Itchmo Forums for Cats & Dogs Brought to you by Itchmo: Essential news, humor and info for cats, dogs and pet owners.
August 17, 2019, 05:09:03 AM *
Welcome, Guest. Please login or register.

Login with username, password and session length
News:
 
   Home   Help Search Login Register  

Go To Itchmo.com: Read the latest cat, dog and pet news, pet food recall info, product reviews and more — updated daily.


Pages: [1] 2
  Print  
Author Topic: Phosphate Binders  (Read 458 times)
0 Members and 1 Guest are viewing this topic.
GKit
Hero Member
*****
Posts: 1527


« on: May 08, 2019, 11:23:06 AM »

Unfortunately we are at that stage of kidney disease with Gypsy where reducing phosphate is a priority. I am currently trying swapping out a portion of her raw Rabbit with egg whites. This may or may not work depending on her allergies.

 Many of you may remember she has chronic, horrible constipation issues in addition to IBD. What are people’s experiences with using aluminum hydroxide as a phosphate binder? Does it inevitably result in constipation?

What I am really afraid of is hard stools that cannot be softened with Miralax and will require enema or manual disimpaction at the vet. I don’t want to put her through that at this point in her life, but also feel a bit of pressure to at least try the phosphate binder, but I’m afraid I may regret doing that, so any feedback would really help. Thanks in advance.
Logged
NedF
Hero Member
*****
Posts: 3787



« Reply #1 on: May 08, 2019, 03:44:07 PM »

I'm trying to recall with Thunder. I think we did not give any binders because she also had constipation problems.
Logged

"It seems that some creatures have the capacity to fill spaces you never knew were empty."  - Jean-Luc Picard
alek0
Hero Member
*****
Posts: 3266


« Reply #2 on: May 08, 2019, 05:33:33 PM »

Ipakitine may result in less issues with constipation compared to aluminium hydroxide. Pumpkin works fine for my cats to soften the stool, you might consider binder +additional source of fiber. It might take a bit of a trial and error to hit correct doses, but it is worth the effort.
Logged
GKit
Hero Member
*****
Posts: 1527


« Reply #3 on: May 09, 2019, 08:27:36 AM »

Thank you, Ned and alek. It’s really helpful to know actual experiences versus what’s laid out in the books.
Logged
catmom5
Hero Member
*****
Posts: 1524


« Reply #4 on: May 12, 2019, 07:35:38 AM »

I understand staying in that balance to maintain a quality of life.

What I am doing now, after working so hard to keep CJ alive and comfortable, is to manage their quality of life for as long as they have. Right now all three are in hospice care. Cassie has lymphoma and sarcoma, in addition to diabetes and IBD. I have refused all further tests and blood work for her. My hospice vet reminded me that if I am not going to change treatment based on the results of the tests, then why do them? Cody is almost 20 with arthritis that slows her down, and some lumps. I made the decision not to put her through a biopsy because I wouldn't put her through the treatment. It has taken a while just to get her to tolerate the gabapentin liquid. And, Gracie, just diagnosed with stage 4 kidney disease, has a terrible time allowing me to do anything. She is accepting the fluids, without too much stress, but I will not do anymore testing for her.

I guess I am trying to say that, for us, maintaining a quality of life is the only goal right now. That works for us, but others may have a different opinion.
Logged
GKit
Hero Member
*****
Posts: 1527


« Reply #5 on: May 13, 2019, 04:03:23 PM »

Thank you for your thoughtful reply, catmom. It’s very helpful to hear the words from not in my own head, if that makes any sense. I really appreciate everyone’s input; it’s extremely helpful in laying out a plan tailored for Gypsy. Cooked egg whites was a bust due to allergies, which I kind of expected, so now we are trying raw egg whites. They  tell you not to use raw egg whites because there a protein called avidin in there that binds biotin, which is a B vitamin. To account for this I am adding biotin supplement at a pretty high dose.

I have also started her on B3 (as niacinamide) which was mentioned at the bottom of Tanya’s page on phosphate binders. No cat studies on this yet, so fingers crossed. She is on pumpkin, Xanthum gum, and Miralax already due to her historic constipation. I got the chitosan half of Ipakitine as a pure powder, which I may try independently of the calcium carbonate.

Despite being skinny now she is still quite alert and loudly opinionated.  Cheesy I can only hope to have her mental acuity when in my nineties.
Logged
alek0
Hero Member
*****
Posts: 3266


« Reply #6 on: May 19, 2019, 10:47:35 PM »

GKit, I think vit. B makes huge difference. I am giving Mitzie human bit. B complex plus extra vit. B12 (also human pills that I cut in required dosage). One thing also which is a huge help for Mitzie is cyproheptadine, she was 3.7 kg in sept. of 2017, and she is 4.7 kg now. I know this is less popular option compared to mirtazipine but she tolerates it well and it is working fine for her.
Logged
GKit
Hero Member
*****
Posts: 1527


« Reply #7 on: May 20, 2019, 03:04:43 PM »

Alek, yes, I am finding that to be true! Gypsy had been getting supplemental B1, B2, B5, folic acid and biotin at way higher than RDA levels. A lot of this is historical to her gut problems, but in the last two years I have found that kicking the B1 up to 5mg/day and adding choline resulted in significant cognitive improvement. I just added B3 and B6 to complete the panel, and even though she ought to be getting enough from her diet, which is unfortunately all protein, she does seem brighter and her anal tone is improved. She gets B12 via injection. But yeah, I definitely agree that adding B vitamins is beneficial, certainly way, way more than I would have expected looking at the numbers on paper.

I was going to ask about your observations on cyproheptadine vs mirtazapine. Do you find the cyproheptadine more effective? We are using mirtazapine at half the normal dose. Vet prefers it for the anti-emetic properties. It works to get Gypsy to eat her food, but I am curious what you’ve seen with Mitzie of one vs the other.

Both raw and cooked egg were busts due to allergies. Surprisingly, Gypsy preferred cooked egg to the raw. Steaming the egg with a teaspoon of water (like making chawanmishi)  then running it through a fine sieve while still warm will produce a sufficiently fluffy textured egg that she couldn’t pick it out when mashed into her regular food. (She’s picked out millimeter diced carrots and hard boiled eggs, leaving a perfect layer of rejects at the bottom of her bowl.  Roll Eyes)But, allergies. Plan B is to try chicken fat to replace protein, and still working the B3 amount upward in hopes of reducing phosphate. (We are at ~30mg/day now.) Fingers crossed.
Logged
alek0
Hero Member
*****
Posts: 3266


« Reply #8 on: May 20, 2019, 05:56:44 PM »

Since cyproheptadine is given daily there is no fluctuation in appetite, and there are no weird mood changes like with mirtazipine and generally she tolerates it well. I just find it works better for Mitzie but every cat is different. I can understand some people prefer to give meds less often.

Before tooth extraction Mitzie was on half a dose of cyproheptadine, she will be on full dose for a while until eating renal dry diet is back to normal.

Btw, considering injections I really like the fact that now they have B complex formulation that doesn;t sting, when we travel I have the vet come to give Mitzie and Max bit B shot so I can reduce amount of meds that pet sitter gives. Vit B supplementation also helps for cats with liver issues, so Max is on it too.
Logged
GKit
Hero Member
*****
Posts: 1527


« Reply #9 on: May 21, 2019, 12:04:21 AM »

Thanks. I had wondered about appetite fluctuations towards the end the every other day dosing for mirtazapine. I give mirtazapine to Gypsy 0.45mg daily, so I probably dodged that effect by sheer luck. It’s great Mitzie managed to gain so much weight back.

Good to know B complex helps with liver too, as elevated liver values are something that periodically pops up with her.
Logged
alek0
Hero Member
*****
Posts: 3266


« Reply #10 on: May 21, 2019, 01:09:30 AM »

Vit. B and SAMe supplements have been keeping liver issues under control for both Mitzie and Max. Max had a huge liver issue with ALT off the scale (machine couldn;t read it), and he was all yellow with very enlarged liver, we noticed late since as Russian blue he is all gray and you could only see yellow once his fur was shaved for abdominal ultrasound and when you know what to look for then you notice whites of the eyes etc. He was active and eating a lot, so nothing in his behavior to point to a problem. He has been on SAMe, ursodeoxycholic acid and bit. B ever since, incident happened when he was 2 years old, and he will be nine in Dec. and it never recurred. Mitzie had elevated ALT in Sept. 2017, again started SAMe and ursodeoxycholic acid, added B complex in addition to B12 and again ALT has been normal since. If she had liver issues before, it may be worthwhile to consider SAMe, does no harm. If you try cyproheptadine which is metabolised by liver, using SAMe may be a good idea.
Logged
GKit
Hero Member
*****
Posts: 1527


« Reply #11 on: May 21, 2019, 03:28:38 PM »

Good thought, especially since the challenge is going to be trying to get the chicken fat past her pancreatitis. Thanks!
Logged
Fizzy1
Hero Member
*****
Posts: 3277



« Reply #12 on: May 26, 2019, 07:45:06 PM »

I’ve gone back and looked at Fizzy’s thread because I don’t remember the details.  She had a problem with constipation so I gave her lactulose and fiber with each meal.  I also used alum. Hydroxide.  I don’t think that it made anything worse.  How is Gypsy doing?  Don’t forget that Zyrtec and its generic can also be used as an appetite stimulant, with no side effects, AFAIK.  Dosing is 1/4 to 1/2 of 10mg tab/day.

Logged

I once asked a four year old what the secret of life was.  "Feed the kitties," she said, "Feed the kitties."--Ellis Felker
GKit
Hero Member
*****
Posts: 1527


« Reply #13 on: May 27, 2019, 03:19:49 PM »

Thanks, Fizzy. Gypsy is getting pretty skinny, but still very spirited. She’s lost almost a pound in the last month, despite eating pretty much what she always eats with both mirtazapine and Zyrtec on board. I gave her the tiniest bit of aluminum hydroxide this morning to see how it would go; she’s been having diarrhea or very soft stools of late so I might have some room to maneuver. The scary thing with her is her ability to go from liquid diarrhea to rock hard poop literally overnight, so I am really nervous and using extreme caution. The vet and I discussed the option of doing an ultrasound to see if there was anything else going on beside the CKD, but ultimately we would be looking for cancer, and say we did find cancer, it was unlikely, given her IBD and kidney constraints, we would put her through a treatment regimen with iffy outcomes, so I passed on doing that. The good thing is she is very talkative and engaged. Two days ago she came into the main part of the house and explored the kitchen, licked Taggy’s empty food bowl and helped herself to his water, while Taggy milled around nervously. She leaned in to sniff him, and he leaned back, because he is a gentleman, and she is still Top Cat. It was good to see that she’s still got it, and he is a sweetheart.
Logged
Fizzy1
Hero Member
*****
Posts: 3277



« Reply #14 on: May 28, 2019, 09:47:45 AM »

Aww, you go, Gypsy girl!  Good boy, Taggy!  It's hard to watch them lose the weight, but it sounds like you're doing all the right things for her.  Hugs for all of you!  Kiss
Logged

I once asked a four year old what the secret of life was.  "Feed the kitties," she said, "Feed the kitties."--Ellis Felker
Pages: [1] 2
  Print  
 
Jump to:  

Copyright 2007 Itchmo.com: Read the latest cat, dog and pet news, pet food recall info, product reviews and more — updated daily.
Powered by SMF 1.1.21 | SMF © 2015, Simple Machines | Sitemap