CRF in Alex

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.

"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 we

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.

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 we

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

"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

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)

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)