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Old November 5th, 2009, 07:35 AM
tiggy2 tiggy2 is offline
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Question Put a feeding tube in or not, that is the question

HI

I'm new to the site but have read a fair number of post and fine the advice here very good so here I go.

I have a 15 year old female with early stage CRF. She has been steadily losing weight for months and the final suggestion by my vet is to put a feeding tube in.

She does eat, Wellness brand wet food (took about 2 months to get her on that), but obviously not enough to maintain or put on weight. SHe's down to 9.7 pounds from over 12 pounds. My Doc. wants to get her onto the low protein diet, but of course she won't eat that, hence the suggestion of the feeding tube to get her to switch to the low protein diet.

Her thyroid is OK had that checked before we found out it was CRF.

So feeding tube or no. It goes in tomorrow)

Sorry for the delay.
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Old November 5th, 2009, 08:00 AM
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Welcome to pets.ca. Although most veterinarians push their low protein prescription diets for CRF, many other people do not recommend them. Wellness brand wet food (the one your cat is currently on) is one of the foods recommended by others, especially the chicken, turkey, and chicken and beef varieties because they are not too high in phosphorus. Growler's cat, Duffy, was diagnosed with CRF in 2007 and she has an excellent thread that you may want to look at. Here it is:

http://www.pets.ca/forum/showthread.php?t=45017&page=1

It is a very long thread. She has a shorter version but I can't find the link at the moment. I will look for it later. Growler comes on here every day and when she sees your post, she will have some more information for you. If you don't have a copy of your cat's most recent bloodwork, it would be helpful if you ask your vet for a copy and post the numbers here.

Here is another excellent website that contains a lot of good information on CRF:

http://www.felinecrf.org/
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Old November 5th, 2009, 08:10 AM
tiggy2 tiggy2 is offline
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Growler's cat, Duffy, was diagnosed with CRF in 2007 and she has an excellent thread that you may want to look at. Here it is:


Thank you for the speedy reply

I've read Growler's posts and been on the other CRF sites, hence I got my cat on the wellness brand..thanks for that. My other cats are doing better on it)

We checked the blood work, can't remember the numbers but I do remember they indicated Tus was in the early stages of CRF, Phosphorus levels were normal, but there was protein in her urine.

I don't understand why she continues to lose weight even though I feed her every 4 hours or so. She'll eat close to a tbls per feeding, sometimes more.

Mind you my other guys are loving it, so much so that they are getting a tad fat(
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Old November 5th, 2009, 09:24 AM
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You said that she eats just under a tablespoon every 4 hours or so. Is that about 3 to 3.5 oz or so per day? How does that compare to the amount she was eating before she started losing weight and how large is her frame? Was 12 lbs. a good body weight for her frame size? I am just wondering if the weight loss is just due to eating less than previously or if there is something else at play here.

There are other people on this board who have had their cats put on feeding tubes for various reasons. I believe sugarcatmom is one of them and she also comes on here daily and will also give you some good information. It is possible a feeding tube would be helpful to help her to eat more if you feel that what she is getting is not sufficient, but I also do not recommend using the prescription low-protein diets. I lost my own cat this year at the age of 18. He also had heart complications. He was diagnosed with early stage CRF in 2007 and in late January of this year, I decided to follow the vets recommendation to put him on a prescription low-protein diet even though his CRF was relatively stable. By mid-March (after being on the low-protein diet for six weeks) his CRF had suddenly worsened rapidly. I'm not saying that this might not have happened anyway, but the switch to this type of diet was obviously not helpful and I sometimes wonder if it might even have been a contributing factor.

There are also medications available to help with the proteinuria. Has your vet discussed this with you? An ACE inhibitor such as Fortekor (benazepril) is sometimes used in conjunction with amlodipine to treat proteinuria.
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Last edited by mikischo; November 5th, 2009 at 09:58 AM. Reason: added something
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Old November 5th, 2009, 10:15 AM
tiggy2 tiggy2 is offline
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How does that compare to the amount she was eating before she started losing weight and how large is her frame?

She used to eat dry food, so to measure that was impossible as I have 4 others who ate it as well. She was a little over weight, small cat in general. She should weight I figure around 10 pounds, but she has lost muscle mass. So aside from the constant weight loss, (1/2 pound a month), it's the muscle mass that concerns me.

Is that about 3 to 3.5 oz or so per day?

It's probably around 3 oz's of food, I've never measured it that way, but not enough to gain or maintain the weight.

but I also do not recommend using the prescription low-protein diets.

I am in agreement, so why do the vet's push it so much? For one thing it has tons of by-products in it.

There are also medications available to help with the proteinuria. Has your vet discussed this with you? An ACE inhibitor such as Fortekor (benazepril) is sometimes used in conjunction with amlodipine to treat proteinuria.

I don't think they (vet) knew about this, but I will mention it. So much information to try and put together and not a lot of confidence in presenting it.

I would like to try alternative ideas to a feeding tube, because she is eating, but the vet did not have any. The suggestion of a stimulant was tossed out due to it's side effects of hard on the kidney's.

So I'm at a loss as to what to do
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Old November 5th, 2009, 10:46 AM
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Hi tiggy2,

Is your kitty on any supplements or medication? Have you tried appetite stimulants? If you could get a copy of her latest lab results, that would also be helpful.

While putting in a feeding tube can be a life-saver in many situations, it should be more of a last resort thing, when other less invasive options have failed. And I also agree with mikischo that you don't want to go the low-protein route. That won't help at all in the weight gain department.

To get her eating more, you might have to try offering her a few different brands and flavours of wet food. Some other good ones to try besides Wellness are Innova Evo 95% venison or beef, Nature's Variety Instinct, and Precise has some good low phosphorus flavours as well. Does she like raw or lightly cooked chicken breast? That would be an excellent source of quality protein.

You can also top-dress her canned food with stuff like powdered freeze-dried meat treats (Halo Liv-a-Littles or Real Food Toppers, for example). Even pulverizing some of her favourite kibble and sprinkling it on top might help. Parmesan cheese or cat nip can also work.

Without knowing what you've already tried and what her blood work results are, I'd say that it's too early to go with a feeding tube, especially if it's just to force a completely inappropriate low-protein diet into her. How long is the vet thinking of keeping it in her? What happens when it comes out? It just doesn't make sense to me.
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Old November 5th, 2009, 10:56 AM
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Sorry, took me a while to respond and you've already answered some of my questions.

Quote:
Originally Posted by tiggy2 View Post
It's probably around 3 oz's of food, I've never measured it that way, but not enough to gain or maintain the weight.
Definitely needs to eat more. Try some of the tips I mentioned, but what you're aiming for is about 20-30 calories per lb per day. 3 oz of Wellness is only about 100-120 calories, and she needs at least 200 calories a day to maintain 10 lbs.

Quote:
Originally Posted by tiggy2 View Post
I am in agreement, so why do the vet's push it so much? For one thing it has tons of by-products in it.
They don't know any better. Vets get woefully limited education on feline nutrition, and what they do get is provided by the very pet food companies (ie Hill's) whose products they then sell out of their clinic. Big conflict of interest.

Quote:
Originally Posted by tiggy2 View Post
The suggestion of a stimulant was tossed out due to it's side effects of hard on the kidney's.
But starving and weight loss are even harder on the kidneys. As is a surgical procedure involving anesthetic. So if some of my tips to get her eating more don't work, I would seriously revisit the possibility of an appetite stimulant. You don't have to use it all the time. There is a good one called mirtazapine that is very effective.
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Old November 5th, 2009, 11:04 AM
tiggy2 tiggy2 is offline
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Thank you for getting back to me. I've just cancelled the feeding tube as I'm not 100% comfortable with it either and now that I have touched base with you guys I might be able to come up with some other solutions.

Tus does eat, just not a lot per feeding. She likes the Wellness brand and if she snubs that I sprinkle Sasha's blend on it and lap lap we go

I don't know what kind of supplements to give her. As for the appetite stimulant, it was tossed out because the vet felt it was too hard on Tus's kidney's. Are there other's that are not hard on the kidney's.

I will be asking for copies of the test results today and I hope you guys will stick with me to at least guide me in a direction..through the path of overload of information)

Thanks again
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Old November 5th, 2009, 05:12 PM
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mikischo mikischo is offline
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Quote:
Originally Posted by tiggy2 View Post
She was a little over weight, small cat in general. She should weight I figure around 10 pounds, but she has lost muscle mass. So aside from the constant weight loss, (1/2 pound a month), it's the muscle mass that concerns me.
Proteinuria can also be a contributing factor to weight loss and possibly muscle wasting as well. When you get the test results, please also post some results of the urinalysis, in particular the urine specific gravity (USG) and the protein number.

Quote:
Originally Posted by tiggy2 View Post
I've just cancelled the feeding tube as I'm not 100% comfortable with it either and now that I have touched base with you guys I might be able to come up with some other solutions.
Great.

Quote:
Originally Posted by tiggy2 View Post
I don't know what kind of supplements to give her. As for the appetite stimulant, it was tossed out because the vet felt it was too hard on Tus's kidney's. Are there other's that are not hard on the kidney's
For stimulating the appetite, one of the safest things you might want to try for starters are the B vitamins, in particular Vitamin B12 (cyanocobalamin). B12 is known to help stimulate the appetite. All the B vitamins are very safe as they are water soluble and any excess will be excreted in the urine.

Also, if you haven't already done this, raising Tus's food and water dishes off the floor can be helpful. Sometimes cats with CRF can experience some nausea and it can help if they don't have to lower their heads so far when eating or drinking.

Quote:
Originally Posted by tiggy2 View Post
I will be asking for copies of the test results today and I hope you guys will stick with me to at least guide me in a direction..through the path of overload of information)
Growler doesn't usually come on-line till very late and will likely be on late tonight. She is the most knowledgeable in explaining and interpreting the test results. If you get a chance to post the results today that would be great. For starters the most important numbers from the blood test are the urea, creatinine and phosphorus, including the reference ranges as well because they can vary slightly from one lab to another. Also the USG and protein numbers from the urinalysis.
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Old November 5th, 2009, 08:22 PM
tiggy2 tiggy2 is offline
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Ok got the blood test results, they are in mmol/L if that makes sense to you guys.

This was done Aug/25

Urea = 10.8 Ref. Range 6.4-11.8
Creat. = 162 Ref Range 67-157
Alk. Phos = 48 U/L Ref Range 14-49

This was done Oct/02
The Urinalysis came back with
PH = 6
Prot. = trace
USG =1.019

This was done Oct/02
Lab result of
ALT = 94 (Low 20 High 100)
BUN = 30 (Low 10 High 30)
CRE = 1.8 (Low .3 High 2.1)

The Aug blood work was a more in depth work up as opposed to the one in Oct.
Hope this makes more sense to you guys as it's rather over my head at this point

For stimulating the appetite, one of the safest things you might want to try for starters are the B vitamins, in particular Vitamin B12 (cyanocobalamin). B12 is known to help stimulate the appetite. All the B vitamins are very safe as they are water soluble and any excess will be excreted in the urine.

Can I try people vitamin B12, or do I need an animal one?

I have lifted the food up and I also give her Pepid AC 3 times a day (10mg cut into quarters)

I've put an email into the vet about your suggestions on Mirtazapine and the ACE Inhibitor's, I just hope she responds favourably, as I will need a prescription for them to try.

Anyway hope this info helps. Off to bed as Tus gets me up very early to feed her, she get hungary early
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Old November 5th, 2009, 11:14 PM
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Quote:
Originally Posted by tiggy2 View Post
Can I try people vitamin B12, or do I need an animal one?
People vitamins are fine and might be worth a try to help with appetite.

Quote:
Originally Posted by tiggy2 View Post
I have lifted the food up and I also give her Pepid AC 3 times a day (10mg cut into quarters)?
The Pepcid AC should definitely be helping if there are any issues with nausea.

The Alk Phos value that you posted is actually the alkaline phosphate value and is a measure of liver function. There should also be a value for Phosphorus somewhere in the test results.

It looks like the first test was done in International Units and the second one in U.S. units? In Canada International Units are normally used.

Given a diagnosis of early stage CRF and the issues Tus has been having with weight loss and lack of appetite, I am quite surprised that the urea and creatinine numbers are not higher, although the USG is definitely low.
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  #12  
Old November 6th, 2009, 12:23 AM
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growler~GateKeeper growler~GateKeeper is offline
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Hi Tiggy2, welcome to the CRF club

First lets talk about how Tus is feeling, what's her energy level like? does she sleep constantly are you having to wake her to feed, is she playing/active, interested in the world beyond the windows? Are her spirits high or is she cranky all the time?

Any unusual symptoms? Does she feel cold? Does she grind her teeth? Is she at the water bowl for long periods?

What's her poop like? How often is she peeing?

Good decsion not to go the feeding tube route at this point, as mentioned above lets try special toppings on the food & a bit of variety first. Will she eat cooked chicken breast? Duffy loves Purebites Chicken it definately helps encourage eating. I've also baked plain chicken breast pieces with even better results. Also adding in a different food once in a while helps peak interest in meal time.

Quote:
Originally Posted by tiggy2 View Post
Ok got the blood test results, they are in mmol/L if that makes sense to you guys.

This was done Aug/25

Urea = 10.8 Ref. Range 6.4-11.8
Creat. = 162 Ref Range 67-157
Alk. Phos = 48 U/L Ref Range 14-49

This was done Oct/02
The Urinalysis came back with
PH = 6
Prot. = trace
USG =1.019

This was done Oct/02
Lab result of
ALT = 94 (Low 20 High 100)
BUN = 30 (Low 10 High 30)
CRE = 1.8 (Low .3 High 2.1)

The Aug blood work was a more in depth work up as opposed to the one in Oct.
Hope this makes more sense to you guys as it's rather over my head at this point
Are all other numbers in normal range?

The Oct blood work in actually in US values in comparison to the Aug which is in SI units, so to make it easier to read I've converted it here:

................Aug................Oct
BUN/Urea...10.8...............10.71
Creatinine..162................159.12

The kidney numbers are fairly stable, dropping just slightly and honestly not that high. The other 2 you posted Alk Phos & ALT are liver enzymes which indicate the health of the liver but can increase due to the kidneys because most everything is filtered through them, just something to keep an eye on at this point.

Tus only has a trace amount of protein in the urine at this point I wouldn't think that was the main cause of the weight loss, more likely it is nausea especially since Tus is already on Pepcid.

What is more concerning at this point than the proteinuria is the USG, that's quite a low number for a cat not currently on fluid therapy. Have you noticed a marked increase in Tus' drinking & peeing? Has the vet mentioned Tus being dehydrated? If you were to run your finger along Tus' gums are they dry & sticky feeling or wet & slick with saliva?

Quote:
Originally Posted by tiggy2 View Post
For stimulating the appetite, one of the safest things you might want to try for starters are the B vitamins, in particular Vitamin B12 (cyanocobalamin). B12 is known to help stimulate the appetite. All the B vitamins are very safe as they are water soluble and any excess will be excreted in the urine.

Can I try people vitamin B12, or do I need an animal one?
Vit B12 is the one generally recommended but should always be under the direction of the vet as excess vitamins can be harmful, some multi-vitamins can be too high in vit a & d for a crf cat. Human varieties may not have appropriate values for cats needs most especially Taurine, plus they are weight based on an adult human. If you want to start a Vit supplement I recommend Nu Cat Senior your vet can order it in for you or if you have a smaller pet specialty or rawfood store they may carry it or you can order online.

Quote:
Originally Posted by tiggy2 View Post
I have lifted the food up and I also give her Pepid AC 3 times a day (10mg cut into quarters)
Did the vet recommend 3 quarters per day? Was she vomiting often? How is that working for Tus, have you seen a marked improvement with little to no vomiting/lip licking/nausea?

Quote:
Originally Posted by tiggy2 View Post
I've put an email into the vet about your suggestions on Mirtazapine and the ACE Inhibitor's, I just hope she responds favourably, as I will need a prescription for them to try.

Anyway hope this info helps. Off to bed as Tus gets me up very early to feed her, she get hungary early
Does she eat more in the morning feeding than the others? Do you give her a bigger portion size then? What time is the last feeding of the night?
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Old November 6th, 2009, 07:45 AM
tiggy2 tiggy2 is offline
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Wow you guys certainly zoom in on the topic, more so then the vet??

Anyway I'll just answer all the questions here with a starting story.

We moved from Ontario to NB last Sept/08, moved into new house Dec/08, I noticed Tus losing weight around Feb/09 and her breath was just terrible. She was not eating well and she would eat on one side of her mouth, so my first thought was teeth. Took her to first vet, we did blood work and they cleaned her teeth and took one tooth out. Charged an exorbitant amount of money for that $700.00 and I never took her back there again. At this point we are eating dry food and a different type then when we were in ON.

The weight continued to drop, found another vet, did the blood work. The Oct. ones and as you guys noted not a big indicator for CRF, but with the weigh loss and nothing else showing up we were leaning towards CRF.

At this point I was switching all of them to wet food and going through the "not wanting to eat this crap" hassle so I figured maybe that was why the weight loss.

I went back again in Aug. that's when they did the blood work in the office and then the urine test and arrived at the CRF. I was sent home with protein reduced food, (which of course she did not eat and I stopped giving) Benazepril for blood pressure and suggested to get pepid ac, as CRF cats are known to have stomache upset.

As for behaviour, the only real change is in the morning she is very agitated, I have to get up feed her and then she will settle down. I noticed she was licking her lips a lot and trying to vomit ( she vomited the first time about a month ago in 15 years). So she gets fed at around 5am then every 4 hours until 11pm. Most of the time she is looking for treats and if she is looking I give her food. If she snubs it, I put Sasha's blend on top and that does the trick. She likes the wellness Turkey and Salmon and there's one that has sardines in it, stinks real bad and I can't always get, it but that one goes down well. The BC (Before Grain) wet foods are a hit but can be expensive as they only come in small cans. The cooked meats are snubbed but I continued to try new things.

Her gums around her teeth seem pale and when she eats her food, which is wet, plus I add water to it, it's like she has to chew it, like it's too dry?? She is dehydrated. I talked to the vet about Sub-q fluids and she is hesitant due to the Sub-q's causing hyper tension in cats and screwing up the electrolytes in the body?

There is no phosphorus reading on the blood work, I guess they forgot that one?

As for drinking more, not that I noticed and as for peeing more not that I noticed and with a muti cat house hold I can't tell by looking in the kitty litter. I don't think she is going any more than usual. No one is the house hold has loose bowels, sometimes the stool can be dry and small.

If there is a way to track it let me know. In some ways she seems more in tune with her surrounding and I don't know if it's because she wants something and therefore is around more?

I guess that's the scoop, so where to go from here? I'm waiting to hear back from the vet on the info I sent her on the appetite stimulant and the ACE Inhibitors. Until then I'll have to continue with the feeding every 4 hours. Any suggestions on the dehydration?

Thanks again guys I can't thank you enough for helping me out with this. Takes a hugh weight off my shoulders. As you can tell I'm very new to the forums as I don't even know how to inset the quotes from others

Sorry if I did not answer the questions properly or to the correct person. I'll get it eventually. I'll even get some Pic's of the old gal so you can see who you're helping out
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Old November 6th, 2009, 07:57 AM
tiggy2 tiggy2 is offline
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PS
One little thing I thought I'd mention.

The hair on the back of the right rear leg is gone, from the join to the ankle. So one leg is partially bald. It's been like that since Feb or March. She also has feline ache, and therefore scratches her chin and mouth frequently. The ache I clean when I notice it.

Don't know if it has any relevance, but knowledge is power!!

Thanx
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Old November 6th, 2009, 08:22 AM
tiggy2 tiggy2 is offline
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An exciting update

My vet just called and we're going to put try Tus on the Mirtazapine for the Appetite and she's going to put her out and have a look in her mouth and stomach to see if anything is wrong as well put her on IV fluids for the day. We'll go from there.

So at least she's willing to look at other options and work with me
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Old November 6th, 2009, 10:32 PM
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Quote:
Originally Posted by tiggy2 View Post
Benazepril for blood pressure and suggested to get pepid ac, as CRF cats are known to have stomache upset.
Did they actually check her blood pressure & what was the number do you know? Or did they put her on the bp meds because of the CRF?

Quote:
Originally Posted by tiggy2 View Post
As for behaviour, the only real change is in the morning she is very agitated, I have to get up feed her and then she will settle down.
When they get hungry & aren't fed promptly sometimes the stomach acid will cause nausea since there is nothing in their stomach for it to work on, and that makes them cranky, especially if she knows the nausea is coming soon. My grrl usually gets me up around 5-530am for breakfast too

Quote:
Originally Posted by tiggy2 View Post
Her gums around her teeth seem pale and when she eats her food, which is wet, plus I add water to it, it's like she has to chew it, like it's too dry?? She is dehydrated. I talked to the vet about Sub-q fluids and she is hesitant due to the Sub-q's causing hyper tension in cats and screwing up the electrolytes in the body?

There is no phosphorus reading on the blood work, I guess they forgot that one?
Re Phosphorus on the test, depends on which test they ran, most of the standard tests do check for phos, calcium, potassium etc.

Did the bloodtest have RBC, WBC, Hgb, PCV, HCT, MCV on it?

A couple of the symptoms you've mentioned (pale gums, lack of appetite, vomiting, lip licking, that specific "chewing" action with the watered wet food, blood pressure meds) are making me think anaemia. To check for this the Packed Cell Volume or Haematocrit needs to be tested. Ask your vet about checking the red blood cell levels for anaemia before she is anaesthetized. While she is looking at her teeth she can also check for mouth ulcers which are also common in CRF cats, can cause lack of appetite & the teeth-grinding-like chewing.

Quote:
Originally Posted by tiggy2 View Post
As for drinking more, not that I noticed and as for peeing more not that I noticed and with a muti cat house hold I can't tell by looking in the kitty litter. I don't think she is going any more than usual. No one is the house hold has loose bowels, sometimes the stool can be dry and small.
Most likely she is peeing more considering she is not concentrating her urine as she should be, plus drinking more to compensate for the water loss, this is reflected in the dehydration & the small dry poops. Often the CRF cat's body will pull water from everywhere (including poop) in order to reuse it throughout the body (which is why they normally concentrate urine), this attests to their desert heritage & low frequency of water drinking.

Quote:
Originally Posted by tiggy2 View Post
Any suggestions on the dehydration?
Depending on Tus' disposition you can have the vet show you how to properly syringe-feed water, this stresses many cats out far more than the benefit of the additional water so that may be a deciding factor there. There is also the option of a water fountain - some prefer running water, or adding a small amount of flavouring to the water - boiling a plain no salt added chicken breast & using some of the now-chicken-flavoured-water from that to add into the bowl.

The hair loss on the back leg could just be ill-health related, unless she is reacting to fleas, laundry soap from the blankets, etc. Have you noticed her washing alot there? Is she pulling the hair out?

Re the acne - what type of bowls do you use for food & water? Plastic? Stainless steel? Plastic bowls have been known to harbour bacteria even after repeated washings which may cause feline acne in some cats as they contact the sides of the dish.

Through the years I've also noticed my dogs & cats (who don't use plastic bowls, except for the current water fountain) have gotten short duration acne in their "teen years" 12-15yrs that clears up fairly quickly not to return.
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  #17  
Old November 7th, 2009, 07:27 AM
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Hi Growler

Thank you for getting in touch with me. Your advice helps keep me on track and not get lost in the tons of information out there Allows me to zero in on specific areas

Did they actually check her blood pressure & what was the number do you know? Or did they put her on the bp meds because of the CRF?

No checking of blood pressure, just put her on it with the assumption of high blood pressure. Any issues with putting her on it without checking blood pressure. Vet said it was very difficult to check cat's BP

When they get hungry & aren't fed promptly sometimes the stomach acid will cause nausea since there is nothing in their stomach for it to work on, and that makes them cranky, especially if she knows the nausea is coming soon. My grrl usually gets me up around 5-530am for breakfast too

I try and feed her as late as possible, but between 5 and 6 up we must get. Of course the rest of the guys are just loving this early morning feeding. They are getting into the habit now

Re Phosphorus on the test, depends on which test they ran, most of the standard tests do check for phos, calcium, potassium etc.

They forgot the Phosphorus test on this one, we're going to see if they still have a sample of her blood and can check it and of course do a check this time around.

Did the bloodtest have RBC, WBC, Hgb, PCV, HCT, MCV on it?

None of those things were on it. It was a "Senior Wellness " test

A couple of the symptoms you've mentioned (pale gums, lack of appetite, vomiting, lip licking, that specific "chewing" action with the watered wet food, blood pressure meds) are making me think anaemia. To check for this the Packed Cell Volume or Haematocrit needs to be tested. Ask your vet about checking the red blood cell levels for anaemia before she is anaesthetized. While she is looking at her teeth she can also check for mouth ulcers which are also common in CRF cats, can cause lack of appetite & the teeth-grinding-like chewing.

I will ask her to check for anaemia as well. Thanks for the heads up on that one.


Most likely she is peeing more considering she is not concentrating her urine as she should be, plus drinking more to compensate for the water loss, this is reflected in the dehydration & the small dry poops. Often the CRF cat's body will pull water from everywhere (including poop) in order to reuse it throughout the body (which is why they normally concentrate urine), this attests to their desert heritage & low frequency of water drinking.

I'll try and keep an eye on her and catch her going into the litter box, might be able to see if she is at least peeing large amounts.

Depending on Tus' disposition you can have the vet show you how to properly syringe-feed water, this stresses many cats out far more than the benefit of the additional water so that may be a deciding factor there. There is also the option of a water fountain - some prefer running water, or adding a small amount of flavouring to the water - boiling a plain no salt added chicken breast & using some of the now-chicken-flavoured-water from that to add into the bowl.

I have 2 water fountains, 1 in the kitchen and 1 close to the bedroom for the arthritic cat, she doesn't have to walk as far at nite. But putting a chicken flavour to the water might work. Would the chicken additive also add bacteria? Would I have to clean it out every day? Force feeding is not top on my list. This was one of the reason the vet wanted to put a feeding tube in was to get more liquids into her

I've also onto putting low sodium tuna water into the cat food and making it very soupy. But did I read somewhere that tuna is not good for cats? If I can do this option. I would blend the tuna up and use it as an additive to the cat food and make her food even soupier.


The hair loss on the back leg could just be ill-health related, unless she is reacting to fleas, laundry soap from the blankets, etc. Have you noticed her washing alot there? Is she pulling the hair out?

She maybe doing it to herself. If I catch her licking that area I get her to go to another area.

Re the acne - what type of bowls do you use for food & water? Plastic? Stainless steel? Plastic bowls have been known to harbour bacteria even after repeated washings which may cause feline acne in some cats as they contact the sides of the dish.

She used to use plastic, but I've changed to glass bowls as I read about the plastic and ache. She's had this for most of her life and sometimes it will get so bad that her chin get all swollen from large under the skin growths. I use an antiseptic wash for a couple of days and it goes away. It also goes around her mouth and of course she scratches it making it worse. It comes and goes, maybe she has PMS

Through the years I've also noticed my dogs & cats (who don't use plastic bowls, except for the current water fountain) have gotten short duration acne in their "teen years" 12-15yrs that clears up fairly quickly not to return.

Hopefully she will grow out of it


I have a question since you obviously have a multi animal house hold. How do I keep my other kitties from getting any fatter with me feeding Tus every 4 hours? I could put Tus in a separate room but I'm afraid they'd pick on her more. She's lowest on the totem pole.

Also how to you put in the quotes from your posts, so I don't have to bold them
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Old November 7th, 2009, 11:50 PM
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Quote:
Originally Posted by tiggy2 View Post
No checking of blood pressure, just put her on it with the assumption of high blood pressure. Any issues with putting her on it without checking blood pressure. Vet said it was very difficult to check cat's BP
The problem I have with that is it is a potentially unneccessary medication. There are a few different bp meds that are commonly used in cats but the blood pressure should be monitored during use otherwise how does the vet know if they have the correct dose or when they need to increase the dose? Depending on certain bloodwork numbers some of the meds should be avoided for potential conflicts, ie some meds may cause increase in potassium levels which should be avoided if a cat already has high potassium, some meds may exacerbate anaemia, etc.

Some vets won't check a cats bp because they feel the cat's bp is not going to read accurately in clinic due to stress but that likely would only affect it by about 20 pts. With the proper equipment it's not difficult to check, they shave a small area on the back leg place the cuff & check the reading, ideally it should be between 120-149. My CRF cat had her bp checked during 2 stressful exams from vet's she hadn't seen before in unfamiliar clinics one being the Emergency vet and both times her bp was 120, perfectly normal.

Quote:
Originally Posted by tiggy2 View Post
They forgot the Phosphorus test on this one, we're going to see if they still have a sample of her blood and can check it and of course do a check this time around.

None of those things were on it. It was a "Senior Wellness " test
Phosphorus especially & calcium are very essential parts of the CRF diagnosis and treatment course.

The Senior Wellness panel should have at least 25 entries under Blood Chemistry (phos, calcium, ALT, Alk Phos, BUN, Crea, Glucose, Albumin, globulin, sodium, CPK etc) plus a Complete Blood Count (WBC, RBC, Hgb, PCV, HCT, MCV, plasma count etc) tested and the Urinalysis.

Perhaps they have the same name for a different series of tests. The full test might be called a Feline Senior Complete Panel.

Quote:
Originally Posted by tiggy2 View Post
I'll try and keep an eye on her and catch her going into the litter box, might be able to see if she is at least peeing large amounts.
It's not always large amounts but may be more frequent trips.

Quote:
Originally Posted by tiggy2 View Post
I have 2 water fountains, 1 in the kitchen and 1 close to the bedroom for the arthritic cat, she doesn't have to walk as far at nite. But putting a chicken flavour to the water might work. Would the chicken additive also add bacteria? Would I have to clean it out every day? Force feeding is not top on my list. This was one of the reason the vet wanted to put a feeding tube in was to get more liquids into her

I've also onto putting low sodium tuna water into the cat food and making it very soupy. But did I read somewhere that tuna is not good for cats? If I can do this option. I would blend the tuna up and use it as an additive to the cat food and make her food even soupier.
The "chicken water" won't add bacteria - it's cooked & you probably don't need very much. You could always try a small amount a tablespoon or two in a regular bowl of water see if they like it before adding it to all the bowls.

Tuna is very addicitive for cats sometimes to the point where they refuse to eat anything else. It also is high in sodium and depletes the body's store of vitamin e causing an imbalance. Try plain slightly warm water.

Quote:
Originally Posted by tiggy2 View Post
I have a question since you obviously have a multi animal house hold. How do I keep my other kitties from getting any fatter with me feeding Tus every 4 hours? I could put Tus in a separate room but I'm afraid they'd pick on her more. She's lowest on the totem pole.
I used to have a multi pet household, right now I just have my CRF grrl Duffy. When I did, the 2 cats were always either fed at opposite ends of the room or in different rooms. My last dog was fed also in a separate room & the 2 dogs before him were fed in the same room but opposite ends.

You could feed Tus her regular meals in a separate room, and the others a small treat instead of full meals like Tus.

Quote:
Originally Posted by tiggy2 View Post
Also how to you put in the quotes from your posts, so I don't have to bold them
When you read to the bottom of my post there is a button on the right hand corner that says Quote when you click that it will put my entire response in your reply box.

To separate into different quote parts - in your reply box you can either highlight what you want & click the pale yellow button to the left of the # (on the same line of buttons where the Bold is) that will separately quote only what you've highlighted. Or in your reply box with a full post quoted you can copy the code that starts the quote looks like this [QUO to the end of the numbers be sure to include the end bracket ], then paste that infront of the line you want and at the end of the line type [/QUOTE] you can then separate one post into several quotes and type a response in between, this way you can also remove extra wording.
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  #19  
Old November 8th, 2009, 10:26 AM
tiggy2 tiggy2 is offline
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Her CL is high could just mean she is dehydrated and her CO2 is high which also could just be dehydration and could be causing the acidic issues.

I think I have all I need to do this time around. Of course we're checking her mouth and I'll be putting her on IV fluids for the day. At least that will help. This vet is not to keen on Sub-Q fluids, supposedly there are new studies out that say that Sub-Q fluids can cause Hypertension in cats. It's better to have them ingest the fluids, if only it was that easy)

Thanks again for all your assistance. I'll keep you in the loop about tomorrow.

If I missed anything let me know as I know you'll pick this up later and I'll get your response before I go in tomorrow)
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Old November 8th, 2009, 10:28 AM
tiggy2 tiggy2 is offline
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OK

My post got all messed up and I had the whole thing done

and I did it the right way too, I was sooo proud. Now I'll have to go back and redo it.

So what you see above is the last bit
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Old November 8th, 2009, 10:48 AM
tiggy2 tiggy2 is offline
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Quote:
Originally Posted by growler View Post
The problem I have with that is it is a potentially unneccessary medication. There are a few different bp meds that are commonly used in cats but the blood pressure should be monitored during use otherwise how does the vet know if they have the correct dose or when they need to increase the dose?
I'll be asking to have her BP done tomorrow and as it is she has a bald spot on her back leg already I presume it would not matter that she is anaesthetized for it?

Quote:
Originally Posted by growler View Post
vets won't check a cats bp because they feel the cat's bp is not going to read accurately in clinic due to stress but that likely would only affect it by about 20 pts.
This is what my vet said, and that it stressed the cat out and that it's hard to keep the cat still.


Quote:
Originally Posted by growler View Post
Senior Wellness panel should have at least 25 entries under Blood Chemistry (phos, calcium, ALT, Alk Phos, BUN, Crea, Glucose, Albumin, globulin, sodium, CPK etc) plus a Complete Blood Count (WBC, RBC, Hgb, PCV, HCT, MCV, plasma count etc) tested and the Urinalysis.

Mine has 15 ( Sodium, Pot., NA:K Ratio, Chloride, Calcium, Urea., Creat., Glucose, Alk. Phos., ALT (GPT), T. Pro., Albumin, Globulin, A;G Ratio and T4 baseline.) The Urine test was just, Ph, Prot., and USG.

Supposedly they have a blood test specific for CRF so I guess we'll be going for that.

Quote:
Originally Posted by growler View Post
"chicken water" won't add bacteria - it's cooked & you probably don't need very much. You could always try a small amount a tablespoon or two in a regular bowl of water see if they like it before adding it to all the bowls.
A good idea, I'll put some in a bowl for her and put it by her sleeping spot.


Quote:
Originally Posted by growler View Post
Tuna is very addicitive for cats sometimes to the point where they refuse to eat anything else.
Thought it was too good to be true

I only use it as an additive. I also found she like chicken and broth baby food. Also use it as an additive, for those fussy days, I put a small amount on top of the wet cat food

Quote:
Originally Posted by growler View Post
could feed Tus her regular meals in a separate room, and the others a small treat instead of full meals like Tus.
I'll try this and/or feed the fat cats less.

Quote:
Originally Posted by growler View Post
in your reply box with a full post quoted you can copy the code that starts the quote looks like this [QUO to the end of the numbers be sure to include the end bracket ], then paste that infront of the line you want and at the end of the line type
you can then separate one post into several quotes and type a response in between, this way you can also remove extra wording.[/QUOTE][/QUOTE]

Thank you for this, now I don't feel like a . Of course I had to do it twice, I'll consider it practice

So tomorrow is the big day for Tus, I think I have all my notes.. I need to have her HCT and HGB checked to see if she is anemic. She also has high ALT which could indicate liver damage or issues with her bile duct. Her potassium is very low, so I'll need some supplements for that, (any suggestion).

The rest of the post is below, now you have it all

I'm just gonna post this without checking it, that's how I lost the last one, so I apologies for any mistakes.
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Old November 8th, 2009, 09:28 PM
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Originally Posted by tiggy2 View Post
I'll be asking to have her BP done tomorrow and as it is she has a bald spot on her back leg already I presume it would not matter that she is anaesthetized for it?
They should do it before anaesthia cuz once she's under her heart rate & bp will be slightly slower & more even thus creating a false reading. It takes less than 5 mins for a check.


Quote:
Originally Posted by tiggy2 View Post
I also found she like chicken and broth baby food. Also use it as an additive, for those fussy days, I put a small amount on top of the wet cat food
Just be sure there are no onions in the baby food.

Quote:
Originally Posted by tiggy2 View Post
I need to have her HCT and HGB checked to see if she is anemic. She also has high ALT which could indicate liver damage or issues with her bile duct. Her potassium is very low, so I'll need some supplements for that, (any suggestion).
ALT is still in normal range so I wouldn't worry too much about that right now, unless she is showing signs of liver issues. The values do fluctuate all the time so it might have just been on the high side of normal when they tested her and lower at some other point during the day.

She has low potassium? Is it still in normal range or below that? The vet will have supplement options for you, potassium should never be supplemented without vets approval as it can be very dangerous if not neccessary.

Quote:
Originally Posted by tiggy2 View Post
Her CL is high could just mean she is dehydrated and her CO2 is high which also could just be dehydration and could be causing the acidic issues.
Yes high CL can indicate dehydration and the conflict with low potassium levels may result in metabolic acidosis (excess stomach acid, nausea etc) though there are other factors in that equation.

Tus for tomorrow
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  #23  
Old November 9th, 2009, 07:31 PM
tiggy2 tiggy2 is offline
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Hi Growler

I'll just post a brief update as I don't have all the info until all the test results come back tomorrow. We have to send out some of our tests.

SO far Tus is not anemic . Her kidney readings have not changed very much and the protein in her urine has decreased. A good sign in some ways but it does not explain the not eating and the upset stomach and extra acid. Her throat is irritated, could be because she has been throwing up this weekend, something she has not done before Not in 15 years

We are waiting on the other test results but are afraid it could be stomach cancer as the kidney's do not seem to be a major issue and if her liver is good then I am at a loss as to what is causing the upset stomach and extra acid.

So another sleepless nite, but at least she's home I'm feeding her some baby food now and then I'll blend up the cat food to make it easier on her throat.

I'll get copies of the test results tomorrow and post them and then I'll have to dive into more research if nothing shows up.

Thanks for hanging with me and keep the paws crossed for some good news.

Chat tomorrow
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Old November 9th, 2009, 09:15 PM
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To help sooth her throat and stomach, mix 1/4 tsp of slippery elm bark powder in with the baby food (along with an extra couple tsps of water).

All fingers/toes/paws here are crossed that you're not dealing with something as serious as stomach cancer.
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Old November 9th, 2009, 11:06 PM
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Good there is no anaemia that is it not stomach cancer or pancreatitis
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  #26  
Old November 11th, 2009, 11:52 AM
tiggy2 tiggy2 is offline
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Ok I have all the test results but we, vet and I are still at a loss as to what's wrong with Tus. The vets's main concern is with her USG which is 1.020, which is too diluted. Her cholesterol and Alk Phos. are on the high side as well and I'm thinking maybe cushing's disease?

Anyway I'll post the results with the reference next to it, see if anything pops with you.
Reference
Sodium 154 149-156
Potassium 4.2 3.3-5.2
Na:K Ratio 37
Chloride 121 112-122
Calcium 2.59 2.28-2.85
Phosph. 1.38 0.94-1.95
Urea 11.6 6.4-11.8
Creat. 145 67-157
Cholesterol 6.31 1.80-5.83
T. Bili 1 0-4
Alk. Phos. 54 14-49
CK 181 58-489
AST (GOT) 27 11-44
ALT (GPT) 60 34-90
Gamma-GT 0 0-6
T. Pro. 69 65-84
Albumin 32 25-37
Globulin 37 35-54
A:G Ratio .86 0.50-0.90
Lipase 100 16-139

WBR 9.0 4.7-17.0
RBC 8.58 6.4-11.5
HGB 124 89-156
HCT .368 .28-.44
MCV 42.9 35-52
MCH 14.5 12-17
RDW 22.9%
Retics .41% = 35.18 x 10E9/L


WBC Diff. (%) (x10E9/L)
Segs 64% 5.76
Eos 17% 1.53
Lymph 13% 1.17
Mono 6% 0.54

NRBC / 100 WBC


PLASMA
Protein 72 g/l

RBC Morphology
Heinz NONE

So there you have it

Some I understand, some I don't.

So any ideas or suggestions on what to look for or where to look would be appreciated, as I don't think the kidneys are the main issue, they are a factor but there is something else going on that needs to be addressed.

Right now we have her on Pepid AC, I have a script for Zantex liquid, if the pepid is not working. I think I'll try and track down some of the slippery elm bark. Also have her on Amitriptyline - 5mg in the evening to help with her appetite and hopefully her gnawing on her back legs, and I still give her the benazepril, but I might give it to her every other day, still debating that one.

Anyway back to the drawing board, as the vet still thinks it's a cancer that has not manifested itself. Maybe so, but this illness has been going on for almost a year now, seems kinda long for a cancer and no serious decline

Also looking into poisons plants a long shot, but you never know
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Old November 11th, 2009, 11:58 AM
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tiggy - Growler is normally the one who reads the test results. She normally is on later in the day, although Wednesday is her day off, maybe she will pop in a bit earlier today.
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Old November 11th, 2009, 02:50 PM
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Hi Chris21711

Do you know anything about cushing's disease or anyone else have knowledge on it. If someone had some knowledge about it I might be able to rule it in or out as an illness.

Thanks for the response.

I guess Growler has gotten very good at reading tests results
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Old November 11th, 2009, 03:39 PM
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Quote:
Originally Posted by tiggy2 View Post
Do you know anything about cushing's disease or anyone else have knowledge on it. If someone had some knowledge about it I might be able to rule it in or out as an illness.
Cushing's is extremely rare in cats, and usually manifests as uncontrollable diabetes. What makes you suspect Cushing's? One thing I don't see on your lab results above is a blood glucose value. Do you know if they tested for it?
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Old November 11th, 2009, 05:51 PM
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Hi

The only glucose I have is just the Glucose at 6.1 which is a little high as 6.7 is the top of the scale.

As for cushing's. I read that having high ALK Phos. and high Cl values could indicate cushing's as well as the USG of around 1.020. That's the only guess I have and believe me it's a guess. I'm grasping at anything to find out what's wrong with Tus as I don't want her suffering if it's something terminal or if it's something that can be fixed.

So any suggestions on what it could be I'm all ears..or eyes in this case)
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