Update on Gem

Hi all

So I just picked up Gem from her 1 week stay at the vet while we were out of town. Unfortunately, more bad news. In addition to the still unregulated diabetes, she has heart and kidney issues. The vet gave me a lot of information, which was hard to take in. But seems these are chronic conditions that we can only try and manage and keep from getting worse. So besides the insulin, she needs to take 3 other pills twice a day. I am feeling quite overwhelmed with all this and wondering about her (and our) quality of life. The vet says she is not in pain, just probably uncomfortable, as one would be with a heart and kidneys that are not working properly. And of course, there is no way to address her peeing issues while all this is going on. I feel like she is just a mess inside and out - she smells from the litterbox problems. I just don't know what to do.

Any advice, good words???

Thanks

I'm sorry to hear about Gem.  is there more to this story?  How old is she, what's her background, etc.  Sorry, I'm not familiar her history, her peeing issues, etc. 

So, she has diabetes, kidney and heart disease? What did the Vet advise, other than to medicate her?  With medication, will she still be "uncomfortable"?  What will her quality of life be, does he think, assuming you can give her her meds without too much of a hassle?  Is she easy to pill or does that cause her more stress? 

mrsgreenjeens said:

I'm sorry to hear about Gem.  is there more to this story?  How old is she, what's her background, etc.  Sorry, I'm not familiar her history, her peeing issues, etc. 

So, she has diabetes, kidney and heart disease? What did the Vet advise, other than to medicate her?  With medication, will she still be "uncomfortable"?  What will her quality of life be, does he think, assuming you can give her her meds without too much of a hassle?  Is she easy to pill or does that cause her more stress? 

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Thanks, mrsgreenjeans, I've posted on and off about Gem for a bit, here's her story:

She's almost 13. At the end of last summer she started peeing outside the litter box. We took her to the vet, who diagnosed her with diabetes. We were heading away for vacation so we boarded her at the vet so they could get her levels under control. When we came home, she wasn't eating so we couldn't give her the shots. Brought her back to the vet, who said she was not diabetic anymore. A recheck a month later re-confirmed this. Meantime she continued to pee outside the box. We tried prozac for a bit but that didn't help. She was peeing everywhere - carpet, hardwood, tile, didn't matter.

Last month, brought her to a new vet to be checked out. New vet re-diagnosed diabetes and we started insulin again. Her breathing seemed really unsteady, brought her back, treated for respiratory infection. Not much improvement, vet heard irregular heartbeat. We were going away again so we boarded her with vet. While there, they did an ultrasound which confirmed some kidney malfunction as well as restrictive cardiomyopathy. Naturally, all 3 conditions exacerbate each other.

So here we are! Vet feels that for right now, her quality of life is ok as she is not in pain, and she wants to see how things go with the medications. Surprisingly, Gem has been taking the pills in the greenies with no problem! I was really concerned about it, one of the pills is really big! So for now that is not an issue. I really don't know what to think or what to do. I want to do what I can to help her, but don't want her to be miserable. We are now keeping her in a kitty condo to control the litter box issues. I feel bad doing this when she is not well, but I can't deal with the mess anymore. She doesn't seem to mind being in there, but she will just pee on the bottom and doesn't care that she is laying in her own pee. It's really sad, and gross

Any thoughts??

Right now my only thought is it's absolutely not normal for a cat to lay it it's own pee!  They are normally such fastidiously clean creatures.  But you said she doesn't seem to mind being in her kitty condo, which I am guessing is a large cage type thing?  What does the NEW Vet say about that issue, the peeing outside her box and now laying in her urine?  That doesn't seem to be being addressed in your above post, except the one time she was on Prozac.  What is her quality of life...is she just laying in that cage all the time, or does she seem to be alert, etc, or is it too soon to tell with all the new pills she's on? 

Within the past two weeks we lost our beloved Sven , who had kidney disease and suddenly developed what might have been heart disease.  The problem there is, you usually treat kidney disease by giving them extra fluids, and heart disease with diuretics.  Complete opposites.  Tricky, but apparently it can be done. But Sven told me he was ready to leave this world and go on to the next, so we let him .  I'm not saying that's what's right for Gem, just trying to get a handle on her quality of life, that's all. 

I would really talk to this new Vet about her peeing issues and see what she has to say, and also see how she does on the new meds.  She might be a changed cat in just a week or so   It's wonderful that she likes Pill Pockets

Thanks for your reply. Sorry if my post wasn't so clear. We tried the prozac at the suggestion of the original vet who felt that since the diabetes seemed to be resolved meant we were left with a behavioral issue. When the new vet reconfirmed the diabetes, she said that would be the reason for the peeing issues. And these other issues don't help matters. She feels it's virtually impossible to address the litter box while we are still trying to regulate her. Unfortunately, having the kidney and heart problems makes regulation that much harder. You are correct, the meds for these work at odds with each other, and the diuretic will only make her more thirsty and pee more often. So we are still on an uphill climb right now. 

Yes, the kitty condo is a large cage. We decided this morning not to keep her in anymore. The main purpose in getting it was to try and cage-train her back to the litter box. Since that clearly isn''t happening, and seems unrealistic right now, it seems unnecessarily cruel to leave her in there. She didn't complain much, but she is more active outside of it. We may keep her confined to one room at night to keep the peeing somewhat controlled and keep her off the furniture. At least this way, even if she pees on the floor, she's not laying in it. Hopefully, that will let the smell coming off of her to subside somewhat. Her paws are all yellow, and her stomach (which hangs pretty low!) smells pretty rank. As we just started with the cage Friday evening, I didn't get to speak to the vet about her laying in her pee. Hopefully that will stop now that she's not in the cage.

It's hard to tell how her quality of life is right now. As you said, lots of changes going on, and she did just come home from a week at the vet so naturally she's not herself. She is definitely lethargic, and breathing heavily, but the vet feels she's not in pain. The plan now is to give the meds a week or so, then recheck blood counts and do another x-ray to see what effect they are having if any. I guess at that time we can reevaluate. As of now, I can't imagine that it's time for her to go, she doesn't seem like she's dying, kwim? But I don't know how I will know when that time comes. So hard to think about. So we take it day by day for now. Hopefully she will keep taking the pill pockets…I've heard some cats get wise to it and stop taking them, but we'll deal with that when it happens! And hopefully we'll see some improvement.

Thanks for your good thoughts. So sorry about Sven.

Well, gosh.  I had no idea cats with diabetes had peeing outside the litter box issues, but, luckily, I've never had a cat with diabetes, and hopefully never will  .  Let's just hope and pray the meds work and she gets used to them and the lethargy goes away and she returns to her old self! 

p.s.  sounds like a bath is in order...does she let you bathe her?  Sven loved baths...AND especially to be blown dried (isn't that weird!)  We only found out when we took him to the groomers because he absolutely HATED to be brushed, so the groomer had to bathe him to get out some mats   Cats...gotta love 'em

Update:  I just read your other about the sore on her leg and how she doesn't like baths, so guess my suggestion above is out.  Sorry 'bout that. 

I'm sorry your Gem has so many medical issues. I know what it's like to help a cat who has several problems at once and working on one can hurt another. I am glad she is out of her condo because it sounded like she was getting depressed in there.  I had no idea diabetes could cause inappropriate elimination either. I think it's the one health issue I haven't had to deal with so far with my own cats or fosters though it's bound to happen at some point.

My Zazesh has a progressive neurological disorder and has pain/altered sensation in his hind legs, probably caused by his being allowed to get so matted by his previous guardian that his legs fused together. When I bathe him, I'm very careful to touch his back legs as little as possible. I 3/4 fill a plastic bucket, hold his hind feet together and immerse him into the water, allowing him to grab the rim with his front paws.  I just swish the soapy water around him and let him soak. He gets in a terrible mess when I give him diaper-free time, falling into his own waste repeatedly, so he is definitely a stinky mess. When I get him out, I simply press the towel against his sides, squeeze the towel around his lower hind legs to get out the most moisture and then put him in front of the heat vent. Even with the minimum amount of toweling, I know he's uncomfortable and I have to be very careful to keep my hands out of biting range. Perhaps a bucket bath would work for Gem, or perhaps you have tried this already?

mrsgreenjeens said:

Well, gosh.  I had no idea cats with diabetes had peeing outside the litter box issues, but, luckily, I've never had a cat with diabetes, and hopefully never will 

.  Let's just hope and pray the meds work and she gets used to them and the lethargy goes away and she returns to her old self! 

p.s.  sounds like a bath is in order...does she let you bathe her?  Sven loved baths...AND especially to be blown dried

(isn't that weird!)  We only found out when we took him to the groomers because he absolutely HATED to be brushed, so the groomer had to bathe him to get out some mats

  Cats...gotta love 'em

Update:  I just read your other about the sore on her leg and how she doesn't like baths, so guess my suggestion above is out.  Sorry 'bout that. 

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Thanks, yeah a bath is definitely not happening! I do try and use cat wipes and Vets Best waterless cat bath. It is hard to clean her in the areas where she needs it most, but it helps somewhat. Today she is definitely a bit fresher and cleaner, though she is still peeing everywhere  

I am hoping that we will see some improvement with the meds, but the vet feels we need to give it a week at least to see. I don't think she will be totally better but hopefully more comfortable and a bit more energetic.
 

Simka said:

I'm sorry your Gem has so many medical issues. I know what it's like to help a cat who has several problems at once and working on one can hurt another. I am glad she is out of her condo because it sounded like she was getting depressed in there.  I had no idea diabetes could cause inappropriate elimination either. I think it's the one health issue I haven't had to deal with so far with my own cats or fosters though it's bound to happen at some point.

My Zazesh has a progressive neurological disorder and has pain/altered sensation in his hind legs, probably caused by his being allowed to get so matted by his previous guardian that his legs fused together. When I bathe him, I'm very careful to touch his back legs as little as possible. I 3/4 fill a plastic bucket, hold his hind feet together and immerse him into the water, allowing him to grab the rim with his front paws.  I just swish the soapy water around him and let him soak. He gets in a terrible mess when I give him diaper-free time, falling into his own waste repeatedly, so he is definitely a stinky mess. When I get him out, I simply press the towel against his sides, squeeze the towel around his lower hind legs to get out the most moisture and then put him in front of the heat vent. Even with the minimum amount of toweling, I know he's uncomfortable and I have to be very careful to keep my hands out of biting range. Perhaps a bucket bath would work for Gem, or perhaps you have tried this already?

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Thanks Simka, it is hard to be dealing with so many things at once. And unfortunately, the medication for one thing makes the other worse. Yes, diabetes is a big reason for cats to start elimination issues. I don't know why, beyond that being a main way that kitties tell us something is wrong.

I've thought about some way of not really fully bathing her, but getting her chest/belly in some water. But it does seem better today so I'll take it day by day. Yeah, I'm not sure if she was depressed in the condo but it didn't seem ideal given everything else going on. If we can get the medical stuff somewhat under control and the vet feels she's ready, I may try it again as a training method, but now is just not the time.

Jkbank said:

In addition to the still unregulated diabetes, she has heart and kidney issues.

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Aww, so sorry to hear that. You and Gem have certainly been through the ringer lately. Do you happen to have the lab work they did to diagnose the kidney insufficiency? I'm just curious because in many cases, unregulated diabetes can also throw the renal values outta whack and once the diabetes is better controlled, renal issues normalize.
 

Jkbank said:

So besides the insulin, she needs to take 3 other pills twice a day.

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Yikes! Thank gawd for Pill Pockets. What medication is she on? And what dose of insulin is she getting now?

Jkbank said:

I am feeling quite overwhelmed with all this and wondering about her (and our) quality of life.

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I can so sympathize! One of my cats many years ago was very sick with IBD and would projectile vomit all of his (very liquidy) food many times a day. For a while my life revolved around desperately trying to get him to eat and then cleaning up the resulting splatter-fest of barf afterwards. It was frustrating, depressing, and extremely overwhelming. One thing I learned was that you have to make sure you look after yourself as well. Get a good night's sleep, eat well, and take some time to relax and unwind when you have to. It doesn't help your kitty any if you get exhausted and sick.

Apologies for my bad memory, but were puppy pads (or maybe even human incontinence pads) an option to help make cleaning up Gem's pee easier?

Hugs to you during this trying time. I really hope it gets better soon.

I don't have the lab work in hand. If I remember correctly, the diagnosis was not just on labs but on ultrasound where I think they can see the damage. I was getting so much info at once that it was hard to take in and remember everything!
I know! I was surprised she went for it because the one previous time I tried to use them she wouldn't touch it! She is taking furosemide (twice a day), vetmedin (twice a day) and benazepril (once a day). I realize that these meds run counter to each other but it seems that's what's needed. I'm also giving a half a baby aspirin 3x a week to help prevent clots. She is on 3 units of insulin, twice a day. Oh and she gets cosequine for arthritis (sprinkled right on the food) and occasionally laxatone. Wow, that's a lot!

One thing I learned was that you have to make sure you look after yourself as well. Get a good night's sleep, eat well, and take some time to relax and unwind when you have to. It doesn't help your kitty any if you get exhausted and sick.

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Thanks, I am trying! I haven't been sleeping well the past few nights, keep thinking I will wake up and she'll be gone, but I'm trying to stay positive.

Apologies for my bad memory, but were puppy pads (or maybe even human incontinence pads) an option to help make cleaning up Gem's pee easier?

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Yes, we do use wee wee pads. They help somewhat, though she has a tendency to stand on the edge of the pad and pee half on and half off. Then we extend the coverage with more pads, and now 3/4 of the floor in that room are covered! Not ideal, but better than directly on the carpet over and over.

Thanks for all your good thoughts. Hopefully we will hear some good news when we go for a recheck.

Completely OT but how do you quote parts of a reply like you do?! I can't seem to figure it out. The way I did it here was a wacky roundabout way.

I just had to giggle about the pads.  My Sven would put his front feet in the litter box, then proceed to pee on the floor    .  I couldn't get upset with him, because he was trying so hard to do the right thing toward the end, even though it obviously hurt  him to hobble over there to the box .  (sorry,  I know it's not a laughing matter when you've got to clean it up, but it also reminded me of my long ago puppy when she'd have just one paw on the newspaper and pee and think she was the best puppy in the world because she was using the paper )

So, how is Gem doing today? 

mrsgreenjeens said:

I just had to giggle about the pads.  My

Sven

would put his front feet in the litter box, then proceed to pee on the floor 

 

.  I couldn't get upset with him, because he was trying so hard to do the right thing toward the end, even though it obviously hurt  him to hobble over there to the box

.  (sorry,  I know it's not a laughing matter when you've got to clean it up, but it also reminded me of my long ago puppy when she'd have just one paw on the newspaper and pee and think she was the best puppy in the world because she was using the paper

)

So, how is Gem doing today? 

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LOL, that's exactly right! The past day she's been putting her front paws in the box and then peeing on the floor. I can't tell if she can't hop in the box, or this is just the newest incarnation of all this. You know, at some point, we do have to laugh a little to get through all this!

Gem does seem a bit better today, a little more energetic and more appetite. It's hard to know whether her lessened appetite has been a good thing or a bad thing. While I know usually it's not a good sign when they start eating less, but appetite had been so ravenous, that I thought it's possible that being less ravenous may be a good thing, meaning a sign that her diabetes is getting regulated. But it is good to see her meowing for her food today. She will be going back to the vet a week from today for some rechecks - they feel that's a good amount of time to see what effect the medications are having. Til then, we just keep an eye on her and see if anything looks worse (or better!). Thanks so much for asking.