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Old April 27th, 2013, 10:30 PM
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Sam's CRF/CKD is Worse - new vet as well

Sorry but this is going to be a long post.

I took Sam to the vet this week because he has been pulling the fur out of his belly for a few months now and I have wondered if he is in pain. He also was very constipated having very dry stools until I put him on coconut oil a few months ago. My vet retired last year and this was my first visit to the vet that took over. I initially was apprehensive about taking any of my cats to a new vet, but I liked the new vet and she is well qualified on paper, having a PhD in veterinary science.

So she weighed Sam and he has not lost or gained any weight but is still fat at 23.2lbs. He is a large cat who should weigh between `16 and 18lbs if he wasn't overweight. He will be 17 years old in July and has weighed roughly the same give or take a lb or 2 since his brother died in the year 2000.

For the last 6 years Sam has been treated for struvite crystals. Initially with Royal Canin SO prescription food until he finally stopped having bloody urine and stopped producing the crystals.

In late 2011 he was diagnosed with CRF by my old vet but the only abnormality in his blood work was his creatinine level. The results were

Creatinine 224 mmol/L/l normal range 50-177 mmol/L/l
BUN 11.1 mmol/L/l normal range 5-13 mmol/L/l

this was not unexpected because of the length of time and severity of his crystal problems. He had one episode where he was completely blocked before I got him to the vet.

So on Wednesday I took him to the new vet. She was very concerned about his weight despite the fact that he has weighed approximately that for a very long time and it has been a challenge trying to get him to lose weight mainly because I have 4 cats and he chooses to eat their food as well as his own.

She noted the fact that his belly looked like it had been shaved due to the fur pulling. I also mentioned the fact that he has had asthma for a few years that I have been unsuccessful getting him to use the aerokat inhaler with flovent to relieve his occasional wheezing, he has never had a severe asthma attack. He also tends to have a clicking sound when he walks that I thought was coming from his left hip because I am forever finding matts in his fur over that hip and brushing them out. He did have a problem with very dry stools and constipation until I started giving him a daily spoonful of Coconut Oil which completely cleared up his constipation. I also told her about that as well as the fact I give him UbaVet (glucosamine,chondroitin, msm and other supplements) daily which has improved the clicking sound.

She examined his abdomen, put his left hip through complete range of motion without hearing the clicking sound and listened to his heart and chest. She could not hear any wheezing and he was purring so loudly she also couldn`t hear his heartbeat. His ears and eyes were clear and she clipped his nails.

She recommended an abdominal xray and I told her I wanted blood work done to evaluate his crf and compare the new results to the previous ones. She asked what I was feeding him and I told her he was eating mostly canned food Wellness and Nature`s Variety Instinct. She told me I would have to stop the canned food and give him Prescription kibble because he should not be eating canned food... first thing I wasn`t happy with. (In the office now, where my old vet used to keep animals up for adoption is a wall size display of different types of Royal Canin kibble... no canned food at all.)

So after her repeating over and over about the need for an abdominal xray because she couldn`t feel anything wrong in his abdomen I agreed to it. I also wanted to know there was nothing wrong because he was pulling his fur out on a regular basis especially immediately after he ate. She also said that his weight was causing all of his problems.

So the xray and blood work were done. She showed me the xray when it was developed and it had been taken with Sam lying on his right side and it showed that 1) he wasn`t constipated 2) his kidneys were normal sized 3)his bladder was small and empty 4)there were no signs of any stones in his kidneys or bladder 5)no evidence of a tumour or other mass in his abdomen 6)there was no arthritis or other abnormality of his left hip 7)you could see the fat cells protruding from his entire abdomen. So absolutely normal xray for a 17 year old cat.

She then talked about the prescription food again and I just listened and said nothing at all because I got the distinct feeling that she was not willing to discuss any alternates to prescription food.

She said she thought he had probably torn his cruciate ligament in his left hind knee and that was what was making the clicking sound. Then she said she would discuss pain killers for him once she had the blood work back the next day. Since one of my dogs tore the cruciate ligament in both of her knees, one after the other, I am very aware of how weak a leg is when an animal has a torn cruciate and Sam shows no signs of having weakness in his knees so I highly doubt this is his problem.

She also said that he had been wheezing while she was drawing the blood from his jugular vein and that he had asthma. For that she would recommend I put him on a daily dose of prednisone to control his asthma. What I found stupid about that suggestion is the fact she wants him to lose weight and prednisone causes weight gain when given continuously.

The next day she called me with the results of his blood work. She said his kidney disease was definitely apparent and that I needed to put him on Royal Canin Renal LP DRY.. gawd knows why dry.. I didn't bother to ask. I asked about a pain killer and she said we'll wait until he's eating the prescription food.

I told her we'd tried it before and he wouldn't touch either dry or canned. It became a joke when I tried the canned because he might eat 1 tablespoon a day canned but refuse the rest. I always ended up throwing the can away on the third day with more than half the food uneaten. She also wants to provide me with some special litter to get a urine specimen from him. I have to isolate him until he pees in the litter, which is also going to be a problem because as king of the cat family he resists any form of separation from the others, but I'll try it to see if it works. It remains to be seen if Sam will use the litter.

The blood work results I had to ask for each result because she did not want to give me details. I finally got his BUN and Creatinine out of her:

BUN 15 mmol/L/l normal range 8-12.5 mmol/L/l
Creatinine 227 mmol/L/l normal range 130-212 mmol/L/l

She also wants to put him on a supplement called Azodyl which I read is effective in crf cats. I told her I want a copy of all of his blood results when I pick up the litter and the Azodyl and she reluctantly agreed.

I have my doubts that I am going to be able to discuss diet with her, she is quite insistent that prescription kibble is what a cat should eat. That is not going to happen, so this is my first problem with her. The fact that she doesn't seem to take no for an answer, also concerns me. She also didn't listen to my statement about not having a lot of extra money to pay for unnecessary vet bills when she suggested I take him to a groomer for a bath to help control his dandruff that he's always had. His fur has a double coat like a chartreux and needs brushing daily to keep the dandruff down, but it's always been that way since he was a kitten. I also was rather surprised that she did not seem to have access to his previous file, which I know my vet left for their use. If she has no background information about my cats then there is little reason not to change vets.

I don`t think she listened to much of what I said to her and she was very insistent that I have the xray done and about changing him to a Prescription kibble, not even prescription canned food.

I have been considering making food for him here at home using Dr Strombeck`s ckd recipes and other recipes that have been posted by vets on the internet. I do know I will know a lot more when I get the full blood test results and be much more able to decide how bad he actually is. Thanks for any help you can give me...

I have referred to both http://www.felinecrf.org and http://www.felinecrf.com on a regular basis since he was first diagnosed as well as several other sites linked from their pages but have yet to find foods that he will eat and are low enough in high quality protein and phosphorus to provide him with a proper diet. Any suggestions beside Wellness, Nature`s Variety Instinct or Weruva?

So my questions to everyone especially growler and SCM are: the blood work results do not appear to me to be much worse than they were a year and a half ago. I know he has ckd but the change in his levels really don`t make me feel that he is considerably worse since his first blood work showed crf 1 1/2 yrs ago. I only see a slight elevation in his BUN and a mild worsening of his creatinine. Should I increase the restrictions I`ve placed on him and get really serious about his diet. What would you do if he were your cat?

I would also like some suggestions on what to say to her about an obligate carnivore`s best diet enough that she will know I do know something about feeding cats with kidney disease and what a proper diet should be. If it were my old vet I would definitely tell her what I thought of kibble for cats with ckd, but she would have recommended canned and did when he was first diagnosed. This vet comes across as fully believing her knowledge of prescription foods for cats and that kibble is preferable to canned.

I have been trying him with Almo Nature Chicken and Salmon & Chicken and he really likes them but they do not appear to be a complete diet so he needs something else to go with it. Sam has also been getting Merrick Cowboy Cookout at times which is supposed to be low in phosphorus. I have also been feeding them Oven Baked Chicken Kibble which seems to agree with all of them. However I am not sure of the protein or phosphorus content of either. They do not appear in any of the websites I`ve seen that have that information.
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Last edited by dbg10; April 28th, 2013 at 01:57 PM.
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Old April 28th, 2013, 10:31 AM
Barkingdog Barkingdog is offline
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My dog Marty had struvite crystals and he has gotten better, but his stools are dry and the vet said he need to drink more water. Your cat may not be drinking enough water , can you add some water to Sam' food to increase his intake of fluid? I knew my dog does not drink enough water and I will have to buy some chicken or beef stock that is unsalted to get Marty to drink more. I hope your cat will feel better soon.
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Old April 28th, 2013, 10:47 AM
pattymac pattymac is offline
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I would say considering he's 17 and other than a few issues he's a happy cat, you do what you feel is best for him! I've put my guys on prescription diets for crystals but once they are feeling better then I take them off. I think though I do have to change food. I got a few cans of the sensitive from the vet for Coco and there's been no more throwing up. So I don't think what I've been feeding has been agreeing with everybody. I add a few tablespoons of water to their food which helps and limit crunchies to a handful or two at night.
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Old April 28th, 2013, 02:27 PM
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Thanks Barkingdog and Pattymac I appreciate your response. BD the reason canned food is so important to Sam is because it has more water than kibble so that's why I didn't understand why she wanted him on kibble. I usually add extra water to his canned food and he does drink a fair amount of water.

Patty one of my other cats Smokey, has an ongoing problem with vomiting up his food. I have found that he tolerates Chicken as long as it's grain free and beef grain free and always starts to gain weight again(he had lost a lot of weight when he started this food intolerance a couple of years ago) I've had a hard time getting him to eat what he can tolerate because he likes variety in his diet. He is also a junk food addict and cleans off any human plates that are left out of the dishwasher by mistake. He's forever trying to steal human food too so it's an uphill battle. I tried the prescription sensitive with him while my old vet was still around but he refused to touch it.

Sam on the other hand will eat anything in the way of cat food dry or canned. He was on RC SO for the crystals for ages until they finally cleared up, but it took some doing to get him to eat it at first and he wouldn't eat the canned, just the kibble. I finally stopped it when he was diagnosed with crf because it is not good for crf cats because the protein and phosphorus levels are too high in SO.

I agree with you about him being 17 and happy. I guess I am just trying to decide what I plan to do with him. I know when I get a copy of his full blood work I'll know better what I want to do. I was an RN and can definitely understand the blood test results but have to use the information I've found where the values relate to cats, not people. That`s the main reason I asked what people thought about his BUN & Creatinine results.. how much worse are his kidneys in the space of time.

The major thing I see with him is the fact he`s pulling the fur out of his entire belly area right after he eats. I see no other signs that his ckd is any worse, despite the increase in his BUN now. Other than that he has had no changes in behaviour at all.
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Old April 28th, 2013, 09:41 PM
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The difference between the previous tests & this latest one is not a bug jump by any means, I would say at this point he is fairly "stable", meaning gradual changes.

Regarding the fur pulling - did this start after a specific event? ie change of food, adding the coconut, moving, change in household dynamics, new detergent, etc ?
It's usually displayed as a self stress reliever or as an intolerance reaction to something either in the environment or that they're ingesting or lacking as in Vit B deficient.
Fur pulling can also be a symptom of HyperThyroidism - for that diagnosis you would need a T4 (Thyroxine) blood test add-on unless it was done already within the Geriatric panel.
I've not had any personal experience with fur pulling.

Personally I would start the Azodyl, Duffy had good results from that.

I would either have the food discussion with the vet if you are comfortable with this one & want to stay or find someone more willing to work with you.

If you stay with this vet you can always tell them you are not willing to further compromise the health of Sam's kidneys by feeding him a food that is almost completely devoid of the moisture his body & kidneys so desperately need to function normally that you will not discuss diet with them.
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Old April 29th, 2013, 09:03 AM
Barkingdog Barkingdog is offline
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Originally Posted by dbg10 View Post
Thanks Barkingdog and Pattymac I appreciate your response. BD the reason canned food is so important to Sam is because it has more water than kibble so that's why I didn't understand why she wanted him on kibble. I usually add extra water to his canned food and he does drink a fair amount of water.

Patty one of my other cats Smokey, has an ongoing problem with vomiting up his food. I have found that he tolerates Chicken as long as it's grain free and beef grain free and always starts to gain weight again(he had lost a lot of weight when he started this food intolerance a couple of years ago) I've had a hard time getting him to eat what he can tolerate because he likes variety in his diet. He is also a junk food addict and cleans off any human plates that are left out of the dishwasher by mistake. He's forever trying to steal human food too so it's an uphill battle. I tried the prescription sensitive with him while my old vet was still around but he refused to touch it.

Sam on the other hand will eat anything in the way of cat food dry or canned. He was on RC SO for the crystals for ages until they finally cleared up, but it took some doing to get him to eat it at first and he wouldn't eat the canned, just the kibble. I finally stopped it when he was diagnosed with crf because it is not good for crf cats because the protein and phosphorus levels are too high in SO.

I agree with you about him being 17 and happy. I guess I am just trying to decide what I plan to do with him. I know when I get a copy of his full blood work I'll know better what I want to do. I was an RN and can definitely understand the blood test results but have to use the information I've found where the values relate to cats, not people. That`s the main reason I asked what people thought about his BUN & Creatinine results.. how much worse are his kidneys in the space of time.

The major thing I see with him is the fact he`s pulling the fur out of his entire belly area right after he eats. I see no other signs that his ckd is any worse, despite the increase in his BUN now. Other than that he has had no changes in behaviour at all.
I would think it would harder to eat kibble at his age , maybe you should ask the vet why he/she want your cat to have kibble
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Old April 29th, 2013, 12:49 PM
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Thanks so much for your help growler. That is exactly what I thought about his BUN and Creatinine because after reading your thread about Duffy, her blood work certainly changed quite radically compared to Sam's over a similar period of time, while you were treating her with raw and homeopathic remedies. You did a fabulous job with her BTW and it almost makes me want to find a good homeopathic vet but doubt if I have the $$ to do it.

About the fur pulling, it seemed to start after I started changing foods. Years ago before I joined any forums, all of my cats were on Iams kibble with fancy feast canned. Then Sam developed crystals and I had a heck of a time trying to get him onto RC SO as he hated the stuff. After a crisis when his bladder was blocked he finally accepted the RC SO kibble but not the canned.
He was on that for about 2 years trying to reduce crystal formation and get his urine clear of blood.

Then Smokey lost almost 3lb of weight about 4 years ago and I had also joined the forum by then so I had learned a lot about nutrition for cats. So I started introducing newer much higher quality foods to get Smokey to stop vomiting. I have struggled to find at least one or two foods that were high quality and all of them were able to eat.

By that time (2011) Sam had been diagnosed with CRF and I had to take him off the SO and we tried the low protein canned. He would have nothing whatsoever to do with the kibble and as I said above the canned wasn't much better.

I think it was about a year ago when I really noticed he had an obsession with pulling the fur out of his belly. (years ago in the early 2000s after his brother died, he started pulling all the fur out of the top of his front paws and that lasted for 2 years and stopped on it's own)

I assumed this time it was related to food because that was the only major change other than Raggs passing away which they all reacted to. I find if I rub his belly gently he stops pulling the fur out. He seems to only do it immediately after eating though I don't watch him all the time but that is definitely the time when it's the worst. It made me think that when he eats he is getting cramps in his tummy but no proof of that.

I also noticed late last fall that he was constipated and added coconut oil to his diet which has cured that problem. What I learned through elmination diet was that he seemed more likely to pull the fur out after he'd been fed canned chicken cat food. So I started him on beef and salmon excluding chicken but it didn't seem to consistently stop his fur pulling. In the last few weeks I've been switching him to Wellness and NV Instinct, but he is not impressed with either of them. I am still playing with the foods to find a couple he will eat that are good for his CRF and he will eat consistently. I am thinking I may have to try raw but know that feeding all of them raw will be very expensive unless I make it myself.

I still am waiting for them to get back to me about the Azodyl coming in (in fact it isn't azodyl, it's another drug that the vet said is exactly the same but in powder form so I can add it to his food rather than give him a pill). Also the special litter for his urine specimen and I plan to pick up a copy of ALL of his blood work including a T4 that was done. I am looking forward to that so that then I can really find out how bad his kidney function actually is and if there are any other borderline abnormalities that she didnt tell me about. It was like pulling teeth trying to get his blood work, if I didn't ask for the results of each specific test, then she didn't tell me what it was.

I love what you said I should say to her... that is prefect for getting her off her kibble fascination. I was so surprised they had absolutely no canned food on display, yet had every possible variant of the different prescription kibbles.

BD Thanks I probably will start by asking her why he shouldn't have canned food and then tell her what growler suggested. That will probably eliminate any discussion on diet.
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Old April 29th, 2013, 02:01 PM
Barkingdog Barkingdog is offline
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I will not buy Iams pets for this reason.
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Old April 29th, 2013, 05:50 PM
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http://www.iamscruelty.com/



I will not buy Iams pets for this reason.

doesn't surprise me in the least.. they are unscrupulous as far as I'm concerned. My cats haven't had Iams since way back in the mid 2000's before they became a grocery store food, None of my dogs were ever given Iams. Raggs came with Iams and Pedigree mixed and I quickly changed him to a much better food then shortly thereafter I put him on a homemade diet and he never had any kibble or canned after that. I had not seen that website before, thanks BD
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Old April 30th, 2013, 01:45 AM
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I still am waiting for them to get back to me about the Azodyl coming in (in fact it isn't azodyl, it's another drug that the vet said is exactly the same but in powder form so I can add it to his food rather than give him a pill).
Is it a phosphorus binder instead?
For some unknown stupid reason they manufactured some phos binders for pets with mint flavouring usually doesn't go over too well unless it's given to a dog. If it is a phos binder make sure it's flavourless & if not ask for the composition (ie is it aluminum or calcium based) & you can then ask your local pharmacy for the odourless/tasteless version with the same composition.


Have you ever needed to pill Sam? How did he react?

A cautionary note on mixing powder into food ~ Given how fussy he seems to be with food, if there is the slightest hint of flavour to the powder he may refuse to eat it - which can lead to a refusal to eat whatever brand/flavour it was added to.

Some cats are fine with extra stuff mixed in to the food, but sometimes it's just easier/faster to pill them.
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Old April 30th, 2013, 07:35 AM
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I still am waiting for them to get back to me about the Azodyl coming in (in fact it isn't azodyl, it's another drug that the vet said is exactly the same but in powder form so I can add it to his food rather than give him a pill).
Would that be the Renal Advanced powder by Candioli? It's not exactly the same as Azodyl, but uses the same premise that probiotics help "clean up" the nitrogen waste by-products in the intestinal tract. If it is the Renal Advanced, introduce it very gradually by starting with a quarter or less of the recommended dose, then work up over many days (or more) to the full amount. Aztec was taking it for a little while, but honestly, I think a human probiotic from the health food store is a more potent option.
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Old May 1st, 2013, 03:41 PM
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Originally Posted by growler~GateKeeper View Post
Is it a phosphorus binder instead?
For some unknown stupid reason they manufactured some phos binders for pets with mint flavouring usually doesn't go over too well unless it's given to a dog. If it is a phos binder make sure it's flavourless & if not ask for the composition (ie is it aluminum or calcium based) & you can then ask your local pharmacy for the odourless/tasteless version with the same composition.


Have you ever needed to pill Sam? How did he react?

A cautionary note on mixing powder into food ~ Given how fussy he seems to be with food, if there is the slightest hint of flavour to the powder he may refuse to eat it - which can lead to a refusal to eat whatever brand/flavour it was added to.

Some cats are fine with extra stuff mixed in to the food, but sometimes it's just easier/faster to pill them.
Apparently the powder is called something like "RENO" she didn't spell it for me but she said it's the same as Azodyl. I will be calling them a little later today to find out if it's in and if they have everything I want eg the special litter, and the copy of his blood work.

Sam used to get Buscopan pills which are tiny white tablets. It usually took some doing to get it down his throat as he'd hold it in his mouth and then a few minutes later spit it out. However when he recognized he needed the pill he would let me toss it down his throat without a problem. The azodyl looks like large capsules to me, I have no idea how large they are though. I think I would have a heck of a time getting them down his throat and you can't open them up.

I am concerned about adding the powder to his food. It's only in the last month or so that he's been refusing to eat the food that has UbaVet in it but I do know they have changed the formula by adding green lipped mussels and a variety of herbs to it and this may be what he's objecting to. The next bottle I will ask if they have the plain one with just glucosamine,chondroitin & MSM in it to see if that's the problem. The chewable tabs only have those 3 in them, and I may have to try them. However, he has totally refused any chewable tabs in the past no matter what they were.

This past week I have been low on the cat food he likes and he hasn't been eating as much as he usually does. I am very concerned about that.. the very last thing I want is for him to stop eating. However, he also hasn't been pulling the fur out of his belly very often either, so something is going on. I just can't wait to get my hands on the blood work.

Thanks growler for the help you've given me, your thread about Duffy is fantastic as well.
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Old May 1st, 2013, 03:59 PM
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Originally Posted by sugarcatmom View Post
Would that be the Renal Advanced powder by Candioli? It's not exactly the same as Azodyl, but uses the same premise that probiotics help "clean up" the nitrogen waste by-products in the intestinal tract. If it is the Renal Advanced, introduce it very gradually by starting with a quarter or less of the recommended dose, then work up over many days (or more) to the full amount. Aztec was taking it for a little while, but honestly, I think a human probiotic from the health food store is a more potent option.
Thanks SCM as I mentioned to growler all she did was call it "Reno" or something like that. I suspect the product you are talking about is the one she has ordered for me. I agree with you that a human probiotic may be the answer to help him. Do you have any suggestions for a human renal probiotic?

Also thanks for the suggestions on how to introduce it in his food, that is exactly what I planned to do because I want him eating and I sure don't want to turn him off his food.

What I also found a little strange was she kind of poo-pooed the idea of Ubavet helping him because "it was only a supplement". Then when it came to mentioning azodyl she said, it "would help his kidneys enormously".. even though telling me it was a supplement as well. It just seemed odd that one supplement she doesn't think does anything for him, when I've seen it work with all my dogs and with Sam. When he is taking it regularly I don't hear the clicking when he walks. Again I think I'll be looking for a new vet but I will finish off with her by hopefully getting the urine specimen and having it analysed.

Just talked to the vet's office and it was the vet tech I know really well. She is printing off the blood work, getting the no sorb litter and the powdered reno (whatever) together and we'll be picking it up tonight. So I'll post all his results when I get home.
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Last edited by dbg10; May 1st, 2013 at 04:02 PM. Reason: addition
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Old May 1st, 2013, 04:47 PM
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Thanks SCM as I mentioned to growler all she did was call it "Reno" or something like that.
I wonder if she might also be talking about Renavast, although that's nothing like Azodyl (consists of amino acids, not probiotics). I'm curious to know what the product is so do tell us when it comes in.

The human probiotic I use for Aztec is Natural Factor's Ultimate Multi. MegaFood's MegaFlora is also a good one but more expensive.
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Old May 1st, 2013, 10:16 PM
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Ok I picked up the supplement and a copy of Sam's blood work

The supplement is called "Renal" (I am copying directly from the box) and says it is a "new palatable powder" so I assume their first attempt was rejected by every cat that was given it.
It also says it "helps in improving renal function balance" The Composition of the powder are: maltodextrin, calcium carbonate, chitosan, with additives of kg preservatives: potassium citrates E332 mg 320,000
Analytical Constituents: Moisture 4.0%, crude protein 7.0%, crude fiber 1.0%,
Indications: "helps in improving renal functions conditions. It is suited to complement treatment during acute stages either or alone in association with specific diets, following your veterinarian advice. In most advanced stages Renal cats can be administered in combination with Renal Advanced Cats." (please remember I am copying directly from the box.)

I am not impressed with the ingredients they've used I have my doubts it will do anything for Sam. It is made by the same company you mentioned SCM Candioli but is not the same product.

Sam's Blood Work results were the following:

Total Protein 79 norm range 52-88
Albumin 39 norm range 25-39 not marked but I notice it's borderline high
Globulin 40 norm range 23-53
A/G ratio 1.0 norm range 0.35-1.5

BUN 15.0 norm range 5.0-12.9
Creatinine 227 norm range 53-212


BUN/Creatinine Ratio 66 (there is no normal range mentioned and its not marked as abnormal

Phosphorus 1.37 norm range 0.77-2.65
Glucose 7.1 norm range 3.5-9.4
Calcium 2.67 norm range 2.05-2.70 not marked but near top end of range
Sodium 154 norm range 145-158
Potassium 4.6 norm range 3.4-5.6
sodium/potassium ration 33 norm range 32-41

Hemoglobin 151 norm range 93-159
Hematocrit 44 norm range 29-48
red blood cells 9.0 norm range 5.9-9.9
Platelet count 279 norm range 200-500

Those are most of the tests that mean anything and again the only abnormal results are for his BUN and Creatinine. He is not anemic as I thought he might be as shown by the red blood cell count and his hemoglobin. He is not dehydrated as shown by his hematocrit. His bone marrow is producing red blood cells and platelets adequately and the tests done for liver disease or pancreatitis were all normal too.

So I picked up some NVInstinct tonight. a can of Wellness Chicken and I`ll see if he will eat them. The last time I tried Wellness Chicken he wouldn`t touch it.

I don`t think I`m going to give him the Renal supplement because I honestly don`t think it will do anything for him. I would like to hear what SCM and Growler think of the supplement before deciding to give it to him.
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Old May 2nd, 2013, 07:37 AM
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This new vet is an idiot if they think the Candioli Renal supplement is the same thing as Azodyl. "Renal" is a used as a phosphorus binder (that's what the calcium carbonate and chitosan do). Does not contain a single probiotic. Azodyl contains only probiotics.

What Renal IS similar to is Epakitin, from the same company that makes Azodyl. So perhaps that's where her confusion lies. But still! I mean seriously, if you're going to be prescribing supplements to your clients, at least know what the frig they are!!!!

And Sam's phosphorus levels are not too high so I don't think a phosphorus binder is essential at this point. Plus they can cause constipation so if he's at all prone to that, use with caution.
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Old May 2nd, 2013, 01:38 PM
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Originally Posted by sugarcatmom View Post
This new vet is an idiot if they think the Candioli Renal supplement is the same thing as Azodyl. "Renal" is a used as a phosphorus binder (that's what the calcium carbonate and chitosan do). Does not contain a single probiotic. Azodyl contains only probiotics.

What Renal IS similar to is Epakitin, from the same company that makes Azodyl. So perhaps that's where her confusion lies. But still! I mean seriously, if you're going to be prescribing supplements to your clients, at least know what the frig they are!!!!

And Sam's phosphorus levels are not too high so I don't think a phosphorus binder is essential at this point. Plus they can cause constipation so if he's at all prone to that, use with caution.
When I saw the ingredients on the package I really wondered what she was thinking. It also goes along with her statement about Ubavet "only being a supplement" yet this so-called supplement is supposed to almost cure his ckd... it was very weird. I don't think she knows her Canadian meds but even so, it's useless for Sam. I looked at his phosphorus level and didn't think it was worth adding a phosphorus binder except if the food I was feeding was high in phosphorus. I would probably use crushed egg shells before I'd use this stuff she prescribed.

I am wondering about his calcium level though and adding calcium carbonate to his diet. It seemed in the upper range of normal and I wouldn't want to push it higher with his diet. What do you think SCM?

Thanks for the name of the human probiotic I will pick it up when I have a chance.
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Old May 2nd, 2013, 07:37 PM
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growler can you please tell me how large the Azodyl capsules are? I am wondering if I could pill him with them since this supplement the vet gave me is next to useless as a probiotic.

I may try the human probiotic that SCM uses for Aztec and that would eliminate any vet products. I also intend to call the vet tomorrow and ask why she thought he needed a phosphorus binder when his phosphorus is not elevated. I think the call will probably stir up a hornet's nest, but we'll see.
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Old May 2nd, 2013, 08:32 PM
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good luck with everything. It's quite amazing how much things have changed with regards to kidneys in the the last few years! My first cat had major kidney issues in his last year and there was nothing really to do. Little better for my second cat. I'm glad to see this as Coco's going for bloodwork on Monday and now I know there's things they can be given to help!!
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Old May 2nd, 2013, 11:35 PM
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I am wondering about his calcium level though and adding calcium carbonate to his diet. It seemed in the upper range of normal and I wouldn't want to push it higher with his diet. What do you think SCM?
There is that potential, so something to keep in mind for sure. From Tanya's CRF page: http://www.felinecrf.org/phosphorus.htm#calcium_binders

Quote:
Calcium-Based Binders
  • Calcium Acetate
  • Calcium Carbonate
  • Ipakitine/Epakitin
  • Renal

Sometimes your vet will recommend using a calcium-based antacid such as Tums or PhosLo as a phosphorus binder. These are not an ideal choice because:
  • these binders are not as effective as binders containing aluminium hydroxide;
  • they may make your cat's calcium levels rise too high (hypercalcaemia).
Hypercalcaemia in cats (2001), a paper by Dr Chew presented to the World Small Animal Veterinary Association World Congress 2001 mentions that using calcium-based binders may cause hypercalcaemia. Thus, if you are using a calcium-based binder, frequent monitoring of blood calcium levels is essential. You should not use a calcium-based binder if your cat is taking calcitriol.
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Originally Posted by dbg10 View Post
growler can you please tell me how large the Azodyl capsules are?
If you scroll down a bit, there's a pic of the 2 sizes of caps available next to a quarter for comparison: http://www.felinecrf.org/treatments_...ion.htm#azodyl

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Originally Posted by dbg10 View Post
I also intend to call the vet tomorrow and ask why she thought he needed a phosphorus binder when his phosphorus is not elevated.
After reading more on Tanya's page about the similar product Epakitin, perhaps it's more for chitosan's supposed uremic-toxin absorbing capabilities than for the phosphorus binding factor. http://www.felinecrf.org/treatments_...ipakitine_what
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Old May 3rd, 2013, 09:09 AM
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Pattymac sorry to hear about your first two kitties. Good luck with Coco's blood work I hope his levels are low enough so you are able to take advantage of the new treatments.

SCM thanks for all the links to Tanya's information. I have been using them since Sam was diagnosed several years back but there is so much information there, I find it hard to keep track of what is there, and what isn't and where things are located. Her website has to be the most comprehensive information on the web today. Also for the link to the Azodyl capsule sizes. You also have done so much investigation into diets for kitties, I really admire your knowledge. Thank-you for sharing it with me. Growler is another one who has an encylopedic knowledge of CKD. I thank you for also sharing her knowledge with me for Sam's benefit.

I am not sure what time I am going to call the vet because it seems to always be busy there now because they are down one vet tech. But I do want to ask about the "Renal" because I have a feeling he will fight me when I try to give it to him.

I introduced a small amount of NV Instinct Turkey last night, one can split among 4 cats so it really wasn't much and I also had other food in their bowls. Well not one of them ate it. They totally ignored it and ate everything else in their bowls. That was the only flavour that Global had in stock, so when my son went in, he didn`t have a choice.

I will post the reason the vet ordered Renal after I talk to them. Thanks again!
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Old May 3rd, 2013, 04:43 PM
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so I talked to the vet tech that is the one I know and she told me that the phosphorus binder would help his kidneys the same as Azodyl does. So here I go again talking to people who know absolutely nothing about diet or supplements used in CKD.

So I told her that the vet had told me the supplement was the same as Azodyl and since Azodyl is a probiotic, it seemed more appropriate than giving him a phosphorus binder when his phosphorus level is not yet elevated.

I then mentioned that the company also makes Renal Advanced which is a little more similar to Azodyl and she agreed that they carry both of them. She told me if I want the Renal Advanced instead she would talk to the other vet. She called me back to tell me that the Renal Advanced was for very advanced kidney disease and they didn`t think it was appropriate for Sam, but if I wanted it they would exchange the Renal for the Renal Advanced formula. I told her I`d get back to her on Monday with my answer after looking into it further. When I looked at the composition of Renal Advanced it does have some vitamins in it but seems to only have two probiotics in it and only one I think that's the same as Azodyl:

Composition of Renal Advanced: Maltodextrin, Fructooligosaccharides, Lespedeza capitata dry extract (titration 4% in Rutin), Orange bioflavonoids (titration 40% in Hesperidine), Vitamin C, Enterococcus faecium SF68 (10 bln/g), Vitamin B6, Lactobacillus acidophilus DSM13241 (50 bln/g), Folic acid, Vitamin B12


So what do you think SCM? It would probably be better to get the human probiotic that you recommended instead of either of them.

I did look at the two capsule sizes against the size of a quarter on Tanya`s site and the smaller cap still looks too big to shove three down his throat a couple of times a day.

When I was reading her website I noticed there is a human form of Azodyl called Renadyl and it has twice the number of bacteria in it and the capsules have been taken apart and given to the cat mixed with a small amount of fatty food with success. I just wondered SCM if you have heard of this being used? However it does look like it's expensive, definitely more expensive than the human probiotics you recommended.

So I probably will decide to give Sam one of the human probiotics and hope it works to lower his BUN.

Thanks again SCM for your help with this decision I have to make.
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Old May 5th, 2013, 12:45 AM
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growler can you please tell me how large the Azodyl capsules are? I am wondering if I could pill him with them since this supplement the vet gave me is next to useless as a probiotic.
I honestly had no issues pilling the Azodyl, and at that time there was only the 1 larger size available. Despite how small a cat's mouth seems to be, they can get that size capsule down without issue. You can always slather the capsule in a bit of butter to make it slippery going down.

I know it's recommended not to open the Azodyl but some people do & mix it with a small bit of food or butter etc to make sure the cat gets all of it, then feed regular meal later, according to Tanya's site those that do are still having success with the intended outcome of the product.
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Old May 5th, 2013, 01:05 PM
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I honestly had no issues pilling the Azodyl, and at that time there was only the 1 larger size available. Despite how small a cat's mouth seems to be, they can get that size capsule down without issue. You can always slather the capsule in a bit of butter to make it slippery going down.

I know it's recommended not to open the Azodyl but some people do & mix it with a small bit of food or butter etc to make sure the cat gets all of it, then feed regular meal later, according to Tanya's site those that do are still having success with the intended outcome of the product.
Thanks growler. A question had you pilled Duffy before you had to give him Azodyl and how easy was it to pill him before?

I have been Pilling Sam at times with Buscopan which is a very small tablet. Sometimes it went down his throat easily if I got it to the back of his throat but other times he would hold it in his mouth and a few minutes later spit it out despite the fact I rubbed his throat to get it down. Obviously I didn't get it back far enough those times.

Then there were times when he seemed to know it helped him and just literally took it out of my hand and swallowed it. I believe those were the times when he was having a lot of bladder spasms and knew it helped him.

So I'm not sure about the Azodyl, I had read about people opening the capsule on Tanya's site but also saw it seemed to depend on what they put the powder in.. butter seemed to work the best for absorption of the probiotics.

I will be calling them tomorrow to tell them what I want, I may ask them about the smaller caps of Azodyl but since I have to give him 3 at a time, I just feel I'm going to have trouble with Sam but I may be surprised.

They don't seem to know much about the different things available and how they work because they told me they all work the same to improve kidney function. Obviously they don't work the same or Azodyl wouldn't have the reputation it does.

Thanks again growler
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Old May 7th, 2013, 10:46 PM
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A question had you pilled Duffy before you had to give him Azodyl and how easy was it to pill him before?
I did on occasion have to pill her prior to the Azodyl, she was really good about it but if I didn't get it far enough back she would hold the pill in her mouth & spit it out even with rubbing the throat

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 them 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 & 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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Old May 15th, 2013, 09:18 PM
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Thanks growler I will definitely try your method, that's how I eventually was able to get some antibiotics down Sam's throat a few years back. It always seemed to work because he couldn't see what I was planning to do until I did it.

Sorry for the delay in answering you, had a major plumbing problem and got tied up with that and didn't get back to the vet either with my decision. She should be back from the week's holidays she was taking when I last called, so it's probably a better time to discuss the advantages of each item she suggested. I had planned to pick up the human probiotic that SCM mentioned but haven't had a chance yet.

I was doing some reading about chitosan and it sounds like it does some really good things for cats with CKD. I wonder if I should give Sam the Renal in his food and see if it helps him. I was also thinking of adding the human probiotic as well if he'll tolerate both of them.

If you see this growler or SCM, what do you think of my idea?
thanks again for all the help you've given me, it's invaluable..
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Old May 15th, 2013, 10:11 PM
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I wonder if I should give Sam the Renal in his food and see if it helps him. I was also thinking of adding the human probiotic as well if he'll tolerate both of them.
Sure, I don't think it would hurt to try either or both of them. Aztec didn't mind the Renal powder at all. Was a little pickier about the Renal Advanced. The Renal also contains potassium citrate, which can help counter acidity (a common problem with CKD cats). It did raise Aztec's urine ph from his usual 5.0 to 6.5, which was good, except that he also suffered a severe episode of constipation (required an emergency vet visit) so I stopped giving it to him. I'm not saying the constipation was directly caused by the Renal powder, I just thought it best to minimize any further risk factors wherever I could.

Good luck! Let us know how Sam does on the supplements.
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Old May 15th, 2013, 10:35 PM
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Chitosan is one of the ingredients in Epakitin, looks good, should be no issues w/the Renal & probiotics
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Old May 17th, 2013, 11:23 AM
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Thanks SCM and Growler for your help with the Renal. I think I will start trying to give it to him in his food since it shouldn't hurt him. Sam did have an episode of severe constipation when his stools were very large and dry but after I added the coconut oil, that seemed to remove the problem. I guess I could always add more ccoconut oil if he gets more constipated with Renal, but I would like to work on his BUN to start with as it is the most potentially toxic element in his blood at the moment.

I still haven't been able to get a urine specimen from him, he looks at the nosorb litter and just walks away and uses another box... so I don't know hen I am going to get his urine specimen to measure his specific gravity. Everytime he goes to the vet, his bladder is empty ... so there is absolutely no chance of getting a specimen at the vet,,, I don't want to leave him at the vet to get the urine specimen because I think that will cause him a great deal of stress, and I don't know that it's absolutely necessary at this point in time.

Thanks again! I'll keep you posted...
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Old May 19th, 2013, 12:11 AM
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Duffy refused to use the nosorb litter the 2nd time I tried it. Unless you use several containers of nosorb or have the box tilted & the cat stands on the higher side they just end up stepping in their pee anyways.

If you can get a first of the morning appt & lock Sam up in a room without a litterbox for a couple of hours prior, hopefully you can get him in to the clinic with enough in his bladder for a sample, providing he doesn't pee on the way there.
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