More Concerned for Boo

@LillyDSH, the recommendation for a low-protein food is based on the phosphorus content. It's possible to provide a low phos diet without low protein. The low protein is rather old school thinking at this point, and generally only applies to advanced stages of CRF: http://www.vetstreet.com/dr-marty-becker/kidney-failure-in-cats-what-you-can-do?Wt.mc_id=mbfacebook

Do you have the blood results yet?  Waiting on needles and pins here   (not that YOU have better things to do, but some of us live on this site )

mrsgreenjeens said:

Do you have the blood results yet?  Waiting on needles and pins here   (not that YOU have better things to do, but some of us live on this site :lol3: )

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:anon:

Thanks everyone!     Boo is my buff-colored boy. I remember when another TCS member described him as "creamy" in another thread and I thought that was a perfect adjective!  And yes, @LDG, he does look similar to Baloo.   

mrsgreenjeens said:

 
Do you have the blood results yet?  Waiting on needles and pins here

  (not that YOU have better things to do, but some of us live on this site

)

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LOL...sorry to keep you waiting! I sort of have the results. According to the doc, Boo's blood work looks "pretty good" except there is protein in the urine (proteinuria). She didn't say there was anything else abnormal, but I will see when I get a copy of the results they are sending me this week along with the rabies certificate. She's mostly concerned about this protein, so they are going to run the special protein:creatine ratio test to check how concentrated it is. It could be an indication of possible glomerular disease, as opposed to the more common interstitial disease, but could still be an early indicator of interstitial disease. I won't get the P:C results back until next week. So...more waiting...

:vibes; for a nice, comfortable P:C ratio. :rub:

Well, I've got good news and bad news.

The good news is that I got a copy of Boo's blood work in the mail and it does look pretty good. His BUN, creatinine, B:C ratio, phosphorus, etc. are all within range. His cholesterol is a little high.

The bad news is that they didn't have enough urine to do the P:C ratio test, so I have to bring him back for another urine sample at some point in the near future (maybe this week since I'm off from work).

He's still getting these episodes where he's trembling and twitching. Could this be related to a heart condition?    I told the doctor that he's still not eating all that great, and she had suggested putting him on a low dose of pred to address any low-grade GI disease and the hyperesthesia. She said she's seeing more senior cats with low-grade GI disease. I don't know about this. I mean, he has had chronic constipation for awhile now, but....

Poor Boo....I don't  really know where to go from here. I guess I'll ask the doc about a possible cardiovascular issue. He's been sitting in the meatloaf position a lot within the past week. He's trembling and twitching right now. 

Crap. I was doing research and I definitely need to discuss possible CHF/HCM with the vet. Boo does get this increased respiratory rate thing that I can't figure out. That coupled with the recent lethargy and decreased appetite are huge red flags. 

If you suspect heart trouble, there's a blood test for HCM: Cardiopet proBNP It picked up Jamie's HCM as part of his senior panel before he started showing any symptoms.
for Boo.

Now that you mention possible heart issues, what DID the Vet say about his other symptoms, the lazy eye, hot ears, increased vocalization?  And did she detect a heart murmur?  Almost everything I read on HCM said one of the symptoms was a heart murmur.  Yes, he's got some of the symptoms, but they are also symptoms of other things, and those turned out not to be an issue (kidney disease).

And I wonder what she meant by "low grade GI disease in older cats"? 

Thanks for the link, @jcat. I'll mention it to the vet.

@mrsgreenjeens, I showed the doc the video on my phone of Boo trembling, twitching and having an increased respiratory rate. It's really hard to see the trembling on a video though, and the twitching is sporadic. The weird thing is Boo doesn't seem distressed during these episodes, so she really didn't know what to think.    I didn't get a chance to talk to the vet today. I actually forgot to mention the lazy eye at the appointment, and she didn't comment on the red/hot ears and vocalization.    And I can't remember if she heard a murmur or not. Ugh...I'm good for nothing right now. She was primarily focused on his hyperesthesia/back rolling (this is different from the trembling and focal twitches) and kidney function.

By "low grade GI disease," I took that to mean a form of IBD, but at a lesser scale...something that lingers in the background. 

I'm debating whether or not it's worthwhile to put him on a limited ingredient, novel protein diet and see what happens. Perhaps rabbit, like Sebastian? I don't know what to think. Boo's "symptoms" are all over the place. Perhaps there's nothing wrong with him at all other than some neurological issues?

GoHolistic said:

By "low grade GI disease," I took that to mean a form of IBD, but at a lesser scale...something that lingers in the background.  :dk:

I'm debating whether or not it's worthwhile to put him on a limited ingredient, novel protein diet and see what happens. Perhaps rabbit, like Sebastian? I don't know what to think. Boo's "symptoms" are all over the place. Perhaps there's nothing wrong with him at all other than some neurological issues?

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I believe it wouldn't hurt to try it. It may not help GI/heart issues, but it would most likely help GI issues. :rub:

I wasn't able to get Boo back to the vet for another urine sample, but it is on my to-do. His drinking seems close to normal at the moment. He does not keep going back to the fountain all day. He'll visit it a few times in the mornings and any time he's had a little dry food.

This week, I decided to go ahead and start the limited ingredient, novel protein diet (rabbit) to see if it helps with any of his other issues. WELL...Boo is not happy. He is appalled at everything I'm putting down in front of him to the point where he is avoiding the kitchen entirely. He'll pace in the dining and living room because he's hungry, but he won't eat what I give him. I've tried the RC canned rabbit, Hound & Gatos rabbit, Addiction rabbit, and Nature's Variety rabbit. He will not eat them. I will at least give him credit that he will TRY it before deciding whether or not he likes it. So he has taken a few licks of each, but will not go back. I've tried to do the "tough mommy" thing and he just goes back to bed and would rather starve. I'll finally have to put down some of the Instinct LID dry rabbit or the RC dry rabbit. It seems he'll eat the dry of either, but he needs the wet food because of his chronic constipation.

I was thinking I could try venison. I have both the Natural Balance LID venison and EVO venison at home. Boo does get tired of the same food and in the past each meal has been different, so I don't know how well this is going to work out.

Sure, putting him on a special diet doesn't hurt to try, but is it worth the fight? His eating has been less as it is and this is just making it worse.

ETA: I should have said that the one he ate the most of was the Addiction rabbit, but it was still only 1/8 of can and he wouldn't go back. Should I keep trying? I also have a can of Wild Calling rabbit that I have not given him, yet; I'm not happy that this is canned in an Evanger's facility.

The novel protein diet isn't working. I've been at it for 6 days and I've now tried 5 brands of rabbit, 2 brands of lamb, 2 brands of venison, and 1 brand of buffalo - all canned. We're at a point where he either 1) will not eat at all or 2) will eat some dry rabbit kibble that I put down so that he eats something. Neither of these in an option. Because he hasn't been getting as much wet food as he should, he had a constipation "fit" this morning, as I like to call it (multiple trips to the box, squatting in random areas, straining, meowing, etc.). His poor bum was so sore. So I'm back to his regular food.

Tonight I started him on krill oil for his arthritis and to see if it helps with anything else. I pilled him with it and that was easy.

Sorry the limited ingredient diet didn't work out for him.  That has to be frustrating.

So it's really a matter that he doesn't LIKE these foods, not that he can't tolerate them.  Did you try giving him some of Sebastian's cooked rabbit?  Just wondered if he might like that?  Is that rabbit kibble freeze dried raw?  If so, what would happen if you put just a tiny bit of water in the bottom of the bowl with it.  Do you think he would lap up the water?  Reason I ask is because my Tinky is only eating freeze dried raw right now (without being rehydrated), but today I put a little water in the bowl with it (not waiting for it to rehydrate, just put some in there to see if he would drink it, and he did.  So....maybe you could try that and mix in a little Miralax for his constipation?  Just a thought. 

 

Yes, I did try giving him some of Sebastian's cooked rabbit...but just a little. He ate it, but I didn't pursue it in large quantities since I'm still unsure of the effect it has on them. Unfortunately, the rabbit kibble is not freeze-dried raw. I have both the Royal Canin hypoallergenic rabbit kibble and Nature's Variety LID rabbit kibble at home. Boo does like the S&C freeze-dried rabbit medallions for dogs, but this cannot be given long-term as meals, so I only offer it as a treat.

On a whim, I took the day off from work today, so I decided to take Boo back to the vet for the urine sample they need to do the P:C ratio test. Check that off my to-do. He hasn't lost any more weight, so that is good.

The doc came out to chat with me very briefly while Boo was in the back and said she'd like to try him on prednisolone for two weeks to see if it helps with the hyperesthesia. This, along with the other trembling and facial twitching episodes I describe, make her think that this may be as a result of some kind of pain. My guess is that she'd like to see if the pred reduces some kind of inflammation that we can't quite pinpoint. He does have arthritis and spinal disc degeneration. I really don't want to have to put another cat on pred, but she promised that we could re-evaluate in two weeks, and if I have observed no improvement, then we will taper him off.

He's eating better now that we're back on his regular food, but he didn't like the canned food I gave him this morning (it was something new I thought I'd let him try), and tonight he regurgitating his entire dinner.

P:C results are back. Doc said everything looks okay, so that's good news. But we'll have to keep an eye on this periodically. I asked them to fax me the results, but we're having technical difficulties.

Also, she doesn't see the need to jump through hoops right now trying to feed him a lower phosphorus diet since his numbers look okay. She just wants to make sure he's eating, so to give him what he likes.

But what about all the weird twitching, constipation, appetite, etc.? No explanation?

Raintyger said:

 
But what about all the weird twitching, constipation, appetite, etc.? No explanation?

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I'm not sure if you saw both updates from yesterday. In the first, I mentioned that the doctor wants to try Boo on steroids to address the FHS (feline hyperesthesia syndrome). This is just one of his issues. The trembling/jerking/breathing episodes he gets are separate from the FHS, and the doctor thinks this may be due to some sort of pain. If it is pain, we don't yet know where it's coming from. She wants to see if the steroids will also help with this. Her thought is to see if the steroids will reduce inflammation somewhere in his body that we can't quite pinpoint. It is a trial run. If we do not see improvement, then we taper him off.

The constipation has been going on for awhile now (5+ years), so this is nothing new. It might just be characteristic of Boo.

I am still concerned by how boney his spine has become. In certain positions, its like you can see every vertebrae. I know this is usually associated with CRF, but it his labs came out fine. Perhaps he is just losing muscle at his age and its nothing to worry about.