RawPetMedics Feline Fridays: Renal Dilema

And for all of those who are wondering what the joke is, you should have watched the last episode. Welcome to Raw Pet Medics. Hopefully you're going to get an insight into renal disease. And joining me today, I'm just going to bring in on screen, we have Julianne.

Hello, hello.

And coming on screen, we should have Am I? Hello, I'm in the background, but there we go. So today is all about renal disease. I nearly accidentally put this up, but I thought that actually I really should title it this. So I'm just going to make sure that everyone can hear me. Everything's going well. So Welcome, Amaya. Welcome, Julie. And can you say something? Say something to everybody out there.

Hello, hello, hello, hello, hello, guys.

Can you hear anything?

How are you? Another month, another session.

Yeah, where is the time gone?

So let's have a little look.

Yes, it's amazing.

My sound's not working now.

It's already our third.

I know, I can't believe it. Brendan, your sound is working. We can hear you. Hi, Heidi.

Yes.

Yeah. Can you hear us, Brendan?

Anybody out there?

We are here.

Yeah, can you hear us?

Can you hear us on Facebook?

It was all going so well. I don't know what's happened. I'm just gonna have to go flipping back to, uh—

We can hear you.

Yeah. Oh, but he does. Yeah, do you hear us? I can't hear you.

Are you trying to get us to sing?

I just have to flick something else off.

Oh, okay.

Yeah, I was.

Okay, sound check.

Yay!

Well, I was always the one with the problem, so we had to switch someone else.

Sorted now. Right, so we're back on. So, renal dilemma. I just thank for all of those people that are out there, um, and helping us out on Raw Pet Medics. Um, do join our Patreon page. There's a few bits of extras on there. Uh, you'll get some other insights, a few bits that we're going to be posting today. So hopefully you get loads of information. Um, I think we're gonna go through— oh, we've got some thanks from Heidi for you just coming up. Can you see the comments, guys?

Yeah, I can see it. So beautiful comment from Heidi saying that she's had amazing results with a nervy cat after giving a herb garden. He's playing, head bumping visitors, and sleeping on his herb garden. Oh my goodness, that warms my heart so much, Heidi. I'm really, really pleased. That's great news. Yeah, an amazing power of herbs, right? Yeah, fabulous.

Brilliant, brilliant. So I'm going to make sure that we get this back right. So renal dilemma, I'll just remind you, so we do try and make some podcasts out of all of this as well. So if you are following us now, available on all streams from Amazon all the way through to— which is their Audible streaming service— all the way through to the Apple streams and Spotify. So you can find us there if you want to follow Raw Pet Medics. And listen to us as you're out and about. I was going to say walking your dog, but I've got the wrong one.

Don't you dare!

As you're walking your cats.

You're getting confused.

You know, I'm always confused. You know, I've had—

This is Friday, it's not Tuesday. It's a Friday.

To me, everything's just blended into one.

You don't have to keep working tomorrow.

Oh yeah. Well, so how's your month been, Julianne? What have you been up to?

I can't believe it's been a month. Like, how is that, how is that possible? How has it been a month already? So what have we been up to? I've had very poorly little boys. So Leo and Max have both been unwell and it's both been a food issue. So we've been doing a lot of work in the house looking at energy and feeding stations and the colors of, you know, their bowls, their collars, all that kind of stuff. So, you know, I'm the— I use the complementary treatments and modalities. So we did a bit of work with that first, but we had to get the vets involved, which again, you know, I'm not adverse to that. I think it's, you know, holistic approach is about having the vets and, you know, complementary practitioners together. So Leo had an overnight at the vets. Max, we haven't got to that point yet, but we're still waiting for test results from Leo's lovely, beautiful poo sample and to see if there's any information in that. And yeah, Max, we've just moved him to an even higher feeding space to see if that encourages him to eat a little more. So we've had a few challenges with food. And I have to say, I have revisited our own live that we did. Was it last month? Was it the first one when we talked about transitioning and tips and tools and You know, we've, I've been trying some of the things that we've talked about, you know, to encourage the boys to eat. So it's, yeah, it's been a bit of a, bit of an up and down month, I have to say. Yeah.

Wow. Wow.

Yeah. We've had quite a lot of panleukopenia has actually made a resurgence in local cities around us. Fortunately, as a practice, we've not experienced this, but, you know, for us particularly, but I know a lot of practices around have had problems. And so we're sort of like giving a bit of an alert out there. So watching out for the vomiting, diarrhea. Obviously there's all sorts of immune suppression stuff comes along with that, hence the panleukopenia as the name. But it is really parvo for cats. So that's what we just say to people. So just another little shout out if you're kitty cats have got a bit of an upset, they go out and about. Also, if you walk and leave your shoes in the hallway for them to play around, okay, be aware that's how the virus can get in. So just be— not saying that's what you've got, Julianne, at all. There's other issues there.

Yeah, no, no, absolutely.

I mean, yeah, this is a nice warning anyway.

Yeah, and that's a great tip. You know, we've— we haven't had vomiting and diarrhea. They're just it's the food, then it's a lack of eating. And Leo had a bout of anorexia 2 years ago, so, you know, we are heightened with that. But now Max is a bit funny as well. You know, it's a bit of a, it's a bit of a jigsaw, you know, that you're trying to maneuver each little piece. But, um, that's a great tip about the shoes, because we do have shoes by the front door, but, and we very rarely put them in the shoe rack. So that's my learning for today already, and we're like 10 minutes in. Thank you very much, Brendan, job done.

Oh, so Amaya, how's your month been? What have you been up to? Holidays?

Well, no, I wish. No, I'm looking forward— I'm looking forward to move to a better city that is not so polluted. Uh, I'm looking forward to move it, uh, to Mallorca. And, uh, you know, I want the beach. I want, you know, the nice weather, then at the beach and everything else. And so it's quite hard because I never expected that the prizes were going to be just like in Madrid. So, you know, I'm dealing with talking to people from the other city and just, you know, trying to manage all that. But animal-related, I've been working, joining forces with a dog behaviorist, and we've been doing this kind of thing of families, you know, mixed families with dogs and cats, because usually they have a problem with their dog and the cat is left behind and the other way around. So, uh, we've been trying to create this multi-species family and work together and start, you know, connecting people between the different behaviors.

Yeah.

So we, we did a, yeah, we did a course last weekend and we are going to, it's going to be a 4 webinar kind of thing, so it's gonna be long.

Only 4? It's just like, this could go on for some time.

Only 4, 3 hours each.

Wow, that's a marathon.

So yeah, it's a lot of information there.

I hope it's recorded and they can go back through it step by step.

You want it to be like Lord of the Rings or something like that?

How about you, Brendan? How was your month?

Oh, brilliant. Oh, uh, yeah, it's been— I was just saying to Amaya before we came on, it's been a little bit hectic. We've had, um, a few vets that have, uh, been waiting for visas to get into the UK, uh, and it's just been slowly having people going off, um, because they're on maternity leave now or being taken ill or been on holiday, and it's just sort of like snowballing all the time to do things. And I'm just saying, no, I've got to do this. See ya. So, um, uh, so hats off to, um, Andra, who's currently managing the practice and, uh, and dealing with all of that at the moment, and emergencies, and the nursing team who are great. You know, having a nursing team like I do around us, you know, that's like— well, you know, I say she's on her own, she's there with, uh, Niall and 15 other nurses and, uh, people around to help. So, you know, it's a, you know, a juggling act, but I'm sure they're coping admirably at this point in time while I enjoy myself with you two, which is great. Yes, they're not watching this and saying, what are you doing? Why aren't you working?

This is why you're living here alone.

Oh, anyway, let's— without further ado, yeah, we did say to everybody we would deal with this Okay, thanks for everybody who shared the post. We're going to talk about renal disease, really important in cats. And I think we sort of want to address a few elements here about what it is, what the kidneys do, and what you might see as symptoms and when you might see that symptoms. And then what we can do from a holistic point of view of support, you know, feeding, you know, myself and Amaya particularly into raw nutrition, so we can deal with that, but we can touch on some of the commercial foods that are out there and what they're trying to achieve. And Julianne sort of like slightly broke out into a cold sweat that I was going to start asking her to go into the detail of medical stuff on this, but actually, uh, I think Julianne's purpose is to sort of pin us down and ask the questions that all of you guys out there want to know. But we do have live, um, comments coming up, so if you have, um, any questions at all, please do type them in the comments section, whether you're on YouTube or whether you're on Facebook. If you type them and we can see them pop up, um, and we'll be able to— and we can just show them if we need to. So there you go, thank you. Um, and, uh, you know, hopefully we can answer some of those pertinent questions for you as we're going along. It's always nice to see live audience as well. So great stuff. So without further ado, renal disease. Amaya, do you want to sort of point us in the direction of, you know, what your impression of the kidneys and what they're doing for our little kitty cats?

But you mean in the healthy way?

Yeah, in the healthy way. Yeah, before they fail.

Yeah. Okay, before— that's exactly— okay, so, so our— I mean, well, everybody's kidneys, because they're usually— they're all the same in a way. Um, they filter our blood. They, they make sure that we have this, uh, balance between, um, certain, uh, minerals. How do you call— ions? It's, it's the word.

I think we'll leave it as minerals because most people are exactly so.

Yeah, minerals. Yes, that's okay. Anyway, okay, so the kidneys, uh, what they have, the main, uh, the main function is to filter, uh, all toxic toxins out of, uh, to the urine and make sure that, you know, the blood stays balanced in minerals and blood with the toxins and everything. So it's like, um It's like a very selective, um, uh, how do you say this?

Filtration.

Yeah, anyway, um, it's filter. Yes, that, yeah, a filtration system. It's like when you filter water just to get the best out of it, so you get the best inside the body. And then the other way, the other thing is, uh, it also promotes the production of red blood cells. So that's, uh, that's another important function that the, the kidney has. And from a Chinese point of view, it's also, it's like where the energy comes from. It like, it builds up, it's a very important organ for the traditional Chinese medicine as well. So, um, and on another way, it also regulates the water, you know, how much water it's going, because sometimes filters, uh, this filter can retain too much water and sometimes lose a lot of water. So it also balance the amount of water your body is going to have. I don't know if that I'm making myself clear because this is for me.

I am sitting here going, amazing, because if you asked me to do that in Spanish, I would be running for the door. No, no, do you know what? I don't think I could even get to kidneys in Spanish.

It's a— nothing I like.

That was it, that was a really great explanation and I have to say it, Amaya, like that was really simple but detailed, you know, to understand this tiny little organ and what it does but actually like how crucial and important it is, you know, to have it functioning well. So Brendan, tell us like what happens when it goes wrong? What is it, you know, when we talk about disease and failure, like what happens to this beautiful system when it starts to go wrong.

Yeah, and we're going to bring in some of those. There's a couple more things that the kidneys control, and that's about acid-base, so the sort of acidity of the tissues, because that's really important for oxygenation and biochemical processes to go on. And the last thing is about conversion of vitamin D and actually how that also has a mineral balance. Okay, so the, the kidneys actually control that, believe it or not. So we all think about it, you know, being from UV light and it's a convert, you know, created from, you know, in the skin from that UV, um, and our liver's doing stuff to help absorb it from the gut and plant materials, etc. But actually the kidneys have a vital role in converting the vitamin D into an active form for the calcium-phosphorus imbalance. So we're going to deal with that too. But as you point out, the kidneys are so vital, so important, that actually evolution has created an excess, a functional reserve we call it, in the system. So we will have anywhere up to 4 times the amount of kidney function as we actually need to survive. So this means that actually your cats can deplete their kidneys over time by 3/4 and still be functioning at the end of their life.

Wow.

Which is amazing, isn't it? But don't we see so many cases, unfortunately, of elderly cats with kidney disease? I think, you know, anybody who's owned a cat probably has seen that process towards the end of life. And so it's really important. So we see, it used to be reported that there's two major things, the creatinine ratio, so the creatinine and urea. So creatinine is just a general muscle turnover protein that is dealt with by the kidneys and it's a way of monitoring if the kidneys are filtering properly. Doesn't have any toxic effects or anything like that, but it is a sort of monitor of kidney function. And the urea, which is effectively ammonia, so that's bleach, that's a byproduct of protein breakdown, that's converted in the liver into something slightly less toxic, which is called urea. And that's why the kidneys produce urine, okay? Because that urea is then filtered out into the water, and that water is urine, okay? So urea is still quite toxic. It's a little bit like bleach, and it will be as caustic on the membranes of the mouth and the tongue, of the intestine. But actually, internally, it's doing exactly the same thing as ulcerating those areas on the surface. That damage is happening in the organs and will ultimately lead to organ failure if those levels get too high. So it's really important to understand that urea level has to be controlled. And the kidneys do that function, and that's what we're talking about.

Very well explained.

Okay, well, I don't want to take your brilliant—

Steal your thunder. He didn't. No, I mean, that was great.

Very, very clear. I mean, you could have— I don't think I would have done it better.

Oh no, hang on a second.

I think from that point—

Come on, come on.

Oh, oh. Got cats coming in the window. Sorry, I was gonna say it's a bird cat. It's just flown into the window. What did I say?

I'm on the second floor of the house and he's on the roof. All of a sudden this, this face just appears at my window. Yeah, yesterday he walked along and there's no other window that way but the neighbor's roof, so I'm like, Max, come Come back. Right, sorry everybody.

No, that's okay. So just having a moment. So what we want to sort of make clear is that once those levels go up, now we in the UK usually work on sort of millimoles per litre, which is, you know, so you'll see certain levels talked about. And if your cat's sort of going above 10, and if they're raw fed above 13, then we start to get a little bit worried about the urea level. But it is so important that those tests are done on a starved sample, because if your cat has just eaten and they take that blood, then of course, as I've said, it's part of protein breakdown that urea is formed, okay? And therefore the levels will be higher. So don't get freaked out until you've made sure that it's a starved sample and in the morning. And we call those two parameters of creatinine and urea, if they're both raised, then we call that something called azotemia. And that azotemia is a first sign of renal insufficiency. The kidney's not functioning properly.

So insufficiency is different to failure, isn't it? Insufficiency is that, like you said, that there's an issue with the processing going on rather than it's, you know, it's impacted rather than deteriorating.

Yeah, we, we try to refer to everything as insufficiency now because failure is really the endpoint when there is no coming back. You're, you know, that is the final decline. That is, you know, we're going to talk about that at the end of today. You know, when we determine that's the case. So we do sort of really want to deal with, you know, insufficiency, how we can actually bring that back. There's a few herbs that can deal with that as well, and we're gonna sort of go through that. But I think getting to grips with how it's diagnosed is really important, and there is something now called SDMA which is available which can diagnose way before we get to that 75%. If you start to get kidneys that are damaged, then that enzyme starts to go up, and we'll see that in the blood. So we do monitor.

Yeah, but the thing is, with those levels—

yeah, sorry, yeah, I was just going to say to Amaya, do you deal with the grams per deciliter as a a level, or are you still in millimoles per liter?

Uh, well, it depends on the lab, actually. I have to actually use both of them. Yeah, it depends on the lab, um, but it is, it is the same thing. Uh, we use both of them. Um, the thing is about diagnostics that it's very, very important is that not everything is decisive as well, because I had kidney diseases that weren't actually— well, you know, the kidney was being affected, but it wasn't the cause in the beginning. So that's another thing that I wanted to point out, because sometimes I've seen some test results that come with creatinine levels that are high, maybe urea, it's normal, or maybe you find that the cat has been losing weight a lot. Or maybe you find that, um, SDMA, it's, uh, it's associated with another disease. For example, I've seen lots of cats with pancreatitis that maybe, you know, it's affecting the, the kidney, so SDMA, um, you know, appears like really high, and actually it's an infection or something else. So one of the things that I, I'm very concerned every time I receive a lab report is that Have you made, you know, have you ruled out everything else? Or sometimes I get, you know, liver enzymes that are high and maybe you got a hyperthyroidism or, you know, there are so many things because the kidney is not just receiving the blood and, you know, filtering and that's it, you know. It's affected by what's going on in the rest of the body. And that's one of the things that I really I really like to make, like, give a lot of importance for diagnostics. It's very important that the cats are fasting before having— that's one of the biggest problems that I have because people sometimes struggle to go to the vet in the mornings or maybe just, you know, not make them fast before going to the vet, and that's really bad because, you know, they cannot take it. I don't know if that happened to you ever, Julianne, that you had to not feed them for one night and so you didn't have— you don't sleep all night because of that.

It's highly stressful, highly stressful. And it's the worst thing is the mornings, like, you know, they know the routine, so there's nothing but yowls and cries and sad looks and, "Mummy, why aren't you feeding me? You're the worst person in the world." So yeah, it is really hard, really hard. Why is it that—

Don't you get them just as you're drifting off when they're doing this.

Yeah, you both said about fasting, and why it's important to do that when you have those tests done. Why is it important for the morning? Because Brendan, you mentioned this. Is it because of the time of fasting, or is there a kind of like a difference in the body levels in the morning?

Yeah, there is a cyclic rhythm as well. So for many of the parameters to try and stabilise this, to sort of get it consistent across all of the samples that we're doing, we will generally try and say a morning sample. Because there is all sorts of influences, you know, we have circadian rhythms influenced by our cortisol, our natural cortisol from our adrenal glands being released, and that will influence organ function and what's happening. So making sure that we try and standardize as much as possible is key. And that's why we say a morning sample. It's not impossible to do it in the evening, but we just have to sort of draw a caveat or an inference in our own minds. If there are slight differences, that it may not be that that animal is worsening, it's just we've taken it at a different time of day. So it's consistency.

Okay.

And the other thing also, Saying about the consistency of the test, the other thing is, uh, the weight loss. I, I will really take that into consideration because I've seen cats losing a lot of weight that the creatinine levels, you know, run high, and that's not necessarily that something is— well, it is worse because they're losing weight, but in a way, I don't focus that as a kidney problem itself. I just, you know, make sure that the weight loss its control, and that's not very looked after.

And I would just say to Heidi there, you know, you're asking about what we expect for these, the difference. I would say about 25% higher for the azotemia, and that's why some people have inferred that therefore you shouldn't be feeding raw for a kidney cat. And I would say I don't believe that's the case. I think that actually, you know, they talk then about, oh, gently cooking the food and effectively using it that way, that's a better option. I don't think that's true at all. I think it's just that you've got to accept that if cats are in more normal protein and fat metabolism, they will produce a slightly higher azotemia than they otherwise would. And hence the kidneys should be functioning at a level, and we should be helping that process. You know, there's other things that we're going to talk about for that, but I think right now, if you think that for those levels it should be about 25% higher, I think there's some other blood parameters we should also talk about here, isn't there? And that's the, you know, in reference to this little one. I'm just going to hide ours so that people can see. We can still speak, but there is this thing which is the IRIS staging. Okay, now we're going to post that up so that people are going to see it in more detail, but it will talk not just about azotemia, but there's other things about how chronic this is to do with urine protein creatinine ratios. We'll talk about a little bit about phosphorus, levels, and that can have an influence on whether your cat's appetite goes down. So there's all sorts of things there that we need to bring in. And I know that there's been a query already with regards to what we do as far as feeding the bone versus eggshell for calcium.

I was going to bring that one up.

So should we deal with the calcium-phosphorus ratio? Should literally, in a normal cat, should be about 2 parts of calcium to 1 part of phosphorus. Okay, so it's usually a 2:1 ratio. Now there are more specifics around the levels, and some people will quote if they go about above 0.7 on a certain scale that they start to get worried about phosphorus levels, but I don't think that's the case. I think the ratio is more important. And you will see them start to switch around and go from, you know, 1:1, so 1 part calcium to 1 part phosphorus. That to me is a big issue that you're, you're losing the battle. And by the time you get to that the phosphorus is more than the calcium, you should be doing something active about binding out phosphorus, etc. There was a really good article brought up by one of our colleagues on the difference between inorganic phosphorus put in kibble feed versus what you'll find in bone material. Can you remember that, Amaya? I think it was Pete Colshaw raised that.

Yeah, it's— yeah, Pete Colshaw just, you know, uploaded that study, and it's very interesting because what it says is that inorganic phosphorus is absorbed in the 100% like all of it. And then vegetable, or, you know, phosphorus from plants, it's absorbed in the 40 to 60%. And some other raw materials or organic phosphorus is absorbed also in a 60% or so. I don't remember exactly the percentage, but it means that natural phosphorus is not organic one from sources that are natural, it's going to be less absorbed than the ones that come from inorganic sources of phosphorus. And this is important because that what it's telling me from the first thing that, you know, you should improve the quality of proteins when you have this issue, and then you have this phosphorus absorption from inorganic sources that it's completely absorbed, then We have to be careful. It's kind of telling us that we shouldn't be feeding any processed food because this is what happened, the low quality of proteins and inorganic phosphorus. So it's not a good combination for what we are dealing with. So in this sense, what I do if I have to treat, it depends on the ratio, as you said, because sometimes I start working on this ratio before or it's the phosphorus, it's like, you know, going up like too much. I always try to work on the ratio from the beginning. I mean, if the calcium is not properly adjusted from, you know, this ratio with the phosphorus, I'll try to work on that before something happens. And if it's already high, you know, some of these phosphorus binders or blockers, for me are not the— you know, they work until a certain point, and that's a point that it's really hard to deal with a cat because then— I don't know if you have any— do you have any options for that when you have this problem that the binders are not enough? Because they are good, they can help you, but they are not enough in really high phosphorus levels.

Can we just— sorry, before you answer that, Brendan, can we just go back a stage and talk about why phosphorus is important important because for somebody that is, you know, just perhaps new to finding out they're dealing with renal issues with their cat, we haven't really talked about why we're talking about phosphorus. Could you just explain a little bit about why this level we need to look at it and what it's— why it's important?

Yeah, so what we start to get is the sort of feedback mechanisms with the hormones and what's happening with your calcification of bone, but you also find if phosphorus levels are high generally reflects directly on the appetite for your pet, and also their nausea levels will start to come in too. So if you've got really high phosphate levels, they generally will be off their food, if not nauseous. Okay, and so we want to try and drive that level down. That's the simple, simple answers for those.

Yeah, and as we said before, Sorry, sorry, Brendan, carry on.

No, so I was just gonna say, I was just gonna say about, um, from my experience, that there's, there's, um, different phosphate binders, we call them, uh, some people call them blockers, you know, uh, some of which, you know, things like aluminium hydroxide, I wouldn't particularly personally want to be adding, but there's quite a few foods out there in the kibble company world that add them into the foods. But aluminium has all sorts of other issues with disease and what that can cause if you've got high levels of that in a food. There is the other ones, ipacatine, which is sort of like— and chitins are in that, which is a way of— so the chitin again blocks the uptake of phosphates from the intestine. That's a good way of binding out the phosphorus. And then, and you find that in some of the other liquids, etc., like there's Pronephra, I think from Virbac use some of those alongside some of the NutriVet renal products, which also has the VetPro range. They use hypocytin, so chitin within those sort of supplements. So you'll often find a phosphate binder in that sense. Other people will then talk about increasing the calcium level. So getting your calcium up within the food will almost draw, bind back the phosphates, the inorganic phosphates fine, but maybe not the organic phosphates. So they'll use crushed up eggshells, things like that. Even calcium carbonate. And firstly, I don't find that they're necessarily the best thing to add. You can end up with increasing levels of calcium as well. You're not necessarily controlling the phosphate levels.

But now I have a question for you because I had to deal with ipakatine. It's that the one you call? Yeah. And at a certain level, For me, those binders like Pronephra or Epacadene are not enough to deal with this issue. So do you have anything else, like say any other product that you like?

So I always double-check at that point. This is where the vitamin D really comes in as being important, you know, and if you've got a kidney that's so badly damaged and the phosphate binder is not controlling, then you can get the alpha-calcitrol, which is, I think, you know, a supplement that you are adding in drops to the food. So you're increasing bioavailable vitamin D just to try and compensate for the fact that kidneys can't do the conversion. And that will have the feedback mechanism on the parathyroid as well and the various controls of calcium-phosphate balance within the body. So it all starts to become a lot of tinkering, but I would definitely say that it's your vitamin D levels will need supplementing because all of the levels that are on FEDIAF and the NRC guidance, which led to AFCO, is all about what's right for the normal average animal and is not about how to deal with if it's all going wrong. So getting the levels right, there is no way that you should be adding phosphorus, inorganic phosphorus, into a diet for a sick animal. And certainly I don't think that's appreciated, so they'll end up adding it in, strangely enough, and then binding it out. And you're just like, what on earth are you doing? It's, you know, and there is— and then the vitamin D levels that they quote are often not the active vitamin D levels that should be in that food. They will look at a general, you know, precursor vitamin D before conversion. That they will get from a plant source or some other source and add into the food to sort of top it up because the absorption and the heat processing will damage the level of vitamin D otherwise, and you can have insufficient levels of the active form in a disease case. So really important, I think, if you're having real problems with your calcium-phosphorus ratio and your phosphates are climbing and the binders aren't helping, vitamin D is probably your answer.

Beautiful. Yeah, that was kind of— you were going to explain it much better than I did.

So, okay, so we've talked—

I'm a fan of vitamin D.

We touched a little bit there about diet, and obviously we are Raw Pet Medics, Feline Fridays, but Raw Pet Medics. So What, what would your advice be? Let's go to Amaya first. If you've got, you know, a guardian who's got a cat that's on, say, dry food with a little bit of wet, you know, what would be your recommendation? How can we support them? Brilliant. I was going to bring that question in. How can they support the cat with nutrition, with the diet? And Beth says, for those of us making our own raw, how should we adapt the 80/10/10 recipes? So can you talk a little bit about nutrition for us?

Yes. Well, what I would do first of all is to look at the symptoms because usually I focus on the symptoms and the diagnostics and I try to make sure where is the biggest issue. For example, sometimes you get renal disease for inflammation, you get renal disease from the phosphorus levels. Sometimes renal disease is not always the same thing. Sometimes they are very toxic, intoxicated. So it depends on the main symptom. And I try to work on that first. And then once that is addressed, then I will look into the rest of the things because for me with cats, it's really hard sometimes to actually, okay, you have to improve the quality of protein. You have to do that. And the cat is like, yeah, whatever. I just want my kibble. Right. And it's like, okay, let's see what we can do anyway. So the first thing that I would do is not prescribe any renal kibble. I'll never do that. I don't like them. I've never seen them work. Actually, I've seen them making them worse because of this lost weight. I've seen many, many cats losing weight, sometimes due to that they don't eat it, sometimes due to the quality of the food. It doesn't matter, but they usually don't don't work. And then the other thing that I look into is that if they're constipated or not, because they need to have a really good function working out there. So, you know, there are some bacteria in the colon that actually can, you know, have some urea and break it down. And so you need to have a really good digestive system working out. And to help him, to help the cat actually have less symptoms. And so what I would work on first is try to get all wet. I don't care which one, I just, you know, would like to go wet completely. Yeah, moist your food for totally. And then if I can, I will just try to add some food. And I'm not into the cooking all the time the food. I would cook the food if I have high phosphorus levels. And maybe I would make some variations. I try to keep a variety of different meats. I don't like to just feed chicken. I know sometimes people suggest to do this, but I have better results every time that I keep the variety of different proteins, and I decide depending on the phosphorus levels if I cook them or not. Sometimes I put bones, sometimes I don't. It depends. Actually, I don't have like a complete diet that I would suggest every single time because I had cats that actually for deboning some diet, I got really bad results. And sometimes just, I need that in another cat. So it depends, it depends on the symptoms. So I focus first mainly on wet food, really good quality and variety as well. I add fiber. I make sure that the digestive system works perfectly. I add usually pre- and probiotics and a lot of omega-3. That's kind of my biggest, and for most of cats. And then I'll just make some adjustments if I need to.

Lovely.

There's some great papers on omega-3. Yeah, great omega-3 supplementation for renal disease. So, you know, using some of those high omega-3s are really, really important. And again, you know, varying the source, making sure that they are protected. You know, we've, we've talked briefly on Raw Pet Medics with regards to making sure you don't use oxidized oils. So don't— it should be stored in the fridge, you should be using it in the week, if not freezing it. You should try and, you know, use the capsule forms that are sealed individually where you can, and you can even then pierce those and squeeze them out, or using egg yolks, if they'll take sort of quail eggs and things like that, the yolks of those can be really rich in omega-3s. Those are options certainly for those, and I'd absolutely compound that. I think it's so important for their quality of life that they get a readily digestible quality protein. Too many people have got low protein foods, our renal diets, and they end up with cachexic, that's starved cats that are skeletally thin and end up deteriorating in their quality of life, not because of what their blood parameters are doing, but they just become so fatally weak to move around because they've been starved, literally starved by giving these low protein diets. And so it's so important that we get across that actually it's not about the protein level. Even the kibble companies have stood up and said this. It's about quality of protein. And what better quality of protein can you get than feeding raw? Okay, so don't be silly about it. You need to think about the appetite of your cat. You know, you may need to cycle through proteins for those that are neophiliacs. You know, we've talked about that in the past. Between 3 of us. For those that really want something different each day, then those are the things to, to watch out for. But I think, you know, quality protein, try and keep it fresh and raw. Think about how you're going to give those omega-3s within that diet. Absolutely would be the slight adjustments that I'd make to those 80/10/10 rules, you still need all of those other nutrients that are in there. Okay. But at least you know that you're not being silly and starting to add a load of balancers which are full of inorganic chemicals which are going to be absorbed across damaged gut without any control. I think let's get sensible about this. Ways that we can help keep the gut integral and healed, soothed, you know, adding some herbs, which I hope we're going to get time to talk about any second, just to help their nausea, help their, you know, how the gut is coping. But we've also— Doris Lowry, I said I would raise this. She's sort of pointed it out across the world. There's different areas which will allow subcutaneous injection of your own pets with fluids. They must be sterile fluids. This is not just water. One of my other colleagues said, what, injecting water? I don't think you were meaning that. I think, you know, it is, you know, these are sterile fluids which are built for rehydration, normally intravenously. And what we do is we teach the owners how to inject subcutaneously, and they can attach a bag and actually just rehydrate their cats to just keep that, because that's so important that they are, you know, kept hydrated. It's almost a way of doing the dialysis. You know, there was a point in the mid-'90s we were even doing peritoneal dialysis of these cases where we would flood their abdomens with fluids and then effectively leave it for 8 hours and then drain off the fluid, you know, sometimes even less, just to try and draw out the urea. But so many cats just absorb the fluid that you pumped in because, you know, they were just so dehydrated that most of it just ended up coming out in their urine.

Oh, so that's amazing because I thought my teacher, my— the one that taught me into feline medicine, he, he did that, you know, and I was like, he's crazy. I know, it seems like it was— it was a practice in the past for us old people.

You're not old.

No, he is. But anyway, the '90s, the '90s are not that long ago.

Yeah, it's So anyway, those are things that we're taught, but I think realistically, you know, just getting them hydrated, they will lose the urea in the urine, even in a dilute form, just because it's just sucked out. And just, they are not able to keep the fluid in the system, so they need rehydrating. So if you're really losing the battle to keep them feeling well, you need to really give them the fluids. Now, I always say to my other vets—

Another thing about that.

Yeah.

The vets, what?

Yeah, no, I was going to say to my colleagues, I always have this conversation that we can get cats in, we can make them feel better for the time they're in hospital, we can give them fluids and do massive improvements. But if they're at that point, you've really got to assess them as they come off fluids. Because those poor cats are not going to have a quality of life in the veterinary hospital for the remainder of their days. And so we need to work out how we can achieve that at home, that they can maintain quality of life. And one of the ways was to give this subcutaneous fluids. Okay, so under the skin rather than intravenously. Sorry, Amaya, you were going to come in with a point as well.

No, yes. What I wanted to say about this fluid is that it is a really— I mean, it helps a lot to actually keep the urea and the creatinine levels down. It actually, uh, it's easy to— once you teach the owner how to deal with that, it's not that hard to actually do it. Um, but then there is another thing. If you don't switch diet to a more moisture Ah, well, what diet? I just wanted to— yes, but with diet, uh, then there's— you're gonna be adding the fluids like every single day. Once— if you get— if you switch to a raw diet or maybe any, any other wet diet, then you can get, um, you can, I don't know, do fluids, uh, every 2 days, every 3 days. It doesn't matter, it depends on what the cat needs. But it's actually also a good a good way to improve their quality of life at home. So one of the things is that make sure you do it if the cat feels comfortable as well. You have to actually learn how to do it. Make sure your vet explains it because then at home it's not the same thing. It's the other way around. And there are different ways. I don't know if you have different techniques. I saw in the United States they sold this kind of collar or harness that actually had— you can just leave the bag of water there, like, of fluids, and then it would be just infusing the fluids inside, like, during the day, or maybe a couple of hours, and then you just remove the harness and that's it. And I'm like, this only could work in America, because otherwise, if I put that into my cat, my cat will just run away and say, what the hell are you doing with this harness on top, right, with all this weight, let alone the needle.

But just the point of the backpack, I mean, just like, you know, it's just like, that's just another thing. Yes, ignore the needle.

Wow.

I imagine the cat going like this, you know. But well, they sold that, those things. I was like, wow, so the cats are really actually letting you do that anyway. Uh, and another thing that I wanted to add before is, uh, about the omega-3. One thing that I, uh, I do is that, you know, since most of the omega-3 actually sold here in Spain, they're like half, uh, I don't know, quarter liter or something like— they're huge bottles. Yeah, huge bottles of omega-3 bottles. Yes, thank you. Uh, what I, what I do is I, I pass it on to another small one of course sterile glass, and the same thing, you know, the same material, dark glass, small bottle. And what I do is I freeze the other one and I just keep having this small bottle. So every time that I open it, it doesn't, you know, you can serve it much better. Because otherwise you can get, you know, opening the bottle just to extract a few amount, just a little bit, it can also oxidize the omega-3. So I'm a little paranoid with that. So if you like to have just that in small bottles and freeze the big one, that could be a—

and to that, I would also say if you can get the BPA-free plastic bags, they do like a bag that you would tip water into to make ice cubes. Okay. I know it sounds very much like plastic waste, but they effectively seal the ice cubes inside the plastic. You can pour the oil into those and it actually just then gives you an ice cube size amount of oil to defrost rather than trying to have to defrost the whole bottle, repour it out and then freeze it again. You've just got small packets of oil that you can defrost at a time. So you're not ending up with all of those.

Yeah, that's a good one.

Okay.

It's a little too much plastic waste for me, but yeah, I love the idea anyway.

You could use a tray, you know, if you you want to do that, you could just use a recyclable tray, a reusable tray, and do that. But it really depends on the—

I didn't even know that you could freeze— I didn't even know you could freeze oil. That, I mean, like, again, this is just like, yeah, it's a learning point for me that you can— that you're both suggesting, you know, or recommending freezing it. I mean, I find that fascinating. Never thought about that.

Yeah, fats are very sensible. Oils and fats are really sensible to Oxygen. So if you want to give the best quality of it.

Okay, so we're almost— I can't believe, like, where does the hour go? Seriously. So Brendan, there's two things you mentioned. So one was herbs and two is about when we've switched from, you know, a renal insufficiency to, you know, renal decline and what would we be looking for? Yeah. So can you talk a little bit about that for us?

Okay, maybe I'll give my top 3 things for treatment with complementary medicines. So I would definitely say for me, the majority of cats that suffer with renal disease will go into a constitutional sort of natrum muriaticum. So that's a salt remedy that we use. Okay, usually I will give a high potency because it very much affects them mentally. And I will just use a sort of night, morning, night dose at the max once a week. Okay. And sometimes we can spread that out. So they just get a single dose once a week, once a fortnight, just as some support. Adding in then some of the commercially available products now will have some antifibrotics in there. So, the kidneys are often at this point starting to, as they get damaged, becoming fibrosed. And that actually walls off the function of the glomeruli, the little filters within the kidney. And actually, if we can remove some of that fibrosis, then actually what we'll get is, you know, re-putting those glomeruli back online to filter again. So, we can use anti-fibrotics from the sort of rhubarb family of herbs. So the rubinols that are out there, there is a few products that are available commercially. Pronephra, I believe, has it in as well. That's the liquid one I said has a phosphate binder in. There is another one by Vetequinol, which I don't think is Vetequinol anymore, but used to be rubinol as an actual tablet that's crushable. So there are some options out there herb-wise too as an anti-fibrotic, and they're certainly worth looking at. They are quite bitter as a herb, so you do have to hide them well in the food, but they are worth looking at certainly. So nature mure, rubinols as a herb, and just, you know, getting a good quality of food protein, you know, making sure that actually what they are able to eat, I think, is just vital. Those are my top 3 things. I don't care whether it's going to be, well, the urea level is going to go up at some point. If they're not eating, they're not going to make it, you know, through the week. So you need to get them to a point where they're taking food on board.

Yeah, lovely.

Okay, that's my top 3. Amaya, what's yours?

Yeah. Well, I don't have as many as you do, but anyway, I'll just, well, first of all, I usually do self-selection, but that's the thing. That's just me. But what I'll choose, I usually choose dandelion because I like, you know, to detoxify and sometimes it works really good. They choose it most of the time. So that's one of the ones I use. And I also use burberries as well. That's another one that has been very, very helpful. And, and then I had the other one just here. Alfalfa?

Do you use some alfalfa for their appetite stimulant?

Oh, yes. But yeah, well, I use alfalfa for another thing. I use alfalfa mostly for digestive issues. But yes, that could be. Yeah, that could be another one to use. And oh, yes, I remembered. I use sometimes MSM, like the one I use for arthritis, because I like to build collagen and I like to build— like, also I use the inside, the membrane inside of the egg, you know, those things, because they— MSM and omega-3.

Hang on a minute, what was that, Brendan?

I was just like, you're the person that peels the eggs? I've been looking for who are the patients that peel eggs, right?

It's, it's actually very easy. I mean, if you—

come on, Amaya, you've started now. You've got to tell us your technique. How do you peel your egg?

Okay, okay, so I break the egg. I just use it normally like you normally would use it. And then you take the shell and then you just go like this membrane, this white membrane they have inside, and you just go with like that and you just take it out and that's it. You mix it up in the food and that's it. That's a really good source of many things like collagen especially. But then you can, if you don't want to do that, if you feel that I'm being really crazy by doing, by peeling eggs, You can always do, you know, MSM, which is sulfur. It's a, it's a bioavailable sulfur which also helps to, uh, as an, as an, um, for inflammation. It helps, it aids, uh, omega-3. And if you maybe like to add a little bit of, uh, The one we said the other one, the green-lipped mussel, that's the name. Because collagen is also good to protect the kidneys. And that's one of my favorite things. It's natural. I always focus too much in the food. And as a herbal thing, I don't have many, many things to give, just burberries and dandelions sometimes. But then I focus on that. I try to make sure that inflammation is down stress, and they feel they get, uh, you know, the anti-fibrotic, um, elements as well. Um, I really try to protect the kidney. That's my, like, biggest concern always, to make sure that they have everything they need just to get there. But I like the first one. How do you spell the first one? Do you mention the first herb? Because I've never heard from that one.

Uh, so the Natrum Muriaticum is a homeopathic medicine. Okay, so it's just, um, Natrum Muriaticum is sodium chloride. Okay, in— but it's just the, the homeopathic version.

Oh, okay.

But it's a constitutional. But absolutely, I'm so glad you mentioned Berberis Taraxacum. Um, are that— so that's dandelion, so that's berberine and the, um, uh, dandelion. Um, I absolutely would say it's a mother tincture. We create a very low potency remedy from so that it's a little bit more palatable to cats. And we add in alfalfa if their appetite is down. And literally 3 drops, 3 times a day of that can be a massive protection for kidney cases. Definitely would advocate that. And so glad that you— I did need to leave you something to say.

You're not like me, like I say everything and just drop you.

But monosulphur monamine, I think, is the MSM, is the something that I get, you know, inflammation is just such, has such an important role in kidney disease. And we've not had chance, we're going to talk about dental disease in cats at some point in the future because that's another really important role. And I would definitely say, look, if your cat has dental disease and then they start to get kidney problems, weighing up whether they need to have that dentistry dealt with over the fact that the risk that they've got kidney disease whilst you're going to anesthetize them, I would absolutely say there is a point where the dental disease outweighs the risk. You need to get that dental disease under control because all of that inflammation is circulating around the bloodstream. They are more likely to get infections of the kidney, or further depletion of the kidney function. So think about those and monitoring urine samples following the initial diagnosis are so important to monitor that they're not picking up urinary tract infections, that they're not further deteriorating. Do they need some of the other drugs your conventional vet will talk about? Using some of the benazeprils and things like that to try and help the kidney function. They will be advocating adding those in. So when we need to sort of look at all of those things coming in, so, you know, the blood pressure monitoring, you know, do they need Amlodipine as a way to control blood to improve filtration rates. You know, these are the things that they will talk about, and yes, they have a place to play in kidney cases, but we can do other things to monitor. It will always come down to quality of life at the end. You know, are they able to interact? Are they able to feed themselves and maintain their body weight? Are they able to keep themselves clean? You know, if you are unsure about that quality of life question, have a look at the Royal Pet Medics on euthanasia and time of life conversation that we've had. We've got a whole episode on that.

Lovely.

I wanted to add something else. This is for Julianne. It's about— there is a— I know there is an energetic kind of side for this renal disease because I mentioned that renal disease, the kidney actually, is a Uh, it's an organ that it's very important. Uh, it gets cold, like in, when in renal diseases, you know, the function starts dropping down. It's, it's kind of, you know, it slows down, you know. So how do you measure this? Because I'm sure you get patients, uh, as a, for energetic, um, healing and everything, that they're, they're currently suffering from a disease and How do you manage the kidney once you get that? Because I would like to have that because that actually improves the quality of life. And I would like to have your point of view.

Thank you. I get to answer a question. Woo! Thanks, my love. Great question. I'll take that one. So, yes, you're right. So the kidney is, is linked with the solar plexus, but more so the sacral chakra. So a bit sort of further down. So, you know, generally, as you said, it gets cold, so it's depleted. The chakra is underactive. So it's about trying to boost that energy flow, get the energy moving. So, you know, the— you guys have made some wonderful suggestions for like the physical body, but there's also another layer which is the energetic body, and it's about helping that energy to flow. So for me, there would be two things. So one, a remedy that I would recommend would be ginger root. So you guys obviously mentioned a few herbs. Now, ginger for me, you know, it's really warming. Now, like you and Maya, I don't put it into food. I would use self-selection. It can also be an appetite stimulant if there is, you know, if they are slightly nauseous or off their food. But ginger, like the color of it is golden, you know, and I'm talking not the powdered stuff you get for cooking. Do you mean it like the organic, the organic root? So I would be offering ginger on a herb garden. So you put a towel or a blanket down and let the cat choose it. I've had a lot of cats ingest it when they're dealing with kidney issues. So majority of the time cats work with self-selection on the herbs— sorry, with inhalation. They work with the energy of the herbs, but with ginger they have ingested it. And I'd also be looking at color therapy. So for me, like, to get the energy into that area, it would be a golden color, so in between the yellow and the orange. So it's not a sunshine yellow, it's not— which is this the solar plexus. It's not the bright orange, which is the sacral. It's almost like a golden, a golden color, like in between the two, because that's— if you look at where the body positioning is, that's kind of where it is for cats. So, and I would be putting it down and letting them, letting them sit with it, you know. Um, think about if you wanted to put a colored mat like under their food, or sometimes using water as well. So having a colored water bowl, because obviously everything's got a different vibration and frequency. So when you have water particularly, in a colored bowl, it will impact the frequency and energy of the water. So for me, I would be looking at putting some, some water into, again, a good kind of orangey golden color bowl to see if that would help with them ingesting fluids. I had a client last night when we did our energy insight session, and she— sorry, on Monday when I did my cat chakra course, she shared about how she's got two colored water bowls. One's pink and one was orange and yellow. And her cat's got an overactive solar plexus and it wouldn't drink from the yellow bowl. And I'm like, well, no, of course not, because that's going to just, you know, increase the energy in that area. So for me, I'd be looking at color therapy, having a couple of herbs down as well. And alongside ginger, I'd probably offer chickweed and peppermint. So peppermint, you know, quite cooling if there is quite heightened inflammation and chickweed, you know, it supports the digestive tract. But it also helps with the, you know, the function with the kidneys as well. So I'd be putting those down. That's me.

That's amazing.

I mean, there's so much we could go on with that, isn't there? I mean, just— I think we're going to have to do part 2, which is revisit all of these treatments in a bit more detail and talk about energetics versus physical treatments. And, you know, because I'm sure there's probably some good color therapy stuff that we could go into and, you know, Amaya, I know you love sound therapies with music and, um, you know, all of that kind of things.

So are we all though? Like, it's all connected though, do you know what I mean? It's, you know, for me, like, there is the physical— you said just then, you said physical versus, you know, energetics, but it's all the same thing, you know. It's that we— the physical is easier to manipulate, to adjust, to tweak, to deal with, you know, to, to actually have those you make a change, you see an, um, an impact of that. Whereas with the energetics and the color and the sound and the complementary, the reaction's not as quick, the reaction's not as obvious, it's not as fast, you know. And I think that there is an element there when we look at holistic about that whole approach. So using the medications and the supplements and the physical changes supported with the energy and the healing and the herbs you know, so that it manages the healing on all levels because we're not just the physical body, are we? You know, there's more to it. And with any illness, if you heal one bit, you've got to do the rest as well. Like we've talked about today, it's not just, you know, look at the phosphorus levels, is look at, you know, the Rhea, the food, you know, it's everything. You know, we could just talk for hours about cats. Let's face it, people.

Couldn't we?

And the other thing is that we didn't have any time. Actually, we need to do a second part because we haven't talked about cats suffering from renal disease and having anemia.

I will also—

absolutely—

behavior with renal—

there's no time.

Sorry.

Yeah, I think we should do behavior. Oh, we're going to do a part 2. Yeah, it will be coming, guys. It'll be coming.

We're just going I mean, I was going to ask you earlier on, like—

And I want a video on how to peel eggs. I want a video on how to peel eggs. Okay. In this part 2.

Only for patrons. Yeah, yeah.

I'm going to— when I come out to see you in Barcelona, you know, next week, we're going to do a peeling eggs video. I think that's got to be a—

We should do a challenge. Who can do it the quickest? I was going to say, like, there's a couple of things that we have—

What do you think of this nail? I just let it grow. To peel.

Sorry, the first people, the first person that's got a kilogram of egg membrane wins. I'm gonna be like, God, people.

We haven't talked about like this, what would people see? How do you know, you know, that you're, you need to go and get the cat checked? What behaviour implications would there be? Like, I think there is quite a lot we do, we do need to cover, so I think we should consider doing that next month. I'll make a note.

Yes, you know that down.

I'm on it, people.

Remember that.

Okay, right, Brendan, do you want to wrap it up?

Oh, thank God Juliette is here.

Yeah, no, guys, uh, it's been great to see you. I mean, look, this just goes to show kidneys are a renal dilemma. I think from a, uh, a point of view of thank you for all accompanying us on today's Feline Friday. And if you want to know more, you want to join our cause, then please do visit us on patreon.com/rawpetmedics. We look forward to seeing you. We've got the next one. Oh God, dates, give me dates. Come on, you've got it there. I know you have, Julianne. You're the super organized one. Our next date is Friday the 7th of October. There we go. I knew it was there, tip of my tongue. 7th of October. Yes. Okay. Let's go there. Okay. So we look forward to seeing you all if you want to join us. See you then.

Thanks everyone. See you next time.