Tanya's Comprehensive Guide to Feline Chronic Kidney Disease

This page is about how to cope with living with CKD on a daily basis, both from an emotional and a practical perspective.
The fact that CKD is ultimately terminal can be very hard to deal with. You may also be worried about how much to put your cat through, bearing in mind your cat's personality and the costs involved - looking after a CKD cat may sometimes require a lot of your time and energy and sometimes money.
However, in most cases people and cats do learn to cope, and seeing how your cat improves and then stabilises makes it well worth it in most cases.

Getting Started

If you've just received the diagnosis, you're no doubt feeling scared and frightened. You're worried you can't do this, and you may well be feeling guilty for not noticing sooner thar your cat is sick.

Remember, it's not actually possible to notice CKD until at least 66% of kidney function has already gone - that's the nature of the disease, so you have nothing to feel guilty about. Even if you still think you have something to feel guilty about (food choices are a major source of guilt, even though food does not cause CKD), ditch it anyway, because it uses up valuable energy which you need for the journey ahead. And your cat loves you whatever you did or didn't do.

If you're not sure how much you and your cat can cope with, I would suggest that you opt for a trial period of, say, one month, during which you treat your cat to the best of your ability, and according to your financial limitations, and then review the situation. With luck your cat will be stable and happy and you will both be getting into a routine that works for you both. If your cat is critically ill, I would still give yourselves a minimum of two weeks of treating proactively before making any irrevocable decisions.

What is the Emotional Rollercoaster?

The emotional rollercoaster refers to the mixed emotions you will feel as you care for your CKD cat. When your cat is doing well, you will feel good but will probably also be wondering how long it will last; and when your cat is poorly, you will feel emotionally drained and very frightened. These ups and downs are referred to on Tanya's CRF Support Group as the emotional rollercoaster. This section talks about how to cope with the rollercoaster ride.

taking care of yourself

worrying about the future (anticipatory grief)

on-line support

working with your vet

if people around you do not understand

Taking Care of Yourself

One of my support group members, Stephanie, wrote "We cannot control whether they will die, because they will, as all living things do, but oh boy, can we control the way in which they live." Although this is good news, it is also a big responsibility, and occasionally things will get on top of you, particularly if you have little or no support at home. Some people cope better than others, depending upon their own personality or how well their cat is doing; but everybody living with CKD needs some level of support at some stage of the disease.

You have to accept that you are going to have days when you feel overwhelmed, when you really do not think you can cope anymore, or when you feel you don't want to live this way anymore. You know what? - it is perfectly fine to feel that way. You are caring for a chronically ill family member, and facing the eventual loss of a treasured friend, a major emotional trauma. Accept that you may feel this way, and that it is fine to do so; and just get through the bad days the best you can.

Be kind to yourself and accept that something's probably got to give. Yes, your home may in part resemble a pet food or hospital supply store, but as long as it's hygienic, who cares. Focus on the important things: make sure you get enough sleep, eat properly, keep things clean, hang on to your job if you have any. Anything else is a bonus.

Your cat may not act exactly the same, which you may find scary at first, fearing a crash. We all want things to be the way they were before, but life is all about change, and we must go with the flow. Eventually you will both learn to accept this new normal.

Try to get into a routine, but don't sweat it if things slip sometimes. Consistency is the goal, not perfection. Cats are very forgiving. If you're having a really bad day, or if sub-Qs don't go too well one day, take a day off. I would always give blood pressure or heart medications and make sure your cat eats, but otherwise the occasional day off should not be a problem for either of you.

If you are feeling stressed, take a hot bath, buy yourself a book or whatever, and most importantly, give your cat a big hug and tell yourself that having to live with CKD is much, much superior to the alternative. Consider using Bach Flower Remedies (see Holistic Treatments) for yourself on days like this.

Don't forget, your cat can pick up on your mood, so try also to focus on the fact that you do still have your cat with you, and try to enjoy his or her presence. Don't only interact with your cat by medicating and giving fluids. Stroke him/her, talk to them, tell them how you are trying to help. Many people find the bond with their cat is deepened as they progress along the CKD journey together, and find that they develop as a person whilst learning how to care for their beloved cat.

Special Needs Pets discusses how caregivers need care too.

Helpguide has an article on recognising and controlling stress.

Worrying About the Future (Anticipatory Grief)

Anticipatory grief means that you worry about and grieve over losing someone you love before they have actually gone. When you are caring for a terminally ill cat it is common to panic if your cat is having an off day, even though ups and downs are very common in CKD. But sometimes it's even worse than that, and you find yourself worrying even on good days. You worry so much about what is around the corner, and how you will cope, that you forget to enjoy the time you have together now. You may begin to focus more on your cat's illness than on your cat, forgetting that this is still the cat you know and love, even though his or her behaviour may be a little different.

I did this all the time with Tanya (though I was a little better with Thomas). I spent much of my time sobbing, as I envisaged life without Tanya, and I forgot to focus on the fact that right at that moment we were still together. Yet all that worrying and sobbing did not change the course of her disease, or postpone her death. When I look back now, I wish I had spent less time fearing the future and more time living in the present, stroking and holding my lovely girl.

You may also find yourself trying to distance yourself emotionally from your cat, in a sub-conscious effort to spare yourself pain when he or she dies. But it doesn't work, you are going to feel pain at that time anyway, so you may as well try to enjoy your time together now, in fact try to savour every moment, enjoying your cat's uniqueness.

Try to take it a day at a time rather than thinking too far ahead. When you get up each day, if your cat seems relatively stable, give thanks and resolve to enjoy the day. If worrying thoughts enter your mind, send them away, telling yourself "yes, s/he will die, but not today."

When Harpsie was diagnosed with terminal cancer, and the vet said he might only have a week or two to live, I made a conscious decision that I was going to do my best not to do anticipatory grieving. I figured if we didn't have much time left, I was going to savour and cherish every moment, and anyway, there would be plenty of time for tears later. So each day I would get up, and be glad Harpsie was still there, and if he would eat breakfast (I was very lucky that he did keep eating) and his breathing was no worse (he had secondary lung cancer), and he seemed reasonably comfortable, I'd say to myself "I don't think today is the day", and then I'd focus on enjoying his company.

Of course I would get bad moments if he became subdued later in the day or something like that, and sometimes I'd get upset anyway, because the thought of losing him was so horrible. But I did largely avoid anticipatory grief, and I'm so very glad I did. I now have memories of our last two weeks together of him eating as I held the plate for him, of little chats where I told him how much I love him, rather than of me sobbing into his fur coat all the time (though I did this sometimes, of course). So do try if at all possible to just live in the moment and not worry too much about tomorrow. But of course there's nothing wrong with expressing your sorrow and fear sometimes too, bottling it up is not good for you.

Anticipatory grief often includes bargaining. When Harpsie was diagnosed with terminal cancer, my bargain was "OK, I accept I have to lose him, but I would at least like to be allowed to keep him until June please". In fact, we had to have Harpsie put to sleep on 23 May because of breathing difficulties ( he had secondary lung cancer). My bargain was not a bargain at all, because the situation was completely beyond my control - Harpsie's cancer progressed at a rate that had nothing to do with me. The Pet loss link below does have some information on the types of bargains which are more likely to be helpful to you.

I know all this is easier said than done, but this quotation might help you to live in the moment:

"There are persons who shape their lives by the fear of death, and persons who shape their lives by the joy of life The former live dying; the latter die living".

Horace Kallen

Doug and the B Brothers has an excellent article about how to cope with the fear that typically accompanies caring for a cat with CKD.

Pet-loss net has a helpful article about what it calls "pre-bereavement", or coming to terms with the fact that your cat has a terminal illness.

American Hospice Foundation has some information about coping with anticipatory grief.

The Association for Pet Loss and Bereavement has a weekly online chatroom available on Thursday evenings (US eastern time) to help people deal with anticipatory grief.

Working With Your Vet

If you and your vet have a good rapport and are able to work as a team, it can make a world of difference to how you cope with CKD. Conversely, if your vet is not prepared to work with you at giving your cat a chance, it is an extra burden, making you feel like your cat's fate ultimately rests in your hands.

It may be that you are never going to see eye to eye, in which case you need to find another vet; but it might equally well be a simple misunderstanding. British vets are very conscious of the quality of life issue, and may misinterpret your attempts to give your cat a chance and to make him/her more comfortable as you being incapable of letting go, no matter how ill your cat is.

Do be prepared to listen to your vet's opinions and medical knowledge, they have an important role to play in helping you to make decisions about your cat's wellbeing. At the same time, your vet must understand and respect that this is your cat and your opinions are valid too. Try to make it very clear to your vet that you have your cat's interests at heart, not your own, that you will let go when the time comes (if indeed you will), but that you feel that time is not yet here. Essentially you have to learn how to be your cat's advocate. The Working with Your Vet page has more information on how to work in partnership with your vet.

On-line Support

If you're feeling alone, come and join Tanya's CRF Support Group, where you will find other people prepared to rejoice along with you on your up days and to support you on the down days. Many people find it really comforting to learn they are not alone as they ride the CKD rollercoaster, and it really can make all the difference to how you cope on a daily basis. As an added bonus, you can obtain practical advice on problems that arise from people who have already experienced the same problems and who know what works in handling them.

If Others Do Not Understand

Sadly this is a common problem. Many people around you will not understand why you are so upset about your cat's illness. I only had one friend who really understood how I felt when Tanya was sick. You will probably also lose count, as I did, of the number of people who tell you that you are foolish to spend your money treating your cat; yet what could be a more important way of spending money than on extending the life of a loved one?

If you wish, you can try to explain to those around you why it matters to you that your cat is terminally ill; but if they are unable to understand, then save your energy and try not to take it too personally. Really, these people are to be pitied because they obviously have never experienced the special bond that you have with your cat. If all else fails, tell them you need to feel you have done your absolute best to help your cat in order to minimise any guilt you might feel later on; many people will be able to understand if you phrase it that way. Then do not raise the subject again, but instead seek support elsewhere, such as on Tanya's CRF Support Group.

Practical Issues and Support

Although it is hard to accept, your life and that of your cat have now changed. This is upsetting, I know, but you have to face up to it and focus on finding your "new normal" - what works for both of you now in light of the diagnosis and all that comes with it. Your new normal may change again over the months and years, but that is OK, you will adapt to that normal too. Here are some tips to help you from a practical perspective:

creating a routine

minimising the financial burden

financial support in the USA

balancing commitments

going away on holiday or business

Creating a Routine

One important step I recommend is to get into a routine as soon as you can. This may be hard initially when you don't know if you are coming or going, but it will help you and your cat cope better (cats love routine) and will ensure you don't forget to give a medication. Keep a written record of your cat's situation so you have less to remember.

Also try to make things easier for both of you. For example, if your cat adopts a bed a long way from the kitchen, place food and water bowls and a littler tray nearby so your cat does not have to go too far.

Medications are often an important part of your cat's treatment plan. See Medicating Your Cat for tips on making giving medications less stressful for both of you. If you are prone to forgetting whether or not you have given a pill, My Med Schedule allows you to create a free med schedule and to receive reminders via text or e-mail. People who work fulltime and who are using gelcaps to give medications often find it can be less stressful to fill a week's worth of gelcaps in one go at the weekend.

It is always hard at the beginning, especially if your cat is in crisis at diagnosis, but hang in there. Once you have your routine going (e.g. you've managed to find a food your cat likes, and s/he enjoys it and keeps it down), and you can see how it is helping your cat, the thrill and relief will be indescribable.

Minimising the Financial Burden

Unfortunately veterinary treatment is not cheap. There is no reason why it should it be, vets have trained for many years and have a lot of overheads, but that doesn't make it any less stressful for you if money is tight.

If your cat is insured, then the financial burden will be much less. I strongly recommend insuring your non-CKD cats (I do not know of any insurance company that would take on a cat post-diagnosis) in order to remove this strain in the future. You can either obtain commercial insurance or self-insure (save money every month in a savings account for a rainy day). If you do insure your cat, make sure you use a company which provides cover for life; some companies will only pay for a condition for a maximum of twelve months, which is of limited use for a cat with a chronic disease like CKD. Other companies may only insure up to a certain age (as young as eight in some cases). Pet Insurance Review compares cover options in USA and Canada.

It is possible to buy many of your supplies, particularly those relating to sub-Q fluids or ESAs (Aranesp, Epogen, Procrit or Eprex) from on-line pharmacies at much reduced prices. Obtaining Supplies Cheaply has links to such suppliers in the USA, UK and Canada.

If your cat is not insured and you are unable to obtain cheap supplies, but your cat is doing well on treatments, politely ask your vet if he/she could possibly give you a reduction for ongoing treatments, or perhaps provide some of the supplies you need at cost, either regularly or occasionally. Your vet does not have to agree to this but may do so in some cases. Also, if you can afford the upfront outlay, consider buying in bulk: once we knew Thomas was stable we bought his supplies for two months at a time from our vet and it worked out much cheaper for us.

If you are finding things a struggle, check out the Essential Treatments page to learn which treatments are crucial and where you can afford to be a bit more flexible.

The Humane Society of the United States has an article about what to do if you are having trouble paying for your cat's care (this page sometimes needs a few tries before it opens).

Petlovers Online lists UK organisations which may be able to help with vet bills.

Financial Support in the USA

In the USA or Canada, some veterinary clinics accept a payment scheme known as Care Credit. This is essentially a credit card just for veterinary fees, which offers a variety of payment options, from interest free periods (usually for six months, though it depends upon the vet) to extended payment plans. Unfortunately it did not have a very good report from the Better Business Bureau (though it has improved recently and is now rated B), but if you already have a standard credit card, you might prefer to use that.

The American Animal Hospital Association may be able to offer assistance of up to US$500 a year to people in the USA who qualify.

In Memory of Magic may also be able to offer assistance to people in the USA on a low income via its special CKD fund for CKD cats.

United Animal Nations offers assistance with veterinary emergencies to people on low incomes.

Angels 4 Animals. tries to help animals in need, especially if they are facing euthanasia if no financial assistance is forthcoming.

The Feline Veterinary Emergency Assistance Programme may be able to help those on low incomes in case of emergency (not currently accepting new applicants as at July 2010).

Help a Pet offers a similar service.

The Pet Fund offers fundings to those with pets in need, though there is a waiting list of up to twelve weeks.

Mid-Atlantic Great Dane Rescue League has many links to organisations which may be able to offer financial assistance.

Balancing Other Commitments

Most people have to earn their living in some way, which will probably limit the amount of time that they can spend with their CKD cat. This can be particularly distressing if your cat is having a bad time yet you have to go into work or care for your children or elderly relatives.

Try not to feel guilty about the conflicting demands on your time. If possible, take some time off work or find somebody who can take your children out of the house for a few hours if your cat is very poorly but do not beat yourself up if this is not possible. Try to make your cat comfortable and if possible arrange for somebody to call in and check on the cat's wellbeing - if you are at work, a phone call at lunchtime to tell you your cat is bearing up can be enormously comforting.

If you need to take time off work because of your cat, I would simply say a family member is sick. If you say you need time off to care for your cat, many people will be unsympathetic, but your cat is indeed a family member, even if it does not occur to them that that is what you mean.

If you work five days a week, spend some time on your free days doing things that will help you during the busier times, such as cooking and freezing meals for you to eat during the week, putting a week's worth of pills into gelcaps, placing online orders for supplies etc.

Travel

It can be problematic if you are due to go on holiday when your cat is diagnosed, or if your work requires that you travel on business.

You may decide not to go on holiday while your cat has CKD but bear in mind that your cat could live for several years with this disease. In the USA and Canada it is possible to book petsitters who are happy to give your cat fluids and medications each day, but at this stage fluids are largely unknown in the UK so most petsitters would not be able to do this. You might be able to persuade a family member or a friend to learn how to treat your cat and to step into your shoes while you are away if your cat is relatively stable; or a local cattery may be able to assist.

You could also ask at your vet's: often one of the vet nurses (vet techs) will be happy to come in twice a day to check your cat, give sub-Qs and medications and deal with food and littertrays in order to boost their income. This is what I do.

If all else fails, consider booking your cat into your vet's - a least your cat will get the necessary medications while you are away and the staff in most veterinary surgeries will also stroke the cats and play with them if they are well enough and if time permits.

And if you do go away, please try to enjoy your break: if you return with recharged batteries, it can give you the boost you need to carry on and your cat will benefit.

Some people who travel regularly on business set up a webcam so they can check on their cat. This can be very reassuring.

Of course, you may have to travel with your cat. I've flown across the Atlantic twice with cats, so I know something about this. Please visit Harpsie's website for more information.

Petsitters International can help you locate a petsitter in a number of countries.

National Association of Professional Pet Sitter can help you find a petsitter in the USA.

Quality of Life and Personal Limits

You will probably be very concerned about your cat's quality of life; but please do not forget your own quality of life in the process. CKD is a very hard disease to live with, and if you feel you must be a saint in the process it can be even harder.

You may experience immense frustration e.g. if your cat is urinating inappropriately. Whilst your frustration is probably aimed more at the disease than at your cat, it is possible that occasionally you will find yourself taking this stress out on your cat by shouting at him or her. This is obviously not something to be proud of, and you should try to avoid this kind of behaviour; but it is at least understandable. Please do try your best not to take your stress and frustration out on your cat, but if it does happen, try to put some space between you for a while until you regain some perspective; and tell yourself that your cat will remember many years of loving care rather than one moment of weakness.

We all have our own personal limits in other ways too. Just as some people have more emotional resources than others, so some people have more money than others. If you can easily find the money to pay for your cat's treatment, that is one less stress for you; or you may not have too much money but are happy to go without other things in order to pay for your cat's treatment. It becomes more complicated though if you have others to consider apart from your cat; or if you simply do not have much money. It might theoretically be possible, for example, to take out a loan to pay for your cat's care; but not everybody can bear the strain of making loan repayments for months or years to come.

There is no shame in acknowledging your own personal limitations in all these areas, and trying to accept them. This does not mean you love your cat any less, just that you have other demands on your financial and emotional resources, and that you must juggle everything as best you can. You are only human and can only do your own personal best - as long as you do that, you have nothing to reproach yourself for.

Mary Helen and Snicklefritz

Here is Mary Helen's story of how she decided what was important to her and her elderly CKD cat, Snicklefritz. This was in response to someone who asked why people keep cats with CKD alive when there is no cure for the disease. Your own criteria may be different but I think Mary Helen's words help us to realise that cats do not worry about their own health the way we worry for them.

"Snicklefritz wanted to live, and it was my job to support that until she was ready to leave. Because she could not speak English, it was up to me to work with the vet to carry out her wishes. Really very simple.

"My father is in kidney failure and he doesn't always feel great, but he is preparing for dialysis and transplant screening, because he's willing to endure those "extreme measures" so that he can continue to live. Why should our cats be different?

"Snicklefritz was 22 years old and age had taken its toll, but her will to live was strong. Her eyesight had dimmed over the years and she no longer looked out the windows, but just because her world had gotten smaller didn't mean she didn't treasure her little niche.

"She was arthritic and didn't walk and jump like she had, but that didn't keep her from enjoying her plush cat bed right in the middle of the living room, the center of the action, where she could watch and enjoy as family life with a toddler swirled around her. She happily slept with crayon drawings, stuffed animals, all kinds of crazy things tucked into her bed by my daughter, to the point where sometimes her happy purrrring face and the tip of her tale were all that you could see. She didn't need to walk much, her loving presence filled our house and people came to her.

"She reigned supreme in her little fiefdom, and she was not about to give that up until she was ready. I'm not saying she liked the medicines, the vet trips, the fluids. But even though her life was very limited physically, she was happy loving us and being loved, and it was enough for her.

"My mother lives out of state and had heard the saga of Snicklefritz's decline. She loved Snickle dearly and had gently suggested a couple of times that perhaps it was time to let her go. Well, my mother came to visit and watched as my darling 3.5-pound, arthritic old girl carefully and slowly walked across the room. With tears in her eyes, Mom looked at me and said it was like watching the walking dead.

"And then, Snickle taught my mom a lesson. In her classic Snickle-way, she taught my mother an important thing about life. Never cranky, never scolding, always full of joy and love...

"She went over and somehow managed to hop up to Mom's lap by herself. And she settled down and began to purrr her HUGE happy purr. And she looked up at my mother's face and gave her that slow wink of contentment and love.

"Snickle may not have had much of a life, but it was enough. She might have felt pretty lousy, but it was worth it to be able to be with those that she loved.

"She was 22 and wasn't going to be cavorting about like a kitten, CKD or not. But she was older and wiser and needed different things to make her happy. A soft bed, a loving family, that was what mattered to her at the end. She made a tremendous effort to say "goodbye" to us in her final illness and then she let go and stopped fighting. It was time, and although I miss her more than I can describe, I know that she was ready to go.

"I think we can focus too much on what our cats have lost through their illness and not enough on what remains. Simple things like warm sunshine and time with our loved ones are the essence of joy...

"My daughter was privileged to know Snicklefritz until she was almost 3.5 years old and was nursed through her second surgery by that old, frail kitty that loved with a passion and a strength that belied her tiny, arthritic body. We have greatly mourned the loss of our beloved feline companion, but we have also learned so much about the strength of love. And I know that my daughter knows that I would care for her with the same love and patience that I gave Snickle, even when it was not easy, even when I felt I could barely go on. And I learned that about myself as well..."

Other Family Cats

Many people have more than one cat, and can find that this makes dealing with CKD even harder. You may find it tricky trying to feed your CKD cat a different food to the others (see Which Foods to Feed for more on this). You may feel guilty for giving so much of your time to the cat who is ill, perhaps feel you are neglecting your healthy cats.

Your healthy cats will probably sense that something is not right, and may start to act differently. This is fairly common when the sick cat has been hospitalised and returns home - the other cats may hiss and spit and not accept the sick cat. This is usually only because the sick cat smells differently, and of the hospital to boot: if you can make all the cats smell alike, perhaps by rubbing each cat with a piece of your clothing or dabbing them on the nape of their neck with a tiny amount of vanilla, this behaviour usually disappears.

If you can, try to find a little time each day for your healthy cats - it can be very comforting spending time with a cat who doesn't need much care, and of course it is good for the cat too. But if you simply cannot find the time, do not worry too much, you can always spend time with your healthy cats later on, but your CKD cat's needs must take priority for now.

I am sometimes asked whether people should get another cat to keep their CKD cat company. This question often arises if another family cat dies, and the CKD cat becomes an only cat. It does partly depend upon the personality of your CKD cat - some cats are simply more sociable than others. However, cats are solitary predators, which means they will need time to adapt to a newcomer; and to expect an elderly sick cat to suddenly accept another cat in his/her territory can be very stressful. A 16 year old cat is 80 years old in human terms, so being asked to suddenly share the home with a baby or teenager (a kitten or young cat) can be really hard. For this reason I would be particularly reluctant to adopt a kitten in such circumstances, but if you do decide to do so, please adopt two kittens so they can play with each other and leave your CKD cat in peace. Harpsie's Website has some tips on how to introduce a new cat.

Creating Memories

It can often be very helpful to create memories of your cat, in the form of photographs, video recordings, collecting locks of hair etc. - whatever appeals to you. My husband arranged for portraits of Tanya and Harpsie to be painted for me as a birthday present one month before Tanya was diagnosed, and I find them enormously comforting now both of them are gone.

I had also happened to start videoing Tanya a few weeks before her diagnosis, and I continued to film her even when she was ill. Before she died, I felt sure I would never be able to watch the videos after she was gone; but in fact, only a few days after she died, I felt the urge to watch them, and I sat there, with tears streaming down my face, yet at the same time finding the images tremendously comforting. I had begun to worry that I had kept her with me for too long, but watching the video taken only two weeks before she died, when she actually looked relatively well and happy despite being very thin, reassured me about her quality of life during those last few weeks; while seeing her before her diagnosis enabled me to remember her at her best. I still watch those videos even now, and they never fail to lift my spirits. Of course, I also have videos of Thomas, which are equally cherished.

One Last Thing...

Please try to remember that living with CKD is not always doom and gloom. The first few weeks after Thomas crashed when we were trying to stabilise him were certainly very hard emotionally, with us wondering every day if he would last another week; but after the first few weeks it was really quite simple. Giving him his medications took only 15-20 minutes a day and for the rest of the time he acted like a healthy cat, eating, sunbathing, grooming himself - and it delighted us to see it.

When you reach some level of stability like this, then it really does make the emotional rollercoaster worthwhile. In addition, many people on the Tanya's CRF Support Group find that their bond with their cat is deepened as a result of the joint effort in fighting CKD. If you'd like some support, come and join the group.

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This page last updated: 18 January 2012

Links on this page last checked: 14 July 2010