? 8/8 Uncle AMPS 258, +5 111, PMPS 170, +2 190 *BACK FROM VET -long post alert...*

http://www.felinediabetes.com/FDMB/...-4-5-52-5-5-49-6-54-8-60.181313/#post-2009260

Hi All, I took Uncle to the vet to have a check up about 2 weeks ago. He was only a month away from his scheduled 6 month visit. I took him in early because I was concerned about how much water he is drinking and the fact that he started eating the clay cat litter. I have posted his labs on a separate tab cleverly named "Labs" on his SS. Basically as I understand from the vet his kidney values have worsened and his urine is very dilute. My vet even called me into the room to see the vial of urine right after they extracted it.
She was also concerned because she felt his arrythmia had worsened since March when she first noticed it and he should see the cardiologist as soon as possible. Which happened today. More on that at the end of this post...
IDEXX SDMA, Bun & Creatinine values are all worse than 5 months ago, however she suspects (or wants to rule out?) a kidney infection so has put him on a 20 day course of Zeniquin. I really messed up and gave him a half a pill every 12 hours instead of once a day for the first 6 days until I caught my mistake yesterday. She said there can be neurologic toxicity issues, but he hasn't presented any of the things she told me to look for (at least as far as I can tell) so she advised me to keep going with the treatment -giving the proper dose to him finishing out the 20 day course. We will recheck his kidney values a week after that to see if the kidney values improve.
Needless to say I am very stressed out and feeling terrible about possibly overdosing him with this medication
So the cardio visit today is making me very sad and feeling a bit down but not really surprised.
The short form diagnosis reads as follows:
1. Restrictive Cardiomyopathy - Severe
2. Multifocal Ventricular Premature Complexes - Moderately frequent

I have a copy the entire Cardio report so if anyone is interested in more of the details or may be able to help advise me, I have them!
The take away in talking with my vet is that the left atrium and auricle are severly enlarged, right ventricle mildly enlarged. Some scar tissue thinkening is limiting some of the effiacy of the electric charge that is neccessary for proper function. Irregular heart rhythm with intermitent extrasystoled noted.
Meds recommended at this time: Enalapril, Pimobendan, Plavix, and Sotalol.
I am familiar with Enalapril and Plavix but not the other two and I am a bit concerned because apparently the Sotalol is going to be compounded. Not sure about any potential BG issues with that.

So anyway, here we are. I am a bit overwhelmed by everything right now. And like everyone here on the board, I just want my little guy to have a good quality of life -for however long that may be

Thanks for checking in and listening

 

I can't offer any advice, but sending and prayers.

 

Thank you so much, they really help and I appreciate your thoughtfulness.

 

Tons of hugs from us too.

Tagging @Marje and Gracie hopefully she can look at the labs and meds and give you some input. @Wendy&Neko and @Doodles & Karen for heart input.

 

I'm so sorry Barbara, very overwhelming. Marje is out for a few days but @Amy&TrixieCat and @tiffmaxee have lots of experience with kidneys.

It's very hard to have a heart kitty into the mix. It doesn't however sound like Uncle has reached CHF (congestive heart failure) which is good although I may be missing something. Doodles had severe HCM and CHF. RCM is different. Wendy's Neko was on Pimobendan which is Vetmedin. Doodles was not, only Enalapril and a high dose of Lasix for the CHF. All Doodles heart meds were compounded. You should request that they are sugar free. I'm not familiar with Sotalol but it treats irregular heart beats. Doodles keep going pretty strong for a year after his HCM/CHF dx. Hang in there and sorry if this wasn't so helpful. Sure Wendy will pop in when she can with loads of info. I would keep an eye on Uncle's resting heart rate. When he's sound a sleep count the number of breaths he's taking. You want him under 30. Doodles often had higher RR here and there but stayed under 40 for the most part. Sending lots of vines, prayers and

 

That was awesome, thank you for alerting the troops or I should say, the village .

 

So sorry, Barbara... thinking of you & Uncle and sending hugs & prayers Don't be too hard on yourself about the medicine...think of all the love, comfort & care you have provided to Uncle for so many years...that cat is blessed to have you for his mommy, and I'm sure that he feels the love from you and has lived so well so long due to your thoughtful care. I will ask Samba to try to think of others, namely Uncle, and not just his tummy and immediate needs tonight I'm sure he'd want the best for Uncle too.

 

P.S. Uncle is obviously one strong, resilient kitty!

 

I'm sorry you received this disturbing news about your kitty. Sending positive energy your way ...

 

Many prayers and hugs to you and Uncle .

 

More hugs...


I was on plavix for a while for poor circulation and it gave me headaches..... so I stopped. I don't know how it affects kitties.

 

Hi Karen thank you for your reply. VERY helpful!!! You are right. His diagnosis today is RCM not HCM or CHF like Doodles' and Uncle's little brother, so that IS somewhat of a bright spot. I think all the meds are to try to stave off the progression into HCM/CHF and to try to prevent the develpment of an aortic thrombo embollism (which is my biggest fear since I've had two cats experience that and I know how horribly painful it can be). Great advice on watching his RR. I was watching him sleep last night and it was only at 20. The Cardio report recommended the monitoring of his resting breaths as well and noted that if goes above 35 it may indicate the development of left-sided CHF. I will take him in if I see him going above 30 as you say, which is the threshold I used for his brother as well.
Good to know about the sugar-free compounded option. It wasn't until I got home until I realized I should have asked about that. Also, I didn't realize the Lasix and Enalapril could be compounded. If Uncle gets picky about eating the pills in his food, it's good to know that's an option.
Thanks again for all your support

 

I don't have any advice. Just sending prayers. Uncle is lucky to have you to look out for his best interest.

 

((((Barbara))))

Sorry to hear the news about Uncle, but I know you'll do what you have to do to keep him as healthy and happy as possible. He's lucky to have such a good and caring mamabean!

I don't have any experience with all those meds (other than my mom has been on a lot of them!) so don't have any advice, but want to send you some virtual hugs and mega-huge jungle vines for Uncle!

 

Barbara, I'm so sorry that this happening. When Max's kidney values started to rise they went up way too fast. Uncle's creatinine has gone up a lot in six months but it's not horrible if you can keep it from rising. Was a culture run so in case there is infection to see if zenequin is the right antibiotic? Managing heart disease and kidney is no easy task. If fluids are needed you need to give less than normal and unless there's an infection he's at the point where dehydration can be a concern. I'm guessing you put water in his food? I'd add a little more. How's his appetite? With all the meds and the creatinine rising he may become nauseous and need cerenia or ondansetron if he becomes inappetent. I'm hoping for an infection. I was with Max too or at least crystals but it wasn't the case.

 

I had the not so fun task of managing heart and kidneys, with diabetes/acromegaly and a side helping of lymphoma. As others said, Neko was on Pimomedin or Vetmedin and Plavix. She was also on benazapril for her beta blocker - it was doing dual purpase for her proteinuria. She had moderate HCM, 2nd degree heart block and at first CHF that reversed itself for quite a while. Both the initial CHF and later one were brought on by administering fluids to help the kidneys. The vet thought a reversible myocarditis. That's the tough part - kidneys need fluids but the heart can't handle them. Lasix can be hard on the kidneys. At the end, Neko had a really small dose every other day Lasix. At this point we were seeing an IM vet to try to find the balance that worked for her.

You may find some BG impact from some of the drugs. I found that Neko would have a short term BG hit when a new med got added to the regime, but then she stabilized as her body got used to it. @Doodles & Karen Karen found injectible Lasix raised the BG and oral did not. Vetmedin can also be compounded. @Woodsywife (I think it was), had a heart coctail compounded so it was only one drug administration. @jayla-n-Drevon was also balancing kidney/heart issues in her civvie. Another comment on Vetmedin, it really helped with in a couple of days. We were given a powder format, and apparently it is bitter so I ended up loading it into smaller capsules with the Plavix for Neko's heart cocktail.

The RR is a really useful tool. I found what I think was Neko's normal, which was 18-22. When it started to increase, even up to 26, I contacted the vet. It turned out that higher than Neko's normal, but still in the normal range, still meant fluid developing in her chest.

How is Uncle's appy? As Elise mentions, that can be a concern and it was my first clue something was off.

 

I'm so sorry Barbara! I have no advice, just lots of

 

Hi Barbara
Wendy certainly has so much knowledge about this subject.
My Rico was getting sq daily for 6 years when he started pred for water poo which put him in heart failure and a er vet suggesting euthanasia that night
I had her keep him in oxygen overnight and give lasix injectable.
Cardiologist next day.
I understand how you feel as my heart sank after what she said.
She gave him 2/3 weeks.
She put him on vetmedin 2x a day which he still takes. I agree with Wendy that it does really help. He was also on a small lasix dose.
After a year he is off the steroid and I recently stopped the lasix.
The cardiologist told me to give the lasix if over 40rr. (1/2 of a 12.5)
My regular vet also suggested I get a good stethoscope and learn his breathing sounds as it may come in very handy one day. He actually said I should give lasix according to what I hear or don't hear.
Keeping you in my prayers

 

My goodness, Uncle has a lot going on. Just wanted to share that I had two CRF cats, well, way back when we called it CRF, not CKD , and it has been a long while since I've looked at blood tests, and with the multi-layers of Uncle's issues, it wouldn't be fair for me to offer much advice based on my CRF experience alone.

It sounds like you are doing as much as you possibly can, and I will simply just send you and Uncle lots of .

 

Sending vines and hugs.

 

Hi Barbara

We had a bit of a delay so I'm still around tonight I'm so sorry to read so much is going in with Uncle.

When I see kidney values pop up that quickly, I also think about kidney infection. I wish your vet had done an ultrasound before she started him on Zeniquin because she would have easily been able to tell if he had a kidney infection via X-ray ultrasound. If he does have a kidney infection, 20 days is not enough for the a/b. I've been through this a few times and my vets, after dx via ultrasound, have always put my cats on Baytril for 6 weeks. It takes that long to totally get rid of a kidney infection.

If it is a kidney infection, once it is successfully addressed, the creatinine "can" come down. I think it's important to try and get his P down around 4.5. He also needs some B Vitamins to stop his decline towards anemia. Here's a good discussion on Vitamin B supplementation to slow the decline towards anemia.

Insofar as the heart, the atrium and auricle are the same thing. Auricle is the very old term used for the atrium. Scar tissue is often equated with RCM and is what makes it difficult for the atrium to push blood into the ventricle.

One addition to Karen's comment: any drugs that you have compounded, you need to go a step further besides asking for them "sugar free". You also need to indicate "no artificial sweeteners". I found this out when I first had ursodiol compounded for Gracie. It raised her BG and they said it was "sugar free" but when I looked further into it, I found they had used maltodextrin, an artificial sweetener. The compounding pharmacy told me it's typical, when asked for sugar free compounded medicine, to add artificial sweeteners.

 

And I am lucky to have you all, sharing your knowledge, wisdom and compassion to whomever needs it.
Can't thank you enough for being a companion on this journey with us

 

Hi there! Thanks for checking in on us. No culture was run because the vet felt that it was too late to culture the sample (by the time the test results came back) and that she has seen a lot of false negatives anyway. The change in the Creatanine number was a red flag to her in suspecting an infection, thus the antibiotic recommendation.
Yes, I have been adding water to Uncle's food since March in every meal, which is 6 to 8 times a day. I will add more and hopefully he will still be interested in his food. He hasn't had the greatest appetite since I started the Zeniquin, but when I mix in a little of my other cat's raw food, he seems to like it better. I haven't started him on all the heart meds yet, as I need to get the Plavix filled at a human pharmacy and the Sotalol compounded. Thanks for reminding me about cerenia and ondansetron. I have seen many condos here where people have used them but I have never had to.
I also really hope Uncle just has a kidney infection and his levels will go down after it is cleared up.
Thank you again for your advice

 

Hi Wendy, yes I remember all the amazing care you gave to Neko and Karen gave to Doodles. You both are inspirations to me and one of the first people I "met" here. I formed a unique attachment to you both because I read how you were treating heart issues with your kitties as well as diabetes. I treated Uncle's little brother for about 3 years after he had, and survived a saddle thrombus and was given only a 6 month estimate for survival. So I am familiar with Plavix, Lasix, Enalapril, baby aspirin and RR. I also had to do a balancing act with Squeaky as he had pemphigus foliaceus, an auto-immune disorder which required prednisolone. Somehow I'm feeling more overwhelmed by this news. Thankfully you all are already helping me sort things out. Interesting info about Neko seeing a temporary BG impact from new drugs added.
Lasix isn't in the mix right now and also the vet hasn't recommended sub Q fluids for Uncles kidneys yet, so at least that's not in the mix -for now anyway.
Good news that the Vetmedin helped Neko right away. The vet gave me Vetmedin today that says it's chewable tab. Makes me wonder if there is any form of sugar in it. Maybe I need to call the company.
Uncle's appetite has been off since I started the antibiotic. I really hate the idea of adding 4 more meds to the mix while he's on AB's but I probably shouldn't wait till the course is over which won't be for another 2 weeks.
I will be vigilant about monitoring Uncle's RR. It's probably the easiest task of them all.
I'm sure I will want to ask you for a lot more advice as I get my wits about me and start this new journey.

 

Hi Marje, glad you were able to see and repond to my post today.
I do believe I have seen some discussions regarding treating kidney infections on this board. Now I'm not sure how to approach my vet. Should I request an ultrasound asap, finish the Zeniquin to see if the creatinine has come down, and if not have a discussion about the Baytril?
I did speak with her about B vitamin support and she told me she would show me how to administer B-12 at home. Seems a more complete B vitamin regimen would be better though. I also asked her if she thought Uncle may have aenemia because he started eating the clay cat litter and the RBC was low. She didn't think so because the HCT still seemed okay. I also told her even though I switched off of Darwin's to a lower P food I am worried about his phosphorus level rising. We were going to follow up on all this and then today I got the news about his heart. I feel like I need to get a clear plan together to deal with everything, and maybe someone on the board can help me prioritize.
I guess the first thing I need to do is make sure none of his heart meds are going to raise his BG, and then have a discussion about the ultrasound and then talk more about vitamin B supplementation and p-binders.

 

Hi Sarah, that is such a sweet post. Made me smile. I hope you and Samba are doing well

 

I'm so glad to hear your Rico made it through the worst and has thrived. It gives me hope for Uncle. Sounds like you got some good advice from the cardiologist and your regular vet. I do have a stethoscope, maybe I'll play around with it and ask my vet what I should be listening for.
Thanks for the prayers and checking in on us

 

I will just give you this name for online RX. I just had two rx's filled with them for Gizmo. They will (do) compounding.

They have an online form so you can get a quick quote from them and I already had the prescription so just emailed the rx's to them and then called to give payment/shipping info.

http://www.diamondbackdrugs.com/

Please keep us posted.

 

Barbara, I am so sorry to hear Uncle is having all these issues. You must be feeling quite overwhelmed.
You have been given lots of great advice from so many knowledgeable people. I have no experience with cats with heart conditions. Sheba had early CRD but I think anything I know about it has been said already.
I was put onto Sotolol once for an arrhythmia. It slows down the heart beat and makes the heart beats stronger.
He's very lucky to have you for a mamabean.
Sending a plane load of the best Aussie vines to Uncle

 

Oh Barbara, I hate to hear about all the troubles Uncle is having. I can't offer any advice but I'm sending tons of prayers and healing vines for Uncle, as well as hugs for you.

 

Once you start the a/b, the results of the u/s will be a bit skewed as he will, hopefully, have some response to the a/b. I think the choices are to gather info to take to your vet about switching to baytril or finish this a/b, wait a week, u/s and possibly recheck labs and then go from there based on results.

We are driving right now but I know I can find some info to help you with that and I'll try to post it later tonight.

Your vet doesn't seem to understand the difference hetweeen the types of B vitamins. However, it's not unusual. Most of them only think about cyanocobalamin B12 injections for things like IBD and don't think about ORAL methylB12 and multiB supplementation for anemia. You don't need a script or anything from the vet to do the latter.

While B Vitamins should be started as soon as the HCT gets to 30%, I think it is helpful to start as the HCT even approaches 30% esp considerIng how much his has dropped and we know he has CKD.

BBL. thanks for your patience.