Elderly cat with CKD and high blood pressure, leg weakness and urinary retention

blindasabat123

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My 17-year-old is on a renal diet with stage 3 CKD, and is also being treated for high blood pressure (now within normal range).

He's been a bit unsteady on his feet occasionally for a while - vet and I assumed leg weakness due to the CKD - but suddenly, over the last week or so, seems to have got much worse to the point where he now struggles to stand at all. The other problem is that he sometimes struggles to pee, and will climb in and out of the tray several times before he finally goes. It'll happen almost daily, but in the same day he'll also pee successfully the first time, so a blockage isn't the issue. And now, since his legs have worsened, he's had a couple of accidents - whether because he couldn't reach the tray or not, I'm not sure.

Going to try and arrange a video consultation with the vet tomorrow, but in the meantime, can anyone shed any light on what might be causing these issues? His appetite is fine (in fact, it's improved) and his overall spirit is still strong, but I can tell this is getting him down and it's upsetting to watch :frown:
 

KatherineE

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You might ask the vet about a B12 deficiency and supplementation. CKD cats tend to urinate more and lose B12. That in turn can cause muscle weakness. The same goes with potassium.

If you haven’t had a full blood panel done in a while, I’d start there.
 
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blindasabat123

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Thanks for the info, KatherineE. He hasn't been urinating any more than usual (once overnight and twice today), could it still be his potassium/b12 if urine volume is normal?
 

mrsgreenjeens

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Definiately it could be. I immediately thought "this sounds like low potassium", which can easily be raised with medication, and doesn't need to be a long term thing, as far as I know. But it IS serious if not taken care of. The low potassium is for the back leg weakness issue, but that could very well also be the issue with the urination. He simply may not have the strength to stay in the box long enough to relax his urethra long enough to pee.

Are you familiar with this website? http://www.felinecrf.org/potassium.htm It was my "go to" when I had kidney cats. See if the section on low potassium rings true, then discuss with your Vet.

Keep us posted.
 
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blindasabat123

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Thanks, mrsgreenjeens. I'm familiar with Tanya's CKD site and it's been a godsend, but there's a lot of information to wade through and it can get confusing for this layperson(!)

I should've mentioned in my OP, it looks like it's his front legs that are struggling more than his hind legs. He's been scooting around on his chest a bit today, I can tell it's exhausting him and it's horrible to watch :sniffle:

We've had two accidents this evening, too. Seems he's just refusing/unable to try and make it to the tray at all now :sigh: Hopefully the vet will have something useful to say.
 

mrsgreenjeens

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Hmm. Now that is something I'm not encountered, and believe me, I have read a LOT on kidney cats, having had three in my lifetime, not to mentioned trying to help out members here. And with your guy, it appears to be front leg weakness, not joint pain?

Have you tried using puppy pads for him to potty on? My 2nd kidney cat would try and try to make it to the litter box and if he got one foot in would think he was ok to go, so I put puppy pads all around it and then would praise the heck out of him when he got his little foot in the box and went :cloud9:.

Let us know what the Vet says.
 
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blindasabat123

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mrsgreenjeens He's been slightly more upbeat and mobile today, but still had a couple of toileting accidents (and subsequent trips to the shower!) :sigh: The room's already covered in puppy pads just in case, but thanks for the tip - great minds! :biggrin:

Meanwhile I've been watching him more closely, and although it's definitely mostly his front legs he does seem to be struggling a bit with his hind legs, too. His front paws will buckle underneath him, whereas his hind legs sort of stiffen and slide outwards, if that makes sense.

Video consultation with the vet tomorrow, so we'll see what she has to say.
 
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blindasabat123

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Oh, sorry, forgot to answer your question: it doesn't seem to be joint pain, no. No physical reaction when I touch any of his legs, although he does howl a bit when he's struggling to stand/move...
 
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blindasabat123

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Had a video consultation with the vet this morning. She's recommended he be seen in person to check for the possibility of arthritis or neurological disorders, so he's going in tomorrow.
 

mrsgreenjeens

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Ok then. If it does happen to be arthritis, Buprenorphine can safely be used for pain relief in kidney cats (I just checked it out on Tanya's site), so that's good.

:vibes::vibes::vibes:
 
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blindasabat123

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Back from the vet's.

Diagnosis is neuropathy in both front paws - generalised, so highly likely to be age-related and untreatable :sigh: - and arthritis in all four paws. Doesn't like to do things by halves, my boy! His blood pressure's also up, so his bp meds have been adjusted, and he's been put on a week-long course of Buprecare to see if it makes any difference to his mobility and incontinence.

Follow-up call due in a week, and I'm keeping everything crossed in the meantime...not sure how much longer I can keep doing 3-4 loads of laundry a day in a one-person household! :help:
 

mrsgreenjeens

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So your Vet thinks it's the pain causing the incontinence (due to just not wanting to walk because of either the pain or not being able to feel his paws due to the neuropathy?) Boy, I feel for your boy AND you with the clean-up. Having neuropathy myself, I know it's no picnic in the park. Does your Vet think it's causing him pain or numbness on the bottom of his feet? I do know there are some things out there now for humans (capzasin patches) that help with numbness, but not sure how they effect cats. Maybe, if it's pain vs numbness, the Bup will help and he will start feeling so much better that he will start using the box again, and soon :crossfingers: And, of course, BP effects kidneys, so all of the meds could end up helping. Let us know how he gets along.
 
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blindasabat123

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Last night was the first night in several without any accidents :hyper: Had his first dose of Buprecare this morning and has perked up to no end, peed in - or next to - the tray twice, and been much more alert and mobile since then :cloud9: Having said all that, his appetite's not as good today as it has been the rest of the week :rolleyes3:

mrsgreenjeens Sorry to hear you're suffering with neuropathy, too, sounds horrible! Vet said he was probably experiencing a "pins and needles" type sensation in his front paws, so I'll ask him about the capzacin when I speak to him next week.
 

mrsgreenjeens

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Bup doesn't typically effect their appetites, so not sure what that's all about. But how great that he seems to be feeling better! AND that he's trying very hard to get to his litter box. Woo Hoo!
 
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blindasabat123

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Appetite seems better so far this morning, must've just needed a good 💩:biggrin: No more accidents again overnight - one today, though, and slightly loose stools.

What's worrying me most today is that he seems to be intermittently confused and disorientated, and he's been pacing/circling quite a bit. Could those be side effects of the buprenorphine? He's also changed BP meds (to Semintra/telmisartan) and switched from tablets to liquid, so maybe it's that?
 

mrsgreenjeens

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The Bup could be the cause of the loose stools as it can cause gastrointestinal disorders. But so can the new BP med :sigh: (and that one can also cause loss of appetite) As to the other confusion and disorientation, I don't see that as a side effect of either medication, as long as the dosage is correct. I would give the Vet a jingle about that one.

If you aren't already aware, the Bup can actually lower BP, so that is something to keep on eye on, especially since they increased his BP meds. Not sure how you are to keep on eye on it since I doubt you can take his BP measurement at home. But just thought you should be aware of this.
 
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blindasabat123

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He's acting very strangely today, almost manic :sigh: Lots of pacing, non-stop yowling, hiding under the sofa/behind the bed (but only for a couple of minutes before he's out again). His temperature's fine, maybe a bit warm. Ate a lot this morning, with encouragement, but nothing since even though he's clearly hungry. Peed 4 times before the middle of the day, too - all in the tray, at least.

I've been trying to comfort him, and he'll purr and allow me to stroke his head for a couple of minutes before he's up and about again, pacing restlessly or hiding somewhere :frown: I'll be calling the vet first thing tomorrow.
 

mrsgreenjeens

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I did see when I looked up side effect of the Bup that it can cause pacing, and in dogs it can cause aggitation, so that may be what he is experiencing. Not sure about the yowling bit though. I can't find anything that would account for that at all. You might try cutting back on the dosage a little bit and see if that calms him down. since it's a pain reliever, I don't see how that could possible hurt him, except to let some pain through, which, or course, you don't want, but it might help him settle down. I didn't see anything on the other drug that might be causing this, BTW.
 
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blindasabat123

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Fingers crossed it is just a bad reaction to the bup. Thanks for all your help so far, mrsgreenjeens - I'll update when I've spoken to the vet tomorrow!
 
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