H-T/CKD cat owners - thoughts please!

[FeebysOwner]

I am in a mental struggle about Feeby's newest blood work numbers. And, with little pro-active support from the vet, I need some additional thoughts from others who know what I am dealing with.

Currently: Feeby's number are - Creatinine 3.0 (range 0.6 - 2.4), Phosphorus 6.0 (range 2.4 - 8.2), T4 3.9 (range 0.8 - 4.0). But, these numbers, by themselves, don't tell the whole story in terms of progression, so I have attached a copy of the related blood work records going back two years. If there are some other numbers that someone wants, please let me know.

Bottom line:
Feeby is 17+ yo
She is on Felimazole (1.875 mg AM, 1.25 mg PM) as of last March (2021). She was previously on 1.25 mg twice a day since her 10/2020 diagnosis.
She takes Mirataz (1/2 dose every 3 days) - more frequently only provokes howling but no more food intake - started in 11/2021
She does/will not eat low phosphorus foods nor is she taking any phosphorus binders at this point.
No vomiting, no diarrhea, just lethargy.
She has never had an SDMA run as no vet in my area considers this to be valuable information once CKD has been diagnosed (neither does the CKD forum I joined).
BP last averaged 152 mmHg
Weight being maintained relatively stable at around 11.9 pounds, with the help of Mirataz.

The vet said she was OK if I wanted to try a phosphorus binder but wasn't suggesting it on her own. She also doesn't think Feeby's Felimazole dosage needs to be increased.

I am thinking of going it on my own for right now - increasing her Felimazole to 1.875 mg twice a day and adding the lowest dose possible of a phosphorus binder at least 2-3 times a week. I am also considering buying a BP monitor for home. I honestly don't know what else to do - but, yes looking into other vets.

Any advice, guidance, help???

 

[fionasmom]

Probably this is not going to be helpful, just supportive. Fiona was on 2.5 mg twice a day of the Felimazole, but if you can hold it down that is a good idea. It can raise BUN readings for one thing. However, the amount that you are proposing increasing it to is still within a safe range. Did the vet have strong objections to it being increased?

Jamie's BUN and creatinine are the same as Feeby's, despite the fact that he is only 6.

Jamie has never had SDMA run either, as his vets don't think it is valuable information....either of them. While he eats good quality food, his diet is the reverse of ideal for any kidney condition and I have not added a phosphorus binder yet, nor has one been offered, but I have vet # 3 in mind for another opinion on everything ( the one who helped my GSD reach 16 despite numerous health issues).

It has also occurred to me to try one of the binders on my own.

 

[FeebysOwner]

Probably this is not going to be helpful, just supportive. Fiona was on 2.5 mg twice a day of the Felimazole, but if you can hold it down that is a good idea. It can raise BUN readings for one thing. However, the amount that you are proposing increasing it to is still within a safe range. Did the vet have strong objections to it being increased?

Jamie's BUN and creatinine are the same as Feeby's, despite the fact that he is only 6. Jamie has never had SDMA run either, as his vets don't think it is valuable information....either of them. While he eats good quality food, his diet is the reverse of ideal for any kidney condition and I have not added a phosphorus binder yet, nor has one been offered, but I have vet # 3 in mind for another opinion on everything ( the one who helped my GSD reach 16 despite numerous health issues). It has also occurred to me to try one of the binders on my own.

I won't increase Feeby Felimazole by any more than 0.625 for the PM dosage - making two doses a day of 1.875 mg. The vet said it wasn't necessary in her mind. because to her the 'drawing line' is 4.0 vs Feeby's 3.9 - even if it has been inching up. Crazy, but what it is!

I just wanted to get the vet to agree to something - be that an increase in Felimazole or adding a phosphorus binder, because that will make it so much easier for me to ask for another blood work up in the near future without her wondering why. She said if I can get a phosphorus binder down Feeby for 30 days (not worried about that, tbh) she would recommend another set of blood work (as opposed to waiting another 6 months if we do nothing, as she proposed ). That gives me the 'go ahead' to try both and get no 'questions' about follow up blood work - assuming there would be any issues.

If Jamie's blood work for his phosphorus level is high enough, you might just want to say to one of the vets - "how about if we try...". If you get the go ahead, I would think they will at least support a blood work follow up sooner than later, so you know if it helps any..

If you have not already seen this, the basic IRIS standards (I am simplifying a bit) are:

Stage of CKD​	Creatinine Level in mg/dl​	Phosphorus Goal​
IRIS Stage 2​	Between 1.6 and 2.8​	2.7 - 4.59 mg/dl​
IRIS Stage 3​	Between 2.9 and 5.0​	Below 5.0 mg/dl​

The dosage recommendations are also on Tanya's web site: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease -All About Phosphorus Binders (felinecrf.org). But, whatever I do, I will be going 'as low' as I can to start off with. Phos-Bond seems to be the preferred choice among the CKD forum.

 

[FeebysOwner]

It has also occurred to me to try one of the binders on my own.

I forgot to mention that if you do choose to try a phosphorus binder, have some Miralax on hand. Apparently it is known to cause harder stools, up to and including constipation in some cats. Not ideal, but better to have a lower creatinine and have to add some Miralax to the med/supplement schedule!

If you don't mind me asking what is Jamie's phosphorus level? Strictly asking from a curiosity perspective.

 

[silent meowlook]

Just remember that hyperthyroidism increases the blood flow to the kidneys which is good for the kidneys but of course it also effects other areas of the body and that’s bad. So you don’t want to give more Methimazole than necessary.

 

[fionasmom]

Jamie's phosphorus was at 6 the last time. I appreciate the info about the Miralax which I do keep on hand for the cats as needed. We are transitioning to a new cardiologist as well as the current one has moved to a mobile practice. That is another story in his case which I don't need to bring up here but I am looking forward to another opinion for him.

I do see your point about wanting to get another blood test when you feel it is necessary rather than waiting for the vet, although I think that if you are willing to spend the money, it is your business when you request a new test.

 

[FeebysOwner]

Just remember that hyperthyroidism increases the blood flow to the kidneys which is good for the kidneys but of course it also effects other areas of the body and that’s bad. So you don’t want to give more Methimazole than necessary.

Unfortunately, I am aware that improving Feeby's T-4 level could affect the blood flow to her kidneys and will likely be reflected in an increase of her creatinine level. However, there are too many other consequences (heart issues for example) to allowing her T-4 to climb too high. I actually am not looking to drop her T-4 by a whole lot, just enough to lessen the odds of those 'other consequences'. I think if I can get to a happy medium of let's say 3.0 to 3.5 and keep it there I would feel better.

Since I am only increasing her overall daily amount by 0.625 mg - from the current total of 3.125 mg to 3.75 mg, I don't expect a serious drop. It is, also unfortunately, common for some elevation over time in the Felimazole as the tumor continues to grow and produce an even greater amount of unwanted hormones.

That and the fact that her phosphorus is high - which can also impact the creatinine level and make the kidneys work harder - I might actually get 'lucky' (for a while, anyway) and bring both numbers down, which should make her feel a bit better on both counts.

 

[FeebysOwner]

Jamie's phosphorus was at 6 the last time. I appreciate the info about the Miralax which I do keep on hand for the cats as needed. We are transitioning to a new cardiologist as well as the current one has moved to a mobile practice. That is another story in his case which I don't need to bring up here but I am looking forward to another opinion for him...I do see your point about wanting to get another blood test when you feel it is necessary rather than waiting for the vet, although I think that if you are willing to spend the money, it is your business when you request a new test.

I hope your additional consults will help find a more productive route with Jamie!

I would imagine that I could get blood tests done without question, but it does need to be authorized first by the vet. And, if something screwy comes up, she needs to know at least the basics - as in trying the phos binder. I am willing to explain later to her about the Felimazole. Better for her to at least know ahead of time about one of them!