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7/12 Tigger AMPS 172, blood work fully uploaded on SS

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Moms2Tigger&Blu, Jul 12, 2019.

  1. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    http://www.felinediabetes.com/FDMB/posts/2400297/
    1. So it took me a while, but I got all the blood work from past 4 years uploaded to the LABS tab on Tig's SS, including this most recent full senior work up. Anyone willing to take a look? @Sienne and Gabby (GA) @LizzieInTexas
    2. Also, I called his IM specialist and made an appt for the 25th for a consultation and general discussion about what we should be doing to keep Tigger as happy and healthy as possible. They recommended a repeat Renal Panel to be sure all numbers are accurate - Tig will have that tomorrow at his reg vet. (It's been 2 weeks exactly).
    3. Also, Tigger went for his BP check on Wednesday and it was perfect - 115, so atleast that's in our favour.
    4. I did start giving him Slippery Elm Bark once a day in his dinner - since he seems most nauseous/acidy at around 6 am. The vet was surprisingly cool about trying this before pepcid ac but I did have to tell her all about it . . . . even though it is mentioned on their own website. Again, I plan on working with the new vet more as he seemed way more up to date.
    5. My regular vet is adamant that a Kidney Diet will help him the most, but when I brought up that his phosphorus wasn't even high, she mentioned the Rx foods also have antioxidants and other things good for the kidneys. I don't know what to say so for now I will continue trying him on some of the foods recommended to me in the first post about all of this. (link to that thread at the top). Today I was able to find the Whole Earth Farms Duck, The Tiki Cat Puka Puka Luau and Koolina Luau, Soulistic, and Organix. Still no Natures Logic Beef which is number 1 on my list to find! The soulistic on the list from @Bronx's dad says "pate & shreds" and while it looks like it came that way before (literally pate with shreds) they now have straight pate. Pictures of both can be found online but not in stores or website - pate only is new. The mineral content and stuff is all on the website but its in % . . . so I'm confused. But then at the bottom it says mg of Phos per 100 kcal is 133 so thats good right. (link to info at the bottom)
    [​IMG][​IMG]https://www.soulisticpet.com/s/SOULISTIC_NUTRITIONAL-INFO_PATES_V1R3-compressed.pdf
     
    Last edited: Jul 12, 2019
  2. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    Here is another list for phos/carb (etc). Want to stay ~1% on this list.

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

    There is a thread somewhere that explains how to calculate. I never learned I used the lists and websites of the manufacturers.

    Soulistic Chicken & Turkey pate & shreds is 1.15 phos and 6.82% carbs. I haven't given the pate only so no knowledge.

    Careful with beef. It can be hard to digest and upset kitties tummy. It also raised Gizmo's BG numbers (regardless what it said the carbs were). The one I tried was the I and Love and You beef.

    Tagging @Marje and Gracie for the labs (not sure if she is around, I haven't been on as much the past coupke of weeks).
     
  3. carfurby

    carfurby Well-Known Member

    Joined:
    Feb 19, 2012
    Yay for good BP. I hope the Renal Panel is good too. Sending prayers.
     
    Moms2Tigger&Blu likes this.
  4. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I hate to say this but you need to adjust the labs in one of two ways. Either lock the first 2 columns so the lab and the reference range are visible as you scroll to the last column or reverse the date order so the most recent dates are next to the reference range. I'm on a laptop and I have to keep going back and forth and can't see what lab the July values are for.
     
    LizzieInTexas likes this.
  5. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    ok thanks
     
  6. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    i think its done
     
  7. Sonia & Leo

    Sonia & Leo Well-Known Member

    Joined:
    May 24, 2018
  8. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    A couple of thoughts...

    Staging of feline kidney disease is primarily based on creatinine levels (see this link for IRIS staging). They note that SDMA may be a more sensitive measure. The standard blood panel includes SDMA if your vet uses IDEXX for running lab work. I'd suggest asking for this test. Has Tigger's blood pressure been tested? With potential kidney issues, it's important to make sure your kitty's BP isn't the source of the problem. You'll see this referenced in the Treatment section of the IRIS info that's in the link.

    Gizmo's SDMA and creatinine were elevated. I switched him to a high protein (raw food) and as low phosphorus diet as I could. He also has IBD so needs novel proteins. The vet prescribed calcitriol which is a form of vitamin D. After about a 12 - 18 mos., his kidney values are all normal range.

    How big of a cat is Tigger? The larger the cat, the more wiggle room there can be with some of these values.

    Does your vet have any thoughts about why Tigger's ALT is elevated? Are you still giving Tigger denamarin?
     
  9. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    • All the vets explained that the SDMA test was a better indicator of early disease, once chronic, its just repetitious, but he is having a repeat Renal Panel today so i can ask.
    • Tigger had his blood pressure checked on Wednesday and it was good - 115.
    • I'd say Tigger is a medium guy - he looked really good at 12-13 pounds. To me he looks skinny at 11 but the vet insists he would even be healthy at 10.
    • They have no good answers about the ALT, felt it was "barely elevated" and we will watch it. We haven't given the Denamarin in a year, since all the FD started. The vet has never fully diagnosed Tigger with one specific disease because every time we recheck the numbers a different problem seems likely. (Apparently vets are very likely to call this Triaditis and stop looking for an answer - that's why Tig is seeing the IM specialist in a few weeks). He had an inconclusive ultrasound. The ALT's went down with the denamarin but his GI issues never subsided. We tried steroids and wound up here. Then off the denamarin for a while his liver levels were fine. Even his GI panel that we had to have sent to Texas A&M wasn't really specific for anything. I was calling daily to ask about a different value on the bloodwork and felt like I was the only one concerned so many things were elevated. I got no answer about the urinalysis either. They did recommend we do a three day culture to make sure there was no signs of growth, but when that came back neg they never really mentioned why he had so many RBC's in his urine. Again, I am so glad we decided to see the specialist, its been a year after all.
     
    Krystina & Nelli likes this.
  10. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    First, I’ll agree that the ALT is barely elevated and somewhat consistent with what he’s seen for quite some time. He only had two mid-range numbers (69 and 88) and that was a while ago. I would not call this triaditis with that low of an ALT. It’s possible pancreatitis can cause the ALT to be slightly elevated. My little one, Livia, who is 3, has always had an ALT between 100-126 even from when she was a tiny baby. Because it’s always been stable, the vets think that just might be “her” normal. There is also some research indicating that raw fed cats (and dogs) can have a higher ALT. But, I wouldn’t worry about his ALT right now. It’s so mild, it’s not even really an elevation. Even 300s are considered to be “mild”.

    It sure looks to me like early CKD if I look at it the old fashioned way before SDMA. His urine specific gravity is pretty low indicating he’s not concentrating his urine. Yes, the urine becomes more dilute as the day goes on and they drink more. It would be interesting if you could do a free catch of urine very first thing in the morning with his first pee and let your vet check the USG. That would tell you if he’s capable of concentrating his urine. However, looking at his USG, his creatinine, his BUN, and his P level (which is really too high), it looks like early CKD to me.

    You want the P level down as close to 4 as you can get it. Your vet is correct that the prescription diets have the lowest P levels; controlling the P is really tantamount to longevity. However, the prescription diets also have the worst ingredients and nutrition and they are lower protein. The latest research indicates that cats with CKD, until they are very late stage, should have moderate (at least 50%) amounts of excellent quality protein.

    Have you thought of trying a raw diet supplemented with something like EZ Complete from FoodfurLife? With the meats added, the P levels are lower than most commercial canned foods (less than 200 mgP/100 kcal as-fed and less than 1.00% P on a DMB).
     
  11. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    To be honest I haven't considered anything yet. The first vet we spoke too called with his lab results and made it sound life or death. She doesn't really want to discuss anything but the Rx diets. She didn't know what SEB was, she made me feel stupid for asking about SDMA, and she was surprised to see me today for a repeat Renal panel which the IM Specialist recommended we have done before Tigger's visit on the 25th. I guess right now I am gathering all the info and advice I can before we see that vet. It's alot to take in and try to organize in my head. The only thing I did do was stop all FF completely and search out foods from the "under 200 mg P/100kcal list." All I want is a competent vet who helps us keep Tigger as healthy as possible for as long as possible. I fear I won't get that from the specialist as she is also of the "don't test BG all day" variety. If this doesn't help much it looks like we are going to Tufts Medical in Worcester, MA.
     
  12. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    Any way for the IM to be primary for Tigger? What was the IM's input on FD? From my experience the visits to the IM weren't that much more $$. If the visit was more it was due to more through tests and examinations. They are also more equipped to handle the multiple issues with my Gizmo (like if they wanted to do an ultrasound they did it during that visit, they didn't have to schedule me to come back). The IM still provided all test results to his regular vet (and regular vet kept IM in the loop if i saw him).
     
  13. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    well . . . they were of the "don't test so much" variety . . . did not love that. They are also a 40 min drive vs 5 min - which is not really a problem, but our cats don't love car rides. They had a hard time getting Tigger to cooperate and sent us home with gabapentin to dope him with next time. Our regular vet has never needed or suggested that and I wonder if the longer ride got him scared? mad? etc. I mean, don't get me wrong, he WAS a handful in the past, but the techs at his current reg vet love him, call him chill, tell us he's easy to work with most of the time. I just didn't love the overall experiences we had there in terms of "bedside manner" but they are definitely more knowledgeable. They email, answer all questions, know what I am talking about when I ask about treatments I learn from you guys (unlike the reg vet). They will no doubt have more to say on the subject of what more we can do for Tigger's health like Calcitriol and Phosphate Binders and any number of things I've been told about on the forum. But, I do feel stuck between the two. Until now things were going smooth enough that we physically went to the local vet and electronically consulted with the specialist if it was even needed. Our regular vet was fine to continue that but as it's been a year since the DKA that sent him to the ER/Specialist and he's had this worsening CKD I figured it was time to go back. I want more answers aside from "feed him prescription kidney diet." If this vet has no better treatment advice I'll find another. And if that one doesn't either I guess I'll do it myself. It just seems harder than FD.
     
  14. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    :bighug:

    I sympathize with the vet woes :( I had a fabulous one and then she left. Not just the practice but left the field completely. I struggled from that point on. The IM was the only doc I truly trusted and then he moved up to administrator duties and quit seeing patience :mad:. It was the worst thing ever.

    Keep looking. Get all of the previous records you can. I even started making "interview" appointments.

    Laid out all that was going on, his many issues and diseases and would just flat out ask them if they were prepared to work WITH me to provide the best QOL for as long as he had left. Be prepared educate yourself and argue for what you believe is right for your cat.

    I think I have finally found a good group where I am taking Frankie now but I also have my defenses up from all my horrible experiences. And I told my current vet as much. :joyful: She said that she completely understands and will work with me to earn my trust. That means a lot to me.

    :bighug:
     
  15. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    Yes, yes, and yes. This is all I want. As much as I don't love the IM vet the difference is, when I ask the regular vet about a medication or supplement, whatever, their answer is "no, you don't need to do that." Maybe they are just saving me money in their mind, but still. At least the IM vet usually says "Sure we can try that and see if it helps." That open mindedness is all I'm asking for. I feel helpless doing nothing. And I really don't want to feed Tigger that horrible Rx food. It was a struggle to get him to eat it those few months we tried it, at the vets suggestion, years ago. Now with the FD he can't go hours and hours protesting food.
     
  16. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    Low carb, low phos food that Trigger will eat is the best food. The longer you can control the phos level with food (before having to add binder) the better. The Rx foods have too many carbs.

    This site is the bible for ckd

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

    Keep posting daily condos, asking questions and doing research. We are all here to help :bighug:
     
  17. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    Thank you. I have had that site as a permanent tab on my browser for the last 2 weeks and I keep reading a little more every day. I have also scouted 3 pet stores and gotten a number of foods to try. It will have to be trial and error with this guy. It seems like a lot of the higher quality shreds are on the list, unfortunately toothless Tigger snarfs and barfs those so they have to be mixed. I am doing a food tab on his SS as we speak. This is more work than work . . .or school ever was!
     
  18. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    Emmersion blender ;)

    I used a large tall drinking cup, put food and a little water and blended. No more shreds :smuggrin:
     
  19. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    omg you're a genius. wth didn't i ever think of that. GAME CHANGER!!!!
     
    LizzieInTexas likes this.
  20. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    Tiki Pets – October 10, 2018
    Hello! The Velvet Mousse Chicken is a complete and balanced diet for all life stages by AAFCO standards. The carbohydrates are 3% and phosphorus is 0.23% in a recent batch. Unfortunately, we do not have phosphorus available in mg/100 kcal. Please feel free to email mail@tikipets.com with any other questions. Thank you!
    This is response from tiki cat about the new mousse foods. Is this good? I am so confused by the different scales of phosphorus
     

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