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Kidney Disease in cat or something else?

MnM
November 28th, 2009, 08:44 PM
I'm hoping for some help here! I'm currently living in Bangkok with my two 12.5 year old cats. The vets here are ok...hard to understand and I'm just wanting to be sure that I'm not missing something. Recently my boy, Mikey, had a urinary tract obstruction and then infection. The doc used the catheter to push back the plug, took blood, gave sub-Q fluids, and meds. This was Monday night. The blood tests came back with BUN at 26 and Creatinine at 2.14-doc said renal failure. Continued sub-Q fluids, pill for bladder lining, pill for anti-inflammatory and an antibiotic. Since then started him on phosphorus meds and had to get an injection for stomach acid reduction. Doc had him eating Hill's C/D then switched Saturday morning to K/D (though that was when he was vomiting and we brought him in for the stomach acid, so didn't really get much of it in). Took blood again and BUN is up to 31 and Creatinine up to 2.41. Back in June of 2008 his BUN was at 26 and his Creatinine was at 1.0.
Does Mikey have renal failure and kidney disease? Is there any chance, any at all, that he could come back from this and live to the ripe old age of 20something? Is there something more I can do? I feel like my heart is breaking...any ideas or info would be appreciated.

sugarcatmom
November 28th, 2009, 09:26 PM
Do you have a value for his Urine Specific Gravity?

Another member here, growler, has lots of experience and excellent advice regarding CRF in cats. I'm sure she'll chime in shortly, but in the meantime, here is her thread that is worth reading: http://www.pets.ca/forum/showthread.php?t=45017&highlight=kidney+disease

growler~GateKeeper
November 29th, 2009, 12:04 AM
Do you have the reference ranges for the lab that was used for the bloodwork? The creatinine @ over 2 is definately high, though most but not all labs put the BUN as normal when under 35.

Was there anything else out of normal on the blood test? I see Mikey's on phos meds - what is the phos level?

Do you have the names of the meds Mikey's on?

Did they do a urine test? Do you have a value for the urine specific gravity (USG), and what was the amount of crystals?

Urinary crystals & stones can also raise the BUN & creatinine values.

Renal failure and kidney disease are two terms for the same condition. Many cats do really well for years with renal failure, my own grrl, who's 18yrs, has been dealing well with renal failure for 2 years now.

This is a wonderful, informative site by a woman in the UK who has had a couple of cats with renal failure - http://www.felinecrf.org/index.htm - it is not meant to replace veterinary advice but written from an owners perspective.

rainbow
November 29th, 2009, 12:22 AM
Welcome to pets/ca MnM :thumbs up but sorry to hear about Mikey. :grouphug:

I don't have any advice but just wanted to say that growler and sugarcatmom are the two best members on the forum to give you information about feline kidney disease. :thumbs up

MnM
November 29th, 2009, 02:42 AM
Thanks so much for writing back...I'm feeling helpless being in Thailand. I read through Duffy's entire story-Mikey's sis (McKinley) is a tortie and her face looks so much like Duffy's! We love the 'tortitude', that is SO McKinley.

The 'normal' range for the lab here is BUN (7-26 mg/dl) and Creatinine (0.4-1.8 mg/dl). Mikey's Monday/Saturday were 26/31 BUN and 2.14/2.41 Creatinine. I don't have a copy of the urine tests, but will get those at our appt tomorrow-they're going to do it again tomorrow too. I'm worried about him having had blood drawn so close together (Monday and Saturday). If they want to do it again tomorrow that will be three times in a week. How long should I wait to test his blood again?

His glucose was high, which is high every time I've had his blood tested-in the past we fast him then retest it comes back normal (glucose 267 [normal 79-126]). His protein was at 8.0 (normal 5.8-7.9). The phosphorus was not high, but because of hind end weakness and wobbly balance on Thursday night, that vet trip resulted in Alumilk 1.5ml 3x/day.

There is another thing called "ALK.P" and it was VERY high at 147 (3-60 U/L is normal range), but we don't know what this is and couldn't understand the vet-I'll ask again tomorrow.

He is also on:Cystaid, Mabocyl, and Tofidine and between 250-300ml of subQ fluid a day.

On Saturday morning we rushed him because of vomiting (saliva and then the k/d food) and straining in the litter box with multiple trips and even though he pooed, still coming back and straining-then vomiting. He was given an injection for stomach acid reduction and an anti-nausea injection.

Yesterday afternoon was the first I felt hopeful that he may 'recover'. Then the vet called with the new lab results of the elevated BUN and Creatinine. Back into depression I sank.

Last night/wee hours of this morning, Mikey was very much his usual obnoxious self (kneading and drooling in my hair at 3am-though instead of the usual toss off the bed, I let him knead and drool away!). Today he actually PLAYED with a piece of paper and a shoe lace-not for long, but still...I cried (again). He's eating about a can+ of K/D a day-seems to actually like it, though we can't feed his sister something else when he's around or he'll refuse to eat his. He's not drinking ANY water, but the poor guy walks around like a slushy most of the day with that much fluid being poured into him, so I can't blame him.

I can not get ANY of the good canned foods here, I'm lucky to be able to get the prescription ones. I was all of last year (Sept-June) feeding him a homemade cooked diet-duck, sweet potatoes, mung beans with calcium citrate, probiotic, flaxseed oil, taurine added in. He liked it. I also bring back as much as I can carry from the states of canned foods like wellness, weruva, etc, but can't bring enough to last long. Starting this Sept though, I forced him on to a dry diet with a can once or twice a week. He started losing weight (which was what prompted my original move to the homemade/canned food diet, a vet suggested grain allergy after $3K in tests revealed no other cause-ugh; part of this testing did show he had some scarring on the kidneys and two small kidney stones, but everything else checked out). He gained some weight back and had regular bowel movements, he maintained this for a year. Then about three weeks ago I noticed he was dropping weight again and having trouble pooing and was frustrated (as even the dry kibble was grain free). So started throwing whatever canned food he wanted at him-which unfortunately was mostly Thai canned cat foods which I have no idea what was in them, LOTS of fish though.

I noticed him acting 'funny' a week ago Friday. Left for the weekend, came home on Sunday and still had that funny feeling. He didn't cry, or stop eating, or anything that you can describe to a vet-but we knew something wasn't right. Monday night took him in and found the urinary tract obstruction. And then I've told you most of the rest...

He's only 12 1/2...I was banking on another 8 or so years of having to toss the 3am drooler off the bed...with moving around as much as we do, he IS my family, he is home.

Thanks for listening, sharing and giving hope. It's rare to find people that understand that he's not 'just a pet'...thank you.

rainbow
November 29th, 2009, 03:04 AM
I'm not the person to give you advice but Growler is logged on and I'm sure she will help you. :thumbs up

I do know that a mainly fish diet is not good for cats ....especially ones with urinary problems so hopefully you can get Mikey to eat some other flavours. :fingerscr

rainbow
November 29th, 2009, 03:43 AM
MnM, I left a message for Growler to reply to this thread. It's 1:45am here and I'm off to bed but I'm sure she will respond before she logs off.

MnM
November 29th, 2009, 03:49 AM
Thanks Rainbow-I appreciate the help.

I'm just looking for some more direction and guidance-my head is spinning from all of the websites I've been reading and the conflicting information. Mostly I'm wavering between confusion and crying! Somehow, too, I don't get the feeling that Thailand is going to have the most current research on how to best help cats in Mikey's situation.

Thanks again...

growler~GateKeeper
November 29th, 2009, 04:37 AM
The 'normal' range for the lab here is BUN (7-26 mg/dl) and Creatinine (0.4-1.8 mg/dl). Mikey's Monday/Saturday were 26/31 BUN and 2.14/2.41 Creatinine. I don't have a copy of the urine tests, but will get those at our appt tomorrow-they're going to do it again tomorrow too. I'm worried about him having had blood drawn so close together (Monday and Saturday). If they want to do it again tomorrow that will be three times in a week. How long should I wait to test his blood again?

The BUN is not too bad, the creatinine rising but still in low 2's is not alarming (Mikey's BUN & cre are both lower than Duffy's right now but she is good-stable with little to no symptoms right now)

Given the severity of symptoms vs the relatively low numbers I would say there is something else more pressing right now than the kidney numbers, likely either the crystals/stones, a liver issue or a possible diabetes issue

I would say blood drawn no more than 3 times a week once a month in emergency type situations.

Having blood drawn too often on a sick animal can push them into anaemia especially with cats (due to size) & smaller sized dogs.

In a stable cat the blood values are not going to fluctuate enough for a significant change 1 week to the next. However when formulating a treatment plan for a sick cat (as Mikey would be classed now) one may need more frequent testing.

For chronic conditions such as renal failure once every 3 months is standard, the exception being diabetes however the amount of blood taken for a glucose-only test is far lower than a lab work up.

His glucose was high, which is high every time I've had his blood tested-in the past we fast him then retest it comes back normal (glucose 267 [normal 79-126]). His protein was at 8.0 (normal 5.8-7.9). The phosphorus was not high, but because of hind end weakness and wobbly balance on Thursday night, that vet trip resulted in Alumilk 1.5ml 3x/day.

Sugarcatmom is better able to guide you regarding the high glucose & possible diabetes. Glucose will rise with stress but shouldn't go 100+pts due to stress more like 20.

The wobbly back legs could be as a result of: low potassium, anaemia, high phos, metabolic acidosis (one symptom being excess stomach acid), diabetic neuropathy, arthritis, hypertension or constipation

There is another thing called "ALK.P" and it was VERY high at 147 (3-60 U/L is normal range), but we don't know what this is and couldn't understand the vet-I'll ask again tomorrow.

Alkaline Phosphatase is an enzyme produced by the biliary tract (liver). High levels indicate bone disease, liver disease or bile flow blockage. Can also be indicated because of vomiting, several days of not eating enough proper balance nutrition.

He is also on:Cystaid, Mabocyl, and Tofidine and between 250-300ml of subQ fluid a day.

Cystaid is for the bladder lining, Marbocyl treats tissue infections & URI and while I can't find a direct english explaination for Tofidine it appears to be an antibiotic

Are you dividing the amount into 2 subq session a day? Are the fluids fully absorbed by the next day?

On Saturday morning we rushed him because of vomiting (saliva and then the k/d food) and straining in the litter box with multiple trips and even though he pooed, still coming back and straining-then vomiting. He was given an injection for stomach acid reduction and an anti-nausea injection.

Can you ask the vet about something more frequent acting for controlling stomach acid: http://www.felinecrf.org/treatments.htm#controlling_stomach_acid Also if you raise the food dishes up about 3-5 inches off the ground it puts their head higher than the stomach when eating so it keeps the acid below & out of the throat. Small frequent meals also helps especially one right before bed.

The straining there was likely him trying to pee & being unable to pass urine due to the stone/crystals. Cats will sometimes vomit after straining w/multiple attempts in the litterbox, this then puts them at further risk if dehydration.

I can not get ANY of the good canned foods here, I'm lucky to be able to get the prescription ones. I was all of last year (Sept-June) feeding him a homemade cooked diet-duck, sweet potatoes, mung beans with calcium citrate, probiotic, flaxseed oil, taurine added in. He liked it. I also bring back as much as I can carry from the states of canned foods like wellness, weruva, etc, but can't bring enough to last long. Starting this Sept though, I forced him on to a dry diet with a can once or twice a week. He started losing weight (which was what prompted my original move to the homemade/canned food diet, a vet suggested grain allergy after $3K in tests revealed no other cause-ugh; part of this testing did show he had some scarring on the kidneys and two small kidney stones, but everything else checked out). He gained some weight back and had regular bowel movements, he maintained this for a year. Then about three weeks ago I noticed he was dropping weight again and having trouble pooing and was frustrated (as even the dry kibble was grain free). So started throwing whatever canned food he wanted at him-which unfortunately was mostly Thai canned cat foods which I have no idea what was in them, LOTS of fish though.

Why did you take him off the homemade diet and put him on dry? I would suggest to put him back on the homemade diet with canned and most definately get rid of all dry food. It is entirely inappropriate for cats with crystals/stones and compromised kidneys. http://www.catinfo.org/#Common_Feline_Health_Problems_and_Their_Ties_to_D iet_

You do also want to limit the amount fish in the diet (no more than 1 per week/two weeks) as too much may not only cause an imbalance in vit e but also lead to refusing to eat other varities

MnM
November 29th, 2009, 05:30 AM
I can't tell you how much I appreciate your thoughts and insight!

Could all of this be linked to diabetes then? I'm so confused and SCARED!

I'll try raising up the food bowls-since the injection (which was only supposed to last 8-12 hours) he has seemed to feel better-no more vomiting or funny lip smacking. We are doing lots of small meals this weekend (but we go back to work tomorrow so that will be harder) and he's eating a lot today. He'll finish a can of K/D and likely start another. It's tough to leave food out because of his sister, so we have been keeping them separated (they don't mind being separated but hate being locked out of parts of the house) and because we live in the tropics so get massive ant infestations if food is left out for too long. Right now I'm combating the little buggers with cinnamon which seems to help for a while.

I would say most of the fluid is gone, he pees 10+ times a day though. Prior to the subQs he didn't ever drink or pee much. We do it in one session-I'm hoping to reduce that/wean him off of it this week after the vet visit tomorrow.

I thought the straining was inability to pee too, which is why we rushed back to the vet (we've been there almost every day this week, once twice in a day!). The vet said his bladder was empty-so determined he was trying to figure out a way to alleviate the pain in his tummy from the stomach acid. That hasn't happened again.

He is very weak still, his legs are all a tiny bit wobbly. He can still jump up on our very high bed and run up and down the stairs, but you can see slight little tremors in his legs.

Do you think we should run the tests again tomorrow? We had planned to fast him for 8 hours to get an accurate test, but with the subQ fluids, would it be an accurate read? I'm so worried about the little guy.

I'll go back to his homemade diet (would you vote for that over the K/D stuff? what about a combo?). I took him off of it because I went back to work full time and thought maybe he didn't 'need' it...so I do feel like I've caused this problem and it just makes it all hurt even more.

Thank you thank you thank you for your help. I appreciate it so very much. Our vet appt is tomorrow afternoon but the blood results won't be back until sometime Tuesday our time. I'll let you know.

On a completely different topic-do torties tend to be heavier? Poor McKinley is about 13lbs and she eats way less than Mikey-we defend her to people calling her big boned. No amount of food regulation or 'diet' food makes a significant difference for her. One vet made me cry because of her weight!

14+kitties
November 29th, 2009, 06:12 AM
One thing that concerns me. You said you fasted Mikey and then took him into the vet? A cat should never go without food. Even 24 hours can be critical in a cat. I know that SCM can explain much better than I why it shouldn't happen. That in itself would probably make a difference in his numbers.

MnM
November 29th, 2009, 09:30 AM
Two different countries- China (the vet was German though) and the US both had me fast Mikey for 8 hours before they did the second blood test because both times the glucose was elevated. Both times it came back fine on the second read...in the US they even did a further fructosamine (or something like that) test to be sure.

This vet here asked me to do the same to get an accurate reading of the levels for tomorrow.

My earlier optimism is now clouded as Mikey is back to acting like he is in pain and refusing to eat or be petted. This morning was SO good and even into this afternoon he was still a pretty happy cat. Not so now. I did finally get him to eat some chicken breast so I could give him the last of his meds. Looks like it's another night on the bathroom floor for me. Hopefully morning will be brighter.

sugarcatmom
November 29th, 2009, 11:41 AM
Pre-blood work fasting of about 8 hrs is normal and not usually a problem. And stress OR infection can actually raise blood glucose quite a bit (even more than 100 pts in some cats). The fructosamine test that you mentioned is the best way to rule out diabetes because it takes an average reading of blood glucose levels over the previous weeks. How long ago was that one done?

What is a little "off" here though is that you say Mikey's fasting blood glucose reading is normal. I would think that if "white-coat" stress was the issue, it wouldn't matter if he had been fasting or not, it still would have been higher. It could be that infection (or pain) was causing it to rise rather than stress those other times, and that at the time that the fasting blood work was done, either the infection or pain wasn't a factor. Does that make sense? (I'm still drinking my morning coffee, so it's possible that it doesn't).

Anyway, that is something to keep an eye on. As for food, you might want to go back to making your own, although if you can do raw rather than cooked, that would be best. You also don't need to add sweet potatoes or mung beans, except maybe in very small quantities for additional fibre if Mikey has digestive issues. Not sure if you've seen this site: www.catinfo.org It has excellent info on making your own raw cat food. One caution on the recipe there is that it isn't appropriate for a cat in renal failure because it's quite high in phosphorus. There are modifications that can be made for it to be suitable, or else you could add a phosphorus binder. We can talk about that more later if needed.

14+kitties
November 29th, 2009, 03:08 PM
Pre-blood work fasting of about 8 hrs is normal and not usually a problem. And stress OR infection can actually raise blood glucose quite a bit (even more than 100 pts in some cats). The fructosamine test that you mentioned is the best way to rule out diabetes because it takes an average reading of blood glucose levels over the previous weeks. How long ago was that one done?

Ooops, sorry. When I see the word fasting I think of 24 hours or more. I don't think 8 hours. I shall back out now........ :o

chico2
November 29th, 2009, 04:05 PM
MnM,I too have no advice to give,other than good luck with the little guy:pray::goodvibes:,
I know how heartbreaking and confusing it can be,with a bit of a language-barrier even more so.:cat:

Love4himies
November 29th, 2009, 04:12 PM
I have no advice to give, but am sending you lots of :goodvibes: for your kitty.

Here is a :grouphug: for you.

You are in good hands with SCM and Growler :thumbs up

MnM
November 29th, 2009, 04:23 PM
Thanks everyone for your thoughts...

Mikey's last blood tests (before these two this week) were a year and a half ago. Both times the glucose was elevated initially (though not to the point it is now) but with the fasting was normal.

So his elevated glucose from the test Monday could have been from the infection from the urinary blockage? The vet called on Saturday night with the new results and besides the increase in BUN and Creatinine, he didn't say anything else-though it is hard to understand especially over the phone. He did say that all signs of infection had cleared, which he felt was positive. Today at our appointment we'll get a copy of numbers from Saturday's blood test and see what they said. I'm worried as at the initial appt on Monday, the vet did say Mikey was slightly anemic (sp?). I know that drawing more and more blood just increases this risk factor...but not knowing what's going on could be just as risky...I don't know what to do.

Mikey is still really unwell. I spent yet another very sleepless night checking on him. He's weak and wobbly and in pain or uncomfortable. I tried giving him the antacid that the vet prescribed both last night and this morning, but it doesn't seem to be helping. He munched a little bit of chicken breast last night so I could give him his meds and licked at the new can of K/D I opened just now. But it was all half-hearted.

I don't know what else to do! I just wish he could tell me what hurts so I could try and make it better for him. My husband is taking a sick day today because we're scared to leave him.

Thanks for writing-it helps to know someone else understands.

sugarcatmom
November 29th, 2009, 06:09 PM
I know that drawing more and more blood just increases this risk factor...but not knowing what's going on could be just as risky...I don't know what to do.


Has a urinalysis been done recently? I would do that before more blood work.

MnM
November 29th, 2009, 08:31 PM
Even though he's been on 300cc's of fluid for the last week? (we did not give it to him today as we're heading to the vet this afternoon and he does it easier at the vet than with us).

Would you recommend waiting a week to do another blood draw-unless symptoms worsen of course. He's just NOT getting all the way better and I don't know what's going on!

My husband just emailed and said he seems marginally better than last night/this morning...

growler~GateKeeper
November 29th, 2009, 11:50 PM
I'll try raising up the food bowls-since the injection (which was only supposed to last 8-12 hours) he has seemed to feel better-no more vomiting or funny lip smacking.

Stack them on something fairly thick & non-slip like a phone book.

We are doing lots of small meals this weekend (but we go back to work tomorrow so that will be harder) and he's eating a lot today. He'll finish a can of K/D and likely start another. It's tough to leave food out because of his sister, so we have been keeping them separated (they don't mind being separated but hate being locked out of parts of the house) and because we live in the tropics so get massive ant infestations if food is left out for too long. Right now I'm combating the little buggers with cinnamon which seems to help for a while.

If you have a tray you can put under the dishes & fill it with water then put in a "mini table" to raise the dishes, the ants can't get to the food through the water. Something similar to this http://www.theantser.com/

I would say most of the fluid is gone, he pees 10+ times a day though. Prior to the subQs he didn't ever drink or pee much. We do it in one session-I'm hoping to reduce that/wean him off of it this week after the vet visit tomorrow.

If the fluids are not fully absorbed but the next session, you should wait until they are & also slightly reduce the amount you give the next time. One shouldn't give fluids again until the previous amount is absorbed.

I'll go back to his homemade diet (would you vote for that over the K/D stuff? what about a combo?).

I would remove all the dry stuff, either go back to homemade or do a combo with canned if you/your vet thinks the homemade is not complete enough. I'm not too impressed with the ingredients in the prescription diets but since you can't get the holistic brands, there's little choice. Duffy's raw fed so that of course would always be my first choice.

On a completely different topic-do torties tend to be heavier? Poor McKinley is about 13lbs and she eats way less than Mikey-we defend her to people calling her big boned. No amount of food regulation or 'diet' food makes a significant difference for her. One vet made me cry because of her weight!

Not sure about that but it is possible, Duffy's adult weight has always been around 12-12.5 lbs, several years ago I also had a calico-Van-point Siamese who was longer, leaner & always around 10 lbs they ate the same food in the same portions. But then my mum has a long haired tortie who is around 8 lbs :shrug:

Even though he's been on 300cc's of fluid for the last week? (we did not give it to him today as we're heading to the vet this afternoon and he does it easier at the vet than with us).

Would you recommend waiting a week to do another blood draw-unless symptoms worsen of course. He's just NOT getting all the way better and I don't know what's going on!

The subq's will affect the urine specific gravity number, but it will tell if there are still crystals, epithelial cells, or blood in the urine.

Given the anaemia the vet has already stated I would wait a week on bloodwork, unless the vet has a specific value he is looking for that would affect diagnosis/treatment.

MnM
November 30th, 2009, 12:11 AM
Thanks for the advice, Growler, I appreciate it more than I can say.

My husband is giving me hourly updates with an iPhone photo included. Mikey's still showing very little interest in food, but since the vet may decide to draw more blood and originally wanted him fasting anyway, I think we'll wait to pull out all stops to get him eating. Our appt is in three hours...three very long hours. We could go now, but the vet we like the best isn't there until 4pm our time.

On Wednesday when I brought him back in to the vet in a panic because of his blood test results from Monday, they wanted to keep him and put him on an IV. I asked if we could avoid that (he's SUCH a particular cat that I really think if he had to stay it would make it harder for him to get better). That was when they sent us home with the subQs. Now I'm wondering if I made a mistake? Should I have let them keep him, would the IV fluids have been better? He's been absorbing the subQs and peeing a lot. I'm so very conflicted...and obviously being pretty useless at work today!

Could this all be stomach related? If he has ulcers/too much acid could this be a part of the weird blood levels? The antacids I gave him did not make a difference. He's not puking or smacking his lips, but I can hear his stomach making gurgling sounds that is not usual for him.

Does anyone have a crystal ball? Sigh.

growler~GateKeeper
November 30th, 2009, 12:56 AM
You know your cat better than anyone, if you think Mikey would've been worse staying at the vet for treatment then you made the right choice.

The blood values definately drop more significantly & often into normal when on IV because the fluids are flushing the blood directly - right from the veins, where the subq's are flushing more indirectly by way of the filtering through the kidneys. As to whether the IV fluids would've been better, in a true crisis situation yes better, in a chronic situation it's a great temp fix but subq's are still needed afterwards. I guess it would depend on what else if anything is going on & if the infection is truely cleared up.

Forgot to mention the urine testing will also determine if the infection is gone.

Excess stomach acid doesn't necessarily mean he has stomach ulcers. If Mikey is drinking alot of water & vomiting right after I would think it would be more likely. Stomach ulcers would afftect the blood results only if they were bleeding to which you would see the BUN elevated but creatinine normal, curdled blood in the vomit, poops would be black.

:goodvibes: for the appt

MnM
November 30th, 2009, 02:37 AM
Leaving for appt in 5 min.

Doc said on Saturday night that his blood tests showed the infection was gone. But I'm still wondering if the IV would have been a better way to go.

No vomiting and no drinking water-we've been force feeding some water today as we didn't to the subQs. He has been yawning an awful lot today, which is unusual...is that a sign of something? He right now seems to be asking for some food, but we're holding off until after the appt.

Will write more when I'm back, as long as I'm not crying too hard (Thais don't show sad emotions, so me sobbing in the office is weird to them).

MnM
November 30th, 2009, 05:32 AM
We're back...no good news, but no bad news...sigh.

We couldn't get Mikey's urine sample as he had an empty bladder, of course. But we did do a quick glucose test (just a drop of blood) and it came back fine.

Mikey's last urine test on Monday showed his USG at 1.010...no idea what that means.
Other numbers from the test a week ago:
Leuco 3+
Nitrite negative
pH 5
Protein 2+
Glucose 3+
Hemoglobin 4+
All else negative or normal. The doc is most worried about the glucose as he says that is from renal disease since we just got the negative on diabetes. Is that true? Could ALL of this be from his infection and complications from the urinary blockage? I so want to hope that his urine sample comes back with an FLUTD diagnosis and that all of this is from that-which he can recover from. The doc said it is not likely...is he right?

I got a copy of the blood test from Saturday, besides the elevated BUN and Creatinine, these were other numbers:
Sodium 157
Potassium 6.0
Chloride 110
Calcium 11.4
Phosphorus 4.0

We'll do another blood draw next week and retest everything. In the meantime, we are taking more of the cystaid but finished with everything else. Also, fluids only if he starts to become dehydrated.

He said he doesn't think Mikey is in pain (I disagree, there is something making him seriously uncomfortable). He was horrified at my chicken breast feeding and said maybe some fresh water fish if I must do people food. But he really wants me to stick with low-protein (ie K/D). And of course now Mikey is refusing to eat ANY of the K/D. Now what do I do? How long do I wait him out? He had a couple bites of chicken breast at 9:30am and besides a lick of K/D an hour ago, nothing else (at 6:30pm). Help!

sugarcatmom
November 30th, 2009, 07:29 AM
The doc is most worried about the glucose as he says that is from renal disease since we just got the negative on diabetes.

I thought the positive urine glucose was from last week? And the blood glucose from last night was normal, right? I don't know why the vet would still be concerned about that then. The positive urine glucose could have easily been from infection and is not likely still an issue if the blood glucose is now normal. The glucose has to reach a certain level in the blood (around 200-250) before it "spills over" into the urine.

He was horrified at my chicken breast feeding and said maybe some fresh water fish if I must do people food. But he really wants me to stick with low-protein (ie K/D). And of course now Mikey is refusing to eat ANY of the K/D. Now what do I do? How long do I wait him out? He had a couple bites of chicken breast at 9:30am and besides a lick of K/D an hour ago, nothing else (at 6:30pm). Help!

Your vet knows nothing about what cats should be eating and I wouldn't listen to a word he says on the issue. Feed Mikey chicken breast if he'll eat it for now (not long-term because it isn't balanced, but he needs to eat now). Do not feed fish!!! And do not feed K/D, especially since Mikey apparently doesn't want it anyway. Can you get Fancy Feast or Friskies there? There are some flavours that are lower is phosphorus than others and they tend to be liked by lots of cats. You can always add a phosphorus binder if necessary. Here are a couple charts showing the nutritional levels of various foods, maybe it will give you some ideas:
http://binkyspage.tripod.com/CanFoodNew.html
http://binkyspage.tripod.com/CanFoodOld.html

MnM
November 30th, 2009, 10:40 AM
Thanks Sugarcatmom-I will look up that info. Canned cat food here (imported) is slim pickings. I'll scour the import stores of Bangkok and see what I can come up with.

So the glucose in the urine could be from infection??? Seriously? This is one of the things the doc is using to bet on kidney failure...yes, the glucose in the urine was from a week ago. Same with the elevated glucose in the blood draw. Tonight the doc took a dab of blood (Mikey fasted today) and put it in the little glucose strip reader. He said anything over 300 was a worry, Mikey's was 130. Next week when we do the blood draw I said to do a full panel of tests-just test for everything. The doc is going to do a fructosamine test then, to be absolutely sure diabetes is not a problem.

Finally we got him to pee (whew, that took a lot of eye droppers of water!). My husband just ran the urine in to the doc and called with the results. I'm taking this as good news: there is still an infection, but it's getting better. We have to send off for the blood cell counts in the urine so wait on that for two days...
The USG was up to 1.030
Leuco 3+
pH 6
Protein 1+
Glucose 1+
All else is negative or normal
Glucose down to 1.5-2

He still won't eat the K/D, so we'll try again in the morning and if not chicken breast it is. I'll try a new recipe with chicken breast, small amt of sweet potatoes and broccoli tomorrow with the added supplements and see if he'll go for that.

For the first time in a week I'm hopeful that he'll recover and the vet is wrong about the kidney failure. It helps that Mikey just crawled up on me purring too!

sugarcatmom
November 30th, 2009, 11:05 AM
That is a MUCH better USG! I would have trouble believing kidney disease is a major concern at this point. Please forget about trying to feed Mikey K/D, it is a nasty food which could actually cause kidney problems instead of "cure" them. I won't go into the details, but basically cats NEED protein. Feeding a diet devoid of quality protein is counter productive to good health.

I think the vet is confused about the glucose issue and how it relates to CRF. Another fructosamine is a good idea, but this would indicate diabetes, not kidney issues.

Let us know what the results are, and good luck with getting more food into Mikey. :grouphug:

MnM
November 30th, 2009, 04:47 PM
Yeah for Mikey's pee!

He's been acting better (we swear it's psychological, a trip to the vet ultimately = feeling better).

This morning already he did a number 1 AND a number 2 AND ate some K/D food. I'm in agreement about what you're saying about his diet. Tonight I'm going to whip up a homecooked recipe with some chicken. Would you recommend just breast meat or a mixture? I'm going to avoid duck for a bit because I want ease him back into the homecooking and he's been having a lot of chicken in his wellness/weruva/etc brands that he was eating off and on (ones I bring back from the US). I'd actually love to do raw, but living in Thailand and the chemicals and hormones they inject into the animals...well, that's too scary for me. I am able to find some chicken pieces that are certified hormone/chemical free, which is what I'm planning to use for the cooked food.

Also, I'm planning a Christmas visit to the States-which again compounds the issues he's having (do I leave him or take him-ugh, usually I leave them with the maid watching them, but I don't trust her to make sure he's fine with what's going on now-and I hate the idea of leaving him at the vet)! But I always make a pet store run and am wondering if there is a mix of supplements for home cooking that I can purchase. Right now I crush the calcium citrate myself, divide a taurine capsule between a couple of containers of food, measure out flaxseed oil and probiotic. If there's something I could order online too (especially if it saves money) I've got time to have it there for me (there is Seattle, WA).

Thanks so very much for the advice and help. Since I started writing to you all, I've been so much better emotionally. Fingers crossed that next week's blood test/urine test is getting us closer to the numbers we want and not closer to confirming the kidney disease.

Right now, Sugarcatmom's having "trouble believing kidney disease is a major concern at this point" officially makes her my most favorite person on the planet right now!

growler~GateKeeper
November 30th, 2009, 10:45 PM
We have to send off for the blood cell counts in the urine so wait on that for two days...
The USG was up to 1.030
Leuco 3+
pH 6
Protein 1+
Glucose 1+
All else is negative or normal
Glucose down to 1.5-2

Urine testing definately looking better, though infection is still showing.

That's a very good USG :thumbs up

But I always make a pet store run and am wondering if there is a mix of supplements for home cooking that I can purchase. Right now I crush the calcium citrate myself, divide a taurine capsule between a couple of containers of food, measure out flaxseed oil and probiotic. If there's something I could order online too (especially if it saves money) I've got time to have it there for me (there is Seattle, WA).

There's a pre-mix powder from Feline Futures called TC Intincts Plus that you add to raw meat - it has all the necessary supplements including liver, the TC Instincts doesn't have the liver because you add fresh liver yourself. This can be added to cooked chicken as well. http://www.felinefuture.com/

MnM
December 1st, 2009, 07:26 AM
Thanks growler for the advice! Mikey is doing well today, appetite back and almost 'normal' acting. We're keeping a close eye on hydration and still giving him cystoid for the bladder.

I like the website you gave me...I may just give the raw thing a go since I can get higher quality chicken. I'd like to get his sister on to it as well, but she's a die hard kibble eater. Licks the wet stuff a bit, but not really interested. She's not as stubborn as he is, so we might be able to bring her around. I think he may take to raw pretty quickly and easily, but I'm going to hold off on any significant changes until after next week's blood test.Things are good right now, so I'd like to maintain status quo for a bit-for my mental health too!

I will continue to keep you posted-you and sugarcatmom have helped more than I can say. I wish there was some way for me to express my gratitude-no matter what happens, I'm thankful to have people who are willing to listen, offer sound advice, and most of all to care. From the bottom of my heart, thank you.

growler~GateKeeper
December 1st, 2009, 11:46 PM
Good to hear Mikey is feeling better already :highfive: You are right definately don't change anything until after the next lab report.

For McKinley's transition off dry food here are some tips http://www.catinfo.org/#Transitioning_Dry_Food_Addicts_to_Canned_Food_

I know I can speak for sugarcatmom and myself in saying you are very welcome we are just glad Mikey is on his way back to being himself :cat:

MnM
December 2nd, 2009, 08:42 AM
Thanks for the food transition tips...I'm excited to try this but want to be careful about it. I would love to have the supplement mix, trying to do that myself is time consuming (I even had to crush the pills myself) and worrisome because I'm not sure of exact conversions.

We got the rest of the urine results back, no more blood in the urine, still high white blood cells (fighting infection?) and some dead cells that the doc said were from the bladder flushing out. No indication of continued inflammation too.

Mikey was SO good yesterday and this morning until noon, then he started crashing again...I feel like I'm on a roller coaster. He ate really good (K/D) all yesterday and today until noon, now won't show interest in anything. I'm currently waiting on my chicken to finish slow cooking to mix with the pumpkin and supplements I put together following the recipe on the Feline Futures website. I'm so hoping that will entice him to eat.

Is it normal for a cat to fluctuate like he is? He feels better for a while then crashes back down to feeling crummy. The thing keeping me sane is that every time he seems better, the duration of 'betterness' lasts a little bit longer. I wish I could magic away his pain.

growler~GateKeeper
December 3rd, 2009, 01:51 AM
What symptoms is he showing when you say "crashing"?

Has Mikey been to the litterbox?

How did Mikey react to the cooked chicken? Has he eaten some?

MnM
December 3rd, 2009, 07:49 AM
Yes on the litterbox trips, both kinds. We keep him separated from his sister about half the day to monitor that. He doesn't seem to be straining or 'worried' when using the litter box either, to date.

Crashing-he seems like he's getting better, purring, wanting to be petted and snuggled. He'll play a bit, move around, etc. Then all of a sudden he starts withdrawing. He moves further away from us, doesn't want to be touched, then wedges himself behind/under things. His tails starts twitching and he won't eat. This has happened four times now. Each time he's 'better' for a bit longer time and the 'crashing' doesn't last as long or seem quite as bad. But it's still scaring me. I'm so afraid we're missing something. Is it normal (let's say it's FLUTD and not Kidney disease) for him to take this long to heal? He's still a bit weak and wobbly and his hind legs especially seem just a tiny bit funny when he walks. Also, when he's sitting on his haunches or sitting with his head up, he has this odd little waver to his head. It's a tiny, almost imperceptible, back and forth movement.

He did eat the chicken breast. He's also eating the pumpkin/chicken recipe from Feline Futures. I used the supplements that I had from the last time I was cooking for him. I'm putting lots of water in it, too, when he eats to make sure he stays hydrated. That said, he just ate a couple of bites, then went and drank a bunch of water from two different water bowls-I'm not sure if this is a good or bad thing.

Overall, he does seem better, but it's not a steady incline of improvement, it's a huge rollercoaster and it's freaking me out that I'm missing something, something important!

Love4himies
December 3rd, 2009, 08:13 AM
Poor kitty.

Is it possible that he is getting into some toxins?

Here is a great link to explain reading cat's blood work results:

http://www.sniksnak.com/cathealth/labreports.html

MnM
December 3rd, 2009, 08:42 AM
Thanks for the link to the website, I'll check it out.

I can't think of any way that Mikey could be getting into toxins now. He's a huge plant chewer-but he hasn't chewed on anything in at least a couple of weeks. We take them outside to 'play' in our yard and a couple of weeks ago my husband 'lost' Mikey for a bit (not a good day for him). Mikey was outside in very hot weather and absolutely could have gotten into all sorts of toxins, including weird plants and even a snake bite (this is Thailand after all). We saw no marks no him, no vomiting, just lots of open mouthed panting. I'm not sure how much this could play into his current state.

As I write this, he is currently once again 'withdrawing' and hiding in the back room behind the ironing board.

The more I research, the more I'm wrecked with guilt. I had Mikey on a primarily dry kibble diet (grain free and high quality, but still dry) AND then I started feeding him loads of crappy, total fish based Thai wet cat food...the two worst things you can do for a cat to contribute to urinary problems. I'm an idiot. Lesson learned, I just pray it's not too late...

Love4himies
December 3rd, 2009, 09:35 AM
Don't beat yourself up about the kibble :grouphug: Many, many people, including me, put our trust in the pet food industry. It just makes me angry when vets are not educated enough to advise people on good feline nutrition. :yell:

Open mouth breathing could be a sign of asthma, blocked sinuses, heart disease or other lung ailments such as chylothorax. Has the vet x-rayed your cat?

chico2
December 3rd, 2009, 04:00 PM
MnM,I am so sorry you are still having issues with Mikey,we all get guilt feelings when our animals get sick,feeling we have not done enough or done something wrong.
I feel you are doing everything possible for Mikey,seeing you are living in Bankok,and not having the food choices we have here.
I can just:pray:he'll get better very soon,from whatever ails him:pray:

MnM
December 4th, 2009, 04:27 AM
Mikey was GREAT this morning, drooling, purring, kneading, etc. He's again been okay this afternoon. Not as bad as before, but still not back to normal. I find myself wondering if it's because his insides are still in chaos that when he eats, it causes pain and discomfort. he stops eating, feels better, so starts eating again...then feels slightly uncomfortable again?

He for sure eats more in the morning before noon than he eats after that. Now it's just some licks and nibbles.

Overall, still on the mend. Can it really take THIS long to heal from FLUTD? I can't find a recovery time anywhere online. I'm still hopeful that Monday's blood/urine tests will indicate progress towards complete recovery. Maybe I'm naive!

He's at least letting me lay next to him now without moving away, so that's progress!

sugarcatmom
December 4th, 2009, 07:03 AM
I'm wondering if there might be some pancreatitis issue going on here. It can be tricky to diagnose, and while there is a blood test (fPLI) which is helpful, I'm not sure how available it is in Bangkok. Something to keep in mind maybe. In the meantime, I'm so glad Mikey is doing better! :highfive:

MnM
December 4th, 2009, 07:41 AM
Interesting that you would say that...what makes you wonder about pancreatitis? When we did the zillion tests a year and a half ago because of unexplained weight loss, Mikey was diagnosed with pancreatitis. Though the docs kept thinking there must be something else coming on. He was put on metranidazole and immediately gained weight (actually, the only time he gained weight was on the antibiotic, he only maintained weight off of the med).

Could this be an issue right now? Would FLUTD make the pancrease react? I'm so confused!

MnM
December 5th, 2009, 07:54 PM
So an update on Mikey-

Overall he seems better-he's is acting much like his old self again. Although he appears to actually be getting weaker (shaky legs front and back, difficulty retracting his claws, that kind of thing).

He's eating well, drinking some, going to the bathroom, purring...so on one hand I'm staring to feel hopeful. But then my husband says he suspects elevated Creatinine is the cause for the muscle weakness...so spiraling back down I go.

I just wish I had a vet here that I completely trusted-could this current muscle weakness be from the elevated Creatinine levels from before, but he could actually be getting better?

Our appt is tomorrow with blood results likely back on Wed night our time. I'm back to being very scared.

rainbow
December 6th, 2009, 12:35 AM
MnM, I have no answers for you but just lots of :pray: :fingerscr :goodvibes: :grouphug:

Sugarcatmom and Growler should be here soon to give you some advice. :thumbs up

growler~GateKeeper
December 6th, 2009, 12:57 AM
could this current muscle weakness be from the elevated Creatinine levels from before

It's very unlikely the creatinine would cause it, crf cats with muscle weakness is usually caused by: anaemia, high phosphorus, low potassium, constipation, hypertension, arthritis, metabolic acidosis, diabetic neuropathy, or heart problems.

How much is Mikey eating? Does he look like he's lost weight?

:goodvibes: for the blood results & the appt :fingerscr

MnM
December 6th, 2009, 01:13 AM
He's eating actually really well! If anything, he's gaining weight!

He responds to being petted, is constantly rubbing his chin up against stuff. But his legs are shakier today than yesterday. I also have heard his joints 'cracking' a few times which I've never heard before. He doesn't seem to be in pain, though. He is doing A LOT of stretching. Even when he was just sitting, he'll suddenly go to walk and stop and stretch. He also lays down oddly, curling his right paw under then slowly dropping his body down, then stretching his legs out in front-which is not how he normally lays down.

We're trying to move his appt up to tonight, that way it's one less day to wait on blood tests.

growler~GateKeeper
December 6th, 2009, 01:32 AM
Good news on the eating/weight gain :thumbs up

Mention it to the vet when you see him, it may just be some joint stiffness/trying to get comfortable possibly a bit of normal aging arthritis what with the cracking sounds, you can always try supplementing with something like Glyco-Flex II (http://www.vetriscience.com/glycoflex-1-2-cats-dogs.php) that has green lipped muscle, glucosomine & msm in it.

rainbow
December 6th, 2009, 01:54 AM
Glad to hear that Mikey is eating well. :thumbs up

The joint 'cracking' could very well be age related arthritis. :sad:

This is what I am wondering about ...

He is doing A LOT of stretching. Even when he was just sitting, he'll suddenly go to walk and stop and stretch. He also lays down oddly, curling his right paw under then slowly dropping his body down, then stretching his legs out in front-which is not how he normally lays down.

As we all know, cats are so very good at hiding everything and, to me, that sounds like he is in pain. :sad:

MnM
December 6th, 2009, 04:58 AM
I'm in agreement that I don't think this is age related...it is definitely out of the ordinary behavior and increasing day by day.

He's in the 7th hour of no food now so we can do the blood test tonight, he's not thrilled about this-which is a good thing I think. He's right now playing with my husband and his favorite long piece of ribbon.

...which didn't last long because he suddenly seemed to feel pain and halted his playing. It seems to be primarily his back right leg now, but all of his legs are wobbly and weak.

I can't believe I have to wait two days to get blood test results! This is killing me!

MnM
December 6th, 2009, 09:05 AM
Back from the doc's...I still feel as lost as I did before.

The doc said he had a type of 'strain' in his right back leg and one in his right front leg. This he was worried could be caused by 'rubber bone' which is a problem with kidney disease...and it's not 'fixable'. So they x-rayed him while I quietly cried. Not rubber bone-so that's some decent news I guess.

His urine isn't as great as we'd like: USG fell to 1.026 but the doc said that could be because of the Leuco which is still at 3+.
Ph 6
Protein 1+
Bilrubin 1+
All else negative or normal.

The vet said tomorrow we should get the blood tests except for the fructosamine that we're having done, that will take a week (sigh). The vet is now leaning more towards diabetes than kidney disease. And then he suddenly starts saying something about the pancreas. I tried to figure out if he does have pancreatitis (which he did have before a year and a half ago) could THAT lead to diabetes and then the muscle weakness that he's experiencing now? And if so, if we can get the pancreas under control, would the diabetes regulate itself so he could lead a normal life? And sugarcatmom already brought up the pancreas...why?

I've been spending all my time researching (or trying to) kidney disease and FLUTD. Now I have to turn to diabetes and pancreatitis...maybe. I'm so scared that there is something happening that we're missing and he's going to slip away or have permanent, irreversible damage. I did get some electrolyte powder from the doc today to try and see if that helps with the weakness (it's orange flavored so I'm going to try and find it w/out flavor tomorrow). The doc could tell that there was significant muscle weakness and that the damage was caused because of this muscle weakness.

I am so frustrated and scared.

sugarcatmom
December 6th, 2009, 11:53 AM
I tried to figure out if he does have pancreatitis (which he did have before a year and a half ago) could THAT lead to diabetes and then the muscle weakness that he's experiencing now? And if so, if we can get the pancreas under control, would the diabetes regulate itself so he could lead a normal life? And sugarcatmom already brought up the pancreas...why?

Pancreatitis and diabetes frequently go hand-in-hand, yes (the pancreas is where insulin is produced). The reason I was wondering if maybe Mikey had pancreatitis was because of his waxing and waning symptoms that seem to correspond with eating, plus his periodic hyperglycemia. Since cats more commonly develop chronic pancreatitis (as opposed to the acute form), and may have periodic symptom flare-ups throughout their life, I think the fact that Mikey has had pancreas issues in the past is a big clue here.

Hard to say what the connection would be with the muscle weakness. Pancreatitis can result in electrolyte imbalances, which may be a factor. Pain can manifest as a stiff gait or odd positions while lying down. Diabetic neuropathy usually develops after pro-longed hyperglycemia, so hopefully the fructosamine results shed some light on whether that's an issue.

chico2
December 6th, 2009, 03:56 PM
MnM,I let our kitty-experts do the advicing,I just wanted to say,I feel for you and hope you and Mickey will get some definite answers very soon:pray::grouphug:

MnM
December 6th, 2009, 07:07 PM
Thanks everyone for the positive thoughts and kindness. It helps.

Sugarcatmom-I am more and more wondering about the pancreas too. Unfotunately, the doc said they do not have the test here in Thailand (but at least he knew what the name of it was!). All of the sites I have read, though, say it's almost always characterized by a decrease in appetite. This is definitely not Mikey. However, last time when they did diagnose it (based on an ultrasound), Mikey was actually begging for people food-jumping on the counter and ripping open pizza boxes which was NOT him at all, refusing to eat his dry kibble. I always thought he was trying to eat something/anything that would make him feel better-like he felt bad and was trying to find that magic thing to make it go away. Again, I was feeding him some crappy Chinese Whiskas fish packets because he had struggled with constipation once, so I was supplementing his dry kibble with one packet a day(we lived in China at the time). He lost over 2 pounds, but gradually over the course of three years so it wasn't really noticeable/worrisome until he fell under the 8 pound mark. Then they gave us metronidazole and the ONLY time in a year and half that he has gained weight was the two times he was on that med (gained 1/2 pound in ONE week when he first started it).

All night last night I woke up to Mikey wanting to snuggle, but I could hear his joints cracking-which is breaking my heart. WHAT IS GOING ON???

The doc should call tonight with his blood test results-minus the fructosamine. I'll continue to give him the electrolyte powder and see how that goes.

growler~GateKeeper
December 6th, 2009, 09:17 PM
I would suggest an abdominal ultrasound that way they can check the pancreas, kidneys, intestines and bladder all at the same time & ask them to take a quick peek at Mikey's heart since you're already there & then they can rule out or confirm everything all at once.

MnM
December 7th, 2009, 08:00 AM
So the vet called with the blood test results, then we went in to the vet to talk about them because we were so confused...we spent over an hour discussing things with him (which we were not charged for, pro for Thailand). Unfortunately we're still just as frustrated and scared (con for Thailand).

So here are Mikey's latest blood results (Potassium we'll hopefully get tomorrow):
BUN 28 (down from last time from 30.2) [norm 7-26]
Creatinine 2.07 (down from 2.4) [norm .4-1.8]
SGPT/ALT 56 [norm: 5-60]
ALK.P 29 [norm 3-60]
Albumin 2.92 [norm 2.4-4.3]
Calcium 10.9 [norm 9.6-11.6]
Phosphorous 4.27 [norm 2.5-6.2]
Total Protein 7.2 [norm 5.8-7.9]
The doc must have called in a favor because the fructosamine also came back while we were meeting with him-290, well within normal range.

So no diabetes, and the kidneys are looking better and better (right?) Phosphorous levels are great (am anxious to hear the potassium). So why the heck is my cat losing muscle/having front and back leg weakness? His joints are clicking more and more...what could be causing this?

The doc wanted us to start subQs again, but we questioned why. Mikey's hydrated, urinating normally, why would we give him 200ml a day? I said unless it will fix the muscle weakness problem, I'd rather not. He sent us home with a calcium supplement and a 'come back on Sunday and if he's not better we'll do an ultrasound'. Sunday is a LONG way from now.

As a side note, we went ahead and had McKinley's blood drawn for a check up as well. HER creatinine came back high at 2.17 (higher than Mikey's is now) but her BUN was only 16. Her SGPT/ALT was 115 (high) and her ALK.P was 89 (high)...he wanted us to start giving HER subQs! I feel like I'm pounding my head against a wall.

We did try and push the pancreatitis theory-but Mikey doesn't exhibit a single symptom...though when we was diagnosed with it before he had zero symptoms except weight loss as well. The problem is the food I'm feeding him is a recipe for kidney problems (lots of pumpkin) and for pancreatitis, this is supposed to make it more inflamed right? HELP! Could pancreatitis cause Mikey's muscle/bone/weakness?

growler~GateKeeper
December 7th, 2009, 11:29 PM
Here is an article wrtten on pancreatitis written by a vet.
http://www.manhattancats.com/Articles/pancreatitis_test.html

As I mentioned earlier if it was my cat I wouldn't wait for Sunday I'd book the ultrasound appt :2cents: The ultrasound will also check on the kidney stones you mentioned in the first post. Depending on the type & severity of the stones it can cause acute kidney failure which is reversible when treated promptly & correctly.

A few months ago Duffy had an ultrasound to rule out pancreatitis, check the condition of her kidneys and the severity of her heart murmur, all of which were normal/or better than expected but the vet did find some inflammation in her intestines which explained the symptoms Duffy had been showing (sudden onset vomiting, straining to poop, diarreah, bloated doughy feeling abdomin, lethargy, depression) - IBD with previously suspected but now known specific food triggers. http://www.manhattancats.com/Articles/IBD.htm

Was there a FIV test done at any point?
http://www.manhattancats.com/Articles/FIV_Feline_Immunodeficiency_Virus.htm

The numbers look quite good obviously high on BUN & creatinine but not by very much. McKinley's numbers show raised liver enzymes plus the creatinine however if the blood sample was haemolysed (http://www.felinecrf.org/diagnosis.htm#haemolysis) the ALT will appear falsely inflated.

MnM
December 8th, 2009, 09:26 AM
Thanks for the advice growler-it was the catalyst that pushed me to work HARD to get in to see the only cat specialist in all of Bangkok. She only sees patients on referral after they've been to one of the recommended vets and she's only available from 7:30-3:30 on Tues and Thurs and this coming Thurs here is a holiday...so at 1pm today I started the ball rolling (why I waited so long is something that will haunt me). Very long story short-my secretary is my hero. She had a friend who had a friend who was a doctor at the university hospital where the specialist worked. The woman who was near impossible to get an appt with I saw within a couple of hours. I spent 5 hours there, saw 5 different doctors...and walked away with a diagnosis of Progressive Polyarthritis. It makes me sad-but I'm hopeful that they are wrong and Mikey can make a full recovery. He will start taking glucosamine and he's on some pain killers temporarily. He already seems better (pain killers?) but they said it will take up to 6 weeks to see the glucosamine and how much cartilage can be regenerated. Their fancy schmancy x-rays showed he's lost all cartilage in the back hock joint and much in the hip.

So the entire vet visit (5 hours, 5 docs, x-rays, some blood work) cost me around $25USD...the glucosamine? Over $50USD! Thailand is so interesting.

I have just gotten home, exhausted and emotionally drained so haven't even begun to learn about the 'new' disease my boy has. Or about the Meloxicam he's taking for pain (.15 mg today, tomorrow, then e/o day for a week). The box said for dogs, but the vet said it was approved for use in cats in CA...not US.

What still continues to baffle me, is how quickly this came on. I always thought arthritis was a slow progression towards worsening...my boy went from fine to all cartilage gone in his hock joint and other joints looking bad in less than a week! I will probably feel more sad tomorrow, but right now, I'm relieved to have a diagnosis and treatment.

FYI-Mikey is digging the raw food, I added brown rice b/c my other vet was freakin' about the kidney issues. This vet said 'pooh' to the creatinine and BUN...high'er' but not HIGH she felt. Next time no brown rice I say!

Any thoughts or advice would be appreciated. Again-you all have been an invaluable resource. My husband calls you my 'peeps' now: "you writing to your peeps?". Thanks so much for being there.

rjesak
December 8th, 2009, 10:20 AM
I don't know how similar it is, but my sister's dog got this diagnosis a couple of years ago. She says that acupuncture has completely changed his life. When it hit his spine, their vet told them that he may not have much longer, but in the month or two of acupuncture, she says he's no longer exhibiting pain at all. It might be worth looking into - seems like something that might be available there. It's called Eastern medicine, right? :laughing:

sugarcatmom
December 8th, 2009, 05:30 PM
I spent 5 hours there, saw 5 different doctors...and walked away with a diagnosis of Progressive Polyarthritis.

At least you have something to go on now.

I have just gotten home, exhausted and emotionally drained so haven't even begun to learn about the 'new' disease my boy has.

I did find some info on how it might be related to a retrovirus called Feline Syncytia-Forming Virus (FeSFV), and how that virus might have a tenuous connection with FLUTD, which I thought was rather interesting.
http://www.familyvet.com/Cats/Imune.html

CHRONIC PROGRESSIVE POLYARTHRITIS

Progressive polyarthritis is a disease characterized by joint damage in young or older cats. While this is considered an immune mediated disease, there may be a link to feline leukemia virus and its relative, Feline Syncytia-Forming Virus. (FeSFV) All cats with the disease have been found to be positive for FeSFV and over 60% are positive for FeLV. Immune complexes (clumps of antibodies and antigens) related to these viruses seem to be involved with causing the damage related to the disease.

There are two classifications of the disease; a surface inflammation of the bones and joints most common in young male cats and severe joint deformity most often seen in older cats. Besides damage and inflammation of multiple joints which gets worse over time (hence the name), clinical signs include fever, weight loss, loss of appetite, muscle wasting, lameness and joint swelling. Diagnosis is based on history, clinical signs, physical examination, X-rays, joint fluid cytology, blood counts and serum chemistries. Most cats get worse with time but can be maintained with early and aggressive therapy.

TREATMENT OF CHRONIC PROGRESSIVE POLYARTHRITIS

Cats positive for feline leukemia will often respond poorly to treatment. FeLV negative cats can do well on prednisolone therapy alone or combined with azathioprine and cyclophosphamide. Adequan, Cosequin or Synovi-Cre may also be helpful but little research has been done as to their effectiveness.


Or about the Meloxicam he's taking for pain (.15 mg today, tomorrow, then e/o day for a week). The box said for dogs, but the vet said it was approved for use in cats in CA...not US.

Careful with this (also known as Metacam). It's actually not approved for oral use in cats in Canada either, only as a one time post-surgical injection, and it has been implicated in causing or exacerbating renal failure. I realize there's a quality of life issue where chronic pain is concerned, and Metacam can really help some cats. Just keep a close eye on Mikey's kidney values with regular check-ups. I also second rjesak's recommendation to try acupuncture.

Good luck!

MnM
December 8th, 2009, 06:21 PM
Thanks for the info and thoughts!

I will definitely see if I can find an animal acupuncturist here...easy to find for humans, not sure if they've progressed to animals yet. I do like that idea.

I will tread lightly with the pain med...he gets one drop today and then we move to e/o day. I'd like to stop it asap, but also don't want him in pain. I'm wondering if there is another option that has less scary side effects? My husband read something about aspirin?

He's supposed to rest and take it easy too, problem with the pain med is he's feeling better so not resting (went up and down the stairs 3 times last night for no apparent reason. I don't give him his second dose until late tonight...so we'll see.

I'll keep you all posted. I can't tell you how much I appreciate your help and ideas. We are collecting ALL of his paperwork/x-rays to make an appt in Seattle with someone to get another opinion, too. I again can't believe that he went from fine, to no cartilage in less than a week and it happened right after he began to improve from the FLUTD...there just has to be the connection. Thanks-at work trying to do some massive catch up!

sugarcatmom
December 8th, 2009, 07:39 PM
I will tread lightly with the pain med...he gets one drop today and then we move to e/o day. I'd like to stop it asap, but also don't want him in pain. I'm wondering if there is another option that has less scary side effects? My husband read something about aspirin?

I wouldn't use aspirin. Cats metabolize it very slowly and it's too easy for it to reach toxic levels. It won't provide enough pain relief at the low dose you'd have to use.

Not sure how available something like Buprenex (aka Buprenorphine) is in Thailand, but that one tends to have less noxious side effects than most other pain meds, although it can make some cats rather dopey. It's also really expensive (here, anyway).

Other than that, a low dose of Metacam with regular monitoring might be your best bet.

Other supplements along with the glucosamine that could be worthwhile are MSM, chondroitin, green lipped mussel, and omega3 fatty acids (in the form of fish oil).

Some info on chronic pain management: http://www.vasg.org/chronic_pain_management.htm
And a great site with info on arthritis: http://www.harpsie.com/arthritis.htm

growler~GateKeeper
December 9th, 2009, 10:30 PM
I'm glad to hear you've got a diagnosis nailed down, now you can start on ensuring Mikey is always comfortable. :grouphug:

A little bit more info here on polyarthritis (http://www.petmd.com/cat/conditions/musculoskeletal/c_ct_polyarthritis_erosive_immune_mediated).

The reason it comes on so quickly is being immune mediated means the body's own immune system (which is what protects the body from threats - virus etc) sees the joints/cartilage as a threat that needs to be eliminated, so it starts destroying the cells in the cartilage.

MnM
December 10th, 2009, 06:39 AM
Again the info has been so incredibly helpful.

So far no luck on finding an acupuncturist here in Bangkok for animals, but will continue to search.

This is killing me. Mikey is in so much pain and it's getting worse, not better. I can tell when the pain med starts wearing off because he gets much much much worse. But I can't keep giving it to him because it will destroy his already 'fragile' kidneys. This is like the most impossible choice!

I know the glucosamine (with choindrotin in it) won't take effect for a couple of weeks, but I swear he's deteriorating before my eyes. It's like he went from FLUTD, to Kidney Disease, to Progressive Polyarthritis in two weeks-a perfectly healthy, normal spunky boy, to a diseased, old cat that people are wondering if I'm going to 'put him down'. How is this possible? I just can't understand how this happened so fast.

chico2
December 10th, 2009, 07:03 AM
MnM,so sorry I was hoping he was doing better:sad:

sugarcatmom
December 10th, 2009, 07:16 AM
I can tell when the pain med starts wearing off because he gets much much much worse. But I can't keep giving it to him because it will destroy his already 'fragile' kidneys.

Quality of life is an important consideration here, and I'd be inclined to keep giving Metacam if it's helping him feel better. Not every cat that takes it ends up with renal failure, I know of many cats that have been on it for years without a problem. If Metacam is the only option for pain relief and Mikey's pain is profound enough to be affecting how he's living, it might be worth the risk.

rjesak
December 11th, 2009, 09:01 AM
I'm so sorry MnM. Watching Oscar suffer with Asthma has been heartbreaking so I really know what you're going through. :cry2: I can't offer you any of the extraordinarily helpful advice that others here (like SCM and Growler) can but I wish you and Mikey all the best. I think I agree with SCM that it's worth giving him the Metacam as long as that's giving him quality of life. Best of luck!

MnM
December 13th, 2009, 07:53 AM
Hi all-just to keep you updated. Mikey has rallied a bit yesterday and today. Acting a bit more like his old self, just 'creaky' when he moves sometimes. We go back to vet #1 tomorrow night for a check up and urinalysis to see if the FLUTD is cleared completely (if that's ever what it was).

Here's the crazy part (I wouldn't even write this because I'd be too afraid people would think I was nuts, but my husband confirmed it and he's definitely not paranoid)...the last few days, I have noticed McKinley (Mikey's sister) having the same 'crack' sound in her joints that Mikey has. Not near to the same level as his, but when I can't remember EVER having heard either of my cats' joints make that 'crack' sound, it really becomes significant.

So am I crazy? Paranoid? (please feel free to tell me if you think so!) Here's my new question: could Mikey have caught a virus from the vet's office when we first took him in for the FLUTD? His immune system was at an all time low, and cleanliness/sterility has a different meaning for people here, so animals I can't imagine it's any better. Then could he have transferred the virus/bug to McKinley and because she's healthier it's not impacting her as drastically? Is there something he could 'catch' that would erode his cartilage? I am supposed to get on a plane and leave them for three weeks and I'm now freaked out that as Mikey is slowly/somewhat improving, I'm leaving McKinley to start down the same path. Is there something I can test for before I go? Or is this completely off base? Should I start giving her the Glucosamine too?

I feel like I'm turning into one of those people that becomes obsessed! Sigh.

hazelrunpack
December 13th, 2009, 09:28 AM
:grouphug: Noticing things that are amiss with your pets isn't paranoia, it's being a good pet parent. Even if down the road it turns out to be a false alarm, congratulations on being so in tune with your kitties!

Not having had cats, I can only speak to dogs, but if McKinley is truly Mikey's sis--from the same parents--then it would more likely be something genetic. It is not too unusual for closely related pups to have similar orthopedic problems. Are they from the same litter or was "sister" used in the "adoptive sister" way?

If the same litter, I'd start her on the Glucosamine, as well. Watch her closely for other symptoms and have her checked to confirm the diagnosis. If she does have polyarthritis, at least you won't have to waste any time trying to figure out what it is.

Being from tick country, the first thought we'd have if two of the dogs presented with joint problems at the same time was that we were dealing with anaplasmosis or Lyme's (both tick-borne). If you don't have disease-bearing ticks in Thailand, then that's not the issue here...

:fingerscr that it's nothing. :goodvibes: for both Mikey and McKinley!

sugarcatmom
December 13th, 2009, 11:23 AM
Here's my new question: could Mikey have caught a virus from the vet's office when we first took him in for the FLUTD?

Maybe not from the vet's office, but there is a virus that is at least statistically linked to progressive polyarthritis (a direct link hasn't been proven), called Feline Syncytia-Forming Virus. I mentioned it previously (you might have missed it in all the hubbub): http://www.pets.ca/forum/showthread.php?p=858975&highlight=Feline+Syncytia-Forming+Virus#post858975

You could have Mikey and McKinley tested for it (along with FIV and FeLV), but it's quite unlikely that if they do have it, they got from the vet clinic. Transmission is either passed down from the mom (less common), or more typically from prolonged social contact like grooming, but also from bites. How long have you had these kitties and how much of their history do you know? http://jcm.asm.org/cgi/reprint/37/9/2848.pdf

Several natural modes of transmission have been suggested for FeFV infec- tion. These include vertical transmission from queen to kitten (4) and salivary transfer, either by the respiratory route (3) or through aggressive behavior such as biting (13, 23).

Could also be something entirely different, such as a hereditary link like Hazelrunpack mentioned, or perhaps diet related. Were you feeding both your cats homemade food, and for how long? Was it properly balanced for all the required nutrients, like taurine and calcium-phosphorus ratio? Was there a particular commercial food that they ate exclusively for extended periods?

Glad to hear that Mikey seems to be feeling better. Hopefully McKinley doesn't come down with anything so serious.

growler~GateKeeper
December 13th, 2009, 04:53 PM
I would go ahead with the glucosamine with McKinley as well, being in the same age range it will help in the long term as well as right now.

If you can get them both in to tomorrow's appt have the vet have a look at McKinley's joint range of motion and mention that you're hearing the same sounds from her.

:goodvibes: for the UA results