What can/should I do about my senior cat's behavior change?
March 13, 2022 1:52 PM Subscribe
This is Rosemary, a sweetheart of a cat who is having a tough time of it. She's about to turn 15 and was recently diagnosed with hyperthyroidism and chronic kidney disease. Lately things have taken a turn and her behavior is worrisome. She's been to the vet and everything checks out ok, but she clearly is not happy and I'm trying to brainstorm solutions.
Last year Rosemary started showing classic signs of hyperthyroid - excessive shedding, constant thirst, hyperactivity. Blood tests confirmed this and we started her on methimazole gel to good effect. Follow up testing revealed kidney problems, so six weeks ago the vet cut her methimazole down from 2 doses per day to 1.5. This didn't have any immediately observable effect, but her last round of bloodwork was what the vet wanted to see - slightly elevated thyroid, but better kidney function. She remains skinny but has not lost any weight, her heart and lungs sound fine, no physical ailments detected.
Meanwhile, unrelated to any obvious specific change or trigger, Rosemary started spending all her time in the third floor guest suite. Previously a very social cat, she refused to engage with either of the humans or the other cat in the house. She stopped coming downstairs for morning treats or evening dinner unless I physically carried her down, and while she sometimes would stay and get some lap time, most often she just dashed back upstairs. Eventually I had to put extra food and water bowls upstairs, and finally a litter box.
Now, Rosemary sits in the litter box almost 24/7. She has started on a prescription wet food diet, but will only eat if I leave the bowl right near the litter box. She will let me pick her up and will sit on my lap while I pet her, but no longer comes on her own. I have set up a variety of comfy spots using her favorite blankets/towels/etc. to no avail. She ignores toys, treats, brushes or anything else she used to enjoy. She doesn't exhibit any signs of pain when using the box, she has no problems jumping up or down when she needs to, and still purrs happily when getting a good petting in my lap, so I'm at a loss as to what I can do to help.
I'm going to call the vet again tomorrow and see if she has any advice, but I'm wondering if anyone else has has a similar experience or can suggest questions I should be asking. I like our vet, she is friendly and seems competent, but she is very vague when talking about illness and treatments and I'm struggling to make her understand just how unusual this behavior is.
Last year Rosemary started showing classic signs of hyperthyroid - excessive shedding, constant thirst, hyperactivity. Blood tests confirmed this and we started her on methimazole gel to good effect. Follow up testing revealed kidney problems, so six weeks ago the vet cut her methimazole down from 2 doses per day to 1.5. This didn't have any immediately observable effect, but her last round of bloodwork was what the vet wanted to see - slightly elevated thyroid, but better kidney function. She remains skinny but has not lost any weight, her heart and lungs sound fine, no physical ailments detected.
Meanwhile, unrelated to any obvious specific change or trigger, Rosemary started spending all her time in the third floor guest suite. Previously a very social cat, she refused to engage with either of the humans or the other cat in the house. She stopped coming downstairs for morning treats or evening dinner unless I physically carried her down, and while she sometimes would stay and get some lap time, most often she just dashed back upstairs. Eventually I had to put extra food and water bowls upstairs, and finally a litter box.
Now, Rosemary sits in the litter box almost 24/7. She has started on a prescription wet food diet, but will only eat if I leave the bowl right near the litter box. She will let me pick her up and will sit on my lap while I pet her, but no longer comes on her own. I have set up a variety of comfy spots using her favorite blankets/towels/etc. to no avail. She ignores toys, treats, brushes or anything else she used to enjoy. She doesn't exhibit any signs of pain when using the box, she has no problems jumping up or down when she needs to, and still purrs happily when getting a good petting in my lap, so I'm at a loss as to what I can do to help.
I'm going to call the vet again tomorrow and see if she has any advice, but I'm wondering if anyone else has has a similar experience or can suggest questions I should be asking. I like our vet, she is friendly and seems competent, but she is very vague when talking about illness and treatments and I'm struggling to make her understand just how unusual this behavior is.
My experience is that as my cats have aged, their travel circle has gotten smaller. Our 17 year old Safi sounds very similar to Rosemary. Safi spends almost all of her time in our bedroom. She was previously an indoor/outdoor cat, and would make a daily patrol around the backyard and roam throughout the house. We put food, water, and a litter box in the bedroom, and she is completely happy to spend her days on our bed. The vet hasn't been able to find anything physically wrong with her, and she purrs happily when petted and snuggles with us at night.
One of my pervious cats went through a similar shrinking of her travel circle when she was about 15, but she chose the living room as her primary domain. (The sun is very good there.) Again, the vet could find nothing physically wrong, and she spent the last four years of her life almost exclusively in the living room.
So, perhaps the vet is not understanding how unusual the behavior is because, while unusual for Rosemary, it is not that unusual or an older cat.
posted by hworth at 2:32 PM on March 13, 2022 [4 favorites]
One of my pervious cats went through a similar shrinking of her travel circle when she was about 15, but she chose the living room as her primary domain. (The sun is very good there.) Again, the vet could find nothing physically wrong, and she spent the last four years of her life almost exclusively in the living room.
So, perhaps the vet is not understanding how unusual the behavior is because, while unusual for Rosemary, it is not that unusual or an older cat.
posted by hworth at 2:32 PM on March 13, 2022 [4 favorites]
Get her meds lowered again, they are hurting her cognitive functions, and check out your house to make sure about contaminants. Some cat foods are for special effects, I think they may put in additives which speed up metabolism to make sure their weight loss claims work. Just get regular maintainence cat food. One emergency cat food you can make, is tuna sized can of salmon put up in water, a hand full of pecans, and either half and half, or heavy cream. Blend until very smooth, thicker than pea soup. No patent remedies for your cat. Iodine and thyroid function, maybe. Get your cat back. Read up on side effects of flea prevention meds, if you use those. Something has driven this cat nuts. My one cat lived to be 21, and only in her last year did she change at all.
posted by Oyéah at 2:57 PM on March 13, 2022 [2 favorites]
posted by Oyéah at 2:57 PM on March 13, 2022 [2 favorites]
This same thing happened to my cat where she needed the litter box to be where she was because she couldn't get there on her own anymore and for me that was The Sign.
posted by bleep at 3:28 PM on March 13, 2022 [2 favorites]
posted by bleep at 3:28 PM on March 13, 2022 [2 favorites]
Anxiety can be a symptom of elevated thyroid. Since you're not able to medicate the thyroid issue enough to bring it down to normal, maybe an anxiety medication might be in order.
posted by Serene Empress Dork at 3:43 PM on March 13, 2022
posted by Serene Empress Dork at 3:43 PM on March 13, 2022
Depending on how much much money you're willing/able to throw at the problem, radioactive iodine therapy is "the gold standard" and has a very high success rate in completely curing hyperthyroidism in cats. It's not cheap though, and I'm not sure if it's something worthwhile to look into at this age; that's a conversation for the vet(s). Its not done in a vet's office; it's usually done in a special clinic set up for that one task. Kidney disease and hyperthyroidism are linked in cats - in fact hyperthyroidism has a tendency to mask the kidney disease; only once is the hyperthyroid treated does the kidney disease show up in the bloodwork. (At least according to both my vet and the clinic that did my cat's iodine therapy, successfully I might add). But once you eliminate the hyperthyroidism completely, you have more freedom in treating other ailments.
And if you're not getting answers from your vet, there's no harm in considering a second opinion. Even the best vet in the world might not see the problem in the same way as another vet with a fresh set of eyes.
posted by cgg at 5:11 PM on March 13, 2022 [3 favorites]
And if you're not getting answers from your vet, there's no harm in considering a second opinion. Even the best vet in the world might not see the problem in the same way as another vet with a fresh set of eyes.
posted by cgg at 5:11 PM on March 13, 2022 [3 favorites]
We have a female CKD cat, and she has had two UTIs in the past few months, the CKD seems to promote them and it seems pretty common. The signs of a UTI are losing interest in her usual routines, and just generally withdrawing and seeming very unhappy. Once she gets treated for the UTI she bounces back very quickly. So I would start by testing for that.
I am also of the opinion that when a cat loses interest in food, you ignore all the prescription diets and give them whatever they will eat. We generally have several high quality wet foods in rotation to keep her appetite strong.
Finally, just my humble opinion, but I think 15 years old is too young to have that much behavioural change without an underlying medical reason (beyond CKD and thyroid). But if you can't get it resolved so that she is enjoying her old life again, I don't think the quality of life of a cat who spends almost all its time in its litter box is worth continuing.
posted by nanook at 5:13 PM on March 13, 2022 [2 favorites]
I am also of the opinion that when a cat loses interest in food, you ignore all the prescription diets and give them whatever they will eat. We generally have several high quality wet foods in rotation to keep her appetite strong.
Finally, just my humble opinion, but I think 15 years old is too young to have that much behavioural change without an underlying medical reason (beyond CKD and thyroid). But if you can't get it resolved so that she is enjoying her old life again, I don't think the quality of life of a cat who spends almost all its time in its litter box is worth continuing.
posted by nanook at 5:13 PM on March 13, 2022 [2 favorites]
Response by poster: Thanks everyone for the posts so far, it’s super helpful to get some other ideas and perspectives.
I suspect the litter box is a bit of a red herring - her reclusive behavior began last week, the only reason she has a litter box upstairs to sit in is that she wouldn’t come downstairs to use the regular box. Obviously the reclusive behavior could still be bathroom related and I will definitely bring that question to the vet.
cgg, we were all set to do the radiation treatment but as you note the initial treatment revealed the kidney disease and our vet said that makes Rosemary a poor candidate for it. That’ll be the first second opinion I get though, if we can’t get a good resolution to this current issue. If anyone has thoughts/experience in handing kidney disease after thyroid treatment, I’d love some anecdotes there, too.
posted by Banky_Edwards at 5:51 PM on March 13, 2022 [2 favorites]
I suspect the litter box is a bit of a red herring - her reclusive behavior began last week, the only reason she has a litter box upstairs to sit in is that she wouldn’t come downstairs to use the regular box. Obviously the reclusive behavior could still be bathroom related and I will definitely bring that question to the vet.
cgg, we were all set to do the radiation treatment but as you note the initial treatment revealed the kidney disease and our vet said that makes Rosemary a poor candidate for it. That’ll be the first second opinion I get though, if we can’t get a good resolution to this current issue. If anyone has thoughts/experience in handing kidney disease after thyroid treatment, I’d love some anecdotes there, too.
posted by Banky_Edwards at 5:51 PM on March 13, 2022 [2 favorites]
So, my question for you is, do you know the level of kidney disease she has? Are her numbers really terrible, or is she in the early stages?
My humble opinion, and I had a cat with kidney disease that was not ever that advanced, it was a lot more important to get her to drink water and keep her interested in food. I fed a high protein, wet food only diet, and her kidneys really never advanced beyond mild disease. She lived to 18.5. If her interest in the Rx food is that low, honestly, it's not worth trying to force it. Just my two cents.
I would really, really interrogate, with a specialist if possible, how feasible the radiation treatment is for her, if the meds are suppressing her personality this much. Regular vets can be great, but a specialist opinion would be my route here. There is a Blue Pearl Hospital that I think may be near enough to you -- Their local branches treated my cat's cancer, and my best friend's cat recently had the thyroid radiation treatment there as well. In my experience they are really great.
posted by Medieval Maven at 6:02 PM on March 13, 2022 [2 favorites]
My humble opinion, and I had a cat with kidney disease that was not ever that advanced, it was a lot more important to get her to drink water and keep her interested in food. I fed a high protein, wet food only diet, and her kidneys really never advanced beyond mild disease. She lived to 18.5. If her interest in the Rx food is that low, honestly, it's not worth trying to force it. Just my two cents.
I would really, really interrogate, with a specialist if possible, how feasible the radiation treatment is for her, if the meds are suppressing her personality this much. Regular vets can be great, but a specialist opinion would be my route here. There is a Blue Pearl Hospital that I think may be near enough to you -- Their local branches treated my cat's cancer, and my best friend's cat recently had the thyroid radiation treatment there as well. In my experience they are really great.
posted by Medieval Maven at 6:02 PM on March 13, 2022 [2 favorites]
Sometimes UTIs or kidney infections can be obscure to testing in aged kidney kitties. Ours had to have a course of IV antibiotics for a few days in the ER and bounced back for a couple months. I’d suggest vet first, in case it’s that. With Hugo we mainly focused on getting him to stay hydrated and fed with anything he would eat, over the last couple of months, and didn’t worry about prescription food or meds because it just stressed him out. You may be at the point where you need to have an honest conversation with your vet about just keeping your kitty comfortable and happy in the final period of their life. This phase of chronic illness is always so tough, my heart is with you.
posted by matildaben at 6:46 PM on March 13, 2022
posted by matildaben at 6:46 PM on March 13, 2022
My childhood cat had long-standing mild to moderate kidney disease when she developed hyperthyroidism in the 2000s. Honestly, the hyperthyroid made her perkier, she lost weight and was more active. After the radiation treatment she declined rapidly as the kidney symptoms returned. My mom felt pressured into the radiation treatment and regrets it, wishes she had stuck to palliative care. Cat was in her late teens.
posted by momus_window at 9:31 AM on March 14, 2022
posted by momus_window at 9:31 AM on March 14, 2022
Are you giving her subcutaneous fluids? They’re not difficult to administer and can make a world of difference. Good luck!
posted by 2soxy4mypuppet at 9:36 AM on March 14, 2022
posted by 2soxy4mypuppet at 9:36 AM on March 14, 2022
Response by poster: Hi everyone, thanks again for all the ideas, thoughts and anecdotes. I spoke to the vet this morning and she is as mystified as I am. I am prepared for the possibility that this is the first indicator of a bad end, but Rosemary seems healthy by almost every metric. She is eating, drinking, using the litter box, compliant when I give her meds or move her around, etc. Of course it’s hard to tell if she is doing the appropriate level of these things because her behavior is so unusual.
For now the plan is to give it a little time and try to coax her out of the litter box/closet. If her behavior doesn’t change or she shows signs of physical distress/deterioration we’ll bring her in for an ultrasound and go from there. The vet is reluctant to change her meds while her bloodwork is good, and I’m ok with waiting a bit on that. If we can’t get any resolution there we’ll switch to a new vet for some fresh ideas.
Anyway, in true feline style, Rosemary appears oblivious to all the drama.
posted by Banky_Edwards at 6:05 PM on March 14, 2022 [3 favorites]
For now the plan is to give it a little time and try to coax her out of the litter box/closet. If her behavior doesn’t change or she shows signs of physical distress/deterioration we’ll bring her in for an ultrasound and go from there. The vet is reluctant to change her meds while her bloodwork is good, and I’m ok with waiting a bit on that. If we can’t get any resolution there we’ll switch to a new vet for some fresh ideas.
Anyway, in true feline style, Rosemary appears oblivious to all the drama.
posted by Banky_Edwards at 6:05 PM on March 14, 2022 [3 favorites]
Response by poster: Hi again, just dropping an update in case this scenario is relevant to future askme searchers. Things have not gone well for Rosemary and the specific cause of her decline is still unknown. She has almost entirely stopped eating, regardless of what kind of food is offered. She has been to the vet, who confirmed there are no visible signs of illness or injury beyond dehydration and weight loss. Basically, it could be anything, but her rapid decline argues against pursuing any intensive or expensive diagnostics if we can't stabilize her condition.
To that end, we have started her on mirtazapine for appetite stimulation, and her latest blood tests indicate some kind of infection that will hopefully respond to a shot of antibiotics. I've moved her litter box into the bedroom/home office so I'm with her all day and can keep the box clean, refresh her water and offer food when she's not sleeping. Dementia seems like a likely cause of her behavior change + physical decline, so the best case scenario might be making her more comfortable at the end but we'll see how this treatment goes.
posted by Banky_Edwards at 9:26 AM on March 23, 2022
To that end, we have started her on mirtazapine for appetite stimulation, and her latest blood tests indicate some kind of infection that will hopefully respond to a shot of antibiotics. I've moved her litter box into the bedroom/home office so I'm with her all day and can keep the box clean, refresh her water and offer food when she's not sleeping. Dementia seems like a likely cause of her behavior change + physical decline, so the best case scenario might be making her more comfortable at the end but we'll see how this treatment goes.
posted by Banky_Edwards at 9:26 AM on March 23, 2022
Response by poster: Final update for future reference, Rosemary passed away at home this week. We obviously do not know what precipitated this collapse so there's not a lot of useful information to be gleaned from this case. I do wish I had let her go a few days earlier - I knew it would eat at me if we didn't try the appetite stimulant and antibiotics, but in retrospect we were almost certainly past the point of no return anyway so I'm going to take that as a lesson.
posted by Banky_Edwards at 3:01 PM on March 27, 2022
posted by Banky_Edwards at 3:01 PM on March 27, 2022
I am sorry for your loss, and thank you for your updates. I have two 18-year-old cats who are both living with CKD and one with hyperthyroid. May your story give me strength when the time comes.
posted by slenderloris at 12:39 PM on March 29, 2022
posted by slenderloris at 12:39 PM on March 29, 2022
This thread is closed to new comments.
posted by amtho at 2:05 PM on March 13, 2022