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Old July 4th, 2011, 08:19 PM
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My oldest cat diagnosed with Chronic Renal Insufficiency

About a month ago, the oldest of my 4 cats, Sam, now a week short of being 14 years old, was having spasms of his abdominal muscles that were definitely painful for him. Some of his background story is here Food for Senior Cat with long history of crystals in his urine. I started giving him Buscopan again which has been an off again on again medication for Sam since he was diagnosed with struvite crystals about 6 years ago. It relieves his pain and usually stops the spasms, as well as allowing him to pass the crystals.

I also took him to the vet. She did extensive blood work and it appears he has CRI about Stage 2 CRF. He is also wheezy at times, which my vet is very concerned about. We started him on a new diet, MediCal low protein canned which he's not particularly fond of but he is much better now. She wanted him off the Urinary SO and on Hill's KD but he loves the stuff and I've tried to give him Wellness Chicken and Wellness Turkey kibble in its place and he refuses to eat any other kibble than the SO. So I've got my work cut out for me switching his kibble to anything else.

We also started Fortekor to increase the blood flow to his kidneys and she recommended that I put him on a Flovent inhaler. However since I altered his wet food I haven;t heard him wheezing at all. I have a feeling he is going to freak out when I put a mask over his face, and so I've hesitated to pick up the inhaler and Flovent, especially since he hasn't been wheezing. He "asks" for his Buscopan every night and refuses it on the nights he doesn't need it. What he does is come immediately when I shake the pill bottle and sits in front of me waiting for his pill and then takes it without any hassle at all. The nights he won;t take it, he spits it out when I try to give it to him and avoids me trying to open his mouth to put it in. So I've decided he knows when he needs it and when he doesn't...amazing animals they are!

To make a long story short, he is back to himself again, loving, cuddly, asking for attention all the time and coming for food when he's hungry. He has been very slow eating the MC low protein, about 1/8 of a can a day at the most until last night when he ate about 2/3 of the can. I plan to change him to grain free wet, either Innova or Wellness wet. He likes the Innova Senior but none of the flavours of Wellness so far. So time will tell what I end up feeding him. Obviously something of better quality than the low protein food but I need to experiment to find what he'll eat. What I'm aiming for is a low phosphorus food with animal protein, My next trial will be Nature's Variety Instinct to see if that appeals to him

BIOCHEMISTRY
Total Protein 78 (norm 60-85 g/L)
Albumin 37 (norm 28-43 g/L)
Globulin 41 (norm 25-51 g/L)
A/G Ratio 0.9 (norm 0.6-1.3)
ALP 42 (norm 10-85 IU/L)
ALT 63 (norm 5-110 IU/L)
glucose 5.2 (norm 3.9-8.0 mmol/L)
Urea 11.1 (norm (norm 5.0-13.0 mmol/L)
creatinine 224 (norm 50-177 umol/L)
Sodium 157 (norm 145-158 mmol/L)
Potassium 4.8 (norm 3.7-5.8 mmol/L)
Na/K Ratio 33 (norm 25-40)
Chloride 118 (norm 109-130 mmol/L)
Calcium 2.83 (norm 2.00 - 2.90 mmol/L)
Phosphorus 1.4 (norm 0.8 - 2.5 mmol/L)
Hemolysis 2+
Icterus normal
Lipemia normal

HEMATOLOGY
WBC 7.7 (norm 5.5-19.5 x10E9/L)
RBC 9.9 (norm 6.0-11.0 x10E12/L)
Hemoglobin 154 (norm 80 - 150 g/L)
Hematocrit .47 (norm 0.24-0.45 L/L)
MCV 48 (norm 39-55 fl)
MCH 16 (norm 13-18 pg)
MCHC 327 (norm 290-360 g/L)
Platelets 265 (norm 120-600 x10E9/L)

DIFFERENTIAL
Bands 0.0% 0.0 abs (norm 0.0-0.3 x10E9/L)
Neutrophils 58.5% 4.5 abs (norm 2.5-12.5 x10E9/L)
Lymphocytes 30.7% 2.4 abs (norm 1.5-7.0 x10E9/L)
Monocytes 3.5% 0.3 abs (norm 0.0-0.9 x10E9/L)
Eosinophils 7.2% 0.6 abs (norm 0.0-1.5 x10E9/L)
Basophils 0.1% 0.0% (norm 0.0-0.2 x10E9/L)

MORPHOLOGY

WBC Morphology - normal
RBC Morphology - normal
PLT Morphology - normal

ENDOCRINOLOGY
T4 22.2 (norm - 10.0-60.0 nmol/L)

IMMUNOLOGY
Cardiopet proBNP Feline 69 (norm pmol/L)
Interpretation: proBNP measure NTproBNP which is released from heart muscle in proportion to the severity of the heart disease and detects the presence of cardiomyopathy in cats with or without clinical signs. If the reading is <100 pmo/L it indicates that clinically significant cardiomyopathy is highly unlikely.
If the reading is between 100-270 pmo/L it indicates clinically significant cardiomyopathy is unlikely but early disease may be present. Consider repeat NT proBNP in 3 to 6 months or an echocardiogram. If the cat has clinical signs, it is unlikely that these signs are associated with cardiomyopathy,

NOTES
There are signs of renal insufficiency. Diet should be changed to low protein RC MediCal or K/D as well as Fortekor 2.5mg x1 OD

There you have it, the blood work wasn't really bad, he was dehydrated so that could account for some of the abnormal results and there was no urinalysis done due to the fact his bladder was totally empty. He goes back for another check in a few weeks and we'll see how he is then. He had lost 2 1/2 lbs since his last visit so that is a good thing as every bit he loses makes him more likely to improve.
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Last edited by dbg10; July 4th, 2011 at 08:45 PM.
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Old July 5th, 2011, 01:48 AM
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Quote:
Originally Posted by dbg10 View Post
My next trial will be Nature's Variety Instinct to see if that appeals to him
Skip the Natures Variety Instinct, the only one that is low enough is canned chicken but just barely at 1.23% dry matter phosphorus, all the rest are far too high.

Here's a short food list here to start you off:

By Nature Organics Turkey & Turkey Liver, Chicken & Chicken Liver, Turkey & Chicken, Chicken & Mackerel, Beef & Beef Liver

Innova Flex Beef & Barley Stew
Evo 95% Chicken & Turkey

Felidae Platinum
Felidae Cat & Kitten
Felidae Grain Free

Merricks Before Grain 96% Beef
Merricks Before Grain 96% Turkey

Merricks Cowboy Cookout
Merricks Thanksgiving Day Dinner

Halo Spots Stew Wholesome Chicken
Halo Spots Stew Wholesome Turkey

Wellness Turkey, Chicken, Beef & Chicken, Beef & Salmon, Kitten, Wellness Core Chicken Turkey & Chicken Liver

Holistic Select Turkey & Barley
Holistic Select Duck & Chicken

Many more choices listed here http://www.felinecrf.org/canned_food...od_data_tables


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Originally Posted by dbg10 View Post
There you have it, the blood work wasn't really bad, he was dehydrated so that could account for some of the abnormal results and there was no urinalysis done due to the fact his bladder was totally empty. He goes back for another check in a few weeks and we'll see how he is then.
Hopefully they can get a urine sample at the next appt, that is just as crucial as creatinine for an accurate diagnosis, especially for one w/a history of crystals

The bloodwork does reflect dehydration, but it would be nice to see how much of that is just dehydration & what his cre averages at over a couple of tests to see what "normal" is.

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He had lost 2 1/2 lbs since his last visit so that is a good thing as every bit he loses makes him more likely to improve.
Not unless he's currently several pounds overweight. I would far prefer a cat with kidney issues to be slightly chubby than to be normal/slightly underweight. Kidney cats tend to loose weight, sometimes quite rapidly, & it becomes very hard to bring them back up to normal especially once they've stopped eating normal serving sizes

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Old July 5th, 2011, 08:56 AM
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Sorry to hear about Sam, dbg It never rains but it pours.

I'm glad he's rallied some for you and I know you'll do as well by him as you have by Raggs! They're very lucky critters!
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Old July 5th, 2011, 10:41 AM
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I don't know much about the kittys, (except they are so soft and purring warms the heart), but wanted to send good wishes to Sam.
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Old July 5th, 2011, 11:15 AM
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Thanks Growler for the links. I have been using the list at http://www.felinecrf.org/canned_food...od_data_tables but so many of them are high in phosphorus it makes for a difficult choice. Especially since he is so fussy about what he eats. Last night I gave him Innova beef and barley stew wet with his low protein wet and he ate his usual 1/8 can of low protein and 3/4 can of Innova. So that was a hit and relatively low in phosphorus. I will go out and buy a couple of cans of the others you recommended and see if he will eat them. I noticed that Petsmart is now carrying By Nature organic wet food and it has a very good phosphorus content by the looks of things.

Thanks hazel for your good wishes.
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Old July 5th, 2011, 11:19 AM
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dbg,Sorry to read about Sam,but I am sure with you by his side,he'll get the best care possible
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Old July 5th, 2011, 01:17 PM
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Thanks Scottiedog and chico2.

Growler I forgot to mention that Sam weighs 21.4 lbs and should weigh about 17 lbs. He has had a problem with obesity for years and diets never seem to work with him. He was 24.1 lbs at his previous visit and so it is good that he has lost weight. He started gaining after we lost his brother a number of years ago and has maintained his excess weight for all that time no matter what or how much I fed him. Both my vet and I are happy to see him losing weight now unless he continues to lose beyond his target weight.

He is not allowed to free feed and neither are the others. As I said he loves his Urinary SO and that is going to be the big challenge getting him to eat another dry food unless I can get him over to all wet. However, he's been eating dry for his entire life and can be very stubborn when it comes to changing foods. Thanks for the information and links.
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Old July 5th, 2011, 11:36 PM
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Quote:
Originally Posted by dbg10 View Post
Thanks Growler for the links. I have been using the list at http://www.felinecrf.org/canned_food...od_data_tables but so many of them are high in phosphorus it makes for a difficult choice. Especially since he is so fussy about what he eats. Last night I gave him Innova beef and barley stew wet with his low protein wet and he ate his usual 1/8 can of low protein and 3/4 can of Innova. So that was a hit and relatively low in phosphorus. I will go out and buy a couple of cans of the others you recommended and see if he will eat them. I noticed that Petsmart is now carrying By Nature organic wet food and it has a very good phosphorus content by the looks of things.
If Sam is content to eat a couple of different varieties that's great, some like variety, some are okay with the same flavour for a time before wanting something different. Occasionally you can slip back in a previously rejected food as something new later on

When looking at the phos content of the food on the table I linked above they are already converted into dry matter basis, so anything under 1.24% max is what you want to look for, keeping in mind any ingredients you want to stay away from and that some of the foods are marked as being supplemental only.

From Sam's blood work his blood phosphorus levels are okay now so it's not essential to keep to the dm% under 1% (always what the vets recommend) but as close to it or below is best long term.

Quote:
Originally Posted by dbg10 View Post
Growler I forgot to mention that Sam weighs 21.4 lbs and should weigh about 17 lbs.
Ah okay, slow incremental weight loss is good then, if there is a sudden drop or he stops eating ~ time to pack him off to the vet.

Has he shown any symptoms yet? Increased drinking/peeing, lip licking, vomiting etc?

Do you have his food dish elevated? I found that raising the food/water dishes up between 2-6 inches helped tremendously especially with the food dish to keep the nausea at bay. Also easier on the older kitties necks not having to reach down so far to have a drink/bite of food.

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He is not allowed to free feed and neither are the others. As I said he loves his Urinary SO and that is going to be the big challenge getting him to eat another dry food unless I can get him over to all wet. However, he's been eating dry for his entire life and can be very stubborn when it comes to changing foods.
How much dry food is he eating per day? That unfortunately is contributing to the dehydration level a bit.
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Old July 6th, 2011, 07:58 AM
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So sorry to hear about Sam. Just a word of caution when you are reading labels and the phosphorus levels. Most manufacturers post their MINIMUM value of phosphorus, which doesn't necessarily reflect the more accurate level. That's one thing I like about Nature's Variety's website, they post both their minimum guaranteed and the more realistic value for each flavour.

Liver, organs, brown rice, some fish and seafood, venison, bran, oatmeal, dairy and legumes are generally high in phosphorus.

Chicken, turkey and beef meat are generally low in phosphorus (as far as meat goes).

If you check the ingredient label on the cans of food, you may be able to determine better what the phosphorus levels are.

Sending lots of your way.
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Old July 9th, 2011, 05:59 PM
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growler not sure why I never saw your post about Duffy when she was diagnosed with CRF but I finally found it today and have been reading it. I have a question for you about the raw diet you started her on:

Quote:
Originally Posted by growler~GateKeeper View Post
Raw feeding was also discussed - something I have been mulling over for about a week - phos levels are lower than the canned she's on now. He is also against the conventional low protein theory as am I, which is one reason I will not switch to the prescription food.
I know you mentioned this before but did your H vet tell you how much protein to include in Duffy's diet? Are the higher protein foods acceptable or not with a CRF cat.


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Originally Posted by growler~GateKeeper View Post
She loves the raw, started with chicken - easiest to digest 2 weeks of straight chicken & this week added beef so she'll get that 1x per week for a bit then I can maybe up it to 2x. Can add a 3rd meat next week.
did you start exclusively with meat or did you add other things to her raw diet?

I know I should have read your thread a long time ago, but for some reason I totally missed it.

Also I wanted to ask and think I will post a separate thread if you have ever heard of a cat having a reaction to Fortekor. Sam has consistently refused to take it and I hesitate to force him when I know he will take his Buscopan willingly. He keeps spitting out the Fortekor and the vet tech has suggested I use pill pockets for them but is there a possibility that Sam is going to react to it? After all it is an ACE inhibitor and they can cause major reactions in humans.
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Old July 10th, 2011, 12:21 AM
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Originally Posted by dbg10 View Post
Yes I know she mentions some of the Fancy Feast varieties but she also says they have redone the ingredients last year and upped the amount of phosphorus in them so I'll look for the ones with the lowest phosphorus in them for Bailey and if necessary give it to Sam. He is chowing down on the Innova right now as well as about 1/8 of a can of prescription food a day. He seems to like it but it also seems to fill him up so he's eating the Innova too. I've started leaving the canned out for a few hours before I pick it up and they have been eating it.
Would be nice/easier to be able to get most/all of them on the same food

Perhaps with the canned out a little longer they will choose to eat that instead of the dry food You can always add a bit of water to soften the canned back up too.

Quote:
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As for Smokey he pigs out on any food he finds around, human or cat or dog. That's why it is hard to get him to only eat one food and now he refuses to eat any canned even though I have a variety out for them. He has been barfing again the last couple of days but he also had some human food that was left out by mistake so hard to tell what it's from. I do need to take him for an Xray...that's the next step in his diagnosis. Have been putting it off because he seemed to be holding his weight steady, but now appears to be losing again.
Has the vet ever mentioned the possibility of Smokey having IBS or IBD or just a sensitivity to a certain food type? Perhaps you can talk to the vet about the advantages/disadvantages of xray vs ultrasound for diagnosis.

Have you noticed a pattern ie just when he eats beef or turkey or food with rice in it for example or is it anytime something is "different" from what he had the day before?

Quote:
Originally Posted by dbg10 View Post
I know you mentioned this before but did your H vet tell you how much protein to include in Duffy's diet? Are the higher protein foods acceptable or not with a CRF cat.
He didn't give a % of protein number, just that you can feed a regular protein value raw diet to a kidney cat. You wouldn't necessarily want to always feed something that is very high or very low in protein, somewhere in the middle is best. In moderation as they say.

Duffy's blood protein value was always mid normal & she was not leaking protein into her urine, so I never considered restricting the amount. If Sam's blood protein level was high or if he had proteinuria then it would be wise to look to the mid-lower end of the protein values. The problem with restricting protein is the cats rely on protein for energy as well as building/maintaining muscle mass, also when on the low end the taste is restricted or enhanced with higher fat content.

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did you start exclusively with meat or did you add other things to her raw diet?
When I started raw, it was from Natural Instincts a BC local produced commercial ground raw that had meat/bone/organs already in it. While recovering from a severe allergic/IBD reaction to duck (weekend stay @ the ER Vet) it was apparent she was also becoming intolerant to bone (even ground bone ~ mild IBD diagnosed via ultrasound) so I switched for a short time to just chicken breast meat on the advice of her H Vet. After that I fed her TC Feline Plus Premix with ground chicken.

A normal home prepped prey model or ground raw or commercial ground raw diet is fine. There is a site from the USDA that allows you to check the nutrient analysis for any food so you can decide if the phos/protein/fat/etc content is appropriate. http://www.nal.usda.gov/fnic/foodcomp/search/index.html

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Also I wanted to ask and think I will post a separate thread if you have ever heard of a cat having a reaction to Fortekor.
I'll have a look at that thread.
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Old July 10th, 2011, 01:13 PM
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Originally Posted by growler~GateKeeper View Post
Would be nice/easier to be able to get most/all of them on the same food

Perhaps with the canned out a little longer they will choose to eat that instead of the dry food You can always add a bit of water to soften the canned back up too.
It certainly would be easier but I find the others will eat almost any wet I give them Smokey barfs after most of them. I did start adding water to the food when I decided to leave it out for a few hours and that has helped it remain soft with no crusty layer on the top.

Quote:
Originally Posted by growler~GateKeeper View Post
Has the vet ever mentioned the possibility of Smokey having IBS or IBD or just a sensitivity to a certain food type? Perhaps you can talk to the vet about the advantages/disadvantages of xray vs ultrasound for diagnosis.

Have you noticed a pattern ie just when he eats beef or turkey or food with rice in it for example or is it anytime something is "different" from what he had the day before?
Smokey has had this problem since I adopted him at about 13 weeks old. He was very small appeared to only be about 7 to 8 weeks old but when examined he definitely was older. He and his sisters had been found in the bathroom of a hockey arena abandoned. That is the reason I think he will eat anything and everything that he finds that might resemble food. When he was full size he was a very large boned cat and weighed 16 lbs without any fat on him at all and stayed that way until he was about 4 1/2 years despite all the vomiting and spitting up food he did, so we thought there wasn't a major problem.

Then about the time Pepper got sick he seemed to start losing weight and I took him in for a weight and exam. Blood work was done each time I took him in and exam revealed absolutely no reason for his weight loss. The blood work was all absolutely normal with no even hints of what might be going on. Urinalysis also normal each time. His weight dropped over a year to 11 lbs but I had found that if I fed him Merrick's Grammy's Pot Pie he didn't barf after it and rarely ate anything else.So my vet recommended I bring him in for an abdominal Xray but at the time I had Pepper's surgery and Sam's issues and since I had appeared to have found an answer I haven't taken him back. I did find out at one point that he couldn't tolerate the Urinary SO when I ran out of both dry and wet food and he ate it for a couple of days. He gained weight back to 12.5 lbs and I thought we'd found part of the answer. So then Pepper passed and Raggs came, Smokey has always liked dogs much better than cats. Raggs rejected him for awhile but has now accepted Smokey's affection and returns it at times. Then Smokey decided about 3 months ago that he wasn't going to eat anymore canned food of any kind, including the Grammy's. I have no idea why but he won't touch any of it and I have at least 4 varieties of canned food out every day for them including the MC Lo Prot for Sam. Smokey seemed to like the Innova Dry, but now he;s barfing again and losing weight. I know it;s time to take him back but money has been an issue recently and I haven't had the extra cash to take him in with Sam needing care. I hope to have this straightened up by August and take him in then.

As for a pattern I did notice he does better with Chicken but won't eat Turkey after enjoying a few cans of it. I tried Wellness Turkey and it bombed with him but I am about to try it again with all of them especially Sam. Fish seemed to upset him but then again he wasn't really eating enough of it to tell if it was the Fish. I don't remember what happened with the beef because I had found the Grammys and stuck to it when he liked it.

Quote:
Originally Posted by growler~GateKeeper View Post
He didn't give a % of protein number, just that you can feed a regular protein value raw diet to a kidney cat. You wouldn't necessarily want to always feed something that is very high or very low in protein, somewhere in the middle is best. In moderation as they say.
So basically stay away from the really high protein foods even if the protein is animal origin and try to stay in the middle range. That's what I thought.

Quote:
Originally Posted by growler~GateKeeper View Post
Duffy's blood protein value was always mid normal & she was not leaking protein into her urine, so I never considered restricting the amount. If Sam's blood protein level was high or if he had proteinuria then it would be wise to look to the mid-lower end of the protein values. The problem with restricting protein is the cats rely on protein for energy as well as building/maintaining muscle mass, also when on the low end the taste is restricted or enhanced with higher fat content.
I know that restricting protein allows them to catabolize their own muscle and that isn't a good thing, I am trying to stick to animal protein but reduce the carbs which nowadays seems to be a problem. However I had forgotten to look at the guaranteed analysis of the foods and that really tells the story on how much carb there is in each food.

Quote:
Originally Posted by growler~GateKeeper View Post
When I started raw, it was from Natural Instincts a BC local produced commercial ground raw that had meat/bone/organs already in it. While recovering from a severe allergic/IBD reaction to duck (weekend stay @ the ER Vet) it was apparent she was also becoming intolerant to bone (even ground bone ~ mild IBD diagnosed via ultrasound) so I switched for a short time to just chicken breast meat on the advice of her H Vet. After that I fed her TC Feline Plus Premix with ground chicken.
A normal home prepped prey model or ground raw or commercial ground raw diet is fine. There is a site from the USDA that allows you to check the nutrient analysis for any food so you can decide if the phos/protein/fat/etc content is appropriate. http://www.nal.usda.gov/fnic/foodcomp/search/index.html
I think they have raw food at the Global Pet Foods near me their website shows 4 different brands and I can check it out. However, they don't carry a lot of the food their website says they do, but will order cases when you ask them to. I'll check out the raw food brand they have there but I think it's Natural Instinct.

Thanks so much for all the links and information, from what I read about Duffy you definitely became an expert on CRF and diets to treat them. So glad you had some reimbursement from RC for all the tests you had to run.
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Old July 17th, 2011, 07:56 PM
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Just an update on how Sam's doing. He is still eating a very small amount of SO but seems to wait for his canned food. However, he is eating a variety of canned foods. I usually put out 4 different foods for them the FF for Bailey, Innova Senior for whoever wants to eat it, Sam's RC Medical Lo Protein for Sam, and usually a can of Grammy's Pot Pie hoping Smokey will eat it. It appears that Bailey and Tiger like the Lo Protein food also and I usually have to grab it to prevent them from eating it. Sam will start with his Lo Protein and work his way from dish to dish snacking on everything I have out. One night I had FF chicken out and Smokey dove into it, the only canned food he's tried since he swore off the Grammys. He still won't touch the Grammys but I decided canned food of any kind is good for him so I've given him a can of FF chicken every night and he's eaten it. He's still very thin (have to take him in I know), but I'm hoping he starts to gain a little now that he's eating the FF. Everyone except Smokey is eating some Grammys so it's not going to waste. As for dry food for the rest of them, none of them will eat the Innova dry or the Wellness dry now, so I guess I'll be trying something else. They will all eat the SO, until it is finished, I am going to continue to give it to them but I also wonder because of their ages is they may have some bladder crystals as well but they have not shown any symptoms yet..

To get back to Sam, the Fortekor is still a no-go, he continues to spit it back every time I try to give it to him. I'm no longer trying on weekends in case he does react to it, if I manage to get it down. He has perfected his spitting skills and now the Fortekor goes much farther than it used to when he spits it out and I've had trouble finding it. : However he is eating more of the Lo Protein which I think may be counteracting the SO he gets so until I find something he will eat that is low phosphorus, I'll continue to give it to him.

He is doing better than he was and is cuddly and lively as he was before he got sick this time. He is still taking his Buscopan some nights, asking for it as he started doing a few weeks ago.
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Willing Slave to: Sam 17 yrs; Bailey 13 yrs; Tiger 13 yrs; and Smokey 9 yrs.
R.I.P. Raggs 1997 - 2012 ; Pepper 1997 - 2009
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  #14  
Old July 17th, 2011, 11:16 PM
growler~GateKeeper's Avatar
growler~GateKeeper growler~GateKeeper is offline
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The easiest way I've found to pill a cat:
Sit the cat on the floor in the kitchen facing the cupboards, pills at the ready on the counter above, crouch behind him w/your legs on either side to block escape. One hand holding the head still, pill between the thumb & forefinger of the other hand, use your ring or middle finger, of the pill hand, to pry open the mouth. With forefinger on the pill place it on the roof of the mouth & quickly slide it all the way down the back of the throat. This way there is no chance for them to spit it out, and it's over much faster. Treat afterwards.
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