Internet or the Vet?

taomom · Sep 22, 2016

So after I get results from my vet, I do ask her questions but I also do my own research online. The vet told me that my 13-year old cat's recent blood test was pretty good(click pics below to enlarge):

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taomom
Sep 22, 2016

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taomom
Sep 22, 2016

http://www.felinecrf.org/how_bad_is_it.htm

http://www.2ndchance.info/dxme-CreatBlood.htm

http://www.allfelinehospital.com/chronic-kidney-disease.pml

But according to the links that I saw online about kidney disease, a cat with a creatinine level 2 and above can be stage 2 to stage 4 kidney disease. She doesn't think that my cat has kidney disease but more likely intestinal cancer(small lymphoma) because he has thickening in the stomach combined with an occasional vomiting and constipation/diarrhea. I hired another vet, this time an in-house vet, she believed that my cat does have kidney disease. Who to believe?

Now the vet from the clinic who told me that my cat could have small intestinal lymphoma mentioned that we can do an endoscopy to confirm if he does have the cancer. She said it is about 90% to 95% accurate. I did my research, according to internet sources, it's hard to see through small intestine with endoscopy. Soooo confused now on what to do....

denice · Sep 22, 2016

I know what you mean about the internet. I too consult Dr Google but I always go with the vet. I do ask about what I found on the internet. Small cell lymphoma is very difficult to diagnose even with a biopsy. The most reliable biopsy is a full thickness intestinal biopsy which involves major surgery. I have an IBD kitty and this question of which it is always comes up. A vet experienced with reading ultrasounds can tell a lot from the ultrasound but it still isn't definitive.

Fortunately I haven't dealt with CKD so I don't know a lot about it. From what I have read here it is much easier to diagnose from blood test results.

I believe that vet medicine is at least partially art rather than science just as human medicine is. Have you found a vet that you trust? If so than I would always go with the vet that you trust rather than Dr Google. Which vet do you trust, that is the question? I take it you went to another vet for a second opinion which is fine. Was their something about the first vet that made you want a second opinion?

taomom · Sep 22, 2016

The vet thinks it can be either IBD or lymphoma, but she said mostly likely lymphoma because of his age. I wish I can find a vet I can 100% trust! What influenced me to try the in-house vet is because if the time comes that he has to go(hopefully he has more quality years), I would like to have him put down in the comfort of his home. He gets really violent and stressed being in the veterinary clinic to the point where he always poop and pees on himself. This is the main reason I don’t want to do a biopsy.

Geoffrey · Sep 22, 2016

I am a physician in internal medicine, human, not feline, so any advice that I give about your cat should be checked with your vet. Having said this, the blood tests that you have posted are all within normal limits, in particular the BUN and Creatinine, so any kidney disease that your cat may have is likely to be mild. Incidentally there are no urine tests shown, these are important - were they normal?

The most important thing to consider is neither Google nor pathology - but the actual symptoms. Does your cat have any urinary symptoms such as passing more urine than usual? Is the cat unduly thirsty? Are the motions normal? Is the weight stable? Is the appetite normal? Does the cat look sick? These are much more important than an ultrasound scan, a biopsy or a shower of blood tests!

If you do not know what you are treating and if there are no obvious abnormalities, then you can try waiting and careful watching (expectant treatment) - and there are only three possible outcomes from expectant treatment:

1. The patient gets better - and you have cured him!

2.The patient becomes worse - and this may produce symptoms and signs that will clarify the diagnosis.

3. There is no change - so you wait some more.

The other thing that I taught in human medicine was that you are not treating a blood test, nor an X-Ray, nor a scan. You are treating a person - and this applies just as much to your cat as it does to a human!

With all best wishes,

Geoffrey

missmimz · Sep 22, 2016

You can't diagnose kidney disease off of just creatinine levels. Raw fed cats, for example, often have higher creatinine levels but are not CKD. If you're worried about kidney function get a urinalysis, and next time ask for an SDMA on blood work, which can diagnose early stage kidney disease.

Geoffrey · Sep 22, 2016

missmimz said:
You can't diagnose kidney disease off of just creatinine levels. Raw fed cats, for example, often have higher creatinine levels but are not CKD. If you're worried about kidney function get a urinalysis, and next time ask for an SDMA on blood work, which can diagnose early stage kidney disease.

High protein diets cause high normal or slight elevation of the creatinine because creatinine levels are a function of nitrogenous foods.

Urine tests can demonstrate increased protein and white and/or red cells and these abnormalities would be suggestive, but not diagnostic, of kidney disease. The urine in a patient with prostatic disease or a tumour of the bladder can also have these abnormalities.

Incidentally early or mild kidney disease can be present with normal blood urea and creatinine, however an elevated creatinine may be the first abnormality in nephritis.

With kind regards,

Geoffrey

taomom · Sep 23, 2016

urinalysis.jpg

taomom
Sep 23, 2016

Geoffrey, vet said his urinalysis were normal except for the pseudomona that he had since 4 years ago(we tried to cure this with different types of antibiotic with no luck). My cat does seem to urinate this year more than last year..I also been giving him more water too and have recently bought him a water fountain. He lost 1 pound this year but his appetite is back from the episode of diarrhea he had a couple of days ago. I should buy a baby scale to keep track of his weight at home! I might have to wait it out with any surgery…I’m kinda nervous about having my cat going through endoscopy or biopsy because every time he goes to the clinic vet, he poops or pee on himself. He was good with going to the vet almost all his life up until the point where he had a dental cleaning for the very first time last year. Now everytime he goes to the vet, he is terrified.

Missmimz, my cat cannot tolerate raw meat (he started to vomit more on that). But his diet consist of mix of canned and homecooked meat. I would say that he is on a high protein diet because even the canned goods that I buy are “grain-free.”

Pics just took today of my cat, it looks like he is starting to feel better:

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taomom
Sep 23, 2016

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taomom
Sep 23, 2016

Geoffrey · Sep 24, 2016

The pseudomonas infection appears to be very resistant to every antibiotic except Amikacin, this is typical of pseudomonas infections and I would agree about reserving the Amikacin for when the vet thinks the cat really need it . The trace of protein is consistent with mild nephritis but the test for micro albumen has not been done; this test may be necessary to help diagnose nephritis. I would avoid a high protein diet, there are special foods for cats with kidney disease and the best include Royal Canin and Hill's prescription diet. You should ask your vet about these and about the test for microalbumen.

Your cat is a real beauty!

With kind regards,

Geoffrey

taomom · Sep 24, 2016

Thanks for the info, I will talk to the vet about Amikacin. I've included the Hill's K/D prescription food in his diet along with homemade fresh meat.
As far as high protein diet goes, it shouldn't be bad as long as it's high grade type of meat right?
A lot of commercial canned goods and dry kibbles are not that good quality plus they are processed. This is probably what's making most cats have kidney disease and cancer

It's like a human eating processed canned good or packaged food all his/her life, eventually it will take a toll on the most important organs.

Geoffrey · Sep 24, 2016

TaoMom said:
Thanks for the info, I will talk to the vet about Amikacin. I've included the Hill's K/D prescription food in his diet along with homemade fresh meat.
As far as high protein diet goes, it shouldn't be bad as long as it's high grade type of meat right?
A lot of commercial canned goods and dry kibbles are not that good quality plus they are processed. This is probably what's making most cats have kidney disease and cancer It's like a human eating processed canned good or packaged food all his/her life, eventually it will take a toll on the most important organs.

It seems to me that combining fresh meat, a high protein food, with Hill's KD, a low protein food, is defeating the purpose of using Hill's KD! You should ask your vet what to give to your cat .

Nobody knows why so many cats develop kidney disease, however it is most unlikely that it is due to poor quality meat (whatever is meant by "poor quality" meat.) and I have never heard that "poor quality meat" causes cancer, neither in humans nor cats. However there is certainly a controversy about a high protein diet causing cancer! Feeding tinned or packaged meals to humans all their life will certainly cause problems due to vitamin deficiencies. However this has nothing to do with too much, or too little protein in the diet.

There is nothing wrong with doing your own feline, or human, medical research on the internet, but my advice is to be very careful about believing what you find. There is no control over what is put online and anybody with an axe to grind can - and does - publish as much unmitigated nonsense as they like.

With kind regards,

Geoffrey

taomom · Sep 24, 2016

Geoffrey said:
Nobody knows why so many cats develop kidney disease, however it is most unlikely that it is due to poor quality meat (whatever is meant by "poor quality" meat.) and I have never heard that "poor quality meat" causes cancer, neither in humans nor cats. However there is certainly a controversy about a high protein diet causing cancer! Feeding tinned or packaged meals to humans all their life will certainly cause problems due to vitamin deficiencies. However this has nothing to do with too much, or too little protein in the diet.

There is nothing wrong with doing your own feline, or human, medical research on the internet, but my advice is to be very careful about believing what you find. There is no control over what is put online and anybody with an axe to grind can - and does - publish as much unmitigated nonsense as they like.
With kind regards,
Geoffrey

High quality means organic food that has not been treated with antibiotics or hormones and without the use of synthetic fertilizers or pesticides. Poor quality is basically the opposite to me.

Why would packaged meals or canned food cause vitamin deficiencies for humans? Aren't there packaged meat and vegetables like Lean Cuisine and Healthy Choice? And these processed food have preservatives(to extend shelf life) and sodium, so must be the same for cat canned goods and kibbles. They are convenient, but are they really good for the body? I fed my cat processed kibbles for most of his life, maybe if I fed him more organic fresh meat, he wouldn't have this problem

I agree we can't believe everything we see online, but can we really say that what everyone says in real life is not unmitigated nonsense?

Internet or the Vet?

taomom

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denice

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