Starting Prednosone

zoneout said:

Yes, it is clearly indicated on the prescription bottle label  `May cause increased thirst and urination.`   So what????   How is knowing that supposed to have helped me (my cat)??



I was feeding her raw.    Everyone seems to be missing the point though.....   she was not eating or drinking as she was in the grips of a severe IBD flare.   The only food she was getting was a jar of baby food I syringe fed daily.   For fluids I was syringing a mixture of pedialyte with water.    Heavy vomiting of clear fluid.   Soooooo.... she was severely dehydrated from the IBD flare (heavy vomiting + not drinking on her own = dehydration).   



I brought her to the vet who gave her a subQ and handed me a bottle of pred.     I started the pred that evening and the next day she urinated next to the litterbox what looked like a volume of pee = volume of the subQ.   



So the label warning is correct `May increase urination`.  However the part about increased thirst had not kicked in - nor had my vet advised me to come back for more subQs.   She only said I should see improvement in 2-3 days and so I became falsely optimistic.    A few hours after urinating her entire subQ is when she likely had a stroke from dehydration and died later that day.



So I am trying to wrap my mind around what the pitfall is in order to hopefully spare another cat the same fate.    It seems what others are saying is that they:



A) did not start pred while the cat is in severe flare - heavy vomiting and not eating or drinking on their own  (in other words cat was already stablIized before they started pred)


B) started pred during flare but were also aware of what to do to rehydrate the cat after sudden and excessive urination.


C) were using other meds to control symptoms until the pred could kick-in.


D) just by chance were lucky enough that their cat was immune to this excessive urination side-effect.

Click to expand...

Hyperbole?

My cat went through the exact same thing as yours, but the only difference is that I gave it a shot of Cerenia for the nausea. It wasn't until then that the cat started to eat/drink again.

My kitty was started on Pred while in a severe flare with vomiting.  In fact he had gone into fatty liver and a feeding tube was put in.  The only other medicine he was on was Flagyl which is an antibiotic that also acts as an anti-inflammatory.  

The sad truth is that not all kitties survive a severe flare.  Other organs can fail because of the stress on the body.  There is also the possibility of a reaction to the pred that couldn't be foreseen.  It is generally well tolerated by kitties at least short term, blood sugar issues usually crop up with long term use, but all medications can cause a negative reaction in a kitty just as they can in people.  With medicines it is always does the benefit outweigh the risks.  

Denice said:

 
My kitty was started on Pred while in a severe flare with vomiting.  In fact he had gone into fatty liver and a feeding tube was put in.  The only other medicine he was on was Flagyl which is an antibiotic that also acts as an anti-inflammatory.  

The sad truth is that not all kitties survive a severe flare.  Other organs can fail because of the stress on the body.  There is also the possibility of a reaction to the pred that couldn't be foreseen.  It is generally well tolerated by kitties at least short term, blood sugar issues usually crop up with long term use, but all medications can cause a negative reaction in a kitty just as they can in people.  With medicines it is always does the benefit outweigh the risks.  

Click to expand...

I agree, I still wonder if this cat had a cardiovascular/renal event unrelated to the prednisone.  Prednisone usually causes retention of water, not dehydration (think Cushing's when on pred). 

I hope you can find peace with all this soon, @zoneout.  I remember when I did everything I could, including feeding that crap renal food by Hill's and put her back on insulin, only to still have to say goodbye.  I was dating a psycho at the time and I had to scream at him that morning to get him out of my house.  The yelling scared and upset my cat, but I've had to forgive myself that I did the best I could at the time and that's all anyone can ask of me.  Even without the psycho, there was simply nothing more that I could do for my cat and she was probably going to die in less than 12 hours.  I released her from pain/discomfort and that is the best I could do.  You did your best, and that's all anyone can ask of you too.

myrnafaye said:

 
I am so sorry to hear this,  it is terribly sad and distressing.  Do you know if her kidneys were functioning?  That is the only thing I can think of.  Most cats should be able to process sub Q fluids; and I believe that pred can also adversely effect kidneys, but it is unlikely that that happened - overnight - from the pred... :  (

Click to expand...

She had an ultrasound and the internist said one kidney looked either misshapen or small (I forget which) but she said she wasn`t concerned since cats (and people) can survive fine on one kidney.    The urine test showed high protein and the blood test showed some kidney associated values were high like BUN off the top of my head.  However, the vets (3 different ones) didn`t make anything of it.   The issue being that I was taking my cat to the vets during these flareups because she was vomiting, not eating and therefore DEHYDRATED.   Unless my research is off - Blood and urine tests will yield false positive readings for kidney malfunction if the cat is DEHYDRATED.   This is because the substances they are testing for (like protein for example) become concentrated in urine even in healthy cats that are dehydrated.   So dehydration winds up masking kidney related issues in the tests.

So wouldn`t common sense dictate to get the cat back to normal hydration levels then RETAKE the blood/urine tests?  Then check to see if the readings are still high?   Why is this obvious to a Joe Shmoe like me but 3 vets (2 very experienced) it never occurred to?    Maybe the problem is that common sense is rather uncommon and unfortunately it can`t be taught in a class. 

JClark said:

 

zoneout said:

 
Yes, it is clearly indicated on the prescription bottle label  `May cause increased thirst and urination.`   So what????   How is knowing that supposed to have helped me (my cat)??

I was feeding her raw.    Everyone seems to be missing the point though.....   she was not eating or drinking as she was in the grips of a severe IBD flare.   The only food she was getting was a jar of baby food I syringe fed daily.   For fluids I was syringing a mixture of pedialyte with water.    Heavy vomiting of clear fluid.   Soooooo.... she was severely dehydrated from the IBD flare (heavy vomiting + not drinking on her own = dehydration).   

I brought her to the vet who gave her a subQ and handed me a bottle of pred.     I started the pred that evening and the next day she urinated next to the litterbox what looked like a volume of pee = volume of the subQ.   

So the label warning is correct `May increase urination`.  However the part about increased thirst had not kicked in - nor had my vet advised me to come back for more subQs.   She only said I should see improvement in 2-3 days and so I became falsely optimistic.    A few hours after urinating her entire subQ is when she likely had a stroke from dehydration and died later that day.

So I am trying to wrap my mind around what the pitfall is in order to hopefully spare another cat the same fate.    It seems what others are saying is that they:

A) did not start pred while the cat is in severe flare - heavy vomiting and not eating or drinking on their own  (in other words cat was already stablIized before they started pred)

B) started pred during flare but were also aware of what to do to rehydrate the cat after sudden and excessive urination.

C) were using other meds to control symptoms until the pred could kick-in.

D) just by chance were lucky enough that their cat was immune to this excessive urination side-effect.

Click to expand...

Hyperbole?

My cat went through the exact same thing as yours, but the only difference is that I gave it a shot of Cerenia for the nausea. It wasn't until then that the cat started to eat/drink again.

Click to expand...

Yes totally agree, in my cat`s previous flareup, in February, they did give her Cerenia tabs and it definitely seemed to help her stabilize and get over the flareup and vomiting.    I then started her on raw food for the next 3 months she never looked better - I actually thought it cured the IBD - silly me.     But then early June came another of these cyclical flareups - vomiting - severe dehydration.   I brought her to the vet and - you guessed it - she advises me to have more tests done including an xray (which we already did back in Feb) and that will be $650 thank you very much.   When I questioned the need for the tests (since these were recurring symptoms - not new ones) she became indignant and stormed out.   She sent a tech out to me to give the cat a subQ and hand me the pred.   No further explanation/follow-up of any kind.   `....Here`s your cat and your prednisone (not even PREDNISOLONE) and will that be visa or mc? `  

Zoneout, I dont know.  I am not a vet. I have had a cat with kidney disease, and hydration helped him when he was episodic.  However, I assume that badly diseased kidneys might lose their capacity to process fluids - that is why humans get dialysis.  I also know the Creatinine value is more sensitive and a better indicator of how the kidneys are doing.

It sounds like you really want some closure with this issue - I dont blame you - have you considered a consult (phone) with the Cornell Feline health center?  Just a thought.

peaches08 said:

 
I agree, I still wonder if this cat had a cardiovascular/renal event unrelated to the prednisone.  Prednisone usually causes retention of water, not dehydration (think Cushing's when on pred). 

I hope you can find peace with all this soon, @zoneout.  I remember when I did everything I could, including feeding that crap renal food by Hill's and put her back on insulin, only to still have to say goodbye.  I was dating a psycho at the time and I had to scream at him that morning to get him out of my house.  The yelling scared and upset my cat, but I've had to forgive myself that I did the best I could at the time and that's all anyone can ask of me.  Even without the psycho, there was simply nothing more that I could do for my cat and she was probably going to die in less than 12 hours.  I released her from pain/discomfort and that is the best I could do.  You did your best, and that's all anyone can ask of you too.

Click to expand...

@peaches08  - a heart-felt thank you.   It`s just that nothing frustrates me more than sheer incompetence in people I rely upon - especially the so-called professionals.  LOL... I was given a case-full of that crap Hill`s i/d (pork by-products and corn meal .....YUM!!!)  - that`ll fix yer feline - yeah right.

Look at the bright side though.... at least you were just dating a psycho....not married to one.   

myrnafaye said:

 
Zoneout, I dont know.  I am not a vet. I have had a cat with kidney disease, and hydration helped him when he was episodic.  However, I assume that badly diseased kidneys might lose their capacity to process fluids - that is why humans get dialysis.  I also know the Creatinine value is more sensitive and a better indicator of how the kidneys are doing.

It sounds like you really want some closure with this issue - I dont blame you - have you considered a consult (phone) with the Cornell Feline health center?  Just a thought.

Click to expand...

Thanks.   Yes, I actually have considered calling the Cornell center - unfortunately I found out about it after my cat was already gone.   So at this point what`s the use.  I am trying to chalk this up to experience and hopefully pass along to others some of what I learned the hard way.     Being overly-analytical is just my nature.   My brain is wired that way so it`s hard for me to let things go.  It will just take time.

zoneout said:

 
Thanks.   Yes, I actually have considered calling the Cornell center - unfortunately I found out about it after my cat was already gone.   So at this point what`s the use.  I am trying to chalk this up to experience and hopefully pass along to others some of what I learned the hard way.     Being overly-analytical is just my nature.   My brain is wired that way so it`s hard for me to let things go.  It will just take time.

Click to expand...

You have good traits in you zoneout. You're very smart, caring, and as you said you'd like to find out some things to make others more wise and aware. Do whatever you need to do to seek closure. 

What I've discovered sadly in medicine, i think its fair to say veterinary or human, is that no matter what you do, including the best and most current treatments, sometimes it doesn't work out and there is no explanation why.  Whether 9 patients out of 10, or 19 out of 20 react well to treatments, some will not and there is sometimes no medical explanation as to why.   Medicines are tailored for conditions, not individuals, and the individual sometimes trumps the condition.  I know this is philosophical, but there is a reason why medicine is described and both art and science.

StephenQ said:

 
What I've discovered sadly in medicine, i think its fair to say veterinary or human, is that no matter what you do, including the best and most current treatments, sometimes it doesn't work out and there is no explanation why.  Whether 9 patients out of 10, or 19 out of 20 react well to treatments, some will not and there is sometimes no medical explanation as to why.   Medicines are tailored for conditions, not individuals, and the individual sometimes trumps the condition.  I know this is philosophical, but there is a reason why medicine is described and both art and science.

Click to expand...

Not philosophical at all, that is the way medicine goes.  Prednisone is a wonderful drug, but something happened in this one case.  Like food poisoning in which it isn't always because of the last thing that you ate, we really don't know if it was the prednisone that set everything in motion.  I used to think "well, that was the only thing that changed" until experience taught me that the person/animal is dynamic and they can change.  Cancer, an unknown CV condition (was it a septal defect that caused the murmur?), etc. could have been quiet until something or a combination of things caused it to rear it's ugly head.

Had the cat ever received prednisone before? 

Hi;

I only read the first question so if it has already been said please disregard.

Prednisone is not a diuretic. The reason it causes increased urination is due to the increased thirst and drinking. It is the drinking in  excess that causes the urination, not the pred itself. So, if the cat were not to drink more they wouldn't urinate more. No dehydration would be caused by the pred. I hope this helps. I will try to go back and read some of the posts

.

Ok Zoneout.

I read a little. First off, I am so sorry.

What it sounds to me like should have happened (not a vet ) is that your cat should have not been given sub q fluids and should have been hospitalized and closely monitored on IV  fluids watching for any signs of fluid overload. So a fairly slow drip. If she still wasn't eating and it was looking like an appetite stimulant such as mirtazapine was not going to work ( I have mixed feelings on that drug) and she had already been given a steroid to reduce the inflammation in her GI tract, and was staying hydrated on the fluids without showing signs of overload ie increased respirations, watery eyes, then they could have considered a feeding tube if her actual GI could handle food or intravenous feeding, which is a huge thing to undertake and best only done at a university or specialty hospital that is knowledgeable and experienced with intravenous feeding. It is very easy to get a blood infection if not total aseptic technique is used.

The heart murmur is, in cats often a sign of Hypertrophic Cardiomyopathy. HCM. It is only diagnosed through an echo exam (ultrasound of the heart with a color Doppler), and only very experienced cardiologists or DACVIM Boarded Veterinarians should be diagnosing it. 

Sadly cats can become fluid overloaded with just sub q fluids. It is also possible to cause fluid overload with enemas as well. Not that it pertains to this but just something to keep in mind  for the future.

I see many a vet doing things that I think are way off base or just plain barbaric in my opinion. I hear of cats being left overnight on IV fluids and they think cause there is a fluid pump involved there won't be a problem. I think that should never happen. They have never seen what a cat can do to a long iv line in the cage. I see so many vets that treat almost everything with an injection of dexamethasone, convenia and sub q fluids, when they don't even know what they are treating. In Quiet's world this would never happen. I see vets doing C&S on a free catch urine sample. Yeah no bacteria on that table huh? I could go on but I don't think people want to hear it, especially you.

The sad thing is that if your cat was not treated the best way there is little that can be done about it. Veterinarians are governed by Veterinarians and nobody else. They tend to stick up for eachother. I could tell some horror stories but I won't. Believe me they are not held accountable. Unless they break a rule like practice in another state they are not licensed to practice in. For that they get in trouble.

I understand you are angry and hurt and anyone with a soul would be. I am sorry for your loss and your pain, I will also tell you that sometimes very very bad things happen to very sweet innocent little cats for no reason what so ever. Things just happen. It is wrong and a million other things but there is nothing that can be done to it. I cannot tell you how many cats I have done absolutely every thing including being with them 24/7 and cure them of what ever trauma or disease and think that I have done a great thing, only to find out they died a horrible death, or worse by some (cant say the words on here) supposed owner who completely adored me for saving their kitten/cat and swore never to let them outside again (I live in coyote central) only to find out the let them out the next week.

I am sorry to rant. But what I am trying to say is just as wrong as it is, things happen, you cannot change what has happened. You can dwell on it and be upset and angry and hurt and feel everything you need to and should feel, but it just doesn't change anything.

I hope this makes sense. I mean everything in only a supportive way. I didn't mean to take over and rant. You will not "get over" this but you will learn how to exist with the grief. I better add some smileys so nobody takes this as not being nice.  

peaches08 said:

 
Had the cat ever received prednisone before? 

Click to expand...

Nope.   First time.

zoneout said:

 
She had an ultrasound and the internist said one kidney looked either misshapen or small (I forget which) but she said she wasn`t concerned since cats (and people) can survive fine on one kidney.    The urine test showed high protein and the blood test showed some kidney associated values were high like BUN off the top of my head.  However, the vets (3 different ones) didn`t make anything of it.   The issue being that I was taking my cat to the vets during these flareups because she was vomiting, not eating and therefore DEHYDRATED.   Unless my research is off - Blood and urine tests will yield false positive readings for kidney malfunction if the cat is DEHYDRATED.   This is because the substances they are testing for (like protein for example) become concentrated in urine even in healthy cats that are dehydrated.   So dehydration winds up masking kidney related issues in the tests.

So wouldn`t common sense dictate to get the cat back to normal hydration levels then RETAKE the blood/urine tests?  Then check to see if the readings are still high?   Why is this obvious to a Joe Shmoe like me but 3 vets (2 very experienced) it never occurred to?    Maybe the problem is that common sense is rather uncommon and unfortunately it can`t be taught in a class. 

Click to expand...

I JUST saw this post.  My understanding is that high protein in urine is a problem, regardless of hydration status.  I'm wondering how much this may have attributed to the large amount of urine you saw?

catconcern said:

 
You have good traits in you zoneout. You're very smart, caring, and as you said you'd like to find out some things to make others more wise and aware. Do whatever you need to do to seek closure. 

Click to expand...

Thanks catconcern.  I decided I had enough because I had another sleepless night over this.  Going over and over in my mind I felt I was missing something.    So today I was going to seek out some answers and hopefully allow me to have closure.   I went back to the animal hospital where I brought my cat in February (when she had her previous flareup (vomiting, anorexia, dehydration)).   I wanted to see copies of the blood and urine tests.   If they showed abnormal results for kidney function (due as I suspect to masking caused by dehydration) I was going to ask one of the vets to explain why they didn`t mention to retake the tests after she was re-hydrated and stabile.

So the secretary went and pulled the file and gave me a copy.   I looked at it and there it was - multiple elevated kidney-related values.  Then I looked at the discharge papers which I never recalled seeing.  There on the bottom it said `Recheck: Schedule an appt in 3-5 days to recheck kidney values and hydration).    Why had I no recollection of any of this????   I remember dropping the cat off and they kept her overnight.

Then I looked at the owner`s release signature..... it was my idiotic ex-wife who picked her up the next day.   She never felt it necessary to do the follow-up or even inform me of it.    

I just slowly walked out of the center into the parking lot in stunned disbelief.   I just went over to a retaining wall, sat down, stared blankly into the distance and watched the sunset.

zoneout said:

 
Thanks catconcern.  I decided I had enough because I had another sleepless night over this.  Going over and over in my mind I felt I was missing something.    So today I was going to seek out some answers and hopefully allow me to have closure.   I went back to the animal hospital where I brought my cat in February (when she had her previous flareup (vomiting, anorexia, dehydration)).   I wanted to see copies of the blood and urine tests.   If they showed abnormal results for kidney function (due as I suspect to masking caused by dehydration) I was going to ask one of the vets to explain why they didn`t mention to retake the tests after she stabilized.

So the secretary went and pulled the file and gave me a copy.   I looked at it and there it was - multiple elevated kidney-related values.  Then I looked at the discharge papers which I never recalled seeing.  There on the bottom it said `Recheck: Schedule an appt in 3-5 days to recheck kidney values and hydration).    Why had I no recollection of any of this????   I remember dropping the cat off and they kept her overnight.

Then I looked at the owner`s release signature..... it was my idiotic ex-wife who picked her up the next day.   This communications major in college never felt it necessary to do the follow-up or even inform me of it.    

I just slowly walked out of the center into the parking lot in stunned disbelief.   I just went over to a retaining wall, sat down, stared blankly into the distance and watched the sunset.

Click to expand...

Forgive me my brain isn't working properly atm. So what you're telling me is because of both your ex and the major in college your cat was denied a follow up appointment?

catconcern said:

 
Forgive me my brain isn't working properly atm. So what you're telling me is because of both your ex and the major in college your cat was denied a follow up appointment?

Click to expand...

Sorry, it wasn`t written clearly.  My ex was the communication major in college (I sarcastically threw that in there because she often berated me during our marriage for not communicating as well as she could).   I am certain the vet informed her about the importance of a follow-up in a few days in order to get accurate kidney function results.   Either way she could have read it herself on the discharge paper or have given a copy to me - or simply told me.   No doubt in my mind that a follow-up would have revealed kidney problems that we could have dealt with and her life extended considerably.

So basically yes, the cat`s life came down to a miscommunication - or no communication from someone that had expert training in the field of communications.    

Like I said,  I just kind of have been walking around numbed the past few hours by the irony of it all.

zoneout said:

 
Sorry, it wasn`t written clearly.  My ex was the communication major in college (I sarcastically threw that in there because she often berated me during our marriage for not communicating as well as she could).   I am certain the vet informed her about the importance of a follow-up in a few days in order to get accurate kidney function results.   Either way she could have read it herself on the discharge paper or have given a copy to me - or simply told me.   No doubt in my mind that a follow-up would have revealed kidney problems that we could have dealt with and her life extended considerably.

So basically yes, the cat`s life came down to a miscommunication - or no communication from someone that had expert training in the field of communications.    

Like I said,  I just kind of have been walking around numbed the past few hours by the irony of it all.

Click to expand...

That's pathetic I'm sorry this has happened to you. When situations like this happen we have to put ourselves in your shoes. If someone hadn't passed on information to me or a copy of a letter etc I'd be mightily annoyed especially with what's transpired. I'd let your ex know if I were you. But I'd do it in a way that wouldn't spark an argument or if it isn't a good time between you wait for a better moment. Those are things which only you are aware of so I'd think them through. Also, for yourself, it doesn't sound like a good time as you are in shock and are numb. I'd wait zoneout until you are more rested and grounded. But as I mentioned do what you have to do to get closure but just do it the right and honorable way. 

It's a very hard time for you atm. Hard times for many of us. I think you should see a doctor and also a pet grief counselor. With the doctor though, careful anything you're prescribed as they have side affects. And you know what the experts are like!

catconcern said:

 
That's pathetic I'm sorry this has happened to you. When situations like this happen we have to put ourselves in your shoes. If someone hadn't passed on information to me or a copy of a letter etc I'd be mightily annoyed especially with what's transpired. I'd let your ex know if I were you. But I'd do it in a way that wouldn't spark an argument or if it isn't a good time between you wait for a better moment. Those are things which only you are aware of so I'd think them through. Also, for yourself, it doesn't sound like a good time as you are in shock and are numb. I'd wait zoneout until you are more rested and grounded. But as I mentioned do what you have to do to get closure but just do it the right and honorable way. 

It's a very hard time for you atm. Hard times for many of us. I think you should see a doctor and also a pet grief counselor. With the doctor though, careful anything you're prescribed as they have side affects. And you know what the experts are like!

Click to expand...

Thanks.  I think I do finally have closure.   I mean, now I understand the critical part that went horribly wrong.   Before, I was chasing my tail, trying to understand how I could have spent $3,000 and still had no diagnosis.  I always tell myself if you want something done right - do it yourself.  And so I have always been overly self-reliant - to a fault even - ever since I was a boy.   And here once again I relied on someone else and got burned.  

I actually got the strength to go back to the vet today from thinking about you doing it - when you needed answers.   So reading of your experience helped me a great deal.   

I did see a doctor a couple of weeks ago and got some meds that have helped me relax.   The grief counselor is a good idea.  I think they have group sessions not far from me for a very reasonable sum.

Oh don`t worry about me with prescriptions.   I just dumped my last doctor that had me take pills with horrible side-affects.   I was taking something that made me faint due to a sudden drop in blood pressure and fell down a flight of stairs.  I thank God every day that I didn`t break my neck from that.