PDA

View Full Version : Ideas about these lab numbers?


Corey Kaye
January 18th 06, 04:16 AM
Hi everyone,

I'm new here <waves>

What brings me to this group is some recent very odd bloodwork on my cat,
Celia. I had a long conference with my fabulous vet regarding this, and
will be visiting the vet teaching hospital for an echocardiogram. I'm just
wondering if anyone has other ideas or experiences :)

First, some history:

Celia is a 4 year old spayed female. She eats Innova dry food (free
choice), and is in good weight with good muscle tone. She is an indoor-only
kitty. She tested FeLV/FIV negative as a kitten. Approximately two years
ago, she had issues with bladder infections and was diagnosed with cystitis.
Zenequin and the purchase of a couple drinkwell fountains solved those
issues. Approximately one year ago, Celia started having asthma attacks,
which were initially well controlled with an anti-histamine, then oral
prednisone, and now steroid injections. She is symptom free for 10 weeks
after an injection.

Now, onto the latest news! Yesterday, we pulled blood. She was also
examined by the vet and pronounced "excellent." He was quite surprised with
the results:

Of note:

CPK: 1988 (range 56-529)
HCT: 52 (range 29-48)
Platelet count: 9 (range 200-500) Yes, 9! Platelet count was also markedly
decreased on the smear.

My vet suspects hypertrophic cardiomyopathy, due to the elevated CPK, and
has instructed me to go get the echo. I'll make the appointment tomorrow.

I suppose I'm looking for reassurance, any other ideas about what this might
be, or stories from people who have been through something like this.

Thanks :)

Corey

Phil P.
January 18th 06, 10:15 AM
"Corey Kaye" > wrote in message
...
> Hi everyone,
>
> I'm new here <waves>
>
> What brings me to this group is some recent very odd bloodwork on my cat,
> Celia. I had a long conference with my fabulous vet regarding this, and
> will be visiting the vet teaching hospital for an echocardiogram. I'm
just
> wondering if anyone has other ideas or experiences :)
>
> First, some history:
>
> Celia is a 4 year old spayed female. She eats Innova dry food (free
> choice), and is in good weight with good muscle tone. She is an
indoor-only
> kitty. She tested FeLV/FIV negative as a kitten. Approximately two years
> ago, she had issues with bladder infections and was diagnosed with
cystitis.
> Zenequin and the purchase of a couple drinkwell fountains solved those
> issues. Approximately one year ago, Celia started having asthma attacks,
> which were initially well controlled with an anti-histamine, then oral
> prednisone, and now steroid injections. She is symptom free for 10 weeks
> after an injection.

Have you considered inhaled steroid therapy? Much better than injections.
Prednisone wreaks havoc on all body systems.


http://www.maxshouse.com/inhalation_therapy_for_airway_disease.htm

http://www.maxshouse.com/feline_asthma_and_bronchitis.htm



>
> Now, onto the latest news! Yesterday, we pulled blood. She was also
> examined by the vet and pronounced "excellent." He was quite surprised
with
> the results:
>
> Of note:
>
> CPK: 1988 (range 56-529)


Not unusual if the vet had trouble drawing blood. Accidentally hitting a
muscle during the blood draw can cause a 3-4x increase inCK. An increase
in CK can also be caused by shooting the blood sample back through the
needle into to sample tube which damages the blood cells (hemolysis). CK
can also be elevated if your cat hasn't been eating-- muscle catabolism.

> HCT: 52 (range 29-48)

Could be due to dehydration. What was the Total Protein (TP)?


> Platelet count: 9 (range 200-500) Yes, 9! Platelet count was also
markedly
> decreased on the smear.


I don't think so. If your cat had a plat smear of 9 she would bleeding from
every orifice! I think someone screwed uo the blood sample.



>
> My vet suspects hypertrophic cardiomyopathy, due to the elevated CPK, and
> has instructed me to go get the echo. I'll make the appointment tomorrow.


Good plan- but cats with HCM usually don't have abnormalities in their blood
work.


>
> I suppose I'm looking for reassurance, any other ideas about what this
might
> be, or stories from people who have been through something like this.
>
> Thanks :)
>
> Corey


My best advice would be to get another blood test.


Best of luck,

Phil

Corey Kaye
January 18th 06, 11:39 PM
Phil P. wrote:

> Have you considered inhaled steroid therapy? Much better than
> injections. Prednisone wreaks havoc on all body systems.

We did discuss inhaled steroid therapy, but my vet said that he'd found it
ineffective.

> http://www.maxshouse.com/inhalation_therapy_for_airway_disease.htm
>
> http://www.maxshouse.com/feline_asthma_and_bronchitis.htm

Interesting reading! Thank you!

Celia is doing so well on the depo-medrol that I'm reluctant to change
anything. She has no asthma attacks on 1cc every 10 weeks. I'll definitely
consider the inhalents if she worsens.

This, however, from you second link, makes me wonder:

"Cats with heartworms often cough like cats with asthma and will respond
temporarily to corticosteroids. Therefore, cats in locations where
heartworms are common in dogs may be misdiagnosed as having asthma."

I'm in Colorado--we barely have DOGS with heartworm, and I would be shocked
to find them in an indoor-only cat...but maybe I should get her checked
anyway...

> Not unusual if the vet had trouble drawing blood. Accidentally
> hitting a muscle during the blood draw can cause a 3-4x increase
> inCK. An increase in CK can also be caused by shooting the blood

Interesting. The tech did say she was not a very good kitty for her blood
draw.

> sample back through the needle into to sample tube which damages the
> blood cells (hemolysis). CK can also be elevated if your cat hasn't

Hemolysis is noted on the report.

> been eating-- muscle catabolism.

She does eat well :)

> Could be due to dehydration. What was the Total Protein (TP)?

TP is 7.8, range 5.2-8.8.

> I don't think so. If your cat had a plat smear of 9 she would
> bleeding from every orifice! I think someone screwed uo the blood
> sample.

I think you've got to be right.

> My best advice would be to get another blood test.

Forgot to mention--she went back in today for repeat labs. Results will be
back tomorrow. Since she's not hemmoraging from the needle mark, I think
it's a safe bet that her platelets are more than 9! ;) Hopefully all the
weird stuff was just bad handling, and she's perfectly healthy.

Thanks for your response, Phil. :) I'll post again when I get the new labs
in.

Corey

yngver
January 19th 06, 12:31 AM
Corey Kaye wrote:
> Phil P. wrote:
>
> > Have you considered inhaled steroid therapy? Much better than
> > injections. Prednisone wreaks havoc on all body systems.
>
> We did discuss inhaled steroid therapy, but my vet said that he'd found it
> ineffective.

Really? In what way? For most cats with asthma, inhaled steroid therapy
is very effective. My cat has been symptom-free for two years now with
the use of Flovent with an Aerokat inhaler, and if you take a look at
http://groups.yahoo.com/group/felineasthma_inhaledmeds/
you will find hundreds of people who are using inhaled steroids to
control their cats' asthma with great success.
>
> > http://www.maxshouse.com/inhalation_therapy_for_airway_disease.htm
> >
> > http://www.maxshouse.com/feline_asthma_and_bronchitis.htm
>
> Interesting reading! Thank you!
>
> Celia is doing so well on the depo-medrol that I'm reluctant to change
> anything. She has no asthma attacks on 1cc every 10 weeks. I'll definitely
> consider the inhalents if she worsens.

The problem, as Phil points out, is that repeated use of systemic
steroids eventually causes all sorts of other health problems. This has
not been found to be be true with inhaled steroids.
>
> This, however, from you second link, makes me wonder:
>
> "Cats with heartworms often cough like cats with asthma and will respond
> temporarily to corticosteroids. Therefore, cats in locations where
> heartworms are common in dogs may be misdiagnosed as having asthma."
>
> I'm in Colorado--we barely have DOGS with heartworm, and I would be shocked
> to find them in an indoor-only cat...but maybe I should get her checked
> anyway...

The majority of cats diagnosed with heartworm are indoor cats, because
most people think they are not likely to meet with a mosquito. But it
only takes one. If heartworm is not very prevalent in dogs in your
area, however, it's not going to be likely for cats either.
-Yngver

Corey Kaye
January 19th 06, 04:35 AM
yngver wrote:

> Really? In what way? For most cats with asthma, inhaled steroid
> therapy is very effective. My cat has been symptom-free for two years
> now with the use of Flovent with an Aerokat inhaler, and if you take
> a look at http://groups.yahoo.com/group/felineasthma_inhaledmeds/
> you will find hundreds of people who are using inhaled steroids to
> control their cats' asthma with great success.

My vet has said that cat asthma is mainly inflammation rather than
constriction. He says that inhalants address contriction rather than
inflammation. I believe his experience is only with albuterol inhalant.

Thank you for the link to the group! I'll check it out, and pass the info
to my vet.

> The problem, as Phil points out, is that repeated use of systemic
> steroids eventually causes all sorts of other health problems. This
> has not been found to be be true with inhaled steroids.

I kept Celia off of systemic steroids for as long as I could--I thought that
was the only option once the anti-histamine stopped working. I'm certainly
glad to hear your cat has been symptom free for 2 years. I'll look into it
:)

> The majority of cats diagnosed with heartworm are indoor cats, because
> most people think they are not likely to meet with a mosquito. But it
> only takes one. If heartworm is not very prevalent in dogs in your
> area, however, it's not going to be likely for cats either.

I have a history of having weird problems with my animals. The kind that
makes the vets say "huh. Well, I've never seen *this* before." I don't
know if it's just because I have a lot of animals (cats, dogs, horses) or if
I really pay attention and notice the little things. Sure, it'd be
incredibly odd for Cilly to have heartworms, but it wouldn't shock me too
much ;)

Thanks again!

Corey

yngver
January 19th 06, 05:01 PM
Corey Kaye wrote:
> yngver wrote:
>
> > Really? In what way? For most cats with asthma, inhaled steroid
> > therapy is very effective. My cat has been symptom-free for two years
> > now with the use of Flovent with an Aerokat inhaler, and if you take
> > a look at http://groups.yahoo.com/group/felineasthma_inhaledmeds/
> > you will find hundreds of people who are using inhaled steroids to
> > control their cats' asthma with great success.
>
> My vet has said that cat asthma is mainly inflammation rather than
> constriction. He says that inhalants address contriction rather than
> inflammation. I believe his experience is only with albuterol inhalant.

Yes, albuterol is a bronchodilator and owners of cats with asthma may
use it to relieve an attack. Perhaps your vet is not familiar with the
use of inhaled corticosteroids rather than bronchodilators in the
treatment of feline asthma.Flovent (fluticasone) is used daily or twice
daily (some cats might be able to taper down to less) to prevent asthma
symptoms and doesn't relieve an attack that is already in progress as
albuterol does. So your vet is correct in what he said about albuterol,
but Flovent does address the inflammation, not the constriction.
>
> Thank you for the link to the group! I'll check it out, and pass the info
> to my vet.

Another good Web site is http://www.fritzthebrave.com/
>
> > The problem, as Phil points out, is that repeated use of systemic
> > steroids eventually causes all sorts of other health problems. This
> > has not been found to be be true with inhaled steroids.
>
> I kept Celia off of systemic steroids for as long as I could--I thought that
> was the only option once the anti-histamine stopped working. I'm certainly
> glad to hear your cat has been symptom free for 2 years. I'll look into it
> :)

Asthma is usually a life-long condition--it can be controlled but not
cured, and you don't want to keep your cat on injected steroids for
many years to come. The advantage of the inhaled steroids is they only
target the lungs and don't get into the bloodstream, etc.
>
> > The majority of cats diagnosed with heartworm are indoor cats, because
> > most people think they are not likely to meet with a mosquito. But it
> > only takes one. If heartworm is not very prevalent in dogs in your
> > area, however, it's not going to be likely for cats either.
>
> I have a history of having weird problems with my animals. The kind that
> makes the vets say "huh. Well, I've never seen *this* before." I don't
> know if it's just because I have a lot of animals (cats, dogs, horses) or if
> I really pay attention and notice the little things. Sure, it'd be
> incredibly odd for Cilly to have heartworms, but it wouldn't shock me too
> much ;)

It's unlikely but if you want to be sure, it wouldn't hurt to have
Cilly tested. Of course, the tests for heartworm are not a hundred
percent accurate either.

Good luck--hopefully all your cat has is a case of asthma, and that can
be sucessfully controlled.
-Yngver

Corey Kaye
January 22nd 06, 05:10 AM
yngver wrote:

> Another good Web site is http://www.fritzthebrave.com/

I appreciate the info. I spoke with my vet regarding the issue (I was in
the office everyday but friday for various issues!) and he's very happy to
try inhalent steroids when the depo-medrol wears off. He suggested a
nebulizer and didn't know about the spacers with flutter valves.

> It's unlikely but if you want to be sure, it wouldn't hurt to have
> Cilly tested. Of course, the tests for heartworm are not a hundred
> percent accurate either.

We did the antigen and antibody test and both were negative. A FIV and FeLV
were also negative.

Repeat labs two days after the initial ones were totally normal. CPK and
HCT within limits, platelets clumped but normal on the smear. My vet
grilled the lab, and they stand by their numbers for both. We'll retest in
4 weeks and 8 weeks, and I'll be watching Celia for behavior changes or
signs of bruising.

> Good luck--hopefully all your cat has is a case of asthma, and that
> can be sucessfully controlled.

I hope so. <fingers crossed> So far, her asthma has been faily well
controlled. I'm eager to try the inhaled steroids. I hope she doesn't have
IMTP.

Thanks again,

Corey

yngver
January 24th 06, 08:46 PM
Corey Kaye wrote:
> yngver wrote:
>
> > Another good Web site is http://www.fritzthebrave.com/
>
> I appreciate the info. I spoke with my vet regarding the issue (I was in
> the office everyday but friday for various issues!) and he's very happy to
> try inhalent steroids when the depo-medrol wears off. He suggested a
> nebulizer and didn't know about the spacers with flutter valves.

We use the Aerokat,
http://www.aerokat.com/Animal_Health/ah_aerokat_fac.asp

At this point I can't remember whether we ordered it ourselves or our
vet ordered it for us. He knows Dr. Padrid so he was already familiar
with the use of the Aerokat spacer with Flovent for the control of
feline asthma. At that time (a couple years ago) he had a few cats
using it with no problem--now I'm sure there are a lot more since
feline asthma is unfortunately becoming more common. At first of course
we didn't think our cat would use the Aerokat willingly and it took
about a week to get her to settle down and not struggle, but after that
she didn't mind it much any more. I think they realize it makes them
feel better. Now we don't even pick her up--just put the mask over her
face wherever she happens to be sitting or lying, and she doesn't
object.
>
> > It's unlikely but if you want to be sure, it wouldn't hurt to have
> > Cilly tested. Of course, the tests for heartworm are not a hundred
> > percent accurate either.
>
> We did the antigen and antibody test and both were negative. A FIV and FeLV
> were also negative.

Good. I wouldn't worry about any of those possibilities then.

>
> Repeat labs two days after the initial ones were totally normal. CPK and
> HCT within limits, platelets clumped but normal on the smear. My vet
> grilled the lab, and they stand by their numbers for both. We'll retest in
> 4 weeks and 8 weeks, and I'll be watching Celia for behavior changes or
> signs of bruising.

Sounds like they did make a mistake at the lab, though. Maybe Phil will
comment.
>
> > Good luck--hopefully all your cat has is a case of asthma, and that
> > can be sucessfully controlled.
>
> I hope so. <fingers crossed> So far, her asthma has been faily well
> controlled. I'm eager to try the inhaled steroids. I hope she doesn't have
> IMTP.
>
> Thanks again,
>
> Corey

Good luck. The normal lab values are a relief, I'm sure. If you have
more questions on the inhaled steroids and the Aerokat, consider
joining the yahoo list. The regulars have a great deal of experience
dealing with feline asthma and its treatment and can answer all your
questions!
-Yngver