More Concerned for Boo

can the vet email a copy(of the pic) to the tcm?

mycatwasthebest said:

 
can the vet email a copy(of the pic) to the tcm?

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Yes, she is getting (got) a copy of everything.

So I had a chat with the integrative vet about Boo yesterday afternoon. Like our regular vet, we're basically going off of observed symptoms since his blood work and labs are almost perfect. She encourages the Adequan injections, so I called our regular vet again about that and they are going to order it (they didn't have it in stock). She also likes Gabapentin for pain (which Boo is on) and doesn't have any concerns with it in cats with possible renal issues (a concern of mine). She's sending me a couple Chinese herb blends, and made some other small recommendations to help with appetite and make sure he's getting enough nutrients.

That's where we are. I'll be taking Boo back to the regular vet in a couple months for another urinalysis so that we can keep tabs on that protein in his urine. 

I finally got the Chinese prescription the integrative vet prescribed for Boo for chronic pain (it was on backorder). It has only been two days and I'm slowly introducing it. I hope it helps. He has lost more weight and his appetite sucks.    I'm starting to think the worst here, folks, but I just don't understand it. All his labs/tests came out okay except for a little protein in his urine, which at this point is not an issue according to the protein to creatinine ratio.

The good news is that since I've eliminated chicken, beef, and fish from his diet, his allergy symptoms have significantly decreased. The problem is, he doesn't like many of the foods I am presenting to him. I have a very small rotation that he's already getting sick of. I'm not sure if he's just being picky and stubborn (he's a very stubborn cat) or if it's a result of his discomfort. I guess we'll see once the Chinese med kicks in.

I'm trying to start him back up on some other things, like digestive enzymes, probiotics, omega-3s, and a B complex per the integrative vet. He will no longer take probiotics in his food, so I have to pill him with it. He doesn't like the omega-3 in his food either, so I put a couple drops of that in his gel cap. He is being such a PITA.

I spoke with our traditional (Western) vet yesterday and she really doesn't have any more suggestions other than to put him on prednisolone to address any underlying inflammation and to help with his appetite. If he continues to lose weight, I may have to consider it.    Not sure what else to do. My old man is withering away.

Glad you got them in but sorry he is doing so poorly.  Many good vibes to Boo.

So sorry to hear about Boo! I hope the medications and supplements help.

I know you've researched foods due to Sebastian's issues. Does Boo have the same sensitivity to guar gum that you're aware of? If not, that opens up some other brands of food that Boo might like. Off the top of my head, I can think of several that have flavors with no chicken, beef, or fish: Party Animal (duck and turkey varieties), Pure Vita (turkey), and Hounds & Gatos (multiple). All contain guar gum, but no carrageenan. Abby really likes Party Animal turkey.

Sending positive thoughts your way.

Did the vet say why he's losing protein through the urine?

Are you noticing any chnges now that he's been on the Chinese stuff for a few days?  It's just got to be so frustrating

Sending vibes for you and your little old man (I know almost how you feel, since my little old girl is withering away too, although she's a kidney cat, so at least I KNOW the reason why on her )

I appreciate the vibes, everyone. 

Cloudy urine with proteins a month ago...?

peaches08 said:

 
Cloudy urine with proteins a month ago...?

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Yes, why? What are you thinking? I'll be taking him back in for another urinalysis and P:C ratio test next month.

Hold on....let me refer to my notes....

He also had a urinalysis in late November. The urine was clear that time, but 1+ was still noted on protein, so we had the P:C ratio done and that came out as 0.1 (reference range is <= 0.5). In January, we had a "Feline Serology II" test done (which all came back negative), as well as x-rays and ultrasound. You want that report, too?

Well, the 2 things that come to mind are existing glomeruler damage and possible hypertension.  But I am certainly no expert.  I would imagine he's been checked for hyperthyroid?  What have they said about his protein needs?

peaches08 said:

 
Well, the 2 things that come to mind are existing glomeruler damage and possible hypertension.  But I am certainly no expert.  I would imagine he's been checked for hyperthyroid?  What have they said about his protein needs?

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His blood pressure was also checked in late November, and it was fine. I, too, keep going back to glomerular disease. Everytime I read up on it, it sounds a lot like what might be going on. But I guess our vet feels that if the P:C ratio test is within range, then we sit on it.     The only thing that can really be done for proteinuria is an ACE inhibitor. I can ask the vet about this and what the risks are of starting it now. This article (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354822/) talks about proteinuria and glomerular dysfunction in cats and dogs.

Yes, in the blood work I posted above, his Total T4 is within range. Well, as we all know, many vets are not experts in nutrition. I asked about diet, and she said at this point, we just need to keep him eating since he has lost weight and is not eating well in general.

ETA: Oh, I should add that omega-3 supplementation is promising in reducing proteinuria, so I may need to get a little more aggressive with that.

What I should have said was, has he ever been hyperthyroid?  Gah, fingers went faster than brain.  You would have mentioned prior thyroid treatments if that were the case.

P:C ratio? 

peaches08 said:

 
What I should have said was, has he ever been hyperthyroid?  Gah, fingers went faster than brain.  You would have mentioned prior thyroid treatments if that were the case.

P:C ratio? 

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Oh, okay. He has never had any issues with his thyroid, either hyper or hypo. We include the T4 test in all his check-ups and they were always normal.

Urine protein: creatinine ratio, sometimes noted as UP/C. According to the article I linked to above (written in June 2012):

In cats, what has been deemed significant proteinuria is changing and the International Renal Interest Society (IRIS) now puts feline proteinuria into 3 substages, nonproteinuric [urine potein/creatinine ratio (UP/C) < 0.2], borderline proteinuric (UP/C 0.2 to 0.4), and proteinuric (UP/C > 0.4) (16).

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Boo's UP/C was 0.1 the last time it was checked, so they are considering that nonproteinuric. 

Well, in the absence of kidney disease, most would suggest more protein.  But HOW with a cat that won't eat? 

peaches08 said:

 
Well, in the absence of kidney disease, most would suggest more protein.  But HOW with a cat that won't eat? 

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IF it was glomerular disease and/or unexplained, persistent proteinuria, it is usually suggested to limit protein. This is the only condition in which I've read where feeding a lower protein diet may be helpful. However, blood work is not really saying we're there, yet, but many of his symptoms seem to fit.     Either way, like you said, I can barely get him to eat as it is. Right now he's eating foods pretty high in protein and low carbs - Nature's Variety LID Lamb, Wellness Core Turkey & Duck, and Nutro Natural Choice Soft Loaf Turkey. A few times a week I'll try another brand/flavor, which he may or may not eat. I even brought the S&C back out, which was a no-go.

Is there an emoticon/smiley for ripping hair out? 

I remember when I was researching protein and CRF, it turned out that lower protein isn't always the answer.  Especially in a cat that is wasting away as mine was.  But, that's what she needed at that time.  Boo is an individual with no real diagnosis.  And even if you had one and here's the new diet in shiny tin cans...HOW to get him to eat it?  I feel ya.  I had to look at Grey (RIP) many times, "PLEEEEASE eat for mommy!"

peaches08 said:

 
I remember when I was researching protein and CRF, it turned out that lower protein isn't always the answer.  Especially in a cat that is wasting away as mine was.  But, that's what she needed at that time.  Boo is an individual with no real diagnosis.  And even if you had one and here's the new diet in shiny tin cans...HOW to get him to eat it?  I feel ya.  I had to look at Grey (RIP) many times, "PLEEEEASE eat for mommy!"

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I read that, too, and agree. Apparently it's a little different with feline glomerular disease, or so I've read.    But you're right! Eating is important. I don't need fatty liver on top of everything else.   

I do think he has multiple issues going on, which makes it more difficult. I think his arthritis and disc disease has progressed.

Hi

I just want to remind everyone that you need to have 70% loss of kidney function before it turns up in the blood work.

To me personally from what I learned from the Internal Medicine Vet I worked for that all cats should have urine concentrations higher than what is considered "normal". So a urine specific gravity or 1.031 is actually kind of dilute for a cat.

Here is a link to a fairly good paper written that lists several diseases. Try to read through it if you have time. There is some things you might find interesting on the thyroid and the kidneys.

I know I got onto this late and have not read all of the posts, but if an ultrasound wasn't done with an internal medicine vet it should be if you can.

I am sorry you and your kitty are going through this . I hope things improve soon. http://www.dcavm.org/07oct.html

The 70% loss before lab work reveals a problem is related to renal failure, no?  I only brought up renal failure in my old cat and protein needs because of the slight possibility if existing glomerular damage in Boo and him still needing protein if he's spilling it and his ammonia levels are normal.  The only reason I questioned hyperthyroid is the weight loss and hyperT causes hypertension that can cause glomerular damage.  Thankfully Boo didn't have these issues.

Sorry for confusing the whole thread!