Weight loss worry

Minette has lost weight - despite a raging appetite. She has also been a lot more talkative than usual. Her owners are (and Dr Kate) are suspicious that she might have hyperthyroidism. Minette very kindly let us take a sample of blood - you can see the hair under her collar was clipped so we could see her vein.
Minette is about 20 years old and very fit for her age. She is on medication for high blood pressure and has kept her kidney disease at bay with a special diet for over a year. Her owners' vigilance and care should keep her going for a few birthdays yet!

Tabby all patched up

Remember Tabitha? She was diagnosed with kidney disease earlier this year. After a bit of persuasion she took  to her special diet for failing kidneys with relish, although she misses her weekly fresh rabbit.
This week she had her progress tests. Her potassium levels were fine - diseased kidneys lose potassium - and her phosphorus levels were normal too. If phosphorous gets too high or potassium too low then cats lose their appetite and feel ill.
We were concerned to find that her creatinine levels were creeping up but as they are not affecting her appetite or quality of life we will just monitor her again in 3 months time.
Overall the special low protein, low phosphorous, high potassium kidney diet is keeping her healthy and happy so that she can properly supervise the next patchwork project - and at 16 years of age that's pretty important!

Tiger, Tiger sitting tight

Tiger is just on his way home after having his blood pressure checked. He sat quietly while we wrapped a cuff around his arm. He thought the cold gel we put on his wrist for the Doppler probe was the worst part.
Because a cat's pulse is so small we have to amplify it with the Doppler. We pump the cuff up until we cannot hear the pulse and then slowly let the air out until we hear the pulse. At this point we read his blood pressure from the dial.
Tiger has a heart murmur and kidney problems. Heart disease often lowers the blood pressure but kidney failure increases it. Fortunately Tiger's blood pressure is normal.

High blood pressure

Hypertension is the medical term for high blood pressure, a silent killer of older cats.

What causes hypertension in cats?

Hypertension is usually secondary to another disease. Kidney disease is the most common cause of hypertension but cats with adrenal gland tumours or treated for hyperthyroidism also develop high blood pressure at times. Sometimes no underlying cause is found.

Most cats with hypertension are older than 9 years of age.

What are the effects of hypertension?

Hypertension damages all body organs but we notice it most in:

• the eyes. The small vessels in the retina break under pressure. The bleeding detaches the retina and the cat becomes blind.
• the brain. Ruptured blood vessels cause ‘strokes’, fits, twitches or unusual behaviour
• the kidneys. Increased blood pressure damages the delicate filtration system of the kidney.
• the heart. The heart has to work harder to push the blood out into the body and the heart muscle thickens and becomes less efficient. Sometimes the heart goes out of rhythm or we hear a murmur with the stethoscope. Affected cats may show signs of heart failure such as breathlessness, lethargy, weakness or fainting.

How do we detect hypertension?

We measure the blood pressure of all cats over 9 years old as part of the regular seniors’ examination. We also check the blood pressure of all cats with kidney disease or hyperthyroidism, or with any signs of eye, brain or heart disease. 

Most cats tolerate the cat sized cuffs we put on their arms. Some don’t like the feel of the gel or the sound of the amplifier we use to hear the pulse. We try to put them at ease so that we get an accurate reading.

How do we treat hypertension?

A daily dose of amlopidine as a fragment of tablet (Norvasc), or as chicken, fish, cheese or beef flavoured drops to put on the food, brings the blood pressure down rapidly.

After a week on amlopidine we recheck the blood pressure to see if it has come down to normal. If all goes well we recheck it every 3 months. 

Sometimes other medications like benazepril (Fortekor or Vetace) are added in, particularly if we detect kidney disease.

Pale and wan

In the last few weeks we have seen several anaemic cats. Their carers brought them in because they sensed something was wrong but they weren’t sure what. 

All of the cats had gone off their food and were a bit quieter than usual. Anaemic dogs

are more lethargic than normal, but it’s hard to tell if a cat is lethargic, especially in winter!

On examination we found the cats’ gums were paler than usual and ordered a blood count. All of them had red cell counts that would have humans gasping for an oxygen mask. Cats are definitely experts at conserving energy and hiding any illness.

The youngest kitten had found a tasty box of rat poison, which stops the blood from clotting normally. He had bled into his chest and was having difficulty breathing. The direct antidote and a few days in hospital soon had him back on the prowl.

The pathologist found some blood parasites called Hemoplasmas in a blood smear from a four year old Burmese named Chloe. Rest and a course of antibiotics soon had Chloe in the pink again.

Old Jester was not so lucky. His vet found that he had an enlarged liver. When we took a sample of the liver we found cancer cells. He had bled into his abdomen. Chronic diseases like cancer also suppress the bone marrow where blood cells are made. 

Old timer Lord Wellington had kidney disease. Cats with kidney disease are often anaemic. Wellie is on a special diet for his kidneys, which has bought him several extra years of life so far. He is comfortable with his moderate anaemia at the moment as he has had time to compensate for it. Anaemia of kidney disease is difficult and expensive to treat but his carers are considering his options at the moment. 

Blood transfusions in cats are always a risky business. Both donor and recipient have to be exactly the same blood type. We also cross match the bloods because some cats react even to their own blood type. On most occasions we can avoid a transfusion if we keep the patient quiet and unstressed for a few days.

If you think something is not quite right with your feline friend you are probably right! We always take your gut feelings seriously so don’t hesitate to call us. Better to catch dropping blood counts early than let your cat suffer.

Kidney Failure

Mittens getting the right balance

What do kidneys do?

The kidneys remove waste products from the blood stream, regulate fluid and electrolyte balance, maintain the acid-base balance of the body and remove toxins and drugs. They also help maintain blood pressure and stimulate blood cell production.

What happens when my cats’ kidneys fail?

Signs of kidney failure don’t appear until at least 70% of kidney function is lost. Chronic kidney failure, also known as renal failure, is the end stage of a number of different disease processes rather than a specific condition in its own right.

Kidney damage accumulates for years before we see any signs. Even then the early signs of kidney failure - increased thirst and urine production - are not easily recognised in our feline friends.

You may notice an increasingly wet litter tray if your cat is only indoors. However if you have other cats you may not pick up increased urine production in a single cat. 

Cats often drink from multiple water sources making it difficult to recognise increased  consumption.  

Other signs of kidney failure such as weight loss and poor coat quality are often put down to normal ageing. 

Often the first thing we see is a cat off her food, vomiting, depressed and dehydrated. The kidneys are already badly affected by this stage.

How do we diagnose kidney failure?

We diagnose and stage kidney failure with blood tests for the two waste products, urea and creatinine and a urine analysis to measure the kidneys ability to concentrate urine. We also  check the urine for protein loss or a urinary tract infection.

Tests for other substances like potassium, phosphorus and calcium as well as blood cell counts help us decide on the best course of treatment. 

Could it have been diagnosed earlier?

Because signs of kidney failure and rises in blood urea and creatinine are not evident until significant loss of kidney function has occurred early diagnosis is difficult. However, we strongly recommend at least annual blood and urine tests, as well as regular body weight checks. If urine concentrating ability is deteriorating or the creatinine is trending up we are able to slow down the progression of the disease with a special kidney protective diet. Any weight loss in a cat should be fully investigated.

What treatments are available?

After initial hospitalisation to treat dehydration and electrolyte disturbances, most cats are managed with a diet change and one or two other medications.

• Low protein and phosphorus diets lower the level of waste products in the bloodstream.  Try a few of the ready made kidney diets like Royal Canin renal or Hills k/d to find one your cat likes. Once your cat accepts the diet it must be her sole source of nutrition. Although if renal failure is advanced and your cat’s appetite is poor, any diet that the cat enjoys is acceptable.

• If blood phosphorus levels remain above normal after a few weeks on the special diet we add phosphate binders like Ipakitine to the food. Reducing blood phosphorus makes your cat feel better and slows progression of the disease. 

• Urinary tract infections are common in kidney failure and are treated with antibiotics.

• Cats with renal failure lose potassium in the urine leading to muscle weakness, stiffness, a poor coat and exacerbation of the kidney failure. The special kidney diets contain extra potassium but sometimes we have to add more.

• Severely affected cats need extra fluids. We can teach you to administer      subcutaneous fluids at home to reduce dehydration in advanced cases.

FRESH WATER MUST BE AVAILABLE AT ALL TIMES 

How long can I expect my cat to live?

Unfortunately aged kidneys do not recover. However, we can slow the progress of the disease and improve your cat’s well being with treatment and regular checkups. We check  phosphorous and potassium levels to see if your cat requires supplements and check for urinary tract infections at least every 3 months. This should give your cat a good stretch of high quality, active life.

George's spectacular appetite

My cat George was always hungry.  When he was young we called him Fat George.  As he aged he became thinner and thinner.  When he was 12 years old I noticed that his activity levels as well as his appetite were reaching record levels.
At first I thought he'd reverted to kittenhood but soon found that one of the thyroid glands on the lower part of his neck was as big as a lima bean.  A blood test confirmed the diagnosis of hyperthyroidism.
I surgically removed the gland and he was normal for a few years before I noticed his appetite rocket again.  This time I medicated him with an anti-thyroid drug that worked very well.  I gave him a tablet twice a day until he became too cunning for me. I switched to applying a medicated gel to the inside of his ears and won the battle.
Like most old cats George eventually developed kidney disease.  I had to ease off the antithyroid medication and nurse his old kidneys along.
This candid shot is of George not long before he died.  Even when his kidneys were about to collapse his overactive thyroid drove his appetite to spectacular heights (depths?!)