Struggling this week- need help with sub q, hypo and now hyper, can't hold bladder, kidneys...

We are struggling this week, and the emotional toll it is taking is unreal.

6/15- went to vet- inappetite, weight loss, increased drinking and peeing, BGs all very normal.
6/20- last day I gave dose of 1 unit at 6pm.
6/23- went back to vet- inappetite worse, more weight loss, more drinking, BGs hovering in the 150s.
6/23- ER for ultrasound of kidneys. Diagnosed with Stage IV kidney disease, polycystic kidneys.
6/24- Moved to a different hospital because the first one was HORRIBLE.
6/26- Home from the hospital. BG in the 300s, gave one unit insulin.
6/27- Followed all directions from ER doctor- gave sub q fluids, antibiotics, anti nausea, anti acid
6/27- 10 PM, nagging thought says check BG. LOW... syrup didn't help, she wouldn't eat.
6/28- Leave ER at 2 AM after one oral dextrose, one IV dextrose, and a second oral dextrose, and a dose of mirtazapine.
6/28- Appetite so much better today. Still drinking a lot. Gave sub q fluids on my own without help, yay, at 2:30 PM. 5:30 PM she empties her entire bladder on the couch. Crying ensues, strip the couch, start washing sheets and cushion covers, clean up urine. She wants to be outside with SO, he is watching her, all of a sudden he brings her in and she is just urinating while he is holding her in the air. Clean up the floor, the cat, the SO. Totally horribly lethargic after this. Barely eating. I slept (or didn't sleep) on the floor in her room (really the office). She won't sleep next to me- only on the desk. Wake up at 2:30 AM, she is eating and drinking, she snuggles in by my feet- still won't come close so I can pet her.
6/29- Appetite totally horrible. Really won't eat. Having a lot of twitching and spasms. No accidents yet, knock on wood. Nose is white- anemia must be getting worse. Fluid bubble gone after an hour.

For those who give sub q, how often do you give, and how much? She had 3 days of IV fluids, and 3 days of 100 ML of sub q. Maybe it is not enough? We are going back to hospital doc for re-check on Monday.

I am afraid to give insulin when she isn't eating, even though BGs are solidly in upper 280s-330s. Hospital nurse said to decrease to 0.5 units once a day. I am petrified to do so! What would you do if you were me? I can't go through another hypo episode because she will not eat for me, it is not something that can be treated at home- we will HAVE to go to the ER. I am already in the hole $8k+ since March and my bank account is nearly depleted.

Also, to add to the stress, we had agreed a month ago to dog sit for SO's dad- bernese mountain dog- he is sweet and doesn't bother Nugget. Alternate arrangements couldn't be made given the current circumstances, so now we will have the dog Monday and Tuesday night. The dog goes to work with SO, so I won't have him during the day... but this is SERIOUSLY the LAST stressor I need in my life.

 

I'm so sorry you're dealing with all these complications. I wish I had advice but I don't. Did the most recent vet say that incontinence is related to Stage IV kidney disease or is the possible stroke the culprit (saw that in your signature)? I know you're worried about hypo. The situation is so complicated because no insulin and not enough food invites ketones and not eating can also raise the risk of hepatic lipidosis.

Re fluids: from what I've read here in the posts of people who give sub Q fluids, the total amount and frequency varies a lot depending on the kitty's situation. Did the vet(s) give you any idea of what to expect with the supportive treatments they and you have given?

 

Kris those are all things that worry me so much... not one doctor, nurse, vet that we have seen can tell us how long we have left with Nugget- could be days, weeks, months... it just makes this anticipatory grief so much worse.

Incontinence (per my own research) can be a result of end term kidney failure. The hospital vet said they believed she may have had a mini stroke (because a nurse noticed some nystagmus in her eyes), but couldn't give me more info than that. Her balance is also very off. It's gotten better since we brought her home, but she's not steady on her feet. I am not sure if this is stroke related, or if she is just too weak to keep herself upright.

The vet didn't give me much info on the supportive care except that we would have to see if she could make it a week with the treatments at home, and then do a re-check to see if it is working. He said if it was not working, we could have to make that horrible decision I've been dreading.

They released her from the hospital because they said she had made improvements with the IV fluids, but it was unlikely that she would continue to improve. All the supportive treatments were supposed to just keep her from getting worse.

I am sitting with her in our office/cat room because I'm afraid of further incontinence (even though there are plastic tablecloths on all the couches with sheets over them, just in case), and I keep looking at all of her things.. her tower that she can't even climb on anymore, her scratching post that she used to be too fat to fit in, her toys, her bed, and I have no idea how I am going to handle this when she passes. I can't stop crying. I just didn't get long enough with her and I feel like I failed her because I can't save her.

 

The peeing is probably due to the kidney disease. Horrible disease. Been there twice. Generally the rule of thumb with fluids is 10 ml per pound. So if she's 7 lbs, give 70ml, 10 lbs, 100 ml.

Have extra boxes or puppy training pads where she typically hangs out. Remember she isn't peeing on purpose. She can't help it.

if her bg is over 300 give half a unit. Otherwise for now I'd skip or just give a few drops if 200-300. They can be very insulin sensitive after a hypo.

More important then what she eats is that she eats at all. Give her what she is willing to eat even if it's higher in carb.

 

There are a few groups on Facebook that may be helpful. One is Cats with Chronic Renal Failure


The other is Cats with Multiple Medical Conditions (one of the administrators is a vet).

 

I was most afraid that she would drop again. I'm going to see if I can get her to eat a gravy lovers- she used to LOVE those. I gave her a beef and chicken pate today and she wouldn't eat it. Actually, as I type this she did just take a few licks of it. MIRACLE. I'll test her in 15 minutes, and hopefully SO will be home by then, and maybe I will give 0.5 units. I just can't take another night in the ER.

 

I'm not on facebook, but I will see if I can get to either page without having to log in. Thanks for the links.

 

I totally understand your anticipatory grief as you are really just trying to keep her as comfortable as you can at this point. It's awful. I understand and have been there.

This website has free chats with counselors for people going through recent loses, and for those dealing with anticipatory grief. I found them helpful when I lost my cat last year.

https://aplb.org/

 

I am looking into the website now. I definitely need help getting through this. Thank you Janet. It makes it easier knowing that there are others who have gone through this. This is the first time I will see a pet die and I just have no coping mechanisms for it.

 

I have been in your spot a few times and it never gets easier. Just remember, there is no wrong decision at this point.

 

Well you definitely have my empathy. Most of us have been where you are.

 

I cannot be any help but just wanted to say that I am sorry.

 

You're not alone. Just like a lot of people here we have done this over and over again.
Try and get some rest this weekend.

 

My cat had no appetite last week after getting an antibiotic shot. I had to syringe feed him his wet food for about a week and he's back to eating on his own. In fact, he's eating ravenously now. I'm not sure syringe feeding is something you want to consider, because it can be stressful for both you and the cat. Toby did OK with it, but I didn't really restrain him... I just did it in a small area and let him walk about in between feedings. I hope Nugget starts to feel a bit better!

 

I know this pain well. I've been there many, many times over the years. All of us here understand.

 

I'm so sorry for what you're going through. Everything in my apartment that Elvis could pee on is covered in plastic or paper towels at this point.

 

I definitely would like to avoid syringe feeding. It is hard enough to give her oral meds. The mirtazapine seems to be helping her eat- in fact, last night I gave her 1/4 cup of her Purina DM dry, and she ate all of it by noon today. That's the best she's eaten in quite a few days. Still won't touch the wet food.

We are off to the hospital for a re-check with the internal medicine vet in about an hour. They will repeat labs to see how her kidneys are doing. She may need a blood transfusion for her anemia.

Mostly I am concerned about how out of control her diabetes feels. Prior to hospitalization for kidneys, she hadn't needed insulin- her appetite was poor, and I was worried about her going too low. She went without insulin for 6 days. Once she came home (after 72 hours of IV fluids and meds) her appetite came back- and her BG was up in the 300s. So I gave one unit the day she came home (her normal dose), the next day she was in the low 200s, gave one unit, as I have always done when she was in the low 200s, and she crashed. The next day I was too scared to give her insulin- now we are spiking into the 300s and 400s consistently. The hospital recommended decreasing to 0.5 units once a day, which I did last night and the night before.

Anyone experience this, or have advice to get her back under control? I am trying to closely monitor the amount of food she eats, using measuring cups, weighing out wet food- but I am just unfamiliar with giving insulin when she isn't eating like she used to. This poor baby used to plow through a 3 oz can of wet food every 12 hours and would BEG for more when I got home from work!

Also, I'm noticing she does MUCH better at night in terms of kidney fatigue. I have been sleeping on the floor in her room (the office), and she wakes me up every time she gets up for water or food. She sleeps literally on top of me- if I am face down, she is on my back, if I am on my back she sleeps on my chest, this morning my SO woke me up and I was on my side and the cat was carefully balanced on my hip. During the day she goes to one spot on the couch (which is now covered with plastic tablecloths, a sheet and a towel in case of accidents), and she doesn't want to be touched.

Is it possible to post a video to the message board? She has been experiencing these weird stupor, trance-like episodes that no vet seems to be able to explain, I'm wondering if anyone else has experienced with their cats. I took a video of her yesterday to show to the internal medicine hospital vet today.

 

If you post the video to YouTube you can link it here.

Can you post the cats most recent labs? Once a day insulin is probably not going to work, but I agree going to 0.5 is a good idea.

Has she ever had the blood pressure checked? It's common for ckd cats to have high bp.... I wonder if that may be a reason for the trance like behavior.

 

I have copies of all the labs, but I have no idea what they mean- they are in lab speak, not layman's terms... I am trying to decipher them so I can post them- but I might have to scan them and just add them to her spreadsheet.

BP has been high, as a result of the kidney failure. Dr today said it is likely she is fainting- either from heart beating too fast, or not beating at all. He said keep an eye, but not concerned it is an immediate danger.

Her creatinine did come down, but her anemia is getting worse. They recommend a blood transfusion- cost $1100. I do not know enough about this stuff to come to a decision about it!

 

Just scan them and post them. Or if you have a smart phone just snap a picture. There are folks here good at reading them.

Is she on amlodipine for the high bp?

How low is her hct level? Is she on Aranesp for the anemia? Or does she get b12 shots?

 

There's a really good group for cats with ckd on Facebook called Cats with Chronic Renal Failure. Please join there.... Lots of helpful experienced people.

 

Janet I didn’t even know there were meds to treat anemia- they are ready to do a blood transfusion tomorrow. They told me today we could do a transfusion tomorrow, and, if that doesn’t work, we can try the very costly erithopromicin (spelling?!)

7/2/18- HCT was 23, and Hb was 7.6
6/26/18- HCT was 23, and Hb was 7.7 (72 hours of IV fluids)
6/24/18- HCT was 27, and Hb was 9.1 (48 hours of IV fluids, admittance to 2nd hospital)
6/24/18- HCT was 23, and Hb was 7.7 (24 hours of IV fluids)
6/23/18- HCT was 26, and Hb was 8.9 (admittance to ER)

 

Ugh I am not on Facebook for personal/safety reasons. Wish I could see more without being a Facebook member.

 

You could make a fake name to join.

 

Aranesp is an erithroprmicin. They usually don't do that until the hct is under 20. He should definitly be getting b12 treatments.... Either shots from the vet or pills. When my cat Zimmy had ckd he was boarderline anemic with an hct of 29. I have vit b12 methylcobalamin supplements (reg human ones) 500 mcg twice a day. Just opened a capsule and mixed it in his food. 4 weeks later his level was 42 and the anemia had completely resolved itself.

 

Read Tanya's page about anemia. Toward the bottom talks about treatments.


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

 

I replied to your other thread but I'm coming back here. Looks like your cat is stage 4 kidney failure.... Are you doing sub q's at home? At this stage he should be getting daily sub q's in addition to treating the anemia

 

WOW she has a lot of information on there... I am reading and reading and reading, and the more I read, the more confident I am in the decision NOT to take her this morning for a transfusion!

 

Yes, 100 ML of sub q fluids every day. Stage IV is what they have said.. her creatinine yesterday was 4.9 (down from off the charts on 6/23- the first hosp we took her to said their machines couldn't even read her creatinine it was so high... but something tells me their machines suck because the next hospital had no issues reading creatinine, and it was literally a 12 hour difference, only on IV fluids for 5 of those 12 hours)

 

I think ask for a b12 shot, get some b12 methylcobalamin supplements to add to the food, and check the levels again in 3 weeks. If they go below 20 then consider other Options. If they go up then keep giving the b12.

Start daily sub q's at home. It's your best chance of slowing the progression.

This is my favorite video about giving sub q's

 

Well the iv and sub q's no doubt helped bring the levels down as her system was flushed.

 

These are the two vitamin supplements I gave Zimmy.
Just b12 methylcobalamin : I liked this because I didn't have to crush it
Vitacost Vitamin B-12 Methylcobalamin -- 500 mcg - 300 Capsules https://www.amazon.com/dp/B0046IET7C/ref=cm_sw_r_cp_api_y-5oBbYWG3PQ9


And a multi b complex with a little iron.

Rx Vitamins Amino B-Plex, 2 fl. oz./One Size https://www.amazon.com/dp/B007Q4BPCU/ref=cm_sw_r_cp_api_E.5oBbW6P230W

 

I also fed liver and beef flavored foods.

 

Thanks for making me cry Janet.
That is just perfect. Why put him to sleep when he needs this one little thing that might cost less than those shoes you just "must have".
It's not always easy but don't they deserve it?

 

Since Coby is dealing with stage I CKD, I have sorted the food chart to show low phosphorus (<250) and low carb (<10%) food. Please see attached.

 

I'm just sending you lots of not much experience in this CKD stage but I do think giving her B12 could be a very good idea, given her state I would go for a couple of injected ones (those kick in faster ) you could even give them in the subq's (ask wich one, how and the dose with your vet) and later the oral 500mcg Janet suggested I gave her to one of my civies that had also a lot of problems and was borderline anemic and it made a world of difference (this is the one I use https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-500-mcg-300-capsules)

You could also try joining Tanya's support group there are very nice experienced in CKD people there and you do not require a facebook account

https://tanyackd.groups.io/g/support

 

If she takes them you could give her little pices of chicken hearts that will help her iron without the risk involved in meds

 

Fluids do seem to make a huge difference when it comes to creatinine levels. Oreo's creatinine was also too high to read but after a week of sub q fluids 2x a day, it was much better...not completely within normal range but pretty close. She now gets 100 ml of sub q fluids once a day and will continue this for the rest of her life.

 

I was thinking of trying methyl B12 for Oreo's diabetic neuropathy. Isn't it supposed to help that too? Thanks for the amazon link.

 

Yes. For neuropathy and healthy kidneys try zobaline on amazon.
Zobaline™ (for Diabetic Cats) 3 mg x 60 tabs https://www.amazon.com/dp/B008G3LI2M/ref=cm_sw_r_cp_api_on9oBbSRAH647
With compromised kidneys I wouldn't do the whole 3mg dose of zobaline because it would strain the kidneys to flush excess out. Could do a half a zobaline a day for a cat with compromised kidneys.

 

I’m looking at all the B vitamin supplements and came across this on Amazon. I know I can’t go entirely by reviews. She’s not eating her wet food, so I’m not sure how adding a supplement to her dry food would work, and I saw this was liquid with a dropped.

 

That’s the same one I linked to you. I gave this because I liked that it had iron and some folic acid, but added the extra b12 methylcobalamin because the b complex didn't have enough of it.