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The Caregivers

Dealing with the Initial Diagnosis of CRF

The 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.

Weighing the Alternatives and Making the Commitment

A 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:

  • Can you afford both the initial and the lifelong expense and, if you can, can you emotionally afford not to try the surgery?
  • Would you rather lose your cat on the operating table in an attempt to save his life or deal with the progressive deterioration of CRF?
  • Are you emotionally stable enough to endure the added stress of this process?
  • Are you willing to give your cat the best chance of surviving the surgery by "letting go" while he is still in good condition?
  • Can you adopt the donor and deal with the possibility that the donor may be "replacing" your cat if the surgery is not successful?
  • Are 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 rejection?
  • Does your cat's age mean that the surgery may not extend your cat's life any longer than aggressive treatment?
  • Can you take the necessary time off from your job in order to take your cat to a distant city for the surgery?
  • Can your cat deal with this ordeal?
  • Have you come to grips with the fact that CRF is fatal and a transplant may be the only hope?
  • Can you handle the fact that every case is different and no one can provide absolute assurances about any aspect of the process?
  • Will your family and friends support you? Does it matter if they don't?
  • Do you fully understand that this process WILL change your life?

Costs

A 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.

It 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.

After 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).

The Human Connection (Working with the Medical Professionals Involved)

Because 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.

When There's No Turning Back

As 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).

The First Postoperative Visit

Smokey, the transplant recipient, in the hospital the day after the surgery. Read Smokey and Buffalo's story in the CRF Tributes Gallery.

Your cat's appearance after the operation will 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.

Watching the Recovery

Depending 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.

Returning Home

When 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 your cat.

In the Final Analysis

As 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.