11/13 Texas Gizmo AMPS=162, +2=151, +4=144, +11=223 *Received lab report SS updated*

11/12 +11=150

AMPS=172

Happy appy, perfectly purry. Shot may have been a drop skinny.

Hope everyone has a wonderful Monday.

 

Nice report for Gizmo. I hope he keeps surfing today.

 

Good start. Hope he works that juice today.

 

Nice start, Gizmo! Keep it up.

 

Received lab reports. SS updated on Lab tab and actual report here

@Marje and Gracie Could you review and give me your advise and opinion?

@Wendy&Neko I told you I would notify you too.

 

PMPS=162

History:
AMPS=172, +2=134

 

How can his SDMA be so low with his BUN and creatinine so elevated? His phosphorus level is good. Hematocrit is more important than RBC. His hematocrit is declining but still better than Yum's. I see this on Tanya's page: "Cats with a particular form of diabetes called ketoacidosis may have elevated BUN and creatinine levels, particularly if potassium and phosphorus are normal. "

 

I have no idea, but leave it to Gizmo to be the one . He has never (to my knowledge) ever had DKA. Potassium is not normal - it is low. I have a theory but will wait and see what Marje and Wendy have to say.

 

Prayers and hugs to you, Lizzie

 

Interested to hear what they say. I have learned so much on here over the last year about FD, BW is whole other learning experience. Nice to see the SPECfPL came down.

 

Hi Lizzie

I’m responding to the PM you sent me with info about what supps Gizmo is getting and also his lab results.

First, in regard to the SDMA dropping and the creatinine increasing, it’s important to understand what SDMA tells us about the kidneys, specifically.

In humans, we look at the glomerular filtration rate (GFR) to determine at what percent the kidneys are functioning. The SDMA test was designed as a reflection of the GFR. In cats, as GFR drops below normal (indicating decreased kidney function), the SDMA increases. It is more sensitive to changes in kidney function than creatinine so we see changes in it earlier than in creatinine.

While I’m sure there might be other reasons why the SDMA would decrease and creatinine increase (and you might want to ask your vet to call IDEXX), there are two things I can think of:

• With creatinine and SDMA, there is a 20% biologic variability even within a week. So an SDMA of 16 with a 20% biologic variability, can be anywhere from 13-19. A creatinine of 3.9 can be 3.12-4.68. Think of it like the variability in Glucometer readings.
• If you give any type of medication or supplement that improves the GFR, the SDMA will drop. But you might not see that change in creatinine.

I do find his variability in SDMA from a year ago to now interesting, to say the least but it’s not beyond possible.

Here is the info you provided in your PM:

I have started Potassa-Chews (200 mg each). I am trying to get 4 tablets into him per 24 hr. That was started on 11/09. He loves them and eats them like a treat.
i believe you've been giving him potassium (K) for a while so it’s odd it hasn’t stopped his K from dropping. I’d just continue to follow your vet’s advice and keep an eye on the K. I’m glad he’s not having symptoms of low K but I sure would like to see it above 4.

Vet has called in a compound for Iron but I don't have it yet. I will be calling the pharmacy this morning.
I assume this is due to his low RBCs.

I did start FD chicken hearts this morning - I gave him one whole, re-hydrated and put 1/4 in each of his snacks for the AM cycle. Not sure if I should do one or two per day (1 each cycle).
I don’t know the answer to this. I will refer you to your vet.

Increased B-12 to 1/16 AM/PM mixed with his food. B-Complex was 1/64 AM only and I added it to his PM now (so he is getting 1/64 AM/PM) mixed with his food.
I’m not sure which specific products you are using, but methyl B12 is usually given are the dose of 250 mcg bid. I’ve only used Jarrows BRight multiB and that is dosed at 1/20 a capsule a day. I’m not sure if the above amounts are teaspoons or fraction of a capsule.

I have also increased the water in his food by a bit. He was getting 5 spoon fulls (distributed) and I increased that to 8 over the 3 snacks/cycle (these are regular eating spoons - not measuring spoons), in addition a small ice cube is added on top of that. The #1 (PS) meal I add marshmallow root mixed with about 1 1/2 Tablespoons of hot water so he gets that water too. He is drinking a bit from his bowls but not much at all.
Excellent. I can’t remember if you are giving subq fluids yet but the general recommendation is to start a small amount of daily fluids when the creatinine goes above 3.5. I know some people give a larger amount every few days but I think cats do better with a smaller amount daily. I would discuss starting subq fluids with the vet if you are not doing them. If you are doing them a couple times a week, I’d discuss increasing to a daily amount. His BUN has really popped up there. I would also suggest Lactated Ringers Soln as it has potassium in it which “might” help his low K levels.

He is itching like crazy. Has been for about a month but has only got worse. I caught him eating litter overnight - not sure how long that has been going on.
I’ve not had to deal with skin allergies and so I don’t want to give you any thoughts about something I have no experience with. Eating litter can be a sign of anemia although he’s still above 30% so it’s a little unusual but ECID.

Canna Companion is given as needed but no other meds are being used currently. Notes on SS are fairly accurate on what/when I give stuff (except for the Canna). Oh, and the PancraPlus that is mixed with his food (7/8 teaspoon mixed with 26oz of food that is divided into 5 cycles of meals).
I guess I’ve never understood why he’s on pancreatic enzymes without a GI Panel showing he has EPI. Did your vet diagnose him with EPI based on symptoms?

Eating is good and enthusiastic. He has holing his weight (~11#'s). Active (for a 14 yo) and interactive. Purry, happy. He has had an increase in hairballs but I attribute that to the amount of grooming he is doing due to the itching (he will lick then scratch, lick then scratch).
This is great news that he’s eating....so important. You are doing a great job with is P levels.

I hope this is helpful. He’s very lucky to have such a proactive Mom!

 

I suspect the Adequan - but just a gut feeling. He did not react well to it at all.

Can the BUN/creatinine # come back down?

No, the Potassa-Chews were just started. He would NOT eat any food with the potassium powder added. He loves these so I am hopeful.

He was having some symptoms - he was wobbly and lethargic. Those issues have improved in the week that I have been giving the chews.

They are teaspoons - sorry I didn't clarify.

I am not and will keep that in mind. I do not think he will tolerate sub-q fluids so am a bit hesitant to try them but I will if necessary.

I was pretty sure the itching was due to anemia - I may try Zyrtec and see if it helps since you think it may be allergies. We discussed allergies here as a possibility of the cause.

I am not sure. The tests may have been run at some point when he was hospitalized for pancreatitis (3x's). This was pre-FD and I don't have copies of the labs from that time. Since starting PP, if he has had a panc flare it has been relatively minor and I have been able to manage at home so am hesitant to discontinue the PancreaPlus. He has been getting it for about 3 years now.
Here are the ingredients.

Overall I am fairly pleased with the numbers. The higher BUN/C have me a bit concerned. Is there ANYTHING else I should be doing for those?

Thank you so very, very much for your advise and review. You are an invaluable asset to the team here at FDMB and I really appriciate your time and energy you give to me and all the beans here.

Gizmo says "thanks" too

 

Remember that whatever increases the GFR is a good thing. I don’t know specific drugs or supps that might do this but I wouldn’t draw the conclusion that because he didn’t react well to Adequan that it was why the GFR went up.
Yes, I’ve seen BUN and creatinine come back down. The one I would focus on is creatinine. There are two situations in which I’ve seen it come down markedly:

• When kitty has received 1-2 days of IV fluids in the vet’s office. This is usually not done unless the kitty is at high Stage 4 creatinine values (think 7 or more) or kitty has crashed and numbers rapidly have increased. It doesn’t always work; my kitty that had PKD (a genetic condition which is fatal sooner than later once it presents in the kidney values) went from a creatinine of 5 to over 10 in a couple of day. Three days in the hospital on IV fluids didn’t touch it. But, it works really well for many cats in a CKD crisis. The goal is to keep that from happening.
• If there is a kidney infection that has been resolved with long term antibiotics like Baytril or Zeniquin

Great...let’s hope this works. His K is really low. It should help him feel much better as it increases.

I don’t know if you’ve seen my video on How to Give Subq Fluids at Home but I’ve had literally hundreds of people tell me they were never able to give them before watching the video and enabled them to do so.

I haven’t seen or heard of anemia causing itching and it doesn’t make much sense to me but I do believe in ECID.

The GI Panel has to be run through Texas A&M and vets don’t typically run it especially if they just suspect pancreatitis. I think I’ve commented before that I would not give my cats a pancreatic enzyme unless I knew they had EPI diagnosed via a GI Panel. They are very caustic especially if not given correctly. Digestive enzymes....absolutely! I’d give them. The symptoms of EPI ( http://www.ibdkitties.net/pancreatitis/epi/) are horrible smelling stools kind of yellow in color, horrible coat condition, weight loss. I can give you more info on EPI and it is certainly your decision on whether to continue the PancrePlus but, especially with a CKD cat, I’m very cautious about what I give.

It’s also generally not a good idea to give a CKD Vit A and Vit D supplementation, especially if they have not been diagnosed with a condition warranting it. You might want to read the discussion on Nutritional Requirements of CKD cats http://www.felinecrf.org/nutritional_requirements.htm on Tanya’s (scroll way down to get to vitamins). Sorry...I’m on my iPad and the hyperlink function is not working all of a sudden
Pancreatic enzymes are just not usually given for pancreatitis or to prevent it but for EPI. Of course, it is recognized that chronic pancreatitis can cause EPI so...a conundrum of sorts.

@LizzieInTexas I’ve added more since you “liked” this because my iPad is acting goofy today. It would,not allow me to use the reply function without going through a crazy rigamarole so I had to post a bit, save, reopen, and then do the next section. Crazy.

Insofar as what else to do, I think I would definitely look into subq fluids with your vet. I would also start to read as much of Tanya’s as you can. I know you probably already have and there is a toN of info...you can’t absorb it all at once. But focus on what’s going on now with him and then read other sections.

 

I don't completely understand. I am trying to figure out why the creatinine (and BUN) went up. More the creatinine because it jumped so much. Adequan was one of the only factors that was introduced in between 07/05 BW and 11/08 BW.

As I said before, I don't understand how all this works together.

Oh, I can (and have) given sub-q's. It isn't me that has the issue - Gizmo is a bit of a PITA. My sweet Missy-cat got fluids for her last two years. Gizmo isn't quite as sweet.

Thanks for the input.

 

Have you seen the EZ IV Harness? I thought about it for Neko, but what ended up working for her was putting her in a small room (bathroom) on a reflective heat pat. Cats are less antsy in smaller spaces. I've also heard of people using top loading kennels or towels over a laundry basket.

Neko's creatinine did a good sized jump at one point. I'd tell you the numbers but it's in World #'s. At the end, her creatinine came down quite a bit as she lost muscle tone. I asked the IM vet why the big jump, and he just shrugged. It happens, not much we could do about it. SDMA's can vary. Neko's hit a high of 23, then dropped to 16, then back up to 22, all in a space of 6 months. Her creatinine was just slowly inching up during that time. The big jump came later. Then her lab results weren't going to Idexx anymore so I stopped getting the SDMA. Neko was complicated with acro, heart condition and lymphoma in the picture too. Lots of moving parts.

If you do fluids, make sure your vet has a good listen to Gizmo's heart first. In spite of a clean echo 6 months before, I found out the hard way that Neko's heart had changed and could not take fluids.

 

Yes. I have looked at this. I will keep it in mind.

She did listen very good this past visit. Gizmo actually cooperate and didn't hiss, growl and spit while she listened so she got a good listen. Said it sounded very good and strong. Got pulse and heart rate which were also good but she didn't tell me what they were.

 

Heating the fluid is a big help, and his potassium levels will probably improve with the fluids. Try to get the terumo needles - they slip in easily - it's the shock of the liquid flowing in that then becomes the problem. But if it's nice and warm, it's more comfy. His creatinine is too high, but it's not bad or crazy; it's manageable and you are managing everything very tidily.

 

After thought:
I'd go with the 20 guage or 19 at most. Here's a link to a good explanation of the thinnest walled needles:
https://www.vetrxdirect.com/product/view/terumo-needle-for-cats-and-dogs-rx

 

I’m glad Wendy jumped in as I hadn’t to go out. But, as she said and the info I provided, both creatinine and SDMA can vary by 20% between tests. Creatinine can also go up esp if there is any other Kidney insult.

I just don’t think the adequan would affect either.

In the video, I give lots of tips, like warming the bag, freezing the needles, etc they might help his comfort. I used 21g UTW needles.

 

I looked at the harness Wendy mentioned and stumbled across the video. I just find it really interesting how this lady manages giving fluids to her different cats - lots cats, lotsa fluids! I hope I can give fluids like Marje or like this lady when that day comes...both make it looks so easy.