UTI suspected - ok to submit a free-catch sample for Urine Culture?

[Nimi S]

Link to previous post for continuity:https://felinediabetes.com/FDMB/thr...-a-bad-option-for-regular-daily-meals.276613/

Shen has completed a week on Glargine @ 1U twice daily (prior to that he was on Insugen 30/70 40IU for 11 days).
I’ve been keeping an eye out for ketones by using Keto-Diastix strips for the past 10 days or so, and while all the ketone results have been Neg/Trace, I wanted to do a routine urine test for added measure. I brought this up to his vet and she suggested getting it done from a diagnostic center (human).

His lab report is attached (also updated in his SS) but I’m mentioning below only the out-of-range values:

• Glucose: 3+
  (Interpretation: Glucose: 1+ = 50 mg/dl, 2+ = 100 mg/dl, 3+ = 300 mg/dl, 4+ = 1000 mg/dl)
• Bacteria: 2-3 /hpf
• Pus Cells: 8-10 /hpf
• Epithelial Cells: 6-8 /hpf
• Urine Specific Gravity: 1.010 (I’m unsure if this is outside the normal range)

Since I had to collect his urine sample, I did a free catch and submitted it for testing. I’m mentioning this because I’ve been reading that free catch samples are more likely to be contaminated with bacteria from the external genitalia, litter box etc. So I don’t know if the bacteria was a false positive result or an indication of an actual UTI. And also whether the pus and epithelial cells can be explained away by the limitations of a free-catch sample.

So I now want to do a urine bacterial culture and sensitivity test too, before going to the vet to get her advice / medicine for any possible UTI that Shen may have. I’m sure she might prescribe something based on just the Routine Urine results but in that case I wouldn’t be able to do a culture for 7-10 days after his antibiotic course is done.

Another thing is that since the vet did not offer to collect his urine sample the last time I took him there, I assume she will not be able to perform cystocentesis for the culture sample. Which brings me to my main question - is it ok to give a free catch urine sample for bacterial culture and sensitivity? I would need to get the specific sterile/boric acid container from the diagnostic center.

I’ll enquire with another vet in the morning to see if they can do cystocentesis but I’m not very keen on switching to another vet right now (the current vet is already the third) and describing Shen’s entire diabetes history and getting new/differing advice. But if they do perform cystocentesis, I’m likely to get it done from there, so long as it doesn't require sedation / anesthesia.

Advice requested on doing blood work

I was planning to wait for a few months before getting Shen’s blood work done. His previous blood work (CBC, Fasting BS, Liver and Renal profile) was about 1.5 months ago (08 Mar), prior to starting the insulin. His liver values had improved a month back (20 Mar), after stopping the steroid he was on, but we hadn’t gotten a CBC and Renal profile done again then.

His current vet had suggested doing a complete blood work after completing a week on glargine as she didn’t have a definite response for his continued drooling and prescribed a mouth gel (Metlichlo) for gingivitis and halitosis. A week prior to this she’d said his gums and teeth looked ok and the drooling did not seem to be due to a dental issue :/

While browsing through some other posts on FDMB on UTIs, urine culture etc., I came across some posts on CKD which led me to felinecrf.org.
Over there, I came across the term Uraemia which lists drooling as one of the symptoms. Maybe I’ll get better at identifying symptoms with time, but at this stage half the symptoms for Uraemia seem to be something Shen exhibits too. (I've noticed loss of appetite, licking gravy and leaving some of the solid food behind, eating lemon grass, hunched over water bowl (this has stopped completely since he’s not drinking any water at all ever since I’ve started adding water to all his meals), drooling, lip licking. Basically everything other than vomiting. I don’t know if he’s grinding his teeth but he does something with his tongue which looks like he’s trying to clear something stuck in his mouth. I feel like he’s peeing a lot more than when he was just diagnosed with diabetes - I counted him go 6 times in 12 hours today.

When I first posted on FDMB, Bhooma @Bandit's Mom pointed out that Shen’s phosphorus values were strangely on the higher side (6.1 mg/dl) for a cat with otherwise very good kidney values. felinecrf.org says that one must definitely take action if a cat's blood phosphorus level is above 6 mg/dl.

Does any of this sound alarming enough to get a complete blood work done within the next 1-2 days or should I just do the urine culture for now? I know I might do it anyway since I don’t like the uncertainty around his drooling but wanted to check if the symptoms I've listed called for doing it ASAP.

 

[Larry and Kitties]

A urine specific gravity USG) of 1.010 is bad.. If that is real that means severe kidney degradation. However. attachment image say that was measured by chemical indicator (a pad on urine test strips). USG via pad on urine test strips in not really accurate. A refractometer like this is what should be used.
https://www.amazon.com/Bubblefin-AT...82288829&s=industrial&sr=1-73&ts_id=393272011
I have a similar one.
A culture of a free catch is not optimum but I would say OK is caught midstream. Why can't the vet obtain a urine sample via cysto?
The march bloodwork say "NOTE : Sample Lipaemic" That means there is fat in the blood. Lipaemic book can interfere with some results. In the future I recommend fasting before bloodwork.

 

[Nimi S]

A urine specific gravity USG) of 1.010 is bad.. If that is real that means severe kidney degradation. However. attachment image say that was measured by chemical indicator (a pad on urine test strips). USG via pad on urine test strips in not really accurate. A refractometer like this is what should be used.

I figured that the USG was low but chalked it up to the diabetes. If I'm reading his other symptoms correctly as him having uraemia, then there's something up with his kidneys.
I want to break out into full-blown panic right now, but I'll hold on to the little bit of optimism I've got left and wait for his blood work and urine culture to indicate what stage it’s at.

A culture of a free catch is not optimum but I would say OK is caught midstream. Why can't the vet obtain a urine sample via cysto?

It was pretty easy to catch his urine, just had to lift his tail a few seconds in.

I assumed that the vet I'm taking him to currently doesn't want to or doesn't know how to get a sample via cystocentesis because she didn't offer to do it while we were there. Whereas she offered to do the bloodwork. I'll check with the other vets around who send the samples to veterinary pathology lab instead of human one since the methods of conducting the tests might also make some difference.

The march bloodwork say "NOTE : Sample Lipaemic" That means there is fat in the blood. Lipaemic book can interfere with some results. In the future I recommend fasting before bloodwork.

Unfortunately, all samples were taken after fasting for 14-14.5 hours (advised by vet after fasting for 12.5 hours the first time gave a lipemic sample). I'm not very sure but it was probably prednisolone induced lipemia since the most recent sample wasn't lipemic and that was taken when Shen was about 24 days off the prednisolone. Apparently fasting for too long also causes lipemia by increasing breakdown of fat stores in the body (something that prednisolone also promotes).

 

[Bandit's Mom]

Bandit's urine almost always has some pus cells and epithelial cells (her labs are in her SS). I've usually done a urinalysis with a human lab and sample collection even for the C&S I did only once was by free catch. I've never had a vet offer to collect urine through cystocentesis - might be an India thing.

Bandit's USG is also only 1.01. The first urine of the day is more concentrated so if you can catch that, it might have a better USG. Bandit's urine is always dilute. Probably because she gets fluids daily. And she has CKD stage 2. Strangely, Budge's USG is not much better and she also, like Shen had high phosphorus with pretty normal kidney values. I could not find a reason for that (even with the help of the support group of felinecrf.org) so I've just taken to adding phosphorus binder in her food (Vivaldis Phos-Clear). Here are her labs:
https://docs.google.com/spreadsheet...2AQhwVPRSmngN_k2BMWRppKNkk/edit#gid=490543966

It's possible that Shen is dehydrated from all the peeing from being in higher numbers. Bandit did feel terrible for the first 6 months after diagnosis. She also had neuropathy which did not help. Does he lick his lips at the sight of food? That could indicate nausea.

 

[Nimi S]

Bandit's urine almost always has some pus cells and epithelial cells (her labs are in her SS).

Bandit's USG is also only 1.01. The first urine of the day is more concentrated so if you can catch that, it might have a better USG. Bandit's urine is always dilute. Probably because she gets fluids daily. And she has CKD stage 2. Strangely, Budge's USG is not much better and she also, like Shen had high phosphorus with pretty normal kidney values. I could not find a reason for that (even with the help of the support group of felinecrf.org) so I've just taken to adding phosphorus binder in her food (Vivaldis Phos-Clear).

Yes, I had a look at Bandit's labs a couple of days back and yesterday too, to compare Shen's labs and for the normal ranges. So I wasn't particularly alarmed just by the USG
I was also looking at getting phosphorus binders and B12 methylcobalamin supplements for Shen but was waiting to do blood work first.

I’ll try catching his first urine of the day tomorrow. We don’t use kitty litter for any of my cats - they directly pee in the tray, so I can see that Shen’s urine is very pale compared to the others’.

I've usually done a urinalysis with a human lab and sample collection even for the C&S I did only once was by free catch. I've never had a vet offer to collect urine through cystocentesis - might be an India thing.

I thought it was a vet thing and that the bigger, fancier vet clinics in Mumbai might be doing it. It sounds simple enough. All the bigger clinics are too far (not to mention too expensive) and I don’t want to put Shen through that stress if a free catch sample cuts it.

It's possible that Shen is dehydrated from all the peeing from being in higher numbers. Bandit did feel terrible for the first 6 months after diagnosis. She also had neuropathy which did not help.

I thought he's getting enough water but then he's peeing a lot more too. What will help with the retention/hydration? Only the BG going back to the normal range?
I'm not sure if I'm overhydrating him by adding all that extra water in his food - that also will be an issue right?

Does he lick his lips at the sight of food? That could indicate nausea.

I think he licks/smacks his lips otherwise too, not just at the sight of food. Bron did mention that Shen might be nauseated and if I could get a prescription for Ondansetron or Cerenia. So that is also on the agenda.

On another note, how many hours is good enough for fasting before blood work? Would it be ok if he has his AM shot after the blood is collected, since that’s the only way I can have him fast post his PM shot.

 

[Bandit's Mom]

I was also looking at getting phosphorus binders and B12 methylcobalamin supplements for Shen but was waiting to do blood work first.

I give Budge methylcobalamin mixed in her food. This what I use:
https://www.flipkart.com/zenith-nut...les-each-pack-2-lab-tested/p/itm2645bbb2abcb3
I also give both Budge and Bandit B complex (1/4 tablet of Neurobion Forte) once a day. B complex and B12 supplements are supposed to be good for CKD cats. They're both almost 15 years old now!

I thought it was a vet thing and that the bigger, fancier vet clinics in Mumbai might be doing it. It sounds simple enough. All the bigger clinics are too far (not to mention too expensive) and I don’t want to put Shen through that stress if a free catch sample cuts it.

Maybe the bigger fancier clinics do it... I don't know. No vet has suggested it to me though! They all said midstream catch is fine. And I too want to avoid dragging these two to the vet to the extent possible.

I thought he's getting enough water but then he's peeing a lot more too. What will help with the retention/hydration? Only the BG going back to the normal range?
I'm not sure if I'm overhydrating him by adding all that extra water in his food - that also will be an issue right?

Yes, bringing his numbers below the renal threshold (below 220 or so) will help reduce the excess urination and the load on the kidneys. You cannot overhydrate orally, so don't worry about that.
If you've switched Shen to 100% wet food (ignore the dry food he steals on occasion) you might want want to switch to TR. Get him to better numbers faster.

I think he licks/smacks his lips otherwise too, not just at the sight of food. Bron did mention that Shen might be nauseated and if I could get a prescription for Ondansetron or Cerenia. So that is also on the agenda.

You don't need a prescription. Just go to a chemist and buy a strip of Ondem 4mg (or any brand of Ondansetron 4mg) and give him 1/2 a tablet and see if that reduces his lip licking and improves his appetite. If it does, you know he is nauseous. You can give Ondansetron every 8 hours, if needed, but try twice a day first.

On another note, how many hours is good enough for fasting before blood work? Would it be ok if he has his AM shot after the blood is collected, since that’s the only way I can have him fast post his PM shot.

Bandit is also prone to lipemia for some reason. I cannot fast her - she will not let me sleep. I have at best managed to fast her 5-6 hours because she doesn't eat much during the day. So I usually schedule a blood draw in the early evening late/afternoon when I can get 5-6 hours without food.

 

[Nimi S]

I give Budge methylcobalamin mixed in her food. This what I use:
https://www.flipkart.com/zenith-nut...les-each-pack-2-lab-tested/p/itm2645bbb2abcb3
I also give both Budge and Bandit B complex (1/4 tablet of Neurobion Forte) once a day. B complex and B12 supplements are supposed to be good for CKD cats. They're both almost 15 years old now!

You don't need a prescription. Just go to a chemist and buy a strip of Ondem 4mg (or any brand of Ondansetron 4mg) and give him 1/2 a tablet and see if that reduces his lip licking and improves his appetite. If it does, you know he is nauseous. You can give Ondansetron every 8 hours, if needed, but try twice a day first.

Thanks for the suggestions! I’ll get the supplements and Ondansetron in place and start them from tomorrow once his blood is collected. Don’t want the new medication to affect the sample since I might have to keep getting bloodwork done more often till whatever this is is identified and treated.

Maybe the bigger fancier clinics do it... I don't know. No vet has suggested it to me though! They all said midstream catch is fine. And I too want to avoid dragging these two to the vet to the extent possible.

I’ll try the routine and culture with a free-catch then with the first urine of the day.

If you've switched Shen to 100% wet food (ignore the dry food he steals on occasion) you might want to switch to TR. Get him to better numbers faster.

I think I’m done with the dry food since his stools seem to be becoming somewhat better. I might have to add some variety to the wet food though as I don’t see him finishing all the wet food (for his main AM/PMPS meals at least). That might also be because of the nausea though. I think TR requires most conditions to remain the same, so I wouldn’t be able to experiment with the wet food, I guess. I’m testing more than 4 times a day, so I think I qualify for TR, but it makes me nervous for some reason.

Bandit is also prone to lipemia for some reason. I cannot fast her - she will not let me sleep. I have at best managed to fast her 5-6 hours because she doesn't eat much during the day. So I usually schedule a blood draw in the early evening late/afternoon when I can get 5-6 hours without food.

I had this issue with Shen pre-insulin where he'd knock things down in every room in the middle of the night for food He was the gang leader for the other cats.
I think I can have Shen fast for 8 hours and get his sample collected some time before his AM shot to break his fast with. Poor guy has been very accommodating these last couple of months

Thank you for all the advice and tips you give! It is both relieving and overwhelming to have this forum to fall back on.

 

[Bandit's Mom]

I’ll get the supplements and Ondansetron in place and start them from tomorrow once his blood is collected. Don’t want the new medication to affect the sample since I might have to keep getting bloodwork done more often till whatever this is is identified and treated.

The B vitamins and Ondansetron will not affect tomorrow's blood test.

I think TR requires most conditions to remain the same, so I wouldn’t be able to experiment with the wet food, I guess. I’m testing more than 4 times a day, so I think I qualify for TR, but it makes me nervous for some reason.

There's no requirement that you should feed the same food with TR. Only that you should feed low carb wet food. Dealing with lower numbers is indeed scary till you get used to them. Then they become addictive.

 

[Nimi S]

The B vitamins and Ondansetron will not affect tomorrow's blood test.

I'll start them today then.

I'm sharing a link to a video of Shen doing that thing with his tongue (half gagging, half trying to remove something stuck in his mouth) which I haven't been able to figure out if its a sign of nausea or dental issue. It doesn't look like teeth grinding and there's no noise.
He smacks/licks his lips in the middle every now and then.

I forgot to mention that a couple of days ago while pricking his ears for testing, the blood wouldn't pool into a droplet but would instead sort of spread over. I didn't think too much about it but read a member describe something similar today (thrombocytopenia). It seemed ok yesterday and today though.
I'm just throwing out things/symptoms here in case they can be explained by his blood work reports later.

 

[Bandit's Mom]

I'm sharing a link to a video of Shen doing that thing with his tongue (half gagging, half trying to remove something stuck in his mouth) which I haven't been able to figure out if its a sign of nausea or dental issue. It doesn't look like teeth grinding and there's no noise.
He smacks/licks his lips in the middle every now and then.

Does he have issues with hairballs?

I'm going to tag a few experienced members for their inputs.
@Bron and Sheba (GA)
@tiffmaxee
@Wendy&Neko
@Marje and Gracie
@Sienne and Gabby (GA)

 

[Nimi S]

Does he have issues with hairballs?

I don't think I've ever seen a hairball in person.
Shen and another one of my cats regurgitate their food sometimes from eating too much too quickly.
But Shen hasn't regurgitated or vomited even once in the last 2 months, except for a few days back when he ate some lemon grass and threw up just that.
His grooming has reduced considerably too (for a hairball to form).

I've given him half an Ondem 4mg just now. Will see how he responds to that.

 

[Bron and Sheba (GA)]

I've just looked at the video. Its like he has something in the back of his throat and it is making him gag.
Like a post nasal drip or maybe something irritating with his teeth.
Has the vet had a really good look in his mouth?

 

[Larry and Kitties]

I’ll try the routine and culture with a free-catch then with the first urine of the day.

Make sure it is a midstream catch. That mean you stick you collector in the urine stream after it the stream has started and you take it out before the stream ends. The beginning of the stream is not sterile and end of the stream is not representative of the urine since it can have sludge. Also make sure you refrigerate the urine same as soon as practical.

 

[Nimi S]

Has the vet had a really good look in his mouth?

I personally don’t think so..the first time around, the vet looked at his teeth and gums, so she looked more at the sides than the inside of his mouth.
The second time around she did open his mouth wider but I don’t think she peeked in long enough to see if there was anything stuck or any growth inside.
Shen is really well behaved at the vets and all his symptoms go on standby there, so there was minimal drooling and no lip smacking/ gagging while he was there.

I somehow managed to take a video today since by the time I start the camera he stops doing it.
I’ll show this video to the vet while I’m there for his blood work tomorrow and ask for a better look inside his mouth.

 

[Nimi S]

Make sure it is a midstream catch. That mean you stick you collector in the urine stream after it the stream has started and you take it out before the stream ends. The beginning of the stream is not sterile and end of the stream is not representative of the urine since it can have sludge. Also make sure you refrigerate the urine same as soon as practical.

Thank you for the tips. I did let Shen pee for about 3-4 seconds before collecting his urine, but I managed to collect almost 20 ml so I think I can let a bit more go. He even peed some more after that.

I’ll check with the lab if they can do the USG by the refractor method, in case that makes the result more reliable.

The lab’s very close to home and should be open in time for his first urine of the day but in case he’s early, I’ll refrigerate the sample.
Actually I’m not sure what would qualify as his first urine of the day since he pees so often during the night too. He’ll be fasting from ~4am to 12pm, he almost peed on command last time so I was planning on getting a sample at 7:30am (assuming he doesn’t pee while I’m asleep )

 

[Bron and Sheba (GA)]

I’ll show this video to the vet while I’m there for his blood work tomorrow and ask for a better look inside his mouth.

That should be very helpful to the vet. Please let us know what she says

 

[Sienne and Gabby (GA)]

There can be problems with a free catch urine sample. You don't know if the container is contaminated. The best way to test for a UTI is a cystocentesis -- the vet inserts a needle into the bladder. It's a sterile sample. They then do a culture and sensitivity to determine whether there's bacteria growing and if so, when the bacteria is. This allows the vet to pick an antibiotic that will work on the bacteria.

 

[Larry and Kitties]

You don't know if the container is contaminated.

The following was stated in the initial post: "I would need to get the specific sterile/boric acid container from the diagnostic center.".

 

[Bandit's Mom]

Hi Nimi, did you get the results for the urine C&S back? I think it takes 2-3 days, so probably not. I don't see all the kidney values in his Labs for Apr 25th?
Is the Ondansetron helping with his appetite? Reduced his lip licking etc?

Btw, I think you can take Shen up to 1.25U. Tagging @Bron and Sheba (GA) for confirmation.

 

[Bron and Sheba (GA)]

Yes, I agree with @Bandit's Mom. I would increase the dose.

 

[Nimi S]

Hello everyone! Thank you for checking in
Meant to update sooner but was lost in a funk after the vet visit yesterday and after getting incomplete labs (I see Bhooma noticed that). I also read some more about kidney disease and felt worse the more I read about it.

I'm trying to figure out a better vet who can take my concerns seriously and not make things worse for Shen with their confidently harmful but well-meaning advice.

Wasn’t sure if I should share an update since I have only partial labs (updated in SS) and I am going to see another vet tomorrow depending on when I get the urine culture and sensitivity report. I also got an incomplete kidney profile report (only BUN and creatinine) so I will need to do more blood work tomorrow for the serum minerals and electrolytes.

Vet visit update

I really only meant to visit the vet to get Shen’s blood sample collected and to get an opinion on his drooling/gagging/licking. She is vet no. 2 (of 3) I’d been consulting since the diabetes diagnosis in hopes of getting better advice. The 3rd one is the one who prescribed a mouth gel for the gingivitis.

• When I gave her a ~20 day update of Shen’s insulin journey, describing changes to the insulin type, dosage and his diet, she offered me a syrup called Diamel (I didn’t buy it). She had a look at his BG readings and suggested giving 1U in the AM and 2U in the PM based on Shen being a night eater.
• She didn’t have any response to the bacteria in his urine report other than asking me why I was doing these tests.
• When I described his drooling and showed the video, she made a face and said it could be a dental issue, and that it happens in diabetic patients. For some reason she said that since Shen is diabetic no one would want to work on his dental issues (???). I was equal parts stumped and amused hearing that.
• She checked both sides of his mouth and said he has gingivitis on one side based on the redder gums there. When I asked if there was any medicine for it, she just shrugged.
• For his loose stools, she gave some fiber which I was going to use but then saw that it has Wheat feed, alfalfa meal, sugar beet, wheat bran among other things.
• When it came to the blood collection, she thought I only wanted to check his fasting blood sugar and didn’t understand why I wanted the rest of it too. When I got the report, it had only the BUN and creatinine values in the kidney function tests. I assumed that the serum electrolytes/ minerals would be a part of it and didn’t specify I needed those too since last time they were a part of it. So I need to do that part again since I was counting on the phosphorus levels pointing to something.
• She kept suggesting that I should give Shen the Farmina Obesity dry food or the Royal Canin Diabetic prescription diet. Also suggested including fish regularly and when I said that isn't really recommended, she looked clueless.

It was a totally ridiculous visit. I assume the vet is more of a dog specialist and hasn't a clue about diabetes, especially in cats. I was pissed when I got the labs on mail and when I asked why the KFT only had BUN and creatinine, she replied that the next time I visit, I should bring the names of all tests I want to get done since there are many parameters in each.

Urine test - Routine done, Culture results awaited
I repeated the routine urine with the first urine of the day (mid-stream, free-catch) and the report is more or less the same with a very slightly better USG value but increased pus and epithelial cells. Awaiting the culture and sensitivity report.

General Health update
Shen had a relatively better day yesterday despite the vet visit. He didn’t start drooling till like 3pm, I thought that might have been the Ondansetron but he was back to drooling even after another half Ondansetron 12 hours later.

Yesterday night he also had a tiny bit of blood in his stools which were semi loose. I haven’t been giving him anything for his stools recently - meant to try the S Boulardii capsules but they took a backseat during the last few days.

Drooling because of Uraemia/ CKD
I think I was so focused on thinking about preventing DKA that I overlooked the possibility of him having a kidney issue all along. I don’t know what the culture and KFT results will throw up (his BUN and creatinine values seem within the normal range) but Shen has most signs of Uraemia barring the loss of appetite and vomiting. Felinecrf.org lists drooling as a symptom and while randomly googling I came across this on https://vetspace.2ndchance.info/kidney-disease-in-your-cat/:

In advanced kidney disease cats just peck at their food. They often gag as they would with fur balls and may have digestive disturbances such as nausea and diarrhea. Their apathy causes their water intake to decrease so they become dehydrated. They might stand over their water and/or food bowl without attempting to eat or drink. These cats have all developed uremia – an intolerably high level of nitrogen-containing metabolic waste products in their bloodstream.

This is the only thing that comes close to explaining what I've been seeing him do. I'm unsure now whether the drooling started after the insulin or whether I only started noticing it then, since I paid closer attention once the shots started.

https://www.ovrs.com/blog/kidney-disease-in-cats/ mentions that symptoms of chronic renal failure in cats include:

• Excessive thirst/urinating more
• Loss of appetite
• Weight loss
• Dehydration
• Lethargy
• Strong ammonia smell to breath
• Depression
• Drooling
• Hunching over water bowl
• Muscle wasting
• Dull, unkempt coat

I’m guessing that sort of explains the drooling. I think if he had dental issues bad enough to drool he wouldn’t be eating as much and would also feel some pain on his gums/teeth being touched. But then again cats hide all sorts of pain, so he might have dental issues too.

I’d mentioned that Shen used to hover over his water bowl and food for half a minute or so before drinking/eating but couldn’t really figure out the reason. I’m getting more convinced that it’s uraemia now but don’t know which labs would support with the diagnosis.

I don't know what an ammonia smell is like. Closest I could describe Shen's breath is that of socks but not reeking.

I really need to find a better vet who doesn’t brush away my concerns and who doesn’t make things worse with their advice. Would I have to do an X-ray or an ultrasound if the blood/ urine tests don’t point to anything conclusive? I still feel he has something lumpy/raised going on in his stomach/rib cage area (which the 3rd vet checked the first time she saw him, said it was fine) which is more pronounced when he lies on his side. I'm trying to check with a friend who had a cat with kidney and bladder issues for a vet reference.

DOSAGE INCREASE?
I can see that Bhooma and Bron have suggested to increase the 1U to 1.25U. Thank you since I meant to check about that as well. Will make the change with his PM dose today.
After today’s AM dose, Shen has completed 10 cycles post his first green (97). I hope that merits an increase to the dose. Would love for anything that'll help his kidneys relax a bit. I somehow don’t feel confident enough to take on TR right now without knowing what else I’m dealing with

I haven’t started posting in the Lantus & Biosimilars ISG since I keep having queries for things unrelated to the dosing.
I can’t really make sense of his readings to be honest. I do try to keep the feeding timing and amount consistent nearly every day but I haven’t noticed a pattern yet, especially the last 5 days. I guess whatever infection (UTI/kidney/dental) he has going around is sort of messing with the overall response to the insulin?

OK to give de-worming tablet & spot on?
Shen is due for a de-worming but I'd been holding off while he was on the steroid. I also need to reapply a spot-on since his ear mites are back. Is it OK to give these to him right now?

I'm giving him half an ondansetron during his AM and PM meals pre-shot. Also started with 1/4th of a tablet of Neurobion Forte from today during one of his snacks.
Have ordered the Phos binder and should receive it in a few days. Also ordering the B12 Methylcobalamin 1000mcg capsules.
Is there anything else I could add to his diet/medication right now? I'm guessing he might get on a course of antibiotics based on his reports.

Sorry for the wall of text. I'm all over the place with my updates and queries The only positive thing right now is that Shen's appetite is intact and I hope that counts for something.
Will update more when I have the other lab reports tomorrow.

 

[Nimi S]

The following was stated in the initial post: "I would need to get the specific sterile/boric acid container from the diagnostic center.".

I did get the sterile containers for the routine urine and culture from the center. The culture container had some sort of powder inside which I was told to not discard.

 

[Nimi S]

For some reason, I missed getting all the notifications on mail after Sienne's post.

Yes, I agree with @Bandit's Mom. I would increase the dose.

Would that mean I pull up 1.5U and twist the plunger a bit till it's between 1U and 1.5U ? Will try filling with some water first.

I also meant to update that I'd gotten an x-ray of Shen's head taken on the advice of the 3rd vet who prescribed mouth gel for his gingivitis. She wanted to see if there was some tooth decay she could spot on the x-ray that was causing the drooling. I had a stupid experience at the x-ray center as well, which is probably why I wanted to forget about it.
I'm attaching it here, in case anyone can make any sense out of it. But I'll be taking Shen to her tomorrow morning to have it read along with his other reports and for doing additional blood work for his kidney.

 

[Bandit's Mom]

Going to respond in your condo on the LBL forum so as not to bump up an old condo.