ON THIS PAGE:
Cats With High
Numbers Which Reduced After Treatment
Cats With High
Numbers Which Did Not Change After Treatment
Cats With Low
Numbers Who Remained Stable
What You Need to Know
What Happens in
Causes of CKD
How Bad is It?
Is There Any
Appetite Loss and Excess Stomach Acid
The Importance of
All About Constipation
Coping with CKD
Tanya's Support Group
Alphabetical List of Symptoms and Treatments
and Urinary Imbalances (Dehydration, Overhydration and Urinary
Waste Product Regulation Imbalances (Vomiting, Appetite Loss, Excess
Stomach Acid, Gastro-intestinal Problems, Mouth Ulcers Etc.)
Phosphorus and Calcium Imbalances
(Pain, Hiding Etc.)
WHAT DO ALL THE TEST RESULTS MEAN?
Blood Chemistry: Kidney Function, Potassium, Other Tests
(ALT, Amylase, (Cholesterol, Etc.)
Complete Blood Count (CBC):
Red and White Blood Cells: Anaemia and Infection
Urinalysis (Urine Tests)
Other Tests: Ultrasound, Biopsy, X-rays etc.
Renomegaly (Enlarged Kidneys)
Tests to Have and Frequency of Testing
Factors that Affect Test Results
International and US Measuring Systems
Which Treatments are Essential
Finding a Good Vet and Record Keeping
Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence,
Waste Product Regulation
(Mouth Ulcers, GI Bleeding,
Adsorbents, Azodyl, Astro's CRF Oil)
Phosphorus, Calcium and PTH (Calcitriol)
Miscellaneous Treatments: Stem Cell
Transplants, ACE Inhibitors - Fortekor, Steroids, Kidney Transplants)
Antibiotics and Painkillers
Holistic Treatments (Including Slippery Elm Bark)
ESAs (Aranesp, Epogen etc.) for Severe Anaemia
General Health Issues in a CKD Cat: Fleas, Arthritis, Dementia,
Medicating Your Cat
Obtaining Supplies Cheaply in the UK, USA and Canada
Working with Your Vet
DIET & NUTRITION
Nutritional Requirements of CKD Cats
The B Vitamins (Including
What to Feed (and What to Avoid)
Persuading Your Cat to Eat
Food Data Tables
Canned Food Data
Dry Food Data
Cat Food Manufacturers
Canned Food Data
Dry Food Data
UK Cat Food Manufacturers
2007 Food Recall USA
Tips on Giving
to Give Subcutaneous Fluids with a Giving Set
to Give Subcutaneous Fluids with a Syringe
Subcutaneous Fluids - Winning Your Vet's Support
Polycystic Kidney Disease (PKD)
OBTAINING SUPPLIES CHEAPLY
Coping with Your Loss
Other People's Losses
Other Illnesses (Cancer, Liver) and
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Three CKD Cats: Tanya, Thomas and Ollie
My Multi Ailment Cat,
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> Success Stories
are no guarantees with CKD, but this section aims to show how some other
have overcome crises and regained a good quality of life, or have simply
quietly continued to enjoy life despite a CKD diagnosis.
record is held by
Paris, who was diagnosed with CKD at the age of six months, yet who
lived a long happy life for a further 16 years, dying at the age of 17
years and 2 months.
histories are anecdotal, don't give up hope if your cat has high bloodwork
Prolonging the life of the renal failure patient (2000),
Waltham Focus 10 (3), Dr Jonathan Elliott states that
"in a retrospective study, the correlation between plasma creatinine and
survival in cats who presented with signs of stable CKD was very poor,
with only 5% of the variation in survival time being predicted by the
initial plasma creatinine concentration".
This supports Tanya's Support Group's mantra,
"treat the cat, not the numbers", and there are some excellent examples
of this in the success stories below.
Please see the
page for information on the various test results quoted and
Treatments for the treatments mentioned in the stories.
Cats with High Numbers at Diagnosis Which Reduced Following Treatment
and Purr Box
Diagnosed October 1999 aged 13, survived five years and seven months
after diagnosis, died 14 May 2005 aged 18 years and 11 months of an
Helen, Colleen and Simon
Colleen diagnosed April 2002 aged 16, survived two years and two months
after diagnosis, died 26 June 2004 aged 18; Simon diagnosed December
2002 aged 9, died of cancer on 26 September 2005 aged 12.
Diagnosed August 1999 aged 15.5, survived one year, eight months after
diagnosis, died 11 April 2001.
Vickie and Isis
Diagnosed July 2000 aged 6, survived three years and eleven months after
diagnosis, died 11 June 2004 aged 10 after developing heart problems.
Tammy and Chula
Diagnosed June 2003 aged 12, died 21 September 2007, aged 16.
Diagnosed May 2005 aged 13, died 7 July 2008 aged 16.
Jaye and Morgan
Diagnosed October 2004 aged 3, died 24 January 2012 aged 11.
Diagnosed January 2009 aged 7, died April 2011 aged 9.
Larry and Myla
Diagnosed May 2010 aged 14, died December 2012 aged 17.
and Purr Box
are not your typical case, Purr Box and I. We stopped at the threshold of
death’s door more than five years ago and have not taken that last step
yet. I can say that without exaggeration because the veterinarian
recommended euthanasia in October of 1999 and fortunately, my wife and I
did not take that advice. We are not typical and I know that because I
have known many people whose cats have "crossed over the rainbow bridge"
due to CRF since Purr Box was diagnosed.
Box was diagnosed in mid September, 1999 - 13 years old and just a few
months after getting a clean bill of health. Her BUN was 159 (urea 56.8), her
creatinine was 12.9 (1140) and her prognosis was very poor. Reluctantly, our vet
said that we could try IV fluids for a couple of days. Her numbers rose
slightly in the first 24 hours and after 48 hours dropped by an amount
deemed to be insignificant. Euthanasia was the recommendation as it would
"probably be easier on everyone". He said that Purr Box would
certainly die in a very short amount of time if we did not intervene and
if we did intervene, she might have a few days or weeks of questionable
quality. After 72 hours on IV we let it be known that we were not giving
up, and the vet agreed that Purr Box could continue to receive IV fluids for 9
hours per day in his office and then come home at night. We pressed on as
there was no way in the world that we could bring ourselves to euthanize
our buddy of 13 years while she was still responsive and quick to purr. We
hit the books and the internet with the time we had bought and, after a
crash course in CRF, decided that we would fight as long as Purr Box was
willing and able to do so.
numbers started to fall more rapidly on the sixth day and continued to
drop through day 11 when we brought her home, hopeful but afraid. She was
sent home with a prescription diet and vitamins as her only treatment, and
when we asked about sub-Q fluids, we were told that they were ineffective.
As a result, her numbers slowly rose over the next eight weeks and by the
time December arrived, she was back in the hospital on IV fluids again.
This time we saw a different veterinarian in the same practice and
successfully lobbied him to prescribe sub-Q fluids if we could get Purr
Box's numbers under control again. We were lucky and a few days later
started sub-Q's on a daily basis.
was well for the next three months - until diabetes struck. We learned how
to administer insulin but after eight weeks of trying to find the correct
dose, the diabetes vanished just as mysteriously and as quickly as it
appeared. The diabetes brought us into contact with a specialist and in
the course of events we learned through an ultrasound that
Purr Box had significant
hypertrophic cardiomyopathy - the cause of her
previously undiagnosed heart murmur. Three pills a day were added to the
crashed again just two weeks after starting her new heart medication and
her BUN and creatinine soared to nearly the same levels that they were at
diagnosis. We feared that Purr Box's end was very near but once more she
rallied after being on IV for a week. That was in May of 2000 and we have
not looked back. She is still with us, living life and loving it, and we
have shared countless hours of play, purrs and love since the vet
recommended that she be euthanized. Her bloodwork in November 2004 was BUN
43 (urea 15.3, creatinine 3.4 (300) and phosphorus 49 (1.58). Three times a day she takes her pill
and had more trouble adjusting to them than she did her fluids. Now, she
takes them in her stride. Every other night she receives sub-Q fluids and
watches me warm them. For the first three and a half years, almost
unbelievably, she voluntarily joined me
on the couch after seeing me hang up the bag. These days I carry her to
the couch, but she is as patient as can be for the four minute
session during which she enjoys her favorite treat, beef baby food, hand
fed from a demi-tasse spoon. She often wants to play after the session.
(Purr Box is the model in
Subcutaneous Fluids: Giving Set Method).
1000 fluid sessions, 5200 pills and many trips to the vet,
Purr Box remains a happy cat. Throughout all of the tribulations she has
proved to be resilient: remaining loving, trusting, affectionate and
playful - quick to purr and eager to find a warm lap.
We count our blessings every day.
Update: Purr Box was put to sleep on 14 May 2005,
one month shy of her 19th birthday. Her CRF was still under control,
but her quality of life was suffering because of severe spinal pain, and
the usual treatments could not help.
and Colleen, and Simon Too
was diagnosed with CRF in April 2002 at the age of 16. She had
seemed a little under the weather for a week or so, but I didn't think she
was ill enough to see a vet. Then, over the course of two or three hours,
she took a sudden turn for the worse. I found her trembling, barely
able to stand, and only then did I realize she was severely dehydrated.
I rushed her to the emergency clinic; the vet took one quick look at her,
smelled her breath, and told me her kidneys had failed. I was
devastated, and I felt guilty that I hadn't taken her to a vet earlier.
Colleen was kept at the emergency clinic for IV fluids overnight.
I picked her up the next morning, in tears, to take her to my regular vet.
I was sure she was going to have to be put to sleep; in fact, I thought
about taking her home for a couple of hours so that we could say our
goodbyes. But bringing her home then putting her through the trauma
of taking her out again would be cruel; I was being selfish. With a
heavy heart I drove straight to my regular vet's office, as ready as I'd
ever be to let her go.
I will always be grateful to my vet for urging me to treat Colleen.
I knew almost nothing about CRF and even less about how it was treated.
Perhaps it was better that I didn't know how bad her lab results were on
the papers I brought from the emergency clinic, or I might have insisted
on euthanasia. My vet wisely made no predictions and simply assured
me that cats with CRF could live for weeks, months, or even years with
Colleen remained at the clinic for another three days of IV fluids, then
she came home with fluids for subcutaneous administration, prescription
foods, and several medicines and supplements. She's always been
nearly impossible to pill, so I was sure that she would not tolerate my
giving her sub-Q fluids every day. But she surprised me - she co-operated, though
grudgingly. She hated the needle stick, but as my technique improved
with practice, she grumbled less. She still does her best to avoid
me if she thinks it's fluids time, but once I catch her doesn't protest.
She knows that a favorite treat of baby food and a drop of milk follows
the session, which helps both of us end on a positive note, and then she
climbs onto my chair for a cuddle-and-purr session to let me know she's
At the ER, Colleen's BUN was over 130 (urea 46.4) (the highest their instruments could
measure), her creatinine 9.3 (82), and her phosphorus 9.7 (3.1). After three
days of IV fluids at my regular vet, her BUN was 154 (urea 55) and her
creatinine had dropped to 7.3 (645), but her phosphorus had risen to 12.1
So we began administering a phosphorus binder to limit her absorption
of phosphorus. That wasn't so easy as the fluids; she hated the
taste of the liquid that had been prescribed, and she wouldn't touch it
mixed in her food. Fortunately, I learned there were tasteless
powdered binders that she doesn't find unpalatable. So that I didn't
have to pill her with Pepcid, my vet gave me a prescription for famotidine
injectable, which Colleen gets with her fluids. At first, she also
took Reglan injectable for nausea and vomiting, but we were able to
discontinue it after several weeks, and so far the nausea has not
She wouldn't eat enough of the prescription foods to maintain her weight,
and I started trying to find a low-phosphorus regular food that she would
accept. Hundreds of dollars later, I gave up entirely and went back
to her preferred Fancy Feast, sticking with the varieties that were lower
in phosphorus. I increased the binder dose to help compensate for
the high phosphorus, but we still had a battle ahead of us.
Over the next few weeks, her creatinine rose again. By June it was
8.2 (725), and her BUN was 177 (urea 63.2). Her phosphorus had come down to 9.1
was still dangerously high. I increased the binders and continued to
let her eat her favorite foods along with some treats. By now we
were fighting anemia as well, so she started on an iron supplement
and injectable B-complex vitamins. Her rear legs were still weak, so
her potassium supplement was increased.
The next test, in July, was greatly improved. Her BUN had dropped to
105 (urea 37.5) and her creatinine to 6.4 (566). I hoped that we could keep her at
that level for a while, as further improvement seemed unlikely. But
she surprised us. By December 2002, her BUN had dropped to 93 (urea
her creatinine to 4.8 (424). Her phosphorus was a reasonable 5.6
took her out of the danger zone for soft tissue calcification.
Shortly thereafter we started her on calcitriol, a medicine for the
hyperparathyroidism that develops in CRF, and it has given her more
energy and improved her appetite. In February 2003, blood
tests revealed a BUN of 73 (urea 26.1) and creatinine of 4.0 (354), with phosphorus holding
steady at 5.5 (1.77). We are thrilled by how well she's doing.
Today Colleen is maintaining her fighting weight of just over 6 lbs.
Her appetite is excellent; she eats on her own and demands to be fed. If
she doesn't want what I serve, she turns up her nose and waits for me to
open another can, which I do with a smile. Her fur is sleek and
glossy, the uraemic smell is long gone, and her strength has returned
completely. I have been able to remove the ramps I put up so that
she could clamber up to her favourite high spots; she again jumps two to
three feet with ease and precision. She's perky and affectionate.
I've caught her doing the "mad dash" around the house,
racing up and down the stairs, and playing with her toys. She's as
energetic as a kitten at times.
unrelated brother, Simon, was diagnosed with early CRF in December 2002,
with BUN 61 (urea 21.8) and creatinine 3.1 (274). He is only 9 years old. I was
saddened, of course, but at least I knew what we needed to do for him, so
I took it in stride. His treatments are virtually identical to
Colleen's, including fluids every other day, but he also takes
medicines for other health conditions. Treating two CRF cats isn't
much more work than treating one, and fluids take less than five minutes
per cat. We're all coping well with the daily routine, leaving
me some time to spend with my other two healthy cats so they don't feel
Colleen's and Simon's current treatments include supplemental potassium,
iron, and B complex; an antioxidant formula; subcutaneous fluids;
famotidine; phosphorus binder; calcitriol; and lactulose syrup for Colleen
to prevent constipation. I bought a pet fountain on the
recommendation of other CRF cat caregivers, and it's the most popular spot
in the house - sometimes one cat is drinking and another is queued up
for a turn! Their appetites are good, and they clearly are enjoying
CRF is not curable, many cats live comfortably for years, including
some with worse numbers at diagnosis than Colleen's. From my online
CRF support group, I've learned many tricks and tips from long-time CRF
caregivers. As long as Colleen and Simon are feeling well and
enjoying their lives, I will continue to provide them with the best care I
November 2002, Colleen celebrated the 17th birthday we never expected her
to see. Colleen is truly my miracle kitty and a testament to
Note: Colleen was put to sleep on 26 June 2004 aged
18 and 8 months. Simon was put to sleep because of cancer on 26 September
2005, aged 12.
was 15.5 years old when he was diagnosed with CRF, on August 6, 1999.
CRF seemingly took us all by surprise. Fred had had his minor ailments in
the past in the form of an impacted anal gland that every 18 months or so
had to be treated. When he was 9 years old, he had a very bad reaction to
a "light" cat food, and we very nearly lost him, but luckily
someone thought of changing his food, and within 48 hours he had stopped
vomiting and was eating
normally again, and a week or so later, he
regained his strength and nearly all the weight he lost.
CRF was a dark horse for us. From one day to the next, Fred stopped
eating, acted listless, smelled very strange, and hovered over the water
bowl. I thought he had an upset stomach, so I rushed out to buy him his
tried-and-true comfort food (Purina EN), which he immediately gobbled
down. I would have let things go at that, but there was something about
his demeanor that was not "quite right," and he looked thinner
than usual. The vet's advice was to take him in for an exam as soon as
possible, and we immediately followed that advice. A call that afternoon
to the vet produced the news that Fred was in kidney failure with a
creatinine level of 9.8 (866)! We were lucky - the vet was very well versed in
the ups and downs of CRF, and he advised immediate IV treatment bolstered
August 6, 1999... Fred spent the day on IV at the vet's and in the
afternoon, I moved him to a local emergency clinic, where the vet in
charge was amazed that Fred was in kidney failure - his remark was,
"He looks so good, so healthy!" Fred was not released until the
following Monday morning. I spent hours visiting him off and on throughout
the weekend. When I wasn't there, Fred's temperature would drop, he would
stop eating, and he would urinate all over himself. When he saw me, he
responded to my coaxing with food and he used the litter box.
Fred came off the IV, his creatinine had dropped to 5.1 (451). We began a regime
of sub-Q treatments, 100 ml of Lactated Ringers Solution (LRS) once daily.
A vet tech, who would later care for Fred every time I was away, trained
me in giving sub-Qs. It took me months before I felt confident enough to
sub-Q Fred on my own. The most difficult thing for me was removing the cap
from the needle! Fred was a patient and tolerant recipient of the sub-Qs
nearly all the time - OK, he did squirm once in a while... and he hid from
the vet tech.
flourished at home. When I was at work, he was left in the care of Renata
- his then 19.5 year old grandmother. She showed Fred how
"yummy" Hill's K/D tasted, and he followed suit. As she had always done,
she led Fred to his food bowl, and they both enjoyed their K/D
"treat." Renata had an incredibly stabilizing influence on Fred.
He felt protected. He was back in his own environment, and nothing was
different for him, except for a few pills, and a 5-minute sub-Q treatment
as well as a change in diet that grandmother Renata assured him was truly
his next blood test, three weeks later, Fred's creatinine dropped to the 4.0
(353) range. A month after that, Fred's creatinine was at 3.1 (274). We increased the
time between sub-Qs. Perhaps that was wrong; I now know more about CRF
and understand that it probably would have been better for Fred to get
more frequent sub-Qs with less LRS per sub-Q.
the major part of Fred's last twenty months of life, his creatinine remained
below 4.0 (353), and with the help of Pet-Tinic (iron medication), his PCV was
just below 29.0 (ranged between 26.0 and 28.0), the lowest normal reading.
Fred was active, agile, and alert, and he maintained his weight. As time
went on, we dropped cyproheptadine (appetite stimulant) from Fred's treatment (in reality, Fred
didn't require cyproheptadine for more than a couple of weeks - Renata did
a good job of convincing him to eat again, and he felt so much better on
sub-Qs). We had to add Tumil-K (for low potassium), Norvasc (for high
blood pressure), and Renagel (phosphorus binder). Fred was fairly
easy to pill, and he was equally easy to sub-Q. He was angry with me
post-sub-Q treatment, but within five minutes, he forgave and forgot (in
reverse order, of course).
vet revised his original prediction that Fred would live from six months to
possibly a year following diagnosis to an undetermined life span. Fred
seemed to be beating the odds.
sudden decline was at about 18.5 months post diagnosis. His BUN and
creatinine were relatively low (creatinine was close to 5.0 (422) at the highest
reading then). He started having visual difficulties. Anemia caught up
with him, and he suddenly failed massively. He required an emergency
transfusion before starting Epogen. One morning, the vet tech had to rush
him to our vet because I had to be at a (silly) meeting at work. At that
time, Fred had developed pancreatitis and was hospitalized - the vet
donated the special IV treatment Fred needed. Then, he required emergency
dental surgery. Pancreatitis hit again. Nothing we did seemed to help once
the pancreatitis was diagnosed for a second time. Both the emergency vet
and Fred's own vet suggested that he be helped to cross. I went to the
emergency clinic on April 1, 2001, not knowing what to do. Fred stood up,
walked over to me, and talked to me, and then ate from my hand. He also
ate from the hand of the vet tech who had been treating him at the clinic.
He wanted to come home, and I honored his wishes.
declined at home, but a day before he went into a coma, he seemed to
rally. Renata hovered over him all the time. She would prod him and
deliberately eat his food to get him to react. He was listless, he lost
the use of his back legs, he ate very little, and he fought every attempt
I made to syringe-feed him (but I did get some food down). Renata just
watched him - he stayed on the floor next to my bed on a special hospital
padding, and Renata was always a few feet from him, if not next to him.
She never left the bedroom. Fred spent his last night on the hospital
padding, asleep next to me, with Renata curled around him on his other
side. At that point, he gave up and lapsed into a coma - he seemed to be
sleeping peacefully and breathing evenly with no stress, but he would not
respond. I knew I would have to help him cross. He left this world around
noon on April 11, 2001. Renata knew he was gone.
left a void that has never been filled. Renata followed him on September
29, 2001, when she was 21 years 7.5 months old. I believe that she never
recovered from having lost her Fred. No one could ever take her place, or
and Renata's Memorial page shows their photos, in each case taken not
too long before they passed, and tells their life story.
Vickie and Isis
little Isis was diagnosed with CRF on July 3, 2000. Her sister, Sheba, had
been diagnosed in February of 2000. The vet I had at the time said "her
numbers are off the chart", and told me that every day would be harder for
little Sheba. That vet told me I should put Sheba to sleep. I trusted him
and his advice, and sent my little Sheba to Heaven that same day.
Since Sheba was only 6 years old,
the vet told me that the CRF was probably congenital. I asked him to test
Isis to see how she was, but for reasons that never made sense to me, he
wouldn’t do it.
In June of 2000, Isis started
having problems with her back legs. It seemed like she was always limping
and/or hurting herself. It wouldn’t really last long, but in July of 2000,
I took her to the vet and insisted that bloodwork be done on her. That’s
when she was diagnosed with CRF. Her creatinine was at 7.9 (international:
698)… all other numbers were within normal ranges.
That vet wouldn’t do anything for
her. He was apparently against sub-Q’s, saying that her quality of life
would be an issue if we went that route. He said to let him know if Isis
quit eating and drinking… that would be the time to put her to sleep.
Luckily, in the months since
Sheba’s death, I had started volunteering at a no-kill shelter where they
had a vet on staff. This vet is a pioneer in the CRF field, being one of
the first vets to do peritoneal dialysis and kidney transplants. When I
received Isis’ diagnosis, I spoke to this vet at the shelter, who
suggested I bring Isis in. She confirmed the diagnosis, but had me start
Isis on sub-Q’s. When I asked her what I could expect, she told me that
"an excellent outcome would be if Isis lives for two years". Also, we
tried to get Isis onto several different renal foods, but Isis has never
gone for any of them. The vet always told me that keeping her eating was
the most important thing, and not to worry too much about the quality of
the food. I had always given Isis the Iams dry food (free feeding). She
went on the Iams canned chicken cat food, and has pretty much remained on
that through the years.
After two weeks, Isis’ creatinine
came down to 5.9 (522). Over the next few months, her creatinine wavered,
but finally seemed to settle in at about 4.5 (398). The only treatment she
was getting was sub-Q’s which eventually went up to 250ml every day.
Isis was always EXTREMELY
traumatized at the vet’s office. When we lived in California, we had a
wonderful vet and Isis was fine there. But when I moved to Ohio, the vet I
first took Isis to was an idiot! Isis is aggressive at the vet’s office.
Apparently, this vet was afraid of aggressive cats, so she muzzled Isis.
When I say "muzzled", I mean she put a muzzle over Isis that closed off
her mouth, her eyes, her ears… all her senses. Then, she turned away from
Isis while she was on the examination table. When Isis stumbled and
started to fall, this idiot vet grabbed her by the hair around her sides,
pulling a lot of hair out. This is when I told the vet to take a flying
leap, and I got Isis out of there. Unfortunately, however, the damage was
already done, and Isis has had a very difficult time with any vet since
So, because Isis is so
traumatized at the vet’s office, my new vet wanted to limit the visits to
as little as possible, because it would take Isis a full week after a
visit to get back to eating and behaving normally.
In August of 2001, Isis didn’t
seem to be doing very well. She wouldn’t eat, her weight was dropping,
etc. So I took her in for bloodwork, expecting the worst. However, I was
pleasantly surprised… her creatinine had come down to 2.9 (256)!! Isis
seemed to be having some sinus/allergy problems: her eyes would water a
lot. Anyway, I switched over to some Iams catfish food, and she gobbled
that up. The vet was VERY encouraged by her numbers. She told me I could
expect Isis to have pretty much of a normal lifespan. Imagine my joy!
In March of 2003, Isis started
acting very weird after receiving her fluids. About 90 minutes after I
gave her fluids, she’d slink off of wherever she was and slither to the
ground, like she was terrified. Sometimes she’d cry if I came near her.
She would go hide under a bed, and stay there for hours. It always
happened about 90 minutes after giving her fluids. My regular vet was out
of town, but I was able to reach her. She felt it sounded like a blood
pressure problem, and told me to get her to a vet immediately, which I
did. Her blood pressure was fine, but her creatinine had risen to 5.4
(477). According to the stand-in vet, "she had rounded her last bend".
Both this vet and my regular vet told me to prepare myself…they said she
wouldn’t make it to Christmas.
We increased her fluids to 300ml
per day, and added Pepcid AC, Calcitriol, and Pet-tinic to her daily
routine. Also, I started warming her fluids, which I had never done
before. Within a few days, she was back to her old self. We never did
determine what the initial problem was.
My regular vet said there was no
need to do any more bloodwork (the stand-in vet actually had to
anesthetize Isis to do a blood draw…it was horrible). She said there
wasn’t really anything we would change in her treatment, even if her
creatinine continued to rise (remember, all other numbers were still
pretty much within normal ranges). We couldn’t increase her fluids any
higher, so she felt there was no reason to put Isis through the trauma of
any more visits.
Right after Isis was diagnosed, I
purchased a vet scale to keep track of her weight. I have weighed Isis
every Friday morning since she was originally diagnosed. From July of 2000
to December of 2003, her weight never fluctuated more than 3 ounces.
However, in January of 2004, her weight started dropping. I was having a
hard time finding something that she would eat; however, I felt that she
was hungry. I always felt that if I could just find the right food, she
would eat it. Isis would only eat certain dates of the Iams food…I could
put down 10 plates of food, and she would pick out the one plate that had
a particular date on the food that she liked! So, about every 6 weeks,
when I had run out of that particular date, I would have to start over,
trying to find one that she liked. In January of 2004, I just couldn’t
find anything she liked.
When I mentioned this to my vet,
she suggested that I quit weighing her every week. She would send a
"cocktail" of appetite stimulants home with me to give Isis, but she felt
it was just stressing both Isis AND me to see her weight dropping. So, I
haven’t weighed her since the middle of February. However, towards the end
of February, I was able to find food she liked, and she has continued to
eat well every since then. I believe her weight started to come back up.
Last week, I noticed that she
wasn’t absorbing her fluids by the time I was to give her more. Just this
past Tuesday, I spoke to the vet, who had me reduce her fluids to 150ml
per day. She feels that Isis has developed some circulatory/heart
problems, so we now begin that balancing act between making sure she has
fluids to keep her hydrated, and not giving her so many that it will
compromise her heart or lungs.
I feel the end is very near…but I
have included a picture of my precious little Isis that was just taken
last week. As you can see, to anyone who isn’t aware of her story, she
looks to be the picture of health… and I believe she will continue to defy
Note: Isis was put to sleep on 11
June 2004 after developing heart problems.
Tammy and Chula
Chula first crashed on 7th June 2003 at 12 years
old. She had never been sick and although she had been losing weight I
attributed it to her aging years since she showed no other signs. Her
crash literally happened overnight. We went to bed with her acting normal,
sleeping by my side as always and woke up with her hiding and not letting
me touch her. That was a Sunday and first thing Monday morning she was at
the vets for blood tests and x-rays. When the vet called me with the
diagnosis of chronic renal failure I honestly did not understand the depth
of what she was saying. I certainly know the meaning of all those words
but my mind could not wrap itself around what it meant. When I dropped her
off to start IV fluids and one of the other vets at the clinic (not
Chula’s vet) said I could probably buy her a few months with sub-Q’s at
home it finally sank in that I was dealing with a fatal disease.
Her BUN was too high for their labs to read, her creatinine was 13 (1149)
and her phosphorus was 16 (5.16). At the check after 48 and 72 hours her
numbers actually climbed higher. She was also diagnosed with a grade 2
heart murmur. I am very fortunate that the vet who initially treated her
refused to give up and only told me afterwards that she had been scared we
were going to lose her. After almost 6 full days of IV fluids in the ICU
her numbers finally came down into a manageable range and she came home. I
was given lessons on sub-q’s, K/D renal diet and that was it at that
I found this site and the support group and started learning everything I
could do to help my girl. She was not due to go in for re-testing for 3
months but had another crash again in August with numbers not quite as
high as the first time but again she was dehydrated. We had been doing
fluids every other day and decided she was going to need 100ml daily
fluids to maintain. She also would not eat any of the renal diets and try
as hard as I might could not get her switched over from her much loved
Fancy Feast. So aluminum hydroxide binders were added to the regimen to
try and compensate for the phosphorus. Her stools were a little on the
hard side so Lactulose was added for her constipation and we started her
on Pepcid AC since she had started vomiting the foamy acid She again
seemed to rally well, her kidney values came back down to just over normal
and overall she seemed to be doing really well. But still there were days
when she just seemed worn out and her appetite was still horrible.
It was then that I found out that dehydration can mask anemia. Her HCT had
come back in normal range each time we had blood run so I had felt there
was no reason to worry. Well the only time her HCT had been done was the
times she had been dehydrated. We had values run again in Dec 03 and she
was found to be slightly anemic. I immediately started her on Fer-in-Sol
and in spite of giving her double the dose of Lactulose it caused her to
become so constipated she ended up at the vets for an enema. She took
about 10 days to fully bounce back from it, was started on Pet-Tinic,
folic acid and B vitamins and within 3 weeks her HCT went from 23% to 29%.
At the same time we had her BP checked and it was 210-220 so we started
her on Norvasc. Her dose had to be adjusted but within 6 weeks had come
down to 165, a level we were comfortable with.
We had several good months until all of a sudden in April 04 her eating
went downhill again. She had managed to gain back three of the four pounds
she had initially lost and now was losing again.
The problem turned out to be her teeth. She has FORL and one of the teeth
that was being re-absorbed was cracked and causing her mouth pain. After
talking to her vet and feeling confident that they would do all procedures
that were recommended for CRF kitties when having a dental done, (they
actually practice this on all geriatric or compromised patients) we went
ahead with it.
She came through the procedure great, was treated for a mild urinary tract
infection and has been doing great since.
She continues on 50ml of fluids daily, BP medicine, B’s and iron,
phosphorus binders (still loves that FF), and Lactulose. It takes less
than 10 minutes a day for all the meds and her quality of life is great.
We just ran her kidney values again 6 weeks after her dental and her BUN
was 50 (17.85), creat 2.5 (221) and phos at 5.6 (1.8). Her BP has remained
stable, her eating has been great and most days no one would believe she
is sick or was near deaths door at her initial diagnosis.
While I know that CRF is terminal and I know that things can certainly
change quickly with this disease I feel so blessed to have had an extra
year (so far) that I never believed I could have and I pray for many more
cuddles with my “Mama’s baby” .
Update: Chula died on 20 September 2007 aged 16.
Cori and Ebony
was diagnosed with renal failure on May 18th, 2005 at 13 years of age, and
was admitted to the hospital and put on IV fluids for 3 days. I brought
her in because she had crashed, though I didn't know that was what we call
it at the time. I had noticed some bad breath for a while, though
ignorantly didn't know just how much of a danger sign that could be. I had
noticed she'd been losing a bit of weight, but as I was focused on my new
baby I didn't quite notice just how bad it was until I noticed she looked
really ill and I picked her up and she felt light as a feather - she had
dropped to between 4-5 pounds and is normally an 8 pound cat. We
immediately got her in to the vet.
We brought her in Monday morning and they did bloodwork and sent her home,
which concerned me because of how bad she looked. The next day I insisted
she be admitted to the hospital because of how ill she looked and how
dehydrated she was. Her labs came back the next day with a BUN of 253
(international: 90.3), creatinine of 18.2 (international: 1609) and
phosphorus of 25.8 (international: 8.3). Needless to say my little girl
was in dire straits. To add to her condition, she wasn't eating the whole
time she was in the hospital, which concerned me greatly and I went in
every day to try to get her to eat. The vets basically said that with the
IV therapy her numbers might come down and that if they headed downwards
there might be hope. After 3 days of IV fluids her levels dropped to BUN
still over 130 (international: 46.4) and phosphorus 13.2
(international: 4.26), but creatinine remained the same at 18.2
(international: 1609). Even though the numbers had come down some, they
said that it wasn't enough and that there was no hope. I was devastated
because I blamed myself for not being more attentive to her and noticing
how ill she was earlier. The recommendation was to put her to sleep.
It was the same day we got that dreadful call that I found this website,
and what a lifesaving find that turned out to be. Through the site I came
to realize that there might be hope and I also found a CRF
support list. After a desperate plea for help several very caring
individuals offered me advice and support. I was still expecting the worse
when we went to pick Ebony up from the vet, for what we thought would
likely be our final evening together before saying goodbye. I spoke with
the vet about treatment options but they basically said that the only
thing that could be done was to keep her on an IV, or try 300ml of
sub-q fluids, but that in her case there really wasn't hope. I was sent
home with the comment that we'd see how she was doing by the next day and
maybe (if she was still alive) they would give her some fluids for me to
administer at home. I wasn't as sure as they were that she was on death's
door - she still had that gleam in her eye and she had perked up somewhat
and I felt like she was telling me she wasn't ready to go.
I didn't actually spend much time with Ebony that evening because I spent
about 8 hours online giving myself a crash course in feline CRF. My mind
was swimming and I was nearing a breakdown because I felt I couldn't
handle this. A kind listmember gave me some advice that I needed to take
things one at a time, focus on the basics of getting food in her, getting
phosphorus binder, and getting sub-Q fluids. I found that writing notes
was extremely helpful in keeping track of what I needed to do for Ebony.
We got started on the 300ml of fluids a day, but Ebony seemed to be
reacting badly to it, she looked lethargic, very fluffy, and like she was
having difficulty breathing. After consulting the group, I was very
concerned about filling her with so much fluids that her lungs would fail,
or overworking her heart. I called the vet and the answer I got was
basically that 300ml was the only amount I could give that might help her.
Well, I went with my gut and the advice of the experienced members of the
group, and cut it back to 150ml a day. Ebony did much better and was
looking more herself.
During this time I had also discovered that I had to make my kitty eat if
she was going to have a chance at life, so we started doing that the night
she came home. Thankfully she didn't reject the food, and in time we
learned the best methods for feeding her. She was assist fed three times a
day for several months. We had to give her Zantac, then Pepcid, to help
with her upset tummy, and we got the phosphorus binders (aluminum
hydroxide powder) to help bring her phosphorus down. Ebony also had a
raging infection during the first couple months and was put on Baytril for
9-10 weeks. She was also on Tumil-K to increase her potassium. After
several months Ebony started munching dry KD on her own, eating a little
more over time and so we tapered back her assist feedings until she was
eating entirely on her own, which took many months to achieve. Though I
felt at first like I was doing something cruel to her, I now realize that
what I gave her was time – time for her body to heal, while still being
nourished, until she was able to eat on her own. She now eats a mixture of
dry KD and senior formula.
Within about a week after being
diagnosed with CRF we discovered she was getting dangerously anemic and
learned about Epogen. We also changed vets at this time, and thankfully
our new vet was very willing to work with us, and she was open to hearing
the advice of listmembers. Her attitude was that the collective experience
of the listmembers was more than she would ever have in her career and it
was worth listening to. I was so thankful for her. She has continued to be
Ebony's vet, and she has been grateful for all that she has learned
through Ebony's case. Her willingness to listen to listmember advice was
what got us through her complete inexperience with Epogen. Ebony responded
very quickly to the Epogen and her levels rose very fast, to a point of
concern (for both potential Epogen antibodies and fear of high blood
pressure and clots), so we ended up stopping the Epogen. After a month her
levels started to decline and we were concerned about antibodies because
of how fast it dropped. We consulted with various experts, and it was
suggested that we wait to start Epogen until it got down to 20%. During
the entire time of her anemia she was given Super B complex and Pet Tinic,
and still gets these. Well, thankfully Ebony's little reticulocytes
started producing again on their own and her HCT slowly began rising over
a couple of months and has remained in normal range ever since.
It has been a very emotional ride, we went from the rollercoaster to the
merry-go-round, and now it feels like we're on the tram (only a few little
potholes here and there to jostle us about). I couldn't have gotten
through this without the wonderful members of these groups. Ebony, now 14, is doing
great, she's a plump 8½ pounds, eats well (perhaps a little too well), is
her normal "kitten-boo" self who loves to spaz through the house and go
flying up the cat tower. Her levels are now (as of June 2006) down to BUN
50 (international: 17.85), crea 3.2 (international: 283), phosphorus 3.7
(international: 1.19) and have stayed steady at these levels for the past
6 months. Ebony is on 75ml of fluids a day, gets her Super B and Pet Tinic
and phosphorus binders still, but she is thriving and looking very
healthy, but most importantly - happy. I have cherished every moment I've
had with her. There were many prayers given on her behalf and I believe
that many were answered through the angels I met through this site. While
I've had friends tell me I was crazy for spending as much money on Ebony
that I did to get her where she is today, I say she is worth every penny.
As a final note, I had created an excel spreadsheet to track Ebony's
bloodwork and have found it to be very helpful in watching trends and
doing comparisons. Others have found this chart helpful and I have placed
this chart online for anyone to use. It is available
Update March 2007: We are nearing
Ebony’s two year anniversary of her CRF diagnosis and Ebony is doing
great. She is a chunky 8lbs 6oz (actually overweight for her), she’s got
great muscle tone; she’s eating well and has lots of spunk. Ebony just
recently had a checkup and her blood pressure was 148 (under stress) and
her bloodwork came back with a BUN of 47 (international: 16.77),
creatinine of 2.8 (international: 248), phosphorus of 3.5 (international:
1.13) and her CBC was great, all normal. Her heart and lungs sound good
and overall the vet says that she seems to be doing great. Ebony gets 75ml
sub-q a day with some Super B complex and phosphorus binder in some wet
food. She eats a mixture of Hills Feline Senior and K/D dry. We make sure
she gets lots of water and LOTS of love. I never imagined Ebony would have
the levels she does now based on where we started, but lots of TLC and
lots of help from Feline CRF listserv friends have helped us reach this
point. Here’s hoping for a long time yet with our Boo-kitty.
Update July 2008: Ebony was put to sleep on 7 July
2008 because of heart problems.
Jaye and Morgan
case is an unusual one. First, she was diagnosed very young, and second,
she’s a genuine UK success story! I’m writing this in the hope that other
UK people will read this and take heart. CRF is not an automatic death
sentence, no matter what your vet may tell you!
Morgan is a beautiful black
part-Persian female with big amber eyes and an even bigger personality.
When she first arrived in my life, she was a terrified little 8-week old
feral who hissed at me from the back of the cat-carrier. But over the
weeks and months that followed, she learnt to trust me and she became my
little black shadow. She is the most gentle and loving cat I’ve ever met
and we share a very special bond. I was absolutely devastated when, aged
only 3 years old, she stopped eating, became very sick and depressed, and
was diagnosed with so-called ‘end-stage’ CRF. Her BUN was 221
(international: 79) and creatinine 17.53 (international: 1550). Her vet
gave her a week or so (at most) to live.
I wondered – was there anything I
could have done to prevent it? Why didn’t I notice the symptoms earlier? I
felt so incredibly guilty. But that frame of mind wasn’t going to help
Morgan. I had to do something now. So Morgan went on IV for 4 days and
nights, and by some miracle, her numbers dropped and she began eating by
herself again. She was sent home with no ongoing treatments, just a dry
prescription diet that she refused to eat. Normal ‘treatments’ in the UK
are prescription diet, steroid injections, vit B injections and Fortekor.
My vet was no different. Unsurprisingly, Morgan became dehydrated and when
she ‘crashed’ again 5 weeks later, with numbers almost as high as on
diagnosis, those were the only options he offered me, although even he
wasn’t convinced of the benefits of Fortekor in Morgan’s case.
Eventually, after further IV
treatment, Morgan’s numbers dropped again and she was sent home, but when
I mentioned this site and the various options available, including Sub-Q’s
to combat dehydration and Pepcid AC for stomach acid, he told me to "stop
second guessing the treatments and let me do my job". If I had, Morgan
would be dead. It’s that simple. I did eventually persuade him to try
giving her Sub-Q’s at his practice, but he refused to let me do them at
home. Unfortunately, that proved to be the worst of all possible worlds.
The vet trips were stressful for Morgan, and twice a week was not
sufficient to keep her hydrated. She crashed again 2 weeks later.
It was clear what the vet thought
I should do, but I couldn’t give up on her until I was sure there was no
chance of stabilising her and giving her quality of life. Besides, Morgan
was still on her feet and interested in the world around her – and if she
was not ready to give up, how could I?
With the help and encouragement
of Helen (the owner of this site) and others, I tried to find another vet.
I was given the details of a top UK feline renal specialist who had just
moved to within driving distance of where I lived. I told my vet I wanted
a referral, and I think he was glad to get rid of me!
The specialist saved Morgan’s
life. I have no doubt about that. The delays in getting the proper
treatment meant her problems had gone from very bad to even worse. When we
went to see the specialist, Morgan’s creatinine had risen to 21
(international: 1850) and on top of these very high numbers Morgan had
severe metabolic acidosis. It was amazing she was still alive.
But Morgan’s fighting spirit was
very strong, and somehow, she pulled through. There were some ups and
downs in the following weeks until we got the right balance of
medications, but since January 2005, Morgan has been treated entirely at
home, with just the occasional check up and adjustment in medication. She
is on 100ml of subcutaneous fluids every day, plus one empty gel-cap a day
filled with the following medications: sodium bicarb to treat metabolic
acidosis, aluminium hydroxide as a phosphorous binder, ranitidine (Zantac)
for excess stomach acid, ondansetron (Zofran) as an anti-sickness drug,
periactin as an appetite enhancer, iron for mild anemia, and vit B
complex, also for mild anemia. All of this is administered at home and
takes less than 5 minutes a day.
Many UK vets either don’t
understand the value of Sub-Q’s, or believe they compromise the quality of
life of the cat. I ask you – how can less than 5 minutes a day compromise
the other 23 hours and 55 minutes? I don’t understand why it is acceptable
to treat diabetic cats at home (which also can involve needles), but not
CRF. It makes no sense.
As I write this, Morgan is a
bright, happy and playful 5 year-old, and you’d never know she has a
life-threatening illness. I pray this continues for a very, very long
time. At her last check-up, Morgan’s BUN was 60 (international: 21.5) and
her creatinine was 4.2 (international: 373).
Morgan’s case has been reported
in the International Cat Care’s journal and in the February 2006 edition
of ‘Your Cat’ magazine, in an attempt to educate people and their vets
here in the UK that there are treatments available for CRF. If her story
changes the viewpoint of just one vet, or saves the life of just one other
cat, then at least it’s a start.
died in January 2012, aged 11.
DeeDee was diagnosed with CRF in January of 2009 at
seven years of age. Right before Christmas I noticed a change in her
behavior. I noticed she had lost a little weight too (she was always a
small cat). I took her to the vet, confirmed she had lost almost 2 lbs,
and left her there for blood work.
When the vet called me to tell me she had CRF, I had never heard of it
before. I asked as many questions as I could think of, but I was in shock.
Did this mean that DeeDee would die?
I realized her numbers indicated early stage CRF. At
this time she didn't need anything but the prescription food. Over the
next couple of weeks, I alternated between tears and determination. I
scoured the internet for information. The more I learned, the more in
control I felt.
Even though we had some trying times getting her to
eat prescription food, the next several months weren't too bad. Until
April. She stopped eating completely. I took her to the vet the first day.
She sent me back home after an antibiotic, some sub-Qs at the vet, a
vitamin shot, some Pepcid and a little hope. DeeDee stopped playing,
purring, walking around. I syringe fed her as I had read about and heard
about. After three days of continued decline, I took her to emergency.
DeeDee had a urinary tract infection that had turned into a kidney
infection. She was very sick and had lost another 1 1/2 lbs. She wouldn't
even make eye contact. I thought she was dying.
After three days at the vet on IV fluids and
antibiotics, she started eating and pepping up. They sent me home with six
weeks worth of antibiotic injections. Things were looking up. The vet
warned me to keep a very close eye on her though, because her kidneys may
not survive another infection.
After six weeks, I took her for a
re-check. She was doing great, though her numbers had climbed higher. The
doctor said the infection probably further damaged her kidneys.
Three days after her re-check, she started to
decline again. I immediately took her back to emergency. They took some
blood and urine, and sent me home. I was to make an appointment with
another branch of the emergency clinic (where they have internal medicine
specialists). Within twelve hours, the vet called me and left me three
messages, saying to take DeeDee to that other clinic immediately.
DeeDee's numbers were astronomical and her potassium was at dangerous
levels. Scared to death, I rushed her to the other clinic, thirty miles
away. She was immediately admitted. She did not have another infection
this time. She had a kidney stone lodged in her ureter. DeeDee's numbers
were rising exponentially every twelve hours, despite aggressive fluid
treatment. DeeDee was dying. I had several conversations with the vet
about performing emergency surgery to remove the stone. I agonized. I
decided against it. I promised DeeDee that I would never selfishly put her
through pain and discomfort. The doctor could not guarantee survival, or
that she would even get better afterwards. The risks were too great.
On day three, her numbers had tripled. I decided to
take her home to die with her family. It was the hardest, yet the most
selfless decision I ever made. That night, I laid right next to her, my
eyes open all night. They didn't expect her to make it until the morning.
It was mid-June. Summer was just starting to warm up the skies. I thought,
this is the day my sweet girl is going to die. I had just gotten engaged
to be married. I should have been clicking my heels in excitement.
Instead, it was one of the saddest times of my life.
As I write this, it is now almost February. DeeDee
is out in the patio laying in the sun. Last night, she was chasing her
brother around so fast she was sliding all over the wood floors and
slamming against the walls.
Today, DeeDee is feeling pretty good. Back in
October, her blood test results yielded an elevated, though greatly
reduced BUN (from a 191 to 66), an almost normal creatinine (from an 8.8
to a 2.9), and a normal phosphorus. Whatever the miracle that got her
here, I am so grateful each day that she is feeling pretty darn good. The
vet told me to "keep doing what I am doing", because he believes that it
is what got her back to feeling good. The assumption is that she passed
her stone. She was on muscle relaxers for about 6 weeks after that last
crash. They were supposed to help relax the ureter so that the stone could
dislodge and pass.
We still do fluids every other day, and sometimes I
can even hear her purring during fluid time. She takes daily Azodyl and is
still taking the binders in every meal. She also gets Pepcid at night.
A year ago, I would never have thought that she would still be here today.
I had no idea what we were in for. It is a roller coaster indeed, but
these times of her feeling good are worth every penny, every tear and
aggravation. I got to have DeeDee through my birthday in July, through my
wedding in August, and through Christmas. Here's to hoping for many, many
more healthy years.
Update: DeeDee died in April 2011 aged 9.
Larry and Myla
journey with CRF started in May of 2010. The subtle symptoms were there
for several months. Diminishing appetite, gradual weight loss, she was
changing but at age 14 I figured it was just age catching up with her.
Since the previous December, there had been larger clumps in the litter
boxes but my other cat had been through surgery for bladder stones so I
thought that was just part of his recovery.
eating and her breath was foul. I thought for sure this was a dental
issue. She was also very cranky, not willing to play with my other cat,
Lucky. I called her vet’s office and they told me to bring her in.
The call came
at work. As I picked up my phone I thought "I wonder how much this dental
is going to put me out." I was stunned with what the vet tech told me:
"Your cat’s in renal failure." Her labs were terrible. Creatinine 10.2
(902 international), BUN 116 (41), phosphorous 11.9 (3.84).
I was crushed.
My background is in clinical diagnostics so I knew these were awful
numbers. Myla would stay at the vet’s that weekend for observation and
treatment with subcutaneous fluids.
Monday, Myla went home. Her creatinine had dropped to 7.9 (698). The vet
sent me home with subcutaneous fluids, an appetite stimulant (cyproheptadine),
a few different prescription foods, and advised me to get some Pepcid for
her stomach acid.
We started off
with subcutaneous fluids twice a day, Pepcid twice a day, and
cyproheptadine once a day. It was awful. Myla spent all her time hiding in
the basement, avoiding all contact completely. She also was not drinking
much. I tried everything I could imagine. Finally, she really took to a
water fountain and tall glasses of ice water. She hated the prescription
food and wouldn’t touch even her traditional favorites.
into this fight, Myla had not improved. Her creatinine was still at 7.9
(698), she was living in the basement, very tired and weak. I had a
decision to make. I was ready to make that fateful call, setting up an
appointment for pts. Watching her in such a state was unbearable. I
decided to wait, give her a few more days and make sure I was making the
There was a
subtle change. Even though her numbers were still awful, Myla was acting
better. She was coming up out of the basement to socialize. I could see a
small improvement in her and had a glimmer of hope. She was eating more
and her weight was going up.
One month after
Myla’s crash, I was excited to go into the vet. She was eating well and
looking a lot better. Surely, we had made progress. I was stunned when her
creatinine came back at 8.0 (707). It was a warm, sunny day, a really
pleasant day. But all I could think about as I walked out of the vet’s
office was that this was going to be a short fight for us. I was crushed.
Over the next
two weeks, Myla continued to improve. She was eating better and almost
back to acting like her old self. When her vet came into the exam room
smiling and hugged me, I knew it was good news. Her creatinine had dropped
to 5.5 (486).
Back at home,
Myla celebrated by launching up into a tree, only the second time she’s
ever done that around me. She obviously was feeling much better.
Myla had now
settled on a particular food and was eating a lot. Her weight was going up
steadily and she looked great. Two weeks after her last labs, Myla’s
creatinine was now 4.5 (398).
Life was much
easier. Although she was getting subcutaneous fluids five days a week, we
only had to use an appetite enhancer or antacid on rare occasions. She did
go through two UTIs which required antibiotics, but recovered well. Her
creatinine dropped to 3.6 (318) four months after diagnosis.
To this day,
Myla is a fairly low maintenance cat. She gets her subcutaneous fluids and
aluminum hydroxide in her food. That’s about it. She had a bout with
abscesses in summer 2011 but is an otherwise healthy and fun loving cat.
I can’t thank
my vet enough for all her and her staff have done to make this possible.
When Myla crashed, there was never any mention of pts, only a "can do"
attitude. Even when things looked bleak during the first few weeks I was
still encouraged not to give up hope.
In addition to
a great vet, it’s helpful to develop a schedule of care. Figure out which
times sub-Qs, meds, etc. are to be given. If something doesn’t work (can’t
get a pill down for instance), then move on. This was key to my own sanity
while dealing with the rollercoaster of CRF.
crashed, I didn’t think we’d get two weeks together. As I write this, 18
months later, she’s doing great!
Note: Myla died
on Christmas Eve 2012, aged 17.
Numbers Unchanged After Treatment But the Cat Managed Quite Well
Diagnosed August 2001 aged 7, survived one year
after diagnosis, died August 2002.
Diagnosed July 2001 aged approximately 10,
survived two years after diagnosis, died July 2003.
Diagnosed March 2007 aged two, survived 27 months after
diagnosis, died June 2009.
Anne and Thistle
Diagnosed November 2007 aged nine, survived 21 months after diagnosis,
died August 2009.
Jenica and Nikki
Diagnosed June 2010 aged 5-10, still alive two years later.
mid-August 2001, I noticed that Moses was drooling. I assumed it was a
tooth problem, and I scheduled him for a dental. He had had a check-up the
previous year, and everything was normal. Since he was only 7 years old,
we never thought it would be anything more than a bad tooth. Other than
the drooling, he was not acting differently.
we had the preliminary blood work done before his dental, the numbers were
frightening - he tested off the scale for BUN/urea and creatinine. My vet
immediately put him on IV, and he was alarmed, but he is a "treat the
cat, not the numbers" doctor. He thought perhaps it was an infection,
but the blood work that was sent off came back confirming kidney failure.
BUN was 216 (urea 77), creatinine was 17 (1502), but other key numbers were only slightly
elevated. So, he spent a week in the hospital, and, by the week's end, we
had no great improvement - BUN 135 (urea 48) & creatinine 10 (884).
vet sent him home with fluids, supplements, and hope. And, for a year,
that is where we hovered - after testing faithfully for several months, we
came to accept his numbers - they regularly registered BUN 125 (urea
44.6) and creatinine 9-10 (795-884). He
never developed serious anemia, and his phosphorus levels remained stable.
He ate Hills Senior Diet and turkey. He refused to eat any of the kidney
diets, and I was not going to force him.
did 150 ml sub-Qs nightly. You would never have known he was
"sick." He maintained his routine until the week before he died.
It was almost a year to the day that we found out that he was in kidney
failure. That week was frightening. It started Thursday... he had a seizure
at 2 in the afternoon, and we rushed him to the vet. The vet prescribed a beta
blocker, but on the way to the drugstore, Moses had another seizure, and then
he had six more. The next day his eyes were dilated, and I posted on the CRF
group - detached retinas - the vet gave me a prescription for Norvasc,
of choice as recommended by the folks on the group who had "been
there, done that." Amazingly within the day, he was seeing again, but
you could see it was starting to take its toll. He seemed weak, but he was
eating... But, he started to show signs of weakness - and he started to
Monday, we knew we were probably facing the final hours... he had a nose
bleed, and he seemed to struggle with each step. We took him to the
vet Tuesday, and, since our vet had seen him come back before, he did not
say, it is over. But you could smell the uremic poison, and so they were
going to try an IV flush. A quick blood test indicated the numbers were
now deadly. While they were trying to stabilize him, he went into cardiac
nearly a year of "normal" life, Moses could no longer fight the
disease - his mind was willing, but his body was shutting down. It was
hard not only on us, but on the doctors and vet techs as well. They had
never seen a cat survive for that long, and they thought for sure he would
pull through even in those final hours. But, it was not to be... yet I am
glad I did not have a vet who said, put him to sleep when the first
numbers came in. We had a year to love him and care for him, and he died
Deb and Laney
My sweet little peanut Laney was diagnosed with CRF
in July 2001. Her renal failure was considered advanced. At diagnosis, her
BUN was 228 (urea: 81.39), her creatinine was 15 (1326) and her phosphorus
was 31 (10). The outlook was grim. She was such a petite little girl (at
only 5 lbs) – the vet thought she simply had ‘nothing left’. Well, Laney
had other ideas. She clearly had a strong will to live, and a personality
ten times bigger than her small frame. Once I knew she was willing to
fight, so would I.
With IV fluid therapy, change in diet and a host of
other treatments, this little girl lived for exactly two years after her
diagnosis. During this two year period, she remained a ‘high numbers’
kitty. On an average check-up, her BUN was anywhere between 80 and 200
(urea between 29 and 71) and her creatinine between 8 and 12 (700 to
1000). However, with a lot of hard work, we were able to keep her
phosphorus in check, usually in the mid 4’s to low 5’s (1.45 - 1.6).
In Laney’s particular case, we found that how ‘good’
she felt (playing, eating, general demeanour) was strongly associated with
keeping the phosphorus and parathyroid hormone in check with aluminium
hydroxide and calcitriol therapy. At one point, we had to give her as much
as 2000mg of aluminium hydroxide binders per day to lower her phosphorus.
We did not see any ill effects and she clearly felt better. Yet her BUN
and creatinine always remained high.
Like all CRF parents, we were victims of the ‘roller coaster’ ride. After
Laney's initial diagnosis and subsequent ‘bounce-back’, she crashed four
times and had to spend a few days in the hospital on IV therapy. In April
2002, her battle with anaemia began after she lost a lot of blood from a
gastro-intestinal bleed. Her anaemia
was complex and resulted from gastro-intestinal bleeding, an autoimmune
condition, and the ‘traditional’ lack of erythropoietin hormone because
her kidneys were not functioning well. After two transfusions, we treated
her anaemia with high doses of carafate (sucralfate), Epogen, Pet-tinic, B
vitamins and prednisolone.
One of Laney’s crashes was a result of an
electrolyte imbalance. However, the kidneys play a role in regulating
electrolytes (especially calcium) so it still resulted from her CRF. She
was having ‘seizure’ like events. At the ER, we found that her calcium was
very low (which is a bit unusual in CRF – usually calcium is too high). We
started to supplement her with calcium carbonate and of course calcitriol.
With this therapy, we never saw such seizures again.
I know this all may sound bad, but in between the
crashes and after the ‘bounce-backs’ she was a happy little girl. She
loved us so much and would literally follow me everywhere. At night she
would sleep on my head or on my pillow ‘cheek to cheek’. She would often
play with the plastic rings on coke bottles and she loved to attack the
‘blanket monster’ or protect us from the ‘plastic bag monster’. She had
such a big spirit and was the embodiment of pure love. But I’m
In my opinion, another key reason for Laney’s two
year survival with extremely high BUN and creatinine levels was her vet.
We switched from a general practitioner to an internal medicine specialist
who is just outstanding. This vet was very knowledgeable about CRF and
anaemia, and completely open to new research and new approaches (the
calcitriol is one example). Together we formed a partnership that really
benefited Laney. Since she was an understandably busy vet, I would
communicate my questions or my research findings via fax. Getting an
‘efax’ number helped a lot because I could simply send a fax via email and
receive one back via email. She would often respond to my
questions/concerns/findings within a day. (The staff at the vet office
joked about my ‘love notes’ to Dr. Z, consisting of ‘Laney questions’ and
copies of articles).
I also kept track of all of Laney’s test results
using a spreadsheet – this was helpful to our vet because she could easily
look at trends. I also kept a chart at home so we could keep track of her
meds - when they were given – and also make general notes as to how Laney
was feeling that day. This also helped the vet if something were to go
Towards the end, Laney’s calcium and phosphorus
became very hard to control. We didn’t know it at the time, but I guess
this was a sign that her kidneys were just starting to shut down. Only a
week before she died, she was eating well and seemed fine. Whether
expected or unexpected, sudden or drawn out, the pain of losing a little
one is just so acute. As I write this, it’s been four weeks since losing
her and we’re still not over the shock and loneliness of missing her sweet
little face and her gentle touch. But I hope her story will somehow help
other ‘high numbers’ kitty parents to not lose hope.
It often surprises me to read posts from folks whose
babies have a BUN in the 30s (urea in the teens) and a creatinine in the
4s (350 - 450) and the kitty feels really, really bad. Of course, it’s not
possible to generalise because some kitties just may be able to tolerate
the high numbers better than others. But I often wonder if the feeling of
sickness is truly more a function of the phosphorus or the anaemia or the
parathyroid hormones, and less associated with high BUN/creatinine. At
least that was our experience.
I know this is long – there are so many aspects of
Laney that I didn’t touch on, but I hope this will help a panicked
fur-baby parent who may think their sweetie is on the verge of death.
Please know that this disease can be managed, even if the initial
diagnosis/prognosis is grim. Many vets who aren’t aware of all the
treatment options may be too quick to judge. I know second-guessing is
common, but I sometimes think my little girl could have lasted even longer
than the two years.
journey began in the spring of 2007, at the height of the
Menu Foods recall,
after eating a brand of food that was later recalled. Within a week she
crashed, and spent the next four days in the hospital on IV. She was just
two years old.
Bateste came home with a creatinine of 3.7 and a BUN of 57 – much better
than the crash, but certainly some kidney damage had set in. It was soon
time to turn our focus from an
AKI (acute kidney injury) crisis to CRF management. Bateste started
on the usual treatment plan of phosphorous binders, sub-Q fluids and
benazepril, and we set about integrating the new routines into our lives.
We continued through the spring and early summer without much change in
our treatment plan.
Summer 2007 brought scary changes. Without warning her creatinine went
into a rapid freefall, finally settling in the low 6s. By now her BUN had
ticked up to the low 100s. Food avoidance and vomiting started to creep
into the picture. I really thought I might lose her and, deciding I needed
to do more, I started to teach myself about CRF by reading on the
internet. That’s when I found this website, learned how to read labs, and
started to ask questions. Her doctor was so amazing and supportive. We
added aluminum hydroxide, vitamins, Azodyl, and Pepcid. As well I learned
how to coax Bateste to eat, first with blended food in a dish, later with
We didn’t know it at the time, but Bateste’s numbers would never go down
substantially, and yet she would continue to thrive for more than two more
years. Indeed, Bateste was a true “high numbers kitty” who maintained a
very high quality of life despite creatinine in the low 6s and BUN in the
low 100s. She played, purred and cuddled with her brother.
She took great pride in her appearance. She could catch a fly in
mid-air! She really did just about everything a “normal” cat would
do. Somehow her little body adapted, and we got on with life.
That said, CRF is a giant roller coaster and we had our share of scary
times. About a year in, we
started on Aranesp for the anemia. Anemia was
frightening, but Bateste responded very well to treatment and we never had
any regrets about choosing Aranesp. Also around this time, a dental
became unavoidable and though risky, her doctor took every precaution and
Bateste did amazingly well. Then about a year and a half in, the Pepcid
suddenly stopped working, resulting in uncontrolled vomiting and weight
loss. Each of these times I worried and cried, but somehow Bateste
I think it’s important to recognize that CRF brings
a lot of changes, and we can’t spend too long mourning over how things
used to be. It’s better to adjust to the “new normal” and move on,
accepting that there will be change and it will be scary. During
Bateste's journey there were several distinct periods of time where I
thought "ok, this might be it" but, looking back, I can see how well she
was doing, and it was often my perception of what she should be doing or
she used to do that made me think she was near the end. Each of these
episodes was a period of tremendous growth, for her and me. Bateste
was an amazing teacher, and each of these times she was telling me to step
it up, that my skill set was stale and we needed to rework things.
So many things in the CRF game have a work-around, and it's a constant
discovery game to find new ways to treat symptoms, new foods to try, new
methods of pilling and feeding...
I am amazed Bateste had so much patience with me.
But we plodded on together, me awkward and scared, her brave and patient,
and she taught me much of what I needed to learn. I believe working so
closely with another species can be an intensely spiritual journey. Its
hard to see it when there is a crisis at hand, but stepping back, its
amazing how much we learn from each other, and the intensity of the
bonding and love we can share.
My agreement with Bateste had always been that so long
as she wanted to fight this, I would be by her side every step of the way,
and when she decided she was tired and wanted to stop, I would support
that decision, too. We fought a good fight for more than two years.
And then, suddenly, she made her decision that she wanted to stop.
She went from fine to gone in three days, and so the journey ended as
quickly as it began.
If there is any advice to pass on from my experience, it would be:
Get into a routine with all the medical stuff and
scheduled meal times. Structure really empowered Bateste (she knew what to
expect), and allowed me to build in enough time each day that we never
Learn now to assist feed so kitty can always
maintain her weight, whether or not she feels like eating. Learning how
to feed Bateste was the single best thing I ever did for her, and was
absolutely essential for her long-term success.
Think through in advance what some of the major
medical milestones may be, and how you want to react. For example
Bateste’s doctor and I discussed well in advance how we would start
treating the anemia when her PCV reached 16%. When it did, the Aranesp
decision was a lot less stressful.
Treat the cat, not the numbers.
The greatest medicine of all is love.
Anne and Thistle
our beautiful silver mackerel tabby, was a gift from nature. Born wild to
feral parents, Thistle didn’t want to be a wild cat — he wanted to be a
lap cat with a forever home and adoring parents to love him. He was always
so affectionate, almost as if he remembered being lost and lonely during
his first months, and once Thistle came to live with us he quickly became
the heart of our home and the leader of our little pride.
Thistle was first diagnosed with "kidney problems"
in November 2007 at age 9, when he lost his appetite after gradually
dropping a pound in weight. At that time Thistle’s labs were only slightly
off, with a creatinine of 2 and an elevated BUN of 55. An ultrasound
revealed his kidneys were abnormally small and misshapen, and the vet
confirmed that Thistle’s kidneys had felt small from the time she had
first met him. She thought that Thistle might have been born with a
congenital kidney problem, or may have sustained kidney damage within the
first few months of his life before he found us. The other dark
possibility was lymphoma (a type of cancer), so she suggested a kidney
biopsy that we ultimately declined, deciding we weren’t going to put him
through the uncertain rigors of chemotherapy. With heavy hearts, we took
Thistle home with guarded advice to start him on a renal diet but with
enduring faith in the strength and vitality of his spirit.
Thistle bounced back quickly with lots of loving
interaction, extra feedings of wet cat food, and plenty of tuna in water —
he would rarely eat the renal diet — and he soon regained weight and was
back to enjoying his adventures in the garden and ruling over our
household. The following November of 2008, when after new bloodwork we
were told "everything was fine," we rejoiced in our good fortune — surely,
if Thistle had lymphoma, it would have manifested by then.
But on Thursday, March 5, 2009, Thistle stopped
eating his favorite dry food and would not be tempted by chicken breast,
baby food, fancy little kitty treats, or even his favorite tuna — he
seemed to be having trouble chewing. Aside from his lack of appetite,
Thistle didn’t seem sick at all. Our vet was unfortunately away, so we saw
another vet who informed us Thistle’s thyroid seemed slightly enlarged and
his gums were a little inflamed, and she drew blood to test his thyroid
function and advised putting him under anesthesia to do a dental and "look
around in there" the following week. This diagnosis just didn’t feel
right, and no way were we going to wait a week without Thistle being able
to eat, so we left urgent messages for our regular vet who was able to run
additional tests the next day from Thistle’s thyroid blood sample. She
called us with the news that although his thyroid was fine, Thistle’s
kidney function had worsened and he had advanced chronic renal failure —
our kitten was crashing. By this time, his creatinine was 8.2, BUN 112,
phosphorus 8.1, and hematocrit 26.
With fear in our hearts and deep reluctance to be
separated from him, we hospitalized Thistle for IV fluids to give him the
best chance at stabilizing. But Thistle had never been away from us
before, and no one but my husband and I had ever handled our special
little wild cat. In the hospital Thistle’s systolic blood pressure soared
to 220 mmHg, pushing the IV fluids gave him a grade 3 heart murmur, and
poor Thistle trembled in the back of his cage, couldn’t eat, and was
referred to as "that scared kitty in cage 106." I abandoned everything to
spend as much time as the hospital would allow to try to comfort and feed
my baby Thistle, but after three stressful days in the ICU with numbers
that barely responded, we were told to take him home before the worst
could happen, armed with Norvasc for hypertension, Pepcid AC for stomach
acid, subcutaneous fluids, and very little hope.
After a week at home on his meds and 100 ml/day of
subcutaneous fluids, Thistle’s blood pressure returned to 125 mmHg but his
numbers remained high with a creatinine of 6.6, BUN 106, and phosphorus
8.9. His potassium was now only 3.6 so we added potassium chloride to his
fluids, and started him on phosphorus binders. The subcutaneous fluids
were bumped up to 150 ml/day, which Thistle tolerated extremely well. He
seemed to know we were trying to help him, and always sat quietly for his
fluids while I kissed his fur and rubbed his chin.
Over the next few months and with very high numbers
despite the medications and fluids (creatinine ranging from 5.6 to 12.4,
BUN ranging from 103 to 136, and phosphorus ranging from 6 to 9.9; his
hematocrit remained stable between 24 to 26), Thistle had good energy,
played with our other cats, climbed trees in the garden, purred, groomed,
and acted normally … but he needed my assistance to eat other than at
breakfast-time, which was when he felt best — perhaps because in the
morning he felt the most hydrated from his subcutaneous fluids the night
before. So we worked out a new routine in which I assist-fed Thistle at
least four times a day, much of it licked from the tip of my finger. He
would only tolerate certain pureed cat foods or baby food (ham being his
favorite flavor), and Thistle would sit calmly on the kitchen or bathroom
counter to lean against me and look out of the window while he licked and
swallowed. My husband and I agreed that if Thistle were to crash again, we
would not re-hospitalize him for IV fluids since he’d been so traumatized
by it before and his numbers really hadn’t responded anyway — we were
going to do everything we could for our beloved Thistle at home. We began
focusing on the day-to-day joys of our time together, and my definition of
hope changed from having Thistle get lower numbers, or gain weight, or
live to age 20+ (as I had once dreamed for this most special cat), or "get
better" … instead, hope meant loving interaction, the energy to purr and
lie smiling in the sun together, an actively licking tongue on my
food-laden finger, and a happy, alert cat who played with our other three
cats and enjoyed watching the birds fly by in the garden, occasionally
trying to catch one.
We treasured each day, until quite suddenly Thistle
began to feel more nauseous and was no longer able to lick the food from
my finger — he needed me to place every bit of food into his mouth for him
to eat — so we adjusted our routine again, changing the medications for
stomach acid from Pepcid AC to Prilosec then to Cerenia and finally
Zantac, while tripling the phosphorus binder. But although he was alert,
responsive, and as loving as ever, Thistle needed to rest more and began
to withdraw. All this time he had managed to maintain the same weight, but
by his recheck a week later Thistle had lost half a pound, his systolic
blood pressure had risen again to 210 mmHg despite an increased dose of
Norvasc, and his hematocrit had dropped sharply to 17.8. His labs were now
deadly: Creatinine 15.9, BUN 216, and phosphorus 17… Thistle’s kidneys
were shutting down. We briefly discussed the possibility of a blood
transfusion followed by Epogen (Thistle’s beautiful rose-colored nose,
gums, and tongue were growing pale), but we agreed that although this
might help his energy levels and strength, it could not help dear Thistle
battle the nausea and anorexia from the rapidly rising levels of toxins in
Our brave sweet Thistle continued to purr, interact
with us, pounce on his spotted pink mouse toy, and do all of the little
cat things he loved so much, until almost overnight he began hovering over
the water bowl, stopped being able to swallow, became too weak to walk
more than a few steps before having to rest, and was starting to zone out
more and more although he continued to respond to us with clarity and
connection — his spirit was much stronger than his body could sustain. I
spent our last night together on the floor gently curled around him,
trying to stay awake in the moonlight to comfort him and whisper our love
to him. On August 5, 2009, five months to the day after he crashed,
Thistle was laid to rest at home in the garden he loved so much with our
kisses on his face and our loving arms cradling his beautiful silver body.
Thistle fought hard against CRF to stay with us, and
won each battle until the war was over — he left knowing that we had done
everything we could to give him more quality days in the sun, and that he
was the most loved wild cat who ever lived. Although Thistle remained a
high numbers kitten after his crash, we had five more months together than
I thought we'd be blessed when he was hospitalized, a full 21 months after
we first learned Thistle’s kidneys were abnormal. Despite his high
numbers, Thistle enjoyed his days to the fullest, and through his example
taught me to put aside my fears to live in the moment with him. Until the
last, each day I knew by the light in his eyes and his perky behavior that
"today was not the day," so I was content to refresh my hope for another
day together with my beloved friend. What our vet wrote to us in the end
expressed it well: "Thistle’s spirit and will to live a good life, no
matter what his bloodwork looked like, was truly impressive to me. I
learned a life lesson from his example."
Life will never be the same again without our most
special kitten, the one with the shimmering silver fur that paled in
comparison to his warm, loving heart and pure, bright soul. It was our
great good fortune to love Thistle and to be loved in return so
completely. Thistle was the cat of a lifetime, a free spirit who chose to
generously share his wild heart with us, and an inspiration to us all.
Jenica and Nikki
June 3rd 2012 we celebrated Nikki’s Unbelievable, Miracle
2-Year Anniversary since her dire and sudden CRF diagnosis.
Two years earlier when I
told Nikki “Let us be a success story too”, I was merely trying to have
hope against hope and find a way to survive the devastating news and pts
verdict from the vet! Perhaps, in retrospect, the vet simply could not
believe that a cat with those extremely high numbers would ever survive
the week! But I BELIEVED!!! I believed in Nikki’s strength and
willingness to fight and I believed God would help and guide us to find a
way to be together a while longer. And since Nikki’s survival would have
been nothing short of a miracle that is all I prayed for every day!
Although I had been taking
my cats there for 5 years, the vet offered no treatment and told me that
even if I gave her a million dollars she couldn’t help Nikki and the only
option was pts. I was shocked and couldn’t even process the news but I
knew one thing with certainty, I was not going to let my sweet little
Russian Blue girl go without trying to find if there was anything I could
do to help her. I had never even heard of crf and just couldn’t believe
that absolutely nothing could be done about it.
I told the vet that I had to
sort out what just happened and took Nikki home. After crying for hours I
realized that I wasn’t any help to my sweet little girl so I pulled myself
together and started researching… After all, that was one of my
And there it was, Helen’s
site, Tanya’s crf and the crf support group! That was my first ray of
hope! I read almost the entire site with the exception of ‘Saying good
bye’ I just couldn’t bring myself to go there. I read the ‘Success
Stories’ instead and they gave me hope and strength when I had neither.
That is when I kissed Nikki and told her that we had to fight and become a
success story and inspire other sick kitties to fight!
Nikki is one of the crf
kitties whose numbers have never really come down significantly from the
extremely high values at diagnosis on June 3rd 2010: Bun130,
Phosphorus 16.1, Creatinine 12.7, Ca 11.4, K 4.1, HCT 20.4%. The best we
ever had were, for a short while and not all at once: Bun 53, Phosphorus
4.9, Creatinine 3.9, Ca 10.5, K 4.7, HCT 34%.
After reading Tanya’s site
and receiving encouragement and advice from Helen and the Group I went
back with Nikki and asked for subqs and B12 shots as Nikki’s HCT was 20%.
The vet was shocked and aggravated as she expected us to be there for pts.
She also said that Nikki had bad gingivitis and grade III heart murmur and
hinted that it was all in vain; too risky to do dental work or IVs.
Reluctantly, she agreed to show me how to do subqs. I faint when having
blood drawn and if my life depended on it, I couldn’t use a needle… But
that all changed when Nikki’s life depended on me! So with both vet and my
husband in shock I proceeded to treat Nikki and kept asking for help and
advice from the Group.
Nikki showed up in our front
door bushes in July 2005. Nikki was an outdoor/indoor cat, loved her
garden which she fiercely protected. Her diagnosis was a shock as her
symptoms happened over a couple of days. I found her in the backyard
soaking wet from the sprinklers, just laying there. I picked her up and
she was so light. Got her all comfy, fed her but the next morning I found
her wet again so I took her to the vet.
A couple of weeks after
diagnosis, Nikki didn’t seem to get much better and I was desperate
because every cat in the Group seemed to have a treatment plan except my
Nikki. I had to ask the vet for every single treatment or medication based
on information provided by group members. The vet kept saying we needed
more tests and on June 19th, over 2 weeks in, Nikki’s numbers
were a bit lower: Bun 69, Phosphorus 10.8, Creatinine 10.1, Ca 10.9, and K
4.3. That was the good news. Her HCT however, dropped to 13.5%! I was
going to lose her to anemia. Everybody urged me to do a transfusion to
save my girl or start Epogen immediately! But the vet wanted to test some
more and wanted to compound Epogen which can’t be compounded! That is when
I decided that I was going to forgo her opinion and services. We got help
from a friend’s vet who came and gave Nikki a shot of Epogen, got a
prescription and continued treatment. While I appreciated the vet’s help I
really did not appreciate his request that we return the Epogen vial
when…. It is a very small vial and it could only mean that he did not
expect us to use it for too long… It sent a dagger in my heart but I
thanked him and tried to move on….
I also decided it was time
to find a vet that would work with us and felt that Nikki had a chance.
But it was not a happy move as the second vet was unstable to put it
nicely and wanted to test Nikki every week… She also stopped Epogen after
2.5 months when Nikki’s HCT was high enough she said and constantly
belittled other vets or even the information I provided from the group
-the group that helped save Nikki’s life.
The great news was that on
July 9th 2010, 5 weeks after diagnosis, her numbers looked much
better: Bun 55, Phosphorus 4.9, Creatinine 4.5, Ca 11.0, K 4.5 and HCT
23%. We dared hope we were heading in the right direction! Those numbers
maintained through late July with only HCT climbing at 34% following
Epogen injections. August was almost the same and then October 1st
Nikki had the lowest Creatinine to this day: 3.9! The rest of it was about
steady: Bun 72, Phosphorus 5.3, Creatinine 3.9, Ca 10.9, K 4.7 but a drop
in HCT to 22% because the vet stopped Epogen when Nikki’s HCT reached 34%.
At the same visit on
October1, Nikki’s blood pressure was high about 150-170 (I know now that
it might have been because of the Epogen) so the vet prescribed
Amlodipine. I followed her plan but 4 days after treatment and the best
blood work Nikki ever had since diagnosis, I almost lost her! She crashed,
stopped eating and I thought that it was the end. I took her in and was
very angry as I was not told about side effects or that we should have
started with a much lower dose. Nikki is a very tiny cat at 5.38 pounds at
diagnosis! The vet came in and when I told her I was worried and
concerned, as I didn’t take meds and didn’t know much about side effects,
she threw her arms in the air and said that she didn’t know either! Nikki
was in her carrier; the vet didn’t even look at her and then charged us
for it! That was the final straw for me! After having the best renal
values I almost lost her to vet’s incompetence to put it nicely.
Back to finding vets,
especially when Nikki was so sick… Thank God, the third time was a charm
and we are still with this vet today. She works with me and is receptive
to all the information I present and answers all the questions. Don’t give
up or settle for a bad vet! If you have other options, please explore
All October 2010 we tried to
recover from the crash caused by the high dose of Amlodipine. Nikki’s
blood work on October 25 2010 was as good as expected whit her final stage
crf diagnosis and after fighting the crash: Bun 107, Phosphorus 7.5,
Creatinine 5.6 Ca 10.8, K 4.9 and HCT 26%. We also did X-rays and Nikki’s
arthritis was pretty bad but the vet didn’t think she was in pain so we
were going to monitor it. And the heart murmur was almost undetectable.
We were doing quite well
until January 5th 2011 when Nikki crashed and her breath was
fowl, she didn’t want to eat, was very weak and seemed she gave up
fighting. I took her in and her vet was off that day but the owner of the
clinic consulted her and was not very hopeful. We decided to try fluids
every day and increase phosphorus binder; not much else could have really
been done he said. Her numbers were bad: Bun 158, Phosphorus 14.3,
Creatinine 7.9, Ca 10.5, K 3.6 and HCT 22%:
I went home and started K
supplement as the 3.6 value was dangerously low. I also began throwing
every food possible to motivate Nikki to eat and fight.. Finally she ate
some tuna and especially the juice. I mixed it with her renal food and we
started making progress. We were fortunate that Nikki ate renal food k/d
canned from the beginning, and after she refused it we switched to Purina
NF canned which is the food she still eats today along with k/d dry.
We did daily fluids for
about 10 days and increased ALOH (always used it in the renal food due to
Nikki’s high P) and so she pulled back from the brink! After those first 2
weeks in January, she thrived, gained weight and was doing extremely well!
You could hardly see she was sick… She is the nicest girl, sleeping
through fluids and being the best patient ever! We switched from weekly
vet visits and blood-work to almost 8 months of much needed vet break! We
were only doing EOD fluids and ALOH and some Pepcid for stomach acid. It
was remarkable that her treatment was so limited and she was doing so
We ran another complete
Senior Screen on October 7th 2011 and her numbers were pretty
good, in fact better than in October a year earlier, which was amazing. It
meant that we somehow managed to keep that crf under control. The one
issue was high potassium 5.6 which we were going to monitor. Values were:
Bun 78, Phosphorus 5.2, Creatinine 5.1, Ca 10.9, K 5.6 and an HCT of
27.2%! With her BP on the high end, I finally agreed to try Amlodipine
again after the scare a year earlier, but this time we started with a very
small dose and when Nikki’s body adjusted, we increased it. We are now
getting compounded chews and she happily eats them! For an impossible to
pill cat, it is a fantastic victory!
With her litter box
accidents still present we tried Baytril for a potential infection (urine
culture didn’t show it) but nothing changed. We also tried to treat an ear
infection but Tresaderm didn’t work. She was given Tresaderm, although I
requested Animax which she had for a very short time in September 2010. I
followed the vet’s protocol but now, in retrospect and still looking for
anything that can explain Nikki’s neurological issues I wonder if
Tresaderm might have caused her these problems. I read that it is a short
term med. But the vet wanted us to do 2 weeks. I think I stopped after 10
day as every article said it should be only used for 3-5 days!
cognitive dysfunction symptoms seemed a serious cause for concern so I
took her to a neurologist to find answers. Sadly, we did not. The
specialist said that anesthesia was too risky for a cat scan and without
it we were limited in diagnosis. She did watch Nikki and said that Nikki
did see but her brain couldn’t process what she sees. I am not sure
exactly what that means… If it was a tumor the vet said, it would have
progressed much faster and Nikki’s condition has been pretty much the same
for months. We had another obstacle and we are still trying to adjust to
this very difficult situation… Unfortunately she does not jump on the bed
anymore but is still walking around, and somehow manages to find her way
back to her ‘quarters’. We still have litter box accidents from time to
time but she is so good about going in her 3 boxes of choice! She has
water and food bowls raised and in the same place and she has learned how
to find them. We even venture in the backyard which has been HER garden
before crf forced us to bring her indoor entirely.
In May 2012 we redid the
complete Senior Screening and it was OK but we still haven’t found answers
to our neurological issues and of course we can’t address them if we don’t
know the cause. Values were: Bun 67, Phosphorus 6.1, Creatinine 5.4, Ca
14.3, K 4.9 and HCT 24%. Her potassium apparently resolved itself from 5.6
to 4.9. The one serious issue was her very high calcium levels and now the
vet fears that it might be secondary hyperparathyroidism or worse
(lymphoma). Combined with Nikki’s neurological problems and her weight
loss, it could be a mountain much harder to climb. But her neurological
symptoms have not progressed as fast so we hold on to hope… We are
considering ionized calcium test to see if the high Ca is really
worrisome. I am still learning new things every day and am on a mission to
het Nikki’s weight back so I am chasing with that food bowl day and night.
Otherwise, we are hopping
along. Nikki has better days when she is a house traveler or venture in
the garden for a nice stroll. I hope she remembers her garden and all the
great times she enjoyed out there where she spent most of her time before
getting sick. This evil crf altered our lives forever, but we can treasure
the wonderful times we had before we even knew it existed and I am so
happy that Nikki was healthy, happy and got to live those times…
Nikki’s current treatments
include subcutaneous fluids; phosphorus binder; B12 and Amlodipine. I
think that this treatment is unbelievable considering where we started.
But the most important treatment is our unbreakable bond and our love for
each other which has carried us through everything…
It is hard to be a caregiver
and even more emotionally draining when you are caring for a loved one
battling an incurable disease while trying to appreciate every extra day
you are given…. I have been caring for Nikki with just as much love and
compassion and dedication as I did for my mom… it was heartbreaking to see
her fade away… so frail and so different from the oh, so beautiful,
energetic and lively best mom ever! Nikki most recently has also become
more frail and fatigued and battling those other issues when we
miraculously managed to contain her CRF. But I learned to appreciate,
enjoy and be grateful for every day I have with them… and love the moments
which one day will be my most treasured memories…
We hope that by having the
honor to post Nikki’s success story here, we can offer hope, strength and
inspiration to those who in that difficult time are scared and lost and to
encourage them to follow their heart and their kitty’s signs… because
nobody, not even the vets truly know for sure when it’s time… All we can
do is try and fight and then we know for sure that we did our best and
that means we loved and honored our cats and would feel at peace with
whatever outcome we must face…
From an extreme feral kitty
from the bushes, so scared of humans it took me half a year to touch her
and endless open door winter evenings to lure her into the house and
back-yard for safety… to the sweetest, most loving girl I could ever hope
for ! That has been my Nikki’s unbelievably wonderful journey and we are
still on it together today…and when I hold her tight but gentle in my arms
and kiss her with all my love, all is well in the world!
Cats with Low
Numbers at Diagnosis Who Remained Stable
Back to Page Index
Diagnosed 1996 aged 15, survived almost seven
years after diagnosis, died May 2003 aged 22 of an unrelated condition.
Diagnosed March 2000, aged 10, survived 3.5 years
after diagnosis, died 7 September 2003.
Diagnosed June 2000, survived 2 years, 10 months
after diagnosis, died 10 April 2003.
Merlin and Circe
Diagnosed August 2001 both aged 8. Merlin died on 22 July 2007 aged 14.
Circe died January 2014 at age 20, having lived for almost 13 years with
Diagnosed September 2001 aged 15,
survived three years and seven months after diagnosis, died 7 April 2005
Jan and JR
Diagnosed December 1995 aged 3, survived six
years after diagnosis, died January 2002.
Diagnosed in 1997 aged 14, survived four years
after diagnosis, died in 2001.
Lynn and Hope
Diagnosed October 2001 aged six months, died 31 March 2014 of lymphoma
(cancer) aged 12.
Diagnosed October 2002 aged 4, died 6 July 2010 aged 12.
Dorothee and Paris
Diagnosed January 1990 aged six months, died September 2006 aged 17
years and 2 months.
Mieke and Pimmy
Diagnosed April 2006 aged 17, survived 19 months
after diagnosis, died December 2007 aged 19 from heart disease.
Cindy and Custard
Diagnosed October 1999 aged 10, survived eight years, died September
2007 aged 18 from cancer.
was diagnosed with CRF in 1996, not long before his 16th birthday. He'd
had a thyroidectomy, and the pre-surgical bloodwork was all normal. He
seemed to be recovering, but worsened after a few weeks. His BUN was 26.8
(urea: 9.3) and creatinine 2.78 (245). Not only did the vet say "early CRF" but he
was now diabetic.
the next five years, the only CRF treatment was making Hill’s K/D a
significant portion of his food. Due to the diabetes, he was put on
scheduled feeding. During the first year of his CRF, his diabetes was
virtually uncontrolled, and I consider this a major contribution to the
fact that by year two his BUN was 50 (17.9) and creatinine 3.6 (318). Once his diabetes was
regulated, his CRF bloodwork remained stable at these levels except for an
incident in 1999 - he was ill with very high calcium levels and his
creatinine spiked to 4.3 (380) for a time.
December 2001, a routine geriatric screen showed his kidney values hadn't
changed significantly, but his electrolytes were off in all directions.
Add to this the fact that he was vomiting occasionally, and the decision
was made to treat his azotemia with sub-Q hydration. He was started on
normal saline at very high rates (300 ml/day, divided) which didn't bring
his numbers down at all, so I backed down slowly, giving him less and less
until physical signs indicated I'd gone too far. Currently he's on
Ringer's and happy with 50 ml every 1.5 days as long as I keep his
glucose tightly controlled. The vomiting was solely associated with the
strain of constipation, and the LRS (along with lactulose and fibre) keeps
that under control.
the last year (2002) Pooter's BUN (urea) has been up and down, but the creatinine
has exhibited a small and slow increase from 3.2 to 3.4 (283 to 300). Given that his
diabetes and CRF are largely stable now, his electrolyte variations are
being addressed. Calcium has run consistently at high normal, chloride
consistently low. Phosphorus has been low, then high, then low again, so
we change his diet to compensate. Potassium recently went very low and is
being supplemented. He has no sign of anemia or appetite problems.
CRF and diabetes, he has an arthritic hip, no thyroid gland, serious
gingivitis, and a low-grade and stable heart murmur. We presumed
hypertension last winter when he woke up blind one morning, and put him on
Norvasc (his sight returned after a few weeks) as well as Fortekor (more
for his kidneys than BP). Most of his medications are hidden in a small
serving of canned Hill's K/D, the rest are injected.
can't say I've observed any physical decline that is definitely
attributable to his kidney deterioration, except urine pH. He's been
"early CRF" for six years, and whenever he's weak and wobbly it
always turns out to be failed glucose control. He's 22.5 years old now,
and still able to bounce back as soon as I get him normoglycemic again.
Pooter is a handsome grey tabby. He's been with me since he was a
weanling, never caring much where we lived as long as we were together. Pooter had a housemate named Sparrow for 19.5 years, but she succumbed
to bladder cancer and now he only has me. He is very smart, feisty or
tolerant on his own terms, generous, affectionate, and protective - he
once put himself between me and a moose, all fluffed up and growling - my
have regrets. I regret neutering him, as he would have greatly improved
the local gene pool if he'd bred. I regret not firing promptly enough some
veterinarians who didn't do their best, like the one who cost him his
hearing. I regret that he didn't go out in a blaze of glory before his
once-abundant whiskers became wispy, his powerful legs became unreliable,
and his superb vision dimmed. While I am committed to tending one by one
all his discomforts, I regret that some day the only way I will be able to
relieve his pain is by putting him to death. Loving him to death.
has always lived with wonderful spirit, grace, and intellect - sometimes I
think he will do me the ultimate kindness of simply not waking up one
morning. Other times I think he will break the record for the world's
oldest cat. Mostly I think he stays because I need him so.
Note: Pooter was put to sleep on 10 May 2003 because
of a pulmonary embolism, which was not related to his CRF. He had CRF for
almost seven years.
Bandit was found on a rifle range in late September of 1989, and a
friend's landlord brought him home thinking he would be a good pet for her
daughter, Marisa, who was just five. He was so malnourished he couldn't
even jump up on anything. My friend felt her daughter was too young to
take care of him and called me. I hadn't become the cat lady yet - I wasn't
sure I wanted to have anything I could love and lose as I had just lost
both my mother and grandmother whom I lived with and the home I grew up in
the previous year. Well, Bandit moved in and rest is history.
age five he was diagnosed with feline hyperesthesia syndrome and was put on
phenobarbital twice daily to control his attacks, and that necessitated him
having bloodwork yearly to check his liver function values. Fortunately he
is an easy cat to give pills and, as I found out, any medications. I adopted
Dami when Bandit was seven and Finnian when he was ten.
March of 2000 I came home to find Bandit limping - I guessed he jumped off
the sink and landed badly while chasing Finnian as he often did. My vet
felt a lump there and gave him a cortisone shot which seemed to work for a
few days but then he became weak in the back legs so I took him in and
bloodwork was done (I had noticed he seemed to be drinking & peeing
more for the last few months). I was given the news of a CRF diagnosis and
felt my world had collapsed. His numbers at diagnosis were BUN 82 (urea
creatinine 4.7 (416), phosphorus 8.0 (2.58) and HCT 29.4. My vet told me Bandit would
have to be on daily sub-Q fluids for two weeks to see if his numbers came
down - fortunately my boss is a big animal lover and let me leave work to
go and learn how to treat Bandit.
his numbers only came down a little (I hadn't learned to get copies of
bloodwork then) - I think his creatinine came down to 4.5 (398) and I was told
he had to eat special food - he could not have K/D because the egg would
give him diarrhea so I tried the Purina CNM NF (now called kidney failure
formula) and continued with regular wet food as he would not eat any
prescription wet food. Fortunately all three cats LOVED the Purina (Dami
doesn't eat much dry food) so that worked, and in another two weeks his
creatinine came down to 3.5 (309); we had also gone to fluids every other day at
July his creatinine was just barely above normal at 2.5 (221) and we stopped
fluids entirely (Bandit was only getting them once a week anyway) but at
next bloodwork it started to edge up. Over the next year we gradually
increased fluids as the numbers went up a bit each time and in May 2002
when his creatinine went to 3.9 (345) we went to 100mls every day - at next
bloodwork his creatinine was 3.4 (301) and it went to 3.5 (309) in November 2002, with
BUN of 66 (urea 23.6), phosphorus of 7.0 (2.26) and HCT of 35.4. He looks great and acts
wonderful – it might be nice if he didn't roughhouse with Finnian so
much. He has lost weight and at next bloodwork if that continues we will
do an ultrasound because my vet is concerned he might have irritable bowel
disease; his thyroid has been checked and is fine - he also has a good
appetite. People who see him don't believe there is anything wrong because
he look & acts great. I'm not sure if the weight loss is because
Finnian eats faster than Bandit and I have to watch Dami because she has
to eat special food for chronic cystitis. I have been feeding Bandit an
extra meal at bedtime which seems to be helping and also he is not
vomiting at all except when he has a hairball from grooming Finnian! He is
the only cat ever nominated for office in the Gaspee Days committee
(against me and he didn't win!) and has traveled all over New England
and into upstate New York where my family lives. He is two years and nine
months past diagnosis and going strong - he will always be the number one
man in my life!!
Note: Bandit died on 7 September 2003, after
fighting CRF for 3.5 years.
was diagnosed June 6th of 2000 and, looking back at his numbers, I'm
almost shocked that they started us on sub-Qs. His BUN on an
"in-house" test was 51.4 (urea 18.3) on a range of 18.0 to 36.0
(6.42 - 12.85). His
creatinine was only 1.76 (156) on a range of 0.80-2.40 (71 - 212). Another test on 27 June
2000 showed BUN 29.4 (urea 10.5) and creatinine 2.67 (236). So, we started sub-Qs
immediately and have been on them since, every other day, started at 150ml
and have been at 200ml for about 9 months.
His numbers have been up and down but never above BUN 60 (urea 21.4) and creatinine
The last check in August 2002 had his BUN in the 50s (urea 18 - 21) and his creatinine was
2.7 (239). I now try not to stress over his bloodwork like I had done for 1.5
years. What will be, will be.
We have his blood pressure checked about every 3 months and at the last
check (November 2002), it was 100! Our Vet Tech came to the house to get a
reading and he was so relaxed!
We have our good days and an occasional bad day but I wouldn't change
anything! Well, of course I'd change the fact that we're dealing with this
disease but we're managing very well today and, that's what counts.
Lucky has acupuncture once a month. Focusing on his bladder, kidneys and
occasionally his lungs. So, we're working with a traditional vet as well
as an holistic vet. We love them both!
Lucky also has FIV. That was diagnosed in 1997. I often feel that the
fevers he was having a few years ago brought on the CRF but we'll never
know. You know, fever = dehydration and dehydration = kidney issues.
Oh! As for his diet, I stay away from the kidney friendly foods. I figure
a higher quality protein, the easier it is for the kidneys to break it
down. He eats a brand by the name of Wellness. Occasionally some Fancy
Feast, and he always gets a jar of Chicken baby food after sub-Qs.
Note: Lucky was put to sleep on 10 April 2003 after
fighting CRF for almost three years.
Jenney, Merlin and Circe
two CRF kitties, Merlin and Circe, were diagnosed in August 2001. Merlin
has been stable since then and Circe had a crash this past June but is
still here with me today (and I hope for many days, but we take it one by
and Circe are Siamese littermates. They were 8 years old at diagnosis in
August 2001, during a routine pre-anesthetic panel for dental work. At
that time Merlin's creatinine was 2.6 (230) and Circe's was 2.7 (239) on a
range of 0.8-2.3 (71 - 203), while they both had BUN of 37 (13.2) on a
range of 15-34 (urea: 5.4- 12). I
didn't know enough to ask for any more blood work, and the vet didn't make it
sound earthshaking, just said to feed them K/D. They were both completely
re-check in December 2001 revealed the following:
creatinine 3.2 (283), BUN 36 (urea 12.85)
creatinine 3.5 (309), BUN 42 (15)
this point the vet recommended starting sub-Q's, which we did, 100 ml every
other day. Both Merlin and Circe were still acting fine, Circe had lost a
little weight, down to 11 pounds from 12, but not skinny.
changed vets after their March, 2002 checkup. There was not much change in
their numbers at that point, but the vet kept calling Circe
"he" (arghhh!!!!) and the techs brought her back from her
bloodwork with blood all over her chest. I found a great new vet who
really seems to care about them.
both continued to do fine until June, 2002, when Circe crashed. She stopped eating and dropped a lot of weight, down
to just under 9 pounds. She went in for a couple days of IV. Her bloodwork
95 (urea 33.9)
IV, her creatinine had gone up to 11 (972), BUN to over 100 (urea 35.7), and phosphorus over
8 (2.58). Her vet thought she was end-stage and would die very soon, within the
week. They checked her blood pressure, checked for anemia and infection while she was
there, said no problems with any of that. They said they would come to the
house and put to sleep when it was time. She was still too feisty when we picked
her up for them to suggest it just yet. She was still acting very much her
sweet little self, just didn't want to eat and was vomiting more often
than before. I started researching, found the CRF websites. I checked with
her vet and got approval to increase her sub-Qs to every day, started her
on phosphorus binders, got her on cyproheptadine to get her to eat, Pepcid
AC for vomiting.
was over five months ago, and she is still very much her sweet little self. I
have maintained her at just over 9 pounds with her sub-Qs, binders, Pepcid
AC and cyproheptadine. Her vet calls her our "miracle kitty". I
spend as much time with her as I can, and we have had a wonderful time
together the past five months, lots of time outdoors in our wonderful
mountain yard of meadows and rock formations. She has not been back to the
vet because it is extremely traumatic for her and her vet feels that
keeping her stress levels down is the best thing for her now. Her vet says
her heartbeat is off the charts when she is there being examined. (I have
checked her heartbeat at home resting quietly, and it is around 120-130
beats a minute.)
don't know how much time we have left, but I am treasuring every day and
just taking them one by one. She is such a high-strung little thing, but
so loving, that I think that just being with her is one of the best
medicines I can provide. She leaps up to greet me if I am gone for just a
few hours. She is my wonderful little companion and it is well worth all
the time caring for her and all the time staying home to have her still
with me. She is a Siamese tortie point with wonderful asymmetrical
markings, a little white stripe right down her nose. She never tires of
hearing me tell her how beautiful and smart and perfect she is (except for
those darn kidneys!).
is still stable. He was diagnosed with borderline hyper-T in September and
is now on a low dose of tapazole (thyroid medication). He was stable at about 14.5 pounds for a
long time, has dropped to 13.5 pounds, but is not skinny at that weight.
We are monitoring him frequently now due to hyper-T to avoid overshooting
the T4. He's a charmer, at the vet's office the techs call him
"Merlin the Magnificent". He is a gorgeous blue-point Siamese,
much more mellow than his sister. He's such a little man about taking his
medications, I pop in his gelcap with the tapazole and he swallows it
right away and then takes his baby food chaser graciously. His current
(November 2002) bloodwork values are:
3.2 (283), BUN 29.9 (urea 10.7), phosphorus 4.09 (1.32), potassium 4.91, calcium
11.4 (2.85), HCT 44.1. T4
was 4.1 (53.3), now 2.3 (29.9) after 30 days of tapazole.
Update: Merlin died on 22 July 2007. Here is
Jenney's updated story of Merlin's success in dealing with CRF and his
passing. Skip this if you feel it would upset you too much.
Merlin remained stable and didn't really need any
treatment other than his Tapazole and sub-Q's until February, 2007. His
creatinine remained steady in the mid 3's, and his phosphorus stayed in
the low to mid 4's. He was the picture of health, a robust, big,
beautiful, playful cat with glossy fur and bright, luminous eyes. Although
he weighed over 14 pounds, he was never fat, he was long, sleek, and
muscular. He was a boy who loved his life and enjoyed all his daily
rituals with gusto. He was a big, silky bundle of love lying on my pillow
next to me every morning, with my ear pressed up against him so that his
big, rumbling purr filled my head. We both would lay there in a perfect
bubble of happiness.
In February 2007, he suddenly had a spell of
vomiting that was a lot worse than usual and he got very lethargic. I
whisked him to the vet and they discovered that his numbers were off the
charts. This was a huge shock, my robust boy, my force of nature. His
sister was the fragile one, the one that had crashed back in 2002, the one
we worried about. My boy was invincible!
We put him in the hospital on IV, where he stayed
for 3 days. The first day when I visited him he still seemed pretty
subdued, but he did lick some baby food off my fingers. The second day, he
had noticeably perked up, enjoyed being brushed, and meowed in protest
when I had to leave. When they re-checked his numbers the third day, his
creatinine was back down to 4.9, and all his other numbers were down too.
So we took him home. He was a little subdued for the first couple of weeks
but then he bounced back and it was like nothing had ever happened. We
played, he ate well and maintained his weight, he was his wonderful self.
In June, a re-check of his numbers revealed they were all back to the
levels he had before the crash, creatinine in the mid 3's, phosphorus
good, no anemia. We had a wonderful five months and I soaked in his
wonderful presence every day, rejoiced in every morning snuggle and head
butt, every walk we took together in the yard with him brushing up against
me and looking up at me happily, every cheek pat I got from his large,
beautiful paw as he sat beside my keyboard studying me intently as I
worked, my magnificent little lion.
On Monday, July 16, I once again awoke to his
vomiting more than usual and he was subdued. It appeared very similar to
what had happened in February, and just as sudden and unexpected
considering how well he had been doing. He went back into the hospital on
IV. This time, however, everything was different. He seemed worse every
day instead of better like the first time. A re-check of his numbers
showed they were still off the charts, and his potassium had shot up, and
he was no longer able to urinate. I knew how grave these two things were,
and I had to face the fact that my boy was dying.
We took him home on Friday to spend his last few
days with us. Although he was clearly not feeling well, I could tell he
was comforted to be home and Friday night was good for us, he laid on his
beloved deck that evening with me, my husband and his sister Circe, in a
comfortable position in his favorite spot, which he walked over to all by
himself. We looked into his eyes and we both got the very strong feeling
that he wasn't quite ready yet. He loved his life so much and he just
wasn't quite ready to give it up. It's true his eyes were somewhat dull,
not their usual amazing luminous depth, but he did make eye contact with
us and we saw our boy there, confused and sad, but wanting so badly to
stay with us.
By Saturday he was clearly continuing to decline,
and I called his vet Saturday morning and made an appointment for an
in-home euthanasia on Monday. He was very weak and could only walk a few
steps at a time, and could not eat, drink, or urinate. Saturday night was
very hard, he started to seem as though he could not lay comfortably any
more. By Sunday morning he was having trouble keeping his tongue in. He
tried to stagger towards his water but was unable to drink. We wet his
lips and tongue with water and this seemed to help. Then so quickly, just
in a couple of hours, he was unable to walk at all, and I noticed his
breathing getting a little labored. Suddenly and unmistakably, his eyes
changed, and I knew, my heart shattering into a million pieces, that the
moment had come. He let out a meow, and he was telling us, Mom and Dad, I
can't do this anymore, please help me.
My husband called the emergency clinic and they were
very kind, they agreed to be waiting as soon as we got there. It was a
quick drive and they whisked him instantly into an exam room. He still had
his IV catheter in, so the vet administered a powerful anesthetic into the
catheter and told us it would only be 10-15 seconds. He died with me
stroking his sweet head and whispering in his ears the last words he ever
heard, the ones he heard every day of his life, "I love you, Merlin, I
love you, Merlin", over and over like a mantra, until I felt the soft
whisper of his beautiful soul taking flight. I felt that moment so
strongly, I suddenly looked up at the vet and said, "he's gone", and with
her stethoscope she confirmed this. It was very quick and gentle. I will
miss my special, wonderful, brave, gentle boy every day of my life. The
thing that keeps coming into my head is, "he loved his life". And he truly
did. What an honor it was for me to share it with him.
Circe died on 17 January 2014 just a few weeks before her 21st birthday,
having lived with CKD for almost thirteen years.
was born in our closet to a stray we had adopted 8 weeks earlier; we kept
all 4 kittens. But Mittens was special, always a sweet baby even though he
grew to 22 pounds. Mittens is now 16; his brother, sisters, and Mom have
Mittens was diagnosed with early CRF in September 2001. We lost his
to CRF in February 2000 and I was an active member of the feline
CRF support group, so I knew about feline CRF. We found a vet who could do
blood pressure readings since I knew that CRF cats were prone to
hypertension; Mittens' was 240, so we started him on Norvasc. His blood
pressure dropped to 160 with a week. Then his teeth were cleaned while his
CRF was mild.
My regular vet heard a small heart murmur with a high heart rate, so off
to the cardiologist. Mittens had mild hypertrophic cardiomyopathy (HCM) so
he was put on medication for that; his follow-up visit to the cardiologist
showed improved heart function, a heart rate within normal ranges, and a
blood pressure of 125. His visit to the cardiologist in December
2002 month showed even more improved heart function, a normal heart rate
and a blood pressure of 122.
By January 2002, Mittens was getting fussy about his food - he wouldn't
touch the healthy stuff, and was not too enthusiastic about eating
anything. I remembered the agonies of getting Snowball to eat,
and I decided we weren't going that route. So I pureed his
food and started syringe feeding him. He didn't like this at first, but
within a week the feedings became routine. His weight stays constant at 22
I am very aware of the dangers of high phosphorus levels in a CRF kitty,
so Mittens' diet is low in phosphorus, and phosphorus binders are blended
into his food. He also takes potassium supplements to ensure that his
potassium does not get low. When his HCT dropped to 31, I started iron
supplements; 2 weeks later his HCT was 38.
At the time of writing, it is over 16 months since Mittens was diagnosed.
At diagnosis his creatinine was 3.5 (309) and now it is high normal at 2.4
BUN is stable at a slightly elevated 38 (urea 13.6), his phosphorus is low normal, and
his potassium is in the mid 4s where it should be. Mittens is not yet on
fluids. His teeth are clean, his blood pressure is normal, and his heart
function has improved. All in all, he is probably healthier than he was
before his CRF was diagnosed.
Update: Mittens died on 7 April 2005, aged 18.5. He
had CRF and heart problems for over 3.5 years.
was a registered Oriental Shorthair cat, bred and owned by me. He was born
in 1992, and was used once as a stud when he was just over 3 years old.
6 weeks after he had bred this out-of-state queen, I took him to the vet
because he was looking scruffy and unkempt and generally "ADR"
("ain't doin' right"). An ascending kidney infection was
diagnosed, bloodwork was done which confirmed this, antibiotics were
prescribed, prescription food (Hills KD) purchased. A blood recheck in
January 1996 confirmed the CRF diagnosis - BUN 75 (urea 26.8), creatinine
2.4 (212) - but his weight was good,
appearance much better; in fact JR was looking the picture of health.
the time of initial diagnosis in December 1995 until the fall of 2001, JR
did really well: his numbers were stable (creatinine in the 2s or 3s (200s or
300s), gradually rising to the 4s (400s), with his BUN between 45 and 90 (urea between 16
and 32). His appetite was wonderful, he looked and acted really healthy and clearly felt fine. I had bloodwork
done about every 6 months from time of diagnosis until the end; I also
used Winstrol (anabolic steroid) to keep that borderline anemia at bay -
his HCT (measurement of anaemia) remained steady at about 29% all those
the fall of 2001 the decline began in earnest. His values in October 2001
were BUN 84.7 (urea 30), creatinine 5.37 (475), and by November
2001, these had risen to BUN 108 (urea 38), creatinine 5.9 (521). Fluids were started, 100
mls a day. Gums remained nice and slick at this rate. I was feeding a
homemade diet along with prescription dry food. Hills had changed the k/d
formula towards the end of the 1990s, and JR HATED the new formulated dry
food, so we had switched to Select Care Modified Feline Renal formula - he
adored this food.
decline was pretty rapid. By early January of 2002, I knew the end was
very near. We had planned a weekend trip north for an overnight, so we
took him with us - Friday night in the hotel he was happy and ate well,
slept with us, generally had a wonderful time. Saturday he suddenly
stopped eating, began drooling, and displayed the meatloaf position of
discomfort. His mouth had grown ulcers almost overnight, and by Sunday it
appeared that the whole mouth had ulcerated and was sloughing away. Had I
been somewhere where I knew a compassionate veterinarian I would have
taken him to be put to sleep that very day. As it was, I didn't, so I
waited until we got home, called my vet first thing Monday morning, and
made arrangements to bring him right in to be put to sleep.
then, as miserable as his mouth must have made him feel, he resisted the
final shot - his heart didn't stop for several minutes - my vet and I just
looked at each other, commenting that even now he was wanting to fight for
his life. His heart finally stopped, necropsy was done, NO kidneys left!!!!
should backtrack here and add that in probably 1997 or so, in the spring,
I had the opportunity to have his kidneys ultrasounded - at that time,
they were already about 90% scarred.
day with this cat was a blessing - some do live long even after major
crashes!! Who knows who may be the next JR!!! He would want to be honored
as a kitty who loved life and wishes to serve as a positive example to
other kitties, and especially the young ones, for whom some might consider
this diagnosis a kiss of death.
cat Pebbles was diagnosed with CRF at the age of fourteen years in 1997,
when she had a blood test because she had cystitis. Pebbles' CRF was mild
at diagnosis (urea (BUN) and creatinine were approximately 50% above
normal) and her kidney levels of urea (BUN) and creatinine never really
changed in the four years since diagnosis until she died in 2001 at the
age of eighteen years; they remained at between 40 and 90 for BUN (between
16 and 29 for urea) and at between 2.0 and 3.0 (between 234 and 300) for creatinine,
with phosphorus at around 4.0 (1.87) and PCV in the 30s.
developed cancer at the end of her life, and her death was caused by
cancer. Her CRF was not the cause of her death. If Pebbles had never had
blood tests, I would never have known she had CRF, as her CRF never caused
her any serious or very visible symptoms apart from an increase in water
consumption and occasional vomiting. Pebbles also had hyperthyroidism, so
the symptoms of increased drinking and occasional vomiting were possibly
caused by the hyperthyroidism, as when we treated her hyperthyroidism with
medication, the symptoms of increased drinking and vomiting eased. Pebbles
never needed any treatment for her CRF, no phosphorus binders as her
phosphorus was normal, no sub-Q fluids, and she was never anemic. The vet
did prescribe a renal diet and I fed this to Pebbles for two years.
Eventually she became a bit bored with the renal diet, so I let her eat
whatever she liked, particularly as her phosphorus levels were good. I did
give a B vitamin daily to Pebbles, and I consulted a homeopathic vet who
prescribed homeopathic medication for Pebbles' bladder and kidneys, but
other than that, no other treatments were used or needed.
quality of life was good despite having CRF. I remember when Pebbles was
first diagnosed I worried so much about her, but as each year passed and
there were few changes in the blood test results, and as Pebbles was doing
well, I relaxed a bit more. I wanted to share Pebbles' story because I
want to give hope to others whose cats have been diagnosed with CRF. CRF
is not always a death sentence. In my Pebbles' case and in the cases of
other cats I have heard about, it is simply a condition that the cat lives
well with. Pebbles' CRF was essentially just numbers on a blood test
result. She ate well and enjoyed life, despite having CRF. I wish I had
known that cats can live long and happy lives with CRF when my Pebbles was
diagnosed in 1997. Our vet did say some cats live for years with CRF, but
others didn't and there wasn't really any way to predict this. It's
possible that Pebbles' hyperthyroidism kept her kidneys functioning, as
hyperthyroidism can create more blood flow through the kidneys and keep
them functioning, but even when we treated Pebbles' thyroid with
medication, her kidney levels of urea (BUN) and creatinine still remained
wish all who read this all the very best and may you and your kitty be
blessed with many happy and healthy years together, despite CRF, as
Pebbles and we were.
Lynn and Hope
came to me with her brother at just two weeks old. She was a foster
through the animal shelter, and was at death's door when I received her,
hence the name Hope. She didn't grow as quickly as her brother did, and
her growth was clearly stunted. I had many tests run on her, but a
diagnosis was never given. Due to the fact that she was so small and
sickly, the animal shelter didn't want to take her back when she was
weaned, since she wasn't adoptable with her health issues; and would be
euthanized, so I agreed to adopt her.
we went to get her spayed at six months of age, the vet ran the pre-op
bloodwork, and this is when the CRF diagnosis came. I will never forget
that day, and the phone call. The prognosis was unsure, as this was such
a rare case. Her fasting BUN was 48 (16-33) and creatinine was 2.18
(0.6-1.6). I was devastated, this was my baby, only six months old! Why
was this happening? I had so many questions.
picked Hope up from the vet that evening, with a bag full of supplies,
lactated ringers, needles, and I.V. sets, and scared to death as to how I
was going to make it through this disease with my baby. I immediately
looked for answers. I was so overwhelmed by all of the information I
found, but eventually understood that this wasn't the death sentence that
I thought it initially was, and that cats can live many months, or even
years with this disease. Hope has youth on her side. She has no other
health issues for her body to be weakened by, other than CRF.
We started subcutaneous
fluids, 50ml, every other day, and retested in a month. Hope's blood
levels had dropped to well within the normal levels, so we then went to
every third day. After remaining at normal levels for six months,
(an average of BUN 24 (urea: 8.56) on a range of 16-36 (urea: 5.71 -
12.85), and creatinine 1.5 (international: 133) on a range of 0.8-2.4
(international: 71 - 212) my vet had me stop fluids altogether. Hope's
levels have remained stable now for some years after stopping fluids.
She was diagnosed on October 4, 2001, and her last blood test in August
2008 showed her BUN at 30 (urea: 10.71) on a range of 16-36 (urea:
5.71-12.85) and creatinine at 2.2 (international 194) on a range of
0.6-2.4 (international: 53-212). I am still not administering subcutaneous
fluids, although I am giving phosphorus binders, as her phosphorus levels
have been elevated in the past.
As at 2013, we
have been living with CRF for twelve years, and Hope is a "normal"
twelve year old
baby, very full of life and vigour. Hope is truly an inspiration to me,
and to everyone that she comes in contact with. I never knew when I gave
her the name of "Hope" that fateful night that it would be so fitting to
Update: Hope died of cancer on 31 March 2014 just four
days before her 13th birthday.
August 1998 our son brought us a present, a tiny ball of orange fluff we
named Killian. She had a bit of a rough start, a scratch near her left
pupil that required antibiotic cream. A week or two later she started
limping, a bacterial infection was attacking her joints and antibiotics
were started – later we found out the infection could have killed her. One
of her nine lives used up at such an early age. I will add here, Killian
loved water and she wanted it in the strangest places – out of a cup on
our bathroom sink, on our kitchen sink, a bowl in front of the
refrigerator, and an ice cube in it was a special treat.
In the Fall of 2002 we noticed
Killian was losing weight and took her in early for her yearly exam. The
vet called in the blood work results to us, I remember being on the phone
and hearing ‘kidney failure’, the tears started and I could barely talk to
the vet. I did hear the word ‘diuresis’ and the explanation [IV fluids], I
did hear ‘give her fluids at home’ and even though not knowing what that
meant I said we would do it!
Kill’s creatinine was 5.5
(international: 486) and BUN 73 (international: 26) and she was
down to 9 pounds when diagnosed at the age of 4 years and 4 months (I say
4½ years because it is easier). She had diuresis, then, after she had been
home a couple days, my husband and I took her back to the vet’s office to
learn how to give her sub-Q fluids. We were full of confidence and
optimism, oh my, were our heads in the clouds. Our plans for me to sit in
a chair holding Killian while Tom inserted the needle and having the 100ml
of fluid drip in without a hitch quickly went out the window, Killian had
different ideas. Killian did not cooperate at the other locations we came
up with, when I think now of what we put her through, being the novices we
were, I feel so guilty. The three of us made a number of trips back to the
vet so the tech could watch to see if we were doing it correctly, we were
doubting ourselves. Finally we decided to try the hall bathroom where
there was plenty of room on the counter for Killian to lie down on, it
worked, we had found the perfect location! Tom drilled a hole in the
soffit, placed a hook in it and hung the IV bag. Everything wasn’t perfect
but in time Killian came to accept the procedure, Tom inserting the needle
and me loving her. We did discover that Killian did not like the needle in
the scruff of her neck so we tried the scruff on her side near her hip and
have been doing it in that location ever since. We were told to give her
100ml 3-4 times a week, we decided every other day would be much easier to
In October 2003 Killian went in
for her yearly exam and all was well for a kidney cat, creatinine 2.34
(international: 207) and BUN 59.7 (international: 21) and 12
pounds. Shortly after that – and this period is very fuzzy because we
nearly lost her – she wasn’t well, a UTI was discovered and antibiotics
prescribed. Killian is extremely difficult to medicate but I was getting
most of the liquid antibiotic down her, then the vomiting started and the
antibiotic was changed but she started throwing that up too. Her
creatinine went up to 3.1 (international: 274) and she was dehydrated so
another diuresis was recommended. An ultrasound was done but all that was
found were her teeny misshaped kidneys. The morning of the day we were to
bring her back home she had a seizure; she has not had one since, thank
heaven. She was in a bad way and when we picked her up the vet told us to
take her home, stop the sub-Qs and we would know when the time came. We
were absolutely devastated! She was barely moving, she wasn’t eating much,
but we decided to keep the sub-Qs going because she didn’t really mind it
and in my head I was thinking she may feel worse if the toxins built up
and I just couldn’t have her feeling worse if she was going to die.
We prepared in our minds for her
death, the vet had said he and a vet tech would come to the house to put
her to sleep when the time came. We loved her and loved her. She began to
eat a little bit. She started coming around! Killian used up another one
of her remaining nine lives and pulled through! After we knew she would
make it, we promised her she would never go to the vet’s again unless we
noticed a problem or for her yearly exam. Before her second diuresis she
didn’t mind going to the office, but after that second diuresis she hated
the vet, the techs, the office, she had to have a towel over her cage to
keep her stress level down, and she wouldn’t eat there.
During the above crisis her
creatinine bounced between 3.1 and 1.68 (international: 274 and 149), BUN
between 50 and 27.8 (international: 17.85 and 10), her weight went down in
a month to 11 pounds from 12 pounds. Someone asked me what we were doing
giving Killian sub-Qs with her numbers that low – we were, and are, giving
her sub-Qs because she is in kidney failure and she will dehydrate at the
We have been very fortunate
because Killian’s other blood work comes back good. She is on no
medication at this time and we pray she never will have to go on
Benazepril (Fortekor) was offered but after researching it we decided
not to put her on it – two reasons: 1). how do they really know it extends
the life of a CRF kitty; and 2). we just didn’t want to rock the boat, she
is doing well so why tempt fate. Besides her eye and kidneys, her only
other known problem is megacolon.
Killian’s right eye is blind due
to a congenital defect, the retina not forming before birth. My belief is
her very small and misshaped kidneys are due to a congenital defect also.
At her last yearly check up on 3
October 2005 her creatinine was 2.6 (international: 230), just above the
upper normal level of 2.4 (international: 248), BUN 40 (international:
14.2) and weight 14.8 pounds. She was put on a diet of only ½ cup of k/d a
day, loves a dab of pumpkin mixed with water which helps her bowels, has ½
teaspoon of mineral oil mixed with ½ teaspoon of baby food meat three
times a week for her megacolon [note: giving mineral oil in this way can
be dangerous - see
Treatments - and should only be attempted with the full knowledge and
consent of your veterinarian], and sometimes she will eat baby food peas.
She is receiving 150ml of fluid eod, she has taken to going under our bed
if she sees my husband and me in the bedroom around 5pm on a sub-Qs day,
she actually knows the days she will receive fluid and the time! She is
very good during sub-Qs, she lies on her self-heating pad, sometimes she
will give a meow when the needle is inserted (or when my husband is
getting her scruff) and sometimes she doesn’t. She always gets a lot of
loving and petting and talking to during the sub-Qs and a treat of pumpkin
June 2006 we celebrated Killian’s
8th birthday, October 2006 we will celebrate Killian’s 4th
anniversary with CRF. We are very thankful to have this "bonus" time
with this very wonderful kitty we have nicknamed The Queen of Everything!
Update: Killian was put to sleep on 6 July 2010
after her numbers suddenly increased. She lived with CRF for 7 years, 8
lived to the age of 17 years and two months. And this despite the fact
that he was diagnosed with kidney disease when he was still a kitten. Our
vet first noticed it when we visited him to discuss Paris's constant
constipation problem. This was in January 1990, at which time Paris was
only six months old. The vet was surprised by how subdued Paris was,
considering that he was still a kitten. He ran bloodwork, which showed
that Paris had very high phosphorus levels. Paris was given aluminium
hydroxide phosphorus binders and he soon perked up.
From this point onwards, Paris's bloodwork was
checked every six months. In October 1992 the vet suggested that we switch
Paris to a prescription diet for CRF cats, but Paris did not like any of
them. I therefore began cooking homemade food for him morning and evening,
either rice or noodles mixed with chicken or liver. Paris did very well on
this diet until January 1994. He refused to eat and became very subdued.
Blood tests showed that his creatinine level was now 4.9, his BUN was 120,
and an ultrasound of the heart indicated heart problems too. The
ultrasound also showed that one of his kidneys was shrunken
whilst the other one was only working at 50% of capacity. This meant that Paris had
by now lost 75% of his kidney function. His only chance was a 14 day stay
at the vet's where he was given IV fluids for two weeks [note: this is
extremely aggressive treatment; most cats with creatinine at this level do
not need IV fluids].
When we asked about Paris's
chances, we were told that he would probably live for another couple of
months, possibly for as long as a year.
Paris was given an ACE inhibitor
called Vasotop in addition to his home-cooked diet. Our vet had had good
experiences with this medication in dogs, having found that it had
stopped the bloodwork from worsening. He wanted to try it for the first
time in a cat. We agreed, because we felt this was another chance to help
With the strict diet and the
Vasotop, Paris soon improved. By November 1995 his creatinine level, which
had fallen following the two weeks on IV, had risen once again, to 3.5.
Thereafter the vet gave him sub-Qs once a week, and his creatinine level
fell once again, to 2.4. We were so pleased that Paris was doing so well.
In December 1998 a further ultrasound of Paris's heart showed that a
diuretic would help to reduce the strain on his heart - he was prescribed
In January 2000 we discovered
that creatinine was over 4 and BUN over 100. Paris began to refuse to eat
his home cooked food, and our hearts sank. We tried a number of different
prescription diets and managed to find a dry food which Paris liked. We
also began to give him sub-Qs twice weekly at home - this was less
stressful for him than going to the vet. He continued to receive his
medications: Lasix and phosphorus binders in the mornings, and Vasotop,
potassium and calcium in the evenings.
Paris was a very tolerant patient
and took all the treatments in his stride. He knew that they helped him.
In autumn 2005 I could tell from his coat that he needed more sub-Qs, so I
increased the dose to 100ml twice a week. But Paris had his first crash
shortly before Christmas. He refused to eat and was very weak. The vet
said we should prepare ourselves for the worst, and should be grateful
that Paris had already managed so long with his poor bloodwork. But I did
not want to give up. We began to give sub-Qs daily, and also gave Paris
Reglan. In desperation I fed him ham. He also received treatment for
stomach acid. Gradually Paris began to eat again.
On 19 January 2006 we went to the
vet, who noticed that Paris was breathing heavily. The ultrasound showed
fluid on the left side of his heart. His Lasix dose was doubled, and Paris
was soon acting better. He could run upstairs again, and it was obvious
that he was far more comfortable.
During this period I found this
website and asked the vet for Zantac and for an appetite stimulant. I was
given both and Paris began to eat better. Admittedly he only wanted to eat
ham, chicken and dry food with liver sausage added, but at least he was
now eating voluntarily and was almost his old self. Thanks to this site I
could gauge how much fluid to give, and the
Symptoms and Treatments was particularly helpful. We constantly
adjusted the medications according to Paris's needs.
Paris really enjoyed spending his
summers on the patio, and it was our hope that he would get to enjoy one
more summer in this way. When the warmer weather arrived in June, Paris
became really excited. By 6 a.m. he would already be standing at the door
asking to go out. He lay outside for the entire day, and even explored
a part of the garden which he had never bothered with before. We were so
incredibly happy, and we got the impression that he was too. I spent every
possible moment with him.
In April I had discovered that he
did best when he was given his three Lasix tablets separately, every four
hours. Fortunately one of us was always at home so we could give him the
medications in this way. We did the same at night with his evening dose.
In mid-August we noticed some hind leg weakness, so we increased the
sub-Qs to about 50ml a day.
We won a few days reprieve, but
the next big crash came on 1 September. Paris cried out suddenly one night
and I found him lying stretched out on the floor, his legs felt cold and
he was virtually lifeless. I brought him into my bed and kept him warm.
After a couple of hours he improved, and sat up purring. Later that day he
had another seizure. He let out a dreadful cry and foamed at the mouth.
But by the evening he was jumping onto his favourite chair once again and
The next day Paris ran howling
and with his mouth open through the garden. Even after that he improved
once again, only this time he began to have difficulties eating. He wanted
to eat and approached his food bowl, but then turned away. The vet nurse
suggested baby food, which helped until the next crisis. He had spent the
entire day in the garden and came back inside as it became cooler. He jumped onto
his favourite chair but missed and fell badly. After that he got into his
basket. When I went to give him his medicine, he didn't move. He lay
quite relaxed in his basket but somehow I knew that something was not
right. I picked him up and tried to set him on the floor but he collapsed.
He could no longer walk, and his head hung to one side. I suspect he had
had a stroke. I lay him on his cushion and hoped that he would cross
peacefully. We had agreed that we would not choose euthanasia. I know many
might consider that to be torturing Paris, but what gives me the right to
decide when it is the right time for such actions, and who is to say that
Paris would agree with me. We had already had so many moments when the vet
had told us that we must accept the inevitable. If we had believed the vet
last Christmas, Paris would have missed nine wonderful happy months with
us, and we with him.
Paris lay from Saturday evening
until Monday evening in his basket, with one of us constantly by his side,
of course. He neither drank nor ate, but on Monday evening he suddenly got
up and went to his litter tray to pee. I was exhausted but so happy. We
began sub-Qs, medications and food once again. Fortunately the weather was
good so Paris spent his days lying in the garden. He enjoyed the baby
food, and whenever I snuggled up to him, he would purr as he did in his
One of us was constantly with
Paris. On the Friday morning I noticed that he was becoming weaker. During
the day he slept most of the time and was very weak. In the evenings he
would perk up and run through the house and rest in various places He even
began jumping up onto his favourite chair again. On the Saturday we took
him onto the patio, where we lay in the sun and snuggled and slept. In the
evenings we did the same. Towards 7 a.m. Paris became very weak and once
again he spent the entire day lying on his cushion on the patio with me.
He had a reasonably peaceful night, but then suddenly at 4.44 a.m. he
became restless and began to breathe heavily and with effort. He fought
his last fight for an hour, and died at 5.44 a.m. Paris was an
extraordinary cat, a fighter right to the end.
Mieke and Pimmy
Pimmy was a very active and playful cat during his
life, but in the spring of 2006 he seemed to change. He became slow, a bit
depressed it seemed and just didn't do much anymore. Since he was 17, we
explained this (wrongly) by old age.
Around February 2006 he started drinking a lot
occasionally, and was more and more withdrawn and passive. In April he was
in pain somehow and the vet put him on antibiotics. This led to heavy
diarrhoea, and he was really sick for a day or two. After this he had a
major constipation attack one evening and we rushed him to the vet. When
he came home the next day he stopped eating altogether.
After two days of not eating at all, the diagnosis
of CRF was made. Although his creatinine was not dreadful at 374 (US:
4.24), his urea level was 39 (BUN 109), and he was completely dehydrated
and needed IV fluids at the vet. We were told that unless he started
eating again, he'd die that week, or if we were lucky, he'd live for
another month or two. By using tricks like heating the food, offering it
from my hand etc, I managed to get him to eat after three days of IV
fluids. But CRF and everything concerning it was just very scary to me and
it took me a long time to read up and get informed before I felt it was a
disease we could somehow "handle".
The first months Pimmy didn't do very well. My vet
had told me he needed the kidney diet no matter what, but Pimmy refused
all the different brands I tried. He became less active and skinnier every
day. Then one night he woke us by coughing heavily. He had difficulty
breathing. Looking back, cats with heart problems hide their symptoms:
they just restrict their activities, and stop sleeping on their side etc.
But by this time Pimmy clearly was breathing much faster than normal.
Another vet visit and x-rays showed that he had a massive amount of fluids
in his lungs. While he was put in an oxygen cage, the vet decided to check
his kidney values, to see if treatment was still useful.
To my big relief his CRF values had improved
greatly. He still had CRF, but his numbers had come down considerably to
creatinine of 222 (US: 2.51) and urea of 21 (BUN: 59). Anyway, an echo was
made of his heart and my vet told me Pimmy
(HCM), a type of heart disease which is
quite common in cats. However, the echo only showed he had a leaking
valve. For the rest his heart seemed normal. Then a heart film was made
and it turned out he had a heart block. Basically the electric signals
from his heart chambers didn't get through anymore. Again I was told that
his life perspective was short. But my vet (who was fantastic with Pimmy)
told me: were going to try to give him as much quality of life as
possible. He was put on Vasotop (Ramipril) and Lasix for his heart.
Luckily after a few days the Lasix managed to get his respiration back to
normal and though he first got dehydrated from it, we managed to stabilize
him on a low dose of 10 mg per day.
The first weeks the CRF was his major problem. He
refused the kidney diet, he ate very badly and he would vomit almost daily
on an empty stomach. He was really very skinny by this point. Then one
night I decided enough was enough and I took him off the kidney diet.
Through Helen's website I looked up what food was best and what was needed
for him with his conditions (taurine and potassium since he also had weak
back legs) and I switched him to Hill's Science Diet Senior wet food. The
change in him was unbelievable. I've always thought there was something in
that food he had a shortage of, because after a few days I found him
running through our garden again. One evening there were lots of
butterflies and he was dancing through our garden, chasing them, which
brought tears to my eyes. He wasn't passive or depressed anymore and
enjoyed all the extra care.
From that moment on he did a lot better. His major
CRF-related problem was the vomiting, which we managed to control by
feeding him as often as possible, to avoid an empty stomach. During the
night I set the alarm once and fed him. Other then that he had major
constipation problems. He was a normal cat again, but he would have
terrible episodes of constipation, so bad he would even start bleeding. We
rushed him to the vet twice in the middle of the night but they couldn't
help him, he just needed rest to stop the bleeding. He was put on Isogel
for his constipation, and overall this worked well, but like once a month
or so he'd be constipated again.
Apart from this he had a great year and his CRF
remained stable. The major challenge was that for his CRF he needed extra
fluids but for his heart he needed to get rid of fluids. This was a tough
balancing act, which I solved by adding hot water to his food, which kept
him from dehydrating and also made his food tastier.
In February 2007 one of his medical problems got
more serious: since he had CRF he would have twitching/shocks in his
paws/head. It became more and more serious and a vet (not my own) wanted
to put him on anti-epilepsy drugs. After reading Helen's website for
possible causes I decided to try and add a little extra potassium to his
food and this worked miracles. The twitching disappeared completely. [note
from Helen: never supplement potassium without your vet's knowledge and
I didn't take Pimmy to the vet for regular blood
tests, because I tried to avoid stress for him as much as possible, and
the vet meant major stress. With his heart condition he just wanted his
quiet life with lots of routine, and his garden. He stopped eating Hill's
Science Plan and I switched him to regular senior food (Felix), but since
he didn't get phosphorous binders, I was very concerned about his CRF
Then in April 2007 I took him to the vet and to our
major surprise it turned out that his CRF values had not become worse at
all, but had stabilized, with creatinine of 243 (US: 2.74) and urea of 20
(BUN: 57). I'm not sure how this was possible. The ramipril
he got for his heart is an ACE inhibitor and the company that makes it
claims it has a positive influence on CRF, but I'm not a vet, so I'm not
sure if that's true. In the meantime, Pimmy did great. If you didn't know
it, you couldn't see he was ill, it was just that he needed a lot of extra
In August 2007 all of a sudden his respiration
started to go wrong again. It was fast, heavy and it seemed that the Lasix
that had worked so well for a year was no longer working anymore. My vet
looked into this and decided to put Pimmy on Digoxin on top of the
Lasix/Vasotop. Again, after a few days he reacted very well to this. Then
after a few days one night all of a sudden his front paw was paralyzed. I
immediately suspected a blood clot and we rushed him to the vet. But
luckily after three or so minutes he could use his paw again, though he
was in pain. No signs of a blood clot were found and looking back he
probably had one but it moved on. After three days of rest he could walk
But slowly he started to deteriorate. He was almost
19 now and besides the heart/ kidney troubles he also became completely
deaf. The deafness seemed to bother him more then CRF/heart disease, since
it made him insecure and scared. He would walk into a room and howl in a
loud voice and only stop after he saw you, and unfortunately he also did
this during the night. I didn't dare to leave him out of the bedroom
because with his condition he could get very sick all of a sudden and I
wanted to know that and be there for him. So all in all we had very little
sleep the last months. In November his respiration became too quick again
and he was given a shot of Lasix and needed more Lasix per day to keep his
respiration under control. My vet warned me that we were doing everything
possible to support his heart but that it would one day end.
His last weekend in December he was in a remarkably
good condition. He was active, wanted to go outside and walked around a
lot. Then completely by surprise, his front paw became paralyzed again.
We rushed him to the vet in the middle of the night
who diagnosed him with a blood clot. This time it didn't pass or become
better. His paw was cold and no heartbeat could be heard in it. The vet
suggested that we take him home and see if rest and medication would help.
He got two injections, one with painkillers. But in the two hours after
this, his condition deteriorated quickly. He was in pain in his back and
his back paws, and his breathing became more and more difficult.
I had put him in a secluded area because he wasn't
allowed to walk, but when I tried to see what was wrong with him, he could
not even walk two steps and was clearly also paralyzed in his back paw. He
could hardly breathe now and he looked at me and gave me the saddest meow
possible. Then I decided that enough was enough. I had always said that I
didn't want him to suffer, and he clearly was in a lot of pain/discomfort
now. We took him to the emergency vet again at 5 in the morning and there
he was put asleep. It all went so quickly that I'm sure he didn't suffer
So far this has been a story about Pimmy's medical
condition. Like any cat owner we always feel our cats are special, but
Pimmy was the most special cat I've ever had. We picked him up from an
animal shelter when he was three months old, and he was severely abused
before he came to the shelter. He was extremely shy of strange people for
his entire life, but never for us. He was very active and playful in our
garden, where he slept, hunted and climbed trees all day long. He was a
very sensitive, sweet cat who sensed your emotions and ran up to me
whenever I felt sad. He was the best friend you can wish for.
I was totally in shock in April 2006 when he was
diagnosed with CRF because it all seemed so scary and difficult to
understand. His initial crisis was bad, but once he managed to get through
that there is a lot you can do to manage the CRF with extra food at
regular times, heated food, adding water to his food against dehydration,
My vet told me that cats with a heart disease like
Pimmy had can only live for another year maximum, but Pimmy managed to
survive CRF and heart disease for a total of 21 months with a very good
quality of life. When he died he was 19 years old. I miss him terribly.
Cindy and Custard
Definitely one of the best days of my life was when
my grandfather picked this precious baby kitty out for me. He put this
little boy in my arms and said, "Here is your kitty, Cindy."
My fiancé, at that time, did a great job of naming
Custard. It all tied in very well considering Custard's coloring and that
my grandfather had a bakery business. Custard's birthday is June 28,
In October 1999, when Custard was 10, he needed a
dental cleaning. We did his first labs and that's when I got the CRF
diagnosis. His creatinine was 3.1, and BUN was 35. Custard weighed 11
pounds. We absolutely did the dental.
Diagnosis day was very crushing. I went to Barnes &
Noble bookstore to read up on CRF and had to leave the store because I
couldn't stop crying. It really seemed like this was very close to the
From the day of his diagnosis, Custard got tuna
water mixed in with spring or distilled water for the rest of his life. Of
course, I kept a close eye on his sodium levels.
I was very lucky Custard loved the KD dry and ended
up gaining about 4 pounds after his diagnosis. During his early CRF years,
Custard ate the KD dry along with NF can mixed with Friskies Senior Can.
In mid 2001, he had his first internist visit. I
pushed her for a estimate on how much good time my boy had left. She said
about 6 months. That was devastating to hear. Very thankfully, 6 months
turned out to be 6 years!
Custard's lab values remained pretty stable until
the summer of 2002. He had a creatinine spike of 7.1, with BUN at 41.
We started 150 mls of fluid every other day. Shortly after, we retested
and his creatinine had come down to 4.9 and BUN to 35.
He had a few slight creatinine spikes in 2003. By
the end of 2003, he was up to 150 mls daily. That kept his creatinine at
2004 was rough... A few more creatinine spikes and
the amount of fluid was up to 200 mls daily. Custard still maintained a
very good weight of 14.5 pounds. On 200 mls, Custard's creatinine was 4.8
and BUN 36. In mid 2004 he wasn't felling well and not eating well. He
was hypertensive and put on Norvasc. He recovered well and got up to 15
In the summer of 2004, Custard developed a kidney
infection and a UTI. He was in the hospital for a few days. He had lost
over a pound in a month that I didn't even notice. Not noticing that
weight loss hit me hard! After Custard recovered from this, I got a
digital baby scale and also starting keeping a daily log of how he was
doing. That way I could report trends to Dr. Heidi. Gosh, IMO, getting a
scale is absolutely vital.
Custard had another dental cleaning in late 2004,
which ended up being his last.
Somewhere I have to talk about grooming. That was
not fun. Hairballs were a problem. I used Zoom Groom everyday but he
wouldn't let me go near his stomach area. So, I had to get his stomach
shaved just to try to keep his vomiting down. Stomach shaving and nail
trims did become a part of his vet visits.
In very early 2005, Custard's GI tract could no
longer handle his KD dry. He was diagnosed with IBD. This was rough as he
really loved that dry food! I switched to Science Diet Senior dry which
worked out well for some time. At this point, Custard still had nice
weight on him, 14 pounds.
Custard's slight creatinine spikes were helped with
fluids. To keep his creatinine in the mid 4 range, I gave him 150 mls 2 x
daily. He got slightly less fluid if his GI problems were quiet. Custard
would remain on 300 mls LRS daily for the rest of his life. His heart
handled the fluids very well. There was some controversy about going to
300 mls daily. Three vets and one internist bought into this. The other
internist didn't recommend it. She did come around slowly as she was
seeing Custard was doing well. We did check his blood pressure
frequently, which was a concern of hers.
Early in 2005, he had two phosphorus increases in a
row of 5 and 5.4. I put him on aluminum hydroxide gel for six months to
get that value down. After the six months of being on the gel, his
phosphorus stayed below 5.
In May 2005, I gave Custard steak as a mother's day
treat. Oh man, big mistake!! That triggered an acute pancreatitis
attack. He spent a few days in the hospital and had another internist
That summer, Custard became more difficult about
getting his fluids. So, I did get an IV stand, which definitely saved
both of us from a lot of stress! I did his fluids anywhere from on the
bed, to the patio, under a blanket, in a closet... Most times, it
worked out fine the first attempt. Sometimes, Custard would show some of
his "Custardness" and just decide to walk away...lol. Yeah, patience is a
really good thing and definitely not my best quality.
Sadly, I had to move in 2005. My plan was to have
Custard spend the rest of his life where we were living. That just didn't
work out. Custard lost a pound the first month after the move.
As time went on, Custard's renal situation remained
very stable. I did labs approx every six weeks. His creatinine was
averaging about 3.5 and BUN about 40. His HCT, potassium, sodium, and
phosphorus were fine.
In the summer of 2006, I tried a pill pocket for his
meds. The good news was he loved it and the very bad news, he went into a
colitis attack. Ugh! He was in the hospital for 24 hours with this. I
switched to plain gel caps which are great.
As time went on, Custard slowly lost more weight and
was clearly developing more intense gastro-intestinal type problems. Since
this is about CRF, I won't get into the rest of his hard battle in detail.
Custard developed arthritis, iris atrophy, and most sadly, splenic mast
In 2007, he ate mostly Friskies Senior can and
boiled chicken breast. At times, Custard ate chicken baby food. Dry food
was out of the question. I did a lot of assist feedings in 2007, including
overnights. That did become extra stressful and exhausting as I was doing
it all by myself. Thinking back to that very hard time, I wish I had got
some help a few times a week from a vet tech. Custard would not have
liked that, though.
Looking back at the lab reports from early to mid
2007, his renal numbers still looked nice. His creatinine was around 3,
BUN 35. There were lab increases five days before he passed. Custard's
creatinine was up to 4.6, BUN was 55.
Custard survived the cancer for about 20 months with
prednisone and at times dexamethasone. He was on those meds for about his
last 15 months. I was very lucky his kidneys handled the steroids. Some
other meds he was on at times: Pepcid AC, Reglan, Zofran, Flagyl, Valium,
Benadryl, Cosequin, and B12 injections.
A great and committed vet is really a big key for
having the best life for as long as possible. Dr. Heidi was wonderful in
treating all of my boy's problems and also being with me every step of
this long journey.
People have said you will know when it's time. I
didn't think that could be possible, but it was. Custard's battle with
cancer finally did take its toll and that's what took my precious boy away
from me. September 16, 2007 at 11 pm, I made the decision I thought I
could never make. I ended my Custard's brave battle and now carry that
pain as my own. My precious Custard was 18.
I will never know how to put into words how very
proud I am of Custard and how he battled CRF (for eight years),
hypertension, IBD, pancreatitis, colitis, iris atrophy, arthritis, and
splenic mast cell cancer for 20 months. I truly hope my Custard's story
can encourage others that their little ones can have a good life for a
long time despite multiple problems.
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