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My cat has low ALT levels is it a concern or a norm? Not…

My cat has low...

My cat has low ALT levels is it a concern or a norm?

Veterinarian's Assistant: I'll do all I can to help. What is wrong with your cat?

Not eating, lethargic....took her to the vet. The only abnormality was the low alt level

Veterinarian's Assistant: Could be a lot of things that cause lethargy. The Expert will know how to help your cat. Is there anything else the Veterinarian should be aware of about your cat?

The heartbeat was elevated during the vet visit

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Answered in 9 minutes by:
3/22/2018
DrSarah
DrSarah, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 811
Experience: Veterinarian with over 10 years experience
Verified

I'm Dr. Sarah, a veterinarian with over 10 years experience and am here to help! I am reviewing your question and will be back soon with a reply.

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I'm sorry your kitty isn't feeling well. I would not be concerned about a low ALT. The normal ranges at the lab are based on averages, so there are going to be normal cats that are above and below the reference ranges. Usually we don't get to excited about elevations until they are 2-3 times normal, and I've never seen a low ALT be of clinical significance. Were xrays taken?

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Customer reply replied 4 months ago
Hi, Dr Sarah! Will be waiting for your reply before scheduling an ultrasound

Typing at the same time! :) Did you see my previous response? Were xrays taken?

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Customer reply replied 4 months ago
Would you suggest taking X-rays ? As the vet mentioned, if X-rays will be unremarkable, the next step is the ultrasound. So, I’ m trying to figure out should we proceed with ultrasound right away?

They are looking for different things. Xrays are looking at outlines/shapes and position of organs...shape of liver, position of stomach which could indicate enlarged liver, shape and size of kidneys, and also lung tissue which wouldn't be seen on an ultrasound. Ultrasound is more for looking at the interior of organs...inside of liver, layering of bowel, etc.

Heaven forbid your cat had tumors in her lungs...it would give you a solid answer which would have been missed on an ultrasound. I always recommend xrays before ultrasound. Yes, they may be normal....but what if they're not?

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Customer reply replied 4 months ago
Thanks, ***** ***** X-rays first, makes perfect sense! Should I also request to redo the liver( metabolic ) panel?l’ve read that alt half-life is about 4 hrs in cats....could there be an error in test results if the specimen was processed after this time? Or is it standard the vet will run it right away?

I don't think that's necessary. If there's a major issue it would have shown up.

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Keep me updated on how things go...hope she feels better soon! Let me know if I can help in any other way! Kindly consider rating my answer; you can always get back to me with questions and updates after rating.

DrSarah
DrSarah, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 811
Experience: Veterinarian with over 10 years experience
Verified
DrSarah and 87 other Cat Veterinary Specialists are ready to help you
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Customer reply replied 4 months ago
One last question if the x-rays will be unremarkable and she is still not feeling well, should we proceed with an ultrasound?

Yes, I definitely would.

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Hi,
I'm just following up on our conversation about your pet. How is everything going?
DrSarah
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Customer reply replied 4 months ago
Hi Dr. Sarah, we have done x-ray and ultrasound and, unfortunately, there is no way to attach these results on this platform. We would greatly appreciate a second opinion because it seems like the dr. cannot draw a definitive diagnosis based on the results and the next step would be exploratory surgery. However, the IBS was not ruled out and some other possible conditions. Is there a way for you to look at the results?

I'm sorry you haven't gotten a diagnosis. I don't know enough about this site to give you direction on how to post it....maybe contact customer service?

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Customer reply replied 4 months ago
Actually, I figured out how to attach the results

Great! I am heading to work right now...I will look at these tonight and get back to you!

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Customer reply replied 4 months ago
Thank you

So I looked through all the labs. It looks like the big abnormalities are increased monocytes (which indicates chronic inflammation) and a tumor in the abdomen, which they suspect is a lymph node. I'm glad cytology was tried...unfortunately it didn't give a definitive diagnosis, but it at least confirmed that we are dealing with a lymph node. I'd say you can get a diagnosis from cytology about 60% of the time, which is great because it's non-invasive...but this time it fell in the other 40%. The two possibilities based on those results are cancer (lymphoma) or inflammatory (IBD-inflammatory bowel disease). As I see it you have 2 options depending on how aggressive you want to be:

1. Exploratory surgery with biopsies of the bowel and mass. This would give the definitive diagnosis and come up with the best treatment plan.

2. Forego surgery and treat for inflammatory bowel disease without having a definitive diagnosis.

There's some pros and cons to both. With surgery you get a diagnosis and probably (PROBABLY) would get a longer life as you'd be on the best treatments possible for her condition. Cons are surgery with its costs and risks....cutting into the bowel could always lead to other problems like infection.

Steroids and other immune-modulating drugs are the cornerstone of treatment of inflammatory bowel disease. They also happen to be cornerstone drug treatments for lymphoma. You'd likely get response regardless of which condition she has without the need for biopsies. BUT...you would not be able to utilize any chemotherapy drugs without a diagnosis, and long term use of steroids will obscure future diagnosis...so you have to be sure you're not going to pursue biopsies later.

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And eventually the steroids would stop working, leaving you with not many options without a diagnosis.

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Customer reply replied 4 months ago
What about aspirating spleen, small intestine , liver....would it rule out lymphoma?
Customer reply replied 4 months ago
Thank you for looking at the results and sharing your opinion.

I don't think aspirating the spleen and liver in general would help...you need to have a deposit of abnormal cells, that's why they usually only aspirate when they see a mass. Bowel cannot be aspirated.

So it's a tough call. If it's aggressive cancer you may not have a whole lot of time regardless of what you do. But with IBD or low grade lymphoma she could live several years.

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Customer reply replied 4 months ago
Thank you!

You're welcome! I wish the best for her!

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Customer reply replied 4 months ago
I wanted to thank you again. We are proceeding with the exploratory surgery on Monday. Hopefully, the exact condition will be figured out after it.

Great...let me know how it goes.

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Customer reply replied 4 months ago
I will!
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