Tuxedo is at the emergency vet

[Barbara Boehmer]

Tuxedo is doing better. I am posting this on multiple forums, since he has previously been diagnosed with diabetes (for 4 or 5 years until 3 weeks ago), and more recently moderate kidney failure, severe highly regenerative anemia, and suspected bone marrow leukemia, and some or all of it may be related and I now believe that the suspected diagnosis of bone marrow leukemia is wrong. I don't know what he has or had and don't know whether to expect it to continue to get better or not and am willing to reconsider any possibilities at this point.

I took Tuxedo, who is 16 years old, to the vet today for a pre-scheduled appointment to check his packed cell volume. I had been told that his severe highly regenerative anemia was probably caused by bone marrow leukemia, as various other causes, such as viruses, parasites, insufficient hormones from the kidneys, autoimmune disorders, and such had been ruled out through various blood and urine tests that showed no viruses, no blood parasites, a high reticulocyte count, and no rise in bilirubin. It was considered that further diagnostics and treatment might do more harm than good, so he was considered terminal. After a few days of hospitalization and i.v. fluids, I have been giving him subcutaneous fluids and pepcid at home. We also gave him some Clavamox to see if it helped relieve some of his other more minor symptoms. We were just planning to recheck the packed cell volume periodically to determine when it was time to give him a blood transfusion to try to provide him with a couple of more weeks of quality time. I told the vet he was doing better, gaining weight, and more alert and active. She said that the anemia and the packed cell volume would not get better, so I was probably seeing the results of a little improvement in his kidney problem. Well, surprise, surprise, his packed cell volume has gone from the original 12, to 8 during hospitalization, that was explained to me that was misleading because the fluids dillute it, to the last tests of 13.5 and 14.3, that the vet said were really so close that they were just the same, to today's shocking 20.5, that definitely means he is improving. It is not in the normal range of 29 to 48, at least not yet, but it is a drastic improvement. At this point the vet has no speculation as to diagnosis or prognosis.

Here are some of the things that I have been mulling over, in chronological order of occurrence:

I suspect that his diabetes problem that began 4 or 5 years ago may have been caused by poor diet, just like peopele get type II diabetes from a poor diet, although I was feeding so-called premium cat foods. Once he was diagnosed, we may have made it worse, by feeding the vet-recommended diet of that era, a high-fiber dry cat food.

In late 2005, when another cat in the house had dental problems, I started also feeding some soft canned cat food. It was around that time that Tuxedo started his strange yowling, that I mentioned to the vet, but the cause was unknown. I now know that he does that when he has had too much insulin. Unfortunately, we were relying solely on fructosamine tests every six months that seemed to indicate he was doing fine. I suspect that, once he began eating the canned cat food, that happened to be one where the main ingredients were quality protein, he gradually stoppped being diabetic, and we unknowingly had him on too much insulin for a long time.

When they stopped making one kind of insulin and we switched to another earlier this year, we spent a few months trying to determine the correct dosage with blood glucose tests at the vet every week or so. This happened to be in the midst of a transition between a retiring vet and a new vet and some part-time vets that fill in once per week, that caused a lack of continuity and added to the confusion. Eventually, we get settled in with the new vet, who suspected that we were seeing a rebound syndrome, and he might not be diabetic anymore. At that time, I figured I needed to learn to do home glucose testing, in order to help figure out what was happening. He has now gone three weeks without insulin and his blood glucose has remained between 131 and 224. Prior to stopping the insulin, it was between 28 and 409.

Although he was no longer diabetic, he was skinny, dehydrated, and lethargic, which is why we did the tests that revealed the kidney failure and anemia, that resulted in the hospitalization, and so on. His increased packed cell volume pretty much throws the bone marrow leukemia diagnosis out the window. So, the big question now is what caused the kidney and anemia problems, and are they going to continue to get better or is he likely to have recurring problems? Here are some possibilities I have been considering:

Could it be that the whole mess was caused by being on too much insulin for too long and he just needs more time to recover?

At one point, one of the vets, thinking that the yowling was due to stomach upset, prescribed 50 mg of tagamet twice per day. Another vet had me gradually wean him off of that. Then when he was hospitalized, they started him on 2.5 mg of pepcid once per day. Is it possible that the whole mess is just from not eating enough between when he was taken off of the tagamet and when he was started on the pepcid?

Could it be that he had a virus that was not tested for and the Clavamox cured it?

Could it be that he has some sort of auto-immune disorder that has flare-ups and remissions and comes and goes and gets better or worse unpredictably?

Could it be that his anemia has multiple causes and giving fluids has made the kidney problem better and that has lessened that impact on the anemia problem?

I am continuing to give him 2.5 mg of pepcid every monring, 100 mililiters of subcutaneous lactated ringers solution every morning, and he is not quite done with his 10-day course of Clavamox antibiotic pills twice per day. I keep dry food and canned food made with high-quality protein available constantly. I am also feeding some people-type chicken and roast beef and such daily. His appetite is good and he eats some of everything, except the canned Science Diet K/D that the vet prescribed, which I offer a bit of every morning and evening, but he won't eat it. That was all they fed him at both hospitals he was in. I think he might have eaten more if they had offered something else. If he ever has to stay for a day or night again, I will bring some of what he likes for them to feed. It is so good to have him jumping up in my lap and purring again. He still needs to gain some more weight, but he is improving, and I hope he continues to improve, but it sure is a big mystery. The vet looked absolutely dumbfounded and speechless, other than to say that the packed cell volume of 20 is good news. When I asked if she wanted to take a guess at what the problem was, she just said, "no". He is not currently scheduled for any further tests. We are just waiting to see how he does.

I also took my 21-year-old, Rowdy (she was in her youth), with kidney failure and hyperthyroidism to the vet today. She is also doing better, gaining weight, and more active. She gets daily subcutaneous fluids and tapazole twice per day. We did a full blood panel to check the thyroid and kidney levels and should get the results tomorrow. As with Tuxeddo, I am now feeding more high-quality protein, instead of the formerly recommended low protein diet for cats with kidney problems.

[CarolC]

This has interesting explanations for the symptom of howling (yowling).

http://www.felinecrf.org/symptoms_treatments_index.htm

[moo]

I am glad that Tuxedo is doing better than the last time I logged on. You seem to have such a full plate on your hands. i don't know how you do it!!!! You are one strong lady!!!!