Expert: Ali - 5/4/2009

Question
Hi my cat is 15 years old and is hardly eating her food, drinking more  - she still
meows for food but turns up her nose to what ever I give her - any ideas

Answer
Brett,

As I've indicated in my instructions to questioners I am not a vet and I can't diagnose illnesses in cats, that's beyond the scope of my experience. Given the fact that your cat is geriatric - at 15 she's about 76 years old in human terms her symptoms are more concerning than they would be in a significantly younger cat. Contrary to popular belief cats won't simply start eating again when they get hungry enough, if the reason for their loss of appetite isn't diagnosed and treated they can actually starve themselves to death. Your cat might have swallowed something she shouldn't have, she may even have a foreign body in her digestive tract. Other possibilities that I'm aware of include infected and painful teeth needing to be removed, diabetes, kidney failure or a potentially fatal uterine infection called pyometra which is quite common in unspayed elderly female cats.

In an elderly cat the state of her dental health may be causing problems, if her teeth are in bad shape she would find eating painful and in some situations cats will conclude that it's just not worth the pain that eating can cause even though the cat's hungry. The good news about oral health issues is that they can be easily addressed - rotten, infected teeth can be pulled, the rest can be cleaned up and have tartar and plaque build up removed so that her mouth feels better. Dental care like this requires a general anesthetic, pain medicine and antibiotics to prevent the infection in the mouth from spreading and reduce the pain in the cat's mouth so that she can eat and drink normally. When my oldest cat, MC had her dental care done she was left with three teeth in her mouth besides the tiny incisors between the two sets of fangs. I assumed that I'd have to baby her a bit and went out to get her favorite meats so I could make her baby food - amazingly enough she didn't want anything to do with the gourmet canned foods and homemade meat based baby foods that I offered her, she wanted to eat her crunchy food. It just goes to show you that cats can be quite resilient overall!

Since you have mentioned that your cat is drinking more than normal and she's lost her appetite it's possible that your cat has developed diabetes or renal failure. Both of these conditions can be associated with a loss of appetite and increased water consumption. I'm working on the assumption that the cat's litter box reflects the decreased appetite with a decrease in poop and the increased water consumption with increased urine output, if not the vet will likely have to do other tests to diagnose the cause of your cat's symptoms and offer a prognosis that will tell you whether or not it's something that can be treated in such a way as to allow your cat to continue to have a good quality of life.

Caring for a diabetic cat requires careful record keeping, committing to making sure that the cat's meals and insulin injections are on time and monitoring blood glucose levels. Diabetic cats can be treated with insulin and diet, their care requires commitment to avoid significant dips or spikes in blood glucose levels as these can have fatal consequences. Once a diabetic cat's blood sugar levels are stabilized then they have to be checked routinely. The cat's insulin shots and meals need to be given on an appropriate schedule as directed by the vet in order to maintain the balance. For the majority of cats living with diabetes and receiving proper treatment and regular follow ups with the vet, life after diabetes provides a good quality life for some time after diagnosis, though that is dependant upon their caregivers being willing and able to make the changes needed to properly monitor the cat's condition.

Kidney failure is also a possibility since your cat is elderly. I've been through diagnosis, hospitalization and having my cat come home so that I could take over her care after she was diagnosed and received treatment for kidney failure. A few months before MC turned nine she didn't seem like her usual self, nothing pointed to anything overly serious - she was eating, drinking and using the litter box so I watched her closely for a couple of days to see if she'd get whatever was bothering her out of her system on her own. On the second night MC woke me up shortly before 2 am, she was vomiting and obviously feeling pretty awful. I immediately bundled my little girl into a blanket and woke my partner up, and we took MC to the after hours emergency clinic. I was shocked and deeply concerned when the vet came in to explain the results of MC's blood tests. MC's kidneys were failing badly and given the seriousness of her condition, I should prepare myself to say good-bye to my little girl within a fairly short period of time by bringing down the final curtain of euthanasia to end her suffering. Numb from the brisk explanation of MC's condition we took MC home and tried to make her comfortable until morning when we could see our regular vet.  

MC's kidney failure happened during the tail end of the Menu Foods pet food recalls. Some ingredients contaminated with melamine were  purchased from China and used in countless brands of so-called vet recommended, premium and high quality cat and dog foods. So many cats and dogs became seriously ill as a result of the contaminated food, many didn't survive the toxic insult to their kidneys. In the early days after MC's diagnosis we weren't sure whether she'd respond to treatment and survive because in the first couple of days her kidney values actually got worse while she was hospitalized. It was absolutely amazing to get the call from my vet's office on her 4th day in hospital on IV fluids telling us that by some miracle MC's kidney function had improved significantly, her demeanor had improved and she was ready to come home just as soon as we could come and get her.

I wanted to share MC's story with you so that you would have a bit of information about kidney failure, which helps you know that renal failure in older cats doesn't have to be a death sentence. If your cat's kidneys have started to fail your vet will most likely keep her in the hospital so that she can receive IV fluids and her kidney values and overall medical condition have a chance to improve. Once a cat with kidney failure is stable you have a couple of different treatment options. I've heard that there are some veterinarians that perform kidney transplants for cats although I suspect that the cost of this option could be prohibitive and there's a chance that this surgery may not be available worldwide yet. Traditionally the treatment most vets turn to when a cat's kidneys begin to fail isn't quite as good as a kidney transplant, although many cats with chronic kidney failure who receive appropriate treatment for their condition have a high quality of life and they have a reasonable chance for a happy, relatively healthy life.


Initially the treatment for kidney failure involves admitting the cat to hospital for awhile and giving them IV fluids. The fluids are needed because cats with renal failure are no longer able to effectively concentrate their urine which means that they pee significantly more than they normally would and they aren't able to drink enough to replenish their fluids on their own. The cat can become quite dehydrated and might be feeling pretty rotten because their kidneys just aren't working the way they normally would to filter the toxins to be passed out of their body when they urinate. Giving a cat with kidney failure IV fluids helps them to feel better by replacing fluids that are lost when the cat pees more than they normally would and they also help correct any imbalances within the cat's system that are caused by dehydration. It's important to realize that administering fluids to a cat with renal failure won't cure the problem. The opinions differ from veterinarian to veterinarian when it comes to deciding which treatment protocol is best once a cat is stable enough to go home. Some vets believe that cats with chronic renal issues need to have fluids injected under their skin every day for the rest of their lives, others believe that doing so gives the cats excessive fluids and that may cause congestive heart failure at a later time. Some vets believe that cats shouldn't receive any fluids at home, instead the cat should be brought directly into the vet clinic when s/he's not well. Somewhere in the middle are the vets that believe that subcutaneous fluids should be given on an as needed basis.

Another recommendation to help cats with renal failure includes changing their diet and controlling the quality and/or quantity of protein the cat's eating in addition to administering fluids as per your vet's recommendations. Some vets believe that the key to keeping a cat with renal failure healthy is to limit the quantity of protein that cat receives, others believe that the issue isn't about quantity, but rather the quality of protein the cat's being fed. Ultimately it's important to discuss treatment options with your vet and do some research to learn more about your cat's treatment if your cat's diagnosed with kidney failure. I also suggest that pet parents, find a vet you're comfortable with and make sure they're willing to answer all of your questions and address your concerns completely. My cat, MC didn't like the prescription low protein food and as soon as she came home from the hospital she went on a hunger strike. Initially I was told to force feed MC, so I did for a couple of weeks and I just didn't have the heart to keep it up anymore. I was bothered by the fact that MC would run and hide if I looked at or approached her because she was afraid that I'd force something on her whether it was fluids or the food she didn't like. After speaking with my vet and asking for her opinion on the situation we came to the agreement that continuing to force feed was increasing MC's stress levels and that it was substantially more important to get her eating enough food on her own to sustain herself rather than forcing it down her throat.

My family vet was willing to compromise where some other vets wouldn't have. It's possible that her views are different because she's a holistic vet and views medicine and healing differently than a vet who is only focused on conventional medicine and treatments for disease. It's been a pleasant surprise to see MC's kidney values remain stable within the normal range for a little over a year we're in the process of trying to wean her completely off of subcutaneous fluids. I have to admit it's nice not to have to poke my precious girl with a needle every day, but for now I still haven't managed to get her completely off of the fluids, but it's significant in my mind that we're down to fluids once a week or so and she's still living a happy, healthy and good quality life.

There are other reasons for a lack of appetite and increased thirst. For example if your cat's not spayed her increased drinking and loss of appetite could be a sign that she's got a potentially fatal uterine infection called pyometra, it's quite common in unspayed older female cats. If this is what's going on it's urgent that your cat sees a vet immediately to have emergency ovario-hysterectomy. It's important that she's treated before her womb becomes so full of pus that it bursts spreading infection throughout the abdomen, if this happens her chances of survival aren't good. The treatment for pyometra is an immediate ovario-hysterectomy or spay. Obviously the surgery is more time consuming, complicated and expensive than a routine spay and the cat's at a higher risk of having surgical or anesthetic complications because she's got an infection combined with the fact that she's elderly.