Second vet opinion?

[Tigerblue]

My 17 year old male cat is in the early stages of kidney disease. He's been slowly losing weight for a couple of years now and after three blood tests, kidney disease is now showing. He needs some treatment on his teeth, but as he's losing weight fast (4.25kg in March, now 3.9kg), the vet said she wouldn't risk putting him under anaesthetic. I accept all of this.

The vet thinks he's losing weight because kidney disease can make them feel sick and nauseous and this puts him off food. He can eat despite his teeth and is interested in food, just not eating much.

I've asked if there's anything he can have to keep his mouth comfortable or help him with the nausea. Due to the fact he's got kidney disease, there isn't anything that can help him with pain and supposedly nothing for the nausea. I can't believe there's nothing that can help him now, or in the last few days if he's in pain. DH thinks I'm looking for a needle in a haystack as we'd never be able to pill him (it takes two at the vets). Would you ask for a second opinion on treatment or accept the situation and not keep him hanging on when he's had enough?

Can only tell you the situation my dm had with dcat. . Same story as you really. Second opinion, lots of tests, a bill of £996.00. Then decided they couldn't do anything for him and charged her another £100 to pts!!
My dm said in their defence they sent a nice 'sympathy' card . Think that's was to her bank account not her personally.

Thanks for that, it's so hard to know what to do . I was hoping initially it would be the cost of a couple of consultations, full bloods and urine analysis (if by the slightest chance I could get a sample). Obviously if he then needed medication and follow up appointments that would be extra, but at least that's because they'd got something to keep him more comfortable..

I don't know why he can't take medication. I had a cat who (due to serious stomach surgery) couldn't take metacam. We had her on tramadol.

A lady on her made a bucket list for her dcat. .

Maybe something to consider.

Xxx

Another one who doesn't get why he can't take meds. What stage CKD is he?

Eleventycat has been stage 2 for over a year now. Nausea is well managed and she's on Pronefra to try and slow progress down. Working well so far, although keeping her weight up is a struggle (always has been tbf).

If it's early stages I'd be tempted to ask for a second opinion. I don't see why they'd need to repeat the tests though. Surely it's more a question of treatment options?

Appreciate all cats respond differently and you know your cat best OP but might be worth seeing what a second vet thinks.

Maybe try a hone made cat treat recipe and add a pinch of ginger to counteract nausea?

Thanks for your further replies. He Stage 2 CKD. I thought a new vet would want to do their own tests so they could come to their own conclusions, although, they may be able to give me some advice at first consultation.

DH has been away (with the car) so will discuss when he returns late tonight or tomorrow. If we do go for a second opinion I want him seen ASAP while it's easy with the car here.

Depending on his blood and urine results it's should be possible to manage his CKD medically and give him a reasonable quality of life for a while. Dietary management and blood pressure monitoring are key

icatcare.org/advice/cat-health/chronic-kidney-disease-cats-–-management

inpractice.bmj.com/content/38/Suppl_3/10.full

icatcare.org/press-media/ISFM-new-guidelines-CKD

How bad are his teeth?

I've made the decision to take him to another vet and as I said I'll see where we are after a consultation or two and what I hope will initially be blood/urine tests. Hopefully at that point they'll have a feel of whether they can help him or if it's really worth looking into things further.

His teeth have quite a lot of scaling on one side and on the other his gums look almost red raw - that side must be really sore and I think this was the final thing that got me worrying about keeping him more comfortable, whether in his mouth or the CKD. When he's in the mood for eating (a bit and miss these days) he can certainly eat although he'll only choose wet now.

If he has stomatitis-gingivitis this can be excruciatingly painful and would explain his reluctance to eat. Dental treatment is still possible as long as your vet knows what they're doing - aim for a cat friendly vet/clinic

That's what I was worried about, he was in pain or discomfort with his teeth and/or CKD. Even if I don't get anywhere tomorrow, at least I will know I didn't just leave him to suffer without trying.

CKD isn't usually painfully - though it can cause nausea and lethargy
Good luck with the new vet
Blood pressure and diet are crucial
They prob don't need to reblood sample - they could just ask the last practice to email through the history if you ask them to in advance if you appt so that they're prepped

Thanks for your quick reply. Do you know if nausea can be helped in most cats? I doubt I'd ever pill him (someone has to hold him for the vet to do it, let alone me trying on my own), but I'm willing to do what I can to keep him comfortable if I can.

Yes by controlling the kidney disease - so diet, blood pressure management and depending on severity of disease phosphate binders and/or ACE-inhibitors

Just an update.

I've agreed full bloods to include T4, take urine and analyse and blood pressure to get the full picture. The vet felt she was looking at a cat with other issues, not kidney disease (even though he does have it). She noticed his heart rate was fast, which our other vet commented on and she felt he wasn't walking right on one leg but that could be down to the fact he's quite wasted at the back and may have lost too much muscle.

If not as a temporary boost, he could have ABs as as his teeth may be going rotten under the gums and she doesn't know what else is happening. Also, an appetite stimulant.

DH needs the car for work until mid week, so I'm having tests done next week. In the meantime I chose to have the ABs and an appetite stimulant as well. The vet said even if I changed my mind about going back to her, she'd asked if I could phone in and let her know if I I noticed any difference after the ABs and stimulant.

She's assured me we can treat nausea (explained how we or they could administer) but she wouldn't give painkillers due to CKD, so at least I know we can help him a little which my other vet wasn't offering. She made no promises but wouldn't rule out operating on his teeth depending on results. At the same time she pointed out there's always the chance we can't reverse anything we find, just do what we can to keep him comfortable (which is what I wanted).

He did himself proud, growling on examination, hissing and struggling so she had to let him go and it was a two person job to adminster ABs and a tablet!

Aw that sounds like you have a better vet Tiger.

Not ideal (due to CKD diet) but my ridiculously fussy cat will eat some ABs (synulox) if you mix them with a couple of dreamies.

After trying giving up on Ranitodine, she's on Tagamet to control her nausea. It mixes well with food and has worked brilliantly. Her nausea problems started well before the CKD was diagnosed but it's very well managed (she has some health issues as a result of complex surgery to deal with her spleen which somehow ended up in her chest a few years ago).

I'm not a vet but my experience backs up your new vet and veterinari. There are treatment options and ways to manage the damage.

Eleventycat also had a dental about 2 years ago when she was 15. CKD wasn't diagnosed then but we were worried about the anaesthetic (her age plus suspected kidney damage following her previous surgery). She was fine. I wasn't

Oh and she also has a heart murmur (probably since birth).

None of these are affecting her quality of life at all at the moment. Except the dreamies ban

Thanks for the links veterinari. I find the icatcare website really useful but hasn't seen the new guidelines. Good to understand why my vet has started blood pressure monitoring. Super cute to see eleventycat in the world's tiniest cuff

Yes BO is c important - and great she's checking thyroid too

BP

Your new vet sounds excellent. There is a brilliant group on Facebook called Feline Chronic Kidney Disease full of very knowledgeable owners who are going through it too. There's lots that can be done to control symptoms.

Thanks for your further replies.

He's been eating better since he had the ABs, nausea and appetite stimulant, and looks more alert. The vet did say she'd noticed one of his (back) legs wasn't right and he's stumbled on this since. Today he's not right on his front legs, he's walking, weight bearing but sometimes holding one in particular out or walking like he's drunk. I think low potassium in CKD cats can cause this or it could be his muscles are wasted as he's lost so much weight.

He's in tomorrow for testing, so hopefully they'll pick or something they can help with or at least we'll known a bit more.

How'd you get on, Tiger?

I'm glad I got a second opinion, but I had to let my boy go yesterday.

He was in for testing all day Tuesday (far longer than I thought so I suspected something was up). I'd chosen for testing out of house as it was cheaper and covered T4, but they weren't happy with him so decided to do in house testing (more expensive which they didn't charge me for) so they had results quicker. It came back his creatinine had gone from 229 to 550 and urea 18 to 46 (the top end of their measuring scale so could have been higher) in less than seven weeks. They said there was no point in doing T4 now as the result wouldn't help. They were able to tell me his blood pressure and phosphorus levels were high, I didn't ask the the figures as they were offering to put him to sleep as they said he was very poorly. I felt he still had a little life in him so he came home so he could have whatever time relaxing and feeling safe, rather than have his last few hours at the vets. He enjoyed the sun, eating and love on Wednesday, but on Thursday I felt he was going through the motions, so I booked him in on Friday morning. He suddenly started to go downhill as we were leaving, so I feel he lived his life to the last possible hour he could.

My new vets confirmed my old vets were basically correct in that he was too poorly to operate on, even though they hadn't done further testing to confirm he's moved from stage 2 to 4 or pointed out why they felt this. The timing of these tests meant I knew what was happening rather than having him at home, not knowing his CKD was fast progressing. I found out there were options to help a CKD cat, appetite stimulants and nausea treatments, B12 injections as CKD cats lose B12 quicker, and other options I didn't take in as I didn't need to (my old vets told me there was nothing available), also ABs in case he had infection - none of this was offered by my other vet when he was in stage 2. Also, they talked me through putting to sleep with them and afterwards, so I knew what would happen. Nothing was going to change his fasting moving CKD, but for another cat there was help there. My old vet didn't point out he had teeth problems in March and I can't believe there was no scaling/soreness then, or even back in November. For that reason, when I've got the strength, I'm going to get my girl checked out by the new vet, especially her teeth and a blood test.

So in summary, it was worth getting a second opinion as I learnt there could have been more help available back in March. I'd been with my old vet 17 years and I guess felt I was being disloyal, but my cat was the most important one.

Oh, Tiger - I'm so sorry that your old boy is gone. But it sounds as the gh his last day or so with you were just where he needed to be. Massive hugs though as I expect it's still very raw.

And agree it's worth getting your little lady thoroughly checked out too.

They claim such a special place in our hearts