lady_curmudgeon: (Lars)
2016-05-25 09:17 am

State of the Lars: tentatively optimistic?

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.
lady_curmudgeon: (Lars)
2016-05-22 09:58 am

State of the Lars: Sigh...

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
lady_curmudgeon: (Lars)
2015-08-20 09:27 am
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State of the Lars: Urinalyses results back...

...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. :)
lady_curmudgeon: (Lars)
2015-08-04 08:14 am
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State of the Lars: Cardiac studies and food trials...

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.


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***
lady_curmudgeon: (Lars)
2015-08-03 01:21 pm
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State of the Lars: Lackluster appetite...again, or is it still?

Used to be if Lars' appetite waned we could give him a dose of Mirtazepine (appetite stimulant) and his appetite would soar! He'd get the Cat Crazies, sure, but his appetite would be voracious! Eat anything we'd give him, and the effects of the dose would last a good 3-5 days.

Not so the last couple of weeks...I'll put down his bowl of either gushy fud or kibble, he'll eat with gusto for a few minutes, then he'll slow to a crawl and eventually wander off like a homeless person, leaving a goodly portion of whatever food he's been given behind. If I stand nearby and coax him, he'll stick around and continue to pick at his food until it's mostly gone, but otherwise it goes half-eaten.

This could be any number of things: rejection of the prescription food (he's a finicky fucker), the house being stuffy and a bit warm rendering his tummy a bit queasy and therefore not as hungry, something related to his now myriad health conditions getting worse that we're as yet not aware of...Hard to say.

Gave him a dose of Mirtazepine yesterday morning and it seemingly did much of anything for his appetite, so I called Dr. B this morning for advice. He suggested perhaps Lars is feeling a bit dehydrated and sluggish, so if we've still got a bag of fluids hanging around the house to give him 150ccs of sub-qs. I reminded him of Lars' stage 4 heart murmur and posited that perhaps 150ccs might be a bit much for him. Dr. B asked had Lars just been diagnosed with a physical exam or had an electrocardiogram been done? Just a physical. He suggested I contact internal medicine at the VCA to schedule an electrocardiogram to further study the heart murmur to make sure it's not a factor in his current state, or if it could become a factor if Lars needs to receive regular sub-qs. I'm all like "what-what???" Now I've got to worry about this heart murmur I was told not to fret about??? Sigh...

Dr. B also suggested trying a common sense approach to Lars' food--try to feed a 50/50 mix of his old non Rx food/Rx food and see if he showed more interest in that plan of food attack than just his Rx food. I tried it and he did show more interest--in fact he largely ate around the Rx stuff in favor of the non Rx stuff so that says a lot about how he feels about the K/D kibbles right now... :/ The folks with internal medicine out at VCA don't even prescribe Rx renal diet until a cat's in stage 3 so technically speaking Lars probably doesn't need to be on the Rx renal diet just yet, but we'd like to keep him on it to be more aggressive with treating his CRF, so after work J's going to pick up a bag of Royal Canin's version of renal care kibbles for us to try with Lars to see how he likes it. I daresay he's probably going to eventually end up rejecting it as well, LOL,'s worth a try.

As far as the temperature in the house goes, we've got a working solution in the works for that until we can afford to fix the whole house AC unit, too. We bought a 12,000 BTU window AC unit on clearance from the Meijer last night which we're going to place in the kitchen window; we're hoping it'll help cool not only the kitchen, but also the den and part of the living room as well with the help of the standing oscillating fan we also bought on sale at Meijer. J's installing the unit tonight after he's done with getting the renal food.

Hopefully the combination of cool places in the house and the change in food will help Lars eat more...Not holding my breath, but...yeah.

Sigh. This cat is truly my soul mate cat--finicky as fuck eater and sensitive to temperatures like his mama... :/
lady_curmudgeon: (Lars)
2015-07-24 01:46 pm
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State of the Lars:Revised--Not Stage one renal failure, but stage two...

I called VCA Aurora on Monday to update them about Lars' newly discovered renal failure diagnosis because I figured they might want to know for their records for their ongoing care with his ongoing digestive issues they're still helping Dr. B treat. Told them his creatinine levels and that I didn't know his BUN, but that it was high end of normal, that Dr. B felt it was very early stage renal failure, that Lars had been prescribed Hills K/D, and to contact Aurora Cat Clinic for more information if they needed it.

Cindy from VCA called me back on Tuesday. She said Dr. M called Dr. B and they'd discussed the labs and, according to the one set of very specific guidelines for renal failure staging they go by, Lars was not in stage one renal failure, but square in the middle of the range for stage two instead. :/ Stage TWO?!!? Sweet Bast, there's only FOUR stages to this fucking disease and he's already halfway gone???


To say J and I are dismayed is beyond an understatement. Lars is only six fucking years old and shouldn't even be in stage one yet for fuck's sake!!

I talked to Cindy again today to double check to see if Dr. B's got Lars on the correct treatment and she surprised me by saying that Dr. B is actually going pretty aggressive--most of the time Dr. M doesn't start Rx food or any other treatment for the renal failure until the beginning of stage three. I found that to be interesting. And, no--we're not taking Lars off the Rx food! He actually *enjoys* the food so far and it can only do his numbers good. It's a balanced food otherwise, too, so he'll be fine on it.

I've joined the two feline renal failure groups on Facebook and have sought out more information on the rather popular layman's site--Tanya's Comprehensive Guide to Feline Chronic Kidney Disease that I used to frequent when I was dealing with Jazz's and Diva's renal failure. Gotta get myself re-acclimated to the logistics of the disease and care for same...

What is it with us and Broken Cats? I tell ya, we fairly seem to attract them...:/
lady_curmudgeon: (Lars)
2015-07-19 09:02 am
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State of the Cats:errant one found?

Yesterday morning. J and I took both Lars and Dorene into Dr. B for blood work and urinalyses and for Lars' yearly exam and vaccines. It started off as quite the adventure. We've got several carriers, including three soft-side collapsible carriers. We decided to use my cutesy and questionably functional Laurel Birch carrier (I got it on clearance at PetSmart (go figure) and it's cute as hell...that's about all it's worth, as you'll find out soon), and a Martha Stewart carrier we got for free from the cat coordinator at the shelter. Lars got the Laurel Birch carrier and Dorene got the the Martha carrier. Dorene was fine in her carrier, but Lars managed to escape the not-so-surly bonds of his carrier in less than 2 minutes, LOL. So much for my cutesy carrier, LOL. We've decided to donate it to a charity we frequently use (AmVets); perhaps somebody with smaller and less frisky cats can use it for awhile...

Anyway, get Lars in a hard shell carrier, drive out to Aurora Cat Clinic, and start our appointment. Dr. B sees each cat in turn, palpates both of their bladders, and finds that neither of them has any urine in their bladders! :( In order to get the proper samples, we left them with Dr. B for fluids and observation for a few hours. Lars got his vaxxes and his exam, the fecal sample got processed, and bloods got drawn and started in the lab...

Fast forward to early afternoon when we pick them up. The results are back. Despite the fluids, there wasn't quite enough for a full urinalysis, meaning Dr. B wasn't able to test either cat for crystals (which we want to do for Lars, who's been squatting but peeing small amounts frequently lately), but he was able to get enough to determine there wasn't glucose in the urine or any white or red blood cells for either of them.

Blood work: Dorene's was fine. No surprises there. She's four years old, eats well, seemingly healthy as a horse--everything *better* be fine...

Lars' was not quite alright...

His BUN is high normal and his creatinine is .1 above normal. Both mean there is something amiss with his kidneys. And he's only 6 1/2 years old...

What does this mean? Dr. B didn't say specifically, and we didn't ask, but we know enough about renal failure in cats from our past experience to know this means that Lars is in the very, very earliest of the first stage of chronic renal failure. It's enough that Dr. B prescribed renal care food for Lars to get things under control, and we're to bring Lars back in two months for follow-up. We're to watch his food and water intake, and his urine output as well as his energy level for any changes with the new diet. He also wants another crack at getting a full urinalysis on Lars--we're planning on bringing Lars back in on Tuesday to spend the day with Dr. B and his staff for that, which Dr. B has offered to do for free, I might add.

I was gobsmacked. I thought renal failure was something that cats in their double digits had to worry about, not some half way to seven year old kitteh! But Dr. B explained he's seen this before in long-haired kittehs especially. He said something about the bits and bobs of purebred genetics found in most long-haired kittehs (who knows what it could be with Lars--we've tried guessing what his pedigree could be and gave up, LOL) cause some weaknesses/predispositions to renal issues. Something, something read some studies about same, yadda yadda. Still didn't make *us* feel any better, especially me, the former Mom of two CRF kittehs. I am a bit beyond sad and overwhelmed by this... :(

Sigh. So now, on top of digestive/downloading issues, we've got to worry about his kidneys. My poor, sweet, broken boy. :(