? 6/21 Walter AMPS 293, +3 309, +8 255, PMPS 224 / Questions about CRF

[Mandarin'sMom]

Yesterday's condo

Not a good day here. My civvie Capone went in for what I thought would be a routine dental cleaning. I knew he had quite a bit of tartar and some gingivitis, but that was about it. He just had a dental with a few extractions 2 years ago. He is about 8 years old (maybe a bit older, he was an adult cat when I found him 5 years ago). He has always been a healthy cat and eats an all canned food diet (same as my sugar cats).

The first shock was that the x-rays showed extensive dental issues. He had 8 resorptive lesions and needed to have all of his molars as well as some pre-molars pulled. On top of that, his pre-surgical blood work showed that his Creatinine levels were elevated and the vet believes that he is in early stage kidney failure.

Here are the numbers:
Creatinine: 2.5 (normal is 0.8-1.8)
BUN 23.4 (normal is 15-32)
Phosphorus 3.7 (normal is 3.7)

Almost all of his other values were in normal range. His Cholestorol is a bit high and so is his Globulin. His WBC is a bit low (4.8 with normal being 5.5- 19.5).

They gave him IV fluids during his dental and he pulled through like a champ. He came home, groomed the kittens and ate a nice snack while his bean is still recovering from the shock (and I might have to look for a summer job after I paid the bill that was about 5 times higher than I originally thought ).

So now what? They recommended prescription food, but I'm sure there are better options. Ideally, I would like something that is fine for CRF and FD and that doesn't break the bank. Still trying to wrap my head around this.

...and to make matters worse, Flora is still feeling rather crummy. She got more fluids today, but we are still waiting for the results from her fecal. The vet suggested that I start her on Albon, but I might hold off for another day to hopefully get the results first.

I am feeling completely overwhelmed...

 

[Red & Rover (GA)]

Rx kidney food follows the old school low protein approach and is high in carbs. New school is high protein with a phos binder if necessary. Loads of information here: http://www.felinecrf.org/

 

[Mandarin'sMom]

And here's how his snack worked out - poor Capone, those kits have no respect!

 

[Doodles & Karen]

Sorry to hear about Capone! I think early CRF is determined on more than just the Creatinine levels but not sure. There are Phosphorus binders you can add to FF which is what I believe @Amy&TrixieCat does. From what I understand the RX food is certainly not needed. @tiffmaxee feeds Wellness Turkey to Mr. Max which is low P. My note here is not put together well but hopefully others will chime in soon.

 

[Wendy&Neko]

As Red mentioned, new school for CKD is low carb, low phosphorus wet food. If you look in the New to the Group Sticky Note, one of our members put together a list of low carb, low Phos fuds. I feed raw and home made raw for Neko with a few selections from the list.

Did you get the SDMA test done too? Vines for Capone, and maybe some kitten respect.

Down Walter.

 

[jayla-n-Drevon]

Rico was dx at 11--he is 17 now.... we started fluids quickly--1-2x a week to start and now he is every other day.
He has BW every year and the fluids have kept him in normal range-as recently as when he had his dental about 6 weeks ago he is still in normal numbers.
We have been lucky as he has not had a phos issue.
Up until this 2016 he didn't even need any nausea meds (from the acid that comes with CRF)
Take a breath.... it is manageable.
Honestly I never thought Rico would be here nearly this long and he still plays and has maintained 11-12 pounds over the years. I recently added a appy stimulate that is wonderful along with the nausea med.
I would talk to your vet about fluids ... in my opinion that what was what has contributed to him having less issues than being dx later in the disease. You can still "catch it"...
@manxcat419 has a kitty that has more things related to CRF and has great insight-
This is Rico just a few weeks ago--he has been getting fluid 6 years.

 

[tiffmaxee]

My Tiffany was diagnosed at the same age but that was 9 years ago and my vet put her on a kidney diet. Nowadays as Red mentioned most vets don't start a kidney diet until stage 3. Your cat is likely stage 1. I'd look at the food list on Tanya's site and try some of the lower phosphorus foods to see which he likes. I used to feed Max Hills Ideal Balance which he liked but it's too high in carbs for a diabetic. Now I feed Hi Tor Neo, Wellness grain free turkey, and Mauri Kangaroo.

I'd ask for your vet to email all the labs and post them. Was a urinalysis done and if so what was the USG? Was there any protein in the urine? You want the phosphorus to be under 5 which it is and it might just stay there for a long time (years).

Many cats stay constant with just lower phosphorus food. Max jumped all of a sudden for unknown reasons but he is almost 18 1/2 and I took him off the lower phosphorus food because of his diabetes when he was diagnosed. At that time he didn't have CKD.

I disagree about fluids provided your cat is well hydrated. Water works just as well and doesn't have the added salt. I'd add water to the canned food and if not drinking I would get a fountain. Most cats don't need fluids until a creatinine of around 3.5. You will gets lots of different opinions about that. What all would agree on is that he needs to be well hydrated.

 

[Mandarin'sMom]

Did you get the SDMA test done too? Vines for Capone, and maybe some kitten respect.

I didn't even ask about any additional testing - and they probably figured that I might need a few days to recover from his $1,300 dental. What exactly is an SDMA test?

...I have actually though about switching to raw food too - maybe this would be the moment to do it. Luckily, he has a great appetite. He weighs 14.5 pounds which is a pretty good weight for him (he is a big-framed cat.... well, maybe 13.5 would be even better, but he sure isn't underweight).

 

[Red & Rover (GA)]

I agree that the key is fluids. And you've already got the "poking the cat" part down pat. Rover is my second CKD cat. Fluids prolonged the life of my first CKD cat, who was diagnosed the same time she was diagnosed with a large cell tumour. We kept her going for 11 months after diagnosis, supportive care only, mainly because of the fluids. Do the reading about Phos binders on the above-mentioned website. There's a lot of reading on the site but it is laid out in a simple way. I add tasteless aluminum hydroxide powder to Rover's LC food in an attempt to keep his Phos #s down. The vet will try and sell you something much more expensive and is *the horror* mint flavoured.

 

[Judy and Boomer]

Sorry to hear about Capone! But it is manageable; I too had a CRF kitty. I'm sure the members here who now have kitties with CRF have lots of good info to share with you. Breathe! And, yeah, I feel your pain about the bill.

 

[jayla-n-Drevon]

what the heck cost $1,300????
fyi you can get fluids lines and needles at a very reasonable cost NOT thru your vet just need the script-

 

[Red & Rover (GA)]

what the heck cost $1,300????
fyi you can get fluids lines and needles at a very reasonable cost NOT thru your vet just need the script-

My vet sells a "kit" which is one bag of fluid, one line, and 10 crap needles in a plastic grocery bag for $40 CDN. You can get the same things online for less than 1/4 the cost - if/when you need to go that route.

 

[Wendy&Neko]

Ideas includes SDMA in their regular tests now. It is supposed to be an indicator of early kidney disease.

If you start fluids, you have to make sure the heart is OK. I started fluids for Neko recently based on a clean echocardiogram last fall and deteriorating numbers, but we found out the hard way her heart had deteriorated and could not take the extra fluids.

 

[carfurby (GA)]

I'm sorry the vet things Capone has early kidney failure. You've gotten some good advice here. I hope Capone recovers quickly from the dental. Sending prayers.

 

[Mandarin'sMom]

what the heck cost $1,300????

Well, in all fairness, that includes the blood work, IV fluids, x-rays, antibiotics, pain meds, flea prevention (which I just happened to need) in addition to the actual dental. But, mostly, it was expensive because there were so many extractions.

@jayla-n-Drevon @Red Luckily, one of the benefits of volunteering and fostering for a rescue is that I can order supplies through them at cost. They quoted me $6 for a bag of fluids, a line and Terumo needles (as long as I am willing to get 6 bags at a time).

Ideas includes SDMA in their regular tests now. It is supposed to be an indicator of early kidney disease.

If you start fluids, you have to make sure the heart is OK. I started fluids for Neko recently based on a clean echocardiogram last fall and deteriorating numbers, but we found out the hard way her heart had deteriorated and could not take the extra fluids.

Lots of good points - thank you! I am starting a list of questions for my vet. Capone has to go in for a recheck anyways (and one of my dogs has an appointment next Tuesday), so I will have plenty of opportunities to talk to her in person.

I agree that the key is fluids. And you've already got the "poking the cat" part down pat.

Luckily, Capone is the nicest cat on the planet and I don't think I'll have any problems. He already gobbled up his ABs in a pill pocket and never even realized they were there.

It just still boggles my mind that I have yet another animal with medical issues. The thing that scares me the most (other than losing my sweet boy) is the food issue. My cats are very much used to eating together and I would hate to have to change that. But it sounds like there are some good options that will work for my two diabetics as well as for Capone.

Now I feed Hi Tor Neo, Wellness grain free turkey, and Mauri Kangaroo.

The Wellness is already part of our rotation! WellPet has a production plant here in town and it is a food that is widely available.

@jayla-n-Drevon Rico is such a handsome boy! And that's wonderful to hear that he has done so well for so many years. My first cat, Jazz (GA) had CRF and hyperthyroidism, but this was before I knew as much as I do now and before I knew to ask a ton of questions and question some of the recommendations from the vet. I never even managed to get her to eat canned food - she was a dry food addict and I never realized the importance of wet food.

I'll start reading some of the sources that you recommended. Thank you, everyone, for your help!

...and, surprisingly enough, Walter's PMPS is his lowest number this cycle. That might make for an interesting night!

 

[jayla-n-Drevon]

I buy 4 cases at a time....

 

[Mandarin'sMom]

I'd ask for your vet to email all the labs and post them. Was a urinalysis done and if so what was the USG? Was there any protein in the urine?

I have a paper copy of the labs and will scan them at work tomorrow to post them. And, no urinalysis. I don't think he has ever had one done. He had pre-surgical blood work for his last dental too, but that was perfectly normal. I'll add that to my list too.

 

[tiffmaxee]

The urine specific gravity will show how well he is concentrating his urine. Is he urinating lots more than he used to or drinking more? I forgot to mention my vet would check a second time at least a month later rather than make za diagnosis based on one set of labs.

I just bought a case for $33 at Walgreens using a discount code I got on line.

 

[Wendy&Neko]

Ditto with my vet, one set of labs can be an anomaly, not the second. At least with Idexx here, you get a discount if you recheck labs in less than 30 days. You should be able to get a mini Chem panel, not redo all the blood work so a bit cheaper. Any you can get a urinalysis at the same time.

 

[tiffmaxee]

Ditto with my vet, one set of labs can be an anomaly, not the second. At least with Idexx here, you get a discount if you recheck labs in less than 30 days. You should be able to get a mini Chem panel, not redo all the blood work so a bit cheaper. Any you can get a urinalysis at the same time.

You could just run the kidney panel and a urinalysis.

 

[Red & Rover (GA)]

I buy 4 cases at a time....

I stock up for the winter around mid-October. Some companies don't ask for signature on delivery and I don't like the idea of the bags sitting on the front porch on a bitterly cold day for any length of time.

My vet pushed a kidney drug called Semintra for Rover and also the most previous cat when it was first authorised for use in Canada. It has been used in the UK. I don't know about the US. Neither of my cats could tolerate it - took out their stomaches and made them feel like crap. Nothing helped. I also thought it was making Rover's BG#s go up and took him off it. I tried to contact the company but you have to be a vet to get anywhere. When I mentioned my concern to my vet at the time, she tasted a drop and found it on the sweet side. I asked her to contact the company on my behalf. I never heard back from the vet. It was also the last time I saw that particular vet at the clinic.

https://www.drugs.com/vet/semintra-oral-solution-4-mg-ml-can.html

 

[Bobbie And Bubba]

Christina, so sorry to hear about the dental and so many extractions, poor Capone. And the CRF as well. I hope the information that Red provided will help, I do not have any experience with this. Sending vines to him and the photo of him trying to eat his snack was tooooooo cute.

 

[Amy&TrixieCat]

I'm not super-great with interpreting the labs because Trix is my only CKD kitty experience, but just to let you know it's manageable. Like Elise's Max, Trix's values suddenly skyrocketed for some unknown reason. When it first happened, she was already Stage IV!! We were shocked - she really had no outward symptoms. We did run a battery of tests but they showed nothing but basic CKD, except for one thing: We found out her BP was elevated, and once we got that under control she improved to Stage III. Since then, she has been teetering between Stage III and Stage IV. So I would suggest getting Capone's BP checked now, and regularly from now on.

The kicker for us is...it has now been over 2 years! The things I attribute her success to are being VERY consistent with her meds; giving her daily fluids; and keeping her eating. She does get Pepcid and cerenia every day and while that's not ideal for most kitties, for Trix it keeps us ahead of her CKD-induced tummy issues. I found that if I tried to wean her off the meds, her issues returned and she would backslide, so I learned that it was better to stay ahead of the game and now she very, very rarely has an upset tummy. And just like doing her insulin, I very rigidly follow a 12/12 schedule.

She gets daily fluids - that's pretty basic for a kitty at her stage.

For food, she will only eat Fancy Feast and Purina One. Both are horribly high in phosphorous, so not at all good for a CKD kitty. BUT, eating trumps everything and she just won't eat any of the low phos/LC foods we tried. So I do use a phosphorous binder - that keeps her phosphorous down and she keeps eating. If she does hit too long of a run of poor eating, I will assist-feed her rather than wait it out like I would with my healthy kitties.

I know Capone isn't at the point Trix is at yet, but I just wanted to let you know that it is manageable and there are all sorts of ways to customize things so they work well for your and Capone. I know Trix has amazed many people, our vet included, because she has been doing so well for so long (anti-jinx!), and I know with your care Capone will be fine!!

Iris is just way too cute!!!

 

[jayla-n-Drevon]

I stock up for the winter around mid-October. Some companies don't ask for signature on delivery and I don't like the idea of the bags sitting on the front porch on a bitterly cold day for any length of time.

My vet pushed a kidney drug called Semintra for Rover and also the most previous cat when it was first authorised for use in Canada. It has been used in the UK. I don't know about the US. Neither of my cats could tolerate it - took out their stomaches and made them feel like crap. Nothing helped. I also thought it was making Rover's BG#s go up and took him off it. I tried to contact the company but you have to be a vet to get anywhere. When I mentioned my concern to my vet at the time, she tasted a drop and found it on the sweet side. I asked her to contact the company on my behalf. I never heard back from the vet. It was also the last time I saw that particular vet at the clinic.

https://www.drugs.com/vet/semintra-oral-solution-4-mg-ml-can.html

I am not sure but I think starting the fluids so early has really made the difference for Rico and genetics play a role probably -- his phos is good and I let him eat whatever he will eat (no dry) he does not have FD-I never supplemented with anything until recently with nausea med and cypro for appy-they both get adequan as well-
I have seen fluids literally bring a cat "back to life" I actually named 1 of my resumes "Lazarus"