Kafka was a very healthy cat as of May this year (2002), except for having hyperthyroidism, which was being controlled very well with Tapazole. The only problem was, he had a relatively large thyroid tumor, which seemed to be starting to make swallowing difficult. We had been monitoring its size for a year, and finally, my vet suggested I go to a veterinary oncologist, who specializes in the radioactive I-11 (?) treatment of thyroid tumors. The oncologist examined Kafka and performed a scan of his body with radioactive material injected in him. She said the bulk of the tumor was not active thyroid cells, and concluded that, although it is very rare, his tumor was quite possibly malignant. She said the I-11 treatment would not be effective, and recommended surgery.

I was very upset to think that we'd sat on a tumor, that could be malignant, for a whole year, and scheduled surgery right away. My vet performed the surgery and released Kafka the same day. The tumor turned out to be benign, and we thought our worst fears were over. After surgery, Kafka was fine for about 1 1/2 days, then started acting very strangely. We had been giving him pain medication, and thought he must be in pain, so fiddled around with the dosages and frequency of his medicine for a couple of days, until finally, after he still hadn't eaten for days, he was rushed to the emergency vet, where he even had a seizure. It turned out he had become hypocalcaemic, and could easily have died. This happened to him because one of his parathyroids was damaged or removed during surgery, and the remaining one was either damaged or inactive. In any event, he had been exhibiting a classic symptom of hypocalcaemia (facial twitches/blinking), yet we had no idea of its significance b/c our vet had never mentioned the possibility of hypocalcaemia to us. After that, I did research on the internet, and virtually every article I found on thyroid removal mentioned this "calcium crisis" as a possible side/after effect of the surgery, which could have been easily avoided with careful monitoring of his calcium level for a few days.

After this episode, his calcium and thyroid levels had to be checked every few days and, after about 10 days, the tests revealed that he had a new problem - renal failure. It was at this point that we took him to veterinary specialists, and he was put on subQ fluids and many of the typical meds for CRF-related problems. We were able to maintain his creatinine level at around 4.6 for a while, but in September, it had shot up to 8.3, and he was in obvious distress the day we had him put to sleep.

After Kafka was diagnosed with CRF, I did research on its connection with the thyroid. I learned that hyperthyroidism often masks the presence of kidney deterioration/CRF, and the removal of the thyroid is very often followed by a showing of renal failure. Most distressing is the fact that, again, all of the articles I found (after the fact) warned of this possibility, and suggested that with an older cat, more thorough testing be done for the presence of hidden kidney failure. If it is possible or likely that the cat has some renal failure, surgery is not recommended, and management with medicine is preferred. (The same advice goes for the I-11 treatments). I really wish we had been told all of this before we opted for surgery!

Of course, we were faced with a pretty big tumor and the oncologist's opinion that it was malignant, so we might have had to go the surgery route anyway. However, perhaps the mass could have been biopsied and, given that it was benign, we could have opted for medical management of the hyperthyroidism. One other thing that has always bothered me was the possible connection between the episode of hypocalcaemia and the renal failure. Kafka was in very bad shape for those few days after his surgery, and I know that thyroid and calcium levels are very important to the kidneys. I can't help but think that the shock to his system probably kicked less-advanced CRF into full gear, which he might not have experienced otherwise for a few more years.

I'm just heartbroken that only months ago, Kafka was a healthy, happy cat, and that a manageable illness like hyperthyroidism eventually led to his death. Knowing that hyperthyroidism is so common in cats, I wish that we had been told about the calcium issue and the possibility of CRF following the thyroid removal. At the very least, I think vets should give out a handout or article on these issues. I wish I had done more research before Kafka's surgery, and can't help feeling guilty that I didn't. I guess I assumed the vets would tell us of any risks involved - bad assumption.

Liz

I have a cat that I got when she was approximately 4 months old - a barn cat. She has been an indoor/outdoor cat the whole time. She was diagnosed w/CRF when she was 16. Her BUN count was 69 and creatinine 3+ . I was told by one vet that even if I did fluids daily she would only have months to live. She also has a heart murmur rated 4/6. I of course could not accept what this vet said, and quickly made an app't for her reg. vet (who was out of town when I got the diagnosis). He agreed that daily fluids would be best, but stated that they have had cats that lived anywhere from months to years. I told him I was unable to do the daily fluids & I would not stress Chelsea into doing that. He suggested hooking her up to an IV and running 1 bag of fluids thru her every day for 3 days. We did that. That was October 2000. Her BUN count went down to 30 and creatinine 0. something.

Chelsea had always been spoiled and ate whatever she liked - from age 14 on she ate only boneless,skinless chicken breast. Prior to that she ate 9 lives canned and dry (but then they changed it to new & improved, and she no longer liked it) She no longer eats hard food as her teeth are few and far between. I couldn't get her to eat any of the prescribed food, so I decided I would make her as happy as possible for as long as I could. By Nov of 2000 her BUN & creatinine were above normal. I started experimenting with food. She would eat pork chops, bacon (which I thought was good because of the salt, she would retain and drink more water), she still was fed chicken, turkey and now her main food was tuna,(starkist in water) drained - she would drink the water, then eat the tuna only after it was mixed with miracle whip - not mayo. she also likes vegetable oil on top.

My cat now is 20. It has been 2 years since she has been diagnosed with CRF. She has lost weight, her normal weight is around 8 pounds, she is now about 6 1/2. She has bouts of constipation that I'm treating now with mineral oil (added to her tuna water). She is deaf in one ear, and losing hearing in the other. She has cataracts. A lot of fur dander, and where they shaved her fur for the last blood test, (3 months ago) it still has not fully grown back. The vets can't believe how well she is doing! She has rec'd no treatment EXCEPT for the 3 day of fluids once per year, Oct of 2000, and again in Oct of 2001. She eats tuna, oven roasted turkey lunch meat (does not like honey roasted or any other type of flavor), pork, roast beef, deer meat, chicken, Kentucky Fried Chicken, Boston Market Chicken, and turkey. I give her a few treats daily. She drinks tuna water, and water. The vets can't explain it, other than she's a tough old cat. I can't explain it but cherish every day I have with her. Like I said, she has always been extremely spoiled, and very much loved. I don't know how I will deal with the day that she goes. Unfortunately, I have no children ~ and she has become mine. My husband says I'll need therapy - I just might. Anyway, just wanted to share my story with you, I don't know if it’s the miracle whip that helps, the veg oil or what, but anything that can be helpful to anyone else, please share.

Hi, Your website is wonderful, it helped me so much. After 2 years of caring for my "Juliet" with kidney failure she passed this week. I want to offer perhaps an insight to my cat's failure. Prior to my change in vets, the old vet gave Juliet shots of cortisone for years for skin allergies which she had badly in the fall months. What I believed to be standard practice. Upon bringing her to the new vet who cared for Juliet in her sickness, she believed that the shots of cortisone caused her kidney failure. I wish I had know that. Please let your readers know that this may add to an animal's kidney failure although I could never prove it.

Thank you once again for this website.

Deborah

Hi,

Having had one cat in kidney failure and on sub-q fluids for two years (18 months of that time on Epogen) and another on sub-q fluids for nearly three years, I offer a couple of tips that may help someone else, if you want to use them somewhere.

On fluid-giving at home, I learned:
1). Don't be afraid to learn how to do this. It's usually much less stressful for your cat to do it at home, and you can use the easy-to-learn needle skill for giving some other medications (such as some antibiotics, and Epogen) in a way that is virtually stress-free for your cat and for yourself. (Especially if you have cats that will NOT accept pilling or liquids.)

2) Each cat had a totally individual "style" preference -- and figuring out that preference was essential to low-stress and successful fluid-giving. Venus I stretched on her side and held her firmly and vigilantly down at her shoulder with one hand while giving her the fluids with my other hand. I could NOT ever relax my firm hold on her or she was halfway across the room. But Lily turned into a demon when I tried to hold her in any position at all -- and it turned out that she was completely calm (although wearing an enormously martyred expression) if I simply let her sit and stand and move around slightly while she was receiving fluids. All I needed to do with her was the lightest of occasional touches to keep her from moving too much.

3) A cat usually has not only a favorite way to be held (it's even possible to hold the cat in your arms, if that's what he or she prefers), but a preferred PLACE for you to insert the needle. Lily preferred the area just around her right shoulder. When the skin eventually got tough there I had to switch to the left shoulder and that was upsetting to her for several days until she got used to it.

4) Warming fluids gently (letting the bag sit in a pan of hot water for a few minutes) really can help in colder weather.

On Epogen:
It was truly a miracle for Venus, who stopped producing red blood cells on her own very soon and very dramatically after she went into kidney failure. It completely gave her her zest back.

A strange dosage note that may help somebody: Venus started out doing very well on twice-a-month injections, but gradually over the next 7 months she stopped responding so well. My wonderful vet worked very hard trying more frequent and larger injections. Finally, when even twice-a-week injections at the maximum dose were no longer helping and she was rapidly approaching a dangerously low PCV -- in fact, in looked like I had only a week or so left with her -- he suggested I could give her Epogen every 48 hours, which was the limit allowable for the drug.

And that was another miracle -- she instantly responded. For whatever reason, it turned out she needed her Epogen every 48 hours. Twice a week was not enough! We did PCV tests every week for her last year, and we had to keep cutting the Epogen dosage down until she was getting just a tiny tiny amount every 48 hours (at one point, until we found the correct tiny dosage, she even had TOO MANY red blood cells for a few days). She stayed steady as a rock at 40% for her entire last year. A miracle! Someone may find this every 48-hour thing helpful -- if we hadn't tried it in desperation, she would have died.

On food:
It may help to let your cats eat their food off your fingers, or out of the palm of your hand. (If your cat likes this, once you start, you may never be able to stop, though!) Finger-or-hand food seems to be harder for the cat to ignore than a plate or dish of food. (None of the other tricks I've read about -- warming food, sprinkling it with various things, etc. ever worked for us.)

Don't give up on your cat because he or she is gaunt. They don't seem to mind as long as they keep enough strength to do what they want. Lily appeared to have no thigh muscles left for a very long time before she died, but she could still jump up onto chairs and do what mattered most to her.

Be creative about food -- neither of my cats would eat the proper low-protein food (in any variety, canned, dry, or home-made) for the last years of their lives. I mixed Venus's regular canned (high-quality) cat foods with cooked rice and she accepted that pretty well. It may not have been a good healthy solution, but it was the only one she would accept. Lily put her paws down and made it clear she would rather die than eat any more low-protein food, or any rice mixed with food -- so she spent the last three years of her life eating whatever she wanted -- any and every variety of canned food; and people food frequently. I know it is exactly the opposite of what every vet would recommend -- but she deserved to make a choice she felt so strongly about.

On quality of life:
I was lucky -- even though my cats had a couple of rough spots (Venus especially) -- most of the time they were simply happy and clearly feeling OK. For each of my amazing and beloved ladies it was a gentle way to leave their lives here, Venus at 18 and Lily at 20. It's not an easy human thing to do, but so many cats are strong and matter-of-fact -- and generous-- and enjoy what is, more than mourning what was. There is so much joy in giving to your cat, and in honoring his or her spirit and his or her wishes. I wish I could help everyone on this path.

Trudy

I don't know why there isn't more info about PEG tubes related to CRF management. I have a cat that was diagnosed with CRF 14 months ago. The Veterinary Teaching Hospital where I live highly recommended placing a PEG tube - as they recommend in general for CRF cats.

I was very skeptical about it, but I now attribute how well she is doing to the PEG tube. Her creatinine and BUN values have been maintained at virtually the same levels the past 14 months. Because of the PEG tube she gets the recommended low-protein diet which she's not interested in eating on her own; she gets enough calories to maintain healthy weight; she gets all her fluids via the most natural and effective route of absorption (the digestive tract) without having to be traumatized with needles, and she enjoys the feeding times. She runs into my room and perches on my leg during feedings, purring all the while. She still eats some food on her own. The feedings through the PEG tube stimulate her to eat, since she is usually nauseous on an empty stomach and doesn't feel like eating on her own.

I have been in touch with several schools that provide kidney transplants and several specialists with which I've spoken have told me that some of their clients have PEG tubes placed before transplants, then cancel the transplant because their cat does so well after having a PEG tube. Of course there are drawbacks to having a PEG tube - including obligations of the owner. I give my cat water or food through hers every 3 hours, except for through the night when I sleep. But I'm sure there are other owners such as myself who would prefer this option over the other alternatives. I also think public opinion may be more negative about PEG tubes than is warranted if they had more information.

Hi! I think I have written you before re: my cat, Chelsea. She will be 21 mid March, diagnosed w/CRF in Oct of 2000. At first the vet gave her 6-8 weeks, because of her age and test results. In Nov of 2000 I had her admitted & she had a bag of fluid ran thru her a day for 3 days. This brought all her levels back down to normal. During this time she ate tuna w/Miracle Whip, the tuna water, occasionally chicken (I know all this is bad for her because of the protein, but it was all she would eat), pork, ham, and occasionally bacon. In Oct of 2001 I had the same done again. In Nov of 2002, the vet & I discussed having this done again, but agreed she wasn't strong enough (she has to be gassed - knocked out - for the catheter, and the stress of being left at the vet for 3 days was too much for her, even tho I visited twice daily). Starting in Nov I have taken her weekly to have fluids under the skin. She gets on the avg 250-300 cc. She's still doing ok for the most part. She is 80% or more deaf, and has cataracts - all caused just from being old.

The vet can't explain why she's still w/us, except for the fact that she's a very, very strong willed cat. I just want to tell people not to give up, and to experiment with foods, even tho they may not eat whats healthy for them, sometimes it just works. My cat is extremely spoiled, and I will do anything for her, she's like my child - especially since I have had her since 4 months old. I feed her whatever she likes and hold her and talk to her as much as I can. People say that she is truly a miracle and its because of the bond of love we share and the strength we give each other. To be 21 years old is a wonder, but with her medical condition it is just amazing.

I have been giving fluids to my cat, Annie, for the past 8-1/2 months. Foolishly, without question, I purchased the fluid from my vet. At $69.00 per carton of twelve.

I inquired at Sam's Club if the product was available there. As it turned out, it was.......at $19.00 per carton. There isn't anything I would not do to keep Annie with me. In addition to the fluids twice a day, she receives Epogen twice a week and Alternagel twice a day.

Just a word of advice and caution.......ask around to get the best possible price for the care of that little, precious life.

Barbara