How far would you go for a nearly 12-year-old with kidney stones/failure?

mrsgreenjeens · May 8, 2015

OK, I'm not sure of you've seen THIS particular page on Tanya's website, but it speaks specifically to kidney stones: http://www.felinecrf.org/kidney_stones.htm

The issue is knowing exactly what he has...and it seems as if he has "big kidney, little kidney syndrome", but how far has it progressed is the question? Since he IS able to urinate, that's GOOD! (it means only one ureter might be blocked)

Does Bailey normally take to new foods well? He's not a picky eater? If you think you can get him to eat a new food without having to force it down his throat, then I would certainly try to fight for him! If he is the type of cat that is not easy to work with, ie giving him fluids, pills, etc, then you would need to think about his quality of life in the future since he will need to deal with these new changes in his life

. Most cats take sub-qs very well at home, some of them even purr as they get them, mainly because I think they start to feel better with them, and maybe they actually recognize that fact

. I have a kidney cat, my third one, and whenever she gets her fluids, she always gets more social, her appetite improves, etc. We're discussing increasing the number of times per week she gets them because it's now noticeable how much better she feels afterwards. I think in YOUR case it's the stones that are the hurdle.

I actually started typing BEFORE you brought him home, and how see he's home

. Please be aware that even if he doesn't like the renal food, there are things you CAN do, and for kidney cats, you can use phosphorus binders in their regular food if necessary. But lots of hydration is always needed, thus the sub-qs. Hopefully the mirtazipne will make him hungry

that the stones flush out,. I see one of the meds you were given is to help the ureter to relax in order to help them pass

. Keep up posted

ldg · May 8, 2015

SO glad he's home!

Are you still going to have the vet that does home visits provide a second opinion? Based on your experience, and the recommendation for a renal food, I am seriously questioning the ability of this current vet to treat your cat. Not that all vets should be current on everything, but there are serious problems with renal diets. Unless a cat is in very late stage kidney failure vs kidney insufficiency, they are not recommended.

I would ask .. your vet? the new vet? about corn silk tea for your kitty and helping dissolve those stones and flush the excess minerals out of his system IF they are not calcium oxalate (everything else can be slowly dissolved as I understand it - they are made of the same minerals as bladder crystals and stones). It is a balancing act, because it is a diuretic - but that's partly why it works, though it does bind to the minerals that forms the stones.

FYI, Tanya's site has info on kidney stones: http://www.felinecrf.org/kidney_stones.htm She does not mention corn silk, but here is info on the corn silk tea and kidney stones

Hasanudin et al 2012 "Corn Silk (Stigma Maydis) in Healthcare: A Phytochemical and Pharmacological Review," Molecules 2012, 17, 9697-9715

http://www.mdpi.com/1420-3049/17/8/9697/pdf

From WebMD: http://www.webmd.com/vitamins-suppl...gredientid=140&activeingredientname=corn silk

From an alternative med site: http://www.altmd.com/Articles/Cornsilk--Encyclopedia-of-Alternative-Medicine

On the renal diets: Article by a vet, published March 13 of this year http://www.veterinarypracticenews.com/Why-Feline-Kidney-Insufficiency-is-still-Tricky-to-Treat/

From the article:

Diet

A changing view of the best diet is a key development in the treatment of chronic kidney insufficiency, Nortsworthy said.

In the past, the approach was a low-protein diet. Now the practice is to put such a cat on a high-protein diet, he said.

There are several reasons for this switch in thinking, particularly to keep the cat from losing too much weight and muscle. Muscle wasting is a common problem in senior cats, Norsworthy noted. Their spines and hips become very prominent because they have lost muscle mass. This occurs due to protein deprivation.

“The low-protein diet really hasn’t done the good that we thought it was doing,” Norsworthy said, adding that its benefits to kidney function “are minimal to nil” and that many older cats on a low-protein diet will begin to lose muscle and get thin.

Despite this change in thinking, many manufacturers continue to make low-protein diets that are officially labeled for the kidney disease, he said.

“I don’t even use those official kidney diets anymore,” Norsworthy said. Instead he recommends foods made for diabetes patients because they are low in carbohydrates, which is in excess amounts in many cat foods, and the food makers have replaced the carbs with mostly proteins.

Norsworthy noted that creatinine is artificially lowered when a cat loses a lot of weight, and muscle mass is needed to make creatinine.

“In a very thin cat, the creatinine will not be a true reflection of the kidney function,” he said.

That means the creatinine measurement is not reliable in a thin cat, and on the other hand the BUN measurement is falsely elevated in a cat that’s dehydrated. “Therefore, you have to consider body condition and hydration status when interpreting creatinine and BUN values,” he said.

High protein diets will elevate the BUN measurement, but that doesn’t mean the kidney function is down, he said. “It just means the cat’s on a high-protein diet.”

A picky appetite is one of the most common concerns Quimby hears about patients with chronic kidney disease

“Appetite should be actively addressed, as poor body condition is linked to a poor prognosis,” she said.

Treating complications of the disease, like hypertension, dehydration and anemia, will help maintain appetite, Quimby said, but feeding tubes, appetite stimulants and anti-nausea medications should be considered to manage nutrition.

And a (referenced) article on the myth of the low protein diet for renal failure. In the end, it is about management of phosphorus, not protein, and it is possible to provide a high protein diet that a cat needs with low phosphorus. http://www.optimumchoices.com/Downl...tion_for_Dogs_with_Reduced_Renal_Function.pdf

Many vibes for you and your boy! :vibes:

2bcat · May 8, 2015

He will be much more comfortable at home with you. Here's hoping for a weekend of improvement!

jwathas · May 8, 2015

2bcat said:
He will be much more comfortable at home with you. Here's hoping for a weekend of improvement!

Exactly! The vet tried to make us feel very guilty for taking him home today, saying that it could be fatal and is strongly against their recommendations. We know Bailey a million times better than they do and we know that he will NOT get better if he is away from home. He is extremely attached to us and we weren't doing him any favors by keeping him there. Plus, we literally couldn't afford to keep him there anymore. We already accumulated a huge bill for the almost 3 days he was there. I don't think will be using that vet any longer. We have his pain medication, fluids, and the medication for his ureters and he's been drinking a TON of water since getting home, which he wasn't doing at the vet. He still hasn't eaten yet, but he's also on an extremely strong pain medication right now. We just gave it to him an hour ago.

I have been e-mailing with the house call vet this evening and she is very nice. She said she will call me on Monday to see how he did over the weekend and she would be more than happy to come see him if needed.

Can anyone recommend a good food to put Bailey on? The vet wanted us to eventually switch him to Royal Canin renal food, but the price for just a little tiny bag is INSANE!!! I really want to keep him mostly on wet food at this point. Any food recommendations would be appreciated!!

pharber-murphy · May 8, 2015

Oh, I'm glad you got Bailey home. No matter what happens in the future, he'll be so much happier in familiar surroundings with his family nearby. Here's hoping you and Bailey have a wonderful weekend, that his stones melt away like ice in the summer, and he feels better soon. Keep us posted!

Best regards.

P.S. You guys know that you don't have to to through Yahoo to access Tanya's website, right? You can get there from any Web search engine :-)

jwathas · May 8, 2015

Yup, we found the site last night by doing a Google search for it and I've already gotten some great advice on there!

2bcat · May 8, 2015

My thinking on food would be, in roughly this order of importance:

1. Something he will EAT vs continuing to not eat, even if it's not real cat food (I used some meat baby food at times)

2. Cat food

3. Preferably wet food

Could easily swap 2/3

3.5 (or maybe earlier) enough total intake to be sustainable

4. Maybe low in phosphorus

That last one is where the renal diet comes in. That said, don't take this as gospel at all because I'm thinking in terms of kidney disease in general. Maybe the stones really mean you have to prioritize the special food more, not sure, although I kind of doubt it.

In terms of that food, some of the veterinary diets do not have any purchase restiction. I went into Petsmart and bought the Royal Canin vet diets with no extra paperwork required, but the Hills were off limits without a card from the vet.

My understanding is that the renal food is low in phosphorus. But even this is somewhat controversial in that we don't know that keeping a cat on lower phosphorus foods really helps any more than not bothering. Certainly wet food is better than dry, and any food is better than none if you're having trouble getting him started.

I remember digging for lower phosphorus options that were high in calories and found a few, but I was completely ignoring cost and they were mostly just as pricey as the renal foods, just made by companies and with ingredients that I trusted more. Not that it really helped as it was so hard getting her to eat much of anything.

jwathas · May 8, 2015

2bcat said:
My thinking on food would be, in roughly this order of importance:

1. Something he will EAT vs continuing to not eat, even if it's not real cat food (I used some meat baby food at times)

2. Cat food

3. Preferably wet food

Could easily swap 2/3

3.5 (or maybe earlier) enough total intake to be sustainable

4. Maybe low in phosphorus

That last one is where the renal diet comes in. That said, don't take this as gospel at all because I'm thinking in terms of kidney disease in general. Maybe the stones really mean you have to prioritize the special food more, not sure, although I kind of doubt it.

In terms of that food, some of the veterinary diets do not have any purchase restiction. I went into Petsmart and bought the Royal Canin vet diets with no extra paperwork required, but the Hills were off limits without a card from the vet.

My understanding is that the renal food is low in phosphorus. But even this is somewhat controversial in that we don't know that keeping a cat on lower phosphorus foods really helps any more than not bothering. Certainly wet food is better than dry, and any food is better than none if you're having trouble getting him started.

I remember digging for lower phosphorus options that were high in calories and found a few, but I was completely ignoring cost and they were mostly just as pricey as the renal foods, just made by companies and with ingredients that I trusted more. Not that it really helped as it was so hard getting her to eat much of anything.

Right now, we're just trying to get him to eat. We have some Royal Canin senior wet food, but he's still not interested. I really think that's because he's very heavily medicated on a very strong pain medication right now and is completely gorked. He's sound asleep next to me right now. He just had the pain meds a couple of hours ago. I'm praying that by tomorrow he'll feel like eating, even if just a little!

mrsgreenjeens · May 9, 2015

In my opinion, it is IMPERATIVE that you get food into him one way or another or you'll have even bigger problems on your hands

. Did they give him ANY nutritional support at the Animal Hospital? Cats CANNOT go very long without eating something, and when I say something, I actually mean at least 1/2 to 2/3 of their normal caloric intake. Especially if they started out a little overweight (which I have no idea if this was the case with Bailey or not) What this means is, if he isn't eating on his own, you may need to help him along by syringe feeding him for awhile.

From Tanya's website, here are some tips to encourage him to eat (scroll down approx 1/3 of the page, although this entire page is worth reading): http://www.felinecrf.org/persuading_cat_to_eat.htm

As far as what foods to feed, the only thing I don't know about is those darned stones! I know that for kidney disease even my Vet is now on board for feeding good quality HIGH protein, medium fat, low carb, low phosphorus WET food, or if that fails, anything the cat will eat. Here is a list of foods from Tanya's website in order of phosphorus levels. This chart is pretty current. http://www.felinecrf.org/canned_food_usa.htm#canned_usa

NOW, here is pretty much that same chart, but in alpha order, however, it hasn't been updated since 2012. http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf I use this in case I see a new food that I like, so I can make sure it's not WAY high in phosphorus.

Hoping by now he's at least eating a little bit

. I can tell you that with my kidney cat, I do warm it up, I serve very small portions at a time, I add a little to a lot of water, depending on the food, I sometimes serve up as many as 3 different foods, and I often resort to using toppers...right now she's crazy for FortiFlora, also crushed Temptations.

2bcat · May 9, 2015

I start worrying sooner because it's so stressful, but it is a significant concern if you're getting to 72 hours and later with zero or almost zero food intake. Anything you can do.

When my cat was close to 72 hours I bought chicken Gerber baby food, just chicken water and salt. I spoon fed her and she ate it off the spoon, we sat there and went through almost the whole jar (good because a jar is 100 calories), what a relief it was at that point. Any meat variety is fine as long as it's just meat, water and maybe salt. You're making sure there's no onion, garlic, etc. Not a good long term solution but if he eats nothing else you can supplement this a little. I eventually bought taurine powder, b vitamin in capsules, etc to add to foods.

With regular cat food make it soupy, make it warm, make it whatever, anything that'll get him back started. Using a syringe (no needle) is a possibility, food needs to be really puréed like Hills a/d or you can purée something yourself. Read that persuading to eat page and maybe something will work.

jwathas · May 9, 2015

We picked up some Gerber baby food today. We got the turkey and chicken flavors and we just syringe fed him a decent amount. He wasn't too thrilled, but we did manage to get a decent amount into him and we'll give him some more a little later.

jwathas · May 9, 2015

I really think we are going to stop giving him the Buprenorphine. It's WAY too strong and I think may be a big part of why he's not eating on his own. He's just WAY too out of it on this medication and just wants to sleep. After he had it yesterday, he got his entire face soaking wet while drinking water because he couldn't hold it up away from the water because he was so out of it. My husband and I decided to skip the next dose of Buprenorphine and see if he comes out of this huge fog and starts eating and acting a little more normally. Obviously, we're going to continue his fluids and other meds, but I really don't think this stuff is doing him any real favors and may be counterproductive, especially if it's causing him not to eat.

jwathas · May 9, 2015

Just had a thought - we have some Bragg's organic apple cider vinegar. I read that ACV can help in dissolving stones, but I don't know if this would be the best thing to try, although I am curious if it's worth giving a shot....

aniebie · May 10, 2015

I treated my Tember for the kidney failure, and used many things, but never did any vet suggest bupenorphrine. Not sure if any other posters have used it , but I have not seen it suggested for kidney failure. I have heard that they may not feel well, but am not aware that they need a pain medicine. You can ask on tanyas site also. I think that I would not give it, as that may be really making him out of it.

I gave it for my cats broken leg.. one other cat got it recently for a soft tissue injury, but it does throw them for a look. they only got a small dose, too. So I think your concern about giving it is legitimate. Maybe some one else here can chime in on this issue? I would perhaps ask another vet, or maybe the traveling one, if using bupe is new protocol?

Is your kitty getting anything for the stomach acid? You can give regular strength pepcid or zantac (zantac seems to be the better tolerated imho), and you can find the dosage on Tanyas site. I bought pill pockets to wrap the zantac in, as it is bitter, and if they taste it, they foam at the mouth like crazy... just a piece of the pocket will wrap about the little piece of pill, wet it and it goes down fast. follow with several cc's of water, with a syringe, slowly.

Good for you , in getting food into your little one. Keep offering little bits sometimes works. warmed a touch.

Tanyas was so helpful for me, and I can't praise them enough. for help with renal issues.

hugs,

mrsgreenjeens · May 10, 2015

jwathas said:
I really think we are going to stop giving him the Buprenorphine. It's WAY too strong and I think may be a big part of why he's not eating on his own. He's just WAY too out of it on this medication and just wants to sleep. After he had it yesterday, he got his entire face soaking wet while drinking water because he couldn't hold it up away from the water because he was so out of it. My husband and I decided to skip the next dose of Buprenorphine and see if he comes out of this huge fog and starts eating and acting a little more normally. Obviously, we're going to continue his fluids and other meds, but I really don't think this stuff is doing him any real favors and may be counterproductive, especially if it's causing him not to eat.

It sounds like he's probably being given too high of a dose, but I'm thinking he might be in pain from the stones, so may need SOME pain killer. Is there any way to just lessen the dose? How's he doing with NONE of it?

jwathas said:
Just had a thought - we have some Bragg's organic apple cider vinegar. I read that ACV can help in dissolving stones, but I don't know if this would be the best thing to try, although I am curious if it's worth giving a shot....

Did your Vet think these stones are Calcium Oxalate? If so, they don't dissolve, but have to be passed. Additionally, have you ever tried drinking apple cider vinegar? It's dificult to drink, even in an entire glass of water. I don't know how you would get a get to drink it

, although I have heard of people giving it to their cats. (I have NEVER figured out how they did it though)

In general, how's your little patient doing today? Better, I hope. The problem with stones is, you can't see if they pass, so unless they can tell you they feel better, it's hard to know if they've passed

mrsgreenjeens · May 12, 2015

jwathas said:
I really think we are going to stop giving him the Buprenorphine. It's WAY too strong and I think may be a big part of why he's not eating on his own. He's just WAY too out of it on this medication and just wants to sleep. After he had it yesterday, he got his entire face soaking wet while drinking water because he couldn't hold it up away from the water because he was so out of it. My husband and I decided to skip the next dose of Buprenorphine and see if he comes out of this huge fog and starts eating and acting a little more normally. Obviously, we're going to continue his fluids and other meds, but I really don't think this stuff is doing him any real favors and may be counterproductive, especially if it's causing him not to eat.

Haven't gotten a status update for a couple days. How's he doing?

jwathas · May 13, 2015

Sorry I haven't updated in a few days! Bailey is doing better! We've been syringe feeding him 3 jars of baby food a day (breakfast, lunch, and dinner) and last night, he actually ate on his own! He went up to the bowl of dry food (Purina One Indoor turkey & rice formula) and ate! He ate a fairly decent amount, too! He also ate a bit more food at around 3:30 in the morning as I was going to bed (night owl here). He also started cleaning himself for the first time yesterday since getting sick! This morning, he was VERY perky, was talking to us, rubbing up against things like he always does, and he REALLY fought us when we were giving him his fluids. I could barely hold onto him and he even nipped me! The vet said it definitely sounds like he's turned a corner, so hopefully this keeps up!

2bcat · May 13, 2015

Sounds like some good news! Definitely some behaviors of feeling a bit better, probably in no small part because he DID get some food in, one way or another.

Fluids might take two people if you have a struggling cat! It's odd to my thinking that Amber never fought us with the fluid, only with the syringe feeding. We made a really specific habit of the fluid, same spot each time, same time of day (evening), in a basket that had become one of her favorite beds (it was a rectangular basket that we had put a fleece blanket into). Often she was already in the basket and we just carried her over, and if not we put her into the basket first then carried her over (rather than carrying her loose). We didn't try to make her change the position she was already lying in.

The only time I had trouble is when I tried some smaller needles. Sure the smaller needle is a smaller prick, but it too the fluid nearly twice as long to go in, and that was a bit of a problem. But for the minute or so that it usually took, it was okay. You may want to check on the needle size if it seems to be the amount of time that's an issue, but if he's fighting you right away then that is not the issue I suppose.

The baby food is fine temporarily but I would suggest for any future sessions (with any luck you won't need to, but in case) that if you're syringe feeding anyway you syringe a cat food that gets him more of the nutrients and such that he needs. You can use Hill's a/d which is generally considered to be chopped enough to fit through the syringe, or Iams Max Cal if you can ever find it (it's pretty soupy and nasty but the highest calorie food there is which means he'll get enough calorie intake with less volume). Or you can puree a normal cat food in a blender.

Hope you see some more signs of improvement. :-)

jwathas · May 13, 2015

I did try putting some Royal Canin Senior canned food in the blender because I know he needs the taurine, but since it has those meaty chunks in it, it was really difficult to get it all blended, so I added a bit of water, but that made it too runny and it just ran out of the syringe

. Maybe I'll give that another go today. Hopefully we won't have to do these syringe feedings much longer! He is a pro at the syringe feedings now, though, and takes it like a pro. I don't even have to hold him or wrap him up in a towel. I just sit next to him, hold the back of his head, and squirt it in the side of his mouth. This morning was the first time he fought us on the fluids, so he obviously has way more energy now!

delilahs mom · May 13, 2015

I would definately get a second opinion when dealing with a serious issue like this, preferably from a very experienced vet.

How far would you go for a nearly 12-year-old with kidney stones/failure?

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