ALT levels?

chi83February 1, 2011

Hi all,

I brought my cat into the vet in December for mild vomiting. He has a history of eating fast and often throws up immediately afterwards. I wanted to get him checked out since I was going out of town for 2 weeks over the Christmas holidays.

Anyway, the vet ran a blood panel and the ALT levels came back as slightly elevated at 105-110. I believe the normal range is up to 100. She wanted me to bring him back in a month to retest.

I took him back last night and the levels were the same. Since it's just barely above average, and the vomiting seems to have stopped, she wants to see him again in 6 months.

She called with the results today. She didn't seem overly concerned but she kept throwing around possibilities like liver damage or heart failure and possibly using ultrasounds and biopsies to do further testing. He's only 5 years old, has a great appetite. Doesn't seem sick in any way. I feed them only Wellness food so they eat really well.

One thing of note is that he often, at least a few times a week in the winter, starts coughing. It sounds like a mild asthma attack to me, but it's been going on since I adopted him in 2005. The attacks last maybe 5-10 seconds and he's totally fine afterward. I treat him with Laxatone just in case it's hairballs. I notice it seems much worse in winter with all of the heat. During the spring/summer I maybe only notice it once every two weeks or so. I live in an apt so I can't really clean out the vents. I've mentioned it to my vet before and she doesn't think it sounds severe enough to treat him with steroids or anything. I figure if he's done it for 5 years without increasing severity, it's nothing to worry about.

The only other thing is that when he heavily exercises, like when he chases the bird on the string and he jumps around like a maniac, he gets out of breath and I can hear him wheezing slightly. He doesn't pant but I can hear a little bit of a wheeze for a few minutes till he calms down. I don't know if that's cause he's out of shape (typical lazy house cat) or if he has some other issues. When I first got him, another vet told me that he thinks his nasal passage is a little deformed so he sounds more wheezy than other animals. I also notice that when he's grooming himself, he makes little tiny grunting noises.

So I guess my question is this - do you know if sometimes cats just have slightly elevated ALT levels without having liver problems? Do you think it's necessary to run all these tests? Ultrasounds and biopsies? I'd like to trust my vet but she tends to run to the very thorough side, which is great but it really hurts my wallet not to mention stressing him out. Does the breathing sound like anything to worry about? Anyone have any experience with this?


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I can't address the breathing problems and hope Meghane will chime in. Has the vet ruled out any heart problems? Is the kitty overweight?

Re: the ALT levels, I once owned a dog that had high readings all his life and he lived to an old age of 17+ yrs (wasn't sure of his age when I adopted him). One vet wanted to run all types of tests but since he had no other symptoms or problems I chose to have blood panels done every 6 months. Another vet I took him to said some animals just have high levels with no cause to be found and as long as the levels didn't change much she wasn't worried about it.

    Bookmark   February 1, 2011 at 10:35PM
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Did only the ALT levels come out slightly high? For liver damage, there should be other elevated values and other symptoms. When you say you are feeding Wellness, do you mean dry or canned? Canned would be much better.

As for the breathing/coughing, does he ever throw up hairballs to explain laxatone (to me, it is just useless)? Did you ever have a fecal done to rule out parasites (such as roundworms)? How about heartworms? It certainly could be an allergy to the heating system, or some heart problems.
Before an ultrasound, I would ask the vet about X-rays (lungs). This said, a deformed nasal passage might explain the problems you see... Anyway, do stay away from steroids if you can (weigh the risks carefully). High risks of diabetes involved!

Hope you get some answers from your vet. I would be more concerned about the breathing issues than the liver ones..

Best of luck,

    Bookmark   February 2, 2011 at 6:58PM
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Thank you for the replies.

Yes, the only abnormal blood result was the ALT coming in slightly high. She did a CBC and everything else was normal. He did also have a slight fever when I took him in back in December but she thought it might be stress-related from the vet visit.

I have 3 cats, and sometimes I find hairball surprises when I get home. I have no way to track who is doing it but he's the only one I notice coughing. He likes the laxatone so I don't know if it actually helps or not but I figured it won't hurt.

She listens to his lungs every visit (he had 2 last year - the vomiting and a UTI a few months earlier) and doesn't hear congestion.

We did have a fecal done at the time of the UTI infection

They are fed Wellness canned food twice a day. I also leave out a small bowl of Wellness dry food in case they get hungry. He's a big cat - 17 pounds and could stand to lose a little but he's not obese. It sounds cliche but he does have a big frame. :) Another one of my cats is also overweight, but the 3rd is underweight so I have trouble trying to get them to lose weight while making sure the other one eats enough. I'm going to try harder cause i'm sure the little bit of extra weight isn't helping.

There's another thing too. It's hard to describe so I hesitate to even mention it but he seems different in the last year or so. Nothing I can exactly pinpoint. Maybe slightly more lethargic? Maybe not as happy? He has a great appetite, purrs a lot, sleeps fine, plays. He just seems a little different and at first I chalked it up to him growing out of the kitten phase but now I'm not so sure. With such vague observations I don't know if it can mean anything.

I'm definitely not going to put him on steroids unless it becomes a dangerous situation. My cat before him was put on steroids for a cough and died a week later and I'm not convinced that there wasn't a correlation. When I first got him, he coughed/sneezed/wheezed a lot and since he was from a shelter, the vet tried several rounds of antibiotics in case it was a respiratory infection, but it never stopped. That's when he suggested maybe a deformed nasal passage. He's been doing this for 5 years without it getting any worse so I see no reason to medicate. I watch him carefully and he doesn't seem to have problems breathing during it.

I also ordered some feline milk thistle so I'm going to try a little bit of that as I know it's good for liver health. I've done a lot of research and I feel confident that it's safe for him. He's not on any other medication.

I appreciate all your input!

    Bookmark   February 2, 2011 at 7:28PM
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Yes, milk thistle is said to improve liver function (be aware it does have a nasty taste), but.. does your cat really have liver issues???

As for his being "different".. If YOU noticed, then you are right, because you know your cat. By any chance, did his "slightly off" behavior start after a vaccine?

By the way, I do understand the headaches to feed cats with different needs (we have 5)! But keep an eye on your "17-pounder"!

Hope all your concerns clear soon,
Good luck,

    Bookmark   February 2, 2011 at 10:06PM
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Hmm, that's interesting. I did take them in for vaccines roughly a year ago. I was new to the area and I had found that vet from a Google search. I really didn't like him at all and that was the first and last time we went there.

I didn't know it at the time, but one of my cats had severe gingivitis. I was asking about his bad breath and the vet told me to just moisten a cotton ball with Listerine and rub it in his mouth. That's when I decided to find a new one! And the way that he would weigh the cats would be to hold the cat, drag his ancient metal scale over (made a very, very loud noise that terrified the cats) then stand on it with the cat then deduct what he thinks he weighs from it. So who knows what was in the vaccines.

Can you tell me more about that? Hypothetically, what could have happened after the vaccine? I admit I don't always get them vaccinated when I should because I think over-vaccination can be bad, and they are strictly indoor cats with no access to others.


    Bookmark   February 3, 2011 at 7:04AM
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I have noticed one other strange behavior. He just did it again, which made me think of it. But I've noticed it for the last month or two. I don't see how it could be related to ALT levels but I'll share anyway in case anyone has an idea.

Monkey loves running water, and if I go into my bathroom he jumps on the sink and demands I turn the water on so he can drink from it. There are a lot of things on my vanity, including a hairbrush, and he'll be sitting there happily drinking and I pick up my brush to brush my hair and he looks up with a terrified look, cowers like i'm about to beat him with it then takes off running at full speed!

I can't figure it out! I don't beat my cats, much less with hair brushes, so it breaks my heart that he fears I'm going to smack him with it. I have a roommate but I can't picture him sneaking into my room (with private bathroom) to hit my cat with my brush, and that's a pretty serious accusation anyway, so I have no idea why he would suddenly be afraid of this object.

I tried different things, lifting other bottles, etc and nothing else got the reaction from him. I had another brush and I brought that in and used it and the same thing happened. It's so strange and sad. I've tried to hold him there and gently brush him with it so he sees it's not scary but it doesn't work.

It's really strange. This cat isn't afraid of anything. He'll run right up to dogs or strangers, and to be terrified of a hair brush all of a sudden is mystifying.

    Bookmark   February 3, 2011 at 7:20AM
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I don't beat my cats, much less with hair Now, I'm starting to wonder.. Are you sure??? Lol!

All that came to my mind when I read about this strange reaction was that .. when you were away for the Xmas holidays (did you board your cats or did you have someone care for them at home?), someone may have brushed Monkey with a brush that he did not like.. hence the association. Does he let you brush him? Each of my cats has his/her own favorite brush--and I better remember which one they like!

As for vaccines.. Well.. that is quite a topic! Which vaccine(s) did Monkey get?
If your cats are indoors, the only vaccine you might want to consider (especially if you board your cats) is the rabies one (non-adjuvant, and the one-year one). Don't even consider vaccinating a cat who is sick, weak, old (Monkey is not), with allergies... and do not go for combo shots-even if it implies 2 trips.

There is good info on this site: vaccine protocol. I also learned a lot from this little book Vaccine Guide for Dogs & Cats by Dr. Diodati. I just wished I had known all of this 3 years ago.. Both my 'senior' outdoor cats had bad reactions.

My first one developed a serious limp that lasted 2 weeks. He got oral Metacam, then he started drinking/urinating a lot (that was from Metacam), pulling his hair like crazy (got ivermectin injection..for possible parasites). He had damaged kidneys. One bad thing (shot) led to more 'bad ones'..
My other 12 year-old cat got a combo vaccine (distemper /leukemia+booster!!) after we moved up here. There was no 'real' symptoms-- just subtle ones.. like being un-interested in the outdoors-totally unlike him, sleeping more.. and I could not convince the vet there was something wrong with him. He went down very fast. And what really haunts me is that our previous vet had made a special note in his file about negative reactions to comboFVRCP/FeLV combo.. right on the first page.. and had discontinued the Leukemia vaccine for him (which is why he got a booster from new vet 2 weeks later!).. He was my first cat to go, the other one followed 5 months later. This is what it took to make me take charge of my cats' health and make more informed decisions. Vaccines weaken the immune system and are not necessary after the first round (usually). You should weigh your cat situation with the risks.

I am now to my 3rd vet here. But my faith in vets was horribly shaken. What I would really want is a holistic vet...

It is wonderful that you are trying to stay on top. Education is key! May I suggest you always get copies of bloodwork, and of your cats'records if you change vets. By going through those files, I learned a lot. I joined a yahoo group WholeCatHealth not long ago, and I find it quite enlightening!

All this said, Monkey is probably in his 'winter' mood. Do NOT get alarmed!

Best of luck,

    Bookmark   February 3, 2011 at 1:30PM
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Thanks again.

Well, I did have a pet sitter come for the two weeks I was away. She came every other day and I have every indication that she did a great job but I guess I don't really know for sure! The thing is, it's my brush and I don't really use it on them, haha. They have a Furminator comb. He tolerates it fine but I don't think he especially likes it. The whole brush thing is really strange. This cat isn't afraid of anything - I can vacuum right next to him and he doesn't blink.

Honestly, and this is bad, but I'm not sure what he got other than Rabies last year. I'll be sure to pay better attention from now on. They're due for shots again but I don't think I'll get them this time. I try to care for them as naturally as possible, which is why I spend so much on their food.

One other strange thing he does is lick things. He loves to lick the cord for the mini blinds. He licks plastic bags, books, all sorts of random things pretty obsessively for a few minutes. I've heard this is fairly common so I don't know if it means anything. He's also started licking my arm a lot and he LOVES to chew on my hair and will do it any time i'm sitting on the couch or otherwise at his level, haha. He purrs like crazy while he does it. I have to stop him cause I have long hair and I don't want him ingesting it. Very strange cat I have.

    Bookmark   February 3, 2011 at 1:48PM
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They were also born in Florida and lived there up until last year when I moved them to cold and snowy Boston. He's not used to the heaters and dry air so I think that might be partly why he sounds congested.

    Bookmark   February 3, 2011 at 1:50PM
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Cats just do stange things.. that's their nature. It becomes a concern when there is a CHANGE in behavior. I have to hide ANY plastic from 4 of my cats, or they'll bite, chew on it!

Anyway, if you check your bill/receipt, you should know what they got vaccinated for. If not, call the vet's office and ask for a copy of their medical records. You SHOULD have those. Otherwise how would you know what to vaccinate them for? If they are indoor only cats, really think twice about shots besides rabies, even rabies, and know there are several types. I'm surprised your current vet would not have asked for those records..

Yes, you are right about the coughing/wheezing.. that could come from the fact they are not used to heating systems!!!

Hope you like snow.. Although I don't think we are getting as much here in Maine as in Boston this year, I am really getting tired of it... Just storms after storms, and mountains of snow everywhere!

Enjoy this sunny day,

    Bookmark   February 3, 2011 at 3:04PM
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Hardly something I would say for sure, but something that comes to mind for me that might affect both breathing and ALT would be some kind of chemical. Do you use a lot of commercial cleaning agents in your home? Candles or other scented items?

My old cat has many medical problems, but had high ALT for a time. I swear she would have higher readings after I used a particular commercial carpet cleaner. (she use to have blood work 4 times a year). I don't know for sure if something like that could cause an increase of values, but maybe not something to rule out either.

Any new upholstered furniture lately? New carpets? That is something else I have read about- all the dyes, fire retardants, sizing, etc. in the fabric causing immune system problems in cats, however that is particularly for cats who already have some health issues, but it's possible something like that could cause a slight increase for a little while.

I used milk thistle with my cat for a while and was pleased with it. My understanding is the same as yours, in that it is relatively safe, and if you are using a small dose, you can think of it as liver support. I do think it helped my cat, and I know it has been proven in human studies.

As far as the hairbrush goes, I have to agree that cats are weird. Is it possible that your cat doesn't like your hair products? One of my cats freaks out over shoes in the funniest way- she has always done that. I think it is because shoes smell distinctly like individuals and maybe have more smell associated with them than other items around the house. The same might be true for hairbrushes. She will sometimes sit next to a shoe for quite some time before having a freak out session over it, or she will suddenly become aware of the shoes when you pick them up but not before then, even if they were close by.

    Bookmark   February 3, 2011 at 4:40PM
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Hmm, I try to keep my home as chemical-free as possible in terms of cleaning products. I usually just use vinegar/water or some of the non-toxic brands. I do put perfume on in the morning so maybe I can go into another room to do that.

Like I mentioned before, I really notice it much, much more during the winter so I think it might have something to do with the heating. Come to think of it, I adopted him in November of 2005 in Florida and we were using the heater a little bit then and that's when I first noticed the coughing attacks. Maybe he just doesn't do well with forced heat or maybe the vents are dusty. I have a humidifier somewhere that I can dig out and see if that helps. Actually, all 3 of my cats are currently sneezing/sniffling a little bit. Not enough that I think it's a URI but more dusty.

I live in an apartment and I move around a lot so it's hard to tell about carpet.

I hate to think it's my kitty litter. :( I use EverClean and I LOVE it compared to other litters. I tried to go natural but with 3 cats and working all day, the smell would get overwhelming because I can't scoop multiple times a day.

I think I'll try the milk thistle, mostly because I already bought it. If he has slightly elevated levels now at his middle-age, then I can't see how it would hurt to use it as a preventative measure before any other major things come up.

Oh, and my current vet does have all their records. In fact, today I got a notice saying they were due for Rabies and FVRCP and I know that's based off of the old crazy vet. I just don't have personal copies and you're absolutely right, I should keep them.

Thanks for all of the suggestions!

    Bookmark   February 3, 2011 at 5:53PM
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ALT is released from liver cells when they are damaged. We usually get pretty concerned to see elevations at all because it means there is some active liver-damaging process going on. While it's great that the levels have not increased, the fact that they still ARE increased means that whatever is damaging the liver cells is still causing damage. If it was a one-time event, the ALT returns to normal within a few days.

If I was working him up, I would suggest x-rays to evaluate the size and shape of the liver, make sure there are no obvious tumors, and take a peak at the lungs while we were getting pictures anyway. Then I'd do an ultrasound to evaluate the structure of the liver. If nothing scary turned up, I doubt I'd go further diagnostically as long as he was 100% healthy otherwise.

As far as empirical treatment, I would deworm with fenbendazole, treat with metronidazole for 2 weeks, and start milk thistle and SamE. Then I'd recheck the ALT in a month. Usually that fixes my patients.

As far as the breathing issue, most large cats, whether they are overweight or not, have some degree of asthma. If he truly cannot stand to lose a pound- ie he's already skinny- then I wouldn't do much. But I have yet to meet an 18# cat that isn't overweight, except one Maine Coon.

Non-adjuvented rabies every year no matter what you think your cat's exposure could be. Indoor only cats get exposed to rabies, just look at the "Don't make my mistake" thread. It's not worth risking your cat's head being sent to a state lab for rabies testing, or being quarrantined for 6 months.

FVRCP: I do a kitten series every 3 weeks until the kitten is 16 weeks old. Then I booster one year later, then every 3 years after that. Of course, I'd only vaccinate a healthy cat, so he will have to wait.

FeLV: no need in an indoor only cat.

You should be able to get the records from the old vet. Either way, you will have to authorize the release of medical records to the new vet.

Hope your kitty does well. Please keep us posted.

    Bookmark   February 4, 2011 at 3:15PM
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Thanks so much Meghane.

I started him on Milk Thistle today. It said 10-20 drops 1 to 2 times per day but I'm nervous with that quantity so I did 5 drops and they're eating the food just fine. It's specially formulated for cats so hopefully it'll help.

Do you think it's okay to wait 6 months? The vet said that since it's only slightly above average, the rest of the blood work is clean and he's not vomiting anymore that I can wait to get it tested again.

And he can definitely lose a pound or two. He's not extremely overweight but he has some chub so I'll work harder on that. I just hesitate to play with him a lot because the breathing gets worse then and I'm not sure how far I should let him go. Once he gets into his flying bird toy, he'll chase it till he drops.

    Bookmark   February 4, 2011 at 6:20PM
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So a follow up...

I didn't have Monkey tested in July like I was supposed to but he's been acting just fine. Yesterday I took him into the vet for a check up and I brought the lab results and asked the vet about them. The ALT from 12-2010 was 104 (100 maximum) and the Jan-2011 ALT was 112. That was the only liver enzyme that was high. The vet said it was just barely above and he only really worries when it's two or three times the maximum range.

Monkey has also lost 3 pounds in the last year. I believe it's because I moved him from a free-freeding dry food diet to a strict canned food only diet so he's slimmed down. He was 17 pounds and now he's just under 14, which is good for his size. But between that and the ALT levels, the vet wanted to do another panel.

He just called me with the results. Now, there are four affected liver enzymes (he didn't tell me specifically which ones) that are high, but he said they are just barely above normal. He also said that the blood was clumpy (he gave a more scientific word for it - can't remember the name, something that started with an h and ended in -sis, lol) and that there was some fat in it from eating so he thinks that may have caused some of the elevations instead of it being a true elevation. He's calling the lab to find out. I should say the other two blood tests last year also had a note about the clumpy blood and how it might affect the ALT levels.

The thing is, Monkey didn't eat before he came in. He gets food at 6 am when I wake up, and then again when I get home. When I got home to take him to the vet, I didn't feed him beforehand. The vet did give him treats in the office but he said that wouldn't have affected it. So I don't know where this fat came from. I told the vet he didn't eat but he didn't seem that concerned.

Oh, and the night before, Monkey got into a bag of those candy melts and ate some and threw it up. I brought the bag with me to show the dr. It's full of sugar and oils and milk derivatives and it's not something I would have dreamed he'd get into but I wonder if that had an affect. He's been snacking on a lot of bad foods as I've been making holiday treats (I don't give them to him but sometimes he'll snatch something I drip in the kitchen before I can get it).

So what I'm taking away from this is that:

1. it might be a lab issue because of Monkey's blood and he might not have higher elevations at all

2. It's been a year between tests and his elevation is still just slightly high. I tend to think that active liver damage would be more progressed in a year, right?

3. There are three other high enzymes now but just slightly above and they may be inflated because of the blood

4. All other blood levels were fine and I did the full senior panel so they looked at everything

He said he doesn't think it's anything to worry about but he recommended supplementing with milk thistle and samE just in case there's mild damage of some sort.

I'm trying not to worry about it. All things considered, I think this is good news. Not the best possible news but much better than high numbers!

Any thoughts?

    Bookmark   December 23, 2011 at 4:32PM
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Hemolysis...that's the word. It's been present in all three tests and apparently can contribute to elevated levels in reporting. It took them a really long time to get the blood from him yesterday, over 20 minutes, and the vet thinks that may have contributed to the hemolysis because he struggled so much. They took a little, then he jumped down, ran a lap around the hospital and then hid in a cubby in the vet's desk before they were able to finish the draw...

    Bookmark   December 23, 2011 at 6:34PM
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Doesn't sound like much going on, but a simple ultrasound of the liver would never hurt (harmless and uninvasive). Levels are indeed too low to get excited about, but weight loss, if continues, is not something I would ignore. I wouldn't even worry about putting a cat on Denamarin with liver nz changes that minimal... could be normal for your cat, even... unless the ultrasound was not normal.

    Bookmark   December 26, 2011 at 12:56AM
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