December 29th, 2009
I’ve been meaning to write this up for quite awhile as another data point for people whose cats are sick, and I’m sure that my desire to concentrate on our veterinary success story while we’re waiting (and waiting) to find out my mother’s cancer prognosis is a pretty obvious case of transference, but it’s good to think about things that work, sometimes.
In the summer of 2004, we adopted a second cat from the Multnomah County Humane Society in Portland to keep company with Zoot, our highly sociable four-year-old bachelor cat. Oyster came home from the pound with an upper respiratory infection that required emergency care, and despite our best attempt at quarantine, Zoot picked it up and became so ill that we had to feed him with a syringe of paté-style canned food for almost a month.
It’s not quite clear what happened next, medically, but shortly after Zoot began eating on his own again, he ended up back in the kitty hospital with acute renal failure. Several months and a few more episodes later, we got the bad news: his kidney function was down to less than 25% (Stage III, if you want to keep track), and the loss of function was permanent. Chronic renal failure in cats is degenerative and fatal, and the survival of a cat with Stage III test results is usually measured in months rather than years. Our vet recommended a prescription diet (which he wouldn’t eat, natch), a short course of steroids, and IV + hospitalization if/when he “crashed,” which he did twice more over the next six months.
So I went to the internet, found a lot of sad stories and some gently optimistic advice, cried a lot, and began working out a much more active plan of treatment in consultation with a new vet who was equally good and closer to home.
Five years later, after bouts of obvious illness, a lot of wrangling over food rejection, and many boxes of medical supplies later, Zoot is stable, eating like a champ, and just got back bloodwork that is officially Stage II, one step back from the Stage III and IV numbers that had characterized his first few years with the disease. Our vet in Portland used the word “miraculous”; our new vet in NYC paused for a long moment on the phone and pronounced the numbers “very, very good news.” Every time I pick him up and feel meat on his bones, my heart does a dopey little tap-dance.
Mostly, we’ve gotten incredibly lucky. Zoot was deathly ill several times, and there’s no way to know why the disease has been so slow to progress. That said, it’s pretty clear that some of the things we’ve done have made a big difference, which is why I’m documenting this now. We won’t always have him, but five years is an extraordinary gift.
What We’ve Learned
If you have a cat who’s been diagnosed with CRF and you somehow wound up here first, which is unlikely, start with Tanya’s Chronic Renal Failure Information Centre, and the Feline Chronic Renal Failure Information Center. They both have an enormous amount of information and offer good entry points for people who are new to the disease. (One personal recommendation: skip the stories about cats who didn’t make it. You can always read them later, but for now they’ll distract you from your mission, which is to help your cat.)
- The mantra of the online feline CRF research and support community is “Treat the cat, not the numbers.” They’re right.
- Cats telegraph all sorts of things if they’re socialized and you’re attentive. Extra hunching = extra antacid for a few days; dampened appetite means food rotation, extra antacid and dehydration checks. You can’t stay ahead of everything, and the disease progresses unpredictably and despite wonderful care, but some things you can help.
- Subcutaneous hydration is not often recommended by vets, but it seems to dramatically improve quality of life and, in some cases, extend it. This is, I think, the most critical part of our treatment, and we’ve gradually gone from 100ccs of fluid once or twice a week four years ago to 200ccs every other day.
- The prescription diet is important, but it won’t help if the cat is starving. CRF cats go off their food all the time; my theory is that the spells of nausea and vomiting produce the same revulsion response to food in cats as it does in humans. Rotating in healthy (and even less-healthy) canned foods when Zoot goes off the prescription food has kept his weight up, and the heavier he is, the better his overall health seems to be.
- Pepcid A/C, regular strength, is the only actual drug we use. We’ve tried some vitamin and herbal supplements that didn’t seem to help him feel any better or move his numbers, and most of them decreased his appetite, so away they went.
- Most vets are quite good. Great vets are rarer, but worth finding. Some vets will over-test, over-supplement, and over-treat CRF cats while attempting to scare owners into extra treatments. These people suck. For us, doing less at the vet’s has been really important: no vaccinations (he’s an indoor cat), bloodwork only twice a year unless he worsens rapidly, and more treatment at home (sub-Q) have produced a healthier cat.
- Practical stuff really matters, if you’re fortunate enough to have a cat stabilize for long-term treatment. Finding the right needles, the right venoset, good suppliers for everything, a good setup for hydration, and a great cat-sitter who can do hydration when we’re away has made a big difference in how long-term treatment has affected our stress levels and financial situation. Calm, happy people make cats calmer and happier too.
Here’s what we use:
- Prescription food: Hills K/D dry and Royal Canin LP pouches wet. No kibble would be better, since dry food encourages dehydration, but kibble keeps Zoot’s weight much more stable, and that in turn seems to help him feel better overall. We get both from Southern Agriculture.
- Ringer’s solution and Bauer venosets from Thriving Pets. Nice people, superfast shipping. They accept emailed scans of prescriptions, too, so you don’t have to find a fax machine.
- Terumo 20-gauge needles. These are famous in the CRF world for an excellent reason, which is that they kick the ass of everything else—they’re wickedly sharp and the 20-gauge runs as fast as 18-gauge (much larger) needles from other manufacturers. We get boxes of 100 by calling Farris Labs (800-537-0411), because their shopping cart is always down. I like them too much to switch now, and I get my sharps containers from them as well.
- Pepcid A/C regular strength, 1/4 pill per day. If he’s queasy, I bump him up to twice a day for a week or so and then back down.
In the end, it’s about keeping everybody warm, hydrated, chill, and fed. Good luck to all humans and kitties.