Bad news

[Amy&TrixieCat]

I am so glad he's doing better today! Trix had some very rocky ups and downs when she first spiralled into CKD, too, but it's been 3 years now and she's pretty stable once we figured out what works for her (which did take a few months).

I'm very glad you're getting anti-nausea meds. Let us know what the vet gives you when we have a chance - it's good-to-know info for those who are trying to help.

Remember what Marje said about the binder - it works by pull the phos out of food, so only give it if you are definitely giving food at the same time. Giving it without food doesn't do anything at all.

I absolutely agree about getting him to eat anything at all at this point - he has to eat. Hopefully once his tummy is settled, that will help. Do you think you'd be able to assist-feed him if necessary? I did have to assist-feed Trix for a while to get her over the hump, but not all cats are receptive to the idea.

Continued prayers from us.

 

[carfurby (GA)]

I hope the meds help Riley feel better and want to eat. Sending more prayers.

 

[Noah & me (GA)]

Sorry Riley. We're all sending positive thoughts. Noah, Andy, Lewis, Sam, Daniel, Marco and me. Sometimes miracles do happen.

 

[Gussie's mom (GA)]

 

[suki & crystal (GA)]

Many prayers and vines for Riley to feel better soon, and a few of these for you Cherie

 

[Marje and Gracie]

Glad you talked to your vet and glad he’s better. Just so you know, and I hate to keep repeating myself (and what Amy said as well) but I really want to help you, Cherie. Giving him P binder in baby food will only bind that small amount of P in that food. It will not bind the P in any other foods you give him. It will not lower his P. However, if he’s not eating, you will see a drop in the P because he’s not getting any foods with phosphorus in them. So if/when you have labs done, the P might be lower if he’s not been eating. But don’t think it’s because you are giving him binder in baby food.

Vines and prayers.

 

[Cherie Hogan]

Wonderful news today!

Glad that you got meds for Riley. Erythropoetin or epogen is to stimulate his bone marrow to produce red blood cells. Is that what she is looking for?

Yes, that is what she is looking for. Says it is very expensive....about $150 for a small vial.

 

[Cherie Hogan]

Glad you talked to your vet and glad he’s better. Just so you know, and I hate to keep repeating myself (and what Amy said as well) but I really want to help you, Cherie. Giving him P binder in baby food will only bind that small amount of P in that food. It will not bind the P in any other foods you give him. It will not lower his P. However, if he’s not eating, you will see a drop in the P because he’s not getting any foods with phosphorus in them. So if/when you have labs done, the P might be lower if he’s not been eating. But don’t think it’s because you are giving him binder in baby food.

Vines and prayers.

So, what to do then? He won't eat anything with the phosphorus binder in it. I can't give it to him in pill form. I have been mixin in baby food and syringe feeding him. Neither he or the other cats will touch the low phosphorus Weruva foods. What to do????

 

[Marje and Gracie]

It’s important to know if he’s not eating because he’s not feeling or because of the binder. Do you know? Because cats with high P levels don’t want to eat.

There are a lot of other low P/low carb foods than Weruva; it’s not the only one. I'd rather see you feeding him what he will eat and putting binder in it and mixing it really well than to not give him any binder at all. As Amy and I both said, the binder in the baby food is only going to bind the P in the baby food.

Yes, ECID, but I’ve never had a cat that wouldn’t eat aluminum hydroxide mixed in their food mainly because I fed them often so the amount of P in each helping was not enormous. If you even feed four times a day and you give a total of 1/4 tsp (I don’t remember what dose he needs of binder as I’m also helping others with it), then he’s only getting about 1/16th tsp of binder in each helping. That’s pretty minute and it is odorless.

 

[Cherie Hogan]

He was not feeling well at all. The vet feels that he went hypo but he was really, really sick even prior to that. Giving him that pill for his stomach really helped and he was a different cat this morning. The vet said he has to eat and she doesn't care what it is. So, I will mix a little phosphorous binder in everything he eats and I will try some different low phosphorus foods. Will it hurt my other cats to eat the low phosphorus foods with the phosphorus binder?

Did you see the recipe for the liver posted earlier? Would that be ok to feed him. Also, he loves shrimp. Can I hide the phosphorus binder inside the small pieces of shrimp that I give him? He has to gain weight!!

 

[Cherie Hogan]

As clarification, I am feeding him the RX Vitamins for Pets Phos-Bind and it says one scoop a day which is about a half teaspoon. I don't think it has any taste but he will lick his wet food first and if he suspects anything he moves to another cat's bowl. I would be happy to mix it in all their food but not so sure that is a good idea.

 

[Amy&TrixieCat]

What did she give him for the upset tummy? What did she say about dosing the tummy med? It really can make a huge difference once their tummy settles!

This is not an ideal suggestion, but it can be an option if worse comes to worst: If you can actually pill Riley, and if he will eat a reasonable amount of regular food, you can put the binder in a gelcap and pill him with it - BUT, you have to do that immediately after he eats so the binder can grab on to the phosphorous in the food. It is definitely more ideal to get the binder mixed into his food, but if that just won't happen, then this may be a workable option. And, I can't say for 100% sure if it will actually work this way - it's something my vet suggested as a last-ditch option, but it's not something I've ever done.

If you syringe feed him, which sounds like it might be a wise idea at this point, you can mix the binder into that food, too. The food you would want to use for syringe/assist feeding would be cat food rather than baby food.

It's not ideal if your other cats get a lot of the binder, especially if they are younger, but if they get a little bit, it's not the worst thing. I know some of my guys do a get a little bit because sometimes they'll snack on plates I leave out for Trix; however, it is not in the bulk of the food they eat so they really don't get much at all (plus they are 14 years old).

I don't have experience with the liver shake or shrimp; hopefully others can help with that.

 

[Marje and Gracie]

Cherie

I know you are anxious to help your baby but if you just go about this helter skelter, it isn't helping him. I'm sorry to be so blunt but we are really trying hard to give you the best advice based upon our experience.

Here is what I wrote earlier in this condo about amount to give him:

It is not one size fits all for the phosphorus binder. I've provided you with the info on how much he should get based on his P level and his weight so just taking a scoop out of the jar and giving it to him is not the way I would approach this. And as I stated yesterday, you can't mix it with water or juice and give it to him. It won't help and you are throwing money away. It has to be mixed in with the food he is getting as it binds the P in the food; it doesn't lower his P directly.

While I am not a fan of RX Vitamins for Pets, if that is what you have, I'm just trying to get across that one scoop may be too little or too much. While aluminum hydroxide doesn't have to be extremely accurate in dosing, if he needs 1/4 tsp and you are giving him the equivalent dose of 1/2 tsp, there is an issue.....or vice versa.

As long as you have no kittens in the house, it's ok if the other cats eat food with a bit of binder in it but not potassium.

I can't possibly see how hiding the binder in a piece of shrimp will help him except to bind the P in that one piece of shrimp.

I've used the liver shake before for one of my CKD cats and, yes, you can put binder in it. Just give him a tiny bit to start with because it's raw liver and it can make some cats vomit.

In reference to Amy's vet's suggestion about putting the binder in a capsule and giving the capsule right after they eat, I agree with her that it is last ditch and there is no evidence it works. In fact, I did ask my vet and an internist and they both said they felt it was not a viable option and they wouldn't recommend it because the binder needs to be mixed into the food and given a bit of time to bind the P. It can't do that in the very acidic environment of the cat's stomach. But...it's your choice.

I'm also curious what tummy med they gave. My guess is famotidine or Pepcid ...or possibly cerenia. Likely because the P level is causing him to have acid tummy.

 

[Amy&TrixieCat]

In reference to Amy's vet's suggestion about putting the binder in a capsule and giving the capsule right after they eat, I agree with her that it is last ditch and there is no evidence it works. In fact, I did ask my vet and an internist and they both said they felt it was not a viable option and they wouldn't recommend it because the binder needs to be mixed into the food and given a bit of time to bind the P. It can't do that in the very acidic environment of the cat's stomach. But...it's your choice.

Actually, this is from Tanya's site...research seems to have shown that a binder will work if given shortly after eating. Like I said, I've never gone this route, but it does seem like it's worth trying if a cat absolutely won't touch food with binder mixed into it.

Tanya's Site/phos binders

How and When to Give Aluminium Hydroxide: Mixing Binders with Food

Phosphorus binders must be given with food so they can bind with the phosphorus in it. One human study,Effectiveness of aluminum hydroxide timing administration in relation to meals in controlling hyperphosphatemia in dialysis patients(2005) Katopodis KP, Andrikos E, Pappas M & Siamopoulos KC The International Journal of Artificial Organs 28(8) pp803-7, found that giving aluminium hydroxide binders 30 minutes before eating only reduced phosphorus levels by 7%, whereas administering them mixed with food or up to 30 minutes after the meal reduced phosphorus levels by 28.5%. This is not always easy to do, especially if you are adding binders to dry food (see below). Dr Chew in Chronic kidney disease (CKD) in dogs and cats - staging and management strategies (2015) A Presentation to the Virginia Veterinary Medical Association 2015 Virginia Veterinary Conference says "Intestinal phosphate binders work best when given with meals or within 2 hours of feeding to maximize their binding of dietary phosphorus." The test is to give the binders the way that works best for you and check your cat's blood phosphorus levels after about two weeks, when with luck they will be falling nicely.

 

[Cherie Hogan]

I left all my notes at home. I'll get them tomorrow when I am back in town so I can answer better. Yes it was the cerenia that was given..,1 pill to start and 1/4 to 1/2 pill per day if he needs it. The vet looked at the RX phos-bind and said to give as per instructions on the jar. Same with the potassium. And she is ordering the injectible stuff for his red blood cells.

 

[Marje and Gracie]

Actually, this is from Tanya's site...research seems to have shown that a binder will work if given shortly after eating. Like I said, I've never gone this route, but it does seem like it's worth trying if a cat absolutely won't touch food with binder mixed into it.

Tanya's Site/phos binders

If you read the first study linked, they found that the binder had the best efficacy when given with meals. But, the study, which had a very small sample size, was also done in humans who were on hemodialysis. And while there was a small % decrease in P when administered prior to a meal, I would be cautious about extrapolating too much to apply this study to cats.

The second link was to a paper presented at a veterinary conference and the summary points included this

All intestinal phosphate binders provide treatment of the food to prevent phosphorus in the diet from being absorbed into the circulation

I left all my notes at home. I'll get them tomorrow when I am back in town so I can answer better. Yes it was the cerenia that was given..,1 pill to start and 1/4 to 1/2 pill per day if he needs it. The vet looked at the RX phos-bind and said to give as per instructions on the jar. Same with the potassium. And she is ordering the injectible stuff for his red blood cells.

Wow...one pill of cerenia is a lot for a cat although it depends on the dosage of the pill but the smallest dosage is 16 mg. Typically, it is dosed at 1/4 pill per day although I would imagine a larger cat could have a max dose of 1/2 pill per day if the vet thought it was warranted. Cerenia is typically given for vomiting although it does address nausea to a small extent. It doesn't do anything for tummy acid, per se.

You understand that once she gives the epogen or whatever she is giving for the anemia, you have to have blood tests run to stay on top of it? Same as the potassium....you want his levels up but don't want to end up with the levels too high.

 

[Gussie's mom (GA)]

The epogen really helped my cat Jett who ran aenemic as a kidney cat, expensive but did really help, and as Marje mentioned you do need to pop back in and get a hematocrit reading after its had a chance to work, but it is a simple test, not full blown labs each time. So don't freak out, it was a quick in and out test done at my vets office.
Sending vines as you try to sort out and absorb all these new things to learn and steps in this new feline diseases academy course you've been thrown into

 

[Michelle and Mannie (GA)]

Thanks so much for letting me know I can safely do this with the potassium. He is down to about 10 lbs now and the vet told me to give him 1/4 teaspoon a day. Does this sound right to you?

Hi, I am trying to remember.. dosage sounds right. I would also pay head to what Jill and Sienne have said about monitoring levels. We had Mannie in for potassium level testing once he was on the supplement. It is very important to monitor levels. What they say is very true. As I recall they were able to test just for those levels, so I didn't have to pay for full or even partial BW panel testing.

 

[tiffmaxee]

How anemic is he? The Nutrived might help but might not agree with him. With Tiffany I was able to put a small amount of potassium and the binder in baby food and she would eat it. She would not eat Beechnut but liked gerbers ham and beef she wouldn't eat their chicken though. Then I would give food she liked right after without binder. Ondansetron really helps for nausea which is likely with toxins in the blood. I used Epogen for her and she never built up antibodies which is the risk. If not in tge danger zone with the anemia Aranesp is better. I got mine from Walmart Specialty Pharmacy. They get an RX from your vet and send it on ice very quickly.

 

[Donna and Flame]

Cherie, I feel for you. I am just starting this CKD journey with my Flame as well. I am so sorry to hear that Riley has had these setbacks and was feeling so ill. I can't offer you too much advice as I'm new to managing this myself, but I can offer you support and send along some for you and Riley.
I've found sometimes, the best thing you and do is step back, take a breath and regroup so you can think things thru clearly. All of this can get very confusing.

My vet told me the same thing that folks here are saying... they have to eat, so even if you have to give Riley some higher phos foods for a bit with the binder in it - if he will eat it, that's most important.

You're doing the best you can for your sweet Riley. Keep working with your vet and posting here for input and advice. Everyone here cares and wants to help.

Sending prayers for Riley and for you.

 

[JeffJ]

I hope Riley pulls through. You are a great cat parent doing the best you can.

 

[HWright]

Hi Cherie, sending heaps of feel better vines and hugs for you and Riley.

Here's the link to the Liver Shake recipe that I think Ella provided earlier:

http://www.felinediabetes.com/FDMB/threads/the-liver-shake-for-sick-cats.30432/

I can attest from personal experience in the recent months that the liver shake can be a real boost in many ways for a sick cat. Worth a try.

Also...and I'm not trying to complicate the phosphorus binder factor..or add yet one more thing for you to juggle with, but has anyone used cooked egg white or egg white powdering diet in conjunction with phosphorus binder or in place of? I'm not so sure that it would technically be a phosphorus binder but it is low phosphorus with beneficial and digestible protein.
Might ew be a reasonable addition for Riley?

Here's link about eggs and ckd in Tanya's ckd website:
http://www.felinecrf.org/persuading_cat_to_eat.htm#eggs

I started including powdered egg white in food a few years ago (and in azalea's liver shake now too) when my vet suggested it for Azalea re her on-the-cusp renal issues. At the time he gave me a copy of an article about egg whites and phosphorus management in ckd, the article now being amidst the now Sherlock Holmesian filing "system" on my desk. But the info closest to that article that I could find online is in the Tanya's link above.

Cherie, might be worth an inquiry to your vet? And love to hear others experience etc. The Tanya's article mentions that ew can inhibit iron absorption but I'm not sure whether that effect means as a result of excess quantities of ew or not. I add about 1/4-1/2 tsp powdered to total fud intake daily.

Vines vines and more vines for you and Riley,
Sina