Subq's and litterbox flooding. Odd behavior.

[bsmith]

Right around the time that Edwin went OTJ, he started having issues with eating ( http://www.felinediabetes.com/FDMB/threads/appetite-stimulants.135643/ ). After a vet visit on April 8th, blood tests, and urinalysis it was determined that there was no real apparent cause. Spec fPL showed no pancreatitis, which was one concern. Constipation was ruled out by physical exam. I had, however, already been giving him 1/8 tsp of miralax daily, which I just recently upped to 3/16 tsp daily since his stool still seems on the hard side.

The big thing that the test results showed was that his kidney levels were elevated since his blood work up in January (the results from both these labs are on the "LABS" page on my spreadsheet). His BUN went from 39 to 51 and his creatinine from 1.6 to 2.4. He's still Stage 2 CKD, but just barely. Some of this may be due to the version of Fancy Feast that I was feeding him just to get him to eat anything. It wasn't ideal for his CKD.

Anyways, we started Edwin on a 100 ml subq every other day. We also added Cyproheptadine 1 mg BID and 5 mg Pepcid QD (once a day). Due to some reading about famotidine (Pepcid) on Tanya's CKD site, I lowered that amount to 2.5 mg a day. I also bumped Edwin's B12 to 325 mcg BID. All this helped and someone became a hungry, hungry kitty who was willing again to eat the much more appropriate Friskies Special Diet with ground Young Again Zero Carb Mature mixed in.

Finally getting to my point here, four days ago, Thursday, Edwin started acting a bit off. Not terribly so, but a little odd. I had given him a subq the day before (Wednesday). I clean out his litterbox before bed and was shocked to see it absolutely flooded, about 2-3 times the normal amount. I thought it might be subq related, but between that and his odd behavior I thought a BG test was in order. He threw a slightly high number, 149, that night and a slightly high number, 138, the next morning. Since then he's been totally normal at about 100. (Actually exactly 100 three times in a row, so I double checked the meter. It was working fine, but what are the odds of that?)

I figured the litterbox flooding must be subq related, but the next night Friday (no subq Thursday) it was flooded again. I checked his hydration. Not dehydrated (skin snap back and gum check) or over hydrated (not squishy and no swelling in legs). I skipped that night's subq worrying about fluid overload.

After skipping his Friday night subq, the next day I did see him drinking more water than normal. Saturday night's litterbox check reveled less urine, closer to two times the normal amount, but still way more than normal. There was one piece of slightly hard stool tracked onto the carpet outside the bathroom (must have gotten stuck). Earlier that day I had found him inside crouching by the bedroom instead of outside enjoying the beautiful day. Again strange behavior. All around he seems off and in a bit of pain.

I'm really not sure what is going on here. Too much fluid, too little fluid, one of his other meds? I'll be calling the vet tomorrow. In meantime, and in addition to whatever the vet suggests, do any of you have any ideas of what might be going on or any suggestions?

I do have an account on Tanya's CKD board, but I have yet to post there. I posted here first since I'm at least familiar with the people here.

 

[Mogmom and Goofus]

Right around the time that Edwin went OTJ, he started having issues with eating ( http://www.felinediabetes.com/FDMB/threads/appetite-stimulants.135643/ ). After a vet visit on April 8th, blood tests, and urinalysis it was determined that there was no real apparent cause. Spec fPL showed no pancreatitis, which was one concern. Constipation was ruled out by physical exam. I had, however, already been giving him 1/8 tsp of miralax daily, which I just recently upped to 3/16 tsp daily since his stool still seems on the hard side.

The big thing that the test results showed was that his kidney levels were elevated since his blood work up in January (the results from both these labs are on the "LABS" page on my spreadsheet). His BUN went from 39 to 51 and his creatinine from 1.6 to 2.4. He's still Stage 2 CKD, but just barely. Some of this may be due to the version of Fancy Feast that I was feeding him just to get him to eat anything. It wasn't ideal for his CKD.

Anyways, we started Edwin on a 100 ml subq every other day. We also added Cyproheptadine 1 mg BID and 5 mg Pepcid QD (once a day). Due to some reading about famotidine (Pepcid) on Tanya's CKD site, I lowered that amount to 2.5 mg a day. I also bumped Edwin's B12 to 325 mcg BID. All this helped and someone became a hungry, hungry kitty who was willing again to eat the much more appropriate Friskies Special Diet with ground Young Again Zero Carb Mature mixed in.

Finally getting to my point here, four days ago, Thursday, Edwin started acting a bit off. Not terribly so, but a little odd. I had given him a subq the day before (Wednesday). I clean out his litterbox before bed and was shocked to see it absolutely flooded, about 2-3 times the normal amount. I thought it might be subq related, but between that and his odd behavior I thought a BG test was in order. He threw a slightly high number, 149, that night and a slightly high number, 138, the next morning. Since then he's been totally normal at about 100. (Actually exactly 100 three times in a row, so I double checked the meter. It was working fine, but what are the odds of that?)

I figured the litterbox flooding must be subq related, but the next night Friday (no subq Thursday) it was flooded again. I checked his hydration. Not dehydrated (skin snap back and gum check) or over hydrated (not squishy and no swelling in legs). I skipped that night's subq worrying about fluid overload.

After skipping his Friday night subq, the next day I did see him drinking more water than normal. Saturday night's litterbox check reveled less urine, closer to two times the normal amount, but still way more than normal. There was one piece of slightly hard stool tracked onto the carpet outside the bathroom (must have gotten stuck). Earlier that day I had found him inside crouching by the bedroom instead of outside enjoying the beautiful day. Again strange behavior. All around he seems off and in a bit of pain.

I'm really not sure what is going on here. Too much fluid, too little fluid, one of his other meds? I'll be calling the vet tomorrow. In meantime, and in addition to whatever the vet suggests, do any of you have any ideas of what might be going on or any suggestions?

I do have an account on Tanya's CKD board, but I have yet to post there. I posted here first since I'm at least familiar with the people here.

I would suggest reposting this on the Lantus forum, you more apt to get more people to help you. Good luck to you!

 

[BJM]

Acute renal failure to rule out.
Maybe hyperaldosteronism to rule out (rare).

 

[bsmith]

I would suggest reposting this on the Lantus forum, you more apt to get more people to help you. Good luck to you!

I think a number of the people there look at the main board too, but I'll cross post there if more traffic is needed. Thanks for the suggestion.

 

[bsmith]

Acute renal failure to rule out.
Maybe hyperaldosteronism to rule out (rare).

Going through Tanya's AKI page (acute kidney injury is apparently the new acute renal failure): http://www.felinecrf.org/acute_kidney_injury.htm

Looking through the AKI symptoms, Edwin's a bit more subdued, but I don't think he reaches the level of lethargic. He's still eating well. No vomiting and still peeing. Urination and drinking looking a little more normal so far today, but I won't be sure until I do the final nightly litterbox check. He doesn't seem to be crashing so this isn't an emergency type situation. He has been "meatloafing", but he will come out of it with slight encouragement and to walk around. Has been sleeping on his side too (right now he's sleeping on his side curled up on my arm so I have very little range of motion for typing, must not disturb sleeping cat).

Looking on the crashing page, he has been walking a bit strangely so it could be constipation. Felt around in that area (more poopsmithing), and it could be a possibility. Massaged to get things hopefully moving. Maybe I should give a subq tonight. (I don't want to end up with the q-tip and glycerin to get things moving.)

Hmm... still doesn't answer the original subq and litterbox flooding question.

Do you think that his lab values could have changed enough in a week and half, with no traumatic event, to go from CKD to AKI (potassium, calcium, etc. levels were all normal on April 8th)? There's no anti-freeze that he can get into. The peace lily in house is kept in a room he does not have access to.* I'll start looking at hyperaldosteronism.


*Years ago, when I was much less knowledgeable about cat health, I brought an Easter lily home. Edwin ate half of it that first day and then I suddenly remembered there was something about Easter lilies and cats. Yup, really poisonous. Plus, at the same time, I also had a peace lily that Edwin had been chewing on regularly for a few years. I'm not sure if lilies don't effect him somehow, or if his fantastic throwing up skills really helped there, but he had no side effects. It was many years later that his kidney issues started. (His CKD onset was at almost the same age as the CKD onset of my previous CKD cat. However, my previous CKD cat never ate poisonous plants like a weirdo.)

 

[bsmith]

Maybe hyperaldosteronism to rule out (rare).

That one was faster to rule out. It requires high blood pressure. Edwin also had his blood pressure taken on 4/8/15 and it was normal. Probably better than mine. (I already have white coat syndrome. Combine that with a kitty not feeling well and not eating and another vet visit. Yeah. No good for bean's BP.)

 

[Tiger(GA) and Ruth]

Did your vet run a Culture and Sensitivity? What did your vet say about the urine PH and the leukocytes? I'm certainly no vet or expert but I wonder why the fluids with creatine at 2.4?

I see you are treating with cypro and famaodine, is he vomiting clear foamy stuff in the morning due to acid? (Noticing the low sodium and chloride levels) You might want to ask about anti-nausea-either Cerenia or Ondansetron. Hard to eat when you might be nauseated. Constipation is pretty common with CKD kitties, if he's still producing rocks you might consider upping the Miralax, it is dose-to-effect.

I would also recommend you post this on the Tanya's Support Site- you will need to post the labs probably on DropBox but there are people on that site that know their stuff when it comes to CKD.

 

[bsmith]

Did your vet run a Culture and Sensitivity? What did your vet say about the urine PH and the leukocytes? I'm certainly no vet or expert but I wonder why the fluids with creatine at 2.4?

I see you are treating with cypro and famaodine, is he vomiting clear foamy stuff in the morning due to acid? (Noticing the low sodium and chloride levels) You might want to ask about anti-nausea-either Cerenia or Ondansetron. Hard to eat when you might be nauseated. Constipation is pretty common with CKD kitties, if he's still producing rocks you might consider upping the Miralax, it is dose-to-effect.

I would also recommend you post this on the Tanya's Support Site- you will need to post the labs probably on DropBox but there are people on that site that know their stuff when it comes to CKD.

I don't know what a culture and sensitivity is, but I'll look it up. I'm pretty sure it hasn't been done. The pH was normal this time (there are labs from two different dates, 1/16/15 and 4/8/15, on there). I was wondering about those leukocytes (Edit: meant lymphocytes here) too. They've been border line low twice now. I've tried to figure out the possible implications of that, but I've yet to find a clear explanation. I wondered about the fluids at creatine of 2.4, but I assume it was to try to bring down the BUN level that went from 39 to 51.

Edwin has not vomited since 4/2/15 (to my knowledge, he is outside for part of the day). This is surprising as he has been a big vomiter his whole life. He stopped when he became diabetic, started again a few days before OTJ day, them stopped again. I don't think he's nauseous as I've been through the many symptoms listed on Tanya's CKD page and they don't seem to fit. The Cyproheptadine and famotidine are simply to help with his appetite issues and they have definitely got him eating better.

More miralax may be the key. Do you know if there are issues using it long term? I know it's not a problem for humans, but is it for cats with kidney issues?

I already have a login over a Tanya's site, but I have not yet posted there. I'm afeared to go over there as I don't know them yet. Alright, alright, I'm putting on my big girl pants and going over there. Wish me luck. Is there a reason I need to put the stuff in Dropbox instead of Google Docs? I have accounts for both so it's not an issue, but I was wondering why.

 

[bsmith]

@Tiger and Ruth, I forgot to include your quoted message in the above reply message. I edited it, but I'll tag you just to make sure you're notified of my reply.

 

[bsmith]

@Tiger and Ruth, I cross posted on Tanya's CKD board. I'm "Bsmith" over there. I just linked to my FDMB spreadsheet from there to let them see my lab results. I think they have had a fairly recent change in the forum platform they are using. It linked fine. No Dropbox needed.

And I see you over there too. Now I feel safer.

 

[bsmith]

What did your vet say about the urine PH and the leukocytes?

Sorry I missed it before, but you were talking about leukocytes and I was responding about lymphocytes. The test on 4/8/15 did not include leukocytes, but there were some other results from that urinalysis that I didn't include because I had no idea what they were. I added them to the spreadsheet, but I'm not sure if any of them have to do with leukocytes.

Brain no working so good today. I should go to bed.

 

[Critter Mom]

Hi B,

Not sure if this will be of any help to you, but there's a current discussion on Tanya's support forum about reliability of Spec fPL test results for cats with CKD. It might be worth reading.

I find that joining new groups on the intertube can be quite intimidating: there's no-one to help make introductions. I only recently joined Tanya's support group (user ID is Moglet). I was pleased and relieved to see Edwin's sweet, familiar little face when I got there. Made it feel more welcoming.

 

[Melanie and Smokey]

High urine output is a common thing with CKD, not just acute failure, but chronic kidney disease also. I don't know why it would have just suddenly hit, but it might be worth another kidney panel just to see that the numbers are stable. Taz's advanced very quickly on us in the early stages.
One thing I found very useful from Tanya's site is the info on phosphorus. My vets are very much the kind that believe that under the normal threshold of 8.0 is great. But following Tanya's guide to keeping it under 5.0 for CKD really helped with Taz I think.

 

[bsmith]

Hi B,

Not sure if this will be of any help to you, but there's a current discussion on Tanya's support forum about reliability of Spec fPL test results for cats with CKD. It might be worth reading.

I find that joining new groups on the intertube can be quite intimidating: there's no-one to help make introductions. I only recently joined Tanya's support group (user ID is Moglet). I was pleased and relieved to see Edwin's sweet, familiar little face when I got there. Made it feel more welcoming.

I saw that thread about the Spec fPL test reliability in CKD cats the other day and read through it. I should go back to see if there's any new posts on that thread. I know that Saoirse has had pancreatitis issues. Is there anything that you would suggest that I look for? I've read a fair amount of information on pancreatitis, but, as with many medical issues, so many of its symptoms overlap with other issues.

It's nice when people include the same picture of their cat on other sites. I think, "oh hey, I know that cat." I agree that it does make it more welcoming.

 

[bsmith]

High urine output is a common thing with CKD, not just acute failure, but chronic kidney disease also. I don't know why it would have just suddenly hit, but it might be worth another kidney panel just to see that the numbers are stable. Taz's advanced very quickly on us in the early stages.
One thing I found very useful from Tanya's site is the info on phosphorus. My vets are very much the kind that believe that under the normal threshold of 8.0 is great. But following Tanya's guide to keeping it under 5.0 for CKD really helped with Taz I think.

Edwin has had CKD for a few years now and had been pretty stable. However, I think the whole diabetes, food changes, going OTJ, not eating, and especially the only agreeing to eat canned foods that were okay, but not great, phosphorus wise has definitely caused the rise in his BUN, Creatine, and phosphorus levels.

I'm thinking the BUN going from 39 to 51 and his phosphorus going from 3.1 to 5.6 is why my vet decided to start subq's even though his creatine was only 2.4. I'm thinking though that 100 ml every other day may have been to much and may have pushed him over the edge. Edwin is back to eating better and eating much more appropriate foods, phosphorus wise, than he was before. Hopefully this will help get his phosphorus levels down.

I'm still waiting on my vet to get back to me from this morning's phone call. I'm also still waiting for a reply to an email that I sent last Tuesday about his pepcid dosage and the results of his B12 and folate tests. Not particularly happy with my vet right now.

I may very well have to have them run another kidney panel on Edwin to make sure nothing has changed. Some good news though, last night's litterbox looked good. Normal amount of urine and a good size piece of stool. However, the stool was still hard so his miralax was upped to 1/4 tsp today.

One other thought, since Edwin has been eating much more than before, does anyone think that this could account for the couple of slightly high BG readings (that have returned to normal now)? Of course, those high numbers could just be glucometer error too. However, is there a chance that I am overloading his only recently healed pancreas and stressing it? I've wondered if I should back off on his appitite stimulant. Thoughts on this would be welcomed.

 

[Tiger(GA) and Ruth]

Hi again, glad to see you found your way to Tanya's, I'm Ruth & Tiger over on that site... Yes, it was very scary to get a CKD diagnosis first off, because the site tells you right away that eventually there is no cure but it can be managed. However, I joined that site almost a year ago and have learned a lot but have lots to learn still, and gotten familiar with some of the kitties and their caregivers. It hurts like H!!! when it's their time to cross the bridge. It's hard, but it is life so you just try to embrace what time we have with our babies and learn what we can to make them loved, pampered and have a good QOL.

Urinalysis with Culture and Sensitivity means that your vet has to send the urine to an outside lab to be cultured for bacteria. It takes several days to get the results too. With FD and CKD kitties urine is usually dilute, so bacteria often can't be seen, it's good to have it sent out anyway to be sure. Many vets don't do this, trying to save expenses, but that's how UTI's and kidney infections get missed. (This happened to us! ) Plus, urine has to be obtained via cysto rather than free catch- otherwise it's not sterile. I knew none of this a year ago...

Regardning nausea, kitties are tricky -they hide pain and nausea in ways that humans can't always get. I keep both cerenia and ondansetron on hand because Tiger has chronic pancreatitis as well as CKD and probably IBD. By the way, I'm sorry if I sound like I'm pushing all these meds, especially since I'm not a vet. Truthfully, I hate to take meds myself, I have a sensitive stomach. However, Tiger can't tell me if she feels like crap- I have to read the clues and I don't want her to ever suffer if there's something I can do to help her I would do it. So yes, all drugs have their long term consequences, like Miralax, I honestly don't know the 20+ year effects, especially in cats! But sometimes we have to make tough choices.

Lymphocytes were low on both test dates, it's a mystery even for vets because all it tells us is that the immune system is reacting to "something" Has Edwin ever had steroids for example? Plus, I read the dates backward, Edwin had a trace of protein in his urine 4/8? And high PH plus leukocytes in January, that looked like some sort of infection. UTI? Which is why I asked if the vet sent out for culture and sensitivity on 4/8.

Well my goodness, sorry for the mini-novel, and it still does nothing to explain the flooded LB If it continues, I would take him in again and get it checked- infection can happen quickly. Please keep us posted

 

[bsmith]

Hi again, glad to see you found your way to Tanya's, I'm Ruth & Tiger over on that site... Yes, it was very scary to get a CKD diagnosis first off, because the site tells you right away that eventually there is no cure but it can be managed. However, I joined that site almost a year ago and have learned a lot but have lots to learn still, and gotten familiar with some of the kitties and their caregivers. It hurts like H!!! when it's their time to cross the bridge. It's hard, but it is life so you just try to embrace what time we have with our babies and learn what we can to make them loved, pampered and have a good QOL.

Urinalysis with Culture and Sensitivity means that your vet has to send the urine to an outside lab to be cultured for bacteria. It takes several days to get the results too. With FD and CKD kitties urine is usually dilute, so bacteria often can't be seen, it's good to have it sent out anyway to be sure. Many vets don't do this, trying to save expenses, but that's how UTI's and kidney infections get missed. (This happened to us! ) Plus, urine has to be obtained via cysto rather than free catch- otherwise it's not sterile. I knew none of this a year ago...

Regardning nausea, kitties are tricky -they hide pain and nausea in ways that humans can't always get. I keep both cerenia and ondansetron on hand because Tiger has chronic pancreatitis as well as CKD and probably IBD. By the way, I'm sorry if I sound like I'm pushing all these meds, especially since I'm not a vet. Truthfully, I hate to take meds myself, I have a sensitive stomach. However, Tiger can't tell me if she feels like crap- I have to read the clues and I don't want her to ever suffer if there's something I can do to help her I would do it. So yes, all drugs have their long term consequences, like Miralax, I honestly don't know the 20+ year effects, especially in cats! But sometimes we have to make tough choices.

Lymphocytes were low on both test dates, it's a mystery even for vets because all it tells us is that the immune system is reacting to "something" Has Edwin ever had steroids for example? Plus, I read the dates backward, Edwin had a trace of protein in his urine 4/8? And high PH plus leukocytes in January, that looked like some sort of infection. UTI? Which is why I asked if the vet sent out for culture and sensitivity on 4/8.

Well my goodness, sorry for the mini-novel, and it still does nothing to explain the flooded LB If it continues, I would take him in again and get it checked- infection can happen quickly. Please keep us posted

At least when Edwin was diagnosed with CKD I had already gone through CKD once before. The kitty I grew up with had CKD for many years and lived a normal happy life to age 17. Her passing was probably partially from CKD, but mostly from her arthritis pain getting to unbearable levels. When she stopped eating and drinking, and was in to much pain to make any trouble, I knew it was time to let her go. Edwin has CKD and arthritis too (and diabetes), but at least now there are pain meds for cats with arthritis, which weren't around for my previous kitty. I'm so glad there are more medication options for cats now.

I'll check with my vet about whether a urinalysis with culture and sensitity was done. The test results that I had received showed a result for "Bacti none seen," but that may have been in house testing. Thanks for all this information about urinalysis. I wasn't aware of any of it. I'd hate for Edwin to be dealing with an infection that is being missed because of his dilute urine. Also, Edwin has never been on steroids so that can't be the answer. I'll ask about the lymphocytes too.

Don't worry, I don't see you as pushing meds. I think it's good to know about the medication options that are available. Better too much information than too little.

I do have ondesteradon on hand, though not for Edwin. However, I personally dislike mixing it with tramadol, which Edwin is currently taking. Part of the way that tramadol works is by increasing the seratonin in your brain, while ondesteradon makes you less nauseous by decreasing the amount of seratonin in your brain. (I've read some medical papers about using these two medications together. The papers make some claims about it somehow being "different" seratonin or some such foolishness. As far as I can tell the authors are just guessing at how it all works.) Anyways, combining the two makes me have to sing "White Rabbit," by Jefferson Airplane and that's no good for anyone . That being said, there isn't an "actual" drug interaction between the two, but I like to mess with brain chemistry as little as I possibly can (as do most people for themselves and for their animals).

Keeping your kitty feeling well with medications for nausea is not something that I see as an issue at all, especially if you're having issues with inappetence. A kitty who is too nauseous to eat very well won't be around for long. Edwin is currently taking famotidine and Cyproheptadine and that has him eating much, much better AND eating food that is much better for his diabetes and CKD. About miralax, I don't need 20+ year type information. Edwin is already 16.5, if he makes it another 20+ years I'll have to call the Guiness records people. I just need information for a couple of years or so. On the non medication side of things, I've been finding that massaging his stomach and bowels seems to help with discomfort, bloating, digestion, and getting things moving.

Don't worry about the novel writing as I've replied in kind. Short post are often difficult for me to write. Don't most people need lots of commas, asides, and ellipsis to get their point across? That's why I often have to do things like what is shown below.

To sum up:

• Edwin eating much better and eating appropriate food.
• Water intake slightly increased.
• Last night's litterbox showed a normal amount of urine and a reasonable amount of stool. The stool was still hard, so upped miralax to 1/4 tsp a day.
• Still no explanation of previous flooded litterboxes.
• Still holding off on subq's for now. If subq's are resumed it will probably be at a reduced amount.
• Will speak to vet about possibly doing another kidney panel. Will also discuss doing a urinalysis with culture and sensitivity to double check that we are not missing an infection.
• Still looking for input on whether having Edwin eat more, to try to put back on some weight, may be stressing his newly healed pancreas.

 

[bsmith]

Update: Edwin's B12 and folate test came back normal. This hopefully helps to rule out intestinal disease.

@Tiger and Ruth, I forgot to ask one thing. For urinalysis what is a cysto? Is that like a catheter?

 

[BJM]

Cystocentisis is getting a urine specimen by inserting a needle through the abdomen into the bladder.

Serotonin may be taken up by different types of nerve receptors, so if the meds affect different receptors, they may not interact. If the action is to block the receptor, more serotonin may circulate. If the action is to facilitate the serotonin landing and staying in the receptor site, there may be less serotonin circulating. It is very complex; this is a simplified explanation.

 

[Critter Mom]

Short post are often difficult for me to write. Don't most people need lots of commas, asides, and ellipsis to get their point across? That's why I often have to do things like what is shown below.

I'm the same way. Indeed, when I need help the most or when I'm really worried about someone else's kitty, the pressured speech part of my cluster of anxiety symptoms is overwhelming and I end up writing rambling, 'stream of consciousness' replies that I end up never posting because they end up in drivel.

The key things I look out for re the pancreatitis:

• Crouching in meatloaf / semi-meatloaf position (top half of body hunched, rear legs stretched out).
• Any signs of nausea or inappetence (lip licking, refusal to eat a particular food).
• Increases in BG (including conducting food trials to see if a food will markedly elevate Saoirse's BG).
• Hiding - including the location (varies with intensity of discomfort for Saoirse).
• Crouching/sitting in a place where the floor or surface is cool.
  
• Lethargy/subdued or low mood.
• Loose stools / discoloured stools / malodourous stools. (I do daily fecal exams.)
• Signs of nutrient malabsorption (e.g. B12/folate level checks, and also clinical signs such as the way her coat is becoming discoloured again since ceasing insulin therapy, plus the regrowth of her fur after she was shaved for her scans is only going at a glacial pace ).

Saoirse has had 3 Spec fPL tests done. They've all been when she was quite symptomatic for pancreatitis and ranged from 20 at diagnosis to 17 at the most recent one. I wish that I had been able to get a Spec fPL done just after she finished her insulin treatment because her symptoms were minimal: I think it may have been lower at that time. For information, Saoirse started showing increased signs of pancreatic distress about two months after her last dose of insulin.

 

[bsmith]

Cystocentisis is getting a urine specimen by inserting a needle through the abdomen into the bladder.

Serotonin may be taken up by different types of nerve receptors, so if the meds affect different receptors, they may not interact. If the action is to block the receptor, more serotonin may circulate. If the action is to facilitate the serotonin landing and staying in the receptor site, there may be less serotonin circulating. It is very complex; this is a simplified explanation.

Two questions BJM:

My vet is going to do a cultured urinalysis. @Tiger and Ruth said they need to collect this via cysto. The vet says that they are going to collect a sterile sample using their ultrasound. Last time I checked, ultrasound doesn't involve a needle (or another way to get urine out). In cysto's do they sometimes use an ultrasound to guide the needle placement? I'm figuring that has to be what my vet is talking about.

Question two, oh well informed information guy who seems to have a decent grip on neurochemistry too, could you recommend some good introductions/references to neurochemistry or neurobiology? I've been looking for a while for some good texts on those topics, but have yet to find one. I have a hard science background, but not in those specific fields, so I'm not adverse to more technical tomes. Suggestions on this topic are welcome from anyone.

 

[Larry and Kitties]

In cysto's do they sometimes use an ultrasound to guide the needle placement?

Yes, that is the usual way to find the bladder so that the vet can get the needle in the bladder safely. However, an experienced vet does not really need ultrasound with a full bladder. They can feel the bladder.

 

[bsmith]

I'm the same way. Indeed, when I need help the most or when I'm really worried about someone else's kitty, the pressured speech part of my cluster of anxiety symptoms is overwhelming and I end up writing rambling, 'stream of consciousness' replies that I end up never posting because they end up in drivel.

The key things I look out for re the pancreatitis:

• Crouching in meatloaf / semi-meatloaf position (top half of body hunched, rear legs stretched out).
• Any signs of nausea or inappetence (lip licking, refusal to eat a particular food).
• Increases in BG (including conducting food trials to see if a food will markedly elevate Saoirse's BG).
• Hiding - including the location (varies with intensity of discomfort for Saoirse).
• Crouching/sitting in a place where the floor or surface is cool.
  
• Lethargy/subdued or low mood.
• Loose stools / discoloured stools / malodourous stools. (I do daily fecal exams.)
• Signs of nutrient malabsorption (e.g. B12/folate level checks, and also clinical signs such as the way her coat is becoming discoloured again since ceasing insulin therapy, plus the regrowth of her fur after she was shaved for her scans is only going at a glacial pace ).

Saoirse has had 3 Spec fPL tests done. They've all been when she was quite symptomatic for pancreatitis and ranged from 20 at diagnosis to 17 at the most recent one. I wish that I had been able to get a Spec fPL done just after she finished her insulin treatment because her symptoms were minimal: I think it may have been lower at that time. For information, Saoirse started showing increased signs of pancreatic distress about two months after her last dose of insulin.

Ahh, the pressured speech strikes again. That could explain my rambling. Thanks for reminding me about that. We've discussed it before, but I'd forgotten about the written component. Well, I didn't so much forgot about it as I just failed to connect it to my own behavior.

About the pancreatitis, I think we may be in the clear with Edwin as his B12 and folate levels came back normal last night. His fur is looking good. His stool is still on the hard side, even with 1/4 tsp of miralax a day, but otherwise normal.

I don't blame Edwin for being subdued lately as it's gone from warm and sunny outside to cold, grey, and rainy outside. (There was a whole bunch of that white stuff coming from the sky a few minutes ago. Really, really? It's almost May. April showers bring May flowers, not April snowstorms.) With this weather he's not lying on cool surfaces. He's streched in front of the electric radiator in my bedroom.

The Cyproheptadine continues to do its work and he's still eating well. Thanks again to you and others who suggested that instead of mirtazapine. There have been a few borderline BG readings, but I think they may well have been brought on by the stress of the fluid overload and perhaps his increased eating stressing his newly healed pancreas. Also, I'm now suspecting he may have an infection that we've been missing for months. I've scheduled him for a cysto tomorrow so we can get a cultured urinalysis done.

Edwin's still meatloafing on occasion, but you can usually pet him out of that position. I think part of it is pain from his stomach, which is still bloated at times, and constipation. Massage loosens those issues up and he seems to feel better after. I'm also starting to think that some of his meatloafing is "emotional" rather than "physical." He also adopts the meatloaf pose when he's angry or unhappy about something.

Thanks for giving me your list of pancreatitis symptoms. I think we're good for now, but I'll keep this list around for future reference.

 

[Tiger(GA) and Ruth]

To sum up:

• Edwin eating much better and eating appropriate food.
• Water intake slightly increased.
• Last night's litterbox showed a normal amount of urine and a reasonable amount of stool. The stool was still hard, so upped miralax to 1/4 tsp a day.
• Still no explanation of previous flooded litterboxes.
• Still holding off on subq's for now. If subq's are resumed it will probably be at a reduced amount.
• Will speak to vet about possibly doing another kidney panel. Will also discuss doing a urinalysis with culture and sensitivity to double check that we are not missing an infection.
• Still looking for input on whether having Edwin eat more, to try to put back on some weight, may be stressing his newly healed pancreas.

RE:the flooded LB- we may not ever know why some things happen. If it continues though, I would get it checked out. Is he still acting off?

You are asking about Edwin eating, FWIW, I say yes, Edwin needs to eat if he has lost weight. Small frequent meals are usually easier on the pancreas. But for any older kitty, eating trumps everything. Have you tried testing his BG 3 hours after a meal to see if it goes down? If his BG goes up, then you ask your vet about starting insulin but if he is losing weight, he needs to eat.

 

[Critter Mom]

Re the cyproheptadine, it seemed to help Saoirse in other ways above and beyond improving her appetite. For the last while she started mewling after eating and the frequency was increasing (as was my worry about her). As luck would have it, I asked our vet if he could prescribe an antihistamine for her current mild rhinitis (didn't really respond to the mucolytic initially prescribed). He prescribed 1mg Piriton twice a day. Since starting on the antihistamine, Saoirse hasn't mewled after any meals. Saoirse definitely has food intolerances and shows strong signs of low-grade IBD (recent allergy testing gave more info about which foods she's sensitive to and her clinical signs and recent diagnostic tests support the IBD Dx) and I think she is probably allergic to soy. Prior to Saoirse's diabetes/pancreatitis Dx last year, her tum had been getting progressively balder (previous vets put it down to stress/boredom ). As soon as the soy-containing dry diets she was on were eliminated, the fur on her tummy started regrowing immediately.

In Saoirse's case, I think antihistamines definitely help her digestive system. Maybe it might be worth asking your vet about whether any of Edwin's digestive discomfort might have an allergy basis?

 

[bsmith]

RE:the flooded LB- we may not ever know why some things happen. If it continues though, I would get it checked out. Is he still acting off?

You are asking about Edwin eating, FWIW, I say yes, Edwin needs to eat if he has lost weight. Small frequent meals are usually easier on the pancreas. But for any older kitty, eating trumps everything. Have you tried testing his BG 3 hours after a meal to see if it goes down? If his BG goes up, then you ask your vet about starting insulin but if he is losing weight, he needs to eat.

After stopping the subq's, and a few day to clear the extra fluid out, Edwin's urine output is back to normal. I'm pretty sure that he was being fluid overloaded and the vet agrees, for what that's worth. I asked the vet for a clarification as to why we started the subq's, given his kidney numbers, and she didn't have a really clear answer. We're going to hold off on any future subq's for now. Edwin seems to be handling his hydration fine on his own. I'm definitely getting a "second opinion" from this board and the CKD board before starting subq's again.

As far as Edwin's eating, he's always been free fed so he already does small frequent meals on his own. Bonus. He has lost weight. In his younger years he usually ran 10-11 lbs, but that was a little heavy and he had the pot belly that fixed male cats sometimes get. When he got older (12ish) he dropped to 10 lbs, but that was around the time of his arthritis diagnosis so some of that could be muscle loss too.

After starting him on Adequan, and the consequent jumping of the deck gate, he became a part time outdoor kitty (daytime only and also only if I'm home). He dropped down to 9 lbs about that time, but it was a good weight loss from increased activity and actually looked good on him. He looked healthy at that weight.

At the time of his diabetes diagnosis he was 8.1 lbs (January) and looking a bit scrawny and his fur was thin. His arthritis had also worsened right around this time so some of that weight loss could again be loss of muscle mass. At his vet visit earlier this month I was convinced that he had lost even more weight. (The kitchen scale lied. Of course, it wasn't exactly made to weigh cats. Also, apparently my worry about him not eating made him feel much lighter to me.) At the last vet visit he was once again exactly 8.1 lbs, but now with nice looking fur (darn my worrying imagination).

I'd like to see him up towards the 9 lbs range again. That was a lean healthy weight on him. Right now he's eating 1-1.25 times the amount of food to support a 10 lbs cat.

I haven't tried doing a pancreas function test (test, feed, test 1-2 hours later, test 3-4 hours later to see if his BG went back to normal). I should though. Yesterday he had a 122 BG and today a 120. I'm afraid that the insult of the fluid overload plus the extra food intake (and a possible infection) may be stressing his only recently healed pancreas. Tomorrow he goes to the vet for a cysto so we can do a cultured urinalysis to double check that he doesn't have some sort of infection that has previously been missed. Wish us luck.

As far as restarting insulin, when Edwin went OTJ from Lantus I was giving him 0.25 U once or twice a day (depending on his preshot number) and my no shot limit was still 185. Edwin reacted very strangely and strongly to Lantus, which is why I never was able to use it properly as a depot insulin. Even 0.25 U had the potential to drop him 120 points in two hours. I would have eventually done drop dosing, but his OTJ was totally unplanned (after a food change) and his numbers just weren't high enough for me to shoot without knowing how low even a drop would take him.

I'm hoping his BG numbers hold and don't go any higher. With Edwin I'm not even sure what number he needs to reach for me to consider putting him back on Lantus. He's a tricky one. Wish me luck on this front too. I've been whispering "go pancreas, go" into his ear to try to encourage it to work better. Do you know of any information about what to do in cats with borderline BG numbers?

I'll make sure to get a weight at the vet tomorrow when we go in for his cysto for the cultured urinalysis. That "weigh" I'll be able to see if we've "gained" any ground. (Bad pun, sorry.)

 

[bsmith]

Re the cyproheptadine, it seemed to help Saoirse in other ways above and beyond improving her appetite. For the last while she started mewling after eating and the frequency was increasing (as was my worry about her). As luck would have it, I asked our vet if he could prescribe an antihistamine for her current mild rhinitis (didn't really respond to the mucolytic initially prescribed). He prescribed 1mg Piriton twice a day. Since starting on the antihistamine, Saoirse hasn't mewled after any meals. Saoirse definitely has food intolerances and shows strong signs of low-grade IBD (recent allergy testing gave more info about which foods she's sensitive to and her clinical signs and recent diagnostic tests support the IBD Dx) and I think she is probably allergic to soy. Prior to Saoirse's diabetes/pancreatitis Dx last year, her tum had been getting progressively balder (previous vets put it down to stress/boredom ). As soon as the soy-containing dry diets she was on were eliminated, the fur on her tummy started regrowing immediately.

In Saoirse's case, I think antihistamines definitely help her digestive system. Maybe it might be worth asking your vet about whether any of Edwin's digestive discomfort might have an allergy basis?

Edwin definitely has airborne allergy issues. They seem to be the same as mine. The way that I can tell if I have a cold or allergies is to check if the cat is stuffy too. Cat stuffy = allergies, cat not stuffy = I have a cold. I like to joke that we're allergic to each other. I'm allergic to cats, but I'm allergic to so many other things that having a cat really doesn't make any noticeable difference.

The spring allergens have really been effecting me. I'm really congested and my ears are all blocked up. Edwin is totally fine since Cyproheptadine is also an antihistamine and seems to be helping him with his allergies as well as his appetite. Yay for multi-purpose medications. Hmm... maybe Cyproheptadine could work for me too?

About food allergies, the only thing I am really concerned about is the fish oil in the Young Again Zero Carb Mature. When I called them, prior to purchasing the food, they claimed that it did not contain any fish. However, the ingredients on the bag list fish oil (and now salmon oil too on the website).

Edwin's hard stomach started when I switched him to another Hill's formula that was lower carb than k/d and did not contain fish meal, but did contain fish oil. That food caused a hard stomach and some serious BG spiking. The YA food was great at dropping his BG numbers and letting him go OTJ, but his hard stomach returned during the food switch. Eventually his stomach softened as he adjusted to the YA. The hard stomach returned around the time that he stopped eating, but at that time I was again switching around foods to get him to eat anything.

Actually, in writing this all out, I think that just switching foods around is more of an issue than any particular food allergy. And I'm about to do it again. The Friskies Special Diet is apparently not a good choice for CKD cats according to the people on Tanya's board.

If the fish oil in the YA turns out to be an allergy issue, I'm not sure what I'll end up feeding Edwin. I'm kind of running out of food options. I guess I'll just have to go to the pet store for feeder mice. I'm pretty sure this food stuff is starting to make me nuts. I'm sooooo tired of combing through the food lists and I spend an awful lot of time in the cat food aisle muttering to myself and cursing (the cursing is usually accompanied by the word fish - they sneak it into everything).

Bah, I'm done talking about cat food tonight. I'm going to go feed my cat some slightly inappropriate food and go to sleep. Sorry about this rant. It's not in any way for you, it's for all the conflicting and difficult issues surrounding trying to feed a cat with multiple medical issues. I hope you skipped reading a bunch of it. I'll be better tomorrow and back to probably ask you about food allergy testing in cats.

 

[bsmith]

Okay, I'm back today with a better attitude. Sleep helped. So does the fact that the sun has once again reappeared and that white stuff has stopped falling from the sky. Edwin got his cysto today for his cultured urinalysis and we should get results in a few days if negative. If it's positive it will take a few more days so they can identify what is growing.

@Critter Mom, sorry again for the ranting last night. With Saoirse's food allergies did they do a blood test to find the possible allergens? I know they do that for humans. For airborne allergies they do a skin test, but I'm pretty sure you'd have to shave your cat to do that. A shaved cat always looks so sad.

I know with human and food allergies that you would normally do an elimination diet. I'm assuming you did something like that with Saoirse, for soy, but after you had the results of the allergy tests to guide you.

Sometimes humans also do elimination diets even if no allergens show up on the tests. They do this since people can have food sensitivities, which are not quite allergies, that don't show up on the tests, but still cause issues for them. I've done elimination diets myself for dairy and gluten, but I've never done the full hardcore elimination diet where you're only able to eat a few foods and then gradually add foods in to try to find the issue. It's a tremendous pain to do that and it takes some real dedication.

My cousin had to do the full elimination diet for some time when she was nursing her oldest who has numerous food sensitivities/allergies. I'm trying to get her to take her oldest in for actual allergy testing as we have a top notch allergy center nearby. The treatment is a reasonable $30 a month (the testing is the most expensive part and their insurance will cover that). At this point in time the poor kid isn't allowed gluten, dairy, birch related foods (apples, peaches, pears, almonds, peanuts, carrots, celery, etc. - she can have some of those vegetables if they're cooked), and a number of other things. I would hope that actual allergy testing would help make it more clear which foods she really needs to avoid. That kind of food restrictions is hard on a little kid, especially at parties and pot-lucks, even though my cousin has worked really hard to provide a variety of other foods.

Come to thing of it, I need to make an allergy appointment myself. I've had a bit of a lapse in my allergy treatment. Hey, maybe that's why I'm so stuffy. That stupid birch pollen is whacking me too.

 

[BJM]

Actually, I took a psychopharmacology course back in the 80s, when I was thinking about becoming a clinical psychologist. (I'm an epidemiologist, now) maybe do an Amazon or Google search on psychopharmacology to see if you can locate a text or two on it. (I'm in chorus rehearsal right now, or I'd do that.)