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I have a 14-year-old cat, Wintressia, who means the world to me (I'm sure you all understand). I have been admittedly neurotic about her health since "our" dog (in her mind, the cat "owned" the dog, not me) died of cancer two years ago. So whenever anything seems even the slightest bit off with Win, we head to the vet.

Six months ago, her bi-yearly "senior checkup" and bloodwork were normal - at least, that's what the vet said at the time.

At the beginning of last week, Win's attitude and behavior seemed a little bit off. She had an appetite - she still begged for food and ran to the food dish the second I put it down - but she then seemed unwilling to eat. She'd take a few tiny licks or bites of the food and walk away, but if I acted as if I was going to the cupboard to get a new can of food, she ran over and began to beg as if she was starving. If I offered her the food again, or new food, she would sniff, lick, and then leave. She is usually a black hole for food, so this was completely off-base for her.

Last Tuesday she vomited, almost immediately after eating. The vomitus was basically just undigested food with a few blades of grass. I didn't want her to be starved or dehydrated, so after cleaning up the barf, I offered her a small amount of fresh food. She seemed to have an appetite and consumed the food. She hasn't vomited since, and although her appetite is lessened, she still eats. I took her to the vet on Thursday, though, since she's an older cat and I'm paranoid.

The vet called me Friday night with the blood/urine results. She started off by telling me that my cat had lost approximately 75% of her kidney function. Off to a great start with the news, there, doc - thanks!

She said most of Win's bloodwork/urine tests looked normal, except for her "kidney enzymes".

Win's BUN is 53 (vet said upper limit of "normal" is 36)
Win's creatinine is 2.8 (vet said upper limit of "normal" is 2.4)

The vet did mention that her phosphorus levels are normal, though she didn't give me the exact amount. She also said that Win's urine was still concentrating properly, whatever that means. When I asked her to explain what that meant, she said "Don't worry about it."

My vet also didn't outright SAY that Win has CRF/CKD, but with those elevated levels and the whole "lost 74% of kidney function" thing, I'm assuming that's the diagnosis I'm rolling with.

I asked for treatment options, and my vet said that at this level, she wanted to start Win on "Azodyl" and put her on a low-protein diet. She recommended Science Diet - which they sell at the vet's office, of course. One whole wall is devoted to SD products.

I'm not trying to bash Science Diet or Royal Canin, as I know they're good companies who have spent a lot of time and money developing special-needs diets, but I really, really wanted to stay away from grains and grain by-products. I looked at some of the ingredients listing for SD k/d formula: Pork By-Products, Brewers Rice, Oat Fiber, Corn Starch, Psyllium Seed Husk - and I know that psyllium seed husks are what's in human fiber/laxative products like Metamucil. Cats don't need to be sucking down Metamucil.

After feeding my cat Weruva, which she loves and is grain-free, it seems almost negligent of me to move my cat back to a food that's filled with grains and grain by-products. I know many cats thrive on diets of commercial pet foods which are mostly grain-based, and I probably sound like a premium-food snob, but aaargh. I just don't know what to do. Weruva is about 66% protein, depending on the flavor - and something like the SD k/d formula is 28% protein.

I've also read a lot of things - written by vets - that say that a low-protein diet for CRF cats is not PROVEN to be helpful and may in fact be harmful by leading to muscle loss. A lot of times I've seen the mantra repeated "it's better that your cat eats SOMETHING, rather than waiting for it to eat the prescription diet."

I've been reading some other sites recommended for cats with CKD/CRF (Tanya's - felinecrf.org - has been particularly helpful) but I'm still kind of working through the shock of "your cat may die of this". Win is all I have left from a large "family" of pets, and I'm nowhere near ready to lose her. I'm willing to do anything for her, subcutaneous injections, medications - but I don't want to be making her worse by feeding her the "wrong" diet.

I'm seriously feeling sort of neglected by my vet in this situation - the clinic I go to has several different vets, and I see a different one each time I take Win in. I feel like I get no consistency of interaction with the vets, and even though they all have access to Win's medical records, I just feel... lost in the shuffle. The vet who called with the results sort of glossed over things, and when I asked what the next step was, she said "oh, bring her back in two months, that's all." I'm thinking of going to a feline-only clinic nearby for a second opinion of sorts.

Win has been on the Azodyl since Saturday night. The vet also sold me a few cans of Royal Canin renal diet and Science Diet k/d. Her appetite still isn't great, but I've gotten her to eat some of the Royal Canin and some of her old favorites (Ziwipeak and Weruva). I keep going back to the ingredients in these so-called prescription diets - why do vets think it's okay to feed a grain and grain by-product-filled food to an obligate carnivore?! Aaaargh. :/

Has anyone here had any personal experience with choosing to keep their cats on a normal diet instead of the prescription low-protein diet? Conversely, does anyone have any personal experience with a low-protein diet being effective?

Also, are there any specific things I should ask my vet (or a new vet...) about CKD/CRF?

Since CRF kitties need to have lots of moisture go through their systems, has anyone tried lightly wetting their cat's paws with water and sort of tricking them into ingesting the water when they lick it off? I'm not going to traumatize my cat by jamming her paws into the sink or anything, but I'm thinking more along the lines of dripping some water from my wet hands onto her paws.

Sorry for the extra-long rambling post - I'm surrounded by non-pet-lovers IRL and it feels very comforting to have a community to talk to. I'm still pretty jumpy and freaked out by this whole CRF thing and haven't quite gotten over the guilt that it's my fault because I fed Win mostly kibble throughout her youth. :{
 

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She probably wouldn't appreciate you putting water on her paws...You can mix a couple teaspoons of water into her food. Or see if a pet water fountain would interest her in drinking more.

Don't really know about the food, but I didn't feed any "special diet" to the 2 cats I had that lived to 17 and almost-18.
 

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I recommend that you join these 2 yahoo forums right away:

Feline-CRF-Support : Chronic Renal Failure Cats


http://pets.groups.yahoo.com/group/Calcitriol/

There is a TON that you need to learn quickly. Unlike in 1989, when my cat Lenny was Dx'd w/ CRF, you no longer have to spend hours in the science library, interlibrary loaning books from vet schools. There are now these 2 awesome groups, as well as several good websites (one linked above). I recommend not wasting time--go to the main CRF group and post your kitty's numbers and other info. You will get some really great advice from vets and people who have dealt with this and who have really done the research.

Most vets are really NOT up on the most recent trends in CRF treatment (even, really, some older ones). So you will need to educate yourself so you will know what to ask for.

Hang in there!
 

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Oh, and your cat needs to be on CANNED FOOD ONLY. I'm not a Hills fan. I would put her on any canned food she will eat (preferably grain-free). Keep tabs on her phos level and get a phosphorus binder ASAP to add to her food if it goes up.

You need to know all her numbers. Ask the vet to fax you the bloodwork and to do that automatically from hereon out. You will need this info before posting on the CRF group.
 

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I've also read a lot of things - written by vets - that say that a low-protein diet for CRF cats is not PROVEN to be helpful and may in fact be harmful by leading to muscle loss. A lot of times I've seen the mantra repeated "it's better that your cat eats SOMETHING, rather than waiting for it to eat the prescription diet."
Honestly, the low protein thing was debunked YEARS ago. It's not protein that puts strain on failing kidneys, but phosphorus. And yes, most high protein foods are also high in phos. But that can be dealt with by adding a phos binder (you can order OTC on the internet) to the cat's food. This can be done now or wait until phos goes up -- I would probably start now.


Aluminum Hydroxide - Thriving Pets

Lots more info at the CRF group.

've been reading some other sites recommended for cats with CKD/CRF (Tanya's - felinecrf.org - has been particularly helpful) but I'm still kind of working through the shock of "your cat may die of this". Win is all I have left from a large "family" of pets, and I'm nowhere near ready to lose her. I'm willing to do anything for her, subcutaneous injections, medications - but I don't want to be making her worse by feeding her the "wrong" diet.
Here's the thing: She WILL die of this, or something triggered by it or made worse by it. You know that now. Your goal is to extend her life, with good QUALITY of life, as long as possible. This is hard to deal with, I know, but everyone has to die of something--no one is immune to that. At least you know what her problem is, you caught it relatively early, and there ARE things you can do. You will have to be very proactive, however, b/c your vet is more than likely not really up on all this stuff.

There is a clin trial for stem cell therapy in CRF in cats:

http://www.news.colostate.edu/Release/6352

http://www.amcny.org/sites/default/files/clinical%20trial%20web%20protocol%20feline%20MSC.pdf

A friend of mine is trying to get her 2 CRF cats into it--you might contact them as well.
 

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I'm sorry about Win. I wish I could help but I'm not well-versed in this sort of thing. MY sister's Cheshire cat was diagnosed with CRF and Diabetes 2-3 years ago, though, and he's still around to squawk for food.

If you don't mind my asking, how long have you been feeding her grain-free (Weruva/Ziwipeak)?
 

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I am sorry for Win's diagnosis, but I want to assure you that it's not as bad as it sounds at this point. Yes, it appears that she's in renal failure, but that's no big surprise for an elderly cat. In fact, I have become increasingly convinced that most or all cats will go into renal failure eventually if they live long enough. Old bodies wear out, and in cats, the kidneys seem to be the organs with the shortest natural lifespan.

I've been through CRF (CKD) with quite a few of my own cats over the decades, and I currently live with four CRF cats. I know this road regrettably well. You've already made four of the most critically important achievements relative to your cat's diagnosis: 1) you got her diagnosed early in the course of the disease, 2) you started researching CRF (most importantly, you found Tanya's site, which is our CRF "bible"), 3) you're prepared to learn the skills necessary to manage Win's disease, and 4) you've already recognized the need for an effective veterinary partner and are prepared to leave your current vet in search of one who will provide the sort of proactive care Win needs. CONGRATULATIONS! You are well on your way to becoming an exemplary CRF caretaker!

Here's the next step I recommend you take ASAP. Go to your current vet and obtain hard copies of ALL of Win's current and past lab results (blood, urine, and any other tests run on her over the course of her lifetime with you). You should maintain all of these records at home so that you can reference them when researching her condition. You will also find it extremely helpful to put all of her labs into a database on your computer so that you can easily track any changes over time. Vets rarely have or take the time to go over a patient's complete lab history at every exam, so they're likely to miss what may be very important changes in condition. It'll be up to you to track these changes and bring them to your vet's attention at every exam to make sure they don't get overlooked or dismissed. Any time you have tests run on any of your animals, you should ALWAYS obtain copies of the results for your own files.

whenever anything seems even the slightest bit off with Win, we head to the vet.
Thank goodness for your paranoia! That's what will make the difference in Win's health going forward with CRF.

She had an appetite - she still begged for food and ran to the food dish the second I put it down - but she then seemed unwilling to eat
That's common behavior for a nauseous cat. They know they're hungry, but the smell of food makes them nauseous. It's quite common for CRF cats to have a buildup of stomach acid that irritates the stomach and makes them nauseous. That's why one of the most common CRF meds is an acid blocker like Pepcid AC or Zantac 75. Read up on them at Tanya's. Win would likely benefit from one of them.


The vet called me Friday night with the blood/urine results. She started off by telling me that my cat had lost approximately 75% of her kidney function.
This isn't at all uncommon. Elevations in creatinine and BUN don't generally occur in bloodwork until at least 66% of renal function has already been lost. Many cats maintain good quality of life with as much as 90% renal function loss.

Win's BUN is 53 (vet said upper limit of "normal" is 36)
Win's creatinine is 2.8 (vet said upper limit of "normal" is 2.4)
Of these values, creat is of much greater significance in a CRF cat. BUN can elevate for non-kidney-related reasons, but creat is kidney-specific. Win's creat classifies her in Stage 2 CRF, which is the earliest stage in which CRF can be diagnosed via bloodwork.

BTW, it would be very helpful if, when you obtain her most current lab results, you post them here for us to take a look. Please post ALL results (not just those out of normal range), and include the lab's reference ranges like so:

BUN 53 (18-36)
creat 2.8 (1.2-2.4)
etc.

It's important to include the lab's reference ranges, because those ranges vary somewhat from lab to lab depending on the equipment and testing techniques used.

The vet did mention that her phosphorus levels are normal
That's excellent, though you need to know the exact value. The lab's normal reference range for phos may extend as far as 8.5 or higher, but a CRF cat should be maintained below 5.0 (ideally below 4.0).

She also said that Win's urine was still concentrating properly, whatever that means.
That's very good, but again, you need the lab report to know exactly what Win's USG is at this point. You can read about this on Tanya's site here:

Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Urinalysis

My vet also didn't outright SAY that Win has CRF/CKD, but with those elevated levels and the whole "lost 74% of kidney function" thing, I'm assuming that's the diagnosis I'm rolling with.
Read this page and its links:

Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Diagnosis

I asked for treatment options, and my vet said that at this level, she wanted to start Win on "Azodyl" and put her on a low-protein diet. She recommended Science Diet
Typical veterinary advice.

I really, really wanted to stay away from grains and grain by-products.
I agree.

I know that psyllium seed husks are what's in human fiber/laxative products like Metamucil. Cats don't need to be sucking down Metamucil.
CRF cats often have problems with chronic constipation, for which psyllium husk can be very helpful. One of my CRF cats has this problem. I give her psyllium, Miralax, and subQ fluids to manage her constipation.

I've also read a lot of things - written by vets - that say that a low-protein diet for CRF cats is not PROVEN to be helpful and may in fact be harmful by leading to muscle loss. A lot of times I've seen the mantra repeated "it's better that your cat eats SOMETHING, rather than waiting for it to eat the prescription diet."
This is why I, and a number of other CRF caretakers, don't even attempt to feed the low-protein renal prescription diets until the cat is in end-stage (stage 4) renal disease. Even then, I've never had a CRF cat who would eat any of the renal prescription diets. I feed them whatever they want in order to keep them eating sufficiently for as long as possible. I try to stay away from kibble, but if that's all one of my CRF cats wants to eat, then kibble it is.

I'm still kind of working through the shock of "your cat may die of this".
CRF will eventually be fatal because it is a progressive disease ... unless something else kills your cat first. It serves no useful purpose to dwell on the inevitability of death. Just take each day as it comes and enjoy every minute of your time with Win.

I don't want to be making her worse by feeding her the "wrong" diet.
The only truly "wrong" diets are those that are toxic (like those containing chocolate, onions, raisins, etc.) and those that she refuses to eat.

Also, are there any specific things I should ask my vet (or a new vet...) about CKD/CRF?
Research calcitriol, which is most effective in early stage CRF, and print out the website linked below to share with your vet:

Calcitriol Reference Page

Since CRF kitties need to have lots of moisture go through their systems, has anyone tried lightly wetting their cat's paws with water and sort of tricking them into ingesting the water when they lick it off?
Is your cat drinking excessively? I'm guessing not, if she's still concentrating her urine well. It certainly wouldn't hurt to mix a significant amount of warm water into her canned food to create (canned food soup) that she can lap up. That would improve her hydration.

Is she constipated at all? Are her stools small and hard, or elongated and firmly squishable? If they are small and hard (like hard clay marbles), she definitely needs the extra hydration.

I'm still pretty jumpy and freaked out by this whole CRF thing and haven't quite gotten over the guilt that it's my fault because I fed Win mostly kibble throughout her youth. :{
If you must feel guilt (which I know from a lifetime of experience can be nearly impossible to shake) use it productively to keep you extra vigilant going forward. And remember that organs age. There's nothing we can do about that. Her kidneys would have lost function eventually, regardless of what she did or didn't eat over the years. Maybe they would have remained healthy longer if she'd eating a natural prey diet her entire life. Maybe not. That's all moot now.

Laurie
 

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I agree w/ laurie--about everything above, but specifically re: records. PM me your email addy and I can send you the excel DB I use to keep track of all my critters' labwork. It really helps to be able to compare current to past results at a glance.
 

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Wow! Laurief is so thoughtful to take the time to break all that down for you. I read every bit of that and took it all in. This is why I joined this forum........the people and information here is truly valuable and unlike anywhere else.
The only thing I can add to this is find a vet or "cat specialist" ( which is what I did ) that is truly an advocat for you and your baby.
One that will take the time to educate you on your baby's condition.
I love my original vet and still take my dog to him. I think he's wonderful with her. But I feel a difference when I take my cats to a cat specialist. I feel armed with knowledge when I leave and I feel when I describe what's going on with my cat they know right away where I'm coming from. I'm not saying a regular vet is unable to do this; it's just been my experience that in my situation, changing to a cat specialist has been beneficial to both me and my babies.
Good luck to you. It's sounds like your very pro-active towards her care which can only benefit her.
 

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If you have a referral practice in your area, with board-certified internists, ask your vet for a referral there. Barring that, you can get referred to the nearest vet school. Either of those places will be up-to-the-minute on calcitriol, phos binders, etc., which your regular vet may well NOT be.
 

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Thank you guys so much for the replies. My family really doesn't understand how important pets can be - in fact, I haven't even told anyone about my cat's diagnosis yet. My German Shepherd was diagnosed with mammary cancer three years ago, and my mother's responses involved such charming things as "cancer is contagious, get that dog away from me" and "when are you going to kill her?"

I'm pretty sure if I told her that my cat had kidney disease/failure, she'd immediately act as though Win actually had the bubonic plague, so I'm trying to keep things under wraps IRL.

I still have to live at home because my father is disabled with a serious brain injury and I am his primary caregiver, but I try to keep my cat out of my family's collective face as much as possible.

I have made an appointment with a feline-only clinic for Wednesday. It's not that I feel like a feline-only clinic is natively superior to an all-pets clinic, but I was really starting to feel as though my cat and I were on a conveyor belt whenever we visit the regular clinic.

Nan - yeah, maybe I'll skip the water-on-the-paws idea ;} I do mix warm water into all of her food now to make delicious Goop Soup, so hopefully that will help her hydration.

Hoofmaiden - Yep, Win's on canned only :} I still have plenty of guilt as she was a kibble kitty for most of her youth/adult life, but three years ago when Ember (the German Shepherd) got the cancer diagnosis, I switched them both to grain-free moist diets. The dog got a homemade raw diet, but Win wouldn't eat the fresh meats, so I found grain-free canned foods that she and I could be happy with.

In the past, she's had:
Wellness
Merrick Before Grain
Ziwipeak
Weruva

Right now she's on the Weruva and occasionally some Ziwipeak. She loves both of them.

I'll also definitely be looking into the stem cell trials, thank you! My aunt had stem cell treatment on one of her rescue dogs and it worked wonders. (Ironically, my dad also had stem cell treatments twice after his initial accident. Sadly, it didn't seem to help his condition.)

Jacq - she's been on grain-free food for about three years. For a while I gave her a mix of grain-free kibble (free-fed Merrick Before Grain) and canned grain-free, but she's been sans kibble of any kind for around two years. I actually didn't have much trouble transitioning her from her "kibble addiction", thankfully!

Laurie - Thank you so much for taking the time to go over so many things with me. I did see Pepcid mentioned on Tanya's site, and I picked some up at the store today, and might try some tonight before dinnertime.

It's also been a brutally hot summer lately, so some of Win's loss of appetite could be due to the heat.

I've gotten a hold of Win's urinalysis. I've scanned the pages and popped them onto my personal website in case it's easier to have a look at the little graphs. (I snipped out the clinic's name just in case.)

http://www.splintyr.com/wintressia/crf/urinalysis_8.17.12

Here are some of the CRF-notable values:

BUN: 53 (14 - 36)
Creatinine: 2.8 (0.6 - 2.4)
Phosphorus: 4.2 (2.4 - 8.2)
Calcium: 10.2 (8.2 - 10.8 )
Potassium: 4.3 (3.4 - 5.6)
Hematocrit / HCT: 38 (29 - 48%)

Other values that were flagged as "high":
Amylase: 3057 (100 - 1200)
CPK: 664 (56 - 529)
Microalbuminaria: 2.7 (<2.5)


On AssistFeed.com, I found: "[CPK] is an enzyme which is very useful for diagnosing diseases of the heart and skeletal muscle. This enzyme is the first to be elevated after a heart attack (3 to 4 hours). If CPK is high in the absence of heart muscle injury, this is a strong indication of skeletal muscle disease."

:/ I'll be sure to bring up that value to the new vet, and whether she's a candidate for calcitriol. I'm also going to get her started on phosphorus binders ASAP, so I'll bring that up to the new vet if she doesn't bring them up herself.

Win's stools are well-formed, long, and somewhat squishable. She doesn't seem to be constipated, as she deposits Number Two in the litterbox at least once per night. She doesn't always return to the litterbox during the day, and sometimes goes in the garden/backyard, but she faithfully uses the box at night with no accidents.

She does pee a lot, in large amounts. But, she hasn't vomited since last Tuesday and no diarrhea at all.

I don't SEE her drink pretty much ever. Sometimes I used to catch her drinking out of the gutter in front of the house (aaaargh), but I haven't seen her do that in months. I've got several bowls of water in various places and one cat-fountain, but I haven't physically seen her use any of them. I'm mixing a good amount of warm water into all her canned food now.

I've also stocked up on various things just in case she decides to stop eating - everything from some all-meat baby food to some clam juice. I've also ordered some of that Catsip lactose-free milk for cats. Win's had it as a treat in the past and she loved it.

Other than a slight lack of appetite, she really seems okay. She has one of those ball-in-a-plastic-circular-track toys, and she goes nuts over it. She spends quite a bit of time playing with it in the garage at night, and is pretty energetic about her play even though she's 14 years old. She's still affectionate and vocal (so very, very vocal) and only has slight hip/joint issues so far. I've had her on a glucosamine/chondroitin supplement for a couple of years now, and I had her on "senior vitamin" treats until recently (she stopped eating them a few weeks before her CRF diagnosis, which is probably a result of the whole lack of appetite thing.)

My apologies for my huge posts. I have a tendency to be pretty verbose and my cat is a subject I can get REALLY wordy about.

I'll update everyone after Win's appointment at the new vet on Wednesday.
 
Thank you all so much for your replies and thoughts! I felt pretty overwhelmed after I got the diagnosis, but now I know I could have several more good years with Win if I pursue treatment.

Win, give everyone a smile!


 
 
 
 
 

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Wow....some great advice.

I can't add to the science, but I can say I had a lovely little Siamese girl who was diagnosed at fourteen and a half and lived happily for another three.

She loved her prescription diet food....and ate it eagerly.

I think it essential that you find a proper vet. I have a fabulous clinic and they talked me through everything and were extremely thorough with Miranda's management, as well as treating her like a princess.

Congratulations on your approach to all this and your love for your cat.

It's so tough when you know they have a fatal condition.....but I know my Miranda had a great quality of life far longer than I ever thought she would.
 

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I did see Pepcid mentioned on Tanya's site, and I picked some up at the store today, and might try some tonight before dinnertime.
Check Tanya's site for dosing information on Pepcid. You may find it most effective given right before bedtime, since acid buildup is often a bigger problem for CRF cats overnight when they don't eat. Also, it's important to note that Pepcid can interfere with the absorption of many other meds and supplements. It's best to administer it at least 2 hrs before or after any other med or supplement (unless you know specifically that it is a med or supplement with which Pepcid does not interfere).

I've gotten a hold of Win's urinalysis. I've scanned the pages and popped them onto my personal website in case it's easier to have a look at the little graphs. (I snipped out the clinic's name just in case.)
Here is a link to downloadable explanations of various blood and urine values that I find particularly helpful in interpreting my cats' lab results:

Broadway Veterinary Hospital / Laboratory Assessment Descriptions

Of specific relevance to you are the following downloadable explanations:

http://www.broadwayvh.com/refId,9196/refDownload.pml
http://www.broadwayvh.com/refId,9123/refDownload.pml
http://www.broadwayvh.com/refId,9005/refDownload.pml
http://www.broadwayvh.com/refId,9080/refDownload.pml

Phosphorus: 4.2 (2.4 - 8.2)
whether she's a candidate for calcitriol. I'm also going to get her started on phosphorus binders ASAP
Most CRF caretakers don't utilize a phos binder until serum phos exceeds 6.0. Those of us who use calcitriol (myself included), will use a phos binder, if necessary, to maintain serum phos below 5.0 in order to maintain full effectiveness of the calcitriol.

Personally, I would not use a phos binder with a serum phos below 5.0. The most effective phos binder, aluminum hydroxide, is very constipating, and constipation can make a CRF cat extremely and painfully ill and entirely inappetant. Then you have to start administering a laxative like Miralax and/or fiber like psyllium daily, along with extra hydration to stave off constipation. I don't like to load any unnatural products into a CRF cat's system until and unless absolutely necessary or unless the benefits clearly outweigh the risks. So, know the slippery slope you're starting down before administering a phos binder to a cat who may not yet need one.

I've also ordered some of that Catsip lactose-free milk for cats. Win's had it as a treat in the past and she loved it.
Dairy is one of those things you're going to want to stay away from unless it's the only thing she'll eat, because dairy is very high in phosphorus.

There are two things I would suggest you do now. One is to have a T3 Suppression Test run to further clarify her thyroid status. Her TT4 is in the borderline high range, and her FT4ED is high normal. The facts that she's very vocal and apparently more playfully active than a typical 14 yr old may be symptoms of hyperthyroidism. Other typical hyperT symptoms of strong appetite and weight loss may be confused or masked by her renal issue. In any event, you need a clear answer about her current thyroid health, and you need to follow up on the thyroid testing every few months to make sure it's not a progressing problem.

The other test I recommend is a second urinalysis performed on a free-catch urine sample (not one taken by cystocentesis). Her urinalysis had blood in it, which may have resulted from the cysto itself. Another urinalysis on a free-catch sample will clarify whether there is actually blood in her urine. If so, the source can then be further explored.

Laurie
 

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I've never had a problem w/ phos binders being constipating. Perhaps more of a problem in kibble-fed cats? You can always reduce the dose as well. I'm a believer in starting it ASAP b/c any amount of phos is damaging the already damaged kidneys. By the time any changes at all are noted on labwork, more than 50% of the kidneys are already destroyed, so they are already working way less efficiently.
 

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Nutritionally speaking, cats require phosphorus in their diets. The goal for a CRF cat is not to eliminate phos entirely, which would compromise the cat's health by completely throwing off the electrolyte balance. The goal is to minimize phos intake as much as possible without causing electrolyte imbalances or depleting the body of essential nutrients.

Calcium-containing phos binders are not reported to cause constipation, but they do have the potential to cause hypercalcemia (and should not be used in animals receiving calcitriol), and they are not as effective as aluminum-containing binders. Aluminum-containing binders are much more effective at binding phos, but they are seriously constipating in many cats, and they do present a low risk of aluminum toxicity with prolonged use.

Laurie
 

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From Plumb's Veterinary Drug Handbook 7th Edition:

"In small animals, the most likely side effect of aluminum hydroxide is constipation. If the patient is receiving a low phosphate diet and the patient chronically receives aluminum antacids, hypophosphatemia can develop.

Potentially, aluminum toxicity could occur with prolonged use. While previously believed unlikely to occur in small animal patients, at least 2 dogs in renal failure have been documented to have developed aluminum toxicity after receiving aluminum-containing phosphate binders ... "

Aluminum hydroxide also has a number of drug interactions listed, including several acid-blockers, thyroid medications, and others.

Adverse effects noted for calcium acetate are as follows:

"Hypercalcemia is the primary concern associated with using high dosages of this agent; adequate monitoring is required. In humans, GI intolerance (nausea) has been reported."

Drug interactions for calcium acetate include calcitriol and others.
 

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Discussion Starter #20
Oh, man, I didn't think that her playfulness could be a symptom of a problem, but now that I've read up a bit on hyperthyroidism, I'll definitely ask the vet to see if she's willing to administer that test to Win. Thank you!

Win has always been ridiculously vocal since kittenhood. We had all the usual theories of "being seperated too early from mom" or "got traumatized as a kitten", but she has been vocal her whole life. In fact, when she ISN'T constantly meowing is when I've taken her to the vet's in the past, as it's a big change in her behavior. I think she really only meows constantly when there are humans present (I let her toddle around with a pet collar camera a few years ago and she didn't meow once...) but I'll keep tabs on her "tone of voice" to see if it sounds different to me lately.

I won't blindly start Win on any phos binders just yet, then, nor on the Pepcid AC. I got her to eat most of a can of Ziwipeak just a little while ago, and a can of Fancy Feast Classic this morning when she wouldn't touch anything else an hour after she had her azodyl. I mixed in plenty of warm water with both foods, making a delightfully hideous slush that Win seemed to enjoy, heh.

I still feel strangely like a horrible pet owner for feeding Fancy Feast (for some reason) ... but as far as I can tell, the Classic flavors are grain-free!

I have her "second opinion" appointment tomorrow morning at 9:30. One of the vet assistants called me just a few minutes ago and advised me to fast my cat from about midnight tonight just in case the vet wanted to do an ultrasound. Just hearing that the vet MIGHT do an ultrasound made me feel so much better about this new clinic. Win isn't just going to be a write-off there, I hope.

Thank you again for all the advice!
 
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