11 year old male cat, lost 2 pounds in 7 months, drinking more water and urinating more, had labs done in 2/2010 because he was acting strangely (nervous and afraid of his shadow, just strange). The results were (selected for what I think are relevant for purpose of this question): amalyase high at 1787 (normal(NNN) NNN-NNNN; CPK high at 1189 (normal 56-529; everything else is normal, including creatinine normal at 1.3 (.6 to 2.4 normal); and blood glucose was 117 (normal is 64-170). Got blood work today again with teeth cleaning. He has lost over 2 pounds, blood glucose was 268 (high), amalyse was high at 2602 (normal of(NNN) NNN-NNNN. Note that he hates the vet and was under extreme stress when the glucose test was taken. After sedation for 24 hours, with no food, his glucose was 117 when I took him home. He has been home for 10 hours and is just now coming out of sedation. H has been throwing for the last 10 hours (x4) and not eating or drinking. The vet had no real answers. Put him on antibiotics following cleaning noting that he found very bad gingivitis (but no extractions). He suggested that the gingivitis/infection could be a cause of the high glucose somehow. I'm not satisfied with this answer. He seems to have symptoms that are consistent with diabetes, kidney failure (but blood work seems to rule this out), and pancreatitis. There is no plan for figuring out what the real problem. The only plan is antibiotics for 10 days. Help, please!
Type of Animal: Cat
Everything is in the question. I have more lab values that I can provide.
Thanks for using JustAnswer.com, I'm Dr. Dan and I'll try to help you.
Was a thyroid test done recently?
In February, it was done and all normal. T4 was 1.7 (.8 to 4 normal) and 3T4 was 35 (and range was 10-50). Nothing done today for the testing.
Also -- second page of of 2-10 testing included MCHC of 38.8 (range is 30-38) and platlet count was 196 (200-500 normal)
Well I agree with the vet that it's not likely diabetes. A 268 blood sugar when a cat is stressed is not unusual at all. If your cat were diabetic the glucose could not return to normal the next day.
Do you know if the kidneys were tested the day of his teeth cleaning?
Today's results in full (all normal but ALB, AMY and GLU)--
Thank you that is very helpful.
I think that it is time to re test that thyroid. I know that it was recently done but right now thyroid problems fit perfectly with they symptoms. Normal appetite increased drinking, increased urinating, and weight loss. The other causes of increased drinking and weight loss (liver problems, kidney problems and diabetes) are ruled out on the last blood work. The elevated amylase doesn't mean a lot in cats by itself and the MCHC and Platelets are not far enough out of range to worry about.
Thyroid fits best. If the thyroid is negative then we need to look closely at the intestines. Preferably with an FPLI/cobalamin/folate test for pancreatitis. If that is negative then a biopsy searching for lymphoma would be the next steps if you were my client. I think though it's thyroid disease until proven otherwise in my opinion.
A few follow-up questions -- Do we just need the T4 blood test again? Anything else to figure out if it is thyroid? Also, what is the FPLI/cobalamin/folate test for pancreatitis? I really want to know what to ask for, given that I lack confidence in my current vet.
Other history that could impact your opinion -- he's had chronic problems with constipation and hard BM, had had chronic gingivitis / red gums that has been so bad as to cause a prior vet to test for FHIV (negative).
Thanks for the information.
I would think just the T4 is more than appropriate. In my opinion t3 and the rest are not that helpful in cats.
The other test basically looks for the presence of an enzyme (pancreatic lipase) that will help us diagnose chronic pancreatitis. Cobalamin/folate are vitamins that are specifically regulated and absorbed by the gut if they are low that tells us for sure that we are dealing with disease of the gut and not "something else" (which could be many things).
If he has had problems with constipation then "problems" with the gut may certainly be possible, but I still think T4 is the most important test currently.
One little sneaky test... if your vet has not heard of the FPLI/Cobalamin/folate then it's time to find a different one as he/she may not be "up" on current testing
You've already earned your keep and will get an "accept" but still picking your brain a bit more -- FPLI/Cobalamin/folate test is just for pancreatitis or is broader than that? Anything else that should be tested for "gut" issues? I just have a feeling that T4 will be normal again. What other "gut" issues could it be?
It's kind of hard to explain... but I'll try
PLI tests for presence or absence of pancreatitis... pretty straight forward.
Cobalamin/Folate are absorbed and processed by the gut. When the gut is diseased they are not processed appropriately. The two most common types of gut disease in cats is lymphoma, and inflammatory bowel disease. Other issues would be protein losing enteropathy, and lymphangectasia. The specific diseases after pancreatitis are usually found by a surgical biopsy of the intestine there are no other non-surgical ways of making intestinal diagnosis beyond the FPLI/cobalamin/folate test.
My recommendation would be to run the T4, if normal then run FPLI/cobalamin/folate test, if there are abnormalities then deal with them accordingly (there are about a dozen treatments depending on the pattern of abnormal results). If that is negative then search for other disease like heart disease or adrenal disease.
I hope that's more clear. I'm not trying to avoid your question but without a good background in intestinal physiology it can be hard to understand.
If you have more questions please keep asking.
Last question -- we live 40 minutes away from the vet and our boy is not a happy camper when we go. Would it be unreasonable to run T4, glucose, and FPLI/cobalamin/folate all at once?
No it is not unreasonable at all! Make sure you fast him for 12 hours before running the FPLI/cobalamin/folate test.
The FPLI/cobalamin/folate test is a couple hundred bucks so I usually rule out the other conditions before running it but besides cost there is no other reason not to run it.
8 years of experience with domestic and exotic cats
Not sure if you got the last one. Here it is again -- dental was 24 hours ago (10 pm yesterday). Cat was grogy when I picked him up this am, still is. Walking a little better, but threw up 4 times today. He literally fell over just a few minutes ago when moving from my lap to my wife's lap. Our vet told me earlier this evening that it was no problem, that some cats take time to come out of it after being under. This seems a little much -- 24 hours later and he falls over? Maybe I should have been asking about this more immediate problem.
When was the last time he vomited?
It's been a few hours. His stomach has been empty and it's just foamy bile. I've just never seen an animal act like this.
I have seen cats that are still woozy and nauseas from anesthesia up to 72 hours later. However if the wooziness continues into tomorrow then that problem takes priority over the other and he needs to see this vet or another that you trust more.