Our beloved Pesto died in our arms last night after an 8 month struggle with Chronic Renal Failure. In the hope that something we learned may be of use to others here are some details of what we learned.
Get your cat’s kidney values checked annually after 8 years.
THE most important thing you can do is diagnose early and take measures before too much damage is done. Please learn from us and heed the words on this site – and tell others – you prolong your love (and probably save money too) if you get annual blood tests and track BUN and creatinine levels over time.
We found out about Pesto’s CRF the hard way; through an acute renal failure event. She had slowed eating over some weeks and then was listless. Our vets did house calls – but as a second priority to emergencies. Pesto was very opinionated and hated going to veterinary offices. Sometimes she appeared so stressed when we took her, we thought the visit was doing more harm than good. So we delayed her check up waiting for a house call time slot. This almost cost her life. Our first vet did not take a blood sample on the home visit. This would have caught the problem before it became acute (cost I think $200). When we finally brought her in, a blood test showed she had very high BUN and a urinary tract infection. After 7 days of heroics (coming in on his days off and late at night to check on her), IV fluids and amphigel (to get rid of Phosphorous), our vet was able to save her. She hated being in the vet’s cage but we came and visited her at least twice a day and stayed and sat with her. This could have been avoided if we had her kidney values checked annually. We both have a great deal of guilt, and anger, over this.
Find a vet you trust and who sees your family member in the same way you do – who has experience with this disease or is willing to read and learn.
With CRF you will have a very intense relationship with your vet. Ideally you should find someone who has treated CRF cats before. Sadly, that is not hard to find. You also need to find someone you are comfortable with and shares the same philosophy on pet care, life and death. This might become a critical factor when it comes to the end of your pets life. This is the worst time to be questioning whether you are with the right vet. We were lucky to have two excellent vets. We did end up switching our vet after a few months into the diagnosis. Our first vet was an outstanding clinician in traumatic cases, however we felt Pesto was one of many animals he was trying to take care of. We needed more attention than he could give.
We switched vets to Dr. Gerry Dendzel in Orinda, CA. He was closer, had fewer patients so could spend more time thinking about Pesto, answered our calls and patiently answered our questions, was open to our suggestions, and also did house calls – but he made a significant point; you need to acclimate your pet to visit the vet (feed her in the car, take her on short non-traumatic trips, etc.) since this is a terminal disease and, if you are lucky, you will be having many visits.
They have to eat
Once diagnosed your cat will be switched to special foods. Fortunately, Pesto tolerated the new food. When she got sick of one brand, we switched to another. There are many different canned kidney diets out there, Science Diet, Kd, Purina, Royal Canin and others. However, all of a sudden the commercial foods started to make her ill and therefore she would not eat. She lost a pound. This is when our vet came up with this recipe for her. She ate this diet for the last three months of her life and gained a pound in the process.
Pesto Diet, a la Dr. Dzendzel:
1 part (1 cup) boiled organic chicken breast
1 part (1 cup) frozen string beans
2 parts (2 cups) boiled white rice
Boil the chicken in enough water to cover and cook the rice, boil till cooked through and then simmer white rice in the same liquid (with the chicken in) for about 15 minutes (till slightly overcooked). Add the string beans and cook 3-4 minutes (just till tender). Once cool, (chop chicken up first) measure and put this all together in a food processor until it has an oatmeal consistency (add water). Then serve and refrigerate leftovers (it does not keep as long as canned food).
To insure freshness, we would make this in small batches every few days. She loved this. The most important thing cats can do with CRF is eat and maintain weight. In our minds, protein intake and nutrition is secondary if your cat isn’t eating at all.
In the end we also supplemented with Nutrical, a vitamin/high calorie supplement that we squirted into her mouth 2x a day (4mls) from a 5ml syringe. That has lots of oil and maybe this was not ideal.
You will have to learn, and get used to giving, pills.
At the beginning, we thought we would never learn to give pills to Pesto. We used a pill wand and ‘Pill Pockets’ (available at many Pet stores) Pill Pockets are little globs of food paste that you can wrap and load into the pill shooter. Maybe you will be lucky and your cat will simply eat the pill pocket with the pill in it. However for the rest of us it will be necessary to learn to give the pills using the wand. This can be shown to you at the vet’s office. It does take some practice.
Reach over their head and firmly but gently grab her upper jaw with your forefinger and thumb and then slowly pull her head back so she is looking straight up. The mouth will open and you can quickly, and carefully, use the pill wand to pop the pills to the back of their tongue. Be careful so you don’t gag or choke them.
We had a whole routine she got used to. We would lay out a large towel and wrap her in it so only her head was out. When we were first learning, this “toweling” was self preservation. (She sent one technician to the hospital who tried to give her pills without toweling.) Wrapping made Pesto feel safe. She liked being cuddled like this and then, when calmed, we would give the pills, Carafate and Nutrical.
Perfusion helped prolong her life.
We ‘perfused’ (sub-cutaneous fluids) nightly 150 mls of warm, lactated Ringers. When Pesto’s weight dropped (from 9.5 to 8.5lbs) we went to 125 milliliters a night. We heated the fluids to 90 F with a heating pad (we got a reptile terrarium liquid crystal thermometer to measure the bags temperature: $3) and kept a nightly map drawing of where we injected so to rotate over a wide area. Pesto was so good that she let us do this with no complaint. She had a ‘better’ side (you could put in more at a higher rate without her getting antsy) and did not like around the spine. We did about 1/2 inch back from the shoulder blades and never more than 1.5 inches down from her backbone.
Have someone show you how to do this; it is harder to explain than it really is; don’t be afraid. Injecting really did not hurt Pesto too much; even when I messed up (which I did too often and she patiently tolerated). Pull out a tent of loose skin around the back of the neck (pinch a 1/8 inch thick layer and pull out about an inch) and poke the needle tip into the center of the tent parallel to your cat’s body – not down into her. We used the pink 21 gauge needles – 18 was too big and she did not like those. We used a fast drip set – not the low flow ones. We made her comfortable. We had a little box for this on the table lined with a sweater and would often play Barry White – (whose music she loved). Initially, we were concerned about the accuracy of the volume and bought Buretrols (you can get these online from companies like life-assist.com that supply ambulances and fire departments – get a prescription from your vet. We paid as much as $30 from the first vet but you can get them for $5 online.). Later, we got pretty good at gauging volume and decided the added complexity and risk of contamination was not warranted. Sterility IS a big deal; be careful (read about ‘sterile technique’ or ‘aseptic technique’ on Google). We did this for 8 months, sometimes 2x a day without any infections.
Watch for ANYTHING out of the ordinary
There is such a fine balancing act you have to work with; a little off here and it throws that off there. And Pesto tried so hard to not cause us anguish; we really believe she hid her symptoms.
Urinary tract infections
The symptoms that were red flags were frequent visits to the litter box with no urine – trying to go to the bathroom in strange places, scratching her paw on the floor to get our attention; right away that meant to check for a urinary tract infection. There are a number of antibiotics that can be prescribed but it is important to diagnose this early.
Dehydration was an issue, especially as the disease progressed, even with the ‘subQ’. Despite changing her water daily, after we started giving her fluids she drank NO water for the entire 8 months. She took to sleeping on our chest or back. We think this was to let us know she was in trouble and wanted help. Be kind, they are asking for help. We put her on a heating pad initially, which she loved, but we believe this led to possible further dehydration so we stopped it. These are not designed to carefully regulate temperature.
The lack of hydration meant she was prone to constipation. This meant straining and vomiting and stress on the heart. To deal with this issue we gave her a pinch of Psyllium husk (that is what is in Metamucil – get from a health food store) in her food once a day (maybe a 1/16th of a teaspoon). A little goes a long way. You have to be a little patient at first or you can overdo it (loose stools means loss of precious water). It is tasteless so Pesto did not reject it. The litter box had only a little litter and we would change it nightly so as to monitor and keep it clean. She was a very fastidious cat till the end. This meant that she would do anything to mask symptoms like loss of bladder or colon control.
This was our biggest battle because when cats are nauseous they don’t eat. When they don’t eat, they lose weight. When they lose weight they don’t have the strength to fight the disease. She licked her lips frequently, indicating nausea. She would come get us when the acid was too much and she knew it was time to get the acid reduction and anti nausea pills (Zantac and Reglan metoclopramide 1.25mg 2x per day).
We did lots of reading on this site and also looked what was being done with humans. It turns out Zantac (ranitidine 1/8 75mg pills 2x a day morning and eve) is much better tolerated by kidney and cancer patients than cimetidine (pepcid-ac). We had a pill splitter and zantac was hard to break properly, but if you read the contraindications/safety sheet (looking specifically for kidney issues) you can see what dosage is dangerous – ranitidine is pretty safe and so we erred on the high side.
Towards the end the issues become more challenging. When Pesto got a bleeding ulcer, common with the high acid production of CRF, we gave her Carafate (0.4ml 2x a day). This really helped though it was strawberry flavored and she hated it (we would give her 4ml of Nutrical right after to get the taste out of her mouth). With all this we were able to maintain decent weight levels so she could fight the disease.
We do not believe that feline’s are just prone to this disease. We think it is environmentally induced with maybe a genetic predisposition – probably something in the canned/prepared food. But we just feel that, have no evidence, and don’t know. We won’t be feeding canned and dry food if we live with another cat or dog. It also is amazing that we knew what was wrong and what needed to be corrected, simple electrolyte levels – not cancer – just ions and small molecules, but we could not fix it. We are still in such a primitive time period of medicine.
On her final weekend she lay out on the deck and seemed almost fine, basking in the sun and enjoying life. We carried her around to her favorite spots. She was a stray Norwegian Forest cat. Lord knows what idiot gave her up – and what a gift to us that they did. We feel cheated that we only had 8 months – after she was diagnosed. Yes, it was not easy – nothing worthwhile ever is. Caring for Pesto consumed our lives. It also gave our lives meaning. Would we do it again? Absolutely.
We miss you so much, Pesto. We love you. Good bye.
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