Wednesday, July 25, 2012

Nikki's Kidneys, Redux


I talked to the vet this morning in order to get a better sense of what is actually going on with Nikki's kidney values. It was a very instructive conversation, actually, and I'm glad she (this vet) is willing to actually go over technical details with me.

As for the nature of those details...apparently there IS actually some concern about her creatinine, even though it's technically within the normal range (2.1). The reason for this is the fact that her urinary specific gravity is lower than it should be.

The important lesson I'm taking from this is the fact that lab values can be kind of misleading if you just look at absolutes. Often you have to check and see how certain values relate to certain other values. Brodie's creatinine is actually higher than Nikki's (2.3) but since his urine was much more highly concentrated, this isn't indicative of a problem. The ability to concentrate urine is, it seems, a really significant function of feline biology and even an apparently small loss of this ability shouldn't be ignored.

...but all that said, the vet stopped short of actually officially diagnosing Nikki with chronic renal failure (CRF), though it certainly sounds to me like that's what we're looking at long-term. Which doesn't freak me out nearly as much as one would think it might, probably because I've known some cats-of-friends with the condition who've nonetheless gone on to live to ripe old ages. It's not a death sentence, nor is it the sort of thing that means the cat is going to be living for years in constant pain.

Moreover, there's no way to know how fast it will progress...the vet said she used to see a 23-year-old cat who had numbers very similar to Nikki's (and who'd had those same results for something like six years in a row). Of course I'm going to watch Nikki more carefully now for signs of discomfort and pay more attention to things like making sure she stays well-hydrated, but I don't see any reason to treat her with pity or what-have-you. She'd hate that, and it just doesn't seem logical besides.

As far as treatment goes...the vet did end up recommending I try offering Nikki some prescription food. There are different "levels" of RX for kidney trouble, apparently, and not all of them are extremely low in protein. She's going to leave me a can of Purina kidney diet this afternoon when I go and pick up the Panacur (giardia medication) for the younger kitties. Nikki is the pickiest eater I've ever met, so even if she's not at the stage yet where she absolutely needs a prescription diet I figure it's worth seeing how she reacts to it. And I was relieved to learn that there are other options if she refuses the RX food, e.g., mixing in a phosphorous-binding powder with her regular food.

She's not yet at the medication-needing stage, mind you, but when and if she gets to that point they will probably try an ACE inhibitor first. Either way, I'm just...really glad that veterinary care even exists, and that nobody is trying to pressure me to just "put her down". Nikki is a tough kitty and while she's never been much of a happy-go-lucky sort (except in case of copious sunbeams) I am absolutely certain that she has a whole slew of very important reasons for living all her own.

8 comments:

  1. I meant to come back to this: I'm glad it seems mild and something Nikki can live with for a long time. I do hope it turns out that way.

    The "put her down" pressure can be extreme in some situations. I ended up losing a cat because despite being treatable, I couldn't afford to treat him for another two days. I mean two whole fracking days before I'd have money, but since the condition was acute...ugh. It was horrible. :( If the vet had been willing to bill me, he might have lived another 8-10 years.

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    1. Lisa Harney: Thanks for the well-wishing. Nikki seems to be doing great for the time being. And that's awful re. the cat you lost. There's this really misguided sentiment among a lot of people, including (unfortunately) some vets, wherein it is believed that keeping a sick animal alive is "selfish". I mean if it were truly a matter of "cat is suffering horribly and there's no way to treat hir and you're just dragging out the inevitable" that's one thing, but I suspect that's not what happens the vast majority of times you see euthanasia pressure at work.

      My favorite piece of writing on that subject, incidentally, is here (warning: it's a really wrenching read, but a good one nonetheless):

      http://dsq-sds.org/article/view/435/612

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    2. In my cat's case, he had some kind of blockage develop in his bladder. Like there were crystals in his urine that were preventing him from going. He rapidly deteriorated when it started, I was able to have him connected to a catheter overnight at the vet's.

      After I took him home the next day, he had the same problem. So I took him back to the vet and they said "Have to euthanize him." There were no other options: I couldn't be billed for services, I couldn't have him catheterized and sent home with me. If he could have been catheterized for ~three days he probably would have been fine. They suggested another surgical solution which would have involved removing his penis, but said that was a terrible idea because euthanasia is better.

      So it was this huge pressure plus a refusal to do anything that would increase his chances for surviving this acute treatable condition, and thinking about it still upsets me a lot, even ten years later. I read a lot about euthanasia culture as described in that link right afterward and I felt very manipulated because of the whole thing.

      I remember taking my parents' dog to the vet a few years ago. He was having trouble walking, which I noticed while I was feeding him. He'd found a place where he could be comfortable and dragged himself around, you know? So I got him an emergency vet visit and the vet said "You should put him to sleep."

      Now, this was a pet that had been in the family for over a decade, and most of the family didn't even know he'd gone to the vet. I refused to have him euthanized - killed - because I felt it would be extremely unfair to him and to everyone else to just do that without them having a chance to say goodbye to him.

      It's a really harsh thing, and I hate how pets' lives are deemed so expendable that euthanasia is deemed more viable than medical care.

      Thank you for the link, by the way - it is wrenching. But I am glad that people speak out against this.

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  2. I agree that chronic renal failure isn't exactly a death sentence. I had two brothers who got renal failure at 2 years old (probably a genetic problem). One had it very severe and died. The other one had milder renal failure that could be managed by changing his diet, and he lived to age 10 before his remaining renal function disappeared. From the ages of 2-10 years, he had a great deal of enjoyable experiences, good cuddles and so forth.

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    1. Ettina: Wow, that's awful about the one brother who died so young. :/ It does sound like it must have been a genetic issue. I'm glad the other brother at least got some decent happy years.

      Nikki's vet did just start her on a phosphorus binder (aluminum hydroxide powder) and thankfully she doesn't seem to mind that mixed into her wet food. Apparently phosphorus is one of the most important things to control in the event of feline kidney disease, if not *the* most important thing, other than making sure kitties stay well-hydrated.

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  3. I'm at that stage with one cat - the wait and watch. He's had an UTI, and some abnormal urine tests (for 4 months!), but the last blood and urine test looked OK. However the vet said that they see this kind of pattern of abnormal test results before kidney problems actually are detected.

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    1. darchole: Yeah, that's exactly what got my vet's attention...a pattern of specific results being slightly out of whack, plus the fact that her BUN/creatinine were higher than they were last year. I'm really glad they caught it early, though, as this means Nikki has a much better chance of living a lot longer and with less discomfort. And adding phosphorus binder to her food is no big deal at all, I just need to be more careful about making sure the other cats don't get into any leftovers she leaves in her bowl (as their mostly-raw diet is configured to have specific amounts of bone and organ to maintain a particular calcium-phosphorus ratio; they'd be at risk of hypercalcemia if they started getting into phosphorus binders).

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    2. Yeah I just switched both cats over to the prescription urinary health food. They whined (and begged, and whined, and pestered) about the new food for about the first week but got used to it. I figure in the long run the Rx food is a lot cheaper than multiple vet visits ...and a lot less annoying than having to clean all the carpets and furniture when you find the cat may have urinated on some stuff.

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