When I have clients who are in a financial bind, yet they are working hard to help their pets, I like to send them home with a kit. If their cat has chronic kidney disease (CKD), then all the ingredients should go into that kit that could promote a better appetite and health, and none of these ingredients should complicate heart failure. I also let them know that if they cover the basics (i.e. an exam or recheck fee, once a year), then legally, I can help them via prescriptions all they want! Even if they can't afford the next check up, they get to talk to my nurses, who leave me messages, and then we all coordinate together as a team.

So see what your clinic can do for you with a simple re-check exam. We don’t need blood work for many recommendations - just a thorough discussion of what your goals are, a physical exam and accurate body weight can get us there. Tell them what your goals are. Tell them your limitations. I respect people immensely when they are fighting for their cats health, even though life has dealt them a lot of debt or financial insecurity.  

I’ll be going to Cuba this month. On my last trip, I saw this:

I'll meet people who care immensely, but have less money or resources.

I was in Uganda this year. Same situation. Harsh situation for animals sometimes, but you also see this:

People fight to take care of the basics, and sometimes that’s all you need.  

There should be solutions to help you. If they have seen you within one year, then maybe even a phone call could work. It depends on the relationship you have with your vet. If people are working together for a shared purpose, then you don’t always need a lot of money for that.    

Without doing diagnostics, all you must accept is that you will go through more guess work. More trial and error. This still exists even if you do diagnostics, but you're just typically doing less of it. But it shouldn't stop us from providing care, right?

CKD and heart disease is a special case situation. In a cat with heart disease, they may be in a state of sodium overload. High sodium fluids that are typically used for SQ fluids are not always the best choice, because your are administering more sodium to an overloaded cat...and there is a root cause of why a cat with heart disease may react badly to SQ fluids.  So fluids need guidance, in the type of fluid, when to give, and how much. So you might want to hold off on that until you are in a better place to access those vet visits.

But the CKD kit you can master. Fight for it if your not getting anywhere. Lots of things can be recommend (including the B12) to help increase appetite and energy for your cat. Ask to talk to the vet nurses. They can be worth their weight in gold, and if they can sometimes influence these things as well. “So doc, I had a call with misty’s owner. She’s really trying this and that, and we just saw her 4 months ago. Her cat is doing ok, so can she try x, y and z now for her CKD? Here is her file”. You want those kind of conversations happening behind the scenes for your cat.

Let people know you are trying and you are willing to take on shared responsibility. That is a biggie. You can let the clinic now that you understand that there is more trial and error without the annual testing, but you are ok with that because you are doing the best you can and you accept the risks. Vet's don't like to do things over the phone without seeing your pet, because the onus of responsibility is on us. If things don't work, and the vet get's blamed (I've been there, done that, go the t-shirt), it can be an emotional and time vacuum that we just don't want to get sucked down into. If it's clear we are all on the same team, with the same purpose, amazing things (without a lot of money) can happen.

I know this is kind of a vague answer but it's a start.

Dr. Kris