Feedback (Page 1)
opinions expressed in the Caregiver Feedback pages are those of the
authors and do not necessarily reflect the opinions of the Feline CRF
want to compliment you on an excellent Web page. As someone
who has an almost 19 year old cat who was first diagnosed with
CRF in 1991, I certainly wish there had been a comparable page
to refer to at that time. I have answered many posts on rpc
from people whose cats have recently been diagnosed with renal
failure and it is nice to know that I will now have another
resource to direct them to besides sharing Spike* and my story
you mind if I mentioned a couple of things I have found in my
experience with this problem? I hope I don't offend, I'm just
trying to share some knowledge.
a recent visit to our vets, who have been looking after Spike
since we got him at three months, the vet we were seeing that
day told us about just returning from a conference where she
attended a presentation by a specialist in geriatric cats. The
specialist mentioned that low-protein was a bit of a misnomer
when it came to changing the diet. She said that they have discovered
that it is more a matter of feeding a form of protein that is
easily digested and relatively free of additives that put stress
on the kidneys. Their research has shown that mice (big surprise)
are the best source of this kind of protein but that chicken
is second best. Maybe you can check into this and if cats are
having a hard time adapting to the formulated low-protein diet
foods, a substitution of skinless poached chicken might be offered
as an alternative.
the question of uremic gastritis, our vets explained to us that
as the urea toxins build up in the blood, they irritate the
small capillaries in the stomach and intestinal tract and cause
pinpoint hemorrhages that, as the disease progresses, can lead
to ulcers. Spike seems to have reached this stage and is now
getting 1cc of Sulcrate Suspension Plus, three times daily.
This is also a part of a family of drugs that is used in the
treatment of human ulcers. It works by coating the ulcers and
protecting them from the stomach acids, but is not absorbed
into the system, thereby possibly causing other problems. It
does seem to have worked quite well with him.
I noticed in your coverage of the sub-Q topic that you only
mentioned what I call the "drip" method. We had to start Spike
on the sub-Q routine about four months ago and our vets, being
very aware of Spike's nature, taught us a second method that
I call the "down and dirty" method. Good for cats who aren't
very good patients, like Spike. Takes a much shorter time to
administer (1 to 2 minutes) and therefore gets the stress over
quickly. It is an injection method. We have a couple of syringes
that look to be about the size of small turkey basters (60cc),
fill them up twice daily with the required amount of fluid,
use the needle sizes you mention and then *inject* the fluid
into the same area as with the "drip" method. Spike has taken
pretty well to the routine, once I got over my nervousness about
giving them. Is definitely a two-person operation.
some of this is of value and keep up the good work.
August 14, 1996, Spike lost the battle with CRF. His photo and
story are in the Tributes to CRF Cats Gallery.
took a look at your CRF pages and think they are excellent.
I will be sure to put a flyer for your site on my vet's bulletin
board (the old fashioned paper kind) next time I'm over there.
Keep up the good work! Somewhere around here I have a recipe
for a homemade chow that is designed for CRF, I'll hunt that
up and send you a copy. Star likes it and its a good change
from KD. I would also suggest adding a note about Pedialyte
in your section on water. It replaces lost electrolytes and
while it isn't a specific remedy for anything, it is a minor
just wanted to express my thanks and awe over your new web site.
What a service! For a while I have been lurking in rpc, never
posting, but sending to those who might benefit a word about
things I have learned from my beautiful 16-yr old little Siamese
girl who came very close to dying over a year ago. Last summer
Mitzi was in end-stage renal failure. Her kidney deterioration
had probably been exacerbated by a urinary tract infection,
but antibiotics in conjunction with 48 hours of diuresis at
Angell Memorial hospital allowed her kidneys to bounce back
very well. After returning home, it took several days for Mitzi
to eat voluntarily, and weeks before she was eating k/d in sufficient
quantities. It was a rough first month or two, and the subcutaneous
injections were dreadful until we were used to them. However,
the last year has been a joy. Mitzi has been happy, excruciatingly
affectionate, and even playful. There are stretches of days
when she seems unwell and mopey and I prepare myself for the
slide to the end. But then she coughs up a hairball and is herself
case it might be useful, below is an excerpt from a letter I
recently sent to someone whose cat was just diagnosed with CRF
blather on about my understanding of the relative significance
of creatinine and BUN:
is a byproduct of muscle metabolism that is concentrated into
urine by the kidneys. Since most creatinine produced is a product
of simply living, and it doesn't fluctuate that much with changes
in activity, it is a pretty stable indicator of how well the
kidneys are working. That is, you won't get significant changes
in readings throughout the day or depending on the last meal.
1.7 is typically the upper end of normal, but my vet has a 20
year old Siamese who has been stable and happy with a reading
of nearly 4 for the past two years. Creatinine itself is not
toxic to the kidneys, so increased physical activity need not
be feared even though it may cause creatinine values to elevate
blood urea nitrogen, on the other hand, *is* toxic, it fluctuates
somewhat throughout the day so it is a less reliable indicator
of how the kidneys are doing, but it is a great indication of
how a cat is feeling with regard to kidney toxicity. Urea is
a product of breakdown of extra protein in the diet. That is
why a low protein diet is recommended and why levels may fluctuate
in the day based on when was the last meal. When the kidneys
fail to concentrate urea, the increased blood concentrations
of urea further destroy kidney tissue. Subcutaneous fluid therapy
is so crucial because it allows you to dilute out the urea and
slow the damage remarkably, making the cat feel a lot better
in the process since when urea is high they will have a horrible
taste in their mouth and will feel nauseous.
hydration is so important, I don't mind the fact that I have
to make Mitzi's wet k/d into a mush with water in order to get
her to eat it. I have found an abstract on medline that even
demonstrates a difference in lab values that normal cats will
have with respect to BUN after eating dry food or wet. Though
the point of the article was to show that cats who are healthy
may show different lab values depending on diet, in my mind
the clinical significance for a sick cat is that having lots
of water with food may keep BUN from spiking up right after
K/D is good, too, though, because it allows cats to nibble just
a little bit throughout the day; keeping calories up while not
being flooded with too much protein at once.
also taken a cue from some advice on the web I've read a couple
of times: I spike Mitzi's drinking water 1:2 parts unflavored
pedialyte/water. It helps keep electrolyte balance and Mitzi
recently I have made subcutaneous treatments even more comfortable
for Mitzi by prewarming her fluids. If you direct some fluid
from the IV bag, say, on to your bare tummy; you see the main
reason why cats don't like this stuff pouring under their skin.
The initial needle poke doesn't seem to be the big deal. So
I fill up the sink with water, even submerging my room thermometer
to that it will be 80-90 F, and submerge the IV bag. (keeping
the tubing attachment site above water level). Mitzi greatly
appreciates the extra effort.
needle technique I've developed: Mitzi is wedged lying on her
tummy between two pillows. I stroke the area between her shoulder
blades several times while playing at pinching up a tent, until
she relaxes and I have a good tent. I test the tent with the
index finger of my other hand, making an indentation where the
needle will go and sensing whether there is a nice pocket for
it. Before I put Mitzi in position, the new needle is preflushed
with H2O so that there are no air pockets and the flow is up
to speed when it is inserted.
for your excellent cat renal pages. It has provided more useful
information than any vet I have encountered.
My own cat
is a 24 year-old Siamese who has had CRF for at least 6 years.
She is on ringers and is actually gaining a little muscle in
the last year. There are several reasons, I think, for this.
One is that I am supplementing her potassium by about 15mg per
day--although both the reduced protein food and the ringers
add it, too much is "washed out." For the same reason I supplement
her vitamins and minerals. The third reason is--and I found
almost immediate improvement--is that I have been adding 500
mg of L-Taurine to her daily diet. Although I don't see this
treatment documented in any feline renal literature, I have
found taurine mentioned as a potential treatment in legitimate
human nutrition studies in relation to renal failure.
or not the improvement in my cat reflects the remedy of an existing
deficiency or a positive treatment, I don't know. (I found one
study which found added taurine in cat foods was made unavailable
by the heat processing).
In any case,
it would be good to see a study some day on taurine in relation
to feline CRF.
for your excellent webpage.
a follow-up letter, Terry said "...I would have included a warning
if I had known it (the letter) might be generally viewed, about
the dangers of overdosing on vitamins and minerals (i.e.. someone
may try un-cut human vitamins)."
CRF cat is Reka Mao*, age 17. She refuses to eat Hills KD and
has frequent constipation. We feed her a mix of WD and Nature's
Recipe Feline lite/senior. Both are low protein (though not
as low as KD) and high fiber. My vet has ok'd this for two reasons:
she won't eat KD anyway, and she says these foods are probably
the next best thing to KD, though not ideal. So far Reker's
only needed fluids about 4 or 5 times since diagnosis 1.5 years
ago. Through endless trial and error we've learned to give her
1/4 can daily of Kal Kan Optimum (a supermarket canned food)
mixed with Metamucil to keep her bowels working adequately.
point is that many CRF cats suffer from constipation and that
a high fiber food is needed for some of them, also that cats
who hate KD may be willing to eat WD. As always, a vet should
be consulted. (can you tell I wrote the cat constipation faq?)
have a few comments about kidney transplant too. My vet and
I believe that kidney failure isn't so much a disease as a way
the body wears out. The kidneys in cats seem to have the shortest
life of the organs so if a cat simply lives long enough to fail
from simple age and wear, the kidneys are very often the thing
that goes first.
this in mind, you have to consider that almost every cat will
get kidney failure unless he dies from some trauma or disease
first. So the donor cat in his later years is just as likely
to get kidney failure himself, and having only one kidney will
certainly reach dangerous malfunction levels sooner. Therefore,
a transplant involves serious surgical trauma for both cats
(especially the one who gets the transplant, who is already
sick and stressed), and will probably shorten the donor cat's
life. Is the benefit to the recipient worth it? I don't know
enough about feline transplant results to have an educated opinion.
one more thing to consider. Thanks for a great page.
Mao lost her fight with CRF on October 20, 1996. Her photo and
story are in the Tributes to CRF Cats Gallery.
visited your Web page for the first time a short time back and
sent you my first impressions via email, which were very positive.
Now that I've had time to look through the entire page, I'd
like to congratulate you again on your great work!
also like to tell you a little about my own experience. If you
find anything useful, please incorporate it into your page.
cat, Lucky*, was diagnosed with CRF almost three months ago.
Much of what I've learned is consistent with what you have described.
But, in my case, some other issues were also very important.
Since it is likely that a lot of people visiting your page will
have cats who were recently diagnosed, you might devote an area
to what to do and what not to do immediately. For instance:
panic. I think this is the most important thing. The diagnosis
can be a terrible shock, especially if the cat seems to be OK.
My cat was initially treated for acute renal failure. The cat
was no better or worse off after 8 days of IV treatment, and
the vet recommended putting him to sleep. Fortunately, I found
another vet, but I wonder how many people put their cat's to
sleep during the initial panic.
make the animal worse by trying to help him. In my case, I schlepped
the poor cat to the vet for days. He wouldn't eat while at the
vet and continued to lose weight. He was also totally stressed
out. Outwardly, he seemed to be getting worse and worse. In
addition, in my ignorance, I switched him to a "natural food"
diet, thinking this would help. I'm sure many people have good
luck with natural diets, but in my case, it was a disaster.
It contributed to my cat's apparent decline.
think everything is a symptom of CRF. Once my cat and I settled
in with a different vet, I started the cat on Hill's K/D wet
food. Shortly after, I added in the dry food. The vet suggested
free feeding, which turned out to be a mistake. The poor cat
went through a terrible spell of vomiting and diarrhea. I thought
this was an indication that he was getting sicker. Actually,
he just ate too much. I know you mention that any change of
diet should be gradual. You might also want to mention that
even subtle dietary changes can cause vomiting that is not related
be too quick to assume that the cat will only get worse. You
have to be patient and let the animal adjust to its condition
gradually. In my case, after the first two months of therapy,
his blood test results got worse. But, after three months of
therapy he's finally beginning to improve. He is acting like
a much younger cat (he's 8). He's also beginning to gain a little
weight, and his most recent blood test shows no anemia, normal
white blood cell count, lower BUN, and lower Creatinine.
still don't know for sure if my cat has CRF, although three
vets have now told me he does. What I do know is that my cat
was poisoned (accidentally) and that the poison combined with
extreme stress either caused or accelerated his condition. I
don't know whether he will continue to improve. I'm just happy
to have him around at all. I'm going to send a picture of my
cat to that first vet every year on the anniversary of his recommended
"death." I hope to be doing that for years.
care and good luck with your kitty,
lost his fight with CRF on July 20, 1997. His photos and story
are in the Tributes to CRF Cats Gallery
found your web site last night fairly late in the evening! (There
was a reference to it on rec.cats about using the correct URL
and I just happened to spot it.)
read everything late at night, printed it out, and my husband
and I have underlined and read it this morning.
is perfect as our cat is going in for a check up this afternoon.
cat, H.T. (because he was a holy terror when he was a kitten),
developed hypothyroidism at probably the same time the CRF symptoms
started. Because the symptoms were similar, we didn't catch
the CRF until his thyroid was under control (they kill the tumor
with radioactive iodine and he was in quarantine for about 17
days until his radiation level came down.) This was in June.
(He has just turned 13, having been born in August, 1983.)
coming home and being happy and full of energy for about two
weeks, he had what I would consider a drastic down shift. He'd
started drinking a lot (but we were told this was common due
to the iodine treatment). But then lethargy and weakness. Rushed
him back to vet and after a full work up got the results back
that showed his kidneys weren't working very well.
having some luck with changing to the science diet feline k/d
but he isn't eating too well (I plan to try the clam and tuna
juice route). My main concern is his weight loss and his muscle
loss. The last ten days have been bad. We also have other cats
so it's been a bit of a challenge of getting him off "their
food". One complication is that my spunky young Maine Coon cat,
Cassie, loves the feline k/d so we also have to keep her away
from it. Some days it's funny. Some days it's awful.
good news is that we've got an excellent vet (been with him
for 20 years with various pets) and know that he is highly regarded
for his first class scientific and medical knowledge.
was so encouraged to see that perhaps this could be managed
more assertively. Our vet, in giving us the bad news a few weeks
ago, said that it could be a few months or perhaps up to a year.
The main things he said were to keep him in, keep him comfortable,
work with him to eat and make sure he's got fresh water available.
I'm sure he will begin to make the other suggestions as matters
change (and that's why we are going in today.)
keep you posted. Again, many thanks,
something I thought might be interest if you are planning any
addendums to your web page:
some cats develop CRF at a young age, it does seem to be (am
I correct in this assumption?) something more likely that will
happen to an older cat. If that is the case, I think it is important
to make sure that a complete geriatric workup be done to see
if anything else is happening. If one's vet isn't real skilled
in the area of small animal geriatrics, it would be good to
have a consultation with a vet who is a specialist in this area.
vet had complete x-rays made of HT as part of the overall "intake"
process and sent them out to another vet to read -- a vet who
does happen to specialize in animal geriatrics. This vet noted
"patches" on HT's elbows which he has diagnosed as arthritis.
Our assumption is that some of his lethargy, stiffness and what
we thought might be muscle wasting (which didn't seem to make
sense because he was gaining weight and all other vital signs
seemed fine (ie., potassium levels, etc) was due to difficulty
in moving around. We now think that he has been in a lot of
pain due to the elbow problems.
is a (somewhat new) drug out for arthritis in cats and dogs.
It seems to work well in 75% of cases, and makes a fairly dramatic
change. In the other 25%, there is just no change at all. (These
statistics are from my own vet's practice.) It's called Cosequin.
It takes 4 to 6 weeks before you can tell if it will help. We
are only in week two but keeping our fingers crossed.
just seems to me that while CRF is such an overwhelming situation,
it may be easy to think that everything is caused by the CRF.
Making sure that nothing else is happening is real important,
too. And perhaps if there is also something else going on, it
may be treatable and help keep the kitty comfortable.
small thing: my vet suggested using a baggie to catch the urine,
more room to manipulate it between the cat and the litter. This
worked very well for me as I was not successful with plastic
containers. Then I just sealed the baggie, rinsed off the outside
and put in refrigerator.
glad to hear that Avatar is hanging in there. Mitzi is still
doing very well. She had a rough eleven days last month because
the Baytril I was giving her for a urinary tract infection destroyed
her appetite and gave her reflux. She lost a lot of weight and
was looking absolutely miserable, but 36 hours after her last
pill she was much better, and has now regained all the weight.
have been experimenting with diet supplements, and highly recommend
two things that Avatar may benefit from if you haven't tried
them already: The first is Prozyme* (probably there are other
suitable enzyme sources). The product contains enzymes to digest
proteins, fats, starches, and even cellulase (which mammals
don't normally digest unless they, like cows, have bacteria
that do the work). Since Mitzi has had Prozyme mixed in her
food, she has gained a little weight and has had less constipation
and vomiting (and I think it really helped her make a little
food go a long way while she was on the antibiotic). At first
I was concerned that the fewer bowel movements Mitzi was having
(as a result of digesting more of the food, presumably) might
cause constipation, but in fact we have required Petromalt *less*
frequently. A cautionary note: it is probably not good to leave
wet food out after it has been treated with enzyme, since the
enzymes are activated by moisture and predigested food makes
a great bacterial growth medium. (I am concerned that my leaving
treated food out may have contributed to Mitzi's recent UTI.)
also give her about 10 IU of Vitamin E daily, either from Nutrimalt
or by squeezing out a drop from my own 400 IU capsule. I know
that it is Vitamin E that is responsible for keeping her coat
in great condition and preventing shedding (and the resulting
hair balls and constipation); twice when she lost her taste
for Nutrimalt for awhile, her coat became scraggly again. Linatone,
another skin-and-coat supplement, did not help, I think because
it has a lower dose of Vitamin E. In each case Vitamin E from
my capsules restored her coat after a couple of weeks. I also
think that oxidative damage may have a lot to do with geriatric
organ deterioration, so as long as I'm sure to do no harm, I
think it is good to experiment with antioxidants.
that end, I am also adding to her food small amounts of Vitamin
C powder (a few milligrams--since I don't want to acidify her
urine with too much), on the grounds that an old cat may not
make it herself that well anymore. I also make sure Mitzi gets
extra A and D, usually from a little cod liver oil. I can't
say whether I have seen any benefits from adding Vitamins C,
A, or D, since there are no controls in the experiment. Anyway,
she looks great.
took a look at the book "The New Natural Cat" at the bookstore
last month (can't remember the author) and noticed that the
diet supplements recommended for CRF cats is very much what
I have worked toward, which surprised me since I am naturally
skeptical of things that are, well, "natural." The author did
recommend a rather whopping dose of Vitamin C, which, as I mentioned
before, concerns me since it is so acidic; maybe it is OK, though.
An idea: maybe potassium ascorbate would be good for CRF cats,
since it offers both neutral Vitamin C and the potassium supplementation
that is crucial for many CRF cats?
hope some of the above may be useful to Avatar or other cats.
Thanks again for maintaining this great site for us! I look
forward to seeing the feedback you have been getting from people.
a follow-up letter, Stephanie wrote, "I hope you find Prozyme
useful for Avatar. One thing to watch out for: I'm not *sure*
about the correlation, but I think that when I have added too
much enzyme to canned food, it has resulted in the food foaming
up in Mitz's stomach, causing her to vomit. (I guess the enzymes
just go crazy with the food as soon as they hit the stomach
acid.) I've not noticed any problem using the recommended amount
(more than 1/16th teaspoon per 1/3 cup) on the dry food; perhaps
this would make sense, since the dry is more "time-released"
in that it takes awhile to turn to a mush so that the nutrients
are accessible to the enzyme. For wet food, I add a sprinkling
of Prozyme (mixed-in) only to the amount she is likely to eat
when I first bring it to her, and leave the rest of the canned
food out untreated, since I am concerned about the digested
stuff becoming a nice bacterial-growth medium if left out during
have a soon to be (hopefully) 19 year old Siamese that has been
in renal failure for three and a half years.
my walls hang more ringers than pictures. On my counters are
periactin, tagamet, lactulose, drip lines, needles and who knows
know about the roller coaster that you speak of very well.
I write this, she's lying next to my foot weighing more than
she did two years ago, her creatinine and BUN are the same as
they were when this all started and most importantly, she's
still enjoying her life, albeit much more slowly. It has been
a tremendous effort but I've had the help of two very good people,
my vet and technician. When they saw that I was willing to go
the extra mile, they went the extra five.
learned a lot and found a few things that work that aren't in
also had the added problem of having a three legged cat that
for some reason that we haven't fiqured out, loses the use of
her only hind leg when given periactin. Best of luck.