The mainline Alzheimer's drugs are good, but once the disease - Alzheimer's or one of its numerous related dementias - gets a toe hold, there's no magic bullet. The drugs can stabilize someone for a time, then they reach plateaus, then have a downturn with more and different symptoms, reach another seemingly stable plateau, then downslide again. It's a natural progression - but without the drugs it's almost impossible to calculate what the rate of decline might be. I won't say anything negative about alternative therapies since nutrition is key to everyone, not only those suffering dementias, but nutrition will not bring back or regenerate those brain functions that have been lost. From someone who was a caregiver for five years, it was difficult enough keeping my Mother ineterested in a decent, balanced diet without having to contend with the idea of her taking a handfull of nutritional supplements. There comes a time when food, hydration, etc. is no longer of interest to them. Systems are slowly, systematically shutting down - including the mechanisms controlling the ability to swallow. Mom lived to be 91 1/2 and it was pneumonia that finally took her. She had an easy, pain free death - the kind of death we wish for ourselves and those we love. I would agree with seeking out a new doctor that is at least sympathetic with the treatment of the elderly - any doctor that dismisses things simply because one is old would not have my confidence. And because the population is aging, there are plenty of good doctors out there who still have their elderly patients' best interests at heart. You wouldn't buy a rug for your livingroom you didn't like - should be the same for primary physicians.

Even middle age people are being over medicated by many Dr's The pharmaceutical people who visit the Dr's will really push their products, free this free that etc even to the reception people. Very few Dr's will evaluate a persons condition why??because the insurance companies dictate how long they spend with each patient, in fact a Physician's Assistant will do most of the work, ask most of the questions, and Doc will glance at the chart, ask about 3 questions, and say get this filled and rarely follows up and gets annoyed if either the patient or family asks a question. Just the way it is unless you yell, scream and threaten! Which I have been know to do. Our Dr is so good with us and takes more time that he is prescribed to and does follow up and/or listens to us Very unusual!

Here's my experience: I had 3 cats, two yellow males and a yellow female, all from the same litter. They showed up here as feral kittens. After feeding them for awhile, we finally tamed them, got vaccinations, spayed and neutered and started keeping them inside. About 5 years ago,when they were about 9, one male got sick. I took him to the vet, he was diagnosed with renal failure. The doctor said we might try giving him fluid and trying to keep him alive, but she didn't sound very hopeful about the outcome, so I had him euthanized. I had bloodwork on the other 2 done then, and they were normal, although the other male was in the high normal range. The vet didn't suggest that I should have him rechecked after some time had passed, so I assumed I didn't need to worry about his kidneys. After about a year and a half passed, the other male lost weight (down to about 8 pounds from about 11) and I suspected he had renal failure too. I took him to the vet, a different doctor saw him, and it was renal failure. He convinced me to do the fluid and see if he would improve. So I did. After about 3 days of force feeding him canned Hills AD, he started eating dry Hills KD and gained weight. His appetite was fine once he started eating. He eventually gained weight to 10 pounds, and maintained it until a few months ago. He started out with fluid every day until his creatinine and bun went down some. Then every other day. Then every third day. Early on, he was anemic, so the doctor started him on EPO injections. That took care of the anemia and he didn't develop the antibodies that some cats develop. After a few months I asked the doctor (this time it was the doctor who had seen the first cat) if I needed to be concerned about his blood pressure, and she said that she was sure his blood pressure was fine. (They couldn't check it anyway, no Doppler machine.) One evening about a week later I realized he was blind. I took him to the emergency clinic in Charlotte, NC and his blood pressure was so high it wasn't readable. They kept him overnight, got his bp down, and sent him home with a prescription for Norvasc and told me to give him Pepcid daily, as well. That took care of that problem. While at the emergency place, which is also a specialty veterinary clinic, he was transferred to internal medicine, and was fortunate to get an excellent doctor who told me his specialty is nephrology. I started taking him there for his regular bloodwork and checkups, even though it was more expensive. There's no doubt in my mind that taking him to the specialist made a big difference in how well he did for so long. As time passed, and his creatinine started rising as his remaining kidney got worse, I increased the fluid to 200 ml. once a day. His creatinine never did go down near normal. It was always over 5, and even when it was around 8 his appetite was good and he seemed to feel fine. That's how I gauged how he felt, by how he was eating and how he acted. About 6 weeks ago his creatinine had gone up from 6.6 to 10. I could tell he was not feeling as well, and he wasn't eating as much. I increased his EPO injections to once a week, from every other week. Dr. Jaeger said EPO seems to help lower the creatinine in some cats. When I took him back about 10 days ago his creatinine had only gone down to 9.6 from 10.1. His blood pressure was a little high, too. He wasn't eating much at all, so I got Cyproheptadine (appetite stimulant). That was on Friday, July 6. He was scheduled for another appointment on July 26. When I brought him home that Friday, I persuaded him to eat a little canned Hills AD twice that evening. Saturday he ate a little more of it. Sunday he wouldn't eat it, so I tried no salt added canned tuna. He ate just a few bites. He also was not drinking much at that point. I was still giving him 200 ml fluid daily, and his medications. Monday he wouldn't eat at all and had not drank more than a couple tablespoons of water. Thinking it might take a while for the appetite stimulant to work, I put off calling the vet. Monday night I opened his mouth like I would to give him a pill and popped a little tuna in. He swallowed it but wasn't interested in eating at all. Tuesday I called the specialist and he said to bring him in. We had discussed at the previous appointment that he was near the end, and the doctor and I agreed that I wouldn't force feed him since he wasn't going to get any better, but the doctor thought he'd be ok for another 3 weeks or so. Our objective was to keep him comfortable if possible. By Monday night I had already made up my mind that it was time to end it before he got in worse shape. I had also realized Monday that he wasn't urinating as much as he should have been for the past couple days, so his remaining kidney function wasn't enough to produce much urine. I weighed him and it looked like he had gained about a pound, but I know it was fluid because he hadn't eaten enough to put on any weight. So when I took him to the doctor Tuesday morning he examined him and said that there was nothing we could do to help him at this point. So I had him euthanized. I hated to do it but I know it was the right thing to do. I feel better about it knowing that he only seemed to feel really really bad for a couple days at the most. Monday night, before I took him to the doctor Tuesday, he jumped up on the bed and I petted him for a good while. He purred while I petted him, even though he hadn't purred for at least a month. Now, here's what happened with his sister. She had some spells of vomiting, starting 6 months ago. The regular vet couldn't find anything wrong with her. Her bloodwork was fine, although her calcium was a little high. After a couple days she'd be fine, and start eating again. She had gradually lost some weight, but he attributed it to her getting older (she was obese at 15 pounds for a long time, and even when she got down to 10 pounds she looked chubby, because she was a small cat). After one of the vomiting spells, I took her to the emergency clinic at night because I thought she might be dehydrated. They did bloodwork and it was fine, but the specific gravity of her urine was not quite normal, and could possibly be an indicator of early renal disease. They didn't suggest she needed to be transferred to internal medicine, so I didn't worry about it. That was in April, I think. She seemed fine for a while. Then about 6 or 7 weeks ago, she was sick again so I took her to the regular vet, mostly because I thought she might need fluid and I couldn't tell if she was dehydrated, so I didn't want to do fluid at home if she didn't need it. They did bloodwork and her creatinine and bun levels showed renal failure. Other than the urinalysis being somewhat abnormal earlier, we had no clue that it would be renal failure. I don't remember how high it was, but she needed IV fluid at least overnight, so the new young female vet at the regular vet's office said that if it was her cat she'd take her to the specialty vet, and since he was already seeing my male, I knew he'd see the female too. They took her as an emergency patient, hospitalized her, and kept her for about 4 days. He said her kidneys were worse than the male's. Her creatinine didn't go down much, but I brought her home and started the same routine with her, fluid, blood pressure meds, pepcid. She seemed to do a little better, and started to eat, so I took her for her followup appointment around the first of June. Her creatinine wasn't going down much, but we didn't think she was in any danger of getting worse quickly and her appetite had improved. That afternoon when I brought her home from the appointment she went to the bowl and ate some food. I thought she was ok, but from then on, she went downhill fast. I had an appointment for her about a week later on Tuesday, June 12, but she got so sick I took her to the emergency clinic the following Saturday night instead of waiting til Tuesday. She wouldn't eat, I was forcefeeding her canned Hills AD. She hated getting the pills but got too weak to object much. She couldn't even walk to the litter box. I had to carry her. They called Sunday morning to say she had perked up some, but wasn't ready to go home. So I thought she might be ok. Then Sunday night the emergency doctor called and said she wasn't doing well at all. She wasn't producing urine and had fluid in her chest and abdominal cavities. That doctor had called the specialist (who had not been able to see her that time because of an out of town conference, but had just got back into town), and he agreed that there was nothing they could do for her, so I had her euthanized. It was harder with her, because with the male, I had about 3 years to know it was going to happen eventually. She had seemed ok (except for the occasional vomiting spells) up until a few months ago. The specialist said that the male had done much better than he would have predicted when he first saw him with the high blood pressure, and the female went down much quicker than he expected, although he knew her kidneys were worse than the males. The male was diagnosed in September of 2004, I think, and he lasted until this past Tuesday, July 10. The female was diagnosed this past May 21, and I lost her on June 10. Exactly a month apart. One thing the specialist said early on was that you never can predict how long the cat will live or how they'll respond to treatment. He didn't think my male would live much longer from when he first saw him in Dec. 2004, and he's had a lot of renal failure patients.

Here's my favorite site for interpreting feline lab results. Click on the name of each lab value of interest, and it'll download a small pdf file that explains the primary implications of that particular lab value: lab value explanations If Ziggy dislikes the liquid al hyd that your vet provided, you can purchase it in a tasteless powder form that is easily mixed into food at the following link: aluminum hydroxide powder At the same website, you can purchase the needles that are most popular with CRF caretakers (Terumo Ultra Thin Wall 20 ga.). Terumo needles are considered by many (myself included) to be better manufactured and sharper than the Monoject needles that most vets use. The superior sharpness and smoothness of Terumo needles seems to be more comfortable for cats. The 20 ga. Ultra Thin Wall Terumos have a flow rate that is almost equivalent to the larger, more uncomfortable, 18 ga Monojects, as well. You can also purchase IV lines at the same site. In case you're not aware, you can purchase Ringer's very inexpensively by the case if you call around and price shop at your local pharmacies. You probably won't find any pharmacies that keep it in stock, but they should all be able to order it for you overnight. You'll just need a prescription from your vet. I can purchase a case of 14, 1000ml bags of Ringers for $23/case from my local Target Pharmacy. Lactulose and Miralax are both osmotic laxatives with similar action in the gut. Lactulose, however, may cause digestive upset in lactose-intolerant animals (which most cats are), whereas Miralax will not. Miralax, being a nearly tasteless crystalline powder, is MUCH easier to administer than Lactulose, as well. It is easily mixed into canned food and is undetectable to most cats. Like Lactulose, Miralax is a dose-to-effect drug, meaning that you can adjust the dose up or down to maintain optimal stool consistency. But like Lactulose, Miralax is only effective in a properly hydrated animal, which is one more important reason to be consistent with subQ fluids. From your description, I have to assume that Ziggy is responding to your husband's nervousness during fluid admins. If I were you, I would kindly dismiss your husband from fluid duty and handle it yourself. It's also extremely important to warm the fluids before admins, as room temp fluids can badly chill a cat and make him extremely uncomfortable. If you'd been using room temp fluids on Ziggy and just recently started warming them, he may still be anticipating the chill of unwarmed fluids. Just give him a little more time to trust that he'll be getting a warm internal shower instead of a cold one from now on. I have found that the less restraint I use, the more cooperative my cats are during fluid admins. I do admins on diningroom chairs by a large window. I use my body and the chair backs to block the cat's movement off of the chairs without actually having to hold the cat, while the window helps to distract the cat a bit during the admin. I'll post a pic of my setup if you'd like to see it. It's very common for CRF cats to have problems with excess stomach acid, so many of them do take an acid blocker. As I noted earlier, Pepcid AC is the most commonly used med for this purpose. I use Zantac 75, instead, because it has fewer potential drug interactions than Pepcid. But Zantac is a pain in the neck to cut into 1/8's. I don't know of anyone who uses Prilosec, which is why I'd be very interested to know why your vet chooses to use it. If he knows of any studies of Prilosec's use in CRF cats, I'd love to read them. We CRF caretakers are always on the lookout for potential improvements in our management protocols. Laurie