Elevated Calcium

[kasey&roxie]

Hi,

I have an approx. 2 yr old neutered male, Kasey. We have had him for a year and we think he was approx 1 year old when we got him from our local shelter so his age is approximate.

Since June/July his eating has been slowly declining. During the summer when it was hot, he spent most of his day under our bed and would eat a bit in the morning and night. But we thought it was heat related as he was not sick in any other way. He was not vomitting, did not have diarrhea, was drinking water well and peeing okay. He was not losing weight at all.

Through August and September his eating kept declining. I had him to the vet to originally check his teeth and gums in August as we thought maybe something in his mouth was bothering him. Everything looked fine and we continued to monitor. When it did not improve I took him back and we did initial bloodwork. Everything came back fine except for his calcium. Normal range should be 2 - 2.9 and his was 2.98. I took him back for a recheck on his calcium after fasting for 12 hours and it still came back at 2.98.

He is scheduled to go in tomorrow morning for x-rays to rule out tumors. The vet did a thorough physical exam and did not feel any masses around abdomen or intestines. His lymph nodes are not swollen and everything else on his bloodwork was within normal ranges. He is not vomitting, does not have diarrhea and is still drinking well. I also have to see if I can get a urine sample for analysis. I did a test run this morning and when he peed in the litter box I was able to collect a sample in a spare container from the vets.. Hopefully we will be able to repeat that tomorrow.

I have been doing alot of research on hypercalcemia for cats. One thing I am reading about is hyperparathyroidism. The vet did not mention it when we were talking but I am going to ask about doing the testing for PTH in his blood.

My old girl, Tigger who passed away a year and a half ago at 18 yrs old had elevated calcium, but she also had kidney issues and a tumor in her colon that we had her on lactulose to make her stools softer so she could poop better so that I can understand.

Kasey has lost some weight now as this has been going on since July. He has lost about 1/3 of a pound or about 6 ounces. I am really worried that it might be cancer but I know that I shouldn't jump the gun. He will eat some but usually will go the bowl and only eat a few pieces at a time. I have fed him in a different area but he still only eats a little at a time.

I'm sorry for the long post but am just wondering if anyone has had any experience with this or hyperparathyroidism or if there some other tests I should ask about.

Thank you for any information or advice you can offer.

Karen

[sugarcatmom]

Can't really comment on the elevated calcium (my cat has also had elevated blood calcium levels over the years but it's normal for him).

About Kasey's appetite: have you tried feeding him different foods? How about wet food? What does he eat now, and is that what he's always eaten?

[sugarcatmom]

Forgot to mention, elevated blood calcium levels can be a sign of vitamin D toxicity, and pet foods are notorious for having excessive vit D. Just see the latest Blue Buffalo recall: http://www.newsoxy.com/health/blue-b...all-15148.html

[Love4himies]

Puddles had elevated blood calcium in the last few years, but now it is in the high normal range. My vet suggested to stick with canned food with no Alfalfa in it, so I changed her food. Also, I now make my cat's raw so I control the ingredients and limit the amount of bone in it. They are on 50/50 raw canned. She also gets very wet food to keep her very hydrated and flushed, to keep the chance of formation of stones to a minimum.

[kasey&roxie]

Thanks for the replies. Love4himies: were medical causes ruled out with Puddles's elevated calcium? It was only related to food?

Kasey is and has been eating Wellness Complete Health Chicken dry food. He has been on this since Jan/Feb 2010. Prior to that he was on Merrick Before Grain Chicken flavour dry food.

We also have a two year old spayed female, Roxie. We got them both at the same time. She is also on the Wellness dry but I have got her eating approx half her daily intake from Wellness canned, usually Chicken and Turkey varieties. As I have been leaving food out for Kasey, she has probably been getting a bit more dry than normal.

I have tried to get Kasey to eat some canned but he will not come within 2 inches of canned food. I have tried different brands and types and he will have nothing to do with it. I have put itty bitty bits in with his food, they are left in his bowl, I have left it out with his food, I have tried it instead of his food when he was really hungry. He is a stubborn one, I am dedicated to trying to get him to eat canned but right now I just want him to eat.

When we got them Roxie had bloody diarrhea from one week after we got them until approx May 2010. We discovered Clostridium bacteria and we did a round of Metronidazole. Kasey did have some diarrhea and gas as well but not as bad as Roxie. They both cleared up after the Metronidazole and there have been no poop issues since.

Looking back I can see a gradual progression in his eating:

- initially feeding 4 - 1oz servings per day - morning, noon, dinnertime, before bed - would eat each feeding all at once and would let me know when he was hungry - usually well before time for next meal
May/June - stopped eating noon meal - figured he was starting to settle down with us and didn't need as much food
June/July/Aug - would eat all of morning meal - picky at night - didn't usually eat all of his night meal - during heat of summer thought it was because it was hot, not losing weight - also checked at vet for tooth/gum issues
Sept/Oct - now picky morning and night - will eat but very few pieces at a time - does not bug for food - elevated calcium discovered

He has always drank water well and still continues to. The vet did mention Vitamin D toxicity but I could not think of anything else he may have eaten/drank. I only have one plant in my house, a Christmas cactus and it is in a spare bedroom that they don't usually have access to.

Thanks for any information.

Karen

[catlover2]

Can't offer any new suggestions you haven't already received, but just want to thank you for keeping forum updated. I'm following this thread with great interest, as it is a puzzle. Hope you can get some sort of definitive diagnosis soon.

[Love4himies]

Kasey's calcium is not overly elevated, like Puddles's was, and yes, the vet did mention thyroid cancer and hyperparathyroidsm, however, my vet thought a diet change was in order first off. Like your vet, he checked for swollen thyroid and masses and couldn't find any sign of anything. All her other bloodwork was in normal ranges.

I did have to get her off all kibble (after poor quality, I changed to Orijen, didn't help), and the change to all canned made a HUGE difference in her health. Then I changed her onto homemade raw and canned and it was that diet change that finally brought her calcium levels in normal range. Another thing is that her food she eats now has a lot more water in it than before, so perhaps keeping her very hydrated helps keep the calcium down .

Wellness canned is a great food. For Jasper, I had to sprinkle a few kibble over his canned to get him to eat canned. He is still a kibble addict, but he doesn't get too much, so he will eat canned/raw. When he ate kibble, he would drink a lot of water, now he hardly drinks any.

[kasey&roxie]

Thank you catlover2, I definitely hope we find an answer quickly. I know that elevated calcium can start doing other damage so the quicker the better.

Love4himies: I really wish I could get Kasey to eat canned. I should take a picture of his little face when I present him with it. He actually pulls his head back and wrinkles his nose at it as if it is the vilest thing on this earth!

Roxie likes her canned food with extra water so she is getting well hydrated as well.

Thanks,

Karen

[sugarcatmom]

Originally Posted by kasey&roxie

I have tried to get Kasey to eat some canned but he will not come within 2 inches of canned food. I have tried different brands and types and he will have nothing to do with it.

Have you tried Fancy Feast? Most cats will eat some flavours of FF, and after a while you can slowly start mixing a better quality food in.

There's also this link with tips for transitioning kibble addicts to wet food: http://www.catinfo.org/#Transitionin...o_Canned_Food_

One of the things that worked for my cat was pulverizing his favourite dry food and sprinkling it on top of his canned, so that he'd recognize the new food as edible. Powdered freeze-dried chicken (like Pure Bites or Halo Liv-a-Littles) is also irresistible to many cats.

Here is some more info for you on hypercalcemia in cats: http://www.vin.com/VINDBPub/SearchPB...00/PR00123.htm

[Love4himies]

Kasey&roxie, the link to vin.com posted by sugarcatmom is an excellent overview of hypercalcemia in cats. I read that many times when Puddles was first diagnosed. Interesting note that this is a recent increase in occurrences in cats "Though hypercalcemia is less common in cats than in dogs, recognition of an important new syndrome in cats has emerged since 1992. In cats, the frequency of hypercalcemia without obvious explanation is increasing.". To me that really indicates diet.

Puddles was a kibble addict too, and it took many tears and frustration as Sugarcatmom and growler (another kitty health guru) can testify to, but with their suggestions, Puddles who would not touch cooked meat, let alone raw, will now eat raw. Fancy Feast, canned is like a kitty crack, lol, so perhaps trying that canned first off may be your best bet.

Good luck and please, keep us posted

[kasey&roxie]

Thanks Sugarcatmom and Love4Himies for the information. I did try some Fancy Feast as well but usually if I added it to his food I would take tiny bits and kinda roll it up and place it in amongst his kibble. I will definetely look into the information and try some other "tricks" of the trade I know with Kasey it is going to be an uphill battle, he is so stubborn but I know in my heart it will be better for him in the long run so we will pursue any means possible to help make it happen.

I have read the link you posted for hypercalcemia and every other thing I could find on the internet about it as well.

I do have a question about the parathyroid test if anyone knows. Is the blood test for the parathyroid hormone test different than a thyroid or Free T4 test ?

When I dropped Kasey off this morning our vet was not in but I told the tech that was admitting Kasey that I wanted to talk to her about hyperparathyroidism and there was a blood test to check the PTH levels. Since he is there for the morning could they do that as well then I wouldn't have to bring him back later. She added it to the quote as a Free T4 test. And she made a comment that there is usually weight loss associated with the thyroid. I know there is with hyperthyroidism but may not be with hyperparathyroidism.

We did weigh him this morning and he was the same as last week so that was good news. He is still picky with his food but there is no vomitting, diarrhea or anything. And he peed at 6:45 this morning and I was able to catch it all in the sample bottle for the vet

Thanks,

Karen

[Love4himies]

I have no idea about the parathyroid test as my vet did not think that was what was going on with Puddles. Sending lots of Kasey's way.

Just wanted to let you know that Puddles actually has hypOthyroidism. Her thyroid counts are below normal, but the vet is not concerned about that either as she has no other symptoms. I am very interested in the Kasey's results.

[sugarcatmom]

Originally Posted by kasey&roxie

I do have a question about the parathyroid test if anyone knows. Is the blood test for the parathyroid hormone test different than a thyroid or Free T4 test ?

Yes, it's a different test. The parathyroid gland is not the same thing as the thyroid. http://en.wikipedia.org/wiki/Thyroid

Originally Posted by kasey&roxie

She added it to the quote as a Free T4 test.

She must have been confused. I personally would refuse to pay for the Free T4 (and they tend to be expensive). There is no reason to test a 2 year old cat for thyroid function as it would be virtually unheard of for a cat that young to have hyperthyroidism.

[kasey&roxie]

Thank you for the ..they are very much appreciated!

Thanks sugarcatmom for the answer. I figured she was confused as soon as she said there is usually weight loss associated with it and then called it a T4 test.

The T4 measures the main thyroid function. The PTH measures the parathyroid function. The parathyroid controls calcium and phosphorus levels in the system and can malfunction and produce too much PTH causing the calcium levels to rise. Sometimes the malfunction is due to a tumor of the parathyroid gland and the affected gland would have to be removed.

Our vet called me directly regarding the PTH test, and it was her day off too, and the test should be done fasting and since Kasey did eat some this morning we decided to book the blood draw for this for next Monday morning. If we determine something else from the tests today then we can cancel this for next week.

The lab that had originally done his bloodwork from last week still has some of the serum but they refrigerated it, not frozen so they couldn't use it for the PTH test.

We also talked at length about idiopathic hypercalcemia which she also said is becoming more prevelant in cats. As Kasey has a mild elevation and is not symptomatic other than the eating less,which could also be issue with food, placement, discipline over food (I posted about discipline with the water bottle..bad bad cat mom ), we may look at a food change and a re-check in a few months unless something drastic shows up on his x-rays or urinalysis.

She should have results to me tomorrow from the urine and x-rays.

Thank you all, I will keep you informed on what we find out tomorrow.

Karen

[kasey&roxie]

Hi all,

Had a message from our vet on Kasey's results from yesterday.

Urinalysis - completely normal - no bacteria, specific gravity normal, no evidence of crystals or stones

X-rays - everything looks normal, no masses, no stones in bladder

So, needless to say I am extremeley relieved by these.

We have an appointment on Monday morning to draw blood for the PTH test and then we will go from there.

Thanks for all the information and I will keep this updated on Kasey's progess. Both on the calcium and food front. I am off to do some more reading on shaking the kitty kibble crack addicts habit..

Karen

[Love4himies]

Thanks for keeping us updated. I don't think Puddles ever had her parathyroid tested.

[kasey&roxie]

Well, Kasey's appetite continues to slide down.. Yesterday I don't think he even ate 1/8th of a cup of food all day. He continues to eat, but will only eat a few kibbles at a time and I basically have to prompt him to go to the food to eat.

He is not even asking for food. If he doesn't like the food, he is not even crying for any food. He will eat any food I give him, just a few pieces of it though. He has lost a bit more weight in the last few days too.

He is still drinking, peeing and pooping and he has his play moments but I don't think he can sustain this for long.

I have put a call into our vet. If the elevated calcium is making him not want to eat I don't know what can be done about it at this time until we can determine what is causing it if anything. They are going to be drawing blood for the PTH test on Monday. I should have gotten him in sooner for this so they could send it away this week for testing.

I am ready to break out the Whiskas cat food

I just want to cry..

[chico2]

I did not want to comment anything,because the outcome for my 14yr old Rocky was not good.
His calcium level was very high and test told us he had a growth on his parathyroid.
my vet did not recommend surgery,as rocky was down to 7 lb's and weak.
he had hyperthyroidism and was on meds for a few years,did not do too badly,had a great appetite.
i had never even heard of a para-thyroid and when his kidneys and liver functions were ok,i thought he was out of the woods.
when he stopped eating,it was because the tumor was pressing on his esophagus(sp?)and he was unable to bend his head and swallow.

however,your kitty is not as old as rocky was and i hope it is nothing as serious

you should feed your kitty whatever he likes,the most important is that he eats...

[sugarcatmom]

Originally Posted by kasey&roxie

Well, Kasey's appetite continues to slide down.. Yesterday I don't think he even ate 1/8th of a cup of food all day.

Time to pull out all the stops. Don't limit yourself to cat food, get some baby food (plain chicken, no onions), cheese, yogurt, a variety of kibble (Innova Evo is highly appealing to many cats - but yes, use Whiskas if you have to), deli meat, boiled/broiled chicken, canned salmon (low sodium if you can find it). Sardines, tuna, Cat Milk, Temptations, Greenies, whatever it takes to get him eating. Worry about a balanced diet later.

It might also be time to think about an appetite stimulant. Mirtazapine would be my choice, especially if you think Kasey might be nauseous (does he lick his lips much? sniff the food like he wants to eat, but then turn away as if disgusted?). Mirtazapine also only needs to be given once every 3 days, which is much easier than cyproheptadine (2x/day dosing) if Kasey is difficult to pill.

that Kasey's appetite picks up soon!

[growler~GateKeeper]

Was Kasey tested for FeLV (Feline Leukemia Virus) and/or FIV (Feline Immunodeficiency Virus)?

Any chance he got into rat poision? That will give the same symptoms/results as Vit D toxicity

Ask your vet if the lab is set up to run a serum Ionized Calcium test as well as PTH concentration (parathyroid hormone) and the PTH-rP concentration (parathyroid hormone related protein) tests.

If the tests rule everything else out Kasey might just have Feline Idiopathic Hypercalcemia

Originally Posted by kasey&roxie

I am ready to break out the Whiskas cat food

Offer it to him see if he'll eat it, also the Fancy Feast or Friskies brands seem popular with cats refusing to eat other foods.

Have you tried Innova Evo? See if he likes that better than the Wellness Evo also has a grain-free line of canned food that might appeal to him such as 95% Chicken & Turkey they have a higher protein content than many foods which satisfies the real-meat cravings.

[kasey&roxie]

Thank you everyone for your replies.

Chico2 - I'm very sorry about your Rocky..we lost our Tigger a year and a half ago and it still feels like yesterday. She was 18 and started getting kidney disease and ended up with a tumor in her colon and a mass behind her stomach. We did sub-q fluids for 7 months and syringe fed for the last 3 months. Although on her last bloodwork her kidney values were back in the normal range. We just knew she would never eat on her own again. It is so hard to see them go through all that as you just don't want them to suffer.

Kasey has been tested for FELV and FIV and both are negative. We are doing the PTH concentration test next week but I will definitely ask about the other tests.

We did talk about idiopathic hypercalcemia last week as well. As Kasey has not had any other symptoms and all his other bloodwork were within normal ranges this is one possibility we have to think about. A change of diet was definitely in the cards as I wanted to try to get him to eat some kind of wet food. His x-rays and urinalysis came back clean as well.

Last night I gave him some Purina One Chicken and Rice kibble. Between 5 pm and when I went to bed at 10:00 he ate close to 1/4 cup. During the night he ate some more, about 1/2 of the 1/8th cup I left for him and this morning he has eaten close to another 1/4 cup.

I spoke with the vet last night and we are also going to check his calcium again to see if it has increased since we did the last test two weeks ago. He had eaten most of the Purina when I spoke with the vet last night but I am to contact her at anytime through the weekend if he stops eating or any other symptoms show up like vomiting, diarrhea etc. She said to watch for increased thirst and increased urine output as it could be affecting his kidneys if his calcium is elevated more. We also talked about an appetite stimulate, if his eating continues to slide or stops we will look at this option. I have used cyproheptadine with Tigger, but had heard that Mirtazapine seemed to be a better alternative.

This morning he was chasing Roxie around, playing with his Purrfect Play fuzzy balls and hanging out with us while we had our morning coffee. He is drinking normally and has not had any increase in his urine output over the last few days. He is grooming himself, Roxie and me..

Hopefully I can keep him eating the Purina and as he gets more intake he will want to eat more. He doesn't appear nauseous, doesn't lick his lips, will walk up to the food and start eating but will only eat a few pieces at a time. He would do this for a few hours in the morning and then maybe a few kibbles at lunch and then nibble again for a few hours in the evening. But he never finished a full serving.

I am also going to go out and stock up on some of the items you suggested Sugarcatmom and some Innova EVO as well.

Thank you everyone for all your knowledge, ideas, & prayers. Hopefully Kasey will continue to eat this weekend and we can find out soon what may be causing this.

[chico2]

he is eatingthat's wonderful news,i hope he'll be eating from now on.
the fact he's chasing roxie,is very encouraging,he seems to have nothing of my rockys symptoms,which is greati think kasey will be all right

thank you for your sympathy,i miss my boy very much

[kasey&roxie]

Hi all,

I thought I would give a quick update on my Kasey boy.

He turned his nose up at Purina One after a day so I tried a bunch of other different foods as well. I put Whiskas out and he again only nibbled at it (although that kind of thrilled me as I really don't want him eating it at all), I had a sample bag of Performatrin from Pet Valu. I gave him an 1/8th of a cup and he ate about 3/4 of that in one sitting. After a day he was eating the whole portion at once and asking for more food in 5-6 hours later.

I was leaving food out 24/7 for him to nibble on but most of the time Roxie was getting most of it and soon she was going to be as big as a house. So I took up all the food and started them on scheduled feedings, which I was doing back in the spring/summer before Kasey starting getting fussy.

I am also feeding Kasey downstairs in our rec room and Roxie in her normal spot in the kitchen. I feed them at 6:30 am, noon, 5 - 6 pm and between 10-11 pm before I go to bed. Kasey has been eating the Performatrin all week and finishing all his portions so he is getting close to a 1/2 cup a day. He races me to his spot everytime and he starts sitting at the top of the stairs before feeding time to let me know he is hungry. This is the way he used to act for feedings and I am so happy to see this behavior again..

I know the Performatrin is not the best food but he is eating and that is what he needs right now. His weight had dropped from 12 lbs 10 oz to 11 pounds 13 oz and right now he is just over 12 pounds. I would like to keep him stable at this weight as I think it is a good weight for his size. You can still see his abdomen tuck at the sides and I can still feel his ribs with a little bit of fat layer over them.

We had blood drawn for the Ionized Calcium, PTH and PTH-rP and Total Calcium on October 25th. His Total Calcium test came back at 2.98, which is the same as it has been the last two tests that were done.

The other tests have to be done at Michigan State University as the labs here (or just the lab my vet uses..I don't know) don't do it. My vet called me the other night with good and bad news..the good news was they ran the PTH test and it came back at 0, so probably not Hyperparathyroidism.

Bad news (1)... the lab report stated they didn't have enough sample to do the Ionized Calcium. My vet called them and inquired why there wasn't enough sample, but never really got a straight answer. They have to mix it with something to get the sample to a certain PH level before they can run the test and for some reason they didn't have enough blood sample. So..we have to get another blood sample from Kasey to send for the Ionized Calcium. My vet was clearly frustrated with this but I guess there isn't much we can do about it..

Bad news (2)..We are also still waiting on the PTH-rP, there is a reagent that has to be applied to the sample to run this test and they don't have any of it and the supplier says [B]possible[B] shipment by November 16th. So we have to wait for that as well.

I am just so glad that Kasey is eating well again and he is acting normally.

Sorry for the long post. I hope everyone and their babes are doing well. I am off to catch up on all the posts as I haven't been on much. We have been super busy at work and I have had a sinus infection thrown in there too.

Thanks for everyone's help and good thoughts to get Kasey eating again.

Karen

[kasey&roxie]

Hi,

Just got a call from our vet on the rest of Kasey's lab results. We had to re-do his ionized calcium and it came back at 1.17 (normal range 1 - 1.4). So it is within the normal range.

We were still awaiting the PTH-rP concentration test and the Michigan State University lab informed them that they are no longer offering this test and there is no other lab doing it.

The reagent needed for this test is no longer available and they are cancelling all requests for this test. Their website says they are actively seeking an alternative solution.

Kasey is eating well again and we are going to re-check his calcium in about 3 weeks just to see if everything is okay.

I am going to be trying to get Kasey to eat canned food, although right now I am still a little gun shy about doing anything with his food. I know I need to try, it will be better for him.

Thank you everyone for all your information and encouragement, although I think I will be needing it more when I try to get Kasey off the kibble.

Karen

[chico2]

Karen,it's great that Kasey is eating,a bummer that the test could not be completed.
However,Kasey seems to be doing good,compared to my Rocky,who weighed 16 healthy lb's and at the end only 7lb's.
I am certain your Kasey is doing fine,no scary cancer or anything like that.

[Love4himies]

Thanks for the update and glad to hear his ionized calcium is in normal ranges

Have you given any thought to changing to a quality canned? That was the only thing that brought Puddles's down into normal ranges. Diet can affect how much calcium is leached from bones

[kasey&roxie]

Thanks, Chico2..I don't think now that it is anything major either. It is too bad that the other test can't be done At least I have a credit at my vet's office now from the refund

Thanks L4H, I have given alot of thought to switching to canned. I just have to put a game plan together to do this, as I think it is going to be a BIG battle with Kasey. When I give Roxie canned food and Kasey is sitting in front of the patio doors beside where I feed Roxie, he won't even sit beside the bowl..he turns and runs from it.

Right now I am gun shy on switching his food and I need to have a clear plan in my head and have the will to stick to it to get him to switch which I know I'm not in that spot right now.

I am doing research on all the tips, tricks, successes, failures of switching and I know I will be on here asking questions, whining (), crying and hopefully celebrating!

Thanks for all the information, this forum is filled with a wealth of knowledge and great people.

Karen

[Love4himies]

It was very painful to switch Puddles who loved her kibble, but with the help of this forum I was able to switch her, and she now eats raw. I had many tears of frustration.