The next day we were shocked to hear that Duncan’s BUN (98) and creatinine (8.2) numbers were so high. In addition, his phosphorus was far beyond high normal at 11.9. His specific gravity was very low at 1.015.
We knew that he needed IV fluids and we wouldn't leave him at our regular vet’s office with no staff in attendance overnight so we took him to our local emergency and critical care facility where he would be monitored constantly. Both our vet and the ER doc were leaning towards this being an acute renal event. The possibilities were a urinary infection or a kidney stone since his white blood cell count was elevated. A urine culture was done and came back negative. His medications while he was on IV fluids were Pepcid AC, Alternagel and Ampicillin.
We visited Duncan twice a day and each day his BUN and creatinine numbers came down. His creatinine was decreasing by approximately 25% every day. He was not eating well and his liver values were being checked daily since hepatic lipidosis was a very real concern. We were reluctant to give him an appetite stimulant based on our personal experience with Avatar, so the vet techs began assisted feeding instead. Fortunately his liver values remained within normal range.
We felt all along that this was CRF and a few days after Duncan had been on IV fluids, the ER vet we were working with was inclined to agree.
The first few days that we visited Duncan, he seemed happy to see us though obviously stressed. On his third day of IV fluids, Duncan seemed extremely distressed when we visited him. He was holding his head in a strange, rigid way that is hard to describe. He seemed to be much too upset to even notice that we were there with him. We began to seriously consider bringing him home sooner than planned because of his agitated state. We discussed it with the vet.
Our plan was to get him home where he would be more comfortable and we could start administering sub-Q fluids. We had not been aware (or hadn’t remembered) that a cat has to be weaned from IV fluids so we had no choice but to leave him there for a couple more days. His blood pressure continued to be high. He was throwing up everything they fed him.
We had hoped that on the fifth day of Duncan’s hospital visit, he would be able to come home. Each morning, Carol would get a report from his ER vet by telephone and on this morning, Carol was told that Duncan was pulling out his IV and chewing on it. He was still throwing up his food and they started giving him Reglan in addition to Pepcid AC. Carol had noticed the night before that Duncan's respiration rate seemed slightly elevated and that morning the vet told her that Duncan was having some respiratory distress with respiration of 60 at times. Normal respiration is 20 to 30 but no more than 40.
IV fluids were stopped. The vet recommended a chest x-ray and did it immediately. They found fluid build-up in his lungs and his heart looked “a little big” on one of the x-rays. He was transferred from the ER vet to an internist at this point.
Fortunately, the internist had a cancellation that day and was able to do an echocardiogram within a short period of time. Though Duncan was in the oxygen cage for five hours, we were told it wasn’t a life-threatening situation. The internist called us in the afternoon with the awful news that Duncan had restrictive cardiomyopathy. Both the right and left atriums of his heart were enlarged. In addition, there was fluid around his heart. During the echocardiogram, the vet also examined Duncan's kidneys and while they both looked somewhat abnormal, the right kidney is smaller than the left. Chronic renal failure was confirmed.
After Duncan had been in the hospital for nearly seven and a half days, we were finally able to bring him home along with his medications, a bag of Ringer's solution, an administration line and a handful of needles. It is about 10 miles from the veterinary clinic to our house and Duncan’s constant meows on the ride home were distressed and even sounded angry. Once we got him home, he immediately went under a bed and there he stayed for hours at a time. His litter mate, Joseph, kept vigil on the floor by the bed. Eventually Duncan would come out for brief periods but still would go back to his safe spot frequently. Over time, he relaxed and ceased to hold his head rigidly at a strange angle.
Now we were faced with several problems. Duncan is one of those cats who panics when he is immobilized. We had to pill him three times a day and administer 100 ml of Ringer's solution subcutaneously once per day. We faced this with some anxiety. Although we have had this web site online for more than ten years and have both assisted with the administration of fluids many times, neither of us had ever done the dreaded 'stick'.
When Avatar started getting sub-Q fluids more than 11 years ago, we took him to the vet's office (which was only a couple blocks away) every other day. This time, we were determined to bite the bullet and do the fluid therapy ourselves.
We set up a fluids station on the kitchen counter and prepared for the first session with much trepidation. It was decided that David would do the stick and Carol would assist by holding Duncan. For the first few sessions, we had the assistance and support of our friend and website colleague, Sandy Carr.
With two people holding him in place, Duncan wanted badly to get away. As we said before, he panics when he feels trapped. To make matters worse, even though he has lost some weight, it is very hard to raise a tent of skin on his back. Making that first stick was extremely hard. Somehow we got through the first session and were physically and emotionally drained by the experience.
The second day was worse than the first and we were beginning to wonder if we would ever get better at it. There were several days when he got less than 100 ml, but we didn't give up.
We noticed that, although Duncan was struggling when being held down, he was tolerating the fluids themselves quite well. He didn't seem to mind the stick and when the sessions ended, he walked over to his food bowl as if nothing very bad had happened.
We began to use less forceful restriction. Carol now places a hand on Duncan's rear-end and another on his head. Instead of holding him down, she is just keeping in contact. Duncan no longer panics and the job is getting easier for all involved.
We even survived our first instance of bleeding from the injection site. You should know that it happens occasionally. So far it has only happened to us once and while it proved to be inconsequential, we'd prefer that it not happen again. Click here to read the full story of how we went from nervous newbies to proficient caregivers.
Duncan never ate canned food in the entire eight years of his life. After he got home from the hospital, he showed no interest in the upper-scale dry food we had fed him before. Though we brought some canned Hill’s k/d with chicken home we assumed that he would not eat it. And he didn’t... until Carol assist-fed some and got him jump-started. Since then he has been eating it every day along with Hill’s dry k/d and other dry foods. He has absolutely no interest in the dry food that he ate for so many years.
While his appetite is not what it used to be, he is eating without too much coaxing.
Four or five days after he got home from his IV fluids, we began to see signs of the old Duncan. He was obviously much more relaxed and began to behave as he always had, snuggling with Mom, playing with his brother and stretching out for naps in the sun.
We had been told that he should not have much exercise owing to his heart condition and that he should not jump or play with his brother or exert himself. We feel that the only way to stop him from doing those things would be to put him in a cage. We want him to be a cat and enjoy his life so we watch him carefully but we may not be as strict as we should be.
Shortly after Duncan’s cardiomyopathy diagnosis, a friend sent us a beautiful blue (to match his eyes) set of carpeted stairs. He and Joseph both use the steps now to get to the bed rather than jumping from the floor.
On March 6, 2007, we took Duncan for a re-check and his BUN was 33 and creatinine was 3.6. His blood pressure was high and we are in the process of acquiring a stethoscope to monitor his heart rate which was also high. In addition, we have purchased a baby scale to keep track of his weight. Since all other numbers were in normal range, the only medication we give him now is a half (.5 mg) of a Pepcid AC per day. He continues to eat Hill’s k/d and miscellaneous dry foods.
We will be taking Duncan in for follow-up echocardiograms and blood tests on a regular basis. His most recent echocardiogram looked fairly normal, the doctor said.
We plan to add to Duncan's Journal from time to time. We will take you along as we ride this emotional roller coaster.
Update - July, 2007
Since March, Duncan has been faring amazingly well. Many people have asked us how he is doing, so we felt an update was called for even though there have been no new clinical developments.
July 24, 2007