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Is my 16 year old cat with renal failure suffering?

Violarolla
January 5th, 2011, 04:37 PM
Hi there,

Viola my 16 year old cat just returned from the Vet. She has suffered renal failure and has been on IV fluid treatment for 3 days.

The vet mentioned that after the kidney flushing and fluids, her blood test results show that her hemaglobin is really low and it looks like the kidney failure might have spread to her bone marrow.

She's not keeping any food down and has been shudderring.

Last night when we brought her home she appeared to be gasping for breath. I called the vet and he thought she might just be overstimulated and to monitor her.

She basically is just lying on her side. She purrs whenever I pet her.

The vet has suggested she try medicine for a month and get more bloodwork done after that time.

To me her quality of life has gone drastically downhill and I'm thinking it would be more humane to put her to sleep.

Has anyone been through this?

Suggestions?

Koteburo
January 5th, 2011, 05:12 PM
Well don't you think is to rush it a bit?
Give her a chance to get better at least and if not you can think about that. (well that's my opinion only)
There are members here that have experienced that kind of health problem with their kitties I'm sure they'll advice.
Hang in there kitty <3

:pray: Get better

Violarolla
January 5th, 2011, 05:14 PM
Thanks for your reply.

Yes I'll monitor her for some more time. It's just been difficult to see her not able to breathe properly. I just want to make sure she's not in pain.

Violarolla
January 5th, 2011, 06:41 PM
Hi there,

Viola my 16 year old cat just returned from the Vet. She has suffered renal failure and has been on IV fluid treatment for 3 days.

The vet mentioned that after the kidney flushing and fluids, her blood test results show that her hemaglobin is really low and it looks like the kidney failure might have spread to her bone marrow.

She's not keeping any food down she throws up immediately.
She also has tremors almost like shudders.

Last night when we brought her home she appeared to be gasping for breath. I called the vet and he thought she might just be overstimulated and to monitor her.

She basically is just lying on her side. She purrs whenever I pet her yet her purr is very raspy.

The vet has suggested she try medicine for a month and get more bloodwork done after that time. He thinks she may have cancer.

To me her quality of life has gone drastically downhill and I'm thinking it would be more humane to put her to sleep yet as the vet has not suggested that I'm not sure what to do. I don't want her to be in any pain.

Has anyone been through this?

Suggestions?

rainbow
January 5th, 2011, 07:19 PM
Sorry to hear about Viola. :grouphug:

One of our members here (growler) has a very informative thread about her cat Duffy that had kidney disease. She still logs on periodically and I'm sure she will answer your thread and any questions you may have.

rainbow
January 5th, 2011, 07:21 PM
Here is growler's thread if you would like to read it in the meantime .....

http://www.pets.ca/forum/showthread.php?t=45017

sugarcatmom
January 5th, 2011, 07:24 PM
Are her renal issues a sudden occurrence or did she have renal insufficiency for a while? What is the medicine that the vet wants to give her? Is she eating and drinking right now?

Spending 3 days at the vet can take a lot out of a cat, she could just be exhausted from the ordeal. Do you have her in a quiet, comfy and warm spot while she recovers?

growler~GateKeeper
January 6th, 2011, 01:20 AM
Hi Violarolla :grouphug: Take a deep breath.

Viola my 16 year old cat just returned from the Vet. She has suffered renal failure and has been on IV fluid treatment for 3 days.

What were her blood/urine results before the IV treatment? Specifically BUN, Creatinine, Phosphorus, Potassium, Calcium, MCHC, MCV, Hct/PCV, Urine Specific Gravity.

What else was out of normal range?

Please post the normal range values with the numbers.

And what results do you have from after the IV treatment?

The vet mentioned that after the kidney flushing and fluids, her blood test results show that her hemaglobin is really low and it looks like the kidney failure might have spread to her bone marrow.

Last night when we brought her home she appeared to be gasping for breath. I called the vet and he thought she might just be overstimulated and to monitor her.

The likely cause is Anaemia (http://www.felinecrf.org/anaemia.htm), this will require treatment asap. Has your vet mentioned treatment options for anaemia?

She's not keeping any food down and has been shudderring.

Regarding the shuddering - are her ears & feet cold? If they are please increase the room temperature slightly & put a lightweight fleece blanket over her (some cats prefer their heads uncovered, while others will duck under the cover), check her ears & feet regularly to ensure she's not cold to the touch.

What does the vomit consist of? just food or is there clear/white foamy liquid with the food? any blood?

She's probably nauseous that's why she can't keep any food down. Try small amounts finger fed over time, letting her lick little bits off your finger will allow her to have something in her stomach for the acid to work without overwhelming her stomach.

If she'll sit up to eat raise her food/water dishes up between 2-6" off the ground - this will put her head higher than her stomach to help the excess stomach acid stay out of her esophagus (this is what triggers the vomiting response).

Feed small frequent meals or add a couple extra snacks especially before bed so there is less time with nothing in her stomach, if there is nothing for the stomach acid to work on it tends to increase faster.

How well was she eating before the 3 day stay @ the vet? Was she vomiting/lip licking/excessive swallowing before then?

Has the vet mentioned nausea/acid blockers? (Slippery Elm Bark, Ranitidine, Metoclopramide, etc)

What food are you feeding?

The vet has suggested she try medicine for a month and get more bloodwork done after that time.

To me her quality of life has gone drastically downhill and I'm thinking it would be more humane to put her to sleep.

What meds?

What symptoms did you first notice & how long ago?

Have you or the vet determined the cause of the renal failure? Toxic substance injested or chronic degradation?

What treatments have been used so far other than the 3 days of IV fluids?


He thinks she may have cancer.

Based on what tests?

Does she have any other health related issues?

I don't want her to be in any pain.

Kidney failure itself is not painful, some symptoms can make them feel uncomfortable (ie dehydration, nausea etc) which is why we need to treat the cat based on how she is feeling not just by the numbers.

If you can make a note of symptoms she's displaying (excessive drinking, not eating, weakness in legs, etc), behaviours that are not usual (eating litter, grinding teeth, pulling out hair) this will help to give you a good picture of what needs to be addressed.

Depending on the severity of the kidney failure cats can live a quality life for years with good disease management. Often it's not the kidney failure that takes these cats in the end but something else, my CRF girl (2007 toxic food recall) has 3 good years after diagnosis until the unrelated Lymphoma she couldn't overcome.

Lots more info available here: http://www.felinecrf.org/index.htm

Violarolla
January 6th, 2011, 02:54 AM
Thank you for the great information.

Here are her first results:HEMATOLOGY
Test Results Reference Units Lab

M. hemofelis/hemominutum
NEG - LAN
4.0
White cell count 16.0
7.8 x10E9/L
- LAN
6.3
RBC 10.8
6.5 x10E12/L
- LAN
104
Hemoglobin 160
93 g/L
-
LAN
0.32
Hematocrit 0.49
0.28 L/L
-
LAN
41.0
Mean Corp Vol. 55.0
42.4 fl
- LAN
13.5
Mean Corp HGB 17.3
14.2 pg
- LAN
306
MCHC 352
336 g/L
- LAN
10.0
RDW 26.0
24.5 %CV
- LAN
Hem Micro Comm * - LAN
Platelets clumped, this will interfere with the accuracy of the
platelet count and underestimate the number of platelets
present
Variability in platelet size apparent
Platelet numbers are adequate
1+ Anisocytosis is present
2+ Poikilocytosis is present
Moderate echinocytosis present
Slight acanthocytosis present
Differential: % abs.
x10E9/L
88.0 6.864
Neutrophils -
2.700 10.560
x10E9/L
7.0 0.546
Lymphocytes -
1.770 6.560

x10E9/L
4.0 0.312
Monocytes -
0.000 0.870
x10E9/L
1.0 0.078
Eosinophils -
0.000 1.246
x10E9/L
0.0 0.000
Basophils -
0.000 0.100
BIOCHEMISTRY
Test Results Reference Units Lab

Hemolysis
++ - LAN

Icterus
Normal - LAN

Lipemia
Normal - LAN
4.0
Glucose 8.0
9.0 mmol/L
-
LAN
5.0
Urea 12.0
51.4 mmol/L
-
LAN
71
Creatinine 203
663 umol/L
-
LAN

Bun/Cr Ratio
19.5 - LAN
147
Sodium 156
156 mmol/L
- LAN
3.9
Potassium 5.3
3.7 mmol/L
-
LAN

Na/K Ratio
42.2 - LAN
111
Chloride 125
124 mmol/L
- LAN
13
Bicarbonate 25
9 mmol/L
-
LAN
12
Anion Gap 26
26.7 -
LAN
2.00
Calcium 2.90
2.29 mmol/L
- LAN
1.00
Phosphorus 2.40
2.51 mmol/L
-
LAN
59
Total Protein 85
65 g/L
- LAN
23
Albumin 33
30 g/L
- LAN
27
Globulin 51
35 g/L
- LAN
0.5
Albumin/Globulin 1.3
0.9 - LAN
0
Total Bilirubin 7
4 umol/L
- LAN
0
ALP 62
20 IU/L
- LAN
28
ALT 76
52 IU/L
- LAN
0
GGT 6
1 IU/L
- LAN
64
CK 440
374 IU/L
- LAN
285
Calc Osmolality 314
357 mmol/kg
-
LAN
Comment *** - LAN
Please note that chemistry tests in the Edmonton, AB
laboratory have been performed on a new chemistry
analyzer and, consequently, the normal reference ranges
have changed.
These ranges are for cats, dogs, horses and cattle of either
Breed:
DSH
e Species:
Age: Feline
16 years

Her hemoglobin has gone down since the 3 days of IV which isn't good and can show that it's gone to the bone marrow.

She's also having difficulty breathing and seems very uncomfortable.

I am handfeeding her but she throws it back up. She can't keep anything down.

I'm looking on the renal sites she's passed stage 4 renal failure.

Violarolla
January 6th, 2011, 03:03 AM
Basically her hemoglobin is very low

and her creatine levels are very high.

She is on her favorite pillow and I've taken the next few days off work to tend to her care.

I'll look into the homeopathic suggestions you have.

Thanks again.

You're very helpful

growler~GateKeeper
January 6th, 2011, 04:58 AM
These are from before the IV fluid treatment correct? Do you have the numbers after IV treatment?

Couple of things that stand out here:

HEMATOLOGY
104-Hemoglobin-160 === 93 g/L
0.32-Hematocrit-0.49 === 0.28 L/L

Differential: % abs.
7.0% 0.546 Lymphocytes-1.770-6.560

BIOCHEMISTRY
5.0-Urea-12.0 === 51.4 mmol/L
71-Creatinine-203 === 663 umol/L
3.9-Potassium-5.3 ===3.7 mmol/L
13-Bicarbonate-25 === 9 mmol/L
12-Anion Gap-26 === 26.7
1.00-Phosphorus-2.40 === 2.51 mmol/L
285-Calc Osmolality-314 === 357 mmol/kg

Low Hemoglobin & hematocrit indicate anaemia, lack of rbc production.
Lymphocytes are often low in CRF cats due to high uraemia.

Both the BUN & Cre are fairly high & subq's should be employed as part of the treatment plan. Discuss with your vet adding products such as Azodyl (http://www.vetoquinolusa.com/CoreProducts/CardioNephrologyRenal/Azodyl.html), Epakitin (http://www.vetoquinolusa.com/CoreProducts/CardioNephrologyRenal/Epakitin.html)

The low potassium and bicarbonate and the slightly high anion gap are indicating metabolic acidosis. This also needs treatment as it does cause muscle wasting leading to weakness. Sub-q fluids at home using Lactated Ringers Solution may be enough to balance this out to normal, though potassium supplements may also be needed.

Phosphorus is too high & needs treatment asap, high phos levels can contribute to or cause nausea, vomiting, weakness, twitching, plantigrade posture etc. More info here: http://www.felinecrf.org/phosphorus.htm. Discuss with your vet adding Calcitriol (http://www.felinecrf.org/treatments.htm#calcitriol) or other phosphorus binders.

Calc Osm is showing the high uraemia (BUN/Creatinine), as well there are other causes.

What was the cause of the renal failure? If this was a poisoning she may need more time in the vets for IV treatment.

Her hemoglobin has gone down since the 3 days of IV which isn't good and can show that it's gone to the bone marrow.

She's also having difficulty breathing and seems very uncomfortable.

I am handfeeding her but she throws it back up. She can't keep anything down.

I'm looking on the renal sites she's passed stage 4 renal failure.

See if you can prop her up on some pillows a bit or have her sit on you to have her head higher than her stomach - both for to help clear the airways for her breathing & to keep the excess stomach acid down.

:2cents: If this was my cat I'd be back at the vet first thing tomorrow morning for a treatment plan including subq fluids, acid blocker, phos binder and Azodyl. If she's feeling this poorly & repeatedly vomiting waiting a month for the next check up is not going to do any good, she needs to eat soon.
:goodvibes:

marko
January 6th, 2011, 11:15 AM
Thanks for all this advice growler :grouphug: and I so wish the OP the best of luck.

It's so sad when cats get older and their health starts to fail. I lost my own 17 year old kitty sweetie a few months back to CRF and it's still painful. He was doing pretty well for a while and then suddenly went downhill.

In terms of "when is the right time" that's so personal and it's often difficult to truly know....and I hope you and your kitty have some good time left but I'm sure you know by now that all cats with CRF are on borrowed time. I just wanted to point you to an article that might be helpful, put out good vibes :goodvibes: and wish you the best of luck. www.pets.ca/dogs/tips/euthanasia-and-the-hhhhhmm-scale-pet-tip-228/

Sincerely - Marko

BenMax
January 6th, 2011, 11:37 AM
My thoughts and prayers are with you.:grouphug:.
A cat I rescued and gave to my mom 16 years ago recently died of the same. We kept her well loved, well cared for and spent as much time as possible with her until her passing.

Keep strong.:grouphug:

Violarolla
January 6th, 2011, 03:28 PM
Hi everyone,

Thank you again.

The blood numbers post IV didn't change sufficiently and her hemoglobin went down.

Just got back from the vet and xrays show a large shadow on her lungs.

Her vet and I along with naturopathic care are working together to do all we can.

Again thank you so much for all your helpful tips. I really appreciate it.

Violarolla
January 6th, 2011, 03:29 PM
Thank you

Violarolla
January 6th, 2011, 03:29 PM
Thank you.

growler~GateKeeper
January 7th, 2011, 03:12 AM
I'm glad you brought Viola back into the vet :grouphug: I'm sorry the news isn't better :(

The blood numbers post IV didn't change sufficiently and her hemoglobin went down.

Just got back from the vet and xrays show a large shadow on her lungs.

Her vet and I along with naturopathic care are working together to do all we can.

Sometimes depending on the severity of the kidney failure the numbers don't change dramatically on IV but may stabilize & continue to improve at home with supportive treatments.

Did the vet give an indication of what they think the shadow on the lungs is? In cases of fluid retention or overhydration fluid may collect in the lungs (pulmonary oedema), or around the lungs (pleural effusion) which will show on an xray and can be tapped for removal. Some info on fluid retention/overhydration here: http://www.felinecrf.org/treatments.htm#fluid_retention

Is there a registered Homeopath in your clinic? Something like Arsenicum Album or Carcinosin or Phosphorus may be of help providing Viola can prove the remedy for accuracy. Seek professional advice for any and all remedy potency/dosages.

If needed I can provide a recommendation for a Registered Animal Homeopath in the lower mainland area.

Has the vomiting reduced? Is she keeping anything down? How is she feeling since the vet visit? :goodvibes:

Koteburo
January 10th, 2011, 07:27 PM
:( Not good news I came to see how your kitty was doing.
I'm impressed by all the info by growler

I really hope your kitty gets better :pray: :goodvibes:
The best for you both