Hima's Check-Up: High ALT, high creatine. What is going on?

[MissClouseau]

Good to see the site back, hello everyone. We guess Hima’s age to be 4-6 years old. I took Hima to her annual check-up last Monday. We couldn't go last year due to the pandemic. In June 2019 her creatinine was 1,37 mg/dl.

So now, at least two things going on. One is Hima had this wound/fungus on the same spot in June 2019. It disappeared on its own by time (or at least got better enough to not be visible from the fur.) I noticed a new thing there on December 2020. I try to keep it clean but she plays with it and to this date it's still there. The vet saw it only with scab and said "the best option it's fungus" and prescribed a fungus oinment.


Well the other problems are more worrisome, it's her bloodwork. Her ALT is 8 times higher than normal. And to my surprise and what freaks me out the most, her creatinine is also high. But BUN and phosphorus are normal. PLT is low.



A few things that may be related:

• The test was done to empty stomach as it was asked by the vet. Hima had a bit Acana dry food around 11pm on Sunday, the blood was taken at 09:45am. BUT, that Sunday I gave her a bit more than usual boiled turkey breast as treats. Other than that she had Gourmet Gold pate (like Fancy Feast), Miamor pate liver wet food, and Me-O liquid treat.
• Her dewormer was 2,5 weeks late as I waited for the clinic so they could give her a dewormer pill. So it's possible she had intestinal worms.
• She has gingivitis, bad breath, and been salivating more the past couple months. It gets better and worse some days depending on how hard what she ate was.
• She gets temporary tummy ache occasionally. Sits hunched for a bit, then goes back to normal.
• I normally give her a milk thistle supplement but she was off of it the last 2 weeks. I wanted to see the numbers without it.
• I don't see her bowel movements as she goes in the yard but she spends like 15 minutes outside in total so she can't have diarrhea. She's playful, acts normal, jumps normally, eats normally, shiny soft coat, no puking.
• Two weeks before the test she hunted a rat in the yard. She never eats them and didn't eat this either.
• Normally Hima doesn't drink any water. She eats 2 cans of wet food with added water. (But that may not be enough as she also eats dry food.) For the last maybe 2 months she drinks some water once a day or so. Not a major change, but a change.

I have three questions:

1. What do you think is going on here?
2. I will ask for re-checking her BUN, creatinine, and ALT at the end of April. I will ask for a blood SDMA test and bile acid test too. Is there any other test I should ask for?
3. The vet suggested ultrasound for the liver and kidneys. I can afford it cost-wise but going to the clinic is stressful enough for Hima, ultrasound will be x2 worse and it will be done by a stranger too. (Another vet comes to the clinic to get it done.) ALSO, the weather is getting warm here so there are more insects around. With a shaved belly she will be more exposed to all kinds of bites and allergens. Should I ask for repeat of the blood test first or go straight to ultrasound?

 

[tabbytom]

So now, at least two things going on. One is Hima had this wound/fungus on the same spot in June 2019. It disappeared on its own by time (or at least got better enough to not be visible from the fur.) I noticed a new thing there on December 2020. I try to keep it clean but she plays with it and to this date it's still there. The vet saw it only with scab and said "the best option it's fungus" and prescribed a fungus oinment.

You may want to try to use this on Hima's fungus spot. It';s called Colloidal Silver. This product works well on fungus and it's non toxic to cats. There are many brands out there, do a check on them and just make sure you get the ones that are meant for cats.

It comes either in eye dropper form or in spray nozzle form, depending on the brands. Get the type that suits the use best. I find the one with the spray nozzle easier to use if you have a finicky cat as you don't have to keep holding your cat to apply it.

I use them on my boy I'm a fan of it. All the antiseptic cream from the vet does not work on my boy and I hate the mess of creams.

I have these two brands

 

[MissClouseau]

You may want to try to use this on Hima's fungus spot. It';s called Colloidal Silver. This product works well on fungus and it's non toxic to cats. There are many brands out there, do a check on them and just make sure you get the ones that are meant for cats.

It comes either in eye dropper form or in spray nozzle form, depending on the brands. Get the type that suits the use best. I find the one with the spray nozzle easier to use if you have a finicky cat as you don't have to keep holding your cat to apply it.

I use them on my boy I'm a fan of it. All the antiseptic cream from the vet does not work on my boy and I hate the mess of creams.

I have these two brands

View attachment 376030 View attachment 376031

I will ask the vet if it’s available in Turkey, thank you!

 

[tabbytom]

I will ask the vet if it’s available in Turkey, thank you!

You can get it online. I don’t think vets carry this product.

 

[FeebysOwner]

Hi. I don't really have much to offer, but I believe I have read that diabetes can impact ALT as well as creatinine in some cats. From what I recall reading about it, diabetes will have less of an impact on BUN. And, I think all of the abnormal readings could be related to some form of toxin. Just some other things to discuss with the vet. Wish I could help more. Keep us posted.

 

[MissClouseau]

Hi. I don't really have much to offer, but I believe I have read that diabetes can impact ALT as well as creatinine in some cats. From what I recall reading about it, diabetes will have less of an impact on BUN. And, I think all of the abnormal readings could be related to some form of toxin. Just some other things to discuss with the vet. Wish I could help more. Keep us posted.

Thank you! Glucose is in there in the test and looks like in the normal range. If there is any other indicator of diabetes, I don’t know but worth to ask the vet.

I thought maybe her gingivitis somehow increased ALT but I see street cats with such severe dental issues, and they have surgery. For scale the vet said she doesn’t operate a cat if ALT is as high as 250. So I guess not likely oral issues would increase ALT.

Paging daftcat75 here. Have you seen a bloodwork like this?

 

[daftcat75]

Dental disease can cause elevated ALT. You can take her in for a dental exam with mouth x rays and while they have her sedated for that, they can do the ultrasound too. That may take some scheduling finesse. But that would be the least stress for Hima while covering all the bases. If she has dental disease, that needs to be addressed just the same as infection anywhere else including possible extractions. An infected tooth or gums can spread to the rest of the body or the bone.

 

[MissClouseau]

Dental disease can cause elevated ALT. You can take her in for a dental exam with mouth x rays and while they have her sedated for that, they can do the ultrasound too. That may take some scheduling finesse. But that would be the least stress for Hima while covering all the bases. If she has dental disease, that needs to be addressed just the same as infection anywhere else including possible extractions. An infected tooth or gums can spread to the rest of the body or the bone.

Vets here refuse to sedate with such ALT. I hear also with low PLT which Hima also currently has.

 

[daftcat75]

Vets here refuse to sedate with such ALT. I hear also with low PLT which Hima also currently has.

That’s stupid! Yeah Krista’s vet tried to cancel her dental because her ALT was 1400. I told the doc she needed to be treated and we couldn’t just wait it out. Krista was on IV fluids for the ALT value and they helped. But it was slow going and very expensive. I think they wanted to start with ultrasound and Krista was being her feisty self. They ended up sedating her anyway because they weren’t going to get an ultrasound otherwise. And as long she was sedated, the doc did the dental after all. She had a broken tooth and needed a couple more extractions (resorption.) The ALT would have gone nowhere with an untreated broken tooth had Krista herself not insisted upon sedation.

Edit: The IV fluids helped only after the dental procedures.

 

[MissClouseau]

That’s stupid! Yeah Krista’s vet tried to cancel her dental because her ALT was 1400. I told the doc she needed to be treated and we couldn’t just wait it out. Krista was on IV fluids for the ALT value and they helped. But it was slow going and very expensive. I think they wanted to start with ultrasound and Krista was being her feisty self. They ended up sedating her anyway because they weren’t going to get an ultrasound otherwise. And as long she was sedated, the doc did the dental after all. She had a broken tooth and needed a couple more extractions (resorption.) The ALT would have gone nowhere with an untreated broken tooth had Krista herself not insisted upon sedation.

Edit: The IV fluids helped only after the dental procedures.

That’s good to know. I will discuss this with the vet too. Thank you!

 

[daftcat75]

Does Hima have IBD, suspected IBD, or history of vomiting? That could also cause her ALT to go high. That’s a question for the ultrasound. I would tackle the teeth and the ultrasound in one visit if you can manage it. Less trips and less stress. And if she has a history of being feisty in the back room, it’s a two-for-one deal on the sedation. But you need more answers than abnormal blood work and retests. Liver supplements alone will get you nowhere very slowly (they take a long time to work!) if there is something being left untreated (like teeth or gut.)

 

[MissClouseau]

Does Hima have IBD, suspected IBD, or history of vomiting? That could also cause her ALT to go high. That’s a question for the ultrasound. I would tackle the teeth and the ultrasound in one visit if you can manage it. Less trips and less stress. And if she has a history of being feisty in the back room, it’s a two-for-one deal on the sedation. But you need more answers than abnormal blood work and retests. Liver supplements alone will get you nowhere very slowly (they take a long time to work!) if there is something being left untreated (like teeth or gut.)

All good questions. Hima puked a total of 3 times last year - one was hours-long heavy rainstorm stress, one was hairball, third was hair too probably. So far zero puking this year.

Unfortunately, everything is at a different clinic. I can manage to get two things at one clinic if I choose to go with vets I have no experience eith, but not all three - ultrasound, bloodwork, dental. And as I said, literally no vet here would operate with a bloodwork like this. They would probably prescribe medicine first, then see how it goes. But it doesn’t feel comfortable at all to make Hima go though all the stress, several different trips and on-going risk afterward when she’s doing all find from outside.

If it wasn’t for the pandemic my original plan was to take her to the vet dentist last autumn. I have a plan of going there in October. Unless we have to do it sooner. My reason to wait was (without the bloodwork) Hima spends only like 15 minutes in the yard when the weather is cool. But could sit there for couple hours in the summer and interact with the resident cat neighbors. So she’s more exposed to virus/bacteria and didn’t seem like a good idea to have her immune system get vulnerable with a surgery during that.

 

[MissClouseau]

Some updates for the thread. I chatted with a young vet for a bit at another clinic. She said periodental disease doesn’t cause x8 high ALT. Some parasites might if they can go up to liver. She did say though creatinine going up to 2 mg might be about dental issues, that’s one of the options.

Well then on Friday at 05:30am Hima woke up to puke bile.

Spoiler

Spoiler: Puke pic 2

She’s not a frequent puker so I don’t think this is unrelated to her blood test result. She got a dewormer pill, Caniverm, on April 5 at the check-up so it makes me also think the elevated numbers were probably not about worms.

She’s in a good mood generally but something is bothering her and she definitely has excessive saliva. Saliva part must be partially her gingivitis for sure but maybe not only that.

 

[daftcat75]

What are all the vets recommending if they won’t perform a dental on her? The dental issues may not be her only issues. But they can’t be ignored nor postponed for much longer.

 

[MissClouseau]

What are all the vets recommending if they won’t perform a dental on her? The dental issues may not be her only issues. But they can’t be ignored nor postponed for much longer.

They suggest doing an ultrasound, repeating blood test (liver and kidney only) and maybe urine test to understand what is going on, hopefully find and treat it. Sounds like a good plan at first but I’m scared of things rather getting worse with all the stress of going through these tests, more clinic visits and the shaved belly in parasite/allergy season.

 

[daftcat75]

They suggest doing an ultrasound, repeating blood test (liver and kidney only) and maybe urine test to understand what is going on, hopefully find and treat it. Sounds like a good plan at first but I’m scared of things rather getting worse with all the stress of going through these tests, more clinic visits and the shaved belly in parasite/allergy season.

Do the ultrasound. You would never forgive yourself if you missed something treatable because you were worried about fleas and ticks. Begin with the problems at hand rather than all the possible problems that may never happen. Besides. The shaved belly just makes it easier for the both of you to keep clean. No place for a stowaway to hide!

 

[MissClouseau]

Do the ultrasound. You would never forgive yourself if you missed something treatable because you were worried about fleas and ticks. Begin with the problems at hand rather than all the possible problems that may never happen.

You are right. Thanks for the encouragement.

 

[daftcat75]

And you tell them that if she’s feisty and they have to sedate her to complete the ultrasound, then you also want a dental and any necessary extractions done while they have her under. Or at the very least, they should perform mouth xrays. You can only make a dental plan after you’ve seen the lay of the land.

 

[MissClouseau]

And you tell them that if she’s feisty and they have to sedate her to complete the ultrasound, then you also want a dental and any necessary extractions done while they have her under. Or at the very least, they should perform mouth xrays. You can only make a dental plan after you’ve seen the lay of the land.

Oh she never gives them trouble in that way. She’s the “freeze” kind of stressed cat. Only does a stressed meow a few times.

I have a question if I may. Have you ever had a cat’s urine taken at the clinic? And if yes, what method did they use to take it. I have no experience in that. I don’t want to take Hima to the clinic more than necessary so it may be nice to get the urine test done too.

 

[daftcat75]

Oh she never gives them trouble in that way. She’s the “freeze” kind of stressed cat. Only does a stressed meow a few times.

I have a question if I may. Have you ever had urine taken at the clinic? And if yes, what method did they use to take it. I have no experience in that. I don’t want to take Hima to the clinic more than necessary so it may be nice to get the urine test done too.

They stick a needle into her bladder and extract urine into a syringe. It’s no more uncomfortable than having blood extracted. Maybe less so. The few times Krista was too feisty for blood and urine tests, it was the blood she put up a fight over. But that may also be because they took it from her back legs (weak and arthritic.)