Vet/animal peeps: CRF in cats

Here's our scoop:

I lost a cat to CRF a few years back, however, she was 19, and it was relatively quick. Her treatment was palliative only. Our newly diagnosed kitty is Momo, a male, black DSH. He's 8 (will be 9 in November). Until recently, he was a hale, hearty, and...well...chunky fellow. (we have three other cats and two dogs)

He lost close to 5 lbs prety quickly--one of our first signs. (he went from 17 lbs to 15.2) I told him this wasn't a good weight loss plan, and we should leave crash diets to the celebrities, but he didn't listen.

After a rapid decline (which was preceded by a gradual one that we didn't notice much until after the fact), we made an emergency trip to the vet yesterday. His levels were pretty high-- BUN 129; Creatinine 5.3; Phos. >16.1. He was also anemic (mild). He was given 150 mls of subQ and a B12 shot, and will have his levels rechecked tomorrow.

He hasn't eaten more than a treat/kibble or two in probably 5 days. I DID manage to get a bit of tuna into him today, finally (I know, it's bad...but it is the ONLY thing he's even so much as sniffed at. At this point, if all he does is breathe tuna fumes, we cheer. :p).  He has shown no real improvement otherwise following yesterday's fluids.

The vet we saw in the AM yesterday was NOT our regular vet (who was at a bike race :p). One thing I am a bit curious about is why she didn't run an IV right away--from what little i know about CRF, those numbers are pretty high--and accompanied with his symptoms, seem to indicate a pretty decent "crash."

Hmmm, I wonder if it is in the name... I have a Momo (short for Mozart) who is 'chunky' too...18lbs!

Yeah, I would have wanted some IV fluids with those blood results.  Kitty cats will hide their illnesses as long as possible unfortunately, so they will often be quite sick before we notice.  Survival mechanism. 

Re the anorexia--that is a big problem with these guys.  They feel yucky because their blood values are high, they don't want to eat.  Right now, he is in a negative energy balance, so to me it is more important to get him eating than what you are getting into him.  Canned food gently warmed can be helpful here.  Low protein food and all that can wait.  Try whatever you can get into him.

Sounds like you will be seeing your regular vet tomorrow.  Ask as many questions as you need to feel comfortable with everything.  These guys can do pretty well for a long time.  Of course, he needs to get over this 'episode' first--possibly IV fluids, hospitalization, etc.  But with SQ fluids at home (assuming you are willing to do that), and meds, they can live for years.  Good luck with him and keep us posted. 

Well, a momo is a type of dumpling...so it was a self-fulfilling prophecy, in our case, anyway. (Although he's now down to 11.5--so he's less of a dumpling and more of a....mmm...something skinny, I guess.)

I'm trying to get in to the vet this AM (our original follow up was for tomorrow. I don't think we can wait any longer.). I shall keep you posted.

Thanks!

Did you get in to see the vet today?  I had a CRF kitty who like your first one was mostly just palliative care.  There are websites out there with lots of information like http://www.felinecrf.com/ .  We never did the at-home saline injections, but tried some of the other things (like Pepcid to make his tummy feel better).  If yours is still not eating, keep trying different types of food.  One time mine was refusing wet food or tuna, but ate the other cat's dry food (at least for a little while).  Another time tuna would work - we'd never know from time to time.  Baby food also worked sometimes.

A woman I used to work for also had a CRF kitty, but hers was much different.  Once he got past the initial crash, he was pretty much fine for ~4 more years.  He drank a LOT and peed a LOT, but otherwise you would never have known there was something wrong with that cat. 

Good luck!

Up until 2 years ago when I switched to a daytime job, I was a veterinarian in emergency/critical care for 9 years.  It's tough to give advice over the internet, but that's a really low potassium and can contribute to a lot of other symptoms (muscle weakness, malaise, not eating).  I'm frustrated for you that you don't have any right now because that's something that's relatively easy to correct and can make a significant difference in how they feel.

If your vet and their supplier don't have injectable potassium to add to the IV fluids, they don't have it, but your cat really needs it and you live in a big enough city that somebody has some and you can find it tonight.  I all but guarantee it will take less than an hour of phone calls, it's commonly used stuff.  They're unlikely to give it to you until tomorrow morning when your vet authorizes it since it can have serious consequences if misused (it's the component that stops the heart in executions by injection), but you should locate a source tonight and go pick it up first thing in the morning and drop it off at your vet's office for them to administer.  I'd make phone calls in the following order until you get some:

1-All the 24 hr veterinary clinics you're willing to drive to, there are several within the Twin Cities metro area.  You should ask if they'd be willing to dispense/sell injectable potassium chloride, 2 mEq/ml, for your vet to administer.  You'll want ~40 mls volume (typically two vials)

2-Your local human urgent care.  We used them all the time for weird stuff we didn't use enough to keep in stock, but needed ASAP.  It's the same stuff whether used for people or pets.

3-Your local human hospital outpatient pharmacy.  They'll have this for all the people that are on hospice and pick up fluids for use at home.  Many times you'll hit their soft spot for a pet and the potassium is dirt cheap, I suspect they'll give it to you for free just to avoid paperwork, especially since you don't need much

3-Any human pharmacy that advertises that they do compounding.  This means they reformulate drugs from other forms and I'll bet they have some potassium.  If they don't have injectable, ask for availability oral potassium gluconate and be willing to take the pills, powder, or gel.  It's not as good as the IV fluid additive form, but it's a band-aid and you'll need it longterm anyway

4-If somehow you strike out tonight with all of the above, ask your vet tomorrow if they can call some of their local colleagues at other neighborhood general practices to see if they have some you can pick up and bring back.  it's really common to "loan" supplies when someone runs out for whatever reason and they'll just need to replace it back when their order comes in. 

Correcting the low potassium will improve strength, help improve the chances of eating (this isn't the only reason your little one isn't eating, but is contributing), and let your vet give the IV fluids at a higher rate without diluting the blood potassium more (to hopefully flush out the BUN and creatinine that are markers of kidney toxin build up that make them feel ill).

Best wishes to you both.  I know when I've been in places like yours, I always feel better if there is something I can do

Glad that he is at least 'relatively' better.  Unfortunate that potassium is on backorder.  Hopefully getting him eating will help with that too.  There is one food that I have found seems to often work when cats won't eat-- it's made by Royal Canin, and in Canada it is called 'Reducing' (a red can).  I think it is because it is really stinky fishy.  Warmed up, many anorexic cats will try it.  Your vet may have it in stock, so you could try that.  Sometimes, just getting a titch on their nose/lips so they  lick it off will stimulate them to eat.  

I'll be saying prayers that his values come down tomorrow.   

Thanks again for the helpful words <3

We went in to see him tonight--I wouldn't say he was "perky", but compared to the utter zombie he was (it was like there was no "there" there...he was awake, and alive, but...empty), he was better. He seemed responsive to us, and not in an agitated way. He ate a big pile of catnip, and then took eight pieces of dry fancy feast kibble from our hands (I told him it's just like we're in CA and hitting  the medical maryjane). I think the mouth sores make dry kibble hard to eat, but he is refusing all manner of wet food, so... eight kibbles is not sustaining, obviously, but it gives me hope that if we can get the levels down, he'll be hungry again.

His poor little paw where the IV is attached and taped on is swollen up so much, which worried me, but the tech said it wasn't any different than when I had my leg bandaged and my foot swelled.

I think I'm just jumpy, b/c I cannot for the life of me figure out why the other vet didn't either put momo straight on an IV on Saturday or refer us to the ER right away. Our regular vet basically said yesterday--he was going to die. He was 12-24 horur away from crossing the point of no return. The other vet was like "Oh, his numbers are high...here's a shot. Bring him back tuesday or wednesday for a recheck." It wasn't until I got home and looked at the write up of the labs, that I was like "Huh. Those seem pretty high, from what I remember with our last cat. But..." Whatever. It's done now. Can't change the past.

ANYWAY...our vet managed to score some K from the ER vet who had just got some in this afternoon, so they had started a drip with that right before we got there. Hopefully that will help, too. We are super lucky to live a block away from our vet and our ER vet, so it makes going to see Momo easy <3 And I love our regular vet--he is a cool dude, and someone I'd consider a friend. I think  that level of trust is a good thing to have.

We shall see what tomorrow brings. At this point, we are still operating on t he "let's get the levels down before we think about anything else at all."

mmrocker13 - 2012-09-19 1:32 PM One more update... I talked with our vet this AM. Momo's levels have come down a bit from yesterday, but not a lot...and not as much as teh vet had hoped for after 50 some hours on the IV.
BUN=95 
Creatinine=5.9
Phos=in the 5s--can't recall exactly, but normal again. 
K=3.3 (still low, but up from 2.3)

Putting in a new IV/Catheter for another 24-48 hrs. is an option, but he recommends bringing him home. His preferred plan would be to bring him home tonight, start a kidney-safe diet (or ANY diet), and administer 100 ml Sub Q daily for 10 days, and then bring him back in for a recheck (provided he does not lapse into actute distress between now and then, and is using his box, and we can get SOME food in him).

He is of the opinion that the IV/vet experience is, at this point, stressing the cat more than it's benefitting, given the slow climb downward of numbers, and that Momo woudl do better at home and stand a better chance of eating with us.

He said if the recheck shows maintenance at these levels, he would be happy. If they tank again, we'll reassess options. If they continue to improve...he'd do his ecstatic happy dance in the street So we're bringing him home tonight, and we'll have a more concrete prognosis then, but it's definitely closer to the end than the beginning of the end, I guess. But all we can do is do what we can do, right?

Very sorry to hear and I hope Momo gets better. I don't have much to offer other than that

mmrocker13 - 2012-09-19 1:32 PM One more update... I talked with our vet this AM. Momo's levels have come down a bit from yesterday, but not a lot...and not as much as teh vet had hoped for after 50 some hours on the IV.
BUN=95 
Creatinine=5.9
Phos=in the 5s--can't recall exactly, but normal again. 
K=3.3 (still low, but up from 2.3)

Putting in a new IV/Catheter for another 24-48 hrs. is an option, but he recommends bringing him home. His preferred plan would be to bring him home tonight, start a kidney-safe diet (or ANY diet), and administer 100 ml Sub Q daily for 10 days, and then bring him back in for a recheck (provided he does not lapse into actute distress between now and then, and is using his box, and we can get SOME food in him).

He is of the opinion that the IV/vet experience is, at this point, stressing the cat more than it's benefitting, given the slow climb downward of numbers, and that Momo woudl do better at home and stand a better chance of eating with us.

He said if the recheck shows maintenance at these levels, he would be happy. If they tank again, we'll reassess options. If they continue to improve...he'd do his ecstatic happy dance in the street So we're bringing him home tonight, and we'll have a more concrete prognosis then, but it's definitely closer to the end than the beginning of the end, I guess. But all we can do is do what we can do, right?

I'm sorry you didn't get more support from the first visit to the vet, that is definitely frustrating.  I'm glad to hear he ate something, and you may find he is happier to eat more at home.  Cats are funny creatures who don't always read the textbook, so I'll keep my fingers crossed that he soaks in the love you obviously have for him and makes a comeback.  Please keep us posted to how he is doing.  I assume your avitar is Momo, and he looks like a cool cat indeed!  Hugs.

Thank you for the story about your dog--it IS good to think of positive stories. :-) I am glad your pupper is doing well <3

The cat in the avatar is indeed the one and only Momo. He's the third youngest of our four cats (ages 11, 10, 8, and 6 months <--guess who the devil in the house is). And while we love all of our cats and dogs equally (but differently)...I fully admit that he is my baby, and one of those "A-team" animals that you only get once or twice in a lifetime. He's even got a fan club b/c of his...sartorial stylings :-)

https://www.facebook.com/media/set/?set=a.10150370350166262.348940.655441261&type=3&l=b6d79d7f59

Our concern now is getting him to eat. I am trying all the tips on the felinecrf.org site, but it's frustrating. He's taken in maybe 2-3 tablespoons of food (some tuna, some wet food...all watered down and hand fed (sloppily) over the last 14 hours or so). Plus, the other dogs and cats--the kitten, in particular--make it hard. I can't just leave food out all over and let him go where he wants (I have him in the bathroom today, with a wide selection of foods to choose from in my absence :D).

We have our first solo Sub Q session tonight...wish us luck! :-)

We just lost our cat Moose to renal failure mid summer.  He was 17 YO and made it almost 2 years with it.  Moose was ALWAYS a picky eater but it obviously got worse with the renal failure.

For us, the biggest thing that helped was giving him 1/4 tablet of pepcid each day.  That and buying him the cheapest, crappiest food we could find! 

I know they recommend certain foods for cats with renal failure but ours wouldn't touch that stuff.  So we would just buy him crappy fancy feast (or kitty cocaine as we would call it) and for whatever reason he would woof that crap down.   We figured it was better for him to eat a decent amount of crap food vs. very little of the good food.  

Good luck. 

Sub Q fluids can be hard for 'moms and dads'.  Try to insert the needle quickly, short and sharp.  Warm the fluids up (put the bag of fluids in a bowl of warm water for a few minutes) and they generally don't object.  Good luck, and be brave!

ETA: Oh my gosh, I just had a look at those pics.  He certainly is tolerant isn't he?  That's my Momo too--I can use him for any demos for my students with no problems.  Now, we haven't ever dressed him up...  I can see why he is a 'forever cat' to you.

When I was a kid, my friend had this big black cat named Turtle. He let all of us do anything to him...cart him around in a stroller or wagon, put clothes on him, make GI Joe guys ride him like Hannibal on an elephant. I swore that when I grew up, I'd have my own Turtle.

From Day 1, Momo has been awesomely awesomesauce. He is Turtle times 10 :-) He's got a fan club. He's got People. He's got azzless chaps, a purple monkey suit, and a Paris Hilton wig.

As far as the sub qs...He's always been pretty placid and easy going. We've done pills, and syringes, and creams, and drops, and just about every form of med you can think of in his life, and he's always been pretty good. (And pilling a cat is NOT always an easy thing :D) I was worried about the Sub Q, though. I mean, a syringe in their throat with medicine is one thing. Stabbing him with a giant needle is another altogether.  He LOOKED okay with it at the vet...but the tech was young and cute (Momo loves the ladies) and a PROFESSIONAL :p

But he was great--really, our biggest issue was he kept rolling over and trying to nap or have his tummy rubbed, so we had to make sure he didn't get tangled in his line. The needle went in like butter (we used 18G), no coming out the other side of the skin folds, no leaking or bleeding or vomit afterward. It will be a bit trickier when my husband is out of town next week, but I think we'll manage.

Here's the best part of teh day--we picked up some cipraheptadine for an appetite stimulant and also some of the nutrient paste. And without even having to take the pill, he ate a couple spoonfuls of tuna (not liquified!) AND a scosh over a quarter cup of the RF dry kibble--all on his own volition--during the evening when we were out (we put him in a separate room with food, so the others couldn't get to it)! Granted, that's not as much as he NEEDS to eat...but since he's been eating NOTHING, and having no interest in anything, it was a big deal. Honestly, it was the best birthday present I've ever gotten <3

I know that it is just one day, and I know that CRF kitties, esp. the high stage ones, are notorious for being a roller coaster of issues. And I am very well aware that his prognosis, even optimistically, is probably only months...but it made me happier than I thought possible to see him eat, just that little bit.

Yaaaaaaaaaaay Momo!  As a tech, I have been known to tear up watching sick kitties in hospital eat, so I hear ya!  Some is better than none for sure.  Glad you had no trouble with the SQ Fluids--and happy birthday!!