Daisy, an 8 y.o. f/s dsh cat, had a history of mild azotemia since 3/09 and 3-4/6 heart murmur. Her owner brought her to the DVM on 6/16 after 2 weeks of lethargy and declining appetite. She had lost 2.5# and was down to 9# at that time. Lab results of note : BUN 89, CR 8.8, Phos 10, K 3.6, HCT 22%, 3+ blood in urine with Ca ox. crystals. XR showed bilateral ureter stones. 48h of IV fluid therapy did not move the stones.
I first met her on 7/7, and she was down to 8.3#, was lethargic and not eating well. Her lab values at 7/7 were BUN 110, CR 10.8. She had been getting 100ml fluids SQ each day at home (added K, as she was also hypokalemic). SHe was BAR in exam room and did not seem like a "sick" cat. (She actually tried to escape in the middle of her AP.) Her pulses were very hard to find. R femoral so soft I could barely locate, L femoral soft but choppy (quick fall off). Tongue moist and whitish in center with reddish margins. I placed needles at BL23, BL24, BL25 and ST 36R, for about 10 min. Bilaterally GB25 were covered with mats and not accessible. She had not groomed for a while and would not stand for brushing.I did not notice active pts along Shao Yin, but could have missed something.
She hid for the entire afternoon after this first AP and was lethargic the next day. The following day she resumed playing with her cat nip ball (had not done so for a while)and was eating a little better.
Next week for second AP I felt P&T were unchanged. Placed BL23, 24,25 and GB25R. Started her on 3 Seeds (Kan bottle dose). She had no trouble after this TX and finally started grooming again. At some point during the week she "groomed" a large pile of mats off of her left flank and left a significant hairless patch. (Was this pain??)
Due to scheduling I did not see Daisy again until 8/4. At this time her tongue margins were pinker (but her HCT was also dropping), L pulse same and could not find R pulse. Her owner reported that Daisy's behavior had started to decline 5-6 days prior to this, i.e. decreased playing, appetite, and more lethargic, and had stopped grooming. After her AP (BL22, 23, 27, GB25L) she again resumed grooming and playing and her appetite improved. So, through trial and error we determined that the AP seemed to be making her feel better (using different combos of BL22-25, BL27, GB25 +/- ST36 with about 6-7 total needles). Her owner feels that Daisy starts to decline if she does not have AP about every 10 days. I would like to stretch out the intervals if we can.
Currently Daisy is "stable," at a weight of 8.3#. She is acting "almost herself," which she had not been doing since May. She is still eating but has boycotted everything except Evo dry. I really want her to eat more. Her latest Chem is very concerning, as HCT has slid to 15%. Latest BUN is 121, Cr 8.0, Phos 9.3. She was also lymphopenic (784).
Where to go next? What more can we do to help this little cat? Would Reh 8 be helpful? The primary DVM was going to suggest Epogen, or the newer EPO drug. Thanks!