Emma and Cuddles to the vet this evening - Early Stage Kidney Disease for Cuddles

Emma is the cat I got in June when my aunt died.  She is a spayed 12  year old, possibly a Turkish Van.  Front paws declawed.  She is out of date on her rabies shot and I needed to get that done.  She had a complete check up and needs a dental.  She only has about 6 teeth left, one is a canine with lots of tartar and redness, and it wiggles easily.

I took Cuddles in because she is losing weight.  She is my 13 year old tortie.  Vet said he could easily feel a tumor on her thyroid.  So Cuddles 'gave blood' and once we get the results we develop a plan.  Paws crossed she has no kidney issues, or anything else, and the thyroid is the only issue.  Seems she could also use a dental, but that is on hold till we learn more.

These photos are from last week.

Cuddle is far left, Bobby behind her, Tommy in front.  Crystal is on the cat perch.



Emma

Tumor on the thyroid, sounds like they think it's hyperthyroidism. Hoping for no kidney issues, although it's worth noting that if it is hyper-t, that can sometimes mask kidney problems, and treatment can un-mask them. But, hoping it's just the thyroid. Usually they eat more with hyper-t but in Sara's case, when the T4 was really high, lost her appetite, so that does happen.

Hopefully you get the results tomorrow and get some answers!

Vet just phoned with results of the blood work for Cuddles.  Interesting, after he hung up, I got an email with the entire report! 

Kidney disease is the issue.  First step is to get her on Hills k/d canned and dry.  In a multi cat household, where I usually have kibble available around the clock, this will get interesting.

Thyroid blood test is elevated but still within the normal ranges.  T4 normal is 0.8 to 4.7.  She is at 4.0

BUN and Creatnine were in the high normal range.  SDMA is quite high, normal is zero to 14, she is at 18.

I will have to go pick up the food this afternoon.  Vet would like a urinalysis, but the bladder was empty when I had her in for the exam.

Just phoned in to ask if I should put her on Azodyl, Epikitin, and AminAvast (new name for Renavast)  Tech is familiar with the first 2 but not the last one.  She will call me back.  Getting an Amazon order ready!

Based on the blood work, the vet said Cuddles should not be on Azodyl or Epakitin at this time.  Good thing I did not order!  He is not familiar with RenAvast aka AminAvast so could not say.

Azodyl, the cat has to be azotemic; Cuddles is not.

Epitikin, the cat has to be (I forget what he said) not only is her blood work ok but if she takes it she could go too low and then be in a crisis.  I don't need that!

So I got the food, kibble and canned, and some appetite stimulant.  Vet wants a urine sample, need to find out if she is throwing off protein.  So that is where we are at!

Freedom said:

 
Vet just phoned with results of the blood work for Cuddles.  Interesting, after he hung up, I got an email with the entire report! 

Kidney disease is the issue.  First step is to get her on Hills k/d canned and dry.  In a multi cat household, where I usually have kibble available around the clock, this will get interesting.

Thyroid blood test is elevated but still within the normal ranges.  T4 normal is 0.8 to 4.7.  She is at 4.0

BUN and Creatnine were in the high normal range.  SDMA is quite high, normal is zero to 14, she is at 18.

I will have to go pick up the food this afternoon.  Vet would like a urinalysis, but the bladder was empty when I had her in for the exam.

Just phoned in to ask if I should put her on Azodyl, Epikitin, and AminAvast (new name for Renavast)  Tech is familiar with the first 2 but not the last one.  She will call me back.  Getting an Amazon order ready!

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4.0 is definitely in what they refer to as "the grey zone". It's normal, but they prefer it below 2 if I remember correctly. It can also mask kidney disease symptoms, so it's possible her kidney levels would be a bit worse if her T4 was down below the "grey zone".

Question - was this the first blood work they've had recently? I'm just surprised they'd diagnose kidney disease based on one blood test. Especially with the values so... not crazily off. Not sure how else to put it. SDMA is a godsend but it's also a bit new (came out in July I think) so CAN be an indicator of early kidney disease in the presence of other symptoms. Not eating is definitely a symptom, but it could be a symptom of oodles of things at that. Anyway, not saying she doesn't have it, just saying it's weird to have a diagnosis with only the one test.

Yes this is the one blood test; not had one in over a year.

Last night I gave her the appetite stimulant, but then I set down the food bowl right away.  The medicine couldn't possibly have had time to be absorbed.  She polished off the bowl, licked it clean.  K/d kibble plus one small can of k/d.  So I won't give the stimulant again, that is not an issue.  This morning she has again cleaned her bowl.

She gets a recheck on blood work in 3 months.  Should I be asking for something more, now?  She had the T4.  I know there is Free T4, T3 and Free T3.  Never have understood which is more important and when.

At this time, the vet said we should address the kidney issue and try to get her weight back up.  With luck we will see that at the 3 months mark when we redo the blood work. 

What do you think?  The blood draw was Monday, this is Friday, not sure if the lab would still have the sample, if I ask for another test on it, but may be worth a try.  I just wouldnot know which to ask they do!

Here is the lab report; I had to do it in 4 parts.  I made sure to overlap a bit on each so you are not missing anything. Does this help?





Yes just the one blood test.

And, I discovered last night that she does eat, ravenously!  I gave her the appetite stimulant, but immediately put the food down, so the medicine could not possibly have had time to work.  She polished off the entire bowl, licked it clean!  I was shocked.  So I will not use the stimulant again (it was to be every 3 days).  Again this morning, she has polished off her bowl.  K/d kibble and one small can of k/d food, GONE in a flash.

She is supposed to have another blood test in 3 months.

Should I be asking for something more than the Rd\\

If it is kidney disease, appetite can come and go at the drop of a hat. Hopefully you won't need the stimulant again, but just be aware of that possibility. 

I would definitely inquire about the T4. Anything above 2.5 - 4.7 is considered a "grey zone", which mean it can be considered normal or high, depending on circumstances. My vet says they definitely prefer it to be under 2. Anything higher than that is on major watch.

I don't think they need to do any more tests just yet. Personally, I wouldn't want to wait three months to re-test though. I think that is sufficient amount of time to see if the k/d is keeping it at bay. The current values may not go down, but if they stay the same that should be ok. Plus I have a feeling that T4 could go up as time goes on. If you notice she starts going bonkers with eating - as in, eating as if she can't get enough and not gaining weight (or possibly losing weight), don't even wait a month. Those are very classic symptoms of hyperthyroidism.

Like I said before, not saying it's not kidney disease. It definitely seems like there are things brewing that will ultimately need attention. If it is kidney disease, the k/d should help as it's still pretty early stages. And I don't personally think it's bad for her to have it, it's not like she's a kitten or anything. It will also help with the weight since there k/d is relatively high in calories. If she has the hyper-t though, you may find she doesn't gain weight. So just keep an eye on that. And see if it's doable to get another blood test in a month instead of three. It may sound like overkill, but generally when treating something new, you usually want to get blood work sooner than three months. 

Thanks!  Part of the problem, why we set follow up for 3 months, is that I am having a left total knee replacement Jan 20th, and will not be able to drive for 6 weeks post op.  Having a bit of trouble lining up rides for ME, and not sure I could swing a follow up for Cuddles.  Of course if she shows a major change I WILL get her in somehow.  But for setting the appt., we decided on 3 months, due to my situation.

Freedom said:

 
Thanks!  Part of the problem, why we set follow up for 3 months, is that I am having a left total knee replacement Jan 20th, and will not be able to drive for 6 weeks post op.  Having a bit of trouble lining up rides for ME, and not sure I could swing a follow up for Cuddles.  Of course if she shows a major change I WILL get her in somehow.  But for setting the appt., we decided on 3 months, due to my situation.

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Oooooh ok, well that is an entirely different story. I thought the vet just didn't want to see her for three months. I get sometimes we have to work around other things. My mom had that a few years ago so well aware of how long it can take to recover. She was in in-patient rehab for about three weeks afterwards, I don't think that's the norm though.

Hopefully you won't have any issues with Cuddles in the three months then. Just make sure you have enough k/d on hand so you don't have to worry about it. And maybe get some individual cans of various foods just in case she goes into an "I'm not eating and you can't make me" mode.

Vet wants a urine sample. At her exam, Cuddles' bladder was very small, the vet said he couldn't get any with a needle, she must have peed just before I got her in the carrier. The office suggested I use a small litter box, put in some litter so she feels it beneath her paws, cover box with plastic. They gave me a syringe and capped bottle so I can syringe up the urine. Sounded good!

Cuddles spent all day Friday in one bedroom, with her food and water bowls, and the above. I went in a few times to check, no urine in the box. Come bedtime, I realized yes she had pee'd - ON THE BED! Moved her with her entire set up into the bathroom. Changed bed, started laundry, went to bed. Cuddles howled and hammered at the door for 3 hours. I couldn't stand it so I went in to check.

Yep, she peed, AND pooped, IN THE BATHTUB!

I am being outsmarted by a cat!

Freedom said:

 
Vet wants a urine sample. At her exam, Cuddles' bladder was very small, the vet said he couldn't get any with a needle, she must have peed just before I got her in the carrier. The office suggested I use a small litter box, put in some litter so she feels it beneath her paws, cover box with plastic. They gave me a syringe and capped bottle so I can syringe up the urine. Sounded good!

Cuddles spent all day Friday in one bedroom, with her food and water bowls, and the above. I went in a few times to check, no urine in the box. Come bedtime, I realized yes she had pee'd - ON THE BED! Moved her with her entire set up into the bathroom. Changed bed, started laundry, went to bed. Cuddles howled and hammered at the door for 3 hours. I couldn't stand it so I went in to check.

Yep, she peed, AND pooped, IN THE BATHTUB!

I am being outsmarted by a cat!

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The one doctor at my vet's office is considered the "cysto-king" because can always get it, no matter how little there is. And usually with just the one stick. 

Kitties are pretty stubborn. Were you able to suck up any of the urine from the bathtub into the syringe? Not ideal but something tells me that might be the only chance you had lol.

Donutte said:

 
The one doctor at my vet's office is considered the "cysto-king" because can always get it, no matter how little there is. And usually with just the one stick. 

Kitties are pretty stubborn. Were you able to suck up any of the urine from the bathtub into the syringe? Not ideal but something tells me that might be the only chance you had lol.

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Nope, she pee'd over the drain, pooped next to it!  Tomorrow I will try again.  Didn't over the weekend as the vet office hours weren't going to work for me.