Friday, October 25, 2019

Katharine-Phenobarbital and Liver Values change; Enzyme or Failure? Bowenoid in situ Carcinoma for Baby

Cats update -*I updated spelling of blood values and the correct cancer name.
Katharine is low on vitamin D again and we need to add it to her food once a day. Yes-cats can be low just like humans and have the same run down feeling and weakness as humans. She was retested for pheno level-well within range of therapeutic levels; and tested for B12: cobalamin/folate blood test to test for absorption of nutrients and it can indicate any gastric issues. She was normal.

**We tested those because her albumin (1.3-normal high is 1.2 but should be lower) and her ALP (81-normal is 59) were high and globulin (2.9-low normal is 3.0 but should be higher) was low-indicating liver issues which can occur with phenobarbital. We will retest and do gastric scan in December or January and monitor for signs of liver issues-vomiting, bowel movement, eating, jaundice, etc.

We hope it’s not liver failure but just an enzyme increase. Her history has shown that last year, normal pheno dose led to high ALP and albumin; when we decreased the dose, those fell to normal levels but the PHENO level fell too low; we returned to the normal pheno dose and have now seen a rise/fall in the three liver related blood values. We will tweek the pheno to a lower dose but not each day, hoping the three liver values improve while maintaining a good pheno therapeutic level.

But Baby-Baby has had a lesion on her front paw for a year. We treated it with antibiotics, a cream; the scabs came off then regrew. Microscope showed only bacteria. Vet school in May said it wasn’t cancer but they only did a microscope view. We did a biopsy last week and the result is BOWENOID in situ carcinoma. Cancer. She likely has them elsewhere under her fur but not raised and one became ugly and scabby. It requires CO2 laser to remove. Not sure what else. They likely will return and more will develop. If we don’t remove as we find, they can metastasize and spread cancer to her body organs. This is due to a related issue called papilloma virus, the brown/black spots on her ears and face we tried treating years ago with a cream.
Because it’s due to a compromised immune system, she’s been receiving an immune booster for a few years which helped the body remove the marks. But they returned last year-just when she began showing signs of CKD, and her CKD maybe due to aldosteronism-for which she was tested in May and will be retested in November. That is possibly cancer.
It seems that she is likely in for an arduous endeavor, with multiple issues that might need multiple solutions but that might all be related.

Wednesday, July 24, 2019

Kidney Disease Cats Need More Protein Than Renal Diets Allow-But Also Need Low Phos in Food

Interesting read. She recommends that cats with kidney disease (which would include HCM cats that have high levels of diuretics which have begun to affect their SDMA, BUN, and creatinine) have 40% of calories from protein and not just the 20% that is found in CKD special diet foods. Cats need protein for health. Any more than 40% and you run the risk of creating a load of BUN-blood urea nitrogen-on the kidneys to filter and remove. If the cat has CKD or low performing kidneys, you need to reduce the load of BUN on the kidneys. Of course, if the cat's kidneys continue to decline, you'd want to reduce the protein level to the 20%. But she argues that a cat on a low protein diet may not eat it (because it's not that tasty); and will lose weight. The cat would need to eat 2-3x the amount of the diet to make up the protein and caloric needs. So, feed a CKD diet along with some of a regular diet and continue to monitor the CKD with regular checks at the vet's.
I've always recommended HCM cats take iron and other vitamins and supplements to help the kidneys (see Med tab at blog or here in Notes.) Actual kidney disease can be caused by other health issues-thyroid disease, hyperaldosteronism (what Baby apparently has), etc. So, finding the cause of CKD and treating the cause as well as the CKD requires more than just a careful diet.

Monday, July 22, 2019

Many Uses of Spironolactone

Spironolactone-reduces the intake of sodium and water. It's used for heart patients as a mild diuretic-control CHF and blood pressure by reducing the sodium intake that prohibits the natural exchange of sodium and potassium in the cell, due to the intake of a lot of water into the cell due to the sodium; as a potassium saving drug-good for those on diuretics (again, by controlling the sodium intake); and for hyperaldosteronism because it's an aldosterone antagonist. It reduces the action of the hormone by again, reducing sodium and water intake.

We will likely begin using this on Baby but need to consult with the MSU vet hospital vets.

"Since aldosterone inhibition decreases sodium reabsorption, it also decreases potassium excretion resulting in higher serum potassium levels."

Sunday, July 21, 2019

Hypertension-High Blood Pressure, Low Potassium-May Not Be Due to Diuretics or CKD

More on hyperaldonsteronism:
CKD can be misdiagnosed as a primary issue when it can be a secondary issue caused by hyperaldosteronism.
It's rare for HCM cats to be tested for this as CKD and low potassium come with taking diuretics. HCM cats do not generally get hypertension. So if your HCM cat has hypertension, test the cat also for hyperaldosteronism.
And test your non-HCM cat as well.

"Depending on the etiology, PHA can be treated surgically or medically, which may cure or alleviate the associated hypertension and/or hypokalemia. Primary hyperaldosteronism is most likely underdiagnosed, which excludes a potentially large number of cats from appropriate therapy and a possible cure for the disease.

This may in part be due to the frequent association of arterial hypertension and/or hypokalemia with chronic kidney disease (CKD). Often, CKD is thought to be the causal factor of the hypertension and/or hypokalemia, when in fact the CKD may be a consequence of PHA."

Hand Feeding A Sick Cat-the Importance of Keeping the Cat Hydrated and Fed

Facebook post April 15:

From a discussion with a pet owner:

"Your cat cannot go more than a day without eating. The longer it does not eat, the faster it goes into decline. Weakness sets in, driving it to not feel well enough to eat. The body begins to eat at fat then muscles, further weakening the state. You need to begin hand feeding. Get a 3ml syringe from the vet or store. Do NOT use any glass droppers.
First, make up some sugar water: 1/8 tsp per 3oz of water. As long as the cat is not diabetic. This will be a quick energy source. Give one 3ml syringe of sugar water every three to four hours. Hand feed every 3-4 hours or as often as possible. Feed this along with the following: get Hills AD or any special needs/high caloric cat food for cats in recovery. This is a pate that mixes easily with very little water and is easily syringed up and fed to the cat. Feed 24mls to 30mls to the cat per feeding. Each ml is about one calorie. The cat needs about 120 or more calories per day.
Then give the cat some potassium-either Renal K gel or powder (Amazon) or baby food banana or sweet potato. Syringe up and feed by hand or add to AD mixture. It's an electrolyte the cat needs for the body to function, for the kidneys to work the diuresis process (assuming the cat's on a diuretic), and the heart needs it to function properly. Use tuna juice as a source of added protein. Drain it, put it into a container for the frig. Give 3-6mls per feeding. The idea is to feed the cat now to prevent it from starving to death; give it a boost in energy to recovery; to help it to feel better to want to eat; and to restore as many nutrients/electrolytes as necessary for proper bodily function, energy, and to feel better to eat.
Cerenia is an antinausea med that will work but it's short lived. If the cat isn't eating, the med won't help. Appetite stimulants such as cyproheptadine or mirtazapine are great but are also short lived. The cat really needs to be fed NOW and to eat well enough on it's own. You can't try a med and wait for it to kick in and expect the cat to recover. But I would try cypro. Ask the vet. It's a milder stimulant which I feel works best for heart patient cats as it will make them less anxious. Remember-the cat must be fed NOW. Do not wait for it to try to eat on its own. The cat cannot starve to death. As for the heart meds, they can interfere (with appetite) but so can being sick with heart disease. The meds won't help if the cat isn't eating well.
The way to hand feed: don't stress the cat. Hold or wrap a towel around the front. Expect cat food to go out more than in until you get the hang of it. The water/liquid food will go in easier. But the cat food/water mixture will land on you and the cat and the counter. But syringe up the food; hold the cat in one arm-assuming the cat isn't squirming. And gently squirt food into the side of the mouth. The cat will move it's head but keep chasing either side of the mouth. One 3ml syringe or whatever size you use should go in over a few seconds. But it will seem like longer and will be if the cat doesn't cooperate. You must gain control of the cat. Don't force it or hold it down but keep at it until you have fed it 24-30 mls per feeding.
...I forgot to add: boil beef or chicken without salt or spice; use the broth to hand feed."

Signs Cat Needs the Vet ASAP-Not Grooming, Not Eating, Not Moving, Drinking a TON of Water, ETC. Pay Attention!

Facebook April 27:

I had a friend who suddenly lost a cat last week, not to HCM but to a virus or sepsis or kidney failure or something. A week in the hospital, two antibiotics, all the tests they could muster, and still they couldn't find what happened. The liver and glucose and kidney values were through the roof, higher than I've seen with HCM (in our experience with our cats.) One was in the hundreds, clearly due to organ failure but what was the cause? She noticed that the cat hadn't been grooming well for a month or a few weeks; she noticed the cat drank heavily but that it always had, just suddenly more. She noticed that the cat wasn't active but then it was 8 yrs old.
I'm sure all of those signs had become more prevalent than usual because when a cat is sick, "normal" behavior can increase to being extreme. 

A lack of grooming is a good sign the cat is sick; and lethargy is a good sign. This is why we must pay attention DAILY to the behaviors of our cats so that we may hopefully notice when normal behavior is now off. We must look for the minor changes, that look that says "I'm not well today; I've not energy today; I'm not myself." Look for a lack of grooming, wet eyes and nose (virus, irritation, damage to eyes); dry mouth and skin that tents (sign of dehydration due to an illness); yellow eyes in the whites and yellow skin around the ears (liver trouble); abscess teeth or injury or a skin rash or infection (can be signs of a disease, can lead to sepsis); and changes in eating and litter box use and energy levels.
 And is the cat suddenly needing you, being more of a lap cat, is snuggling more or not as much with the other cats; is the cat more vocal, anxious, worried, unsettled? So many signs of changes are possible and all should be monitored, catalogued, and discussed soon with the vet.
Of course, even if she had noticed sooner and had taken the cat to the vet, it's likely she may have still lost the cat because the vets couldn't find what happened (she's didn't do a necropsy-autopsy to know for sure).

Successful Heart Disease Treatment Surgery Performed for Dogs Outside of the US-Coming Soon to the US

A certain heart valve surgery on the mitral valve for dogs (no updates about cats yet but dogs do tend to have more heart surgeries than cats) is successfully performed in England and in Japan. Surgeries in the US have not been successful. But a hospital in Florida hopes to soon begin the surgery. I found out about it when my cats' cardio posted that a dog patient of hers, returned from overseas after a successful surgery and was continuing to do very well. 

"Friends I would like to thank everyone here for their vocal support of the University of Florida’s plans to bring Dr. Uechi and his team to the USA to perform this life saving open heart surgery, while also teaching our US veterinary surgeons how to perform the mitral valve repair (MVR) surgery, successfully..."