Need help understanding cat's rapid CKD decline & vet saying euthanize if no improvement in 2 days

[silent meowlook]

I would limit her to a room, unless it is going to cause her stress. Just m as le sure your cat sitter warms her fluids.

 

[Joxer]

Do you think I should restrict her to one room? I’ve already closed off the downstairs since she seemed wobbly on the stairs. The upper level is only 900 square feet. There is water in every room and 2 litter boxes, which she has been using. I have been hand-feeding and she is eager to eat.

The vet mentioned transfusion as a later option. I’m going to call and ask how to know when she needs one to tide her over.

I’m having her cat sitter, who is a very experienced veterinary nurse, administer her fluids daily.

Regarding feeding, you can add water to Phoebe's food, especially to dry food. My experience, including with one cat who would never drink water from a bowl, is that cats eventually come to accept it. So if you put dry food in a bowl, then pour some water in it, which will make the dry food float on top, your cat has to drink the water in order to make the dry food stop moving around so she can eat it. This works to achieve a higher water consumption than would happen otherwise. I've had success with this approach in the long-term treatment of both constipation and recurrent urinary tract infections, both conditions having been caused by underconsumption of water.

 

[cowkittymom]

Sadly, Phoebe was very lethargic late last night & having trouble walking. I took her in today. Her RBC are up, but her creatinine is back up to 7. I wish I had noticed the kidney symptoms earlier. I think it's too late. I've decided to let her go tomorrow. I also have her littermate brother and small dog. However, she was my favorite pet.

 

[FeebysOwner]

How much sub-Q fluids have you given her? Maybe it needs to be increased for a period of time. I give Feeby 100 mls a day, and she has been getting that since last May.

 

[silent meowlook]

I am so sorry. Kidney disease is a horrible disease. I am so sorry. It sounds to me like you’re doing the right thing. She is terrified in the hospital, but being hospitalized is what she probably needs. Even with an extended hospital stay she will most likely wind up in the same situation again. Even with a blood transfusion, in my experience, it is only buying some time. Unless we’re talking acute blood loss or something like that.

I kept my cat rusty going for about three years in kidney failure with daily seven times twice a day sub Q fluids of dangerously high amounts. He wasted way to nothing, as they do. I finally did have him euthanized, but I know I waited far too long to do it, and I know that he suffered in the end.

Unfortunately, with kidney disease, unless it’s acute, it is not curable, only treatable provided the treatments work. But still not a cure, just prolonging the inevitable.

You will second-guess yourself and overthink this, and even regret whatever decision you do make. This is human nature. I think we all like to feel we have some sort of control over situation like this, and therefore can somehow change things. In reality really bad diseases happened to really good cats for absolutely no reason at all and, we have no control over it sometimes.

I wish you peace with whatever you do decide.

 

[cowkittymom]

Thank you for your wise message, S silent meowlook . I am at peace with my decision to euthanize Phoebe. Given the progression from 1.7 to 2.2 between August & the end of October, it does seem like her kidneys were rapidly deteriorating. Even though an abdominal ultrasound in October only showed mild degeneration consistent with age, during her annual exam in August, she had a strange finding of glucose in her urine despite not having high blood sugar. Guess this was a clue that her kidneys were more compromised than would be expected for an only 10-year-old cat.

I do wish I had recognized & taken seriously earlier that she was drinking & peeing even more than the higher baseline with prednisolone. It started sometime in February, which was a horrible month for me, so I had various random thoughts like "oh, the dog must have drunk all of the water" and since her littermate has a urinary blockage, I'm usually happy to see lots of pee clumps. I was also more focused on getting the prednisolone into her & making sure she ate enough.

However, even if I had recognized it earlier, it does seem like I would have only bought us a short amount of time, given the rapid progression for her. It is sad that there are no real treatments for kidney disease.

I'm spending my last evening with Phoebe, thinking back on the wonderful times we've had the past 10 years. She is still being such a good girl. Grooming her shaved legs and still managing to get off the sofa to pee in the litter box that I've placed next to it. She will be euthanized at home in the living room where she has spent hours watching the birds in the trees.

I've attached photos of us in healthier times. I love the selfie of her on my back, above my bun. I will eventually write a tribute to her in the Crossing the Bridge forum.

 

[silent meowlook]

What a lovely cat. I am so sorry.

 

[cowkittymom]

I am so sorry. Kidney disease is a horrible disease. I am so sorry. It sounds to me like you’re doing the right thing. She is terrified in the hospital, but being hospitalized is what she probably needs. Even with an extended hospital stay she will most likely wind up in the same situation again. Even with a blood transfusion, in my experience, it is only buying some time. Unless we’re talking acute blood loss or something like that.

I kept my cat rusty going for about three years in kidney failure with daily seven times twice a day sub Q fluids of dangerously high amounts. He wasted way to nothing, as they do. I finally did have him euthanized, but I know I waited far too long to do it, and I know that he suffered in the end.

Unfortunately, with kidney disease, unless it’s acute, it is not curable, only treatable provided the treatments work. But still not a cure, just prolonging the inevitable.

You will second-guess yourself and overthink this, and even regret whatever decision you do make. This is human nature. I think we all like to feel we have some sort of control over situation like this, and therefore can somehow change things. In reality really bad diseases happened to really good cats for absolutely no reason at all and, we have no control over it sometimes.

I wish you peace with whatever you do decide.

S silent meowlook , thank you for this message. I'm needing to re-read it because I'm of course second-guessing my decision.

Phoebe was euthanized on Tuesday at noon.

In my heart, I think I made the right decision. After I got home, Phoebe was willing to eat a little, but continued to drink and pee copious amounts. Poor girl just couldn't stayed hydrated even though they had given her sub-Q fluids that day. She seemed so weak that I sometimes tried to help her to the litterbox, but she squealed every time I picked her up. Her stomach must have hurt. I stayed with her all night, while she snoozed on the sofa. She continued to seek out the water bowl and use the litterbox by herself up until 10 am the next morning. When my friend arrived before the vet, she didn't even stir until she was startled by the noise from the bag of food that my friend had brought. Normally, she would have run away immediately once someone entered the house.

But now my mind is second-guessing & wishing that I had pushed to talk to the specialist again before making the decision. On Saturday, the specialist said that if her creatinine jumped back up, then the main option was to rehospitalize, but I didn't push to speak to the specialist again after receiving the news about the rebounded creatinine on Monday. Instead, I immediately lost hope & decided to take Phoebe home and euthanize her. Maybe I should have tried to give her sub-Q fluids for a few days, even though I know this was extremely unlikely to have helped given Phoebe's deterioration overnight. The morning of the euthanasia, at many points, I thought she would pass before the vet arrived. The vet said she was in the initial stages of dying and that it was good let her go before she lost all awareness.

The vet who euthanized Phoebe was amazing. He founded a local organization that helps people in need take care of their pets and is an end-of-life doula. He asked me about her life story, placed a little stone heart on her before the final injection to capture her spirit leaving, and honored her passing with the ringing of Tibetan bells, a sage stick, and a small service. She was placed in a small wicker basket and I carried her out to his car. Later that day, he sent me a poem about her life. Touching the small stone heart gives me great comfort. I think I'll feel better when her remains are back with me.

 

[silent meowlook]

Hi. It sounds like you had a very compassionate caring vet come to your house. It sounds like her passing was peaceful. He told you she was was going to die. Did he say you could try several things to save her? Did he question your decision? No. He didn’t because it was the right thing to do. You have to have some very firm conversations with yourself like this. I think you trusted this vet. He knew it was the right thing to do.

I worked at a specialty vet hospital for 9 years. I am not a vet. One thing I learned, is that specialty vets do not recommend euthanasia like some general practice vets do. The ones I worked for did not consider it an option. So, if your specialist mentioned it, then honestly they didn’t think she would make it, and didn’t want her to suffer.

I honestly think that this was acute on chronic kidney disease. Her kidneys were failing for quite some time and got suddenly very bad for no reason.

Of course I don’t know this and I am not a veterinarian, and am just speculating.

You couldn’t have saved her. All the fluids were doing was diluting the toxins in her body that the kidneys could no longer filter out. She was drinking so much because she was also trying dilute the toxins. Can you imagine if you were so thirsty yet nothing you drank would stop that thirst?

The other thing to keep in mind is that the creatinine numbers can be falsely lowered due to muscle loss.

The urinating was because the kidneys no longer worked and all she drank was going right through her.

If you think of kidney failure like the kidneys are balloons with pin holes in them. So, fluid in leaks out. After a while the holes get bigger and bigger until the balloons can no longer hold water.

I hope this makes sense.

Try to allow yourself to grieve without blame. This honestly was never in your control.

 

[cowkittymom]

S silent meowlook , thank you so much for this reply. You are absolutely right. I need to be firm with myself so I have the energy to take care of my others pets, Phoebe’s littermate Calvin and my dog. Calvin has the exact same coloring as Phoebe. It is comforting to see him.

 

[fionasmom]

I am so sorry for your loss. I agree with S silent meowlook that a specialty vet would not recommend euthanasia unless they believed it was the only and best option. Most people who lose a beloved pet go through second guessing themselves, even in situations where the outlook is dire. It becomes a question of a few more days, or a week, which really has no meaning for the cat who is ill. You arranged a beautiful passing for Phoebe with a very caring house call vet and allowed her to pass peacefully and with dignity.

 

[AbbysMom]

I'm so sorry for your loss. My niece with through something similar with her cat a few months ago. She is a vet tech and made the same decision as you. We all have regrets no matter what we decide. I feel you made the right decision.

 

[cowkittymom]

Thank you so much for all of your replies and comforting words. I am feeling less guilt and better about my decision, little by little. In case this is of any help to someone who finds this thread in the future, here's a link to an article about the outcomes of cats experiencing acute on chronic kidney disease (Acute on chronic kidney disease in cats: Etiology, clinical and clinicopathologic findings, prognostic markers, and outcome). It really helped me put things into perspective.

 

[fionasmom]

Thank you for posting the link to the article which will help others who are facing the same disease. Once again, I am sorry for your loss of Phoebe. When a cat passes, we lock the thread out of respect. If you would like to post a tribute to Phoebe in our Crossing the Bridge forum, you are welcome to do so.

Crossing the Bridge