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post #1 of 44 (permalink) Old 08-08-2018, 06:25 PM Thread Starter
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Millie Uncertain Diagnosis

I just returned from taking my 14 year old cat Millie to the vet for her annual exam and blood work. Everything but her heart and weight checked out clean. She now has a slight difficult to hear heart murmur and her weight has dropped from 7lbs down to 5.15 within the last couple years(last year she was around 6lbs). I'm wondering if anyone here has any experience with what our possible culprits are for this. Hypothyroidism, Hypertrophic cardiomyopathy, kidney failure or cancer...its possible it is her teeth as well as we haven't done a dental in a few years due to her age. I won't receive the test results until this weekend...so any feedback on what I may be dealing with if any of you have dealt with any of the above would be great...thank you all.
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post #2 of 44 (permalink) Old 08-08-2018, 07:42 PM
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Do you know what bloodwork exactly she had done? If you look at the invoice, it should say. It's unusual that you'd need to wait that long to get results for blood chemistry and CBC, even when sent to an outside lab, unless additional tests that aren't normally included were ordered. If she had a standard senior panel, or senior screen, done, it would include a urinalysis and a T4 test to check thyroid function. T4 isn't generally part of a regular blood chemistry (but is part of a regular senior panel). If she is having the urine cultured, that will also take several days.

Is Millie showing any other symptoms? Vomiting, lack of appetite, etc?

If she's eating normally but still losing weight, the most likely causes are diabetes or hyperthyroidism (probably not hypo - I think that's quite rare in kitties who haven't been treated for hyperT). Diabetes would be diagnosed more by the presence of glucose in urine than in blood. Sometimes a fructosamine test is done to confirm. I'm wondering if the vet was thinking diabetes and is also doing that test, which may be why the results will take longer than usual. I don't know much about hyperT, but in addition to the T4, I believe there's another test that can be done to confirm.

If it's CKD, you'd probably notice that she is drinking more water and peeing more, possibly eating less, but CKD by itself wouldn't cause weight loss if she's still eating. That would also require a urinalysis in addition to bloodwork for a diagnosis.

I also know next to nothing about HCM or cancer in kitties. I do know that murmurs can come and go, so just detecting a murmur once doesn't necessarily mean heart issues. Some bloodwork results may suggest cancer, and depending on what kind, an ultrasound might be ordered. Some masses can be felt on physical exam, so the fact that Millie checked out clean is a good thing.

With dental issues, again, I'd expect the kitty not to eat. As an aside, if the test results come back without anything major, and Millie is otherwise in good health, I would strongly encourage you to get a dental done now, as the risks only increase with age. My Celia had a dental and an extraction done when she was 16.5, and already in stage 2/3 CKD. She came through it just fine, and I know many other kitties have as well.

In case you're totally panicked now, all of the things above, even some kinds of cancer, can be managed for quite a long time with the proper treatment, so even if the diagnosis is one of the above, it's by no means a death sentence.

No other conditions come to mind to explain weight loss in the absence of other symptoms, but maybe other members will have more ideas.

Hope that helps.

Last edited by spirite; 08-08-2018 at 07:45 PM.
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post #3 of 44 (permalink) Old 08-09-2018, 10:05 PM Thread Starter
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Thank you for all of that information! My vet/old boss called me today it is stage 3 or 4 kidney failure...we ran a T4 test and a Cardiac Feline BPN I believe it was for her heart. The results of that have no returned though. Her thyroid levels are on the higher end of normal however so we could be dealing with an issue there in the future. Right now he hasn't given me a life expectancy age anywhere from 3 months to 2 years depending on how she does clinically. So far not urinating more then usual or drinking more then usual so thats a good sign. He wants us to switch to a prescription kidney diet and he is consulting with a specialist who knows more about feline kidney disease then he does and how the new protocols for treating it are. Once he consults with him he will call me back with a game plan. I'm completely heartbroken by this news though she means the world to me and I can't help but wonder how I didn't catch it sooner. Blood work and urine were perfect last year though so this came out of the blue.
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post #4 of 44 (permalink) Old 08-10-2018, 03:28 AM
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I am so sorry about the CKD diagnosis. It's hard to say without knowing all the numbers, but it is possible to still have a lot of quality time with the right treatments.

If you're not already familiar with Tanya's site, it is seriously *the* resource for all things CKD: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat

I would read that page and the section "Just diagnosed?" Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - What You Need to Know First

I'd also really encourage you to join the affiliated support group. It was enormously helpful to me, and the advice I got gave me 3.5 extra months with my Celia after the vet recommended euthanasia. I'd also be happy to try to answer any questions you may have. I had a crash course in CKD between the website and the support group, and while I'm far from an expert, I have learned quite a bit.

The one thing that I think is absolutely necessary is for you to always get printouts of all tests performed, including urinalyses. Keeping a spreadsheet of the results is really helpful so that you can track the changes over time.

It's great that your vet is consulting a specialist. So many vets just won't treat older kitties with CKD, even when they're at a stage where they're doing well and the progression of the disease can still be slowed down quite a bit. And some vets just don't seem to want to acknowledge that there's stuff they don't know and aren't willing to learn. That is the worst.

Are you seeing any behavioral changes? It's quite surprising that a stage 3/4 CKD kitty wouldn't show at least some of the usual symptoms. It just makes me wonder if there isn't something else, like an infection, driving up the kidney numbers artificially, given that you haven't noticed more drinking, more peeing, inappetance, etc.

Yes, the proBNP tests heart health. I'll keep my fingers crossed for a good result, and toes crossed that Millie will eat the renal food!
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post #5 of 44 (permalink) Old 08-11-2018, 07:03 PM Thread Starter
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Thank you so much for that link I will for sure be checking that out! How was your experience with CKD?(feel free to message me if that would work better) I know it varies by cat. I will have to ask my old boss for a copy of her test results I didn't even think to ask for that. Thankfully my old boss is very willing to learn new ways and if he doesn't know the newest thing will consult with a specialist. Still waiting on a call back from him on the game plan the proBNP results. The only behavioral change I'm seeing is she is more active and wants to be downstairs more then ever. She pretty much lives in my bedroom due to her life before I adopted her so that is the only change I've noticed. She already has a chronic vomiting problem which is why shes on special sensitive stomach formula so we are highly concerned with switching her over to a renal formula. We will be trying canned and dry versions to see which works the best for her and we plan on adding Fortiflora to help with digestion since she won't be on a food specifically for that anymore. She's always been a water drinker but no increased thirst or urination. How would you rule out infection?
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post #6 of 44 (permalink) Old 08-12-2018, 02:04 AM
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You are really lucky to have a great vet. Soooo many of us have had to fight to get what we wanted, and you just don't need that stress on top of everything.

Ok, so Millie is actually *more* active? And she's eating, drinking, peeing, pooping normally, just still losing weight? This would be unusual with stage 3/4 CKD, though of course not all kitties will have the same symptoms.

As for ruling out infections, well, things get tricky. If Millie does indeed have CKD, it's almost impossible to rule out infections...It's probably better to look for evidence that there isn't an infection; CKD kitties are particularly prone to UTIs and kidney infections. The important to keep in mind is that "normal" reference ranges for bloodwork don't apply to CKD kitties for some values, like WBC, phosphorus, and potassium. In terms of values relevant to diagnosing infections:

WBC: normal range is somewhere between 5-17, but for a CKD kitty, an infection should be considered once the WBC hits about 10.
NEUT: high neutrophils can indicate infection/inflammation
LYMPH: weirdly, both high and low values can indicate infection/inflammation
GLOB: high globulins can also indicate infection

That goes for any kind of infection. Specifically for UTIs or kidney infections, even if a urinalysis shows no evidence of bacteria, a urine culture & sensitivity test should be done. That's considered the "gold standard" for diagnosis. The problem is that with CKD kitties, even a negative urine culture does not necessarily mean there's no infection, because with a chronic infection, or one that's moved up into the kidneys, bacteria may not be present in urine. Yep...so that's what I meant about the impossibility of ruling one out. That's when looking more closely at the WBC count and the other values above (maybe some others too, but those are the ones I'm familiar with) may be helpful. If a urine culture came back negative, but my CKD kitty's WBC count was 11, I'd be pushing my vet for an antibiotic.

As for the experience, not gonna lie, it's tough. Tanya's site refers to the CKD rollercoaster, and that's really what it is. Kitty will have her good and bad days, but you can't predict based on the previous day. Kitty can be doing well, eating, grooming, etc. one day, and you're thrilled. Then next day she refuses all food, looks miserable, and hides under the bed all day, and you worry that she's not going to make it through the night. CKD just makes you feel powerless, but it really helped me to educate myself so that I could take an active role in Celia's treatment. When the vet saw that I knew what I was talking about, he was ok with going with what I wanted to do, even though it wasn't the choice he would have made.

I'm happy to talk more about it here or via pm. I think I could talk about CKD for hours...
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post #7 of 44 (permalink) Old 08-12-2018, 10:23 AM Thread Starter
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Yup literally everything but her activity level and weight loss have remained the same with her. Thats why we really thought it was a thyroid problem and the slight heart murmur we heard also made us think that. Thank you so much for all of that information! It was incredibly helpful. I'll have to post her results once I get a copy. I probably won't hear anything back until this week.

Millie hasn't been acting like that at all...I'm really starting to wonder if there is an infection going on and not CKD after all...


Thank you!
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post #8 of 44 (permalink) Old 08-12-2018, 03:11 PM
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I agree. I would think hyperT with unexplained weight loss and no other symptoms.

A UTI probably wouldn't explain that, but maybe some other kind of infection? It would actually be kind of great if that was it, rather than CKD.

Please do keep us posted. I really hope that the tests point you to a diagnosis, and fingers crossed that it's neither hyperT nor CKD, just a run-of-the-mill infection!
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post #9 of 44 (permalink) Old 08-13-2018, 10:28 PM Thread Starter
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I'm still waiting to hear back on the cardic proBPN results and what the specialist has said but I will update this as soon as I find out any news. She's still not showing any signs minus the weight loss and increased activity. I'm really wondering whats actually going on.

If it was an infection causing the levels to go up that would be so much better then CKD.
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post #10 of 44 (permalink) Old 08-14-2018, 09:59 PM Thread Starter
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My vet/old boss just called me back today and hes pretty certain we are dealing with CKD based on what the specialist told him. Her cardiac proBPN came back elevated so we can't rule out cardiac disease either. We have an appointment with the specialist for the 27th where we will get her blood pressure tested and most likely ultrasound her kidneys, thyroid and heart(my old boss has the ability to ultrasound so if we can cut the cost on it by doing it with him thats the plan but it will all depend). Once we figure out how everything looks we will be looking into a food switch to Purina NF with Fortiflora to help her sensitive stomach and then find out which meds to do and possibly supplements as well depending on her results.
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