Monday, September 1, 2014

Wikipedia-Start Here to Learn More About Kidney Function

Supplements to Use to Improve Kidney Function

We mix krill oil, COQ10, vitamin E oil, and vitamin C powder, and about 1/2 ml of water, and some Gerber Baby's First Foods Sweet Potato into a small bowl.  I syringe it into a 3ml syringe and give it by mouth to Myrna (and was to Cooper.) It did help to improve Cooper's kidney values somewhat. We will see in September if they are improving Myrna's values or not.

 We give almost 1 ml of apple cider vinegar by mouth to combat stomach acid and to help the kidneys by preventing metabolicacidosis. I mix one part vinegar and one part water or more water as needed so that the cat can tolerate it.
 I ordered this from Amazon.
 I ordered this from Amazon.
 Nature Made and Sundown supplements seem to work well for Myrna. I give her 1/2 iron three times a week.  The Sundown Potassium is inexpensive but works well. I give 1/3 of a pill to her four times a day.
 I give 1/2 a B12 twice a week.  I give 1/4 of a magnesium three times a week.

Feline Heart Patients-Heart Size Might Matter and Potassium Support in the ER May Be Key

Coopers heart left atrial went from 1.9 in May to 2.3 with Friday's echo. That's a large jump in a short time. In comparison, in March, Myrna's left atrial was 2.2. I do not have any notes on what it was in June although I do know the cardio said it was stable. She sees the cardio again in September and we'll see how things are then.

Coopers potassium level in July was 3.6-low but decent. It was about the same Friday but tanked hours later in the ER to 2.4. Perhaps a lack of potassium support in the ER (doesn't seem to be noted in chart records which I obtained unless I missed it) and not having had his daily doses of potassium pills and sweet potatoes since Thursday is the key to why the kidneys could not function well enough to get rid of congestion on Saturday. Yet he was still urinating large amounts in the ER. But something was causing the fluid to not leave his lungs. Low blood pressure-which is why he was on dopbutamine-is also a clue. I'm not sure I can solve the puzzle. Vets assume the kidneys hit a tolerance to diuretics and can do no more. But potassium support in the ER seems necessary if potassium declines.

Support Kidney Function When on Heart Meds

There is much that needs to be done to support kidney function for cats with either CKD or those on heart meds. Why wait until kidney values begin to decline? We didn't act until Cooper's values were too high. Myrna's (our HCM cat) values were high normal. So, we began giving her the same supplements. We won't know until she sees the cardio for a checkup in September if her values have improved. But Cooper's had in just a month, just not enough or other things were wrong with the kidney process.

We have always been told to support potassium levels. We gave them both Sundown potassium-a third or a half of a tab twice a day for Cooper, four chunks a day for Myrna; Cooper had Tumil K twice a day (and now she will finish the pills.) By giving the following oils, we are giving omegas and antioxidants and whatever else comes from the mix of these oils: a gel cap of Krill oil 300mg (this replaces the usually recommended cod liver oil which is no longer pure and cod is almost extinct from over fishing), COQ10 100mg, and 1/2 of 100IU vitamin E, mixed with 1ml of water. I give this orally via a syringe because neither was eating all of their food if the oil was mixed in. I put a smidge of Halo xtra C vitamin C powder (made for cats) in their food. They take 1/2 of a B12 (for energy), 1/4 magnesium (needed electrolyte and muscle/nerve help), 1/4 iron (helps to make blood cells for kidneys)-every other day (it had been every day but I was worried about hypervitaminosis but perhaps more doses could be given.) If the phosphorous level begins to creep up and is above a 4, give a phos binder. Cooper was on a phosphorous binder which binds with iron and causes constipation so I had just decreased his iron to a weekly amount.

In addition, we need to decrease protein intake a tad if kidney values are creeping up and decrease it a lot if kidney values are high. Protein in food should be 6-9% for cats needing to lower protein. Watch those treats-they have about 30% protein. With Myrna, we mix lower protein foods with her regular food and I am breaking up treats when she gets them. She gets a lot due to her litter box encouragement process. (She needs us to take her to the box, encourage her to go, and treat and praise her, and when she goes, treat and praise her again. Helps her go in the box and not have accidents.)

Some Science Diet canned cat food sold at the pet store has 6-9%. It was hard to find an over the counter, low phos cat food because the stores did not carry all of the types flavors in a brand that are produced. Fancy Feast makes pouches of broth with fish. If you buy the "Classic", it is broth. There is another version with milk which I would not use. The broth had very low protein due to it being mostly water. But when poured over his food, this broth enticed Cooper to eat. Tuna fish in a can is low in phos but may not be the best thing to give due to pollution and such. But sometimes, that was all he would eat. Or if we put some on top of his food, he would eat everything.

And finally, water. To support kidneys, the cat must take in water. If your cat gets sick and stops taking in enough water, the cat will become dehydrated and kidney function can be impaired. If the cat stops drinking enough, you can gently give liquids in a syringe or eye dropper by mouth, about 6-9mls every couple of hours.

Feline Moderator Band Cardiomyopathy-A Difficult and Often Quickly Ends a Life

From Facebook post August9:

What I want owners of cats with FMBCM to know is that the disease may end a life quickly. It's a very difficult disease due to the bands. But it is worth fighting to keep the cats healthy and alive. Torsemide is an option. Giving supplements to support the kidneys is a must: B12, magnesium, potassium, Gerber baby sweet potato added to food as a potassium source, Tumil K or Sundown Potassium; vitamin E oil mixed with 100mg of COQ10, and Krill Oil and some water-given by mouth. These improved his kidney values enough. 

But in the end, nothing was enough. Only God knows why we are given cats with a disease, why some do well and others do not, and why they are taken from us. Sometimes there are no answers there is just a responsibility and a job we need to do to help them

A Collection of Posts re: When Our Feline Moderator Band Cardiomyopathy Cat Died in August

(August 8, 2014)  Cooper had to go to the ER just after midnight.  Cooper is responding well to oxygen and lasix. Cardiologist will see him later and we will know more about his condition then. He has Feline Moderator Band cardiomyopathy. Similar to Myrna's HCM-different physically-but produces similar symptoms and he takes almost the same meds.

(August 9, 2014)  [When he left the cardiologist office, the cardiologist said he was stable, a bit congested but she expected him to respond well to Torsemide and to recover in the next few days at home. But he never really came home again except for a couple of minutes before we were off to the local ER again.)  Tried to bring Cooper home but he began not to breathe on the way home. He was stable and clear when released. But he began breathing fast in the car ride home. He was drooling, open mouth and rapid breathing. He's at the local ER because he is in too serious a condition to make an hour return trip. The cardio had expected him to recover at home this weekend and to maybe bounce back some. But not practically crash the minute he left the vet's.

Update: at 10 p.m. he was breathing 36 per minute but with effort and is unable to breathe outside of oxygen tent. Cardio called and instructed them on lasix injections and a protocol (We have the BEST cardio!) But there is the concern that he's not bouncing back and had such a sudden recurrence shortly after leaving the ER earlier today after having been in there for 14 hours and doing well at discharge. We are praying for his recovery.

Remember the holistic medicine discussion about a couple months ago? I don't believe in replacing effective heart meds with plants and powders. It takes too much plant and powder to decrease symptoms, improve the heart. And they are costly. BUT I do believe in supplements to support the heart and the body. We do need vitamins and minerals, especially our cats that are on diuretics and heart meds. So, the only good news about Cooper today was that due to the supplements I give him, his kidney values have improved. Good, because after two days of high doses of diuretics, his kidneys will take a hit. I give him Krill oil 300mg, COQ10 100mg, and 1/2 of 100IU vitamin E, mixed with 1ml of water. I give this orally via a syringe. I put a smidge of Halo xtra C vitamin C powder (made for cats) in their food. They take 1/2 of a B12, 1/4 magnesium, 1/4 iron-every other day and once a day, and never all on the same day or time. We've done this for a month (but he's on a phosphorous binder and it binds with iron and causes constipation which is why he gets only a small amount.) A month ago BUN was 115, now 105. Creatinine was 6.6, now 6.0. Phos was 9.6, now 6.6. He has been urinating larger amounts lately which is a good sign of kidneys concentrating urine-producing it. Great! Now if only he could breathe.

Update Cooper: still in ER, being weaned off meds and oxygen. Will be a few more hours before he's ready to leave and then he'll come home and we'll monitor and see how he does. But he's breathing well on his own. The cardio is reviewing via email the xrays (modern technology!) and talking to the ER as needed. The new a.m. doc was surprised that Cooper is normally on a high level of diuretics-a combination of torsemide and spironolactone (the actual diuretic is torsemide with spironolactone playing a minor supporting role while it also preserves potassium.) They have been treating his congestion with low levels of lasix injections so I've asked the cardio to review his diuretic ER needs. They need to not only treat what they see but maintain a therapeutic dose to stay ahead of, to prevent congestion-something the ER doesn't normally do because they treat only what they see. So, if he's free of congestion now, they think he doesn't need more lasix. But he does. So, I'm running over his torsemide and regular meds.

Cooper still has a foggy X-ray. Lasix injection at noon and four, new X-ray at four to see how he is and then home. If he crashes, off to Novi. But we'll know the time between being almost clear at four and the next CHF incident, which will tell us if he's able to overcome congestion or not; if we are aggressive at home can we help him or not; or is he unable to recover.

At 12, the ER vet gave a lasix injection,expecting Cooper to respond well and to be able to come home at four. He had been on dobutamine which helps the heart pump blood better, allowing the blood to go to the kidneys better, allowing the kidneys to use the lasix to work better as a diuretic. He was weaned from this by noon.

At four, the xrays showed he was again in CHF because he was no longer on dobutamine. In consultation with the cardio, we could keep him on dobutamine for 48 hrs (max one time dose is 48 hrs and then the body hits a tolerance) and he would get lasix (dobutamine is only an IV drip drug and not one given at home). But she thought this wouldn't work well in the long run, that it showed his kidneys-while he was concentrating urine and going huge amounts-was in some way compromised enough that after the dobutamine, he would again not be able to process lasix or torsemide and would again go into CHF. This meant that it was time to put him to sleep.

We went to the ER at 5p.m. and spent time with him. They brought him into a room where he walked around, cried, wanted to be petted, wanted out. After about ten minutes, he began breathing hard. After a few more minutes, we knew it was time.  He was put to sleep at 6 p.m. 
The vet gave a sedative which Cooper fought and cried over.. Then there was another sedative that made him vomit up white foam and which made him more anxious. Then the vet gave the drug that stopped the heart. 

We chose to donate his heart and kidneys for research to Michigan State University vet school. We have a clay paw print. We chose to bury him.

We can't believe he's gone so quickly when he was just fine the other day. We can't believe he didn't bounce back and come home for a bit longer. We don't understand why and yet I know why but then don't know why. His heart is larger than it was in May. His kidney values were bad but had improved and he had in the last two weeks due to supplements, gone back to urinating large amounts. The ER vet was surprised he was on such large doses of diuretic and yet doing so well. The cardio said he's lived longer with kidney values and a bad heart of his sort than she has seen in her practice. He was the rare cat to take and to need a powerful diuretic torsemide. But as "fine" as he was, he's needed extra torsemide and a couple lasix injections at home since his last CHF in May. So, it wasn't all perfectly working. We struggled since early July to get enough food and nourishment into him and he had lost a pound since May. And still he held on and even fought our attempts to put him to sleep. 

Feeding a Sick Cat That Won't Eat

From July 9 Facebook post about trying to get Cooper to eat when he wasn't eating:

Has anyone fed sweetened condensed milk to a cat reluctant to eat or that needed nutritional support? I gave some to Cooper and he liked it. (DO NOT feed sweetened condensed milk or any form of milk to kittens under the age of about six months at all and never to kittens to replace a missing nursing mother or aid the nursing mother. Use kitten formula KMR from pet stores. Milk products might be tolerated by those six months and older but only if they need nutritional support. A cat of a year or older shouldn't have milk on a regular basis due to stomach/diarrhea issues.) The math: one serving is 2 tablespoons. In 2tb are 110 calories, 55 mg of sodium, about 140mg of potassium, 20g of sugar, and some iron, calcium, and vitamins-if I calculated correctly. I mixed 1tb scm with 2tb of water. So, per 3ml syringe serving, the amounts above are greatly reduced if 3ml is one serving. If your cat isn't diabetic, and doesn't need to avoid the sugar for any other reason, it's a good energy source. Sodium might be a bit much but it comes out to 7mg in a 3ml serving (the syringe size we use.) There are six calories in a 3ml syringe. We are counting every calories Cooper is eating. Since his kidney values are now high, we tried reducing the Torsemide and found we could not. He needed extra and it came out to 2.5 QID regardless. He was fine before he went to the vet Saturday for a blood draw and once we found his values were high, and we reduced his Torsemide, he began to stop eating as much and then wouldn't eat on Monday. We had to cut back the Torsemide but again, later, had to give more. Tuesday he got the appetite stimulant Mirtazapine which helped. He's eating small amounts but is not ravenous. His breathing rate was up this morning to 12 and then 10 after his 7:30 Torsemide dose. It was still 10 at 11:30 so I moved up his lunch med to that time and gave him 2.5 and not 1.25 Torsemide. He was breathing well at 8 by 2 p.m. I created a chart to track fluids we give by mouth, calories given, calories eaten. Daily goal is 90 cals a meal. Yesterday, he ate a total of 135 calories by the end of the day. Today, after lunch, he's about 135 calories, slight improvement. He's not drinking enough on his own so our goal is 72ml of fluids by mouth to support his kidneys. And that is water, club soda, KMR, sweetened condensed milk, and sweet potato liquid baby food that is included in the total. We are surprised and perplexed by the sudden increase in kidney values and sudden decrease in eating. He was fine until Monday. But that is how it goes, says the vet. One day the cat is fine, with 69% of kidney function lost but no outward sign of it and then the next day the cat hits the 70% loss and then all manner of issues and symptoms appear.