CKD cat--let go or push vet for treatment

[oyster]

I posted here about constipation in my 17 yr. old CKD cat. (He was diagnosed at 14). It was his first time and he is still not pooping on his own--a week later.
Since then, I have realized that he has a lot of foam in his urine. I told the vet when we went to see him 3 times last week. He seemed unconcerned and treated only for constipation. Can't understand how a vet could ignore such a big indicator of CKD.
Then, I researched online and found out about proteinuria. My cat is going downhill by the day. He has stopped eating and I am force feeding him. Also, pushing through a product similar to Miralax. He was prescribed Lactulose but that has done nothing for him. I gave him a glycerin suppository yesterday and he pooped.
So, my question is that he clearly going downhill--not eating, lethargic, listless. Should I force the vet to give him a urinalysis tomorrow and medication or is that going to make him even more unwell? Also, will have to push for subq fluids because he isn't on any and I am syringe feeding water, broth every 30 min.
I have the alternative to take him to a big pet hospital about an hour and half away. I think that will prove to be too stressful for him but if I must, I will.
Or is it just time to let him go? (I know I have to make that call sometime but not sure if we are ever ready to do that).

 

[di and bob]

I would try the urinalysis, and meds and insist on a sub q first and see how he does. If no improvement at all then you will have at least known you have done all you can. Keep giving him the Miralax, i gave my cat 1/4 tsp twice a day mixed in a little lickable treat. You are already doing a lot, my heart goes out to you, I'll pray for you both.......

 

[silent meowlook]

Honestly, I would go to the big hospital. Yes, it might stress him but not as much as having a veterinarian that is not on the same page as you. You should have fluids at home that you have been taught to give to him sq. Many people are able to do this at home and cats have a much better quality of life. Also if he is dehydrated, he is not going to be pooping on his own.

Is there a feline only hospital anywhere near you?

With the urine, is this urine you are seeing in the cat box that is foaming? If so, the cat litter can make it foam

 

[FeebysOwner]

Try starting with your vet first BUT ask for a complete blood work up (CBC, Chemistry panel) in addition to the urinalysis. The chemistry panel will tell you how your cat's kidneys, among other organs, are doing. That will help to determine whether or not he has CKD, as foamy urine is not necessarily a good indicator. My cat (18+ yo) has CKD and has never had foamy urine. The urinalysis will identify if there is protein in his urine, if not, he will not be labeled as having proteinuria.

Maybe the results of these tests will change your vet's mind. You can also ask the vet to share the results, as appropriate, with the big pet hospital, in a consulting role.

There are things like appetite stimulants and anti-nausea meds that could also work wonders for him. These meds can be used short-term to help getting him to eat again until you can find out more about what might be going on. They can also be used long-term if needed, as a lot of CKD cats, including mine, are on these to aid with symptoms associated with this disease. If his phosphorus is high, the renal food he is eating may not be enough - and then, phosphorus binders could be used. And, sub-Q fluids, as you already know, might also help a great deal.

In the meantime, try supplementing what you are doing to feed him with baby food meat (Gerber Stage 2 or Beechnut). It is pretty amazing how many cats who lack an appetite are still willing to eat them. It might help to reduce the number of times you have to force feed him.

 

[Alldara]

Not fully having a diagnosis yet, I would insist on the urinalysis and bloodwork.

After that, it's the decision on whether you think quality of life will improve with medical support. The quality of medical support in your area may impact this decision, as well as your cat's temperament. Unfortunately, they can't tell us, so we have to extrapolate how much care and when to end care.

 

[oyster]

Thank you all.
Firstly, he has managed to poop but it looks like diarrhea. I am going to scale back on that Miralax dosage(Kinderlax for me). I am guessing it is the liquid around the constipated area but it's better than nothing.
I will talk to the vet about subq fluids and urinalysis. Am planning to take a sample the night before and if possible, in the morning. Not sure when he will go because it has been very irregular lately.
Then, if he refuses, I will call the big hospital. Vets here have to share the medical info if you transfer to a different doctor so that's no issue. The issue is time--how fast they'll do it and how fast Oyster can get treatment.
Thank you again. He is weak but he walked to the litter box which is a flight of stairs. We have one for him near his bed too. He ate a spoonful of food.
If I mix a non-renal food (say a spoonful) with his renal food just to coax him to eat, should I still use a phosphorous binder?

 

[oyster]

I would try the urinalysis, and meds and insist on a sub q first and see how he does. If no improvement at all then you will have at least known you have done all you can. Keep giving him the Miralax, i gave my cat 1/4 tsp twice a day mixed in a little lickable treat. You are already doing a lot, my heart goes out to you, I'll pray for you both.......

Thank you. I need those prayers and am grateful.

 

[FeebysOwner]

If I mix a non-renal food (say a spoonful) with his renal food just to coax him to eat, should I still use a phosphorous binder?

I would not do that until you have blood work done to tell what his phosphorus level is. And, regardless, a spoonful or so of non-renal food isn't going to make that big of a difference on a temporary basis.

If you can't get a sterile sample, a urinalysis might not be informative. If you can, then store it in the fridge, which I think is 'good' for up to 48 hours before it is no longer viable.

 

[oyster]

Try starting with your vet first BUT ask for a complete blood work up (CBC, Chemistry panel) in addition to the urinalysis. The chemistry panel will tell you how your cat's kidneys, among other organs, are doing. That will help to determine whether or not he has CKD, as foamy urine is not necessarily a good indicator. My cat (18+ yo) has CKD and has never had foamy urine. The urinalysis will identify if there is protein in his urine, if not, he will not be labeled as having proteinuria.

We just got bloodwork done in Jan. And on Tanya's CKD page it says that if a cat has proteinuria, then a bloodwork should be done 5-10 days after starting Fortekor (Benazepril) as the creatine levels will rise temporarily. So, should I do a bloodwork tomorrow or wait for the urinalysis results?

 

[oyster]

I would not do that until you have blood work done to tell what his phosphorus level is. And, regardless, a spoonful or so of non-renal food isn't going to make that big of a difference on a temporary basis.

If you can't get a sterile sample, a urinalysis might not be informative. If you can, then store it in the fridge, which I think is 'good' for up to 48 hours before it is no longer viable.

His phosphorous level as of Jan. 2023 was 4.5mmol/l with 5.8 being the highest. So, it is high but not over the limit.

 

[FeebysOwner]

Vets here have to share the medical info if you transfer to a different doctor so that's no issue. The issue is time--how fast they'll do it and how fast Oyster can get treatment.

You could get copies of his records and send them yourself, if the big hospital will accept them from you. If you get an appt. with the hospital, a lot of times they reach out to the previous vet to obtain the records before the appt.

We just got bloodwork done in Jan. And on Tanya's CKD page it says that if a cat has proteinuria, then a bloodwork should be done 5-10 days after starting Fortekor (Benazepril) as the creatine levels will rise temporarily. So, should I do a bloodwork tomorrow or wait for the urinalysis results?

If you haven't started Benazepril, it would be more cost effective to wait the 5-10 days for new blood work, IMO.

His phosphorous level as of Jan. 2023 was 4.5mmol/l with 5.8 being the highest. So, it is high but not over the limit.

I don't know the range for phosphorus on the lab that was used. But Tanya's web site also says the range typically includes kittens who should have a higher phosphorus level, so it is not a realistic range for CKD cats. However, I think I recall 4.5 being OK per IRIS - although that does somewhat depend on the creatinine level and Staging too.

 

[oyster]

Thank you. This exchange with wiser heads allays my panic and gives me some breathing room. Thank you so much.

 

[mrsgreenjeens]

Just want to add that with all three of my kidney cats, none of them ever ate renal food and none of them ever needed phos. binders. Our Vet told us that it is much better that they eat than that they eat renal food. So we fed them whatever they would eat. We also used appetite stimulants and gave them antacids. But the most important thing we did was to give them sub-q fluids twice to three times a weeks. That was what did the most good, even though we also added extra water to their food, and always had lots of water dishes out for them. AND, they still had constipation issues, so we also gave them miralax.

Once they started consistently having more bad days than good, I let them go peacefully to the bridge . I do say "consistently", though, because sometimes they would have an entire bad week and I would think it was time, then for whatever reason, they would perk up for awhile.

I HATE kidney disease and am so sorry you are going through this

 

[Meowmee]

So sorry you and Osyter are going through CDK. I went though it with 4 of my kitties. Most of them had other conditions also such as HCM/CHF, anemia, cancer… in one case an unknown condition, in that case it was believed the kidney disease was caused by high blood pressure but it never got advanced I think, he was put on blood pressure medications and phosphorus finders. I don’t think we ever gave him very much fluid. In one case she had hcm chf and the lasix damaged her kidneys. Just be careful with fluids if you do that because to much fluid put my Sybil who had undiagnosed hcm into congestive heart failure. Never do too much fluid.

I guess you could do the bloodwork, and have them take a urine sample and see what is going on with him. As far as the treatment, and when to stop and just let him go unfortunately you have to decide that yourself. There are a whole array of concerns such as quality of life, finances etc.

It’s a very hard decision. Usually my cats crashed from some thing else, and it was a slow decline up until then. If you don’t have a water fountain it can help, heating pads and stuff like that makes them feel better. There’s a lot of anti-nausea medications, and appetite stimulants which can help. Also check for anemia to the bloodwork will show that, they might need B12 injections or even Epogen.

With Wizard Dvm said just feed him normal food… he also had lymphoma. I think I did that with all of them actually, although I consulted that list for the ones that were low in phosphorus.

The fluid is a lesser substitute for actual dialysis since that is not available for the most part for cats. So it’s not as effective. People can live a long time on dialysis although some die on it depending on what is causing the kidney failure etc. if they never receive an organ transplant.

I think we have to think about their quality of life too…just imagine how you would feel if you were gonna die in a few weeks, and you were told you can’t eat anything you like to eat anymore etc. so maybe you can live 3 weeks more. Maybe it would be better just to live for three or four weeks and eat what you like to eat.

Unfortunately they can’t make the decision, we have to make the decision for them which is what makes it so hard. The one good thing about kidney disease is that they don’t have a lot of pain from it or so I have been told anyway. But I think at end stage they feel pretty ill.

Hugs

 

[Furballsmom]

I am syringe feeding water, broth every 30 min.

It's the both of you, by the way.

I got somewhat close to this sort of hospice with my angel Poppycat his last months, and if your cat were having good days physically while going through this, I'd say push forward. Even with all the things that Poppycat had going wrong, he was on the top of the refrigerator a couple weeks before.

think that will prove to be too stressful for him

However, sometimes, it's just time. Your baby's emotional well-being means more than anything else.

When Is It Time? - Making The Difficult Decision - TheCatSite Articles

 

[misty8723]

I haven't read through everything, but my best advice is to find another vet, preferable cat only if available, and one who gets good reviews. I would start with the hospital you mentioned and go from there. I would not give up yet.

Many years ago my cat Cynthia had a mass that they knew was cancer but not which kind. One vet said to take her home and make her comfortable, and she probably had 3 months. Another vet said she was a good candidate for surgery. The surgery was successful, she had chemo, and lived another 2 happy years.

 

[oyster]

Thank you all for your advice, suggestions, and encouragement. It has been wonderful to share that burden here. And of course, Tanya's CKD web site is a fantastic resource.
So, Oyster's urinalysis has been done and he certainly has proteinuria at well over 0.4. He also had blood in his urine so I am pushing to get his blood pressure checked. Will call the vet tomorrow.
He has been prescribed Semintra because that is what they use for CKD cats in Europe. I looked for Fortekor (Benazepril) but I couldn't get it without a prescription. So, I will try that and see if it helps.
I addressed his high cholestrol and low reticulocytes (haemoglobin) in Jan. especially asking for anemia but the vet insisted that he doesn't have it because the numbers don't show that in the blood test.
Oyster ate his whole bowl of food today so that tells me that he wants to rally on. But I also know, the time we have is now short because he is probably in Stage 4. I will go for a blood test in 10 days after starting medication. Hopefully, we will know more.
Unfortunately, I cannot change the vet. There are two decent vets within 25 miles and one is not at all feline friendly, and we are stuck with the other one. He treated our bunnies (who died last year from GI Stasis) and we thought he was quite decent. But now, I am not so sure. This just means that I have to advocate for my cat vociferously and proactively because the vets here aren't going to do that. The big hospital is an option but they are not that great there either. They told us our last cat had two weeks to live after doing an MRI and diagnosing him with lung cancer. He lived another 3 years and had no signs of lung cancer. He died from a tumor along his spine.

I will now join Tanya's support group and hopefully, learn things fast. My spouse is on the local cat kidney group as he speaks the language. We asked for a vet who is good with cats and kidney disease but haven't received an answer yet.