10/30 Maggie AMPS=106, +2=94, +5=74

http://www.felinediabetes.com/FDMB/...-1-83-3-103-7-110-pmps-101-2-78-6-101.186054/

Hope to do some green surfing today. Today's agenda: annual physical for me this morning, then at +7 Maggie goes to the vet to get a urine sample taken for a C&S to confirm the infection is gone and I'm going to have blood work done too. Cuz you know, I'm afraid the vet needs more of my money...

 

Nice start for Maggie. I hope her vetty appointment goes well and your physical goes well.

 

Looking good Maggie. Sending vetty vines to Maggie and vines to you to Alicia!

 

Ugh, it's no fun to go to the doctor. When I was a little girl and had to go to the doctor, on the way home we'd stop at the drug store and my mom would get me a small toy (crayons or bubbles or something) as a "sick present." To this day, I get myself a little "sick present" when I have to go to the doctor. So I hope you and Maggie will treat yourselves to a little something special this evening for being such brave girls!

 

@Marje and Gracie If you have time, could you look at the labs Maggie got today? No rush. Thank You!!

 

I’m happy to. When you have time, you might want to enter those values on the Lab tab on the SS because it is very helpful to have that as a tool for future comparisons.

Her hematocrit is hanging in there but as she approaches 30%, I would strongly suggest you start her on oral methylB12 and a Multi B vitamin. I see she is getting Vit B12 right now but I don’t know if that is for some intestinal issues (in which case it is usually injectable cyanocobalamin). The Zobaline is a methylB12 given orally but it is primarily for diabetic neuropathy. However, it will work towards controlling anemia as long as the dose is correct and you pair it with a Multi B vitamin.

I wouldn’t worry about her ALT. It’s basically normal. Even if it were in the 300s, it would be considered a “mild” elevation.

The low MCH just tells your vet that the hemoglobin is trending towards the lower end of normal but the HGB already tells that story. MCV is the size of the red blood cells and indicates hers are smaller. Lots of things can cause this including intestinal issues, anemia, low iron, chronic diarrhea, etc. I’d just keep an eye on it.

Her potassium is low and I see you are giving her potassium. This can be a difficult one because it’s common for CKD cats to have low potassium and, in that instance, it indicates that the cellular potassium (where you want it to be) is lower than the serum potassium. That’s why we want the potassium above 4.0 because if it is 4.0 in the blood, it’s less in the cells. However, insulin can cause the uptake of potassium into cells in which case the cellular potassium would be higher than the serum potassium. Even still, a diabetic cat’s potassium should still be at least 4.0 so I’d talk to the vet and see if you need to increase the potassium or give it more time. I don’t know how long she’s been getting it.

High albumin can indicate a bit of dehydration. And, obviously, her BUN and creatinine indicate she is in early stages CKD. Her phosphorus needs to be much lower. You want it at about 4.2-4.5. I would focus on feeding her lower P and low carb foods. There are links in the “New to the Group” sticky that provide some examples. I’d try and feed foods less than 1.00% phosphorus on a dry matter basis or less than 200 mg P/100kcal as fed.

Her calcium is borderline high. I would definitely keep an eye on this. You want to be sure the Ca x P stays below 70. If the body balance systems are working properly, if you get the P down, the Ca should come down some. However, sometimes in CKD cats, the balance systems run amok and you see the Ca continuing to rise.

I hope that helps. Please let me know if you have questions. I’m sure you are familiar with Tanyas Comprehensive Guide to CKD. If you aren’t, it is the gold standard treatment and will tell you things to watch and catch early that your vet never will.

If I have one single most piece of advice to give you about CKD it is control the Phosphorus. While many other things can go wrong and cause issues (e.g. anemia would be the second thing I’d tell you is critical to stay on top of), a cat with a higher P will feel really crummy and recent studies show it is one of the top indicators of longevity in a CKD cat.

 

Nice numbers Maggie! Hope they vet wasn't too stressful!

 

@Marje and Gracie Thank you sooooo much! I do have some questions and some additional information to give you about her current treatments, but my brain is too full and tired to do it. I'll tag you again tomorrow. Again thank you!!

 

You’re welcome. Sounds good but I have FDMB friends coming tomorrow for two days. So there’s very little chance I’ll be on the board before Thursday. If I can, I will but I wouldn’t count on me until Thursday. I hope that’s ok.

 

@Marje and Gracie I hope you had a nice visit with your friends. Please see my questions/comments below. I put Maggie's labs in for the last 1.5 years if you'd like to see a little history. No rush on this at all.

Since her CKD dx in June 2016, I’ve been giving B-Right which has methylcobalamin B12, pantethine, and P-5-P. Not sure of the exact dose I’m giving (that sounds terrible!), but I sprinkle less than 1/128 teaspoon with approximately 6 meals a day. Been giving Zobaline since July of this year. 2 months of 1 tablet twice a day, then 1 a day after that. She did exhibit neuropathy and it has helped. What changes or additions would you recommend?

Maggie’s taken Potassa-chew since July 2016. They have 200mg of potassium gluconate per tablet. She gets about 4 tablets per day. I’ll up that to 6 tablets per day, unless you think that’s a bad idea.

Lowering the P is my biggest challenge. She’ll only eat pate, and there are few foods with low P and low carbs. Been feeding Fancy Feast pate for the low carbs, but I know the P is high. Considering making my own semi-raw food. Do you have any experience with that for a CKD cat? Is it time to ask for a P binder?

I found Tanya’s shortly after the CKD dx. Talk about info overload! Got on the potassium and B12 issues, she started feeling better, and I let her cruise until the FD dx. Now that it is under control, it’s time for me to focus on the CKD.

Boy, this is long, I apologize! I am curious, are you a vet or does your knowledge come from hands-on experience and research? I am so thankful that you are here to help me and other interpret labs! Thank you so much!!

 

She's in the lagoon! Hope you bought yourself a "sick toy" like Susan does!

 

What's a "sick" toy?!

 

Sorry "sick present". Susan and Felix posted it on your thread today. Post #4. I thought that was so sweet.

 

I knew it sounded familiar! This is actually yesterday's post, so it's almost wiped out of my brain!

 

Oh, yes, I wasn't on yesterday so I responded today. I understand about it going out of the brain. Yesterday's dinner is a mystery to me, LOL.

 

Thank you for your patience and also for putting in the historic labs. People underestimate the value of that so I really appreciate it when a member has it. No, I’m not a vet. I have an MS in biology and have taught anatomy and physiology at the university level. I was accepted to vet school out of college but I changed my mind. My experience comes between my background and having had cats for 56 years including four that had CKD.

What changes did you make after you got the initial CKD dx because her creatinine went from 2.5 in May, 2016 down to 1.6 in July 2017. Unless a cat has acute renal failure or a kidney infection, you don’t often see that happen. Her quick increase has me scratching my head a bit and wondering what was going on that made her go up in 2016, come down, and now go back up. Any ideas?

You’ve also done a really good job of bringing her HCT back up. She needs 250 mcg of methylB12 twice a day so if you are giving her more than that for the neuropathy, then that is excellent. She should be getting 1/10th of a BRight capsule twice a day. How do you measure 1/128th of a tsp? Holy cow! Since I don’t remember how much actual powder there is in one BRight capsule, I don’t know if you are where you need to be with the dosing but she is the poster child for HCT improvement! I would, however, see if I could get a better handle on how close you are to 1/10th capsule twice a day.

Her P shooting up, as well as the creatinine, also tells me the kidneys are not working like they were in July. That’s a fairly big increase in P unless you are giving her bone broth or something like that. We don’t typically start binders until the P is about 6 or the Ca x P is over 60. You could try and add some cooked egg whites to her food as it is a good source of protein and has no P so it would make the overall P level in food decrease....if she will eat them.

I feed my cats a balanced raw diet using FoodFurLife powder. The instructions tell you how to use it with home cooking the raw meets and the food, including the powder and meats, is below 1.00% P. It is definitely more of a challenge to feed a consistently low P and LC food. I’m sure you’ve seen the LC/Low P table in the "New to the Group" Sticky?

You’ve also done a good job with her potassium. Because one has to be really careful with potassium and the dosing, I will leave that to your vet. I think, even though you’ve made great progress, her serum potassium level should be higher. But I don’t give potassium dosing recommendations.....too much or too little can cause serious issues.

Her eosinophils are higher....could be allergies or parasites if that is a potential issue. It’s likely the reason her basophils are high although it is very odd her basophils were high in July but her eosinophils were not.

No apologies needed. I hope the info helps. Pls let me know if you have any questions but I do think that jump in creatinine and P is “interesting”. Without a urine test, we don’t know if she’s got any white blood cells in her urine. I always worry about kidney infections with CKD cats because that can cause the levels to jump; it’s not always the reason they do but it can be “a” reason. Do you have her BP checked every time she’s in? If you don’t, you should and if you haven’t, I’d talk to the vet about doing that ASAP.

 

@Marje and Gracie The changes I made after the CKD dx were to add the Potassa-chew, the B-Right, and change to Royal Canin Renal food (dry & canned). Her BP was found to be high shortly after that, so amlodipine was added. Since the FD dx the changes have been the switch to FF canned food, Zobaline, Natural Moves (constipation), D-Mannose, and taurine. She had a bad UTI in June of this year, and the BW at that time disclosed the FD. She's been on AB since June until 2 weeks ago when a urinalysis showed the UTI was gone. I'm waiting on the C&S to confirm.

1/128th of a tsp was my wild guess on the BRight! I use a 1/64th tsp, but fill it only 1/3 to 1/2 full. And that is 6 times a day, so I'm guessing I do more than 1/10th of a capsule. Previous vet told me excess B12 would flush out, so no overdose worries. I will open a capsule and see if I can divide it into roughly 10ths to get an idea of how much I really give.

Re: the high P, I don't give her any bone broth, etc. Don't know what the P level in the Royal Canin renal food was; maybe the increase is all FancyFeast related? Good to know on the binders and the egg whites.

On Dr. Pierson's blog about raw, she says the method she details there isn't suitable for CKD cats, but rather than using a premixed powder she adds individual supplementss, so I wasn't sure if raw was the way to go for Maggie. But you've fed raw with the FoodFurLife powder to CKD cats, right? Yes, I've seen the LC/LP table, thanks. My problem is she only wants pate and most of those foods aren't. Hard to find many of those locally to just try a can as opposed to having to buy a case online. But finding a LP/LC food is my focus right now.

Is there any other way to increase her potassium?

Maggie does have asthma and allergies if that would explain the high eosinophils.

Thanks again for taking the time to help us out!

 

I’m sorry I asked you about BP when you list amlodipine in the signature block. I do remember reading that at first and I’m helping several people with CKD cats so I should have reread your signature block instead of trusting my memory

The switch from the RC renal diet to a nonrenal diet likely accounted for the rise in the P. I am not a fan of prescription diets and I don’t like the low protein in those diets but you won’t find any lower P diets. It is a challenge with diabetic cats with CKD on feeding but you don’t want to start binders too soon because you might need them a very long time.

Your vet is correct the two they will pee out excess vitamin B but you don’t want to just throw money down the drain so you might want to fine tune it if you can. You’ve done a good job with her HCT!

Dr. Lisa only references TC Feline special formulation as a premix she wouldn’t use. .....not all premixes. I also don’t like the TC Feline regular or special diet mixes. Dr. Lisa says she likes to formulate diets for each CKD client cat but that isn’t necessary. I had her formulate a raw diet for one of my CKD cats long ago and it cost me a fortune to have her do it. I couldn’t tell that he did any better on it than how he was doing on the diet I fed him before. No, I haven’t used FoodFurLife with a CKD cat but I wouldn’t hesitate to do it. It’s an excellent premix (I know the owners of the company and their dedication to outstanding feline nutrition) and I’ve looked at a ton of them. I’ve also gone the route of buying all the supplements and making raw as Dr. Lisa does and I really prefer the FFL. So do my cats. But we all have our different philosophies....Dr. Lisa uses Fortiflora as an enhancer and I really think it is a substandard product that I would not use...ever. I tend to really like the advice and information from Dr. Becker with Mercola and so does my vet.

I’m not saying you need a different method to get more potassium in her. I just want you to discuss it with your vet as I don’t do potassium dosing. Potassium gluconate is a good way to get the potassium in them but dosing requirement for a specific cat needs to be done by a vet. Too much or too little can really cause issues. It’s not like dosing Vitamin B.

Am I reading correctly that she was on Zeniquin for the UTI?

 

Forgot I was going to tell you her BP hasn't been taken in a while, maybe June. My new vet doesn't have a doppler BP machine. She is running her own practice and it's more dogs and horses than cats. She took a reading at the first visit; seems like it was around 200/100, but Maggie gets white-coat syndrome pretty bad. I actually considered buying a doppler myself right after the high BP dx, but didn't.

I'll check out what Dr. Becker has to say, and I will talk with my vet on the potassium, thanks.

For the UTI, we started with amoxicillan, but didn't do a C&S because she was trying to save me money. Big mistake! After several weeks of that, her urine sample looked better but the UTI was still active, so she switched to ciprofloxacin for 3 weeks. Still active, so she did a C&S and we did Zeniquin for 6 weeks.

 

Just fyi.

http://www.felinecrf.org/vitamin_b.htm

Jarrow's B-Right: How to Create Cat-sized Doses

I have been asked so often about how to divide the small amount in these capsules into ten. There are a number of ways people on Tanya's CKD Support Group do this:

• Empty the contents of the capsule onto foil and divide it roughly into ten with a knife or razor.
  
  
• Pour the capsule contents into a shallow bowl or plate and divide it into ten.
  
  
• Use measuring spoons. These are discussed here. Apparently the drop spoon holds about a tenth of a Jarrows B-Right capsule and the smidgen spoon holds about an eighth of a Jarrows B-Right capsule.

I have found the mini-measuring spoons invaluable.

https://smile.amazon.com/gp/product/B0009X1P9S/ref=oh_aui_search_detailpage?ie=UTF8&psc=1

Tad = 1/4 tsp
Dash = 1/8 tsp
Pinch = 1/16 tsp
Smidgen = 1/32 tsp
Drop = 1/64 tsp

 

I have those as well....well, I have the dash, pinch, smidgen. You just have to be sure that, roughly, one drop spoonful = 1/10th Jarrows B Right.

The thing that worries me about all this is whether there is also kidney infection present, potentially. You will not necessarily see any evidence of bacteria, etc in a C&S if the infection is in the kidneys.

On the BP, it’s important you have it checked because I’ve seen the “typical starting dose” of amlodipine not be enough in some CKD cats. Trixie was one of these; she had to have a couple of BP meds to keep her BP under control. I think 200/100 for a cat on amlodipine is a lot more than vet stress (unless I’m misunderstanding that that was the first time before the meds were started), IMHO. Dopplers are expensive and it can take two people to do it. Perhaps a mobile vet in your area has one and can come check her at home.

 

I'm using those same measuring spoon, and using the 1/64 one, but probably dose 1/5th of a capsule in a day.

What would be symptoms of a kidney infection? How is it confirmed? I asked the vet if it could be a kidney infection back in June, and she said Maggie would be in pain, but she showed no discomfort when poked and prodded. Could she have a kidney infection and be feeling this good and have such good BG on such a tiny dose of insulin? Around the time the UTI was diagnosed in June, I noticed she was doing a lot of circling and squatting in the box before she would pee. She didn't seem to be straining or in pain, and when she does pee it's a strong, steady stream. I thought it would stop when the UTI was taken care of, but it hasn't. The vet took an x-ray on 10/30 when I said it was still occurring, but she saw no problems other than some backed-up fecal matter. Could this be related to constipation, somehow restricting the urethra?

No, 200/100 was after she'd been taking amlodipine for a year. I need to double check with the vet to confirm those numbers.

 

Sorry I didn’t get back last night. I fell asleep

You know, my last CKD cat, Gus, had a kidney infection twice with no symptoms. He had a few white blood cells in his urine....no bacteria. He was not painful, he didn’t have a fever. However, Zeniquin is an a/b in the same class of drugs as Baytril without the potential neurological side effects and so if she had a kidney infection, six weeks of Zeniquin should have taken care of it.

I don’t know the answer to whether backed up fecal matter could be restricting the urethra. I rather doubt it, though. But I never say “never”.

Yikes....200/100 is way too high for a cat on amlodipine. You absolutely need to get her in to a vet or get a mobile vet and have that rechecked. She might need a higher dose, a different med, or a combo. But that’s too high even considering vet stress.

 

Beautiful numbers, Maggie!

And thanks to @Marje and Gracie for all this CKD and other info...I've bookmarked this for future reference. Very helpful!

I wasn't sure - is the UTI completely gone now? I hope so!

 

Yes, the UTI is finally gone!!

 

No worries, you gotta sleep sometime!

Yesterday I got the C&S that confirms the UTI is gone. I've attached it here, if it would reveal anything else. I also put info in her labs for urinalyses from 10/31/17 and 5/20/16.

Do you have any thoughts on why Maggie is circling and squatting several times before actually peeing? I don't think she has always done this, but I didn't use to watch her pee with such interest!

Sincerest thanks for the time you've spent helping me, and I'll try to leave you alone for a while!

 

I fed raw to Neko, and didn't change that when she got CKD. I did switch to half of her food with a premix. I started out with TC Feline Special - the formulation in Canada is different than that in the US. I did switch to FoodFurLife when her civie (who also got the same food), got an IBD diagnosis. TC Feline Special, but not the other formulas, has xanthum gum in it. The one thing I like about the TC Feline was that it had calcium carbonate in it, which is a bit of a phosphorus binder. It did help keep Neko's P numbers down. The FoodFurLife is low P, so was an acceptable food choice - until she decided to go off of raw completely. In her case, I think it might have been a mouth soft tissue growth/acromegaly thing and the texture wasn't working for her.

Fancy Feast is high in phosphorus - changing to as low P as you can is a good step. As I found when Neko went off of raw, there are some canned choices out there that work.

Neko also got really bad white coat syndrome when it came to taking her BP. It took a quiet specialist vet's office, with Feliway running, to get a truer reading.

 

Thanks for the info, Wendy! Maggie makes it extra tough to find low carb, low P food because she only eats pate. She's had lot of teeth pulled and it is hard for her to eat shreds or chunks, so she just quits after a bit.

 

I wonder if you could take the shreds or chunks food and put it in the food processor to make your own pate?

 

Yeah, you're right, I should try that, I just haven't.

 

Neko had her own immulsion blender. It even went on the road with us once so I could make food just the way she wanted it.

 

It would be a bit of a pain and extra work, but you'd have more options. Maybe a magic bullet and the smaller cups it comes with, that would be pretty easy cleanup at least.

 

@Alicia & Maggie

Thanks for posting the urine results. There are two things that raise a red flag for me:

• Protein in her urine; it’s not uncommon to see a trace of protein but when it’s more than that in a CKD cat, I think it’s smart to ask about having a urine protein:creatinine ratio done to see if she has proteinuria due to the CKD. You should be able to take a free catch sample in as it doesn’t need to be sterile for them to run that. If she has proteinuria, there are some meds they can put her on. Wendy’s Neko had to take benazepril for her proteinuria which was due to the acro.
• She has white blood cells in her urine. If they just did a dipstick and found them, I wouldn’t be too worried but if they looked at the urine under a microscope (which I would expect since they did a C&S), I would discuss it with my vet further. This is how I knew when my Gus had a kidney infection. It doesn’t make sense that’s she would after six weeks of Zeniquin but sometimes they need the a/b even longer with a kidney infection.

I don’t know about her pre-urination behavior. None of my CKD cats did that. Maybe there is something about the litter box she doesn’t like.

 

Hi, I've come across this page as my cat has been diagnosed with stage 4 CRD, to be honest we are at a loss with what to do. the vet is saying she doesn't really stand a chance but from all what I've read I feel like she might, and they are not even 100% sure it is CRD unless we pay £370 more for a few lab tests. I feel like they are just telling me its the worst because at the moment I dont have the money to pay for everything they are asking. currently she is at the vet on a drip and antibiotics just incase its only a bad infection. the vet ruled out diabetes even though the symptoms are the same as CRD. I have a feeling it could be that instead of CRD or even possibly both.
I would really appreciate any advice anyone can give you all sound like you have much more information than my vet is telling me.
we've already paid £350 for blood test, urine test drip and overnight stay, the further £370 is for further tests at the lab to see if it is kidney failure which we thought the original tests were for.

 

Hello @paris I'm going to copy your message and repost it on the Feline Health Forum. Experienced members will do what they can to help you. One thing that will help them is if you can post the results of the blood and urine tests. I hope you find some answers for you cat.