Renal failure

Discussion in 'Feline Health - (The Main Forum)' started by Zoey & Carol, Dec 29, 2017.

  1. Zoey & Carol

    Zoey & Carol Member

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    I spoke with the vet again. He said she was eating all the time there. In fact they all were laughing over how much she was eating. He only gave her anti nausea meds the first day. He said since her phosphorus level was down she should not be nauseous. He thought maybe th aluminum hydroxide might not be agreeing with her. They had been giving it to her in her IV and this is a liquid. He said to stop that and see if it helps. Of course that was about a half hour after I gave her another dose!

    The vet said I could drop her insulin down to 1 unit if I wanted to. With it still being so high at +6 today (306) I’m not sure I want to do that. I’ll see what her preshot number is.

    I don’t know about the spec fPL test. I forgot to ask him. What specifically does that measure?
     
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  2. tiffmaxee

    tiffmaxee Well-Known Member

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    I’m so glad she’s improving. Tiffany’s numbers came down but after she was gone went up but not as high as they had been. I would want nausea meds on hand. Mine wouldn’t eat KD well.

    The Spec fPL tests for pancreatitis. It is high carb so you may need more rather than less insulin.
     
  3. Zoey & Carol

    Zoey & Carol Member

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    He did say she had a bladder infection and inflamed pancreas so he must have done the test. She’s on Clavamox.
     
  4. Critter Mom

    Critter Mom Well-Known Member

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    Per the result you got from the vet, the SNAP fPL test was 'abnormal'. The SNAP fPL test is helpful when there's an urgent need to check whether there is any pancreatic inflammation because it can be done on the spot in clinics that offer it. However the SNAP test doesn't shine any light on the degree of inflammation present. The Spec fPL test returns a numerical result which gives an indication of the severity of pancreatic inflammation but it needs to be sent to an external lab and the results usually take a few days to come through.

    But, Mr. Vet, cats don't read the 'should' manual! ;)

    As we say so often here, every cat is different. If a cat has had a major bout of inappetence and nausea it can take quite some time for them to start eating reliably and regularly under their own steam. With a supply of anti-nausea meds at home to be administered as needed, it helps the kitty make steady progress towards a really solid recovery. So often we see here that cats are sent home from the vet or the hospital without a supply of anti-nausea meds and often the kitty's appetite wobbles shortly afterwards, hence my earlier suggestion that you ask the vet to prescribe something for Zoey for you to give at home if needed. Granted mirtazapine is supposed to provide some anti-emetic benefit so a lot of vets seem to think it's unnecessary to prescribe dedicated anti-nausea medication alongside it but, based on my own experience plus the reports I've seen about many other cats here, mirtazapine alone tends not to provide sufficient anti-nausea support. Cerenia and ondansetron are much more effective. Indeed, we often see that a cat with poor appetite due to nausea issues tends not to need that much support from an appetite stimulant if its nausea is managed well with appropriate medications specifically designed to treat it, ondansetron and Cerenia.

    If the mirtazapine doesn't help much in the next 12 hours I'd suggest contacting the vet again to request anti-nausea meds. Fingers and paws crossed that Zoey's appetite will pick up again in the meantime.

    Re the AlOH, once you get the powdered version you'll be able to mix it in with a bit of wet food and it should be tasteless. Hopefully Zoey's appetite will have picked up again by then and she'll eat it without coaxing. If you keep the amount of food small enough for her to finish it as soon as it's offered you'll be sure she got all the AlOH down. (You can always give her the rest of her meal after she has finished the small 'medicated' portion.) Split the daily AlOH dose across several of these little wet food 'snacks' throughout the course of the day. If Zoey's still iffy with the wet food, perhaps she might eat the little bit of food containing the AlOH from your hand?


    Mogs
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    Last edited: Jan 7, 2018
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  5. Critter Mom

    Critter Mom Well-Known Member

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    It's a good idea to ask him for the result of the Spec fPL so it can be used as a baseline. You can then get follow-up Spec fPL tests periodically to check the status of Zoey's pancreas. Being able to compare them to the baseline will enable you to see how much progress is being made (and also to inform possible treatment choices and diet selection to help the pancreas).


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    Last edited: Jan 7, 2018
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  6. tiffmaxee

    tiffmaxee Well-Known Member

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    The clavamox might be causing the loss of appetite as well.

    Max would not necessarily act more sick with a high SfPL than a moderate level. Maybe for others that might be the case. From tge cats I’ve read about it’s rarely the case. The reason for getting it over the SNAP is that the SNAP just gives a positive or negative. So if in the gray area that would make a difference. Once his pancreatitis became chronic I treated him and we only ran the test to rule other issues in or out.
     
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  7. Critter Mom

    Critter Mom Well-Known Member

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    Good point, Elise.

    (Forgot about that; if Saoirse needed antibiotics I'd ask the vet for the 3-day injectable preparation (for as long a period as required - vet offers house calls) so as to minimize chance of causing/exacerbating digestive system disturbances.)


    Mogs
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  8. Marje and Gracie

    Marje and Gracie Well-Known Member

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    Carol

    Although you are making great progress and the phosphorus is looking better, it is still way too high. It needs to be around 4.5. At the level it is at, it can easily be causing her nausea. Control of P is directly related to longevity and QOL so it’s important you get it down.

    The best way to get it down, other than the renal prescription diets, is to give a binder such as the aluminum hydroxide powder. Was he having you put a liquid in her food? The binder should be mixed in with every single helping of food and allowed to sit a minute to bind the P before she eats the food. It is tasteless and most cat staff are fine with eating it in their food.

    I’ll be happy to fix your SS. Can you please send me a PM so I can give you some info so I can get editing rights? Thank you!
     
    Last edited: Jan 8, 2018
  9. tiffmaxee

    tiffmaxee Well-Known Member

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    Where are the labs posted? I can’t see the tab on your ss.
     
  10. Critter Mom

    Critter Mom Well-Known Member

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  11. Critter Mom

    Critter Mom Well-Known Member

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    Hi Carol,

    How's Zoey doing on the food front? And how are you? Have you managed to get any rest?

    :bighug:


    Mogs
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  12. tiffmaxee

    tiffmaxee Well-Known Member

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    @Critter Mom Thanks. Maybe it was because I was using my phone. The labs have dramatically improved! In fact if they hold It is possible the infection caused the very high levels. The only number I’d like to see come down is sodium. I suspect it’s high from all the IV and will come down as well.
     
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  13. Zoey & Carol

    Zoey & Carol Member

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    I didn’t give Zoey the aluminum hydroxide last night and this morning per vets advice. He thought that might be affecting her appetite. She ate some through the night and again this morning. I gave her some dry food (half zero carb) and a bite of rabbit and quail soft food. She ate some. I haven’t given her the clavamox yet but I will probably give both shortly. I hesitate because she’s eating a little better but I know she also needs her meds.

    Her preshot last night was HI which is over 600! At +3 she was still at 556. I tried testing for ketones but couldn’t get her to cooperate. I did put the stick into the litter right after she peed and it didn’t show anything. Needless to say I didn’t sleep very well. This morning she was 469. But she is eating and drinking a little better.

    I’m trying some lower carb food today but I’m so confused about how to balance her food requirements for both issues. Right now I’m focusing on getting her to eat and controlling her diabetes. Any suggestions on foods for her?
     
  14. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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  15. tiffmaxee

    tiffmaxee Well-Known Member

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    Balancing CKD and diabetes is hard. The best thing is to look at Tanya’s site and try and find the lowest phosphorus food she will eat that is under 12 grams carbs. You can also use Dr. Lisa’s chart. Once you get the powdered AH it will be easier as it’s tasteless. You just add enough water to get the right consistency. In the meantime if you have a food she will eat without it you could syringe a little with the binder in it and then let her eat the rest without on her own. You just need to make sure she gets some binder every time she eats.
     
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  16. manxcat419

    manxcat419 Well-Known Member

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  17. Critter Mom

    Critter Mom Well-Known Member

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    How's Zoey's appetite holding up, Carol?


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  18. Zoey & Carol

    Zoey & Carol Member

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    Her appetite isn’t great but the only thing she really wants to eat is the dry KD. I just checked her BG before her pm shot and it read HI again. I put up the dry food and I’m giving her the Fancy Feast Pate that she is used to. Hopefully she will eat it. I’m calling the vet tomorrow about the high BG. When she was in the clinic it never got that high! This is extremely stressful because I don’t know what to focus on.
     
  19. Critter Mom

    Critter Mom Well-Known Member

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    Hi Carol,

    I agree a call to the vet is necessary.

    Juggling concurrent conditions can be tricky indeed. Obviously first and foremost Zoey needs to get nutrition into her but the HI BG means she's not getting the full benefit of the grub she is getting down. I think perhaps you may be in a situation where you might need to continue with what she can actually eat for a while and work the insulin dosing around the diet temporarily.

    Your vet should hopefully be able to advise you about the amount of time that Zoey should remain on the k/d food in order to allow her kidneys to recover from the effects of the bladder infection (plus it's not good to muck around much with different foods when a cat is still not eating reliably for fear of triggering any further GI upsets). The other thing to chat about would be the anti-nausea support. (Again, I can't speak highly enough of ondansetron in this respect.) If you could watch her physical behaviours and response to trying to eat the wet k/d and her regular wet food to check for even slight clinical signs of nausea it might better help your case for securing an anti-nausea Rx from the vet.

    Longer term when Zoey is fully recovered it should hopefully be more straightforward finding more suitable diet choices for her.

    Be sure to let us know how you both get on.


    Mogs
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  20. Critter Mom

    Critter Mom Well-Known Member

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    How's tricks with you two today, Carol?

    :bighug:


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  21. tiffmaxee

    tiffmaxee Well-Known Member

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    I agree with Mogs. She has to eat and ondansetron was the key to that for both of my seniors. One had lymphoma, kidney disease, and chronic pancreatitis and Max had chronic pancreatitis, fo,Lowe’s by diabetes, and then kidney and ate well until heart disease.
     
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  22. Zoey & Carol

    Zoey & Carol Member

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    She's eating better today. Not a great deal, but she seems to like one kind of the K/D canned food. We are increasing her insulin to 2 units hoping that will bring down her BG even with eating the higher carb food. The vet said that it is imperative that she stay on that food for a while, even if she prefers the dry. She's still very fragile. However, when I went home at lunch to give her the Clavamox, she ate some more, and when I left she was kneading her bed. All good signs!

    In reading the diet info on Tanya's website, it does sound like the therapeutic kidney diet is the best food according to the research. You can supplement it with 15-25% other food, but I wouldn't do that until she is much better.

    Both of the vets that have seen Zoey seem to be reluctant to give her the anti nausea medication. I'm not sure why that is. I take her in again on Friday, so I will ask again. I can give her the appetite stimulant again tomorrow, so we'll see if that helps. I gave it to her on Saturday, and she did start to eat a little more.
     
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  23. tiffmaxee

    tiffmaxee Well-Known Member

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    The problem with giving an appetite stimulant to a nauseous cat is you risk causing a food aversion to the food that you are feeding. I don't understand the reluctance to give medication for nausea. Please ask why. With Max, once he got the right dose of ondansetron when he was inappetent , he's didn't need the stimulant.
     
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  24. Critter Mom

    Critter Mom Well-Known Member

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    I second this.

    Ditto for Saoirse.

    I'm glad to hear that Zoey's started eating a bit more, Carol, and it was heartwarming to hear she was kneading her bedding. :) How is she today?


    Mogs
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  25. Zoey & Carol

    Zoey & Carol Member

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    This morning her BG was over 600 again. I checked her at +6 and it was down to 289. Still not great, but I'm hoping she won't be quite as high tonight. She's walking a little more, but she is still a little wobbly in her hind legs. She's not down on her hocks, just a little unstable. But much better than last week! She's still eating some and seems to like the Hill's K/D canned food. I've been checking and it seems that Royal Canin Veterinary Diet Renal Support D food has fewer carbs (22 as opposed to 38). I don't know if this vet carries it, but I might ask for a prescription so I can buy it online. The problem is I hate to buy a case of it when I don't know if she'll eat it!

    I'm going to stay at the 2 unit dose of insulin until Friday when she goes back to the vet clinic. If she still isn't going low enough, he'll probably raise her dose. It's amazing how much the carbs affect the BG levels. The only time she ever went over 600 in the last 3 years is when she got into dry dog food!
     
  26. Critter Mom

    Critter Mom Well-Known Member

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    Good girl, Zoey, eating more fudz. :)

    Wherever you end up looking to purchase it, it might be worth enquiring whether Royal Canin give a 100% satisfaction guarantee where you can return the food for a refund if the kitty won't eat it. (I've read here that Hill's do this type of scheme but I'm not sure whether it's only offered if you buy the food through a vet.)

    Chalk it down! Saoirse went from sky-high preshots and 3IU Caninsulin BID down to near normal preshots and 0.5IU BID within 48 hours of changing from Hill's w/d Dry to low carb wet food. I had to take her off Caninsulin a few days later because, although she still needed a little insulin support, that particular insulin became unsafe to administer any more. (We switched to Lantus shortly after.)

    Is the vet doing more blood work on Friday? (Wondering about the wobbly legs and potassium levels.) BTW, did you notice whether Zoey shows any signs of nausea at all when she's eating (e.g. 'yawny' lip licking after eating)?


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  27. Maggies Mom Debby

    Maggies Mom Debby Well-Known Member

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    If your vet doesn't carry it or can't get a couple of cans for you, call around to other area vets to see if they have it. Or check with a good pet store if you have one nearby.

    And I do know that Chewy.com stands by their products and will refund the cost if your cat will not eat the food. They told me to give it to a local shelter.
     
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  28. Critter Mom

    Critter Mom Well-Known Member

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    Useful tidbit of information to know, Debby. :)


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  29. Zoey & Carol

    Zoey & Carol Member

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    Thanks for the tips on the food. I'll check first with the vet on Friday and then go from there. Re her wobbly legs: Last week she wasn't even moving. She would try to get up and fall over. She was a little better over the weekend and is now walking around the house. Just a little tentatively. I think it's just because she was too weak and hasn't moved around much. I've been keeping her in a bathroom so she has everything she needs close by. Now that she is getting out a little bit, she's moving much better. This morning she was eating well! But her BG last night and again this morning was over 600. I've only been giving her K/D wet food even though the vet said she could eat the dry. If she wouldn't eat the wet, I'd feed her the dry just to be sure she's eating.
     
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  30. Critter Mom

    Critter Mom Well-Known Member

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    If you have the space and you need some way to restrict a kitty's movements during convalescence without having to sequester it in a separate room then these are brilliant:

    https://www.amazon.co.uk/Portable-P...F8&qid=1515607851&sr=8-4&keywords=cat playpen

    They have an airy and spacious feel to them, not one of confinement, and with the right size playpen there's room for bed, feeding station, and litter box. A flat sisal scratching mat is a helpful addition, too.

    Our vets were so impressed with Saoirse's 'kitty hotel' they started recommending them to other clients whose animals needed quiet time during recovery.

    Very glad to read of Zoey's continuing progress. :)


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  31. Zoey & Carol

    Zoey & Carol Member

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    Zoey is almost purrfect! She went in yesterday for her one week checkup, labs, and glucose curve. I put the results on her spreadhsheet but her creatinine and BUN levels are normal and her phosphorus is slightly low. She is almost back to her old self. She doesn't have to eat the K/D food. I have her on Hill's W/D for the time being. The vet said to just give her the aluminum hydroxide once a day. I just received the powdered AH from Jayla, but I'm not sure how to dose her. I'm trying to figure that out. The vet said I could increase her to 2.5 units, but with switching to a lower carb food (W/D is 6.2%) I'm sticking at 2 for a few days. Today when I checked her at +6 she was 86. Almost purrfect!

    I'm sure there will be future incidences, but right now we're all good! Thanks so much for all of your support and advice!
     
  32. Critter Mom

    Critter Mom Well-Known Member

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    Hi Carol,

    Thank you so much for the update. What wonderful news! I am thrilled for both of you!! :cat:

    Just had a look at Zoey's labs. W.O.W. :woot: (@manxcat419 - check these out! :) )

    I'm tagging @jayla-n-Drevon for you about the AlOH. Needless to say, keep a regular check on her phosphorus levels when using a binder.

    I really want to give that second vet of yours the biggest hug. :D

    Sending lots of fusses for Zoey and a :bighug: for her wonderful mama.


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    Last edited: Jan 13, 2018
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  33. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Great news! :smuggrin:
     
  34. tiffmaxee

    tiffmaxee Well-Known Member

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    With phosphorus at 3 the binder is not needed. You want it no higher than 5. If only given once a day the other beaks she will get all the phosphorus as it binds with the food only when given with the food. It seems pointless to give it at all. This must have been ARF with everything coming down so nicely. She must only be stage 1 or 2. Great news.
     
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  35. Critter Mom

    Critter Mom Well-Known Member

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    That's what I was hoping might be the case, especially once the vet identified the presence of bladder infection. :)


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    Last edited: Jan 14, 2018
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  36. Zoey & Carol

    Zoey & Carol Member

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    What is ARF? And no phosphorus at all? How would I know if she starts needing it?
    I love that vet clinic. Our rescue dog (black lab/pit/??) had 2 TPLO surgeries there. I took them a thank you card and some chocolates today!
    The vet wants Zoey back in 2weeks for a glucose curve but I can just do that at home. He didn’t say anything about more blood tests.
     
  37. Critter Mom

    Critter Mom Well-Known Member

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    ARF = Acute Renal Failure, aka Acute Kidney Injury.

    Acute kidney issues may arise due to infections, kidney stones, etc., but with intensive support during the acute phase along with treatment of the underlying cause thereafter it may be possible for the kidneys to return to fairly normal functioning. Chronic renal failure (aka chronic kidney disease) is usually seen in older cats and is due to steady deterioration of kidney function over time. Even with CKD there is so much that can be done to keep a kitty happy and comfortable - possibly for many years! - and to slow progression of the disease (as you can see from the information on Tanya's Site).

    At start of treatment with a phosphorus binder, phosphorus levels need to be monitored via regular blood checks initially. The binder dose is based on the cat's IRIS stage and is usually started low and titrated upwards as needed based on the results of serial blood checks. Once the kitty is stabilised and has a 'good dose' of binder it's OK to leave a longer time between blood tests. I don't have a specific page reference to link for you but Tanya's Site should give you further information about the process of phosphorus regulation. Alternatively you could ask the membership of your CRF support group and they'll be able to give you better specifics.

    I don't blame you. I think they're wonderful! I really appreciated the way that they were immediately so responsive to Zoey's needs and they really wanted to do everything possible to help her. And it worked! I honestly can't put into words how delighted I am for you both. :D


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  38. tiffmaxee

    tiffmaxee Well-Known Member

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  39. tiffmaxee

    tiffmaxee Well-Known Member

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  40. manxcat419

    manxcat419 Well-Known Member

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    Carol, this is wonderful news. I'm so happy for you and Zoey. Even in my wildest dreams, I wouldn't have dared hope for her numbers to come down this far and then stabilize there. I agree on the phosphorus binder - I would leave it out completely for now...you really don't want her phosphorus going any lower and it does seem as though it may have been an acute kidney episode, so she really shouldn't need the binder at this point with her phosphorus so low. I would just maybe do a blood work on her about every 6 months to keep an eye on things...obviously more frequently if you do start seeing any new symptoms of anything at all. But for now, relax and enjoy having your baby back to her usual self and feeling good.
     
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  41. tiffmaxee

    tiffmaxee Well-Known Member

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    I wouldn’t wait six months for blood work. I’d test again in a month. If stable I would then test in three months.
     
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  42. Critter Mom

    Critter Mom Well-Known Member

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    I'd do similar.

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  43. Zoey & Carol

    Zoey & Carol Member

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    Thanks so very much for the encouragement. I will not use the phosphorus binder for now. I will see how she does and take her in to the clinic in a month or so for another test. Her PMPS tonight was 286. The same as this morning. I think she has not felt good for a few months. Her BG was so inconsistent and high. I couldn’t get it close to regulated. I’m hopeful that we are on the right track now. My little neighbor girl has been so worried about Zoey. She came to visit tonight and hugged her. She was so happy she lived through this!
     
  44. Critter Mom

    Critter Mom Well-Known Member

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    Nice, smooth cycle today - and a very welcome nadir. :)

    The bladder infection could have been feeding into the regulation difficulties.


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  45. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

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    Carol, if you can find it, Royal Canin 'Recovery' is much easier to syringe, has all sorts of good stuff in it and most of mine really like it. It's not overly high in carbs either.

    HUGS!
     
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  46. tiffmaxee

    tiffmaxee Well-Known Member

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    Definitely.

    AD is even easier to syringe. Not as many calories but mine liked it better.
     
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  47. Zoey & Carol

    Zoey & Carol Member

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    She was HI again this morning but she dropped to 59 last night at +5 so it is probably a bounce. I gave her a bit of higher carb food before I went to bed. Just checked her again at +4 and she was 131. This will be another bouncy day I suspect. I’ll check her again in a couple of hours.
     
  48. Critter Mom

    Critter Mom Well-Known Member

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    Away from that trampoline, young lady! ;)
     
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