How long did symptoms -> diagnosis -> treatment take for your cat?
May 12, 2020 8:37 PM Subscribe
My 14-y.o. Maine Coon Cat is not feeling well. Details below the fold (warning: minor cat poop and pee details), but briefly: a UTI and elevated kidney markers. He has (and takes medication for) hyperthyroid, and chronic kidney disease is not unexpected for a male cat of his age and breed, though his most recent blood work in February was fine. He's been to the vet, has started antibiotics, and I know what and when the immediate next step is (collect urine sample early/mid next week and bring it back to the vet for analysis). I've read all the old asks about cats with kidney issues, have poked around on the Tanya's Comprehensive Guide to Feline Chronic Kidney Disease page recommended in several asks, and have googled info on UTIs in cats. I'm looking for reassurance from other cat people of metafilter and/or your own experiences specifically around the timeline of his diagnosis and treatment.
(Older obligatory cat photo is in my profile. Recent photo of his regal fluffiness can be viewed by request.)
Week 1: Three weeks ago (April 20), I noticed my cat's appetite had diminished - he was eating less than half his usual amount, missed his daily poop, and refused his favorite treats. In retrospect, he was displaying signs of nausea (enthusiasm for all of the routines around eating until he had the food in front of his nose, then turning away as if it smelled bad). He got slightly better mid-week (eating closer to normal amounts, and taking his thyroid medicine and treats), but then returned to minimal eating, refusing treats, and more pronounced nausea symptoms that Friday and over the weekend.
Week 2: Brought him in to the vet on Monday, April 27 for a basic check-up, and his weight was down but otherwise all looked well (temperature, teeth, nothing untoward that the vet could feel with external palpitation). He had been in for his six-month blood work (monitoring his thyroid levels as well as kidney and blood pressure) in mid/late February and was fine then, and we had brought a new cat home (kept in a separate room so far) on Friday, so we started with the least invasive option of maybe it was stress-related, and gave him a dose of Mirtazapine (appetite stimulant) and four days of Cerenia (anti-nausea). He started eating regularly again, but also started drinking and peeing excessively. I called back on Wednesday as instructed, but miscommunication with the front desk staff meant that the update wasn't communicated to the vet techs or the vet. So he didn't go back in again until Friday, when the meds wore off and his nausea returned and appetite went down again (and excessive drinking and peeing continued, though slightly less than when he was on the appetite stimulant and eating more). He got a full blood panel then, and they kept him for the afternoon to try to get a urine sample, but he was not up for peeing at the vet's office, so they instructed me to collect his urine at home and bring it in first thing the following Monday (vet is closed over the weekend due to reduced hours due to the pandemic). Blood work showed just above normal levels of the two markers that they check for kidney function. Cat continued with minimal eating, extra drinking/peeing, signs of nausea, and only pooping small, hard poops with lots of hair every other or third day over the weekend.
Week 3: Brought the urine sample in first thing Monday morning on May 4, and the test showed signs of urinary tract infection. Density was normal, but on the low end, and my collection method (leaving a tray in his litter box overnight, since he likes to pee before I get up in the morning) may have led to some concentration of the urine, so the true value may have been below normal range. This time the vet sent me home just with another four days of Cerenia, in hopes that would be sufficient to get him eating again (he was still drinking and peeing more than normal once the Mirtazapine wore off, but not quite as much), so that he'd be eating regularly enough to begin oral antibiotics. It wasn't. So he went back in last Thursday and got another dose of Mirtazapine at the vet as well as subcutaneous fluids. He started eating well again right away that evening, so I was able to start the antibiotics (Clavaseptin) on Friday, and he had a regular poop again Sunday evening.
This week so far: Thursday's Mirtazapine wore off on Sunday night/Monday (yesterday, May 11), and he had run out of the Cerenia anti-nausea meds and the end of last week, so he was not taking his pill pockets willingly last night or this morning, and was eating less again today, despite giving him another dose of Mirtazapine last night. So I also picked up some more Cerenia from the vet today and gave him the first one about an hour before his dinner tonight. He ate this evening's pill pockets ... of his own volition rather than me having to pop them down the back of his throat, but not eagerly; and he's been a little more lethargic again today. He also feels to me like his temperature may be elevated? But I don't have a cat thermometer, and am likely prone to exaggerated worry at this point. Good poop Monday night, but none today.
Looking ahead: he's on a 14-day course of antibiotics (this is the end of day 5), and he'll have his urine tested again next Tuesday. My understanding from the vet was that next week's urinalysis would tell if we needed to extend the course of antibiotics or not, and also if this is marking the start of chronic kidney disease (which would not be unexpected for a 14 year old male Maine Coon Cat who was diagnosed with hyperthyroid a year and a half or two years ago), or if the kidney concerns clear up as the infection clears up. I've been reading up on symptoms and treatment for chronic kidney disease. The vet seems to think that I've been a very attentive cat owner (upside of staying at home all day every day due to the pandemic, I guess?) and that we've caught it at the very beginning. But, you know, [gestures around at world] + beloved cat who has been by my side for 14 years = anxiety. My coping method is making sure I'm as well informed about everything as possible, but there's a timeline detail I haven't been able to find any information about:
For those of you who have had cats that have developed chronic kidney disease in their senior years, how long was it between when your cat first started showing symptoms, through diagnosis and any potential complications (like this uti), to when you got treatment (special diet or whatever) sorted out and started? Is my cat's experience within the normal range, including normal range of potential hiccups?
(Older obligatory cat photo is in my profile. Recent photo of his regal fluffiness can be viewed by request.)
Week 1: Three weeks ago (April 20), I noticed my cat's appetite had diminished - he was eating less than half his usual amount, missed his daily poop, and refused his favorite treats. In retrospect, he was displaying signs of nausea (enthusiasm for all of the routines around eating until he had the food in front of his nose, then turning away as if it smelled bad). He got slightly better mid-week (eating closer to normal amounts, and taking his thyroid medicine and treats), but then returned to minimal eating, refusing treats, and more pronounced nausea symptoms that Friday and over the weekend.
Week 2: Brought him in to the vet on Monday, April 27 for a basic check-up, and his weight was down but otherwise all looked well (temperature, teeth, nothing untoward that the vet could feel with external palpitation). He had been in for his six-month blood work (monitoring his thyroid levels as well as kidney and blood pressure) in mid/late February and was fine then, and we had brought a new cat home (kept in a separate room so far) on Friday, so we started with the least invasive option of maybe it was stress-related, and gave him a dose of Mirtazapine (appetite stimulant) and four days of Cerenia (anti-nausea). He started eating regularly again, but also started drinking and peeing excessively. I called back on Wednesday as instructed, but miscommunication with the front desk staff meant that the update wasn't communicated to the vet techs or the vet. So he didn't go back in again until Friday, when the meds wore off and his nausea returned and appetite went down again (and excessive drinking and peeing continued, though slightly less than when he was on the appetite stimulant and eating more). He got a full blood panel then, and they kept him for the afternoon to try to get a urine sample, but he was not up for peeing at the vet's office, so they instructed me to collect his urine at home and bring it in first thing the following Monday (vet is closed over the weekend due to reduced hours due to the pandemic). Blood work showed just above normal levels of the two markers that they check for kidney function. Cat continued with minimal eating, extra drinking/peeing, signs of nausea, and only pooping small, hard poops with lots of hair every other or third day over the weekend.
Week 3: Brought the urine sample in first thing Monday morning on May 4, and the test showed signs of urinary tract infection. Density was normal, but on the low end, and my collection method (leaving a tray in his litter box overnight, since he likes to pee before I get up in the morning) may have led to some concentration of the urine, so the true value may have been below normal range. This time the vet sent me home just with another four days of Cerenia, in hopes that would be sufficient to get him eating again (he was still drinking and peeing more than normal once the Mirtazapine wore off, but not quite as much), so that he'd be eating regularly enough to begin oral antibiotics. It wasn't. So he went back in last Thursday and got another dose of Mirtazapine at the vet as well as subcutaneous fluids. He started eating well again right away that evening, so I was able to start the antibiotics (Clavaseptin) on Friday, and he had a regular poop again Sunday evening.
This week so far: Thursday's Mirtazapine wore off on Sunday night/Monday (yesterday, May 11), and he had run out of the Cerenia anti-nausea meds and the end of last week, so he was not taking his pill pockets willingly last night or this morning, and was eating less again today, despite giving him another dose of Mirtazapine last night. So I also picked up some more Cerenia from the vet today and gave him the first one about an hour before his dinner tonight. He ate this evening's pill pockets ... of his own volition rather than me having to pop them down the back of his throat, but not eagerly; and he's been a little more lethargic again today. He also feels to me like his temperature may be elevated? But I don't have a cat thermometer, and am likely prone to exaggerated worry at this point. Good poop Monday night, but none today.
Looking ahead: he's on a 14-day course of antibiotics (this is the end of day 5), and he'll have his urine tested again next Tuesday. My understanding from the vet was that next week's urinalysis would tell if we needed to extend the course of antibiotics or not, and also if this is marking the start of chronic kidney disease (which would not be unexpected for a 14 year old male Maine Coon Cat who was diagnosed with hyperthyroid a year and a half or two years ago), or if the kidney concerns clear up as the infection clears up. I've been reading up on symptoms and treatment for chronic kidney disease. The vet seems to think that I've been a very attentive cat owner (upside of staying at home all day every day due to the pandemic, I guess?) and that we've caught it at the very beginning. But, you know, [gestures around at world] + beloved cat who has been by my side for 14 years = anxiety. My coping method is making sure I'm as well informed about everything as possible, but there's a timeline detail I haven't been able to find any information about:
For those of you who have had cats that have developed chronic kidney disease in their senior years, how long was it between when your cat first started showing symptoms, through diagnosis and any potential complications (like this uti), to when you got treatment (special diet or whatever) sorted out and started? Is my cat's experience within the normal range, including normal range of potential hiccups?
Best answer: I brought my cat in on account of more-frequent-than-usual vomiting, and her chronic kidney disease was diagnosed immediately based on her bloodwork (stage 3, I think). We got a treatment plan at the point of diagnosis that we never really had to veer from. Anyway, she survived another 18 months or so beyond diagnosis and died in her 20s of complications from CKD.
Your cat may or may not have CKD, but if he does have it, it sounds like it would be very early stage.
posted by phoenixy at 9:22 PM on May 12, 2020 [1 favorite]
Your cat may or may not have CKD, but if he does have it, it sounds like it would be very early stage.
posted by phoenixy at 9:22 PM on May 12, 2020 [1 favorite]
Best answer: You asked about older cats and CKD, but as you mentioned a UTI, here’s one ”younger cat” anecdote. (A Maine Coon, too, as it happens.)
Our 3-yr-old went off his food before last Christmas. First there was nausea, later he got a fever. After a couple of days, we took him to the vet. Lab results indicated some sort of infection and elevated kidney markers, quite high. He was put on antibiotics and Cerenia. Symptoms of a UTI appeared only after a week or so. If there’d been any before the fever, they’d been so minor I had missed them.
At first things didn’t look good. He had nausea, the kidney markers were still elevated, and the first urinalysis results were horrible, the kind you’d get in advanced CKD. Then, finally, an ultrasound scan confirmed an acute infection - pyelonephritis - so we stubbornly continued with the antibiotics and Cerenia. At times he’d seem to be getting better and then suddenly become anorexic again, but after maybe eight weeks, he began to get better and remain that way.
Between Christmas and March, he needed six visits to the vet for bloodwork, two ultrasound scans, a few urine samples... and antibiotics for 2,5 months (!).
After we finally got rid of the infection, the most recent bloodwork and urinalysis came back normal. He’s off Cerenia and eating like a horse. The second ultrasound scan showed some minor scarring in the kidneys as a result of the infection, but they seem to function well. So what first looked like possible CKD (symptoms + lab results) was, after all, caused by acute infection. There’s no way of knowing what caused it.
The thing is, we have another cat who does actually have CKD. What I learned while treating the young one: it’d be very difficult for me to tell acute kidney and/or UTI trouble from chronic kidney disease getting worse. I feel it’d be quite impossible without all the labwork and ultrasound scans. The symptoms were so annoyingly similar.
If there’s a chance that an acute infection is causing nausea, anorexia and elevated kidney markers, antibiotics should clear those up. Healing just might take some time.
As to your question about first signs of CKD and starting treatment, our CKD cat got seriously ill rather quickly. His first lab results put him at borderline stage 4 CKD - the final, most advanced stage. He was immediately put on all sorts of medication. The vet thought he’d live for a month, perhaps two. That was two years ago. The most recent labwork says his pee is normal and his kidney markers now belong to a stage 2 CKD cat. All we did was medicate and let him eat whatever the hell he likes. (The vet: ”Feed him whatever he’ll eat” - he probably didn’t think we’d be desperate enough to try literally any food such as Pecorino cheese and that this would go on for years.)
Anecdotes are, well, anecdotal, and reading about one more CKD cat probably doesn’t help that much, but if you want to share some of the stress of being worried because of all things kitty-kidney, memail me whenever (same goes for anyone who’s ever spent a sleepless night over feline kidneys).
posted by kaarne at 5:16 AM on May 13, 2020 [1 favorite]
Our 3-yr-old went off his food before last Christmas. First there was nausea, later he got a fever. After a couple of days, we took him to the vet. Lab results indicated some sort of infection and elevated kidney markers, quite high. He was put on antibiotics and Cerenia. Symptoms of a UTI appeared only after a week or so. If there’d been any before the fever, they’d been so minor I had missed them.
At first things didn’t look good. He had nausea, the kidney markers were still elevated, and the first urinalysis results were horrible, the kind you’d get in advanced CKD. Then, finally, an ultrasound scan confirmed an acute infection - pyelonephritis - so we stubbornly continued with the antibiotics and Cerenia. At times he’d seem to be getting better and then suddenly become anorexic again, but after maybe eight weeks, he began to get better and remain that way.
Between Christmas and March, he needed six visits to the vet for bloodwork, two ultrasound scans, a few urine samples... and antibiotics for 2,5 months (!).
After we finally got rid of the infection, the most recent bloodwork and urinalysis came back normal. He’s off Cerenia and eating like a horse. The second ultrasound scan showed some minor scarring in the kidneys as a result of the infection, but they seem to function well. So what first looked like possible CKD (symptoms + lab results) was, after all, caused by acute infection. There’s no way of knowing what caused it.
The thing is, we have another cat who does actually have CKD. What I learned while treating the young one: it’d be very difficult for me to tell acute kidney and/or UTI trouble from chronic kidney disease getting worse. I feel it’d be quite impossible without all the labwork and ultrasound scans. The symptoms were so annoyingly similar.
If there’s a chance that an acute infection is causing nausea, anorexia and elevated kidney markers, antibiotics should clear those up. Healing just might take some time.
As to your question about first signs of CKD and starting treatment, our CKD cat got seriously ill rather quickly. His first lab results put him at borderline stage 4 CKD - the final, most advanced stage. He was immediately put on all sorts of medication. The vet thought he’d live for a month, perhaps two. That was two years ago. The most recent labwork says his pee is normal and his kidney markers now belong to a stage 2 CKD cat. All we did was medicate and let him eat whatever the hell he likes. (The vet: ”Feed him whatever he’ll eat” - he probably didn’t think we’d be desperate enough to try literally any food such as Pecorino cheese and that this would go on for years.)
Anecdotes are, well, anecdotal, and reading about one more CKD cat probably doesn’t help that much, but if you want to share some of the stress of being worried because of all things kitty-kidney, memail me whenever (same goes for anyone who’s ever spent a sleepless night over feline kidneys).
posted by kaarne at 5:16 AM on May 13, 2020 [1 favorite]
I've never had the diagnostic process for a cat take more than a week or two tops. It moves much faster than human diagnostics because most vets seem to have the necessary diagnostic equipment at their practice -- no needing to schedule your scans at one place, blood sent out to a different place, etc
posted by Jacqueline at 6:31 AM on May 13, 2020
posted by Jacqueline at 6:31 AM on May 13, 2020
My cat died this year of kidney disease—she was somewhere between 12 and 16 years old, we didn’t know her exact history. She was diagnosed with stage 4 kidney disease back in 2017 and aside from a poor appetite and no interest in playing, she was fine up until quite recently. We started giving her subcutaneous fluids maybe 6 months before she died, and it wasn’t too bad, just every few days, and seemed to help her feel a lot better. We had to put her to sleep after she developed “acute on chronic kidney disease” and had a seizure followed by a scary and very sudden decline over the course of about 3 weeks.
But, as a point of anecdata, she lived for years quite happily after her diagnosis.
The diagnosis was fast, within a week after bringing her in for bloodwork. We got a calcitriol prescription and the special diet prescription filled soon after the diagnosis, probably also in the same week, but mostly our cat refused to eat the prescription wet food and so we gave her prescription kibble but basically any wet food she’d eat, with the calcitriol squirted on top until her last half year or so when she would barely eat her wet food, so we gave her the calcitriol orally at that point.
We were given Mirtazipine/Cerenia around the same time as her diagnosis, but neither seemed to do much for her so we stopped those.
Tanya’s CKD page was an amazing and comprehensive resource.
Good luck, I hope once your kitty’s more acute issues are taken care of, he can live a long and happy life with minimal extra adjustments. I gave my cat’s leftover food/supplies to my friend whose cat has CKD and is now 18 years old, I think, and has been sick longer than my cat was.
posted by music for skeletons at 11:22 AM on May 13, 2020
But, as a point of anecdata, she lived for years quite happily after her diagnosis.
The diagnosis was fast, within a week after bringing her in for bloodwork. We got a calcitriol prescription and the special diet prescription filled soon after the diagnosis, probably also in the same week, but mostly our cat refused to eat the prescription wet food and so we gave her prescription kibble but basically any wet food she’d eat, with the calcitriol squirted on top until her last half year or so when she would barely eat her wet food, so we gave her the calcitriol orally at that point.
We were given Mirtazipine/Cerenia around the same time as her diagnosis, but neither seemed to do much for her so we stopped those.
Tanya’s CKD page was an amazing and comprehensive resource.
Good luck, I hope once your kitty’s more acute issues are taken care of, he can live a long and happy life with minimal extra adjustments. I gave my cat’s leftover food/supplies to my friend whose cat has CKD and is now 18 years old, I think, and has been sick longer than my cat was.
posted by music for skeletons at 11:22 AM on May 13, 2020
Just another version of this process -- my beloved little guy Xander was never officially diagnosed. His numbers never hit the range that would make the vet definitively say "yes, this is kidney disease." Instead they were "at the high end of normal for a cat" for years and years.
His symptoms, however, were very obvious. They were cyclical, and several times a year we did the whole "cerenia + antibiotic shot + IV fluids" routine. There were long periods when he was fine, punctuated by times when he'd vomit more often than usual (sometimes pink froth), avoid food, and pee in inappropriate places.
This went on for most of his adult life until he finally passed away last year at 19. We actually called it for other reasons - his arthritis had reached the point that it was extremely painful for him to get around, and the only meds that relieved the pain made him incredibly confused, groggy, and clumsy. We decided not to put him through that or make him continue on with the pain.
There were a lot of times during his "vomit cycles" when I questioned whether it was just time to let him go. But the thing was -- when he was fine, he was really fine. Healthy, happy, grumpy as hell, adorable. When he was sick, there was a quick and easy way to fix it and get back to fine. Honestly the worst part after a while was the expense -- I'm not broke, but I have been, and having a randomly appearing $300-500 vet bill always hovering on the horizon was pretty damn stressful.
I feel like for cats, this is one of those things that you can't fully predict, which I know is not great to hear when you have anxiety around it and when it's your best cat friend. But the good news is that while some cats do have a fairly steady decline after diagnosis, others have a much slower kind of punctuated equilibrium, and can be their happy selves most of the time for years.
posted by invincible summer at 8:01 PM on May 13, 2020
His symptoms, however, were very obvious. They were cyclical, and several times a year we did the whole "cerenia + antibiotic shot + IV fluids" routine. There were long periods when he was fine, punctuated by times when he'd vomit more often than usual (sometimes pink froth), avoid food, and pee in inappropriate places.
This went on for most of his adult life until he finally passed away last year at 19. We actually called it for other reasons - his arthritis had reached the point that it was extremely painful for him to get around, and the only meds that relieved the pain made him incredibly confused, groggy, and clumsy. We decided not to put him through that or make him continue on with the pain.
There were a lot of times during his "vomit cycles" when I questioned whether it was just time to let him go. But the thing was -- when he was fine, he was really fine. Healthy, happy, grumpy as hell, adorable. When he was sick, there was a quick and easy way to fix it and get back to fine. Honestly the worst part after a while was the expense -- I'm not broke, but I have been, and having a randomly appearing $300-500 vet bill always hovering on the horizon was pretty damn stressful.
I feel like for cats, this is one of those things that you can't fully predict, which I know is not great to hear when you have anxiety around it and when it's your best cat friend. But the good news is that while some cats do have a fairly steady decline after diagnosis, others have a much slower kind of punctuated equilibrium, and can be their happy selves most of the time for years.
posted by invincible summer at 8:01 PM on May 13, 2020
Response by poster: Reminder: the question is not about how long your cats lived overall, it is about the length of time the onset of symptoms -> diagnosis -> treatment process took. Thanks!
posted by eviemath at 5:26 AM on May 14, 2020
posted by eviemath at 5:26 AM on May 14, 2020
Response by poster: (That is, my anxiety is more around the detail that I can control, which is the "should I be doing more for this cat right now?" piece of this situation.)
posted by eviemath at 5:30 AM on May 14, 2020
posted by eviemath at 5:30 AM on May 14, 2020
This thread is closed to new comments.
My cat was not your cat! Please take my experience as a possibility rather than a prediction. It was a couple months before we got his diet sorted out, after being diagnosed with kidney disease. That followed a couple UTIs - the diet also proved problematic, and kept messing up his stomach. He kept going about a year and a half after that, with increasingly unpleasant (for him and us) health problems.
One really hard thing was deciding when to stop treatment - cats will just keep going, but steroids and painkillers *suck* for cats, and I feel like we stuck it out a little too long because we loved him so goddamn much. He was a rescue, but estimated to be around the same age at the beginning of this whole thing.
posted by aspersioncast at 9:13 PM on May 12, 2020 [1 favorite]