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Author Topic: Stefie's kidney problem- need advice  (Read 25076 times)
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alek0
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« on: December 07, 2015, 08:57:02 PM »

Stefie will be 16 in May next year. His teeth have never been great, but on today's check up the vet said it might be good to think about teeth cleaning.

We did blood test today since he is drinking a lot (but he also has good appetite and his fur looks great so I am hoping its just one of his things, he used to lick his belly bald before, and he's been drinking more for the past few years but last time we did blood test it was all normal but I wanted to repeat it since he is drinking even more since I got new Drinkwell fountain). After I see what that looks like, I guess I will need to decide. It isn;t just a matter of tartar, he has a lot of gingivitis. So the question is whether to risk anaesthetic now since I am sure it is not good for his health to have infection in his mouth, or to probably need to risk it later down the road?

I could also go back to brushing his teeth but he would hate that.

Advice, opinions?

Another problem is Mitzie. She is very attached to me. Last weekend we were away for a short trip, she was glaring at the pet sitter, had nausea and was vomitting and had no appetite. She is fine when we got home, still sulking a bit and needed persuasion to try tuna sashimi, something she normally practically inhales.

Next year we will have several trips scheduled - proper honeymoon trip (16 days), visit to my family (10 days), visit to his relatives in Thailand (7 days). What can I do to make it easier for her? I also need to leave for a conference on Friday but at least Barry will be home, she is OK with him, sometimes if it is cold she sleeps on him because he is warmer  Grin

I am thinking to ask pet sitter for staying overnight (she offers that option), and add one extra visit during the day. We try that for a short trip over Easter to see if it works any better. Not sure if Feliway would help, but I can try that too.
« Last Edit: December 10, 2015, 07:33:33 AM by alek0 » Logged
Fizzy1
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« Reply #1 on: December 07, 2015, 09:09:12 PM »

Hi alek0.  My feeling is to get the dental done.  I wavered with Fizzy and Scooby and probably waited too long.  Fizzy was 15, Scooby 12 I think.  They usually tolerate it better than we do!  Since Stefie has gingivitis I think a dental is warranted as long as his lab work allows it.  Bad oral health can really affect the rest of the body. 
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alek0
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« Reply #2 on: December 08, 2015, 01:06:54 AM »

I am sort of leaning that way too, though that will probably require visit to the doc for me for some calming meds and one sleeping pill for the night before.

I know that bad oral health can cause problems  Undecided He has always had bad teeth but we sort of kept it under control with brushing, but he hated it and those Q tips by Vet's best were eventually discontinued.
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lesliek
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« Reply #3 on: December 08, 2015, 06:12:03 AM »

I would do it now also , you don't want to have to do it later . He is probably starting to have some kidney issue which don't show on testing early .  On the anxiety , have you tried rescue remedy along with the feliway ?
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mikken
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« Reply #4 on: December 08, 2015, 04:29:19 PM »

Agree on doing the dental now.  Speak to the vet about your concerns, make sure they run fluids during the procedure, keep pet warm, etc.

I just had a 15 year old cat in renal failure get all of his top teeth extracted (pulled him from the shelter in that condition).  He did surprisingly well!  

As for the anxiety, have you considered a product like Zylkene?  Also, maybe the petsitter can do special things - car rides or walking new places, etc.  Things that aren't associated with your regular routine, but are interesting and engaging.
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alek0
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« Reply #5 on: December 09, 2015, 04:05:03 AM »

Indeed, early stage of kidney problems. Changing diet and adding supplements, retrsting in two months and then we will decide on the teeth. I would appreciate links for the cat foods for kidney failure and any info youmight want to share. 

Vet said we caught it early so it should be manageable. Ill have lots of practical things to figure out with four cats which are all picky eaters
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Mandycat
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« Reply #6 on: December 09, 2015, 04:57:49 PM »

alek,
You do not need to feed Stefie a prescription kidney diet.  It is not needed in early stage kidney disease.  Cats are obligate carnivores and require high protein and low carbs in their diet to maintain muscle mass.  Old theory was to feed a low protein diet to cats who had CKD, but that has changed with more recent studies and information about how to treat renal disease in cats.  Here is a link to an article that discusses the reasons why a low protein diet is not appropriate in early kidney disease. It can do more harm than good.

          http://www.catsofaustralia.com/cat-kidney-disease.htm

Here is the link to a page on a website that is the very best resource for everything having to do with feline kidney disease.  This page discusses all aspects of the proper diet at different stages of renal disease.  If you scroll down the page, you will see specific information about why one should not feed a low protein diet to a cat with early stage kidney disease.  The most important element to control in CKD is the phosphorus.  There are many choices of good cat foods that are lower in phosphorus but still have adequate protein and low carbs to meet the cat's specific nutritional needs.  You can also find a list of foods and their phosphorus contents on this website.  Also, wet food is always best for cats with CKD.

           http://felinecrf.org/nutritional_requirements.htm

I hope you find this helpful. 
« Last Edit: December 09, 2015, 05:03:43 PM by Mandycat » Logged
alek0
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« Reply #7 on: December 10, 2015, 07:33:03 AM »

Thanks for the info.

Vet prescribed phosphate binder (Ipakitine) to be mixed into his regular food, Adenosyl supplement and prescription dry (Royal Canin Renal). The dry has low protein but also really low phosphorus. When I asked about his anemia, vet suggested to give him erythropoietin injection, but I am a bit confused with what I read about it, i.e. whether it is good idea to start and stop with that since his anemia at present is not severe and he has good appetite.

I plan on feeding him Applaws and Weruva, all with phosphorus below 1% per 100 g dry weight.

I've been reading on Tanya's webpage, but the troublesome part is I am leaving for tomorrow, will be back home on 20th. So any tweaking of the protocol will have to wait till I am back, I am seeing the vet again on Jan 4th since he will be away for Christmas.

Three weeks of eating low protein and low P dry should not do much harm if that is not the best choice, I hope? Please advise.

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BW
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« Reply #8 on: December 10, 2015, 03:06:00 PM »

Aleko, am sending you positive thoughts for  Stefie  and for yourself.  I had several cats with kidney problems during and after the pet food debacle back in 2007.  I was able to keep my Barkley Peeperton with me for quite a few years by giving him lactated ringers at home, when he reached that point in the disease,  so he didn't have to be upset by trips to the vet to be hydrated.  He was very good about it.
If Stefie is in early the early stage, such treatment may not be necessary at all yet. 
Tanya's website it just wonderful, with all kinds of important info.  Sooo again, I am sending you both positive thoughts.
Hopefully, the vets will be able to help him quickly and well.
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Meowli
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« Reply #9 on: December 10, 2015, 04:14:46 PM »

Sending positive thoughts from here, too.
((hugs))
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Mandycat
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« Reply #10 on: December 10, 2015, 11:09:22 PM »

alek,
Without knowing Stefie's BUN and Creatinine test results, I am at a disadvantage. But with early stage CKD, if there is anemia, I would be very surprised that it would be caused by kidney issues at an early stage.  This usually comes with more advanced disease.  Use of the erythropoietin is rather controversial, and, again, not usually used with early stage CKD.  If Stefie has some mild anemia, you might want to try giving him subcutaneous injections of Vitamin B12 once a week for about 6 weeks to see if it corrects it.  There are other causes of anemia, so you would eventually want to try to determine if the cause is something like blood loss from a GI problem or if there is blood in his urine from cystitis.  Just a couple of examples for the anemia.  Also, the anemia that is caused by CKD is a non-regenerative anemia and it should be possible for the vet to determine if Stefie's anemia is non-regenerative or regenerative by doing a CBC that includes a reticulocyte count.  Again, I don't know Stefie's phosphorus test result, but with early CKD, it should be around 4.0.  Unless it is extremely high, if you are going to use food that is low in phosphorus, you shouldn't have to also use the binder in it.  The binder is usually used when the cat's regular food is rather high in phosphorus in order to assure that the cat will eat his familiar food, but that the addition of the  binder will keep the phosphorus level in check.  A few weeks should not do any harm for you to feed the prescription dry, but I would encourage you to continue reading Tanya's site for information for the future.
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alek0
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« Reply #11 on: December 11, 2015, 03:23:04 AM »

Thanks for the advice. I am currently on my way to Hawaii so for next ten days while i am away we'll follow instructions. When i get back ill get some second opinions and explore other food options.

His values are: rbc 5.78 10^12, low, mcv and mch are elevated. Urea is 27.2 mmol/l creatinine is 290 umol/l phosphorus is 2.82 mmol/l ALT and lipase mildly elevated.
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alek0
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« Reply #12 on: December 11, 2015, 02:24:05 PM »

Update- regenerative anemia, we will not do Epo shot now, just vit B
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BW
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« Reply #13 on: December 13, 2015, 11:14:41 AM »

Aleko, Just sending positive thoughts and prayers for your Stefie's kidney problem.  So sorry that you are having this problem. I hope the doctors can get a handle on the situation and be genuinely helpful to dear Setfie.
Wish I was more expert at giving advice, but you have already received excellent advice.   Many prayers for Stefie.
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Mandycat
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« Reply #14 on: December 14, 2015, 01:10:18 AM »

alek,
I am glad I asked about Stefie's test results.  If your vet said that his CKD is early stage, that is a misleading statement.  Stefie's CKD is pretty significant based on the test results you posted.  His kidney disease is actually Stage 3.  You can find lots of information on Tanya's site about treatment of the kidney disease at this Stage.  His Phosphorus is particularly high, so it very well may be necessary to use the prescription kidney diet for both dry and wet food, and the phosphorus binder would be definitely indicated in any regular food.  With the Creatinine and BUN as high as it is, you might also discuss the use of subQ fluids with your vet.  The fluids can be helpful at this Stage of CKD to help flush the toxins from his system that are causing these high values.  If the testing shows that the anemia is regenerative, then it is most likely caused by the Vitamin B12 deficiency (as indicated by the high MCV) and not yet from the CKD.  However, you should monitor that in the future.  You might want to do a specific test for Pancreatitis also (called a fPLI) due to the slightly elevated ALT.  Lipase is a pancreatic enzyme, but the elevation is not very reliable in cats for indicating a problem with the pancreas, as strange as that may seem.  You need the more specific test for that.  It may turn out that he does not have Pancreatitis, but it is one of the conditions that can cause the elevated ALT, so should be ruled out.  The other condition that can cause an elevated ALT is hyperthyroidism, and, although that should also be ruled out with a T4 test, I am less confident that he would have hyper-t since it also masks kidney disease by lowering the kidney function test values and Stefie's values are much higher than we would usually see with a hyperthyroidism diagnosis.  The Adenosyl is for support of the liver, but you should also try to determine what is causing the ALT elevation.

I am sorry that Stefie has this condition, but it can be treated and managed, and at Stage 3 requires more active management than Stage 1 or 2.  The test results were much higher than I had anticipated when you said your vet said early kidney disease, and my original comments were based on that understanding.  Please use Tanya's site as a resource for learning about treatment of his CKD, and join the support group there because you will find a lot of helpful advice from others who are dealing with this same condition with their cats.  There is nothing like personal experiences to give insight into such a condition that vets don't always give.
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