3/9 George amps 96 +3 81 BW results are in

Morning Everyone,
hugs and vines for those in need, I hope Max is feeling better today


Yesterdays Condo

recap
amps 86
+1 86 +3 95 +6 74 +11 79 +11.75 96 (fed and should have shot here but forgot)
pmps 86 (tfs 30minutes late 45 minutes after +11.75)
+1 70 +3 71 +4 79 +5 107


Well mostly green yesterday that blue in the pm cycle was unexpected, made me wonder whether he might be going up before dropping, I didn't get a test in later in that pm cycle, maybe I should have??

Yesterday evening he was alert and playful so he was feeling good and this morning all the p's were in place, we got a few extra snuggles this morning as I shot late last night by accident so we had a mini FD lie in of 15min.
This is now the
Amps of 96 dropping to 86 by +1 and still surfing there by +3 81 this is cycle.

BW results were in yesterday and there's good news and bad news.
I'll start with the bad (get it over with) the lab F***ed up and didn't have enough blood to do the whole panel that my vet had requested.
Good news is the liver values which were a bit off at diagnosis back in october are now falling into the normal range(that was a worry) . Creatine and BUN (urea) are slightly up from test (not sure if that is significant) and urinalysis came back normal.
I am not going to take him in for the rest of the panel just now, I think he got a bit traumatized by the draw this time and it's a long drive which he hates. We will redo it in 3 months, and get the full panel, we will be sending it to another lab, my vet was not happy with the lab at all.
I've translated the results and they are attached to ss

Hope everyone has a good day
Surf safely Kitties

 

I'm so happy George's bloodwork came back normal Way to go, George! The same has happened to me before, that I didn't get the full panel, because of a mistake made by the clinic. I hope George is back to himself soon, after the unpleasant visit at the vet

 

Bummer about the BW screw up. What tests did not get ran? I don't blame you for not taking him back in just yet.....very stressful on our babies and us.
BFG is looking good!

 

The kidney and the liver tests was all that got done.
We wanted a T4 for thyroid done as a baseline as BFG is getting older now.
Then a bunch of others basically about 1/2 of what we had asked for. annoyingly we asked for more this time and got less than the first. Vet thinks that the tech that called her from the lab was having a bad day or perhaps new, she was apparently quite rude our vet.
The ones that were out of range last time got checked and they came back within normal range.
In the original test it seemed as if George had a bit of liver damage going on, @Marje and Gracie did ask if he had been eating poorly at the time, I have never known George to go off his food, but then I was thinking just the other day that he had lost a fair bit of weight prior to diagnosis, when I checked Georges weight he was 8.1kg in 2014 about a year prior to diagnosis and then 7.8kg at diagnosis 2015, with some loss in muscle tone, I wonder whether the weight loss was a bit fast, and being too fluffy, whether that triggered a touch of fatty liver??

 

George is back to himself now, he's a resilient little chap.

 

Great news about the good blood test results. Bummer about them missing out on some of the tests, Same thing happened to me, except is was my vet's mistake and she didn't order all I asked for. Nice to see George looking good!

 

Sorry the lab messed up and didn't get all the tests run, but it's good the ones that did get run were normal. George is looking good today.

 

Geez it's always something huh! Glad the tests that got done show good results.

 

Glad that George's BW is improving and that he headed right back into the lagoon after the vet visit. Sorry about the screw-up though. I am making yet another attempt to take Walter to the vet on Friday. I have pretty much given up on them ever getting urine out of him... but I sure hope that they will finally approve him for a dental.

 

Good to hear the bw results you were able to get have improved! He's been looking fantastic and I wouldn't be eager to do the drive and another test again either. Surf safely today!

 

I'm a little concerned about the creatinine and urea levels. I'm tagging @Marje and Gracie who's far better when it comes to kidney values than I am. I think this is a "heads up" for you to start looking at low phosphorus foods and doing what you can proactively regarding kidney issues. Diabetes is notoriously hard on kidneys. Weight loss can also be associated with kidney issues. You might want to do some reading on Tanya's site about the lab values (I linked the page.).

 

Thanks Sienne I will take a look now.

ETA just checked Phosphorus content of his food,
granata symphony no3 0.9 (2.9% carb)*
thrive chicken breast 0.8 (1.8%carb)*
granata Deli 1.2-1.5 depending on flavour (need to double check what flavours I have just bought)(4-7%)
*These are his staples.
Also the initial weight loss at diagnosis was not planned in as much as he had been eating hills metabolic dry food to try and get him loose weight and until last year it hadn't been successful.
Since moving to wet at diagnosis, I have been watching his calories so tried to buy food that was FD appropriate but lower in cal and fat. The 300g he has lost since has been over the last 6 months, I haven't got a baby scales but I use a regular human digital weighing scales, I weigh myself then myself + George, to figure out his weight.

 

Happy for good BW--I agree to have Marje look at the values as they can be slowed down greatly by some preventative maintenace

 

That's really too bad about the bloodwork being incomplete. But look at George enjoying the lagoon. That's great!

I see that he has an elevated BUN and CR. I will be curious to see what your vet recommends. Rosie's last tests showed that her CR had returned to the normal range with BUN still elevated. Like George, she has and has always had normal phosphorus. My understanding is that when the cat has normal phosphorus, a binder is not necessarily a good idea. My vet has always said there is not much point in restricting it too much when the blood levels are normal, and so I remain on the fence about what to do for Rosie. I'm interested in anyone's experience with this and with what you will decide for George..

 

Vet said there was nothing to worry about, not action to take, not overly concerned about the raised cr and BUN, have to go in to pay for the BW so will have a proper chat with her then.
His last BW his phosphorus was normal, as was his creatine, urea being just out of range at 66, now creatine is up and urea is 30%( 91) higher than it was at diagnosis. Unfortunately, we didn't get a phosphorus reading this time

I thought I remembered reading somewhere that urea can be higher with a high protein diet, pre diagnosis he was on an RX diet for weight loss which is certainly lower in protein than anything he is eating now, so don't know if that is a factor.

It's looking likely that will need to take him in again to get the rest of the tests, to get the full picture. I might wait a few weeks at least.

 

I wish I had a dime for every time vets told me there was nothing to worry about on labs....but there was. Perhaps worry is too strong of a word here....perhaps "pay attention to" or "monitor" is better. I hope the labs are reliable....if the sample was compromised in any way, it could affect the numbers.

First..I'm thrilled to see his liver values back down!! Although we have no way of knowing for certain, I would highly suspect that the dramatic weight loss over a short time could have triggered a response in the liver.

I think, based on George's labs, if the ones that were run are accurate, that he is in Stage 2 chronic kidney disease. Some times, only one or two values might br indicative of it but could also be attributable to something else. But here is what I see in George's labs:

---the USG (urine specific gravity) is indicating dilute urine. Normally, the USG should be above 1.030 and in most cats without CKD or not receiving any supplemental fluids, it is above 1.040. Low USG is often an early indicator of CKD long before the serum chemistry shows anything. But USG also can vary during the day so if all other labs are normal, it's worth just checking the very first sample of the day as it should be the most concentrated. I think You don't need to do that with George because of his other values.
---he has protein (a lot) in his urine. They did do a protein:creatinine ratio and below 0.2 is normal. However, I've not ever seen one like George's which is 0.018. Did you accidentally add a zero after the decimal? Could it actually be 0.18? Normally, it is reported as 0.1, 0.2, 0.5, etc. The P:C ratio is also a good indicator of CKD when the rest of the picture also points to CKD. It can indicate the progression.
---his BUN is pretty high and when it's high and the creatinine is high, it's not just attributable to high protein diets. He would need to be consistently eating a diet of approx 50% protein (50% of calories from protein not just the DMB or as-fed number) to see it affect the BUN. At this point in time, you would not start subq fluids but try to help Georgr get as much hydration as possible through drinking water or by adding it to his food. Be cautious about using tuna juice, broths, etc, because they likely contain salt and perhaps onion .....neither are good for cats with CKD (I actually don't think any cat needs salt and onions can cause anemia).
---his creatinine clearly indicates an issue. This is the number used to stage CKD and his falls into IRIS stage 2.
---feeding a phosphorus binder doesn't need to be done (and generally should not be done) until P levels are around 6 but, as I have long suspected and they are now finding, phosphorus control is crucial to longevity and QOL for a CKD cat. The goal is to keep it as close to 4 as you possibly can, first with diet, and then with binders as it creeps up (and it will) to 6 but for CKD Stage 2, the target level would be under 4.5. I think this is one area where vets really tend to fail in treating CKD so it's going to fall on you. For now, you want his food to be lower than 1.00% on a DMB (prescription renal diets are around 0.3%). If you have only as-fed numbers, then the P should be lower than 200 mgP/100 kcal and that usually has to be calculated using the as-feds if you don't have DMB.
---hooray! His HCT looks great! This is another number to closely watch. An anemic cat does not feel well. The goal is to keep it above 20% and this is another area where vets drop the ball. Once he gets around 30%, you want to start supplementing with B vitamins to help keep it up.

Other important numbers which you don't have besides the P are potassium and calcium, for right now.

I find that vets can generally be complacent about numbers like these but I think there are things you can do to start addressing it now. Minor things but things that help QOL and longevity in the long run:

---feed lower P foods but don't skimp on high quality protein
---help George get as much hydration through drinking water/healthy liquid or adding it to his food. Water is best. Be careful about giving bone broth. It's great for them but it will shoot the phosphorus levels up so be conservative.
---while I have never had much luck using Azodyl, some people say it helps their cat feel better even if it doesn't affect the BUN or creatinine
---elevate his bowls; CKD cats develop acid tummies and often vomit foam early in the day. Elevating bowls can help and it might be a good idea to get him used to it before he might need to have it done
---don't let him go too long without eating; because of the acid, which does seem to be worse in early mornings because kitty has not eaten for several hours, maybe think about getting him use to LC snack like freeze dried chicken from an auto feeder some time half way between his last evening meal and his first morning meal. It's probsbly not necessary now but it won't hurt him and it might delay when he starts to see acid tummy. While Gracie did not have CKD, her IBD caused her to have early morning acid tummy and giving her a LC freeze dried chicken snack early in the morning from her auto feeder completely stopped the problem and didn't affect her BG.
---recheck his labs in a few months at the longest.
---read as much as you can from Tanya's CKD site or buy her book. Just get familiar with she to find things..it is a lot of material but well organized...don't let it overwhelm you. This site saved my cats' lives in regard to CKD. Three of the four lived a long time with it and were extremely stable.....I never saw creatinine over 3.8, I was able to keep their BUN and P down, and HCT up. Those three crossed from other health issues but their kidneys were hanging in there (2 of them after four years of CKD; the third was 21 and had congestive heart failure so a balancing act with CKD but her kidney values looked great when she crossed). The fourth kitty had polycystic kidney disease which has the same symptoms but it's always fatal and usually pretty fast once the numbers start to go up.

I wish they had done an SDMA as this is the new test for CKD and could have given you the best indicator.

Well, I'm not sure I agree with this because vets will say that a creatinine of 2.4 is normal but actually, if the USG is down, and there is no other reason why the creatinine should be up there (e.g. Kidney infection), then I would suspect CKD and I'd be controlling phosphorus in foods and trying to keep them between 200-250 mgP/100 kcal or around 1.00%. Although healthy cats without CKD should have no issue with a higher P level in food, I actually feed high P foods sparingly. Tobey loves raw rabbit but it's really high in P so it's not a main staple of his diet although it would probably be just fine. I try to keep the level of P in his regular rotation foods below 350 but that's just me. He's no longer a kitten so he doesn't need high P foods for bone formation. Especially with a diabetic cat, I'd try to keep the P levels in food pretty moderate. Has your vet done an SDMA on Rosie?

Sorry this is so long!

 

Thanks for a fantastic assessment of Georges BW.

I am seriously starting to wonder, when the phoned the vet they said the plasma (the clear liquid) wasn't clean and they didn't have enough?? the sample didn't go off till the afternoon but his blood draw was done in the morning, and obviously I don't know about how careful the couriers are.

I checked and no I haven't made a mistake about the decimal, but I did check the same sample with DUS 10 strip and that was negative for protein, (only thing that was positive was for was leucocytes, but I've read somewhere that test is not reliable with feline urine) and I kept the sample refrigerated until I got it to the vet and took it in a cooler, surely if it was high then I would have got a positive result with that? I'm going to double check that, looks like I will be doing the litter box lurk again.

He is not getting SQ fluids but he does get water added with every meal, he gets a 3oz tin for his main meal and I fill that up with water and pour it on his food, his meal is quite soupy, but he doesn't seem to mind, laps it all up, he also has a water fountain which he enjoys drinking from, doesn't drink as much from it now as he was just prior to diagnosis with FD. Again I'll see what the DUS 10 shows up with that.

Is BUN the same as urea? he had urea done not BUN, according to Tanyas site in europe we get urea not BUN.

The phosphorus figures for his foods are of the UK food list and are dry matter, he is mostly eating below 1% some of his higher carb LC snacks are 1.5% tend to use this less as they are for days when he is running a bit low and I have to go out. I've seen on Tanyas website the instructions for calculating the phosphorous from the as fed numbers.

I would say that George is totally asymptomatic at the moment, he has only in the 10years we have had him puked a handful of times, he has a great appetite, no foamy vomits. Let's hope we can keep him that way for as long as possible.

I will elevate his bowl for eating so he get's used to it, that's a good idea.

Thanks Marje, you are an angel

eta I think I will get another set of labs in a couple of months.

 

Sometimes samples become hemolyzed for different reasons and, depending on the degree of hemolysis, it may or may not impact results. In the US, they typically state if it has occurred and the chance it could impact a result.

I’ve not used these before so I don’t know how reliable they are. If urine has leucocytes in it, it “could” be indicative that there is bacterial infection. I wouldn’t think that the amount of protein in the urine would have been affected by the way you transported it. Cats can have protein in their urine for other reasons besides related to CKD and that’s why we check the P:C ratio. If the P:C ratio is higher than the range, that tells you it is because of the compromised kidney function. If it’s in the normal range, then protein in the urine can be associated with other inflammatory processes anywhere in the body.

Good...he shouldn’t be at this point. Usually subq fluids are not started until the creatinine is around 3.5. Good that you add extra liquid and that could actually be affecting his USG to some degree. Just as when we drink a lot of fluid, our urine becomes less concentrated. The best way to check USG at home is to buy a hand held refractometer. The link is the one I bought and I was surprised at how simple it is to use and was actually pretty darn accurate once calibrated (which is also easy).

Yes...they do refer to it as “urea” outside of the US and “BUN” here. I don’t remember about Canada.

That’s great! There is a huge difference, though, between 1% and 1.5% even though it doesn’t sound like much. You want to continue to use the 1.5% really really sparingly as that is fairly high in P.

Given his numbers, I would totally expect this to be true. I’m very happy about that but a lot of CGs assume that if there are no symptoms, there’s nothing they can do. I think small changes early often add up to big results in longevity and QOL for many cats.

you’re very welcome...I’m happy to help.

 

Totally with you on that.

Maybe that's what the phone call was about? there is no note on the paperwork though.

I can get some lower phosphorus ones too 0.6 and .7 they are slightly higher in carb than his main amps meals which are 0.8 phos so I'll use the higher P ones sparingly and won't get those anymore, I'll get the lower P for his snacks, and even see if he will tolerate them Blood sugar wise as a more regular meal. At least he's not a fussy cat and I think he has been enjoying all the variety he has been getting the last 4 months after years of Rx kibble.

The hand held refractometer looks cool, I might just have to get one, I think my vet has one in her practice I am sure she would double check SG for me.

Looks like if there is Albumin in the urine it will detect it but not reliable for other proteins, that might explain the difference.
The leukocyte test in it isn't reliable because it will give a false positive in cats.

Well looks like I have some more studying to do

 

Here's some more info on CKD Treatment which reminded me to suggest you have his BP checked next time you are in.

 

Gill

I use the Chemstrip 10 and you are correct about the readings for the leucocytes on the strips being unreliable for cats. The one thing mine does say is that the urine should be tested at room temperature and should not have been standing for more than 2 hours. I know my vet uses a 7 strip test strip so going on the assumption that your vet is also using the test strips for urine I wonder if the sample was at room temperature when they did it and if not then how might that have affected the results??? Just thought I would throw that out there. I know samples need to be kept cold for doing the culture but for the other strips I don't know how important the room temperature is.