Ebony Update More Questions

[Sara and Buttercup]

I want to say thank you to everyone who has written me on this. You don't know how much this means to me. I am going to read through everything more carefully after writing this. Thanks for the letting me know what kind of phosophorus binder to use. I'll mention that to the vet although I think it will annoy him. All the vets where I go get annoyed when I bring up new meds or ideas. I saw Ebony today to visit and it was my normal vet's day off which I didn't know. Anyway, he was hooked up to his IV with Vit B in it. He had his blood pressure taken today and it was normal. No other tests were done yet and his biopsy results aren't in yet, either. So, tomorrow I'll know a lot more. I'm scared to get his results, really scared. He looked ok today and they said he is eating but he is really thin and bony. 8 pounds. He's hydrated again, though, I could feel it in his skin. I have a few more questions before I talk to the vet tomorrow. Oh, and I've asked for his bloodwork but they said they coudn't get it for me yet grrr. I'll get it tomorrow for sure. Ok, here are my questions:

At what point does a cat need a phosphorus binder? Do you have to wait until his phosphorus is actually low? I think I remember the vet saying that his phosphorus was dropping but it wasn't below normal yet. I think that is another reason he didn't want to start it yet but I'm not sure. Is that right?

What is the maximum amount of sub Q fluid that can be given to a cat? Last time I saw my vet on Monday he mentioned giving it every other day. I said, "Oh, think I saw someone on the internet who said they gave 200 ml every day". Instinctively, I feel my cat needs the fluids every day if not twice a day. Does anyone ever do it twice a day. I know you don't know all the details of Ebony's situation but what do you think would be reasonable sub Q amount and how frequently?

Should I ask them to give me some Vit B to put in the bag for at home use? Is that something anyone does? If so, how often do you add?

Are there any other drugs that I should ask for or tests? The vet mentioned the anemia shot.. I don't have the name of it right now. The vet said he is not anemic yet when I talked to him but I think that he thought he was headed in that direction. But, again, he didn't suggest starting it. I'd rather do a preemtive strike than wait until he's totally anemic but I don't understand how that works. He hasn't had an xray yet, just an ultrasound. Should I push for the xray to help diagnose why his left kidney is so huge? I talked to a vet in california on Monday and she said that it helped to diagose stones to get the xray as well as the ultrasound. or should I push for him to get a pilogram?

There are two other drugs that I have read about for CRF, Benazepril and Calcitriol. Has anyone heard of them or used them?

I want to thank you all very much. This is a very hard time for me and my cat. thank you for the advice and prayers and offers of help.

 

[LynnLee + Mousie]

we used benazepril for the two years Kitty had kidney issues. not sure why, that's just the one that her vet put her on and it seemed to work.

i believe most others here have used calcitriol though and i think it might be considered the "latest & greatest". to be honest, i never looked into it since the benazepril was working for Kitty so i can't tell you why one would be better than the other. Jess has posted a bit about this though if i remember correctly from the old board

 

[Sara and Buttercup]

Thank you. From the article I read from Meowmeowmom.com It says "Benzaepril is thought to increase bloodflow to the kidneys. (It's also used for heart conditions) Calcitoriol is a form of Vitamin D thought to improve their overall feeling of health and well being." So, I just didn't know anything other than that and don't really know if either would be appropriate for him now.

 

[Cassandra and Sasha]

At what point does a cat need a phosphorus binder? Do you have to wait until his phosphorus is actually low? I think I remember the vet saying that his phosphorus was dropping but it wasn't below normal yet. I think that is another reason he didn't want to start it yet but I'm not sure. Is that right?

Phos binders are typically used when the phos goes above 6. The kidneys are no longer capable of excreting phos efficiently in many renal kitties. Was the vet talking about phosphorous or potassium? Potassium can go high or low.

More on Phosphorous Binders
More on High Potassium
More on Low Potassium

What is the maximum amount of sub Q fluid that can be given to a cat? Last time I saw my vet on Monday he mentioned giving it every other day. I said, "Oh, think I saw someone on the internet who said they gave 200 ml every day". Instinctively, I feel my cat needs the fluids every day if not twice a day. Does anyone ever do it twice a day. I know you don't know all the details of Ebony's situation but what do you think would be reasonable sub Q amount and how frequently?

Many people give fluids SID or BID. Dr. Lisa often says it is like flushing a toilet. Do you want to flush a toilet once every other day or once or twice per day?

The amount you give should be decided by your vet, based on the blood levels you are trying to lower, the weight, other conditions (such as the heart), and the overall dehydration of Ebony.

More on Fluid Therapy

There are two other drugs that I have read about for CRF, Benazepril and Calcitriol. Has anyone heard of them or used them?

Benazepril is often used to reduce protein spilling into the urine (proteinuria), which may increase the progression of renal disease. Benazepril can cause the creatinine levels to rise.

More on Benazepril

Calcitriol is used to help with PTH (parathyroid hormone) levels, which control the balance of calcium and phosphorous in the body. The tests you would need before starting this treatment are ionized calcium and PTH. The phosphorous level also has to be below 8 before starting Calcitriol, and it works best if the phos is below 6.

More on Calcitriol
And the Dr. Nagode & Dr.Chew Calcitriol Reference Pages

 

[Lisa dvm]

From the article I read from Meowmeowmom.com It says "Benzaepril is thought to increase bloodflow to the kidneys.

This is false - it does the opposite.

 

[Jess & Earl]

Hi Sara

A few quick additional answers since you've gotten some good ones so far.

SQ--yes every day or BID is better than every other day if you have a cat with advanced renal disease. Phos. binders are used to reduce the amt of phos. that the cat absorbs from food.

Benazepril is good for the type of renal disease characterized by loss of protein in the urine. This type of renal disease is more common in dogs. It has shown zero beneficial effect in cats who do not have proteinuria, and personally I wouldn't use it unless my cat did have proteinuria. It is no fun getting meds into cats and I'd rather save my battles for something that works. There are vets who prescribe benazepril for all cats with chronic kidney disease, however.

Calcitriol is another sort of controversial topic. I don't have time to go into it (I'm getting ready for work) but if your cat's phosphorous is high, he can't start it now anyway.

The anemia treatment should only be used when the cat has been shown to be irreversibly anemic with no where to go but down. It can have serious side effects, including causing the cat to stop producing any red blood cells (making them transfusion-dependent). It is not a benign medication. I started it in my cat when he was at the end of his rope, to be honest. He didn't have good results, but the reasons for that are complex.

Hang in there and post an update when you can. Did you check the ACVIM site to see if there were any internists near you?

 

[Karen & Smokey(GA)]

You give a phosphorous binder when the cat's phos is TOO HIGH (not too low).

The amount of fluids given depends upon what stage of renal failure the cat is in.

I started Smokey on 50ml daily for the first year. Upped it to 75, then 100ml daily as things
progressed over the next two years (3 years total).

In the last two months of his life, he was getting 100ml 2x/day. Mostly because he was being tube
fed his food and not drinking any water at all on his own, and had many medical problems.

 

[WCF and Meowzi]

Thanks for the letting me know what kind of phosophorus binder to use. I'll mention that to the vet although I think it will annoy him. All the vets where I go get annoyed when I bring up new meds or ideas.

You won't need a script from your vet to purchase aluminium hydroxide, if that's the phos binder you plan to use. We purchase ours from ThrivingPets.com - we get the 500 g jar aluminium hydroxide powder. (Ack! I went to get you the link and noticed they've raised their price!).

It's however a good idea to get your vet's input and keep him informed of any meds/supps/treatments you're planning to try, even if you won't need a script for it, b/c he should be your partner in Ebony's care, and he can watch for drug interactions.

There are two other drugs that I have read about for CRF, Benazepril and Calcitriol. Has anyone heard of them or used them?

We use calcitriol. As Jess writes, it is controversial. Cassandra posted links that'll give you information on it. You will need a script for this, if you and your vet decide to try it.