De. Jean Hofve介紹: 為美國獸醫師, 貓咪營養及醫藥專家. 任多間動物營養公司的顧問.

最近我非常榮幸的可以與獸醫師Dr. Jean Hofve 聊聊關於貓咪的腎臟疾病. 以下是我們之間的對話,再加上部分的修改與資料補充.

Recently, I had the pleasure of talking about Kidney Disease in Cats with Dr. Jean Hofve, DVM. Below is the transcript of our conversation with a few edits to add more information.

我衷心的感謝Dr. Jean肯花時間跟我聊聊. Dr. Jean在Little Big Cat有自己的網頁,裡面也有聊到這個議題.--Kidney Disease

A sincere thanks to Dr. Jean for taking the time to talk this out with me.  Dr. Jean has a page on her site, Little Big Cat, dedicated to this subject as well – Kidney Disease.

下面是我們的對話:

Here is our conversation:

Jenny: 貓咪的腎臟病有幾種? What are the different types of kidney disease in cats?

Dr. Jean: 

腎臟疾病可分為急性與慢性. 像是腎小球發炎(慢性發炎)及腎結石就是慢性. 腎結石在老貓間很常見. 急性則是像中毒及感染. 像是寵物食品內有三聚氰胺汙染,就會有中毒的結果.

Kidney disease can be either acute or chronic. Chronic would be things like glomerulonephritis (chronic inflammation) and kidney stones and things like that. Kidney stones are pretty common in older kitties. Acute would be things like toxins and infections. You can have a toxic insult, like with the melamine in pet food.

腎臟敗壞造成了很多的動物死亡. 其會造成急性腎功能衰竭. 很多的動物在病癒後會有慢性腎臟敗壞, 可能會隨時間而越來越差. 所有的貓咪都會隨著年齡而產生腎功能衰竭. 現在, 我對於這個有一個假說: 這和貓泛白血球減少症(貓瘟)病毒有關.

That caused a lot of animals to die of kidney failure. It caused acute kidney failure or acute renal failure. Many of those animals that recovered had chronic kidney damage which is probably going to get worse over time. All kitties it seems, practically all of them anyway, do develop renal failure with age. Now, I have theory about that. The theory has to do with the feline distemper (panleukopenia) virus.

而這和我們給貓咪不必要的每年施打預防針有關係. 疫苗中的病毒原本是在貓咪的腎細胞中培養. 而過濾出這些病毒時會伴隨這一些貓咪的蛋白質在疫苗中. 然後再將這些東西注入貓咪的身體,貓咪會產生抗體來對付這些外來物,進而造成慢性發炎. 疫苗會讓免疫系統產生對付紅血球及結締組織的抗體. 而在腎臟中有很多的結締組織, 所以你是在用疫苗產生很多很多的抗體, 而這些抗體又產生更多的發炎反應, 而這些免疫反應多發生在腎臟組織. 因此你在腎臟造成了一個低度慢性發炎的環境, 而如果你每年都做這件事, 腎臟會因此產生很多的傷痕組織. 如果傷痕組織夠多, 對腎來說就會是種壓力, 而疫苗就是這些發炎反應的開端.

And it’s our bad habit of vaccinating cats every year for something they don’t need. And consequently, the virus itself that goes into the vaccine is grown on Crandall-Reese kidney cells, and they are feline kidney cells. So when those viruses are filtered, some of the kitty proteins get in with the vaccine, and then you inject it into the cat, and the cat will make antibodies against it and cause chronic inflammation. With vaccines, the immunesystem tends to make antibodies to things like red blood cells, and particularly connective tissue. There’s a lot of connective tissue in the kidneys, so you’re setting up a situation where you have each vaccine creating more and more antibodies, which creates more and more inflammation as the antibodies bind with the kidney tissue. So you set up a chronic low-grade inflammation in the kidneys, and if you do that every year, the kidneys can just only take so much of that and leave scar tissue at its wake. If you have enough scar tissue, then you have very little functional kidney tissue left. I believe that most chronic renal failure in cats arises from years of dry food that’s caused chronic dehydration, which is a burden on the kidneys, and/or vaccines that caused prior inflammation.

Jenny: 那有沒有方法能夠預防貓咪得到腎臟疾病呢? 以你上面的說法我知道應該要避免施打疫苗. So are there ways to avoid kidney disease in your cat? Obviously, from what you just said I could conclude to avoid the vaccination.

Dr. Jean: 

是的. 貓瘟對幼貓是致死性的, 所以我建議你施打前面的2,3劑預防針. 因為這算是一個比較常見的疾病. 這種細小病毒, 存在於環境中的每一處, 有可能你穿的鞋子就會帶病毒給貓咪. 我的朋友們, 有些沒有讓貓咪打這個預防針, 而總共有11隻貓咪死亡, 全部都是幼貓.

Right. Now, panleukopenia will kill a kitten, so I recommend that you get the first couple or two, three distemper vaccines for your kittens. Because it’s a kind of disease that’s very common. It’s a parvo virus, it’s everywhere in the environment, and you can bring it in to your cats on your shoes. I have friends who did not vaccinate and lost 11 cats and all the kittens.

這是因為有一個工人在她進入房子的時候沒有更換鞋子. 所以, 你知道應該要讓幼貓施打疫苗. 但過了幼貓時期後, 他們不需要增進劑. 這個疫苗有效期約8~15年, 或更長, 而這幾乎就是貓咪的一生了. 如果你是個貓咪, 而你有一個正常的生活, 就算你都在室內, 你也曾不斷的暴露在細小病毒下. 這會讓你有一生的長期免疫力. 他們不需要多餘的預防針. 因為當他們有這個免疫力, 得到嚴重致死性疾病的機率幾乎為零.

It was because a worker was not careful about changing shoes when she came in. So, you know, vaccinate the kittens for distemper. But after kittenhood, they don’t ever need a booster. That vaccine lasts from eight to fifteen years or more, which is you know, pretty much a cat’s lifetime. If you’re a cat, if you’ve lived a normal life, even if you’ve lived indoors, you’ve been exposed to that parvovirus over and over again. It produces really long-lasting and I suspect lifetime immunity. They’ll never need another distemper shot. Because once they have immunity to it, the chances of ever getting severe disease from it is pretty much nothing.

Jenny: 這很好. 我很感謝能用Email和您有這段對話. 因為我知道我的獸醫一定會恐嚇我去打. 我知道我可能就會容許這件事發生. 而當我不確定這件事好不好時, 我會開始產生疑問, 所以我很高興我們談了.  

That’s good. I’m so thankful that I have this conversation with you via email before I took Charlie and Trig in. Because I know that my Vet would have scared me into it. I know that I would allow that to happen and when I don’t have a good gut feeling about it, then that’s when I start to question it so I’m glad we’re here.

Dr. Jean: 

我很高興我能提供這個資訊而讓你感到安心. 這幾年來, 我想獸醫們都知道這件事. 你知道的, 當你去研討會時, 你總會學到更多的東西... 獸醫在狗狗身上賺到更多的錢. 狗狗體型比較大, 需要較多的藥量, 吃較多的食物. 人們比較會在狗狗身上花錢. 如果你是一間小型動物診所的獸醫, 你可能會學到如何賺到更多錢, 而狗狗的東西就是其中一項. 大部分的獸醫不是貓奴. 他們不會跟貓咪"心靈溝通". 你知道我的意思是什麼嗎? 我大部分是跟貓咪一起做事, 我了解他們. 我可以看到, 感受到, 到達某種程度而知道他們發生了甚麼事. 大部分的獸醫不太會跟貓咪相處. 而他們當然不知道這個研究, 就算這個研究已經公開很多年了. 你知道, 這不是個常見的知識. 而在疫苗這個議題上有很多的分歧意見. 所有的專家都會建議你最多每三年打一次預防針, 這部分的資訊在狗狗上有很強的證據, 貓咪也是, 你不需要讓毛小孩們施打這些對他們來說沒有威脅的疾病疫苗. 但很多的獸醫仍是需要預防針的收入, 而在疫苗標示上寫著"每年施打". 所以他們覺得這表示他們應該要信賴這個說法, 而讓每年施打成為標準程序.

I’m glad I’m presenting this information that comforts you. For several years now I’m sure the (veterinary) profession is well aware of it. You know, when go to a conference and you’re getting your continuing education… vets make more money out of dogs. Dogs are bigger. They take bigger pills, they eat bigger bags of food. People are more willing to spend money on dogs. If you’re a vet in a small animal practice, you’re going to probably go to the lectures that are about something that you’re going to be able to use and make money with, and that’s going to be the dog stuff. Most vets aren’t cat people. They don’t “grok” cats. You know what I mean? I have worked primarily with cats. I understand them. I can see, I can feel, I can get into a sort of intuitive kind of level, and “get” what’s going on. Most vets are not that comfortable with cats. And they certainly don’t know this research, even though it’s been out there for many years. You know, it’s just not common knowledge. And there’s always controversy about vaccines. All the experts recommend that you vaccinate no more than every three years, if that, and the data’s very strong in dogs and it’s pretty good in cats, that you don’t need to be revaccinating these guys for these diseases that aren’t a threat. But many vets are still tied to the vaccine income, and the things it says on the label “give it every year”. So they think that presents a great liability, and that it’s the standard of practice. 

這有很多的原因.

There’s a lot of reasons.

有一次我去一個會議, 我們討論了疫苗, 而獸醫們有很多的意見, 我很驚訝這麼多獸醫都找到不同的方法來解釋"疫苗是金錢的來源". 但是什麼讓所有的獸醫都得到相同的結論--收入. 1994年時, 疫苗相關的腫瘤資訊開始出現. 所以我們有將近20年的時間來找到別的方法替代這項收入. 但老一輩的獸醫堅持自己的方法, 管他的研究,管他的科學, 忘了它吧! "我一直都是這樣做. 而所有的寵物反應都沒事". 因為疫苗而生病或是得到癌症的動物, 那些人不會再回到同一個獸醫. 所以那個獸醫從來就沒有看到疫苗所造成的結果. 沒有方法可以紀錄始末.

I went to a meeting once where we talked about vaccines and dozens of vets commented, and I thought it was just amazing how many different ways that individual veterinarians found to say “it’s the money.” But that is what it came down to with every single one of them. It came down to the income. That should have started in 1994 when the information about vaccine-associated tumors started to come out, when Macy started to publish about it. And so we’ve had almost 20 years to figure out a way to replace that income with something else. But the older generation of vets will do it their own way, to hell with research, science and uhh forget it! “You know, I’ve always done it this way, and everybody’s done just fine”. The animal that got sick from vaccinations or or got cancer from vaccinations, those people simply don’t go back to that vet. So the vet never sees the real outcome of that policy. There’s no way to keep track of that.

美國動物醫院協會有了一個對疫苗的全新看法, 知道疫苗的有效期可能至少有3~5年. 但他們只是改成每5年要施打疫苗, 這不是完全正確的.

The American Animal Hospital Association just came up with a whole new thing about vaccines, saying, really, we know they last three years, and we know they probably last at least five years. But they refrain from recommending that we get on every five year schedule. Because that is not politically correct.

Jenny: 那...我完全同意. 其實我是帶貓咪到一間只看貓咪的診所, 但是... 

            That …I completely agree. I actually take my cats to KC cat clinic so it’s only cats. But..

Dr. Jean: 喔, 這很好. 因為這個診所只看貓咪,應該會比較好一些. 

                Oh that’s good. Because it’s a cat only clinic, they tend to be a little better about it.

Jenny: 腎臟病會有什麼症狀嗎?  What are some signs of kidney disease?

Dr. Jean: 

喝多尿多. 這是第一個癥狀. 如果越來越嚴重, 他們會開始體重減輕. 如果真的很嚴重時, 你的房間會聞起來像室外, 因為他們口氣中的阿摩尼亞很重. 但到這個情形時是已經病的很重了.

Drink a lot, pee a lot syndrome. That’s the number 1. If it’s get bad, they’ll start losing weight. If it gets really bad, you’ll walk into the room and it will smell like a outhouse, because the ammonia in their breath would be so bad. But they’re pretty sick by that time usually.

而且, "突然"增加喝水量及尿量才是. 事實上, 如果以"雞生蛋,蛋生雞"的理論來看, 尿液增加是起因.

And you know, it’s the sudden increase in drinking and urinating. Actually urinating comes first if you want to do the chicken-and-egg thing.

Jenny: 所以如果你看到尿量增加或是貓沙裡的尿塊變大, 這就是一個徵兆? 

            So if you saw more amounts of, or you saw bigger clump of litter for example, that would be a sign?

Dr. Jean: 

是的, 我的貓就曾發生過. 我曾有兩隻貓咪有這個病史... 比較年輕的貓咪有泌尿道感染病史. 但比較老的看起來還好. 他們沒有減輕體重. 沒有甚麼事情發生, 但是貓沙裡的尿塊就突然從每天2~3塊變成8~9塊. 自然的我就先檢查比較年輕的貓, 因為他有病史. 如果有貓咪生病, 應該就是他. 但他沒事. 我只好等到四月的時後才給老貓做全血檢, 因為他正參與一項研究. 當你是獸醫系學生的時候, 所有身邊的貓狗都在參與研究. 他在四月時做了全血檢. 所有數據都很完美. 但在七月時他有了腎功能衰竭. 他又活了5年. 他是個堅強的孩子. 那是腎臟病早期, 他的尿液無法濃縮. 所以你知道可能一個晚上就出現這個狀況. 多注意貓沙的情況永遠是值得的. 那是你觀察毛小孩們的方式.

Yeah, I can tell you what happened with my cat. I had two cats and they had a history… the younger cat had a history of urinary tract infections. But the older one seemed fine. They weren’t losing weight. Nothing was happening. Then all of a sudden, we went from 2 to 3 clumps of litter in a box every day to 8 or 9. And so naturally, I took the younger cat at first because she was my “big ticket item” cat. And if anybody’s going to be sick, it’s going to be her. But it was all fine. I had just run complete bloodwork on the older cat I think in April, because she was in a study. You know when you’re a vet student, every cat or every dog is in a study of some kind. She just had a full blood workup in April. Everything was perfect. This is July and she’s in kidney failure. But she went on another 5 years. She was a tough old broad. It was early kidney failure, she wasn’t concentrating her urine. So you know it could just be overnight like that. So you know, it’s always worth paying attention to what’s in the litter box. That’s your eye on them in your world.

Jenny: 是阿, 我在Rags有慢性腎功能衰竭時都沒有發現這個情況. 但我曾有一次是他們叫我要注意. 我的網站中最常被搜索的關鍵字是腎臟病及貓食. 有其它的東西可以代替處方食品嗎?

Yeah, I certainly never noticed it when Rags had a chronic renal failure. But I did once when they told me to notice it. You know one of the things that’s often searched for in my site is kidney disease cat food. Is there such a thing other than the prescription diet stuff?

Dr. Jean: 

是的. 只有做腎處方食品的寵物食品公司所提出的研究成果才會顯示這個食品是有好處的. 在我的經驗中, 如果你太早開始餵食這些食品, 你會有麻煩. 我還在學校的時候, 他們說"在腎功能真的開始衰竭前, 不要給予k/d", 你真正需要開始的是限制磷的攝取量. 因為這些食品中的蛋白質太低, 無法提供身體所需, 所以這隻貓就會開始體重減輕及身體情況變差. 大多數的貓咪不喜歡吃它, 而吃的不夠. 只有一項研究指出, 這會延長生命及減少併發症, 如果你覺得可以接受,那你就做吧. 我的主張是,如果有個人跟我說"Jean, 只要你放棄好吃的冰淇淋, 我就可以讓你多活10年." 我會說"把你的10年留著吧,給我冰淇淋!". 我想要看到貓咪們吃的開心, 所以我給他們喜歡吃的東西. 高蛋白的食物也含有較多的脂肪, 因此可以保持體重. 這都跟貓咪的食物動機有關... 他們真的會喜歡所有的高蛋白食物嗎? 我連把這些食物移開都很難! 而且這讓他們活得更久, 而非過著不開心,無聊的生活. 很多人(及大部分的獸醫)不會同意我的說法, 但那就是我的主張.

Yeah. The thing about the kidney cat food is that the only study that’s every really shown a benefit was done by the company who made the food. In my experience, those foods, if you start them on those diets too early, you’re going to have problems. When I was in vet school, they said, “don’t start them on k/d until the kidney function has really declined, and you really start to need the restricted phosphorous. Because those diets, they’re so low on protein, they don’t really give enough protein for ongoing body maintenance so this cat tend to lose weight and body condition. Most cats don’t like it and don’t eat enough, on top of the reduced nutrition. You know, one study showed, it increased length of life and pure complications, and you know that’s fine if you want to do that. My philosophy is that if somebody says to me, “Jean, I can let, you can live 10 years longer if you just give up the Ben and Jerry’s.” And I would say, “Stick your 10 years and give me the ice cream!” You know, I like to see them happy to eat, so I give them what they like to eat. The higher protein food also have more fat so it maintains your body weight better. You know, it just depends on the food-motivation of the cat… do they really get a lot of joy out eating their whatever high protein food? You know I just have a problem taking that away from them, and making their life longer, but boring and less enjoyable. A lot of people (and most vets) wouldn’t agree with me, but that’s my philosophy.

Jenny: 你可以解釋layman's term嗎? 腎功能衰竭是什麼意思或是它的過程及你所知道它給貓咪的感覺是什麼? 

            Can you explain in layman’s terms, what kidney failure means or what’s the process and what your understanding is of how it makes the cat feel?

Dr. Jean: 

過程是腎細胞開始死亡,被傷痕組織代替. 而腎臟可以容忍細胞失去的空間很大. 只要是一點點的徵狀出現, 就表示75%的功能已經喪失. 就像你摸到繩子的末端時...這表示後面已經沒有繩子了. 如果你仍繼續, 你就會落下懸崖. 所以毛小孩們已經到他們所能容忍的極限, 才顯示出了徵狀, 而因為腎臟會幫助骨隨的產生紅血球, 當腎功能衰竭時, 會產生貧血的情形. 當他們開始喝大量的水時是什麼情況呢? 這表示他們沒有辦法吸收足夠的水分以平衡失去的. 吃罐罐或是自製鮮食的貓咪會比吃乾乾的貓咪攝取到更多的水分, 但是不管吃哪種食物, 他們總共失去的水分是一樣的.

Well the process is, that kidney cells die off overtime and are replaced with scar tissue. And the kidneys have a huge capacity and you can lose, by the tiniest show of symptoms, 75% of your functional tissue. It’s like when you come to the end of the rope… that means there’s no more rope. And if you keep going, you will fall. So these guys have come to the end of their reserved capacity, and now we have symptoms and because the kidneys are responsible for retaining water and certain ions and excreting other things, it’s very active tissue. For instance, there’s a hormone produced in the kidneys that helps the bone marrow to produce more red blood cells, so when the kidneys are failing, they get anemic because that signal is not being sent anymore. Sowhat happens is that they drink more water, but they can’t take in enough water to make up for the losses. Cats eating canned or homemade take in a lot more water than the cat that’s eating dry food, but either way they lose fluid overall and become dehydrated.

當腎臟不健康的時候, 它沒辦法維持足夠的水分. 所以當貓咪變的口渴而喝水時, 他永遠無法平衡掉腎臟所損失的水分. 而且, 他們也在喪失蛋白質, 會由尿液而損失很多重要的東西. 因此他們開始減輕體重, 因為它們在損害組織以試圖提供一些通常腎臟會回收的東西. 這是個不好的循環, 當腎臟沒有排出阿摩尼亞及其他毒素, 這些東西就會開始累積在血液裡面. 有一次我搬到酪農場後面住, 廠家有阿摩尼亞流出. 當時是夏日早上一點鐘, 我醒來的時候像是有人用冰鋒刺向我的眼睛. 這馬上給了我非常嚴重的頭痛. 這些阿摩尼亞進入了我的血液. 如果毛小孩們的血液中有很多的阿摩尼亞, 這會讓他們的頭很痛. 而且會嘔吐. 他們會開始不吃東西, 所以身體會開始破壞自身的組織以維持身體所需.  如果你還不做些甚麼, 這會像快速下降的溜滑梯一樣.

So the kidneys are extremely unhappy because they can’t hold on to enough water. So then cats get thirsty and drink, but can never make up for what the kidneys are losing. And also, they’re losing proteins, you’re losing important things in the urine. And so they start to lose weight because they’re breaking down tissue to try and supply some of the things that the kidneys would have normally held back in and recycled. So it’s a bad cycle. When the kidneys are also not excreting ammonia and other toxins for you, well those now start to build up in the blood. And one time I moved behind a dairy, and they had an ammonia leak. It was one o’clock in the morning and it was summer, I woke up, and it was like somebody took an icepick and shoved it to my eye. It gave me an instantaneous severe headache. I had that ammonia go into my bloodstream. These guys have a lot of circulating ammonia, and that gives them a headache. And they’re nauseous. They don’t want to eat, so they cannibalize their own tissue to try and maintain themselves. You know if you don’t do anything, it’s a very fast downward spiral.

有些事情我會為毛小孩們做... 現在沒有很多種治療的藥物, 而這些藥物都是用來控制鈣磷比,貧血與高血壓. 但有件事比其他都重要--皮下液體. 所以學著怎麼輸液, 然後放棄.

Now the things that I like to do for these guys… Now there’s quite a few drugs nowadays, all these things to control the calcium/phosphorous balance, and to manage the anaemia, and the high blood pressure. But the one thing that is more important than anything else is subcutaneous fluids. So learn how to give fluids and give up.

這個早上有個人寫信給我, "我每周幫貓咪進行皮下輸液一次." 這就像是, 你有著持續的疼痛, 你每周吃一次止痛藥.  拜託! 注意! 他們需要這些液體. 而補充液有許多的好處, 像是稀釋阿摩尼亞及減輕脫水, 這就解決了90%的問題.

I just had somebody write me this morning, “Well, I’m giving my cat fluids once a week.” That’s like, yeah, that would be like if you have chronic pain, you take an aspirin once a week. C’mon dude! Pay attention. They need the fluid. And supplementing fluids does a host of wonderful things, including that flushes ammonia and other toxins out through the kidneys, so it brings those levels down. Dehydration causes headache all by itself, and it causes nausea. So, you know if you can correct the dehydration, you’ve got 90% of the problem licked.

當貓咪有了很多的水分, 你要煩惱的就是補充磷. 在獸醫學校時, 我在藥局工作. 這些輸液磷含量很低. 因為這些輸液都是為人類製作的, 而人類常常攝取了太多的磷, 所以這些液體中的磷非常低. 為了要能維持磷的平衡, 你必須另外添加. 現在你知道我是唯一一個獸醫知道這件事實的, 因為我曾在藥局工作! 有另外一個人在我之後也在藥局工作, 她也是個獸醫. 但她是唯一的另一個人.

Now, when cats are on a lot of fluids you have to worry about supplementing potassium. In vet school I worked in the pharmacy. Every bag of fluids that went out was spiked with potassium. Because all those fluids are made for humans, and humans tend to get too much potassium, so all fluids are too low potassium. To make the potassium even back to normal, you have to add it. So you know I’m the only vet that I know that does that because I workfor the pharmacy! Well there is one other person who worked in the pharmacy after me, and she’s also a vet. But she’s the only other one.

你知道的, 沒有事情是完美的.

You know, nothing’s without complications.

Jenny: 沒錯. 磷這個問題很有趣. 我非常希望在Rags還活著的時候就知道這件事. 

            Right. That’s interesting about the potassium. I definitely wish that I would have known that when Rags was alive.

Dr. Jean: 

是的, 而你知道, 磷所造成的問題其實是由我的一位老師及一位教授所發現的. 他是Marty Fettman. 他是第一個發現者! 在過去, 這是一件很大條的事. 他們發現k/d, 會造成貓咪有低血鉀的現象, 也就是磷含量低. 因為這個食物沒有足夠的鉀, 而他不能補足貓咪從尿液中所流失的磷. 所以現在的k/d含有更多的磷.

Yeah, and you know, it used to be that there was an issue with the potassium and it was actually discovered by one of teachers and one of my professors at vet school. He was Marty Fettman. He was the first veterinarian in space! That was a big deal in old days, back in the day. They found that k/d, the food k/d, was causing cats to become hypokaemic which is low potassium. Because it just didn’t have enough potassium and it didn’t make up for what they lose in the urine. So now, k/d has more potassium and some of the others do too.

我會這麼說, 如果你要餵腎處方的食品, 請只餵濕的版本. 餵乾乾就像打自己一巴掌一樣, 你試圖讓他們不要脫水的同時, 讓他們處於一個更脫水的現象! 因為乾乾內的水分極低. 所以你應該要放棄掉那個, 貓咪的食物是非常非常重要的.

I would say, if you’re going to feed a kidney diet, only feed the wet version. The dry version, is just you know, you’re slapping yourself upside the head by making them more dehydrated at the same time you’re trying to combat dehydration! Because the dry food sucks the moisture out of them. So you’re gonna lose that one. So the cat food’s extremely important.

Jenny:我媽媽的貓, Murphy, 在轉成全濕食前, 曾吃腎處方好一段時間 .

           Well my mom’s cat, Murphy, had been on kidney food dry for a long time before she took him off dry food altogether and put him on a wet food only.

           當Rags得到慢性腎衰竭食- 我給他乳酸林格式液, 本來是一天一次, 後來是一天兩次, 因為他們很不喜歡... 我不太記得真正的原因, 但是我記得給腎衰竭的腎臟太多液體是不好的, 所以我最後把它分成一天兩次.

           When Rags was in chronic kidney failure -I gave him lactated Ringers, it was once a day and then it became twice a day because they didn’t want… I’m not gonna be able to say this right but basically my memory of it was too much fluid in failing kidneys could really hurt him so that’s why they broke it down to twice a day eventually.

Dr. Jean: 

你輸入液體的地方(後頸)沒有很好的血流, 所以它可以吸收液體的空間比較限制. 所以如果你給一隻5磅的貓咪200cc的輸液, 這些液體只會直接流到他的腳部, 不會被吸收. 所以你要分好幾次給予. 我不建議使用乳酸林格式液. Normasol, Plasmalyte 或是其它相似的生理食鹽水會比較好. 林格式液裡面含有乳酸. 這對他們來說太酸了. 酸是一個很大的問題, 你絕對不想要再讓他們吃更多的酸.

The area where you inject fluids (scruff of the neck) does not have a great blood supply so it has a limited capacity to absorb fluids. So if you give a 5 pound cat 200 ccs of fluids, it’s just gonna drain down to his legs and not absorb it. So you give smaller amounts more frequently. I don’t recommend lactator Ringers though. It really needs to to be Normasol or Plasmalyte or similar fluids. Ringers has lactic acid in it. And these cans are already too acidic. Acid is a big problem and the last thing you want to do is add more acid. And lactate is lactic acid.

Jenny:另外一個我添加到輸液裡面的是B12. 你覺得這個呢... 

           Then another thing that was added that I had to shoot into the bag was B12. What do you think about…

Dr. Jean: 

我通常是加B群, 維他命C及磷. B群可以由水分排出. 所以多餘的會跟著輸液一起被排出, 所以, 是可以的.

I usually just put B complex, and C, and potassium. The Bs tend to get washed out with water. They tend to get washed out with fluids, so yeah.

Jenny:這大概是我所有的問題了, 你還有什麼要補充我可能忘記問的事情呢? 

           Those were kind of all of my questions, do you have anything to add to this that maybe I forgot to ask?

Dr. Jean: Omega-3 不飽和脂肪酸對毛小孩們非常非常重要.

Omega 3 fatty acids and probiotics are really, really important for these guys.

Jenny: 你說的毛小孩們是指有腎衰竭的還是所有的貓咪?

            When you say these guys, you mean kidney failure cats or all cats?

Dr. Jean: 

嗯, 全部的貓咪. 尤其是有腎衰竭的. Omega-3s有研究顯示可以改善他們的狀況及自身的益生菌. 有一個牌子的益生菌叫Azodyl. 那是他們研究時所使用的牌子. 有一位讀者跟我說他看不懂也搞不清楚要用哪一種比較好. 但是我覺得所有的牌子都OK. 因為益生菌有幫助...很多的尿毒都是由大腸裡面的細菌所產生的. 蛋白質在那邊被破壞. 因為一些原因, 我不記得其中的原理, 但是益生菌可以穩定及平衡腸菌叢, 這對於保持壞菌數低是絕對有幫助的. 藉由保持壞菌的數量低, 你是在幫助改善貓咪的感受. 

Well, all cats. Especially kidney failure. Because Omega 3s have been shown to improve their status and self-probiotics. Now there’s a particular brand of probiotics called Azodyl. That’s the one they did the studies on. One of our readers just told me that they can’t get it and they can’t figure out where to go. But I think any probiotic in the store would be just fine. Because the probiotics help… a lot of the urine toxins are manufactured by the bacteria in the colon. Proteins are broken down there. For some reason, I can’t remember what the logic was but stabilizing and balancing that population, it definitely had a huge beneficial effect in terms of keeping the numbers down. By keeping the numbers down, what you’re doing is you’re proving how the cat feels. The numbers are themselves critical. It just that, that’s how you know.

Dr. Jean: 

我怎麼知道貓咪正感到痛苦? 或是我怎麼知道是時候了? 我會說的第一件事是"你會知道的". 有時候, 你必須知道, 有時侯你去看獸醫, 他們會說"嗯, 你知道的, 這個情況看起來不太妙." 而所有被我說這句話的都會說"喔, 是阿, 我好像有這樣的感覺. " 每一個都這樣說, 所以, 沒有人是真的了解.
直到你因為阿摩尼亞而感到頭痛前, 腎衰竭並不是真的很痛. 大部分的腎都受到損害了. 當他們開始停止理毛且不想要被愛撫, 只是躲著... 這會成為生活品質的問題. 因腎臟病死亡是非常可怕的. 所以大部分的毛小孩們會需要一點幫助.  

They’re like, how do I know if the cat’s in pain, or how will I know if it’s time. The first thing I will say is, “You’ll know.” Sometimes, you have to, sometimes you go to the vet and they’ll say “Well you know, this doesn’t look good.” and every single person I’ve ever said that said, “Oh, yeah I kind of had that feeling.” Every single one. So nobody doesn’t every really know.
Kidney failure isn’t really painful until you start getting headaches because of the ammonia. Most of the stuff can be managed. When they quit grooming and they quit wanting to be petted, and they just hide…it’s quality of life issue. Dying of kidney disease is pretty horrific. So most of these guys would need a little help.

這個網站有很多關於這方面的資訊細節.

The other this is that felines CRF website have incredibly detailed information and they refer to each other back and forth all the time so…

Jenny: 這是? and that’s felinescrf.com?

Dr. Jean:  

他們有很多的資訊. 所有醫療上的細節. 我已經退休了, 所以我沒有一直更新這些細節. 如果我仍在執業, 我會用那裏面的一些療法, 因為我想要讓貓咪在不用送出國的情況下,感覺好一點, 時間越長越好. 我不推薦腎臟移植. 為什麼? 你可以因此得到多一點的時間, 但同時你是讓貓咪接受一項很可怕的手術, 其也需要很長的恢復期... 我看過至少兩隻貓咪經歷過這個手術及一些術後的恢復等等. 然後呢? 他們可以再活6個月或一年? 對有些人來說這是值得的. 但我的主張不是, 我的貓教我, 他們不想要費這麼大的功夫.

And they’ve just got so much information. All the details and all the meds. You know I’m retired so I don’t keep up on the details. If I were still in practice, I’d be using some of these medications, because I want to make the cat feel better for as long as possible without going overboard. I wouldn’t recommend the kidney transplant and all that kind of stuff. WHY? You’re gonna buy a little time but in the meantime you’re gonna put the cat to the horrific surgery with a long recovery… two cats for this surgery, and recovery and stuff. So what? For another 6 months or a year? For some people that’s gonna be worth it. But my whole philosophy is kinda minimalist. My cats have taught me that. They taught me that they didn’t want extraordinary effort.