This page has tips on deciding whether your vet is the
best vet to help you on your CKD journey, how to work together as a team, how to find another vet if
you decide to move, and how to get a second opinion.
The Importance of a Good Vet
If you want to be able to give your cat the best possible treatment, you
need a good vet. Whilst not the only factor (it also depends upon your
particular cat, how sick s/he is at diagnosis, how much s/he wants to
fight, how well s/he copes with being handled etc.), a good vet can make
all the difference to your cat's quality of life and chances of survival,
whereas if you have to fight your vet for treatments, it is reducing your
cat's chances of survival, not to mention using up your time and energy
and stressing you out.
This is not only my opinion:
Delaware Valley Academy of Veterinary Medicine says "With appropriate therapy, cats with stages 2 and 3 CKD commonly
survive 1 to 3 years...however, many survive much longer. A host of
factors influence prognosis of CKD, both favorably and unfavorably.
Included among these factors are the quality of medical care provided to
the patient, the degree of interaction between the veterinarian and pet
owner, and the level of owner commitment."
ISFM consensus guidelines on the diagnosis and
management of feline chronic kidney disease (2016)
Sparkes AH, Caney S, Chalhoub S, Elliott J, Finch N, Gajanayake I,
Langston C, Lefebvre H, White J & Quimby J Journal of Feline Medicine &
Surgery 18 pp219-239 state "A good relationship and good
communication between the clinic and the cat's owner is vital for
successful management of CKD."
I do not wish to disparage vets, who work very hard to qualify, and most
of whom genuinely love animals; but as in every other profession, some
vets are good, others not so good, and a small percentage very poor. Thus
it is essential that you can recognise a bad vet — your cat's life depends
upon finding a good one.
Unfortunately, at initial diagnosis many of us do not know our vets that
well and have no real relationship with them.
In the dim and distant days when I had young, healthy cats and therefore
didn't need to go to the vet very often, I didn't know the vets at my
practice at all. I only went there because my family used the practice for
my childhood dog, and they were fairly close to my home. For a long time I
didn't even realise that I could ask to see a specific vet, so I just saw
whoever was free. It did gradually dawn on me that I got on better with
certain of the vets, so I started asking for appointments with them, and
eventually relationships were formed. And Gill, I still haven't forgiven
you for retiring!
So what should you look for?
You need a vet with whom you can work in partnership. You do not have to
like your vet (though I think it's probably better if you do), but you have to be able to communicate and work together.
your vet has superb diagnostic and caring skills, if your personalities clash,
or if you are too intimidated to ask questions, you
are not a good match.
It can be hard enough finding a vet you trust and respect, but finding one
who is also skilled at managing CKD is an additional challenge. This does
not mean your vet is incompetent. Most general vets will be good at what they deal
with most of the time. Typically, they will be seeing primarily dogs and cats,
who in the main are young, usually healthy animals,
for vaccinations or the occasional infection. Unlike GPs for human
patients, vets also regularly perform surgery such as
teeth cleaning. Vets deal with multiple species and run busy practices
(every vet I know works very long hours), and cannot possibly be expected
to keep up with the latest research for every ailment in every species.
For this reason, it is not necessarily a dealbreaker if your vet is not up
to speed on CKD, because as a general vet s/he simply does not have the
time. What is more important is that your vet is willing to
learn and is open to new information. This is where you come in. You are your
cat's advocate. You know your cat best, and you can research treatments
that might be suitable, ready to discuss them with your vet. This site
will help you with that.
Forming a Partnership
Your goal therefore is to find a vet who accepts that you are a
partnership. This is not being unreasonable, it is essential to your
Evidence-based step-wise approach to managing chronic
kidney disease in dogs and cats
(2013) Polzin DJ Journal of Veterinary Emergency and
Critical Care 23(2) pp 205–215 says "It is essential to
develop an ongoing relationship with the pet owner because they will be
expected to adhere to treatment recommendations and monitoring protocols
over a long period. Failure to do so will result in a sub-optimum
therapeutic response, which may lead to owner discouragement and
unsatisfactory outcomes including premature euthanasia. After performing
many clinical trials, it has become apparent to us that patient outcome is
improved through an ongoing active relationship between the pet owner and
Your Vet's Rôle
Your vet is the professional, with many years of training and experience.
Your vet knows things you that you probably couldn't understand even if
you tried. Therefore you should not be telling your vet how to do his or
Good vets are prepared to listen, to answer all your questions, to explain
all the options available to you (not just the ones they favour),
including the risks and benefits of those options, and to admit they don't
know everything. They should be prepared to read selected research papers
you bring in (though it is unreasonable to expect your vet to read a 20
page research study overnight!). They should also accept that old age is
neither a disease nor a diagnosis.
Being a vet is a
stressful occupation and the suicide rate is scarily high.
Accept that your vet is human and can have bad days. I don't think I could
cope with a job that required me to put animals to sleep, but they do it,
day in, day out. Treat your vet with courtesy and compassion. I hope you
don't need to be told this, but basically treat your vet how you would
like to be treated yourself.
Your rôle is to care for your cat and report accurately to your vet what
You should listen to your vet, who has medical training which you do not
have, because you may have got the wrong end of the stick. You should be on
time for appointments, pay your bills promptly (or according to an agreed
payment schedule), inform your vet of every treatment you are using (some
people think their vet doesn't need to know about holistic treatments, but
they do) and basically try to be the kind of client you would like to have
yourself. You also have to be prepared to pay for your vet's time and
How you approach your vet can make all the difference. If you ask for a
treatment with which your vet is not familiar, you are taking the vet out
of his/her comfort zone, especially if you utter the dreaded words "I read
it on the internet." Make it easier by providing supporting documentation
(I'm not a vet, so I link to veterinary references to support what I say,
and you should use these rather than my site itself if possible), and ask
them to help you understand it. Perhaps offer to fax or e-mail it over and
give your vet time to digest it; this can mean less pressure for both
parties than talking face to face, and can help avoid the risk of
your vet losing
face if s/he does not actually know about what you are asking about. This
also ensures you don't forget to ask important questions. If you want your vet
to do a lot of additional preparation and research, it is only fair to
offer to pay more.
Make it clear to your vet that you will listen to his/her advice, but that
you also would like your own
views to be taken into account. You see your cat every day, your vet does not.
Perhaps offer to make
a deal regarding when you would consider letting go (see
The Final Hours for more information on quality of life
The five most difficult veterinary clients
(2011) Gair D & Hall Johnson C Firstline describes clients
from a vet's perspective. I am definitely a Demander and I'm not ashamed
of it. (I do try to do my demanding politely. Perhaps I am actually a
Polite But Persistent Requester).
Choosing a Vet
If your cat is in crisis and you simply want to find somebody who is
willing to give your cat a chance, you may not have much time to shop around.
If you are in the UK in particular, just finding a vet who permits
sub-Qs is a bonus, and you may be prepared to move on that basis alone.
Animal Medical Center of Chicago has useful information on choosing a vet,
and on working together with him or her.
also has helpful suggestions on finding a good vet.
Factors to Consider
If you do have the luxury of picking and choosing, below are some of the
factors you may wish to consider. This is how I would go about obtaining
the information I require:
If you are lucky, you may even get to speak to a vet or a vet nurse/tech with
your more technical questions. Do not abuse this, take just five minutes of their time,
with them calling you back at a time convenient to them if necessary,
and try not to exceed the time limit.
If you like the sound of the practice, consider making a paid
appointment to see the vet where you can discuss your cat's case and
check out the facilities. You may not even need to pay for your first
visit — some US chains (e.g. VCA, Banfield) often give you the first
appointment free. Not everyone takes their cat to this appointment, but
I figure if I'm going to see the vet anyway, it is helpful to see how
the vet handles my cat.
If you ever have to rush your cat to the vet in an emergency, time can
be of the essence. Even for non-emergencies, it is less stressful for
both you and your cat to have a vet nearby. However, it is better to
travel to a more competent vet than to make do with a less competent one
Mobile vets can be a good choice to reduce stress. Some mobile vets have a
van where they can perform blood tests whilst at your home. As a bonus,
they may see more elderly animals and therefore be relatively experienced
at treating CKD.
You need to know both the practice hours and the vet's own hours. Some
vets will only be at a practice for a day or two a week, which is not
ideal if you want continuing care. If your vet is not there fulltime
(and even if s/he is), ask to meet another vet at the practice so you
have back up available in case of need.
Ascertain whether it is possible to e-mail your vet with questions/concerns in
advance of appointments. Many vets would like this because it gives them
time to prepare, but do not effectively give them two hours additional
work and expect to get it for free — offer to pay extra as and when
One very important question with a CKD cat is whether you can be seen on
the same day if your cat requires it. I would never use a vet who did
not do this.
If you are in the UK, vets are obliged to provide 24/7 cover, but this
will not necessarily be from your own vet's practice, so ask about that.
24 hour emergency first aid and pain relief
(2017) Royal College of Veterinary Surgeons Code of
Protessional Conduct explains more about
If you are in the USA, you will often have to travel to an ER facility
for out of hours cover, so clarify which facility your vet uses.
This matters to most of us, but ideally it should not be the defining
factor. Ask how much a consultation costs, and how much standard blood
tests and blood pressure checks cost. Do they charge for every little
thing, or might they give you smaller items for free, such as a syringe
for assist feeding.
Also check hospitalisation costs — if your cat ever needs intravenous
fluids, you don't want to get a nasty shock when you get the bill.
Can they provide CKD supplies at reasonable cost? If not, do they charge
to write a prescription? This is now legal in the UK. If they do, ask if
they make prescriptions valid for a year.
Ascertain how long appointments last. My NYC vet allocated 30
minutes to each appointment, which is obviously good. Strangely enough,
he didn't charge more than other local vets whose appointments only
lasted 10-20 mins.
If your vet only allocates shorter appointments, ask if you can book
longer ones when necessary (paying more for the privilege, of course).
Facilities and Testing
My ideal is a cat-only practice, but I've never found one that worked
for me. If you can't get that, you might at least be able to get a
cats-only waiting area in a clean waiting room. Even better is a
cats-only treatment area.
Watch how the vet handles your cat.
Ask if you can be present for basic testing. Many vets do not agree to
this because there are potential liability issues if you get bitten or
scratched by your own cat, even if you ask to stay, but my vet trusts me
not to sue her in such circumstances. I always ask to be present for
blood pressure testing in particular, because being away from me can
increase my cat's blood pressure.
Clarify how easy it is to park and whether it is free.
Make sure they do not sedate all cats routinely for blood draws.
Although some people care about punctuality, and this may matter if you
have to get to work, it's not something that I stress over too much.
Basically I figure that if the vet keeps me waiting because of another
client, I also won't be rushed should my cat need longer on occasion.
What I do care about is that my vets share test results with me
promptly. My vets ring me the same day that they receive specialised
test results back, and have done so at 10 p.m. on occasion when
something has been faxed over late at night because they know I will be
It is worth asking how often the vet treats CKD cats and what is the usual
It is encouraging if the vet has experience treating CKD cats over a
period of years, and can deal with complications such as anaemia, but a
less experienced, open-minded vet is not a problem for me.
You also need to know how much experience your vet has in other areas,
e.g. can basic surgery be performed in-house, who do they use if a cat's
needs are outside their area of expertise or if they or you require
additional help or a second opinion.
Remember, you cannot get everything you like in one vet, so decide what
matters most to you. For me, having a vet whom I trust who listens to my
suggestions and who can see my cat quickly in an emergency is more
important than the fact that she charges to write me a prescription.
Finally — it helps, but is not essential, if your vet likes cats.
A Specialist Vet or a General Vet
If you live in a small town, you probably don't have much choice of
If you live in a large city or near a vet school, you have more choices
available to you.
In the UK, you will usually need a referral to a specialist from your
main vet, but this is not always necessary in the USA.
International Cat Care
runs a cat-friendly clinic campaign and enables you to search for
cat-friendly clinics throughout the world.
American Animal Hospital Association explains about hospital
General VetsSome people use mobile vets who come to their home. This is much less
stressful for most cats. Your current vet may offer a housecall service,
at least for some services, such as euthanasia, or you can search for one
in your area.
Most of us end
up using a general vet. This is not necessarily a bad thing. Although I
used an ACVIM diplomate vet (see
below) in the USA who was excellent, my UK vet is a general vet in the small town
where I live, and she is great. (Well, she was until she retired. I still
haven't forgiven her).
Even general vets have access to specialists for chats about complicated
If you're using a general vet, you may wish to find one who is
interested in feline health. In the USA, The
American Association of Feline Practitioners
lets you search for a vet
in your part of the USA. These vets do not necessarily have specialist
training, but they like treating cats, which is encouraging.
Some people use specialist vets, either on an ongoing basis or
occasionally. This can be particularly helpful if your cat has
multiple heath issues, e.g. CKD and pancreatitis or diabetes, or if
there is a problem (e.g. a mystifying symptom) that your regular vet is
unable to resolve. However, I used a board certified vet as my regular
vet in the USA. If additional skills are available, why not make use of
The American College of Veterinary Internal
Medicine has tips on how to
prepare for a visit to a specialist vet.
Specialist Vets: USA
You may wish to use a vet who is an internal medicine specialist. I used
such a vet in the USA. These
vets have additional training, which can be very helpful when dealing
with CKD. The
American College of Veterinary Internal Medicine (ACVIM)
has a list of its diplomates, who have undergone an additional three
years specialist training. Search for a specialist in Small Animal
Internal Medicine (SAIM).
The American Board of Veterinary Practitioners
has 84 active feline diplomates who are listed on its site.
Another option is to visit a vet school (veterinary teaching hospital).
If you do this, your cat's care will be overseen by a specialist vet,
but you will usually be dealing with other vets such as residents and
will not necessarily even meet the specialist vet. Residents are fully
qualified vets but they are still undertaking their specialist training.
Vet students will probably also be involved in your cat's care, and will
probably take the initial history, with the resident running through
their findings with you. You can of course ask to speak to the
specialist vet, though you may well have to wait in order to do so.
Vet schools and some specialist vets (especially if they work in a
practice with other specialists) will have access to very sophisticated
tests and equipment. They will also be used to dealing with complex
cases. You may have to leave your cat there for several hours in order
for all the tests to be performed, partly because the necessary tests
can take a while, partly because it can take longer when trying to
instruct student vets, and partly because emergency cases will take
priority, as in any hospital.
In my experience specialists, especially at vet schools, will do tests on the first day, such as bloodwork,
urinalysis and perhaps an ultrasound. You may then be able to take your
cat home, and possibly return on another day for additional tests or
surgery; or they may wish you to leave your cat for in-patient treatment
such as intravenous fluids. None of this will be cheap, but it will be
I get mixed reports about US vet schools and specialists. Most of the time people are very
happy with them, but occasionally they are a disappointment.
Vets in the UK
As in the USA, there are veterinary specialists available in the UK.
They may work in private practice or at a vet school (veterinary
The European College of Veterinary Internal
Medicine has details of its
diplomates throughout the world, including the UK.
The American Board of Veterinary Practitioners
has 84 active feline diplomates who are listed on its site, with
a couple registered in the UK (though one is a dermatologist).
Vet Index has details of
If you visit a vet school, your cat's care will be overseen by a
specialist vet, but you will usually be dealing with other vets such as
residents and will not necessarily even meet the specialist vet.
Residents are fully qualified vets but they are still undertaking their
specialist training. Vet students will probably also be involved in your
cat's care, and will probably take the initial history, with the
resident running through their findings with you. You can of course ask
to speak to the specialist vet, though you may well have to wait in
order to do so.
The Royal Veterinary College in London
(near Kings Cross) offers free health screening, follow up monitoring and
therapeutic kidney diets for CKD cats. Medications and additional tests
will be charged for. Eligible cats include cats who are aged at least nine
who fall into one of the following categories:
Cats diagnosed with chronic kidney disease who have not yet started
eating a therapeutic kidney diet
Cats diagnosed with an overactive thyroid and not yet on medication
Cats diagnosed with high blood pressure
Cats suspected of having one
of the conditions listed above
Cats with diabetes,
hyperthyroidism or on corticosterolds are not eligible.
I maintain a private list of British vets who permit sub-Qs when
appropriate. Most of them are not specialists, but they are open-minded
about sub-Qs. If you are in the UK and need such a vet, please read
here about how to
obtain details of any vets in your area, though unfortunately the list
is very short, so the chances of such a vet being in your area are sadly
These are other sources of support and information which some people
have found helpful.
Cornell Feline Consultation Service
Cornell Feline Health Center Camuti Consultation
Service may be worth
considering, as long as you or your vet can speak English. This service
offers advice on feline health related issues. It cannot diagnose or
guide treatment for your cat or offer a second opinion, but it can
provide general information and support.
You need to provide as much information as possible (e.g. blood
test results), then the consultant will contact you or your vet to
discuss your cat's situation, usually within 48 hours but occasionally
it takes a bit longer. The service costs US$55 and is available Mondays,
Wednesdays, and Fridays, 9 a.m. - 12 p.m. and 2 p.m. - 4p.m. Eastern
time (not holidays). If you are calling from outside the USA, you may
have to pay for the cost of the call back from the consultant.
I have heard from a number of people who have used this
service, and virtually all of them were very satisfied.
Cornell will not be able to assist if your cat is deceased.
The Veterinary Information Network
offers assistance from 250 veterinary specialists, including four
nephrology consultants, to its members. Your vet can join for US$64 a
month, but a 30 day free trial is also available.
Vet Professionals was founded by Dr Sarah
Caney, a feline specialist in Scotland. She offers e-mail advice to vets and will do
with cat owners who are referred to her by their
own vet for £348. She also runs referral clinics in Dunfermline.
A Second Opinion
If you are concerned about your vet's approach, or if your cat has
multiple heath issues, e.g. CKD and pancreatitis or diabetes, or if
there is a mystifying symptom that your regular vet is unable to
resolve, you may wish to seek a second opinion. Vet schools or feline
specialists are a good choice if there is one in your area.
In the UK, if you ask for a second opinion, your vet should be happy to
Referrals and second opinions (2017)
Royal College of Veterinary Surgeons Code of Protessional Conduct states "Veterinary surgeons
should facilitate a client's request for a
referral or second opinion." Unfortunately it is not always easy
finding a specialist to consult, though see
specialist vets for
Of course, you may decide simply to consult a second general vet if you
have concerns about the treatment your cat is currently receiving,
or you would just like a fresh pair of eyes. Do not disparage your
current vet, this is not courteous and puts the second opinion vet in a
If Your Vet Refuses To Assist
This is particularly common in the UK, especially for people who are
trying to find a vet who will allow them to give sub-Qs to their cat, but people in other countries may
also have problems.
If your vet is not helpful, you need to find out why this is the case.
There are two main reasons why some vets may seem to be less than helpful:
Concern For Cat's Welfare
Firstly, the vet may think it is unfair on the cat, usually because they
think there is no hope so any treatment is pointless (though in the UK,
people also have trouble obtaining sub-Qs because the vet thinks they are
You do need to respect your vet's knowledge and experience, and accept
that it might well be true that your cat's case is hopeless. At the same
time, most people also need to know they have done all they can to help
their cat. Treatment
may not always work, but not trying to treat certainly won't.
As one member of
Tanya's CKD Support Group
put it, what adversely affects her cat's quality of life is denial of
The current situation is like a snapshot in time, especially if
your cat has an infection, high blood pressure or is dehydrated, and
things may change dramatically with appropriate treatment.
No vet has a crystal ball.
Contrary to popular opinion, medicine is not black
and white, there are many shades of grey, and different vets will have
varying knowledge and experience which will mean they may have different
opinions, sometimes even within the same practice. So your vet's opinion
is just that, an opinion, albeit a professional one.
Belief That The Client
Does Not Wish to be Proactive
receiving the CKD diagnosis, many people simply assume that things are
dire and the end is nigh, especially if the vet uses the term "renal
failure." Even if they knew of the treatment options
described on this site, they would not be willing to try them or think
their cat would not tolerate them, or they (or the vet) think they cannot
afford them. Since most people take this approach, your vet may assume it
is also your approach.
Thus, you need to make it clear to your vet that you
wish to fight for your cat and be proactive. You also need to discuss your
financial limitations, though if your vet is prepared to write you a
prescription, you can often buy basic supplies cheaply online. If your vet
doesn't know you very well, perhaps because your cat has always been very healthy
up to now, you will also need to win your vet's trust.
If Your Vet Continues to
Refuse to Assist
If your vet is still not helpful or hopeful, discuss the situation and see
if you can nevertheless find a way to work together.
Your opinion matters.
Communication and consent (2018) Royal
College of Veterinary Surgeons Code of Protessional Conduct states "veterinary surgeons and veterinary nurses must accept that
their own preference for a certain course of action cannot override the
client's specific wishes, other than on exceptional welfare grounds." If
you are in the UK, you could politely point this out and ask for your
wishes to be respected.
It can be hard to do this, especially if you're not a
particularly confident person or somebody who finds it hard to negotiate.
is not about winning. It's about reaching an arrangement that both parties
are reasonably happy with.
Your vet cannot insist on euthanasia without your input.
Euthanasia of animals
(2017) Royal College of Veterinary Surgeons Code of
Protessional Conduct says "Where a veterinary surgeon is concerned about an owner's refusal to
consent to euthanasia, veterinary surgeons can only advise their clients
and act in accordance with their professional judgement. Where a
veterinary surgeon is concerned that an animal's welfare is compromised
because of an owner's refusal to allow euthanasia, a veterinary surgeon
may take steps to resolve the situation, for example, an initial step
could be to seek another veterinary opinion for the client, potentially
Asking to treat for two weeks before making a
decision to euthanise is a reasonable compromise that many vets can
accept. Also see
Subcutaneous Fluids: Winning Your Vet's Support
for tips on this issue in particular and how to win your vet over
If your vet still won't help, you will need to either get a
which may help persuade your vet to work with you, or
find a new vet.
How to speak for Spot
(2009) Kay N
discusses how to decide which treatments would be the best choice for your dog
in your particular circumstances but the principles apply to cats too.
Why your vet won't help you and what to do about
K has some suggestions about what to do in this situation.
If you feel that your current vet is not the best fit for you and your
cat, or if your vet refuses to treat your cat in a way that you deem
appropriate, you will have to change vets. See
above for tips on choosing a vet.
It is a good
idea to keep your own records, so you can monitor trends and have
information readily available should you decide to move (either town or
particularly important to keep your own records if you are in the USA,
because most people in the USA have to go to the ER if their cat is sick
out of hours, and it is very helpful to the ER staff if you can provide
them with records.
I strongly recommend keeping your own records of your cat's
symptoms and behaviour on a daily basis, together with bloodwork results
and which treatments you have tried, and those which you continue to use. This can help you to monitor trends, and
can also serve as a reminder of what treatments worked should a symptom
recur some months later.
Be very sure to
keep records of allergies, particularly to drugs, and make sure these are
clearly marked on your cat's notes.
Setting up a
spreadsheet with space for daily entries can be very helpful because it
means you are less likely to forget to record information. I would
recommend recording the following:
My Mum has a
lot of health issues so I have a one page summary of her medical history
which I can show to
paramedics and doctors, and they have all said how helpful it is. Having
something similar for your cat is advisable.
Vitus Vet Pet Medical Records is a free
app that has good reviews. It is also available for android phones.
Obtaining Records From
You should always
keep records of your cat's blood tests etc at home, especially if you are
in the USA and need to visit an ER vet if your cat requires urgent help
when your vet's office is closed.
are strangely reluctant to share records. I think some of them worry that
a little knowledge can be a dangerous thing (and they are right in some
cases). I've also been told in the past by a vet nurse that there was no
point giving me my cat's records because "you won't understand them." I
must admit, that gave me a bit of a giggle. In fairness to the vet nurse,
she didn't know I run this site, and what she said is probably true of
most of their clients.
From what I hear, if you ask the receptionist for your records, you will
often be refused. Therefore I would ask your vet for copies directly, who
will probably agree. It is often best to ask at the end of each
appointment. They may prefer to e-mail them over to you later, which is
If you continue
to have trouble obtaining copies of your records, especially in cases
where the clinic says the records belong to them (which they do, but you
are entitled to copies), you can insist as follows:
The American Veterinary Medical Association
states "Veterinarians are obligated to provide
copies or summaries of medical records when requested by the client.
Veterinarians should secure a written consent to document that provision."
Clinical and client records (2017) Royal
College of Veterinary Surgeons Code of Professional Conduct
requires that vets must give owners records
and test results when asked to do so, although they can charge for doing
Unfortunately it would appear that if you live in Victoria in Australia,
you have no legal right to copies of your cat's records.
However, ongoing problems in this area may indicate that
this practice is not going to too good at treating you as a partner in
your cat's care.