Hypercalcaemia in a cat

RE: Hypercalcaemia in a cat

Anthony Todd — Fri, 13 Nov 2015 17:18:38 GMT

[quote user="Sarah Keir"]

The most common clinical sign of hypercalcaemia in the cat is... NONE! i.e. no clinical signs, usually incidental finding.[/quote]

Fair enough then. If all the signs and the D+ resolve, as a dinovet, I'll stay under the nearest boulder, not forever though.

If there are no clinical signs do you test every oldish cat that comes in?

RE: Hypercalcaemia in a cat

Martin Atkinson — Fri, 13 Nov 2015 16:28:26 GMT

[quote user="Sarah Keir"]The most common clinical sign of hypercalcaemia in the cat is... NONE! i.e. no clinical signs, usually incidental finding.[/quote]True Sarah,hypercalcaemia in cats is common and usually idiopathic - or at least we don't find out why. But this cat is symptomatic, it has chronic squits with blood, thickened guts, poor appetite and losing weight. Given this, at the age, the most likely cause is still lymphoma.

RE: Hypercalcaemia in a cat

Sarah Keir — Fri, 13 Nov 2015 15:16:43 GMT

The most common clinical sign of hypercalcaemia in the cat is... NONE! i.e. no clinical signs, usually incidental finding.

RE: Hypercalcaemia in a cat

Anthony Todd — Fri, 13 Nov 2015 10:20:18 GMT

[quote user="Martin Atkinson"]if she doesn't act now then by the time it becomes critical it will be too late, I would waste any more mental time of effort over it.[/quote]

Or a more sensible approach might be to sort out the only clinical sign, which could be due to HyperCa [although lists of signs don't all agree, nor do upper blood levels] and suggest repeating the blood test.

As far as I can see, and there are loads of lists of symptoms on Dr Google; diarrhoea, mentioned by some, and the opposite, constipation by others, others mention both [??], which doesn't make it clearer to me, added to the value which is less than 10% above the upper normal level.

I have a feeling that the next blood will be normal; one site lists lab. variation as a symptom!

I don't think I'd like an ex-lap and biopsy, based on the evidence so far, if it was me and I'm an ex-lap disciple.

RE: Hypercalcaemia in a cat

Martin Atkinson — Fri, 13 Nov 2015 09:17:27 GMT

[quote user="Kara Gibson"] I've lost count of the number of times I've suggested an ex-lap and intestinal biopsy for this cat but her owner is unwilling to go down this route.[/quote]Then whatever you do don't lose any sleep over it, tell the owner that she has to adjust her expectations and that if is doesn't allow you to your job she cannot expect a resolution, if she doesn't act now then by the time it becomes critical it will be too late, I would waste any more mental time of effort over it.

RE: Hypercalcaemia in a cat

Kara Gibson — Fri, 13 Nov 2015 02:11:21 GMT

I agree a strict diet trial would be useful in this cat for her diarrhoea but a food hypersensitivity still doesn't explain her hypercalcaemia which is pretty significant, is not just a mild increase. I've lost count of the number of times I've suggested an ex-lap and intestinal biopsy for this cat but her owner is unwilling to go down this route.

RE: Hypercalcaemia in a cat

Anthony Todd — Thu, 12 Nov 2015 15:41:24 GMT

[quote user="Martin Atkinson"]

[quote user="Anthony Todd"]I'm not talking about a diet trial for six months, only six days maximum, if compliance is good, then pursue all the other possibilities [see recent posted list....][/quote]It is generally recommended that dietary trials continue for 3 weeks, it is unlikely that a sustained response will occur in less than that so your six days is well off. And some may take up to 10 weeks although if its longer than 6 then a dietary sensitivity is unlikely. I agree that this would be the way forward to start in a young cat but not at 12-13. IME food intolerant/allergic cats show a raised eosinophil count but an intestinal biopsy would still prove definitive. However, if the OP's client doesn't want to go down that route then there is no much of a way forward.

[/quote]

I really can't agree with the above in any way; I think it's total baloney. I don't know what else to say except that no wonder dietary intolerance is so far down on people's list of diagnoses.

We always got a response on the first stool, at least by the second, which might take three days, so where your idea came from who knows, all I can say is it's just not necessary, and perhaps the reason why nobody these days appears to do them right?

I suppose if you were trying to find the culprit and you wanted to go through every food including the "treats" [see posts passim] it could take that long?

Dietary diarrhoea can occur at any age, just try giving most cats, of any age, cream and see! [even as a "treat"]

In the days of tinned food, where fat content was very high it used to be so common [Kaobiotic and Neosulphentrin in 500 tab jars etc] now not so bad at all, as dry food is very low in fat.

Dinovets really knew how to sort them out as we saw so many, mind you I bet owner compliance is just as hard to instill!

RE: Hypercalcaemia in a cat

Martin Atkinson — Thu, 12 Nov 2015 14:33:27 GMT

RE: Hypercalcaemia in a cat

Anthony Todd — Thu, 12 Nov 2015 13:39:43 GMT

"Not withstanding that I can't understand what the hell you're saying here Anthony"

Yeah but the "not withstanding that" is the whole bleeding point!

Although there was a diet trial done my experience is that many clients are certain that half a saucer of cream can't do any harm to a diet trial, and "treats" don't even count.

All I continue to say is that it is very likely, given the history, that it is not a life threatening cancer and, even if it is, it is sensible to eliminate the obvious, less serious, easily treated ,conditions first rather than last.

I'm not talking about a diet trial for six months, only six days maximum, if compliance is good, then pursue all the other possibilities [see recent posted list....]

RE: Hypercalcaemia in a cat

Kate Richardson — Thu, 12 Nov 2015 11:45:30 GMT

Read the op again. chronic diarrhoea only recently sought attention and diet trial performed.

Have you checked T4/TLi/b12?

Causes of hypercalcaemia in dogs and cats:

Acromegaly

Apocrine gland adenocarcinoma

Carcinoma (squamous cell, mammary, bronchogenic, prostate, thyroid, nasal cavity)

Chronic and acute renal failure

Factitious: lipemia, postprandial, young dog (<6 mo old)

Granulomatous disease

Hematologic malignancies (bone marrow osteolysis)

Humoral hypercalcemia

Hypercalcemia of malignancy

Hyperthyroidism

Hypervitaminosis D: iatrogenic, plants (eg, day-blooming jessamine), rodenticides, antipsoriatic cream

Hypoadrenocorticism (Addison disease)

Iatrogenic disorders: excess calcium or oral phosphate binders

Idiopathic hypercalcemia of cats

Laboratory error

Lymphoma (lymphosarcoma)

Metastatic or primary bone neoplasia

Multiple myeloma

Myeloproliferative disease (rare)

Primary hyperparathyroidism

Skeletal lesions: osteomyelitis, hypertrophic osteodystrophy

RE: Hypercalcaemia in a cat

Martin Atkinson — Thu, 12 Nov 2015 10:51:25 GMT

[quote user="Anthony Todd"]My simple trial would have eliminated the obvious presenting sign as a diagnosis within 3 or 4 days max., which, playing percentages instead of blood values, and the other expensive non-confirmatory but expensive tests, would be so much cheaper, simpler and have a greater chance of success than the much rarer lymphoma.[/quote]Notwithstanding that I can't understand what the hell you're saying here Anthony (other than I expect its banging on about not doing what in your usual dinovet opinion are unnecessary and expensive tests albeit the rest of thus think they would be useful) I would suggest that intestinal lymphoma or other neoplastic conditions, far from being rare, are probably the most common cause of severe, unresponsive diarrhoea in old cats and probably very under-diagnosed by those who don't care to look.

RE: Hypercalcaemia in a cat

Anthony Todd — Thu, 12 Nov 2015 00:43:07 GMT

[quote user="Martin Atkinson"]Because a primary food intolerance is highly unlikely in a previously asymptomatic 12 year old cat whereas lymphoma is highly likely.[/quote]]

In a 12yo cat with no symptoms other than chronic diarrhoea and an abnormal blood value? Could the two things be related, I have to suggest.

My simple trial would have eliminated the obvious presenting sign as a diagnosis within 3 or 4 days max., which, playing percentages instead of blood values, and the other expensive non-confirmatory but expensive tests, would be so much cheaper, simpler and have a greater chance of success than the much rarer lymphoma.

Some cats, of any age will get D+ with a small amount of cream, say, [as a treat], at any age......

To paraphrase an old vet who I still admire "my cats only get ordinary things wrong with them" to which I would add "usually".

PS and this might be relevant too:

Would have thought at least one sign would fit but some seem to be actually opposite????

RE: Hypercalcaemia in a cat

Martin Atkinson — Wed, 11 Nov 2015 18:18:22 GMT

[quote user="Anthony Todd"]why don't you start by a simple, single protein diet of boiled chicken or fish, and water, nothing else, no treats, no milk etc. etc. [/quote]Because a primary food intolerance is highly unlikely in a previously asymptomatic 12 year old cat whereas lymphoma is highly likely.

RE: Hypercalcaemia in a cat

Anthony Todd — Wed, 11 Nov 2015 17:19:26 GMT

[quote user="Kara Gibson"]Any ideas on where I can go from here?[/quote]

At risk of being accused of turbo-posting yet again why don't you start by a simple, single protein diet of boiled chicken or fish, and water, nothing else, no treats, no milk etc. etc. Compliance may be a problem. particularly with "her mum"....

Many of the changes described may just be due to the D+ so why not see if that sorts it out rather than chasing blood values which seems to be the thing to do these days.

If there's no change then, I agree, a high dose of pred, is the next step.

RE: Hypercalcaemia in a cat

Robin Grimmer — Wed, 11 Nov 2015 11:03:17 GMT

free webinar yesterday on hypercalcaemia:

www.thewebinarvet.com/webinar/the-diagnosis-and-management-of-hypercalcaemia

RE: Hypercalcaemia in a cat

Martin Atkinson — Wed, 11 Nov 2015 09:04:11 GMT

Although hypercalcaemia in cats is not a consistent symptom of neoplasia in cats, IMO this is intestinal lymphoma until proved otherwise! You're shooting the messenger by trying to treat the hypercalcaemia and not addressing the cause. Time to get tough with the client, this cat needs an ex lap and intestinal biopsies to make a diagnosis.

Incidentally what dose of preds are you using? If it is lymphoma and your not using immunosuppressive doses of pred (40mg/msq - 10mg for the average cat) then you will get no response and you are ruining your chances of response to full chemo with this a sole therapy. COP is a reasonable chemo therapy for lymphoma in cats but I've had some respond to preds and cyclophosphamide where the owners don't want the expense of IV therapy.