Back in July, my 11 year old cat was tentatively diagnosed with possible early renal failure. This past Saturday, however, she had another round of bloodwork and urinalysis...the results of which indicated her kidneys are probably fine! Needless to say, I'm very happy about this. But the more I think about it, the more it seems like the clinic folks jumped to conclusions way too quickly based on too little information. Am I off-base here, or is it perhaps really time to explore other local veterinary options?
This past July, the vet informed me (following one of Nikki's
"senior wellness" appointments) that her urine was very dilute, and that in combination with BUN and creatinine at the higher end of the normal range, this indicated compromised kidney function.
The working assumption going forward was that Nikki was in the early stages of feline chronic kidney disease (which basically always progresses to renal failure over the long term). She was prescribed aluminum hydroxide powder (a phosphorus binder) which I duly mixed into her food. Meanwhile, I was told about future possible treatment options: ACE inhibitors, appetite stimulants, and ultimately subcutaneous fluids.
Fast forward to last week. After several days of observing Nikki repeatedly refuse food, I got worried that either she had a dental issue of some sort or was experiencing a sudden progression of her assumed kidney disease. So I made an appointment to get things checked out.
(I should probably note that Nikki does have a history of gastrointestinal issues, including frequent vomiting, constipation, random bouts of poor appetite, etc. She is also an extremely picky eater. This all "fits" with CKD, but obviously it fits a bunch of other conditions too, including plain old hairball trouble, etc.)
Of course, being a cat, Nikki managed to magically regain her appetite the day before her appointment...but since it was still such close temporal proximity to one of her "DO NOT WANT ANY OF THE FOODS" episodes, and since I figured it was about time to check the status of her renal functioning, I kept the appointment.
And this is about where things started getting weird.
During Saturday's exam, the vet made several comments that had me going, "huh?", most notably one about "possibly starting subcutaneous fluids sooner [within the next few months, most likely] rather than later". I am, of course, fine with learning to administer sub-qs if any of my cats end up really needing them...but it was alarming to hear it being suggested as a near-term thing in response to my merely noting that sometimes Nikki got constipated.
Bloodwork was performed, and I spent a full two days bracing myself for bad news. What I got, however, was news so good I momentarily wondered if I was dreaming when I heard it!
Basically, said Ms. Vet., Nikki's urine was "perfectly concentrated", and her kidney values looked wonderful. Apparently her prior results (with the dilute urine, etc.) were most likely a fluke. Of course I was thrilled to hear this!
That said, I was told to keep giving the phosphorus binders. Which I now don't understand at all given I looked at her July results again and her phosphorus was normal!
This means my cat was prescribed a treatment and given a probable diagnosis of a chronic disease based on what looks to me like way too little information.
I feel very stupid for not realizing this back in July, but I was all wrapped up in trying to "avoid being in denial" and "not second-guess people who know better than I do". At this point I'd have to say I'm pretty concerned about continuing to take my cats somewhere that jumps to a rather serious conclusion due to a single test, and then tells me to keep treating her as if she has this condition even though they themselves acknowledge that "her kidneys are apparently working well". I'd at least think they'd want to do a differential diagnosis to rule out something like, say, pancreatitis, but they haven't mentioned anything of the sort.
Anyhow...I know that when it comes to doctors, whether for self or for one's companion animals, it is beyond okay to shop around and try different clinics for ANY reason, even if it's something as silly as "I don't like the decor in the waiting room".
But I really wanted to ask this question for the sake of determining whether what I'm seeing with this clinic is typical of most clinics, or whether I have real reason for concern. Maybe I'm expecting too much attention to detail?
I am not a vet, but if I were a vet, and one of my patients came back with weird urinalysis results, the first thing I'd do would be to schedule a second urinalysis, perhaps this time with specific instructions re. whether the cat should eat or drink beforehand, etc. I would certainly not prescribe any medication until I was more sure of what we were dealing with. The fact that none of this (basic?) investigation was performed or even mentioned makes me nervous. And I just want to get a sense of whether that nervousness is justified before I uproot my cats from this clinic and go elsewhere.