Joes Bloodwork. Any and all input appreciated

Joe has kidney disease and diabetes. He hates all the foods that are alright for him to eat. Sometimes he will not eat them. I do not want him to lose weight so if I were to cheat on one thing, which would be better?
1) allow him to have higher Phosphorus
2) allow him to have higher carbs.
Which of the two choices is less detrimental to him

 

My advise here is entirely based on what I learned about dealing with kidney failure for almost 10 years and it's just as applicable in an animal as a human...
My mother was a severe diabetic and had total renal failure. I became intimately familiar with dialysis, dialysis prescriptions, reading lab reports and how everything interacted.

Between those two choices you presented, I'd risk the higher carbs over higher phosphorus any day. If the whole calcium/phosphorus thing gets screwed up it can cause MAJOR issues with skin, bones, blood vessels and organs - All things that are not easy to correct after-the-fact. Though not ideal, higher carbs you can 'dose' around to some extent.

My heart goes out to you. You're dealing with a combo that I would never wish even on anyone.

 

I don't have any experience with this, but I agree that carbs are the lesser battle.
Consider that many people never find the information available here. They feed their cats the higher carb prescription food, give their cats insulin per the vet's instruction, test for urine glucose every once in a while (if that) and their animals do fine. Obviously, it's not as ideal as the protocols recommended here, but it's also not the end of the world.

Kidney disease is very different. I don't think there are as many roads to stability there.

Sending you and Joe good wishes.

 

I have never used them, but I think adding phosphorus binders help reduce the amount of phosphorus absorbed from food (experienced users please correct me if I am wrong). If that is true maybe you could find foods that may be lower in carbs and use the binder to help reduce the phosphorus.

I wish Friskies never stopped making their special diet canned foods. They were lower in both. That is what I fed Witn and Rascal. They had both diabetes and kidney disease and it help keep their levels under control.

 

Phosphorus binders do exactly that. However, be prepared for diarrhea... that's their downside. The phosphorus has to go somewhere.
It's a delicate dance and it's extremely hard to balance. It is worth having the conversation with the doctor.

 

Have you tried the Weruva foods? They have a large selection of both flavors and textures (sometimes, texture is more important than flavor for some cats) that are both low carb and low phosphorus. They also have the nutritional breakdown of all their foods on their website.

My China wouldn't eat them so I had to go back to feeding her the Fancy Feasts and using a phosphorus binder. I never noticed her having any diarrhea from it. Luckily it's tasteless so you mix it in with each meal (if you have to feed something higher phos just to get him to eat)

 

Hi Chris, we have tried each and every one of the Weruva's including the Bff's. I actually wrote to Weruva and got a list of all the ones with Guar Gum as Joe had constant diarrhea and I was beginning to think Guar was the culprit. I have a lifetime supply of both Tiki and Weruva that he will not eat.
I am going to ask the vet about a binder. I am assuming it is the vet I go to for that?

 

Tyler's brother had kidney disease, had to put him on the binder
He didn't get diarrhea at all
I got the binder from my vet and she instructed me in how much to give
At one point I had to decrease the amount
I would definitely talk to your vet
It has to be added to every meal they eat
So how ever much I had to give for the day I would just device it up into every meal he ate

 

Be prepared that the vet may say not to use phosphorus binders....mine did. He said that she was still in normal range (she was 6.0, but that is technically the level that is recommended for phosphorus binders) and that she wouldn't eat with it in the food. I have not found that to be the case. She doesn't mind it at all.
We use phos-bind, purchased on Amazon, because according to the different sources on Tanya's ckd site, she is at the range where she needs it.
https://www.felinecrf.org/phosphorus_binders.htm

 

The most important thing is that Joe eats, even if it isn't the best food available.
If he's a junk food junkie (Starburst is), Friskies pate is better in phosphorus than fancy feast.
And everything I've read says low carb diet is most important in ckd/diabetes combo cats. I think Tanya's covers that too.
http://www.felinecrf.org/diabetes.htm

 

I've read constipation is more likely an issue with binders. Either way I've added fortiflora to help digestion, but Starburst hasn't been having digestive issues.

 

SM mom! Thank you for your input. I gave baby food ham last night. I had a sick kitten once and that was all they would eat so I tried it. I am going to buy some Friskies pate today and am checking out the Phos-bind. Did you buy the big one or the little one? The scoop in each one is a different size causing more confusion

 

If you can find Beech-Nut Beef baby food, grab a jar to try. It's ~0% carbs and Temp LOVES it.
I feed it to him later in his cycle after nadir when he's hungry. He will scarf the entire jar.
Pretty much exactly the consistency of the Gerber, silky and palatable.

https://www.walmart.com/ip/Beech-Nut-Stage-1-Beef-Beef-Broth-Baby-Food-2-5-oz-Jar-10-Pack/36545226

 

Smorg, Joe loves the Gerber Ham. I will try the Beechnut. Do you happen to know the phosphorus amount?

 

Call from Joes Vet. He has a little blood in his urine. Possible bladder infection. fPLI test came back with some pancreatitis. Not bad. The internist at the lab suggested a good ultrasound if one wanted to look further. The vet and I decided to not do that as it would have to be done at a specialty hospital. She is giving me a prescription for Cerenia for nausea if his pancreas flare up again. She is giving me Orabax for his bladder infection
The rest of his bloodwork looks great and his kidney value is 4.5
I will be picking up the labs tomorrow. Tonight Joe is celebrating with some Friskies Pate and he says he plans to stuff himself full of it.
I am off to trap ferals for TNR Friday

 

I don't know the P level for the Beechnut, but beef is a good source of P, as all protein is. At this point, I would say go for it, in moderation (don't want poopy disasters).

Ok, ok, so pancreatitis. Great news, you know exactly why he was feeling nauseous and crappy. I don't know anything about pancreatitis, why would an ultrasound be helpful? If your vet deemed him ok to not have an ultrasound, then that sounds great!
Blood in the urine isn't as scary as it sounds. Temp has had blood present in his urinalysis strips before, and drugs knocked out the bladder infection just fine.
And 4.5 for kidney, woot! Less worry for you and I'm so glad to hear all of this. Hope Joe understands how happy mom is now and gorges all of it.
And gl with Feral Friday.

 

What does kidney value is 4.5 mean? Is that the creatinine value?

 

hmmm...I wish I knew. I was on the phone with the vet and said "I have heard they do not need a binder unless their value is 6 or more, what is his" and she said "4.5"
I will be picking up the test in about an hour

 

I think I see where the 4.5 comes from and think it is the Phosphorus level maybe

 

@JanetNJ
Looks like Joe needs to be raised again. He is just starting to feel better and allow testing. Should I wait until I get more readings or raise now. Please give me your thoughts

 

Phosphorus is good, awesome!
That WBC and urine panel look like a UTI.

 

what is a UTI
edited. Urinary Tract?
She suspects bladder infection

 

SBM, based on his phosphorus number do you think it is alright to give him his fav Friskies Pate again. He is so tired of the 'good' foods. And I am tired of paying for them, every three days to the tune of $30-$40 dollars of stuff brought home that he turns his nose up at

 

Urinary tract infection. Bladder is part of the urinary tract.

I don't know.
I'm not an expert and haven't dealt with phosphorus values in that range.

 

4.5 Phos, yay!
I'm curious to what "d" is that is 13.8 on your last page?
Can you take a photo of the whole page and upload it again so we can see what value of 13.8 is assigned to? Just put a post-it note over your personal information at the top


But no WBC from the urinalysis, is that normal for UTI? @StarburstMom

ETA: oh NM, "d" is the fPL test to determine pancreatitis.

 

You could compromise and give him Friskies Chicken or Turkey for now? Poultry is lower in P than red meat.

 

Not a terrible lab. Stage 2 kidneys which we knew. I'm glad the phosphorus is under 5. You could raise to 2.25 but do get a mid cycle reading whenever you can. Is he being put on antibiotics?

When you can is add the values to your lab tab on the spreadsheet.

Maybe you could mix the food stuff and the Friskies, but I wouldn't go back to high phos food because higher phosphorus makes them feel bad and can progress kidneys faster.

 

D'uh, I cannot believe I allowed that to be cropped out. That is his result for the fPL
@JanetNJ thank you so much for suggesting this test. I think back to a couple of days ago and I was allowing him to just cruise into hospice mode and you gave a gentle nudge and told me to get his pancreas checked.

 

Yes, he started Orabax last night

So I do not need to stay under 1 then? What do you consider high Phosphorus please

 

You want that phosphorus lab to stay under 5. I would continue to feed the low phosphorus food (foods under 1% or 200 depending on the chart you look at) but you were concerned with him not eating enough which is why I suggested mixing a little Friskies in just to get him more interested in it. If you start giving higher phosphorus food again, Joe's p levels will raise up again.

So dr said uti and some pancreatitis? Pancreatitis is painful which is probably why he's hiding and not eating well. That's how I knew something was wrong with my Zimmy. He had ckd but was always very food motivated. He always ate like 4 cans a day and suddenly was barely eating one. Once we got him on pain killers and cerenia for nausea he went right back to eating. He also got daily sub q's but not sure that would be easy to do with joe.

 

Janet it was so great that you piped in and told me to check. My vet said that the internist that read the bloodwork to her when she called said "your client is paying attention to what is going on with her cat" and when my vet relayed it to me I confessed it was all the wonderful cat forum peeps keeping me informed.
Janet could the pancreatitis have contributed to the diarrhea.
I went to all the trouble of eliminating all guar gums and it never helped with the diarrhea.

 

Your cat is lucky to have you for sure. Pancratitis causes pain and I'm sure that can upset the digestive system.

 

Just looked it up. Looks like it can cause diarrhea.

 

That must have been wonderful to hear. Sounds like you have a good team.

Did you decide to raise to 2.25? Hopefully you can, and get rid of those blacks and reds.

 

I have not raised it yet as I need to do more mid-cycle testing. He has those horrible reds and blacks at AMPS and PMPS even when he is doing good mid-day. Look back around 8/16-8/24. Beautiful numbers mid-cycle, yet some red and blacks at pre-shot time.
I am also wondering if I should wait until his anti-biotic treatment is done before raising it

 

True, he’s very good at recovering from high PSs. Get that dose raised as soon as you can test enough. Antibiotics don’t matter for this, gotta get his numbers lower.

 

OK. Smorg. Thanks for letting me know about the anti-biotics. I will get one more mid-cycle today.
Do you think it would be alright to take him up .25 at PM shot time?

 

As long as you can give him a +2

 

Antibiotics usually kick in in 24-48 hours. I hope he's feeling better quickly.

 

The second dose was given tonight and I do think he is feeling better. Back to being clear-eyed and seems a little more active

 

Oh good. So glad you were able to get answers, I don't know what I would have done if Temp were hiding and eating poorly for 5 days.

 

I thought he was dying and I thought the only humane thing to do was to leave him alone.
He is back to hyper hungry now and I probably need to get him to his happy dose of 3. or 3.25 as soon as I can

 

Friskies is really high in phosphorus. His phosphorus levels are so good that you want to keep them there. Ever consider raw feeding? https://www.felinediabetes.com/FDMB/threads/raw-feeding-senior-kitties.248460/

 

I have used a phosphorus binder (aluminium hydroxide) in the past and they do work. However, they dend to cause constipation but propylene glycol 3350 (generic Miralax) resolves any constipation.

 

I am going by this https://www.felinediabetes.com/FDMB/threads/friskies-v-ff-phosphorus-content.68789/
And these are the ones I bought Joe to mix with his low phosphorus Weruva's. I will mix half and half and I hope this is considered low enough.
I am not game for the raw right now. I might start making him his cat food but not raw. I make my dog her dog food
(Not Special Diet):
Country Style --------------------------------- 1.32%
Salmon Dinner -------------------------------- 1.32%
Turkey/Giblets ------------------------------- 1.32%
Mixed Grill ------------------------------------ 1.41%
Liver/Chicken -------------------------------- 1.45%

 

HI Larry
Which binder did you use? Do you think it is appropriate to use now with his Phos level at 4.5? Maybe as a preventative?

 

Phos content needs ideally to be less than 1%.

 

As I said in my original post: "I have used a phosphorus binder (aluminium hydroxide) in the past"

Your Labs tab show a level of 5.4. I like to keep the phosphorus level in the middle of the range so using a lille binder no would not be unusual.

 

Joe's fav Weruva's

Steak Frites .57 phos
Peking Ducken .79 phos
On the Cat Wok .74 phos
If I mix these with something that is 1.32 phos I should still be doing good

 

Is this the name I look for?

 

Yes, aluminium hydroxide is a common phosphorus binder used for cats.

 

4.5 not 5.4. What is a good phosphorus level for a cat that does not have CKD?

 

You might want to talk to your vet about this but from what I know, you don't need a phosphorus binder if the number is under 6. https://felinecrf.org/phosphorus_binders.htm

You filled in 5.4 on your lab spreadsheet. You might want to correct it as there is a big difference between that and 4.5.

 

With only 4.5 I would not use a binder

 

HI Perfumed, his Blood test from last time was 5.4. This time it is 4.5. I thought Larry was looking at the above test

 

I just added his new lab values. Thanks Perfumed and Larry I appreciate your input

 

Agreed no phos binder needed yet. It seems controlled with the weruva.

 

Good job adding the labs, that must have been a lot of work. But satisfying seeing them side by side with the lower P of 4.5. What was Joe eating when he was diagnosed with diabetes?

I see you're getting more mid-cycle tests in. You need to get a test right before his PM shot, even if his mid-cycle test was high. Reason being, safety, of course, and also it's a good thing to compare to his +2 to get an idea if it's going to be an active cycle.
If the latest test you have is his AM +8, then when you get his PM +2, it's hard to get a good idea of where he was at shot time.

 

OK Smorg. I am on it. Will do tonight. Wish I could raise him again another .25

 

Me too, I liked that 3U dose. Ask Janet or another Prozinc user? What's the protocol with SLGS again, 10 cycles on this dose?

 

@JanetNJ, can I just raise Joe back up to his 3 units? Maybe in every other day increments. He was doing good at 3 units

 

One week Smorg.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

 

Yay for lower pink preshot!
You know, I’d forgotten the 3U took him below 90, which is a reduction with SLGS. So maybe 2.75?
I wonder if @JanetNJ will say you can go back up to that quicker than standard protocol. After all, the only reason you dropped down to 2 was because of the low PS on the 30th.

 

going to start a new thread
https://felinediabetes.com/FDMB/threads/advice-about-raising-joes-dosage-faster.252613/