3/6 Fortune PMPS 528 +2 557 - dose increase question

Yesterday

Can someone pass me the patience pants? Seeing these high numbers, and Fortune's kidney having lotsa trouble, is giving me heart palpitations!

Going to try and give fluids closer to mid-cycle today and see if it can be used to our advantage.

Happy -urday, everyone!

 

I see Fortune's BG meter was being overly friendly this morning. Please come down, Fortune!
I'm curious about Marty from your condo yesterday...with him recently being dx'd with early CKD. Why does he need special food with 34% carbs from the vet for that? Why not just feed him low phos LC food? Just asking out of curiousity.

 

Let's hope Fortune is listening!

Based solely on my research of low phosphorous moderate protein foods for Fortune, a therapeutic level of low phosphorous is =/<50 per 100mg. Unfortunately, that is only available through "prescription diets;" the foods I'm feeding Fortune right now I'm aiming for under 170 per 100mg! That's why I'm anxiously awaiting the phos binder (I hope it comes today!)

I don't love the higher carbs, or how low the protein is; Marty is also a bit fluffier, so we are trying to help him lose weight. We were feeding him fewer calories than he needs to maintain but he wasn't losing weight so the vet and the practice's nutritionist recommended 1 5.5oz can of this food/day to move things along.

I'm also wary of him losing TOO much weight - both of my boys are/were on the bigger size, they don't have small figures Marty is 16.3 lbs, so we are aiming for like 14-15. Of course with CKD there can be weight loss and muscle wasting, so we want him to have some cushion.

 

I'm handing out patience leggings because it's been a year of pandemic and no one is wearing pants anymore.

Hope the fluids help!

 

OMG Katherine I NEED those!!!

Question for the CKD crowd - can I feed Fortune higher phosphorous food (like Fancy Feast) with the phos bind?

 

You can feed him the FF with the phosphorus binder, yes, but you have to make sure that he gets it with EVERY meal (I mean every time he eats any of the high phos. food -- so if he's a nibbler this could be a real pain.) Kisses to Fortune!!! Love that guy!

 

OBTW, that's the advice always given on Tanya's CKD Support group.

 

Thanks Suzanne! I'll post there for more clarity- I'm befuddled by HOW MUCH to give him with each meal. But he loved FF, so hopefully he devours it

He wolfed down the A/D earlier today - so calorically I'm happy, but carb wise it's not great...

 

Oh yeah. there's a chart for how much binder to give. let me see if I can find it.

 

I think it's based on cat's weight.

 

Right, so he would get 500mg per day. So would I just give it to him once, and can give him phosphorous foods throughout the day?

 

How do I attach a phot to this? Argh. Photo of dose chart is on my phone!

 

If cat’s phosphorus level is below 6, give 30 mg per kg of cat or 14 mg per lb. of cat.

if cat’s phosphorus level is between 6 and 7, give cat 60 mg per kg of cat or 27 mg per lb. of cat


If cat’s phosphorus level is above 7 give 90 mg per kg of cat or 40 mg per lb. of cat.

1/2 tsp. =600 mg (loosely packed).

 

Had to type it! I need to figure out how to attach photos to posts. Sorry

 

Oh yes. That is a daily starting dose!

 

Thank you

 

I know. How do you split that up? I guess you just figure out about how many times per day you are feeding and divide it up. This is a lot more challenging for a diabetic cat since we so often give them little meals and snacks throughout the day.

 

Hi Rachel, Tyler's brother Perry passed away 10-6-20. He was not diabetic My vet told me how much binder to give him . You do have to put it in every meal they eat.
If I rember I started Perry with 500 mgs per day. I would put more in his larger meals and less in his smaller meals.
Then I had to reduce the amount because it was too much, I had blood work done probably every 3 months for him.
I would get it from my vet , it was RX Vitamins.
A big jar was 30.00 from my vet and lasted a very long time.
I still have almost half a jar left , why I kept it is beyond me lol
You are welcome to it, since I'm in N.J. also it shouldn't take that long to mail it to you.
It's the Aluminum Hydroxide binder
You can show your vet my jar and ask how much to give
I was giving 1/8 of a teaspoon 3 times a day, then had to reduce it to 2 times a day
I would just take out the amount I needed and put it in a separate container and
use that for the day.
If you would like it just PM me and give me your address and I will mail it to you

Rachel this is weird , When I try to look at your SS it just keeps twirling and never comes up.
I can see everyone else's SS. I wonder if any one else is having the same problem.

I tried it on 3 different tablets I have
@RachelG

 

OK BIG UPDATE: FORTUNE LOVES PHOSPHOROUS CONTAINING FOODS!! Haha we picked up some new low carb options with higher phosphorous (cuz phos bind) and oh my goodness!! He ate like himself!! We were CRYING with joy!! Now hopefully we can fatten this cat up while we figure out wtf is going on with his kidney...

Thank you, Diane! That would be great I'll PM you later on. The treating internist told us that he doesn't need a phos binder yet so we are going a bit rogue while we figure out how to get him in with a new internist who is a bit more proactive! That just means that for now I'm eyeballing the dose - we only started today, but tomorrow hopefully I will be able to give him the full 500mg. I like the idea of a separate container for keeping track, in no small part cuz I have spilled the container 3x so far.

That is weird! I haven't changed the link

 

I got in ok though it took a bit longer than usual

 

OH - it could be because we are messing around in it right now? We are adding a column for daily grams in addition to daily calories. Cuz I'm a big data nerd kitty mama that wants to fatten up Fortune. We also got a baby scale today - I'm very excited about more parameters, lol.

Is it my way of coping with the substandard care this internist has been providing Fortune? Maybe. Does it make me happy? Yes!

 

LOL I think it's a 'control' thing....better to be tracking data yourself than just waiting for words of wisdom from the vets. Not that the vets aren't necessary, but I'm so much happier now I'm getting my own data!

 

So Fortune has been on the 2.75 dose for 8 cycles, tonight will be cycle 9. Other than that green outlier, and a few blues, he has consistently had high BGs.

According to TR, we would hold this dose for 5-7 days (or 10-14 cycles)

Nadirs under 200: hold doses for 5-7 days. Why? Day 1 & 2 - may see higher numbers due to "New Dose Wonkiness," Day 3 - this would probably be the day to see a lower nadir, if there is going to be one, Day 4-6 could be bouncing. If good numbers don't return, increase the dose. Use your own data to determine how long to wait before deciding the good numbers won't be returning.

But since his overall numbers are SUPER high on average, would we condense it? I.E. we haven't seen numbers under 200 in 3 cycles, so increase the dose.

Yes, absolutely! We had NO IDEA how much weight Fortune had lost, and I only found out because I requested his FULL medical record! I was under feeding a cat with cancer, diabetes, and CKD! So yeah, it does give me control, and I think help him better, since I can control (to an extent) what he eats, how much, etc.

 

Sounds good Rachel, it's yours whenever you want it . I'm so happy Fortune ate the new food , give him kisses for me ♥

 

It's always good to keep in mind that Lantus is dosed on how low the kitty goes, not the average. Hopefully someone who gives dosing advice will be able to chime in about a possible increase before your shot time

So glad to hear Fortune is eating - what a wonderful update!

 

Thank you, Susanne!

Yes definitely, that's why I'm trying not to be overly aggressive. At the same time, if it is hurting him/his kidney to stay hyperglycemic, we don't want that either! TR seems to be a bit flexible to accommodate a kitty that is having very high numbers; but I'm still very inexperienced.

 

Definitely the phosphorus binder is supposed to be at every meal. That much I do know. So one doc says no phosphorus binders and the other one says binders?

 

LOL no doc has said binder, and the only one I asked (his treating internist) said it was not necessary, despite his VERY high phosphorous levels. So, I'm going rogue!

 

Reposting my question so it isn't lost!

@Wendy&Neko
@Marje and Gracie
@tiffmaxee

So Fortune has been on the 2.75 dose for 8 cycles, tonight will be cycle 9. Other than that green outlier, and a few blues, he has consistently had high BGs.

According to TR, we would hold this dose for 5-7 days (or 10-14 cycles)

Nadirs under 200: hold doses for 5-7 days. Why? Day 1 & 2 - may see higher numbers due to "New Dose Wonkiness," Day 3 - this would probably be the day to see a lower nadir, if there is going to be one, Day 4-6 could be bouncing. If good numbers don't return, increase the dose. Use your own data to determine how long to wait before deciding the good numbers won't be returning.

Following the letter of the law, he would be due for a dose increase of .25IU in 5-7 days. So 10 cycles would be tomorrow AM, with a dose increase tomorrow PM. Does that track?

Additionally, Fortune's ears seem in bad shape - DH has been accidentally PIERCING them I applied a cold compress, but with no neosporin, any suggestions to baby the ears more?

 

I would increase. You had to take a reduction and yes there have been a few blue nadirs but overall not. See what the others think. Sheets was not behaving for me. I had to keep reloading until I finally could see the last few days it’s on my end not yours.

 

Have you tried Ledum Palustre 30c?

I read about that somewhere here and bought some at Whole Foods, under $10 though not completely sure about the dosing. I read 2 pellets dissolved in couple Tbsp of pure water, apply to the ear. It's homeopathic, for scratches and insect bites. I don't know if it's helping or not but it doesn't leave her ears as greasy as the neosporin. She doesn't seem to mind it, though I had a scratch on my arm and put some on and it felt a bit sting-y to me.

HA I just did a quick search and I read about it on YOUR condo here - did you get hold of any?! I definitely searched the forum afterwards to read up on the dosing.

 

If no one else responds to me tonight, when do you think we can increase? Tomorrow morning?

LOL yes! It arrived today; I'm glad you mentioned dissolving them in water and applying - the instructions were very unclear! Will give it a go tomorrow perhaps.

 

I would be very reluctant to increase. He got at least as low as 56 a couple nights ago, maybe lower. That leaves practically no room for an increase. He is bouncing. This is only cycle 4 after the low. Put on those lovely patients tights from Katherine and hang tough with this dose and give him time to clear the bounce.

 

I hear you! I'm just really really scared.

I thought the green might have been an outlier. Should we be waking up more often to get spot checks in the PM cycle?

 

But since you didn't retest, we don't know if it was a true value or not. If he really is going that low on this dose, you don't want to increase. And he did see green on the 2nd on this dose. If he's just bouncing from blues and the 56 was an error, then he does need an increase. Once the bounce is over, you'll know which situation you are dealing with.

 

Sorry, forgot to answer this part. I'd always get a before bed test. The +2 on the 4th was so much higher than preshot, that the 56 does seem out of place. If the +2 is quite a bit lower than preshot, then you do need a later test at night.

 

That makes sense. We have been doing a +2 before bed to see if it is lower than PMPS.

Tonight will be his 4th cycle since the suspicious green, and the 9th on this dose. Assuming he isn't reading this and he stays high, would we increase in the 10th cycle of the dose/5th cycle since the green? It takes 2-3 days to clear a bounce, right? So that would mean the 5th or 7th cycle?

Really worried about his kidney function, and the toll of constant hyperglycemia.

 

It can take 6 cycles to clear a bounce, after that you should know if the green was true.

 

You go, Girl!!! Go rogue!

 

You are right Wendy. I was just thinking that the 56 was a bad strip but better to be cautious.