Early Stage Kidney Failure in Cat

[growler~GateKeeper]

brewerk sounds like things are going great

Many many for the coming test results

[mikischo]

Growler, sorry for not replying sooner.

Since you've read the thread I guess you can tell I don't follow the low protein theory being that Duffy is raw fed .

I have never tried raw feeding although I have considered it. It always seemed so complicated, for one thing and I guess I wasn't sure if it was the way to go. I have given Mickey small pieces of raw chicken or steak from time to time over the past couple of years (for a treat), when we were cooking it for ourselves and he actually loved it, especially the chicken (he much prefers the raw to the cooked). He would likely have been fairly easy to convert to raw feeding, but since his last crisis that brought his numbers up so high, it has been a challenge just to make sure he eats enough of anything, so this is not the time to try to make any drastic food changes.

An interesting thing is, back in late January when I took him in to be treated for constipation and dehydration, his creatinine on admittance was 282 (reference range 71 - 212). At that time I let the vet convince me to try him on their prescription low-protein diets. He turned up his nose at every one of them except Medi-Cal reduced protein. He actually liked that one and ate it with gusto for the next several weeks until he went into crisis on March 8 with another bout of constipation and dehydration. This time his creatinine on admittance was 489 and, even after being on 5 days of IV fluids followed by sub q's at home, has been bouncing between 369 and 592 ever since. I can't say I would go so far as to blame the low protein diet for his sudden and rapid decline in health, but it does seem like a strange coincidence that he went downhill so rapidly after changing his diet.

Right now he is still eating some Medi-Cal because it is one of the few things I can get him to eat. I am also now giving him Wellness beef and chicken formula and he has been eating a bit of that every day lately. Trying to slowly move him to eating more of it and less of the Medi-Cal. I also have been giving him lightly boiled chicken thighs and sometimes I give him a little of it raw as well. Between those three things he manages to eat enough to sustain himself. When I first brought him home from the hospital it was a struggle to get him to eat anything at all. Even now I have to take the food to him to make sure he eats enough each day.

Thanks for the info on the comparisons between the LRS and sodium chloride solutions. It helped to reinforce that I am on the right track by working out the 3 to 1 LRS and sodium chloride compromise with the vet. Mickey's calcium levels were 2.45 (reference range 1.95 to 2.83) when they were last tested so still well within normal as well as the potassium being still at a safe level. If we can keep things going (am taking things one day at a time right now) I plan on getting a full blood chemistry done again in about 2 weeks (will then be 5 weeks since the last one) so that will determine where we go from there.

Are you getting your fluids, lines & needles from the vet? You can purchase these from any pharmacy usually much cheaper. I purchase from a medical supply company locally. What needles are you using? I and many other CRF parents prefer the Terumo Ultra Thin Wall 20 gauge, the flow rate is about the same as the 18g regular ones from the vet but the actual poke is hardly felt due to the thinner walls & sharper beveled edge & tip.

My vet charges $19 per bag of fluids. I had started looking for other sources. After reading your post I decided to check around in earnest and found I can get them from Stevens Home Medical Supplies Store for $4.15 a bag. Wow, what a difference. I can also get the needles and lines from them. They have warehouse locations in several cities and they will also ship, although I don't know what the shipping charges would be (I can pick them up here myself). Here is the link in case someone else might find it useful:

http://www.stevens.ca/generic.htm?ECINFO=LOCATIONS.

I started out using the Terumo Thin Wall (not Ultra) 18 gauge which is what the vets here use in their practice. I did recently switch to the 20 gauge Terumo Ultra Thin Wall which the vet also carries and you are right - Mickey doesn't even seem to feel the poke. I will now be buying these much more cheaply from Stevens.

I am now giving Mick lactulose regularly as needed to prevent constipation (with his high numbers another episode would likely pull him over the edge). I am also giving him probiotics (acidophilus from the health food store) once or twice a day as well as B complex and B12. I find the Holistic route you have taken quite interesting and it seems to be working very well for Duffy. If we can pull out of this recent crisis and stabilize things a bit (consistent creatinine levels in the high 300's or even low 400's would make me very happy at this point) I might consider looking into that myself. My regular vet, like most, is very "by the book" in treating renal failure. She has a 17 year old cat who is in early CRF and she has her on the prescription renal diet, so she really believes in it.

I still plan on starting my own thread (didn't get it started last weekend). Mickey has so many issues going on right now and I have so many questions that I really need to get my own thread going.

Thanks again for your response and for sending the our way.

[growler~GateKeeper]

Originally Posted by mikischo

I can't say I would go so far as to blame the low protein diet for his sudden and rapid decline in health, but it does seem like a strange coincidence that he went downhill so rapidly after changing his diet.

Muscle wasting can and does make a large impact on the blood creatinine levels as cre is a by product of muscle. If he hasn't been eating enough or enough protein to keep up the strength in the muscles it could make an impact in 2 months time. Dehydration can also play a role here.

Originally Posted by mikischo

When I first brought him home from the hospital it was a struggle to get him to eat anything at all. Even now I have to take the food to him to make sure he eats enough each day.

Have you had a look at this page: http://www.felinecrf.org/persuading_cat_to_eat.htm

Originally Posted by mikischo

My vet charges $19 per bag of fluids. I had started looking for other sources. After reading your post I decided to check around in earnest and found I can get them from Stevens Home Medical Supplies Store for $4.15 a bag. Wow, what a difference. I can also get the needles and lines from them. They have warehouse locations in several cities and they will also ship, although I don't know what the shipping charges would be (I can pick them up here myself). Here is the link in case someone else might find it useful:

http://www.stevens.ca/generic.htm?ECINFO=LOCATIONS.

I started out using the Terumo Thin Wall (not Ultra) 18 gauge which is what the vets here use in their practice. I did recently switch to the 20 gauge Terumo Ultra Thin Wall which the vet also carries and you are right - Mickey doesn't even seem to feel the poke. I will now be buying these much more cheaply from Stevens.

Amazing the difference eh?

Sounds good I'm paying $5.15/bag with a different local company Pacific Health Care. PCH ships also, their cost is just under $6 for either same or next day courier delivery from the next city over.

Originally Posted by mikischo

I am now giving Mick lactulose regularly as needed to prevent constipation

Are you adding a teaspoon or 2 of extra water in Mickey's food? I found that helped when Duffy was eating canned.

Have you tried Salmon oil? Duffy is getting a pump of Grizzly Salmon oil twice a day, it's been wonderful for her.

How much fluids are you giving? How much in total per day? Has your vet mentioned a change to the schedule/volume to help combat the dehydration & constipation?

[mikischo]

We have had some ups and downs in the past 10 days since my last post. I made several attempts to reply to your post but somehow couldn't get my thoughts together to finish it so here goes again.

Originally Posted by growler

Muscle wasting can and does make a large impact on the blood creatinine levels as cre is a by product of muscle. If he hasn't been eating enough or enough protein to keep up the strength in the muscles it could make an impact in 2 months time. Dehydration can also play a role here.

Mickey is definitely showing signs of muscle wasting in the hind end and legs, walks more slowly since becoming so ill in March and often limps quite noticeably and is otherwise showing signs of weakness (has increasing difficulty going up and down stairs). He has had arthritis for the past 3 years or so; therefore it is hard to know what problems are attributable to a worsening of the arthritis and what are related to the CRF and anemia (his PCV was only 18% when his last blood work was done four and a half weeks ago but up from 17% two weeks prior. The anemia is a major concern).

Originally Posted by growler

Have you had a look at this page: http://www.felinecrf.org/persuading_cat_to_eat.htm

That is an excellent website and everyone who has a CRF cat would benefit greatly from reading it. Thanks for pointing it out. I had come across it previously and have used several of the suggestions over the past couple of months. I have done some syringe feeding of Hill's AD when his appetite was at its worst and he was turning away from everything I offered him. I raised his water dish a couple of years ago because I thought it might be easier for him to drink with his arthritis. I now keep his food dishes raised as well. I also offer him food frequently when I am at home because he eats very little at one time. His taste changes frequently so I have a small variety of things to offer him (if he turns up his nose at one thing he may accept another at any given time). Lots of food gets wasted this way but what can you do? I took him to the vet yesterday and the good news is that he weighs the same as he did 4 weeks ago. I was pleasantly surprised as I fully expected some substantial weight loss because of his eating issues. Guess these frequent feedings are working.

Originally Posted by growler

Are you adding a teaspoon or 2 of extra water in Mickey's food? I found that helped when Duffy was eating canned.?

I usually add some water but have to be careful with this because he is so finicky. Sometimes he prefers it watered down more, sometimes less, sometimes not at all.

Originally Posted by growler

Have you tried Salmon oil? Duffy is getting a pump of Grizzly Salmon oil twice a day, it's been wonderful for her.

I do have a product from the vet called Aller-G-3 which has much the same ingredients except it doesn't specify what kind of fish the oil comes from. Am having trouble giving it to him regularly though because he is so finicky and sometimes it gets wasted along with the food if he turns up his nose at it. Is there any other way to give it to him besides in his food? How do you give the oil to Duffy?

Originally Posted by growler

How much fluids are you giving? How much in total per day? Has your vet mentioned a change to the schedule/volume to help combat the dehydration & constipation?

Mickey is getting a lot of fluids already (so much it is scary). He is currently taking 100 to 150 ml twice a day (200 to 300 ml per day). Back in March when he first came off the IV fluids he was taking up to 400 ml per day for a while. I would feel more comfortable if I could taper it down further than what he is currently getting but right now he seems to need it. He is a big cat. For years he weighed about 19 lbs (wasn't all muscle) He was 13.25 lbs. when he was at his worst after his crisis in March and is now holding at 14.75 lbs for the past 4 weeks. We are still having trouble with the constipation. Last Sunday he was straining so hard that he vomited twice but managed to get a reasonable amount out and a little more the next morning. Had the same problem on Wednesday (straining followed by vomiting but at least still managing to get a fair amount out). I took him to the vet yesterday because of these issues and my concerns about the continued weakness. We are going to wait a couple more weeks before doing more blood work so all he got yesterday was an enema to completely clean him out. I need to find better ways to help regulate the bowel movements without increasing the fluids. Lactulose is proven to be quite safe for cats to take long term and I am going to give him about 2 cc's twice a day whether he goes or not and up it to at least 3 cc twice a day on the days he doesn't have a movement. I have also bought a jar of Heinz Organics Butternut Squash like you recommended in one of your posts so we'll see if that helps too. He loves the taste of it.

So at the moment my biggest concerns are the constipation and his continued weakness. As I'm sure you know, unregenerative anemia can be very serious and Epogen treatments would be very scary to have to put him through (chances of developing antibodies). Since his PCV went up slightly over a two week period I am still hopeful that we can somehow get the numbers to a safer level without having to resort to that. I have now also started giving him benazepril (Fortekor) (started with a low dose of 1.25 mg per day). He did have protein in his urine when it was tested before. Maybe that will also help with the muscle wasting and weakness.

Thanks again for your suggestions and support.

PS: I noticed Duffy celebrated her 18th birthday a few days back. Sorry I missed it at the time. Congratulations to Duffyand to her devoted owner!!! Mickey and I wish her continuing good health and many more birthdays.

[growler~GateKeeper]

Originally Posted by mikischo

Mickey is definitely showing signs of muscle wasting in the hind end and legs, walks more slowly since becoming so ill in March and often limps quite noticeably and is otherwise showing signs of weakness (has increasing difficulty going up and down stairs). He has had arthritis for the past 3 years or so; therefore it is hard to know what problems are attributable to a worsening of the arthritis and what are related to the CRF and anemia (his PCV was only 18% when his last blood work was done four and a half weeks ago but up from 17% two weeks prior. The anemia is a major concern).

Unfortunately the arthritis does make the determination of which is causing it more difficult. :sad: Will Mickey allow you to give small gentle massages to his back legs & hip areas? Helps to loosen the tension in the muscles and increase blood flow to the area, the gentle movement also helps arthritic joints - I used massage therapy on my who had arthritis in his hips & spine he showed definate improvement after the massages.

Originally Posted by mikischo

Lots of food gets wasted this way but what can you do? I took him to the vet yesterday and the good news is that he weighs the same as he did 4 weeks ago. I was pleasantly surprised as I fully expected some substantial weight loss because of his eating issues. Guess these frequent feedings are working.

You can freeze the rest of the can of food for the next time you feed that particular one. Empty the food into something like Ziploc freezable single serve containers. A while ago I asked the customer service department at Wellness if freezing their food changes the taste/nutrients etc and they said no it's fine to freeze it.

Excellent news on the weight holding steady

[QUOTE=mikischo;780422]I do have a product from the vet called Aller-G-3 which has much the same ingredients except it doesn't specify what kind of fish the oil comes from. Am having trouble giving it to him regularly though because he is so finicky and sometimes it gets wasted along with the food if he turns up his nose at it. Is there any other way to give it to him besides in his food? How do you give the oil to Duffy?

Picky eaters Duffy gets the salmon oil mixed into her raw food, she quite likes it. The salmon oil capsules I'm now of are quite large - more the size to give to a large dog, but there is another alternative, another member Sugarcatmom recommends using Slippery Elm Bark, you can try that:

originally posted by Sugarcatmom
If you can find some slippery elm bark powder (from a health food store), mixing just 1/8 to 1/4 of a tsp in with some canned food a couple times a day can help with constipation, and it's a very safe supplement. Make sure any other meds are given about an hour apart from the SEB as it can interfere with their absorption.

Originally Posted by mikischo

Mickey is getting a lot of fluids already (so much it is scary). He is currently taking 100 to 150 ml twice a day (200 to 300 ml per day). Back in March when he first came off the IV fluids he was taking up to 400 ml per day for a while. I would feel more comfortable if I could taper it down further than what he is currently getting but right now he seems to need it. He is a big cat. For years he weighed about 19 lbs (wasn't all muscle) He was 13.25 lbs. when he was at his worst after his crisis in March and is now holding at 14.75 lbs for the past 4 weeks. We are still having trouble with the constipation. Last Sunday he was straining so hard that he vomited twice but managed to get a reasonable amount out and a little more the next morning. Had the same problem on Wednesday (straining followed by vomiting but at least still managing to get a fair amount out). I took him to the vet yesterday because of these issues and my concerns about the continued weakness. We are going to wait a couple more weeks before doing more blood work so all he got yesterday was an enema to completely clean him out. I need to find better ways to help regulate the bowel movements without increasing the fluids. Lactulose is proven to be quite safe for cats to take long term and I am going to give him about 2 cc's twice a day whether he goes or not and up it to at least 3 cc twice a day on the days he doesn't have a movement. I have also bought a jar of Heinz Organics Butternut Squash like you recommended in one of your posts so we'll see if that helps too. He loves the taste of it.

So at the moment my biggest concerns are the constipation and his continued weakness. As I'm sure you know, unregenerative anemia can be very serious and Epogen treatments would be very scary to have to put him through (chances of developing antibodies). Since his PCV went up slightly over a two week period I am still hopeful that we can somehow get the numbers to a safer level without having to resort to that. I have now also started giving him benazepril (Fortekor) (started with a low dose of 1.25 mg per day). He did have protein in his urine when it was tested before. Maybe that will also help with the muscle wasting and weakness.

Thanks again for your suggestions and support.

PS: I noticed Duffy celebrated her 18th birthday a few days back. Sorry I missed it at the time. Congratulations to Duffyand to her devoted owner!!! Mickey and I wish her continuing good health and many more birthdays.

If Mickey is still having constipation issues you probably won't be able to lower the fluids right now, plus a majority of the determination of the volume of fluids needed is based on his blood test results. Try the butternut squash, and/or slippery elm bark see how that works. I found it best to freeze the amount of BNSquash needed per serving in ice cube trays then dump it into a freezer bag, that way it won't go bad in the fridge before you finish the jar

Will Mickey eat raw chicken? The next time you are cooking chicken, save a small (thumbnail or so) piece of raw meat no bone, & see if he'll eat it. If he does you can add a couple of small pieces of raw meat to his daily feedings (no more than 5-10% of his daily food intake because meat alone is not properly balanced) to provide extra nutrition & improve muscle mass.

Thank you for the birthday wishes for my grrl

[PMFan]

hello. i'm new here.

thanks for all the great information in this thread !

i'd be interested in seeing what combinations of foods, meds, etc members here are using/have used successfully. is this the thread for that or is there another?

one issue not addressed here (that i could see) is sodium content in the commericially available high quality canned cat food.

since the script varities have lower sodium content, should i also aim for lower sodium when selecting the no grain/non-script brands? if so, what % or DM numbers should I look for ?

here are details on my 15+yo cat, rachel, diagnosed May 4, 2009.

BEHAVIOR
- drinking pretty well, i've not measured qty as i have another cat
- using the litter box
- goes pee/poo outside also, from what i've seen her pee is very clear
- appears to be well hydrated based on the skin grab/release test
- playful at times
- sleeps quite a bit
- we recently have a stray moved in and she shows territorial aggression toward her. so she still has quite a bit of spunk.

DIET THEN
- previous to now
-- CANNED friskies and 9lives (now transitioning to high quality canned)
-- various dry foods - friskies, goodlife recipe (have not stopped this yet)
-- occassionaly enjoys raw/cooked chicken, cooked hamburger/steak
- treats - various

DIET NOW
- started this week feeding NV chicken mixed w/ small amt of Purina NF (to lower phos levels). after reading here, should i stopt the Purina NF?
- will try EVO venison since is lower at 146 mg phos per 100 kcal according to analysis chart
- 1 TBP/day of 2% plain fage yogurt for the good bateria
- i want to start giving probiotic and digestive enzymes - any good brands out there?
- raw/cooked chicken
- treats - various

TREATMENTS for CRF
- diet only
- conventional vet mentioned sub'q's at home at some point, has not metioned anything else, but i've not discussed CRF progression w/ him.

URINALISYS
- none done nor suggested by vet. will have them perform at followup for bloodwork.

BLOOD WORK
last 3
Oct 08 / Feb 09 / May 09 (ref range)
*indicated bold on results meaning outside normal range

CK 207/127/1033* (64-440) = this one skyrocketed=vet said prob indicates kidney damage? her potassium was high in feb which i've read can cause heart damage.

BUN 38*/38*/47* (15-34)

Creatinine 1.7/2.8*/2.7* (.8-2.3)

Phosphorus 4.9/4.2/3.9 (3.0-7.0) trending down ?

Potassium 4.3/5.8*/5.0 (3.9-5.3)

Calcium (CA) 10/9.9/9.7 (8.2-11.8)

TCO2 21/24/19 (13-25)

T4: 11.4* Oct 08 /less than 0.4* Feb 09 (0.5-5.8) (t-131 iodine treatment given in Jan 09). possibly hypothyroid? will have vet recheck blood work and T4 levels soon.

BP: taken in Dec before t-131 and ok. not taken since, will request in June

WEIGHT: was always ~10#. was down to ~7# (hyperthyroidism), after iodine trtmnt in Jan 09, is now ~9.5#

[Catzig]

We lost our beloved Siamese, Oscar, in August 2006 to CRF. During Oscar's journey with CRF, I found this site very useful ... http://www.felinecrf.com/manag0.htm (I think it may even have been mentioned in a previous post?) I referred to it often, especially when we were about to start giving sub-Q fluids at home.

Good luck Growler!

[growler~GateKeeper]

Originally Posted by PMFan

hello. i'm new here.

thanks for all the great information in this thread !

i'd be interested in seeing what combinations of foods, meds, etc members here are using/have used successfully. is this the thread for that or is there another?

Hi PMFan welcome to the board and the CRF club

It appears of all the members currently dealing with Feline CRF, I have been dealing with it longer than others, most are recently diagnosed & some have started their own threads, but anyone/everyone is welcome to post here

If you missed the thread summary it's here

As for what food/supplements I am using see Duffy's schedule here: http://www.pets.ca/forum/showpost.ph...&postcount=229

Originally Posted by PMFan

one issue not addressed here (that i could see) is sodium content in the commericially available high quality canned cat food.

since the script varities have lower sodium content, should i also aim for lower sodium when selecting the no grain/non-script brands? if so, what % or DM numbers should I look for ?

Sodium hasn't been an issue for my grrl Duffy or as yet brought up by other members, one cannot completely cut out sodium as it is still an essential electrolyte however, as with people, high levels can lead to hypertension aka high blood pressure so balance is important.

The AAFCO Nutrient Profiles for canned foods have sodium content necessary for growth & development as 0.2% DM, the prescription canned foods range from 0.16 - 0.56 % DM. The Wellness canned varieties all have a DM sodium content of between 0.2 - 0.93% with most under 0.5%.

If you are reducing the sodium content of the canned food you are feeding it should be done gradually to allow the kidneys time to adjust

Originally Posted by PMFan

here are details on my 15+yo cat, rachel, diagnosed May 4, 2009.

BEHAVIOR
- drinking pretty well, i've not measured qty as i have another cat
- using the litter box
- goes pee/poo outside also, from what i've seen her pee is very clear
- appears to be well hydrated based on the skin grab/release test
- playful at times
- sleeps quite a bit
- we recently have a stray moved in and she shows territorial aggression toward her. so she still has quite a bit of spunk.

DIET THEN
- previous to now
-- CANNED friskies and 9lives (now transitioning to high quality canned)
-- various dry foods - friskies, goodlife recipe (have not stopped this yet)
-- occassionaly enjoys raw/cooked chicken, cooked hamburger/steak
- treats - various

DIET NOW
- started this week feeding NV chicken mixed w/ small amt of Purina NF (to lower phos levels). after reading here, should i stopt the Purina NF?
- will try EVO venison since is lower at 146 mg phos per 100 kcal according to analysis chart
- 1 TBP/day of 2% plain fage yogurt for the good bateria
- i want to start giving probiotic and digestive enzymes - any good brands out there?
- raw/cooked chicken
- treats - various

TREATMENTS for CRF
- diet only
- conventional vet mentioned sub'q's at home at some point, has not metioned anything else, but i've not discussed CRF progression w/ him.

URINALISYS
- none done nor suggested by vet. will have them perform at followup for bloodwork.

BLOOD WORK
last 3
Oct 08 / Feb 09 / May 09 (ref range)
*indicated bold on results meaning outside normal range

CK 207/127/1033* (64-440) = this one skyrocketed=vet said prob indicates kidney damage? her potassium was high in feb which i've read can cause heart damage.

BUN 38*/38*/47* (15-34)

Creatinine 1.7/2.8*/2.7* (.8-2.3)

Phosphorus 4.9/4.2/3.9 (3.0-7.0) trending down ?

Potassium 4.3/5.8*/5.0 (3.9-5.3)

Calcium (CA) 10/9.9/9.7 (8.2-11.8)

TCO2 21/24/19 (13-25)

T4: 11.4* Oct 08 /less than 0.4* Feb 09 (0.5-5.8) (t-131 iodine treatment given in Jan 09). possibly hypothyroid? will have vet recheck blood work and T4 levels soon.

BP: taken in Dec before t-131 and ok. not taken since, will request in June

WEIGHT: was always ~10#. was down to ~7# (hyperthyroidism), after iodine trtmnt in Jan 09, is now ~9.5#

If you can get both your cats off dry food altogether that would be best some tips here for Transitioning Dry Food Addicts to Canned Food

The probiotic I give is PB8 1 capsule twice a day, another member Sugarcatmom likes Natural Factor's Ultimate Multi

A urinalysis should be done with every 3 month kidney blood test, the Urine Specific Gravity is an important factor especially before starting fluid therapy.

For the bloodwork:

The high CK level is often a muscle enzyme release reponse to stress see the post here I just wrote for another member: http://www.pets.ca/forum/showthread....334#post782334

Everything else looks alright for a recent diagnosis, nothing alarming but I would keep an eye on the calcium : phosphorus ratio ideally it should be around 2:1 basically meaning for a good balance between the two the calcium should be around double the phosphorus level but with both still in their respective normal ranges.

As for the HyperThyroidism, I've been through that & also went with the Iodine therapy, it is not unusual for the T4 to be hypo for several months after 131 treatment - Duffy took close to a year before her level came back up to normal range. There is a HyperT thread here if you wish to go more into that

Great news on Rachel gaining some weight back

Originally Posted by Catzig

We lost our beloved Siamese, Oscar, in August 2006 to CRF. During Oscar's journey with CRF, I found this site very useful ... http://www.felinecrf.com/manag0.htm (I think it may even have been mentioned in a previous post?) I referred to it often, especially when we were about to start giving sub-Q fluids at home.

Good luck Growler!

Sorry to hear about Oscar
Thanks Catzig Duffy & I have been dealing with CRF for the past 2 years and still going strong

Duffy has her 3 month recheck tomorrow - will keep ya'll updated

[mikischo]

Mickey has lost the battle against CRF due to complications from heart disease. In the last several days he was having increasing trouble walking and by Wednesday he could no longer jump on his favorite pieces of furniture (sofa and loveseat). This continued to deteriorate. Each step become a terrible struggle for him. Finally he could walk two to three steps with great effort and then stumble and fall. Weakness was in all legs but greatest in his front legs. I had previously planned on getting blood work done in a couple more weeks but moved the appointment to Saturday. I had hoped the bloodwork would help solve the mystery and help us to find a solution. By Saturday it was an extreme effort to just make it to his litter box but try he did. Amazingly he was still eating through all of this. The bloodwork showed his kidney numbers still were high but no worse than before other than the phosphorus (now 3.03) and phosphorus binders were prescribed. The high phosphorus should not have contributed to such extreme weakness and uncoordination. Potassium was very good (over the midrange of normal). His PCV had actually improved rising from 18% to 21.6% so that should not have been contributing to this terrible weakness. There was nothing in the bloodwork that could explain what was happening to him. The vet then did an xray and found his heart to be enlarged. There was no indication of fluid on the lungs on Saturday. Otherwise no other abnormalities could be detected on the xray. In the past there was nothing to cause them to suspect heart problems. He was scheduled to go to another vet hospital to get an ultrasound on Monday. Sunday, he was almost unable to move at all and then started with open mouth breathing that was indicative of congestive heart failure. When I got him into emergency, there was now fluid on his lungs and his poor heart was stopping and starting even after being put on oxygen. He was barely conscious. I was told the prognosis was not good considering the condition of his heart and they might not be able to pull him out of this. If they somehow did, it would be very difficult, considering his high need for fluids for the CRF, to try to balance things to do what was best for both the kidneys and the heart. In any case his remaining time would have been very short. Watching my poor boy lying there almost lifeless struggling for each breath, I knew there was only one thing left to do for him. My heart is aching and I will miss him so much.

Thank you so much for your help and support! Mickey had too many complicating factors working against him and sometimes things are just not meant to be.

IF ANYONE WISHES TO EXPRESS THEIR CONDOLENCES PLEASE DO SO ON THE FOLLOWING THREAD THAT I STARTED IN MEMORY OF HIM.

[URL="http://www.pets.ca/forum/showthread.php?t=62994"]R.I.P. sweet Mickey

[growler~GateKeeper]

mikischo again I'm very sorry about Mickey

[growler~GateKeeper]

I got the results from Duffy's Sunday appointment, a comparison to the previous test:

Test....................reference..........Feb.... .........May
UreaNitrogen/BUN..(5.0-12.0)........H..15.........H..16.1 mmol/L
Creatinine............(71-203)..........H.216.........H..254 umol/L
Calcium (Ca).......(2.00-2.90)...........2.42...........2.57 mmol/L
Phosphorus..........(1.00-2.40)..........1.45...........1.43 mmol/L
Anion Gap............(12-26)................25.8.......H..28.8
Specific Gravity....(1.015-1.060)......1.014.........1.020

Overall not too bad I'm quite happy the BUN only went up by 1.1mmol/L, the rise in creatinine is not too bad considering past jumps/highs, of course it would've been better had it not risen CA & Phos around the same as before, these have always been within normal for Duffy. Anion Gap basically equals (sodium + potassium) – (chloride + bicarbonate), if the Anion gap increases it may indicate metabolic acidosis, though there can be other reasons for metabolic acidosis not just the anion gap. Some slightly technical info on Acid-Base, Electrolytes, and Renal Failure. I have noticed some minor lip licking & occasionally needing to be bribed to eat - though that could just be cuz I have her fave cereal on hand & she wants some A bit of a surprise given that Duffy gets regular fluids, but nice to see a slightly higher concentration in the urine

As always the values do fluctuate, so there may be some ups and downs with some while others remain fairly consistant.

Duffy was given a different dose/schedule of a remedy we've used before so that was given Sunday night & Monday morning. Plus we added a new remedy for cleansing the toxins from the kidneys, that is given daily for a month.

I haven't yet had a chance to speak w/the vet about what he thinks of the results, there were a couple of other values either slightly high(H) or low(L) Calc osmolity H, albumin H, lymphocytes L, platelets L, none of the changes were very high/low or significantly different from the last test.

Overall I'm happy with the results

[Love4himies]

Oh Growler, I am so happy that Duffy is doing so well. You are such a terrific mom, she is so lucky to have you

[hazelrunpack]

That's great that she's concentrating her urine better despite the sub-q's

Good job, Duffy! (And great job, Mom! )

[mikischo]

Glad to see Duffy's great test results. I found the increase in urine specific gravity to be quite surprising.

[growler~GateKeeper]

I will preface this post by saying Duffy is fine now & back home.

We had a scarey crisis here over the last couple of days, all started Thursday at 5 am with straining to poop from the inability to pass fairly normal looking/feeling poop plus some granule bits of poop and diarreah, combined with vomiting and open mouth panting. This all resulted in a trip to the conventional vets cuz they were open (plus closer), Duffy was manually evacuated of normal size & consistancy poop and diarreah. She was taken into the back briefly for xrays which did not reveal any blockages, nor any definative reason for her other symptoms of elevated breathing and heart rate, though her temperature was fine, and she was shaky on her back legs when straining.

I left there at 10am since I had to go into to work that day & could not stay home to monitor her, she spent the day in hosp for monitoring and by 1:30 when I called to check on her she was still the same as earlier, with the addition of drooling and laying in the litterbox :sad:

The hosp ran some in-house blood work which showed out of normal values:
- elevated pCO2 partial pressure carbon dioxide
- decreased tCO2 total carbon dioxide
- decreased K potassium
- normal BUN/Urea
- slightly elevated Creatinine but lower than the test run 2 weeks ago
- elevated AST aspartate aminotransferase a liver enzyme that rises relatively easily and is not as important in liver evaluation as ALP elevations but a substantial increase may also warrant follow up liver testing
- decreased ALKP alkaline phosphatase - liver and bone disease are the most common causes for increased values in cats but nothing I've found so far defines why it would be lower except the kidneys rapidly excrete any excess

At this point she stiil wasn't feeling any better, hadn't eaten the Wellness I had my mum bring out for her, was still straining and they were unable to get a urine sample for testing. The Dr was concerned about liver damage & wanted her on IV fluids LRS with KCl Potassium Chloride added plus meds & to stay in hosp overnight however they did not have anyone staying, just someone who came in periodically for treatments. I of course wanted 24 hr monitoring so we arranged for me to transfer Duffy to the Animal Emergency Clinic. At this point she was still feeling sickly but looked so much better than when I saw her in the morning and no more drooling. When we got there she was reassesed, had blood drawn again & this time sent out the the lab for an accurate comparison to the tests taken 2 weeks ago, her BP checked 120 nomal, more xrays taken, hooked back up to the IV & kept overnight. The ER vet was not too concerned about the liver enzyme that was elevated since that one AST does not generally indicated liver disease in small animals, she was more concerned about the possibility of pancreatitis. I did get to go visit with her in the back for a bit and to say goodnight. They asked what I wanted them to feed her since I didn't have time to pick anything up but they did have a can of Wellness on hand for her to have, she did eat some overnight & Friday morning.

Early Friday afternoon I discharged her from the Animal ER and transferred her to her Homeopath Vet for monitoring for a couple of hours till they closed, there she was given a remedy for the kidneys, the liver and nausea, set back up on IV. The homeopath also opened up a large can of Wellness for her which I took for her back to ER. When I went to pick her up from the Homeopath she was in even better spirits than earlier but we still hadn't gotten the lab results back so I transferred her back to the ER for overnight monitoring. Back in ER she was hooked back up to the IV and I gave the vet instructions on the next 2 doses of the remedy, we briefly discussed the results of the pancreas panel that came back negative. I was later allowed in the back to visit, coax her into eating, and say goodnight.

I got a copy of the lab results that were sent from the ER out of normal:

- elevated glucose to which the lab attiributes to stress
- decreased potassium - same value as the inhouse blood work despite having KCl added to the IV in the meantime - the lab has attributed this to anorexia lack of eating proper portion amounts
- elevated AST but lower than the inhouse test to which the lab attributes to muscle injury
- elevated CK Creatinine Kinase - this value elevates during struggling while blood is taked/hit by car/stress so not always indicative of - damaged muscles produce creatinine kinase, which goes into the bloodstream. High values indicate problems with muscle, possibly including the heart - the lab has also attributed this to muscle injury

The really interesting thing is:
- BUN/Urea is still in normal range but lower still than the inhouse test that was run
- Creatinine has dropped again from the inhouse test and is now in normal range!

Saturday morning I was to call ER between 9-10am for an update and speak to the vet on staff but they had 2 emergencies that came in so she didn't get back to me until ~ 11:45am. We spoke briefly and I was told I would be speaking to a vet upon discharge so I didn't get to ask all the questions I wanted to about the test results/theories of possible causes etc. She said they would wean her off the IV during the afternoon. I was then to call back at 1:30 pm to arrange a discharge time - that was set for 5pm.

They had a couple more emergencies that came in that afternoon, when I arrived at 5pm for Duffy's discharge appt they set Duffy & I up in an exam room with litterbox, water & food so I could get her to eat - I guess she hadn't had very much for them - and the Dr was to come talk with me. Duffy certainly looked ready to go home at that point. I asked the tech about her still having the catheter in since as of the morning they were going to discharge her then, but they wanted to keep her a few more hours longer to make sure she didn't vomit the food I was able to get her to eat. The Dr was not able to come in to talk to me then because while I was feeding Duffy there were several emergencies that just walked in. The tech came back in to take Duffy back to the kennel & reset the IV. I was told to check back around 9pm and she could be discharged around 10pm.

So I hung around the general area of the clinic for the next 4 hours, got something to eat then went for a walk & went back at 9pm which at that point I saw they had even more emergencies come in. The receptionist told someone on the phone at 9:30pm that the wait time to see the Dr for a less critical case was 4 hours. At that point I knew I would be waiting until about midnight, the receptionist came over to tell me about the new emergencies & that they couldn't discharge Duffy without me speaking to the Dr and having her instructions. The next 3 hours I waited in the clinic during which more emergencies came through, until midnight when I was finally given Duffy's discharge papers/instructions but I still never got to talk to the vet. Called a cab & got home at 1am Sunday morning.

I have a theory about the cause being a combination of a bad reaction to the new protein - duck - she had on Wed resulting in the diarreah but all other symptoms a result of the metabolic acidosis that was shown on the test 2 weeks ago but was normal on these last 2 tests plus the decreased potassium levels from these 2 tests. I want the vets opinion on the probability of that being the cause, since her ER discharge papers have undetermined cause.

Right now Duffy is doing good she's still a tiny bit shakey on the back legs but also has been kenneled for 64 hours, she's been to the litter box for both pee & poop - which was a little bit of a strain at first but came out normal size, consistancy and not at all dry. She has her appetite back is enjoying the canned Wellness she will be on for the next couple of days to settle her tummy down until the homeopath vet gives the go ahead to switch back to raw. I will be home Monday to monitor her, and will try to get her in for a check up and repeat bloodwork & do a UA on Wednesday. Unfortuately this weekend the homeopath is closed Sun/Mon - Murphy's Law

[growler~GateKeeper]

The patient relaxing at home after 64 hours in the hospital

[hazelrunpack]

Holy catz!!! What an ordeal! And those blood results! but Normal range!!

I'm glad she's home and resting comfortably during her recovery--I 'spect you and Duffy feel the same only moreso

[growler~GateKeeper]

Thank you Hazel we are both so very happy to have her home and feeling better

Wouldn't you know the first thing she did when I let her out of her crate was mush a bit with me then run over to see if there was any food for her at her table

[hazelrunpack]

She obviously missed Mom's cookin'!

[Magicwildwolf69]

oh what a scare! i'm so glad she's home now and seems to be a bit more stable. she's such a pretty cat. hope she continues to get well. for both of you!

[growler~GateKeeper]

Thanks MWW

[TeriM]

What a scary time for you both . Hope she has continued improvements .

Lucy also can't handle duck and she can eat almost anything .

[growler~GateKeeper]

Thanks Teri

I think the duck might've been only part of the situation ~ possibly the catalyst One thing for sure is she will never have duck again.

[chico2]

OMG Growler,it must have been an ordeal for both you and Duffy,so glad you posted in the beginning she is ok..
I faintly remember having had problems with duck too at one time.
Duffy certainly is a tough little girl,maybe it's the way the pic was taken,but she looks to be a little skinnier than earlier pics.

[Love4himies]

OMG, that must have scared the begeesis out of you . She is looking very relaxed and her normal beautiful self.

[PMFan]

glad to hear Duffy is a-OK and her numbers are so good !




off topic -- shouldn't this thread be in the cat health forum ? I tried to find it there but it's actually located in the DOG health forum...?

[growler~GateKeeper]

Originally Posted by chico2

so glad you posted in the beginning she is ok..
I faintly remember having had problems with duck too at one time.
Duffy certainly is a tough little girl,maybe it's the way the pic was taken,but she looks to be a little skinnier than earlier pics.

That was why I put right at the top she's home & okay now
I think duck might be an issue for a number of pets - too fatty/rich/gamey I suppose
She's only lost a few ounces over the last 3 months since her previous checkup. This last incident likely hasn't caused any measureable weightloss.

Originally Posted by Love4himies

OMG, that must have scared the begeesis out of you . She is looking very relaxed and her normal beautiful self.

She is doing good right now. Very happy to be home, purring anytime I go near her

Originally Posted by PMFan

glad to hear Duffy is a-OK and her numbers are so good !


off topic -- shouldn't this thread be in the cat health forum ? I tried to find it there but it's actually located in the DOG health forum...?

PMFan this thread was started long before the cat health forum was created - back when there was only the one health forum It was just never moved, not quite sure how it works but I suppose it could be too large to now

Thank you Chico, L4H & PMFan for the good wishes

[luckypenny]

I have to remember the next time I'm not feeling well to go to your place for care, Growler .

YOU ARE AWESOME!!! What a lucky girl Duffy is to have such a mom . I'm so glad she's home with you and feeling better .

[Jim Hall]

yah i tried meriick duck twiceaa and both kits threw it up
manda is like that too canttolerate real rich stuff

[TeriM]

Originally Posted by growler

She is doing good right now. Very happy to be home, purring anytime I go near her

Woohoo .