CRF kitties can develop thyroid issues, so you might want to have that checked as well. George is 18 and has been CRF since 2004, and hyperthyroid since 2006. You can keep your kitty comfortable with meds and fluids, but the osteo is something I'm not familiar with in kitties. Only that it can be excruciatingly painful, so you do need to be prepared to treat for pain and make the hard decision :(

I've been through CRF with several of my cats and have one now with both CRF and hyperthyroidism. The most difficult aspect of CRF is that it can be extremely variable from one cat to the next, and from one day to the next with the same cat. There is no "normal" progression of the disease. Some cats live for years with CRF, while others fail very quickly. A cat can also be on death's door one day and rally back to relative health the next.

The most important aspects of CRF management are regular bloodwork to check levels so that you can quickly address anything that goes out of whack, and vigilant observation of your cat on a daily basis. Whenever your cat's condition or behavior shows a rapid change, have another blood panel run. Blood levels can change in a matter of hours, so you really need to stay on top of things.

Keep an eye on your cat's vision, as well. High blood pressure often accompanies CRF, and untreated HBP can cause blindness.

Anemia is another common CRF accompaniment. If your cat becomes weak, have your vet run a CBC to check for anemia.

The fact that your cat is still eating is great. Many CRF cats become inappetant, so keeping them eating can be extremely difficult. There are stomach acid reducers and appetite stimulants that can help if inappetance becomes a problem with your cat.

If your cat is still drinking excessively in addition to the fluids you are administering, it's probably time for you to increase the fluids. Ask your vet if you should start giving fluids every other day or even every day. Fluids are the primary lifeline for CRF cats.

I hope your boy can maintain a happy, comfortable life with you for a good long time to come.

Laurie

Cynthia & Laurie, thank you very much for your prompt replies.
Yes, he is drinking a lot more in spite of the fluids. We take him to the vet's for this. Is there a simple way to do this at home? I'll have to ask the vet.

Anyway, he has not had any bloodwork for at least 8 months (fructosamine and BUN /Creatinine tests then). He used to have monthly ones when he was briefly treated for diabetes a year ago. The vet made us stop the insulin because his fructosamine test consistently showed slight hypoglycemia and he had become quite lethargic-we always wondered if he was not misdiagnosed and if the insulin shots (for 5 months) did not create more problems (such as losing his leg last May)-the vet says no (naturally). Strangely enough, he started losing weight rapidly after insulin was stopped. His urine was tested in December: gravity 10.14 (it was reported to us)

Anyway, we can't tell how bad the pain is from the recently diagnosed osteosarcoma. He certainly seems to have difficulties finding a comfortable position, but he still purrs and he does not cry. He sleeps a lot, but still enjoys spending some time outside (right by the front door) when the weather is nice (much snow this past week..). He was on pain medicine (buprenorphine) for a little while, but we stopped it because it made him sleep the whole time. The choice of pain killers is very limited for a cat with kidney disease.

He is probably anemic to a certain degree (pale gums) but the vet says that treatment (iron supplement) would cause constipation which he struggled with for a while.

Anyway, I would hate to take him to another vet's for a second opinion (that would mean driving 40 miles in weather that has been bad for a while), but I think it is about time.

Well, thank you so much.
By the way, Cynthia, I love the garden quote you have chosen on your page!
Anne-Marie

Many CRF caretakers administer subQ fluids at home. It takes a while to get comfortable with the procedure, but it's really not at all difficult, and it's a whole lot less stressful for most cats than constant trips to the vet. Your vet (or his tech) can teach you how to administer subQs and set you up with the IV sets, needles, and fluids that you'll need - but you can order all of those things much more cheaply online if your vet will write you a prescription for the fluids.

It's been waaaay too long since you've had bloodwork on your cat. You should have a full blood panel at least every 3 months, IMO, and more often if symptoms indicate a problem. You really need a full panel to check all of the different levels that can be affected by CRF. Partial panels tell only part of the story and may leave out information critical to your cat's proper management.

If your cat is still eating well but has lost a substantial percentage of his body weight in such a short span of time, you should definitely get him checked for hyperthyroidism (that's a separate blood test from a blood panel).

Additional fluids should help with constipation problems. If your boy is anemic, you should definitely be treating that, as well. If iron supplementation causes additional constipation, Lactulose is a very effective and safe stool softener for CRF cats.

Just a note on diabetes - Cats can be misdiagnosed with diabetes if they are under stress and/or in pain when their blood is drawn for testing. Stress and pain can both cause a temporary but substantial rise in blood glucose, resulting in misleading test results. Also, even some accurately diagnosed feline diabetics have been documented to go into spontaneous remission from the disease (an uncommon but known phenomenon in diabetic cats). So it's possible that your cat either wasn't diabetic at all or that he was diabetic and went into remission.

The link below is the online "bible" to CRF management. It will teach you all of the basics and a whole lot more. I can't even count the number of times I have read through that site and continue to refer to it to refresh my CRF knowledge for the best possible management of my boy's illness.

Laurie

Here is a link that might be useful: Tanya's CRF Information website

Thank you so much, Laurie. I also have often gone to Tanya's site. I actually think this is in this forum (I had been lurking for a while) that I discovered the site. Will go back again, as all this is very hard for me to fully understand.
Anyway, since your previous post, I checked hyperthyroidism at length, and.. oh.. I'm just amazed to realize that our cat presents so many of the symptoms. We just moved up here 18 months ago, and our previous vet was very good about bloodworks. He had his last full one there, before we left. Our new vet is extremely nice but does not take any initiatives. She waits for us to ask her if she would test him for this or that. We even had to insist on X-rays to understand what was going on with his leg. She could not even see the symptoms of brain tumor in our other cat until we just happened to come across the symptons on the internet (and he had them ALL!!--textbook description!)
I had been thinking about bloodwork for a while, but he is so skinny now that the thought of it scares me. Yet, I will bring the issue to her on my next visit (Tuesday), and I will also consult another vet. I can't help thinking she has given up on him-she already wanted to put him down just before Christmas. After everything we have spent, she should know we truly care.
By the way he has been on lactulose for just over a month, and it is finally helping him!!

Thanks again Laurie. I'm going back to Tanya's site.
Anne-Marie

Some vets are better than others, Anne-Marie. You need to find a vet who is willing to be as proactive as you are in the care of your animal companions. I, too, was faced with a vet who wanted to give up on my first CRF cat. Needless to say, that veterinary relationship was permanently terminated as soon as I found a more competent vet.

As I mentioned, my boy, Billy, is both CRF and HyperT. The relationship between these two diseases makes managing them both a balancing act. Mild hyperT is actually helpful for a CRF patient, because hyperT infuses the kidneys with blood, keeping them healthier. When Billy was first diagnosed, both illnesses were in the early stages, so my vet recommended NOT treating the hyperT so that the extra blood infusion could continue to support his kidneys. HyperT also stimulates the appetite, which is commonly suppressed in CRF cats.

Now, Billy has dropped more weight than I am comfortable with, and his coat is really thinning, so I suspect the hyperT has gotten worse. He's due for more bloodwork in two weeks, and I expect the results will show that it's time to start him on thyroid med.

BTW, Lactulose is a dose-to-effect remedy. It really shouldn't have taken a month to help your boy. It won't cure an impaction, but once the vet has cleared the constipated material, Lactulose should prevent constipation from recurring if it's being given at the proper dose. You'll know that you're giving too much if he develops diarrhea or his stool gets sloppy soft. If that should occur, you simply reduce the dosage a little until the stool returns to a soft firm consistency.

Laurie

Oh Laurie, you are a wealth of information!! I can't tell you how much I appreciate your time in sharing your knowledge! And Tanya's site is so helpful! What's Billy's weight now? Hope his blood work will be as good as can be...
Yes lactulose took a while to work, and we had to go through a few enemas.. Now our Picasso has become quite regular, without being a big producer.
Well, thanks again.
Will keep you posted,
Anne-Marie

I just pulled out my Pill Book Guide to Medication for Your Dog and Cat and read up on Lactulose again. There are a couple of cautions that might apply to your cat. First, Lactulose can affect blood sugar, so if your cat is borderline diabetic, this may be an issue. Second, Lactulose should not be given to a dehydrated animal. It pulls a lot of water out of the cat's system as it travels through the colon, so the cat needs to be kept well hydrated. Your cat's excessive drinking and problems with constipation imply to me that he may be chronically dehydrated (thus my recommendation that you start administering subQ fluids at home), so you shouldn't increase his Lactulose until you get him properly and consistently hydrated.

You can check for dehydration by feeling your cat's gums. If they are slimey, he is probably adequately hydrated. If they feel tacky, he is dehydrated. You can also check hydration by pinching up some loose skin. If, when you release the pinch, the skin immediately flattens back out into normal position, the hydration level is probably OK. But if the skin remains partially tented for a second or two after you release the pinch, then he is dehydrated.

For your reference, the recommended dosage of Lactulose for constipation in cats is 1 ml/10 lbs 3 times a day, then adjust as needed.

Laurie

It was good that you asked me about Billy's weight because it reminded me of another recommendation I was going to make to you. Buy a digital baby scale so that you can weigh Picasso regularly. When Billy's brother, Bitsy, was diagnosed with CRF in Oct. 06, he was pretty severely dehydrated. My vet told me to administer 300 ml of fluids every day for 5 days to rehydrate him. On day four, Billy went into respiratory and cardiac distress because I didn't recognize the signs of overhydration. He was not absorbing the fluids quickly enough and was essentially drowning internally from all the fluid retained around his heart and lungs. I almost lost him, but with quick veterinary intervention was able to pull him through. I had never experienced overhydration with my first CRF cat and didn't even realize that it was a possibility.

After researching overhydration, I immediately bought a digital baby scale off of eBay so that I could monitor Bitsy's weight changes. By checking his weight daily, I could tell how quickly he was absorbing and eliminating fluids so that I didn't risk overhydrating him again.

The scale has also come in handy as a weight management tool for my other cats (14 at present). My biggest cat, Noddy, also had a diabetes scare back in June, so I finally decided to get serious about taking weight off of my chubby crew. I've been weighing all of my cats every two weeks since early July 07 to help me establish and adjust proper food portions for each of them.

The two-week weigh-ins have proven particularly helpful since Billy's CRF and hyperT diagnosis, because now I can go back to before his diagnosis and recognize the reasons his gradual weight loss. On 7/9, Billy weighed 10.35 lbs. At his last weigh-in on 2/1, he weighed 9.4 lbs. Billy has never been overweight and is not one of the cats who has been on dietary restriction. In fact, I try to convince Billy to eat every time he is awake to help him maintain as much weight as possible.

Anyhow, consider buying a baby scale to help you monitor Picasso's condition. And give that boy a gentle hug for me.

Laurie

Hi Anne Marie. It sounds like Picasso is in good hands. Don't be afraid of administering the sub-q's at home. Your cat might just surprise you with how he accepts them. I've had two CRF cats in the past and they both (after some inital struggles) actually came to look forward to their injections...which were up to twice a day toward the end. It was no big deal for me either once the routine was established.

There is nothing much I can add to Laurie's comprehensive advice excecpt an idea about the constipation issue. My late cat was badly constipated: The first year we treated him much like you are proceeding with Picasso. But then the situation became increasingly more difficult. I think Max had a touch of 'mega-colon' in addition to the de-hydration from the kidney problem. In addition to the lactulose (which he barfed up half the time), my vet told me to give him Petromalt a few times a day as well. Some cats like to eat it right from the tube...Max did not, so I would just smear some on his paw a few times a day. Ask your vet about adding that to his treatment if the constipation comes back.

The other drug my vet prescribed was something called Cisapride. It is only FDA approved for vet use. It enhances digestive trac motility. His treatment also included a small amount (as Laurie mentioned) of Pepcid AC (NOT to be confused with Pepcid Complete!). This combination helped him tremendously during his last year of life.

LF

Anne-Marie, I have another suggestion you might find helpful. I highly recommend the Pill Book Guide I mentioned in one of my posts on this thread yesterday. It's inexpensive (about $7.00 new, cheaper used) but is invaluable in the information it provides about veterinary drugs. Since CRF cats often end up on a whole cocktail of drugs and supplements, it's important to understand how each one should be administered, potential side effects, and drug interactions. For instance, Pepcid AC (which is commonly given to CRF cats with stomach acid issues) can affect the absorbtion and efficacy of many drugs if given within 1-2 hrs together.

The Pill Book Guide provides complete information on just about all drugs used in veterinary practice up to its publication date in 1998. I refer to mine all the time.

Laurie

I just can't believe how helpful you all have been, and I simply don't know how to say thank you. I am very touched.
I just came back from another vet to check the place out, first, but also to see if the vet would feel comfortable giving us a second opinion. Made an appointment for WEd. morning, but of course with another snow storm approaching, I don't know--mostly secondary roads, and much further..

WE should see our regular vet tomorrow (for fluids), so I will ask about hyperT, and complete blood work. At this point, giving fluids myself scares me a little, so I'll have to wait a bit on this one.
Laurie, now that you have pointed out the side effects of lactulose for a borderline diabetic cat (I still can't be sure this was a serious problem for our cat although he got insulin injections for 6 months), I wonder if this is not why his drinking/urinating are so MUCH worse right now! His constipation is made much worse from the fact he has no muscles left in his right hind leg (completely useless).

Anyway, Laurie, I was going to ask you if you were/had been a vet, but when I read you had 14 cats, I figured they taught you a lot... My 2 sick cats in the last 18 months have also taught me a lot.. more than I ever wanted to know, unfortunately.

Yes, I'll try to find one of those baby scales.. Excellent advice.

Thank you all again for all your wonderful advice,
Anne-Marie

Nope, I'm not a vet and I've never worked for one. I am, however, almost 53 yrs old and have been taking care of animals all my life. I've dealt with most of the more common veterinary ailments along with some of the obscure ones. I also make a point of researching the veterinary issues that arise with my animals so that I can advocate properly for them with my vets. Experience is the best teacher, as you have already learned yourself.

I'm glad you'll be seeing another vet for a second opinion. I'm far from impressed with what you've mentioned about your current vet. Even when you're dealing with very good vets, second opinions often bring fresh approaches and treatment suggestions.

When discussing thyroid testing with your vet, request a "Free T4" instead of an in-house test. The Free T4 is more accurate (also more expensive) and will have to be sent out to a specialty lab. Still, you're going to want accurate results so that you know how to proceed with treatment if Picasso is hyperT.

I completely understand your reluctance to administer subQ fluids at home. I remember being very nervous about doing it at first, too. Unfortunately, my reluctance resulted in a lot of needless suffering on behalf of my first CRF cat, Pea. Pea experienced bouts of severe constipation which caused her tremendous pain and make her extremely ill and ultimately completely and permanently inappetant, forcing me to syringe feed her for the last 6 mos of her life. The vet I was using at that time mentioned fluid supplementation but neglected to explain its importance, so I disregarded the suggestion. Also, Pea was drinking huge amounts of water, so it made absolutely no sense to me that she could possibly require more fluid than she was already taking in.

I just didn't understand that in renal failure, a cat's body is no longer able to utilize fluids properly, so all that water she was drinking wasn't doing her any good. The more dehydrated her body became (which was causing her constipation), the more she drank, but it still wasn't enough to hydrate her adequately. She was drinking ALL THE TIME, and she was still severely dehydrated.

It wasn't until I finally researched CRF myself and learned the critical function of subQ fluids that I finally learned how to administer them myself. As soon as I started giving Pea subQs at home, she never experienced another constipation, and everything about her behavior (except her inappetance) indicated that she felt MUCH better and stronger. Dehydration makes all animals feel very ill, weak, and disoriented.

So, please, try to find the courage to learn and administer subQs at home. Yes, it'll be scary at first, and you'll undoubtedly make a few booboos along the way that might make Picasso a little uncomfortable until you get the hang of it, but it's really not difficult with a little practice. You just need to bite the bullet and know that you are doing it for Picasso's GREAT benefit. There is absolutely NOTHING you can do for him that will make him feel better than subQ fluids.

The complete blood panel and thyroid test you'll have run on Picasso this week will tell you a tremendous amount about his current physical state. There's no sense speculating about cause and effect now when you'll have the answers soon. Make sure you get copies of ALL of his test results to take home with you so that you can track his condition and do relevant online research. Also, the second opinion vet will want to see all of his current and past test results. I'm also very interested in knowing what his numbers will be, if you're inclined to share the information after his tests.

Laurie

Yes, we did have a bad snow storm overnight and this morning (and wintry mix all afternoon), so we had to cancel the appointment for a second opinion. Not sure I will re-schedule after the test results we got.

So you were curious about the tests results, Laurie?
Thyroid? all fine // Glucose: fine
The bad numbers: (are they hopeless?)
BUN: 74.1 (was 51 last June)
Cr.: 4.4 (3.9 last June)
Phosphorus: 12.7 (would you advise ph. binders?)
Calcium high (don't have the exact number)
Hct: 15.8 (very low)
So, he is anemic (which I had expected from the color of his gums)
Anyway, I'll pick up a copy of the full results tomorrow, so I can study them (I found a nice internet site that helps analyse all of this) and will come prepared with specific questions for a plan of action when I take Picasso for his fluids on Friday.

To be honest, I did not have a good 'feeling' for the new vet's office. The clinic we have been going to for over a year has 2 vets. The one we have seen the last 10 days (our regular one was out of town) is much more competent --in my opinion, he is the one who does surgeries--, and much clearer in his explanations . So I'll see how it goes on Friday. The clinic I would really like to try is a holistic clinic, but it is far. We have had such bad weather in the last month.. It could never become our main one. We should have gone for a second opinion as soon as Picasso's hind leg went bad--last May!! I really feel so bad about it now..
Well, I'll try to remain positive. Sorry for such a long message.
Hope Billy's tests will be unchanged.
Thanks again,
Anne-Marie

Anne-Marie,

Thank you for posting some of Picasso's latest test results. I assume that they did not run a T4 thyroid test (I can't imagine you could have received those results so quickly). They probably just ran an in-house thyroid test which isn't as accurate. Why did you put the question mark next to thyroid?

The other numbers certainly aren't hopeless, but they also can't be properly interpreted without knowing the norm ranges of the testing equipment. When you get copies of the test results, they will show normal ranges for each blood level. Since these norms vary a bit depending on the testing equipment, you need to know the ranges in order to understand where Picasso's numbers are in relation to the norms. If the test results you receive don't indicate the norm ranges, ask your vet for them and write them down.

All of the numbers you posted above are concerning, but the ones that I would consider the most critical in my own cat's bloodwork are the high phosphorous and HCT. You must get those under control ASAP. Picasso should be on phosphorous binder immediately. Once you get his phosphorous down, his calcium should come down with it. Also, his anemia needs to be addressed right away. Research these issues on Tanya's site so that you'll know what to discuss with your vet.

It's often possible to bring down elevated BUN and Creat somewhat with more frequent subQs to help flush toxins out of his system. Talk to your vet about bringing him in for subQs more often (at least every other day), if you're still too uncomfortable with the idea of learning to administer them at home.

Don't give up yet. CRF is a terminal illness, but it certainly doesn't have to be immediately terminal. Like I said, some cats live for years with properly managed CRF, while others can never seem to get stabilized. I've been in both positions.

Post again tomorrow, please, when you have the full test results. I am posting a link below that can provide additional information on blood values.

Laurie

Here is a link that might be useful: blood test results

Oops, obviously I posted my most recent response too late at night after my brain had already begun to shut down for the night. What I meant to write was, " I assume that they did not run a FREE T4 thyroid test (I can't imagine you could have received those results so quickly)."

Sorry I could not (emotionally) bear to talk about it until now.
Yes, seeing the full blood results is scary. Here are the numbers not mentioned before. Laurie, maybe you wished you had not asked about them...
RBC: 3.47 -low
HCT: 15.8 -low
HGB: 6.1 -low
MCHC: 38.3 -high
WBC: 25.49 -high
NEU: 22.59 -high
PLT: 615 -high
AS for Thyroid T4: 3.7 (it was 2.0 in May 06)--vet could not find anything wrong with his thyroid gland from touch.. I asked (because it is borderline high), if we could rule HyperT out and if a Free-T4 would be helpful. He said it was all fine.

Anyway.. same old story, we run all these tests, spend much money and we can never get 'a plan of action'. He had nothing to say about phosphorus binders, teatment for anemia.

The MAJOR problem is his constipation (yes, it is back). 2 enemas this week. Yesterday's has not produced any results yet. The vet did remove some stool manually (was quite dry). He thought next time, it would have to be removed under anesthesia, which he (nor we) recommended. Again: it was time for him to go. Cannot do it! He is now down to 5.4lbs (from 13 exactly a year ago)

I really believe Picasso's biggest problems is not CRF but that tumor (osteosarcoma according to vet) in his pelvic area, that presses against his colon. That was diagnosed late last November after he had been hopping on 3 legs since May 15. They first thought it was neuropathy, then she thought it might be a tumor (traces in his lungs in June) whose origin she could not yet tell. Anyway, when she talked about cancer then, we kind of accepted it and hoped for the best, because we were not going to drive him miles away for chemo or anything else. This is really when we should have gone for a second opinion. I simply feel terrible. We still had some confidence then in the diagnostic, I guess, since we had never dealt with this. It is when our second cat died so quickly that I started questioning a lot of things.

This is just way too long. I apologize. I did call the holistic clinic late this morning-some 40 miles away. The vet was just on his way out, was not very optimistic, but told me to call him first thing on Monday, and that he would do his best to see him.

so.. fluids every other day, B 12-complex injection once a week). That's it.

In the meantime, he still eats (reasonably), purrs occasionally, sleeps a lot. There is still light in his eyes.

I am very sorry for this LONG post. I may soon start another one on risks of vaccines and certain drugs!!! Maybe this will help some cats!

Thanks for listening,
Anne-Marie

Anne-Marie, I understand how overwhelming it can be and how sometimes all you can do is hide your head in the sand for a while to let your emotions settle. It can be nearly impossible to think clearly when there are so many difficult issues at hand. There's no need to apologize for disappearing for a few days. I've been known to disappear for months when focused on an ailing animal.

I haven't commented on Picasso's cancer because I have no experience with or knowledge pertinent to it. It does, however, sound reasonable to assume that if he has a tumor pressing against any part of his digestive tract, it may be playing a profound role in his chronic constipation. If more frequent hydration and perhaps an increased dosage of Lactulose don't resolve this problem, it may be time to seriously consider releasing Picasso from his maladies. In my experience, constipation is extremely painful for cats, and I know that's not something you want Picasso to have to live with constantly.

The high phosphorous is poisoning his body. The anemia is leaving him weak. His high white blood cell count makes me think that he's also fighting some sort of infection. Anne-Marie, Picasso is dying, and not in a comfortable, peaceful way. If you can get his phosphorous and anemia under control quickly and find a way to control the constipation (which, BTW, can be made MUCH worse with phos. binders), Picasso may be able to live with the cancer for a while longer. But unless you can find a vet who is interested in addressing those issues, Picasso will continue to sicken, and his pain will increase.

I want so badly to be able to reassure you, Ann-Marie, but Picasso is in critical condition. Your vet either hasn't explained things to you properly, or you're just not able to hear it. You either need to find a much more proactive vet, or you need to let Picasso go in peace.

I'm so extremely sorry.

Laurie

Unfortunately, I think Laurie is right about Picasso. I decided to put my Max down because of the constipation. Over the 2+ years that he lived with CRF, we tried everything to relieve the constipation and the various meds, fluids, and an occasional (every few months) enema did the trick. But over time, nothing seemed to work. In addition to the dehydration problem, Max had megacolon, which makes it physically more difficult for a cat to expell stool. In Picasso's case, he has a tumor probably presents a similar situation. In the end, I just couldn't bear to see Max straining...and I didn't want to have to put him through the trauma of weekly enemas. My vet agreed, and he went peacefully.

L

Yes, it is very painful to see him strain. Yet, he'll be purring the next minute! He is such a trooper! If it were not for this bright, shiny light in his eyes, I would have had the courage to go through euthanasia. If this holistic vet can see him VERY soon, I'll wait for his opinion. I guess, I do not have enough confidence with our vet regarding cancer. I think it is probably a vaccine-induced growth. Why did it show up almost 6 months after developing plantigrade stance? Could it be a swelling in the joints from not being able to use his right leg, and putting extra burden on his pelvic area? No, the vet has not explained things properly when it all started and lost interest, and this is why I feel so bad about not having done anything then, when he was still strong.
Deep down, I know you are both right, Laurie & L. (and I am VERY sorry about Max, L.). You both have gone through tough decisions, and I apologize for making you revive these memories.. We simply can't leave him go on this way.
Will keep you posted. Thanks for all the help you have provided. It has helped me more than you can ever imagine.
Anne-Marie

Anne-Marie, I completely understand your reluctance to make the euthanasia decision when you are so uncertain of the diagnosis you've been given. It's always much more difficult to make an irreversible decision when so many questions remain unanswered. If you need more clarification, is there a university vet clinic within driving distance to which you could take Picasso? That's where you'll find the veterinary specialists and advanced diagnostic equipment necessary to provide the most accurate diagnosis.

Even in the absence of a certain diagnosis, you must consider Picasso's current state of illness above all else. He could suffer a major crash at any moment, and that is not a happy sight. That is, in fact, exactly how I lost Billy's brother, Bitsy, almost exactly a year ago. Bitsy was diagnosed with CRF in Oct 06, and I worked for several months trying to get his ever changing blood values to normalize. I never could get him stabilized, though. In spite of being on high doses of phosphorous binder, he suddenly crashed one day. His HCT plummeted and his phosphorous skyrocketed ... all within the matter of a few hours. As weak and close to death as he was, he still purred in my arms as the euthanasia drug was administered. Purring is not an indicator of feeling good. It is simply a consoling vocalization. I just don't know if Bitsy was trying to console me or himself in those last moments.

Because Picasso is at high risk of crashing, you must make sure you have access to an after hours emergency clinic where you can take him for euthanasia to end his suffering. This is NOT a disease that will take him quietly and painlessly in his sleep. You do NOT want his death to happen at home.

Laurie

Ann Marie

How ironic I see this post and find this board for the first time today. On Monday evening I had to euthenize my 16 yr old Tonkinese female who was in the end stages of kidney disease. A year ago I noticed she was drinking and peeing a lot more than normal. I took her to the vets and he ran blood work which showed her kidneys were at the very early stages of problems. Otherwise she was acting and eating just fine. She weighed 8.5 pounds which was normal for her (she was the runt and always quite small).

About a month ago I noticed a change in her. She was skinnier and not drinking as much. Within two weeks she went down hill considerably. Stopped eating altogether. Her breath became atrocious. Her fur looked bad. She slept all the time and wobbled when she walked. The vet confirmed via bloodwork that her kidenys had begun shutting down. She was done to just over 4 pounds.

I tell you, it was the hardest thing I've ever had to do. Everyone was crying (except the cat, who just seemed content to be held). It was the right thing to do, and I just sang her to sleep with her in my arms.

Kideny disease is so terible. I'm sorry you have to go through this. I'm sorry anyone has to.

Sam
1992-2008
{{gwi:2008930}}

Dgmarie, I am ever so sorry for Sam. Such warmth in her fur and in her eyes!!! I just wished I could find any comfort words for you...

Our Picasso is still with us. We had scheduled a house call visit to put him to sleep peacefully at home for this past WEdn.. But it must have been his way of telling us.. not yet, for he suddenly improved, so we simply could not go through this. He had a great BM then and has had several since. He still eats a reasonable amount on his own. LAst night he even groomed himself and kneaded for a while in his favorite seat.. SO we keep rescheduling the fatal appointment. Regular fluids, chicken broth, fish broth, moist food, and A LOT of attention!

Although we have often wondered if our vets had been on top of things, they are really good in always making time for him and we are lucky they have emergency calls and house calls.
This has been quite a draining week!!!
Laurie, your words are with me all the time. WE lost a cat to brain tumor just 3 months ago. He died in my arms after an awful night just a few hours before he was scheduled for euthanasia. So, I really do not want a repeat of this!!!! Whenever I can, I read the stories of your feline 'family' on your web page. This is so touching! You are one of a kind! Thank you so much for sharing. Will keep you posted. In the meantime, I hope Billy's tests will be OK..

Anne-Marie

Anne-Marie, I am very glad that Picasso is giving you a bit more time with him and that he has rallied and seems to be feeling better. That is, in my opinion, one of the most difficult aspects of CRF. A CRF cat can be on death's door one day and rally back to relative health the next. It makes it so incredibly difficult to decide when to make that final decision because we always hold out hope for one more rally. That's why my own CRF cats have been euthanized after major crashes. I just can't euthanize while I'm still hoping for another rally.

As long as you have a vet on call who can euthanize after office hours and on weekends, you won't risk having Picasso suffer for many hours even if he does crash. For now, as long as he's eating, remaining hydrated, acting comfortable, and is not constipated, I'd be doing the same thing you're doing - cherishing every minute with him and making sure he knows how much he is loved.

Thank you for your good wishes for Billy. He goes in for his bloodwork on Tuesday, and I'm hoping I'll have the Free T4 results by the end of the week or beginning of the following week. Based on his appearance and behavior I'm guessing that his kidney values won't be too terribly high, but that his hyperthyroidism has progressed to the point where I'll have to start him on Tapazole. As always, I'll handle whatever comes as it comes.

I found a new food that he actually likes (at least for the moment) and that isn't too terribly bad for him. It is higher in protein than recommended for CRF cats, but it's relatively low in phosphorous (which is critical) and pretty high in fat (which is important to try to maintain weight). Unfortunately, no store within a hundred mile radius of me stocks it, and I'll run out of the free sample today that Wysong sent me. I have to special order it and won't receive it until the end of this coming week. Billy's so hooked on it, though, that he's barely touching any canned food right now, so I'm not sure how or what I'm going to convince him to eat until I can get more Wysong Uretic for him. I know he'll eat the Innova Evo that I feed the other cats, but I can not give him that because it is extremely high in phosphorous, and that puts his tenuous health at much too great a risk.

I'll figure something out. I always do.

Give Picasso a kiss and a snuggle for me, please.

Laurie

Laurie,
I did some research on that Wysong Uretic food you mentioned above. It is only dry, right? I thought CRF cats should stay away from dry foods..

Since I learned how high Picasso's levels of Ph. were, I have checked contents of ph. on canned foods (especially the ones he is used to). Nothing. Same for 99.9% of cans. But I have found some interesting info on line (I think through Tanya's site). This is how I got to try wysong canned & Innova. Also, Innova Evo gives the complete analysis on line, and the Ph. is very low (0.36%). On a different site it was listed at 0.50%. How reliable?? Anyway, I recently tried it on Picasso-was interested at first, but like always, it did not last. Since you mentioned it (as bad food for phosphorus), I thought I would pass this along. When you get to the site, go down to Evo Cat & kitten , click on learn more, then nutrient analysis (right of screen).
Phosphorus is present in poultry, meat, fish (all good source of proteins)... so how to avoid it?
This is all too confusing for me.

Well, hope Billy finds something he enjoys eating, the poor guy. Please keep us posted about his blood work.
Anne-Marie

Here is a link that might be useful: Innova Evo analysis

Anne-Marie, first let me say how proud I am of you using this tragic situation with Picasso to learn so much about his illness, its management, and its potential causes. I have always believed that the best way to honor and validate the lives of our loved ones is to learn as much from the circumstances of their lives as possible.

My first cat who I believe died of CRF was Tempest, the cat who raised me. Because she was so terrified of trips to the vet, I opted not to take her in when she fell ill. I allowed my precious Tempie to suffer here at home until the day I had to take her in to be euthanized - all for the misguided sake of sparing her the stress of a vet visit. That was a particularly harsh and guilt-ridden lesson to learn, but learn it I did.

As a result of the horrible mistake I made with Tempest, Pea received much better care when she was diagnosed with acute kidney failure, though I made some very serious mistakes with her, as well. I did, though, learn a tremendous amount about CRF while trying to manage Pea's illness and associated symptoms.

Bitsy received the benefit of my CRF educations from both Tempest and Pea, and he presented me with even more symptoms and lessons about CRF. I took those lessons to heart and will apply them as necessary to Billy, who is the first cat to present me with CRF and HyperT simultaneously. More lessons to learn.

Now to address your post. Yes, it is certainly preferable to feed a CRF cat canned food - better yet when the food is mixed into a gruel with additional water. Ideally, the cat will eat one of the prescription canned renal veterinary diets ... if only the cat will agree to do so (which mine NEVER have). Above all, though, is the golden rule of CRF cat management - FEED THEM WHAT THEY WILL EAT.

CRF cats often become inappetant or at least extremely picky about what they will eat. In Billy's case, he has always been a picky eater, and his pickiness has become progressively worse with his illness. Until recently, he was eating canned food quite well, though he would cycle through the "acceptable flavors" quite quickly. For a long while, all he wanted to eat were seafood flavors. Then suddenly he wanted nothing to do with seafood at all and would eat flavors which contained liver (something he has never tolerated before). Right now he has lost almost all interest in canned food and wants only dry, so I have been researching dry foods that are as close to "CRF-acceptable" as possible while still being palatable and appealing to him.

Here are links to two sites that do both dry and canned cat food comparisons relative to the issues most critical to CRF cats (protein, phosphorous, fat, etc.):

dry cat food comparisons
another site with dry cat food comparisons

Read the pages carefully so you will understand how these comparisons are made. You will also find links on both pages to their canned food comparison pages.

It is my personal belief that, particularly for cats in the beginning and moderate stages of CRF, low phosphorous is more critical than low protein, so I tend to give more consideration to the phos than the protein. As you noted, phosphorous is in just about everything, so when the cat's phos blood level goes above normal range, the only option is to use phos binder to prevent the phos from being metabolized by the cat's body.

Anyhow, you'll understand more about how the various foods compare once you read the pages linked above.

Yep, it's confusing!

Laurie

Hi Anne-Marie,

As promised, copied below are the results from the blood panel I had run on Billy today. Free T4 results will hopefully come back by the end of this week, and I will post them when they arrive. My vet and I are both certain that his T4 will be more elevated than when he was first diagnosed in Oct., though. Billy continues to lose weight (9.2 lbs today), the mass on his thyroid is a bit larger than it was in Oct., and he has developed a grade 2-3 heart murmur. Several weeks ago, Billy also started overgrooming and pulling out hair.

OTOH, I am encouraged by his kidney values. BUN has remained essentially the same since Oct, and his creat is now within normal range. Those may elevate, though, if I have to start him on Tapazole after the thyroid results come back.

I am somewhat concerned with the ALT and AMY. I realize (from Tanya's site) that ALT is sometimes elevated in hyperT cats, so perhaps his current blood level is unremarkable and not indicative of liver disease. I have also read on Tanya's site that AMY is often elevated in CRF, so perhaps I needn't worry about that value, either.

All in all, Billy seems to be doing pretty well. I think that his current physical issues are mostly related to the uncontrolled and worsening hyperT. I do believe I'll have to start him on Tapazole once we get the thyroid results, and I'm concerned about what effect that will have on his kidneys (and his appetite, which is becoming increasingly problematic). I know that CRF and hyperT require a balancing act in their simultaneous management, and that's one veterinary tightrope I've not had to walk before. Always a learning experience with these wonderful beasts of mine.

ALB 4.3 (2.2 - 4.4)

ALP 59 (10 - 90)

ALT 110* (20 - 100)

AMY 1231* (300 - 1100)

TBIL 0.2 (0.1 - 0.6)

BUN 40* (10 - 30)

CA++ 10.6 (8 - 11.8)

PHOS 4.7 (3.4 - 8.5)

CRE 2.0 (0.3 - 2.1)

GLU 134 (70 - 150)

NA+ 153 (142-164)

K+ 4.2 (3.7 - 5.8)

TP 7.6 (5.4 - 8.2)

GLOB 3.4 (1.5 - 5.7)

I hope that Picasso is comfortable and happy today.

Laurie

Oh my, Laurie.. These are simply SUPERB!!! Billy does have FUNCTIONING kidneys!! I certainly hope his thyroid results wont't be as bad as you seem to expect. Maybe it is just a slight inflammation of the pancreas. What did your vet say?
I haven't had a chance to read through the food sites you posted. As yous wrote in your earlier post, I have learned A LOT in the last 18 months, but I am always a few steps behind, and it is not helping...
Picasso hardly ate yesterday, but had a good bite this morning. So I hope he'll have a good day.
Give a big congratulation hug to Billy and keep us posted,

Anne-Marie

Neither of the two vets who are consulting on Billy's case seem concerned with the high ALT and AMY values, and they're both very encouraged that his Creat has dropped into normal range (it was slightly elevated in Oct.). On another happy note, Billy is once again eating canned food gruel today. :-)

I know what you mean about always feeling like you're a few steps behind. I am in that state perpetually. I still feel very ignorant of hyperT. Even with my old nemesis, CRF, I am constantly having to reread online materials to refresh my knowledge. I do love having the internet at my fingertips, though, to help me learn what I need to know to help my kids.

I'm glad that Picasso has eaten today. Funny how our priorities shift, isn't it? I don't get excited when I see any of the other cats eating, but with Billy eating is an EVENT!

Laurie

Billy's Free T4 results are in. As expected, his hyperthyroidism has gotten worse. It's a bit tricky interpreting these new results because the reference range is very different from his last test (different testing equipment, apparently). After doing a bit of math, however, it looks like Billy's T4 level that was 6.1 (normal reference range 1.9-4.8) on 10/12/07 is now somewhere around 8.61 using the same reference range. (The actual results of the current T4 is 2.51 with a reference range of 0.50-1.40). So my primary vet wants to start him on a low dose of Tapazole to try to protect his heart and hopefully eliminate the heart murmur, along with preventing further weight loss. I've forwarded these new test results to my other consulting vet and am waiting for his input.

Joe will pick up the Tapazole on his way home tonight, and I will wait to hear from the consulting vet before finalizing Billy's optimal starting dosage. It may take a few months of juggling the dosage to find the right balance for Billy, and then his blood will need to be tested every 6-12 mos to make sure that the fine balance is being properly maintained as his diseases progress. For now I'm just focusing on the good news about his kidneys and hoping the Tapazole doesn't have too deleterious an effect on them. He'll need blood tests every few weeks for these first few months of Tapazole treatment to monitor the effect it's having on him.

So that's where things stand now.

How is Picasso doing today?

Laurie

Thanks for the update, and I am really sorry that you were right about Billy's hyper-T! As always, a few steps ahead.. I certainly hope that Tapazole will work for him without too many side effects--it has plenty, unfortunately, as you are already aware.
Well, concentrate on the positive, and give Billy a big hug.
With Picasso, it is one day at a time. Fluids trip this morning.
Take care,
Anne-Marie

Hello I'm a newbie,
I don't see any resent posts so I figured I would say hello.
My cat has hyperthyroidism. I live in Costa Rica and the Vet has told me they don't have the treatment here. I asked the Vet if she is in pain and he said No, as of now she likes to eat a lot and poop alot but she is very thin.I don't think she is in pain I feed her and make sure she has plenty of water.I don't know what else to do.