2nd Post. Day 8. One Week Since Diagnosis.

Well today was Sunday and I had a good sleep in. For the first time a what feels like a long while I feel adequately rested. If anyone reads this had posted or emailed me from a forum, yahoo group or elsewhere to help with Milo, thank you so much *hugs* Here is where I (try to) keep my thoughts and ideas together.

I will be making a time to see Richard Gowan at The Cat Clinic in Prahan, Melbourne, I am not in a panic as I have done more research, and Milo is eating some of the renal food. So as long I see him soon, I will be happy.

QUESTIONS
Weightloss
How does having CRF cause weightloss in a cat that is eating? I don't question that it occurs, but I want to understand how it has happens.

Phospherous Binder or Calcitriol?
Milo with CRF has normal calcium and phosphate levels.
He has high Urea 21.6 mmol/L (normal 5 - 15) and Creatinine 0.37 (normal 0.08 - 0.21 mmol/L)
I am feeding him 50% Hills Prescription Diet k/d and Innova Evo wet, plus Royal Canin Dry 'Renal'. Some days he gets chicken or turkey or beef, Raw,
Question: With that in mind, do I use a phosphorus binder or calcitriol, or neither. I understand both can not be used.

Which phosphorus binder: Ipakitine or aluminium hydroxide?
If the answer is to use a phosphorus binder, do I get ipakitine or use Aluminium hydroxide. Ipakitine uses lactose and calcium carbates, and the aluminium hydroxide has no calcium (to be double checked).
***[Answer is debatable: One argument is Ipakitine because Ipakitine is partly a phosphorus binder, containing calcium carbonate. However, the key for Milo is that it also contains an adsorbent called chitosan, which is said to help with uraemic toxins. Chitosan is a polysaccharide similar to cellulose and is obtained from the shells of crustaceans. When protein is eaten and digested, an amino acid in the food called tryptophan is converted into indoxyl, which in turn is converted by the body into indoxyl sulphate, a type of uraemic toxin. Chitosan is said to bind with the indoxyl, so it cannot be converted to indoxyl sulphate, thus reducing toxin levels, which helps the cat to feel better. Chitosan is also said by the manufacturer to help reduce BUN/urea levels, and indirectly to reduce creatinine levels. This is based on human research but it still applies potentially to cats. Ipakitine seems to be effective for its phosphorus-binding effects and for its toxin-binding effects (since higher levels of protein in the diet may cause increased BUN/urea levels). The writer of this article says "My own vet in the UK has seen falls in creatinine and urea in some cats when using Ipakitine and no other treatments. I would be happy to try it myself in a CRF cat who did not have very high phosphorus levels.

The other argument is Aluminium Hydroxide because it has more effective calcium binders. aluminium Hydroxide is definitely the choice for cats with high phosphate levels, but Milo's are fine. If calcitriol can be administered with aluminuim hydroxide, and that combination is better that ipakitine, then its worth looking into. But it seems to me that Ipakitine is the way to go.

Ref http://felinecrf.org/treatments.htm#ipakitine

Thyroid
*Milo's T4 is 43 nmol/L (Normal 10 - 48). This is the high end of 'normal' - does that mean we have to watch it? Does that have anything to do with his weightloss?

Diet-Diet-Diet
This is a more difficult than I ever thought.
Traditionally, CRF cats must eat CRF food only - a special renal diet low in all things to keep the load off the kidneys (Calcium, Phosphate and Protein - I think). Once diagnosed with CRF, it is my understnding a kidney is already likely to be 70% or more gone, so we need to look after the rest. Milo's life depends on it. Problem is that the traditional renal diet is low in protein and there is a debate on a low protien diet being more harmful than good on the cat as a whole (I think). So I need to work out what diet I will feed him. I have an interim plan, but that may change as I learn more.

What I learned
* BUN is sometimes just referred to as Urea Nitrogen or just Urea.
* America does not use the international standard of test results/measures called SI, therefore to get assistance from those who can help in America I need to convert Milo's test results from SI to US.I put the converiosn in link my list of links to the right.
* Glucose results reflect diabetes: Milo is normal
* Thyroid problems can cause weightloss. Tetralodothyronine (or T4, which is the indicator for the thyroid). Milo's T4 is 43 nmol/L (Normal 10 - 48)
* Hypertrophic cardiomyopathy - heart muscle getting thick resulting in heart needing to work harder