The trip out to VCA Aurora was a busy one. It included an ultrasound and a complete renal evaluation. The following is a summary from the summary we got from the internal medicine service.

Physical Examination: Coat is unkempt in appearance, patchy loss of hair or thinning hair; oral exam presents mild to moderate dental tartar; abdomen is distended and mild discomfort on palpation; cardiovascular presents stage II/VI parasternal heart murmur (this is down from a stage IV/VI heart murmur previously--must've been previously misdiagnosed somehow at VCA Aurora, as our regular vet has always insisted Lars had a stage II vs stage VI)

Diagnostic imaging: abdominal ultrasound revealed small left kidney with moderate renal pelvic dilation (we already knew this from last year's ultrasound--this kidney is basically thought to be non-functional); the right kidney has caudal infarcts which appear to have worsened since the last ultrasound; crystals noted in the urinary bladder (not stones as Dr. E and Dr. L thought); the renal pelvis contains a single stone; pancreas is mildly thickened in comparison to previous studies; mildly hyperechoic liver.

labratory testing: paraphrasing the tech-blood gas analysis came back as being unremarkable; blood glucose came back as hyperglycemic under their parameters at 217. We consider hyperglycemic to start around 250 for Lars ever since his hypoglycemic event back last February, so at 217 we personally consider that to be a pretty good number; kidney values: BUN at 45 and Creat at 2.6--on Saturday they were at 66 and 3.7 respectively, so both of those numbers have come down nicely with the daily 100 ccs of subcutaneous fluids.

Blood pressure: normal at 140/90 This is important because cats in renal failure tend to have high blood pressure.

Pending tests: PTH/Ionized calcium; urine culture and sensitivity; urinalysis

Diagnosis**Open for urinary straining: cystitis vs. urinary tract infection
**Stage II Chronic Kidney Failure
--Renal calculi (stone) with no evidence of obstruction
--Renal infarcts (right)

medication: No medications prescribed or changed today. Continue any previously prescribed medications/treatments as directed.

diet: A renoprotective diet is recommended (ha, good luck with that)

TL;DR: "The ultrasound performed on Lars today shows a single non-obstructive stone within the pelvis of the right kidney. There are suspect crystals in the urinary bladder. There is no sign of urethral obstruction. We are sending urine out for analysis to determine the presence of a urinary tract infection.

"As we discussed, the increased chronic elevation of calcium can cause an increased risk for soft tissue mineralization and stone formation. Once we receive additional blood work we may suggest medication changes."

So after all of that, and A Lot of $$Money, no blockages were found and Lars' kidney values are actually improving again. Figures, right? :o/ Regardless, it was worth the peace of mind to rule out The Worst Case Scenarios. Now we get to wait up to seven business days for the pending results; the ionized calcium test gets sent to a university in Texas if I'm not mistaken, so...yeah...

I think the best part of the day, aside from the most wonderful news of decreasing kidney values and no urethral obstructions, was the vet tech telling us what a good patient Lars was! He was so good, in fact that they didn't need to sedate him for the ultrasound! That's a bit unusual as far as I've heard. I'm still so very proud of my good boy!! :o)

I will definitely keep you all posted on how things progress!! :o) Thanks again for all your support, good thoughts/mojo/prayers/etc.
Things did not improve after his last vet visit and the daily sub-q fluids. His appetite still waned despite the Mirtazepine appetite stimulant kick-starter, which was a concern. What sealed the deal was yesterday morning when he both downloaded a watery deuce in the litter box and followed it up by vomiting what remained of his dinner the night before twice about five minutes after that.

While we could explain away the diarrhea (his constipation med is stimulated by hydration, so with the added hydration of the daily sub-qs along with not lowering the dose of his constipation med...that could be an explanation), we could NOT explain away the vomiting. Vomiting in a CRF kitty can be a sign of worsening renal failure (more toxins in the body making kitty sick), so I called Brookville and go Lars squeezed in onto Harlow's already scheduled laser therapy appointment.

Physical exam was unremarkable, but Dr. E agreed that we were probably right that something might be up, especially in light of the recent discover of all the stones in his bladder and working kidney. A blood chem panel was in order.

Results were not good. Kidney values continue to worsen, and badly. Dr. E and Dr. L talked about things and they both agreed that it's a pretty good bet that Lars probably has some sort of blockage in his urinary tract/system from one of the stones, and that surgery is probably indicated, and soon. The thing is, neither of them is willing to do it with their skill sets on such a chronically ill cat...

Dr. E said, given the worsening numbers, the best bet would be to bring Lars out to VCA Aurora or Arboretum View to one of the specialists for a more experienced/skilled vet's look see. We've been going out to VCA Aurora to Dr. Medinger for awhile for Lars' myriad health issues, but Dr. E likes the specialist (whose name escapes me right now) out at Arboretum View better because he's got "a much better bedside manner". We've never really had a problem with Dr. M out at Aurora, save for he talks too fast sometimes and he's always in way too much of a hurry, but...yeah...We're going to stick with Dr. M and VCA Aurora because they know Lars and his issues pretty well...

I was actually able to get Lars into Dr. M's schedule tomorrow at 1100 for a longer initial consult appointment for his current issues. Whew! I'm to bring all of Lars' current meds with us and to arrive 15 minutes early for paperwork. Can do, though it might be interesting, what with me having to wrangle him by myself as J absolutely cannot take tomorrow off. The cage puttings in are going to be the hardest, I think. I think I can handle the meds carrying by putting everything in a backpack, LOL; the hardest thing to tote will be the fluids bag, which is sorta too big to safely put into even my biggest purse.

So...yeah...Preparing for A Large Vet Bill tomorrow, as well as Really Bad News about my boy. I'm heartbroken, scared, and totally worried for my Lars cat. :o( I simply cannot fathom life without this floofer nutter. I just can't. :o(

If you're the praying/chanting/candle lighting type, could you please add Lars to your healing energy rituals for awhile? If you're not into that sort of thing, could you send some good thoughts his way anyway? We'd all appreciate it out here... :o/ <3
As of the last couple of weeks, Lars' appetite has been less than optimal. We've tried introducing different, non-Rx food, which he really appreciated initially, but then quickly became disinterested in. So...A trip to the vet was in order.

Took him in last Saturday. Physical exam was uneventful, though he'd lost a couple of ounces from the last time he was seen. Dr. E suggested a short blood draw to make sure his kidney functions were still stable. Nope--his kidney values were a slightly elevated, as was his calcium levels, which could indicate dehydration, or, obviously, that his kidneys were getting worse. Switch from diabetic diet to renal diet, and introduce twice weekly sub-q fluids.

At first Lars ate the renal stuff, especially the kibble, with a fair amount of gusto. But that only lasted the first few days. Then...Meh. Call Dr. E back. She asks if Lars pees a lot. Of course he does--he's both diabetic and in stage 2 renal failure! Could you bring him back in for a urinalysis? Sure!

Urinalysis shows visual signs of blood and, of course test positive for same. X-rays are done to determine if there's any crystals or stones in the bladder/kidneys/urinary tract. Jackpot! Several small stones in both the good kidney and in the bladder, and a undefined blob in the bladder that could either be an uncalcified stone or, more likely a blood clot. Ultrasound could be done to try to determine the exact nature of the blob, but it'll probably come back inconclusive and Dr. E doesn't want to waste our time or money on that just yet.

The usual course of action for so many stones in the bladder especially is surgical removal. Because of Lars' multiple health issues (asthma, diabetes, stage 2 renal failure, stage 2 heart murmur, etc), he's not a good candidate for surgery as he might not survive anesthesia. The second course of action is daily sub-q fluids to flush out the stones, which brings the obvious risk of urinary tract blockage, especially in a male cat. :o( Our choice, as Henry Rollins' old monologue bit goes, is fish--it's got to be the sub-qs for now. We're to administer 100=150ccs of fluids every day for a week, then return for follow-up x-rays to see how many stones have been evacuated.

How the hell did we miss this? Lars has been straining in the litter box for awhile, but he's got chronic constipation among his chronic health issues, too, so we thought he was straining from not being able to poop. The blood? Well, we use a combination of grey colored Cat Attract litter and brown colored World's Best cat litter and the brown stuff turns a lovely dark brown, which to mind, disguised any signs of blood that might have been present. Sigh.

All that on top of J and me being distracted with my recovery from my back surgery...yeah...We've now got a fairly seriously sick(er) cat. My heart is breaking and I feel like a rotten cat parent for not noticing sooner and taking action sooner. I know, I know--cats are good at hiding their discomfort and illness, we're dealing with multiple illnesses to boot with him so it's harder to tease out what might be wrong, we've got our own life distractions in the way, etc. But...yeah...Still beating myself up for this.

Will keep y'all posted on what happens... :o/
lady_curmudgeon: (feel the love)
( Mar. 4th, 2016 04:23 pm)
Here's a picture J took of me with Lars at the e-vet on Monday night when I was bidding goodnight to him before we left him there for his emergency care. There's nothing quite like the love between soulmates.... <3


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His blood glucose is still a bit wonky, with numbers ranging from the 150s-180s up to as high as the 270s on one stick, but...yeah...very much above the incredibly scary numbers he was clocking in with on Monday night. We're still foregoing any insulin if he measures in over 200 for a few more days, but so far he's only had a couple of sticks where he's actually been over the 200 threshold for giving him any anyway.

He's active, alert, bright-eyed and otherwise his amusing and loving self. His appetite could be a little better, but otherwise he's about back to normal.

His downloading remains okay on the lower doses of Lactulose, so we're slowly tapering him back up to his regular dose on that as we see fit. No need to make him go from the constipation extreme to the other end of the spectrum so...yeah.

So...

Whew. Think we got him through this one...
We had to go out of state for a funeral (my Uncle Fred, who lives in Ohio, died) over last weekend, so we had to board the kittehs while we were gone. Things went well according to all reports. They did mention that he'd been picky with his wet food but that he'd eaten his kibbles pretty well, and that he'd only needed insulin that morning when I'd come to pick him up.

Brought him home and he was acting normally initially. He disappeared not long after I got home, but that's not unusual for him. J got home from work around 1830, was looking for the kittehs to say hello again after not seeing them since Friday morning, but couldn't find Lars. Weird...

Fast forward to around 1900-1915; we hear one of the cats start howling. Sounded like a Dorene howl when she saw a strange cat outside. Happens again, but it's coming from the den. Look around and find Lars hiding under the Fancy Chair, looking Not Right. Eyes dilated, panting. I ask J--should we take a blood glucose reading? Yes...

Do it, comes back at 23!!! WTF?!?! Shit!!! We know to give him sugar right away, but the only liquid form of sugar we have in the house is maple syrup--okay, that's gonna have to do. Give Lars a bit via syringe while I'm calling up Brookville trying to get ahold of a vet there to let them know/ask how the fuck to proceed as they're about to close for the night and do not offer overnight care. Dr on site says to it's better to use light corn syrup, but maple syrup will work, too. Give 2cc every 10 minutes, then test blood glucose (BG). Call back right after. We manage to get the BG up to 28, lather/rinse/repeat, it goes back to 25.

Time for the e-vet. We bundle a very limp and unresponsive Lars into his carrier and drive him out to Lisle's Emergency Veterinary Services. They do a quick triage on him and determine he needs to stay overnight. We tell them his extensive medical history, give him all the vet information for both Brookville and VCA Aurora, and go home to try and rest so we can get up in time for the 0730 deadline for pickup.

We get a call around 2330 from Dr. S at the E-vet--Lars' BG is not coming up very quickly. In fact it goes up a little bit, then goes back down again. They've been giving bostules (like bursts) of dextrose along with the constant dextrose drip, feeding him, and giving him a high calorie gel supplement. She wants to run blood work on him to rule out any other issues going on--I give consent. All blood work comes back normal, thank Bast. Also, Lars had a couple of bouts of diarrhea--probably related to stress. Probably wouldn't want to give Lars any of his Lactulose constipation medication for a couple of days once he was home...

Lars' BG finally comes up and maintains a low normal in the 150s around 0500. We get sent home with an almost full bag of IV fluids with glucose, a tube of the high calorie supplement, the Cone of Shame that Lars had been wearing because he'd been fussing with the catheter during his stay, and Lars with the capped catheter still in his leg. He's to go straight to his regular vet for further monitoring, so I take him right to Brookville. No docs were in when I got there, but they had the faxed over docs from the e-vet and knew that Lars was to continue on the Dextrose IV drip, so they did that until one of the docs arrived.

I had my pre-op screening with my GP at 1000, so I did that and just drove right back out to Brookville after my appointment was done to get a Lars update in person. Dr. Lyn told me Lars' BG was stable in the 150s and I could take him home, to go back to our regular routine of checking his BG twice a day, and to let him "run hot" as the e-vet recommended for several days, meaning no insulin even if his BG was over 200 to let his body systems recover a bit. Also, reminded me to forego the Lactulose for a couple days, too.

Get home and notice the first thing Lars is doing is fussing with the compression bandage where the now removed IV catheter had been. I knew it was too soon to try to remove same, so I put Lars back into the Cone of Shame for an hour before I called back Brookville to see when I could remove the bandage safely.

I got the all clear around 1215. Take the Cone of Shame off of Lars so it's not in the way and get to work. It was a bitch to get off. In fact...Yeah...I couldn't get it off. I tried to find the loose end on the wrap, but it was so tight I couldn't get it off. Lars was uncomfortable and showed it with gentle licks and nips until...all of a sudden...CHOMP!!! Bit my left thumb in the middle of my cuticle line very VERY hard--so hard I thought I heard a crunching noise. I leave Lars where he is on the bed, grab the phone with my good hand, and race to the bathroom to go put my thumb under hot water to start flushing the wound. It was bleeding quite well and it hurt like a mother fucker.

GPs office tells me to go directly to Urgent Care, where they've got more means to care for me than their office. I go, get seen right away. Betadine soak immediately after initial exam, then x-rays of my thumb at my stern prompting to make sure no bone chipping happened from the bite because of the crunching sound I heard. X-rays came back clean. Get a scrip for high dose Augmentin for ten days, instructed to soak thumb at least twice a day in warm water, to wash it at least twice daily with antibacterial soap and to keep it bandaged up for at least the next 2-3 day and then to leave it unbandaged overnight thereafter.

Go home and find that Lars has partially chewed some of the compression bandage off his leg. I'm out of give-a-fuck calories at this point and decide to just let him chew at it until his daddy gets home. :o/ Once J gets home we try again, have no luck, and finally dig out the first aid snub nosed safety scissors and do what I should've done in the first place and cut the fucking thing off. We're all happier for the fact that the bandage is finally off.

How's Lars doing now? Yesterday's BG numbers were in the mid 150s again, but this morning he turned in somewhere in the 270s if I'm remembering correctly; I don't feel like getting up to look at his log book, so...yeah, LOL. He's acting like his normal self for the most part. Active when he should be, seeking out attention. His appetite could be better, but it's not terrible by any means. Downloads are still a little soft, but coming around. J gave him 1 Cc of his laxative this AM, so we'll gradually ramp him back up to his normal dose on that.

That was some scary fucking shit. I hope we don't have to go through that again any time soon... :o/
When we brought Uly in yesterday for his urinary issues, we also had Dr. B check out a small marble sized lump under his left front arm that J had discovered a couple of months ago. Upon further inspection a smaller cousin lump was found under Uly's right front arm. Dr. said it was a mass in the mammary tissue and that both should be removed. So, instead of spending the day with Dr. B for some fluids to get him to pee and get a urinalysis and blood draw, he had what basically amounted to a bi-lateral radical mastectomy of two of his eight (?) kitteh bewbs. Poor fella.

But what about the rest of it? The urinalysis found small to moderate crystals in his urine, which was likely causing irritation and also causing the errant pissing. Blood work all came back normal, thank Bast, as did the chest x-ray to check the lungs out for any extraneous lumps from the mammary masses issue. The larger of the two removed mammary masses was sent out for cytology and we should hopefully hear something as early as tomorrow, but by early next week for sure.

So Uly had to spend the night at the Cat Clinic, with the Cone of Shame because of the stitches in his armpits. We brought him home this afternoon. Poor fella won't let J out of his sight for very long, and he spends a lot of time laying around with his head down. While I was gone out bowling tonight, he briefly removed the Cone of Shame to give Uly a break from it and it didn't take but several minutes for Uly to start fussing with this sutures, so back on it went. We've both realized that the lids on the three covered boxes must all come off in order to accomodate for Uly's Cone, and we're praying that Uly doesn't have any potty issues while he's stuck with is "buddy".

So home treatment includes a once daily pain medication for post-op pain and a once daily liquid antibiotic for any possible secondary infections that might be brewing in his urinary tract as a result of the irritation of the crystals.

So...yeah...We've got a pretty sad sack post-op baby in the house right now. Our hearts are breaking for him--how do you explain to a kitteh that 1) he can't go into his former comfortable safe room because we don't trust him not to piss on everything in sight out of habit in there; 2) that he has to wear that ridiculous and somewhat heavy cone so he won't pull out his stitches, making everything he tries to do from eating to pottying a pain in the fucking ass; and 3) that his "sibling" kittehs are suspicious of him because he smells of Cat Clinic and medicines. Sigh. It's tough for us, but even tougher for him, and that's what makes it so bloody hard. </3
You may or may not recall last summer when we had an errantly pissing cat in our midst. We took all four kids in for checkups and nothing physically panned out. Eventually the errant pissing stopped as far as we knew, and since we were never able to catch any of the silly bastards in the act of actually errantly pissing we eventually let it go and forgot about it.

Fast forward to about two-three weeks ago. We had a nylon cube and tunnel cat toy set up dealie for the kids to hide and play in for over a year. We'd noticed Uly had started to scratch a lot as if he were trying to bury something at the end of the tunnel over the last couple of months, but there was no evidence of any potty doings so we figured he was just being weird. That is, until the aforementioned two-three weeks ago. While we were attending to Lars' medical needs one weekday morning we heard a tell-tale pissing sound hitting nylon--and we caught Uly in mid-piss. That was the end of the cube/tunnel toy...RIP...

Today while I was gone getting at my therapist's getting my head shrunk, J went into the guest room to make a note in Uly's health notes book that he'd vomited his breakfast this morning. Uly followed him in there, jumped up on the guest room bed, squatted, and proceeded to piss all over the bed right in front of J. WTFBBQ!?!?!?! J sometimes sleeps in the guest bedroom to give me a break from his snoring and to give his back a break from the dying mattress in the master bedroom and he'd mentioned about a week or so ago that he thought the bed smelled of cat piss, but he thought it might just be the litter box next to the bed needing to be changed out. Upon stripping the bed to launder the pissed upon linens, we discovered that the mattress pad showed many many other cat pissings. Thank Bast for the plastic mattress cover beneath that which was still intact from being put on from back when Diva cat was with us and having trouble controlling her pissings. The mattress itself, again, thank Bast, appears to be stain free...Whew...

Uly had yet another errant pissing event this evening while we were (finally) disassembling Christmas. J had the tree storage unit thingus (it's like a nylon thing with compartments for each part of an artificial tree with a handle on one end and wheels on the other for easy movement) out and laying flat on the floor, ready for the tree parts to be placed in it. Uly jumped in the open thingus, squatted, and PSSSS!!! Promptly pissed in it. Sweet Jesus Christ you never saw two people move so fast to get a cat out of a container!!!

Clearly something is up with our boy. J's able to work from home/take some time away from work to take Uly to the vet for a look-see. He has a past history of urinary crystals, which we still think are under control with Rx food, though that's not a certainty right now with his errant pissing of late. We'll find out tomorrow. It should be fun--arctic frigid temperatures and a cat who acts out at the vet? Yeah, good times, which is why J's taking time out of his day as I'm unable to assist the vet/techs to control Uly while they examine him (J can do so very well). Fingers crossed that it's nothing that we can't rectify, and we're hoping upon all hopes that it's not some weird sort of behavioral thing we'll have to learn to live with...

Dammit!! This is why we can't have nice things!!! :/
He's basically been chugging along relatively well, really. His blood glucose levels, sadly, have remained in the mostly low-ish diabetic range (200-300) most days despite being off the oral Prednisone now for almost a month now. He's usually around the low to mid 200s range most of the time and the insulin does bring his BG down to under 200 after his insulin, so...yeah. The good news is he's generally been taking his ear sticks and his insulin doses like a total champ, so we're really pleased about his good-naturedness about that.

He's not so thrilled about his other meds, though. He still fusses over the mask on his inhaler sometimes and there's usually some quibbling over the Lactulose, too. He also hates his once weekly dose of Fosamax for his hypercalcemia, too, but at least that's once weekly! Otherwise he's eating his diabetic Rx diet like a champ most days and a very happy and content kitteh when not going through his twice daily meds regimen, LOL.

He's due for blood work to check his kidney function this month and due for a serum calcium check next month. We're mightily curious about his kidney function, what with him not being on a renal treatment diet for several months now. Last we knew late summer he was still firmly in stage II, so we're hoping that's still the case. *Fingers crossed*
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We had to make a somewhat impromptu trip up to Minnesota for a funeral for J's family over Thanksgiving weekend (J's Aunt Linda died on 20 Nov and her funeral was up in Bagley on the Friday after Thanksgiving), so we therefore had to board three out of the four kids while we were away. Ulysses gets severely anxious and upset at the vet/in caged situations, so we had friends take care of him here at home. We boarded Dorene to make feeding time easier for our friends and because Dorene takes boarding like a champ anyway, and we have to board Harlow and Lars because of their medical needs.

A little pre-story: we'd not been testing Lars' blood glucose per instructions from VCA Aurora internal medicine; they'd said that at his very low dose of insulin it wasn't necessary. We'd told them that at Brookville when we brought him in (and in his copious medical and feeding instructions notes), but we toted along his glucometer in case they decided to go ahead and test his blood glucose anyway.

They did, and it's a good thing they did. In doing so, they discovered that our boy was turning in normal to almost low normal blood glucose numbers when they tested him before his feedings and thereby didn't need any insulin at all while in their care!! :) To say we were pleasantly surprised was an understatement! :) They encouraged us to let VCA know of their results and to continue regular blood glucose testing at home, which we have been. VCA was happy to hear the news and also encouraged us to regularly test and record his numbers. He's largely been turning in great numbers since he's been home, although the past couple of days he's been in the low 200s, which meant he needed his one unit of Lantus insulin before his meal(s). This seems to have some correlation with his still slowly tapering prednisolone taper--his BG numbers go up after he gets the pred, which does not surprise us at all as pred is known to increase blood sugar in all species who've ingested it and have had their blood tested.

We're hoping the Pred Taper That Never Ends will end with the current dosing regimen of .5ml every third day. He's really on so little of the stuff as to basically be inconsequential anyway, so...yeah...We shall see in about a week when I call back for new instructions.

The best news is that Lars' asthma is under decent control with the negligible dose of oral pred and the primary controller being the steroid Flovent inhaler. I do notice a slight bit of a wheezy purr every now and again, but nothing to be really concerned about in my mind. So at least there's that going for us, which is nice. I've talked to Dr. Lehal at Brookville about Lars' asthma; he says if Lars has symptoms after he's off the oral pred we can increase the Flovent puffs and add an albuterol rescue inhaler if needs be to avoid going back on the oral pred if at all possible, so we've got other options in that regard, too. Good to know... :)

So, yeah. We're hoping that once Lars is completely off the oral pred that his diabetes will largely be under control and hopefully his need for any insulin will be negligible to completely unnecessary! :)
Eh? What's that?

We took Harlow to the vet about two weeks ago now because he was dragging his hind legs around and generally having a bad time getting around; we figured his arthritis was out of control from all the constant weather changes and we wanted to get some good pain control for him.

We got some Good Stuff for him, and x-rays were taken to quantify where and how bad his arthritis had gotten. Interestingly, aside from some slight right side hip dysplasia and some mild arthritis in his hind knees his x-rays came back fine--nothing in his spine, hips or the rest of his legs. But, that being said, Harlow was definitely showing signs of discomfort when his hind legs were being manipulated.

It was suspected that perhaps some of his mobility issues were post-dictal seizure related, so a serum level for his phenobarbital was drawn up; it came back a bit on the low side, so his AM dose was doubled from 1/4 pill to a 1/2 pill.

ON TO THE LASERS!! :o)

Dr. E is not one to be a sales person, but the hospital recently invested in a laser therapy system that was touted as being able to help with inflammation control--it would be of benefit to both Harlow's sinus issues and to his hind leg discomfort. She gave us the $$ price for the initial six session and J decided that, after breaking down the price per session, it was worth a try.

Harlow's had four sessions so far. His gait is still a bit odd, but he's up on his hinders begging for his meals a lot more often than he used to which tells me those hind legs are feeling a might bit better than they were before the treatments. As for his sinuses, he's sneezing some, but no nasal discharge to speak of and his breathing sounds less Darth Vader like in general.

Is The Laser Treatment worth it? I'm of mixed mind on it. Both his sinuses and his hind quarters seem to be improved, but not by an immense difference. I'm not sure how much we're supposed to expect by this point in the treatment, so...yeah...He goes in next Tuesday for his 5th treatment, so I will ask then about what our expectations should be compared to what our observations have been.

So, yeah. LASERS!! ;o)
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lady_curmudgeon: (feel the love)
( Nov. 9th, 2015 09:20 am)
I think most of us here could go for a little bit of Kitten Therapy for our stress... ;)

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Dr. Medinger ordered blood work a couple of weeks ago--TLI and PLI to rule out pancreatitis skewing the glucose results; they came back with numbers indicating pancreatitis. But that didn't nullify the diabetes Dx...

After those results came back, Dr. M wanted to do a home based urine drop; evidently glucose levels in cat's urine are higher when they are stressed, and almost every cat is very stressed when at the vet's office. Got special litter from Aurora Cat Clinic, bought a new box for the proceedings, and plonked Lars into the guest/safe room for the morning last Friday morning.

It didn't take long for him to produce a sizable sample for me to bring out to the cat clinic for testing. The results were then sent to VCA internal medicine for scrutiny.

Many back and forth calls ensued, but the verdict has been handed down: it's official--Lars is diabetic.

What does the mean?

It means he's getting weaned off the prednisolone in favor of using the Flovent inhaler twice daily. Getting off the prednisolone should go a LONG way in getting his blood glucose under control, at least from all I've been hearing. It means Glargine insulin shots--one unit twice daily after his breakfast and his dinner meals. It means learning how to use a blood glucose meter, of course. It means transitioning from a renal diet to a diabetic diet. It means I get to *really* scrutinize his eating, drinking and toilet habits much more closely now.

It's just another crack in my already crack filled breaking heart for my sweet boy. This is becoming A LOT to manage, but I know we'll figure out how to do it all. We have to--Lars' health depends on us. I broke down into a puddle of tears after I got off the phone with the tech who gave me the news/information.

Sigh...

Anybody out there with experience with caring for diabetic cats, any words of wisdom that can be imparted are very welcome...
We took Lars into Dr. B on Saturday the 26th for a check of his serum calcium and his ionized calcium to see how the Fosamax is working out for him. We also mentioned how much water he's been drinking of late and how much he's been urinating. We figured it might be a kidneys issue going on, so we figured an abaxis blood draw to check his kidney values was in order. Dr. B thought differently--he wanted a full blood panel to check for everything.

Good thing, that...

Lars' serum glucose came back at 240; high normal is 170 evidently. A second blood test was ordered (forgive me, but I don't remember the name of it--I'll get the name of it from the paperwork I'll get from VCA Aurora eventually) to help confirm and it came back high normal. Dr. B had us bring Lars back last Friday for the day for a urine capture to see if his urine was positive for glucose. It was.

Lars, it seems, has diabetes, in addition to his other myriad chronic health problems.

Dr. B seems to think it's the Prednisone that's brought it out into the open, that reducing the dose and eventually eliminating it will bring the glucose numbers back under control. That being said, he's deferring to Dr. M at VCA Aurora internal medicine for counsel since Lars is already under primary care for his other conditions there. We're currently waiting to hear back from them.

Sigh. My poor, sweet, broken boy...
...and blood was shed. J's blood to be precise. Lars lacerated J's left index finger in the process of me trying to actuate the inhaler the first time tonight. Sigh...

The AeroKat chamber contraption is really quite something. It came with two masks--one that was about two inches in diameter or Lars size and one that was about 1 1/2 inches or kitten sized--obviously we went with the larger. Got everything prepped, Lars none the wiser, and set to trying to get him properly medicated.

We figured he'd freak so J tried to do it on his own, scruffing Lars and holding his head while I held the inhaler/mask to Lars' face and actuated the inhaler. HA! The lacerating happened within the first minute of that fiasco. Onto the floor we went, with Lars' body pinned to the floor, J struggling alternatively hold back paws, scruff, and hold his face for me. The goal was for me to actuate the inhaler, get Lars to take seven breaths with the mask to his face, then be done with it. He was so squirmy and out of control I think we might have managed two-three breaths before it became futile to keep trying.

But it wasn't over yet! No, it was time for the remainder of his evening meds--the Lactulose and the Prednisolone. That didn't go well, either, with Lars wearing more than a bit of both meds. J was understandably irate that he'd gotten quite nastily lacerated and I was freaked out that my cat was so freaked out AND that my boyfriend was so badly lacerated. Sigh.

We've got a grooming bag we can restrain Lars in if needs be for future use--I bought that "just in case" before I knew he was even an asthmatic cat, because he's so notoriously difficult to medicate and trim his claws, too. Hate to traumatize him with that, but who knows? He might actually get some comfort from being bound down.

Lars is simply NOT good at being a chronically ill kitty. Though he's not done it in the evenings just yet, he's taken to hiding in random places around the house every morning after he eats his breakfast in efforts to avoid getting his AM medications. :/ When he first started doing this, simply shaking the Mystical Bag of Treats would get him out of his hidey holes--reward him with a bunch of treats, medicate him, then reward with a bunch more treats. But now he's gotten wise to that and won't come out for that. :/ We search the house (and it's not a terribly big three bedroom ranch) seemingly endlessly for that fucker every morning, which is a drag, especially on mornings when J has to be at work early. We can't medicate before food because the prednisolone is rough on the tummy and the lactulose isn't much easier on him without a food buffer, either, so the reward with breakfast trick is straight out. Sigh...

He's still my sweet soulmate cat, though, all the troubles be damned. My heart breaks for him; I know how much of a drag it is being a chronically sick being, and I can cognitively understand my situation, whereas he obviously cannot. Poor floofy fella... :/
Things have been a bit wacky around here, so I've been remiss in not posting timely updates about my boy. Mostly I've been trying to mentally digest everything that's been happening, LOL, as well as going about the business of treating the new things going on so I haven't been at the computer as much as I usually am to post about new goings on.

Pre story...

Lars has always had a wheezy sounding purr. He's also had a somewhat chronic issue with an on again-off-again dry cough that does not produce any hairballs or vomitus. It wasn't anything I worried about until we discovered the heart murmur diagnosis; after which I really started paying attention to how much/how often he coughed...

In the last couple of weeks, Lars has coughed and wheezy purred more often than normal. It increased last week dramatically with the introduction of an air freshener thingus in the master bedroom; every morning he started waking me with his dry cough when he'd come to wake me for his breakfast. Last Tuesday his cough was particularly bad and persistent, so I called out to VCA Aurora to see if they wanted to check him out. They did.

They did a physical exam which got him to cough upon tracheal palpitation. Thoracic x-rays were taken to see what was going on in the chest cavity--there was some mild bronchial thickening in his lungs. This, at that point could mean three things--allergic bronchitis, complications from heart worm disease, or feline asthma. Blood work was drawn to rule out heart worms. Prednisolone was prescribed to get the coughing/wheezing under control, at least until the heart worm test came back.

Heart worm test came back, mercifully, negative. Diagnosis: "Suspect feline allergic airway disease." We're to continue the prednisolone (5 mg/ml) .9ml every 12 hours and to add a puff of a Flovent HFA 220mcg inhaler once a day for three weeks and then re-evaluate to see how the treatment is doing. Flovent HFA is not available as a generic, ergo it is quite expensive. The cheapest we found it was at Costco and it was still $$expensive. I also had to purchase an AeroKat chamber/mask to administer the inhaler to Lars, which was almost a big fiasco, and was also $expensive. First attempt at ordering it off amazon was a bust--they initially said I would have it arrive by yesterday, but yesterday sent me an email that the earliest *ship* date they could tentatively promise me would be Wednesday the 9th. Uh, no, we need this thing NOW. Ended up ordering it through vetrxdirect.com for about the same price, though I did have to pay $5.95 to expedite the shipping by a few days; it'll be here tomorrow according to the USPS shipping tracker.

So, yeah: feline asthma/bronchitis. We, at this point, have idea if this is a lifetime affliction or if it's just a temporary thing. We'll know more as we continue treatment. His wheezy purr already sounds less wheezy just on the Pred, which is a good thing, and the cough is all but gone already, too.

I swear, I'm gonna stop bringing Lars out to the VCA--they always find something else wrong with him! :/

That being said, he's seemingly doing alright outside of when it's around time for him to get his twice daily meds. He kinda knows when to expect when it's going to happen, so he's taken to hiding himself in clever places so we have to do all sorts of tricks to get him to come out so we can take care of business. :/ Smart kitty is smart.

Sigh...So now his diagnoses include stage IV/VI physiologic heart murmur, stage II kidney chronic kidney disease, small intestine dysbiosis, and now feline allergic airway disease. He's special, alright. :/
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...and it's a mixed bag. Of course it is, right?

Three of the four tests came back fine. UPC unremarkable, urine culture negative, PTH within reference ranges. But his urinary calcium levels, both ionized and total, are high. Our boy has a new diagnosis: idiopathic hypercalcemia. Basically, my understanding, with the Google-Fu I've done on this, is that his body isn't absorbing calcium properly and it's evacuating to some degree in his urine, as is evidenced by the high calcium reading in same.

This could probably eventually mean low-bone density for our boy, among other issues, so the treatment is the same as it is for humans: bone density drugs. For Lars' case, this means 10mg of Fosamax 1-2 times per week. This is not a veterinary formulary drug, we've come to find out. Neither VCA nor Dr. B could get it via their veterinary pharmaceutical channels. It has to be specially compounded by a compounding pharmacy that does veterinary compounding. Tried the Bolingbrook Compounding Pharmacy first--they can't get the needed components from their suppliers. Sigh. Called VCA and told them of my lack-o-Fosamax woes, and they called their go-to compounding pharmacy, The Compounder, which is a stone's throw (evidently) from the VCA out in Aurora, and they are able to order the necessaries to compound the drug for us. Waiting on them to contact us regarding same once things are ordered. Cindy out at VCA says they do mail service either free of charge or at a nominal fee, so if I don't feel like being adventurous and attempting to drive out to find this place I won't have to, which is nice and convenient.

So Lars' CRF diagnosis has changed some. It's now Chronic Kidney Disease IRIS Stage II, Renal Hyperparathyroidism to include the hypercalcemia component.

Hypercalcemia can explain away his lack of appetite issues as well as his chronic constipation issues. J and I are both hoping once he's on the Fosamax for a time both those issues will start correcting themselves, but we're not foolish enough to count on any changes, either. We're just not that lucky. :/

My poor, broken boy just keeps getting more broken. We'll keep trying to fix him, though. :)
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Yes, that's plural. He not only got the full cardiac monty, but also a renal evaluation while we were there for good measure. Dr. Medinger asked us how Lars' renal failure was diagnosed--by short blood panel (abaxis it's called--I'm sure I'm butchering the spelling of it) and urinalysis--and he suggested that by doing a renal work-up we could really know for sure where Lars stood as far as his kidneys were concerned. No blood work this time, but urinalysis again and a urinary tract ultrasound to look at the actual physical condition of his renal system to see if anything had changed since his abdominal ultrasound back in the beginning of April. J and I talked about it and figured he'd have to get the renal work-up eventually anyway, so we decided to kill two birds with one vet visit.

First things first: cardiac exam. Physical exam still presented as stage IV/VI heart murmur, which was a good thing--it hasn't worsened at the very least. Electrocardiograph revealed normal cardiac structure and function. Based on that, Lars was Dxed with a physiologic murmur (no heart pathology or systemic cause present). This means that unless excited/stressed/too active it should cause no problems for Lars and he's good to go to eventually receive subcutaneous fluids for his renal failure, which was one of our primary motivators for investigating the heart murmur further in the first place. This is most excellent news. Dr. Medinger does recommend follow-up electrocardiographs every six months to make sure the murmur is not worsening, so he'll be back out there for that come winter time.

Renal exam was a mixed bag. Based on what results are currently back (we're waiting on a couple of urinalysis related tests, which will be back next week), he's still firmly in stage II out of VI of Chronic Renal Failure (CRF). This is good, as it's not worse than we thought. The urinary tract ultrasound revealed that his left kidney (the one that was found to be severely shrunken compared to the right back in April on his abdominal ultrasound) showed a mild increase in pelvic dilation compared to April's scan; I didn't ask about what that meant, which I should've, but I would think it has at least something to do with his recent renal failure Dx. Yesterday's ultrasound also found cellular debris and crystals in the urinary bladder, which could indicate infection of the urinary tract/bladder; they sent out urinary cultures to see what grows out and will let us know once those come back if anything grew out and/or if any antibiotics are needed. No subcutaneous fluids needed just yet, just continue with the renal Rx diet.

So yeah. That cost a small fortune, but it was worth it for the peace of mind and the knowledge it gave us.
Our poor, broken boy...
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As per Dr. B's wishes, I contacted VCA Aurora's internal medicine department to see if they wanted to do a more intensive cardiac study on Lars before we begin administering any quantity of subcutaneous fluids. Yes, Dr. M would like to do a full cardiac study on Lars before we do any fluid therapy with him to make sure his heart can handle it. Our appointment is scheduled for noon on 12 August when J will be on vacation to help me wrangle the wildebeast into and and out of his carrier. Yet another specialist's visit that's gonna Cost Me. My boy is worth it, though. They usually have a cardiologist proper on staff out there to do the exam, but their new cardiologist doesn't start until the end of the month and Dr. M doesn't want to wait that long for the work-up so he'll be doing it. A friend had to bring her boy out there for a similar cardiac exam to what Lars can expect and it was done by Dr. M, so I have faith that he's got the skills to do it.

Onward to the food conundrum...

Tried in vain to get a small bag of Royal Canin Renal formula kibble from Dr. B, but they were out and told me it would take a few days to get more in stock, so I gave Brookville Animal Hosptial (Harlow's vet) a call to see if they had any--they did, and sample packs of the stuff, even! Turns out, Royal Canin recently overhauled their Renal formula line to three different flavors/types of kibble and three different types/flavors of gushy fud. They all have weird names, LOL, like "aromatic" and "savory" to name a few, instead of being named by their meaty flavoring, which is kind of strange. To paraphrase their sales tagline "what good is a renal food diet if a cat won't eat it?" AMEN, Royal Canin! Amen! Name your food whatever you want to if my cat'll eat it! :)

Had Dr B fax Brookville a scrip for the renal food and we went over to pick up the sample box after J picked his truck up from his mechanic dude (that's another story, but short story--it seems to be repaired and among the living again!). The sample pack is the CUTEST thing--the small bags of kibble are about 2 pounds each, enough for several of Lars' kibble feeds and there are two small cans each of two of the flavors and one big can of another. No charge for that, though I offered something for their trouble, which they refused. J mentioned picking up at least a couple of needles in order to have fresh ones for Lars' possible eventual sub-qs; they asked us what size (!?), which was curious, because I thought the only optimal choice was 18 gauge. Turns out they offer the slightly thinner 20 gauge as well, so we got 2 of the 18s and 1 20 to try to see which one Lars responds better to. That, too, was at no cost to us, and they didn't ask us to contact Dr. B to send over a scrip for the needles, either. They are too damned good to us over at Brookville--I think between Ra's and Harlow's "Frequent Flyer" miles with them we've probably earned the rock star treatment, LOL, but...yeah, it's nice.

Aside...

So, last night we installed and deployed the window AC unit we bought Sunday night in the kitchen and the kitchen cooled down nicely, the den became more comfortable, too, and the living room a little bit more tolerable. All four cats spent a bit more time in the kitchen and den after we had it fired up for awhile, too...

Back to the food story...

Then came food time. Lars got to try Royal Canin Renal formula A kibble last night and he snarfed it down really well--only leaving a couple kibbles behind. This morning was even better. I put down a bowl of K/D gushy food (futilely I thought) and he ate 3/4 of the serving I gave him! He did well with his Royal Canin Renal formula A kibble this AM, too! :) So that tells me that the stuffiness/warmth in the house was negatively affecting his appetite to at least some degree! I knew it! Thank Bast for that AC unit!

He's acting more himself, too, if not even a bit more feisty than normal. In the middle of the night he tried rousting me for some affections/lovins by jumping all over me and finally biting me on my left wrist where my FitBit sleeping band was. OUCH! Little bastard. ;) He also gave me love nips on my nose later in the morning to help wake me up so I could fetch him his breakfast. That's something he used to do more consistently before, but kind of fell out of favor after he started not feeling well these past few weeks.

So, yeah. I'm cautiously optimistic about the food sampler pack yielding a new fave food choice for Lars. At the very least, with it being somewhat cooler in parts of the house, he's feeling better in general so he'll likely just plain eat better because of feeling okay. YAY!! :)

***fingers crossed***
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