Rowdy has weak hind legs due to CRF, what to do to help?

[Barbara Boehmer]

I have been rethinking my feeding plan.

I intend to continue to keep both the Royal Canin Mature 27 dry cat food and Iam's Hairball formula dry cat food available. I keep the dishes arranged so that they come to the Royal Canin first. Some of them will eat that, but most, includig my two CRF cats, pass it up and cotinue to the Iam's.

I was reviewing the phosphorus, sodium, protein, and fiber contents of the three canned foods that I feed. The Nutro MaxCat Senior is the lowest in phosphorus, sodium, and protein, and highest in fiber of all three. So, I think I am going to try feeding only that canned food and see what happens. I should not need to add any additional fiber. I think it is important that I try this because the phosphorus has become such a critical issue. I have only been feeding the others (Iam's and Fancy Feast) because they are more appealing and I was trying to encourage them to eat more. I am hoping that once they realize I am not going to give them any Iam's of Fancy Feast canned food that they will just eat the Nutro MaxCat Senior.

[Barbara Boehmer]

I got an email advising that the aluminum hydroxide that I ordered should arrive Friday afternoon. In the meanwhile, I have been trying to figure out what I can feed her and my other crf/anemia cat that is lower phosphorus that they will eat. Each morning and each evening, I try to coax them to eat some Science Diet K/D canned cat food. Sometimes they eat up to an eight of a can and sometimes they don't eat any. Then I offer some Nutro MaxCat Senior canned cat food, then I resort to Fancy Feast canned cat food. I discovered that the minced beef Fancy Feast has less than a third of the phosphorus that some of the fish flavors I have been feeding, like salmon do, so I switched from fish flavors to beef. They also have Royal Canin Mature 27 dry cat food and Iam's hairball formula cat food available at all times.

Rowdy hasn't had a very good day today. She got stuck in the kitty door in the panel of the sliding glass door that goes from the house to the outdoor enclosure. She got her front paws out, then her hips fell over and she could not drag them through or get back up. Fortunately, I was home at the time and saw it, so I could help her. I have been just leaving the back door open when I am home and the weather is nice, so that she does not have to use the kitty door, but I hadn't opened it yet when she tried to go out. She had what looked like the dry heaves while peeing about the same time yesterday as today, about 8 hours after her morning fluids. She makes all the sounds and motions as if she is going to vomit, but nothing comes out. Perhaps a little goes into her mouth and she swallows it again. She seems to do better in the evenings than during the day. The only thing that I can think of that is different is that she gets her fluids in the mornings. I am not sure how to interpet that. I don't know if she feels better in the evenings because she has absorbed the morning fluids or what.

[CarolC]

The only thing that I can think of that is different is that she gets her fluids in the mornings. I am not sure how to interpet that. I don't know if she feels better in the evenings because she has absorbed the morning fluids or what.

My cat clearly feels better after her fluids. You can tell in her personality. I am convinced she knows she feels better, which is why she is so agreeable about getting the fluids--she made the association early on. She always knows that's what we're going to do at lunchtime and bedtime, and she never resists or tries to walk away, and when I put her on the counter she sits and waits. I think she also likes them because they are warm and it feels good because she is cold-natured. But the odd thing is she hates to have me pick her up and set her on the floor afterward. I've learned to leave her on the counter and go cap the needles and put away the setup, then come get her to set her down after a couple of minutes. She objects to being picked up less if I put one hand on her bib (the front of her chest under her chin) and the other on her rear behind her hind legs and set her down that way. Maybe the fluids slide straight down to under her chest/abdomen and it is uncomfortable to be lifted there, I'm not sure, it is hard to tell on a longhaired cat. Anyway, that is the only part of fluids she objects to (being set down afterward) and I am convinced it is because she knows they are going to make her feel better. She's wonderful.

[Barbara Boehmer]

I posted the following message on the Yahoo feline phosphorus management group, but would appreciate any comments from anyone here as well.

I just joined this group, just got some aluminum hydroxide gel, and am trying to figure out how much to give my cat and when and how. My regular vet is on vacation until January 15th and the substitute vet at the same facility has not returned my call since Wednesday. I called again today, but no return call yet, and no estimate of when there might be.

My cat, Rowdy, is 21-1/2 years old, hyperthyroid, has kidney failure, and non-regenerative anemia, and high phosphorus. She is having difficulty walking, due to problems with her hind legs. She acts as if her hind legs are weak or numb or something. When she tries to walk, her hips swing from side to side and fall over to one side or the other. Sometimes she gets back up and sometimes she just drags her hind legs. I have kitty litter boxes with low entry and carpeted ramps for her to get up and down off the couch, but she is still havig a very difficult time. Some people on the Yahoo CRF group suggested that her hind leg problem might be something called lower-motor-neuron due to high phosphorus levels and suggested a phosphorus binder, such as aluminum hydroxide.

She started losing weight and having some slight problems walking about five months ago. Blood and urine samples revealed that she was hyperthyroid and she was given 1/4 tapazole tablet twice daily. A recheck four weeks later showed that the tapazole dosage was correct for the thyroid problem, but she was having kidney and anemia problems. Further testing showed that the anemia is non-regenerative. I have been trying to get her to eat Science Diet K/D, but she only nibbles a little each morning and evening and eats what the others eat inbetween: Iam's hairball formula dry cat food, Nutro MaxCat Senior canned cat food, and Fancy Feast canned cat food. She only weighs about 6 pounds now. I have been giving her 50 ml daily of lactated ringers solution subcutaneously as per the vet's instructions. She had troubles with vomiting, so she also gets 0.8 ml reglan twice daily 1/2 hour before I try to get her to eat the Science Diet, and 1/4 pepcid twice daily after she has eaten. She had a runny nose and was given Clavamox, but it caused some gastrointestinal bleeding, as evidenced by the dark stools, presumably from dried blood, so she was given sucralfate for about 5-1/2 weeks.

Initially, the vet said that it was more important to keep her on the tapazole, because the risk of heart attack without the tapazole outweighed the risk of worsening the kidney problem with the tapazole. But as she got worse, the vet said we might be about to lose her due to the kidney problem, and told me to discontinue the tapazole on December 20th, so she has not had any tapzole since then.

Here are some partial blood test results from her last full panel on November 17th:

RETICULOCYTE COUNT 0.1
ABSOLLUTE RETICULOCYTE 4,730
BUN 65
CREATININE 3.7
PHOSPHORUS 10.5
WBC 30.4 -- prior to Clavamox
RBC 4.73
HCT 22.1

She had only her pcv checked on December 11th and it was 22. We are planning to start her on epogen if it reaches 16.

I suspect that if I try to give her the gel before she eats or mix it with her food that she may not eat. So, I am guessing that the best plan would be to give it to her right after she eats, probably using a syringe. I am hoping that it does not cause her to vomit or cause constipation. She already has a tendency to vomit occasionally, especially while pooping or peeing and seems slightly constipated.

Although the substitute vet could not talk to me either on the phone or in person on Wednesday, when I went in person to pick up reglan refills, I asked if they had any aluminum hydroxide. The receptionist asked a vet tech, who asked the vet, and I was given a slip of paper that said amphojel and told I could probably find some at a pharmacy. I believe the vet responded only to whether they had it and not to whether or not it was appropriate for Rowdy, so I am still concerned about that. They did not have amphojel or anything similar at Walgreen's on Wednesday, so I ordered a generic substitute from vetmeddirect and it arrived today. It is Rugby aluminum hydroxide gel and is unfortunately mint-flavored. The directions for people says to take 2 teaspoons 5 to 6 times daily after meals. It has 320 mg aluminum hydroxide per 5 ml teaspoonful. So, how many mililiters after each meal should I try to give to Rowdy, my 6-pound cat? I am inclined to start with a low dosage, watch for side-effects, then increase it.

[Barbara Boehmer]

I finally got a call back from the vet. She said to go ahead and give 1 to 1-1/2 cc of aluminum hydroxide gel twice daily for the phosphorus problem. However, she said she does not think the phosphorus problem is the main cause of her leg problems. She suggested glucosamine for arthritis and is going to order some. She said it could also be due to blood clots or anemia. However, she is not howling in pain, as she said she would be with blood clots and is not weak all over as she would be if the anemia were more severe, so it is probably not either of those. She has not exhibited any signs of pain and is alert and has no problems moving her front legs.

My post to the phosphorus management group hasn't appeared yet, as it is still sitting in the queue, waiting for approval from one of the moderators. Aren't you glad we don't require that here?

[Barbara Boehmer]

http://handicappedpets.com/help/viewtopic.php?t=7675