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Caregiver Feedback (Page 1)

The opinions expressed in the Caregiver Feedback pages are those of the authors and do not necessarily reflect the opinions of the Feline CRF Information Center.

I 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 with them.

Would 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.

On 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.

On 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.

Finally, 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.

Hope some of this is of value and keep up the good work.

 

-Melinda Sheridan
jsherida@netcom.ca

*On August 14, 1996, Spike lost the battle with CRF. His photo and story are in the Tributes to CRF Cats Gallery.


Just 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 help.

- Martin


I 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 again.

In case it might be useful, below is an excerpt from a letter I recently sent to someone whose cat was just diagnosed with CRF -

I'll blather on about my understanding of the relative significance of creatinine and BUN:

Creatinine 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 slightly.

BUN, 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.

Since 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 a meal.

Dry 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.

I've 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 likes it.

Just 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.

The 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.

-Stephanie
meyer@biosun.harvard.edu


Many thanks 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.

Whether 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.

Thanks again for your excellent webpage.

Terry Humby

In 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)."


My 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.

My 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?)

I 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.

With 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.

Just one more thing to consider. Thanks for a great page.

Susan

*Reka Mao lost her fight with CRF on October 20, 1996. Her photo and story are in the Tributes to CRF Cats Gallery.


I 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!

I'd also like to tell you a little about my own experience. If you find anything useful, please incorporate it into your page.

My 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:

Don't 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.

Don't 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.

Don't 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 to CRF.

Don't 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.

I 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.

Take care and good luck with your kitty,

Louise
WilsonTnL@aol.com

*Lucky lost his fight with CRF on July 20, 1997. His photos and story are in the Tributes to CRF Cats Gallery


I 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.)

I read everything late at night, printed it out, and my husband and I have underlined and read it this morning.

Timing is perfect as our cat is going in for a check up this afternoon.

Our 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.)

After 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.

We're 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.

The 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.

I 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.)

I'll keep you posted. Again, many thanks,

Carol


Here's something I thought might be interest if you are planning any addendums to your web page:

While 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.

My 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.

There 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.

It 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.

One 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.

Carol


I'm 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.

I 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.) :-(

I 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.

To 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.

I 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?

I 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.

Headbumps for all,

Stephanie (& Mitzi)
meyer@biosun.harvard.edu

*In 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 the day."


I have a soon to be (hopefully) 19 year old Siamese that has been in renal failure for three and a half years.

From my walls hang more ringers than pictures. On my counters are periactin, tagamet, lactulose, drip lines, needles and who knows what else.

I know about the roller coaster that you speak of very well.

As 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.

I've learned a lot and found a few things that work that aren't in the books.

I 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.

Jim