4/12 Jenks AMPS 110 +4 65 +8 74 PMPS 80 +7 41 +9 121

4/11

Jenks had an odd late night bump in the numbers but is already showing signs of coming down into AMPS. He ate a good bit of his breakfast food on his own and without any enhancement, and then a little more with the help of FortiFlora. That's three of the last four meals that he's eaten, which is a good sign.

I mixed up a starter batch of Slippery Elm Bark (weird stuff, by the way!) and he tolerated it better than expected, especially since I think that he thought I was trying to give him metronizadole again. I ended up wearing a little bit of it, but he got the majority of the first dose down. The next one is planned for an hour or so before PMPS. Fingers crossed!

I'm going to put a call in to the vet to get an explanation of what he thinks of the creatine kinase number. In the meantime, I'm checking for nearby vets with cardiology experience, though the place @Doodles & Karen mentioned is probably going to turn out to be the most experienced, if not the only, option in the area.

I'll need to do some research to figure out what the best approach is: IDEXX CardioPet BNP Pro blood test vs. echocardiogram vs. something else?

A brief look at IDEXX for the BNP test seems like it merely indicates normal vs. abnormal, and if abnormal, recommends follow-up diagnostics like an echocardiogram. If that's the case, it seems like it may be simpler just to jump right to the echocardiogram? I'll have to call around and get estimates for all this stuff.

Resting respiration was 27 while he was snoozing (at least I think he was) about an hour before AMPS.

 

You’re right about the snapBNP, that’s a positive or negative result and just tells you, yes, there is an indication of a heart problem, go get an echo. There is another one that isn’t yes/no and gives you values, I don’t know how useful that would be though and I imagine it’s more expensive. I would just get the yes/no and an echo or just the echo. You certainly could skip it and go right to an echo since you already have concern.

Paws crossed the SEB does wonders for him. It is weird stuff, gloopy gloppy goop. Has he vomited recently? I’m not sure how you would tell it was working unless he vomits and the SEB stops that.

 

I'm glad Jenks is eating pretty good for you. I hope you can figure out which tests are best and get them scheduled soon. Sending prayers.

 

Here is an article my vet gave me. We were going to do the BNP test but decided that we would do an echo should it be warranted (in the future). Gizmo has a heart murmur that is worse when he is dehydrated (not sure if it is worse or it is just more noticeable).

I don't know if it will help you, but I did find it informative.

 

I just saw our vet today. I had the snap BNP back in January because Asia was doing some funny breathing things. It came back positive so I knew an echo was in the future. Talked with vet today about it, she said the full proBNP test, not worth it, if snapBNP test is positive, just go get the echo, more bang for your buck. You could skip the snapBNP too and just get the echo, but I wanted to share that with you because it seems the full proBNP is at least one thing to cross off the list.

 

Trying to catch up with everyone all over the place.

Pleased to read that Mr Jenks is eating for you. Long may that continue.

All the best of British for the tests too.

 

The challenge is that inappetence, vomiting and diarrhea, lethargy can all be caused by things other than pancreatitis. While I am a proponent of “if you hear hooves, think horses, not zebras”, cats are complicated. Considering the diabetes and his specfPL, treating it as if it is pancreatitis given his normal liver values, is probably just fine at this stage. However, giving fluids to a cat with pancreatitis is a great support even if the cat is not officially dehydrated. If he bounced back pretty quickly, I’d not worry about it but if he had ongoing symptoms, fluids might help him.

Typically, I try not to get too wrapped up in mild changes to white cell count. As you’ve seen, it can be due to many things. As long as they are fairly mild changes, I usually watch them. It’s when there are massive changes that you need to take action. When you have a parameter that the range is from 2620 to 15,000+, then an elevation of 2,000 is not dramatic. An elevation of 15,000 would be.

I love that you took the time to do this and let us know what is really not a consideration. Not that we can diagnose anything here but I know it helps to run through the list and perhaps we can give you other ideas. Thanks for letting me know there was no hemolysis of the sample. Even if there had been, I would not expect to see that much of an elevation.

Just an interesting observation in humans about CK (and this actually happened to my mom). If one falls and is not able to get up and lies there for a time before being found, the tissue damage from lying there undetected can cause the CK to go up and result in a condition called rhabdomyolysis (you listed it above as an external disorder). If it’s treated promptly, it can fully resolve and the CK can come down quite fast. I don’t know if he has a kitty buddy, but no chance they could have been playing roughly while you were gone or no chance that he could have fallen from a high spot and landed uncatlike (e.g. not on four feet).

If you were shooting into muscle, you would know it because he would likely screech. It’s painful. Think about when you receive an IM injection. So Jenks would let you know. It seems to me it would take repeated and violent vomiting to cause muscle damage to this extent.

One thing I will say about Doodles is that his BG literally went off the rails when his CK went up. I don’t know if that is ECID or not but Jenks is still looking really great. If he lost 3 lbs slowly in a year, it depends on his normal weight. If he weighs 17 lbs and he loses 3 in a year, it’s not likely too significant but if he weighs 8 lbs and loses 3, it is especially if he has muscle wasting which is really easy to tell as the hip bones will stick out as will the shoulder blades. Sudden weight loss can be attributable to many things including heart issues. However, conversely, Doodles also did not lose a lot of weight so I wouldn’t use weight loss as a specific indicator of heart disease across the board. You may or may not “see” anything if it is heart disease. Cats can compensate a very long time until they get to a tipping point. Karen didn’t really see any symptoms until Doodles was a bit further along and then she would see open mouthed breathing and inflated RR. Because cardiomyopathy is so easily hidden in the cat, one might not see anything at all until it is quite advanced.

The fact that your vet did not remark upon that elevation concerns me. I’ve had cats for more years than I’d like to admit and I’ve never once seen a CK elevation on any of their labs and I believe the only other cat I’ve seen with a marked elevation is Doodles (and you know how many labs I look at on the board) so it’s not a common thing to see elevated. If you had just had his heart completely checked out and everything was fine, I’d be less concerned that it be addressed right away and would likely think a recheck could be done in a week. You might want to do that anyway especially if you are waiting to get him into a specialist.

As I indicated yesterday, you could get the CardioPet ProBNP done to give you an initial indication of heart disease. If it comes back elevated, then an echo would be in order, for certain. That test will indicate cardiomyopathy but it doesn’t indicate all heart issues. For example, my Tobey has a left fascicular bundle branch block and, under stress, has premature ventricular contractions. His CardioPet ProBNP came back beautifully normal and his CK is always normal; CK would not be elevated unless there was heart muscle damage. But I have him echoed every two years to be sure his bundle branch block is not causing any other issues (it’s not expected to do so; a bundle branch block is synonymous to a detour in a road when you are driving. You still get there, you just go a different way).

I hope this has helped you a bit as you think about it and decide how to discuss with your vet. If you decide to just go see a cardiologist, as Karen said, Dr. Church is in Phoenix (he’s Tobey’s cardiologist) and he is the absolute best. I don’t know where you are in northern AZ and what specialists you have access to. I have found that while IM vets can do echoes, they don’t really know what they are looking at to the extent a cardiologist would.

Hugs for you.....I know this is stressful news along with him being not quite himself. One thing I will add is I don’t know if there is a situation where the CK is elevated that much and it has absolutely no significance. I did not find this to be the case in the reading I’ve done on it, but obviously, I don’t have access to veterinary journals that might have addressed it more.