Milo's visit to the new vet

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Bebe Kaye

Member Since 2013
Finally I got Miley into a new vet and oh what a difference it made...though maybe it was better being in the dark! He originally went in to just get blood pressure testing, but seeing as I paid for a consultation, I thought I'd ask a few questions (something I couldn't do at the last vet).


For starters, Miley has high blood pressure it was sitting at 215-220 :sad: ...he was pretty comfortable there so they think it's pretty accurate and so he will start on Amlodopine when they order it in on Monday/ Tuesday (and luckily it's ham flavoured, he should love it!). They also checked him right over for me, the first thing they noticed before we even walked into the office was his colour change and said that they were pretty certain he has Cushing's Syndrome, but after the discussion, they agreed with me that the testing costs are way too much and even then the treatment is close to impossible with him as the Cushing's would be naturally occurring and require surgery that they doubt he would survive. They have never treated a cat with Cushing's either so would have to send me to a specialist which I simply can't afford. So we are just going to do what we can, as we can. They spent quite a while checking his eyes, due to the hypertension (and my last vet saying he was fine and didn't need BP testing) we're not sure how long it's been up, but they said it's been a while because he has small bleeds in the back of his eyes, though his vision is still really good. They don't think he will lose his vision and will be keeping a close eye on him from here on.


They also found a heart murmur that has never been mentioned to me before. By this stage I was in tears, I had trusted my other vet to look after Miley for the last 13 years and what else has been missed? Nothing was mentioned about treatment for that just yet, so maybe it was rather minor or there are just too many other things to worry about lol. Miley also has quite bad arthritis in his shoulders and hips, the hips are rather stiff too, so when I have the money I will start his on some injections for that (gahhh forgot the name of it), something they can give monthly. I knew his front right shoulder was really bad and he also had a lot of heat in the left shoulder, but I didn't know his hips were so stiff. She said that she will give me some tramadol for pain, though I will only give that when it gets worse, right now I know his behaviour and he's still quite comfortable.


His thyroid tests came back perfect, so that's one thing I don't have to worry about. His phosphorus levels were only very slightly elevated and everything else was perfect. So far Miley isn't anemic which is great (I had been worrying about it), but from here on in I will have to try and get him in for more regular blood tests to keep an eye on his creatinine, Bun and all the little worrying ones. When I go in next week to pick up his hypertension medication, I have to drop off a urine sample; this could be worth videoing...me chasing after him trying to get his first morning waters! But really, it shouldn't be too hard he really doesn't care who is watching. With the urine they will test the specific gravity (no urine analysis has been done grrr), proteinuria and just check that there are no UTI's.


And to the positive bright sunshine glittering on dew bits, his diabetes is going well and she wants me to start reducing his dose of Lantus to see how he goes. She was also really impressed with how good he looks and how happy and content (even with them prodding and poking him all over). Miley doesn't look dehydrated and they are considering teaching me and giving me the supplies to do sub q's at home...they've never had anyone want to do it so they have to ask the big boss. I found the new vet really great, willing to listen to my opinion and very open about all the options and how things are...what a refreshing change! Another thing that surprised me is some things are actually cheaper there as they have their own pathologist on staff and do a lot of 'in-house' testing...yay! They even said that to save money they will let me do Miley's vitamin B shots at home...another thing they were surprised I would want to do, I don't think they realise that a lot of people would do all this stuff for their animals if they actually knew they could!


Miley came home worn out! He scoffed down two tins of food (he literally breathed the first lot down, 10 seconds it took for a clean plate), then had a big drink and curled up in the cutest little ball on my grandson's foam couch...one tired old kitty cat! Oh and did I mention that he 'christened' my car for the second time this month!?! Not an impressed Mumma, but to put a good spin on the bad, because his urine is so dilute, it doesn't really smell lol. cat_pet_icon


I have probably missed out on a lot, but this bean is very tired, I was up all night due to my own health issues, but it was perfect because Miley gave me quite a low BG result at his +5...I was about to head to bed and just read...thank goodness I tested. It's not as bad as some of the poor Kitty cats, but for him it's the lowest BG i've had, it was 3.2. Another good reason I should cut back his insulin dose I think! I'm just a little worried because as of yesterday, I'm pretty much demand feeding him to try and get some more meat on his bones. Not sure how good it will do as there is quite a bit of muscle wasting (vet thinks it's from the Cushing's??). But she said that while he was hungry and BG's were good, that I should feed him as he wishes.


Hope you're all having the most splendiferous day/ evening and all the beautiful furry children are healthy and happy! Now...how do I convince one of the family to carry me upstairs...there are just too many stairs!! I-) I-) I-) I-)
 
Re: Milo's visit with the new vet

The new vet today took a look at Milo's numbers and when I asked, said that reducing his insulin to 1.5 units BID would be fine. Even though I have doubled his food over the past two days, his BG's have been quite low to the point where he's too low this evening to even give him his PM shot. I'm still learning about Lantus, and have never had to reduce doses before. Is there anything I should do, or need to know while reducing insulin?

Oh and after posting the opening post, I found the forum for acrocats, cushings etc and read a few posts and links. I'm now confused if he really does have it...his insulin control is quite good and I gather one of the top symptoms is insulin resistance. Ugh...the more I read the more confused I become. Right now I shall forget the rest and just concentrate on doing everything I can to keep him comfy and happy...this starts with reducing insulin! If his BG levels are higher at his AMPS, I will drop him Lantus dose from 2 units to 1.5 units...I would prefer to go slower and drop it at 0.25 units but the needles I have are shocking, they aren't the usual ones I use but it was all they had. Not sure any other Aussies out there have issues with buying diabetic supplies over the counter, but a lot of pharmacies won't do it unless you are diabetic yourself with a NDSS card (national diabetes services scheme). I've had places refuse to sell me not only insulin needles but also the testing strips :-x, I simply can't afford to buy them through my vet as they were up to 4 times the cost of the pharmacies!

Anyway, if Milo's BG test at the AMPS tomorrow morning is still low, is it okay to skip two consecutive doses or should I just give a reduced dose? What level should I be looking at to skip and what level to give reduced dose? ANy help here would be so greatly appreciated.

Hope everyone is still doing wonderfully, the sun is bright, the birds are singing and all the sugar babies are having the best possible day!

Bebe and Milo
 
Re: Milo's visit with the new vet

Okay it's +4 and Milo's BG is 11.9, I'm starting to worry about not giving him his insulin earlier! confused_cat
 
Well all I can say is LESSON LEARNT! Milo's AMPS was 17.5 :YMSIGH: I stuffed up big. I have to wonder...will I ever get this down pat? It's my fault his BG is so high, and instead of us moving forward...we just took a mighty leap back. I just wasn't comfortable giving him a shot that low...guess I will just have to do it next time and then sit up and do hourly BG tests so I really start understanding this stuff.
 
When you wind up skipping Lantus shots frequently, it suggests you need to lower the dose so that you can give the same dose every 12 hours.

If you are shooting 2 units, you might see if shooting 1.75 or 1.5 lets you do that.
 
For arthritis you can treat that now - you can purchase cosequin and if that is too expensive you can buy cat treats that are for hip and joint - it should contain glucosamine, chrondroitin and MSM.

Some options include -

Pet Naturals of Vermont hip and joint
Catswell Happy Hips (this doesn't contain MSM and MSM is good to include)

You can see what other options are available to you by doing a search for cat - hip and joint
 
Sounds like the new vet picked up on some things... It's better to know since you can then take action if need be!

I would post on the acromgealy board and ask more about the cushings.. I don't see insulin resistance yet in your BG espeically with those nice blues and greens recently..and I thought those cats had skin that tears easily? Does Milo?

Here we some urine catching tips that might kelp... https://docs.google.com/document/d/1quta5WLEjdO0Y_t2dAYSwN84h-LNZWxOdtVsJDKZ16A/pub

Wendy
 
BJM said:
When you wind up skipping Lantus shots frequently, it suggests you need to lower the dose so that you can give the same dose every 12 hours.

If you are shooting 2 units, you might see if shooting 1.75 or 1.5 lets you do that.
Click to expand...

Since joining this forum, it's become clear to me that Milo's number's aren't too bad and relatively stable, as of tomorrow I will try lowering him to 1.5 units, with the new odd needles it's near impossible to do the 1.75 that I would prefer. His numbers have remained higher than normal all day today...guess I learnt this the hard way...I just hate that I've made my boy suffer.


Hillary & Maui said:
For arthritis you can treat that now - you can purchase cosequin and if that is too expensive you can buy cat treats that are for hip and joint - it should contain glucosamine, chrondroitin and MSM.

Some options include -

Pet Naturals of Vermont hip and joint
Catswell Happy Hips (this doesn't contain MSM and MSM is good to include)

You can see what other options are available to you by doing a search for cat - hip and joint
Click to expand...

Thank you so much for this information, I will try and find somewhere that sells this stuff...at the moment he has the whole house running after him, he stands at the baby gates and meows and someone runs to open it, he meows at the stairs and someone goes and carries him upstairs...he seems to know his limitations and knows we will help. Oh and he loves his heat packs and shoulder rubs! We're heading into the colder weather here, I know how much extra pain it gives me, I hope he won't suffer too much.
Wendy&Tiggy said:
Sounds like the new vet picked up on some things... It's better to know since you can then take action if need be!

I would post on the acromgealy board and ask more about the cushings.. I don't see insulin resistance yet in your BG espeically with those nice blues and greens recently..and I thought those cats had skin that tears easily? Does Milo?

Here we some urine catching tips that might kelp... https://docs.google.com/document/d/1quta5WLEjdO0Y_t2dAYSwN84h-LNZWxOdtVsJDKZ16A/pub

Wendy
Click to expand...
Yes, it broke my heart to hear all the extra things. With everything, I'm not sure how long I will have him with me...my days will be a lot darker without him.
I saw the acromgealy board, but with having no definitive diagnosis, i'm loath to post there and annoy people. I simply can't afford the diagnoses which the vet told me could be up to $5000 (plus the additional cat clinic costs) worth of tests and with there realistically being no really favorable treatments at the moment and with Miley's other illnesses, even the vet said it's no use worrying about.

The relatively nice controlled status of Milo's diabetes has me doubting the Cushing's too, he is coming up to his one year anniversary since his diabetes diagnoses and there hasn't ever been a time where his numbers have been out of control. I have had him tested yearly for the 4 years before I found out about his diabetes and there was no indication of it then either, he's always had a voracious appetite and was a big boy so I always worried about his sugar levels.

As to the skin thing, his skin seems very delicate, it doesn't tear but it does bruise very easily where before it didn't. He's always been an over groomer and had a bit of a thinning and balding tummy, but now he has barely any fur over his tummy up the sides, insides of his legs and under tail. He's also lost a lot of his black colouring and now only has a black head, mane area and tail...the rest is a very distinctive orangey rust colour.


Oh and his weight at the vet visit was 7.3KG thought I'd put it in this post so I can remember.


Thanks for all your replies and help.
Hope everyone is having a wonderful weekend and all the beautiful Kitty cats are happy and purry.

Bebe and Miley
 
Bebe

Just catching up but I'm glad you saw the other vet and that Miley will soon be on amlodipine.

Just a couple things that caught my eye:

1. For the arthritis, you might be talking about adequan injections? Usually it's once a week for a month and then a monthly injection. You can do these at home.

2. I'm glad he's not anemic so now is the time to get him on the B vitamins we told you about. I would not waste money on the shots because the vets usually give cyanocobalamine and he needs methylcobalamine (methylB12). He also MUST have the B complex along with the methylB12. It won't help him to give it alone. I can't overstress the value of these vitamins for a CKD cat; Gus is going on more than 2.5 years with CKD and is still not needing an ESA for anemia which is really great.

3. It's a great idea to have the USG and the proteinuria (also known as protein/creatinine ratio) done. But in order to tell if he has a UTI, they must do what is called cystocentesis where they insert a needle into the bladder and draw a sterile sample. It doesn't hurt the kitty...just be sure your vet has done many of these and know what they are doing. A free catch sample will often show bacteria just because its not a sterile sample.

4. On the phosphorus level....I don't know about in Australia, but in the US, the "normal range" includes kittens and kittens always have a high phosphorus level. This was a hard lesson for me to learn on my first CKD cat because phosphorus control is ally, really important to longevity and quality of life. My first CKD kitty's phosphorus was at 8 (reference range in US is 2.4-8.2) and because it was in the normal range, my vet did not have me do anything. But 8 was wsy too high and at that point, I was not able to get it down. But for a CKD cat, you want to keep the phosphorus level at about or below 4 if you can and for as long as you can. If his creat and BUN are elevated but his P is 4 or so, then now is the time to start feeding a low phosphorus diet and keep that number down for as long as you can. Again...the reference range might be different there.

5. Did she mention giving subq fluids at home? Normally when the creat is about 3.5 or 300-350 if you have European type reference ranges, then you should start some daily subqs. Since he has a heart murmur, you have to be careful but it can be done. You have to start with small amounts and let him absorb it before you give it again. I would definitely talk to the vet again about subqs if his creat is near or over those levels. Giving subqs can also bring the BG down a bit and you don't want to give subqs near the time you give insulin.

6. If you can find some digital calipers there, you can dose more accurately and get those in-between doses. Here is some info on Dosing With Calipers.

7. Cushings is rare in cats but does occur. There are alot of online resources about Cushings in cats.

Hope this info helps. Let me know if you have questions.
 
saw the acromgealy board, but with having no definitive diagnosis, i'm loath to post there and annoy people. I simply can't afford the diagnoses which the vet told me could be up to $5000...
Click to expand...
I would post there anyway and tell them this, and ask their input. They are helpful people - I am pretty sure you wouldnt annoy them! I would also ask them to look at your spreadsheet to see what they think..

Meanwhile I saw your SS, about "learning to shoot low numbers" really you have already done that since we advise most newbies to come on here and post whenever they shoot under 12 and you have done that !! So now its just getting comfortable shooting even lower. Here is some stuff that will help

1. Read this http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147
2. Unless your cat is having low numbers (50 or below) dont feed two hours before the test/shot time
3. Next time you see a number under say 9, come on here and post. Dont shoot, dont feed and retest in 30minutes. You are looking to see what he is doing naturally. Make sure you are stocked up on strips, HC food with gravy and syrup and are able to stay up and test. if you post a 911 on here someone will stay up with you and help watch. Also I would post on the Lantus Tight Regulation Board since that one is more active and has a lot of very experienced members who can help!

Remind me what you are feeding? Your SS says a "tin".. its low carb canned right?

Wendy
 
Wendy&Tiggy said:
saw the acromgealy board, but with having no definitive diagnosis, i'm loath to post there and annoy people. I simply can't afford the diagnoses which the vet told me could be up to $5000...
Click to expand...
I would post there anyway and tell them this, and ask their input. They are helpful people - I am pretty sure you wouldnt annoy them! I would also ask them to look at your spreadsheet to see what they think..

Meanwhile I saw your SS, about "learning to shoot low numbers" really you have already done that since we advise most newbies to come on here and post whenever they shoot under 12 and you have done that !! So now its just getting comfortable shooting even lower. Here is some stuff that will help

1. Read this http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147
2. Unless your cat is having low numbers (50 or below) dont feed two hours before the test/shot time
3. Next time you see a number under say 9, come on here and post. Dont shoot, dont feed and retest in 30minutes. You are looking to see what he is doing naturally. Make sure you are stocked up on strips, HC food with gravy and syrup and are able to stay up and test. if you post a 911 on here someone will stay up with you and help watch. Also I would post on the Lantus Tight Regulation Board since that one is more active and has a lot of very experienced members who can help!

Remind me what you are feeding? Your SS says a "tin".. its low carb canned right?

Wendy
Click to expand...

Miley is on the lowest carb (and cereal free) that I can find at 1.0% and under crude fibre, I really have to print out the list and highlight exactly what is available over here, I just haven't had the chance and my own health issues have been interfering with it all.

If my head feels better than the twice the size it currently does now, I will post on the forums you mentioned and thank you for taking the time to post and help me.

Bebe and Milo


Marje and Gracie said:
Bebe

Just catching up but I'm glad you saw the other vet and that Miley will soon be on amlodipine.

Just a couple things that caught my eye:

1. For the arthritis, you might be talking about adequan injections? Usually it's once a week for a month and then a monthly injection. You can do these at home.

2. I'm glad he's not anemic so now is the time to get him on the B vitamins we told you about. I would not waste money on the shots because the vets usually give cyanocobalamine and he needs methylcobalamine (methylB12). He also MUST have the B complex along with the methylB12. It won't help him to give it alone. I can't overstress the value of these vitamins for a CKD cat; Gus is going on more than 2.5 years with CKD and is still not needing an ESA for anemia which is really great.

3. It's a great idea to have the USG and the proteinuria (also known as protein/creatinine ratio) done. But in order to tell if he has a UTI, they must do what is called cystocentesis where they insert a needle into the bladder and draw a sterile sample. It doesn't hurt the kitty...just be sure your vet has done many of these and know what they are doing. A free catch sample will often show bacteria just because its not a sterile sample.

4. On the phosphorus level....I don't know about in Australia, but in the US, the "normal range" includes kittens and kittens always have a high phosphorus level. This was a hard lesson for me to learn on my first CKD cat because phosphorus control is ally, really important to longevity and quality of life. My first CKD kitty's phosphorus was at 8 (reference range in US is 2.4-8.2) and because it was in the normal range, my vet did not have me do anything. But 8 was wsy too high and at that point, I was not able to get it down. But for a CKD cat, you want to keep the phosphorus level at about or below 4 if you can and for as long as you can. If his creat and BUN are elevated but his P is 4 or so, then now is the time to start feeding a low phosphorus diet and keep that number down for as long as you can. Again...the reference range might be different there.

5. Did she mention giving subq fluids at home? Normally when the creat is about 3.5 or 300-350 if you have European type reference ranges, then you should start some daily subqs. Since he has a heart murmur, you have to be careful but it can be done. You have to start with small amounts and let him absorb it before you give it again. I would definitely talk to the vet again about subqs if his creat is near or over those levels. Giving subqs can also bring the BG down a bit and you don't want to give subqs near the time you give insulin.

6. If you can find some digital calipers there, you can dose more accurately and get those in-between doses. Here is some info on Dosing With Calipers.

7. Cushings is rare in cats but does occur. There are alot of online resources about Cushings in cats.

Hope this info helps. Let me know if you have questions.
Click to expand...

Thank you so much for this information, I unfortunately tend to trust the vet and that's what got Miley into the sorry state he's now in. I have high hopes with this new vet who seems very open and helpful, I hope so much she can help me to keep Miley with me as long as possible (and as long as he is comfortable and happy). He must know I'm talking about him as he just hopped up and curled up with his head on my lap. I learn how to do sub q's Thursday next week, and he'll also be getting his first vitamin B needle...though am not too sure if it is the vitamin B or the arthritis meds, it is 4 weekly needles and then monthly from there on. I will ask what Milo's phosphorus levels are exactly, she just said they were low...but I don't know if that is her low or if it is hgh...this is so confusing.

Thank you for your help

Bebe and Milo


______________________________________



It's been a rough few days, not just for my sugar baby but the rest of the house are all being knocked around by a bad head cold (UGH!).

I managed to go get Miley's BP meds and he started those today...fingers crossed. His sugar has been way up high for him, I can only assume the fancy feast that I just bought is the wrong one and is causing havoc or maybe the greenie treats that I bought, so i've returned him to what I was feeding prior and have my fingers crossed his numbers will come down, the vet told me to raise his insulin by half a unit, so I hope that helps...panicking a little. Miley hasn't gotten any worse or better, I have noticed that he is drinking even more than usual, but that's it. He is a little put out because yesterday and today because I have cut back his food a little with such high readings, I want to get it back under control. Usually when he has a high number, it goes back down in +4 to +6 hours...this is worrying me greatly. nailbite_smile

He is just such a sweet boy, he takes all the probing and poking in his stride and always gives us a purr and a kiss no matter what his mood. I'm pulling my hair out with the financial side of having a sick kitty...oh I so should have got insurance when he was younger!

Oh the joy, well i'm climbing back up into bed and am going to try and sleep and fingers crossed these antibiotics kick in. I hope everyone has a really wonderful start to their week and all the little purry babies are safe and well.

Bebe and Milo
 
Re: cutting back food with high readings.

When there isn't enough insulin, the cat is starving because the glucose cannot be used. In that situation, you may feed as much as 50% more food to keep the cat more comfortable.

Spreading the food out across the 12 hours helps keep the cat from getting too hungry and pulling a scarf 'n' barf at mealtime.Some folks freeze part of the food so it may be nibbled as it thaws.
 
Sorry you arent feeling well. The greenies treats are likely high carb so i would think they could be the culprit. Many of us here feed freeze dried chicken treats you can get in pet stores since they are low carb and the cats seem to love them - or the liver ones. Just make sure they are 100% chicken or liver.
 
BJM said:
Re: cutting back food with high readings.

When there isn't enough insulin, the cat is starving because the glucose cannot be used. In that situation, you may feed as much as 50% more food to keep the cat more comfortable.

Spreading the food out across the 12 hours helps keep the cat from getting too hungry and pulling a scarf 'n' barf at mealtime.Some folks freeze part of the food so it may be nibbled as it thaws.
Click to expand...

Wow, really?!? I always thought I had to cut back on his food a little with high readings, THANK YOU SO MUCH! I had increased his food to basically 'on demand' because of his weight loss, so about every 3-4 hours, I will continue to do! Miley has always been a kitty who did the scarf and barf thing as a youngster, but it's been about 2-3 years since i've seen him throw up food. I did a ketone test and it came back negative, should I be testing it a few times a day while his readings are high?


Wendy&Tiggy said:
Sorry you arent feeling well. The greenies treats are likely high carb so i would think they could be the culprit. Many of us here feed freeze dried chicken treats you can get in pet stores since they are low carb and the cats seem to love them - or the liver ones. Just make sure they are 100% chicken or liver.
Click to expand...

Thank you for the info on treats, I went into a petstore a few days back and I think their range must have been lacking, there were only 3 types of treats and all were quite high in carbs (the greenies were the lowest but still REALLY high, I shouldn't have bought them)...I may have to try making my own for him. So many petstores are closing down over here and I can only think of one other, I will try to get over and see what they have in the next few days.


I can't thank you both (and all the others) for taking the time to post and help me out, it really does mean the world to me. It might sound silly, but my Miley is my best friend; he's seen me through a lot of really rough times...he's the one that never pestered me for answers, would just know when I wasn't right and be there for me. Funny thing is, when my daughter fell pregnant nearly 2 years ago, he was the first to know, he kept wanting to sleep on her tummy or curled up close to it...he would even smooch it...we found out 6 weeks later she was pregnant, through her 9 month ordeal of being bed ridden with hyperemesis gravidarum, he rarely left her bedside...it was so cute. When he goes, we will have a very huge hole left in our family...one I don't think will ever be filled.

Again, thank you so much.
Bebe and Milo
 
Wendy&Tiggy said:
I found these on an Australian website so I think they are out there..http://www.naturalpetstore.com.au/d...store-freeze-dried-chicken-breast-treats-50g/

Dd you change the food too? It's very strange why he is so high pink all of a sudden,..
Click to expand...

Yup, do I get a crown for the MOST STUPID thing of the week? I changed his food, gave him new treats and his sugar went skyrocketing! Then to top off the whole stupidity thing, I took the vet's advice and raised his insulin 0.5 units AND changed his food back which caused a hypo. :YMSIGH: Will I ever get this right?

My hair pulling thing at the moment is trying to find correct food for him, no matter how many times I read those food charts, I can't work them out. Low carbs, low protein and low phosphorus...ugh! If I wasn't insane already, I would definitely be so now! I gather I have to be under 10% carbs under 0.5% phosphorus and for the life of me the protein one has currently evaded me. I think my best bet will be to print them all out, highlight ones that look safe and then TRY to find them in Australia. Biggest problem right now is that my health is as bad as my kitty cat, we make an awesome pair! So getting out to the shops is a little hard, might have to hit the internet shops...if only Milo could surf the net! :dizcat

I reduced Milo's insulin today by 0.25 to 1.75 (or as close to that as I can get with the stupid needles I currently have). His behaviour is normal and he's his sweetheart normal self today.

Hope so much everyone is having the most splendiferous of days!

Bebe and Miley
 
Yeah....well....changing too many things at once can make it difficult to pinpoint which change made things better or worse. You changed so many things at once, they could have mostly cancelled each other out.

If the low phos foods and low carb and low protein are hard to find, I believe there is a phosphorus binder that can be added to food to remove it from his system. Keeps the phosphorus from affecting him so much, passed in the feces I believe?
 
Let's see how the dose decrease works. Paws crossed it settles well.

Also has anyone spoken to you about posting in a regular way on the tight regulation board? You are testing regularly and if you post there often they will keep a close eye and advise on dose etc.
 
Yes, I have him on a phosphorus binder, it's Ipakitine but others have said it's not very good...problem is that both my old and new vets have never heard of anything else and have said that's the best one, so i'm a little worried about it.

Miley's numbers are looking good, though a little low. :-D
 
fwiw, epakitin is the only phosphorous binder we've ever used. my late Kitty was on it for over a year if i remember correctly and my LePewie has been on it now for well over a year too
 
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