Itchmo Forums for Cats & Dogs

Pet Health (not to be substituted for qualified vet advice) => Help With My Sick Pet => Topic started by: GKit on May 08, 2019, 11:23:06 AM

Title: Phosphate Binders
Post by: GKit 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.

Title: Re: Phosphate Binders
Post by: NedF 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.

Title: Re: Phosphate Binders
Post by: alek0 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.

Title: Re: Phosphate Binders
Post by: GKit 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.

Title: Re: Phosphate Binders
Post by: catmom5 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.

Title: Re: Phosphate Binders
Post by: GKit 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.  :D I can only hope to have her mental acuity when in my nineties.

Title: Re: Phosphate Binders
Post by: alek0 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.

Title: Re: Phosphate Binders
Post by: GKit 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.  ::))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.

Title: Re: Phosphate Binders
Post by: alek0 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.

Title: Re: Phosphate Binders
Post by: GKit 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.

Title: Re: Phosphate Binders
Post by: alek0 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.

Title: Re: Phosphate Binders
Post by: GKit 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!

Title: Re: Phosphate Binders
Post by: Fizzy1 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.

Title: Re: Phosphate Binders
Post by: GKit 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.

Title: Re: Phosphate Binders
Post by: Fizzy1 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!  :-*

Title: Re: Phosphate Binders
Post by: alek0 on May 28, 2019, 05:45:28 PM
Some of the Weruva fish flavours are relatively low in phosphorus (Mideast Feast for example), and they keep poop soft better than adding pumpkin for example. If Gypsy can eat fish, maybe that would help. Mitzie also gets rock hard poop occasionally, and feeding Weruva more often seems to take care of it. I was feeding it rarely before because of soft poo, but I've been using it more often lately after her tooth extraction since it has lots of liquid and she loves that.

Title: Re: Phosphate Binders
Post by: GKit on May 29, 2019, 12:39:33 AM
I did not know that about the Weruva fish flavors, alek. Good to know for future reference! Gypsy cannot have fish, unfortunately, but Taggy likes fishy smelling things, so it’s always handy to have these bits of info. I wish she could have some fish, because almost every make your own cat food recipe calls for adding fish oil to get vitamin A & D in there, and almost every cat food has some fish oil in it. She is not allergic to green lipped mussel powder, go figure, and we’ve been using that for a few years. It gives us some of the trace minerals we don’t get enough of in her rabbit.

Title: Re: Phosphate Binders
Post by: alek0 on May 29, 2019, 06:06:50 PM
Have you tried giving her fish oil? Allergies are usually to protein, not to fats. Though of course you can always go for liver as a source of vit. A. Some shellfish and shrimp can be a source of bit. D if she tolerates that, and egg yolks also, but egg yolks are high in phosphorus. You can probably find some bit D enriched butter I suppose since I am getting option for salted high in bit. D and unsalted no vit. D.

I like this website for detailed food comparisons, and you can actually search foods high in A and low in B based on 100 g or 200 kcal servings. Useful for humans, but possibly useful for knowing what you can try for cat's diet:

You have everything, omega 3 & omega 6, amino acid profiles, vitamins, minerals...

Title: Re: Phosphate Binders
Post by: GKit on May 30, 2019, 12:23:12 AM
That is what I thought about the fish oil too, but it did not prove out in testing.  >:( When Gypsy reacts to a food, her butt gets red and puffy and bleeds. You take away the food, the redness and bleeding stop. Fish oil was a no go, which was a bummer. Fortunately the ground raw rabbit we get now includes liver, which gave us the Vitamin A. For D, I am using a lanolin sourced vitamin D capsule made by Bluebonnet Nutrition. Their VCap vitamins and minerals had the fewest number of excipients in them, usually just vegetable cellulose and vegetable magnesium stearate, so that’s worked for us. But yeah, I was looking at goat milk and all kinds of things before I found the stuff I am using now.  

I love! It is my go to site too, but I never looked at the search tools available. That is awesome!

Title: Re: Phosphate Binders
Post by: GKit on June 01, 2019, 11:40:59 AM
Gypsy appears to be allergic to aluminum hydroxide.  ??? I did not think this was possible, (?!?!?!?!) but Gypsy excels at doing the unexpected.  Ordered some soy protein isolate after pulls that up as a high protein low phosphorus option other than egg white; from what I read soy is controversial for cats but a couple of Royal Canin and Hills? K/d renal foods use it, so, plan D. The soy protein isolate has 0.8% phosphorus and 92% protein on a dry matter basis, compared to 2.3% phosphorus and 62% protein in the rabbit.

Title: Re: Phosphate Binders
Post by: catwoods on June 17, 2019, 02:24:45 PM
Many hopes that this will work for Gypsy, Gkit.