Case Study: The value of one feline’s annual wellness exam

January 11, 2013

Posted By : Lombard Animal Hospital

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“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 :

  1. A 100% canned, moderate protein level, but high quality food
    • The canned option provides the increased moisture to aid with mild dehydration.
    • The moderate protein level prevents muscle wasting while not making the workload on the kidneys too intense.
    • The high quality protein results in less end-byproducts of digestion, which helps to keep BUN/Creatinine at a reasonable level.
  2. Feline Renal Support Supplement ($17.00 for 60 Tablets = 1-2 months of treatment depending on dose)
    • Nutritional support specifically targeting the kidneys.
  3. Subcutaneous fluid therapy at home : 1 treatment per week. ($23.30 for 1 Kit = 6-10 treatments)
    • 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.
  4. 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
  5. 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.

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