My cat, Titi, is 9 years old. Just over 2 years ago, the vet diagnosed him with Stage 3 CKD. He advised me to feed him renal dry food and give him Semintra once a day. Those two years went quite well. He even went from weighing roughly 8 lbs 13 oz to 15 lbs 7 oz. About a week ago, Titi stopped eating; his coat was dull and he had very bad breath. He was isolating himself. I took him back to the vet who told me he is now at Stage 4 (his creatinine, urea, and phosphate levels were higher than the machine could detect). He had large ulcers under his tongue. So, he has an AKI (acute kidney injury) on top of the chronic condition. The vet's prognosis was guarded, if not very pessimistic, and he talked about putting him to sleep. The vet said the AKI might be caused by kidney stones. He did an ultrasound where he saw large stones. He then referred us to a veterinary hospital. Titi had another ultrasound which showed that he has almost no left kidney left and that his right kidney is still quite large but with irregular borders. But that wasn't the main issue. The vet hospital advised trying a 48-hour stay to put Titi on an IV drip. The vet also gave him an injection of a steroid and a broad-spectrum antibiotic. After just under 48 hours (around 30 hours), the levels had come down but not enough. They are detectable by the machine but still very close to the maximum limits. The vet stopped the drip and explained that it wasn't right to keep pushing, and since he wasn't eating anymore, it was the end. He gave him a week at the absolute most to live. He could have fitted a feeding tube, but he didn't recommend it. So we decided to bring him back with us to be with him in his final days and give him some comfort. Titi is back home now. For the first three days, I still did two round trips a day to the vet for morphine and anti-sickness injections. I started feeding him (cat fish soups) and giving him water with a pipette (almost every hour) plus Semintra. The vet then suggested trying liquid renal food. Titi took it very well at first. After three days, he had regained some strength and even the vet was surprised. His prognosis went from a few days to a few weeks. So he decided to stop the morphine but keep the anti-sickness meds. This is the first morning without morphine, and I find Titi is really flat, and it's very difficult to feed him. He's drooling from the sides of his mouth. Plus, Titi is constantly going back and forth to the litter tray without necessarily doing a wee. No poo for at least three days. What should I do? Thank you so much for your replies.
Translated from French
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Good evening,
I’m so sorry for you and for him. CKD is a cruel disease that claims far too many cats, unfortunately. I also believe that letting him go peacefully is now the best solution and the final act of love you can show him. Wishing you a lot of strength; we all know on this forum just how difficult this decision is. Please keep us posted. Stay strong.
Thanks again for your reply; it was definitely hard to read, but it’s helped. I just can’t bring myself to accept it because this cat is pretty much my whole life. I already know what the vet would suggest, but I wanted to cling to any glimmer of hope. I think I’ll go back and see him tomorrow and take the time to talk it through with him.
You can pick up some Nutri-Plus Gel from your vet. But honestly, based on what you’ve described and with his levels being off the charts, I’m really worried this might be the end. I’m only saying this because I’ve unfortunately had four cats with CKD at the same time, and those were the telltale signs that their kidneys had finally given up. Having been through it myself far too many times, I know it's such a heartbreaking decision to make. It feels like we’re the ones ending their life, and the guilt is overwhelming. But the guilt of letting them suffer just to keep them here for another day or two would be so much worse. They don’t deserve to suffer; they deserve to pass away peacefully in our arms.
As for the IV drip, it usually perks them up a bit, but when they’re near the end, they often crash again the very next day. And if the vet has already put him on morphine, it means he’s already in a lot of pain.
I understand you’re clinging to every shred of hope—we’ve all been there—but there’s only so much anyone can do. Just remember that your cat was so lucky to have such a wonderful mum who took such good care of him. Keep giving him that love right until the end; it’s the kindest thing we can do for them now.
The hardest part is making the call, and you’re the only one who can do that for him.
Ask your vet what they would do if it were their own cat. It really helps when you have to make that choice.
Hi,
Thanks for your support and advice. I’ll see what the vet says tomorrow. Where can I get hold of Nutrigel plus? Titi weighs about 11 lbs now, so he’s lost about 4.5 lbs.
He’s like night and day compared to yesterday. I don’t know if it’s because he’s come off the morphine, but he’s just been lying there all day (he’s sleeping constantly). On the plus side, he isn’t trying to hide, and when he does move around (which isn’t very often), he manages to get about okay, apart from a slight limp. I really don’t think the stay at the vet’s for the drip helped him at all. Before that, he’d almost stopped eating but was still having a tiny bit, and he was still quite alert (even though he’s never been particularly active). When I picked him up, he was very weak, found it very hard to walk, and wasn't eating anything at all.
I love him so much that I’m finding it really hard to make the decision to have him put to sleep because I’m still holding on to hope. I just hope I’m doing right by him.
Thanks again.
I'm so sorry about your little one; I know exactly what you're going through, unfortunately.
Phytophale and Rubenal are supplements given to help support the kidneys, but they should be used alongside the medication your vet prescribed for his CKD. If he starts picking up, you can give them morning and night; it won't do him any harm, quite the opposite.
To try and get his appetite back, try Nutri-Plus Gel. It’s a brilliant high-calorie supplement for cats that aren't eating or are recovering. You need to give about a 2 cm ribbon of it morning and evening, and keep going as much as you can if he isn’t picking up. I’ve saved quite a few of my cats with it, and it really helps stimulate their appetite. Keep syringe-feeding him for now, otherwise he won't last long.
Unfortunately, if he’s in stage 4, it’s going to be hard for him to pull through, but I’ve learnt never to give up on cats because they sometimes bounce back even when you think they’re at death’s door. However, if you notice he’s very withdrawn, trying to hide, and struggling to stay on his feet, then help him on his final journey so he can go without suffering, as it’s a disease that causes a lot of pain at the end. Don't hesitate when the time is right, but for now, if there’s any hope, you have to cling to it.
Best of luck.
Hi,
Thank you so much for your reply. I’m fully aware that Titi’s case is very complicated. However, I don’t feel like he’s reached the end of the road just yet because, despite being exhausted and refusing to swallow anything, he’s still quite responsive and isn't showing any other signs of suffering. Maybe I’m just kidding myself. The vet, who was much more optimistic than I was yesterday, gave me a bit of hope that is now starting to fade. I’m finding it very hard to come to terms with it. Should I keep syringe feeding him? Should I do it less often? etc. I don’t want to put him through any misery.
I also know the vet is doing his best and is really listening to us. I think it’s also difficult for him to suggest putting him to sleep. I was also wondering if there are any treatments to stimulate his appetite. For instance, I’ve often read about using Phytophale (I think) and Rubenal. I don’t want to try self-medicating, but I’d like to discuss it with my vet tomorrow. I’d appreciate some advice on how to bring it up with him and find something that would make things easier for Titi. Thanks a lot.
Hi there,
Your cat’s situation is very complex. You and the vets are clearly doing everything you can to give him as much time as possible, which is really admirable.
For a vet, suggesting euthanasia is a very difficult thing to do, as it means admitting there are no solutions left for their patient. Most vets go into the profession because they want their patients to live for as long as possible in the best possible conditions.
It’s already wonderful that your cat has managed two years with this illness, and recent events show that he’s a real fighter.
It is quite worrying that your cat isn’t passing any stools, as if he’s blocked up, it will eventually start to cause him pain. He’s already in discomfort because of his kidneys, so you wouldn't want to add to his struggles. Since your cat is on a special diet and is already on quite a lot of medication, I think it would be risky to try any home remedies you might come across online. The best thing to do is to ring your vet surgery; they’ll be able to advise you on a different food, medication, or a technique to help with this.
Your cat’s health is very fragile at the moment, and you just have to keep doing what is best for him, just as you’ve always done. As you mentioned, your cat has a very serious condition and is nearing the end of his life. At this stage, it’s not always easy to get the balance of treatments right, and sometimes you just have to take it one day at a time.
Wishing you all the best,
Kind regards,
Solène
