5/15. TiTi has CKD and Hyperthyroid, and made a huge kibble raid

Discussion in 'Lantus (Glargine) / Levemir (Detemir)' started by Kathy and TiTi, May 15, 2018.

  1. Kathy and TiTi

    Kathy and TiTi Well-Known Member

    Joined:
    Feb 12, 2016
    http://www.felinediabetes.com/FDMB/...gh-pink-after-dosecrease.195575/#post-2189794

    Well, she has everything Ifeared, except cancer, and for that I am very grateful. I forgot to get a copy of the blood values, but the salient numbers are as follows:
    BUN: (10-30 range) 71
    Creatinine (.3 -2.1 range) 2.9
    Phosphorus: (3.4-8.5 range) 11
    Thyroid: (1.5-4.8 range) 5.3
    From the diabetes, she has developed cataracts. One eye is almost completely blind, the other is somewhat better. I'm glad she has at least a little sight. She's no longer as frightened as she was when it first happened. She knows where everything is, and if I don't change anything, she's fine. TiTI's developed lots of tricks to figure out where her food is and how much of it is there, and where other things are placed. What a smart kitty.

    TiTI is on 2.5 BID Methimazole Had her first dose tonight.
    Vet recommends 50ml BID sub-q fluids 2 or 3 times a week.
    She has ordered phosphate binders. I should get them in 2 days.
    Interestingly, on a visual exam of TiTI, acromegaly was confirmed. Several physical "extras" were seen that are typical of acro.

    Her heart seems fine on physical exam - basically listening and taking pulse and so on. And certainly TiTI has well tolerated 100mls sub-q only a few months ago, so I hope we're safe there.

    Unfortunately, hyperthyroid masks kidney problems, so I'm returning after 2 weeks of Methimazole to have her kidney values run again. I'm hoping the results will not be too much worse, since her hyperthyroid is, at this point, fairly mild.

    At least she'll be gaining weight soon, and now that I know what's going on with her, I can handle. Based on other cats I've had with CKD, if it is only deterioration of a normal sort, she has at least 2 or 3 years more. However, the diabetes will, I suppose complicate that rate of deterioration.

    I didn't test her until PMPS because the blood draw was hard on her, and I didn't want to further distress her.

    I guess she's feeling a lot better though, because she succeeded in a humungous kibble raid. The bedroom door no longer closes completely, I have just discovered. I live on top of limestone, and my house sometimes shifts after a big storm, one of which we had last week. As I walked towards the kitchen, I had one of those disconcerting moments of shifting reality as I saw her black form strolling from the kitchen , both her sides distended by what must have been almost a cup of kibble. When she heard me squeak, "Oh no" she hurried back into the bedroom. She contentedly washed herself and fell asleep on the bathroom counter, one forepaw and hind leg lazily dangling over the edge.

    Long day for both of us.
    Oh, and a tiny calico semi-feral cat showed up with 3 kittens (2stripey boys and one black gal), can't be more than 4 weeks old. Sigh
     
    Last edited: May 16, 2018
    Reason for edit: mixed up BID and TID
  2. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I am sorry for the diagnoses. :bighug::bighug: But as you said, probably the least worst of the possibilities. Acro is hard on kidneys. Which type of phosphorus binders are you getting? Have you looked at lower phosphorus foods?

    I guess Titi felt she deserved a kibble treat after her hard day.:rolleyes:

    Oh dear on the new kitties.
     
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  3. LizzieInTexas

    LizzieInTexas Well-Known Member

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    Jul 25, 2016
  4. carfurby

    carfurby Well-Known Member

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    Feb 19, 2012
    I'm glad it's not cancer. I know it's not a great diagnosis, but at least you know what you are dealing with now and can treat her. Sorry about the kibble raid, but at least she enjoyed it. Oh no on the feral cat and kittens. Sending prayers. :bighug::bighug::bighug::bighug::bighug::bighug::bighug:
     
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  5. Kathy and TiTi

    Kathy and TiTi Well-Known Member

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    Feb 12, 2016
    I do need to find some food lower in phosphorus. But it must be low in price, as well.
     
  6. Kathy and TiTi

    Kathy and TiTi Well-Known Member

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    Feb 12, 2016
    $ 29.+ at Thriving Pets? God only knows what my vet will charge, and I've already ordered it thru them. My vet marks up 30-50%. Too late now.
     
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  7. Mandy & Rex

    Mandy & Rex Well-Known Member

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    Mar 22, 2017
    My first thought is this dose is extremely high for a T4 of 5.3. I would only do 1.25 mg methimazole BID. If you overdose, it can negatively impact her kidneys. Also, 2 weeks on thyroid meds is not long enough to get the thyroid settled. It needs to be at least 3 weeks before checking again. Can you change that?

    Hugs... it can all be managed!!
     
  8. Kathy and TiTi

    Kathy and TiTi Well-Known Member

    Joined:
    Feb 12, 2016
    Sure. But getting my vet, lovely woman though she is, to change the methimazole dose is tricky. Can you point me to any scientific evidence that I can present to her?
     
  9. Mandy & Rex

    Mandy & Rex Well-Known Member

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    Mar 22, 2017
    It recommends to start with 1.25 to 2.5 mg twice a day. You can see it on the top of 2nd page.
     

    Attached Files:

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  10. Kathy and TiTi

    Kathy and TiTi Well-Known Member

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    Feb 12, 2016
    Thanks. It recommends starting at 1.25 to 2.5 twice daily. I printed this out and will give it to my vet, Dr. Spence.
     
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  11. Pamela & Amethyst

    Pamela & Amethyst Well-Known Member

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    Dec 11, 2016
  12. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jun 15, 2015
    I started Forrest at 1.25 twice a day also on Marje's recommendation as she say starting at 2.5 twice a day is old school and throws a lot of kitties into hypo thyroid and you have to back track and take them off the med for a while. When I returned to the vet in 3 weeks for a blood test to see how he was responding on the med. he was smack in the middle of normal. I then told the vet that I started lower than he suggested and he responded with "Good call"

    I am going to earmark what Mandy sited as I didn't have anything in writing to present to my vet.
     
  13. Mandy & Rex

    Mandy & Rex Well-Known Member

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    Mar 22, 2017
    My own experience was I went with the vet's recommendation and started my civvie on 2.5 mg BID and he became severely hypOt at 0.6 so I lowered it to 1.25 mg BID and he was perfect at 1.9. He was 6.6 at diagnosis.
     
  14. LizzieInTexas

    LizzieInTexas Well-Known Member

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    Jul 25, 2016
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  15. Kathy and TiTi

    Kathy and TiTi Well-Known Member

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    Feb 12, 2016
    Hey, I like your style! That way I don't need to threaten her, or challenge her, just do it. Now I am using 5m pills, and they are tiny. Dunno if a further cut is going to work - might just end up with granules.
     
  16. Mandy & Rex

    Mandy & Rex Well-Known Member

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    Mar 22, 2017
    What I did was crush the pill, take a Pill Pocket, roll it up really good then divide it into however you need. In this case, do quarters. It worked just fine. Does TiTi like Pill Pockets?
     
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  17. Kathy and TiTi

    Kathy and TiTi Well-Known Member

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    Feb 12, 2016
    I don't think she's ever had them. I think she'd like them.
     
  18. Kathy and TiTi

    Kathy and TiTi Well-Known Member

    Joined:
    Feb 12, 2016
    The pills divided nicely into quarters. A few of them are too small, so I'm going to toss them.
     
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  19. Stacy & Asia

    Stacy & Asia Well-Known Member

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    Oct 2, 2017
    Hi Kathy, I’m glad there was no cancer and you can manage the things she has going on.

    That phosphorous is quite high and will make TiTi feel pretty awful all by itself. I’m glad you ordered phosphorous binders. Until they come, you could look for low carb/low p foods she might enjoy or replace a bit of her meals with cooked egg whites to get a jump start on bringing that P down. Even in the higher end of the “normal” range, it is still too high. That level of P is only normal for growing kittens.

    Here’s some info on Tanya’s re: phosphorous. I personally think feeding a prescription (lower protein) renal diet is outdated and not great for CKD cats (muscle wasting). The current research suggests they don’t need less protein, they need less phosphorous, but I encourage you to do your own research on that and decide what is best for TiTi.

    https://www.felinecrf.org/phosphorus.htm

    :bighug::bighug::bighug:
     
  20. Kathy and TiTi

    Kathy and TiTi Well-Known Member

    Joined:
    Feb 12, 2016
    Thank you. I've been here before, many times now. And finally conventional wisdom has caught up with me. I always gave good nourishing low phosphorus food, but still needed to use binders.
    I don't know what effect the acro will have on the ckd, nor what her normal vales are, but I think maybe higher by a lot. I gave her 50mls sub-q, and they diminished so quickly. Will give her 50 more tonight. I think daily is in order, not the 2 or 3 times a week she recommended. Hope she has a lot more time. She's just 12 years old this month.
     
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