Last week was really hard. My vet recommended I keep Julianna on S/D for another month at least. In addition, he contacted A&M to find an internist.
You know I've been struggling/disagreeing all along about keeping her on S/D. Not only because of her behavior, recent oral probs. Hher pre-anesthesia teeth cleaning blood work last Monday showed levels suspect of early kidney failure, I don't have the levels in front of me -- BUT vet is not sure whether these values are due to her fasting for 8 hrs before dental work or what exactly(I think) the S/D. I had blood work done in May & her blood tests were perfect! So if you're not 100% sure of the health of the kidney, why would you put a cat on S/D?? That's the worst thing you could do. I'll get off my S/D soapbox. The more I thought about it the more I got back to the original reason I took her to the vet in the first place in March -- WHAT IS CAUSING THE CHRONIC BLOOD IN HER URINE. This is what I want to resolve!!! We don't know with 100% certainty that the kidneys are the cause (bear with me & read on). To make a long story short, I got a second opinion last week from a vet that only treats cats.
Here's what she recommended:
1) Get her off S/D -- she had strong concerns with using this product in general plus with the uncertainty of the kidneys. I didn't even have to mention my concerns. She wants her on K/D. I started mixing S/D & K/D together Friday evening. She will be completely off it in 5 days.
2) None of the urinalysis's the vet did showed bacteria, only blood. I would collect the urine at home in one of their cups and took it in. The tests they did were: dipstick, urine specific gravity & urine cytology. The 'cat' vet asked if they'd ever done a urine culture & sensitivity test. They didn't. She explained to me what it was & why she would recommend that as a next step. In addition she said to get the most accurate results she'd have to collect it via cystocentesis. This seemed like a logical next step to me...I felt like the other vet had completely ruled out bacteria as the cause and was moving right to the kidney stones as the cause. I was furious!!! It's like he prescribed Baytril as a "cure all or best guess" without knowing what type of bacteria she had which wasn't showing up on the test results anyway!! Don't you think after prescribing Baytril for a second time he would have recommended cystocentesis & urine c&s? It has nothing to do with money either. I have dropped over $1000 on Julianna alone not including my other 2 cats.
Anyway, that's the latest. If urine tests show no bacteria the next step is to ultrasound her bladder. I am moving as fast as I am comfortable. Kidney surgery is not minor and could cause her more harm than good. I absolutely want to rule out bacterial infection & bladder first.
Julianna is doing okay. I know she is uncomfortable and in some pain but, bless her heart, she is using the litter boxes and is getting used to the K/D. She has been through a lot and I blame myself for not knowing more but I have learned my lesson. You have to be educated and question everything. I keep telling her we're going to get her feeling better she just has to trust me.
Feline Kidney Stones in young cat
Re: Feline Kidney Stones in young cat
First, you need to be aware that bloodwork can be perfect one month and totally off on the next, especially where the kidneys are concerned.
I'm sorry, but I had assumed your vet had done a cystocentisis, as he knows that's the most appropriate way to collect an uncontaminated sample for testing. Also, I had assumed he had prior cultured in order to base his decision on the baytril. (which your current vet might probably do anyway if she finds bacteria upon the culture results). I'm also wondering how the specialist missed this?
And, you said your first vet found kidney stones upon x-rays, both times, second time indicated no resolve. This would be one likely source of the blood. I suspect the specialist suspected similar.
While it's still possible a bacteria might show up on culture, you're still going to have to treat with antibiotics, and will need to know if the stones are indeed causing the blood (I suspect they are)....these stones can cause enough damage to cause blood and bacteria, as well as everything mentioned previously. An ultrasound may tell your new vet about bladder inflammation, or thickening, but she still has to focus on the potential of the kidney stones.
Are you saying you and the second vet are questioning there are NO kidney stones present? I would understand if she wants to start kitty on K/D, but how this is going to resolve any stones is beyond me, perhaps she wants to get the pH to a normal level and retest the urine for signs of new crystals for identification, but the K/D isn't going to target crystals. She may be presumptively treating with K/D simply based on the renal enzyme levels at this point, still have to focus on those stones.
Could you update when your vet tells you more?
I'm sorry, but I had assumed your vet had done a cystocentisis, as he knows that's the most appropriate way to collect an uncontaminated sample for testing. Also, I had assumed he had prior cultured in order to base his decision on the baytril. (which your current vet might probably do anyway if she finds bacteria upon the culture results). I'm also wondering how the specialist missed this?
And, you said your first vet found kidney stones upon x-rays, both times, second time indicated no resolve. This would be one likely source of the blood. I suspect the specialist suspected similar.
While it's still possible a bacteria might show up on culture, you're still going to have to treat with antibiotics, and will need to know if the stones are indeed causing the blood (I suspect they are)....these stones can cause enough damage to cause blood and bacteria, as well as everything mentioned previously. An ultrasound may tell your new vet about bladder inflammation, or thickening, but she still has to focus on the potential of the kidney stones.
Are you saying you and the second vet are questioning there are NO kidney stones present? I would understand if she wants to start kitty on K/D, but how this is going to resolve any stones is beyond me, perhaps she wants to get the pH to a normal level and retest the urine for signs of new crystals for identification, but the K/D isn't going to target crystals. She may be presumptively treating with K/D simply based on the renal enzyme levels at this point, still have to focus on those stones.
Could you update when your vet tells you more?
..........Traci
Re: Feline Kidney Stones in young cat
just an opinion without reading everything that has been written and without x-rays but i think, at that is all, just a thought that regardless of what types stones these are..the long you wait for antibiotics, diets, etc etc to disolve them i think they should be surgically removes, scrap the lining of the bladder gently, sew the cat up (whoops take a culture while inthere) and then after the cat heals start working on a diet to hope to prevent their return...the longer these things sit in the bladder the more damage they ar doing to the lining of the bladder...get them out as soon as possible and then go for prevention of their return after pathology of the stones them selves as well as the bladder epithelium.....this is strictly an opinon and may not fit the situation but my opinion is that they (the stones) are a strong irritant to the bladder and are weakeing the bladder wall....again strictly a thousand mile away opinion ....lmay abe wrong but i think if it were my patient that is what i would do providing the cat is not at a surgical risk---and the longer it is delayed the more cjhance of irritation and damgae.......davet. (not corrected for errors.
Re: Feline Kidney Stones in young cat
whoops, just read the opening statement and these stones are in the kidney, not the bladder, well again i think i would follow the same procedure. ie have a veterinary urologist take out the stones in both kidneys (if possible) becuse, again the longer they are in ther the more glomerulae damage can take place plus uremia.. again read no farther but the longer it takes to get rid of them the more damage they can do..lithotripsye is fine, but i don;t know if they can do one kidney at a time but i know they can remove one stone at a time.... to atleast releive the pressure on one kidney....again a thousand miles away...maybe if i read more or see x-rays i might write more....
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holtergirl
- Posts: 4
- Joined: Wed Jul 30, 2003 1:56 pm
Re: Feline Kidney Stones in young cat
Will write more a little later. I've only seen 2 vets, no specialists yet. I'm waiting for my 1st vet to call me. When I refer to the "she" vet I'm referring to the vet I got the 2nd opinion from. Neither vet is disputing the existence of kidney stones. They're still there after cd/s & s/d over 2 months. She vet wants to be sure they stones are 'active'. It's possible the kidney stones are 'inactive' and not causing the blood. (I'm minimizing her explanation but that's how I understand it.) The internist she consults with 'typically' frowns on removing stones of this size. The trauma causes more problems than leaving them in if they're not the source of pain/blood etc. I'm not against going this agressive but I don't want to put her through this if we don't have to. Don't you think it's worth nailing down whether we can control the blood & bacteria with the right medication? Believe me, I'm torn between racing to the internist & putting her through surgery vs trying what this second vet is recommending. It's frustrating for me to know what to do. If we do surgery, who says the kidney stones won't come back after they're removed? Will removing them throw her into renal failure? I would never forgive myself.
BTW, K/D was a 'precautionary' move until we know more about the kidneys. She said it would help them function as opposed to the effects of S/D.
More later. .. Julianna is at the she vet now getting the urine culture done.
BTW, K/D was a 'precautionary' move until we know more about the kidneys. She said it would help them function as opposed to the effects of S/D.
More later. .. Julianna is at the she vet now getting the urine culture done.
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holtergirl
- Posts: 4
- Joined: Wed Jul 30, 2003 1:56 pm
Re: Feline Kidney Stones in young cat
First, you need to be aware that bloodwork can be perfect one month and totally off on the next, especially where the kidneys are concerned.
http://www.cvm.tamu.edu/vsam/VSAMFacultyListing.htm. Dr Willard advised against kidney stone removal given the size and overall 'health/pain/discomfort" of Julianna. He said if they took the stones she would lose 25% of kidney function and questioned whether it was worth it. He recommended freq blood tests to monitor kidney function and in-home monitoring of blood in urine. Dr Willard would only recommend removal if her kidneys worsened (e.g. early renal failure). He said diet at this point won't affect things one way or the other. I asked the vet about meds to alleviate her discomfort. He recommended against pain meds -- I can't remember why exactly -- and didn't offer an alternative. Bottom line: he wants to leave things "as is" and redo blood work in 2 weeks.
And, you said your first vet found kidney stones upon x-rays, both times, second time indicated no resolve. This would be one likely source of the blood. I suspect the specialist suspected similar.
Are you saying you and the second vet are questioning there are NO kidney stones present? I would understand if she wants to start kitty on K/D, but how this is going to resolve any stones is beyond me, perhaps she wants to get the pH to a normal level and retest the urine for signs of new crystals for identification, but the K/D isn't going to target crystals.
Could you update when your vet tells you more [/quote]
Talked to orig vet about this today. He said he normally doesn't do a cysto unless the patient has had > 1 urinalysis showing bacteria. Plus he said he doesn't "believe in them" but wouldn't explain why. I asked why he prescribed Baytril each of 3 times. He said Baytril kills most bacteria. It doesn't make sense to me. He prescribes an antibiotic because he suspects bacteria but won't do a cysto for the same reason. Anyway, I dropped it. He consulted with Michael D Willard, an internist at Texas A&M:I'm sorry, but I had assumed your vet had done a cystocentisis, as he knows that's the most appropriate way to collect an uncontaminated sample for testing. Also, I had assumed he had prior cultured in order to base his decision on the baytril. (which your current vet might probably do anyway if she finds bacteria upon the culture results). I'm also wondering how the specialist missed this?
http://www.cvm.tamu.edu/vsam/VSAMFacultyListing.htm. Dr Willard advised against kidney stone removal given the size and overall 'health/pain/discomfort" of Julianna. He said if they took the stones she would lose 25% of kidney function and questioned whether it was worth it. He recommended freq blood tests to monitor kidney function and in-home monitoring of blood in urine. Dr Willard would only recommend removal if her kidneys worsened (e.g. early renal failure). He said diet at this point won't affect things one way or the other. I asked the vet about meds to alleviate her discomfort. He recommended against pain meds -- I can't remember why exactly -- and didn't offer an alternative. Bottom line: he wants to leave things "as is" and redo blood work in 2 weeks.
And, you said your first vet found kidney stones upon x-rays, both times, second time indicated no resolve. This would be one likely source of the blood. I suspect the specialist suspected similar.
Our new plan with she vet is a process of eliminating bacterial uti & bladder inflammation before we turn to the kidneys. An internist she vet consults with said the stones are small which pointed to the unlikelihood that they were causing problems. There is definately something going on with her bladder. Today during the cysto she vet said Julianna's bladder wall felt thick. Of course we would need to do an u/s to verify. If, even after we treat the bacteria and bladder inflammation, assuming both are problematic, we again find blood/bacteria then the source has to be the kidneys. Over 70% of female cats her age with these symptoms have iLUTD only 13% have stones. I believe this is why she vet is recommending this approach -- attack the higher percentage diagnosis first.While it's still possible a bacteria might show up on culture, you're still going to have to treat with antibiotics, and will need to know if the stones are indeed causing the blood (I suspect they are)....these stones can cause enough damage to cause blood and bacteria, as well as everything mentioned previously. An ultrasound may tell your new vet about bladder inflammation, or thickening, but she still has to focus on the potential of the kidney stones.
Are you saying you and the second vet are questioning there are NO kidney stones present? I would understand if she wants to start kitty on K/D, but how this is going to resolve any stones is beyond me, perhaps she wants to get the pH to a normal level and retest the urine for signs of new crystals for identification, but the K/D isn't going to target crystals.
I believe this is why she recommended K/D. Better to be safe than sorry.She may be presumptively treating with K/D simply based on the renal enzyme levels at this point, still have to focus on those stones.
Could you update when your vet tells you more [/quote]