Baby Hyper Aldosterone, CKD, High Blood Pressure, Bowenoid Skin Cancer-She Has Many Issues

Baby has been seen by vets and specialists since May due to low kidney values, hypertension (high blood pressure), skin lesions, kidney disease, and hyperaldosteronism.  I last wrote about this on Oct. 25, 2019.

The update: the cancer specialist on November 5, removed the Bowenoid lesion from her left paw and we are to continue to monitor for the appearance of others.

The CAT scan they did November 5 did not show any signs of lymph node or adrenal gland tumors. So, it's likely, for now, that her hyperaldosteronism is idiopahtic-no known cause. Her blood level aldosterone was 1011, up from 829 this summer. The vet will now put her on 1/4 tab a day of Spironolactone 20mg.  Spironolactone is an aldosterone antagonist and is supposed to help reduce the hormone level. We will retest the blood level in a month or so. 

This summer, "mast cells" were found in a lymph node by biopsy. Mast cells are more commonly signs of cancer in cats. BUT they can also be signs of IBD or mastocytosis or inflammation.
So they think she has inflammation in the gastro system. For now, we will monitor.

She has signs of asthma in her lungs despite the Albuterol she receives BID (twice a day.) But MSU vet had told us this summer to reduce it and wean her off of it. We reduced it for awhile but then continued twice a day since September. Perhaps reducing it to once a day and trying to wean her off wasn't a good idea. We may need to put her on Flovent, a steroid inhaler which I've been trying to avoid. Her heart is great so there wouldn't be an issue but steroids should not be taken lightly; and chronic use might lead to other issues. She sees the cardio yearly (she has never had heart disease; heart disease cats CANNOT have a steroid at all, even an inhaler.) 

We must continue to monitor with future ultrasounds of her gastro system and kidneys; test aldosterone levels; check blood pressure and kidney values; and keep her on a kidney disease diet. We must still monitor for inflammation vs. possible cancer. 

Fish Based Food Allergy Might Be What Affects Jimmy Stewart Again-or Idiopathic Illness?

Last week, on Saturday, Jimmy wasn't eating well. So, I put fish Fancy Feast on top of his chicken pate for two meals. By Sunday night, he wasn't eating at all. Then he vomited.  I gave him 1/4 tab of Cerenia (anti nausea medication.) By Monday, I had to hand feed using Hills AD mixed with water, fed with a plastic syringe.  He vomited twice on Monday. I have Cerenia once again and on Tuesday.  Tuesday we saw the vet.

We ran full CBC/chem panel, PLI, and urine. NO signs of illness or infection appeared. His glucose and other electrolytes were normal so he's not pre-diabetic again. His liver and kidney values were great and the liver continues to respond to Denamarin (a supplement to improve liver function; his blood values had gone up last year.) He also had no signs of a fever. I thought he wasn't able to use the litter box but the vet said there were no signs of a blockage (which can happen with male cats), he wasn't showing signs of pain on exam, and the bladder wasn't hard from an inability to pass urine. Vomiting and not eating would contribute to not having produced enough urine to excrete.

Without signs of an illness, inflammation, or infection, there were no other medications prescribed. Meanwhile, the vet gave a B12 shot, sub q fluids as he was dehydrated; and I used Cerenia for the next two days (1/4 tab once a day.) By Wednesday he was better and eating enough on his own. By Thursday, he was eating normally again.  He continues to do well.

Was the illness created from eating the fish? Or the herpes virus for which he receives daily lysine? About three years, he began to lose weight and was always hungry. Various tests were run to no avail. He had also had bouts of vomiting and diarrhea. The vet said to try non-fish based foods and the problem was resolved and didn't return. Because he can become finicky, I've given a smidgen of fish food from time to time without issue. But not last week. Was it the fish? The only way to tell is to not give it ever again; give him time to make sure he's fully recovered. If this happens again, we will need to do further tests such as a gastro ultrasound, etc.

Sometimes cats do this. An issue will arise, tests will be done and it will turn out to be idiopathic-no known cause; and that home remedies and things such as having Cerenia on hand, and hand feeding the cat food and water, go a long way to help the cat recover. Sometimes all we can do is treat the symptoms and never find a cause. Of course, the symptoms can also be related to any variety of serious illnesses-cancer, FVP/FIP, heart disease, pancreatitis, food allergy, etc. And that is why we go to the vet to rule out/find a cause. We don't want to take chances.

Good home remedies for sick cats are feeding Hills AD mixed with water by hand using a plastic syringe; adding 1/8 tsp of corn syrup to the mix (if the cat isn't diabetic) for energy; giving rice water to stop diarrhea (poured off of boiling rice) via plastic syringe by hand, and giving regular water via plastic syringe by hand, and-when the cat isn't allergic to it-giving tuna juice for protein via a plastic syringe by hand. You can also boil chicken or beef and use that water (without adding salt or onion or garlic or spices) as a protein source to give by hand. Medications that help cats are Cerenia (anti nausea med-get from the vet); and in some cases of illness, you may use Pepcid, 1/4 tab (for antacid and inflammatory inhibitor.) Use under vet supervision and not long term.

NEVER let a cat go a day without eating. Cats may be finicky but not eating is not normal, is dangerous as it leads to dehydration, and dehydration leads to a whole set of health issues-weakness, further not eating, and death. And never let a cat have a severe bout of vomiting and diarrhea without trying home remedies to ease it and without seeing the vet. 

Katharine-Phenobarbital and Liver Values; Baby-Skin Cancer Bowenoid in situ Carcinoma

Cats update -*I updated spelling of blood values and the correct cancer name.

Katharine is low on vitamin D again and we need to add it to her food once a day. Yes-cats can be low just like humans and have the same run down feeling and weakness as humans. She was retested for pheno level-well within range of therapeutic levels; and tested for B12: cobalamin/folate blood test to test for absorption of nutrients and it can indicate any gastric issues. She was normal.

**We tested those because her albumin (1.3-normal high is 1.2 but should be lower) and her ALP (81-normal is 59) were high and globulin (2.9-low normal is 3.0 but should be higher) was low-indicating liver issues which can occur with phenobarbital. We will retest and do gastric scan in December or January and monitor for signs of liver issues-vomiting, bowel movement, eating, jaundice, etc.

We hope it’s not liver failure but just an enzyme increase. Her history has shown that last year, normal pheno dose led to high ALP and albumin; when we decreased the dose, those fell to normal levels but the PHENO level fell too low; we returned to the normal pheno dose and have now seen a rise/fall in the three liver related blood values. We will tweek the pheno to a lower dose but not each day, hoping the three liver values improve while maintaining a good pheno therapeutic level.

But Baby-Baby has had a lesion on her front paw for a year. We treated it with antibiotics, a cream; the scabs came off then regrew. Microscope showed only bacteria. Vet school in May said it wasn’t cancer but they only did a microscope view. We did a biopsy last week and the result is BOWENOID in situ carcinoma. Cancer. She likely has them elsewhere under her fur but not raised and one became ugly and scabby. It requires CO2 laser to remove. Not sure what else. They likely will return and more will develop. If we don’t remove as we find, they can metastasize and spread cancer to her body organs. This is due to a related issue called papilloma virus, the brown/black spots on her ears and face we tried treating years ago with a cream.

Because it’s due to a compromised immune system, she’s been receiving an immune booster for a few years which helped the body remove the marks. But they returned last year-just when she began showing signs of CKD, and her CKD maybe due to aldosteronism-for which she was tested in May and will be retested in November. That is possibly cancer.

It seems that she is likely in for an arduous endeavor, with multiple issues that might need multiple solutions but that might all be related.

Kidney Disease Cats Need More Protein Than Renal Diets Allow-But Also Need Low Phos in Food

Interesting read. She recommends that cats with kidney disease (which would include HCM cats that have high levels of diuretics which have begun to affect their SDMA, BUN, and creatinine) have 40% of calories from protein and not just the 20% that is found in CKD special diet foods. Cats need protein for health. Any more than 40% and you run the risk of creating a load of BUN-blood urea nitrogen-on the kidneys to filter and remove. If the cat has CKD or low performing kidneys, you need to reduce the load of BUN on the kidneys. Of course, if the cat's kidneys continue to decline, you'd want to reduce the protein level to the 20%. But she argues that a cat on a low protein diet may not eat it (because it's not that tasty); and will lose weight. The cat would need to eat 2-3x the amount of the diet to make up the protein and caloric needs. So, feed a CKD diet along with some of a regular diet and continue to monitor the CKD with regular checks at the vet's.

I've always recommended HCM cats take iron and other vitamins and supplements to help the kidneys (see Med tab at blog or here in Notes.) Actual kidney disease can be caused by other health issues-thyroid disease, hyperaldosteronism (what Baby apparently has), etc. So, finding the cause of CKD and treating the cause as well as the CKD requires more than just a careful diet.

https://healthypets.mercola.com/sites/healthypets/archive/2018/03/06/cat-care-tips-for-kidney-disease.aspx?fbclid=IwAR1O1BY3WcGAHM6aAjJPapP7kme_ADMzw26d62JB407fj3EmQYsIUxxk0dQ

Many Uses of Spironolactone

Spironolactone-reduces the intake of sodium and water. It's used for heart patients as a mild diuretic-control CHF and blood pressure by reducing the sodium intake that prohibits the natural exchange of sodium and potassium in the cell, due to the intake of a lot of water into the cell due to the sodium; as a potassium saving drug-good for those on diuretics (again, by controlling the sodium intake); and for hyperaldosteronism because it's an aldosterone antagonist. It reduces the action of the hormone by again, reducing sodium and water intake.

We will likely begin using this on Baby but need to consult with the MSU vet hospital vets.

"Since aldosterone inhibition decreases sodium reabsorption, it also decreases potassium excretion resulting in higher serum potassium levels."

https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/aldosterone-antagonists

Hypertension-High Blood Pressure, Low Potassium-May Not Be Due to Diuretics or CKD

More on hyperaldonsteronism:

CKD can be misdiagnosed as a primary issue when it can be a secondary issue caused by hyperaldosteronism.

It's rare for HCM cats to be tested for this as CKD and low potassium come with taking diuretics. HCM cats do not generally get hypertension. So if your HCM cat has hypertension, test the cat also for hyperaldosteronism.

And test your non-HCM cat as well.

"Depending on the etiology, PHA can be treated surgically or medically, which may cure or alleviate the associated hypertension and/or hypokalemia. Primary hyperaldosteronism is most likely underdiagnosed, which excludes a potentially large number of cats from appropriate therapy and a possible cure for the disease.

This may in part be due to the frequent association of arterial hypertension and/or hypokalemia with chronic kidney disease (CKD). Often, CKD is thought to be the causal factor of the hypertension and/or hypokalemia, when in fact the CKD may be a consequence of PHA."

https://www.merckvetmanual.com/endocrine-system/the-adrenal-glands/feline-primary-hyperaldosteronism?fbclid=IwAR0Ufs9_DcwxXLKLQWa-yAp7E0J6K88qKMuXXt8kkfOyZYWT03HvaUvDYis

Hand Feeding A Sick Cat-the Importance of Keeping the Cat Hydrated and Fed

Facebook post April 15:

From a discussion with a pet owner:

"Your cat cannot go more than a day without eating. The longer it does not eat, the faster it goes into decline. Weakness sets in, driving it to not feel well enough to eat. The body begins to eat at fat then muscles, further weakening the state. You need to begin hand feeding. Get a 3ml syringe from the vet or store. Do NOT use any glass droppers.

First, make up some sugar water: 1/8 tsp per 3oz of water. As long as the cat is not diabetic. This will be a quick energy source. Give one 3ml syringe of sugar water every three to four hours. Hand feed every 3-4 hours or as often as possible. Feed this along with the following: get Hills AD or any special needs/high caloric cat food for cats in recovery. This is a pate that mixes easily with very little water and is easily syringed up and fed to the cat. Feed 24mls to 30mls to the cat per feeding. Each ml is about one calorie. The cat needs about 120 or more calories per day.

Then give the cat some potassium-either Renal K gel or powder (Amazon) or baby food banana or sweet potato. Syringe up and feed by hand or add to AD mixture. It's an electrolyte the cat needs for the body to function, for the kidneys to work the diuresis process (assuming the cat's on a diuretic), and the heart needs it to function properly. Use tuna juice as a source of added protein. Drain it, put it into a container for the frig. Give 3-6mls per feeding. The idea is to feed the cat now to prevent it from starving to death; give it a boost in energy to recovery; to help it to feel better to want to eat; and to restore as many nutrients/electrolytes as necessary for proper bodily function, energy, and to feel better to eat.

Cerenia is an antinausea med that will work but it's short lived. If the cat isn't eating, the med won't help. Appetite stimulants such as cyproheptadine or mirtazapine are great but are also short lived. The cat really needs to be fed NOW and to eat well enough on it's own. You can't try a med and wait for it to kick in and expect the cat to recover. But I would try cypro. Ask the vet. It's a milder stimulant which I feel works best for heart patient cats as it will make them less anxious. Remember-the cat must be fed NOW. Do not wait for it to try to eat on its own. The cat cannot starve to death. As for the heart meds, they can interfere (with appetite) but so can being sick with heart disease. The meds won't help if the cat isn't eating well.

The way to hand feed: don't stress the cat. Hold or wrap a towel around the front. Expect cat food to go out more than in until you get the hang of it. The water/liquid food will go in easier. But the cat food/water mixture will land on you and the cat and the counter. But syringe up the food; hold the cat in one arm-assuming the cat isn't squirming. And gently squirt food into the side of the mouth. The cat will move it's head but keep chasing either side of the mouth. One 3ml syringe or whatever size you use should go in over a few seconds. But it will seem like longer and will be if the cat doesn't cooperate. You must gain control of the cat. Don't force it or hold it down but keep at it until you have fed it 24-30 mls per feeding.

...I forgot to add: boil beef or chicken without salt or spice; use the broth to hand feed."

Signs Cat Needs the Vet ASAP-Not Grooming, Not Eating, Not Moving, Drinking a TON of Water, ETC. Pay Attention!

Facebook April 27:

I had a friend who suddenly lost a cat last week, not to HCM but to a virus or sepsis or kidney failure or something. A week in the hospital, two antibiotics, all the tests they could muster, and still they couldn't find what happened. The liver and glucose and kidney values were through the roof, higher than I've seen with HCM (in our experience with our cats.) One was in the hundreds, clearly due to organ failure but what was the cause? She noticed that the cat hadn't been grooming well for a month or a few weeks; she noticed the cat drank heavily but that it always had, just suddenly more. She noticed that the cat wasn't active but then it was 8 yrs old.

I'm sure all of those signs had become more prevalent than usual because when a cat is sick, "normal" behavior can increase to being extreme. 

A lack of grooming is a good sign the cat is sick; and lethargy is a good sign. This is why we must pay attention DAILY to the behaviors of our cats so that we may hopefully notice when normal behavior is now off. We must look for the minor changes, that look that says "I'm not well today; I've not energy today; I'm not myself." Look for a lack of grooming, wet eyes and nose (virus, irritation, damage to eyes); dry mouth and skin that tents (sign of dehydration due to an illness); yellow eyes in the whites and yellow skin around the ears (liver trouble); abscess teeth or injury or a skin rash or infection (can be signs of a disease, can lead to sepsis); and changes in eating and litter box use and energy levels.

 And is the cat suddenly needing you, being more of a lap cat, is snuggling more or not as much with the other cats; is the cat more vocal, anxious, worried, unsettled? So many signs of changes are possible and all should be monitored, catalogued, and discussed soon with the vet.

Of course, even if she had noticed sooner and had taken the cat to the vet, it's likely she may have still lost the cat because the vets couldn't find what happened (she's didn't do a necropsy-autopsy to know for sure).

Successful Heart Disease Treatment Surgery Performed for Dogs Outside of the US-Coming Soon to the US

A certain heart valve surgery on the mitral valve for dogs (no updates about cats yet but dogs do tend to have more heart surgeries than cats) is successfully performed in England and in Japan. Surgeries in the US have not been successful. But a hospital in Florida hopes to soon begin the surgery. I found out about it when my cats' cardio posted that a dog patient of hers, returned from overseas after a successful surgery and was continuing to do very well. 

"Friends I would like to thank everyone here for their vocal support of the University of Florida’s plans to bring Dr. Uechi and his team to the USA to perform this life saving open heart surgery, while also teaching our US veterinary surgeons how to perform the mitral valve repair (MVR) surgery, successfully..."

https://mightyheartsproject.org/travel-to-florida-uf?fbclid=IwAR07wKPey4-btklJ2qUYS58prcDhFoOZhhzU7Le7owadoPOu1YLI68qzVZo

Feline hyperaldosteronism-Adnrenal Cancer, Cause of CKD/Hypertension/Low Potassium

There has been a lot going on in our house of cats. In June and July, I think I've been to the vet-regular vet, cardio, vet for check-ups, vet for illness, vet for rechecks, shots, etc.-about 25 times. There are some serious issues to discuss and I'm still working on the information. But-all of the cats have seen the cardio except Roxanne (she goes in Dec.) and all are fine and no HCM.

The siblings went through a virus in late June through July with mild vomiting and diarrhea presenting in almost all four but not at the same time. At first, I thought nothing of it, that if one vomited, and another had diarrhea, that it's not unusual for those things to randomly appear by chance. As long as the cat that vomited didn't continue and didn't appear lethargic and continued to eat, I let it go. The diarrhea I treated as needed with either less fiber, more Forta Flora (probiotic) or rice water (great binding agent.)

But then early in July, Bette Davis vomited violently and then decided she was going to spend the day sleeping and not eating. I took her to the vet the next day (while hand feeding her liquids the day before to keep up hydration and nutrition.) She didn't have a fever and her blood work CBC/chem panel and PLI (pancreas test) was normal. But she did present with pain reflexes in the gastro/bladder/kidney area of the body upon exam. So, three days of Buprenex (pain reliever, swelling reducer) twice a day (about .3ml or so each-the vet sent home syringes of the med so I have forgotten the exact amount) did the trick. They also gave her sub-q fluids.

BUT-Baby has had signs of CKD-kidney disease-which I reported weeks ago. I did not review all that the vet hospital was testing. She has hypertension and is on a calcium blocker and her pressure went from 240 in May to 130 in June and now 124. She's responding very well. She's on a diet for low phos kidney food and her SDMA went from 21 to 20, while her BUN and creatinine remain normal.

BUT the vet suspected that she could have hypertension and low potassium NOT because of CKD (although the SDMA is supposed to indicate CKD) but due to hyperaldosteronism, a possible cancer of the adnrenal gland connected to the kidneys. I'm still reading up on it. But her blood test this week came in at 829-NORMAL is about 100-350. What's next? Not sure. She might need an MRI (the ultrasound in May didn't show a lot of change or masses) and further tests to try to pinpoint the cause which apparently is one form of cancer or another, or idiopathic masses or tumors that are caused by other issues.

Since May, I've been trying to learn all I can about CKD to help her. But now, if it's cancer, CKD is more like a secondary response to the cancer and not a primary issue that can be itself treated. Here's a link to a site about the issue. I'll write more soon.

"Screening for this disease should be performed in any cat presenting with hypokalemia or hypertension, as well as the subset of cats presenting with mild azotemia, if preliminary minimum database diagnostics fail to identify other underlying disease processes. Diagnostic tests should include a complete physical examination, complete blood count, serum chemistry profile, total T4 measurement, urinalysis, and blood pressure measurement."

https://veterinarymedicine.dvm360.com/feline-hyperaldosteronism-recognition-and-diagnosis?id&sk&date&pageID=5&fbclid=IwAR3o1gOhzRkIPM8GG-ArsBtCk4GMJfIZaXIy3HiS2UX90ZquZotkqpy6B9M

Kidney Disease-Even HCM Cats May Need Treatment

If your cat develops kidney disease-CKD-the cat needs a low protein, low phos diet. The article lists some of those brands. This may also apply to your HCM cat but in a different way. With heart disease, the kidney function declines. With diuretics, the kidneys take on the load of the work. Both issues create some decrease in function. At some point, your HCM cat may need a CK diet.

Both CKD and HCM cats need more potassium supplementation (Renal K, Nature Made, Sundown, etc.) as well as COQ10, vitamin E, vitamin C (made for felines), and iron (use human iron cut into halves or quarters.)

https://www.medicanimal.com/The-truth-about-renal-diets-for-cats/a/ART111494?fbclid=IwAR2TmszV--YG90Pa1AIGHKuJcUbFi3Vhs7dqegpsd-CcGlv3WJYfNKiDDyw