Indy goes for a second opinion at a new vet’s

I don’t want to leave any stone unturned with Indy.

His kidney readings are off the roof and he remains clinically well enough. I just need to know if I’ve missed anything or there are other options that I could try for Indy.

So I found out that there’s a vet much nearer to our house whom I’d like to check out. In case of any emergency, I can reach there in 10 minutes or less.

So I made an appointment for today and off we went. Before the appointment, I had already sent Indy’s entire medical history (of 15 years) and softcopies of all blood tests done to the vet’s whatsapp number.

The vet is very knowledgeable, attentive, approachable and has very good bedside manner. He spent an hour with Indy and believe it or not, he had actually read everything that I had sent. AND he remembers what he had read too. Indy’s entire medical history has already been stored on his computer and his phone.

In short, the diagnosis is the same. Indy has reached Stage 3 and is actually in Stage 4 now, based on his kidney readings. There is no reversal for chronic kidney disease, I know.

The vet analysed the entire medical history and says it is likely that Indy’s CKD actually began in early 2019 (stage 1) when he needed subcut for eight months. Then, his readings were all good and the subcut was stopped. Indy continued being okay through the years until the blood test in September this year which placed him at Stage 3.

The vet agreed that I had done everything possible for Indy and CKD is something which we just need to manage as best we can.

Based on Indy’s creatinine level in September, that was already a Stage 4 reading, actually, but it improved slightly after that. The estimated remaining lifespan for a Stage 4 CKD cat is only 35 days (based on a chart) so Indy has outlived the 35 days. It’s three months now. I am thankful that so far, Indy’s appetite has been good and he is active and alert. In other words, as “normal” as ever.

The vet also observed Indy and said he is a very “happy cat”.

He also explained that at this advanced stage of CKD, the subcut fluids will not bring down the creatinine and urea levels anymore. Its function is more of keeping the cat hydrated so that he feels good. So, maintaining the subcut at 200ml should be sufficient for Indy. Indy’s hydration has always been good all this while. The vet also explained that the pinch test can only detect dehydration when it reaches 5%. So if there is dehydration less than this percentage, we would not know. Another way of checking for dehydration is the condition of the gums, whether it is moist. But even this also only shows when the dehydration is at 5%. This is something new for me to learn.

So, there is nothing much that we can do for Indy now except to add on one probiotic renal supplement, which is the age-old Azodyl. Yes, I know about Azodyl and have used it before a long time ago (I cannot remember for which pet now), but it wasn’t effective then and from all the conversations I’ve had with other caregivers and even vets, they all say it doesn’t work. Maybe it is because the Azodyl capsule has to be refrigerated and is quite unstable.

I’ve enquired from our vet previously and she said Renal-N is the same as Azodyl.  So since we are already giving Renal-N, we don’t have to duplicate it.

But today, this vet checked the ingredients and found that Azodyl has three different strains of probiotics while Renal-N only has one. So maybe, just maybe, the other two probiotics might help Indy, even a bit?

Azodyl’s ingredients: Streptococcus thermophilus, Lactobacillus acidophilus, and Bifidobacterium longum (all three are probiotics)
Renal-N ingredients: Lactobacillus acidophilus, Olea Europaea and Fructo-oligosaccharides (of these, only the Lactobacillus acidophilus is a probiotic)

So yes, I agreed. Why not just try it? After all, I aim to leave no stone unturned.

Today’s vet is very approachable and open to discuss whatever I asked. I liked that. He checked all the ingredients carefully and said since we are adding Azodyl, I could reduce the Renal-N to 2 scoops twice a day (instead of 3 scoops twice a day). That made sense. Even though we cannot possibly overdose on probiotics, why duplicate too much?

I also asked the vet about my present big jar of Renal-N as it started clumping up while there is still powder which is in powder form (not clumped). He advised me to discard everything since the clumping had already started and this means moisture has already entered the jar. This is despite me closing the jar very carefully and tightly each time. Lesson learnt: Never buy a big jar. I only bought the big jar because both Cleo and Indy were using it at that time in September. It’s been three months now, time to discard it anyway. I was earlier informed that I could break up the clumped parts with a spoon and still use it, but this isn’t true. I shouldn’t. Once probiotics clump, it means the moisture has activated it, so it loses its efficacy. I’ve since discarded it and bought a new small bottle. All small bottles from now on, even if it costs more.

On thing I liked about today’s vet is that when I told him about all the supplements I’m giving Indy now, although he had not heard of them before, he did not dismiss them or ignored them. In fact, he actually checked them out immediately on the internet and gave me his thoughts about them. Then, together, we discussed how much of what to give and if any should be discontinued. And together, we agreed on a new treatment regimen for Indy. One could see that the vet was genuinely interested in designing the best possible treatment plan for Indy.

I also lamented that I’ve already given Indy “everything” that has been recommended and some come with such great reviews and yet, we could not bring his kidney readings down. I know, even saying it is me just lamenting because I know for a fact that CKD is progressive and it will come to a stage where there is nothing more we can do except to keep the pet comfortable, of which the vet agreed that I am already doing.

Indy is a “happy cat”, he says.

Yes, he is.

So the vet carefully packed a week’s supply of Azodyl in ice, with newspapers to preserve the cold, and placed it in a big cardboard box for me to take back home. I appreciate the care given by this vet. He says to monitor Indy for diarrhoea or any possible reaction to the Azodyl. If there are no adverse reactions, I can go back to his clinic to get more Azodyl for Indy.

We came home happy. I’m comforted knowing from a second opinion now that I’ve done everything possible for Indy and I’m happy too that even the vet observed Indy and says he’s such a happy cat. I would like to believe Indy is comfortable. That’s all we can ask for when our pet has a terminal disease, isn’t it?

I’m also grateful that I’ve found a vet nearby whom I can go to quickly for emergencies now. I’m bringing Tabs and Ginger for a geriatric check-up at this vet later this evening. When going to different vets, it is important to ask what machine they use to do the blood tests and what scale is used so that we know if we can do a 1-1 comparison or we have to do some arithmetic before we can compare the numbers. This vet uses a different machine from our regular vet, so I want to let Tabs and Ginger start a file at this clinic.

For cats who are 9 years and above, this vet recommends doing a blood test every 6 months so that we can catch any disease or condition earlier. It’s true, you know. Indy’s last year’s blood test in October 2022 was given the “all clear” but this year, in September, after 11 months, he already progressed to CKD Stage 3. The vet says it is possible Indy’s CKD progression happened slowly but surely without us knowing. The typical visible symptoms were not there. He showed no symptoms at all, except maybe for being choosy with food. But Indy had always been “difficult” with food, so I didn’t think it was a sign.

We do our best, and it is only on hindsight that we can say, “Oh, I should have suspected that!”. But we should not beat ourselves up because we did do our best and we had no ill intentions at all.

Life happens.

Stay happy and comfortable, Indy. We are with you all the way!






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