Weight loss in regulated cat part 5

Hi @Yong
At BG 214, I gave him 1.2u his +4 reading is mid 171. But this morning at BG 209, I gave him 1.4u, he went low. Doesn't it mean for this BG range, I should give him 1.3u? Lol! I don't know how to do that cos my u-100 syringe has no half point mark so I'm already eyeballing every 0.2. If I were to reduce to 1u as your suggestion, won't he be going high? Is my reasoning logical?

 

209 and 214 are kind of the same number...
The idea behind lowering is we don't want him to go as low as 47 and have to be steered. I think I made another suggested scale on end of part 4.
170 - 220: 1.0U
>220: 1.2U

 

Yup the 2 numbers are close, so I thought if 1 makes him go low while the other makes him a bit high, I thought we meet halfway. So that's not how it works
But u are lowering to avoid the lime green numbers. Ok got it! Will try. Thanks!

 

Hi @Kris & Teasel @Yong @JanetNJ
Can help take a look at my SS?
I thought we were doing well with the dosage, staying mostly in the blues. But this morning he bounced but dropped down in the blues and had a low pmps. No shot was given which I really don't like to do cos he'll be high tmr. Where did I go wrong? How do I adjust the dose?

 

Here's my take on it: you've used a sliding scale and it's helped. However, my thinking when things go wonky is to revert to consistent dosing for a bit to see if that will help to calm him down. I suggest you try 1 u both AM and PM for a few days to see if that approach helps.

 

1u regardless of his pre shot values? Even below 200?

 

Sorry - I should have been clearer. When he gives you at least your lowest to shoot number (170?) give 1 u. If he's above that at PS, give 1u. I see that that you've alternated higher with very small doses or NSs. This suggests to me that a middling dose that can be given both AM and PM is worth trying. The goal is to even out the PSs somewhat to get away from such different AM/PM doses or NS at one dose time.

 

We were having similar amps and pmps few days ago. It's only 2 days back it gets wonky!
What do you mean by middling dose? Sorry if I'm asking dumb questions.
My boy's weight is also worrying me. Weighed him at the vet and he gained like 0.01kg since April! I'm trying to figure out what to do.

 

I'm calling 1 u a middling dose. If he's gaining weight and is getting too heavy, you'll have to cut back on food, especially the dry YA (if you still feed that) - it's very calorie dense.

 

I see. So it's 1u for 170 onwards. I do shoot at 140-170 too. 1u will be too much for that values. What do you suggest I shoot?
His weight is stagnant! Not gaining since last weighed at the vet in April. But then again I suspect he probably would have lost some more in April to May cos his BG was in 300's.

 

OK. Don't shoot if BG is between 140 and 170. Only shoot if it's 170 or higher and then give 1 u. This is a standard way of giving insulin. Sliding scale is a more advanced technique. Problem is, the higher doses are driving his BG down low enough that it's either a NS or much smaller dose next cycle. Then the opposite happens - small dose or NS causes BG to rise, along with any bouncing caused by the low BG. When a problem arises it's sometimes best to go back to basics for a bit. That's why I suggested a consistent 1 u assuming PS is above 170. The goal is to try to even out some of the ups and downs.

Sorry, misunderstood the weight issue. If he needs to gain, feed him more. More FF, more small meals, etc. You're right though, getting better control of BG is key.

 

ok so it's back to 1u twice a day. Any other views @Yong @JanetNJ ?
I dread to think how high he'll go tmr amps. On top of no shot, double stress at the vet.

 

You can try it. I've always been a pretty aggressive dose. If it were my cat I would have done a Skinny 0.5 on that 128 (equivalent to about a 160 on my alphatrak)provided I could test... But I would be hesitant to suggest it to someone else because I would feel aweful if they had to deal with a hypo because of my advice.

 

Hi Waheeda!
I like the suggestion of trying 1.0U BID. We have another Vetsulin kitty that we're trying to switch to consistent dosing instead of sliding scale as well. So things may still look a little wonky when starting it out but be patient. Jebat definitely seems to be saying he doesn't need as much insulin . Let's try giving 1.0U as long as PS is over 200 and when if he gives 170 - 200 while starting this new consistent dosing, skip the first time, get a before bed test to see how he's doing on his own. If he does go up, then next time we'll try 0.25U between 170-200 if you'll be there to monitor him for a bit . He's looking good!

 

You learn by experimenting!

 

I was thinking of just a 0.1 or 0.2 cos he usually runs slightly higher at night. But couldn't try as I had a funeral to attend. Won't be able to test him at critical +3 onwards. I'll be so worried if he's not monitored.

 

Well, without any insulin last night he's 205 at amps! What a surprise! I was expecting a high 300.
So I'll experiment the 1u for the next few cycles. I'm confident 1u is gd enuf in the morning but he tends to run higher at night. We'll see.
Thanks @Kris & Teasel @Yong @JanetNJ

The vet was trying to push the prescriptive wet food to help him put on some weight. Have any of you tried it? I know it's pricey but I won't mind trying if it's good. I can mix it with FF cos he loses interest in FF if I give him that whole day.

 

Honestly, the YA should help him gain weight. Maybe you could do FF for meals and the Burp for during the cycle foods?

 

The naughty boy doesn't consistently eat YA. Some days he eats quite a bit and some days he doesn't. But surprisingly he has finished a whole bag in 2 months. Ya will giv him FF twice daily and see how it goes.

 

Morning!
Jebat is doing well last few days. Yesterday pmps he was hovering around 120. I know I'm not supposed to shoot but I did. A tiny dose I could hardly see in the syringe. I was nervous the next few hours hoping he won't go low. Thankfully he stayed flat. Do you know why he's always flat at night. No curve. Based on last night, do u think it's safe for me to shoot a bit more at 120? Mayb a skinny 0.2? I definitely won't shoot at amps cos he tends to drop more in the morning but I think he can handle it at night. Your thoughts ?

 

Hi @Kris & Teasel @JanetNJ @Yong
Not a good day today. Just came back from the vet. Jebat is having kidney failure too. And he's anaemic and high amylase which is an indicator for his pancreas. I have attached his blood test. We are going for ultrascan on Thursday as his abdomen is a bit bloated and vet wanted to check his pancreas. He'll have sub q of 100ml daily and is on iron tablet. I feel like crying now. My poor boy!
Any tips on his diet? Cos diabetes and kidney failure food is opposite of one another. What do I do?

 

I'm so sorry for double bad news now, Waheeda!
I'm going to tag @Marje and Gracie to have a look at your labs that you posted too. She'll be able to help know which stage CKD which can help determine phosphorus levels. Good news, you're not the first to have a sugar kitty with kidney issues

 

Thanks Yong! I'm feeling so depressed now. Hopefully no more bad news after the scan. Is the anaemia due to the kidney disease?

 

I feel like I've read something linked with anemia before . I'll have to dig around again, unless Marje knows

 

Just when I've managed to regulate his BG, this happens. He's doing so well lately and I was hoping to see the old jebat again.

 

More . He is doing very well with his diabetes, so hopefully we can get this under control too!

 

Thanks so much for being around! I needed to talk to someone. Hopefully we can manage it well.

 

You're welcome, Waheeda .
Pretty sure Janet has some kidney issue experience with her GA boy so she may have some more insight too.

 

Sorry to hear that bad news. I see from the labs he's stage 2. This is about where my Zimmy was when we started sub q's. You may only have to do the sub q's daily until the pancreas settles, then a few times a week. Very anemic. In addition to the iron please give him Vitamin B12 Meth... My cat was boarderline at 29% HCT. I gave b12 for four weeks and the next time he tested he was at 42% and it had completely resolved itself. The other thing I noticed was the phosphorous is high. You want to try to keep that down under 5... so that means either finding a food low in phosphorous, OR adding a phosphorous binder to his current food. the best phosphourous binder is aluminium http://www.thrivingpets.com/index.php/aluminum-hydroxide.html.

The good thing is you caught this relatively early. Sub q's help a LOT. There's a great group on facebook called Cats with Chronic Renal Failure that can really help.

 

this is the best resource for all things kidney failure http://www.felinecrf.org/vitamin_b.htm

 

Thanks Janet. I'll ask the vet for vit b. Is YA low in phosphorus? He's only eating YA, FF classic and burp. I still can't get the info for burp but FF and YA should b ok? Cos I read that kidney disease can't take high protein. So diet wise do I take care of his diabetes or his kidney?

 

The vet did mention phosphorus binder in passing but didn't press for me to get it. I'll Chk with her on Thursday. What about the amylase level? His is out of the scale.

 

He's alrdy taking zobaline which has methylcobalamin. Is that enuf?

 

Actually protein is ok in these early stages. It does more harm then good to lower the protein at this point. That's an outdated idea. The YA zero mature is low in phosphorous at .5 (YOu want to keep it under 1) Fancy feast tends to be a little high in phosphorous BUT that doesn't mean you have to stop feeding it... it just means you sprinkle a little of the phosphorous binder in it. (no idea on the burp food). The phos binder the vet usually gives is mint flavor... not a favorite with cats. the one that I linked you is flavorless. a vitamin b shot at the vet won't help.. you need to get the oral one. I just bought it on amazon. I'm sure you can use Zobaline if you have it. I bought vitacost capsules and just opened them up and sprinkled on the powder.

 

Tanya who does that awesome CKD site also has a book out now... available on amazon. I was going to buy it when I lost Zimmy (not because of his kidney's... he acutally stayed in stage 2 for 2 years without much progression because of the fluid treatments.)

 

Ok I'll get the phosphorus binder online. He's been taking zobaline for 2 mths for his neuropathy. Do I need to give him double dose?

 

I've just joined the cdk group on Fb. Dey hv diabetic cats with cdk too?

 

There are low carb/low phos. foods. When I started feeding Zimmy BFF food his phos level went form 4.7 down to 3.9 in a month. So it might be worth a food change if you want to try that before trying the binder. If he is picky though, then keep feeding the ff and just give him the binder.

 

We have very limited low carbs food over here. From the list, I can only find wellness core and one other brand. And he doesn't like them. I think the best would be the binder with burp. What's BFF food?

 

best feline friends made by weruva

 

https://www.chewy.com/s?query=bff&nav-submit-button=

 

Thanks. I see if there's any local supplier online. Buying from overseas will be too expensive.
I'm anxious thinking about the ultrasound on Thursday. Praying hard everything will be ok.

 

I'm sorry you have this to deal with. The others have given you some good info to get started.

 

Thanks Kris!

 

Waheeda, Zobaline is good for neuropathy and does have Methyl B12 but it doesn't have a lot in it. You could see if your Vet is ok with giving some additional Methyl B12 with Zobaline since that does have folic acid to help absorb it better. Not like you can really overdose him on B12 anyways, they pee out excess.
Bronx's Dad uses these: https://www.amazon.com/dp/B008NIHCZC/ref=cm_sw_r_cp_ep_dp_UHZfzb5BJ1R0R
If you can order them, you could add 1 of those with his Zobaline

 

Thanks Yong! I'll order this online today. The vet didn't even talk about vit b. She was also quite clueless about food for diabetic ckd cat.

 

The BFF food is so expensive if I order online! 1 can is like $20! I thk I will continue with his normal food n add in phosphate binder.

 

@Yong tagged me about the labs and I have a few different thoughts for you. I've had four CKD cats, three who were stable for several years and passed from something else.

First, elevated amylase in cats is insignificant; it's an indicator of pancreatitis in dogs, but not cats. The half Life of amylase is very short so levels can change frequently during the day. The ultrasound will help but the lab test for pancreatitis is the snapfPL if done right there in the vet's office or the specfPL if the labs are sent out. You might want to read my Primer on Pancreatitis for more info.

It's too soon for him to be on daily subq fluids if it's for the CKD. Until the creatinine is above 3.5, he should get as much fluid as possible from drinking water or from you adding extra water to food which will be tough with YA. If you can get the BFF or another canned food, you can add lots of water to it. Subq fluids are a treatment for pancreatitis but I'd want to be sure he has it before I started giving fluids esp daily fluids.

The reason I am cautious about fluids is because if there are any unknown heart issues, subq fluids can quickly overwhelm the heart. I always think it's best to have an echo done before giving longterm daily fluids.

Phosphorus control is critical in how the kitty will feel with CKD. I think it is one of the biggest priorities to longevity. Elevated P can really make kitty feel bad and if you multiply the P level by Ca (calcium), a result between 60 and 70 increases the risk of tissue calcification. He is there so that means you can't just get the P down by feeding a lower P food.

I would not feed a food that is higher in P and hope the binder will work if he will eat one that is lower in P because you have some work to do to get his P down and I think you will have to be aggressive. If he absolutely won't eat a lower P food, then your options are more limited.

While the most important thing is for him to eat, the lower P food you can get, the better but you will also need the binder because his target for P level is 4.5. I believe you are outside the US but I'm not sure where or what you have access to. The food tables (there are US and outside of US) from Tanya's will help you but also remember you need to keep an eye on sodium as well but, for right now, getting the P down is the priority. The renal prescription diets as the lowest P and are quite effective in getting it down but they are way too high in carbs.

You also can't just dump binder on food. I, personally, think aluminum hydroxide powder is the best one...it's tasteless and inexpensive. I used to buy mine at Thriving Pets which Janet also linked. Here is the discussion on Phosphorus control, binders, and dosing. If you need help on the dosing, pls let me know. The binder needs to be mixed into the food, allowed to sit a bit, and then fed. The binder binds the P in the food, not the cat.

Your vet should check his blood pressure. Many CKD cats have high BP and it can usually be controlled easily with a a drug like amlodipine although some cats require a combination of drugs.

And finally, because of his anemia, he does need B vitamins but not just oral methylB12. To properly address anemia, he also needs a multi B. The discussion on B Vitamins on Tanya's can guide you in what to buy based on your location.
It's also critical to address that anemia and get the drop to stop and hopefully increase the HCT. Once the HCT gets below 20%, more significant measures have to be taken.

Please tag me if you have questions.

 

T

Thanks @Marje and Gracie for your reply!
Wow that's quite lots of info to absorb.
His abdomen is a bit bloated so the vet thinks an ultrasound can detect if there's any liquid there which is also harmful cos it can push the diaphragm and affect the heart. I think for my peace of mind, I should go ahead and just check on the organs. It's not easy to arrange for a sonographer to come down.
So first thing to do is to push the phosphorus down. But I don't have BFF here. I'm in Singapore. I can buy online but it's gonna be so costly and I have to wait. Where do I get Tanya's food table?
I've got the phosphate binder from the vet. I've attached the photo. Is that good enough? It's flavourless and I read some reviews online and it's all positive. He's also on iron tablet now, 1 pill a day. The vet said if the red blood doesn't improve then mayb a transfusion is needed.
So u think I shouldn't do the sub q now? But he's so much more alert today after last night's sub q. He does drink about 2 cups full a day.

 

I went to Tanya's website for the food table but the link doesn't work.
Since I don't Hv BFF here, can I feed him Applaws?

 

Hi @Marje and Gracie
I looked through the multi b vitamin list and they are either discontinued, found to contain chemicals not suitable for cats or have sugar which is not suitable for diabetic cats. I'm not sure which I should be buying.
The vet gave me wanse tablets which contain iron, folic acid and cyanocobalamin and I read that cyano is not good cos of the cyanide accumulation. It's mind boggling reading through all the literature.
Can I just buy the b12 methylcobalamine? My boy is still eating well.
As for the binder, the vet has given me the dosage to use. What's your dosing guideline?

 

@Yong
Do you have the formula to calculate the carbs content in a can of food? I can't seem to find it. I found a new brand of cat food from U.K. So am wondering if it's suitable.
Moisture 75%
Protein 10.5%
Oils n fats 10%
Crude fibre 0.5%
Inorganic matter 3.5%
Additives/kg - vit a 5300iu, vit d3 530iu, vit e 7.95mg, taurine 500mg, zinc sulphate monogydrate 151mg, ferrous sulphate monohydrate 35mg, manganese sulphate 16.5mg, sodium selenite 1.18mg, calcium iodate 0.84mg. @JanetNJ this food din seem to have phosphorus. If the carbs is low, I should be able to feed jebat?

 

Wow it's like $1 each here. Just use a binder... It's perfectly fine to use.

 

What do you mean? Zobaline is 3mg... That's a lot! I used to give 2 500mcg pills a day which only equals 1 mg.... One zobaline would be 6 of the pills I used to give. 1000mcg=1mg

 

Yes you can just buy b12 methylcobalamin. I buy capsules of it so I dont have to crush it. Just open the cap and sprinkle on.

 

Maybe drop their customer service a call or email and ask what the phosphorus count is.

 

@JanetNJ
So if zobaline has lots of methyl and yet his red blood cell value is still low, it means I need to give him more?

 

They dont declare every ingredient?

 

You can give it twice a day

 

I'll buy b12 methyl from the pharmacy here. 1000 counts. The zobaline was ordered from Amazon and it costs me $70+ (Us52) a bottle.

 

Can you give the zobaline along with something like this? This is about complex with iron. Iron might help. You need to follow the dosage instructions because you can overdose iron. I have this in addition to the b12

NutriVed B Complex Plus Iron Liquid (4 oz.) https://www.amazon.com/dp/B00076HU3W/ref=cm_sw_r_cp_api_h4gEzb4ES0Q0D

 

Ouch. Yeah I'd get it from the pharmacy too. This is the one I used. Vitacost Vitamin B-12 Methylcobalamin -- 5000 mcg - 60 Capsules https://www.amazon.com/dp/B006U8QZAK/ref=cm_sw_r_cp_api_c8gEzb88V233K


Eta... I used the 500 mcg not the 5000

Vitacost Vitamin B-12 Methylcobalamin -- 500 mcg - 300 Capsules https://www.amazon.com/dp/B0046IET7C/ref=cm_sw_r_cp_api_FdhEzbCXDVWRG

 

Wow 5000mcg. I can only find 1000mcg.
So I just get the vitacost n use with zobaline? No need additional methylcobalamin?

 

The vitacost IS b12 methylcobalamin. That's all it is.


The only difference between the vitacost brand and zobaline is Zobaline has folic acid.

 

@JanetNJ
They replied on the phosphorus and calcium count. Too high?

 

Not sure... I know you want as close to 0.5 % or lower... Not good at the metric system. Lol

Are you on Facebook? There's a great group on the called Cats with Chronic Renal Failure. They are good at this sort of thing. do you know, @Marje and Gracie

 

Yes I just joined the group. I will ask them. Thanks!

 

It's a very vague calculation so the most accurate is going to be if you contact the company and ask for As-Fed values. But the rough carb content is 2% carbs

 

It's mainly based on what I've heard people have been told by their Vet's for needing extra B12. Maybe 3000mcg (3mg) isn't sufficient for more than neuropathy assistance? I haven't looked into it myself, just what I've read around the forum

 

Thanks Yong! Anyway, the phosphorus is too high. No go for this food.

 

I only gave my cat 1 mg plus the b complex with iron and he went from 29 hct to 42 in 4 weeks.

 

I would definitely get the ultrasound done.

I'm sorry to throw so much at you but CKD hasn't so many "moving parts". Right now, I would focus on getting the P level down and dealing with the anemia. Tanya's can be overwhelming and there is a lot to read. It's a steep learning curve.

Sorry...I read you all talking about BFF so I thought you had it. Here are Tanya's food tables for the U.K. I don't know if that means these brands are more likely available in Singapore. The only issue is she doesn't have the carbs on this table like she does the US table.

Yes...you can use the RX Vitamins for Pets Phos Bind. It is aluminum hydroxide powder. I didn't realize you already had it. So you're fine to use it. Just be sure you read what I left you on dosing because it's really important. If it were me, I'd go with the middle of the road on binder dosage to start with. That would be 60 mg/kg or 27 mg/lb of kitty weight for a P level at 7. A loosely packed 1/4 tsp of aluminum hydroxide is 300 mg. You don't have to be exact on aluminum hydroxide so don't worry if you get it a little more than loosely packed. If your kitty weighs 10 lbs, for example, I'd round up and give 1/4 tsp daily. I would just measure out the amount in the morning and sprinkle some on each meal and mix in just being sure that all is used by the end of the day. You should have his P levels rechecked 10-14 days after starting binder, and if it's not down, than the binder dose needs to go up.

If he will eat a lower P food, it's important that you do both...lower P food and binder. I have fought a similarly high P level in my first CKD cat and I can tell you that it is not easy. You can't just dump binder on any food and hope to make progress of the kind you need to make. Again....that's if he will eat a lower P food. If he will not, then you have to deal with what you have because the best food for a cat is the one it will eat and that is especially true for a CKD cat. Personally, I would not have used a binder to drop P from 4.5 down. You don't need binders until the P gets to around 6; low P food can keep the P level down below 4.5 if that's where the numbers are starting. But if the P level is starting at 6 or 7, it takes more effort to bring the numbers down to 4.5.

Also be aware that the binder can be constipating. I did not have this issue in any of my cats but ECID? It's also important that you and your vet monitor the MCV value in his labs since he is already anemic and use of aluminum hydroxide binders can affect this through aluminum toxicity. I've used binders for years in cats and not had an issue with aluminum toxicity but be aware. Watch for any drop in MCV.

I'm not surprised that he benefitted from a subq session and I'm also not saying he doesn't have pancreatitis or some other condition besides CKD that would benefit from temporary subq fluids. I'll let you read Tanya's on Subq fluids and you can decide. Again, for some other condition besides CKD, he might benefit from temporary subqs. But, sometimes, when kitties are stable with CKD, you could be giving fluids a very long time and you can build up scar tissue. One of my stable CKD cats got subqs daily for four years. So it's important to heed what is said on Tanya's about subqs for CKD.

Cats cannot absorb cyanocobalamin orally and so it is usually given as an injection but this type of B12 helps with intestinal issues, not anemia. I am not familiar with those tablets but I feel it's just the iron you want because he is iron deficient, I'd look at some of the iron products on Tanya's under anemia. If you scroll way down on that page, she discusses iron deficiency and also the kind of treatment needed for anemia depending on the hematocrit. If he is not iron deficient, he doesn't need iron for the anemia.....he needs the B Vitamins. And if he has any kind of infection, he should not be getting iron.

The reason he also needs some kind of multiB is because B3, B6, B9, and B12 are all need for red blood cell regeneration and all will help with anemia. For all four of my CKD cats, I never had to do anything for anemia except give methylB12 and a multiB. Back then, the Jarrows BRight did not have the issue of P in the formula and none of my cats were diabetic. However, when my last CKD cat crossed, I sent the capsules I had made with the methylB12 and Jarrows to an FDMB member and it did not raise her cat's BG. When her cat crossed, she sent the remainder to another FDMB member and it also did not raise the BG. It's such a minuscule dose. Of more concern to me is the P becausemyou don't want to add more P when you are fighting P. I still don't believe the amount of P is that great because it's a tiny amount of multi B they get. It would only add 2.8mg of P per day. If it were me, I'd try to find some of the other products or find the older Jarrows without the phosphorus and if I couldn't, I'd just give the Jarrows. I don't think it will raise his P level but you can give more binder if necessary. If it raises his BG, you can tweak the insulin. But what is more difficult is if his HCT drops below 20% and you have to start erythropoietin stimulating agents. That's a whole different ballgame.

You can't tell from this data. You need mg P/100 kcal or the percent on a dry matter basis.

I'm not familiar with this group. The one I belonged to and learned so much....they were amazing....was the yahoo cRF group. Whether members have moved over to FB or not, I'm not sure.

Another long post...I'm sorry and I hope I've answer your questions. Pls let me know.

 

Thanks @Marje and Gracie ! Appreciate the info.
The only food I can find in that list is applaws which is more of a supplement. I just remembered a friend who has migrated to Melbourne so I will ask her to send over weruva. I think this will then help to bring down his phosphorus faster ?
I'll go to the pharmacy here and check on the multi b vits they have. Will get your views thereafter. I don't think the blood test indicates the level of iron and I doubt the vet knows. But if I were to give him what Janet recommended in her earlier reply, will that be ok? Otherwise I'll just buy multi b vit and see how he does with that. I really don't want to mess up his BG when he's doing so well.

 

The Nutrived does not have B3 and B9. The latter is important for anemia. Since B9 is folic acid, you can continue to give him the one you are giving, I guess, it would be nice if you can just give two products instead of three.

 

Hi @Marje and Gracie
Found a vit b complex here with composition as in attached. It has b3, b6, b9 n b12. Should be ok to use? On top of this, I will also give him zobaline and the vet's iron tablet.

 

Nutrived does have folic acid and niacin (b3)

 

Looks good.

Thanks! The listing I had for it only showed the top B Vitamins.

 

@Marje and Gracie @JanetNJ
I found the vit b complex and also b12 methylcobalamin at the pharmacy! So now I have these 2 plus zobaline and the wanse iron tablets.
He eats about 4-5 times a day. So I divide the 1/4 tsp of binder equally and mix in his food. And at each meal I add in either the zobaline or iron tablet or vit b complex. Will this be ok? There won't be any reaction between the binder and the vitamins? No issue of too much vit b either am I right?
Did the ultrasound today. He behaved well and need not be sedated, thank god for that! He can be quite fierce at the vet. Result will be out tomorrow. Hopefully nothing serious. My heart can't take in another bad news.

 

Correct on the b12 that you can't overdose, but some b vitamins you can overdo I think

 

The b complex is 3mg with zinc. Should I give him all or half it? Zinc is ok?

 

That I have no idea maybe ask on fb group

 

The B complex nutrived I have was specifically for cats with a dosing chart. You could see how your b complex compared. I know some people use Jarrow B Right which is for people......
http://www.felinecrf.org/vitamin_b.htm

 

Wow! I hv to give only 1/10 of a tablet daily! That will be tough to estimate. But no mention of zinc or vit c.

 

Grind it up and make cocaine lines. Lol. You could put it in empty gel caps.

 

@JanetNJ @Yong @Kris & Teasel
So got his ultrasound result. I've attached it in case u know anyone who can help. It's either IBD or lymphoma of small intestine. I'm seeing the specialist on Tuesday. Anyone with such experience?

 

I don't have any experience with it. @Marje and Gracie

Do you?

 

I do... with both. I'll read them in a bit and give you some thoughts a little later. We are headed to a movie right now....sorry but thanks for your patience.

 

I don't have any experience either, Waheeda. I hate to tag you @Lisa and Smoky because I know you went through this with Smoky but if you are up for it, do you have any information you can share? @JeffJ I believe is also dealing with this right now and using Chlorambucil as well. And @Lillie had to use it for her Leo's IBD I think.

 

Thanks @Yong for the tags and @Marje and Gracie ya I can wait.

 

Small Cell Lymphoma (SCL) diagnosis and treatment
Leo had the ultrasound and it showed various symptoms about a month ago. The most distinguishing one was thickened intestinal walls and enlarged organs. We opted for direct biopsy thru surgery. The biopsies conclusively showed Small Cell Lymphoma (SCL) in lymph and intestines. Leo is now on:
> Chlorambucil (chemo) every other day
> Prednisolone (steroid)
> Insulin
> B12 weekly injection

He had an esophagus tube installed, but he resumed eating after the Pred started. SCL is treatable. The objective is to knock it into remission. There is nothing certain in the world. But we are treating and hoping. The prednisolone really stimulated his hunger again. Since treatment started he has re-become a normal sugar kitty. My objectives with insulin are to keep him "caloried" without hypo danger. So I am more conservative than many. Leo has an insulin plateau. If I go just over that plateau, his BG goes low real quick. So it is hard to have him in the 100-200 range. Besides all this shxt, he is just about the sweetest kitteh ever. (Spreadsheet tabs updated)

 

Thanks @JeffJ for sharing.
Did the vet give you the option of endoscopy instead of a biopsy which is less invasive? How long is he on chemo? Any side effects? I'm seeing the specialist on tues. Any advice on questions I should be asking the specialist? My boy on top of diabetes also has cdk. He's actually off insulin for 3 days already and I hope this will continue. I hate to think the biopsy and chemo will mess up his bg.

 

This article discusses using a higher chlorambucil dosing every two weeks vice a lower dose every other day (or frequently three time weekly like MWF).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092124/
My Mario was originally on MWF and then switched to a higher dose every two weeks.

 

Sure, no problem. There was not an endoscopy option with my vet. Plus there were multiple organs involved. Open surgery and multiple biopsies were the only way with Leo. He actually recovered from the surgery in "record time". And the stitches weren't that bad. A good side effect is that his belly was shaved and It Was So Soft

The specialist will know what to look for. For SCL, I am not yet an expert. But I know this stuff below.
> Chemo can cause nausea, and there are drugs that can help offset this. For Leo, this has not been an issue.
> The chemo did not mess up his bg much. The prednisolone causes BG rises, so you have to compensate with insulin.
> SCL, if caught early, can respond to chemo. It can go into remission.
> Cats don't lose their fur from the chemo. For Leo, he seems to be sweeter.
> Chemo is pretty cheap, ~$60 for 2 months. Compared to other costs, that is nothing.

I think the chemo is given for months. And Leo may be on it for the rest of his life to combat the SCL. At this point we measure Complete Blood Count (CBC) to measure the effectiveness of the chemo. White blood cells are focused on. Some cats don't make it. Our vet tech's cat only made it a few months on chemo. Our veterinarian had a cat on chemo for 3 or 4 years. With this realization, we make sure we give Leo extra time every day - laptime, extra brushing, some cat gravy, and more rub downs.

Leo is on Every Other Day (EOD) chemo. He has mild nausea all the time. But it doesn't affect him that much. I was heavily recommended by another forum to do Every Other Week (EOW) chemo. You dose really high one or two days in a row, then for 10 days there is reduced nausea. My vet is familiar with both and we are on EOD.

 

Thanks @JeffJ. Your 2 cats look exactly like my first 2. My sugar kitty is the ginger tabby.
My vet said the ultrasound shows it could either be IBD or lymphoma but I have a feeling it's the latter. So I just need to administer the medicine at home? Grind into food? He has b12 and phosphate binder in his food already so I'm afraid he may just not want to eat if he smells or tastes sth different. I feel so sorry that he has so many medical conditions all at once. And he needs a dental soon too. I'm worried sick thinking about his treatments. I just hope he's not in pain and I'm doing the right thing for him.

 

Well, let's wait and see the final diagnosis. He may not need chemo. In Leo's case I had a pharmacy compound it into a liquid. So he gets a squirt in the mouth, then his favorite food right after that. SCL is not painful, it is a slow growing cancer and is treatable.

Ginger kittehs are the best. We had Little Buddy (19 pounds) from 1996 - 2005. Now we have Little Dude who was feral last year. We slowly tamed him, and now he is a luv bug.

 

In 2012, my Gracie showed some very mild intestinal thickening on an ultrasound. She had no symptoms but her semi annual labs indicated her liver values were mildly elevated so my vet had me take her to an internal medicine specialist, who is supposed to be renowned in intestinal issues, for an u/s. I asked him if she could have IBD or lymphoma and he said because she had no clinical signs, that he was certain the intestinal thickening was related to the liver. Her liver values came down but, for some odd reason, every summer, they went up. Clinically, she remained fine with just occasional scarf and barf vomiting. Her intestinal thickness remained the same and so we did this for three years with no changes in her u/s. He assured me that if she had IBD or lymphoma, we'd be seeing clinical signs and the thickness would worsen.

Finally in July, 2015, she started losing weight and her bilirubin went up. He talked me into endoscopy which I wish I had never, ever done. Yes....many cats have no issues with it and many cats have no issues with exploratory surgery. But she did. I had gotten her stable and doing well all around when we did the endoscopy and it was a slow slide downhill after that. Everything changed. I, personally, believe he somehow weakened her intestines in one of the biopsy samples he took but I have no proof.

Her biopsy came back as IBD but the UofA lab always sends all IBD positive samples to UC Davis for PCR and the result of that was small cell lymphoma. I wanted to start her on budesonide, not prednisilone because I felt, even though it is not part of the protocol for SCL, it would be easier on her. But the oncologist and the IM specialist felt the pred and chemo were a better choice.

The pred caused a weakening in her heart (which can be a side effect and all of her previous echoes showed her heart to be totally normal). I think it also contributed to an erosion in the weak spot in her intestines. Ten days after I started the steroid, I lost her to a spontaneous bowel perforation.

What would I do differently? I would not have done the endoscopy. I would have assumed SCL and treated for it with pulse dosing of leukeran (chlorambucil) and budesonide. There is a SCL group in yahoo and the IM vet who often posts there and works with members of that group said, even though there is no research to show that budesonide and leukeran together can treat SCL, for a FD, he would do it. I wish I had done that and taken whatever time I could have had.

Gracie's liver was normal as was her pancreas. It appears that the IM specialist had it backwards....it was the IBD that was affecting her liver values. She would likely still be alive today if I had started treating the IBD with budesonide in 2012. It could have kept the lymphoma at bay for longer although it is generally thought now that with an IBD cat, it's not "if" he or she will progress to SCL, it's "when".

I am not trying to discourage you from doing endoscopy or even exploratory surgery. I just want you to know of the other risks. I'm sure that what happened with Gracie is fairly rare but @Wendy&Neko treated both her cats, FD Neko and nonFD Theo, in the more conservative manner by not doing endoscopy or exploratory surgery and I think she is glad she went that route.

I do know of some kitties that have gone into remission with SCL for a couple years. The main issue I see without a biopsy is knowing if you are treating large cell lymphoma or SCL. They are entirely different beasts. LCL typically has lymph node involvement which is seen less in SCL. Also, typically with LCL, tumors will be present. However, ECID. LCL has to have a more aggressive chemo treatment and it does not go into remission that I am aware of. The prognosis is not usually too good for LCL (I did have a kitty with LCL and even with chemo, she did not live long).

I would join the FB IBDkitties and also the FB Raw Feeding for IBD Kitties groups. They are both great although I think the latter is much more active and you don't have to be feeding raw to post or learn a lot. You can also get a lot of info from IBDkitties website.

I would encourage you to go to the yahoo groups and join either the LCL or SCL groups. The members of the LCL group are friendlier and they welcome SCL cat caregivers. But both groups have an amazing amount of info and help and if Dr. Jory posts, there is a lot of good information from him. You could join both so you can access the info from the SCL group but post in the other, if you like.

There are different protocols for the chemo. My neighbor is currently dealing with SCL in her kitty, Sophie. She has been through two long rounds of chemo and they really seemed to zap her each time. They had issues with appetite; she became more lethargic, and she lost a lot of weight. She did go into a very brief remission after the first round. They have now stopped all chemo and are just doing palliative care. Her appetite has picked up but they know it is short lived.

I hope this helps.

 

Nice summary Marje. I didn't know all that about your kitteh.

I was welcomed into the SCL group. However they heavily pushed the EOW dose, and at least a couple of them were discouraged when I went with EOD (every other day) dosing. So a bit of help there, but also some negativity. They do in fact have a lot of good info on their wiki about cancer, SCL, and treatments.

 

Sorry, I have no experience or expertise in this case.

 

I was unlucky enough to have two kitties with GI issues at the same time. Civie Theo did not have endoscopy or surgical biopsy because his vet is not into invasive surgery unless necessary. Plus he had periodic ultrasounds, and that is supposed to be almost as good as surgery to determine what is happening. He was on pred and pulsed Leukeran, and went into remission for about a year, until he was taken by pancreatic cancer.

Kitty Neko had a heart condition that precluded anesthesia, so she could not have a biopsy or endoscopy. At this point she was going to a specialist because she was too complicated for her regular vet. She had diabetes from acromegaly, kidney disease as well as the heart issue (HCM and CHF) and either severe IBD or lymphoma. The treatment would have been the same in both GI conditions. She was on budesonide because her heart could not take prednisolone. We started out EOD Leukeran, but changed to pulsed because she was nauseated all the time on EOD. Pulsed, which is once every two weeks, gave both her and me a break. You do have to get the dose right. The IM started her on a slightly higher dose than i thought she should be (after consulting the oncologist), and sure enough, her red blood count tanked. Once she was on the right dose, her blood counts were fine, or as fine as they could be with her kidney issues. She had 4 days of nausea followed by 10 OK days.

I learned a lot from the SCL group. They do go a little overboard on pushing for the endoscopy/biopsy IMHO. I know you should have a diagnosis before treatment, but most of the kitties who have these conditions are older and can have other things wrong with them. Civie Theo had his first ultrasound two days after Marie's Gracie did. Marje and I compared a lot of notes during the journey. Needless to say, I was very reluctant to have surgery after what happened to her. Thankfully Theo's vet shared my concerns. She was also very open to learn and we were her first client on pulsed Leukeran. Which I think was better for him too. He didn't seem to be nauseous, or at worst very mild. A little ondansetron took care of it. Neko, on the other hand, ended up needing both ondansetron and Cerenia.

Food becomes challenging. Neko needed low carb, low phosphorus, low salt. Raw fit the bill until she stopped eating it. For her it might have been a texture issue. She had soft tissue growth in her mouth from the acromegaly that I couldn't get treated because it required anesthesia. Finding canned foods that met the requirements and she would eat was tough. I would add a good quality probiotic to the food.