Sister's cat, Pixie, will earn her wings tomorrow morning

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Deborah & Shasta

Deborah & Shasta

Member Since 2012
Hi friends,

I'm writing on behalf of my sister, Susan, & her cat, Pixie. They are not members of this board as Pixie has never been diagnosed with FD, but she was diagnosed with hyperthyroidism a few years ago. The vet insisted Pixie be put on Hill's Y/D dry and wet and apparently, Pixie's numbers jumped back to normal. Susan called me last night to ask for prayers because Pixie had stopped eating. Took her to the vet and her kidneys are shutting down. They gave her fluids and antibiotics (she didn't have the paper in front of her to tell me what kind, but will check when she gets home.) She is going in today so that they can teach her how to give sub-q fluids.

I have already sent her @Marje and Gracie & Gus' video, along with links to Tanya's website & Dr. Pierson's website. But, as you all know, it is very overwhelming to receive the news of kidney failure, agonize over a cat that is not eating AND try to read and decipher all the information on those sites. She is absolutely beside herself with worry. Her question to me this morning was WHAT TO FEED Pixie? She knows that her vet will push the Hill's prescription, but if it's not good for Pixie...what else will be ok? She is also dealing with the hyperthyroidism. She said that she'll try the medication for the hyperthyroidism, if that's an option, but she just wants what is best for her girl.

Pixie is 15 y.o. and she is nasty to all other humans except my sister & family. (Pixie & Shasta are related - niece/aunt...the dislike for all other humans must literally be in their DNA! :p) Here are her labs from yesterday: https://drive.google.com/file/d/0B4QkzekNQKfYOWNEaVk1TmJqVGc/view?usp=sharing

I know there are many on this website that have dealt with/have become mini-experts on kidney disease & hyperthyroidism...please help & advise. Biggest question: what should she be feeding Pixie? HELP, please!



p.s. In the past, I've tried talking to my sister about the evils of dry fuds. Like many, she now regrets being talked into it by her vet and not listening to me when I tried to help. She has wet Y/D fuds that she's been adding water to, but Pixie only licked at it a little yesterday and then nothing today.
 
What were the results of the the bloodwork?
Do yo have an values for urine specific gravity?
Without more info we have no idea of how severe the kidney degradation is.
 
So first things first. I'd ditch the Y/D and go to methimazole for the hyperthyroidism. The pill can be dissolved into some food, or into a syringe for administration, or even compounded for application to the ear (wear gloves if you do this!)

And I might get her on a low phosphorus, low carb food, even if she isn't diabetic. It'd be OK if it had a little more fat, for the calories. Do the food transition slowly to avoid GI upsets.

Pick up some Pepcid for the upset stomach (1/4 tablet 15-20 min before meals; do check with a vet), maybe some Slippery Elm bark, (instructions per Tanya's site).
 
Link works for me on my laptop.

The potassium is very low, probably from excessive urination due to the renal compromise.

The glucose is elevated but may come down if the cat is dehydrated and gets fluids ... after or with managing the potassium.

Fluids will make the anemia worse; is a transfusion possible?
 
BJM said:
So first things first. I'd ditch the Y/D and go to methimazole for the hyperthyroidism. The pill can be dissolved into some food, or into a syringe for administration, or even compounded for application to the ear (wear gloves if you do this!)

And I might get her on a low phosphorus, low carb food, even if she isn't diabetic. It'd be OK if it had a little more fat, for the calories. Do the food transition slowly to avoid GI upsets.

Pick up some Pepcid for the upset stomach (1/4 tablet 15-20 min before meals; do check with a vet), maybe some Slippery Elm bark, (instructions per Tanya's site).
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I told her the same on the Y/D. She was going to ask the vet about the transdermal medication (methimazole) and I asked to ask one more time about the I-131. I'm willing to pay for the treatment if it helps save her cat!

What is considered "low phosphorous"? 300's, 400'2, 500's? I was just looking at the Fancy Feast Classics which my cat likes and I know the carb counts, but just wasn't sure if the phosphorous levels were acceptable. FF Classic Chicken - 546 phos.; FF Classic Chopped Grill - 569 phos.; FF Turkey & Giblets - 355 phos.
 
This really gripes me when a vet who suspects something going on doesn't run a full panel. The P is critical to know because that can really make a kitty sick. It doesn't matter what the USG is because with the creatinine and BUN where they are, we already know she is not concentrating her urine. Here are the primary issues I see:

  • dehydration: your sister should discuss daily subq fluids although I will say I have seen numbers improve significantly with in hospital IV fluids but if the kitty is fractious, that probably is not an option.
  • azotemia (increased creatinine and BUN): indicative of stage 4 CKD but if she gets on top of the fluids and some of the other issues, than it could come down; another thing which can raise BUN/creat is a kidney infection and keep in mind that cultures do not always show bacteria which comes from a kidney infection; many people have seen good results using Azodyl. I didn't but I wouldn't let that stop me in a situation like this.
  • potassium: way too low; she needs to discuss with the vet immediately about supplementation with potassium (usually Tumill K)
  • phosphorus: she needs to find out what the P is but I'm betting it's high. If it is over 5, she needs to discuss with the vet using aluminum hydroxide binder (there are others but it is the most palatable and really the gold standard although she will need to read on Tanya's if there are any contraindications for her kitty); she should also get her on the lowest P food that she can (normally less than 1% or less than 200 mg P/100 kcal but that is still high for advanced CKD; again...I'd go as low as possible). While I am not a fan of prescription diets, if she were my cat, I'd probably try to get her on a renal diet temporarily to get the P down and then move her gradually to a better, low P diet. However, as Helen says on her site, if she's not eating, right now she just needs to get her eating whatever she will eat and add binder to it (if the P is above 5)
  • hematocrit: usually vets will not start giving an erythropoetin stimulating agent such as Aranasp until the HCT is below 20%. However, if your sister starts Vitamin B immediately, it might help. I used the following for Gus and his HCT stayed close to 28% the entire four years: Methylcobalamin and Jarrows B Right.
  • calcium: it would be good to also see just a Ca value; if Ca x P is greater than 70, she is at danger of calcification so it's important to get the P down.

I do not think she is a candidate for I131 as it will zap her kidneys even further. When Gus had I131, the specialist was extremely careful to ensure his kidney levels were completely within the normal range once his thyroid levels were normal after treatment with methimazole.
 
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Thank you, all. I just got off the phone with my sister. Pixie is still not interested in eating. :( So, here's what she told me today...

Her regular vet is out-of-town until the end of the week, so it was some other vet that she saw today (and my mom & nephew saw yesterday.) Apparently, they did NOT do a full work-up/blood panel because that would take a few days. :arghh: The vet wants her to keep with the Y/D wet and start daily sub-q fluids tomorrow. The vet said she's not excessively worried that Pixie hasn't eaten in 2 days because they gave her sub-q fluids yesterday and pumped her full of electrolytes. o_O My sister is so worried about the hyperT aspect that she's not willing to try other fuds off of Dr. Lisa's list (Ann & Tess' condensed list). :nailbiting: ggrrrrrrr. I don't know how else I can convince her. Again, thank you for all of your help. I've shared all of your responses and can only hope that she'll take some more time reading the websites and researching.
 
Thank you. I convinced my sister to go buy a can of the Friskies Special Diet T&G. She was/is so nervous that it will negatively affect the thyroid and kill her cat. I tried explaining that not eating for two days would also kill Pixie...rock...hard place. Bottom line...Pixie needs to eat. So, she bought a can and next thing I know I'm receiving a text that said "She ate it immediately."
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Then, she sent me this video:
(hope the video link works!)

Anyways, she's still really worried about the thyroid. Also, what concerns should she have over GI problems from the abrupt fuds change? Pixie refused to eat any of the Y/D (smart girl!), so there was no way to introduce the Friskies slowly.

Thank you, again for all of your help and advice. She finally breathed a small sigh of relief when Pixie started eating. I think we all know that feeling so well. :woot:
 
Deborah & Shasta said:
Also, what concerns should she have over GI problems from the abrupt fuds change?
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Maybe keep an eye out for nausea symptoms. Here's the symptom checker from Tanya's Site. The page has details of various things that can help if nausea is in the mix, though how issues with the thyroid might affect things I do not know. At least it might be a basis for discussion with her vet.

I'm very relieved that Pixie's eating. (Great to see the dancing kitties again! :) ) Saying a little prayer that the abrupt change won't irritate her digestive system.
.
 
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Thank you, Aine! I will pass along the symptom checker to my sister. I sent her the link to Tanya's website, but I feel certain that she hasn't done much reading today. Obsessing and staring at Pixie...as much as possible!
 
An afterthought. It might be an idea to elevate Pixie's dishes as a precaution. It helps a lot with queasy tummies. Adding a tablespoon of water or two to each meal is normally helpful, too, but I don't know how that would work with Pixie's other health concerns. Perhaps other members might be able to advise whether it's a good idea.
 
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I am so sorry for your sister's little Pixie- but so delighte to read she ate!!! :bighug::bighug: My Tiger was diagnosed HyperT last year; and after getting the radio-iodine 131 treatment, it turns out HyperT was masking early stage CKD :rolleyes: (and then we discovered she is now Hypo-thyroid :rolleyes:)

I would recommend your sister join the: Yahoo Hyper Thyroid support group . Since Tiger is diabetic, our vet and the specialist who performed the R131 recommended a high protein diet which supported her diabetes rather than any prescription type HyperT or Renal foods. I love my vet because they never push prescription foods and FWIW, Tiger's BUN and Creatinine are none the worse a year later. With CKD- the most important food is one they will eat.

I also highly recommend joining the Tanya's Website CKD support group--there is a wealth of information to be found.
 
Thank you, Ruth! I will pass along on this great info to my sister. I'm not sure I'll be able to convince her to join any support groups....only because she's not online much due to lack of free time, but I will absolutely give her the info and suggest she get more info from other people that are going through the same. (hence why I'm on the board asking questions for her!!! apparently, I have not-much-life!) haha!
 
Undershooting a little on the thyroid control at first, while you work to stabilize the renal conditions, may be the way to go. Feed a bit more to handle the higher caloric need. It'll be a tightrope, I know.
 
She just texted me, freaking out...Pixie is not able to walk (just like when she was first diagnosed with hyperT). She said that she put her on the floor by her dish and she can barely walk. :nailbiting:
 
It is likely electrolyte imbalances, which can be fatal. She needs to see the vet for stabilization or to help her cross.

My civvie Emmy had CRF and seizures from electrolyte imbalances caused her death.
 
Electrolyte imbalances...meaning from sub-q fluids? The vet supposedly pumped her full of electrolytes on Friday and then Susan gave her 100mL sub-q fluids today.
 
BJM said:
I'm sorry I can't be more encouraging.
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No, you've been very helpful and kind. I keep praying for a miracle for my sister because I think that may be the only answer right now. :( I just asked her how Pixie was doing...she said she ate a little and then Susan put her in the LB...she peed! It's been a few days since that happened, but then she just laid down in the LB. Susan picked her up and put her on her bath mat. :(
 
(((Deb &Pixie))) I was so hoping Pixie was better today. Is she taking methimazole (Tapazole and Felimazole for her hyperthyroid yet?

I think your sister needs to get Pixie to the vet now- See where Marje noted the potassium is way too low? That can cause muscle weakness(so can hyperthyroid but that is why I asked if she was on meds for the hyperthyroid yet) Pixie also has low sodium and chloride, also electrolytes out of balance. Does Pixie vomit a lot? (Tiger does vomit, and her electrolytes are out of whack as well that's the only reason I bring it up.) Most people on the Tanya's CKD Website use Potassium Gluconate which Tumil K that Marje mentions above. Here is another link to the website: Tanya's CKD.

I'm sorry I keep pushing the links and websites, but the truth is, I am a newbie to CKD myself, I have had to read everything I can find about myself. And please don't despair, people on that Tanya's CKD Support Group are fighters, exactly like the people on this forum;they are wanting to help all kitties live a quality life and to help anyone who joins and asks questions- there is lots of experience, many of the cats there have lived for years with ckd.

I'm praying and sending ton of vines for Pixie and you and your sister
 
Thank you, Ruth. Pixie is not on methimazole, yet. IF she survives the night, my sister (actually, my mom) will take her back to the vet tomorrow (I think.) I told my sister to ask about Tumil K for the Potassium and she's already on board for insisting on the methimazole. Apparently, it takes a few days for the pharmacy to make and that's why the vet wanted to hold off? Susan hasn't mentioned anything about Pixie vomiting, but I'm sure her entire system is totally out of whack from never addressing the kidney problems and only looking at the hyperT issue. My sister did do a little reading on one of the websites...not sure if it was Tanya's or Dr. Pierson's...I sent her both. In fact, I sent her a ton of stuff...websites, videos, screen shots of everyone's responses on here. She's just beside herself with worry. So am I...over a cat that pretty much hates me...until I feed her wet fuds and then she likes me again! :p
 
Yes the low potassium can indeed cause her to be so weak she can't stand and hers is CRITICAL low. The vet should have given her something to raise that level. Potassium is a major part of what makes the muscles work. The fluids had potassium in it but not an overly large amount - she likely needs additional supplementation like Marje suggested. This low of potassium can cause her heart and breathing to be affected negatively. Those are both controlled by/are muscles - altho' they're the last muscles to be affected, her number is so low it's getting close to that range where they just don't have any more ability to work at the cellular level. The level needs to be monitored closely.

PRAYERS AND HUGS,
 
Squeaky and KT said:
Yes the low potassium can indeed cause her to be so weak she can't stand and hers is CRITICAL low. The vet should have given her something to raise that level. Potassium is a major part of what makes the muscles work. The fluids had potassium in it but not an overly large amount - she likely needs additional supplementation like Marje suggested. This low of potassium can cause her heart and breathing to be affected negatively. Those are both controlled by/are muscles - altho' they're the last muscles to be affected, her number is so low it's getting close to that range where they just don't have any more ability to work at the cellular level. The level needs to be monitored closely.

PRAYERS AND HUGS,
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I told her all of these things earlier this evening. I will text her in the morning and remind her to say something to this vet. I know Shasta's levels were really low and this was a huge concern. Pixie's levels are much lower and that was one of the first things I thought about...muscle weakness & her heart. :nailbiting:
 
My baby is Hyper T and completely stopped eating a few months ago due to a gallstone occurrence. I ignored the vet and fed her whatever food I could get her to eat - which ended up being Friskies Temptation treats for a few days until she regained her strength and went back to normal food.

As for the the Hyper T - vet started me out on 2 Felimazole (generic for methimazole) 2.5mg pills per day and Thai's elevated t4 level was off the charts at 10 (4 is the max normal level). We retested 1 month later and were at .5 which is slightly low. We have now been on 1 pill once a day and her levels are perfect. I opted out of the radioactive therapy because my girl is going to be 17 soon. I didn't see the point in stressing her out over something that could easily be managed with medication and wouldn't dramatically increase her lifespan.

That's the point I wanted to get to. Tell your sister that Hyper T is EASY to manage and you don't have to do the surgery route. I smash up one pill per day and toss it on Thai's wet food and she doesn't even notice (i've heard the ear compound is less effective and also very dangerous for humans to touch). She is also in remission right now :: knock on wood :: for diabetes after only 4 insulin doses - she's being completely managed with Friskies Pate and Fancy Feast Classics (she likes those more than Friskies) and a handful of low carb dry food per day.
 
Squeaker is also CRF and we just started sub-q. He also has had anemia a couple of times.

Any food will do to get Pixie eating again. If necessary mix it with water and syringe feed. A cat who doesn't eat runs the risk of hepatic lipidosis. Yes, add phosphorus binder. You can get this from Thriving Pets. Mix it with every meal. There is a chart on Tanya's site that can guide you on the dose.

I am not aware that any food has much of an impact on hyperT so that isn't an issue.

As for the anemia, I would be cautious about jumping to a transfusion right now. A transfusion can just as easily kill as save. The vet can give B12 shots daily to get the anemia to respond quickly. Squeaker had to have this in January, 5 B12 shots in 5 days. There is also AminoBPlex with iron that the vet can prescribe. I would also suggest looking for human B12 (methylcobalamin) if you can't find that then just use the plain B12 (cobalamin). Do not use the cyanocobalamin. I got the plain cobalamin at the health food store brand name Solgar.

Dosage is as follows:

500 mcg daily of the B12. You can mix this with the food.
also B complex, 1/10 of the human dose daily. Can also be mixed with the food.
Give both of these every day. They are water soluable and whatever the body doesn't need is flushed out.

The potassium supplement should ideally be potassium gluconate. Squeaker's dose was 468 mg until his K came back into the mid 3's.

Wet food is the best for kidney cats too. Given they are at risk for dehydration wet food gives them a little extra fluid. And I would also mix in water to give a little extra for hydration.

On sub-q's----------should not get more than 100mL. If the dehydration is so bad that more is needed, then hospitalization and IV is better.

We have a renal group on yahoo. Here is the link: https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info

Please encourage your sister to join for Pixie.

Anita and Squeaker
 
Thank you, Anita. Great information that I will pass along to my sister. She is only feeding wet food now and I'm hoping that she is mixing in water. I remind her every time I talk to her!

Update on Pixie: Susan picked up some baby fuds and said that Pixie likes them!!! :joyful: She likes them even more when my mom feeds her and holds her plate. Susan thinks it's because mom is "low" anxiety; whereas Susan is "high" anxiety with high expectations. I understand every emotion she is going through. Her regular vet is back tomorrow and she has an appointment scheduled for 3:30pm - CST. I told her that they better run more blood work...full panel, like they SHOULD HAVE DONE last Friday. :mad:
 
Pixie will earn her wings tomorrow morning. cat_wings>o Susan needed one last night to snuggle and say goodbye (kids needed to say goodbye, too.) Please keep them in your prayers. My heart hurts so bad for my sister. :(:(

Thank you, all, for the advice, knowledge, prayers, vines & love. This board is a wealth of knowledge and kindness. Love to you all.
 
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