Arthritis (hips and back), kidney failure, not eating

Hi All,

New to this group and I'm desperate for any kind of answer or relative story.

My 14 year old kitty, Harley, was diagnosed 4 weeks ago with early stages of kidney failure. We put him on Tramadol before the results were in as he was having trouble walking and laying down.

2 weeks go by and he's getting worse, as in not eating as much and even more walking difficulty, so I bring him in for an Xray. The results are severe arthritis in his hips and back. The vet sent me home with a steroid, Prednislone liquid form, to give home everyday for 5 days then every other. Double edge sword as this works against the kidney failure.

At first he was doing great though after the 3rd day his eating got worse. A couple nibbles to nothing for eating. He stopped jumping on the bed and couch. I called the vet on that following Monday and they gave me nausea meds, Cerenia. He still hasn't eaten but maybe a bite here and there and they told me to continue with the steroid.

I've been feeding him all his favorites (soft and hard) plus whatever I can just get him to eat. A bite of cheese off my pizza :/ he is now down to 9 lbs when 4 weeks ago he was 12!

I called the vet today and they have given no hope except this appetite stimulant, Mirtazapine, which got him up and eating however he is a bit alert in the sense that he can't relax. They also continued with "it might be time"

Is it time? With a cat who still has a full soft fur coat, using the litter box (pee only for the past 1 1/2 weeks), alert to me and his surroundings, moving around an apt (though now he is very wobbly). Or do I have hope still?

I do not have $1000+ for heavy medical work. Wish I did!!

I truly would love any advice or anyone with similar stories. I don't want to lose my best friend when he still has some life in him! Though I also don't want him in any pain. I'm so lost and I'm losing him so fast!!

I'm so sorry. You asked for opinions, so I'm going to give you mine.

If it was me, I'd be seriously looking at euthanasia. I know that isn't what you want to hear. I've lost many animals over my life. The losses I regret the most - the ones that haunt me - are those where I've kept fighting as the animal slips away slowly and in pain. And he will be in pain - no pain meds are 100 % effective. I truly believe that the final gift we can give our animals is a death with dignity, before they are lost in the final depths of sickness and suffering. My heart goes out yo you in this painful, difficult time.

I am so sorry you are going through this. It is such a hard decision to take. I can only say that you must put his interests above yours. Look closely into his eyes. Most cats will let you know when they have had enough, a loving owner can tell. And yes, he probably is in pain and discomfort, but it does not necessarily mean he has lost interest in living. Only you can decide. And I agree with Columbine that it is the decisions one leaves too late that one regrets. My thoughts are with you.

I appreciate your advice greatly and thank you for taking the time out of your day for your advice!

I see so much life in him still and JennyR you made me think of his eyes... They are sad but he still comes to me with actions of the old and looking for me to help him and live/act as of a month ago. My mom is telling me 3 more days to try a hollistic route (in a sense) and with him eating a bit more on this pill I feel comfortable with it. I am done with the meds he was originally prescribed and I hope to have a positive reaction.

Either way, I won't let him live in such pain and will update you both with the prognosis. Thank you so much again for your thoughts and if you know anyone in a similar situation, I would love some input [emoji]128571[/emoji]

I am sorry that you are dealing with this now. My cat Lloyd lived until almost 20 years old. He was diagnosed with early kidney failure when he was around 17. He probably had it longer. He also had arthritis, and was slowing down. Sometimes I think when I started worrying about the kidney situation, he started becoming constipated. He wasn't used to too much attention, and I think he sensed my worry!  I would take him in for fluids, and cut all dry food. They will drink a lot of water, so always have available. I also bought some pet stairs so he could get up on the bed, and night stand where I always kept a bowl of water. He still took his morning walk around the parameter of the yard, and had a very healthy appetite! I  was lucky there. They do lose their appetite. Towards the end, the constipation was getting worse. I  would take him in for in office enemas. He surprised me when he went from the night table, across a precarious box full of stuff to the big table in front of the window! From then on, I put his heated bed on the table, he could keep warm and enjoy the front yard scenery. He had become anemic, and lost several pounds. The thing that did him in, was that he had eaten the Breeze litter pellets, and had to have an enema under anesthesia. He just never snapped out of the anesthesia, and died the next morning. Sorry that I  probably rambled, but as long as he seems happy, you should see him through. The arthritis is probably worse in the cold weather. Try some glucosamine products, keep him warm, and most of all plenty of water!  Have you looked at the Tanya's website? They also have a yahoo group with some really educated members. If you get a copy of the complete blood work, someone on that site will actually review and give very detailed advice! You will not believe the efforts that these cat owners provide for their cats! Hang in there, your kitty is in early stages, and you can get stuff to help the arthritis. Best of luck to you both! 

I posted it before somewhere and I post it again.

I had a cat with kidney failure too but at the time I didn't know it. I was just being selfish and thought the cat was getting grumpy and old and his cries at night were out of some spleen or something. I wont go into all the details because after 20 years it still haunts me that i waited so long to do the right thing.

Believe me, if you let your cat suffer and/or drag her through all these treatments you will regret it.

I know it's hard to have a pet put down but when there is no reasonable hope for an improvement anymore, it is the best thing to do and if you don't do it, it will stick with you.

there are vets that come to your house to do it, maybe there is on in your area

annah777 said:

 

Click to expand...

Hi

Obviously you're giving him a lot of important treatments, but the one treatment for kidney failure that has the most effect for least effort is giving Sub Q fluids.  Is he on them? Has your vet discussed them? A cat with kidney disease can loose appetite for several reasons and sub q fluids addresses them very well and can help with appetite.  Also, pepcid, as instructed by your vet can help with acid stomach that occurs when they don't eat.

And Hill A/D is a very special and tempting food for cats who won't eat.

Having said all this, your cat's loss of appetite can be self-perpetuating and can lead to death or euthanasia, so i would suggest, if you feel your cat still has life in him, that you talk to your vet about a big push on getting food in him.  Possibly syringe feeding for a few days to stimulate (jump start) his appetite along with fluids, possibly pepcid, while continuing with the cerenia.

My vet likes to do a jump starting sub Q cocktail of fluids, injectable cerenia, injectable pepcid, and injectable Zofran (faster working anti nausea drug) and in your case possibly some syringe feeding.  A prompt and urgent aggressive approach could jump start your cat, but time is running out and the window is getting shorter, and if this doesn't work then he may have just reached the point where things aren't working out.

A listed side effect to Tramadol is stomach upset so another way to go (and something i would discuss with my vet immediately) is the dosage and the medication (there are other high quality pain meds like Buprenorphine) which if it works also comes in a multi day dose, like about 5 days per injection).  For tramadol side effects see this link and again i suggest you discuss this with your vet.

http://www.vetinfo.com/tramadol-side-effects-in-cats.html#b

Cat with kidney disease going through periods of eating/not eating is a trial I know very well from a couple years ago.  It's the most intense roller coaster of emotions that I can remember going through, with a cat who'd been my companion essentially all her life.

Additionally, trying to strike a balance of giving time for things to work vs not having the cat suffer through diminishing quality of life is another thing I struggled with and have two cats' worth of experience there.  Not as many experiences as some folks.  I have yet to personally buy into the thinking of "the cat will tell you when it's time" aspect that some people mention, but it is mentioned often and is something to pay attention to.

Anyway, a long way of saying I understand a little what it's like and I'm sorry you have to go through this. 

As Stephen noted just above, I was wondering if Harley was getting sub-q fluids.  The fluid treatment goes a long way just towards a general overall feeling.  A cat with kidney disease can feel generally poorly, and the fluid treatments help with that.  The stomach upset is another issue but it sounds like some of that is being covered with the Cerenia and other things.  My cat eventually had Cerenia, and before that she had Pepcid, among the things we tried to help with such issues.  A cat that doesn't feel well won't be inclined to eat on his own.

There are some comments above about dragging through treatments and so forth.  A lot of thinking on this can be subjective so I wouldn't necessarily discount anyone's own choices on this, but for kidney disease there are some typical things that I personally wouldn't consider invasive or aggressive.  Sub-q fluids for example, shorthand for subcutaneous, basically a needle just under the skin and you learn to give this at home (trust me you can learn, I thought I couldn't do such a thing and it was by far the easiest thing compared to pilling issues or feeding).  Most cats tolerate it well and will potentially even associate it with feeling better.  If this were tried and not tolerated well, then that would be another story, but it is something to try first.

The "is it time" question I always figure comes down to overall quality of life and a little bit of prognosis.  It's a tough thing, because to some degree something too aggressive could be seen as negatively affecting quality of life.  Unlike us humans, a cat is not necessarily able to understand that an unpleasant thing now could lead to feeling better later.  But to me, most medications, sub-q, and maybe a little assist feeding aren't too much to do.  I will say that having done some assist feeding, one really must have some sense that it will be temporary.  If there's one thing I remember from Amber that looking back I might have changed, it was the syringe feeding, which we maybe did for too long.  But the reality was, we couldn't have known.  I was on the path of kidney disease with the idea she would turn a corner, but she was on the path of congestive heart failure, which has negative reactions to some of the things we do for kidney disease and was a "could go anytime" type of situation at that point.

So you look at things, like appearance of getting enjoyment from your attention, ability to use litter box, eating on own, aware of favorite sleeping spots, etc.  The thing is kidney disease can have some ups and downs so the things you see that are obvious negative indications like not eating, hiding, etc. to me are important only if sustained over a significant time.  A few days is not enough, a few weeks maybe.  But it's always a judgment call and what we all have to realize, I suppose, is that it probably won't be perfectly timed.

I like to type I guess, that is my thing. ;-)  Anyway, in summary and after looking at the initial post again, I'm struck by it being 4 only weeks and being supposedly early stages of kidney disease.  As I relayed recently in another kidney disease thread, I know of cats whose remaining time measured in YEARS after initial early stage kidney diagnosis.  A few years, one friend gave a cat sub-q fluids for about 4 years.  Every cat can be different and that 4 years is probably an outlier on the high end, but age 14 is on the earlier side I would think.  I understand that the arthritis complicates things a bit and if he is in constant pain and discomfort from that, the prognosis of the kidney disease may not be the main thing after all.

I wish you well in determining what is best in your situation.  My short answer to "is it time" based only one what you've written so far is "no" at this stage, but that is only my opinion of course.

I have a question about Harley before you make any decisions. I had to have Mr. Grimsby euthanized on March 20th. The results of his blood work weren't terrible, but he started downhill and never got back up again. Within a couple of weeks, we could actually see the the curvature of his spine - I'm talking about where it curves down into the ribcage. This was despite almost daily sub-Q fluids, steroid injection, daily Prednisone tablets, syringe feeding. His back legs got so weak that I bought pet stairs for him to get onto our bed. He was hungry, but he would take a few licks of food, then shake his head violently from side to side as if something in his mouth was really bothering him. He went through the same treatments your Harley has been through.

I firmly believe that Mr. Grimsby died of metabolic acidosis, which is entirely treatable. I feel he died unnecessarily and I've become very sensitive to this issue. Take Harley back to the vet and ask him to check for this condition. For some unknown reason, most vets don't consider this issue, but it is easily treated and can save your cat's life. If metabolic acidosis is not the problem, it may be time to consider euthanasia. I know how difficult this decision can be, but you have to think of Harley's well-being more than your own.

Good luck!

Pharbor-Murphy- I am so sorry for your loss! That's my worry is putting him down for something that's not even the cause. What you are saying sounds exactly like what Harley is going through! I am definitely going to look into metabolic acidosis. Thank you so much for sharing your story and advice.

As for the sub Q fluids... This is the first time I'm ever hearing if it. The vet hasn't given me much to work with or options besides saying "we can send you to a specialist". It's a cat only clinic and I would think they would be better than just shipping me off and giving me no hope.

As for an update- his eyes looked much more open and clear today and he is much more aware of what he wants. He has been eating more of his hard food which is also a plus. I'll have a better sense when I get home from work and will keep everyone posted. Thank you so much everyone! I truly appreciate it!!

annah777 said:

Pharbor-Murphy- I am so sorry for your loss! That's my worry is putting him down for something that's not even the cause. What you are saying sounds exactly like what Harley is going through! I am definitely going to look into metabolic acidosis. Thank you so much for sharing your story and advice.

As for the sub Q fluids... This is the first time I'm ever hearing if it. The vet hasn't given me much to work with or options besides saying "we can send you to a specialist". It's a cat only clinic and I would think they would be better than just shipping me off and giving me no hope.

As for an update- his eyes looked much more open and clear today and he is much more aware of what he wants. He has been eating more of his hard food which is also a plus. I'll have a better sense when I get home from work and will keep everyone posted. Thank you so much everyone! I truly appreciate it!!

Click to expand...

Sub Q fluids with a cat who has CRF (kidney disease) is the number 1 treatment above all others. There is no debate about this in the vet community.  I am perplexed by your vet's not discussing this, and concerned.

PHarber-Murphy said:

I firmly believe that Mr. Grimsby died of metabolic acidosis, which is entirely treatable. 

Click to expand...

Can someone kindly explain what the treatment protocol is for metabolic acidosis?  Our vet believes this is a distinct possibility (1 year old with CRF), yet hasn't mentioned what can be done to treat it.  I get the feeling only specialists can diagnose and treat MA...? 

@Annah, I'm sorry to hear that you're dealing with such a trying and complicated disease.  I wish you and Harley the best and hope his condition continues to improve.  I'll echo what everyone else has said about the sub-q fluids.  I took Rory to the vet's a few times for sub-q treatments and have been doing it at home (with a little assistance!) ever since.  It's a really quick and easy process once you get the hang of it.  And Rory, who struggled like mad in the beginning, is becoming much more tolerant of the whole business.  She almost fell asleep last time, she was that relaxed.  

the3rdname said:

 
Can someone kindly explain what the treatment protocol is for metabolic acidosis?  Our vet believes this is a distinct possibility (1 year old with CRF), yet hasn't mentioned what can be done to treat it.  I get the feeling only specialists can diagnose and treat MA...? 

@Annah, I'm sorry to hear that you're dealing with such a trying and complicated disease.  I wish you and Harley the best and hope his condition continues to improve.  I'll echo what everyone else has said about the sub-q fluids.  I took Rory to the vet's a few times for sub-q treatments and have been doing it at home (with a little assistance!) ever since.  It's a really quick and easy process once you get the hang of it.  And Rory, who struggled like mad in the beginning, is becoming much more tolerant of the whole business.  She almost fell asleep last time, she was that relaxed.  

Click to expand...

There are many causes of metabolic acidosis, but it isn't a disease, but an imbalance of the acid/alkali levels of the cat's blood supply, so treatment depends on the cause.  Kidney failure is a major cause, the treatment being addressing the kidney failure with supportive care.  This link explains a lot.

http://www.petmd.com/cat/conditions/respiratory/c_ct_metabolic_acidosis

There is a specific treatment with bicarbonate but it is not risk free. 

http://www.felinecrf.com/comm0.htm

http://vetbook.org/wiki/cat/index.php/Metabolic_acidosis

Here is some information on metabolic acidosis:

Alkalinization Therapy

Metabolic acidosis is a common complication in cats with CKD, in part due to uremia. In some cases, sodium bicarbonate or potassium citrate may be offered once acid base imbalances are detected. While it makes sense to immediately address acidosis with alkalinization therapy for immediate relief, this therapy is often not well tolerated by the patient especially since it must be given multiple times per day. Many patients do better with a diet with increased buffering capacity. Patients with severe acidosis may be admitted to the hospital for intravenous treatment in the short term and then controlled with renal diets.

And here is a link to a website that explains CKD in more detail. As StephenQ says, though, sub-q fluids is vital to Harley's recovery. Please share the links that he provided with your vet. The more vets we educate about this problem, the less our poor CKD kitties have to suffer.

Good luck with Harley and with your cat, 3rd Name!

annah777 said:

As for the sub Q fluids... This is the first time I'm ever hearing if it. The vet hasn't given me much to work with or options besides saying "we can send you to a specialist". It's a cat only clinic and I would think they would be better than just shipping me off and giving me no hope.

Click to expand...

That is a little dismaying, that you're already going to a cat-only vet and they haven't suggested the fluid treatment. It's not expensive or overly aggressive. Unless they have some reason that they wouldn't recommend for specific issue with Harley , this seems odd at this point in time.

Now our earlier cat, probably around 7 or 8 years ago, went to a regular large dog/cat practice. That vet at that time never suggested fluid, except when she crashed and she went to ER and got some IV fluid. I had done some reading later on kidney disease and discovered sub-q but kind of too late in the game. If I had known then what I know now we might have been able to keep her comfortable for much longer. She lived for several months after diagnosis even without sub-q....

So, much as I would hate to suggest you add to the stress of it all, I would think you might want to a) at least bring this up with current vet and see if they are up for helping you with it or b) consider a different vet, after checking and making sure the new vet is on board with kidney treatment. To me a specialist is not necessary for kidney, particularly when the specialists are typically multi-animal and the protocols aren't always the same for dogs and cats, but if the specialist is particularly versed in this maybe it's fine. Just seems like overkill. Normally I'd trust a cat specialist over anything else, but it always can vary depending upon the individual vets.

Good to hear that Harley seems to be feeling a little better today!

I am checking out a new vet tomorrow. I need that second opinion before I go back the original vet, if I go back. I am very upset with them and the way they handle their vet care and Harley. They have great reviews which is why I chose them plus the cat only factor however a year ago I brought my other baby in because she wasn't eating and they ended up giving her 2 enemas in 24 hours. When she got home she could barely get out of the carrier or get to where she needed to be cause her back legs wouldn't work. She was so out of it the rest of the night so I brought her right back the next morning and they said that her condition seemed neurological and there is really nothing they could do. So my precious Cailey is no longer with us. I still don't understand what happened as she was perfectly fine besides some weight loss when I first brought her in.

Now with Harley being perfectly fine when I first brought him in, besides a little trouble laying down, has all this other stuff happening suddenly. He was eating, bowels were fine and still jumping on the bed an couch as of a month ago. Maybe I am wrong to blame the vet and feel free to call me out on it however I am hopeful for a second opinion (or third as you all have been tremendous help!) with helping me in deciding what is best. Thank you all again!

Hi Everyone! I am saddened to say Harley is no longer with us.

I got the second opinion and they took another Xray. He had fluid surrounding his heart creating it difficult to eat and breathe. They gave him 2 days maybe to live so I did what I thought was best and put Harley to sleep. He was not in severe pain but he was suffering due to the not being able to eat or drink.

Even with a specialist there was nothing that could've saved him. It was a condition he supposedly had for quite some time now and when it hits, it strikes.

PHarber-Murphy- I'm not sure what kind of X-rays your Mr. Grimsby had but maybe going back to vet for another look. Maybe he had the same. My original vet did not take an X-ray to include the heart area which is why this was missed.

The vet was great and they treated him as if he was their own. Unlike the other one. I felt very comfortable with them though obviously very sad with the outcome. The Dr even mentioned that the arthritis and kidneys were not her main concern after her exam and that it seemed to be his respiratory or heart. This was prior to the X-ray. They even gave me a holistic form of grief medication at the end of payment which made me fall in love even more with this vet!

Thank you all again and I hope to be back soon! With some advice and possibly introduce a new baby [emoji]128569[/emoji]

You sure did the right thing. It's always hard to loose a pet, but you still have all your memories

Take your time and hopefully you will find another cat in a shelter one day

I am so sorry to hear this news, but it was obviously the right thing to do. Please accept the sympathy and condolences of the moderator team. In accordance with TCS policy and out of respect for Harley, I will now close this thread. I hope that when you feel able, you will open a tribute thread for him in the 'Crossing the Bridge' forum. And of course, that we see you back here when the time is right to welcome a new kitten into your life.

So sorry to hear this, but yes, given the additional info it sounds like it was time after all. My condolences.