Tiger: kidney failure, FIV+ & stomatitis

Hi, I'm new here. I need information and advice but I need to explain my situation first. I live in a small 1 room studio apartment with a very small bathroom. There are no separate rooms to separate any cats - just a 6'x4' kennel built in the center of my apartment. I have five cats, 2 are feral and only eat when I'm not around so food must be left out for them. I also have a rescued Turkish Angora that was severely neglected as a kitten. The only food I have found that stops him from having liquid diarrhea is Royal Canin dry Special or canned Digest Sensitive, so all of them have to eat it to prevent him from eating anything else.
My question & problem is my elderly cat - Tiger- who is probably over 10 years, is FIV+, and has chronic kidney disease and stomatitis. He was a feral and when I got him he was in bad shape with infected wounds, malnourishment and stage III kidney failure . His kidney levels improved with better diet and antibiotics and they leveled out almost normal before he got tooth/mouth pain that was causing trouble eating. He had his 4 fangs removed and was fine for another 2 months, then couldn't eat again & dropped 3 lbs. He was diagnosed with severe stomatitis. Since he had lost so much weight he wasn't a candidate for full mouth tooth extraction and since his kidney levels were still good he was given a depo shot for fast relief so he could eat again. 10 weeks after the shot his mouth pain started returning but now his kidney levels were elevated making him still not a candidate for the surgery. I do not do sub Q fluids at home. He will not allow it and I refuse to make him fear and hate me by doing that to him. It took a lot of time to win his trust and I don't want to ruin that. I lock him in the kennel with kd kidney diet half a day & he eats the canned Royal Canin with the rest of them when he's loose.
At last check his BUN was 58 and creatinine was about 3.4. That was several weeks ago and he has since been on .8 ml of prednisolone once a day for the stomatitis. (Vet said twice a day but I do it once a day.) He also has just started spending a lot of time scratching in his litter box and I found a pee spot on my bed that I think was him. He goes back to the vet to check for a urinary problem tomorrow and I may have his kidney values rechecked again.
I have had so many different suggestions for what to do for him regarding both the stomatitis and kidney disease that I have no idea what is right and what isn't. I also don't know if his FIV+ status would affect any of the treatments I've read about. I will read through the closed forum on here about kidney disease but I am just so very confused and overwhelmed at this point and need help for my boy - help that I can actually do on a work schedule that has me often working 12 hours a day, sometimes six days a week. Is there anything at all I can do to help Tiger in this situation, or should I just give him whatever he wants and make him comfortable for whatever time he has left?
Thank you so much!!

Hi Aauda!

I think we know each other 

So glad to see you joined us here at TCS.

I'm sure that soon others who have the same problem will start helping.

Laurie/Sivyaleah

(Team Tank! LOL)

I have a 17-year-old cat who has had stomatitis for as long as I can remember.   For at least the last 12 years, she has been receiving injections of DepoMedrol whenever she has a serious flare up.  In addition, I keep some buprenex on hand to medicate her if she gets a flare up on the weekend and we can't get to the vet immediately.  Usually I see it coming on, sometimes it is sudden.  In the past I had two cats with stomatitis who were brothers.  I got the full tooth extraction done on each of them.  For one, it cured him and he lived to be 19 years old.  For the other, it did not, and he continued to need depo shots about every monnth until those stopped working and I dont think they had buprenex back on those days (maybe 30-40 years ago) because nothing would help his pain so we put him to sleep.

What I have read is that the percentage of cats that are cured by total tooth extraction is about 50%, and that has been my experience.  The DepoMedrol will hold them anywhere from a month to three months and then they need another shot, but it works very well for as long as it works.  In the case of my old girl, it has worked for 12+ years.  Her last blood tests showed no diabetes, no kidney failure, nothing at all bad.   In fact steroids are often helpful in kidney disease, and the DepoMedrol is long acting and stronger than prednisone or presnisolone.  I have used it with at least five cats over the years and never had any problems with any bad reactions.  They seem to feel better within 12 hours.  The younger vets seem more worried about steroids and cats than the older ones who have had experience.  My vet says cats tolerate steroids much better than dogs or people. Steroids also increase their appetite and increase their thirst, so they would be eating and drinking more which would be better.  My girl went from a 6 lb. skinny thing to an 8.8 pound healthy girl once she got on this program. 

My advice would be to ask your vet about giving him a shot of DepoMedrol and see if it doesn't help him quickly.  It lasts at least a month and you won't have to be medicating him with the prednisolone daily.  He should also be on totally WET food, no dry food, except a tiny bit as a treat.  He needs the natural hydration.  You said he may be getting urinary problems and that too can be helped with a WET FOOD diet.  That's another whole discussion for another time.  However, if you offer him canned food with a little added water, and he gets a shot of depo, the urinary problem may clear up.

Are you connected to Tanya's CRF Website?  If not, do check it out.  It is loaded with information specific to that problem.  http://www.felinecrf.org/index.htm#search

Thank you Red Top Rescue. He had the depo shot when he was first diagnosed with stomatitis and it helped greatly. But it was after that shot that his kidney values went up. My vet said prednisolone is easier on the kidneys that the depo shot & that continual depo shots can cause heart problems with all his other issues. I will speak to the vet about it again tonight. It really did work for the stomatitis & made him act like a kitten again but I'm concerned about his kidneys.

Aauda said:

Thank you Red Top Rescue. He had the depo shot when he was first diagnosed with stomatitis and it helped greatly. But it was after that shot that his kidney values went up. My vet said prednisolone is easier on the kidneys that the depo shot & that continual depo shots can cause heart problems with all his other issues. I will speak to the vet about it again tonight. It really did work for the stomatitis & made him act like a kitten again but I'm concerned about his kidneys.

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While we aren't dealing with kidney disease (yet) our older boy, Casper, has been having stomach issues for a few years now and, has had many teeth pulled.

Without going into that long story which I've written here, he was given a shot of prednisone about a month ago after an ultrasound revealed that his intestines were inflamed.  A biopsy was declined; at 15 years old we didn't want to put him through that. The vet feels it is either a lymphoma or, IBD.  He did mention that the steroid typically doesn't help if it's a cancer.

For the first 3 weeks, his vomiting and lethargy were nearly gone and he too, was exhibiting much better behavior overall and his appetite, which had gone really down hill (he's lost 2 lbs over this year) was fantastic.  

Now, on the 4th week, he's been throwing up again.  We take him back tomorrow for a followup.  I am bringing up stomachitis, as I do think this is a potential problem.  But, the steroid really worked extremely well.  Here's hoping your vet will find a good solution which will give Tiger the relief he needs right now.  

That timing is about right.  The depo shot can be wearing off by the third week  What I found with my cats was that over time, the depo was needed less and less often than at the beginning.  She would sometimes go two to three months between attacks, which was great.  She did urinate a lot after the shot but that was actually healthy for her.  If I were you, I would weigh his comfort versus his lab results, and if he can be comfortable for whatever time he has left, between the depo and the buprenex, that would be my choice.  Quality of life always trumps quantity of life in my book.

Red Top Rescue said:

 
  Quality of life always trumps quantity of life in my book.

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Adding some info re: probiotics which I know some have mentioned to you as helpful.

There's a lot of info here at TCS on this subject.  Some find it helpful, some not for cats with kidney disease. I personally have taken them when on antibiotics as per recommendation of my dentist during major dental work. Not sure if it helped my stomach but it also didn't hurt

If you search for "probiotics" you come up with a lot of hits, try and read through some of the newer ones. I know there are links to where people purchase theirs, brands, comments about dosages etc. You don't have to buy a brand specifically for cats; in fact those probably cost much more.

You can probably pick up a decent sized bottle for around $25 or so and see if it works.Maybe even less - I've seen small bottles in CVS/Duane Reade, etc.  No need to spend more than that.  

Thanks Sivyaleah. I have 1 jar & 2 boxes of probiotic powder I already use, as well as lysine. [emoji]128522[/emoji]

We have had good results so far with using Clindamycin with two cats in our rescue with stomatitis. One of these has chronic stomatitis and has since he was a kitten. We basically pulse Clindamycin on an as needed basis. He typically requires a 10 day course and then he's good for 8-12 weeks (sometimes longer.)

I too keep Buprenex on hand for flare ups. I've been lucky in the fact that the kitty with the chronic case is extremely food oriented and he has never missed a meal, despite the condition his mouth is in. The other cat lost nearly 2 lbs by the time we figured out the issue (he also has a cardiomyopathy).

I know it is frustrating when you are dealing with different health issues in a multi-cat home, especially when you cannot feasibly completely separate. However, I do think you are doing an excellent job working with what you can!

CatPack, i never heard of Clindamycin. It's from a vet? Tigers creatinine level is 2.4 from yesterday's test and I'm not sure about the BUN because the vet tech said 17 and I know that isn't right. The vet is going to call me back.

Yes, Clindamycin is an antibiotic that works excellent on mouth issues. I also think I was told it has some anti-inflammatory properties as well (?)