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7 year old with CRF, Questions

mharrigan
February 26th, 2011, 05:53 PM
I've been trying to do a lot of research on my own, but there's so much conflicting information out there, it's extremely overwhelming, so I'm coming here for advice.

The history: Our 7 year old Milo was diagnosed with early stage CRF in June of 2010. The vet put him on the k/d prescription diet (dry.) We also started him on Azodyl pills (2x a day) Recently he has developed some constipation problems (2 emergency room visits with enemas in the past 2 months) So the vet has put him on Cisapride to help with the constipation. At this point I began to do a ton of research and learned that dry food was not a good thing for Milo (probably contributed to his constipation). I also have read a lot of conflicting information about feeding him a low protein diet. Obviously my vet that recommends only Hills brand food is going to recommend the k/d, but it seems that a lot of other professionals say that a high quality protein diet is better than the prescription stuff.

We are now debating what the best path is for him. Either switch him over to the k/d wet with the Azodyl and Cisapride, or try something high quality protein with a phosphorous binder (I was thinking Evo 95% Chicken and Turkey with Epakitin and Azodyl)

Can anyone who has been in my situation or is knowledgeable on crf provide some guidance? I don't want to go against my vet's advice by not using the prescription diet, but the amount of studies that I've read about the negative affects of feeding a low protein diet are overwhelming, and so far I've read nothing but good things about Epakitin and Azodyl

thanks in advance guys.

kathryn
February 26th, 2011, 06:17 PM
Welcome to the forum! Some of the others will have more information than I will, but dry food is the worst thing you could be doing for renal failure. Cats are not meant to be eating kibble, especially not some of the junky brands of kibble that are out there. That's why renal failure is so common cats. Many people are just led to believe that renal failure is just part of having cats. No one ever thinks to look at the way we are feeding cats. And vets will happily recommend any food that gets them a nice payout for referrals ;)

One thing that I have to note is, Evo (Natura) was bought out recently by Proctor & Gamble. Please be aware that P&G is known for inhumane animal testing and just general mistreatment of people, animals and the planet. I personally will no longer be buying ANYTHING from Natura, but that is totally up to you to decide how you feel about the issue.

http://www.truthaboutpetfood.com/articles/breaking-news-proctor--gamble-purchases-natura-pet-products.html

sugarcatmom
February 26th, 2011, 07:55 PM
The history: Our 7 year old Milo was diagnosed with early stage CRF in June of 2010.

Wow, that's rather young to already be suffering from renal issues. Do you have a copy of the lab work (blood and urinalysis) that this diagnosis was based on?

The vet put him on the k/d prescription diet (dry.)
:wall::wall::wall:

That is SO not the answer, but unfortunately very typical of many vets (who don't know squat about what cats should be eating)


Recently he has developed some constipation problems (2 emergency room visits with enemas in the past 2 months) So the vet has put him on Cisapride to help with the constipation.

More :wall::wall::wall:

At this point I began to do a ton of research

Good for you!. I know it can be confusing to sort through all the various sources of info. One thing I will point out is that any studies done on diet as it relates to renal insufficiency were funded by pet food companies. So obviously it would be in their best interest ($$$) to have results which make their product look good. I personally don't think low protein diets are warranted until a cat is in end-stage renal failure, and only because they might help the cat feel a bit better. There is no valid reason to use them in the early stages of the disease. And especially not kibble!

try something high quality protein with a phosphorous binder

Does your cat's blood work warrant the use of a phosphorus binder yet?

and so far I've read nothing but good things about Epakitin and Azodyl


Some bad things about Azodyl: the price, the size of the pill and potential difficulty in administering it, and the fact that the company (Vetoquinol) that bought it from Kibow Biotech turned it into an exclusive veterinary product with a hefty price tag, ensuring it was more about their profit margins than actually helping cats. There are other probiotic products available that contain the same types of organisms as Azodyl which may (or may not) do a similar job of absorbing nitrogenous waste.

Aluminum hydroxide might be a better choice as a phosphorus binder if you need to go that route. Epatikin is basically just expensive calcium carbonate, and adding calcium is not always a good idea in a kitty with CRF.

Another member here, growler, will have tons more info for you on dealing with CRF. The first step will be to take a look at your lab results, if you have them.

mharrigan
February 26th, 2011, 09:02 PM
I wrote a post up but it dissapeared, so I'm trying again. His BUN is 36 mg/dl (reference range 16-36) and his Creatine is 3.6 (reference range .8-2.4) We were told that's just over the normal level on both accounts. Not sure if those numbers warrant a phosphorous binder yet?

thanks for the info on the Evo, we will look into a different high protein brand - I have heard others talk about Wellness, but not sure which type (regular, Core, or healthy indulgences) is the way to go - or if anyone has any other suggestions for high protein, relatively low phosphorous wet foods, feel free to post!

We will also look into alternatives for Azodyl - it is quite expensive. Does anyone have any recommendations? He doesnt have any trouble taking the pill, we put it in a pill pocket and he inhales it.

thank you for your responses, I already feel better talking to someone who isnt a confusing vet!

sugarcatmom
February 27th, 2011, 03:01 PM
His BUN is 36 mg/dl (reference range 16-36) and his Creatine is 3.6 (reference range .8-2.4) We were told that's just over the normal level on both accounts. Not sure if those numbers warrant a phosphorous binder yet?

Do you have any other lab values, like the urine specific gravity, a urine protein to creatine ratio, and the results for blood phosphorus, potassium, calcium, sodium, hematocrit and total protein? Also, does your kitty have any symptoms (increased drinking, urination, inappetance, vomiting....)? These are all aspects of determining renal insufficiency, especially since there are other conditions (dehydration, diet, kidney infection, metabolic disorders) that can effect creatinine levels.

thanks for the info on the Evo, we will look into a different high protein brand - I have heard others talk about Wellness, but not sure which type (regular, Core, or healthy indulgences) is the way to go - or if anyone has any other suggestions for high protein, relatively low phosphorous wet foods, feel free to post!

There's some good info at these 2 links on phosphorus levels in various canned foods:
http://www.felinecrf.org/canned_food_usa.htm
http://binkyspage.tripod.com/CanFoodNew.html

I like Wellness grain-free Chicken, Turkey, Beef & Chicken, Kitten and the CORE Chicken and Turkey. Also some of the Merrick flavours (Grammy's Pot Pie, Cowboy Cookout, Turducken and Thanksgiving Day Dinner) are quite good. I'm also a big fan of rotating foods and not feeding one brand/flavour exclusively so as to avoid food addictions or boredom.

We will also look into alternatives for Azodyl - it is quite expensive. Does anyone have any recommendations? He doesnt have any trouble taking the pill, we put it in a pill pocket and he inhales it.

I don't mean to dissuade you from using it, especially if your kitty doesn't have a problem taking them. It's just that I personally prefer not to purchase Vetoquinol products. I give my renal cat a pinch of MegaFoods MegaFlora (in his food), which contains 20 billion cfu's per capsule, including the 4 types of organisms found in Azodyl. Can't say whether it's made a difference, but it certainly doesn't hurt and his poops have been great (he's been prone to constipation in the past).

mharrigan
February 27th, 2011, 04:14 PM
Do you have any other lab values, like the urine specific gravity, a urine protein to creatine ratio, and the results for blood phosphorus, potassium, calcium, sodium, hematocrit and total protein? Also, does your kitty have any symptoms (increased drinking, urination, inappetance, vomiting....)? These are all aspects of determining renal insufficiency, especially since there are other conditions (dehydration, diet, kidney infection, metabolic disorders) that can effect creatinine levels.


I have some of these: phosphorous: 4.8 (reference range 3.0-7.0) potassium 5.1 (rr 3.9-5.3) calcium 10.1 (rr 8.2-11.8) sodium 149 (rr 147-156) total protein 7.7 (rr 5.9-8.5) I didnt see anything on his results about urine specific gravity, urine protein to creatinine ratio, or the hematocrit.

he had some increased drinking before, but it has subsided. Same hearty appetite, he loves his food. He had a few episodes of vomiting but it was always when he was constipated, he would vomit after straining on the litter box, otherwise he doesn't ever vomit. I would have no idea he was even sick with CRF unless the vet had told me his BUN and Creatinine were high :(

We picked up some Wellness grain free turkey canned food today, really hoping he likes it! We've also noticed that he hasn't passed stool in a few days, so I'm worried we're in for another vet visit for an enema soon. Apparently the Cisapride alone isn't working, we are now looking into giving him some Miralax based on some other threads on this forum. We are very worried parents right now, his constipation is turning into a regular occurrence :shrug:

growler~GateKeeper
February 27th, 2011, 09:58 PM
Welcome to pets, would love to see a pic or two of Milo if you have some to share :)

The history: Our 7 year old Milo was diagnosed with early stage CRF in June of 2010. The vet put him on the k/d prescription diet (dry.) We also started him on Azodyl pills (2x a day) Recently he has developed some constipation problems (2 emergency room visits with enemas in the past 2 months) So the vet has put him on Cisapride to help with the constipation.

Has Milo always eaten dry food or does he also eat canned? With canned foods you will want to add in 1-2 tblspns of water to the canned food, this will increase the amount of moisture your cat is getting and being in the food this will allow for maximum absorption of the extra water.

First recommendation is drop the dry food all together, next drop all vet prescription food. If you check the ingredients of the vet food you will see very few actual named real meat ingredients, but lots of grains/corn/rice.

My crf cat had good results with Azodyl, so that's good you've started on it already. :thumbs up

At this point I began to do a ton of research and learned that dry food was not a good thing for Milo (probably contributed to his constipation). I also have read a lot of conflicting information about feeding him a low protein diet. Obviously my vet that recommends only Hills brand food is going to recommend the k/d, but it seems that a lot of other professionals say that a high quality protein diet is better than the prescription stuff.

Of course the vet will recommend only Hills - that's what they sell. There are more appropriate alternatives for Milo that include real meat, no grains and little/no chemicals.

The kidneys need to work to process phosphorus (which comes in large part from protein), this is why many vets say low protein. The problem there is the protein levels are too low for a carnivore, which leads to muscle wasting another symptoms of CRF. If you feed a moderate to high level protein food that is good quality, the cat can process and use more of the nutrients and rather than have undigestable corn/grain "protein" eliminated as waste with no use to the cat. The quality protein will convert into muscle mass rather than the body leeching protein from the muscles for regular body functions.

We are now debating what the best path is for him. Either switch him over to the k/d wet with the Azodyl and Cisapride, or try something high quality protein with a phosphorous binder (I was thinking Evo 95% Chicken and Turkey with Epakitin and Azodyl)

Reading your below mentioned test results I think at this point you can hold off on the phos binder unless the next set of tests show an increase in blood phos levels. :2cents:

Also if you were to start a phos binder given that Milo has Calcium just on the high side of normal I wouldn't use a binder that contains calcium, as that could push the levels out of the ref range. Instead a generic odorless/tasteless aluminum hydroxide phos binder that can be purchased from a pharmacy - do not get the peppermint flavoured one from the vet, most cats will not tolerate the taste.

One thing you need to be cautious with the Evo Chicken & Turkey is they have 2 foods with nearly the same name, you must be sure to pickup the right one everytime. The Purple label Chicken & Turkey cat & kitten food is too high in phos for a crf cat, but the Orange label 95% Chicken & Turkey has good phos numbers.

His BUN is 36 mg/dl (reference range 16-36) and his Creatine is 3.6 (reference range .8-2.4) We were told that's just over the normal level on both accounts.

Good to see this has been caught so early. What was the original reason for the blood test? Just routine or was there some symptom that prompted a test?

I have heard others talk about Wellness, but not sure which type (regular, Core, or healthy indulgences) is the way to go - or if anyone has any other suggestions for high protein, relatively low phosphorous wet foods, feel free to post!

By Nature Organics (http://www.bynaturepetfoods.com/productpages/organiccannedcat.php) Turkey & Turkey Liver, Chicken & Chicken Liver, Turkey & Chicken, Chicken & Mackerel, Beef & Beef Liver

Innova Flex Beef & Barley Stew (http://www.innovapet.com/products/default.asp?id=1693)
Evo 95% Chicken & Turkey (http://www.evopet.com/products/default.asp?id=1662)

Felidae Platinum (http://www.canidae.com/cats/platinum/canned.html)
Felidae Cat & Kitten (http://www.canidae.com/cats/cat_and_kitten/canned.html)
Felidae Grain Free (http://www.canidae.com/cats/grain-free-cat-food/canned.html)

Merricks Before Grain 96% Beef (http://www.merrickpetcare.com/store/detail.php?c=114&s=20481)
Merricks Before Grain 96% Turkey (http://www.merrickpetcare.com/store/detail.php?c=114&s=20480)

Merricks Cowboy Cookout (http://www.merrickpetcare.com/store/detail.php?c=52&s=20246)
Merricks Thanksgiving Day Dinner (http://www.merrickpetcare.com/store/detail.php?c=52&s=01803)

Halo Spots Stew Wholesome Chicken (http://shop.halopets.com/Canned-Cat-Food/Wholesome-Chicken-Recipe-3-5-oz)
Halo Spots Stew Wholesome Turkey (http://shop.halopets.com/Canned-Cat-Food/Cat-Canned-Turkey-3-5oz)

Wellness (http://www.wellnesspetfood.com/recipes.aspx?pet=cat&ft=2) Turkey, Chicken, Beef & Chicken, Beef & Salmon, Kitten, Wellness Core Chicken Turkey & Chicken Liver

Holistic Select Turkey & Barley (http://www.holisticselect.com/product.aspx?pet=cat&cat=2&pid=33)
Holistic Select Duck & Chicken (http://www.holisticselect.com/product.aspx?pet=cat&cat=2&pid=30)

Many more choices listed here http://www.felinecrf.org/canned_food_usa.htm#food_data_tables

I have some of these: phosphorous: 4.8 (reference range 3.0-7.0) potassium 5.1 (rr 3.9-5.3) calcium 10.1 (rr 8.2-11.8) sodium 149 (rr 147-156) total protein 7.7 (rr 5.9-8.5) I didnt see anything on his results about urine specific gravity, urine protein to creatinine ratio, or the hematocrit.

As mentioned above the blood phos is okay for now & not really needing a phos binder unless feeding a food that has phos levels far higher than recommended.

Also as mentioned above the calcium is a bit on the high side, but still in normal, so you would not want to add to that value with a supplement that adds calcium.

Hematocrit should be on the blood results in the Complete Blood Count (CBC) section, it may be listed as HTC or PCV.

Did the vet test a urine sample? That is where the urine specific gravity, urine protein to creatinine ratio will be. If they did not do a urinalysis I would suggest you ask for one with the next blood test.

he had some increased drinking before, but it has subsided. Same hearty appetite, he loves his food. He had a few episodes of vomiting but it was always when he was constipated, he would vomit after straining on the litter box, otherwise he doesn't ever vomit. I would have no idea he was even sick with CRF unless the vet had told me his BUN and Creatinine were high :(

Good to hear Milo has a good appetite, please make sure that doesn't change we don't want him turning into a picky eater.

Adding some water to the canned food will increase moisture content of the stool, also if you can encourage a bit of drinking by adding another water dish, using a water fountain, an accessible dripping faucet if he likes that, will also help flush out the kidneys. We want his fluid intake to increase a bit but not excessively as that would be a symptom needing a trip to the vet.

We picked up some Wellness grain free turkey canned food today, really hoping he likes it! We've also noticed that he hasn't passed stool in a few days, so I'm worried we're in for another vet visit for an enema soon. Apparently the Cisapride alone isn't working, we are now looking into giving him some Miralax based on some other threads on this forum. We are very worried parents right now, his constipation is turning into a regular occurrence :shrug:

How active is Milo? If he will play with a feather dancer/fishing rod type toy or chase a laser pointer the extra movement might help with motility.

Are his poops of normal size/consistancy or are they large & hard/dry?

There is also a long but informative thread on CRF here you may find some useful info : Early Stage Kidney Failure in Cat (http://www.pets.ca/forum/showthread.php?t=45017)

:goodvibes:

mharrigan
February 27th, 2011, 10:37 PM
He has always eaten dry food up until this week. We have him eating Wellness Turkey and so far he likes it. We will skip the phosphorous binder for now since Wellness seems to be in the safe zone for phosphorous levels.

The origin of his blood work was just to do a "wellness profile." No symptoms prompted the test, we just wanted to have it done to be proactive as we had just lost our 10 year old Fitch to liver failure.

i found his HTC, which is 41 with reference range Of 29-45%. They didn't do any urine samples, but I'll ask for that next time.

He isn't a very active boy, he's kind of a fatty so he is pretty lazy :) we are trying to get him to chase around a feather on a string right now, which he is doing a bit, but otherwise he has been sleeping all day and hasn't had a BM still, so I think we are going to take him in tomorrow to be safe :( Im hoping the vet is ok with us starting the Miralax since it seems to have such good results with kitties. I'm also praying that we aren't going to get a Megacolon diagnosis.

Also I just wanted to say thanks again for your responses, you guys are great. Oh and I will post a pic of him tomorrow, I'm posting from my iPad right now and don't have any pics on here.

mharrigan
February 28th, 2011, 08:58 AM
was so excited to wake up this morning to find that Milo had a BM after his breakfast! Never been so excited about a cat using his litter box before :) Hopefully it continues and he gets to be regular again, I do not want to put him through another enema. And I also wanted to post a picture, here's my fatty boy:

http://i53.tinypic.com/2rqlwxy.jpg

hazelrunpack
February 28th, 2011, 04:18 PM
He's a sweetheart, mharrigan! Thanks for sharing his pic. :flirt: And good luck with Milo's treatment :goodvibes: You've got our best kitty gurus helping you out!

mharrigan
February 28th, 2011, 08:11 PM
so we are trying some holistic therapy later this week - we are going to take Milo to get some kitty acupuncture. There is a holsitic vet that practices out of my regular vet's office, I talked to her today and she's really interested in trying out some accupuncture and chinese herbs on him to help control the GI problems and the CRF.

On a sad note, he was diagnosed with a heart murmur today :(
Vet said its a II out of VI (not sure what that means.) He wants to re-evaluate it in 6 months, and if it has escalated we have to take him to a specialist, because he might have Heart Disease or some other disease. Seems like we cant catch a break with this guy.

I am trying to think positive about everything, and hope that with the help of the accupuncture, the new wet food, and some miralax that we can control the GI issues and mange the CRF. Then we can focus on the heart murmur...

sugarcatmom
February 28th, 2011, 09:17 PM
so we are trying some holistic therapy later this week - we are going to take Milo to get some kitty acupuncture.

I think that's an excellent idea! I've been taking my boy for acupuncture/aquapuncture and osteopathy for both his arthritis and renal insufficiency. The vet he sees also practices TCM and prescribed some herbs (Rehmannia Eight Combination), which he surprisingly likes! I mix them in with his wet food.

On a sad note, he was diagnosed with a heart murmur today

Aztec has been living with a heart murmur for many many years. He's had a few echocardiograms to diagnose the cause (mild hypertrophic cardiomyopathy) and monitor progress, and he takes a beta blocker to help slow down his heart rate. Honestly, his heart is the least concerning of his health issues. Plenty of cats live long happy lives with a heart murmur, so I wouldn't stress too much over it for now. But absolutely an echocardiogram is the best diagnostic tool (although pricey). Hopefully Milo's murmur isn't anything to worry about. :fingerscr

mharrigan
February 28th, 2011, 10:13 PM
Thanks, I'm really excited to see how he takes to the acupuncture. His lethargic behavior and problems passing stool is breaking my heart. He had some diarrhea tonight and although I'm glad he went potty, it seams to have made his rear end uncomfortable, he keeps shifting positions and just lays there curled in a ball. I know acupuncture won't be some miracle cure, but this vet sounded really excited about getting Milo feeling back to his old self. Praying the next few days go smoothly.

sugarcatmom
February 28th, 2011, 10:20 PM
He had some diarrhea tonight and although I'm glad he went potty, it seams to have made his rear end uncomfortable, he keeps shifting positions and just lays there curled in a ball.

Can't remember, have you ever tried slippery elm bark or marshmallow root powder for Milo's digestive issues? Both are soothing to inflamed mucous membranes and help rebalance moisture levels in the intestines, making them good for both diarrhea and constipation.

http://www.littlebigcat.com/health/slippery-elm/

mharrigan
March 1st, 2011, 08:33 AM
I was looking at that, but we didnt want to overload him with things for his constipation since we already give him Cisapride and Miralax. I think we're going to see what the Holistic Vet says on Thursday, I will ask her about the the Slippery Elm Bark as well as what we are already giving him, and see what she recommends.

mharrigan
March 1st, 2011, 01:30 PM
WOW, Wellness just announced a recall of their canned food. I cant catch a break lately :( I'm sad cause Milo actually liked the Wellness.

Going to switch right to By Nature I guess, at least until Wellness gives the all clear.

sugarcatmom
March 1st, 2011, 02:28 PM
Going to switch right to By Nature I guess, at least until Wellness gives the all clear.

Anyway you can feed a variety of foods? I personally don't think cats should eat the same brand day in and day out (unless there are allergy issues and you're doing an elimination diet), for reasons such as this recall. I feed my cats Wellness in rotation with many other brands and to be honest, I'm not even going to check if my cans of Wellness are on the recall list. I know that any vitamin deficiencies are going to be balanced out by the other foods my cats eat.

mharrigan
March 1st, 2011, 05:54 PM
thankfully I just got home and checked my case, and it's not part of the recall, the best by date is in Oct 2013. I was super excited about that! But I am taking your advice and rotating some other foods into his diet, starting with By Nature Organics Chicken flavor. He INHALED his dinner so it seems he's feeling a bit better than he has been feeling. I'm looking forward to his acupuncture on Thurs!

sugarcatmom
March 1st, 2011, 06:12 PM
He INHALED his dinner so it seems he's feeling a bit better than he has been feeling.

Fantastic!

I'm looking forward to his acupuncture on Thurs!

Let me know how it goes. My kitty does pretty good during his sessions, mostly just sits there, but he's pretty calm at the vet anyway. He used to be paralized with fear at every vet appointment (and with all the ailments he's had, there have been MANY), but after taking him for regular osteopathy treatments, he's become much more laidback about the whole thing. He even purrs sometimes and lets the vet give him chin rubs. This new level of comfort has also transferred over to his regular vet.

Just a warning that for some cats, having to sit still while the needles are in place is the hardest part. That's where aquapuncture can be a better alternative: it's basically the injection of a liquid (usually vit B and maybe some homeopathics) into the acupuncture points. The liquid continues to stimulate those points after the needle is removed. Not all vets trained in acupuncture can also do aquapuncture though.

mharrigan
March 3rd, 2011, 12:04 PM
We just got back from Milo's first accupuncture treatment. It went well. The doctor started by doing an assessment, she basically asked a ton of questions about his lifestyle, diet, habits, and how he gets along with our other cat. She then explained a bit about how acupuncture worked, and told us her game plan. She wants to first focus on controlling his constipation issues, and then focus on the kidneys. She said acupuncture can stop or vastly slow down the progression of kidney failure, because it stengthens the kidneys. She is ok with us continuing to feed him Wellness canned. She wants us to cut down his Cisapride dosage to once a day, continue the Miralax, and also add some Pumpkin to his food. We are to continue the Atenolol and Azodyl for now.

The acupuncture itself went pretty well. He only got upset once and jumped off the table, when she put a needle in his back leg. Other than that he was pretty calm and didnt complain at all when the needles were going in (even when she put one right on his butt.) I'm still slightly skeptical about it, it's hard to believe that those tiny needles can make a difference, but she seemed pretty optimistic about seeing results. We have another session in 3 weeks. I was also suprised at the price, it's less than I thought. The first visit with the consultation was $70, but any further sessions are only $30 (i'm in the US.) Seems well worth it to me if it's going to make him feel better.

We are going to do bloodwork and urinalysis in about 10 weeks to see how his numbers are. I'm so hopefull that we will get everything under control and he can live a somewhat normal, long kitty life.

I'll keep you posted on his progress.