Cat has CRF

"Kolbard" wrote in message
...
On Sat, 25 Apr 2009 00:25:51 GMT, "Phil P."
wrote:


"Kolbard" wrote in message
.. .
Hmm, I read a bit more and this "knuckling" seems to be from high
phosphorus levels rather than low potassium.

I don't think so.


No? Is it from low potassium?

That's my guess.


We managed to get her back on IV at the vet's clinic. We won't be
able to speak with the doc until tomorrow, but I'll definitely lobby
for a diuretic; the vet assistant mentioned that they will use it
under certain circumstances.


I think a BUN of 171, creatinine of 7.9 and Pi of 19.7 qualifies as a
"certain circumstance", don't you?

On Sat, 25 Apr 2009 03:59:22 GMT, "Phil P."
wrote:


"Kolbard" wrote in message
.. .
On Sat, 25 Apr 2009 00:25:51 GMT, "Phil P."
wrote:


"Kolbard" wrote in message
.. .
Hmm, I read a bit more and this "knuckling" seems to be from high
phosphorus levels rather than low potassium.

I don't think so.


No? Is it from low potassium?

That's my guess.


We managed to get her back on IV at the vet's clinic. We won't be
able to speak with the doc until tomorrow, but I'll definitely lobby
for a diuretic; the vet assistant mentioned that they will use it
under certain circumstances.


I think a BUN of 171, creatinine of 7.9 and Pi of 19.7 qualifies as a
"certain circumstance", don't you?



I do, but I don't know if the vet does. In any case, we're pushing
for it.

Kolbard

"Kolbard" wrote in message
...
On Sat, 25 Apr 2009 03:59:22 GMT, "Phil P."
wrote:


"Kolbard" wrote in message
.. .
On Sat, 25 Apr 2009 00:25:51 GMT, "Phil P."
wrote:


"Kolbard" wrote in message
.. .
Hmm, I read a bit more and this "knuckling" seems to be from high
phosphorus levels rather than low potassium.

I don't think so.


No? Is it from low potassium?

That's my guess.


We managed to get her back on IV at the vet's clinic. We won't be
able to speak with the doc until tomorrow, but I'll definitely lobby
for a diuretic; the vet assistant mentioned that they will use it
under certain circumstances.


I think a BUN of 171, creatinine of 7.9 and Pi of 19.7 qualifies as a
"certain circumstance", don't you?



I do, but I don't know if the vet does. In any case, we're pushing
for it.

If I were you, I'd also push (I'd actually insist) she add a K+ supplement
to the fluids. Your cat's K+ is already low- fluid diuresis will lower her
K+ stores even further. Cats can die of complete muscle paralysis from fluid
diuresis if the body stores of K+ are already severely depleted. Also, if
your cat is acidotic, she'll need a taurine supplement, too. K+ depletion
with acidosis can cause reductions in taurine levels that can be fatal.

I'll be trapping all weekend so I might not get a chance to get back here
for a few days. If I can't, I want to wish you the best of luck.

Phil

On Sat, 25 Apr 2009 08:51:12 GMT, "Phil P."
wrote:
If I were you, I'd also push (I'd actually insist) she add a K+ supplement
to the fluids. Your cat's K+ is already low- fluid diuresis will lower her
K+ stores even further. Cats can die of complete muscle paralysis from fluid
diuresis if the body stores of K+ are already severely depleted. Also, if
your cat is acidotic, she'll need a taurine supplement, too. K+ depletion
with acidosis can cause reductions in taurine levels that can be fatal.

I'll be trapping all weekend so I might not get a chance to get back here
for a few days. If I can't, I want to wish you the best of luck.

Phil

Thanks, Phil. I really appreciate this.

Kolbard

Just an update.

We weren't even able to speak with a vet until today. They had her on
IV from Fri-Mon, but no diuretic. Some of her levels have gone down,
but they're still very much in the bad range:

ALB 4.3
ALP 21
ALT 48
AMY 2375 *
TBIL 0.2
BUN 131 *
CA 11.2
PHOS 10.3 *
CRE 5.4 *
GLU 116
NA+ 148
K+ 5.5
TP 7.2
GLOB 2.9

QC OK
HEM 0 LIP 1+ ICT 0

She did seem much more alert when we first brought her back this
evening, but she's been sleeping in a chair since then; she hasn't
eaten any of the prescribed food, and as far as I can tell, she hasn't
drank any water, although she that may be because she was hydrated.
She tried to eat some regular dry food; I'm still wrestling with the
idea of letting her eat it.

I asked if it would be possible to put her back on IV with a diuretic,
but the vet said it would be better for her to rest a couple of days,
and then maybe we could give her a diuretic ourselves (?!), and
possibly an IV at home. I really want to find a place that will treat
this aggressively, but I just don't know if driving to the next big
city is feasible. This sucks. I really don't know what to do at this
point, besides playing pin the tail on the donkey with the other
clinics in town.

Kolbard

She ate a few spoonfuls of food today, so far.

I forgot to mention that we asked the vet about Tumil-K, and she
prescribed half a tablet twice a day.

On Tue, 28 Apr 2009 01:31:27 -0500, Kolbard
wrote:

Just an update.

We weren't even able to speak with a vet until today. They had her on
IV from Fri-Mon, but no diuretic. Some of her levels have gone down,
but they're still very much in the bad range:

ALB 4.3
ALP 21
ALT 48
AMY 2375 *
TBIL 0.2
BUN 131 *
CA 11.2
PHOS 10.3 *
CRE 5.4 *
GLU 116
NA+ 148
K+ 5.5
TP 7.2
GLOB 2.9

QC OK
HEM 0 LIP 1+ ICT 0

She did seem much more alert when we first brought her back this
evening, but she's been sleeping in a chair since then; she hasn't
eaten any of the prescribed food, and as far as I can tell, she hasn't
drank any water, although she that may be because she was hydrated.
She tried to eat some regular dry food; I'm still wrestling with the
idea of letting her eat it.

I asked if it would be possible to put her back on IV with a diuretic,
but the vet said it would be better for her to rest a couple of days,
and then maybe we could give her a diuretic ourselves (?!), and
possibly an IV at home. I really want to find a place that will treat
this aggressively, but I just don't know if driving to the next big
city is feasible. This sucks. I really don't know what to do at this
point, besides playing pin the tail on the donkey with the other
clinics in town.

Kolbard


Kolbard

"Kolbard" wrote in message
...
She ate a few spoonfuls of food today, so far.

I forgot to mention that we asked the vet about Tumil-K, and she
prescribed half a tablet twice a day.


I have nothing constructive to add, just wanted to say that I am sorry that
you and your girlycat have to go through this. I don't know about CRF, but
do know how hard it is for the ones who love them when they are feeling so
poorly and barely eating. Praying she rallies.

We took her to a third vet today.

The vet said her kidneys were tiny and barely there. She's nothing
but skin and bone. The vet agreed to put her on IV to try and flush
out the toxins, but said the process would end up repeated, and we'd
likely end up in the same spot again.

Phil, what kind of diuretic do you refer to? This vet mentioned lasix
(sp.) but said she wouldn't use it, because the other IV fluids would
have to be increased and it would just cancel everything out, making
her kidneys worse. I don't know if that's true or not, but I know
that there isn't a vet in this town that thinks she could be saved.

I don't have much hope, but I thought it was worth a try. There's no
way we could afford to take her to Dallas, at least at this point, so
this is probably the last effort to save her life. I don't know what
else to do.

Kolbard

"Kolbard" wrote in message
...
We took her to a third vet today.

The vet said her kidneys were tiny and barely there. She's nothing
but skin and bone. The vet agreed to put her on IV to try and flush
out the toxins, but said the process would end up repeated, and we'd
likely end up in the same spot again.

Boggles the mind... Once the uremic crisis is over, SQ fluid therapy at
home should keep her hydrated and azotemia under control.

Is your cat urinating ok- or better- a lot? Very important.



Phil, what kind of diuretic do you refer to?

For initial intense diuresis, we use hypertonic dextrose (10% or 20%) or
furosemide (Lasix). Hypertonic dextrose is good because you' can check to
see if diruesis is beginning by simply checking the sugar in the urine with
a simple urine dipstick. It also supplies some calories and energy without
increasing the BUN.


This vet mentioned lasix
(sp.) but said she wouldn't use it, because the other IV fluids would
have to be increased and it would just cancel everything out, making
her kidneys worse.

Unbelievable.... The purpose of intense diuresis is to flush uremic toxins
out of the blood *quickly* to resolve a uremic *crisis*. ID is a *lot* less
taxing on the kidneys than a uremic crisis and death.


I don't know if that's true or not, but I know
that there isn't a vet in this town that thinks she could be saved.

If you plan to live with cats, you might want to consider moving to a town
that has conscientious and competent vets. A lot of vets know what to do-
but many just don't *want* to go through all the trouble when they can make
the same or a little less for doing a lot less. Also, a lot of small
practices aren't equipped to do much more than spays and neutering and minor
procedures. OTOH, a lot of vets are just plain lazy and indifferent-- and
some just don't like cats- that's a fact.


I don't have much hope, but I thought it was worth a try. There's no
way we could afford to take her to Dallas, at least at this point, so
this is probably the last effort to save her life. I don't know what
else to do.


You live in Texas? Great!! I wish I knew that earlier (I should have
asked). Call Dr. Steve Taylor ASAP. He used to be at the Animal Medical
Center in NYC- now he's at the Lexington Boulevard Animal Hospital in Sugar
Land,.Texas. Phone281) 980-3737 (24 hour). He's an ACVIM Diplomate in
internal medicine and an expert in Feline CRF and in fluid and intense
diuresis. If your bozo vet's ego isn't too big, maybe he could ask Dr.
Taylor to advise him how to proceed.

I'll try to get back a little later and respond to your other posts.

Keep the faith,

Phil

On Wed, 29 Apr 2009 21:24:50 GMT, "Phil P."
wrote:


"Kolbard" wrote in message
.. .
We took her to a third vet today.

The vet said her kidneys were tiny and barely there. She's nothing
but skin and bone. The vet agreed to put her on IV to try and flush
out the toxins, but said the process would end up repeated, and we'd
likely end up in the same spot again.

Boggles the mind... Once the uremic crisis is over, SQ fluid therapy at
home should keep her hydrated and azotemia under control.

Is your cat urinating ok- or better- a lot? Very important.



Phil, what kind of diuretic do you refer to?

For initial intense diuresis, we use hypertonic dextrose (10% or 20%) or
furosemide (Lasix). Hypertonic dextrose is good because you' can check to
see if diruesis is beginning by simply checking the sugar in the urine with
a simple urine dipstick. It also supplies some calories and energy without
increasing the BUN.


This vet mentioned lasix
(sp.) but said she wouldn't use it, because the other IV fluids would
have to be increased and it would just cancel everything out, making
her kidneys worse.

Unbelievable.... The purpose of intense diuresis is to flush uremic toxins
out of the blood *quickly* to resolve a uremic *crisis*. ID is a *lot* less
taxing on the kidneys than a uremic crisis and death.


I don't know if that's true or not, but I know
that there isn't a vet in this town that thinks she could be saved.

If you plan to live with cats, you might want to consider moving to a town
that has conscientious and competent vets. A lot of vets know what to do-
but many just don't *want* to go through all the trouble when they can make
the same or a little less for doing a lot less. Also, a lot of small
practices aren't equipped to do much more than spays and neutering and minor
procedures. OTOH, a lot of vets are just plain lazy and indifferent-- and
some just don't like cats- that's a fact.


I don't have much hope, but I thought it was worth a try. There's no
way we could afford to take her to Dallas, at least at this point, so
this is probably the last effort to save her life. I don't know what
else to do.


You live in Texas? Great!! I wish I knew that earlier (I should have
asked). Call Dr. Steve Taylor ASAP. He used to be at the Animal Medical
Center in NYC- now he's at the Lexington Boulevard Animal Hospital in Sugar
Land,.Texas. Phone281) 980-3737 (24 hour). He's an ACVIM Diplomate in
internal medicine and an expert in Feline CRF and in fluid and intense
diuresis. If your bozo vet's ego isn't too big, maybe he could ask Dr.
Taylor to advise him how to proceed.

I'll try to get back a little later and respond to your other posts.

Keep the faith,

Phil




Thank you, Phil, we will call him as soon as we can. I never even
thought about having a vet consult with a specialist over the phone.
As long as she's breathing, I don't want to give up now.

BTW, the previous vet even recommended something called a fleet enema
to bring the phosphorus down!!! I've never even heard of such a
thing, and the current vet almost seemed offended when we told her
about it. Just doing a quick Google Groups search (amazing any posts
show up at all since their search is nearly broken), it sounds
extremely dangerous and wrong. I'm in disbelief.

Kolbard