05/11 Bubba (skipped AM dose) +11.75 59; +12.25 52; +12.5 58; +13 68; +15 92; +20 86; PMPS & +4 103

Yesterday

Should I still give Bubba his dose of 6.5U?
Woke up late and shot time is in 5 minutes

he has a pretty low AMpS and is going to the vet in a few hours. And he isn’t all that hungry

 

Spoon feeding him and will recheck in about 10 min. Which will be 15 min past shot time

 

Bubba went up slightly from 2.9/52 to 3.2/59

Should I give half a dose at least? He's been inappetent the last few days (we have a vet follow up appt in 2hrs). If he was at least eating on his own volition I would feel better about giving a full dose in case he goes super low then I can feed him MC, but its been a struggle to get him to eat.

Its now 45min past shot time

 

@Wendy&Neko @Bandit's Mom

 

Just saw this. You could also skip so you aren't worried about feeding and testing when you have to go to the vet. So a skip or half dose.

 

thanks Bhooma. I was thinking of half dose too just to keep things coasting, but not drop his sugars and go hypo; or because he's been less than 9.0 / 170ish the past few days, I'm ok with skipping too.

easier to shoot at regular PM time today, than give AM dose 1.25hrs late and have to walk back dosing for PM shot. I think I will skip

 

Good luck with the vet visit. I hope you get answers.

 

Thanks Wendy... I got answers, but one's that are hard to hear

Based on Bubba's various BW values, we suspect Bubba has progressed to Stage 3 CKD... hence his lack of appetite if toxins, etc are building & Bubba just generally feeling poopie

RBCs have decreased to 5.96 from 8.57 (April 20)
WBCs have nearly tripled to 28.43 from 10.70 (April 20)
Neutrophils have nearly doubled to 17.09 from 9.45 (April 20)
Lymphocytes & monocytes have increased
Platelets decreased to 88 from 203 (April 20)
IDEXX SDMA jumped to 28 from 18 (April 20)
Creatinine increased to 361 from 213 (April 20)
UREA (BUN) decreased to 15.7 from 25.8 (April 20)
luckily his electrolytes are all within normal range (although his phosphorus jumped to 2.23 from 1.39 April 20; it was 2.62 March 7)

Urinalysis
for the first time since Bubba's DM Dx Sep 2022, he has ZERO glucose in his urine!
Protein has decreased to 30 from 500 (April 20)
blood is now negative; it was 250 (April 20)
suspected bacteria, query UTI - given antibiotic IM (Covenia - he's had it before with no side effects)

Bubba was given mirtazapine approx. 1.5hrs ago to stimulate his appetite... so far he ate some food - and properly ate too! dove right in, maybe ate a tablespoon (definitely not the whole lot of food I put down, but better than the 2-3 nibbles he would eat at a time the past few days).

Since we've been home, Bubba has meowed twice and starting purring when I picked him up - more to Bubba's old self. He looks more alert than previous few days; I hope this means perhaps the mirtazapine along with restarting buprenorphine yesterday is working to help my precious beast feel comfortable.

Of course my vet and I discussed the "quality of life" factor. We want to assess whether mirtazapine will work to stimulate Bubba's appetite the next day or two and to get him going again with his food intake back to normal.
I want to do more research on providing supportive care for CKD cats and to weigh my options. Of course I want my boy to feel comfortable and pain free, but I also don't want to subject him to invasive care options if it's going to make him feel miserable (such as NG tubes). As a psyc nurse I am aware of weighing health care options for patients. For my boy, it's a matter of food intake (since he LOVES food more than life itself), whether he is comfortable and enjoys the things that make him happy (food, catnip and fresh air). He hasn't been as mobile the past few years due to his OA, so I am used to him slowing down ambulation wise and diabetic neuropathy hasn't helped in that regard as he still walks low to the ground.

It's just so unfair that we've worked so hard to get his diabetes better regulated that we just started to see good numbers on a consistent basis, that his kidneys have decided they're tired themselves and are on the way to retirement

 

Bubba holding pretty steady in the greens at 4.8 / 86 - pretty good for a boopsie who didn't get his insulin this morning!

He just nibbled some raw + MC - not a whole lot, but still better than turning away from food completely (as he's been doing since last Saturday).

Fingers toes eyes arms legs crossed mirtazapine works for my boy and we get his appetite back on track.

 

Sorry to hear the news about the kidneys, but cats can live good quality lives even in Stage 4 so there's still hope.
Tanya's Comprehensive Guide to CKD is our "Bible" on kidney disease. There's also a very good group on Facebook, the Feline Chronic Kidney Disease group.

Feeding a low phosphorus food and/or using a phosphorus binder are ways to help. Weruva has a new line of food they recently came out with called Weruva Wx. They are SUPER low in phosphorus (so low they warn people not to use them in healthy cats)

Giving subq fluids also helps flush the toxins and make kitty feel better.

Don't dismiss the idea of feeding tubes if necessary. Most cats tolerate them very well and they save lives! More info on those here on Dr. Lisa's website.

Hopefully you still have a good amount of time to continue loving on Bubba!

 

Are they going to culture the urine to make sure he's getting an antiobiotic that will treat what he might have? Also note, did the vet say anything about kidney infections (pyelonephritis)? When numbers shoot up quickly (as they did) it's something that should be considered. More information here. And it's treatable. That site is the best place to start on CKD. And I see Chris posted the link to their FB group while I was typing.

Did you discuss ondansetron? Sorry to be a broken record, but it's really the best drug in this case. You do want to control nausea before giving an appetite stimulant.

 

Thanks Chris. I’ve had the Tanya’s comprehensive guide bookmarked for a while now! Have been perusing it today. So much info to consider.

 

No, she never mentioned a culture and I didn't think of it. I was too distraught during the appointment. I'm going to send her an email with follow up questions.

 

Bubba has had really good numbers today! Regardless of his many other issues

He is 5.7 / 103 at PMPS .... I gave Bubba 3.25U - half his current dose of 6.5U.
He got mirtazapine this morning at the vet to increase his appetite; while his appetite has increased a little bit, he still needs some encouragement to eat and doesn't quite eat his usual portion amount; nor really actively seeks us out to feed him/eat (we have been going to him to feed him)
If I could rely on Bubba to independently eat some raw + First Mate canned MC if his numbers dipped, then I would give have given his full dose of 6.5U -- since I can't rely on him to do that (), I only gave half a dose.

@Wendy&Neko @Bandit's Mom - does that sound reasonable?

 

Let's see how he does on the half dose. Plus ketones have not been an issue. After last night, you need sleep too. Have to take care of yourself so you can take care of others.

Did your vet get you Mirataz or the pills? Also, how often are you supposed to give it? Just asking cause some vets aren't up on the latest dosing.

Add ondansetron to that follow up email.

 

Thanks Wendy. I am totally drained and have legit caregiver burn out (not only taking care of psyc pts at work, but also my baby boy at home)... luckily I'm off till the 20th on "vacation", LOL. I'm dreading the heat wave we are supposed to get this weekend... it's gonna drain me even more LOL

Bubba got a mirtazapine pill; his vet says it's every 48hrs. I believe he got 2mg this morning. She said to wait out how this dose goes, then reassess. I'm going to ask for more. I found this handy guide here to Tx cats with CKD

 

So Bubba just ate about a tsp or so of raw beef + some canned tuna! He lied down on his usual spot on the kitchen floor (where he usually goes when asking for num nums) and meowed at my mom LOL. She put food down & he walked away Then she added some canned tuna and voila he ate about 3/4 of it.
Luckily Bubba hydrates independently. Hopefully his vet will Rx more mirtazapine for the next few days/weeks to boost his appetite even more.

OH and Bubba is staying steady at 5.7 / 103 +4hrs after his PM shot ... his PMPS was the same

 

Mirtazapine lasts about 8 hours in cats, every other day dosing is old school. See if you can get Mirataz, it's a transdermal cream you rub in their ears, less likely to have mirtazapine side effects too.

Also this reference, talks about nausea meds too, plus dosing: (2016) ISFM Consensus Guidelines: Diagnosis & Management of Feline Chronic Kidney Disease
and http://www.iris-kidney.com/education/treatment_of_vomiting.html

 

Thanks Wendy. Where can I find info about every 8hours? Anything about dosing I find is every 48hours??

 

I haven't read through the thread fully, but I wanted to share my own experience with Bandit. In Sep 2021, she suddenly began to pee and drink a lot more. Her appetite was non-existent and she was miserable. Her kidney values had deteriorated from Stage 2 to 3. Her labs pointed to an infection. We put her on a 15 day course of Baytril. For 3 weeks we had to give her Ondansetron for nausea, Famotidine for acidity and Cyproheptadine as as appetite stimulant. All of us were miserable. She was feeling unwell and we were shoving pills down her throat 2-3 times a day. I too had doubts about QOL. I think what really worked for her was fluids. We started giving her fluids every day and within a month, she was off all meds and her kidney values had improved significantly. She was back to feeling good and eating well.

Check out Tanya's website. It's superb. I think a kidney infection can elevate kidney values. Treating the infection and making sure he is not dehydrated will make him feel much better. Just wanted to tell you that these things can be turned around. It's like diabetes. With proper treatment and lifestyle management, CKD cats can live happy lives.

 

Here are some relevant pages from Tanya's website:

http://felinecrf.org/pyelonephritis_utis.htm

http://felinecrf.org/appetite_loss_nausea_vomiting.htm

http://felinecrf.org/persuading_cat_to_eat.htm#mirtazapine

 

Thanks Bhooma for sharing your experience; I appreciate that. Last night I sent an email to my vet advocating for Bubba to get ondansetron and mirtazapine for longer term to turn things around and enquired about kidney infection too and about a urine culture. I also enquired as to whether his anemia could also be caused by infection / inflammation as an alternative to reduced kidney disease causing same. I’m just wanting to look at all options and possibilities as to what could be causing Bubbas ailments. Rather than shutting the door on him. Especially since I worked my ass off to get his sugars down and here we are in the blues and greens!!

 

Here is the page on Anaemia and an infection/inflammation can indeed cause anaemia:
http://felinecrf.org/anaemia.htm