Ailing Chf/ckf Cat... Meds Hurting?

[mark87]

Hi all,

I'll try to keep this short and to the point. I have a cat (~20 years old) with several health issues that up until recently we had been managing well.

Conditions: Feline Leukemia, hyperthyroidism, congestive heart failure, kidney failure

Current meds: Methimazole (hyperthyroidism), Enalapril & Vetmedin (CHF).

She was diagnosed with CHF about 3 years ago. We thought she wouldn't live more than a year at best, but she's had no return of heart symptoms since her first onset. In fact, she has been off of the Lasix for more than a year. In that fist year, she was also diagnosed with Hyperthyroidism. We put her on Methimazole, which slowly 'unmasked' her kidney disease. We first began putting her on a kidney diet about 8 months ago, which she never really took to, so we eventually resorted to feeding her what she would eat (she's quite picky). Over the past 2 months, her appetite has quickly decreased to nearly non-existent, and she has lost a ton of weight. I understand this to be directly related to her kidney issues and build up of toxins in her system making her not want to eat.

My question: Are these medications helping or likely making this worse? I know this seems like a silly question to ask over the web, but hear me out on my reasoning. I know that most medications are taxing on the kidneys. She was diagnosed with heart failure, but has had no return of symptoms for three years. She's even stopped taking her medicine for nearly 5 days before while I was out of town, and still had no return of symptoms. Additionally, she is taking methimazole, which is known to affect appetite and be hard on the Kidney. Now I can barely get her to eat at all. From what I understand, not controlling hyperthryoid can be taxing on the heart. However, given the alternative to her withering away, would that be more ideal at this point? I feel like the #1 priority should be addressing what is best for her Kidney, and her heart seems to be doing much better than the kidney at this point.

I also know that she is mortal. I'm just trying to make sure that the kidney issue is not being primarily contributed to by unnecessary medications, and if these medications are 'buying her time' that she's never going to be able to use, due to them killing her kidney.

Any guidance is appreciated.. Also, in knowing that I am likely to have made improper assumptions, please feel free to correct any misunderstanding on my part.

 

[white shadow]

Hi mark87 !

Wow......she's amazing!
Just one quick suggestion....there's one thing for sure: unless you deal with the nutrition immediately - probably by syringe feeding, she will develop yet another (often fatal) condition, "fatty liver disease" ("hepatic lipidosis").

Here's a post I made a while back about to syringe feed: Nico-Wasting away, help In case the video in there doesn't work, it's also here:
I'd also be starting her back on those meds.

And, I wouldn't be making any assumptions about anything....I would be getting her re-assessed, though.....and using that to determine where 'she's at'/what might need adjustment......remembering that she'll need a little time to stabilize first.

 

[Mamanyt1953]

There is not one thing I can add to what white shadow has advised. Do have her reassessed, and don't be afraid to ask about her quality of life, and what the vet would do if it were his own cat.

 

[mark87]

Thanks to white shadow and Mamanyt1953 for your thoughtful responses. I apologize for not having responded sooner - I was out of town when she took a turn, so I left very soon after posting to drive back home. I've since taken her to the vet, and had blood work and a urinary analysis performed.

What came of vet visit: the doctor says her kidney levels are off the charts, and that she is most definitely in Kidney failure (referring to some ratio or number that is normal ~30, while hers is in the 120's... She gave me instructions to make her comfortable and to get her to eat in any way possible. She sent me home with an appetite stimulant - Mirtazepine - we gave her the high end recommended dose, and she has had zero response to it. In fact, she seems very lethargic and withdrawn at this point. Not sure if I will give this again.

She also suggested a feeding tube, depending on how far I was willing to take it, saying that she has seen many cats live quite a while with them. I'm wasn't sure how I felt about this. They also administered sub-q fluids, which seemed to really make her skin 'snap back' a lot faster than it was. However, her skin as of this morning was already 'tenting' again. Finally, I was informed today that her urinary analysis prove a UI, and send me home with an antibiotic.

What we are doing now: We have begun syringe feeding her today, and I added a calorie gel to the mixture (gel is low phosphorus and sodium). I also began administering the antibiotic this evening (amoxicillin). She still seems very weak and stumbled around a bit when she is up to drink and use the litter box.

Moving forward: The vet doesn't recommend the sub-q fluids more than 1x per week due to her heart failure. However, I'm wondering how logical this is, considering how well managed her heart failure is (she doesn't even need the diuretic), paired with the chronic dehydration. I'm wondering if, considering the alternative, it may be worth it to try 2x a week at least.

Questions: 1) Does anyone have any suggestion for the dehydration aspect? I've considered giving flavorless Pedialyte in her water, but am not sure if this will interact with the CHF. 2) Does anyone have experience with the feeding tube, and/or would recommend it, at this point?

 

[mark87]

Also - white shadow -- I didn't syringe feed Bella nearly as much as you, I maybe did 5-10 mL each of the three times I fed her today, out of fear of her getting nauseous and throwing it up. After watching your video, I think I'll try doing more.

 

[white shadow]

Hi again.
Now, I don't have a lot of time, so I'll have to just drop some replies/notes.

Just to your last post on amounts of food....the basis of how much MUST be considered in calories, not in liquid measurements, e.g. ml/oz. That said, you need to 'up' the quantity substantially. One of the links I'll give you speaks to syringe feeding, so I'll suggest you take that in. Don't expect to replicate the amounts you see in the video, especially at this stage - that shouldn't be your immediate goal.

That same link also speaks to feeding tubes....I heard your reluctance, but I'd really encourage you to hear the reasoning behind their use. The fact that your Vet is saying it's an option tells me she could manage the insertion and it would probably benefit her. If its temporary use could stabilize her, it would make for a much better overall situation.

This link is a reliable piece of reading (people in the know about kidney cats consider this site 'The Oracle' [!])...some won't apply, so you can skim over those parts. Early on you'll see a reference to Vitamin B injections that can make a remarkable difference (suggest you ask for them right away).

OK, here it is: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Persuading Your Cat to Eat

Each major area in there has direct links. (The top left corner of that page has a 'Table of Contents' with these.) Make sure you've covered/understood these sections:
http://www.felinecrf.org/persuading_cat_to_eat.htm#calorie_needs - Caloric Needs
http://www.felinecrf.org/persuading_cat_to_eat.htm#vit_b - Vitamin B
http://www.felinecrf.org/persuading_cat_to_eat.htm#assisted_feeding - Assisted Feeding
http://www.felinecrf.org/persuading_cat_to_eat.htm#mirtazapine - Mirtazapine

I think I agree with you about more frequent sub-q fluids....if necessary, you could always start a diuretic. Here's a snip from The Oracle about that:

For cats with CKD, it sometimes happens that the cat receives both sub-Q fluids (usually in small amounts) as well as a diuretic. This sounds counterintuitive but seems to work for some cats to keep them hydrated while controlling their tendency to develop fluid build up.
[2nd paragraph here: http://www.felinecrf.org/heart_problems.htm#needle_aspiration - Diuretics

The complete CHF section is here: http://www.felinecrf.org/heart_problems.htm#congestive_heart_failure - Congestive Heart Failure

The Mirtazapine? I would continue it....with some Vit B and fluids, it will be ready to kick in.

The antibiotic may cause diarrhea....the fourth paragraph here speaks to that and to the solution, a probiotic given in between the a/b doses (as far away in time as possible from the a/b dose): Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Antibiotics and Painkillers

Here are some notes on probiotics I have:

- dairy-free high potency probiotic - capsules (in refrigerator section)
- Natural Factors Ultimate Multi (what I use) or MegaFood's Megaflora​

There's an specialized online community for kidney cat caregivers sponsored by the woman who owns that website...I think you'd benefit from membership. They're here: Tanya's Support Group
You can read about how it works here: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Tanya's Support Group

Hope something there helps.
.

 

[white shadow]

'Thought I'd share another piece with you - just to try to have an clear 'picture' about the feeding tube issue - for an informed decision.....

This is the beginning of an article by a very well-respected feline Veterinarian:

Feeding Tubes For Cats
Lisa A. Pierson, DVM

Feeding tubes save lives and are not used as often as they should be for anorexic patients.

Unfortunately, when most people hear the term “feeding tube,” they tend to panic – feeling like this is the end of the road for their cat. However, feeding tubes should not necessarily be viewed as a doom and gloom overly heroic measure.

I often hear people say “oh, I would never put my cat through that!”

Unfortunately, these folks are not recognizing the tremendous value of feeding tubes.......​

The rest is here: Feeding Tubes For Cats - CatInfo.org
.

 

[Mamanyt1953]

Since you are getting more and more concise advice from white shadow than I could ever manage for you, I'm now going to hang back and be your cheering section . Or a shoulder, should you need that .

 

[mark87]

Thanks so much white shadow . I came home from work today and she seems even weaker and more dehydrated. Her back is 'tenting' when you pinch it. She is having trouble walking around even. She barely fought the food syringe this time. I have upped her food, but haven't seen an increase in energy.

I spoke with the vet this evening. She insisted that giving the 2nd round of sub q fluids in 1 week could prove fatal because of her Congestive Heart Failure, and said she wouldn't do it. My counter argument was that it seems very well controlled, in that she doesn't event need the diuretic. She called back a bit later and said that if I truly feel it would increase her quality of life for now, that she would, as long as I understand the danger. She added that her kidneys are 'gone' and that there's no 'slowing this down'.

As far as the feeding tube... we are getting food into her now at this point with the syringe, so that decision can wait I think, until we see if she is even going to respond to the food we've been giving her. I gave her 20 mL this morning of her renal food, mixed with a calorie booster, and another 20 mL when I got home about 1.5 hours ago.

I'm torn. I want to keep giving her food but am afraid it is to no avail and making her miserable. Should I reasonably expect to see a slight increase in energy after the food I've administered? Or would you think I'm expecting a slight improvement (rather than decrease) soon? I'm heading to the store now to get her some pedialyte - don't think that will make much of a difference, but worth a try.

 

[white shadow]

I think it's more about not expecting anything.....and 'simply' giving/offering her opportunity....no one knows what may/may not be the result. What is certain is that by not providing certain basics, she will only decline.

I would be getting the Vitamin B shot asap and the fluids.....I've given you the reading about fluids, diuretics and the balancing act involved (in the quote box there). On Vit B..."provision of B vitamins is simple and should be considered in all inappetent cats"

You might share that website with the Vet......and, seriously consider joining Tanya's group.....even, just join and watch/get a sense of what happens there.

 

[white shadow]

Check out the one section only...here Treat the Cat Not the Numbers: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - How Bad Is It?

Is there hope: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Is There Any Hope?

"Success stories": Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Success Stories
.

 

[mark87]

Thanks for all of the info, white shadow . Tanya's page is so informative, and you can tell the owner of the website is incredibly passionate about helping people deal with this terrible disease.

In all, I fed her about 60 ml worth of food from the syringe today (3 20 ml syringes), with the calorie gel added. Some of this was wasted as part of the 'mess' involved. I also forgot to mention she is a rather small cat -- weighing about 3.9 pounds at last check ~2 months ago, and considerably less now. For the last batch, I mixed in pedialyte. I administered her medications in a syringe of food as well, along with her antibiotic. I'm holding off on feeding her any more this evening. She is very weak, and stumbles around quite a bit when she walks.

I haven't seen her pee a whole lot, and I haven't noticed any bowel movements. She had been laying mostly in the meatloaf position, but is now resorting to laying on her side, resting what appears to be peacefully under the bed.

I'm going to reassess in the morning and consider calling the vet to administer the fluids. I'm wondering if it may be 'safer' to administer the fluids in smaller amounts. I will also inquire about the B vitamins. I'm also trying to arrange options for in-home euthanasia, in case the time comes.

Thanks for all of your advice so far. It's always relieving to have someone to talk to who can relate and offer advice from experience.

 

[Mamanyt1953]

She will remain on my candle list.

 

[mark87]

Hi all,

Bella passed today. Despite our best efforts, she began today barely even able to stand. She stopped drinking water yesterday due to weakness. I'm amazed at the rapid decline she took. We made the difficult decision to euthanize. I first called my vet, who said she believed it was time as well, given her high kidney levels and described QOL. We had a in-home euthanasia vet come over, and she whole-heartedly agreed that it was the right thing to do, due to her apparent suffering. She passed very peacefully in a window on a cat perch, with the sun shining down on her. We are pretty sure she was knocking on death's door before the vet even came. We had the option to ship her off for cremation, but instead drove her to a crematory in the Maryland countryside. It was rough, but I feel confident we did the right thing. I didn't realize how difficult it would be even just handing her body over.

Bella was an amazing cat with a remarkable story. I first found her in the late 1990's behind my dads shop in my family's rural Kentucky back yard when I was in 7th grade -- she had a litter of kittens in a rusted out, turned over barrel. Her kittens were feral, and wouldn't allow us to move them. Neighborhood dogs eventually killed them, and then half of a second litter she had (I'm still salty to this day that my parents didn't do more to help protect them, but this is sadly typical for country animals).

Many years passed. I went off to college, and graduated. She continued to be an 'outside' cat at my parent's house all this time, feasting on rodents and birds. Miraculously, she was never hit by a car or killed by dogs (a common end for cats in my hometown). She eventually began showing signs of hyperthyroid, and because my parents weren't seeking vet help for her, I took her in 'temporarily' to my place in nearby Lexington, a 'City' in comparison to her country upbringing. As soon as I brought her inside at my place, she soon developed Congestive Heart Failure, likely a result of the Hyperthyroidism. This is when I found The Cat Site. I posted on here in desperation on how to keep her alive, fearing she would die in a matter of weeks of months, at best. This site was an amazing support system for me. She pulled through and adjusted to her new living space very well, and became 'frenemies' with our other 2 cats.

Things quickly changed when my partner and I eventually moved from Kentucky to the Navy Yard in Washington DC for work. She lived here for about 16 months, until she died today. She had an intriguing life- born in the Kentucky countryside, living outside for 17 years, and then eventually moving to live a mile from the U.S. Capitol.

Thank you so much, white shadow , for being so attentive to a cat you don't even know across the country. It was very selfless of you, and I appreciate a stranger's thoughtful kindness in my Bella's last days. Thanks to the others on The Cat Site who were so supportive back in 2015 when I first came here. It was truly appreciated, and your kindness was deeply felt.

I'm leaving with a photo of Bella taken about 2 years, 8 months ago, right after we pulled her out of her first crash from Congestive Heart Failure.

IMG_9131.jpg

• mark87
• Mar 9, 2015

 

[mark87]

View attachment 207722 She will remain on my candle list.

Thank you for this. You posted this about an hour before she was put to sleep. It means a lot that a stranger was thinking of her in her final moments.

 

[Mamanyt1953]

The two of you remain close in my heart. She is not entirely gone, just...translated...although that is precious little comfort just now.

 

[betsygee]

So very sorry to read this news. We'll close this thread now out of respect for your loss. We invite you to post a tribute to your beloved kitty in our Crossing the Bridge forum.