? Mixing medicines

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Cherie Hogan

Cherie Hogan

Member Since 2016
Hello everyone,

At Marje's urging, I took Riley in for an ultrasound and urinalysis and bloodwork. He is definitely in remission with his diabetes but now has CRF coupled with a kidney infection. He also has a sick stomach. Since I am constantly pushing pills or supplements or medicine down his throat, I thought I'd try using gel caps and combining some of his meds but I don't want to use the wrong combination. I am currently giving him Zobaline and Jarrow B-Right, Benazepril, Cerenia for upset stomach, potassium gluconate and phosphorous binder. He is also getting Clavamox for his kidney infection and this last one, which is an antibiotic, is making him sick but he needs to stay on it for another four weeks. The Cerenia is $15 for four pills and I do cut them in half, however I have read that Peptid AC is good for preventing stomach acid so cats don't get sick. Also, another member sent me some slippery elm and I've heard this is good for upset stomach as well. Does anybody out there have any knowledge about what medicing I can combine? I hate to see him sick and he is hard to pill and is refusing the potassium and phosphorous binder. I feel if I can combine the meds and only have to give a couple of pills instead of constantly poking and prodding it would help so much.
Thanks in advance!!
 
The Slippery Elm Bark should not be given within two hours of any other meds, as it coats the stomach and intestine and will prevent absorption. I don't know about the others. I often put several different meds in one gelcap without issue. Much easier to give.

Are you making sure to give the Clavamox with/after food? I never had a problem with it, but I did always make sure my kitty was eating before I gave it. I know some cats have tummy issues with it.

Zobaline and Jarrow aren't "drugs", so I don't think it matters what you combine them with. Will he not eat food with the Zobaline crushed in it?

You generally don't want to give Pepcid unless you are sure stomach acid is an issue - is he have throwing up clear or foamy liquid at all? That's usually a sign. That said, it was the first thing my vet prescribed for tummy issues. I always found it worked best given at night.

I'm glad Riley's FD seems to be in remission. It's nice to take that out of the equation, with everything else you have going on.

Sending vines and prayers for sweet Riley and :bighug:s for you.
 
Slippery elm bark shoold be given two hours before or after any other medicine. Pepcid and benazapril should be given apart, maybe one in AM and the other in PM. Your vet should be able to help you decide how to give meds.

Are you giving probiotics? Antibiotics can kill tummy flora that probiotics can replace. If he can eat dairy, maybe try some plain Greek yogurt. Or maybe the vet can suggest another antibiotic Riley could take that is easier on him.
 
Is the clavamox in liquid form? That is what I have given Gizmo in the past. ECID - but he tolerated it fairly well.
 
Is there a vet school anywhere in your state? If so, I'd call and ask if there is a veterinary pharmacist you can speak with. The pharmacist would be able to tell you definitively if there's any chance for an interaction between medications or how they should be taken. For example, some meds need to be taken solo -- they need the acid environment of the stomach to breakdown the drug so it shouldn't be taken with food or anything that coats the stomach. If the medications are used in humans, your local pharmacist should also be able to help.
 
Hi Cherie,
My only add to the super suggestions from others about meds and dosing interactions is:

1. Re dosing SEB (slippery elm bark powder), another way to dose it so that it's separate from other meds is to make a liquid of it, adding enough water until it's syrup consistency (it does get gummy). squirt about 1ml the liquid a couple hours in between other meds.
I've added it to food (be sure to add water to food so that it doesn't get gummy), too. Some cats like the taste and smell of it, others don't.

2. Probiotics: agree it's an essential, particularly so while doing antibiotics.
Whether you add to food or dose in gelcap, it has many benefits. Plain Yogurt a good source, too.

Glad to hear that, even though CRF and chronic uti infection is big factor, that Riley is doing better and in remission. Hang in there!
:bighug::bighug::bighug:
 
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Clavamox can be really tough on kitties. My vet only gives it as a last resort because it can upset their tummies so much. One of my civvies had one dose and didn't eat for more than a day afterwards. But, since Riley needs it, I would definitely keep up with the anti-nausea meds and probiotics while he's on it.

For the cerenia, I get mine here: Cerenia at Valley Vet because it is a bit cheaper. (It used to be a lot cheaper, but I see that they've recently raised their prices.) They do need a script from the vet, but there is a box you select at checkout that asks them to contact the vet for you for the script. I buy them 6 4-pill boxes at a time to get the free shipping.
 
Thanks all. For some reason your responses weren't coming into my email. I'll update on Riley's condition. He had an ultrasound, more bloodwork and urinalysis on Monday at vet an hour away. Left with Clavamox and Benazepril and advice to enjoy what time I had left with Riley. I talked to Marje right after that and she said something wasn't right and gave me a series of questions to ask the vet. I finally spoke with her on Friday and guess what....Marje was right...a kidney infection. In desperation, just before I spoke with vet #2, I called my own vet and asked if she had received Riley's test results from vet #2. She had just gotten them and so began trying to answer the questions Marje had given me. That's when I was told that the notes had listed a possible kidney infection however vet #2 had sent Riley home with enough Clavamox to last only 10 days. A kidney infection requires 4-6 weeks of treatment. Long story short, Riley's elevated numbers are very possibly the result of a kidney infection.

Well the Clavamox is making him sick and the cerenia isn't doing much to help him. With his calcium numbers so high I'm not sure it's safe to give him the slippery elm although that would be my first choice. Peptid AC is also recommended but the downside to that is that it depletes b12 over long term use. I do have a probiotic called PureAll but I'll have to research that. I also found a couple other products called Viyo b/c and Chanca Piedra. I haven't investigated those yet but thought one of you might know about them.

The two problems I am having with Riley are that he won't eat and something I am giving him is making him sick. The Clavamox is probably the culprit but I don't know what to do about it. Everything I read on Tanya's website contradicts something positive I read before that. The Clavamox no doubt is playing havoc with Riley's stomach but what can I do? The cerenia doesn't seem to be helping. The poor boy greets me in the morning and I can see he is feeling a little better and then I start poking medicine down him and he is sick and lethargic two hours later. There seems to be no end to his misery.

Please give me some suggestions.
 
I probably should have told you all what I am giving Riley and explain that I know there is a CRF website and I have been reading through that for hours and can make nothing of it except one piece of information contradicted by another piece. I feel more comfortable that I will find a solution through you.

AM. Cerenia 1/2 pill combined with Jarrow B Right in #5 gel cap followed by Zobaline and more Jarrow in same. Then 1/8 teaspoon potassium in baby food, an hour later Weruva with phosphorus binder that he won't eat or just licks. An hour later 1ml Clavamox. A half hour after that he is sick.

PM..Riley finally starts to look a little better and here comes the potassium in baby food, a quarter pill of Benazepril, more food with phosphorus binder he won't eat, and an hour later Clavamox 1ml and an hour after that the poor boy is sick.

In desperation today I gave an appetite stimulant prescribed by the vet and all that has done is make him restless not hungry.
 
Hi Cherie,
Although there are others here far more experienced than me in managing CRF, and the meds you've described,
I'll offer some nursing sick cat suggestions, in hopes that others will also weigh in on whether these make sense or should be modified for your situation with Riley and re meds.Ok?

If I'm understanding correctly, Riley has been found to be in FD remission but with CRF and kidney infection requiring antibiotic. Hope I've got it right!
You're trying to get him to eat, recover from the two primary medical challenges/their effects and keep bg in control. One or more of the meds, including the clavamox, might be one of many factors in his inappetance.

I don't remember which food you are offering him (canned that he usually likes)?

During sickness, IMO, the more simple the food source the easier it is for the body to digest and assimilate. This is why baby food meat (gerbers or beechnut stage 2 because they don't have seasonings; the Gerber's has some cornstarch, the Beechnut is plain meat and meat broth) are good go-to's.
If you have some great! If you don't, please get some: beef, turkey, chicken, ham (whatever and add a a couple of jars of beechnut or gerbers winter squash or butternut squash to the grocery basket. You may need it to add some LGI fiber to the slurry.

I tweak it with water, a bit of SEB or probiotic (alternating feedings with SEB food and the probiotic food). Depending on the situation, I add a bit of baby squash or plain baby oatmeal to the slurry. If you are assist feeding, make it liquid enough to work with oral syringe. Small frequent feedings.

Under a lot of circumstances, a plain bone broth (easy to make, just takes a little time) would be the first to try. However, learned from wise friends here that bone broth can be high in phosphorus...not ideal for kidney cats.

Probiotics will help restore the beneficial digestive flora. The SEB can help in its own ways too. But as others have said, it coats/settles the digestive tract and has other beneficial properties.

Also there is the "Raw Liver Shake for Sick Cats". Here's the fdmb link to the recipe:

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

I can attest to its benefits, particularly recently for my 18 year old who has been "borderline renal" most of her life and has undergone two major surgeries, the first in mid-December, the second in early February.

In summary, I'd suggest go with simple foods for now and sneak in the probiotic and slippery elm in that. I think egg white powder (or cooked egg white mixed in food) helps with managing phosphorus but that's my own feeling about it.

Hope this helps with some aspects of the immediate hurdle.
Vines for an on-the-mend weekend for you and Riley,
Sina
:bighug:
 
You've gotten lots of good info here so far. One thing I would suggest is that since the cerenia isn't helping him, ask your vet for a script for ondansetron (Zofran). Some cats do better with cerenia (which is more of an anti-vomiting ned), and some do better with ondansetron (which is more anti-nausea). The Ondansetron may work better with the Clavamox...it is actually a drug that was developed for chemo patients. It worked very well for my Dad when he was battling cancer and on chemo. I know some (if not most) chemo patients take their anti-nausea meds BEFORE all the other crap that makes them sick, so they are ahead of the nausea. So that is something to keep in mind, too. And, although I have no first-hand experience, it my understanding that ondansetron and cerenia can be used together.

Famotadine may help just a tad, but since it is more of an anti-acid, it might not do a whole lot for full-on nausea.

Continued prayers. Please keep posting with updates and questions...the board is sometimes a bit quieter on the weekends, but I know everyone who can help will jump in whenever they can.
 
Amy, you are right, both ondansetron and cerenia can be given. Neko was getting daily cerenia and ondansetron as needed, sometimes twice a day. Give the ondansetron 30-45 minutes or so before giving food so their tummy will feel better before being presented the food.
 
HWright said:
Hi Cherie,
Although there are others here far more experienced than me in managing CRF, and the meds you've described,
I'll offer some nursing sick cat suggestions, in hopes that others will also weigh in on whether these make sense or should be modified for your situation with Riley and re meds.Ok?

If I'm understanding correctly, Riley has been found to be in FD remission but with CRF and kidney infection requiring antibiotic. Hope I've got it right!
You're trying to get him to eat, recover from the two primary medical challenges/their effects and keep bg in control. One or more of the meds, including the clavamox, might be one of many factors in his inappetance.

I don't remember which food you are offering him (canned that he usually likes)?

During sickness, IMO, the more simple the food source the easier it is for the body to digest and assimilate. This is why baby food meat (gerbers or beechnut stage 2 because they don't have seasonings; the Gerber's has some cornstarch, the Beechnut is plain meat and meat broth) are good go-to's.
If you have some great! If you don't, please get some: beef, turkey, chicken, ham (whatever and add a a couple of jars of beechnut or gerbers winter squash or butternut squash to the grocery basket. You may need it to add some LGI fiber to the slurry.

I tweak it with water, a bit of SEB or probiotic (alternating feedings with SEB food and the probiotic food). Depending on the situation, I add a bit of baby squash or plain baby oatmeal to the slurry. If you are assist feeding, make it liquid enough to work with oral syringe. Small frequent feedings.

Under a lot of circumstances, a plain bone broth (easy to make, just takes a little time) would be the first to try. However, learned from wise friends here that bone broth can be high in phosphorus...not ideal for kidney cats.

Probiotics will help restore the beneficial digestive flora. The SEB can help in its own ways too. But as others have said, it coats/settles the digestive tract and has other beneficial properties.

Also there is the "Raw Liver Shake for Sick Cats". Here's the fdmb link to the recipe:

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

I can attest to its benefits, particularly recently for my 18 year old who has been "borderline renal" most of her life and has undergone two major surgeries, the first in mid-December, the second in early February.

In summary, I'd suggest go with simple foods for now and sneak in the probiotic and slippery elm in that. I think egg white powder (or cooked egg white mixed in food) helps with managing phosphorus but that's my own feeling about it.

Hope this helps with some aspects of the immediate hurdle.
Vines for an on-the-mend weekend for you and Riley,
Sina
:bighug:
Click to expand...
Yes, it helps and thank you. I got some 20 mg Peptid AC and crushed the pill and divided it into eighths and put it in a gel cap and gave it to him. I hope it helps with the Clavamox. I can't imagine him being this uncomfortable for another 4-6 weeks.
 
Amy&TrixieCat said:
You've gotten lots of good info here so far. One thing I would suggest is that since the cerenia isn't helping him, ask your vet for a script for ondansetron (Zofran). Some cats do better with cerenia (which is more of an anti-vomiting ned), and some do better with ondansetron (which is more anti-nausea). The Ondansetron may work better with the Clavamox...it is actually a drug that was developed for chemo patients. It worked very well for my Dad when he was battling cancer and on chemo. I know some (if not most) chemo patients take their anti-nausea meds BEFORE all the other crap that makes them sick, so they are ahead of the nausea. So that is something to keep in mind, too. And, although I have no first-hand experience, it my understanding that ondansetron and cerenia can be used together.

Famotadine may help just a tad, but since it is more of an anti-acid, it might not do a whole lot for full-on nausea.

Continued prayers. Please keep posting with updates and questions...the board is sometimes a bit quieter on the weekends, but I know everyone who can help will jump in whenever they can.
Click to expand...


I'm definitely checking with the vet on the Ondansetron. Thank you.
 
HWright said:
Hi Cherie,
Although there are others here far more experienced than me in managing CRF, and the meds you've described,
I'll offer some nursing sick cat suggestions, in hopes that others will also weigh in on whether these make sense or should be modified for your situation with Riley and re meds.Ok?

If I'm understanding correctly, Riley has been found to be in FD remission but with CRF and kidney infection requiring antibiotic. Hope I've got it right!
You're trying to get him to eat, recover from the two primary medical challenges/their effects and keep bg in control. One or more of the meds, including the clavamox, might be one of many factors in his inappetance.

I don't remember which food you are offering him (canned that he usually likes)?

During sickness, IMO, the more simple the food source the easier it is for the body to digest and assimilate. This is why baby food meat (gerbers or beechnut stage 2 because they don't have seasonings; the Gerber's has some cornstarch, the Beechnut is plain meat and meat broth) are good go-to's.
If you have some great! If you don't, please get some: beef, turkey, chicken, ham (whatever and add a a couple of jars of beechnut or gerbers winter squash or butternut squash to the grocery basket. You may need it to add some LGI fiber to the slurry.

I tweak it with water, a bit of SEB or probiotic (alternating feedings with SEB food and the probiotic food). Depending on the situation, I add a bit of baby squash or plain baby oatmeal to the slurry. If you are assist feeding, make it liquid enough to work with oral syringe. Small frequent feedings.

Under a lot of circumstances, a plain bone broth (easy to make, just takes a little time) would be the first to try. However, learned from wise friends here that bone broth can be high in phosphorus...not ideal for kidney cats.

Probiotics will help restore the beneficial digestive flora. The SEB can help in its own ways too. But as others have said, it coats/settles the digestive tract and has other beneficial properties.

Also there is the "Raw Liver Shake for Sick Cats". Here's the fdmb link to the recipe:

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

I can attest to its benefits, particularly recently for my 18 year old who has been "borderline renal" most of her life and has undergone two major surgeries, the first in mid-December, the second in early February.

In summary, I'd suggest go with simple foods for now and sneak in the probiotic and slippery elm in that. I think egg white powder (or cooked egg white mixed in food) helps with managing phosphorus but that's my own feeling about it.

Hope this helps with some aspects of the immediate hurdle.
Vines for an on-the-mend weekend for you and Riley,
Sina
:bighug:
Click to expand...
Is there a probiotic you would recommend? And thank you.
 
Cherie Hogan said:
Is there a probiotic you would recommend? And thank you.
Click to expand...

There are so many probiotic brands and varieties. And I hope others here will chime in about the ones they use.
I look for ones with as many micro strains as possible and at least 10-15 billion CFU's. I steer away from ones that include maltodextrin.

Jarrow Dopholis-eps (human)
http://www.jarrow.com/product/228/Jarro-Dophilus_EPS
(And is the one I'm using right now for all of the civvies except the 'dental' one who I recently switched to the vrs entero)

VRS entero (veterinary probiotic that is recent add specifically for my civie azalea with history of oral infections)
http://vrshealth.com/feline-products/entero-trubenefits/

Another one (though right now am using the jarrow)

Renew Life everyday ultimate flora 15 billion
http://www.renewlife.com/everyday-probiotics/ultimate-flora-everyday-probiotic-15-billion.html

The renew life is usually available in stores such as cvs, Walmart etc. and online
The jarrow brand I get at my local health food store and is available online
The vrs entero is online only.

Some brands are made to not require refrigeration. But refrigeration does extend its viability.

Hope this helps.
 
I dug out a probiotic I bought last year called PureAll. I didn't refrigerate it so was a little concerned that it wouldn't be viable but the reviews on Amazon and from the company itself says it's still ok. I gave all my cats this probiotic last night and again this morning. What a difference it made in Riley. As usual, my ignorance has hurt him. I should have known that his gut flora would be killed off by the Clavamox so I am trying to time both to give the probiotic time to work. A quick question about the B Vitamins I am giving him. Could it be that they, too, are making him sick? This morning, about 30 minutes after I gave him the Jarrow B Right he started looking green around the gills. He has never reacted that way with the Zobaline. He also could not tolerate the Nutrived plus Iron. Could he have an intolerance to one of the b vitamins? He also seemed to have a little boil on the center of his lower lip which looks like it popped. I know years ago, we had rolled up aluminum foil into balls, and would throw them for him and he would bring them back. A small boil formed in this exact place so we took him to the vet and he determined that Riley had an aluminum allergy so we threw the aluminum balls away, the problem cleared up, and I didn't even make the connection between the phosphorus binder, which is aluminum hydroxide, and the boil until I saw the exact same boil in the exact same place. What am I to do if he is alergic to the phosphorus binder and that is the real culprit behind him not feeling well? All this time, I have been blaming the B vitamins, the Clavamox, etc.

On a positive note, if I wouldn't have found you all, Riley would have been dead last December. I thank my God for each and every one of you.
 
First off....no beating yourself up! Kitties can't talk, which makes the learning curve all that much steeper. You are doing an amazing job for Riley.

Unfortunately I don't know about the vitamins, so hopefully someone else will come along with that.

Very interesting about the foil ball/possible binder connection. I also don't know how to address that one....sorry, I'm no help at all today! With any luck, once the kidney infection clears his phos will come down and maybe you can eliminate the idea of binder....fingers crossed on that!!

But, I'm glad the probiotic is helping him! Prayers continue from us!!
 
Hi Cherie
Am just home from work so didn't catch yours til now.

I echo what Amy said: please don't beat yourself up! you are a great mom!

Great news that Riley is responding to the probiotic! That's a giant step! :)

To your other questions:
The Jarrow-B vitamin: I've never tried it so can't speak to it from personal experience. There are others here who use it and/are more knowledgeable about it and its ingredients. I am more familiar with the zobaline for diabetic cats and the standard process cataplex-b (but some of the ingredients in the cataplex-b IMO aren't FD-friendly, even though minute quantities).

I did just pull up the manufacturer page for the Jarrow b vitamin to look at ingredients.

http://www.jarrow.com/product/57/B-Right

Whereas the Zobaline for Diabetic Cats is methylcobalamine and folic acid,

The Jarrow includes more b vitamins and other ingredients. If Riley was fine with the Zobaline, yes could be he's reacting to something in the Jarrow B. ECID and Riley's trying to balance so many things going on in his body. For example B3 (niacin) can cause a "niacin rush" (it's described in the 'more information' section of the page). Also, I'd like to know more about the P-5-P coenzyme of vitamin b6 which is a form of phosphate. I'm not a chemist, hence my understanding of the interrelationship of phosphate, phosphorus and other minerals such as calcium is rudimentary at best. If there is a relationship of the phosphate coenzyme converting to higher phosphate and or phosphorus levels, Riley might be telling you something by his reaction to the Jarrow-B.

IMO if Riley was having no adverse affects with the Zobaline for Diabetic Cats, I'd consider switching back to it.

I have no direct experience with phosphorus binders. I have read (I think in the CRD for Cats site) that long term use of the aluminum based phosphate binder can have side effects.
But it sounds like your connecting the dots about Riley's years-ago aluminum allergy and that his reaction to the aluminum based phosphorus binder could be related is spot-on. Another factor in the puzzle.

I don't have any chemical suggestions for other phosphorus binders. But others here and your vet surely would.
I add about 1/2 tsp powdered egg white to azalea's food and to her raw liver shake. It is high protein the albumin being very kidney-friendly, low phosphorus. Whether it is technically considered to be a phosphorus binder, I don't know. That being said, might be worthwhile to look into, discuss here and ask your vet about.

Until you sort out an alternative phosphorus binder, I'd consider stopping the aluminum one (probably allergic) and instead add small amounts of powdered egg white or mashed cooked egg white in his food at least until you and your vet come up with a substitute binder. Riley might not like egg white but then again he might.

Here's the link to the section in Tanya's website about eggs (and there is another section about phosphorus binders that I think is identified in the left column in the site):
http://www.felinecrf.org/persuading_cat_to_eat.htm#eggs

Also, for you added reading pleasure!
http://feline-nutrition.org/answers/answers-in-a-bind-over-phosphorus

Am tagging @Marje and Gracie and @Gill & George and @Wendy&Neko for their input and suggestions re your b- vitamin and phosphorus binder questions and observations.

And oh yes, have you thought about trying the liver shake?

Hope this helps.
 
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I am glad he is feeling better with the probiotic.

You know, if he continues to feel sick on the clavamox, you could ask the vet for a different antibiotic.
Some cats don't tolerate clavamox well at all.... I think Marje's Gracie may have been one of them.
 
Cherie Hogan said:
A quick question about the B Vitamins I am giving him. Could it be that they, too, are making him sick? This morning, about 30 minutes after I gave him the Jarrow B Right he started looking green around the gills. He has never reacted that way with the Zobaline.
Click to expand...
For cats that are CKD and aneamia is a concern, which it is in Riley, you want to give broad spectrum B vitamins (the Jarrow B Right is what I used too) and methylcobalamin or B12. Tanya's page on B Vitamins. Some cats don't like the taste of B-vitamins. Neko started out OK with it, but I ended up having to put it in gel caps.
Cherie Hogan said:
What am I to do if he is alergic to the phosphorus binder and that is the real culprit behind him not feeling well?
Click to expand...
There are other types of phosphorus binders other than aluminum hydroxide if that is bothersome to Riley. Here is the summary on Tanya's site of the different types of binders. Neko's vet was originally thinking of putting her on a calcium binder, but she had a higher calcium value at one point so we stayed away from them. Riley's calcium is also a little high so it's not the best choice for him. Ask your vet what alternative binders they have and would suggest if Riley has an aluminum allergy.
 
I have to laugh sometimes to keep from crying. You all are so amazing. You keep me on my toes and keep sending me pertinent links that helps me more than you know. And especially the encouragement...it keeps me going. Thank you.
 
The only thing I might add is that I wouldn't use the Pepcid unless you see evidence of an acid tummy, like vomiting clear or foamy, especially when the tummy is empty. Here's a link on Pepcid.

Especially since he's getting a lot of meds, I'd want to be certain he needs each one and not just try things out.

Every day with these little ones is a blessing, isn't it?!
 
My biggest concern is trying to get medicine in him in a way that won't make him sick continually. I wish he could talk and tell me what works. The Peptic AC gets rid of stomach acid where the cerenia masks it. Probiotics need stomach acid in order to work effectively. Clavamox, the antibiotic that Riley is taking kills stomach flora thereby causing upset stomach and nausea. Slippery elm, the NATURAL method I would prefer, works to prevent stomach upset by coating the stomach and intestines but should not be given if calcium numbers are high like Riley's. So you see my dilemma. Plus, I have to determine when to get the potassium in him, the Zobaline, Jarrows B Right, the Benazepril, plus the phosphorus binder the later of which the dose has been doubled. I'm surprised my poor boy has any stomach left at all.
 
Hi Cherie
How are you and Riley doing?
Hope you could talk to your vet today.
How's it going with the probiotic and the meds?
Sending heaps of feel better vines
:bighug::bighug::bighug:
Sina
 
Cherie

First, please do not give him Pepcid AC 20 mg. The one you should give a cat is 10 mg and you should only give 1/4 at a time with no more than twice a day.

Second, clavamox is not going to be enough antibiotic for that kidney infection. He needs baytril for 4-6 weeks. He does need a strong probiotic like Renew Life Ultimate Flora Critical Care, 1/3 cap twice a day. The antibiotic should be give separately from the probiotic.

With his phosphorus levels this high, I would not be surprised if he has an ulcer in his mouth from high P levels. I'm not ruling out the aluminum issue but I'm not so sure if your vet was right about an aluminum allergy. Possible, certainly, but I think the more likely issue is an ulcer from high P. BTW, CKD cats should not have bone broth because of the P in it...it will raise his P level even more.

The Jarrows should not be making him sick.

I would try and give the Pepcid AC, 1/4 10 mg cap, before you go to bed. Cerenia will not want dress stomach acid, only vomiting and some nausea. Ondansetron (zofran), as Wendy said, is good for nausea but using the cerenia and ondansetron together can be helpful. They are given 30 mins before a meal.

You should be able to give both B vitamins in a gel cap after you feed him. I don't know about the benazapril.

You can forego the SEB if you are giving Pepcid.

I hope he starts to feel better.
 
Tonight I got home and knew something was terribly wrong. I will not give him another Benazopril. He was extremely weak and wobbly, crying at the door, his face was changing shape, he wouldn't leave me alone, going from food bowl to food bowl, sniffing, not eating apparently not recognizing that food was in the bowls. My husband is extremely angry with me, says all the stuff I am forcing down him is making him sicker and ruining his quality of life. He is refusing to medicate Riley while I am out of town.
Tonight, I was in such a panic that I drove 25 miles to a Rite Aid that said they had kelp only to discover it was in a pill form. I picked up the beef liver, some organic tomato juice, and rushed home and made the raw liver tonic minus the kelp and put about a tablespoon down for Riley and he lapped it right down so I gave him another half tablespoon and also gave my other cat a tablespoon as she also was wandering from food bowl to food bowl and not eating.

Right now Riley is sleeping and I am trying to calm down. To Marje, who has the patience of Job, I will not give him another Benazepril even though both vets recommended it stating it would take stress off his kidneys. I will go and get the Baytril. I am extremely concerned about everything I am pumping into him. If he does have a kidney infection and it is affecting his numbers, why would I double the phosphorus binder if there is a secondary cause? His potassium levels looked good so I really think I should lower the dose I am giving him from 1/4 teaspoon to 1/8 don't you think? I will order the new probiotic but my youngest cat will not eat anything with probiotics in it. They all hate the Weruva. Someone on this thread suggested powdered egg whites in place of the phosphorus binder and I would much rather try that if it works. I have fed the Weruva because I could cut down on the phosphorous binder I was pumping in to him.


As far as the Peptid AC, I divided the 20 mg pill into eighths after I crushed it and put in #5 gelcaps. The dose is one every other day and I've only given him one dose a couple days ago.

The liver tonic is full of iron and should help his anemia. It says maximum dose is 66cc per day given in 3 to 6 settings. I think it really helped tonight. I want to switch Riley to the powdered egg whites instead of the phosphorus binder. Will it work. BTW, I tasted the phosphorus binder and it has no taste but somehow he knows it's there. Advise please.

Hope all is well.
 
This just isn't my area of expertise, Cherie, but I wanted to send you a little moral support tonight. I can imagine it's especially hard if your husband is now upset by what you're doing. :bighug:
 
There is nothing wrong with giving benazapril. Just give it at least several hours apart from the Pepcid.
 
Cherie, am adding to the moral support vines. My DH, kind and loving soul that he is and as much as he lives each of the tribe, for many years he didn't help with hour-in-hour-out nursing care or pilling or preparing foods or t/f/s. I will add that he's become more engaged with feeding and helps when sub q's are a two-person job. ❤️
Much of his reluctance based in his own fear. So, hope you can take a deep breath to get through this with Riley. And, each cat and each situation being different, trying to find the right combination of meds etc, let alone in a crisis, is hard enough.

Yes, I'm the one who mentioned powdered or cooked egg white addition to food (note: if using the powder use the plain powder not the meringue powder) as well as the liver shake for sick cats recipe.

Re the egg whites (and I think I stated this earlier) added to food: I'm not sure if it replaces phosphorus binders or not. To date, I haven't come across any sources that describe its use as technically being a phosphorus binder. But its benefits as being a low phosph, highly digestible protein food source adjunct in renal situations is recognized (even on Tanya's site) and in studies of human dialysis patients. Those studies also indicate that the inclusion of egg white in daily diet can help to lower phosphorus levels, thereby reducing phosphorus binder dosages.

If you do add egg white to Riley's food (or to his liver shake) please inform your vet so that Riley's levels can be monitored and the phosphorus binder dosage (whether you stay with the aluminum one or switch to another kind) can be adjusted accordingly. When is he due for his next b/w?

Re B-complex: I totally agree that b-complex (and often with the added methyl b12 such as Zobaline for diabetic cats) is essential especially under the circumstances. But if something in the Jarrow B Right isn't agreeing with Riley, another source of B-complex could be considered. After all, ECID.*

You're in a catch-22 situation. On the one hand, Riley needs pharmo support but also needs the nutritient support for his body to mend and for good results with the pharmos, whatever the ones that work best for him may be. Finding the sweet spot, the right balance of meds and nutrition and the tweaks that become the right, most beneficial fit is challenging. You are the one who knows Riley best.

I'm glad you're ordering the probiotic that Marje suggested (and thanks, Marje for suggesting it; I'll be ordering some too for our household) and trying a different antibiotic (the Baytril that Marje also suggested). Marje's mention of Baytril reminded me that my Bo was not 'a fan' of clavamox but was more amenable about Baytril.

And Tricia's earlier observation about the number of meds (ref: "....since he's on a lot of meds..."), working out which are the most necessary (and I'd add the most crucial even if in stages) and which ones need to be changed or modified to work best for Riley makes sense to me, too.

I'm glad that Riley liked the liver shake (and your civies too) and that the introduction of probiotic has been promising.

You mentioned difficulty in finding kelp locally. Most health food stores carry spirulina and kelp or dulce. But if a HFS isn't nearby, here's a link to an online source of herbs (one of many sources out there) that I use. They also carry kelp powder.

https://www.mountainroseherbs.com/products/spirulina-powder/profile

Hang in there! ❤️
Sina

* P.S: mentioning as a query re on Tanya's website about Jarrow B-Right about calcium phosphate (and yes I originally asked if p-5-p could increase phos levels):

"Unfortunately the product was reformulated in 2016 to include calcium phosphate, so it contains 28mg of phosphorus in a human dose (2.8 mg in a cat-sized dose). Members of my group have been shopping around and have managed to find the old formulation in some stores with expiry dates of 2018, so you may also be able to find the product locally. Other members are prepared to use the new formulation."

Whether the inclusion of that ingredient affects some cats and not others or whether Beans using the Jarrow-B are using the old or that the new formulation is not a problem, I don't know. But it seemed to be enough of an issue for Tanya to mention.

**And about bone broth: yes, Marje, I mentioned it earlier within the scope of nursing inappetant sick cats but also stated at same time that is not suggested in Riley's case bc of the high phosphorus content of bone broth. I hope that you weren't inferring that I was suggesting bone broth in Riley's situation ❤️
 
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Thanks so much for the advice. I thought Riley was a goner last night. I know when something is wrong. I think the Benazepril is wrong for him. When I came home last night he looked wild and I could feel the pulsing in his poor little body. The only thing I had given him in the past couple hours was the Benazepril. The raw liver drink even minus the kelp helped settle his poor emaciated, overmedicated body down. My husband is furious. Last night I went to bed with the full knowledge that Riley would not make it. In addition to his other problems, he has a slight congestion to his lungs and has developed a runny nose IN SPITE OF the Clavamox so I know that in addition to that medication making him sick it also isn't working. It makes no sense to me anymore to be plugging Riley full of crap that I wouldn't take myself. He continues to deteriorate, he can hardly walk, refuses most food except the liver shake. He is still drinking plenty of water though.

I can only reference what happened to me a couple of years ago. I was deathly sick, ended up at the hospital, was diagnosed with diverticulitis, given two strong antibiotics which made me so ill I was crawling across the floor, nauseous, could not hold my head up, and had a massive headache. I don't get headaches and I never get sick so I was taken completely off guard with what to do. I called my doctor and they prescribed an anti-nauseous drug given to chemo patients. I had taken only two courses of the antibiotics with 28 more courses to go. I knew I couldn't do it, I knew these drugs were doing horrendous damage to my body. I called my doctor and they insisted that I continue with the meds or I would face very serious consequences including possible death. I called my pharmacist and he said I wouldn't die but I would be terribly I'll for many weeks if I didn't finish the course of antibiotics. I looked at those pills and I told my husband that I was all done with the drugs. He was very upset. He's the kind of person that would stand on his head naked in the middle of the street if the doctor told him to. Well, I never took another pill. Instead, I started taking a teaspoon of asorbic acid, otherwise known as vitamin c with a little bit of baking soda in about a half of a cup of water and a packet of EmergenC a couple times a day and worked my way up to about 8000 mg of vitamin c and have stayed on this regimen ever since. The only deviation is I now split my tonic dose evenly between the asorbic acid and calcium absorbate which cuts down on the acid. Within three days, I was better and I would say cured. My friend, who also went through this, and did everything her doctor told her to do, lost part of her intestine.

So as I look at Riley, I am beginning to question why I would do to my cat what I wouldn't do to myself. He is miserable and I have presided over his steady decline. His immune system is shot. Antibiotics are taking a further toll on him. He has no energy in spite of me pumping him full of crap and then pumping him full of more crap to counter the first crap. I think I will be going off in a different direction. Call it crank medicine but I am going to try a more holistic approach. I will keep giving him the liver tonic drink with the potassium, Zobaline, and Jarrows mixed in. No more antibiotics for awhile, slippery elm for his upset stomach, cooked egg whites for his phosphorus level and I am going to call a holistic website today that is advertising a miracle supplement called Shirley's Wellness Cafe. If anyone has had any experience or luck with the holistic approach vs what I have been doing, please chime in.

Thanks again for all your support!
 
I hear you,loud and clear, Cherie.

My mother was hospitalized once for a fever of unknown origin and was delirious. They did all kinds of tests and added meds to her iv that was their protocol but made her worse. If you can imagine my tiny usually good natured then 85-year mother punching out a doctor in her drug worsened delirium, it was horrible. Then another doctor came in and ordered all meds to be stopped. Within 48 hours she calmed down and was lucid again and was back home within two days.

On the flip side of that experience, I have found there are times when homeopathy and or herbal has helped more than traditional, other times when a combination of traditional and alternative has been more effective than one or the other as a singular approach.

That's not to say that traditional medicine can't and doesn't help. But there's a time and place for every approach. It's finding the approach or mixed approaches that do help for the individual being. And each situation, each variable in a situation, each person, each cat is unique.

If there is a wholistic vet, a homeopathic vet or a vet who is trained and accredited in both traditional and alternative (homeopathic, eastern and western herbal) approaches, in your area, I'd seek them out and see if h/she can help and is a good fit for you and Riley in this situation.

My own primary vet resources are a traditional and two homeopathic vets (one local, one long distance) and an AC. I'm not the only one here who has a homeopathic or Chinese or herbal trained vet in h/her arsenal or who looks at food sourced nutrition as an essential and subtle key in healing.

My suggestions, and I am sharing from my own experience and the many times I also have had to think outside the box in a crisis:

Simple food sources like liver shake, baby food, and with plain pumpkin and or baby food plain squash mixed in as needed and with the food and vitamin supplements you're adding (whether in food or liver shake). Your immediate goal is nutrient rich easily digestible food (that he will eat and that you can assist feed if necessary) with the least amount of phosphorus possible, hydration, support gi tract with probiotics (which will help support immune system) and hydration.

My HV's, in identifying what to them are meats that are "warm" (inflammation producing) or "cool" (inflammation neutral): chicken and beef and some fish tend to be the warmest (more inflammatory) while turkey, rabbit are less inflammatory. My cats resonate along these lines and with occasional plain sardines or mackerel (in water) also being in the less inflammatory realm for them. I have found this to be the case at least with my cats.

Also here's a link to Food fur Life, a food supplement for raw or home cooked meat. Laurie is extremely knowledgeable (and the founder of the IBD kitties website that also includes IMHO solid nutritional information.
She has helped me a lot. And will send you a sample of food fur life. In addition to using it in home prepared cat food, I've added it to baby food for the additional nutrients.

http://www.foodfurlife.com/

And a link to IBD Kitties that may include information helpful in knowledge and in determining what might or might not make sense for Riley.

http://www.ibdkitties.net/

Re the liver shake: I'd get some spirulina or kelp powder to add to it (for the reasons stated in the recipe) soon as you can. Also, you can use carrot juice in place of tomato juice for a little variety. For Azalea, I've been adding some raw prepared (stella & chewys frozen raw rabbit or radcat turkey) to the liver shake.

Also, in case powdered egg white is not available in a store near you, here is where I get mine since the kind I have used became unavailable:

http://www.modernistpantry.com/egg-white-powder.html

I'll pm you the contact info for my long distance homeopathic vet should you want to at least call him and inquire.

Follow your heart, you being the one who knows Riley best, listen to your instincts. You will find your way for you and Riley by listening to him and to your own being.

Sina
 
Cherie

A couple things I need to stress and I say this as one who does not use antibiotics unless it is absolutely necessary:

  • If you do not treat the kidney infection, you will be causing him to suffer as his kidneys will continue to be damaged by the infection. The clavamox might very well and is likely the culprit making him sick and it is not the right drug for kidney infections. He needs baytril.
  • The kidney infection and his phosphorus level are two separate things. The P level is not going to come down with antibiotics; it needs to be bound in his food. If he were my cat, there is no way I would halve his binder with his P levels being what they are.
  • Cooked egg whites will not bind the phosphorus. All they do is bring the amount of the overall P lower in the food. Simply put, if a food has 200 mgP/100 kcal per 1/2 cup and the egg has none, if you fed 1/4 c food and 1/4 c egg white, then the amount of P in the food has been lessened to 100 mgP/100 kcal by the presence of the egg white but the P in the food is still available to his body. I'm not suggesting you do the above because you can't just feed a lot of egg whites but I was trying to use a simple example to illustrate that the amount of P in the foods would come down but he'd still be getting P. He needs binder.
  • I also doubt seriously that the benzapril is causing him issues but, as I told you, your vet put him on it without checking his urine protein:creatinine ratio accurately. Based on the level she gave you, she tested him with a urine dipstick which can be very inaccurate. To determine if he has proteinuria and needs benazpril, she needs to have a lab run the test with diagnostic equipment and not a dipstick.
 
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Cherie Hogan said:
I probably should have told you all what I am giving Riley and explain that I know there is a CRF website and I have been reading through that for hours and can make nothing of it except one piece of information contradicted by another piece. I feel more comfortable that I will find a solution through you.

AM. Cerenia 1/2 pill combined with Jarrow B Right in #5 gel cap followed by Zobaline and more Jarrow in same. Then 1/8 teaspoon potassium in baby food, an hour later Weruva with phosphorus binder that he won't eat or just licks. An hour later 1ml Clavamox. A half hour after that he is sick.

PM..Riley finally starts to look a little better and here comes the potassium in baby food, a quarter pill of Benazepril, more food with phosphorus binder he won't eat, and an hour later Clavamox 1ml and an hour after that the poor boy is sick.

In desperation today I gave an appetite stimulant prescribed by the vet and all that has done is make him restless not hungry.
Click to expand...

I know the CRF website pretty well, and I would suggest that you put out your question about meds to the group, and then hope for some replies from the moderators or scientists who frequent it. There are thousands of members, some very experienced and knowledgeable, some not quite so much. I benefitted greatly from several people there. Is Erin still there? She's exceptionally knowledgeable, helpful, and kind.
 
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