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Old April 27th, 2013, 10:30 PM
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dbg10 dbg10 is offline
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Join Date: May 2008
Location: Ajax, Ontario
Posts: 488
Sam's CRF/CKD is Worse - new vet as well

Sorry but this is going to be a long post.

I took Sam to the vet this week because he has been pulling the fur out of his belly for a few months now and I have wondered if he is in pain. He also was very constipated having very dry stools until I put him on coconut oil a few months ago. My vet retired last year and this was my first visit to the vet that took over. I initially was apprehensive about taking any of my cats to a new vet, but I liked the new vet and she is well qualified on paper, having a PhD in veterinary science.

So she weighed Sam and he has not lost or gained any weight but is still fat at 23.2lbs. He is a large cat who should weigh between `16 and 18lbs if he wasn't overweight. He will be 17 years old in July and has weighed roughly the same give or take a lb or 2 since his brother died in the year 2000.

For the last 6 years Sam has been treated for struvite crystals. Initially with Royal Canin SO prescription food until he finally stopped having bloody urine and stopped producing the crystals.

In late 2011 he was diagnosed with CRF by my old vet but the only abnormality in his blood work was his creatinine level. The results were

Creatinine 224 mmol/L/l normal range 50-177 mmol/L/l
BUN 11.1 mmol/L/l normal range 5-13 mmol/L/l

this was not unexpected because of the length of time and severity of his crystal problems. He had one episode where he was completely blocked before I got him to the vet.

So on Wednesday I took him to the new vet. She was very concerned about his weight despite the fact that he has weighed approximately that for a very long time and it has been a challenge trying to get him to lose weight mainly because I have 4 cats and he chooses to eat their food as well as his own.

She noted the fact that his belly looked like it had been shaved due to the fur pulling. I also mentioned the fact that he has had asthma for a few years that I have been unsuccessful getting him to use the aerokat inhaler with flovent to relieve his occasional wheezing, he has never had a severe asthma attack. He also tends to have a clicking sound when he walks that I thought was coming from his left hip because I am forever finding matts in his fur over that hip and brushing them out. He did have a problem with very dry stools and constipation until I started giving him a daily spoonful of Coconut Oil which completely cleared up his constipation. I also told her about that as well as the fact I give him UbaVet (glucosamine,chondroitin, msm and other supplements) daily which has improved the clicking sound.

She examined his abdomen, put his left hip through complete range of motion without hearing the clicking sound and listened to his heart and chest. She could not hear any wheezing and he was purring so loudly she also couldn`t hear his heartbeat. His ears and eyes were clear and she clipped his nails.

She recommended an abdominal xray and I told her I wanted blood work done to evaluate his crf and compare the new results to the previous ones. She asked what I was feeding him and I told her he was eating mostly canned food Wellness and Nature`s Variety Instinct. She told me I would have to stop the canned food and give him Prescription kibble because he should not be eating canned food... first thing I wasn`t happy with. (In the office now, where my old vet used to keep animals up for adoption is a wall size display of different types of Royal Canin kibble... no canned food at all.)

So after her repeating over and over about the need for an abdominal xray because she couldn`t feel anything wrong in his abdomen I agreed to it. I also wanted to know there was nothing wrong because he was pulling his fur out on a regular basis especially immediately after he ate. She also said that his weight was causing all of his problems.

So the xray and blood work were done. She showed me the xray when it was developed and it had been taken with Sam lying on his right side and it showed that 1) he wasn`t constipated 2) his kidneys were normal sized 3)his bladder was small and empty 4)there were no signs of any stones in his kidneys or bladder 5)no evidence of a tumour or other mass in his abdomen 6)there was no arthritis or other abnormality of his left hip 7)you could see the fat cells protruding from his entire abdomen. So absolutely normal xray for a 17 year old cat.

She then talked about the prescription food again and I just listened and said nothing at all because I got the distinct feeling that she was not willing to discuss any alternates to prescription food.

She said she thought he had probably torn his cruciate ligament in his left hind knee and that was what was making the clicking sound. Then she said she would discuss pain killers for him once she had the blood work back the next day. Since one of my dogs tore the cruciate ligament in both of her knees, one after the other, I am very aware of how weak a leg is when an animal has a torn cruciate and Sam shows no signs of having weakness in his knees so I highly doubt this is his problem.

She also said that he had been wheezing while she was drawing the blood from his jugular vein and that he had asthma. For that she would recommend I put him on a daily dose of prednisone to control his asthma. What I found stupid about that suggestion is the fact she wants him to lose weight and prednisone causes weight gain when given continuously.

The next day she called me with the results of his blood work. She said his kidney disease was definitely apparent and that I needed to put him on Royal Canin Renal LP DRY.. gawd knows why dry.. I didn't bother to ask. I asked about a pain killer and she said we'll wait until he's eating the prescription food.

I told her we'd tried it before and he wouldn't touch either dry or canned. It became a joke when I tried the canned because he might eat 1 tablespoon a day canned but refuse the rest. I always ended up throwing the can away on the third day with more than half the food uneaten. She also wants to provide me with some special litter to get a urine specimen from him. I have to isolate him until he pees in the litter, which is also going to be a problem because as king of the cat family he resists any form of separation from the others, but I'll try it to see if it works. It remains to be seen if Sam will use the litter.

The blood work results I had to ask for each result because she did not want to give me details. I finally got his BUN and Creatinine out of her:

BUN 15 mmol/L/l normal range 8-12.5 mmol/L/l
Creatinine 227 mmol/L/l normal range 130-212 mmol/L/l

She also wants to put him on a supplement called Azodyl which I read is effective in crf cats. I told her I want a copy of all of his blood results when I pick up the litter and the Azodyl and she reluctantly agreed.

I have my doubts that I am going to be able to discuss diet with her, she is quite insistent that prescription kibble is what a cat should eat. That is not going to happen, so this is my first problem with her. The fact that she doesn't seem to take no for an answer, also concerns me. She also didn't listen to my statement about not having a lot of extra money to pay for unnecessary vet bills when she suggested I take him to a groomer for a bath to help control his dandruff that he's always had. His fur has a double coat like a chartreux and needs brushing daily to keep the dandruff down, but it's always been that way since he was a kitten. I also was rather surprised that she did not seem to have access to his previous file, which I know my vet left for their use. If she has no background information about my cats then there is little reason not to change vets.

I don`t think she listened to much of what I said to her and she was very insistent that I have the xray done and about changing him to a Prescription kibble, not even prescription canned food.

I have been considering making food for him here at home using Dr Strombeck`s ckd recipes and other recipes that have been posted by vets on the internet. I do know I will know a lot more when I get the full blood test results and be much more able to decide how bad he actually is. Thanks for any help you can give me...

I have referred to both http://www.felinecrf.org and http://www.felinecrf.com on a regular basis since he was first diagnosed as well as several other sites linked from their pages but have yet to find foods that he will eat and are low enough in high quality protein and phosphorus to provide him with a proper diet. Any suggestions beside Wellness, Nature`s Variety Instinct or Weruva?

So my questions to everyone especially growler and SCM are: the blood work results do not appear to me to be much worse than they were a year and a half ago. I know he has ckd but the change in his levels really don`t make me feel that he is considerably worse since his first blood work showed crf 1 1/2 yrs ago. I only see a slight elevation in his BUN and a mild worsening of his creatinine. Should I increase the restrictions I`ve placed on him and get really serious about his diet. What would you do if he were your cat?

I would also like some suggestions on what to say to her about an obligate carnivore`s best diet enough that she will know I do know something about feeding cats with kidney disease and what a proper diet should be. If it were my old vet I would definitely tell her what I thought of kibble for cats with ckd, but she would have recommended canned and did when he was first diagnosed. This vet comes across as fully believing her knowledge of prescription foods for cats and that kibble is preferable to canned.

I have been trying him with Almo Nature Chicken and Salmon & Chicken and he really likes them but they do not appear to be a complete diet so he needs something else to go with it. Sam has also been getting Merrick Cowboy Cookout at times which is supposed to be low in phosphorus. I have also been feeding them Oven Baked Chicken Kibble which seems to agree with all of them. However I am not sure of the protein or phosphorus content of either. They do not appear in any of the websites I`ve seen that have that information.
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R.I.P. Raggs 1997 - 2012 ; Pepper 1997 - 2009
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Last edited by dbg10; April 28th, 2013 at 01:57 PM.
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