Blood Test Advice

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booktigger
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Blood Test Advice

Post by booktigger »

Need a bit of advice please. Lucy normally has her bloods every March, she's not had any since March 2020, so I wanted both her kidney and calcium levels checked, but the vets EPOCH machine needs a part and it's quite old so they can't get it, so the only thing they can do is the lab test, which requires 1ml of some kind of serum, which takes quite a few ml of blood to get, and the vet doesn't think Lucy will oblige long enough while she is awake, so my options are

1 - Just have her boosters and kidney function test
2 - Sedate her and have boosters, kidney function and calcium levels done in one go
3 - Take her for her boosters and see what the vet thinks, bearing in mind that if we then want to sedate her, it's an extra vet visit

The other downside is that doing the lab test and sedation requires a morning appointment, and Lucy might twig something is going on as she always has evening appointments.

Normally I'd go with sedation and get everything out of the way, but I'm a bit reluctant as she is 14 and has had early stage CKD for 5 years, and obviously sedation is a risk. There is no rush to make a decision, even if I was bothered by her boosters being overdue, the nurse says there is an 8 week grace period so we've got till middle of May.

Thoughts?
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Mollycat
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Re: Blood Test Advice

Post by Mollycat »

Tricky one. Thoughts that might help or might make it even more difficult:

What has the progression been like from diagnosis to the last test? Has there been much more loss of function, and at the last test what was the situation - IRIS stage, etc?

How is Lucy in herself - have you noticed any signs of deterioration - lethargy, bad breath, unkempt fur, increased thirst or urination, change of sleeping position or places, etc?

Sedation is not the same as anaesthesia.

When I had to get Molly in for early morning fasting, it was easier to have her go in overnight. That was where mine messed up and took bloods that evening just after food instead of morning fasting, and also failed to collect urine. This also allows for a drip to keep hydration and protect the kidneys and system generally from the worst effects of the anaesthetic. Has this not been mentioned?

A sedation would also allow a close look at her teeth, and at this kind of life stage I really would! Molly showed no signs of trouble bar what I thought was a slight swelling on the gum, but turned out to have one FORL and a cracked tooth which may have been another FORL. We'd never have know. She was 14 too.

Lucy isn't going to get any younger and her kidneys aren't going to get any better, so my personal thoughts are, let's get her under and run as full checks as we can while she's still young and fit.

Also, if there is going to be a new machine, get full checks now for comparison to future tests.
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Re: Blood Test Advice

Post by fjm »

I would go for sedation and the full set of tests plus a thorough examination - you are going to need them sooner or later and might as well get them sorted now, and one visit is easier on Lucy than multiple visits. As Mollycat says, sedation is much easier on the system than full anaesthesia, and with luck would mean Lucy has no memory of the procedures, which is also a bonus.
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Re: Blood Test Advice

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Thanks - sorry, think I missed something out last night - we can do pretty much full bloods on her without sedation, it's only her calcium levels they can no longer do in house, and there are no signs that has gotten worse, I do think her kidneys have though, she does drink more and immediately after eating. Have to say I haven't noticed any sign of bad breath while doing her weekly meds, but I know she did have a slightly dodgy tooth when she had her hip op, but they couldn't do both at the same time, so might be wise to let her have everything done. Not sure about the drip, as sure the vet nurse said they'd just book a double appointment if I wanted sedation, so I would potentially be with her.
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Re: Blood Test Advice

Post by Mollycat »

Maybe they only do the IV for a full anaesthetic, not sedation, I wouldn't know.

This might be of some interest http://www.iris-kidney.com/education/hy ... n_ckd.html with reference to diet and treatment. Do your vets check sodium and potassium? Would that be checked along with calcium?

My thoughts if Lucy already has a history of hypercalcaemia I would want that test for sure, and maybe ask about magnesium too.
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Re: Blood Test Advice

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That's why I'm torn, I want to know the full story with her underlying health issues (£3k of tests showed she has idiopathic hypercalcaemia - although seeing as it started 7 weeks after her hip operation, I'm convinced it is connected, even though 2 vets and a specialist said not), but she seems stable calcium wise, so I'd hate to risk making things worse by sedating her when it isn't clinically necessary, it's just for my peace of mind. Going to pay for a telephone consult with the vet and see what she thinks.
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Re: Blood Test Advice

Post by Mollycat »

Idiopathic eh? I'm afraid the word makes me think of the words idiot and pathetic in a train crash. It's what they say when they run out of ideas. Five years ago I had idiopathic urticaria - it wasn't magic, it was some mineral deficiency. I don't even know what, all I know is switching to raw sea salt clinched it and that has nearly 100 trace elements.

When was her hip op? How long after the CKD diagnosis? Or before?

It would be really strange if two health conditions known to be linked were coincidental. There are so many micronutrients involved in calcium balance, and there's hyperparathyroidism.

I'm aware I'm being a big hypocrite though, when it comes to taking cat to see vet.
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Re: Blood Test Advice

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Yeah, basically the various tests ruled out causes, so no idea what caused it!

She was diagnosed with CKD in March, hip op April, hospitalised for her calcium in June, looking back at what I posted then initially there was a concern it was infection from the operation, but that was ruled out and they ruled out her CKD causing it as her specific gravity was fine. Some expensive blood test for parathyroidism was done, I remember that one! Did remind me she's had 4 sedations since her diagnosis, mainly in that first year, so maybe I am worrying over nothing.
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Re: Blood Test Advice

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"Secondary Hyperparathyroidism" - that was thought to be THE way CKD caused hypercalcaemia, but now they believe it's more complicated than that. Isn't it always.

To be fair Lucy is older and anaesthetic risks increase with age, so worry is understandable. Oh you should see Hubby whenever his dog is in for the slightest thing, even X-rays - he is like an anxious first time father, he phones me every hour to ask if there's any news yet. The states of worry we get ourselves into! Then it happens and what was all the fuss about? I would definitely seize the opportunity to get as full a health check as possible in one go.

But I think I would be asking for a complete minerals panel as well. If it's not caused by CKD maybe it caused the CKD - it's a 2 way relationship - and it could still be a simple thing to correct.
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Re: Blood Test Advice

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Apparently her blood test ruled out secondary and tertiary hyper-parathyroidism, but not primary! Just rang vets, they test potassium and sodium, not magnesium, but she's not had full bloods since August 2017, she's just had SDMA and Calcium since then, but everything was normal. Have got some provisional dates next month for her to have everything done, I just need to check when I can get time off work, as it will be about an hour and a half including recovery time, they offered to see what kind of mood she is in that day (unlikely to be in a good mood, being starved from 8pm the night before) to see if they could get enough without sedating, but I said at least sedating her they will be able to have a better look in her mouth than normal.
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Re: Blood Test Advice

Post by Mollycat »

Ok, fingers crossed!
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Re: Blood Test Advice

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Well, yesterday was the day. She did well being starved, it was girls night out, so I got up, fed them, and me and Lucy chilled in bed watching TV. She has lost weight, now 5.2kg from 5.8kg last year, I'm just hoping it's the diet and nothing more! Apparently she went down really quickly, so they did it all in 20 mins in case she came up as quickly as she went down! We did a full set of bloods, cost a fortune though. I picked her up about an hour later, so she was still wobbly, I was hoping she'd lie on the bed and relax so I could see her while working, but she wouldn't settle till about 3pm (sedation was bout 11am), and she was very quiet and not interested in food, she's only been acting like herself since about 7pm tonight, so not sure I'd do that on a regular basis. Now just waiting for the results, they are going to ring when they are all back and the lab test is about 48 hours, so I might not hear till Mon.
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Re: Blood Test Advice

Post by Mollycat »

Must be a great relief after all the self-questioning. Fingers crossed for the results. Lucy is welcome to some of Molly's fat, we have some surplus here!
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Re: Blood Test Advice

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Rang today, partly to chase the results and partly to order her gabapentin, I'm on the list for a phone call tomorrow, there was a delay with her calcium results. I did get the receptionist to tell me her Urea and Creatnine though, she said Urea is 7.1 and Creatnine 120, and said both said normal at the side, so I'm quite relieved now as I was a bit worried about the 600g weight loss, even though she has been on a diet, and the fact that every time she eats, she goes and has a drink. Surely if her results are normal on a standard pre op type blood test, that means she's still early stage? We normally only get enough blood for an SDMA test, so I'm more used to analysing those!
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Re: Blood Test Advice

Post by Mollycat »

I was thinking your results ought to be due soon.

Those number are not even borderline, just upper part of normal range. Great. SDMA should hopefully tell the same story but if it does say early changes, what would you do about it? Starting diets and treatments too early can be counterproductive.
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Re: Blood Test Advice

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Thanks, glad they sound upper part of normal, seeing as it's 5 years since her initial diagnosis. I'll just stick to what we have been doing, and glad that her refusing renal wet hasn't had an impact on her values (although she only had 2 pouches a week, as more affected her calcium levels). I just wonder why she eats and then immediately has a drink. Today I'm trying splitting her gabapentin into two meals, given that she isn't always eating her dry food with it in now and I think that ends up being part of the problem, as she isn't getting her full pain meds, which probably affects her appetite.
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Re: Blood Test Advice

Post by Mollycat »

I had to look on Tanya's Pages for the normal scale and she is well within those numbers, either you've worked miracles or maybe she could have been wrongly diagnosed? If the original diagnosis was made when Lucy was a little dehydrated, or just after a meal, or with other issues going on, that could have skewed her results into stage 1 or even a little asymptomatic kidney infection that cleared up by itself. Did they do SDMA back then?

Could the drink immediately after eating be the dry food making her thirsty? There is a huge difference in Molly's water consumption according to how much dry she has. When I was still giving her renal wet she leaned on dry more and drank a lot more. Now I've stopped it (may as well have been chucking my money straight in the bin) her water glass is not so far down when I change it.

As for weight loss, do you measure out portions for her or let her nibble what she wants?

Ed: Tanya's Pages normal range tables at the bottom of the page http://felinecrf.org/diagnosis_test_ran ... lood_urine
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Re: Blood Test Advice

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Had a voice mail from the vet, she said there is nothing concerning about any of her blood tests and her calcium is normal, so didn't need to speak to me. I'm picking up a copy of her results next week when I go for her meds. At least it seems the weight loss is the diet and nothing sinister.

I doubt it's a wrong diagnosis, apart from last year, she's had at least one SDMA test for the past 5 years (sure one year she had to have more than one, turns out the extra renal wet food was affecting her) and her bloods have been mainly just after work, so unless she'd had some leftover breakfast, pretty much an empty stomach.

She likes to drink water after wet food, dry food and human food!

Her dry food is supposed to be measured, the batteries died on the scales, so I go off eye, but that's only one of her three meals, the other two are wet, breakfast is a mix of 50g, 85g and 100g, and supper is 50g.
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Re: Blood Test Advice

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Picked up Lucy's meds and blood results today, not quite as happy as when the message from the vet was nothing concerning! There are two red items on it, her SDMA is the highest it's been, at 18 (top end of scale 14) - it was 16 on diagnosis in 2017 and we did get it down to 9 in 2019, so I think the fact she no longer accepts renal wet food is having an effect, although I have to remind myself that it is 5 years since her initial diagnosis, and her Urea and Creatnine are still within normal limits, so she's not up to 70% loss yet. Her creatnine looks just under half way on the little line - 122, top end of scale is 212, although this is up from 2019, when it was 104 although there is a graph at the top that shows it was a lot higher in 2017. Her urea is near the bottom end of normal, the top end is 12.9, but no comment about the last result. Guessing her BUN:Creatnine ratio (no idea why one is measured as urea and one BUN!) must be normal at 14, as there is no comment against it. The other red item is globulin, but I can see why the vet wasn't concerned, it's 54, and the top end of scale is 51, plus there is no flag against her Albumin:Globulin ratio and a quick google search shows that could just be dehydration - I don't have any water bowls upstairs as when I have, she's refused to drink out of them, she only likes it in the front room, so she had gone without water as I'd kept her in my room all morning.
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Re: Blood Test Advice

Post by Mollycat »

Looking at IDEXX https://www.idexx.com/en/veterinary/ref ... a-results/ that looks to me as though dehydration can have an effect on SDMA, but in any event take a look at their flowchart and I don't know about you but in the absence of markers on the traditional tests despite possible dehydration, that wouldn't necessarily push me to reduce phosphorous and risk worsening the hypercalcaemia.

Incidentally, was the hypercalcaemia spotted before or after the CKD diagnosis and what was the time difference?

Every cat is different and every owner different just trying to do our best for our own cats but I have to say I'd be very pleased with those results after 5 years with both urea and creatinine inside the normal range, and personally at that level - with hypercalcaemia - I wouldn't have put mine on any renal. Maybe pre-renal, at a push.

Do you have all the calcium sodium potassium etc back yet?

The urea:creatinine ratio is another way of measuring proteinuria apparently.
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Re: Blood Test Advice

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Thank you, that makes me feel better. The note about the SDMA mentions likely impaired GFR and renal function, not sure what GFR is.

Her CKD diagnosis was March, her IHC was June the same year, just after her hip op, that numerous vets have told me isn't related - still seems odd you remove part of a cats hip then they start with calcium issues during the recovery period (think it was about 7 weeks post op, although may have been sooner, as initially she was just off her food, it was only when the sickness started we did a full blood test, I wasn't that concerned by her food given that she was unhappy being confined to the kitchen). The renal must have helped though, as it did get her SDMA from 16 down to 9, although she's never had a full renal diet, we changed her biscuits initially, as she's never been a fan of wet food, I did get a selection pack of renal wet to try her on and it was the first 100g pouch she'd devoured! So we did 2 renal, 2 senior and 2 50g adult, with a soup on Sunday. When we tried 3 renal, her calcium levels went funny. Yeah, all results back and everything within normal limits - her sodium and total protein look a bit on the high end of normal to me, but vet said there was nothing concerning.
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Re: Blood Test Advice

Post by Mollycat »

Glomerular Filtration Rate - Tanya's Pages has a great section on interpreting results and explains all the different tests is quite a bit of detail.

I'm with you on coincidences, they are relatively rare and when a vet categorically says two things are unrelated, that's when I reach for google. The vet at my practice who told me bilirubin was unrelated to hyperthyroidism was just plain wrong, I knew it because it's all liver related but thankfully it resolved so I didn't dig all the way to the bottom, just far enough to lose trust in that one vet. Like I don't readily accept "idiopathic" I like to understand what may be going on even if I can't do anything about it!
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Re: Blood Test Advice

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Thanks. I don't like the thought of idiopathic, but I suppose once you'd done £3k worth of tests and ruled out all the standard causes, you kind of have to accept it. I was hoping we could have found a diagnosis and then it might have been treatable, but at least we went for the once a week medication, and luckily it's first thing, so if I get her half asleep, it's quite an easy task.
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Re: Blood Test Advice

Post by Mollycat »

Yes I do understand. No clues in your own research? It's bugging me, sorry :)
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Re: Blood Test Advice

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As I said, I'm still convinced it's connected to her hip op, although pre Covid, we were struggling to get hold of her meds, as they are human meds, but not a dosage humans often take (they come in 10mg or 70mg, humans can do one a day or one a week, I know which one I'd go for), so we tried giving her a quarter to drag them out till we could get some and she did start being sick more, so it is clearly still underlying, just kept under control. So the only other thing could be her kidneys, but then they ruled that out with the tests at the time, so I'm stumped. Given my track record, it wouldn't be surprising for it to be truly idiopathic!
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Re: Blood Test Advice

Post by Mollycat »

We are going for updated bloods and widdles Tuesday. I have some reservations about overly frequent testing, but it's early days on Loxicom and I am still trying to establish a better home diet for her, and the vet wants to monitor her kidney function to make sure the Loxicom isn't doing damage. We must play ball to get the drugs!
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