BH is still in big trouble after returning from a 3 day ER stay last night - liver and ??

[FeralHearts]

and we just took 10 steps back...

She was to see the vet today, but I had to bring her in yesterday.

Sunday night - I got 10ml of food it her and she promptly threw up all the undigested dry food she had snacked on during the day.

Monday Morning - I was making her breakfast and she promptly threw up another load of dry food she had munch on during the night. That food is not going through her system well due to her motility.

Called the vet Monday morning and they told me to bring her in. They also said okay to tube feed. Gave her some cerenia, waited a while, fed her her tube feeding... 30 minutes later - up in came. This also means she lost some of her antibiotics and pred.

She was a lot less Jaundiced at this time.

At the vets checked her tube - all good. Did bloodwork, got that back today ALT over the moon again - doubled into the 700's again, bilirubin down significantly though from 250 to to in the 80's.

He gave her a shot of Cerenia and said he was surprised she hadn't tossed her cookies once until now.

Body is also making red blood cells again.

Today:

This morning she looked jaundiced again. Tonight it looks a bit improved.

She spent most of the day today sleeping quietly. She ventured out for water and a pee but looks a bit exhausted.

No interested in food today. Can't say I blame her.

Feeding went well this am, this evening so-so. All the antibiotics and pred stayed down.

Gave her her 2nd B12 shot. About 30 minutes later she looked a bit more perked up.



Below is the AI comparison of the differences in the weekly bloodwork.

This is the AI comparison of the bloodwork From Mon, Sept 16, 2024 to Mon, Sept 23, 2024 :

1. Blood Glucose (GLU)

• Old: 6.12 mmol/L (normal)
• New: 8.64 mmol/L (normal, but higher)
• Change: Increased.

2. SDMA (Symmetric Dimethylarginine)

• Old: 15 μg/dL (high)
• New: 12 μg/dL (within normal range)
• Change: Improvement; now within normal range.

3. Creatinine (CREA)

• Old: 148 μmol/L (normal)
• New: 165 μmol/L (normal)
• Change: Slight increase; still within normal range.

4. Urea (UREA)

• Old: 4.6 mmol/L (low)
• New: 8.6 mmol/L (normal)
• Change: Improvement; now within normal range.

5. Phosphorus (PHOS)

• Old: 1.48 mmol/L (normal)
• New: 1.60 mmol/L (normal)
• Change: Slight increase; still normal.

6. Calcium (CA)

• Old: 2.36 mmol/L (normal)
• New: 2.51 mmol/L (normal)
• Change: Slight increase; still normal.

7. Total Protein (TP)

• Old: 80 g/L (normal)
• New: 85 g/L (normal)
• Change: Slight increase; still normal.

8. Albumin (ALB)

• Old: 29 g/L (normal)
• New: 28 g/L (normal)
• Change: Slight decrease; still normal.

9. Globulin (GLOB)

• Old: 51 g/L (high)
• New: 56 g/L (high)
• Change: Increased; remains high.

10. A/G Ratio (Albumin/Globulin)

• Old: 0.6 (normal)
• New: 0.5 (low)
• Change: Decreased; indicates a worsening ratio.

11. ALT (Alanine Aminotransferase)

• Old: 392 U/L (high)
• New: 772 U/L (high)
• Change: Increased; worsening liver function.

12. ALKP (Alkaline Phosphatase)

• Old: 301 U/L (high)
• New: 127 U/L (still high but decreased)
• Change: Decreased but remains high.

13. GGT (Gamma-Glutamyl Transferase)

• Old: 19 U/L (high)
• New: 6 U/L (high)
• Change: Decreased but remains high.

14. Total Bilirubin (TBIL)

• Old: 229 μmol/L (high)
• New: 87 μmol/L (high)
• Change: Significant decrease; but still high.

15. Cholesterol (CHOL)

• Old: 6.12 mmol/L (high)
• New: 5.86 mmol/L (high)
• Change: Decreased but remains high.

16. Red Blood Cell Count (RBC)

• Old: 5.58 x10^12/L (low)
• New: 6.78 x10^12/L (normal)
• Change: Improvement; now within normal range.

17. Hematocrit (HCT)

• Old: 22.2% (low)
• New: 26.4% (low)
• Change: Improvement; but still low.

18. Hemoglobin (HGB)

• Old: 7.9 g/dL (low)
• New: 9.0 g/dL (low)
• Change: Improvement; but still low.

19. Platelets (PLT)

• Old: 554 K/μL (normal)
• New: 614 K/μL (high)
• Change: Increased; now high.

20. White Blood Cell Count (WBC)

• Old: 9.54 x10^9/L (normal)
• New: 10.06 x10^9/L (normal)
• Change: Slight increase; still normal.

Summary of Changes:

• Improvements:
  • SDMA decreased to normal.
  • Urea increased to normal.
  • RBC, HCT, and HGB have improved but remain low.
  • Total Bilirubin significantly decreased but is still high.
• Worsening:
  • ALT has significantly increased, indicating worsening liver function.
  • Globulin levels have increased and the A/G ratio decreased.
  • Platelets are now high.

Overall, the new bloodwork shows some improvements in certain areas, particularly regarding kidney function and red blood cell parameters, but liver function appears to have worsened, necessitating further evaluation and management by a veterinarian.

So a mixed bag of nuts here. She had a bad day.

 

[silent meowlook]

Honestly, stop using the AI. It is not telling you what you need to know. It is just stressing you out. Sorry, but the AI is stupid

The fact that the HCT has gone up is wonderful. From 22 to 26 is great. Of course it is still low according to the lab test normals. But what the AI doesn’t know is that older or sick cats have different normals. You can’t expect the HCT to go up any quicker.

The fact that the bilirubin has dropped that much is incredible. Who cares if it is still high. It’s dropping.

I don’t have the time to go through all of them, but I hope you understand my point.

Why are you feeding her the dry? Can you just give her canned? The dry itself can cause vomiting. If she won’t eat canned, but you have a feeding tube. She eats whatever you want her to.

 

[FeralHearts]

Honestly, stop using the AI. It is not telling you what you need to know. It is just stressing you out. Sorry, but the AI is stupid

The fact that the HCT has gone up is wonderful. From 22 to 26 is great. Of course it is still low according to the lab test normals. But what the AI doesn’t know is that older or sick cats have different normals. You can’t expect the HCT to go up any quicker.

The fact that the bilirubin has dropped that much is incredible. Who cares if it is still high. It’s dropping.

I don’t have the time to go through all of them, but I hope you understand my point.

Why are you feeding her the dry? Can you just give her canned? The dry itself can cause vomiting. If she won’t eat canned, but you have a feeding tube. She eats whatever you want her to.

LOL yup that being said ... I use the AI to try to understand certain things better. It doesn't usually stress me out - it usually makes me go hmmmm. (Edit to add: but I totally get what you mean though.)

Maybe you can answer this - the ALT went up massive again - not sure what that means for her (Edit to add:- or really why that happened) but I know that's not good.

The dry food is if she'll eat on her own. I offer wet and she might take 0.5oz. but the dry she'll eat a bit at a time. I can certainly just offer the wet but it makes it hard as you can't leave wet food out all day or all night. Unless there is a way and I'm simply not being creative enough? Remember three cats too...

On the weekend I can cater to her with the wet food - but while I'm sleeping or at work... I'm not sure what I can or should do.

I was excited about the bilirubin dropping that much.

Anything else you can think that I can do for her?

I'm open.

 

[F+V]

I'm so sorry BH is not feeling well again I guess a liver supplement like Denamarin (SAMe and silymarin) wouldn't help her at this stage?
Can't the antibiotics and pred be given by another forms like shots or subcutaneous meds to bypass the digestive system?
You're already giving her fluid and feeding via tube without stressing the liver...

What's AI? Artificial Intelligence?

 

[FeralHearts]

I'm so sorry BH is not feeling well again

Thank you.

It's the roller-coaster for sure and not the fun kind but day by day. Day by day. I hate not just being able to fix her. Editto add: There is a certain type of helplessness you feel when you know you are doing what you can to make them comfortable but beyond that you can't fix it. So when she has a bad day it hurts a bit more as you don't know how many good days are left.

Day by day she goes.

but more good days than bad right now - so it's a blessing.

I guess a liver supplement like Denamarin (SAMe and silymarin) wouldn't help her at this stage?

She's taking Zentonil, which essentially is Denamarin - different name, same thing though. I think it helps.

Can't the antibiotics and pred be given by another forms like shots or subcutaneous meds to bypass the digestive system?

I could ask but I think there is a reason we are doing it through the tube ATM. I'm adding some probiotics to her feed now. It has to be hours after though, not with.

You're already giving her fluid and feeding via tube without stressing the liver...

I wonder about the food, I am thinking about asking about a liver food as right now she's on Urgent care food, which is suppose to be easy on both but it is higher in fat which will stress the liver a bit.

What's AI? Artificial Intelligence?

Yes. Exactly. It scares people. I find it useful for certain things just one of those grain-of-salt / use with caution deals.

 

[F+V]

There is a certain type of helplessness you feel when you know you are doing what you can to make them comfortable but beyond that you can't fix it. So when she has a bad day it hurts a bit more as you don't know how many good days are left.

100%... my problems pale in comparison with what you are dealing with but still I often feel helpless and that nobody, even the vets, doesn't really know what to do.

She's taking Zentonil, which essentially is Denamarin - different name, same thing though. I think it helps.

It is exactly the same! SAMe is supposed to help repair damaged liver cells..

I could ask but I think there is a reason we are doing it through the tube ATM.

Probably, considering your vets seem to know what they are doing. I just thought these meds might be tough on the stomach in her condition.


Today I had a very long conversation with Chat GPT when I was making cat food! It's not perfect but is pretty insightful, though I got a little frustrated with it and said "how many times do I have to repeat myself?"

 

[FeralHearts]

100%... my problems pale in comparison with what you are dealing with but still I often feel helpless and that nobody, even the vets, doesn't really know what to do.

Nope. You are equal... they are just different problems - but the same beast. Illness.

Sadly a lot of medicine is creative problem solving. I say this often, but I'll repeat it as I think it's important for people to understand.
I grew up around one of the best diagnosticians in my country. When I was a kid he used to say to me that "medicine is 90% creativity and 10% science. There could be 2000 things wrong with you and I have tests for 100. After that - I better be good at what I do."

He is right. It's why my heart goes out to doctors and vets as when things don't check mark the boxes - it's a game of experience, gut and best guess work. I don't envy them being in that spot when everyone expects them to have all the answers and they simply can't. We don't know as much about the human body as we are lead to believe and less about animals.

Hang in there. You've reached creative problem solving. One step at a time. It's all you can do. XOXOXOXO

It is exactly the same! SAMe is supposed to help repair damaged liver cells..

It is. I wonder if a higher dose... but I would think they would suggest that if they thought it would help? Might make it worse? Hard telling. Another question I can ask though.

Probably, considering your vets seem to know what they are doing. I just thought these meds might be tough on the stomach in her condition.

She definitely does. I think people try to make her stick with "check boxes" but I can hear it when she speaks - she's an outside the box thinker - and that's what these furkids have needed all along. A quiet rebel (I like rebels - a lot!) ...and one who understands creative problem solving when things that should make sense - don't. I like her. I think BH stands the best chance of more good days than bad with her Doc by her side.

Today I had a very long conversation with Chat GPT when I was making cat food! It's not perfect but is pretty insightful, though I got a little frustrated with it and said "how many times do I have to repeat myself?"

It can be. It's all in how you phrase things to it ... and of course ... always double check ... it does fairly well when used correctly.

You'll get better at the phrases and have to repeat yourself less.

 

[F+V]

Sadly a lot of medicine is creative problem solving. I say this often, but I'll repeat it as I think it's important for people to understand.
I grew up around one of the best diagnosticians in my country. When I was a kid he used to say to me that "medicine is 90% creativity and 10% science. There could be 2000 things wrong with you and I have tests for 100. After that - I better be good at what I do."

I will have to keep that in mind! That reminds me of what my boss told me when I was a new grad; "success is 20% effort/knowledge, 80% luck" or something like that.

She definitely does. I think people try to make her stick with "check boxes" but I can hear it when she speaks - she's an outside the box thinker - and that's what these furkids have needed all along. A quiet rebel (I like rebels - a lot!) ...and one who understands creative problem solving when things that should make sense - don't. I like her. I think BH stands the best chance of more good days than bad with her Doc by her side.

I'm really happy BH is in such good hand. That's one less thing for you to worry about! I don't think many on here can say the same about their vets unfortunately.

I hope BH will feel like eating soon

 

[FeralHearts]

No real change so far. She's okay. Better than Monday for sure.

Cerenia helps but with that is that it's hard on her liver which is already in rough shape. So here's the rub....

She gave no real indication of nausea until she started to wretch and tossed her cookies. Back on the cerenia - it helps. I take her off, we risk her tossing her cookies again.... leave her on.. it's hard on the already serious liver issue. Total catch 22.

I looked into slippery elm bark, but what I don't know is if it will interact with any of her meds. I have emailed the doc to see what she thinks of that idea, and if it could impact her meds if I try that root, or, is there another option that's not going to tax her body so much.

I've add a grey wolf fibre boost +GI Grey Wolf Fibre Boost + GI . I give that in a meal that's at least 4 hours from her antibiotics. I want to add a probiotic to help combat all the antibiotics without screwing her up. The list is so endless I have no idea what's good for her.

Any thoughts on either of these issues?

Getting her to eat on her own is a problem for another day.

 

[F+V]

Have you asked your vet if Cerenia can be given to her subcutaneously or via injection to reduce the strain on the liver?

As for slippery elm, I just started giving it to my boy this week but read that it would need to be given on an empty stomach, 1-2 hours apart from meds, supplements and food because of its mucilaginous properties which create a coating in the digestive tract that interferer with the absorption of nutrients and meds.

 

[FeralHearts]

As for slippery elm, I just started giving it to my boy this week but read that it would need to be given on an empty stomach, 1-2 hours apart from meds, supplements and food because of its mucilaginous properties which create a coating in the digestive tract that interferer with the absorption of nutrients and meds.

I put in an email yesterday to ask about alternatives and I'm hoping we have one.

As for the Cerenia, as it's process by the liver, I don't think it matters which delivery system we use as it's processed by the liver itself. Which is the issue. It's why it's a catch 22.

As for slippery elm, I just started giving it to my boy this week but read that it would need to be given on an empty stomach, 1-2 hours apart from meds, supplements and food because of its mucilaginous properties which create a coating in the digestive tract that interferer with the absorption of nutrients and meds.

I read that too. TIming would have to be perfect as I already have the liver protector that is two hours after a meal or one hour before. There is only so much time in a day to balance out all the meds that need food or shouldn't have with food.

I'll let you know if we find an alternative but most meds are processed through the liver so... I'm not hopeful.

 

[F+V]

Yes, Cerenia is still processed by the liver regardless but SQ or shots method bypass the digestive system, and I would think reducing GI involvement should help cats with liver disease and vomiting?

I also started giving Denamarin which has be given on an empty stomach at least an hour before meal. Some herbs like slippery elm and marshmallow root also need to be given apart from other herbs and meds. So today I created a schedule for all the supplements and it's full on from 6am to 10pm

 

[FeralHearts]

Looks like she might have slipped her bandage again around her belly. I'm nervous to look. I think I can manage to do something with it if she did. If not it's a trip to ER and a big bill and money is somewhat tight as I am sure anyone can imagine with everything that's gone on..

They do not make this easy these furkids.

Yes, Cerenia is still processed by the liver regardless but SQ or shots method bypass the digestive system, and I would think reducing GI involvement should help cats with liver disease and vomiting?

Valid point. I can ask.

I also started giving Denamarin which has be given on an empty stomach at least an hour before meal. Some herbs like slippery elm and marshmallow root also need to be given apart from other herbs and meds. So today I created a schedule for all the supplements and it's full on from 6am to 10pm

Yup 2 hours after or an hour before. So there is like this three hour window.

She is unsure of the slippery elm. I'm still researching.

I so feel you there! I have a wacked schedule for BH too! It can be rough some days. lol Rubber rooommmmmmmmmm

They are worth it though.

 

[F+V]

Oh no, why do these things always happen on weekends and after hours! Getting pet insurance definitely paid off for you. I just bought insurance for mine because the premium was only $40/month for two.

 

[FeralHearts]

The insurance was a blessing for sure as it took some of the pressure off but that was used up before the biopsy and tube. Everything pretty much after the ER hospitalization has been on me. I wish I got more now - but of course I was never anticipating this bad of an issue with any of them. Live and learn. If I ever have other after these - I'm def doing more.

I'm glad you have some insurance as well. XOXOX It does really help.

 

[silent meowlook]

Hi. I honestly wouldn’t mess with the PEG tube bandage yourself. If that tube comes out you are in real trouble. I mean real, not fixable trouble. I have seen it happen and it’s horrible. If it was an E tube I would offer advice, but not a PEG tube.

 

[FeralHearts]

She puked a bit last night. I cried my eyes out.

This morning it was like night and day, - she started to try to eat on her own again after a week of not wanting to and walking around like nothing was up. Tra-la-la through the daisies. Happy happy.

My nerves. I may end up medicated.

Hi. I honestly wouldn’t mess with the PEG tube bandage yourself. If that tube comes out you are in real trouble. I mean real, not fixable trouble. I have seen it happen and it’s horrible. If it was an E tube I would offer advice, but not a PEG tube.

I am with you on this one. I can usually work my way through fear and do what I need to do - but this kind of fear I feel towards that bandage I think isn't a test of courage - but a warning to stay with what I know. I'll follow your advice and my gut on this one. Thank you for confirming that messing with it at all is a dumb idea.

It's not slipped badly, just the underside a bit from where she is trying to be a cat a curl into a ball... so I will keep a close eye. Worse case if it slips to a point I see pressure on the tube area at all, or I'm really concerned, I have her carrier ready for ER.

 

[RudrakshS]

Following the case from a while. You are such a brave soul and so is BH. I do not have any medical advice but I’ll be keeping both of you and every furr buddy in my thoughts and prayers. 🫂

 

[FeralHearts]

Following the case from a while. You are such a brave soul and so is BH. I do not have any medical advice but I’ll be keeping both of you and every furr buddy in my thoughts and prayers. 🫂

Thank you. That means a lot to BH, myself - and her kitty family.

I can't say this has been easy, but worthwhile, yes.

Cats really do teach us a lot... how to live each day, one day at a time - and one moment at a time.

I'm at the office today but I see her on the cameras and I look in awe at her. The little miracle and gift that she is.


---

Update: She is eating like I’ve starved her. (I am not complaining at all!) All week—nada—now it’s food, food please. Fingers crossed we stay on this good path. She didn’t drink at all yesterday, but now she’s drinking too. What a relief.

When the Veraflox antibiotic finishes tonight, she will stop that medication but will still be on Clavamox and the rest of her meds. The vet has approved her staying on the probiotic as well, so more is being picked up for her.

Now about the bandage: I spoke to them about it when I discussed her meds.

There are two bandages: one over the tube and one wrapped around her body like a cocoon. I checked carefully; the slipping one is the cocoon, which is slipping from the belly section downward towards her surgery site. It’s not near the tube site and isn’t putting any real pressure there. I can do one of two things (while wearing gloves):

Option 1: I have vet wrap at home, so I can gently pull it up or simply tape it so that it doesn’t slip further.

Option 2: If the cocoon wrap is too tight to gently pull up, I can cut it a bit from the underside and tape it after gently pulling it up. (I did this once before when she slipped. That time, there was pressure at the tube, so I cut around the bottom, where the surgery site is—far, far away from the tube site—to relieve the pressure and brought her in. I had been instructed how to do this, but it was nerve-wracking.)

The tube site is located on the side of her body, while the surgery site is underneath her belly.

If the tube is exposed at all or is caught/pressured at any point between now and her change date (Tuesday), that’s when I need to bring her in.

From what I saw, I’m fairly confident I can just tape it more, and it’ll be fine, but I have to keep a close watch. It’s not what I originally thought it was. I won’t do anything I’m not comfortable or confident with, as S silent meowlook is 110% correct about the tube: don’t touch near it at all, or you risk causing bad things you can't fix.

Since this is above my comfort zone, I need to breathe through it and be completely calm before I attempt even simple taping. If I can’t control my emotions and be purely calm, I’ll have to bring her in.

Fear isn’t always the bad thing people think it is; it can lead to very positive outcomes when used properly. But if you can’t or shouldn’t get past it, then let it guide you to know when flight or freeze is necessary.

Feeding:

The amount she needs for her weight is pretty hard to get into her, even with the tube. However, since she’s a small cat and has lower energy than one of her sisters, this helps.

The most her tummy seems to be able to handle before looking uncomfortable is 45 ml. So it’s 30-45 ml per feeding, and I’ll watch closely for any reaction from her. She doesn’t show much at all before she heaves. I did notice a very small "tell" last night when her head stretched a bit, so I’ll need to watch for that going forward.

 

[FeralHearts]

Okay so we ran into some more timing snags along with some good news / bad news.

Keep in mind we are dealing with multiple things here, history of pancreatitis, GI issues (probably IBD), her immune issues that are probably lurking - along with this liver issue.

Timing snags: We've added some more medication that really messes with timing things out. I work, I can't work from home, I can't take a leave and the bills still have to get paid along with very expensive kitty bills. That's just a fact that I have to work with..So timing wise it's going to be really tough.

Good news:

- She's eating on her own / trying - she's doing pretty well there. Still not enough - but we are on the positive of that right now.
- Her liver values have gone down to look a lot more reasonable. (will post below)

Bad news:

- We have some muscle wasting happening
- She's lost a bit more weight 9.9 pounds (4.5kg) pounds now from .10.36 pounds (4.7 kg)
- and in true medical fashion, we are resolving one issue and causing another.... liver numbers came down but so did her HCT (red blood cells.) One we wanted (former) - one we did not (latter).

So the plan is some added meds and we will re-check her blood this Friday night.

These are the list of the meds will a note on what was removed / completed / changed:

• Zentonil -once a day 100mg - same, no change
• Clavamox - Twice a day and continuing for a month - same, no change
• Gabapentin - Twice a day / as needed - no change
• Lactulose - 1ml once a day (twice if needed) - same, no change
• Cernia - this one is only as needed as it can be harder on the liver processing. ATM we are stopping to see how she does without it. - CHANGE - 1/4 tablet a day / as needed but right now needed daily.
• Mirtazapine - Right now not being used. It's on the side just in case a time comes.
• Prednisolone - 10Mg per ML 0.5ml twice a day - CHANGE - 10mg per ML 0.25 once a day
• Vit B12 shot - 1000 mcg/ml 0.25 once a week for 4 weeks and then once a month. (at home)(I guess Charlie's Cartrophen shots helped prep the way for that. Bless Nurse A for teaching me the ways so I am able to do this for her and for all of them considering the $ aspect as well.) - same, no change

Completed:

• Veraflox - Completed this Sat, Sept 28, 2024
• Buprenorphine - Completed

Added:

• Sucralfate every 8 hours. As I work - I can only do 12 hours based on the timing of everything - I will try my best for eight.
• Omeprazole 10mg tablet - 1/2 tablet every 24 hours for 2 weeks.

The reasoning and plan:

While the pred is wonderful for getting them to eat, inflammation etc etc. There are side effects as with any meds. It's also one you cannot abruptly stop. It could be the cause of the red bloods cell going down so we are using caution and for now lowering a fair bit.

Omeprazole to reduce stomach acid in case there is an ulcer etc and that's why the blood count ins messed up.

Sucralfate, I am very familiar with this one. I call it the healing inside band aide. With that being said. Sucralfate is another one of those that require no food or meds for hours. At least one hour before food and two hours before any medication. See the issue? Both the liver pill and the sucralfate pose timing issues for both food and meds. So somehow I have to work this out.

We will recheck the blood on Friday night and see if anything has helped.

The goal is to try to balance out things between the two, or more, opposing forces.

Feeding:

Right now is still through a gastro tube. I image this will continue for quite some time. Her wanting on her own has picked up - let's hope it was her will and not just the pred's will.

Bandage:

They made in narrower to allow for more freedom of movement and less likely for her to slip it. Let's see how that goes. THe idea sounds good and reasonable since her reason for slipping is her movement.

Life quality:

She is being a cat. Mostly good days, interested in things and wants to do things.


Blood work:

Yes, I used AI to chart this for me LOL. It's easier than me right now time wise.

BLOODWORK 1 is last week. BLOODWORK 2 - is the week before that. AI reversed them LOL. (in some ways - in other ways it's idea makes sense too.)

Here’s a detailed comparison of the new bloodwork with the previous ones:

Hematology (RBC, HCT, HGB, Reticulocytes)

Parameter	New Bloodwork	Previous Bloodwork 1	Previous Bloodwork 2	Trend/Interpretation
RBC	4.13 (LOW)	6.78	5.58 (LOW)	Decreased – RBCs are now lower than in both previous tests, indicating worsening anemia.
HCT	15.6% (LOW)	26.4% (LOW)	22.2% (LOW)	Decreased – Hematocrit has dropped further, indicating worsening anemia or blood loss.
HGB	5.3 g/dL (LOW)	9.0 g/dL (LOW)	7.9 g/dL (LOW)	Decreased – Hemoglobin levels have decreased further, signifying more severe anemia.
MCV	37.8 fL	38.9 fL	39.8 fL	Relatively stable – No significant change.
MCH	12.8 pg	13.3 pg	14.2 pg	Slight decrease, but not significantly concerning.
MCHC	34.0 g/dL	34.1 g/dL	35.6 g/dL	Relatively stable.
RDW	28.1% (HIGH)	27.1% (HIGH)	26.8%	Increased – High RDW indicates more variation in red cell size, possibly due to ongoing regeneration or bone marrow stress.
Reticulocytes	2.0% / 81.4 K/μL (HIGH)	0.3% / 21.0 K/μL	0.8% / 43.5 K/μL	Increased – High reticulocyte count indicates a strong regenerative response to the anemia, suggesting the bone marrow is trying to compensate.

White Blood Cells (WBCs)

Parameter	New Bloodwork	Previous Bloodwork 1	Previous Bloodwork 2	Trend/Interpretation
WBC	10.39 x10^9/L	10.06 x10^9/L	9.54 x10^9/L	Stable – No significant changes.
Neutrophils	8.46 x10^9/L (81.4%)	8.77 x10^9/L (87.1%)	7.97 x10^9/L (83.5%)	Stable – Slight variations but still within the normal range.
Lymphocytes	1.67 x10^9/L	0.83 x10^9/L (LOW)	1.0 x10^9/L	Increased – Lymphocyte count has improved from the previous low.
Monocytes	0.20 x10^9/L	0.43 x10^9/L	0.32 x10^9/L	Slight decrease.
Eosinophils	0.05 x10^9/L (LOW)	0.02 x10^9/L (LOW)	0.22 x10^9/L	Consistently low.
Platelets (PLT)	404 K/μL	614 K/μL (HIGH)	554 K/μL	Decreased – Platelet count is closer to normal now.

Liver Function (ALT, ALKP, GGT, TBIL, CHOL)

Parameter	New Bloodwork	Previous Bloodwork 1	Previous Bloodwork 2	Trend/Interpretation
ALT	266 U/L (HIGH)	772 U/L (HIGH)	392 U/L (HIGH)	Decreased – Improvement in liver enzyme levels, but still elevated, suggesting ongoing liver stress.
ALKP	139 U/L (HIGH)	127 U/L (HIGH)	301 U/L (HIGH)	Improved – ALKP has decreased significantly from the older values, but still above normal.
GGT	7 U/L (HIGH)	6 U/L (HIGH)	19 U/L (HIGH)	Decreased – GGT is improved compared to the oldest test.
TBIL	23 μmol/L (HIGH)	87 μmol/L (HIGH)	229 μmol/L (HIGH)	Improved – Total bilirubin is much lower than in previous results, indicating less liver dysfunction or cholestasis.
Cholesterol	4.56 mmol/L	5.86 mmol/L (HIGH)	6.12 mmol/L (HIGH)	Improved – Cholesterol is back within normal limits.

Kidney Function (CREA, UREA, SDMA, BUN/CREA)

Parameter	New Bloodwork	Previous Bloodwork 1	Previous Bloodwork 2	Trend/Interpretation
CREA	139 μmol/L	165 μmol/L	148 μmol/L	Improved – Creatinine is stable and within the normal range, indicating kidney function is holding steady.
UREA	12.3 mmol/L (High End)	8.6 mmol/L	4.6 mmol/L (LOW)	Increased – Urea has increased and is now at the high end of normal, potentially reflecting dehydration or dietary protein levels.
SDMA	10 μg/dL	12 μg/dL	15 μg/dL (HIGH)	Improved – Lower SDMA suggests improved kidney filtration.

Electrolytes & Minerals

Parameter	New Bloodwork	Previous Bloodwork 1	Previous Bloodwork 2	Trend/Interpretation
Phosphorus (PHOS)	0.97 mmol/L (LOW)	1.60 mmol/L	1.48 mmol/L	Decreased – Now low, which may reflect nutritional imbalance or kidney function changes.
Calcium (CA)	2.23 mmol/L	2.51 mmol/L	2.36 mmol/L	Slight decrease, but still within normal range.
Sodium (Na)	164 mmol/L	163 mmol/L	161 mmol/L	Stable.
Potassium (K)	3.8 mmol/L	4.3 mmol/L	4.0 mmol/L	Stable.

Summary of Changes

• Improvement:
  • Liver function: ALT, ALKP, GGT, and TBIL have improved, though still high, indicating liver stress is ongoing but better than before.
  • Kidney function: SDMA and creatinine have improved, suggesting better filtration.
  • Platelets: Decreased but within a normal range, reducing concern about clotting issues.
  • Cholesterol: Back within normal range, indicating an improvement in metabolism or liver function.
• Worsening:
  • RBC, HCT, HGB: Significant drop, worsening anemia.
  • Reticulocyte count: Increased, indicating the body is responding to anemia but the bone marrow is under stress.
  • Phosphorus: Now low, which could be related to kidney or nutritional issues.

Conclusion
There are both improvements and setbacks in the new bloodwork. While liver function markers have improved, anemia has worsened, which could be a major concern for your cat’s overall health. The kidneys appear to be functioning better based on SDMA and creatinine levels.