Angel update

Discussion in 'Feline Health - (Welcome & Main Forum)' started by SweetAngel, Jan 8, 2021.

  1. SweetAngel

    SweetAngel Member

    Joined:
    May 30, 2014
    hi, Angel and I are back after a long silence due to numerous personal issues (will explain later) Basic history for Angel, he was diagnosed in May 2014. OTJ beginning of September 2014 then had a 'blip' on the 5th Nov 2016, on insulin 15th Nov-12th Dec and remained OTJ ever since. I have been feeding him and the others an ultra low carb diet (Gourmet cat pate, Gourmet country collection pouches, and Felix AGAIL) now he has sadly been diagnosed with early stage 3 ckd. I'm in UK. What foods can he safely eat that will not risk bringing back his diabetes? Also I've applied to join a ckd support group and left a message with the vet, but just in case anyone can tell me, I have a copy of his investigations and his phosphorus levels are high, the food they prescribed (Royal Canin) is I think 0.9 phosphorus, should I be thinking about phosphorus binders?
    Now to my situation, it turned out that my partner was a narcisisst. I knew he could be pretty nasty sometimes but put it down to his abusive past. He basically slowly but surely took away what little self confidence I had, and when I was at my lowest after losing one of my best friends through cancer, he was unknown to me romancing online a Filipina prostitute young enough to be his grand daughter. He had told me he had become too old to make love to me. Well turns out he went to the Philppines for 'a break' got engaged to her, and she became pregnant almost immediately and they got married 2 days after my birthday. All this time he was telling me he was thinking of buying a bar over there for OUR future (when really it was for him and her) and trying to get my 91 year old father to invest his life savings (luckily he did not!!) I'm still dealing with the aftermath of all this, then Nov 2019 I lost my beloved aunt who was like a sister to me when I was growing up. Angel has been there for me throughout the bad times, I call him and the others my '4 reasons to live'. I love them all equally but there is this added bond between me and Angel from when I was treating his diabetes. He really is the nicest natured most loving little soul ever.
    I have so wanted to be back here and give back the support Angel and I received, but have not been emotionally strong enough and for that I apologise.
    Cassandra and Angel x
     
    Last edited: Jan 8, 2021
    Reason for edit: forgot to say in uk
  2. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Hi. My cat is almost stage three ckd right now. I feed weruva foods but not sure if that's available there. You could do phosperhous binders if his phospherous is high. Most use aluminum hydroxide. what is the phospherous (dry matter) in the food you are currently feeding? I don't use it yet, but probably will have to at some point. Do you have a copy of the lab reports? you don't want to use the binders unless your cat's phospherous is actually high.

    The other thing I do for my cat is sub q fluids every three days, and b12 and b complex vitamins because so many of them get washed away and leave them prone to anemia.
     
  3. SweetAngel

    SweetAngel Member

    Joined:
    May 30, 2014
    Hi Janet, weruva is not available here and the bff ones were discontinued as there was some sort of problem with them. Angel's phosphorus is very high, uk level 3.11 US level 9.64. His creatinine uk 297 US 3.36. He's just been started on Royal Canin renal diet which is apparently 0.09 phosphorus, but it's pretty high carbs. Luckily my vets are supportive of sub q fluids but they said he's not at that stage yet. I do have the lab reports and will try to get it into the forms tomorrow. When he goes for his check up on Monday I'll ask about B vitamins as he was slightly anaemic. He had numerous investigations, ultrasounds, scans, x rays as his white blood cells were elevated but they couldn't find a sinister reason and it's possibly down to his allergic rhinitis which they said is borderline asthmatic. His thyroid was normal.
    He's got a good appetite but is thin, he was losing weight which is why I initially had the tests done. He was given fluid therapy at the vets and seems much more himself, he was so happy to be home after 2 nights away. He always snuggles on the bed with me (sometimes on the pillow) and I've missed him.
    Is that your CC in the photo? She's gorgeous xx
     
  4. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Yes that's CC. I just started fluids a few weeks ago when her creatnine crept up to 2.8. I would do them at the 3.3 level you are at... At least a couple times a week.

    The problem with the Renal foods is 1. Too high in carb 2. Too low in protien which can lead to muscle wasting. Definitely sounds like your cat needs a binder, but I'd put it on his regular food if that's what he likes.

    Glad to hear his thyroid is good. Cc developed hyperthyroidism about a year ago. As if acromegaly diabetes, CKD and a heart murmur weren't enough. But she's a fighter and a happy girl and the boss of the other five cats.
     
  5. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Tagging @Gill & George who's kitty is in remission and CKD. Although she's now in Europe, she has a good handle on low phosphorus food that are diabetic friendly in your part of the world.
     
  6. SweetAngel

    SweetAngel Member

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    May 30, 2014
    Thanks Janet and Wendy. I'm wondering if Angel's worryingly high phosphorous is due to the fact I was giving him tuna and sardines the day before to encourage him to eat. I didn't know it was about the worst thing you could give a ckd cat. I'm going to ask about binders, fluids and Vitamin b supplements when he goes for his check up on Monday. I'm assuming they will re do bloods if not I will probably ask. He's not impressed with the small amount of food he's now on, but apparently it's more than enough for his weight and body condition. I want to get that phosphorus down. I've joined Tanya's group as well. x
     
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  7. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    There's a good facebook group too that I belong to called Cats with Chronic Renal Failure.
     
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  8. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Hi Cassandra,

    It's good to 'see' you again, albeit I wish the circumstances were better. I'm sorry you've been through such a rough time. :bighug:


    Mogs
    .
     
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  9. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Hi Cassandra,
    On the UK food list there are a number of Low Carb foods with Phosphorous under 1%, though they are not down at therapeutic levels. The problem with the kidney diets is they are all too high in carbs for a diabetic cat.

    I've been feeding George a these for a while now. George is in Stage 2-3, his P has remained within normal levels and stable from the start. I don't know if this will be enough for your kitty.
    I add extra water to his food to help flush out toxins and keep him hydrated, and he has a water fountain which he loves to drink from, keeping him well hydrated is also important.

    It might be worth looking into a homemade diet for your guy, and using a supplement to make it a complete diet that is lower in phosphorous than the commercial diets that are available, I'm considering using this myself though I haven't made the change yet.
    Felini Renal it's available from zooplus (that's the link I've given you)

    ETA
    the ferringa pure meat lamb and the ferringa pure meat chicken as well as some of Lily's kitchen suppurs are the commercial diets with the lowest P % (0.6-0.7%)I aim for under 1%.
     
    Last edited: Jan 10, 2021
  10. SweetAngel

    SweetAngel Member

    Joined:
    May 30, 2014
    Hi Mogs, Gill and George. @mogs I've been thinking of you.
    Gill, I think I will probably get phosphorus binders along with as low as possible phosphorus low carb diet. Angel likes the renal food but is not impressed with the amount he is allowed. His wbc count was elevated and they've ruled out anything sinister so I'm going to ask for antibiotics for him as he has a bit of a cough. He has seemed better since being on fluids at the vets and definitely has his appetite back, of course he wants his normal food and the others want his renal, typical. Thanks for all your support xx
     
  11. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    What's his BG like at the moment? Are you/have you starting insulin again?
    George has been on a vit B complex for a while now, he was anaemic a while back so I started him on the vitamins, the anemia has resolved, I still keep him on it. I use Jarrows B-right (vit B12 complex) it was one of the ones recommended on Tanyas site. He get's 1/9 of a capsule a day mixed into his breakfast, it's has no flavour so it goes down well.

    I've just been doing a bit of research and running some numbers on a dry matter basis, though non of them are LC I thought you might find them useful if Cassandra is back on insulin and you are needing to bring her numbers up.

    Integras renal protect diet is 10% carb, phos 0.695
    beaphar renal diet is 0.4% P with carbs at 20% (maybe good option for HC for steering her BG if she goes low)
    concept for life renal is 0.5%P and carbs at 14%
     
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  12. SweetAngel

    SweetAngel Member

    Joined:
    May 30, 2014
    Hi Gill,
    I haven't been able to check his bg as my testing stuff is all out of date, but I'll get them to do it at the vets tomorrow. I don't think the royal canin is too horrendously high in carbs but I'll check that too. The Integra Protect looks like a good compromise as he's done fine on around 8% carbs and I'd probably add a bit of the phosphorus binders. I've ordered some binders, plus some of the lowish phos low carb foods from the UK list. (Feringa, Smila (which he used to have) and Lily's kitchen). I'll see if the vet can give me some cat vitamin B, but if not I'll get the ones you suggested. Thank god for my dad, who regards the cats as his grandchildren. I'm on PIP. I have Angel insured but I have to pay excess plus 20% of vets bills, but nothing is too much for my boy. Plus there's a question mark over exclusions which should have been removed after the first year so not 100% sure insurance will pay yet. Oh well he's worth all the money in the world and more.
    How is George doing? He's gorgeous. 2 of my non sugar babies Romeow and Shakira are black and white. x
     
  13. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    If you've not come across Tanya's Feline CRF group, the site is an incredible resource for information on renal disease.
     
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  14. SweetAngel

    SweetAngel Member

    Joined:
    May 30, 2014
    Hi Sienne, yes it's really helpful and I've joined the forum. At the moment Angel is so hungry, I daren't give him more of his renal food than prescribed in case it sends him out of remission, and I daren't give him any of the low carb stuff I have in the house as I have a feeling the phosphorus levels would be horrendous. Oh well, vets tomorrow and I'll ask their advice. Binders and low carb lowish phos food arrive Tuesday. X
     
  15. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    If you are getting new testing stuff, the SD code free meter, is quite economical when it comes to test strips. I used it throughout Georges insulin journey. It requires a little more blood than some, but it wasn't an issue for me.

    It's good that he is eating, hopefully that means he is not feeling sick and maybe that's a sign his P is returning to more normal levels.

    George says thanks and sends you some head bumps.
    George is doing well at the moment, at 21 he's a little arthritic and a bit slower than he was but generally he's doing well and still is the boss of the other 3 cats in the house. His creatinine is up a bit at his last blood test, but other parameters were stable, at the moment the advice from the vet was to carry on doing what I was doing.
    I've run the numbers, from the analysis info on zooplus
    Carbs 26%
    P 0.375%
     
  16. SweetAngel

    SweetAngel Member

    Joined:
    May 30, 2014
    Hi Gill, thanks that is so useful. I've been looking around the internet and found out I could possibly add egg white to his renal food to keep the phos. and carbs low. I'll do that if he's mega hungry today, then binders and Lily's kitchen arrive tomorrow. I have an alphatrak meter but need new strips if his bg is dodgy today. I wish someone would make food specially for cats with diabetes and ckd. Have found a few home made recipes online, they both list a load of vitamins to add, so I may try the recipes with the stuff from zooplus. If his bg is normal today I'll probably order the Integra Protect, he's had the diabetic one and liked it. Just bought the cats a flippity fish, it's charging at the moment and Shakira and Romeow are going mad over the catnip. Angel and Bonnie havent seen it yet. x
     
  17. Larry and Kitties

    Larry and Kitties Well-Known Member

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  18. SweetAngel

    SweetAngel Member

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  19. SweetAngel

    SweetAngel Member

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    May 30, 2014
    Update on my baby. Back from the vets, Angel's BG is fine, and he's been started on antibiotics as a safety measure due to his high wbc count. Vet totally on board with low carb food and binders, also I asked about something called Porus Plus, he kindly looked it up and said go for it and if I can't get it he'll source some. Still awaiting urinalysis, still possible he has an infection along with the ckd. xx
     
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  20. SweetAngel

    SweetAngel Member

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    May 30, 2014
    Hi, I just had a conversation with a vet about Angel's urine results. He has protein in his urine but not horrendously bad, so will be started on meds for that.
    Well this vet also said:
    1 do not worry about carb content in renal food being as he had been on the Royal Canin for 4 days and bg normal, don't worry about addressing the diabetis as it's probably no longer a problem.
    2 do not feed him anything other than either Royal Canin or Hills renal, (I have just recieved my order of Integra renal!) and do not add egg white.
    3 Do not give him Porus One as she has never heard of it and the vets would have heard of it if it was any good.
    4 Don't start B vitamins until bloods are repeated as he wasn't anaemic on latest blood tests.
    The only thing I was happy about was she said to give him more food if he wanted.
    I've made an appointment on Monday (new regular vet thank God, not the one I spoke to) and they will do his bg and check for anaemia. Now I'm doubting myself. All I want is to do my best for my sweet boy, to keep him happy and healthy for as long as possible, but am I trying every option just so I can have some control? I got so discouraged I promptly ordered another 24 pouches of the Royal Canin.
    If I hadn't joined this group I would never have got Angel off the Caninsulin and into the diabetic trial of Prozinc so maybe I shouldn't doubt myself. Help! xx
     
  21. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Cassandra,

    Sorry to hear you're having vet woes. :bighug:

    Can I ask what they've prescribed for the proteinuria?


    Mogs
    .
     
  22. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Renal food is not diabetic appropriate food.... Unless your cat is late stage 3 or 4 ckd I would opt for a low carb low phosphorus wet food such as weruva. Your call but keep an eye on those bg numbers.

    Can you post a copy of the Bloodwork?

    Is he taking Benezapril for the protienuria?

    Did they check his blood pressure? Ckd cats are prone to high bp
     
  23. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Oi! You're stealing my thunder, Janet! :D ;)


    Mogs
    .
     
  24. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Haha. I just remember that's what my Zimmy had to take. Then they added in amlodipine for the bp.
     
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  25. SweetAngel

    SweetAngel Member

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    May 30, 2014
    Thanks everyone.
    Integra renal is only just over 10% carbs so I'm going to go for that for now, as his phosphorus levels were very high for early stage 3, and keep an eye on his glucose levels. I'm sending a copy of his test results. Can't find any mention of his blood pressure so I'll ask. I can't remember what meds they are prescribing, I'll find out when I pick them up, hopefully tomorrow if they have them by then.

    Lianna used to take Fortekor for her hcm so wondering if it might be that. That would bring back some memories of my little Birman diva. My current Birman, Bonnie is I'm sure having spiritual conversations with her as she plays the exact same game Lili used to play, she liked me to chase her and then to hide and leap out at me, and also to chase me and me to hide and then pick her up and cuddle her. Never known any other cats that like being chased by humans!!
    x
     

    Attached Files:

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  26. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    @Marje and Gracie can you look at these labs?
     
  27. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    If they're prescribing Benazepril (or other ACE inhibitor), make sure they have checked his blood pressure. In general terms, for a stage 3 kitty they should definitely be checking his blood pressure and also checking his eye health. While Benazepril may be prescribed for proteinuria, it can also lower blood pressure. (Relevant info from Tanya's Site here.)

    Good news is that the Integra Protect Renal trays are only 7.0% kcals from carbs, so suitable for a feline diabetic (10.87% on a dry matter basis).


    Mogs
    .
     
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  28. SweetAngel

    SweetAngel Member

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    May 30, 2014
    thanks everyone for your support. The meds are called Semintra. Angel's blood pressure wasn't done so I've asked for it to be done on Monday. I also forwarded info for vets about Porus One and they will look at it. The regular vet is stuck in South Africa but apparently the one we are seeing on Monday is really good (and not the one I spoke to yesterday)

    Just a couple of quick questions, how do I calculate protein on a dry matter basis? I've been advised to keep it below 35% dmb. My maths is lousy and I just can't think of the formula to work it out. eg Lily's kitchen is 80% moisture and 10% protein. Is that 50% protein?

    Also Angel's glucose was 6.something (UK) after 4-5 days on the Royal Canin, and it was apparently too LOW when I originally took him so could it actually be safe to feed him the Royal Canin? It's the lowest phosphorus and his phosphorus was worryingly high.

    xx
     
  29. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Active ingredient in Semintra is telimisartan, an angiotensin receptor blocker (different mode of action to ACE inhibitors, but also affects blood pressure). I'm glad to see the vets are going to check Angel's blood pressure. As a reminder, be sure to get them to check his eye health too (safety precaution).

    IRIS Website - Hypertension Info

    My civvie, LĂșnasa (aka The Noodle), is IRIS stage III and I monitor her blood pressure at home. I bought a veterinary oscillometric meter for Saoirse so have it available (not cheap). If you're interested in monitoring Angel at home, nowadays there are more affordable pet BP meters on the market. There's a recommendation for one on Tanya's Site (can't remember exactly where, probably in the section on hypertension).

    Re calculating nutrient DMB %s, the following thread shows you how:

    https://www.felinediabetes.com/FDMB/threads/calculating-calories-from-carbohydrates.205128/

    Per Tanya's Site, here's a copy of my little summary of their nutritional recommendations:

    upload_2021-1-15_15-26-47.png



    Mogs
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  30. Gill & George

    Gill & George Well-Known Member

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    Oct 27, 2015
    That so everyone else is used to US numbers is over 108, so blue. Not too low.
    Check her with your meter and strips when you get them, at the vets they can get dodgy readings, though most cats see a spike, some cats do in fact drop.

    When a kitty is OTJ they are still diabetic, so they should stay on a LC diet for life, otherwise they will, and we have seen it here numerous times, come out of remission. If that does happen you want to nip it in the bud ASAP. So if you decide to continue with the renal food I would monitor him daily so you can nip it in the bud really quick if it starts to impact her BG. Getting a kitty into remission a second time is harder.
    In fact it is good practice to always monitor BG when you introduce a new food, medication, or kitty is off.

    I do agree with the not adding the egg white to the Rx food to lower the carbs, because it will also be altering the nutritional balance of the food, I don't know if that could lead to any adverse effects, but it might mean the food is not well balanced for him.
    Have you got previous blood test results for Angel? It's more interesting to look at trends in the values than just if he is in range, as that might tell you if it's something you need to be watching.
     
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  31. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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  32. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    @Gill & George -

    Hi Gill,

    I just wanted to post a note of gratitude to you for the recommendation of Animonda Integra Protect Renal foods.

    My civvie, LĂșnasa (aka The Noodle), is IRIS stage III and for the last few months I've been having a terrible time trying to get her to eat (appetite is there and she's getting ondansetron, just didn't want the food offered). She's got a very sensitive digestive system so for years I've had to keep her on a pork-based kibble (Virbac Digestive Support) as it was the only food I could find that agreed with her. Several months ago I was able to very gradually transition her to their renal support kibble (similar ingredients). It really didn't agree with her and it was a battle to get her to eat enough each day. She started overgrooming her belly and eventually refused to eat any of it. (It contains rice and I think that's probably the ingredient that was giving her trouble.) For the last few weeks, out of desperation I had to put her back on the gastro support kibble and I didn't know what to do for her. :(

    I saw that one of the Integra Renal flavours was mostly pork and was rice-free so I ordered some from Zooplus. I am very pleased to report that the Noodle's been eating it for the last few days. Her energy, alertness, mood, and coat condition have all really improved. She's enjoying the food and I'm greatly relieved that she's on a food more appropriate for a CKD cat.

    Thank you, thank you, thank you! :bighug:


    Mogs
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    Last edited: Jan 16, 2021
  33. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Aug 5, 2016
    Hi, I'm jumping in a bit late in the discussion, sorry I've had some busy days and haven't been around much but still I just wanted to share some thoughts with you

    Vets usually panic with CKD what ever the stage and I've heard way too many times that you should treat the kidneys and too bad if his diabetes comes back or gets out of control you just give them insulin, the same was recomended to me by the vet with Babu-Chiri and in my opinion that is seriously not a good approach since uncontrolled diabetes will do more harm to the kidneys

    What I have done is keep away from comercial renal diets ( prescription or not) and stick to low carb food with the least phosphorus content in it, I do cook my own food but I do give them canned food once in a while if I can get my hands in some that meet the criteria, weruba and other ones are not easily available where I live so I do not have many options that's the reason I started home cooking.

    So far I would say it's worked Babu-Chiri has remained in remission and his CKD more o less controlled although I've needed to give him some phosphorus binder lately just to keep the blood phoshporus levels under 4.5 (US) as is mostly recommended and I give the same diet to my other CKD cats and it has worked great they all get vitamin B complex not because they are anemic but because cats with renal problems do benefit from some extra B complex vitamins and they also get omegas
     
  34. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    May 18, 2016
    In some cats, Semintra can cause stomach upset. Watch for that.
     
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  35. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    Given that diabetes is very hard on the kidneys, ignoring the diabetes may also make getting the kidney values to improve can be a struggle. The food suggestions above are all good. One additional consideration is that you can use a phosphorus binder if you can't find a low carb low phos food that your cat likes.

    @JanetNJ - Also benazepril is an ACE inhibitor -- it's a blood pressure medication that's in a different class than the telmisartan. Benazepril is not specifically a medication for proteinurea but can have a positive effect on lowering urinary protein.
     
  36. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    I just know that's what my vet have my cat Zimmy for his protienuria and it resolved the problem.
     
  37. majandra

    majandra Well-Known Member

    Joined:
    Oct 11, 2018
    My Rhubarb just got diagnosed with kidney issues today (I'll know more when I pick her up from dental).
    Bad reception and working, so mostly just posting to follow the thread and read through later.
     
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  38. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Aug 5, 2016
    I'm sorry about the diagnose, but make sure to get a copy of the lab work done and post it in the forum for everyone to see ( I would suggest opening a new thread) so that you can get more specific suggestions on how to handle the CKD, just know that CKD even on top of diabetes is not a death sentence, cats with CKD can have a long happy life with just some precautions and a bit extra care
     
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  39. majandra

    majandra Well-Known Member

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    Oct 11, 2018
    I'll do that once I have everything- I don't mean to hijack thread.

    One question relavant to everyone- what do you buy for B complex for cats, and what is a standard dose? I've only used zobaline for Rhubarb.
     
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  40. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Hi Majandra,

    According to Tanya's Site, Jarrow B-right is popular with members of their support group. IIRC the cat dose is 1/10th of a capsule per day, preferably divided across feeds (not easy - it's a tiny amount of powder. More information here.


    Mogs
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  41. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    @majandra
    Hi to answer your question in your post #39 I used Jarrows B-Rite I had joined Tanya's site and was told to use this for CKD kitties


    I joined Tanya's Kidney group , they advised me to give Jarrows B-Right Vitamins , along with Methyl B-12 .
    I will post the links below

    Now with the Jarrows they told me to open the capsule and divide it into 10 doses.
    You don't have to do it that way, they told me to buy the set of mini stainless steel
    spoons and use the one that says DROP on it. You give it once a day , mix it in the
    wet food with the Methyl B-12 .
    I will give you the links for these.
    Check out Tanya's site
     
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  42. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
  43. SweetAngel

    SweetAngel Member

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    May 30, 2014
    Angel update and @majandra
    Majandra, after reading it on Tanya's site I got some empty size 5 capsules and apparently they are exactly a tenth of the Jarrows B right, so I put slightly less in as he's under 5k, then have the rest of the B complex myself as I think I need it.

    Angel's update, he had his check up yesterday, he has put on weight (which he needed to) and his coat is soft and shiny again. His BG and blood pressure were both normal, his cough has disappeared since starting the antibiotics.

    He's had bloods taken to recheck phos and wbs's, to check b12 levels and another test to see what's going on with the stomach lining. They said no indications at the moment that a biopsy is needed. This vet was much more supportive. She said go ahead with the porus one, and at the moment pending his phos levels I'm giving him half the Royal Canin and half Integra with binders, she said fine.

    Insurance are playing up, apparently they were supposed to review and remove the exclusions on his policy 4 years ago, due to an oversight on their part they didn't, and they are trying to use that as an excuse not to pay up. Urinary system disorders were excluded due to one incident of cystitis years ago!!! They also said drinking too much was excluded as a symptom, I said that too should have been removed and besides he was being investigated for weight loss. They are looking at it again but I pointed out with a furbaby with a progressive illness the last thing i need is more stress. If necessary my dad would have to pay vets bills.

    I'll keep everyone updated,
    purrs from Angel and hugs from me x
     
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  44. majandra

    majandra Well-Known Member

    Joined:
    Oct 11, 2018
    So glad Angel is improving!
    I hope your insurance gets their stuff sorted soon and gives you money
     
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  45. SweetAngel

    SweetAngel Member

    Joined:
    May 30, 2014
    Angel update, his bloods are much better, WBC's and phosphorus are now normal, even creatinine is within normal range but he does definitely have ckd. His bg is normal despite him having 2 pouches of the royal canin renal per day (along with one tray of Integra Protect and phosphate binders)
    He was borderline low b12 so has started a course of injections. He's put on another .8 of a kilo which is good.
    In view of the diabetic remission and whatever is going on with the stomach, he is being referred to a specialist. It won't be anywhere near, don't drive and we are in lockdown but luckily I have a friend who is my 'support bubble' who will coincide her visits with his appointments. Angels ckd bloodwork attached x
    xx
    https://docs.google.com/spreadsheets/d/13TuoxcCK-KfwPrOWm7kJ1bHU6OZB7aOU27SAH-hp-1E/edit?usp=sharing
     
    Last edited: Jan 22, 2021
    Reason for edit: attached bloodwork
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  46. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Are you still using an Alphatrak meter, Cassandra?


    Mogs
    .
     
  47. majandra

    majandra Well-Known Member

    Joined:
    Oct 11, 2018
    Is urine ph of 5 a typo? That seems way too acidic! Does he have kidney stones or something?
     
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  48. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    I'm glad things are looking up.

    I've been looking at the porus on, have you started that? Is angel tolerating it?

    Monitor his bg regularly if you are going to keep feeding the renal foods.
    I would start doing it daily, perhaps for a month. But at least weekly, following up if you catch a high reading.
     
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  49. SweetAngel

    SweetAngel Member

    Joined:
    May 30, 2014
    hi everyone,

    Angel's urine was tested when his WBC was up, so could be he did have a slight infection. I do still have an alphatrak meter but the strips are out of date, I'll get some more ordered, though as his phosphorus levels are normal at the moment I'm reducing the royal canin and feeding him more of the integra protect plus phosphorus binders. They are testing weekly when he has his B12 injections.
    He's having the porus one quite happily, plus semintra and a course of weekly b12 injections. Insurance still playing up and I'm now overdrawn from paying 2 lots of excesses as his policy renewed a few days ago! Oh well, my boy is worth every penny and my dad will help until I get money through from my aunt's estate. I lost my aunt Nov 2019, she was like a sister to me when I was growing up.
    He seemed a bit out of sorts on Saturday but back to normal now, I think he was put out about having to go to the vets yet again!!
    xx
     
  50. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    How high are the phosphorus levels? Unless they are over 6 I wouldn't give the binder. Just feed low phos food.... What is the level now? I know it was high before.
     
  51. SweetAngel

    SweetAngel Member

    Joined:
    May 30, 2014
    Hi Janet,
    Angel's phosphorus are UK 1.17 which is US 3.63, so much better, they were US 9.14 before!
    The Integra protect is 0.16 phosphorus and I know they recommend less than 0.05 so that is why I've been giving the binders. Do you think it's ok to stop them?
    With the kidney disease, even for a diabetic cat I'm supposed to feed 35% or less protein dry matter, the only food that addresses that and is borderline ok for carbs (right on 10%) is the integra protect renal.
    Any advice would be welcome
    x
     
  52. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

    Joined:
    Aug 5, 2016
    His phosphorus levels are quite resonable and if you are giving him low phosphorus food I don't think giving phosphorus binders is necessary unless you start seeing his numbers raise, an regarding the 35% or less protein that may not be very accurate, what you need is low phosphorus it really doesn't matter how much % protein you give actually for a cat the higher the protein the better if you want to avoid muscle loss. Sometimes people (even vets) suggest lowering the protein as a way to lower the phosphorus ( there's a relationship between the amount of protein and the amount of phosphorus) but there are ways to not lower the protein and still have low phosphorus and that would be giving high quality protein (that not necessarily means expensive, for example egg whites are way high in protein and almost no phosphorus ) that is why you can actually find low phosphorus, low carb diets which is what you want to aim for

    Usually renal diets which are low in protein and usually high in cabs are recommended when the kidney problems are more advanced than what Angel is ( that would be end stage 3 or stage 4)
     
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  53. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Cassandra,

    Assuming that you're feeding the wet Integra Protect Renal foods, the DMB values are as follows:

    Protein: 33.9% dry matter (Tanya's Site CKD target - 35.0% DM).
    Phosphorus: 0.7% dry matter (Tanya's Site CKD target - <0.5% DM)
    Sodium: 0.74% (Tanya's Site CKD target - as close to 0.20% DM as possible, though less critical than protein and phosphorus content).

    Carbohydrates: 10.9% dry matter | 7.0% of kilocalories from carbs (FDMB FD target - <10% kcals from carbs).

    With regard to using a phosphorus binder, Angel's most recent serum phosphorus level of 1.17mmol/L is in the lower part of the normal reference range. The recommendations from Tanya's Site for initiation of binder use are:

    * if P >1.9mmol/L

    - OR -

    * if P x Ca >= 5.0 (serum levels in mmol/L)

    Angel's latest phosphorus result alone wasn't high enough to indicate a binder being required at present. You'd need to check where his calcium levels were at in the same set of blood tests. Did you get the calcium result from your vet in the last round of blood tests? Giving a binder when it's not needed could potentially result in phosphorus levels getting too low.


    Mogs
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    Last edited: Jan 26, 2021
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  54. SweetAngel

    SweetAngel Member

    Joined:
    May 30, 2014
    hi Janet and Mogs,
    Angel's bloodwork https://docs.google.com/spreadsheet...kJ1bHU6OZB7aOU27SAH-hp-1E/edit#gid=2009190441
    Latest results to left, calcium normal. sodium borderline high.
    I am holding off on the binders.
    Getting conflicting advice about protein, people at Tanya's site say less than 35% but I'll ask again pointing out he seems to be in early stage 3. He needs to continue putting weight on, can't believe at his heaviest he was over 8 kilos. After the diabetic remission he has stayed more or less steady at 3.8 and I always felt he was too skinny but his bloods were fine. He should have had them taken earlier last year but due to lockdown he didn't. When I took him he'd gone down to 3.5 kilos but now he's up to 3.78.
    Mogs, thanks for integra protect info, yes it is the wet renal in trays. I took the values from zooplus but probably didn't work them out correctly, that is great that they are below 7 carbs but depending on next bloodwork I may need to look at reducing his sodium so an advice re that would be appreciated.
    I've held off on the b complex as his folate was high. I've also held off on the oral b12 as he's getting a course of weekly injections, but wondered if it would help to give it on the other 6 days.
    At the moment the integra protect does seem to be the food to address all issues, but obviously if it's safe to give a higher protein one I would do that.
    If I free fed him the integra and also gave him 1 pouch of 85g royal canin chicken in gravy a day do you think weekly bg checks are enough for now?
    He's being referred to the Ralph clinic after his bloodwork, and my support bubble friend in Cambs will shedule her stays with me to coincide with his visits. Just hope insurance pays up although if not I would live on gruel for the rest of my life if it meant a happy healthy Angel for as long as possible.
    Re prognosis for early stage 3 I've heard average 6 months to a year, best case 2-3 years. Cera was gone within weeks so by rights the universe should give us at least the 3 years, but who knows.
    I'm just making the most of the time with all my babies. Also breaking my heart that I haven't been able to see my 93 year old dad since August when Warrington went into teir 3. He still hasn't had his first vaccine neither have his carers!!! He's all there mentally but a bit forgetfull due to old age not alzheimers. I hate this virus, if it wasn't for that Angel would have been diagnosed earlier, people I know would not have lost loved ones.
    xx
     
  55. SweetAngel

    SweetAngel Member

    Joined:
    May 30, 2014
    I'm wondering about feeding Angel a low carb low phos but 50% protein food once a day. I know with ckd they recommend 35% protein for diabetic cats, but he needs to put on weight. The one I'm thinking of is Feringa Lamb from the UK list. Any advice?
     
  56. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    There are different opinions about what to feed CKD kitties. The 'old school' approach is to reduce protein whatever the stage of the disease; the emerging approach (for all the but the later stages of the disease) is to feed a decent amount of good quality protein to maintain muscle mass. In both instances keeping phos under control is also important.
    In my experience - just as with managing diabetes - it ultimately comes down to gathering information, weighing up the options, and then making a choice about what path to take.

    With my own cats I have never restricted protein. I have just used a phos binder if the blood phos level got above normal range. And I've fed good quality foods with as low a phos content as the cat would eat and enjoy (for me, 'quality of life' is a major consideration, and I don't want to have to feed my cats stuff that they don't really want and would prefer not to eat).

    And sometimes additional factors also affect the food choices, especially if there are other concurrent conditions, such as diabetes...
    My previous diabetic, Bertie, had early kidney disease. In his case I made a choice to keep feeding low carb foods to try to keep his blood glucose in a good range, since that meant less work for his kidneys.
    It was also important that he maintained his body weight for as long as possible (he became very prone to weight loss). He also had gut issues, and ultimately could only eat raw food (a commercial brand that he was particularly fond of). That food was not particularly low in phos, but it kept his diabetes and gut issues under control. This strategy worked well for us.

    Another cat I fostered (and later adopted) came to me as an emergency case. Elliot was a completely emaciated and weak CKD kitty who was no longer wanted. His physical condition was so bad that the vet who examined him suggested to me that we just have him PTS straight away, since there was little chance of improvement and no chance of getting him adopted. Instead I said I'd keep him for just a little while first, just so he had the chance to feel loved.
    I put him on a higher protein diet against the advice of the vet. Over the next month Elliot gained half a kilo in weight. Over the following month he gained another half kilo. He went on to regain his body weight and a lot of his strength. And his kidney values actually improved.

    My current diabetic girl, Bonbon, only has one functioning kidney (after an episode of acute kidney failure about 18 months ago). And the remaining kidney isn't in great condition. I feed her a good quality low carb cat food. And I also add lots of extra water to her food to help keep her hydrated. At the moment her blood phos is still in normal range. But if/when it goes up I'll add a binder to her food.

    Some cats live for years with kidney disease and it develops only slowly over time, maybe even improving for a while at certain times; and a cat will end up eventually dying of something else entirely. In other cats it will develop more quickly. Sometimes it's just 'the luck of the draw'. Sometimes the way we choose to care for them can make a considerable difference to the outcome. But it is up to us to weigh up the options and then choose how best to proceed. We just do the best we can, and try to let love guide our choices. :bighug:
     
    Last edited: Jan 28, 2021
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  57. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Cassandra,

    Can't help on the Feringa food question. It might be worth asking on the CKD support group about whether supplementing one of the renal foods with a little additional protein might be an option. From what I've read, some people use cooked egg white but I've no direct experience to share.

    I don't know what you've been feeding previously but the Integra Protect Renal food is quite calorie-dense: 127kcal/100g. A significant chunk of the calories are from fat. Maybe it might help Angel to gain a bit of weight? BTW, I asked Zooplus to send me info on the ME of those foods and they sent me this very helpful table of the Integra Protect Renal analytical constituents from Animonda, and I thought you might find it helpful:


    Animonda Integra Protect Renal - Analytical Constituents.png



    Mogs
    .
     
  58. SweetAngel

    SweetAngel Member

    Joined:
    May 30, 2014
    @Elizabeth and Bertie I remember meeting your lovely Bertie. Angel is early stage 3 so I could probably risk giving him a higher protein food for part of his daily allowance. So glad you gave Elliot the chance of being loved and cared for. Sorry to hear about Bonbon (that is my Bonnie's nickname) but she couldn't wish for a more loving caring mum, and I know she has the best chance with you.

    @Critter Mom the renal food I decided to go for is the integra protect as it is the only one that seems to address both issues. I'll keep a close eye on Angel's phosphorus levels. I did try the egg white but the one vet who was so negative (the one that told me to ignore his diabetes) said that was basically undoing all the good work of a renal diet and he might as well not be on one.
    I do have some of the Feringa lamb and was going to wait and see what the people at Tanya's site suggested but no one's got back to me about that, so I'll see if he's put more weight on and if not I will probably give it a go.

    With all this going on I forgot to order my anti depressants (I metabolise meds like crazy and am on the max dose) and ended up going cold turkey for a week. I've been having mini meltdowns for the past few days, but got them today and am going to try and be sensible and ease back into them. Honestly I forgot how awful it is coming off them, the cats were trying to get into each others food, I cried, I stepped into a large pile of fox poo, I cried (and swore), the civvies tried to eat Angel's food, I asked them if they were trying to make themselves ill, Angel tried to eat their food, I asked him if he was suicidal!!

    Anyway Bonnie is snuggling right next to me on the sofa, going off to bed in a minute and Angel (and probably Shakira) will be there, and some time in the early hours Romeow will jump on me (and most likely trump in my face!!!) so nite, Bonnie says goodnight in Birman cat language
     
  59. SweetAngel

    SweetAngel Member

    Joined:
    May 30, 2014
    Some good news, Angel is putting on weight. He's now almost 4 kilos. His body condition is still underweight but at least he's on the right track. I'm grateful he has always loved his food (and anyone elses!). I gave him a small amount of the feringa lamb and feeding him mainly the integra renal and just a tiny touch of the royal canin with his porus one in the morning and his semintra in the evening.
     
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  60. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Great to hear Angel's regaining some weight, Cassandra. :cat:

    How is he taking to the Porus One? What sort of texture does it have and how voluminous is the daily dose? (Thinking about it for the Noodle.)


    Mogs
    .
     
  61. SweetAngel

    SweetAngel Member

    Joined:
    May 30, 2014
    @Critter Mom I'd definitely try it. Its like a black powder in a little sachet.
    I mix it in with Angel's food and he eats it no problem, but they sent me some free cat treats to mix them in. I haven't tried them on him yet.
    xx
     
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