Q: My cat is about 9 months old. When she was 6 months old I was told she had elevated liver enzyme; her vet said it was probably just because she was still growing. He didn’t seem concerned but he said if I wanted to follow up at 9-10 months, growth should be slowed by then and he could recheck. She seems healthy and is very energetic; my only concerns about her are that she consistently has awful breath, is very small, and sometimes breathes hard/pants but usually during or after exercise. Should I get her checked again? What are the possible issues & treatments? I ask because, unfortunately, money is an issue and if the possibilities are only diseases that mean expensive treatments, I might not be able to do much regardless.
A: There may be several things going on. Growing kittens will often have an elevated level of alkaline phosphatase (ALP). In adult cats, elevations of this enzyme typically indicates that there is a liver issue, however, this enzyme is also found in bone, and growing kittens experience lots of bone growth activity, explaining the elevation of this enzyme. It is a normal finding. If your vet said elevated liver enzymes rather than just that one enzyme, then there may be some other problem going on. I cannot tell from your letter.
Her small size is difficult to comment on. Cats come in all shapes and sizes, and she may just be a small cat. There is a liver disease called a portosystemic shunt which causes small stature in cats, as well as other clinical signs. Elevated liver enzymes are sometimes seen in this condition, so again, it would be important to know if your cat, at the age of 6 months, had just a high ALP, or if the other liver parameters were affected.
The awful breath is hard to interpret. Some cats have terrible breath when their baby teeth fall out and their adult teeth are coming in. I suspect that this is the problem, but again, I cannot be certain without looking in her mouth myself. If this persists, of course it should be checked out again by your vet. The breathing hard/panting when she plays hard is normal for kittens. Labored breathing, especially when the cat is at rest, is a different story, and should be investigated promptly by your veterinarian.
I would get her checked again, for peace of mind. Your vet can weigh her and give you an idea whether she is simply a small cat, or if she has stunted growth. He can look in her mouth and perhaps give you a possible explanation for the foul breath. Rechecking just the chemistry panel to evaluate the liver enzymes is not terribly expensive. If the liver enzymes are elevated, the work-up involved in figuring out the underlying cause can become expensive, and this should be discussed with your veterinarian before embarking on a series of costly diagnostics.