Still has chronic diarrhea after treatment

[F+V]

It sounds like he has some underlying illness that can only be detected via ultrasound/x-ray.
If you are worried about his heart, you should be able to get an echocardiogram without making Jengo fast for 12 hours unlike abdominal ultrasounds. Powder CoQ10 is ineffective so you can throw that away.
Why do you need to keep giving him Zofran? That's like masking his symptoms without treating the cause...and my understanding was that you needed to give b-12 continuously for CKD cats?

SDMA can still be useful in stage 3. It can serve as a cross reference for creatinine levels, particularly if Jengo has muscle wasting, which can lower creatinine and make kidney function seem better than it actually is, but blood phos level and UPC (urine protein-to-creatinine ratio) may be more important for him at this stage.

It is interesting that your cats don't show interest in treats. What do they enjoy every day?

You've tried so hard to make him feel better but there's only so much you can do under the circumstances.

 

[Sillycat41]

It sounds like he has some underlying illness that can only be detected via ultrasound/x-ray.
If you are worried about his heart, you should be able to get an echocardiogram without making Jengo fast for 12 hours unlike abdominal ultrasounds. Powder CoQ10 is ineffective so you can throw that away.
Why do you need to keep giving him Zofran? That's like masking his symptoms without treating the cause...and my understanding was that you needed to give b-12 continuously for CKD cats?

SDMA can still be useful in stage 3. It can serve as a cross reference for creatinine levels, particularly if Jengo has muscle wasting, which can lower creatinine and make kidney function seem better than it actually is, but blood phos level and UPC (urine protein-to-creatinine ratio) may be more important for him at this stage.

It is interesting that your cats don't show interest in treats. What do they enjoy every day?

You've tried so hard to make him feel better but there's only so much you can do under the circumstances.

Had a rough couple of days. I was so mentally and physically exhausted from worrying about the vet appt., only getting a couple of hours of sleep, etc., that I fed the cats at 7:30 this morning and went back to bed. Didn't wake up until 10:10 AM.

The vet insisted that an ultrasound was useless if he doesn't fast for 12 hours. I asked about xrays and she said they wouldn't show much. She palpitated his abdomen and said she didn't feel any bloating or signs of possible lymphoma. I'm finding it harder and harder to trust vets.

I had her check his blood pressure again and can't believe how long that takes! After 10 minutes or more, she finally said it was very high... over 220. She insisted that I keep him on the Amlodipine for at least a month and that the side effects will subside. The partner vet who does the echos of the heart is on maternity leave. His old vet doesn't do them and it's impossible to get established with a new vet in this area. I'm very depressed... I can see that his days are numbered and I can't get any more help.

Some one else also asked why I give him Zofran twice a day. That's what his old vet put him on for nausea caused by renal failure. I miss a dose one morning and didn't notice any difference. ?? As for B12, some question giving that regularly too until the Cobalamin test from TAMU says he needs it. This is all so confusing... mixed messages from vets... half the time I don't know whether I'm helping him or hurting him. I have lost faith the vets.

I asked the vet about the SDMA test again... same answer that it is only useful in early stages of renal failure. :-(

I opted for the blood test to be sent to an outside lab because they test for more things. The results should be back tomorrow. I'm very nervous because I'm so afraid that he is in Stage 4 now because of more damage done to his kidneys from untreated high blood pressure. :-( She did take a urine sample and I'm supposed to drop off a stool sample too.

I also think it's weird that my cats don't like treats. I've tried about 10 or 12 different ones. Our 3 yr old doesn't like canned food either. Jengo only eats canned.

Also even though she said an xray of his spine and legs probably wouldn't show the extent of his arthritis, she did check with her fingers. Can't they really tell??? Since supplements like Cosequin can take months to show improvement (doubt he has months), I asked about pain meds for arthritis. She said a mild dose of Gabapentin might help and prescribed a liquid. Don't want to make him too groggy because he has trouble walking now.

He has tested for slight anemia in the past and I asked how to treat it but she said there was nothing. I find that hard to believe.... more research today.

Thanks for listening to me whine.

 

[F+V]

I feel your pain. Getting out of the bed every hour or so between 3 to 6am every day to pill my cats and collect their urine was painful, and I also had to go back to bed during the day. You said you were feeding Jengo every 3 hours, and I don't know how you found yourself in that situation but if that's taking a toll on your health you need to start readjusting the routine, say feeding every 4 hours instead of 3. Is he getting enough calories from each meal?

Abdominal ultrasounds usually require patients to fast for at least 12 hours, even then there's still some food left in the stomach. Internists at more advanced clinics may be able to still do ultrasound because their equipment tend to be more high tech. I took my boy to a local cat clinic today for a bloodwork and ultrasounds, and an echocardiogram, but I got the impression that these regular vets in town could only detect obvious abnormalities.

Vets can sometimes detect potential signs of lymphoma through palpation, but not definitive. They can feel for enlarged lymph nodes or abnormal masses, which can sometimes suggest lymphoma or other conditions. However, lymphoma diagnosis requires additional testing, as swollen lymph nodes or masses may also result from infections, inflammation, or other non-cancerous conditions. If lymphoma is suspected based on palpation, they recommend further tests such as FNA or biopsy of the lymph nodes.

They can also get an idea of whether a pet might have arthritis by feeling and manipulating their joints. Palpation can reveal signs consistent with arthritis, it may not confirm the severity or extent of the condition, so if it's suspected X-ray is required to get a clearer picture of joint health, assess cartilage loss, and look for bone changes that are typical of arthritis. Liquid gabapentin is easy to administer, so hopefully you will notice some kind of improvement.

Jengo must have been very stressed out, so the high BP levels aren't surprising. I took my boy to the vet today but he was unusually very indignant so we didn't check his BP. When we were looking at his heart on the monitor it was beating so fast... but it's great he's now on at least one BP med. BP meds should not be discontinued if Jengo has stage 3+ CKD. What side effects was she talking about?

Pause Zofran to see how he responds. Did you tell your new vet he was still taking Zofran? Anti nausea meds are usually given as necessary. Instead I would give probiotics daily.

I don't know much about B12 but if the bloodwork shows he's deficient, he needs to take it. Even if you suspect his days are numbered, I would still give him Cosequin. I sometimes give a whole Cosequin capsule in his mouth with about 3ml water.

External labwork is a good idea because it's more comprehensive. The cat clinic I take my cats to always send out the blood sample to IDEXX. Did you talk about his dehydration with the vet? Hydration is crucial in CKD cats. Anemia will show up in bloodwork, so you will find out.

Finally, it's none of my business but you might want to consider getting the 3 year-old cat off dry food slowly because there's nothing good about them.

 

[Sillycat41]

I feel your pain. Getting out of the bed every hour or so between 3 to 6am every day to pill my cats and collect their urine was painful, and I also had to go back to bed during the day. You said you were feeding Jengo every 3 hours, and I don't know how you found yourself in that situation but if that's taking a toll on your health you need to start readjusting the routine, say feeding every 4 hours instead of 3. Is he getting enough calories from each meal?

Abdominal ultrasounds usually require patients to fast for at least 12 hours, even then there's still some food left in the stomach. Internists at more advanced clinics may be able to still do ultrasound because their equipment tend to be more high tech. I took my boy to a local cat clinic today for a bloodwork and ultrasounds, and an echocardiogram, but I got the impression that these regular vets in town could only detect obvious abnormalities.

Vets can sometimes detect potential signs of lymphoma through palpation, but not definitive. They can feel for enlarged lymph nodes or abnormal masses, which can sometimes suggest lymphoma or other conditions. However, lymphoma diagnosis requires additional testing, as swollen lymph nodes or masses may also result from infections, inflammation, or other non-cancerous conditions. If lymphoma is suspected based on palpation, they recommend further tests such as FNA or biopsy of the lymph nodes.

They can also get an idea of whether a pet might have arthritis by feeling and manipulating their joints. Palpation can reveal signs consistent with arthritis, it may not confirm the severity or extent of the condition, so if it's suspected X-ray is required to get a clearer picture of joint health, assess cartilage loss, and look for bone changes that are typical of arthritis. Liquid gabapentin is easy to administer, so hopefully you will notice some kind of improvement.

Jengo must have been very stressed out, so the high BP levels aren't surprising. I took my boy to the vet today but he was unusually very indignant so we didn't check his BP. When we were looking at his heart on the monitor it was beating so fast... but it's great he's now on at least one BP med. BP meds should not be discontinued if Jengo has stage 3+ CKD. What side effects was she talking about?

Pause Zofran to see how he responds. Did you tell your new vet he was still taking Zofran? Anti nausea meds are usually given as necessary. Instead I would give probiotics daily.

I don't know much about B12 but if the bloodwork shows he's deficient, he needs to take it. Even if you suspect his days are numbered, I would still give him Cosequin. I sometimes give a whole Cosequin capsule in his mouth with about 3ml water.

External labwork is a good idea because it's more comprehensive. The cat clinic I take my cats to always send out the blood sample to IDEXX. Did you talk about his dehydration with the vet? Hydration is crucial in CKD cats. Anemia will show up in bloodwork, so you will find out.

Finally, it's none of my business but you might want to consider getting the 3 year-old cat off dry food slowly because there's nothing good about them.

So you have also lost a lot of sleep taking care of kitties in the middle of the night. :-( The reason I started feeding him every 3 hours was because that seems to stave off the vomiting. If he went too long between meals, he tended to vomit. So far that has worked... he rarely vomits any more... but he is getting an anti-nausea med too so that may be the reason. Most nights he wakes me up when he's hungry, other nights I feed him when I get up to go to the bathroom which is frequently thanks to my old bladder. He'll only eat small meals unless I syringe feed him so I tally up the calories for a 24 hr period making sure that it is 200 for his weight.

I've put having an ultrasound done on hold for now. I panicked about the lump on his neck thinking it was a swollen lymph node and might be cancer. As it turns out the lump wasn't in the area of the neck lymph node... further done the neck. When the vet stuck a needle in to aspirate it bloody fluid leaked out. She never did take a sample and the lump is flatter now. So basically I don't know what it is, however it's in the area where the other vet used to draw blood so maybe related to that.

I'm sure my situation is similar... the regular vets probably only detect obvious abnormalities. Don't have much faith that they'll find out anything. His old vet is just learning how to do ultrasounds so not much confidence there.

On Monday the vet did palpitate his abdomen and said that it didn't feel bloated. Hmm.... is that what an abdomen with lymphoma feels like??? I sure wish I lived near some specialists.

She also checked his spine and said there was signs of arthritis. No surprise there... at his age he is sure to have it. I started him on Cosequin but it's probably too little too late. :-( I asked about xrays but our appointment time ran out so I'll have to take him in again this week. I did get some liquid Gabapentin but am afraid to try it since he is so wobbly that it'll make it worse. I'll have to watch him carefully and only try the smallest dose.

Jengo is very nervous when at the vet clinic... flattens out on the exam table and doesn't move. It took her 10 or 15 minutes to get his blood pressure and she said it was 230!!! I think that he must have high BP though because I doubt that it would go from a normal of 140 to 230... probably is up around 180 or 190. He's been on Amlodipine for 2 weeks now... I got nervous and cut the dose back before his vet appt. but she said to continue the prescribed dose. I thought it was making him more wobbly... plus I read that sometimes they need to be on two BP meds.

Yes, the new vet knows what meds he is on and didn't say anything about the Zofran. The old vet put him on it because of nausea associated with kidney disease. ??? I have missed dose and didn't notice any change. So you don't think he needs it?? Use probiotics instead?

Actually his blood test didn't show los B12 and I think his old vet put him on it for IBD. Does that make any sense? Is there such a thing as an overdose of B12??

Sorry I didn't finish this Friday. After I got the blood test results I was devastated and too depressed to write. His BUN and Creatinine are off the chart! I did have her do the IDEXX test instead of the in-house one because I wanted more details. He is anemic and his Cardiopet proBNP was up from the last time it was checked. He is so weak and wobbly now and I still don't know exactly why other that muscles wasting. I don't think it is saddle thrombosis because I keep reading that it comes on suddenly. So now I'm doing more research weakness in rear legs, shaking or kicking read legs after jumping off the furniture, wobbliness, etc. So many reasons but none fit so far. :-( I'm so afraid that I'm going to lose him before I get any answers and can help him.

I am trying to get the 3 yr old off of dry food. She just doesn't like canned... very stubborn little girl.

Sorry this got so long. Take care now.
Barb

 

[F+V]

I'm so sorry about his blood test results... Was SDMA also elevated? ProBNP detects stress felt in the heart even if the cause lies elsewhere in the body, and not necessarily implies a heart deterioration, but it's safe to assume he has HCM due to high BP.

CKD cats lose B12 through increased urination due to their reduced ability to concentrate urine. Did you get the results of the urinalysis? If his B12 wasn't deficient, maybe that's because you give him a B12 supplement? It's generally difficult to overdose on B12 because it's a water-soluble vitamin and any excess is typically excreted rather than stored, so toxicity is extremely rare. I'm not familiar with saddle thrombosis but does he cry in pian? What was his platelet count? High counts might suggest an increased risk of clot formation, while the opposite a bleeding risk. Saddle Thrombus in Cats: Causes, Symptoms, and How To Help Your Cat

Did the vet suggest anything about managing his anemia? If it's caused by his CKD, you need to manage both the underlying kidney disease and the anemia. Darbepoetin or Epoetin (synthetic erythropoietin) mimic the hormone erythropoietin, which is typically produced by the kidneys to stimulate red blood cell production in the bone marrow. Erythropoietin Stimulating Agents or ESAs can help the body produce more RBCs. However, cats on ESAs need regular monitoring as the body can sometimes develop antibodies against the synthetic erythropoietin, leading to a serious condition known as pure red cell aplasia. Does Jengo get appetite stimulants? Mirtazapine or capromorelin may help increase his appetite and improve overall nutrition and energy levels. Did you confirm with your new vet the right amount of subQ fluids? I recently read that too much fluids would put stress on the kidneys. Do you give him a gentle massage after giving him subQ fluids to optimize the absorption?

Anti-nausea drugs like Zofran are generally considered safe for short-term or intermittent use to manage nausea and vomiting associated with CKD or GI issues, but using Zofran long-term or daily can have some considerations. Possible side effects in long-term use include constipation and changes in heart rhythm. While Zofran is safe for CKD cats, the vet needs to monitor organ health closely in cats with compromised kidney or liver functions. And it's important to address the underlying cause of nausea rather than relying solely on anti-nausea meds long-term. For CKD cats, hydration, dietary adjustments, phos binders, and treatments to control uremia can reduce the frequency of Zofran use. You can try giving it on as as-needed basis.

As for BP meds for CKD cats with elevated BP, amlodipine (a calcium channel blocker) is often the first-line treatment, but some cats may not respond fully to it alone, particularly if their hypertension is severe or persistent. In these cases, a second med may be added to provide better control and to protect kidney and heart health. Amlodipine is often used together is ACE inhibitor (benazepril or enalapril). This combination can be particularly helpful if proteinuria is also a concern, as ACE inhibitors may reduce protein loss in urine. Amlodipine is also used together with Angiotensin Receptor Blocker (ARB) such as telmisartan. It's FDA approved and may be used alongside amlodipine if BP is not adequately controlled with one med. Some cats with CKD and hypertension may have more severe or difficult-to-control BP that requires multiple approaches to manage, hence the use of two BP meds. Two meds will also minimize side effects of high dose of amlodipine. And measuring BP should ideally be done at home.

Regarding the lymphoma, yes, bloating or distension can occur. Cats with lymphoma often lose muscle mass, which can make abdominal bloating more noticeable due to the loss of lean body mass elsewhere.

It's good that you started giving Jengo Cosequin. What about omega 3? Why don't you try Antinol for dogs since they can also be given to cats, unless omega 3 supplement you are giving him has shown efficacies in cats. And if I were you, I would also consider visiting a holistic vet and/or a licensed traditional Chinese veterinary medicine practitioner.

Poor boy, he didn't even have the strength to resist... gabapentin is generally considered safe for cats with CKD when used at appropriate doses and under veterinary supervision.

 

[Sillycat41]

I'm so sorry about his blood test results... Was SDMA also elevated? ProBNP detects stress felt in the heart even if the cause lies elsewhere in the body, and not necessarily implies a heart deterioration, but it's safe to assume he has HCM due to high BP.

CKD cats lose B12 through increased urination due to their reduced ability to concentrate urine. Did you get the results of the urinalysis? If his B12 wasn't deficient, maybe that's because you give him a B12 supplement? It's generally difficult to overdose on B12 because it's a water-soluble vitamin and any excess is typically excreted rather than stored, so toxicity is extremely rare. I'm not familiar with saddle thrombosis but does he cry in pian? What was his platelet count? High counts might suggest an increased risk of clot formation, while the opposite a bleeding risk. Saddle Thrombus in Cats: Causes, Symptoms, and How To Help Your Cat

Did the vet suggest anything about managing his anemia? If it's caused by his CKD, you need to manage both the underlying kidney disease and the anemia. Darbepoetin or Epoetin (synthetic erythropoietin) mimic the hormone erythropoietin, which is typically produced by the kidneys to stimulate red blood cell production in the bone marrow. Erythropoietin Stimulating Agents or ESAs can help the body produce more RBCs. However, cats on ESAs need regular monitoring as the body can sometimes develop antibodies against the synthetic erythropoietin, leading to a serious condition known as pure red cell aplasia. Does Jengo get appetite stimulants? Mirtazapine or capromorelin may help increase his appetite and improve overall nutrition and energy levels. Did you confirm with your new vet the right amount of subQ fluids? I recently read that too much fluids would put stress on the kidneys. Do you give him a gentle massage after giving him subQ fluids to optimize the absorption?

Anti-nausea drugs like Zofran are generally considered safe for short-term or intermittent use to manage nausea and vomiting associated with CKD or GI issues, but using Zofran long-term or daily can have some considerations. Possible side effects in long-term use include constipation and changes in heart rhythm. While Zofran is safe for CKD cats, the vet needs to monitor organ health closely in cats with compromised kidney or liver functions. And it's important to address the underlying cause of nausea rather than relying solely on anti-nausea meds long-term. For CKD cats, hydration, dietary adjustments, phos binders, and treatments to control uremia can reduce the frequency of Zofran use. You can try giving it on as as-needed basis.

As for BP meds for CKD cats with elevated BP, amlodipine (a calcium channel blocker) is often the first-line treatment, but some cats may not respond fully to it alone, particularly if their hypertension is severe or persistent. In these cases, a second med may be added to provide better control and to protect kidney and heart health. Amlodipine is often used together is ACE inhibitor (benazepril or enalapril). This combination can be particularly helpful if proteinuria is also a concern, as ACE inhibitors may reduce protein loss in urine. Amlodipine is also used together with Angiotensin Receptor Blocker (ARB) such as telmisartan. It's FDA approved and may be used alongside amlodipine if BP is not adequately controlled with one med. Some cats with CKD and hypertension may have more severe or difficult-to-control BP that requires multiple approaches to manage, hence the use of two BP meds. Two meds will also minimize side effects of high dose of amlodipine. And measuring BP should ideally be done at home.

Regarding the lymphoma, yes, bloating or distension can occur. Cats with lymphoma often lose muscle mass, which can make abdominal bloating more noticeable due to the loss of lean body mass elsewhere.

It's good that you started giving Jengo Cosequin. What about omega 3? Why don't you try Antinol for dogs since they can also be given to cats, unless omega 3 supplement you are giving him has shown efficacies in cats. And if I were you, I would also consider visiting a holistic vet and/or a licensed traditional Chinese veterinary medicine practitioner.

Poor boy, he didn't even have the strength to resist... gabapentin is generally considered safe for cats with CKD when used at appropriate doses and under veterinary supervision.

I'm physically and emotionally exhausted. I fell asleep with my hand on the laptop keyboard again yesterday. mmmmmmmmmmm

I'm not sure if she ordered the SDMA test but there is a note on the results referring to it: "SMDA and Creatinine are increased: acute, active or chronic kidney injury likely" The Cardoipet proBNP went from 354 in FEb 2024 to 531 now. It says "cats with hyperthyroidism, hypertension, or severe azotemia may have increased NT-proBNP" His T4 is in the normal range.

Some of the tests results indicate high protein. I guess it was a big mistake to continue feeding him regular canned food with Phos-Bind instead of force feeding him prescription diet which he hates. :-( Now he's weak and I assume has muscle wasting and treatments say he needs more protein. Catch-22... he's already getting too much.

So do high blood pressure and HCM always go together?? I have an appointment this afternoon to have his BP checked again and will ask the vet questions about the test results and what we can do to help him. Don't have much faith in the vet though.

His urinalysis result was: Urine Protein +2 Again too much protein. :-( I didn't see a test results for B12. ??

Yes, saddle thrombosis is painful and causes them to cry. So far no sign of that. Another symptom of that is the rear legs and feet feeling cold. I check them all the time. His platelet count is in the normal range at 466 with normal being 155 to 641.

The vet said there was nothing we could do about his anemia. I find that hard to believe as I know others are using Epoetin. Maybe it's not bad enough. ?? His RBC is low at 4.64 - normal range is 7.12 to 11.46. Heoglobin is low too. I assume these all indicate anemia.

Yes, I give him a small piece of Mirtazapine every other day. He whines for food but still doesn't eat a lot at each meals so I supplement by syringe feeding him a couple of meals a day.

I need to ask the new vet about how much sub-Q. I read that too much is also hard on the heart. Yes, I always massage him giving fluids to reduce the bump. I added Zofran to my list of questions. It was his old vet who said to give a half twice a day for nausea from alleged IBD. I think Porus One that was prescribed by an earlier vet is used to control uremia or toxins. He's been on that for a couple of years now.

You mentioned that Amlodipine may not work along and said Benazepril was also used to control BP. I just receiving an email from the vet minutes ago.
"He doesn't have evidence of a urinary tract infection as there is no bacteria or white blood cells in his urine. His urine protein is either from his renal disease and/or hypertension. I think we need to determine if his hypertension can be controlled to help the protein loss, but it may be inevitable and related to his renal disease. Benazepril is a medication that works well in cats for protein loss in urine and can help with hypertension. We can try him on this medication, but I also think we need to see if his protein loss in his urine is controlled better in a few weeks when he's consistently on the appropriate Amlodopine dose.

He's only been on the correct dose of Amlodopine for 7 days, as you had decreased it prior to his visit on October 28th. There is not going to be a significant change in his blood pressure in that short of time. I still recommend waiting 3-4 weeks to recheck his blood pressure, so 2-3 weeks from now as long as he is kept at the dose. I don't think the appointment today is necessary. "

Doesn't think checking his BP is necessary yet?? She also mentioned giving him Pimobendan to help with his heart contractions. More meds to put him on! I wish I could get the home BP monitor to work so I could check his BP. I need to order some fresh omega-3 fish oil. Had some in the fridge but found out that it doesn't keep long.

Thanks for your help. I'm very depressed... not trusting either vet is stressful. Wish I could go back in time. Take care now. Barb

 

[stephanietx]

The normal dose of B12 for IBD kitties is weekly for 6 weeks, then once a month. They can be on it longer and you basically cannot overdose a cat on it because it's flushed out of their systems when they urinate.

Zofran does help decrease nausea in IBD and CKD kitties. If you're not noticing a difference when you skip a dose, try giving it once a day rather than twice a day. I have a girl on in once a day now (at night) and that seems to work for her. My boy had to be on it twice a day.

If he's stressed at the vet, then his blood pressure is going to be high. Can you email or call the vet and leave a message asking your questions rather than making another trip? Stress is a major contributor to IBD flares and for CKD kitties.

 

[F+V]

What about phos and calcium levels? Were they also high? I said this before but if blood phos level is elevated, you can also give him cooked egg white. I also linked a page explaining the relationship between the kidneys and gut health, but for CKD cats you need to give probiotics, but not forti flora or some random, ineffective probiotic products. There are stains that are known to work in cats, which I also shared with you previously.

Hypertension can be associated with HCM but many cats with early stages of HCM have normal BP. Hypertension can develop as the condition progresses or if there are other underlying health issues such as kidney disease, which is common in older cats and can cooccur with HCM. I wouldn't recommend taking him back to get his BP measured again, because not only would he be stressed out which is bad for his heart, his BP would be elevated at the vet. When I do fecal exam or urinalysis, I don't take my cats with me to the vet for that reason. Why don't you measure his BP at home since you got the device? Measure and record his BP daily and share the log with your vet in 3 weeks time, and then your vet may agree to prescribe an ACE inhibitor if his BP is consistently elevated.

B12 can be found in blood test results, not urinalysis. I thought you said Jengo didn't have B12 deficiency because you saw the results. Maybe your vet didn't test his B12 and B9. Does she know you are giving him a B12 supplement? Urine protein 2+ is bad but could be worse, and I don't think he's on a very high protein diet like raw meat. I assume your vet didn't check his UPC? Did you check with your vet the correct dosage of phos binder?

It looks like your vet wants to see if Amlodipine alone could lower his BP because introducing new meds could potentially spike liver enzymes. Did ALT, AST, GGT, Total Bil look ok? I don't know what UTI has anything to do with Benazepril as it's an ACE inhibitor and is primarily used to manage conditions like CKD, High BP, and heart disease. Maybe your vet has mistaken it with an antibiotic?
Pimobendan is often prescribed to HCM patients as it helps increase the function of the left atrium and left ventricle during the pumping phase.

Don't put off ordering omega 3 any longer. I think you said you were going to last week. It's fine you insist on getting the liquid omega 3 but know that it oxidizes quickly once opened even if you keep it in the fridge.

 

[FriendofFerals]

With CKD in cats you want to limit the phosphorous, not necessarily the protein (until the end stages). In humans, they say limit protein b but cats require it more than we do. My 19 yr old stage 2 CKD cat is on methimazole transdermal for hyperthyroidism (which goes with the CKD), Amlodipine daily for hypertension (that goes with the hyper T)...add some severe asthma, allergies, and dermatitis requiring prednisolone, albuterol and amitriptyline for the OCD overgrooming/fur pulling and you get the idea.

I started giving a vitamin supplement a few weeks ago after weight loss thanks to a parasite (indoor cat, flea treated). His appetite was poor and IBS was flaring with the change of seasons and allergies. Here's what I've been using. ...It smells like bacon.

Amazon.com

I also give him a squirt of Omega 3. It's also helped tremendously with his chronic inflammation in general.

Amazon.com

He's old, cranky, and picky but a dropper full of that has made him go for the food. He's on Weyruva BFF OMG Gravy. Weyruva low phos chicken in a hydrating puree as a topper and occasionally a RAWZ shredded chicken breast and egg pouch.

It's a battle, I know. There is so much information out there, it's overwhelming, It's taken me over a year to get the spastic diarrhea under control with him. Lord knows, it ain't perfect but at least it looks like a poo and it isn't 25 times a day/night like it was before.

Pic for reference. He's quite the old wizard.

 

[Sillycat41]

The normal dose of B12 for IBD kitties is weekly for 6 weeks, then once a month. They can be on it longer and you basically cannot overdose a cat on it because it's flushed out of their systems when they urinate.

Zofran does help decrease nausea in IBD and CKD kitties. If you're not noticing a difference when you skip a dose, try giving it once a day rather than twice a day. I have a girl on in once a day now (at night) and that seems to work for her. My boy had to be on it twice a day.

If he's stressed at the vet, then his blood pressure is going to be high. Can you email or call the vet and leave a message asking your questions rather than making another trip? Stress is a major contributor to IBD flares and for CKD kitties.

Thanks for writing. I just checked the instructions on the bottle of B12 and it says "once weekly for 6 weeks, wait a month and then give the next injection then retest." I must have gotten the idea that Jengo needed B12 once a week from the cat forums I've been on. Guess I'd better back off even though too much is flushed out.

I guess his first vet put him on Zofran twice a day because he figured that he probably has nausea. It's hard to tell whether he has nausea or not since he has a problem is soft stools from an upset GI tract. I can hear gurgling noises.

I did email the vet asking question but she hasn't replied. I'm so frustrated with vets. When a cat has serious health issues, we can't wait for weeks to get answers. :-(

 

[Sillycat41]

With CKD in cats you want to limit the phosphorous, not necessarily the protein (until the end stages). In humans, they say limit protein b but cats require it more than we do. My 19 yr old stage 2 CKD cat is on methimazole transdermal for hyperthyroidism (which goes with the CKD), Amlodipine daily for hypertension (that goes with the hyper T)...add some severe asthma, allergies, and dermatitis requiring prednisolone, albuterol and amitriptyline for the OCD overgrooming/fur pulling and you get the idea.

I started giving a vitamin supplement a few weeks ago after weight loss thanks to a parasite (indoor cat, flea treated). His appetite was poor and IBS was flaring with the change of seasons and allergies. Here's what I've been using. ...It smells like bacon.

Amazon.com

I also give him a squirt of Omega 3. It's also helped tremendously with his chronic inflammation in general.

Amazon.com

He's old, cranky, and picky but a dropper full of that has made him go for the food. He's on Weyruva BFF OMG Gravy. Weyruva low phos chicken in a hydrating puree as a topper and occasionally a RAWZ shredded chicken breast and egg pouch.

It's a battle, I know. There is so much information out there, it's overwhelming, It's taken me over a year to get the spastic diarrhea under control with him. Lord knows, it ain't perfect but at least it looks like a poo and it isn't 25 times a day/night like it was before.

Pic for reference. He's quite the old wizard.

Thanks for writing and for the pic. Handsome boy with a big paw!

I think part of his problem might be that his phosphorus is still too high. I just read on Tanya's site that it should be below 6.0 and his last blood test on Oct 29th his was 6.2. I'm going to add more Phos-Bind to his food and see if that helps.

You mentioned that protein should be limited in the end stage. With his high Bun 101 & Creatinine 5.0 isn't this end stage??? I was super depressed to see how high his numbers jumped since the previous blood work on Aug. 29th. :-(

Wow! Your 19 yr old is on a lot of meds! Jengo was put on Amlodipine a couple of weeks ago and I'm wondering if he is having a bad reaction to it in spite of the fact that most cats are on it for high BP. I made an appt. last Tues. to have the vet check his BP but she cancelled it and said she wants him on it for a 3 weeks to a month before rechecking!!! That doesn't make sense to me... others online said that they have their cats rechecked weekly. I am so disappointed in the two vets were have been seeing. I wish I could find a new vet but there is a shortage in our area and none are taking new patients.

I bought a home BP monitor but haven't been able to get an accurate reading with it. Must be something to do with the position of the cuff. I took it to the vet and she tried unsuccessfully too. Question: how long does it take your vet to get a Doppler reading? It took this vet about 10+ minutes and then she said his BP was 230. I don't have much confidence in her ability to take it. But his old vet would never take his BP... I asked as far back as 2022 and he kept putting it off.

Jengo is very wobbly today... just watch him almost fall over. Now I'm wondering it the Amlodipine is making his BP too low or what else could be going on. Arthritis doesn't deteriorate that fast. I'm scared... after we are losing this battle. :-(

Wow! You sure have your hand full taking cats of your guy! I also experiences chronic diarrhea for a t least 6 months. I should try omega 3s. Also haven't tried Weruva BFF OMG Gravy. Did try their low phosphorus chicken but he didn't like it much.

Thanks for the links. More research this afternoon. Hope we still have time... he seems to be slipping every day. :-( Take care now. Barb

 

[Sillycat41]

The normal dose of B12 for IBD kitties is weekly for 6 weeks, then once a month. They can be on it longer and you basically cannot overdose a cat on it because it's flushed out of their systems when they urinate.

Zofran does help decrease nausea in IBD and CKD kitties. If you're not noticing a difference when you skip a dose, try giving it once a day rather than twice a day. I have a girl on in once a day now (at night) and that seems to work for her. My boy had to be on it twice a day.

If he's stressed at the vet, then his blood pressure is going to be high. Can you email or call the vet and leave a message asking your questions rather than making another trip? Stress is a major contributor to IBD flares and for CKD kitties.

Can't remember if I answered this already. :-( Not getting enough sleep and very forgetful. According to the label on the B12 I have been giving him more than prescribed. But like you said excess is flushed out. I'll back off now.

I have tried skipping the Zofran but I really can't tell if it's helping or not. He still has an appetite but rarely eats more than a teaspoon or tablespoon at a time.

I emailed the vet yesterday morning but she didn't respond yet. As much as I hate stressing him by taking him to the vet, I would like to know for sure what his BP is and whether he is taking the right amount of Amlodipine. Maybe it's too much and that's why he is getting weaker.

I'm so frustrated with vets. I really don't think that know a lot about treating cats with CRF or other serious illnesses other that prescribing meds. Unless they've care for their own cats with these diseases they just seem to want to push prescription diet which isn't treatment enough in my opinion.
Later...

 

[Sillycat41]

What about phos and calcium levels? Were they also high? I said this before but if blood phos level is elevated, you can also give him cooked egg white. I also linked a page explaining the relationship between the kidneys and gut health, but for CKD cats you need to give probiotics, but not forti flora or some random, ineffective probiotic products. There are stains that are known to work in cats, which I also shared with you previously.

Hypertension can be associated with HCM but many cats with early stages of HCM have normal BP. Hypertension can develop as the condition progresses or if there are other underlying health issues such as kidney disease, which is common in older cats and can cooccur with HCM. I wouldn't recommend taking him back to get his BP measured again, because not only would he be stressed out which is bad for his heart, his BP would be elevated at the vet. When I do fecal exam or urinalysis, I don't take my cats with me to the vet for that reason. Why don't you measure his BP at home since you got the device? Measure and record his BP daily and share the log with your vet in 3 weeks time, and then your vet may agree to prescribe an ACE inhibitor if his BP is consistently elevated.

B12 can be found in blood test results, not urinalysis. I thought you said Jengo didn't have B12 deficiency because you saw the results. Maybe your vet didn't test his B12 and B9. Does she know you are giving him a B12 supplement? Urine protein 2+ is bad but could be worse, and I don't think he's on a very high protein diet like raw meat. I assume your vet didn't check his UPC? Did you check with your vet the correct dosage of phos binder?

It looks like your vet wants to see if Amlodipine alone could lower his BP because introducing new meds could potentially spike liver enzymes. Did ALT, AST, GGT, Total Bil look ok? I don't know what UTI has anything to do with Benazepril as it's an ACE inhibitor and is primarily used to manage conditions like CKD, High BP, and heart disease. Maybe your vet has mistaken it with an antibiotic?
Pimobendan is often prescribed to HCM patients as it helps increase the function of the left atrium and left ventricle during the pumping phase.

Don't put off ordering omega 3 any longer. I think you said you were going to last week. It's fine you insist on getting the liquid omega 3 but know that it oxidizes quickly once opened even if you keep it in the fridge.

I'm losing it because of lack of sleep, I'm fumbling around with too many tips and emails, have to narrow it down. He's getting weaker and I'm trying to figure out why. Is the Amlodipine dose too high? The vet wants him on it for 3 to 4 weeks before checking it. That doesn't sound right to me. Maybe she just wants to write him off because I ask too many questions. Back to his old vet???

The last email I got from the new vet about having his BP checked (when she canceled the appt) she mentioned that he has HCM and to put him on Pimobendan. Her partner had him on it for a month 6 months ago, did an ultrasound and then said he didn't need it. This is why I'm frustrated with vets!!!

Yes, I hate stressing him out taking him to the vet anyway but I haven't been able to get an accurate reading on the home machine. Took it with me to the last appt. at the vet and she could get it to work either. It got fair reviews... maybe his little leg is too thin for the smallest cuff. ???

His phos was high normal at 6.2 range is 2.9 to 6.3 and his calcium was 10.2 normal is between 8.2 to 11.2. Potassium was 4.9 normal between 3.7 to 5.2.

Right, I don't think B12 and B9 were in the IDEXX blood test. Isn't that a different test done by TAMU? I always take a current list of everything he on when I see the vet. Isn't the "Urine Protein 2+" the same as UPC???

His ALT, AST, GGT and Total Bil were all in the normal range. She said that his white count wasn't elevated so no UTI. "His urine protein is either from his renal disease and/or hypertension."

I takes so long to get orderes from Amazon.com that I was going to get the omega 3 from the local pet store when I go to town in a day or so.

Thanks for all the tips and moral support. Lack of sleep is turning me into a zombie. Twice last week I drifted off with my hands on the keyboard and woke up to some gibberish. Hope all is going well at your end. Take care now. Barb

 

[F+V]

What's the current dosage of Amlodipine? Typical dose seems 0.057-0.114 mg per pound, though I'm not sure. The effects of the drug on BP can usually be observed within 4-7 days. Maybe your vet told you to come back in 3-4 weeks time because she thought a trip to the vet could be very stressful for even healthy cats, and to be frank it's pointless to measure BP again because it's highly likely his BP will be over the top due to stress. I ask way too many questions as well and am likely persona non grata.

What made your new vet to suspect Jengo has a HCM without an echocardiogram? Cardiac Troponin I or Pro-BNP blood test?

It's great that his Phos, Cal, Potassium as well as liver enzymes and WBC are within the normal range! B12 & B9 can be ordered through IDEXX or other labs depending on the relationship with the vet. Incidentally, WBCs also elevate in the absence of UTI when there's an infection or inflammation.

Urine Protein of 2+ is not the same as UPC. Typically when Protein is detected UPC is performed to confirm significant proteinuria. In Jengo's case protein loss in the urine is likely due to high BP, so amlodipine or other antihypertensive meds are prescribed if systolic BP > 160. ACE inhibitors and Omega 3 also help reduce proteinuria. If proteinuria is severe, anti-thrombotics should also be taken to prevent blood clots.

Take good care of yourself. Have a nap with Jengo if you can.

 

[Sillycat41]

What's the current dosage of Amlodipine? Typical dose seems 0.057-0.114 mg per pound, though I'm not sure. The effects of the drug on BP can usually be observed within 4-7 days. Maybe your vet told you to come back in 3-4 weeks time because she thought a trip to the vet could be very stressful for even healthy cats, and to be frank it's pointless to measure BP again because it's highly likely his BP will be over the top due to stress. I ask way too many questions as well and am likely persona non grata.

What made your new vet to suspect Jengo has a HCM without an echocardiogram? Cardiac Troponin I or Pro-BNP blood test?

It's great that his Phos, Cal, Potassium as well as liver enzymes and WBC are within the normal range! B12 & B9 can be ordered through IDEXX or other labs depending on the relationship with the vet. Incidentally, WBCs also elevate in the absence of UTI when there's an infection or inflammation.

Urine Protein of 2+ is not the same as UPC. Typically when Protein is detected UPC is performed to confirm significant proteinuria. In Jengo's case protein loss in the urine is likely due to high BP, so amlodipine or other antihypertensive meds are prescribed if systolic BP > 160. ACE inhibitors and Omega 3 also help reduce proteinuria. If proteinuria is severe, anti-thrombotics should also be taken to prevent blood clots.

Take good care of yourself. Have a nap with Jengo if you can.
QUOTE]
His Amlodipine dose is "1/2 a tablet once every 24 hrs". They are 2.5 mg so 0.125 mg. I read online that the starting dose is usually 1/4 to 1/2 a tablet. (1/3 being 0.625). I wondered why she didn't start him on the lowest dose since he is so frail and thin... down to 8# now. I also read that about the effects can be observed after 4-7 days, that's why I questioned her about waiting for 3 to 4 weeks. Yes, trips to the vet are stressful for him but I thought we should make sure that the dose wasn't too much and making his BP too low. He is walking slower each day... breaks my heart to watch him going down hill and not to be able to stop it. :-( There are two mobile vets in the U.P.... neither one of them will come out to where I live. i thought if they could take his BP at home that would be a more accurate reading.

I saw a different vet at that clinic back in Dec. She was the one who heard a heart murmur and did an the pro-BNP test. The results back then were 354 and now it's 531. I read somewhere that anything over 270 means a heart issue. That vet prescribe Pimobendan . But then she did an ultrasound and said he didn't need to be on it if it cause lethargy. Now her partner says he should be on it. The first vet is still on maternity leave... it's been several months now... so I can only go by what she put in this records/

The vet just emailed and gave me a short appt. on Friday just to check his BP and get a urine sample. I'll ask if it's a UPC test for proteinuria. I already asked her about putting him on an ACE inhibitor but her response was:
" I need to know where his blood pressure stands on Amlodipine first, before I can add in Benazepril, because I don't want to cause hypotension. Yes, Benazepril can be used for proteinuria, but it is also an adjunctive blood pressure medication, though it doesn't work as well as Amlodipine does for this use. It has already been shown by his last lab work that his kidney values are greatly increasing, prior to being on Amlodipine. Again, he has HCM and CKD which make it difficult to treat the side effects from one, without possibly making the other disease worsen some."

Somehow I get the impression that she's given up on him because of his last blood work with elevated BUN and Creatinine.
me
I'm falling asleep at the keyboard again. Time to take a nap. Thanks for writing. Barb

 

[F+V]

I thought you went to a different clinic when you said you found a new vet.... you can ask on Friday when she intends to prescribe an ACE inhibitor after measuring Jengo's BP if she still wants to wait despite the high BP. He's been on a prescribed dose of Amlodipine for at least a week, hasn't he? I would read everything on Tanya's CKD site Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat I would also explore holistic as well as TCVM.
Everything comes down to managing his BP it seems. High BP deteriorates his heart and kidneys which leads to proteinuria. If you don't see improvement on the current dose of Amlodipine, he needs an ACE inhibitor. When first starting both Amlodipine and Benazepril, it can potentially cause hypotension. Hypotension can lead to symptoms such as lethargy, decreased appetite, cold extremities or pale gums, and in severe cases collapse, so your vet's concern is warranted. Dehydration also makes cats more susceptible to BP drops. To prevent that you can begin with a low dose of either med and monito the response before adding the second, recheck BP 3-7 days after adjusting the dose and regular kidney function tests to ensure creatinine and BUN levels don't worsen due to reduced kidney perfusion from low BP.
Getting a veterinary BP measuring machine for home is also an option, though it won't be cheap. Our vets told me their BP machines cost $2 to 3k. But one of their patients uses a device sold on Amazon for around $300 and when compared the results, they were both similar according to my vet.

 

[Sillycat41]

I thought you went to a different clinic when you said you found a new vet.... you can ask on Friday when she intends to prescribe an ACE inhibitor after measuring Jengo's BP if she still wants to wait despite the high BP. He's been on a prescribed dose of Amlodipine for at least a week, hasn't he? I would read everything on Tanya's CKD site Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat I would also explore holistic as well as TCVM.
Everything comes down to managing his BP it seems. High BP deteriorates his heart and kidneys which leads to proteinuria. If you don't see improvement on the current dose of Amlodipine, he needs an ACE inhibitor. When first starting both Amlodipine and Benazepril, it can potentially cause hypotension. Hypotension can lead to symptoms such as lethargy, decreased appetite, cold extremities or pale gums, and in severe cases collapse, so your vet's concern is warranted. Dehydration also makes cats more susceptible to BP drops. To prevent that you can begin with a low dose of either med and monito the response before adding the second, recheck BP 3-7 days after adjusting the dose and regular kidney function tests to ensure creatinine and BUN levels don't worsen due to reduced kidney perfusion from low BP.
Getting a veterinary BP measuring machine for home is also an option, though it won't be cheap. Our vets told me their BP machines cost $2 to 3k. But one of their patients uses a device sold on Amazon for around $300 and when compared the results, they were both similar according to my vet.

I've only been to two clinics with him... 17+ years a his old clinic and a year + at the new clinic closer to home. His old vet is in his 60s and there are two young women maybe 30 at the new clinic. I was seeing one exclusively but she has been on maternity leave for several months and see I'm seeing her partner now. It was the first women who put him on Vetmedin (Pimobendan) after seeing the results of his Cardiopet proBNP test results in March. Then a month later she did an ultrasound of his heart and said he didn't need to take it.

However now her partner says he should be on it. She's the one who checked his BP and put him on Amlodipine... wanted him on it for a month before bringing him in to recheck it. I thought that was too long to wait for a recheck so I pressed her on bringing him in sooner... thus the appt. Friday. I read online that cats with high BP that are on Amlodipine also are on Benazepril so I asked about that. She wants to wait and see how the Amlodipine does first. He's been on it for about 3 weeks except that I stopped it for a few days because I thought he was having a bad reaction to it.

I've been reading Tanya's and email her a clip I found. I think she got upset because she wrote back about her having a vet degree. Actually I'm not very confident in the BP readings she is getting. It seems to take her a long time... 10 minutes... and the last reading was 230!! I can't get the home BP machine to work so that's out.

I did read that high BP deteriorates the kidneys and he has Proteinuria according to his last urinalysis: Urine Protein 2+. That's why I asked her to prescribe it. The longer she waits, the more damage is done. She may be worried about hypotension I guess.

I think we are losing this battle. He's very weak and wobbly... don't think he'll last thru all these trials. Sure wish we had better vet care near here. I don't have much faith in these vets. I'm very depressed at the way things are going.
Take care now.

 

[F+V]

I find it strange that the old vet prescribed Pimobendan based solely on the results of proBNP. The med is typically prescribed after an echocardiogram detects left atrial enlargement, systolic dysfunction, or fluid buildup in the lungs.

It takes a long time to measure cat's BP because as you understand their BP is all over the place in a stressful situation. Since he's been on Amlodipine for at least 10 days, hopefully you will see some improvement on Friday.

Since you can't take him to a more advanced hospital for extensive diagnostic tests and can't get your hand on a reliable BP machine, and don't explore alternative medicine, and I don't think you got his stool retested, all you can do now is spend the quality time with Jengo and make him as stress free as possible. 18 years is impressive, and I'm sure you did everything in your power.

 

[Sillycat41]

I find it strange that the old vet prescribed Pimobendan based solely on the results of proBNP. The med is typically prescribed after an echocardiogram detects left atrial enlargement, systolic dysfunction, or fluid buildup in the lungs.

It takes a long time to measure cat's BP because as you understand their BP is all over the place in a stressful situation. Since he's been on Amlodipine for at least 10 days, hopefully you will see some improvement on Friday.

Since you can't take him to a more advanced hospital for extensive diagnostic tests and can't get your hand on a reliable BP machine, and don't explore alternative medicine, and I don't think you got his stool retested, all you can do now is spend the quality time with Jengo and make him as stress free as possible. 18 years is impressive, and I'm sure you did everything in your power.

I wondered about that too since I read on the forums that his proBNP wasn't that high at the time. Now it is higher though and her partner says he should be on it after looking at his records. So far no fluid in the lung... I would hear it, right? Can't have another ultrasound of his heart done at this clinic since it's the vet who is still on maternity leave that does them. She also detected a heart murmur which his old vet didn't.

I am so frustrated with the veterinary care... wish we had some specialists around here. His life and mine will be shortened due to the stress from all this. :-(

I am very disappointed that I can't get an accurate reading with the BP monitor I bought. I've watched videos and read about how to put it on his leg or base of tail, but I'm wondering if his legs are too skinny. I would like to try alternative medicine but I think it's probably too late for any more supplements. Doubt that there is a miracle cure out there. I have purchased so many supplements recommended but people on the forums that I have to spread the administering out over the day... bugging him to get another pill down his throat. He's been very tolerant but I think he's close to having enough of this.

You recommended that special omega-3 that's rather pricey and I didn't order if because it'll take a long time to get here and he might not late that long. Plus can it possibly make a difference at this point??? Wish I'd found out about it months ago... now it's too little too late. :-(

His stool was tested 10/29 and nothing was found. Most of his stools are normal now with occasional soft ones with lumps... no diarrhea thankfully. The soft ones could be from different foods or not putting enough psyllium in.

I'm on a terrible guilty trip because I feel like his life was cut short because I neglected to push the vets to check his blood pressure 2 years ago when he was diagnosed with CRF. I thought that he'd live to be at least 20. He's a tough little guy but I can tell that he is getting tired of being poked with needle for sub-Q and also getting pilled. He still forgives me though but for how long.

Thanks for your suggestions and support... appreciate it.

 

[F+V]

If the old vet didn't detect a murmur but the new vet recently did, which implies his heart condition is worsening unless the old vet missed it. And you need an echocardiogram, not ultrasound to accurately diagnose HCM. If the new vet thinks he could benefit from Pimobendan, you could give it a try but might want to ask about potential side effects.

On Amazon there are many devices that look almost identical but lower-priced ones are apparently useless. Some come with optional cuffs for cats and small pets by the way.

If it was my cat, I would try anything from alternative meds to pricey supplements even if it takes a while to get delivered. If you had ordered antinol when I first mentioned it, surely it would've arrived by now. And that could be taken by your 3 year old too, and they should while still young and healthy. There's no guarantee any of these work for Jengo, but your vets seem unhelpful or that's the best they could do at a small town clinic.

The last time you gave me a list of meds and supplements you were giving, there weren't that many. Did you add new ones recently beside the BP med? Making him stress free is of utmost importance when no further diagnostic tests are available. If you can drop any of supplements or meds (zofran comes to mind), that's a good start. Did you ask your new vet if he should keep taking zofran? I don't remember if you confirmed with your new vet if the subQ amount is appropriate, but you'd better make sure.

It's possible that his persistent diarrhea was from taking antibiotics for a long time, and that's good to know he doesn't have c. perfringens anymore.

This is a good probiotic supplement that contains reuteri. This is for babies but can be taken by cats and adults humans BioGaia Nurture & Grow - Probiotic Drops

And some of these contain Pediococcus acidilactici as well as s.boulardii Plant-Based Probiotics for Dogs and Cats' Digestive, Joint, and Urinary Health | Imagilin® USA

If he's taking any other probiotics, you might want to review what probiotics they are. If he's not taking any, he should start taking them not just for his gut health but for his kidneys.