Princess Krakens successful Vet trip, but now is back on Kidney meds.

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Kitty Anderson

Kitty Anderson

Member Since 2019
Princess had a trip to the vets today. I was worried that the vet wouldn´t listen to what I had to say as I have had that experience before with another vet who used to be at that vet´s office.. For background see here: http://www.felinediabetes.com/FDMB/...-in-22s-400s-to-over-33s-close-to-600.211353/
Note I use U100´s with U40 insulin and give dose with U100 markings in brackets.

However, it went really well. The vet wasn´t aware that a cat´s first Nadir would be earlier than a dog´s Nadir or that they often had 2. After seeing Krakens curve for Saturday she fully agrees that her previous dosing was way to high and that my actions were the correct ones. While Lantus isn´t available for cats here then she is perfectly fine with working on that shift with me if I can get it myself, I won't be able to probably before April 16th so we will see how she is doing on Canininsulin until then.

Her creatine is elevated again (148-219) so back on Enalapril 2.5 mg (half tablet) and I´ll be administering fluids under the skin (subcutaneous) to help her flush out. I´ll also look into the phosphorous content of her food and try to limit her Phosphorous intake. Looking into if Omegas are beneficial.
We will be home urine testing on the regular now to monitor and she has another appointment for bloodwork in 2 weeks.

Anyone with experience in diet management for diabetic cats with kidney disease? I´ll be reading up on that tonight and tomorrow.

Her BG are bit high today due to less insulin. I did her PMPS last night and it was 9.8 (176), planned to do a +1 but had a minor noncat related emergency pop up and couldn´t retest until +2 when she was 17.8 (320) (part food, part no insulin) so I gave her a third of the dose or 0.1 U (0.25 u100), did a check two hours later (+4) and she was 11.6 (209), had planned to get up for a four hour after shot test (+6) to base the morning dose on but when my alarm went off Kraken jumped on my chest, licked my face and lay down on my chest/neck. I planned to let her snuggle for a couple of minutes and dozed off again... :/ So with a 241 reading and us going out at her Nadir I went with a 0.2 (0.5 U100) which was a little to low. She would have been good at 0.3 (0.75 U100).
Note: While I´m new to feline diabetes I have a lot of experience in the humanoid variety, not transferable but the unconventional dosing wasn't quite pulled out of thin air.

Princess has been happy and active today, unlike past vets visit´s when she would just snuggle down into her sling carrier on the way this time she had her head out, was looking around and telling people off who didn't stop to say hi and giver her a pet. She´s been going places she hasn´t been able to get to for a while now. Her sister has also stopped avoiding her. She even tried to ambush Kraken today but stopped short when she saw me looking at her (ambush is her jumping out onto Kraken, usually leads to Kraken putting her paw on Mandla´s head and pushing it down and then they fall into a pile and clean each other)
Kraken has also started grooming again!!! yesterday and today.

Things are looking up and I hope to have Princess Kraken fairly stable soon :)
 
:bighug: THANK YOU!!

Here´s Princess Kraken in her carrier to say thanks!
 

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Good overall report for Princess K, sorry about the kidney values. Was it just the Creatine that was high? Or were some other values out of range too? Did they run an SDMA?


Kitty Anderson said:
I´ll also look into the phosphorous content of her food and try to limit her Phosphorous intake.
Click to expand...
The felini supplement I gave you a link to also do one that's phosphorus free for CKD cats.
https://www.zooplus.co.uk/shop/cats/supplements_specialty_cat_food/vitamins/569069

George has early CKD IRIS stage 2-3
I've been feeding lower P foods (under 1%), they are all in that list I gave you, and I add a little water to every meal/snack he gets to keep him well hydrated and so far that has kept him stable.(paws crossed).

Prescription kidney diets are not a good choice, too high in carbs, better to be feeding a high quality protein diet. Diabetes takes precedence at this stage you want to aim to have her below the renal threshold as much as possible, it varies from cat to cat but as a general rule (below 200).
Tanya's site is super informative,
https://www.felinecrf.org/ there's a huge amount of information, on treating, and managing CKD and further reading, if you are struggling to find some info just shout.
 
How good she's feeling better and in the mood of playing

What exactly are her creatinine values I'm guessing when you say is 148-219 you mean she's stage 2, like George mentioned look for low carb low phosphorus diets do not go for renal diets at this stage because they are way high in carbs and getting her diabetes out of control will damage her kidneys more.

Why was she given Enalpril does she have high blood pressure?

Did the vet mentioned she's dehydrated ? usually subcutaneous fluids are given when creatinine levels they are consistently over 300 - 350 , when they were very high at diagnose or dehydrated if this is not the case is better to do as George mentioned add water to everything she eats, water taken orally is always better than subcutaneous even though subcutaneous fluids are a great resource once the CKD advances.
 
Sheba had early CRD as well as diabetes and I fed her a home prepared diet. We had no complete supplement I could buy here in Australia to add so I used to make my own. I also made my own egg shell powder (to replace the calcium source as it is very low in phosphorus) which is very easy and quick. Here is a link to a discussion about the diet I used. You may be interested in it. You don't have to use the same muscle meats I used..
http://www.felinediabetes.com/FDMB/threads/home-prepared-diet-of-crd-cats.150441/
 
Gill & George said:
Good overall report for Princess K, sorry about the kidney values. Was it just the Creatine that was high? Or were some other values out of range too? Did they run an SDMA?



The felini supplement I gave you a link to also do one that's phosphorus free for CKD cats.
https://www.zooplus.co.uk/shop/cats/supplements_specialty_cat_food/vitamins/569069

George has early CKD IRIS stage 2-3
I've been feeding lower P foods (under 1%), they are all in that list I gave you, and I add a little water to every meal/snack he gets to keep him well hydrated and so far that has kept him stable.(paws crossed).

Prescription kidney diets are not a good choice, too high in carbs, better to be feeding a high quality protein diet. Diabetes takes precedence at this stage you want to aim to have her below the renal threshold as much as possible, it varies from cat to cat but as a general rule (below 200).
Tanya's site is super informative,
https://www.felinecrf.org/ there's a huge amount of information, on treating, and managing CKD and further reading, if you are struggling to find some info just shout.
Click to expand...


No SDMA. Her Creatin increased from 148 to 219 in just over a month. If the SDMA needs a seperate vial of blood it might have been that. We needed to administer subcutaneous fluids for a leg vein to be usable... And just got that one vial barely. Her veins have always been super tiny.

I've gone through the food list thoroughly but I can't find any of the food here. A couple of brands yes, but only the dry kibble versions. One of the petshops has there website down for maintenance and one doesn't have a website. I'm going to try and get there this week. I can't tomorrow because I have my human doctors appointments tomorrow and need to go to the pharmacy for more lancets and don't want to leave her home alone to long. But I'll keep looking. And from April them homemade. I'll be ordering the renal additive! Thank you!

I'll also be sending an email to the company that produces the food she is eating asking about phosphorus levels. Its the lowest carb wet I've found that she eats. It is high fat though..
And expensive. But if I don't find other options then I think she will be OK on this until mid April. I did some cost calculations and depending on the time of year will cost 15 to 25% of current diet, 15% in fall or if I include cheaper meat like horse meat. If I were not to supplement then even cheaper as hearts, livers, chicken necks, sheep's blood and such are super cheap and readily available. And I have farmers in my family.

ETA.. Supplement as in the full mix I would always supplement taurine.
 

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Veronica & Babu-chiri said:
How good she's feeling better and in the mood of playing

What exactly are her creatinine values I'm guessing when you say is 148-219 you mean she's stage 2, like George mentioned look for low carb low phosphorus diets do not go for renal diets at this stage because they are way high in carbs and getting her diabetes out of control will damage her kidneys more.

Why was she given Enalpril does she have high blood pressure?

Did the vet mentioned she's dehydrated ? usually subcutaneous fluids are given when creatinine levels they are consistently over 300 - 350 , when they were very high at diagnose or dehydrated if this is not the case is better to do as George mentioned add water to everything she eats, water taken orally is always better than subcutaneous even though subcutaneous fluids are a great resource once the CKD advances.
Click to expand...


She was 148 in January and 219 now. I entered her bloods and urines in her labs on SS.

She got subq fluids today to make a vein take the needle. She is still bit dry after her ordeal the last weeks. We would have given her a little IV if she could have handled a catheter, since she was being pricked anyway.

I add a little water then when she's done I add more water to the scraps left iand mash them down to make the water smell meaty and she loves that. She also likes the tap

She has had repeated dehydration in the last few months so we just want to boost her a little bit before my next trip. She's not getting Subq every day. But probably a couple of times before I leave. She's super good with getting subq.

ETA enalapril. She's on a smaller dose than for blood pressure . That's what they give for kidneys here..
Kidney issues are my next study project. So I'm just starting to learn there.
 
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Bron and Sheba said:
Sheba had early CRD as well as diabetes and I fed her a home prepared diet. We had no complete supplement I could buy here in Australia to add so I used to make my own. I also made my own egg shell powder (to replace the calcium source as it is very low in phosphorus) which is very easy and quick. Here is a link to a discussion about the diet I used. You may be interested in it. You don't have to use the same muscle meats I used..
http://www.felinediabetes.com/FDMB/threads/home-prepared-diet-of-crd-cats.150441/
Click to expand...

Thank you! I'm going to read up on this before I decide to order full mix or just taurine!
 
I relation to liver, hearts, kidneys etc. they are all high in phosphorus, especially liver, so you need to limit the amount of them with a CRD cat. I used to give Sheba a small piece of liver each day about the size of the top joint of a finger for vitamin A which they must get. Some supplements have vitaminA in it so you don't need to use the liver. With the hearts I used to give Sheba one or two a day as they are very high in taurine. And a small piece of kidney just a bit bigger than the liver is OK.
Have a look at chicken gizzards, they are good too. And should be cheap.
I feed my current cats a frankenprey diet which I think is the best of all diets for cats. If you supplement some of the meat with cooked egg white, you reduce the amount of phosphorus. I use only human grade meat for my cats and use a big variety and it is still cheaper than buying tins of food.
 
You may have already come across this site, great for feline nutrition, Dr Lisa is also a member of this board.
In there, amongst other things, she talks about homemade diet.
Felini, also do just a taurine supplement also available from zooplus if you have difficulty getting a supply in Iceland.
There's a section on CKD too, which made me think, has Princess K lost weight while she was ill, wondering if she's had muscle wastage and if this might have resulted in the higher creatine? Perhaps if that's the case you will see improvement at next bloodtest??


Catinfo.org
 
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L 08
Veronica & Babu-chiri said:
How good she's feeling better and in the mood of playing

What exactly are her creatinine values I'm guessing when you say is 148-219 you mean she's stage 2, like George mentioned look for low carb low phosphorus diets do not go for renal diets at this stage because they are way high in carbs and getting her diabetes out of control will damage her kidneys more.

Why was she given Enalpril does she have high blood pressure?

Did the vet mentioned she's dehydrated ? usually subcutaneous fluids are given when creatinine levels they are consistently over 300 - 350 , when they were very high at diagnose or dehydrated if this is not the case is better to do as George mentioned add water to everything she eats, water taken orally is always better than subcutaneous even though subcutaneous fluids are a great resource once the CKD advances.
Click to expand...


Ugggggghhhhh Enalapril is known to Interact with Insulin


Although enalapril is used to treat some forms of chronic kidney failure, there are instances in both dogs and cats where enalapril therapy has worsened the underlying kidney problems.

Enalapril is eliminated from the body by the kidneys. Animals with decreased kidney function will need additional monitoring.

Enalapril may change the insulin requirements in diabetic animals. It is likely that a diabetic pet will need additional monitoring.

https://www.wedgewoodpetrx.com/lear...ners/enalapril-maleate-for-dogs-and-cats.html
​
and

Enalapril may increase the risk of hypoglycemia (low blood sugar) when used concurrently with insulin.
​

Thanks for asking that question. I´m calling the vet tomorrow about this. I had planned to increase Krakens dose to 0.3 caninsulin tonight as her BG indicate she needs a raise but... Maybe not tonight....
 
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Gill & George said:
Good overall report for Princess K, sorry about the kidney values. Was it just the Creatine that was high? Or were some other values out of range too? Did they run an SDMA?



The felini supplement I gave you a link to also do one that's phosphorus free for CKD cats.
https://www.zooplus.co.uk/shop/cats/supplements_specialty_cat_food/vitamins/569069

George has early CKD IRIS stage 2-3
I've been feeding lower P foods (under 1%), they are all in that list I gave you, and I add a little water to every meal/snack he gets to keep him well hydrated and so far that has kept him stable.(paws crossed).

Prescription kidney diets are not a good choice, too high in carbs, better to be feeding a high quality protein diet. Diabetes takes precedence at this stage you want to aim to have her below the renal threshold as much as possible, it varies from cat to cat but as a general rule (below 200).
Tanya's site is super informative,
https://www.felinecrf.org/ there's a huge amount of information, on treating, and managing CKD and further reading, if you are struggling to find some info just shout.
Click to expand...


I did find something on the list available here!! The Miamor food, I haven´t seen it in online store just on the wholesale website but it is available somewhere. However, that´s one of the few foods without phosphorous in the list, but gives me hope I´ll find more! :D
 
Gill & George said:
You may have already come across this site, great for feline nutrition, Dr Lisa is also a member of this board.
In there, amongst other things, she talks about homemade diet.
Felini, also do just a taurine supplement also available from zooplus if you have difficulty getting a supply in Iceland.
There's a section on CKD too, which made me think, has Princess K lost weight while she was ill, wondering if she's had muscle wastage and if this might have resulted in the higher creatine? Perhaps if that's the case you will see improvement at next bloodtest??


Catinfo.org
Click to expand...

She did lose a LOT of weight from October until January, from 2.8kg to 2.1, but yesterday she had gained 100 grams!
 
Bron and Sheba said:
I relation to liver, hearts, kidneys etc. they are all high in phosphorus, especially liver, so you need to limit the amount of them with a CRD cat. I used to give Sheba a small piece of liver each day about the size of the top joint of a finger for vitamin A which they must get. Some supplements have vitaminA in it so you don't need to use the liver. With the hearts I used to give Sheba one or two a day as they are very high in taurine. And a small piece of kidney just a bit bigger than the liver is OK.
Have a look at chicken gizzards, they are good too. And should be cheap.
I feed my current cats a frankenprey diet which I think is the best of all diets for cats. If you supplement some of the meat with cooked egg white, you reduce the amount of phosphorus. I use only human grade meat for my cats and use a big variety and it is still cheaper than buying tins of food.
Click to expand...

The food Kraken is eating now is actually the most expensive food I´ve seen in Iceland.. It´s the same price per kilo as a Grade 1 fillet of lamb...

While I don´t mind spending money on Kraken, then it does add up fast. Somethings just cost what they cost, like her test strips, syringes (hard to bring in 100s of syringes in cabin luggage) and insulin.

However, going the homemade food route is going to save a bundle and buying lancets abroad will definitely be much cheaper. I just paid 50 Us dollars for a box of lancets today, found them online for less than half that. Her monthly food bill on this food is close to 200 US dollars :/ I just don´t feel comfortable doing homemade without at least adding Taurine. I know it´s present in foods.. But yeah, not there yet.
I did some calculations and this month is going to be close to 1000 US. Well worth it for a happy and safe Kraken, but yeah.. I don´t think we spend 200 US a month on food per human person in the home unless we go out for a fancy dinner. The cat eats better than us!! :D
 
Kitty Anderson said:
owever, going the homemade food route is going to save a bundle and buying lancets abroad will definitely be much cheaper.
Click to expand...

I think if you take a look at Dr. Lisa's recipe you can have a pretty good idea of what it takes to make your own food, the kind of supplements you need and even where to buy them (I think i-herb and vitacost both deliver almost everywhere ) you will need to make adjustments because the one she gives in her web page is not appropriate for CKD but you can get an idea and maybe even an approximate budget this is the link

https://catinfo.org/making-cat-food/
 
So I raised her dose to 03 (U100 0.75) this morning with BG of 16.9 (304), thank goodness I didn't try that last night. She just dropped to 2.3 (41)!! A drop of honey and a little HC and she is up to 2.7 (49). Still monitoring. When she got 0.4 on the 02. of march she dropped by 150... today by 250 with higher BG.

Called the vet and asked, is there anything else that she can get other than enalapril as it is known to cause hypoglycemia in cat´s who are on insulin. She said that was bullshit and that the food I was giving her is why she had kidney issues now. Their recommendation when they guessed Kidney disease (no blood work, no urine analysis) d was that she could not get any wet food again and would have to be on Renal kibble for the rest of her life. She said that the food I was feeding her now was going to kill her and then said "Cats don´t die from diabetes, she´s going to die from Kidney disease."

We are seeing a new vet at 13:00 today and just paying for a taxi there when we can´t get someone to give us a ride.

Im angry, frustrated and kind of freaking out internally.
 
Kitty Anderson said:
She said that the food I was feeding her now was going to kill her and then said "Cats don´t die from diabetes, she´s going to die from Kidney disease."
Click to expand...

On a renal kibble diet there is no way she is going to be able to be regulated. And unregulated diabetes, is really hard on the kidneys, so I'm afraid the vet is misinformed.
You are correct in that she hasn't got enough of the tests to confirm kidney disease, much less what stage she is at. And also, current thinking is that at a good quality high protein diet is preferable to these crappy kibble Rx diets. The diabetes has to be controlled to protect the kidneys, getting her to spend most of her time below the renal threshold, has to be the priority.

From catinfo.org
Renal’ diets restrict protein to the point that many cats – those that are not consuming enough of the diet to provide their daily protein calorie needs – will catabolize (use for fuel) their own muscle mass which results in muscle wasting and weight loss.

This internal breakdown of the cat’s own muscle mass will cause an increase in creatinine (and BUN) which needs to be cleared by the kidneys. The rise in creatinine and BUN, and muscle wasting, can lead to an often-erroneous conclusion that the patient’s CKD is worsening.

Of course, the same deterioration can occur in any cat that is not consuming enough protein, but the level of protein in these diets is not only at an extremely low level, it is in an incomplete form for a carnivore. Note that they are often made up mainly of plant proteins – not meat proteins – especially the dry versions.

I'm going to ask another member to pop in who is very experienced both with CKD and diabetes, and can also help you with the lab numbers, there are some differences between cats, humans and dogs when it comes to the numbers and she can guide you through those.
 
Additionally
From Tanyas CKD site
Enalapril (Enacard)

Another member of the ACE inhibitor family is enalapril (Enacard). This is excreted largely by the kidneys, so is not usually the best choice for a CKD cat. Benazepril is primarily excreted (85%) via the liver in cats, which puts less strain on the kidneys.



Mar Vista Vethas more information on enalapril.
 
Babies just waiting for a blood pressure test to see if she can be switched to Benazepril.

New vet was first a bit skeptical about home made food.. Asked some questions. After í could answer them all she's positive towards switching her to home made.

I like this vet!
 

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She looks so relaxed.
Sounds like a possitive visit.
When you get the blood test results if you can put them onto the tab for labs on the ss, you can put in historical data too, it makes it easy to compare the numbers and we can easily access them that way.

ETA ignore that, I just saw that you have the historical data there.:oops:
 
Just got home a couple of hour ago. I feel relaxed for the first time since I got back Iceland.

The decision was made to not switch her to Benazipril but she will be switching to Captropil. The new vet was positive towards Benazapril, said it was a much more appropriate kidney med for a diabetic cat. She then went and spent some time looking into all available renal meds for cats in Iceland and suggested that Captropil might be a better fit. It´s especially recommended for diabetic kidney cats. For the first time since this journey started, I felt like I was having a discussion with someone who could teach me something. She was super kind, super patient and while Princess Kraken isn´t fussed by vet´s visits I have never seen her this chill at a vets visit. She was purring super loud while chilling on my coat. Was super chill even during her blood pressure test.

I had her medical history sent to the new vet.. That was an interesting read. Several of her vet´s visits are not recorded in the past years. Including some of her flu shots, the time she was put on steroids, at least one round of antibiotics.

New vet was super happy about her SS, thought it was great that we were urine testing especially for Ketones, spent time asking questions and double checking information. I have never spent this long in a vet´s office! Which I see as a good thing.

Our previous vet did not tell us that apparently, vets in Iceland CAN write prescriptions for human meds! In the past when I had asked if that was possible it seemed to be impossible, at least for them. So during my call with the vet tomorrow I´m going to ask her about the possibility of switching to Lantus after my next trip. The new vet also printed off information for me, is going to check if there is a way to get a steady supply of Felini mixes for home food imported to Iceland!! (talk about above and beyond, that process would take a while), talked with the pharmacist about her meds.

After coming home I realized that there were questions I should have asked, like what to do in the unexpected case of her BG not raising as we expected on HC today... But I still feel 100% more secure.
 
Kitty Anderson said:
what to do in the unexpected case of her BG not raising as we expected on HC
Click to expand...
When she dropped below 50, you gave some honey and high carb kibble, then you were testing every 15min, and she was not coming up above 50 for a while, did you keep giving a little high carb each time or were you just monitoring?

Usually we would give HC, wait 20min recheck, if still below 50 more HC recheck in 20 and so on until above 50. Once the BG is above 50, we stop the HC and then monitor to make sure they stay up. It's not clear from the notes or your post if that is what you did.
 
Gill & George said:
When she dropped below 50, you gave some honey and high carb kibble, then you were testing every 15min, and she was not coming up above 50 for a while, did you keep giving a little high carb each time or were you just monitoring?

Usually we would give HC, wait 20min recheck, if still below 50 more HC recheck in 20 and so on until above 50. Once the BG is above 50, we stop the HC and then monitor to make sure they stay up. It's not clear from the notes or your post if that is what you did.
Click to expand...

Her 2.3 (41) she got a smear of honey and HC, then I kept offering HC at each reading until 2.8 (47), then measured 2.9 (52) just before we got in the car to go to the vet. I monitored closely by eye while we were getting to the vet with her BG kit and hypo kit at the ready (I have honey in a small container, a ziploc with cotton swabs- the ones on a stick, a small spoon and HC in a sealed container). The honey dose was very small and small doses of HC. On her slight hypo on 02 March I fed to much HC so gave smaller doses this time. She measured 4 (72) at arrival at the vet, first thing I did was to BG test. The receptionist guy looked kinda confused.. Asked is anything wrong when he realized I was BG testing, blood drop came super fast and as I was sticking the drop on I answered that it was slight hypo and he started running, reading came in and I called at him, She´s good! hypo stabilized. Then I waited an hour (they squeezed me in with no appointment) because I said she was ok and I could continue BG testing in the waiting room. She made friends with N, the overexcited teenage labrador who was waiting as well. :)
Tests were every 15 to 25. First two were 15 apart, then maybe 18, then 20. 25 for the trip to the vet. Yeah.. those notes are a mess. On my phone just trying to track info as fast as possible :P while also trying to feed myself so I wouldn´t go hypo at the vets (I´m not diabetic, checked 7 times!! but weirdly just burn through my carbs a bit to fast, so basically opposite of diabetic)
 
If anyones intrested, but I did this primarily to send the old vet a visual of the difference appropriate curve based dosing can make, but here is Princess Krakens old chart, input into the SS format. DH and I went through every email, text message and Signal message between us to put this together. The dose changes might be off by a day or two, but otherwise it´s a decent picture of her first month and a week or so, vs when I took over her dosage. I know her charts aren´t perfect yet and I am still learning how my baby reacts to what, and I´m learning to manage my own stress when it comes to this, but it shows night and day.

OLD chart:
 
You are doing amazingly well

I'm really impressed that you were able to test even at vet's office!!!, and your new vet seems like a good one

Today may be a weird day regarding his BG because you are probably going to see effects of the HC, vet stress , etc
 
Veronica & Babu-chiri said:
You are doing amazingly well

I'm really impressed that you were able to test even at vet's office!!!, and your new vet seems like a good one

Today may be a weird day regarding his BG because you are probably going to see effects of the HC, vet stress , etc
Click to expand...

Thank you! :)

Princess Kraken actually doesn´t mind the vet's office at all... I think that´s partially because when she was younger she would come out with me all day, come to the office with me, come to cafes if it was warm enough to sit outside, come visit other people´s houses and we have a lot of friends with animals. I used to also stop with her very often at the vet's office just to go in, nothing treatment-related, might pop her on the scales and buy some treats and give her one there. She would also get a treat after every vet´s visit. So she´s used to lot´s people, used to going to new places, used to car rides and used to the smell of a vet´s office without it only being related to stressful vets visit´s. The vets commented on how super super chill she was, especially waiting with all the other pet´s. The most invasive thing yesterday was blood pressure check and my BG tests and she barely noticed.

Yeah, today is weird. DH is certain this morning was not a fur shot but she is very high, all reds all day following a pink AMPS reading. It might be the high carb yesterday and reduction on last nights shot because she was blue PMPS and with her still on Enalapril (got new renal meds today!!yay!!) I just didn´t chance it after seeing her drop from 304 to 47. You can´t really drop almost 250 points from 184. Her dose of Enalapril was also halved last night. It´s probably a combination. Hope to see some improvement tomorrow and Saturday and that part of this is just HC and a bounce from the 250 drop..
 
You are rocking this! So glad you found a vet that is so open minded. Hope Princess Kraken's number settle back down after that roller coaster.
 
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