? Rocky - Ultrasound/Bloodwork results - IBD/PANC/CKD/DIAB - the end?

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Jim (NJ)

Jim (NJ)

Member Since 2019
The love of my life was diagnosed in March 2020 with ckd and pancreatitis when I brought him in to get checked out for concern of his diabetes. He was diagnosed in May 2019 with diabetes when his glucose levels were off the charts at 450-500+. The vet started him on Lantus with 2u and would do a fructose test every month, to see his numbers remaining 450+ so she increased him to 3u, then to 4u each month until finally in August when I started doing research on my own. I was able to find this great site and found out a great amount of info that would go on to save & extend his life. He ate Blue buffalo dry food and 2 wet meals a day all his life until the vet recommended switching to Royal Canin Glycobalance for his diabetes. He was always starving when on glycobalance and it did nothing to help his condition.

Once I found out about high protein, low carb diet I switched him over to Fancy feast classics pate which he loved eating compared to the glyco food. This is when I started testing his glucose levels daily and really changed my lifestyle to take care of him properly. I immediately noticed the drop in his BG levels going to an all wet high protein/low card diet. As you can see on his spreadsheet, he continued to improve and eventually went into remission on January 1st 2020!

We started 2020 with his 1st no shot and his numbers glucose were low all through January & February. They started to rise into the 150 area on a human meter so we brought him in to get checked out by a new vet since we moved from our original vet and I felt like I did more to save his life then they did. My 1st visit was on 3/18 which I have blood work & urine test for. The new vet determined from a ultrasound that he has pancreatitis and ckd. It broke my heart how she explained it to me and thought we were bringing him home to basically die at that point. She did not provide any treatment and I just continued to monitor his glucose levels until they started getting into the 200-250 range. At this point is when I started him back on .5u Lantus and working his way back up to where he is now at 2u.

We brought him back into the vet to get his teeth cleaned as this was originally what his appointment back in May 2019 was for when they found he was diabetic. They cleaned his teeth & pulled a tooth, I was hoping this could of been the cause of his glucose levels rising but they still continued to creep up. I started Rocky on Hills k/d diet food at the end of May per the vets recommendation. After a few days of not really wanting to eat it, I then find some more info about how high in carbs the food was and low in protein, so I did more research. I learned about home raw food but we hesitant to do raw, so we just boiled chicken breast and he loved it. After about 2 months of eating boiled chicken, I ended up switching him to ezcomplete premix with raw chicken to balance out his diet and he loved it.
He started acting a bit strange the past 2 months, avoiding the rooms were in. Vomiting more than usual, loss of appetite, poop outside the box when he never went outside the box all of his life. Drinking a lot of water & urinating a lot too. I knew something was up with my guy so I brought him back in this week to get tested again. I wanted to start him on sub-q fluids as I read the benefits so I got a 1000ml bag on his last visit and we started fluids Saturday 10/3. He seemed to respond ok to fluids, he allows us to do them while purring and his coat feels much softer. I can tell hes still uncomfortable so I am trying to find more that I can do to help him. I had a bad breakdown on Tuesday night 10/6 as he stopped eating around noon and I felt like he was taking a turn for the worst and from reading about crashing, I got very scared and started a panic attack on myself. Luckily he started eating again the next day and has been since. But I just got the blood results today from the vet and his number have me really concerned. The vet just said at this point we just want to make him as comfortable as we can. She was going to provide with anti-nausea meds and continue doing daily 100ml sub-q fluids. I currently give him a probiotic but read about prebiotics so I mentioned that to her after reading about them on this site. I ordered Renadyl due to being able to put it in his food but when I told her that, she said even if less bacteria lives breaking it out the capsule she would still go with Azodyl. Now after seeing his high calcium levels, I question if either prebiotic is ok for him.

I am so desperate to do anything I can to help my guy get comfortable. I don’t personally feel like the vet I am seeing now is doing much good besides writing prescriptions and doing blood work. I was fortunate enough to get him help with his diabetes, but feel like I’m behind the ball on ckd and his time is running out.

I brought him in on 10/20 for the ultrasound and here are the results below with recommendations from the internal medicine specialist. I made the mistake of thinking his appointment was on 10/19 so I gave him 50mg Gabapentin the night before, then 100mg the day of the 19th. Once I realized the appointment was a day later, I spoke to the vet and she gave me more so I repeated the same dose for 10/20. I was concerned about him being on Gabapentin for 2 days but he was very relaxed and actually went poop at the vet waiting for his ultrasound. He is usually very upset with the vet and she was concerned that they might need to sedate him, but they were able to do it with just the Gabapentin.

Here are his results below: https://docs.google.com/spreadsheet...iWueLE8NRpUSgRlTzjFmlKSKc/edit#gid=1236880821

ABDOMINAL FELINE

R Adr Gl L Adr Gl

Right Adrenal Caudal Pole

Height 0.57 cm

Left Adrenal Caudal Pole

Height 0.53 cm

Gastroint

Duodenum

Thickness 0.33 cm

Jejunum

Thickness 0.35 cm

[0.33, 0.36]

Ileum

Thickness 0.42 cm

R Kidn L Kidney

Kidney Right Sagittal

Length 3.86 cm

Kidney Left Sagittal

Length 3.93 cm

OBSERVATIONS:

HISTORY: History of diabetes mellitus, went into remission in January, recent relapse with increasing insulin requirements over time. Progressive azotemia. On freeze dried raw chicken diet, Cerenia PRN. Aluminum hydroxide.


LIVER: The liver is normal in size and contour. It is normal in echogenicity with no focal masses or nodules.

GALL BLADDER: The gall bladder wall is thickened >1 mm. There is echogenic bile or sludge in the lumen of gall bladder. The common bile duct is normal.

SPLEEN: The spleen is normal in size and measures less than 1 cm in thickness.

KIDNEYS: The kidneys are normal in size and contour. Both kidneys have mild loss of corticomedullary definition and normal renal architecture. There is bilateral renal pelvis dilation and no ureteral dilation.

ADRENAL GLANDS: The adrenal glands are symmetrically enlarged.

BLADDER: The urinary bladder is normal. No calculi or masses are seen.

STOMACH: The stomach is normal.

SMALL INTESTINES: The small intestines are diffusely thickened with a prominent hypoechoic mucusal and muscularis layers. Normal wall layering is seen in all areas evaluated.

COLON AND ILEOCOLIC JUNCTION: The colon and ileocolic junction are normal. The ileocolic lymph nodes are prominent and surrounded by Hyperechoic fat.

PANCREAS: The pancreas is diffusely hypoechoic and enlarged.

LYMPH NODES: There is no mesenteric lymphadenopathy

PERITONEUM: There is no effusion.


ASSESSMENT:

The thickened gall bladder may be normal in an older cat or could indicate cholangiohepatitis.

Mild chronic renal changes the renal pelvis dilation may be an individual variant or indicate pyelonephritis.

The bilateral adrenomegaly may be an incidental finding or indicate pituitary dependent hyperadrenocorticism.

Thickened intestines R/O diffuse enteropathy, like inflammatory bowel disease or small cell lymphoma vs. normal in older cat

Pancreatitis

RECOMMENDATIONS:

I would recommend a urinalysis and culture. Since animals with diabetes mellitus can have an inactive sediment, I would treat with antibiotic for 4 weeks if the urinalysis suggests infection or the culture is positive or both.

-------------------------------------------------------------------------------------------------------------------

The vet recommended a urinalysis and culture based on the ultrasound so I proceeded with them. I am still waiting on the results that should be back on Monday but the vet was very concerned with his condition and the results of the ultrasound. He has IDB, the gall bladder walls are thicked, the adrenal gland are very enlarged and she said that is possible due to stress? As she went over the long list of things, my heart just dropped and I had a hard time remember everything.


Pending the results of urine test & culture, she believe he might have a deep UTI or kidney infection that is causing the spike in the Blood glucose and what caused the downward spiral the past few months. She wants to put him on 30 day antibiotics but waiting for results to proceed.

She mentioned steroids but didn't want to go that route and recommend starting a B12 injection but I am currently giving him Vita-cost 2000mcg B12 a day with 200mcg of folic acid. I was giving him zobaline for over a year which is the combination of these 2, but switched to this as much cheaper on my wallet and found this info diabetics forum. I read the injection can be better for pancreatitis since a lot of the powder is not absorbed, but then also read to do both as it won’t hurt him. So I'm not sure what to proceed with?

I also saw a lot of talk about Vit B complex supplement, which I am not giving, but leads me to believe I should start that now too?

He has been taking 4mg of cerenia & getting 100ml sub-q fluids daily which seemed to help alot in his attitude and appetite. I feel like his constipation has gotten worse since starting the phos binder which I read is a common side effect. Since starting the binder, we upped his miralax to 1/8 tsp per meal ( 4xday) and he did not poop since his vet visit in almost 4 days. I put 1/2 tsp of coconut oil in 4 meals yesterday and upped 2 of the meals to 1/4 tsp mirralax. He finally passed some poop outside the box this morning, but not as much as I was expecting. Today he barley ate any of his food and when I tested his BG # before dinner, it was at 285 which is slightly higher than his normal preshot.

After doing some reading on pancreatitis, I always see pain management being talked about and bupe. My vet has never mentioned this and its something that now looking back on, I feel like he has been in bad pain from his pancreatitis & he also suffers from arthritis. I feel like I should be asking the vet for bupe and need to get him on something to help manage his pain. He didn't really take well to the gabapentiin and Ive heard bupe is a lot stronger, so Im concerned he will freak out with it and doesn't like the medicated feeling they bring. Also bupe causes constipation which I think may be my biggest concern atm.

I feel like she did not have many recommendations to offer and feels like he time is going to be soon. I have been an emotional wreck all week, but not ready yet to give up on my guy. I don't want to see him suffer and sit in 1 spot for the rest of his life either, so I feel like I'm starting to run out of options to try. Doing research everyday on his conditions is taking its tool mentally and physically on me too, just so lost and so much conflicting info. If anyone sees a vitamin or prescription that I am possible missing that could help, I'm willing to try anything before throwing in the towel. Thank you all your time and support in this journey. It’s amazing the love and support you can get from a community of such great people <3

https://docs.google.com/spreadsheet...5iWueLE8NRpUSgRlTzjFmlKSKc/edit#gid=600488661
 
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Hi Jim,

How is Rocky doing today?

I'm sure you've already found the following highly regarded sites but I'd rather err on the side of caution and post them anyway:

Tanya's Site (for everything feline CKD)

ibdkitties.net

I think Tanya's Site may have a support group (check the links on the LHS of the screen).

ibdkitties.net used to have a link to their support group but I couldn't find it tonight.

(((Jim and Rocky)))


Mogs
.
 
Jim (NJ) said:
He has IDB,
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I don't see where that is indicated. The results say IBD or small cell lymphoma. Don't let that latter one scare you, on the right mild chemo protocol of every couple weeks, the large majority go into remission. First off, you can't differentiate IBD vs small cell lymphoma via ultrasound. You need a tissue sample either via endoscopy or biopsy. Unfortunately the ultrasounds wasn't very detailed (amount of thickness and where in the small intestines) so don't know if you could use the easier endoscopy. The treatments for the two conditions are different. You treat IBD with novel proteins and probiotics - Visbiome is the one I use. May be you need to try a protein other than chicken and see if that helps. Chicken is a common allergen. The suggested GI panel may also be a good idea to see if he needs B12 supplementation. You are giving methyl B12 which helps neuropathy. It's cyanocobalamin (B12) that is good for the gut. But unless he's low (the GI panel will tell you), there's no need for supplementation.

It sounds like Rocky has gotten a little bit more complicated. My main suggestion is that you should see if your vet will refer you to an internal medicine vet. IM vets are great at handling multiple conditions, prioritizing the conditions and treatment. When Neko had all of her conditions (heart issues as well as kidney, GI, diabetes/acromegaly), my vet did me a great favour and "fired" me, saying it was best I go to an IM vet. It gave me huge sense of relief to talk to someone who could handle everything.
 
Thank you for Rocky’s history. It is evident you love him very much and are doing your best. Wendy has given you some great info on IBD so I’ll give you some thoughts about labs.

First, his ALT is high. This is a liver enzyme so combining that with the ultrasound findings, I wouldn’t be surprised at the cholangiohepatitis diagnosis. I wish the vet would have been a bit more forthcoming and diagnostic. I would discuss with my vet giving him some milk thistle to help support his liver. I use Herbsmith from Chewy’s as it is so much easier to give than Denamarin.

Some people have seen positive results using Azodyl or other probiotics (I also use Visbiome). I saw Mogs linked Tanya’s and I would read her info about giving calcitriol. When I had CKD cats, calcitriol wasn’t used as it is now. The one huge caution is his calcium levels are already really high and so the calcitriol might be contraindicated. It’s sometimes difficult to know how bad the calcium really is unless you have an ionized calcium run.

Hand-in-hand with calcium is phosphorus and his is say too high. Tanya’s has a great discussion on binders and tables that will help you be sure you are mixing the correct amount in the food. I prefer aluminum hydroxide and it looks like you’ve used that. The EZ Complete with added meat is fairly low P but I’d avoid feeding rabbit. If you can get venison, elk, lamb, pork, bison....those are good choices. It’s really crucial to get the phosphorus down ...and “sometimes” the Ca will come down when you get the P down. But the two multiplied together should, be less than 70 and he’s over.

As Wendy said, there are two uses for B12:
Methylcobalamin is what we give to ward off anemia. His hematocrit is 34% and anemia is below 30% although the “big guns” aren’t used until the HCT gets to 20%. In the interim, you can give 250 mcg twice a day if methylB12 plus 1/10 of a multi B12 like Jarrows BRight divided into two doses. Methylcobalamin is also used for diabetic neuropathy.

Cyancocobalamin is usually given by injection for intestinal issues or to help with appetite. As Wendy said. A GI Panel through Texas A&M can check his folate and cobalamin levels as well as for pancreatitis and exocrine pancreatic insufficiency. You can have just the former two checked. I wouldn’t give him folic acid unless you know his folate is low. For cats with low folate, the dose is 200 mcg daily for one month.

Kidney infections, pyelonephritis, can cause the creatinine to increase. Usually the best say to dx it is via the ultrasound so it’s odd the radiologist then suggested a C&S which is less likely to be indicative of a kidney infection. My one CKD cat had a kidney infection twice and, both times, his C&S was negative but the U/S clearly indicated the infection. Usual treatment is baytril or zeniquin for about six weeks. You can’t use a broad spectrum antibiotic like clavamox or a shot like convenia to address a kidney infection.

MY CKD kitty had arthritis and he was on a low dose (0.1 ml bid although I don’t remember the concentration) of compounded buprenorphine for years with no constipation. I also had to add aluminum hydroxide binder to his food for a couple years and he didn’t have constipation. If you do get the bupe compounded, be sure you tell them no added sugar or sugar substitute like maltodextrin since he’s diabetic. You can give a small amount of raw egg yolk for constipation and FoodFurLife sells a great egg yolk powder which is very helpful for motility. I do not like gabapentin, myself, for my cats and only ever use bupe at low doses for pain management. If gabapentin is not very carefully dosed, it can result in respiratory distress.

There are several good groups to help with kidney issues. Tanya’s has one; there is a FB group, and there is another kidney group at groups.io.

I hope some of that info is helpful. Many wishes and healing vines for your sweet boy.
 
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Sorry to chime in over a month later - I have had a kidney transplant, and when I saw enlarged adrenals I thought of my own situation before the transplant, and now. Fluid intake was a balancing game.
Also can someone tell me if blood pressure was mentioned? The adrenals take part in regulating blood pressure, and I have been taking either or both amlodepine and atenelol to control it.
I hope the vet is monitoring or did take blood pressure for Rocky to ensure it's not an issue.
 
Thank you so much everyone for your support and advice,. Before reading this post I had concerns as well once I saw my charts that switching him to the raw food + ezcomplete was probably a bad decision and I hated the prep..etc required for it. I was going to switch him off it but then he made that decision for us. On 10/25 he wouldn’t eat any meals so I gave him an extra 4mg cerenia that night for 8mg total. I was concerned with his low bg numbers from not eating so I gave him some emergency high carb Fancy Feast Gravy & Beef @ 2am, in which he loved it <3 . His face lit up like I haven’t seen in a while so I knew right then it was time to switch him back to his old Fancy Feast Classic pates that he’s ate for over 18 months as a diabetic. So I started the 7 day transition to FF Classics pate while increasing his cerenia dose to 8mg a day. He started clavamox on 10/22 for a month after his urine culture came back negative. I know the FF Classic pate is very high on phos but he enjoyed eating it so much more than the raw. I started to look for lower phos wet foods and ended up with B.F.F. P.L.A.Y. Til' Then Chicken & Tuna + B.F.F. P.L.A.Y. Oh Snap! Tuna & Salmon which are ½ the amount of phos @ 1.01 & 1.1 vs almost 2.0 for the FF classic pate. I tried a few other flavors like checkmake chicken, but if it didn’t have tuna or salmon in it, he wanted no part of it. I was just happy to get him on something with lower phos that he actually enjoyed eating. I read about the concerns of a diet with tuna & fish and planned to try other things, but most important thing is just getting him to eat atm.

Things seemed to improve over the new 2-3 weeks and his bg’s were down, but bouncing all over the place. He had several preshot bg test that were around 100 so I even skipped a shot with his numbers being so low. He started popping every day or 2 now and they look much healthier. Feel like his constipation issues have gone away being off the raw diet now. Around 11/20 after being on 8mg cerenia for almost a month, he started to not eat again and was very lethargic so I decided to skip the cerenia that night after finding this thread. The next day he was a lot less lethargic and ate a lot of food with a very big appetite. So I decided to see how he did with stopping the cerenia and the next day it was one of his best days in a long time. He jumped on the couch in the 1st time in months, much more alert & active with a bigger appetite so it was very clear the cerenia was not agreeing with him. I started .25ml B-12 cyanocobalamin injection once a week at this point and stopped giving him zobaline. So I essentially reduced his B12 from 2000 mcg to 500mcg a day and stopped the 200 mcg folate acid. This next week is when his blood glucose #’s started to rise to 300+ for some of his preshots.

I brought him in to the vet on 11/30 to get bloodwork done and most of his values remained the same except his alt dropped to 69 but creatinine went up to 6.3 and his wbc to 17.4. She said his is anemic now and considered stage 4 with the creatinine numbers. She was basically out of options to do for him and in over her head, she suggested getting him into Internal medicine specialist as soon as possible to get a 2nd opinion. She prescribed another month of the clavamox for 8 weeks total and I was able to get prescription for adaquen .3ml shot to help with his arthritis at this time and started him on Jarrows B-complex 1/10 capsule to help with the anemia. He was eating very little during this time so I started giving him 1000 mcg B12 methyl split into his meals as I don’t believe he even got the full 500mcg when I reduced his dose due to not eating every little bit of food. His BG#’s were continuing to rise so I upped his lantus to 3u and he seemed to be getting much worse or going thru a prolonged crash. I had some Buprenorphine on hand so I gave him .05ml for the 1st time on 12/5 at night and I didn’t notice any difference really in him. He was still very lethargic and basically sleep in his one corner spot all day. I gave him another .05ml on 12/6 at night and managed to get an appointment with IMS on 12/7. I noticed he smelled like urine in the morning and seemed to leak some small spots out of him wherever he went. I presumed this was due to him not being used to Buprenorphine and feeling sedated.

I took him in the next day to see the Internal medicine specialist and felt like I walked away with very little for a large bill. He basically said I was doing everything he would suggest and I could tell he thought I was there to put him down. He noticed his eyes were dilated most likely from the bupe the night before and checked them. He said he saw some blood hemorrhage in his eyes and his blood pressure was at 220. Rocky was hissing and growling at him as so he was very unhappy and with covid times we are not even allowed to go in with him to try to keep him calm. He prescribed Amlodipine 2.5mg 1/4 tablet once a day and suggested getting his blood pressure checked in 2 weeks with my vet.

I then went and purchased a Contec08A-VET for home testing since I don’t think there is any way to get an accurate reading at the vets office since he gets so upset when going. I received the unit 2 days later with the 6-11cm cuff. I was not able to get any reading on his tail but did on his arm and the next 3 days his sys would be around 90. I read a bit more and ordered a 4-8cm cuff which should be here in a week as either the unit is greatly off, the cuff is not the correct size which I think might be the case or he really doesn’t need the Amlodipine at all.

It has been such a rollercoaster ride these last 2 months and I don’t believe without the help that Ive received here, Rocky wouldn’t even still possible be here with me. I feel like both the vet and IMS think it’s time for him but at least the vet is willing to work with me and help in any way she can with prescribing what I ask for. It is extremely tuff times with covid and trying to find a new vet or bring him somewhere else as just like the IMS visit, no one wants to deal with such a big book of history that he has. I don’t want to give up just yet and trying to help him pull thru this episode, but he doesn’t seem to be improving at all. I stopped the bupe after the 2 initial days to see if he was still leaking urine from being drugged, he did stop for 1 day then but then started again the past 2 days.

The incontinence has me really concerned at this point as it’s something he’s never done in his life before. He basically stays in the same corner all day with towels that I put down and just comes out to eat and yell at the basement door a few times a day to go downstairs which we don’t really let him unless we are down there. I figure he might hear the mice now its winter or some other stuff or maybe just wants to a break from us since with covid we are always home every day.

We adopted him on 12/30/06 and I get the feeling he might be leaving us around that time this year. I don’t know why it’s a sickening feeling I have in my stomach. If anyone see’s anything that I am possibly missing or can try out, the few things I have left in my mind to ask as questions are:

1. Should I continue with the clavamox at this point as he’s been on it for 6 weeks and I get the feeling it’s not helping him and possible causing the lethargic, loss of appetite for him the past few weeks. If he does have kidney/liver infection and it’s not getting deep enough, should I try switching him to baytril or Zenequin or something else? Or just take a break from an antibody for a few days to see how he responds, then possibly trying a cycle of another antibody?

2. I’m at a loss why he is incontinence and thought maybe getting him tested for a UTI, but I don’t see how that possibly while on 6 weeks of clavamox. Could it just be his age and condition is getting to bad that he no longer has the strength or is the clavamox just taxing his body too much causing the lethargy which leads him to leak urine. Could Amlodipine or adaquen be causing it too? Im just looking at things that were new recently in his life.

3. Somehow he has maintained his weight thru all of this at 12.4 lbs

4. His phosphorus and calcium did not decrease at all since starting 1/8 tsp of ALHO for almost 2 months. I upped his dose to ¼ tsp after his last bloodwork on 11/30 but read that is towards to higher dose recommended and to try adding in a 2nd binder. I was suggested Niacinamide but one of the side effects is raising BG for diabetics so I don’t think that is a good option. What other options or what should I do to bring down his phos & calcium?

5. I feel like his diabetes bg numbers are greatly being influenced by something else, either high blood pressure, high phos/calc or a liver/kidney infection and its causing insulin resistance. What else would explain why he sometimes is around 100 on a preshot, then will test 250 on a nadair that same night.

6. With Contec08A-VET reading 90 sys, should I continue the Amlodipine until I am able to get the smaller cuff for a more accurate reading, as I feel the vet’s office will always be a white coat reading?

7. I used to give him Sam-e for his liver back a few years ago before he was diabetic, should I start that again or does it conflict with any of his current medicine or offer little value in his state now with his ALT levels being lower? I guess is there an upsides to it and or little downside atm?

I have extensively updated his spreadsheet with everything I could possibly think of to track, if you can please take a look and I am willing to try any suggestions as you all are my last hope. I am truly grateful for the gods work and time of day you all take to offer advice and help keep the love of our life’s here with us every day. I don’t believe Rocky would still be here if it wasn’t for this site & tanya's ckd. Thank you all so much!!! <3

https://docs.google.com/spreadsheet...5iWueLE8NRpUSgRlTzjFmlKSKc/edit#gid=361360320
 
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Jim you are an amazing dad!
Just a thought......With the incontinence, is it happening all day every day or just every so often? I’m wondering if it could be FLUTD. Sheba had idiopathic cystitis and she used to dribble wee. Not all the time but whenever she was getting an episode of it. I remember being really concerned when it first happened as she had never done it before.
 
He's not draining his whole bladder on the floor, just seems to be leaking small amounts. I cant even see it on the towels since I put them down but you can smell it. His bottom smells the most and we try to wipe him down, but he gets really upset when you wipe his bottom. He does goto the litter box to poop, its just urine that is leaking. He's always been a super clean kitty and I can tell it upsets him. From reading into idiopathic cystitis it could possible be, but I dont think its an UTI as hes been on clavamox for 6 weeks now. My gut feeling is telling me the clavamox might be doing more harm then help with the side effects of lethargy, upset stomach, loss of appetite. The Internal medicine specialist thought there was no point of keeping him on it, but everything I read on Tanyas suggest 4-8 week cycles due to how long CKD cats take to clear infections. I dont want to stop it without getting some more feedback as once I choose to stop I dont want him to build antibiotic resistance if I made the wrong call.
 
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Jim (NJ) said:
I read a bit more and ordered a 4-8cm cuff which should be here in a week as either the unit is greatly off, the cuff is not the correct size which I think might be the case or he really doesn’t need the Amlodipine at all.
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Jim (NJ) said:
6. With Contec08A-VET reading 90 sys, should I continue the Amlodipine until I am able to get the smaller cuff for a more accurate reading, as I feel the vet’s office will always be a white coat reading?
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Cheap oscillometric BP machines like the Contec08A-VET are not that accurate.
http://www.iwillhelpyourcat.com/blood-pressure-can-i-measure-it-at-home
Especially if you use the wrong size cuv like you tried to use on the tail. A cat's tail typically requires a#2 cuff like the one you ordered.
I would continue to administer the Amlodipine until you get the new cuff andr see what BG values you get.
I myself have a doppler BG machine which I use for my Mia. I try to maintain Mia's systolic BP under 160. SHe is on 1/2 of 2.5mg Amlodipine AM and 1/4 PM.
 
I think the urinary issues and the hypertension are probably secondary to the adrenal issue discovered in the ultrasound. My cat Snowcrash (GA) had adrenal issues, plus diabetic, pancreatitis, FLUTD, progressive hypertension.... Since the vet checked his eyes and saw evidence of hypertension, I wouldn't discount it as stress only. Progressive hypertension can be an issue with cats with adrenal issues. Snowcrash was on max doses of blood pressure meds when he passed in January.

I'm attaching a picture that shows the medication schedule Snowcrash was on at the end. Additionally, he was getting buprenorphine twice daily, 150mL fluid therapy daily, and b12 injections weekly.
 

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Thank you so much for your replys. It really helps to see some common theme's when diagnosing our little loved ones. I def agree with continuing the Amlodipine until I can test with the proper cuff. While I know it might not be the most accurate unit, I feel that he gets so upset going to the vet's that he will always suffer from white coat syndrome thus never giving me an accurate number either.

I was able to get his full blood work results sent to me just now and filled out the rest of the fields on the chart. Looks like more things are red (out of range) then the vet mentioned but Im not sure what those other values mean. His Abs Neutrophils is more then double of whats its ever been at 15486.

Rocky went into his litter box to pee & I was able to catch his stream with 2 ketone test strips https://www.trividiahealth.com/products/other-products/true-plus-ketone-test-strips/ . The color shades are hard for me to match up exactly but it is either negative or trace 0-5 amount. After reading the instructions on the website, they are only good for 2 months after opening the bottle even if its remained closed, so I'm not sure the accuracy of these as this bottle is a year old. I am going to pickup another bottle tomorrow and will rest test him several times with them to confirm.

I spoke to the vet's office and got an appointment on Monday @ 11:15am to bring him for an urinalysis. The vet is going to call my before to discuss and I asked if I could just bring a urine sample to save him the stress of the visit. I will also make sure to get zeniquin, if I should ask for 6 or 8 weeks to be safe? Also anything else that comes up before then from this great community. Its especially hard to get time to talk with the vet so I like to have everything ready to ask or request from her once I get her on the phone. Thank you all so much!
 
I would recommend a urine culture to be sure he's getting the right antibiotic. Plus sometimes cats with kidney issues have false negatives for bacterial infections because their urine is so dilute.
 
Jim (NJ) said:
if I could just bring a urine sample to save him the stress of the visit.
Click to expand...
Any sample you get is not really suitable for a culture since it wouod be contaminated with bacteria. Also, any antibiotic should have been discontinued for a week or so before doing a culture.
Jim (NJ) said:
I will also make sure to get zeniquin, if I should ask for 6 or 8 weeks to be safe?
Click to expand...
6 weeks should be OK and even 30 days.
 
If you are wanting to get a BP taken at the vet when you go on Monday, you could cover the cat carrier with a towel or rug and keep him away from the waiting area where dogs may be barking until he is seen. (Or maybe the vet would come out the the car to just take the BP.) When I needed Sheba’s BP taken, I used to do that and the vet used to take the BP as soon as we went into the office before doing anything else and he just used to take Sheba’s arm out of the carrier to do it so she still felt safe. It was hilarious really watching her let him do that but it worked.
Maybe if you sterilised the collection jar and wiped Rockys rear end before he pees, that may help with the contamination.
 
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