New and have hypercalcemia question

Hello to all,

I am new, my first post. Hope I am doing this correctly. I have an 11 y/o female who was diagnosed with hypercalcemia January this year. Controlled quite well on 5 mg of prednisone daily, until recently. Ionized calcium continuing to elevate. Pred is no longer controlling it. She sees an internist for this particular problem who will be looking into other treatment options and get back to me shortly once she has gathered all her info. Anyone here have a similar health issue that they could share some insight. I believe it will most likely be bisphosphonate infusions, but that's assumption on my part.

She has other health issues as well, chronic constipation/motility disorder for which she is on Lactulose and cisapride, after a megacolon situation. She is a little teenie cat, who has just gone from her normal weight of 5 lbs 3 oz down to 4 lbs 7 oz. She was hospitalized for 4 days 2-1/2 weeks ago with a pretty significant work up that revealed nothing in addition to her chronic constipation and some degeneration of her knee (arthritis). Her recovery has been very slow and very discouraging (but definite). I have learned to never underestimate how painful constipation can be. This new news is so depressing. I thought we were on an upward swing. Without control of her hypercalcemia, things could become very bleak. I love her to death and we have been through a lot. Sorry so wordy....anyone will a similar problem??? Love to hear from you.

Hello and welcome.

I don't have experience with this, although I know some other members have.

Has the vet suggested that the lactulose could contribute to the hypercalcemia?

There is more info about that here:

http://felinecrf.org/treatments.htm#constipation

and here

http://felinecrf.org/diagnosis.htm#hypercalcaemia

From that first section on constipation, there is a link to the PDR that explains it in more detail.

Thank you immensely for this information. This was something I did mention to my vet, who in turn, discussed it with this internist, who both poo-poo'd the efficacy of this...but please know you have pointed me in a different direction to investigate this to my fullest...the ironic side of this, her lactulose was just increased from 1.5 ml two times daily to 2-3 ml twice daily, dependent on stool consistency. I find it quite interesting her calcium level increased as well. Thank you.

Sorry to hear your kitty is unwell

Any parathyroid evaluation (PTH levels)? Hypothyroid? No cancer? (Sorry if you've already explained this elsewhere

)
Did your vet say why your cat is suffering from hypercalcemia? Increased calcium can cause many symptoms:

-nausea
-vomiting
-alterations in mental status
-abdominal/flank pain
-constipation
-lethargy
-depression
-weakness, vague muscle/joint aches
-polyuria
-headache

Treatment would depend on the underlying cause. Careful hydration is usually recommended, and a loop diuretic (such as furosemide) can help with volume overload and help eliminate calcium. (avoid thiazide diuretics! these can worsen hypercalcemia). Is the lactulose to help with constipation? Like beandip said, it can worse the calcium levels. It'd be best to get to treat the underlying cause if possible. GOOD LUCK

PTH normal. Thyroid study normal. Malignancy ruled out through radiographic survery, ultrasound, CT scan, EMG. After all known causes have been ruled out ,they term it idiopathic hypercalcemia, e.g. no known reason. Yes, Lactulose & cisapride for chronic constipation with motility disorder. Both vets (regular and internist) seem pretty closed to the idea that Lactulose could be accountable.

Internist just called as I write, wants to increase pred to 7.5, recheck in 2 weeks. Doesn't feel there is enough experience in this arena for the bisphosphonate therapy (pamidronate).

Originally Posted by luvmyhimmy

PTH normal. Thyroid study normal. Malignancy ruled out through radiographic survery, ultrasound, CT scan, EMG. After all known causes have been ruled out ,they term it idiopathic hypercalcemia, e.g. no known reason. Yes, Lactulose & cisapride for chronic constipation with motility disorder. Both vets (regular and internist) seem pretty closed to the idea that Lactulose could be accountable.

Internist just called as I write, wants to increase pred to 7.5, recheck in 2 weeks. Doesn't feel there is enough experience in this arena for the bisphosphonate therapy (pamidronate).

Click to expand...

Good, your vet was thorough. Here are 2 websites with info that you might find helpful/interesting: (but sounds like you're an expert already by necessity )

http://www.vin.com/VINDBPub/SearchPB...00/PR00123.htm
http://www.merckvetmanual.com/mvm/in...m/bc/40409.htm

Besides a high fiber diet, if your cat can stay adequately hydrated, a loop diuretic might be worth a try -- it can be used in people in such a case. I'm not sure why a bisphophonate would be helpful if there are no lytic bone lesions/bone loss.

Healing vibes for your furry guy

I have nothing to add but I just wanted to say that that both you and your vet seem to be doing a VERY through job. Not a lot of people out there would be willing to have all of those tests run on their kitties (considering how costly some of them are) I just wanted to applaude you for how far your willing to go for your baby.

Good luck with finding some answers!

Thank you...and thanks to CareCredit I have 2 years to pay this off. Fortunately it has been over a 6 month span of time. Her hypercalcemia work up was not the majority of the expense. Her recent bout of constipation is what prompted the hospitalization, CT scan and EMG. She appeared to be in so much pain. This otherwise sweet, docile, mild tempered kitty would hiss and growl at me if I even walked near her. Didn't seen it could all possibly be a result of constipation so all this neurological testing was done. All negative, so I have learned from this, never underestimate the discomfort and pain they can experience from constipation. I know we are at the end of the road. I have done all I can do for her. Right now she is eating well and feeling well. I will cherish each day. Who knows what benefit we will see with the the increased prednisone dose. I don't have any unrealistic expectations but I can hope. I just lost my boy Himmy in January to a very aggressive cancer and I just don't want to lose another one, not yet...her comfort level, or lack of, will guide me in the days ahead.