Thursday, July 23, 2009

Senior cats and the silent killer

As most of you know, The Country Doctor has been home to Lucky the cat since he arrived at the clinic 9 years ago as a tiny 0.7 lb kitten. We like to tease him because as cats go, well, he doesn't have much of a personality. He really is kind of a cool cat to live at a clinic though. When he came to us, he had a badly deformed rear leg. His bad leg has always prevented him from jumping up on counters and the like. Also he has a cataract in one eye and I'm sure this messes up his depth perception so that he doesn't like to attempt to jump up on things. This is a really good thing for a cat that lives at a veterinary clinic since there is lots of "stuff" on the counters that should not be messed with by a cat. Unfortunately, this past week, Lucky was diagnosed with kidney disease. We are very early into the treatment and diagnosis so his prognosis is really unknown at this point. Kidney disease is never good, but if a cat has the chronic form of the disease, they usually do better than those with the acute form. It will be at least a week or maybe a few weeks until we can determine what form Lucky has. I'll keep you posted on Lucky's progress as time goes by.

Since the staff and I are personally involved with a cat with kidney disease, I thought this would be a good blog topic. Kidney disease in middle aged and older cats is probably the second most common disease we see (dental disease being #1). Unlike dental disease though, kidney disease is a true silent killer. Cats will have kidney disease for months or possibly a year or more before any symptoms are seen. In fact around 65% of the kidneys have to quit functioning before the very first symptom is visible and that would be a slight increase in thirst and an increase in the amount of urine produced. Not many owners will pick up the disease at this stage. In fact, I probably wouldn't pick it up in my own cats because it is so subtle. Next, when 75% of the kidneys quit functioning, the cat will finally have abnormal blood test results. Even at this stage, most cats will seem normal although some cats will start to show a little weight loss. As the disease gets worse, the cat will lose more weight, have a gradual loss of appetite and may start vomiting. All this time, most cats will still urinate more than normal. The poorly functioning kidneys in their failing attempt to get rid of waste products in the bloodstream will let more and more water escape from the kidneys and out of the body. Unable to keep up just by drinking more water, these cats are very slowly dehydrating themselves to death.

Like I said before, kidney disease is never good, but if caught early, this is one disease where a SIGNIFICANT impact can be made to the cat's quality and quantity of life. And I'm not talking heroic measures here (although kidney transplants are being regularly performed in cats in this country). I'm talking some VERY simple changes in the cat's life. But first, we must catch this disease in the early stages before the cat starts acting sick. Folks, this is why we stress the importance of yearly blood work in our older cat patients. In a moment I'll tell you why, if we catch this disease early, what a difference can be made. You will be stunned!!!!!!!!

When a cat is diagnosed with kidney disease, it will fall into one of four stages. Stage 1 is the earliest stage when the blood work is normal. We do not catch cats in this stage very often. Stage 2 are the cats with abnormal blood work, but are still feeling good. This is where we can do the most good. Stage 3 and 4 cats have a worse long term prognosis because their disease is further along, but we can often help most of these cats at least somewhat. Also cats that have lots of protein in their urine have a worse prognosis. Cats whose kidney blood tests get worse in the first few weeks have a worse prognosis. This points to the need to recheck blood work every month or so at the very beginning.

So here is where several different scientific studies of cats with kidney disease have had similar findings. If I diagnose a cat with chronic kidney disease and do nothing, the average amount of time until that cat will die is about 6 months. If the owner can get the cat to eat a veterinary prescription diet (which believe it or not is possible in 90% of cats and if an owner is persistent enough), the average amount of time until that cat will die is about 18 months and some studies have average survival times of over 2 years! That is extending life span by 3 times just by changing the diet. BUT we have to catch the disease early!!!!!!!!!!!!!!!!! One thing to note though is that there is really no benefit to changing to a veterinary kidney diet in a cat that does not have kidney disease. Diet is an important treatment for kidney disease, but it does not prevent the disease from starting in the first place. In addition to diet, there are other treatments available that have a major impact in both quality and quantity of life in a cat with kidney disease. You may read about subcutaneous fluids, blood pressure medicines, B vitamins, potassium supplements, hormonal treatments, phosphorus binders and stomach protectants to name a few. Not every medicine is appropriate for every patient, but if needed, they can make a big difference to an individual cat.

So meet Snow. Snow is a cat owned by our very own veterinary assistant Ashley. Snow was diagnosed with chronic kidney disease 4 years ago. He was started on Hills Prescription Feline k/d diet and a hormonal treatment calcitriol. Unfortunately, he developed side effects from the calcitriol so we just kept him on the kidney diet and monitored his blood work periodically. This year he started experiencing some occasional vomiting, but he has responded well to periodic administration of a small amount of Pepcid. Four years is longer than average, but it just goes to show how just a change of diet and then the later addition of just one medicine has made all the difference to Snow's life.

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