HYPERCALCEMIA ANYONE EXPERIENCING IT?

I recently had a blood test done on my Jojo just on a gut feeling.  All his labs came out normal except for his calcium.  Normal is up to 10 and his was 12.4.  The vet said that it is usually due to not enough fiber and prescribed fiber pills and a retest in 2 months. 

I did some research and there could be some underlying serious conditions resulting from this such as cancer (lymphoma) being the worst.  Best case scenario is a benign thyroid tumor which can be removed but could also mean kidney failure too.

My vet also said that if his calcium doesn't come down there are medications that she could give him to lower it.  Something has to be causing this and I am concerned.  I know down the road it is going to be expensive; more blood tests, ultrasound, etc.

Has anyone had any experience with this?

Thanks.

Did you have a gut feeling because Jojo wasn't being himself? Is he acting sick?

Did they do the special Ionized Calcium (iCa) test? This confirms true hypercalcemia where it would be of concern.

In July 2012, I began assist-feeding Caesar after 48 hours of not eating. I took him to the vet and he was given a very bad "diagnosis." He had elevated calcium (including ionized calcium), elevated total protein, elevated globulin, low platelet count.  The doc at the time was thinking he may have lymphoma, multiple myeloma, or FIP, all very fatal conditions. Things did not look good. He was given fluids, shots (antiemetic, antibiotic, antacid, B12) and we were sent home with an appetite stimulant to get him eating again.

Recheck in 2 weeks showed continued elevated calcium (although it did go down a little) and a slightly elevated urea nitrogen, but everything else was back within range. I continued the appetite stimulant for a month, gradually increasing the number of days in between doses until I was confident he was eating again on his own. He ended up recovering and we never know what happened or why. Clearly it wasn't FIP since he's still around. He's due for a check-up, and it'll be interesting to see where his numbers are.

Cats can also have idiopathic hypercalcemia (no known cause), and there is a site dedicated to that: www.felineihc.org

Elevated calcium must be considered with other symptomology before it's considered the only finding, and no disease process diagnosed.

What else is Jojo doing, how does he feel? How did his exam go? Normal temp, lymph nodes, abdominal palpation? Ausculting his chest, did the vet hear abnormal heart/lung sounds/rhythm?

His liver and renal values were all within normal range, his phosphorus and electrolytes included in the chemistry? No sign of inflammation in the CBC? When the rest of bloodwork is normal, and a total calcium is elevated, the likelihood of scary diagnoses, such as renal disease or neoplasia, are unlikely. This may be why your vet's primary diagnosis is idiopathic (unknown cause) hypercalcemia, which sometimes can be decreased by fiber.

Any high total calcium should prompt a vet to order an ionized calcium, as the total calcium is not always an indicator of the biologically active calcium in the blood. His result is only 20% above normal, and his ionized Calcium may actually be normal, which means he doesn't have hypercalcemia. Parathyroid hormone should be sent in the same order to the lab when they send Jojo's serum, as the 2 results help better rule out disease that causes changes in blood calcium levels.

Increased fiber won't harm him, while the tests are pending.

@GoHolistic  and Puck

I had originally brought him in just for a blood test because of the gut feeling.  His weight fluctuates by a pound.  On November 8th he weighed 10.8, 11/17 10.6 and 2/17 9.8.  He maintained a weight of 9.6-9.8 from 3/30/14 to 9/10. At the vets he was 9.6 

 He was acting "a little" less active and I felt his fur didn't look as shiny.  That was the only thing I noticed.  He'd still plays but it hard to tell if the activity level is the same because I have a 11 month old who dominates the activity.  He just seems frail to me know but my boyfriend doesn't see it.  He does agree with me about the activity level though.   Oh, and a couple of times he was constipated it think because he was dragging his butt. 

She did a specific gravity test on his urine which checked the concentration and that was normal.  After the course of the fiber pills she wants to do the ionized calcium and then based on that an ultrasound.  I am going to request a PTH also as I didn't see that in the results.  Is that a separate test? 

I am a worry wart when it comes to my cats and keep a close eye on them, more than most people my vet says.  I can't get the calcium in him this morning because he knows I give it to him before he eats in the AM and I'm sure he senses that now.   He mostly eats dry food and just licks the juice from the grain free canned I give them and is basically a closet eater.  I only see him eat the grain free treats I give them.  I have tried just about every grain free canned food but he is a dry food junkie.  Is it OK to give him the fiber pills in between eating?

I don't know whether to take him in sooner than the 8 weeks to have the ionized calcium done or just worrying too much. 

As we have the ability to check an ionized Calcium in house, with one of our diagnostic machines, my vets will ask me to verify a high total calcium from a chemistry result. But, in emergency medicine, my patients are all sick, and knowing that information is vital to effectively diagnose and treat what is ailing them.

If they have enlarged lymph nodes and high ionized calcium, the vet discusses cancer prognosis and quality of life. If they have an arrhythmia and high Ca we consult our cardiologist, after running an ECG, looking for Vtach.  If they have a history of difficulty urinating and high Ca, calcium oxolate stones are high on the list, and Xray is ordered stat.  Weight loss, large urine output, high BUN/CREA and high Ca would prompt advanced renal insufficiency discussion, with a guarded prognosis, and potentially euthanasia.

But, it sounds like your Jojo was deemed healthy on exam, with all anatomy looking, feeling, and sounding normal. Knowing his ionized calcium right now won't affect his already good health. If you're suspicious of his exam findings, as you feel he's not his normal self, consider getting a different vet to examine him thoroughly.

If you note any changes in his eating, litterbox, energy level, or behavior you can discuss with the vet within the 8 week waiting period any concerns these changes raise, and if she's considering a possible diagnosis when combining these changes with his possible hypercalcemia. She may opt to check the ionized calcium sooner if you note any abnormal changes. The PTH is checked with the ionized calcium, as hyperparathyroidism combined with hypercalcemia is indicative of a smaller list of diagnoses, helping track down what is causing these elevations, and treating more effectively.

Thank you Puck.  You have quite the knowledge.  Are you a tech?  For some reason yesterday and today he has seemed his old self.  Has, seemed to me, got his kick back.  Maybe the fiber is doing him good.  He is a very private cat.  I don't see him eat dry food or go to the litter box as I do my others.  I only see him lick the juice from the canned food when I feed them.  His coat seems shiner now too.  Do you think it's the fiber?  Maybe he was constipated.  Would that help with that? 

I am going by my knowledge of high calcium in humans.

In humans: 90% of the time it is a benign tumor on the parathyroid gland. Because it is not very common a lot of times it will take a very knowledgeable specialist to diagnose. Because it is a sensitive area it does take a highly skilled surgeon to remedy, but once the tumor is out you pretty much go back to a normal lifestyle.

Although it can be cancer most of the time you know about the cancer before you start getting high calcium readings. High calcium readings show up late in the game.

Other causes include thyroid disorders and lung diseases, but these are not very common.

Hope your baby is doing ok. Yes, I have experience with this too.  After ruling out all the other possibilities, Hazel was diagnosed with idiopathic hypercalcemia.  We have managed it for a couple years with a biphosphonate infusion, fluids, a diuretic, and a steroid.  However two years later it is getting more difficult to manage.  Hazel is on an appetite stimulant now, and I'm afraid we are running out of options. I am beyond frustrated with the "no known cause" diagnosis.  Can't someone figure it out??????  Wish I could.