Milo was a 12 year old, neutered male, predominantly indoor, domestic short hair cat who presented to his usual veterinary practice for his annual vaccination and health check appointment. His owner had no concerns, other than perceiving a slow but gradually increasing thirst over the preceding few weeks. Milo was otherwise described as well, ate a commercial senior cat food appropriate for his age, and was up to date with routine flea and worming treatments. But his owners, Pam and Nicky, were about to get a terrible surprise…
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Milo’s check up
Milo was checked over as part of his wellness examination. Whilst it was subtle to note from a cursory examination alone, once placed on the weighing scales, vet Susie noticed that Milo had lost 8% of his previous weight since he had been examined 6 months previously. The result had been to reduce his body condition score from an ideal 5/9 to 4/9. His coat had become a little clumped/matted and “starey” (fur tips stuck together); Pam reported that he was finding it increasingly difficult to get up and down the stairs. And Nicky added that he was also struggling to reach around and groom the lower half of his body.
On further clinical examination, Milo had normal clinical parameters (heart rate, breathing rate, temperature), no goitre (palpably enlarged thyroid gland) but some mild gum disease due to tartar accumulation on his teeth. Small firm feeling kidneys were palpated bilaterally and a soft moderately large bladder was also evident. He was a bit uncomfortable in his hindlimbs, with a reduced range of expected motion. Milo tensed up when his hindlimbs were examined and vocalised when his hips were attempted to be fully extended.
Testing to diagnose
Susie decided that testing to assess Milo’s overall systemic health was appropriate; and opened such a conversation with Pam and Nicky. In order to obtain a minimum database of information, she recommended performing blood tests; including thyroid hormone levels and a urine test. Given Milo’s age, she also felt it was wise to test his blood pressure. Milo was admitted to the clinic for the day for these investigations to be undertaken. Bloods were successfully taken. And a sterile sample of urine was collected from Milo’s bladder using a needle through his abdomen (cystocentesis).
Once settled in his cage within the dedicated cat ward of the practice, Milo had his blood pressure measured gently on a number of occasions. This found that he had a significantly high blood pressure, with an average systolic blood pressure of 210 mmHg. (A normal value would be considered to be below 150mmHg). Milo’s blood results showed mildly raised kidney markers (urea and creatinine) and a dilute urine specific gravity (urine concentration). Put together, this was diagnostic of kidney disease. Due to the slow onset and lack of associated acute disease, a diagnosis of chronic kidney disease was made.
Further investigation
Following on from these results, Susie contacted Pam and Nicky to have a discussion regarding his diagnosis. She relayed the news and went on to explain the staging systems used for ascertaining the severity of kidney disease.
Staging Milo’s disease thoroughly would involve performing some more tests on the urine sample, to check whether his kidneys were leaking protein, and whether there was a urinary tract infection. Whilst Milo’s kidneys were not palpably enlarged, she also mentioned the possibility of imaging (by means of non-invasive ultrasonography and radiography). This is to ensure that certain underlying diseases (such as cysts and tumours) were ruled out.
Milo’s treatment
Susie recommended slowly transitioning Milo to a wet renal diet to help ease his kidneys’ workload, and also implemented immediate medical treatment to control his dangerously high. The degenerative nature of chronic kidney disease was also discussed, with the associated advice that regular periodic re-assessment of Milo’s disease state would be sensible.
The vet also discussed with Milo’s owner about a potential diagnosis of osteoarthritis (degenerative joint disease). Various environmental modifications and specific supplements and treatment options were discussed in an individual context for Milo.
Insurance
The cost was significant, and Pam and Nicky were very anxious over how they would afford it. Until Susie reminded them that most of the costs would be covered by Milo’s insurance. They had nearly cancelled it that year because of the increased costs as he got older, but fortunately, hadn’t got around to it yet!
Milo’s case of chronic kidney disease highlights how pet health insurance can be significantly beneficial when investigating a medical disease. Given that Milo still (phew!) had comprehensive lifetime insurance cover, this meant not only could his initial investigations be undertaken without hesitation, but also that much additional information could be obtained to stage Milo thoroughly.
Additionally, but importantly, it also meant that he would be able to attend the vets for regular subsequent checkup appointments, thereby frequently reassessing his kidney disease and tweaking any adjustments in management and medications accordingly. As is so often the case, insurance can have many useful benefits, especially so when owning a middle-aged or elderly pet who sadly, may be prone to developing ongoing or lifelong issues.
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