Belle

[Susan and the girls]

Hey y'all,
I wanted to pass along the latest turn of events with Belle. She began acting differently and not eating, so I made an appointment with the vet for updated bloodwork. We've struggled with her kidney values in the past, and then her thyroid went bad, so we had radioactive iodine treatment. I was warned that the thyroid issues could mask kidney problems, and I really hoped that she would not go downhill. Initially, I wasn't very good with sub-q fluids like I should have been, but lately, I've been really faithful with them. Belle turns 14 in April.

Still, bloodwork yesterday was not good.

The vet is keeping her for 48 hours giving IV fluids. She was severely dehydrated, and she's lost 2 pounds since last July - something I didn't realize, even though I knew she'd lost some. I just didn't know it was THAT much. We hope she will feel better after the fluids and eat/drink more.

Here are the values from yesterday's bloodwork.

Her urine concentration was 1019. That means her kidneys are not concentrating her urine. The dehydration alone should have been reason for her urine to be very concentrated, and it wasn't.

She is anemic.
Hematocrit: (normal 30-45) - she was 27.3 (in July 10, she was 44.7)
Hemoglobin: (normal something-to-15) - she was 8.5 (in July, 10 she was 13.9)
WBC - normal
glucose was high (stress) but not in urine
T4 - good (normal)
There were leukocytes in her urine.

Here are the scariest values:
BUN: (normal 16-36) she was 129
Creatinine: (normal 0.8 - 2.4) she was 12.3
Phosphorus: (normal 3-7.5) she was higher than the machine would register, which was >16.1

She is facing major kidney issues right now.

I visited her yesterday afternoon & she ate ten treats right out of my hand, one after another, and the vet was pleased. (Belle hasn't been eating well, so I was feeding her whatever she would eat -- treats, tuna juice, milk, etc. She won't touch wet food - never has.)

This morning, my 5 year old daughter & I visited her, and she looked remarkably perkier. She ate more treats for us, purred, rubbed on our legs, and "mewed" at us. She seemed very content. They'd told me yesterday that her veins were so tiny and she was so dehydrated that they had to use the smallest needle for the IV. They'd managed to get 400 cc into her (IV) in the last 24 hours. They're hoping to get lots more in her by tomorrow morning, when they'll repeat the bloodwork.

This morning, when I petted her, she definitely "felt" more hydrated -- her bones in her shoulders weren't as prominent and the nape of her neck felt more normal. She also had gone up 1/4 a pound -- that's about 400 cc, right?

The vet has been honest with me. If Belle's bloodwork/values improve some, and her kidney function shows at least a little improvement, she'll let Belle come home & we're going to do 200 cc fluids daily to try to keep her hydrated. If her values don't improve, we have to figure out where to go from there. My heart is breaking, and I am praying for a miracle.

If you believe in miracles, would you say a prayer for my precious friend? I know you all understand how important pets are. Thanks.

[Traci]

Susan, I am so sorry to hear Belle isn't doing well.

Unfortunately, those values are very serious. I don't want to give false hope, but it's possible she could make a recovery at this point, yet you will more than likely need to maintain her fluids aggressively at home for some time.

Fortunately, it doesn't look as if she is predisposed to any secondary conditions, which helps you and your vet focus strictly on her kidneys. I'd ask your vet about her diet and try to get her on something that is consistent and better for her kidneys (low protein), but something she will eat (some cats won't eat prescription diets, but you should always at least attempt to try them) - try both canned and dry versions because cats will often surprise you and suddenly choose a preference when you least expect it. Just try to keep a bit of both types available at home if you can, or at least easy access to your vet so you can pick it up when you need. Try to avoid feeding too many types and brands of food because this can and often does create finickiness and then you compromise her nutrient needs, which in turn compromise her weight, and makes it harder to treat more effectively.

I'm assuming her oral health is good? If so, this will make it better for Belle when you might need to administer oral medications, which will likely be necessary at some point (binders, or antibiotics, or supplementation, or pepcid, etc to keep stomach acid at bay - your vet can discuss these options with you if they are warranted)

Keep an eye on the glucose and probably opt for another urinalysis in the near future (possibly at her recheck in another week or two) - if there is any glucose present in the urine at that time, it might be an infection, so will need treating (antibiotics). Otherwise, try to ensure her next blood panel at recheck includes blood glucose again.

The numbers are telling, but her attitude also has to be taken into account. If she's otherwise perky, seemingly feeling better each day, and does well at home, she could make a favorable "recovery" from this, at least getting her lab values down to a more normal, but be prepared you may have to treat this as chronic renal failure that will require aggressive maintenance at home or any additional medication your vet feels is warranted.

Please follow your vet's direction and followup with her as she advises. Get those rechecks and follow her home-care instructions to the letter.

Belle is in my thoughts and prayers, I know she is not liking being hospitalized right now, but the sooner she can get those levels down, the sooner she can come home and you can treat her at home. Please post an update when you know more. Give her a kiss for me, we're pulling for her!!

[Susan and the girls]

Thank you, Traci. I knew you'd reply. I'll reply more when I get home (get carsick trying to type on the phone!!) But I wanted to say thanks for responding.

[Susan and the girls]

Ok - I'm home now. I appreciate your prayers more than you know! I am trying to be realistic about Belle's condition, but I also know that the God who created her can also heal her body. I pray that He answers my prayers to that end!

The vet has promised to be honest with me about whether or not Belle is improving and to what degree, and I believe she will. I know that when Belle comes home, I'll have to do very serious sub-q fluids daily to keep her hydrated. I just want the bloodwork to show big improvements. I will post the results when I get them tomorrow.

On a positive note, the vet's office called while we were out (my son's 7th birthday is today, so we took the kids to a local pizzaria for supper to celebrate) and left a message about Belle. The vet tech who was there when I brought her in yesterday (and saw how lethargic & generally "bad" Belle obviously felt) was also there today, and she was the one who left the message. She said that Belle was remarkably more alert & seemed like she felt MUCH better today. (I had visited earlier and thought the same thing.) She also said that Belle had eaten some dry food they gave her there -- and that's a definite positive report, since Belle has not been eating much of anything for a few weeks. (I've been feeding her treats, milk, tuna juice -- whatever she will eat - since she has refused "food.") Oh - and I have had all the cats here on Hills Science Diet Mature Adult for many years. I don't buy anything but that. Treats are rare; table food is never; moist food is refused by all three of them. The only reason I was giving Belle the treats & milk (I know they're not good for her) is I felt that any nutrition was better than none. I had to wait over a week & a half past when I really needed to get Belle in for a vet appointment (not happy about that) because the vet I trust most didn't have any openings when I called. I wish I could have gotten her in two weeks ago.

Oh - fyi -- Her obvious downward turn began the first week of March, and at that point I stepped up the sub-q fluids & tried to get her to eat. She made a big improvement within a week of doing that, and that's when I called to make the appointment. Then she started going downhill again. I was just trying to maintain until I could get the vet to check her out.

I hope to have better news to post in the morning. I am totally on board with the increased sub-q fluids -- whatever it will take to keep her healthy. I just hope and pray her kidneys do respond to the IV fluids. PRAY hard with me!

Thanks!!

[Traci]

Susan, you can do this, I know you can. Of course, any time you are uncertain or scared, just find me, ok?

I've seen some pretty serious cases where the BUN and creatinine are off the charts and somehow, some of these cats just throw you a nice big surprise. That's not to say we don't have those cats in critical health and sometimes we lose them soon after, but the point is, you won't truly know until her kidneys have been diuresed enough to know if they brought down her values. The rechecks are also necessary to keep one step ahead and treat accordingly as much as possible to keep the levels from falling rapidly again. Your vet too, wants to keep a very close eye on Belle's levels and her attitude/feeling at home, so do be sure to keep an open dialogue with her at all times. If she doesn't call you in a week or so, call her with a report, she'll understand and appreciate it.

Yes, it was better to feed something, rather than nothing, and the same is true in those cats who are critically ill. But, when talking about chronic renal failure, at least when initially diagnosed, it is better for the cat to try to get them started on a renal-appropriate diet to help maintain the protein levels and avoid too much of certain nutrients and minerals like phosphorus (which then can reek havoc with the calcium and vice versa).

She responded to fluids because they helped rehydrate her, and while not as good as IV fluids and diuresing, they do help the cat feel better overall and it acts sort of like a pick-me-up. Adequate hydration is CRITICAL in renal patients. The reason she went off her food the next time was most likely due to nausea and hydration, and inappetance usually occurs. At those times, no milk or treats but instead, other cat foods, closet to the nutrient makeup of the prescription diets as possible. Although, I should say this is not always possible, because very few commercial cat foods on the market are formulated for primary health conditions.

Canned food is ideally better than dry for CRF patients in that they contain a bit more moisture if the cat isn't drinking enough on his/her own. Most CRF patients drink their water like it was going out of style (dehydration is a common occurance), and it will fast be eliminated through the urine, which is why sub-q's are necessary and vital in treatment. There are various canned foods you can use to tempt her in times of stress, but don't start now, ask your vet first for her recommendations, then ask for tempting-type canned foods you can get at your local supermarket to have on hand. In times of stress or illness, it doesn't so much matter the nutrient makeup as much as taste, palatibility, texture, and potentially mixing with water for added moisture. Just don't opt for generic or off-brand or "natural" or "holistic" diets because they often contain unnecessary ingredients that aren't truly helpful for the renal patient.

Belle remains in my thoughts and prayers, please think positively and kiss her for me when you visit! Keep me updated?

[Susan and the girls]

Thank you Traci. You are always so helpful. How on earth do you have time to take care of all your "patients" here??? You are such a godsend!

I plan to start Belle on the KD diet -- although I've been told it is not tasty at all. Maybe if I mix it into her other food for a while she will try it..... They (all my indoor cats) won't touch wet food (never have - they try to cover it!), but I did find one pouch food that had "pieces" of meat in it and lots of liquid, and Belle licked the liquid a little. The others promptly gobbled up the pieces. I think it was "Whiskas" name brand. Would something like boiled chicken be ok for her - if she'll eat it? One website I found about CRF says (and you can tell me if this is accurate, or one of those sites I should not be looking at) that a diet as close to a diet a cat in the wild would have is best for a renal patient. (They said that the equivalent of a rodent - bones, brains, etc included - is the best diet, since that's the most 'balanced' diet a cat could get. Sounded fishy to me.)

The mother of one of my students is a vet, and although she's not my vet, I mentioned Belle to her a couple of weeks ago. She said that she has seen improvement with renal patients using accupuncture and some homeopathic medicines (can't remember the name of the med, though). She says both of those things stimulate renal function. What do you know about that? Her veterinary practice actually offers both traditional and homeopathic medicine. I'm willing to try anything.... you know?

I mentioned to my vet that I hadn't bought the "cuff" to do a quick bolus of sub-q since I was concerned that a quick bolus might be painful. She still felt the quick bolus was best for cats (like Belle) who protest so much. (It's a terrible wrestling match every time I do them.... and I have lots of battle scars to show for it. I think I dread it more than Belle does, though!!) Oh - and I noticed this morning that they'd actually trimmed her front AND back nails. Apparently, she got them, too....

I'll be doing 200 cc each day for a week when she comes home (provided the 48 hours of iv fluids brings the numbers down enough to bring her home soon), after which they'll repeat the bloodwork to make sure we're maintaining. At that point, we may drop back to every other day. Forgive me for second guessing a vet, but wouldn't it be better (or best) to do the fluids daily? I mean, not getting them for a day would be kinda like not drinking enough for a day, which is going to dehydrate her in between sub-q administrations, right? I'm just sayin.....

Thanks again Traci.... you're so wonderful.

[Traci]

Re: the CRF pet food advice.....NO.

They're talking about evolution diets, and there is no evidence this is appropriate. Not to mention our domesticated and indoor-only cats have evolved requiring totally different needs per their activity, health condition, optimal health etc. Our domesticated cats don't mice to survive, and don't die in two years due to parasitic infection, viruses, predators, disease process, et al. That's a very specific fact the evolution diet-promoters fail to mention. Lastly, the moral values of killing mice and processing them to feed cats, we already have a moral problem killing cows for our consumption (well some people don't, but we normally don't feel good about it, even if considered a necessity).

If it sounds too good to be true, it most certainly always is!

Re: accupuncture and homeopathy. NO.

There is no scientific evidence that accupuncture works in animals, and very little suggesting it works in humans. There are few conditions accupuncture might help in humans, like vomiting, nausea, or some types of pain, but it is all mostly subjective on the observer, and most research is heavily biased toward the researcher's agenda (don't confuse this with pet food manufacturers or "big pharma", they are entirely different institutions, the latter two are are not quackery)

In pets, we don't know this, since they can't tell us how they are or are not improving, and it is entirely subjective upon the observer (owner or alternative vet performing the accupuncture). It's the placebo effect. Not doing anything is probably as good as doing accupuncture.

Picture an alternative vet performing accupuncture on a CRF cat - the owner observes the cat purring, rested, comfortable and the vet observes the same thing. Based ONLY on observing the cat's purring and resting state they automatically conclude accupuncture works. Where's the proof? Is the labwork significantly changed? Is the kidney's ability to filter more efficiently improved? Is dehydration suddenly cured? Are all other blood parameters suddenly changed for the better? Nope.

Re: homeopathy. NO, NO, and definitely NO. The only thing homeopathy is going to "stimulate" is your checkbook.

Homeopathy is water. Simply water. There is no accounting for quackery at it's finest when vets promote homeopathy. If it's not water, then it's in a sugar pill form, with NO active substance, meaning it will NOT address any physical problem. NOT one form of homeopathy contains any measurable substance to make any measurable effect on health. If it did, we could take one drop of all that ills the world into the ocean, and we could cure everyone of every ill.

Sound like B.S.? That's because it IS!

Btw, if any homeopathy actually worked, that would mean it would actually have to have a measurable substance in it, (which is not in the laws of similars for those promoting homeopathy), and in today's world of quackery and fraud, that substance would most likely be a drug, which would mean the FDA will be knocking on the promoter's door in a real big hurry.

Just to be clear, this is not just my opinion, it is undisputable, scientific fact.

Those who promote alternative "medicine" (which is not medicine but is an alternative TO medicine), for pets are clearly not acting in the best interest of the pet. This is like denying proven and beneficial real medical treatment to pets, which in my opinion, is fraud and incompetence. The power of persuasion is easy because people are desperate if conventional medicine cannot cure a specific disease, but that does not make it appropriate, nor the least bit ethical.

As for the K/D, there are other veterinary equivalent diets, ask your vet what she has available (i.e., like Purina Veterinary diets, IVD veterinary diets, Royal Canin veterinary diets, etc) - she might be able to give you a few samples to try for Belle. The one thing about K/D, it was reformulated a couple years ago to be more palatible for cats, but some cats still don't like it.

Please try to refrain from giving boiled chicken unless it is in time of inappetance, to tempt her. Another option is canned white chicken meat in water (like Swanson's, chicken of the sea, etc - just make sure it's canned in water); you can either use the juice to pour a little amount over her food, or blend the entire can with a bit of water in the blender and pour a small amount of it over her food. You can do the same thing with tuna (packed in water, NEVER oil) - use the blender and use it as only a tempter or to mix a bit with canned food to get her to eat). Do not feed tuna too much or too often, unless only as a tempter with her regular food.

As for the amount of fluids to give, you have to allow your vet to direct you, based on Belle's followup exams and bloodwork rechecks. The numbers determine the need for and amounts of, the fluid therapy at home. Initially, the every-day schedule will benefit her more at this point. If a recheck shows her levels down, your vet may suggest every other day or every two days, and so on, and you'll also need to gauge her attitude, how she seems to be feeling, her urination and drinking habits etc, then contact your vet to see if she would prefer you give an xtra day of fluids.

No, depending on the case, labwork, the cat, the cat's weight, and degree of dehydration (and ability to concentrate the urine, etc) depends on the required amounts to give either daily or other days during the week. It IS possible to give too much fluids to a cat via sub-q, and it can be uncomfortable for them if they are so dehydrated that the fluids don't disperse in a normal time frame. Constant needle pricks are not fun for the cat either, although when you're on a consistent schedule, they seem to get used to it and are not so fidgety. It's also all in the technique as you administrate them and how you hold her attention while you're giving them. (i.e., I feed them on the countertop as I give fluids, and ensure the fluids are slightly warmed under warm water first, ensure the line is a fast-drip type and ensure the needle is as big as they and their skin can handle comfortably - it's the little attention to details that helps them stay more comfortable)

I'm not sure I agree with the bolus, since it will produce a very big and heavy pocket of fluids that may (or may not) be uncomfortable for Belle. However, if it is easier for you to do so, then you could try, and then gauge how she handles that. If your vet is insistent on this, then have her show you at her clinic, so you feel comfortable in the procedure at home. It would be the quickest way to administer fluids, but take into account not always the most comfortable for the cat (every cat is different). Also, this may not be suitable for a cat who is losing significant amounts of weight on a rapid basis, since their skin is very sensitive and less elastic. Some cats, particularly senior cats, have very thin skin due to weight loss or severe dehydration or age, so one has to be extremely careful when administering fluids, inserting the needle, correct size of needle, how much fluids to give, etc, in which to provide for their comfort.

[Susan and the girls]

Thank you again, Traci!

I appreciate all of your help. I will post as soon as I get word from the vet today about Belle's values.

I wanted to reassure you that I didn't mean actual "mice" when I mentioned what I'd read on the internet about diet. LOL I would never in a million, zillion years do that. I just wondered if more protein might actually be better for her. And I didn't intend to go the holistic route (entirely, at least). The other vet (my student's mom who's a vet) had just suggested accupuncture as an *added* treatment, and the supplement (can't remember the name of it) as an additional treatment that (she said) had been shown in some cases to stimulate kidney function. She also mentioned an anti-nausea medicine (actual pharmacy medicine, cut down for cats - again, can't remember the name).

Thank you for all your advice and help. I sure hope I have good news to report today.....

[Cleo]

Praying hard for you and Belle and hoping you get good news to report back with!!

[Susan and the girls]

Thank you Cleo. I appreciate your kindness!

Unfortunately, the news was not good.

Belle's values haven't improved much.

Her Creatinine was down to 8.9 (from 12.3 two days ago)
Her BUN was down to 93 (from 129 two days ago)
Her Phosphorus was down to 12 (from >16 two days ago)

The vet says that at this point, if we can keep her feeling "good" and eating, and urinating some, then "quality of life" is the most important thing. My heart is breaking. I had so hoped her values would drop more dramatically.

Of course, they never say how long to expect since it's individual to each cat, but the vet mentioned that she didn't have long. I'll be doing twice a day fluids - or once a day at twice as much, if she's too stressed, feeding her any cat food she will eat (preferably her usual Science Diet food for older cats), and making her happy.

A dear friend of mine just went through losing her 17 year old cat, and I was there as a shoulder for her to cry on. I felt so good about being the understanding friend, and tried to be the voice of reason when her sweet lifelong friend was truly ready to go (as opposed to living out her days on all sorts of ivs and medicines at the vet's office). Now I'm facing it. I do know my friend will be there for me -- she's one of the few friends who'll understand my crying for days.... I just hadn't expected to go through this so soon after her Fuzzy's passing.....

Please pray that my Belle will outlive the expectancy -- and will improve miraculously. I know we all want that for our failing cats. My heart is broken....