An integrative approach to chronic kidney disease (CKD) in cats

By: Barbara Fougere, BSc, BVMS (Hons), BHSc (Comp Med), MODT, MHSc (Herb Med), CVA, CVCP, CVBM

CKD is a common but manageable condition in feline patients, and responds well to integrative medicine. Herbs and acupuncture are key therapies.

Chronic kidney disease (CKD) is a common problem in cats, and one which all veterinarians encounter in practice. An integrative approach that includes herbs and acupuncture can help treat and even reverse this condition in feline patients.

CKD can be detected early through careful monitoring at annual wellness programs. IRIS (International Renal Interest Society) staging allows for the conventional staging of treatment, including any dietary changes. Key treatment strategies for feline CKD include supporting hydration, reducing phosphorus (usually through protein restriction), regulating blood pressure and controlling calcium levels. The intensity of intervention increases with disease progression.

Integrative treatment goals

Using integrative approaches to CKD, we have observed cats moving from IRIS Stages 2 and 3 to Stage 1, and remaining there for years. This reversal implies that nephrons are hypoxic and under-functioning, and that improving their functional capacity is a key goal. See below for integrative treatment goals for CKD.

Herbs can optimise kidney cell function by reducing oxidative stress, improving renal blood flow and mitigating fibrosis, thereby maintaining patients in early stages for extended periods. Acupuncture, manipulative therapies and other modalities can also be a part of the integrative approach.

With acute renal disease, the goals are modified to regulate/decongest the kidneys by reducing blood flow, and provide anti-inflammatory support to inflamed glomeruli. This may be a starting point with pyelonephritis, for example. Most cats, however, benefit from increased perfusion unless the renal disease is acute in onset (inflammatory).

Dietary considerations

Despite numerous experimental studies and clinical trials, questions about feeding protein to cats with chronic kidney disease (CKD) remain. What is the optimal amount of protein for a cat with CKD? How much restriction is necessary? Do different types of kidney disease require different dietary therapies? At what point in disease progression should protein restriction be implemented? Does the type of protein make a difference? Does every meal have to be restricted? Will a cat in IRIS Stage 3 or 4 benefit if phosphorus is restricted by other means? Might some cats with advanced disease benefit from increased protein levels?1 These concerns remain despite the common practice of prescribing therapeutic renal diets to cats in any stage of CKD.

Integrative practitioners provide, or are requested to provide, natural feeding advice to cat owners. Excellent resources include the veterinary Diplomats in Nutrition; Balance It and several software programs that can be used for formulating diets while taking feline preferences into account. See page xx for an example of a low-phosphorus diet for cats with CKD.

From an integrative perspective, real food is considered to have many benefits, including palatability for ill cats, and these benefits may outweigh those offered by processed foods. In IRIS Stage 1 and early Stage 2, the diet may not need to be modified, although serum phosphorus and the phosphorus content of the diet should be evaluated. From late Stage 2 onwards, consideration may be given to reducing protein by diluting with fat and carbohydrates.

Herbal help

Herbs can delay the onset and progression of CKD in cats by improving mitochondrial function, and providing antioxidant protection and ACE-inhibiting effects. Many herbs are anti-inflammatory, anti-fibrotic and nephroprotective, and several improve renal blood flow. A principle of herbal medicine is that formulations containing multiple plants can have greater effects than the same herbs taken separately. These synergistic effects enhance the desired action.2

Following are several herbs to be considered and included in formulas for renal treatments.

1. Rehmannia glutinosa

Rehmannia glutinosa occurs in many Chinese herbal formulas, including Rehmannia Eight Combination (Shen Qi Wan, Jin Gui Shen Qi Wan, Ba Wei Di Huang Wan), which is very useful for cats with CKD and weight loss, loss of strength, polyuria, polydipsia, and that are seeking warmth. It is also included in Zhi Bai Di Huang Wan, which is useful in cats with CKD and hyperthyroidism, particularly in those tending towards constipation, agitation and weight loss, along with polydipsia and polyuria.

Rehmannia has a long history of research and effective use in CKD. In humans, studies have found that it has a 91% efficacy in reducing renal damage from nephritis, due to the enhancement of renal blood flow and glomerular filtration.3 In a model of renal ischemia, ligated rats that received Rehmannia extract showed improved renal blood flow (to near normal levels) and reduced mortality and hypertension compared to controls, through either ACE inhibition or juxtaglomerular desensitization.4 Rehmannia reduces oxidative stress and can promote red blood cell production through bone marrow stimulation; reduce serum creatinine and urinary protein excretion and glomerulosclerosis in compromised patients; and inhibit the expression of Angiotensin II as well as Type IV collagen in the renal cortex.5, 6

Fresh Rehmannia is utilised in Ba Wei Di Huang Wan and Zhi Bai Di Huang Wan. Interestingly, a recent study supports the use of fresh over prepared Rehmannia; the former acts more powerfully on attenuating interstitial fibrosis by downregulating the expressions of transforming growth factor, a smooth muscle actin, and Type 1 collagen.7

2. Astragalus membranaceus

Astragalus membranaceus is known as a Qi tonic in Chinese medicine, and as a major immune-modulating herb in Western herbal medicine. It should also be known as a major kidney herb. Its major constituent, astragaloside, ameliorates renal interstitial fibrosis in vivo by inhibiting inflammation.8 It has major antioxidant effects.9 Astragalus has been reviewed by Cochrane and was found to offer some promising effects in reducing proteinuria and increasing haemoglobin.10 Its nephroprotective effects against oxidative stress include anti-inflammatory and anti-apoptotic mechanisms.11 In a systematic review of Astragalus on diabetic nephropathy in animal models, this herb was able to reduce blood glucose and albuminuria levels and reverse the glomerular hyperfiltration state, thus ameliorating pathologic changes.12

3. Angelica sinensis

Angelica sinensis contains polysaccharides that inhibit oxidative stress injury in mouse kidneys.13 Like Astragalus, its nephroprotective effects include anti-inflammatory and anti-apoptotic mechanisms.11 Renal microvascular lesions can contribute to the progression of glomerular sclerosis and tubulo-interstitial fibrosis in chronic kidney Both Astragalus and Angelica can improve microvascular lesions by increasing local renal blood flow to lessen hypoxic renal injury, promoting the recovery of renal blood flow and glomerular filtration rate after ischemia-reperfusion; modulating the imbalance of vaso-activators such as nitric oxide and angiotensin; increasing the expression of vascular epithelial growth factor; inhibiting the release of the intracellular calcium ion; and promoting DNA synthesis in endothelial cells to improve the function of endothelial cells. The evidence suggests that both herbs may retard the progress of renal diseases through the above-mentioned mechanisms.14

In one study involving rats with an obstructive uropathy, Astragalus and Angelica were administered with Enalapril and compared to monotherapy. Enalapril with Astragalus and Angelica decreased tubulointerstitial fibrosis to a significantly greater extent than did treatment with Enalapril alone.15

4. Cinnamon

Cinnamon is readily accepted by cats and offers a mono-herbal treatment for fussy felines. It occurs in the Wei Ling Tang formula, which is useful for overweight CKD cats with proteinuria, hematuria, urolithiasis, azotemia, glomerulonephritis and pyelonephritis. Cinnamon can inhibit advanced glycation end products (AGE) and can ameliorate AGE-mediated pathogenesis in diabetic nephropathy.16 Cinnamon is a major antioxidant and anti-inflammatory spice, and has had over 178 papers published on it from 1995 to 2015.17 Cinnamon at a dose of 50 mg/kg for two weeks was given to dogs; the systolic blood pressure and heart rate in the treated dogs was significantly lower than in the normal group.18

5. Silybum marianum

Silybum marianum is one of our preeminent nephron-protective herbs. It should be considered an adjunct to ameliorative potential effects against drug-induced kidney disease, particularly in chemotherapy.19 It is also an herb that could be considered for CKD support. It is a potent antioxidant and free radical scavenger that inhibits lipid peroxidation and stabilizes cell membranes. It also increases intracellular glutathione, which plays a crucial role in the body’s antioxidant capacity, and it has anti-inflammatory properties inhibiting T-cell proliferation and cytokine secretion.20 There is also evidence that Silybum has a regenerative effect on renal tissue after injury.21

Mushrooms — Ganoderma and Cordyceps

Mushrooms are well tolerated by cats when given in the form of powders or concentrated tinctures added to food. Ganoderma lucidum is a medicinal mushroom that has been widely used in China and Japan for hundreds of years for its immune-modulating, anti-inflammatory and anti-tumor effects. Ganoderma compounds are renoprotective.22.The active peptide in Ganoderma counteracts oxidative stress from renal ischemia, and in an animal model of diabetic nephropathies has renal protective effects.23

Likewise, Cordyceps sinensis is extensively used by Chinese physicians to treat chronic renal diseases and to stimulate the immune system. It also displays anti-oxidative activities. It is commonly used in renal transplant patients; it has been shown to significantly improve renal fibrosis.24

Acupuncture and moxibustion

A recent single blinded randomized controlled study in patients with CKD showed that acupuncture at bilateral LI4, ST36 and KI3, and electroacupuncture to right ST36 and KI3 and left ST36 and KI3, once a week for 12 weeks, led to reduced creatinine levels and increased glomerular filtration rates.25 Moxibustion at Bl 23 in patients with CKD reduced renal vascular resistance.26

Most of the benefits that acupuncture offers in renal failure are undoubtedly due to the ability of these points to manipulate blood flow. Local blood flow is manipulated using BL23, BL22 and GB25, while systemic blood flow is manipulated with GB34, BL40 and KI3. Systemic blood flow greatly impacts renal function. Peripheral vasoconstriction can be induced to drive more blood to the kidneys. Peripheral vaso-relaxation can be induced to decongest the kidneys.

For animals in Stage II renal failure (using the IRIS classification system), and particularly where UPC ratios are greater than 2.5, use GB25, BL22 and GB34. These animals will typically have benefited from hypotensive drugs and low-protein diets, but won’t show an immediate improvement from fluid therapy. For animals in Stage I renal failure, or where UPC ratios are less than 2 to 2.5, use KI3, BL40 and BL23. These animals will typically not benefit from low-protein diets and hypotensive drugs, but will show an overt improvement from fluids.27

Integrative treatment goals for feline CKD

·         Mitigate oxidative stress by using antioxidant herbs

·         Improve renal perfusion (in most cases)

·         Prevent fibrosis, which is a natural consequence of renal disease

·         Optimise systemic health and well-being

Example of a low-phosphorus diet for cats with CKD

·         50 grams or ¼ cup pearl barley

·         200 grams raw chicken breast meat

·         10 grams chicken liver

·         1 large egg yolk

·         2 cups raw sweet potato

·         4 teaspoons salmon oil plus 4 teaspoons flaxseed oil

Cook barley, sweet potato, chicken and liver are on low heat with water. When warm, mix in egg yolk to lightly cook it (and preserve the choline). When cool, the recipe is divided into four meals (average 250 kcals) with the addition of 1 teaspoon of salmon oil and 1 teaspoon of flaxseed oil daily. The meals are divided.

The whole recipe provides 1,029 kcal, 36% carb, 40% fat, 24% protein and 724 mg of phosphorus. It needs to be supplemented as it is low in a number of minerals and vitamins, and is still low in choline. Any supplement added should be evaluated for its phosphorus content. This should demonstrate the complexity of balancing diets. Another excellent strategy is to have several recipes and vary the composition of diets over time. More protein can be utilised alongside phosphorus binders in later stages of kidney disease.


Chronic kidney disease in cats is a manageable condition that responds well to integrative medicine. In the author’s experience herbal medicine and acupuncture are key. Many integrative practitioners have reported success with other additional therapies, including homeopathy, cell salts, flower essences and osteopathy.


1Larsen JA. “Controversies in Veterinary Nephrology: Differing Viewpoints: Role of Dietary Protein in the Management of Feline Chronic Kidney Disease”. Vet Clin North Am Small Anim Pract. 2016 Nov;46(6):1095-8.

2Bangar OP, Jarald EE, Asghar S, Ahmad S. “Antidiabetic activity of a polyherbal formulation (Karnim Plus)[J]”. Int J Green Pharm, 2009, 3(3) : 211-214.

3Su ZZ, He YY, Chen G. “Clinical and experimental study on effects of man-shen-ling oral liquid in the treatment of 100 cases of chronic nephritis”. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih. 1993;13(5): 259–260,269–272.

4Yi NY, Chu W, Koang NK. “Pharmacologic studies on Liu Wei Di Huang Wan: its action on kidney function and blood pressure of rats with renal hypertension”. Chin Med J-Peking. 1965;84(7):433–436.

5Yuan Y, Hou S, Lian T, Han Y. “Rehmannia glutinosa promotes the recovery of RBC and Hb levels in hemorrhagic anemia by promoting multiplication and differentiation of CFU-S and CFU-E bone marrow cell line”. Chung Kuo Chung Yao Tsa Chih. 1992;17(6):366–368.

6Lee BC, Choi JB, Cho HJ, Kim YS. “Rehmannia glutinosa ameliorates the progressive renal failure induced by 5/6 nephrectomy”. J Ethnopharmacol. 2009;122(1):131–135.

7Liu DG, Zeng M, Gao HY, et al. “Rehmanniae Radix and Rehmanniae Radix Praeparata Ameliorates Renal Interstitial Fibrosis Induced by Unilateral Ureteral Occlusion in Rats and Their Mechanism”. Zhong Yao Cai. 2015 Dec;38(12):2507-10.

8Zhou X1, Sun X1, Gong X1. “Astragaloside IV from Astragalus membranaceus ameliorates renal interstitial fibrosis by inhibiting inflammation via TLR4/NF-кB in vivo and in vitro”. Int Immunopharmacol. 2017 Jan;42:18-24.

9Shahzad M, Shabbir A, Wojcikowski K. “The Antioxidant Effects of Radix Astragali (Astragalus membranaceus and Related Species) in Protecting Tissues from Injury and Disease”. Curr Drug Targets. 2016;17(12):1331-40.

10Zhang HW1, Lin ZX, Xu C, et al. “Astragalus (a traditional Chinese medicine) for treating chronic kidney disease”. Cochrane Database Syst Rev. 2014 Oct 22;(10):CD008369.

11Shahzad M1, Small DM2, Morais C. “Protection against oxidative stress-induced apoptosis in kidney epithelium by Angelica and Astragalus”. J Ethnopharmacol. 2016 Feb 17;179:412-9.

12Zhang J1, Xie X, Li C, et al. “Systematic review of the renal protective effect of Astragalus membranaceus (root) on diabetic nephropathy in animal models”. J Ethnopharmacol. 2009 Nov 12;126(2):189-96.

13Fan YL, Xia JY, Jia DY. “Protective effect of Angelica sinensis polysaccharides on subacute renal damages induced by D-galactose in mice and its mechanism”. Zhongguo Zhong Yao Za Zhi. 2015 Nov;40(21):4229-33. [Article in Chinese].

14Song JY1, Meng LQ, Li XM. “Therapeutic application and prospect of Astragalus membranaceus and Angelica sinensis in treating renal microvascular lesions”. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2008 Sep;28(9):859-61.[Article in Chinese].

15Wojcikowski K1, Wohlmuth H, Johnson DW. “Effect of Astragalus membranaceus and Angelica sinensis combined with Enalapril in rats with obstructive uropathy”. Phytother Res. 2010 Jun;24(6):875-84.

16Muthenna P1, Raghu G1, Kumar PA, et al. “Effect of cinnamon and its procyanidin-B2 enriched fraction on diabetic nephropathy in rats”. Chem Biol Interact. 2014 Oct 5;222:68-76.

17Mollazadeh H1, Hosseinzadeh H2. “Cinnamon effects on metabolic syndrome: a review based on its mechanisms”. Iran J Basic Med Sci. 2016 Dec;19(12):1258-1270.

18Kaffash Elahi R. “The effect of the cinnamon on dog’s heart performance by focus on Kortkoff sounds”. J Animal Veterinary. 2012;11:3604–3608.

19Dashti-Khavidaki S1, Shahbazi F, Khalili H, et al. “Potential renoprotective effects of silymarin against nephrotoxic drugs: a review of literature”. J Pharm Pharm Sci. 2012;15(1):112-23.

20Sedighifard Z1, Roghani F1, Bidram P, et al.  “Silymarin for the Prevention of Contrast-Induced Nephropathy: A Placebo-Controlled Clinical Trial”. Int J Prev Med. 2016 Jan 22;7:23.

21Sonnenbichler J, Scalera F, Sonnenbichler I, et al. “Stimulatory effects of silibinin and silicristin from the milk thistle Silybum marianum on kidney cells”. J Pharmacol Exp Ther. 1999 Sep; 290(3):1375-83.

22Wang XL1, Zhou FJ2, Dou M3, et al “Cochlearoids F-K: Phenolic meroterpenoids from the fungus Ganoderma cochlear and their renoprotective activity”. Bioorg Med Chem Lett. 2016 Nov 15;26(22):5507-5512.

23Joob B1, Wiwanitkit V2 Linzhi. “(Ganoderma lucidum); evidence of its clinical usefulness in renal diseases”. J Nephropharmacol. 2015 Dec 27;5(1):9-10.

24Du F1, Li S2, Wang T, et al. “Cordyceps sinensis attenuates renal fibrosis and suppresses BAG3 induction in obstructed rat kidney”. Am J Transl Res. 2015 May 15;7(5):932-40.

25Yu JS1,2,3, Ho CH4,5, Wang HY6,7, et al. “Acupuncture on Renal Function in Patients with Chronic Kidney Disease: A Single-Blinded, Randomized, Preliminary Controlled Study”. J Altern Complement Med. 2017 Apr 19.

26Matsumoto-Miyazaki J1, Miyazaki N1, Murata I, et al “Traditional Thermal Therapy with Indirect Moxibustion Decreases Renal Arterial Resistive Index in Patients with Chronic Kidney Disease”. J Altern Complement Med. 2016 Apr;22(4):306-14.

27Marsden S. “Introduction to veterinary acupuncture course notes’> College Integrative Veterinary Therapies, 2017.



Feline inappropriate elimination

Feline inappropriate elimination

By Dr. Karen Shaw Becker and comments by Diane Weinmann

Feline inappropriate elimination — a fancy name for those times when kitty pees (or poops) outside the litterbox — accounts for about half of all reported behavior problems in cats. Sadly, it’s the reason pet owners give most often when they relinquish their kitty to an animal shelter. According to Dr. Nicholas Dodman, a professor at Tufts University’s Cummings School of Veterinary Medicine and founder of the Tufts Animal Behavior Clinic:

“It is a cold, hard fact that cats who fail to use the litter box once a week are four times more likely to be relinquished; if they eliminate outside the litter box daily, these odds increase to over 28:1. About 4 percent of cats urinate outside the litter box weekly, and 1 percent eliminate outside the litter box daily.”1

Cats relieve themselves outside the litterbox for a number of reasons, some having to do with natural feline tendencies, and others involving their environment. Often there are both natural and situational factors underlying a problem with inappropriate elimination. The three main causes for feline inappropriate elimination are:

1.    A medical problem

2.    Urine marking

3.    Aversion to the litterbox

Estimates are that 10 to 24 percent of all kitties have an inappropriate elimination problem at some point in their lives.

Medical Conditions That Can Cause Inappropriate Elimination

If your cat suddenly forgets her manners and starts either peeing or pooping outside the litterbox — especially if she starts using the bathtub or a sink instead —the first thing I recommend is a visit to your veterinarian. There are a number of medical conditions that can contribute to inappropriate elimination, including feline lower urinary tract disease (FLUTD), urinary tract infection, cystitis, obstruction of the urethra, diabetes, cognitive dysfunction and hyperthyroidism.

Diagnosing and treating an underlying medical condition is extremely important to your kitty’s health and to resolving inappropriate elimination behavior. Your veterinarian will perform a physical exam, and order a complete blood count, a blood chemistry profile, a urinalysis and check the thyroid if your cat is older. If the problem involves pooping outside the box, a fecal sample will be taken.

If your cat gets a clean bill of health from the vet but is a senior or geriatric kitty, it’s possible the aging process is causing changes in her elimination habits. For example, does she have to climb stairs to get to the litterbox? Is the box easy for her to get into and out of? It can be challenging to determine if a cat is uncomfortable or in pain. If your older cat is otherwise healthy but could be experiencing joint pain, make sure you’re doing all you can to make it easy for her to use her litterbox.

Urine Marking

Urine marking can be hormonally driven, but it’s most often the result of a natural system of feline communication, or stress. Both male and female cats spray, as do both neutered and intact cats. However, neutered cats spray less, and neutering can reduce or eliminate spraying in some cases.

Kitties who urine-mark generally use the litterbox normally, but also perform marking behaviors. Some cats do both house soiling and urine marking, but it’s easy to tell the difference between the two once you know what to look for.

Urine marking, when it takes the form of spraying, typically happens on vertical surfaces. However, some cats urine-mark on horizontal surfaces, which can make it more difficult to determine whether you have a marking problem or a house-soiling problem. Where your cat marks is of primary significance. Generally speaking:

·         If he marks under windows or on baseboards, he may perceive a threat from animals outside, usually other cats

·         If he marks on or near furniture or doors inside your home, he might be having problems with other cats in the household

·         If your cat marks personal belongings, such as clothes, bed linens, a favorite chair or a computer keyboard, he’s probably experiencing some anxiety about the human who owns those things

Other places cats are known to urine-mark are on shopping bags just coming into the house, heating registers and household appliances.

Resolving urine marking involves identifying and addressing the source of your kitty’s stress. When did the marking begin, and what was happening in your cat’s environment at that time? Just as cats favor certain scratching surfaces, they also return to the same spot to urine-mark. You’ll need to use an enzyme-based product for cleanups to remove stains and odor.

You might also want to spray a synthetic pheromone like Feliway on kitty’s favorite marking spots. Cats also “mark” by rubbing their cheeks against objects (for example, the top of their human’s head), and Feliway may encourage your cat to mark with his cheeks instead of his urine.

It’s important to note that urine marking can be difficult to manage, as often the root cause, if determined, can’t be resolved completely. And sometimes despite addressing all possibilities, cats still mark. 

One option is talking to an animal communicator, like Diane Weinmann to understand the underlying problems your kitty has.

Litterbox Aversion

Cats who are happy with their bathrooms behave more or less like this:

·         Approach and jump or climb into the box without hesitating

·         Take a little time to poke around and choose a good spot

·         Dig a hole

·         Turn around and do their business

·         Inspect the result and then cover it up with litter

Cats who are developing a litterbox aversion may approach it tentatively. They may balance on the side of the box or put only two feet in. They may actually use the litter, but immediately leap from the box when finished. Worst case they may walk to the box, sniff at it, turn, walk away — and eliminate elsewhere. Pooping outside the box, but very close to it, is almost always a litterbox aversion problem.

Your cat can decide she doesn’t like her litterbox for any number of reasons. Perhaps it isn’t being cleaned frequently, or not frequently enough for her comfort. Maybe she’s sensitive to a chemical used to clean the box, or perhaps she’s not fond of a box with a hood. The box may be in a noisy or high-traffic location, or where another pet in the household can trap her in there.

Tackling Kitty’s Litterbox Aversion

Extra boxes for multi-cat households. If you have multiple cats, you may need to add more boxes. The general guideline is one box per cat, and one extra.

Litter preference. It could be kitty doesn’t like the type of litter in the box, or it’s not deep enough (4 inches is recommended). You can discover your pet’s litter preference by buying the smallest amount available of several kinds of litter, and several inexpensive litterboxes. Place the boxes with different litters side by side and see which box gets used most often.

Studies on the types of litter cats prefer show they are quite particular about particle size. The cat’s evolutionary substrate, for potty purposes, is sand. When kitties started living indoors, clay litter came along and most cats were okay with it. But clay has its own issues, as do corn- and wheat-based litters.

These days, there’s a wide selection of organic and natural types of litters on the market, but many of them feature big particle sizes, which don’t appeal to most cats. Kitties also don’t like synthetic scents or odor control additives in their litter. The litter I use for my own cats is our own Biocharged Kitty Litter made with organic biochar. Biochar has a large surface area and is a recalcitrant, which means the charcoal itself holds onto things such as water and smells.

Our litter has incredible clumping properties, which means it lasts longer and there’s less total wetness and mess. It’s also 100 percent biodegradable and compostable. And it’s entirely fragrance-free, because the carbon helps to lock in odors.

Litterbox location. Find locations for litterboxes that are somewhat out of the way, and away from noisy household machinery and appliances. Choose warm locations in the house rather than the basement or garage. And make sure boxes aren’t close to kitty’s food or water bowls.

Litterbox cleanliness. Boxes should be kept scrupulously clean. They should be scooped at least once a day and more often if you’re dealing with a potential litterbox aversion situation. Dump all the used litter every two to four weeks (I recommend every two weeks, minimum), sanitize the box with soap and warm water (no chemicals), dry thoroughly and add fresh litter. Plastic litterboxes should be replaced every year or two.

To review, litter box aversion can usually be resolved by:

·         Determining the type of litter and litter box your kitty prefers

·         Using the right amount of litter (4 inches, minimum, at all times)

·         Keeping the boxes scooped, and doing a thorough cleaning at least every two weeks

·         Having enough boxes and locating them in safe, easy-to-access locations

Diane has encountered many litter box issues in her 20 years as an animal communicator.  Many litterbox problems are related to changes in the household, cleanliness and actual litter preference.  Please note that sometimes cats change their mind about the preference of litter they like so the tried and true litter you’ve used for years may not cut it any longer.  Contact Diane at to schedule an animal communication session.


Kidney Disease and your Cat

By Dr. Karen Shaw Becker and comments by Diane Weinmann


Feline expert Dr. Lisa Pierson, founder of the fabulous website Dr. Lisa graduated from the University of California, Davis veterinary school in 1984. For the last 15 years, she has focused almost exclusively on feline nutrition and feline medicine. Her passion is trying to help prevent some of the diseases we see in kitties today (e.g., diabetes and urethral obstructions) by feeding them properly.

“My biggest goal, as you well know,” says Dr. Lisa, “is to get people to stop feeding dry food to cats due to the water depletion, which can lead to urethral obstruction, and the carbohydrates, which make cats more susceptible to diabetes.”

Feline Kidney Disease May Be Linked to a Particular Vaccine

The no. 1 problem veterinarians see in cats today is kidney disease, and so I wanted to talk with Dr. Lisa about the best way to feed kitties with kidney disease. When I was in veterinary school 20 years ago, I was told 3 out of 4 cats will die of kidney disease. No reason was given. We were told, “There’s nothing you can do. Cats are predisposed to die of kidney failure.” We were taught how to identify the problem, but not what causes it. I asked Dr. Lisa for her thoughts on what’s behind the epidemic of kidney disease in cats.

“That’s a fabulous question I wish I had the answer to,” she replied. “We do know that a well-respected researcher, Dr. Michael Lappin at Colorado State University, has established a possible link between feline kidney disease and the feline viral rhinotracheitis, calicivirus and panleukopenia (FVRCP) vaccine, which is grown in feline kidney cell cultures.”

“We really want to be very careful not to over-vaccinate cats,” Dr. Pierson continued, “because they can possibly set up an autoimmune type of reaction to their own kidney cells. Having said that, my own cats still developed kidney disease.

I assure you they were not over-vaccinated. They got vaccinated as kittens. They passed away between 18 and 20 years of age. They were never vaccinated again after their kitten shots, yet they still got kidney disease. They were not on dry food. They were on a water-rich diet. So the short answer to your question is, ‘I don’t know, but I wish I did.'”

An important point to make here is that as Dr. Lisa’s situation demonstrates, we can do everything right and our cats may still acquire a debilitating disease, including kidney disease. Many parents of sick cats say, “I don’t know what I’ve done wrong.” Often, they’ve done nothing wrong. Even in optimal environments, cats can and do get sick.

How Many Vaccines Do Indoor-Only Cats Require?

I usually recommend, for people with indoor-only cats, that they skip all vaccines. If you know your cat will never step foot outside and no other cats will be brought into the home, there’s virtually no risk of exposure to the diseases we vaccinate against. I asked Dr. Lisa what she thinks about not vaccinating indoor-only cats at all.

“While I’m definitely against over-vaccinating, I always give at least one vaccine when the kitten is at least 16 weeks of age,” Dr. Lisa says. “I’ve seen enough cats die from panleukopenia to make me uncomfortable with the thought of no vaccines at all.

We do take these cats to veterinary clinics and many people do wear shoes in their homes so there is not zero exposure. I would at least vaccinate once. I differ with you on this issue. I’d be worried about leaving them completely unvaccinated for panleukopenia.

I had five cats two years ago. I lost four out of my five cats in the last two years. They were between 18 and 20 years of age. They received [two] FVRCP vaccines as kittens with the last dose administered when they were at least 16 weeks of age. A couple of them may have received another FVRCP vaccine a year later but no FVRCP vaccine was administered after that. None had been vaccinated since they were kittens or maybe a year old.

On their last day with me, I ran panleukopenia titers to measure the antibody levels in their bloodstream. Antibodies aren’t the only things that fight disease, of course, but for all intents and purposes, all the cats’ titers indicated they were protected against panleukopenia.

My mom’s cat is 20 years old. I don’t think I vaccinated him after age 5. I ran a couple of panleukopenia titers on him when he was 18 and again just recently and the titers were at a level that immunologists feel is a protective level against this disease.

My own cats are 100 percent indoor-only. They get vaccinated with FVRCP when they’re kittens, with the last vaccine at about 16 weeks of age when the maternal antibodies should be gone. I do not administer the FVRCP vaccine again.”

So Dr. Lisa does vaccinate her indoor-only cats, but minimally. Historically my indoor cats also received one vaccine at 16 weeks. But I think if I get another kitten who will live strictly indoors, I’ll probably not vaccinate at all. I’ll probably do none, since his or her exposure will be none, in my opinion.

‘Protein Is NOT the Enemy of the Cat Kidney!’

Next I asked Dr. Lisa for her thoughts on what cat parents can do early on in their pet’s life to try to prevent kidney disease.

“I really don’t know anything concrete,” she explained. “Some people believe a water-depleted diet of dry food can harm the kidneys, but I don’t know if there’s any research to support that theory.”

Often, cats fed exclusively dry food have super-concentrated urine because their kidneys are trying to preserve water for the body. “Does that cause or lend itself to kidney disease?” asks Dr. Lisa. “I really don’t know.”

“I feed a water-rich diet. I feed a species-appropriate highprotein/moderate fat/zero carb diet. With regard to how protein affects the kidneys, it’s important to understand protein is not the enemy of the cat kidney. Protein doesn’t cause kidney disease. It doesn’t exacerbate kidney disease. It is not the enemy of the kidney.

If there’s one take-home message I want to get across, it’s ‘Please stop vilifying protein!’ I would not feed any of the protein-restricted, so-called ‘prescription’ diets to any cat in my care. There are always better options.”

The Problem With Protein-Restricted Diets for Cats

Back in 1994, Dr. Delmar Finco proved cats will die of hypoproteinemia (insufficient protein) long before they die of kidney disease. I can’t figure out why, if we’ve had research available for over two decades, there’s still this pervasive idea in veterinary medicine that we should restrict protein. I asked Dr. Lisa why she thinks veterinarians still have not recognized that limiting protein is a really bad idea.

“We have to ask why this idea of protein-restricted diets came to be in the first place,” she replied. “Why did our profession glom onto the idea that protein is the bad guy? When we eat protein, our bodies break it down. We use what we need and our bodies produce BUN (blood urea nitrogen, or urea), which is a waste product of protein metabolism.

The more protein we eat, the higher the BUN load. If the kidneys are efficient and healthy, they filter the BUN out into the urine. When the kidneys become less efficient filtration organs, the BUN rises in the bloodstream. So the powers that be decided, ‘BUN comes from dietary protein. Let’s just minimize dietary protein.’

I do not have a problem with cutting back a little bit (say, from 60 or 70 percent to 40 percent) but I do not agree with feeding cats only 20 percent of their calories from protein.”

My thought is that if you’re feeding a poor-quality, rendered, dehydrated protein that conceivably consists of indigestible animal parts such as hooves and nails, it may negatively affect the kidneys long term. High-quality, human-grade, bioavailable protein — which is what cats in the wild eat — should have little to no negative impact on organ systems. If it did, felines wouldn’t have survived as a species.

However, we’ve preached the low-protein thing for so long, to switch viewpoints now could dramatically impact the billion-dollar pet food industry. I fear it’s possible we’ve gone too far to turn back.

“I’m still hopeful,” says Dr. Lisa. “I spoke with a colleague the other day. She had just attended a seminar at which someone said, ‘We’ve got to stop protein-starving these cats.’ And I thought to myself, ‘Hallelujah!’ I’ve been preaching this for 15 years, as have you.”

What Amount of Protein in a Cat’s Diet Is the Right Amount?

“I want to give your listeners some numbers to chew on,” says Dr. Lisa. “If you look at metabolizable energy, meaning the calories from protein, fat and carbs, they have to add up to 100 percent. Hill’s k/d, Purina NF, Royal Canin are prescription diets that restrict protein to a level between 20 [to] 27 percent of calories. A cat’s natural diet is about 60 to 70 percent.

When I formulate recipes for my chronic kidney disease (CKD) cats, or I recommend over-the-counter diets, using my proteins, fats, carbs, phosphorus chart at, I recommend a nice happy medium of 40 percent calories from protein. I don’t think cats truly need the 60 to 70 percent they find in the wild. All you are doing is adding to the BUN load. I don’t think it’s necessary.

I’ve had fabulous results over the last 15 years feeding thousands of CKD cats right around 40 percent protein, and less than 10 percent carbs. My homemade diets have zero carbs. That means they have 60 percent fat, because it has to add up to 100 percent.

So those are some numbers I want to share with your listeners. In the vast majority of patients, I find that 40 percent protein calories will support muscle mass and the immune system without unnecessarily overloading the BUN bucket that the kidney then has to deal with.

Of course, more BUN is generated with a 40 percent protein diet than one with 20 percent protein. That is obvious. However, all disease processes are a trade-off and one has to remember a very basic equation: 6 ounces of a 20 percent protein diet = 3 ounces of a 40 percent protein diet in terms of grams of protein ingested — assuming the same caloric and water density.

Sure, a cat can meet their protein requirements on a diet that has only 20 percent of the calories from protein, IF they eat enough of it. But what happens when a cat on a protein-restricted diets starts to eat less? The answer is they will become protein malnourished and the diet needs to be more protein dense to make up for the decrease in volume intake.”

When You Lower the Protein in a Cat’s Diet, You Should Raise the Fat Content, Not the Carbohydrate Content

Interestingly, Dr. Lisa’s 60 percent fat figure lines up with the recommended fat intake in ketogenic diets. I think we need to educate pet parents that fat is an excellent source of energy, and it’s also dogs’ and cats’ evolutionary source of energy.

“In the wild, cats eat about 60 to 70 percent protein, 0 to 2 percent carbs, and then 10 to 30 or 40 percent fat,” says Dr. Lisa. “So the 60 percent fat for a CKD diet can end up being double what their natural diet is if we want to hold back on the protein a bit and NOT overload them with carbohydrates.

Research on fat content in cat diets indicates that some cats with GI problems such as chronic vomiting, chronic diarrhea, inflammatory bowel disease, and pancreatitis don’t do well on a 60 percent fat diet, but it’s rare.

Felines are obligate carnivores. They’re designed to eat protein, fat and no carbs. When pet food producers formulate prescription diets, k/d for example, with lower protein, they have to raise the percentage of either fat or carbs to get to 100 percent. Hill’s raises the carbohydrates, which makes the diet even more species-inappropriate.

Royal Canin actually chooses to raise the fat and keep the carbs down a bit. That’s much more species-appropriate. If you’re going to lower protein at all, don’t raise the carbohydrates. Raise the fat. Cats deal with fat more efficiently than carbohydrates.”

A Brilliant Tip for Monitoring Your Cat’s Kidney Function at Home

In my experience, many people with CKD cats are frustrated that the condition wasn’t discovered earlier. That’s why I like to be proactive and perform annual bloodwork to identify subtle changes that can occur in cats’ bodies long before they start showing symptoms of kidney dysfunction. I asked Dr. Lisa what she feels is the best age to start doing annual bloodwork on cats.

“That’s a great question, but I’m going to turn it around,” she replied. “What I check, because it’s usually the first thing to head south with respect to kidney disease, is urine specific gravity. I have a spoon sitting next to all my litterboxes — the boxes are uncovered because I’m not a fan of covered or hooded litterboxes — and a little syringe.

For around $50 to $70, you can buy a refractometer — this information is actually on my urinary tract diseases page towards the bottom under the video showing how to obtain a free-catch urine sample at home. There’s a link there to a refractometer. I put a couple of drops of urine from the syringe on it and look at urine specific gravity, which is a measure of the concentrating ability of the kidneys.

All my cats go in for annual bloodwork anyway, no matter their age. Of course, if they’re sick, I’ll take them in more frequently. Bottom line is, I do annual bloodwork, but I’m checking their urine specific gravity frequently ([four to six] times a year) when they get to be 10 years of age or if I notice them drinking more than usual. My cats are very used to spoons stuck under their butt!

The SDMA test — which is the proprietary IDEXX urine test that is supposedly better than creatinine levels in detecting early kidney disease — can also be run. However, measuring urine specific gravity can be done at home for no cost other than a refractometer and it may be even better than the SDMA, in some cases, to help us recognize kidney disease earlier.

Urine specific gravity parameters:1.040 and above shows a normal urine concentrating ability of the kidneys; 1.012 is rock bottom. When you start getting 1.030, 1.025, 1.020, you may want to take your cat in to check the BUN, the creatinine, the phosphorus and the potassium.”

That’s really great advice. Cheap, easy, and you’re not stressing out your cat. Just follow kitty with your spoon when he goes into his litterbox, stick spoon under butt, collect a bit of urine, pull it into your syringe and put a couple drops in your refractometer. You can start when he’s a kitten, or as soon as you bring a new adult cat home. You can continue to do it proactively throughout their lives. It’s a brilliant tip!

The Kidney Disease Staging System (IRIS) Has Serious Flaws

“I also suggest setting up an Excel spreadsheet for all the BUN, creatinine, phosphorus, potassium and urine specific gravity results,” Dr. Lisa continues. “Those are my big five: BUN, creatinine, phosphorus, potassium and urine specific gravity. I’ve charted all my cats, which brings me to the IRIS staging system.

The IRIS staging system — IRIS stands for International Renal Interest Society — establishes parameters for judging the severity of kidney disease. When the creatinine is over X, they’re stage one. When it’s over Y, they’re stage two. There are four stages.

I personally strongly dislike this system. I think it’s far too strict. Creatinine over 1.6 is deemed a problem. I disagree with that. My own cat, Robbie, has had a creatinine in the low [2s] for the past 10 years.

He’s 17 years of age, and his kidneys are still fine. I think the IRIS staging system alarms people unnecessarily, and too early. I think it’s too strict. I just want readers and your listeners to understand that when your vet says stage 1 kidney failure it’s a case of maybe, or maybe not.”

This is very true. There’s a whole lot of doom and gloom around IRIS staging. I think it can actually lead to premature euthanasia, when the fact is there is much that can be done for these cats, sometimes for years to come.

“The cats are put on a prescription renal diet, which I strongly dislike,” says Dr. Lisa. “It’s also one of the reasons I have a problem with the SDMA test, because these cats are being put on protein-restricted diets even earlier. I think to myself, ‘Great. We’ve got an early marker, but now these 6-, 7-, 8-year-old cats are being put on protein-restricted diets, which makes me cringe.'”

Why Supplementing With Fish Oil/Omega-3s Is so Important

So let’s say we have a cat for which we regularly check urine specific gravity, and all is well until kitty turns 9 or 10 and his number dips to, say, 1.025. We take him in for an SDMA test, and the vet determines he’s in the beginning stages of renal disease. I asked Dr. Lisa how she would proceed at that point.

“First of all, let’s hope the cat has been off of dry food all his life, or at least as soon as his owner learned dry food is not a very healthy diet for a cat,” she says. “So let’s hope he’s on a water-rich diet.

Regarding urine specific gravity: Picture a sieve in your kitchen, and the holes of that sieve are getting bigger and bigger and bigger. When urine specific gravity drops, it means the kidneys are leaking more and more water. They’re unable to save water for the body.

There’s nothing that frustrates me more than to see cat owners leave their vet’s office with a bag of fluids under one arm and a bag of dry food under the other arm. They’ve been told to feed a water-depleted diet and then stick a needle in their cat’s back to put water into him. That’s pretty nonsensical

The sensible approach? Step one, provide a water-rich diet. Step two, the diet should be low in phosphorus. Step three, supplement with omega-3 fatty acids— fish oil, fish oil, fish oil. When we do post-mortems on these cats, we see nephritis. ‘Neph-‘ means kidney, ‘-itis’ means inflammation.

We know that fish oil and omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA), are anti-inflammatory. There was a meta-data study done that looked back at all the individual CKD studies that were done, and the researchers discovered that cats getting high amounts of fish oil seemed to live the longest.

Now, I’m not that bright, but two plus two might equal four in this case, where we have an inflammatory process. Fish oil happens to have anti-inflammatory properties, so it stands to reason that fish oil may slow the progression of kidney disease.

Here’s my goal: one capsule per cat per day. One regular strength capsule should have about 300 milligrams of combined EPA plus DHA. They’ve done safety studies to show that 600 milligrams of combined EPA plus DHA per cat per day is safe.

Fish oil can cause bleeding problems in some patients, which is why if you’ve gone in for surgery in recent years you’ve probably been told to stop taking aspirin and also fish oil ahead of time because they have anti-clotting properties. But 300 milligrams of combined EPA plus DHA is safe.”

“We also treat with potassium as needed,” explains Dr. Lisa, “because sometimes these cats get very hypokalemic, meaning they have low blood potassium levels.

One of the reasons I don’t like the prescription renal diets is because toward the end stage, CKD cats can get hyperkalemic, meaning they have too much potassium in the blood. All the renal diets are fortified with potassium, so they end up compounding the problem of hyperkalemia and are detrimental to the patient.”

Switching a Dry Food-Addicted Cat to a Moisture-Rich Diet

“I really love homemade diets,” says Dr. Lisa. “I’m a big fan. The recipes I formulate mimic the prescription diets in that they include plenty of B vitamins and antioxidants, plenty of fish oil, and I can adjust the potassium as needed based on the patient’s blood levels.

They’re low in phosphorus. They contain a moderate amount of high-quality proteins versus the prescription diets, [which] are more protein-restricted and often have very [poor-quality] (low biological value) sources of protein (e.g., [Brewers’] rice). My patients thrive on these homemade diets.”

I’m of course a huge proponent of homemade diets as well. The number one complaint I get from clients, though, is their cat won’t it eat.

“First of all, there is no need to make diet ‘all or nothing,'” says Dr. Lisa. “Many cats will not eat a diet of 100 percent homemade and always need a bit of commercial canned food mixed in to make it more flavorful. It’s fine to mix commercial with homemade. Some homemade is better than nothing.

That said, I find that people give up far too easily when trying to get their cats to eat a new diet. People shouldn’t get discouraged as quickly as they do. They have to roll up their sleeves, work at it, and be patient. Also, the key issue is change the diet before your cat is really sick. No sick cat wants to try something new.

And use your cat’s hunger as your friend. Don’t put the food down, watch them walk away from it, and just give up by putting their old food back down. Make them go 12 hours without food. Make them go 18 hours without food. Get a little tough.

Look at my tips for transitioning a dry food addict. It’s applicable when you need to change any diet. Hunger is your friend, number one. Take the diet they like, 90 percent of it. Mix in 10 percent homemade, then go 80-20 or 70-30. Or do the opposite, take 90 percent of the homemade, start slipping in a little Fancy Feast or Sheba, or whatever you want to feed.

But be patient. Don’t give up. You can actually out-stubborn your cat, but people give up far too easily. It took me three months to get my cats off 100 percent dry food. Some of them had never seen canned food in their entire lives, including my 10-year-old. It took me three months to get them from dry food to canned food.

And then it took me a little bit longer to get them from the canned to the homemade, because the canned tends to be gamier-smelling, and probably a little bit more flavorful.

I love FortiFlora, which is a Purina probiotic. I use it as a flavor enhancer, not as a probiotic. If I were to put that powder on cardboard my cats would eat it! I just use it like salt and pepper, just sprinkle it on their meals. It’s a liver digest. If you’re going to pick something that a cat likes, most cats love liver.

Or you can buy something like Fancy Feast Chicken and Liver or Turkey and Liver, the classic feast, which is kind of my go-to enticement. I try to stay away from fish. I don’t want to create a fish addict. There are other problems with fish. But when you’re trying to transition a cat away from dry food, I don’t mind giving them a little bit of fish, but you’ll have to wean them off it.”

A Word About Fish Versus Fish Oil

For those of you confused as to why we’re recommending fish oil but not fish, I should clarify that our issue with fish as a protein source is that not only are many types of fish contaminated, they are also high in iodine, which can cause hyperthyroidism. Good-quality fish oil supplements don’t contain iodine and are tested for purity and potency, which means they’re screened for heavy metals and PCBs.

Fish oil also doesn’t cause food sensitivities, unlike fish fed as a protein source. Bottom line, fish oil is really in an entirely different category from fish fed as a protein source. It’s protein versus fat, as Dr. Lisa points out. Fish oil is safe and a good source of omega-3 essential fatty acids. However, feeding fish to cats is not recommended.

If Your Cat Has Kidney Disease, Ask Your Vet About Calcitriol

I asked Dr. Lisa what else she would suggest cat parents do to help enhance their kitty’s quality of life, longevity and kidney function.

“You might want to ask your veterinarian about calcitriol,” she answered. “Calcitriol is the active form of vitamin D. One of the jobs of the kidneys is to take the inactive form of vitamin D and activate it. In other words, it makes calcitriol.

The parathyroid gland, not the thyroid gland, but the parathyroid gland, is very intimately involved with calcium and phosphorus balance. It secretes parathyroid hormones (PTH), which can be toxic to the kidneys if it gets too elevated. The off switch for PTH production is calcitriol.

If we don’t have enough calcitriol in our body, there’s nothing to tell the parathyroid gland, ‘Shut up. Be quiet. Stop making so much PTH.’ The research on cats is scant and a little iffy. But calcitriol proved to be beneficial in a study of dogs.

There are some feline specialists who are big proponents of calcitriol for cats, and I personally think it’s a ‘can’t hurt, may help’ issue. Your viewers should ask their vets about administering calcitriol to their CKD cats. It’s recommended early in the disease. If the dosage is adhered to properly, I think it’s a can’t-hurt-may-help.

When we first tried the calcitriol we got some hypercalcemia early on because we were giving it every day and at higher doses than we currently use. We now give it twice a week instead. And for the record, I don’t recheck CKD patients to death. I feed a high[-]quality, low-phosphorus diet with plenty of antioxidants and anti-inflammatories. I use calcitriol and call it a day. Beyond that, the chips are going to fall where they may.

I find that most of my clients get frantic, asking ‘What can I do, what can I do, what can I do?’ The truth is, not much. Cats’ kidney disease will progress as it’s going to progress. So again, don’t over-vaccinate. Feed a water-rich diet. Sit back and relax with your cat. Don’t keep fretting about it because the kidneys are going to do what they’re going to do on their own timetable. There’s really nothing we can do about it beyond the basics I’ve just discussed.”

If Your Cat Is Diagnosed With Kidney Disease, There’s No Need to Panic

I am always impressed with how resilient cats’ bodies are. Even in a state of decompensation (organ failure) they keep going and going and going. Often the BUN is very high and they’re still eating and physically look fine. If we’re chasing a number or making decisions based on a lab result, I think it’s easy to become so overwhelmed that it takes away from our quality of life. It’s possible to fret so much about the future that we don’t enjoy the time we have left with our pet.

“I’m glad you brought that up,” says Dr. Lisa. “I find that subcutaneous fluids are used far too early in the disease process. I’m also not a fan of Azodyl. I don’t feel it works. I don’t feel there’s any benefit. I don’t want to see cats being pilled with these humongous capsules.

You know me, I’m typically not much of a supplement person. I’m a ‘Give them good food, give them fresh water, love them and don’t keep poking a needle in their back until it’s really time’ sort of person.”

Dr. Lisa brings up a great point. I love Azodyl, but I do not believe we should be shoving anything down a cat’s throat. I think if your kitties will eat supplements like Azodyl or probiotics on their own, awesome. But the last thing you want to do is chase a cat, especially a sick cat around the house and have her hide under the bed and fear you.

This is completely disruptive to your relationship with your kitty, and even more important, it significantly increases her stress response, which will end her life sooner than anything else. There’s no reason we should be cramming anything down a cat’s throat. If they take supplements voluntarily, great. If they don’t, don’t force it.

“Absolutely,” says Dr. Lisa. “I have an article on pilling cats on my website. I hate pilling cats. I may be a real weeny about it, but I just hate it. And again, be careful about starting fluids too early. Cats can live a long time with CKD.

My cats got kidney disease at 14 and 16. They both died four years later, but not from kidney disease. They died from cancer. And I want to also mention that just because your cat has a low urine specific gravity, it isn’t the kiss of death. Cats whose kidneys have stopped fully concentrating the urine can live three, four, five years and longer and quite often die from something else. If your cat starts to get a low urine specific gravity number, there’s no reason to panic.”

Honoring Your Sick Cat’s Wishes

All of Dr. Lisa’s suggestions today have been common sense and very respectful of the feline body and spirit. But I think, most importantly, they should provide peace of mind for those of you watching or reading who are worried about your cat and kidney disease.

Sometimes the more information we gather — even though we want to understand everything we can so we can make good decisions — can create profound stress. It can also cause vets to give their clients with CKD cats long lists of tasks to perform that can be daunting. Often, we’re making decisions not on how the cat looks or seems to feel, but on a theoretical disease progression that may or may not occur. We end up creating stress for everyone in the family, including the cat, and it doesn’t have to be that way.

“Exactly,” Dr. Lisa says. “When I go on VIN (the Veterinary Information Network), colleagues are asking each other questions like, ‘When do you start fluids?’ The answer more often than not is something like, ‘When the creatinine is 3,’ which is a very arbitrary approach to a procedure that is stressful for both the cat and the owner.

Instead, you need to look at the patient. Are they eating a water-rich diet? Are they eating plenty of it? Do they have any vomiting or diarrhea? Are they bright and alert? You don’t just start fluids arbitrarily at a number. You look at the patient.

It’s also important to understand that plain water (no sodium, chloride, etc.) taken in orally is healthier for a body then the fluids that are administered subcutaneously. Therefore, we should do whatever we can to increase oral water intake before starting sub Q fluids. This means feeding no dry food and adding some extra water to canned food or a homemade diet.”

I think if an animal is saying, “Don’t do that to me,” we need to not do it to them. That’s one of the hardest things to convince clients of, that “This will be a really nice approach IF our patient participates.” But if we have a cat who chooses not to participate, we need to respect that. I think we need to encourage our clients to be more respectful and push less. “I agree 100 percent,” says Dr. Lisa. “My Toby, I thought he’d be very easy to give fluids to. I tried it, and he hated it, so I didn’t force him to accept the procedure.”

Sometimes we end up making decisions to not treat the patient, because they have decided they don’t want to be treated. That’s called honoring our patients’ wishes. To honor their wishes, why not ask your cat?  Contact an animal communicator like Diane Weinmann at to discover your cat’s wishes.

“Quality over quantity,” Dr. Lisa agrees. “Because let’s face it, we want everybody, human and animal, to live forever. There’s a selfish component to it, because you don’t want to lose them. But don’t be selfish with your cats. Listen to them.”

I very much appreciate Dr. Lisa Pierson making time for me today and sharing her tips, tricks, ideas, thoughts and amazing information with us. Be sure to visit her website,, which provides a wealth of extremely helpful and practical information about your cat’s health.


Cat’s Drool—Dogs Rule or Visas Versa???

By Dr. Becker and Diane Weinmanncat drool

One of the most memorable quotes from the 1993 movie “Homeward Bound: The Incredible Journey” is spoken by Sassy the cat, who tells Chance the Bulldog, “Cats rule and dogs drool.”

When Chance brushes off such a notion, Sassy explains, “But it’s true. Cats are smarter than dogs, and more attractive … and we don’t drink from the toilet!” Someone needs to tell Miss Sassy that in fact, members of her species do drool (and some even drink from the toilet) and some even use the toilet to eliminate!

If you have a feline dribbler on your hands, you’re not alone. Kitties drool for a variety of reasons. However, there are only a few truly benign causes of drooling in a cat.

Some kitties drool when they’re purring and feeling very content. Others drool when they “make biscuits” (knead). Many cats drool while enjoying a bit of catnip.

A cat who drools at any other time, or a lot of the time, warrants a visit to the veterinarian. Potential serious causes of excessive salivation include:

  • Dental or oral disease
  • Chronic kidney disease
  • Poisoning
  • Trauma or foreign body
  • Motion sickness/nausea

Dental or Oral Disease

A mouth problem is by far the most likely cause of kitty’s excessive drooling. He could have a buildup of plaque and tartar. His gums could be inflamed or infected (gingivitis). Or his dental disease could be so advanced that he’s experiencing bone loss.

Another problem called tooth resorption can also cause drooling. Tooth resorption is the gradual destruction of a tooth or teeth caused by cells called odontoclasts.

Often an affected cat will drool, bleed from the mouth, and/or have difficulty eating. Occasionally there can also be vomiting of unchewed food, behavior changes, and bad breath.

Another oral disease with similar symptoms, including drooling, is feline stomatitis, a very painful and chronic condition that is thought to be autoimmune in nature. An affected cat’s immune system seems to overreact to dental plaque around the teeth, which triggers inflammation in the tissues of the mouth.

Stomatitis can also occur at the back of the throat at the oral pharynx, and underlying bone in the mouth can become inflamed or infected. The inflammation appears as angry, red, and swollen tissue in the cat’s mouth.

Another mouth problem that can cause drooling, especially in older kitties, is an oral tumor, which can be either benign or cancerous.

Chronic Kidney Diseasecat drool 2

If your cat has chronic kidney disease (CKD), it means the kidneys have been gradually and irreversibly deteriorating over a period of months or years. Sadly, CKD is extremely common in older domestic cats and is a leading cause of death in kitties. In fact, I lost my cat, Milo to this awful disease, although my cat did not drool.


Symptoms of failing kidneys can include increased thirst and urination, leaking urine (especially at night), vomiting, diarrhea, lack of appetite, weight loss, depression, anemia, and overall body weakness.

Other signs of kidney disease can be fractures resulting from weakened bones, high blood pressure that can lead to sudden blindness, itchy skin, bleeding into the stomach, bruising of the skin, and painful sores on the tongue and gums that cause excessive salivation and drooling. Just remember that your cat does not have to have all of the symptoms to have kidney disease.

Cats with kidney failure are also often dehydrated, which causes drooling. If you suspect your kitty is having kidney problems, it’s important to make an appointment with your veterinarian as soon as possible.

If your pet’s kidney disease is the result of irreversible kidney damage, in many cases renal function will stabilize for weeks or even months at a time. The disease will continue to progress and kidney function will continue to deteriorate, but your cat’s symptoms can be minimized with supportive treatment.

Fluid therapy is the cornerstone of treatment for animals with kidney failure, primarily to prevent dehydration. Subcutaneous (under the skin) fluid delivery may be necessary, and many pet owners can learn to do this at home.


Almost any type of toxin your cat is exposed to can make her drool. A short list of examples:

Lawn fertilizers and pesticides ✓ Antifreeze
✓ Nicotine products ✓ Human drugs, especially topical medications
✓ Certain plants containing insoluble calcium oxalate crystals (e.g., Peace Lilies and Schefflera) ✓ Liquid potpourri
✓ Laundry detergent pods ✓ Household cleaners

If you suspect your cat has ingested a poisonous substance, immediately call your veterinarian, a local emergency animal hospital, and/or a poison control hotline such as the ASPCA’s Poison Control Center at 1-888-426-4435. The hotline is answered 24 hours a day, 365 days a year.

Trauma or a Foreign Body

Cats allowed outdoors unsupervised are especially at risk for many threats to their safety and health. If a kitty roaming freely outdoors experiences head trauma as the result of being hit by a car or attacked by a dog, injuries to the jaw or temporomandibular joint that prevent the mouth from closing can cause heavy drooling.

Another serious situation that can cause a cat to drool is the presence of a foreign object lodged in the tongue, soft or hard palate, or the back of the throat. Kitties aren’t indiscriminate eaters like many dogs are, however, there are certain strange objects that seem to entice them, for example, Christmas tree decorations, glow sticks and jewelry, and sewing needles attached to thread.

The best way to protect your cat from these types of injuries is to allow her outside only for walks with you on a harness and leash, or inside a safe feline-friendly enclosure. It’s also important to keep all indoor choking hazards out of reach of your kitty.

Motion Sickness/Nausea

It’s the very rare kitty who enjoys a car ride, and it’s not unusual for a cat who’s not used to traveling to develop motion sickness. It may not even be the movement of the vehicle that triggers nausea in your cat — it could just as easily be the stress she’s experiencing. My Milo hated the car- in fact all my cats hated traveling in a car.


Cats prefer to stick close to home and feel threatened by unfamiliar places, sights, sounds, and smells. They like to feel in control wherever they are, which is why being held hostage inside your car as it zips down the highway is so stress-inducing for kitty. One of the first signs your cat is feeling nauseous is excessive drooling. Other symptoms include loud crying, fear-induced immobility, urinating or defecating, and of course, vomiting or regurgitation.

Bach Flower essences, including Rescue Remedy can be beneficial in helping to calm a frightened or stressed-out cat. Administer 4-5 drops directly in your cat’s mouth about 10 minutes before you need to put them in the car. If they are still stressed out you can give another 4-5 drops more as you cannot overdose them and the drops do not interact with any other medications your cat may be taking; therefore, they are safe. In addition, Feliway is a calming pheromone product that you can spray in the cat carrier 15 minutes before you put your kitty in it for travel.


If your cat is having episodes of drooling at home, combined with a reduced appetite or vomiting it’s important to find out why by making an appointment with your vet. I wish I would of taken my cat sooner to the vet. Maybe the eventual outcome would have been different.