Tuesday, January 10, 2012
He's been licking his lips for two weeks or so, and doing some throwing up. Nothing very major, nothing particularly unusual. His teeth are again in need of a dental, so I made an appointment for him to have bloodwork. He's never, in all his years, had any bloodwork results that were abnormal except for glucose and cholesterol.
But, this one came back with:
ALT 154 (high) ref. range 10-100
AST 106 (high) ref. range 10-100
Calcium 12.8 (high) ref. range 8.2 - 10.8
Amylase - 1407 (high) ref range 100 - 1200
Plus:
Neutrophils (high) 9225 ref range 2500 - 8500 75%
When Dr. G. called with the bloodwork results, I was shocked that there was something wrong, and even more by what it appears to possibly be. Hypercalcemia. Excess calcium. Most often an indicator of lymphoma, or also of parathyroid adenoma, or kidney disease/failure, or hyperthyroidism. Only, his kidney values were just fine, as was his Total T4.
Also, he's lost somewhere in the range of at least a half pound. His little face is tiny, suddenly. And then I realized that his fur is horrible - getting dandruffy and sticking up all spiky in every direction. When he lays down, meatloaf-style, the fur on the tops of his back legs sticks out like clumpy batwings. He's never had nice fur, but this reminds me of all those months of uncontrolled glucose levels in the 300's and 400's......
Poor Scruffy's been very sniffly for several weeks. He did finish a course of zeniquen for herpes in early December, successfully. I had thought maybe the lip-licking might have had something to do with his ears, actually; he has a history of ear infections, and if I rub in front of his ears, he shakes and scratches at them in a fairly frantic manner. He's been sleeping significantly more than usual for the last week. One night, he didn't even show up to sleep with me for the first time in months, although he's always tucked away with his little head in my hand in the morning. For the last two days, he's been throwing up foam once or twice a day, usually when his stomach is empty. And he's drinking water very frequently, although he doesn't seem to be spending any more time in the litter box than usual. (Unless, of course, he's wandering downstairs to pee on the rug when I'm not around. ) I was consoling myself by thinking that at least he was still eating in Scruffy fashion. Scruffy never not eats. Until this morning, when he ate only a few bites, sniffed and wandered slowly away. (And the final blow - the melanosis in his right eye - I can't see it totally clearly and I haven't been able to get a picture of it - seems to have a second area of discoloration suddenly.)
It was the vet's suggestion that we wait two weeks or so and then retest the calcium level, and add in testing on a bunch of the other possibilities. And an ultrasound - which would be interesting, I guess, solely because everyone who has ever examined his abdomen has thought that there was Something Wrong In There. (That was the reason that the Emergency Hospital thought that he had FIP, way back when I first brought him home in 2003.) He did have xrays with the last dental, about a year ago, that included his lungs and the area around them, and his hips and spine; there didn't appear to be anything abnormal then.
Anyway, with today's rare and frightening lack of interest in food, I called the vet and asked about cerenia, which he had mentioned the last time I talked to him a couple days ago. We have never resolved our definition of "vomiting" and "regurgitating" - I think Scruffy's throwing up his whole life has been "regurgitating" - the food never hits his stomach; he just gobbles it down, and within seconds, it comes right back up, untouched by teeth or digestive process. The vet says that cats don't "regurgitate", and that it's vomiting. Not that all of that is of any particular import, it's just an issue that has come up repeatedly. Anyway, I thought I would try pepcid, but after thinking about it, I realized that, with all of the other stuff that seems to be going on, maybe it would be better to just start out with the Big Gun instead. Turns out cerenia, which I know people on FDMB have had very good experiences with, is an injectible. Dr. G. says it stings. And that it can be given with an insulin syringe, sub q. Thank God, I guess. It took me forever to get used to giving Scruffy insulin, and the only other time I ever had to inject anything, they gave me four HUGE syringes full of Reglan to inject into my little 3 pound kitten, Burble. With one of those enormous thick syringes and needles that are NOT insulin equipment. I could only bring myself to do that once, and it was horrible. I just don't know if I can do injectible cerenia, and I have mixed feelings about doing something that will cause him more pain and discomfort. So, anyway, there's a pill form, which may or may not last 24 hours, like the injectible does. I picked up 4 pills - I don't know why that number, since it's Tuesday and the fifth day is Sunday, when the vet's not open. I guess to see if it works or not. I came right home and gave him the first pill, with his prozac, because he's really difficult to pill, unfortunately. Another reason to consider the injectible, I guess. Waited three or four hours for the pill to start circulating, and then got out the food. He did come out to the kitchen and wait in his usual place for his dish, but he didn't really eat any of it. He likes to wait until I fix the dishes for Tootie and Milk - adding a little dry kitten food for them, and I always put three or four pieces on his plate at the same time; he did eat that dry, and a couple of snuffling bites of the canned. And then he went back to sleep for three or four hours.
Dr. G. said today that 12.8 isn't exactly the level of calcium that is considered an alarm sign for hypercalcemia/lymphoma. That's closer to 15, apparently. And he says that electrolytes can vary - we might have just caught him at a time when it was unusually high. But it's high enough to need to be checked, because high calcium can cause kidney disease, among other awful things. An elderly cat who had totally uncontrolled glucose levels for more than two years and still manages to have well-functioning kidneys doesn't need anything to damage them. I spent a long time reading stuff I didn't really understand about hypercalcemia today; everything that I thought might be an explanation for his level seemed to be negated by all the other stuff that's suddenly going wrong with him all at once. The weight loss is worrying and sudden. What if he's working up to hepatic lipidosis and that's why his liver values are screwy? See, why didn't I ask the vet that? Should I call him and ask him tomorrow? Wouldn't he have mentioned it if he thought it was a problem?
I have literally spent every minute that this poor cat has lived with me keeping him alive. He had a urinary blockage a half hour after I brought him home - the first of three that required surgery in the first two months I had him. And then the "FIP scare", and the "sinus infection" that turned out to be herpes, and the diabetes and DKA, and the iris melanoma and subsequent laser surgery, and then the glaucoma, and now - after worrying for 3 years about the possibility of melanoma metastasis - now lymphoma, maybe? Not fair. I am so weepy I can hardly look at him. The poor thing, none of this should have happened to him.
He's been licking his lips for two weeks or so, and doing some throwing up. Nothing very major, nothing particularly unusual. His teeth are again in need of a dental, so I made an appointment for him to have bloodwork. He's never, in all his years, had any bloodwork results that were abnormal except for glucose and cholesterol.
But, this one came back with:
ALT 154 (high) ref. range 10-100
AST 106 (high) ref. range 10-100
Calcium 12.8 (high) ref. range 8.2 - 10.8
Amylase - 1407 (high) ref range 100 - 1200
Plus:
Neutrophils (high) 9225 ref range 2500 - 8500 75%
When Dr. G. called with the bloodwork results, I was shocked that there was something wrong, and even more by what it appears to possibly be. Hypercalcemia. Excess calcium. Most often an indicator of lymphoma, or also of parathyroid adenoma, or kidney disease/failure, or hyperthyroidism. Only, his kidney values were just fine, as was his Total T4.
Also, he's lost somewhere in the range of at least a half pound. His little face is tiny, suddenly. And then I realized that his fur is horrible - getting dandruffy and sticking up all spiky in every direction. When he lays down, meatloaf-style, the fur on the tops of his back legs sticks out like clumpy batwings. He's never had nice fur, but this reminds me of all those months of uncontrolled glucose levels in the 300's and 400's......
Spiky hair from his ears to his feet. :(
It was the vet's suggestion that we wait two weeks or so and then retest the calcium level, and add in testing on a bunch of the other possibilities. And an ultrasound - which would be interesting, I guess, solely because everyone who has ever examined his abdomen has thought that there was Something Wrong In There. (That was the reason that the Emergency Hospital thought that he had FIP, way back when I first brought him home in 2003.) He did have xrays with the last dental, about a year ago, that included his lungs and the area around them, and his hips and spine; there didn't appear to be anything abnormal then.
Anyway, with today's rare and frightening lack of interest in food, I called the vet and asked about cerenia, which he had mentioned the last time I talked to him a couple days ago. We have never resolved our definition of "vomiting" and "regurgitating" - I think Scruffy's throwing up his whole life has been "regurgitating" - the food never hits his stomach; he just gobbles it down, and within seconds, it comes right back up, untouched by teeth or digestive process. The vet says that cats don't "regurgitate", and that it's vomiting. Not that all of that is of any particular import, it's just an issue that has come up repeatedly. Anyway, I thought I would try pepcid, but after thinking about it, I realized that, with all of the other stuff that seems to be going on, maybe it would be better to just start out with the Big Gun instead. Turns out cerenia, which I know people on FDMB have had very good experiences with, is an injectible. Dr. G. says it stings. And that it can be given with an insulin syringe, sub q. Thank God, I guess. It took me forever to get used to giving Scruffy insulin, and the only other time I ever had to inject anything, they gave me four HUGE syringes full of Reglan to inject into my little 3 pound kitten, Burble. With one of those enormous thick syringes and needles that are NOT insulin equipment. I could only bring myself to do that once, and it was horrible. I just don't know if I can do injectible cerenia, and I have mixed feelings about doing something that will cause him more pain and discomfort. So, anyway, there's a pill form, which may or may not last 24 hours, like the injectible does. I picked up 4 pills - I don't know why that number, since it's Tuesday and the fifth day is Sunday, when the vet's not open. I guess to see if it works or not. I came right home and gave him the first pill, with his prozac, because he's really difficult to pill, unfortunately. Another reason to consider the injectible, I guess. Waited three or four hours for the pill to start circulating, and then got out the food. He did come out to the kitchen and wait in his usual place for his dish, but he didn't really eat any of it. He likes to wait until I fix the dishes for Tootie and Milk - adding a little dry kitten food for them, and I always put three or four pieces on his plate at the same time; he did eat that dry, and a couple of snuffling bites of the canned. And then he went back to sleep for three or four hours.
Dr. G. said today that 12.8 isn't exactly the level of calcium that is considered an alarm sign for hypercalcemia/lymphoma. That's closer to 15, apparently. And he says that electrolytes can vary - we might have just caught him at a time when it was unusually high. But it's high enough to need to be checked, because high calcium can cause kidney disease, among other awful things. An elderly cat who had totally uncontrolled glucose levels for more than two years and still manages to have well-functioning kidneys doesn't need anything to damage them. I spent a long time reading stuff I didn't really understand about hypercalcemia today; everything that I thought might be an explanation for his level seemed to be negated by all the other stuff that's suddenly going wrong with him all at once. The weight loss is worrying and sudden. What if he's working up to hepatic lipidosis and that's why his liver values are screwy? See, why didn't I ask the vet that? Should I call him and ask him tomorrow? Wouldn't he have mentioned it if he thought it was a problem?
I have literally spent every minute that this poor cat has lived with me keeping him alive. He had a urinary blockage a half hour after I brought him home - the first of three that required surgery in the first two months I had him. And then the "FIP scare", and the "sinus infection" that turned out to be herpes, and the diabetes and DKA, and the iris melanoma and subsequent laser surgery, and then the glaucoma, and now - after worrying for 3 years about the possibility of melanoma metastasis - now lymphoma, maybe? Not fair. I am so weepy I can hardly look at him. The poor thing, none of this should have happened to him.
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