reading an account of the condition, diagnosis and treatment
on the CompuServe CatsForum. “I knew she would have
radioactive iodine treatment.”
She began looking for a facility to have Blanche treated.
The facility Dr. Bressler recommended was moving, though,
and Karen was also making plans to relocate to Las Vegas.
The timing just wasn’t right.
Until a facility could be found, Blanche was given the drug
Tapazol to suppress the action of her overactive thyroid
gland. “She’s not that hard to pil , but I hate to inflict that on a
cat every day, so I asked if it could be compounded.” Karen,
who expected a flavored oral medicine, was surprised and
pleased at the form of application. “You put it in the ear for
transdermal absorption,” she says. The medicine is the
texture of Vaseline and is measured onto a finger, then
placed in the ear. “For Blanche it was something that
irritated her ear for a second. For me it was easy as pie.”
Karen searched the Internet to locate a veterinarian and
facility for Blanche’s treatment. “Dr. Hager was surprised
beyond measure that I found him, because he’s a California
doctor who comes in once a month to do procedures in Las
Vegas,” she says. “He sat with me the better part of half an
hour, going through the procedure with me, tel ing what would
happen, what to expect, tel ing me about the disease, what
the findings were on Blanche. Dr. Hager has a great bedside
manner—and al the time he was holding and petting
Blanche.”
Blanche had more blood tests done before the procedure
and Karen was told to stop treating with the Tapazole a
week before the radioactive iodine treatment. Then the cat
was checked into the hospital. “The vet was just wonderful
with her,” says Karen. After the dosage was figured out,
based on Blanche’s history, the beneath-the-skin injection
was given. “They kept her for five days, which is the
government minimum [for quarantine],” says Karen.
Radioactive emissions have to be under a certain level
before treated cats are released.
The cat’s body is radioactive for a period of time fol owing
treatment even once she comes home from the hospital. “I
was told to think about her as a little flashlight, radiating this
radioactivity,” says Karen. Although Blanche posed no risk to
other pets, Karen was cautioned to avoid close contact for
another week because the emissions could damage her
own thyroid gland.
Karen had just moved to Las Vegas, so when Blanche
came home from the hospital, both Stanley and Blanche
started life in the new house in the guest bedroom suite.
They stayed there until Blanche was no longer radioactive.
“I was under instructions to take away her feces every day,
and not have her on my lap. They said don’t touch her too
much and don’t let her touch her face to yours,” says Karen.
“Blanche is a big lap cat, and she loves head bumps. That
was a week I didn’t like very much, but she got through it
okay,” says Karen. “Stanley certainly wasn’t under orders to
stay away from her, so she had some companionship.”
A month fol owing the radioactive iodine treatment,
Blanche’s thyroid levels were tested. “She was perfect,” says
Karen.
Today Blanche is ful y recovered. “She has been active,
and obviously happier,” says Karen. “She stil is quite thin,
and went from 13 to about 9 pounds. She’s gotten
comfortable with the lesser weight and doesn’t seem to be
putting too much back on.”
Blanche and Stanley love their new home in Las Vegas,
especial y the 18-foot-high ceilings with tal platforms over
the tops of closets and shelves halfway up the wal s, al just
made for feline climbing. “That’s definitely a cat
arrangement, not a person arrangement,” says Karen.
“Stanley keeps Blanche very active by chasing her around.”
The lost weight seems to have increased her agility and
triggered a new trick. “This is a cat that never hopped onto
anything except my bed, and that was a big struggle,” says
Karen. Ever since coming home from the treatment, Blanche
evening drink of water before she goes to sleep. “It’s
become a ritual,” says Karen.
Paying attention to the feline details is more than a ritual
for Karen; it’s a kind of health insurance. “Cats don’t ever tel
you when they’re sick. You just have to figure it out for
yourself.”
KIDNEY FAILURE
The cat’s kidneys have several functions, including the
manufacture of hormones such as ethrytopoien which
controls the production of red blood cel s and blood
pressure. In addition, kidneys regulate the nutrients carried
in the bloodstream and the fluid content of the body, and they
also screen toxins and waste from the bloodstream and
eliminate them in the urine.
Renal, or kidney, failure is not necessarily caused by age,
but it is extremely common in aging cats, says Dan Carey,
DVM, a veterinarian with the Iams Company. A recent survey
by the veterinary teaching hospital at the University of
Minnesota indicates that kidney disease is one of the top six
reasons cats begin veterinary treatment. When the kidneys
fail to screen out toxins the way they’re supposed to, the
poisons build up in the blood—a condition cal ed uremia.
“That’s what causes the animal to feel bad,” says Dr. Carey.
Senior Symptoms
Typical signs of kidney failure begin gradual y, and increase
with the progression of the disease.
Increased urination, missing the litter box
Increased thirst
Lethargy
Loss of appetite, weight loss
Dehydration
Vomiting, diarrhea or constipation
Mouth sores, foul ammonia breath
Yowling
The acute form of the disease happens suddenly,
often as a result of ingesting a poison such as antifreeze. In
old cats, though, kidneys fail a little at a time, perhaps from
simple wear and tear over the years. Chronic disease
creeps up on the cat. “Kidney disease is either the number
one or number two cause of death in cats and dogs in every
study that’s been done,” says Debbie Davenport, DVM, an
internist with Hil ’s Pet Nutrition. “About 30 percent of cats in
the senior population have renal disease and the owners
may or may not be aware of it.” That’s because the cat’s
kidneys are able to compensate and work wel even when a
large percentage of their function is gone.
Individual structures inside the kidneys, cal ed nephrons,
form the urine. As kidneys age, nephrons die and are not
replaced, and when enough are lost, the cat begins showing
signs of kidney failure. “Typical y when 75 percent or more of
signs of kidney failure. “Typical y whe
n 75 percent or more of
the nephrons are lost, that’s when we begin to see the real
critical problems,” says Dr. Hawley.
Symptoms are similar to other diseases, such as
diabetes. Blood and urine tests are necessary to diagnose
kidney disease. By checking blood urea nitrogen (BUN) and
creatinine levels, and comparing them to specific urine
gravity, veterinarians can get a good idea about kidney
function. “You begin to see an inability for the animal to
concentrate its urine,” says Dr. Hawley. “And you may see a
persistent low urine specific gravity.” Further screening of the
kidneys by X-rays or ultrasound may be necessary.
“Kidney disease very often is intertwined with high blood
pressure and thyroid disease,” says Dr. Little. Hypertension
in cats, though only recently recognized, is quite
manageable. “Cats with kidney insufficiency have a
derangement of the physiological system that helps monitor
blood pressure and it can get out of whack, and they get high
blood pressure from it.” Many cats have kidney disease,
hypertension, and hyperthyroidism at the same time.
About one in four cats with chronic renal failure or
hyperthyroidism also develop hypertension. “We don’t wait
until they’re il . We do blood-pressure checks routinely on any
older cat with a blood-pressure cuff,” says Dr. Little. The
Doppler blood-pressure monitor is currently considered the
most accurate machine for use on cats. An inflatable cuff is
placed on the cat’s foreleg, and a transducer reads reflected
ultrasound signals bouncing off moving red blood cel s.
Getting an accurate reading can be tough, though. Normal
systolic blood pressure (during heart contraction) is about
110 to 125. Stress from going to the hospital can make the
cat’s blood pressure go higher and cause an inaccurate
reading. Sedation also interferes with accuracy. Often,
multiple readings over several days must be averaged to get
the best picture of the cat’s situation. “When their high blood
pressure is control ed, they often feel better and do better
with their kidney failure. So they’re intertwined, it’s hard to
separate them,” says Dr. Little.
Diet Therapy
Chronic renal failure wil progress, regardless of what
you do, says Dr. Carey. “Our objective is to slow the
progression.” Medications help normalize the blood, and
special therapeutic diets are prescribed that reduce the
workload of the kidneys.
Many of the “regular” senior diets for cats offer a nutrient
profile that reduce the risk factors associated with kidney
disease, says Dr. Davenport. Dietary phosphorus, sodium,
protein, and essential fatty acids are of particular
importance, as wel as ensuring the diet does not acidify the
urine. The point is emphasized because regular feline
maintenance diets often do acidify the urine to reduce the
risk of certain kinds of crystals, cal ed struvite. Calcium
oxalate crystal formation that typical y block the kidney
ureters is promoted by an acidic diet, though.
Usual y the first step is a special diet designed to
minimize the amount of stress placed on the kidneys, says
John F. McAnulty, DVM, an associate professor of surgery at
the University of Wisconsin. “I’ve seen cats that were not
doing wel that start to gain weight, and real y seem to be a
lot more energetic on the diets.”
Nearly al the major pet food companies offer therapeutic
diets for kidney disease, and most also have one for “early
stage” and another for a more advanced stage of the
disease. Most restrict phosphorus and sodium, and provide
a low to moderate level of highly digestible protein to help
relieve the burden on the organs. “Protein and phosphorus
are linked together, so when you try to control dietary
phosphorus, you also reduce dietary protein,” says Dr.
Davenport.
Adding the right type of fiber to the diet also reduces the
workload of the kidneys, says Dr. Carey. Here’s how it
works. Failing kidneys leave behind nitrogen waste in the
blood. Certain kinds of bacteria trap this nitrogen in the
intestine. Feeding a fermentable fiber to the cat maintains
the health of these beneficial bacteria. “You can shift the
excretion of nitrogen from the kidney to the intestine enough
to help the body,” says Dr. Carey.
Most cats with renal failure lose their appetite, and most of
these diets are not tremendously palatable, says Dr.
McAnulty. Some cats refuse to eat the therapeutic diet. You
can then offer other brands and try to find a kidney diet your
cat wil accept. In many cases, though, you must give in to the
cat’s preferences. “You have to cut your losses; you are
better off feeding a sub-optimal diet than you are starving it.”
Feeding For Health
Cats can suffer different degrees of kidney failure, and may
prefer one food over another. Some of the more common
therapeutic diets available from your veterinarian for kidney
disease include:
Iams Veterinary Formula Multi-Stage Renal/Feline
Hil ’s Prescription Diet Feline g/d (early stage)
Hil ’s Prescription Diet Feline k/d (moderate stage)
IVD (Royal Canin) Select Care Feline Modified
Formula
Purina Veterinary Diets, NF Kidney Function Formula
Waltham Feline Renal Support
Fluid Therapy and Medications
Once the disease progresses to the point that diet
alone isn’t enough, additional medications along with fluid
therapy are the next step. Kidney failure often causes severe
dehydration. Fluid therapy not only improves your cat’s
physical status but also makes a difference in quality of life.
“If the animal needs fluids, there is no single thing you can do
for them that’s greater than rehydrating them,” says Dr.
Wynn.
Initial y, once or twice weekly administration of fluids
at the veterinarian’s office may be sufficient. But it’s more
comfortable and less stressful for your cat to have you give
them at home. Once the disease progresses to the point that
fluid therapy several times a week is required, the cost may
be prohibitive unless you learn to give subcutaneous (under
the skin) fluids.
Most owners are more concerned about the needle than
the cat is. A needle-less option is the implantation of a
beneath-the-skin catheter. The fluids are then administered
by attaching the IV line to an external port that feeds fluids
beneath the cat’s skin. You’l find further details about
administering fluids in Chapter 5.
Dr. McAnulty says that often by the time your cat requires
fluids, she’l also need drugs to control symptoms of the renal
failure. For instance, medications such as cimetidine
(Tagamet or Zantac) or famotidine help to control stomach
acidity, and other medicine helps reduce the amount of
phosphorus. “A cat that’s on home fluid therapy can get
potassium supplement in their fluid, so they may not need an
oral form,” says Dr. Little.
Since the kidneys are responsible for producing the
hormone that stimulates the production of red blood cel s,
kidney failure can result in anemia. Commercial
replacements of erythropoietin such as Epogen are helpful in
these cases, says Dr. Little.
Hypertension as a result of kidney failure can cause a
stroke at worst, and erratic behavior and yowling at night at
best. In fact, increased blood pressure is one of the major
factors causing the disease to progress. Some diets
increase omega-3 fatty acids to help reduce hypertension,
and if they don’t, you should supplement the food with fish oil,
says Susan G. Wynn, DVM, a certified veterinary
acupuncturist and holistic veterinarian in Marietta, Georgia.
Hypertension can also be treated with a number of drugs,
says Dr. Little. She says one of the best choices for cats is a
human heart drug cal ed Norvasc (amlodipine). “That can
make an amazing difference to their quality of life.”
Dr. Wynn is a great believer in natural therapies, if the cat
wil tolerate additional medications. “There are some herbs
that are pretty amazing. A Chinese herbal formula cal ed Liu
Wei Di Huang Wan real y does seem to help some of these
animals live longer, feel better, and it just seems to be the
little extra something that some of them need.” The herbal
combination also is known by the brand names Six Flavor
Tea Pil s or Rehmannia Six. These prescription medications
are available only through a holistic veterinarian.
Golden Moments: Tending Daffy
Last July, Chris Jevitz of Chicago noticed that her 15-year-
old tortoiseshel cat, Daffy, just wasn’t herself. “She’s a fairly
outgoing cat,” says Chris, but she seemed to be losing
weight and not eating as much. “She spent a lot of time
under the bed, and I also noticed she was dehydrated. Daffy
was more lethargic than normal.”
Daffy always had an annual geriatric screening, and
everything had checked out fine in January. “But a change in
behavior is an indication that something must be going on,”
says Chris. Over the years she’d loved, cared for and lost
other geriatric cats to kidney disease, hyperthyroidism,
diabetes, and heart problems, and she had learned to get