Dealing with Feline Chronic Kidney Disease in Singapore

[applefreak]

My girl was diagnosed with Feline Chronic Kidney Disease (CKD) in Mar 2012. Since then, I have learnt a lot about the disease and also joined a Yahoo! group for people facing the same.

I won't say I know a lot now, though what I DO know is that we have very little resources in Singapore to deal with the disease. I would like to share my experience and also point in the right direction for those who might someday find themselves in my shoes.

First off, DO check out Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat. There are so many things to learn about this disease and as our cats' caregiver, we need to keep on top of things to make sure the rest of their lives are as comfortable as possible.

 

[applefreak]

Sure u can do a lot of things but all is palliative, baring renal transplant there really is no cure for CRD just do things to make patient comfortable until the end comes. Debatable as to how good stem cell therapy is and what is the efficacy, it doescost a lot of money

With FORL it's often very painful and affected gum is swollen and inflamed. Has your vet refer ur cat for CT scan of the nasal passage ?

I agree that everything we do is palliative
as i am fond to say on the group i join, life is terminal
everything we do is to make the process as comfortable as possible.
cats have lived years, up to eight after diagnosis with the right support
so who is to say we should give up on day one?

based on what i have learnt, stem cell therapy is actually cheaper than transplant
ethics aside, the life expectancy of a cat AFTER transplant is a lot shorter than what i expect (about one to two years)
issues like rejection, immuno-suppressants causing infections, the surgery itself

then we got to talk about ethics, who are we to take a kidney from another cat
some people may think that since i 'own' the donor cat or i will be giving the donor cat a home, it should be fine.
but really thinking about it, would it be fine if i adopt an orphan from the orphanage and take one of his/her kidneys? i'm giving him/her a home after that!
given cats' propensity to CKD, it is just hurrying the donor cat along the way to CKD.

wrt the CT, not done cause my girl isn't the most cooperative patient
given her current condition (issues with body weight and anaemia), we are unwilling (the vets and me) to let her go under

 

[applefreak]

Let me share my journey

In Mar 2012, I brought my girl for her vet appt as she has been plagued by an upper respiratory infection.
A blood test was done and it was found that she has mild CKD.
She was put on a renal diet and a blood test was done every three months to monitor her condition.

In Jun 2013, her numbers went a little higher and we started doing subcutaneous fluids for her once a week at the vet.

End Sep 2013, I noticed that she has not been eating or drinking.
No urine or poo in her litter pan as well.
After about three days (I know I should have rushed her in instead of waiting), I finally brought her to the vet when she became very weak.

A blood test shows that her numbers were through the roof and the vet was pessimistic about her condition.
She was put on IV fluids and the vet advised me to bring her home at night so that she will have someone around and in a familiar environment when she passed.
Every morning we will drop her off at the vet and collect her in the evening to spend time with her at home.
Thankfully she rallied and was well enough to be home on maintenance after ten days.

On her discharge, daily subcutaneous fluids, renal food, weekly shots for her anaemia, phosphorus binder (for adding to a/d) and a probiotic were prescribed.
I have since added others on what I have learnt from both Tanya's website and the Yahoo! group with the blessing of the vets
They do not prescribe actively, but do not object to the addition of these medications/supplements.

Her condition is now stable with some issues which we are addressing i.e. hypertension and anaemia
These are very common in CKD cats and please have your vet check them out if your cat is diagnosed with CKD.

 

[applefreak]

Some resources I found during my frantic search for necessary items

If you are giving subcutaneous fluids, Terumo needles are better than the others available
They are sharper, and thus it's easier to pierce the skin without much pain.
Depending on the tolerance level of your cat/dog, you may want to experiment with different sizes (needles go by gauge, the lower the number, the bigger the needle is and the faster the flow)
So far I have only managed to find Terumo in Unity Pharmacy. If you know anywhere else that sells it, do let me know

As for the fluids, I am giving lactated ringers
It is available from hospital retail pharmacies with a prescription
Or from a shop in Jalan Besar, no prescription needed.

 

[applefreak]

CKD cats often have stomach acid problem, thus causing inappetance.

To combat stomach acid, I give famotidine to my girl (or you can give ranitidine depending on which works better for your cat)
both are available over the counter without prescription
it has helped my girl feel better and more willing to eat.

 

[applefreak]

Anaemia

there are many things to watch out for when your cat is diagnosed with CKD
however, some of these things are more critical than others and needs to be watched with an hawk's eye

our kidney produces a hormone called erythropoietin that helps our body produce red blood cell
when the kidney is damaged, the level of the hormone drops and not enough red blood cells are produced, thus causing anaemia

CKD is not curable generally, but it takes quite some time for it to reach the end stage
anaemia kills, FAST so addressing the anaemia is very important

do remember to do a PCV (or HCT if you are doing the full blood panel) every time you visit the vet
your vet should be able to advise you based on the PCV level
when the level gets low, vitamin B12 injection is advisable
if it drops to 20%, it will be time to consider erythropoiesis-stimulating agent (ESA)
ESAs functions as the hormone the kidney is not producing, thus helping the body produce red blood cells

when it gets too low, you may need to consider the possibility of blood transfusion
a donor cat and the recipient cat's blood should be typed and cross matched to ensure compatibility

 

[lycans]

I agree that everything we do is palliative
as i am fond to say on the group i join, life is terminal
everything we do is to make the process as comfortable as possible.
cats have lived years, up to eight after diagnosis with the right support
so who is to say we should give up on day one?

based on what i have learnt, stem cell therapy is actually cheaper than transplant
ethics aside, the life expectancy of a cat AFTER transplant is a lot shorter than what i expect (about one to two years)
issues like rejection, immuno-suppressants causing infections, the surgery itself

then we got to talk about ethics, who are we to take a kidney from another cat
some people may think that since i 'own' the donor cat or i will be giving the donor cat a home, it should be fine.
but really thinking about it, would it be fine if i adopt an orphan from the orphanage and take one of his/her kidneys? i'm giving him/her a home after that!
given cats' propensity to CKD, it is just hurrying the donor cat along the way to CKD.

wrt the CT, not done cause my girl isn't the most cooperative patient
given her current condition (issues with body weight and anaemia), we are unwilling (the vets and me) to let her go under

Fair enough, I mention renal transplant because the place I work is not far from one of the best feline specialist in Australia with experience in renal transplant in cats. Everything cat related that I am not confident of doing, I just refer away

Meet our staff - Vet Staff - The Cat Clinic

 

[applefreak]

Fair enough, I mention renal transplant because the place I work is not far from one of the best feline specialist in Australia with experience in renal transplant in cats. Everything cat related that I am not confident of doing, I just refer away

Meet our staff - Vet Staff - The Cat Clinic

I WISH WISH WISH there is something like this in Singapore
prior to my cat being diagnosed, I was pretty satisfied with the level of care my babies were getting
now, I'm not so sure...

 

[applefreak]

hi bbgg31, my girl is seeing dr huang from animal ark in tampines
so far he has been the vet that is most open to suggestions and discussions

my girl is on
1. famotidine (for stomach acid)
2. fortekor (for high blood pressure)
3. azodyl
4. pet-tabs (iron+b complex)
5. subcutaneous fluid

i got my azodyl supply from here
they charge quite a bit for shipping but if you get more than one bottle as a time, it's still way cheaper than getting from the vet
it took about a week or less to arrive

the vet prescribed cyproheptadine for her inappetance but it gives her the shakes so i stopped giving it to her
at this current moment, she is being assist fed every two to three hours with 30ml of blended food
it's a blend of egg white, pumpkin, dry royal canin kidney diet and a can of hi-tor neo (imported from US as well)

i only use ipakitine if i am feeding her with non-prescription food
if you are already giving prescription diet, there is no need for any kind of phosphorus binder
similarly, i got mine from amazon

my girl's numbers currently stand at CREA 2.4 and BUN 41
for fluctuating numbers, you may want to consider the probability of an infection and ask for antibiotics

HTH
applefreak and kitty

 

[bbgg31]

hi bbgg31, my girl is seeing dr huang from animal ark in tampines
so far he has been the vet that is most open to suggestions and discussions

my girl is on
1. famotidine (for stomach acid)
2. fortekor (for high blood pressure)
3. azodyl
4. pet-tabs (iron+b complex)
5. subcutaneous fluid

i got my azodyl supply from
they charge quite a bit for shipping but if you get more than one bottle as a time, it's still way cheaper than getting from the vet
it took about a week or less to arrive

the vet prescribed cyproheptadine for her inappetance but it gives her the shakes so i stopped giving it to her
at this current moment, she is being assist fed every two to three hours with 30ml of blended food
it's a blend of egg white, pumpkin, dry royal canin kidney diet and a can of hi-tor neo (imported from US as well)

i only use ipakitine if i am feeding her with non-prescription food
if you are already giving prescription diet, there is no need for any kind of phosphorus binder
similarly, i got mine from amazon

my girl's numbers currently stand at CREA 2.4 and BUN 41
for fluctuating numbers, you may want to consider the probability of an infection and ask for antibiotics

HTH
applefreak and kitty

Hi Applefreak,

My boy is still boarded at the Mount Pleasant Sunsetway...tomorrow will be the time to tell how do he do after days on iv, 2 antibiotics & etc. So far how often do you have to bring ur gal back for review?

Will you be interested to give ur gal natural remedies in aid to her daily life? The previous vet is giving my boy Pet Alive...I do not know how well it works yet but I'm interested to give him as daily aid...fyi google : nativeremedies/petalive- (Sorry, here don't allow me to post link!)

I looking to order Kidney support, UTI free and DetoxPlus..if you are interested, perhaps we can share!They have this Buy 2 Free 1!

Do your gal like Hills K/D, my boy hates it...my boy like RC Renal pouch but its so expensive and honestly I taste it alittle...it seems a little salty. How well do ur gal take hi-tor neo? The review seems very good...can you give me the link you bought from? I'm checking Amazon, but this seller don't seems to ship international.

By any chance do you want to top up from entirelypets recently...fyi~they have this promo code discounting at -12% of total purchase,Promo Code: 12thman expiry: 25 Mar 2014.

Do you have a referral code or link? I don't mind buying under your referral generates some reward for you!You have been so helpful!

 

[applefreak]

Hi bbgg31

I hope your boy is slowly recovering
The antibiotics should help though it'll take some time for his numbers to go back down
Remember, treat the cat not the numbers

I bring her back every two weeks because of her anaemic
Though we run a full blood panel every three months or so depending on how she is doing

I did give my girl omega 3, b complex and even human growth hormone for a while
But I decided that I want her to live as normal a life as possible instead of having pills forced down her throat or jabbed every other hour
So now I'm only giving her what is necessary, nothing more.

My girl is still been assist-fed, about 30ml every two hours via syringes
So I can't really tell if she like which food better, though she has been eating kibble so all her life

I ship the hi-tor Neo back using freight forwarding service
If you are interested I can pass you a can to try first before you order a whole carton

Sorry for replying so late coz I'm on a holiday

Hi Applefreak,

My boy is still boarded at the Mount Pleasant Sunsetway...tomorrow will be the time to tell how do he do after days on iv, 2 antibiotics & etc. So far how often do you have to bring ur gal back for review?

Will you be interested to give ur gal natural remedies in aid to her daily life? The previous vet is giving my boy Pet Alive...I do not know how well it works yet but I'm interested to give him as daily aid...fyi google : nativeremedies/petalive- (Sorry, here don't allow me to post link!)

I looking to order Kidney support, UTI free and DetoxPlus..if you are interested, perhaps we can share!They have this Buy 2 Free 1!

Do your gal like Hills K/D, my boy hates it...my boy like RC Renal pouch but its so expensive and honestly I taste it alittle...it seems a little salty. How well do ur gal take hi-tor neo? The review seems very good...can you give me the link you bought from? I'm checking Amazon, but this seller don't seems to ship international.

By any chance do you want to top up from entirelypets recently...fyi~they have this promo code discounting at -12% of total purchase,Promo Code: 12thman expiry: 25 Mar 2014.

Do you have a referral code or link? I don't mind buying under your referral generates some reward for you!You have been so helpful!

 

[CatLuVer]

Hi TS, I came across a post in facebook. Someone made a homemade renal diet for cats.

Homemade grainless renal diet for cats
Ingredients:
Chicken, Liver, Sweet Potatoes, Potatoes, Green Peas, Carrots, Pumpkin, Ground Eggshells, Dulse, Taurine, Salmon Oil, Vit E, Filtered Water
Price: $3.75 per 150g tub
Eggshells are the preferred source of calcium carbonate for renal cats. Eggshells also act as phosphorous binder. Chicken is the preferred source of protein.
All ingredients are human-grade, no by-products.
Protein 40%
Phosphorous 0.35%
The consistency is very smooth and creamy and therefore ideal for syringe-feeding.
For orders sms Helga at 96799966

This is for your info and you can try to making this diet yourself at home

 

[applefreak]

hi CatLuVer, thanks so much for the info
i'll probably get some for my girl to try
I did read some articles / blog posts on home made food but it's all too 'chim' for me

 

[applefreak]

It's been a while since I updated this thread
Been really busy with work and taking care of my girl.

Came across this youtube video that I think is very helpful with people with newly-diagnosed CKD kitty
how to give subcutaneous fluid
the second part where Ro (a fellow forummer who shares her knowledge on bigtent regarding CKD) injects into the port is not really applicable for us as it is almost impossible to get injectable vit B or ESAs in SG

It's been close to two years since my girl was first diagnosed with CKD and ten months since her first crash
I'm doing all I can to keep her comfortable for her remaining days (which I hope can be long and good)

Currently looking into stemcell therapy for her
Anyone read/heard/tried anything about stemcell therapy for animals?

 

[bbgg31]

It's been a while since I updated this thread
Been really busy with work and taking care of my girl.

Came across this youtube video that I think is very helpful with people with newly-diagnosed CKD kitty

the second part where Ro (a fellow forummer who shares her knowledge on bigtent regarding CKD) injects into the port is not really applicable for us as it is almost impossible to get injectable vit B or ESAs in SG

It's been close to two years since my girl was first diagnosed with CKD and ten months since her first crash
I'm doing all I can to keep her comfortable for her remaining days (which I hope can be long and good)

Currently looking into stemcell therapy for her
Anyone read/heard/tried anything about stemcell therapy for animals?

Hi! applefreak,

Thank you for sharing!

Vit B jabs I think hv to prescript from vet. My first vet did add into my boy's iv then.

I read little into stemcell...i think this is not available in SG?

I do not check back here much and I'm so limited to post links in my reply ...if you don't mind a more direct connect, we can do thru watsapp...hv pm you my contact.

 

[petjourneyz]

Video Scrapbook anyone?

Hi all,

We are looking for Beta Users to try our website at the following link;
petjourneyz.com (google petjourneyz)

We would appreciate if you could send us your feedback and entries to the following email;
petjourneyz(at)gmail.com

Do send us some entries (Landscape short videos, >5photos) of your pet (with/without you) and in return we would be sending to you a free digital scrapbook to relive your memories with your pet.

For each photo/video, please give a caption and a short description.

 

[applefreak]

Hi! applefreak,

Thank you for sharing!

Vit B jabs I think hv to prescript from vet. My first vet did add into my boy's iv then.

I read little into stemcell...i think this is not available in SG?

I do not check back here much and I'm so limited to post links in my reply ...if you don't mind a more direct connect, we can do thru watsapp...hv pm you my contact.

hi bbgg31

i've not had any success in getting vit b12 jabs prescribed...
it stings so i'd prefer to be able to add it into the fluids at the end of the session so that it won't sting so much since there is already quite a bit of fluid in her
at this current moment, we are holding off the ESA to see if the vit b12 (monthly jab at the vet and daily b12 orally) can help her maintain her PCV/HCT

my girl's new vet does stemcell, he has the machine at his clinic so the fat don't have to get sent to an external lab for processing
however, we are holding it off as the effect on CKD is still unclear
but the risk of GA for a CKD cat is very real

will be whatsapp-ing you in a while

 

[gilliantng]

help

my cat was diagnosed with renal failure today - sent him in to the vet hospital (Mt pleasant at Mandai Rd) 3 days ago and he came back in such a bad shape...really very afraid for him now.

he's been peeing and drinking water (not much) then the cycle repeats. he is not eating anything as well.

can someone advise what to do? am really at a loss and it is so sad to see the once lively cat living like so miserably...

greatly appreciate any advice...thank u!

 

[applefreak]

hi gilliantng

what exactly did the vet did for your cat?
any IV fluid or antibiotics or anything?
a knowledgeable and open-minded vet is very important in the battle against CKD
if you feel that the current vet is not doing anything for your cat, I'd suggest going to another vet who is willing to help your cat in fighting the battle
both bbgg31 and myself are lucky to have found vets who are supportive in our cats' battles
I have went to at least five vets before I found the current one (the previous one is taking a long break so I had to find a new vet)

my cat was diagnosed with renal failure today - sent him in to the vet hospital (Mt pleasant at Mandai Rd) 3 days ago and he came back in such a bad shape...really very afraid for him now.

he's been peeing and drinking water (not much) then the cycle repeats. he is not eating anything as well.

can someone advise what to do? am really at a loss and it is so sad to see the once lively cat living like so miserably...

greatly appreciate any advice...thank u!

 

[adoptadog]

Hi there,

You've mentioned you had buy azodyl from Entirelypets but it arrives in a week's time, isn't it supposed to be kept cold to keeps its efficacy? Thanks!