Update on Puddy; she's gone*9/29* see post #421

[cassiesmom]

I roasted a chicken w/stuffing for dinner and I took some white meat w/a little broth on it to her and she scurried down those little steps so fast, I could hardly believe it. And she ate almost all of the chicken.

Thatagirl, sweet Puddy!

[Medusa]

I know why she was put on the Epogen, but did she act this way at all before it was started? And it is the only new medication she's on, correct?

Before I would say good bye to her, I would stop the med and see how she is.

I'm thinking back and it does seem that she started this weird behavior after she started the Epogen. But if I take her off it, then her anemia will be so bad that she won't have any energy at all. Her energy level does seem to have improved; you should've seen how fast she came down that little staircase and went to her food dish. I'm hoping Dr. Lee will have some answers for me tomorrow. Every time I think I'm done crying, the tears start up again. I'm exhausted. If my head and my heart would just be congruent, I could make a decision one way or the other. Right now, I'm frozen.

[carole]

Mary i can understand how torn you are inside about what to do next, maybe you should ask Dr lee, be straight to the point and see what he say's he may be able to take the decision out of your hands, if you know what i mean, or at least help you make one, in the meantime , try and get some rest and remember you are amongst friends here who really care about you and Puddy, HUGS

[Emeraldgreen]

Oh my goodness Mary, you two have been through so much! It seems that her inappropriate urinating is getting more and more excessive. It might be that she is dealing with a UTI and she may be associating an uncomfortableness that she might be feeling is connected with the use of the actual litter box. I found this quote on the net tonight:

"Inappropriate urination can be as a result of a urinary tract infection (UTI) or constipation, whereby the cat associates the litter box with the pain of the UTI or constipation, so starts urinating and/or defecating elsewhere."

It would be great if you could get a urine sample and bring it in to the vet. Those little pellets that are like litter but allow you to collect a urine sample are called No-Sorb.

Or you could put the plug in your drain in the sink and then check it every now and then and if she uses it, you could use a syringe to draw up a sample. I know it wouldn't be entirely sterile but it might be worth a try.

"UTIs and kidney infections may also damage your cat's kidneys further, so if your cat urinates or defecates in the wrong place more than once, you should go to the vet as soon as possible in order to have tests done and treatment begun if necessary."

I've read that you can't determine if a cat has a kidney infection through collecting a sample using NoSorb though and that a urinalysis and/or blood work is what is needed to show if a cat has a kidney infection or not.

I found the following quote on a site about kidney infections:

"In older cats, if you notice anything different about their behavior, like not using their litterbox, or blood in their urine, it is in your aging cat's best interests to get him/her to a vet as soon as possible. Older cats are more susceptible to kidney infections and disease than younger cats."

But I seem to remember that Puddy has been on or is on meds for a UTI or something similar. I will have to go look through some of your older threads.

I have one other idea about her excessive and inappropriate urination.

It is kind of a weird thought but after I read this quote:

"In animals, erythropoietin has one major use: the treatment of anemia due to chronic renal disease. Since most erythropoietin is produced by the kidney it should make sense that a damaged kidney cannot produce normal amounts of erythropoietin and anemia results."

I started thinking, what if her kidneys have been helped by the Epogen to the point that the sub-q fluids are not as necessary as they once were and now Puddy's body has too much fluid on board?
I started thinking about that the more I read about Erythropoietin and how it is a synthetic form of the naturally occurring hormone normally produced in the kidneys. If a cat has suffered a reduction in this hormone for a length of time and then becomes dependent on sub-q fluids to help the kidneys along, it seems like it could make sense that the kidneys might not need both fluids and the hormone at the same time because maybe it's too much help. I don't know if there is a direct connection between the hormone and urinating but the kidneys themselves are related to urinating so if changes are happening within the kidneys with the addition of meds, it seems possible that the act of urinating might be effected as it is the 'end' result of what is happening in the kidneys.
I don't know how often you are giving sub-q's at this point but you might want to try backing off on it (if your vet okay's it) and see if the inappropriate peeing decreases.
Does that make sense?I might be grasping at straws here but I want to help you so much to find some answers. I know this has been so hard on you and it would be for any of us if it was happening to one of our pets.

In the meantime, since the runner in the hall seems to be her fav spot for peeing out of the box, could you put a tarp down, folded in the shape of the runner (to fool her of course!) and then put some towels on top or an old blanket that you could toss in the wash each day until this thing is figured out? I can only imagine how frustrating this is becoming for you and something has got to give and soon. I'm praying for resolution and that you and Puddy will both find healing ASAP! Whatever you decide, Puddy has an awesome mom and she surely knows how much you love her.
p.s. I'm sure you've come across this site in your searches of CRF over the years but just in case I'll include it here because it seems to have a ton of info on it, including a bunch about Anemia and Epogen. Here is the link.

[Medusa]

Oh my goodness Mary, you two have been through so much! It seems that her inappropriate urinating is getting more and more excessive. It might be that she is dealing with a UTI and she may be associating an uncomfortableness that she might be feeling is connected with the use of the actual litter box. I found this quote on the net tonight:

"Inappropriate urination can be as a result of a urinary tract infection (UTI) or constipation, whereby the cat associates the litter box with the pain of the UTI or constipation, so starts urinating and/or defecating elsewhere."

It would be great if you could get a urine sample and bring it in to the vet. Those little pellets that are like litter but allow you to collect a urine sample are called No-Sorb.

Or you could put the plug in your drain in the sink and then check it every now and then and if she uses it, you could use a syringe to draw up a sample. I know it wouldn't be entirely sterile but it might be worth a try.

"UTIs and kidney infections may also damage your cat's kidneys further, so if your cat urinates or defecates in the wrong place more than once, you should go to the vet as soon as possible in order to have tests done and treatment begun if necessary."

I've read that you can't determine if a cat has a kidney infection through collecting a sample using NoSorb though and that a urinalysis and/or blood work is what is needed to show if a cat has a kidney infection or not.

I found the following quote on a site about kidney infections:

"In older cats, if you notice anything different about their behavior, like not using their litterbox, or blood in their urine, it is in your aging cat's best interests to get him/her to a vet as soon as possible. Older cats are more susceptible to kidney infections and disease than younger cats."

But I seem to remember that Puddy has been on or is on meds for a UTI or something similar. I will have to go look through some of your older threads.

I have one other idea about her excessive and inappropriate urination.

It is kind of a weird thought but after I read this quote:

"In animals, erythropoietin has one major use: the treatment of anemia due to chronic renal disease. Since most erythropoietin is produced by the kidney it should make sense that a damaged kidney cannot produce normal amounts of erythropoietin and anemia results."

I started thinking, what if her kidneys have been helped by the Epogen to the point that the sub-q fluids are not as necessary as they once were and now Puddy's body has too much fluid on board?
I started thinking about that the more I read about Erythropoietin and how it is a synthetic form of the naturally occurring hormone normally produced in the kidneys. If a cat has suffered a reduction in this hormone for a length of time and then becomes dependent on sub-q fluids to help the kidneys along, it seems like it could make sense that the kidneys might not need both fluids and the hormone at the same time because maybe it's too much help. I don't know if there is a direct connection between the hormone and urinating but the kidneys themselves are related to urinating so if changes are happening within the kidneys with the addition of meds, it seems possible that the act of urinating might be effected as it is the 'end' result of what is happening in the kidneys.
I don't know how often you are giving sub-q's at this point but you might want to try backing off on it (if your vet okay's it) and see if the inappropriate peeing decreases.
Does that make sense?I might be grasping at straws here but I want to help you so much to find some answers. I know this has been so hard on you and it would be for any of us if it was happening to one of our pets.

In the meantime, since the runner in the hall seems to be her fav spot for peeing out of the box, could you put a tarp down, folded in the shape of the runner (to fool her of course!) and then put some towels on top or an old blanket that you could toss in the wash each day until this thing is figured out? I can only imagine how frustrating this is becoming for you and something has got to give and soon. I'm praying for resolution and that you and Puddy will both find healing ASAP! Whatever you decide, Puddy has an awesome mom and she surely knows how much you love her.
p.s. I'm sure you've come across this site in your searches of CRF over the years but just in case I'll include it here because it seems to have a ton of info on it, including a bunch about Anemia and Epogen. Here is the link.

Y'know, Lara, you and I are of the same mind. Puddy has been fighting me tooth and claw during her subQ treatments and that's odd because she's always just sat there calmly, even purred during it. Yes, in the beginning she put up a fuss but after a few treatments, she got used to it and no more fussing. Yesterday, she carried on so badly that she pulled the needle out and so I stopped the treatment. The reason I started her back on daily treatments is because she was so dehydrated. After a treatment, she always has a sack of fluid under her right front leg but for a while, this wasn't occurring. Dr. Lee said "Wow, she's absorbing all that fluid because she's so dehydrated" so I kept up the dailies. I decided yesterday after she fussed so much to skip today and see how she does.

Last night she paced nearly all night. She has one funky claw that grows weird and I'm not able to clip it down the way it should be so I heard that claw "tap tap tap" on the hard wood floor all night. I'm waiting to hear from Dr. Lee yet this morning; I'm anxious to hear what he has to say about all this.

[smokey the elder]

When my Luna (RB) was at the end stages of his kidney failure, he became incontinent.

[Medusa]

I just got off the phone w/Dr. Lee and he feels that she more than likely has yet another bladder infection. He said "When it stings to urinate, a cat will go right where s/he is even if the litterbox is right there". So he's starting her on another round of Clindamycin and he said that I could back her off the subQ's to every other day if my instincts are telling me to do so. He's concerned, though, that fewer subQ's may set her back because when he last saw her, she was lying in a ball, so I have to observe her and, if she regresses, to immediately give her a subQ. I told him how she paced all night and he said "The very fact that she has the energy to pace is a good sign. She's been checked for diabetes, thyroid and everything else we can think of and she has none of these, so she's probably become nocturnal. She's a mixed up kitty." So I'll start her on the Clindamycin today and see if it stops the inappropriate peeing.

I feel bad that I lost it yesterday. None of this is Puddy's fault. I'm sleep deprived; I know that's half of it. The other half is seeing my girl act like someone else's cat. I miss my TV partner. No more sleeping on my chest while I give her a noggin noogie.

[greendoor678]

Hopefully the UTI meds will help. Though, it does seem like patching up one problem leads to another problem. I wonder if she were an outdoor cat how she would react? (Of course, I don't mean putting her outdoors). But growing up in the country, whenever I had a cat with medical problems he/she would wander off into the woods and we would never see them again.
We would always say that they went away to die because they were generally always very close to the house, then they would just go away, like they were walking towards the light.
Devastating to think about PTS your Puddy. I just wonder if patching up each problem is really enhancing her quality of life? I do hope the UTI meds and adding a day between sub-q will help.

[Medusa]

Hopefully the UTI meds will help. Though, it does seem like patching up one problem leads to another problem. I wonder if she were an outdoor cat how she would react? (Of course, I don't mean putting her outdoors). But growing up in the country, whenever I had a cat with medical problems he/she would wander off into the woods and we would never see them again.
We would always say that they went away to die because they were generally always very close to the house, then they would just go away, like they were walking towards the light.
Devastating to think about PTS your Puddy. I just wonder if patching up each problem is really enhancing her quality of life? I do hope the UTI meds and adding a day between sub-q will help.

Well, seeing that Puddy has only one kidney and that one isn't working too well, it's understandable that she would get continuous UTI's. I don't see it as a patch job so much as continuing to treat her remaining failing kidney but I can see why you would think that because I felt that way, too, in the beginning. When Puddy was curled up in a ball, I thought it was nearing the end. But she's got energy now so I think Dr. Lee is right; it's the bladder infection that's acting up and causing her to pee everywhere. I feel neither better nor worse about this. I'm kinda in limbo now.

[Catty1]

The Epogen does seem to be helping her! I'll mention the alternative med in case it becomes useful. darbepoetin (Aranesp ®)

Lara, I don't think Epogen makes the kidneys better...but maybe the one remaining kidney doesn't work as hard because the anemia is being healed? That could be.

Hopefully the Clindamycin works - Puddy wouldn't be the first kitty to have a recurrence of a UTI! When something "normal" happens during crisis illness, it easily becomes part of the crisis.

HUGS and prayers to you and Puddy.

[Lisacl]

I will be thinking of Puddy.

[Medusa]

She hates it. It's so neat, too, because it has a spigot just like a sink and the water flow can be controlled, so I have it streaming just as I do w/the bathroom sink for her. She isn't having it. She is so exasperating! But she got another shot on Saturday and showed improvement, so we're going back to shots twice a week. I have to pick up more syringes at Dr. Lee's today. I asked about darbopoetin and he said that it's more than double the cost of Epogen, so that isn't doable anyhow. And he said no iron shots. Iron supports red blood cells but Epogen produces them and he said that he isn't big on iron shots or supplements so no iron shots either. She's definitely nocturnal now; she's tap tap tapping on the floor all night, jumping up on the sink, jumping down, going back and forth from her food dish to under my bed to up on the sink. (Yes, I allowed her back into my bedroom at night because I can't hear what's going on w/the door closed.) All in all, I feel she's improved somewhat but she's still acting weird; the senility probably.

[Emeraldgreen]

Darned finicky cats! Do you think you could return it or would your other cats appreciate it? I once bought a pet fountain and then sold it to a friend for her cats because mine were afraid of it.
I'm glad to hear that she is back with you in your room. I'm sure she is happier being with mom. It sure must be tough on your sleep pattern though with her nocturnal activities. I guess the fact that she is active at all though is a blessing.
Does the Clindamyacin seem to be helping with the accidents?

[Medusa]

Darned finicky cats! Do you think you could return it or would your other cats appreciate it? I once bought a pet fountain and then sold it to a friend for her cats because mine were afraid of it.
I'm glad to hear that she is back with you in your room. I'm sure she is happier being with mom. It sure must be tough on your sleep pattern though with her nocturnal activities. I guess the fact that she is active at all though is a blessing.
Does the Clindamyacin seem to be helping with the accidents?

I'm sure the rest of the Fur Posse would like it; they have two others that they enjoy. I just thought that this one would please Her Highness because it looks like a faucet and the flow is the same but no, of course not. The Clindamycin isn't helping w/the peeing. I spoke w/Dr. Lee yesterday and I told him that I don't think her problem is medical; I think she has an attitude toward me now. She's pi$$ed at me, if you'll pardon the pun. I've removed the hall runner so that she won't pee on it any more but she still occasionally goes on the hardwood floor. I'm afraid it's going to warp if she continues w/this behavior. That's the one thing that really has me perturbed. Any other time when she's gotten mad at me, she'd take a swat at me or nip at my ankle when I walked by. This is not like her but there it is. I also thought that maybe she doesn't like her litterbox any more so I'm giving her a new one and I'm giving Cat Attract litter a try. I'm probably asking for trouble w/changing the brand of litter but I'm willing to try it, at least.

[Medusa]

I crawled into bed and became instantly sad that my bunkie was under my bed rather than in bed w/me watching TV and I started to cry. Puddy crawled out from under the bed, hopped up into bed w/me, climbed onto my chest and licked away my tears, then kissed me right on the lips. Then she moved to the pillow next to me and sat there as if she was saying "I'm staying right here until I know you're ok, Mom". We sat there for a few minutes, she purring, then she walked off the bed to the doorway, turned and looked at me and then went into the bathroom to lie on the countertop, as though she was saying "My work is done here". She slept on the countertop most of the night but I felt that she was letting me know that she's ok.