Several of you responded to last Wednesday’s post about Pierre’s vet appointment with surprise that he had been diagnosed with chronic kidney disease, so I wanted to bring you up to date on what was going on.
The Stuff We Didn’t Tell You Back Then
You probably read the story about Pierre’s trip to the vet in mid-March that resulted in en enema, but I didn’t write about his second trip in late March. He stopped eating, so I bundled him back into the carrier and off to the vet we went. This time, the vet ran bloodwork to see what could be the problem. Fluids, appetite stimulants, and anti-nausea medicine got him started eating, though he was still very picky. More picky than his usual eating, which is really picky to begin with.
Pierre’s bloodwork came back from the lab the next week with a creatinine reading of 2.8 mg/dl. Creatinine is a waste product of muscle metabolism which is normally filtered out out the blood by a cat’s kidneys. When the kidneys aren’t working well, they don’t filter out as much creatinine, and the amount of it in the bloodstream rises. That’s why creatinine is an indicator of kidney problems in cats.
The International Renal Interest Society, which establishes guidelines for diagnosis and treatment of chronic kidney disease (CKD) in small animals, has a staging system to help identify the severity and appropriate treatments for cats and dogs with kidney disease. They have identified any creatinine reading over 1.6 as an indicator of stage 2 chronic renal disease, so I didn’t take a reading of 2.8 lightly.
I asked the vet what kind of proactive things we could to to help Pierre, and her treatment plan was to put him on low-protein prescription food and recheck his bloodwork in a few months.
That’s Not Going to Fly
Pierre was barely eating the nonprescription food I was trying to get him to eat. Even if he was willing to eat a lower-protein food, I couldn’t imagine giving it to him when I know that senior cats need more protein, not less.
There had to be something else we could to to help. I brought the lecture notes from last winter’s NAVC course where I heard a veterinarian with an all-feline practice in San Antonio talk about the things he did for his feline CKD patients. I even offered a consultation fee to discuss those options so that we could work out a treatment plan of some kind to help Pierre, but my vet told me no, put him on the renal prescription diet and come back in three months.
Second Opinion
After several more weeks of Pierre picking at his food as I worried about his health, I decided he needed a second opinion. That led to his visit to the all-cat vet. I liked that the new veterinarian listened to my concerns and didn’t brush off my questions about my research.
She wanted to know whether our regular vet had run any urine tests. He hadn’t, so those were included with a new batch of labwork.
When Pierre’s lab results came in from the lab, the new vet called with the results. I sat at my desk at work with a tissue in one hand and a pen in the other, afraid of the news I was going to get. “These lab results look good,” she told me.
“Wait, what do you mean?” I asked, caught off guard by her unexpected words.
“His urine specific gravity is fine, and his creatinine is 1.6.” She said he was was still pre-renal.
What happened to his high 2.8 creatinine reading? Creatinine readings in labwork are impacted by dehydration, and since the previous blood sample was taken while he wasn’t eating his canned food — the source of most of his moisture — it’s not surprising his creatinine reading was off.
I guess that’s why my old vet hadn’t wanted to do anything but change foods and wait. Knowing he was probably dehydrated made those numbers not look so bad. Why couldn’t someone have explained this to me instead of my spending six weeks worrying every day about Pierre’s advancing kidney disease?
So That’s Good News, Right?
It’s great news! Pierre will continue to live the life of a normal cat without kidney issues for who knows how much longer. Chronic kidney disease is exhausting for cats and their humans both, and it’s such a relief to know we aren’t dealing with that yet for our ornery guy.
We still don’t know why Pierre is so unenthused by his meals right now. There doesn’t seem to be a medical reason for it, so we will just keep feeding him what we can, when we can. He’s like the rock stars who demand only green M&Ms in their dressing rooms. He can ask for a food and he knows he will get it because we humans know he’ll eat it. For now, if his only problem is a green M&M-worthy diet, we’re grateful that’s the biggest problem we have to tackle.
(Don’t worry, Pierre isn’t not eating actual M&Ms!)
Summer says
My human had the same problem with Sparkle being picky for… um, you’re not going to like this… years! But then, you are WAY more informed about feline health than my human is (she’s a website and word nerd, not a medical nerd), so you are asking the right questions and getting good insights. I just hope Pierre finds some food that suits him – he could be nauseous or digestively uncomfortable for many other reasons than CRF, and sometimes that only expresses itself through appetite and food preference.
Nicki and Derry (Fuzzy Tales) says
I sitting here reading this, relieved beyond words that Pierre is okay at the moment, but filled with disgust for your previous vet. I felt that way about my previous vet, who was fixated on putting Derry on an anti-depressant for his chronic cystitis, and wasn’t open to anything homeopathic (which, knock on wood, has worked brilliantly for several years now).
Does Pierre like “juice” from canned? You’ve posted about raw, but he doesn’t eat it? Would he eat one of the Weruva flavours, do you think? (Derry won’t, but Nicki loves the one I give him as a treat — limited to once a week because most Weruva’s have tuna or other fish in them, unfortunately — wish they’d make more of their products without. Nicki used to gobble up the shredded chicken and pumpkin one too, but now he won’t eat it…and I have all those pouches in my cupboard of course!)
Anyway, long-winded, but good luck finding something he’ll eat. Honestly, our fur “babies” can drive us to the brink, with all the stress they can generate. Hugs. And purrs to Pierre from Nicki and Derry!
Nicki and Derry (Fuzzy Tales) says
P.S Even my old vet would have run a urine analysis! Bloody-arsed stupid previous vet of yours. Sorry…but really!!!!
The Daily Pip says
That’s GREAT news! When I was four months pregnant, I brought my cat Toonces to the vet for bloodwork and she was diagnosed with kidney disease. The vet said and I quote “she probably won’t live to see the birth of your daughter”. I was shocked by her lack of sensitivity, but also worried it might be true. I immediately found a new vet who worked with us through diet, fluids, etc. and Toonces lived for almost four more years. Always good to get a second opinion …
Connie says
Sadly vets become desensitized because too many clients aren’t willing to go the extra mile – or even a few extra steps – for their cats. So they simply assume you aren’t as well and treat you as such. it is a shame.
Ellen Pilch says
I am happy to hear that Pierre does not have CKD. It is sad that the other vet didn’t run the urine test, at our vet, that is included in the testing. I love the photo with the green M&M’s 🙂
Fur Everywhere says
I was soooooooooo happy when you told me Pierre doesn’t have CRF!! You’re right – CRF IS exhausting for cats and humans, both!
I wonder if Pierre has a bit of heartburn or something? Maybe ask your vet about a trial of Pepcid to see if that helps?
Carmine is also quite fussy about what he will eat, so I can definitely relate. I just give him whatever he’ll eat. I’m just so happy that Pierre is still a healthy baby. <3
caren gittleman says
First, I missed that post because I was in the hospital having a lithotripsy for my kidney, I am sorry I missed it!
Next, I am THRILLED that all is well with Pierre and I want to share a similar story, that may help you and many others.
Over a year ago when Cody suddenly became extremely ill (I had blogged about it), my regular Vet was out of town. The Vet at their practice that saw him ran tests (like yours, with NO PREP) AND the tests were run AT THE VET (that is super important). Cody’s calcium number came back SKY HIGH…….the young Vet who was treating him insisted he had to have cancer. She wHanted a battery of tests run. I was in SHOCK.
We were told to take him to the Emergency clinic for some of the tests, (I had asked our original office to please contact our regular Vet and update him)…..thankfully, because he is an ANGEL, he called (FROM VACATION). He told us what tests were REALLY needed and instructed me to bring Cody in that Monday when he would be back.
When we came back Monday, he insisted that we PREP Cody (fasting) for a re-take of the test that this time would be SENT AWAY to the Michigan State University (I believe). (Tests run AT THE VET are often inaccurate)………..the test was costly……but the results had Cody’s calcium at COMPLETELY NORMAL…………there was NO CANCER.
It turned out that Cody had stopped eating and became sick from food that had ended up on a recall list.
After this experience (that went on for weeks as yours did), I would ALWAYS have a more thorough test run after the initial test at the Vet and I am beyond grateful that our normal Vet that we see at the same practice the other one was at, knew enough to run a more thorough test after Cody was prepped properly (and, he doesn’t put the fear of God into me)
Sorry this was so long, but I felt it was important to share.
The Island Cats says
We go from being picky about our food to eating it with gusto. It drives the mom crazy. And blood tests have always been up and down with us…particularily with Wally. Right now, he is probably stage 2 CKD…creatinine about 2.2, still within normal according to the labs, and USG about 10.31, good but not great. The vet recommended the kidney diet food, of course, but the mom has feeding him a high protein good quality canned food…though Wally still likes his kibble.
We’re glad you got a good report with Pierre. We know how test results can be affected by so many things…why vets don’t explain that to us we don’t know. It pays to ask lots of questions and being on top of things.
Oz the Terrier says
Well, this is great news! We are so glad to find out that Pierre is going to be just fine despite his picky eating habits. MOL It is too bad that your previous vet was not as forthcoming with ALL the information in the first place. It would’ve saved you a lot of worry and heartache. I do not understand why some vets do not think to share all relevant information. It is why it took us 5 different vets before we finally found one we completely trust.
Melissa & Mudpie says
That’s fantastic news!!! Four paws up to you for doing your own research and finding a vet who would actually *listen* to you. Pierre couldn’t be in better hands.
I say we name Pierre and Mudpie the King and Queen of Fussy…
Hannah and Lucy says
We are so relieved that Pierre has finally seen someone who could talk to you and saved you all that worry.
Random Felines says
sounds like the change in vet was a good one. we will never understand why doctors (animal and people) are all “do this and report back” without some form of explanation – and then are unwilling to discuss alternatives. what great news with better test results though (and mom has gotten those phone calls – they make your heart stop). [oh – and mom says she is willing to sacrifice herself and eat Pierre’s share of the m&ms]
Savannah's Paw Tracks says
Second opinions are always best. And we are prejudiced about cat only vets. They are feline specialist and simply far more informed about the feline body which is different f of a dog. Pleased Pierre is out of danger. As for his eating, I have found that sprinkling freeze dried green tripe gets both my cats to eat. TKS will eat anything anytime. But Savvy is our “Pierre”. She is very happy with her raw digest but always with tripe sprinkles. I get it from Raw Paws Pet Food. I believe they deliver free to Florida. Also, have you tried to get some Pepcid or Zantac into him? Nausea could be a factor, or heartburn.
Sometimes Cats Herd You says
Pierre had a ten-day course of Pepcid when his appetite problems first got so signifigant. They didn’t seem to help. I hadn’t tried tripe with him, so I ordered some to see if he likes it. Thanks for the idea! Maybe it will help us get him away from the fish flavors that have been tempting him recently, because they aren’t a good long-term solution.
Annabelle says
What a relief!!! We are so glad Pierre does not have CKD!
Any illness is very difficult. I guess we all have our picky eaters. Even my outside (feral) cat is getting tired of the food I am giving her. She tired of the wet food and now she doesn’t like the dry food. *SIGH* What to do is always a dilemma.
da tabbies o trout towne says
dood…..we iz BUZZED happee for ewe that de eeeeeeeeeeeevil… kid knee dee seez ….haz been rooled out….tho sorree for de funkee ree port yur mom getted { N de food servizz gurl haz ta stop rite heer with de train her thoughts iz runnin on with, bout vetz…ree portz } ……sew heerz a wee samplin oh sum food we think ewe wood like….donutz, ham, perch pizza, sghetti, flounder, surf & turf, NOE CHICKN, pie, friez, did we men shun donutz ~~~ 🙂 🙂 ♥♥♥
Cathy Keisha says
I am beyond thrilled at the good news! I too am a very picky eater and because of this I get more meals than most other cats. TW has found that I eat far better the more exercise I get. If she’s busy and can’t play with me, my food sits. If we play, I’ll stop every few minutes and eat. Maybe Pierre needs stimultaion to eat.
Connie says
Thumps for your old vet for not taking a minute to explain things to you, and the possibility that Pierre might be dehydrated causing the off reading.
I’m so glad the new vet was so much more helpful (and I’m glad you shared them, just the thought there are vets out there like that makes me happy)
Purrs for Pierre and his picky green M&M life rules, hopefully, this too will pass. (was an appetite stimulant ever discussed?)
Sometimes Cats Herd You says
You read our vet’s mind! We have some mirzaprine that he got at the bad-diagnosis visit. We’re watching his intake carefully and he’ll get another dose if it drops off any more. It doesn’t have a long-lasting effect on him, so it’s a very short term answer unless we decide to give it daily. Pierre strenuously objects to daily pills.
William's Kith & Kin says
OMC, we totally blocked the significant part of the last post about Pierre. 🙁 (William had CRF, so maybe that’s why.) Anyway, we’re so glad he’s OK for now and happy you found a vet who will help him should he need it.
In my mom’s effort to get William to eat (he’d gotten extra extra picky), she turned to liquids formulated for cats. William needed weight, too, so he got kitten milk replacement (which he loved!), but there are other (adult) formulas that might work for Pierre if he needs it.
Pawesome Cats says
That’s awesome news – we are so happy that Pierre is pre-renal and that you took the time to do the research and question the initial advice given. Angel Rose and Angel Onyx both had CKD, it’s an awful disease.
The Swiss Cats says
Those are wonderful news ! Yay for Pierre ! We always learn so much about cat health on your blog, ; asking the right questions to a vet can make such a difference ! Purrs
Sweet Purrfections says
So glad to hear everything looks okay for Pierre. Brulee is a very finicky eater and sometimes will not go near her wet food. She’ll eat one brand one day and won’t touch it the next day. One of the vets at the clinic where I take the girls used to work at a Cats Only vet and I’m impressed with her. I took Praline to the only cats-only vet in Columbia and didn’t like them.
Camille says
Yay!!!! That is so not where I thought this story was heading, but I’m so happy to hear the great news!! 🙂 We used to see skewed blood test values periodically in the mixed small animal practice where I worked. Results can be affected by everything from dehydration to stress to a lipemic blood sample (where the patient hadn’t fasted first and there were elevated levels of fat in the blood). Some patients even had values that were high by testing standards, but just turned out to be normal for them – they never exhibited any progression or symptoms, so we just monitored them closely.
SO very happy for Pierre!! He is such a cutie pie. And with his permission, I’m more than happy to take those M&M’s off his hands! 🙂
Mary McNeil says
Such good news ! Over the years I have had 2 elderly cats diagnosed with kidney problems and when they wouldn’t eat the “special” food, the vet emphasized that having the cat EAT was the most important thing. “Lucky Pierre!”
The Florida Furkids says
We’re so glad you got the second opinion. We’re sorry you had to go through that agonizing time thinking Pierre had kidney disease. We’re not particularly picky here.
The Florida Furkids
Three Chatty Cats says
Second opinions are so important. Sometimes it’s easier to just stick with the same vet, but sometimes you just have a feeling about something. We’re very happy with our all cat vet too.
Brian Frum says
Oh yea, that is darn good news and we’re thrilled for that good report. Zoe was diagnosed Stage 2 but now she is fine. Turns out her problems were due to tooth resorption which can typically best (or only) be detected with High Definition Digital XRays. Of course she had other problems, like the massive furball, and diabetes, which is also gone. A specialty Dental Vet made a big difference in her life. Just wanted to toss that out there. By the way, we love our Cat Only Vet.
Raven says
Great news about Pierre. I had one CKD kitty, but lost him to neurological problems before the CKD became severe. I think most vets still take the old-school “prescription renal diet” approach without factoring in the higher protein requirements of senior kitties. Pierre is lucky to have such an educated owner who isn’t afraid to ask questions and get the best care possible for him.
Madi says
Pierre thank goodness your mom is your advocate and by no means ready to give up!!
yay for you new vet and great news. Hugs madi and mom
Kitties Blue says
We are so happy for your news. Dealing with a CKD cat can be exhausting. I hate that the first vet was less than forthcoming. I am so happy to have a vet that listens and answers my questions. Stay healthy, Pierre, and eat your noms. XOCK, Lily Olivia, Mauricio, Misty May, Giulietta Fiona, Astrid, Lisbeth and Calista Jo