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Ask Dr. Michael Salkin Your Own Question

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 26174
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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I'm in the UK. I took my 16 year old cat to the vet today

Customer Question

I'm in the UK. I took my 16 year old cat to the vet today and she said her kidney level was 12 when it should be 10, I thought I would come home and google it but can't see anything about a level 12 so I'm confused.
Submitted: 1 year ago.
Category: Cat
Expert:  Dr. Michael Salkin replied 1 year ago.
I believe that you're referring to Faith's BUN - the normal range is usually stated as 6.4 -14.6. A 12, then might be normal. Assessing the importance of the BUN without looking at the rest of Faith's biochemistries can't be done. Can you upload a copy of her test results to our conversation? I understand that you might not have a copy of the results at home but his vet should be able to give you one which you could scan into your computer and give me the link or you can photograph the page(s) and upload the images by using the paperclip icon in the toolbar above your message box (not if you're using the chrome browser) or by using an external app such as imgur.com or dropbox.com. It's very important to not only look at her blood tests but also her urinalysis when we're concerned about her kidneys.
Customer: replied 1 year ago.

I don't have a copy of her results, the vet said that it could be that there was a lot of protein in her last meal that made it go up if that sheds any light? She definitely said that it should be 10 and 12 was high? She only tested her kidney function (I think) because she wanted to put her on Loxicom for what she thinks is arthritis, the bottom of her back and her back legs are bad.

Expert:  Dr. Michael Salkin replied 1 year ago.
Thank you. Yes, excess protein in the diet can elevate the BUN. As I mentioned, however, a 12 should be normal - particularly for a cat of Faith's age in which we expect a certain degree of renal insufficiency. I believe that the Loxicom is more important to Faith than the finding of that BUN level. Please continue our conversation if you wish.
Customer: replied 1 year ago.

Faith doesn't drink at all, she was a BIG drinker until around 9 months ago but suddenly one day stopped completely. I now only give her wet food and still put fresh water down daily which she never touches but will this add to her kidney problems or could her kidney problems be the reason she stopped drinking? Also, how long does it take the Loxicom to work?

Expert:  Dr. Michael Salkin replied 1 year ago.
It's actually a good sign that she's not drinking excessively. That would be a worrisome symptom of renal insufficiency. She's apparently getting enough fluid out of her canned food. Loxicom begins to work within hours of its being administered.
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 26174
Experience: University of California at Davis graduate veterinarian with 44 years of experience.
Dr. Michael Salkin and 2 other Cat Specialists are ready to help you
Expert:  Dr. Michael Salkin replied 1 year ago.
Thank you for your kind accept. I appreciate it.
You may receive an inappropriate follow up sent by the site ostensibly sent by me. It wasn't and I apologize in advance should you receive it.
Customer: replied 1 year ago.

I managed to get a copy of her records as you asked. I hope it makes sense to you. What is scoliosis of the spine, is it something the vet or I should have noticed sooner or can it come with age? - is she in a lot of pain with this? She has had an arched back for AGES but it was put down to that rolling/twitchy skin syndrome.

Her next appointment is next Tuesday 4th August, is there anything I should be asking or even requesting?

Expert:  Dr. Michael Salkin replied 1 year ago.
Scoliosis is a sideways curvature of the spine. It would be congenital - present at birth. An arched spine is called kyphosis and is likewise congenital. It could cause discomfort and hyperesthesia ("rolling/twitchy").
The posted files are identical. The only test mentioned is the BUN of 12 which concerned the vet because a nonsteroidal antiinflammatory drug (Loxicom) could affect her kidneys. But, once again, that BUN is normal. The vet wants to recheck the BUN to make sure that the Loxicom hasn't increased the BUN.
Customer: replied 1 year ago.

Oops sorry I thought I had only uploaded it once :-) I found out myself that she had hyperesthesia by googling, she has always bitten her back pulling her fur out leaving bald patches and gone a bit loopy chasing ghosts (as I called it), my last vet thought I was a bit mad when I explained it and thought it was just flea bites but I've always treated her or fleas monthly, he vet gave her steroids which obviously did nothing. To be honest I was left feeling that I was making a fuss over nothing but to see it on almost a daily basis is actually quite distressing.

Would that have got worse with age? Also, what would you recommend for her next tests / steps, I want to go to the vet with a clear mind of what she needs rather than leave a bit bewildered like the last time? She is still sleeping almost 24/7, maybe slightly more alert but no real change in her to be hionest.

Thanks for your advice :-)

Expert:  Dr. Michael Salkin replied 1 year ago.
I'd like to see a complete senior/geriatric profile of blood and urine tests performed at Faith's age. The feline hyperesthetic syndrome (please see here: http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=2873) has quite a few possible etiologies and to be quite frank, I'm not likely to pursue them with anything more than the Loxicom at her age!
Be sure to fast Faith for at least 4 hours prior to a blood draw for the most accurate results. Please ask for a copy of the test results which you can then upload for me. I want to review those results for you.
Customer: replied 1 year ago.

That's Great thanks! I'm presuming most decent vets would do this as a next step anyway? The Loxicom has relieved some pain as she now sleeps curled up again as she used to and not with her back legs stretched out but I can;t overlook the fact that she is still sleeping. Her heart rate still goes into the 60's 70's while she is laying on a daily basis and she has mild fits in her sleep but the vet didn't seem worried about either of these symptoms.

Expert:  Dr. Michael Salkin replied 1 year ago.
I understand that a geriatric cat will sleep as much as 20 hours daily but if you feel that her sleeping is excessive we need to consider that she's ill; hence, the testing I suggested. Yes, I would think that her vet will suggest the same thing. I'm not sure if "fits" are an appropriate description as REM sleep can cause motor activity suggestive of fits. Her heart rate may or may not be significant but, of course, her heart needs to be carefully auscultated (listened to) for arrhythmia (irregular heart rate) and murmur. Heart muscle disease (cardiomyopathy) is the most common of the heart disorders in cats and can be a challenge to manage.
You're quite welcome.
Customer: replied 1 year ago.

Great thanks! She sleeps around 23 hours a day, she's only ever awake for food and to toilet. Her appointment is not until next Tuesday 3pm (UK time) so I'll make sure she has her breakfast at 8-9am then nothing else until after her appointment. The vet suggested euthanasia but I don't want any regrets or to do that and wonder what her diagnosis was after, surely I should have all the facts as it's still quite vague at the moment. I'll ask for a copy of her results and be back in touch.

Thanks for your help :-)

Expert:  Dr. Michael Salkin replied 1 year ago.
Sounds good. I'll watch for your next post.
Customer: replied 1 year ago.

Sorry for the delay, she's been on Metacam for around 6 weeks, at first she was like Super Kitty, she became territorial again and saw off every feline visitor to her catflap, she was my old girl once again and when I took her for her 2 week check up she had been grooming and either allowed me to remove her matted fur from her back or done it herself. Over the following 4 weeks though I saw her go slowly back to how she was before she went on the Metcam, she's either sleepy, matted again at her lower back and will not let me near her to groom and unmat it.

I knew before I went that the Metacam should have helped the pain for longer than a month, you hear of cats on it long term for arthritis so I did wonder if there is something else going on there? I've also seen her panting once or twice and she has been sick twice over the past 3 days (that I've seen).

The vet has now decided on her being anaesthetised and having xrays tomorrow. I have been asked to consider what I might do if the outcome is not good and I have decided that if she is in pain that cannot be controlled long term then I will let her go. I know she's not going to live forever but the next step is going to be tramadol, if the tramadol would only work for a month then I really don't see the point in that to be honest, it's not fair to her.

Sorry to babble on but I thought I would check in and let you know. do you have any ideas why she might be in pain again so soon and why the Metacam may have stopped working? It's okay to be honest. Also, the vet has said not to feed her for 18 hours before, my poor girl will be soooo hungry as if she is not home until tomorrow afternoon then she will not have eaten for over 24 hours, is there a bit of leverage there on the 18 hours?

Expert:  Dr. Michael Salkin replied 1 year ago.
It's not unusual for a condition to exacerbate to the point that pain associated with it can't be controlled with a previous dose of a drug. We either increase the dose (not with meloxicam) or switch drugs - in this case, yes, to an opiate and that will end up being highly sedative for her and Faith is already sleeping the great majority of the day. X-rays might give you a prognosis but I can't see them changing how you'll address her. Either an NSAID or opiate is going to help or not. I suspect that her vet wants to see if something like a multiple myeloma (cancer than invades the bone) is present. I can't set a follow-up in this venue and so would appreciate your returning to our conversation with an update - even after rating - at a time of your choosing.

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