06/19/18 Texas Gizmo PMPS=266, +2=268, +4.5=231, +11=257

06/18 +11=228

AMPS=190

Have a terrific Tuesday!

 

Nice start for Gizmo. I hope he is still eating for you.

 

“Oh, Master, what is the best day?”
“Tuesday is the best day.”
-Kehlogg Allbran

Let’s all have a good Tuesday! ❤️❤️❤️

 

Hey Lizzie

I looked at his labs. He has had a slight increase in creatinine and BUN but it’s to be expected. He’s still doing very well in that respect.

His potassium is holding pretty steady but his P is back up. Did you lighten up on the binder or change foods? He definitely needs to be back down around 4.5 if you can get it there.

So, just to be sure I understand....you had his labs done at Blue Pearl on 6/1 and his anemia was back big time (20%). The labs yesterday were at your vet’s office? With the HCT at 33%, I’m assuming you had put him back on epogen between 6/1 and yesterday?

Other than really having to fight that anemia, he’s staying pretty stable. This is the crazy thing about CKD. I was just looking at labs for a cat in end stage CKD (his creatinine is 9 and P is 10) and his darn HCT is 29%!! You would think at the numbers he’s at on creatinine and P, he’d be anemic. He doesn’t have a kidney infection or anything else you’d expect to drive up the creatinine and he’s on a renal diet PLUS 3/4 tsp binder and his P is still crazy high. But he’s not anemic. And yet, Giz’s other numbers look pretty good yet he has this issue with his hematocrit. I wish I had the knowledge to know what could be at play that it’s such an issue for him and if there isn’t some kind of solution. I guess what I’m wondering is if his anemia is definitely caused by CKD or if it could be something else? I wish Blue Pearl had done a test on his reticulocytes. If his reticulates were low at that time, I’d think, “yes, non-regenerative CKD associated anemia”. What I don’t know is if the epogen affects reticulocytes but I’m assuming it must and that’s why his reticulocytes are so high on his recent test.

But....his Blue Pearl labs state this regarding his HCT:
"The hematocrit in this patient is <27. (Normal range 29-48). A recent study has indicated that >23% of anemic cats are infected with one or more species of hemoplasma and several studies confirm that PCR is significantly more sensitive in detecting hemoplasma. Antech now offers a Feline Hemoplasma (mycoplasma) PCR panel for detection of M. haemofelis, M. haemominutum and M. turicensis. To add this follow up test, please call customer service and request test code T985.”

I actually had a friend whose CKD cat kept having issues with anemia and they did additional tests and found out that it was, in fact, caused by Hemobartonella and was regenerative so when they treated the Hemobartonella, the anemia issue resolved. Hemobartonella has recently been renamed to Mycoplasma. Have you discussed with your vet having these tests done to see if this could be the cause of his anemia?

 

Just a quick note and I will add more later - did you see his US results? He has blood in his urine and they found a mass, tumor or blood clot (unknown) in his bladder - it has blood flow but it could also be from the urinalysis "poke" - I have no way of knowing how long this has been an issue because the only way I found out is he pee'd in his carrier on a white towel on the way home from the vets a while ago. That was when we went to the IM (Blue Pearl) for the US. It could be some of the cause for the anemia.

 

PMPS=266

History:
AMPS=190, +1.5=191

 

Gizmo's looking good.

 

Dose increase probably Thurs AM.

 

03/05 Labs done by Vet (Cole) and sent to outside lab (on SS) - Superchem, CBC, T4 (TBF) SA120, BP check, Sub-q fluids and B12 injection
- lab work showed high WBC (no urinalysis was done - and we assumed UTI)
Oral AB started and given for 7 days and he couldn't tolerate them.
03/23 - Convenia injection, B12, Cerenia injection
03/30 - BP check, Antech Senior Wellness, Urinary Cystocentesis (on SS)
04/07 - Convenia injection, B12
04/23 - B12
04/24 - Convenia injection, Antech Senior Wellness, Urinary Cystocentesis (on SS)

Continued B12 shots 1x/week at home.

**vet basically fired me and referred me to IM @ Blue Pearl. I had to wait until 05/29 for the appointment**
The vet I am going to is privately owned by a husband/wife (Cole). Dr. Jen (wife) is who has been working with me but she wasn't available and I had to see hubby (Wil) - he is the one that "fired" me - I think the complications and number of issues with Gizmo is a bit over their heads. They are still doing bw and scripts for me and the wife (Dr. Jen) is really super - hubby, not so much.

05/29 Blue Pearl CBC, serum chem, urinalysis and culture
05/29 Blue Pearl Detailed Labs
05/29 Blue Pearl U/S anaysis
6 doses of 20U epogen
06/16 Cole Vet CBC (only to check Anemia)

We did not test for any additional - if I do, what is the treatment? We have not tested for Reg/non-reg because the treatment was the same (epogen) and was trying to save a bit of $$.

Could the pancreatitis cause anemia? Could the phos level increase be due to dehydration? I have continued the AH binder (and still doing so). No changes in food and still trying to give low phos food even with the binder.

Of course - this is Gizmo Even the vet shakes her head and rolls her eyes.

I hope this helps clear up some of the confusion.

Thank you so very, very much for looking over all this for me (and my furry face).

Trip to Scotland won't be until I have taken care of Gizmo to the end. Trip to anywhere won't happen until then.

 

Pancreatitis unlikely to contribute to anemia. For hemo..etc. Massive antibiotics for a long time, and something for inflammation. With a crit of 20, seems doubtful
33 now? Pretty high. I think you can live with 33.

 

No sure I understand.

Yep. He was suppose to get a shot last night but I skipped. I was hoping the IM would call today with plan for long term, maintenance dosing, but he didn't. I called my vet office to get the copy of the labs yesterday and they told me they had already been sent to him. I hope I can call him tomorrow if he doesn't cal me first.

 

TiTi's crit is 23.?, but I'm figuring I'll intervene at 20. Cats can do very well at 19, but I like to get on top of things. Epogen, thank goodness is still reasonably priced. It something of a miracle drug. Marvelous how our kitties respond to it.

 

I think this is the first firing a patient by a vet that I've ever heard of. Good thing his wife doesn't go along with it.

 

It was really weird. Gizmo is aggressive on top of his issues and I do think that was part of it too. Driving home I realized that he, in a nice but firm way, stated that he didn't really want us back. If they had refused helping me get meds, I was going to send an email to Dr. Jen. The more I thought about it, the more upset I got. I had called and explained the entire situation / issues with Gizmo to the intake person, then Dr. Jen called me back herself and I set up the initial appointment to take in all his records and talk with her in person. At that time I specifically asked if they were up for taking us on. But about a week later the tech called on behalf of Dr. Jen and was "just checking on us" so I knew it was the hubby only. And, really, in the end, I am glad I got to take him to the IM for all of our sakes.

 

I also wonder if having a very bright, well informed woman, perhaps sometimes disagreeing or adding information that he might not have had, was too much for him?

 

Who knows? I think it was more a time/money thing and a bit outside his comfort zone. He also touted the "safety" of his staff . Gizmo is an 11# cat that is muzzled at my request for everyone's safety including himself for Christ sake not a 150# aggressive dog.

 

I agree with that

 

Ah, I didn't know that tidbit. But as Alice (of wonderland) might have said, "Curiouser and curiouser!". I find this doctor a puzzle. You're right about the labeling of tiny Gizmo a threat to the safety of the staff. It's ridiculous.