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cindys
March 19th 07, 06:31 PM
Well, I just got the bad news from the vet. Alex, who is 16 years old, is
just beginning CRF. The vet told me in addition to switching his food to NK,
I should begin weekly subcu fluids. She stated that by so doing, since he is
still in the very early stages of the disease process, it is actually
possible to reverse the situation and return him to relatively normal kidney
function. Has anyone ever heard of this before (that beginning subcu right
at the beginning of CRF can reverse the process?). I did successfully cure
him of diabetes with Lantus insulin, and I never would have thought that
would be possible. Now that he'll be eating NK, we are going to have to keep
a very close watch on his blood glucose to ensure the diabetes doesn't
return. The doctor recommended that we repeat bloodwork to reassess kidney
function in about three months. Does anyone have any thoughts on any of
this?
Best regards,
---Cindy S.

sheelagh
March 19th 07, 06:57 PM
On 19 Mar, 17:31, "cindys" > wrote:
> Well, I just got the bad news from the vet. Alex, who is 16 years old, is
> just beginning CRF. The vet told me in addition to switching his food to NK,
> I should begin weekly subcu fluids. She stated that by so doing, since he is
> still in the very early stages of the disease process, it is actually
> possible to reverse the situation and return him to relatively normal kidney
> function. Has anyone ever heard of this before (that beginning subcu right
> at the beginning of CRF can reverse the process?). I did successfully cure
> him of diabetes with Lantus insulin, and I never would have thought that
> would be possible. Now that he'll be eating NK, we are going to have to keep
> a very close watch on his blood glucose to ensure the diabetes doesn't
> return. The doctor recommended that we repeat bloodwork to reassess kidney
> function in about three months. Does anyone have any thoughts on any of
> this?
> Best regards,
> ---Cindy S.
http://www.shirleys-wellness-cafe.com/felinekidney.htm

http://www.catsofaustralia.com/urinestainremoval.htm

http://www.felinecrf.org/related_diseases.htm

Hi Cindy,
I am so so sorry to hear your news about your baby.
I have added a link to site that tells me that you can reverse it. I
hope that it is of some use to you & gives you some of the information
that you are looking for too.

We had old Jasper who had CRF , but his condition had gone too far for
treatment to reverse it.
I think that there are others here who would be better qualified to
advise you than me.

Keep us up to date though, won't you?

I am glad that you have nipped it in the bud, & will continue to think
of you whilst you are going through this hard time

Best Wishes, & devoted Purrs of a soothing nature from them all & us
too of course!!
S;o)

sheelagh
March 19th 07, 07:21 PM
>
> Hi Cindy,
> I am so so sorry to hear your news about your baby.
> I have added a link to site that tells me that you can reverse it. I
> hope that it is of some use to you & gives you some of the information
> that you are looking for too.
>
> We had old Jasper who had CRF , but his condition had gone too far for
> treatment to reverse it.
> I think that there are others here who would be better qualified to
> advise you than me.
>
> Keep us up to date though, won't you?
>
> I am glad that you have nipped it in the bud, & will continue to think
> of you whilst you are going through this hard time
>
> Best Wishes, & devoted Purrs of a soothing nature from them all & us
> too of course!!
> S;o)

Sorry Cindy, I posted the wrong page to one of the links.
It should have been

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

http://www.felinecrf.org/related_diseases.htm

http://www.petshealth.com/dr_library/felrenfail.html

Aplogies,
S;o)

Phil P.
March 20th 07, 03:01 AM
"cindys" > wrote in message
...
> Well, I just got the bad news from the vet. Alex, who is 16 years old, is
> just beginning CRF. The vet told me in addition to switching his food to
NK,
> I should begin weekly subcu fluids. She stated that by so doing, since he
is
> still in the very early stages of the disease process, it is actually
> possible to reverse the situation and return him to relatively normal
kidney
> function. Has anyone ever heard of this before (that beginning subcu right
> at the beginning of CRF can reverse the process?).

I'm sorry to hear about your cat- I'm going through the same thing with my
20 year-old.

ARF (acute renal failure) is reversible in some cases but CRF is not. By
the time CRF shows up in the bloodwork (high BUN/creatinine 60-75% of renal
function has already been irreversibly lost. The reason why CRF doesn't
show up in the bloodwork as its happening is because the feline kidneys'
have a huge nephron reserve, and 'glomerular hyperfiltration'-- the
indivudual intact nephrons increase their filtration rate to compensate for
the lost and damaged nephrons.



I did successfully cure
> him of diabetes with Lantus insulin, and I never would have thought that
> would be possible. Now that he'll be eating NK, we are going to have to
keep
> a very close watch on his blood glucose to ensure the diabetes doesn't
> return. The doctor recommended that we repeat bloodwork to reassess kidney
> function in about three months. Does anyone have any thoughts on any of
> this?
> Best regards,
> ---Cindy S.

Fluid therapy should be administered *only* to correct or prevent
dehydration or short-term to augment GFR in a uremic crisis. Premature or
unnecessary chronic fluid therapy can *promote* the progression of CRF
because it makes the kidney work harder. What is your cat's BUN and
creatinine concentrations and urine specific gravity?

I think you should seek a second opinion from a veterinary nephrologist or a
vet who is experienced in treating feline CRF.

You might want to start thinking about giving your cat a potassium and
omega-3 supplement. Both will delay the downward spiral of CRF.

Best of luck,

Phil

cindys
March 20th 07, 03:38 AM
"Phil P." > wrote in message
news:%[email protected]
>
> "cindys" > wrote in message
> ...
>> Well, I just got the bad news from the vet. Alex, who is 16 years old, is
>> just beginning CRF. The vet told me in addition to switching his food to
> NK,
>> I should begin weekly subcu fluids. She stated that by so doing, since he
> is
>> still in the very early stages of the disease process, it is actually
>> possible to reverse the situation and return him to relatively normal
> kidney
>> function. Has anyone ever heard of this before (that beginning subcu
>> right
>> at the beginning of CRF can reverse the process?).
>
> I'm sorry to hear about your cat- I'm going through the same thing with my
> 20 year-old.
>
> ARF (acute renal failure) is reversible in some cases but CRF is not. By
> the time CRF shows up in the bloodwork (high BUN/creatinine 60-75% of
> renal
> function has already been irreversibly lost. The reason why CRF doesn't
> show up in the bloodwork as its happening is because the feline kidneys'
> have a huge nephron reserve, and 'glomerular hyperfiltration'-- the
> indivudual intact nephrons increase their filtration rate to compensate
> for
> the lost and damaged nephrons.
>
>
>
> I did successfully cure
>> him of diabetes with Lantus insulin, and I never would have thought that
>> would be possible. Now that he'll be eating NK, we are going to have to
> keep
>> a very close watch on his blood glucose to ensure the diabetes doesn't
>> return. The doctor recommended that we repeat bloodwork to reassess
>> kidney
>> function in about three months. Does anyone have any thoughts on any of
>> this?
>> Best regards,
>> ---Cindy S.
>
> Fluid therapy should be administered *only* to correct or prevent
> dehydration or short-term to augment GFR in a uremic crisis. Premature or
> unnecessary chronic fluid therapy can *promote* the progression of CRF
> because it makes the kidney work harder. What is your cat's BUN and
> creatinine concentrations and urine specific gravity?
>
> I think you should seek a second opinion from a veterinary nephrologist or
> a
> vet who is experienced in treating feline CRF.
>
> You might want to start thinking about giving your cat a potassium and
> omega-3 supplement. Both will delay the downward spiral of CRF.
------------------
Thank you. I don't remember what the vet said the BUN and creatinine were,
but it would be easy enough to find out. She wants to put the cat on a
prescription low protein kidney diet. On one of the websites for which
Sheelagh provided a link, I read that this would actually be a bad idea
because there is no evidence that low protein diets delay progression and in
the meantime, the cat's body is not getting sufficient protein. Would you
agree or disagee with that? BTW, I have a feeling my other approximately
15-year-old cat may be headed down the same path. His BUN and creatinine are
high normal. Do you have any thoughts on anything I can be doing to prevent
the development of CRF in him?

(The other problem is that I have several younger, presumably healthy cats,
and all my cats eat the same dry food. I also give them canned food, so I
could continue to give the young healthy cats the high protein canned food,
but one of my younger cats refuses the canned food and is only willing to
eat the dry. She does not need to be on a low protein diet, which would be
the net result if I switched over to the NK prescription food.)
Thanks in advance.
Best regards,
---Cindy S.

22brix
March 20th 07, 04:36 AM
"cindys" > wrote in message
...
>
> "Phil P." > wrote in message
> news:%[email protected]
>>
>> "cindys" > wrote in message
>> ...
>>> Well, I just got the bad news from the vet. Alex, who is 16 years old,
>>> is
>>> just beginning CRF. The vet told me in addition to switching his food to
>> NK,
>>> I should begin weekly subcu fluids. She stated that by so doing, since
>>> he
>> is
>>> still in the very early stages of the disease process, it is actually
>>> possible to reverse the situation and return him to relatively normal
>> kidney
>>> function. Has anyone ever heard of this before (that beginning subcu
>>> right
>>> at the beginning of CRF can reverse the process?).
>>
>> I'm sorry to hear about your cat- I'm going through the same thing with
>> my
>> 20 year-old.
>>
>> ARF (acute renal failure) is reversible in some cases but CRF is not. By
>> the time CRF shows up in the bloodwork (high BUN/creatinine 60-75% of
>> renal
>> function has already been irreversibly lost. The reason why CRF doesn't
>> show up in the bloodwork as its happening is because the feline kidneys'
>> have a huge nephron reserve, and 'glomerular hyperfiltration'-- the
>> indivudual intact nephrons increase their filtration rate to compensate
>> for
>> the lost and damaged nephrons.
>>
>>
>>
>> I did successfully cure
>>> him of diabetes with Lantus insulin, and I never would have thought that
>>> would be possible. Now that he'll be eating NK, we are going to have to
>> keep
>>> a very close watch on his blood glucose to ensure the diabetes doesn't
>>> return. The doctor recommended that we repeat bloodwork to reassess
>>> kidney
>>> function in about three months. Does anyone have any thoughts on any of
>>> this?
>>> Best regards,
>>> ---Cindy S.
>>
>> Fluid therapy should be administered *only* to correct or prevent
>> dehydration or short-term to augment GFR in a uremic crisis. Premature
>> or
>> unnecessary chronic fluid therapy can *promote* the progression of CRF
>> because it makes the kidney work harder. What is your cat's BUN and
>> creatinine concentrations and urine specific gravity?
>>
>> I think you should seek a second opinion from a veterinary nephrologist
>> or a
>> vet who is experienced in treating feline CRF.
>>
>> You might want to start thinking about giving your cat a potassium and
>> omega-3 supplement. Both will delay the downward spiral of CRF.
> ------------------
> Thank you. I don't remember what the vet said the BUN and creatinine were,
> but it would be easy enough to find out. She wants to put the cat on a
> prescription low protein kidney diet. On one of the websites for which
> Sheelagh provided a link, I read that this would actually be a bad idea
> because there is no evidence that low protein diets delay progression and
> in the meantime, the cat's body is not getting sufficient protein. Would
> you agree or disagee with that? BTW, I have a feeling my other
> approximately 15-year-old cat may be headed down the same path. His BUN
> and creatinine are high normal. Do you have any thoughts on anything I can
> be doing to prevent the development of CRF in him?
>
> (The other problem is that I have several younger, presumably healthy
> cats, and all my cats eat the same dry food. I also give them canned food,
> so I could continue to give the young healthy cats the high protein canned
> food, but one of my younger cats refuses the canned food and is only
> willing to eat the dry. She does not need to be on a low protein diet,
> which would be the net result if I switched over to the NK prescription
> food.)
> Thanks in advance.
> Best regards,
> ---Cindy S.
>

Cindy,

I'm not an expert on this but I've read that finding a food low in
phosphorus is more important than a low protein diet. The bad part is that
higher protein foods are frequently high in phosphorus. The biggest problem
with the low protein, kidney diets is that they're not always that
palatable. You may want to play around with different kidney foods.

My CRF kitty was finally put on fluids last summer when she became
dehydrated after several years of high normal BUN and creatinine. I'm
currently giving her 100ml fluids every other day subQ. Molly's BUN and
creatinine levels are actually slightly better than they were in August.
I'm giving her omega-3 and potassium supplements. Molly has her good days
and her bad days. I cherish the good days--they still outweigh by far the
bad days.

I wish you the best.

Bonnie

Phil P.
March 20th 07, 04:50 AM
"cindys" > wrote in message
...

She wants to put the cat on a
> prescription low protein kidney diet. On one of the websites for which
> Sheelagh provided a link, I read that this would actually be a bad idea
> because there is no evidence that low protein diets delay progression and
in
> the meantime, the cat's body is not getting sufficient protein. Would you
> agree or disagee with that?

Protein shouldn't be restricted in cats until the BUN reaches 65-85 mg/dl,
and only to ameliorate clinical signs of uremia. The theory of restricting
protein to slow the progression of CRF was based on old studies in *rats*.
Later studies showed that mechanisms that can alter the progression of CRF
in the rat don't have the same effect in cats. In fact, protein restriction
can have deleterious effects in cats- e.g., impaired immunological response
and resistance to infection, reduced hemoglobin production and anemia,
decreased plasma protein levels, and muscle wasting. I've been feeding my
20-yearl old x/d- its almost identical to k/d- its an alkaline diet with
higher protein and a little more phosphorus. What you want to avoid are
acidified diets.



BTW, I have a feeling my other approximately
> 15-year-old cat may be headed down the same path. His BUN and creatinine
are
> high normal. Do you have any thoughts on anything I can be doing to
prevent
> the development of CRF in him?

Omega-3 fatty acids derived from menhadan fish- not flaxseed or any
plant-derived omega-3. Plant-derived omega-3s contain too much omega-6-
which are proinflammatory and contribute to the progression of CRF. Omega-3
fatty acids derived from fish down-regulate intrarenal inflammatory
responses and are thus renoprotective. A potassium supplement would be
beneficial also. You want to keep his K+ levels in the upper half of the
normal range.


>
> (The other problem is that I have several younger, presumably healthy
cats,
> and all my cats eat the same dry food. I also give them canned food, so I
> could continue to give the young healthy cats the high protein canned
food,
> but one of my younger cats refuses the canned food and is only willing to
> eat the dry. She does not need to be on a low protein diet, which would be
> the net result if I switched over to the NK prescription food.)
> Thanks in advance.
> Best regards,
> ---Cindy S.

As I said, I don't think you should feed a restricted protein diet yet. Just
don't let the normal cats eat x/d because it could predispose them to
struvite.

Best of luck,

Phil

cindys
March 20th 07, 05:11 AM
"22brix" > wrote in message
...
snip
>>
>
> Cindy,
>
> I'm not an expert on this but I've read that finding a food low in
> phosphorus is more important than a low protein diet.

Several websites that I've read have said the same.

> The bad part is that higher protein foods are frequently high in
> phosphorus. The biggest problem with the low protein, kidney diets is
> that they're not always that palatable. You may want to play around with
> different kidney foods.

And right now, Alex is not eating an awful lot, and he has lost over a pound
since last May. This is the pattern I went through with Molly during the
last two years of her life. I've been feeding my cats Fancy Feast in the
morning. What happens is that Alex eats a little and then Bullwinkle ends up
polishing off the rest of Alex's portion (and Daisy's portion and Tux's
portion as well) in addition to his own. Despite his voracious appetite,
Bullwinkle has also lost weight. He was recently tested for thyroid problems
and that came back negative. All of my cats have been on OM prescription
food since Alex's diabetes diagnosis last spring. At any rate, Alex has not
seemed overly enthusiastic about eating. He's not starving himself, but he's
picking and eating small amounts. I'll give the kidney diet a try, but I can
pretty much guarantee already that he is not going to go for it. For the
last year of her life, Molly existed exclusively on human tuna. It was the
only thing she would eat other than deli meats or my home cooking (beef or
chicken). I supplemented her with feline vitamins.

>
> My CRF kitty was finally put on fluids last summer when she became
> dehydrated after several years of high normal BUN and creatinine. I'm
> currently giving her 100ml fluids every other day subQ. Molly's BUN and
> creatinine levels are actually slightly better than they were in August.

So your kitty has actually shown improvement! That's great! My Molly never
really went on subcu fluids. At the end, she did receive subcu fluids a few
times at the vet. I was going to initiate them at home, but she was already
close to the end of her life at that point and she was suffering, so I opted
to euthanize. Now, I feel sort of confused. Phil (whose opinion I respect a
great deal) is advising against the subcu fluids at this point because of
additional stress on the cat's kidneys. A website I just read is saying the
same thing as my vet (that the subcu fluids should be initiated early and
will prolong the cat's life). Your cat has been on them for seven months and
has shown improvement. And then, there's Bullwinkle whose lab values are
still within normal limits but high. Is there any way to diagnose impending
kidney disease before the BUN and creatinine are elevated (in an effort to
prevent it)? I am so confused and so upset. I intend to speak to my vet
tomorrow and follow Phil's advice to seek a second opinion from a
specialist. There is no veterinary nephrologist in my area, but there is a
veterinary specialist who completed a nephrology residency (currently
specializing in some other organ system).

> I'm giving her omega-3 and potassium supplements. Molly has her good days
> and her bad days.

I will absolutely give these supplements to Alex and Bullwinkle. I also gave
Alex 5 mg of Pepcid today. He has thrown up some clear liquid several times
(I know from experience this is due to nausea from kidney disease). His
nausea may also explain why he is less interested in food. It seemed like he
perked up a little bit after the Pepcid (I hope it wasn't wishful thinking
on my part), but I'll give it to him again tomorrow before breakfast and see
if his appetite improves. I will also begin offering him canned food
multiple times during the day.

>I cherish the good days--they still outweigh by far the bad days.
>
> I wish you the best.
>
Thank you so much.
Best regards,
---Cindy S.

cindys
March 20th 07, 05:21 AM
"Phil P." > wrote in message
news:[email protected]
>
> "cindys" > wrote in message
> ...
>
> She wants to put the cat on a
>> prescription low protein kidney diet. On one of the websites for which
>> Sheelagh provided a link, I read that this would actually be a bad idea
>> because there is no evidence that low protein diets delay progression and
> in
>> the meantime, the cat's body is not getting sufficient protein. Would you
>> agree or disagee with that?
>
> Protein shouldn't be restricted in cats until the BUN reaches 65-85 mg/dl,
> and only to ameliorate clinical signs of uremia. The theory of
> restricting
> protein to slow the progression of CRF was based on old studies in *rats*.
> Later studies showed that mechanisms that can alter the progression of CRF
> in the rat don't have the same effect in cats. In fact, protein
> restriction
> can have deleterious effects in cats- e.g., impaired immunological
> response
> and resistance to infection, reduced hemoglobin production and anemia,
> decreased plasma protein levels, and muscle wasting. I've been feeding my
> 20-yearl old x/d- its almost identical to k/d- its an alkaline diet with
> higher protein and a little more phosphorus. What you want to avoid are
> acidified diets.

Now, I'm confused. Isn't the idea to lower phosphorous while keeping protein
the same? Won't an alkaline diet predispose him to crystal formation? Isn't
K/D a low protein diet? How does K/D differ from this NF that my vet wants
me to feed the cat? (I don't remember for sure what the lab values were, but
I'm pretty sure the BUN was lower than 65 mg/dl).
>
>
>
> BTW, I have a feeling my other approximately
>> 15-year-old cat may be headed down the same path. His BUN and creatinine
> are
>> high normal. Do you have any thoughts on anything I can be doing to
> prevent
>> the development of CRF in him?
>
> Omega-3 fatty acids derived from menhadan fish- not flaxseed or any
> plant-derived omega-3. Plant-derived omega-3s contain too much omega-6-
> which are proinflammatory and contribute to the progression of CRF.
> Omega-3
> fatty acids derived from fish down-regulate intrarenal inflammatory
> responses and are thus renoprotective. A potassium supplement would be
> beneficial also. You want to keep his K+ levels in the upper half of the
> normal range.

Thank you. Omega-3 fatty acids from fish and potassium. I can make that
happen tomorrow.
>
>
>>
>> (The other problem is that I have several younger, presumably healthy
> cats,
>> and all my cats eat the same dry food. I also give them canned food, so I
>> could continue to give the young healthy cats the high protein canned
> food,
>> but one of my younger cats refuses the canned food and is only willing to
>> eat the dry. She does not need to be on a low protein diet, which would
>> be
>> the net result if I switched over to the NK prescription food.)
>> Thanks in advance.
>> Best regards,
>> ---Cindy S.
>
> As I said, I don't think you should feed a restricted protein diet yet.

Okay.

> Just
> don't let the normal cats eat x/d because it could predispose them to
> struvite.

Are cats with CRF less inclined to get struvite or is it simply a question
of the need for a more renoprotective alkaline diet needs to take priority
(and we cross our fingers that the cat doesn't develop struvite)?

Thank you again for all your advice.
Best regards,
---Cindy S.

22brix
March 20th 07, 05:46 AM
"cindys" > wrote in message
...
>
> "22brix" > wrote in message
> ...
> snip
>>>
>>
>> Cindy,
>>
>> I'm not an expert on this but I've read that finding a food low in
>> phosphorus is more important than a low protein diet.
>
> Several websites that I've read have said the same.
>
>> The bad part is that higher protein foods are frequently high in
>> phosphorus. The biggest problem with the low protein, kidney diets is
>> that they're not always that palatable. You may want to play around with
>> different kidney foods.
>
> And right now, Alex is not eating an awful lot, and he has lost over a
> pound since last May. This is the pattern I went through with Molly during
> the last two years of her life. I've been feeding my cats Fancy Feast in
> the morning. What happens is that Alex eats a little and then Bullwinkle
> ends up polishing off the rest of Alex's portion (and Daisy's portion and
> Tux's portion as well) in addition to his own. Despite his voracious
> appetite, Bullwinkle has also lost weight. He was recently tested for
> thyroid problems and that came back negative. All of my cats have been on
> OM prescription food since Alex's diabetes diagnosis last spring. At any
> rate, Alex has not seemed overly enthusiastic about eating. He's not
> starving himself, but he's picking and eating small amounts. I'll give the
> kidney diet a try, but I can pretty much guarantee already that he is not
> going to go for it. For the last year of her life, Molly existed
> exclusively on human tuna. It was the only thing she would eat other than
> deli meats or my home cooking (beef or chicken). I supplemented her with
> feline vitamins.
>
>>
>> My CRF kitty was finally put on fluids last summer when she became
>> dehydrated after several years of high normal BUN and creatinine. I'm
>> currently giving her 100ml fluids every other day subQ. Molly's BUN and
>> creatinine levels are actually slightly better than they were in August.
>
> So your kitty has actually shown improvement! That's great! My Molly never
> really went on subcu fluids. At the end, she did receive subcu fluids a
> few times at the vet. I was going to initiate them at home, but she was
> already close to the end of her life at that point and she was suffering,
> so I opted to euthanize. Now, I feel sort of confused. Phil (whose
> opinion I respect a great deal) is advising against the subcu fluids at
> this point because of additional stress on the cat's kidneys. A website I
> just read is saying the same thing as my vet (that the subcu fluids should
> be initiated early and will prolong the cat's life). Your cat has been on
> them for seven months and has shown improvement. And then, there's
> Bullwinkle whose lab values are still within normal limits but high. Is
> there any way to diagnose impending kidney disease before the BUN and
> creatinine are elevated (in an effort to prevent it)? I am so confused
> and so upset. I intend to speak to my vet tomorrow and follow Phil's
> advice to seek a second opinion from a specialist. There is no veterinary
> nephrologist in my area, but there is a veterinary specialist who
> completed a nephrology residency (currently specializing in some other
> organ system).
>
>> I'm giving her omega-3 and potassium supplements. Molly has her good
>> days and her bad days.
>
> I will absolutely give these supplements to Alex and Bullwinkle. I also
> gave Alex 5 mg of Pepcid today. He has thrown up some clear liquid several
> times (I know from experience this is due to nausea from kidney disease).
> His nausea may also explain why he is less interested in food. It seemed
> like he perked up a little bit after the Pepcid (I hope it wasn't wishful
> thinking on my part), but I'll give it to him again tomorrow before
> breakfast and see if his appetite improves. I will also begin offering him
> canned food multiple times during the day.
>
>>I cherish the good days--they still outweigh by far the bad days.
>>
>> I wish you the best.
>>
> Thank you so much.
> Best regards,
> ---Cindy S.
>

According to my vet, cats will do better long term on the kidney diets but
if they don't eat it, it won't help them! What I have been doing with Molly
is mixing her diet food with a really stinky cat tuna food. It's the one
thing she really likes. I wish she'd eat the kidney food alone but. . .I'm
opting for calories.

I'm not sure Molly has improved over all--her lab values are a little better
but we've had some crises along the way. She was diagnosed with high blood
pressure in February. As soon as we got that under control she had a raging
urinary tract infection. She's now been off antibiotics for a couple of
weeks and seems to be feeling pretty good. One endearing thing about her is
her purr--it's the loudest purr I've heard on a cat. I can hear her in the
next room when she's really going. She's been doing that a lot the past
couple of weeks and she only does that when she's feeling pretty good.

As far as the fluids my vet didn't put her on fluids initially; her kidney
values were borderline for several years--it wasn't until she got
dehydrated and was feeling punky that we started the fluids. As my vet
explained it to me, a high BUN makes the cat feel nauseated. The additional
fluids dilute the BUN and should help some with appetite. I know that once
Molly was on fluids, she perked up quite a bit. I, too, really respect
Phil's knowledge. He has a lot of good information regarding CRF. Getting
a second opinion is a very good idea.

There are a couple of crf support sites as well, a lot of information and
people who are going through the same thing.

Good luck with Alex and Bullwinkle, both. I love older cats but they bring
their own issues!

Bonnie

cindys
March 20th 07, 06:41 AM
Sheelagh, I don't think I thanked you for these weblinks. Thank you! I'm
reading them.
Best regards,
---Cindy S.


"sheelagh" > wrote in message
oups.com...
>
>>
>> Hi Cindy,
>> I am so so sorry to hear your news about your baby.
>> I have added a link to site that tells me that you can reverse it. I
>> hope that it is of some use to you & gives you some of the information
>> that you are looking for too.
>>
>> We had old Jasper who had CRF , but his condition had gone too far for
>> treatment to reverse it.
>> I think that there are others here who would be better qualified to
>> advise you than me.
>>
>> Keep us up to date though, won't you?
>>
>> I am glad that you have nipped it in the bud, & will continue to think
>> of you whilst you are going through this hard time
>>
>> Best Wishes, & devoted Purrs of a soothing nature from them all & us
>> too of course!!
>> S;o)
>
> Sorry Cindy, I posted the wrong page to one of the links.
> It should have been
>
> http://www.catsofaustralia.com/cat-kidney-disease.htm
>
> http://www.felinecrf.org/related_diseases.htm
>
> http://www.petshealth.com/dr_library/felrenfail.html
>
> Aplogies,
> S;o)
>

Phil P.
March 20th 07, 10:09 AM
"cindys" > wrote in message
...

> Now, I'm confused. Isn't the idea to lower phosphorous while keeping
protein
> the same?

Its difficult to lower phosphorus while keeping protein the same because
most of the phosphorus content in the diet in contained in the protein
component of the diet.

The difference in phosphorus content between k/d and x/d isn't that great--
..38% and .53%, respectively- which is only about 25 mg/100 kcal more and not
a problem unless your cat is hyperphosphatemic. The higher protein content
is more beneficial than the slightly higher phosphorus content is
deleterious.


> Won't an alkaline diet predispose him to crystal formation?


k/d, nf and Euk Multistage Renal are all alkaline diets. You want to avoid
acidified diets for cats with CRF-- especially acidified diets that are also
magnesium restricted- which most diets are- because they can promote
hypokalemia and metabolic acidosis. Acidosis will really make your cat feel
sick and not want to eat anything.


> Isn't K/D a low protein diet?

Yes.


How does K/D differ from this NF that my vet wants
> me to feed the cat?


Slightly different formulation- not enough to make a difference either way.


(I don't remember for sure what the lab values were, but
> I'm pretty sure the BUN was lower than 65 mg/dl).


If your cat isn't dehydrated or severely uremic, I'd get a second opinion on
fluid therapy at this stage.



> Are cats with CRF less inclined to get struvite or is it simply a question
> of the need for a more renoprotective alkaline diet needs to take priority
> (and we cross our fingers that the cat doesn't develop struvite)?

CRF cats already have a problem with renal acid excretion- so you don't want
to add to it. Besides, older cats are more prone to develop calcium oxalate
than struvite.

>
> Thank you again for all your advice.
> Best regards,
> ---Cindy S.

I hope it helps.

Best of luck,

Phil

David Mooney
March 20th 07, 01:44 PM
Hi Cindy,

I am sorry about your cat. I hope he gets better soon. Take care.

regards,
David M


"cindys" > wrote in message
...
>
> "Phil P." > wrote in message
> news:%[email protected]
>>
>> "cindys" > wrote in message
>> ...
>>> Well, I just got the bad news from the vet. Alex, who is 16 years old,
>>> is
>>> just beginning CRF. The vet told me in addition to switching his food to
>> NK,
>>> I should begin weekly subcu fluids. She stated that by so doing, since
>>> he
>> is
>>> still in the very early stages of the disease process, it is actually
>>> possible to reverse the situation and return him to relatively normal
>> kidney
>>> function. Has anyone ever heard of this before (that beginning subcu
>>> right
>>> at the beginning of CRF can reverse the process?).
>>
>> I'm sorry to hear about your cat- I'm going through the same thing with
>> my
>> 20 year-old.
>>
>> ARF (acute renal failure) is reversible in some cases but CRF is not. By
>> the time CRF shows up in the bloodwork (high BUN/creatinine 60-75% of
>> renal
>> function has already been irreversibly lost. The reason why CRF doesn't
>> show up in the bloodwork as its happening is because the feline kidneys'
>> have a huge nephron reserve, and 'glomerular hyperfiltration'-- the
>> indivudual intact nephrons increase their filtration rate to compensate
>> for
>> the lost and damaged nephrons.
>>
>>
>>
>> I did successfully cure
>>> him of diabetes with Lantus insulin, and I never would have thought that
>>> would be possible. Now that he'll be eating NK, we are going to have to
>> keep
>>> a very close watch on his blood glucose to ensure the diabetes doesn't
>>> return. The doctor recommended that we repeat bloodwork to reassess
>>> kidney
>>> function in about three months. Does anyone have any thoughts on any of
>>> this?
>>> Best regards,
>>> ---Cindy S.
>>
>> Fluid therapy should be administered *only* to correct or prevent
>> dehydration or short-term to augment GFR in a uremic crisis. Premature
>> or
>> unnecessary chronic fluid therapy can *promote* the progression of CRF
>> because it makes the kidney work harder. What is your cat's BUN and
>> creatinine concentrations and urine specific gravity?
>>
>> I think you should seek a second opinion from a veterinary nephrologist
>> or a
>> vet who is experienced in treating feline CRF.
>>
>> You might want to start thinking about giving your cat a potassium and
>> omega-3 supplement. Both will delay the downward spiral of CRF.
> ------------------
> Thank you. I don't remember what the vet said the BUN and creatinine were,
> but it would be easy enough to find out. She wants to put the cat on a
> prescription low protein kidney diet. On one of the websites for which
> Sheelagh provided a link, I read that this would actually be a bad idea
> because there is no evidence that low protein diets delay progression and
> in the meantime, the cat's body is not getting sufficient protein. Would
> you agree or disagee with that? BTW, I have a feeling my other
> approximately 15-year-old cat may be headed down the same path. His BUN
> and creatinine are high normal. Do you have any thoughts on anything I can
> be doing to prevent the development of CRF in him?
>
> (The other problem is that I have several younger, presumably healthy
> cats, and all my cats eat the same dry food. I also give them canned food,
> so I could continue to give the young healthy cats the high protein canned
> food, but one of my younger cats refuses the canned food and is only
> willing to eat the dry. She does not need to be on a low protein diet,
> which would be the net result if I switched over to the NK prescription
> food.)
> Thanks in advance.
> Best regards,
> ---Cindy S.
>

cindys
March 20th 07, 03:37 PM
"David Mooney" > wrote in message
...
> Hi Cindy,
>
> I am sorry about your cat. I hope he gets better soon. Take care.
>
> regards,
> David M
--------
Thanks, David.
Best regards,
---Cindy S.

cindys
March 20th 07, 11:05 PM
"Phil P." > wrote in message
news:%[email protected]

>
> Fluid therapy should be administered *only* to correct or prevent
> dehydration or short-term to augment GFR in a uremic crisis. Premature or
> unnecessary chronic fluid therapy can *promote* the progression of CRF
> because it makes the kidney work harder. What is your cat's BUN and
> creatinine concentrations and urine specific gravity?
>
> I think you should seek a second opinion from a veterinary nephrologist or
> a
> vet who is experienced in treating feline CRF.
>
> You might want to start thinking about giving your cat a potassium and
> omega-3 supplement. Both will delay the downward spiral of CRF.
-----------
BUN 54.2
Creatinine 2.1
Urine specific gravity 1017 (Normal 10/23)
Potassium is in the middle of the normal range.

FTR, the BUN was around 24 or 25 in December, so it doubled in just a few
months.

I questioned the vet quite a bit about the subcu fluids. She said that while
it is true that the diseased nephrons can never recover, the subcu will
"open up tubules" and prevent more nephrons from being lost. She stated that
she has almost never failed to see improvement in lab values once the subcu
fluids are started. She said the low protein diet was less critical, and
that it would be no big deal to keep Alex on his current diet. She said that
her plan, anyway, is to repeat his bloodwork in three to six months, and
then we can go from there.

I know you think I should still get a second opinion regarding the subcu
fluids. Do you know if it is possible for me to speak to someone at Cornell?
I think the question at this stage is a simple yes/no, i.e., I would ask the
second opinion vet whether he/she generally believes it's a good idea or a
bad idea to start subcu fluids in a cat with early CRF. I don't think the
cat would need to be reexamined.

I am going to start Alex on the Omega-3 (from fish) as you have advised. I
intend to give that to Bullwinkle as well (for prevention). My vet advised
against starting the potassium until Alex's values slip out of normal range.
Right now, they are in the mid-range of normal.

Does all of this seem like a reasonable plan to you?
Thanks in advance.
Best regards,
---Cindy S.

22brix
March 21st 07, 03:49 AM
"cindys" > wrote in message
...
>
> "Phil P." > wrote in message
> news:%[email protected]
>
>>
>> Fluid therapy should be administered *only* to correct or prevent
>> dehydration or short-term to augment GFR in a uremic crisis. Premature
>> or
>> unnecessary chronic fluid therapy can *promote* the progression of CRF
>> because it makes the kidney work harder. What is your cat's BUN and
>> creatinine concentrations and urine specific gravity?
>>
>> I think you should seek a second opinion from a veterinary nephrologist
>> or a
>> vet who is experienced in treating feline CRF.
>>
>> You might want to start thinking about giving your cat a potassium and
>> omega-3 supplement. Both will delay the downward spiral of CRF.
> -----------
> BUN 54.2
> Creatinine 2.1
> Urine specific gravity 1017 (Normal 10/23)
> Potassium is in the middle of the normal range.
>
> FTR, the BUN was around 24 or 25 in December, so it doubled in just a few
> months.
>
> I questioned the vet quite a bit about the subcu fluids. She said that
> while it is true that the diseased nephrons can never recover, the subcu
> will "open up tubules" and prevent more nephrons from being lost. She
> stated that she has almost never failed to see improvement in lab values
> once the subcu fluids are started. She said the low protein diet was less
> critical, and that it would be no big deal to keep Alex on his current
> diet. She said that her plan, anyway, is to repeat his bloodwork in three
> to six months, and then we can go from there.
>
> I know you think I should still get a second opinion regarding the subcu
> fluids. Do you know if it is possible for me to speak to someone at
> Cornell? I think the question at this stage is a simple yes/no, i.e., I
> would ask the second opinion vet whether he/she generally believes it's a
> good idea or a bad idea to start subcu fluids in a cat with early CRF. I
> don't think the cat would need to be reexamined.
>
> I am going to start Alex on the Omega-3 (from fish) as you have advised. I
> intend to give that to Bullwinkle as well (for prevention). My vet advised
> against starting the potassium until Alex's values slip out of normal
> range. Right now, they are in the mid-range of normal.
>
> Does all of this seem like a reasonable plan to you?
> Thanks in advance.
> Best regards,
> ---Cindy S.
>


Cindy,

I don't know if you'd be interested in this or not--it's Cornell
University's consulting service--looks like it's available for both vets and
owners. Of course it's not free.. . but you might want to try it.

http://www.vet.cornell.edu/fhc/camuti.htm

Alex's numbers don't look that different from Molly's. His creatinine is
slightly higher but that number isn't as important as the BUN. All I know
is that she really started feeling better once we started her on fluids.

Good luck, Cindy.

HTH
Bonnie

cindys
March 21st 07, 04:16 AM
"22brix" > wrote in message
...
>>
>
>
> Cindy,
>
> I don't know if you'd be interested in this or not--it's Cornell
> University's consulting service--looks like it's available for both vets
> and owners. Of course it's not free.. . but you might want to try it.
>
> http://www.vet.cornell.edu/fhc/camuti.htm
>
> Alex's numbers don't look that different from Molly's. His creatinine is
> slightly higher but that number isn't as important as the BUN. All I know
> is that she really started feeling better once we started her on fluids.
>
> Good luck, Cindy.
----------
Thank you so much. By description, the Cornell service seems to be made to
order for what I had in mind.

BTW, Alex had been looking under the weather for quite some time, sleeping
all the time, very little appetite, not wanting to leave the kitchen much.
He had also thrown up a few times, the clear liquid that is so typical for
cats with CRF (due to nausea). On one of the websites (I think it was a
website and not this forum), I read about giving the cat 5 mg of Pepcid
daily. I just happened to have some (20 mg tablets that had been cut into
four parts) left over from when my Molly was nauseated and dying and I tried
giving it to her (I had forgotten all about that).

To make a long story short, I gave Alex a single dose yesterday, not really
expecting much, and today he was like a new cat! This is the liveliest and
best we have seen him in weeks. Perky, happy, he came upstairs twice. Every
time I went in the kitchen, he would follow me around asking for food. Great
appetite. Overall, he was much more active than I've seen him in a very long
time. It was a like a miracle. So, if you didn't know already, if ever your
Molly seems under the weather, the Pepcid is something easy you can try.
It's also inexpensive and relatively innocuous.

Thank you again.
Best regards,
---Cindy S.

22brix
March 21st 07, 04:47 AM
"cindys" > wrote in message
...
>
> "22brix" > wrote in message
> ...
>>>
>>
>>
>> Cindy,
>>
>> I don't know if you'd be interested in this or not--it's Cornell
>> University's consulting service--looks like it's available for both vets
>> and owners. Of course it's not free.. . but you might want to try it.
>>
>> http://www.vet.cornell.edu/fhc/camuti.htm
>>
>> Alex's numbers don't look that different from Molly's. His creatinine is
>> slightly higher but that number isn't as important as the BUN. All I
>> know is that she really started feeling better once we started her on
>> fluids.
>>
>> Good luck, Cindy.
> ----------
> Thank you so much. By description, the Cornell service seems to be made to
> order for what I had in mind.
>
> BTW, Alex had been looking under the weather for quite some time, sleeping
> all the time, very little appetite, not wanting to leave the kitchen much.
> He had also thrown up a few times, the clear liquid that is so typical for
> cats with CRF (due to nausea). On one of the websites (I think it was a
> website and not this forum), I read about giving the cat 5 mg of Pepcid
> daily. I just happened to have some (20 mg tablets that had been cut into
> four parts) left over from when my Molly was nauseated and dying and I
> tried giving it to her (I had forgotten all about that).
>
> To make a long story short, I gave Alex a single dose yesterday, not
> really expecting much, and today he was like a new cat! This is the
> liveliest and best we have seen him in weeks. Perky, happy, he came
> upstairs twice. Every time I went in the kitchen, he would follow me
> around asking for food. Great appetite. Overall, he was much more active
> than I've seen him in a very long time. It was a like a miracle. So, if
> you didn't know already, if ever your Molly seems under the weather, the
> Pepcid is something easy you can try. It's also inexpensive and relatively
> innocuous.
>
> Thank you again.
> Best regards,
> ---Cindy S.
>

So good to hear Alex is feeling better! And thanks for the great tip
regarding Pepcid. My geriatric dog and I are both on pepcid so I already
have some around--10 mg tablets--so I'll definitely keep that in mind! How
big is Alex? Molly is pretty small--around 6 lbs give or take an ounce. I
wonder if the dose would be the same. My dog is on 5 mg once daily and she
is 45 to 50lbs.

Let us know about the consultation service--I thought it was a neat idea and
not that terribly expensive.

Take care, I wish you and Alex the best.

Bonnie

cindys
March 21st 07, 05:04 AM
"22brix" > wrote in message
...
>
> "cindys" > wrote in message
> ...
>>
>> "22brix" > wrote in message
>> ...
>>>>
>>>
>>>
>>> Cindy,
>>>
>>> I don't know if you'd be interested in this or not--it's Cornell
>>> University's consulting service--looks like it's available for both vets
>>> and owners. Of course it's not free.. . but you might want to try it.
>>>
>>> http://www.vet.cornell.edu/fhc/camuti.htm
>>>
>>> Alex's numbers don't look that different from Molly's. His creatinine
>>> is slightly higher but that number isn't as important as the BUN. All I
>>> know is that she really started feeling better once we started her on
>>> fluids.
>>>
>>> Good luck, Cindy.
>> ----------
>> Thank you so much. By description, the Cornell service seems to be made
>> to order for what I had in mind.
>>
>> BTW, Alex had been looking under the weather for quite some time,
>> sleeping all the time, very little appetite, not wanting to leave the
>> kitchen much. He had also thrown up a few times, the clear liquid that is
>> so typical for cats with CRF (due to nausea). On one of the websites (I
>> think it was a website and not this forum), I read about giving the cat 5
>> mg of Pepcid daily. I just happened to have some (20 mg tablets that had
>> been cut into four parts) left over from when my Molly was nauseated and
>> dying and I tried giving it to her (I had forgotten all about that).
>>
>> To make a long story short, I gave Alex a single dose yesterday, not
>> really expecting much, and today he was like a new cat! This is the
>> liveliest and best we have seen him in weeks. Perky, happy, he came
>> upstairs twice. Every time I went in the kitchen, he would follow me
>> around asking for food. Great appetite. Overall, he was much more active
>> than I've seen him in a very long time. It was a like a miracle. So, if
>> you didn't know already, if ever your Molly seems under the weather, the
>> Pepcid is something easy you can try. It's also inexpensive and
>> relatively innocuous.
>>
>> Thank you again.
>> Best regards,
>> ---Cindy S.
>>
>
> So good to hear Alex is feeling better! And thanks for the great tip
> regarding Pepcid. My geriatric dog and I are both on pepcid so I already
> have some around--10 mg tablets--so I'll definitely keep that in mind!
> How big is Alex? Molly is pretty small--around 6 lbs give or take an
> ounce. I wonder if the dose would be the same. My dog is on 5 mg once
> daily and she is 45 to 50lbs.
-----------
Alex weighs somewhere between 11 and 12 pounds. The dose mentioned on the
website was 5 mg for a cat (without mention of the size of the cat). When I
phoned my vet's office, I asked "would it be okay to give Alex a 5 mg dose
of Pepcid?" and I was told yes. When I opened the Pepcid box, I saw that I
had already quartered some of the 20 mg tablets the last time I used it. I
am presuming that was for my Molly who weighed about 6 pounds at the time.
So, I suspect that the vet must have told me 5 mg for her. But, I wouldn't
swear to it, as I had also given Pepcid to Alvin (my dog) who weighed about
45 pounds. Somehow, I have it in my head that Alvin's dose may have been
more than 5 mg. At any rate, I suspect the proper dose for your Molly will
be 5 mg, but obviously ask your vet.

>
> Let us know about the consultation service--I thought it was a neat idea
> and not that terribly expensive.

I agree. Not much more than the price of an office visit. I spent close to
$200 at the vet last week, so $55 seems like a relative bargain.


> Take care, I wish you and Alex the best.

Thanks Bonnie. Same to you and Molly.
Best regards,
---Cindy S.


>
> Bonnie
>
>
>
>
>

Phil P.
March 22nd 07, 04:13 AM
"cindys" > wrote in message
...
> -----------
> BUN 54.2
> Creatinine 2.1
> Urine specific gravity 1017 (Normal 10/23)
> Potassium is in the middle of the normal range.
>
> FTR, the BUN was around 24 or 25 in December, so it doubled in just a few
> months.

BUN is not as important as creatinine. What was his previous creatinine?


>
> I questioned the vet quite a bit about the subcu fluids. She said that
while
> it is true that the diseased nephrons can never recover, the subcu will
> "open up tubules" and prevent more nephrons from being lost.


As her for a reference on that on....


She stated that
> she has almost never failed to see improvement in lab values once the
subcu
> fluids are started.


Its true that fluid therapy will impove renal parameters *acutely*, but it
should not be used chronically as a form of dialysis.


She said the low protein diet was less critical, and
> that it would be no big deal to keep Alex on his current diet. She said
that
> her plan, anyway, is to repeat his bloodwork in three to six months, and
> then we can go from there.
>
> I know you think I should still get a second opinion regarding the subcu
> fluids. Do you know if it is possible for me to speak to someone at
Cornell?

You might want to give Dr. David J Polzin at U of Minn. a call @
612-625-4254. You can also send him an email @
He's one of the leading experts on CRF in cats. I don't think he'll charge
you for his opinion.


> I think the question at this stage is a simple yes/no, i.e., I would ask
the
> second opinion vet whether he/she generally believes it's a good idea or a
> bad idea to start subcu fluids in a cat with early CRF. I don't think the
> cat would need to be reexamined.

You're right.


>
> I am going to start Alex on the Omega-3 (from fish) as you have advised. I
> intend to give that to Bullwinkle as well (for prevention). My vet advised
> against starting the potassium until Alex's values slip out of normal
range.
> Right now, they are in the mid-range of normal.

I really think you should find another vet. The reason for supplementing
potassium is so Alex's potassium *doesn't* "slip out of normal range" and to
protect tissue from potassium depletion. Blood or serum potassium levels
are not accurrate markers of the body's potassium stores because ~97% of the
body's potassium is stored in *tissue* not in the blood or serum. By the
time potassium "slips out of normal range" potassium depletion has already
begun in the tissues. IOW, cats with normal serum potassium levels can still
have deficient potassium levels in the tissue.

"Interestingly, muscle potassium content has been shown to be decreased in
normokalemic cats with spontaneous CRF, indicating that a total body deficit
of potassium may develop well before the onset of hypokalemia." (David J
Polzin, DVM, Dipl. ACVIM)


>
> Does all of this seem like a reasonable plan to you?

Dump your vet *now* before its too late.

Btw, Pepcid was a good idea. Uremia can cause uremic gastritis.


> Thanks in advance.
> Best regards,
> ---Cindy S.

Best of luck,

Phil

cindys
March 22nd 07, 03:56 PM
"Phil P." > wrote in message
news:[email protected]
>
> "cindys" > wrote in message
> ...
>> -----------
>> BUN 54.2
>> Creatinine 2.1
>> Urine specific gravity 1017 (Normal 10/23)
>> Potassium is in the middle of the normal range.
>>
>> FTR, the BUN was around 24 or 25 in December, so it doubled in just a few
>> months.
>
> BUN is not as important as creatinine. What was his previous creatinine?

I don't remember the exact number, but I do remember that there was not a
significant change.

>>
>> I questioned the vet quite a bit about the subcu fluids. She said that
> while
>> it is true that the diseased nephrons can never recover, the subcu will
>> "open up tubules" and prevent more nephrons from being lost.
>
>
> As her for a reference on that on....
>
>
> She stated that
>> she has almost never failed to see improvement in lab values once the
> subcu
>> fluids are started.
>
>
> Its true that fluid therapy will impove renal parameters *acutely*, but it
> should not be used chronically as a form of dialysis.
>
>
> She said the low protein diet was less critical, and
>> that it would be no big deal to keep Alex on his current diet. She said
> that
>> her plan, anyway, is to repeat his bloodwork in three to six months, and
>> then we can go from there.
>>
>> I know you think I should still get a second opinion regarding the subcu
>> fluids. Do you know if it is possible for me to speak to someone at
> Cornell?
>
> You might want to give Dr. David J Polzin at U of Minn. a call @
> 612-625-4254. You can also send him an email @
> He's one of the leading experts on CRF in cats. I don't think he'll
> charge
> you for his opinion.

Thank you, thank you!
>
>
>> I think the question at this stage is a simple yes/no, i.e., I would ask
> the
>> second opinion vet whether he/she generally believes it's a good idea or
>> a
>> bad idea to start subcu fluids in a cat with early CRF. I don't think the
>> cat would need to be reexamined.
>
> You're right.
>
>
>>
>> I am going to start Alex on the Omega-3 (from fish) as you have advised.
>> I
>> intend to give that to Bullwinkle as well (for prevention). My vet
>> advised
>> against starting the potassium until Alex's values slip out of normal
> range.
>> Right now, they are in the mid-range of normal.
>
> I really think you should find another vet. The reason for supplementing
> potassium is so Alex's potassium *doesn't* "slip out of normal range" and
> to
> protect tissue from potassium depletion. Blood or serum potassium levels
> are not accurrate markers of the body's potassium stores because ~97% of
> the
> body's potassium is stored in *tissue* not in the blood or serum. By the
> time potassium "slips out of normal range" potassium depletion has already
> begun in the tissues. IOW, cats with normal serum potassium levels can
> still
> have deficient potassium levels in the tissue.

And being in the medical field myself, I should have known/remembered that.
>
> "Interestingly, muscle potassium content has been shown to be decreased in
> normokalemic cats with spontaneous CRF, indicating that a total body
> deficit
> of potassium may develop well before the onset of hypokalemia." (David J
> Polzin, DVM, Dipl. ACVIM)
>
>
>>
>> Does all of this seem like a reasonable plan to you?
>
> Dump your vet *now* before its too late.

We've been going to this office for years. We were previously seeing a
different vet in the same office who left for a different practice (a much
further drive and very limited hours). It's also going to be hard because
the vet has become somewhat of a personal friend, the office is near our
house, it's staffed 24/7, it has overnight boarding, and a hospital, etc.
Most of the other vet hospitals around here don't offer all of this. In
spite of all of that, I am willing to change to another vet, but how will I
know that the new vet will be better than the old one? One way, was I was
thinking of phoning a particular Cats Only practice and asking them how they
would treat my cat's CRF and see what they say. Or I could say "I was
thinking of doing this (naming what my vet had suggested), do you think
that's a good idea?"

Again, Phil, thank you so much.
Best regards,
---Cindy S.

>
> Btw, Pepcid was a good idea. Uremia can cause uremic gastritis.
>
>
>> Thanks in advance.
>> Best regards,
>> ---Cindy S.
>
> Best of luck,
>
> Phil
>
>

March 22nd 07, 05:19 PM
"cindys" > wrote:

>>
>> Dump your vet *now* before its too late.
>
>We've been going to this office for years. We were previously seeing a
>different vet in the same office who left for a different practice (a much
>further drive and very limited hours). It's also going to be hard because
>the vet has become somewhat of a personal friend, the office is near our
>house, it's staffed 24/7, it has overnight boarding, and a hospital, etc.
>Most of the other vet hospitals around here don't offer all of this. In
>spite of all of that, I am willing to change to another vet, but how will I
>know that the new vet will be better than the old one? One way, was I was
>thinking of phoning a particular Cats Only practice and asking them how they
>would treat my cat's CRF and see what they say. Or I could say "I was
>thinking of doing this (naming what my vet had suggested), do you think
>that's a good idea?"

Is your vet open to exchange of ideas and other opinions? Perhaps
Phil's advice may sound logical to your vet and he will modify his
recommendation.

cindys
March 22nd 07, 06:56 PM
> wrote in message
...
> "cindys" > wrote:
>
>>>
>>> Dump your vet *now* before its too late.
>>
>>We've been going to this office for years. We were previously seeing a
>>different vet in the same office who left for a different practice (a much
>>further drive and very limited hours). It's also going to be hard because
>>the vet has become somewhat of a personal friend, the office is near our
>>house, it's staffed 24/7, it has overnight boarding, and a hospital, etc.
>>Most of the other vet hospitals around here don't offer all of this. In
>>spite of all of that, I am willing to change to another vet, but how will
>>I
>>know that the new vet will be better than the old one? One way, was I was
>>thinking of phoning a particular Cats Only practice and asking them how
>>they
>>would treat my cat's CRF and see what they say. Or I could say "I was
>>thinking of doing this (naming what my vet had suggested), do you think
>>that's a good idea?"
>
> Is your vet open to exchange of ideas and other opinions? Perhaps
> Phil's advice may sound logical to your vet and he will modify his
> recommendation.
-------
Well, she'll go along with what I think is best for Alex, i.e., she's not
going to give me an argument about what I want to do, but that's not the
same as modifying her recommendation. When I told her that I didn't think I
wanted to change the food to NF, she said fine. When I asked about the
omega-3 and potassium, she said fine to omega-3 but advised against the
potassium for the reasons, stated etc. And if I speak to Dr. Prozin (I have
e-mailed and also left him a phone message), and he agrees with Phil, and I
tell her I don't want to initiate subcu fluids, she will say okay to that
too. But I don't think that's the issue.

I think the real issue here is that I have five cats, all of whom are her
patients. After this, will I still have confidence in her abilities, as a
whole? What happens when my next cat gets sick with something else? Am I
always going to be second guessing this doctor? That's really the issue at
hand. I have already made an appointment to get a second opinion at another
veterinary practice. Once I hear the other doctor's opinion and Dr. Prozin's
opinion, I will decide what I want to do. I lost another cat (Molly) to CRF
last October. The vet whom we were seeing during most of that time (the one
who moved to a more distant practice) never once suggested putting Molly on
subcu fluids until she was in acute renal failure at the end (as Phil said).
OTOH, she also never suggested omega-3, potassium supplementation at any
point. She did suggest the K/D food at some point in the middle but Molly
wouldn't eat it, so that was a moot point. My husband feels that overall she
was a better vet than this one. But was she really? Who knows? The reality
is that at some point down the road, Alex will die from CRF. No matter when
that happens, I will never know for sure if the interventions (any of them)
actually prolonged his life or shortened it. How can I know for sure if he
would have lived for six months more or six months less if only I had done
this or hadn't done that?
Best regards,
---Cindy S.

cindys
March 22nd 07, 08:39 PM
"cindys" > wrote in message
...

snip
>And if I speak to Dr. Prozin (I have e-mailed and also left him a phone
>message),

----
Dr. Polzin, not Prozin. I did get it right on the phone message and e-mail
however.
Best regards,
---Cindy S.

Phil P.
March 23rd 07, 09:27 AM
"cindys" > wrote in message
...
>
> We've been going to this office for years. We were previously seeing a
> different vet in the same office who left for a different practice (a much
> further drive and very limited hours). It's also going to be hard because
> the vet has become somewhat of a personal friend,


I realize switching vets or even getting a second opinion can make you feel
uncomfortable- especially if you have a close relationship with your vet.
However, I think your first loyalty should be to your cat, not to your vet.
You have to ask yourself "is this vet doing the best thing for my cat?".
From what you said she said, I'd have to say no. Just because she says she
has treated cats with CRF before doesn't mean she's good at it. Sounds like
she's mediocre at best.



the office is near our
> house, it's staffed 24/7, it has overnight boarding, and a hospital, etc.
> Most of the other vet hospitals around here don't offer all of this. In
> spite of all of that, I am willing to change to another vet, but how will
I
> know that the new vet will be better than the old one?

I know what you mean. You could go from bad to worse. If you have a vet
college near you, you might want to give them a call for a referral or you
could do a search for a ACVIM diplomate or ABVP feline specialist in your
area. They have much more training and experience. Very few general
practioners are really knowledgable about treating CRF. Renal diets and
fluid therapy are about the extent of their experience.



One way, was I was
> thinking of phoning a particular Cats Only practice and asking them how
they
> would treat my cat's CRF and see what they say. Or I could say "I was
> thinking of doing this (naming what my vet had suggested), do you think
> that's a good idea?"


I don't think a vet will give you a specific recommendations for a treatment
plan without seeing your cat.

If your email is working I can send you a very good file about CRF and the
importance of potassium.


Best of luck,

Phil

cindys
March 23rd 07, 01:02 PM
"Phil P." > wrote in message
news:[email protected]
>
> "cindys" > wrote in message
> ...
>>
>> We've been going to this office for years. We were previously seeing a
>> different vet in the same office who left for a different practice (a
>> much
>> further drive and very limited hours). It's also going to be hard because
>> the vet has become somewhat of a personal friend,
>
>
> I realize switching vets or even getting a second opinion can make you
> feel
> uncomfortable- especially if you have a close relationship with your vet.

Hi, Phil! I'm bringing Alex to a different veterinary practice for a second
opinion on Monday.

> However, I think your first loyalty should be to your cat, not to your
> vet.
> You have to ask yourself "is this vet doing the best thing for my cat?".
> From what you said she said, I'd have to say no. Just because she says
> she
> has treated cats with CRF before doesn't mean she's good at it. Sounds
> like
> she's mediocre at best.

Thank you so much for the phone number and e-mail for Dr. Polzin. I have
been in touch with him. Basically, what he said was that it would be
unethical for him to provide a treatment plan for my cat. I wasn't really
asking him to do that, but since I did provide him with the lab values and
Alex's medical history, I can see why he would have interpreted it that way.

He said that he thinks some of my vet's suggestions are "optional," but he
disagreed that I needed to switch to a different veterinarian. He said he
would be willing to act as a consultant and communicate with the current
veterinarian directly if she were open to that (and I initiated that). I
thought that was incredibly kind.

>
> the office is near our
>> house, it's staffed 24/7, it has overnight boarding, and a hospital, etc.
>> Most of the other vet hospitals around here don't offer all of this. In
>> spite of all of that, I am willing to change to another vet, but how will
> I
>> know that the new vet will be better than the old one?
>
> I know what you mean. You could go from bad to worse. If you have a vet
> college near you, you might want to give them a call for a referral or you
> could do a search for a ACVIM diplomate or ABVP feline specialist in your
> area. They have much more training and experience. Very few general
> practioners are really knowledgable about treating CRF. Renal diets and
> fluid therapy are about the extent of their experience.

We have a *veterinary specialist* group. It is by referral from the primary
vet only. There are five specialists, none of whom is specifically for
renal. Two are for ophthalmology, one is for orthopedics, one may be
cardiology, one is surgery. But one of them (I can't remember which one) did
complete a renal residency, so I would try to see him. I have made an
appointment to get a second opinion from a different (general) vet on
Monday. Depending on how things go, I could ask her for a referral to the
specialist. Actually, what I would prefer to do is to make a photocopy of
the article you e-mailed me and present it to my current vet. Can you
reference for me any articles specifically about the subcu fluids? (Unless
the subject is addressed in the article you already e-mailed me- I just
turned on my computer five minutes ago and haven't read the potassium
article yet).
>
> One way, was I was
>> thinking of phoning a particular Cats Only practice and asking them how
> they
>> would treat my cat's CRF and see what they say. Or I could say "I was
>> thinking of doing this (naming what my vet had suggested), do you think
>> that's a good idea?"
>
>
> I don't think a vet will give you a specific recommendations for a
> treatment
> plan without seeing your cat.

I have an appointment on Monday.
>
> If your email is working I can send you a very good file about CRF and the
> importance of potassium.

I got it. Thank you! I will ensure that Alex starts on potassium. Do you
have an article about subcu fluid treatment in early CRF?
Thank you again for all of your help. Yesterday, I was wreck, but after
communicating with you and Dr. Polzin, I am starting to feel better. I think
my next step is to e-mail back to Dr. Polzin and asked him what he thinks
about subcu fluid treatment in early CRF *in general* and thereby he won't
feel that I am asking him to write a treatment plan for my cat (which I
really wasn't).

Again, thank you again for all of your help and for e-mailing me that
article. I will keep you updated as I go along.
Best regards,
---Cindy S.

Phil P.
March 25th 07, 11:16 AM
"cindys" > wrote in message
...


> Hi, Phil! I'm bringing Alex to a different veterinary practice for a
second
> opinion on Monday.


Hi Cindi, I'm glad to hear it. You made a wise decision.

>
> Thank you so much for the phone number and e-mail for Dr. Polzin.

You're welcome.


I have
> been in touch with him. Basically, what he said was that it would be
> unethical for him to provide a treatment plan for my cat. I wasn't really
> asking him to do that, but since I did provide him with the lab values and
> Alex's medical history, I can see why he would have interpreted it that
way.
>
> He said that he thinks some of my vet's suggestions are "optional," but he
> disagreed that I needed to switch to a different veterinarian.


I think that was just a professional courtesy. He's a very nice person.

It was bad enough that your vet didn't recommend a K+ supplement to protect
Alex's body's K+ stores, she should have definitely recommended a K+
supplement when she recommended fluid therapy. Cats with CRF produce more
urine and urinate more frequently
because they lose their ability to concentrate urine. Producing urine
rapidly and frequently promotes potassium loss-- fluid therapy induces
diuresis which increases rapid urine formation and thus even greater K+
losses. That's why most vets and human doctors prescribe a K+
supplement whenever they prescribe a diuretic. I think she erred at a very
basic level- which is inexcusable as far as I'm concerned. I couldn't trust
a vet who made such a basic error with my cats' lives. I see it as an early
waning sign to find another vet with more experience in treating CRF. Alex
can't afford to have a vet that learns by trial and error on him.


He said he
> would be willing to act as a consultant and communicate with the current
> veterinarian directly if she were open to that (and I initiated that). I
> thought that was incredibly kind.

That's why I suggested you contact him. He's a very kind person and he
really cares about the animals' well-being.



> We have a *veterinary specialist* group. It is by referral from the
primary
> vet only. There are five specialists, none of whom is specifically for
> renal. Two are for ophthalmology, one is for orthopedics, one may be
> cardiology, one is surgery. But one of them (I can't remember which one)
did
> complete a renal residency, so I would try to see him. I have made an
> appointment to get a second opinion from a different (general) vet on
> Monday. Depending on how things go, I could ask her for a referral to the
> specialist.

It would be great if you could find a general vet who has a special interest
in nephrology- or at least CRF- and is up to date on current treatments.


Actually, what I would prefer to do is to make a photocopy of
> the article you e-mailed me and present it to my current vet.

Here's another quote about potassium by Gary Norsworthy (excerpted from
Feline Practice):

"Recently, two important discoveries have been made concerning potassium and
older cats. A mild form of hypokalemia (low blood potassium) has been
identified in the older cat; it is associated with lethargy and inactivity,
a poor appetite and haircoat, and the development of a mild anemia.
Formerly, we have considered these to be part of the aging process. Now we
know that this process can be reversed with supplementation of potassium.
Unfortunately, we do not have a test to conclusively identify these cats
because the blood test for potassium is a poor reflection of the body's
total store of potassium. Blood potassium may be normal in cats who are
actually depleted of potassium within their body's cells. For these cats, a
30 to 45 day trial of potassium is necessary. If response occurs and
potassium supplementation is continued, the cat will continue to feel, act,
and eat better and will live longer.



The second discovery about low blood potassium is related to the effect of
potassium on the kidneys. The kidneys are the organs that usually wear out
first in the older cat. As the kidneys become less efficient in removing
waste products from the blood, the cat drinks more and more water in an
attempt to flush toxins from the body (via the kidneys). An undesired
consequence of increased urination is the loss of potassium from the body in
the urine. As urine production increases, more and more potassium is lost,
eventually leading to hypokalemia. The potassium loss associated with
increased urine production has a negative effect on the kidneys. Research
has demonstrated that low potassium will depress kidney function. This
results in a vicious cycle: declining kidney function results in increased
loss of potassium, and the loss of potassium then speeds up the
deterioration of the kidneys."



Do you see why its very dangerous to wait until Alex's K+ values "slip out
of the normal range"?



Can you
> reference for me any articles specifically about the subcu fluids? (Unless
> the subject is addressed in the article you already e-mailed me- I just
> turned on my computer five minutes ago and haven't read the potassium
> article yet).

Sure. Here's a quote by Dr. Kathy James- the Urology/Nephrology Consultant
for VIN:

"There are certainly some theoretical reasons why prolonged diuresis could
promote progression. The elevated glomerular filtration rate could be
associated with hypertension in the kidney itself. Also diuresis will result
in more Na+ filtered that has to be reabsorbed and more energy consumed by
the kidney.
More energy consumed means more O2 burned and more O2 metabolites the kidney
has to process. Just some theoretical reasons why we need to
start SQ fluids when crf cats are at risk for dehydration but not before."

Here's a link to a chart on my site that shows you how to calculate the
amount of fluid to administer at different levels of dehydration:

http://maxshouse.com/Calculation_of_24-Hour_Fluid_Requirement_at_Different_Levels_of_Dehy dration.htm


> I got it. Thank you! I will ensure that Alex starts on potassium. Do you
> have an article about subcu fluid treatment in early CRF?
> Thank you again for all of your help. Yesterday, I was wreck, but after
> communicating with you and Dr. Polzin, I am starting to feel better. I
think
> my next step is to e-mail back to Dr. Polzin and asked him what he thinks
> about subcu fluid treatment in early CRF *in general* and thereby he won't
> feel that I am asking him to write a treatment plan for my cat (which I
> really wasn't).
> Again, thank you again for all of your help and for e-mailing me that
> article.

I'll send you Drs. Polzin & Osborne chapter on CRF from the lastest edition
(6th) of Ettinger's TBVIM. You won't find a better paper on CRF anywhere.



>I will keep you updated as I go along.

Please cc a copy of your updates to my email (topcatATmaxshouseDOTcom). With
kitten season beginning I have even less time to follow the group.


> Best regards,
> ---Cindy S.

Best of luck,

Phil

22brix
March 27th 07, 06:12 AM
Hi Cindy,

Just wondering how Alex is doing. Did he see the second vet today? I hope
all is well.

Bonnie


"cindys" > wrote in message
...
>
> "Phil P." > wrote in message
> news:[email protected]
>>
>> "cindys" > wrote in message
>> ...
>>>
>>> We've been going to this office for years. We were previously seeing a
>>> different vet in the same office who left for a different practice (a
>>> much
>>> further drive and very limited hours). It's also going to be hard
>>> because
>>> the vet has become somewhat of a personal friend,
>>
>>
>> I realize switching vets or even getting a second opinion can make you
>> feel
>> uncomfortable- especially if you have a close relationship with your vet.
>
> Hi, Phil! I'm bringing Alex to a different veterinary practice for a
> second opinion on Monday.
>
>> However, I think your first loyalty should be to your cat, not to your
>> vet.
>> You have to ask yourself "is this vet doing the best thing for my cat?".
>> From what you said she said, I'd have to say no. Just because she says
>> she
>> has treated cats with CRF before doesn't mean she's good at it. Sounds
>> like
>> she's mediocre at best.
>
> Thank you so much for the phone number and e-mail for Dr. Polzin. I have
> been in touch with him. Basically, what he said was that it would be
> unethical for him to provide a treatment plan for my cat. I wasn't really
> asking him to do that, but since I did provide him with the lab values and
> Alex's medical history, I can see why he would have interpreted it that
> way.
>
> He said that he thinks some of my vet's suggestions are "optional," but he
> disagreed that I needed to switch to a different veterinarian. He said he
> would be willing to act as a consultant and communicate with the current
> veterinarian directly if she were open to that (and I initiated that). I
> thought that was incredibly kind.
>
>>
>> the office is near our
>>> house, it's staffed 24/7, it has overnight boarding, and a hospital,
>>> etc.
>>> Most of the other vet hospitals around here don't offer all of this. In
>>> spite of all of that, I am willing to change to another vet, but how
>>> will
>> I
>>> know that the new vet will be better than the old one?
>>
>> I know what you mean. You could go from bad to worse. If you have a vet
>> college near you, you might want to give them a call for a referral or
>> you
>> could do a search for a ACVIM diplomate or ABVP feline specialist in your
>> area. They have much more training and experience. Very few general
>> practioners are really knowledgable about treating CRF. Renal diets and
>> fluid therapy are about the extent of their experience.
>
> We have a *veterinary specialist* group. It is by referral from the
> primary vet only. There are five specialists, none of whom is specifically
> for renal. Two are for ophthalmology, one is for orthopedics, one may be
> cardiology, one is surgery. But one of them (I can't remember which one)
> did complete a renal residency, so I would try to see him. I have made an
> appointment to get a second opinion from a different (general) vet on
> Monday. Depending on how things go, I could ask her for a referral to the
> specialist. Actually, what I would prefer to do is to make a photocopy of
> the article you e-mailed me and present it to my current vet. Can you
> reference for me any articles specifically about the subcu fluids? (Unless
> the subject is addressed in the article you already e-mailed me- I just
> turned on my computer five minutes ago and haven't read the potassium
> article yet).
>>
>> One way, was I was
>>> thinking of phoning a particular Cats Only practice and asking them how
>> they
>>> would treat my cat's CRF and see what they say. Or I could say "I was
>>> thinking of doing this (naming what my vet had suggested), do you think
>>> that's a good idea?"
>>
>>
>> I don't think a vet will give you a specific recommendations for a
>> treatment
>> plan without seeing your cat.
>
> I have an appointment on Monday.
>>
>> If your email is working I can send you a very good file about CRF and
>> the
>> importance of potassium.
>
> I got it. Thank you! I will ensure that Alex starts on potassium. Do you
> have an article about subcu fluid treatment in early CRF?
> Thank you again for all of your help. Yesterday, I was wreck, but after
> communicating with you and Dr. Polzin, I am starting to feel better. I
> think my next step is to e-mail back to Dr. Polzin and asked him what he
> thinks about subcu fluid treatment in early CRF *in general* and thereby
> he won't feel that I am asking him to write a treatment plan for my cat
> (which I really wasn't).
>
> Again, thank you again for all of your help and for e-mailing me that
> article. I will keep you updated as I go along.
> Best regards,
> ---Cindy S.
>
>
>

sheelagh
March 27th 07, 02:51 PM
Same here. I haven't been posting, but I have been following this one
Cindy.
I really hope that all goes well with the second vet too.

S;o)

Patty
March 27th 07, 07:27 PM
On Sun, 25 Mar 2007 10:16:24 GMT, Phil P. wrote:

> "cindys" > wrote in message
> ...
>
>
>> Hi, Phil! I'm bringing Alex to a different veterinary practice for a
> second
>> opinion on Monday.
>
>
> Hi Cindi, I'm glad to hear it. You made a wise decision.
>
>>
>> Thank you so much for the phone number and e-mail for Dr. Polzin.
>
> You're welcome.
>
>
> I have
>> been in touch with him. Basically, what he said was that it would be
>> unethical for him to provide a treatment plan for my cat. I wasn't really
>> asking him to do that, but since I did provide him with the lab values and
>> Alex's medical history, I can see why he would have interpreted it that
> way.
>>
>> He said that he thinks some of my vet's suggestions are "optional," but he
>> disagreed that I needed to switch to a different veterinarian.
>
>
> I think that was just a professional courtesy. He's a very nice person.
>
> It was bad enough that your vet didn't recommend a K+ supplement to protect
> Alex's body's K+ stores, she should have definitely recommended a K+
> supplement when she recommended fluid therapy. Cats with CRF produce more
> urine and urinate more frequently
> because they lose their ability to concentrate urine. Producing urine
> rapidly and frequently promotes potassium loss-- fluid therapy induces
> diuresis which increases rapid urine formation and thus even greater K+
> losses. That's why most vets and human doctors prescribe a K+
> supplement whenever they prescribe a diuretic. I think she erred at a very
> basic level- which is inexcusable as far as I'm concerned. I couldn't trust
> a vet who made such a basic error with my cats' lives. I see it as an early
> waning sign to find another vet with more experience in treating CRF. Alex
> can't afford to have a vet that learns by trial and error on him.
>
>
> He said he
>> would be willing to act as a consultant and communicate with the current
>> veterinarian directly if she were open to that (and I initiated that). I
>> thought that was incredibly kind.
>
> That's why I suggested you contact him. He's a very kind person and he
> really cares about the animals' well-being.
>
>
>
>> We have a *veterinary specialist* group. It is by referral from the
> primary
>> vet only. There are five specialists, none of whom is specifically for
>> renal. Two are for ophthalmology, one is for orthopedics, one may be
>> cardiology, one is surgery. But one of them (I can't remember which one)
> did
>> complete a renal residency, so I would try to see him. I have made an
>> appointment to get a second opinion from a different (general) vet on
>> Monday. Depending on how things go, I could ask her for a referral to the
>> specialist.
>
> It would be great if you could find a general vet who has a special interest
> in nephrology- or at least CRF- and is up to date on current treatments.
>
>
> Actually, what I would prefer to do is to make a photocopy of
>> the article you e-mailed me and present it to my current vet.
>
> Here's another quote about potassium by Gary Norsworthy (excerpted from
> Feline Practice):
>
> "Recently, two important discoveries have been made concerning potassium and
> older cats. A mild form of hypokalemia (low blood potassium) has been
> identified in the older cat; it is associated with lethargy and inactivity,
> a poor appetite and haircoat, and the development of a mild anemia.
> Formerly, we have considered these to be part of the aging process. Now we
> know that this process can be reversed with supplementation of potassium.
> Unfortunately, we do not have a test to conclusively identify these cats
> because the blood test for potassium is a poor reflection of the body's
> total store of potassium. Blood potassium may be normal in cats who are
> actually depleted of potassium within their body's cells. For these cats, a
> 30 to 45 day trial of potassium is necessary. If response occurs and
> potassium supplementation is continued, the cat will continue to feel, act,
> and eat better and will live longer.
>
>
>
> The second discovery about low blood potassium is related to the effect of
> potassium on the kidneys. The kidneys are the organs that usually wear out
> first in the older cat. As the kidneys become less efficient in removing
> waste products from the blood, the cat drinks more and more water in an
> attempt to flush toxins from the body (via the kidneys). An undesired
> consequence of increased urination is the loss of potassium from the body in
> the urine. As urine production increases, more and more potassium is lost,
> eventually leading to hypokalemia. The potassium loss associated with
> increased urine production has a negative effect on the kidneys. Research
> has demonstrated that low potassium will depress kidney function. This
> results in a vicious cycle: declining kidney function results in increased
> loss of potassium, and the loss of potassium then speeds up the
> deterioration of the kidneys."
>
>
>
> Do you see why its very dangerous to wait until Alex's K+ values "slip out
> of the normal range"?
>
>
>
> Can you
>> reference for me any articles specifically about the subcu fluids? (Unless
>> the subject is addressed in the article you already e-mailed me- I just
>> turned on my computer five minutes ago and haven't read the potassium
>> article yet).
>
> Sure. Here's a quote by Dr. Kathy James- the Urology/Nephrology Consultant
> for VIN:
>
> "There are certainly some theoretical reasons why prolonged diuresis could
> promote progression. The elevated glomerular filtration rate could be
> associated with hypertension in the kidney itself. Also diuresis will result
> in more Na+ filtered that has to be reabsorbed and more energy consumed by
> the kidney.
> More energy consumed means more O2 burned and more O2 metabolites the kidney
> has to process. Just some theoretical reasons why we need to
> start SQ fluids when crf cats are at risk for dehydration but not before."
>
> Here's a link to a chart on my site that shows you how to calculate the
> amount of fluid to administer at different levels of dehydration:
>
> http://maxshouse.com/Calculation_of_24-Hour_Fluid_Requirement_at_Different_Levels_of_Dehy dration.htm
>
>
>> I got it. Thank you! I will ensure that Alex starts on potassium. Do you
>> have an article about subcu fluid treatment in early CRF?
>> Thank you again for all of your help. Yesterday, I was wreck, but after
>> communicating with you and Dr. Polzin, I am starting to feel better. I
> think
>> my next step is to e-mail back to Dr. Polzin and asked him what he thinks
>> about subcu fluid treatment in early CRF *in general* and thereby he won't
>> feel that I am asking him to write a treatment plan for my cat (which I
>> really wasn't).
>> Again, thank you again for all of your help and for e-mailing me that
>> article.
>
> I'll send you Drs. Polzin & Osborne chapter on CRF from the lastest edition
> (6th) of Ettinger's TBVIM. You won't find a better paper on CRF anywhere.
>
>
>
>>I will keep you updated as I go along.
>
> Please cc a copy of your updates to my email (topcatATmaxshouseDOTcom). With
> kitten season beginning I have even less time to follow the group.
>
>
>> Best regards,
>> ---Cindy S.
>
> Best of luck,
>
> Phil

Hi Phil,

Is there a risk of a CRF cat getting too much potassium? I have a very
early stage CRF cat (16 years old) he does not appear to drink or pee
excessively, though. His first test results were:

Bun 42 mg/dl (Lab normal 16 - 36)
Creat 2.9 mg/dl (Lab normal 0.8 - 2.4)

I will be taking him back in for follow up blood work. He appears to be
doing well on NF food, though.

Thanks for all your wonderful info, I will be discussing this with my vet.

Patty

cindys
March 27th 07, 08:54 PM
Hi, Phil (and everyone else) ! I went to see a different veterinarian for a
second opinion. Here is what she said:

1. She thought that in Alex's case the subcu fluids would be a good idea
since he is a little dehydrated. She said that it might be problematic to do
them every day but once a week should be okay (would not stress his
kidneys). She said she would not supplement with too much fluid however
because he does havecardiomyopathy.

2. She thought that the Pepcid 5 mg was a great idea. She said 2.5 to 5.0
mg was okay, but not to go higher.

3. Omega-3 she also thought was a great idea.

4. She stated that she generally gives supplemental potassium only when the
blood levels drop. She stated that this is also the policy of the internist
at the veterinary specialty clinic.She stated the reason is as follows:
*If* the cat is being fed NF or K/D or X/D or some other special kidney
diet, the special food contains extra potassium. She said if I wanted to
give my cat additional potassium (since he is not eating a special kidney
diet), that would be okay provided that he is urinating a lot. If he is only
urinating a little, potassium supplements could be dangerous for his heart.
Dr. Polzin (in his paper) also recommends potassium supplementation *only
when the blood levels drop*. He states that the justification for
prophylactic (preventative) potassium supplementation in cats who have
normal blood potassium levels has not been well established. He then goes on
to state that potassium supplementation is not harmful as long as the cat
continues to urinate copiously. Phil, you cited some other authorities who
endorsed potassium supplementation in normokalemic cats, but this is not Dr.
Polzin's view.

5. The second vet also mentioned that kitties with CRF can high phosphorous
levels, so I might want to ensure that I am not feeding Alex high
phosphorous food and that down the road, he may need a phosphorous-binding
agent to get rid of the phosphorous.

Again, I can't thank you enough for providing me with advice and Dr.
Polzin's research paper (extremely lengthy and detailed) and also Dr.
Polzin's phone number and e-mail address. I hope to know a lot about CRF by
the time I'm finished. My mind is at much greater ease than it was a week
ago.
Best regards,
---Cindy S.

cindys
March 27th 07, 08:57 PM
"Patty" > wrote in message
.. .
snip
>
> Hi Phil,
>
> Is there a risk of a CRF cat getting too much potassium?

Knowing what I know now, yes. If he's not urinating enough.

>I have a very
> early stage CRF cat (16 years old) he does not appear to drink or pee
> excessively, though. His first test results were:
>
> Bun 42 mg/dl (Lab normal 16 - 36)
> Creat 2.9 mg/dl (Lab normal 0.8 - 2.4)
>
> I will be taking him back in for follow up blood work. He appears to be
> doing well on NF food, though.

The NF food contains additional potassium.
>
> Thanks for all your wonderful info, I will be discussing this with my vet.
>
Phil provided me with tons of information and really made a huge effort to
help me. I'm really glad he is participating on this group, and I can't
thank him enough.
Best regards,
---Cindy S.

Patty
March 28th 07, 01:15 AM
On Tue, 27 Mar 2007 15:57:53 -0400, cindys wrote:

> "Patty" > wrote in message
> .. .
> snip
>>
>> Hi Phil,
>>
>> Is there a risk of a CRF cat getting too much potassium?
>
> Knowing what I know now, yes. If he's not urinating enough.
>
>>I have a very
>> early stage CRF cat (16 years old) he does not appear to drink or pee
>> excessively, though. His first test results were:
>>
>> Bun 42 mg/dl (Lab normal 16 - 36)
>> Creat 2.9 mg/dl (Lab normal 0.8 - 2.4)
>>
>> I will be taking him back in for follow up blood work. He appears to be
>> doing well on NF food, though.
>
> The NF food contains additional potassium.
>>
>> Thanks for all your wonderful info, I will be discussing this with my vet.
>>
> Phil provided me with tons of information and really made a huge effort to
> help me. I'm really glad he is participating on this group, and I can't
> thank him enough.
> Best regards,
> ---Cindy S.

Thanks, Cindy. I read your other post. Rusty is doing very well, I'm
surprised since he was diganosed very early CRF a year or two ago and I
began feeding him Hills k/d at the time. When my other cat, Grady, got so
sick with liver failure, poor Rusty sort of got put on hold while all the
attention went to Grady. I wasn't even feeding him renal food, but just
senior food. When Grady passed away, I had Rusty re-tested and his numbers
were still pretty low for a CRF kitty. So, he held his own through
everything. I'm waiting now to see how well his tests come out now that I
have him on renal food again. The thing with Rusty is, though, he never
has stuck with one food. He needs variety, so I'm thinking of going back
to the vet to see if I can get another renal food to help give him more
variety, however, he won't touch the k/d food anymore. Rusty is an outdoor
cat. He always was a hunter. He never ate catfood exclusively since he
always ate what he caught. Perhaps that's the issue with him now, he'll
never be happy with just a cat food, because he's always had variety in his
food from birds to mice.

Patty

Phil P.
March 28th 07, 06:33 AM
"cindys" > wrote in message
...
> Hi, Phil (and everyone else) ! I went to see a different veterinarian for
a
> second opinion.

Hi Cindi, That's great.


Here is what she said:
>
> 1. She thought that in Alex's case the subcu fluids would be a good idea
> since he is a little dehydrated.

If he's dehydrated-- absolutely. But just enough to replace the deficit and
keep up with urinary losses.


She said that it might be problematic to do
> them every day but once a week should be okay (would not stress his
> kidneys). She said she would not supplement with too much fluid however
> because he does havecardiomyopathy.

That's good to hear. Fluid overload can be fatal for cats with HCM/CHF.
Sounds like you've found a good vet.


>
> 2. She thought that the Pepcid 5 mg was a great idea. She said 2.5 to 5.0
> mg was okay, but not to go higher.

Great.


>
> 3. Omega-3 she also thought was a great idea.


Great.

>
> 4. She stated that she generally gives supplemental potassium only when
the
> blood levels drop. She stated that this is also the policy of the
internist
> at the veterinary specialty clinic.She stated the reason is as follows:
> *If* the cat is being fed NF or K/D or X/D or some other special kidney
> diet, the special food contains extra potassium.


That's a pretty big "if". I have the same argument for the protein content
of renal diets. All of the nutrient levels are based on the ASSumption the
cat will eat his entire portion-- which most cats on renal diets don't.


She said if I wanted to
> give my cat additional potassium (since he is not eating a special kidney
> diet), that would be okay provided that he is urinating a lot. If he is
only
> urinating a little, potassium supplements could be dangerous for his
heart.


Absolutely.


> Dr. Polzin (in his paper) also recommends potassium supplementation *only
> when the blood levels drop*. He states that the justification for
> prophylactic (preventative) potassium supplementation in cats who have
> normal blood potassium levels has not been well established. He then goes
on
> to state that potassium supplementation is not harmful as long as the cat
> continues to urinate copiously. Phil, you cited some other authorities who
> endorsed potassium supplementation in normokalemic cats, but this is not
Dr.
> Polzin's view.

I don't know he said that when everything else he says about potassium
depletion suggests supplementing potassium even if serum K+ is in the normal
range.

"Interestingly, muscle potassium content decreased in normokalemic cats with
spontaneous CKD, indicating that a total-body deficit of potassium may
develop well before the onset of hypokalemia."

"Total body potassium depletion is likely to be even more common than
hypokalemia"

"Thus although the value of providing supplemental potassium to cats with
chronic kidney disease having normal serum potassium concentrations has not
been established, it is clear that muscle potassium, and probably total body
potassium stores, are likely to be reduced in cats with chronic kidney
disease, increasing the risk for developing hypokalemia."

Dr. Kathy James- the Urology/Nephrology Consultant for VIN says: "I try to
maintain serum potassium concentration in the upper half of the laboratory
normal range because serum potassium concentration may be preserved when
total-body potassium is low. "

I'm a firm believer in supplementing K+ to keep it in the upper half of the
normal range as long as as the cat is polyuric.

>
> 5. The second vet also mentioned that kitties with CRF can high
phosphorous
> levels, so I might want to ensure that I am not feeding Alex high
> phosphorous food and that down the road, he may need a phosphorous-binding
> agent to get rid of the phosphorous.

Most of the Science Diet line is low in phosphorus- but after the recall, I
don't trust Hill's as much as I used to. Some oFancy Feast diets are lower
in phosphorus but their protein content is very high.


>
> Again, I can't thank you enough for providing me with advice and Dr.
> Polzin's research paper (extremely lengthy and detailed) and also Dr.
> Polzin's phone number and e-mail address. I hope to know a lot about CRF
by
> the time I'm finished. My mind is at much greater ease than it was a week
> ago.
> Best regards,
> ---Cindy S.

I'm glad it helped.

Best of luck,

Phil

sheelagh
March 28th 07, 04:56 PM
On 28 Mar, 06:33, "Phil P." > wrote:
> "cindys" > wrote in message
>
> ...
>
> > Hi, Phil (and everyone else) ! I went to see a different veterinarian for
> a
> > second opinion.
>
> Hi Cindi, That's great.
>
> Here is what she said:
>
>
>
> > 1. She thought that in Alex's case the subcu fluids would be a good idea
> > since he is a little dehydrated.
>
> If he's dehydrated-- absolutely. But just enough to replace the deficit and
> keep up with urinary losses.
>
> She said that it might be problematic to do
>
> > them every day but once a week should be okay (would not stress his
> > kidneys). She said she would not supplement with too much fluid however
> > because he does havecardiomyopathy.
>
> That's good to hear. Fluid overload can be fatal for cats with HCM/CHF.
> Sounds like you've found a good vet.
>
>
>
> > 2. She thought that the Pepcid 5 mg was a great idea. She said 2.5 to 5.0
> > mg was okay, but not to go higher.
>
> Great.
>
>
>
> > 3. Omega-3 she also thought was a great idea.
>
> Great.
>
>
>
>
>
> > 4. She stated that she generally gives supplemental potassium only when
> the
> > blood levels drop. She stated that this is also the policy of the
> internist
> > at the veterinary specialty clinic.She stated the reason is as follows:
> > *If* the cat is being fed NF or K/D or X/D or some other special kidney
> > diet, the special food contains extra potassium.
>
> That's a pretty big "if". I have the same argument for the protein content
> of renal diets. All of the nutrient levels are based on the ASSumption the
> cat will eat his entire portion-- which most cats on renal diets don't.
>
> She said if I wanted to> give my cat additional potassium (since he is not eating a special kidney
> > diet), that would be okay provided that he is urinating a lot. If he is
> only
> > urinating a little, potassium supplements could be dangerous for his
>
> heart.
>
> Absolutely.
>
>
>
> > Dr. Polzin (in his paper) also recommends potassium supplementation *only
> > when the blood levels drop*. He states that the justification for
> > prophylactic (preventative) potassium supplementation in cats who have
> > normal blood potassium levels has not been well established. He then goes
> on
> > to state that potassium supplementation is not harmful as long as the cat
> > continues to urinate copiously. Phil, you cited some other authorities who
> > endorsed potassium supplementation in normokalemic cats, but this is not
> Dr.
> > Polzin's view.
>
> I don't know he said that when everything else he says about potassium
> depletion suggests supplementing potassium even if serum K+ is in the normal
> range.
>
> "Interestingly, muscle potassium content decreased in normokalemic cats with
> spontaneous CKD, indicating that a total-body deficit of potassium may
> develop well before the onset of hypokalemia."
>
> "Total body potassium depletion is likely to be even more common than
> hypokalemia"
>
> "Thus although the value of providing supplemental potassium to cats with
> chronic kidney disease having normal serum potassium concentrations has not
> been established, it is clear that muscle potassium, and probably total body
> potassium stores, are likely to be reduced in cats with chronic kidney
> disease, increasing the risk for developing hypokalemia."
>
> Dr. Kathy James- the Urology/Nephrology Consultant for VIN says: "I try to
> maintain serum potassium concentration in the upper half of the laboratory
> normal range because serum potassium concentration may be preserved when
> total-body potassium is low. "
>
> I'm a firm believer in supplementing K+ to keep it in the upper half of the
> normal range as long as as the cat is polyuric.
>
>
>
>
>
> > 5. The second vet also mentioned that kitties with CRF can high
> phosphorous
> > levels, so I might want to ensure that I am not feeding Alex high
> > phosphorous food and that down the road, he may need a phosphorous-binding
> > agent to get rid of the phosphorous.
>
> Most of the Science Diet line is low in phosphorus- but after the recall, I
> don't trust Hill's as much as I used to. Some oFancy Feast diets are lower
> in phosphorus but their protein content is very high.
>
>
>
>
>
> > Again, I can't thank you enough for providing me with advice and Dr.
> > Polzin's research paper (extremely lengthy and detailed) and also Dr.
> > Polzin's phone number and e-mail address. I hope to know a lot about CRF
> by
> > the time I'm finished. My mind is at much greater ease than it was a week
> > ago.
> > Best regards,
> > ---Cindy S.
>
> I'm glad it helped.
>
> Best of luck,
>
> Phil

Thanks for keeping us updated Cindy.
It is very kind of you to find the time to share it all with us. I am
delighted to hear that your mind is at ease now that you have seen her
too.

Continued Best wishes & mega purrs on their way over to you and yours
S;o)

sheelagh
April 11th 07, 02:57 PM
On 27 Mar, 20:54, "cindys" > wrote:
> Hi, Phil (and everyone else) ! I went to see a different veterinarian for a
> second opinion. Here is what she said:
>
> 1. She thought that inAlex'scase the subcu fluids would be a good idea
> since he is a little dehydrated. She said that it might be problematic to do
> them every day but once a week should be okay (would not stress his
> kidneys). She said she would not supplement with too much fluid however
> because he does havecardiomyopathy.
>
> 2. She thought that the Pepcid 5 mg was a great idea. She said 2.5 to 5.0
> mg was okay, but not to go higher.
>
> 3. Omega-3 she also thought was a great idea.
>
> 4. She stated that she generally gives supplemental potassium only when the
> blood levels drop. She stated that this is also the policy of the internist
> at the veterinary specialty clinic.She stated the reason is as follows:
> *If* the cat is being fed NF or K/D or X/D or some other special kidney
> diet, the special food contains extra potassium. She said if I wanted to
> give my cat additional potassium (since he is not eating a special kidney
> diet), that would be okay provided that he is urinating a lot. If he is only
> urinating a little, potassium supplements could be dangerous for his heart.
> Dr. Polzin (in his paper) also recommends potassium supplementation *only
> when the blood levels drop*. He states that the justification for
> prophylactic (preventative) potassium supplementation in cats who have
> normal blood potassium levels has not been well established. He then goes on
> to state that potassium supplementation is not harmful as long as the cat
> continues to urinate copiously. Phil, you cited some other authorities who
> endorsed potassium supplementation in normokalemic cats, but this is not Dr.
> Polzin's view.
>
> 5. The second vet also mentioned that kitties with CRF can high phosphorous
> levels, so I might want to ensure that I am not feedingAlexhigh
> phosphorous food and that down the road, he may need a phosphorous-binding
> agent to get rid of the phosphorous.
>
> Again, I can't thank you enough for providing me with advice and Dr.
> Polzin's research paper (extremely lengthy and detailed) and also Dr.
> Polzin's phone number and e-mail address. I hope to know a lot about CRF by
> the time I'm finished. My mind is at much greater ease than it was a week
> ago.
> Best regards,
> ---Cindy S.

Hi Cindy,
I was just wondering how Alex is doing presently, & more to the point,
how are are you coping too?

Hugs,
S;o)