Help us set expectations for our cat with kidney failure
March 28, 2016 1:48 PM Subscribe
One of our cats was diagnosed with early stage IV renal failure about six weeks ago, and it's advanced very quickly. We're now weighing the decision to try to treat it further in the hopes of getting him some relief at the end of life, or to accept that this is the end. Details below.
We brought him into the vet in late February when we noticed that he had lost weight rather quickly, and the blood test came back that he was already on the low end of late-stage failure, with a creatinine of 4.6 and a BUN of 61, both of which we understand were about twice the safe range. The doctor put him on the special KD food, and gave him appetite stimulants and anti-nausea pills in an attempt to get him to eat. Results haven't been great, but he did eat for a while.
In the last week or so he really wasn't eating much of anything, so we tried normal food, tuna, just about anything. Today we brought him in to get the blood work re-checked and the vet said the news wasn't good -- creatinine up to 9.5, BUN up to 153. I asked what we could do and she said 3 days of fluids might help, but she thought that we might just be buying an extra month. It's "only" a couple hundred bucks, and I'd gladly pay that if I knew I could get him an extra month where he's not suffering, but it's hard to know whether we're doing the right thing.
Other than the lack of eating and general lethargy, there are no major signs that he's experiencing discomfort. He still wants to be petted fairly often, jumps up on the couch, etc. He had a bit of trouble walking last night but after fluids today at the vet he seems to be a little better. He's definitely slowed down over the last few months, and we don't want him to starve himself to death, but he's only 13, and I feel like if there's a reasonable chance that a few days of fluids could help him buy some extra time and make him comfortable, I'd do it in a heartbeat.
The problem is he'd be at the vet's office all day, we'd drop him off in the morning and pick him up at night. I was thinking it's worth it to try at least one day of that and see if it helps, but I don't want him to spend his last days stuck in a crate at the vet's office, either.
Has anyone had any experiences with treating advanced feline kidney failure that could give us some hope? I don't want false hope here -- just an idea of if it's reasonable to try to treat the disease at this stage. Also, is there some sign we can look for to know when to give up? I don't want to wait so long that he's in pain for a long time before it becomes apparent, and he can't tell us how he's feeling.
We brought him into the vet in late February when we noticed that he had lost weight rather quickly, and the blood test came back that he was already on the low end of late-stage failure, with a creatinine of 4.6 and a BUN of 61, both of which we understand were about twice the safe range. The doctor put him on the special KD food, and gave him appetite stimulants and anti-nausea pills in an attempt to get him to eat. Results haven't been great, but he did eat for a while.
In the last week or so he really wasn't eating much of anything, so we tried normal food, tuna, just about anything. Today we brought him in to get the blood work re-checked and the vet said the news wasn't good -- creatinine up to 9.5, BUN up to 153. I asked what we could do and she said 3 days of fluids might help, but she thought that we might just be buying an extra month. It's "only" a couple hundred bucks, and I'd gladly pay that if I knew I could get him an extra month where he's not suffering, but it's hard to know whether we're doing the right thing.
Other than the lack of eating and general lethargy, there are no major signs that he's experiencing discomfort. He still wants to be petted fairly often, jumps up on the couch, etc. He had a bit of trouble walking last night but after fluids today at the vet he seems to be a little better. He's definitely slowed down over the last few months, and we don't want him to starve himself to death, but he's only 13, and I feel like if there's a reasonable chance that a few days of fluids could help him buy some extra time and make him comfortable, I'd do it in a heartbeat.
The problem is he'd be at the vet's office all day, we'd drop him off in the morning and pick him up at night. I was thinking it's worth it to try at least one day of that and see if it helps, but I don't want him to spend his last days stuck in a crate at the vet's office, either.
Has anyone had any experiences with treating advanced feline kidney failure that could give us some hope? I don't want false hope here -- just an idea of if it's reasonable to try to treat the disease at this stage. Also, is there some sign we can look for to know when to give up? I don't want to wait so long that he's in pain for a long time before it becomes apparent, and he can't tell us how he's feeling.
I'm so sorry.
When my beloved older cat was going through the same thing, felinecrf.org was a massive help to me in understanding his treatments, what options existed, and what was going on. It's also a great resource in terms of others' experiences with cats with chronic kidney disease. One thing that was very clear to me was that there is a wide range of experiences, even in cats with the same numbers. There's a mantra they use on that site: treat the cat, not the numbers. If he's mostly pretty comfortable and seems to be enjoying his life, it's probably worth it to explore the treatment options. There are stories on the site about cats with worse numbers than his who lived happy lives for many years.
That said, it wasn't my experience. My buddy was pretty far gone when he was diagnosed--he'd been off for a while, but his numbers were good until they just weren't. I did the three days of IV fluids with him, and the vets let me come visit him, hold him, and sing him Bruce Springsteen songs while he was there. The fluid therapy did make him more comfortable until he was able to come home, where I administered subcutaneous fluids to him every other day. However, it was just too late for him. Within two weeks, I had to concede and call the vet to the house, but I'm so glad I got him comfortable and was able to make a few last happy memories with him before he went.
One final tip: Purina's Fortiflora supplement is magic in terms of appealing to cats with no appetite, and can be put on your cat's renal food. (Check with your vet first, of course, but it shouldn't be a problem.)
posted by lemonadeheretic at 2:20 PM on March 28, 2016 [5 favorites]
When my beloved older cat was going through the same thing, felinecrf.org was a massive help to me in understanding his treatments, what options existed, and what was going on. It's also a great resource in terms of others' experiences with cats with chronic kidney disease. One thing that was very clear to me was that there is a wide range of experiences, even in cats with the same numbers. There's a mantra they use on that site: treat the cat, not the numbers. If he's mostly pretty comfortable and seems to be enjoying his life, it's probably worth it to explore the treatment options. There are stories on the site about cats with worse numbers than his who lived happy lives for many years.
That said, it wasn't my experience. My buddy was pretty far gone when he was diagnosed--he'd been off for a while, but his numbers were good until they just weren't. I did the three days of IV fluids with him, and the vets let me come visit him, hold him, and sing him Bruce Springsteen songs while he was there. The fluid therapy did make him more comfortable until he was able to come home, where I administered subcutaneous fluids to him every other day. However, it was just too late for him. Within two weeks, I had to concede and call the vet to the house, but I'm so glad I got him comfortable and was able to make a few last happy memories with him before he went.
One final tip: Purina's Fortiflora supplement is magic in terms of appealing to cats with no appetite, and can be put on your cat's renal food. (Check with your vet first, of course, but it shouldn't be a problem.)
posted by lemonadeheretic at 2:20 PM on March 28, 2016 [5 favorites]
We've lost two cats this way. Not eating is a huge, huge indicator that it is time, for your kitty even if not for you. We tried pushing liquids on our last cat but it was a nightmare -- she absolutely hated the process, and I would have in her paws too.
The good thing about kidney disease seems to be the lethargy it brings, which I think is a cushion against pain. But I think your vet is gently letting you know what I would say more bluntly -- it is time now to let your cat go peacefully. I'd take your kitty in for the fatal shot or invite the vet to your home to do it if they are willing.
Internet hugs. This is a great way of being kind to your cat in a way we often cannot be toward our beloved people.
posted by bearwife at 2:22 PM on March 28, 2016 [1 favorite]
The good thing about kidney disease seems to be the lethargy it brings, which I think is a cushion against pain. But I think your vet is gently letting you know what I would say more bluntly -- it is time now to let your cat go peacefully. I'd take your kitty in for the fatal shot or invite the vet to your home to do it if they are willing.
Internet hugs. This is a great way of being kind to your cat in a way we often cannot be toward our beloved people.
posted by bearwife at 2:22 PM on March 28, 2016 [1 favorite]
I've been giving fluids to my cat with "advanced" kidney failure for more than a year -- we were told in May/June that he might not live out the year, so I was prepared to let him go. I'm pleasantly surprised that he's still here.
Have you tried baby food? That might get your kitty excited to eat again. Fancy Feast is also kitty crack, especially the gravy kind.
My cat gets fluids every other day and pees a hell of a lot, but he's alert and alive and mostly interested in his surroundings. The cost of the fluid and needles are worth it for me, but if you're not sure your kitty has the quality of life anymore, this Internet stranger says it's OK to let him go.
posted by vickyverky at 2:29 PM on March 28, 2016 [3 favorites]
Have you tried baby food? That might get your kitty excited to eat again. Fancy Feast is also kitty crack, especially the gravy kind.
My cat gets fluids every other day and pees a hell of a lot, but he's alert and alive and mostly interested in his surroundings. The cost of the fluid and needles are worth it for me, but if you're not sure your kitty has the quality of life anymore, this Internet stranger says it's OK to let him go.
posted by vickyverky at 2:29 PM on March 28, 2016 [3 favorites]
Our cat also stayed overnight at the vet's last year for extra fluids and attention, and it definitely seemed to perk him up. So if you can afford it, I'd do it.
posted by vickyverky at 2:30 PM on March 28, 2016
posted by vickyverky at 2:30 PM on March 28, 2016
I regret keeping my cat who had kidney failure alive as long as I did. I was pushing sub-q fluids, encouraging her to eat, etc.. When she stopped bathing herself, I knew she was ready. I regret she was in so much pain.
posted by heathrowga at 2:39 PM on March 28, 2016 [3 favorites]
posted by heathrowga at 2:39 PM on March 28, 2016 [3 favorites]
I'm so sorry about this.
Both of my late elder cats had to be on sub-q fluids, which I administered at home. Dizzy's kidneys failed very quickly and he never responded to the fluids at all, whereas Vicky remained alive for another year. In both cases, it was very obvious when it was time to make the call: he was clearly in pain on the final night (he urinated on the floor, which he had never done before, and was unable to get up the stairs or even onto the couch) and she stopped eating entirely. If your cat is still responsive and willing to eat a bit, it probably can't hurt to at least see what sub-q fluids might be able to do for him in terms of making him more comfortable. Is it possible for you to administer the fluids yourself after the first day or two?
posted by thomas j wise at 2:56 PM on March 28, 2016
Both of my late elder cats had to be on sub-q fluids, which I administered at home. Dizzy's kidneys failed very quickly and he never responded to the fluids at all, whereas Vicky remained alive for another year. In both cases, it was very obvious when it was time to make the call: he was clearly in pain on the final night (he urinated on the floor, which he had never done before, and was unable to get up the stairs or even onto the couch) and she stopped eating entirely. If your cat is still responsive and willing to eat a bit, it probably can't hurt to at least see what sub-q fluids might be able to do for him in terms of making him more comfortable. Is it possible for you to administer the fluids yourself after the first day or two?
posted by thomas j wise at 2:56 PM on March 28, 2016
Do/can either of you work from home? Fluids are not very difficult to administer (and the supplies are not terribly expensive), and this would give you an opportunity to observe him closely to watch for signs of suffering. My vet taught me how when my old boy was starting to fade, and it did help him a great deal and helped him feel good enough to eat a little. I was also able to coax mine into eating with feeding by hand. He was definitely humoring me but it helped him.
There is a good chance he will manage to let you know when it's time, but it's all right to make the decision.
posted by notquitemaryann at 3:05 PM on March 28, 2016 [1 favorite]
There is a good chance he will manage to let you know when it's time, but it's all right to make the decision.
posted by notquitemaryann at 3:05 PM on March 28, 2016 [1 favorite]
So sorry you and your kitty are going through this. We went through this as well, and though I don't remember the exact timeframe, subcutaneous fluids bought our cat something like a year past the point where the numbers were very high.
We couldn't do them at home. She was just too angry. However, our vet is close and the techs did this for us three times per week at a really affordable price. We were generally in and out in 20 minutes. Our kitty was nervous and generally on better behavior in the vet office. It became really clear when she was eventually ready to go.
Good luck and best wishes.
posted by cnc at 3:07 PM on March 28, 2016
We couldn't do them at home. She was just too angry. However, our vet is close and the techs did this for us three times per week at a really affordable price. We were generally in and out in 20 minutes. Our kitty was nervous and generally on better behavior in the vet office. It became really clear when she was eventually ready to go.
Good luck and best wishes.
posted by cnc at 3:07 PM on March 28, 2016
Extending companion animals' lives when faced with terminal illness is almost always something we do for us, to make the process of losing them a little easier for us to bear. We think we need to give them every chance, try every option, explore every possibility; anything else feels like a betrayal, like giving up too soon on a good friend.
But that's actually not the case. Those are human reactions to terminal illness that we anthropomorphize onto them. As far as we know, cats have no sense of their own lifespan, nor any idea of what they might be missing once they're gone. They don't lie awake worrying about what happens after death, nor do they have any existential fear of dying. They don't grieve for their missed opportunities or the things they won't be able to accomplish. Whether they die today or in a month or in a year, they will never know or understand the difference the way humans do.
Your cat doesn't know that he's "only 13." He has no conception of what another month of life means, and assigns no value to it. Those are things that you feel deeply, of course, and I'm so sorry that your kitty is ill.
My husband and I have had a series of senior kitties who've had different experiences at the end of their lives. One had no apparent issue with getting put into the carrier and going in the car to the vet--he never vocalized or panted or soiled himself in the carrier, and he just sort of sat there while the vet examined him. His heart rate wasn't elevated, and he never scratched or hissed or swatted. When we got home after a trip to the vet, he walked calmly out of his carrier and resumed his life as though nothing had happened. Because of this, we did a lot more to extend his lifespan than we did for the other two, who were abjectly terrified of the entire going-to-the-vet process and were visibly, obviously distressed each time.
So I think this depends a lot on how your cat responds to vet visits. If he's stressed and scared the whole time, I'm not sure it's fair to put him through three days of all-day vet time. If he's pretty chill at the vet, it might be worth a try. But as soon as he seems scared or stressed, it's time. You might not be ready, but he will be.
All the best to you and your kitty.
posted by jesourie at 3:45 PM on March 28, 2016 [10 favorites]
But that's actually not the case. Those are human reactions to terminal illness that we anthropomorphize onto them. As far as we know, cats have no sense of their own lifespan, nor any idea of what they might be missing once they're gone. They don't lie awake worrying about what happens after death, nor do they have any existential fear of dying. They don't grieve for their missed opportunities or the things they won't be able to accomplish. Whether they die today or in a month or in a year, they will never know or understand the difference the way humans do.
Your cat doesn't know that he's "only 13." He has no conception of what another month of life means, and assigns no value to it. Those are things that you feel deeply, of course, and I'm so sorry that your kitty is ill.
My husband and I have had a series of senior kitties who've had different experiences at the end of their lives. One had no apparent issue with getting put into the carrier and going in the car to the vet--he never vocalized or panted or soiled himself in the carrier, and he just sort of sat there while the vet examined him. His heart rate wasn't elevated, and he never scratched or hissed or swatted. When we got home after a trip to the vet, he walked calmly out of his carrier and resumed his life as though nothing had happened. Because of this, we did a lot more to extend his lifespan than we did for the other two, who were abjectly terrified of the entire going-to-the-vet process and were visibly, obviously distressed each time.
So I think this depends a lot on how your cat responds to vet visits. If he's stressed and scared the whole time, I'm not sure it's fair to put him through three days of all-day vet time. If he's pretty chill at the vet, it might be worth a try. But as soon as he seems scared or stressed, it's time. You might not be ready, but he will be.
All the best to you and your kitty.
posted by jesourie at 3:45 PM on March 28, 2016 [10 favorites]
I'd just add some things I think people tend to underestimate. Maybe I've read too many books about the Holocaust this past year and listened to too much survivor testimony, but one thing is now very clear to me, and that is that starving is very tough to endure, with or without an appetite. Also, cats must express themselves with body language and voice. When sapped by illness, it is hard for them to do more than show their desire for comfort. That your cat is lethargic and not eating and seeking to be petted makes me pretty concerned. If you can't get your cat eating, via fluid pushing or tempting items . . . . be kind and let go.
posted by bearwife at 3:59 PM on March 28, 2016 [1 favorite]
posted by bearwife at 3:59 PM on March 28, 2016 [1 favorite]
I'm very sorry.
Please give sub-q fluids at home a try. I have had three cats now who lived a number of (happy! eating!) years after kidney diagnosis. Fluids are not expensive, and not difficult to administer.
Be well, all of you.
posted by 2soxy4mypuppet at 6:21 PM on March 28, 2016
Please give sub-q fluids at home a try. I have had three cats now who lived a number of (happy! eating!) years after kidney diagnosis. Fluids are not expensive, and not difficult to administer.
Be well, all of you.
posted by 2soxy4mypuppet at 6:21 PM on March 28, 2016
I'm so very sorry this is happening to you and your cat.
Has anyone had any experiences with treating advanced feline kidney failure that could give us some hope?
Yes! We've had two cats with kidney failure. Our cats maybe weren't as late-stage when they were diagnosed: Loot was given a year to live. But pretty much always, by the time kidney failure is spotted, they've lost 90% of their function. In both cases, we gave the cats fluids daily at home. Our cats got used to it pretty easily.
When we eventually put them each to sleep, it was for unrelated reasons (cancer). Loot lived another 5 years. It doesn't sound like that's in the cards for your cat. But what it's worth, we found administering fluids at home made a HUGE difference in quality of life.
Also, is there some sign we can look for to know when to give up? I don't want to wait so long that he's in pain for a long time before it becomes apparent, and he can't tell us how he's feeling.
Does your cat play? When our vets evaluate our cats over the phone (for a follow-up, or to discuss a new problem), they usually treat playing as a sign that the problem is not that serious. So if your cat is playing, then I think you should not feel guilty about keeping him alive.
On the other hand, if your cat is playing, that doesn't mean you should feel guilty about euthanizing him. Better too soon than too late, I feel (we've done both). So yeah: I'm another internet stranger who says it's ok to let your cat go.
posted by feral_goldfish at 6:29 PM on March 28, 2016
Has anyone had any experiences with treating advanced feline kidney failure that could give us some hope?
Yes! We've had two cats with kidney failure. Our cats maybe weren't as late-stage when they were diagnosed: Loot was given a year to live. But pretty much always, by the time kidney failure is spotted, they've lost 90% of their function. In both cases, we gave the cats fluids daily at home. Our cats got used to it pretty easily.
When we eventually put them each to sleep, it was for unrelated reasons (cancer). Loot lived another 5 years. It doesn't sound like that's in the cards for your cat. But what it's worth, we found administering fluids at home made a HUGE difference in quality of life.
Also, is there some sign we can look for to know when to give up? I don't want to wait so long that he's in pain for a long time before it becomes apparent, and he can't tell us how he's feeling.
Does your cat play? When our vets evaluate our cats over the phone (for a follow-up, or to discuss a new problem), they usually treat playing as a sign that the problem is not that serious. So if your cat is playing, then I think you should not feel guilty about keeping him alive.
On the other hand, if your cat is playing, that doesn't mean you should feel guilty about euthanizing him. Better too soon than too late, I feel (we've done both). So yeah: I'm another internet stranger who says it's ok to let your cat go.
posted by feral_goldfish at 6:29 PM on March 28, 2016
Response by poster: Our cat ate a little bit of tuna last night and seemed to improve a bit from the fluids administered at the vet's office yesterday, so we decided to bring him in for the first day of fluids this morning. How he responds today will determine whether we decide to continue for the rest of the treatment.
I agree with those who've said that it's important to not get so attached that we neglect to do the right thing when he's suffering, and we both decided that if he's not eating at least a little each day, we're going to take that as a sign that it's time to let go. We just didn't want to make a snap decision within the first 24 hours to put him down based on the results of one blood test.
In terms of doing fluids from home, my wife does in fact work from home, and the vet techs showed us how to do the injections yesterday, but our feeling was that for a couple hundred bucks, it's worth it to have him there at the vet's office with the techs around to keep tabs on how he's responding. They've always been great with our pets, and we trust them to give us an honest assessment and let us know if it's worth continuing. If the treatment shows promise, we'll definitely do injections at home for as long as it's helping him.
Thanks so much to all of you for sharing your advice and similar experiences.
posted by tonycpsu at 5:46 AM on March 29, 2016 [1 favorite]
I agree with those who've said that it's important to not get so attached that we neglect to do the right thing when he's suffering, and we both decided that if he's not eating at least a little each day, we're going to take that as a sign that it's time to let go. We just didn't want to make a snap decision within the first 24 hours to put him down based on the results of one blood test.
In terms of doing fluids from home, my wife does in fact work from home, and the vet techs showed us how to do the injections yesterday, but our feeling was that for a couple hundred bucks, it's worth it to have him there at the vet's office with the techs around to keep tabs on how he's responding. They've always been great with our pets, and we trust them to give us an honest assessment and let us know if it's worth continuing. If the treatment shows promise, we'll definitely do injections at home for as long as it's helping him.
Thanks so much to all of you for sharing your advice and similar experiences.
posted by tonycpsu at 5:46 AM on March 29, 2016 [1 favorite]
For what its worth, IV fluids over the course of a weekend absolutely saved my cat.
For kidney cats keeping their fluid levels up seems to have a big impact on their well-being and appetite. We bought our little fur-ball a water fountain to encourage him to drink more on his own, gave him subQ fluids twice a week, and appetite stimulant medication as needed (once or twice a week) to keep him eating the "proper" amount. Giving him subQ fluids was challenging at first, but he adjusted quickly and minded the needle less than the taste of his medication. We kept him going for 2 1/2 years with this routine, living a happy active life.
Wishing you and your cat the best of luck.
posted by Secret Sparrow at 10:40 AM on March 29, 2016
For kidney cats keeping their fluid levels up seems to have a big impact on their well-being and appetite. We bought our little fur-ball a water fountain to encourage him to drink more on his own, gave him subQ fluids twice a week, and appetite stimulant medication as needed (once or twice a week) to keep him eating the "proper" amount. Giving him subQ fluids was challenging at first, but he adjusted quickly and minded the needle less than the taste of his medication. We kept him going for 2 1/2 years with this routine, living a happy active life.
Wishing you and your cat the best of luck.
posted by Secret Sparrow at 10:40 AM on March 29, 2016
In my experience when my old cat was dying, sub-Q fluids at home are totally worth it and should be nearly painless for your cat if you do it right whereas assisted/force-feeding is a horrible experience for all involved.
You can encourage the cat to eat on its own by liquifying tuna and pouring the juice over his food as well as heating up the food a little to make it extra stinky. Cats' appetites are driven primarily by their sense of smell, which begins to decline as they age, so upping the stink factor can revive their appetites.
posted by Jacqueline at 3:20 AM on March 30, 2016 [1 favorite]
You can encourage the cat to eat on its own by liquifying tuna and pouring the juice over his food as well as heating up the food a little to make it extra stinky. Cats' appetites are driven primarily by their sense of smell, which begins to decline as they age, so upping the stink factor can revive their appetites.
posted by Jacqueline at 3:20 AM on March 30, 2016 [1 favorite]
This thread is closed to new comments.
Talk to your vet. Most vets I know don't want your companion animal suffering any more than you do. It's so hard to say goodbye, but better to do it when your kitty can feel up to accepting the love you feel and is on one of his better days.
Talk about palliative care, see what makes sense for you, your kitty and your family.
posted by Ruthless Bunny at 1:52 PM on March 28, 2016 [2 favorites]