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I need to know all my options. I feel like, even when we have our cat at a cat specialist, they do not consider to tell us all the options as they might be expensive or a long shot. We have plenty of money and we are willing to do whatever it takes if we can help our cat recover and have a good quality of life. So far the general theme from vets has been: "let's give her fluid and some blood and hope she heals herself."
The situation:
My cat is in severe renal failure. She has been in ICU at one of the most recommend vet hospitals in the area since Monday morning (it's Tuesday night as I write this).
This seemed to have come out of nowhere, however we see now that we missed a lot of signs.
She is a 9 year old Tonkinese (normally a average life expectancy of 15-18 years). Other than chronic limp, and a successful surgery to remove a bladder stone many years ago, she has always been in excellent health.
Recently, we have been treating her limp over the past 4 or 5 months with acupuncture, shockwave therapy, and a few times of both oral and site injection steroids. Around 2 months ago up until this weekend, she was as playful and active as she has ever been. The therapy seemed to help. Up until 3 days ago, she acted in great shape.
But what we took as the benefits of therapy now look to have been mistaken for kidney failure. She was losing weight, which we thought was because of her increased activity due to the limp not bothering her as much. She wasn't overeating anymore, which we thought was because she wasn't stressed by her limp. We had another cat in the house who was always next to the litter box when we found pee outside the box, so we didn't attribute the peeing outside the box to her having an issue (we had the other cat checked and he was fine). Her coat looked more dry and with less sheen, but we thought it was because she was finally able to go outside (she's an indoor cat, but we take her for walks and she always rolls on the sidewalk to get dirty).
We didn't notice severe changes until 3 days ago. On Saturday, she stopped eating and never came to bed like she normally does. On Sunday, she was hiding in dark places that she never goes to and still didn't eat, then started having trouble drinking water. On Monday morning she was lethargic and seemed to be very uncomfortable.
We ran her to our normal vet thinking she needed an antibiotic or something, next thing we know we get a call saying she needs to go to an emergency vet clinic but will likely not survive the trip. Our normal vet said she had labored breathing, severe dehydration, and looked like heart disease. She gave our cat a sedative and small amount of fluids under the skin.
Once to the emergency vet clinic, they did an ultrasound and found the heart to be just fine but that the kidney appeared bright white on the image. They started her on fluids immediately, gave her antibiotics, sent off for blood work, and sent off urine sample for culture. The blood work came back bad with the following:
BUN: 174 (not a typo)
Creatinine: 15.1
Phosphorus: 27.5
Red blood count: 21%
By 9pm Monday night the red blood count didn't improve so they gave started giving her blood.
Tuesday morning they ran more blood work, and found a mixed bag:
BUN: undetermined (they didn't get a proper result so they are testing again)
Creatinine: 15.5
Phosphorus: 19.6
Red blood count: 26%
One moment she is fairly coherent and alert, even wanting to jump down from the cage. The next moment she is very sleepy and too tired to stand so she lays on her side, and is having facial twitching. Monday night she started breathing with an open mouth but has since stopped.
I don't know if it was a chronic issue coming by, a reaction or destruction by some of the therapy done in the past few months, or something acute like an infection or poison.
What I need to know is if there is anything else we can do? Can we clean her blood with dialysis to get her to a point where she might be able to be considered for a transplant (we are fine with the costs, both upfront and ongoing care, and would love to adopt a donor cat). Is it possible it's a kidney infection that requires other types of antibiotics? ANYTHING we can do to give her a chance! If she has to go, we can cope, but what I can't cope with is hearing afterwards that "you could've tried this or that", or "well, it's just a cat, so you wouldn't really do anything like a transplant."
Chem levels are high in part to dehydration. I'd like to see another panel after 3 days on fluids.
I'd also start her on a phosphorous binder to get that level down.
At any time was her thyroid level checked?
You'll just have to take it one day at a time. I was a wreck when my Daisy became seriously ill with kidney issues literally out of nowhere. She was 14 when she became sick.
I don't have enough experience or knowledge to add much EXCEPT cats are masters at hiding ailments, and even the most observant cat owner or handler can't see things coming. There's a great chance two things were going on, the kidney issue along with, as you thought, the benefits of the therapy.
In other words, don't take a guilt trip and do continue with proactive care -- your cat will tell you what to do next.
Some cats will get worse faster than others. It happens.
My 17-year old cat was diagnosed with chronic renal failure earlier this year. He was one of the lucky ones where we caught the diagnosis early. Is he well enough to eat and take supplements? I used Liqui-Tonic 4x to treat the anemia and he is on a prescription Hills brand k/d diet. After a month on these foods, my cat's anemia got better, he gained 1 pound and seem to be doing a little better than before. Unfortunately, you won't see the results until about 3 weeks on this food.
Even if you do the transplant, you have to consider the risks for a 9-year old to go through such an invasive surgery. Moreover, replacing a kidney does not necessarily mean your cat is completely cured. Without being able to address the cause, you are only buying time.
I wish there are other treatments to consider other than what I suggested above. I also tried looking into this. It is heartbreaking to hear this diagnosis. When I first found out, I urged my vet to give me all the options, no matter the costs. He has always been an honest man who has over 20 years of experience working with cats. He always put the animals' best interest before his own. He looked at me in the eye and said, "This is a disease that comes with old age. We can try everything under the sun but there is no cure at this time. Some cats can have several more years while others will succumb to it in a year or two. Shouldn't his last years be as happy and comfortable as we can give him?"
I can so appreciate the position you are in, and applaud you for being willing to do anything for your pet, but there is so much to a kidney transplant..
If you really want to explore this option, I highly suggest you talk to your vet about finding a specialist and talking to them about what is going on.
Nine is very young to be in full kidney failure, so I would have to wonder (if this were my cat) if there wasn't something else going on. I owned a cat years ago that limped right before she was diagnosed as diabetic. She stopped limping as soon as I made the vet appointment to get it checked out. When I found out she was diabetic I told the vet that I think she limped to tell me something was wrong, and he scoffed at the idea.
I agree that more investigation needs to be done. a full blood panel with a full thyroid etc should be done if the kitty starts feeling better on fluids.
But it might be kinder to consider this an end of life event. Be it now or after a few days on fluids and things aren't better, or in a few weeks / months if fluids do help.
Your vet might have been trying to be kind by not bringing up kidney transplant, because $15,000 is a lot of money and you are not promised a good outcome, even if everything goes well. It is also still quite rare and not done in many locations. Your own personal vet isn't trained in this sort of thing so you will need to be go to a specialist and I have no idea how far one is from you. For me I would have to travel several hours at minimum.
Nine is so young, I am so sorry you are facing this. I hope against hope that your kitty improves dramatically and a solution is found for you.
Thanks for all the comments. She didn't last to Wednesday morning. My girl is gone.
I think the vets were decided later on Monday that she wasn't going to make it, so they didn't give any more blood and never discussed doing anything else for her other than seeing if she'll get better on fluids. They were probably right, I just wish I had expressed as soon as I brought her in that I want to do everything possible as fast as possible, instead of trying just one or two things and waiting out the night (while she's in distress the entire night). I feel I might have been given more options if I had just expressed that money wasn't an issue and we want to do everything right away.
I'm so very sorry. I am sure your vet made the best decision for her at the time. Please know that even if they had done everything possible, she may have been too weakened already to survive.
Sending you a hug and again, I'm very sorry this happened. :-(
I am also very sorry.. it hurts so much when a cat we love dies, and it can hurt so much more when guilt is piled on top when we think we did something wrong or didn't do enough.
When a body is as sick as your kitty was, you need to be slow and methodical in your care and treatment. You can't always go at it full blast and guns blazing because that can cause even more damage, especially since you have no idea what caused the problem in the first place. What if it was the prednisone that cause the kidney failure in the first place, giving more to suppress the immune system so you could do a kidney transplant .. well that would also not be a good thing.
Maybe it wasn't the steroids. Maybe your kitty ate something toxic.. maybe this, maybe that, so many maybes because sadly biology is sometimes more of an art than a science.
Please, forgive yourself for what you think you should have or could have done..
Kiaser ... so so sorry. I'm actually where you are - one of mine went to Rainbow Bridge last week after herculean efforts. I fully understand.
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