Need Help Interpreting Labs and Adjusting Diet Please!

My kitty Nat just had his labs drawn - a CMP/CBC/Geriatric panel and Phenobarb level.  He has had seizures of unknown origin for the past 4 1/2 years now.  I know what a lot of the labs mean but I'm afraid I just can't be objective in interpreting the data:

CBC

WBC  10.9   (5.5 - 19.5)

Neut    7.7    (2.5 - 12.8)

Lymph 1.4    (1.5 - 7.0)    LOW

Mono   1.1    (0.0 - 1.4)

Eos      0.7    (0.0 - 1.5)

Baso    0.3    (0.0 - 2.5)

%Neut  70.7   (35 - 78)

%Lymp 12.7   (20 - 55)  LOW

%Mono  9.7    (0 - 14)  

%EOS    6.6   (2 - 12)

RBC    8.86   (5 - 11)

Hgb    13.36  (8 - 15)

Hct      39.2    (24 - 45)

MCV   40.0    (39 - 52)

MCH   15.1    (12.5 - 17.5)

MCHC  34.1   (30 - 37)

RDW  19.6     (11 - 19)   HIGH

Plt       113      (150 - 500)   LOW

MPV  10.1      (5 - 20)

CMP 

Glu    70     (70 - 160)

BUN  32     (20 - 30)   HIGH

Creat 1.7    (0.7 - 1.9)   HIGH 

Ca#   9.2    (8.6 - 11.0)

Na    153    (145 - 155)

Na K ratio 31.2   (27 - 40)

K       4.9    (3.5 - 4.9)

Cl     116     (117 - 124)  LOW

CO2   22     (14 - 19)    HIGH

Chol  155    (50 - 180)  

T. Bili  0.1    (0 - 0.8)

PO4   5.5    (2.7 - 7.6)

Trig   177    (25 - 160)   HIGH

TP     6.3     (5.6 - 7.7)

ALKP  26    (5 - 110)

ALT    54     (2 - 100)

AST   35     (10 - 50)

Amy  2204  (625 - 1400)  HIGH

CR     328   (64 - 440)

GGT      1    (0 - 5)

Alb      2.9   (2.3 - 3.8)

Globulin  3.4   (3.0 - 5.6)

AG ratio  0.9   (no low/high listed)

Total T4  1.74   (1.2 - 5.0)

Free T4  0.83   (0.70 - 2.50)

Phenobarbitol level  14.9   (10 - 30)

The vet suggested Hill's KD of course, and highly digestible proteins from a good source.  When I asked about the amylase, he said it didn't really indicate much.  I had been thinking of adding an enzyme to their food, but if his Amy is already high, that wouldn't be good, right?  The other enzymes weren't tested so I don't know if they are high or low.  

Right now and for the past few years I've been feeding mostly Friskies pate (Mixed Grill/Ocean Whitefish and Tuna/Turkey and Giblets) and Fancy Feast Tender Liver and chicken Classic and sometimes Flaky Tuna Classic.  This past year or two I've switched them off Purina Beyond kibble to Natures Variety Instinct Duck and Turkey with raw freeze-dried bites (81% protein).  

They would not eat the NVI canned unless they were starving.  I didn't like having to pick out the peas.  

I'm hearing that FF has a high phosphorus level so I should stop that?  Also, should I just avoid kibble altogether and look for a lower protein canned food that he will eat?  His appetite is still good, and he does like the water bowl, not excessively though, just more than say a few years ago.  

Whatever diet I feed him, I will have to feed all the rest too.  They switch bowls while eating.  

I am mixing in Jarrow Petdophilus probiotic powder at each meal.  

I also put city water in their bowls.  Any suggestions for a good type of filtered water for them?  We have a lot of chlorine in our tap water.  

Any suggestions please?

Cutting fish out of the diet would help.  You can find phosphorus levels of most canned foods on the food comparison chart http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf.

I too feed Friskies but mainly the Poultry Platter since it is the only one with CHICKEN as the first ingredient.  I also feed Sheba, the turkey, the beef and the chicken pate, but Not the fish and not any of the cuts, only the pate.

As for water, there are many home filtration systems, either those that go on your faucet or the simple Brita Filter pitchers that you fill with tap water.  I have used that for my cats and myself for years. 

In terms of the lab results, here is a good link:  http://www.allfelinehospital.com/blood-work-explanation.pml

Your Vet only addressed the kidney values, it appears.  Those are the BUN and Creatinine, as far as I know.    So far they aren't TOO bad.  That's good.  And your Vet is in tune with the newer way of thinking, which is to feed a good quality HIGH protein diet, as long as it's lower in phosphorus.  FF pate is NOT that .   Of the foods you listed, the Friskies Turkey and Giblets would be the only one that has "acceptable" phos. levels to me, and I've had three kidney cats.

I always look for food that is under 1% phos on a dry matter basis.  Here is the chart I use, which is a little more updated than the one above. http://www.felinecrf.org/canned_food_usa.htm#canned_usa      It's listed in order of the amount of phosphorus in it.  Now the key here is trying to provide a GOOD, High Quality Protein as well as the low phos.  When feeding multiple cats, if you are any kind of a budget, this can get pricey.  Is there any way you can separate Nat so you can feed him a different food, or at least keep an eye on him to keep him out of the others' bowls.  I would strongly suggest stopping all dry food, as you thought.  It's as it sounds...drying, and IMHO, that's NOT what kidney cats need.  As a matter of  fact, I always added extra water to my cats' food, just because...even though they were drinking more anyway.  I still do that for all my currently cats, just as a preventative.  What I do is purchase filtered water in 5 gallon bottles and use that.  I buy from the Water and Ice stores. 

Thank you so much @Red Top Rescue  and @mrsgreenjeens  for the links and the info/advice!  His Po4 level is fine right now but I assume it would eventually start going up.  I didn't realize FF was so high in phosphorus!  Jeepers. Actually the vet never said anything about his phosphorus.  

So basically I don't need to reduce  his protein, I need to get a better quality  of protein which is more easily digestible?  Is fish hard to digest?  Or is it just the potential for mercury contamination? And so easily digestible protein would rule out any legumes (like NVI canned has peas in it) because they are hard to digest.  

I'm really not sure how I can separate Nat.  He's always been a nervous kitty and he's used to eating as a group.  If I separated him it might make him more suspicious of me (he already is nervous around me because I have to give him Phenobarb twice a day) and eat more nervously and disturb his digestion.  He already tends to throw up a lot, although here lately it's been more than a week now.  That's almost a record for him.  is it ok to feed them all the same thing?  They are all 12 years old.

I've been thinking for a while about just getting rid of the dry food altogether.  They just aren't that into it anyway, except Oreo.  Oreo LOVES his kibble, but he will get over it.    I used to feed them Temptations, and I think they are over them now, but it's taken them a while.  I started out just giving them a teensy bit, then it became a little more and then a little more.  You know how it goes.  Oreo begs me for kibble

That's a good idea about adding water to their food.  That'll make it easier to mix in their probiotic anyway.   I haven't drunk city water in so long.  I get reverse osmosis purified drinking water in gallon jugs from the store.  I filled up one of their bowls with it one day, not thinking I needed to go slowly and increase it over time, just like with new foods.  When I came back, someone threw up in the water bowl!  Yuck!  So I'll go slowly this time.  I guess they can taste the difference,and you know cats don't like change! I just wondered if any of you like a certain brand of water filter or knew of one that is good for pets and people.  I don't know of a Water and Ice store here.  

The water you are getting from the store should be fine to use.  I dissolve probiotics in the water I add to their food too.  It seems to help them eat it better...otherwise sometimes they don't want to eat the food that them sprinkled on top.

As to high quality protein, maybe this article will help you there:  http://www.thecatsite.com/a/what-makes-the-best-canned-cat-food   So after reading that article, then you begin the daunting task of trying to find foods that fall into both high quality protein AND low phosphorus.  That's where it becomes an issue, because so many of the low phosphorus foods are FULL of carbs, which are NOT high quality protein

As for trying to separate Nat from the gang, don't do it if you think it will stress him out.  Can you just monitor everyone, especially if you don't feed dry anymore, and make sure Nat gets his fair share?  Yes, at 12 years of age, I think it's perfectly ok for you to feed them all the same food, but it might be adviseable to double check with your Vet.  Just give them a call. 

So why is Nat on Phenobarbitol twice a day already?  Does he have seizures?  And what is his issue that he throws up often?  IBD or IBS, or what?

Yes, he has seizures of unknown origin which I mentioned that in my OP.  He has had none since March 2015, before that he almost approached status epilepticus, they were so frequent.  Poor baby!  He's such a sweet boy. 

You nailed the problem right on the head.  Trying to find a quality protein that is low in phosphorus.  And to add to the difficulty - low carb/grain-free AND one he will eat!   It will definitely help him to accept a new food if the others are eating it too.  I will ask the vet if it's ok for them too.  

Nat has always had a sensitive tummy.  But it got worse about 4 months BEFORE the seizures started.  The vets he has seen say vehemently that his digestive difficulties had nothing to do with the seizures.  But that was what preceded them.  

After several X-rays and many rounds of lab work, there has been no diagnosis of IBD or IBS, but it seems likely so.  His fur used to be so soft and pretty, now it's rough, choppy and dull.  And this began around the time of his digestive upsets.  The vet recommended a supplement for that.  

Oops!  Sorry I missed that fact about his seizures in your original post.  It's great that the pheno is keeping them at bay

OK, so on the food.  Since the chart that I provided lists the % of carbs, that really helps a LOT.  What I always did was go down the chart and find the first food that had under 10% carbs, then check the protein levels and if they were good, try it and see if my kidney cat would eat it, if not, I'd go to the next one, and so on.  Luckily, my cats all eat from their own bowls, so it wasn't a problem to feed her one food and the others something different, because some of these foods are quite expensive.  I currently feed my remaining cats different foods at mealtimes, mainly because they don't like the same things. 

Anyway, the very first food on the list that is not a prescription food is Weruva Truluxe Steak Frites.  I would say it definitely falls into the "good food" category    Then you've got Weruva Truluxe On The Cat Walk, also good.  And so on.  (I didn't check the ingredients though, just checked the initial Dry Matter Analysis.  I know Weruva is famous for using water as it's first ingredient, which I don't like, but the are known for being a great cat food) 

As to his digestive issues, it could actually be the food. One of my guys will occasionally throw up FF, which is part of their rotation. 

Here's his picture by the way.  Helps to see a pic of the one who needs the advice!  Nat is the tuxedo tabby on the left.  This was back in the fall of 2004 when they were warming up to me.  Honey is his sister, on the right. They were both still kittens here 
I couldn't find Weruva at Petco, so instead I just got some chicken platter Friskies to replace their ocean whitefish and tuna.  They do like it!  I don't think they even miss the ocean whitefish so far.  I'm going slow with the changes.  Next I will switch their water from city to reverse osmosis, which shouldn't take too long, then after that I will add a new food to their menu like the Weruva you were talking about.  

What a handsome boy

OK, since you have Petco near you, check out their own brand, Soulistic, on that food chart.  The ones "in Gelee" fit the bill very nicely, and these foods are actually manufactured by the same folks who do Weruva!  And they are quite a bit less expensive

Here's ONE of theme:  Soulistic Polynesian Picnic Chicken & Tilapia Dinner in Gelee   Phos  0.94  Protein  74.44  Sadium  0.55  Fat 11.88  Carbs  6.81  Cals per oz 17.33  Not, granted, this one has Tilapia in it, but that's not an ocean fish, so I figure you're not going to get too much mercury in it .   Look around the 82% phos area to find some of the other Soulistic foods (on the food chart)

I've seen Soulistic before but didn't know it was manufactured by Weruva so I will check those out and see if the kitties like it.  Thank you for the tips and info!

It's going to be a bigger problem to get them off their kibble.  I've already started weaning down on the amount. They've been on just about every kind from Meow Mix when they were feral to NVI which is what they are eating right now.  I understand the need to crunch, but then I'm not an obligate carnivore.  I may have to move out of the house to get them off kibble.  Just show up at meal times and then run!  Oreo's power of persuasion is pretty strong, being the alpha cat he is.  Nat is a big ole sweetheart.  He's been through so much and when he says "meow" sweetly I want to give him the keys to my car if that's what he wants, lol.  I have to be strong though.  This is for his good.  He doesn't realize it yet though.  

If you can't get them completely off dry food, so be it.  Not the end all, be all.  If the majority is wet, that's best.  AND, if you can add in water to their wet food, that's better.  I add about one tablespoon of water to each meal of canned food, because I give my guys freeze dried raw (un-rehydrated) as treats, so technically I feed a little dry food myself .  My last kidney cat loved to eat that freeze dried raw food too, and I felt good about giving it to her, in small amounts, just because it's good, healthy food.  That's how I started adding that extra water to all their already wet meals. 

The main thing is, you don't want anyone losing weight with a food change....unless they need to

Good advice,  I'll slowly start adding some water to their food tonight!  Everything with cats has to go so slow or else they get suspicious!  Lol, gotta love 'em!  I wish I could add water to their dry food but then it wouldn't be dry food anymore.  Plus I hear that increases the bacterial content.  

The vet says Nat does need to lose some weight.  For now, he's stable weight-wise.  And that's why I'm going so slow on the introduction of new foods.  I don't want him to lose too fast because I read that when weight is lost, catabolism makes the BUN and Creat go up, which is why it's not a good idea to limit protein in kidney kitties, just phosphorus.

How often should his labs be checked? 

I'd ask the Vet on how often to check his blood.  Thinking every 6 - 12 months at this stage though.  Have you been doing it annually?  Of course, if he starts acting differently, throwing up frequently or anything, then you'd want to go back in to see what's up.

Have y'all heard of this product for kidney failure?  There are all 5 star reviews, which immediately makes me suspicious.  What do you think?

https://www.petwellbeing.com/produc...t - Kidney Failure#pr-header-back-to-top-link

Ginny said:

 
Have y'all heard of this product for kidney failure?  There are all 5 star reviews, which immediately makes me suspicious.  What do you think?

https://www.petwellbeing.com/produc...t - Kidney Failure#pr-header-back-to-top-link

Click to expand...

There's no science behind any of these products. Personally, I wouldn't waste my money on these for my cat. I'm all for "natural" treatments when there is science behind them, but these holistic methods have nothing to support them. 

Thank you.  That's what I was wondering. Maybe placebo effect, if anything?  This morning I had time to read some of the 1, 2, and 3 star reviews.  One lady gave 3 stars even though 5 days after starting the product her kitty stopped eating altogether and went down quickly.  It seemed to make her kitty worse, not better.  I felt bad for her.   So I'm not going to waste my money either.  This product had 96% 5-star reviews.  That doesn't sound believable. 

Right now he's only interested in some wet foods and mainly the NVI duck/turkey kibble.  He hasn't thrown up in over a week now and he's maintaining his weight.  I still haven't tried switching them to other brands yet because Harry and Honey are having problems with the changes I've made so far, and so had to switch back some of the foods they were eating before.