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Worried the V.E.T. may not be right about kidneys and diabetes

1994 Views 10 Replies 7 Participants Last post by  sunset97

Facing a bit of a dilemma and would really appreciate some advice.
My vet has known our cat Poppy for 16 years but as a robust and healthy sort, she hasn't been a frequent flyer .... until recently.

In December, I took her in because despite being regularly treated, she suddenly developed a flea allergy and had some scabby bits on her back underneath her fur. That was the only problem she had.

As she is getting on, the vet recommended we do a geriatric blood profile once a year so we could be aware if anything was to start deteriorating. He also gave her some low dose steroids temporarily which cleared the scabs up very quickly and that was that ....or so we thought.

A week later, now the beginning of January, I took her back so he could see that her skin on her back was better and while we were there, he said that all her bloodwork had come back fine but that her kidney function BUN was not surprisingly for an old lady creeping up to the higher side of normal 9.8 mmol/L within a normal range of 5.7 to 12.9 so we should keep an eye out for any signs of her kidneys starting to fail. Wanting the best for my girl, I asked if it would be good to put her on a diet which would be sympathetic to her kidneys and help her to not develop any problems. He certainly didn't 'sell' it to me but did say we could try Hills Renal Diet. So we started her on a mix of their wet and dry instead of the Sheba and Iams she had been on.

Over the next three months, I didn't realise how much weight she lost because she is quite a fluffball and due to my stepdad's terminal illness and work I've not been around very much. It was only when I went to pick her up and give her a cuddle last week that I realised it was all just fluff. When I expressed my concern, my other half (not spent much time with animals before meeting me (and my cat and daughter) piped up that he had noticed that she had been drinking more in the last couple of weeks and that actually she hadn't been eating much since swapping food. I lost the plot slightly as she had been entrusted to his care while I was otherwise distracted but am getting over that now as it was ignorance rather than lack of care, she was eating some food but he just hadn't realised that she normally ate more and ignored all the leftovers she left at each meal.

So given he was off work I insisted he rake her to the vet that day. Shock news - she'd lost 1.5 kg since January and her glucose and calcium were very high. The vet told us she has probably got lymphoma in her kidneys and is diabetic. Also that she probably had a week or so left, and did we want to have her put to sleep.

We cried and talked and decided that as she didn't seem as poorly as the vet believed, we would just trundle along but make her last days happy. Then, at the first sign of distress, take her to be put to sleep. At that point we said sod the Hills renal diet, giver her the Sheba and Iams she wants.

Well, she's gone back to eating very heartily ( but not more than a normal cat would), has gained almost 0.5kg in a week, stopped drinking and seeing quite so much and is running around the house and garden like a kitten. Her catnip mouse has been taking a beating and this afternoon jumped over the garden fence! Horrified to think we almost took her to be euthanised last night based on the vets opinion!

So, couple of questions after my very long story (thanks for reading)

How much could the stress of practically starving herself for 3 months and being taken to the vets by someone not very confident have affected her blood glucose results 31.52 against a norm of 3.94 to 8.83? Apparently she freaked a bit at the vets which she's never done with me, plus OH has no idea if she ate just before he took her in.

Could self imposed starvation and resulting weight loss throw her results on glucose or calcium (3.31 against norm of 1.95 to 2.83)? All her other results are normal.

Why would she be 'getting better' if she is actually that sick?

This may seem like I am clutching at straws but actually I have accepted that she won't be around long. Just confused and concerned and not sure what to do next.

Thank you so much for 'listening'


So, as he was off work I got him to take her to the vet. Shocking news. She had lost 1.5kg since January, her
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Sorry, ignore the last bit. Couldn't get my iPhone to scroll down to delete the bit of duplicated text. Doh!
Maggie had a bout of vomiting, hyperventilating, diarrhea etc. that lead to her hyperthyroid diagnosis. Her blood glucose that day was extremely high, I don't have the numbers handy...but like triple the upper limit. Did a urine glucose test on her a couple weeks later and it was perfect. So yes, I think the blood glucose could be due to the stress. I'd recommend a urine test to be sure, it's more of a problem when the glucose is in the urine.

Not eating enough can have serious effects on her entire system. Since she seems stable on her old food, is gaining weight and all her symptoms have gone away, I'd just wait it out a bit and see how she's doing. Then I'd recommend re-running the blood work in a few weeks.

It's possible that there is something wrong with the food, if you still have it and are inclined...having a lab test it might not be a bad idea.
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A blood test for renal function is always more accurate and complete than a urine. You had multiple factors playing in this scenario. I would keep her on her "normal" diet for the next week and then YOU should take her back to the vet for a repeat blood test. Stress can always elevate blood sugar because of the so called "stress hormones". The Ca++ I suspect might be related to her diet. As well as the drinking. Some cat foods have quite a bit of sodium in them. What was her creatinine? If her creatinine is not elevated she doesn't need a renal diet anyway. I don't think you are over reacting, just asking reasonable questions. I am not at all sure why the vet felt she has lymphoma? But I would give it a bit more time as long as she is not in any discomfort. Please keep us posted. GL B
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Stress increases the blood sugar. And prednisone also increases blood sugar temporarily.
her kidney function BUN was not surprisingly for an old lady creeping up to the higher side of normal ... Wanting the best for my girl, I asked if it would be good to put her on a diet which would be sympathetic to her kidneys and help her to not develop any problems. He certainly didn't 'sell' it to me but did say we could try Hills Renal Diet.
Please forgive any abrupt tone that may come across in this response. My mother had a pretty bad stroke a few days ago, so I'm in hyper-logical mode right now trying to cope with all that's going on with her right now. So please don't take any offense if my tone seems impersonal. I just want to give you as much useful information as possible as succinctly as possible.

First, please get copies of all of your cat's lab results ASAP from your vet. You'll need them in order to make sense of the information I'll link for you, and we'll need to see them posted here in order to give you the best possible guidance.

While BUN is one of the blood values often associated with renal function, it can be elevated for non-renal reasons, as well. The more important blood value is creatinine, because it is kidney-specific. If the creat is elevated, there is something going on with your girl's kidneys.

Renal foods should not be fed to cats who are not in renal failure, and many people now believe that they are counter-productive any earlier than late-stage renal failure. The reduced protein in renal diets can seriously weaken a cat. This is why many people now believe that these foods should not be fed until the benefit outweighs the potential harm - namely, in late-stage renal failure. In addition to the issues related to protein deficiency, renal diets, as you've sadly discovered, are unpalatable to many cats. Cats will starve themselves to death rather than eat undesirable foods, and your girl was apparently on her way to doing so. It's a good thing that you caught the problem in time.

The rule of thumb with cats in renal failure is to offer them whatever is the optimal diet for their stage of disease, and if they won't eat that, then offer them whatever they WILL eat. The bottom line is that they MUST eat, regardless of what you have to feed them in order to get them to do so. You have done absolutely the right thing by switching her back to her regular food, though I also recommend that you slowly try mixing in a bit of higher quality foods like canned EVO or other premium canned foods to upgrade the quality of the protein sources in her diet.

she'd lost 1.5 kg since January and her glucose and calcium were very high. The vet told us she has probably got lymphoma in her kidneys and is diabetic.
Cats can spike very high blood glucose readings when stressed or in pain. Eating a meal within 8 hrs of the blood draw can also elevate glucose to some degree. A much more reliable way to test for diabetes is to request a fructosamine test. This is a blood test that averages the blood glucose over, I believe, several weeks, so it is not subject to those high-stress spikes.

Elevated calcium may be a much greater concern, though if her renal values were also elevated at that time, serum calcium is not necessarily an accurate test. If she still has elevated serum calcium now that she's feeling better, I strongly recommend that you have your vet send a new blood sample to Michigan State University's lab for an iCa and PTH test. MSU is generally regarded as the most reliable and one of the only labs capable of performing these particular tests. iCa tests ionized calcium, which is the only calcium that counts in a cat with renal disease. PTH tests for hyperparathyroidism, which is one potential cause of elevated calcium. The following link will provide you with MSU's information page on these tests:

Diagnostic Center for Population and Animal Health

Why would she be 'getting better' if she is actually that sick
Cats in renal failure can act perfectly normal, esp. if they've been starving and suddenly start eating again. So, I recommend you get her back to your vet for a full blood chemistry now that she's feeling and acting better and see what her status is now. If she is still having renal issues, or if her calcium or glucose are still elevated, further testing of fructosamine, iCa & PTH, and a urinalysis would be in order to clarify her condition.

It doesn't sound to me like a death sentence is justified without a lot more diagnostic information on your girl.

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My mother had a pretty bad stroke a few days ago,

Sending warm thoughts and prayers to you mother, you and your family, Laurie.

God Bless.
Thank you, Marie.

Claire, I apologize for not noticing that you're in the UK. Obviously, the information I provided you specifically about Michigan State University isn't going to be useful, though hopefully your vet will be able to locate a lab in the UK capable of running the same tests.

If, after you have blood tests run on Poppy again, you find that her creatinine is elevated and she does, indeed, have an ongoing renal issue, the following website (authored and maintained by a woman named Helen in the UK) is the most comprehensive resource available for information on feline renal disease:

The site can be completely overwhelming at first, but don't let that deter you. There is simply no question about renal disease in cats that can't be answered there. None that I've come up with over the last decade or so, anyway. And Helen provides all sorts of links, resources, and contacts for additional information in both the UK and US.

Please keep us updated on Poppy's condition.

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Thank you so much for your replies doodlebug, Binkers, Mom of 4 and laurief.

The vet has mailed Poppy's blood results (original Dec '11 and recent March '12) to me so will hopefully get them today.

Have some human glucostix so will also do a check for glucose in her urine later.

Will post when I have all the info.

We weighed her again this morning and she continues to gain slowly but surely :0)

I'm going to do what you suggest and keep her on her wet, quality protein, low carb food (Sheba) which she loves. We've actually stopped giving her Iams (which she also ate before being put on hills renal) as it is a dry food and I want everything to give her as good a chance as possible. Will look up the evo that you recommend on the internet too to see if we can get it here.

Then plan to take her to the vet for repeat tests in a week (ish) to see what happens.

Thanks again for your help.

Hugs to laurief, thinking of you. I'm also having a bit of a coping crisis and am functioning in 'get to the point' mode dealing with my step-dads late stage lymph cancer. Your tone wasn't abrupt at all. Really appreciate you taking time to respond given everything you have going on.

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Hi all ..... Thought I would post an update as you were all so kind and helpful!

So here we are over 2 months from when the second vet at the surgery that my other half saw with Poppy said she should be put to sleep.

She is asleep next to me in her basket after a hectic early morning chasing paper balls and catnip mice. Her weight has stabilised at a healthy level although she hasn't put back what was probably excess anyway. She has been fed a wet only, low carb high protein diet (various gourmet pate range from supermarket). Expensive but good quality. She is a happy kitty and has been back to the first vet, taken by me rather than OH. Glucose levels NEGATIVE!!! Kidney on one side slightly enlarged but this vet says not unusual in a geriatric cat and certainly not a clear indication of cancer. He says she's a bit arthritic ( no surprise at that age) but that whatever we are doing just keep on doing it because it obviously works and there is no way he would consider putting her to sleep at this time. (I asked him 3 times if I was being cruel and keeping her alive for myself and he said absolutely not!).

I don't expect she'll go on for years but she has a good bit of a healthy enjoyable life left yet. This particular vet has now started researching the use of an Atkins style diet as an alternative to insulin for some 'diabetic' cats. I know of 3 cats (including his own) who are now reported as having no glucose leakage. Not to be done without a vets supervision but it makes you think doesn't it!?!?! Come to think of it, my own Dr has told me to cut out refined carbs - no sweets, cakes, bread, pasta or other things made with flour and all my bloodwork has gone from bad to good too.

Gonna stop now as I'm starting to preach the horrors of carbs for any living beings. But lesson I take from this is:

Ask questions....and keep asking
Old medical science gets replaced with updated thinking. Old medical science was once regarded as madness in it's early days too.
Trust your instincts- you know your pets better than most vets
Forums like this one can really help get to the best outcome for your furry friends and you.

Many many thanks again.

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I am glad Poppy is doing better. I hope she continues to do well.
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