Skinky recent blood work. Any thoughts?

[skinky44]

Here's Skinky's blood work...
concerned about some of the findings...
I welcome anyone's feedback...

I was thinking of bringing her to the dentist, i have an appt on Tuesday morning, but after looking at this blood work, I think I should bring her in to either an oncologist or an internist at one of the specialty hospitals.

The steroid helped a bit, but today it looks like the swelling is starting to come back. I did feel some moisture on her back yesterday, so maybe I didn't get all of the steroid into her.

I'm probably going to go to Animal Medical Center in NYC. If anyone has vets there that they recommend please let me know! I'm looking at the super high WBC and high Neutrophils and low Lymphocytes, combined with the protein in her urine and am feeling sad. Clearly an infection (cancer?) but protein in urine could be kidney issues, yes? Hence, trying to determine if I should see an internist or oncologist. She does have that "tumor" in her nose...

In reviewing, I can see that she has gotten worse since her blood work in December

 

[Larry and Kitties]

What does your vet say? I too do not like the high neutrophils and low lymphocytes since that would tend to indicate infection.
Also I do no tlike the low
Calcium 14.4 mg/dL 8.2-10.8 HIGH Result verified.
Sodium 173 mEq/L 145-158 HIGH
Chloride 129 mEq/L 104-128 HIGH

 

[Meya14]

Depending on the type of cancer, you'd expect to see changes in other blood counts (RBC, WBC differential) which isn't present on these labs. Has your vet taken dental xrays? Have they tried an antibiotic. I've seen images of abscesses from a tooth infection becoming so huge in cats and dogs that it can even displace the eye. The labs indicate that there is an infection, and a pretty significant one at that.

 

[phlika29]

Hi

I wish I could help you interpret these results but I am just not any good at this stuff. When remi was poorly he had lots of things out of whack but with treatment things improved.

The bun and the urea are kidneys but they are only just high and I wonder more to do with the limited food and water consumption. Glucose obviously needs to be worked on.

I've linked tyanas CKD info on calcium etc. she actually has quite a lot of info on the various test results if you look down the menu on the side

http://www.felinecrf.org/diagnosis_calcium_phosphorus_pth.htm

She does talk about how the high Calcium may be due to a few things. One of them being metabolic acidosis http://www.felinecrf.org/metabolic_acidosis.htm.

I really feel that you need to keep up with the sub q fluids, get her to eat as much as possible and talk to the vet about getting an exact diagnosis and how to begin to deal with these results.

 

[skinky44]

What does your vet say? I too do not like the high neutrophils and low lymphocytes since that would tend to indicate infection.
Also I do no tlike the low
Calcium 14.4 mg/dL 8.2-10.8 HIGH Result verified.
Sodium 173 mEq/L 145-158 HIGH
Chloride 129 mEq/L 104-128 HIGH

Vet went over the results briefly on the phone this week, but i just got the results for myself today. she pointed out indications of infection and that the high calcium can be indicative of cancer. she suggests ct scan at a major vet hospital. I have some money now so I can do something, but i need to pick wisely. so i'm ready to go to the big animal clinic here in NYC, but trying to decide between oncology for (maybe) a ct scan or internist because I think some of these numbers indicate kidney issues. or dentist, because her face is swollen, perhaps it's the tooth? although it really does seem to be a tumor in her nose...

 

[skinky44]

Depending on the type of cancer, you'd expect to see changes in other blood counts (RBC, WBC differential) which isn't present on these labs. Has your vet taken dental xrays? Have they tried an antibiotic. I've seen images of abscesses from a tooth infection becoming so huge in cats and dogs that it can even displace the eye. The labs indicate that there is an infection, and a pretty significant one at that.

so this blood work doesn't correlate with cancer? no one wants to put her under anesthesia. a dental vet in NJ quoted 1400 to put her under anesthesia and do exam, and i believe xray..hopefully that included a tooth being pulled, but not sure.

yes, tried a bunch of antibiotics. convenia 3x, zeniquin, clin-something. she is getting dexamethasone injections and those did seem to be helping, although it kills her blood sugar. today, she doesn't look good again, poor baby. sleeping. seems to be in a little bit of pain. gave her a pain med injection. her bg is 214, not so bad, but this is pre-steroid injection.

anyhow, the vets can be mercenaries and they are all about 170 to 180 just for a consult at the specialty hospital. i'm just trying to pick wisely here between internist (for infection/kidneys?), dentist or oncologist...

present vet said that IF it is lymphoma cancer, it MIGHT respond favorably to the dexamethsasone....

 

[skinky44]

Depending on the type of cancer, you'd expect to see changes in other blood counts (RBC, WBC differential) which isn't present on these labs. Has your vet taken dental xrays? Have they tried an antibiotic. I've seen images of abscesses from a tooth infection becoming so huge in cats and dogs that it can even displace the eye. The labs indicate that there is an infection, and a pretty significant one at that.

yes i'm also now freaking out because i can see that the numbers for the infection NOW vs in DEC are *significantly* higher

 

[skinky44]

Hi

I wish I could help you interpret these results but I am just not any good at this stuff. When remi was poorly he had lots of things out of whack but with treatment things improved.

The bun and the urea are kidneys but they are only just high and I wonder more to do with the limited food and water consumption. Glucose obviously needs to be worked on.

I've linked tyanas CKD info on calcium etc. she actually has quite a lot of info on the various test results if you look down the menu on the side

http://www.felinecrf.org/diagnosis_calcium_phosphorus_pth.htm

She does talk about how the high Calcium may be due to a few things. One of them being metabolic acidosis http://www.felinecrf.org/metabolic_acidosis.htm.

I really feel that you need to keep up with the sub q fluids, get her to eat as much as possible and talk to the vet about getting an exact diagnosis and how to begin to deal with these results.

Thank you. Tanya's sight is incredible. ALL vets suggest CT scan at major hospital. I got alarmed because on decembers blood work, none of this calcium or BUN was flagged. you are probably right about all of this happening because of her lack of eating/drinking. have been keeping up w/ sub qs. vet suggested just half a unit to .75 of unit coz of her size. have call into vet, who wanted an update about how the steroids were working....hoping to get a name of a doctor from the big animal place from her and hopefully they can work together...no cb yet.

 

[Meya14]

If it's an infection, the steroid could lead to sepsis. The CT scan is probably where to start, to figure out really what it is. And to get her on antibiotics again. A tooth abscess won't resolve without surgical draining if it is that bad, antibiotics wouldn't be enough, but might help. The high calcium sometimes occurs when there is bone destruction which can happen from a tumor, but this can also happen from an infection that has spread to the bone, so it's hard to say.

The kidney issues should be addressed, but it's going to be hard to get a clear picture of that until this other stuff is under control, as the labs might be elevated due to inflammation and medications that she is on.

Her sodium is very elevated. Try to get more oral fluids if you can because oral fluids don't have as much sodium as the subQ and will help bring that down to a normal level.

You're probably going to want to find someone that is well versed in oral/facial surgery in cats and can do the CT ASAP.

 

[BJM]

Do the scruff test for dehydration and the gum test (see my signature link Secondary Monitoring Tools for directions); if/when dehydration is present, it will inflate some of the numbers unless they adjust for that.

With the elevated glucose, plus steroids on board, an option is to add a tiny dose of a short-acting insulin (regular insulin, also known as R) to pull those numbers down so the Lantus can work with it better. Let's see what others think.

 

[skinky44]

BJM - thats good to know about the possibly inflated numbers. So this vet said to use about 300 as a threshold as to whether to administer insulin. About 1 unit once or twice a day. So not a lot of direction but I think that's because kitty just has SO much going on and the diabetes is secondary to whatever else is happening, like this infection. Seeing an oncologist on Tuesday at one of the big animal hospitals here in the city. She WAS supremely dehydrated - despite my best efforts. up until the steroids started she was peeing like CRAZY. I don't know WHERE all of the liquid was coming from. One night after the first steroid, she started drinking tons of water. she is more amendable to the syringe feeding and i've been syringing water too. vet wants less IV in her, but she gets about a half unit of ringers solution daily. she's peeing much less. BUT her hind legs...it's just sad. she shakes the water from herself (i have to use a facecloth after syringing her) and she falls down. I was encouraged a couple of days ago...and she is still better than last week...and at least her tummy isn't rumbling..but she has SO much going on.

Trying to figure out the best food to syringe to her. Vet says - just get the calories into her, which was my MO as well. but now with the steroid, her sugar is SO high. What is high calorie, hypoallergeric, and easy on her kidneys? if i go grain free, high protein, concerned about her kidneys. but i need to try to keep her BG down. and i need something that is easy to mush up for syringe feeding...

 

[BJM]

Are you seeing the skin tent up on the scruff of her neck? If yes, keep going with the water.
Methylcobalamin, a specific form of Vitamin B-12, may help with the difficulty standing and walking if it is due to diabetic neuropathy., in addition to controlling the glucose.
I gave you a possible schedule for doing the insulin up to Wednesday; I hope you can follow that. And I would stick with at least 1 unit, plus get input about using some R to help bring the numbers down so the Lantus can work better. R is often available from pharmacies on request. It, too, is a U-100 insulin so you can use the same syringes, however, the dose must be very tiny to start and initially, you need to check how it works in Slinky by testing hourly. It lasts only 4-5 hours and is used as an aid, not the sole insulin, to help control the numbers.
Most kitten foods are high cal, so you might try Evo Cat and Kitten.