Triglyceride problem stumps the vet

[Annie's Mom]

Annie is now 10 yrs old. She was feral kitten we got at approx. 4 weeks old. Strictly indoor. History of digestive problems (IBS, vomiting) but stabilized on Science Diet brand food. Blood test 2 years ago showed abnormal triglycerides (over 500), was put on SD W/D. Retest after one month showed levels much reduced, so told to stay on this diet. Test last month showed triglycerides back up to over 500. Put on SD R/D (extremely low fat) diet. Retest yesterday showed triglycerides UP to over 700 in one month on extremely low fat diet!!! All other tests (including liver function) normal. Compounding problem is that Annie must be sedated at each vet visit, and neither vet nor I want to put her through this ordeal. The only advice the vet could give me was to put Annie on another brand of low-fat food, thinking there is something in the Science Diet that is affecting her, and retest her in a year. Our other cat, same age, eats all the same food as Annie but all her tests are all normal. Annie does not ever eat anything except the food I give her and has never been fed table scraps. Any suggestions on a particular food, and/or any insight into this condition? Today I switched her to Nutro Lite, the only other low-fat brand available in my area, but I would mail-order anything that would be better. Thanks, Lynne

[Traci]

Lynne, your vet should also be testing for hypothyroidism, diabetes and pancreatitis. While the liver values appear to be normal, pancreatitis may be ruled out, but I would strongly suggest discussing these three potentials with him. (i.e., ask specifically for blood and urine glucose, cholesterol, hepatic and renal function enzymes, may need more than the general liver profile, may need to opt for full geriatric or endocrine profile)

It doesn't seem likely that the W/D or R/D is the problem, they are both low in fats and the carbohydrate source is sufficient, unlesss she isn't processing the carbohydrates. (cholesterol enzymes, if elevated MIGHT suggest carbohydrate problem) You could try another diet of course, but without ruling out the above mentioned, you might end up going in circles without detecting the true source of the problem. See my Dietary Page for more veterinary dietary options.

Also, blood should not be drawn within 12 hours of a recent meal, and if kitty was by chance on recent steroid therapy, this can also alter the bloodwork. Be sure that's ruled out.

Why does she have to be sedated each time for a vet visit or blood draw? Seems the vet and a properly trained tech or assistant should be able to properly and gently restrain her in order to get a blood draw.

[Annie's Mom]

Annie had a complete blood panel and also complete urinalysis, which I understood to mean that the conditions you listed were included, but I will confirm that. I was not told to withhold food before the tests. The vet thinks this is a food-related condition and perhaps some ingredient in the SD formulas might be causing this. Annie is a little muffin at home, but at the vets she is impossible to restrain without hurting her. She turns into a monster -- screaming, swiping, trying to claw and bite, throwing her little body around. The screaming is blood-curdling. I've heard of a containment device ("Wild Child") that some vets have, that restrain the cat and allow exams and tests, and I suggested that to our office. I'm really afraid Annie will have a stroke or heart attack, but I also do not want her given gas every time I take her in. Oh, and Annie is not overweight, and has not had any steroids except for a couple weeks about eight years ago. Going to your Dietary Page now. Thanks, Tracy.
Lynne

[Traci]

Please DO confirm those with your vet.

As for the not withholding food, did your vet tell you that or a receptionist? Your vet knows that a recent fed meal, particularly when testing triglycerides, may alter the results. Usually, an alteration will occur when it is a high-fat fed meal, but any type of diet can affect the results, at least in triglycerides.

If the above mentioned enzymes were double-checked, endocrine function, including pancreatitis, etc, then one might assume it could be the diet. Another option is running this through a human lab in the event that the analyzer is uncalibrated, or the sample was improperly handled. Sometimes, when we get consistent results that are alarming or unexplained, we will run them through a human lab and sometimes we find it was the analyzer or improper handling.

[kk]

Lynne, I totally agree with Traci that further testing is in order. General blood panels do not usually include some of the more specific tests that would be necessary for what Traci said to look for. I would like to suggest that perhaps a trip to an Internal Medicine specialist might be in order. They might recognize something and pursue avenues that your regular vet might not think of. Good luck. kk

ps. I had a sweet boy who turned into a wildcat at the vet, so I know exactly what you mean!

[Traci]

Hmmm..I can understand the fractious cat, have worked with many, but only met one cat in all these years who was too fractious to handle. Something is amiss maybe. I'm not saying, Annie's Mom, that you're not correct, I just feel that it is probably a fear-factor amoung the techs or assistants, it really shouldn't be that way. I don't recommend sedation for a fractious cat, unless absolutely necessary. (it's so complicated to sedate for a simple, quick blood draw)

[Annie's Mom]

Sorry, I meant that nobody told me that I should withhold food. I'm wondering what the odds are that Annie's blood sample is still available for further testing. I'll try to get hold of the vet tomorrow. This is probably a very stupid question, but is there any possibility that her extreme stress could effect the test results?

Please DO confirm those with your vet.

As for the not withholding food, did your vet tell you that or a receptionist?

[Traci]

Blood is discarded immediately once it has been tested. The entire sample is centrifuged, unless part of it is needed to be sent to an outside lab (as in whole blood, uncentrifuged). As for stress, the tests most affected by stress would have been clearly noted, such as the ALT (liver) and glucose (blood)

In thinking further, she has a history of intestinal problems and perhaps you might opt for x-rays or ultrasound to rule out possible mass, inflammation or lymphoma. Not to scare you, but with a history of intestinal problems, that would be high on your vet's list of diagnostics if he were thinking along those lines. Still would like you to talk to him about pancreatitis, diabetes and hypothyroidism. At least discuss it. If you do choose a more conservative approach, such as with a new diet, and you get quick results, the triglycerides are stable, etc, with no apparent signs of illness or other symptoms, again you could maybe conclude it was the diet. But, if this were my kitty, I'd go further at this point, especially given her age.

[Annie's Mom]

I'm thinking like you. The tech refused to let me accompany her to the lab. When I advised her to take Annie out of the carrier (unzip top) wrapped in the towel I provide for this purpose, she gave me that condescending "I know better than you" look. We live in very rural area, so it's not like I can shop around for other offices. But I am not happy about this at all, especially being informed after the fact that Annie was sedated for the last 2 tests without my permission.

Hmmm..I can understand the fractious cat, have worked with many, but only met one cat in all these years who was too fractious to handle. Something is amiss maybe. I'm not saying, Annie's Mom, that you're not correct, I just feel that it is probably a fear-factor amoung the techs or assistants, it really shouldn't be that way. I don't recommend sedation for a fractious cat, unless absolutely necessary. (it's so complicated to sedate for a simple, quick blood draw)

[Traci]

Whoa, without your permission??? Yikes, Lynne, now I'm upset. They need to require your permission prior to any anesthetic procedure, no matter what it is. Also, in a kitty this age, testing at least two liver, two kidney enzymes, platelets, etc are recommended to determine candidacy for anesthesia. Suppose kitty had an undetected heart condition or kidney failure, and your vet anesthetized her, a reaction occured, and you had not given prior permission, they are so liable, setting themselves up for a great big negligent lawsuit.

I understand the rural area, but is there no other vet available? If you have a gut instinct about this particular clinic and it's employees, I'd definately be taking my business elsewhere, regardless of the distance or inconvenience. Any vet who performs anesthesia without permission, or a staff unable to handle a fractious kitty for a simple blood draw....well, I wouldn't be placing much trust in them. You and your kitty deserve better.