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Old October 8th, 2009, 02:56 PM
Tommy Cuddles Tommy Cuddles is offline
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Arthritis in cats

Hi,

My cat Tommy Cuddles has what appears to be sever arthritis. Especially in hind legs (hips). his behavior has really tailed off and all he does is sleep. he barely eats and only poops once every 2-3 days. This is probably a product of lack of food intake. We end up syringe feeding every night. He also has crf (diagnosed 4 years ago), but the crf has not worsen since diagnosis. he also has a heart murmur, high blood pressure and intestinal enteritis. At one point 6 years ago he was 15 pounds. He is now hovering around 6. He looks very thin and in pain. Medications he is on include: Amlodopine, zantac, dexamehtosone, adequin and metazapine. nothing seems to work in getting him to eat. He has been looking miserable and feeling miserable for a while now and we are trying everything. Any thought and suggestions would be very helpful.

Thanks
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Old October 8th, 2009, 06:57 PM
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Before I start rambling on about stuff, my first question is - what does Tommy Cuddles normally eat?
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Old October 9th, 2009, 01:31 AM
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What are you doing to treat the CRF? Fluid therapy? Phosphorus binders? Calcium supplements? Potassium supplements? Probiotics? Transfer Factors? ACE inhibitor?

The increase in sleeping, lack of energy, lack of appetite, weight loss, looking and feeling miserable can also be attributed to untreated CRF.

Do you have the most recent bloodtest results? When were the last tests done? Can you post the BUN/Urea, Creatinine, phosphorus, potassium, calcium, and any other abnormal value. What is the USG (urine specific gravity)?

What are you feeding? and what have you tried in the way of appetite stimulation?

A very valuable resource site about CRF http://www.felinecrf.org/index.htm
From the same person as the CRF link one for arthritis http://www.harpsie.com/arthritis.htm

My 18yr old cat was diagnosed with azotemia/early stage CRF 2 years ago her thread is here http://www.pets.ca/forum/showthread.php?t=45017
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Old October 9th, 2009, 07:06 AM
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Quote:
Originally Posted by Tommy Cuddles View Post
Medications he is on include: Amlodopine, zantac, dexamehtosone, adequin and metazapine.
How long has Tommy Cuddles been taking the mertazapine? Also, I'm assuming the dexamethasone is for the arthritis - how long has he been on that and how much does he get?
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Old October 9th, 2009, 09:52 AM
Tommy Cuddles Tommy Cuddles is offline
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Hey everyone,

let me first say thanks for all the help. To answer some of the questions:

1) Re; the CRF. i will get the blood work. We take it every 3-4 months to see where he is. his numbers have been level for a while. We had originally changed his diet to help with the CRF. We also give him zantac for the nasuea. As mentioned before he gets amlodipine (liquid) for the HBP. We have not needed to do the sub-q's yet, becasue he was drinking well. We have a fountain for him. However he has ceased to use it, but still drinks regularly. We did try phosphorous binders but only for while. his numbers are good. We tried probiotics and other herbal remedies early on. however he is very picky with food and would walk away if he smelled anything he did not like. it came down to a choice medication and no food or find foods he liked and ensure he eats.

2) Dexamehtosone: We give him this for the enteritis he has. he had an episode once where he did not poop for 4 days. After an ultrasound, we started him on dex. it helps, but does not seem to do anything for the arthritis. it seems he has developed arthritis (at least sever arthritis) recently, but has been on dex for 6 months now. The dose is the lowest dose, .5 mg.

3) we have started him on adequin for the arthritis, shots. I know it takes time. the funny thing is there are days where he looks better and then just looks bad the next day. We do syringe feed him everyday, to ensure he gets nutrition.

4) Appetite stimulant: the vet said the Dex would increase his appetite, which it does. We also have him on Mertazipine. That really gets him going. The problem, i put the wet food down in front of him and he either just licks it or walks away. I do not know if this is part of the various illnesses he has or just being picky.

5) normal diet is wet food as much as possible. We also leave out dry food (innova). We tried to give him innova and evo wet and he used to like it, but no longer. We have also given him pro-plan. unfortunatley, we give him whatever we can now, just to ensure he gets something. like I said it is better he eats something than trying to get healthy food in him and him not eating at all.

thanks.


i will get the latest BW and post it. My wife has done a ton or research on crf and has been on the sites you mentioned.
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Old October 9th, 2009, 02:50 PM
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Quote:
Originally Posted by Tommy Cuddles View Post
As mentioned before he gets amlodipine (liquid) for the HBP.
Has he ever had an echocardiogram to diagnose the nature of his heart murmur?

Quote:
Originally Posted by Tommy Cuddles View Post
We have not needed to do the sub-q's yet, becasue he was drinking well.
A cat with CRF can drink plenty and still be dehydrated. The decision to use subQ fluids should be based more on Tommy's lab values rather than how much he's drinking, although having a heart murmur and high blood pressure certainly complicates this.

Quote:
Originally Posted by Tommy Cuddles View Post
2) Dexamehtosone: We give him this for the enteritis he has. he had an episode once where he did not poop for 4 days.
Ah, sorry, I missed the enteritis part. Does he have any other symptoms? Typically enteritis (aka IBD) results in diarrhea and/or vomiting. Rarely, constipation may be seen, but in this case it could also be attributed to dehydration from the CRF. Here is more info on IBD if you're interested:
http://www.moggies.co.uk/html/ibd.html
http://maxshouse.com/inflammatory_bowel_disease.htm
http://www.catnutrition.org/ibd.php

Quote:
Originally Posted by Tommy Cuddles View Post
it seems he has developed arthritis (at least sever arthritis) recently,
How old is Tommy? Has he ever had any x-rays to see the extent of the arthritis? I'm a bit worried about it coming on so suddenly and wonder if there might be something else going on related to one of his other conditions. For instance, dehydration can cause a cat to appear weak and stumbly, as can the lack of food intake that you already mentioned. A heart condition can also cause weakness, lethargy, and a lack of appetite.

Quote:
Originally Posted by Tommy Cuddles View Post
3) we have started him on adequin for the arthritis, shots. I know it takes time. the funny thing is there are days where he looks better and then just looks bad the next day. We do syringe feed him everyday, to ensure he gets nutrition.
Cosequin or Dasaquin can also be very effective for arthritis, especially when used in conjunction with the Adequan injections. Some other supplements to consider would be Omega3 fish oils, Green-lipped mussel (Perna canaliculus) extract, and MSM. If you have access to a holistic vet, they should be able to come up with a treatment plan that involves other modalities like acupuncture, osteopathy, or homeopathy. If it truly is the arthritis that is causing Tommy's current decline, then you might want to consider pain meds, although these can be tricky in a cat with compromised kidneys. However, consider Tommy's quality of life over quantity.
http://www.veterinarypartner.com/Con...?P=A&A=587&S=1


Quote:
Originally Posted by Tommy Cuddles View Post
The problem, i put the wet food down in front of him and he either just licks it or walks away. I do not know if this is part of the various illnesses he has or just being picky.
What happens if you leave the wet food out? Does he come back later to eat it? Growler would also recommend raising the dishes a couple of inches to prevent stomach acid from gurgling up while his head is down.

To make the wet food more enticing, try dusting the top of it with powdered freeze-dried meat treats like Halo Liv-a-Littles or Real Food Toppers. Parmesan cheese works for some cats. The juice from a can of low-sodium tuna or salmon might help, although normally you want to stay away from fishy foods for both IBD and CRF reasons. But the dude's gotta eat! Whatever it takes, don't limit yourself to just cat foods. Try plain yogurt, plain chicken baby food (no onions), freshly broiled or boiled chicken breast. Leave stuff out for him to snack on when he feels like it. Don't worry about canned food going bad, you can safely keep it out for many hours.

Quote:
Originally Posted by Tommy Cuddles View Post
We also leave out dry food (innova).
Innova EVO? If it's the only thing he'll eat, okay, but dry Innova is waaay too high in phosphorus for a CRF kitty. Same with the Innova EVO Cat & Kitten canned (the 95% meat varieties are excellent though). A better choice would be Eagle Pack Adult dry food, although I'm sure you know it would be ideal if he didn't eat any dry.

What food are you syringe-feeding Tommy with? Has Tommy had his T4 value checked recently?
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Old October 10th, 2009, 02:05 AM
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Quote:
Originally Posted by Tommy Cuddles View Post
he also has a heart murmur, high blood pressure
What grade is the heart murmur and what is his blood pressure number?

Quote:
Originally Posted by Tommy Cuddles View Post
1) Re; the CRF. i will get the blood work. We take it every 3-4 months to see where he is. his numbers have been level for a while. We had originally changed his diet to help with the CRF. We also give him zantac for the nasuea. As mentioned before he gets amlodipine (liquid) for the HBP. We have not needed to do the sub-q's yet, becasue he was drinking well. We have a fountain for him. However he has ceased to use it, but still drinks regularly. We did try phosphorous binders but only for while. his numbers are good. We tried probiotics and other herbal remedies early on. however he is very picky with food and would walk away if he smelled anything he did not like. it came down to a choice medication and no food or find foods he liked and ensure he eats.
Has there been an increase/decrease in the amount Tommy Cuddles is drinking since he stopped using the fountain? Depending on the lab values you might want to start subq's ~ it's not as scary as it may sound I've been giving fluids for a little over a year, right now she gets it every day and she still drinks regularly from her fountain - I use bottled water and don't use the charcoal filters. Sophia gets her Subqs is a great intro/step by step instruction.

My grrl also has a heart murmur either just barely audible or graded at a very low 1, I asked about the fluids and for that level there's no problem. She doesn't have hbp though.

Much of the problem with phos binders is they have a minty taste cats hate. You can get odourless tasteless generic (no brand name) phos binders from the pharmacy. Even if his blood phos value is normal he should have a binder if the food he is eating is high in phos. The binders don't remove the phos that's already in the blood, but prevent the phos in the food from being absorbed into the body.

Natural Factors Ultimate 12/12 Probiotic is odourless and tasteless (yes I tasted the powder) it will also help the intestines by replenishing the good gut microflora. You don't need a full capsule each meal, about 1/4-1/3 capsule twice daily is what my grrl gets.

What herbal remedies did you try? There is a difference between herbal and homeopathic.

Quote:
Originally Posted by Tommy Cuddles View Post
Appetite stimulant: the vet said the Dex would increase his appetite, which it does. We also have him on Mertazipine. That really gets him going. The problem, i put the wet food down in front of him and he either just licks it or walks away. I do not know if this is part of the various illnesses he has or just being picky.
My grrl goes nuts for PureBites Chicken Treats, it's just freeze dried chicken breast they are easy to crumble ontop of the food or treat first to get the appetite started.

As sugarcatmom mentions I tell everyone w/a crf cat to raise the food & water dishes between 2-5 inches off the ground helps keep the stomach acid where it belongs in the stomach lessening the feelings of nausea.

When you put the food infront of him is he licking his lips or swallowing frequently? If so that's the nausea which will turn him off food. One thing with nausea is it stops them from wanting to eat, but if they go too long without eating they get nauseous from having nothing in their stomach.

Will he eat more if you offer it on your finger? I know it takes longer & requires patience but sometimes it will jump start the appetite abit.

Quote:
Originally Posted by Tommy Cuddles View Post
normal diet is wet food as much as possible. We also leave out dry food (innova). We tried to give him innova and evo wet and he used to like it, but no longer. We have also given him pro-plan. unfortunatley, we give him whatever we can now, just to ensure he gets something. like I said it is better he eats something than trying to get healthy food in him and him not eating at all.
I agree the Innova is too high in phos especially w/out a phos binder, have you tried Wellness? The canned Turkey, Chicken, Beef & Chicken have good phos values. Eagle Pack Holistic Select Canned foods also have fairly good phos levels, again try to stay away from fish as much as possible.

How many times per day are you feeding canned? What is the latest time you have canned out for him or the last feeding?
Smaller more frequent meals are best for crf (see above re nausea) so a small meal right before you go to bed is also a good idea, shorten the distance between dinner & breakfast will keep something in the stomach longer to occupy the stomach acid.

Quote:
Originally Posted by sugarcatmom View Post
If you have access to a holistic vet, they should be able to come up with a treatment plan that involves other modalities like acupuncture, osteopathy, or homeopathy. If it truly is the arthritis that is causing Tommy's current decline, then you might want to consider pain meds, although these can be tricky in a cat with compromised kidneys.
My crf grrl sees a Homeopath vet and a physiotherapist for IntraMuscular Stimulation {GUNN IMS} (very similar to acupuncture) every 3 months, I highly recommend trying homeopathy and physical therapy.

There are several very effective homeopathic remedies for pain management with no adverse affects. (My grrl had a dental cleaning w/a few extractions, her pain management was a couple of homeopathic remedies, she did not require conventional pain medication)
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Old October 10th, 2009, 04:30 AM
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I sprinkle parmasean cheese on top of my cats food when they don't want to eat it and that seems to perk their interest more and then they eat.

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Old October 14th, 2009, 05:33 PM
Tommy Cuddles Tommy Cuddles is offline
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Hey everyone. Sorry for the delay. We had taken Tommy to the vet. He hadn;t looked good at all. We did blood work, see results below. The vet thinks something is wrong, but tommy is to weak to have any tests done and even then what can be done to treat. We have started on sub-q fluid and he seems to perk up after and even eats hi shard food. He is still only licking his soft food. We are also syrige feeding him. He has probably gained 1/2 pound since monday. Here are the results of the blood work. The glaring thing is his iron levels. Also, can anyone answer why his CRF levels look great, especially his creatin levels.

ALK Phosphate - 17 (0-62)
ALT - 28 (28-100)
AST - 28 (5-55)
Albumin - 3.5 (2.3-3.9)
Total Protein - 7.6 (5.9-8.5)
BUN 46 (15-34)
Creatinine 1.4 (0.8 - 2.3)
Glucose 195 (70-150)
Calcium 9.8 (8,2-11.5)
TCO2 (bicarbonate) 27 (13-25)
B/C ratio 32.9
RBC 5.32 (6-10)
HGB 6.5 (9.5 -15)
HCT 22.2 (29-45)

THe weird thing is the creatinine, which 3 months ago was 2.2.
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Old October 15th, 2009, 02:05 AM
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Quote:
Originally Posted by Tommy Cuddles View Post
Hey everyone. Sorry for the delay. We had taken Tommy to the vet. He hadn;t looked good at all. We did blood work, see results below. The vet thinks something is wrong, but tommy is to weak to have any tests done and even then what can be done to treat. We have started on sub-q fluid and he seems to perk up after and even eats hi shard food. He is still only licking his soft food. We are also syrige feeding him. He has probably gained 1/2 pound since monday. Here are the results of the blood work. The glaring thing is his iron levels. Also, can anyone answer why his CRF levels look great, especially his creatin levels.
Since he's visibly perked up & ate after the fluids that shows he was definately dehydrated.

Creatinine is a waste by product of muscle mass and is less affected by diet, stress and dehydration than the BUN is, however if BUN levels are high and creatinine is only slightly elevated, it usually means the cat is dehydrated, has gastro-intestinal bleeding, or is eating a high protein diet. Since creatinine is produced in the body, and does naturally increase with the increase in muscle mass, one possible reason for the drop is a loss of muscle mass. See more below


Quote:
Originally Posted by Tommy Cuddles View Post
ALK Phosphate - 17 (0-62)
ALT - 28 (28-100)
AST - 28 (5-55)
Albumin - 3.5 (2.3-3.9)
Total Protein - 7.6 (5.9-8.5)
These numbers all look good.

Quote:
Originally Posted by Tommy Cuddles View Post
BUN 46 (15-34)
Creatinine 1.4 (0.8 - 2.3)

THe weird thing is the creatinine, which 3 months ago was 2.2.
What was the BUN on the last test?

Here are a few reasons that may explain the drop in creatinine:

Quote:
http://www.felinecrf.org/diagnosis.h...creatinine_low
If BUN (urea) levels and phosphorus levels are high yet creatinine is normal or only a little elevated, it can mean that there is a pre-renal factor at work, for example:

the cat is dehydrated;

the cat has gastro-intestinal bleeding;

the cat is eating a high protein diet;

the cat has severe metabolic acidosis; or

in some cases it may indicate heart failure.

In end stage CRF, creatinine levels may fall (although this is pretty rare). This occurs because creatinine is a by-product of muscle, and towards the end CRF cats may lose a lot of muscle, and therefore cannot produce as much creatinine.
Has Tommy Cuddles lost more weight in the last 3 months or lost muscle mass? That is also one possible explaination for the creatinine dropping.

Amlodipine does have the very rare side effect of raising renal blood values, though given that it relaxes the muscles in order to allow the arteries to dilate passing blood faster & there by reducing blood pressure, I would speculate that is might also have a slight lowering effect on creatinine given that the muscles are not working quite so hard to push blood through

Quote:
Originally Posted by Tommy Cuddles View Post
Glucose 195 (70-150)

Calcium 9.8 (8,2-11.5)
TCO2 (bicarbonate) 27 (13-25)
B/C ratio 32.9
High glucose is common in cats that get very stressed at the vets, however it may also indicate secondary hyperparathyroidism - not to be confused with hyperthyroidism.

What's the phosphorus level?

Quote:
Originally Posted by Tommy Cuddles View Post
RBC 5.32 (6-10)
HGB 6.5 (9.5 -15)
HCT 22.2 (29-45)
These numbers are indicative of anaemia http://www.felinecrf.org/anaemia.htm#why_anaemia

Did they check the reticulocytes level when they did the blood test?

Has the vet raised the possibility of pancreatitis? When the creatinine is normal or fairly low ~in the 2s~ but the cat is more lethargic or showing symptoms of being sicker than mild kidney failure would, you should consider the possiblility he might also have pancreas issues. Amylase and lipase can indicate pancreas issues but they are not necessarily reliable for diagnosis http://www.manhattancats.com/Article...itis_test.html
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Old October 28th, 2009, 01:56 PM
Tommy Cuddles Tommy Cuddles is offline
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Thank you everyone for your help with Tommy. Unfortunately, Tommy passed away (we had to put him to sleep) last week. he had deteriorated to nothing and was not moving anymore. We thought the feeding, iron, sub-q's would help, but they did not. his CRF values were fine. We believe he may have had cancer and we did not know, since his vet visits focused on the crf and any physical exams did not find any tumors. It may have been deep in an organ, who knows. Tommy is in a better place and hopefully he will want to come back to us.

Thanks for all your help.
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Old October 28th, 2009, 03:09 PM
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I am so sorry for your loss! You can be sure that Tommy Cuddles is running free of pain at the Rainbow Bridge!

RIP little one!
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Old October 28th, 2009, 03:19 PM
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I am so sorry to hear about Tommy Cuddles.
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Old October 28th, 2009, 05:22 PM
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I'm so sorry you've lost Tommy Cuddles

sweet S/He is playing at the Rainbow Bridge with those who've gone before
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