Need some opinions on my 16 year old cat's health

We took our 16 year old cat, Max, in for her check-up last weekend. The results were not good, but they are definitely confusing to us. She has elevated liver enzymes, elevated thyroid levels, elevated kidney enzymes, a slight anemia, protein in her urine, and a mass in her kidney.

She is now five pounds - she has lost a couple of pounds since her last vet visit. She is doing well physically, though - she eats a lot, drinks a normal amount of water, pees and poos normally, and has good energy for a cat her age. One different thing she is doing is meowing a lot, though - every time we go in the kitchen, she goes in there and meows for food.

The vet would like us to do an abdominal ultrasound (for $400); the vet who was examining her did a short ultrasound just to see what was up with her kidney, and she found that at least half of her kidney is just a mass - no normal kidney tissue.

I’m waiting to hear about her urine culture results - they think she either has a bladder infection or protein in her urine because her kidneys are bad. We haven’t heard from them for a week, so I don’t think it’s an infection.

The vet would like to put her on a low-protein diet because of her kidneys, and on a low dose of thyroid medicine for her hyperthyroid levels. The vet also thinks that bringing her thyroid levels down could possibly help her liver enzyme levels, kidney enzyme levels, and anemia. I’m not sure about this - when you put all these things together, it kind of sounds like she isn’t doing too well - her thyroid levels aren’t terribly high (about 67 when the upper limit is 55, I think).

Any ideas? Should we go ahead with the ultrasound to find out the extent of the kidney problem, and if there is any liver involvement? Should we do the low-protein food and thyroid meds? Should we just let her eat whatever she wants, because she doesn’t have that much time left?

I don’t know anything much about cats but my pure gut instinct reaction is to see if she likes the special food. If she doesn’t, just give her what she wants. 16 years old is a lot for a cat and I would expect that the benefit from the healthy food is such that random chance is far more important.

What I mean by that statement is that no doubt the vet’s advice is good for a population of cats. But for one cat at the age yours is luck is going to be far more important than pretty much anything you can do to improve her health. So focus on happiness/quality of life first, then eeverything else second.

Sounds like your cat has two conditions common in the older cat - overactive thyroid and renal insufficiency. One of the problems when these conditions co-exist is that, to a certain extent, the elevated blood pressure common with thyroid hormone excess alleviates some of the increases in renal values that would otherwise be seen due to the renal insufficiency. So trialling a low dose of thyroid medication and a renal diet is not such a bad idea - trying to treat each condition a little to reduce their impact while hopefully avoiding decompensating the patient. The thyroid level may be artefactually low due to concurrent disease (so-called euthyroid sick effect).

To me, the most worrying thing in your message is the presumed mass in the kidney. Renal lymphoma would be top of the list, and while lymphoma generally responds pretty well to chemotherapy (and there are several protocols of varying intensity), the presence of an overactive thyroid and renal insufficiency is going to complicate treatment and monitoring.

Figuring out which blood results go with which disease assuming she has thyroid and kidney problems and a tumour is not necessarily going to be straightforward. Only you can decide if further investigations are worth it - both financially and emotionally - but abdominal ultrasound would be a logical next step. But you can count on there being several more steps too, if you want an definitive answer.

As Simple Linctus points out, your focus should be on quality and not quantity of life. If your cat can be medicated/eat special food and have quality, then you may get more quantity. But don’t go for quantity over quality.

If money is literally no object for you, and spending it on your cat brings you happiness, then go for it.

If things are tight for you, then put on a smile, pet your kitty, and let her get older and sicker until it gets to the point that you have to put her down, or she just dies peacefully on her own.

16 years is a long time, and I’m sure kitty has had a good life.

I think I would go for the meds and the diet and skip the $400 ultrasound.

If it finds a mass will you pay $2500 to have it removed? Do you think kitty would survive even if you did?

I’m familiar with the senior kitty deal - honestly I think would pick up an extra soft kitty doughnut and a heating pad to make an extra comfy spot for him/her, try the diet and pills and forget the rest. There is no point worrying about a senior kitty - just enjoy them while you can.

PS - please give kitty an ear scritch from me. :slight_smile:

I’ve had two cats with hyperthyroid. One reacted well to the medication, which you put in the ear while wearing latex gloves. The other was a freak who would hide for days if she thought I was going to medicate her. The medicine, as far as I understand it, is generally pretty well tolerated by most cats and it cost about 15-20 dollars for a month.

So, yeah, I’d try a combo of the medicine and an adjusted diet. Kidney disease can be lived with for a long-ish time, and hyperthyroid (which might be the cause of the crying) is treatable.

Good luck.

I don’t think I’d pay for the ultrasound–mostly because if I had a sixteen year old cat, I’d be reluctant to follow up with surgery or expensive medication. Though it might be worth asking the doctor for more information on how the recommended care would change based on the results of the ultrasound.

I do think I’d give the diet and medication a try, so long as they weren’t exorbitantly expensive, difficult to acquire, and were well-tolerated by the cat.

Your description of the cat’s behavior makes me think that the cat is in reasonable health, and still enjoying life, which is important.

Thanks for the input, guys. This really is confusing for us, made even more so by a second cat in the house who has her own special food for her hyperthyroid condition - the cats are not supposed to sample from each other’s bowls, but of course they do.

We can do the medication and the low-protein food route for the old gal - my concern with that is that her favourite things in the world are pork, chicken, and turkey - this is where “quality of life” comes into play, I think.

You all make good points about the next step after doing the ultrasound - I don’t think we would go ahead with any surgeries or chemotherapy for her, even if we had unlimited funds (which we don’t). My gut feeling is that the ultrasound would be an exercise in making her life miserable for no real good reason, since she hates going to the vet.


spend the money if you got it but if there was a general decree #1 for any living thing it would be “quality of life”. Make the declining years of your pet as good as you can make them.

It’s such a difficult decision. I think that ‘not pursuing every medical option’ does not make you a bad or uncaring cat owner, nor is it a sign you do not love your cat enough.

I had to come to this point with the cat I had with the chronic cough and thankfully, my vet was on side. There were many things we could have done to pinpoint what was wrong and try to fix it, but in the end, the decision was made to just medicate the symptom.

I would try the food and the meds and see if that makes a difference. I would also check up on recommendations for kidney diets. There is research that suggests that a low protein diet is not the only option, and that a high quality high protein diet is a better choice. I would discuss this with your vet.

All the best to you and your kitty. I hope the time you have left with her is full of snuggles and purrs.

It is a difficult decision.

I hate to say it, but as one who has owned cats his whole life, I feel correct in saying that age 16 for a cat is fortunate. Any additional time is a blessing.

Were I in your shoes, I’d look at the cat’s quality of life. If that’s fine, and if the changed diet won’t change the quality of life, then try that. But at this point–and I know it’s difficult–I might avoid the tests and instead, try to keep the cat comfortable until its quality of life suffers to the point where–well, you know.

I will tell my guys about your Max, and ask them to send good kitty thoughts his way.

16 human years is apparently 81 cat years - she really has had a good run!

She was just up looking for a late-night snack - I gave her a good tablespoon of the hyperthyroid food, and she gobbled it down. Her appetite sure isn’t suffering - she seems to just want wet food now. The vet wants her to eat dry as well to keep her teeth cleaner, but I’m okay with giving her wet food on demand. I’ll have to look into some low-protein wet food if that’s what she really wants.

Thanks for the good kitty thoughts, Spoons. :slight_smile:

If the vet is recommending or giving the cat prescription diet for the kidney, ask for the wet version. Most diets come in both forms.

The appetite is not suffering in part because of the hyperthyroidism. Hyperthyroid cats eat a lot (and don’t seem to gain weight, and my lose some).

I’d go with udlander’s first paragraph. Try and treat both the kidney and thyroids first. The mass in the kidney may be lymphoma (if it is a big homogenous mass), although I’m not sure how a couple other cat renal diseases look in ultrasound. BUT, if it is a tumor confined (for now) to one area, the rest of the kidneys and their function, with treatment could improve and decrease the kidney enzymes.

I’ve heard of a number of cases with renal failure kitties where a suspected mass actually turns out to be an enlarged kidney, which is not atypical for a cat with CRF (chronic renal failure).

I lost my 19 year-old kidney kitty to CRF in July. She had it for five years and was my fourth with the disease. There are a LOT of things you can do to improve/maintain quality-of-life.

Wet food is the best choice for her as dry food requires quite a bit of fluid to process and CRF kitties are already verging on dehydrated. Canned food is 80% water. I’m not sure why your vet would think her teeth are more important than hydration, and the dry food/cleaner teeth theory hasn’t been proven to my knowledge anyway. Maybe Udlander (who must be a vet-great post) would have some input on that? was my Bible for the five years Tickle had CRF, and I credit it and a Yahoo group for my being able to keep her comfortable for so long. I’ll PM you the URL for the Yahoo group, CW. It’s a CRF group, but senior kitties often have multiple issues and this group has a vast amount of experience in unraveling a cat’s physical picture, and suggesting treatment/care. It’s a group that’s been around for at least ten years and has an unbelievable breadth of knowledge. I can’t recommend it more highly.

If anyone else is interested, please PM me as well. :slight_smile:

This would be my most important concern. If I was 90 years old and someone told me I could live 5 more years by playing video games, watching movies, and eating pizza, or 10 more years by exercising regularly, seeing doctors three times a week, and eating grape nuts, I’d be checking out of this planet at 95. Give that kitty the yummy stuff!

Thanks for the link - I’ll check that out.

That’s kind of what I’m thinking, too - I’ll definitely look into the low-protein wet food, but I think she might still be getting some pork and chicken scraps. The low-protein wet food is a good idea - the two cats keep eating each other’s dry food, but they gobble up the wet food, so I can keep that straight better.

Another question - I’ve been pretty much giving her wet food on demand this weekend, and she has been eating A LOT - does that seem normal? Is that maybe the higher thyroid hormones, that make her hungry non-stop? It does seem limited to the wet food, though - she’ll leave her kibble all day.

Yeah, hyperthyroid does that, and if she doesn’t normally get much wet food, simply novelty will have her acting like she’s going to starve.

Yea, hyperthyroid cats eat a lot, drink a lot, and stay skinny.

wet food chews easier and probably poops easier too.