Sub-Qs for Cory

"MacCandace" wrote in message
...
Sure, intense fluid therapy will make a cat feel much better because it
promotes diuresis and lowers the concentration of uremic toxins in the
blood. Uremic toxins make the cat feel sick and queezy. Intense fluid
therapy should be used only in a uremic crisis or during acute
decompensation. Otherwise, daily (or chronic) fluid therapy should be
used
*only* to prevent or correct dehydration.

Each cat has a different fluid requirement - but 100 ml/day or e.o.d. is
much closer to the average.

Thank you, Phil, Laura, Cathy, everyone for your advice and well wishes.
This
is my update today.

Fortunately, the "real" vet's partner, who was not there yesterday either
called me instead of the bonehead relief vet. All of Cory's bloodwork is
normal or only slightly elevated. His BUN is only 39 (down from 45 5
months
ago and his creatinine is 2.3 down from 2.8).

What are the lab's reference ranges? Those values aren't very high at all.
Unless Cory was severly dehydrated, I think 300 ml was *way* too much fluid.



His USG was low, as to be
expected.

If the urine sample was obtained after fluid therapy begun, what the hell
did he expect? Fluid therapy can bring down even a normal cat's USG. The
influence of the fluids on urinary values can be very misleading and very,
very difficult to sort out.

Urine, blood and body weight should be obtained before *any* treatment
begins. Once the samples have been obtained, fluid can be admisintered
while you're waiting for the results.

The hydration status shouldn't be based on BUN/Cr. or on USG alone. Serum
protein levels and PCV (Hct) coupled with USG provides a much more accurate
assessment of renal function than either test alone.

The skin pinch test is very unreliable for assessing the hydration status
especially on older cats because many older normal cats that aren't
dehydrated have reduced skin turgor. You said Cory lost weight -- Cats that
have lost weight often have delayed skin-pinch return without dehydration
because of reduced elastin and adipose. OTOH, the skin pinch return is
usually normal in obese case that *are* dehydrated because the extra fat
enhances the skin return. So, the skin pinch test can underestimate
dehydraton in obsese cats and overestimate dehydraton in older cats or cats
that have lost weight and and emaciated cats.

Serum protein/PCV coupled with USG provides the most accurate assessement of
hydration status.


Everything else was normal altho his amylase was slightly elevated
but that can be attributed to his kidney disease, she said.

So...meanwhile, last night, Cory had 3 coughing episodes lasting about 3-5
minutes. He never coughs. I looked it up on Helen's site and coughing
can be
a sign of overhydration. I mentioned this to the vet's partner today and
she
concurred that he was probably overhydrated.

I'm *sure* he was. He's lucky he didn't develop cardiac overload. Thoracic
ausculation for signs of respiratory distress should be routine procedure
while administering fluids - especially when the volume is more than the
cat's total daily water requirement!



She also reiterated that he
has a
heart murmur (grade 1 out of 6)

Might be secondary to hyperthyroidism and not from primary heart disease.


even tho the relief vet said he could not
hear
it when I asked him and one especially does not want to overhydrate a cat
with
a heart condition. His coughing seems to have subsided now, 28 hours
later, so
I'm sure that was the cause. She said she also concurs that 250ml every
day is
too high; she suggested 200 ml every other day but, in looking at these
levels,
I'm thinking he may not need them at all or maybe 100 ml 3X a week at
most.

I think you may be right. I'd really like to see his total protein, PCV
(Hct) and USG values.


Today he is eating pretty well and seems better but I'll have to see how
he's
doing tomorrow. If he seems to be not drinking enuf, I will go ahead and
give
him 100ml or so but I don't want to tax his heart.

Additionally the bonehead relief vet did not order the bloodwork to test
Cory's
hyroid. How dumb is that?

Very... bordering on incompetence.


Here we have a cat who has lost 1.5 pounds in
5
months, who is on tapazole, and the vet commented on that, and he still
doesn't
order thyroid levels in the bloodwork?

Thyroid function has a *direct* impact on kidney function in cats with
underlying renal disease. The fact Cory is on Tapazole should have
instantly alerted the vet to the possibility of a change in Cory's thyroid
function. Hyperthyroidism is also a dynamic disease that changes. Cory's
tapazole dose may simply need to be adjusted.


The woman vet I talked to seemed
to
find that rather shocking, too, although she didn't quite come out and
lambast
him. I'm sure, like regular doctors, they have that code where they
protect
each other...esp. since this is the guy they hired for relief.

Vets are slow to criticize other vets. They call it "professional
courtesy"... I call it fear of a law suit.


He looked
to be
about 22, a big, strapping blond frat jock looking type that seemed full
of
himself. I'm ****ed. My poor cat could have had a heart attack or
something.
The woman vet is going to call the lab and see if they still have some of
Cory's blood to test but I certainly assume this will be a free test for
me.

I'd order a complete work up (CBC/chem screen/urinalysis) using *fresh*
samples. Never rerun tests with the same samples as the first test.


The guy must be an idiot to not order a thyroid test on a hyper-t cat.

Vets like that make me want to add a tip to my vet's bill.



So, I realize what Phil said in that pure numbers don't determine the
necessity
for fluids but, for instance, on Helen's site, she said fluids don't
generally
need to be given until creatinine hits 3.5-4, which is a long way from
where
Cory is. Prior to a couple of days ago, he didn't appear dehydrated. I
just
hope he doesn't have yet another condition going on...it seems CRF,
hyper-t,
heart murmur, is enough. His urine is being cultured to see if he's
developed
a resistance to the low level clavamox he takes to prevent chronic UTIs.

Make sure the urine sample is obtained by cystocentesis to avoid
contamination with bacteria that normally inhabit the distal urinary tract.
Many cats diagnosed with UTIs don't really have a UTI. True bacterial UTIs
are actually uncommon in cats. However, older cats may be at increased
risk of developing bacterial UTIs, because of diminished urinary tract
defenses secondary to aging - or secondary to disorders that are more common
in geriatric cats. Renal failure, diabetes, and hyperthyroidism, all impair
the normal defense mechanisms of older cats.


For today, he seems much improved, is eating, although he may still be
feeling
the effects of 1/4 tab of cyproheptadine I gave him about 28 hours ago.
That
always makes him hungry...yet hyper. He still doesn't seem his normal
self,
however.

I will check out the chart you suggested, Phil, and thank you all. Maybe
my
kitty is still going to be with me for quite awhile.

Based on the BUN/Cr. numbers you posted, I agree 100%!

Cats are amazingly resilient creatures.

Keep the faith, Candace!

Good luck.

Phil

Thanks, Phil. I'm printing out your reply and giving it to the real vet when
he gets back. Cory's thyroid was normal although I don't know the exact
number. I was in there today and requested a copy of his lab results but that
one isn't on there...because it was done later, I guess. At least they didn't
try to charge me for it...yet.

Anyway, here are the abnormal values:

BUN 39 (14-36) HIGH
Creatinine 2.3 (0.6-2.4) not abnormal
Amylase 1432 (100-1200) HIGH
CPK 575 (56-529) HIGH
Lymphocytes 504 (1200-1800) LOW

Urinalysis:
Ph 5.0 (5.5-7.0) LOW
Occult Blood 3+ (neg is ref. range) HIGH
RBC/HPF 3-10 (0-3) HIGH
Casts/LPF Fine Gran 0-1 (Hyaline 0-3) HIGH

USG is 1.023 (1.015-1.060)

So, his kidney values aren't esp. high and his USG isn't really abnormal
either. He always has blood in his urine and always has ever since he started
having UAs when he was about 5.

I'm confused about the CPK and amylase.

To clarify, the fluid therapy was done the day I was at the vet..after they
took the blood and urine samples... and the lab results were not obtained until
the next day. I guess the relief vet felt he was dehydrated based on the pinch
test. He did appear dehydrated, tho, and had not eaten well for a few days so
I think he was, however the real vet generally only gives about 100-150ml when
hydrating him. This was the most he ever got.

So...he seems better, he's eating and drinking, does not appear dehydrated so
I'm not going to give him sub-qs at this time. But he does not appear totally
his normal self either. He's not as chatty as usual. He's not particularly
lethargic or hiding or anything but he isn't interacting quite as much, not
quite as much eye contact. It's subtle but he's different. I don't
know...maybe he just went senile all of a sudden. but why's he losing weight?
Are any of these values indicative of cancer or anything? He urinates,
defecates normally and has not vomited since being hydrated. His cough is
gone. His eyes are clear, fur soft.

I think you may be right. I'd really like to see his total protein, PCV
(Hct) and USG values.

Total Protein 7.7 (5.2-8.8)
What's PCV? Is there something else it could be called? I don't see that on
his results.

He's been on low-dose clavamox for several months because he was routinely
developing a UTI. The vet didn't want to do it but I inisisted. They did a
urine culture, preliminary results are that nothing is growing.

Thank you.

Candace
(take the litter out before replying by e-mail)

See my cats:
http://photos.yahoo.com/maccandace

"One does not meet oneself until one catches the reflection from an eye other
than human." (Loren Eisely)

Thanks, Phil. I'm printing out your reply and giving it to the real vet when
he gets back. Cory's thyroid was normal although I don't know the exact
number. I was in there today and requested a copy of his lab results but that
one isn't on there...because it was done later, I guess. At least they didn't
try to charge me for it...yet.

Anyway, here are the abnormal values:

BUN 39 (14-36) HIGH
Creatinine 2.3 (0.6-2.4) not abnormal
Amylase 1432 (100-1200) HIGH
CPK 575 (56-529) HIGH
Lymphocytes 504 (1200-1800) LOW

Urinalysis:
Ph 5.0 (5.5-7.0) LOW
Occult Blood 3+ (neg is ref. range) HIGH
RBC/HPF 3-10 (0-3) HIGH
Casts/LPF Fine Gran 0-1 (Hyaline 0-3) HIGH

USG is 1.023 (1.015-1.060)

So, his kidney values aren't esp. high and his USG isn't really abnormal
either. He always has blood in his urine and always has ever since he started
having UAs when he was about 5.

I'm confused about the CPK and amylase.

To clarify, the fluid therapy was done the day I was at the vet..after they
took the blood and urine samples... and the lab results were not obtained until
the next day. I guess the relief vet felt he was dehydrated based on the pinch
test. He did appear dehydrated, tho, and had not eaten well for a few days so
I think he was, however the real vet generally only gives about 100-150ml when
hydrating him. This was the most he ever got.

So...he seems better, he's eating and drinking, does not appear dehydrated so
I'm not going to give him sub-qs at this time. But he does not appear totally
his normal self either. He's not as chatty as usual. He's not particularly
lethargic or hiding or anything but he isn't interacting quite as much, not
quite as much eye contact. It's subtle but he's different. I don't
know...maybe he just went senile all of a sudden. but why's he losing weight?
Are any of these values indicative of cancer or anything? He urinates,
defecates normally and has not vomited since being hydrated. His cough is
gone. His eyes are clear, fur soft.

I think you may be right. I'd really like to see his total protein, PCV
(Hct) and USG values.

Total Protein 7.7 (5.2-8.8)
What's PCV? Is there something else it could be called? I don't see that on
his results.

He's been on low-dose clavamox for several months because he was routinely
developing a UTI. The vet didn't want to do it but I inisisted. They did a
urine culture, preliminary results are that nothing is growing.

Thank you.

Candace
(take the litter out before replying by e-mail)

See my cats:
http://photos.yahoo.com/maccandace

"One does not meet oneself until one catches the reflection from an eye other
than human." (Loren Eisely)

I think you may be right. I'd really like to see his total protein, PCV
(Hct) and USG values.

Okay, never mind. I figured it out. PCV (packed cell volume) or HCT
(hematocrit) was 40 (29-48). Total protein 7.7 (5.2-8.8) and USG 1.023
(1.015-1.060).

Candace
(take the litter out before replying by e-mail)

See my cats:
http://photos.yahoo.com/maccandace

"One does not meet oneself until one catches the reflection from an eye other
than human." (Loren Eisely)

I think you may be right. I'd really like to see his total protein, PCV
(Hct) and USG values.

Okay, never mind. I figured it out. PCV (packed cell volume) or HCT
(hematocrit) was 40 (29-48). Total protein 7.7 (5.2-8.8) and USG 1.023
(1.015-1.060).

Candace
(take the litter out before replying by e-mail)

See my cats:
http://photos.yahoo.com/maccandace

"One does not meet oneself until one catches the reflection from an eye other
than human." (Loren Eisely)

"MacCandace" wrote in message
...
Thanks, Phil. I'm printing out your reply and giving it to the real vet
when
he gets back. Cory's thyroid was normal although I don't know the exact
number. I was in there today and requested a copy of his lab results but
that
one isn't on there...because it was done later, I guess. At least they
didn't
try to charge me for it...yet.

Anyway, here are the abnormal values:

BUN 39 (14-36) HIGH

The BUN can be affected by nonrenal causes that's why creatinine is a better
indicator of renal function. That slight elevation could have been caused
by a meal or even from muscle (protein) catabolism from not eating


Creatinine 2.3 (0.6-2.4) not abnormal

That's the important indicator of renal function. Although its still within
normal, its
high-normal. Could be an indication of very early renal disease. I'd
monitor Cr. closely. You don't have to order a full blood workup every
time. You can order specific tests for monitoring indivudual analytes.
Saves a fortune!


Amylase 1432 (100-1200) HIGH

Not nearly high enough to even suggest pancreatitis or even pancreatic
infammation. Could be due to a slight decrease in renal excretion.


CPK 575 (56-529) HIGH

Nothing to worry about. CPK indicates muscle injury or damage.The slight
elevation could be caused by muscle catabolism if Corey didn't eat recently
or from an injection.

Lymphocytes 504 (1200-1800) LOW

Doesn't say which - T or B lymphocytes. Without seeing the rest of the
hemogram, I won't even guess.



Urinalysis:

Are these values from before or after Corey received fluid therapy? If
after, its`very difficult to determine the effect the fluid had on the
actual values.


Ph 5.0 (5.5-7.0) LOW

What food are you feeding him?

Occult Blood 3+ (neg is ref. range) HIGH
RBC/HPF 3-10 (0-3) HIGH

How was the urine sample obtained? Catheterization or cystocentesis can
produce hematuria.


Casts/LPF Fine Gran 0-1
(Hyaline 0-3) HIGH

A few hyaline or granular casts (~1 to 2) can be found even in normal
urine.
Cory's are just slightly above normal. Hyaline casts are a sign of very
mild renal irritation -- but the number of casts in a single sample is no
way a reliable indicator of the stage of CRF.


USG is 1.023 (1.015-1.060)

If this value is the USG *after* Corey received fluid therapy, then his
normal value is probably close to or even normal. The usual "normal" range
for cats is beyween 1.035-1.060.




So, his kidney values aren't esp. high and his USG isn't really abnormal
either. He always has blood in his urine and always has ever since he
started
having UAs when he was about 5.

Again, how are the urine samples obtained? Catheterization or cystocentesis
(obtained via needle directly from the bladder) can produce hematuria.




I'm confused about the CPK and amylase.

CPK is Creatine phosphokinase - is an enzyme that's found in the brain heart
and muscles.
Its an enzyme that's usually associated with muscle damage or injury. Just
for a frame of reference, simple IM injections can raise CPK 2-3 times.
Cats that
haven't eaten can also usually have high CPK values from muscle catabolism.
I
don't think I'd be alarmed by the *slight* increase.



To clarify, the fluid therapy was done the day I was at the vet..after
they
took the blood and urine samples...

Ahhh, ok, that makes a big difference! In that case, Corey's USG is only
slighly delute but the bloodwork (PCV/Hct & T Protein) shows *no* evidence
of dehydration.

and the lab results were not obtained
until
the next day. I guess the relief vet felt he was dehydrated based on the
pinch
test.

The pinch test is too highly subjectve to be reliable. As you can see, the
bloodwork and the USG don't indicate dehydraton. TP, PCV (Hct) and USG are
much more accurate.


He did appear dehydrated, tho, and had not eaten well for a few
days so
I think he was, however the real vet generally only gives about 100-150ml
when
hydrating him. This was the most he ever got.

So...he seems better, he's eating and drinking, does not appear dehydrated
so
I'm not going to give him sub-qs at this time.

I think you made a wise decision.


But he does not appear
totally
his normal self either. He's not as chatty as usual. He's not
particularly
lethargic or hiding or anything but he isn't interacting quite as much,
not
quite as much eye contact. It's subtle but he's different. I don't
know...maybe he just went senile all of a sudden. but why's he losing
weight?

You might want to have his thyroid function tested again with another T4
followed by a Free T4 by Equilibrium Dialysis (fT4ED). fT4 is more
sensitive in assessing thyroid function in sick cats and cats with
concurrent or undiagnosed diseases that could alter routine T4 tests.

Are any of these values indicative of cancer or anything?

Hell no!!!

He urinates,
defecates normally and has not vomited since being hydrated.

His cough is
gone.

That's a relief. I was a little worried about cardic overload from all that
fluid.



His eyes are clear, fur soft.

I think you may be right. I'd really like to see his total protein,
PCV
(Hct) and USG values.

Total Protein 7.7 (5.2-8.8)
What's PCV? Is there something else it could be called?

Hct - Hematocrit.

Hct and PCV are almost identical. PCV is the total percentage of cells in a
sample of centrifuged blood anf HCT refers to the RBC (red blood cells)
only. WBC's (white blood cells) and platelets usually make up less than 1%
of the blood volume, so the difference between PCV and Hct is moot - for
most clinical purposes.



I don't see that
on
his results.

He's been on low-dose clavamox for several months because he was routinely
developing a UTI. The vet didn't want to do it but I inisisted. They did
a
urine culture, preliminary results are that nothing is growing.

Then how did your vet diagnose UTIs?



Thank you.



I hope this helps a lttle.

Good luck.

Phil

"MacCandace" wrote in message
...
Thanks, Phil. I'm printing out your reply and giving it to the real vet
when
he gets back. Cory's thyroid was normal although I don't know the exact
number. I was in there today and requested a copy of his lab results but
that
one isn't on there...because it was done later, I guess. At least they
didn't
try to charge me for it...yet.

Anyway, here are the abnormal values:

BUN 39 (14-36) HIGH

The BUN can be affected by nonrenal causes that's why creatinine is a better
indicator of renal function. That slight elevation could have been caused
by a meal or even from muscle (protein) catabolism from not eating


Creatinine 2.3 (0.6-2.4) not abnormal

That's the important indicator of renal function. Although its still within
normal, its
high-normal. Could be an indication of very early renal disease. I'd
monitor Cr. closely. You don't have to order a full blood workup every
time. You can order specific tests for monitoring indivudual analytes.
Saves a fortune!


Amylase 1432 (100-1200) HIGH

Not nearly high enough to even suggest pancreatitis or even pancreatic
infammation. Could be due to a slight decrease in renal excretion.


CPK 575 (56-529) HIGH

Nothing to worry about. CPK indicates muscle injury or damage.The slight
elevation could be caused by muscle catabolism if Corey didn't eat recently
or from an injection.

Lymphocytes 504 (1200-1800) LOW

Doesn't say which - T or B lymphocytes. Without seeing the rest of the
hemogram, I won't even guess.



Urinalysis:

Are these values from before or after Corey received fluid therapy? If
after, its`very difficult to determine the effect the fluid had on the
actual values.


Ph 5.0 (5.5-7.0) LOW

What food are you feeding him?

Occult Blood 3+ (neg is ref. range) HIGH
RBC/HPF 3-10 (0-3) HIGH

How was the urine sample obtained? Catheterization or cystocentesis can
produce hematuria.


Casts/LPF Fine Gran 0-1
(Hyaline 0-3) HIGH

A few hyaline or granular casts (~1 to 2) can be found even in normal
urine.
Cory's are just slightly above normal. Hyaline casts are a sign of very
mild renal irritation -- but the number of casts in a single sample is no
way a reliable indicator of the stage of CRF.


USG is 1.023 (1.015-1.060)

If this value is the USG *after* Corey received fluid therapy, then his
normal value is probably close to or even normal. The usual "normal" range
for cats is beyween 1.035-1.060.




So, his kidney values aren't esp. high and his USG isn't really abnormal
either. He always has blood in his urine and always has ever since he
started
having UAs when he was about 5.

Again, how are the urine samples obtained? Catheterization or cystocentesis
(obtained via needle directly from the bladder) can produce hematuria.




I'm confused about the CPK and amylase.

CPK is Creatine phosphokinase - is an enzyme that's found in the brain heart
and muscles.
Its an enzyme that's usually associated with muscle damage or injury. Just
for a frame of reference, simple IM injections can raise CPK 2-3 times.
Cats that
haven't eaten can also usually have high CPK values from muscle catabolism.
I
don't think I'd be alarmed by the *slight* increase.



To clarify, the fluid therapy was done the day I was at the vet..after
they
took the blood and urine samples...

Ahhh, ok, that makes a big difference! In that case, Corey's USG is only
slighly delute but the bloodwork (PCV/Hct & T Protein) shows *no* evidence
of dehydration.

and the lab results were not obtained
until
the next day. I guess the relief vet felt he was dehydrated based on the
pinch
test.

The pinch test is too highly subjectve to be reliable. As you can see, the
bloodwork and the USG don't indicate dehydraton. TP, PCV (Hct) and USG are
much more accurate.


He did appear dehydrated, tho, and had not eaten well for a few
days so
I think he was, however the real vet generally only gives about 100-150ml
when
hydrating him. This was the most he ever got.

So...he seems better, he's eating and drinking, does not appear dehydrated
so
I'm not going to give him sub-qs at this time.

I think you made a wise decision.


But he does not appear
totally
his normal self either. He's not as chatty as usual. He's not
particularly
lethargic or hiding or anything but he isn't interacting quite as much,
not
quite as much eye contact. It's subtle but he's different. I don't
know...maybe he just went senile all of a sudden. but why's he losing
weight?

You might want to have his thyroid function tested again with another T4
followed by a Free T4 by Equilibrium Dialysis (fT4ED). fT4 is more
sensitive in assessing thyroid function in sick cats and cats with
concurrent or undiagnosed diseases that could alter routine T4 tests.

Are any of these values indicative of cancer or anything?

Hell no!!!

He urinates,
defecates normally and has not vomited since being hydrated.

His cough is
gone.

That's a relief. I was a little worried about cardic overload from all that
fluid.



His eyes are clear, fur soft.

I think you may be right. I'd really like to see his total protein,
PCV
(Hct) and USG values.

Total Protein 7.7 (5.2-8.8)
What's PCV? Is there something else it could be called?

Hct - Hematocrit.

Hct and PCV are almost identical. PCV is the total percentage of cells in a
sample of centrifuged blood anf HCT refers to the RBC (red blood cells)
only. WBC's (white blood cells) and platelets usually make up less than 1%
of the blood volume, so the difference between PCV and Hct is moot - for
most clinical purposes.



I don't see that
on
his results.

He's been on low-dose clavamox for several months because he was routinely
developing a UTI. The vet didn't want to do it but I inisisted. They did
a
urine culture, preliminary results are that nothing is growing.

Then how did your vet diagnose UTIs?



Thank you.



I hope this helps a lttle.

Good luck.

Phil

I hope this helps a lttle.

Good luck.

Phil

It does, thank you!

Candace
(take the litter out before replying by e-mail)

See my cats:
http://photos.yahoo.com/maccandace

"One does not meet oneself until one catches the reflection from an eye other
than human." (Loren Eisely)

I hope this helps a lttle.

Good luck.

Phil

It does, thank you!

Candace
(take the litter out before replying by e-mail)

See my cats:
http://photos.yahoo.com/maccandace

"One does not meet oneself until one catches the reflection from an eye other
than human." (Loren Eisely)