Warren - 5/29/2000 - 7/1/2016 rest in peace my furry friend

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I try not to update if things are going well :). Jinx and all that....... I usually update his spreadsheet every 3-4 days with his glucose numbers and any other notes (accidents, changes to medications and such). I've had to up his dose to get his numbers back in line and haven't updated his spreadsheet to reflect that yet, but we're back to around 0.6 ish.

Here is his bloodwork
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for the last 2 years.
 
Oh also the vet gave me cosequin for his arthritis. I didn't think arthritis is curable so not sure what this is supposed to do, but they said if it does anything, it would take 4-6 weeks before it would have a noticeable effect.

We also have #&$#*^$ fleas. I live in a duplex and our next door neighbor has outdoor cats (As some of you know this was a potential source of warren pooping by the door). When they get fleas, we get fleas. On the 2nd round of Sentry FiproGuard now and it doesn't seem to be working as it has in the past. My kids are getting eaten alive by these things. (Advantage and Frontline are too expensive when you have 4 cats and need to do 3 rounds). Based on my research, this is the same formula as previous generation Frontline.
 
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I just looked at the above labs, as well as the urinalyses on the last page, and I am a bit skeptical about kidney issues being a major problem for him right now. His creatinine and Bun:creatitine ratios are normal. The urea nitrogen from April of this year is elevated, but from Tanya's CRF page:

"If BUN or urea levels are high yet creatinine is normal or only a little elevated, it usually means that the cat is dehydrated, has gastro-intestinal bleeding, or is eating a high protein diet. Effects of dietary protein content on renal parameters in normal cats(2011) Backlund B, Zoran DL, Nabity MB, Norby B & Bauer JE Journal of Feline Medicine and Surgery 13(10) pp698-704 found that BUN levels were significantly higher in healthy cats fed a high protein (46%) diet compared to a low protein (26%) diet, though (since these were healthy cats) they were still within normal range." So, I mean, it's possible the kidneys are starting to decline, but if you tested it now, I think his BUN and creatinine would both have to be high if that were to account for a urine specific gravity as low as 1.014. I know all this is pricey, but if you really want pursue a diagnosis of kidney disease, you can have them run a urine: protein creatinine ratio during his next urinalysis, or redo BUN and creatinine since his USG has dropped since the last blood test. If they're not both high now, I would start thinking about alternative diagnoses.

I am not a vet, but have been through this before... so my two cents is that his pee is dilute from his BGs being in 400s, or he could actually have partial diabetes insipidus. I think it's worth having a desmopressin trial. (The only other way to test for DI is through a water deprivation test, and I would definitely not put your cat through that since a desmo trial is just as accurate.) Or at least try finding out if the vet thinks it's likely for his diabetes mellitus to dilute his urine that much in the absence of another issue (like kidney disease or DI)- my gut is that it's not likely to be diabetes mellitus alone despite high-ish BGs, but I'm not positive about that. (I am happy to ask my vet about it if you want, since he's diagnosed DI before.)

If he does have partial DI, desmo shots will completely treat it once you find the correct dose. I feel like a moron for throwing out the rest of our desmopressin, but I couldn't bear to look at it after we lost my sweet kitty a couple weeks ago. It is expensive ($100-200 per vial), but you don't use much at all and it lasts for at least 6mon. You can order online, or what we did is to print discount cards and get it at the cheapest pharmacy nearby (CVS for us). It is marketed as a nasal spray for humans.

Sorry if this is too much info. I just really want things to work out well for Warren! I can tell how much you love him!
 
Just a quick rant: It's annoying to me that kidney disease is the "go-to" diagnosis for any cat with dilute pee, sometimes even in the absence of supporting labs. I feel like 99% of vets do this. That's what we were told was going on when my kitty first started having dilute pee and we had to push hard to get real answers because the numbers just didn't make sense. I understand that CKD is common, but that doesn't mean that's what every single cat with dilute pee has. (ECID!) Ironically, when we lost my sweet kitty to cancer, his kidneys were still completely healthy according to his labs and U/S.
 
You can get Capstar from WalMart which is a pill you can give daily (if necessary)..it kills all the fleas on the cat within 6 hours

The problem is that the fleas are becoming resistant to the same active ingredients, so you might try something other than Frontline, like Advantage II

Follow up by treating the house...Diatomaceous Earth is cheap, safe and non-toxic for pets and children....and very effective too!!
 
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SpecklesandMe said:
Just a quick rant: It's annoying to me that kidney disease is the "go-to" diagnosis for any cat with dilute pee, sometimes even in the absence of supporting labs. I feel like 99% of vets do this. That's what we were told was going on when my kitty first started having dilute pee and we had to push hard to get real answers because the numbers just didn't make sense. I understand that CKD is common, but that doesn't mean that's what every single cat with dilute pee has. (ECID!) Ironically, when we lost my sweet kitty to cancer, his kidneys were still completely healthy according to his labs and U/S.
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I agree, it doesn't always follow. But I do think it might still be worth investigating in this case. Comparing his 2014 results to his 2015 ones, his BUN has gone from 28 (well within normal range) to 42 (above normal range by around 17%). That's a 50% increase in BUN in a year - that's pretty significant. I don't see either Phosphorus or Potassium levels on the 2015 blood work so there's no way of knowing if those have moved without additional tests. And although his glucose hasn't changed much, his USG has dropped from 1.03 (within normal range) to 1.014 in just the last few months. The creatinine looks fine, but that was the last thing to start moving with my Rosa - and hers is still within normal range, though higher than it was. Yet we're having real problems regulating her kidney issues which we might have avoided if the initial increase in BUN hadn't been put down to her kidneys being overworked by the diabetes (and she's still only Stage 2 on IRIS - I honestly dread to think what we're in for as it progresses, and it's progressing fast). While DI is of course also a possibility, kidney problems can be a nightmare and personally, I'd try to rule that out first simply on the basis that kidney disease can kill but is also easier to control for longer the earlier you catch it. I'm not trying to start an argument, just giving my reasoning for why I'd investigate further in this case. :)
 
manxcat419 said:
While DI is of course also a possibility, kidney problems can be a nightmare and personally, I'd try to rule that out first simply on the basis that kidney disease can kill but is also easier to control for longer the earlier you catch it.
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I totally agree. I would do a new BUN and creatinine, and/or a urine protein: creatinine. If they come back normal (or BUN and creatinine have not increased further), then I would start looking into DI. Sorry if I didn't make that clear before.
 
Agreed! :) I'd also like to see electrolyte levels re-checked - if his BUN is raised as a result of a high protein diet, then there should be a reduction in the phosphorus level to go with it. I do see the creatinine is down slightly in 2015 compared to 2014, which again might be covered by a high protein diet - that's also expected to lower slightly.
 
Chris & China said:
You can get Capstar from WalMart which is a pill you can give daily (if necessary)..it kills all the fleas on the cat within 6 hours

The problem is that the fleas are becoming resistant to the same active ingredients, so you might try something other than Frontline, like Advantage

Follow up by treating the house...Diatomaceous Earth is cheap, safe and non-toxic for pets and children....and very effective too!!
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I use DE too Rob. It is excellent. If you do get some, go ahead and spring for the applicator! I though I could rig something up myself. Ha! It is a super fine talc like powder, and you need the applicator!!
I use it everywhere outdoors too, around any doors, walkway edges and so on. In the vacuum bags too!
I haven't needed Frontline/Advantage at all for years.

You would laugh yourself silly if you saw my contraption for dusting the kitties with it.
Hope you can make it work, its safe & super cheap.
 
Chris & China said:
You can get Capstar from WalMart which is a pill you can give daily (if necessary)..it kills all the fleas on the cat within 6 hours

The problem is that the fleas are becoming resistant to the same active ingredients, so you might try something other than Frontline, like Advantage

Follow up by treating the house...Diatomaceous Earth is cheap, safe and non-toxic for pets and children....and very effective too!!
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Just make sure you get "food grade" diatomaceous earth! Non-food grade DE is not good to use in that capacity, as it is a carcinogen.
 
Flea dosing 4 kitties - try dosing 9 cats and 11 dogs! Whew! I use Advantage II and buy the large DOG dose. I can then use an empty syringe and dose it down and get 8 cats out of 1 pkg - they only get .47ml. NOT the Advantage Multi or regular Advantage, it's the white capped Advantage II. It's the same product in both dogs and cats. It works better than Frontline on everyone here. We live on ancient beach sand so fleas are an ever-present problem. We also rarely get cold enough for long enough to kill them.
 
I get my flea meds Revolution from Australia. http://www.vetshopmax.com It's cheaper, you don't need a script and I can get 12 pipette. Here the vets can only give me the box of 6. So it's making trips to the vet constantly. I have 3 cats so I order frequently. This past order I caught a sale-they were $30 cheaper. Sometimes they offer free shipping. They are from the same manufacturer as here in the states. Last time I looked, Revolution was cheaper than Frontline and Advantage. One of my cats need adult and kitten dose due to weight so he got 2 every month. The only reason I use it was years ago it was the only one that did more than just fleas. I needed one for ears too. Maybe this is an option for you. Wish they did insulin.
 
Just a quick update as I've fallen behind on updating the spreadsheet since starting my new job. We've had only 2 accidents in just about a month which is a huge huge improvement. His numbers are still kind of all over the place but as long as his behavior is good and he seems healthy, then everybody is happy.
 
I'm so glad to hear the good news!!! Like Chris and China, I have been thinking about Warren but was afraid to ask. I am so, so happy to hear he is doing so much better! :):):)
 
So glad that Warren is doing well.

So Rob - what has Warren's number been lately? Maybe there is a clue somewhere in there?
 
There's definitely a clue, the poop accidents seemed to be around the time he had some very low numbers. In the past the low numbers seemed to make him pee, but it's the only obvious relationship. I just updated the spreadsheet.
 
Rob, I've been following your posts and have been keeping you and your wife and of course Warren in my prayers and positive thoughts. Thank you for keeping us updated, I think you have quite a lot of people watching and following his progress. I think we all very much appreciate your perseverance and care, and are sending well wishes.

I'm sure you're aware of this already, but to keep Warren safe we would recommend testing him before every shot.

From the spreadsheet it looks like he's bouncing around from some lower numbers than his body is comfortable with.
Maybe, some more mid-cycle tests would determine that a dose reduction is needed, and maybe the bouncing would settle down. I know you know that we recommend mid-cycle tests as much as possible but everyone has different circumstances and situations. I work full time and long hours, and would get most of my tests at night and during my infrequent days off.

On the evening of September 30th, I would have tested 30 minutes after that PMPS of 41, to make sure he was going up. And I would have continued testing for a while (maybe the whole cycle depending upon the numbers) to make sure he was going up. I know your situation is different than mine was, as it was just me and the cat.

I just want you to know that I've been helping people on the Lantus forum for a long time, and I just want to help you to keep Warren safe and sound diabetic wise.
I don't want to preach at you as I'm sure you've done this before, but perhaps rereading the dosing protocols on the Lantus forum would be beneficial. I know it's a ton of information and not easy to understand and remember all of it the first or second time around, and sometimes we "get" some of it, and every time we re-read the information we might understand a bit more. I'm just writing all this because I care and I want Warren to stay in healthy and safe numbers as much as you do.

Blessings, Good Thoughts, and Good Luck, to you and Warren.
 
Dyana thanks very much for your note. First off, I screwed up. I cut/paste the 0.5 all the way down when I was playing spreadsheet catchup last night. I did not dose him when he was reading that low.
As you've read, it's also very very hard to give an accurate dosage when you're dealing with 0.5u (even with a micrometer) . A dosage change of even 0.1u make a huge difference in his numbers. I'm just trying to do my best with his dosing. On the days he dropped very low, it likely means he got an extra 0.1u. But I will try to do better with measuring before dosing.
 
robr said:
Dyana thanks very much for your note. First off, I screwed up. I cut/paste the 0.5 all the way down when I was playing spreadsheet catchup last night. I did not dose him when he was reading that low.
As you've read, it's also very very hard to give an accurate dosage when you're dealing with 0.5u (even with a micrometer) . A dosage change of even 0.1u make a huge difference in his numbers. I'm just trying to do my best with his dosing. On the days he dropped very low, it likely means he got an extra 0.1u. But I will try to do better with measuring before dosing.
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You are doing a great job Rob! It's good news that there is harmony in the house. Continued success to you and Warren.
 
All is quiet here. Only one accident since my last report. My son's friend left his sneakers on the floor in my son's bedroom. Warren went into my son's bedroom and peed on the shoes. In the past he'd only peed on shoes in the kitchen, this was a first. So, nobody leaves shoes anywhere on the floor any more. He leaves the shoes alone if they are elevated, even if he can jump up and reach them.

I still haven't been checking his BC every time I shoot (yes, yes, I know, I'm bad), but every time I have checked it's pretty much been in the mid 100's.
Still doing the cosequin thing, no other supplements.

If you're not hearing from me, then Warren is doing well :)
 
robr said:
I desperately need help. I will refer you to a couple of threads and then summarize where am at:

Intro forum:
http://www.felinediabetes.com/FDMB/threads/meet-warren-again.136271/#post-1424641

Lantus forum:
http://www.felinediabetes.com/FDMB/threads/5-4-warren-amps-518.137335/

Warren was diagnosed with diabetes a bit over a year ago. He was on Vetsulin for a couple of months and went into remission for almost a year. When he started having problems again, I had a full lab workup done, urinalysis, blood, physical, etc and my vet said the only health issue Warren has is his diabetes. In Warren's 15 years, he has NEVER had issues with behavior.... problems using the litter box, etc.

I put him back on Vetsulin but it did not last more than 8 or 9 hours. After perhaps a month of Vetsulin, I switched him to Lantus (a month ago). In that month I have not been able to regulate him. 1 unit pushes his blood sugar too low (40s) and the Lantus can last as long as 16 hours. 0.75 (approx, no way to measure exactly) doesn't seem to be enough. You can examine the spreadsheet, I have probably 150 data points over the month and a couple of curves.

He has been peeing on the kitchen rug, so I placed a litter box about 5' away in the bathroom. When he is locked in the bathroom, he uses it 100% of the time. When I let him out, he uses the rug too often. My wife has sentenced him to living in the bathroom and wants me to have him put to sleep. She will not tolerate any more peeing outside the litter box. The ultimatum is coming and I feel like I'm just about out of things to try.

I believe the peeing problem is related to his diabetes being unregulated. His levels looked reasonably stable the past 48 hours (200s-300s - not great numbers but first time I've seen him out of 400s and 500s for this long of a stretch), I was hoping we were finally starting to stabilize, then he peed on the floor and I checked and he had bounced (556. First time he'd been over 400 in 48 hours).

My wife feels his peeing is behavioral since he has an option of a litter box 5' away from where he is going.

Warren does not seem stressed in any way. He's happy, purring, playful, sitting in laps, he's his normal self.

I need a plan I can communicate to my wife and be able to tell her 'if x,y,z doesn't work, I will have him put to sleep'. I don't know if he'd do better with Lenevir, that's one option, but from what I've read it seems when Lantus doesn't work, it's because it's not bringing down the glucose levels, which is not what I'm experiencing. I'm not in a position to throw a lot more $$ at shots in the dark, again my wife feels I have spent enough $$ already on an "old cat" (an awesome old cat) but I can probably get away with a few hundred. I just lost my Mom in March and really hate the idea of saying goodbye to another close friend when there may be a straightforward solution. Any help is greatly appreciated.

Thanks everybody.
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Probably uti and the smell of it in the rug.my civie sable when she is sick she will poop on the floor.she never does it any other time just when she feels really bad.her way of letting me know how she feels I guess?cats are very strange.lol
 
My son's cat has a terrible problem with idiopathic cystitis. He is on elavil which calms him (he is very skittish due to whatever he went through before my son took him in) and pees on everything. The elavil, besides calming him, helps with bladder inflammation and the problem is almost completely eliminated. Worth running this by your vet. You say Warren is doing everything else normal, so he certainly doesn't need to be put to sleep. That shouldn't even be an option. Sorry but that's my opinion.

robr said:
I desperately need help. I will refer you to a couple of threads and then summarize where am at:

Intro forum:
http://www.felinediabetes.com/FDMB/threads/meet-warren-again.136271/#post-1424641

Lantus forum:
http://www.felinediabetes.com/FDMB/threads/5-4-warren-amps-518.137335/

Warren was diagnosed with diabetes a bit over a year ago. He was on Vetsulin for a couple of months and went into remission for almost a year. When he started having problems again, I had a full lab workup done, urinalysis, blood, physical, etc and my vet said the only health issue Warren has is his diabetes. In Warren's 15 years, he has NEVER had issues with behavior.... problems using the litter box, etc.

I put him back on Vetsulin but it did not last more than 8 or 9 hours. After perhaps a month of Vetsulin, I switched him to Lantus (a month ago). In that month I have not been able to regulate him. 1 unit pushes his blood sugar too low (40s) and the Lantus can last as long as 16 hours. 0.75 (approx, no way to measure exactly) doesn't seem to be enough. You can examine the spreadsheet, I have probably 150 data points over the month and a couple of curves.

He has been peeing on the kitchen rug, so I placed a litter box about 5' away in the bathroom. When he is locked in the bathroom, he uses it 100% of the time. When I let him out, he uses the rug too often. My wife has sentenced him to living in the bathroom and wants me to have him put to sleep. She will not tolerate any more peeing outside the litter box. The ultimatum is coming and I feel like I'm just about out of things to try.

I believe the peeing problem is related to his diabetes being unregulated. His levels looked reasonably stable the past 48 hours (200s-300s - not great numbers but first time I've seen him out of 400s and 500s for this long of a stretch), I was hoping we were finally starting to stabilize, then he peed on the floor and I checked and he had bounced (556. First time he'd been over 400 in 48 hours).

My wife feels his peeing is behavioral since he has an option of a litter box 5' away from where he is going.

Warren does not seem stressed in any way. He's happy, purring, playful, sitting in laps, he's his normal self.

I need a plan I can communicate to my wife and be able to tell her 'if x,y,z doesn't work, I will have him put to sleep'. I don't know if he'd do better with Lenevir, that's one option, but from what I've read it seems when Lantus doesn't work, it's because it's not bringing down the glucose levels, which is not what I'm experiencing. I'm not in a position to throw a lot more $$ at shots in the dark, again my wife feels I have spent enough $$ already on an "old cat" (an awesome old cat) but I can probably get away with a few hundred. I just lost my Mom in March and really hate the idea of saying goodbye to another close friend when there may be a straightforward solution. Any help is greatly appreciated.

Thanks everybody.
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FYI, Feliway collar did this to Warren. Can't believe we didn't notice until today. The other side of his neck has an even larger bald patch. The collar was fitted loosely.
 

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Oh no!! I guess that's a good reminder that no matter what it is, we should always keep our eyes out for reactions!

Hope Warren suffers no permanent problems and his fur grows back quickly!
 
Is the skin red? I can't tell in the pic. A normal collar had actually done that same thing to my Speckles, but my civvie had the same kind of collar and never had an issue.
 
I used Feliway collars on two of my crew and had no issues (thankfully!) Sorry Warren has had a problem with it, hope his hair grows back soon!
 
Hi all, Dyana reached out to me to see how Warren is doing, so thought I'd share my note to her.

Warren has for the most part been doing quite well. He does have the occasional accident (all of which are noted in his spreadsheet), though most of those seem to be tied to when we have guests in the house. He will often go out of his way to find their shoes (even if they are in the kids rooms which he generally has zero problems with) and pees on them. So we've managed to remedy that issue by training any guests. As long as the shoes aren't on the floor, he doesn't seem to target them. Even still, he does seem to like to express his dissatisfaction with strangers being around by the occasional poop in front of a door.

But the wife has not really complained in quite some time, at least not in a serious manner, so I think we've achieved a balance around here that people can live with. I have stopped regularly measuring Warren's levels. Though I do take them a couple of times a week, I haven't been updating the spreadsheet with them. At this point, I'm monitoring behavior more than anything else. Warren has been on Cosequin now for almost 3 months. Not sure if it's doing anything, but it's not hurting him. I totally spaced B-12. I have a whole bunch of B-12 shots around here somewhere, but because they have to be kept in the dark, I put them in some unusual location and can't find them!! I should probably just go get some more from the vet.

I think someone may have a tape worm issue.... we found a bunch of little worms in my daughter's bed last night. Thought they were pin worms at first, but after lots and lots of googling, the closest thing we could find was tapeworm. The cats did have fleas as you may recall, those are mostly under control now, but not 100% gone, and the cats like to sleep on my daughter's bed, so they will be getting tapeworm and flea treatments today.

On a completely unrelated note, one year ago I had to rehome one of my favorites, Kaya was 7 years old and just wasn't doing well with other cats. I called her new person last week for the 1st time since she was adopted, an elderly woman who treats Kaya like the princess she is. Kaya is a DLH, 100% black, petite cat (5 lbs). So sweet, loves to bathe you and sit next to you for hours. We called her "perma-kitten". I miss her, but it's what was best for her and I'm very happy for the two of them.

Warren's brother Brak I also had to rehome 7 or 8 years ago. We're good friends with his person, Brak is also diabetic and seems to have far worse bathroom habits than Warren, but she doesn't care.

Our other three, Star, Crystal and ZZ (this is what you end up with when you let a 5 year old name a cat) are all well. Warren just came over as I was typing this and says MEOW to everybody. Or perhaps he just wants some help getting up to my lap.

Happy Holidays to everybody and their fur buddies.
 
Thanks for the update! Sounds like things are going fairly well.

There are over the counter tapeworm tabs one may get to treat those. I've gotten them off of Amazon.
 
Rob, how wonderful to hear that all is well with Warren! I'm so glad things worked out for all of you. Thank you for the update.

Happy Holidays to you and yours, too! :)
 
Great to hear from you! And even better to hear that peace has pretty much returned to your home (and marriage!)

It sounds like Warren is just a bit of a crotchety old man and doesn't appreciate those "young whippersnappers" invading his space ;)

It's definitely easier to train the humans!! "You have a choice folks....either pick up your shoes or listen to them "squish squish squish" all the way home".....LOL

Happy Holidays to you and Warren!!
 
Thank you so much for the update on Warren and the household!!
This literally made my day.

Rob, you are a wonderful, caring *patient* person. You did everything under the Sun to achieve this harmony and I know you are enjoying it. You deserve it!!

Super Happy Christmas to you and yours, and God bless ya for that huge heart of yours and your family.
Wishing you continued success. :)
 
Hi Rob,

I've been away from the board for quite a while (I have a lot of health difficulties). I have thought of Warren and yourself often and I was absolutely delighted to see your update this evening! Well done, you, for being Warren's champion and getting him through such a tough time. :D

Blessings to you all,
:bighug:


Mogs
.
 
Happy New Year everybody. A quick 2016 Warren update...... Warren is having lots of litter box problems again of late (noted in spreadsheet). I'm going to start taking his blood sugar readings regularly again but the few samples I've taken over the course of the week have looked pretty good (for him). 200s for the most part. But the poor guy has not had a solid poop since probably March 2015, at least not that I've seen, so this could be a case of other issues just catching up to him. It's been pretty much pure thick liquid. Maybe I will try the probiotics again, but those seemed to be triggering accidents the couple of times I'd tried them earlier in the year. He's still taking his daily cosequin, getting B-12 shots and has been treated for tape worms (just in case) a few weeks back. Personality wise he is his same old self, sitting in my lap now, purring away, trying to roll onto his back so I will scratch his belly. He does seem a little slower, and last month he was on the coffee table trying to get into some people food my kids left out and I gently and slowly pushed him away with my foot and he fell off the table and landed on his back. I felt terrible, but I mention it because he had plenty of time to adjust and it was just not like him to be so uncoordinated. I now pick him up and place him down any time I need him to move. Sigh. Poor guy :(
 
Hi Rob,

Thanks for the update. A couple of thoughts:

1. Maybe try adding a little canned plain pumpkin to Warren's food. It helps with both constipation and diarrhoea and helps normalise the GI tract. (Lots of info on GI tract health at www.felineconstipation.org.)

2. Perhaps get Warren's potassium levels checked next time you have a blood work-up. I've read here that low potassium levels can cause weakness with symptoms akin to those of neuropathy.

Happy New Year to you and your family, Rob, and some extra-special, TLC-filled :bighug::bighug::bighug: for Warren. Tummy rubs, too! :) Warren sounds like such a sweetheart. I'm glad he has such a loving Bean to care for him.


Mogs
.
 
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Hi Rob. Happy New Year!!!
Since this thread has become quite lengthy and cumbersome now, how about starting a new thread when you come back to the board? You can link this one to the new post.

Thanks much,
Jill
 
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