I never wanted to have to write this post.
Chronic Kidney Disease, also known as Chronic Renal Failure (CRF) is a common condition in cats. It is the result of a gradual decrease in kidney function. I’ve been fortunate that I’ve never had to deal with this disease with any of my previous cats.
Until now. Last week, Ruby was diagnosed with kidney disease, and sadly, it’s already in the advanced stages. I’m still trying to wrap my mind around how my little girl could go from seemingly healthy to terminally ill in less than two months. It just goes to show how good cats are at hiding signs of illness, and how even an experienced cat parent like me can miss the signs (or, admittedly, be in a bit of denial about the signs).
Slowly appearing symptoms
At her most recent annual check up in August, everything looked good. Then, starting the beginning of September, her appetite started to drop off. Since this had been a previous occasional pattern with her, I chalked it up to “fussy eating,” even though I could hear my veterinarian’s voice in my head from when I had mentioned Ruby’s finickiness in the past. “There’s no such thing as a fussy eater,” says Dr. Andrea Tasi, a holistic veterinarian and owner of Just Cats, Naturally. “A healthy cat will eat her food with relish. There’s always a reason when a cat becomes finicky.” Ruby was eating, she just wasn’t finishing her meals.
Toward the end of September, I noticed her drinking more water. Before that, I’d rarely seen Ruby drink from the bowl. The girls both eat raw and the occasional canned food, and I mix additional water in with their meals, so she was getting plenty of moisture from her meals. Now, apparently, that wasn’t enough. Something had changed.
Two weeks ago, Dr. Tasi came to my house to examine Ruby again. This time, one of her kidneys was slightly enlarged. That was not the case in August. We ran bloodwork to determine whether her kidney function was compromised, and if so, how much.
The next step to further clarify what was going on with her would be an ultrasound. The most likely causes for an enlarged kidney are a benign cyst, an infection, inflammation, or cancer.
I chose to decline, with the full support of Dr. Tasi. I previously wrote about the topic of diagnostic testing, and how one of the most important questions to ask yourself before agreeing to any test is “what will you do with the information from the test?” In Ruby’s case, that meant: if there’s a growth or cyst on her kidney, it would most likely require surgical removal. If it looks like cancer, it would require a biopsy and possibly surgery and/or chemotherapy. And while surgery and chemo might be right for another cat, I know in my heart that they’re not right for Ruby.
Coping emotionally, and making treatment decisions
My heart felt like it was shattering into a million pieces when Dr. Tasi called with the bloodwork results. We expected to see elevated kidney values, given her symptoms, but we didn’t expect them to be as high as they were. I thought I had prepared myself, but while listening to Dr. Tasi, I broke down in tears. Ruby is only nine years old! The thought of losing my little girl, and losing her sooner rather than later, was incomprehensible.
Conventional treatment for kidney failure typically starts with rehydration via IV fluids, which would require hospitalization for at least two or three days. And while this may be right for another cat, I know in my heart that it wouldn’t be right for Ruby.
Treat the patient, not the lab values.
I am blessed that in Dr. Tasi, I have a vet who treats the patient, not the lab values. She is also one of my closest friends, so she not only knows Ruby, she also knows me really well. She understands the unique bond between me and Ruby. She has been a tremendous support both in treating Ruby holistically, and in supporting my decision to forego aggressive diagnostics and treatment, and to simply keep her happy and comfortable for as long as we can. Until we can’t anymore. And when that time comes, she will be gently eased out of this life, in my arms, in the comfort of her familiar home.
Ruby is feeling good
As of this writing, Ruby is feeling good. She’s still playful, she still cuddles with me, and she still aggravates her big sister. She’s still eating pretty well. I’m feeding multiple small meals, stretched out over a period of two or three hours, which is challenging, because I can’t leave the food down, or Allegra will eat it. But we’re working it out. Ruby is getting subcutaneous fluids once a day. I’m adding a phosphorus binder to her meals. I’m using the Assisi Loop. And of course, she is getting daily Reiki treatments from me.
Ruby doesn’t care that her lab values are a mess. She doesn’t think about how much time she might have left. All she wants is to be happy and loved. And that’s what she’s going to get, for as long as I can give it to her. I have little doubt that she will let me know when she’s done.
And while I have moments of profound sadness, and have shed more tears in the last few days than I have in a long time, I’m doing my best to focus on living in the moment and treasuring every minute I have with my baby girl.
Allegra has been a trouper through all of this. As those of you with multiple cats know, when one is sick, that cat tends to get all the attention, and the others take a little bit of a back seat. She clearly knows something is wrong with Ruby, and I think in her own way, she is holding the space for Ruby. Somehow, the three of us will get through this.
I realize that the decisions I’m making about Ruby’s treatment may not be the decisions you might make for your cats in a similar situation. I ask that you respect my choices. We are in the best possible hands with Dr. Tasi. We have explored all treatment options, and we’ve chosen the ones that are best for Ruby, for Allegra, and for me.
To me, the most important thing is to not just take care of Ruby’s medical needs, but to honor her unique spirit in every decision I make about her care.
Hi Ingrid – Checking to see about your Ruby’s health. Praying she is stable, and you are feeling supported and comforted by the outpouring of love here.
I may have missed it, but do you have her on a special diet? (I know there are controversies about protein. I’m fearful of the muscle wasting that can happen with lack of protein. And I think keeping phosphorous dry matter under .5% seems fairly standard.
Our vet wants to put our kitty on Hills prescription k/d. But I am not comfortable with the ingredients at all. Not even any easily digestible protein – chicken – until the third ingredient. Then way too many unnecessary, poor quality fillers in my opinion.
[Primary ingredients: Brown Rice, corn gluten meal, chicken, pork fat, grain wheat, pearled barley, wheaten gluten, pea protein, too many non-organic flavors].
I would like to feed her a more natural, organic diet – but I don’t know where to start. I know if her labs get worse, we could put her on a phosphorous binder if need be – but the balance is challenging.
Her brother is also part of our family. They are both grazers. So if she’s on a special diet, we’ll need to deal with how to separate them.
Our current compromise with the vet is to put them both on a Senior diet (they are nearly 15). They’ve been on Merrick Limited Ingredient Chicken Pate, plus boiled chicked, multi-vitamins, & Dasequin for their joint health.
The vet recommends Royal Canin for Seniors. But those ingredients are even more unacceptable than the Hill’s k/d.
Corn, brewers rice (known as “sweepings rice” because it’s the worse quality leftovers), wheat gluten, corn gluten meal, wheat, chicken by-product meal, pea fiber, chicken fat, etc etc. Nowhere is there even any good quality digestible protein.
Honestly, looking at these labels, I don’t know how cats can even survive on these ingredients. 🙁
Any thoughts on a good quality renal support diet/wet food?
Same for senior wet food?
Feeling lost here.
With thanks for anything you can offer.
~Nancy, mom to Titi & Sam (apple face, traditional, seal point Siamese siblings, and mommy’s sweethearts)
Ruby is doing remarkably well all things considered, Nancy, thanks for asking. She gets to eat whatever she wants to eat, which right now is Darwin’s raw and a variety of canned foods. It’s more important that she eats than what she eats. Like you, the ingredients in the so-called prescription diets make me shudder, and while protein restriction might be indicated in the final stages of kidney disease, to me, a lot of cats won’t eat the Rx diets anyway, especially if they’ve been used to a better quality premium diet for most of their lives.
You can find more information about what to feed a cat with kidney disease here: https://ingridking.com/2016/02/15/the-right-diet-for-cats-with-kidney-disease/ and what to feed senior cats here: https://ingridking.com/2015/06/29/your-hypecarnivore-why-senior-cats-need-protein-to-thrive/ I’d be happy to schedule a consultation to discuss your unique situation in more detail.
I have a third cat now with CKD; this time it’s secondary to hyperthyroidism. With the first cat, someone recommended a Rx “junk food” (as I think of it) diet which was supposed to be helpful to cats with CKD. Not only would he not touch it, once I had a good look at the ingredients I felt as you do, Nancy — ‘there’s no FOOD in this food!!’
Senior cats need protein, good protein, animal protein. I’ve mentioned “Tanya’s” before, the book and website by Helen, who also had 3 cats with CKD and did a great deal of research. She said, it’s more important that your cat eat than what she eats. Cats with CKD can, when they don’t feel good, stop eating and die of starvation. With the first two cats, I bought a phosphorus binder and fed them the best, highest protein foods they would eat. Neither of them died of kidney disease. Neither of them died miserably. I was never sorry I had not tried to get them to eat that junk food.
In addition to “Tanya’s,” I highly recommend a book by a vet with 30 years experience as a feline-only vet. (She also worked for Hills for 10 years and never recommends their products for her patients.) YOUR CAT, by Elizabeth M. Hodgkins, DVM.
I love and trust the vet I take my cats to for care. But he takes care of dogs, too, and doesn’t have the time to learn a lot more about cats. He has been very open to my sharing what I’ve learned, and has attended conferences and returned with new info helpful to cats. I’m a nurse (retired now) and feel it’s perfectly OK to challenge, gently, a doctor who makes a lousy recommendation. It’s OK to talk to him about why you won’t feed you cat that junk. It’s OK to talk to him about what you will do.
Another tip I share with every cat owner, regardless of their cat’s age and health: when I had two cats with CKD the importance of encouraging them to drink water became very evident after I had to learn to give SQ fluids. I now have water bowls all around the house — one in the bedroom, 2 in the livingroom, one in the bathroom, one in the kitchen (not next to food). The senior cat living with me now drinks a lot more water than she would if there were only one bowl. When she’s walking thru the house every time she comes to a bowl of water it’s as if she thinks, ‘Oh water, how nice!’ and drinks. Mostly I put the water in stoneware bowls as they keep it cool longest. Sometimes I add ice cubes as this cat loves iced water.
Don’t be afraid to do what you know is right or best for your cats. Just educate yourself so you really do know.
Oh Ingrid, I am so sorry to read this news. I am sooooo sorry. I couldn’t agree with you more with how you are making your decisions. I believe if it were me, I would do the same. It is so important to have an understanding of ones individual cat, what their needs are and YOURS. I am soooo sorry. I am in shock. Ruby is so young. I am stunned. I am confident that you are going to make Ruby as comfortable as possible and she will be happy and loved for the rest of her days. I am ALWAYS here if you need me. Sending lots of love to both of you.
Hi, Ingrid, I read your column and follow your posts. We are Facebook friends. I am sorry to hear about Ruby. But glad you are doing what you feel is best for her. Each situation is different and I respect your decision. I had a cat named Missy who developed kidney disease in June 2013 and did well on a changed diet for about a year. When Missy’s condition worsened as in needing the IV treatments I had a friend come in and help me with that. Due to my mobility issues. Then one day I was supposed to take her to the vet for a check-up and more fluids to bring home. Missy was hiding and growling when my friend tried to get her out. So I said just let her be and I’m done taking her to the vet for more treatments. I knew that was Missy’s way of telling me she had enough. So I kept her comfortable with food and water around her. She passed at home on Labour Day weekend in 2014. Such a hard time. But I knew it was the right decision. When I told the vet that I was going to for treatment for Missy. About Missy not wanting to come out from her hiding place. They said well just get her out and bring her to us. They really did not understand. So I began to deal for a short time until her passing with another more understanding vet. Just sharing my experience with you. I will pray for you and Ruby and your kitties. I am glad Ruby is doing well. I will keep her and you in my thoughts and prayers.
Oh, I’m so sorry to hear this sad news, but glad to know you are doing what is right for Ruby. Sending love, from Janet and all of the kitties who own her.
Good morning. My name is John. I would like to tell you a little about myself and would ask that you read as there is a reason.
My wife and our two children have 8 cats. I know that that is a lot. They are all rescues. I like you am an animal lover, I am also a repossession agent which means I spend a lot of time on the road. I carry cat food with me and when I see homeless cats, I stop and leave food for them.
I cannot save them all but if I could I most certainly would. If I were single, I would spend my time and money to do all I could for the homeless and feral cats I encounter, but I have a family.
This post is for you and not about me. I tell you the above to let you know that I understand the value of care, of life, of family and of difficult choices.
I treasure your bond with your cats as I treasure my bond with my family and my own pets. I love my wife, I love my children, but somehow my bond with our pets is different and wholely unique. Its different and difficult to put into any amount of words.
We each have our special cats. My wife has a ginger called Tiggy. My son has a white and black cat called Oreo. My daughter has a cat called Edgar. I have an older cat, a ginger called Gypsy. I also have a very special bond with Baby an outside feral cat I found and brought home. She is ferocious and had 6 kittens, 3 boys, 3 girls. The boys were all black and no one wanted them. We kept those boys. The three girls we quickly found homes for, and of course we kept baby as each time someone other than me picks her up she becomes violent in a way that does that word no justice.
Edgar my daughters cat is one of those kittens. He also has two siblings, Shadow and Bear Bear. Shadow cleaves to me as he was the runt of the litter and was always picked on and had to be hand fed after birth. So when I am home he follows me around. That leaves just one unnamed cat, Sophie2, who is totally anti-social but loves my wife to death.
There is a story for each cat and each cat is loved and given attention and care.
I could tell you of all of their quirks and eccentricities but its not important to anyone but me and my family and only we will understand them. I could explain why we have those eight and how I rescued them and why we could not find other homes, but unless you understood then you would not. Its simple and black and white.
That is how I understood your above post and how and why I won’t question your decisions, because the bond you have you understand on a level that you can’t make others understand for any number of reasons tangible and intangible.
I could also tell you of the other cats before these that we had and have passed.
I would talk to you about Punch a 35 pound ginger tom that I found and brought home who had paws like my hands. He was a gentle giant and when he died he died in my arms and I wept like a baby. I could also tell you about Chance a grey tuxedo cat who I found as a kitten who was covered in green mucus and who a vet told me had no chance to live, but we persevered and he survived and lived a good life until cancer took him from us.
I would also tell you about Chaos or Jezebel or Tramp or Ez who came and went before Chance and Punch, but those are just names that mean something to me, and not anyone else. They all have their stories and now they live in my memories. And before those lives there were others, Sophie1, Tashka, Chchch, Mango and Matsi.
I forget none of those names, each one lives inside me and is never forgotten. I could lastly tell you about Louie an outside cat that was sick and came to our door. He was feral and refused to be caught but would always come for food. One day he came to the door and let us pet him, we knew then he was sick. The vet confirmed he had feline aides and kidney disease and it would be a kindness to put him to sleep. We refused and returned him to our door step where he continued to come each day and eat and drink until one day he stopped leaving and just wanted to sit and not be alone. We sat with him for days until the end. He experienced love before death. I buried him in our back yard.
There is a story for all of them, but more important than that there was and has always been love.
From my family to yours. From our pets to yours. From past to present. We offer our love and support.
You have our best regards.
Thank you for sharing your stories, John. They touched me deeply.
John, thank you. like you, we have ferals, and had a couple of ferals come to our door, they also passed being with us. it will soon be time I think for our ferals to leave us (all 3 are 13 yrs, one isnt doing well), but like you and Ingrid, I have developed a special bond with each. two more so than the other one, he’s more hubby’s cat.
but they each put a mark on our hearts that stays forever. I hope and pray Ruby is doing better and you and Allegra will have more time with her, but if not, then cherish what you do have until then. God bless you all and know many, many hearts and prayers and eventually tears will be with you all.
I am very saddened to hear that Ruby is ill. I feel that she and Allegra are a part of my family. I’m heartened to learn of your treatment plan for sweet Ruby, it follows my own thoughts for when this will happen to one of my clowder- a familial bunch all 10 years old, with their momma 6 months older, 4 cats in all. I am truly sorry, Ingrid. Don’t forget to take care of yourself- Donna and the Catz.
Ingrid! I cannot tell you how sad I feel reading about Ruby’s declining health. I am sure you will do everything to make sure she is comfortable and feeling as good as possible – that she is safe and loved beyond loved goes without saying. Prayers are not for me, I just wish you all my best. Sending love to Ruby and you.
I’ve been away a few days and have only just read your post and the sad news about Ruby. My heart really goes out to you. My beloved first cat, Chica, who adopted me (she kept coming in through the window and I would find this beautiful green-eyed black and white cat asleep on my bed or the sofa) and introduced me to the joys of having a cat, developed chronic kidney disease at the age of 10. I didn’t know much about cat nutrition and had been feeding her dry food at one meal (on vet’s advice for her teeth). She was constantly thirsty and as soon as I realised the dry food might be a contributing factor, I stopped it. Medication was also recommended but I didn’t like what I read about it, and chose not to go down that road. I was very lucky, she stabilised and lived another four years. One thing I do remember that she really seemed to like after the diagnosis was good quality tinned salmon. I totally understand and agree with you about avoiding aggressive diagnostic procedures and treatment and keeping her at home with you. The love and affection shared between you both and her quality of life are by far the most important thing. Your approach also keeps stress to a minimum, which is terribly important in managing any chronic disease, in a cat or a human being. When Chica eventually died, I was lucky enough to find a vet willing to give her the final injection at home. She was honoured with a beautiful ceremony and buried in a garden beneath a kangaroo paw plant. It’s 10 years this year since she passed, and I still think of her and miss her. The fact that she was able to die at home and was spared unnecessary suffering and stress is a great comfort to me. I very much hope that you still have a good deal of time with Ruby. It is impossible to know what that time span will be. But the outpouring of sympathy for you is testimony to how much cat lovers everywhere appreciate the marvellous site you have created, and the knowledge and insight you bring to it. So it seems to me that Ruby could not be in wiser or better hands. Lots of warm wishes and grateful thanks to you.
Ingrid – I am so sad to hear about Ruby’s health. I can’t believe she is already 9 years old. I remember the day you adopted her from SPCA NOVA. You are making the right decision for you and for Ruby. Aggressive treatment is not always what’s best for the kitty. Your post reinforces how I have always approached my own cats and the thousands of cats who have been rescued by SPCA NOVA over the years. What matters is the cat’s quality of life. Ruby is so lucky to have been adopted by you. I know she is happy and loved. That’s what matters.
So lovely to hear from you, Kathleen – I wish it was under better circumstances. These past 9 years have just flown by, and it is hard to believe, especially since Ruby still acts like a kitten, even now.
Oh Ingrid, I just read the news and I am sitting here mopping up the tears. Oh oh oh. There are no words to give you but I will send prayers and Reiki to you all every day. Since time is shorter than expected, perhaps more tuna cakes would be in order. You think?
Love from us, Patty and Cricket