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Mike McIntyre
Mike McIntyre,
Category: Cat
Satisfied Customers: 8300
Experience:  Veterinarian at Sioux Nation Pet Clinic
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Mike Writing to you about Louis again. On the plus side,

Customer Question

Hi Dr MikeWriting to you about Louis again.On the plus side, I’ve been able to get him to eat quite a lot (I’ve been liquidising food and using persistence and patience to feed him in his bed) and he has gained weight!We had a couple of good days where the walking was much better. Today, he is all over the place and falling again. The ataxia is bad today.I don’t know what this means. He isn’t shaking his head so much anymore so I am guessing if there was an ear infection, the antibiotics are taking care of it.We see the vet again tomorrow and will do some bloods mainly to look at kidney values but I think I will ask for potassium (as I still wonder if supplementation could help with the leg weakness) and are there other tests I should be asking for?If this were some kind of neurological condition/ event, would it be atypical for it to seem to resolve and then become worse?Thanks as ever for any insights
Submitted: 7 months ago.
Category: Cat
Expert:  Mike McIntyre replied 7 months ago.

How long has the ataxia been going on for? What did he eat today? Have you noticed any wax or debris in the ear canal?

Customer: replied 7 months ago.
The ataxia has been there prominently since the anaesthetic but it’s been getting so much better! It was there a little before the dental but I attributed this to the weakness from not eating for so long.The vet checked the ears again on Tuesday and cleaned them. And he is still on the noroclav. Should I look and see what I can see with the naked eye?
Expert:  Mike McIntyre replied 7 months ago.

Yes, that would be helpful. Did they get much debris out of the ear canals? Do the pupils look normal sized, or are they different sixed?

Customer: replied 7 months ago.
They are same size. The cotton wool did come out from the ears very brown
Expert:  Mike McIntyre replied 7 months ago.

Do you have any ear flush at home? I feel if they are filling up that much, it will be good for us to get them cleaned.

Expert:  Mike McIntyre replied 7 months ago.
The cats ear canal is in the shape of an "L", this allows for the ear canal to become very moist and warm, then the opportunistic yeast and bacteria that normally live in the ear canal can start to grow to higher levels. The key is we need to flush the ears twice a day to start with. There is an ear flushing solution that has chlorhexidine and miconozole in it. This will remove the debris and the chlorhexidine will also kill the yeast and the bacteria in the ear canal. Then once the ears get healthier we can decrease on an as needed benefit. You may need to do from time to time to keep the ears healthy. The miconazole will also help with the yeast too. One product name you can look for is Micochlor. This product can be purchased over the counter at pet stores or online like on Amazon
Expert:  Mike McIntyre replied 7 months ago.

Here is a brief explanation of what is going on in a cats ear canal.

Customer: replied 7 months ago.
There is some brown stuff still in one ear. Ok thank you for the recommendation. Could this be the culprit for the ataxia?
Expert:  Mike McIntyre replied 7 months ago.
Khttps://www.amazon.com/-/es/Thomas-Labs-micochlor-Plus-Flush/dp/B07CGCXRRL?language=en_UShttps://www.amazon.com/Zymox-Plus-Otic-HC-Advanced-Formula/dp/B00TYMKNT8
Customer: replied 7 months ago.
Hi Dr Mike. We went to the vet this morning and she prescribed antibiotic ear drops and well as the antibiotics and gabapentin that he is already taking. So I will hold off the ear flushing for now.The really bad news is that Louis’ kidneys have got a lot worse. Creatinine has gone from 220 one week ago (and 150 the week before) to double that at 441. Urea is at 37.6 (again doubled since last week) and phosphorous is now 4.84 (1.88 last week).I’m absolutely devastated.(In addition to phosphate binders), The vet is offering 48 hours on IV or sub cut fluids 2-3 times per week.Louis had 48 hours IV last week and the creatinine increased after 24 hours and only dropped by 7 after 48. His urea did come down by 9.What do you recommend? And what is his life expectancy realistically with this rapid a progression of renal failure?
Expert:  Mike McIntyre replied 7 months ago.

Hello, sorry to hear this. How does Louis feel? HOw is the eating and the drinking?

Customer: replied 7 months ago.
Drinking ok. Eating more tricky because of the resorptive lesion. I liquidise his food and can get quite a lot in with a tremendous amount of time and persistence. And sprinkling forti flora on top. He seems quite bright in a way but sleeps all the time which might be the gabapentin
Expert:  Mike McIntyre replied 7 months ago.

I really feel, if we can get more fluids in, like we had talked before about daily 100 ml SQ to be given at home, this will be the best way to get those kidney values down and to flush all the more. You mentioned SQ fluids above, is this veterinarian now willing to let you do the fluids at home now?

Customer: replied 7 months ago.
It’s a new vet and now she has seen the horrible progression. Yes she can teach me to do at home. Probably not until Monday....
Customer: replied 7 months ago.
She was suggested we brought him in each time initially but is open to us learning
Expert:  Mike McIntyre replied 7 months ago.
That is great. I feel this will be the best. It is actually quite Simple to do. I am sure you will learn it quickly. If you have questions. You can ask me. We can also keep this message open for 5 days too. This way we can do more in one message line. I do not want to run your bill up too much as I feel we will be talking for quite some time. Want to help you all I can.
Customer: replied 7 months ago.
That’s so kind!!! Thank you...
Expert:  Mike McIntyre replied 7 months ago.

I am just going to select the answer option now. However we can just keep writing here for another 5 days before you need to accept it. Will that work for you?

Customer: replied 7 months ago.
Hi Dr Mike. After the 100ml sub cut fluids yesterday, Louis seemed quite bright. I took him to the vet (yet another one, same practice, because it’s Saturday) and he did 100ml sub cut fluids but also gave him an injection of anabolic steroids to help with the remaining
Customer: replied 7 months ago.
To boost remaining tissue function. It’s called Laurabolin. Since getting him home, I have never seen him so zonked. I know there is a lot going in with him and this could be the progression of the CKD or the effects of the gabapentin but I am really worried that steroids might have been a bad idea. I didn’t question it because he seemed so knowledgeable. Is it ok that he had that injection?
Expert:  Mike McIntyre replied 7 months ago.

Hello, how are things going now? I have not used that product in USA for these cases, however I see that it is used for this purpose in the UK, we may be a bit tired just from all the stress and the activity. If we are going to be able to do fluids under the skin for the next days at home this will be most helpful.

Customer: replied 7 months ago.
He is more zonked than I have ever seen for sure. My husband told me that Louis was perkier than he has been for a long time this morning but I then packed him off to the vet so I have been feeling terrible that I did something wrong. I agree that aggressive fluid treatment is what we need now, which is why I went to get another 100ml of sub cut fluids.And I was really hoping to see another increase in perkiness not the opposite! Hopefully you are right and it has all been hugely tiring and stressful.I had to actually go to the vet and get the fluid treatment because I haven’t been taught yet how to do this at home (nor do I have the fluid). Tomorrow is Sunday so we will be unable to give any fluids but hopefully I will learn on Monday.
Expert:  Mike McIntyre replied 7 months ago.

Does he feel a bit cooler to the touch? I feel that if you can wrap up or sit on a heating pad it will help to get the core temperature back up.

Customer: replied 7 months ago.
We keep a hot water bottle in his box with a fluffy blanket so hopefully he is keeping warm. He really likes this. I can’t check his temperature right now because he is in my daughter’s room (she sleeps on the floor next to him) but I will in (our) morning. I’m so hoping he will seem better tomorrow, I’m so worried
Expert:  Mike McIntyre replied 7 months ago.

I would also recommend tomorrow to buy a small heating pad, they are cheap, the continuous heat will help him even more, also can put some sugar in a syringe with water to give him for more energy also.

Customer: replied 7 months ago.
Ok thank you! I will definitely invest in one. And I will try the sugar water too. Thank you so much!!
Expert:  Mike McIntyre replied 7 months ago.

You are more than welcome. Have a good evening and keep me updated.

Customer: replied 7 months ago.
Hi Dr Mike. I bought the heating pad and Louis really likes it.He is at the vet at the moment as they have wanted to give him IV fluids for 24 hours. Later they will do a blood test and I am hoping so much that we will see those awful urea, creatinine and phosphorous levels go down. I will then learn how to do the sub cut fluids at home. I’ll be back later to update you on the bloods. Thanks!
Expert:  Mike McIntyre replied 7 months ago.
Good morning. Thank you for keeping me updated. Glad to hear all is going well.
Customer: replied 7 months ago.
While still not fantastic, after IV fluids, Louis' creatinine has dropped from 441 on Friday to 362 today. And his urea has fallen from 37.6 on Friday to 27.9 today. And the reply exciting thing is that he seems so much more alert and bright.One finding that I can scarcely believe is that his phosphorous was off the chart on Friday (greater than 4.84) and it is now 1.49. This is wonderful but so weird. Is such a decrease usual? I have only been using the binders for four days!I am going back with him on Thursday morning for some sub cut fluids and to learn how to administer these at home and buy the provisions.I have also done a spreadsheet of all of his tests which shows everything up until the 3 hour anaesthetic and everything afterwards too (I am not very techie so I hope it works!). It includes Friday and today's results:https://drive.google.com/file/d/1mAVwymW7L1c2SN8swj3HAwPi48P7rWSI/view?usp=sharingI am wondering if I should still be giving the binders? Or this a temporary decrease brought about by the IV fluids? Also, do you think we may be able to get his creatinine and urea down even more by using the sub cut fluids every other day?Thanks very much for any input
Expert:  Mike McIntyre replied 7 months ago.
Hello. So happy to hear how things are going. More days of fluids I feel will keep things Likeky moving in the right direction.
Expert:  Mike McIntyre replied 7 months ago.
I willl review the spreadsheet later today when I have time. I feel the fluids have helped a lot
Customer: replied 7 months ago.
Thanks so much. Please let me know once you’ve had a look! And what you think re continuing the phos binder?
Expert:  Mike McIntyre replied 7 months ago.
I feel the phosphate binder can help. However most importantly lots more of the SQ fluids. These lab results are very promising
Customer: replied 7 months ago.
I've just got back from the vet with Louis and his external haematology test results were now available. Turns out his anaemia is getting increasingly bad very quickly.Two weeks ago, Louis PCV was 25.6 and on these results it is 19.6 (with 0 retics which were 11,000 two weeks ago). RBC and Haemoglobin is also marked low now. The vet said that - because he had been on IV for about 24 hours when the blood was taken, the blood was more dilute and that it probably looks worse than it is. She is the vet that I like - but she did say it wasn't a big problem till PVC hits 13 which I definitely know is not right! However, when I said I was worried about the speed of the decrease, she did agree that an EPO injection may help.She needs to research which EPO is available in the UK (as she is Italian) and will then order it and call me. What I would really appreciate help on is how often he will be likely to need this injection? Could the anaemia be cured or will he need these for life? And what happens if he develops antibodies against it?I am pasting Louis' results to include the latest haematology here (most recent on left):https://drive.google.com/file/d/1mAVwymW7L1c2SN8swj3HAwPi48P7rWSI/view?usp=sharingOn the plus side, his lymphocytes are no longer low - meaning that we are on top of any infection, I hope (he is still on Norclav)?I will be giving him 100ml sub q every other day. The dose he received today has been transformative. He has been much more lively and active.Thank you so much for any insights you can offer! As always, I am hugely grateful
Expert:  Mike McIntyre replied 7 months ago.
Hello. If we can get the kidneys to start too work better. Then perhaps he will not need the Epogen injections as often.
Expert:  Mike McIntyre replied 7 months ago.
We have not had hematology done for some time. It wil be beneficial to see how it responds in a few weeks too. How does Louis feel yet? He has lots of good going for him yet. I feel you have a very good veterinarian you are working with now also. She is quite willing to be proactive it seems. Let’s ensure to ask her to keep on antibiotics too
Expert:  Mike McIntyre replied 7 months ago.
Perhaps also ask about starting on iron supplementation daily too
Expert:  Mike McIntyre replied 7 months ago.
Have you done that?
Customer: replied 7 months ago.
Hello. Sorry I was so rude. Just leapt straight in. Hope you are well!Yes I hope so! He has never had an epo injection before. Do you agree that with these values/ decrease we should do this? We will be also doing the sub cut fluids.Before the dental his PCV was over 35....
Customer: replied 7 months ago.
Sorry - wrote that before seeing your other answers. He has a supplement which has a small bit of iron
Customer: replied 7 months ago.
Would the iron be oral
Customer: replied 7 months ago.
Louis was in tremendous form after his 100ml sub cut fluids today. Really lively! He seems to be sleepy again now though (but if he weren’t sick I wouldn’t think twice about a sleeping cat!)
Expert:  Mike McIntyre replied 7 months ago.
I did not think rude at all. Don’t worry
Expert:  Mike McIntyre replied 7 months ago.
The iron can be oral. It may be called ferrous sulfate also
Expert:  Mike McIntyre replied 7 months ago.
What medications and what doses are we on now ?
Customer: replied 7 months ago.
Gabapentin 12.5mg x 3/ day. Noroclav x 2/ day. Antibiotic Ear drops. You move (joint supplement) once a day. Phosphate binders (ipakitine)
Customer: replied 7 months ago.
Oh, and probiotics forti flora (as much to get him to eat but also for gut health re antibiotics)
Expert:  Mike McIntyre replied 7 months ago.
How is the appetite today ?
Customer: replied 7 months ago.
Pretty good after the sub cut fluids! Less so later
Customer: replied 7 months ago.
I have been virtually force feeding him these last couple week and he has gained weight!
Expert:  Mike McIntyre replied 7 months ago.
That is excellent about the weight gain. What have you been feeding him
Customer: replied 7 months ago.
Renal diet liquidised with binder
Expert:  Mike McIntyre replied 7 months ago.
Which brand of renal diet? Canned or dry ?
Customer: replied 7 months ago.
Sachet - hills and royal Canin (liquidised) and a bit of dry (he can manage to eat it even with sore tooth so I put out overnight as it doesn’t go off so quickly). I have royal Canin, hills and Purina dry food and mix and match according to his lordship’s flavour of the month/ dayI try to err towards wet food
A) for the fluid content
B) so I can liquidise
C) so I can use the powder binder
Expert:  Mike McIntyre replied 7 months ago.
He is very well taken care of by you. I Iike “ his lordships “)
Expert:  Mike McIntyre replied 7 months ago.
How much of the iron do you give daily ?
Expert:  Mike McIntyre replied 7 months ago.
Are his stools firm or soft ?
Expert:  Mike McIntyre replied 7 months ago.
If the stools are firmer we can try to soften them some. This may help with the appetite more then too
Customer: replied 7 months ago.
Sorry for the delayed reply, my daughter has been very sick. I think we could benefit from softening his stools as he does not go every day
Expert:  Mike McIntyre replied 7 months ago.
I hope that your daughter has a speedy Recovery. Let me know how the stools softening goes also
Customer: replied 7 months ago.
What shall I use to soften them?
Customer: replied 7 months ago.
Oh, and is was disastrous at first but we now have a system and we have managed to administer 100ml sub cut into Louis!
Customer: replied 7 months ago.
it was
Expert:  Mike McIntyre replied 7 months ago.
I am happy to hear that the fluids are going better. Dairy like milk or yogurt will help a lot
Customer: replied 7 months ago.
Hi dr Mike. Louis seems to be doing really badly today. We gave him the 100ml yesterday and it didn’t perk him up in the usual way. The vet has us doing 100ml every other day but I am wondering if we should do another today. He’s off his food, so the other option could be to give him a Mirtazapine tablet. Any suggestions?
Customer: replied 7 months ago.
I’m feeling a bit desperate with Louis off his food yesterday and today because we leave next Sunday for an 8 day trip. I have someone staying who can pill him, love him, and take him to vet every other day for his sub cut fluids but I really want to get him into the best possible health and maximum weight before we go. It’s complex to know what is going on with an unresolved dental, the anaemia and the CKD but it is such a shame because he was doing amazingly well for a few days... he was back to purring and even left my daughter’s room to seek us out (which he hasn’t done for weeks)