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Dr. Deb
Dr. Deb, Cat Veterinarian
Category: Cat
Satisfied Customers: 10141
Experience:  I have been a practicing veterinarian for over 30 years.
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For attn Dr Deb. Following on from last conversation. Have

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For attn Dr Deb. Following on from last conversation. Have opened a new question as this will be easier. Will forward blood test results shortly. I have abdominal x ray too which I will see if I can attach. Thanks for this. Jess x
Submitted: 9 months ago.
Category: Cat
Expert:  Dr. Deb replied 9 months ago.

Jess,

See how easy that was:)

Will look forward to reviewing the test results and x-rays. I have to step away from my computer for a little bit but will log back in shortly to see if you've been able to successfully post the information. Deb

Customer: replied 9 months ago.
it was easy. Silly of me not to do that before. I'm sorry. Can you zoomake in and read these values. This was the bloods done at the referral centre. They were reported to me as normal. Urea and glucose a bit high but he said as she was so stressed and fasted it wasn't unusual. I questioned the possible kidney connection to which he said it may be worth doing the SDMA in a couple of months or so to be sure back at my regular vet but he wasn't overly worried as her BP was perfect and her abdominal x ray showed normal size kidneys and other organs. This was just over a month ago so I guess new bloods may be needed soon. Urinalysis at my vets last Wednesday showed alkaline urine and a trace of blood. I am not sure if this was done with just a dipstick.....I hope not as I asked for thorough evaluation. I asked re specific gravity and glucose. They were perfect apparently. She did not mention protein so I assume nothing abnormal showed. I have requested bloods from when her oral surgery was done 4 months ago....haven't received them yet. At that time Dolly was prescribed a month on metacam which she didn't have as she stopped eating after 2 days of it. I'm pretty concerned the shape her kidneys may have been had she had a month on metacam!So tonight she has tried to pee three or four times and done two tiny pees. She seems to go in fits and starts. Currently sleeping quite relaxed but clearly still troubled by the cystitis. I still don't know if she might have crystals.....if no improvement soon will have to go back for further investigations I guess. In between she was OK. Played with her toys a bit had something to eat.....I wondered about giving her some apple cider vinegar? Have read some people have success with this. She seemed slightly better when having the antibiotics if I'm honest. Not sure what that means as the general consensus is that it's not bacterial.Just to complicate things she did scratch her hotspot again a bit. I managed to cover it to avoid badly injuring it again. She is now wearing soft claws which have been brilliant but she is licking at it a bit. Not harming herself but for some reason it's itchy again. Maybe the two things or all things are somehow related. I have no idea. It's a jig saw puzzle. Jess x
Expert:  Dr. Deb replied 9 months ago.

Jess,

If you sent a copy of bloodwork, I don't see it. Can you possibly resend?

I believe I may have mentioned this before, but my hospital rarely evaluates urine with just a dipstick in the hospital since several studies have shown them to be inaccurate. We almost always send them out to be evaluated. The downside is that the presence of crystals may simply reflect artifact because the urine wasn't evaluated within a short period of time. So, I try not to over interpret crystals when they're present in a patient's urinalysis.

It sounds as if her bladder may be a little irritated or she may be having an FIC episode. If a culture and sensitivity wasn't done, then we can't know for sure if she has a urinary tract infection or not. But, this would require having her rechecked, of course, and not necessarily something that I'd recommend since it will add to her stress level...which in turn could exacerbate FIC.

I've found that acidifying the urine with products which contain cranberry (such as Crananidin) may help to prevent future bacterial infections in dogs but it's not too effective once one has developed. To be honest, I've never used such products in cats. I'm not saying that she has a uti but just wanted to share this information with you.

She's not likely to drink apple cider vinegar on her own...not that I would suggest it anyway....and the risk of aspiration pneumonia not to mention the stress of giving it to her are other reasons why I wouldn't.

The only connection that I might make between her skin issue and what ever is going on with her bladder might be stress. Some cats will excessively overgroom (psychogenic alopecia) which can sometimes be directly related to stress...although it's not always easy to know what that stressor might be as I think I've probably said before.

I wish I had other helpful suggestions for you which might improve what ever might be going on with her bladder but, unfortunately, I don't.

If you have her rechecked, then I'd discuss an ultrasound with your vet to at least provide peace of mind.

Deb

Customer: replied 9 months ago.
Resending bloodwork.... x
Expert:  Dr. Deb replied 9 months ago.

Jess,

Looks like this time it came through so thanks for resending. I have a doctor's appointment this morning so I won't be back home for several hours. But when I do log back on, I'll respond after I've analyzed the results.

Deb

Expert:  Dr. Deb replied 9 months ago.

Jess,

Sorry that it's taken so long for me to respond back; everything took much longer than I expected.

I don't like to disagree with fellow professionals, but it looks as if I may have to in this case, unfortunately, now that I've seen Dolly's test results although it doesn't give me any pleasure to say so:(

I tend to follow the guidelines as outlined by the International Renal Interest Society (IRIS) when staging my feline patients with respect to kidney disease. (http://www.iris-kidney.com/pdf/staging-of-ckd.pdf). According to these guidelines, Dolly is in Stage 2 Chronic Kidney Disease (CKD) although an SDMA test (not done for her) may modify this categorization a bit. For example, if she is very thin, then her creatinine value may actually be falsely reduced; in other words, in reality there may be more renal dysfunction than is suspected.

Treatment options depend on which stage the patient is in. Rather than list what those options might be, it will probably be much easier for you to access the following link so that you can peruse the information at your leisure: http://www.iris-kidney.com/pdf/treatment-recommendation-cats.pdf

Many cats in Stage 2 CKD often don't show many, if any, signs and they can remain in this stage for a fairly long period of time; however, the goal of treatment is to identify any possible other issues (such as Hypertension) and address them to reduce as much as possible progression of the disease.

In order to more accurately stage her which will then help to dictate treatment options, several additional tests need to be done:

1. An SMDA blood test.

2. Urinalysis with Urine protein/Creatinine ratio (aka UPC) if protein is present.

3. Blood pressure measurements although as I think I mentioned before, these are sometimes difficult to interpret

I strongly suspect that I've added to your anxiety level which I hope you know is the last thing I want to do; however, the way I see it is that it's best to face these things head on. Looks like your instincts may have been right after all.

Deb

Customer: replied 9 months ago.
Thanks for your reply. Yes my instinct was telling me that the bloodwork was pointing towards CKD. It's frustrating as you can imagine that having asked for tests to rule in or out serious disease and having paid a lot of money for such tests I haven't really been given the right information. My local vet who last week ran the urinalysis told me her specific gravity was normal. No sign of kidney problems or diabetes.......so where do I go next? Meanwhile I keep getting sent away with metacam which I am fairly sure will finish her kidneys off. So now I need to go back and ask for SDMA? Also do you think these bladder issues are kidney related? Or are we dealing with 2 separate problems. Maybe they do not rush to diagnose older cats with kidney disease over here. I'm not sure we follow the same protocols in uk as you do over there.Lots to think about and more invasive tests ahead I guess. Thanks Deb. X
Customer: replied 9 months ago.
Just to add. She is not thin at all. She weight 3.4kg. She is a tiny cat and has weighed this most of her life. Her blood pressure was measured whilst having x rays and he remarked that it was perfect so I am not sure what all of this means. I guess many cats will lose kidney function as they age....I just have to bear that in mind. X
Expert:  Dr. Deb replied 9 months ago.

Jess,

No question, it's beyond frustrating:(

I'm not necessarily suggesting you take Dolly to another vet but this may be something to consider if you have other options where you live.

Cats are notorious for being able to concentrate their urine even when their kidneys are damaged so I don't rely on this value alone.

Metacam is certainly one of the last drugs I would have dispensed for her; in fact, I avoid it like the plague in all of my older cats, even those with all values at the lower end of the reference range.

If you want to more accurately stage her, then one way to do so would be with an SMDA test. If she didn't have any protein in her urine, then the UPC test isn't needed.

Normal blood pressures are great but, then again, what are they calling "normal"???? Since they said they weren't concerned about her creatinine value....just saying.

Many older cats do experience issues with their kidneys but it's not considered a "normal" function of aging.

Personally, think she may have more than one issue going on but I can't say that with certainty. I'd probably like to run a culture and sensitivity on her urine in addition to the SDMA if she were my patient.

Deb

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Expert:  Dr. Deb replied 9 months ago.

Jess,

I've just now seen your rating and wanted to thank you for it; it's greatly appreciated. Deb

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