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My senior cat, Jolie has osteosarcoma: looking for advice
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Michigan


Member Since:
11 July 2016
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1 March 2024 - 5:44 pm
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I have not forgotten you, Ed. I planned on going over that post further this weekend and reviewing all that has been written. You do the same and cross reference & Let's see who and what else is added to that post. 

Start making your list of questions. I think right now, you start with the most significant concern: the amount and kind of fluids she is recommending.

When we have a disease, we need to learn as much as possible and advocate for our furmily. Which you are!!! If we are comfortable with the treatment plan, there is no issue, but when we are not, yes, we start to ask questions and have the information in hand on why we have these questions. (references to point at)

examples ...

 This is what I am learning and reading. Can you help me understand Jolie's disease treatment plan?

  1. How did we determine Jolie's stage CKD? Has this changed since surgery? Values are still in the low 2 Iris range. (show reference) http://iris-kid.....aging.html, http://iris-kid.....D_2023.pdf, http://felinecr....._is_it.htm
  2. Stage 2 has different treatment recommendations than stage 4
  3. Do I need to be giving fluids every day? 
  4. How do you determine how many ccs/ml of fluids? (http://felinecr.....fluids.htm)
  5. Can we cause Jolie harm by giving too much? Can we overhydrate Jolie & what about Jolie's heart? 
  6. What is the benefit of daily fluids at this stage 2 of CKD? 

From the sage journal - this is the goal with any disease and our furmily!!

A good relationship and good communication between the clinic and the cat's owner is vital for successful management of CKD. 

The vet has gotten the boys thus far, and if you sit and write down specific questions, she will respond with her reasoning, and then you can decide what you both can agree upon. Or if you need to find someone more experienced in this? I'm not sure you have options? Our family vet is not an expert in one field, but they must know a lot in many fields. That doesn't mean you can't work with this vet. Communicate - you both need to be on the same page for Jolie and find peace in how you are treating this disease. There is a middle ground!

The vet even said she was unsure if 200 would help. Why suggest it at all and at stage 2?  That scares me! I say it a third time scares me to death.

Adding more references for you (sorry) we need tools to reference

ISFM Consensus Guidelines on the Diagnosis and Management of Feline Chronic Kidney Disease

 pg 225 says

 

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source above - http://felinecr.....fluids.htm

7. Are we monitoring for over hydration, and how?

8.  Why are we hydrating so much for stage 2 disease?

From the IRIS guidelines ( this is important to note on regions)

Some of the treatment recommendations are not authorized for use in all geographical regions and some may not be authorized for use in cats. Such recommended dose rates are therefore empirical. It is the treating veterinarian's duty to make a risk:benefit assessment for each patient prior to administering any treatment. 

Right now, until you see the vet again, is the time to get all this sorted out. Ask any & all the questions on the ckd board, and we will help however we can. Your biggest concern right now is the stage of kidney disease and the number of fluids she wants you to give daily vs. what the CKD board says and from the reference materials provided. 

I hope something here helps! Give the boys a crunchy snack from us, please!

Hugs

💝💝💝

Virginia







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1 March 2024 - 7:58 pm
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Holly, you are a Saint!!!  A wise and knowledgeable  Saint!♥️

The way you have framed the questions for Edwwrd to ask the Vet are brilliant.

Edward, maybe you could video the appt when you ask for all this clarification.   That way you can take the video home and process her answers when you can really focus.

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

Member Since:
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1 March 2024 - 8:25 pm
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Hello!

Yes, a big thank you to Holly:)

I am reducing the IV to 80cc per day until I can get a chance to talk with the vet.  I am not sure which value on the blood work that the vet is using to base her decision on how much fluid to give. I'll have to ask her when I see her at the end of the month.  

I am also apprehensive about the kind of medication and the amount of the dose of medication.  If she is figuring the medications based on a stage four diagnosis I imagine the types and amounts of medications are wrong.....

I am wondering, before surgery, when Jolie was going to a different hospital, he was doing blood work each 1 or 2 weeks, kidney function came back acceptable. Then, at the new hospital after surgery, blood work came back stage 4 ckd. I wander was it just post surgery when body functions were out of whack, that blood work came back ckd stage 4? Maybe it has normalized since then ???

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Michigan


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2 March 2024 - 8:57 pm
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I 100% understand getting that response and questioning everything!!! Take the time to get all your info to discuss with the vet. Jolie is doing well right now, correct? (that's the focus)!!! I think that is very possible that the stage 4 was diagnosed right after surgery & is now a stage 2 but that is the question for the vet.  What were his numbers? Is that how she diagnosed the stage 4? It could be all the meds he was on for surgery set his kidneys over and now they are stabilized. Those are on your list of questions!!!

You're 75 rather than 100 until the next appointment is very reasonable. Honestly, the more I read and understand, I want detailed explanations with the recommendations on type and amount of fluids. The best route IS working with the vet, asking questions, getting her feedback, and developing a plan you can agree on. Keep in the forefront You both have the same goal Jolie's health! 

Regarding the dosages of the meds (you don't have those, correct?) If you do not, see if you can get that information. I believe you will get more information with the dosages listed. I did not see the Cerenia listed in the med list? 

  • Jolie's creatinine was 1.86; this is why the (the ckd group) stated Jolie is at stage 2. 

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As the members recommend lactated ringers vs saline once again. I know you were reluctant to switch type. The paper that was linked was hard for me to grasp. Take a look at these for simple, straightforward explanations. Lactated Ringer's Solution vs .9% Normal Saline  

I noted these for you too.

Over-hydration vs Volume Overload 

Anemia and Fluid Therapy

Communicating with Vets

Hugs 

Love to the boys, please

💝💝💝

Member Since:
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3 March 2024 - 12:16 am
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Hello♡

After reading the clip about saline versus ringers it seems like saline is an all around bad choice so I don't see why the vet is pushing it, unless ringers is not available in Korea. I'll have to ask about that. I'll have to wait and see what it is next time to see if there is an increasing trend 

The 1.86 creatinine last time was an increase from the previous bw of 1.6 something. The vet gave that as a reason to increase iv fluid.

♡♡♡

Michigan


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3 March 2024 - 6:32 am
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Im glad that one was easier to understand!

A quick Google search will show if you have LRS ; it appears you do on my search. Yes, ask, and I 100% agree with any trends we watch. Continue to request your copy of the boy's labs & yes, get the dosages of meds she prescribes since they are dispensed in the mystery packets.

Please wait to change Jolie's meds until you get your dosages and have these discussions. If Jolie is doing well now and then, you change more than one thing at a time; you will not know what is what. The golden rule is to change one thing at a time, if possible , for two weeks to 1 month to see the results, ensure all is well, and then you KNOW 100%. We never want to make a change and take a chance on Jolie. We need the vet & ideally, you both can work as a team for Jolie & Mignon.

If possible call her and or see if you can email her your questions (ideal) prior to the appt. That way there is no communication gap and you have a copy to translate if needed. 

Hugs
Give the boys a snack from us, please!

💝💝💝

Member Since:
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3 March 2024 - 7:54 am
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Hello♡

Jolie and Mignon have been doing especially well these past few days. So it makes me anxious reading the several emails from the ckd group. They seem to be disagreeing with most of the present medication. I asked them again what I should do about the fluid iv's. One of the group Erika, says that I reduce the iv's to every other days and then stop them completed.

I also just got an email about the anemia and how it is related to kidney function. Jolie has been getting darbepoetin injections with iron tablets taken orally. I think they are saying that taking these injections long-term is dangerous. I think they are also saying in stage 2 kidneys should be able to stimulate rbc production on their own.

I think that reducing or eliminating the iv's is a good idea but I'm unsure about the rest of what the ckd group is advocating. I need to have a more complete understanding of what the ckd group is advocating.

♡♡♡

Michigan


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3 March 2024 - 8:16 am
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Most excellent, the boys are doing well. smiley_clapThat is always at the forefront of ALL this INFO!

I 100% understand how you are feeling. I felt the same on the one email & as I got into it further. I have yet to see the follow ups and will check it out and see if I understand what they are saying.Please hear me: only eliminate things once you talk with the vet. Yes, state your concerns and get her feedback. That way if something does go awry she is in the loop on what you're doing. Things are going well right now. There is no need to change everything at once. You need to do all things slowly and you NEED the vet to work with you and vice versa.

Hugs

💝💝💝

(I'll check the board and come back if I have feedback on it. They go above and beyond which I LOVE but it takes time to read and check etc.) reminder on the ckd board or any for that matter.

DISCLOSURE

This Group provides information and support. The information can make you more knowledgeable about feline CRF/CKD -- a complicated condition - so that you are better able to work with your vets) in providing the best care for your cat.

The support is often emotional and one of the Group's best features according to feedback we receive. Support can take the form of helping caregivers administer sub-q fluids, learning techniques for getting CRF cats to eat, and so on.

This Group does not take the place of the caregiver's relationship with his or her vet; do not implement any change in treatment without consulting your veterinarian. No matter how good the information or support here may be, it cannot take the place of your veterinarian's professional examination and evaluation of your cat. If your cat is experiencing a medical emergency, please take your cat to a vet before

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3 March 2024 - 8:54 am
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Hello♡

One of the things the ckd group mentioned that really worries me is that darbepoetin can stimulate tumor growth or recurrence in cats with sarcoma 

I think I should start the conversation with the vet by coming to an agreement on what stage ckd we are at and work from there, going into subq iv's and if they are needed and if so how much and switching to ringers, and also acertain whether creatinine levels are increasing.

What do you think?

 

♡♡♡

Michigan


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3 March 2024 - 9:24 am
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What do you think?

I think I should start the conversation with the vet by coming to an agreement on what stage ckd we are at and work from there, going into subq iv's and if they are needed and if so how much and switching to ringers, and also acertain whether creatinine levels are increasing.

I think that is PURRFECT!!!👏🏻👏🏻👏🏻 we will be with you in spirit for that convo!

YOU GOT this!!! It will go better than you imagine I believe 🙏🏻 Have references to point out it will be most helpful for you both

💝💝💝

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4 March 2024 - 4:04 pm
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Hello all:)

After more reading and understanding the extra burden the fluid iv's put on the heart and kidneys, I have divided the iv's into two sessions of about 40cc once in the morning and once in the evening. Jolie seems to tolerate this much better also.

Jolie and Mignon are still doing very well.  You won't believe this but they were actually wrestling a little last just like they used to.

 

♡♡♡

Virginia







Member Since:
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4 March 2024 - 5:00 pm
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    Jolie and Mignon are still doing very well.  You won't believe this but they were actually wrestling a little last just like they used to.

 

Holly said. 

Most excellent, the boys are doing well. smiley_clapThat is always at the forefront of ALL this INFO!

 

This is wonderful Edward!   Clearly Joiie  and Mignon are feeling great!  Comfortable, no pain, happy.......that's is that's  all about👍

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

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4 March 2024 - 5:33 pm
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♡♡♡

They are both very active and verbal this morning.  I don't know what they are trying to tell me. They are usually sleeping now before I go to work. I think they are asking for extra snacks maybe:).

Anyway, a good morning...

♡♡♡

Virginia







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4 March 2024 - 5:43 pm
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Haha......they know they have you wrapped around their paws...definitely asking  for more snacks😎😎..

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

Michigan


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4 March 2024 - 6:17 pm
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Yes, fluids & the heart is scary business. I look forward to hearing about the vet convo and what answers you receive. My biggest hope is that you can move forward and feel more confident with whatever treatment is needed. Having all these questions is a terrible feeling. 🫂 I'm glad the twice daily is working better for you both

You won't believe this but they were actually wrestling a little last just like they used to.

OH yes, we would😁👏🏻👏🏻👏🏻

. I think they are asking for extra snacks maybe:).

 Then give them extra snacks. 😽😻 We are tickled they are both doing so well that makes all our day!!!
💝💝💝

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