? 08/21/18 Willow Labs Update... Hypercalcemia & Anemia...Help please

Hi everyone,

I've updated Willow's lab results from blood done Monday. I'm really concerned about the anemia; I started her on Jarrows B Right B-Complex after the last blood, but apparently it's not helping enough. My vet isn't concerned...She seems to have a very "it's her CRF" viewpoint, as if there's nothing that can be done to slow it down, or maybe she waits until it's really bad?

My vet is concerned about her calcium...Wants me to start subQ fluids to flush her (normal saline), suggested furosemide and steroids (if I start steroid I'm to stop her cartrophen), and then if I do the two together, I'm to start oral potassium to prevent hypokalemia, and sulcralfate to prevent GI ulcers.

Waiting on the actual numbers because I forgot to ask for my copy for GGT, TBili and Phosphorus, which she says are normal (though I have doubts on the phosphorus). I'll update lab tomorrow with those.

From Tanya's site I'm seeing I should repeat the Ca test, and if it is still elevated, do a ionized Ca test before treating for hypercalcemia.

I'm scared of more blood drawn with her CBC numbers, since she's not replacing it. Should I be?

Please, can anyone offer advice on next steps??

She's on lowish Phosphorus/LC food (we have to mix foods into a slurry) in 14 meals with meds mixed in.
B12 injections weekly, cartrophen every 12ish days, gabapentin daily, lactulose, cisapride (though we're stopping that, it's not really helping) clearlax, probiotic, along with usual antinausea/Appy stimulation/painkiller as needed.

Also fighting a recurring horrible UTI, just stopped baytril and about to try amoxil tonight 100 mg 3x daily, terrified because she vomits/lethargic/horrible with Aventiclav.

Also just had 3 back to back reductions.

And we're moving Friday 16 hour trip over 3 days.

She's 18 in a few weeks. I'm starting to feel we're maxing her meds out. She's not a great eater and has horrible neuropathy, so hardly moves.

Please, any advice/ help.

With love, Nikki

PS tagging @Marje and Gracie as you've looked at her Labs before, hope you don't mind.

 

Wish I could help, at least I am bumping you! Good luck !

 

Oh Nikki, I'm so sorry to hear you and Willow have so much going on. It sounds tough. I'm afraid I can't give advice, but sending vines and moral support in hopes they help a tiny bit.

 

Just to let you know Marje is away for most of the month so will most likely not be on the forum. Hope someone else can help with the labs.

 

Thank you...I haven't been on as much as I like so am out of the loop as to who is where I do hope someone can help, I'm feeling completely over my head right now!
With love, nikki

 

I wish I was that knowledgeable to help. Very best of luck really hope someone else can help you out.

 

Your head must be spinning right now.

Your questions are way over my grade level and I cannot read labs. And the meds proposed are far more complicated than anything that I dealt with.
@JanetNJ highly recommends a Facebook group "Cats with Chronic Renal Failure"

Some thoughts:

It is very important, since you are moving on Friday, to have a vet lined up in Ontario in advance. Have a copy of Willow's entire file with you. Have two copies so you get to keep one. If you need to make an emergency stop en route, you don't want to lose your only copy of the file. Your vet may want to write a summarizing note but given the circumstances may go along with the whole or most recent files. Get as much as you can.

Diabetes needs to take a backseat to everything else – even the constipation.

Constipation. Are you giving the cisapride 30 minutes before a meal? Hard to do if you are feeding 14 small meals a day. Any of the meals larger than most?

From Tanya's site: Home > Treatments > Phosphorus, Calcium and Secondary Hyperparathyroidism

Slippery elm bark contains calcium, so it is probably safer not to use it if your cat has hypercalcaemia.
Some people have found that using lactulose to control constipation has led to hypercalcaemia in their cats. This may be coincidence, since hypercalcaemia is not uncommon in CKD cats, but you may wish to avoid lactulose if your cat already has hypercalcaemia, and consider alternative treatments if your cat has developed hypercalcaemia since beginning lactulose. See All About Constipation for more information and alternative treatments for constipation.

You may want to hold off on stopping the cisapride if you stop using the SEB (according to your spreadsheet) or switch to something other than lactulose. Adding a bout of severe constipation to the mix is the last thing you want or she needs right now.

I'm hoping the labs are not as bad as the vet makes them out to be.

 

I relate a lot to what you said about feeling like you're giving so many (too many) medicines and she's 18.
I had two seniors cats prior to Macka and the first one, Sonia, was my first cat. Also my first cat to become old: out of despair I moved mountains to try to cure her from all her health issues that she started to develop (she was 20). The problem is, one medicine could help with one symptom, but would create another health problem, and so on... until it was just too much and her body just shut down. It was very, very hard. To this day I feel like I overreacted by wanting to save her at all costs. The second kitty, Minette, had a mammary tumor, gingivitis and bad teeth in general. She wasn't a candidate for anesthesia unfortunately. So we let her live her life of tiny little old lady, no medicine, no stubbornness on my side, I tried to accept fate, she wasn't in pain. She passed peacefully in her bed at 19.

I am not saying you should take example, not at all, your baby's case is unique and I don't know her nor her condition. All I can say is that I don't feel as much guilt with Minette as I feel with Sonia. Now with Macka, I try to find a balance between wanting to cure at all costs versus being more conservative, not simple!

 

From looking at the labs, the hct isn't in dangerous territory yet. You would need to take action when below 20%. When it got there for Gizmo he got Epogen (esa) shots which really helped (albeit $$). I too worried about blood draws but it has to be done. FYI - we never knew the cause of the anemia.

Very curious what the phos level will show.

I know nothing about Hypercalcemia or treatment but here is a link to some info.
http://www.felinecrf.org/symptoms_regulation_minerals.htm#calcium
http://www.felinecrf.org/treatments_regulation_minerals.htm#hypercalcaemia

If phos level remains good (as previous, I think, not used to looking an "international" numbers ) i might consider raw liver or liver shake to see if that would help with the anemia. I also gave Gizmo freeze dry hearts (which he loved). Just keep in mind organs are high in phosphorus. There is always the option to use binders.

Also, have you had Willows blood pressure checked?

Are you using D-Mannose?

How is Willow feeling and doing overall? How is the appy? How well does she travel? Good luck with the move.

 

Thank you I will join that FB group, and thanks for the reminder of the file copy! Will request that today.
Willow isn't constipated with tiny hard stools (yet), is just a very slow pooper(very poor motility) and cisapride doesn't seem to be helping. The lactulose/clearlax just keep it comfortably soft. We generally manage to give cisapride after a 2 hour stretch of no food, before a meal...But only in the morning is it before the biggest one. Absolutely don't want her constipated though. I actually have her off SEB ( couldn't time it with everything else and their spacing) but thanks for the reminder. I have to redo that bit of my SS.
Thanks again, with love, nikki

 

There's also a great ckd group on fb called Cats with Chronic Renal Failure

 

Thanks for the reassurance re blood draws...Do you think it would be wise to have it drawn today to recheck the Ca and have ionized Ca done if it is high?

How pricey were the shots, if you remember and don't mind saying? Probably totally different in Canada, but we're moving to the border of NY.

The shake is a great idea, though she was getting a fair bit of duck liver freeze dried treats on her food for a while. I'll think of that with binder.

Where did you get the hearts?

BP was actually down some to normal it's been borderline high end on visits before this.

Overall doing ok for her Appy varies by day but we usually get her to eat full meals most days. Generally just sleeps and eats, was getting a bit livelier past few days off of baytril. Started amoxi last night. Travels ok.

Thanks so much! With love, nikki

 

Thanks! I'll join that group. With love, nikki

 

Thanks for sharing, Penelope. That drug interaction is just the problem with these drugs, sigh. I know it reads like a crazy amount of meds, but she's not on all of them all the time.
We're quite realistic, and just try to keep her comfortable and happy...For us it's about quality of life, not quantity/length. Took a few pets to learn that.
Thanks again, with love, nikki

 

I agree that the ionized calcium test should be done before treating (our civvie Allen had hypercalcemia)
Allen was on Alendronate for the hypercalcemia....it was given once a week but he had to be fasted beforehand...I think the recommended fast was 12 hours but we kept decreasing the fasting time and got it down to 4 hours and his ionized calcium remained in a good range.

 

http://www.felinediabetes.com/FDMB/...106-3-5-94-4-5-82-11-162.191540/#post-2137165

I used to get it through Drs. Foster and Smith but they are now Petco Pharmacy.
https://www.petco.com/shop/en/petcostore/product/epogen-injectable-solution (~$50/vial)

Epogen must be shipped overnight priority ON ICE - so that added $20 per order. One vial was ~4 doses. I always ordered 3-4 vials at a time because it was $20 for shipping not matter how many I ordered.

Just FYI - I had to get different syringes with stiffer needles because the very hard rubber cap on the epogen vials.

 

Good luck with juggling all the new issues. Are you seeing an internal medicine vet or will you in the new place? I found mine really helped me with the juggling and prioritizing multiple conditions and meds.

You should be able to get freeze dried heart treats at any place that also sells raw pet food. Yappetizers is one Canadian brand that gets all paws up here.

When I was seeing the IM doctor with Neko, I frequently saw another of his clients that was getting Epogen at Costco and he told me that was the best price, at least on the west coast. That meant no shipping cost.