Need help with diet/medication, my cat with chronic kidney insuficiency and diabetes won't eat.

[Dragos]

Hello, I'm new there so if I'm making any mistakes pls forgive me, it is not my intention to break this forum's rules, it's just that I'm desperate to help my cat.
So here it goes. I have a female 7 years and 9 months old, 1.7kg (she never was above 2.2-2.3kg), not neutered, indoor cat. About 3 weeks ago on 17 of April she tried to eat silicat out of her litter box, I panicked and after a 3 minutes "fight" I managed to remove the silicat from her mouth. This didn't seem normal to me so I called my vet (I'll call him Vet1 from now on), who told me my cat was very ill and needed immediate treatement so I sent my mom with the cat to the vet (I was out of town with work). Vet1 gave my cat an anti-biotic, a pill of renalvet, and subcutaneous shots, a pouch of Intestine Royal Canine food and told us to come again in the afternoon for more shots. The second day we went for more shots and another pill of Renalvet. Due to the fact that Vet1 refuzed to do blood analysis because the cat was "too skinny" I went to Vet2 and did blood tests. BUN 185.8 mg/dl, Glu 184 mg/dl, T-pro 8.31 g/dl, ALP 49 IU/L, GPT 30 IU/L, Cre of 6.8mg/dl and got treatment of Phytophale 1/2 pill/day, I was told my cat had diabetes, Chronic Renal Insufficiency and that my cat will live 2 months and I should give her whatever she likes and also Royal Canin Renal. After 5 day I've read on an internet sales website the prescription of this drug and I saw it wasn't recommended in kidney failure, went to Vet2 and switched to Ipakitine 0.5g/day and after 3 days to 1g/day (0.5 in the morning and 0.5 in the evening).
During the 10 days I called every friend to recommend me a vet and called them all, it didn't matter that they were from out of town, sadly not all of them were willing to help/helpful; I also went to several vets from my town with the blood tests and I kept hearing "she's gone, there's noting you can do".
After 10 days I went back to Vet2 to redo the blood tests and these were the results: BUN 139.3 mg/dl, GLU 255 mg/dl, T-pro 7.22 g/dl, GPT 67 IU/L and Cre of 6.5 mg/dl, ALP 54 IU/L, Ca 13.04 mg/dl, WBC 5.7, LYM 1.7, MONO 0.5, NEUT3.5, EOS 0.0, LYM% 31.3, MON% 6.1, NEU% 62.1, EOS% 0.5, HGB 9.1g/dl, HCT 23.3, RBC 5.34, MCV 43.6, MCH 17.1, MCHC 39.2, RDW%19.4, RDWa 30.7, PLT 151, MPV 9.8. I was told to keep the same treatement, maybe mix Royal Canin Renal with Diabetes other than that nothing else, keep with the Ipakitine and the RC Renal or Hills K/D food.
As you can see the creatinin went back a bit (0.3) and the ureea went down too (from 185 to 139), but the Glu went up from 184 to 255.
I then went Vet1 that told me the cat needs antibiotics, and that it has problems with the pancreas too but he can't give her the shots because he's leaving town to go on holyday. So I went to one of the vets I visited in the 10 days I had to wait to redo the blood tests, and she (Vet3) spoke with the Royal Canin representative and took the decision to feed my cat only RC diebetes, we gave her iv fluids on Sunday, Tuesday (she peed 7 times that day) and Wednesday
Another week passed and today I went to do blood tests to Vet3 (as my cat ate little to nothing in the past 3 days) and gave her more iv fluids. Unfortunatelly the blood tests done today are disaterous: Glu 164 mg/dl, BUN over 200 mg/dl, CREA 9.7 mg/dl, B/C 21, Phos 18.1 mg/dl, Ca 11.6 mg/dl, ALB 3.6 g/dl, A AMY over 2500 U/L. I was given "the talk" that there is no more hope, and people die too, and that there are literally no more chances to save or prolong my cats life. Tomorrow I was gonna order Azodyl form somebody out of town and I was told that there is no point in doing that anymore, I can try to keep her on Renal food and she'll live longer if she eats it (she does so rarely), or give her her favourite foods and she'll feel better, be happier and die faster.

I would really appreciate any kind of advices (especially what types of food I can feed her), I found my cat on the streets dragging her both back legs, full of fleas and parasytes and unable to pee or poop... It's been 8 years and now this... I can't lose her...not now. Pls help, and again sorry if I broke any rules.

 

[tiffmaxee]

I don’t uunderstand why insulin was not started. What shots are they giving? The food they gave you is high carb. Sub-q fluids need to be given daily and can be done at home. She sounds like she needs to be hospitalized on IV fluids though to see if the kidney values will come down. She doesn’t want to eat because the phosphorus is super high. Was a urinalysis done and culture to see which antibiotic will work? I’m sorry you can’t find a competent vet. You really need an internist at this point.

 

[Dragos]

I don’t uunderstand why insulin was not started. What shots are they giving? Tge food they gave you is high carb. Sub-q fluids need to be given daily and can be done at home. She sounds like she needs to be hospitalized on IV fluids though to see if the kidney values will come down. She doesn’t want to eat because the phosphorus is super high. Was a urinalysis done and culture to see which antibiotic will work? I’m sorry you can’t find a competent vet. You really need an internist at this point.

I agree with you 100% on the "I need a new vet". Almost all vets in my town are old school, and don't prescribe anything except the diabetes/renal/kd food and sometimes Ipakitine. They've heard of Azodyl (some of them), but nobody has it and only 2 know where to get it (I'll order one tube today). Most of them say to give the cat what she wants, she'll die in 2 months tops and that's it, "there's nothing you can do about it". I don't like that answer, and even if the moment comes I hope it comes as late as possible. I gave my cat yesterday a bit of raw chicken, a bit of boiled and a bit of fried chicken and some chicken soup, all without anything else added. She finally ate something after 3 days of only licking the sauce from the renal pouches.
I'm getting the urine results today, she was on iv fluids yesterday and will be today and tomorrow...at least. The blood flow was very slow when the blood tests were done today. No insulin, no antibiotics no shots were given to her. But since her treatment started she lost some weight and she rarely eats, and generally she's a different, sadder cat. Since I gave her the chicken yesterday she's a bit better, not a lot, but a bit.

 

[tiffmaxee]

If she doesn’t eat at least half the normal amount of food she might get hepatic lipidosis. I suggest you go to the pet store and get some feeding syringes. Mix some food with water and out in a mini food processor and syringe feed her. There’s a yahoo assist feeding group you can join. Since your vets like KD, buy some AD from them. Most cats like it. It’s easy to mix with a little water without needing a food processor and syringe feed. Your cat has to eat. Bake some thighs plain and see if she will eat that. Get some Gerbers 2nd ham, chicken, beef, and turkey and see if she will eat that. Try finger feeding it. It’s not a complete food but neither is plain protein but eating anything is better than nothing. Most cats as sick as yours are are nauseous and don’t want to eat. That’s why daily cerenia with a very small amount of cyproheptadine as an appetite stimulant might help. For some 1/4 regular strength Zyrtec, 1/4 a pill once or twice a day might help with that.

 

[Veronica & Babu-chiri]

Hi! I'm sorry to hear about all the vet troubles you are having. I hope you can find a vet that would want to work with you, neither diabetes nor chronic kidney desease (CKD) are a death sentence both illness can be managed (not cured) and in my experience cats are seriously very resilient so no vet can truly know how much a kitty will live with this kind of deseases, I think the worst issue right now are her kidney values

Have they mentioned what antibiotics are they giving her and does the vet suspect she has urinary tract infection (UTI) ?that could be affecting her glucose levels (which are high but not extremely high) and to a point her kidney values

This are some thoughts after looking at the blood work results:

- You'll need to change her diet to a kidney friendly diet but the most important thing is that she eats so if she doesn't like the kidney diet just give her the one she likes or baby food ( without onions ) or just baked chicken ( better if you give her tights and they like the taste of oven baked over boiled chicken ) and you'll have to help her with phosphorus binders and some other supplements, once the emergency is over you can start transitioning her to another diet that would help her more,
- You may need to assist feed her for a few days which is not that hard you just need some food that is more pathe like and maybe add a little water to it so that you can put it into the syringe most vets like and use Hill's A/D and cats actually like it is mid high in carbs so it won't affect her glucose levels so much but is a little bit high in phosphorus so you'll need to add a phosphorus binder and very important an anti nausea medication sot that she won't throw up what you give her
- You'll need to consider giving her some anti nausea medication a lot of people use cernia but if the vet won't give it to her you can also use slippery elm bark or omeprazole ( I wouldn't use this one for a long time but I think is ok for awhile ) you could discuss some of this options with the vet and see what he thinks
- Ipakatine is used as a phosphorus binder and is good but is given only twice a day and given her high value of phosphorus she needs something a little bit more effective in all her meals to help her lower her phosphorus levels which are probably causing her to have nausea, most people use aluminium hidroxide (If you are in the US you can order it from Thiriving pets http://www.thrivingpets.com/index.php/)
- Is good they are giving her IV fluids but she'll need you to give her subcutaneous fluids at home afterwards that will really help her creatinine and other values
- Azodil comes in pills and given her numbers you'll need to give it to her twice a day is good an in my experience helps but don't stress too much if you can't get it right now focus on her diet first (Thiriving pets also carries Azodil)
- Her glucose levels are not so high it could be high because of the infection but she could probably benefit from some insulin every 12 hours, there are some different types of insulin maybe you could talk with the vet as to which one to use many of us use Lantus/Levemir (gargline ) but there's also vetsulin/caninsulin, prozinc

Here's a link to Tanya's amazing page that will help you a lot in understanding the chronic kidney desease and in knowing what your options are

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

 

[Dragos]

Hi, what home cooked CKD diet do you use? I mean precisely the receipe.

I tried giving her AD food which she ate a bit for 2 days (same can, she ate about 3-4 teaspoons) but then she didn't like it anymore. So I switched to boiled liver and chicken from which she mostly ate the "soup" and she also ate some liver and yogurt since its the only thing she seems able to eat today, which worked to some extent but today she refuses that too. She started grinding her teeth and breathing with difficulty (some say it's the iv's).

Update on the cat. I went with her Bucharest (my country's capital) and did some tests there (expensive) and they gave me a treatement of
2 Renalvet/day (morning and evening)
1/4 Hepatiale force advanced/day
4 Azodyl/day
iv with Ringer some Calcium bicarbonate and Nephrotect, also once every 2 days Eritropoeetin (Neorecormon) 150UI.

But unfortunately I didn't have the funds to buy all the medicine so the Nephrotect, the Neorecormon and the Azodyl I only got today. Since yesterday my cat began grinding her teeth and breathing with difficulty (some say it's the iv).
I can't believe the incompetence of my country's vets and also how fast this problem progresses. A month ago I had a cat I thought was constipated, today I have a rag basically that won't eat, won't do anything a cat would do, and now she might be even closer to the end due to complications from the iv's.

 

[Veronica & Babu-chiri]

Do you have the blood work results, that we can take a look at?

There are very experienced people here that can help you interpret them and then help you sort out all the medicine stuff

What are his blood glucose levels right now? Is he getting any insulin?

When you say iv's you mean subq's ( subcutaneous fluids)?

 

[Veronica & Babu-chiri]

Teeth grinding can be a symptom of stomach acid or dehydration and breathing difficult is not a good thing it can be because of fluid retention, metabolic acidosis, low potassium levels and some other stuff but thing is both of them together usually points to something a vet needs to address as soon as possible