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  #421  
Old October 27th, 2010, 04:45 PM
nemesis nemesis is offline
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Smokey is continuing to get better. His appetite and demeanor are good. I think his remaining odd behaviour is due to him being annoyed at being taken to the vet for a few days and then having his fluids the next day (he get skittish if he sees people congregating in a conspiratorial way, i.e, "what are they up to now?"). I've been giving smaller meals more frequently to help ease his stomach and elevated his food and water bowls. I also heard about an herbal supplement called Slippery Elm Bark which is supposed to help with stomach acid, nausea, and so on, has anyone tried it?

Up to this point he's been receiving 150 ml of fluids twice a week. He had his last dose of IV fluids on Monday, and we gave him his Subq dose yesterday. The water pouch is gone. I'm trying to decide if we should give him another subq dose today, and just go with every day until Saturday, or give him a break. The vet said that we could give him his first dose right away the next day after he comes home, and then switch to every other day after that. But if receiving the fluids every day would be more beneficial, I have no problem doing it. My only concern is that it will upset him if we do it every day. He is more compliant than before, and we are better at controlling him during it, but he doesn't really "like it" per se. On the other hand, it's possible that he was more annoyed at us last night after fluids because he was still upset about having to be at the vet for a few days. Hmm. I wonder if I could even give him a break today, and then resume giving them every day until Saturday. I also wonder if it's better to be consistent in the timing of it, as in, not switch between every other day/every day, and just stick to one.
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  #422  
Old October 28th, 2010, 04:01 AM
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Quote:
Originally Posted by nemesis View Post
Smokey is continuing to get better. His appetite and demeanor are good. I think his remaining odd behaviour is due to him being annoyed at being taken to the vet for a few days and then having his fluids the next day (he get skittish if he sees people congregating in a conspiratorial way, i.e, "what are they up to now?"). I've been giving smaller meals more frequently to help ease his stomach and elevated his food and water bowls.
Excellent

Do you think this most recent hiding/odd behaviour of Smokey's is very concerning/out of character or does it usually take him a couple of days to get over vet visits/changes in the household (visitors staying overnight etc)?


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I also heard about an herbal supplement called Slippery Elm Bark which is supposed to help with stomach acid, nausea, and so on, has anyone tried it?
I did use SEB for a bit as it also soothes & coats the lining of the intestinal tract, soothes mouth ulcers and helps with constipation/diarreah by rebalancing the water absorption in the bowels.

For my girl the issue that prompted me to use SEB was constipation, it worked well for ensuring her poops were not too dry & she could pass them easier. At that time I was feeding bone-in ground raw food and as her homeopath & I discussed her food more we determined that she was starting to react to the ground bone - the content was too high for her system to handle, and once we switched her to a bone-free, calcium supplemented raw food she didn't need the SEB anymore.

A note of caution with SEB you should give it at least 1 hour before or after any other medications or supplements as it can interfere with their absorption, SEB stimulates the production of mucous in the gastro-intestinal tract. Also being that it is a herbal supplement, my animal homeopath & homeopath vet recommended it not be used as a daily long term solution, any herb can react against other herbs, supplements and medications, and as with any herbal remedy it is important not to overdose.

SEB is considered safe & effective however the magnesium content is high which is a concern if the urinary pH is high and it does contain calcium so it's not recommended for one with hypercalcemia.

Some info on SEB:
http://www.felinecrf.org/holistic_treatments.htm#SEB1
http://www.littlebigcat.com/?action=...em=slipperyelm

Quote:
Originally Posted by nemesis View Post
Up to this point he's been receiving 150 ml of fluids twice a week. He had his last dose of IV fluids on Monday, and we gave him his Subq dose yesterday. The water pouch is gone. I'm trying to decide if we should give him another subq dose today, and just go with every day until Saturday, or give him a break. The vet said that we could give him his first dose right away the next day after he comes home, and then switch to every other day after that. But if receiving the fluids every day would be more beneficial, I have no problem doing it. My only concern is that it will upset him if we do it every day. He is more compliant than before, and we are better at controlling him during it, but he doesn't really "like it" per se. On the other hand, it's possible that he was more annoyed at us last night after fluids because he was still upset about having to be at the vet for a few days. Hmm. I wonder if I could even give him a break today, and then resume giving them every day until Saturday. I also wonder if it's better to be consistent in the timing of it, as in, not switch between every other day/every day, and just stick to one.
In your situation I would be comfortable giving fluids everyday providing the fluid is fully absorbed & re-assessing after Sat's bloodwork comes back from the lab, if you think Smokey needs a break then by all means give them every other day as your vet has already mentioned is okay.

If you skipped fluids on Wed & he acts worse/more cranky/drinking noticibly more etc during the day Thurs then give fluids each day starting Thurs through Sat & mention to the vet how his behaviour was during this week.

We do want to be as consistant as possible with the fluid schedule just so the cats are not going longer than recommended/needed without fluids, as that makes the symptoms more pronounced & constant dehydration is not that easy to overcome. It all depends on how much/how frequent each individual cat needs.

Overall shifting the schedule a few times isn't going to be too big of an issue while you figure out what works best for Smokey. The results back from the lab will help your vet determine if it's better everyday or every other day, your observations are also very helpful in determining which is better for Smokey.

A bit about fluid frequency http://www.felinecrf.org/fluid_thera...ency_of_fluids

A bit about overhydrating http://www.felinecrf.org/treatments.htm#fluid_retention

What is he like a couple of hours or so after getting fluids? Is there a difference in his behaviour/demeanor than before giving fluids?

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  #423  
Old November 2nd, 2010, 03:02 AM
tigerbee tigerbee is offline
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Hello!

I moved out of my parent's house a few years ago and was finally able to take my kitty, Tiger, to live with me this August. He will be 14 this month. I am very interested in proper nutrition and ever since he has moved in with me he has been put on a 100% grain-free canned diet (no more kibble!!). He and my boyfriend's cat, a 1.5 yr old calico female terror (that we love dearly) also get a few meals of raw weekly but their diet is mainly canned. They get a variety of flavors from Wellness, Nature's Variety, Weruva, Petcurean, and Evanger's. I am trying to familiarize myself with the lower phosphorous varieties as well as calculating dry matter and read some good pointers in the thread already concerning that, luckily he likes almost everything suggested! I will start making those a more prominent part of his diet. The cats get 2-3 meals a day. His appetite is great, he is my secondary alarm clock which has saved me from being late a few times! I'm glad he is always eager for breakfast. We have several water dishes across the apartment and he seems to drink a lot, perhaps a bit less after starting fluid therapy but I catch him drinking more than Asha. Living with a young and spunky (on the verge of violently insane) kitty has really livened up his life and activity level too.

Tiger went in for bloodwork last month. The following were the only things with abnormal ranges:
ABS Lymphs - 946 /uL L (1300 - 7000)
BUN/Urea - 51 mg/dL H (15 - 34)
CHOL - 274 mg/dL H (82 - 218)
CREA - 3.1 mg/dL H (0.8 - 2.3)

My vet advised me to begin sub-q fluid therapy at home, 300cc's twice weekly. We did not discuss any medications. He is due for another blood profile in one week. Are we supposed to see a drop in his levels? I am uncertain whether or not 300cc's twice a week is better or worse than a smaller amount more frequently. I just ordered a digital infant scale on amazon to track his weight/hydration a bit more accurately as advised by http://www.felinecrf.org which I was linked to in this thread. Lots of great info there (and here!). Glad I found you guys.

Any advice or thoughts on Tiger's specific situation would be greatly appreciated.
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  #424  
Old November 2nd, 2010, 04:17 AM
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Hi tigerbee welcome to the forum

Quote:
Originally Posted by tigerbee View Post
since he has moved in with me he has been put on a 100% grain-free canned diet (no more kibble!!).
Awesome

Quote:
Originally Posted by tigerbee View Post
They get a variety of flavors from Wellness, Nature's Variety, Weruva, Petcurean, and Evanger's. I am trying to familiarize myself with the lower phosphorous varieties as well as calculating dry matter
Good to see you have the holistic brands already, there is a newly updated listing here http://www.felinecrf.org/canned_food...od_data_tables, the numbers are already ordered by phos level and are listed all in dry matter. From here you can find the lower phos flavours of the brands you know your cats already like.

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Originally Posted by tigerbee View Post
The cats get 2-3 meals a day. His appetite is great, he is my secondary alarm clock which has saved me from being late a few times! I'm glad he is always eager for breakfast.
Happy to hear he has a good appetite, I would suggest raising the food & water dishes up between 2-6 inches off the ground. Place a phonebook, box, planter stand/low table etc just be sure the dishes can't slip off & scare the cats while eating. Raising the dishes will ensure the cats head is above their stomach while eating, helps prevent nausea though it sounds like not an issue at this point.

Another tip is feed a snack before bed so there is something in the stomach to keep the digestive juices working properly & not causing trouble.

Quote:
Originally Posted by tigerbee View Post
We have several water dishes across the apartment and he seems to drink a lot, perhaps a bit less after starting fluid therapy but I catch him drinking more than Asha. Living with a young and spunky (on the verge of violently insane) kitty has really livened up his life and activity level too.

Tiger went in for bloodwork last month. The following were the only things with abnormal ranges:
ABS Lymphs - 946 /uL L (1300 - 7000)
BUN/Urea - 51 mg/dL H (15 - 34)
CHOL - 274 mg/dL H (82 - 218)
CREA - 3.1 mg/dL H (0.8 - 2.3)
Very good that Tiger is active & playful & has a friend to keep him amused.

Was there a urinalysis done?

Absolute Lymphocytes being low can be a result of a stressful blood draw, low grade inflammation, or certain medications.

The high cholesterol can be a result of having recently eaten, also can be due to stress. It doesn't have the same meaning as humans with high cholesterol.

Quote:
Originally Posted by tigerbee View Post
My vet advised me to begin sub-q fluid therapy at home, 300cc's twice weekly. We did not discuss any medications. He is due for another blood profile in one week. Are we supposed to see a drop in his levels? I am uncertain whether or not 300cc's twice a week is better or worse than a smaller amount more frequently.
Is that a total of 300cc per week or 300cc given two times a week?

Hopefully you will see the BUN & Cre blood levels start to drop, though it often takes sometime before you see large changes.

More frequency/lower volume vs less frequent/higher volume depends more on how Tiger is adjusting to getting fluids and how quickly he absorbs them. Also how does he feel fluid days vs non-fluid days - is he cranky & moody the day before fluids & feels much better after, perhaps more frequent might work better.

How is Tiger doing with having fluids given? Overall mood before/during/after fluids?

300cc is alot to give in one session & often people will divide that into two sessions per day. You can always speak to your vet about giving it more frequently so Tiger doesn't get so much at once. Be sure that all the fluids are absorbed prior to the next session.

Instead of 300cc two times a week, ask your vet about doing 150cc every other day. You would still be giving the same overall amount just less, more frequently, might be easier on Tiger with more even hydration levels from fluid to non-fluids days. *Please speak to your vet prior to changing the fluid schedule, as they have seen your cat & can tell if there is need to change the dosage.*

Are you ordering fluids & supplies from your vet? What brand/size needle are you using?

If you can find a pharamacy or local medical supply company to order from it is usually much cheaper than buying from the vets.

Terumo Ultra Thin Wall (UTW) 20g is what I and many others have found to be the best brand/size. The ultra thin walls allows the fluids to flow as fast as the Monoject 18g but with much more comfort upon insertion as the point is also beveled & sharper.

Are you warming the fluids before application? I found an extra large ziplock bag the perfect size to place the bag, line & needle into, to place in a sink full of hot (not too hot) water for a few minutes. This allows the fluids to warm up to cats body temperature, so it's not such a shock to the system having room temp/cold fluids under the skin.

Feel free to ask any questions

for next weeks' blood results
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  #425  
Old November 2nd, 2010, 09:25 PM
tigerbee tigerbee is offline
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Yes, a urinalysis was done. I didn't get a copy of those results because it took a second try a few days after the initial blood profile. The vet called and said that the results were what she expected, slightly diluted (this was prior to fluid therapy). I will get copies of everything when we go in next week for the check up.

It is total 600cc's per week. 300cc's at once. It seems like a lot to me when we're doing it. I hadn't thought of splitting it into 2x a day. He wiggles far to much for me to do it alone so I have to get my boyfriend's help. I think doing it every other day may work better for us since we're both only free at night. I will talk to my vet about doing it differently and see what she thinks.

He doesn't seem to be moody ever. He is always very alert and loving. He is always up to greet me when I wake up or get home. The only change is that now that he is older he seems uncomfortable with being picked up and really hates being brushed (although he never loved it..).

I got my supplies online. The vet's prices were about 4x more! The needles are Monoject 18g. I have a box of 100 but when I am out I'm interested in trying the ones you are recommending.

I do warm the fluid bag beforehand. Tiger doesn't notice the needle if I set him up with a small dish of 100% freeze dried chicken breast treats. There is another question! Should I try to cut back on treats? I certainly don't dish them out like crazy but he may get 1 a day, and a little more on his fluid days. I know cutting down on the phosphorous is important, can treats make a huge impact? Everything I have read has made me think that fluid therapy can help more than changing the diet.

Thank you so much for the tips and advice given in your reply.
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  #426  
Old November 3rd, 2010, 02:01 AM
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growler~GateKeeper growler~GateKeeper is offline
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Quote:
Originally Posted by tigerbee View Post
It is total 600cc's per week. 300cc's at once. It seems like a lot to me when we're doing it. I hadn't thought of splitting it into 2x a day. He wiggles far to much for me to do it alone so I have to get my boyfriend's help. I think doing it every other day may work better for us since we're both only free at night. I will talk to my vet about doing it differently and see what she thinks.
Yeah that's a lot for one session. If you can manage it alone splitting the 300cc into 2 sessions each fluid day is not a problem, likely more comfortable for all since you're not confining him for as long.

Usually if someone is doing for example 150cc 2x a week & their cat gets antsy around the last 50cc or so I would say no problem to go 100cc 3x a week (overall same volume/week), but because of the higher volume of fluid Tiger is getting I think it's best to talk with your vet first before changing the volume/number of days.

Have you seen this site? http://www.weirdstuffwemake.com/weir.../catjuice.html Great step by step instructions & tips for fluid administrations.

Quote:
Originally Posted by tigerbee View Post
He doesn't seem to be moody ever. He is always very alert and loving. He is always up to greet me when I wake up or get home. The only change is that now that he is older he seems uncomfortable with being picked up and really hates being brushed (although he never loved it..).
Sounds like a sweetie
The last year & a half my CRF senior girl wasn't too thrill with being picked up often either, the joints get achy, tummy gets a bit touchy......

Quote:
Originally Posted by tigerbee View Post
I got my supplies online. The vet's prices were about 4x more! The needles are Monoject 18g. I have a box of 100 but when I am out I'm interested in trying the ones you are recommending.
Quite the price difference eh? yikes. The Terumo 20g will slide in under the skin alot easier/smoother & less noticably than the Monoject 18g

Quote:
Originally Posted by tigerbee View Post
I do warm the fluid bag beforehand. Tiger doesn't notice the needle if I set him up with a small dish of 100% freeze dried chicken breast treats. There is another question! Should I try to cut back on treats? I certainly don't dish them out like crazy but he may get 1 a day, and a little more on his fluid days. I know cutting down on the phosphorous is important, can treats make a huge impact? Everything I have read has made me think that fluid therapy can help more than changing the diet.
Great especially with winter coming you don't want Tiger getting chilled from the inside.

I wouldn't worry about the freeze dried chicken breast treats, especially since they are great for distracting him while he gets poked Pure chicken breast is not very high in phosphorus and the size of the treats certainly isn't going to make a huge impact.

Diet definately is important as it's an easy way to reduce the amount of phos the cat is ingesting. Changing the diet alone won't remove existing excess BUN/Urea & Cre from the body, just altering how much of them are being produced from the phos in the diet.

Fluid therapy is a fast & effective way of helping flush out the excess toxins BUN/Urea & Cre the body can't handle on it's own as well as helping to balance the electrolytes & re-hydrate the cat. So really both methods are equally important working in different ways.

If diet change and fluid therapy don't reduce the blood phosphorous numbers enough, phosphorous binders are an option to discuss with the vet.
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  #427  
Old November 4th, 2010, 03:21 AM
nemesis nemesis is offline
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Hi everyone, Smokey is doing much better now. Iíve been confused about his fluids though, and I think I need some help figuring out what the best option is, and how to communicate with my vet.

As you might recall, on October 22nd Smokey had a sort of mini-crisis were he refused to eat, became very lethargic and nauseous, and was generally acting quite sick. His blood test showed Creatinine 414, BUN 21. He received IV fluids for 2 days, then came home, and received subqís every day up until October 29th, when Smokey had his follow up blood test. His test results from that day showed that his creatinine went back to down to 185, and his BUN back down to 15. So good news there.

After this, weíve encountered some confusion about how best to continue with the fluids. I decided to switch to fluids every other day, which was between what he was getting before, which was twice a week, and the one week period after his mini-crisis, where he had it every day.
My reasoning for this is that he evidently was not doing well enough on twice a week, due to the fact that he stopped eating, was nauseous, acting very sick, and had to be put on IV fluids, and had elevated numbers, about twice what they had been a few months ago.

What Iím confused about that is the vet wants to do fluids every 72 hours, which is very nearly the same as twice a week, which we were doing on Tuesday and on Friday. I suppose there will be less time between each session, but not really a big difference, since there were 2 days between Tuesday and Friday and 3 days between Friday and Tuesday, whereas now thereíll be 2 days between each session. This change doesnít seem significant enough to me to compensate for how Smokey was behaving and the rise in his numbers, and how much they dropped after we gave fluids more often.

However, the most confusing part is the vetís rationale for this. She says that over-hydration can be harmful. Of course this I know, having read about it. But Iím not seeing any signs of over-hydration, and she hasnít indicated that sheís seen any either. Heís not sluggish or lethargic after fluids, quite the contrary. He doesnít feel squishy. The water hump doesnít take longer than a few hours to disappear. Heís not peeing more than usual. In fact, I can clearly see a difference in how heís behaving now, having been receiving more fluids for a while, compared to how he was behaving in the few weeks before his mini-crisis. It seems to me that if his numbers were twice as high, then surely he wasnít receiving enough fluids at that point? In other words, the degradation of his kidneys must have progressed to the point where he was becoming dehydrated sooner?

The vetís explanation for this is that the mini-crisis may have been caused by stomach irritation/acid, so in fact it may not be necessary to increase his fluids very much. But I donít understand this. How could stomach irritation CAUSE his higher numbers on the blood work? Isnít it the other way around? That is, doesnít stomach irritation, acid, nausea, etc, arise BECAUSE the kidneys are working less well, and thus filtering out fewer waste products (represented in creatinine numbers, for example)? Iíve never understood the causal relationship to flow in the other direction from my reading on the topic. It sounds like the vet is suggesting that Smokeyís kidneys are more or less the same as they were before, and so he doesnít need more fluids. He just needed to get over his stomach upset. But if that were the case, why even put him on IV fluids? Why was there such an obvious and dramatic improvement in his behaviour after getting fluids more often? If he was/is suffering from more stomach irritation, nausea, etc, doesnít this basically show that his kidneys are continuing to degrade, and that he might therefore need more fluids?

Was his mini-crisis caused by stomach upset, or by worsening numbers? If itís the former, then why did blood tests show worsening values? How can stomach upset by itself cause a 200% increase in creatinine, without there being worsening kidney functioning that justifies increased fluids?



I fully admit that I may not know what Iím talking about, and could just be confused. I donít want to give the impression that I donít trust my vet, and I obviously have to defer to her expertise. But I donít quite understand her interpretation of whatís been going on lately, and I want to understand without stepping on her toes. Any advice? Sorry for the really long rant.
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  #428  
Old November 4th, 2010, 08:29 AM
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Just a quick reply, and I'm sure growler will have more info for you, but it is far better to do a smaller amount of subQ fluids more frequently than a large amount less often.
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  #429  
Old November 5th, 2010, 04:20 AM
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Is Smokey still on 2 Azodyl/day? Are you refridgerating the pills?

These last 2 blood test was there anything else that was out of normal?

In the 22 Oct test (Cre 414) & the 29 Oct (Cre 185) test do you have the numbers & ref ranges for Phosphorus (Phos), Calcium (Ca), Sodium (Na+), Potassium (K+), Chloride (Cl) and Bicarbonate (HCO3)?

Did they do a urine test? I'd like to see a timeline of the Urine Specific Gravity (USG) for the times a blood test was done if possible. USG is important for determining how much water is being excreted to flush out the kidneys. Obviously once fluid therapy is started the test is not as reliable as prior, but with a consistant fluid schedule and tests in between you can still get a good sense of when the kidneys need more water to remove the same toxins.

Quote:
Originally Posted by nemesis View Post
As you might recall, on October 22nd Smokey had a sort of mini-crisis were he refused to eat, became very lethargic and nauseous, and was generally acting quite sick. His blood test showed Creatinine 414, BUN 21. He received IV fluids for 2 days, then came home, and received subqís every day up until October 29th, when Smokey had his follow up blood test. His test results from that day showed that his creatinine went back to down to 185, and his BUN back down to 15. So good news there.
The creatinine at 185 is great, that is actually just inside high normal for your lab , the drop in BUN is good too.

The BUN : Creatinine ratio however is higher now than it was before. Metabolic acidosis can be a contributing factor to this being high.

Quote:
Originally Posted by nemesis View Post
What Iím confused about that is the vet wants to do fluids every 72 hours, which is very nearly the same as twice a week, which we were doing on Tuesday and on Friday. I suppose there will be less time between each session, but not really a big difference, since there were 2 days between Tuesday and Friday and 3 days between Friday and Tuesday, whereas now thereíll be 2 days between each session. This change doesnít seem significant enough to me to compensate for how Smokey was behaving and the rise in his numbers, and how much they dropped after we gave fluids more often.
Did she want you to continue with the same volume 150mL? When does the vet want to do the next blood test?

One thing to consider now is Smokey's Cre number is lower than it was when you were doing twice a week and considerably lower than it was during his mini-crisis.

If you were to look at the numbers alone Cre 185 BUN 15 - if this was a just diagnosed cat it wouldn't even be put on fluids at this point - again based on numbers alone.

It's hard for me to advise which way to go because I've not seen how Smokey's acting/how he's feeling etc. My based on the high levels at the start & this recent mini-crisis I would go with every other day see how Smokey does for 2 weeks, if he's showing any signs of over hydration, lethargy, starts fighting the fluid procedure or the fluids don't absorb as quickly anymore then cut back to every 72 hours. I'd also have another blood test likely a mini panel done at that point too.

Quote:
Originally Posted by nemesis View Post
However, the most confusing part is the vetís rationale for this. She says that over-hydration can be harmful. Of course this I know, having read about it. But Iím not seeing any signs of over-hydration, and she hasnít indicated that sheís seen any either. Heís not sluggish or lethargic after fluids, quite the contrary. He doesnít feel squishy. The water hump doesnít take longer than a few hours to disappear. Heís not peeing more than usual. In fact, I can clearly see a difference in how heís behaving now, having been receiving more fluids for a while, compared to how he was behaving in the few weeks before his mini-crisis. It seems to me that if his numbers were twice as high, then surely he wasnít receiving enough fluids at that point? In other words, the degradation of his kidneys must have progressed to the point where he was becoming dehydrated sooner?
I think the reason she is concerned about over hydration is in part due to the creatinine now being back in high normal range. Smokey has cleared enough of the toxins to drop the cre back to normal (after all those extra fluids), so he doesn't need as much fluids for that particular purpose right now, he does still needs fluids for dehydration.

Quote:
Originally Posted by nemesis View Post
The vetís explanation for this is that the mini-crisis may have been caused by stomach irritation/acid, so in fact it may not be necessary to increase his fluids very much. But I donít understand this. How could stomach irritation CAUSE his higher numbers on the blood work? Isnít it the other way around? That is, doesnít stomach irritation, acid, nausea, etc, arise BECAUSE the kidneys are working less well, and thus filtering out fewer waste products (represented in creatinine numbers, for example)? Iíve never understood the causal relationship to flow in the other direction from my reading on the topic.
If the reason behind all this was over production of stomach acid, more fluids won't really fix that issue, the fluids will flush out the BUN & Cre but it doesn't reach/go through the stomach - so not much help there. Remember you've also just added back in the antacid to take care of that.

Increase in stomach acid/irritation etc won't cause higher Cre BUN bloodwork numbers, but the increase in creatinine or BUN also won't cause stomach acid levels to increase either. High levels of BUN, phosphorus etc may produce the feeling of lethargy/feeling sick/nauseous but the physical substance of stomach acid is caused by changes in the hormone gastrin.

Quote:
Gastrin is a gastro-intestinal hormone which stimulates the secretion of gastric acid, which helps the stomach digest food. The kidneys are responsible for the excretion of gastrin, but in CRF this function may not work so well, resulting in the gastrin remaining in the stomach and stimulating the production of too much gastric (stomach) acid.
Your vet may have just had trouble explaining the relationship btwn high bloodwork & nausea, especially if she has not experienced/treated many cases of CRF . Generally when cats have high blood work they also have high levels of stomach acid, it's not that high blood values cause it, but they are concurrent issues both related to (different areas of) kidney function. The higher the BUN value the higher chances are the cat will feel nauseous & vomit.

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Originally Posted by nemesis View Post
It sounds like the vet is suggesting that Smokeyís kidneys are more or less the same as they were before, and so he doesnít need more fluids. He just needed to get over his stomach upset. But if that were the case, why even put him on IV fluids? Why was there such an obvious and dramatic improvement in his behaviour after getting fluids more often?
I'm wondering if this mini crisis was brought on by metabolic acidosis (thats why I asked at the top of this post for the Na+, K+ etc), may show similair signs to standard stomach acid but may account for the severity.

Smokey was put on IV specifically to flush the Cre & BUN out of the blood while the stomach issues were being worked out with antacids

Dramatic improvement because the blood toxins that made him feel super crappy were now gone. Most likely the blood toxins were causing him to feel worse than the increase in actual stomach acid was.

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Originally Posted by nemesis View Post
If he was/is suffering from more stomach irritation, nausea, etc, doesnít this basically show that his kidneys are continuing to degrade, and that he might therefore need more fluids?

Was his mini-crisis caused by stomach upset, or by worsening numbers? If itís the former, then why did blood tests show worsening values? How can stomach upset by itself cause a 200% increase in creatinine, without there being worsening kidney functioning that justifies increased fluids?
As above stomach acid is not neccessarily caused/fully connected to the degree of kidney function. It can also be a symptom of a pancreatitis inflammation. Sometimes with high values they crash and there is not always a pinpoint explaination for why at that particular point, sometimes it's just the breaking point for an overloaded body.

Rant away if you need to
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  #430  
Old November 6th, 2010, 01:22 AM
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HI,
I just wanted to check in with one question, ok two.

Blue was diagnosed with early CRF in August of this year. The vet put him on Sub_Q's and gave him some pain medicine at first, as she said he also had pancreatitis, and he may need the pain meds to eat. For the last two months he has been eating low phos healthy food, with the very occasional can of something tasty and bad that he will eat when he is super fussy. He also has 100ml of Sub-Q twice a week.

I am wondering if everything seems to be going ok (happy, not losing weight, not dehydrated, not throwing up, etc), how often should I take him in for blood work. 3 months? 4 months? 6 months? I obviously want to make sure he is well taken care off, but he hates going to the vet, and I hate paying the bills!

And secondly, I have been getting Sub-Q supplies from the vet, mostly cause I had a credit from when I took back the prescription food that Blur wouldn't eat. My Pharmacist said he could order it in what ever I need, and I am sure it would be cheaper than the vet, but I think buying on line is a good choice. Does anyone have a site they would recommend?

Oh, one final thing. Last month I finally joined the "been stabbed" club. Silly Sub-Q needles!!

Thanks,
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  #431  
Old November 6th, 2010, 02:47 AM
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Hi Blur's Mom good to hear things are going well for Blue

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Originally Posted by Blur's_Mom View Post
I am wondering if everything seems to be going ok (happy, not losing weight, not dehydrated, not throwing up, etc), how often should I take him in for blood work. 3 months? 4 months? 6 months? I obviously want to make sure he is well taken care off, but he hates going to the vet, and I hate paying the bills!
For a CRF cat a vet visit with blood & urine work every three months is pretty standard when there are no obvious new issues (I think everyone hates those bills )

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Originally Posted by Blur's_Mom View Post
And secondly, I have been getting Sub-Q supplies from the vet, mostly cause I had a credit from when I took back the prescription food that Blur wouldn't eat. My Pharmacist said he could order it in what ever I need, and I am sure it would be cheaper than the vet, but I think buying on line is a good choice. Does anyone have a site they would recommend?
Absolutely somewhere other than the vets would be cheaper, your local pharmacy can definately order in for you. Not sure where in BC you are, I'm in the lower mainland and was ordering from Grant @ Pacific Health Care they are listed with www.felinecrf.org as a supplier for CRF cats, so mention that if you contact them. There is no minimum order, shipping cost is minimal and generally delivered within 2-3 days in the GVRD.

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Oh, one final thing. Last month I finally joined the "been stabbed" club. Silly Sub-Q needles!!
Hope it wasn't too bad/hard Happens to everyone at one point or another
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  #432  
Old November 6th, 2010, 10:37 PM
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I made an appointment on 11/11 for Tiger's second blood profile since starting fluids one month ago. I had his old vet fax over blood results from 2008. I noticed the BUN and Crea were at the top of the range then and the vet never mentioned that I should anticipate kidney issues in the future... I'm giving a copy to my new vet. Can that tell us anything about the speed of progression?? I feel bad that I didn't catch it until now but I'm glad that I took him to the vet shortly after I got him from my parents.

It's hard to tell if he has been feeling better because of the fluids or because he likes living here. My parent's got a 45lb. dog over 2 years ago and Tiger pretty much went into hiding for half a year, then only laid around in his "safe spots" and had to creep around and act stealthy or else the dog would chase him playfully. The younger kitty girl's antics are nothing compared to a crazy dog so I think he is much more comfortable here with me. He has been especially frisky the past two weeks. He is VERY into his toy bucket and digs out his favorite catnip toys at least twice a day that I witness. He has also been tackling Asha rather than letting her get him.

He has been very loud and vocal this week before and after fluids so I don't think it is related. He stays by the door if one of us isn't home yet and yowls at the door/paces around yowling at nothing... "Screaming" at me even after I've fed him, given him a treat and paid lots of attention to him. I can't figure out what he wants!! Could be just be acting old and confused? He turns 14 this month.
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Old November 7th, 2010, 01:15 AM
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I made an appointment on 11/11 for Tiger's second blood profile since starting fluids one month ago.
If it's not included in this blood test already, ask them to test Tiger's T4 (thyroxine) thyroid hormone level. May be included already, may be an extra charge. HyperThyroidism is common in older cats 14 years & up.

Keep us updated on the results when they come in

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Can that tell us anything about the speed of progression?? I feel bad that I didn't catch it until now but I'm glad that I took him to the vet shortly after I got him from my parents.
There are no set progression timelines , there are different stages to the diesease but no two animals are going to progress at the same rate even if they had identical values.

Many vets will take the wait & see approach & only treating when symptoms arise.

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Originally Posted by tigerbee View Post
He has been very loud and vocal this week before and after fluids so I don't think it is related. He stays by the door if one of us isn't home yet and yowls at the door/paces around yowling at nothing... "Screaming" at me even after I've fed him, given him a treat and paid lots of attention to him. I can't figure out what he wants!! Could be just be acting old and confused? He turns 14 this month.
Sounds like quite the character

Could be natural aging, could be high Thyroid levels - was his T4 level checked on the blood tests?, could be he wants/expects something specific & you gotta figure out what it is .

How are his litterbox habits? Any straining/non-productive attempts/too frequent trips?
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  #434  
Old November 7th, 2010, 12:13 PM
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His T4 was 1.7 (ref 0.5 - 4.7) last month.

His litterbox habits are good although he was used to using an enclosed box and we have a second that is a little shallower that he lifts too high in sometimes and spills over the edge.. He does urinate more frequently and in a higher volume than Asha.
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Old November 7th, 2010, 07:13 PM
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Absolutely somewhere other than the vets would be cheaper, your local pharmacy can definately order in for you. Not sure where in BC you are, I'm in the lower mainland and was ordering from Grant @ Pacific Health Care they are listed with www.felinecrf.org as a supplier for CRF cats, so mention that if you contact them. There is no minimum order, shipping cost is minimal and generally delivered within 2-3 days in the GVRD.
Thanks Growler. I checked the www.felinecrf.org page for info on where to get supplies, and it looks like Pacific Health Care will be the best bet for me too. I am in Victoria, so I am sure shipping won't be too big an issue. Even if it is a few extra bucks their prices are less than half what my vet charges. It will be worth checking with my pharmacist too.


Blur's mom
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Old November 7th, 2010, 10:51 PM
Squeakypig Squeakypig is offline
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Casper had kidney failure

Hi Growler.

I maintained my cat, Casper for two years after he was diagnosed with kidney disease in 2007. A serious kidney infection that almost took his life there and then resulted in one kidney damaged so bad that it shrank to half size. The other kidney was also compromised, just not as bad. Casper was given less than six months but I worked with him day in and day out and managed to nurse him through two years. Fluid build-up around his lungs and heart finally forced me to put him down but he enjoyed a reasonable quality of life up to then.

So, you have time yet!

From my experience, this is what you need to do and watch for:

1. Don't worry about holistic food. Just start your cat on the special reduced protein food your vet has recommended. The protein must come down because it will damage the kidneys even more and negate any benefit that you might have hoped for from the holistic food.

2. Get your vet to prescribe Epikitin. This is a natural supplement that you sprinkle over the cat's food. The cat won't mind it at all. What Epikitin does for the cat is bind up the excess phosphate so that it passes with the urine. It works really well! Those high counts will drop in about four to six weeks.

3. Check your cat's gums regularly. The gums should be nice and pink. If they go pale or creamy coloured then the cat probably has anaemia. It will happen because, and I didn't know this before, red blood cell production in bone marrow is regulated by the kidneys! As the kidneys weaken, anaemia becomes a problem.

4. Your cat is sixteen so I assume it sleeps a lot, even for a cat! None-the-less, watch for lethargy. It is another sign of anaemia for one thing but, it can also indicate other problems settling in. You cat's immune system may be compromised because of the kidney issue so, you must remain vigilant.

5. If your cat does become anaemic, it will have trouble keeping warm. I bought a heating blanket for the bed and left it on a medium-low setting all day long. When Casper felt cold which was pretty much always, he curled up on the bed in his own favourite blanket and the heating blanket warmed him up from below! It was the best money I spent in the whole affair.

6. Encourage lots of water intake. Put bowls of water everywhere! Leave water in cups. Buy one of those water fountains. The ones with falling water are best as the water tinkling sound will put drinking into the cats head! Another trick is to buy a Beta fish and put it in a fish bowl with an openning just big enough for the cat to poke his head through. Casper loved drinking the water from the fish bowl! (See the attachment)

7. Eventually, you will have to supplement your cat's fluid intake. The vet will show you how to administer subcutaneous injections of Ringers or Saline under the scruff on the cat's back. I did this every couple of days towards the end. Casper would look like a little camel with a big hump full of Ringers on his back! Also, my apartment looked like a little hospital ward with the bag of Ringers Lactate hanging from the chandelier! It was great conversation piece.

8. Much later I was introduced to a syringe that was designed for the purpose of hand-watering small animals. It looked like a regular syringe, about 100cc I think but, instead of a needle it had a tapered curved end moulded into the plastic body of the syringe. You could put the curved end into the cat's mouth even if the mouth was closed. You just wiggle the tapered end in between the moistened lips and once in, you slowly squirt the water into cat's mouth. They swallow it! It takes a bit of practice as you have to learn to allow the cat time to breathe, smack its lips and so forth. Ask the vet about this thing! It will reduce the need for poking your cat in back with a big needle. You'll both be happier.

9. If the kidney disease progresses, be prepared for what will come. Your cat will slowly waste away. No amount of love or encouragement will stop this but you sure can slow it down! So, be prepared for a long, slow, progressive weight loss.

10. Blood work will become something of a routine that your cat will come to hate, vehemently!

11. I spent a lot of time snuggling with Casper, especially in the final six months. He liked to snuggle because it kept him warm and he seemed to be at ease when we sat together. Find a good snuggle chair and spend time watching TV or reading with your cat. It is very rewarding.

Cheers,

Squeakypig
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  #437  
Old November 8th, 2010, 01:27 AM
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Quote:
Originally Posted by tigerbee View Post
His T4 was 1.7 (ref 0.5 - 4.7) last month.
Ah excellent! No need to re-test this one then, since it was done not long ago

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Originally Posted by tigerbee View Post
His litterbox habits are good although he was used to using an enclosed box and we have a second that is a little shallower that he lifts too high in sometimes and spills over the edge.. He does urinate more frequently and in a higher volume than Asha.
Good that he's not showing any signs of litterbox issues other than missing occasionally.
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  #438  
Old November 8th, 2010, 01:34 AM
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Thanks Growler. I checked the www.felinecrf.org page for info on where to get supplies, and it looks like Pacific Health Care will be the best bet for me too. I am in Victoria, so I am sure shipping won't be too big an issue. Even if it is a few extra bucks their prices are less than half what my vet charges. It will be worth checking with my pharmacist too.


Blur's mom
When you contact PHC ask for Grant, he's the sales rep I dealt with & he is wonderful
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  #439  
Old November 8th, 2010, 02:05 AM
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Originally Posted by Squeakypig View Post
Hi Growler.

I maintained my cat, Casper for two years after he was diagnosed with kidney disease in 2007. A serious kidney infection that almost took his life there and then resulted in one kidney damaged so bad that it shrank to half size. The other kidney was also compromised, just not as bad. Casper was given less than six months but I worked with him day in and day out and managed to nurse him through two years. Fluid build-up around his lungs and heart finally forced me to put him down but he enjoyed a reasonable quality of life up to then.

So, you have time yet!
Hi Squeakypig, thank you for your story & tips. This thread was actually started in 2007, I lost my CRF girl Duffy in April 2010 to Lymphoma after 3 years of successfully managing kidney failure with homeopathy, raw food, fluids & lots of love.

Quote:
Originally Posted by Squeakypig View Post
From my experience, this is what you need to do and watch for:

1. Don't worry about holistic food. Just start your cat on the special reduced protein food your vet has recommended. The protein must come down because it will damage the kidneys even more and negate any benefit that you might have hoped for from the holistic food.
Since the 2007 recalled tainted vet food was the cause of her kidney failure, there was no way I would've even considered feeding anything from the same manufacturer to my girl.

The reduced protein theory is outdated & not always a good idea especially in the early stages since cats are obligate carnivores & need meat protein to maintain muscle mass, stave off anaemia and it may also be contra-indicated when acidosis is present. More reading available here: http://www.felinecrf.org/nutritional...ts.htm#protein

Quote:
Originally Posted by Squeakypig View Post
2. Get your vet to prescribe Epikitin. This is a natural supplement that you sprinkle over the cat's food. The cat won't mind it at all. What Epikitin does for the cat is bind up the excess phosphate so that it passes with the urine. It works really well! Those high counts will drop in about four to six weeks.
Not all cats will have high phosphorus levels, my girls was middle of normal for the entire 3 years of dealing with CRF, but definately good for those who need it.

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Originally Posted by Squeakypig View Post
You just wiggle the tapered end in between the moistened lips and once in, you slowly squirt the water into cat's mouth. They swallow it!
you obviously never met my girl some cats will refuse to swallow whatever liquid it put in their mouth and either forcefully expell it or just let it dribble out , Duffy had a fighting spirit & a stubborn streak a mile wide, very tough to make her do what she didn't want .

In order for this method to work, you need to position the syringe tip near the middle or back of the mouth, with the tip opening pointing towards the cheek or lower gums. Administer fluids very slowly to allow for swallowing & not to choke the cat with too much liquid at once.

Quote:
Originally Posted by Squeakypig View Post
It will reduce the need for poking your cat in back with a big needle.
Instead of using the Monoject 18g needles from the vet, a much better choice is the Terumo Ultra Thin Wall 20g. Flow rate is the same with a smaller diameter needle, thinner walls and a super sharp beveled edge/point makes for a nearly unnoticed poke, way more comfortable than the Mj 18g mini-harpoons.

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Originally Posted by Squeakypig View Post
be prepared for a long, slow, progressive weight loss.
Not if you feed a high quality protein diet. You can have good quality meat protein with reduced phosphorus levels and have the cat maintain weight. My girl was raw fed for 2.5 of the 3 years she dealt with CRF, there was no increase in blood phos, calcium or protein, she maintained weight and had fairly even stage 2 BUN & cre numbers. My vets were always delighted with her maintaining weight, in fact she did gain about 1/2 pound at one point. The only weight loss she had was as a result of lymphoma near the end.

Quote:
Originally Posted by Squeakypig View Post
10. Blood work will become something of a routine that your cat will come to hate, vehemently!
Not always, alot depends on the temperment of the cat & how good your vet is. My girl quite enjoyed going to see her homeopath & homeopath vets, for her blood work was no big deal. Duffy's homeopath called her a miracle kitty for coming through so strong after the toxic food recall of 2007
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  #440  
Old December 7th, 2010, 02:18 PM
nemesis nemesis is offline
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Haven't updated in a while since I've been super busy.

Things have been ok for about a month, then on Saturday Smokey started feeling sick again, and I'm really worried. On Saturday he threw up once in the early afternoon, it looked like it was mostly hair and partially digested food. Then, later around 8pm he vomited some clear white foam.

The next day, Sunday, he had very little appetite, and only nibbled at his wet food a little, although he still had some appetite for treats and ate quite a few.

On Monday I took him to the vet. They took blood, and kept him there for a few hours. While he was there, he apparently had a bad bout of diarrhea, although he hadn't had any at home. The blood work came back ok, his Creatinine was at 228, which isn't bad, so the vet figures that's not responsible for how he's feeling. The vet said that the vomiting, not eating, and diarrhea suggests stomach irritation, so they sent Smokey home with some paste that is supposed to soothe his stomach, I believe it's called Progut (I think it's also known as Diarsanyl). They gave him one dose at the clinic, and gave us instructions to give him another in the evening, and to do that for a few days. Finally, they also gave him an anti-nausea shot.

When he came from the vet Monday afternoon, Smokey was in a better mood than he'd been the last few days, and actually seemed to be asking for food. I gave him some wet food and he had some, although much less than he would at a normal meal. He also ate a bunch of treats. However, after that, he barely had anything to eat the rest of the day except for a few treats. He also didn't respond very well to the paste and tried to spit it out, or would just sit there and drool so that it would come out.

The vet's instructions were to give him the paste and see how he did, and to call back and let them know on Tuesday, ie, today.

So this morning Smokey was not interested in eating anything except a handful of treats, which is worrying.

Aside from his appetite, his behaviour is definitely "off" but not that bad. He still walks around and jumps up on the couch and the bed, etc. He's been prone to hiding since he got back from the vet, but that seems to be mostly because he gets really annoyed every time we take him there and they do annoying stuff like take blood and make him eat weird paste he doesn't like. I say this because I saw him walking around and hanging out in his usual spots and then bolted under the couch when he saw me approach him.

So I'm not sure what to do at this point. I called the vet to let them know there hasn't been any change from yesterday and the nurse just said maybe we could try giving him his fluids a day early (tomorrow would be the day otherwise) to see if he's dehydrated. Otherwise she said she doesn't know what else to do. This is confusing because the doctor made it sound like we should give an update and then some new plan of action would be formulated. I mean shouldn't we investigate further if he's not getting better? For example, he was better after getting from the vet, so perhaps the anti-nausea shot helped, in which case, shouldn't that be investigated? I suspect the nurse didn't really understand, or may have not discussed Smokey's case with the doctor. In any case, I'm going to call back in a couple hours and ask to rely my questions to the doctor.

In the meantime, I'm trying to think of what I should do to get Smokey to eat, or what could have caused this. I tried lots of different types of food, and tried adding some tuna water to make it more appetizing. I tried Hills A/D food which he ate last time he refused to eat anything. I tried finding baby food but none of my local groceries have flavours without spices or tons of other ingredients I'm not sure about in them. I also wonder if one reason he's not eating is that he still feels upset about being taken to the vet and just needs to relax a bit, which makes me wonder if I should give him his fluids and stuff now, or leave him alone for a while?

Any thoughts? Thank you!
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Old December 9th, 2010, 01:08 AM
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Ask your vet about using Zantac for the nausea, they will need to give you the correct dosage based on weight. When Duffy was in the e-vet this is what they used with good results.

Is Smokey usually a hairball thrower? Is is possible he still has some hair left that needs to come out? If so you can give him a 1/4 tsp of butter to lick, that will help smooth things out, may get him interested in food again too.

What are his poops like right now? Okay or dry?

Duffy would vomit abit of white foam when she was trying to pass a particularily dry poop or if she went too long with nothing in her stomach so I made sure she had a snack at bedtime.

Sounds like he's running/hiding from you right now cuz you keep giving him the yucky tasting stuff

You can try a 1/4 teaspoon of Slippery Elm Bark powder in his food, just be sure to mix in a teaspoon or 2 of water in as well This will also coat the stomach & intestinal tract, he may respond better to the flavour of it.

Have you tried bit of parmesan cheese, pinch catnip, warming the food, bits of roast or bbq chicken, crushed treat, dab of melted butter on top?

I would give the fluids early if you think he needs it, there is no rule that says the schedule can't be altered if need be.

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  #442  
Old December 18th, 2010, 02:59 AM
nemesis nemesis is offline
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Smokey is feeling much better now. He wouldn't eat at all so we resorted to syringe-feeding for a few days. He was relatively (and mercifully) cooperative. The vet did several tests and nothing out of the ordinary was found, so the current hypothesis is that one of, or the combination of his medications was making him feel sick and nauseous.

So the plan is to take him off the meds for a short period, and then gradually reintroduce them one by one.

It seems to make sense, because although syringe-feeding did *slightly* revive his appetite, his interest really started to come back a couple of days after stopping the meds. Of course, this doesn't actually prove that there's a causal relationship...the two events just followed each other in time. But I think it's a reasonable avenue to pursue.

It's tricky though, I'm starting to appreciate how difficult it must be for vets to diagnose and treat patients who can't speak! It's really like detective work.

Anyway, Smokey is eating again, although he is being very picky about what he will and won't eat. This might be a result of the way we treated him when he wouldn't eat, which was to be extremely indulgent just to get him to eat *something*. He seems like he really expects to get treats all the time, so I have to get him used to the idea of eating normally again.

His poops looking good and normal after a short bout of diarrhea.

Essentially, he's not acting sick anymore, but there does seem to be some kind of (recurring?)issue with nausea/acid/indigestion that is eluding us. Whether it's just a side effect of the kidney disease that has its up and downs, the vet's too many meds theory, or a separate gastrointestinal issue (IBD was briefly brought up but the vet hasn't spoken much about it yet), I have no idea. We're working on it though. In the meantime, I'm at least happy that his blood work is pretty stable and he's being a very good boy about his fluids.
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  #443  
Old December 30th, 2010, 12:55 AM
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Good to hear Smokey has been feeling better, hope that has continued

Unfortunately nausea is quite common in kidney cats, sometimes as a result of too much stomach acid & other times it can be from a combination of things including the meds.

It's always best to restart meds one at a time to make it easier on the tummy and also helps to point to which one may be the issue.
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  #444  
Old February 4th, 2011, 05:40 PM
PMFan PMFan is offline
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when to start Sub Q Fluids

how do i know when it's time to start sub q fluids?

i have two with CRF

female 17yo CREA is 2.7 and holding steady for a year w/ no intervention

male 16.5 yo CREA is up to 3.5 from 2.7 six months ago
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Old February 5th, 2011, 02:25 AM
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how do i know when it's time to start sub q fluids?

i have two with CRF

female 17yo CREA is 2.7 and holding steady for a year w/ no intervention

male 16.5 yo CREA is up to 3.5 from 2.7 six months ago
One indication is when you see a significant consistant increase over time of the amount of water consumed per day.

How much water are they drinking per day? Can you pour a measured amount in the water bowls, write it down, then re-measure after 24 hrs, write that down. I would do this once a week for a few weeks to get a clear view how much they are drinking.

If the cat is showing consistant signs of dehydration ie: pinch test, drinking more, feeling grouchy/not themselves.

Some vets will wait until there is 2-3 tests (showing consistant numbers) with the cre between 3.5-4. Many will base the decision of when to start on a combination of the numbers & physically how the cat feels. There is no strict guidelines since every cat will be different, some are better able to use the water they are drinking to combat dehydration even with higher numbers.

When I started Duffy on fluids the amount she was drinking had increased noticably in the three months since her previous exam/test, and her cre was at 3.03 up from 2.45 - the decision to start her on fluids was actually made before the vet & I got the results of that test back.

Have a chat w/the vet see what their opinion is on how both Rachel & Max are dealing with hydration, if there are any personality changes (more grumpy than usual, not sitting in a favorite place/interacting as much w/you or each other anymore etc) and see when they have recommended starting fluids for other CRF clients.

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  #446  
Old February 5th, 2011, 10:41 AM
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I agree with growler's comments about discussing it with your vet and that individual cats may have different requirements for fluids. One of my vet's guidelines is to consider fluids if the cat starts losing weight (which can indicate dehydration and loss of appetite).
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  #447  
Old February 7th, 2011, 08:39 PM
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thanks for the feeback/suggestions!

we have 3 cats so i'd have to quarantine them to get an accurate fluid intake measurement.

max has been on the lethargic side even before his numbers were elevated. he did seem more a little more alert after his dental which included IV fluids.

to me, the pinch test seems to indicate both are fairly well hydrated.
Quote:
Originally Posted by growler View Post
Can you pour a measured amount in the water bowls, write it down, then re-measure after 24 hrs, write that down. I would do this once a week for a few weeks to get a clear view how much they are drinking.

If the cat is showing consistant signs of dehydration ie: pinch test, drinking more, feeling grouchy/not themselves.

Some vets will wait until there is 2-3 tests (showing consistant numbers) with the cre between 3.5-4. Many will base the decision of when to start on a combination of the numbers & physically how the cat feels.

Have a chat w/the vet see what their opinion is on how both Rachel & Max are dealing with hydration, if there are any personality changes (more grumpy than usual, not sitting in a favorite place/interacting as much w/you or each other anymore etc) and see when they have recommended starting fluids for other CRF clients.
max has been gradually losing weight for the past 3 years. he is down to 12# from 16#. he eats well if it's a food he likes. he is on both (non-CRF) canned and dry food. he loves raw turkey and liv a littles dehydrated chicken treats.
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One of my vet's guidelines is to consider fluids if the cat starts losing weight (which can indicate dehydration and loss of appetite).
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  #448  
Old February 8th, 2011, 02:11 AM
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Quote:
Originally Posted by PMFan View Post
thanks for the feeback/suggestions!

we have 3 cats so i'd have to quarantine them to get an accurate fluid intake measurement.

max has been on the lethargic side even before his numbers were elevated. he did seem more a little more alert after his dental which included IV fluids.

to me, the pinch test seems to indicate both are fairly well hydrated.
Ah I didn't know you have 3 kits, that may make quarantine a bit more interesting/difficult/(and depending on the cats) possibly stressful, to get a reading from each cat. If that wouldn't reasonably work, even measuring what all 3 combined drink in a 24hr period while not separating the cats would give an indication when there is an increase. That wouldn't tell you who but you might also notice a behaviour change that would tell you which one it most likely is.

Do you also have the BUN/Urea and phosphorus numbers for both cats?

When was the dental done? With the test 6 months ago or just recently with this latest test?

Quote:
Originally Posted by PMFan View Post
max has been gradually losing weight for the past 3 years. he is down to 12# from 16#. he eats well if it's a food he likes. he is on both (non-CRF) canned and dry food. he loves raw turkey and liv a littles dehydrated chicken treats.
Are you adding a teaspoon or two of water to Rachel & Max's canned food? I would recommend it if you aren't already, this will provide a little extra moisture with slightly longer time to absorb because it's mixed into food. It's also recommended for all cats since they do drink so little & most of their moisture comes from canned food (unless fed a strictly dry diet which is not recommended for any cat).

How is Max with eating a canned he may not be particularily fond of but is dressed up w/treats in the food?

You can also always add a "treat time" to your day like before bed or something where they get a couple of teaspoons of raw turkey or canned food or some treats.

Kidney cats have a tendency to lose weight and also not want to eat because they don't feel well/no energy, they have no appetite/nauseous, etc so it's always good to encourage them to eat even if that means adding treat toppings to their meals.

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  #449  
Old February 8th, 2011, 09:02 PM
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both had dental in Jan 2011. max has 2 extractions.

below are the blood work results for both from the monday prior to friday dental. w/ previous for reference. i plan to start having BW done every 4 months.


RACHEL - JAN 11 / AUG 10 / OCT 09 [REF RANGE]
BUN 46 / 39 / 45 [14-36]
CREA 2.7 / 2.7 / 3.2 [.6-2.4]
PHOS 4.8 / 4.7 / 4.2 [2.4-8.2]


MAX - JAN 11 / AUG 10 / NOV 09
BUN 49 / 32 / 40 [15-34]
CREA 3.5 / 2.5 / 2.4 [.8-2.3]
PHOS 4.5 / 4.1 / 4.5 [3.0-7.0]
LYMPH 10 / 5 / 20 [20-55]
URINE PRO/CREAT RATIO IS 0.2
URINE RBC 6-10 [0-5] - i just noticed -- blood in his urine - vet didn't mention this ... she said his P/C ratio was .2 = normal? even tho the report from the lab shows .2 is borderline proteinuric

yes, i add water to canned.

i am going to buy some bonita flakes to see if that will encourage max to eat more. he won't eat more when i sprinkle the liv a littles (go figure?)
Quote:
Originally Posted by growler View Post
If that wouldn't reasonably work, even measuring what all 3 combined drink in a 24hr period while not separating the cats would give an indication when there is an increase. That wouldn't tell you who but you might also notice a behaviour change that would tell you which one it most likely is.

Do you also have the BUN/Urea and phosphorus numbers for both cats?

When was the dental done?

Are you adding a teaspoon or two of water to Rachel & Max's canned food? this will provide a little extra moisture with slightly longer time to absorb because it's mixed into food. It's also recommended for all cats since they do drink so little & most of their moisture comes from canned food (unless fed a strictly dry diet which is not recommended for any cat).

How is Max with eating a canned he may not be particularily fond of but is dressed up w/treats in the food?

You can also always add a "treat time" to your day like before bed or something where they get a couple of teaspoons of raw turkey or canned food or some treats.

Kidney cats have a tendency to lose weight and also not want to eat because they don't feel well/no energy, they have no appetite/nauseous, etc so it's always good to encourage them to eat even if that means adding treat toppings to their meals.
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  #450  
Old February 10th, 2011, 03:51 AM
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Quote:
Originally Posted by PMFan View Post
both had dental in Jan 2011. max has 2 extractions.

below are the blood work results for both from the monday prior to friday dental. w/ previous for reference. i plan to start having BW done every 4 months.


RACHEL - JAN 11 / AUG 10 / OCT 09 [REF RANGE]
BUN 46 / 39 / 45 [14-36]
CREA 2.7 / 2.7 / 3.2 [.6-2.4]
PHOS 4.8 / 4.7 / 4.2 [2.4-8.2]


MAX - JAN 11 / AUG 10 / NOV 09
BUN 49 / 32 / 40 [15-34]
CREA 3.5 / 2.5 / 2.4 [.8-2.3]
PHOS 4.5 / 4.1 / 4.5 [3.0-7.0]
LYMPH 10 / 5 / 20 [20-55]
URINE PRO/CREAT RATIO IS 0.2
URINE RBC 6-10 [0-5] - i just noticed -- blood in his urine - vet didn't mention this ... she said his P/C ratio was .2 = normal? even tho the report from the lab shows .2 is borderline proteinuric
Bloodwork is definately recommended every 3 or 4 months for kidney cats allows you to keep on top of any changes. Here is a spreadsheet to help track all the changes in bloodwork, just change the Reference Range values to match the ones the lab your vet uses. Chronological Lab Results in Excel Spreadsheet

Both phos numbers are good, Max does have a decrease in Lymphocytes which can be an indication of inflammation/infection. Rachel's BUN & Crea are not too bad, Max's I'd look into the urine RBC (see below) first before going to fluids, but they'd be on my list to speak to the vet about.

Has the vet mentioned Azodyl? Something to discuss with him/her, I had good results lowering both BUN & Crea with it.

Some vets will consider anything less than 0.5 Urine P/C ratio to be normal. I've also noticed many vets will not mention/not be too concerned about 1 borderline test but will wait until it's either consistantly out of range unless it's a big jump.

There is some talk about the benefits of supplementing Omega3 fatty acids to help reduce proteinuria, though the claims are unproven at this point. A small amount of say pure salmon oil or capsules may be helpful if you've noticed a dryness to Max's coat or if he's having hard dry poops.

Any WBC in the urine?

Have you noticed smaller than normal pee deposits in the litterboxes? (I realize this may be harder with 3 cats) Is Max showing any signs of frequent trips to the litterbox? Straining? Any peeing outside the box?

My I would have Max back into the vet for a cystocentisis, run a urinalysis with a note to the lab "culture if indicated", this will tell them to go ahead with a culture & sensitivity if there is the presence of bacteria without waiting for permission.

Male cats have a smaller urethra opening than girls do & are therefore more prone to complications with urinary crystals/stones. Rechecking the urine will allow for another look at the RBC count, urine pH & if any crystals or stones have developed.


Quote:
Originally Posted by PMFan View Post
yes, i add water to canned.

i am going to buy some bonita flakes to see if that will encourage max to eat more. he won't eat more when i sprinkle the liv a littles (go figure?)
Excellent

Ah those cats they can be picky eh?

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