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

FeebysOwner

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Interesting information.

Oddly enough, Feeby's ALT & Cholesterol were well within the normal range when she tested positive for H-T. Even more odd, her cholesterol level only went 'high' after having been on H-T meds for 2 months. It was also high again after she had been on the H-T meds for 5 months. However, the timing of food intake and blood tests can affect the cholesterol reading. And, while thyroid issues are mentioned as a possibility, there are numerous other potential causes, as I am sure you are aware.

What I am curious about is both ALT and cholesterol can also be high with pancreatitis. What ever came of any further discussions about the pancreatitis (sorry if I missed it when trying to re-read this thread)? Is the hepatic food that Hima is eating also supposed to benefit cats who have pancreatitis? I didn't find any such information, but figured you and your vet might have discussed this aspect. It is a shame that no wet food appears to be specifically helpful for hepatic issues, as it might improve Hima's condition more rapidly if she were on the hepatic food exclusively.

And, since worms can affect ALT to the extent of improper nutritional intake in the intestines - although as extensive as Hima's I don't know - it would seem a routine wormer is likely in Hima's future since she goes outside regularly. Along that line of thought - there are many variables that could play into her situation given she goes outside. I know you don't want to take that away from her - but, what if it is something outside that she is getting into - whatever that might be - that is causing this? Just thinking out loud...
 
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MissClouseau

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What I am curious about is both ALT and cholesterol can also be high with pancreatitis. What ever came of any further discussions about the pancreatitis
They checked her amylase as that was the test available for pancreatic enzymes. It was indeed high but I read it’s not a significant reading. Our vet says when there is pancreatitis, there are symptoms like (frequent) puking, anorexia, etc which Hima doesn’t hav

since worms can affect ALT to the extent of improper nutritional intake in the intestines - although as extensive as Hima's I don't know - it would seem a routine wormer is likely in Hima's future since she goes outside regularly
I thought I was routinely deworming her! She gets Stronghold every month throughout the summer, then got Profender in October, then Advantage Multi every 2-3 months. :ohwell: I decided to take her to the vet for a dewormer pill every 3 months if I can’t manage to pill her myself. Looks like Caniverm pill is more effective (and has far less side effects in Hima than Profender.)

Along that line of thought - there are many variables that could play into her situation given she goes outside. I know you don't want to take that away from her - but, what if it is something outside that she is getting into - whatever that might be - that is causing this?
I do suspect of this too unfortunately. That maybe she got exposed to some sort of toxin on the soil. It’s impossible to not let her outside because of where we live. Hima adopted me right from this yard. The three years-long resident yard cats, Hima has been around them for 3 years now. She chases butterflies (never kill.) She stalks some neighbors. She has such a social life basically, keeping her inside would be like prisoning her with a view of other cats and people doing the things she wants to do. That kind of stress would almost most certainly affect her general health too. On the good side this is mostly in warm weather and maybe 2-3 hours a day in total. Through the winter she spends maybe 15 minutes in the yard a day. Thank goodness I don’t live in a warm all year around climate at least!
 
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MissClouseau

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Some updates. I took Hima to the vet today to re-check everything. She's been doing good this whole time like it first started. This time we did the blood test to full stomach for a change and to check BA (bile acid.)

Good news. Her ALT is down to 463 u/l. It was 815 in early April, 583 in late April. Now 463. So while it's still high, it is going down at least. Her cholesterol though is persistent on being high. IT was 265 in April, even after changing her food to hepatic food it's 263. It's interesting to me GGT has been exactly 5 u/l in ALL the blood tests we did since 2019. Everything else changes from time to time, GGT is always 5.
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I'll continue to give her hepatic food and the holistic detox supplement. We will re-check in August. If it's getting worse or not down more, we will do toxoplasmosis and bartonella tests, if that doesn't answer either, ultrasound.

On the weird news, Hima's original lesion in the first post of this thread is all healed after changing her dry food, fur grew. I still think it was allergic. She then grew another lesion last month that I was sure was fungal infection. Does anyone have a guess what kind of fungal infection this can be?

The vet checked with a wood's lamp and while "there's a mild shine" she doesn't think it's fungal infection. She said the anti-fungal ointment may be causing hair loss too so I stopped putting anything today. We'll see what happens. Confusing though because quite a few cats in the neighborhood lose hair on that area and it has got to be fungal infection on them at least. We'll see.

8f6b47e8-76e0-4f2e-803f-4128741fdaee.JPG
 

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Something came to me as I was reading your post and then the photo. Is there somewhere outside that Hima goes where that part of her back might rub against a support beam or something similar? If so, and you know where it is, could you look at that beam. plank whatever, and maybe take some scrapings from it for the vet to look at?
 
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MissClouseau

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Something came to me as I was reading your post and then the photo. Is there somewhere outside that Hima goes where that part of her back might rub against a support beam or something similar? If so, and you know where it is, could you look at that beam. plank whatever, and maybe take some scrapings from it for the vet to look at?
I will check! The hair loss there started on like 17 May. A day after she got some throat irritation for 1,5 days. I had thought maybe that stress caused fungal infection but maybe not.
 
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MissClouseau

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UPDATES. I took Hima to an intern specialist on Friday, both to check on her liver and to give her regular deworming. Her last dewormer was in June so we are actually almost a month late. In fact Hima has been having tummy ache after meals again so I thought she maybe had worms. The last time she appeared to have tummy ache after meals it was gone 2 days after giving her a dewormer.

The good news is her ALT went down even lower. In June it was 463, now it's 359. We started at 800 in April if you remember. The bad news, to my absolute confusion, all the other liver enzymes AND gallbladder one GGT are high. They were all within the normal range in previous tests. Even her bilirubin is high at 2,3 which means jaundice but Hima is doing and acting quite alright. Years ago when she was hospitalized with 1.1 bilirubin jaundice and mild infection, she had anorexia, wasn't grooming herself, lethargic, etc how can she be worse now but act almost normal. Playful, eating normal, energetic....

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I'm told her Xray doesn't show anything alarming that an xray can see.

So they will perform ultrasound on Hima on Tuesday. It will be done at her regular clinic with a different internist who will join us just for the ultrasound. The internist we went to sees the highest suspect bile sludging and thinks gallbladder/bile duct was probably the main problem all along. I am also confused why our regular vet then outruled gallbladder issues just because her GGT and bile acid test were within the normal range.

I sent the test results to Hima’s regular vet. She put her on Synulox antibiotics, 4 days later she will also start to take VetExpert Hepatiale Forte Advanced.
 
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MissClouseau

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MORE UPDATES.

Ultrasound was performed by another internist at our regular clinic! Hima does not have bile sludging, no gallstones. Everything looks normal except... she has mild fatty liver, and inflammation around. She's officially diagnosed with Cholangiohepatitis.

When her belly was shavede the vet said there was not even a bit yellowness and she also questioned the other clinic's bloodwork on last Friday that showed Hima had all liver and gallbladder enzymes high and had jaundice. We repeated the bloodwork and the result is all clear, only her ALT is high as it was the case since April.
hima 12 october test.jpg

I signed up to TCS in 2019 when Hima was hospitalized. It was after she didn't eat for 3-4 days. The vet and I think her condition has been going on since that time. Like she suspects it's chronic although Hima is doing quite well from outside.

I will have some questions about both Cholangiohepatitis and fatty liver maintenance in the longterm in another thread. Our vet said so far routine bloodwork is needed to catch things before they go bad, longterm (or permanent) supplements to protect the liver, extra attention on diet, hairballs, and parasites.

I have one question here if anyone knows, how much does intestinal worms might affect her ALT? Because the first time her ALT went from 800 to 500something after only a dewormer pill and adding back her milk thistle/curcumin supplement. Maybe it was just the supplement but I also read liver flukes could also cause Cholangiohepatitis flare-ups. No idea if liver flukes is even a thing in Istanbul though.
 

daftcat75

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MORE UPDATES.

Ultrasound was performed by another internist at our regular clinic! Hima does not have bile sludging, no gallstones. Everything looks normal except... she has mild fatty liver, and inflammation around. She's officially diagnosed with Cholangiohepatitis.

When her belly was shavede the vet said there was not even a bit yellowness and she also questioned the other clinic's bloodwork on last Friday that showed Hima had all liver and gallbladder enzymes high and had jaundice. We repeated the bloodwork and the result is all clear, only her ALT is high as it was the case since April.
View attachment 398368

I signed up to TCS in 2019 when Hima was hospitalized. It was after she didn't eat for 3-4 days. The vet and I think her condition has been going on since that time. Like she suspects it's chronic although Hima is doing quite well from outside.

I will have some questions about both Cholangiohepatitis and fatty liver maintenance in the longterm in another thread. Our vet said so far routine bloodwork is needed to catch things before they go bad, longterm (or permanent) supplements to protect the liver, extra attention on diet, hairballs, and parasites.

I have one question here if anyone knows, how much does intestinal worms might affect her ALT? Because the first time her ALT went from 800 to 500something after only a dewormer pill and adding back her milk thistle/curcumin supplement. Maybe it was just the supplement but I also read liver flukes could also cause Cholangiohepatitis flare-ups. No idea if liver flukes is even a thing in Istanbul though.
Didn't Hima need some dental work that her liver numbers precluded? If that's still the case, the inflammation in her gums could be keeping the ALT numbers high. Krista's ALT often elevated when she needed dental work. In my reading, it seems ALT can often be a reflection of inflammation (or muscle damage) elsewhere in the body. Could be teeth. Could be arthritis too. It got to the point where I stopped reacting to elevated ALT if none of the other numbers seemed amiss. Often I would argue with my vet that it was probably her teeth and that regardless of how long it had been since her last dental, she should have another X-ray and maybe more extractions or root clean-ups. I was right more often than I wasn't. But that was my cat. Sample size of 1. 🤷‍♂️ If Hima still needs dental work, I would take care of that and re-test the ALT a month later.
 
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MissClouseau

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Didn't Hima need some dental work that her liver numbers precluded? If that's still the case, the inflammation in her gums could be keeping the ALT numbers high. Krista's ALT often elevated when she needed dental work. In my reading, it seems ALT can often be a reflection of inflammation (or muscle damage) elsewhere in the body. Could be teeth. Could be arthritis too. It got to the point where I stopped reacting to elevated ALT if none of the other numbers seemed amiss. Often I would argue with my vet that it was probably her teeth and that regardless of how long it had been since her last dental, she should have another X-ray and maybe more extractions or root clean-ups. I was right more often than I wasn't. But that was my cat. Sample size of 1. 🤷‍♂️ If Hima still needs dental work, I would take care of that and re-test the ALT a month later.
She does have inflammation currently... on her liver-gallbladder side. Her dental issues are actually (temporarily) quite good as she’s on Synulox antibiotics and that took care of her dental problems for now. And remember her ALT has been high for months. It’s slowly going down since April but we started off at 800. Dental issues apparently cause mild ALT elevation at most. Not moderate or high elevations and 800 is considered high.
 
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