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Old May 16th, 2010, 04:55 AM
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Diabetic boy's kidney declining?

Hi everyone,

I have a little concern about my 12yr old diabetic cat's bloodwork
and urinalysis result he had recently.
His vet thinks that he is in early stage of kidney failure and
prescribed two oral medicines: Fortekor and Covalzin.
Covalzin is to bind toxin. (I live in Japan.)
I have been reading some related threads and links in this forum
but thought to jump in and post the result myself for your advice.

Here's his brief history.
He's been diabetic for almost 3 years.
Has history of seizure from hypoglycemia last summer
and in autumn, developed ketoacidosis twice consecutively.
The vets doubted if he would survive but he did!

Now he is on tight regulation protocol by Dr Hodgkins with home-testing
and he is also on raw diet since last November, although
I am so unconfident if calcium-phosphorus ratio is OK.
It really changed his condition remarkably and he started
play like he used to and he has also gained his weight. It was incredible.
Now I dose him 2 - 3 times a day and his blood glucose seem to
stay under 200 these day except when I oversleep and miss the timing.


<Bloodwork> (average)

(Sorry, I don't know how to convert the numbers..and
I don't know what some of them mean, either..)

WBC 9000 (6000-15000)
RBC 768 (550-1000)
Plate 16.9 (10-80)
Ht 38.3% (25-45)
Hb 13.9 g/dL (8-14)
MCV 49.9
MCH 18.1
MCHC 36.3

BUN 74mg/dL (17-40)
CRE 2.4mg/dL (0.6-2.4)
IP 5.0mg/dL (1.7-7.2)
Na 158 (147-156)
K 4.1 (3.5-5.1)
Cl 116 (117-123)

Last November, when he was critically ill, his BUN was 65mg/dL
and creatinine was 1.5mg/dL.

<Urinalysis>

PH 6.5
blood -
Proteinuria 2+
glucose -
keton -
USG 1.040

I would be happy if you let me know what you see with these numbers.
Is there anything particular about?
I understand that USG is OK and I've heard that high protein diet will
raise BUN level so it's understandable since he's switched to raw from kibble.
But he's got protein in his urine and creatinine is on the threshold.
Are these telling that his kidney has declining?

I would appreciate any thoughts and comments from you.
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Old May 16th, 2010, 12:18 PM
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What are the alternate names for Fortekor and Covalzin?
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Last edited by Dr Lee; May 22nd, 2010 at 10:15 AM.
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Old May 17th, 2010, 07:41 AM
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My first post was so long! Sorry!!

Hi Dr Lee,

Thank you for your advice!

Quote:
Originally Posted by Dr Lee View Post
What are the alternate names for Fortekor and Covalzin? Is covalzin a phosphorus binder?
Fortekor is known as Benazepril. It's an ACE inhibitor, it says.
Covalzin, I think, is not a phosphorus binder but is used to reduce toxin. http://www.felinecrf.com/meds0.htm

I'll ask the vet to check his blood pressure at our next visit and talk about infection and urine protein:creatinine ratio.

So his USG being in normal range does not mean his kidney is still OK?
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Old May 17th, 2010, 10:08 PM
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good luck with your pet
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Last edited by Dr Lee; May 22nd, 2010 at 10:20 AM.
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Old May 19th, 2010, 02:01 AM
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How is your cat's water intake? Same or more than normal?

Is he your only pet - can you measure how much water, volume wise, he drinks in say 4 days?

Pour a measured amount of water into his dishes, make note of date & water volume, re-measure what is left after 4 days make note of how much was consumed in that time frame. This way you can randomly "test" how much he drinks to give a good indication if/when there is any increase.


The slight (2 point) rise out of normal of Na (sodium) can be an indicator of dehydration.

Are you familiar with the skin pinch test? Another way of checking is feeling the gums they should be slick & wet, if they are sticky or dry your cat is dehydrated.

The increase in BUN combined with high-normal Creatinine and normal phos can also be an indication of dehydration, ketoacidosis and/or kidney failure.

Proteinuria is a good indicator of kidney issues, but it is also seen in diabetic cats.


It is wonderful you have him (what's his name btw? ) on a raw diet , if it is properly balanced meat/bone/organ and does not contain any/too much fish, your calcium : phos ratio should be good.

One tip I found very valuable is raising the food/water dishes up between 2-6 inches off the ground by placing something them (phone books, low plant table etc) just enough that he is not bending his head down too much to eat. This will help to control any excess stomach acid & reduces nausea.

There is some info here on Covalzin

Have you read the Early Stage Kidney Failure in Cat sticky thread at the top of the cat health forum? It is a long thread, so there is a summary post link listed in the first post.

A website I found/still find a very valuable resource is Tanya's Feline CRF Info Centre

Welcome to the forum Tontita
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Old May 22nd, 2010, 09:48 AM
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Hi growler,

Thank you so much for your advice!

I'm reading your sticky thread. Still on page 5 but I jumped to the last page and… I'm so sorry..

I'll continue reading and will learn a lot from your thread. I already have. You and Duffy are .. incredible. I'm sorry, my words are not enough to express how I feel. Thank you again for your response with message. I'll keep my eyes on his water intake and do skin pinch test to see if he's dehydrated. I'm adding some water to his meal and have put a phone book thick box under his dish. It seems easier for him to eat. His name is Akane (the brown one in the photo) and he's got a brother, Lyntaro.
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Old May 22nd, 2010, 11:06 AM
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Quote:
Originally Posted by growler View Post
The increase in BUN combined with high-normal Creatinine and normal phos can also be an indication of dehydration, ketoacidosis and/or kidney failure.

Proteinuria is a good indicator of kidney issues, but it is also seen in diabetic cats.
In order for the elevation of BUN to be secondary to ketoacidosis, there must be ketones in the urine which there were not.

Diabetes does not directly cause proteinuria. (I can reference if needed). It can cause it through secondary measures such as urinary tract infection or hypertension. This needs to be worked up and not seen as "part of diabetes". With a 2+ protein in a 1.040 USG with the DM and creatinine/BUN levels, then the top concerns would be glomerular disease, infection and hypertension.
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Last edited by Dr Lee; May 22nd, 2010 at 11:27 AM.
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Old May 24th, 2010, 12:05 AM
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..............
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Last edited by Dr Lee; May 24th, 2010 at 10:57 PM.
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Old May 24th, 2010, 04:50 PM
Atrastella Atrastella is offline
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Dear Tontita,

How is Akane doing?

My boy is 17 years old and has been suffering kidney disease for several years now. Did you have a chance to discuss Covalzin with your vet? Is it really good in inhibiting the disease so far?

Thanks in advance for the information, this is very important for me.

Sincerely
Turhan
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Old May 25th, 2010, 03:22 AM
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Hi Turhan,

Akane has done the bloodwork and urinalysis early in May and our next visit to the vet will be early June. So I still don't know if the current treatment with Fortekor and Covalzin is doing some good to him. In my eyes, he seems to be OK. (or hasn't changed.) I will update his result when we get it.
I'm happy if we could share information. How's your boy? I'm now trying to adjust raw food by adding some vegetable.

Thank you, Dr Lee, for your kind offer. It would be really helpful.
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Old May 29th, 2010, 10:58 AM
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I wonder if it is OK to continue with this thread.
It's about insulin onset. (I'm using BCP PZI.) It used to be 2-3 hours after injection that insulin starts to work and the peak comes at around 6 hours later but these days insulin seems to work late at around 5-6 hours. So the blood glucose keeps rising after the shot until 5-6 hours later and then gradually going down but the curve is so shallow. And the duration is for about 12 hours. Is it about insulin's potency or is it just Akane's condition?
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Old May 30th, 2010, 03:13 AM
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I have no experience with diabetes but I'll pm this thread to sugarcatmom who has a diabetic cat, she may be able to give you some tips
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Old May 30th, 2010, 11:35 AM
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Quote:
Originally Posted by tontita View Post
It's about insulin onset. (I'm using BCP PZI.) It used to be 2-3 hours after injection that insulin starts to work and the peak comes at around 6 hours later but these days insulin seems to work late at around 5-6 hours.
Did the change begin since you started adding vegetables to his diet? Which veggies are you using and how much?

Another factor may be if you've recently started a new vial of insulin, or if it's an old vial that is losing potency. Because BCP PZI is compounded, there can sometimes be slight variations between batches, causing subtle differences in action. It also doesn't tend to have the same shelf-life as the manufactured insulins.

Quote:
Originally Posted by tontita View Post
So the blood glucose keeps rising after the shot until 5-6 hours later and then gradually going down but the curve is so shallow. And the duration is for about 12 hours.
A shallow curve is good if the numbers are all within a decent range. If they're consistently too high, it's possible you need to increase the dose slightly. My guess would be (if it's not an issue with your vial of insulin) that the addition of veggies is the culprit, and maybe you could try eliminating them and see what happens.

As for the rest of your raw recipe, what is your source of calcium? Bones? Bonemeal? Or a calcium supplement? Because of the kidney issue, you might want to consider a calcium supplement in place of bone/bonemeal (if that's what you're using) because bones still contain quite a bit of phosphorus along with the calcium, and phosphorus is something you want to minimize in CRF situations.
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Old June 1st, 2010, 05:03 AM
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Thank you, growler!

Hi, sugarcatmom. Thank you for your advice

Quote:
Originally Posted by sugarcatmom View Post
Did the change begin since you started adding vegetables to his diet? Which veggies are you using and how much?
I'm not sure their English names but the vegetables I'm using are "mizuna", "komatsuna" (both green leaf vegetables), alfalfa, pumpkin, carrot, cabbage, and parsley. Its amount is up to about 20%.

Since I posted, I've realized that after a shot in the morning, the peak seems to come as usual at about 6-8 hours later. So perhaps the vial is still valid? Slow onset is usually seen at night after the 2nd or 3rd shot in the day. When I see a shallow curve, his numbers are above 200 to 250, so it's not really good.. I've added vegetable for reducing a bit of protein to see if it will affect his blood work, which he will do soon. I've heard that cereals affect glucose numbers but vegetables, too?

Quote:
Originally Posted by sugarcatmom View Post
As for the rest of your raw recipe, what is your source of calcium? Bones? Bonemeal? Or a calcium supplement? Because of the kidney issue, you might want to consider a calcium supplement in place of bone/bonemeal (if that's what you're using) because bones still contain quite a bit of phosphorus along with the calcium, and phosphorus is something you want to minimize in CRF situations.
Thank you. I'm adding egg shell calcium I make at home. I use chicken thigh, or turkey thigh without bones. Not a lot of variation. Are there any good supplements you recommend?
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Old June 2nd, 2010, 05:25 PM
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Quote:
Originally Posted by tontita View Post
I'm not sure their English names but the vegetables I'm using are "mizuna", "komatsuna" (both green leaf vegetables), alfalfa, pumpkin, carrot, cabbage, and parsley. Its amount is up to about 20%.
Personally, I wouldn't feed so much vegetable matter (like maybe less than 10%). It's not so much the protein, but the amount of phosphorus you want to limit. A better idea would be to add some cooked egg white if you can. It's a high quality source of protein that is low in phosphorus. Some cats don't really like egg whites that much, so you might have to start with just a tiny amount and slowly work up to more. Chop it very finely and mix it as thoroughly as possible into the rest of the raw mix.

Also, I strongly recommend you eliminate the alfalfa from your recipe. It's actually toxic to cats. Here is some info on that:
Alfalfa - an ingredient in it - canavanine, can lead to abnormal blood cell counts and spleen enlargement as well as interfere with arginine uptake in the body. Arginine (abundant in meat) is critical for cats, and inadequate amounts of arginine can cause serious problems. See article titled "Why does the cat require a high protein diet?" by Rogers QR & Morris JG (1980) Journal of Nutrition 109, 718–723 for details on the deleterious effects of inadequate L-arginine in kitten diets. Last but not least, Alfalfa contains coumarin derivatives that can inhibit blood clotting. There is no reason to use this herb, none.
http://www.holisticat.com/cat-herbs.html
Alfalfa powder, alfalfa sprouts
Alfalfa, known also as lucerne (legume), is widely used as a staple fodder plant for livestock, and has application in human health as tonic, antifungal, laxative, diuretic, detoxifier, digestive, nutritive, and anti-arthritic. However, when referencing veterinary literature it is listed as a toxic plant for cats. Alfalfa contains cyanide producing compounds (cyanogenic glycosides) which will only be destroyed by adequate cooking. In humans, these toxic substances are detoxified by the liver when ingested in small quantities, but in the much smaller cat alfalfa frequently cause vomiting, abdominal pain and/or diarrhea. Raw plant matter of any kind, including alfalfa sprouts and alfalfa powder, will lead to severe indigestion in the cat, who is not equipped to properly digest raw plant matter as a carnivore.

Alone the fact that alfalfa alkalizes the body makes it a dangerous substance to use in the cat’s diet. Cats depend on a slightly acidic acid-base balance; a high body pH - as induced with the use of alfalfa - will put the cat at greater risk of developing urinary crystals.
http://www.felinefuture.com/?p=642


Quote:
Originally Posted by tontita View Post
I've heard that cereals affect glucose numbers but vegetables, too?
Depends on the vegetable, and how much you use. Pumpkin is not the best choice for diabetics as it has a moderately high glycemic index. A better choice would be a small amount of zucchini. I don't know much about the mizuna or komatsuna but green leafy veggies tend to have a low glycemic index. I'm just not sure about the rest of the nutrients they contain and whether they're safe for kitties.

Quote:
Originally Posted by tontita View Post
I'm adding egg shell calcium I make at home. I use chicken thigh, or turkey thigh without bones. Not a lot of variation. Are there any good supplements you recommend?
Egg shells are a great source of low-phosphorus calcium, so that part is good. Other supplements you might consider adding, if you aren't already, would be some omega3 in the form of fish oil (sardine, anchovy, or krill are good sources, as is salmon oil, but there are some environmental issues associated with salmon fishing) and some vitamin E. Do you add any additional taurine to your recipe? If the meat is frozen for any period of time, it might be necessary to add about 100mg/day to make sure taurine intake is adequate. I gotta run, but if I think of anything else I'll let you know.
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Old June 3rd, 2010, 09:36 AM
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Thank you for your time, sugarcatmom.

Quote:
Originally Posted by sugarcatmom View Post
A better idea would be to add some cooked egg white if you can.
I started to add it after I found out his kidney concern. Fortunately he eats OK. I also add omega 3 oil, taurine, digestive enzyme, canola oil, and vitamin B complex + C. (But I've heard adding vitamin C is not recommended.) Not vitamin E.

Quote:
Originally Posted by sugarcatmom View Post
Also, I strongly recommend you eliminate the alfalfa from your recipe. It's actually toxic to cats.
I didn't know that. Thanks for the links. I had checked both sites before but I've missed these info. The title - "When Love can Kill" makes me afraid. I decided to use it because some books recommend to add alfalfa with a little caution if a cat has urinary tract problem.

There are so many information and sometimes they contradict or disagree. Instruction from a vet vs info from website, or web vs web. I'm often How do you decide which info you follow?

I didn't know about glycemic index, either. I just added vegetables 1) because he had hairball problem and I thought he needs fiber (We have cat grass, too.) 2) to reduce his protein intake which now I understand not necessary 3) because I thought it might be better he takes vitamins from food than from supplement. (and.. I keep using supplement.)

I wonder... adding vegetables is not really necessary? And I'm thinking about using slippery elm bark. Is every product same?
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Old June 7th, 2010, 08:04 AM
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We went to the vet today for bloodwork and urinalysis. Akane has been on Fortekor and Covalzin (toxic binder) since the end of April. I added some vegetables and cooked egg white to his raw diet. I'm still thinking what to do with vegetables. Maybe I should reduce the amount a bit..

BUN 52mg/dL (17-40) 22 pts down
CRE 2.6mg/dL (0.6-2.4) 0.2 pts up
Phos 4.9mg/dL (1.7-7.2) 0.1 pts down

PH 6.5
Proteinuria 1+
USG 1.040

About insulin, I have bought a new bottle as the old one was really old...and then the onset seems to get "usual" again. Relieved. Thanks.
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Old June 14th, 2010, 02:22 AM
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Great results for Akane for contnured improvement

Regarding the vegetables, I think reducing the overall amount would be good, but remember to do so slowly keeping in mind it may affect the blood glucose values.
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Old June 14th, 2010, 09:01 AM
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Thank you, growler! ☆
I'll try to reduce the veggies a bit and slowly
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Old July 2nd, 2010, 02:47 AM
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How's Akane doing these days?
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Old July 2nd, 2010, 07:33 AM
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Thank you so much, growler
Just today, I found out how to view the latest messages to Pets.ca (I'm not really familiar with these forum systems) and found your post to this thread. Thank you!

He's less active these days compare to spring time but perhaps (and I hope) it's maybe because of the heat and humidity of the rainy season but I'm not sure. I pinch test every day and it seems OK. But as his BUN, CRE, and proteiuria are already not in normal range (and his blood glucose), I have to be careful…
I'm planning to take his urine for another urinalysis soon.

I read in your thread that your Duffy had homeopathic treatment. I was interested and have found other good reports about homotoxicology treatment in several different places, too. Then I had a chance to have a phone consulting with a holistic vet here in Japan about 10 days ago. The vet suggested combination remedies for Akane's kidney but said "not now" having seen his last test results. She said maybe start treatment when his creatinine is above 3 mg/dL. I'm not really happy with this decision because what I was hoping was something to keep him as he is. Well.. I will contact her with his latest test result again.

Combination remedy seems so convenient to apply compare to classical homeopathy. I was surprised. I'm now trying to learn more about it for cats and for ourselves but information is very limited here. It's not as popular as classical homeopathy. But fortunately, I've found out that I could order BHI/Heel products through "iherb" and have ordered "Detox kit" for myself. I'm taking it now to see if it will bring positive change to me, for trial. Do you know any good sources for a beginner to learn about it?
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Old July 3rd, 2010, 12:18 AM
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Hopefully it is just the season that is making Akane less active I know Duffy was like that even before the CRF always a bit more sleepy during summer.

for the next test results

Sorry I missed this question earlier:
Quote:
And I'm thinking about using slippery elm bark. Is every product same?
There is some info here on SEB http://www.littlebigcat.com/?action=...em=slipperyelm SEB should be given about 2 hours before/after any other medication/supplement as it may interrupt the absorption.

I purchased it from a reliable health food store so I knew I was getting the real thing. You should make sure it is pure slippery elm bark with no extra ingredientss added.

I am more familiar with Classic Homeopathy as that is what Duffy's vets/homeopaths were focused on, I have also used some classic single remedies myself.

The combination remedies, while they may seem simpler at first, are not tailored to a specific individual and their needs, it's more of a broad patient spectrum remedy.

Classic homeopathy is more individual, focused on the patient & every aspect of their health. In most cases 1, though sometimes 2, remedies are given for the same time & the effects are then noted & remedy(ies) adjusted as needed. Of course there are general pain, fever, nausea etc remedies that are known to be useful for most if not all patients, though the potency may vary.

The Healthy Pet Journal has some info

What is Homeopathy? opens as a .pdf

Alternative Vet also has some good info
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Old July 3rd, 2010, 10:26 AM
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Quote:
Originally Posted by growler View Post
for the next test results
Thank you!

I see.. I asked the holistic vet about classical homeopathy, too, but she said that classic one would work better when a problem is more specific and suggested not for current Akane because he doesn't have symptoms at the moment. I was a bit disappointed because I was also hoping a delicately tailored treatment for him. But she told me that she experienced combination remedy (she didn't mention the name but perhaps it's solidago comp.) worked quite significantly to kidney cats. Having heard it, I looked for more info on the internet and found several similar reports using solidago comp. So I wanted to learn more about whole homotoxicology thing. I hope there is something homeopathic treatment can do now? rather than later? I don't want to just wait until he gets worse..

Thank you for the informative links! I'll try to find out more.

I didn't know that slippery elm bark is good not only for intestinal problems but for many other things incl. bronchitis and asthma. Wonderful herb! I'll take it for myself, too, then. I've bought NOW product. Hope it's good.
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Old July 4th, 2010, 11:11 PM
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The holistic vet you spoke to isn't trained in Classic Homeopathy, so she's just going with what she knows, and Akane's numbers are good right now , but I know how you feel wanting something to help now - that's why/when I turned to a Homeopath Vet.

I really am not familiar with combination remedies, and the different effects of various ingredients acting with each other.

With classic homeopathy you really need a trained professional to ask in depth questions to find what the imbalances are throughout the body to find the right remedy for each pet/person. There are various remedies that are associated with certain conditions or symptoms but sometimes the remedy that is most called for isn't one that is usually associated with a certain condition/issue. For example Duffy's main remedy wasn't a traditional kidney related one but it balanced everything else & that had brought the kidneys closer to where they should be.
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Old July 5th, 2010, 08:34 AM
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Quote:
Originally Posted by growler View Post
The holistic vet you spoke to isn't trained in Classic Homeopathy, so she's just going with what she knows
Yes, that's how I felt, too. It may not be easy to find but I'll try look for a homeopath that I could consult with. It's so hot and humid that both cats are "flat" most of the day. I'll post the result soon. Thank you for your help
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