Emma's Top Thirteen Weapons in the Fight Against Chronic Renal Failure (CRF)

Emma was diagnosed with chronic renal failure in September 1996 when she was only 16 years old. She is a gray girl with a STRONG will to live. She is willing to take whatever medications we think might help keep her going and feeling good. She draws the line at eating any kidney diet, claiming they are all disgusting! She does eat canned Whiskas and Friskies (with a heavy emphasis on fish) and a little dry Science Diet RD (there's no accounting for a cat's taste.) Off and on, Emma engages in an after-evening-fluids exercise program. She circles the downstairs singing kitty marching songs ("I know a cat with two left feet . . .")  She claims that this helps reduce constipation and keeps her young but has not been able to get any of the other cats to join her.

Anyway, since her diagnosis, she's been compiling a list of her Top Thirteen Weapons in the Fight Against CRF in hopes that something on it might help some one else.


Emma's Top Thirteen Weapons
1.   Fluids given sub-q (just under the skin) to maintain hydration. Emma gets 100 mls of Lactated Ringers Solution twice a day.  For the first year after being diagnosed with CRF, she was on once a day fluids, but later seemed to need them twice a day. Currently, Emma is back to once a day fluids. Emma says that warming the fluids before administering them is common courtesy!
2.   Norvasc to control high blood pressure. Emma recommends that any cat with CRF or any older cat have their blood pressure monitored regularly. In 6/97 her blood pressure hit 160 and her creatinine was creeping up. She started on a low dose and when monitoring showed the blood pressure was creeping up again, we increased the dosage. We credit Norvasc with greatly slowing the progression of her renal disease.
3.   Potassium Citrate to combat metabolic acidosis. In 4/97 Emma was down to 5 lbs and dropping. A veterinary internist suggested that wasting and weight loss in CRF cats is usually caused by metabolic acidosis. Indeed her CO2 (a measure of acidosis) was low, around 12.  This condition is treatable with potassium citrate which also adds needed potassium. Emma gets 1/4 UrocitK twice a day. Her weight is still holding above 5.5 pounds.
4.   Basaljel to lower blood levels of phosphorus. Emma has had high phosphorus from the beginning but we are able to keep it around 4.0 mg/dl by giving her 1/2 tablet (divided into two pieces) with each meal. Basaljel binds with the phosphorus and lets her excrete it.
5.   Pepcid AC to combat nausea and lower stomach acidity. Emma gets 1/4 pepcid once a day.  This seems to keep stomach upset to a minimum and hopefully prevents blood loss through occult gastrointestinal bleeding.
6.   Lactulose, the old cats friend, to soften stools. This eliminates constipation once you get the dose right. The cats do hate it though! It has helped to mix it with water so it slides down more easily. Human studies suggest that lactulose may benefit kidney patients by binding nitrogenous waste and allowing the body to excrete it through the colon, rather than the kidneys. Our experience with Emma and other CRF kitties is that lactulose does help keep their creatinine values down and helps the cat feel better!
7.   Valium, just a little, to stimulate the appetite. Emma just flat out quit eating in 9/96. As near as we can tell she must have lost her sense of smell. She started on 1/4 mg once a day. Later, her lack of appetite caused us to increase the dose to 1/2 mg twice a day. She now gets 1/4 mg in the morning and 1/2 mg in the evening. (If you and your vet decide to try this drug, Emma suggests you use name-brand Valium only and start with a very low dose. Be sure to check liver values before you start; and if abnormal do not use.) This drug carries risks but has been a lifesaver for Emma. She did not respond to winstrol. Nor did she respond to cyproheptadine initially. But with valium, usually within 15-30 minutes of getting her dose, she wants to eat. As she has aged, we have had to decrease her dose. We are aiming at the lowest effective dose and want no sedative effects.
8.   Cyproheptadine (aka periactin) to stimulate appetite. Eventually we added this rather than going still higher on the valium dose. It does help. We found that it took a week or more to start seeing results. However, as Emma has aged, we have found that some drugs have more potent side effects. When Emma was 22 she began howling and was very active after getting her cyproheptadine dose. When we stopped giving it, the howling went away. So, we have dropped this drug from her daily regimen.
9.   Potassium gluconate to supplement potassium. We added this when Emma got wobbly but she did not need additional potassium citrate since her CO2 was OK. If you do not use a veterinary preparation, be sure to read the label. The tablets should contain no phosphorus or phosphate compounds.
10.  Vitamin B-complex. In July 1998, Emma started shivering a lot. Her kidney values were no worse and the fluids were warm.  An internist friend suggested adding B-complex.  We started with 1/8 of an adult human USP B-complex supplement (not one of the mega-dose ones!) twice a day. Eventually, we began adding B-complex to her fluids as well. Since starting B supplementation, Emma shivers no more. Kitty vitamin supplements were prescribed for her at one time. But because they contained vitamin D, they caused her blood calcium levels to be too high. So, vitamin B-complex is the only supplement she recommends!
11.  Antibiotics when it seems likely she has a urinary tract infection (UTI). A few years ago, Emma displayed all the classic signs of UTI - frequent urination of tiny amounts, jumping in and out of the litter box, paying lots of attention to grooming of the rear. We took her to the vet and had urinalysis (UA) and a culture of the urine done. The UA suggested infection and while waiting for the culture results, we put her on amoxicillin. All the symptoms cleared up. The culture results were negative! Needless to say, we were certain the results were wrong. Now, when we suspect infection, Emma gets a course of antibiotics, usually amoxicillin. A veterinary internist told us that it is hard to get therapeutic levels of antibiotics in the urinary tract of older cats. Because of this, he recommended increasing the length of treatment. We treat Emma for 3-6 weeks, using acidophilus to combat nausea, diarrhea or any lack of appetite during the treatment. Acidophilus is available at any health food store.
12.  Acupuncture for a general tune-up. Whenever Emma starts to seem off, appetite down, activity level down or just not doing her usual Emma things, we take her to a veterinarian who is trained in veterinary acupuncture. Whether it is from the endorphins or unblocking the movement of chi, after a session, she seems to feel better. Emma is very patient during the sessions and doesn't mind the tiny needles at all. 
13.  When Emma was 22, she began to stumble just a bit. Her blood work showed that she was low in magnesium. After a lot of research and asking questions, we added in a magnesium supplement (30 mg Mg given as MgO). She became less wobbly in her walking. This was a very controversial supplement to add and could be dangerous, so don't add it in unless blood work shows a real deficit.
Over the years, Emma has found that finding and fixing dental problems is essential to staying healthy. She recommends finding a vet who is good at dentistry and who is very careful with anesthsia. Mouth infections can lead to heart and kidney problems and can decrease the quality of life! Finding a good vet for dental health can be difficult. You might want to try contacting the American Veterinary Dental Society (http://www.avds-online.org) to see if they have any members in your area.

Although Emma has not needed it yet, she wanted us to mention that erythropoietin (Epogen) is a treatment available for kitties who experience severe anemia because of their kidney disease. Like other treatments, there are risks associated with its use and it should be used carefully and with adequate monitoring of hematocrit and blood pressure. If Emma ever does need it, she hopes that feline erythropoietin will be available by then.

Emma has also gotten a bit more arthritic since turning 22. So, to try and help out her aging joints, we started giving her cosequin. It has seemed to help her move more freely.

For the best and most up-to-date information on treating cats with CRF, read
Dr. Katherine M. James lectures on CRF. Have your vet read them too!
CRF Lectures

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