ckd kitty piglet - trying to hash out ideas

my 9.5 year old piglet has herpes and mild asthma (currently untreated).  she developed a tooth issue that originally looked like a teensy chip - vet said the enamel was chipped off, exposing the dentin.  he said the tooth would die and have to be extracted.  mmmokay.  after a few days, the gum started to swell around it; i began to suspect FORL but the vet will not say that's what it is.  piglet was still eating, using her box, pretty normal - just a bit lethargic.  when her tooth really seemed to be getting covered with the gum, i decided it was time to extract it and made the appointment.

well, an hour after i dropped her off, the vet called and said they couldn't do it because of her kidneys.  they told me she had some kind of infection in the kidneys or bladder but her numbers were bad.  the gave her an antibiotic shot, a bag of fluids, and sent her home with a month of amoxicillin (50mg) and a renal diet.  which she won't eat.  of course.

so here are her numbers from 3/7 (the vet did a wellness panel and urinalysis):

ALB 4.4g/dL

ALP 0

ALT 53 U/L

AMY 1172 U/L

TBIL 0.3 mg/dL

BUN 84 mg/dL

CA 10.8 mg/dL

PHOS 6.2 mg/dL

CRE 4.7 mg/dL

CLU 121 mg/dL

NA+ 144 mmol/L

K+ (says HEM?)

TP 8.5 g/dL

GLOB 4.1 g/dL

urine color, yellow; appearance, clear.

spec grav 1.015

PH 6.0

billirubin neg

urobilinogen 0.2

blood 3+

ketones neg

nitrate neg

protein 1+

glucose neg

leukocyte esterase 1+

wbc 5-10

rbc 20-50

epithelial cells 0-5

bacteria 2+

(everything else negative)

at that time, the vet said the blood and bacteria in the urine pointed to an infection, which might be inflating the BUN and creatinine.  we tried the renal diet, piglet wouldn't eat it, so i switched all my cats to wellness complete indoor health (recommended by a hill's rep i know through the grapevine) and we're using a few different canned varieties with quality protein sources and lower phos (under 1.2% - usually nature's variety instinct and pride).  prior to this, my cats were all eating nature's instinct raw kibble and stella & chewy's dehydrated raw.  

after three weeks, piglet's tooth is completely covered by her gum (it's a canine, forgot to mention that). i took her back for a CBC last saturday because the tooth needs to come out... there's two pages of stuff and i'm not sure what's important, but here's a bunch of the abnormals...

BUN 61

CRE 3.5

PHOS 4.5

MCV 58.2

MCHC 29.3

PLATELETS 40 (!!)

MONOCYTES % 5.2

RBC Morphology 2+

Anisocytosis 3+

Poikilocytosis 2+

i'm thrilled that her BUN, creatinine, and phos levels are down a bit - to me, that means that we were treating an infection; but those are still high numbers.  she was properly hydrated - the vet said she wasn't dehydrated at all.  but i'm confused about the other stuff - such low platelets?  am i looking at a vitamin deficiency as well?  

so the vet says he wants to do the extraction... but keep piglet in the hospital for TWO DAYS prior to the surgery, just to have her on IV fluids.  i asked if i could administer subq at home the days before, and he said no.  and he also said it's not necessary to put her on subq....

i've talked to another vet (or two) who state the surgery can be done same day - they'd take a ckd cat with piglet's numbers in early, get her on fluids right away, and keep her on fluids during the procedure.  neither seem to think a hospital stay is necessary based on the current info we have (one vet has not seen the numbers; just based on what we discussed).  i guess i'm just confused.  i want to do the best by piglet, but i don't want to put her through a bunch of unnecessary crap.  i think i'm just looking for other ideas.  no judgements please!

OK, first, WHY did the first Vet want to have her on IV fluids for 2 days prior to the extraction?  Was it just for fluid therapy, or was it going to be fluids with antibiotics in them?  I can't imagine just fluid therapy if he said she doesn't need sub-qs.  So I would seriously question what the intention is, AND what those other numbers means, the MCV, platelets, etc.  

Did you ask that same question of the other two Vets you talked too:  (I mean what those out of whack numbers meant?)  I would ask that question before making any decision, than try to base my decision on the answers.  If you can't, then come back here with their answers and we'll try to give some feedback. 

When I first started reading I was surprised they wouldn't go ahead and extract the tooth even on a kitty with CKD, but thought, ok, maybe they are just going to wait a while to see if it's all caused by an infection .  At least I'm glad your original Vet (and now a couple others) are willing to do it.

BTW, no judgements here....I feed raw and canned both, continue to do it, and one of mine developed kidney disease.  Just one questions.  I see what you fed was kind of raw kibble.  Did you see if they drank plenty of water, or did you rehydrate the Stella and Chewy's?  Just wondering.  None of mine like it rehydrated, but luckily my kidney cat LOVES her drinking fountain, and always has, so at least I don't have to worry about her keeping herself hydrated, at least at the moment.  For the other two, I add extra water to their "real" raw and canned  food, because they do LOVE their Stella and Chewy's "treats".

Keep us posted as to what happens with Piglet.

thanks for the reply.  current vet said they wanted to give her fluid to help flush the system - no iv antibiotics pre-surgery.  that's one of the things i'm so shocked about. i'm shocked enough that i don't even know if i want to question it! i just kind of want to run.

i contacted a veterinary dentist who said the surgery would be done in one day, but they have not yet seen the numbers.  i told them it was moderate-advanced and they said that was no problem.  i have a friend who is a vet tech (whom i really never bother for professional advice, but this was important) who has seen BUN/creatinine/phos and said she and her vet would do it in one day as well.  i have not specifically asked her about the other numbers because i don't want to overstep my boundaries.  i've done some research on my own on the MCV, platelets, etc. and it looks like it could be from cancers and vitamin deficiencies.  the deficiencies could definitely be a possibility from the ckd; the super low platelet count has less concerned now because i read the smallest print on my copies of the bloodwork and it says 'platelet clumping observed' and i found that platelet clumping can happen and can often throw off the platelet count.

re: infection, piglet's almost done with a month long round of amoxicillin.  her tooth is no better, so that is definitely not due to infection.  i have a consultation set up with the only veterinary dentist on long island (really, just one!) on monday.  they do the consultation first thing in the morning and, if appropriate, will do surgery the same day.  i called my current vet for a referral and, while the paperwork is available to be picked up, the message i got from the vet seemed kind of pissy... how they're just trying to be as careful as possible blah blah blah.  when i called back to have them fax it directly over, i was told 'there are a lot of pages and i can't do it, just come pick it up'.  

which is just about the last straw for me.  this vet is over 20 miles from me (which isn't far in some places, but i literally pass 4 vets on the way there, and there are at least 2 dozen that are closer) and i only went back to them because i trusted them.  

re: canned & raw - they have fresh water daily.  i rehydrated the stella & chewys, they loved it super wet.  it's been hard for me because my old cat was dx'd with ckd and we used diet only to keep him alive in early stage kidney failure for 5 years.  the more i researched, i learned about better foods and raw feeding.  they had been eating high quality foods supplemented with raw for over a year, raw exclusively since august.  i don't know what about it might not have been good for piglet - too much protein?  too much calcium/phosphorous?  i don't know.  but apparently it didn't work for her.  i'm happy enough with the combo we're using now - as long as my bengal mix doesn't gain weight (we were able to get him from 19 to 16 pounds on a raw diet).

My current  CKD cat was eating true raw (I mean ground up meat/liver/bones/supplements) when it was discovered that she had kidney disease.  BUT, she had been on kibble for the first 12 years of her life, so i tell myself that's the reason it happened.  Don't know if that's true or not, but that's what I tell myself.  Anyway, My Vet and I discussed it and decided it would be ok if she continued on raw, but because bones are high in phosphorus, decided to use eggshell powder instead of ground bone to try to lower the phosphorus, and stop feeding any egg yolks, as they are FULL of phos.  But, just about that  same time my little one decided to go on a raw strike (except for the DRY Stella and Chewy's ), so now she's gone to canned food altogether .  it's better than kibble, but she doesn't like any of the "good for her" ones (low phos).   At this point, though, I happy just to have her eat anything.

we've always fed some sort of kibble for convenience (or so we can sleep through the night - we put a bit down at bedtime).  the nature's variety instinct kibble is the closest you can get to 'raw' kibble, and my cats love love loved it.  but with three, it's hard to feed them all different foods.  and i have trouble with the kidney foods - i tried purina and iams even though i hate the ingredients, and i won't bring hill's products in this house.  piglet won't eat either purina or iams k/d so we've moved on.  nature's variety instinct and pride canned are low-ish in phos, most varieties of pride are under 1.2%.