2/27 Bear Man Old Timer update

Last condo: viewtopic.php?f=9&t=7343

February has been kidney month in our Old Timer household. The good news is that Bear Man is doing pretty well on his program of medium phosphorus foods and aluminum hydroxide binder given by capsule twice daily (any more frequently seems to disagree with him). Benazaepril was added to his med list, and his blood pressure is good. His last bloodwork showed improvement in his renal values and usg (up to 1.021). He remains anemic, and we don't know which of his many issues is driving that. Jojo: his last reticulyte count was 0.4 (reference 0.4 - 1.4). Jojo advised me not to increase insulin doses too quickly on him, so I am holding at .75U, and getting a good amount of blue.

OT civie Miss Emily is not doing as well. She is a 17 year old kitty who has been hanging out in renal insufficiency territory for a while, but whose renal values have worsened lately after a string of pyelonephritis infections. A C & S done last week shows no current UTI, and a UPC ratio was normal. She is drinking a lot of water, and has issues with arthritis, a lot of hind end weakness and stiffness, and constipation. She takes Omega 3's, glucosamine, metamucil, and Adequan injections. Her medical history includes a near fatal bout of pancreatitis, weight issues (she has a very good appetite), and pre-diabetes, for which she takes acarbose. The vet wants to ultrasound her kidneys next week, after which we will talk about treatment. As Jojo pointed out on FB, adding on phosphorus binders with a cat who is already constipated will probably require that I add in constipation meds. The Canadian equivalent of Miralax (Lax a Day)is now available here, but I have never used it and I'm not familiar with dosing it.

I am hoping to get these kitties stabilised and on a food and medication routine that I can write up and hand off to their beloved pet-sitter, Andrea, before I go away on a short trip in just under two weeks. I am terrified to leave them, but hopeful that I can pull it off.

WCF has been very helpful to me with info on renal disease and medications. She has asked me to publish some pm correspondence here for peer review. I will post that as a response to this, already long, condo.

 

I hope Miss emily will feel better soon....((((Linda))))...you are such a good mama to your kitties...
Bear Man sounds good...hope he is planning on coming to the party tomorrow night... fll_moon Full Moon time again.
There is a seat at the bar reserved for him....so tell him to spread the word...Moonbeams will be arriving every hour on the hour...
Take good care of yourself Linda...hope all goes smoothly for your upcoming trip.... :YMHUG:

 

Copy and paste of correspondence between myself and Choy-Foong regarding phosphorus binders:

Linda and Bear Man wrote:
Emily will eat anything. I do have to watch fat and carbs on her as she has a history of pancreatitis, and pre-diabetes, and takes acarbose. I'm concerned about the carbs in a prescription renal food.



WCF and Meowzi wrote:
I don't know anything about acarbose, so keep this in mind when reading my comment.
But why a prescription renal food? It's not a secret that I am one of those in the minority who is not averse to rx renal food. I have seen CKD kitties maintain stable renal values on rx renal food, for whatever reason, be it low-sodium, low-phos or low-protein, or something else in the formulation, on the CRF board. So I do not have a strong bias against rx renal foods, although it would not be my first choice, at the stage we are in. You know that.

With that said - why not try a lower-phos non-rx food first? I'm assuming that she's still on a higher-phos diet? Or did you switch her to a lower-phos diet when you switched Bear's? If Emily's being fed higher-phos FF right now, why not switch her to a lower-phos, non-rx food and see how she does? You may possibly reduce her phos intake by just by switching her to one of the foods on the list I sent you. That, and a phos binder and SQuids may be all it takes.

One more thing - has vettybean talked about putting her on a phos binder? I am more concerned - make that *very* concerned - about her phosphorus level than her creatinine. At her age, a little renal insufficiency is not unusual, but that phos level really concerns me.

Did you end up ordering ALOH3 from Thriving Pets? With two cats on phos binders, the powder form would be more cost effective than the capsules you're using now.

Re: Bear - not sure you know, but we have Meowzi on two phos binders, not one. Fosrenol (lanthanum carbonate) isn't used much in cats, but Meowzi doesn't seem to have a problem with it. (Cassandra's dad is on it too but I think she said he hates it ) Don't know if that's an option for Bear. eta: * (see below)

BTW phos binders can be constipating - I did mention that before, right? Wondering if that's the source of Bear's discomfort.
Gotta go, break ended 2 mins ago

eta: *Another binder that I've seen used, but not as much, is sevelamer hydrochloride/Renagel is one brand. And then there's niacinamide, which I know pretty much nothing about.



Sent: Fri Feb 26, 2010 7:57 pm
by Linda and Bear Man
Thank you for all that info, Choy-Foong. The vet wants to ultrasound Emily's kidneys next week. We'll talk about a treatment plan after that. I haven't actually spoken to "my" vet yet, just the other vet in her office who gave me the results. I will start giving her the same food Bear is eating in the meantime. Her urine culture was negative, and her UPC ratio was normal.

I have been looking into buying Amphojel, which I believe the pharmacist can order for me. I haven't ordered the ALOH3 from the US yet, as I think I will stay with the capsules for Bear. I don't think he will eat his food with the powder in it, and the capsules are giving us good results. For sure, I don't want to mess with what I am doing with him for a few weeks, as I am hoping to go away on a short vacation in two weeks, and I don't want to mess with anything before then. I think I will look into ALOH3 from the US, or the amphojel for Emily, as she is more likely to eat food that has stuff mixed in than Bear is. Have you ever used amphojel? The pharmacist said it may contain a bit of calcium in the tablet form, which is worrisome.

Bear's liquipoo is doing much better on the binders, so I am happy about that. Emily already suffers quite a bit from constipation, so she may not do well on the binder.
Anyway, thanks again for all your help. I really appreciate it.
Linda



Sent: Fri Feb 26, 2010 9:08 pm
From: WCF and Meowzi
To: Linda and Bear Man
U/s is a good idea I believe it's what Jess would recommend. And x-rays too, if you haven't had that done, to rule out kidney stones.
That's GREAT news on the normal UPC!

No, we haven't used Amphojel. Miss Finicky here seems to tolerate the powder.
==============
http://members.verizon.net/~vze2r6qt/su ... inders.htm
"Amphojel (Wyeth-Ayerst - NDC# 00008- 0010-01), an over-the-counter thick liquid suspension with 320 mg of aluminum hydroxide per teaspoonful (5 mL) (64mg/mL), available in peppermint and unflavored versions. Comes in 12 oz bottles. Most syringe amphojel down their cat's throats or give in gel caps. The tablet versions of Amphojel have been discontinued in the US and the liquid version is no longer distributed in the US; however, generic versions of Amphojel liquid are widely available - ask for an aluminum hydroxide suspension antacid. "
==============
Hmmm ... thick liquid suspension .... will it go down well for her? (pun intended). If you do the liquid, I'd get the plain flavour - I think Maddie had something similar, but was mint flavoured, and she hated it. Joan ended up getting a tub of ALOH3 powder after that - I know b/c Maddie bequeathed the remainder of her ALOH3 powder to us.

I guess it's good that Bear's liquipoo is better on ALOH3 - haven't seen liquipoo problems much on the CRF group LOL - usually is complaints of constipation, b/c of combo of dehydration, and the binder.

As for Emily - we add Miralax to Meowzi's food to stave off constipation proactively, since we know ALOH3 is constipating. I would be worried about any binder that has calcium in it for Emily - you know my concern about Ca x P.

I understand not wanting to mess with Bear's meds before going away - yay for short vacation, much deserved, I'm sure. But when you return, talk to your vet about whether Bear's ALOH3 dosing is sufficient. This is the dosing chart we started with http://members.verizon.net/~vze2r6qt/su ... m#drnagode although we're now using a modified version because we're combining two binders. But I'm still concerned if it's not making him feel good - don't know if raising dose is do-able with him if so.

Hope this helps.

wcf

 

I am glad to hear that Bear Man is doing well. Sorry to hear about Miss Emily, hope she will feel better soon.
About Miralax, I used to buy it in Walmart Pharmacy, that's the only place they could order it (under the name POLYETHYLENE GLYCOL (PEG) 3350). The usual start dosage for a cat is from 1/8 tsp to 1/2 tsp twice a day. Best thing is to start at 1/8 tsp BID to see how Miss Emily reacts. It can take a few day to see some results. If no results after 3 days, increase to 1/4 tsp, etc. Some cats may need more than 1/2 tsp, Ti-Mi was almost at 1tsp BID (but had severe constipation). You can give Miralax on a daily baisis for the rest of her life if needed.
I used to mix it with very little water and put it on Ti-Mi's food. He did'nt notice at all. Voilà, hope the information will help.

 

The wealth of knowledge never ceases to amaze me and I'm soooooo happy you're sharing

It's like a bio-chemical tap dance up in here! Hang in there Linda, you're doin good. I just wanna mush you all ((((((((Linda,Choy-Foong, Bear, Emily)))))))

 

Hi Linda
I m sorry to hear about Miss Emily not feeling that well and pleased to hear a better
Bear Man's report. With regards to the Miralax, I bought the Lax A Day at Walmart, (didn't you tell me the equivalent CDN name?) and I have been using it BID,
1/8 teaspoon for Max.
I have not seen any liquidpoos and not so sure if he needed it but I guess with all of this wet
food I wanted to make sure he did not have problems.

BTW, I am going to the states on Thursday, not sure where you are going on your vacation.
If there is any medications, or US stuff you need, let me know. I can bring home in my suitcase and send to you in Canada.
Oh and thanks for the offer of the Fortiflora. I am not sure if this is something I need or should use for Max.

 

Glad to hear your tx seems to be helping Bear, and hopefully Ms. Emily will start to improve as well.

It is so hard to leave them, even when they're well.

KB's has hind quarter weakness - he had neuropathy but he also has spondylosis, particularly in his tail bone area. I've noticed improvement with his hind quarters recently. In addition to things like what you mentioned, he also takes Chinese herbal pills twice a day that are supposed to target hind-quarter weakness and help build muscle mass (the vet we started with specializes in alternatives like herbs and acupuncture). They're called Di Gu Pi. Can't say which of his supplements are doing what for him, I don't dare stop any of them.

 

HI Linda !

Sorry to hear miss emily is not doing well.
Glad you are getting some good info from CF. Assuming she also mentioned using calcitriol and azodyl ( wait brain just kicked in. I think you are already using the azodyl?? )
can't use the calcitriol with high phos though. must get that down first.
Use that on my civie Wolfie . He has had crd for 6/7 years. seems to help him from progressing. Winnie also used that and it kept her values low.
We haven't added the azodyl yet....... one of the things on our list. juggling a few things here with Wolfie.

One specialist Winnie saw wanted to add in the acarbose. We ended up deciding against it b/c it can cause gas and diarrhea. her gi tract was taxed enough. In fact , I think sometimes they tout it for relieving constipation. Kinda surprised it isn't helping her that way........ hmmmm.......
I posted on the following thread recently links for information on all manner of treatment for constipation :
viewtopic.php?f=29&t=7345

maybe something there can help.


Take care. I hope the u/s goes well. Will you get to watch ? I love that the internal med spec. we go to gives me the guided tour. she says the kidney should look like a tomato slice

best to Bear and Teddy too.

 

another information condo, I'm bookmarking this to read through later. You're doing a great job, Linda. This is a lot to digest all at once but you can do it.

 

ummm no i mentioned azodyl for bear earlier, but forgot about it for emily. ohmygod_smile i saw her phos and alarm bells just went off, so i just focused on that. glad you brought it up, cheryl.

didn't mention calcitriol for either, b/c of the high phos as you pointed out. but i think cyn had mentioned it in bear's condo sometime ago.

 

((Linda)) ((Furries))

I'm glad to hear that Bearman is doing well on his new regiment.. however, sorry to hear that Emily is not doing so well..

I am always amazed at the wealth of knowledge that this board has to help one another..
We are so fortunate!

Just wanted to send a cyber hug to you!

 

btw, i want ya to know that i was puzzling and scratching my head the other day when i first saw miss emilys lab wondering wth was her BG low on that BW, was she septic, was she etc etc etc., lolol. yeah i saw the other day why. :roll:
did she get her BP taken?
glad that miralax like stuff is easier to get there, will be needing that for sure. and yes she can take it for rest of life, sprinkled on food with water added, will not cause harm. everything just gets so thrown off on them when they are slightest bit constipated, felines just cannot handle it well. i think you and she will be way happier with miralax type products than the current metamucil. i dose constipation meds differently than stephaine, start high and back down until perfect effect. the doses she gave you are correct. either 1/8 or 1/4 tsp bid in little bit of tasty food with water added. good luck! hope this solves that issue for good!


Jojo: his last reticulyte count was 0.4
and that was way back in oct? darn was hoping it was from the hematochezia (or does he have melena?) if he still had that and was regenerative.
btw, while i'm thinking of it, is he still spinning or has that calmed own?
yes see you are getting more blue there. good. totally up to you if you want to wait longer to see if get even more easy blue here or add a little drop of insulin. if you are asking my opinion i would prolly wait a little longer, not looking for bear to be green when you are not home nowadays. (however he is not my cat, is yours, you do whatever you feel is best with dose, your instincts are just fine).
when i think about anything to suggest with bear, my first thought is how will this suggestion effect QOL now, rather than thinking about a lab number and how it might change 6 months-1 yr from now. do you know what i'm saying? like do you think you are still seeing any connection between the binders and his comfort level like what was written in condo not long ago? i know i'm going in different direction than rest of this thread, not trying to play devil's advocate, just my own personal opinion, which you are free to ignore, is fine! i have odd takes on things sometimes based on my own personal experiences with so many years with bunny.

you're doing great job with very full plates. don't forget about you.

 

Cheryl - not starting calcitriol or azodyl yet. Want to get our food and binder routine established before adding in more things.

Jojo - He is still circling, usually when he needs to find the litter box. I am asking for your advice, and I always respect it. I was thinking of lowering dose a bit when DPS is here.
The binders are helping him at bid dosing - helping with liquipoo - but don't work at tid dosing.
I get what you are saying about QOL now.

He is getting B12 shots, and we hope that might help the anemia. It could be thyroid related, GI bleeding (more hematochezia than melena), drug side effects (Omeprazole, methimazole), etc etc.

Thanks for stopping by (Jojo and everyone).

 

Linda... lots of hugs for the Bear man. I always loved that sweet face and wanted to smoosh my hands around him. I wish I could help with advice, but can only offer my warmest healthy thoughts.

 

Sending lots of flufy snowflakes across the sea (((Bearman, Emily, Linda)))

 

Sending Healing vines to Bear Man & Emily to feel well asap! Linda, you are still my hero cat momma!