Chronic Kidney Disease or Pancreatitis?

[ermentrude]

Apologies for length...

Background
Catherine is approximately 19 years old, found as a stray almost 10 years ago. I don't know how long she lived on the street but it took a *long* time for her to trust me. She has mellowed some with age, but she really doesn't like anyone but me.

She has had a couple recurring issues during her time with me, all of which I assume is why she was unceremoniously dumped by her previous humans. She has periodic back toe nail infections. They were very nasty at first but after many vet visits and patience, it is mostly under control with regular cleaning. In about 2008 she went to have her teeth cleaned and the vet identified significant tooth resorption that she estimated had been going on for many years to be that bad. She also had an incredibly bad time coming out of anesthesia. Her body temp crashed and no matter how many heating pads they had it wouldn't go up. It happened to be the hottest day that summer - 102 before heat index. They took her outside and sat with her in the shade and her temp started to recover. At the time they recommended against future use of anesthesia if at all possible. All of this caused them to adjust her age from approximately 6 to 11 - but they said it could be even higher or lower.

There are two other cats in the house, both male, a 7 year old anxious Ragdoll with urinary issues (successfully on Zoloft and Pepcid!) and a 1 year old energetic DSH kitten. The boys wrestle among themselves, Catherine has laid clear boundaries and does not participate. She will use the Ragdoll as her personal hot water bottle / living bed and sleep on him if it suits her. She wants nothing to do with the kitten yet, but it took her a couple years to warm up to the Ragdoll too.

Trouble
Cate started hiding about a week and a half ago, wouldn't come upstairs to my bedroom and didn't seem to be eating as much. She'll have a day once in a while where the other cats annoy her and she'll hide away so this wasn't initially worrying, except it lasted for longer than usual. We went to the vet Thursday. They gave her an antibiotic shot, in case she had an infection, and also gave her some sub q fluids. By the time we got home, she was a different cat . She's eaten like mad the past two days, no more hiding, back monitoring the squirrels in the bird feeders and even came upstairs a few times to see what I was up to.

Her blood labs came back Friday morning and the doctor said she has CKD. Her numbers are not outside of the normal ranges, but have gone up since her last labs 4 months ago. I'm supposed to get a urine sample tomorrow. The bloodwork from her last checkup in March and then Thursday is here:
I posted this on another forum for CKD support and everyone said these aren't CKD numbers, but Pancreatitis numbers instead. My regular vet is preparing for maternity leave and her replacement is new to the practice. I'm not sure if he just made a mistake or the internet could be wrong...

The Treatment
The vet told me I need to change her food and to separate Cate so she only eats the new Renal food. This is easier said than done. Cate has always been and is still a very delicate eater. She takes a couple bites, backs up, watches the food, waits minutes and then has another couple bites, repeats. Or she may walk away, watch the bird feeder for 15-20 minutes and then go back and eat again. Even when it is her most favorite food (kitten food) and there was a realistic possibility another cat could steal it from her, she's just measured.

The anxious Ragdoll is on Urinary SO. His issues seem largely under control for about a year now, between the food and the wonderful miracle that is Zoloft. I don't want to mess that up - it took a long time to get here. They have all-day access to his dry Urinary SO food and get a large can of Urinary SO moist food in the evening as well. But they all are grazers - it can take a couple hours for even the wet food to be done (I suspect Cate eats 2/3 of the wet food to be honest, the kitten prefers crunchy).

Eventually the vet conceded that Urinary SO is lower protein than regular cat food, so if I cannot get her exclusively on Renal, that may be OK. But now the guilt sets in. I could get her some Renal wet food in the morning and at night when the other wet food goes down, but I don't think I can prevent her from having a mid-day bite of the Urinary SO without locking her off from most of the house, but then she'd be miserable. I'm going to ask if that is worth it or not, I just don't want to lock her away all day or trigger the Ragdoll's anxiety changing his feeding around if the compromise will still do the trick.

And if it isn't CKD as he said, but Pancreatitis, then is the Urinary SO making it worse?  I hope not.  

I'm planning to talk to the vet or techs when I go back with the urine sample on Monday, to hopefully iron out the CKD vs. Pancreatitis.  

Thank you in advance for any help or insight...

 

[foxxycat]

did they send you home with Pepcid and anti nausea meds? pancreatitis is very painful. Since this organ is responsible for digestion it would be painful to eat because once the stomach shakes the food it then goes into the small intestine with an enflamed pancreatic the movement of food could cause pain and the cat may not eat if it feels pain after eating-you can ask about Pepcid-some people have had good luck with this. also pain management is another important thing. they can either give an injection there of buprenorphine or send home with syringes made up of oral bupre which gets put in the cheek of the cat=they don't swallow it-it is absorbed by the blood vessels in the mouth.

the other thing is fluids=a dehydrated kitty wont eat or drink. sub fluids are very easy to give-and often a staple in a kidney kittys meds.

the fluids and Cerenia/Pepcid and pain meds will help her feel so much better. there is no rhyme or reason to pancreatitis but we are learning more about how to treat it so your cat will be more comfortable.

I recently had my cat let go to the bridge due to cancer and pancreatitis complications=she had bad tumors BUT she did the same as your kitty=hide in the closet-don't greet me at the door when I come home. didn't want to walk around outside and when she did she ate a ton of grass. I heard that grass eating can be a sign of digestion issues.

There are vets who still believe a low protein diet is better but some vets are finally seeing that elderly cats need higher protein food as they don't eat as much and we want them to have the best nutrition as possible. I fed my old girl Orijen which is one of the best kibbles on the market-she only had to eat 1/4-1/3 a cup a day to keep her calories up where the commercial food she would need 1 to 2 cups of food=so I did this to make it easier on her calorie wise-although some cats don't do well with a sudden diet change but where we knew cancer was involved-she got fed whatever she wanted at this point. I had both kinds down. some days she ate the high test food and other days she ate the lower calorie foods.

the best diet is one they will EAT. they need to keep eating to help push out any infection in the pancreas if that is causing it to be enflamed.

 

[foxxycat]

also I couldn't view that file as my computer blocked it-can you copy and paste the kidney values here?

the BUN and creatinine levels if you could post them here.

 

[ermentrude]

Hopefully this works:

Test	29-Mar	29-Jul	Ref Val
Blood Urea Nitrogen	28	35	14-36	mg/dL
Creatinine	1.9	2	0.6-2.4	mg/dL
PrecisionPSL	16	43 HIGH	4-29	U/L

I went back on Monday with Cate, she had wound down like a little mechanical toy from Thursday to Monday.  I got to see my regular vet, before her maternity leave starts.  

She said that she didn't think it was pancreatitis because Cate was not sensitive to touch.  

She did take a urine sample.  

She said the next step after the urine was to do x-rays and see if there was a tumor hiding away.  I don't deal well with unknowns so I just said to go ahead with the scans.  They came back pretty good.  There was a little calcification in the kidneys and the radiologist thought her kidneys looked a little small.  But otherwise she was the model of health.

Finally, they taught me how to give sub q fluids and sent me home with 4 doses.  For now I'll administer on Sundays unless she is acting strangely.

I don't have a copy of the urine labs yet, but it came in around the same as the blood numbers - high side of normal, just on the edge of being bad.

The bottom line from the vet was she must have CKD, it is just somewhat earlier than usual to find.  If she didn't perk up with the fluids again, then we could look at some pain meds and see if that helps.  

Cate continues to eat, but afterwords she just looks pooped and like she cannot get herself to be comfortable.  I did open the door this evening for her to do some outside observations - it was a very hot July and the door stayed closed.  It is still warm, but she has been in and out for the past 30 minutes and seems genuinely interested in what is going on, so her little ornery spirit is still as strong as ever, she just seems like something doesn't feel right.

She doesn't seem to like this Renal diet, so I'm going to go try another option tomorrow.  And maybe ask about the pain meds.  I just don't want the little lady to be in pain.  It is breaking my heart.