Possible UTI in a CKD kitty with chronic pancreatitis: it’s Darwin

[VeroniqueM]

Good evening Dr Jeff!

I think this could become an emergency...
My 15 yr-old Darwin with CKD and chronic pancreatitis (the pancreatitis got much improved with Arsenicum album) now tonight started frequent small urinations in his litterbox (at least 4 times within 10 min). Also had a small softer than usual BM tonight (quite sure it was him, 95% sure). His bladder is unpalpable so he’s not blocked yet, but I’m quite worried that he might have a UTI.
After trying many remedies he was finally doing so well on Arsenicum album! I have been considering giving him another dose of Arsenicum since yesterday because he seemed more quiet but his mood is still good, his BEAM I’d say has been around 8 (more around 6-7 in the morning). Last dose of Arsenicum 6c/15 succussions was May 16th 2h30am. I don’t know what to do now...
I’m planning to bring him to the local vet tomorrow am for a urinalysis (and might as well do blood work at same time) or as an emergency overnight if I feel that his bladder is blocking. I’m concerned that they might want to prescribe an antibiotic for him.
Could I do something homeopathically for him tonight? I’m hoping this new issue won’t make him relapse on his other issues that seemed to be improving...

Thank you!

Veronique

 

[Dr. Jeff]

Yes Veronique, there are absolutely things you can do!

His frequent attempts to urinate may indeed be a UTI symptom, and you are very wise to about male cat urinary blockage.

Good work with palpating his bladder to make sure that it is small and not blocked.

Because you're a veterinarian you can monitor him at home, but otherwise a trip to the vet for bladder palpation would have been a great idea.

Also, because he's had similar symptoms in the past, and has been doing well with Ars., these symptoms may be part of his healing process.

The next steps in my mind are: 1. Urinalysis to check for internal symptoms (like high urine pH and urinary crystals), 2. Hour by hour monitoring of urinary symptoms and BEAM and 3. A redose of Ars.6c 15/Q-tip to try and help him internally re-balance to relieve symptoms.

I hope Darwin had a quiet night and look forward to talking this am and hearing how he did.

Please update us here on the forum when you are able.

 

[VeroniqueM]

Hello!
I apologize for not updating sooner, but I had to go away for a couple of days and didn't get a chance to update before I left.
Thank you so much Dr Jeff for your advice on the forum and also the following day during our virtual skype consultation for Darwin!
I gave him Arsenicum album 6c q-tip/15 succussions on May 19th 5h30pm. He seemed stressed that night as I was packing to go away and when I went to bed (quite late), his pupils were all dilated and he was not purring no matter what I did to try although no noticeable abdominal pain like he had before. I was also very stressed to leave him for 2 days and he was probably picking up on those vibes... But I was told he ate well that day that I left (usually he was typically eating less after a dose of Arseniucm for a day or 2 then his BEAM would improve). I know you mentioned during our consultation that I should give him Aconite if Arsenicum didn't work, but I was very hesitant to give him a new remedy just before leaving knowing I wouldn't be able to assess his response and worried about a possible aggravation so I did not redose with anything the morning that I Ieft...
He's not urinating frequently anymore (only did it that one evening on May 18th), his urines seem back to normal. The morning that I got back on May 22nd, he was frequently asking to drink from the tap, but of course he had not received his subcutaneous fluids on the Thursday night and Friday night. In the afternoon he was asking to go outside and it really increased his energy as I took him out but he seemed nervous about the cold wind there was that day. Back in the house, he was playing with his toys so his mood had improved (BEAM of about 8). He came to visit us in bed several times that night (so unsure how well he slept...) and at 5h30am on May 23rd he vomited leaves and grass with a small hairball and the last spot of vomit was light red/pink translucent mucus (so with blood in it but no blood clots). He slept all morning after that and didn't touch his meat until mid-afternoon (but was eating small amounts of his canned food). His BEAM was down to 5.5-6 yesterday then 7 later in the day. Today BEAM of about 6. He hasn't played with his toys since Saturday pm, but he still asks to go outside quite often. His pupils were not dilated this morning nor yesterday morning and he purrs fairly easily, but he often changed sleeping position.
Dr Jeff, I sent you his xrays, BW and urine results by email. I wish I could post the xrays here but I was having technical difficulties downloading the most recent ones. His specFPL keeps going down which is good: from 35.7 in March to 10.2 in April and now down to 7 ug/L
SDMA was 23 in March, 21 in April and now down to 20 ug/dL.
Creatinine was 263 in March, 259 in April and now up to 273 umol/L.
Urea was 13.5 in March, 20.8 in April and now 20.1 mmol/L.
The veterinarian that had a look microscopically at the fresh urine said he saw clumps of calcium oxalate crystals. He also finds that the calcifications on the kidneys that were visible last month are decreased now and he wonders if Darwin's Ca oxalate crystalluria is the reason why they are decreasing. Personally, I think the calcifications look very similar on both sets of xrays one month apart, maybe a little less opaque on the most recent ones, but there is a different background of organs overlapping the kidneys this time so I'm a little unsure about this one. Could the Arsenicum be helping him to get rid of the kidneys calcifications by crystalluria? If that is the case, then maybe he needs more Arsenicum? The lab results do not show crystals in the urine though, but maybe because of the shipping delay.
He also has a mild anemia now (Hematocrit 27%, low normal 29), with 2 episodes of vomiting blood tinged mucus within the last few weeks I'm suspecting a gastric ulcer from the uremia caused by his CKD. Conventional medicine speaking, this is when I would normally add famotidine and/or sucralfate to his treatment. I saw that the Aconite you recommended has vomiting with blood as one of its symptoms (and also black stools) and I was wondering: have you used it with success in certain cases of gastric ulcers when symptoms indicate it following a patient consultation?
And the last but not least issue is his heart: the pro-BNP went up from 93 to 119 pmol/L so now in the abnormal range of above 100. The radiologist's interpretation of his last month's xrays including chest mentioned no heart enlargement at the time. I also saw in The Guiding Symptoms of Hering that uncomplicated cardiac hypertrophy was a symptom covered by Aconite which I thought was interesting.
I'm still waiting to find out about his blood pressure measurement and weight from last Wednesday.
And to answer more precisely your question asked during our last consultation, when Darwin experiences a sudden jerking of the front paws as a symptom, it's 90% of the time the right front paw that comes up suddenly.
So, following Darwin's consultation a few days ago and in light of this new information, what should I do? His BEAM was really good Saturday pm, but has been down since yesterday. A dose of Arsenicum or a dose of Aconite? And at what potency?

Again, thank you so much Dr Jeff for all your time and advice!

With gratitude,

Véronique

 

[Dr. Jeff]

Wow, Veronique, great about an 8/10 BEAM! But there's a lot (too much?) going on.

Yes, about the improvement in kidney calcification with crystals in his urine.

I'm sorry though to hear about his kidneys, anemia and proBNP.

Based on his improved SDMA and normal chest x-rays, you can see how one or two diagnostic results can be misleading.

Regarding remedies, I'll ponder this overnight and get back to you when I'm in front of his record and repertorizations. Please reach out again in 24-36 hours if you don't hear back from me.?️