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Elevated ALT

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  • s.theye
    Hi, I was hoping to get some opinions. Have any of your heart kitties had elevated liver enzymes show up during routine blood work? At my HCM kitty Jack s
    Message 1 of 9 , Jul 27, 2011
      Hi,

      I was hoping to get some opinions. Have any of your heart kitties had elevated liver enzymes show up during routine blood work?

      At my HCM kitty Jack's yearly echo this past June, they did blood work, and his ALT was 240. I think the normal upper range is 100. We repeated blood work at his regular vet's 3 weeks later and it had dropped to @ 200 I think, but still above upper normal.

      Jack's vet would like him to have an abdominal ultrasound, which I worry about mainly because of the stress factor. She said it could be nothing or it could be something, so I am not sure whether to put him through the stress of a possible unnecessary procedure, or just wait and see if it goes back to normal in a few months.

      Anyone have any experience with this? Jack hates car rides and I think with abdominal ultrasound he would have to be on his back....

      Thanks!
      Shelley
    • Cathy Mack
      Hi Shelley, One of my kitties did have an elevated ALT, about the same as yours, and it turned out to be hyperthyroidism. Have you had the thyroid test done?
      Message 2 of 9 , Jul 27, 2011
        Hi Shelley,

        One of my kitties did have an elevated ALT, about the same as yours, and it
        turned out to be hyperthyroidism. Have you had the thyroid test done? As soon
        as we had the I-131 treatment done, the ALT returned to normal.

        HTH, wishing you and Jack the best,

        Cathy




        ________________________________
        From: s.theye <veery@...>
        To: feline-heart@yahoogroups.com
        Sent: Wed, July 27, 2011 11:02:03 AM
        Subject: [FH] Elevated ALT


        Hi,

        I was hoping to get some opinions. Have any of your heart kitties had elevated
        liver enzymes show up during routine blood work?


        At my HCM kitty Jack's yearly echo this past June, they did blood work, and his
        ALT was 240. I think the normal upper range is 100. We repeated blood work at
        his regular vet's 3 weeks later and it had dropped to @ 200 I think, but still
        above upper normal.

        Jack's vet would like him to have an abdominal ultrasound, which I worry about
        mainly because of the stress factor. She said it could be nothing or it could
        be something, so I am not sure whether to put him through the stress of a
        possible unnecessary procedure, or just wait and see if it goes back to normal
        in a few months.

        Anyone have any experience with this? Jack hates car rides and I think with
        abdominal ultrasound he would have to be on his back....

        Thanks!
        Shelley




        [Non-text portions of this message have been removed]
      • Kristen G
        My non-HCM kitty had elevated ALT, and much more elevated that your Jack -- I think it was 5 or 600 something like that. We repeated the test and it was still
        Message 3 of 9 , Jul 27, 2011
          My non-HCM kitty had elevated ALT, and much more elevated that your Jack -- I
          think it was 5 or 600 something like that. We repeated the test and it was
          still high. So, we did the abdominal ultrasound which was absolutely normal and
          a couple of months after the whole thing started the number was back to normal.
          Just my experience. I don't know if this helps you.


          It might be worth talking to the vet about repeating the bloodwork in a month or
          what the possible causes could be. My memory of the things that I read at the
          time is that there was some mention that this could be caused by infection,
          which was a reason to find out more so that you could give antibiotics if
          needed. That is why I wanted to get to the bottom of it. I would want to know
          if the potential causes are treatable or not, I guess.


          Kristen



          ________________________________
          From: s.theye <veery@...>
          To: feline-heart@yahoogroups.com
          Sent: Wed, July 27, 2011 2:02:03 PM
          Subject: [FH] Elevated ALT


          Hi,

          I was hoping to get some opinions. Have any of your heart kitties had elevated
          liver enzymes show up during routine blood work?


          At my HCM kitty Jack's yearly echo this past June, they did blood work, and his
          ALT was 240. I think the normal upper range is 100. We repeated blood work at
          his regular vet's 3 weeks later and it had dropped to @ 200 I think, but still
          above upper normal.

          Jack's vet would like him to have an abdominal ultrasound, which I worry about
          mainly because of the stress factor. She said it could be nothing or it could
          be something, so I am not sure whether to put him through the stress of a
          possible unnecessary procedure, or just wait and see if it goes back to normal
          in a few months.

          Anyone have any experience with this? Jack hates car rides and I think with
          abdominal ultrasound he would have to be on his back....

          Thanks!
          Shelley




          [Non-text portions of this message have been removed]
        • acrocat@rocketmail.com
          Hi there I agree with the other poster to check his T4, if he s over the age of 6 and you haven t checked it within the past three months. ALT is the one value
          Message 4 of 9 , Jul 28, 2011
            Hi there

            I agree with the other poster to check his T4, if he's over the age of 6 and you haven't checked it within the past three months.

            ALT is the one value in a bloodtest which actually indicates liver problems. ALT is released when liver cells are broken up, so it means that there was some insult to the liver. Now this can be for many reasons, most of them innocuous and unknown, and in the scheme of things his ALT is not very elevated. An animal with serious liver damage may have an ALT in the thousands!

            Do you have a copy of the blood test? Does it have a "GGTP" on it, and is that value normal?

            As for further testing, you have a few options. YOu can ask your vet about submitting a urine bile acids test. Bile acids is a means of testing how well the liver is functioning. I don't think, with just an ALT of 200, that there is any reason to think the liver is not working well, but it's a test that you can do by collecting urine at home and submitting it. If the liver function is good, it's easier to postpone a workup. Bile acids has normally only been tested in blood, but more recently people are trying the urine test and it seems to be correlating well with blood results. It is not as 'trusted' as the blood test and may not be for several more years as people get used to it.

            You could also have the ultrasound done. You can discuss giving your cat some sedation at home before you go -- a little bit of Xanax or a similar drug to make him less anxious (probably won't be too sedating, just will make him more mellow). You can also arrange to have him be the first appointment of the day, so there is no waiting, and you can wait in the car and ask them to call you when they are ready so he's really only apart from you for 15 minutes or so. That would help.

            I'll warn you that they may find cysts on his liver (hepatic cystadenoma), if he's an older cat. A lot of cats get these benign liver cysts when they get older and it's not clear why. They only cause trouble if they are big and press on the stomach or something, which is rare. I would not be concerned if my own cat was diagnosed with a cystadenoma since, while they aren't normal, they aren't big news either.

            Hope this helps. Keep us posted.

            Adriann
          • Lily
            Hi Shelley, My 15.5 year old cat Jeremy was diagnosed as CRF & CHM Thanksgiving weekend 2010. His abdominal ultrasound showed no real areas of concern, othr
            Message 5 of 9 , Jul 29, 2011
              Hi Shelley,

              My 15.5 year old cat Jeremy was diagnosed as CRF & CHM Thanksgiving weekend 2010. His abdominal ultrasound showed no real areas of concern, othr than a small lightly more active spot on his liver. His Thyroid profile values were nicely normal.

              Jeremy was put on Enalapril and Atenolol at first, and his liver enzymes did go up without his BP going down enough. So they switched him to Amlodipine, which lowered his BP to our target level.

              My vet also suggested trying Denamarin, which is composed of the liver healing components of Milk Thistle, and his liver enzymes dropped to a comfortable level when they were checked 4 weeks later.

              I could tell within a few days that the Denamarin was helping because of the way he was suddenly bouncing around, still thin, but more like his old, feeling well self. Denamarin can be bought through your vet, or if you have approval to use, through Amazon Marketplace.

              I highly recommend asking your vet about the Denamarin.

              Lillian and Jeremy (CRF/CHM)


              --- In feline-heart@yahoogroups.com, "s.theye" <veery@...> wrote:
              >
              > Hi,
              >
              > I was hoping to get some opinions. Have any of your heart kitties had elevated liver enzymes show up during routine blood work?
              >
              > At my HCM kitty Jack's yearly echo this past June, they did blood work, and his ALT was 240. I think the normal upper range is 100. We repeated blood work at his regular vet's 3 weeks later and it had dropped to @ 200 I think, but still above upper normal.
              >
              > Jack's vet would like him to have an abdominal ultrasound, which I worry about mainly because of the stress factor. She said it could be nothing or it could be something, so I am not sure whether to put him through the stress of a possible unnecessary procedure, or just wait and see if it goes back to normal in a few months.
              >
              > Anyone have any experience with this? Jack hates car rides and I think with abdominal ultrasound he would have to be on his back....
              >
              > Thanks!
              > Shelley
              >
            • s.theye
              Hi Adriann, thanks so much for your in-depth reply! We did do a T4 test, just the basic one I think. It came back @ 2.5 I believe. Vet says that s normal. I
              Message 6 of 9 , Jul 29, 2011
                Hi Adriann,

                thanks so much for your in-depth reply!

                We did do a T4 test, just the basic one I think.
                It came back @ 2.5 I believe. Vet says that's normal.
                I do think he has some symptoms, though no weight loss, but I
                have always wondered if he was borderline hyperthyroid if there
                is such a thing.

                I'll have to call and check on the GGTP value.

                I have been going back and forth on whether to keep his appt. for ultrasound
                on Monday, or instead, maybe do a liver panel first. I think I can just do that vs.
                entire blood panel.

                My vet says that any elevation in ALT in a cat is suspicious.
                She worries about possible bacterial infection, etc.

                I believe everything but the ALT was normal in his blood work but I will
                ask about the GGTP.

                He will be the first ultrasound appt. of the day, if I keep appt. :-) and I did push to be in the room with him after reading someone on this groups mention of being pushy about that and they agreed!
                So thanks to that person!

                I am just not wanting to put him through unnecessary stress due to heart.
                I think ultrasound would entail more stress than just drawing blood for repeat blood work, though it's only been a month.

                Shelley


                --- In feline-heart@yahoogroups.com, "acrocat@..." <acrocat@...> wrote:
                >
                > Hi there
                >
                > I agree with the other poster to check his T4, if he's over the age of 6 and you haven't checked it within the past three months.
                >
                > ALT is the one value in a bloodtest which actually indicates liver problems. ALT is released when liver cells are broken up, so it means that there was some insult to the liver. Now this can be for many reasons, most of them innocuous and unknown, and in the scheme of things his ALT is not very elevated. An animal with serious liver damage may have an ALT in the thousands!
                >
                > Do you have a copy of the blood test? Does it have a "GGTP" on it, and is that value normal?
                >
                > As for further testing, you have a few options. YOu can ask your vet about submitting a urine bile acids test. Bile acids is a means of testing how well the liver is functioning. I don't think, with just an ALT of 200, that there is any reason to think the liver is not working well, but it's a test that you can do by collecting urine at home and submitting it. If the liver function is good, it's easier to postpone a workup. Bile acids has normally only been tested in blood, but more recently people are trying the urine test and it seems to be correlating well with blood results. It is not as 'trusted' as the blood test and may not be for several more years as people get used to it.
                >
                > You could also have the ultrasound done. You can discuss giving your cat some sedation at home before you go -- a little bit of Xanax or a similar drug to make him less anxious (probably won't be too sedating, just will make him more mellow). You can also arrange to have him be the first appointment of the day, so there is no waiting, and you can wait in the car and ask them to call you when they are ready so he's really only apart from you for 15 minutes or so. That would help.
                >
                > I'll warn you that they may find cysts on his liver (hepatic cystadenoma), if he's an older cat. A lot of cats get these benign liver cysts when they get older and it's not clear why. They only cause trouble if they are big and press on the stomach or something, which is rare. I would not be concerned if my own cat was diagnosed with a cystadenoma since, while they aren't normal, they aren't big news either.
                >
                > Hope this helps. Keep us posted.
                >
                > Adriann
                >
              • s.theye
                Hi Lillian, I am glad that Jeremy felt better after adding Denamarin. I will definitely ask about that for Jack. One of the options was just to treat liver
                Message 7 of 9 , Jul 29, 2011
                  Hi Lillian,

                  I am glad that Jeremy felt better after adding Denamarin. I will definitely ask about that for Jack.

                  One of the options was just to treat liver with drugs, but I think that wasn't the first option because they wanted to know the cause for the elevated ALT....

                  Jack is now on Atenolol and Plavix, but he wasn't on those yet during his first blood work, though he did have a feline Heartgard heartworm preventative a few days prior to the blood work.

                  Then for the repeat blood work 3 weeks later, he was on Plavix and Atenolol.
                  Vet didn't think Heartgard would cause increased ALT...

                  Jack is just 5 now, and has HCM or borderline HCM since he was about a year old.

                  Shelley


                  --- In feline-heart@yahoogroups.com, "Lily" <latruskalo@...> wrote:
                  >
                  > Hi Shelley,
                  >
                  > My 15.5 year old cat Jeremy was diagnosed as CRF & CHM Thanksgiving weekend 2010. His abdominal ultrasound showed no real areas of concern, othr than a small lightly more active spot on his liver. His Thyroid profile values were nicely normal.
                  >
                  > Jeremy was put on Enalapril and Atenolol at first, and his liver enzymes did go up without his BP going down enough. So they switched him to Amlodipine, which lowered his BP to our target level.
                  >
                  > My vet also suggested trying Denamarin, which is composed of the liver healing components of Milk Thistle, and his liver enzymes dropped to a comfortable level when they were checked 4 weeks later.
                  >
                  > I could tell within a few days that the Denamarin was helping because of the way he was suddenly bouncing around, still thin, but more like his old, feeling well self. Denamarin can be bought through your vet, or if you have approval to use, through Amazon Marketplace.
                  >
                  > I highly recommend asking your vet about the Denamarin.
                  >
                  > Lillian and Jeremy (CRF/CHM)
                  >
                  >
                  > --- In feline-heart@yahoogroups.com, "s.theye" <veery@> wrote:
                  > >
                  > > Hi,
                  > >
                  > > I was hoping to get some opinions. Have any of your heart kitties had elevated liver enzymes show up during routine blood work?
                  > >
                  > > At my HCM kitty Jack's yearly echo this past June, they did blood work, and his ALT was 240. I think the normal upper range is 100. We repeated blood work at his regular vet's 3 weeks later and it had dropped to @ 200 I think, but still above upper normal.
                  > >
                  > > Jack's vet would like him to have an abdominal ultrasound, which I worry about mainly because of the stress factor. She said it could be nothing or it could be something, so I am not sure whether to put him through the stress of a possible unnecessary procedure, or just wait and see if it goes back to normal in a few months.
                  > >
                  > > Anyone have any experience with this? Jack hates car rides and I think with abdominal ultrasound he would have to be on his back....
                  > >
                  > > Thanks!
                  > > Shelley
                  > >
                  >
                • acrocat@rocketmail.com
                  Hi The GGT is normally very low, so that s good. I would keep the appt for Monday, why not have someone take a look. I hope it s a radiologist or internist
                  Message 8 of 9 , Jul 29, 2011
                    Hi

                    The GGT is normally very low, so that's good. I would keep the appt for Monday, why not have someone take a look. I hope it's a radiologist or internist doing the ultrasound.

                    It can be very distracting to have the family in the room when doing an ultrasound, so be sure to stand back and not ask questions during the procedure. Oftentimes the vet will want to go over the images, make some measurements, etc. so I would allow him or her to do this so you can get as much info as possible.

                    Best of luck and keep us posted.
                  • s.theye
                    Hi Everyone, Just an update on Jack. I decided to wait on abdominal ultrasound and instead recheck ALT levels first, since 5 weeks had already passed since
                    Message 9 of 9 , Aug 3, 2011
                      Hi Everyone,

                      Just an update on Jack. I decided to wait on abdominal ultrasound and instead recheck ALT levels first, since 5 weeks had already passed since last blood work. Trying to avoid stress of traveling and ultrasound if not needed....

                      We did blood work yesterday, and vet just called to let me know that his ALT continues to drop and is now at 156. so it has gone from 243 to 203 to 156! Still a bit high, but vet says to wait on ultrasound now....

                      Only weird value is that his triglycerides were high at 595 (no fasting) at last blood work 5 weeks ago, and yesterday with 10 hour fast have increased to 795!!

                      So, she is checking with cardiologist to see what to do if anything. Might put him on liver supplement too for a while, either marin or demarin, she is checking on that also. I was reading that high triglycerides can be caused by a number of things. 2 of which are things that have to do with pancreas, another can be diabetes, but the rest of his blood work seems normal I believe.

                      Shelley


                      --- In feline-heart@yahoogroups.com, "s.theye" <veery@...> wrote:
                      >
                      > Hi,
                      >
                      > I was hoping to get some opinions. Have any of your heart kitties had elevated liver enzymes show up during routine blood work?
                      >
                      > At my HCM kitty Jack's yearly echo this past June, they did blood work, and his ALT was 240. I think the normal upper range is 100. We repeated blood work at his regular vet's 3 weeks later and it had dropped to @ 200 I think, but still above upper normal.
                      >
                      > Jack's vet would like him to have an abdominal ultrasound, which I worry about mainly because of the stress factor. She said it could be nothing or it could be something, so I am not sure whether to put him through the stress of a possible unnecessary procedure, or just wait and see if it goes back to normal in a few months.
                      >
                      > Anyone have any experience with this? Jack hates car rides and I think with abdominal ultrasound he would have to be on his back....
                      >
                      > Thanks!
                      > Shelley
                      >
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