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Diabetes/anemia/heart failure/kidney failure: Please help!

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  • tiger6387
    Hello, We are new to the group. I have read hundreds of your posts and I found a lot of useful information. Thank you so much for sharing! I will now post
    Message 1 of 3 , Aug 3, 2004
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      Hello,

      We are new to the group. I have read hundreds of your posts and I
      found a lot of useful information. Thank you so much for sharing! I
      will now post the recent story of our cat, Sodapop, who has gone
      downhill after a visit with supposed critical care specialists.
      Please offer advice if you have any, as I am very worried for our
      15-year old cat! Thank you very much!

      On Friday, on the suggestion of our normal vet, we brought Soda to
      specialists at "Gulf Coast Veterinary Internists" in Houston. Before
      this visit, we already knew that Soda had diabetes, chronic renal
      failure, and anemia. He was stable, though, for several months. But
      in the past two weeks his appetite had diminished and he was losing
      weight. Also, his blood glucose was not being controlled by his
      insulin, but we found that if we bumped the dose up (from 2 units
      Humilin to 3 units, twice a day) that Soda would have a seizure.
      Still, he was not in terrible shape.

      The specialist ran a battery of tests, took Xrays and ultrasound. She
      diagnosed a new problem: "Restrictive Cardiomyopathy and Congestive
      Heart Failure." They kept Soda in the hospital for four days to
      "treat" this condition. This treatment ($2600 worth) involved: 2-3
      furosemide injections daily; 2-3 famotidine injections daily; 2-3
      enalapril maleate injections daily; 2-3 metocloropramide injections
      daily, two glucose curves, and some other things.

      On Monday the specialist pronounced Soda's heart problems controlled
      and released him to us. But he is MUCH MUCH WORSE than he was before
      we took him to these people! He can no longer walk; his muscles are
      weak, and when he tries to stand he loses his balance. He is not
      eating. He is unbelievably thirsty. He vomits. I fear that he is
      dying. My wife is beside herself, crying and despondent.

      This is the specialist's prescriptive regimin:

      1. 100cc plasmalyte A twice a day
      (Before, we were giving him 150cc Ringers once a day)

      2. Hill's K/D food
      (Before, we were giving him Hill's W/D)

      3. 3 units PZI insulin once a day
      (Before, we were giving him 2 units humulin twice a day)

      4. Enalapril 1mg tablet twice a day

      5. Furosemide 12.5mg, 1/2 tablet twice a day

      6. Famotidine, 1/4 tablet every 12-24 hours

      We are taking Soda to his regular vet in the morning. Please--we will
      listen to any advice! Thank you so much. --Mike and Lesa

      Here are some test results for Soda from the specialist taken on
      Friday when we broght him there:

      BUN 107
      Creatine 2.6
      Phosphorus 7.1
      Glucose 684
      Potassium 4.8
      Osmolality, calculated 372

      Magnesium 2.6
      WBC 8.3
      RBC 3.4
      HGB 5.6
      HCT 15

      Lymphosytes 996
      Monocytes 913

      T4 (RIA) .26

      BPc (blood pressure?) 154-164 over 4 days

      While in the care of the "specialists," Soda's weight fell from 9.4 to
      8.2 pounds.

      Thank you again for any help or suggestions. All the best from Lesa,
      me, our cats Soda, Sammy, and Tiger, to you and your family and pets!
    • Susan
      ... Mike and Lisa, I am sorry to hear about Soda. When Soda was released he was stable but the problem that caused him to have RCM is not something that is
      Message 2 of 3 , Aug 3, 2004
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        --- tiger6387 <tiger6387@...> wrote:

        >
        > The specialist ran a battery of tests, took Xrays
        > and ultrasound. She
        > diagnosed a new problem: "Restrictive Cardiomyopathy
        > and Congestive Heart Failure> problems controlled
        > and released him to us. But he is MUCH MUCH WORSE
        > than he was before
        > we took him to these people! He can no longer walk;
        > his muscles are
        > weak, and when he tries to stand he loses his
        > balance. He is not
        > eating. He is unbelievably thirsty. He vomits.

        Mike and Lisa,

        I am sorry to hear about Soda. When Soda was released
        he was stable but the problem that caused him to have
        RCM is not something that is cured, rather it is
        something that we attempt to modulate via various
        medicines. There are many links in the links section
        specifically about CHF that are very good. It is
        important that Soda eats because of the med he is on
        that enables him to breathe. Ask your vet for a couple
        cans of Hills A/D a critical care prescription food.
        You can either finger or syringe feed it to him.

        See:
        DIAGNOSTIC AND THERAPEUTIC APPROACH TO THE
        ANORECTIC CAT
        http://www.walthamusa.com/articles/Marks.pdf

        RCM is not as common as HCM but a few members have
        dealt with it. Look for posts about a cat named Morag.

        Here is a link to get you started:

        Advances in Treatment of Heart Failure
        http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2002&PID=2529

        Soda's weight fell because an animal in a critical
        care situation catabolizes lean muscle mass. This is
        called cachexia.

        See:
        Nutritional Therapy of Heart Disease
        http://www.vin.com/proceedings/Proceedings.plx?CID=WALTHAMOSU2002&PID=2987

        >
        > This is the specialist's prescriptive regimin:
        >
        > 1. 100cc plasmalyte A twice a day
        > (Before, we were giving him 150cc Ringers once a
        > day)
        >
        > 2. Hill's K/D food
        > (Before, we were giving him Hill's W/D)

        The most serious issue Soda is facing is his heart.
        Hill's A/D is ideal for a cat who is not eating enough
        to maintain his lean muscle mass.
        >
        > 3. 3 units PZI insulin once a day
        > (Before, we were giving him 2 units humulin twice a
        > day)
        >
        > 4. Enalapril 1mg tablet twice a day

        This is an ACE-inhibitor
        >
        > 5. Furosemide 12.5mg, 1/2 tablet twice a day

        This is the diuretic that enables Soda's breathing
        >
        > 6. Famotidine, 1/4 tablet every 12-24 hours
        >
        > We are taking Soda to his regular vet in the
        > morning. Please--we will
        > listen to any advice! Thank you so much. --Mike
        > and Lesa
        >
        > Here are some test results for Soda from the
        > specialist taken on
        > Friday when we broght him there:
        >
        > BUN 107
        > Creatine 2.6
        > Phosphorus 7.1
        > Glucose 684
        > Potassium 4.8
        > Osmolality, calculated 372
        >
        > Magnesium 2.6
        > WBC 8.3
        > RBC 3.4
        > HGB 5.6
        > HCT 15
        >
        > Lymphosytes 996
        > Monocytes 913
        >
        > T4 (RIA) .26
        >
        > BPc (blood pressure?) 154-164 over 4 days
        >
        > While in the care of the "specialists," Soda's
        > weight fell from 9.4 to
        > 8.2 pounds.
        >
        > Thank you again for any help or suggestions. All
        > the best from Lesa,
        > me, our cats Soda, Sammy, and Tiger, to you and your
        > family and pets!
        >
        >
        >
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      • savionna@aol.com
        Hi Lesa, In a message dated 8/3/04 3:52:52 AM, tiger6387@yahoo.com writes:
        Message 3 of 3 , Aug 4, 2004
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          Hi Lesa,

          In a message dated 8/3/04 3:52:52 AM, tiger6387@... writes:

          << But in the past two weeks his appetite had diminished and he was losing

          weight. >>

          A leading contributing factor to weight loss in diabetics is poor glucose
          control. The cells can't use the "fuel" from food without the "right" amt of
          insulin. And while uncontrolled diabetics are usually ravenously hungry, they can
          also be inappetant. Renal issues will also affect appetite.

          << Also, his blood glucose was not being controlled by his

          insulin, but we found that if we bumped the dose up (from 2 units

          Humilin to 3 units, twice a day) >>

          Which Humulin? Ultralente? Lente? N? "Humulin" is the *brand name* of
          genetically engineered insulin from Eli Lilly. U, L, and N are diff. *formulations*
          of insulin with very diff. activity profiles (onset, peak, and duration). For
          info on this, see:

          1. www.petdiabetes.org/insulin.html

          2. www.lillydiabetes.com/Products/TimeActivityProfiles.cfm


          << that Soda would have a seizure. >>

          That "seizure" is more than an indicator of lack of control...it signals the
          potential for significant neurological damage and death when too much insulin
          is given. Did the vets instruct how to care for the cat in a hypoglycemic
          episode? If not, some info is here:
          www.gorbzilla.com/treating_hypoglycemia_by_melissa.htm.

          Did the vets mention that it's possible to test the cat's blood at home using
          a portable monitor just like humans rely on? Hometesting is an easy,
          inexpensive, reliable way to effectively manage blood sugar...to achieve good control
          and avoid the significant dangers of hypoglycemia. Some sites on this incl:

          1. www.petdiabetes.org/home_bg_testing.htm
          2. www.sugarcats.net/sites/harry/bgtest.htm
          3. http://tlb.best.vwh.net/bg_punkin/test_bg.html


          << 2-3 famotidine injections daily >>

          Famotodine (Pepcid Rx) is simply an acid blocker for the stomach that can
          help with nausea.

          << 2-3 metocloropramide injections >>

          Metoclopramide (Reglan Rx) is used to reduce gastric uspet and improve
          gastric outflow (diabetics can have gastroparesis, from nerve damage to the
          digestive system).

          << two glucose curves >>

          What did the curves indicate?

          << But he is MUCH MUCH WORSE than he was before

          we took him to these people! >>

          Part of the reason *may* be that they changed the insulin formulation...and
          it's going to take a while for the cat's body to adjust.

          << He can no longer walk >>

          There can be various contributing factors to this. A possible one is diabetic
          neuropathy, which is related to the same type of nerve damage that affects
          the digestive system. It is caused by excess glucose, which damages the nerve
          sheaths. For some information, see www.laurieulrich.com/jasper.

          << 2. Hill's K/D food

          (Before, we were giving him Hill's W/D) >>

          It may be worthwhile considering the role of diet in diabetes. Hill's w/d is
          high in carbohydrate (38% calories from carbs in the dry; 23% in canned),
          which is exactly the *opposite* of what any cat needs, more so a diabetic, who has
          no ability to control glucose naturally. Cats are *obligate carnivores* who
          have *no* dietary requirement for carbohydrate and limited ability to process
          it. A possible result of feeding an obligate carnivore a high-carbohdyrate diet
          is *diabetes*. The recommended diet for nearly all cats, but esp diabetics,
          is a high-quality, low-carbohydrate (at least less than 10% cal from carb),
          well-balanced, moisture-rich, meat-based diet.

          K/d is low in protein, which is now thought to be the inappropriate approach
          for animals with renal issues. The recommended diet is the highest amt of
          high-quality protein that the individual cat can tolerate with the lowest amt of
          *phosphorus*. K/s is also high in carbohydrate (35% cal from carbs in the dry;
          28% in canned).

          Further, both of these products are poor in the type of high-quality
          nutrients that cats need to survive.

          That said, it is important for the cat to eat, esp when receiving insulin (to
          avoid not only malnutrition but also hypoglycemia and liver
          complications)...so whatever food is palatable and acceptable can be offered. It is also
          important to keep in mind that the amt and type of food will affect insulin
          response. In general, the lower the carbohdyrate level, the less the amt of insulin
          needed.

          For information on diet and diabetes...and general info on feline nutrition,
          see:

          1. http://rocquoone.com/diet_and_health.htm
          2. www.avma.org/convention/recap/news/tuesday16.asp
          3. http://home.earthlink.net/~jacm2/id1.html
          4. www.catinfo.org
          5. www.homevet.com/petcare/feedingyourcat.html
          6. www.maxshouse.com/feline_nutrition.htm

          For info on diet and renal issues, see:

          1. www.southpaws.com/news/99-2-nutrition-CF.htm
          2. www.vetshow.com/download/purina/finco.pdf
          3. www.vetshow.com/download/purina/bovee.pdf
          4. www.cm-d.com/buckeye/tech_manual/8_28.html
          5. www.bowchow.com/kidney.html

          For general info on renal issues in cats, see:

          1. www.felinecrf.com
          2. www.felinecrf.org
          3. www.mindspring.com/~kerspin

          For charts with nutrient information (incl carbohydrate and phosphorus) of
          common cat foods, see:

          1. www.sugarcats.net/sites/jmpeerson
          2. webpages.charter.net/katkarma

          << 3 units PZI insulin once a day >>

          The *starting dose* was 3 units of PZI SID...after 4 days of hospitalization?
          The recommended safe starting dose of all insulins is 1 unit BID, except for
          those in danger from ketoacidosis or other life-threatening complications. The
          protocol for raising the dose thereafter is to let each dose "settle" (which
          generally takes at least 7-10 days), perform a full curve (12 hrs), then
          adjust as needed by no more than 0.5 units. Almost no cats get 24 hr duration from
          any insulin, even the long-duration types like PZI, which makes it all the
          more important to perform curves to see the full effect before adjustment.


          << BUN 107 >>

          Since you didn't give the ref range, I'll go by the Antech range. For BUN,
          it's 14-36, so this is high. BUN can be elevated for various reasons besides
          renal issues (acute or chronic), such as dehydration, infection, and poor glucose
          control.


          << Creatine 2.6 >>

          This is slightly elevated (ref 0.6-2.4)...and can also indicate dehydration
          and poor glucose control.


          << Phosphorus 7.1 >>

          While this is in range (2.4-8.2), it's desirable for the phos to be around 4.
          Did the vet discuss the possibility of using a phos binder?


          << Glucose 684 >>

          This is quite elevated (ref is 50-150 mg/dL and the desirable range for cats
          on insulin is 100-300 mg/dL) However, glucose values are meaningful only in
          relation to each other and to the insulin cycle.

          << Potassium 4.8 >>

          Ref is 3.4-5.6, so this is not too bad.


          << RBC 3.4

          HGB 5.6

          HCT 15 >>

          These are quite low.

          << T4 (RIA) .26 >>

          This is a thyroid indicator. Did you mean 2.6 (micro)g/dL...or is it a diff.
          unit?


          Did the vets perform a urinalysis? If not, you may want to bring a clean
          sample or have a cystocentesis. It would be important to see the urine specific
          gravity for information on renal status...and also to check for infection, since
          diabetics are prone to urinary (and other) infections, incl in the kidneys.
          Indicators to look for incl bacteria, WBC, RBC, and blood. // Rosemary
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