Friday, June 10, 2011

BUN and Creatinine Levels

It's guilt and curiosity that drive me to try to understand Dex's initial BUN and Creatinine levels. How can one vet tell me the values are sky high and another, yesterday, tell me the same numbers are mid range. That is what I cannot understand.

There was also an attitude difference between the two vets. One was holding the numbers over me, like a guilt trip, to tell me I'm a bad cat owner, suggesting she may not really have kidney failure, saying they were not sky high values. If she didn't mean to do that, nonetheless, it's exactly how she came across.

The other vet, the first vet, used them only to form recommendations, on how I wanted to continue. She said lab tests are sometimes off. I asked about euthanasia then. She said if she didn't eat or improve in 48 hours, then euthanasia would be a consideration. The other vet there called me that night, said not to give up on her quite yet, to flood her with fluids, 500 to 600 per day, when she needed it. That is what I did, from then til now. She also went on CRF dry food.

The way they treated me there should say everything to me.

Still, I am driven to find out the truth, because that second vet did make me feel guilty. She tripped that guilt wire in me. "You're a bad person. You're not good enough." That one is close to the surface with me. Three decades in the mental health system ensured that, along with prior daddy issues in childhood. I've had plenty of self-esteem beatings in my life.

Way too many.

BUN (Urea) and Creatinine Levels, are the primary means of detecting renal function. I was told back in late December, when I took in Dex, who was drooling pus and severely dehydrated, that they suspected kidney failure due to mouth sores.

The clinic then ran two tests, I was told, and I was then told the two levels (BUN and Creatinine) were off the charts, undetectable, they were so high. They diluted the sample, they said, then, on the second test, to get values, which then would have to be adjusted for the dilution rate. For example if you dilute a sample by half, the values obtained would need doubled for an accurate assessment of the blood sample's values.

I asked today, when Dex died, for a copy of those original records. The level given me for Dex's BUN was 192 and for Creatinine--5.2. I've deleted the second set of values I at first included in the post because they use a different measurement.

Most of us out there are not made of money and cannot afford batteries of tests and X-rays for ourselves let alone for our beloved pets. We go by signs and symptoms and suffering, and whether a cat is pooping and peeing right or eating or happy and playing and that's probably just as good an assessment as many lab tests, to be honest.

Amount of money spent at vet clinic does not in any way equal the quality of life a cat or dog has at home. Ditto with our own health care.

Guilt trips are not nice to lay on people who love their animals.

Here is an excellent paragraph from a CRF website:

"While lab results are certainly indicative of the progression of CRF, it must be remembered that there can be variations on blood tests - different labs can produce somewhat different results from the same samples because of standards and testing methodology. The manner in which the blood was taken may affect the results of blood work testing. How gentle the technician is, from what vein the blood is taken and what size the needle is can all have an effect on test results. Whether or not the animal is severely stressed can affect the results as can when and what the cat ate and when the cat was last hydrated. In some cases, drugs given to a cat within proximity of taking blood can affect results. What is normal for one cat may not be normal for another. You look for trends and then at the long-term trend. We have found, after becoming frantic over lab results, that how the cat is acting is equally important. A friend of ours, who took care of a CRF cat for several years, gave us this valuable advice - "Treat the cat, not the lab work". Blood tests are just one piece (albeit a very valuable one) of the diagnostic puzzle."

Dex was loved and evaluated two more times before she died today. Until the last few days, she slept in the sun, dorked around, ate grass, snuggled against me, pooped and peed, and ate, although smaller and smaller amounts. She was down to seven pounds from her usual nine pounds. When she could no longer eliminate toxins even with the help of massive influxes of sub cu fluids, I did what I had to do.

The vet just called me, and said the standard for Creatinine is anything over 5.0 and the cat is toast within 60 days. The vet yesterday was full of shit, calling those mid range values.

BUN/Creatinine normal feline blood values, from an American standardized lab.

Approximate Normal Ranges for Common Tested Blood Values
BUN 14 - 36 MG/DL
Creatinine .6 - 2.4 MG/DL

I just talked to a friend, whose cats' initial creatinine levels, a few weeks ago, were over 8, but now, with a lot of fluid flushing and antibiotics, are down to just over 2. They're in a wait and see mode on her and doing fluids just once per week now. Tough thing, renal failure diagnoses.

Isn't it strange to think about, that we let people waste away in nursing homes like we do, suffering, laying in their own pee, with bed sores, often comatose or in dementia, but we won't do that to animals?


Kalli said...

You're looking at two different measurement systems - mg/dL (milligram per deciliter) and mmol/L (millimoles per liter), hence the confusion.

A BUN of 192 mg/dL is indeed quite, quite high. I lost my cat to renal failure and his BUN was 69 mg/dL when we had to make the decision, he was so very ill. And right now I have a dog in renal failure whose creat is 2.9 mg/dL (BUN is 85) and we're hoping just to get another couple of months out of her.

Renal failure sucks.

And making that final decision...well, it's hardest on those of us left behind.

Strayer said...

I know it's two different measurement systems, but the records I got don't list which one they were done under. I am assuming the first and that the second vet was being an ass.

So Dex is as tough as nails to have even been alive until now. That's unbelievable. That fricking vet yesterday. How in the world would she call those values mid range? She even suggested they might have been "so low" because I just gave her fluids before the test was taken. I cannot figure it out and I should just drop it from my mind. It was traumatic is all.

The Elephant's Child said...

A pox on that second vet's house. Karma will get her. And if I knew where my guilt button is, I would permanently disconnect it. It doesn't help me at all. Or from the sounds of it you. Nobody beats up on us better than we do.

Strayer said...

You are right there, Elephant, on beating up on myself. My own vet, who called to explain it to me said I did good, keeping her flushed out for so long.

She lost about two pounds in body weight, going from her normal 9 to just under 7 pounds, before she died. She survived until she survived. She had a good life.

Big Piney Woods Cats said...

Guilt is such a powerful weapon. Shame on that vet, it is so hard to find someone you trust. I lost my Patches in Nov to lupus after she was prescribed thyroid meds and reacted badly (over the coarse of 6 months and much testing and changing vets.) I feel terrible guilt, but my vet said yesterday, when I brought another cat to her because she is vomiting and has black tar stool, that the guilt would have been there if I had done nothing and she died from not giving her the meds. Now my Squirt is so sick and I am awaiting a diagnosis (she is at the vet now.) Barium was given to her last night. She is 100% indoors. Waiting to see if she passes it (no blockage) or she vomits it up. I understand your pain, Strayer. I am so sorry.......

Connie, Orlando said...

Cissy was diagnosed with CRF in March. From March 3rd to June 14th her Creatinine went from 5.6 to 5.7. She's lost weight and was dehydrated again. I was prepped to euthanize her, but since this last test wasn't horribly worse - except for her phosphorus levels - the vet and I concluded it's worth treating the CRF. My fear was that it had progressed to acute renal failure. She's back on meds and fluids and I'm hoping to see much improvement within the next few days. It's a struggle, as you know, and my heart goes out to you that you go to great lengths for your cats, because you value their lives. You continue to inspire me.

Nathaniel Adam Briggs, Complaint Free Humanoid said...

I just wanted to let you know you're not alone in your quest to know more about what happened to your cat. I too am doing this though years behind you.