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Discussion Starter #1 (Edited by Moderator)
My cat Tasha, 17 has been treated for crf for two years. I have her blood work done every six months and yesterday I got the bad news; SDMA 43 Creatine 4.8 BUN 64 Phosphorus 10. Her red and white counts are low and Potassium a bit low. She?s also anemic. She?s receiving 100 mg of sub q every other day and now we are increasing it to daily. B12 shots every other week. The vet is going to call in supplements for the Phosphorus and anemia. She?s a bit lethargic but is still social and using the litter box. Very small appetite. Has anyone experienced a cat with similar numbers and they stabilize for awhile? I love her so!
 

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Hi Tasha999 !

The very best information and support for you is likely to come from the specialized online community of people who are already managing their cats' kidney issues - and have been doing this online for many years. They've had thousands of members - and, by joining up there you'll be able to benefit from all of their collective experience.

The group is sponsored by the same woman who wrote and manages the site (that some people call) the "Oracle" of all things kidney-kitties: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat

You'll find them right here: Tanya's CKD Support Group

BEFORE you join, I recommend you get a new, separate email account (Yahoo & Gmail work) - because they use email as their 'operating platform'. A separate email addy will help you best manage the information flow.

If you'd like to know more about the group, there's lots about it here: Tanya's Guide - Support Group

I know you're worried about the numbers - Helen, who's behind the group and the website, has a mantra..."Treat the cat, not the numbers" and, I can tell you from personal experience with her group, that approach pays off! She has included some 'success stories on her site - look for this
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ON THIS PAGE:

- Cats With High Numbers Which Reduced After Treatment
- Cats With High Numbers Which Did Not Change After Treatment
- Cats With Low Numbers Who Remained Stable

in the top left corner of this page: Tanya's Guide - Success Stories . I think you'll see, especially in the second section/link there (High Numbers/No Change), that numbers themselves will not necessarily determine outcomes. We tend to put perhaps too much trust in our Vets....it's important to consider that they do not have 'crystal balls' when they offer dire warnings. Managing kidney issues is really a re-balancing act....when a part of the system goes down, we intervene with a treatment and things level out again.

Do keep us updated.

Hope that helps !
 

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Hi Tasha,

I am so sorry to hear about your kitty. I strongly second Stryker's suggestion about joining Tanya's CKD support group. I did, on his recommendation.

My Celia is 17.5 years old, in stage 4 CKD. Her numbers last month: BUN 104, creatinine 4.7, and phosphorus 7.3. Her potassium is also low, 3.5, and she also has anemia (HCT 20%). Back in January, the BUN was 97 and phosphorus 10, and the vet said it was time. But based on the suggestions I got from members of that support group, and the knowledge I gained from members as well as from the website, I told the vet that I wanted to start potassium supplements, a phosphorus binder, and an ESA if her hematocrit dropped below 20%. I also had to ask for anti-nausea meds, an appetite stimulant, an acid reducer, and pain meds for her arthritis.

Although Celia's now in her final few days, the help I got from that group has given us almost another 3 months together. In fact, we probably could go quite a while longer if Celia were a kitty that tolerated stress and treatment better. However, I can't do fluids at home, syringe-feed, give her pills, etc. because she gets so stressed that she will hide and run away from me for days after a single treatment that isn't even painful.

There are many members there whose kitties have been stable for a long time. even with high numbers. I would add a B complex and more vitamin B12 (but pills, not by injection). I hope you're using aluminum hydroxide (Amphogel) as a phosphorus binder?
 

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Discussion Starter #4
Thanks for your replies. I did join Tanya?s group last year and received valuable information but wanted to hear more successful experiences. She may feel a bit better today. She had doses of the Phosphorus binder so far.
 

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How bad is Tasha's anemia? If her hematocrit isn't below 20% (ie, you won't be starting an ESA), then you might try feeding chicken hearts and/or liver (though liver is higher in phosphorus) to try to raise it. Celia got an iron dextran shot.

I didn't mean to make you feel that you can't still have quite a bit of time with Tasha. In fact, with her BUN still relatively low, I'd think you have a very good chance of keeping her stable for a long time, especially if you can get that phosphorus down with the binder. There are several current members in the support group whose kitties are also stage 4 and have been stable for many, many months.

I should have noted that there is at least one crucial difference between Tasha and Celia, which is that you're doing subQ fluids daily. Celia has been stable for at least the past 2 months, and I know that we could have more time together, but due to her particular personality, I decided not to do any treatments that would stress her duly, and this includes subQs at home. I also opted give only meds that I could give her without causing undue stress. This means she only gets meds that I can hide in food, which seriously limits our options. Since you're already doing subQs, you'd be able to give some of the meds along with the fluids.

From what you say, it seems like the biggest issue is right now is getting her to eat. Is she getting anything for nausea (Cerenia or ondansetron), stomach acid (famotidine or ranitidine) and/or appetite (Periactin, mirtazapine)? Those would help her to regain some appetite.
 

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Discussion Starter #6
Tasha?s Hemocrit is 26.1 but the vet doesn?t want to treat the anemia until she?s on the Phosphorus binder for three weeks. Her Potassium is borderline low. She takes Mirtapizine for appetite and it seems to be working.
 

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So glad that the mirtazapine is working! Celia had an adverse reaction to it so gets Periactin. HCT 26 is not terrible but ideally you want it in the 30s so anything you can feed to bump it up naturally would help with lethargy. Cooked egg white is another option.

Tasha's phosphorus should come down pretty quickly. Celia's was 10 in mid-January, but 8.1 4 weeks later, after a month of phosphorus binders. It only went down to 7.3 the next month, but that was because she was getting less. The aluminum hydroxide doesn't have a taste, exactly, but it is a little gritty, and to me it had a slightly metallic aftertaste. I don't know if that's what Celia thought, but I had to give only a little bit of the binder in her food, or she would refuse it.

If she starts to show any signs of potassium imbalance, especially weakness in her hind legs, I wouldn't hesitate to add a potassium supplement, and B vitamins daily.

Please keep us updated on how she does with the binder and additional fluids!
 

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Discussion Starter #8
An update on Tasha: She went to the vet yesterday, she gained a bit of weight but the vet said it may be due to daily sub q but at least she didn’t lose. I mentioned I was suspect to her eyesight as Tasha lately has been walking along the wall. Her retina is not detached but when the vet took her blood pressure it was 180. Alas blood pressure meds! She won’t have her phosphorus checked for another two weeks. I’ve been successful giving in food so I’m hoping things will be better for awhile.
 

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Tasha, at 17 years old, has had a wonderful run, she has known you, and Love, and care...
Just wishing you both the best...
Sharon
 

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Tasha, I had a kitty who went blind due to retinal hemorrhage/detachment. It sounds like you may have caught the high blood pressure in time to at least prevent further damage, if not to reverse any vision loss. I hope she's on amlodipine? It should work within a couple of weeks. If her BP doesn't come down at the next check, I'd recommend trying the brand name, Norvasc. Margaux (my blind kitty) was on benazapril for over a year, with zero effect, then amlodipine for another year at least, with zero effect. When Celia was also found to have high BP, and amlodipine didn't make a difference, the vet said many kitties didn't seem to respond well to the generic and asked if I wanted to try the brand name, which is oh, 10 or 20x the cost of the generic. But it brought the BP down to normal and controlled it well for years for both kitties.

Fingers crossed that the phosphorus comes down on the next bloodwork!
 

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Discussion Starter #11
She is on Amlodipine, she’s having her pressure and blood work checked again this coming Tuesday, I hope things improve at least a little.
 

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Tasha went to the vet yesterday. For the last two weeks she seemed more tired than usual and didn’t quite seem like herself. The vet took some blood that she spun in house and she became quite anemic.HCT 19.8; RBC 4.1, HGB 6.8. The daily sub q has helped as her BUN and Creatine has come down quite a bit. Her Phosphorus has come down to 7.9 from 10. Her blood pressure is still at 180. The vet is looking into an injection for the anemia and will contact me as soon as she finds the dosage. Another option that was offered was a referral to a specialist to see if there’s anything left to do. The improvement in kidney values is great until it’s not, the vet won’t increase sub q again. I am torn with the specialist as I don’t want to put Tasha through more testing he probably will want to do an ultrasound of her kidneys. This is not a money issue, I am lucky to be able to provide good care for my cats, I just don’t want her to be prodded and poked more than she needs.
 

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The news about the drop in the kidney values is great, though I'm sorry to hear about the anemia.

It is good, though, that your vet is willing to treat with an ESA. If she is only familiar with epogen, as my vet was, ask her to look into darbopoietin (Aranesp). It is slower to take effect, but the big advantage for those of us who don't want to stress our kitties with constant shots and such is that injections are only once a week, v. 3x/week for epogen. Or you could switch to darbo even if you start with epogen. The initial cost for darbo is far higher though, because you get several weeks' worth of doses in one vial.

Oh, I do need to warn you: darbo (and maybe epogen, I'm not sure) is contraindicated with high BP, because they can cause BP to rise. My vet would not start the ESA until Celia's BP came down.

Since Tasha's BP has not come down on the amlodipine, I would really encourage you to ask your vet about switching from generic amlodipine to Norvasc. The vet who recommended this switch for my kitties said that many cats respond well to the brand name but not to the generic, and that was true for both of my kitties.

Tasha might benefit from an iron dextran injection while you wait for the ESA, especially as her hemoglobin is low in addition to her hct. Celia's vet gave her one while we were waiting for her BP to come down.

B vitamins, especially B12, really seem to help a lot of anemic kitties in terms of energy levels, but most vets aren't believers. My vet wouldn't do B12 shots more than once every 2 weeks or B complex more than once a month. He pooh-poohed the value of giving them more frequently. I finally ended up asking if it would hurt to add them. He said no, but I can't tell you whether it was effective or not, as Celia wouldn't eat her food with the B complex added in, and as she wasn't eating well, I didn't dare try to add B12 (though most formulations have no taste).

I'm not sure what a specialist would do either, but this is a question that might be well worth asking the CKD support group.

Since her numbers have dropped since you first posted, there is really no reason that Tasha couldn't do well for a long time if you can get the BP and anemia controlled.

Sorry this is so lengthy, but having just lost my kitty to CKD, I so empathize with your situation and with anyone caring for a kidney kitty.
 

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Discussion Starter #14
Sprite, I’m sorry for loss. Anyone on this site is such a loving cat parent and I know how devastating the loss of a kitty is.

My vet spoke to the head of the specialty hospital, gave him her symptoms which also include sitting sometimes with her head down sometimes not but her stance is not normal. It was recommended that she see a neurologist. He also said to double her dose of bp meds.
 

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Discussion Starter #15
Tasha crossed the Rainbow Bridge yesterday. In addition to CRF she developed a brain tumor that spread rapidly. The vet said she fought a good fight but it was time. I am so saddened and will miss her deeply.
 

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I’m so sorry for your loss. I feel sad as well. Its never easy. The good times you had together will help you through this. She was lucky to have you.

Sincerely
Larry
 

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I'm so sorry you had to say goodbye to Tasha. It is one of the hardest days we ever have so please know you are not alone and we all sympathize with you deeply and fully. Me and Dizzy spent the last 10 months of his 14 years battling health issues so I know the finality of it can leave a hole in your heart but it WILL get better. Remember, our kitties would never want us to be sad,
Tasha is if you choose to believe it in a better place with my boy and all our little ones...:heart
 

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I'm so sorry about Tasha. :(

If you like, and if you'd find it helpful, please consider posting a tribute to Tasha in the Rainbow Bridge section.

It is such an awful decision to have to make, but we do it out of love and to keep our little furry ones from suffering unnecessarily.

Tasha has lots of new friends at the bridge; she already knows Dizzy, and I'll tell Celia to be on the lookout for her.

Sending hugs and much sympathy.
 

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Thank you for your well wishes. This is so devastating, I pray cats really do have nine lives and Tasha one day will come back to us
 
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