Painkillers For Cat With Chronic Kidney Insufficiency?

gilmargl

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Perhaps somebody has experienced this problem and has a few suggestions.

My own cat Lilly has had kidney problems for many years. She is now 15 and although things are not getting better her recent blood tests were not very different from the values taken 2 years ago, when I was literally sent home from the vet with the advice to try to keep her on her diet and continue with her medication but there was not much hope and it could be all over in a couple of days, weeks or, if we were lucky, months.

Yesterday, I went back to the vet to get help for her as she is so obviously in pain. I imagined it was arthritis or some condition due to her age. I was told it was a neurological problem caused by her kidneys. She had to be lightly sedated as she was hard to control (due to pain) in order to take the blood sample. While sedated, her remaining teeth were checked and a vitamin B injection given as well as an infusion.

I got the results yesterday evening when the vet phoned to say she didn't know what to do about Lilly's pain - the reason why I went in the first place. Lilly loves to sit on laps - she's not fussy whose lap she sits on. She will sit there all day and night if she could. Unfortunately, one has to move but the slightest movement makes her very angry and then she growls and attacks. She was never an aggressive cat. The vet said she will consult with her husband and vets at the animal clinic to try to find a solution. So far no answer. We all know that painkillers affect the kidneys but I can't bear to see my poor little cat in such pain. She can hardly walk. Since her illness was detected about 8 years ago, she only urinates on clean, dry cotton rags (torn up sheets) placed in an empty litter tray. Not sure what new ideas she will have when it gets too painful to get to her toilet.

Her life is mostly spent sleeping but she stays close to us even when we have visitors. She no longer comes on our bed at night as it hurts her when we move and she has to move too. She ignores my other 3 cats and any foster cats who are occasionally allowed in the main part of the house. She may go outside onto the terrace for 5 or 10 minutes a day but she soon returns to sit on the radiator or to a sunny spot on the carpet.

How can I help her, in addition to leaving hot-water bottles under the chair covers to simulate nice cosy laps?
 

Jem

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There is a pressure activated electric heating pad that you can place in you cats favorite bed or simply buy the bed already made (more expensive). After some research and advice I will be getting the pad from K&H Pet company.
There is also another product from "SnuggleSafe", it's a microwavable pet bed/pad, where the heat lasts 10 hours or so. I'll be getting one of these as well for mine.

Now I really hope what I'm about to post doesn't come across as insensitive. I'm where you are right now, with a cat who we are providing palliative care for. So I understand the desperation you feel to give them pain free last days, and a quality end of life, but at the same time you don't want to make things worse either, and have the medical intervention cause other side effects or make them miserable.
This is just my opinion, but, if your kitty is in end stage and the vet said that it could all be over anywhere from a few days to possibly months. I would not hesitate to ask for pain medications. The kidney's are already failing. I don't want mine to go, I wish he could live forever, but even if the pain meds push his kidneys "over the edge", I would sacrifice a month or more of life (for myself) for a few weeks of a pain free end (for him). Again, that's just me. I would talk to your vet about pain management again.

My heart goes out to you :hearthrob:, it's not easy to watch your little ones decline right before your eyes.:alright:
 

PushPurrCatPaws

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I agree with Jem Jem .

With my last beloved kitty, who had a complicated set of medical issues, we (the vet and I) were able to titrate to the smallest dose needed for pain relief using injectible Buprenex. We dosed her way less than the standard dose a vet normally prescribes for a healthier kitty, and in this way, she felt some discomfort but you could tell by her behavior and mood (less crankiness) that she felt mostly pain-free. She was 15 years old as well, like your Lilly.
 
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gilmargl

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Thank you Jem Jem and @PushPurrCat Paws! You both understand the situation completely and I am most grateful for that.

Lilly unfortunately does not have a favourite place to sleep. A long time ago it was at the top of a ceiling-high cat tree and even now it could be on the armrest of the couch. Normally she lies spread out on the floor in the middle of the living room as if waiting for someone to trip over her. I placed a fairly large cat basket lined with soft baby blankets which I was hoping she would accept as her own. But she prefers the floor and my two black cats take it in turns to rest in the basket. After her visit to the vet, when she was still slightly sedated, she stayed on the couch on a nice soft blanket and she has returned to this twice today in between long periods on the floor. That is where I am placing hot-water bottles. I will look into the "pressure activated electric heating pad" as it sounds interesting. Maybe it's available here in Germany. Same applies to the "microwavable pet bed/pad, where the heat lasts 10 hours or so".

No, Jem you are not insensitive! I'll be talking to the vet again after the weekend. Lilly has not had much luck in her life. She was abandoned when a village community fell victim to opencast mining. She was trapped, sterilised, rehomed, returned to the shelter before I found her. She was never a particularly attractive cat - skinny and long legged, one ear with the tell-tale V-snip just to show everybody that she was not high-class! Even the vet I first took her to, looked at me as if to say "Couldn't you find anything better than that?" It was perhaps understandable, my previous cat had been a beautiful British Short Hair.

I was not aware of injectible Buprenex for cats and had no idea whether morphine was suitable for cats or not. But, for humans, morphine drugs can be used for patients with kidney complaints. Perhaps, I will be checked as to whether I can be trusted to treat Lilly with such a drug. It will be a great relief if I could give her something to make her life easier.
:thanks:
Once more, thank you both for the replies. I will let you know how things turn out.
And for Jem's little one:

:vibes::vibes::vibes::vibes::vibes:
 

white shadow

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gilmargl gilmargl -

The "Oracle" of all-things-CKD has a section on choosing painkillers for CKD kitties - I'd suggest a read-through: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Painkiller Choices

Now, your Vet has suggested that her pain originates from a "neurological problem caused by her kidneys". IF that means "neuropathic pain", Gabapentin is a drug already known as and for an effective treatment for this. In that reference I gave you, there is information on it - you'll see it there under "Other painkillers". There are numerous external references there as well. Perhaps you could pass that link along to your Vet.

I suspect that would offer her some effective pain relief.

There are folks on TCS using it currently for arthritic pain and pain from diabetic neuropathy.

Make sure to post back and let us know what's decided!
.
 

Jem

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Thanks for the "good vibes". And yes, please keep us updated as things move forward.
And a big thank you for being such a wonderful care giver to Lily. She may not have had the easiest start, but right now, Lily knows love and compassion, and will continue to know that until the end, thanks to YOU. That is what really matters.
:heartshape::rock:
 

LTS3

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Would acupuncture help? You would need to find a vet who specializes in acupuncture.

You can ask your vet to consult with a vet school or another vet hospital for alternative methods of pain relieving. This vet hospital has a pain medicine department and does consults: Pain and Palliative Care - MSPCA-Angell
 
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gilmargl

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gilmargl

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Would acupuncture help? You would need to find a vet who specializes in acupuncture.

You can ask your vet to consult with a vet school or another vet hospital for alternative methods of pain relieving. This vet hospital has a pain medicine department and does consults: Pain and Palliative Care - MSPCA-Angell
Although it is a great help when treating pain, I'm not sure about acupuncture when everything hurts from top of the head to tip of the tail. But I will ask the vet tomorrow.
 
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gilmargl

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The vet phoned this morning to say that her colleague (head of the clinic) would like to examine Lilly and decide on her future treatment. Although I much prefer the vet I saw on Friday, I will go along tomorrow and hope a) that I understand what he's talking about and b) that he hasn't just received a new drug which he's being paid to test on his patients. (Of course, he wouldn't tell me that!)

Lilly spent the whole day on the couch next to a hot-water bottle. Although she considered going outside early this morning, the rain changed her mind. She did take her medication and ate a small breakfast. Unfortunately for her, my 4 foster kittens (now 12 weeks old) had to be taken to their new homes today, so I had little time to spend with Lilly. I hope I have some time alone with my own 4 cats, before the next homeless kittens, strays or abandoned cats turn up.
:please::petcat:

But, what will be, will be!
:tabbycat::gingercat::redcat::kitty::bigeyes:
 
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gilmargl

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The visit to the vet was not very satisfactory. Lilly's condition had deteriorated since we were last at the clinic on Friday. I honestly did not believe I would be bringing her back home alive. I had great difficulty lifting her in and out of the transport box without causing her pain. She was very apathetic.

The vet was obviously expecting to see a healthier cat as he wanted to operate!!! There must have been some lack of communication between the 2 vets. Lilly has already undergone dental work on many occasions and now has only 4 teeth left. He was hoping to remove a canine! We were both in agreement - this was not the right time for another tooth extraction. He is still hoping to get Lilly fit enough for dental surgery.

We discussed painkillers but he was obviously worried about them affecting her kidneys. In addition he did not want to prescribe anything that would make her even more apathetic than she already is. Having made a mental note of all the possibilities put forward on TCS, he stumped me by injecting Novagin (never heard of it - other names: Metamizol, Dipynone?), with a homopathic medicine (SUC) and the obligatory saline solution.

Novagin has caused her a lot of discomfort - she's been foaming at the mouth! It is only effective for 6 to 8 hours, so the negative reaction has now thankfully worn off. I have another appointment early tomorrow when I will try to resist another dosage.

I'm not feeling very optimistic.
 

white shadow

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I'm beyond angry.........and Lily isn't even my cat.

I think this is completely inexcusable.

By the way, I think her "apathy" is a direct result of the pain she's experiencing.

Does this male Vet realize that Buprenorphine is safe for cats with kidney insufficiency? Does he know that even meloxicam (Metacam), in very low-dosing protocol, has been shown as safe in kidney cats? I hate to suggest it, but this raises serious doubts for me about this practitioner - and perhaps the both of them for that matter. I'm just not sure that you and Lily are being best served at this clinic. I mean....if they don't know this most basic information?

For heaven's sake, there's even a recent retrospective study - note the bolded:
Retrospective case-control study of the effects of long-term dosing with meloxicam on renal function in aged cats with degenerative joint disease (2011) Gowan RA, Lingard AE, Johnston L, Stansen W, Brown SA, Malik R Journal of Feline Medicine & Surgery 13(10) pp752-761 retrospectively examined the records of a veterinary practice over a five year period and concluded that "long-term therapy with meloxicam at a median dose of 0.02 mg/kg/day can be administered safely to aged cats with CKD, provided they are clinically stable. The results further suggest that meloxicam may actually slow the progression of renal disease in cats with both DJD and CKD by direct or indirect mechanisms."​

What they've used - Novalgin - is well known to cause excessive salivation in cats:

ONE EXAMPLE: It looks to me that they've used this drug "off-label"....that is to say, for a purpose for which it is not licensed. Now, I may be wrong, but, The European Medicines Agency, the agency that authorizes drugs for the EU, appears to approve this (metamizole, the 'chemical name') only for cows and pigs. In the UK, The Veterinary Medicines Directorate's site cites cows, pigs, horses and dogs. No authorization for cats is to be found anywhere. Again, I have no particular expertise, so I may be way off base on this.

This is also an NSAID, a non-steroidal anti-inflammatory drug, and it is beyond well-established that NSAIDs have a narrow margin for safety in cats. I wonder just what they are relying on when determining the dosage for Lily?

I'm wondering if her pain may result from arthritis. At 15, she is well into her senior years. A huge percentage of older cats (upwards of 90+ percent) has been shown to have some degree of degenerative joint disease. It just comes with cats. Here's a good coverage for you: Arthritis and degenerative joint disease in cats | International Cat Care

I wonder if you'd consider seeking a second opinion from a feline specialist. That would be my recommendation. Any consummate, competent Veterinarian would welcome this idea when it involves a complicated medical case. What do you think?

I certainly would not be accepting any further use of that drug, were I in your position.

I would be insisting on some well-known feline CKD-friendly pain control for her, and preferably a combination of drugs (known as multi-modal therapy) to ensure she becomes and remains pain-free.

If nothing else, for now, why not give them the link I provided to you above (in post #5). That site and the person who authored and maintains it have received international recognition from Veterinary specialists and organizations - see bottom of the homepage.

If Lily's blood chemistry levels have remained stable for the last two years, I believe you should take great heart from that - I don't think you have any reason for any negativity whatsoever in her regard.

You know, there is a specialized online community of people who are managing their kitties' CKD. It's sponsored by the same woman who's responsible for the 'Tanya' site. If you want some well-seasoned, experienced opinion on Lily's case, you might consider joining them (and, you could always join to evaluate whether/not you feel they might help - a 'test-drive', so-to-speak). Post back if you think that might be of interest.

Again, I hope something there will help.
.
 
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gilmargl

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Sorry for not updating yesterday - I spent my spare time sitting with Lilly, who I'd moved to a heated room in the basement, where there was no WLAN so I did some work for my daughter filling in data in Excel tables. Lilly probably had no idea that I was there, she seemed to have given up on life altogether and I was not expecting to be able to save her. But, back to the facts...

When I took her back to the surgery I was sure there was something else wrong with her - the results of her blood test were bad but not so bad. She was so cold that I asked the vet to take her temperature and test her urine. Her temperature, 38 °C , was not particularly low and he wasn't interested in her urine. I refused any more Noralgin but he also refused to give me any alternative drug. The technician gave her half a bottle of Reconvales using a syringe, and an infusion which included the preparation SUC. I was given an appointment to attend again this morning.

The next 24 hours were sheer hell! She didn't react to anything at all. She hardly moved, except to sneeze. I phoned another vet who I know quite well. She's a very kind woman who helps animals and their owners. Her surgery - just 2 rooms, has no modern facilities. Her customers include the poorer members of society. She offered me Meloxicam, saying "even if it does shorten her life, at least it will be a life without pain". She knows Lilly well and believed she had perhaps had enough, and it was time to say goodbye. I was invited to pick up the medication this morning, assuming I still needed it.

She explained to me why Noralgin makes some cats drool. Evidently, medication (and spot-on preparations) get into cats' mouths (in very small quantities) and cats can taste them. It's the taste that makes them drool. She also said that if Noralgin made Lilly nervous for 5 or 6 hours, there is no guarantee that other painkillers would not affect her in the same way. Opiates would make her drowsy - but would we want that?

So, early this morning I crept into the basement to see how Lilly had survived the few hours without me. She reacted to my presence but was too weak to get up. I gave her some cream with her medication - which she ate. She licked up some Reconvales and some Babycat food and then I noticed the blood! She had urinated in her bed and there it was. I was so relieved - hope at last.

We went back to the vet, Lilly still half dead to the world. Another infusion, SUC, Reconvales and an antibiotic. I cannot tell you what a difference that has made. This evening she purred louder than she'd ever purred during the past week. She still doesn't get out of her bed but it doesn't hurt her when I stroke her. I haven't tried to pick her up - I've been hauling her up in a blanket to get her into her carrier during the past few days. Anything to reduce her discomfort. She feels much warmer and she's at least alert.

I hope we're getting over the crisis. We are back to the vet tomorrow for more antibiotics. Not sure what will happen at the weekend as Lilly is an expert at hiding tablets under her tongue and then spitting them out 5 minutes later. Assuming she recovers sufficiently, the vet wants to do some dental work. I'm not sure I want to let him have this pleasure. Unfortunately, he is the only vet around here with sophisticated, modern equipment.
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I'm beyond angry.........and Lily isn't even my cat.
.
I was angry, disappointed and very sad. This clinic is expensive. It has invested money in equipment and wants some returns. Some say it has a charge for entering the front door. I will definitely get a second opinion about dental work. The vet who I phoned did the first dental work on Lilly, removing most of her teeth many years ago.


Lilly in her bed, but looking much better! Let's hope it stays that way.
 
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gilmargl

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This may be my last post in this thread - as I don't think I'll be able to contribute towards answering my own question. Lilly has Chronic Kidney Insufficiency but she has other health issues which complicate the issue.

Today, the vet's appointment was in the afternoon - whereas up till now we had got the stressful part of the day over before lunch. Up till now, I couldn't observe Lilly's behaviour directly after returning home as, having made sure she was comfy I was busy working in the kitchen and in the rest of the house. In the evening I took my ironing, office work etc. into the basement and could observe her.

The vet was pleased with Lilly's progress. She can eat and drink on her own. I will now have to give her tablets and an infusion for the next 5 days and phone him to let him know how she gets on. We talked about the dental work he wants to do. I said he could forget it, if he thinks he can do an operation without providing painkillers afterwards. I would prefer them beforehand as well, but I didn't say so. He said we should do another blood analysis to see if things have improved. He was surprised to hear that Lilly would require sedation - also not good for the kidneys.

On arriving home I put Lilly back in her dog carrier. She ate a little, drank some water but couldn't settle. She suddenly found some energy and charged around the room. Her stiff limbs getting looser the more she walked. She didn't bump into anything so she wasn't blind and yet it was as though she'd never been in that room before and had to search every corner. Cats investigate new spaces much more slowly. She was hectic.

I opened the door to let her into the area at the bottom of the stairs. It's a space she knows well as the litter boxes are all there. I imagined she would realise where she was and climb the stairs back into living room where she has spent most of her life. But, she circled the area and went straight back into her room where she continued her hectic observation of everything. Whenever she went near her food, she ate a few mouthfulls before continuing her travels, often stepping into the food with her back legs.

So, on top of bad teeth, bladder infection, kidney insufficiency, poor Lilly seems to have dementia. She finally settled down to sleep in a large cat carrier (usually used for mothercat and kittens) which I had strategically placed to stop her disappearing behind the couch. I had already fitted it out with a foam mattress and bedding so I only needed to tuck in a hot-water bottle. So there she lies. I have switched off the light and hope she has a good sleep. I will of course check on her again tonight and leave some fresh food.

Not sure how this will end. I am already so nervous that I am now mislaying things, forgetting things and I even managed to hit another car in the carpark this morning.

Thank you PushPurrCatPaws, white shadow, Jem and LTS3 for your comments and I am sorry that I really have had no time to reply personally. I have looked at all the links and information you recommended, and will continue to consult them. That's what's good about the cat site. Nothing gets lost. I'm now researching dementia.

:read: :compsurfing: :thanks:
 

PushPurrCatPaws

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... On arriving home I put Lilly back in her dog carrier. She ate a little, drank some water but couldn't settle. She suddenly found some energy and charged around the room. Her stiff limbs getting looser the more she walked. She didn't bump into anything so she wasn't blind and yet it was as though she'd never been in that room before and had to search every corner. Cats investigate new spaces much more slowly. She was hectic.

I opened the door to let her into the area at the bottom of the stairs. It's a space she knows well as the litter boxes are all there. I imagined she would realise where she was and climb the stairs back into living room where she has spent most of her life. But, she circled the area and went straight back into her room where she continued her hectic observation of everything. Whenever she went near her food, she ate a few mouthfulls before continuing her travels, often stepping into the food with her back legs.

So, on top of bad teeth, bladder infection, kidney insufficiency, poor Lilly seems to have dementia. She finally settled down to sleep in a large cat carrier ...
It's very possible she was just intent on making sure her home base was "safe", and that it was just how she remembered it to be. I'm not sure I would settle on the idea of dementia yet; cats can get very stressed out from trips to the vet and Lilly could just be trying to adjust to the latest trips to the vet and back home again. How is she doing right now? (I know you said you might want your post to be the last one you submit to this thread, which is absolutely okay! I just wanted to offer some thoughts on her "nesting" and stress behaviors when she got home from the vet this most recent time.)
:alright: :hugs:
 
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gilmargl

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Okay, not my last words on this topic :). Lilly is still right at the back of the large carrier. (The dog transport box was far easier for me when controlling Lilly's condition. The opening is the whole length of the carrier so there is space for me to stroke her and offer her food). I had to put an arm inside and just managed to stroke her head. She purred very quietly. I offered her a treat - I know it's not perhaps the correct thing to do - but tomorrow she will have to swallow tablets twice a day, and I wanted to see whether or not she would accept this particular liquid treat so that I could hide the tablets in it tomorrow. So far so good, she accepted the treat! Unless she accepts tablets in treats or paste, it is almost impossible and highly dangerous to try to put them down her throat. :noway:

Up to now she has only urinated in her bed. But walking around in my socks this evening I discovered that she has made some puddles on the floor. No blood, thank goodness. No bowel movements for 2 days - but she hasn't been eating very much so I'm not panicking yet. I will have to find or make some low-entry litter boxes for her, though I may have some old enamel oven trays somewhere in the house. I found that kitten litter boxes were not heavy enough for clumsy Lilly.

Hopefully, we will have 5 days without visits to the vet. I really don't want to have to use the emergency veterinary services this weekend. There only appear to be vets for farm animals on the list! My daughter, a doctor's nurse, will help me with the infusions, so nothing should go wrong and Lilly can have some peace and quiet in her very own sick room. I don't think she'll miss the other cats as she has always been very short-tempered with them and kept them at a distance.

Thank you again for posting. I'll let you know how Lilly gets on in the next few days.
 
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