actually just picked up a bag of them for CC this week but haven't started giving them to her yet. Let me tag @Marje and Gracie who is good at reading labs to take a look and give you her two cents. I would also ask for an appetite stimulant. The famodedine is like pepcid so it will help a bit, but an appetite stimulant such as Mirtazapine could really help. The B vitamins may help with appetite as well. https://www.felinecrf.org/persuading_cat_to_eat.htm#appetite_stimulants
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Yes labs were on Friday before fluids.
 
Larry and Kitties said:
I have given generic Miralax when I give binders to avoid constipation.
Is Frank amenable to syringe feeding? I have syre fed in the past and my civi Moxie not gets syringe fed about 75% of her calories. This has been going on for years.
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He is a good boy and let’s me do what is needed I think we may be at that point so I’ll try that tomorrow. We do have miralax as well.
 
Mariana said:
Thank you we just took him in to get more fluids and she will do some more blood work. I forgot to ask about appetite stimulant but will email as he is barely eating at all.
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Ask about whether ondansetron might also help with the nausea. Several members here have reported that Cerenia and ondansetron can be used in tandem, since they have different modes of action in the body.

Has the vet said anything about whether the problems could possibly be due to an acute kidney issue, rather than a chronic one (especially as Frank's labs were good only 2 months ago?).

Should it transpire that the kidney issue is thought to be an acute rather than a chronic/late IRIS stage problem then another thing that might be worth asking the vets about is whether a feeding tube could be placed to provide temporary support to enable Frank to receive adequate nutrition and get started on treatment until he might hopefully get his appetite back and start eating under his own steam again. (Note: I'm brainstorming here. I don't know whether this would be a feasible/appropriate treatment option.)


Mogs
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Larry and Kitties said:
I have given generic Miralax when I give binders to avoid constipation.
Is Frank amenable to syringe feeding? I have syre fed in the past and my civi Moxie not gets syringe fed about 75% of her calories. This has been going on for years.
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Yes , I have a thing of Miralax for her and lots of pumpkin.
 
keep in mind that antibiotics do a number on the stomach. My cat gets the runs and doesn't eat much when she's on them.
 
The vet called this morning said his numbers have gotten worse and asked if he maybe ate some type of plant which I don’t believe he did. She pretty much said it’s hopeless and we should let him go this Friday. We will give him fluids one last time today to keep him comfortable, should I stop the Anyibiotics will that help him stay comfortable? I am devastated and can hardly breathe this is so hard.
 
One thing I noticed yesterday and this morning is that he is often going to litter box and only a little comes out. Still drinking a lot too so I dunno if this is just normal once his kidneys are shutting down.
 
Mariana said:
The vet called this morning said his numbers have gotten worse and asked if he maybe ate some type of plant which I don’t believe he did. She pretty much said it’s hopeless and we should let him go this Friday. We will give him fluids one last time today to keep him comfortable, should I stop the Anyibiotics will that help him stay comfortable? I am devastated and can hardly breathe this is so hard.
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I am so, so sorry. From what I’ve read up thread, it seems like our very knowledgeable members believe there is hope. Is there a possibility you could get a second opinion? It bothers me that your vet is suggesting to let him go. :( Maybe a second opinion from a different vet could give you a treatment plan for your precious frank. Sending love!
 
Little Bit’s Mom said:
I am so, so sorry. From what I’ve read up thread, it seems like our very knowledgeable members believe there is hope. Is there a possibility you could get a second opinion? It bothers me that your vet is suggesting to let him go. :( Maybe a second opinion from a different vet could give you a treatment plan for your precious frank. Sending love!
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He’s been in this state now 6 days I’m worried the damage is severe, I wish I had just taken him to the hospital right away and now worry it’s too late. He’s really in a sad state can’t walk his legs r like spaghetti and bow out like a frog, he tries to make it to litter box but has to drag himself so we help him along. His third eyelids r always covering half his eyes, Are these not signs that it’s too late?
 
Mariana said:
He’s been in this state now 6 days I’m worried the damage is severe, I wish I had just taken him to the hospital right away and now worry it’s too late. He’s really in a sad state can’t walk his legs r like spaghetti and bow out like a frog, he tries to make it to litter box but has to drag himself so we help him along. His third eyelids r always covering half his eyes, Are these not signs that it’s too late?
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Oh goodness. :( That’s hurts my heart. That is totally your call. A second opinion would never hurt though. So sorry you’re both facing this.
 
My 19 year old cat Tony was hospitalized for 5 days right after his initial diagnosis. He already had stage 2-3 CLD and his BG was through the roof. He went in skinny and hungry and thirsty and with bad neuropathy. But he came out of emergency hospital WAY worse. He was utterly unable to stand or walk at all. He could barely raise his head. And he’d developed anemia which had his RBC at 11%!! He also had a heart murmur and persistently high sodium.
I made an appointment to have him euthanized to put him out of misery. But an angel of a hospice doctor told me to hold off a few days since he was still eating and drinking. Literally, he was as inert as a pancake - peeing and pooping on himself because he couldn’t stand AT ALL.
Now 2 months later, he is playing, jumping up amd down on whatever furniture he wants, his anemia is gone, his sodium is normal, he’s gained weight, his sugars are under control (almost too low at times), and his neuropathy is pretty much gone.
All this to say....do not give up hope if you feel there is a glimmer of hope. I personally feel that while the hospital was good for his initial critical care, he deteriorated terribly by staying there too long, and there’s nobody who will care for your baby and make him feel safe and loved the way you will. If, god forbid, he passes in your arms, at least you will know you didn’t jump the gun. These are incredibly hard decisions...but it’s also an entirely valid decision to give him more time to rebound, even if that means a natural death ultimately.

My heart is with you. Beat of luck!! Any decision is ok.
 
We just brought him to the hospital I pray that we get some good news and if not it will be knowing we did all we could for him.
 
Prayers for Frank and you as well Marina.. I was super lucky with Vengeance when I took him into vet my vet actually mentioned putting him to sleep his 2nd day in the hospital being he was not getting better... his was in keto and severely dehydrated and etc.. and I said NO do what you have too.. they did get him well enough for me to bring home and thanks to the people on here hes now doing super super well so I was very very lucky... Prayers that Frank can make a comeback that someone will be able to get him the helps he needs.. if not know that you tried the best that you could.. I had to let go one of my outside cats back in Feb he had developed feline leukemia and HIV and it was going to be too hard a fight on him to battle so had to let him go chase the mice in the forever fields... its a hard thing to decide and my heart goes out to you...
 
We let him go, he was too far gone. I can’t breathe, thank you all. I hope I see him again, my god this hurts.
 
Thinking of you...

I know it's not much right now, but try to hang on to the fact that you got him to the place where, if it had been at all possilble, Frank would have got the very best help. And he *knew* you were fighting for the best for him. You are his Person. You will always be his Person.

:bighug::bighug::bighug::bighug:

(((Mariana and Spirit Frank)))

I hope you manage to sleep - even if it's just out of complete and utter shock and exhaustion. And if you feel numb for a while, try to embrace the numbness, flow with it. It's your body trying to do what it can to cushion your mind and heart a little against the terrible pain - even if it's only a little bit of surcease, it helps.

((((((((Mariana))))))))


Mogs
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Larry and Kitties said:
I have given generic Miralax when I give binders to avoid constipation.
Is Frank amenable to syringe feeding? I have syre fed in the past and my civi Moxie not gets syringe fed about 75% of her calories. This has been going on for years.
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I do a lot of syringe feeding because of pancreatitis, sometimes for 5 or 6 weeks at a time. After a while sometimes he is not real agreeable, but hey it keeps him going.
 
So so sorry my heart goes out to you :bighug::(.. always remember they never truly leave us they are always just there out of the corner of our eye watching over us.. Frank knows that you did all you could and that sadly it was his time.. he is always in your heart your memories always a part of you no matter what.. again so sorry for him having to let go.. just know hes not suffering and that you gave each other the unconditional love cat_wings>o
 
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