Chunk attacking Lucy...need to know how to nip it!

[Tina B and crew]

I am not sure if she was able to aspirate or not. She had said something about that but I think her main priority today was getting urine and blood. The nodule felt as it it might have fluid in it when I looked at it. I will discuss it more when she calls with results. I am not sure what the turn around is for their sent out labs.

[Traci]

If they're using Antech, usually no more than 2-3 days, sometimes even get it back the next day.

Fluid is better than firm mass tissue.

[Tina B and crew]

Ok, Chunk's lab work came back.

Urinalysis shows that the calcium oxalate crystals have resolved but there are now some struvite crystals! I feel like I can't win here! We will chat more about that when I take him in on Monday to remove the nodule onhis foot.

The blood work was great except for the hematocrit, WBC, and calcium levels. All were elevated. I didn't get the calcium levels from her but she said both the serum and ionized were elevated. She had hoped the change in diet would have addressed that. His WBC was 16.5K, so not horribly high, but still elevated. She said she wouldn't have been to concerned about that because he was a bit dehydrated when they drew the labs but his neutrophils showed toxicity, so she's thinking there is an infection somewhere. Where, we don't know. He shows no sign of any infection externally, so it could be internal. Of course cancer could also be the cause, but we aren't going there right now. Everything else was fine.

Our next step is start him on a broad spectrum antibiotic tomorrow and then I will take him in on Monday to have the nodule removed. She had managed to get some fluid from it on a slide and said it didn't show anything remarkable, but she's going to remove it and send it off for biopsy. If that comes back benign then we will take him for an ultrasound to rule out tumors. In fact even if it shows malignancy we will take him in for an ultrasound as well. All in all she said this could be one of those idiopathic cases of hypercalcemia and not to be too concerned yet. She just wants to cover all the bases before coming to that conclusion.

It was not the news I really wanted to hear but it is what it is. Chunk is young so I am hoping it is nothing serious, or if it is we can treat it and he will be fine. He hasn't been eating as well this week, seems a little more subdued than he usually does, and I noticed that he isn't having the BM's that he normally has, so something is going on with him. If I'm not mistaken the elevated calcium could be causing these symptoms, am I correct? Additionally if he has some sort of infection I'd guess that could be the cause. When she has him under anesthesia on Monday she said she would check him out from head to toe, check for masses, look at his teeth and gums etc. I haven't looked in his mouth, I wonder if he could have something going on there? That could certainly cause him to cut back on eating I guess.

We are hoping for the best, it's all we can do.

[Traci]

Um, she should have checked his mouth and gums, head to toe, etc while he was in for his exam recently! Otherwise, I understand that she would want to utilize anesthesia to get a closer look at oral health.

Likewise, perhaps she should have hydrated Chunk with either IV or sub-q fluids then rechecked the blood calcium, to rule out lipids or hemolysis from the prior sample. This is always wise to do because oftentimes vets "assume" a single blood calcium test is the know-all when in fact, it may not be.
Can you remind me what you're feeding him now? Have you noticed he did or did not have a healthy appetite on the new food when you first started him on it? Did you notice his hydration status or his not drinking as much before the CBC was done? (in other words, do you know how long dehydration could have been going on?) - cats with high calcium might actually tend to drink and urinate MORE, so have you noticed his water intake and urine output?

The vet should also re-evaluate the diet to make darn sure it has an acceptable calcium, vit D and phosphorus ratio, because if they are off, this can cause malnutrition which will throw off the calcium levels and other balances. Now that struvites are a concern, the diet may again need to be changed. (to perhaps a dissolution formula). Personally, I would ask her to consult her favorite urologist or the MN Urolith Center for more advice before anything).

Was a complete chemical profile done in addition to the CBC? I ask because you want to know his liver and kidney and heart function as well, PRIOR to anesthesia. Plus, knowing the kidney function can tell a great deal and maybe help rule out kidney stones (you might have to opt for an xray to rule them out completely).

Did she mention if Chunk is concentrating his urine normally? Has the pH adjusted since the diet change? The latter might be moot though, considering a new diet change might be necessary. Did she mention the oxalates might have altered blood calcium levels? Or, was the calcium elevation the cause of the oxalates or vice versa?

Other rule-outs, check the parathyroid, and the lymph nodes and check for anal gland masses. There are other tests that can be done, but again, I would ask her if she can consult with a urologist before going too far or before any radical testing/invasive procedures. The thing is, if the ionized calcium is WAY high (abnormally high), then it demands a quick and specific diagnosis and treatment before the kidneys start to malfunction. If the elevation is at this point, just above high normal, then it MAY be safe to evaluate what tests/procedures could be considered and proceed one by one. Again, this is where a consult with a urologist would come in really handy.

[Tina B and crew]

She DID check all that. I have never visited my vet where the don't do a thorough look, including the mouth/teeth/gums, but we weren't looking for infection when he was in there this past week but rechecking his urine and doing the blood work. Upon palpitation she could find nothing obvious. There was no immediate evidence of any infection/inflammation anywhere. That only came up with the last labs. With him being anesthetized she will be able to explore more thoroughly without him being so wiggly.

He's been eating Hill's SD Mature Adult and has been eating it fine up until the last week or so...I have noticed him not showing as much interest. He has been drinking normally but the day she drew blood he was at the vet most of the day and probably didn't. I did see him go to his water bowl several times that morning before we left.

Yes, a complete chem panel was done. Everything was within normal range.

[Traci]

Tina, I was editing my post at the same time as your last post, sorry, and thanks for the additional info. I think it's relatively good news that nothing was palpable, and the chem profile was normal. Based on that, see above for additional things you can discuss with the vet.

[Tina B and crew]

Let's see if I can answer those.

I don't know what the calcium levels were, but I will see if I can get a print out today or Monday. He has had three labs show the calcium elevated - the first was in house, the second two were sent out and included both serum levels and ionized calcium.

She did give him sub-q fluids this last time he was in there.

Chunk has always been a heavy drinker (ha ha...of water!) and has always had a relatively large urine output. His urine output and water intake had DECREASED when we took him in initially but had seemed to be making its way back to what was normal for him prior to this last visit. The one thing I have noticed in the last few days is his reduced BMs, but that could be because he is not eating as much. And as I typed that he just came into the litter box and pooped, what I notice is the stool looks normal but is smaller than his usual stool (narrower - we always joke that Chucnk does man sized poop and this is definitely not man sized) He didn't seem to strain or be constipated and it seemed the same "softness" as usual.

Yes, I was figuring the diet may need to be changed because of the struvites.

She didn't mention concentration or PH and I totally forgot to ask but I will find out this morning when I go pick up his meds. Initially she did mention the oxalates and their relationship to calcium levels. That is what she was hoping for, that once we changed his diet that the calcium levels would go down.

She checked thyroid and parathyroid, because that was one of her second guesses.

He had an X-ray last week and she didn't see anything remarkable on the X-ray.

I will see about consulting with a urologist. Not sure what we have in this area but we do have a vet school near by (Virginia Tech). If we decide to go the ultrasound route I will have to take him elsewhere to do it and she has given me several options for that.

I'll be sure to take a list with me when I go on Monday. She called me on the phone last night, left a message when I didn't pick up and then called me back right away because she didn't want to leave me hanging over the weekend. She's really a great vet, they are all. I am thrilled to have found this place. They are a bit pricier than some vets but it is worth it to me for the care and compassion I get there (and it's feline only too!) I appreciate the input Traci. You of course help keep me from freaking out. My vet too is hoping this is one of those cases of idiopathic hypercalcemia, but wants to rule out other options and I'm glad to do that.

[Traci]

Well, in the realm of testing, you're almost done, there are only a couple other tests (specific parathyroid for example), maybe addison's/cushing's etc but the latter doesn't seem to fit. I would definitely ask your vet if she's willing to consult a urologist for you, or her favorite university - she can do this via phone consult (or VIN if she is a member), and you don't have to take Chunk in specifically for such a consult, unless you wanted to combine a consult with ultrasound, but let your vet decide that action for you. The thing is, a urologist or MN urolith center has data available to make educated guess or provide guidance for treatment if the oxalates are a main issue causing calcium elevations. If I remember correctly, though, didn't you say he once had elevated calcium BEFORE oxalates were detected? It might be possible those little buggers were slowly forming then.

I think you actually are dealing with idiopathic, but anything that can be done to rule out specific causes is wise. If the cause cannot be found, there are usually always secondary issues to treat, such as the oxalates and struvites and diet, and potential supplementation or fluid therapy.

Please keep us updated, try to talk to your vet about her consulting for you, it's worth asking for.

[Tina B and crew]

Ok, I got the lab results. I'm only posting what was out of normal range. If you have questions about others let me know. Started Chunk on Clavamox tonight too. It looks like the calcium levels were not through the roof.

Ionized Calcium - 1.49
Calcium - 13.5
A/G Ratio - 1.1
WBC - 16.5
RBC - 14.19
HGB - 18.0
HCT - 57.5
Neutrophil SEG - 87 (Neutrophils appear slightly toxic)
Lymphocytes - 5
Absolute Neutrophil SEG - 14355
Absolute Lymphocyte - 1320

Urinalysis
Glucose - 2+
Blood - 2+
RBC 0 30-50

PH was 7

There are only a few crystals present

[Traci]

Did she see anything resembling bacteria in the urinalysis, and was there any significant sediment to be worried about (i.e., was sediment sludgy for example)? I'm wondering if a slight urinary tract infection might be present, or inflamed urethra due to those crystals (hint: glucose and blood, not indicative alone, but just a thought, in case should monitor this). It sure looks like there is some inflamation somewhere, did she hint at concerns of UTI or urinary health at all?