I'm so sorry that I was off my computer when you posted your concerns about Dolly; my apologies for taking so long to get back to you.
It certainly sounds as if you're doing all that you can to keep her healthy.
I have several thoughts/comments about what you've said about her.
1. As I'm sure your vet has told you, it take about 70% of kidney tissue to be damaged before we start to see an appreciable increase in BUN and Creatinine and this is irreversible damage. These values can also influenced by other things such as body condition and whether or not the patient was fasted first.
There is a new test here in the States, called SMDA, which is not affected in any way by other parameters and is specific to the kidneys only. It's also an earlier marker for this problem and can be elevated when only 20-40% of damage has been done.
What we're also looking for are changes in all of the values we monitor an upward trend, in other words, even though those values may be within a normal range. This is particularly true for Creatinine.
I'm not trying to add additional concerns or worries, you understand, but just wanted to provide information which, hopefully, you've already been told and I'm just repeating it. If not, then at least you're aware.
2. I absolutely agree that stress can be a trigger for a lot of conditions and can exacerbate existing one; it's best to be avoided if at all possible.
3. I think the behavior you've described when she's outside may be something similar to marking behavior in dogs although she may have mild FIC as well. If this is Idiopathic FIC (the most common kind), then symptoms may appear intermittently and then resolve on it's own. As you probably know, stress can definitely trigger this condition in some cats so I think the Feliway was a wise move.
4. I think a urinalysis isn't a bad thing to do, under the circumstances, if you can manage to collect it without having her seen....sometimes easier said than done!
5. I would increase her water consumption if you can. One thing to consider would be an indoor water fountain which many cats really enjoy. If you're not currently feeding her wet/canned food, then I'd consider this as well since the #1 ingredient is water.
Some of these cats will respond well to Cosequin for Cats which is available online, at least here in the States. This product was originally designed as a joint supplement but it was found to help some feline patients with FIC. Since it's so safe, I often suggest it for my patients with this issue.
I hope this helps, although, again, my apologies for the delayed reply. Deb
Glad I can help:)
1. I wouldn't necessarily rush her back to have more labs done; the next time, I'd make sure that an SDMA is included, though.
2. For stage 3 or 4 kidney disease (usually the latter), phosphorus and potassium can be elevated but isn't typically in the early phases or in healthy cats.
3. Many cats with kidney issues will become anemia (low HCT) but, again, it's usually those in the latter stages of disease.
4. Cats with kidney disease typically drink more water and urinate more frequently...things she's not doing, fortunately. Many patients will also lose weight, start to vomit, display an intermittent appetite....again, none of the things she's doing.
5. I thought you might be feeding wet food but just wanted to mention it to be complete. The tuna in cat food should be fine I would think; it's the human versions which should be fed in moderation.
It doesn't sound to me as if she has a serious problem. Whatever she was doing outside may have been transient behavior for whatever reason. But, I'm glad that the holistic vet is coming to check her out and, hopefully, will reassure you that there's nothing serious going on with her.
You're more than welcome, as always:) And, thanks for the rating and kind words; they're both greatly appreciated.
I know it's hard not to worry about our pets sometimes but I like to remind owners that they're likely to detect our stress about them which, in turn, can be stressful for them since they're quite often very empathetic. Sometimes if we consider how our behavior affects them, we can worry a little less.
Urine dipsticks have been shown to be notoriously unreliable for many things which is why I always like to send them off to a lab. Hopefully, the results you get will be non-remarkable.
Continued best wishes for her. Deb
Thanks for the update.
1. No need to do a culture and sensitivity at this point that I can see.
2. The use of Metacam in an older cat scares me to death but the concentration you have in the UK is different from the one here in the States so perhaps it might be useful.
I give my patients Buprenex in a sustained release formulation which lasts 3 days.
3. I think it unlikely that tuna fish would raise her urine pH. This may simply reflect that she ate prior to the urinalysis and not something which I tend to overinterpret as a general rule. If I'm dealing with a stone or crystal issue, then I may want to manipulate the diet to achieve a certain ph level but not for "routine" or simple FIC cases.
4. Fish oil (Welactin is a liquid product that I like a lot) can be given which has anti-inflammatory properties and which may be of value for her. Otherwise, I wouldn't fee safe suggesting anything else for her since there's no evidence that she has kidney disease.
It's not possible for me to charge you for another question although thanks for offering. I can't see what you see on your end of things but there may be a way to provide a bonus or "tip" since this is something other folks using this website have done. The UK site may be a little different though so customer service might have to be contacted to request it.
By the way, if you posted another question, you wouldn't have to provide any additional history. Simply say "For Dr. Deb only" and something to the effect about your concerns about Dolly. I can access our previous conversations if I need to clarify anything.
Unfortuantely, I don't have a terribly good explanation for her increased affection/attention seeking behavior but I'd probably advise you not to overthink this behavior. It's not indicative of any particular underlying disease process that I know of although cats with hypertension can start to behave in some odd ways. However, increased blood pressure in a cat is rarely primary but almost always secondary to either kidney disease, diabetes or hyperthyroid disease.
It's relatively easy to measure blood pressures in cats; however, it's not always the easiest thing to interpret the results since the stress of the car ride and being at the vet's office can raise it.
Could Feliway be responsible? I suppose since it is intended to reduce stress and anxiety at least in cats, anyway. Too bad it doesn't work for humans, right???
I usually tell owners to trust their instincts when it comes to their pets but in this case, I'm not sure how to more closely define what may be going on with her in the absence of specific worrisome symptoms and essentially normal blood work...at least the last time it was checked.
She's not acting like a cat in pain.
She's not acting like a cat who is blocked (extremely rare in female cats).
She's not acting like a cat who's in kidney failure.
She's not acting like a cat with a bladder tumor.
I know you're worried about her but she's not behaving like a cat in any sort of significant distress. Cats with bladder or kidney issues are typically urinating more frequently, not less.
In addition to the SMDA test I previously mentioned, the only other diagnostic test which you might consider would be an ultrasound which can better evaluate her kidneys and bladder than an x-ray.
If you'd like to share her test results, I can evaluate the numbers to determine if I agree with the three other vets you've consulted.