Wednesday, April 29, 2020

Baby UTI-Common for CKD Cats

Baby woke up today urinating blood. The vet said she has a raging UTI with plenty of bacteria. She had shown no previous symptoms. This is the third one in a year. With the previous two, she was lethargic and seemed unhappy and ill. But she wasn't urinating blood nor having small ones in the box like today. At the Internist last week, her urine was fine.

The vet has her on Zeniquin, an antibiotic, for 14 days.
At vet

Tuesday, April 28, 2020

Katharine Hepburn Possible Gastro Issues-More Tests in the Future are Needed

During COVID quarantine, my cats thought it would be a really good time to come down with other issues. Three cats-Jimmy, Baby, and Katharine have been to the vet during this time.

Katharine has been seizure free since May 2018. She sees the cardiologist annually due to a heart murmur and has no issues or causes. But since she went on phenobarbital in May 2018, she has had issues eating. She has been on increasing doses of Mirtazapine appetite stimulant ever since. Now she takes a weekly dose. She is also very low on vitamin D. She has gone from one drop a day to five. Since she and Baby are both on vitamin D, I give each a .1ml dose-which as well as I could figure, is close to five drops. They will be retested in a few weeks and we'll know more then.

In March her gastro test results-for cobalamin/folate and PLI-came back with possible IBD or pancreatitis. Baby had close to the same results and was put on Metronidazole. Katharine was not and somehow it slipped through the cracks, likely because the COVID virus shut down the state just as we got back the results. Being too busy in general, and then dealing with Baby's CKD vet appointments, I forgot to tell the vet I was ok with Katharine going on the medication. So, we will discuss this tomorrow when another cat goes to the vet for his latest issues.

Katharine's cobalamin was normal; PLI was normal; but folate was too high, possibly indicating an infection or issue. Given the other two were normal, pancreatitis was not indicated per the vet's notes. It could also mean she's absorbing too much of the nutrient which means there's another issue.

Her kidney values are good. SDMA is 5, creatinine is 1.5, BUN is 22. Potassium is good at 4.3 but with supplementation (which we've been giving her since May 2018 because no one could find a cause for the seizures. Insufficient electrolytes was a possible cause, and potassium was easy to give by mouth using Renal K.) I need to check her hyperaldosteronism next time. As we learned with Baby, when potassium is low, a cause could by hyperaldosteronism. Given that Katharine is on a potassium supplement, her level should be higher than it is-or possibly should be higher.

Jimmy Has An Eye Issue but No Infection Detected

Earlier in April, Jimmy was at the vet because his left eye was acting up. He was favoring it by closing it. It was also watery, goopy, but no blood or other eyelid closing over it was present. Unlike a few months ago, he had no cornea scratch this time. But given that there was swelling under the eye, and how it was leaking, they gave him antibiotic drops for a possible infection. Since he was exposed to the herpes virus as a kitten, he has been prone to getting related complications-gastro upsets, eye infections, lethargy. So, I have been giving him extra lysine daily. We use lysine gel by Vetoquinol. 

It is wise to always take a cat into the vet when you see any of these symptoms: goopy eye, blood in the eye, a closing of an inner eyelid over the eye, or when the cat favors the eye by closing the regular lid, or paws at it. The eye could be damaged, scratched, infected, etc. The doctor will put drops in the eye and shine a UV light into the eye to check for scratches and internal issues. Medications and lysine might be recommended. Sometimes steroid drops are needed. These should be used cautiously with HCM cats as steroids are typically avoided for HCM cats. It's rare that steroid drops are needed unless there is a serious infection, such as conjunctivitis or injury to the eye. 

Baby-More Lesions, Higher CKD Test Results; the Importance of Monitoring Kidney Function

Baby has ongoing illnesses: CKD, Bowenoid in situ-cancerous skin lesions, hyperaldosteronism, and possibly mast cells/lymphoma of the gastro system (cancer) or simply IBD.

While she does not have heart disease, many of the same tests are ones that HCM cats should have to test kidney function; and the same medications and supplements that she takes for CKD are ones that HCM cats should also take to help and protect the kidneys while they struggle to do the load of the work of diuretics to rid the body of fluid buildup, and help the heart function better. For more on medications and supplements, please read the Med tab here at the blog.

Baby's vitamin D is too low, also. We were told to increase her dose from one drop a day to five drops a day. I figured out that .1ml is about equivalent to five drops more or less. Instead of putting it in her food and hoping she eats it, I give it to her by mouth. She is also taking B vitamin complex at 1.0ml a day; 3ml of water/bicarb a day (stomach acid).

Baby has kidney disease. We have been trying to fight this and help her since May 2019. She has had scans and tests from her regular vet, a cancer specialist, a vet hospital, and recently, an Internist. The results are the same-she has CKD and there's nothing we can do about it. And no one can tell me what she should be on or not on or take more of or less of, except for two specific medications.

What they have said is this: she needs blood pressure medication Amlodipine; she needs Spironolactone to try to control her hyperaldosteronism; she needs to eat only kidney disease diet food to help control the disease; she does and now does not need her inhaler Albuterol twice a day; she does not and now does need her Buprenex once a day; she should not use Forta Flora because it's not good for kidney disease; she needs Mirtazapine, an appetite stimulant to help her eat.

Her blood tests results have increased despite giving her supplements and medications to control the disease. 

The urine specific gravity keeps falling-currently at 1.012-which means kidneys are not able to concentrate urine, which means the glomular filtration rate is falling likely due to fewer nephrons working properly, a sign of poor kidney function.

The SDMA-a test for kidney disease-is now 31 in April, up from 29 in February.
BUN-now 38 from 32 in February.
Creatinine-now 2.8 from 2.7
Phos-now 4.7 from 4.0-despite using a phosphorous binder

But the Internist believes her CKD is fine for now, to be expected. I'm the only one not impressed.

The Internist now thinks that Baby's hyperaldosteronism is secondary to CKD and not the other way around. Her gastro/kidney scan in April did not reveal any changes in her adrenal glands and no presence of any nodules that would lead to a diagnoses of cancer to cause hyperaldosteronism. She believes it is due to underlying chronic stimulation of her RAAS system, the system responsible for balancing water and blood pressure in the body.

Skin Cancer:
Baby also has skin lesions-Bowenoid in situ-which are cancerous. If they are not removed, they can become malignant. She had them removed in November, and March; and more will need to be removed in May. They continue to pop up in new places which are hard to find under her long, thick hair. They must get rather large like a knot before I am able to tell that a lesion vs. a regular knot, is present.

Gastro Issues:
The folate level for Baby has increased again and will need to be retested in a few weeks. She took Metronidazole for IBD in February after her cobalamine/folate test showed elevated levels.

BUT she does have mast cells and possibly lymphoma of the gastro system. They could do another needle punch biopsy but they believe that may not lead to a large enough sampling to determine if cancer exists. They want to do an upper and lower GI where they could take out a large sample. It's invasive but not open surgery. But it also costs around $3100. We are not sure that at this time-with everyone's jobs on the line due to the COVID-that we should proceed with this. Also, I need time to set money aside in our budget. So, perhaps late summer/early fall.

Meanwhile, we will give her Mirtazapine so that she eats; monitor her overall health for any signs of an increase of CKD; and take her back again in June to have everything repeated.

When our HCM cat Myrna Loy had some CKD with heart disease, I was able to handle it-which did show up near the end due to diuretics and failing heart-by pushing more supplements and vitamins, and iron. None of that is having the same effect on Baby's results as they did for Myrna. The difference is that Myrna didn't have CKD as a primary disease, just an organ that was affected by her heart disease. But Baby has primary CKD which does not want to respond to most of what I am trying to do. While heart disease gave me the sense of a more pressing issue, one that needed constant monitoring, one that could suddenly strike Myrna and cause an issue-CHF, heart attack, thrombosis-CKD alone does not have the same sense of urgency. But I find it far more frustrating. With Myrna, we saw results for the first few years when her heart disease was stable. With Baby, nothing, except the blood pressure medication. But even that isn't working as well. Her BP was down to 120 from 240 in May 2019 but is now up to 140, high but not yet a concern until it reaches over 160. Then her medication will be changed or increased.

Sunday, November 24, 2019

Baby Hyper Aldosterone, CKD, High Blood Pressure, Bowenoid Skin Cancer-She Has Many Issues

Baby has been seen by vets and specialists since May due to low kidney values, hypertension (high blood pressure), skin lesions, kidney disease, and hyperaldosteronism.  I last wrote about this on Oct. 25, 2019.

The update: the cancer specialist on November 5, removed the Bowenoid lesion from her left paw and we are to continue to monitor for the appearance of others.

The CAT scan they did November 5 did not show any signs of lymph node or adrenal gland tumors. So, it's likely, for now, that her hyperaldosteronism is idiopahtic-no known cause. Her blood level aldosterone was 1011, up from 829 this summer. The vet
will now put her on 1/4 tab a day of Spironolactone 20mg.  Spironolactone is an aldosterone antagonist and is supposed to help reduce the hormone level. We will retest the blood level in a month or so. 

This summer, "mast cells" were found in a lymph node by biopsy. Mast cells are more commonly signs of cancer in cats. BUT they can also be signs of IBD or mastocytosis or inflammation.
So they think she has inflammation in the gastro system. For now, we will monitor.

She has signs of asthma in her lungs despite the Albuterol she receives BID (twice a day.) But MSU vet had told us this summer to reduce it and wean her off of it. We reduced it for awhile but then continued twice a day since September. Perhaps reducing it to once a day and trying to wean her off wasn't a good idea. We may need to put her on Flovent, a steroid inhaler which I've been trying to avoid. Her heart is great so there wouldn't be an issue but steroids should not be taken lightly; and chronic use might lead to other issues. She sees the cardio yearly (she has never had heart disease; heart disease cats CANNOT have a steroid at all, even an inhaler.) 

We must continue to monitor with future ultrasounds of her gastro system and kidneys; test aldosterone levels; check blood pressure and kidney values; and keep her on a kidney disease diet. We must still monitor for inflammation vs. possible cancer. 

Fish Based Food Allergy Might Be What Affects Jimmy Stewart Again-or Idiopathic Illness?

Last week, on Saturday, Jimmy wasn't eating well. So, I put fish Fancy Feast on top of his chicken pate for two meals. By Sunday night, he wasn't eating at all. Then he vomited.  I gave him 1/4 tab of Cerenia (anti nausea medication.) By Monday, I had to hand feed using Hills AD mixed with water, fed with a plastic syringe.  He vomited twice on Monday. I have Cerenia once again and on Tuesday.  Tuesday we saw the vet.

We ran full CBC/chem panel, PLI, and urine. NO signs of illness or infection appeared. His glucose and other electrolytes were normal so he's not pre-diabetic again. His liver and kidney values were great and the liver continues to respond to Denamarin (a supplement to improve liver function; his blood values had gone up last year.) He also had no signs of a fever. I thought he wasn't able to use the litter box but the vet said there were no signs of a blockage (which can happen with male cats), he wasn't showing signs of pain on exam, and the bladder wasn't hard from an inability to pass urine. Vomiting and not eating would contribute to not having produced enough urine to excrete.

Without signs of an illness, inflammation, or infection, there were no other medications prescribed. Meanwhile, the vet gave a B12 shot, sub q fluids as he was dehydrated; and I used Cerenia for the next two days (1/4 tab once a day.) By Wednesday he was better and eating enough on his own. By Thursday, he was eating normally again.  He continues to do well.

Was the illness created from eating the fish? Or the herpes virus for which he receives daily lysine? About three years, he began to lose weight and was always hungry. Various tests were run to no avail. He had also had bouts of vomiting and diarrhea. The vet said to try non-fish based foods and the problem was resolved and didn't return. Because he can become finicky, I've given a smidgen of fish food from time to time without issue. But not last week. Was it the fish? The only way to tell is to not give it ever again; give him time to make sure he's fully recovered. If this happens again, we will need to do further tests such as a gastro ultrasound, etc.

Sometimes cats do this. An issue will arise, tests will be done and it will turn out to be idiopathic-no known cause; and that home remedies and things such as having Cerenia on hand, and hand feeding the cat food and water, go a long way to help the cat recover. Sometimes all we can do is treat the symptoms and never find a cause. Of course, the symptoms can also be related to any variety of serious illnesses-cancer, FVP/FIP, heart disease, pancreatitis, food allergy, etc. And that is why we go to the vet to rule out/find a cause. We don't want to take chances.

Good home remedies for sick cats are feeding Hills AD mixed with water by hand using a plastic syringe; adding 1/8 tsp of corn syrup to the mix (if the cat isn't diabetic) for energy; giving rice water to stop diarrhea (poured off of boiling rice) via plastic syringe by hand, and giving regular water via plastic syringe by hand, and-when the cat isn't allergic to it-giving tuna juice for protein via a plastic syringe by hand. You can also boil chicken or beef and use that water (without adding salt or onion or garlic or spices) as a protein source to give by hand. Medications that help cats are Cerenia (anti nausea med-get from the vet); and in some cases of illness, you may use Pepcid, 1/4 tab (for antacid and inflammatory inhibitor.) Use under vet supervision and not long term.

NEVER let a cat go a day without eating. Cats may be finicky but not eating is not normal, is dangerous as it leads to dehydration, and dehydration leads to a whole set of health issues-weakness, further not eating, and death. And never let a cat have a severe bout of vomiting and diarrhea without trying home remedies to ease it and without seeing the vet.

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.