Geriatric Cats

November 18, 2010
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By Jean Hofve, DVM

Just like humans, cats are prone to a number of medical problems as they get older. With diet, supplements, and extra care, many of these conditions can be prevented, delayed, or managed, to give your cat a good quality of life in her older years.

Arthritis

A recent study found that 90% of cats over 12 years had radiographic (x-ray) evidence of degenerative joint disease (DJD or arthritis). This came as somewhat of a surprise to the veterinary community, since few cats are ever clinically diagnosed with arthritis. What is generally perceived as “slowing down” or “a little stiff” may be a sign of significant joint deterioration, and probably causes discomfort in most older cats. Since treating arthritis holistically is so simple and inexpensive, it may be a good idea for every cat over 10 years to be given appropriate supplements. In the cat’s wet food, simply mix glucosamine sulfate (250 mg per day) and MSM (methyl-sulfonyl-methane)(200 mg per day). This combination provides good anti-inflammatory action and pain relief. In a symptomatic (obviously painful or lame) cat, it may take 3-5 weeks for improvement to be noticeable. (For more on arthritis, see this article.)

Chronic Kidney Disease (CKD), formerly known as Chronic Renal Failure (CRF)

Many older cats experience some degree of kidney (renal) disease as they age. The first symptom is usually an increase in both drinking and urination. This reflects the kidneys’ inability to reabsorb water and concentrate the urine. As time goes on, most cats lose weight, sometimes dramatically. This often occurs when the cat’s appetite decreases, which may be due to toxic metabolic by-products, such as ammonia, building up in the bloodstream. In humans, ammonia poisoning causes nausea and severe headaches, and it’s likely CKD cats feel something similar. Bloodwork will usually reveal increases in two kidney indicators, BUN (Blood Urea Nitrogen, an ammonia compound), and creatinine (a protein that is normally filtered out by the kidneys). For a special report on what all those names and numbers are on a bloodwork lab report, see “Interpreting Lab Values” in our Bookstore. CKD is the result of chronic low-grade inflammation, which some experts believe is related to boosters of the feline distemper vaccine.

It is vital that CKD cats get sufficient fluids, either through consumption, or by administration (intravenous or subcutaneous), to stay hydrated. Dehydration is a major problem in these cats, as it compounds the problems of poor appetite and weight loss. Wet food, such as canned food, is an essential part of the diet.

The conventional treatment for CKD is a low protein, low phosphorus diet, potassium supplementation, and a phosphorus binder to further reduce accumulation of phosphorus in the body. If needed, medications for anemia and high blood pressure–common side effects of CKD–can also be given. However, low protein renal diets are not indicated until the disease is relatively advanced (BUN over 60). This is because these diets are so restricted in protein that they don’t provide enough for normal body repair. The cat’s body is forced to break down its own muscles to obtain enough protein, causing further weight loss and muscle wasting.

Many cats won’t eat a renal diet, and will do much better on a regular canned food. Experts agree that it is far more important that the cat eats and maintains her weight, than to worry too much about what she is eating. Hydration is also critical; many guardians learn how to give fluids at home to save the cat from the stress of frequent trips to the vet.

For more information on CKD, see Kidney Disease in Older Cats.

Kidney Stones

Older cats sometimes develop symptoms that are very similar to FLUTD (feline lower urinary tract disease). They may go to the litterbox frequently, cry when urinating, or have blood in the urine. Since FLUTD is generally a younger cat’s disease, it is important to consider the possibility of kidney stones. These stones can grow quite large, and tiny pieces can chip off and pass down the urinary tract, which is most likely what causes the symptoms. Unfortunately there aren’t many viable options for treating kidney stones in cats, but knowing what the problem is will help your veterinarian manage the symptoms effectively and keep the cat comfortable.

Hyperthyroidism

This is another common disease in older cats. The problem is typically a benign thyroid tumor. Because the tumor cells are relatively normal, they continue to produce thyroid hormones, resulting in a high level in the blood. The thyroid regulates the body’s metabolic rate, so this increase is sort of like drinking espresso around the clock. Symptoms include increased appetite, weight loss despite eating more, increased heart rate, anxiety or “hyper” behavior, howling at night, increased thirst and urination, vomiting, and diarrhea. Not all cats will have all symptoms, and about 20% of hyperthyroid cats will be sluggish and depressed instead of hyperactive. Untreated, hyperthyroidism can cause a serious heart problem called hypertrophic cardiomyopathy that will ultimately be fatal.

The cause of hyperthyroidism is unknown, but a recent study found a link between hyperthyroidism and feeding canned food, particularly fish and giblet flavors. Easy-open “pop top” cans also appear to be a contributor. Just what it is in these foods that is the culprit is unknown. Feeding canned food is very important to an older cat’s overall health, but it may be wise to stick to poultry, beef and lamb flavors that don’t contain liver, giblets, or by-products. Get the larger cans that don’t have a pop-top. Many holistic veterinarians also believe that, because this disease is fairly new but rapidly reaching epidemic proportions, that vaccines may also be a factor.

There are four primary treatment options for hyperthyroidism:

  • Methimazole is a medication that can be given in tablet form (the tiny tablet can be crushed and mixed into food) or as a topical gel that you rub on the inside of the cat’s ears (ideal for non-pillable cats). It requires frequent blood tests for the first few weeks as the dosage is adjusted to fit the cat, and then every six months to make sure the dose remains appropriate. Occasionally, cats become allergic to the medication. While this is initially the least expensive option, maintenance can become costly over time.
  • Thyroidectomy is the surgical removal of the thyroid glands. Cats actually have two thyroids, one on either side of the throat. Often only one is involved and can be safely removed. However, there is a significant risk that the second gland will ultimately develop disease and need to be removed later. Removing the thyroids is no big deal to an experienced surgeon, but there is one major problem: four tiny parathyroid glands that are closely attached to the thyroids. Removing or damaging the parathyroids can result in severe, even life-threatening problems with calcium balance. Because of the way the thyroid glands develop in the fetus, there can be thyroid cells scattered here and there that can also become cancerous. A cat who has had both thyroids removed can therefore still become hyperthyroid again. These secondary tumors can form inside the chest where they cannot be surgically removed.
  • Radioactive Iodine is the most definitive treatment. The thyroid uses iodine to make its hormones, and accumulates large amounts of iodine. A single injection of radioactive iodine will be hoarded by thyroid cells and kill them, theoretically curing the disease permanently. Most cats tolerate this procedure well, and most do not need thyroid supplementation. The downside? The up-front cost is very expensive, and regulations require that the cat be kept in the hospital for 7-10 days. However, dealing decisively with the problem may save money in the long run because no further treatment is needed in most cats. A full medical work-up and a few weeks’ trial of methimazole are generally required prior to radioactive iodine treatment, to make sure that lowering the thyroid level (which drops the blood pressure) does not cause renal problems.
  • Restricted Iodine Diet is a relatively new treatment being heavily promoted by Hill’s Prescription Diet for its “y/d” food. This food is so deficient in iodine that it should never be fed to healthy cats. Hill’s has done minimal testing, and y/d really ought to be considered experimental–but the uncontrolled experiment is now being conducted on peoples’ pet cats. The long-term effects of feeding y/d are unknown. The canned version’s ingredients aren’t too bad, but the dry is appalling and should not be fed at all. If you want to try this food, you’ll need to work very closely with your veterinarian to monitor your cat’s progress.

Click here for a more detailed article on the causes and treatments of hyperthyroidism.

Lenticular Sclerosis/Iris Pigmentation

These are eye conditions that develop as animals age.

  • Lenticular sclerosis is not really a disease, but involves the drying out and hardening of the lens of the eye that naturally occurs over many years. This results in a cloudy appearance to the lens. It can resemble cataracts, but does not cause blindness. It does impair the vision somewhat: to the cat, it is probably like looking through a badly smudged pair of glasses.
  • Iris Pigmentation is something like “liver spots” in elderly people, but it occurs on the iris (colored part) of the eye. Technically, these spots are a form of melanoma, but most are benign. However, if you notice one or more spots that develop suddenly and grow rapidly, treatment may be necessary. Surgical removal by laser is the most effective treatment.

Dental Disease

Heavy tartar (calculus), tooth decay, and inflammation (gingivitis or stomatitis) are extremely common in older cats. Erosions and abscesses of the teeth can be extremely painful, but because cats are typically stoic, guardians may not notice any symptoms. However, once the infected teeth are extracted, most cats do very well, bouncing back with better energy and appetite than before. Many guardians find that their cat acts “years younger” or “like a kitten” after surgery. While there are certainly increased risks of anesthesia in an older cat, proper preparation, support, and monitoring make dental procedures, even in very old cats, reasonably safe. Maintaining oral health is extremely important in keeping an older cat healthy and comfortable; it’s wise to get a check-up every 6 months. And if your veterinarian recommends dental care–even with anesthesia–just do it! The consequences of untreated dental disease can be dire–and at the least, it is very painful for your cat. (For more info on dental disease, see Dental Care for Cats.)

Constipation/Megacolon

A small percentage of older cats develop constipation as they age. Many times this is related to feeding dry food, especially high-fiber (hairball or weight control) diets. There is so much fiber and so little moisture in the diet that the colon can’t keep things moving along properly. Other causes include breed (Manx cats are susceptible), trauma, and litterbox avoidance behavior.

If constipation persists and is not treated, megacolon may develop. This is a serious condition in which the colon becomes so full of stool that it stretches beyond its capacity, tearing the muscle fibers and damaging the nerves. The treatment for megacolon is to surgically remove most of the colon. Not surprisingly, this immediately converts the problem from chronic constipation to chronic diarrhea, which may improve somewhat over time as the small intestine takes over some of the colon’s functions.

Clearly, it is best to deal with constipation early before it becomes unmanageable. While it will never replace football as a spectator sport, watching the quality and quantity of your cat’s stool in the box is vital to keeping your older cat healthy. A healthy stool looks like a tootsie roll; if it’s small, hard and dry, or if the cat spends a lot of time in the box, strains excessively, or cries as he’s defecating, it’s time to jump on the problem. Sometimes you’ll see a small amount of very liquid diarrhea, which is the only thing that can get around the mass of stool to get to the outside. Affected cats may not want to eat, lose weight, and become lethargic and depressed. Any change in an older cat’s litterbox habits should be discussed with your veterinarian promptly.

For more detailed information on treatments for constipation, see Constipated Cats.

Cancer

Cancer is affecting more and more of our animal companions, often at younger and younger ages. Many factors contribute to the development of cancer, including over-vaccination, toxic chemicals in the environment, poor nutrition, and stress. Symptoms vary widely with the type of cancer, from obvious lumps and bumps, to weight loss without apparent cause.

If your cat has been diagnosed with cancer, you will face many tough decisions. The treatment of cancer must be a partnership between you and your veterinarian. If you are interested in a holistic approach, you can find a directory of holistic practitioners by state at the American Holistic Veterinary Medical Association. Acupuncture, herbs, homeopathy, and other alternative treatments may be beneficial.

One easy thing you can do right away is make sure your cat is on a high-protein, low-carbohydrate diet. All types of cancer cells love carbohydrates, but they have a hard time getting by on the protein and fat that cats thrive on (see the many articles on nutrition in our Library). Antioxidants are a major cancer fighter and can be added to the food (see “Biosuperfood for Super Health” in our Library). A good Omega-3 supplement is also crucial.

Essences may also be helpful to keep your cat’s mental and emotional balance during cancer treatment. “Healthy Helper” by SpiritEssence is designed to support and balance the body’s cells and organs, and to help deal with chronic illnesses.


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12 Responses to Geriatric Cats

  1. jlee on January 24, 2012 at 9:41 am

    Hi again,

    Here is the article I was referring to: http://www.truthaboutpetfood.com/articles/which-pet-foods-have-bpa-free-cans.html

    And I think I wasn’t completely accurate about saying that all large cans have BPA in the linings. It appears that large cans can be made without BPA or they are being developed. It is not completely clear. There is more information in the comments section of the article as well.

    Thank you for your great website and helping kitties. I find so much helpful info here.

    • jhofve77 on January 25, 2012 at 12:42 pm

      To know, you have to call the manufacturer. Then, you have to believe what they tell you! All in all, a good reason to feed homemade!

  2. Jlee on January 23, 2012 at 8:42 am

    Hi Dr. Hofve,
    I have been aware of some of the ideas concerning hyperthroidism and ‘pop-top’ cans. I thought I was doing a good thing by feeding my cats the large cans (12 – 13 ounce) that don’t have pop-tops. One of the theorized reasons for canned food and pop-tops being a problem is because of BPA in the linings. Well, I recently read that large cans cannot be produced without BPA (it has something to do with how they are welded together). There is an article on Truth about Pet Food about this and it also provides a list of many of the companies that do and don’t have BPA in the smaller cans (5.5 and 3 ounces). Again, all the large cans use BPA (this is my understanding anyway). Many of the smaller can products from different companies don’t contain BPA. One that interestingly does use BPA in the smaller cans (when they can be obtained without it) is Hills Science Diet. Hmmmm. Sorry I don’t have
    the link to the article.

    I was disappointed to learn that I had been buying the large cans thinking it was a good thing because I was avoiding the pop-tops (and the big cans are a better value). It’s upsetting to think my 17 year old boy was possibly getting this stuff in his food. Geez, another reason to feed raw or home-prepared. Also I think this is article provides some insight and questions about the whole pop-top can “research” : http://meowmeowmom.wordpress.com/2008/08/28/pop-goes-the-pop-top-can/

  3. jhofve77 on November 1, 2011 at 7:16 am

    Sorry, I cannot comment or advise on any individual case. This could be a sign of something serious. Please consult your veterinarian.

  4. Nikki on October 20, 2011 at 9:49 am

    Have a 15 y/o cat who’s been on raw for 6 years. She had dental extractions 6 weeks ago and was zombie-like for 2 days after the procedure. Bloodwork was done the day after the dental work kidney and liver still looked good (abnormals were low platelets, high glucose). 6 weeks later T4 and BUN were elevated significantly and SG was low. I wonder now if she’s just dealing with the cumulative stress of the dental surgery and the antibiotics and pain meds given. She is shiny, happy, purring but is is drinking a lot and eating 30% more than normal. I’m pretty sure methimazole will have a negative effect and would like to know if you have other options you recommend. I am considering stem cell therapy for the kidneys and once kidneys improve, I would treat with methimazole. I would love to know what you know about this option.

    Thanks!

    • jhofve77 on October 20, 2011 at 10:37 am

      Thanks for your comment; unfortunately, such surgery can tip a borderline kitty into overt disease, especially if adequate fluids were not given, blood pressure was not maintained, or if the cat doesn’t eat or drink normally afterwards. You might want to take a look at our article on feline kidney disease for more information.

      You may also have missed our article on hyperthyroidism; which more fully describes the main options. The definitive treatments for hyperthyroidism start with a trial of methimazole. I’m glad you asked about stem cell therapy…it is an area of active research, but is thus far unproven for feline CRF. Click here for Dr. Patty Khuly’s excellent post about stem cell therapy in animals.

  5. Beth Marousek on May 11, 2011 at 12:05 pm

    I’m finding very little information regarding congestive heart failure in cats. I lost my 16 yr. old to this last year, and now her full sister, age 17, is showing the same symptoms. Is there a holistic way to keep her comfortable? Many thanks…

    • jhofve77 on May 11, 2011 at 12:38 pm

      Sorry to hear about your kitties! Unfortunately there is not much information, because cats with CHF tend not to do very well. Certainly a good high-protein diet, supplemented with taurine, carnitine, Omega-3 fatty acids, and co-enzyme Q10 is the place to start. I have CHF myself, and I take those supplements as well as several medications to manage it. Your veterinarian needs to guide you on medications; it is tricky to dose them, and not all are suitable for cats. If you are interested in holistic care, I would strongly suggest working one-on-one with a holistic veterinarian who has experience with these kitties. The directory of holistic practitioners can be found at: http://www.holisticvetlist.com.

  6. Brave Rat vs 4 Cats | Taking care of your pet on November 30, 2010 at 11:50 am

    [...] Geriatric Cats | Little Big Cat [...]

    • jhofve77 on November 30, 2010 at 6:12 pm

      Awesome video! :)

  7. Leigh of GoFetchGifts on November 22, 2010 at 5:52 pm

    What would you advise someone feed a cat with CRF then, if they were feeding raw prior? I feed raw and have read that there is no such thing as too much protein for a cat.

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