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.
Diagnosis
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. When it comes to diagnostic testing, 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.
I feel so close to Ruby having read your blogs and info for many years. I am shocked to hear of her diagnosis. So young. She is so lucky to have you to care for her. I love her almost as much as you do and wish her the best outcome. Hope she lives for many more years. Love to you and Ruby and Allegra.
This is so sad! I’m so sorry and Bibi and I send all three of you lots of hugs! I think the way you handle this is so inspiring. I always have cats who’d require the same decisions, because of their sensitive and anxious natures. Your blog has helped me understand that it’s the right thing to follow the path suitable for your situation and cat. I think you are the most loving cat parent who makes Ruby’s life as good as possible. You’ve been a great support when my Snoes died of kidney failure and I hope you’ll have a beautiful time with both cats. I’m crying as I write this, it feels like I know Ruby also a little bit and both girls are so precious.
I know this was a hard post to write. My heart goes out to you. Ruby is lucky to have you to take care of her with so much love and compassion.
I am so very sorry about Ruby, my heart hurts for what your family is going thru. I know how blindsiding and agonizing a diagnosis like this is. I’ll keep you all in my heart and send love and positive energy your way.
Ingrid, I’m so sorry Ruby has kidney disease and that it progressed so quickly. My Thomas has kidney disease, too, and I’ve been very fortunate that his labs have held steady for the past several years. I totally respect the choices you’re making about Ruby’s treatment and palliative care–you know what’s best for Ruby because you share that special bond that comes from knowing one another so well. I am curious about holistic treatment for kidney disease, so I’ll follow along with you in your journey with Ruby.
Im so sorry. You are doing all you can and I’m so awed by your devotion. My BBBT and Cee Cee both had CRF.
My heart is breaking for you. I know exactly how you feel. I have no doubt that you are doing the best for Ruby. She is your baby girl, and she knows how much you love her. Continue to follow your gut and just take it day by day – that’s all you can do. I’m thankful you have a wonderful vet too – that support helps tremendously. Thanks for sharing and being so honest. You are such a help, an incredibly source of comfort and information to others…may you feel all of our care and support back to you. We are with you in spirit.
While reading this post, I realize that our Angel is exhibiting some of the same symptoms as Ruby. I’m now making an appointment to visit the vet. Hugs and purrs to you.
Another voice chiming in with love and support. Much respect to you for your approach to doing right by your girls. Much, much love to you, Ruby and Allegra.
I am so sorry to hear this! We went through the same making the same decisions that you have made. Hope you have the luck we had in that we had our baby 4 more years with SubQ fluids.
I’m so very sorry. I also completely respect your decisions regarding treating Ruby as Ruby, not “treating the lab values,” as we are currently making the same sorts of decisions for one of ours. I think it is a show of understanding and respect for her as a beloved individual. Big hugs to you and yours…
This breaks my heart because I know what you are going through. I had a cat with what appeared to be a sudden onset of kidney disease back in 1994. We tried everything we could for about 2 weeks and I ended up assisting her across the rainbow bridge. She just kept going downhill. Sending prayers your way.
Oh Ingrid, I’m so sorry. It sounds like you are dealing with acute renal failure (vs chronic). In late September of 2015, my boy Lucky’s blood work was perfect. Almost a month to the day later, his levels indicated end-stage kidney failure. With acute, there isn’t much warning. You might notice very subtle things but of course we try to explain those away in our head. In his case it was his moodiness that one weekend. He even growled at me.
I was told all the various things that it could be. Infection was best case scenario. Toxin was a possibility but there was nothing toxic that he could have gotten into. No flowers of any kind either. The other thing we knew thanks to an x-ray was that he had a very enlarged left kidney and somewhat shriveled one.
We attacked the acute renal failure with everything we had, four two weeks. He completely stopped eating during that time. He blood work at the two week mark was 1.5 times worse than before (I didn’t think it could even get that bad – acute actually has what they call Stage 5 apparently). He let me know what HE wanted at that point, and so the day after I got the results, I honored his wishes. 11/12/15.
My absolute biggest piece of advice, feed her whatever she will eat. Try not to worry about feeding her the “right” thing. If you have to pan fry chicken for her, so be it (yes, that’s exactly what we did). You’re already on phos binders so yeah, whatever she will eat is best. Going by how you describe your vet though, it sounds like she already may have told you the same thing. It’s what my vet did.
I also didn’t go through extensive diagnostics. Best case, you’ll know what the enlarged kidney is, but if it’s something bad, there probably isn’t a whole lot that can be done. In hindsight, we do think (in Lucky’s case) that he had a tumor in his left kidney. We don’t know for sure, as we’d only done an x-ray (back when I was thinking he was constipated – oh boy I couldn’t have been more wrong).
I am thinking of you and Ruby. I’m sure you’ve heard of Tanya’s Feline CKD page, but if you haven’t, you may consider googling it. It’s a lot to read – and some of it very difficult – but it helped me out a lot. Especially in the “what could I have done??” department, because there was absolutely nothing I could have done to foresee this. And there was nothing I did or didn’t do that caused it. And I’m sure that is the same case with you.
I am so sorry, Ingrid. I know all of us cat lovers are grateful to you for sharing your thought process – I know I made many of the same decisions with Musetta. That doesn’t make it any easier, though. Your love is a tribute, and it shows in your care. Know that so so many of us are holding you and Ruby in our hearts.
I’m sitting here just sobbing. She’s way too young to be going through this. I’m so very sorry and pray that she rallies and you have lots more time together, as it should be. Regardless of what happens she couldn’t be in better hands than yours. Sending you my love and Mudpie’s purrs.
Ingrid, I am crying for you and Ruby. I know that love is what my cat would want over treatments. My heart breaks for you. I remember decades ago when I faced my beloved terminally-ill Abby, “The kindest act of love for Abby is your last act of loving-kindness when that time comes.”
Dear Ingrid and Ruby,
You both have been such an inspiration having helped me become a more informed and thus better cat parent. That’s why I am extremely saddened to hear this news. I can’t believe this is real. I am praying for both of you and I trust Ingrid to make the best decisions for you Ruby.
Lana
I am sorry to hear about Ruby but I want to tell you that even though her kidney values may be high there are still things that you can do at home to change that. My cat was at Stage 4 CKD with high numbers and we were told in August of 2018 to euthanize her. Of course we didn’t listen and here we are in 2019 and she is still alive. In fact she is now back in Stage 3. We attribute this to daily subq fluids administered at home. Please visit Tanya’s Comprehensive Guide to Feline Chronic Kidney Disease and join the support group. You will be so glad that you did because there a number of very knowledgeable people on the site.
So sorry to hear the news of Ruby. My Vera n I went through kidney issues n I had been giving her fluids at home with I.V. I did what I could until it was time to let my baby girl go one day due to cancer. I also have another kitty-Blu n he has some kidney issues n I choose not to go through home I.V. with him due to my past experience. I have to remember if what is best for the kitty n not me. Again, so sorry to hear the news.
Ingrid,
I read your blog every day. My heart shattered when I read about the news on Ruby. I know you must be devastated and any loving parent would feel when their fur kid is sick. I understand and respect your decision because as Ruby’s mother, you know what is best for her. Sending love, prayers and chin scritches Ruby’s way and hugs of comfort to you. May Ruby be with us for many more years.
I am deeply saddened by hearing this. I sit here with tears in my eyes having experienced this with my two past Torties, Chloe and Samantha, mother and daughter. I respect your decisions and agree with them. As moms we know what’s best for our fur children. Stay strong for the girls. Lean on us when needed. Thank you for sharing. You and Ruby are in my prayers.
Jacinda
Well Ruby is one lucky cat to have you as her Mom, Ingrid. We sure send lots of good thoughts. and sure hope she hangs in there for awhile.
Ingrid,
I just finished reading your post. I’m so sorry to hear about Ruby. This is truly heartbreaking. I went through this with one of my cats several years ago. Even though I don’t know you, the feeling I get from reading your daily emails is that you’re a great cat parent and will do everything right for Ruby. I wish you the best.
Oh Ingrid I am so very sorry. Please know that those of us who know you, know you are doing your very best for Ruby. I love that your vet says treat the animal – I know in our house that there are some that not doing the medical testing will be the only option. It is never easy….but you are all loved.
I’m so sorry to see this post about your dear Ruby. It is never easy getting such news and deciding on the right course of action. I feel for you and know others support you.
Oh Ingrid, I am so sorry to hear this about sweet Ruby. My heart is breaking for you. Y’all have become a big part of my life. I always enjoy reading your posts and seeing your beautiful girls. I know Allegra knows something is wrong and she will be there to help you and Ruby through this. You are the best cat mom I know and I totally agree with your choice. We have to let them live the best life no matter the amount of time they have. I will keep y’all in my prayers.
My precious kitty was diagnosed with CKD in July of 2018 and I was told eight months to a year to live. After lots of research I found Oet Wellbeing’s Kidney Support Gold, all natural kidney support. His creatinine, bun levels slowly started to come back down. Vet said it’s a miracle. Today his CKD is gone. He has the Kidney Support Gold daily and is checked by the vet every three months. Vet said “don’t ever stop giving him the Kidney Support Gold”. It’s natural so it can’t hurt but it worked.
I’ve been using Kidney Support Gold for Tekla, my 16-year-old, for more than two years. She’s doing really well. Her values are a bit elevated, but at her age, it’s to be expected. She’s been raw fed with some canned her whole life. I agree with Sharon — it’s something to look into.
Ingrid, I am SO sorry to hear about Ruby. For you to receive this news @ her young age of 9 is truly a shock. My furry soul-mate, Kalohe, was diagnosed @ age 14 1/2. With great care & lots of love, she was with me until age 20 1/2! I would like to believe your Ruby still has lots of time with you. Only you know her best, so you will give her everything she needs along this path. Love & Peace❣️
This must have been a difficult post to write. I’m so sorry to hear that you and Ruby are starting this journey. When my heart cat Tommie was diagnosed, it was only a few months after a full senior blood screening that showed him to be in perfect health. I hope that researchers are working on a cure that will reverse kidney damage.
I’m so sorry to read this. 🙁 I went through a similar situation with my cat Middori. He was diagnosed with GI lymphoma, but it was similar in that I had to do what was best for him and his situation and not aggressively treat it the way I wanted to. He was a very laid back cat and did not like the vet, with the Passion! So I found a local vet that that could come to the house and do occasionals wellness checks on him. He went me know when he was ready and he was able to pass in the familiar loving environment of our home. I miss him every day. You will get through this, soak up every moment you have with ruby❤❤
My heart goes out to you, and especially to Ruby. Each pet parent has to what is right for their fur child. Other opinions well…
You know your Ruby better than anybody. Will do the best fo her. Keep us informed. My thoughts to you both. Give a hug and kiss to both of the girls from…..
Grayson, Milo, Nan
Thank you for this timely post. My sister is going through the same thing with her 12-year-old cat. I have forwarded this to her.
We are also experiencing this with one of our kitties. I will be following your writing about dear Ruby with much empathy. My very best wishes to all of you, and thank you for sharing. Much love to you all.
I feel such sorrow for you . My baby boy had the same happen a few months ago. He was perfectly fit and well but suddenly stopped eating completely. After blood tests his kidney values were off the scale. We had him admitted to the vet hospital for I/v fluids but he still refused to eat anything. He remained alert and not unwell despite all this. We were told there was really no hope and to spare him having tubes put into his stomach we agreed to say goodbye . I can understand you want to keep Ruby at home and I wish I had had the courage to bring Baz home to see if he could recover but I was afraid he would become even more unwell. He was only 8 and never been ill before. It’s truly heartbreaking but at least Ruby is home with you whereas my boy was put to sleep in a vet hospital without me even being there. I can’t forget or forgive myself for that
I’m so sorry to hear about Ruby. I’ve been reading a lot about NHV supplements. I’m not sure if it’s something you have tried for Ruby? I hope I’ll be as strong as you when the day comes and my cats have a serious illness like kidney failure. Sending you and your kitties lots of love and strength
Ingrid,my thoughts and prayers are with you. I’m so very sorry. Thank you for sharing this difficult time.
Ingrid, as I read your post today with tears in my eyes and a broken heart, I truly understand your pain and your decision making process. Just last Tuesday, I had to make the devastating decision of putting my 4 year old male calico down due to kidney failure. As you said, kitties are masters of disguise because one day Skeeter was playing, eating and annoying the other two kitties and the next day he wasn’t. The next 4 days with the vet were only prolonging the inevitable; I was there with him as he crossed the rainbow bridge. I wish Ruby and you well as your journey continues. Ruby (and Allegra) have an awesome cat mom. Prayers for the best.
Kim
Ingrid, my heart goes out to you and Ruby. We too, spent years caring for our older boy who passed from CKD in February of this year. And we also made the decision to not be overly aggressive with his treatments due to his age at the time of diagnosis and other concurrent health issues.
You of anyone, certainly know your way around the world of cat care and are capable and qualified to make the right decisions for Ruby.
If for any reason you would like more information or to reach out to others who have traveled this road here are two helpful sites that were great resources for me and honestly, don’t know if I would have been able to get through some days without their assistance on tips and tricks for caring for cats with this disease. You might already know of them but others reading may not so I’ll put them here anyway.
First, is The Cat Site https://thecatsite.com Everything cat related. I used to moderate the forums here. Very active community. Many of the members have experience in CKD and can be a wonderful resource for information and support. I learned a lot from others here on how to manage the day to day issues that arose such as times when Casper’s appetite was waning.
Second is Tanya’s Comprehensive Guide to Feline Chronic Kidney Disease https://www.felinecrf.org/
Excellent information on this site, detailed, covers literally everything one needs to know from start to finish. Every detail you can imagine is on this site, noting is left out.
I know that when you first learn of this diagnosis it’s overwhelming and tears your heart in pieces. But as we discovered, as time went by it was more manageable than we first thought it would be and our Casper was with us for much longer than we ever thought was going to be possible due to the great care he received from us and our vet. Every day was a gift and we got way more presents from him than we ever though possible.
Wishing you strength through this journey. All in our home send love to you and Ruby.
Sending love and support to you and the girls. I know this is a bitter sweet time for you. May each moment be a memory that will help you during this difficult time. Thanks for sharing as I fear this is something I’ll face in the future. Take care my friend.
Medical treatment won’t change the final answer, just delay it, but at what cost emotionally to your cat. Thus, I perfectly understand your decisions re her care. You’re her mamma doing your best for her.
Sad the 3 of you are going through this. I pray to God that you will feel God’s arm around you, loving and supporting you. Gail
I am so sorry for all of you. Your treatment decision is to be admired and respected. I am sure that it was a very difficult one to make. Only you and your vet know what is best for Ruby. You have our love and support. As difficult as this post was to write, thank you for doing this. It will help other people when the time comes. Thinking of you, Ruby and Allegra. Much love to you from Pipers & I. ((((((((Hugs)))))))
I am so sorry to hear that Ruby has kidney failure at such a young age! My first kitty, Max, was a loving, playful grey domestic shorthair who lived until the ripe old age of 14. He developed kidney failure suddenly and it really through me for a loop. I understand all of the feelings you are experiencing, and no one but you, the cat Mama, can make decisions for Ruby. It has been over 4 years since I had to say goodbye to Max, but my memories of him are as fresh as ever. All my prayers & love to all of you. Ruby was very lucky to find a cat Mom such as yourself……
So sorry to hear this Ingrid, I’m here in the UK & follow your blog.Think vet procedures differ here I know our cat was prescribed renal food
We went through this with Cleo so know how devastating it is, but Cleo was a grand old lady of about 17 when diagnosed.
Hope Ruby & yourself have more quality time together
My heart goes out to you
Shirley
Hi Ingrid, do you know of Vitality Science, Stephen Becker in New Mexico. He is amazing and has helped people’s beloved pets from all around the world. I’m from Australia and Stephen has helped me with my kitty Charlie when no Vets could offer me anything except steroids and other medications. Though it was worth a mention to you.
Thinking of you and your kitties. Regards Diane, Melbourne Australia
Devastating news!! Me and my 4 kitties have our arms wrapped around the 3 of you!! Sweet Sweet Ruby…I’m at a loss for words. Stay strong my dear friends Ingrid, Allegra & Ruby. You are in my prayers <3
Oh Ingrid, my heart is breaking for you. I know what a special girl Ruby is and the bond you have is beautiful. You will be in my thoughts and prayers xx
Oh no! My human and I are so sorry about Ruby; as you know, my human lost Sparkle to acute kidney failure in 2014. I wish there was more research into this, since kidney issues are so common with cats.
I know you are doing what is best for Ruby. All cats are different, and need different approaches (the same is actually true for humans, although I think they don’t realize it as much as they should). I’m sending lots of purrs to you both, and to Allegra too.
Ingrid –
This post is heartbreaking and inspiring at the same time. I would expect no less from Ingrid King, our guru of conscious living. Thank you for letting us into your life as you, Ruby, and Allegra go through this challenging experience. You are a daily inspiration to all of us, your Conscious Cat family. We are with you in our hearts as your family goes through this difficult time. We love you, all three of you.
Ingrid, I am so sorry. You ‘will’ get through this, and will find yourself doing what you must for Ruby.
16 months ago, we lost our orange male tabby, Bob, to kidney failure. He wasn’t even 8 years yet. I knew that something wasn’t good almost two years ago now. Had his bloodwork done, he was in early stages of same.
Meds given, but he failed fast 7 months later. It’s heart breaking, definitely. We just got an orange tabby male kitten a month ago. I pray that he lives a long, long time. Our first one years ago, was 18 when he passed. Please take care, and know that I will be thinking about you and your kitties, lots.
Hugs, Di
Bracebridge Ontario Canada
❤️
Ingrid,
I have been reading your wonderful and very helpful blog for a few years. I am so sorry to hear of Ruby’s diagnosis and I certainly understand and respect your decisions as I have handled mine in the same manner. May Ruby do well and give you much more joy.
Marilyn