3/2 Trixie +3.25 59 +3.75 175 -one more Q

Yesterday

Nice start for Trix today - she just keeps working this dose very nicely (anti-jinx)! I'm hoping to get her BW results at some point today...hopefully I won't miss the call while I'm at work. I really like my vet's office, but at the same time, any time I tell them to call me at work, they call me at home...and vice versa. The one time I told them to call my cell, it totally failed as they called the wrong number! They are great with the animals and veterinary technology, but don't seem so great with old fashioned phone technology :lol: !!

Last night was pretty good with Frankie...she scratched a little bit at around 3:30, and it was the "mild variety" of scratching (as opposed to her "frantic version"), and if it was a "regular" night, I think she would have settled on her own. However, DH is swimming in a Master's meet this morning, and I wanted him to be able to get the most amount of sleep possible, so I got up. She settled back down quite quickly (good girl); however, Noah decided it was HIS turn and he started meowing and pawing at the bedroom door! I tell ya, if it ain't one cat, it's another. Gotta love 'em.

I keep seeing mixed forecasts for tonight's/tomorrow's storm. Ultimately, I think we're really supposed to nailed with about 14" of s***; however, when I looked at TWC online, their forecast implied about 3" total. THat would be awesome, but I'm skeptical. When I clicked the "warning" box, it said around 8"+. So....we're waiting on the edge of our seats to see what happens!

Our prayers continue for Deborah and Shasta...keep recovering from that anesthesia, little one. Have a great day, LL!

Amy

Re: 3/2 Trixie AMPS 123 +2.75 85

Nice job Trix :mrgreen:
Fingers and paws crossed you don't end up with a huge dump of that s***
And hopefully the labs will get through to you on the results. Impressive that they work on Sundays! Sweet.
Have a great day at tbp and good luck to DH in the Master's meet!

Re: 3/2 Trixie AMPS 123 +2.75 85

Fingers and paws crossed for good vetty results Lovely numbers for Trixie. :mrgreen:
I sure hope that this storm isn't as bad as they predict. Three inches would be much nicer than 12

Good luck to DH ~ Have a wonderful Sunday!

Re: 3/2 Trixie AMPS 123 +2.75 85

Hi Amy! Well, I hope neither forecast is right and you get NO snow :lol: . Paws crossed it's as little as possible. I hope you get your results soon, and that they call the right number! My vets admin girls are really nice but they don't seem to call the right number either. I even did a sheet with all my contact info and work hours to put in Chynas file :roll:

I hope that DH got the rest he needed for his swim meet. Silly Frankie, I'm glad she settled quickly. I saw a "calming" collar at Petsmart that I was thinking of getting for Chynas next vet visit...but she's never worn a collar so that might be more stress added on . Silly kitties. I hope you can get the bedroom situation all worked out soon ;-)

Have a great day at work! And Trixie, you surf that please :mrgreen:

Re: 3/2 Trixie AMPS 123 +2.75 85

Good morning Amy!
Looking good, Trixie!!

Fingers and paws crossed for good b/w results.
I hope you get the phone call soon.
I hate waiting for those calls!
I always get all calls to home transferred to my cell phone whenever I'm waiting for a call from the vet.

Re: 3/2 Trixie AMPS 123 +2.75 85

Hi Amy, nice slide for Trixie. Fingers and paws crossed for good b/w results for Trixie. Your Vet is open on Sundays, nice! I was tuning in on the calming treats. Oh no, on Noah taking his turn, after Frankie :lol: I don't mean to laugh, but just visualizing these kitties in their jammies knocking on the door....no fun for you though with lack of sleep and on a work day.
I hope you don't get that much s....that has to be the last punch. Our storm is moving out today, and unfortunately, moving east.
Scritches and hugs to everyone from AuntieAnnBean and Katie

Re: 3/2 Trixie AMPS 123 +2.75 85

I hope you get the b/w results back today. Nice numbers for Trixie. I'm glad Frankie wasn't too bad last night.

Re: 3/2 Trixie AMPS 123 +2.75 85

Well, we're here and waiting for the snowstorm. If it doesn't materialize, I'll be happy to take the credit (or the blame, if it's a blizzard)!

I hope that the treat will work in "normal" conditions.

Trixie looks so good. Keep the lagoon safe, little LagoonMeisterin. The LagoonMeister got a fur shot this morning!

Good luck to your DH in the swim meet.

Hugs, scritches,

Ella & Rusty

Re: 3/2 Trixie AMPS 123 +2.75 85

Morning Amy

YAY! Trixie is in the lagoon! Good job little one. :mrgreen: :mrgreen: :mrgreen:

And.... a good night for Frankie! maybe those treats are working.... ohno on Noah.... :roll: ;-)

Good luck to DH and his meet. that is so cool that eh races masters. Awesome!

I will hold hopes for a mild version of that s***. What a winter for so many. And it just doesn't want to seem to end... Enough already. Here's to Spring!

Enjoy your day today. I hope all goes well.

Re: 3/2 Trixie PMPS 75 - BW, Kidneys - Qs, long

We got Trix's BW back today, and as is par for the course for us, it is crazy and doesn't really make sense. Her kidney values increased significantly. Here's what we've got:

BUN 85 mg/dL (normal 14-36)
Creatnine 5.3 mg/dL (normal 0.6-2.4)

Her USG is 1.014

Pretty much everything else is in the normal range, including her HCT at 34%.. Her phosphorus is a little high at 7.6 - that falls in the normal range, but I know that the normal range includes kittens so it isn't accurate. I can't remember what would be a good phosphorous reading for a 13 year old kitty.

We were all shocked at these values, including the vet, because she said for her values to be so high, she should be noticeably sick, and she is not. She gained weight, she's eating, she's hydrated, her muscle tone is good. There was physically nothing that stood out to us or our vet to indicate something was up. Now, of course, I'm wondering if I've been missing something.

She said it could be CKD, but because things don't quite match up with that notion, it could also be caused by an infection, a cyst in her kidney, possibly high BP, possible partial blockage by a stone or something like that. We took her back this afternoon for a BP check, and she is just mildly high at 170 (they consider their cutoff to be 160), so - given the kidney values, we are starting her on a low dose of amlodipine.

As for running a culture...unfortunately before the urine draw yesterday, she peed on the table, so the sample wasn't sterile. Vetty offered us several options: run a culture on the existing sample, knowing it might be wonky; try to bring her back yet again for another draw then wait 4 or so days for the results; or start a 2 week course of ABs, then rerun the BW, BP test, and urine sample in 3 weeks. It's not an ideal situation at all, especially since we have this big storm on the way. Since we had her back there today for the BP check, they attempted to draw urine again since we were there, but her bladder was empty.

Since they couldn't get the urine today, and the storm coming tomorrow, and the non-sterile sample could produce inaccurate results, we did opt to start an AB...it IS possible she has an infection and is at a very early stage in it....maybe. We figured it was probably better safe than sorry to start the AB rather than to wait and see if she shows symptoms and crashes or something like that. It wasn't an ideal or easy decision to make...I'd prefer knowing for sure if she has an infection before starting meds, but everything is off all at once.

Also, we are doing fluids....150ml for the next 4 days, then 100mls every day until we retest everything.

I'd appreciate any insight or thoughts. Also...where is the cheapest place to get fluids? Am I remembering ThrivingPets.com correctly? We got our first bag at the vetty just so we could get started ASAP.

We go back in three weeks to recheck everything (unless something pops up in the meantime), and evaluate the next steps - if any - from there.

My stomach is in knots. Just once, I would like to come away from a check up without unexpected results....

Re: 3/2 Trixie PMPS 75 - BW, Kidneys - Qs, long

So sorry for the unexpected test results, Amy! I don't have any answers, but just wanted to send some well wishes your way! Hopefully you have some more answers soon!!

Re: 3/2 Trixie PMPS 75 - BW, Kidneys - Qs, long

Amy --

I'd send a PM to Marje. She's very knowledgeable about kidney issues.

One thought is that values can be elevated with a kidney infection. This is different than a UTI. Kidney infections take longer course of antibiotics to treat. I'd discuss this possibility with our vet. I'd also think about getting the tests re-run. While the values are all related, there is always the possibility of a lab error.

Just as an FYI, there is a critical shortage on fluids. This is nationwide. Marje knows about all of the apparatus you'll need. I'd also check out places like Walgreens. If you use their pharmacy discount card, I think I remember someone saying that the cost was very competitive.

Re: 3/2 Trixie PMPS 75 - BW, Kidneys - Qs, long

(((Amy)))
I'm sorry to hear about the worrisome b/w results.
And I'm sorry that things didn't go ideally with the urine sample and the upcoming storm.
I hope that the kidney values were caused by something that can be easily treated with AB.
It's good that Trixie isn't showing any symptoms. I'm sure you haven't missed anything.
You are such an observant momma.
Sending many many vines to Trixie, and hugs to you, Amy. :YMHUG:

Re: 3/2 Trixie PMPS 75 - BW, Kidneys - Qs, long

Thanks, Sienne! I will definitely discuss the kidney infection thing with the vet. She did say something to that effect today, about how an infection can work it's way up to the kidneys and is harder to treat. That is one reason we did decide to start ABs today, even though the urine sample wasn't clean enough for a culture. Lots of info, so my head was/is swimming. She also did mention the possibility of lab error. I'm just starting to be able to process all that transpired this afternoon.

Yikes on the shortage of fluids....ugh. I'll check to see if we have a Walgreen's around here...I know there isn't one "right in my neighborhood", but maybe there is one fairly close by.

I did PM Marje :smile: ...I know she's busy helping with some low numbers right now.

Re: 3/2 Trixie PMPS 75 - BW, Kidneys - Qs, long

(((Amy)))

I agree that this looks like CKD but also agree it could be a kidney infection. Even if it is, and if she is treated numbers should come down, I would be surprised if they come all the way down to normal. The numbers usually affected by kidney infection are BUN/creatinine and not phosphorus. For a 13 year old kitty, her P should be 4.5. While a C&S is definitely warranted, sometimes bacteria does not show up in the urine in the case of kidney infection and an U/S is required. Both times Gus had a kidney infection, there was no bacteria in his urine but his kidneys definitely were hyperechoic on the U/S indicating infection.

I am glad your vet put her on amlodipine as my vet is also very conservative and starts it at 160. Many vets wait until they are well over 170 multiple times but I don't think it is worth it. It's best to be proactive.

I am also surprised that she's not feeling bad. With a P that high, usually there is an acid tummy and they don't want to eat. Just as in FD, it's important to look at the kitty as well as the numbers.

My priority would be to get that phosphorus down. I actually would be using an aluminum hydroxide binder at this point because it is really one of the things I think can make a kitty feel crummy. I would also take a look at Dr. Lisa's Phosphorus tables and start her on LC/lower P food. You want to try and feed her foods that are under 1.00% P or less than 200 mgP/100 cal. That is not LOW phosphorus; only the kidney diets are LOW P. But look for foods that are lower. Unfortunately, the kidney prescription diets that are low P are too high in carbs. Yes, you can adjust the insulin but I never fed Gus any kidney foods; I just tried to get lower P foods and used binder and his P never went up over 5 and stayed around 4.7 for most of the time.

I sent Josie a bunch of binder and amlodipine and I'm going to put her in contact with you to see if she is able to get it to you quickly. Usually binder has to be ordered. It can be made at the compounding vet but it's really a lot more expensive. Gus was on a low dose of amlodipine and I had it compounded into small caps.

Best place for fluids, if you can get them, is Walgreens but also check Costco. I understand there is a shortage on lactated ringers soln (LRS). Your vet did put her on LRS and not Normosol, right? You can order them from thrivingpets.com as well. I also got my needles (21g) and lines at thrivingpets.com as well as the binder. Here is the link to Gussie's subq video just in case; you might know how to do fluids just fine but it also give lots of info on supplies and where to get them: How to Give SUBQ fluids at home

Can you post her labs on her SS? Take a look at Gracie's SS....I have a labs tab posted there to show you. I'd really like to look at her other numbers like potassium, calcium, etc.

It's great that her HCT is 34%. AWESOME!!! It doesn't really fit so that's why I wonder that there might be something going on in addition to some CKD. However, it does not hurt to start her on B vitamins (and Josie might still have some of Gus's as well). The B Vitamins really help stave off anemia; Gus was never to the point where he needed an erythropoetin stimulating agent because of the B Vitamins. Here's what you need:

Methyl B12: 250 mcg bid (half of a capsule)

Jarrows B Right Multi B: 1/10th capsule bid

I bought #3 empty gel caps from thrivingpets.com and made my own capsules; I'd put 1/2 of the methylB12 cap in and then fill the rest with Jarrows B Right and gave him one of those caps bid in a pill pocket.

Also...did she have protein in her urine? If she did, I'd recommend the vet do a protein:creatinine ratio and it does not have to be a sterile sample for them to do that. It will tell you if she's spilling protein due to low kidney function. If it's in normal limits.....celebrate!!

Sorry to throw so much at you. Let me know what I can do and what questions you have.

Re: 3/2 Trixie PMPS 75 +1 86 - BW, Kidneys - Qs, long

Hi Amy - I am sorry about the elevated values, and unexpected results. My thoughts are with you, sorry I can't be of much help. Hugs to all.

Re: 3/2 Trixie PMPS 75 +1 86 - BW, Kidneys - Qs, long

Thanks Marje! My head is now swimming even further...but I expected that. I will get her labs into her SS, but it might be tomorrow before I have the where-with-all to focus on that.

I have been feeding her Wellness Chicken and BFF Tuna and CHicken Chuckles (Mainly the Wellness; the BFF is just for "flavor enhancement"). She barely likes it, though...and I know she hates EVO. I switched her last year, when she did have numbers that were just barely out of range.

Yes, she gave us lactated ringers.

Here are some other values:

The labs say "trace" with protein in her urine.

Potassium - 5.0mEq/L (normal 3.4 - 5.6)
Calcium 10.9mg/DL (normal 8.2 - 10.8)

Vetty did mention phosphorous binders, although it sounds like she wants to see what happens over the next couple weeks first. I know she's off till Wednesday, but I will ask her about starting them then.


Things don't quite fit to my vet, either, which is why she's scratching her head on this one, too.

Re: 3/2 Trixie PMPS 75 +1 86 - BW, Kidneys - Qs, long

Sending hugs and prayers to you. :YMHUG: :YMHUG: I hope you can find out what's really going on with Trixie and the AB helps treat any infection.

Re: 3/2 Trixie PMPS 75 +1 86 - BW, Kidneys - Qs, long

The potassium and calcium are fine but Phosphorus x total calcium should be below 60 or P x ionized calcium should be below 8.75.

If it were me, I'd get a binder started. My former vet was awesome but she did misguide me on this on one of my CKD cats and before I knew it, his P was over 15. It's almost impossible to get it back down to a normal number when it's that high and it happened fairly quickly. Not to scare you but after 4 CKD cats, I think P is a huge one to pay attention to. If the cat is not FD, it makes sense to try the renal diets first and try to get it down but if that doesn't work, I'd get them on a binder. The binder will not hurt her if they find out the lab messed up the tests. The only cats that you'd worry about getting binder for a short time (if not needed) would be kittens.

From Tanya's on P and binders:

Take action as soon as your cat's phosphorus level goes above 6 mg/dl.
If your cat's level is between 4.5 and 6 mg/dl, but multiplying it by your cat's calcium level gives you a reading of 60-70 or over, take action now.
Your aim is to reduce your cat's phosphorus to a level of 4 mg/dl. You may not be able to get it this low if your cat is in IRIS Stage 3 or 4, but aim never to let it go above 6 mg/dl.
If your cat's level is above 6 mg/dl, you can read below about ways to reduce the level. Check phosphorus levels every month to see if any adjustments to your treatment plan are necessary

Click to expand...

The dosing on the aluminum hydroxide is 50 mg/lb per day sprinkled on the food. You don't have to measure super accurately but 1/4 tsp of aluminum hydroxide bounder = 300 mg. If Trix weighs 10 lbs, that would be 50 x 10= 500 mg which would be about 3/8 tsp/day. Even if you go conservatively and give her 1/4 tsp/day, it will help. We would just put Gussie's dose in a 1/8 tsp spoon and every time we gave him food, we sprinkled the binder on it, mixed it in well, and then let him eat it. The binder has to go on the food; you can't give it directly to Trix as it must bind the P in the food. It is tasteless.

It's good she only has a trace of protein in her urine but I'd check it out. Sometimes Gussie had a trace but his P:C ratio was always normal. BTW, Trix's USG is pretty low especially considering you have not started fluids. It should be above 1.040.

Re: 3/2 Trixie PMPS 75 +1 86 - BW, Kidneys - Qs, long

Sending our sweetest Trixie tons of positive healing vines and hugs to you. :YMHUG: :YMHUG: :YMHUG:

Re: 3/2 Trixie PMPS 75 +1 86 +2 59 - BW, Kidneys - Qs, long

God, my stomach is one huge knot right now. I know I will settle out once I absorb all of this. ANd when I look at her, she is so NOT a cat who feels crappy or crummy...she just chowed down a nice sized +2 snack with big, bright eyes and is now taking a post snack bath.

Where to I get the binder from? I'll order it right away. Or, can I get it at a local pharmacy? Does the binder have to sit in the food for a period, or can she eat it right after I mix it in? How long does it take for the binder to start working on her P levels? Trix weighs almost 12lbs right now....I'm sorry, I can't do the math at the moment, even though my degree is in math. Did you take Gus every month to get his phosphorous levels checked? I have to be honest, I co-own a retail store in a crappy economy (and I'm trapped by the lease, so I can't get out of it for a couple more years)....I don't know if we can afford monthly bloodwork....

Re: 3/2 Trixie PMPS 75 +1 86 +2 59 - BW, Kidneys - Qs, long

I just PM'd you about the binder...

:YMHUG: :YMHUG: :YMHUG:

Re: 3/2 Trixie PMPS 75 +1 86 +2 59 - BW, Kidneys - Qs, long

Also, is there way I can copy Gracies Labs Tabs so I Don't have to reneter all the "normal ranges"?

Re: 3/2 Trixie PMPS 75 +1 86 +2 59 - BW, Kidneys - Qs, long

Amy, i know that all of this must be overwhelming, but I also know that you will be able to get it figured out. How fortunate we are to have Marje's tons of experience to help us out.
Thinking of you and Trixie tonight. Oh, how I hope that it was a lab error!

:YMHUG: :YMHUG: :YMHUG:

Ella & Rusty

Re: 3/2 Trixie PMPS 75 +1 86 +2 59 - BW, Kidneys - Qs, long

P.s. on Rusty's labs spreadsheet I simply entered all of the normal ranges in the second column. So now it is easy to compare whenever the tests are run.

Ella

Re: 3/2 Trixie PMPS 75 +1 86 +2 59 - BW, Kidneys - Qs, long

(((Amy))) I am glad that Trixie is feeling great, and she is probably wondering what all the fuss is about.
Sending you calming vines. It is so much to absorb. :YMHUG:

Re: 3/2 Trixie PMPS 75 +1 86 +2 59 +2.7 - BW, Kidneys DOSE??

I could tell she was dropping too fast....gave her some HC and Karo.

Is this because of hte fluids? she got them 1.75 hours before her shot. What should I do about her dose now that she is on fluids? I feel like I"m back at square one - terrified to dose, terrified of fluids....damn it.

Re: 3/2 Trixie PMPS 75 +1 86 +2 59 +2.75 34 - DOSE????

It could be the fluids, yes. But I think I'd be safe and take the dose back; you can go up if you need to.

I'm sorry to throw so much at you. Josie is going to get the binder to you and I told her I'd pay for the fedex because I sent it to her. Yes, you sprinkle it on the food, stir it in, and let it sit for just a second. I had Gus's P checked every 3 months but he was stable. I'd check with your vet but you could probably give it a couple weeks and have it rechecked and if it's down, then I'd get on whatever schedule your vet recommends. I'd not worry about the math or her weight. At 12 lbs, you could give her up to 1/2 tsp of binder a day. I would not give any more than that. Binders can be constipating but hopefully the fluids will help.

let me see if I can get Gracie's tab over to you, ok?

Re: 3/2 Trixie PMPS 75 +1 86 +2 59 +2.75 34 - DOSE????

How much do you think I should reduce her dose? Trying to remain calm....yikes, it is not easy now.

Re: 3/2 Trixie PMPS 75 +1 86 +2 59 +2.75 34 - DOSE????

Looking at her SS; BRB.

Re: 3/2 Trixie PMPS 75 +1 86 +2 59 +2.75 34 +3.25 59 - DOSE?

So 4.5 hours between fluids and the 34, correct?

While her SS does not look to me like, before this cycle, she was aiming for a reduction, she has had cycles where she's dropped early and fast. For that reason (it's not unheard of for Trixie to do what she did tonight...see 2/11 P.M. cycle and 2/15 A.M. cycle), then I'd probably give the full 0.25u reduction. You are great with her numbers so you'll know if she's not holding the reduction and you can take her right up.

What do you think?

Re: 3/2 Trixie PMPS 75 +1 86 +2 59 +2.75 34 +3.25 59 - DOSE?

Thanks, Marje. I was wondering if I should reduce her even a little bit more...she really scared me tonight.

She gets very frantic with the 30s, and since this was the first time with fluids, I was really afraid she wouldn't come back up. Fortunately she has, but we will keep testing her of course.

Thank you for all your help, and for the binder. In some ways, I do feel like I did when she was first diagnosed with FD...I was so totally not expecting the news we got today.

Also, when should we give the fluids in relation to her shot? The vet tech said maybe close to bedtime...but now I'm really scared to do that- what if she plummets while we're sleeping? She usually does her biggest drop early in her cycles, but now we're changing the game yet again by adding fluids in to the mix.

Re: 3/2 Trixie PMPS 75 +1 86 +2 59 +2.75 34 +3.25 59 - DOSE?

I sent you a PM so I can get the lab SS tab to you.

Whether they drop from fluids and how much is one of those ECID things. Plus you have your work schedule. I would think the best time to do it is when she is past her nadir. We don't know 100% if the numbers tonight were solely from the fluids, her depot is full, etc. If Trix had never done anything like this before at all, I'd suspect the fluids. But she has and so we don't know absolutely.

The challenge with giving the fluids at +7/+8 is you work. I don't know what time you usually get home in relation to her schedule? I'd also be leery about giving them at night after her nadir because (1) it will be late and you need to get some sleep for work (if Frankie lets you) and (2) she could drop late. At least if you could give them about +7/+8, you'd still have plenty of time before her shot in case she did come back down.

eta: on reducing her more, that is your call. You know her best. I just wanted to be sure you weren't thinking of shaving since we don't know if it was fluids or dose. ;-)

Re: 3/2 Trixie PMPS 75 +1 86 +2 59 +2.75 34 +3.25 59 - DOSE?

I just wanted to stop by and give you a hug. ((((Amy)))) Trixie is a very lucky little girl. Hang in there! I'm thinking about you and sending no s*** vines and calming vines your way.

Re: 3/2 Trixie +3.25 59 +3.75 175

I guess I over-sugared her ohmygod_smile ohmygod_smile ohmygod_smile . At least we're both calmer now. She was so frantic, she really had me worried. We'll keep testing...I know the karo will wear off.

No, I definitely wasn't thinking of just shaving...I'm wondering if I should maybe go with a .5u reducie, just till I get my bearings about what is going on here. This drop on top of today's news made my head spin.

We wouldn't be able to do fluids at +7 or +8 consistently. DH works Mon-Fri 8-5, and my schedule does change every week, but for the most part I'm not home until about +11.5. We'd have to do fluids in the evening...I'm thinking around +2.25-ish, because we'll still be up for a little while after that anyway - and, of course, we'll stay up as long as we have to if necessary.

Thank you for sending the SS stuff, Marje. I'm off tomorrow, so I will take care of it then, when (hopefully) my head is on straighter.

Thanks for all the vines everyone. I love LL.

I have lost touch with whatever is going on with the weather...I have no idea what's happening....

Re: 3/2 Trixie +3.25 59 +3.75 175

Hi Amy, wow what a day you are having :sad: . I'm sorry that the results threw you for a loop. Marje is such a wonderful help with these things . I have to do fluids in the evenings too, except for days off, I know how hard it is to plan it. I know you're busy bringing Trixie up now, so just wanted to stop by again and give you hugs :YMHUG: :YMHUG: . I hope she comes up easy for you and surfs.

Re: 3/2 Trixie +3.25 59 +3.75 175

I think if you would feel better about dropping her dose 0.5u so you can get your bearings, that's fine. We all support you. You know what you're doing with the FD.

I think the fluids will just take some experimenting. Try it at p.m. +2.5 and see how she does.

I use need you to PM me your google email so I can send you the SS

Re: 3/2 Trixie +3.25 59 +3.75 175

Thank, guys ...starting to calm down....I think.

I just pmed you me address, Marje. Thank you again.

One last question (for tonight)...

Will fluids lower her phos, or will only the binder do that?

Only the binder will lower phosphorus.
The fluids help to keep her hydrated.

I hope you're able to get some rest tonight, ((Amy)).

:YMHUG: :YMHUG: :YMHUG:

Josie's right. You're welcome and I also hope you can get some rest.

:YMHUG: :YMHUG: :YMHUG: