Update- Back home again- HELP 1/5/21 Moo Moo won't eat, getting a lot worse

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Christie is spot on about the phosphorus and that is one of the most critical values to keep under control with CKD. Her creatinine is not that bad, her potassium is a little low, her calcium is fine, her hematocrit is ok (should be above 40% but CKD cats are often under 30%)

The phosphorus being that high will make her very nauseous and it can also cause mouth and stomach ulcers. Right now, eating is imperative so it’s really important to get binder and add it to every single portion of food you give her. Aluminum hydroxide is best as it is tasteless. Here is info about binders. That is the fire that needs to be put out right away regarding her kidneys. Once the DKA is better addressed, there are other kidney issues to attend to.
 
@Marje and Gracie What should I say to the vet tomorrow in regards to the binders? I was reading about them earlier, and will continue to do more research tonight.

@Christie & Maverick Will do, she doesn't really want to move around right now, but I think that's because she's favoring the leg they put the IV in. She has been eating when offered and drinking when offered.
 
In the info section on phosphorus binders from Tanya's CRF, there are some suggested sources of aluminum hydroxide binders for people in the USA. You want an odourless, tasteless one. I believe quite a few people here have used the Thriving Pets brand (bought direct from) and have been happy with it.
http://felinecrf.org/phosphorus_binders.htm#usa

Just let the vet know that you are going to be getting phosphorus binders, I'm actually surprised they didn't suggest it after seeing how high Moo Moo's phosphorus is.
 
phakewishard said:
He might tomorrow, I think he's trying to see how she responds tonight and tomorrow morning before recommending anything. If he doesn't, I will ask about it
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I understand. My vet many many years ago dispensed Epakatin, which was ok for us at the time, but these aluminum hydroxide ones are much better. Just mentioning it in case that is what they offer you, and you can just let him know that you've done some research on the subject.
 
Sydney, per your vet's comments earlier about the machine not being able to give a result for BUN because the value was so far out of range, I note that on the printout of the labs it has "No result available." I also notice that there are several other tests with a similar comment against them (ALP, AST, GGT and Amylase). Did your vet say anything about those tests also being out of range?


Mogs
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He did not but he did say when there are those stars for the BUN that means it was too high for the machine to read. And, they did not give me a copy of those results at the emergency vet, but they said they forwarded her paperwork to my vet's office
 
phakewishard said:
@Marje and Gracie What should I say to the vet tomorrow in regards to the binders? I was reading about them earlier, and will continue to do more research tonight.
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I’d tell him you’ve been reading and you understand his phosphorus is way too high. It’s almost double the level for kittens. An adult cat’s P level,should be 4-4.5. It’s likely you’ll need a prescription for it. I bought mine from thriving pets. You might be able to get it locally.

I’d also talk to the vet about giving subq fluids at home. Usually we start them when the creatinine is 3.5 or above.
 
Moo Moo won't eat again this morning, and she's stopped purring when being pet. I take her back to the vet in 3.5 hours, I'm just trying to make her comfortable until then. Last night she wasn't able to make it to the bathroom and peed on the floor, and she was hiding under the couch for a long time.
 
Hi Sydney,

Fingers and paws crossed the vet will be able to help. Moo Moo's eye must be sore. Maybe that's why the hiding?

As Diane says above, please let us know how things go at the vets. If the antibiotic treatment needs to be continued then maybe ask about one that can be administered by injection (easier on the digestive system?). Maybe ask about ketones - just to know what's going on there - when you're asking about the urinalysis? (I know you're already on top of all this, but I'm an awful Ma Hen and I can't help myself. :oops:)

Keeping you both in my prayers.

(((Sydney and Moo Moo)))

:bighug:


Mogs
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The vet called and said her sugar is 167 this morning, his plan is to push fluids and to drain the abscess and see if that helps her eat.
 
Oh, I hope it will, Sydney. (((Moo Moo)))

Did the vets mention any other treatments (IV antibiotics, something for for nausea/appetite/pain relief)? Did they say whether they're going to run any more blood work today?

:bighug:


Mogs
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He did not on the phone, but he had just gotten in and they looked pretty busy when I dropped Moo Moo off. Dr. G will be there today too. He said they will recheck her sugar tonight, but I'm not sure if they're doing a whole bloodwork panel or just a glucose meter.
 
I thought Dr. B was going to be in when I dropped her off, but he wasn't. When I pick her up tonight I will be able to ask a lot more questions. I came into work early so I could leave early to pick her up.
 
I will, I'm considering calling after lunch and asking about the binders and the anti-nausea/appetite/pain medicines so it's not sprung on him close to closing.
 
Oh! @Marje and Gracie He had given her a subq last night before she went home for the night and it seemed to help for a little while. Sorry for not mentioning this sooner, I've been trying to figure out and process all this information today.
 
Larry and Kitties said:
The link you provided does not list it as requiring a script. I previously purchased some from Thriving Pets w/o a script and. Here is some from Chewy's and not script is required.
https://www.chewy.com/rx-vitamins-phos-bind-dog-cat/dp/186061?utm_source=google-product&utm_medium=cpc&utm_campaign=f&utm_content=Rx Vitamins&utm_term=&gclid=Cj0KCQiA3NX_BRDQARIsALA3fILoABFG5NhD86pKqwo108pnKFG2f-06Zuky4tKq9TxFGLJyceL-hb0aAmjiEALw_wcB
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When you try to check out, it asks for a script. It always required it when I ordered it. Perhaps that is by state requirements.
 
So I called the vet, and he said he got more pus out of her eye socket than he thought could fit in there. He gave her a long acting antibiotic shot and a pain shot. He wants to see her back on Friday once her body has had a chance to normalize from the infection, and then if her values aren't any better we're going to probably go to phosphorus binders and other medications.
 
phakewishard said:
Moo Moo isn't doing very well. I had to take her to the emergency vet Sunday, they said she had went into ketoacidosis. They kept her overnight, and now she's back home.

S


When my kitty went into DKA he was not released back to me. He was immediately hospitalized for 24/7 treatment. He lived, but it was a full five days and nights or intensive care hospitalization. How is your baby?
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She's tough, but she's not doing great. As the emergency vet said "Her body is like a barrel full of snakes". I'm just trying to take it day by day and enjoy the time I have with her.
 
Poor wee thing! Good that the vet got it out, though. Fingers and paws crossed that it will make Moo Moo feel much more comfortable.

With phosphorus levels still potentially high that might not help on the food front (may cause nausea) and Friday's a fair bit away. I'd suggest asking the vet if he could give you something to use at home to manage any pain and nausea should Moo Moo need support in the interim (e.g. buprenorphine and ondansetron). Did you think to ask about getting copies of Sunday's ER lab results, BTW?

As a safety precaution, I'd also suggest perhaps picking up a blood beta ketone meter so that you'd be able to quickly and reliably monitor for ketones at home (no need to collect pee samples, plus they test for a different type of ketone to the urine test strips, as discussed earlier in the thread).

Did you get any of the cat-safe baby food? It might be something nice and soft for Moo Moo to eat.

(((Moo Moo)))

:bighug:


Mogs
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@Critter Mom The fastest I could order a blood ketone meter and it get here would be Monday. I am going to call a couple local stores to see if it's in stock, but I kind of doubt it.

Dr. G will be the one who I talk to tonight, and I can ask about everything then again. It was apparently Dr. B's off day, but he came in to take care of Moo Moo. The paperwork would've been directly forwarded to Dr. G, so if anyone has it it should be him.

I am planning on making a run tonight for supplies once Moo Moo is home and settled. Are there any treats that are low carb and low phosphorus that you know of, or would it be best for me to just feed cat safe baby food and cook some chicken for her?
 
phakewishard said:
It was apparently Dr. B's off day, but he came in to take care of Moo Moo.
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Good on the doc! :)

Based on observing my own cats, the freeze-dried low carb protein treats can sometimes be a bit too strong for a dicky tummy. I don't know of any low phosphorus treats to recommend, Sydney. I'm tagging @Marje and Gracie to ask whether she can suggest some specific foods and treats. It's vital to help your girl keep eating something, so you might need to try some of her favourite foods (ideally anything you have that's low in phosphorus). If she's a bit sore and has difficulty chewing you might be able to add some water to the food and blitz it into a soupy consistency that she could lap up. It's tricky because ideally a low carb, low phosphorus food would be best but introducing a new food can trigger tummy upsets and that needs to be very much avoided. Ultimately Moo Moo gets to decide the menu choice. Calories are king right now.

(((Moo Moo)))


Mogs
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I'm in between work telecoms so apologies for being super brief. While I wholeheartedly agree to looking into low phosphorus foods, which works just fine with mildly elevated P, with such elevated P that you have going on, your primary focus is getting phosphorus binders ASAP. Please don't wait a couple of days. That really is the only way to get a handle on it. She is going to be feeling very unwell until the P levels gets drastically reduced. It is a vicious cycle, she doesn't want to eat because she is feeling icky, she is weak because of the high phosphorus in her system.

With low phosphorus foods, it can take up to a month to see improvement in P levels. With binders you should see a difference within 7-10 days.
 
Christie & Maverick said:
I'm in between work telecoms so apologies for being super brief. While I wholeheartedly agree to looking into low phosphorus foods, which works just fine with mildly elevated P, with such elevated P that you have going on, your primary focus is getting phosphorus binders ASAP. Please don't wait a couple of days. That really is the only way to get a handle on it. She is going to be feeling very unwell until the P levels gets drastically reduced. It is a vicious cycle, she doesn't want to eat because she is feeling icky, she is weak because of the high phosphorus in her system.

With low phosphorus foods, it can take up to a month to see improvement in P levels. With binders you should see a difference within 7-10 days.
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Okay, I will place an order tonight. Hopefully it will be here ASAP.
 
@Christie & Maverick -

With you 100% on the need for the phosphorus binder. I was just trying to suggest something for tonight unless the vet can give Sydney some form of binder when she goes in later.

Do you know at all whether vets in the US normally keep Ipakitine or similar in stock? If the vet could give Sydney a binder of some sort tonight it would at least be a stopgap until she can get hold of some aluminium hydroxide.


Mogs
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Critter Mom said:
@Christie & Maverick -

With you 100% on the need for the phosphorus binder. I was just trying to suggest something for tonight unless the vet can give Sydney form of binder when she goes in later.

Do you know at all whether vets in the US normally keep Ipakitine or similar in stock? If the vet could give Sydney a binder of some sort tonight it would at least be a stopgap until she can get hold of some aluminium hydroxide.


Mogs
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All good Mogs, for sure good suggestions for tonight, I only had a chance to quickly scan previous messages. I think you and I are on the same page. At this stage, Sydney will likely need to have a smorgasbord of foods anyway, so good to get some low phosphorus options. I agree that trumps the low carb options at this point.

Has this been shared yet? Low phosphorus foods....

http://felinecrf.org/canned_food_usa.htm
 
@Critter Mom There are no blood ketone meters at any of the stores around me, which is in line with almost all diabetic supplies around here also being sold out. Should I go ahead and place the order online for the one that should arrive by Monday?
 
I think that might be your best option, Sydney. Maybe get some extra strips too (especially if there's a bit of a run on diabetic supplies going on at the moment). The only other thing I could suggest is ringing a local pharmacy to ask whether they might be able to order one in for you (plus strips) which they could get delivered to them faster than Monday and you could pick it up from there. (Brainstorming here.)


Mogs
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Dr. G hadn't gotten a chance to look at her paperwork, he said he was so busy today he didn't get to. I asked again about the phosphorus binders and the medicine to help her appetite, and he and Dr. B both want to wait until Friday to see how she does now that her eye socket was drained. He seemed very suprised when I showed him her bloodwork from yesterday (he said 'and when was this from', and I said yesterday and he went o_O but didn't say anything out loud about it), and said that him and Dr. B will put their heads tomorrow. I could only get there 10 minutes before the office closed, but he said to email them any changes I notice (since I go to work before they open and get off after they close) tomorrow. So, we're in the same spot we were before I talked to Dr. G basically. He was very supportive of home testing though, so I guess that's good?? I don't know, I feel like no one communicates well with each other at that office :confused:
 
phakewishard said:
Dr. G hadn't gotten a chance to look at her paperwork, he said he was so busy today he didn't get to. I asked again about the phosphorus binders and the medicine to help her appetite, and he and Dr. B both want to wait until Friday to see how she does now that her eye socket was drained. He seemed very suprised when I showed him her bloodwork from yesterday (he said 'and when was this from', and I said yesterday and he went o_O but didn't say anything out loud about it), and said that him and Dr. B will put their heads tomorrow. I could only get there 10 minutes before the office closed, but he said to email them any changes I notice (since I go to work before they open and get off after they close) tomorrow. So, we're in the same spot we were before I talked to Dr. G basically. He was very supportive of home testing though, so I guess that's good?? I don't know, I feel like no one communicates well with each other at that office :confused:
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That must be very frustrating for you!
They certainly need to up their game!
 
Bron and Sheba (GA) said:
That must be very frustrating for you!
They certainly need to up their game!
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I think Dr. G really just didn't have a chance to look at Moo Moo's paperwork, and Dr. B had come in today, on his off day, to care for her. They stay very busy at my vet's office. While it's frustrating, I still think she's at the best place for her right now, and I think now they're both in the loop and will work together on this to provide the best care for Moo Moo. I just wish they would've both been in the loop from the beginning :facepalm:

She is eating and drinking a lot more than she has since Saturday, so they are probably right about her wanting to eat more with the abscess drained. Or, it could be that she got another IV today. Either way it goes, I'm just glad she's eating.

I am overnighting some of the Thriving Pets aluminum hydroxide. It said it would ask for a script at checkout, but then at checkout the prescription part basically said non-applicable. I also ordered the blood ketone meter and some extra test strips. I ordered some low phosphorus low carb food that should arrive next week, in the meantime I am going to try to find some low phosphorus foods, even if they are higher in carbs (since even at the bet her sugar was in the 160's)
 
Oh I'm so glad to hear she is eating and drinking a little better tonight, and great news on the phosphorus binders you ordered. I almost dug out my old Epakitin to send you but I think it is well past expired by now :D

Keep offering food and water, and give her extra love.
 
I'm glad you were able to order the aluminum hydroxide binder, My civie Perry
Tyler's brother had kidney disease was on it.
Just in case you didn't know your vet will tell you how much to give , at one point
Perry's dose had to be decreased. If I remember correctly the dose goes by how high the phosphate number was. I had to put it in every meal he ate. I would divide the
amount I had to give him and put it in every meal I gave him.
He didn't even know it was in the food , no taste at all.

What food did you order Sydney?
 
phakewishard said:
I think Dr. G really just didn't have a chance to look at Moo Moo's paperwork, and Dr. B had come in today, on his off day, to care for her. They stay very busy at my vet's office. While it's frustrating, I still think she's at the best place for her right now, and I think now they're both in the loop and will work together on this to provide the best care for Moo Moo. I just wish they would've both been in the loop from the beginning :facepalm:

She is eating and drinking a lot more than she has since Saturday, so they are probably right about her wanting to eat more with the abscess drained. Or, it could be that she got another IV today. Either way it goes, I'm just glad she's eating.

I am overnighting some of the Thriving Pets aluminum hydroxide. It said it would ask for a script at checkout, but then at checkout the prescription part basically said non-applicable. I also ordered the blood ketone meter and some extra test strips. I ordered some low phosphorus low carb food that should arrive next week, in the meantime I am going to try to find some low phosphorus foods, even if they are higher in carbs (since even at the bet her sugar was in the 160's)
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It could be that thriving pets didn’t require a script because of your state. It does vary.

Here is a pretty current table on foods and P levels. Keep in mind you don’t want to choose one that has really high Na as CKD cats are prone to high blood pressure. Next time you take her in, they need to check her BP.
 
The store I went to didnt have a huge selection for low phosphorus food to be honest, but I got Purely Fancy Feast natural white meat chicken and tuna in a delicate broth (1.11 for both phosphorus and sodium) and I and Love and You purrky turkey pate (1.53 for phosphorus, .54 for sodium) from that list. I also picked up some cat safe baby food in case her appetite tailspins again
 
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