Regaining strength in an old cat 🐈

I have an 18 year old cat that has recently gotten sick (herpes flair up) and lost weight and also became very weak. He has weighed just over 5lbs for the past few years but at the last weigh in last Friday, he was just under 5lb. He also takes methamazole for hyperthyroidism, Cipiro for the herpes flair up,  Entyce to stimulate his appetite, and has now been taking Nutri-cal for the past 2 days. He is now weak to the point that he has trouble standing/balancing and routinely falls over. Usually he is able to get back to his feet unassisted but there have been times where we have had to help him back up. He's just began taking Entyce in an attempt to pack some more weight onto him. It is working well as he is eating vigorously and also drinking a lot more. His balance almost seems like it may be neuro instead of weakness but I'm not sure.  He does not have any signs of nystagmus so I'm not sure that vestibular disease fits. My question is, how can we help him regain strength /muscle mass and also pack on some healthy weight in such an old cat? Before becoming sick, he was eating Hills Prescription Diet KD (dry kibble) for Kidney care. He was showing early signs of kidney failure months ago but his most current blood work this past Monday shows that his kidneys look great. So, we have been feeding him whatever he wants, to include Friskies canned food, canned human-grade salmon, INABA Churu Cat Treats, and baby food. I'm aware that this guy is very old and his end may be near. However, I also know that overall he is acting normal, eating, drinking, urinating, and having bowel movements so he seems fine other than his balance issues from what appears as being weak. Is there any supplements/vitamins it'd than what I've listed above that truly would make a difference in this case? Also, if he was at your office, is there any injections or IV solutions that you would suggest. I fear the longer this drags on, the less his chance for survival is. I don't want this to turn into a quality of life issue for him. I've been told to check with my vet about giving him Adequan for joint support and pain relief. I can't say for sure that he is in pain but I'm sure at his age there is a great probability that he is. If he was in pain, could this cause the balance problem? Thank you in advance for any advice that you may be able to provide. Jason

Hello I'm sorry to hear that your old cat is ill.  He sounds to be eating excessively despite weight-loss, drinking (water) excessively and showing signs of weakness / falling over. He has been taking Entyce, Nutrical and eating a range of food.  You want to know what nutrients you can give and whether you / the vets should be giving any injections etc. Well, as ever, the answer is 'it depends' - there is a level of understanding needed in between the symptoms and knowing what to do.  I could say 'you should do X, Y Z and for sure it would help your cat,' but hopefully we both know that I would be lying, because if it was that easy, all vets would work this way. Rather, what the fate of any poorly cat depends on, is someone understanding the underlying cause of the problem.  This needs to be your vet.  Hyperthyroid cats should be monitored fairly regularly to make sure that the drugs are at the right dose to keep the thyroid levels in the correct range.  Getting it wrong could result in some of these signs including muscle mass loss - but changing the dose inappropriately could cause problems too.  Furthermore, they may need to examine your cat to see whether the neurological system is working okay;  they may need to recheck the urine and the kidneys;  they should have a feel for any lumps or bumps. Your vet also needs to have a good look at any supplements before you give them, because by over-using supplements, at best you could be repeating nutrients that won't get used (wasting money) - and at worst, this can lead to toxicity. Pain can sometimes cause a balance problem, but so can weakness and so can neurological abnormalities.  Your can can give you their best assessment about this.  I wonder, however, whether there is an elephant in the room - that this is an old cat, with ongoing problems - that you know things can't stay balanced for ever.  You ask, 'what his chance of survival is?' - well, I have met cats in their twenties. But without knowing the cause of these signs, it is very hard to say.  Logically, an understanding of what is happening in the body needs to come before knowing, on any factual basis, how long things can be treated for.  This is sometimes limited by financial limitations, emotional limitations and welfare limitations (for example, if the quality of life can't be improved dramatically very quickly or for very long, you might prefer that they tell you). I would suggest calling your emergency vet for assessment if you are concerned about the state of your cat in the immediate moment / if things are worse tonight, as the weakness does sound concerning.  However, even if this is not the case, it sounds as though you need to take your cat and talk over the options with your vet as soon as you can. Please be honest with your vets about what you are feeding as they will check with nutrient balance out to ensure that it is appropriate. Good questions for your vet include:  What will happen if we do nothing?   What might happen if we (do as you suggest)?   What would you do in this position?  - are all good questions worth asking.  Wishing you and your golden oldie all the best.

Ah yes - pain doesn't cause exactly balance problems, but making adjustments to avoid pain can sometimes add to them.