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Kidney problem or diabetes?

Species: Cat
Breed: Mixed domestic breed
Age: More than 15 ye
Hi Dr Marie,

Hicks is 17 years old now. Still moderately active. 2 years ago, she was diagnosed with marginal kidney problem through a blood test. Unfortunately, she is very fierce and impossible to administer any form of oral medication. As such, Azodyl which was recommended by the Vet cannot be used at all as it has to be fed directly and not mixed with food.

At that point of time, we noticed weight lost in her. In order to reduce stress on her kidney, we switched to K-D diet both dry and wet food. As we did additionally research for cure,we found renal essential from Vetri science which worked well on her. We noticed her weight beginning to gain and back to near normal conditions.

About a year ago, we noticed her making some strange noise occasionally when chewing dried biscuits. Along with the sound, she tends to make exaggerated jaw movement trying to chew the food. We did not take pay any special attention to this matter.

6 months ago, she started to consume more water and tends to drool a lot. Not sure is it due to the excessive water consumption. During the same period of time, she tended to "meow" loudly a lot. For example, when she gets back to her bed, she tended to meow loudly once or twice before leaning back to sleep. At the same time, she became very "sticky", following us throughout the house.

About 2 weeks ago, she seems to be weakening and refused to take dry food. Her weight lost became more apparent. My wife started to make boiled chicken breast for hicks as an alternative and she started to eat again. We have also tried to give him more canned K-D which did help a bit.

We also observed that she is very keen to eat but she prefers to be fed directly instead of eating from her own plate. She does not seem to be losing appetite but just very selective with food. This evening, we tried giving her raw beef and she consumed with great enthusiasm. One more thing, we started to add bi-carbonate to her water and she seems to be a little more active.

Thanks for bearing with my long story. My question is what should we do next?

1. Her kidney conditions might have deteriorated but we are not prepare to introduce extra stress to her such as infusion of Q-solutions unless necessary. What would you recommend?

2. Do you think her eating behaviour is caused by bad teeth? Tried very hard to open her mouth; her front and side teeth looks healthy.

3. Do you think if teeth is the problem, can treatment be done safely on such an old cat?

4. Last questions, about 1 month ago, she jumped down from the table and hurt her legs; was limping for a few days and then back to normal. When I observed more carefully later, I realized one of her front leg seems bent but she can walk normally,

Thanks in advance for your advice.

Regards



Online vet, Dr. Marie

Dr. Marie replied:

Sorry to hear that Hicks is not feeling 100%. I always get concerned when a cat does not want to eat as voraciously as usual. It usually means that there is something significant going on.

A dental problem is definitely a possibility, especially as cats with kidney problems can be more prone to dental issues. However, the vast majority of the time when an older cat develops a picky appetite it is something other than their teeth.

As we know that Hicks has issues with her kidneys this would probably be the first thing that I would be checking if she was my patient right now. As kidney disease worsens it can cause a lack of appetite and even some weakness. I can't tell a lot from the photos (thanks for sending them though) but my guess is that her leg is not the main issue right now. It may be that she is low in potassium (because of worsening kidney problems) and this is causing weakness. I wouldn't want to supplement potassium though without having some blood tests first.

I'd hold off on giving more bicarbonate unless this is something that your vet recommended. While we may occasionally give this to a cat with a condition called acidosis, giving it to a non-acidotic cat could do more harm than good.

Diabetes can cause the symptoms you have described as well - an increase in thirst, weakness, and, if advanced, lack of appetite. But, I think that worsening kidney disease is much more likely.

I would highly advise that you have your vet take a look at Hicks. They will likely want to run some blood tests to determine what is going on. If there is worsening kidney disease then the severity of the elevations seen on blood work may help with decision making. Sometimes, if things are not too bad then a day or two on IV fluids can make a world of difference and buy some good quality time. I have lots of clients who do regular subcutaneous fluid treatments at home and it really seems to help and for most cats is not too difficult to do. However, if Hicks has a grumpy temperament then this may not be an option.

If Hicks does have diabetes, then this is treatable, but can be a challenge to treat. However, it is important for you to know whether diabetes is an issue because if it is it is not fair to let her live untreated.

You may have some hard decisions ahead of you. From what you have described this is unlikely to be something with a simple fix.

I hope she can be seen soon and that things are not too bad.

Dr. Marie.



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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. AskAVetQuestion.com and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

Hi Doctor Marie,

We did some blood work for hicks with the following summarized results. BUN = 180, CRE = 9, PHOS = 11.3, K+ = 3.5 and PCV = 28. Obviously very alarming readings but she was still eating prior to the Vet visit but in a super picky manner.

The doctor suggested either IV or subQ at home. We went for the latter due to the grumpy nature of hicks. The treatment was done in conjunction of eprex, renal flush and a phosphorus reducing medication. As expected, it was never easy to do a 200ml subQ and all the oral medication. On day 3, we stopped the oral medications. As soon as the treatment started, hicks stopped eating completely, initially she might lick her favourite food once or twice but not more than that. Now she totally lost interest.

On day 6, we did the routine check and did another blood work. This time, BUN = 111, CRE = 6.1, PHOS = 6.6, K+ = 2.8 but PCV felled to 25. Clearly, the subQ did help to bring the readings down but also K+. As we were very concerned that Hicks totally not eating and force feeding (which will introduce more stress) was not an option. Doctor then prescribed K+ and B complex to be added to the SubQ treatment.

Today is day 10. After the last SubQ yesterday, Hicks is now bloated with fluid. I guess she is having fluid retention now. To complicate the matter she is very weak now due to refusal to eat and B complex did not help to make improve her appetite. To make it worst, she did not urinate like the earlier days of the treatment. As such, we stopped SubQ today.

This is a very critical stage for us. Because without food, she will not have the energy or may even die due to starvation. Without energy I don't think red blood cells can regenerate. If we force feed her, her body may reject and causes more stress. In the last 3 days, she tried to vomit, nothing during the first time but today, there were some yellow discharge when she vomited.

She is sleeping at her favourite bed now. Still very alert when we approaches. Do you think her kidney and digestive system has shutdown? Shall we leave her at this stage and expect the worst? Or shall we attempt to force feed? Or shall we wait for B complex effect to kick in so that she will start eating? The irony is before treatment, she was still eating but because she showed some early of weakness in her leg, we decided to send her to Vet.

Thank you so much for supporting us remotely.

Best,

On behalf of Hicks


Online vet, Dr. Marie

Dr. Marie replied:

Oh dear, Hicks sounds very sick. From what you have described this does not sound like a case where you should keep doing treatment at home. She sounds way too sick.

If this were my case I would likely be giving you two options. The first would be to have the vet do intensive in hospital care with fluids intravenously which is much more effective than given subcutaneously. But, there is still no guarantee that this will work.

The second, and probably the one that I would be recommending more would be to consider that it is time for euthanasia. I know that this is hard to hear but it sounds like things are getting worse and in my opinion it is not fair to let her get sicker.

The tough point is that no one can predict the future. But from what you have described I thin that the chances that Hicks starts to eat again on her own are small.

I would highly advise having a thorough discussion with your vet about her quality of life.

Dr. Marie



Customer reply:

Dear Dr Marie,

Thanks for your note. Hicks did not made it. She struggled and left us this morning after depleting all her energy. Like you said, no one could predict the future. If we had admitted her since day one or if the Vet had paid more attention to her not eating conditions during our home treatment; she might have survived.

I am very grateful for to you for taking the time replying my note.

Best Regards


Online vet, Dr. Marie

Dr. Marie replied:

Oh. I am so sorry to hear of Hicks' passing. From what you have described I'm not sure that things would have been better even with a more aggressive treatment. Please don't feel that you or your vets have let her down.

I'm so sorry for your loss.

Dr. Marie.



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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.