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Ask Dr. Michael Salkin Your Own Question

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Vet
Satisfied Customers: 27352
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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My cat is around 18 years old and is very ill. He has in the

Resolved Question:

My cat is around 18 years old and is very ill. He has in the last couple of days been diagnosed with anaemia and has according to the vet got some form of cancer that they are not able to diagnose at present without further testing. The vet has given him some 'pallative care', a B12 injection and some steroids. I am to continue to give him steroids twice a day. He has been on Royal Cannin Urinary Wet food for the last few years as he is sensitive to cystitis. He hasn't had a problem since being on this food for some years now which is good. However, I have been researching anaemia on the web and it states that it can be caused by the lack of B12 in the food. The vet says his prognosis isn't good - he may not last a week or two weeks. However, since last night he has livened up and started eating and drinking. He has also done his toilet which is good although his poop was very hard - almost like stones. I am worried about him and don't want to give up on him just yet. What can you suggest if anything. thanks

Submitted: 2 years ago.
Category: Vet
Expert:  Dr. Michael Salkin replied 2 years ago.
Aloha! You're speaking with Dr. Michael Salkin
I'm sorry to hear of this with Denzel. By the principle of Occan's Razor, Denzel's anemia is nonregenerative (Denzel is unable to replace the red blood cells he lacks) and caused by his chronic renal failure rather than an unlikely deficiency of vitamin B12 in his diet. It certainly wouldn't be harmful to receive supplemental vitamin B12 but I don't expect your seeing an appreciable difference in his hematocrit (HCT/PCV) following the injection. Ther reason for this is that he's lost too many functioning nephrons in his kidneys and a certain amount of normal kdiney tissue must remain which is able to manufacture erythropoietin - the factor which stimulates red blood cell production. We administer erythropoietin to these patients by injection if their hematocrit falls below 25. Please discuss the use of erythropoietin with Denzel's vet.

I'm pleased to hear that he's still eating and drinking. Spoiling Denzel rotten is the ticket at this time. I'd rather he eat the "wrong" foods than not eat the "right" ones. I can comment further but I'd need to see his HCT/PCV, BUN, creatinine, and phosphorus levels as well as his urine specific gravity and degree of proteinuria (protein loss in his urine) to be most accurate for you. In fact, I'd be pleased to review all of his recent blood tests for you if you could upload them to our conversation. I understnad that you might not have a copy of the results at home but Denzel's vet can give you a copy that you could photograph and upload using the paperclip icon in the toolbar above your message box (not if you're using the chrome browser) or by using an external app such as imgur.com or dropbox.com

Please respond with additional information and further questions or concerns if you wish.
Customer: replied 2 years ago.

Hi Michael


 


Thank you so much for your response, I have asked Denzel's vet to copy Denzel's blood test results etc for you to have a look at. However, the vet he normally sees isn't in today (Saturday) but will be back on Monday evening. Denzel has an appointment again then so hopefully the results will be ready for me to pick up and send to you.


Again, many thanks.


 

Expert:  Dr. Michael Salkin replied 2 years ago.
You're quite welcome. I'll watch for your next post.
Customer: replied 2 years ago.

Hi Michael


 


Unfortunately, my vet still hasn't emailed me Denzel's blood results yet so I am unable to upload them at present. I am hoping they will arrive in the next couple of days, although my free time with Justanswer is running out on the 12th of this month.


Thank you for your time taken to look at my cats problem.


Kind regards

Expert:  Dr. Michael Salkin replied 2 years ago.
You're quite welcome, Sam. I believe that you're welcome to return to our conversation even after the 12th. Please contact***@******.*** for more information.
Customer: replied 2 years ago.

Attachment: 2014-06-12_174912_blood_results.pdf

Hello Michael, here are the blood results I have received today. Let me know if you have any problems opening the file.


Thanks

Expert:  Dr. Michael Salkin replied 2 years ago.
Thank you! Although there's evidence of early renal failure (the elevated urea with a normal creatinine) the most alarming findings are the significantly elevated liver enzyme ALT and the life-threatening anemia which is only slightly regenerative. His blood sugar is elevated but that may be because of stress rather than diabetes mellitus.

Abdominal ultrasound +/- a needle biopsy of his liver would be necessary to clarify why that liver enzyme is elevated but Denzel is in no shape to undergo such a procedure. Frankly, I'm surprised that he's still with us with such a severe anemia. A blood transfusion would be necessary before any further work could be performed and because his prognosis is so poor at his age and with these findings I would be hard to convince to perform such a transfusion.

Please continue our conversation if you wish.
Customer: replied 2 years ago.

Hi Michael


thank so much for looking at his results. The vet did talk to me about having a blood transfusion but said she wouldn't recommend it because a) his age and b) the results would need to go to the UK and its risk whether they could get an actual blood type match for him.


Well, I'm giving him 2 steroids a day and some Lactulose SOL for his toilet. He's still able to leap about and is still eating and drinking. he's being kept warm and quiet and stress alleviated. I can only but look after him and do my best. He's known at the vets as being a 'feisty' thing!!


Thanks again


Sam

Expert:  Dr. Michael Salkin replied 2 years ago.
You're welcome, Sam. Denzel amazes me if can still leap about and continues to eat and drink. He's going to outlive me.

I'm going to check back with you in a week for an update. Feel free to return to our conversation - even after rating - prior to my contacting you if you wish.
Dr. Michael Salkin, Veterinarian
Category: Vet
Satisfied Customers: 27352
Experience: University of California at Davis graduate veterinarian with 44 years of experience.
Dr. Michael Salkin and other Vet Specialists are ready to help you
Expert:  Dr. Michael Salkin replied 2 years ago.
Thank you for your kind accept. I appreciate it.

I'll speak to you soon.

Please disregard the info request.
Customer: replied 2 years ago.

Hi Michael


 


I am sorry to report that Denzel has today, been put to sleep. He was progressively worse today and I felt that it was the right time. He kept going to his toilet tray for visits and doing some wees on the floor and was very weak in his back legs. I took him outside this morning and he was mostly lying down but enjoying the sunshine. He was loved very much and I am already missing him. I am heartbroken but in time I guess I will heal. I still can't really believe he's gone and still keep looking round for him in the flat.


Thank you for all your help


Sam

Expert:  Dr. Michael Salkin replied 2 years ago.
My condolences for your loss of Denzel. I appreciate your letting me know.

You may receive an inappropriate follow up from the site ostensibly from me. It wasn't and I apologize in advance should you receive it.

Please disregard the info request.
Expert:  Dr. Michael Salkin replied 2 years ago.
May I have an update on Denzel, please?

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