16 yr old kitty, maybe CRF, now having breathing problems and may be constipated

Hello everyone, I have been reading this forum for a day or two and love all the support here.

I am just looking for new ideas or anyone with a similar situation.  My Schmitty cat, 16 y/o nuetered male, was getting lethargic, not eating well and had a watery eye. Other than that he has been quite healthy his whole life. So, I took him to the ER vet 2 weeks ago (on a Saturday). They gave him Mirtazapine to help him eat and subQ to help with hydration. I let them do a blood test. They called the following day to report that he had creatinine just over 3 and BUN about 37 (hadn't been eating) so the best course of action would be IV therapy overnight in their facility. I took him in for that, they called the next day to report his blood work showed his number came down and they felt he could return home (Monday). He is a picky eater, so I didn't even try to start the k/d diet until I knew he was getting enough food in general. That night I noticed he was breathing shallowly and faster, so I took him back in the next morning (Tuesday). They took an Xray that showed an enlarged heart, gave him furosemide and sent us home with a diagnosis of CHF, furosemide, enalapril and 6 mos to live (at best). The pills did not help his breathing, he continued to eat well enough, drink on his own and use the litter box on his own, although he still had no energy and wobbles a little when walking.  I decided to take him to the kitty cardiologist last Friday and got an excellent report, very very mild grade I murmer, and one other mild flaw. No fluid in heart or lungs. Enlarge heart was likely from fluid therapy. Told to stop furosemide and enalapril and start potassium, he had lowish blood pressure. He got diarrhea on Monday from the Tumil K, so I stopped as the vet suggested. Still eating, drinking and litter boxing, but no other improvement after 3 days so I took him back to ER vet (this Tuesday) because his breaths per minute were up from 30-34 to 40-42. I let them take another blood test on that showed his kidney values were back up, mildly anemic (PCV 30%) and low end of normal potassium range. Everything else in the blood panel is quite normal. They cannot tell me why he is having breathing issues. He has not panted or open mouth breathed, just fast and shallow but steady. At this point, he has not pooped since his diarrhea on Monday. He had a regular vet check up today. His heart rate is fine, his temp is fine, his gums are pink and hydration is adequate. The vet is not concerned about the lack of poop, she palpated his abdomen and did not feel and compaction. 

I am open to all suggestions here. My kitty is still bright eyed and engaged, he just can't breath and has no energy.  I did not agree to go to another specialist at this time because he has been to the vet 7 times in 10 days, that in itself is stressful. I realize an ultrasound or another X-ray MAY give us some direction, but even the vet was doubtful. He could have cancer, he could have fast failing kidneys, he could be anemic, he could be lower in potassium than the test showed, he could be metabolic acidosis....  I have read most of felinecrf.com, but I am still searching for answers. Tuesday his creatinine was 3.7 BUN 57 (his normal food is high protein). I know that's not great but I also think is not a death sentence.

Thanks in advance to all you kitty lovers.

Originally Posted by SchmittyCat  

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They cannot tell me why he is having breathing issues. He has not panted or open mouth breathed, just fast and shallow but steady. At this point, he has not pooped since his diarrhea on Monday. He had a regular vet check up today. His heart rate is fine, his temp is fine, his gums are pink and hydration is adequate. The vet is not concerned about the lack of poop, she palpated his abdomen and did not feel and compaction. 

I am open to all suggestions here. My kitty is still bright eyed and engaged, he just can't breath and has no energy.  I did not agree to go to another specialist at this time because he has been to the vet 7 times in 10 days, that in itself is stressful. I realize an ultrasound or another X-ray MAY give us some direction, but even the vet was doubtful. He could have cancer, he could have fast failing kidneys, he could be anemic, he could be lower in potassium than the test showed, he could be metabolic acidosis....  I have read most of felinecrf.com, but I am still searching for answers. Tuesday his creatinine was 3.7 BUN 57 (his normal food is high protein). I know that's not great but I also think is not a death sentence.

Thanks in advance to all you kitty lovers.

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@SchmittyCat   I just wanted to say that you are doing all the right things for your Schmitty.

I think it's difficult when they are 16 and are starting to have their internal organs slowing down, so it takes them some time to adjust, or need help getting over a crisis.

With both kidney involvement and heart issues...it's a difficult balance. (My vet had mentioned that for my rainbow cat Spotty.)

With kidney disease, it leaves our cats in a constant state of dehydration, so they need more fluids,...but with heart disease extra fluids can cause congestive heart failure.

Anemia, also can cause added pressure for breathing, and on the heart, because the heart is trying to get more oxygen to the vital organs that the cat needs.

And it would make a cat very tired. I would ask the vet if some kind of supplement could be given, but not affect the constipation issue.

I don't know if something like B12 shots would help, for your guy.

And I didn't get to use 'phosphorus binders' on my cat, but maybe you can ask your Vet about them.

How is Schmitty doing today?  If he only likes to eat non-presciption food...then definitely ask your vet about the phosphorus binders.

Before you took him to the initial Vet visit 10 days ago, was there any issue with his breathing?  I think you took him in because of his appetite and watery eye, correct?  So this issue started AFTER either certain meds or fluids?  I would check with the Cardiologist via phone and tell them what is going on.  Also tell them how his kidney values have risen substantially and see if it's ok to give him sub-q fluids, and at what amount.  You might even talk about the use of phos binders and whether or not they would be ok.

It has been a month since I first posted and I feel I should give an update. 

After the last unfruitful visit to the same vet clinic I became very frustrated and felt that the vets were not listening to my concerns because the only thing they would talk to me about was CRF.  I talked to every friend and acquaintance I have and found a wonderful clinic nearby.  They don't have all the fanciest equipment, but they have a network of specialists they call to consult with daily.  Whereas the original clinic would run a blood test and then try to shove me out the door to a sister clinic 60 miles away for an expert opinion.  Maybe I had been slightly stubborn, but I certainly felt like ideas and options had not been explained well.

After thoroughly reading Schmitty's charts the new vet presented me with a plan of action to try to get some answers.  His blood work and test for pancreatitis came back fairly normal and his kidney values were even down, lower Stage II. So that part of the diagnosis was put to the side. She agreed with me that we needed to figure out why he wasn't breathing properly and she did not think it was tied to CRF.  An x-ray showed a large amount of fluid in his chest, pleural effusion, but not in his lungs, and fluid in his abdomen.  He had also developed a gallop murmur which they attributed to the fluid build up. The x-ray also showed constipation and the vet suggested it was likely because he was losing hydration to the fluids in his abdomen. We also found advanced arthritis in his spine/pelvis. Remember from the post above, the previous vet DID NOT think we would learn much from an x-ray. She had also said his rapid breathing was just in response to CRF and toxin build up in his system.

After consulting by phone with an internist and a cardiologist the new vet suggested we do a chest tap to give Schmitty immediate relief because the Lasix hadn't helped significantly in the recent past. I was then given the option to schedule an ultrasound or send the fluid off for testing. The vet said at that point the fluid looked suspiciously like what they see in cancer cases. We had about a 70% chance that the test would give us a definitive answer. Unfortunately for my Schmitty Cat the fluid was full of lymphoma cells. A second x-ray was done after the tap because they were be able to see more without the fluid in the way. It showed a shadow in the chest near the sternum which was most likely a cancerous tumor. I was still offered an ultrasound to confirm the status of the possible tumor and look for any others in the abdomen.  I decided that subjecting my boy to more tests wasn't going to change the outcome and would only cause him more stress. We had also found that by this time, likely due to the stress of all the vet visits, he had a full blown bladder infection.

I was given several options, but was told the oncologist felt he was already late stage. This was based on him building/retaining fluid in both cavities. He was also already experiencing cachexia and had become quite anorexic. Chemo was not a good option at this time either because he wasn't very healthy or stable and he was 16. I chose palliative care and was sent home with antibiotics for the bladder infection, prednisolone to try to suppress the cancer and slow down fluid build up and buprenorphine to control pain from arthritis and the bladder infection. The vet said if he stabilized well and perked up we could look revisit some options.

My little guy had 2 wonderful weeks after taking his new meds for a few days. We snuggled more than he had for months, he napped in the herb garden, he watched TV with us, slept in the sun in the hallway, and started jumping up to our bed again.  Sadly, after 2 weeks the fluid began to build again. The vet was willing to tap his chest again as well as draining some of the abdominal fluid, but warned me the oncologist said if we are tapping more often than every 3-4 weeks it is time to consider euthanasia. After a long weekend and a fast decline we felt it was unnecessary to put him through another procedure just to start the spiral again. We put him to sleep on Monday, he was so uncomfortable those last few days and could barely walk. I honestly don't think it was true pain, but with the strained breathing and all the fluid buildup he just couldn't find a happy position.

He was a trooper and would have tried as long as I asked him to just to give me time to become brave enough to say goodbye. He was staggering at the end and couldn't make it more than about 10 feet without stopping to catch his breath. He still managed to use the litter box every time. He was extremely difficult to feed. Yes, a feeding tube could have been an option, but the fact was, he was terminal, and I took his anorexia as a clue from him that he was ready.  I felt very strongly that I did not need to prolong the process until he couldn't walk at all or began to soil himself or for the real pain to begin.

I found so much strength from reading many threads on this site and one other.  Every cat and every scenario is different. I don't put blame on any vet, I only wish the process of diagnosis would have gone smoother from the beginning. I feel blessed to have found the vet we finished with and Schmitty's passing was very peaceful.  When I saw how easily he went, I realized just how sick he had become.  I read two very important quotes during my research, "Will I be allowing my cat to LIVE longer, or die slower," and "it is the last great thing you can do for your pet, taking away his pain and making it your own."  In Schmitty's case, I was only slowing his death.  He did none of things he used to love, he wouldn't even bask in the sun. He wasn't living, he was existing.  It is crazy hard to lose a pet and I miss my little furball furiously. 

I hope this description of Schmitty's journey helps someone out there. I found that I was continuously searching for answers and it was very helpful to read so many others experiences on this site.

I'm so sorry to be reading this update of Schmitty .  The greatest gift we can give them is to let them go when it's their time  

Run free at the bridge Schmitty

Thank you for your thoughts. That saying also played a key role in keeping me strong through this process.

So it turned out to be cancer, lymphoma. I so wish that in the future, they can design better testing for it. Hopefully, the diagnostics get better and better.

I also thank you for this update, and for the quotes that you posted. I do believe Schmitty's journey will help other cats and people.

May your heart heal with time, and may Schmitty be healthy and running free in heaven or over the bridge.  

So very sorry for your loss. Cat Nap said it best-we need to find a better way to diagnose these things without putting so much stress on our babies. I too went through a bought of aggressive cancer. So very heartbreaking. The good thing is you treated your boy to the best of your ability. You tried everything and kept looking when you were not satisfied with answers.

You did the very loving thing you could. My heart aches for you. I know the next weeks will be rough. Be good to yourself. There is no timeline to grief. Give yourself love and acceptance of tears and emotion.

May he run free at the Bridge now. Floey will be showing him around. RIP Schmitty.

I'm so sorry about Schmitty.  The TCS Team offers our deepest condolences.  We'll lock the thread now out of respect for your loss, and we invite you to post a tribute to your kitty in our Crossing the Bridge forum.