When to make the decision about putting the cat down

[FeebysOwner]

Is he pooping normally and as much as before? Is there bile in his poop? Is there hair in his vomit (in your previous thread, I believe he was always throwing up hairballs)? Is there hair in his poop?

I've forgotten what you previously said about the frequency of his meals, so if he isn't eating frequently enough - which the need for frequency/quantity can significantly vary by cat - that can cause bile build up in his digestive tract. Older cats’ digestive systems seem to do better with smaller, more frequent meals; and, for some cats, that can pose more digestive issues when they don’t get to eat that way.

Bowel motility can play a role in vomiting bile, but theoretically, you should see a change in his bowel habits - not to mention a negative change in his eating habits as well.

 

[mommytobuck]

No he eats a lot. I wouldn't say he seems hyperthyroid but he does seme to ask for food about every 6 hours. He is going pee and poo just fine. Daily. There is hair in the poop. How would I tell if there was bile in the poop? It is brown but sometimes it comes out a little tan. Figured that was the raw food I am feeing him.

This morning he hasn't thrown up and slept soundly all night. I got up... got his favorite good -- Kangaroo (for some reason) -- and dumped the gabapentin in there with some Fori Fora... he ate the whole thing. Hopeful I will get a trial run on how he might proceed with the gabapentin. But at least I Know he will eat it with a small amount of food.

 

[mommytobuck]

So the dry run with Gabapentin is complete. Good news.
I gave him about 140 mg. He is very sleepy but able to stay up on his feet.
I took the opportunity to go in and really cut his nails... this is a problem normally but he was so sleepy he only mildly tried to get out of it.
After that I snuck up and just pulled his cat bed into the "soft carrier". He was awake and concerned but didn't move.

The soft carrier has always been a danger for me because he scratches at the walls of any carrier trying to get out. But this time, he didn't. In fact, aside from straining the neck to see what was happening he didn't move much.

I carried the soft carrier to the wheel base and then rolled him to the car. This helped my back.

He was alert enough to be concerned but, no meowing -- no complaining. I think he likes the steady movement of the wheeled based as opposed to how rough it is when I carry the carrier.
I lifted him into the car... quiet no movement.
I put the base on the other side of the car.

I turned the car on and drove around for a bit -- and horror of horror, my boss called me during to tell me he was resigning -- and then I had several phone calls from co workers.. this is usually an issue as my cat doesn't like me talking.
No complaining at all from the back

After about an hour of driving around with me talking during most of it... I took him back into the house on the wheeled carrier.
He did seem more animated now... (about 3.5 hours after getting drugged) -- and the only bad thing is that when I opened the carrier he hissed at me.

I think that was successful and perhaps 200 mg will be the ticket.

I do feel confident that *I* will be able to get him to the vet, even if they have trouble dealing with him.

 

[mommytobuck]

I did want to say that I have been able to find a way to give my cat pepcid (I Have been sneaking it into his treats) which he eats right up. And things HAVE improved a lot. It has been 3 days now since he had a throw up. But I am still taking him to the vet tomorrow because I figure, if nothing else, I will be able to see about the gabapentin and if I can get it to work.

 

[mommytobuck]

Well I have amazing news.. IT WORKED. The Gabapentin worked. I can't believe it, this changes everything. I will have another few years with my cat willingly.

So I gave him 200 mg and slighly more -- about 210 mg in case of shrinkage in food - at 7 am. The appointment was at 10 AM. The entire ride, no complaining. When I talked to the vet tech, no complaining. No growling, meowing... nada. The vet came in and I talked to him, no complaining and they took Buckwheat back. I watched but I heard no MORORRRRWWWWWWWW as I usually do. I didn't see all the vet techs running back to help out. I didn't see them grab the leather gloves as I usually do.

I did see the vet come out with the carrier and I was worried they were washing the carrier off of blood or urine. But turned out he was just weighing it. (When he weighed the cat and the carrier the scale said 9 lbs) I can't believe that is right. My home scale says 13.8 and just what I feel carrying him around I don't think he can be that low.

The vet came back and said he was all set. No ripped out nails... the vet got blood and urine!!

I was amazed. The vet said that his eyes were fine, ears were fine and even teeth looked pretty good. He wouldn't recommend any dental work. My cat didn't have high blood pressure. He thought his coat looked good, no over grooming but he was a little worried about Kidney issues. He said one of his kidneys seemed small on exam.. That doesn't upset me too much at the age of 16 plus he isn't even on kidney diet now. I also am not sure about that because ever since he was 3 years old this exact vet was trying to tell me he had kidney failure and I think his kidneys just have a small size, naturally.

No matter what though, this means I can get treatment for my cat whenever necessary!!

I asked the vet why it worked. He said the last dose was smaller but I honestly do wonder if the two home vets they sent me weren't all that capable.

 

[FeebysOwner]

I am glad to hear everything went well! Very encouraging news for any upcoming vet visits. I also hope to hear good news when you get his blood work and urinalysis results.

 

[mommytobuck]

So the results... and I knew it, I just knew it. Basically, he is fine.

The vet started the conversation sounding like he was going to give me bad news. He said my cat has Kidney Disease... but then he said it was stage two of four.

Ok, now, to be fair, this same vet diagnosed him with kidney failure back in 2009 when he was three. And it was similar circumstances. My cat was dehydrated Monday as I gave him less food than usual anticipating sedation the day before and, frankly, we was so drugged on Gabapentin I am sure he didn't get his normal water. Add that to every three day vomiting ... well, dehydrated. I will get the records and see what I think. Even if it is stage two given his age and the fact that he is not eating KD food right now, I think this is a very minor concern. The vet is giving me samples to see if can restart him on Kidney food.

The basic thyroid panel didn't show up anything to be concerned about. He said we could test T4 to be sure...I authorized that.

He didn't have an answer for throwing up the hairballs. He did suggest discontinuing the Meloxicam (I have been giving it 1x per month) out of concern for kidney issues and gastrointestinal irritation. He said he thought it was unlikely that it was causing the gastro issues but in the absence of anything else... that is my main suspect. He had no answer for me on that. I am going to continue to use the Pepcid AC which does seem to work at least for a while.

Someone else suggested this product. Capilex | bockvetpharma

Any other ideas? I can't have him throwing up every three days.

 

[FeebysOwner]

Thanks for the update! It will be interesting to see the test results, if you plan on sharing them with us, especially the kidney related numbers. I am not sure what a basic thyroid panel is, never heard of it. I have always understood the best indicator of thyroid was done through the T-4 - and it usually requires a small amount of blood to be drawn separately from the blood drawn to do a CBC & Chemistry panel.

If you are giving the liquid Meloxicam just once a month when it is typically given daily, the odds are that it probably isn't affecting Buckwheat's digestive tract, nor doing him any good for that matter. And when used as directed, it typically is a bigger precaution relative to the kidneys than anything else. So, it sounds like no harm in stopping it.

The Capilex, which has been around for at least a decade, might be worth trying since you seem to show some interest in it. It will either help or it won't. The first ingredient is vegetable oil - so the idea of trying something like butter or olive oil might be just as effective. The second ingredient is an artificial sugar and can cause stomach distress - but perhaps not in the quantity that is contained in these chews. Note that this product also contains lecithin - which is part of the egg yolk lecithin that others on this site have suggested for hairballs too.

Frankly, unless his blood work numbers, such as phosphorus, come back high, I wouldn't bother re-considering the K/D food. Too many cats either do not want to eat it, or they get tired of it very quickly.

 

[mommytobuck]

If you are giving the liquid Meloxicam just once a month when it is typically given daily, the odds are that it probably isn't affecting Buckwheat's digestive tract, nor doing him any good for that matter. And when used as directed, it typically is a bigger precaution relative to the kidneys than anything else. So, it sounds like no harm in stopping it.

Discontinuing it. Back story with that was that I said to the doctor when she prescribed it that I thought it was something concerning and she really blew me off and said she had plenty of patients that took it without a problem. Based on that I decided to only give it when absolutely necessary. It is possible that when I was first giving it -- say June or July of last year, I was giving him a daily dose and, possibly, wondering if that played a role.

The vet's office didn't send the paperwork -- grrrr. So I have to go there today.

I also have Epakitin around the house already for my cat. Any thoughts on that for Kidney? I am going to say my cat probably is at stage two Kidney disease (assuming that is true) because I have spend his entire life being very guarded about that. I have given him wet food most of his life and put extra water in it. For most of his life I have given him KD dry -- as a night snack -- and various supplements for kidney health. It was only after the last vet visit my cat started refusing KD food. But I haven't tried it in a while. Last year I had a urine test and his specific gravity was pretty good so... ( one reason I enjoy getting my own urine from the cat is that I can get it when he is in a normal state -- while at the vet his is typically dehydrated).

The pepcid ac does seem to work... I reliably not see thow up if I give him that.. but I have seen that linked to kidney problems. I remain convinced that my cat does have "acid" stomach -- and always has based on other vet's comments to me... and to me, it seems like it isn't necessarily a hairball problem... it is a throw up problem due to acid in the stomach and it just happens to take some hairballs with it. Is there an antiacid that won't be rough on the kidneys? The problems always seem to be when he goes too long without food. And all of the hairball remedies I have tried don't seem to to much except for the pepcid ac.

 

[mommytobuck]

Ok results

Labs show p is still in Stage II CKD. Thyroid is in grey area and fT4 ed is recommended. O states p is still having vomiting of hairballs. O would like to try Capilex. Told ok to do so as can't hurt. P should not take Meloxicam any longer considering GI issues and CKD. Recommended getting p back on kidney diet. Will provide kidney sampler

Blood Results 2022:
-Creatinine 1.9
BUN/Creatinine Ratio 16
Phosphorus 3.8

Urine 2022
Specific Gravity 1.029

Just a couple of notes on this. Back in 2009, when my cat was 3 and he is 16 now... his blood results were this...

Blood Results 2009:
-Creatinine 1.7
BUN/Creatinine Ratio 15
Phosphorus 3.6

Urine 2009
Specific Gravity 1.030
_____________________________

Thyroid
Test Results Unit Lowest Value
T4 2.7 μg/dL 0.8
The Total T4 result is greater than 2.5 mcg/dl and less than or equal to 4.0 mcg/dl. A Free-T4 by equilibrium dialysis may aid the diagnosis of hyperthyroidism in cats with clinical signs of
hyperthyroidism.

The only other thing that was abnormal was platelet count of 130. But the test noted that the platelets were clumped up and they the vet said that given a healthy CBC --with good RBCs.. he thinks it was just due to clumping.

 

[FeebysOwner]

Simply put, the IRIS (International Renal Interest Society) uses both creatinine and SDMA (Symmetric Dimethylarginine) to value the CKD staging. Without the SDMA, if creatinine is between 1.6 and 2.8 it is considered Stage 2. But that is a wide range and Buckwheat is on the low end of the spectrum, not to mention his numbers have hardly changed in all this time. His Urine Spec. Gravity is actually very good!

The standard I have read is for a cat with Stage 2 CKD, the goal is to try keep the cat's phosphorus level under 4.6. That is one of the primary purposes of K/D food. But your cat is well below that threshold, so given the 'reputation' of K/D food, I don't see the point at this time. And, as I have stated before K/D foods are lower in protein, which more current findings suggest is counterproductive to an aging cat, even if they do have CKD.

Since your vet seems to be relatively 'pro-active' about CKD, if/when Buckwheat's numbers escalate, you would be better off asking the vet about a phosphorus binder (vs. K/D food) to add to his regimen - while continuing to give him other foods he will actually enjoy eating. Feeby is also currently considered at Stage 2 - her creatinine is 2.8, but her phosphorus is at 6.2 - numbers far higher than Buckwheat's, but I can't even get her vet to entertain a phosphorus binder. And Feeby will NOT eat the K/D food. So, hopefully your vet will be more receptive to the idea when Buckwheat's numbers warrant action. IMO, right now they don't.

It seems your focus right now would be to work on the vomiting/hairball issue.

 

[mommytobuck]

It seems your focus right now would be to work on the vomiting/hairball issue.

Yes.. so I am right back where I started.

This vet, for whatever reason, has always been absolutely obsessed with kidney issues. I come to the same conclusion as you -- mainly that he has light issues if any.

I will give him KD Kibble (if he will accept it) but I do think it is far more important to keep him eating the wet food he loves. I have considered some of his weight loss was due to the fact that he started not liking the KD food which I had been giving him. And thus that food has a lot more calories.

They have him on the records at 13 lbs but I just don't know if I believe that. He is 13.8 on my home scale.

Does anyone know if there is an acid reducer I can just pick up from the store that will not be rough on the kidneys?

 

[FeebysOwner]

Does anyone know if there is an acid reducer I can just pick up from the store that will not be rough on the kidneys?

Until others respond, I will offer the only thing I do know - it seems to be the magnesium in acid reducers are what affects the kidneys the most. What I don't know is if ALL acid reducers contain magnesium. Tbh, a whole bunch of CKD cats take antacids, so I suspect the impact on the kidneys is not quite as worrisome as you think. And from what I have seen on the CKD forum, Pepcid AC sems to be the most frequent 'go-to' antacid.

Another acid reducer of sorts is slippery elm bark - which btw several folks also use for hairballs. So, you might look into that as well.

Also, in response to a previous question you had - Epatikin as far as I know is a phosphorus binder, which should not be used without vet approval and continued monitoring to see what effect it has on your cat's phosphorus level. I would suspect your vet would not think this med is necessary at this time.

 

[mommytobuck]

And from what I have seen on the CKD forum, Pepcid AC sems to be the most frequent 'go-to' antacid.

After looking into it more I was wrong. Pepcid AC is not a PPI (which causes kidney issues) it is a histamine-2 blocker. Which works a different way. So I can give him that. Yes. I am also wondering if he just needs it at night -- when he is less likely to be sleeping or eating...

Also, in response to a previous question you had - Epatikin as far as I know is a phosphorus binder, which should not be used without vet approval and continued monitoring to see what effect it has on your cat's phosphorus level. I would suspect your vet would not think this med is necessary at this time.

Ok I will see, i am going to check my records from 2020 when he went to the emergency ER and see what the creatine number was.

One other question.. on the urinanalysis... his RBC was high in the urine -- 20 or so... normal is 0-3. Anyone know why no one seems worried about this? Could it be due to the way they got the urine? I know they have always struggled to get urine from him.

 

[FeebysOwner]

One other question.. on the urinanalysis... his RBC was high in the urine -- 20 or so... normal is 0-3. Anyone know why no one seems worried about this? Could it be due to the way they got the urine? I know they have always struggled to get urine from him.

Get a clarification from your vet on this one before you go too far. Very well could be the way they collected the urine. I have never had it happen with Feeby and she has had numerous cystocenteses, but there is a probability of hitting a blood vessel when injecting the syringe into the bladder to gather urine. It is really no big deal if/when it happens, and I suspect that is why no one made mention of it to you.

 

[mommytobuck]

Get a clarification from your vet on this one before you go too far. Very well could be the way they collected the urine. I have never had it happen with Feeby and she has had numerous cystocenteses, but there is a probability of hitting a blood vessel when injecting the syringe into the bladder to gather urine. It is really no big deal if/when it happens, and I suspect that is why no one made mention of it to you.

Will do. In fact, seems they were not completely honest with me about how he behaved. He was described as hissing and growling in the records during the exam. So there was some resistance. This is something I will ask. Most of his urine tests have been by me getting the clean urine sample from him at home.