Is there anything else I can do?

[linda112]

Freckles 12 year old male with advanced Kidney Disease - Blood Level:  BUN 140<, Creatine 21.1, Phosphorus 15< (Creatine went up in one monthyfrom 5.6).  Two rounds of 3 to 4 day flushing.  My Vet indicates that sub fluids may put Freckles in more distress and won't help but I have been doing anyway.  Freckles is eating some, drinking a lot of water.  He lost 1.25 lbs in one month.  He does groom himself and is still affectionate.  He walks about but it is obvious he is a bit wobbly.  No medications offered now other than appetite pills.   Ultrasound shows one kidney gone and the other enlarged apparently doing all the work.

Should I go for a second opinion or give up the battle and make Freckles as comfortable as possible?  I am debating Uthinasia but something inside me is not convinced it is the right time now but I am not sure.  Any suggestions or advice?

 

[dr kris]

If i had freckles, and i did my own physical exam on him, and I knew his heart was stable (as much as you can know anyways), this is what i would do:

1) Absolutely ensure no kidney infections are going on. Pyelonephritis will spike these numbers up. Sometimes the urine test are inaccurate for finding infections. I am treating these guys with an antibiotic if i suspect this.

2) If daily SQ fluids are being used, then follow the 2% rule in the video (providing your vet agrees - Because im a vet I always gotta put that disclaimer there). The point of the fluids is not to take down the creatinine numbers in your cats blood, but to support appetite, hydration, reduce nausea and acidosis. All of those things make it harder for your cat to survive!

3) With numbers that high, dollars to donuts your cat will be suffering from gastritis (acid in the stomach). Who wants to eat with that going on? Appetite stimulants will fail with that going on. Talk to your vet about getting him an antacid. I am showing people how to use these medications every single day. A very common, normal thing to do.

4) If the phosphorous is high, OMG he needs a phosphorous binder in his food. That needs to come down if he's going to feel better.

5) He needs lots of food. I would forget about macronutrients for now, and just go for calories. if it ends up he has an infection, he will need protein to heal his kidney.

6) what is his potassium like? Any anemia going on? You need numbers from his bloodwork. Specific numbers to tweak his therapy.

7) I've seen all kinds of cats coming to me in all kinds of debilitated ways. I never give up hope. There is much to try here. As long as you are not facing true end stage CKD or renal lymphoma (or something else that tramatic), there is always hope.

I vote for second opinion.

k

 

[robinathome]

Linda, as you know Franny is in the same boat.  after 2nd opinion this Vet got her on Renavast(for kidneys), sub-q and Science Diet critical care.  This was last Tues 7/15.  She bounced back for a few days.  We added in the Prednisolone I was orginally using during the weeks before.  By Sunday she had stopped eating.  So 3 times that day I filled pureed food in syringes(including the critical care food) Along with the syringe of liquid Renavast(one powder tab desolved in water).  On Monday I tried again and got her sub-q.  On monday night I decided I needed to let her go.  Franny is very weak and only sleeps now no food or water for 2 days.  I called my original vet to have him on call when he needs to come over.  Since I am off work I am able to stay with her.  So yesterday my vet said any time and he told me to give her 2ML of Prednisolone again just once a day.  I did it yesterday and nothing much changed.  She has thrown up 3 times in 30hrs. a small amount of green grey fluid.  it only lasts a few seconds for her to do it then she goes back to sleep.  My doc said Franny could live with the one kidney but I had to get her weight up for 5lbs to her regular 8lbs.  That did not happen.  She eat enough the first 3 days then stopped again.  I wish I had started force feeding last week.  But Linda, I will be curious if Dr. Kris weighs in.  In my heart I know that Franny is very sick with a small mass in her bowel. Last night was brutal(waiting this out).  Franny stayed in the closet and then threw up a little.  Today I took her out of the closet and placed her in front of the screen sliding door to get some air but she only lasted about 15 min and now back in the closet. She is not in pain.  My vet can come over any time so I will see how the day goes.  I hope you have better luck with Freckles.  They say I will know and today I am 80% there but before you do anything to Freckles be sure enough that you don't have regrets.  Any kind of suffering is no good.  And I am sure there are people who will read mine note today and feel I am not doing the right thing and should have her pts asap.  Today will tell.  

 

[robinathome]

I agree with Dr. Kris, by the time I got my 2nd opinion it was too late.  Franny did rally for a few days.  But I could not get the weight back on her.  And that is what my Vet wanted most.  He told me if we can get her weight up there was still a small chance and we would do a 2nd round of blood work in 1 week.  Unfortunately she became to weak 6 days in and although I kept the med/sub-q going she just went down hill.  Get Freckles a second opinion today.