Galen

Galen was diagnosed with hyperthyroidism on May 13, 2005, just a week before his 6th birthday, but that turns out to have been an incorrect diagnoses. The correct diagnoses is chronic renal failure (CRF).  This error in diagnoses and incorrect treatment resulted in Galen going seriously downhill from being in a bad state to start with.But, he was switched to a different vet in July, correctly diagnosed and treated, and as of November 2006, is doing very well.  So well, that one would never think he is a sick cat!  He went from a weak, skin and bones 5.9 pounds cat with severe anemia who felt too sick to eat, to a 9.7 pound energetic cat with no anemia and a healthy appetite.

We didn't see his blood work results until two months after his incorrect hyperthyroidism diagnoses, and found some alarming things that had not been addressed in all that time, such as Galen's anemia, as well as the test results not indicating hyperthyroidism after all.  We trusted the two vets who saw Galen at that practice were taking care of everything necessary and correctly, but they were not.  After being switched to our usual vet, Galen was then correctly treated for the CRF with subcutaneous fluids (sub-q's), the anemia with vitamins, and retested showing he definitely did NOT have hyperthyroidism.  The incorrect treatment for that had started to make him hypothyroid, plus worsened his anemia as the medication was causing stomach bleeding. 

Galen's story really teaches why one needs to get copies of a pet's blood work promptly, and to keep on top of things.  Ask lots of questions, research and don't just accept what a vet says if something doesn't seem right or seemed to have been overlooked.  Galen's story also teaches that sadly, some veterinarians really are not good, are ignorant about diagnosing and treating chronic renal failure, and should not even be veterinarians if your cat's life depends upon them.  Change vets if you don't feel your pet is getting appropriate care.  Galen would probably be dead by now if we just went along with what the first bad vet said and hadn't gotten copies of his blood tests to find out what was really the situation to then pursue getting him correctly diagnosed and treated.


Galen was born in our home in May of 1999 to a pregnant stray cat we took in, whom we named Snookums.  He had one littermate, his brother Sumner.  Galen loved being held and cuddled from the time he could walk, unlike his brother. Being on the fuzzy side, black, and so cuddly like a little baby bear, we started calling him Boo Boo Bear, then shortened just to Boo Boo.

Galen's mother and brother were short haired cats, as was Galen basically as a young kitten, so it was a surprise when Galen metamorphized into a fluffy, medium long-haired cat with a neck ruff, plumy tail and grayish downy undercoat at around 8 months.

Here are pictures of Galen pre-mane and not so furry.

Galen about 14 weeks old

Galen approximately 6 months old

Galen was always healthy, never having had more than an eye infection, and maybe some sniffles.  At around the end of April 2005, he seemed to feel thinner than he had been when petted over his backbone when he crawled under the covers for his nightly knead, purr and cuddle session.  But it didn't seem anything of great concern at that time, particularly as he didn't act differently.  However, one day it seemed like he suddenly became skin and bones under all his fur and his fur didn't seem as soft as it had been.  His abdominal area has almost nothing when when you gently grabbed it, like his body was basically gone. So off to the vet for full blood work to find out what was going on.  Our regular vet was out of the office for the week, so we had to take Galen to another vet office.  We then found out that Galen had lost 4 pounds, weighing only 6.1 down from 10!  Forty percent of his body weight gone!

Being a fluffy cat, it wasn't possible to tell much by looks.  On the left is a healthy 10 pound Galen, and on the right, a skin and bones 6.1 pound Galen.

Galen at 10 pounds, above and below.

Above and below, Galen at a mere 6.1 pounds. He does not look like the skin and bones cat he has become.

If Galen's fur was shaved off while still at 6.1 pounds, he would look like the illustration of the emaciated cat shown at http://www.placervillevet.com/feline%20body%20condition.htm

In brief, Galen had hematology and chemistry blood testing done, and a T4 to test for hyperthyroidism.  Sudden weight loss in a cat can be a sign of hyperthyroidism.  The vet misread the notes of the vet tech who ran the thyroid test and did not double check the actual results, thereby diagnosing Galen with hyperthyroidism, even his thyroid results were actually normal.  She did note that his kidney values (BUN and Creatinine) were a little elevated but said that once his thyroid got regulated, they should go back to normal.  She sent us off with a prescription for methamazole (generic Tapazole) for hyperthyroidism, and told us to come back in 6 months.  His blood tests also showed he was anemic, but she didn't address that at all.

So we gave Galen the thyroid medication faithfully, but sure weren't going to wait six months to find out if his kidney values were going back to normal, so he was brought back for retesting three weeks later.  Galen had gained back a little weight, and his BUN and creatinine had gone down a little towards normal.  His T4 repeat test actually showed it being low, but the second vet there said it was normal!  His anemia from the first blood work was again not mentioned, nor did the vet retest to check on it.  But we didn't know about that yet.  We were told things were looking good but to bring Galen back the next week for a recheck.

Galen took a downturn that week.  He hardly ate, and would spit up froth sometimes.  He also stayed hunched over the water bowl for prolonged periods of time.  And, he was lethargic.  At the vet check the next week, Galen weighed 5.9 pounds, down from the 7.2 he had been the week before!  Blood work for his BUN and Creatinine showed a rise in them, so the vet recommended Galen stay over a few days to get his kidney's flushed.  This was done, and it perked Galen up.  He ate enough while at the vet's to regain a little weight, up to 6.7 pounds.

By then we had gotten copies of all Galen's blood work, and found he was anemic but that had been ignored.  We asked for retesting to check the anemia, and his red blood count (RBC), hematocrit (HCT) and hemoglobin (HGB) were now lower than the last time they were checked on his initial visit 5/13/05.  Still, the first vet stuck to her erroneous diagnosis of hyperthyroidism, and couldn't explain in any way that could make sense how that could be when the blood test showed Galen initially in normal limits, then the repeat in the low range.  She did agree that it seemed he had chronic renal failure, but that there was nothing more she could do!

We then had Galen's regular vet continue with his care, the regular vet knowing what to do for a cat with CRF. Galen was treated with subcutaneous fluids (sub-Q's) for the CRF, and vitamins for his anemia.  Galen got better!.

Following are the details Galen's early vet visits, the misdiagnosis, blood work results and the start of his correct diagnosed and treatment.  To skip this and get to the update on Galen, Galen Update below.

Diary form of Galen's early vet visits and blood work

5/12/05 Thursday  Dr. P. saw Galen and took blood. Galen weighed 6.1 pounds, down from his usual 10 pounds.

Blood test results in on 5/13/05.  Dr. P. called and said the blood work showed he was hyperthyroid and was to take Tapazole 5mg per day. She also said his BUN and Creatinine were “a little elevated” and that we should bring him in for a recheck in two weeks. So Galen was started on Methimazole (generic Tapazole) that evening. She did not mention that he was also anemic.

We got copies of the blood work a few weeks later, July 2, when I requested them, pertinent results below.

Immunoassay- VetTest SnapReader

T4 < 2.0 ug/dL

Then someone hand wrote "High > 5.0 ug/dl (64.4nmol/L)". This note appears to be what the kit insert said were high values. (Note that the results are not in the high range as indicated by the handwritten note.)

Chemistry (partial results, other values reported were normal)

(normal range)

BUN  (16 - 36) (VetTest)

66.0 mg/dL

High

Crea  (0.8 - 2.4)

5.6 mg/dL

High

PHOS (3.1 - 7.5)

8.2 mg/dL

High

Cl (112 .- 129.) (VetLyte)

134. mmol/L

High

Hematology (partial results, other values reported were normal) LaserCyte

(normal range)

 

RBC (5.0- 10.0)

4.64 M/uL

Low

HCT (30.0- 45.0)

20.1%

Low

HGB (9.0- 15.1)

6.9 g/dL

Low

6/1/05 Wed. Galen was seen by Dr. P. for the follow up visit. He gained weight, weighing 7.5 pounds. Dr. P. said she didn’t think repeating any blood work was needed, as it seemed the Methimazole was working (on the supposed hyperthyroidism Galen didn't really have). We asked about the high kidney values, and she said once the thyroid gets regulated, they may go back to normal and that the thyroid being out of balance could cause the Bun and Creatinine to be elevated. No mention was made of Galen’s low hematology results. Dr. P. said to bring Galen back for repeat blood work in November!

What is particularly disturbing about Dr. P. is that she completely ignored Galen's anemia, which we did not know about at the time as we had not asked for copies of the blood work then.  Always get copies of blood work at the time the results come in!  It is also distressing that she did not consider the possibility of chronic renal failure, which can occur concurrently with hyperthyroidism and has many of the same symptoms.  Most terrible of all is that the T4 results never showed hyperthyroidism, which she diagnosed Galen with and then wound up having him improperly medicated.  That wound up making him on the verge of hypothyroid.  She apparently just saw the handwritten note "High > 5.0 ug/dl (64.4nmol/L)" and without any thought or studying results, figured the tech who ran the blood work was indicating Galen's results were high.  But they were not.

We were certainly not going to wait months until November, as Dr. P. told us to do, to find out if the kidney values did go down, so Galen was brought back to get the blood work repeated June 22.

6/22/05 Wed.  This time Galen was seen by the other vet, Dr. C.  Galen gained a touch more weight, up to 7.6 pounds.  Things seemed to be doing well.  His BUN and creatinine were still elevated, but had gone down some from their high of BUN 66 and creatinine 5.6 initially from the 5/12 blood work, to a BUN of 61 and creatinine of 5.2. (Normal BUN is 16 - 36.  Normal creatinine is 0.8 - 2.4).  Galen's phosphorus was normal.  Another T4 was done, with the results being <0.5, in the low range.

Handwritten on the copy we received at a later date when I asked for the reference values was:

Low < 0.8 ug/dL

Gray < 0.8 – 1.2 ug/dL

Normal 1.3 – 3.9 ug/dL

Oddly, the vet said Galen's thyroid results were fine when they were not normal, but low.  That second vet did not check on the anemia either, and never mentioned it, but said to bring Galen back the next week to get his BUN and creatinine rechecked.

Things didn't seem well about week after that vet visit.  Galen  was eating much less and staying hunched over water bowls a lot, seeming more lethargic as well.

6/28/05 Back to the vet where Galen saw Dr. C. again.  We asked for Galen to be weighed and he dropped down to 5.9 pounds from the 7.6 he was only six days ago! After the blood work showed his BUN went up to 62 and the creatinine to 5.4, the vet recommended Galen stay over to get his kidney's flushed with IV fluids to get the values down to normal.  Unfortunately, yet again, the anemia we did not yet know about, but the vet should have, was not considered.  Galen went in on Thurs, 6/30.

7/1/05 Fri. Galen was possibly going to come home if his kidney values were both normal. His blood work results from that morning showed the BUN within normal limits, but the creatinine still high. However, it was lower than it was two days ago, before he began the fluids. Dr. C. was there, and said the best thing would be for Galen to stay until Tues., July 5, continuing with the fluids. Dr. C. said he was going out of the country Sunday for two weeks.  While I was visiting with Galen, I looked through his chart that was left in the room, and reviewed the initial test results, rather upset to note the anemia from the hematology done May 12.  I wasn't able to talk to Dr. C. about it, as he was then in with a patient.

Galen was being fed Purina kidney diet.

7/2/05 Sat. The clinic was closed to the public, but I was allowed to visit Galen again.  Galen’s blanket was wet with urine and he had been lying on it.  The assistant on duty changed his blanket promptly when I told her it was wet with urine. Galen was much perkier than he had been the past few days.

I asked for copies of the blood work so far and was given them. The blood work showed his BUN having increased, but still in the normal range, and the creatinine having gone down, but still in the high range. I brought a note asking for Galen’s phosphorous, RBC, HCT, HGB and T4 to be rechecked, and said we were concerned about the anemia from the May 12 test results.

7/3/05 Sunday A vet assistant was supposed to call us today to let us know when she was there so we could come visit Galen. By 5:00 PM no one called so I called the clinic, but they had forwarded their phones to the answering service. By about 7:30, still no call. I called the answering service again, asking if they had any way to contact any of the staff or doctors, and they said they did not.  We went to the clinic, saw cars in front of it, and knocked on the door until someone let us in. There were three vet assistants, and a baby and an approximate 8 year old girl were there as well.

Galen was still perky and so glad to see us. He still smelled like urine, but not as strong as yesterday.

The daily blood work had not yet been run so we stayed until it was ready. His T4 was normal. The BUN had moved up into the high range from yesterday’s normal, the Creatinine had gone up, and the Phos. was now in the high range from having been normal on 6/22. His RBC, HCT and HGB were now lower than the last time they were checked on 5/13/05. The anemia was getting serious.

Immunoassay- VetTest SnapReader

T4 < 1.8 ug/dL

Handwritten on it was, “Normal 1.3-3.9”

(normal range) 6/28 7/1 7/2  Sun 7/3
BUN  (16 - 36) 62 29 35 40
Crea (0.8 - 2.4) 5.4 3.1 2.9 3.8
PHOS (3.1-7.5) not done not done not done 7.8

His red blood cell values got worse than than had been on the blood work in May, meaning he is was more anemic. I asked the tech what would be done, and she said she would try to get in touch with Dr. P.  Dr. C. had left the country for two weeks.

 (normal range) 5/12/05 Sun. 7/3/05
RBC  (5.0-10.0) 4.67 2.98
HCT  (30.0- 45.0) 20.1 18.7
HGB  (9.0- 15.1) 6.9 5.6

7/4/05 Mon. We went to visit Galen again, having been called during the day. He still was perky. No blood work had been been done yet, but yesterday’s hadn’t been done until 8:15 PM.  There was nothing being done about the anemia.

7/5/05 Tues. Dr. P. called in the morning and said Galen was ready to come home as his Bun and Creatinine from the day before were normal (it was NOT, she was reading off the numbers from the 7/2 Chemistry results, not from Sunday when they were all high again), but that he was very anemic. We went to get him anyway, but the office manager asked us to please let him stay so they could run blood work today like it was supposed to have been done to see if it was normal. They decided to run another T4 as well.

Galen had gained weight during his 5 1/2 day hospital stay, weighing 6.7 pounds. His legs were shaved so they could find his veins to administer the IV fluids, making him look funny. We called him "poodleboo".  His BUN and Phosphorus were back in normal range, but his Creatinine was still high. His T4 was low, so the female vet said to cut his methimazole from 5mg per day to 2.5mg per day. Galen had been given injections of iron, B 12 and Vitamin B complex for anemia and we were given a tube of Felovite vitamin paste to give him some daily.

Dr. P. said to bring him back in a week to redo all the blood work, but if it was still not good she would refer us to a specialist in Ohio, as she was not able to do more.  This is sad, and scary, as there are things a non-specialist vet could do, if the vet had the knowledge.  A simple internet search of veterinary websites give lots of info on treating CRF, so there really is no excuse for a licensed vet to not know what to do.  So we made an appointment with our regular vet to have him take over.

7/11/05  We went to our regular vet today with Galen for Galen to have repeat blood work.  The vet wanted to do sub-q's too so we left him there for a few hours.  His serious anemia from last week is now even more severe.  His Hematocrit (HCT) is only 12.3 %, down from the already low of 18.7% a week ago.  Normal is between 30- 45%.  On the sort of good side is that it seems his body is making new RBC's based on the reticulate numbers.

His BUN, creatinine and phosphorus all went up also, though the phosphorus is still in the normal range.  The BUN is 54 and creatinine 3.4. Not horrible, but not normal.

We got some Pet Tinic to be given twice a day.  Pet Tinic is a liquid vitamin and mineral supplement the vet said will help build up Galen's blood.  I asked about Epogen to stimulate the body to make more RBC's, but he said we should try the Pet Tinic first.  We are to stop giving that Felovite paste from the other vet, which is a good thing as it is a messy gloppy thing.  I asked about a blood transfusion as if Galen's HCT drops more, he can't survive for long.  The vet said he is not equipped to do blood typing to do transfusions but the ER hospital is.  We take Galen back for sub-q's Wed. and the vet said we'll see how is then and decide what to do next.  He did say we should give some Nutrical.

The vet was surprised as how perky Galen seemed for cat with such serious anemia.  Galen got another compliment for being so patient and easygoing with the needle sticks and sub-q treatments.

Galen Update

Galen went to the vet office for sub-q treatments three times a week, which was helping him to act and feel better.  His appetite was returning as he no longer felt nauseated from the toxins his kidneys couldn't get all flushed out on their own.  As he felt better and ate more, his anemia improved. And it turned out that Galen never did have hyperthyroidism.

7/14/05

Galen didn't have hyperthyroidism after all.  He just has CRF.

His updated T4 came in today (at my regular good vet) and shows his level to be normal, but towards the low end of normal.  The good vet also had a T3 run, which was below normal!  That would mean Galen is being overmedicated.  He is already down to only taking 2.5 mg., since the last T4 at the bad vet showed him to be in the below normal range, so the bad vet had us lower the dose.

My vet has been analyzing the tests results from the bad vet, and doesn't see any way they came up with diagnosing Galen as hyperthyroid.  The first T4 results were T4 < 2.0, which in the normal range.The tech who ran the bloodwork hand wrote "High > 5.".  I think the bad vet just saw the handwritten word "high" and quickly figured that the tech had made the "diagnoses".  But I think the tech was just noting what is considered high when instructed to test the blood for hyper-T, leaving it to the vet to actually look at the numbers to make the conclusion that Galen's numbers were NOT in the high range.  I've already explained how the bad vet doesn't look carefully at things, such as when she told me Galen's kidney values were normal, but she was reading off the numbers from a previous test when they had been normal, but not the most current one at that time, which I had a copy of.

When I asked the bad vet to explain how the initial T4 result shows hyperthyroid, she never could explain it, saying how the results are read differently depending upon whether the cat is on meds or not.  Galen wasn't on any meds then, so that "explanation" made no sense at all, which I kind of said but more diplomatically.  The bad vet finally saying she'd have to look it up. I should have politely said, "Ok, I'll wait", but by then we were never going to bring Galen back to her so I didn't push it.  It is clear the bad vet screwed up.  If high was greater than 5, and Galen's results were less than two, he was not greater than 5.  Period.  Less than two was not in the high range.  Period.

The vet will run another T4 in a month, just to see in case for some unknown reason, the first vet had some kind of reliable good reason to diagnose Galen with hyper-T, but I believe it will be normal.

My good vet said to take Galen off the methamazole, as he believes it is making Galen's anemia worse, as it can cause bleeding in the stomach, not to mention that there is no evidence that Galen has hyperthyroidism.  Galen had spit up some blood the other day, so for him, the methamazole was causing internal bleeding, which would relate to anemia getting worse.

So, that makes things look better for Galen, not having two concurrent diseases.  And maybe his anemia is not really a permanently really serious anemia as it was seeming, having gotten worse just due to the stomach bleeding from the methimazole, and not that his body was not making new red blood cells at all.  He will get repeat bloodwork for his red blood cells and kidney values on Friday.

He had his second sub-q treatment today and gets another one Friday.  I can see a clearly noticible difference in him for the better, including an increased appetite and ability to eat more at one sitting.  So that bad vet who said, "Sub-q's are mostly to make the owners feel good and don't really do anything for the cat" was again wrong.  I feel terrible for all the animals that vet will wind up causing to suffer unnecessarily by her wrong diagnoses and limited treatment knowledge.  But, at least Galen is not going to be one of them anymore.

I feel so much more hopeful for Galen now.

7/19/05  Galen had blood work done yesterday at the vets, but it was not processed by the time his sub-q fluids were done so I don't have copies yet.  The sub-q's only take about 20 minutes.  He looked strange when they were done, with a big bulge in his side that filled in one leg also.  The fluids seem to settle differently each time.  He doesn't act at all like it bother's him, though.

The vet called later on to say that Galen's hematocrit (HCT) went up 3% from the 12.3% it was last week.  That is very good news as that means he does not have non-regenerative anemia. He is still very anemic though.  Normal HCT is 30-45%. Stopping the methamazole, which was causing intestinal bleeding made the difference, not to mention he really didn't need the methamazole.  Still, he started out being anemic from the original blood work back in May when he wasn't taking any meds so I guess the anemia problem is here to stay.  Unless it was due to his having practically stopped eating?  I hope that is it, but it may not be. 

His BUN and creatinine went down some as well.  On last week's blood work, it had been a week where Galen did not have any fluids and the numbers had gone up from the normal they were when he left the bad vet place after having IV fluids, so he really needs them.  I still can't believe that bad female vet said the sub-q's don't really help the cats and just make the owner's feel better, for having something done.  The blood work clearly shows it does make a real difference to the BUN and creatinine.  So if anyone has a cat with CRF whose vet advises against fluid therapy, for sure go to another vet.

7/29/05  Galen's blood is getting better!  On his blood work this week, his hematocrit (HCT) was up to 18.6% (normal is 30-45).  Last week it was 15.4%, and on 7/11 it was only 12.3%.  I don't know if it ever will get up to normal, but I suppose he could be ok being mildly anemic.  He still needs the HCT to go up some more to be considered mild. 

Unfortunately, on this week's blood work, his BUN and Creatinine went up.  I guess because he is eating a lot more now.  His BUN went up to 56 from the 40 of last week, and the Creatinine up to 4.1 from last week's 3.3.

Now I need to work on the diet. Galen won't eat that dry Purina Kidney Diet we got from the first "bad vet". I'm not at all of the opinion that a food with the first few ingredients (in the dry) being: Brewers rice, whole grain corn, corn gluten meal, soybean meal, animal fat and animal digest, is something that will help him much.  Those are horrible ingredients to be the main ingredients no less!There is no meat even and cats are obligate carnivores, not grain eaters. My husband, who has been doing some reading on cat food and what is good, told me to throw it out!  The Purina canned kidney diet starts with water, then liver, beef, trout, rice, beef tallow, chicken by-products, ground yellow corn, animal digest, pea bran, wheat flour, etc. That isn't too terrible, but I don't see why they use the cheapest fat souce that also has a low amount of the linoleic acid cats need.  Since Galen is very anemic as well as underweight also, he needs a high quality food that is not overly low in protein so he can build muscle mass and get enough nutrients to help his anemia.  Our regular good vet didn't say to feed Galen a prescription kidney diet anyway, probably due to what I just wrote.

I agree with this sentiment from http://www.felinecrf.com/managd.htm:

"Furthermore, some believe that a low protein diet contributes to weakness and muscle wasting, two very common symptoms in CRF cats.

Because protein metabolism residue (that the kidneys must filter) is what you are trying to eliminate, high quality protein that produces little waste may be preferable to simply reducing overall protein."

We were late for today's vet appointment for his fluids as I could not find him anywhere when it was time to go.  I had been petting him on the bed only 20 minutes earlier.  I searched the whole house, but only saw all the other cats.  I think they were helping him by telling him which way I was going so he could move to rooms I wasn't in.  Every room I went to had one of the other cats, or a few of them, and they kept changing what area they were in as I moved around the house and the enclosure looking.  I finally sat down at the computer like I was all settled in a for while, and after a few minutes, there he was, just sitting there.  I have no idea where he had been. 

He is lot perkier these days.  But that is good!

8/4/05  I told the vet tech on Monday when I took Galen to get his sub-q's that I wanted to start doing them at home.  It is not so convenient taking Galen in to the vet's 3 times a week and I know some people who do or have done sub-q's at home for their cats. So the tech showed me how to it and set me up with all the stuff.

Seemed easy, but it's not.  I had Galen in his soft sided carrier with the top opening, that he was kept in to get the sub-q's at the vets which worked very well to keep him in one place.  As soon as I started to stick the needle into Galen's scruff, he made a yelpy mew, so I pulled back.  Then I tried again, he mewed again like he did NOT do for the vet tech, and then I got so nervous I couldn't stick the needle in him.  I was feeling all panicky.  So finally my husband did it.  It seemed ok until Galen layed/laid (I never remember which one to use) on his side and I didn't move well with him so wound up with the needle between my fingers with fluid spurting out.  Galen make his escape.

He got almost 100cc's in.  We were instructed to give 300ccs, but didn't do any more last night.  I don't think he needed more, as it took over 7 hours for the fluid that settled in his leg to be absorbed.  Oh, and also, we didn't realize we were supposed to open the flow all the way, to let the fluid in fast.  Or are we not supposed to open it all the way?

The needle looks so fat too. It is an 18 gauge Monoject brand needle.  I don't think I can do this.  I wonder about how much fluid to give. If his leg stayed fat with fluid for 7 hours that was enough for that day, or should we give the 300cc's three times a week like the vet's office was doing? Should we give more tonight or wait until tomorrow?

I don't really think 300cc's at one time is the best.  Galen would have a real, big fat water pouch after that which lasted a real, real long time.  I don't imagine there is harm to that, but either he doesn't really need that much or maybe it would be best to give less more often.  I'm still not so sure how the vet decides how much fluids Galen should get.  It had been 250 cc's, but now he said 300.  The picture on the left shows Galen with his saggy down water pouch after getting 300cc's.  Since he is so much fur, it's hard to tell how big it is, but you can see it slipped down to his lower side.  Being as he is still very underweight, he has no belly fat or even belly flesh.  He is still pretty much skin and bones.  Galen goes back for more blood work the week after next so I'll ask more about how the amount is determined. 

8/5/05  Well, we did good this evening!  Of course I didn't stick the needle in, but my husband did- just zoop! into Galen.  Galen didn't even mew once! Instead of putting him in the carrier, we tried what others said and had him on the bed on a towel.  I have a chandelier type light fixture over my bed so I put an S-hook on it to attach the bag of fluids to.  It worked out well. 

At first I wrapped Galen in the towel, but then he wanted to lie on his side, so I unwrapped him and let him get comfy.  Then my husband stuck him.  The needle didn't seem to bother him, but he jerked a little in seeming surprise when the fluids started going in.  Then he settled down some.  He still wanted to get up and go away, but he did fine with us holding him down.  I realized one time when he was struggling that in my nervousness I was pressing too hard on his hip, so when I eased up it was good.  We did 150cc's and by then, he really wanted up.  I think that was plenty for one session. 

We didn't warm the fluids.  The vet office doesn't.  Maybe I will try them warmed next time and see if Galen likes that better.

Whew!  I'm still nervous about it but since my husband is fine with doing the needle stick, we can manage fine.  One day I will do the needle stick.

8/6/05 A very, very interesting and amazing thing happened early this evening.  Some people said the cats come to want the fluids and I thought, no way, but Galen wanted them, and was begging at the cupboard!  He was begging on and off for many hours at the cupboard and I thought he wanted treats as they are in there too with the fluid setup.  I kept offering him this and that but he didn't want any, not even his most favorite (aside from the now banned Halo Chicken treats) Kitty Kaviar  (bonito flake) treats.

Finally I brought out the bag with the fluids, and he went to it sniffing and rubbing on it with great interest.  So I carried it to the bedroom, where we do the fluids, and he followed!  I put him on the bed, and he just layed there as I hung the bag.  I was going to do the needle stick myself and was about to do it, but just couldn't.  So I went to get my husband, and Galen was waiting for us on the bed, still reclined!  He was fine until the needle jab, which hurt him a little but he put up with process until it got to 100cc's worth and then he was outta there.

We decided we would do 100 cc per day.  Or maybe he could go every other day. 

Some tips to help figure out about the fluids told to me by someone very experienced are:

Does he eat better if he gets them daily?
Does he start drinking more water on the day he doesn't get fluids?
Is there a difference in the way his fur looks on the day he doesn't get fluids (more spiky, not as smooth & soft)?
How long does it take him to absorb the fluids completely?

Galen had been vomiting pretty much every day, before he started on the fluids 3x a week at the vets (the 300 cc's at a time, but one time they did 250), but now he only did it once the other day- actually it was regurgitation of dry food.

He has been eating just fine now though even though we have been doing the fluids every other day, with either 150 or 100 cc's. 

8/17/05

Well, I still can't make myself to stick Galen with the needles, but my husband is getting confident about it, so I can not worry about it for a while.Galen always makes a yelp when he gets stuck, even now that we are using the sharper and thinner 20g Terumo needles a friend sent.  Any needle stick is going to be felt, of course, but that brief yelp just makes me nervous to try myself just now.  My husband said the Terumo 20g needles do go in easier.  We have been warming the fluids in a pot of warm water, and it does make it better for Galen.

Galen's blood test results from Monday were good.  His anemia has improved, with the HCT up to 21.5! Two weeks ago it was 17.6.  The vet had told us to give the Pet-tinic twice a day, but most days it only wound up once.  It might not matter then if he gets it just once a day. I can't imagine his HCT could go up much more in just 2 weeks even with more Pet-tinic per day.

His BUN was 47, pretty much the same as two weeks ago when it was 46.  His Crea. was 3.0, down from the 3.5 two weeks ago.  Getting close to normal for the Crea.  It seems that the amount of fluids we have been giving are good- 100-150ml every other day.  I told the vet how much we were giving and that the 300ml at once just seemed too much.  He said since Galen has been seeming so much better and pretty much back to normal, what we are doing is apparently fine and something to the effect that he starts out more aggressively.

And, Galen gained some weight, up to 7.9 pounds now!  At one time he had gone down to a skeletal 5.9, so this is just wonderful.  I don't know if he will make it back up to his normal 10 pounds, but 8 pounds will be fine.  He is very thin, but no longer skin and bones.

We have not been feeding a prescription kidney diet.  Our regular vet never suggested we do use the prescription diet anyway.  I did study the listing of protein, fats and phosphorus percents of most foods sold from the Kat Karma website, and have been serving those commercial cat foods that had lower phosphorous and protein than other commercial foods.  High phosphorus is bad for cats with CRF.  I had to take into account my other cats as well, since we could not do total separate feeding all day long (such as when we both were at work). So we needed at least a dry food all the cats, including kitten Seamus, to be able to eat and get good correct nutrition, while being ok for Galen as well, in special consideration of his anemia and his being skin and bones. Then I made my selections for foods with lower phosphorus level as well as:

NOT having overly low fat levels. Some of the geriatric foods had low phosphorus, but the fat levels were too low for a cat of Galen's age and "skin and bones" condition, and way too low for kitten Seamus to be able to grow well on. Little kittens can't do well on low fat diets. Seamus was only 12 weeks old when Galen was diagnosed.

Foods NOT being on the lowest quality end of ingredients, as some grocery store cat foods are.

Foods that were not in the highest price range of premium foods, since we have money constraints.

Foods they sell in my local pet store.

Foods my cats, especially Galen, would eat.

What I finally settled on for dry was:
Chicken Soup for the Cat Lover's Soul
Natual Balance
Eagle Pack Holistic and Eagle Pack Adult- depending which one was in stock.

My food selections seemed to be just fine for Galen, based on his blood work and his physical state, energy level, and behavior.

NOTE:  What worked well for Galen may not be fine for other cats with CRF.  Each cat will have different needs and requirements.

We bought another bag of Lactated Ringers, and got charged $25!!!!!!!!!!!!!!!! For one bag!  My husband and I told the receptionist to tell the vet we will want a prescription to order the fluids online as we can get a whole case of 12 for that price.I asked her what on earth do they pay for them to charge so much for one bag, but she didn't know.She must have told the vet everything we said.When the vet called the next day with the blood test results, he said he checked what he paid for the fluids and agreed that $25 was rather much for one bag.  He said he would sell them to us for $5 a bag, and told us to come in and pick up 4 more since we paid the $25 already.  So that will work out to about what it would cost online after also factoring in the shipping charge.  It sure does pay to question a vet charge that seems overly expensive.  I honestly don't think anyone else does sub-Q's at home that uses my vet because I can't imagine anyone would be paying $25 a bag without having said something.

My vet also said he would get Terumo needles instead of Monoject after we told him about them.  He seemed to trust what I said about them being known to be sharper than the Monoject, having the thinner wall, plus my husband's testimony after using both on Galen. 

So now, I wonder if I can relax and assume Galen is likely to be staying steady for some long time period now.  I hope so. 

9/13/05  As I expected, Galen's blood is doing great!  His HCT is now up to 25.3 (normal is 30- 45).  Last month his HCT was 21.5.  At it's worst, it was 12.3, quite seriously low.  So it does seem that his body is not having problems making red blood cells, as can be the case in cats with CRF.  When it got so critically low was when he was on methamazole (generic tapezole), having been misdiagnosed with hyperthyroidism by the bad vet.  The tapezole caused internal bleeding.  I sure hope he never develops hyperthyroidism if the meds will be a serious problem for him.

His BUN did go up.  To 60 from 47 last month.  We had been giving fluids every third day for the past two weeks, instead of every other day as we had been.  So, obviously we need to go back to every other day.

His creatinine was 3.3.  Last month it was 3.0. Two weeks before that, it was 3.5, so it seems to be ok.  Normal is 0.8-2.4.

I can't tell if the Bonito flakes had anything to do with the BUN going up, since we had also changed the fluid schedule.  We'll have to wait until next month's blood work. 

The biggest relief and greatest news is that his body is making red blood cells seemingly just fine. He likely did become anemic to start with, before the methimazole, due to having not eaten much at all for a few weeks. 

So with not being severely anemic and having some flesh and muscle back, he is perky and eating so well.  He now does not act like a sick cat at all!  He has lots of energy again.Obviously, whatever we are doing for him regarding the food and fluids has been

10/16/05  Galen went to the vet Tues., and gained yet more weight! He is getting close to his normal 10 pounds.  He weighed 9.2 pounds on Tuesday.Yay!

It is great to pet Galen's back and not feel the sharp, bony ridges of his spine.  You can feel there is a solid spine, but the dips in between the ridges of the spine are now filled in with flesh.  His shoulder bones still feel a bit prominent, but nowhere as bad as they had been.  His back legs have some flesh on them now too.  Before, you just felt bone and tendons and the depressions between them very pronounced, almost like feeling a skeleton.  Legs tend to be thin and bony but should have some bit of flesh over the bones.

His BUN went down again.  We had previously tried going every two days between sub-q fluids, but the BUN went up at last month's bloodwork, so for the past month we were back to doing it every other day, and the BUN went down.  That is all we changed, so the fluid schedule is what made the difference.  His BUN is still above normal, but not that bad.

It seems is is ok for him to have his bonito flake treats.  After we finish his fluids, he runs to the cupboard where we keep them to get his reward.  Since they mean so much to him and seem to get him to go along with getting the fluids as well as he does, I don't want to stop giving them as his reward.  He has been very good about accepting the fluids.

His anemia is improved, as it has been doing steadily once he started gaining back weight.  His red blood cell count was in the normal range for the first time since back in May when we first took him for blood work.  His hematocrit is still in the low range, but is higher than it had been.  So, his anemia was due to just not taking in nutrients when he was hardly eating, and made worse by the stomach bleeding the methamazole for his incorrectly diagnosed hyperthyroidism caused.  The big worry was that his body wasn't making new red blood cells, so that is one worry that can be totally discarded now.

His fur looks and feel better now too.  Before, it was partly dry and parts of it along his back were feeling a bit greasy.  I think maybe the back area got greasy as when he was so severely anemic, he just hardly had energy to twist around and wash himself well.  He was very weak then.

10/19/05  Now Galen almost has too much energy.  He raced out the front door today and led me on another chase into the backyard.  He tried to snatch a bird out of air with a high jump, but the bird made into the branches of the large, very tall bush before Galen got him.  I only rounded him up so quickly as he went stalking another bird and didn't notice me sneaking up until I was right by him.  I am not glad he snuck out, but I am so glad he is back to galloping at full speed and making high leaps!

12/14/05  Galen had blood work done yesterday. Great news!  He is not anemic anymore!!  Galen gained some more weight, up to 9.7 pounds now, almost at his previous normal 10 pounds. His BUN and Creatinine are about the same as last time, not much above nomal.  His BUN was 47 and his Creatinine 3.4.  The vet said that those values likely won't get in the normal range, rather the best might be just a bit above normal. But since Galen is not showing any symptoms, and is looking and acting very well, things are fine for now and we should keep on doing what we are doing.

1/12/06  For about the past four or five days, Galen is not tolerating getting his sub-q fluids for his CRF. I don't know what the problem is, but it is getting us worried. He always did make a mewl when he got stuck with the needle, but then most always settled down fine in a relaxed way.

What he has now been doing is to mew before getting stuck, knowing it is going to happen, meow loudly in protest when getting stuck, whipping his head around to look at my husband who does the sticks, and then actively tries to get up and escape. When we hold him down, his skin ripples and he meows and squirms. A few times my husband was sure he put the needle in correctly as he had been doing, but it comes out after Galen's skin ripples. My husband tries up to three times, but then gets nervous with Galen's new yelling and active squirming behavior, in case it is a physical thing with Galen now.

I don't know if it is due to the four days we were gone he got out the tolerance mode for getting fluids, or if his skin is hurting due to all the needle sticks he has had. Or, if perhaps something is wrong with the new bag of fluids.

We will try again tonight, but if it doesn't work, I guess I'll have to bring him in to the vet and have them try and see if the same thing happens when they do it.

My husband is wondering if Galen is being extra manipulative. He sure can be, as he was with trying to get lots of Halo freeze dried chicken treats (http://wvcats.com/margarets_musings_on_cats.htm). What makes me think at least some of it is manipulation, is that right after the failed attempts, he quickly sits on his "after fluids treat getting spot" looking at us expectantly for the usual bonito flake treats. Twice when we gave up, we gave him treats anyway. He always jumps up on a table next to the chair we put him on for getting his fluids, to get his "reward". Since he has been doing that immediately after his wiggling and protest meows, I do think it is staged, at least some of the time.

Maybe I will give him bonito flakes before doing his fluids and see if that makes a difference.

1/12/06 PM

Well, we tried giving the bonito flakes first this evening, in case it was that Galen was too eager to get them to wait for his fluids to be done. But, he still got upset about getting stuck, did the sad meowing, and tried to escape. One time the needle was in seemingly fine, but the fluids weren't flowing. That happened yesterday too. At another stick, only about 3 drops of fluid went in, then the needle slid out, and there was a small fluid pouch/bump already.

So, we are not even going to try tomorrow to give him a full day of skin rest.

He is not acting at all like he needs them, and his fur feels wonderfully soft. He doesn't seem at all dehydrated, is perky, eating well, none of the vomiting he did at first, etc. He might not need fluids at this time, or not as often anymore. I guess we'll need to take him in for blood work again soon to see how his numbers are.

Maybe his kidneys are working better now than they had been. They can't fully recover ever but it is possible things could improve a bit. Each nephon (kidney cell) can expand over time to take over some of the work the damaged or dead nephons used to do. Plus, he had been very anemic at first, but now is not at all anemic. That may have something to do with his not taking the fluids now.  But more likely, his remaining good nephrons have expanded and are doing more work than they used to.

I'm not too worried since he seems and acts like a totally healthy cat, but I want him to stay that way.

Jan 14, 2006  Yay! Galen cooperated very nicely this evening for 50cc, then he tried getting up, but not with much wiggling, so we were able to get him stay for a bit more, totaling 75cc before he really made good efforts to get away. Our goal is 100cc. So that was good. I guess his skin just really needed a break those other days. Some days Galen is great about it, so we are not trying to force it if he gets so upset and tries hard to escape. Something just isn't right on those days and no sense torturing him. He is still acting, looking and overall seeming like a normal, healthy cat, so I'm not worried now about some missed fluid days. 

My husband and I think Galen's body is holding the fluid more than when it was so badly depleted, so he probably doesn't need 100cc's at a time anymore.  He'll get a hard bulge now under his skin after just 50cc's sometimes, whereas in the past, it took to 100 or even more for that to happen. I think he starts to struggle when his skin is starting to hurt getting stretched out with the fluid. So on those days, 50cc's honestly seems to be all he needs.  Galen definitely seems to be well hydrated. His scruff skin isn't nearly as loose as when we first started the fluids. That makes us think that he doesn't need the fluids as much now. Also, we tend to think "treat the cat, not the condition."  Galen is probably telling us on those days he fights the fluids, "Hey! I don't need this today!" seeing as how he is completely asymptomatic.

Galen will be going to the vet for more blood work soon, so we'll see then if our giving less fluids now is correct for Galen at this time based on his test results.

Links on kidney disease:

http://www.felinecrf.org/

http://www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00437.htm

http://www.mindspring.com/%7Ekerspin/

http://mailer.fsu.edu/~jmcnair/netvet.html

http://pouncerstone.com/CatCare/KDEducRes.html

Giving Sub-q's at home:

Detailed instructions with pictures on giving sub-q's at home.  http://www.weirdstuffwemake.com/weird/stuff/pets/cats/sophia/catjuice.html

Online veterinary supply stores to order Sub-q supplies (cheaper than what most vets charge):

http://www.lambriarvetsupply.com/ Their site is hard to navigate, see particular links below:

For Terumo needles (some states require a prescription, but not all do.) http://www.lambriarvetsupply.com/sbsite.php?search_query=terumo%20needles

The venoset (tubing connecting fluids to needle- no prescription needed in some states)
http://www.lambriarvetsupply.com/i_014VENIV-15_Venoset-73-Flachback-Bulb-15-Drop.php

Fabulous syringes for dispensing liquid medicines or paste like supplements such as Nutrical- has a silicone O-Ring seal that slides much easier than those with the rubber tip. These really are better,:
http://www.lambriarvetsupply.com/Syringes-Needles-O-Ring.php

Brico Medical Supplies http://www.bricomedicalsupplies.com/CRFpage.html (they require a prescription for needles, venosets and fluids.)

For more information on hyperthyroidism in cats, see the page Diseases Cats Can Get