The lab results are not very good :( and that's partly due to Yuki's resistance to receiving fluids.
Strangely enough, however, her weight is up almost half a pound from her last vet visit, which is a very positive development. She is still eating and drinking well on her own, without any nausea, stomach upset or vomiting -- also good. Although her appetite is not exactly hearty, she's eating most of what is set out for her, both dry and wet prescription food. "Output" seems fine (no constipation, no excessive or inappropriate urination) as well. In other words, despite the lab results, she's not showing many of the symptoms that might be expected with numbers that bad. And in terms of attitude (or should I say cat-titude?) she's still feisty and curious and still has the random scamper attack now and then.
So the good news, of course, is that her quality of life is apparently still quite high. Read MORE... if you'd like to see actual numbers and the continued plan for Yuki's treatment.
Two of the most important tested blood values relative to chronic renal insufficiency are BUN and creatinine.
BUN (blood urea nitrogen) is a waste product excreted through the kidneys. A high number here also reflects dietary changes and dehydration.
Normal: 15-33 mg/dl
Yuki: 117 mg/dl
Creatinine is a waste product excreted through the kidneys. A high number reflects declining kidney function.
Normal: 0.7-1.8 mg/dl
Yuki: 7.5 mg/dl
She is also showing signs of anemia, which is expected in most CRF cats as the disease progresses.
What this means in terms of her treatment is that she (and we) are no longer going to be able to slide on the subcutaneous fluids. No matter how little she likes getting them, she is going to have to receive 150ml at least two times per week. If this means that she has to receive them at the vet clinic where she can be surrounded and her threats neutralized (you think I jest? see above where I say she is still feisty :) ), so be it.
Unfortunately, that would mean paying not only for a vet tech's services, but also paying the clinic's full price for fluids and needles. As anyone who has read this blog in the past already knows, the cost of pet health care is not in itself a problem to us. But if we are able to do some of the needed care for chronic conditions at home it is definitely preferred. Lactated Ringers Solution, venosets and needles can be obtained very reasonably by prescription at most human pharmacies and also through several pet health mail order sources. So, Yuki... please get with the program :)
For the anemia, she will be receiving injections of Epogen, which is synthetic human erythropoietin. This is a hormone produced by healthy kidneys that stimulates the bone marrow to produce red blood cells.
There is one major drawback to this medication, though... and I want to talk to the vet a little bit more about it before Yuki actually begins this treatment. Because Epogen is derived from human DNA, a small percentage of cats develop an antibody reaction to it. In that case, not only will it not help, the cat's anemia will worsen.
Want to check out some of the sites that I have been visiting?
Feline CRF Information Center
Nadia's Feline CRF Page
Tanya's UK Feline Chronic Renal Failure Information Centre
It's always hard when your decisions end up based on quality of life rather then cold hard numbers. At least if it's quantifiable then you can be totally sure it's right, more subjective measures always introduce doubt (well for me anyway, maybe it's the scientist in me?). But you know you cat better than anyone and know that this is worth doing.
You could always fly me over there to make your Ringer's? I used to make up that damn stuff nearly every day during my masters, although we added glucose or mannotil rather than lactose. Not sure about the injecting though, my cats are so placid I've never had to deal with the flying claws thing. I read someone describe cats as "pointy on all ends", which sounds like what you're dealing with.
Oh and we saw a three legged collie dog running along with it's owners the other day so I told Boyd about Jake :D