Final Stage Renal Failure/Pancreatitis-When is it the End?

I'm not sure if I'm here for advice or just support (or both), but I am devastated to find out that my beloved Tigger was just diagnosed today with having stage 5 kidney failure. He was first diagnosed in October, 2012, and I have worked so hard at giving him the best quality of life possible. I have had to work at managing both CKD, chronic pancreatitis, and chronic constipation (with bowel obstructions) with daily sub-Q fluids, frequent meals/special diet, prednisolone, and a slew of other daily supplements. I have been a FT grad student and intern, but have happily welcomed sleep deprivation to wake up 2-3 times during the night to feed and take care of my baby. He has had really long stretches of good periods, followed by flare ups or blockages, and some close calls. Needless to say, it has been a stressful ride, and I've given up a social life, traveling, and had limited romantic relationships due to my commitment to taking care of my cat. I have not left him overnight since his diagnosis. 

Tigger has been at stage 4 kidney failure for quite some time now and has been fairly stable for months, so I was shocked to hear that a visit to the vet for chin acne (which he's on antibiotics for) revealed that his BUN went from 83 to 133, Creatinine from 3.8 to 5.8, Phosphorous 5.1 (normal) to 8, spec fPL 15.7 to 34.7 in 6 months (and he has developed a heart murmur, and a broken k-9). On our last visit the vet found a large free-floating circle that moved positions on his X-ray, but had no explanation for what it could be.

I am not emotionally prepared to cut ties with my cat of 14 years, but I will do what I have to do if he is suffering. The vet does not think euthanasia is necessary yet since he is still eating and drinking (although eating less, and drinking more). He is definitely not himself. He would ALWAYS sleep by me, play, and CONSTANTLY beg for food and was never satisfied (I was worried he had hyperthyroid at one point, but the vet said he isn't), but now he begs less and never finishes his smaller meals. He is typically hiding in the bottom of my closet, but still purrs when petted, vocalizes his friendly greetings with me, uses his litter box, grooms himself, and has a decent amount of energy. I guess I am praying that he has an infection, which has elevated his numbers, and they will fall back down after he finishes his round of anti-biotics, but maybe that is wishful thinking? I would like to hear from other owners who have lost a cat to CKD or been in this situation. I lost my beautiful cat Princess to rapid organ failure (unknown causes), whose health deteriorated FAST (in the span of a day), and I had to quickly euthanize her. This was traumatic and I don't want to see Tigger suffer like that. However, I've also seen Tigger unable to barely stand or eat (I would promise myself to euthanize him the next day), but he would recover the next day with an upped dosage of pred. The bind I'm in is that the pred is necessary for his pancreatitis, but it accelerates his kidney disease, and the kidney disease should be treated with extra fluids, but that could prove deadly due to possible heart disease (the heart murmur). I am exhausted from the tears and heartache, but have thought it was the end before, only to have him rally back several times. How do I know when it's time?

Thank you for listening. 

You sound like a dream companion for any cat lucky enough to find a place in your heart. Taking care of a cat with real failure is no easy chore, since the very foods that keep cats alive, are the foods that will elevate their kidney problems, and most cats have no interest in KD diets. If he would eat the KD food on his own, you are very fortunate.

We lost our Queen kitty this past fall to renal failure. She developed it very rapidly, and even after a round of medications and KD diet, her numbers just kept getting worse. In the Philippines, cats are mostly treated like rodents, and veterinarians don't see a lot of interest in cats, so they don't carry the same stocks of special foods and medications to treat cat problems, making it that much more difficult to treat them when they become ill. Beyond basic surgeries like spay/neuter, there are no surgeons to do complex surgeries on cats, and you need to fly them to Thailand if major surgery is required. For obvious reasons, we don't really have that option.

Anyway, the most important aspect to consider, is quality of life. You love him, he knows you love him, and he has had a wonderful life. I am not a religious person, but there is something magical about cats. I truly believe that they always come back to us, when they love us. Sometimes their body fails, where their heart does not. So they choose another body, and come back to us.

When we lost our beloved Gimpy (rescued at about three months with a broken front leg, hence the name Gimpy) after 7 wonderful years, we thought she was gone forever. Not so, she has come back to us, a little bit at a time. One rescue has her eyes, another has her beautiful colors, yet a other has her manners. Then we rescued Liberty, she is the full Gimpy returned to us. Everything about her, the attitude of Queen kitty, the instant adoration and love she shows us, the way she likes to eat alone, not bothered by the other peasant cats in the house, and her absolute control over sleeping space, she does not like to share us.

So when that time comes, know that you did everything right, and that he is so lucky to have you, when his little body gives out, he will return to you, faster than you can imagine. Thanks for being such a beautiful soul, Tigger 2 will be waiting for you.

Hi KittyKeepers,

Thank you so much for your very kind and thoughtful message. I am so sorry to hear you lost your baby to this horrible disease. I can imagine how helpless you must have felt in another country where you couldn't get the care your kitty needed. It sounds like you did everything you could, and gave her a beautiful life. 

I am starting to make peace with this being the end of Tigger's life. He is my only family, and I thought he would be joining me on my next journey, but you are right, he knows I love him and he has had a good ride. It's so funny you mention Tigger revisiting me. I had a conversation with him yesterday and told him that he can go whenever he needs to, but told him to promise me that he will return somehow. Your story about Queen Kitty revisiting you is so moving, and I'm glad you still have bits and pieces of her appearing as reminders that she is still with you. I think this belief/hope will make letting go easier when the time comes. 

Thank you so much for sharing, and the support.

Well Tigger will always be with you, and even though it may seem strange, but the faster you find him after, the better you will feel. You will know it's him, can't explain it, it will become obvious. I will keep Tigger in my thoughts, I shared your story with my wife, and she is with Tigger too.

We don't know him, but we love him all the same. This site is good, if you like emotions, finding new friends, and lots of support. Please keep us updated about Tigger, even though we call them "our pets", we all really know who the bosses are in these relationships.

Love you Tigger, you are not just lucky to have such a wonderful human companion, she is lucky to have you, maybe more so. Thanks for all the joy you bring, the million smiles that can't be counted like stars on a moonless night. You have been a true trooper and incase you didn't know this, mommies hero as well. You are as much a part of her, as she is of you. And thanks for lifting my heart as well. The kittie keepers!

I'm so touched by you and your generosity. A few kind words during a dark time go a long way. Thank you for reading this and taking the time to respond, it really lifted my spirits! Tigger is perking up a little today, too. I'm hopeful for a little more time!! Warm wishes to you and your wife, and all the kitties that you love.

I'm sorry you are going though this with Tigger.  My Sandra is 18 and has been at stage 4 for a few months.  She is currently on sub-Q fluids daily of 100ml (she was originally getting them every other day).   She was on the Hills k/d diet and liked it for quite some time.  But lately she has been turning her nose up at the food.  She also gets the Royal Canin k/d food in both canned and dry.  She eats from it but not enough.  I have also been giving her non prescription canned food that is lower in phosphorus and protein.  So far she likes the Wellness Core Beef Venison and Lamb flavor.  Today I gave her some IAMS Turkey-lation Pate in gravy.  She gobbled up the IAMS quickly.  I just hope she doesn't get bored with it.  Some days her appetite is poor and some days it's good. Today, thank God, she is having a good one.  I also give her Beechnut meat baby foods.  I can certainly relate to your comment about sleep deprivation.  I've been getting up each morning at 3:45 just so I can give her meals.  I often feel exhausted, but she is worth it.  I love her so much.  She has been with us since she was 3 months old.  Last year at this time my other cat Thomas started to decline.  He passed away last June from CHF.  I'm now always worried about Sandra.  I'm doing everything I can to give her a good quality of life and cherishing everyday that I have with her.

Sending hugs and warm wishes to you and Tigger   .

HI Tamu,

Thank you for the support and warm wishes for me and Tigger. I'm sending warm wishes right back to you and your Sandra. You must be doing an amazing job for her to be 18 and still hanging in there. It is so challenging finding a food that the cats will eat that isn't harmful. I like the chicken only Tiki cat brand because they don't have any nasty fillers (and the phosphorous isn't too high), but I've heard some cats won't eat it. I've just started phosphorous binders to see if that brings his phosphorous levels down. Tigger was in stage 4 for what felt like years, so Sandra may have some life left in her with the fluids and your special care. So sorry to hear about Thomas. What a painful journey to have to go through this with multiple babies. You clearly love Sandra and Thomas. It's nice to hear I'm not alone though, this can feel so heavy and lonely at times. 

Hang in there

@iLovePrincess, I remember you and I remember Tigger. I was there for you when he was having that first bad bout of pancreatitis. I'm sorry that it turned into chronic pancreatitis. I remember you were hoping that it didn't. You've done a fantastic job taking care of Tigger these past few years. I know how stressful it is. Multiple chronic health issues is quite a juggling act and extremely difficult to manage. I shared the same kind of life you did when I was taking care of Sebastian (stress, sleep deprivation, no vacations or social life, etc.). Unfortunately, Sebastian passed away this past March....not from the chronic pancreatitis / IBD.....but from a blood clot / heart failure. He was starting to decline from the chronic pancreatitis / IBD, but the heart failure took him from me suddenly. He was also about 14 years old.

I know everybody says this, but I truly think you'll know when it is time. We seem to not know when it isn't time, and we fear that when it is time we still won't know. But I don't think that's the case. You may begin to see Tigger not enjoying life or being in a constant state of lethargy and pain. He may stop eating. You may say to yourself one day, "That's it. I can no longer let him live like this." Every situation is different. You seem very in tune with Tigger and can gauge his quality of life better than anyone. Try to enjoy every good moment together. You are in my thoughts. 

I'm so sorry to hear about Tigger. I lost my Lucky to acute-on-chronic renal failure in November, just sixteen days after being diagnosed. His blood work was perfect just a month before that, just had some elevated T4. We are pretty sure it was tumor. Then a month later, Sara was diagnosed with CKD, and then on March 19th, acute-on-chronic renal failure from what must have been a kidney infection. She actually started recovering but then she got a URI, and her poor little body just had enough at that point.

I can understand not being ready. I was nowhere near ready to lose Lucky, and had very little time to prepare. I tried to tell myself that I needed to, even when I knew deep down that he wouldn't be around much longer. When I found out that he'd gone from stage 4 to stage 5 in the span of two weeks, after all the stuff we did, I knew it was time. And he made sure I knew by peeing on me. Yeah, I'll never forget that. Mom told me he was showing me he loved me by giving me the only thing of himself he could offer.

Is Tigger still eating on his own?

Sorry to hear about your babies, it is hard coping with that kind of loss. When I lived in the US, and was naive, I had cats that seemed invincible and never needed a vet. Only when I moved to the Philippines and started rescuing cats, did I encounter CKD. It took the very first cat we ever rescued, last November. She was around 7 years old, we began feeding her when she was tiny, and figured that she was not much older than 6 months, based on her size. She had a broken front leg, and such a tiny body and head, but the biggest eyes and heart of any creature on earth. She buried into our hearts from the first time we saw her. Our protective nature caused us to immediately lure her inside our home, so we could keep her safe. She was resistant at first, we even endured having her pee on us while we slept, probably out of frustration.

Soon, she was sleeping in our bed on her own, and the bad behavior had stopped, and she lit the fuse that has us rescuing cats at an astonishing rate. We currently have 30 rescues at our home. I hope you have taken time to read the entire thread, there is a lot of important feedback and advice in regards to loss. I hope that you can find out as we have, that your kitties(kids) never ever leave you. They become a part of us, and we of them. And when their little bodies give out, they return to us in the next rescue at the shelter, they have been waiting for you to come pick them up all along. Our Gimpy is with us, both inside our hearts, and in little attributes of different rescues in our home today. We don't believe it, we know it. Sincerely, the kitty keepers.

iLovePrincess said:

 
HI Tamu,

Thank you for the support and warm wishes for me and Tigger. I'm sending warm wishes right back to you and your Sandra. You must be doing an amazing job for her to be 18 and still hanging in there. It is so challenging finding a food that the cats will eat that isn't harmful. I like the chicken only Tiki cat brand because they don't have any nasty fillers (and the phosphorous isn't too high), but I've heard some cats won't eat it. I've just started phosphorous binders to see if that brings his phosphorous levels down. Tigger was in stage 4 for what felt like years, so Sandra may have some life left in her with the fluids and your special care. So sorry to hear about Thomas. What a painful journey to have to go through this with multiple babies. You clearly love Sandra and Thomas. It's nice to hear I'm not alone though, this can feel so heavy and lonely at times. 

Hang in there

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Thank you.  

Sandra was diagnosed with early CKD in 2013. It started advancing Nov./Dec. 2015.  Her phosphorus level in December got up to 15.  It really made her feel miserable.  She didn't want to eat and she started having trouble walking.  She was wobbly and stumbling.  The vet started her on a phosphorus binder.  It's in powder form.  I mix it with a bit of water and give it to her by syringe.  The binder has helped bring her phosphor down and has improved her mood and walking.  She also is on a potassium supplement as her potassium levels have a tendency to drop.  I also give her Adequan for her arthritis.  I think the biggest help for her has been the subQ fluids and the phosphorus binder.  I think it's really good that you started Tigger on a phosphorus binder.  He is very lucky to have you in his life.  Your patience and dedication to Tigger are amazing.

Sending prayers to you both    .

Hi GoHolistic!!!

I remember you clearly and fondly! Thank you so much for your support back then and now. My heart sank when you told me the news about Sebastian. I am terribly sorry for your loss, I can't even imagine the absence he has left. I know how hard and exhausting a disease pancreatitis is (and difficult to control), and I know how well you took care of your baby. I hope you have found some peace because it's so terrible when you lose them suddenly. You were an amazing mommy, and he loved you and knew he was deeply loved.

I am enjoying my time with Tigger. I realize how thankful I am to still be able to touch and smell him. I know there will come a time where that will only be a memory. I am so thankful for members like you on this forum, and your contributions.

Healing thoughts and warm wishes to you and Sebastian

Oh my god, Donutte, how horrific. I can't believe you lost 2 babies so quickly to CKD. That is so devastating, especially so close together. Again, I can't even imagine what that was like for you. I'm amazed you have a sense of humor about it. Did the vet have any idea why it progressed so quickly in both of them? Sending you bundles of hugs. 

Tigger is eating on his own. He has been fussy, so it has been difficult getting meds in him, but his appetite is pretty good today. For some reason, he is hungry in the AM, but not so much in the evening, which I haven't quite figured out yet. Listening to your story, I am so fortunate that Tigger's CKD didn't progress as quickly as your babies did. Please hang in there.

Kittykeepers,

I love your rescue story, and that one peeing kitty stole your heart, and now you are changing the lives of 30 other cats! Where is the thread about your story? I lived in Asia, so I've seen how cats are treated there. Not well. You are doing amazing work, my friend! Do you have access to quality food over there? I really love to know that there are big-hearted people out there like you, it makes up for all the wackos out there.

Keep doing what you're doing!

Hi Tamu,

Sandra is lucky to have you, as well. What dosage of the phos binder do you give your baby? Do you give it to her before or after meals and how often? Also, what kind of potassium and how much do you give her? I just ordered potassium citrate since Tigger is close to being low on potassium. I worry about his potassium getting too high since I know that can be deadly, though. I'm glad you've found treatment methods that work for Sandra. Has she been pretty stable for a while? 

Thanks for your help!

Warm wishes to you guys!

Sandra gets 1/8 teaspoon of the phosphorus binder per day.  The vet calculated the dosage based on her weight (8 lbs).  I divide it up.  In the morning, I will give 1/16 teaspoon right before her breakfast.  It's in powder form.  So I just mix it with few drops of water and give it to her by syringe.  In the the evening, I give her another 1/16 teaspoon right before one of her meals.  It was recommended on the crf website (www.crf.org) to try and divide the binder as much as possible with meals.

 I feed her small meals of canned food as often as I can during the day.  When I'm at work, I keep out her dry food for her to nibble on.  

The potassium supplement she takes is called Renal K+.  It comes with a small measuring spoon in the jar.  I ordered it on Amazon.  It's in powder form.  I also mix this with water and give it to her by syringe.  I only give her this once per day since her 100 ml of sub-Q fluids also have potassium.  The Renal K+ supplement has B vitamins in it so that also helps her well being.  Originally the vet gave us a gel form of potassium, but Sandra didn't care for it.  She doesn't like the powder either, but at least I can get it all in her and not have to worry about her spitting it out.  I give her some baby food after to wash the bad taste from her mouth.  Also, I make sure that the phosphorus binder and potassium are given at least 3 hours apart.  This was also recommended on the crf website.  I believe giving them together can cause aluminum poisoning.  

She also gets Miralax for constipation.  I'm supposed to give her 1/4 teaspoon twice a day.  I actually haven't given her the Miralx in a few days.  Since I started feeding her the Wellness Core Beef canned food, she has been going on her own.  

She did vomit a couple of times 2 weeks ago.  I panicked and called the vet.  The vet prescribed her Cerenia for nausea.  I give her 1/4 tablet for 5 days, then take 2 days off and start again.  She hasn't had any vomiting since starting the Cerenia.  

Sandra has been stable since around February.  She has both good and bad days. Some days her appetite is poor and she seems more tired.  This was the case last Thursday.  But during the weekend she has been doing good and eating well.  Hopefully the good days last a long while.

I hope your baby feels better  .

Hi Tamu,

Sounds like you have a good system down with your baby. It's really tough being caretaker though and seeing our babies sick.

Your kitty is on a very similar protocol to Tigger. I know about the good and bad days, hopefully the good outweigh the bad. Tigger is also on miralax, phos binder, cerenia, and I just ordered Renal K. How much does your kitty weigh? I'm giving Tigger a lot more phos binder. My vet recommended 250mg. I'm a little nervous to start the renal K because of the dangers of high potassium levels, but I might just start out with a small dosage and see how he responds. 

The good news is Tigger is improving! His appetite is almost back to normal. I'm hoping he just had an infection or something I'm doing is really helping him. Fingers crossed!!

Hi,

Glad to hear Tigger is doing well. 

Sandra is 8 lbs.  The vet put her on a lower dosage of phosphorus binder because her diet was all prescription food a few months ago.  I recently started giving her non prescription canned foods that are lower in phosphorus since she is starting to get finicky.  I will have to call and ask the vet if the dosage should be increased.

My Sandra's potassium dropped to 2.8 around Dec of last year.  The potassium supplement brought it back up in less than a week.  But when we stopped the supplement, her levels dropped again.  I've been giving her half the recommended amount.  The supplement directions say it has to be given twice a day.  I just give her one dose in the morning.  I figure she gets another dose in the evening with her sub-Q fluids. 

She has been doing good since Friday after a bad day Thursday. 

I'm happy for both our babies! 

iLovePrincess said:

 
Hi GoHolistic!!!

I remember you clearly and fondly! Thank you so much for your support back then and now. My heart sank when you told me the news about Sebastian. I am terribly sorry for your loss, I can't even imagine the absence he has left. I know how hard and exhausting a disease pancreatitis is (and difficult to control), and I know how well you took care of your baby. I hope you have found some peace because it's so terrible when you lose them suddenly. You were an amazing mommy, and he loved you and knew he was deeply loved.

I am enjoying my time with Tigger. I realize how thankful I am to still be able to touch and smell him. I know there will come a time where that will only be a memory. I am so thankful for members like you on this forum, and your contributions.

Healing thoughts and warm wishes to you and Sebastian

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Hi! 

Thank you so much for your kind words. Sebastian has certainly left a huge void in my life and hole in my heart.

I'm glad to read that Tigger seems to be improving and feeling better.  Fingers and paws crossed over here, too! 

Sorry for the late reply, I am new to this site, and our home is ever changing. We have rescued 3 more kittens since we became members here. I have so many stories, I could write a book about it.

Yesterday, we rescued an Asian Leopard Cat, that was destined to a horrible life of substandard captivity. We are now debating what to do with him, as even the zoos in the Philippines are horrible places for captive animals. He is so gorgeous, and we are doing as much research as possible to learn how to care for him, while we find a safe place for him to go.

We are working on a post package to introduce all our children to the group, and I will post stories periodically about all of them. All the laughter, and even some heartbreak along the way. There is good food available, but it's extremely expensive here in the Philippines, as the import taxes really add a lot of cost to the food. Between the cats food (special cat, made in italy) and the dog food for our 4 huskies (orijin adult and puppy), plus litter, we are spending over 500 dollars a month. Needless to say, we have zero personal lives, everything revolves around the animals.

Look for a profile update today or tomorrow, where we begin to tell their stories and introduce them all to the world. The kittykeepers.