Monday, October 20, 2014

Jewel's Journey Through CRF

While I'm not ready to talk about Jewel's final days, I want to share our journey through Chronic Renal Failure (CRF) with all of you in hopes that our experience will help someone else.  Remember: always check with your veterinarian before adding anything to your kitty's treatment regimen - prescription or holistic.  Every cat's situation is unique; just because something did or didn't work for Jewel doesn't mean your cat will react in the same way.

Warming Signs and Diagnosis

As many of you know, I was once roommates with Jewel's former owner, but it wasn't a good situation, so I moved out.  A month or so before I moved out, I noticed that Jewel was drinking even more than she usually had.  I planned to take her to my vet as soon as I could because her former owner didn't think this change warranted a vet visit.  

After I moved away from the house, it was two months before Jewel's former owner brought her to see me.  When I saw her, my heart broke.  She had lost 3 or 4 pounds in that short time span.  Jewel went to see my vet shortly after that visit.  The vet took a blood and urine sample from Jewel and called me with the results the next day.  Jewel had CRF.  I was rather upset when I heard the news and began to research the disease and how best to help her.  Jewel received her diagnosis in November, 2011.

Kidney Diets

Since Jewel's phosphorus levels were high, we immediately started her on Epakitin, a powder phosphorus binder you can mix into wet food.  Epakitin worked well for Jewel.  Her phosphorus levels normalized, and she didn't mind eating the powder in her wet food.

The vet also recommended we start her on Hill's Prescription k/d wet and dry food.  While Jewel didn't mind eating her k/d kibbles, she wanted nothing to do with the wet food.  

I did a little research and discovered Royal Canin also has a prescription kidney diet.  Unfortunately, she didn't want anything to do with the Royal Canin LP either.  

I had joined a CRF support group and asked if there were any other kidney diets she could try.  I learned about Purina NF, and tracked some down at a hospital close to her former owner's home.  Sadly, Jewel didn't like Purina NF, either.  

She was eating very little at this point so we started feeding her anything she would eat.  The vet confirmed that this was the right thing to do; we didn't want her to starve to death trying to get her to eat a kidney diet. 

High Blood Pressure's Sneak Attack

High blood pressure often co-occurs with CRF.  Our vet discovered pretty early on that Jewel's blood pressure was slightly elevated.  We started her on Benazepril to help control it.  It was at this point that Jewel's former owner and I decided that it would be best for her to stay with me full-time due to the fact that her former owner had a lot of other people, children, and a kitten living in his home.  We thought the stress was too much for Jewel to handle.  Later on, of course, I adopted her as my own kitty.  

Earlier this year, Jewel's blood pressure became out of control.  Her blood pressure was so high that her retinas were 50% detached.  We changed Jewel's medication to Amlodipine, beginning with one-half tablet once a day.  We had to raise Jewel's Amlodipine dose a few times before we found a dose that was able to control her blood pressure.  Thankfully, her retinas did reattach.  

Coping With Nausea and Stomach Acid

Shortly after being diagnosed with CRF, Jewel didn't have much interest in eating.  While part of this was due to the fact that she didn't like the kidney diets, nausea also played a part.  Our vet recommended giving Jewel 1/4 of a 10mg Pepcid to help her nausea.  This did, in fact, help, and she began to eat more.  However, Jewel didn't get the Pepcid daily because I wasn't able to pill her alone.  Jewel was always VERY stubborn about taking her medication.  

When I talked with the vet about the situation, she recommended we try Reglan for Jewel, which can be compounded into a liquid that I could squirt into her mouth.  Compounding medication can be expensive ($40 for a one-month supply of Reglan) though, so I did a little research and discovered a natural nausea remedy for kitties with CRF - slippery elm bark.  When I wasn't able to afford Jewel's compounded Reglan, I used the slippery elm bark to help her.  The drawback of this remedy is that you cannot give any other medications within two hours of slippery elm bark because it interferes with the effects of medication.  On the plus side, it wasn't difficult at all to get Jewel to eat her slippery elm bark mixed into a little bit of a Fancy Feast appetizer.  

Increasing Appetite

As the disease progresses, kitties with CRF lose their appetites.  Jewel would go for days or even weeks without wanting to eat much, but we found ways to encourage her to eat more.  A few times, I got her Hi'll's Prescription a/d, a canned food that's high in calories and can be syringe fed if necessary.  I didn't use this very often, though, because it really seemed to increase her stomach acid and nausea.  

Most of the time, I would go to the store and pick out a lot of different kinds of food in different flavors to see what Jewel would and wouldn't eat.  I discovered one of her favorites was Fancy Feast Fish and Shrimp Feast, so I always made sure to have at least one of those in the house for the times she turned her nose up at other foods.  

My vet also prescribed Mirtazapine to increase Jewel's appetite when she didn't feel like eating.  This medication really helped when Jewel wouldn't even eat her favorite foods, but after about a year of using the medication as needed, it stopped working for her.  We switched to Cyproheptadine to increase her appetite.  

Fluid Therapy

Fluid therapy helps the kidneys filter toxins out of the body.  I was really nervous at the idea of sticking Jewel with a needle to administer the subcutaneous fluids, and I was doubtful that I could do this effectively given my severe vision impairment.  The first time I stuck her by myself at home, I was a nervous wreck!  

Over time, though, Jewel and I both became more comfortable with this treatment.  Whereas initially, Jewel would try to run away from me during treatment, she soon began to lay down and patiently wait during treatment time.  She always received treats after fluids time, which I know she looked forward to.  Jewel LOVED treats!  


It might sound cliche, but I think what helped Jewel, perhaps more than medication, was being loved.  Jewel had a difficult life, and due to her past, it took her a long time to trust me.  The love my friend, D, and I gave her gave Jewel something to keep fighting for.  Jewel turned from a cranky senior into a little love bug within months of me taking over her care.  She seemed to really begain to enjoy her life, despite all the pilling and poking we had to do to keep her stable.  

CRF Is A Roller Coaster

CRF is truly an emotional roller coaster.  One day, you're thrilled that your kitty seems happy, wants to eat, and seeks out your attention.  The next day, you're worried because she turns her nose up at her favorite food, and she's hiding under your dresser.  

To be completely honest, shortly after Jewel was diagnosed with CRF, I tried to distance myself from her emotionally so I wouldn't have to be hurt when she went to the Rainbow Bridge.  That didn't work.  Jewel wove herself into every fiber of my heart.  Yes, it hurt more than I ever could have imagined when she went to the Bridge, but I don't regret a second of our time together.  I don't regret opening my heart to her and loving her more than I can ever say.  It still hurts me; every single day I have to spend without her is painful.  I don't think that will ever change.  But I know that I will see her again, and I know that she is still around, even if I can't see her or touch her or hear her anymore.  

The love I have for my beautiful Jewel will never go away.  Even though I only knew her for four short years, she changed my life.  I love and miss my baby.  


  1. This is a wonderful post. May I link to it on our "resources" page of our blog? Please let me know if this is ok at rj_schweitzer @ (without spaces). --Rene

  2. What a beautiful post and tremendous love that you two shared. I lost a childhood cat to CRF and my dad did the fluid therapy. It definitely is a roller coaster ride, as is any chronic illness when you know your time together is limited. You were the best cat mom Jewel ever could have asked for.

  3. You were blessed to have that additional time with her, and yes, love has a lot to do with it..

  4. Beautiful, Sierra. There is so much love in your words, between all the pain. I believe you will see sweet Jewel again too. And I agree with you in that, I don't think feeling the loss will ever go away. Its more a matter of learning how to live with it. Your memories, like the love between you and Jewel are treasures always with you. Hugs and much love to you my dear friend. We always have purrs here for you.

  5. I rode the rollercoaster for a year and a half with my Siamese, Indi. As hard as it was at times, it was 100% worth it. It was so satisfying when I was able to keep her comfortable and happy. Our bond grew stronger than ever, and I still miss her years later. She died at 19.5 years.

    Learning to do the fluids, a job I never thought I could do, proved to me what I am capable of--which helped me so much in later crisis's in my life.

    Pepcid made a huge difference. Removing 5 teeth did, too. (I now brush my current cat's teeth every day to prevent that from happening to him.) She came to love getting fluids. In the end, we struggled the most with constipation.

    She was the toughest cat I've ever known. Years later, my vet said she was a cat he will never forget.

  6. That was such a difficult journey for dear Jewel, but fortunately she had you the for love and support. Hugs from all of us.

  7. The love and bond you have with Jewel is still there and will always be there. It's just different now. A new normal. Thank you for sharing this amazing journey, dealing with health issues especially when you're unfamiliar with them is very stressful and challenging. You certainly gave Jewel so much to fight for and she did, yes she did.

  8. It's healing to write about a tough journey and I'm glad you did. My journey with Merlin is similar, also diagnosed @the same time. It's an exhausting roller coaster but that's love. I send hugs for your still grieving heart. You're welcome to participate in my pet loss study.

  9. Thank you for sharing about Jewel's CRF. You did an awesome job of caring for her. Not everyone would have the strength. I agree that love helps more than anything. *hugs*

  10. Lovely post with so much great information and good advice. Thank you!

  11. Thanks for this. My human has lost two cats to renal failure, and she thinks not enough is being done to research its causes, preventative measures and treatment, considering how many cats die from it.

  12. This is a very good, very informative and totally loving post. Thank you for being helpful, and also shwoing us how much love a cat can have from one loving person.

  13. Jewel was truly blessed to have had you, Sierra!

  14. I am on my third CRF kitty and you did a great job explaining it all. What works for one may not work for another and each cat has different symptoms that come to the forefront. Chica had lots of nausea issues and crashed 3 times requiring hospitalization. Yoko on the other hand did not need anything other than fluid therapy and slippery elm. I did find the Iris versicolor homeopathic remedy once a day worked well for stomach acid. A lot easier to give. Both kitties lived years with CRF and died of other issues non-related. Ivy is the current CRF cat and she seems to be doing well with once a week fluids and stomach acid treatments. I never did find a food that they would eat so I gave them the best quality I could find - whatever they would eat. Thanks for sharing your experience.

  15. We love and appreciate what you wrote. xx

  16. What a great explanation about CRF. We have had four CRF cats through the years, and nothing can prepare you for the journey.

  17. What a long and hard road you and Jewel traveled. It is a blessing that you had each other. This blog was so great and I know I will be keeping the symptoms in the back of my mind for a long time...just in case. Thank you and I am so very sorry for your loss.

  18. Thank you for sharing your journey with Jewel. I agree with others that each of you were blessed to have each other. My thoughts are with you as you continue to grieve.

  19. Sending a ton of hugs to you, it must be hard to put all of that info in your blog.
    Thanks so much fur sharing this with all of us.

  20. Thank you for this information. I am currently dealing with this with my friend's cat that I brought to the vet yesterday. I wrote down the meds you listed for appetite and will suggest them today.

  21. Thank you very much for the information. We know it will help a lot of kitties out there in blogland.

    Noodle and crew

  22. All kitties are special, but some become our "heart" kitties, and they can do that very quickly. For you, Jewel was one of those, and no matter where you are or what you are doing, she will always be with you in your heart. Hugs, janet

  23. Jewel was very lucky to have a mom to love her so much and care for her so well. The bond you two shared is unbreakable, even though Jewel has crossed the bridge. Sending love and purrs.

  24. Weez so sowwy fur yous loss. Fank yous fur writin' this posty. Hopefully it may help sumpawdy els in da future.

    Luv ya'

    Dezi and Lexi

  25. Beautiful post ! It was a hard day for Jewel, but fortunately she had your love to support it. Purrs

  26. Such a lovely post, Sierra. Thank you for loving Jewel so much, and so very well.