Cats and kidney disease

Considering we have a household of feline misfits and castoffs, it’s a bit surprising that we’ve never had to deal with kidney disease.  I’m quite sure Pinto died of undiagnosed kidney problems, but he had so many other things going on from the time we bailed him out of animal control that the kidney issues lay buried until his last 24 hours of life.  We know so many people online who manage cats with kidney failure that it’s certainly an issue we’re familiar with, but this week was our first chance to get up close and personal with the problem.  Luckily, the diagnosis didn’t belong to one of our cats, but it was nevertheless stressful when it happened to a young friend.

The story started out in a way I like… young woman graduates from college, moves across country to a cute guy and a good job, and brings along her elderly cat companion.  I know far too many people who would try to dump their cat off on someone if they just moved to the other side of town, so I really respect this person for taking her responsibilities seriously.  Her cat, a boy named Madison, had been dealing with IBS but that seemed to be under control.  Then a few nights ago, he started to drag his back legs around, and stopped eating.  From the description it didn’t sound like a blood clot, but I definitely suggested in a phone call with the that the cat go to the vet the next day.  The diagnosis was rapid—one kidney was shriveled up and probably hadn’t worked for some time, and the other one was operating at about 20% capacity.  The vet ominously suggested euthanasia or dialysis, the latter being ridiculous because a) we don’t have an animal dialysis center in Las Vegas, and b) who can afford dialysis at $1500/week?!  I’m surprised he didn’t just recommend a kidney transplant.  Madison’s owner was justifiably shocked and upset, but I told her that I didn’t think her vet was giving her the complete picture, and I practically begged her to get a second opinion from our vet.  Even if the diagnosis/recommendations came back the same way, there would be no doubt about the decision to be made, and maybe lack of doubt could eventually contribute to peace of mind.

The people working at our vet clinic were incredible, and they treated Madison and his owner like VIPs.  Instead of declaring the situation hopeless, they checked the cat into the clinic for a couple of nights of IV fluids.  A recheck of his bloodwork showed normal values, and he was sent home with instructions on how to administer daily sub-q fluids.  Nothing else was changed—no dietary changes for now, no additional meds, just daily fluids.  As of last night (his first night home), Madison was eating a bit too well (he ate too much and then threw it up), and he was dealing with some residual constipation from being dehydrated before his diagnosis.  He’s scheduled for a recheck of his blood values next week, but in the interim, the vet techs and even one of the receptionists have offered to help with the sub-q fluids of there are any problems.  We’re certainly willing to run over and help, of course, but it’s nice to know that there’s professional help on standby.  Not only did the clinic let Madison’s owner have a payment plan (a plan which essentially said, “pay whatever you can, whenever you can, we trust you because of who referred you to us”), they zeroed out a number of charges on the bill and effectively gave about a 15-20% discount.  I desperately want to get out of Las Vegas for so many reasons, but the one really strong tie that binds me here is our vet and the clinic staff.  It’s incredible peace of mind to know that whatever goes wrong, they’re going to help first and worry about money issues later.  My favourite vet tech has also promised to marry me as soon as she gets rid of her husband, but that’s a story for another time.

The last few days I’ve been trying to cram about feline kidney disease so I can answer the occasional panicky phone call, but it’s a pretty overwhelming topic (I’m so glad I wasn’t a pet owner prior to the existence of the Internet).  Two sites which have been helpful are The Feline CRF Information Center and Tanya’s Feline CRF Information (her “Just Diagnosed?” page was perfect for this situation).  Kudos to YouTube for existing because it’s full of great instructional videos on how to administer fluids. (It’s also full of videos that people have taken of their cats dying… it’s one thing to take the video, but what compels someone to stick it up on YouTube?  Ick.)  Right now I’m hunting around for a local source of sodium chloride solution—I know it can be ordered online, but shipping costs mean it ultimately doesn’t offer much savings.  The Target pharmacy didn’t stock it, so I’m going to call a medical supply place and see if they carry it.  The vet clinic can supply it, but it’s cheaper to buy it elsewhere by the case (if it can be found elsewhere).

I know many of you have had cats in similar situations, so if you have any tips, advice, suggestions… please speak up, and I’ll pass them along!  From what I’ve read, 20% function isn’t as bad as it sounds, and a cat could conceivably live a couple more years if the disease doesn’t progress.  I’m happy to hear about anything and everything that worked for you.  I feel really good that I helped someone give her cat a ninth life.  I know I didn’t do anything but offer a recommendation (and some emotional hand-holding), but I’m glad I went with my gut instinct and suggested that second opinion.  Oh, I went to pick up the mail yesterday and the vet clinic had sent *us* a thank-you card and a gift certificate for referring a new client.  Totally unnecessary and totally appreciated.

Posted by Leigh-Ann on 03/27 at 02:45 PM

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  1. I had a cat, Butchie, who was the love of my life.  I got him in boston in 1972, and I was told when he was 6 and we were in Chicago that euthanasia was my best option when he developed continuous bladder stones.  I found another vet who mentioned a surgery that removed his penis and carved out a urethra that was larger and would pass more stones and that, coupled with regular vitamin c doses (the acidity of which broke down the crystaline formations before they became stones) took care of the problem; he didn’t have any issues again until he was 15 and we were in Seattle. 

    His vet, whom I thought I liked, said his kidneys were failing and that was common with older cats so euthanasia was my best option.  I found another vet who recommended the KD diet and regular fluid injections, and within a week he went from dragging and stumbling around to zooming about and launching himself 7 feet in the air to land on his favorite overlook spot in the house.

    Butchie lived for another 4 years - happily and in good health for a senior cat.  13 years beyond the first euthanasia recommendation. 

    One of the reasons I like my current vet is that he doesn’t just assume that we wnat to kill an animal who suddenly requires care. At the same time he understands the practicality of finances, and is able to outline options without judgement of the decisions we’d make.  He’s also humble; he knows he doesn’t know everything, even though he’s been practising successfully for a few decades, and he has a group of specialists with whom he consults to inform his treatment plans and expand his range without charge to us since it’s part of his continuing education. 

    There does come a time to say goodbye, but I back away from any vet who dismissively pronounces a diagnosis and goes straight to recommending euthanasia without a discussion of options.  Kidney disease does seem to be the most common affliction of cats who live well into their senior years; it can’t always be managed with fluids and diet, but my experience (shared with others who bear out Butchie’s experience) is that the initial presentation is the beginning of a next phase of life, and not its ending. 
    Sorry for writing a book; this stuff makes me nuts when vets just assume that we’ll opt for euthanasia without exploring options.  I can understand your reluctance to leave your clinic!

    Posted by Print  on  03/28  at  04:30 PM

  2. Thanks, Print… I knew you’d have something positive to add to the topic!  I knew of Ziggy’s kidney issues, but didn’t realize it was your second encounter with the condition.  The people who own the Wild Kitty cat food company were telling me that research is starting to show a link between cooked meat and kidney disease, i.e., cats on raw diets are much less likely to have kidney failure.  I can’t remember the exact details (it had something to do with excessive nitrogen), but kidney disease seems to be so common and it would be wonderful if dietary trend changes within the pet food industry could eventually prevent it.

    Our vet isn’t perfect… Pinto’s kidney failure was obvious in retrospect, but he was battling a terrible sinus infection at the time and it seemed logical to blame that for his lack of appetite.  However, like you said, it’s nice to trust that we’re dealing with people who are going to present us with all the options and not withhold information based on their own assumptions/biases.  I initially thought that Madison’s first vet figured a young pet owner might not be compliant regarding daily fluid administration, or might not be able to afford the costs, but that makes no sense when I remember that he mentioned dialysis.  I’m sure there are vets who didn’t get into the business because of their love of animals, and maybe this guy is one of them.

    Where did you buy your sodium chloride and supplies, btw?  I’ve given Madison’s owner the extra needles you sent me (thank you!), but she still needs to buy the lines and the bags of solution.  I could only find ONE place in town selling them, an “infusion pharmacy”, and they only sold kits: a 1L bag of sodium chloride, a line, and a needle, for $20!  Egads!  The vet clinic sells the stuff individually, but just the bag of fluid is $10.  I’ve found it online for as little as $5/bag, but once you add shipping costs the savings are minor.  I can’t figure out why the plastic tubing with its two little plastic clamps should cost almost $6, let alone why a bag of saline solution should cost $10!

    Posted by Leigh-Ann  on  03/28  at  07:29 PM

  3. My beloved male cat, Sassy, was 20 years old when he was diagnosed with serious kidney issues.  The symptoms came on fast, but since Sassy was such a scrapy old man, my wonderful vet didn’t throw in the towel.  A short hospitalization stablized Sassy and the vet taught me how to do sub-Q fluids every other day at home.  Sassy lived another high-quality 4 years—filling his super-senior days with eating trucker-size meals and keeping the neighborhood birds off his windowsill.

    Posted by Tina  on  03/31  at  09:40 AM

  4. Thanks for the great story, Tina!  Sassy obviously had great care from you, but wow, he must have had some super longevity genetics helping him out as well.  I’d be thrilled to have a cat reach 20+ years of age.  In my lifetime I’ve had cats die at ages 8 (cancer), 10 (cancer), and 13 (liver abscess), but that was before I paid attention to diet and nutrition issues.  I truly hope my current bunch, who’re being raised on raw diets and who are kept at proper weights, will come close to Sassy’s success.

    Posted by Leigh-Ann  on  04/01  at  01:27 AM

  5. Tina, Sassy is a wonder!  I’ve known cats who made it to 20, but 24 is amazing.  You must have shared an abiding love; what a special guy!

    Leigh Ann, we ended up getting a rate from the vet since we used so many bags.  They charged us $10/bag, and that included the tubing (new one with each bag) and needles.  Usually we’d tell them to forget the needles; the techs must have thought I was a total incompetent since they’d throw in 30 needles or so each time, so one group would last several bags.  I never thought to try them online.  But one day when we had a regional power outage and our vet wasn’t open, we went to the emergency vet down the hill and I think they charged us $25 for the setup.  Really outrageous, I thought.

    Posted by Print  on  04/04  at  12:41 AM
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