Cat With Crf, Ibd/lymphoma And Maybe Chf

[Mamanyt1953]

That would be problematic, but save it as a last-ditch, if necessary.

 

[Zel]

I will. Thanks for the reminder.

 

[Jem]

Hi!, I just wanted to tell you what my vet said about my kidney cat.
My Toby is in stage 4 CKD (CRF), we have (among other things) been giving fluids for the better part of 2 years, and he was doing very well.
Recently, I noticed that his abdomen had started to grow a bit. At first I thought he was gaining weight because he was really eating well for a while. But then, I noticed that he would not absorb all his fluids by the next time he was to be given his dose. After a few times of that happening, I then started to notice his breathing was a little faster, and only sometimes, depending on how he was laying down, or if we cuddled him with him on his back (we've stopped carrying him like this now).
We brought him to the vet. He believes he has ascites, as I suspected, and said there is a possibility that CHF has started. Our cat is not in a position to undergo any form of sedation, so any kind of imagery is off the table. So we are trying our best with blood work, physicals and common sense to make the proper treatment plan going forward.
Our vet said that we can't give him any diuretics for the ascites, and honestly told us to use our judgment about giving fluids. And suggested that small doses in multiple sites might help with more even absorption, but that it is still a good idea, like we have been doing, to limit the fluids and try to find the sweet spot between his need for fluid, his not absorbing well and his now retention.
At this vets visit, it was also found that he is now anemic. And when doing research on anemia, one of the side effects, is that it can cause CHF and/or fluid retention. When I found this information, I asked him if the anemia meds he is now on would help with the fluid retention, and he said maybe. Our boy is 20 and in stage 4, so we are hoping for the best, but our vet can't really say for sure, but in theory, it should at least prevent more fluid from accumulating as (if) his circulatory system works better.
I know I'm not giving you any real concrete answers, but one thing I did not see you post about your cat possibly having CHF is that it can also be caused by anemia, which is a common development in CRF cats. I was not sure if you knew this, and wanted to tell you. If you have any questions for me, feel free to ask.

 

[Zel]

Thank you Jem, this is super helpful. No, I did not know that anemia could cause ascites or CHF and for sure Zelda is anemic. I think I posted the numbers somewhere upthread, but the vet said at every bloodwork she is becoming increasingly anemic. What anemia meds is your cat on? Does the CRF cause the anemia? Also, did the acscites utimately resolve itself and the fluids get reabsorbed?

 

[Zel]

One more question--how do you judge when Toby needs fluids? Are there some signs you can tell--I know supposedly pinching the skin should show dehydration but I feel I am lousy at telling. I did not mention this but 9 days before the ascites, Zelda was in the ER and they diagnosed her with dehydration! Such extremes.

 

[Zel]

I just double checked and Zelda's PCV last week was 18%. Definitely anemic.

 

[Jem]

Yes the CRF causes anemia, the kidneys are supposed to produce something (I forget what exactly, but I can find it if you need to) that stimulates the production of red blood cells. As the kidneys start to fail, they no longer produce it leading to not enough red blood cells being produced (anemia).
Toby has only just started on the meds for anemia, so no changes on the fluid retention yet, but we are keeping our fingers crossed.
He is taking (injection) Erythrpoietin, 0.15mls 3x a week. This is a red blood cell maker stimulant that replaces what the kidneys don't produce. We will re check his values soon to see if this is a good dose for him.
Because the vet believes that the fluid seems to be (at least mostly) ascites, he is not extremely concerned about totally eliminating fluids, and obviously he still needs them for the CRF. So we judge how much fluid he needs based on,
1) if we feel any squishyness under his skin anywhere, he gets nothing.
2) sticky gums are a sign of dehydration, push his lips up and if they stick or the gums feel "tacky" he's probably dehydrated.
3) the skin test, but that is not super accurate for us either, as he has so much excess skin that even when hydrated it still takes a bit to go down.
4) Sunken eyes are a good visual tell, but I have not seen him get to that point for some time.
5) if he seems a bit more "sluggish" than usual, it can happen if we haven't given him any because he was "squishy" and didn't get any because of that.
6) if I've noticed that he has not peed as much as he usually does.

The absolute longest we've gone without giving fluids is 3 days, but he's supposed to be getting 100mls daily, so he does dehydrate quickly, even if he's retaining fluids internally (ascites). So yeah, I get the whole "extremes" comment you gave.
Honestly, this has all been recent (fluid retention) so we are still playing with the how much and when game. We are just thankful that vet believes that it's mostly abdominal fluid and not in his lungs or around his heart yet, and as long as he does not lay on his back or too twisted up, he can still breath well.
His care is completely palliative at this point, this new medication is the last thing we can do for him, so comfort and keeping him eating is our priority. there is very limited things that can be done when you combine CRF and CHF/fluid retention, as the treatment for each of them are counter productive to the other, so we are simply doing our best to find a balance.

As we move forward with his care for these new symptoms or I think of other things, I'll let you know, and of course ask me stuff too, let's face it, there is so much info rattling in my brain that I sometimes don't think of it until someone asks.

 

[Zel]

Thank you so very much. All of this is so fantastically helpful. I admit I feel kind of miffed at the vets for not assuming anemia could be the cause rather than wanting me to do very expensive test after very expensive test to rule things out. I will do the ECG but I am going to keep declining the second ultrasound. I am going to demand trying to treat the potential CHF and anemia first. The internist wanted me to do an ultrasound to rule out a very aggressive cancerous tumor. I wish they would try to treat the more likely causes first.

I am going to print out your list of dehydration signs so I can check Zelda.

I will let you know what the cardiologist says on Wed. Thanks again.

 

[Jem]

Keep in mind that even though the anemia can cause the CHF, the ultrasound can show how extensive the fluid retention is and where it is, (lungs, heart, chest, abdomen). The ultrasound will also show how much, if any, damage has been done to the heart, which is part of CHF. The thing is, depending on where they think the tumor is, and how much fluid there might be, it may not even be possible to see anything (the tumor) if the fluid is in the way. I remember my other cat who had CHF due to heart disease, we could not see anything in his ultrasound until they drained his chest and lungs. And also keep in mind that treating the anemia to help with the fluid retention is just a theory, although a good one.
I'm sorry, I'm not trying to confuse you more on what you should do about some of the tests they want to perform. Just wanted to clarify some stuff. Although if they only want to do the ultrasound because of a possible tumor....IDK why they would go there...but I'm not a vet.

 

[Zel]

My understanding is that the ECG is an ultrasound of the heart and we are going for that tomorrow. An ultrasound of the abdomen would be an additional charge and I am of the mind to wait and try anemia treatment first. The fluid was tested and did not have cancer cells in it. (Of course just like with most of these tests the absence of cancer cells does not mean for sure it is not there.)
I am trying to think economically as well because the specialty vets will take 10k very quickly. We are already in for about 4K. Honestly I think if she had a tumor that was so aggressive that it was not there at all on her ultrasound a month ago and is now causing fluid retention she would be dead already. She is honestly better without doing subQs than she was. I don’t want to pay to rule out every possibility. I would like to start treating what is most likely given all the tests we are doing.

 

[Zel]

Forgot to say that we did an X-ray on the ascites too.

 

[Jem]

Well that seems reasonable. I would probably hold off on the abdominal ultrasound as well, especially if it's only to test for the possibility of a tumor and the fact that you are getting his heart looked at with the ECG. We all want what's best for our kitties, but I know how expensive these tests can be too. There is always a chance of an "exception", but I too would be focusing on ruling out the most logical causes before getting into every test under the sun.
Keep us updated on what the ECG comes back with.

 

[Zel]

Thanks for the support! I will definitely post how tomorrow goes. This aggressive tumor hypothesis is a hypothesis. But we know, for 100% sure that Zelda is anemic. So I would really like to treat that after the ECG. I would not have been so vocal about the anemia without you posting your experience with Toby, so I appreciate that more than you can know.

 

[Mamanyt1953]

And do keep us posted. Although I had very little concrete information for you, I'm now very invested in Zelda. All of the cats here become, in some way, "our" cats as well, and we fret.

Lighting a candle for you both!

 

[Zel]

Thanks so much Mamanyt! I really feel all the love and concern coming our way. Each person that posted has helped me to make decisions and keep hope alive!

 

[Zel]

And here is a picture of Zelda with her daughter Maud. Zelda has the orange streak on her head. Maud had her nose surgically removed in Feb. because of a cancerous growth. She is cancer free and doing wonderfully.

 

[Zel]

Just finished cardiology appointment and am in waiting room. They said the ascites is due to heart disease. Unclassified cardiomyopathy. Probably worsened by steroids and subQs. We will try to get this under control. Am waiting on 3 prescriptions—Lasix to help flush out the fluids, plavix and something else I am forgetting. No subQs and half the steroid dose. Blood retest in 10 days to check kidneys. Best case prognosis is months.

 

[Jem]

I'm so sorry about the prognosis. We just lost one of ours 2 weeks ago due to CHF from cardiomyopathy. He did not develop the heart disease due to kidney disease though. We lost him about 3 months after diagnosis, and it was so hard because we had no prognosis, it was a, he may last 2 weeks or 2 years. I know how heart breaking it is. Just know that I'm still thinking of you and hope MANY happy months with your little one.

Will you still be treating the anemia as well in hopes that it will take some pressure off the heart?

 

[Zel]

Thanks Jem. I feel very sad about it. I'm sorry to hear about your loss too. SO hard. What was his treatment plan before you lost him?
Cardiologist said the anemia is on the back burner until the heart and ascites are under control. I will check on the meds and post them in case it helps someone else.
I am very, very glad I stopped the Subqs and steroids on my own. I felt Zelda's symptoms were matching heart disease and I could clearly see she felt better without them. We have to be our own vets sometimes.

 

[Zel]

Zelda is on Pimobendan, .05 twice a day,
Generic Plavix 75 once a day, and
Generic Lasix liquid .04 once a day (to flush the ascites)

She is also on Pepcid and anti-nausea. They gave me some empty gel caps to put all the pills into so I can give them to her in one go. Pretty cool. The smaller the pills are, the harder I find it to get down her in one go.
We may eventually add in a smaller dose of the steroids again.