Food Choice Question

[rabernet]

My vet wants Lexi to EAT at this point, and she's been doing well on the renal food, but she's starting to get bored (and I'm rotating between 5 versions - all 3 Royal Canin, and the 2 Hill's Stews.

I asked him if we should consider phosphorus binder if I get some other brands that are not renal food and he is concerned that a binder may actually turn her off of eating more.

Her liver is his main concern right now - the values are worsening, but her creatinine is high normal, BUN is slightly elevated, and Phosphorus is in normal range (5.1). He wants me to get her to eat as much as I possibly can. He added Denamarin and Ursodiol to her arsenal. Along with Cerenia and Mirataz. She also gets 100 ml of fluids a day.

There are days that she will easily eat 2 cans of food a day (the small cans) and others I'm lucky to get her to finish a full can.

I want to pick up some other types of food to see if I can get her to eat more - and I've copied and pasted Tanya's list of commercial foods into a spreadsheet - she says to shoot for phosphorus levels under .5% or protein around 35%.

I guess I'm stressing myself out - I want to keep her kidneys somewhat healthy - but I also understand the importance of food to help heal the liver and not go backwards on that.

My vet vehemently said "I want her eating, even if that means non renal prescription food - and no, I don't want to add a phosphorus binder, because that may turn her off of the food" and then my brain is like "still need to make the best choice for the kidneys" - it's like a battle in my head. I do agree she MUST eat. Fancy Feast is supposed to be kitty crack - but wow the phosphorus levels. It's looking like maybe the non prescription Hills has somewhat good choices.

I guess what I'm asking - it's ok to get her whatever she will eat while we try to get liver under control? I'm about to print this out and head to Petsmart to grab some other options for her (sorted on protein close to 35%) but phos isn't the best on all - but maybe I need to let go of my anxiety around that?

 

[FeebysOwner]

Hi. If you say your cat's creatinine level is high normal - what is that number and the lab's range for it? That would be helpful to know. If it is truly only high normal, with a phosphorus of 5.1 she might not need a phosphorus binder quite yet.

Your vet is like so many when it comes to knowing about phosphorus binders - the 'older' ones are not the best when it comes to taste, but some of the more recent ones are supposed to be flavorless/odorless - such as the one I use: Phos-Bind. This is the brand I use for Feeby:
https://www.amazon.com/dp/B00PT4ORD8/?tag=thecatsite

Because Feeby is so picky, and will not eat the renal foods, nor many of the lower phosphorus foods, I rely on Phos-Bind to help, and worry less about the phos level in the foods she will eat. Note that most phos binders can cause some constipation/harder stool, so if you go that route, you might pick up some Miralax to have on hand if you notice her stools start to become hard.

It looks like you are familiar with the felinecrf web site, based on the chart above looks like it came from that site. There is data in that site about phosphorus binders, and also ranges relative to creatinine and phosphorus levels that would indicate a binder might be appropriate.

 

[NekoM]

When it comes down to it she needs to eat, the more weight she keeps on means the more muscle mass she’ll keep, losing muscle mass is a big deal, physically she’ll get weaker. One thing that’s worth considering is the liver controls the digestive system, the kidneys control the urinary system, the majority of phosphates are re absorbed in the small intestine and combine with calcium. Like FeebysOwner has said you may not need a binder yet. The kidneys can filter any extra phosphates.

 

[rabernet]

Hi. If you say your cat's creatinine level is high normal - what is that number and the lab's range for it? That would be helpful to know. If it is truly only high normal, with a phosphorus of 5.1 she might not need a phosphorus binder quite yet.

Your vet is like so many when it comes to knowing about phosphorus binders - the 'older' ones are not the best when it comes to taste, but some of the more recent ones are supposed to be flavorless/odorless - such as the one I use: Phos-Bind. This is the brand I use for Feeby:
https://www.amazon.com/dp/B00PT4ORD8/?tag=thecatsite

Because Feeby is so picky, and will not eat the renal foods, nor many of the lower phosphorus foods, I rely on Phos-Bind to help, and worry less about the phos level in the foods she will eat. Note that most phos binders can cause some constipation/harder stool, so if you go that route, you might pick up some Miralax to have on hand if you notice her stools start to become hard.

It looks like you are familiar with the felinecrf web site, based on the chart above looks like it came from that site. There is data in that site about phosphorus binders, and also ranges relative to creatinine and phosphorus levels that would indicate a binder might be appropriate.

Her last creatinine was 2.2 and the lab's "normal" range is 0.9 to 2.3 mg/dL. She's gone from 2.9 to 2.3 and now 2.2.

Yes, I am familiar with the felinecrf website, I had a six year old kidney cat 8 years ago - he was a semi feral that I adopted, and the vet suspected he may have had some contact with antifreeze before he was captured.

I do find the site a bit overwhelming at times. I feel like I keep taking side trips following different links and my brain spins and then when I want to remember something I read before, I can't find it again.

I did grab a bunch of the the Hills on the list above, and also grabbed a few FF, Wellness and Purina Pro Plan - she ate a can of beef and gravy so fast - it normally takes her a few hours of small servings to finish a can and she polished one small can off in half an hour and was begging for more. Trying to let her eat as much as she wants while trying to pace her too, so that she doesn't over do it.

Does the phos-bind you linked to require a prescription? I wasn't sure since it says RX in the description. I may order to have on hand.

Thank you so much for your feedback - I see your helpful and informative replies on many of the threads here - I was hoping you'd see it!

Vet wants me to call him tomorrow with a report on how she has done over the weekend. He also prescribed an antibiotic and when he was going to do pills, I did ask if the antibiotic came in a sub q shot - could he just let me pick up and give to her myself - he agreed and it was a 14 day antibiotic shot. He's trying to limit her stress level and didn't feel it was necessary to bring her in just for that when I was capable of administering myself.

This girl has had me up since 2:30 this morning - pawing at me, talking to me, etc - I finally gave up at 4:30 and gave her the Denamarin and then she, and the goldens and myself waited an hour before giving out breakfast (she likes to steal a bite or two of their kibble - and they let her - so everyone had to wait until the hour was up).

 

[FeebysOwner]

I totally get you about Tanya's web site! If someone were tracking me, that would be listed as my most frequently visited web site!! I tend to search for the sections I am most concerned/interested about at that moment - and, yes, they can lead you to many, many others. But the more I am in that web site, the more I know where stuff is at and the better I can navigate.

2.2 creatinine, according to IRIS (also included in Tanya's web site) is Stage 2 CKD, and the guideline is to keep phosphorus below 4.6, so on that note your cat could use a phos binder. But, to me she is almost border line in that regard - my personal opinion. Because she not too high, if you do add phosphorus binders, I would have her level rechecked in probably a month or so. The Phos-Bind I shared with you should NOT be prescription. While I consulted with my vet about it, I bought it without any prescription.

The thing I know nothing of is the liver issue, so I don't have any advice in that regard (sorry).

 

[rabernet]

When it comes down to it she needs to eat, the more weight she keeps on means the more muscle mass she’ll keep, losing muscle mass is a big deal, physically she’ll get weaker. One thing that’s worth considering is the liver controls the digestive system, the kidneys control the urinary system, the majority of phosphates are re absorbed in the small intestine and combine with calcium. Like FeebysOwner has said you may not need a binder yet. The kidneys can filter any extra phosphates.

Thank you! So much to worry over with both kidney and liver involved.

 

[rabernet]

I totally get you about Tanya's web site! If someone were tracking me, that would be listed as my most frequently visited web site!! I tend to search for the sections I am most concerned/interested about at that moment - and, yes, they can lead you to many, many others. But the more I am in that web site, the more I know where stuff is at and the better I can navigate.

2.2 creatinine, according to IRIS (also included in Tanya's web site) is Stage 2 CKD, and the guideline is to keep phosphorus below 4.6, so on that note your cat could use a phos binder. But, to me she is almost border line in that regard - my personal opinion. Because she not too high, if you do add phosphorus binders, I would have her level rechecked in probably a month or so. The Phos-Bind I shared with you should NOT be prescription. While I consulted with my vet about it, I bought it without any prescription.

The thing I know nothing of is the liver issue, so I don't have any advice in that regard (sorry).

I'll ask him about it when we talk tomorrow (the phos binder you told me about).

On a different note, what do you know about or feel about Azodyl for CKD kitties? Any other supplements that can help support her?

BTW - he was thrilled that she had gained weight from her previous visit, he said he rarely sees that in CKD kitties.

 

[FeebysOwner]

I was made aware of Azodyl early in Feeby's CKD journey. It might be just fine, but from what I recall it entails 2-3 capsules a day, that have to be given without food. The capsules are not to be broken apart but taken whole (they are not small btw). That was a no go for Feeby. If you can get your cat to take them, that might be an option for you. Btw, Azodyl is another product to help remove toxins from the body that can accumulate when kidney function is compromised - not unlike, but a bit different from phos binders.

I am not sure of any 'supplements' per se. It seems like most of the things that help with CKD are more along the lines of reducing the progression of the disease - the foods, the meds for offsetting symptoms, the fluids when needed, etc. Maybe I 'missed the boat' on actual supplements to help ward off kidney disease due to when Feeby was diagnosed. Not saying that is out of the realm of possibility.

I hate to do this to you, but have you looked at this section of Tanya's web site? Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Holistic Treatments (felinecrf.org)

 

[louisstools]

I don't have anything to add other than thoughts and prayers your way. I know all about the struggle getting a cat to eat.

 

[rabernet]

I was made aware of Azodyl early in Feeby's CKD journey. It might be just fine, but from what I recall it entails 2-3 capsules a day, that have to be given without food. The capsules are not to be broken apart but taken whole (they are not small btw). That was a no go for Feeby. If you can get your cat to take them, that might be an option for you. Btw, Azodyl is another product to help remove toxins from the body that can accumulate when kidney function is compromised - not unlike, but a bit different from phos binders.

I am not sure of any 'supplements' per se. It seems like most of the things that help with CKD are more along the lines of reducing the progression of the disease - the foods, the meds for offsetting symptoms, the fluids when needed, etc. Maybe I 'missed the boat' on actual supplements to help ward off kidney disease due to when Feeby was diagnosed. Not saying that is out of the realm of possibility.

I hate to do this to you, but have you looked at this section of Tanya's web site? Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Holistic Treatments (felinecrf.org)

Hahaha on the "I hate to do this to you" comment! No - I haven't - but I will. I asked about the Azodyl because I remembered that back when Sammy had CRF (as it was referred to back then vs CKD now), that I also joined a FB group - which I "think" was affiliated with Tanya, or may have been recommended there. Since I haven't interacted with the group since we lost Sammy - I never see posts in my feed, but remembered it and was visiting and reading there this weekend and saw the Azodyl referenced and one gal who said she swears by it and believes with her entire being that it is the reason her two CKD cats have done so well. The name of the group is Feline/Canine Chronic Renal Failure (CRF)

I know vets sometimes hate that we do so much independent research. I had a vet on Sammy's journey that got so angry with me asking about things I found online - he was OLD and OLD school - he as much as told me he went to school for this, and Dr Google did not. He also wanted to euthanize Sammy. The last time I saw him I said "Sammy has not given up this fight, and neither will I. If you are, I will find another vet" and I did.

But - that experience makes me more careful about how I approach these things with my vet - though I adore this vet. We are in a different city than we were with Sammy - and we actually sought out this vet because of our goldens - because goldens are very high risk for cancer - and he is a study vet for the Morris Animal Foundation Golden Retriever Lifetime Study and has about a dozen clients in the study (my boys were born too late to be participants). He has never put them on an exam table, he plops right down in the middle of the floor with them during their yearly exams. And because he's a study vet - he keeps up to date on new findings for treatment/care - such as a new marker for a particular cancer in goldens.

Anyway - I say all that to say - we tend to geek out on the boys' visits all things goldens and things the study is discovering, etc. So I feel like he is more receptive - in fact, on Lexi's last visit there and first with him - because we geek out over the goldens, he started geeking out on me about CKD - and at one point I said "do you see my eyes glazing over?" LOL - like throwing out terms and medications I had never heard about. And he is very patient with me saying "so....tell me that again, but explain it to me like I'm 5". I never feel rushed - though everyone wants to be on his schedule, and he has patients lined up.

He also has a great staff of vets (he's the owner) and even at least one holistic vet, though I've never visited her.

Anyway - once again, I am rambling - but will check out that link. Thank you again!!

 

[rabernet]

I don't have anything to add other than thoughts and prayers your way. I know all about the struggle getting a cat to eat.

Thank you! I spent so much yesterday gathering a variety of foods for her to try. Purina ProPlan Beef and Carrots was a HUGE hit - she annihilated that can - I've sussed out that pates are not her jam - give her shreds or "porridge" texture with gravy.

I am so thrilled that phos binders will allow her to eat what she loves and not limit her to renal food only - though she's been very good with the canned renal food, she doesn't eat it with the gusto she did yesterday (and so far this morning) with the foods I got her yesterday.

She used to be a dry food only cat and now she won't even touch dry. She was never a fan of wet - but it's like a switch went off and she has converted to a wet food only cat (which is great for her condition).

With the renal food - it would take about an hour or longer of offering 1/2 tsp servings to finish a can (any larger servings, she'd just eat the gravy and leave the bits behind - but smaller servings, she'd eat it all). With the foods I got yesterday, she is finishing a small can in 1/2 an hour with heaping tsp and the whisker fatigue bowl is literally licked clean.

But I agree - the struggle is real. I will send thoughts and prayers your way for you baby as well!

 

[Mac and Cats]

Hahaha on the "I hate to do this to you" comment! No - I haven't - but I will. I asked about the Azodyl because I remembered that back when Sammy had CRF (as it was referred to back then vs CKD now), that I also joined a FB group - which I "think" was affiliated with Tanya, or may have been recommended there. Since I haven't interacted with the group since we lost Sammy - I never see posts in my feed, but remembered it and was visiting and reading there this weekend and saw the Azodyl referenced and one gal who said she swears by it and believes with her entire being that it is the reason her two CKD cats have done so well. The name of the group is Feline/Canine Chronic Renal Failure (CRF)

I know vets sometimes hate that we do so much independent research. I had a vet on Sammy's journey that got so angry with me asking about things I found online - he was OLD and OLD school - he as much as told me he went to school for this, and Dr Google did not. He also wanted to euthanize Sammy. The last time I saw him I said "Sammy has not given up this fight, and neither will I. If you are, I will find another vet" and I did.

But - that experience makes me more careful about how I approach these things with my vet - though I adore this vet. We are in a different city than we were with Sammy - and we actually sought out this vet because of our goldens - because goldens are very high risk for cancer - and he is a study vet for the Morris Animal Foundation Golden Retriever Lifetime Study and has about a dozen clients in the study (my boys were born too late to be participants). He has never put them on an exam table, he plops right down in the middle of the floor with them during their yearly exams. And because he's a study vet - he keeps up to date on new findings for treatment/care - such as a new marker for a particular cancer in goldens.

Anyway - I say all that to say - we tend to geek out on the boys' visits all things goldens and things the study is discovering, etc. So I feel like he is more receptive - in fact, on Lexi's last visit there and first with him - because we geek out over the goldens, he started geeking out on me about CKD - and at one point I said "do you see my eyes glazing over?" LOL - like throwing out terms and medications I had never heard about. And he is very patient with me saying "so....tell me that again, but explain it to me like I'm 5". I never feel rushed - though everyone wants to be on his schedule, and he has patients lined up.

He also has a great staff of vets (he's the owner) and even at least one holistic vet, though I've never visited her.

Anyway - once again, I am rambling - but will check out that link. Thank you again!!

Sorry to jump in on this, but I did use Azodyl for my cat for a time. It wasn't super easy for me to use it on him though because at the time, I was working in an office and not from home like I am now. So, I had to give it to him first thing in the morning, but he wanted to eat NOW. And then right when I got home, when he also wanted to eat NOW. If I were working from home, it would have been easier, but he could be very demanding when he wanted food. He was an angel and never complained about eating the renal food unless he wasn't feeling good. The other thing about Azodyl is that it has to be shipped with an ice pack. I can't even remember where I ordered it from, but it I could not afford it, but bought it anyway. At the time, I didn't really understand what Azodyl was even supposed to do, I just got it because our vet said it "could" help. I think I used it for several months to even a year but then ended up abandoning it because of the cost and I was often unable to give it to him and then make him wait 20-30 minutes to be fed (mostly because I didn't want him to be hungry at all). I think, if a) you can afford it and b) you're able to give it to her on an empty stomach and can wait the recommended time (I think it was a half hour) before feeding her, it is probably worth trying.

I didn't realize you had made this post too, so you can ignore my previous question about what you got her to eat!

 

[Furballsmom]

Regarding food that works for both liver and kidney compromised cats, I have walked this path and your vet is correct. Your cat needs to eat to support the liver and pancreas, phos binders notwithstanding.

There are two glaring problems with felinecrf's canned food charts. #1 is that the author showcases a very skimpy selection of Weruva foods, and #2, lists most of those in the chart with the brands that require a prescription, which can be misleading and cause a person whose cat could greatly benefit from them to ignore them. Well, and #3 that iodine numbers aren't provided.

it's ok to get her whatever she will eat while we try to get liver under control?

I would suggest for you to familiarize yourself with all the Weruva brands, cans and pouches. The Weruva website is wonderfully transparent in that they provide every piece of nutritional information (in both formats).

Weruva WX doesn't require a prescription and is uber low in phosphorus. AAFCO requires them to put a note on their cans stating the food doesn't meet their guidelines, however all the other nutrient levels in the WX varieties meet aafco reqs.

If your cat isn't interested in Weruva WX, there are still quite a few other Weruva choices available.

Something else I appreciate about this collection of brands is that Weruva keeps their iodine at the minimum aafco requirements, (which I wish I'd known about earlier on behalf of my angel Poppycat), because cases of Hyper-thyroidism seem to be on the rise especially with medically vulnerable cats. Very few other brands that I researched where I could obtain iodine levels have kept it low.

 

[rabernet]

Regarding food that works for both liver and kidney compromised cats, I have walked this path and your vet is correct. Your cat needs to eat to support the liver and pancreas, phos binders notwithstanding.

There are two glaring problems with felinecrf's canned food charts. #1 is that the author showcases a very skimpy selection of Weruva foods, and #2, lists most of those in the chart with the brands that require a prescription, which can be misleading and cause a person whose cat could greatly benefit from them to ignore them. Well, and #3 that iodine numbers aren't provided.


I would suggest for you to familiarize yourself with all the Weruva brands, cans and pouches. The Weruva website is wonderfully transparent in that they provide every piece of nutritional information (in both formats).

Weruva WX doesn't require a prescription and is uber low in phosphorus. AAFCO requires them to put a note on their cans stating the food doesn't meet their guidelines, however all the other nutrient levels in the WX varieties meet aafco reqs.

If your cat isn't interested in Weruva WX, there are still quite a few other Weruva choices available.

Something else I appreciate about this collection of brands is that Weruva keeps their iodine at the minimum aafco requirements, (which I wish I'd known about earlier on behalf of my angel Poppycat), because cases of Hyper-thyroidism seem to be on the rise especially with medically vulnerable cats. Very few other brands that I researched where I could obtain iodine levels have kept it low.

There are several petstores near me that carry Weruva - but after spending almost $80 at Petsmart yesterday, I skipped that stop, but will definitely make that a stop this week. I also saw Tiny Tiger mentioned on here somewhere - and I see that's a Chewy brand - but you have to buy a case to see if they'll even eat it.

My vet said that Fancy Feast is a good choice and tends to be lower in phosphorus (the non fish ones - which she doesn't care for fish anyway). He also said he likes Purina Pro Plan and that senior formulas are also good choices.

I did "warn" my vet in today's conversations that I research things out the wazoo - so probably will have questions for him on our next visit and he's fine with that. I brought up phosphorus binders today and he stopped me cold and said - we will worry about that in a few weeks if she's still eating well. Liver is our number one priority now. He said he has one in mind that has ground shrimp shells and a probiotic in it - but didn't give me the name of it as he was moving on off the subject to keeping her eating. I told him it is hard to turn my worrying mind off the CKD diagnosis - and once again - he said "liver!!!" Yes, sir!

As for Lexi herself - she is back to being very sociable, purring a lot more when she's asking for cuddles and generally seems by her behavior to be feeling much better than she was when she first went in about six weeks ago. And back to bossing her golden retriever brothers around and grooming their faces.

 

[rabernet]

Sorry to jump in on this, but I did use Azodyl for my cat for a time. It wasn't super easy for me to use it on him though because at the time, I was working in an office and not from home like I am now. So, I had to give it to him first thing in the morning, but he wanted to eat NOW. And then right when I got home, when he also wanted to eat NOW. If I were working from home, it would have been easier, but he could be very demanding when he wanted food. He was an angel and never complained about eating the renal food unless he wasn't feeling good. The other thing about Azodyl is that it has to be shipped with an ice pack. I can't even remember where I ordered it from, but it I could not afford it, but bought it anyway. At the time, I didn't really understand what Azodyl was even supposed to do, I just got it because our vet said it "could" help. I think I used it for several months to even a year but then ended up abandoning it because of the cost and I was often unable to give it to him and then make him wait 20-30 minutes to be fed (mostly because I didn't want him to be hungry at all). I think, if a) you can afford it and b) you're able to give it to her on an empty stomach and can wait the recommended time (I think it was a half hour) before feeding her, it is probably worth trying.

I didn't realize you had made this post too, so you can ignore my previous question about what you got her to eat!

I am working from home 4 days a week. Tuesdays are my office days - until 1 pm, then an hour drive home. I plan to give her Denamarin before I head in to the office, then my boyfriend gets up about an hour after that and I told him I'm leaving a can out for him to open and feed her as much as she will eat before he heads into his job. My neighbor comes over around 10 in the morning to let the boys outside (dogs) to potty - and I've asked him to offer her some if she's begging when he comes over and then I'll take over the servant duties for the rest of the day and following six days - wash/rinse/repeat. LOL

Azodyl sounds like it may be too much of an added expense - but I do plan to bring it up. I started to mention other meds I'd read about and he said "let's limit how much medication we're giving her at the moment - she's already on an antibiotic, two other prescriptions, Cerenia and appetite stimulant - let's focus on liver". Yes sir! I can't argue with how much better she's feeling these days.

 

[Furballsmom]

I told him it is hard to turn my worrying mind off the CKD diagnosis - and once again - he said "liver!!!

That's what my post was about, foods that are viable for both CKD and a compromised liver. I didn't post it just to say that whatever brand might be a nice thing to feed, and I'm not affiliated with Weruva.

Also, about tiny tiger, fancy feast or Purina pro--I don't know what the protein and phos are in these brands without checking. You need to do this, -- research for your cat beyond the chart you copied above, so you aren't guessing or going on a recommendation that might not actually be the best option.

Your cat needs protein and low phos. Weruva .com provides all the nutritional information, please take a look and compare the numbers to the other foods in the second chart on felinecrf . You'll be more comfortable about things when you have a more complete picture and are working from a position of more knowledge.

 

[rabernet]

That's what my post was about, foods that are viable for both CKD and a compromised liver. I didn't post it just to say that whatever brand might be a nice thing to feed, and I'm not affiliated with Weruva.

Also, about tiny tiger, fancy feast or Purina pro--I don't know what the protein and phos are in these brands without checking. You need to do this, -- research for your cat beyond the chart you copied above, so you aren't guessing or going on a recommendation that might not actually be the best option.

Your cat needs protein and low phos. Weruva .com provides all the nutritional information, please take a look and compare the numbers to the other foods in the second chart on felinecrf . You'll be more comfortable about things when you have a more complete picture and are working from a position of more knowledge.

My apologies, I probably should have waited until this morning to respond - as I am up at 3:15 each morning for work, and I was on the last drops of gas in my brain when I replied last night.

I absolutely will be researching Weruva, and I appreciate that you've had a cat with a similar medical situation as Lexi and have valuable information to share. I apologize if it seemed I was being dismissive, I really wasn't. I'm still in the mental stage of information overload - and was at the end of my day - it's not a good combination.

I noticed after briefly looking at the Weruva site this morning (I'm just starting my work day - so I'll have more time to research it in depth later) and I've noticed that they have several "lines". If she doesn't care for the WX line, are all the lines generally good choices (after looking at the nutritionals, of course)? Like the BFF line for example?

 

[Furballsmom]

was on the last drops of gas in my brain when I replied last night.

If she doesn't care for the WX line, are all the lines generally good choices (after looking at the nutritionals, of course)? Like the BFF line for example?

They are, or can be depending on your requirements and her preferences