? Help with interpreting blood work?

[shelaghc]

My Jester's vet took some blood tests last night in-house to see what might be causing him to lose weight.

He went from 12.5 pounds the summer of 2016 (the last visit before he was diagnosed the following year) to about 11 pounds at dx last July and has been slowly losing weight ever since.
Once was because he stopped eating for about ten days. But most of the rest of the weight loss has been inexplicable.

In December he weighed about 9 pounds. I pushed him to eat over two 5.5 ounce cans of food daily - sometimes nearly 3 cans - and his entire weight gain in January put him up to 9.4 pounds.

Over the last several weeks I haven't been home enough to really get him to eat as much because I picked up a job. Even still, he's usually getting over 2 cans of food daily.

Yesterday we weighed him and he's lost even more - down to 8.1 pounds. Jester isn't a tiny cat - he's very long and he was never anything like fat.

The vet was mostly testing for either CKD or thyroid. The latter would have been fairly simple to treat; the former would have been devastating for us.

Both tests came up negative. We're supposed to go back in a month to try again, understanding that thyroids sometimes behave normally even when they've gone wonky.

I've filled in as much as I have from the lab work they did in Jester's SS and am uploading the pdfs to this post.

There was something labelled ALP in the lab work that I can't identify and can't figure out what it might refer to on the SS.

Can anyone look at the available numbers and speculate at all?

I'm beside myself on this. His BG has been so good lately and I can't believe I may lose my baby because he he's dwindling away to nothing.

 

[Nan & Amber (GA)]

There was something labelled ALP in the lab work that I can't identify and can't figure out what it might refer to on the SS.

Think that's Alkaline Phosphatase?

I don't know how to interpret all the results, I'm sorry, I wish I could help. The only think I can offer is that, even though we focus so much on the blood glucose numbers and the need to feed low-carb here, when a cat isn't eating well I'd be inclined to relax that if there's a high-carb food he enjoys more. Whatever he'll eat, basically, dose around that.

 

[Veronica & Babu-chiri]

Hi I'm not a big expert in blood work but he's results doesn't look bad at all , does he have any other symptoms besides losing weight? Is he eating ok no nausea? pooping ok?, how does his hair and skin look?

 

[Kris & Teasel]

Maybe @Marje and Gracie can help.

 

[shelaghc]

Hi I'm not a big expert in blood work but he's results doesn't look bad at all , does he have any other symptoms besides losing weight? Is he eating ok no nausea? pooping ok?, how does his hair and skin look?

Jester has been pretty picky about foods most of his life. He only started eating canned cat food in response to his "sister" Sandi (GA) starting to eat that. At the time, he seemed to prefer pates. Then at some point he started eating the highest of the high carb Friskies canned stuff, Friskies indoor Chunky Chicken and Turkey casserole - on top of gravy it also has rice with a whopping carb content of 24.
Last fall Jester went into a very brief remission (more like a honeymoon) except that the only food I could get him to eat reliably was that carby crap. Honeymoon was over about 1.5 months later.

After some very careful maneuvering over a period of months, we finally latched onto medium carb Friskies shreds as the most reliable stuff - Turkey & Giblets and Chicken, with an occasional foray into Turkey & Cheese because the carbs were ever so slightly higher (13 for the first two and 14 for the last).
About once a day he would eat some single digit pate - but generally not more than 1/6 to 1/3 can.

But for the last several days, the only flavor I could get him to eat was the Turkey and Cheese. This morning, it took over an hour to get him to eat even half a can of that. However, I'd accidentally purchased a can of Tasty Treasures Turkey and Cheese - carb count of 17 - and I decided to give that a try.
He wolfed down about 1/3 can of that pretty happily (although it still took about twenty minutes and I was late for work) so I guess I'm picking up a few more cans on the way home from work.

I just hate the idea of his numbers going back up again.

As far as hair and skin, outside of a little matting (hard for a shorthair!) that all seems fine. Although the vet said he seemed a little dehydrated.

Pooping is harder to determine as I have three furbutts total. No nausea that I've noticed. But now that you mention it, one of the kids did throw up some food on Sunday evening. Not a lot though.

And no other obvious symptoms.

All the vet will say is "he may never get that weight back."

We have another appointment in a month to try the thyroid test again and see if anything shows up.

The hardest part is that I've been unemployed off and on for ten years. I just started this job and now, because I *do* have a job, the vet has taken me off his "charity case" list and is now charging me.

I'm desperately trying to catch up on bills and credit cards that I've been behind on for ages. I need to move out of this apartment but can't save anything if I now have mounting vet bills......

 

[tiffmaxee]

What I would test for is pancreatitis. The labs don’t look like kidney disease at all. If you can’t do the blood test right now I would try to get some ondansetron or cerenia to see if he’s nauseous which is often a reason for inappetence and a sign of pancreatitis and of course many other things. Hope this helps.

 

[shelaghc]

to see if he’s nauseous

When I put something in front of him that he likes, he does eat. He just eats veeeerrrrryyyyy slowly.

However, I did email the vet to see what he thought about the possibility.

How long can a cat have pancreatitis and survive? I ask because this has been going on for months and from what I'm reading, pancreatitis needs to be treated very quickly or it could result in death.

 

[Kris & Teasel]

When I put something in front of him that he likes, he does eat. He just eats veeeerrrrryyyyy slowly.

However, I did email the vet to see what he thought about the possibility.

How long can a cat have pancreatitis and survive? I ask because this has been going on for months and from what I'm reading, pancreatitis needs to be treated very quickly or it could result in death.

A really acute attack could possibly do that. However, there are many members here whose kitty has a relapsing, remitting chronic type. @Djamila can tell you a lot about that.

 

[shelaghc]

A really acute attack could possibly do that. However, there are many members here whose kitty has a relapsing, remitting chronic type. @Djamila can tell you a lot about that.

So you're saying there are more mild forms that are lingering?

How is that treated? Is it something that isn't going to kill me financially?
My charge card is already at nearly $2500 and it maxes at $5000. (I had to charge food for my babies for a few months and, at $100 a month, it adds up....)

 

[Kris & Teasel]

So you're saying there are more mild forms that are lingering?

How is that treated? Is it something that isn't going to kill me financially?
My charge card is already at nearly $2500 and it maxes at $5000. (I had to charge food for my babies for a few months and, at $100 a month, it adds up....)

Talk to @Djamila. Her Sam is chronic and she's worked out a lot of helpful things to do. Ask on the ProZinc forum.

 

[shelaghc]

The vet just replied and is suggesting ultrasounds, hospitalization, and IV fluids.

Is this something that DCIN could help me with?
How would I find out?

 

[Veronica & Babu-chiri]

Why does the vet think he may need hospitalization and IV is he very dehidrated? If he's eating ok (just very slowly ) and drinking ok why would he need the IV what explanation does de vet give?

 

[Kris & Teasel]

The vet just replied and is suggesting ultrasounds, hospitalization, and IV fluids.

Is this something that DCIN could help me with?
How would I find out?

@Chris & China is a DCIN "rep". She can give you info. When did your vet say this?

 

[shelaghc]

Why does the vet think he may need hospitalization and IV is he very dehidrated? If he's eating ok (just very slowly ) and drinking ok why would he need the IV what explanation does de vet give?

I asked about the possibility of pancreatitis and that was his reply.

 

[shelaghc]

@Chris & China is a DCIN "rep". She can give you info. When did your vet say this?

Just a few minutes ago.

Here's my email to him:

Hi Dr. Gerson

Is it at all possible that Jester has pancreatitis?
I was looking at the symptoms and weight loss is one of them, along with decrease in appetite and dehydration.

And his reply to me:

2:52 PM (38 minutes ago)
Possible
This is a complex disease in cats
If they are not eating we can hospitalize and
Give IV fluids
Testing involves ultrasound
The disease in cats includes the liver and
Intestine
As long as the cat is eating may not have a specific treatment beside bland diet

 

[Kris & Teasel]

I asked about the possibility of pancreatitis and that was his reply.

OK. The U/S can show inflammation in the pancreas. They tend to get dehydrated when they have pancreatitis and it can be painful so pain meds are often prescribed, along with Cerenia for nausea/vomiting.

 

[Kris & Teasel]

If intestine and liver are involved they call it "triaditis". For "regular" pancreatitis treatment is strictly of symptoms until the flare subsides.

 

[tiffmaxee]

Max had chronic pancreatitis that started when he was 12 and he passed at 19 from heart and kidney. Acute attacks can lead to hepatic lipidosis which can be fatal if not treated aggressively. Over all those years he was only hospitalized for it overnight once.

 

[shelaghc]

If intestine and liver are involved they call it "triaditis". For "regular" pancreatitis treatment is strictly of symptoms until the flare subsides.

How is it diagnosed? Is that what the ultrasound is for?

And how do I tell a 68YO vet who is *very* proud of his knowledge base that he might be talking about a different thing?

The last time I suggested something that I got from this board he said "don't listen to other people, listen to me."

 

[Noah & me (GA)]

This might be an Ontario/Canada thing. Here we get abbreviated copies of the doctor's report without numbers. Everything is reported as pass/fail which is a joke. If cell count A should be between 200 and 1200 and you score 201 you pass. It's a good reason to be self educated (within reason) in a failing system.

 

[tiffmaxee]

If intestine and liver are involved they call it "triaditis". For "regular" pancreatitis treatment is strictly of symptoms until the flare subsides.

His liver numbers are good so very unlikely. With chronic pancreatitis they aren’t always elevated.

 

[Veronica & Babu-chiri]

I asked about the possibility of pancreatitis and that was his reply.

I agree if he had a bad flare and wasn't eating but if he's currently eating (even if he's losing weight) and not dehydrated he wouldn't need the hospitalization or the IV, the ultrasound on the other side may throw in some light as it allows to see if everything looks normal or if there's something inflamed

 

[tiffmaxee]

How is it diagnosed? Is that what the ultrasound is for?

And how do I tell a 68YO vet who is *very* proud of his knowledge base that he might be talking about a different thing?

The last time I suggested something that I got from this board he said "don't listen to other people, listen to me."

There is a blood test, Spec fPL. If you decide to get it, don’t get the quick SNAP test because it just gives a positive/negative so if in the gray zone you wouldn’t get valid results. Some do the quick one and if positive then the one sent out. Costs more that way. Max had two ultrasounds, one by a very respected radiologist and they looked normal. There are lots of things that can cause weight loss and even the best blood test can be high due to kidney (not an issue here) or Diabetes as hormones are measured.

 

[Kris & Teasel]

How is it diagnosed? Is that what the ultrasound is for?

And how do I tell a 68YO vet who is *very* proud of his knowledge base that he might be talking about a different thing?

The last time I suggested something that I got from this board he said "don't listen to other people, listen to me."

The ultrasound can show enlargement of the pancreas that *can be* related to the inflammation of pancreatitis. It's not a given. You'd need the special pancreatitis blood test (SpecfPL - or similar label) to know what's going on in the pancreas and the degree of inflammation present. Blood is taken and sent to a lab. It's the best one but is pricey. There's a simple, less reliable yes/no test from a blood sample that can be done by the vet (SnapfPL or similar). Vets will often treat symptoms "as if".

 

[shelaghc]

The ultrasound can show enlargement of the pancreas that *can be* related to the inflammation of pancreatitis. It's not a given. You'd need the special pancreatitis blood test (SpecfPL - or similar label) to know what's going on in the pancreas and the degree of inflammation present. Blood is taken and sent to a lab. It's the best one but is pricey. There's a simple, less reliable yes/no test from a blood sample that can be done by the vet (SnapfPL or similar). Vets will often treat symptoms "as if".

Should I ask him about both tests? I'm about to email him again.

Sooner or later he's going to wonder where I'm getting this. *g*

 

[Kris & Teasel]

Should I ask him about both tests? I'm about to email him again.

Sooner or later he's going to wonder where I'm getting this. *g*

When Teasel was first diagnosed my vet was the one who suggested the expensive pancreatitis test. It turned out negative at that time. Later on I had him at the clinic because his appetite was off. Another vet I see there occasionally referred to the quickie test but said it's only yes/no, not that accurate and they'd treat the same way - ie., symptoms. As it turned out, Teasel was having a GI upset from me giving him HC gravy food to steer some low numbers. The gravy doesn't agree with him.

 

[shelaghc]

When Teasel was first diagnosed my vet was the one who suggested the expensive pancreatitis test. It turned out negative at that time. Later on I had him at the clinic because his appetite was off. Another vet I see there occasionally referred to the quickie test but said it's only yes/no, not that accurate and they'd treat the same way - ie., symptoms. As it turned out, Teasel was having a GI upset from me giving him HC gravy food to steer some low numbers. The gravy doesn't agree with him.

tiffmaxee said Jester's liver numbers don't look like he might have pancreatitis.

What do you think?

And should I ask the vet about both of those tests? Or just the cheaper one?
EDIT:
@Kris & Teasel - do you think I should ask Jester's vet about doing either or both of these test? And if only one, which one?

 

[Kris & Teasel]

tiffmaxee said Jester's liver numbers don't look like he might have pancreatitis.

What do you think?

And should I ask the vet about both of those tests? Or just the cheaper one?

She might be referring to liver involvement in what I called "triaditis". If I understood her correctly, it's the liver values that aren't always elevated with chronic pancreatitis. I'm not well informed about this.

As far as testing goes, the best test is quite pricey if I recall. I can't swear to it because it was quite a while ago but I'll say around $200. I could be remembering that wrong. I don't know what the cost of the yes/no one is because I didn't have it done.

 

[Veronica & Babu-chiri]

I'm just going to throw some ideas here, there are a number of things that can cause him losing weight some are more o less complicated, as they've said pancreatitis, IBD , aldosterone problems, and some are not so much like parasites (has he been deparasite lately) , I don't know about the test since we don't have it where I live, so I would say if you can get it done maybe it would be very good since you would know for sure and that's always the best but if not and since he appears to be quite ok, maybe start considering some diet changes trying to pin point if there's some food he accepts better and that doesn't cause his stomach to get upset.

Was he always a slow eater/grazer ? or is this recent ?

And also take into consideration the fact that he was having not so good or high numbers until just a little while ago (if I'm not mistaken) and diabetic cats tend to lose weight ( despite being very hungry and eating a lot ) until they start getting regulated, after they get regulated their appetite decreases and slowly very slowly regain weight it took Babu almost a year to get close to his original weight ( and he was skinny to begin with) he's not there yet

 

[shelaghc]

I'm just going to throw some ideas here, there are a number of things that can cause him losing weight some are more o less complicated, as they've said pancreatitis, IBD , aldosterone problems, and some are not so much like parasites (has he been deparasite lately) , I don't know about the test since we don't have it where I live, so I would say if you can get it done maybe it would be very good since you would know for sure and that's always the best but if not and since he appears to be quite ok, maybe start considering some diet changes trying to pin point if there's some food he accepts better and that doesn't cause his stomach to get upset.

Was he always a slow eater/grazer ? or is this recent ?

And also take into consideration the fact that he was having not so good or high numbers until just a little while ago (if I'm not mistaken) and diabetic cats tend to lose weight ( despite being very hungry and eating a lot ) until they start getting regulated, after they get regulated their appetite decreases and slowly very slowly regain weight it took Babu almost a year to get close to his original weight ( and he was skinny to begin with) he's not there yet

The easiest thing I can do is ask you to look at Jester's SS and read the "remarks" section. I have all of his info dating back a fair number of months about his eating habits. The scariest one for me was back in the fall when he stopped eating almost entirely for about ten days.

He wasn't always this slow an eater. But until Bastian came into the family in 2014, he was allowed to graze. Bastian doesn't know how to graze and made himself fat eating until all the food was gone. Jester has never been happy about the change in feeding arrangements.

 

[shelaghc]

deparasite

What does this mean?

 

[tiffmaxee]

Yes, liver values aren’t always high with chronic pancreatitis. Max ran a slightly high ALT but only when more than double the high range is it a concern according to my vet. I was saying it’s not likely triaditis. It very well could be pancreatitis or an intestinal problem or any of the things Veronica mentioned.

 

[shelaghc]

I'm getting a *lot* of conflicting suggestions with no way to know how to proceed- and no financial resources based on all the various speculations.

Is there anyone who can cut through all of this to keep me from panicking and come up with one or two solid and plausible suggestions I can bring to the vet?

And anyone from DCIN who can help me out on paying for some of it?

 

[Kris & Teasel]

What does this mean?

Veronica is a Spanish speaker. I think she means “dewormed”.

 

[Kris & Teasel]

I'm getting a *lot* of conflicting suggestions with no way to know how to proceed- and no financial resources based on all the various speculations.

Is there anyone who can cut through all of this to keep me from panicking and come up with one or two solid and plausible suggestions I can bring to the vet?

And anyone from DCIN who can help me out on paying for some of it?

Have you contacted @Chris & China ?

 

[shelaghc]

Veronica is a Spanish speaker. I think she means “dewormed”.

*g* This one would be a stretch then.
All three furbutts are indoor cats.

Have you contacted @Chris & China ?

I didn't know I should . I thought that was what your tag was about.

As far as testing goes, the best test is quite pricey if I recall. I can't swear to it because it was quite a while ago but I'll say around $200. I could be remembering that wrong. I don't know what the cost of the yes/no one is because I didn't have it done.

And should I ask the vet about doing one or the other of these tests? And if so, which would you recommend?

Thanks.

 

[Veronica & Babu-chiri]

Veronica is a Spanish speaker. I think she means “dewormed”.

Yes sorry!! Literally I got lost in translation

Didn't knew they are indoor only ,but they still could get some parasites that could just get brought in the house in a thousand ways just something to consider

 

[tiffmaxee]

None of us are vets so we can only offer suggestions. Being indoor cats I think a parasite is not likely. I’m sorry you are so stressed. I would be too.

 

[Chris & China (GA)]

To contact me, just click on my name and choose "Start Conversation" to send a private message @shelaghc

 

[shelaghc]

To contact me, just click on my name and choose "Start Conversation" to send a private message @shelaghc

Thank you so much. I PMmed you this morning.

 

[Marje and Gracie]

The ultrasound can show enlargement of the pancreas that *can be* related to the inflammation of pancreatitis. It's not a given. You'd need the special pancreatitis blood test (SpecfPL - or similar label) to know what's going on in the pancreas and the degree of inflammation present. Blood is taken and sent to a lab. It's the best one but is pricey. There's a simple, less reliable yes/no test from a blood sample that can be done by the vet (SnapfPL or similar). Vets will often treat symptoms "as if".

Just want to clarify this a bit. The ultrasound is really the best way to see if he has pancreatitis. The specfPL or snapfPL can give false positives if he has any other type of illness such as cholangiohepatitis, triaditis, IBD, gallbladder, etc. The test also will not show the degree of inflammation. It is a common misconception that the higher the result above 5.4, the worse the pancreatitis. This isn’t true. If a cat’s specfPL is 30, it doesn’t mean it’s worse than 8.

It is has been estimated that as much as as 50% of cats have a bout with mild pancreatitis over their lifetime. This might present as the cat “just not doing right” but you can’t really put your finger on it. For a couple days, they might seem a little lethargic, might not want to eat, etc. Unless they are really sick with a lot of vomiting and dehydration, there is generally no reason you can’t treat at home with fluids, pain meds, some meds for nausea and/or vomiting.

Your vet does seem to be a bit behind the times. Here is some updated information on Pancreatitis.

I looked at his labs and I’m pretty good with them. Your vet ran a really abbreviated panel but, in what he ran, I don’t see anything that stands out. Regarding the tT4, sometimes cats who have other conditions going on (diabetes or pancreatitis, for example) might have what is called “euthyroid sick syndrome”. What that means is that the thyroid level shows as low normal or normal even though the actual thyroid level, if the cat had no other conditions, might be higher. For now, I’d try to focus on finding out if he’s got pancreatitis or some other intestinal type issue. If he was hyperT, he’d likely be ravenous and drinking a ton of water even if he had euthyroid sick syndrome. It doesn’t sound like he has the symptoms of hyperT at this point.