2/18 Ruby PMPS 101/+2 89/+4 79

[Katherine&Ruby]

This morning Ruby did one of her classic "blue at AMPS, 50s by +3" dives, something she hasn't done in a while. Caught me a bit by surprise but we had her favorite MC tuna+duck in gravy on hand so the situation is under control. She is still hoovering food up at record speed and quantity since her dose of mirtz yesterday.

Yesterday's condo was one of the liveliest I've had in a while, filled with so much information, support, and care, shared with equal parts head and heart. Thank you all for being awesome people and the best cat moms and dads around. So grateful to have found this community.

 

[carfurby (GA)]

I'm glad Ruby came back up. I hope she continues to surf safely. I hope she is eating this morning.

 

[Mariette]

I'm very happy to hear she's eating up a storm today.

I agree. I'd be so lost on this journey without this community.

 

[Katherine&Ruby]

UPDATE: Spoke to Ruby's vet and we're both on the same page about moving forward on her care, which is great! He was happy to hear that she is eating but not so happy about the fact that she will only do it with the assistance of her meds. Her inappetance could be her CKD, and I'll be bringing her in for more blood work in a few weeks to see if the values have changed, but I wanted to really look at the IBD/SCL as a possible reason as well. He agreed wholeheartedly that a biopsy not necessary before proceeding with treatment. He is looking into placing an order of budesonide at Wedgewood Pharmacy for compounding, though everything will be slowed down by the snowstorm we are having today as the vet office closed early. Thanks to @Margaret (and Pearl) and @Marje and Gracie for encouraging me to do this! We will see how she does on the budesonide to determine if we will need to add the Chlorambucil later. Ideally the steroid will help with inflammation and she'll be eating on her own. I also now have a prescription for cyproheptatine, which hopefully will be more effective than the cerenia.

In the meantime, I am looking to change her diet. Right now she's eating Weruva foods that are low in carbs and phosphorus, and I switch up flavors all the time to keep her interested. Should I buy any of the boneless prepackaged raw foods out there? Should I transition to a homemade cooked diet and then to raw? Should I buy EZ Complete? I thought I had to juggle a lot with Ruby's FD, but with CKD and IBD in the picture, it's gotten a lot more complicated! Guess it's time for me to be active in the Raw Feeding for IBD group!

 

[Marje and Gracie]

UPDATE: Spoke to Ruby's vet and we're both on the same page about moving forward on her care, which is great! He was happy to hear that she is eating but not so happy about the fact that she will only do it with the assistance of her meds. Her inappetance could be her CKD, and I'll be bringing her in for more blood work in a few weeks to see if the values have changed, but I wanted to really look at the IBD/SCL as a possible reason as well. He agreed wholeheartedly that a biopsy not necessary before proceeding with treatment. He is looking into placing an order of budesonide at Wedgewood Pharmacy for compounding, though everything will be slowed down by the snowstorm we are having today as the vet office closed early. Thanks to @Margaret (and Pearl) and @Marje and Gracie for encouraging me to do this! We will see how she does on the budesonide to determine if we will need to add the Chlorambucil later. Ideally the steroid will help with inflammation and she'll be eating on her own. I also now have a prescription for cyproheptatine, which hopefully will be more effective than the cerenia.

In the meantime, I am looking to change her diet. Right now she's eating Weruva foods that are low in carbs and phosphorus, and I switch up flavors all the time to keep her interested. Should I buy any of the boneless prepackaged raw foods out there? Should I transition to a homemade cooked diet and then to raw? Should I buy EZ Complete? I thought I had to juggle a lot with Ruby's FD, but with CKD and IBD in the picture, it's gotten a lot more complicated! Guess it's time for me to be active in the Raw Feeding for IBD group!

I saw your dosing question from yesterday and I’ll have input on that and this post but am on the way out right now. So sorry but BBS.

 

[Katherine&Ruby]

Earlier today: AMPS 104/+3 53/+3.5 64/+4 74/+5 81/+9 75

Fed her a +9 and now wonder if I should have done that but she was hungry and bugging me but now doesn't want to eat after her shot. Gave her some more cerenia. The Fluid Man came again today so maybe that accounts for the blue PMPS?

 

[Butters & Lyla]

You're such a great mom, Katherine! Ruby is lucky to have you.
I found with CKD in the picture the easiest thing became using EZ Complete and making raw food myself with different proteins. Butters's levels have remained stable since October.
I found that around me, most of the pre-packaged raw foods have bone in them.
There are instructions on the FFL site for transitioning to a raw diet, if you decide that's the way to go.

 

[Katherine&Ruby]

You're such a great mom, Katherine! Ruby is lucky to have you.
I found with CKD in the picture the easiest thing became using EZ Complete and making raw food myself with different proteins. Butters's levels have remained stable since October.
I found that around me, most of the pre-packaged raw foods have bone in them.
There are instructions on the FFL site for transitioning to a raw diet, if you decide that's the way to go.

Thanks, Lyla! I've been following your raw food journey with Butters with great interest. I don't know that I could convince my civvie Olive to eat raw but I'd like to try it with Ruby. How did you transition? Did you add raw to canned food first?

 

[Marje and Gracie]

From yesterday’s condo:

Yes, this makes sense. I'm always afraid of being too aggressive while also, at the same time, concerned about staying at a dose that isn't doing what it needs to do for Ruby. I find it hard to know what the right thing is to do when she hits a number in the 60s every once in a while. Her AMPS numbers are improving, however. Last night I stopped the +9 feeding because of the dose increase. Is that the right thing to do?

The +9 feeding is independent of dose increases. So it shouldn’t be one or the other. The AMPS is usually the last BG to come down so if a kitty gets down to a drop and the AMPS is still blue, we add the +9 food. That’s where Ruby is different from Buddy.

The +9 feeding is one of those urban legends that raises its head now and then. But it really should just be for those cats that are about to go into remission but have that one stubborn PS or blue bookends. There’s always the concern that if the pancreas is not yet working on its own and you give a +9 feeding, you are working against the duration of the insulin.

It’s really important with a CKD cat that when you get labs done, you get a superchem and CBC. One of the top predictors of longevity with CKD is the phosphorus level. When you are looking at the progression or stability of CKD, you need to see the creatinine, BUN, phosphorus, calcium, potassium, and hematocrit. It’s also important to check the Urine occasionally to be sure there is no protein in the urine and, IMHO, the blood pressure should be checked each time she goes in or every three months. You’ve done a great job getting her P from 5.9 to 4.8 in Dec. The closer you can get it to 4-4.5, the better for her. Don’t forget that a lot of cats’ inappetance is due to nausea so be sure the nausea is corrected before you give appetite stimulants. Nausea in a CKD cat can be caused by tummy acid and slippery elm syrup can help with that.

The Food Cur Life site has a good section on transitioning to raw. I started with the commercially prepared raw foods but felt there was still more stuff in them I didn’t want my cats to have like blueberries and cranberries, etc. They still have preservatives of some type. With Gracie’s IBD, just going straight to raw made her vomit so I started with home cooked using EZ Complete. I never got to make the next step. But my other two cats, who are currently healthy, eat EZ Complete and raw meat. My older one (10) has been on raw since he was 18 mos. I started with Primal and then Alnutrin. But dealing with the liver on the latter was a pain so as soon as EZ Complete came out, I switched. I still had to do it very slowly. I started transitioning my little one the day after I got her. I still went very slow.

If you are going to switch the diet with a CKD kitty, it’s best to do it when they are eating fairly well and the labs are still pretty good like Ruby’s are.
I agree..you are a great mom!!!

 

[Katherine&Ruby]

The +9 feeding is one of those urban legends that raises its head now and then. But it really should just be for those cats that are about to go into remission but have that one stubborn PS or blue bookends. There’s always the concern that if the pancreas is not yet working on its own and you give a +9 feeding, you are working against the duration of the insulin.

Ok, so if I understand you correctly, I should not have started the +9 feeding until Ruby was at a drop dose AND having blue preshot values. Please confirm.

It’s really important with a CKD cat that when you get labs done, you get a superchem and CBC. One of the top predictors of longevity with CKD is the phosphorus level. When you are looking at the progression or stability of CKD, you need to see the creatinine, BUN, phosphorus, calcium, potassium, and hematocrit. It’s also important to check the Urine occasionally to be sure there is no protein in the urine and, IMHO, the blood pressure should be checked each time she goes in or every three months. You’ve done a great job getting her P from 5.9 to 4.8 in Dec. The closer you can get it to 4-4.5, the better for her. Don’t forget that a lot of cats’ inappetance is due to nausea so be sure the nausea is corrected before you give appetite stimulants. Nausea in a CKD cat can be caused by tummy acid and slippery elm syrup can help with that.

Yes, will be getting the full blood panel next time with the fixings. The panel done in January was actually done to recheck the high-ish SDMA number from December. I have been working hard in earnest to feed Ruby low phosphorus foods since her last test result, and so I hope that when I take her back to the vet in March that the phos. will be even lower. I have been giving Ruby the appetite stim only after the Cerenia does not work. I know the mirtazapine is a very powerful drug. I've tried giving SEB to Ruby and she won't go near any food with it unfortunately. Perhaps I should get gel caps and put some SEB in them. I am quite distressed though that she won't eat on her own. Does the inappetence come in temporary waves or will I have to be correcting her nausea all the time?

The Food Cur Life site has a good section on transitioning to raw. I started with the commercially prepared raw foods but felt there was still more stuff in them I didn’t want my cats to have like blueberries and cranberries, etc. They still have preservatives of some type. With Gracie’s IBD, just going straight to raw made her vomit so I started with home cooked using EZ Complete. I never got to make the next step. But my other two cats, who are currently healthy, eat EZ Complete and raw meat. My older one (10) has been on raw since he was 18 mos. I started with Primal and then Alnutrin. But dealing with the liver on the latter was a pain so as soon as EZ Complete came out, I switched. I still had to do it very slowly. I started transitioning my little one the day after I got her. I still went very slow.

If you are going to switch the diet with a CKD kitty, it’s best to do it when they are eating fairly well and the labs are still pretty good like Ruby’s are.

OK, I'm going to dive into the process of transitioning and will see what happens! I would love to start with the prepared foods but most of them contain ground bones, no?

 

[Wendy&Neko]

but I wanted to really look at the IBD/SCL as a possible reason as well. He agreed wholeheartedly that a biopsy not necessary before proceeding with treatment.

Sorry I missed yesterday's post on this. I have the exact opposite thoughts. I am on my third (in a row ) cat with GI issues and the IBD/SCL question. They are NOT treated the same. First kitty, when I knew nothing, vet did not think we should get a biopsy. We treated with metronidazole for a while, sort of presuming IBD (though he was already on a raw novel protein diet), then later when the ultrasound saw things getting worse, we presumed SCL and treated for that. Which meant pred and chlorambucil. The problem with this solution - besides not really knowing what condition we were dealing with for sure - the two conditions are NOT treated the same. IBD may have some steroids, or not, but start with novel protein diet and probiotic. SCL means steroids and chlorambucil, diet not important. Only extreme cases of IBD get treated with chlorambucil. The problem with chlorambucil, even though it's a mild chemo, is that it is a carcinogen. My little guy was doing fine GI wise and was in SCL remission, if SCL was what he had, but got pancreatic cancer. Was it from the chlorambucil? Don't know, but the question will always haunt me.

Kitty number two was Neko. We could not do endoscopy or biopsy as both require anaesthesia. By that time, her heart blocks meant she could not have anaesthesia as it would likely kill her. So yet another cat where we are guessing what we are dealing with. Neko saw an internal medicine vet who consulted with an oncologist and they "guessed" SCL. Again, she was already on a raw novel protein diet and getting probiotics. Her heart could not take pred, so she was started on budesonide and chlorambucil. Budesonide did not impact her blood sugars, and did help reduce the inflammation of her bowels. Unfortunately the chlorambucil was started on a slightly older protocol (every other day) at first and she was constantly nauseous, she was also dealing with CKD and heart disease which can also cause nausea. And I later found out I was underdosing the nausea meds. Anyway, I did finally get her switched to a better chlorambucil protocol and she got some relief from the nausea. However, if I'd known she only had IBD, I might have been able to do away with the chlorambucil and made her last months more comfortable. Again, not knowing what condition I was dealing with for sure put questions in my mind.

Kitty number 3, adopted with some food allergies. Did the raw diet for a while, which helped, but only for so long. Got an endoscopy done - easy peasy, in and out of the vet's office in half a day. I did get some not 100% certain comments from the pathologists , though they were leaning to SCL. Sent the sample to UC Davis for PARR and they said emerging SCL. Treated with pred and chlorambucil (have I said how much I'm tired of giving this drug!!) and she is in remission and has been for over 2.5 years. Best part, I did actually get a diagnosis this time. I know what I'm dealing with. I know that I'm treating for the condition she has. There are no questions about whether I'm doing the right thing.

I would love to start with the prepared foods but most of them contain ground bones, no?

See if Small Batch is available near you. I know of others, but they are Canadian only.