Cannot tell whether it is kidney issue or else?

[whc216]

Hello again,

I am still frustrated to pinpoint what is wrong with my 11 year old cat, and curious if someone can help me?

Before my last vet visit (4 weeks ago), it was 7 months ago and the blood work result was saying that I needed to watch out for her Kidney, but the doctor did not really raise the issue. No CKD, no stage,...just asked if I can do fluid treatment regularly. At that time, her Urea Nitrogen was 39 and Creatine was 2.2.

Moving forward, I went to the vet again 4 weeks ago for a regular check-up. After the vet visits this time, she went through extreme stress which caused her multiple complications. During the visit, we did blood work and x-ray because I spotted her pulling/stretching her neck not often (I don't think it was daily but I just noted to my vet). The x-ray revealed her heart seems enlarged and the vet encouraged me to go to the specialist. The blood work revealed extremely elevated Kidney (Creatine 3.9 and Urea Nitrogen 84), elevated WBC, and low hemoglobin and HCT. However, my vet did not still bring too much concern about the kidney and cannot prescribe or diagnose any until I visit the cardiologist. From my search, this kidney level is very bad?

The thing is that my cat is extremely shy and we have never done this much examination before. After this visit, she was so stressed that when we returned, she couldn't breathe or breathed very fast, refused to eat, and had so many symptoms I have not seen before the visit. Really, things went very downhill. I lost another cat a year ago due to multiple vet visits in a short time that gave him stress and his symptom got worse quickly, so I personally told myself not to repeat it. I know a home vet visit is an option but I would like to hold off for a while too. My cat is very shy and does not like strangers so I don't want to make the symptom worse. I know I am asking a lot.

The past couple of weeks, I made her feel comfortable, and she slowly starts eating and walking around. When we got back from the vet visit, she refused to eat but drank a lot! That made her go to the litter box 4-5 times daily. Now, I think I still see her drink but see her going to the litter box 2-3 times a day. However, I think her pee is still clear and odorless. She also lost a lot of appetite after the visit. It became better, but still, not the same as how she was before the visit. She used to eat dry food and wet food but nowadays, no dry food, and no temptation (it was her favorite), and she also became very picky about wet food suddenly. Additionally, Dyspnea? I do see her breathe deeply because I see her rib moving too, and when she lays down in a different posture (like showing belly),that causes her difficult to breathe and in few seconds, she has to come back to breading posture. However, in average,her breathing count is like 24 per minute. I haven't seen her throwing up yet. I see her poop fine (good look), but that is also every 2-3 days due to amount she eats? She doesn't scream or anything. One thing I need to make a note is that my another cat got Herpes or some sort of cold virus before so I was bit skeptical my cat also got one because I saw her watery eye (which I see it, gets better, then I see it again and constant loop).

I know it's been 4 weeks so I should be patient but really cannot pinpoint where and what is wrong and where I should make her feel comfortable next few weeks. The thing is last blood work from 4 weeks ago was extremely high kidney level that seems CKD, but my vet never raised a concern, and I am not sure if this is kidney, heart, or multiple issues, or what...I plan to try out in house vet visit but not next few weeks until she gets more comfortable, so anyone with similar experience, thought, or suggestion, I really really appreciate it.

Thank you so much

 

[Byrdie]

I understand your distress. I am not a vet, of course, but I can try to help. It does sound like, perhaps, there is a kidney issue going on since your vet implied that you may want tongive your kitty subcutaneous fluids. Is your kitty drinking a lot? My old girl (passed) had kidney issues and loved the fountain I gave her. Is she still urinating inside of the box? If so, that is good. Urinating outside of the box has many reasons - kidney trouble being among them. Perhaps your vet did not express great concern because it is early in its process. Hydration critical. Treats like Temptations may have high ash content that may also contribute to kidney problems. High WBC is a marker for infection, of course, but it is also a sign of inflammation.
Vet visits totally stress my guy. Stress affects kidneys. Watch your stress, too, about your kitty; cats absorb stress and I read they even smell anxiety. I always say that cats are our barometers: I look at my kitty and I know how I am doing.

P.S. Maybe best not to focus on ALL concerns at one time. Addressing the biggest concern, first, can sometimes bring other health issues into balance.

 

[silent meowlook]

You never want the diagnostics to kill the cat. So, I am just speaking as if this were my cat. I would not be stressing her out with another vet visit right away. If you see a cardiologist, what good will it do? Maybe tell you to take it easy on the SQ fluids so you don't send her into heart failure? Well, you could take it easy with the fluids anyway. You would kind of have to because she is already anemic. The elevated white blood count could be infection, could be something bad like cancer or could be a transient lymphocytosis that cats can get when stressed. It depends on what white blood cells were elevated.

There are heart medications that a cardiologist could put your cat on, but is it worth the stress of the visit? Nobody knows, but I would probably not stress my cat out again. The breathing you described sounds like she was extremely stressed.

Keep multiple water sources around and let her and encourage her to drink all she wants. Mix water in the food, try to feed whatever she will eat right now. Eating is very important. Many times, cats with kidney disease can get very nauseous. It is a good idea to have an antinausea medication on hand like Cerenia. You can also ask for an appetite stimulant like Mirtazapine. They even make it in a transdermal formula that your rub on the ear. You should be able to call your vet or email to get those medications or something similar for your cat. I think you should also let them know how upset your cat was after the exam. There is a medication called Gabapentin that you can give prior to the exam to help the cat not be as stressed.

Try asking your vet to email you a copy of the blood work that they did. They should be able to email it to you.

I am sorry your cat is not feeling well. I understand you not wanting to stress her out. I think you are the best one to make the decision to take her again or not

 

[whc216]

I understand your distress. I am not a vet, of course, but I can try to help. It does sound like, perhaps, there is a kidney issue going on since your vet implied that you may want tongive your kitty subcutaneous fluids. Is your kitty drinking a lot? My old girl (passed) had kidney issues and loved the fountain I gave her. Is she still urinating inside of the box? If so, that is good. Urinating outside of the box has many reasons - kidney trouble being among them. Perhaps your vet did not express great concern because it is early in its process. Hydration critical. Treats like Temptations may have high ash content that may also contribute to kidney problems. High WBC is a marker for infection, of course, but it is also a sign of inflammation.
Vet visits totally stress my guy. Stress affects kidneys. Watch your stress, too, about your kitty; cats absorb stress and I read they even smell anxiety. I always say that cats are our barometers: I look at my kitty and I know how I am doing.

P.S. Maybe best not to focus on ALL concerns at one time. Addressing the biggest concern, first, can sometimes bring other health issues into balance.

Thank you very much for the reply. I know the vet is there to help but it stresses my cat too much (she is really shy, took me 3 months to allow me to touch her forehead...) and how I lost another one from stress, I really need to reserve the visit or even in-house visit for at least few weeks.

Thank you so much for sharing your story. In terms of urinating outside of the box, I read this too about kidney issues. Is this everywhere because the cat cannot hold it? I asked because 2 weeks ago, I bought a new mat that she tended to pee there. I read some posts about rubber smell could contribute to that, so I removed it and also cleaned the spot with an enzyme cleaner. Since then, she pee there several times, but it was the exact spot. Yesterday, I decided to block the area and she went to the litter box and used it regularly. She has done similar behavior a few months ago, just peeping in the empty litter box located in front of one of the bathrooms, and then stop doing this behavior after a few weeks. She went to the litter box consistently after. I couldn't determine if this is behavior or kidney related issue since if she pees outside of the litter box, then it would be the same spot (even if I clean). So I am curious when urinating outside of the box means how?

Thank you so much and looking forward hearing back from you.

 

[silent meowlook]

Hi. There can be many reasons a cat will urinate outside the box.
She can’t make it in the box in time.
It is hard for her to get inside the box, arthritis or other pain.
Has had a bad experience in the box.
Feels trapped in the box.
Doesn’t like the litter.
That box is for pooping only ( in the cat’s mind)
Box isn’t clean enough.
Doesn’t like the location.

That’s just to name a few. You always want to have one box per cat plus one. Make sure the litter is unscented. Try different types to see if she might prefer a finer litter.

Of course it is probably somewhat medical in her case. But also, try different things to come up with something that works for her. I have taken an under the bed storage container and used that as a box because the sides are lower.

Sometimes with cats with kidney disease, they urinate allot and their feet get litter clumped on them and it hurts. Check the bottom of the paws and in between the toes for litter clumps.

I would still call your vet and ask about transdermal Mirtazapine for appetite, and Cerenia for nausea.

 

[whc216]

You never want the diagnostics to kill the cat. So, I am just speaking as if this were my cat. I would not be stressing her out with another vet visit right away. If you see a cardiologist, what good will it do? Maybe tell you to take it easy on the SQ fluids so you don't send her into heart failure? Well, you could take it easy with the fluids anyway. You would kind of have to because she is already anemic. The elevated white blood count could be infection, could be something bad like cancer or could be a transient lymphocytosis that cats can get when stressed. It depends on what white blood cells were elevated.

There are heart medications that a cardiologist could put your cat on, but is it worth the stress of the visit? Nobody knows, but I would probably not stress my cat out again. The breathing you described sounds like she was extremely stressed.

Keep multiple water sources around and let her and encourage her to drink all she wants. Mix water in the food, try to feed whatever she will eat right now. Eating is very important. Many times, cats with kidney disease can get very nauseous. It is a good idea to have an antinausea medication on hand like Cerenia. You can also ask for an appetite stimulant like Mirtazapine. They even make it in a transdermal formula that your rub on the ear. You should be able to call your vet or email to get those medications or something similar for your cat. I think you should also let them know how upset your cat was after the exam. There is a medication called Gabapentin that you can give prior to the exam to help the cat not be as stressed.

Try asking your vet to email you a copy of the blood work that they did. They should be able to email it to you.

I am sorry your cat is not feeling well. I understand you not wanting to stress her out. I think you are the best one to make the decision to take her again or not

Thank you so much for the reply! I really appreciate it. It's been frustrating as I am in a constant internal conflict of let's ease my cat's stress and leave her alone vs. what can I do to help without going or asking in-house vet for few weeks, but it is also hard to see her having issues so any type of advise helps. Your advise definitely help me a lot. I understand it's ultimately my decision

Is it possible the breathing issue keeps ongoing given it's been 4.5 weeks since the vet visit? It's something I have not seen before the visit and not sure how long it would go more or is it related to heart...which I never know until another diagonosis.

Yes, I received all those result while ago and have it on my hand. I called a week after the vet visit, but my vet did not really want to go further about further diagnosis unless I bring her again or go to a cardiologist. As a result, nothing has really been prescribed and I am basically try to pinpoint if this is really from stress or something is going on I have thought about some sort of telehealth or somewhere I can get consultation without anyone's visit, but I am not sure if it is good or anyone had good experience.

Thank you so much again

 

[whc216]

Hi. There can be many reasons a cat will urinate outside the box.
She can’t make it in the box in time.
It is hard for her to get inside the box, arthritis or other pain.
Has had a bad experience in the box.
Feels trapped in the box.
Doesn’t like the litter.
That box is for pooping only ( in the cat’s mind)
Box isn’t clean enough.
Doesn’t like the location.

That’s just to name a few. You always want to have one box per cat plus one. Make sure the litter is unscented. Try different types to see if she might prefer a finer litter.

Of course it is probably somewhat medical in her case. But also, try different things to come up with something that works for her. I have taken an under the bed storage container and used that as a box because the sides are lower.

Sometimes with cats with kidney disease, they urinate allot and their feet get litter clumped on them and it hurts. Check the bottom of the paws and in between the toes for litter clumps.

I would still call your vet and ask about transdermal Mirtazapine for appetite, and Cerenia for nausea.

Thank you! Yes, I have a lot of litter boxes around to experiment with while leaving existing ones. I feel like the mistake would be behavior because yesterday, I cleaned with enzyme solution and blocked with litter box, then she is back to the old litter box (which is close to it).

She has been peeing small-medium size 3 times a day now (used to be 5 but smaller). I usually see the dust on her legs but I haven't seen clumped on her toes. I will keep an eyes on it. The thing is she used to pee and leave, but since few days ago, she actually dug the litter, pee, and cover. Not sure if it is good/bad or nothing important sign?

My vet is very hesitant for all. My vet really focused on the enlarged heart from x-ray and it has been difficult to convince my vet to view different things. I tried and I think I barely convinced for Mirtazapine but I don't think Cerenia worked . At this point, I may have to rely holistic med or something

 

[FeebysOwner]

You might ask your vet if they know of a cardiologist that would review the x-rays that have already been done, on a consultation basis. That would at least let you know if the cardiologist felt the vet's assessment was on target. I don't know how common it is, but on x-rays, older cats can look as if they have an enlarged heart when they actually don't. It is caused by the muscular changes that occur naturally with age that alter the placement/positioning of the heart.

How much sub-Q fluids are you giving in terms of the volume and frequency? Just curious, as overhydration can cause some of the issues you are seeing in your cat.

I think you need to start to educate yourself about CKD. I highly recommend you begin to read through Tanya's web site - Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat (felinecrf.org). It is very extensive and tends to overwhelm people at first, but it is well worth it to read all about the varying aspects of health associated with CKD. You can start with the topics/subjects that interest you most and then move on from there.

 

[whc216]

You might ask your vet if they know of a cardiologist that would review the x-rays that have already been done, on a consultation basis. That would at least let you know if the cardiologist felt the vet's assessment was on target. I don't know how common it is, but on x-rays, older cats can look as if they have an enlarged heart when they actually don't. It is caused by the muscular changes that occur naturally with age that alter the placement/positioning of the heart.

How much sub-Q fluids are you giving in terms of the volume and frequency? Just curious, as overhydration can cause some of the issues you are seeing in your cat.

I think you need to start to educate yourself about CKD. I highly recommend you begin to read through Tanya's web site - Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat (felinecrf.org). It is very extensive and tends to overwhelm people at first, but it is well worth it to read all about the varying aspects of health associated with CKD. You can start with the topics/subjects that interest you most and then move on from there.

Thank you very much. I think I saw a similar post here about how an enlarged heart in an x-ray isn't the best to rely on but ultrasound does. I will see what I can do but I don't think the cardiologist will do any consultation without the visit. Previously, my other cat had other issues that I had to go to the specialist for other situations, I wanted to refrain from the visit, but they refused

Unfortunately, I haven't tried or given any sub-Q fluid to my cat. She is extremely stubborn and hard to pick her up and I feel like this would add more stress. Additionally, given this enlarged heart x-ray, the vet told me to not do it since it would stress the heart. But again, we don't know if she has a heart issue or not unless I go to the cardiologist

Thank you! I will definitely try to educate myself about CKD. She has been drinking water. I feel like she drank a lot after the visit but now, less. I don't know if this is good or bad sign.

One thing I didn't add was my cat had severe skin allergy from environment and maybe asthma? She kept licking her neck or belly that often goes to bald and became bad rashes. Last year, we went to the vet, and the vet prescribed steroid but that only helped that instance. It kept returning. Before this vet visit, she had bad rashes around her belly. I put a clothes on, but that gave her too much stress too so yeah. I don't know if this contributed some sort of infection. Also I had another cat (who passed now ) had asthma and compare to him, she didn't wheeze a lot, so often, I wasn't sure if it is from asthma or allergy. Normally when she gets too hyper (like I pet her long time), she purr, that then turns to more asthma or hard to breathe situation. Now, she doesn't purr as much

So sorry I am listing a lot! I want to focus few areas but it's been hard to focus where. Definitely kidney, but not sure if I should also worry about heart, breathing issue, and others.

Thank you so much

 

[FeebysOwner]

You can't focus on much of anything without additional input/testing. The worse her conditions get, the harder it will be for her to handle vet visits. Has your vet ever mentioned trying a calming agent/med to help relax your cat for vet visits/exams?

Have you ever considered another vet? It doesn't seem like your current one is doing much to help, especially after you mentioned other issues going on with her that do not appear to have been addressed.

 

[whc216]

You can't focus on much of anything without additional input/testing. The worse her conditions get, the harder it will be for her to handle vet visits. Has your vet ever mentioned trying a calming agent/med to help relax your cat for vet visits/exams?

Have you ever considered another vet? It doesn't seem like your current one is doing much to help, especially after you mentioned other issues going on with her that do not appear to have been addressed.

Yes, I thought about it but no, I am holding it for now. For my last cat, I visited 4 different vets with a similar situation (one isn't helping so went different one and etc), and they all diagnosed differently Then that made him get even sicker quickly from the stress, so yes. That was not long ago and I haven't recovered much from it yet. I often ask myself "what if..." so for now, I am holding it. I know it's hard to ask and speculate without visiting the vet but also wanted to hear any thoughts or experiences that people had.

 

[stephanietx]

You really need to get her to the cardiologist. Sometimes. when the heart is not functioning properly, it causes other systems in the body to go downhill. Ask the vet for a light sedative to administer prior to the vet visit so it's not as stressful for your kitty. Until you address the heart issue, you're probably not going to get to the root of the problem.