Am I overreacting?

[Twylasmom]

Twyla is such a sneak. My biggest problem right now is keeping her from jumping up on the counter and eating Hooper’s not low phosphorus food. Apparently the combination of Solensia and Mirataz gives her jumping superpowers! She never gets more than a couple of bites so I’m not super concerned. I’ve been giving him the occasional Fancy Feast because it Is one of the few wet foods he will eat and that was Twyla’s favorite pre-CKD food. They both like the Hill’s Tender Tuna so they split that, but he hates the Savory Chicken that is Twyla’s current favorite.

 

[Twylasmom]

We are almost exactly a year out from the day I started this thread! This has been a somewhat difficult couple of days. First part of the week was great, Twyla was cleaning all her plates and meeting calorie goals (eating non-prescription low phos foods, dry renal foods and some treats as enticements to get her going). Then she had a day where she was eating, but regurgitating several times in one day. The next day she got her Cerenia and Mirataz (which she gets two to three times a week) but she ate less than half of her usual. Overnight she was bugging me for food (normal behavior), but was turning up her nose at the usual offerings which continued into today. She definitely wants to eat because she polished off half a jar of baby food. So I tried some Sheba pate and some Fancy Feast, both of which she ate, though still not eating quite as much. Also bugging me for treats and trying to eat my lunch!

I’m not sure what caused the bout of regurgitating, am thinking maybe a hairball but no evidence of one as yet. Of course it could also be her CKD worsening or needing her methimazole dose adjusted. I plan to do Cerenia ever day for a few days (usually do every other) to see if that helps and Mirataz on our usual schedule but I really want her back on her usual diet because of the relatively high phosphorus in the other foods. I do have aluminum hydroxide binder so I guess in the short term I could use these foods with binder and work on phasing her other foods back in. I am always worried about constipation, which fortunately hasn’t been an issue with her usual diet. She has a checkup on the 21st and I am going to request a full blood panel to check all her levels.

She has been doing so well the past six months, with an occasional off day, but this latest downturn feels more worrisome. I would love to see a big old hairball come up and have that be the problem.

 

[FeebysOwner]

I think as cats age, especially those with health issues, they can have 'off' days without it turning into an ongoing problem. Feeby just had a big throw up the night before last, with no hairball, and seems to have recovered from it nicely. I think I might know why, but one can never know anything for sure. She ate canned tuna in water which she hasn't had recently - and probably won't get again for a while! She is never consistent with her food - one time she seems to really like it and the next time she seems to hate it, only to have the time following that where she likes it again. I have her on a rotation of foods so large now that I am having trouble keeping track of them. And just because she doesn't eat a food one time, doesn't mean she won't next time (and vice versa), so I have not ruled out any of her possible foods unless I see a pattern with one of them that extends out over several times. The garbage disposal sometimes 'eats' more than she does!

It's a juggling and guessing game, but I now know not to always automatically contribute a change to a worsening of any one of her conditions. If that were to be the case, it would likely not be so off-n-on. I do feed Feeby Phos-Bind because she won't eat many of the lower phosphorus foods. I do have Miralax on hand, but so far haven't needed to use it - but I will if I have to!

Good about the blood work panels - it is good to have those done just to see if anything changes.

 

[Twylasmom]

I think as cats age, especially those with health issues, they can have 'off' days without it turning into an ongoing problem. Feeby just had a big throw up the night before last, with no hairball, and seems to have recovered from it nicely. I think I might know why, but one can never know anything for sure. She ate canned tuna in water which she hasn't had recently - and probably won't get again for a while! She is never consistent with her food - one time she seems to really like it and the next time she seems to hate it, only to have the time following that where she likes it again. I have her on a rotation of foods so large now that I am having trouble keeping track of them. And just because she doesn't eat a food one time, doesn't mean she won't next time (and vice versa), so I have not ruled out any of her possible foods unless I see a pattern with one of them that extends out over several times. The garbage disposal sometimes 'eats' more than she does!

It's a juggling and guessing game, but I now know not to always automatically contribute a change to a worsening of any one of her conditions. If that were to be the case, it would likely not be so off-n-on. I do feed Feeby Phos-Bind because she won't eat many of the lower phosphorus foods. I do have Miralax on hand, but so far haven't needed to use it - but I will if I have to!

Good about the blood work panels - it is good to have those done just to see if anything changes.

I have a well-fed garbage disposal, too! Between having a CKD kitty and a picky eater lots goes down the drain. You are right about the off days, most of the time I am able to roll with them, but this time it just hit me differently. About 20 minutes after I posted she woke up and ate some of the “approved” wet food I had left out for her. She then asked for more food so I put some of her dry kibble on the rug and she ate that, too! She has trouble eating dry food out of a dish so I usually mix it with Temptaions purée as a binder, but have lately discovered it is easier for her to eat it off the rug, and she thinks it’s a treat. I need to accept the fact that the occasional higher phos food isn’t that big a deal, and I can mix in the binder if I need to.

 

[Twylasmom]

Still struggling with getting Twyla’s eating back on track. She ate better yesterday than today, so got Mirataz this afternoon, still not helping much. She did eat almost a full can of Fancy Feast this morning, and ate a jar of baby food over the course of the day (she will go to the fridge and beg for it), but has totally turned away from the Temptations purées and her dry food (though she wants to eat Hooper’s dry food) and every other wet food I tried. She ate a few bites of other things here and there but it took coaxing. It is frustrating because she is acting hungry and asking for food and then walking away. I didn’t give her Cerenia today and probably should have as that behavior seems to indicate nausea. She did manage to bring up a small hairball today, so maybe that will help. She hasn’t had a bad stretch like this in over six months. I am hesitant to overdo the baby food because she won’t want to eat anything else. I am giving a small amount of phosphorus binder with the Fancy Feast. I hand feed the baby food as she won’t eat it any other way but refuses other things I try to hand feed her.

I also started a new tube of Mirataz this week and it hasn’t seemed as effective. I sometimes wonder if the active ingredients aren’t always distributed evenly throughout the tube (she does get her ears cleaned regularly).

 

[FeebysOwner]

I have found with Feeby that if the food is one she has decided isn't much to her liking, Mirataz isn't all that helpful. Rather, she will just around in the kitchen, hoping I will get rid of it and try another.

 

[Twylasmom]

I did some research on dry food this morning and found the Hill’s 11+ which is about .7 % phosphorus on a dry matter basis (half what Hooper’s Purina One is). Since she wants dry food I am going to try that, and perhaps mix it with her NF Early Care. I gave her a little to try when I brought it home and she was all over it. Also stocked up on salmon primavera and picked up two other low phos wet foods that I haven’t tried or tried recently (a small pool to choose from). Giving 1/8 tsp of phosphorus binder split over two servings of the primavera. Don’t want to overdo as her phosphorus has not been checked recently. Gave Cerenia at 4 am to give it some time to kick in before breakfast And plan to do daily for the rest of the week (only on an 4mg dose). Ate almost a whole can of primavera. She seems to be really off anything with a strong smell, except stinky baby food! Also seems less interested in pate type foods. Bright and alert, helped me unpack groceries and showed great interest in my sandwich for lunch. Trying to avoid between meal snacks so as not to blunt her appetite.

Also did a more thorough than usual ear cleaning in preparation for next Mirataz dose. I think that’s about all I can do for now.

 

[Twylasmom]

She scarfed and barfed her dinner, there was a lot of hair in what came up. She also had an impressive poop about five minutes later. About 15 minutes after that she ate Hooper’s dinner portion, which has stayed down. So her appetite is better and hopefully getting everything out of her system will make her feel better overall. She ate waaay too fast.

I’m assuming she brought up her daily dose of methimazole - better to just let it go for the night or should I redose? She got her meds about 5 minutes before she ate (I know better than to do that but trying to recalibrate schedules after the time change).

 

[Furballsmom]

This is from wedgewood pharmacy

Give this medication to your pet exactly as your veterinarian prescribes. If you miss giving your pet a dose of methimazole, give the next dose as soon as you remember or, if it is close to the next scheduled dose, return to the regular schedule. Do not double dose to catch up.

This one from vca hospital;
If you miss a dose, give it when you remember, but if it is close to the time for the next dose, skip the dose you missed and give it at the next scheduled time, and return to the regular dosing schedule. Never give your pet two doses at once or give extra doses.

 

[Twylasmom]

This is from wedgewood pharmacy

Give this medication to your pet exactly as your veterinarian prescribes. If you miss giving your pet a dose of methimazole, give the next dose as soon as you remember or, if it is close to the next scheduled dose, return to the regular schedule. Do not double dose to catch up.

This one from vca hospital;
If you miss a dose, give it when you remember, but if it is close to the time for the next dose, skip the dose you missed and give it at the next scheduled time, and return to the regular dosing schedule. Never give your pet two doses at once or give extra doses.

Since I can’t definitively say she ejected the dose I think it’s best to not redose, based on what I’m reading here.

 

[Twylasmom]

Today was a much better day. No barfing, full of energy and a healthy appetite. Ate all her new dry food (which is about half her calories) and would happily have eaten more. Wet food was a mixed bag - maybe 1/3 of a can of primavera, a full serving of Sheba pate and a little bit of Hill’s Tender Tuna. I think we are definitely dealing with some food aversion with certain foods. I did a smell test on a Temptations purée and she sniffed it and walked away - and that has been a favorite for about three months. Sheba is her “rescue food” because the phos level isn’t great but I can work it into the rotation. I hope her aversion to the other foods will pass as I feel like I’m running out of wet food options!

Going to continue the daily Cerenia for now. Her last Mirataz dose was on Sunday so her good appetite today was a bit of a surprise. I usually give Mirataz every 3 or 4 days so we’ll see how tomorrow goes. Today was a fluids day as well. It was good to see her playing with springs and chasing Hooper around.

 

[Furballsmom]

I'm so glad

 

[Twylasmom]

Here’s a question: Twyla is happily eating, though not the foods I would wish for. Still no need for Mirataz. She has a checkup on Tuesday and I plan to ask for a full blood panel to see exactly what is going on with her kidney values, including phosphorus levels (getting thyroid checked as usual) since those levels haven’t been checked for 6 months. At that time her phosphorus was high normal. She is getting two meals a day that are higher in phosphorus and is getting 1/16th of a teaspoon of aluminum hydroxide in those meals So 1/8 tsp a day. I’m thinking it would be good to continue this diet up to the appointment and see what effect that might be having on her phosphorus levels. I think it takes about 7-10 days to really see the effect of the binders and we will be right at 7 days.

Does this seem like a good approach? I don’t see being able to switch back to the lower phos wet foods anytime soon (tried one today and she sniffed and walked away but devoured a Sheba pate).

 

[FeebysOwner]

If she is eating better with the higher phosphorus foods, that is what counts the most. This will just tell you if the binder has had any impact on her phosphorus level. But, since it has only been 7 days, it may or may not have. Hopefully, the level is stable!

Are you using Tanya's web site as a guide about phosphorus levels, binders, and relative changes?

 

[Twylasmom]

Are you using Tanya's web site as a guide about phosphorus levels, binders, and relative changes?

Yes, as much as I can given the only phosphorus level I have is six months old so anything I am doing is basically guesswork.That’s why I am using a more conservative amount than the recommended 1/4 tsp a day and only on foods with phosphorus higher than .8 on a dry matter basis. My vet is cat only but when she gave me the phosphorus binder last year the dosage prescribed was 1/4 tsp in every meal! Fortunately I had already read the info on Tanya’s site so I knew that was wrong. I ended up not needing to use it at that time because Twyla was eating lower phos foods. Now that I am adding it in I just need to watch for constipation

 

[FeebysOwner]

Feeby is getting about 1/8 tsp of Phos-Bind daily; but she is not eating the best, so it goes in her breakfast food, and she gets what she gets from it. That is added to a 3 oz can of food, and it is a rare occasion when all 3 oz are eaten. I feed her baby food meat with nutritional supplements, which makes up at least half of her daily caloric intake but am not adding Phos-Bind to that. So, far, no constipation, but I have Miralax on hand, in case. Her last phosphorus level was checked in January, and was 5.8, so I figure there is no way I am going to lower her level enough to worry about it, tbh.

Good luck with the full blood panel!!!

 

[Twylasmom]

We are back from the vet. Even with gabapentin Twyla was fussy but we got everything done.
The good news is her kidney values look pretty good - her creatinine and bun were basically unchanged (slight decrease actually) from six months ago. Her phosphorus was up from 5.1 to 6.2 so need to work on getting her back to lower phosphorus food options and keep using the binder. She weighed 11 pounds five ounces despite her raised T4 (see below)!

However her T4 was up from 3.4 to 5.1 so her methimazole dosage has been increased to 1/4 tablet twice a day. She is also slightly hypertensive so adding amlodipine to her medications (1/4 a 2.5 mg tablet once daily, so I guess It’s my turn to struggle with splitting those!). They are also checking for protein in her urine - may need to add benazepril based on those results.

She also really needs a dental and it is better to do it now when she is in fairly good shape, especially since there is a correlation between dental and kidney health. So that is scheduled in two weeks. My vet carefully outlined the whole process for me, including making sure I give her subq fluids the night before, no amlodipine that morning, and everything they do during the procedure. I am super nervous about this. Two weeks after that they will recheck her T4 and blood pressure.

I can’t say I was surprised about her T4 - she’s been unusually active the past few weeks - but was pleased by the stability of her kidney numbers.

 

[FeebysOwner]

Does the vet think it is appropriate to raise both her thyroid meds and her amlodipine at the same time? I was just wondering if Twyla's T-4 was lowered a bit if that might not take care of the slight elevation in blood pressure. Also, what is her current dosage of thyroid meds? I am curious about the old dose vs. the new one.

Feeby's T-4 was gradually elevating when she was on 1.875 mg twice a day, so we increased her dosage to 2.5 mg in the AM but left the PM dose the same. As a result, her T-4 dropped too much, so we went back to the 1.875 mg twice a day, which brought her T-4 back to a more normal range for her. She went from 3.7 to 1.3 and then finally to 1.9 (she's a CKD cat so her level should ideally be between 2.0 & 3.0). We have no idea why it elevated, or why it dropped so drastically on such a small increase.

EDIT: The creatinine might have decreased slightly because the T-4 was elevated, so it might go back up a bit again. Also, not sure what Stage of CKD Twlya is in, but a lot of times a slightly higher BP is to be expected depending on the Stage.

 

[Twylasmom]

Does the vet think it is appropriate to raise both her thyroid meds and her amlodipine at the same time? I was just wondering if Twyla's T-4 was lowered a bit if that might not take care of the slight elevation in blood pressure. Also, what is her current dosage of thyroid meds? I am curious about the old dose vs. the new one.

Feeby's T-4 was gradually elevating when she was on 1.875 mg twice a day, so we increased her dosage to 2.5 mg in the AM but left the PM dose the same. As a result, her T-4 dropped too much, so we went back to the 1.875 mg twice a day, which brought her T-4 back to a more normal range for her. She went from 3.7 to 1.3 and then finally to 1.9 (she's a CKD cat so her level should ideally be between 2.0 & 3.0). We have no idea why it elevated, or why it dropped so drastically on such a small increase.

She has been on 1.25 mg once a day for the past six months. It’s the pill form so hard to divide in smaller increments. so going from a quarter pill a day to half. And I might be underplaying the blood pressure readings - the vet seemed concerned enough to start.

Do you give amlodipine in the morning or at night?

 

[FeebysOwner]

She has been on 1.25 mg once a day for the past six months. It’s the pill form so hard to divide in smaller increments. so going from a quarter pill a day to half. And I might be underplaying the blood pressure readings - the vet seemed concerned enough to start. Do you give amlodipine in the morning or at night?

I have a pill splitter that works pretty well to divide Felimazole into quarters (not the same one I use for amlodipine). Besides, Feeby gets it twice a day, so if I am a tad off, it is more or less made up for with the second dose. I don't understand the only once a day dosing for the thyroid meds; twice daily keeps the med at a more even keel throughout a 24 hour period. Just what I have read and what my vet thought was best.

Right now, due to Feeby's med schedule, she gets amlodipine around 3PM. I only did this because there are just so many pills I can get down Feeby at a time, and she was already on an AM/PM schedule for her Felimazole and her ondansetron. So, I just split the difference in the day to administer amlodipine (0.625 mg). Feeby's BP, at last check, averaged between 150-160.