Blood Signs and Starting Treatment - Part 2

July 2009 - Tests & Treatment

Before continuing with Simone's treatment facts and figures, I want to write a few words about this business of taking care of cat with a potentially fatal illness.  Why bother?  Why take the time and incur the expenses?  Good grief, this cat is almost 20 years old!  

First of all, Simone is not just a cat.  She's a companion animal and a friend.  She has been with me for all but a few months of her life.  She has been with me for a third of my life.  With the exception of a few months cumulatively, we have spent over 19 years together sharing sleeping quarters.  She has been with me through the best and worst of times, always faithful and attentive, always there.  I cannot abandon her through her time of need.  Until this last year, she was always a healthy cat, never needing a vet.  As long as she responds to the CRF treatment and as long as she enjoys a quality of life with a measure of happiness and comfort, I will do all I can to help her.  I'm sure she would do the same if we could trade places.

From July 25 to August 10, 2009, we fought to restore Simone's kidney function.  During that time she was getting twice daily:  1/2 tab Tumil-K, 1/2 mL aluminum hydroxide suspension, 1/4 tab of cypro.  Each evening she received 50-mL of the sub-Q fluid to flush toxins out.  She received a second blood panel with the following results: 

BUN:  116 mg/dL  (36% reduction!  Yeah!)

Creatinine:  6.4 mg/dL (49% reduction!  Yeah!)

Phosphorus:  6.2 mg/dL (60% reduction!  Yeah!)

Calcium:  12.6 mg/dL (good balance with the phosphorus)

Potassium:  3.2 mg/dL (12% increase!  Yeah!)

It looked like Simone was on the rebound although she was still very low energy.  She had a uremic breath, a sign that her kidneys were still not functioning properly.  Based on the internet research, I found some supplements that were recommended for cats with CRF.  I started her on the following:

Renafood (from Standard Process Inc.):  This is an herbal supplement touted as a renal detoxifier and helps to maximize kidney function.  This product is actually for humans, but it is supposed to be very effective in treating CRF.  The supplement contains kidney bean plant extract, bovine kidney PMG extract, bovine kidney, enzymatically processed tillandsia and beet root, lactoxe, defatted wheat, oat flour, carrot root, Vit C, and Vit A.  Simone was given two tablets a day mixed in with the Hill's A/D food.

Renal Essentials (Vetri Science Labs):  This is a nutritional supplement for kidney support in cats.  It is like a vitamin pill.  It contains EPA, DHA, astragalus, lecithin, rehmannia, arginine, nettle seed, crdyceps sinensis, DMG, potassium gluconate, Vit B6, inositol, Vit B1, Vit B2, Choline, Folic Acid, and Vit B12.  Simone was given two tablets a day mixed in with the Hill's A/D food.

Here was the daily regimen early on:

[The medicines and supplements were mixed in with roughly a teaspoon of Hill's A/D cat food twice daily, morning and evening.]

One tablet of Tumil-K each meal.

One tablet of Renafood each meal.

One tablet of Rena Essentials each meal.

1/4 tablet of Cypro each meal.

1/2 mL aluminum hydroxide each meal.

50 mL of sub-Q fluids administered in the evening.

With the new treatment, Simone perked up considerably and some of her old behaviors were coming back, like following us around the house, wanting stroked, sleeping with us in bed, talking some, and eating her favorite food, tuna (eventually mixed it with Purina NF).

Next time I'll write about suppliers, costs, other supplements, and continued changes in Simone's health.  Purr on!!!

Simone & Me

“The soul is the same in all living creatures, although the body of each is different.”

>< Hippocrates

Blood Signs and Starting Treatment - Part 1

July 2009 - Tests

When I took Simone to get examined for the first time near the end of July 2009, the vet surmised that kidney failure could be the cause of her illness.  However, the final determination was made using a blood panel.  The vet labored intensively to get enough blood from an underweight, dehydrated, and crying Simone.  After several tries in several places, she finally got the bare minimum.  I took Simone home and waited for the hospital lab results.  Of course, when the results came in, it was confirmed that Simone had an advance case of CRF, with some numbers off the chart.  Here are the key blood factors that were tested for:

Blood Urea Nitrogen

This measure is often called BUN for short.  It measures the amount of urea formed from the breakdown of protein.  This is a waste product which with good kidneys should be flushed out in the urine.  The normal range is 12 to 34 mg/dl (milligrams per deciliter).  Simone's result was 181 mg/dl.  Ouch!  Obviously, the higher the number the worse the kidneys are functioning.

Creatinine

This measure is for another waste product.  If both the BUN and creatinine values are high, then that is a sure sign of chronic renal failure.  The normal range is 0.00 to 1.50 mg/dl.  Simone's result was 12.6 mg/dl.  Ouch!

Phosphorus

A cat with chronic renal failure (CRF) will have trouble excreting phosphorus (as phosphate).  A buildup of phosphorus can lead to calcium depletion.  The normal range is 4.0 to 7.0 mg/dl.  Simone's result was 15.5 mg/dl.  Ouch!

Calcium

As mentioned above, calcium is tied to phosphate.  Normally, the calcium level should be 100 to 200% of the phosphorus.  The normal range is 8.4 to 10.8 mg/dl.  Simone's result was 11.9 mg/dl.  Her little body was trying to keep up with the high phosphorus content.

Potassium

This electrolyte in cells is needed to keep muscles functioning properly.  An imbalance causes weakness, twitching, and possibly seizures.  A cat with CRF is subject to increased urination and vomiting, which can lower potassium levels.  The normal range is 3.8 to 5.0 mg/dl.  Simone's result was 2.9 mg/dl.  Ouch!

Other factors were measured, but the ones mentioned above were the most critical for diagnosing CRF.  First and foremost, Simone was dehydrated and not eating well, so we had to correct those conditions right away as her body was not properly eliminating waste products and she wasn't getting enough nourishment.  The only way to adequately hydrate Simone was to give her subcutaneous fluids, i.e. hypodermic needle injections of an electrolyte solution under the skin several times a day.  The vet's assistant showed me how to do it.  It was my choice:  either have them do it at great expense or administer the fluids myself.  I reluctantly chose the latter.  Ugh!  I had no medical training and no clinical experience, but I resolved that Simone and I could do this together.

Next, Simone had to start eating more food.  The vet prescribed cyproheptadine (cypro) as an appetite enhancer.  Then we had to get the phosphorus (phosphate) and electrolytes under control.  Aluminum hydroxide (found in some antacids) is a good phosphate binder, so that was added to her regimen.  To get her potassium up, Tumil-K (or RenaKare), a potassium gluconate supplement, was added.  To help with her diet, the supplements were given to Simone with Hills Prescription Diet a/d which is described as a critical care food.  It's a meat and fish based product packed with minerals and vitamins.  The soft consistency of this food allows for syringe feeding.

That's it for today.  In part 2 of this post, I'll talk more about supplements, the daily regimen, and the results of the second blood panel.   Purr on!

Simone & Me

"There are two means of refuge from the miseries of life: music and cats."
><Albert Schweitzer

Educate thyself! Learning About Simone's Illness

July 2009 - Research

Dang!  I can't believe it.  There was a technical error in my very first blog.  I mentioned that kidney cells lose function ... that's strictly not correct.  The part of the kidney that fails are the functional units called nephrons, which regulate the concentration of water and soluble substances by filtering the blood, taking out what is needed and eliminating the remainder as urine.  The nephron eliminates waste, regulates blood volume and blood pressure, controls levels of electrolytes (salts) and body metabolites, and controls blood pH.  Nephrons are the key operating units of the kidney and, without them, your cat, or you, could not survive.  The good news for cats and for us is that there are hundreds of thousands of nephrons, so, even if we lose a large percentage of them, the kidneys can continue to function with proper care assuming the continued death of nephrons is stymied.  Don't despair ... even with a loss of 75% kidney function, your cat can still survive and live normally.

Having noted my first technical error, it would be a good idea in this post to point you towards more knowledgeable folks.  I do not have a background in veterinary care, animal physiology, or animal science, so, as a word of caution, don't read this blog for technical and scientific accuracy.  If you're new to the topic of CRF, I recommend a few excellent websites.  When I learned about Simone's condition and the dangers of it, I was shocked.  She could die very soon.  I felt compelled to learn as much as I could about the disease and how to care for a cat with CRF.  I cruised the world wide web for several days, jumping from site to site.  Here are some of the best sources of information that I found:

Tanya's Comprehensive Guide to Feline Chronic Renal Failure

http://www.felinecrf.org/what_is_crf.htm

A cat lover by the name of Helen created this fantastic, extremely organized website that covers pretty much any question you might have about CRF.  It's fraught with hyperlinks to take you to other pages with additional information.  The name of the site comes from the author's first kitty who died from the disease.  Although she is self-taught, she has put together an encyclopedia of knowledge concerning CRF.  Look down the left-hand side of the home page to see all the topics that are covered.  Clicking on any topic will take you to a detailed description or discussion.

Living with a CRF Cat

http://cats.about.com/gi/dynamic/offsite.htm?zi=1/XJ/Ya&sdn=cats&zu=http%3A%2F%2Fwww.judysworld.net%2FCRF%2F

A woman by the name of Judy has created a website to address both the psychological and technical sides of CRF.  She kept a journal about her experience with a cat with kidney disease.  There is also a page with Frequently Asked Questions that may be helpful.

Feline CRF Information Center

http://cats.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=cats&cdn=homegarden&tm=259&f=10&tt=14&bt=1&bts=0&zu=http%3A//www.felinecrf.com/what0.htm

This site is co-authored by David DiFiori and Sandy Carr, but I could not find out any information regarding their background.  Their website has the usual information about CRF with an emphasis on scientific studies.  Also, owners of cats who have died from the disease can post a tribute to their cat.

Feline CRF Support Group

http://cats.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=cats&cdn=homegarden&tm=709&f=10&tt=14&bt=1&bts=0&zu=http%3A//groups.yahoo.com/group/Feline-CRF-Support/

Maintained since 1997, this service provides cat owners with a place to share their stories, get information, and contribute ideas.  A Yahoo ID is required.

Home Management of Cat with CRF

http://cats.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=cats&cdn=homegarden&tm=84&f=10&tt=14&bt=1&bts=0&zu=http%3A//www.fabcats.org/owners/kidney/crfhomemanagement.html

This is a short article by Dr. Sarah Caney about CRF, the ideal diet, and treatments of related problems.

That's it for today.  In the next post, I'll write about blood analysis and starting Simone's treatment.   Purr on!

Simone & Me

"Most of the shadows of this life are caused by our standing in our own sunshine."
>< Ralph Waldo Emerson

First Post Ever: What Is Happening to My Cat?

JULY 2009

[This is my first entry on my first ever blog!  I'm definitely meandering through an unknown sea in hyperspace, but, while holding my virtual nose, I'm diving in.]

In July 2009, my best feline friend and companion, Simone, was diagnosed with chronic renal failure (CRF).  She was 18 and a half years old at the time and had never been seriously sick in her life.  I knew for several months that something wasn't right with her.  Her behavior had slowly changed until she wasn't the cat I had once known.  She went from being very social, chatty, and affectionate to being quiet and withdrawn.  She often sat and slept like a Sphinx, instead of curled up on her side.  There was a sour odor about her and she had lost weight.  She seemed unhappy and often hid in dark areas.  What had happened to my best feline friend of 18+ years?  I missed her greeting me at the door, crying for attention and affection, curling next to me at night, and snarling at the other pets in the house.

After returning from a vacation in July 2009, it was clear that Simone was doing badly.  I took her to the vet as soon as possible.  After the blood tests came back (more about blood tests later), the vet told me she had chronic renal failure.  I didn't know what the hell that was.  I could tell in the vet's voice that the prognosis wasn't good.  Simone had a pretty advanced case of the disease.  Later I learned that CRF is a progressive disease and a silent killer.  Kidney cells lose function slowly but there may not be any outward signs of the disease until maybe 70% of the cells are gone.  By then it may be too late to save the cat.  In her most optimistic voice, the vet told me that CRF was treatable and recommended starting treatment immediately.  Of course, I agreed ... whatever it took!  But later she told me that she didn't think Simone would live very long.

The reason for this blog is first to tell the story of Simone and how she deals with her illness, but, even more importantly, I want to convey a sense of hope and optimism to cat owners that face a similar situation.  Yes, CRF can be deadly, but, if the cat is properly treated and cared for, a decent quality of life can be maintained.  Simply put, if you arm yourself with knowledge, patience, persistence and some money, the disease can be kept in check.

Future entries of this blog will present Simone's history, CRF resources, vitals, Simone's personal treatment, selection of veterinarians, info on medicines and supplements, treatment costs, and whatever else comes up.  Stay tuned and purr on!

Simone & Me

"In exchange for not killing and eating animals, they, in turn, will not kill you from heart disease, stroke, cancer, and so on."
>< MW