with the Initial Diagnosis of CRF
shock of the initial diagnosis is where the emotional roller
coaster ride begins. The first priority must be to overcome
feelings of hopelessness, anger, sadness, helplessness and fear
so that you can assist your cat. Regardless of what decision
you eventually make, the immediate need is to find out from
your veterinarian what should be done for the patient right
away. In spite of how sick your cat seems, it is often possible
to improve the symptoms dramatically with aggressive treatment
and care. Then redirect your emotional energy into researching
chronic renal disease and the alternatives that exist for short
and long-term treatment. If you eventually choose a transplant,
knowledge will help you to understand the process, ask the right
questions and anticipate each step.
the Alternatives and Making the Commitment
kidney transplant is not always an alternative for reasons discussed
above but if your veterinarian considers your cat to be a possible
candidate, here are some of the hard questions to ask yourself:
you afford both the initial and the lifelong expense and,
if you can, can you emotionally afford not to try the surgery?
you rather lose your cat on the operating table in an attempt
to save his life or deal with the progressive deterioration
you emotionally stable enough to endure the added stress
of this process?
you willing to give your cat the best chance of surviving
the surgery by "letting go" while he is still in good condition?
you adopt the donor and deal with the possibility that the
donor may be "replacing" your cat if the surgery is not
you willing to change your schedule in order to give your
cat medication every 12 hours for as long as he lives and
understand that failure to do so will result in acute, fatal
your cat's age mean that the surgery may not extend your
cat's life any longer than aggressive treatment?
you take the necessary time off from your job in order to
take your cat to a distant city for the surgery?
your cat deal with this ordeal?
you come to grips with the fact that CRF is fatal and a
transplant may be the only hope?
you handle the fact that every case is different and no
one can provide absolute assurances about any aspect of
your family and friends support you? Does it matter if they
you fully understand that this process WILL change your
feline kidney transplant is a very expensive procedure yet only
a fraction of the cost for the human equivalent. The total expense
for screening tests, preoperative, donor adoption, the surgery
for both cats, travel, hotel, long distance calls, extended
hospital care, postoperative maintenance, scales and medications
will range from $15,000 to $20,000.
is very difficult to provide an exact estimate because total
cost depends on a number of factors: geographic area, willingness
of your local veterinarian to discount services, length of hospital
intensive care, complications, number of follow-up visits, frequency of Cyclosporine blood tests, etc.
the recipient returns home, Epogen injections may be required
until the transplanted kidney begins producing erythropoietin.
Cyclosporine must be given daily for the rest of the recipient's
life. Epogen is about $75 for five to seven doses. Cyclosporine
is about $300 a bottle and may be obtained through any pharmacy
(it helps to shop for the best price). It will last two or three
months, depending on the dosage level (which is normally reduced
after the first 6-12 months).
Human Connection (Working with the Medical Professionals Involved)
transplants are still an infrequent occurrence, many veterinary
practices are not familiar with the procedures or the locations
that perform the surgery. Be prepared to work in partnership
with your vet to do the necessary research to find a surgeon
and a facility. This is a highly specialized procedure and experience
is essential. Once
you locate and connect with the transplant surgeon, spend all
the time you need asking questions until you thoroughly understand
what is involved and are convinced that everything is in order.
There's No Turning Back
the date of the surgery approaches, the agony, doubt and stress
will increase exponentially. Focus on why you made the decision
to go through with this surgery in the first place and stick
to your resolve. Stay with your cat as much as possible while
he is in the hospital just prior to the operation. Prepare yourself
for the long wait while the surgery is being performed and get
ready for the indescribable joy and relief when everything turns
out fine (or the grief if it doesn't).
First Postoperative Visit
the transplant recipient, in the hospital the day after
the surgery. Read Smokey
and Buffalo's story in the CRF
cat's appearance after the operation
probably be something of a shock. The IV tubes, the stomach
tube and the shaven
fur will take some getting used to, but all those things will
eventually go away in time if there are no postoperative complications.
on how quickly your cat begins to recover from the surgery,
he will remain in the hospital for one to three weeks. Unless
you live near the facility, the telephone will then become your
only source of information and you will call frequently to make
sure everything is all right. Many things can and will go wrong
during this immediate postoperative period and it is more difficult
to deal with these ups and downs when you are far away from
the hospital. Remember that your cat is being given 24 hour
attention and care and is far safer in this environment until
completely stabilized. It is a very long wait, however, when
you just want to have your cat come home.
your cat does come home, you will find a whole new set of things
to worry about and will feel very apprehensive about assuming
the responsibility for his care. Since it may take months for
full kidney function to return, the regular blood test results
will add to your concern. Focus on how your cat feels and acts,
not on the numbers. The critical thing at this stage is to be
sure your cat is eating, gaining weight and showing no symptoms
of rejection. Administering medications will be a bit trying
at first but eventually become more routine for both you and
time goes on, and your cat's energy, playfulness and enthusiasm
returns, it will all clearly have been worth it. When treating
a CRF cat, the cat gets progressively worse but with a successful
kidney transplant, the cat gets progressively better and becomes,
essentially, normal again.