Distressed and confused after Vet visit

Hi everyone

I am new to the group so I would first like to say hello to everyone.

My post concerns Missie who is 17 years old on the 19th April.  She has slowly lost weight over the last few months but was otherwise not ill, she was feeding and her litter tray did not produce anything unusual for her but she was drinking more. She is extremely traumatised by Vet visits more than any other cat I know so unless there is an emergency or she is not her usual self and we are worried we don't put her through it. She preempted any decision on Tues this week when she hurt her leg jumping off the chair in a twisted way and was limping so we took her to the Vets but we left with her traumatised and us confused.

The Vet said that her leg was probably just a sprain and then noted she had lost weight.  She suggested that Missie may have Kidney Disease and has a bad tooth but she also that the tests/tooth extraction would require anaesthetic and that she would not do it at Missie's age. She then basically said that we had 2 choices either let Missie live out her life or euthanasia.

Missie has had diahorrea since the visit but not before and is eating very little where she was eating before albeit she can be very choosy. She is still limping but not as bad. I now have no idea what to tempt her with regarding food. If she has kidney disease what should she eat and if she doesn't will feeding her a diet for cats with kidney disease harm her.

She is currently playing with my hand as I type and purring away but I need to get her to eat asap as this is the 3rd day without food though she is still drinking a lot. Sorry for the long post and your help would be much appreciated.

I think your thread got interrupted. Welcome to the Cat Site, there are MANY experts here that can help you, I am fairly new too. I know what you mean about cats being stressed at the vets, We have a 12 year old male who is the same way, we don't bring him in unless absolutely necessary.  Was there any way she could have been bit by another cat and developed an abcess? Maybe her bones are getting more brittle too, with her advanced age. Please finish your thread and maybe we can give you some advise. 

Thanks for your reply. Missie decided to press enter mid sentence. I have now finished the post with her 'help'
 

The rest of your thread appeared! Cats cannot go that long without eating, I would say at this stage get her to eat ANYTHING as long as she is eating. I know there are several canned foods out there that are for kidney problems, but right now get her to eat. Does she like tuna, baby food meat, canned or fresh chicken? There are experts on this site who have been dealing with kidney disease so I'm sure they can advise you on a diet. Water is essential too, but you have to monitor her urination, is she peeing enough? I would also question your vet, you might want to call around for a second opinion on your cat, I've heard of sucessful surgeries at a later age then your cat, you might find a vet that is for the geriatric set, and be willing to help you. I'm sure that bad tooth is not helping your cat to eat. In the meantime, good luck, give your beautiful baby a kiss for me and I'll be sending you healing vibes.

Ah. so sorry to hear this!  I'd do what I could to give her a good quality of life while she has it.  Sounds like she is happy, just not eating.  So, tempt her on what she likes and minimise her stress.  I'm not too clued up on 'kidney disease' diets.  If they are just marketing hype (like Hills), avoid them.  Hills is full of rubbish - just feed her quality wet food.  I'd try and not feed dry as this dehydrates, but at her age, if this is all she will eat, then just get her happy and eating.  Any special treats that she loves?  Cooked fish? Sardines? Some raw chicken? Smell often tempts, so you could try these, and warm the chicken just a bit to enhance temp and smell.  Some cats also love a bit of cheese.

On the vet side of things, have you tried a vet who visits you?  It may just be something up your sleeve that she deals better with, being in her own territory.

Thank you both for your replies. She has only ever had wet food and it is mainly mainstream food. She loves chicken both raw and boiled, and also tuna as an occasional treat. I have tried just about everything short of a syringe including pureeing her cat food in case she won't chew but to no avail. I may try the syringe if nothing else works but obviously that is only a stop gap solution.

The Vet was quite abrupt but I understand her reluctance to give her anaesthetic but half a diagnosis seems worse than none at all in a way.

I will obviously try to get some food into her in the next couple of hours. I really don't want to put her through another vet visit but I am becoming more and more concerned.

Will keep you posted.
 

Thanks again.

I don't really understand. Did the vet run any tests for kidney failure? Is that diagnosis just based on the weight loss and exam? If she has a tooth that needs to come out, it could be causing enough pain to explain the weight loss.

There are quite a few threads, some very recently, about dental procedures for older cats. I really believe that it depends on the health of the cat, not just the age. There are steps that can be taken to mitigate the risks.

I would try to get a second opinion. Maybe a dental specialist? But she needs to eat, first and foremost, before her liver starts shutting down.

Thanks for being there everyone. I have a positive update regarding Missie. Out of desperation I gave her still plain mineral water as she was still drinking shortly after leaving the forum which she drank quite a bit of. An hour and a half later she came into the kitchen while we were cooking so we gave her tuna and she has eaten 1/2 bowl. I have never been so happy to see her eat! I know it is early days so I won't get ahead of myself but hopefully she is turning a corner.

vball91 I know how weird it sounds but she didn't want to run a single test it seems because of her age. I forgpt that she did say if we could get a urine sample off Missie that could be tested but that was it really, She told us about the bad tooth and possible kidney disease suggested that it would not be unreasonable to end her life if that is what we wanted and said book an appointment for 2 weeks. To be fair she wasn't telling us directly to do that but both me and my partner left thinking she meant book her in for the last time but we may have misinterpreted that given the conversation. As you will understand we were both very upset but also stunned.

I will definitely check out the dental threads so thanks for that.

We only have 2 vets in my area and I was told that ours was the best one but that was a while ago. I will make further enquiries esp re home visits.

Fingers xd she keeps improving.

That doesn't make sense to me that your vet didn't want to run any tests because of her age. Running a blood test and chem panel shouldn't hurt her and will give you some info.

Are you by chance in the UK?  I ask because you used the term litter tray vs litter box, and that seems to be more a UK expression than in the U.S.

I have recently learned that Vets in the UK are opposed to treating cats with kidney disease, that's why I ask.  So...that might be why your Vet was the way she was. 

So glad Missie has eaten something.  Hopefully now that she's done that, her tummy will tell her brain she needs more and she'll eat her own canned food  with gusto

Now, back to business.  Without having done blood tests, it's really impossible to know if she has kidney disease or not...take it from me, I have had two cats die from kidney disease, and currently have one who is possibly going down that road.  BUT, losing weight and drinking an excess of water ARE signs .  A urine specific gravity test may be indicative of  problems, but, again, I have never seen a diagnosis with a blood test to confirm. 

All that being said, the main way to control kidney disease is by diet and administering fluids.  Did your Vet happen to say whether or not she is dehydrated.  They usually just pull up on their skin and see whether or not it rapidly falls back in to place.  If it doesn't, then they are dehydrated.  Depending on how quickly it falls back into place depends on how dehydrated they are.  It works the same on YOU.  Our Sven didn't have to have sub-q fluids until that last year of his life, even though he had kidney disease for the last 3 years of his life.  Some cats need it right away.  It just depends.

Here is a wonderful website for you to start reading, just in case Missie DOES have it.  I am directing you to the part on diet, but you should probably look at the entire website as you get time.  It covers kidney disease from A - Z.  I think everyone who has a cat with it uses this as their bible.  http://www.felinecrf.org/diet_and_nutrition.htm   Feeding canned is best, so you're already covered there.  And if she'll eat it with water added, it might be helpful to stir in a little, just to get even more water into her, even though you said she is drinking lots.  More is better!

Don't hesitate to ask questions as you start reading.  Too many of us have been through this, and we're here to help.   (although we can't diagnose it for you)

I'm so sorry your sweet girl and you are in so much distress! 

If the proper precautions are taken during anesthesia 17 isn't too old, but perhaps your vet knows they don't they have the ability to give a senior kitty good anesthetic care.  (My hospital routinely does dental procedures on senior kitties, even with kidney disease, and has good outcomes!)  If that is the case at least your vet is aware and isn't putting Missie into unwarranted risk, though I'm sorry there is no one to offer higher quality care in your area. 

I hope now that she has nibbled a bit of food she gets her appetite back, no cat should go longer than 24 hours with out a meal, and 3 days is the critical point.    If she doesn't get her appetite back fully ask your vet for an appetite stimulant to keep her eating.

Does Missie have any vomiting?  Usually cats that have advancing CRF feel sick and vomit, though if she is nauseated that could cause her to not eat.  Likewise if the tooth is very painful she may be more reluctant to eat, but I've seen cats with multiple tooth abscesses still eating so I'm not sure I'd blame the teeth.

Does she still have the diarrhea?  You said it started after the vet visit right?  It could be stress related so try giving her 1 capsule of culturell once daily until it resolves, probiotics are safe and it couldn't hurt.

If Missie were my cat I would want some blood work done before I did anything, I really don't understand your vet's reluctance to perform it since senior cats are the patients who need it the most.  Is Missie combative, trying to flee or just petrified when she is at the vets office?  Perhaps they didn't think they would be able to collect the sample with out traumatizing her, but it is weird they didn't tell you why they wouldn't take it.  I would call back and ask point blank.

How can they know for sure it is kidney disease if they cannot evaluate the levels clinically?  I'd be deeply upset if any vet treated me and my cat this way.I'm assuming since you say there are only 2 vets in the area you're in a fairly rural place?  I would go ahead and call the other vet and ask:

-If they will run lab work on a 17 year old cat?

-If they are willing to perform a dental cleaning and extraction on Missie even if she has kidney disease, if so what precautions would they take before, during and after anesthesia.  Also, what kind of monitoring do they do during?

-If they are willing to give her a pre-visit mild sedative before her exam so she isn't so terrified and stressed.  For single administration phenobarbital is an excellent drug to calm frightened cats, though in seniors long term use is not recommended.  This would be a one-time dose, 2 hours before the visit.

Good luck to you all, and please keep us updated!

Missie is definitely making progress. She has eaten some tuna, drank some cat milk and also Encore chicken and rice which she has not had before but ate it so that was great.  We are having ham for tea which she normally loves a little as a treat so hopefully she will try it. She still has a very loose bowel but it is not watery any more so that is good too. She is still drinking mineral water atm and I am reading all I can to check whether it is ok for her regular use although I think that it may have kick started her appetite yesterday but accept that it could be a coincidence.

mrsgreenjeens Thanks for the crf site link which I will read carefully over the next few days. I am indeed in the UK and to think that there could be a blanket opinion not to treat kidney disease is scary but as you say it could explain her opinion. It does make you wonder what disease/condition may be next though.

I keep checking for dehydration using the method you described and she is only a little dehydrated so the water must be being processed. Thinking about it I can't remember the vet doing that test though I was quite upset during part of the consultation.

Imbri Thanks for your reply.  She has vomited but only once since this started and there was no sign of blood or anything that looked odd. I think she is working her way through this and I am so proud of her. I actually live in the Suburbs but there are only 2 vets close to us and Missie hates travelling on anything but 4 paws. I have also got a list of vets further afield now and will ask about home visits or alternatively sedation as you suggested.  We don;t have Culturelle as far as I know but I will look into what we do have over here.

Thank you all for your care and compassion it is so very much appreciated.

Now that I know you are in the UK, you might want to read this post http://www.thecatsite.com/t/256235/5-years-old-cat-with-crf.  They are also in the UK and have a kidney cat.  They could be of help to you in finding things you need.  I believe they joined this group on yahoo http://pets.groups.yahoo.com/group/tanyas-crf-support/, which is the offshoot of the website I sent you earlier.  (the owner of that website is actually from the UK )

Keep encouraging Missie to eat.  Right now that is the most important thing you can do.  You can even try sprinkling some parmesan cheese on her food.  I don't know about there, but here you can buy it in a shaker can and it's just about in powder form.  That usually perks up their appetites.  There are lots of tips on that website on how to get cats to eat.  Lots of reading there

mrsgreenjeens Thanks for the links.  If Missie does have crf I now know it is not necessarily the end for her as the vet implied and that with a little help from us she may be able to manage for some time to come. She still has diahrrea though which really concerns me but she is drinking (not excessively now) and eating about 1/2 to 3/4 of her usual amount at each feed now supplemented with a small amount of Whiskas cat milk which she seems to like and cooked chicken.

I want her have to have the blood tests etc but don't feel I want to go back to the same vet.  Sedation sounds like a great idea for her prior to her going but unless she takes a turn for the worse I want to give her a little more time to recover.

Her leg sprain seems much better - no limp when walking now though she still holds it up sometimes and it definitely twinges when she jumps from a height but she loves to be up off the floor.

Thanks again for your help.

Hmmm. that diarrhea is disturbing.  Have you tried cooked chicken with RICE? 

Give her a really easy-to-digest food: boil chicken with nothing added, and make some white rice. Give her meals of shredded chicken in the boiled chicken water broth (no bone!) with some white rice mixed in. This is not a balanced diet, but for 3 days to a week, it may help settle her tummy. 

Also, are you giving her a probiotic?  I give mine the same one we take,  this one:  .  Each cat gets one capsule per day.  I just open it up and mix in with their food.  Probiotics are great for keeping their intestines in tip top shape.

I've just been doing tons of research on kidney disease myself, as my girl's blood test just came back and her numbers are on the high side too, and one thing I found is that additional Omega 3's are good, so I am going to make sure I give her Salmon or Krill Oil every single day.  I TRY to, but sometimes am remiss.  NO MORE!  500mg daily, without fail.  I just slit open the capsule and squeeze it on her food.  'course, she has to eat it , which as you know is no easy task

Glad Missie's leg is getting better

Glad to hear her limp is improving and she is eating more! 

Have you tried setting up ramps and steps for her to get on and off of her favorite high places?  I had a very arthritic oldster who loved to be up on top of things, but couldn't even get onto the couch unaided until I started moving things so he could go in stages.  For the longest time I had a huge stack of books next to the couch so he could get up there, even my young healthy cats would use it from time to time, the lazy beasts.

Just another thought about sedation:  Avoid acepromazine!   It will sedate your cat but do nothing to alleviate the fear and distress they are feeling.  Ace is the most common "old-school" drug used for this, but in my opinion it makes everything so much worse for the cat since they still feel terrified and anxious but are unable to act on it.  The best drugs in my experience are actually Xanax (alprazolam) and phenobarbital.  If Missie is not a combative cat that tries to kill everyone in her escape attempt but is simply frozen with terror or tries to flee frantically Xanax is the drug of choice as it alleviates the anxiety.  If she is a fighter ask for phenobarb, it chills them in body and mind.  Most of the fractious cats who come in to our hospital are given phenobarb before visits, and almost all of them who have been in for multiple visits on it gradually calmed to the point where they sometimes can come in without drugs on board.  (My favorite scenario, in which everyone wins.)

Both drugs will make her a little "drunk" for about 8 to 12 hours, depending on dosage.  If she is anything like my cats they will be very happy hours full of purring and cuddling.