1/23 Cleo AMPS 182, +4.5~116

going pretty well today, except for the mirtz madness. she's been begging for food but turning it down again. ondansetron is on board, tho. babyfood has been a hit and some wellness core dry, but only a little bit of HC FF gravy and that's it.


Cleo has lymphoma and is on CCNU (chemo) + prednisolone.
Inappetance and steroid are big considerations in dosing now. She had liver issues (cholangiohepatitis) but those #s are improving.
She's on chemo, prednisolone, mirtazapine, cerenia, ondansetron, famotadine, denamarin, methyl B12, regular B12 & Bcomplex (weekly), sucralfate for anemia.
Fluids at nite for punky feeling from chemo.
BG#s have been running too high so we need to get them down per vet, and are working to figure out how to balance everything to get her relatively regulated but safe.
We've done the sugar dance for 2.5 yrs using PZI Vet and Lantus, but request input esp from lantus users with steroid/chemo experience

Cleo's SS: http://spreadsheets.google.com/ccc?key= ... 2S1E&hl=en

 

I don't see your SS link. Refresh my memory - is she getting something for stomach acid like pepcid, in addition to the anti nausea meds? I guess the sucralfate does some stomach protecting as well.

Would she allow you to slip a little bit of Omega 3 fish oil into her baby food? It would give a bit of a calorie boost.

 

Hey Chris,
Did I miss it? What was Cleo's phosphorus at with the last test?

 

thanks. added the SS link. sorry, the signature is so puny that i just can't fit much in. very frustrating. so i add more info when i remember.
(forgot to add famotadine BID so thanks for the reminder.)

i've tried fish oil but not one of my kitties will touch any food doctored with it.

cleo gained 1/2 ounce in the past week and her weight has gone up bit by bit since she started the CCNU. before that she was on leukeran and was losing weight by each vet visit. her appetite isn't great, tho, so we've had to throw any diet plan out the window in favor of anything she would eat. she's only been on ondansetron for a few days but i think she looks better since she started it.

vet hasn't faxed me any blood/urine results for the week. i only heard that creatinine is at 2.5 (way higher than normal) and nothing about phosphorus. onco thought it prudent to send the labs outside because some inhouse lab numbers didn't jibe with her prior results so now i have to wait for labs to come in and for onco staff to be around to receive them (they're off friday thru sunday).

 

i'm about to go btb, but just wanted to get a couple more thoughts out there. (i'm becoming the post-and-run bean!) hope they're coherent enough.

you're faced with two potential issues: 1) higher carb foods are not optimal for cancer kitties (and doggies too) - dr ogilvie's work on cancer and nutrition, if you've heard of it, and 2) higher-phos foods are not optimal for renal kitties.

if this was meowzi, and lower-carb, lower-phos canned food was not an option b/c of chemo/appy issues, my choice of the lesser of the two evils would be to feed higher-phos foods and deal with the kidney disease if/when that progresses. i would have to be very cognizant of her phosphorus level, and be ready to jump in with a phos binder or two if/when needed, probably earlier than most other renal kitty guardians do. my reasoning: cancer can kill, quickly. kidney disease is terminal too, but you may (not always, but there's a chance) be able to slow its progression by being really proactive and aggressive in trying to arrest it. in other words, imo, cancer is scarier than kidney disease and i would rather deal with the latter. we went into chemo knowing well the risks to her kidneys (one of her chemo drugs, doxorubicin/adriamycin, is known to be renotoxic or nephrotoxic, if you've seen these terms) and believing the payoff - ensuring that she's cancer-free - to be worth it. would we have made the same choice today, risking kidney disease to avoid the chance of recurring cancer? we don't really know; we try not to second-guess.

you may have to think long and hard on this, and you may come to a different decision than ours on the type of food, and that's fine. just wanted to share my view on this.

 

(((((Chris)))))) can't offer you any advice but wanted to pop in and check up on Ms. Cleo. Just wanted you to know I am thinking about you and sending good vines to Cleo.

 

i appreciate all posts whether support or advice, especially now when we're talking about other issues besides just diabetes. diabetes i've felt i could handle. the other stuff seems much harder.

one thing i forgot to ask the onco is whether cleo's kind of lymphoma is the kind of cancer that feeds on carbs/glucose. guessing not all cancers do.

kidneys are a particular sensitivity of mine because my mom died of kidney cancer (and my first worry about any med is whether it's processed by/retained at all in the kidneys or liver). i asked about phosphorus binders right away and onco said let's not get ahead of ourselves based on one urine test. she clearly really didn't know a lot about nutrition (in my mind) because she immediately talked up KD and i turned her down flat. i know i can find better quality cat food than that to deal with kidney issues.

another question i have is whether the creatinine rise has to do with pancreatitis instead. pancreas on ultrasound looked suspiciously to IM vet like pancreatitis was in the works. but cleo has been more lively lately (for a couch potato) and i'm not seeing the meatloafing i usually see with that. we finally got bupe, tho.

 

Mornin' again, Chris.

I asked about the phos, because you could potentially put binder on the kibble. Most vets (even specialists) will not recommend binders until they register 'high' on labwork. A general guideline for those with kidney disease is to start adding when it reaches 6. We are very lucky to have one of the leading researchers in feline kidney disease here in our city...this is who we see as a specialist. he has always told me to start using it when phos goes over 4.5. Hope that gives you a bit of a reference range. I think there was a link given to you on yesterdays thread to the crf info site. There should be some good articles about phos/diet on that site for you to look over.

Regarding diet - K/D is high carb. Latte has never really liked it and up until the diabetes only tried it every now and again. She ate the kibble for maybe a year, but I took her off because of the grains. The kibble latte gets is EVO, mainly. Sometimes she gravitates to instinct. I use this because she eats it, the protein is of a better source (I hope), its one of the highest calorie foods, and it is grain free. I also understand it is possibly low in carbs, relatively speaking. She has been eating this for about 9 or 10 months. her creatinine has increased from 2.1-2.4 during this time. OBviously other variables could be in play. Her phos has gone up and down during this time, rarely have I even needed to consider a binder. I often choose against it because it can cause constipation and she has enough issues with that already. I think the argument for protein is becoming not so much about how much they get, but the quality.

Good question about the pancreatitis. Since I suspect Latte was/is having a flare at the time of her latest lab work and her creatinine has increased it might be a good question to ask dr p (her specialist) on Monday. i will let you know what he says.

Its a lot of juggling, isnt it? And a lot for the brain to absorb. i think you are doing a fantastic job. Cleo is very lucky to have you on her side.

 

Just a wild guess but how were her BG's doing just before the dx. She'd been ill for a few months before dx, right, so the cancer was probably already growing then. If BGs were dropping or seeming better-regulated than she's been historically, maybe the cancer was using up her glucose. or maybe not. i don't know the answer, just thinking out loud.

she may have a valid reason for not wanting to start phos binders yet. she may not know a lot about nutrition, but i'd hope she knows or can look up pharmacology. binders are not to be taken lightly - alumininium hydroxide, the most effective binder, targets not just phosphates, but also interferes with the absorption of certain meds - the fluroquinolone family (think baytril, zeniquin), among others - and dosing has to be spaced apart. if it interferes with the absorption of a chemo med (not saying it does, i don't know), there could be disastrous consequences. also, certain supps and i'm guessing meds too may increase the absorption of aluminium, raising the risk of aluminium toxicity. with so many meds in cleo's routine, your onco may be prudent in wanting to wait. that said, there are indeed many vets that are too slow in starting renal kitties on phos binders, as carolyn points out.

re: renal food - royal canin's renal line is low enough in carbs, but its quality is pretty much as awful as the other rx foods. we do keep it at home just in case her appy deterioriates, but have only had to feed two cans so far, thankfully.

it is possible. meowzi's renal values shot up when she had her joint UTI-CP flare (could have been attributable to either). and cheryl's winnie's had out-of-whack renal values when she had CP flares. but glad to hear she seems more lively lately.

 

Good Point about the binder and absorption of meds. Thats another reason I am hesitant to use it when latte is on a border line level of needing it...one more possible complication to add to the mix. Thanks for bringing that up!

 

Hoping you and Cleo are having a good day...

 

Just wanted to stop in and say "hi"! Hey, do you ever feel like somebody is following you? :mrgreen:

 

Hi Chris! I hope that Cleo is feeling better and that her appetite has improved..

Sending feel good vines to Miss Cleo!

 

PMPS 238, +6.5 238

higher cycle but she's been pretty happy and bouncy.
walking all over my keyboard each time she jump up and down from the desk.

thanks guys for the wisdom and support. i really appreciate it!

 

It's wonderful to see what kind of resources others here can be for you and Cleo. And it's great to hear that Cleo is 'helping' you at the computer.