Anemia and Prednisolone

Fred is 10 and was diagnosed 12/09. He was off insulin as of 3/10, but recently he developed anemia (red blood count 14). The vet suggested Prednisolone (5mg) twice a day, which increased his red blood count to 32 after one week. However it caused an increase in BG. He's comfortable at around 90 and it shot up to 235.

With twice daily monitoring and insulin, his BG came down to around 120 (1u AM and 1u PM). The vet suggested dropping to 1 Prednisolone in AM. After one week his BG then dropped to 80-90 range and I stopped insulin. Today his red blood count was down to 26. The Vet felt that this was now a more serious situation. At first we thought he may have had parasites -- she's now talking cancer.

The Vet doesn't know what kind of cancer, but she wants me to bump up the steroid to 2 times as day as before and prepare for more insulin injections. She also said that she doesn't expect that we will be able to extend his life much beyond 3-6 months. She says the steroid will begin to "eat away" at his muscle tissue and that he will become more lethargic, etc.

The picture is terribly grim and it was such a shock since Fred and I were doing so well with diabetes. Is anemia a diabetic side-effect or something else entirely, like cancer? Should I get another opinion. What about these steroids -- are they dangerous? Is there a better brand than Prednisolone? Can diet or natural substances make a difference?

You've all helped me so much in the past. Please give me advice on this latest, most scary, challenge.

Thanks,
Fred and Kathleen

 

Have x-rays and/or ultrasounds been done to help see what s going on? Anemia is NOT a side effect of diabetes. I would go to a specialist.

 

It sounds like your vet is going about this all wrong really. Steroids like prednislone are given in order to calm down the immune reaction and inflammation caused by the possible parasites. If it helped his RBC the more he was given, then this seems to confirm parasites. The infection he is most likely talking about is the same thing Yoda is going through right now as we just discovered. I have a thread running here on health about his treatment protocol right now. Has your kitty been tested for the organism? The old name for the test was hemobartonella (a PCR test) and it will test for the presence of all 3 types of this organism. The best way to get rid of it is with at least 3 weeks of a strong antibiotic, and sometimes paired with a steroid to help the inflammation/immune response. It seems like your vet decided to use the secondary treatment that does not get rid of the disease instead of going the route that would give a better long term prognosis.

I would not suspect cancer unless other blood values are off too. Have you had a full blood panel done recently? I am guessing that is how you found out about the anemia.

ETA - regarding anemia as a side effect of diabetes - not really, but they can be connected. Diabetes stresses kitty's system and causes him to become more susceptible to being infected with the organism and it taking hold.

 

Norton was anemic, but he had an inoperable intestinal cancer that was leaking blood into his abdomen at the time.

We did not treat the anemia because when we discovered this, we helped him cross the bridge. (he had a lot of pain)

 

Yoda and Kelley,

I don't really understand all that you wrote, because I'm still trying to get my head around Fred's problem. Blood work has been done on
each Friday of the last month. The Vet never mentioned an "organism", just the possibilities of parasites. Fred was given a week of antibiotics (horrible pink stuff that made him gag and look like he'd been stabbed when it sloshed out of his mouth!!). Because his RBC was much lower, she took him off of the antibiotic after about 10 days of the twice-daily dose. She concluded that it was parasites and said to just give him the steroid. Then, when the RBC came down 6 points, she said the steroid wasn't working and that it must be something more serious, like cancer.

Let me just say that this may have something to do with a cat attack Fred had back in April. He's been tested and found negative for Feline Leukemia, but he was hurt badly by the other cat -- puncture wounds all over this left shoulder and leg. Also, Fred loves to catch and sometimes eat chipmunks -- and the occasional bird. Could any of this contribute to his condition? Have we left the idea of parasites too soon?

I'll try to find your "thread" to understand what Yoda is dealing with and see if it matches Fred. At this point, I don't know what to ask the Vet to do. She told me to start giving him 5mg (one pill) in AM and 2.5 in PM. Is this going to make things worse? I don't mind giving insulin shots, but I don't know what's coming next.

This is all new territory for me. Oh, and we have not had ultrasounds or x-rays done because the Vet says they will be very expensive and I'm on a fixed income. This is just so hard!!

Thanks,
Kathleen & Fred

 

What kind of specialist? We have a trauma center in Richmond, but other than that, I don't know what to ask for.

 

Not to go against what someone else is saying - at this point I would call around to a few vets in town and see what they think about his current situation in order to try to find another regular vet. If that quest is a bust, then contacting a specialist may be in order. I would just hate to spend the money on a specialist if a different regular vet could help you just the same.

 

Based on what the current vet has done, I would go to another vet for a second opinion. Make sure you bring detailed record from you vet and not just the blood tst results.

 

Sounds like a good idea. Here's another thought....this is a large veterinary practice. I haven't worked with this particular Vet for very long. I was wondering if I might suggest a consultation with the managing/owner Vet or someone with more years of cat experience. I don't want to hurt anyone's feelings, but a consultation within the practice may be more readily accepted. If that doesn't produce any better understanding of Fred's condition, I could go to another practice. Frankly, I think I'm with one of the best -- it's hard to know where to look next, except for the trauma facility nearby -- and you need a referral for that!

By the way, what kind of records should I expect to get from my Vet in order to get the second opinion? I don't think we've done anything but blood work. I have all his daily BG charts and journals.

Thanks

 

The bloodwork and list of meds given for this situation would be what I would take with me.

 

Hi Kathleen

I would call and ask to speak to the practice owner if s/he's a vet. They won't put you right through, they'll probably take a message, so I would leave a detailed message and ask for the owner to review Fred's record and call you, since Dr. X said at your last consult that Fred had cancer and was going to die in 3 months after getting a blood test result and you're scared and not sure what's going on. Don't worry about getting Dr. X in trouble; if Dr. X really told you that, there is no harm in sharing that with the owner. This will probably get you a free review of your cat's record by the head vet; perhaps you will get more answer with him/her on the case. Let us know what s/he says ok? I would make this call tomorrow morning.

Do not stop the pred abruptly. Keep going until you talk to the other vet, hopefully by tomorrow or Monday. It shouldn't be stopped abruptly anyway.

 

You can bet I'll call first thing in the morning -- or better still, I may write a note to Dr. Baugh, the owner -- who is a practicing Vet -- so that nothing gets misunderstood. I'll be sure to show the appropriate appreciation for all that Dr. Jones has done for Fred in the past (actually not much, this site has helped me more!). Hopefully, I'll get a better idea of what's going on. Incidentally, a very good friend of mine is married to a Vet. I've sent the information (such as I have) in an e-mail for him. With all these contacts -- and your very helpful suggestions -- maybe I'll get some clearer ideas on what I'm dealing with.

This site is a constant source of encouragement to me.....I may have to increase my monthly contribution!!

 

Hi Kathleen

I'd call so that you get the ball rolling ASAP, you need to find out what's going on. You should write down your thoughts so that you express everything you want to when you speak to the owner. Don't worry too much about showing your appreciation for Dr. J; as nice people (and this seems to be a very female trait too!) we are always worried about being too harsh. I'd address the current issue which is her handling of this recent problem.

Please keep us posted.

 

I did it!! Actually I talked to the receptionists who's been at the practice for years and is almost as knowledgeable as the Vet! She understood my concerns and shared the opinion that a test for Hemobart (relatively new, she says) should be done. She also said I may have to consider ultrasound or x-rays. None of this is cheap!!

The manager/owner/Vet won't be in to get my message until Monday, so I'll just have to continue on with Fred's meds until then. He's a little slow this morning, but we're experiencing extremely hot weather, which is slowing down all the cats. Anyway, I hope his condition won't deteriorate much until then. The receptionist promised to note Fred's file for the Vet to talk with her before calling me, so that she will get the gist of our conversation and my concerns.

My unofficial vet friend has given me the name of a local Internist. So, that may be another option down the road.

Fred's eating sporadically, BG 102 this AM (he likes to be around 85), but no shots today. I'm going to ride it out for a while with the Pred. pills.

If you (or anyone else) can think of another "plan of attack", please send me a message. I'll check back soon.

Many thanks!!

 

What great news. The Hemobart test should have been done first if it was at all suspected. I would wait for that test first before you spend hundreds on an ultrasound. Blood tests with my vet are on the cheap side, but the test for us was only $45 and it tested for all 3 forms of the organism.

 

Just so I'll be knowledgeable when I talk with the Vet(s), what are the three organisms you mentioned? Should I refer to them by name, or are they covered when one Hemob. test is done? I don't want to have to go through another possible misdiagnosis, and I want him to get the proper test as soon as possible.

Was your cat exhibiting the same symptoms as Fred? Is he/she still OTJ? What was used to treat the Hemob. condition in your case? Is there anything else I should ask about before we go the ultrasound and x-ray route? And, lastly, if we haven't caught the Hemob. in time, how long does Fred have?

No rush on the answer....I'll check back here this afternoon. It's now 11:12pm.

Many thanks for your continued support!!

 

What physical symptoms of anemia does your kitty show? Pale gums, anorexia/inappetance, lethargy, etc? Yoda isn't showing any signs of anemia, but we are trying to prevent him from getting worse right now. Since your kitty responded well to the pred, then I personally think there is a real good chance that you guys can turn things around just fine.

The new hemobart test is called Feline Hemoplasma Mini Panel PCR and will test for the 3 types of mycoplasma: haemofelis, haemominutum (what Yoda has), and turicensis. The usual treatment for this is 3-4 weeks of a strong antibiotic - usually tetracycline or doxycycline. Some vets will pair the antibiotic with a steroid like pred in order to lessen the immune response to the organism and lessen inflammation. This organism attaches to red blood cells and the body's immune system attacks the red blood cells in an effort to get rid of the organism, resulting in anemia.

I think your lab may use different values of measurement for the counts. Maybe you could post what is the normal range listed on the blood work, and that will tell us how far off your kitty is. Here is Yoda's results:

RBC 5.6 (normal 5.92-9.93)
HGB 8.7 (normal 9.3 - 15.9)
HCT 24 (normal 29-48)

Other than this, his MCHC is a bit out of range on the high side, but nothing else is out of whack. Are there any other blood values that are not in range for your kitty?

 

I must sadly admit that I don't know ANY of these numbers for Fred. All I was told is that his red blood count was 14 when I first took him in on 6/28. He was said to be anemic. He was exhibiting lethargy, poor eating, & normal BG #'s. His reaction to a week of Vbramycin and Prednisone was immediate. His red blood count went to 32, which is considered normal by my Vet, but his BG's jumped to the 200's and I had to start administering insulin.

When we dropped the antibiotic and kept the Pred once a day, his BG's went back to normal, but his red blood count went to 26. This is when the Vet said she didn't think the problem was parasites, but cancer. And, that's where we are now. I'm giving 1 Pred in AM and 1/2 in PM. His BG is in the 80-100 range. He looks a little "slow" but eating and drinking as usual. Not chasing as many birds!

I'm going to copy your note to me so that I'll have the right words to say about the Hemobart possibility. I'm afraid I won't know the right questions to ask to get to the bottom of this problem.

Let me know if there's something else I should know before I talk with the various Vets on Monday.

Right now -- I just feel drained!

 

Thanks for the info. It is your right to have a copy of the bloodwork to take home, so maybe you can also request that they copy it for you. How long were you on the antibiotic before it was stopped? Was it only one week? If that helped the anemia a bit while you were on it, then I still think it is the hemobart and not cancer. Antibiotics would not have improved the anemia if it was due to bleeding from cancer somewhere I don't think. Sometimes some antibiotics don't take care of everything and another round needs to be given, or another antibiotic tried. And also, the usual regiment is to give the antibiotic 3-4 weeks to work for this type of organism.

 

You make a good argument for Hemobart. Fred was only on this antibiotic for 1 week. It was so much trouble getting the pink stuff down his throat that I didn't question taking him off -- especially since his RBC went up 22 points! Today, He still has pale gums from the anemia, but he's eating well and doing most of the things he usually does -- maybe not with as must "gusto".

My Vet's office may want to do the testing, etc. in-house. However, I'm wondering if an Internist would be a better choice for this diagnosis. There may be one in this practice, but I've not heard of him/her. If I decide to see this specialist in another practice, should I ask for all the records or will they have everything sent over? (Not sure if animals are handled the way humans are with doctors.)

This morning I'm going to spend some time really understanding what antibiotics and steroids do, so that I'll be more knowledgeable about Fred's reactions to both. For instance, why would an antibiotic/steroid combo bring his RBC up 22 points in just 7 days? And, why did it drop from 32 to 26 when the antibiotics were stopped? I thought the steroid was supposed to correct the RBC problem -- not antibiotics. And, why did the Vet automatically suspect cancer just from that reading. Also, what really causes anemia -- is it only cancer? Why did the Vet dismiss the possibility of parasites -- which may have needed prolonged treatment to cure? And, why didn't she recommend the Hemobart test?

Of course she may be right about cancer and his shortened life -- and I'm just grabbing at straws. Maybe the ultrasound is the way to go just to be certain. I was never this pro-active with my other cats. One got cancer from the Leukemia shot. She lived one year with terrible external lesions. One, years later, got a "floating" cancer in the abdominal area that could not be treated. He died in 10 days. I never questioned the Vet's diagnosis or treatments because these were fairly obvious. But, this time, things aren't "ringing" right. Plus, I've had the experience of this site's counsel -- I learned more about diabetes, diet, shots, etc. than the Vet EVER told me. So, I find I question more and struggle more to get my head around these problems as they come up.

Sorry to be so long-winded. Thanks for "listening."

 

This decision is up to you. For me, I would have the hemobart PCR test and see what that gives me. If you still come up empty handed, then I would see a specialist. IM specialists cost so much more than regular vets that I try to get everything done that I can with my regular vet first. Some vets will forward on the medical records for you. It would be a good idea to ask just to make sure. I ask for copies of all tests and bloodwork for my records anyway. That way I don't have to rely on my memory of what I was told.

Hemobart is a very small organism that does not have a cell wall. It lives inside the cells of the host animal. It attaches itself to red blood cells in the body. The body recognizes something is now not right with the red blood cell and sends out the immune system to fight it, which ends up killing the infected red blood cells causing anemia. This increased immune response often causes inflammation in other areas, most notably in the mouth, which can look like gingivitis. Steroids are prescribed to take down the level of inflammation in other areas and the antibiotic is prescribed to kill the organism living in the cells. The antibiotic is the most important drug in the treatment protocol, which is why you saw his RBC decrease once he was taken off of it - not all of the organism had been killed since he was on it for only a week. His RBC increased while on the antibiotic because the organism was being killed so the body no longer had to attack the red blood cells.

Anemia can be caused for a variety of reasons. There are regenerative anemias where the body tries to correct the problem, and there are non-regenerative anemias where the body doesn't produce a hormone that tells the bone marrow to produce enough red blood cells. There are a wide variety of causes for regenerative anemias. Bleeding from trauma or cancer, and infection are just two. I really don't know why your vet suspected cancer without knowing the other values on the blood work, but I still really think he shows the appropriate indicators that it may be due to an infection. Vets are a lot like human general practitioners. They know a little about everything and know a lot about what they see all the time. This vet may not have been exposed to many anemia cases. With any doctor - human or pet, you have to be your own advocate most of the time.

 

Kathleen,
I keep a binder of all papers, bills, test results, lab reports, etc, one binder per cat.
I put the items in clear plastic sleeves so that each reads like a book.
I have a section for blood work, one for special tests, u/s, Xrays, and dental, and one for payments with receipts. I take the binder with the cat on every visit and include an up-to-date copy of BG numbers spreadsheet.

You paid for the tests and treatments; you are entitled to copies of everything.
I don't put all that much faith in words like 'all numbers are within range'. Oh really? And how do they compare to the last tests? What values are up or down? Which ones are close to a range limit and should be watched? Which ones are looking much better?

No. I want the copies and I will do my own research, and be asking questions on the numbers.
Also, when you have your binder of all the data relating to Fred, you can easily take Fred and his binder to any vet you want for a 2nd or 3rd opinion.

You will then be in control and be better equipped to deal with Fred's issues.

 

Thanks for the great ideas about record-keeping. I keep a copy of all the bill info I'm given, but I've never asked for copies of the test reports. I'm going to ask for all that, starting back when he was first diagosed with Diabetes (12/09).

And, Kelly, I really appreciate your explanation of Hemobart. That will be a big help to me.

Could the cat attack, complete with puncture wounds, have ad anything to do with bringing this on? No Feline Leukemia....but could there be other issues down the line from such bites? He recovered and is apparently healed, but it really took the wind out of Fred for about 2 weeks. Just a thought.

By the way, Kelly, Fred looks almost EXACTLY like your Oscar. I'll have to figure out how to post pictures of my brood!!

Thanks again!

 

If blood was exchanged from an infected cat to your Fred, then yes he could have got it from the bite. The usual mode of transmission is from flea and tick bites though. Since it is a blood born organism, there must be infected blood to host blood contact.

Gayle - what a good idea about putting everything in a binder. I'll have to set one up too!

 

Sorry to ask this here, but I'm not sure where to ask.....how do I upload Fred's pic so it will show on my messages? (Hope the Webmaster doesn't zing me!!)

thanks

 

I'm not sure that your vet clinic will have the ability to do a reticulocyte count, which is something else that they really should be monitoring. Right now, it looks like they are simply monitoring his hematocrit levels. (not his rbc counts--those would be reported in the millions, not double digits)

The fact that the hematocrit increased (and fairly dramatically) while on steroids may mean that you're looking at an autoimmune hemolytic anemia as well, where the body begins to attack and break down it's own red cells. The steroids work to suppress the immune system, which stops the red cell destruction going on in the body. I'm not sure that the amoxicillin he was given would have had any effect if it was hemobart. It looks like hemobart is treated with the tetracycline type drugs, not the penicillins. I'm not so sure that the antibiotic had anything to do with the rise in his hematocrit levels.

Anemia is a symptom of many different diseases. In a nutshell, there are 2 reasons for becoming anemic. It is either due to blood loss or to decreased rbc production. Blood loss can be due to infectious agents such as the hemobart (google feline infectious anemia), increased bleeding (like Phoebe saw with the intestinal tumor), autoimmune hemolysis, trauma, etc.

Decreased red cell production can be seen with chronic kidney disease, bone marrow suppression, leukemias, nutritional deficiencies, etc. This week at work we saw a 14 year old boy with severe anemia due to anorexia--he wasn't getting the nutrients his body needed to manufacture red cells.

For your vet to say that it is either parasites or cancer is a bit short sighted. There are a whole host of other reasons for an anemia to occur and you really need a lot more diagnostic testing to narrow it down to the right diagnosis. I don't know what labs you've had run lately but I would definitely repeat a full CBC with reticulocyte count, a full chem panel, a Coomb's test and the Hemobart panel. I would also request that they do a manual differential as part of that CBC. Sometimes there are things that you can see on the slide that aren't apparent with an automated count.

 

Just a few things that may have been missed here.... Kitty is still on steroids. The hemocrite increased while on the antibiotic and decreased when the antibiotic was taken away. The antibiotic given was a form of doxycycline from what is pulling up on google and not amoxicillin.

 

Here is what I found buried in a thread in the tech forum written by Nancy and Cody:

 

Can you tell me what this means, exactly. Does your research indicate that the other comments may not be correct? I need to get all this straight in my mind before I talk with the Vet tomorrow.

 

Can you tell me what this means, exactly. Does your research indicate that the other comments may not be correct? I need to get all this straight in my mind before I talk with the Vet tomorrow.[/quote]

I posted this because sometimes things can be missed in really long threads that contain lots of information. The previous poster was basing the probability that Fred's anemia is more likely due to his immune system on the impression they got that the steroids caused his numbers to get better when it was the antibiotic + the steroids that made the numbers better. Once the antibiotic was taken away, the numbers decreased again. Also, I think there was confusion over what type of antibiotic was used since amoxicilin is a pink liquid as well, but you really used a type of doxycycline. Please correct me if I got anything wrong here. I'd hate for you to get confused about anything because some facts slipped between the cracks.

Based off what you typed here, the steroids did not help the anemia numbers. It was the one week on the antibiotic when the numbers increased - yes?

 

Correct. When he got the steroid twice a day and the antibiotics twice a day, his numbers went from 14 to 32. When the antibiotic was taken away, but the steroid was still given twice a day, the number went to 26. Right now I give him 1 steroid in am and 1/2 in pm. The vet said I could give one, 1 1/2 or 2 -- my choice. (That sounds strange, doesn't it.) I want to keep his BG from going through the roof, so I've opted to do it this way. I still need to fight the anemia.

Hope the longer previous messages weren't too confusing. I appreciate your vigilance!

 

Can you clarify which antibiotic he got?

Also, has his prednisone dose remained the same, been increased or decreased? The actual doses aren't very clear.

 

He was on Pred. 5mg twice a day for 2 weeks. Then 1 pill (5mg) for one week. Now we're back to 1 in AM and 1/2 in pm.

I know the Pred is supposed to help the anemia, but my question is, why not leave him in antibiotics if taking him off caused the red blood count to go lower. Pred was the constant factor. Only the antibiotics changed. Does that tell us something about his condition?

You may understand this better, but it's not sounding right to me.

Thanks

 

The antibiotic used was Vbramycin - a liquid form of Doxycycline.

Kathleen - I've been thinking about Fred all morning. Please let us know how the conversation goes with the vet today!

 

You are so very kind to be thinking of Fred. I feel as though I'm on the edge of a cliff. I called again this morning and spoke with the front desk manager (Cookie) who knows me and Fred. She had promised to give Betty Baugh (Owner/Vet) the message that I needed a review and she, Cookie, was going to explain my interest in the Hemobart test.

When I called at noon, Betty Baugh had not talked with Cookie. Whether or not she was in over the weekend and is looking at Fred's chart, is anybody's guess. She can access all the info via their computer system. HOWEVER, not to give up -- and, by the way, I'm trying to be very very nice so they'll work with me -- I asked for copies of all Fred's records back to Dec. 09 when he was diagnosed with diabetes.

I have them in hand, but, I really can't decipher them. Wish there was a way to scan them and send them to you for a look-see. I was about to sit down and try when I saw your message.

Let me see what I can find and I'll try to post some #'s that will mean something to you.

Back in a little while.

 

There were lots of notes, but here are results on the blood work charts. (Blocks of Low, Normal & High with a dot indicating where in that range the numbers fall. E.g., a number that fall to the lower side of normal is called "low normal".) See what you can make of this.

Dec. 24, 2009 (Diagnosed with Diabetes) Second #'s are June 28, 2010 (Cat attack was 4/23 Treated with Metacam S/D 0.60ml)

RBC 5.87 ( low normal) 0.65 M/ul ( VERY LOW)
HCT 26.9% ( high low) -% (out of reportable range)
HGB 10.0 g/dl (low normal) 4.3 g/dl (VERY LOW
MCV 45.9 fl (low normal) -% (out of reportable range)
MCH 16.98 pg (normal) -% (out of reportable range)
MCHC 37.0 g/dl (high normal) -% (out of reportable range)
RDW 19.5% (normal) -% (out of reportable range)
Retic 14.4 K/ul 34.1 K/ul
WBC 9.82 K/ul ( low normal) 6.04 K/ul ( low normal)
% NEU 73.7% 30.1%
% Lym 14.5% 57.9%
% MONO 5.4% 6.2%
% EOS 5.8% 5.4%
% BASO 0.6% 0.4%
NEU 7.24 K/ul (mid normal) 1.82 K/ul (low
LYM 1.43 K/ul (low normal) 3.50 K/ul (normal)
MONO 0.53 K/ul (low normal) 0.38 K/ul (low normal)
EOS 0.57 K/ul (high normal) 0.33 K/ul (low normal)
BASO 0.06 K/ul (normal) 0.02 K/ul (low normal)
PLT >206 K/ul (low normal) 1059 K/ul (VERY HIGH)
MPV 15.56fl 12.89 fl
PDW 23.8% 27.1%
PCT 0.3% 1.4%
(PLT aggregates detected (PB 5) (Too many RBC fragments. Confirm PLT value with blook film.)

BUN 16 mg/dl (low normal) 23 mg/dl (normal)
CREA 1.0 mg/dl (low normal) 1.7 (normal)
BUN/CREA 16 14
PHOS 3.8 mg/dl low normal) 3.9 (low normal)
CA 8.3 mg/dl (low (normal) 8.4 mg/dl (low normal)
TP 7.1 g/dl (normal) 8.4 g/dl (high normal)
ALB 3.0 g/dl (normal) 2.7 g/dl (low normal)
GLOB 4.1 g/dl (normal) 5.7 g/dl (LOW HIGH)
ALB/GLOB 0.7 0.5
ALT 71.U/L (normal) 52 U/L (normal)
ALKP 78 U/L (normal) 38 U/L (normal)
GGT <0 U/L (low normal) <0 U/L (low normal)
TBIL 0.5 mg/dl (normal) 0.5 mg/dl (normal)
CHOL 163 mg/dl (normal) 80 mg/dl (low normal)
AMYL 515 U/L (low normal) 964 U/L (normal)
LIPA 370 U/L (low normal) 743 U/L (normal)
GLU 397 mg/dl (HIGH) 111 mg/dl (normal)
Na 154 mmol/L (low normal) 161 mmol/L (high normal)
K 5.3 mmol/L (high normal) 4.2 mmol/L (low normal)
Na/K 29 38
Cl 117 mmol/L (low normal) 117 mmol/L (low normal)
Osm Calc 324 mmol/kg (normal) 322 mmo/kg (normal)

PCU = 300/D 14.5%
BC = >1 1
TS = 8.05/d 8.65 dl
S = 10 NL (?) USL (?)

 

Sorry that they ran all the numbers together -- I had them nicely separated!!

I just found this report from IDEXX Laboratories relative to a T4 test. Fred's result was 1.5. The reference range is 0.5 - 4.7 ug/dl. That puts his number in the low-normal range, I think.

Their notes say this: Cats with subnormal T4 values are almost exclusively euthyroid sick or overtreated for their hyperthyroidism. Older cats with consistent clinical signs and T4 values in the grey zone may have early hyperthyroidism or a concurrent non-thyroidal illness. Hyperthyroidism may be confirmed in these cats by adding on a free T4 or by performing a T3 suppression test. Following treatment with methimazole, T4 values will generally fall within the lower end of the reference range (0.5 - 2.3).

I don't think I need to worry about this. What are your thoughts?

 

I don't have experience with hypert, but that value is almost exactly the same as Yoda's T4 and my vet never raised any alarms about it.

All the values that are out of whack are related to anemia - I see nothing that suggests cancer from the blood work alone. The elevated globulin count can be due to a chronic infection (parasites or bacteria/viral) which would fit the bill for the hemobart too. The retic. count shows a regenerative anemia - which is good. The reticulocyte count increased when the anemia got worse, which means the body recognizes its in trouble and is trying to produce more red blood cells. The recticulocytes will normally increase once the anemia gets to a certain stage. You will not always see the retic count rise with a mild anemia. The sharp decrease from December to June really concerns me. Are these the values after the week of an antibiotic or before the antibiotic? I would strongly suggest getting a hemobart PCR test as soon as possible. Since the AB helped that one week that he was on it, it won't hurt to go ahead and start him back on it while you wait for the test results to come back. Hopefully the vet you talk to today will be willing to give you the script.

 

Kathleen, you need a 2nd opinion and you need it now. If that hgb value is correct, then your vet should be treating this much more aggressively. That is a life threatening value. Hemoglobin is the molecule that carries oxygen throughout the body---too little hemoglobin can result in severe respiratory issues.

Was all of the testing done at Idexx? If so, I know what hematology analyzers they use--and while they're very good, they're not perfect. I do wish the person running this test had taken the time to spin a hematocrit and calculate out the other values.

That said, i think your cat has a severe hemolytic process going on and your vet should be more concerned about getting to the bottom of it immediately. If my vet didn't seem concerned about values that low, I would fire him immediately---and i love my vet. If I were you, I would get a 2nd opinion scheduled ASAP.

 

I second this opinion. Those numbers from June are scary!

 

OK. Thanks for looking this over. I have a contact with another Vet who says he can recommend a good internist. Should I take that route?
With the Pred. I'm getting higher BG levels than I've had in months. Up to 212 at this PM. However, Fred seems to be OK. Not lethargic, eating, drinking and urinating -- all seems OK -- for now.

I'll read over your notes so I can ask for the right things -- IF I get to talk with Betty Baugh tomorrow. When you say "immediately" do you mean day or weeks until his condition becomes life threatening?

Thanks.

 

Oh-I forgot to answer....the T4 test and the other blood work was done through IDEXX. If that's who they use, how can I ask for another company to do the tests? Who would you recommend?

 

I cannot recommend a company since our blood work is done through a lab only an hour away. Based off of his June numbers, and I know he is slightly better after the 1 week of antibiotics, I would push for an appointment, blood work, and an AB prescription this week. The sooner the better - tomorrow being the best. If the values go too low, then Fred will need a transfusion, and we really don't want it to get that bad.

 

What is a "hemolytic process"?

So what you're telling me, is that, based on the large numbers of cats they see each week, these numbers just mean "cancer" to them. Nothing else. No further discussion. Just send him home to spiral down and die in 3 months. THAT'S INCOMPREHENSIBLE!!

I'll calling the specialist from the other Vet TONIGHT!!

 

Well, I couldn't do much at the other Vet , but leave a message for them to call me. I understand thy have a new Oncologist as well as an Internist. Which would you suggest I schedule an appointment with?

And, Please, Please.....give me some intelligent questions to ask, so that I can get them to "think outside the box". For some reason, if it is an infection, I just believe it all started on 4/23 with that cat attack. He's never been quite the same since. If not, it's a strange coincidence.

What tests do I need to ask for? What type of antibitic? What about stopping the prednisone?

I have pages and pages of notes from this site and his paperwork from the Vet. I hate to sit there and plow through it all while the Vet waits.

Suggestions??

 

Hemolytic anemia is when the red blood cells are prematurely destroyed. Hemobart would classify as this since the body destroys the red blood cells the organism is attached to.

* Ask for doxy again up front since it helped before, and go ahead and get started on it.

* Ask for the hemobart PCR test - and any other tests they recommend after that.

* Ask for a current CBC to be run if the last blood work was more than 2 weeks ago.

* Do a full physical exam so they can feel for any masses or enlarged organs.

* Ask why the other vet thinks it is cancer even though the ABs worked

* Stay on the pred since it is helping with the immune response


I would schedule an appointment for the internal medicine doc and not the oncologist. The IM vet will have knowledge in both areas.

You might be able to get in sooner with a local vet rather than a specialist. Do you have other practices in town that you can call tomorrow too in case the specialist can't get you in soon enough?

edit: If it is an infection, I don't think it started in April since the blood values were low back in December. I think it has been brewing since last year and it is just getting to the critical point. :cry:

 

Oh - I just came across this information about his Urinalysis (done in-house). First numbers (6/28/10) Second numbers (12/24/09) Sorry, I typed them in backwards. The most recent numbers are first!

Cystocentesis collected in house
Color: Yellow.....Virtually colorless
Appearance: Clear.....Clear
Specific Gravity: 1/053.....>1.040

Leukocytes (++)......(+)
Nitrite: Neg.......Neg
Urobilinogen: 0.2....0.2
Protein: (+++).......Trace
pH: 7.0.....6.5
Blood: (+).....Neg

Sp. Gr Tread on Refractometer:
Ketone: Neg.......Neg
Bilirubin: Neg.....Neg
Glucose: Neg.....2000+g/dl
SEDIMENT:
Rc's: 12-13/hpf.....NSF/hpf
Wbc's: occasional/hpf....NSF/hpf
Crystans: Neg.....NSF
Bacteria: Neg....NSF
Casts: Neg...NSF
Epi: neg....NSF

If something jumps out at you, let me know so I can include this in my discussion -- if I ever get to have one!!!

thanks, again.

 

My regular Vet hasn't call back yet (10AM EDT). I left another message at 7:30am

Have an appointment with the Internist (big bucks!!) at 10:30am. PLEASE keep your fingers crossed that she can define this problem and help my Fred!!

I'll let you know the results.

Many thanks!

 

See what you think of this....Internist (10:30-2PM)

PHYSICAL EXAM FINDINGS: No significant abnormalities
DIAGNOSTIC TESTS: 1. PCV/TS: 24%, 9g/dl 2. Health check (Complete blood count & chemistry) 3. Feline anemia panel.
Chest radiographs and abdominal ultrasound were recommended but declined until pending blood work results are available for evaluation.

ASSESSMENT / DIAGNOSIS: Fred is mildly anemic today (PCV 34%) but clinically stable and healthy. There are many causes of anemia, however infectious causes should not be ruled out based on prior clinical response to treatment with antibiotics and prednisolone. A blood panel testing for infectious agents has been sent out, however because of prior treatment with antibiotics false negatives may occur. Therefore we have started him on antibiotics due to suspected infectious causes of anemia. We have also submitted a sample to reassess Fred's protein levels which were high on initial examination in June. If Fred continues to be lethargic or persistently anemic, further diagnostics (chest radiographs and abdominal ultrasound) should be considered to look for evidence of neoplasia or other causes of anemia.

TREATMENT / DIAGNOSTIC PLAN SUMMARY: We will call you with the results of blood work, at which time we will discuss further diagnostics/treatments if neceaary. We are sending him home on an antibiotic to empirically treat some fo the infectious causes of anemia. Also continue administration of prednisolone prescribed by Dr. Jones. Fred should be receiving 5mg in the morning and 2/5 mg in the evening by mouth.

PRESCRIBED MEDICATIONS: Doxycycline 50mg/ml suspension / Qty: 25 (Rx #:13792) Give 0.75 ml by mouth every 12 hours for 14 days or as directed.

RECOMMENDED AT-HOME and FOLLOW-UP CARE: (1) We have tentatively scheduled Fred for recheck evaluation and further testing on Monday July 26th. Fred should fast prior to this appointment. Fred will need to stay with us for the day for further testing including ultrasound and thoracic radio-graphs.

I am then given instructions to keep him inside (yeah, right!), to watch his eating, drinking, urination and lethargy -- if any. Also, the color of his gums (which are now pink), breathing, etc.

This visit plus a new bottle insulin just cost me $605 ($100 was the Internist's fee). The ultrasound and thoracic radio-graphs (if needed) will cost another $500+

So, how'd I do???? We're back on the liquid shots into his mouth, which will be a struggle but they flavored it with Chicken and liver (ugh!).....we'll manage somehow.

 

Sounds reasonable. What was Fred's PVC? Under the physical exam finding you said 24% but under assessment you said 34%.

 

Go Kathleen and Fred! Nice to see someone confirm your suspicions and concerns! We'll see what the blood work tells us, but I would like to see Fred on at least 3 weeks of the doxy instead of only 2. Everything I have read says that we really need all 3 weeks to kill off all of the organism - and some kitties need longer on the AB. I am hoping and praying that the blood work gives you a diagnosis and no ultra sound or x-rays will be needed!

I hear you about the awful flavoring - ick! Yoda's is fish flavored. Don't think I'll ask for THAT flavoring again *gag*.

Quick question for you - Does the doxy make Fred salivate a lot when you give it? Yoda has no side effects from the doxy like he did with the tetracycline, but it makes him salivate and I am wondering if he is getting a full dose of the AB. I personally will be talking to my vet this afternoon about it, but was curious if your Fred did this too.

 

I'm not sure about his PCV at this point. The previous vet and current internist have written notes everywhere with no dates -- something I'm going to ask for in future.

Today, Saturday, Fred is a different cat! He's back to his old antics of beating up his sister, Lucy, eating TONS of food, going out to sit on his favorite bench (even in 100 degree weather). Unfortunately, he's also getting stronger, which means he fights taking the Pred. pills and the liquid Doxy. No matter. I'm getting it down.

Kelly -- I'm not seeing any "side effects" after giving Doxy (sorry to be so long to respond to that.) It's "chicken flavored" and he hates the syringe, but when it goes down that's pretty much it. Fred's a drooler my nature -- pet him and you get soaked. Once, in the beginning, I think I jabbed the back of his throat, which made him spit up a little. But, I learned to do better with "side delivery" and that hasn't happened again.

His BG, normally around 100, is now around 225. He's back on insulin (1 to 1.5u AM/PM), but that was to be expected with the Pred.

The more I see his progress, the more I think we're dealing with Hemobart or something similar. However, Fred's does follow-up blood work and the entire lab results will be in on Tuesday (had to wait for vet to come back to work!!). I'm going to push for another week of Doxy, as you suggested. Shouldn't be a problem -- if my credit card hold out! In the meantime, I'm just so thankful to have him up and moving around and pretty much himself again. "Lucy's" not so crazy about it!!

Stay tuned!

 

What a great report! I am so glad Fred is feeling better. Keep us posted!

 

I don't have all the numbers yet -- will see the Internist tomorrow -- but she just called to say all the blood work from last week looks really good. His bone marrow is making the necessary red cells, and his tested negative for HIV and Leukemia. She said something about the kidneys reading low so I'll ask about that.

But, the BIG news is that he tested POSITIVE for Hemobart. So, that must be it and they just didn't catch it at the other vet. Plus, this vet says she wants to keep him on Doxy for another 2 weeks -- three in all -- then retest, then wean him off of Prednisilone, then retest, pushing the visits farther apart until we know we've gotten all the organisms that were causing the anemia.

His BG was 245 this AM (down from 295 last PM). He's now on 2u of ProZinc. I'm sorry to have to give him so many meds, but he's doing so much better that I'm not complaining -- even when he's getting too strong to hold, now. Eventually, his BG's will come down to where we can regulate with diet -- as before. If not, two shots a day won't be a problem at all.

I'll check back tomorrow with the final numbers from the lab.

Thanks for all your wonderful knowledge and support -- you saved Fred's life!!!!

Kathleen & Fred

 

flip_cat What good news! Not that we wish for parasites, but this is MUCH better than cancer!!! I am so glad to hear that Fred is getting better and glad to hear that the specialist is going to keep him on the doxy for a little bit longer. :RAHCAT

 

Major kudos to you Kathleen for sticking with Fred and demanding answers. Make sure the internist is faxing stuff to your regular vet, and I would call to lodge a complaint again with the owner, for good measure.

Yay, mycoplasma (hemobart)! Much better than a ruined bone marrow, as it does seem to be responding to treatment quite well.

(Kudos to you too, Kelly, for your excellent attention and support for Kathleen )

 

Kelly....love those cheer-leading kitties!! If I could figure out how to upload the picture, you'd see that Oscar and Fred are absolute TWINS!! :lol:

Jess & Earl....Your comment is "right on". Do you know that my regular vet and the Managing vet-owner have not called me TO THIS DAY!! They had to send the records over to the internist over a week ago, but wouldn't you have thought they'd have followed up?? Is it time to switch vets -- even though they're right around the corner???? :evil:

I'll check in tomorrow with his labs. Thanks again!

Kathleen & Fred

 

Well, here are the WONDERFUL results....

Mycoplasma haemofelis - positive with secondary regenerative anemia. So it IS Hemobart!

Physical Exam showed no abnormalities.

PCV/TS - 34%, 9.1g/dl

Fred is no longer anemic as of today and is clinically stable and healthy. He tested positive for red blood cell parasite which triggered the destruction of the red blood cells by the immune system -- not cancer. He has responded very well to the medications (doxycycline and prednisolone) which will be continued for a full three week course of therapy -- diminishing the Pred. little by little.

He'll be checked by the Internist two days after the doxy course is finished. His BG's have been as high as 295, but we're expecting that to come down with the reduction in Pred. I'm giving ProZinc as appropriate, but she wants me to keep it to 1.5u/day while on Pred. if needed.

He's eating well, playing some, looking for chipmunks and wrestling with "Lucy". The only minor problem is occasional smelly stools, but that's probably the meds.

Can I relax now????

HAPPY DAY!!!

Kathleen & Fred ohmygod_smile

 

Awesome numbers. Paws crossed that the bg's go down once the pred is weaned off!