1/8/21 Moo Moo update-bloodwork

Hey y'all,
Last post here

Here is Moo Moo's new bloodwork

This (below) is what her bloodwork was last time
I don't know why they didn't also check electrolytes this time. I'm guessing since they want to see her again Monday they weren't as concerned about it? I'm concerned about low potassium, so I can ask Monday when I bring her in. They didn't say what stage she is in of CKD, but they were also the busiest I have seen them in awhile.

Dr. B gave her more fluids to get her through the weekend and also prescribed her Epakitin (phosphorus binder) and Metoclopramide (1/4 tab b.i.d. for nausea). He said where they drained the pus from her eye socket is healing very nicely.

Her blood ketone meter is being delivered Monday, and her low phosphorus foods and thriving pets binder are being delivered today at some point.

Some questions I have are: I have some thriving pets aluminum hydroxide binder being delivered today, should I give Epakitin moving forward and return the thriving pets binder? If so, how do I give the Epakitin? I'm 99% sure doc told me how, but it must've just went out the other ear. Also, what are my next steps with her?

She can't make it up her pet stairs still, but she wants to lay in my bed with me. I'm scared she's going to try to jump off and really hurt herself if I let her, and while I can watch her 99.99% of the time, I'm afraid she'll try to follow me if I get up to get a drink or use the bathroom. Should I let her sleep on my bed?

Her sugar has still been low, and so she hasn't gotten any insulin since Monday morning. Either she's in remission (doubtful) or at risk for going into DKA. She is being pretty affectionate right now, so she has to be feeling at least somewhat better. She is purring again, still weak, but purring.

 

This
https://felinecrf.org/phosphorus_binders.htm
says The recommended dose is 1g of Epakitin per 5kg (11 lb) of cat given twice a day with meals.
The above reference also give instructions for using aluminium hydroxide. The aluminium hydroxide is better reducing phosphorus and the dosage is based on weight as well as phosphorus level. I have used only the aluminium hydroxide.

Her potassium level was at low range last time and low potassium cause muscle weakness. Did you vet suggest a potassium supplement?

You need to get her phosphorus level down.

 

Hi Sydney,

Been watching out for your new thread.

I've been down this road. Metoclopramide is primarily a prokinetic agent, not an anti-emetic one in cats. It can help with gut motility issues (speeds up gastric emptying), but it's not great for kitty nausea. According to the section on nausea treatments for felines in the IDEXX pancreatitis treatment guide, it is thought that cats have very few of the receptors upon which metoclopramide acts to exert some anti-nausea effect.

Fingers and paws crossed that Moo Moo won't need any anti-nausea support over the weekend. If she does, I'd recommend asking the vet for ondansetron (human drug, available at regular pharmacies with vet Rx) or Cerenia (veterinary drug). The linked document above has further info on these treatments (and they're indicated for other conditions, not just when a cat has pancreatitis). Also there's very helpful info here:

Nausea symptoms and treatments

How is she eating at the moment, Sydney?

Suggestions: Could you move the mattress onto the floor, or do you have sofa seat cushions or similar that you could use as a makeshift bed, so that you could sleep down at floor level with her?

Another suggestion for when you're at work - a 'kitty hotel' (space for bed, feeding station, 'facilities', and room to move around), e.g:








They're great for keeping a cat that temporarily needs its movements restricted in a safe environment without it feeling cooped up. Also, no risk of catching the eye area on protruding/sharp things when scent marking.

You can get kitty playpens in different sizes for fairly reasonable prices on eBay or Amazon. Lining the base with plastic and then covering it with pee pads can help manage any peeing issues.


Mogs
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@Larry and Kitties He did not suggest a potassium supplement, I was going to ask about her levels and a supplement on Monday. I don't believe they tested for it today. So do you recommend just giving her the thriving pets aluminum hydroxide starting tomorrow? It wasn't here when I got home, so I started with the epakitin. The aluminum hydroxide just got delivered 5 minutes ago.

 

TABLE 2. IRIS Guidelines: Staging Feline CKD by Serum Creatinine Concentration
STAGE & DESCRIPTION SERUM CREATININE CONCENTRATION
Stage 2 Mild Renal Azotemia 1.6 to 2.8 140 to 250
Stage 3 Moderate Renal Azotemia 2.9 to 5 251 to 440
Stage 4 Severe Renal Azotemia > 5 > 440

Looks like she is in the beginning of Stage 3

 

@Critter Mom She hasn't eaten much besides some treats and a bit of baby food. She's sleeping right now, and I am going to try with some more foods when she wakes up.

I've slept on the floor since Tuesday next to her cat bed, but she really wants to come up onto my bed like she would've before she got sick. I will look into the play pens!

 

@Marje and Gracie
Hi Marje, only tagging you because I saw you commented on @phakewishard
last post about Moo Moo blood work
She just had it done again #1

They prescribed a phosphate binder Epakitin , she doesn't know how much to give and how to give it

She did say she already ordered the Aluminum Hydroxide from Thriving Pets


This is what she said below
Some questions I have are: I have some thriving pets aluminum hydroxide binder being delivered today, should I give Epakitin moving forward and return the thriving pets binder? If so, how do I give the Epakitin? I'm 99% sure doc told me how, but it must've just went out the other ear. Also, what are my next steps with her?


Update Please see #4 Her Dr did not suggest a potassium supplement

Also I was reading post #2 When Perry was taking Aluminum Hydroxide I had to put it
in every one of his meals , I divided what the amount was I had to give him and put it in every
meal he ate. You helped me out so much with Perry

Wonder why it says for Epakitin to give only twice a day with meals?
Is it different than the Aluminum Hydroxide?

I know most likely she should clarify this with her vet

Thank you
@Marje and Gracie

 

They're an absolute godsend, Sydney. Really quick and easy to set up, and they collapse down flat when they're not in use.

I got mine when Saoirse was recovering from an operation. (Our vets were so impressed with the set-up it they now recommend them to other clients!) I've used it since when my civvie (Lúnasa, aka The Noodle) has had diarrhoea (she can't hold it long enough to get to her normal litter box) and also I pop it up and place her in it with a small litter tray containing non-absorbent litter pearls any time I need to collect a free-catch urine sample. It's also handy to keep her safe for a few hours when she's been a bit wobbly after sedation (she's not the best behaved at the vets ).


Mogs
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Before all this happened were you feeding more than twice a day?
Another thing I know that these binders can cause constipation, when my civie was on it I had to give him miralax , I bought the store brands , much cheaper and the same thing.
So watch out for that

 

@Diane Tyler's Mom She free fed before everything happened.

 

Fingers and paws crossed over here that she'll eat a bit more for you. The metoclopramide may help a wee bit with the nausea. (Note: If she's a bit consitpated, that might also be putting her off eating, and that's one thing the metoclopramide should help with.)

If she doesn't eat much overnight and your vets are open in the morning, I'd suggest going back to them for a more appropriate anti-nausea med to keep her going, especially over the weekend. Also, I'd suggest asking them about insulin. I had a look at Moo Moo's spreadsheet and she's still a bit above the normal range. Perhaps it might be possible to give her a smaller 'token' dose of insulin (e.g. 0.25IU, maybe even 0.1IU - with appropriate monitoring)? The Lantus depot from the 0.75IU dose should be pretty much drained by now so she hasn't got that to keep her going.

(((Sydney))) Moo Moo is a very lucky girl to have you for her Person.

Do you think there might be something that you could put on top of her steps to make a ramp? (Still a bit of a worry if she were to decide to ignore it on the way down. )

The only other thing I can think to suggest is that you could lift her down before you leave the room, even if it means disturbing her to do so. (Heresy! ) Even with that, you'd still have the worry over whether she might decide to get down from the bed while you're asleep. Tricky one.


Mogs
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I gave Perry the aluminum Hydroxide and I have to was told by my vet it had to be put in every meal , see what I wrote in post #7

What did the vet tell you to do with the Epakitin, how much did he tell you give?
Did he tell you to give it with every meal. ?
I hope she eats so you can give it . I assume you are mixing it in her wet food

That's why I tagged @Marje and Gracie to look over these posts, I saw she posted on your previous post

 

Some helpful resources:

Pocket Guide to IRIS CKD Staging

Detailed IRIS Guidelines to CKD Staging


Mogs
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@Critter Mom It took her 5 months to learn how to use her cat stairs before she got sick, so I don't think she's going to be any faster of a learner now . She still won't go down them, only up. She jumps off the side of my bed when she wants to get down. So, I will probably be sleeping on the floor for a few more days. I put her on my bed for now while I am waiting for lunch/dinner to be done cooking in the oven (a very late lunch and a very early dinner). When I go to check on it, I will take her off my bed. She'll be grumpy about it, but it should give her a chance to drink water and try to eat some again.

My vet will not be open until Monday, and I hope I don't have to take her to the emergency vet but I will if needed. My vet is adamant about not giving insulin unless her blood sugar goes over 300 right now, both yesterday and today he's stressed that. He said with her not eating much and her levels being near normal, he's worried she will bottom out.

@Diane Tyler's Mom I believe the vet said to put the Epakitin on top of her food, but I don't 100% remember.

 

Well how did you give it to her this morning? post #4 you said you started her on it
You have to mix it in all thru the food
@phakewishard

 

With her still being picky with food right now, I dipped some of her treats she loves in water and dunked them in the Epakitin. It doesn't have a taste, so she didn't even notice it. I'm kinda worried that that might've been wrong though. When reading the information about it, it says to sprinkle on food twice a day.

ETA: I measured out how much Epakitin she was getting for her weight before I started dunking her treats, I probably should mention that

 

I can't remember whether you've got any urine ketone strips at home, Sydney. While you're waiting for the BBK meter to arrive, it'd be no harm to monitor for urine ketones in the meantime (if you can manage to catch a 'non-vengeful' sample, of course!).

I've just looked at my tub of Ipakitine (same stuff, different brand name in the UK):

Directions for Use: 1g (1 spoon) per 5kg body weight, twice a day, to be mixed with food.

When using the aluminium hydroxide binder, you spread the daily dose across all meals, mixing it through the food. (Tip: if the texture of your supplement is on the gritty side, you can grind it down to a finer powder with a mortar and pestle and it pretty much disappears into the wet food/broth being served.)


Mogs
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I think that should probably be OK. She's getting a little of the binder along with the food, and that's the whole idea.


Mogs
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The Truluxe Steak Frites just came in, and she's eating it even while refusing other low-carb foods so I guess that's good that she likes it lol

I do have urine strips at home, and will continue to monitor. Maybe by some miracle, the ketone meter will show up tomorrow.

 

Oi! Kitty gods!! You hearing this???

Fingers 'n' paws crossed...


Mogs
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Eat your fudz, Moo Moo!

Really glad she's eating something for you, Sydney.


Mogs
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PS: Is that one of the new, lower phosphorus ones, Sydney?


Mogs
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Yes!! I'm so glad she likes it, that's a big relief. I'm extra glad because the smallest size they offered was a case of 24 I figured if she hated it, I could see if any animal shelters around here would take it.

 

Many's the similar donation I've made myself to the local shelter from which I adopted (((Saoirse))) and her brother, (((Amadán))).


Mogs
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Phosphorus binders works by combining (binding) with some phosphorus in the food when the food is in the digestive tract so the phosphorus does not get absorbed in the blood. The bound phosphorus is passed through the digestive tract and eliminated. The binder does not remove any phosphorus from the blood. The the binder has to be mixed with food.

 

She's eating much better now, I think she must really like the steak frites food. I have the pm dose of Epakitin in it, until I hear word on if it is better to use the Thriving Pets aluminum hydroxide or what the vet gave me (Epakitin). I don't want to mess things up, so any guidance from more experienced people is much appreciated.

When I moved her off of my bed when I went to work on some stuff, she tried to walk back over to her pet stairs because she wanted to be on my bed (bless her). I might have to remove them when I am not home so she doesn't try to climb up them and hurt herself.

 

Hi Sydney,

I'm glad to hear that Moo Moo's been eating better for you.

Here's the link to the Phosphorus Binders page from Tanya's Site. It's a lot to take in, so I'm also tagging @Marje and Gracie to ask her to give you some pointers on use of binders.

Wishing you both a restful and safe night.

(((Sydney and Moo Moo)))




Mogs
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Thank you @Critter Mom I didn't know that about Epakitin

 

Morning Sydney I'm happy to hear she likes the new food. Have a good day

 

Hi Sydney,

How are you and your girl doing today?

(((Sydney and Moo Moo)))


Mogs
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@Critter Mom I gave Moo Moo insulin because her sugar was at 295, and it was at 62 at +6 and is now 44 fifteen minutes later. I have given her high carb treats and a tiny bit of honey on her gums, and will keep checking her blood sugar every 15 minutes. I don't know why it dropped so fast, she's been eating today

 

Hi Sydney,

Only just seeing this now. Having a look at the spreadsheet. BRB...


Mogs
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She's going back up now, I'll continue to monitor but we should be okay

 

That's some drop your girl had today, Sydney, and quite the job you've had to keep her back above 50. I wonder whether, now that the abscess has been drained, she may now need less insulin?

Moo Moo has definitely earned a dose reduction with that 44, but I'm not sure whether the reduction should be more than 0.25IU. To that end, I'm tagging @Wendy&Neko and @Marje and Gracie to ask one of them to give you some input on what to do insulin-wise at this stage in her recovery.

With things in flux so much at the moment, any time you do give insulin I'd suggest testing at +2 latest on each cycle so that you'll get an earlier indication of how active the cycle might be.

I'm glad to hear she's been eating today. (((Moo Moo)))


Mogs
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Have you considered doing the subq fluids at home?

 

Sorry, it has been a hectic week, just trying to catch up on Moo Moo. The main issue with Epakitin is it can increase calcium levels because it contains calcium carbonate. Remember when I mentioned the issue with tissue calcification? Phosphorus x calcium higher than 70 is problematic, and calcium is getting close to the higher end of normal already, so it would be better not to use the Epakitin and switch over to the aluminum hydroxide since you have it now.

I'm glad to see her appy is back, that is good news.

As for the insulin dose, I'd reduce by 0.25u at this point, based on what I see with her SS, although somewhat of a minor point, if you are following SLGS, you would have already reduced her to 0.5u after seeing numbers under 90 on January 4th. With possible history of ketones, I wouldn't reduce more than what is called for with Lantus dosing methods that we follow here.

 

Thank you!! I will reduce her insulin and switch the the aluminum hydroxide. Should I skip tonight's insulin dose since she will likely be more sensitive to it? Or wait and see what the numbers look like

 

Let's see what her numbers are like, from my understanding, sensitivity to insulin is usually tied to symptomatic lows, was Moo Moo showing any signs of hypo?

 

Not any visible signs, I will update with her PMPS. She hasn't wanted to eat much this afternoon, which is why I'm a little nervous about giving a shot tonight.

 

Her PMPS is 184 and I'm mot comfortable giving her any with how low she went today.

 

Hi Sydney,

I can understand that. Ultimately, you hold the syringe.

Did you manage to snag a urine ketone test today, BTW? Or is she still in 'revenge' mode? (((Moo Moo)))


Mogs
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I carried her to the litterbox about 5 minutes ago, because I think she's getting weaker. She started peeing as soon as her feet landed in the litter. Her urine test showed none. I wish she would eat right now.

 

Can you syringe feed her? A cat cannot go very long without getting enough calories in. A better anti nausea med is a must.

• Suggestions on How to Stimulate Kitty's Appetite
• Syringe/Assisted Feeding (Video and Tips)
• THE '~LIVER SHAKE~' FOR SICK CATS

As for dosing, there is no data for yesterday, so it's hard to say what to do, other than a 0.25 unit reduction per SLGS as others have already said.

 

Epakitin is not the best choice for Moo Moo because it can raise the calcium level and her calcium is not abnormally high but you do not want it any higher. She is already at risk for tissue calcification as the Ca x P is over 70. I’m surprised your vet was not aware that Epakitin can raise the Ca and it’s really contraindicated in a cat with her numbers. Having said that, if it was the only binder I could get in her, I’d use it.

I’d really urge you to join the CRF group on groups.io. I haven’t had a cat with CKD in 7 years and things are constantly changing like the routine use of calcitriol now to help them feel better.

 

@Wendy&Neko, @Marje and Gracie - Thank you, ladies.


Mogs
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@Wendy&Neko I would be able to syringe feed her, I have an oral syringe and gave her antibiotics orally before. Thank you for the links! I will begin syringe feeding tonight if she still refuses food. She hasn't been eating well for a week. She is going back to the vet on Monday and I will press for better nausea medicine. I hope that and the phosphorus binder will help.

@Marje and Gracie I have the Thriving Pet aluminum binder that I am switching her to. I don't want anything to make it any worse. She doesn't need more problems right now. I will join the group tonight. Thank you!

Sorry, I don't know why it didn't give me a notification this time when you guys replied. I hope I'm giving her the best care, I just don't know anymore. I'm scared I'm not doing enough, but I don't know what else to do. I hope joining this group will help, and syringe feeding will give her some strength back.

 

Is the vet running CBC and chemistry panel on Monday? You need to see what the blood and kidney markers are at, also the potassium, given how much it had dropped between rounds of bloodwork. Low potassium is one thing that can cause weakness but my understanding is that kitties who need a supplement respond to it quickly.


Mogs
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I know he's doing more bloodwork, I will just ask him to do the full panel with electrolytes. I know for sure he wants to see how she's responding to the binders. And probably will give her more fluids.

I hope you're having a good day/night. How has your week been?

 

About to pass out (literally - sleep meds). Will reply tomorrow.

Have a safe, restful and restorative night, the pair of you.

(((Sydney and Moo Moo)))




Mogs
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Goodnight and sweet dreams!

 

Hi Sydney,

How's Moo Moo doing today? Is she eating for you? How are you doing yourself?

I'd suggest double-checking that the chemistry panel will include potassium. (I've been caught out by that a couple of times.)


Mogs
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She apparently loves being syringe fed. Like LOVES it. I don't even have to put it in her mouth, she just licks it out of the syringe. But she won't eat it out of her bowl, even when it's the same consistency. She's probably had around 90 calories so far, I'm planning on giving her some more food in a couple hours. Her sugar was real high this morning, but it's come down.

I'm tired today, I'm planning on going to Petco today to get another litterbox that is easier for her to get into and some pee pads, and maybe some other kinds of low phosphorus low carb foods.

How are you??

 

Hi Sydney,

While it's not great that Moo Moo needs assist feeding, it is great that she's so comfortable taking food from the syringe. Is her bowl raised? If not, it might be worth a try to stick a couple of paperbacks underneath to raise it a couple of inches so she doesn't need to lower her head to eat.

I'm not surprised you're tired, Sydney. It's been quite the roller coaster for the two of you.

As days go for me, today's fairly OK. My civvie, Lúnasa (aka The Noodle), is IRIS CKD stage III and getting her to eat can be tricky. She's on amlodipine for hypertension and sometimes it takes her blood pressure slightly below the lower bound of the normal reference range (I monitor it at home) and that makes her very subdued and tired, and it also knocks her appetite for six. It takes several days and a fair degree of prompting/coaxing to get her back to eating enough. We're currently on day two of the latest episode. The worry sure takes it out of a person, n'est-ce pas?

Wishing you a successful shopping expedition!

(((Moo Moo and Sydney)))


Mogs
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PS: This morning's high numbers look like Moo Moo is bouncing off yesterdays' low run.


Mogs
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Well, I know The Noodle is in good hands. I'll keep her (and you) in my prayers. Has she eaten any today??
Yes the worry sure does. I've been to three stores now trying to find a litterbox I think Moo Moo can get in and out of, but I have found some low carb low phosphorus foods at PetCo in case she tires of the Steak Frites.

 

The Noodle's has eaten a bit today but not without prompting. I use the 'sleepy eating' techique a lot with her. (Wake the cat up by sticking a bowl of food under its nose. If it works, the cat'll start eating immediately before it has time to think about whether or not to be finnicky about the bowl's contents.)

Glad your foray to the pet store yielded some menu choices for Moo Moo. Sorry you weren't successful in finding a litter box. I had a gander on amazon.com and this was the best I could see, but it's a crazy price for what it is:

https://www.amazon.com/KittyGoHere-...shallow cat litter tray&qid=1610320270&sr=8-1

Can't remember whether or not I've posted the following for you before but it's a very helpful document:

IDEXX Feline Pancreatitis Treatment Guidelines

While its focus is on pancreatitis, the treatments described in the section on management of nausea and appetite issues is relevant to other situations where a cat might be experiencing eating difficulties. It's a good reference to use when asking vets about nausea and appetite stimulant treatments.

Thank you, Sydney. And I'll keep you both in mine. Hope all goes well at the vets tomorrow.

(((Sydney and Moo Moo)))


Mogs
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Similar litter box with low side (no dimensions on web page), but a lot cheaper:

https://www.petco.com/shop/en/petcostore/product/so-phresh-dog-litter-box


Mogs
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Thank you so much! I will probably start a new thread with her updated bloodwork tomorrow. Moo Moo hasn't responded well to the 'sleepy eating technique' (I didn't know it was an actual technique, I just woke her up by putting food in her face recently haha). I will look at the petco litterbox, I had gone in but they had maximum of 4 different litter boxes in the entire petco, I'm sure there's a bunch of different ones online. I did get pee pads though!