Todd Update With Questions About CRF and Anemia at 25%

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ToddyTiger

ToddyTiger

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So, it's been a bit since we posted. I wanted to give a bit of an update on Todd and ask some questions. I have looked at the websites for CRF, but I wanted to ask folks here about their experience with it.

First, my question... for those that have had a cat with Kidney Disease/CRF, realistically, can they ever gain weight back or am I just maintaining his weight at this point? He's lost 4lbs since July, but has been staying around 10.3 lbs for the last month or so. Since he is a picky eater and our vet just wants him to eat, so he's been chowing down on the k/d dry and sometimes the k/d wet. The wet is hard to get into him. He just doesn't like wet food, but we're trying. I am concerned for his weight though. He's so small now. His hips are so, so boney and it just worries me.

Anyway, he has been eating pretty well since his last vet visit on the 22nd of October. He gets Mirtazapine every 72 hours, which is helping to keep his appetite up, so he's been eating pretty regularly since then. Drinking well also. But I am giving 100ml of Sub-Q every other day, just to be on the safe side. His last set of labs, done on Oct 22nd showed the kidney values back into the normal range. YAAY! However, his white cell count was up a bit and they showed that he was slightly Anemic. They wanted to give it a bit over a week and check it all again. If he is still Anemic, they will probably treat for that (what have you all tried for anemia in your cat?) He had more blood work done today and the results should be back in tomorrow morning. Crossing my fingers for good news!!

His mood has been pretty good, though the last couple of days he's been a little slower. I kinda just assume at this point he will have good days and bad days. At least he is eating though. He's been off of the Prednisolone for a little over a week now. I'm wondering if he might need to be on it though. I guess that is for the doctor to decide.

His med list is as follows:

Mirtazapine every 72 hours
Pepcid AC as needed
B-12 injection once a week (usually Wed)
Tumil-K twice a day
Sub-Q 100ml every other day or as needed
Lantus 1.5 units twice a day

Food:

Hill's k/d dry
Hill's k/d wet
Hill's Hypoallergenic treats
Bonito Flakes

Again, questions..

Realistically, will he ever gain any weight back or am I just maintaining what he has?

Are there any supplements I should try for him?

If his blood work comes back that he IS Anemic, what are the medication options and have any of you tried them? Our vet was concerned about one of the medications, because it has a risk of making him worse. I unfortunately do not recall which drug this was. I will have to ask her tomorrow.



Thank you!!
Sarah
 
Re: Todd Update With Questions About CRF and Anemia

Sorry, I have squat to offer about the issues Todd's having but wanted to ask if you could list all the foods you have tried - it may help others to give you suggestions of foods that you have not tried.

I sure hope he starts feeling better soon and starts to put on a bit of weight.
 
Re: Todd Update With Questions About CRF and Anemia

Bear Man had IBD, CRF, and anemia, among other diseases, and was treated for anemia.

Anemia is quite a complicated condition, and you will want to do a lot of reading on it. This is a very good resource:
http://www.felinecrf.org/anaemia.htm

The blood test results you are interested in for anemia are RBC, Hemoglobin, and Hematocrit/PCV. You should also test reticulocytes, so that you know what type of anemia you are dealing with. In a nutshell, anemia can be regenerative (the cat can make red blood cells but is losing them or they are being destroyed) or non-regenerative (the cat can't make enough red blood cells). Non-regenerative is associated with kidney disease.

Non regenerative anemia from kidney disease can be treated with a human hormone called erythropoeitin. The two main brands are epogen and darbepoietin (also known as Aranesp). Bear was on Aranesp. Because theses drugs can cause serious (or fatal) side effects, treatment is not started until the PCV value has dropped to quite a low number. The problems associated with treatment can be (1) there is a risk of an antibody reaction which can completely destroy the cat's ability to build red blood cells. The only treatment for this would be transfusions, or (2) if the red blood cells are rebuilt too quickly, and PCV value rises too quickly, there is a risk of high blood pressure and stroke.

I am not plugged into the anemia world since Bear died, but the last I heard, there was a wide recall of Epogen, and it was not available, so people were starting to use Aranesp instead. Aranesp has not been as widely used, but there is speculation that it is less likely to cause the antibody reaction. Treatment with any erythropoeitin involves frequent (weekly) rechecks of PCV and blood pressure. You may also want to test iron levels or just go ahead, as I did, and give periodic injections of iron dextran when starting anemia treatment.

Bear could not gain weight. He had severe IBD and had a small appetite and trouble absorbing food. He slowly lost weight, particularly at the end of his life. Bear did well on Aranesp treatments. He died of complications from IBD, not from anemia.

There is a yahoo group for feline anemia.
 
Re: Todd Update With Questions About CRF and Anemia

So I just spoke with the vet and he said the numbers had dropped and he was 25% Anemic (?) He was going to call the specialist and see what they wanted to do. Otherwise Todd seems pretty good, all things considered.

Linda, do you happen to have a link to the Anemia group?



Thank you for the info so far folks.
 
Gosh.. Foods I've tried.

We've tried EVO, Merrick, ALL of the wet prescription kidney diets, Fancy Feast and the like.. I've bought a can of just about every wet food on the list for him to try. The only wet thing he will eat without question is canned tuna in water. lol

Dry foods, he's been on m/d, d/m, i/d and now k/d. He likes the k/d.


After doing some reading about Anemia in crf cats. I kinda feel like there is no hope. Am I wrong to think this way? If I read this right, it says we can't test for what kind it is, unless he is below 20%, but he is at 25%. I'm also worried that the treatments will make him worse. I can't afford to do transfusions on him... what do I do?
 
So the medical director of our regular vet clinic just called me. She wanted to make sure I knew what was going on, since she has been following Todd's case. She didn't know the other vet at the office had called me already.

So I guess I was given slightly wrong info this morning with the first phone call. It happens and that is why I always ask lots of questions and get the lab work to keep on hand. Originally I was told the Anemia had gotten worse since the 22nd and that his white blood cell count was high still.

Todd had blood work done on Oct 16th, Oct 22nd and on Nov. 3rd.

On the 16th, his white cell count was 17000-18000 and he was at 29% Anemic.

On Oct 2nd, his white cell count was 25000 and he was 25% Anemic.

On Nov. 3rd his white cell count was back to 17000-18000 and he was still 25% Anemic.

She tells me that they don't treat Anemia until it is below 20%, and even then, she said many cats are fine with lower numbers and no treatment. She asked how he was doing and I told her what I thought. I mean, honestly, he doesn't seem horrible. I would love it if he could gain some weight. But at least he is eating and doesn't seem to be in any pain.

She is waiting to hear from the specialist on what he wants to do, if anything. I guess I jumped the gun about the Anemia thing. But it scared the heck out of me!! Hie white cell count is still high though.

Are there any suggestions on things I can do to help keep the Anemia from getting worse?
 
Why is his WBC count high? Does he have an infection?

As far as I know, there is nothing you can do to prevent CRF related anemia other than do everything possible to support his renal function. I don't know if an iron supplement would be helpful. That might be a question I would ask the vet.
 
AND another update...

Just spoke with the vet again. They spoke with the specialist.. the specialist thinks things look pretty good.. so no changes right now. They want him to be weighed again in two weeks. If his weight is down, they might want to run some more tests, or if he starts acting worse.. but otherwise no changes.

I guess that is good. And actually, Nov 17th till the 22nd, we will be out of town, but Todd will be boarding at our vet's office. So they can easily check his weight, food intake and all of that.

Please keep him in your thoughts folks. I just want him to get better.
 
Linda- I don't know, and I did leave a voicemail for the specialist asking this question. So I hope he calls me back.

I've read that anything from IBD, Stress and of course infection, can cause high WBC. It very well could just be the stress of going to the vet clinic. But this is a question I will be asking the vet.
 
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