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

[Tina B and crew]

The lab results say negative on bacteria in the urine but the clarity was turbid.

I'll discuss the possibility of UTI with her on Monday and see what she thinks.

[Traci]

Well, it seems like Chunk's pH has probably shifted significantly, since he was acidic pH with the oxalates, now either neutral or alkaline with the struvites. If the pH is near neutral, we might not have to obsess about it at this point, but all things considered, it might play into something now or later (now: inflammation and possibly brewing infection from both types of crystals). Remember, a pH of 7 could be normal for some cats, so there is no absolute rule for pH unless there's a condition going on that needs corrected. Likewise, ALL urine markers have to be taken into account during a diagnostic workup.

The glucose/blood in the urine: MIGHT suggest inflammation from either type of crystals, or beginning infection - do you know if the sample was taken from a voided sample or a cystocentisis? The method is important when seeing abnormalities whether large or small (blood could be from cysto, for example - glucose could be extreme stress, for example). I'm assuming she felt the urine specific gravity was normal, although I would expect it to be abnormal at least due to dehydration alone.

Was the chemical profile normal for glucose? Whenever there is an elevation in urine glucose, it's wise to check the blood glucose, and if the blood glucose is normal then recheck the urine again in a week or two to see if glucose is still present, which would necessitate ruling out diabetes or fanconi's syndrome or even kidney infection or tubular problem, which still might need to be ruled out.

The turbidity could be caused by the crystals (which would be normal for it to be turbid in this case), and/or bacterial infection.

I'm not trying to strictly focus on the just the urinalysis, I just wonder if there might be some connection to the calcium problem - it wouldn't be surprising and could actually explain why this is idiopathic, it could be the oxalates caused the hypercalemia. However, I want you to absolutely rule out any potential kidney problem or parathyroid issue (one or two more tests to consider for the latter but let's wait and see what your vet says and pending the biopsy report, do you know when to expect the biopsy report?

[Tina B and crew]

Sample was voided. Specific gravity was normal. Chem profile glucose was normal.

And Chunk has decided that he doesn't want to eat the SD Mature Adult food anymore. Since I didn't want him to take the Clavamox on an empty stomach I offered him some Iams and he ate it just fine.

When you say biopsy I assume you are referring to the nodule on the foot? I am not sure how long it will take.

[Traci]

Yes, I was referring to the nodule on the foot.

A cysto is generally best when obtaining a urine sample because it affords the best uncontaminated sample (as long as it's tested right away). A voided sample can be contaminated simply by passage of urine through the urethra and vagina/penis (or letting the sample sit around exposed to air and temp for some time). If a cysto didn't show bacteria, that's a pretty good indicator there wouldn't actually be bacteria. If a voided sample contained bacteria, it could go either way: could be real bacteria in the bladder, or no bacteria save for the passage potential. But, at the time of collection, your vet probably wasn't suspecting a bacterial infection, more likely wanting to check those crystals and other markers.

Since it's Sunday tomorrow, it should be ok to feed Chunk the Iams, but on Monday, try to get ahold of your vet to discuss a dissolution formula. Remember, it's only temporary food. However, since he's had two episodes of crystals now, he may be prone to them and she may suggest a veterinary diet for long term.

Hang in there, Tina, I know this is frustrating and worrying. Give Chunk a big hug for me and keep us updated, K?

[Tina B and crew]

No, we had no idea at the time there was any infection going on.

BTW..here is a photo of the nodule:



It doesn't appear to have changed or anything since we discovered it, but I am sure it wasn't there the last time I clipped his nails. It is pretty noticable when you squeeze the paw to extend the claw. This photo the paw is relaxed.

[Traci]

Does that nodule feel soft when you touch it (not the skin surrounding it, but the overall feel of the entire nodule)? v Can you slightly depress it with a light touch of your finger, or is it firm? Does it seem to bother him or not?

When is the appt tomorrow, is she using labs from last week or before in lieu of a new bloodwork panel before anesthesia?

Please, keep me updated on this.

[Tina B and crew]

She's using the bloodwork from his last visit...it was done less than a week ago.

The nodule is soft, very smooth, and it gives a bit when I press it. He doesn't seem to be bothered by it.

[Tina B and crew]

Alright...Chunk is home, surgery went well and he has since eaten pretty well, used the litter box and seems to have survived it intact. Vet said he was a bit constipated (which I suspected) and she could feel quite a bit of hard stool in his colon, but he took care of that on the way home. We now know if Chunk gets constipated just put him in the car and go for a ride! It looked fairly normal other than being a bit hard.

While he was under she looked him over from head to toe, checked his mouth throughly, palpitated him up and down, and checked all of his lymph nodes. She said she checked every inch of his body. She could not feel any palpable masses and his gums, mouth, throat all looked fine.

RE: the nodule - it was solid and not cystic. She said there was no fluid inside. Naturally, as she said and you indicated, that brings the chances of it being cancerous up a bit. She also found that the lymph node in that leg was slightly enlarged. She's not jumping to any conclusions and advised me not to until the biopsy comes back, which should be by Wednesday. Once that is back we will further discuss what our next step is.

So..there is no apparent infection readily seen with Chunk, all of the labs done on his urine showed no sign of bacteria. There other thing she has considered with the nodule is a fungal infection, but that seems unlikely. For one Chunk has never been outside, so I'm not sure where he would have been exposed.

At any rate, just holding out hope for the best. If it turns out otherwise we will cross that bridge when we get there. I forgot to ask her about consulting with a urologist, but I will do that when she calls me with the test results. My mind has been in a fog these last few days. A good friend of mine who was the same age as me just passed away unexpectedly last Friday and I'm still reeling from that.

[Traci]

I'm holding good thoughts and vibes the nodule is nothing to worry about. I wish it wasnt so mass-like, but let's not jump to conclusions, I'm sending good vibes Chunk's way!

And hugs for both Chunk and you, I am so very sorry about the loss of your good friend, prayers going out to the family...(((((((HUGS)))))))))

[Tina B and crew]

Thanks Traci...I was really hoping when she cut it it would be mostly fluid. She said it was weird because it felt so soft and she almost expected it to be a cyst but it was completely solid.

What really sucks is my friend had just had a bunch of lumps pop up on her skin in the past few months and when they were biopsied they were all melanomas. That isn't what caused her death - we think it was her heart, she had lost 30+ lbs in just a matter of a couple of weeks - but it's just too familiar.

But I'm not jumping to conclusions. We keep joking that Chunk is a conundrum wrapped around an enigma!