Cyrano - Long time, no see

Hello! Some will remember us, others won't. Cyrano was DX with diabetes two years and a month ago and with the help of many fine people on this board, especially jojo, Cyrano had his last Lantus shot on 4/18/2008 and has been in remission since. I'm posting on the Lantus board because this is where I spent 99% of my time. I can't believe how many cats have gone into remission since February 2008 - 110 cats!!! That's so incredible. Wow! party_cat

I recently contacted a woman on another message board who had a diabetic cat and was on Lantus and I highly recommended she give this board a try. I hope you made it here, Chris!

As for an update on Cyrano, he's doing great as far as remission goes. I've attached his Google spreadsheet in my signature - it goes back to our very beginning. Since going into remission, the highest number I ever got was 77. So we're good there.

I noticed over the past month or so, Cyrano's thirst and urinary output were higher, so I finally found a new vet (hated my other one) and took him in today. He was DX with CRF. [Edited: I'm wrong about the CRF DX - it's just low-grade renal failure at this point. He's not lost 70% of renal function.] He's low grade at this point, with his BUN @ 50. I'm scared for a whole host of reasons. The big question for me is about food. How do you handle the need for a high protein/low glycemic food to keep the diabetes at bay (or under control) with the CRF need for a low protein diet? I really don't know what to do.

While there, it was also obvious he needs a dental cleaning too. As my new vet put it, she's on the fence really. It's a risk, especially with his kidneys starting to fail, but moreso because of the diabetes. She's also concerned about not doing the dental for the very same reasons. I am going to do the dental, probably next week, but I am just praying like mad that this doesn't send Cyrano into a relapse.

So any help out there with CRF/diabetic kitties and the conundrums?

 

Hi there

Welcome to the new Lantus forum!
Cyrano is very striking! What a gorgeous kitty!
And congrats on current BG numbers!

I'm very sorry about the new DX for CRF. I know this comes up a lot in the health forums, you may want to cross post this thread there too, just to get you as much info and eyes on your concerns.

How old is Cyrano by the way? I can't get over how striking he is.

 

Thanks!! Good suggestion to cross post and I will.

We're not exactly sure of his age, but he's 15 or 16 years old, we think. I adopted him as an adult cat back in 1998 and the shelter put him at 2 - 4 years old at that time. He's a pretty boy, that's for sure.

 

it's sooooo good to see you and Cyrano! Cyrano went OTJ at the same time I was arriving here. He's so beautiful and his spreadsheet is legendary. :smile:

We have several people here who are juggling CRF and diabetes so I'll send out a shout to some of them.

 

HI Athena!!!
Cosmo is also OTJ and CRF. he's stage 2 (I think) with his CRF and we've been dx with CRF pretty much since going OTJ. His CRF is probably the least difficult thing for me to deal with, in comparison to the CP (I hate CP).

Anyway. with some encouragement of others (prolly WCF), I did a phone consult with Dr Lisa. She was very very thorough. She took my limits into consideration (student on a budget with limited time) and we agreed to keep him on Wellness (Turkey and Chicken flavors) since Wellness uses human grade protein (aka mostly muscle meat, very few organs), is low carb, and these two flavors are low-moderate in phosphorus levels. Like I said, his creatinine # has been pretty stable for the past 2 yrs. Both of his vets (his old general vet and his current internal med vet) agree that the BUN number can be misleading b/c it can spike due to dehydration.

Cosmo started SQ fluids about 18 months ago, and we do it daily. He also gets calcitriol, but that's kind of an experimental treatment.

Please don't hesitate to PM me if you have more questions. I'll check for you here, but like you, I'm off enjoying OTJ and am not as present on the boards as I used to be!!

Give that handsome feller a big smooch from me!!

 

Hi Cynthia - I totally remember you!

You know - I put in there that he was DXd with CRF, but I don't think he's actually there yet. The vet said low-grade renal failure and I just got to CRF in my head. He's no where near SC fluids yet. I don't remember his creatine levels, and I'm going to call my old vet and get his numbers from two years ago to compare. CRF is 70% loss of renal function, right? If so, we're not there yet.

Good to know about the Wellness. I remember back when I was switching Cyrano to canned food and I tried Wellness - he wouldn't touch it with a 10-foot pole. We're all about the Merrick Cowboy Cookout with some occasional FF. I will look into the Wellness food though because that sounds like a good option. Thank you so much.

Cyrano is supposed to go in for the blood test that determines if calcitriol is indicated, but I didn't realize it was an experimental treatment until I got home and read some online. That blood test is $213 plus the venopuncture fee. I think I am going to hold off on that one for now.

I got a bit panicky when I got home (and I'm still really nervous about the dental throwing him into relapse), but research helped. I don't think he's as bad off as I initially thought. At least not at this point.

 

hi athena! good to see you! sounds like you're getting some good advice already. glad you cross-posted on health, too.
there are quite a few who will be able to offer suggestions.
don't be a stranger...

 

Hi Athena,

Nice to see that Cyrano is as handsome as ever and still OTJ.

Here is a nice bit of information / resources put together by Holly and Spader on CRF/CRD/CRI (seems like everyone is using some different terms these days for same thing

viewtopic.php?f=3&t=7789

Melissa and Popcorn also have a nice post crf resources:

viewtopic.php?f=3&t=8039

Do you have his Creat and phos numbers? would help to see those. You listed BUN at 50 right?
Did they do a USG? ( urine specific gravity)
any bw abnormalities besides the BUN you mentioned?

Winnie had CRD, as does my civie Wolfie.
Cats do not usually show signs of the condition( symptoms and bw ) until there is 70% loss number you mention. (sorry don't mean to scare you ) The reason being that even at/up to 30 % of function, most cats do just fine.

In one way it's just like dealing with FD ...... need to read up on it and learn so you can best advocate for Cyrano and make the best care decisions for him.

There are many tools available to treat the symptoms of this disease and to slow down its progression ( no cure
That said my civie has had the disease for 6/7 years with very slow progression and few symptoms.
I treat him with subQ fluids, calcitriol ( to note we decided not to do the expensive b/w . It's nice to have, but not always necessary. It seems to really have helped him. I *think* the link to dr. nagode and chew's info on it's use is on holly's resource sheet. If not let me know and i will dig it up for you)
Winnie was on it as well. He also has high blood pressure ( a very important thing to have checked w/ a CRF kitty........ Sr kitties in general) and takes med for that.
We are thinking of adding azodyl in the near future.
You mention you are feeding CC. I feed merricks and they are rather moderate phos and i have not had any problems feeding that food. As mentioned by others, protein restriction is no longer considered the best thing to do ( except in very late stage) .
Phos values are more the key to follow. You might find he is ok on his merrick. ECID !

Ok have thrown a lot out here at you and it is late.
Please post back with your b/w and USG results if you have them.
and if you have more questions -- of course ask away !
There are many folks on this board who have experience with this disease.

Nice to see you guys.
Scritches to Cyrano.

 

Hi Jill - I won't be such a stranger. ;-)

Cheryl, I'm sorry about Winnie. Thank you so much for all that you posted.

Here are Cyrano's numbers - 3/4/10:
Creatnine: 2.1
BUN: 50
Phosphorus: 4.9
USG: 1.028

His numbers two years ago - 2/9/08:
Creatnine: 1.1
BUN: 45
Phosphorus: 3.0

We are going to do the PTH, Ionized Calcium test when we have his dental scheduled.

I looked over Janet's canned food list and found out that the Merrick Cowboy Cookout has a phosphorus level of 203, which is good I believe. Dr. Lisa recommended 200 or less, right? There were some other foods on there that I noticed, specifically some of the Wysong flavors, that were low phosphorus, low carb and lower protein. I am going to go out and get some of those and give them a try.

As usual, this place is a treasure trove of information and support!

 

Hello yoyo kitty! Glad you're staying flat these days! Remember this? :razz:

(For those who don't know Cyrano, check out the highs and lows BG-wise on that chart. He was *OFF* insulin then!)

You've got good info from the others, so I won't repeat. Just wanted to share my thoughts on dental cleaning. IMHO, I'd do it. CKD doesn't get better, and is likely to progress. Better to do it now, then wait till his renal values deteriorate further, and the risk of anesthesia is higher. (There is always risk in anesthesia, even for a non-CKD kitty). JMHO. Ask your vet if putting him on IV fluids pre- and post-procedure may protect his kidneys further. She's right to be cautious, but it also means that she's aware of the risks and do whatever's possible to mitigate them.

Meowzi is so much further along in her CKD progression that our two vets and myself are afraid to put her under for a dental unless she absolutely has to have it. If I had the chance, I would have had it done before it's progressed this far, but now we are likely to just monitor and hope she doesn't go beyond her mild gingivitis. Both vets did suggest I consult a board-certified veterinary dentist for a consult if I felt strongly about a dental, but neither of them have the confidence to put her under, themselves (and I appreciated them telling me that).

 

Hi WCF - so good to "see" you! My yo-yo kitty! I know. We went through it with him, didn't we? I feel so blessed that he's been in remission for so long. My new vet (the one who dx the early renal failure) was very impressed that I'd managed to keep him in remission for so long, given his weight, history and age. She's very much on board with home testing too and appreciated my spreadsheet. Two big thumbs up for her!

After doing some research and thinking about (and listening to my gut), I'm going to do the dental. I know there are risks involved, but there are also risks of not doing it, and as you said, if it becomes imperative down the road and his health is further compromised, that's going to be a very sticky situation. This is my vet's position as well. Today she's off, but she's in tomorrow and we're going to talk it all over again and I'll ask her about the pre and post-op IV fluids. He'll have his dental next week.

nailbite_smile

Yeah, it makes me nervous - I can't lie.

Meowzi and Cyrano will be doing the CRF thing together.

 

Yike$$$$$!

This is $213 for just the PTH and ionized calcium??

If yes, I'd call the vet and ask nicely, if 1) the test is being sent direct to Michigan State Univ, and if yes, 2) if someone made a mistake and read the charges for the wrong test.

MSU has the only animal lab in the country that runs the PTH, and if it's sent through any other labs, like Idexx or Antech, there's a markup. MSU charges only $31 for the two tests. See this link. Best to send directly to MSU and cut out the middle-labs, plus it gets there faster too. There'll probably be a lab or tech fee from your vet, which is reasonable b/c you do use their lab and personnel and time and materials for drawing and prepping, and possibly vet follow-up calls to the lab to consult their endocrinologist, but I just don't see it add up to a cost in excess of $200+
(holy kittens! :dizcat )

I forget - you're in the U.S., right?

We just did our PTH and iCa this week (waiting for results either today or next week). We paid $62+ for the tests, not including shipping. If you do decide to start calcitriol therapy, you'll need to monitor his PTH and iCa regularly (we did it quarterly once we had the dose tweaked and values stabilized, initially it was more frequent) - then it is really worthwhile getting the MSU Fedex prepaid mailers - think they were $12 apiece with free overnight shipping back to MSU labs. That's what we use to ship - I have a stock of mailers at the vet's.

Don't forget to fast him for the tests. If his vet isn't familiar with them, bring in the instructions (link above) - it does need to be prepped and frozen/chilled before mailing out.

PS: BTW our total vet bill this week was $213: $138 for Antech tests (CBC, Superchem + thyroid profile); $62 for the MSU PTH and iCA; and $13 to express ... umm certain glands that a delicate princess like Meowzi would prefer I not mention in public.

 

WCF - WHOA! Thank you SO much for all that information. I did call and spoke with the practice manager and they do send it out through another lab and that's why there's a mark-up (aka GIANT RIP-OFF). I sent her the link to the MSU page to help her out. She's going to call me back later and let me know what they are willing to do.

Thanks again - that's a huge difference to pay for a lab to receive a sample and resend it out elsewhere. Ridiculous.

ETA: WCF - thanks again. And my vet thanks you too! She said they've used MSU directly for other tests before but didn't realize that MSU did the PTH and iCa test directly. They are now going to offer this to their patients instead of using the outside lab to shuttle to MSU. So they are going to draw the blood, spin it and freeze it for me (and help me package it the first time) and then I'll ship it directly to MSU and pay them directly. They will then charge me the doctor consult fee. So, instead of $213, it will be $31 + shipping and the doc consult fee. They already charged me one venopuncture fee for the other blood test yesterday and they are just going to include this draw in that fee. You saved me a bunch of money today - thank you SO much.

 

Wonderful! Glad to have helped!