18 yr old kitty with Kidney Disease

Hey guys...

The past few weeks have been rough for my cat Jasmine.  She just turned 18 at the end of July.  Earlier this year she was bleeding from her lower region, and lab tests showed that she was suffering from a UTI.  The labs also showed that she was likely beginning Kidney Disease.

Her high values were as follows:

ALT 196 U/L (range 10-100)

BUN 21.8 mmol/L  (range 5-12.9)

CHOL    6.8 mmol/L  (range 1.94-5.7)

AMYL    1.553 U/L  (range 100-1200)

GLU      6.6 mmol/L  (range 3.5-9.4)  (within range)

PHOS   1.52 mmol/L  (range .77-2.65)  (within range)

So we got her UTI cleared up and went about as normal.

She's been losing weight over the past year, but her appetite was still good, and she was purring, etc. 

The last couple weeks her appetite went right down, and she just wasn't doing good.  She started night screaming, and peeing all over.  So I took her to the vet last Saturday, and he showed me how dehydrated she was, did a full panel again, urine test, thyroid... gave her Sub Q's, mirtazapine and gave us some K/D food (hills).  He also sent us home with one dose of Sub Q's for us to administer... which we did, the next day.

Then Monday & Tuesday no fluids... appetite was nill, and she looked aweful. 

Her high values were as follows:

ALKP     113 U/L  (range 14-111)

AMYL    1741 U/L  (range 500-1500)

BUN      121 mg/dl  (range 16-36)

CHOL    244 mg/dl  (range 65-225)

CREA    5.7 mg/dl  (range .8-2.4)

GLU      181 mg/dl  (range 71-159)

PHOS   14.6 mg/dl  (range 3.1-7.5)

On Tuesday I got some more Sub Q's... he wants to do 175 each day for 2 days... then 175 every other day.... she's 6 lbs.

She ate better yesterday, but not so good today.  She is however more alert and walking around (tho she is weak).  She's only purring very minimally lately (sometimes not at all), and she seems very stiff when trying to lay down.  When the vet felt around her body he could tell she has about zero muscle tissue left.  And she cannot clean herself... as she can't reach her lower end.

I'm wondering if you all have any thoughts?  What can we expect her future to be?  Will she require Sub Q's for the rest of her life now?  K/D food for the rest of her life?  Anything else I should expect?  What would you do in my position?  When is it right to let her go?

Here is a video I took of her the other day:


Thanks so much!

Sandra

Wow... I just looked at Tanya's Website, and with Jasmine's creatine level at 5.7 this indicates that she's in Stage 4, and over 90% kidney function lost

She didn't eat at all yesterday... but did have a vomit.  And last night while she was out of her room (she's in the laundry room due to peeing outside her litterbox), she was very restless... getting up to move over and over again.  And then she was up late night screaming again.

My husband and I are going to see how she does this weekend, but if she doesn't pick up (and esp. eat) then we are seriously considering letting her go.

I'm sorry you're facing this dreaded decision. I believe you will know when the time is right to let her go, and it sounds like you're looking after her well. I'm sure she's had a good 18 years and has known a loving home.

I'm sorry to read this.  I hope the subq treatments give her a little relief.  But you're right--she can't continue to not eat.  I agree with @pushylady  -- you know her better than anyone else, and can judge what her quality of life is.  You will know when the time is right.  

Thanks for the replies guys!!  It's so hard to know what to do.  She's been so weak.  She's been so good about eating up until now... but lately she's not been eating much at all.  I really thought she'd do good last night esp. after two days of Sub Q's... but then to not eat at all the following day was surprising to me. 

And I don't want to let it get too bad for her you know?

And then there is unfortunately the cost issue.  I hate that this is a factor, but this all adds up really quickly... and if there has to be repeat blood work at nearly $200 a go (not to mention everything else), it gets to be really difficult... and that just makes me feel even worse about the whole thing.

I understand--there are so many things to consider.  I think at that age, quality of life is paramount.  My first kitty was almost 18 when she succumbed to kidney disease.  We gave her subq 3 times a week and did all the right things--but there came a point where it was clear it wasn't working any more and it just wasn't worth it to put all of us through the stress--we had to let her go.   I really feel for you.  

About the eating - are you offering anything other than k/d, in case it's just that she doesn't want the new food? 

I agree with momto3cats, don't worry about feeding her K/D and offer her whatever she wants. Baby food (plain chicken) can sometimes help cats with minimal appetite, but even tuna or salmon or Temptations treats are required.... whatever it takes. Pepcid A/C (not Complete) can also help if stomach acid is the reason she doesn't feel like eating (a common problem in kidney cats).

momto3cats said:

 
About the eating - are you offering anything other than k/d, in case it's just that she doesn't want the new food? 

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I agree with this.  My old girl has kidney disease also, and (with the blessing of our Vet) we let her eat anything she will, which isn't much . (when I looked at your video, I could have sworn I was watching our Callie)  Right now she is getting most of her calories from Temptations Treats, which are, thankfully, 100% nutritionally complete.   Are you giving your girl any Pepcid A/C or anything for possible nausea?  You said she threw up....was it just the frothy stuff?  That's really common in kidney cats, and is normally resolved with Pepcid A/C   (1/4 tablet twice a day, or you can get it compounded into a liquid form that tastes a little like tuna, although the pharmacist told me it's still a little bitter, so to mix it in a smelly food still) 

As far as when to say goodbye...always a hard thing to do.  They say you will know.  With our last one, who also had kidney disease, he told us when he was ready.  I always told him when he was ready, all he had to do was let me know and I would let him go, and he did.  He looked me right in the eye one night when I asked him, and he told me  .  And I kept my promise to him, even though it broke my heart.  

Hmmm... no I have been afraid to give her anything other than the K/D.  But before we even got to that food she was turning her nose up at her food and/or throwing up here and there.  I have been feeding her California Natural Chicken and Brown Rice (canned)... or Performatrin Adult Chicken or Performatrin Adult Whitefish.  I will try one of those and see if she'll go for it... I'm just worried about the phosphorus in it.

Pepcid A/C huh... how do I tell if she has stomach acid issues?

Thanks again!!!

Sandra

mrsgreenjeens said:

 
I agree with this.  My old girl has kidney disease also, and (with the blessing of our Vet) we let her eat anything she will, which isn't much

. (when I looked at your video, I could have sworn I was watching our Callie)  Right now she is getting most of her calories from Temptations Treats, which are, thankfully, 100% nutritionally complete.   Are you giving your girl any Pepcid A/C or anything for possible nausea?  You said she threw up....was it just the frothy stuff?  That's really common in kidney cats, and is normally resolved with Pepcid A/C   (1/4 tablet twice a day, or you can get it compounded into a liquid form that tastes a little like tuna, although the pharmacist told me it's still a little bitter, so to mix it in a smelly food still) 

As far as when to say goodbye...always a hard thing to do.  They say you will know.  With our last one, who also had kidney disease, he told us when he was ready.  I always told him when he was ready, all he had to do was let me know and I would let him go, and he did.  He looked me right in the eye one night when I asked him, and he told me 

.  And I kept my promise to him, even though it broke my heart.  

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We did the same with Molly at the end--let her anything she would eat--and it was mostly Temptation treats!  She ate  boiled chicken chopped fine sometimes, and sometimes some Gerbers turkey or chicken baby food with gravy.   

Thanks everyone for letting me know it's o'kay to feed something other than K/D.  I put down some of the natural balance and she ate a few bites.

Actually before this all started last Saturday I was desperate so I went to the store and bought her a few pouches of natural balance chicken in gravy, etc.  She licked up all the gravy and left the chicken 

Jasmine's Mum said:

 
Pepcid A/C huh... how do I tell if she has stomach acid issues?

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If she's vomitting, and especially if it's foamy, combined with not eating, it's amost a given that stomach acid is part of the problem. It won't hurt to give her the Pepcid regardless. Try it in a Pill Pocket if she likes those, unless pilling her isn't stressful.

I agree with the Pepcid AC 1/4 tablet (they are easy to break) twice a day. It's worth a try and may make a big difference. I spent weeks trying to introduce and gradually increase wet k/d. I did this several times. Now, I feed my kidney cat (20% kidney function + loads of other problems - last tested May 2014) anything she wants with the exception of fishy cat foods which are too high in phosphorus. She only gets a tiny, little bit of fish which also contains some of her meds. Most fish cat foods are high in phosphorus. At some point, a happy, eating cat and weight gain (or maintaining weight) becomes more important than k/d or fishy foods. Continued subq fluids are beneficial as well. It really helps the kidneys get rid of toxins.

Edit: if she's not eating and throwing up, it's most likely a combination of stomach acid and kidney toxins. Pepcid AC and continued subq fluids may make her feel much better. Very simple if she doesn't mind being pilled.

I'm glad she ate a bit. My cat has refused every brand of prescription kidney diets. Now she eats Weruva's chicken based flavors, which are relatively low in phosphorous. She's much more like her old self now, since finding food she will eat and giving her subq's regularly. Hopefully Jasmine will improve as well.

Thanks cocheezie, I'm going to look into getting some Pepcid tomorrow.  The throw up she had was food coloured, and not foamy... but if it won't hurt to try the Pepcid then we'll give it a go and see.  She's been very good about the pills I'm giving her now.  My vet showed me how to give pills... i.e. open her mouth and put them waaay back in the back.  Today's pill had to have three tries, but eventually we got it... and then she got a kisses!!  Oh and thanks for letting me know fish foods are high in phosphorus, I didn't know!!

Tonight's subq's went really well also... and by the end she was purring   One day at a time, but thankfully today was an o'kay day!

mrsgreenjeens, thanks for telling me about your Callie (bless her)... when I watch Jasmine walking (and laying down) I kind of hold my breath... it looks just uncomfortable.  Every time I set her down from holding her I hold onto her for a few seconds until she stabilizes herself, or else a lot of the time she falls over.  I've never heard of temptation treats... I'll have a look for them!

Just make sure to get Pepcid AC, and be wary of the store brand in case it has something else in it that is not cat friendly. A packet of Pepcid AC lasts a long time. Good that she doesn't mind the subq. Well done to both of you. Tonight, by the end, mine was growling.

Cocheezie... thanks, I will make sure it's regular Pepcid A/C (and I saw in a post earlier that it said not to get the "complete" one). I'm so sorry to hear that your baby was growling... she just doesn't understand what and why it's happening.  I wish there were a way for us to communicate with words to them, at times like this especially!  Best we can do is to love on them when we're not poking them!  But unfortunately, just like humans they come with all types of personalities, and not all are into that.  I'll be thinking of you and your kitty and hoping for better days!!

So the pill you are already giving her is the mirtazipine?  That's an appetite stimulant and isn't working, apparently.  And her throw-up isn't clear....which is indicating to me that she is truly nauseated, it's not just stomach acid issues    Does she throw up often?   I wonder if she might need an anti-emetic like Cerenia?  My Callie got that about 6 weeks ago because of another issue, and boy did her eating improve (temporarily).  She got a shot of Cerenia which lasted for 2 weeks, but I think it can also be given in pill form something like 5 days on, 2 days off if I'm thinking correctly.  I've never had any of my cats on the pill form because we're terrible pillers over here

My guy was in the same boat as your buddy but he also has IBD as well and for a while he barely ate and he is skin and bones with little muscle. Just about two years later he is doing much better and is actually gaining a little weight now. What I found worked really well for my guy (who is 19.5 years old) was injecting his drugs into his daily sub-q. He gets a steroid for the IBD and Cerenia for the nausea and to reduce inflammation in his insides. I gave my guy anything he would eat and bought all different flavours and tried one after the other until I found something he would eat. Fancy Feast is his current brand and because of his IBD he can eat 5 - 6 of the little cans a day and still doesn't put on weight.

I would make sure she is hydrated with a daily sub-q and try different types of cat treats or food as well as a appetite stimulant and something for the nausea. Your cat is old and may be suffering from stiff joints or pains just like humans and this could be why it is hard for her to lie down. I can see this in my guy so the vet gave me pain meds for him that he takes daily and I also give him shots for inflammation of the bones/muscles to help with the stiffness of the joints. This has made a big difference for him and he can reach all over again and he still jumps onto tables and so on. Sometimes if they are in pain they won't eat as much and can throw up if it is bad. Not saying this is the issue because kidney failure can do the same thing as well as a number of things. In the short term pain meds may help her cope though so check with your vet and see what they think.

Once you stabilize her you may find her numbers settle out so keep the faith and do what you can. I have been giving my guy sub-q's for a long time now and it will never stop as long as he is alive. Once he rebounded after the initial crash I have been able to keep on top of it for the most part although he still throws up from the IBD. He had the screams although his litter box habits were good throughout that time. He started having issues with the litter box not long ago for some reason and I moved the litter box from where it was and he uses it now. Sadly the new spot is in the living room but if it works for him it works for me and he is using it. If she has been having problems with the litter box she may get an aversion to it and maybe even the room it was in. Try moving it and see if that fixes the issue. You should also be watching her go to see if she is having issues going or even getting into position. If her joints hurt it may be hard to get in the litter box and if it has a cover get rid of it or it could be getting into position to go.