From:
Melissa Litwicki
Date: 2002-01-07 19:58:00 UTC
Subject: Continuing mysteries: Puff, baffled vet, p. vera?
I'd love some more vet input on Puff, my 5yo spayed female. My vet, and
all the vets she's consulted are stumped.
Puff weighs ~1000g. She went in Oct. 23rd for a yearly exam. Physical exam
showed excellent apparent health. Symptoms observed by me include
occasional excessive itchiness, occasional vomiting, occasional frequent
lip-licking/smacking, and cyclic malaise - every few weeks, Puff sleeps
constantly and stops eating. Will drink and eat when I present food. After
a few days, Puff returns to normal behavior and appetite. Puff eats a mix
of Pro Plan kitten, Marshall, Iams Eukanuba, and wysong canned foods, with
occasional laxatone and ferretone treats. Following is her recent vet
history:
Oct 23: PCV 72%, RBC 15k
Nov 6: PCV 75%, RBC 16k
Nov 13: 3cc's blood drawn
Nov 24: 5cc's blood drawn. PCV 75%
Dec 9: PCV 65%
Dec 23: PCV 75%
Dec 26: 5cc's blood drawn. PCV 78%
Dec 29: PCV 80%
Jan 6: PCV 70%
CBC results, Dec 26th:
SGOT: 44 SGPT: 63 T. Bilirubin: 0.1 Alk Phos: 10
Tot Prot: 5 Albumin: 2.9 Cholesterol: 100 Creatinine: 0.5
Bun: 14 Glucose: 123 Phosphorus: 6.5 Sodium: 146
Chloride: 110 CPK: 92 Globulin: 2.1
The two things that are baffling are the fact that Puff's PCV was at 80%
three days after having 5cc's of blood drawn, and that it's now at 70%, 8
days later. My vet is confident her machine is accurate. Are there any
factors that could result in inaccurate test results, such as drawing
blood from the leg vs a vein in the neck? Could environmental factors
cause fluctuating PCV? How do we guarantee that the PCV results we see
are accurate?
Puff's periods of malaise may correspond with her high PCV values.
During her next 'slump', we'll take another PCV to confirm the
correspondence. However, we are uncertain that phlebotomies are the
correct course of treatment. Before her 12/26 phlebotomy, Puff obviously
felt poorly. 12/29, she acted as though she felt great. 12/31-1/2, she
clearly felt terrible again. Now, she feels fine. It seems that while a
phlebotomy could have an immediate benefit, Puff's system reacts in an
unpredictable way to the blood loss and the immediate improvements don't
last more than a few days.
I have read a bit on p. vera and high PCV values and am concerned that
Puff might suffer a stroke or her organs might suffer when her PCV is
extremely elevated. Neither me or my vet understand how p. vera is part
of this equation any more. Can anyone speculate on possible causes for
the fluctuating PCV values we're seeing here? Is this p. vera with
another under- or overlying problem? Can anyone suggest further
diagnostic procedures that might help us nail down the cause? The chances
of us doing a bone marrow biopsy are nil; an exploratory, very unlikely.
An ultrasound to check heart/lung appearance is possible.
Since Puff usually feels fine, I'm not going to aggressively pursue
treatment that will make her miserable. In fact, I don't know if there's
any treatment we should pursue until her condition worsens. If/when that
occurs, however, it'd be good to know what we're facing. My vet points
out that we "shouldn't be treating numbers - treat the animal", with which
I agree - the PCVs and phlebotomies have been to establish how Puff
responds to this treatment. Since the positive results of that have been
debatable, we'll resume 'no treatment'. However, now we're both very
curious as to what's wrong with Puff, and hope we can solve the mystery.
If anyone can provide useful (or random :) speculation, I'd be grateful.
If more information is necessary, I'd be glad to provide it.
Melissa