9/22 Nelli AMBG 224 +3 184 +6 212 +7 214 +11 296

9/21 condohttp://www.felinediabetes.com/FDMB/...-182-2-156-5-196-6-184-7-179-pmbg-246.203509/

 

I am just catching up on yesterday’s condo and the labs.

The reason the reference ranges on the lab tab are different from yours on Nelli’s labs is the lab used. The reference ranges on the lab tab are Antech and Nelli’s vet uses IDEXX so just adjust the reference ranges and add the tests that aren’t on there as IDEXX does do some different tests (e.g. SDMA).

Nelli’s labs look pretty good except the protein in her urine and I agree it’s a good idea to get her blood pressure checked. My vet charges $15 and uses a brand new Doppler. If you look on her labs from June, did your vet use IDEXX then and is there a value there for Creatine Kinase or CPK? I know Nelli has a heart issue; she’s on enalapril isn’t she? When was her last echo? I’m sure you’ve told me but I look at so many labs and discuss heart and kidney issues with so many other members.

The reason I’m asking is because the creatine kinase can be elevated due to heart issues (i.e. cardiomyopathy). There are other things that can cause it as well but I’m just putting a few things together. It’s odd for a cat whose kidney values are so excellent and SDMA is normal, to have proteinuria. So that leads me to think of other issues like high blood pressure just because i know she has some heart issues (right or am I dreaming it?).

 

QUOTE="Marje and Gracie, post: 2258164, member: 2058"]I am just catching up on yesterday’s condo and the labs.

The reason the reference ranges on the lab tab are different from yours on Nelli’s labs is the lab used. The reference ranges on the lab tab are Antech and Nelli’s vet uses IDEXX so just adjust the reference ranges and add the tests that aren’t on there as IDEXX does do some different tests (e.g. SDMA).

Nelli’s labs look pretty good except the protein in her urine and I agree it’s a good idea to get her blood pressure checked. My vet charges $15 and uses a brand new Doppler. If you look on her labs from June, did your vet use IDEXX then and is there a value there for Creatine Kinase or CPK? I know Nelli has a heart issue; she’s on enalapril isn’t she? When was her last echo? I’m sure you’ve told me but I look at so many labs and discuss heart and kidney issues with so many other members.

The reason I’m asking is because the creatine kinase can be elevated due to heart issues (i.e. cardiomyopathy). There are other things that can cause it as well but I’m just putting a few things together. It’s odd for a cat whose kidney values are so excellent and SDMA is normal, to have proteinuria. So that leads me to think of other issues like high blood pressure just because i know she has some heart issues (right or am I dreaming it?).[/QUOTE]
Thanks Marje, it good to hear from you. The reference ranges I now understand, thanks for this. I need to go back into her file to see if IDEXX was used in June. I will get her blood pressure check this week- largely appreciate your piping in on type of blood pressure checker .
I get so frustrated and start to beat myself up rough when I entrust a vet (because obviously I’m not one) and they screw up at our expense- doesn’t take long for me to remember I am not the professional here. So then “beating myself up subsides .
Remember her last ER trip when she could not urinate? How they did a urinalysis but neglected to do a UPC?!? Well, she had a urinalysis again this week- at beginning of appointment One thing I mentioned was my concern about protein in urine. Told them she needed a UPC test. OK you win the prize if you guess... Did they use urine specimen to run UPC test?
Nelli does not have many more years or months left in her life based upon her age which I am sensitive to and keenly aware of.
I believe it is always extra stressful for her- to continuously be loaded up and taken to ER or simply a GP Vet... having lived on the streets most of her life. Nelli is not the cookie cutter (ECID ) domestic feline, nor was she a feral.
She just happen to have crossed paths with her bestest friend, Krystina, who when well before was able to bring her into her life... had always promised her she’d have a good end to her life . With God’s blessings and my strength, she will.
Last echo, last cardio report...

Thanks for checking in I appreciate it

 

Come on down Nelli!

Looks like she had a lovely normal BP in March when she got her echo. Did the vet check with the lab to see if they still had Nelli's urine on hand to test? Our local Idexx usually hangs onto samples for a few days in case vet's want follow on testing, sonyou don't have to go back again,

 

Thanks Marje, it good to hear from you. The reference ranges I now understand, thanks for this. I need to go back into her file to see if IDEXX was used in June. I will get her blood pressure check this week- largely appreciate your piping in on type of blood pressure checker .
I get so frustrated and start to beat myself up rough when I entrust a vet (because obviously I’m not one) and they screw up at our expense- doesn’t take long for me to remember I am not the professional here. So then “beating myself up subsides .
Remember her last ER trip when she could not urinate? How they did a urinalysis but neglected to do a UPC?!? Well, she had a urinalysis again this week- at beginning of appointment One thing I mentioned was my concern about protein in urine. Told them she needed a UPC test. OK you win the prize if you guess... Did they use urine specimen to run UPC test?
Nelli does not have many more years or months left in her life based upon her age which I am sensitive to and keenly aware of.
I believe it is always extra stressful for her- to continuously be loaded up and taken to ER or simply a GP Vet... having lived on the streets most of her life. Nelli is not the cookie cutter (ECID ) domestic feline, nor was she a feral.
She just happen to have crossed paths with her bestest friend, Krystina, who when well before was able to bring her into her life... had always promised her she’d have a good end to her life . With God’s blessings and my strength, she will.
Last echo, last cardio report...
View attachment 39135 View attachment 39136 View attachment 39137
Thanks for checking in I appreciate it [/QUOTE]
Thank you for posting the echo. I agree with Wendy that her BP looked good back then but things can change and she definitely has HCM. The vet recommended a recheck in six months which is early November but you could at least have the BP checked now. Personally, I have my vet check both cats’ BP once a year and they are both young and healthy altho Tobey has a minor congenital valve issue but it’s been really, really stable anti jinx.

The UPC is not inexpensive and so I’ve often found that vets don’t necessarily mention it but they certainly should with the amount of protein she has in her urine. I mean, heck, how many of us here mentioned it? Three at least....Wendy, Elise, and me. They usually will not automatically run it because it is costly but they should ask. And Wendy is correct that if the UA has been relatively recent, the lab might still have some urine to run the UPC.

 

Yes (apparently...hmm) they did check with IDEXX. They only keep it for 2 days. The UPC urine test cost $94.
While on phone with Vet he mumble swerved, apologized, admitted that his techs misunderstood.
Before the weekend is out I plan on sending him an email Regarding this and my position that I should not be charged at this point. Based upon her blood pressure back in May do you think it’s important for me to have this done now as well?

 

Nelli next appointment with cardiologist, Mulz is the end of October. @Marje and Gracie, what is HCM.

 

I specifically expressed concern with high urine protein and... thanks to you+ here on FDMB I was empowered to request a UPC done?!?
Frustrated? Ya think?!

 

Actually, now that I’m thinking back through this advice I got from you quite a while ago regarding having UPC test done… Based upon high protein in urine – I expressed the same concern the last time they took her urine which again was when she was at the ER four weeks ago and had a urinalysis done than? Sorry to be redundant but – frustrated, you bet!?

 

HCM is hypertrophic cardiomyopathy or thickened right ventricle of the heart. Which is what the echo report said.

 

Ok.

 

To check for proteinuria when there is protein in the urine (sometimes it’s there but it’s not significant but that’s usually only if you are seeing trace or 1+), they typically do three UPC tests within two weeks. Of course, if the first one comes back that she does not have proteinuria, they don’t need to do any further. But there has to be a reason for that much protein in her urine.

HCM is hypertrophic cardiomyopathy or thickening of the heart muscle. Her left ventricle is thickened in the free wall and the intraventricular septum (which is the muscle between the left and right ventricle) which makes it harder for her heart to pump blood to her body. It’s up to you on the BP check. If she has to go in for anything else, I’d absolutely do it. High BP is often silent in cats but if it is high, she risks a stroke, blindness, or worse. However, I would “think” that being on enalapril would help her BP to some extent although she might need something additional like amlodipine if her BP is high. Not all cats respond solely to enalapril.

left

 

Ok. Got it.
To recap, my understanding is... if it were your kitty cat, advice would be , I should have (quite necessary) her UPC and blood pressure checked this week?

 

If she were mine, I would as I’m a helicopter mom.

 

And what if I may ask is your “helicopter mom” reasoning... remembering your kittie is 20+ and...

 

...UPC tested?

 

@Marje and Gracie- I am not questioning what you would do, just trying to understand relating to Nelli specifically if she was your kitty cat. Prudent not negligent

 

Oops, sorry.

I do would get the UPCR done. Proteinuria can speed up kidney disease. Going on the right med, after properly diagnosing the cause of the proteinuria, can lower the protein levels down to normal.

 

I meant if Nelli were my cat; I wasn’t talking about my own young cats.

Why? Because that’s how I am......I want the full picture. Obviously, Nelli does not have kidney disease right now which is amazing for her age. But something is going on and it’s possible it could be easily treated with benazapril without affecting her QOL. For me, it would be one thing if my kitty her age had CKD or other comorbidities with a short timeframe to live but, as far as we know right now (paws crossed), that’s not Nelli.

However, she’s your kitty and there’s no judgement here but I would absolutely get a BP because you do not want her stroking out when it could be prevented.

 

Thanks. I am going to take her in for BP test this week. Nelli is not a pin cushion- as Nelli is loaded up and rushed off to a vet each time I have learned to question “why”, become more inquisitive and “decline” recommendations.
Nelli has become subject to, has had too many test done or recommended that we’re not dire.

 

This being the case based upon her Labs last week, would it be necessary to have a UPC test drawn? If her kidney values are excellent and SDMA normal could she still have Protienuria?
I’ll have it done if there is a possibility it would be positive-
I am so confused!
I am starting to think like I am trying to analyze and diagnose. No years under my belt in Veterinary School for this .
I will get her BP checked as soon as tomorrow if we can get in.
UPC test? Confused.

 

Her labs confuse me. If a trace of protein or +1-2, I would just retest in a month. A +4 is significant and her kidney numbers aren’t high which begs the question why. She was also +3 in June. According to Tanya’s site diabetes and heart disease can result in protein in the urine as can infection. If the BP is high I might skip it. If normal, I would want to check again either now or a month from now. It’s up to you. If you trusted your vet I would ask but I’m not so sure you do.

 

Elise’s comment above is what I was also telling you. It’s possible the HCM is the culprit because we know she has it, her creative kinase is high, and she has a lot of protein in her urine (protein in urine can = proteinuria = heart issues).

When their is protein in the urine, we first suspect kidney disease but that’s not the only thing that causes it. That’s where you first find out if it is significant by doing the UPC. If that comes back normal, no worries. If it doesn’t, then the next step would be to try and find what’s causing it or just treat it.

Yes, Nelli will need to go in for a BP but they will just put a cuff around her tail so no sticks.

If you decide to have her UPC checked, if you get test tubes and pipettes, from the vet, there should be no reason to take her in for the urine collection. Just catch urine in a large spoon as she pees and then decant it into the tube they gave you using the pipette. There are some studies that indicate the UPC can be affected if you put the urine in a plastic container because the plastic coating can bind protein so it’s best to get the tube from the vet. Mid-day samples are the best to collect but, hey, when they pee, they pee so you don’t always have that choice.

 

Thanks... I’m going to respond more completely in today’s condo which I am going now, to create !

@Wendy&Neko Wendy, I don’t understand why you say “Proteinuria can speed up kidney disease” Nelli does not have kidney disease, does she?