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post #1 of 9 (permalink) Old 04-13-2017, 04:57 AM Thread Starter
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Need help/advice for cat w/ URI and CKD

hello,

I have 13 year old male indoor DSH

He has several ailments. Last year he was diagnosed with early stage kidney failure after getting an infection which required a course of antibiotics. The treatment did the trick and the infection cleared but vet told me this is the start of the kidney disease. So he was switched to special kidney diet with hills science wet food and (he really likes it) and royal canin renal dry food. Most likely as a result of this, he also got diagnosed with high blood pressure and was prescribed pretty much a lifetime of blood pressure medication. It was under control so far and so far so good thankfully with the kidneys. Though he still drinks a lot of water but the vet said that will be the new norm as his kidneys slowly deteriorate.

So in addition to all this, for the past year he has been getting odd random infections around the eyes and nose area. one time he had a weird hair loss right on the top of the eyelid which was treated with topical antibiotics and it worked. Then he would sometimes sneeze blood and had a runny eye and vet said he noticed that eye seems off and he may have an infection so again antibiotics were given and it worked it cleared up. Then out of nowhere his nose bridge just fattened up and became very swollen (like the avatar character) and again antibiotics were given and the swelling went down right away and the infection cleared up.

now here is the important(er) part - about 2 weeks ago I noticed he was having odd breathing issues like for example when he opens his mouth to eat, drink, or groom himself, he sounds like he's slurping or snorting like a pig. And progressively I noticed he makes weird noises while he sleeps and he breaths loudly almost as if he's snoring and he takes big breaths. So I took him again two weeks ago and the vet said at this point I would really recommend a CT scan to see what's happening if it's a bigger problem (which he has said before it may be but the antibiotics seemed to have ruled it out) like a tumor or polyp or some other infection however because he has the kidney issue AND hypertension he is weary because it's risky for cats to be sedated with those conditions as risk of death is higher either on the spot or shortly after even if the procedure and imaging goes smoothly.

So he said let's try another anti biotic and see if it clears - well, it's been two weeks and so far nothing. it's actually gotten worse and his weird noises and loud and labored breathing (sometimes he breaths with his mouth open) have gotten worse especially the last 48 hours. I spoke to him on the phone today and he said at this point we need to do a CT scan (though he said an MRI would technically show more but the risk is higher as sedation period is longer)

So that is the situation. I'm looking for further advice from people who may have gone down this road or similar ones or have expertise in the field.

I've spent a few hours now doing as much DIY investigation as I could online at the hospitals he told me about as well as general info about anesthesia and renal patients and ct scans and all that.

From what I understand, there are a bunch of procedures and methods which are geared towards renal patients, so tomorrow when I call the hospitals, I will ask them a bunch of questions about that.

What I'm most nervous about (other than what the tests will reveal) is the sedation part.

I also read that there are actual board certified veterinary anesthesiologist (here: Anesthesia & Pain Management - Animal Medical Center - New York City) which seems to be more reassuring but I'm not sure if this is more of a marketing gimmick on the part of this hospital or not.

I live in New York City but the vet I goto is in the suburbs so the referrals he gave me are a bit outside.

Here there are:

1) https://vcahospitals.com/westbury
2) Long Island Veterinary Specialists

then there is this place Home - Animal Medical Center - New York City which is sort of the big place but I read a bunch of reviews on yelp and many people complain of under-attentiveness and overcharging which I can totally see. However, they claim they have the only actual board certified veterinary anesthesiologist and they claim that their CT scan machine is a new model that can scan much quicker thus reducing the amount of time of sedation. CT Scan - Animal Medical Center - New York City

I will ask the other places about the equipment they have. The LIVS.org seems to have a great reputation as well though they showcase their tesla 3.0 MRI machine which doesn't do much for the CT scan.

So are these things more just superficial on the part of these hospitals or does it make a difference? In other words, is this AMCNY a better bet even though they have a bunch of horror stories (more so than others) in the reviews if they have a better sedation specialist, and machinery which scans quicker and more accurately?



What other things should I look for? Ask about? Take into consideration?


Has anyone had a similar experience?

Anyone have any general or specific advice for me in this whole case?

This comes at the worst possible time of my life work wise, as times are tough right now financially, so I will have to hope to get approved for the care credit or borrow money from friends as I'm sure the costs for the scans and sedation and additional testing (the vet told me once they find something they would need to do a biopsy or test it more to see what it is) will be expensive though none of the places I called so far were willing to even give ballpark figures. So cost does play a role but ultimately even if I have to borrow money or sell stuff I don't use, the well being of my cat is the priority so I wouldn't want to do something just for the sake of the money. So for example if the other hospital not in the downtown area is a bit cheaper and has the right people who have experience specifically with renal failure cats and have the best equipment to take scans quickly and all that - I would do it, but if they don't and it's just cheaper, I would rather go with the more proficient anesthesiologist (if you folks think that the board certified thing even matters) and the machine which supposedly works faster.

- Moby
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post #2 of 9 (permalink) Old 04-13-2017, 10:48 AM
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Never had a cat with the problems your cat has, nor experience with CT scans, etc. for pets, so can't give any suggestions....I would say go with your "gut", as often it's your spirit or higher power directing you, but others may have better suggestions/advice. Do give us an update as we all can benefit from your experience. Good luck!

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post #3 of 9 (permalink) Old 04-13-2017, 12:03 PM
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Personally I would go with the hospital that seems better overall as long as when you talk to them, they show an appropriate understanding of the needs of renal patients. Having a board-certified anaesthesiologist would be nice, but if the overall quality of care is low I would be concerned that negligence before and after the procedure might outweigh any benefit there. That said, I don't know anything about the specific hospitals in your area; this is more just my general outlook, not a recommendation for or against any particular vet or hospital. I agree with Catloveami that ultimately you should go with whatever one you feel most comfortable with.

I realize this is not your actual question, but do you give your cat subcutaneous fluids at all? My CKD cat is on them and needed extra fluids when he had a URI. It's not a fix, but it made him a lot more comfortable. If your cat isn't set up for a drip, this might be something to consult with your vet about. It's easy to give at home once you get the hang of it and not very expensive.


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Last edited by Blakeney Green; 04-13-2017 at 12:06 PM.
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post #4 of 9 (permalink) Old 04-13-2017, 12:21 PM Thread Starter
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Blakeyney Green, thanks for the response.

No - no IV drip at home. My cat is extremely difficult to handle when it comes to even getting him in the carrier to take to vet or try to administer any medicine or procedure. I've seen videos of the IV drip at home and it seems that you need to have a willing participating, mine is the polar opposite.

Though the issue here isn't really his CKD at this point but more of his URI. I don't think the two are related??

- Moby
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post #5 of 9 (permalink) Old 04-14-2017, 02:36 AM
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Quote:
Originally Posted by aramism View Post
Though the issue here isn't really his CKD at this point but more of his URI. I don't think the two are related??
The URI may lead to a CKD cat becoming dehydrated, so extra fluids may help the cat feel better. It's not by any means a cure for anything, but it can help as a comfort measure.

That said, if it's not an option for you, it's not. You know your cat best.

Maisie is terrible about taking his pills (he's on Famotidine and Enalapril for CKD and related issues) and I get scratched and bitten a lot, but he doesn't mind the drip too much so the fluids are a lot easier.


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post #6 of 9 (permalink) Old 04-14-2017, 09:27 AM Thread Starter
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Yeah we've been doing our best to keep him drinking it's hard because he has a hard time since he's congested... he has the will to drink and eat, just the lack of smell makes eating harder and the fact that his nose is stuffed makes drinking harder since he breathes with his mouth.


So we took him to the more "upscale" AMC hospital to the ER. There was no internal doctor/specialist available anywhere so this was the next best option because they had them tomorrow (meaning today) so I thought just in case there is something super wrong and they admit him then at least a specialist can look at him whereas other hospitals didn't have any internal doctor specialists until monday.

The triage nurse was nice and more compassionate saying that dehydration is a concern as well as his blood pressure so they might put him on IV and also give him oxygen to help him breath.

THEN, came the actual ER doctor who as soon as she heard that the cat can be a bit difficult to handle didn't even feel him or touch around and just took a glance at him through his carrier!!! She then said she wants him to see an internal doctor (which they made an appointment for today at 11am) and that there's not much they can do there except admit him overnight but he will be isolated and alone and might not be good for him (which I agreed with) and she said that she's not worried about anything other than a major general problem like a tumor (which we already knew) and said that she suggests a CT scan also but in the immediate there is not much we can do he can breath through his mouth and it's okay if he doesn't eat for a day and that we should try giving him water but again if he doesn't drink for a day it's not terrible. I was shocked by that because he has the renal issue and I asked about that she said still it's ok. She also said there is no way to decongest him and that he has to see a specialized doctor who along with the family vet will work out the CT scan.

So I thought it was a bit absurd that she was "scared" in handling him to at least check his lymph nodes, look at his face closer, and take his BP and maybe even temperature.

At the very least she didn't charge us anything for the ER visit because they didn't do much except talk, which she spent about 20 minutes doing, so it as ok in that sense, but disappointing that they didn't go further.

Now when we got home, he perked up actually and drank water all of a sudden and I got him to eat some wild sardines (which he used to love before he was switched over to a kidney specific food which he still liked but didn't have as strong a smell) and he still has the stuffy and semi-lethargic but at least is drinking now.


So now the issue is that I checked the doctor who they want him to see today in a few hours, but she's like an intern and a recent graduate. I don't see the point of my own vet recommending to see someone like this when they are less experienced??

So I'm not sure what to do, the X factor here is that it's a holiday weekend and that most good internal doctors are out of town or not working until monday, so I'm sort of flying blind.

I can take my cat for blood tests and stuff to this internist at a so-so experience hospital, or try to schedule a CT scan today. Ultimately I feel most comfortable getting advice from his main vet, who again, is out of town until monday. I just don't know if it's a good idea to not take any steps with him and let him just keep going until monday.

- Moby
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post #7 of 9 (permalink) Old 04-14-2017, 06:44 PM
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I am really sorry to hear about your kitty's health issues. My kitty has early-stage renal failure as well, but as of a few months ago, the vet didn't feel it was necessary to put her on a k/d diet. You're lucky your kitty likes the food though - most don't!

How did the appointment with the specialist go? And did your vet and the ER vet tell you why they recommended an internist? Unless this is something different from a human internist, I wonder what they're looking for, if the primary concern is the issues with breathing.

I don't have any direct experience with your situation, and I am also sorry to hear you had a bad experience with the vet. I will say, though, that for your kitty's particular symptoms, it may not have been as necessary for him to be handled by the vet as with other symptoms, so she may just have wanted to avoid further stressing him. Her attitude seems a bit callous, that of a busy vet who's just not a warm and fuzzy type, but that doesn't necessarily mean that your kitty won't get good care. She may have been able to tell what could and could not be done based on a lot of experience. The two things that are in her favor are that she was concerned about keeping him there overnight and that they didn't charge for the visit. That says, at least, that they're not out to just take all your money.

However, that said, if you're not comfortable with her, then she's not the right vet for you. But maybe that was the last time you need to deal with her?

About the CT scan, their new machine is a huge step up from what they used to have, and is likely a more advanced machine than what most animal hospitals might have - but you'd need to know what kind of machine other places use in order to compare. I'd think the higher "slice number" of their machine is important in your kitty's case primarily because it reduces the amount of time needed for the scan.

The doctor your vet recommended might be young, but she is a specialist, so that alone might be worth something.

Please keep us updated!
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post #8 of 9 (permalink) Old 04-15-2017, 12:37 AM Thread Starter
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Spirite,

yes it was odd about the ER visit because it seems like generally most people complain doctors/vets overcharge AND don't do the thing medically. This case, it was a hybrid. I was thankful that she acknowledged that she didn't actually do any tests or anything other than just look at him through his carrier and spend time talking to us thus saving us $190 ER exam fee + additional testing fees. Though I wasn't looking for a coupon hence why I sat through an hour of traffic to go there because it's supposed to be a very prestigious hospital. I would have rather paid the money and had them test him to see if there was anything pressing. But anyway, what's done is done.

By the way, just to make sure this point doesn't get lost - the ER person was not the regular vet. I am actually quite happy and extremely comfortable and trusting with him. only issue is that he is out of the office until monday april 17th.

Also the young doctor (young as in she is an intern at the hospital and just graduated last year and is filling in for the other internal med doctors) was not referred by my main vet, but by that ER doctor.

The reason why an internal medicine doctor is required is that they are the ones who the do the examination at the hospital where the CT scan is to be done to do a physical and blood work up to ensure the right stuff gets done and the procedure goes as well as possible. Plus, I believe that the internal doctors are a step up from a regular vet as far as they are specialists and they only see patients with referrals from family vets. So I'd assume they are a bit more experienced specifically with internal medicine as opposed to say orthopedics or some other sub-categotory of veterinary medicine. Either way, they are more acting in the capacity of screening the patient for the exams and tests needed and I was told they still work in tandem with the family vet to deal with the test specifics and exam results and plan of action moving forward. I guess two heads are better than one...

Now with regards to updates, so here is what is happening:

I cancelled the appointment today with this AMC hospital (where I went to the ER and where my appointment was with the first year intern) because at this closer hospital (link below/this is one of the original three choices I was given by my main family vet) an internal medicine specialist was available tomorrow (saturday april 15th) to do a consult and pre-testing evaluation. They did tell me the model of the CT scan machine they had over the phone (toshiba aquilion tsx 101a multi slice) but I forgot to ask how many slices it is, I googled it and it seems that there are several different models, but it was over the phone so I will now ask specifically when I get there tomorrow.

This hospital and the doctor chosen has me feeling a bit more comfortable because the doctor we are seeing tomorrow specialized her research with cats and in specific some things involving kidney disease (which my cat has) so I think that is a bit of a plus.

I did as much research as I could on sites like yelp and other review sites and it seems each vet around here has a similar level of extreme love and hate. They all (recommended ones from vet) have right around 4 out of 5 star ratings.


Now MAJOR update and this was the reason I held off on going today to the other appointment at the ritzy hospital. My cat, when we came back from the ER, and through the night, and all of today, is all of a sudden doing better, almost at the level he was doing for the 2 weeks of antibiotics which is still showing symptoms of a bit lethargic and still has little stuffy nose, but nowhere near the total apathy and sneezing blood and constant choking and gasping for air and crying. One cool tip the ER doctor gave me was make the house very steamy by running hot water and I ran the shower scolding hot for like 30 minutes then opened bathroom door and closed all windows and hugged him around the bathroom for a bit and made sure he stayed around there - I'm not sure if that's what did it or he was already getting better but after that his sense of smell seemed to come back and I was able to with a spoon get him to eat and then he drank water finally (which I was SOOO happy about as I was a nervous wreck about him not drinking) and then shortly after that he just all of a sudden "woke up" and started asking for food and literally just feasted on the food and drank water. Then overnight he was better then today he was much better and totally without any encouragement eating like his normal hungry self (he's a big tomcat boy ~13.5-14 lbs) and drinking water without any of the crazy slurping noises.

So I'm really not sure what's happening, if this is some like mirage or odd thing where he just gets better after getting really bad and he might get bad again so I'm super confused. Either way, I felt in lieu of his status change it's better to not have to goto this unknown student doctor (who holds a degree in human biology before vet degree for some reason) at a hospital much further away and with an awkward ER experience and better let him rest a bit and go one day later to this other known experienced (specifically with cats) and not do the CT scan the same day (they wouldn't unless it's an emergency anyway) but let her get a look at him and test him with bloodwork and stuff anyway and MAAAYBE I pray that he just gets better and there is no need for a CT scan, OR at least he's not in that bad shape he was in and I can speak to the ONLY person I trust with advice about him which is his main vet on monday before pulling the trigger on the CT scan after the preliminary testing is done.

So that is my plan so far after many hours spent agonizing over the right decision.

Sorry I seem to be all over the place, this is my first and only companion animal, I've had him my entire life, and luckily he's been very healthy until recently so I don't have much experience with a lot of this veterinary stuff other than basic check ups which he's always passed with flying covers through his life thus far. So when people say "pets are like your family" I say no, they are not "LIKE' your family they ARE your family. And my cat is super duper social and chatty and playful with my his whole life so I'm very close with him and it's very painful and stressful to see him go through this so I'm sort of learning as I go with all this medical stuff and dedicated to doing as much as I can and above and beyond what level of due diligence and research I would do for my own health.


PS - this is the link -> Long Island Veterinary Specialists
PS -
Quote:
Originally Posted by spirite View Post
About the CT scan, their new machine is a huge step up from what they used to have, and is likely a more advanced machine than what most animal hospitals might have - but you'd need to know what kind of machine other places use in order to compare. I'd think the higher "slice number" of their machine is important in your kitty's case primarily because it reduces the amount of time needed for the scan.
about that - as I said I will ask, but let's say this hospital he has the appointment with tomorrow has say a 16 slice machine or something, less slices, I wonder what I will do in that case? Goto the more advanced machine but the weird ER hospital or the LIVS hospital (link above)? I guess once he gets his physical tomorrow, they wont schedule the CT for a few days anyway and I will have time to speak to the main family vet again on monday about his take on the CT scan machine issue.

- Moby
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post #9 of 9 (permalink) Old 04-21-2017, 02:07 AM
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I'm so glad to hear he's doing better! I hope he still is? How did the vet visit go? Were you happy with the hospital and the vets?

I'm still a bit confused about the internist, because I thought your regular vet was recommending a CT scan because of the breathing issues, not because of the CKD? Whatever the case, definitely, having a specialist is always better, and it sounds like the one at this new hospital is more experienced.

Anyway, did the internist recommend a CT scan? I'm not an expert, but since this hospital's CT scan machine is "multislice," even if it's way fewer slices than the machine at the AMC, I can't imagine it would make *that* much difference in precision or in time for a kitty. I've had probably 12-15 CT scans and only one lasted more than 20 minutes - and that's on a human. And considering how many reservations you have about the AMC, personally I wouldn't go there just for a machine that may have bells and whistles that really may be unnecessary.

Now that you know the steamy bathroom really helps his congestion, I hope that will give you some peace of mind knowing there's something that you can do to make him more comfortable immediately.

Did you post a pic of your little guy in the Meet My Kitty forum? I'd love to see him!
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