“Princess” Presented for an annual wellness exam.
13 Year-Old, female, Domestic Long Haired Cat. Stays indoor
except for short excursions into the backyard on sunny days. 100% dry, grocery
brand diet.
On paperwork,
Owner responded that the pet had been drinking “a little more water” than
usual.
The owner has no concerns and
reports that the patient is “slowing down a bit” but is otherwise happy at
home.
Physical exam:
Mild weight loss noted with slight muscle atrophy of the hind limb muscles.
Eyes, Ears, Nose and
throat: normal. Gums a little dry, but nothing remarkable.
Abdominal palpation: normal, abdominal organs are normal size and
shape. Lymph nodes: normal size.
Heart: normal rate and
rhythm. Lungs: normal sounds.
Musculoskeletal system:
normal other than low back and hind limbs.
The low back is sensitive to pressure and the hips have decreased range
of motion.
Clinical impression based on physical exam and
history:
The patient has a mild
increase in water intake which could indicate abnormalities of the renal
(kidney) system, liver, thyroid, or adrenal glands. Diabetes is unlikely based
on symptoms, but can not be ruled out without lab testing. Increased water intake can also occur with
discomfort or pain. Muscle wasting,
sensitivity and decreased range of motion in the hind end can indicate
arthritis. The slightly dry gums,
despite increased water intake, indicate mild dehydration. This increases suspicion of early renal
disease.
Plan presented to owner:
Health Screening Profile to
the Lab – Complete Blood Count (CBC), Serum Chemistry Panel, Urinalysis.
Fecal Float to the Lab –
screens for intestinal parasites (part of LAH Healthy Pet Plan)
Subcutaneous fluid treatment
– to boost hydration, regardless of reason for mild dehydration – it helps and
it makes the pet feel better!
No additional recommendations
until the lab results are in.
Wait on vaccines that are due
until lab results are in.
Total Cost of Appointment -
approximately $240.00
Results:
CBC: Red
blood cell (RBC) count - normal, White blood cell (WBC) count - normal.
Chemistry panel: Mild elevation in BUN/Creatinine (45/2.0) the 2 main values use do
evaluate the kidneys. These values increase when the kidneys are not performing
at least 2/3 normal function. Blood
Glucose - normal (makes diabetes unlikely). Liver values - normal. Thyroid
value - normal.
Urinalysis:
Lower than normal urine
concentration (Specific gravity 1.020): dilute urine, combined with elevations
in BUN/Creatinine supports the diagnosis of early to middle stage renal
insufficiency.
Fecal Float:
No parasites or pathogenic bacteria seen.
Diagnosis:
Early to middle stage renal insufficiency. (The kidneys are not performing at a
high enough level to keep the patient well hydrated through adequate urine
concentration. They are insufficiently clearing BUN/CRET, the end products of
protein digestions, from the bloodstream.)
Treatment Options/Plan: Discussed
results with owner over the phone.
Advised owner that since the patient’s vital signs and quality of life
are stable, there are some good conservative options for slowing down the
progression of renal insufficiency.
These include:
· A 100%
canned, moderate protein level, but high quality food
o The canned option provides the increased moisture to
aid with mild dehydration.
o The moderate protein level prevents muscle wasting
while not making the workload on the kidneys too intense.
o The high quality protein results in less
end-byproducts of digestion, which helps to keep BUN/Creatinine at a reasonable
level.
· Feline Renal
Support Supplement ($17.00 for 60
Tablets = 1-2 months of treatment depending on dose)
o Nutritional support specifically targeting the
kidneys.
· Subcutaneous
fluid therapy at home: 1 treatment
per week. ($23.30 for 1 Kit = 6-10 treatments)
o We can teach the owner how to administer fluids under
the skin. This results in increased hydration and perfusion (circulation) of
the kidneys. This is not required at this stage of renal disease, but could
definitely slow down progression into the later stage in which they will be
necessary for quality of life.
· Recheck a
smaller lab screening panel in 1 month
to see if the patient’s health status is improved, or at least maintained, by
our treatment protocol. This panel will
be recommended every 3-6 months depending on patient’s health status and how
they respond to treatment ($58.62). The
full panel presented earlier in this plan will be recommended at each Annual
Exam, as it is for all senior patients.
· Alternative
medicine consult or Acupuncture:
Discussed in more detail if owner interested. ($74.00 initial
consult/treatment, $55.00 each follow up. Most renal insufficiency patients
receive a treatment every 3-4 weeks.)
Prognosis: Each pet is unique, but many cats diagnosed in early
renal insufficiency can live several years without progressing into the next
phase if treated with a protocol as described above. Appropriate nutrition is paramount to
increasing their quality and length of life.
(More time
with your healthier, happier pet … Priceless!)
We present the best available options, the owner makes the
decisions! You decide which options fit with your beliefs, your
lifestyle and your budget. As doctors and advocates for the patient, we’d like
to do it all. However, we realize that is not always possible. At LAH we strive
to enhance the quality of life for pets and their people. If we can move toward
this goal, we consider it a success.
*This content in this article
is not intended to substitute for veterinary medical advice.
**The patient's name has been changed for the purpose of anonymity.
