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Hi all..
I have a difficult case here... 10 yr old lab that was just adopted by a client of mine. The first time I saw him he had discharge from both eyes, was always itchy, and she said that he cried sometimes when he got up. His exam didn't reveal anything major, and I felt that since he had a history of allergies from previous owners we'd try a novel protein/grain free diet. He did good on this for about two weeks...
Then She called us because his entire abdomen was a hot spot and his eyes were running. She also noted that he seemed to have more pain getting up etc. At this time, I treated him with Pred (20mg bid) and Rilexene. I also gave her some Rimadyl samples to see if that would make a difference for him. She called last Wednesday to say he was a different dog, but was peeing a lot even in the house...I advised this was probably the Pred and we started to taper. On Thursday she called because he was crashing.
Upon exam he had lost 5lbs, was very painful in the jaw (nothing on dental exam, but opening his mouth elicited a yelp) and he had no energy. His skin was some better. Eye discharge worse. I drew blood for a CBC/Chem/Ana Titer/Coombs etc...(thinking Lupus was possible based on skin appearance). Something made me test glucose in truck : 684.
Test results:
RBC: 5.12 5.5 - 8.5 M/µL
Hematocrit 38.0
Hemoglobin 12.9
MCV: 74
MCH 25.0
MCHC: 33.7
% Reticulocyte: 0.2
WBC: 23.1
% Neutrophil: 84.7
% Lymphocyte: 6.0
% Monocyte: 9.3
% Eosinophil: 0.0
% Basophil: 0.0
Neutrophil: 19.566
Lymphocyte: 1.386
Monocyte: 2.148
Eosinophil: 0
Basophil: 0
Auto Platelet:346
SLIDE REVIEWED MICROSCOPICALLY.
NEUTROPHILS APPEAR SLIGHTLY TOXIC
Glucose: 634
BUN:48
Creatinine:1.5
Sodium:137
Potassium: 4.9
Chloride:99
Total Protein:8.6
Albumin:3.1
Globulin: 5.5
ALT: 104
AST:19
ALP:302
Bilirubin - Total:0.1
Cholesterol: 253
Creatine Kinase: 108
ANA titer is positive at 1:400
Coombs and Rheumatoid are negative
I started him on insulin and now at 15 units BID of Humulin N have him at 380 glucose last check... and he is feeling better.. except mouth is still painful. I know that the steroids are not helping the blood sugar etc, but with the positive ANA titer, how do I balance both?
Any suggestions here on getting this poor kid regulated on meds and meds suggestions would be great! I have only treated one Lupus dog before and it was without the complications of DM. | What does he weigh? | I xp'd to clin path, but what's the magnification of the image? |
Hi all..
I have a difficult case here... 10 yr old lab that was just adopted by a client of mine. The first time I saw him he had discharge from both eyes, was always itchy, and she said that he cried sometimes when he got up. His exam didn't reveal anything major, and I felt that since he had a history of allergies from previous owners we'd try a novel protein/grain free diet. He did good on this for about two weeks...
Then She called us because his entire abdomen was a hot spot and his eyes were running. She also noted that he seemed to have more pain getting up etc. At this time, I treated him with Pred (20mg bid) and Rilexene. I also gave her some Rimadyl samples to see if that would make a difference for him. She called last Wednesday to say he was a different dog, but was peeing a lot even in the house...I advised this was probably the Pred and we started to taper. On Thursday she called because he was crashing.
Upon exam he had lost 5lbs, was very painful in the jaw (nothing on dental exam, but opening his mouth elicited a yelp) and he had no energy. His skin was some better. Eye discharge worse. I drew blood for a CBC/Chem/Ana Titer/Coombs etc...(thinking Lupus was possible based on skin appearance). Something made me test glucose in truck : 684.
Test results:
RBC: 5.12 5.5 - 8.5 M/µL
Hematocrit 38.0
Hemoglobin 12.9
MCV: 74
MCH 25.0
MCHC: 33.7
% Reticulocyte: 0.2
WBC: 23.1
% Neutrophil: 84.7
% Lymphocyte: 6.0
% Monocyte: 9.3
% Eosinophil: 0.0
% Basophil: 0.0
Neutrophil: 19.566
Lymphocyte: 1.386
Monocyte: 2.148
Eosinophil: 0
Basophil: 0
Auto Platelet:346
SLIDE REVIEWED MICROSCOPICALLY.
NEUTROPHILS APPEAR SLIGHTLY TOXIC
Glucose: 634
BUN:48
Creatinine:1.5
Sodium:137
Potassium: 4.9
Chloride:99
Total Protein:8.6
Albumin:3.1
Globulin: 5.5
ALT: 104
AST:19
ALP:302
Bilirubin - Total:0.1
Cholesterol: 253
Creatine Kinase: 108
ANA titer is positive at 1:400
Coombs and Rheumatoid are negative
I started him on insulin and now at 15 units BID of Humulin N have him at 380 glucose last check... and he is feeling better.. except mouth is still painful. I know that the steroids are not helping the blood sugar etc, but with the positive ANA titer, how do I balance both?
Any suggestions here on getting this poor kid regulated on meds and meds suggestions would be great! I have only treated one Lupus dog before and it was without the complications of DM. | What's rilexene? | Rest of the chemistry results? |
I have a 16 month old female/spayed bloodhound with renal failure that I received as a second opinion case. Emma was seen by her previous veterinarian for urinating in her sleep, a UA was performed and she had USG of 1.002. Bloodwork was performed which revealed the renal failure 2 months ago.
BUN 27
Creatinine 5.7
Phosphorus 11.1
potassium 4.3
Calcium 10.8
10/31/2012
During my initial exam with Emma I performed:
Radiographs - no radio-opaque stones seen
Lepto titers - all very low
Urine culture - grew E. coli sensitive to Cefpodoxime. Placed on 6 week course.
12/27/2012
7 days after finishing antibiotics
BUN 108
Creatinine 7.2
Calcium 13.0
Phosphorus 8.8
Potassium 4.1
HCT 28%
Urinalysis
USG - 1.011
Blood 3+
Protein 1+
WBC - 0-2
Bacteria - Marked
Calcium Oxalate 3+
Urine Culture - Pseudomonas aeruginosa
Timentin - sensitive
Piperacillin - Sensitive (8 ug/ml)
Imipenem - Sensitive (1 ug/ml)
Amikacin - sensitive (4 ug/ml)
Gentamicin - Sensitive (2ug/ml)
Tobramycin - sensitive (1ug/ml)
Ciprofloxacin - sensitive
Enrofloxacin - intermediate
Marbofloxacin - sensitive (1ug/ml)
Nitrofurantoin - resistant
Chloramphenicol - resistant
This is the first time I've cultured Pseudomonas. I have found only a few posts on VIN and none with concurrent renal failure. I was thinking of Ciprofloxacin 5.4mg/kg BID x 6 weeks, then re-culture 7 days later. Given the dogs progressive azotemia and anemia is this a reasonable option?
Urinary incontinence has cleared with Proin administration. Besides PU/PD this dog appears absolutely normal, very active, gaining weight, etc. She is on Dry K/D. I have recommended phosphorus binder 2 times with no success. Owner wasn't present for recheck urine culture so I was unable to do a blood pressure reading. Please let me know if you have another other case management suggestions.
Thanks! | You did not mention how the urine sample was obtained? | Is there proteinuria? |
I have a 16 month old female/spayed bloodhound with renal failure that I received as a second opinion case. Emma was seen by her previous veterinarian for urinating in her sleep, a UA was performed and she had USG of 1.002. Bloodwork was performed which revealed the renal failure 2 months ago.
BUN 27
Creatinine 5.7
Phosphorus 11.1
potassium 4.3
Calcium 10.8
10/31/2012
During my initial exam with Emma I performed:
Radiographs - no radio-opaque stones seen
Lepto titers - all very low
Urine culture - grew E. coli sensitive to Cefpodoxime. Placed on 6 week course.
12/27/2012
7 days after finishing antibiotics
BUN 108
Creatinine 7.2
Calcium 13.0
Phosphorus 8.8
Potassium 4.1
HCT 28%
Urinalysis
USG - 1.011
Blood 3+
Protein 1+
WBC - 0-2
Bacteria - Marked
Calcium Oxalate 3+
Urine Culture - Pseudomonas aeruginosa
Timentin - sensitive
Piperacillin - Sensitive (8 ug/ml)
Imipenem - Sensitive (1 ug/ml)
Amikacin - sensitive (4 ug/ml)
Gentamicin - Sensitive (2ug/ml)
Tobramycin - sensitive (1ug/ml)
Ciprofloxacin - sensitive
Enrofloxacin - intermediate
Marbofloxacin - sensitive (1ug/ml)
Nitrofurantoin - resistant
Chloramphenicol - resistant
This is the first time I've cultured Pseudomonas. I have found only a few posts on VIN and none with concurrent renal failure. I was thinking of Ciprofloxacin 5.4mg/kg BID x 6 weeks, then re-culture 7 days later. Given the dogs progressive azotemia and anemia is this a reasonable option?
Urinary incontinence has cleared with Proin administration. Besides PU/PD this dog appears absolutely normal, very active, gaining weight, etc. She is on Dry K/D. I have recommended phosphorus binder 2 times with no success. Owner wasn't present for recheck urine culture so I was unable to do a blood pressure reading. Please let me know if you have another other case management suggestions.
Thanks! | Was there a colony count? | Can you post a sample of a recent gulcose curve? |
I am confounded by a 9 year old cat with diabetes diagnosed 6 months ago. He has had extensive workup: no eveidence of infections or concurrent disease except for mild chronic pancreatitis on U/S and a normal insulin-like growth factor test but he shows little response to sc insulin. 2 units regular insulin im will bring his BG down but up to 12 units glargine sc has pretty much zero effect - it is as if I haven't given him anything. He has been hospitalized with me for the past week so I know there is no problem with the insulin, the route of admin etc. He eats well - is on Purina DM canned and Royal canin Diabetic dry - controlled amounts q12h. He is not clinically dehydrated, is mildly PU/PD. Yesterday I tried switching to caninsulin but am seeing similar problem.
Any thoughts much appreciated. | Weight? | What is the value at the nadir and when is the nadir? |
I am confounded by a 9 year old cat with diabetes diagnosed 6 months ago. He has had extensive workup: no eveidence of infections or concurrent disease except for mild chronic pancreatitis on U/S and a normal insulin-like growth factor test but he shows little response to sc insulin. 2 units regular insulin im will bring his BG down but up to 12 units glargine sc has pretty much zero effect - it is as if I haven't given him anything. He has been hospitalized with me for the past week so I know there is no problem with the insulin, the route of admin etc. He eats well - is on Purina DM canned and Royal canin Diabetic dry - controlled amounts q12h. He is not clinically dehydrated, is mildly PU/PD. Yesterday I tried switching to caninsulin but am seeing similar problem.
Any thoughts much appreciated. | Has the cat lost weight? | Has her urine been cultured? |
I am confounded by a 9 year old cat with diabetes diagnosed 6 months ago. He has had extensive workup: no eveidence of infections or concurrent disease except for mild chronic pancreatitis on U/S and a normal insulin-like growth factor test but he shows little response to sc insulin. 2 units regular insulin im will bring his BG down but up to 12 units glargine sc has pretty much zero effect - it is as if I haven't given him anything. He has been hospitalized with me for the past week so I know there is no problem with the insulin, the route of admin etc. He eats well - is on Purina DM canned and Royal canin Diabetic dry - controlled amounts q12h. He is not clinically dehydrated, is mildly PU/PD. Yesterday I tried switching to caninsulin but am seeing similar problem.
Any thoughts much appreciated. | Where are you administering the insulin- flank, legs, shoulder blades? | Neck palpated normal? |
I am confounded by a 9 year old cat with diabetes diagnosed 6 months ago. He has had extensive workup: no eveidence of infections or concurrent disease except for mild chronic pancreatitis on U/S and a normal insulin-like growth factor test but he shows little response to sc insulin. 2 units regular insulin im will bring his BG down but up to 12 units glargine sc has pretty much zero effect - it is as if I haven't given him anything. He has been hospitalized with me for the past week so I know there is no problem with the insulin, the route of admin etc. He eats well - is on Purina DM canned and Royal canin Diabetic dry - controlled amounts q12h. He is not clinically dehydrated, is mildly PU/PD. Yesterday I tried switching to caninsulin but am seeing similar problem.
Any thoughts much appreciated. | Are there any bg values lile a curve you can give us? | How much does the dog weigh? |
I am confounded by a 9 year old cat with diabetes diagnosed 6 months ago. He has had extensive workup: no eveidence of infections or concurrent disease except for mild chronic pancreatitis on U/S and a normal insulin-like growth factor test but he shows little response to sc insulin. 2 units regular insulin im will bring his BG down but up to 12 units glargine sc has pretty much zero effect - it is as if I haven't given him anything. He has been hospitalized with me for the past week so I know there is no problem with the insulin, the route of admin etc. He eats well - is on Purina DM canned and Royal canin Diabetic dry - controlled amounts q12h. He is not clinically dehydrated, is mildly PU/PD. Yesterday I tried switching to caninsulin but am seeing similar problem.
Any thoughts much appreciated. | Pre-insulin bgs? | What does the cat eat? |
I am confounded by a 9 year old cat with diabetes diagnosed 6 months ago. He has had extensive workup: no eveidence of infections or concurrent disease except for mild chronic pancreatitis on U/S and a normal insulin-like growth factor test but he shows little response to sc insulin. 2 units regular insulin im will bring his BG down but up to 12 units glargine sc has pretty much zero effect - it is as if I haven't given him anything. He has been hospitalized with me for the past week so I know there is no problem with the insulin, the route of admin etc. He eats well - is on Purina DM canned and Royal canin Diabetic dry - controlled amounts q12h. He is not clinically dehydrated, is mildly PU/PD. Yesterday I tried switching to caninsulin but am seeing similar problem.
Any thoughts much appreciated. | Have you checked a u/a + usg and a culture? | Is that adequate, or is there a better way to handle this? |
Good Morning,
My patient is my own cat. Help!
Corky is a 7 yr MC DSH, weighing in at 24lbs. Gradually the weight packed on and now I am in panic mode. I have 4 indoor cats in total.
I have always fed free choice dry ( I now know this is bad but my other 3 cats are normal weights).
Corky eats prescription Royal Canin Hi prot/cal control dry. He gets 1 cup per day, that is 259 calories. At times I use RC OTC, Indoor light 40 which has 261 cal/cup.
The other cats eat on a table that Corky cannot get onto. I have tried various toys to get him to play. He is not interested probably because it is uncomfortable. Tried feeding balls. Even if hungry will not use.
I feed a small amount of canned (friskies) to all my cats twice daily and I can get him to eat a little but he is picky and only will eat about a tsp. I have tried other brands and no go.
Complicating this, he sometimes has trouble passing stool even though not large or hard fecal balls. Resolves with subcut fluids as I rarely see him drink.
Any thoughts as to what else I can do? I've thought of walking him but he is stubborn and he would be petrified if I took him outside.
Why does he not lose weight eating 260 cal per day?
Thank you. I know there are no easy answers but I'll take any suggestions.
- | Are the cat boxes on the same level as the food? | Has the owner's alphatrak been checked for accuracy? |
Hi everyone,
I have a 12.5 yr old MN Schnauzer that was recently diagnosed with diabetes I'd like some thoughts on. He has a hepatocellular carcinoma that was diagnosed about a year ago (took him to surgery and removed as much as we could at that time but margins were incomplete) and has been on daily Denamarin. He started on 5 units insulin BID about three weeks ago (at that time his BG was 450 and he presented for pu/pd which has since resolved) and his curve was:
7 am-pet received insulin (clinic opened at 9 am that day)
9 am 325
11 am 194
1 pm 281
3 pm 333
5 pm 347
Right now, the owner is at a point where she wants to manage the diabetes but isn't interested in repeating abdominal ultrasound (declined referral to onc a year ago) to assess the liver given his history. I'm reluctant to increase his insulin with the polyuria and polydipsia resolved (no secondary UTI when we checked, I think the owner caught this fairly early) and things going well at home. Should I keep him at the 5 units twice daily for now or bump his dose up a little?
Owner also asked me about supplementing with flaxseed oil or olive oil to help with his shedding and seborrhea sicca during the winter. Any contraindications for either of these in a diabetic pet?
Thank you in advance for your thoughts on my case! Happy new year!
/p | I'm guessing it's nph? | U100 syringes? |
Hi everyone,
I have a 12.5 yr old MN Schnauzer that was recently diagnosed with diabetes I'd like some thoughts on. He has a hepatocellular carcinoma that was diagnosed about a year ago (took him to surgery and removed as much as we could at that time but margins were incomplete) and has been on daily Denamarin. He started on 5 units insulin BID about three weeks ago (at that time his BG was 450 and he presented for pu/pd which has since resolved) and his curve was:
7 am-pet received insulin (clinic opened at 9 am that day)
9 am 325
11 am 194
1 pm 281
3 pm 333
5 pm 347
Right now, the owner is at a point where she wants to manage the diabetes but isn't interested in repeating abdominal ultrasound (declined referral to onc a year ago) to assess the liver given his history. I'm reluctant to increase his insulin with the polyuria and polydipsia resolved (no secondary UTI when we checked, I think the owner caught this fairly early) and things going well at home. Should I keep him at the 5 units twice daily for now or bump his dose up a little?
Owner also asked me about supplementing with flaxseed oil or olive oil to help with his shedding and seborrhea sicca during the winter. Any contraindications for either of these in a diabetic pet?
Thank you in advance for your thoughts on my case! Happy new year!
/p | How did the rest of the cbc/chem look like when he had bloodwork 3 weeks ago? | Cortrosyn being used? |
My patient is a 2-year-old female spayed Italian Greyhound who weighs 10.1 pounds. She is active and otherwise very healthy. She is fed Taste of the Wild dry and canned several times a day and is allowed to eat as much as she wants. her stools are firm and forend and she defecates once or sometimes twice a day. No other health concerns. A recent Chem 6 and CBC were normal.
This dog is skinny. Not your typical Italian grayhound skinny, but truly underweight. She has very prominent ribs, pelvic bones and dorsal spinous processes, although her thigh muscles are strong and well-formed.
So,
- Is this something to worry about?
- What would my DDX be for this? A quick VIN search showed no breed predispositions for digestive issues and she does not have any signs of maldigestion, malabsorption or PSS (except, of course, being underweight)
- What tests (if any) should I rile? Bile acids? Texas A & M digestive panel?
- Any recommendations on diet?
Thank you! | What's on the chem 6, and would you mind posting results? | What is his bcs right now? |
My colleague saw this cat, MN, 7.7 kg, 10 years old last week for not doing well, vomiting and urinating inappropriately . Blood work was done and all was within normal limits except for glucose being at 15.8. He mentioned that the cat was indeed not diabetic. For whatever reason, the cat was placed on metronidazole and prednisone and given B12 injections. Today the cat re-presented, still urinating inappropriately, but now has a wobbly gait to the point that he almost fell down the stairs. He is no longer vomiting.
Neurologically the only abnormality was ataxia, there was no nystagmus, reflexes were good, posturing was good, but gait was abnormal with some plantigrade stance. When I saw the bloodwork, I thought diabetic for certain, but just to double check, we redid a glucose and retested the urine....
glucose today was 10.8, no glucose in the urine or ketones, SG 1.035, RBCs TNTC, 1+ WBC, no bacteria or crystals visualized. Upon palpation of the bladder, the cat appeared painful (when we saw the urine, we understood why). i happened to rerun the chemistry too, and still all was normal (renal and liver values normal, K was 3.4 (normal 3.5- ).
Owner is a nurse, so i've asked if she might be able to get a hold of a glucometer for home use to keep an eye on sugar levels. Im treating the UTI for now, we've also discussed urine culture, but still have a suspicion of diabetes with the neurological signs. Next step will be to x-ray to rule out stones, but the stream of urine produced today was good.
one thought was metronidazole toxicity since the symptoms were worsened once tx started, but dose was 10 mg/kg so not that high. Any other ideas here? To me everything points to diabetes except for the lab work! neuro signs, plantigrade stance, inappropriate urination, overweight orange cat that has lost some weight, high blood sugar originally, UTI etc. What am I missing?
Thanks | Is this cat eating normally at present? | Was the insulin determination done on the same sample on which the hypoglycaemia was detected? |
11 yr. fs kitty presented for diarrhea. fecal showed bacteria, but no other parasites. Owner left kitty for the weekend and wanted us to treat for diarrhea. Kitty had been diabetic for 8 mo. owner was using glipizide due to inconvenience of insulin.
Her blood glucose was 487 and owner could not bring meds back. Kitty was given 3IU of humulin R..( only insulin we had). She ate well and was drinking well. When we left 2 hrs. later,(20:00) kitty was doing fine. ( food was DM and fancy feast)
6:45 following morning, kitty was recumbent and non-responsive. bg was 20. she was started on iv fluids, dextrose, karo and within 1 hr. bg was up to 80.
My question is: did the 3 IU cause her to have a Zygmogy? if so would it have been better to not treat the diabetese at all for the 3 days?
Thank you very much. | Hopefully the cat has recovered neurologically---is she blind? | Was the fluid submitted for culture? |
11 yr. fs kitty presented for diarrhea. fecal showed bacteria, but no other parasites. Owner left kitty for the weekend and wanted us to treat for diarrhea. Kitty had been diabetic for 8 mo. owner was using glipizide due to inconvenience of insulin.
Her blood glucose was 487 and owner could not bring meds back. Kitty was given 3IU of humulin R..( only insulin we had). She ate well and was drinking well. When we left 2 hrs. later,(20:00) kitty was doing fine. ( food was DM and fancy feast)
6:45 following morning, kitty was recumbent and non-responsive. bg was 20. she was started on iv fluids, dextrose, karo and within 1 hr. bg was up to 80.
My question is: did the 3 IU cause her to have a Zygmogy? if so would it have been better to not treat the diabetese at all for the 3 days?
Thank you very much. | At the same time, she should be on the canned only version of a high protein/low carb diet....what diet has she been on? | The owner moves the insulin around on his body each time? |
nah is a 12 year old MN DSH that I diagnosed with DM on November 20/12. He is being well-regulated on 1.5 units of Lantus bid (most recent 12-hour curve a few days ago showed a relatively flat line that hovered between 4 and 6 mmol/L). The owners report that the cat seems to be feeling great, and that his thirst has returned to normal. We are watching him closely because I think this might be one that goes into remission quickly.
nah is eating 2 cans/day of Friskies Ocean Whitefish and Tuna (split over three carefully-timed meals/day; lunch being a tiny amount, just enough to shut him up). They say he is so ravenously hungry that he is waking them up at night for more food, and yet, when he is offered his daytime meals, he eats them well but not as ravenously. They say it seems as if the food isn't satisfying him.
I know that if cats are not fed enough protein they often feel unsatisfied, but even though I've often thought of Friskies as "junk food", the protein/carb levels seem appropriate for a diabetic cat when I compare them to diabetic-specific products on websites such as Binky's List (protein 11%, fat 4%, moisture 78%, fiber 1%, ash 3.5% on an as-fed basis). A different website I visited said the cans were 137 kcal each, giving him a total of 274 kcal/day.
nah is an overweight cat at 7.1 kg. His ideal weight is closer to 5.5 kg. I do not want to risk preventing the much-needed weight loss by feeding another can per day, and I am hesitant to give him kibbles, but I would like the owners to get some better sleep. Any suggestions? | Are these cans 5.5 oz? | What did the adrenals look like on the ultrasound? |
Hi
A quick question - how high is too high on insulin dosage? I mean, at what point of units/kg do you say, we need to back off and reassess the situation?
The reason being - I have a 28 kg FN Husky who is a very very nervous dog which does need blood glucose curves done. She is currently on 19 units of Caninsulin per day.
When she was at the referral centre a year ago for boarding - they did a blood glucose curve there, and they said it was "all over the place" as the dog wouldn't rest, it stood for the full 48 hours agitated, so sending her back there for one, (especially as they are 1.5 hours away) is not possible.
Admitting her into my vet hospital is also not possible for the same reason - when she first was diagnosed, I had to send her home after two days as she wouldn't eat nor would she sit down, she scraped my bathroom door (we had her home with us overnight), and howled as huskies do.
The owners are not prepared to do home blood glucose testing either - they are managing with the injections though, so that is a good start. I am a solo vet, so what we have done is do a house call at 7 am (we normally open at 9), do the blood glucose, the owenr gives the insulin, and then have done the blood glucose level in house at 4 hourly intervals, finishing at the last one at 6.30 pm (as a housecall 0 on our way home - this makes it a ridiculously stupid long day for us for not much gain!
Based on the last two blood glucose curves, where it got as low as 14 mmol/l, and an elevated fructosamine, we have increased her insulin by 2 units to 21.
But the question lies - at how many units/kg do you start to think that you need to back off and start again.
Thanks.
PS Two hourly blood glucose levels are not possible for this dog - she is a stress head. | Have you rechecked a fructosamine regularly? | Yo-yo-ing on it's glucose? |
Hi
A quick question - how high is too high on insulin dosage? I mean, at what point of units/kg do you say, we need to back off and reassess the situation?
The reason being - I have a 28 kg FN Husky who is a very very nervous dog which does need blood glucose curves done. She is currently on 19 units of Caninsulin per day.
When she was at the referral centre a year ago for boarding - they did a blood glucose curve there, and they said it was "all over the place" as the dog wouldn't rest, it stood for the full 48 hours agitated, so sending her back there for one, (especially as they are 1.5 hours away) is not possible.
Admitting her into my vet hospital is also not possible for the same reason - when she first was diagnosed, I had to send her home after two days as she wouldn't eat nor would she sit down, she scraped my bathroom door (we had her home with us overnight), and howled as huskies do.
The owners are not prepared to do home blood glucose testing either - they are managing with the injections though, so that is a good start. I am a solo vet, so what we have done is do a house call at 7 am (we normally open at 9), do the blood glucose, the owenr gives the insulin, and then have done the blood glucose level in house at 4 hourly intervals, finishing at the last one at 6.30 pm (as a housecall 0 on our way home - this makes it a ridiculously stupid long day for us for not much gain!
Based on the last two blood glucose curves, where it got as low as 14 mmol/l, and an elevated fructosamine, we have increased her insulin by 2 units to 21.
But the question lies - at how many units/kg do you start to think that you need to back off and start again.
Thanks.
PS Two hourly blood glucose levels are not possible for this dog - she is a stress head. | How does that look? | Bg at this time? |
Hi
A quick question - how high is too high on insulin dosage? I mean, at what point of units/kg do you say, we need to back off and reassess the situation?
The reason being - I have a 28 kg FN Husky who is a very very nervous dog which does need blood glucose curves done. She is currently on 19 units of Caninsulin per day.
When she was at the referral centre a year ago for boarding - they did a blood glucose curve there, and they said it was "all over the place" as the dog wouldn't rest, it stood for the full 48 hours agitated, so sending her back there for one, (especially as they are 1.5 hours away) is not possible.
Admitting her into my vet hospital is also not possible for the same reason - when she first was diagnosed, I had to send her home after two days as she wouldn't eat nor would she sit down, she scraped my bathroom door (we had her home with us overnight), and howled as huskies do.
The owners are not prepared to do home blood glucose testing either - they are managing with the injections though, so that is a good start. I am a solo vet, so what we have done is do a house call at 7 am (we normally open at 9), do the blood glucose, the owenr gives the insulin, and then have done the blood glucose level in house at 4 hourly intervals, finishing at the last one at 6.30 pm (as a housecall 0 on our way home - this makes it a ridiculously stupid long day for us for not much gain!
Based on the last two blood glucose curves, where it got as low as 14 mmol/l, and an elevated fructosamine, we have increased her insulin by 2 units to 21.
But the question lies - at how many units/kg do you start to think that you need to back off and start again.
Thanks.
PS Two hourly blood glucose levels are not possible for this dog - she is a stress head. | How is she doing clinically? | Have we done a glucose curve on the cat in between uti/hypoglycemia episodes to ascertain whether or not the cat needs a lower dose all the time? |
Vito is a 13 yr old MN DSH. Diagnosed with diabetes 12/2007, has been a challenge to regulate, but clinically has been doing well on Glargine 2-U BID.
Saw Vito 12/31 for routine biannual senior exam and labs. Appetite is good, water intake & urination seem pretty good to owner (not laying by water dish, not urinating in husband's shoes (!), playful).
On exam, Vito looks the best I've ever seen him! Skin & coat in great shape, BAR, friendly. BCS =3.5/5. Vito has lost 2-lb 1-oz since 5/2012. Rest of exam unremarkable. Vito had been lodging with us prior to the appointment, so that might explain the glucose and fructosamine levels...sometimes if Vito is cranky while lodging with us we do not give him his insulin! But actually, he had been pretty tolerant this visit. Anyway...here are some lab values that I need help sorting out please:
12/31/2012 9/8/2011
ALKP = 74 (0-62) 43
AMYLASE = 3093 (520-2060) No value
ALBUMIN = 4.1 (2.3-3.9) 3.1
T. PROTEIN = 10.4 (5.9-8.5) 7.4
GLOBULIN = 6.3 (3.0-5.6) 4.3
BUN = 59 (15-34) 30
CREATININE = 2.6 (0.8-2.3) 1.3
GLUCOSE = 664 344
FRUCTOSAMINE = 415 397
CALCIUM = 14.4 (8.2-11.8) 9.3
PHOSPHORUS = 5.1 (3.0-7.0) 3.2
T4 = 1.7 No value
CBC = NSF NSF
*Notes on lab report indicate panel was performed on a diluted specimen; albumin, T. protein, glucose, and calcium results were verified by repeat analysis. No lipemia or hemolysis.
**unable to obtain urine specimen.
Next week will check PTH and ionized calcium, and take rads of chest and abdomen.
Could the hypercalcemia be secondary to renal disease? The GLOBULIN and ALKP are what have me stumped.
Any guidance? Thank you! | Was the calcium fasting? | Is he getting enough calories? |
What to do for diabetic cat with a chronic 4+ Actinomyces in one ear. has been tx'd unsuccessfully for long time to no response. Cytology shows 4+ cocci and diplococci. 6 weeks of Baytril otic and oral clavamox has not helped.
Is there any homemade preps that I could whip up that would be stable and overcome this thing? Are oral antibiotics even going to help in a strictly otic infection? He's diabetic and owner does not want to use anything w/ steroids in ear.
Thank you. | I wonder if the actinomyces overgrew? | May need peg tube? |
Boots is a 9 yr old DSH MN cat 8.31kg
presented on 1/3/12 for something wrong with the paw and not really walking.
resp -16, temp 104.8, hr- purring
p wouldn't eat the day before and wouldn't move. o thinks pet might have fallen
pe- gingivitis, dental calc and obese- all other wnl
ran cbc/chem
cbc
lym 0.56 10 *9/L (1.5-7)
chem-
alp 9 (10-90)
phos 2.1 (3.4-8.5)
glu 369 (70-150)
na 141(142-164)
k 3.5 (3.7-5.8)
all others wnl
sent p home with m/d, gave injection of insulin 4 units- galargine
sent home with rx of glaragine insulin and insulin syrynges
gave robenacoxib 12mg q 24hrs- gave first dose in hosp., orbax 30mg/ml- gave 3ml po q 24hrs gave first dose in hosp
gave instructions and info on diabetes on what to do and what not to do.
told o if no improvement by morning to please come back to recheck sugar and recheck p.
p ate that night o did not give insulin per my instructions but p did vomited.
1/4/12
p not improving- o came in for recheck
glucose 138
t 102.6
rads- see attached picture
rads- abd see pic
enema administered to the p
started p on ceia, IV fluids and administered orbax and robenacoxib at admision
p QAR not interested in food m/d or purina one.
p kept on iv fluids 2x maint overnight and in the morning the p was drooling, p removed cath after midnight. and temp was 103.6
1/5/12
called o and updated with status. recmd repeat abd rads after enema, liver profile, and cbc
results
liver
alt- 116 (20-100)
ggt 5 (0-2)
tbili 4.3 (0.1-0.6)
bun 36 (10-30)
cbc
wbc 5.38 (5.5-19.5)
lym 1.09 (1.5-7)
eos 1.2 (0-1)
My plan is to cont IV fluids, cont orbax, stop robenacoxib
add denamarin, ursodiol, metronidazole, cont ceia, and prednisolone
place a feeding tube
any other suggestions- anything else i am missing? | Any chance of posting the full labs, as attachments? | Should we keep him for the day and run glucose levels every hour or two? |
Boots is a 9 yr old DSH MN cat 8.31kg
presented on 1/3/12 for something wrong with the paw and not really walking.
resp -16, temp 104.8, hr- purring
p wouldn't eat the day before and wouldn't move. o thinks pet might have fallen
pe- gingivitis, dental calc and obese- all other wnl
ran cbc/chem
cbc
lym 0.56 10 *9/L (1.5-7)
chem-
alp 9 (10-90)
phos 2.1 (3.4-8.5)
glu 369 (70-150)
na 141(142-164)
k 3.5 (3.7-5.8)
all others wnl
sent p home with m/d, gave injection of insulin 4 units- galargine
sent home with rx of glaragine insulin and insulin syrynges
gave robenacoxib 12mg q 24hrs- gave first dose in hosp., orbax 30mg/ml- gave 3ml po q 24hrs gave first dose in hosp
gave instructions and info on diabetes on what to do and what not to do.
told o if no improvement by morning to please come back to recheck sugar and recheck p.
p ate that night o did not give insulin per my instructions but p did vomited.
1/4/12
p not improving- o came in for recheck
glucose 138
t 102.6
rads- see attached picture
rads- abd see pic
enema administered to the p
started p on ceia, IV fluids and administered orbax and robenacoxib at admision
p QAR not interested in food m/d or purina one.
p kept on iv fluids 2x maint overnight and in the morning the p was drooling, p removed cath after midnight. and temp was 103.6
1/5/12
called o and updated with status. recmd repeat abd rads after enema, liver profile, and cbc
results
liver
alt- 116 (20-100)
ggt 5 (0-2)
tbili 4.3 (0.1-0.6)
bun 36 (10-30)
cbc
wbc 5.38 (5.5-19.5)
lym 1.09 (1.5-7)
eos 1.2 (0-1)
My plan is to cont IV fluids, cont orbax, stop robenacoxib
add denamarin, ursodiol, metronidazole, cont ceia, and prednisolone
place a feeding tube
any other suggestions- anything else i am missing? | What paw? | Is it a large reputable company, or a smaller less experienced one? |
Boots is a 9 yr old DSH MN cat 8.31kg
presented on 1/3/12 for something wrong with the paw and not really walking.
resp -16, temp 104.8, hr- purring
p wouldn't eat the day before and wouldn't move. o thinks pet might have fallen
pe- gingivitis, dental calc and obese- all other wnl
ran cbc/chem
cbc
lym 0.56 10 *9/L (1.5-7)
chem-
alp 9 (10-90)
phos 2.1 (3.4-8.5)
glu 369 (70-150)
na 141(142-164)
k 3.5 (3.7-5.8)
all others wnl
sent p home with m/d, gave injection of insulin 4 units- galargine
sent home with rx of glaragine insulin and insulin syrynges
gave robenacoxib 12mg q 24hrs- gave first dose in hosp., orbax 30mg/ml- gave 3ml po q 24hrs gave first dose in hosp
gave instructions and info on diabetes on what to do and what not to do.
told o if no improvement by morning to please come back to recheck sugar and recheck p.
p ate that night o did not give insulin per my instructions but p did vomited.
1/4/12
p not improving- o came in for recheck
glucose 138
t 102.6
rads- see attached picture
rads- abd see pic
enema administered to the p
started p on ceia, IV fluids and administered orbax and robenacoxib at admision
p QAR not interested in food m/d or purina one.
p kept on iv fluids 2x maint overnight and in the morning the p was drooling, p removed cath after midnight. and temp was 103.6
1/5/12
called o and updated with status. recmd repeat abd rads after enema, liver profile, and cbc
results
liver
alt- 116 (20-100)
ggt 5 (0-2)
tbili 4.3 (0.1-0.6)
bun 36 (10-30)
cbc
wbc 5.38 (5.5-19.5)
lym 1.09 (1.5-7)
eos 1.2 (0-1)
My plan is to cont IV fluids, cont orbax, stop robenacoxib
add denamarin, ursodiol, metronidazole, cont ceia, and prednisolone
place a feeding tube
any other suggestions- anything else i am missing? | Can you further characterise the "not walking"? | Is it possible if it is neoplasia that it could be causing balance problems? |
Boots is a 9 yr old DSH MN cat 8.31kg
presented on 1/3/12 for something wrong with the paw and not really walking.
resp -16, temp 104.8, hr- purring
p wouldn't eat the day before and wouldn't move. o thinks pet might have fallen
pe- gingivitis, dental calc and obese- all other wnl
ran cbc/chem
cbc
lym 0.56 10 *9/L (1.5-7)
chem-
alp 9 (10-90)
phos 2.1 (3.4-8.5)
glu 369 (70-150)
na 141(142-164)
k 3.5 (3.7-5.8)
all others wnl
sent p home with m/d, gave injection of insulin 4 units- galargine
sent home with rx of glaragine insulin and insulin syrynges
gave robenacoxib 12mg q 24hrs- gave first dose in hosp., orbax 30mg/ml- gave 3ml po q 24hrs gave first dose in hosp
gave instructions and info on diabetes on what to do and what not to do.
told o if no improvement by morning to please come back to recheck sugar and recheck p.
p ate that night o did not give insulin per my instructions but p did vomited.
1/4/12
p not improving- o came in for recheck
glucose 138
t 102.6
rads- see attached picture
rads- abd see pic
enema administered to the p
started p on ceia, IV fluids and administered orbax and robenacoxib at admision
p QAR not interested in food m/d or purina one.
p kept on iv fluids 2x maint overnight and in the morning the p was drooling, p removed cath after midnight. and temp was 103.6
1/5/12
called o and updated with status. recmd repeat abd rads after enema, liver profile, and cbc
results
liver
alt- 116 (20-100)
ggt 5 (0-2)
tbili 4.3 (0.1-0.6)
bun 36 (10-30)
cbc
wbc 5.38 (5.5-19.5)
lym 1.09 (1.5-7)
eos 1.2 (0-1)
My plan is to cont IV fluids, cont orbax, stop robenacoxib
add denamarin, ursodiol, metronidazole, cont ceia, and prednisolone
place a feeding tube
any other suggestions- anything else i am missing? | Was it related to the paw or unrelated? | I bet that the free t4 is more expensive than the tt4, am i right? |
Boots is a 9 yr old DSH MN cat 8.31kg
presented on 1/3/12 for something wrong with the paw and not really walking.
resp -16, temp 104.8, hr- purring
p wouldn't eat the day before and wouldn't move. o thinks pet might have fallen
pe- gingivitis, dental calc and obese- all other wnl
ran cbc/chem
cbc
lym 0.56 10 *9/L (1.5-7)
chem-
alp 9 (10-90)
phos 2.1 (3.4-8.5)
glu 369 (70-150)
na 141(142-164)
k 3.5 (3.7-5.8)
all others wnl
sent p home with m/d, gave injection of insulin 4 units- galargine
sent home with rx of glaragine insulin and insulin syrynges
gave robenacoxib 12mg q 24hrs- gave first dose in hosp., orbax 30mg/ml- gave 3ml po q 24hrs gave first dose in hosp
gave instructions and info on diabetes on what to do and what not to do.
told o if no improvement by morning to please come back to recheck sugar and recheck p.
p ate that night o did not give insulin per my instructions but p did vomited.
1/4/12
p not improving- o came in for recheck
glucose 138
t 102.6
rads- see attached picture
rads- abd see pic
enema administered to the p
started p on ceia, IV fluids and administered orbax and robenacoxib at admision
p QAR not interested in food m/d or purina one.
p kept on iv fluids 2x maint overnight and in the morning the p was drooling, p removed cath after midnight. and temp was 103.6
1/5/12
called o and updated with status. recmd repeat abd rads after enema, liver profile, and cbc
results
liver
alt- 116 (20-100)
ggt 5 (0-2)
tbili 4.3 (0.1-0.6)
bun 36 (10-30)
cbc
wbc 5.38 (5.5-19.5)
lym 1.09 (1.5-7)
eos 1.2 (0-1)
My plan is to cont IV fluids, cont orbax, stop robenacoxib
add denamarin, ursodiol, metronidazole, cont ceia, and prednisolone
place a feeding tube
any other suggestions- anything else i am missing? | Was the cat diagnosed with diabetes at this visit? | What are the electrolytes in this kitty and are there ketones on the urinalysis? |
Boots is a 9 yr old DSH MN cat 8.31kg
presented on 1/3/12 for something wrong with the paw and not really walking.
resp -16, temp 104.8, hr- purring
p wouldn't eat the day before and wouldn't move. o thinks pet might have fallen
pe- gingivitis, dental calc and obese- all other wnl
ran cbc/chem
cbc
lym 0.56 10 *9/L (1.5-7)
chem-
alp 9 (10-90)
phos 2.1 (3.4-8.5)
glu 369 (70-150)
na 141(142-164)
k 3.5 (3.7-5.8)
all others wnl
sent p home with m/d, gave injection of insulin 4 units- galargine
sent home with rx of glaragine insulin and insulin syrynges
gave robenacoxib 12mg q 24hrs- gave first dose in hosp., orbax 30mg/ml- gave 3ml po q 24hrs gave first dose in hosp
gave instructions and info on diabetes on what to do and what not to do.
told o if no improvement by morning to please come back to recheck sugar and recheck p.
p ate that night o did not give insulin per my instructions but p did vomited.
1/4/12
p not improving- o came in for recheck
glucose 138
t 102.6
rads- see attached picture
rads- abd see pic
enema administered to the p
started p on ceia, IV fluids and administered orbax and robenacoxib at admision
p QAR not interested in food m/d or purina one.
p kept on iv fluids 2x maint overnight and in the morning the p was drooling, p removed cath after midnight. and temp was 103.6
1/5/12
called o and updated with status. recmd repeat abd rads after enema, liver profile, and cbc
results
liver
alt- 116 (20-100)
ggt 5 (0-2)
tbili 4.3 (0.1-0.6)
bun 36 (10-30)
cbc
wbc 5.38 (5.5-19.5)
lym 1.09 (1.5-7)
eos 1.2 (0-1)
My plan is to cont IV fluids, cont orbax, stop robenacoxib
add denamarin, ursodiol, metronidazole, cont ceia, and prednisolone
place a feeding tube
any other suggestions- anything else i am missing? | If so, any chance there was a urinalysis done? | What is her long term prognosis? |
Female spayed cat 7 y/o. Two days ago presented for lethargy reluctant to move- sitting on the same spot , not urinating but no straining , staring, was still eating. temp normal , normal exam except a large bladder.
Did a cysto and the cat started to salivate, wail , and then passed a large amount of urine. ( I have seen cats spasm before after cysto - quite scarey). Mild urinary infection diagnosed, antibiotics given.
Today cat returned after not eating, not urinating, sitting entire day on the same spot on a chair, (no mobility issues -jumped up). Again full bladder which evacuated after 2cc. cysto and salivation and wailing). so it seems the stimulation of the cysto causes release but cannot do so naturally? Rads look fine.
I assumed some urethral sphincter dysfunction and have started Phenoxy. Urea and Creatinine are moderately high, may have had some form of retention for a while. SG 1.028 bu no rise in phos. general condition seems good.
I worried may have gotten into owner's meds,has moderately dilated pupils eg fluoxetine but does not seem to be the case. Owners are seniors.(re illicit drugs)
Any thoughts here?
thanks, | What size needle are your using for cysto? | What do you think? |
Female spayed cat 7 y/o. Two days ago presented for lethargy reluctant to move- sitting on the same spot , not urinating but no straining , staring, was still eating. temp normal , normal exam except a large bladder.
Did a cysto and the cat started to salivate, wail , and then passed a large amount of urine. ( I have seen cats spasm before after cysto - quite scarey). Mild urinary infection diagnosed, antibiotics given.
Today cat returned after not eating, not urinating, sitting entire day on the same spot on a chair, (no mobility issues -jumped up). Again full bladder which evacuated after 2cc. cysto and salivation and wailing). so it seems the stimulation of the cysto causes release but cannot do so naturally? Rads look fine.
I assumed some urethral sphincter dysfunction and have started Phenoxy. Urea and Creatinine are moderately high, may have had some form of retention for a while. SG 1.028 bu no rise in phos. general condition seems good.
I worried may have gotten into owner's meds,has moderately dilated pupils eg fluoxetine but does not seem to be the case. Owners are seniors.(re illicit drugs)
Any thoughts here?
thanks, | How did you diagnosis this? | Apart from the acth stim test results what other signs of cushing's does he have? |
Female spayed cat 7 y/o. Two days ago presented for lethargy reluctant to move- sitting on the same spot , not urinating but no straining , staring, was still eating. temp normal , normal exam except a large bladder.
Did a cysto and the cat started to salivate, wail , and then passed a large amount of urine. ( I have seen cats spasm before after cysto - quite scarey). Mild urinary infection diagnosed, antibiotics given.
Today cat returned after not eating, not urinating, sitting entire day on the same spot on a chair, (no mobility issues -jumped up). Again full bladder which evacuated after 2cc. cysto and salivation and wailing). so it seems the stimulation of the cysto causes release but cannot do so naturally? Rads look fine.
I assumed some urethral sphincter dysfunction and have started Phenoxy. Urea and Creatinine are moderately high, may have had some form of retention for a while. SG 1.028 bu no rise in phos. general condition seems good.
I worried may have gotten into owner's meds,has moderately dilated pupils eg fluoxetine but does not seem to be the case. Owners are seniors.(re illicit drugs)
Any thoughts here?
thanks, | Was it confirmed with a culture? | Steroids will increase the platelets and can also cause the drop in pcv as they result in iron retention by the marrow, the neutrophilia and monocytosis can also be induced by steroids, was the dog on any along with the hydrocodone for the allergic bronchitis? |
Female spayed cat 7 y/o. Two days ago presented for lethargy reluctant to move- sitting on the same spot , not urinating but no straining , staring, was still eating. temp normal , normal exam except a large bladder.
Did a cysto and the cat started to salivate, wail , and then passed a large amount of urine. ( I have seen cats spasm before after cysto - quite scarey). Mild urinary infection diagnosed, antibiotics given.
Today cat returned after not eating, not urinating, sitting entire day on the same spot on a chair, (no mobility issues -jumped up). Again full bladder which evacuated after 2cc. cysto and salivation and wailing). so it seems the stimulation of the cysto causes release but cannot do so naturally? Rads look fine.
I assumed some urethral sphincter dysfunction and have started Phenoxy. Urea and Creatinine are moderately high, may have had some form of retention for a while. SG 1.028 bu no rise in phos. general condition seems good.
I worried may have gotten into owner's meds,has moderately dilated pupils eg fluoxetine but does not seem to be the case. Owners are seniors.(re illicit drugs)
Any thoughts here?
thanks, | Can you attach the complete lab results (blood and urine) as a pdf? | How many calories does she currently get per day? |
Greetings.
"Nosey" is an 8 y/o F(S) DSH who was previously diagnosed with DM. Was regulated with insulin glargine and fed Royal Canin C/C. Has been in remission for 6+ months and weight is very good now (no longer obese). Recently has developed diarrhea of unknown cause - duration 1 month...still on C/C and has never had an issue with it. Ran CBC/CHEM/T4 and fructoamine. Changed diet temporarily to I/D and no improvement, in fact blood was then seen in stool. Was given flagyl for 5 days with no improvement. Hx of atopic and flea allergy dermatitis. Fecals have been negative. Wondering where to go at this point. Seems BAR and playful. Vomits infrequently (hairballs). Blood results follow:
Superchem
Total Protein 6.9 5.2-8.8 g/dL
Albumin 3.2 2.5-3.9 g/dL
Globulin 3.7 2.3-5.3 g/dL
A/G Ratio 0.9 0.35-1.5 Ratio
AST (SGOT) 39 10-100 U/L
ALT (SGPT) 56 10-100 U/L
Alk Phosphatase 43 6-102 U/L
GGTP 5 1-10 U/L
Total Bilirubin 0.1 0.1-0.4 mg/dL
Urea Nitrogen 28 14-36 mg/dL
Creatinine 0.9 0.6-2.4 mg/dL
BUN/Creatinine Ratio 31 4-33 Ratio
Phosphorus 3.6 2.4-8.2 mg/dL
Glucose 215 64-170 mg/dL HIGH
The Glucose concentration in this cat is >170 mg/dl. A fructosamine level may be helpful in characterizing the nature of this hyperglycemia and differentiating stress hyperglycemia from early or sub-clinical diabetes mellitus, particularly in obese and/or male cats and/or when hyperglycemia is persistent. Please use test code 85881 for this additional testing.
Calcium 8.9 8.2-10.8 mg/dL
Magnesium 1.5 1.5-2.5 mEq/L
Sodium 146 145-158 mEq/L
Potassium 3.2 3.4-5.6 mEq/L LOW
Na/K Ratio 46
Chloride 117 104-128 mEq/L
Cholesterol 110 75-220 mg/dL
Triglycerides 31 25-160 mg/dL
Amylase 1187 100-1200 U/L
Lipase 19 0-205 U/L
CPK 220 56-529 U/L
CBC
WBC 7.4 3.5-16.0 103/mL
RBC 6.25 5.92-9.93 106/mL
Hemoglobin 8.4 9.3-15.9 g/dL LOW
Hematocrit 25.9 29-48 % LOW
The hematocrit in this patient is 27. (Normal range 29-48).A recent
study has indicated that >23% of anemic cats are infected with one or
more species of hemoplasma and several studies confirm that PCR is
significantly more sensitive in detecting hemoplasma.
Antech now offers a Feline Hemoplasma ( mycoplasma) PCR panel for
detection of M.haemofelis,M.haemominutum and M.turicensis.To add this
follow up test, please call customer service and request test code
T985.
MCV 41 37-61 fL
MCH 13.4 11-21 pg
MCHC 32.4 30-38 g/dL
Blood Parasites None Seen
RBC Comment
RBC Morphology Normal
Platelet Count 56 200-500 103/mL LOW
Fibrin clumps present; micro-clotting in the sample may spuriously
lower the platelet count and estimate.
Platelet count reflects the minimum number due to platelet clumping.
Platelet EST Decreased Adequate
Differential Absolute %
Neutrophils 4662 63 2500-8500 /uL
Bands 0 0 0-150 /uL
Lymphocytes 2146 29 1200-8000 /uL
Monocytes 370 5 0-600 /uL
Eosinophils 222 3 0-1000 /uL
Basophils 0 0 0-150 /uL
Comment
Clots are detected in the sample; CBC results may be affected.
Blood smear reviewed by technologist.
Total T4
T4 1.9 0.8-4.0 ug/dL
Occult Heartworm Antigen Negative
There were no measurable amounts of adult female heartworm antigen in this sample. Adult Dirofilaria immitis antigens will not be detected for 5 to 7 months following exposure to early larval stages.
Ova & Parasite/Giardia (ELISA)
Ova & Parasite None Seen
Negative for ova and parasite ( including Giardia ) by Zinc Sulfate centrifugation method.
Giardia (ELISA) Negative
Fructosamine 217 500 Good Regulation
Any thoughts on a next step would be appreciated. | Do you have urinalysis results? | How was your patient on recheck tonight? |
"Willa" is a 16 yo FS DSH who presented for lethargy and poor appetite. She had a loose stool that had a grey color with a hint of mixed-in blood. She started with vomiting the next day. PE was, except for the stool, fairly unremarkable, so she was treated with Cerenia, SQ fluids, famotidine, amoxi, Forti-Flora, and propectalin. Blood work is shown below. Radiographs show an ill defined lung mass, but the abdomen looked OK (I can post those later). After adding metronidazole, she seizured after one dose so this was discontinued (compouded by a local pharmacy). After it seemed like the seizure had more to do with the drug than her disease, we got an ultrasound which showed pancreatic cysts. One was aspirated to reveal an acellular watery fluid of very low TS. The cysts existed throughout the pancreas and up to 12 mm. No other abdominal pathology was reported. | What do you make of the whole scenario ie us and blood tests and is there any additional treatment or dietary changes i should make? | What does he weigh? |
Oscar is a 7 year old, MN, overweight orange tabby with a history of severe gingivostomatitis and diabetes. The diabetes is well controlled on diet (DM) and Lantus insulin. We are trying to get the stomatitis in remission with full mouth extractions AND we have just started oral cyclosporin. Here is the recent history:
1. Presented 7 days ago to pull the remaining teeth in the mouth (13 total) to complete the full mouth extractions.
2. Dental was uneventful - Buprenex and Propofol were used for indution and Isoflurane for anesthetic maintenace.
3. We do NOT use heating pads - we have a warm water circulating pad that we place the patience on (seperated by a towel or blanket, always) and we will also use rice socks if the patient becomes hypothermic (knee-high sock filled with rice - heated in the microwave for a few minutes, until warm, and snugged up to the patient (once again, a towel is placed between the patient and the rice sock). The rice socks will often cool off quickly (10-15 mintues).
4. This patient was under anesthesia for approximately 1 hour.
5. This patient was only sent home with Onsior and oral Buprenex for pain.
6. Patient recovered well and quickly - very uneventful.
The owner noted that when she got home with him, the afternoon of the dental, she went to give him his insulin injection and a tuft of fur came out (she give in the flank).
He presented TODAY with this lesion - I have NO IDEA what has lead to this. The location (on the lateral thorax) suggest that IF it was somthing that occured during the anesthesia that it was the warm-water pad that may have caused this. This thing NEVER gets that hot but I can't imagine what else could have caused this. He dose appear painful over this lesion.
Have you ever seen this before? Could it be vasculitus or infection from something else. Thank you so much! | The sense i get is that they are nearly always associated with anesthesia though, and it makes me wonder if some animals under anesthesia shut down capillary beds? | I'm sorry but i'm confused on this statement....i'm assuming the "i" is you and you wanted to stop it but the owner elected to keep up with administering trilostane? |
Oscar is a 7 year old, MN, overweight orange tabby with a history of severe gingivostomatitis and diabetes. The diabetes is well controlled on diet (DM) and Lantus insulin. We are trying to get the stomatitis in remission with full mouth extractions AND we have just started oral cyclosporin. Here is the recent history:
1. Presented 7 days ago to pull the remaining teeth in the mouth (13 total) to complete the full mouth extractions.
2. Dental was uneventful - Buprenex and Propofol were used for indution and Isoflurane for anesthetic maintenace.
3. We do NOT use heating pads - we have a warm water circulating pad that we place the patience on (seperated by a towel or blanket, always) and we will also use rice socks if the patient becomes hypothermic (knee-high sock filled with rice - heated in the microwave for a few minutes, until warm, and snugged up to the patient (once again, a towel is placed between the patient and the rice sock). The rice socks will often cool off quickly (10-15 mintues).
4. This patient was under anesthesia for approximately 1 hour.
5. This patient was only sent home with Onsior and oral Buprenex for pain.
6. Patient recovered well and quickly - very uneventful.
The owner noted that when she got home with him, the afternoon of the dental, she went to give him his insulin injection and a tuft of fur came out (she give in the flank).
He presented TODAY with this lesion - I have NO IDEA what has lead to this. The location (on the lateral thorax) suggest that IF it was somthing that occured during the anesthesia that it was the warm-water pad that may have caused this. This thing NEVER gets that hot but I can't imagine what else could have caused this. He dose appear painful over this lesion.
Have you ever seen this before? Could it be vasculitus or infection from something else. Thank you so much! | Diabetics definitely have microvascular disease so perhaps that contributed? | What should he weigh? |
Hello,
I have a 5 year old, MN overweight cat who I just diagnosed with diabetes 2 weeks ago (BG 486, 3+ glucosuria, PU/PD). He came in 2 days ago for consult to start insulin. Since diagnosis, the owner had switched cat to canned food only and said he was drinking and urinating less. He had also lost 1 lb in about 1 1/2 weeks. So started 2 units compounded PZI 2 days ago with instructions for 2 units BID. Owner called today, never gave any further insulin over weekend as said cat was lethargic for about 12 hours after insulin we gave in hospital. Cat also vomited 4 times yesterday and does not want to eat. Recent history includes possibly eating Christmas cactus.
Cat presented today with fever of 104.4, otherwise unremarkable PE (no jaundice, no abdominal pain). Blood screen today showed BG 451, ALT high at 177. Urine - 3+ glucose and no ketones.
Abd rads - very large gallstone
So, other than the fever and vomiting, no obvious symptoms for the gall stone. I currently just have cat on IV fluids to try to bring fever down and get him eating so can restart insulin. And, then once have diabetes, vomiting and anorexia under control, address the gallstone.
Any other thoughts please? Start amoxicillin and a quinolone for cholycystitis?
Thank you, | Is ultrasound not possible? | How much should he weigh? |
I have a client who has 2 cats. 1 is on KD (does not like well) for recently diagnosed urate stones in the bladder. the other cat I just diagnosed with Diabetes and have started on DM. Is there are diet that you could recommend for both cats with their conditions. It is difficult for the owners to feed different foods in separate locations. | Are the clients feeding dry or canned diets? | How long is the owner's 'pen needle"? |
Princess is a 12 yr FS Tortoise Maine coon, first diagnost Diabetic DKA, renal insufficiency with secondary hypokaliema in 12/24/12. Start Glargine 1 U BID, a week later went to 2U BID, and was controled well. last recheck BG shot up to 600+ and having trouble bringing BG under 400 with 3U of Glargine, DM diet, oral K+ gluconate. insulin resisntence problem? | At what intervals was the insulin increased and by how much? | Owners ok at drawing up and administering the insulin - might have them demo how they are doing? |
Princess is a 12 yr FS Tortoise Maine coon, first diagnost Diabetic DKA, renal insufficiency with secondary hypokaliema in 12/24/12. Start Glargine 1 U BID, a week later went to 2U BID, and was controled well. last recheck BG shot up to 600+ and having trouble bringing BG under 400 with 3U of Glargine, DM diet, oral K+ gluconate. insulin resisntence problem? | Given the hypokalemia and the renal insufficiency, in this patient hypertensive? | Did you change the cat's diet? |
Hello,
I inherited a Diabetic/hypothyroid/cushinoid sweet poodle mix from another clinic. Unfortunately, she has been on an alternate lysodren dose schedule and I do not know how to help her except to start from scratch.
"Rosie" is a 9 year old poodle mix 14#. Diagnosed last year with Cushings. I am not sure how long ago she was diagnosed with Diabetes or hypothyroidism. Her current medications are 250mg Lysodren eod, and 125mg Lysodren on the opposite days. 11 units 70/30 NPH and 0.1mg Soloxine BID.
A week after I first saw her for a ruptured cyst, she returned due to a "bumpy dermatitis" (looks like calcinosis cutis) and lethargy. Her appetite was great as usual. Normal PE and temp. I gave her fluids sc.
I talked her owner into a urine culture and ACTH stim and chem CBC. (financial constraints). Her Alk Phos was 7000! Glucose 435, urine glucose 250, fructosamine 516, and pre ACTH 3.9, post 24.6. We used Cortrosyn. Culture is negative.
Based on results, I think her Cushings is making her feel weak and develop calcinosis cutis.
I calculated her induction dose as 325mg divided daily, then approx 125mg 2-3 times a week for maintenance. For the past year she has been on this 250mg/125mg alternating day dose, so IF owner okayed induction, would I increase the dose from 325mg? Owner is really not happy with costs of ACTH stims, but I don't know of another way to properly monitor. Should we change to Trilostane? I guess no matter what we need to monitor with ACTH stims.
Also, I am not familiar with 70/30 insulin. Why would one give this?
Thanks for any advice! | How does the owner think the dog is related to the pu/pd? | Did you also get thyroid autoantibodies? |
Hello!
Any tips on treatment of decubital tarso-metatarsal decubital ulcers in cats? I've seen #2 ~14y/o cats in the past week with round, ulcerated, bleeding ulcers of the caudal/plantar proximal region of the metatarsals (pressure points of the hocks)....both cats are not plantigrade, but crouch to eat and rest/sleep. One cat is a methimazole controlled hyperthyroid/early CKD and the other is early CKD/IBD treated with prednisone. These ulcers ooze blood in both instances. My treatment thus far has been chlorhex dilute soln to clean BID, apply SSD (e-collar to prevent licking), apply a simple bandage +/- systemic AB's (clavamox, convenia, etc) as well as soften the environment with padded bedding, etc).
Any other helpful hints? If bandaging, how often to change and do you ever have the owner do this at home?
Thanks! | I wonder if she could protect the area by using baby socks? | Did her adrenal gland width get recorded on the ultrasound? |
Hello!
Any tips on treatment of decubital tarso-metatarsal decubital ulcers in cats? I've seen #2 ~14y/o cats in the past week with round, ulcerated, bleeding ulcers of the caudal/plantar proximal region of the metatarsals (pressure points of the hocks)....both cats are not plantigrade, but crouch to eat and rest/sleep. One cat is a methimazole controlled hyperthyroid/early CKD and the other is early CKD/IBD treated with prednisone. These ulcers ooze blood in both instances. My treatment thus far has been chlorhex dilute soln to clean BID, apply SSD (e-collar to prevent licking), apply a simple bandage +/- systemic AB's (clavamox, convenia, etc) as well as soften the environment with padded bedding, etc).
Any other helpful hints? If bandaging, how often to change and do you ever have the owner do this at home?
Thanks! | I also wonder if some of the topical remedies like silver sulfadiazine with insulin added or even medi-honey would help? | What sort of body condition and muscle condition is he in? |
Presented with an 8 year old M/N Min Pin weighing 7.2 kg who has been lethargic, anorexic and PU/PD for the last 2 days. On questioning owners say he has vomited once or twice in this time frame. Sudden onset of signs. Clinical impression is depressed (owners say usually have to muzzle and restrain to examine but not today), nauseated, pink slightly tacky mm, panting, abdomen somewhat tender (owner say shifts around lots at home), feces scant and firm, T 38.8 and HR 130.
Bloodwork as below:
WBC 27.7
HGB 18.7
HCT 53.7
Granulocytes 25.7 Smear wasn't evaluated--our machine wasn't operating and run A/H at other clinic; will have them look at smear tomorrow
For chemistry I've listed the abnormal first
ALP 384 U/L
Amylase 2332 U/L
Glucose 7.5 mmol/l
Na 118 mmol/l
K 3.6 mmol/l
ALB 27 G/L
ALT 107
TBIL 6
Ca 2.51
Phos 1.26
Cre 72
TP 77
Glob 51
cPL SNAP strong abnormal
Urinalysis;
USG 1.008
trace protein
no glucose
sediment quiet
On questioning this dog has had a severe pancreatitis episode requiring several days hospitalization when he was younger.
If he's a pancreatitis, which ALP, amylase, WBCs, cPL and clinical signs seem to suggest I cannot fit in the extremely low Na and the PU/PD and low USG with no elevation of BUN or cre Yet things don't seem to fit with a Addisonian very well either--potassium isn't technically increased and why the high WBC/high granulocytes?
For now I've got the little dude on 0.9% saline and a ketamine CRI. He's been treated with Cerenia, Zantac, Ampicillin and Enrofloxacin. I've also topped up his pain med with some hydromorphone iv.
Will the saline be enough to address the hyponatremia and if it is, is there potential to increase the Na too fast (I know with the hypertonic saline you have to be careful)? I'm leaning toward loss rather than dilution to explain the hyponatremia since our PCV is right at the high end of normal--am I correct in that assumption?
Any help sorting out my muddle would be appreciated as my brain feels like it is about to explode! I feel like I may be missing something important. U/S would have to be a referral as our machine is broken at present. | Tbili not that bad by my references...how about yours? | Is it 7% carbs on an me (or 'energy' or 'calorie%') basis? |
Presented with an 8 year old M/N Min Pin weighing 7.2 kg who has been lethargic, anorexic and PU/PD for the last 2 days. On questioning owners say he has vomited once or twice in this time frame. Sudden onset of signs. Clinical impression is depressed (owners say usually have to muzzle and restrain to examine but not today), nauseated, pink slightly tacky mm, panting, abdomen somewhat tender (owner say shifts around lots at home), feces scant and firm, T 38.8 and HR 130.
Bloodwork as below:
WBC 27.7
HGB 18.7
HCT 53.7
Granulocytes 25.7 Smear wasn't evaluated--our machine wasn't operating and run A/H at other clinic; will have them look at smear tomorrow
For chemistry I've listed the abnormal first
ALP 384 U/L
Amylase 2332 U/L
Glucose 7.5 mmol/l
Na 118 mmol/l
K 3.6 mmol/l
ALB 27 G/L
ALT 107
TBIL 6
Ca 2.51
Phos 1.26
Cre 72
TP 77
Glob 51
cPL SNAP strong abnormal
Urinalysis;
USG 1.008
trace protein
no glucose
sediment quiet
On questioning this dog has had a severe pancreatitis episode requiring several days hospitalization when he was younger.
If he's a pancreatitis, which ALP, amylase, WBCs, cPL and clinical signs seem to suggest I cannot fit in the extremely low Na and the PU/PD and low USG with no elevation of BUN or cre Yet things don't seem to fit with a Addisonian very well either--potassium isn't technically increased and why the high WBC/high granulocytes?
For now I've got the little dude on 0.9% saline and a ketamine CRI. He's been treated with Cerenia, Zantac, Ampicillin and Enrofloxacin. I've also topped up his pain med with some hydromorphone iv.
Will the saline be enough to address the hyponatremia and if it is, is there potential to increase the Na too fast (I know with the hypertonic saline you have to be careful)? I'm leaning toward loss rather than dilution to explain the hyponatremia since our PCV is right at the high end of normal--am I correct in that assumption?
Any help sorting out my muddle would be appreciated as my brain feels like it is about to explode! I feel like I may be missing something important. U/S would have to be a referral as our machine is broken at present. | Calcium not bad...i think that's normal for you too correct, same for phosphorus? | Using cortrosyn? |
Hi there,
My patient is a 14 year old FS Yorkie who presented today w/PU/PD, hepatomegaly, pendulous abdomen, panting, weight gain, and increased liver enzymes (ALP 545, ALT 250, GGT 11) as well as hypercholesterolemia and thrombocytopenia. She has a hx cataract sx about 6 months ago and has been on pred acetate 1% topically following sx. Blood work was WNL prior to cataract sx.
I was reading the pred acetate needs to be discontinued for 6-8 wks prior to a LDDT. Does this hold true for u/s as well? Should I u/s her now and wait on the LDDT? Or wait to do both?
Thank you, | Question is: what are going to do if the tests come up positive for hac? | What diet exactly .....getting any dog treats? |
Hi there,
My patient is a 14 year old FS Yorkie who presented today w/PU/PD, hepatomegaly, pendulous abdomen, panting, weight gain, and increased liver enzymes (ALP 545, ALT 250, GGT 11) as well as hypercholesterolemia and thrombocytopenia. She has a hx cataract sx about 6 months ago and has been on pred acetate 1% topically following sx. Blood work was WNL prior to cataract sx.
I was reading the pred acetate needs to be discontinued for 6-8 wks prior to a LDDT. Does this hold true for u/s as well? Should I u/s her now and wait on the LDDT? Or wait to do both?
Thank you, | Does the dog have a history suggestive of hac? | Is there a history of gi-associated clinical signs in this big boy? |
"Gus" is an 11 yr old MN cat I first met in 2007. Weighed 21 lb. 4 oz. then, got has high as 23 lb. 4 oz. in 5-10 despite being on a weight-loss diet. Has been treated for constipation long-term with psyllium and for arthritis pain with buprenorphine. He was treated for pancreatitis in 12-11. Was presented yesterday for diminished appetite and reassessment of his arthritis. Normal TPR, weight 21 lb 0 oz. (down 8 oz since October), some tartar but no obvious site of oral pain. No other significant PE findings except obesity and lumbosacral pain. Labs were sent to IDEXX (with exception of UA): CBC was WNL with the exception of a 700 lymphocyte count; chem 21 was WNL with the exception of a BUN of 41 (not fasted, creatinine 1.6) and his T-4 was ,0.4. His urinalysis showed a USG .1,040 and was otherwise WNL.
So, my question is: pursue workup for euthyroid sick cat with imaging, GI panel OR pursue evaluation of markedly decreased T-4? I work up cats not infrequently with mildly decreased T-4 as euthyroid sick, but they usually look much more sickly than this cat looks. With the exception of cats treated for hyperthyroidism, I don't remember ever seeing a cat with a thyroid this low. | What diet is he on for weight loss? | A few questions: was this kitty obese at the diagnosis of his iddm? |
8 yr old FS Brittney Spaniel. Hx of inappropriate urination since Oct. 2011. Starting with hx of urinating in her bed since being spayed at 6 mos of age. Has always had high urine pH (7.5-8.5). Low sp. gr. but not isosthenuric. (1.012-1.018). Was put on Royal Canin S/O diet and proin which seemed to help but owner stopped giving both about a year ago.
Presented late Dec. 2012 with PU/PD, and consciously urinating on carpet. Not leaking or urinating in her bed this time. But licking at vulva a lot. Dipstix normal, pH 7.5, sp. gr. 1.015. Urine culture in-house negative. Plain lateral radiograph showed no obvious uroliths. Rx'd again S/O diet, proin. Dog ended up having allergic rxn to proin after 2 doses, was discontinued.
Superchem/CBC/T4/FT4ED/UA sent to Antech. Mildly elevated triglycerides (non-fasted) 494 (29-291), rest WNLs; euthyroid; CBC normal; U/A: clear, yellow, pH 6.5, sp. gr. 1.012, rest non-remarkable.
I'm not sure where to go from here. Additional diagnostics? Try DES? Possibility of diabetes insipidus?
Thanks.
-- | Do you have specifically first morning usgs? | Does this have any efficay in cats? |
8 yr old FS Brittney Spaniel. Hx of inappropriate urination since Oct. 2011. Starting with hx of urinating in her bed since being spayed at 6 mos of age. Has always had high urine pH (7.5-8.5). Low sp. gr. but not isosthenuric. (1.012-1.018). Was put on Royal Canin S/O diet and proin which seemed to help but owner stopped giving both about a year ago.
Presented late Dec. 2012 with PU/PD, and consciously urinating on carpet. Not leaking or urinating in her bed this time. But licking at vulva a lot. Dipstix normal, pH 7.5, sp. gr. 1.015. Urine culture in-house negative. Plain lateral radiograph showed no obvious uroliths. Rx'd again S/O diet, proin. Dog ended up having allergic rxn to proin after 2 doses, was discontinued.
Superchem/CBC/T4/FT4ED/UA sent to Antech. Mildly elevated triglycerides (non-fasted) 494 (29-291), rest WNLs; euthyroid; CBC normal; U/A: clear, yellow, pH 6.5, sp. gr. 1.012, rest non-remarkable.
I'm not sure where to go from here. Additional diagnostics? Try DES? Possibility of diabetes insipidus?
Thanks.
-- | This is for incontinence...i thought she didn't have signs of this any more? | By "urinations returned to what had been normal" do you mean well concentrated, or do you mean extremely dilute? |
Hi!
I would appreciate your help in a diabetic case..."Beany" is a 6 year old MN Yorkie (5.3 kg) who was first diagnosed last September. He did have ketonuria but was not sick ie. not lethargic, anorexia and no vomiting...the owner had only noticed PU/PD and weight loss, otherwise was doing well. His fructosamine at the time was 701 and a urine culture was negative. I started him on 2 units BID of caninsulin and the w/d diet and showed the owner how to do a blood glucose curve at home. His first curve was Sept 28/12 (he gets insulin at 8am and 8pm and is fed at 8am, 2pm and 8pm):
8 am - error
9 am - 29.7
10am - 24.9
11am - 23.8
12 pm - 20.7
1pm - 23.0
2pm - 27.3
3pm - 33.0
4pm - 40.7
5pm - HI
6pm - 38.2
7pm - 41.4
8pm - HI
Obviously his curve was too high and we increased him to 3 units BID, and a curve was done Oct 15th (insulin and food given at same time):
8am - 30.1
9am - 25.7
10am - 15.8
11am - 13.6
12pm - 9.1
1pm - 9.4
2pm - 17.5
3pm - 30.3
4pm - 30.9
5pm - 35.4
6pm - 31.4
8pm - 32.3
So we increased again to 4 units BID, and his next curve was done Jan 4/13 (I know it was 2 mths later but that was when I could get the owner to do it), again food and insulin is at the same time as previous:
8am - 21.6
9am - 14.9
10am - 6.6
11am - 6
12pm - 4.4
2pm - 16.7
3pm - 28.2
4pm - 25.6
5pm - 31.7
6pm - 32.2
7pm - 25
8pm - 30.1
So it seems that Beany is hitting his nadir at noon which is 4 hours after the 1st insulin dose...should I switch to a longer-acting insulin? Or I did briefly read about using caninsulin TID. I'm a bit hesitant to increase his insulin dose this time because his nadir is at 4.4 even though it doesn't last very long.
Thanks for your help! | Why is the dog getting fed in the middle of the day? | Why is there hypercalcemia? |
Hi!
I would appreciate your help in a diabetic case..."Beany" is a 6 year old MN Yorkie (5.3 kg) who was first diagnosed last September. He did have ketonuria but was not sick ie. not lethargic, anorexia and no vomiting...the owner had only noticed PU/PD and weight loss, otherwise was doing well. His fructosamine at the time was 701 and a urine culture was negative. I started him on 2 units BID of caninsulin and the w/d diet and showed the owner how to do a blood glucose curve at home. His first curve was Sept 28/12 (he gets insulin at 8am and 8pm and is fed at 8am, 2pm and 8pm):
8 am - error
9 am - 29.7
10am - 24.9
11am - 23.8
12 pm - 20.7
1pm - 23.0
2pm - 27.3
3pm - 33.0
4pm - 40.7
5pm - HI
6pm - 38.2
7pm - 41.4
8pm - HI
Obviously his curve was too high and we increased him to 3 units BID, and a curve was done Oct 15th (insulin and food given at same time):
8am - 30.1
9am - 25.7
10am - 15.8
11am - 13.6
12pm - 9.1
1pm - 9.4
2pm - 17.5
3pm - 30.3
4pm - 30.9
5pm - 35.4
6pm - 31.4
8pm - 32.3
So we increased again to 4 units BID, and his next curve was done Jan 4/13 (I know it was 2 mths later but that was when I could get the owner to do it), again food and insulin is at the same time as previous:
8am - 21.6
9am - 14.9
10am - 6.6
11am - 6
12pm - 4.4
2pm - 16.7
3pm - 28.2
4pm - 25.6
5pm - 31.7
6pm - 32.2
7pm - 25
8pm - 30.1
So it seems that Beany is hitting his nadir at noon which is 4 hours after the 1st insulin dose...should I switch to a longer-acting insulin? Or I did briefly read about using caninsulin TID. I'm a bit hesitant to increase his insulin dose this time because his nadir is at 4.4 even though it doesn't last very long.
Thanks for your help! | Could the 2 pm feeding without insulin be the plem? | Repeat? |
Have a patient I would like some advice on please.
S/F DSH 17 year old kitty. First saw 12/11/2009. At that time had been on 2 units PZI q12h for a few years as well as meloxicam every 48 hours and cosequin bid. Cat weighed around 15 pounds and owner was giving between 5-10 pound dose meloxicam.
Not a particularly nice cat but I thought I felt an enlarged thyroid gland. Heart rate was over 200, no murmur. Ran a total T4 IDEXX 4.6 1-4.7 normal range.
Diabetes was fairly well regulated. Told to come back 2 months repeat blood work.
2/20/2010 TT4 in house 7.4 2.5 - 4.8
Ca 8.0 8.0- 11.0
Phos 4.3 3.4 - 7.8
Glucose 138 70 - 150
BUN 22 10 - 30
Cr 0.6 0.3 - 2.0
SAP 42 10 - 90
ALT 40 20 - 100
Na 110 140-180 we were having problems with machine and the Na and K are prob lab error
K 2.9 3.7-5.9
Tot Bili 0.3 0.1- 0.6
Alb 3.2 2.2-4.4
Started on 5mg methimazole q24h
7/20/2010 glucose curve. T4 not addressed 9:30 301 11:30 238 1:30 191
3:30 220 5:30 198
By this time cat was being seen by every vet in our clinic but me
Next notation in chart 1/26/2011 cat was on 3 IU PZI q12h. Same meloxicam and methimazole.
I saw her 4/12/2012. She was on dry DM. I suggested blood work and switched her to canned DM. Owner said she had to have some dry food so continued to mix dry and canned DM
She was scheduled for entropion surgery at local referral center. Cat now weighed 12.5 lbs. Did blood work at referral center
BUN 45 14-36
Cr 1.8 .6-2.4
Phos 5.8 2.4-8.2
Glucose 30 64-170 no idea when insulin given
Ca 10.3 8.2-10.8
Na 163 145-158
K 4.4 3.4-5.6
CBC
WBC 18.8 3.5-16.0
RBC 6.72 5.92-9.93
Hgb 9.0 9.3-15.9
HCT 30 29-48
platelets 586,000
DIFF
Neut 17108 91%
Bands 0
Lymph 940 5% 1200-8000
monos,eos,basos all normal
Was sent to me for a PE pre surgery
HR was 220 no murmur
Had a patch of trunkal alopecia
Weighed 12.5 lb
body score 4/9
basically looked normal. Still mean as hell
I asked the referral opthomologist to grab a UA and FreeT4ED when the cat was out for surgery
UA via cystio
URSG 1.023
Ph 6.5
Blood 3+
RBC 21-50
WBC 0
Bacteria none seen
no crystals
protein/glucose/ketones/bilirubin all neg
FT4ED 53 10-50
Sorry for ramble. My question is should I be monitoring this cats thyroid with FT4ED or TT4 or both?
thanks | From what i can tell, was the free t4 you did the first one that was done since the cat was diagnosed? | The owner moves the injections around on her body every day? |
So, I have a client who is consulting with this guy online, and, I just thought I would put it out there, cause, it kind of feels wrong.
I look up his website. He is on online homeopathic vet. I look over the website, and at first, I thought, hey, advice is advice, no big deal. However, he states on the website that he is providing physical exams, wellness exams, and of course treatments for any and all ailments etc. etc. etc.
How can he do that without physically seeing and touching the animal?
Don't believe me? This is directly copi from website.
Services offer by Dr. Q (not his true name of course):
•Homeopathic treatment of acute and chronic diseases
•Puppy and kitten wellness care
•Scientifically-bas vaccination decisions (my comment = (so for this problem, science is acceptable)
•Nutritional counseling with emphasis on species-appropriate fresh food feing
•Nutritional supplementation
•Physical Examination and evaluation (uh, what, huh? how?)
•Phone and internet-bas consultation with pet owners and veterinarians (I caction":true,"hash":"1abcf02f-5f30-4aab-8744-88dd5f6b9fdb","type":"diminutive_match"}ot wait to call him for help)
•Evidence-bas integrative micine (again, not exactly consistent with homeopathy's law of infintesimals?)
•Infectious disease prevention and treatment (except bacterial or fungal of course)
•"Senior" pet care
•Care for the arthritic pet
•Care for the itchy pet
•Treatment of internal diseases
•Palliative and cancer care
•Pain Management
•Educational resources and seminars
________________________________
I guess it is no worse than when my great, great, great, great, grandfather us to sell tonics from the back of his wagon. (it's true!) -- he did better than I am doing fiaction":true,"hash":"1abcf02f-5f30-4aab-8744-88dd5f6b9fdb","type":"diminutive_match"}cially, that is for sure...
vet m by internet...no more hair, bites, or poop showers....
action":true,"hash":"90146968-4d87-468e-9971-d1e71101239a","type":"signature_match"} | This looks like www.homevet.com, correct? | We are using the right codes with the alphatrak and the measuring sticks? |
Hi,
Indi is an 11yo MN DSH. He presented to us recently for PU/PD (owner measured about 100ml-230ml/kg/day but could be more as has many water bowls around the house) of several months duration. She also reports he is polyphagic and will eat anything!, his latest conquest was a family size frozen apple pie left on the kitchen bench! he ate the lot!. The owner does not overfeed Indi though, but he is always on the prowl.
On presentation Indi had a BCS of 5/9 with NAD on PE except he had a very full bladder. Urine SG was 1.004 with no other abnormalities detected. CBC and biochem were unremarkable except he had mildy elevated cholesterol and triglycerides. Total T4 was normal.
Have spoken to a local feline specialist who recommended we do a LDDST as the next step to rule out HyperA.
One of my top diffetials was diabetes insipidus. To me it seems unlikley to be HyperA as Iv'e read that 95% of cats have uncontrolled diabetes mellitus, which Indi has no signs of at all.
The specialist recommended trialling desmopressin if HyperA is ruled out (she didn't recommend the water deprivation test which I would be too scared to do anyway).
Just wondering the best course of action as I don't want to spend too much of the owners money, even though she is a great client who would do anything. We'll probably do an abdo US and check the adals tomorrow anyway, even though we have no experts within a 3 hour drive.
Would welcome any opinions on this case
Many thanks | Does this cat have loss of adipose or muscle mass over the dorsal spinous processes? | Was this patient brought into the home as a ten? |
Hi,
Indi is an 11yo MN DSH. He presented to us recently for PU/PD (owner measured about 100ml-230ml/kg/day but could be more as has many water bowls around the house) of several months duration. She also reports he is polyphagic and will eat anything!, his latest conquest was a family size frozen apple pie left on the kitchen bench! he ate the lot!. The owner does not overfeed Indi though, but he is always on the prowl.
On presentation Indi had a BCS of 5/9 with NAD on PE except he had a very full bladder. Urine SG was 1.004 with no other abnormalities detected. CBC and biochem were unremarkable except he had mildy elevated cholesterol and triglycerides. Total T4 was normal.
Have spoken to a local feline specialist who recommended we do a LDDST as the next step to rule out HyperA.
One of my top diffetials was diabetes insipidus. To me it seems unlikley to be HyperA as Iv'e read that 95% of cats have uncontrolled diabetes mellitus, which Indi has no signs of at all.
The specialist recommended trialling desmopressin if HyperA is ruled out (she didn't recommend the water deprivation test which I would be too scared to do anyway).
Just wondering the best course of action as I don't want to spend too much of the owners money, even though she is a great client who would do anything. We'll probably do an abdo US and check the adals tomorrow anyway, even though we have no experts within a 3 hour drive.
Would welcome any opinions on this case
Many thanks | Is there a history of gi-related disease? | Does it get tested occasionally against the results you get from your chem analyzer? |
Hello,
I have a glucose curve I would love some feedback on. This dog is 10 yrs old and was diagnosed in August and started having episodes of collapse around 2-3pm or later in the evening which would resolve with feeding so we did a curve. The dog seemed to be under-regulated on 8 Units Humulin N and was having episodes on 8.5 units. She gets insulin at 8 and 8. Here is the curve:
8am: 163 mg/dL 8.5 units insulin and food (pur OM)
9:00: 180
10am: 104
11am: 103
12pm: 102
1 pm: 104
2pm: 111
3:30: 130
5 pm:102
6:30pm: 64
How would you adjust her from here? I have had them giving food just am and pm though they have been giving a small meal mid-day to help with the current events. Is it ok to have them feed mid-day or should we consider a lower pm dose of insulin?
Thanks for the help,
Dr. | It looks like she was fed at the clinic? | It's not fair to the cat to be sent home if it isn't going to be managed well, isn't it nicer for the cat to be euthanased? |
Hello,
I have a glucose curve I would love some feedback on. This dog is 10 yrs old and was diagnosed in August and started having episodes of collapse around 2-3pm or later in the evening which would resolve with feeding so we did a curve. The dog seemed to be under-regulated on 8 Units Humulin N and was having episodes on 8.5 units. She gets insulin at 8 and 8. Here is the curve:
8am: 163 mg/dL 8.5 units insulin and food (pur OM)
9:00: 180
10am: 104
11am: 103
12pm: 102
1 pm: 104
2pm: 111
3:30: 130
5 pm:102
6:30pm: 64
How would you adjust her from here? I have had them giving food just am and pm though they have been giving a small meal mid-day to help with the current events. Is it ok to have them feed mid-day or should we consider a lower pm dose of insulin?
Thanks for the help,
Dr. | How does that time that the food/insulin was given that day compare to the normal time she gets food/insulin? | Have you previously measured the dog's liver enzymes and found the alt to be lower? |
Hello,
I have a glucose curve I would love some feedback on. This dog is 10 yrs old and was diagnosed in August and started having episodes of collapse around 2-3pm or later in the evening which would resolve with feeding so we did a curve. The dog seemed to be under-regulated on 8 Units Humulin N and was having episodes on 8.5 units. She gets insulin at 8 and 8. Here is the curve:
8am: 163 mg/dL 8.5 units insulin and food (pur OM)
9:00: 180
10am: 104
11am: 103
12pm: 102
1 pm: 104
2pm: 111
3:30: 130
5 pm:102
6:30pm: 64
How would you adjust her from here? I have had them giving food just am and pm though they have been giving a small meal mid-day to help with the current events. Is it ok to have them feed mid-day or should we consider a lower pm dose of insulin?
Thanks for the help,
Dr. | Did she eat normally? | Could this be my problem? |
Hello,
I have a glucose curve I would love some feedback on. This dog is 10 yrs old and was diagnosed in August and started having episodes of collapse around 2-3pm or later in the evening which would resolve with feeding so we did a curve. The dog seemed to be under-regulated on 8 Units Humulin N and was having episodes on 8.5 units. She gets insulin at 8 and 8. Here is the curve:
8am: 163 mg/dL 8.5 units insulin and food (pur OM)
9:00: 180
10am: 104
11am: 103
12pm: 102
1 pm: 104
2pm: 111
3:30: 130
5 pm:102
6:30pm: 64
How would you adjust her from here? I have had them giving food just am and pm though they have been giving a small meal mid-day to help with the current events. Is it ok to have them feed mid-day or should we consider a lower pm dose of insulin?
Thanks for the help,
Dr. | We need to decrease the insulin dose a bit...what exactly did the curve look like at 8 units bid and how long ago was it done? | What made you think to look for a problem? |
Hello,
I have a glucose curve I would love some feedback on. This dog is 10 yrs old and was diagnosed in August and started having episodes of collapse around 2-3pm or later in the evening which would resolve with feeding so we did a curve. The dog seemed to be under-regulated on 8 Units Humulin N and was having episodes on 8.5 units. She gets insulin at 8 and 8. Here is the curve:
8am: 163 mg/dL 8.5 units insulin and food (pur OM)
9:00: 180
10am: 104
11am: 103
12pm: 102
1 pm: 104
2pm: 111
3:30: 130
5 pm:102
6:30pm: 64
How would you adjust her from here? I have had them giving food just am and pm though they have been giving a small meal mid-day to help with the current events. Is it ok to have them feed mid-day or should we consider a lower pm dose of insulin?
Thanks for the help,
Dr. | Is this a spayed female? | Is the cat ketotic? |
This diabetic dog is making us a little crazy. He does not seem to respond as expected. Any help would be appreciated. I have summarized the history since the diagnosis. I know it is a bit long, but I always find that leaving information out does not get me where I want to be.
Rocky is a MN, 12yr old (1Nov2002) coon hound mix weighing 62 lbs. He has a history of spinal pain and bilateral cruciate disease. He has also had occasional ear infections. Currently, he is not on any chronic or prescribed medications other than insulin. The owner occasionally gives him a "doggy aspirin" if he seems painful. When diagnosed with Diabetes on 12/13/2011 he weighed 78 lbs and was started on Humulin N 15 U bid. This is the second diabetic dog these owners have had in the past few years. The owners monitored blood glucose at home initially with an Alpha Trac glucometer. He was recommended to be started on RCVD Diabetic formula or a high fiber formula like w/d at the time of diagnosis.
At home glucose curve on 1/14/12:
7:30a gave 15U NPH and fed
8:20a 551g/dl
10:20a 228
12:20p 282
2:30p 453
6:30p 481
The insulin was increased to 18U NPH bid with instructions to check a curve in about a week.
He was lost to follow up until 6/19/12. At that time he was 64 lbs. He had been placed on a homemade diet consisting of oatmeal, rice, veggies, eggs and an alternating meat source (chicken, beef, fish). (Note: another dog in the house has congenital megaesophagus. With this diet he only seldom regurgitates so all 3 dogs were fed the same.) He was reported to be doing well, active and brighter. The owners started a new exercise regimen for the dogs. He was reported to be well regulated on 18 U NPH BID.
On 9/28/12, Rocky presented for having 3 seizures over the previous 4 weeks and for otitis. Weight at this time 60.4 lbs, BCS 4/9. We suspected hypoglycemia as the cause of the seizures. A glucose curve at home confirmed this.
9/29/12
5:15p BG 68, gave 18 U NPH
7:15p 85
9:15p 57
11:15p Lo
Reduced insulin to 12 U NPH bid
The owner was having trouble getting a curve done at home so brought to the clinic for a curve on 11/9/12. He was reported to be much brighter, more active. Not seizuring.
12 U NPH 7:30am just after eating.
8:40- 59 mg/dl
9:45- 96 mg/dl
11:57- 91 mg/dl
1:45- 44 mg/dl
3:35- 51 mg/dl
4:45 - 62mg/dl
Decreased the insulin to 9U NPH bid.
11/19/12 9U NPH at 7:45am
8:38am = 262 mg/dl
10:20am = 292 mg/dl
12:30pm = 225 mg/dl
2:22pm = 184 mg/dl
4:30pm = 102 mg/dl
At this time the owner was convinced to switch to a diet that had a lower glycemic index. We did not have Royal Canin Diabetic in stock so used RCVD Satiety Support (Increased protein and increased fiber). Kept the insulin at 9 U bid NPH.
11/28/12 Rocky was reported to be doing well at home. Midway through gradual change of diets. Got 9U NPH at 7:45am. His ears were bothering him and had a yeast otitis.
9:15am = 330 mg/dl
11:15am = 399 mg/dl
1:27pm = 369 mg/dl
3:20pm = 339 mg/dl
4:50pm = 486 mg/dl
Decided that the food had made a difference and needed to move the entire curve down by increasing back to 12 U NPH bid. Also treated the ears with Mometamax and cleanings.
12/4/12 Rocky was reported to be drinking more at home since the diet change to a dry kibble.
7:45a 12 U NPH SQ
9:30am = 230 mg/dl
11:45am = 369 mg/dl
1:30am = 350 mg/dl
As there was no evidence of a significant response at this time, the curve was discontinued. The owner was instructed to bring the insulin bottle to the clinic the next for another curve and a staff member to give the injection.
12/5/12 He was fed normally at home. A doctor gave 12 U NPH at the clinic at presentation at 8:45am.
8:50 am = 372 mg/dl
10:35 am = 447 mg/dl
12:35 am = 394 mg/dl
Ran a UA to look for a cause of difficulty regulating him.
UA: 4+ glucose, SQ 1.026, pH 7, Protein 1+, NSF on sed
With no evidence of a UTI the owner declined repeating CBC and Chemistry profile. We decided to try a new bottle of insulin to see if that was the problem as the one that was currently in use had been opened about 11/25 when the blood glucose had increased.
12/11/12 Fed normally, gave 12U NPH 7:45am
9:20am = 389 mg/dl
12:00 pm = 411 mg/dl
Rocky is not responding to the insulin as expected considering his previous responses. There were new needles used that are much shorter so Intradermal administration was a consideration. This has been evaluated and ruled out as a cause of this lack of response. About the time he ceased to have a response, his insulin dose was reduced, he had a diet change and his insulin was changed from Humalin N to Novolin N because of the discontinuation of availabitiity of Humulin N. He may not be responding to the new insulin in the same way. A box of Humalin N was obtained. He will be given 9 units tonight and in the am and represented in the am for a blood draw.
12/12/12 Ate normally and have 9U Humulin N at 7:30am
8:40am = 338 mg/dl
11:11am = 395 mg/dl
Rocky didnot appear to be responding adequately to the 9U of Humulin N at this time. Considered several possible reasons for this. These include: 1. an inadequate dose. 2. It could be related to the diet change. 3. There could be an underlying health problem that we have not yet identified. 4. Developing insulin resistence to the NPH insulin. 5. Combinations of any of these.
Elected to try increasing the dose of the Humulin NPH and checking in a few s to see if it appears that he is responding to it. The current dose is about 1/2 of the initial calculated dose for Rocky based on his weight, so we may just be seeing him not decreasing to the expected levels.
Increased Humulin NPH to 13 U SQ bid
Recheck a glucose in the middle of the in a few s to look for apparent insulin response.
12/18/12, The previous the owner got a mid blood glucose of 126mg/dl so we decided to try a curve in clinic. 14 U Humulin NPH SQ 7:45am
8:40am = 322 mg/dl
11:00am = 482 mg/dl
3:05pm = 459 mg/dl (tested against the owner's glucose monitor which got 505 mg/dl)
His values are very different at home compared to in clinic so recommended to do the curve at home. A urine cortisol:creatinine ratio was scheduled for the next . The results were normal at 0.4. Decided hyperadrenocorticism was extremely unlikely.
12/19/12 Glucose readings at home with 14U Humulin NPH
11:44 am = 198 mg/dl
3:00 pm = 259 mg/dl
12/28/12 14U Humulin N He had a BG of 220 approximately 11:30. About 2:00 reading 430 and 4:00 reading HI.
11:30am 220
2:00pm 430
4:00pm HI
Elected to switch insulin to ProZinc. This was ordered.
The ProZinc was started at 14U SQ bid on 1/3/13.
1/8/13: The owner reports tat the lowest he has found the blood glucose to be is about 250 about 2-3 hours after giving the insulin. After this it increases to around 600 mg/dl. About 3-4 s ago he switched back to the homemade diet he was on previously. He was instructed to increase the ProZinc to 18U again.
This brings us up to to. I just spoke with the owner to confirm the medications Rocky is on.
While writing this summary I see that we have not run a CBC/Chem since the diabetes was diagnosed. This should be done.
Thanks, | Do you know what exactly is the problem the owner is having with collecting the samples? | Whatever happened to making an attempt to close the barn door *before* the horse gets out? |
I have a 16 year old MN cat with a very long history -
Simon first came to our clinic in 2009 with a history of being a cat that had always vomited occasionally with some constipation problems in the past.
On Dec 22, 2010 he came in not eating, vomiting and blood work was done. Bloods were normal expect an elevated fpli 5 (0-3.5 uG/L). He seemed to get better on his own so no treatment was done.
Jan 6, 2011 he came back because he was vomiting again, constipated, wt loss and a decreased appetite. Treatment included SQ fluids, Cerenia, Cypro and canned I/D for 3 days. Problems resolved.
Jan 17, 2011 No vomiting but poor appetite
Jan 19, 2011 an exploratory with biopsy samples of the ileum, upper and lower jejunum, liver and pancreas were taken. An esophageal feeding tube was placed. Bloods were re done in clinic - normal except for elevated lipase 1570 (100-1400) no fpli done. Treatment post op included pepcid, denosyl, buprenorphine, Vit B12 inj, Amoxil, Cerenia, canned A/D
Histopath report - Normal liver, pancreatic nodular hyperplasia, lymphocytic enteritis - no malignancy.
Jan 26, 2011 12.5 mg (am) and 10 mg (pm) of prednisolone was added, stop pepcid, denosyl
Jan 31 eating on own, stop all meds but pred. Feb 3 feeding tube removed because vomited up but cat gaining weight and eating well.
March 10 - vomiting about weekly - add in Metronidazole 50 mg BID, lactulose 2 ml BID, Pred at 10 mg BID and start Purina EN canned diet.
March 24 - vomiting about every 2 weeks, appetite good. Pred decreased to 7.5 mg BID x 2 weeks then 5 mg BID, Metro decreased to 50 mg SID, lactulose as needed.
April 29 - doing very well, weight increasing maintaining on Pred 5 mg BID, Metronidazole 50 mg SID, Lactulose 2 ml am and 1 ml pm, diet EN. Tried to decrease pred to 5 mg SID - vomiting multiple times a day - increase back to 5 BID.
June 9 - decreased BM, firm - increase Metronidazole to 50 mg BID, increase lactulose to 3 ml BID
Aug - Tired to decrease pred to 5 mg am and 2.5 mg pm, Metronidazole at 50 mg SID - resulted in vomiting and constipation.
Sept 14 - doing great no vomiting 19 days. Metro and Pred BID, lactulose 2 ml BID
Nov 23 - constipation, added in Vit B12 injections 250 mcg weekly x 6 weeks
Dec 2011 - annual exam 5.7 kg, doing well, all meds same as Sept but laxatone BID as well
Aug 2012 - constipated. Meds = pred 5 mg BID, Metronidazole 50 mg BID, Vit B12 q 2 weeks, Lactulose had been stopped, diet EN with water added. Owners did no additional treatment, constipation resolved.
Jan 2, 2013 - Annual exam 5 kg (BCS 2.5/5) Had done well past year, eating good, decreased vomiting and constipation. Meds = Pred 5 mg BID, Metronidazole 50 mg BID, Vit B12 250 mcg q 6 weeks, 50 ml water added to food BID, Vaseline 2-3 tsp/ day (owners added this on own).
Ran routine bloods b/c been 2 years and long term pred, plus wt loss.
Normal except Glucose 15.6 (4-8 mmol/L), ALP 77 (0-62) IU/L
Added on frucotsamine - 375 (191-349 umol/L)
Sorry for the long run on history but thought important to understand every time we try to lower meds this cat gets worse again. I am worried this is early diabetes. Is this a correct assumption? Is there anything else I can do to confirm? A u/a has not been done. And if I am right to assume diabetes how will the long term pred effect this? Plumbs has pred as a negative drug interaction with insulin. We can't lower the pred without causing vomiting but pred not great with diabetes. EN is also the only diet he will eat or eat and not vomit on. I have not been the vet on this case from the start so I am not too sure where to go or what to do now. Owners are concerned about cost as well.
Thanks in advance for your help! | Has the cobalamin been checked on this kitty recently? | Absolutely sure she's spayed? |
Hi there
I have a 6 year old BSH neutred male cat , long term diabetic , stable for last 2 years on Insuline Lente bid .Recently presented in hypoglyceamic coma and seizuring after maldosing of insulin with cat sitter.The cat has no ketones in urine, all bloods were completely normal with exception of glucose.Electrolytes showed mild hypokaleamia. Cat has been stabilized with boluses of Dextrose iv, continuous IVFT enriched of Glucose and Potassium.The seizures has been settled with combination of Diazepam and Propofol. Despite the normoglyceamia(or slight hyperglyceamia) and correction of eletrolyte dysbalance the cat remains in semicomatous state with massive facial twitching and ocassional seizures unable to stand up for passed 36 hours. Is there a possibility of nerological damage based on dysbalance of glucose metabolism or alternatively could the hypoglyceamia triggered some seisure activity that is now indipendent on Glucose level? The cat is syringe fed and kept on small amount of insulin to keep normoglyceamia.
Thank you very much for any suggestions | Are the patient's pupils mydriatic or miotic? | Have you done chest radiographs? |
Hi there
I have a 6 year old BSH neutred male cat , long term diabetic , stable for last 2 years on Insuline Lente bid .Recently presented in hypoglyceamic coma and seizuring after maldosing of insulin with cat sitter.The cat has no ketones in urine, all bloods were completely normal with exception of glucose.Electrolytes showed mild hypokaleamia. Cat has been stabilized with boluses of Dextrose iv, continuous IVFT enriched of Glucose and Potassium.The seizures has been settled with combination of Diazepam and Propofol. Despite the normoglyceamia(or slight hyperglyceamia) and correction of eletrolyte dysbalance the cat remains in semicomatous state with massive facial twitching and ocassional seizures unable to stand up for passed 36 hours. Is there a possibility of nerological damage based on dysbalance of glucose metabolism or alternatively could the hypoglyceamia triggered some seisure activity that is now indipendent on Glucose level? The cat is syringe fed and kept on small amount of insulin to keep normoglyceamia.
Thank you very much for any suggestions | What is the current potassium value for this patient? | Should i try to repair this if i anesthetize him again for biopsy? |
Well, I feel like I'm getting a crash course in schnauzers and diabetes :(. Treating a 4.5 yo MN miniature schnauzer, 7.5kg. Diagnosed with diabetes about two months ago, and having some trouble getting his insulin dose worked out (now my recent vin searches are suggesting I should have anticipated this going in!). Started at 4U caninsulin BID, which resolved some of his clinical signs (got his energy back, but still PU/PD), but glucose curve showed almost no change. Several dose adjustments later (I've been going 1U at a time and rechecking curve after one week, with consistently disappointing results), he is at 7U BID and curve today (done by owners at home- they are running out of funds and the dog is very anxious at the clinic) looks like this:
9am (pre insulin)- 20.3mmol/L (365.4mg/dl for you americans)
Insulin given at 9 with breakfast
10am- 24.1 (433.8)
12pm- 17.1 (307.8)
2pm- 21.8 (392.4)
4pm- 9.9 (but owners caution that they are not sure if this is accurate, they had difficulty collecting this sample)
6pm- 28.4 (511.2)
Getting his evening insulin dose at 9- owners will call me in the morning to tell me his BG at this point
Turns out the dog is not much of a breakfast eater. He has been picking a little at his food through the day, then eats a full meal around 5pm (owners only explained this today, despite multiple conversations about his meal schedule, but at least I know now!)
Clinically, he is doing better. Seems to still be slightly polyuric (owners feel he goes out more often, but no longer having accidents in the house), very energetic, no ketonuria. We have done a CBC and chemistry, which were normal except for moderately elevated ALP and fairly high cholesterol (can't remember the values, but nearly double the normal!). Urine cultured negative, fasting triglycerides came back normal (!).
Big Questions are:
-If that 4pm blood glucose is spurious, and the low point of his curve is at 12pm and only 17 mmol/L (306), do I keep upping his dose, or do we need to look at switching insulins at this point?
-I would like the owners to repeat the curve given that one weird number, but they have trouble getting blood at home. Have tried the ear and the carpal pad, but he doesn't like to bleed. Is there an easier place they could try? (They are financially at their limits, in-house curves are becoming a hard sell)
-Should I be concerned about that high cholesterol and switch him to a low fat diet regardless of the normal triglycerides?
-Should I be altering his dosing schedule to accommodate his eating habits? The owners are offering him breakfast but he has no interest in eating until the evening.
-Should I be suspecting cushings with the breed/ high cholesterol/ high ALKP?
Of course, yesterday he suddenly developed awful cataracts in both eyes. Starting topical diclofenac given rapid onset- does this seem reasonable? Best part is the owners were on the brink of euthanizing at his initial diagnosis and I convinced them to give him a chance. Naturally he's not cooperating with my big plan to fix him easily (obviously my previous diabetics were not schnauzers).
Apologies for the string of questions- I'm a relatively new grad, and my other diabetics have been very straightforward! | What brand do these owners have? | Is there other evidence of chronic primary renal failure like anemia? |
Well, I feel like I'm getting a crash course in schnauzers and diabetes :(. Treating a 4.5 yo MN miniature schnauzer, 7.5kg. Diagnosed with diabetes about two months ago, and having some trouble getting his insulin dose worked out (now my recent vin searches are suggesting I should have anticipated this going in!). Started at 4U caninsulin BID, which resolved some of his clinical signs (got his energy back, but still PU/PD), but glucose curve showed almost no change. Several dose adjustments later (I've been going 1U at a time and rechecking curve after one week, with consistently disappointing results), he is at 7U BID and curve today (done by owners at home- they are running out of funds and the dog is very anxious at the clinic) looks like this:
9am (pre insulin)- 20.3mmol/L (365.4mg/dl for you americans)
Insulin given at 9 with breakfast
10am- 24.1 (433.8)
12pm- 17.1 (307.8)
2pm- 21.8 (392.4)
4pm- 9.9 (but owners caution that they are not sure if this is accurate, they had difficulty collecting this sample)
6pm- 28.4 (511.2)
Getting his evening insulin dose at 9- owners will call me in the morning to tell me his BG at this point
Turns out the dog is not much of a breakfast eater. He has been picking a little at his food through the day, then eats a full meal around 5pm (owners only explained this today, despite multiple conversations about his meal schedule, but at least I know now!)
Clinically, he is doing better. Seems to still be slightly polyuric (owners feel he goes out more often, but no longer having accidents in the house), very energetic, no ketonuria. We have done a CBC and chemistry, which were normal except for moderately elevated ALP and fairly high cholesterol (can't remember the values, but nearly double the normal!). Urine cultured negative, fasting triglycerides came back normal (!).
Big Questions are:
-If that 4pm blood glucose is spurious, and the low point of his curve is at 12pm and only 17 mmol/L (306), do I keep upping his dose, or do we need to look at switching insulins at this point?
-I would like the owners to repeat the curve given that one weird number, but they have trouble getting blood at home. Have tried the ear and the carpal pad, but he doesn't like to bleed. Is there an easier place they could try? (They are financially at their limits, in-house curves are becoming a hard sell)
-Should I be concerned about that high cholesterol and switch him to a low fat diet regardless of the normal triglycerides?
-Should I be altering his dosing schedule to accommodate his eating habits? The owners are offering him breakfast but he has no interest in eating until the evening.
-Should I be suspecting cushings with the breed/ high cholesterol/ high ALKP?
Of course, yesterday he suddenly developed awful cataracts in both eyes. Starting topical diclofenac given rapid onset- does this seem reasonable? Best part is the owners were on the brink of euthanizing at his initial diagnosis and I convinced them to give him a chance. Naturally he's not cooperating with my big plan to fix him easily (obviously my previous diabetics were not schnauzers).
Apologies for the string of questions- I'm a relatively new grad, and my other diabetics have been very straightforward! | What was the number for the cholesterol level? | Did she have any labwork before the metacam? |
Well, I feel like I'm getting a crash course in schnauzers and diabetes :(. Treating a 4.5 yo MN miniature schnauzer, 7.5kg. Diagnosed with diabetes about two months ago, and having some trouble getting his insulin dose worked out (now my recent vin searches are suggesting I should have anticipated this going in!). Started at 4U caninsulin BID, which resolved some of his clinical signs (got his energy back, but still PU/PD), but glucose curve showed almost no change. Several dose adjustments later (I've been going 1U at a time and rechecking curve after one week, with consistently disappointing results), he is at 7U BID and curve today (done by owners at home- they are running out of funds and the dog is very anxious at the clinic) looks like this:
9am (pre insulin)- 20.3mmol/L (365.4mg/dl for you americans)
Insulin given at 9 with breakfast
10am- 24.1 (433.8)
12pm- 17.1 (307.8)
2pm- 21.8 (392.4)
4pm- 9.9 (but owners caution that they are not sure if this is accurate, they had difficulty collecting this sample)
6pm- 28.4 (511.2)
Getting his evening insulin dose at 9- owners will call me in the morning to tell me his BG at this point
Turns out the dog is not much of a breakfast eater. He has been picking a little at his food through the day, then eats a full meal around 5pm (owners only explained this today, despite multiple conversations about his meal schedule, but at least I know now!)
Clinically, he is doing better. Seems to still be slightly polyuric (owners feel he goes out more often, but no longer having accidents in the house), very energetic, no ketonuria. We have done a CBC and chemistry, which were normal except for moderately elevated ALP and fairly high cholesterol (can't remember the values, but nearly double the normal!). Urine cultured negative, fasting triglycerides came back normal (!).
Big Questions are:
-If that 4pm blood glucose is spurious, and the low point of his curve is at 12pm and only 17 mmol/L (306), do I keep upping his dose, or do we need to look at switching insulins at this point?
-I would like the owners to repeat the curve given that one weird number, but they have trouble getting blood at home. Have tried the ear and the carpal pad, but he doesn't like to bleed. Is there an easier place they could try? (They are financially at their limits, in-house curves are becoming a hard sell)
-Should I be concerned about that high cholesterol and switch him to a low fat diet regardless of the normal triglycerides?
-Should I be altering his dosing schedule to accommodate his eating habits? The owners are offering him breakfast but he has no interest in eating until the evening.
-Should I be suspecting cushings with the breed/ high cholesterol/ high ALKP?
Of course, yesterday he suddenly developed awful cataracts in both eyes. Starting topical diclofenac given rapid onset- does this seem reasonable? Best part is the owners were on the brink of euthanizing at his initial diagnosis and I convinced them to give him a chance. Naturally he's not cooperating with my big plan to fix him easily (obviously my previous diabetics were not schnauzers).
Apologies for the string of questions- I'm a relatively new grad, and my other diabetics have been very straightforward! | Was it run after a 12 hour fast? | What's the blood pressure? |
Help! I have a new patient here and need help in terms of where to start with treating this cat. This cat is a female spayed, 12-year-old DSH. She presented to my associate 1/8/13 for constipation. The cat was depressed, dehydrated and very constipated. The cat has been diabetic for about 5 years per owner, and owner states that her prior vet was not very interested in helping them with the cat, so they had basically been doing it on their own with home-monitoring of the glucose, etc. Long story short, the cat is now on 21 units of Humulin N BID!!! The morning of 1/8/13, the cat did not eat, so they "only" gave her 5 units. They got a home BG of 481 at 8 am. My associate put the cat in the hospital on IV fluids and gave some enemas to help relieve the constipation issues. In the hospital we got a BG of 338 at 12:30 pm and 268 at 3:00. The owners did not want to leave her in the hospital overnight, so they took her home.
When I discussed the cat with the owner on the morning of 1/9/13, we were discussing the glucose monitoring and blood sugar levels. The owner mentioned that at one point in time, they had gone out of town for a couple of days and the cat had received no insulin during that time, and when they rechecked it when they got back, it was 300, yet when they give her 21 units of insulin (!!!) they will often get a reading of HI on their glucometer.
My feeling right now is that her body is so flooded with insulin that it is just not going to respond no matter how much is given. Should I have her stop the insulin all together and monitor her BG twice daily to look for a crash? Through the owner's research, she thinks the cat has acromegaly, but I just do not see chasing down zebras at this point if this is just a case of poor management.
I should also state that money is an issue--the owner complained that we charged her for checking the cat's glucose level when she was in the hospital--we checked it twice and only charged her for 1 check and she still complained. My feeling is that, with the cat being new to us, we need to step back and start fresh, but I'm just not sure how to back her down off the insulin--if we can do it quickly or if we need to wean her off. Any help you can give me would be appreciated. | What brand is this owner using? | Diabetic cats can be fed throughout the day, but the total amount should be measured and reasonable for a cat this size (well, not this size if 'biggie boy' is obese)...what does he weigh? |
My own dog, a 7 y.o, FS, Lhaso-Poo weighing 9 Kg recently went diabetic on me. Previous to diagnosing DM, I had been feeding her ROyal Canin Low Fat for 4 months as she had persistent hyperlipidemia, hypercholesteremia and hypertriglyceridemia with no improvement. Her most recent bloodwork (Dec 15, 2012) which revealed hyperglycaemia (24.3 mmol/L) and glucosuria (3+) with no bacterial growth on culture, also revealed the highest triglycerides she's ever had at 10.86 (0.12-1.6) mmol/L and cholesterol of 14.7 (3.0-9.9) mmol/L.
She stopped eating the Hill's W/D when giving her insulin (also stopped eating ROyal canon GI Low fat) so I have had to resort to Hill's i/d in the meantime to ensure she would eat. Having some difficulty regulating her on Caninsulin - have had to increase her 2 units so far since initiating treatment at 4.5 IU BID on Christmas day to now at 6.5 IU BID. Insulin not seeming to last long with her - perhaps about 6 hours after injection. BG values go up to 33 or higher prior to injection. Have ruled out UTI and Cushings.
I plan to start a homemade low fat diet, recommended and created by a pet nutritionist, Hilary Watson, in an attempt to lower her TG's and lipids but wonder if a higher fibre selection would be better for glucose regulating? | Were these fasting triglyceride and cholesterol levels? | Would these clients be willing to learn how to do at-home curves? |
My own dog, a 7 y.o, FS, Lhaso-Poo weighing 9 Kg recently went diabetic on me. Previous to diagnosing DM, I had been feeding her ROyal Canin Low Fat for 4 months as she had persistent hyperlipidemia, hypercholesteremia and hypertriglyceridemia with no improvement. Her most recent bloodwork (Dec 15, 2012) which revealed hyperglycaemia (24.3 mmol/L) and glucosuria (3+) with no bacterial growth on culture, also revealed the highest triglycerides she's ever had at 10.86 (0.12-1.6) mmol/L and cholesterol of 14.7 (3.0-9.9) mmol/L.
She stopped eating the Hill's W/D when giving her insulin (also stopped eating ROyal canon GI Low fat) so I have had to resort to Hill's i/d in the meantime to ensure she would eat. Having some difficulty regulating her on Caninsulin - have had to increase her 2 units so far since initiating treatment at 4.5 IU BID on Christmas day to now at 6.5 IU BID. Insulin not seeming to last long with her - perhaps about 6 hours after injection. BG values go up to 33 or higher prior to injection. Have ruled out UTI and Cushings.
I plan to start a homemade low fat diet, recommended and created by a pet nutritionist, Hilary Watson, in an attempt to lower her TG's and lipids but wonder if a higher fibre selection would be better for glucose regulating? | Bg values go up to 33 or higher prior to injection can i see some actual curves? | Any agglutination? |
My own dog, a 7 y.o, FS, Lhaso-Poo weighing 9 Kg recently went diabetic on me. Previous to diagnosing DM, I had been feeding her ROyal Canin Low Fat for 4 months as she had persistent hyperlipidemia, hypercholesteremia and hypertriglyceridemia with no improvement. Her most recent bloodwork (Dec 15, 2012) which revealed hyperglycaemia (24.3 mmol/L) and glucosuria (3+) with no bacterial growth on culture, also revealed the highest triglycerides she's ever had at 10.86 (0.12-1.6) mmol/L and cholesterol of 14.7 (3.0-9.9) mmol/L.
She stopped eating the Hill's W/D when giving her insulin (also stopped eating ROyal canon GI Low fat) so I have had to resort to Hill's i/d in the meantime to ensure she would eat. Having some difficulty regulating her on Caninsulin - have had to increase her 2 units so far since initiating treatment at 4.5 IU BID on Christmas day to now at 6.5 IU BID. Insulin not seeming to last long with her - perhaps about 6 hours after injection. BG values go up to 33 or higher prior to injection. Have ruled out UTI and Cushings.
I plan to start a homemade low fat diet, recommended and created by a pet nutritionist, Hilary Watson, in an attempt to lower her TG's and lipids but wonder if a higher fibre selection would be better for glucose regulating? | She's had a urine culture to rule out uti or just looking at the urine sediment? | Some owners aren't reconstituting it well, so are injecting mostly diluent when the bottle is new, then it keeps getting more and more potent as you get deeper into the bottle...could this be happening? |
I have a client who is, shall we say, challenging. Her dog has significant cardiomegaly and a persistent cough. No free pleural fluid on rads. The patient is a very well controlled Addisonian as well. I dispensed benazapril and lasix to start while trying to convince her to see a cardiologist. Instead, she has consulted Dr. Google and informed me that based on her 'research' she feels the two drugs are a poor combination and she has only started the benazapril (which she reports is indeed making the dog urinate more). :) So I told her that I would consult the powers that be about this drug combination. Frankly, I'm hard pressed to remember any case with severe cardiac disease that did not require both of these (or similar) drugs but I will defer to the experts here. I'm also wondering if it's safe to try Vetmedin if I can't get her to pursue the badly needed echo. Thanks! | However, the question is - does this dog have chf? | Canned or dry? |
I have a client with a 10 yr old FS Sheltie that I just diagnosed with PDH. She is having overt signs - with PUPD, recurrent pyoderma. Normally I would not even consider using Anipryl any more, but the client has some mental impairments - has trouble understanding things and some trouble following directions. Most simple conversations with her take 45 minutes. I am concerned putting the dog on a stronger drug like trilostane for fear of a hypoadrenocortical crisis. I am used to using mitotane for PDH and havent used trilostane yet. I have used Anipryl in the past with limited success. Is the risk of inducing Addisons with trilostane very high? Would it be better to try Anipryl first?
Thanks | Is this an owner that will comply with coming in? | Where is this owner getting the samples? |
I have a client with a 10 yr old FS Sheltie that I just diagnosed with PDH. She is having overt signs - with PUPD, recurrent pyoderma. Normally I would not even consider using Anipryl any more, but the client has some mental impairments - has trouble understanding things and some trouble following directions. Most simple conversations with her take 45 minutes. I am concerned putting the dog on a stronger drug like trilostane for fear of a hypoadrenocortical crisis. I am used to using mitotane for PDH and havent used trilostane yet. I have used Anipryl in the past with limited success. Is the risk of inducing Addisons with trilostane very high? Would it be better to try Anipryl first?
Thanks | She may not know why she's there, but will be there? | What's her recent fasting triglyceride level? |
Hi everyone! I have a "problem child" I could use some advice on. Precious is a 10 yo, FS DSH weighing 16.4#, diabetic since March 2012, curtly on 1 unit of glargine BID. She has a few issues, one being her ravenous appetite. I would love for her to lose weight, she probably should be more like a 12# cat, but her insatiability is driving her owner crazy. She's feeding M/D canned, 1 can/day (which I calculate to be quite a bit less than her RER) and cucumbers as treats. Precious will eat cucumbers until she dies if we let her! She has lost a little more than a pound over the past year. Just wondering what the consensus is on diets and weight mgmt in diabetics.
Problem number two I'll cross post to derm, but it's her hair loss. She never regrew hair from a cystotomy in 2010! Now, she's losing hair between the shoulder blades. She is not pulling it out. I will attach a picture. I did a UPC on her within the last week or so that was 13. I was concerned Cushing's could have explained her appetite/hair loss/poor regrowth.
Problem number three is she was seen by a colleague for periods of acute respiratory distress at home in October. She would have periods of tachypnea, open mouth breathing and was lethargic Long story short, chest rads gave no cause, there was no response to Orbax, a cardiac BNP/Echo/HWT were normal, and due to lack of finances, we tried flovent and terbutaline, which she's been on since Nov 2012. Her respiratory rate and pattern have improved, but at times her rate is still increased.
Any thoughts/questions/concerns are appreciated!
☼ | Is she well controlled? | What is happening with the blood glucose since you started the regular insulin? |
Hi everyone! I have a "problem child" I could use some advice on. Precious is a 10 yo, FS DSH weighing 16.4#, diabetic since March 2012, curtly on 1 unit of glargine BID. She has a few issues, one being her ravenous appetite. I would love for her to lose weight, she probably should be more like a 12# cat, but her insatiability is driving her owner crazy. She's feeding M/D canned, 1 can/day (which I calculate to be quite a bit less than her RER) and cucumbers as treats. Precious will eat cucumbers until she dies if we let her! She has lost a little more than a pound over the past year. Just wondering what the consensus is on diets and weight mgmt in diabetics.
Problem number two I'll cross post to derm, but it's her hair loss. She never regrew hair from a cystotomy in 2010! Now, she's losing hair between the shoulder blades. She is not pulling it out. I will attach a picture. I did a UPC on her within the last week or so that was 13. I was concerned Cushing's could have explained her appetite/hair loss/poor regrowth.
Problem number three is she was seen by a colleague for periods of acute respiratory distress at home in October. She would have periods of tachypnea, open mouth breathing and was lethargic Long story short, chest rads gave no cause, there was no response to Orbax, a cardiac BNP/Echo/HWT were normal, and due to lack of finances, we tried flovent and terbutaline, which she's been on since Nov 2012. Her respiratory rate and pattern have improved, but at times her rate is still increased.
Any thoughts/questions/concerns are appreciated!
☼ | Did you mean a cortisol/creatinine ratio? | What should he weigh? |
Hi everyone! I have a "problem child" I could use some advice on. Precious is a 10 yo, FS DSH weighing 16.4#, diabetic since March 2012, curtly on 1 unit of glargine BID. She has a few issues, one being her ravenous appetite. I would love for her to lose weight, she probably should be more like a 12# cat, but her insatiability is driving her owner crazy. She's feeding M/D canned, 1 can/day (which I calculate to be quite a bit less than her RER) and cucumbers as treats. Precious will eat cucumbers until she dies if we let her! She has lost a little more than a pound over the past year. Just wondering what the consensus is on diets and weight mgmt in diabetics.
Problem number two I'll cross post to derm, but it's her hair loss. She never regrew hair from a cystotomy in 2010! Now, she's losing hair between the shoulder blades. She is not pulling it out. I will attach a picture. I did a UPC on her within the last week or so that was 13. I was concerned Cushing's could have explained her appetite/hair loss/poor regrowth.
Problem number three is she was seen by a colleague for periods of acute respiratory distress at home in October. She would have periods of tachypnea, open mouth breathing and was lethargic Long story short, chest rads gave no cause, there was no response to Orbax, a cardiac BNP/Echo/HWT were normal, and due to lack of finances, we tried flovent and terbutaline, which she's been on since Nov 2012. Her respiratory rate and pattern have improved, but at times her rate is still increased.
Any thoughts/questions/concerns are appreciated!
☼ | Have you checked a tt4 lately? | Has this patient lost weight during the time you have been seeing him? |
Hello and thanks for being there --
I am in need of help on this case, as you will see when you read about Bruce. I am currently debating which if any tests to run or if I should just refer him on to referral care for further work up. Please let me know what you think.
Bruce is 6 year old 12# Brussels/Bichon mix who has had a number of significant plems/concerns over the years. His medical history includes: patellar luxation with occasional lameness/discomfort (not current), anxiety and aggression (chronic), pancreatitis (not current as far as we know), more recently suspected IVDD (back pain and ataxia), diabetes with ketonuria. His current meds are alprazolam daily, acepromazine over the last week (2 or 3 doses at night), dasuquin, nph insulin 3 units bid.
Bruce has always had generalized anxiety (fearful of noises, doesn't like to walk due to nervous about seeing people or other animals, and just about any new situation although often seems nervous at home for no reason the owners can determine, episodes of excessive grooming of penis/prepuce and other manifestations), he is also has related fear aggression though tends to be pretty handleable here (always muzzled) as he will become passive. He has bit owners at home. He has been on several anti-anxiety meds over the years though for last year owners have used alprazolam only as nothing else seemed to help. Last few days we have used acepromazine to try to help him relax at night as owners have been unwell and can't be up at night with him if he gets anxious or stressed. The ace doesn't help much (5-7 mg once at night for a couple of doses over the last 2-3 days). He had had back pain and mild related ataxia starting a few months ago which was managed with pred, diazepam and tramadol; his back pain seems much improved, possible due to recent weight loss, and is not a currently active plem. We have had him weaned off those meds for over a month but 2 months ago (while on pred) he became diabetic with sig. glucosuria and mild ketonuria. He is currently on 3 units bid but has never seemed well controlled and last curve on 1/3 showed glucoses in the 400s and mild ketones despite being on insulin bid for over a month.
CURRENT concerns:
Bruce continues to have persistent pu/pd, accidents in the house, worsened anxiety (pacing, barking, not sleeping or resting well) and owners are recovering from the flu and are at their wits end. No vomiting, has been eating well until today. I asked them to bring him in today to look for concurrent disease resulting in inability to regulate his diabetes, especially with his history of pancreatitis. A urine stick shows ++ glucose, ++ ketones. Sediment shows no wbc and a urine culture completed last week was negative. We had him on amoxi during the period we were waiting for urine culture and kept him on total of 7 days; he has been off amoxi for 3-4 days. His blood glucose, which has always been high, today is 130 and a canine pli is negative. His weight is at an all time low of 11.6# (he usually ranges from 13-14# but has been consistently losing weight since his diabetes diagnosis). Owners usually report he eats voraciously, hasn't been vomiting. Owner notes just this morning he did not eat at all which is very unusual for him. He never eats, drinks here at the clinic and rarely urinates (sits in one spot and trembles). He does like me and we sit together a bit to decrease his stress here. Temperature is 102.6 which is almost as low as it ever is here as I think he trembles enough to bump it to 103 most of the time we check it in the hospital (and he's here a lot).
I gave him 1 mg butorphanol just in case as he is so hard to read (heart rate is always pounding while he's here), started him on IV fluids to try to get his ketones down, tested canine pli which was negative. I am debating between running more labs or just encouraging a referral to include labs plus possible ultrasound to look for abdominal plems. He had one a couple of years ago during a bout of pancreatitis which supported lab findings of that disease at that time. I know about Somogyi but he has never seemed well regulated (always pu/pd), always had high glucoses on several curves over 2 months except today and has been consistently losing weight. Again, current insulin dose 3 u nph bid which owner is sure she is getting in, refrigerating, etc.
Anything I should think of before moving him on? I plan to try to get a chance to talk to our referral vets too as they are very helpful to us here.
Thank you! I am going to try to cross post to endocrinology as well --
☼ | Has his insulin dose been adjusted with his curved being high? | I would be concerned about arf, is she producing urine - did you recheck the bun/cr? |
I have an obese diabetic cat that is now in remission. He has been on Purina DM for a while and is no longer diabetic but definitely on a positive weight gain trend. Has anybody use the new formulation of the RC diabetic diet and had them lose weight?
/p DVM | Canned dm? | Can you remove the affected tissue w/o removing the toe? |
I have an obese diabetic cat that is now in remission. He has been on Purina DM for a while and is no longer diabetic but definitely on a positive weight gain trend. Has anybody use the new formulation of the RC diabetic diet and had them lose weight?
/p DVM | Can you not just reduce the volume fed? | Any other suggestions? |
Pharmacy boards urge veterinars to file complaints
By ☼ | Really? | Do you have chest rads? |
Pharmacy boards urge veterinars to file complaints
By ☼ | Do you derive this knowledge from human medicine? | What's the phosphorus level? |
"Charcoal" is a 9yr old MN DSH that was presented to our hospital for a COHAT and tooth extractions due to resorptive lesions. He had otherwise been well at home with no symptoms of pu/pd, v/d, constipation or weight loss. He lives in a multi-cat household and is strictly indoor. The diet in the household consists of a combination or Hills W/d and C/d.
On routine blood screen, an elevated Calcium 2.77 mmol (2.05-2.7) was detected. No other abnormalities were seen. We checked the Ca2+ level about 1 1/2 months later. It was a fasted sample and the value was 2.79.
An ionized calcium and PTH was then run:
Ionized Ca2+ 1.55 (1.16-1.34)
PTH 0.3 (0.0- 3.8)
I did not run a PTHRP test as to me it would have added to the costs of already expensive tests and we still would have been concerned about the possibility of neoplasia whether it was postive or negative - best to invest in diagnostics such as chest rads and ultrasound.
At this stage it appears that primary hyperparathyroidism is ruled out and the diet is balanced and should be not excessive in Ca2+ or Vitamin D. There are no other supplements or meds that he is getting in to or could be exposed to in the hosuehold.
The owner just informed me that Charcoal may be having urine accidents in the house. My plan would be to get a urine sampl via cystocentesis and screen for a possible UTI and/or calcium oxaltae crystals (u/a and culture). We also have the pet booked for 3 view chest rads and full abdominal ultrasound as a cancer screen but also to check for renoliths and uroliths.
If the cancer screen is negative, I know we can not 100% rule out neoplasia as it may be present but just not detectable yet, but at this point my plan would be to assume a diagnosis of Idiopathic Hypercalcemia and start Charcoal on meds to try in lower the calcium levels in order to prevent the toxic effects of calcuim and stone formation.
Meds discussed have been prednisone and Fosamax -each with their pros and cons of course. The plan would be to monitor via ionized calcium testing.
My questions are: Does this seem like an acceptable course of action for this pet? Understandbly, costs to perform the above do add up and now we have a second cat in the household that appears to have elevated calcium on routine testing and we may be heading down the same route.
Do you have a preference of prednisone over Fosamax at this stage?
Thanks for your help - its always appreciated.
☼ | How was his phosphorous level, by the way? | How many calories are in a cup of w/d? |
"Charcoal" is a 9yr old MN DSH that was presented to our hospital for a COHAT and tooth extractions due to resorptive lesions. He had otherwise been well at home with no symptoms of pu/pd, v/d, constipation or weight loss. He lives in a multi-cat household and is strictly indoor. The diet in the household consists of a combination or Hills W/d and C/d.
On routine blood screen, an elevated Calcium 2.77 mmol (2.05-2.7) was detected. No other abnormalities were seen. We checked the Ca2+ level about 1 1/2 months later. It was a fasted sample and the value was 2.79.
An ionized calcium and PTH was then run:
Ionized Ca2+ 1.55 (1.16-1.34)
PTH 0.3 (0.0- 3.8)
I did not run a PTHRP test as to me it would have added to the costs of already expensive tests and we still would have been concerned about the possibility of neoplasia whether it was postive or negative - best to invest in diagnostics such as chest rads and ultrasound.
At this stage it appears that primary hyperparathyroidism is ruled out and the diet is balanced and should be not excessive in Ca2+ or Vitamin D. There are no other supplements or meds that he is getting in to or could be exposed to in the hosuehold.
The owner just informed me that Charcoal may be having urine accidents in the house. My plan would be to get a urine sampl via cystocentesis and screen for a possible UTI and/or calcium oxaltae crystals (u/a and culture). We also have the pet booked for 3 view chest rads and full abdominal ultrasound as a cancer screen but also to check for renoliths and uroliths.
If the cancer screen is negative, I know we can not 100% rule out neoplasia as it may be present but just not detectable yet, but at this point my plan would be to assume a diagnosis of Idiopathic Hypercalcemia and start Charcoal on meds to try in lower the calcium levels in order to prevent the toxic effects of calcuim and stone formation.
Meds discussed have been prednisone and Fosamax -each with their pros and cons of course. The plan would be to monitor via ionized calcium testing.
My questions are: Does this seem like an acceptable course of action for this pet? Understandbly, costs to perform the above do add up and now we have a second cat in the household that appears to have elevated calcium on routine testing and we may be heading down the same route.
Do you have a preference of prednisone over Fosamax at this stage?
Thanks for your help - its always appreciated.
☼ | Is he eating canned or dry c/d and w/d? | Does abby receive any medications, including phenobarbital or glucocorticoids? |
Hi. I am interested to hear thoughts on whether offering an abdominal u/s as either part of a senior profile package or as a free standing senior service makes sense? My thought is to offer this service at a reduced fee. Basically scing the abdomen to look for masses, especially spleen/liver/adrenals/bladder. I am aware of the argument that if there are no clinical signs and there is a suspicion of an abnormality, that this may result in unwanted procedures (FNAs, biopsies, etc.). However, it would be nice to find a splenic mass before it ruptures, especially if it is benign. Recently I had a client who requested us to have her 14 yr old Dachshund sced (both echo and abd). Since we don't do echos, we called in a radiologist. The heart was fine. However, there was a rather large (1.5 mm) adrenal mass on the right side (next to, but not invading the vena cava). We are now working this dog up for cush vs. pheo. We are NOT a practice that pushes unnecessary procedures as a cash extraction. I think long and hard before I offer anything of this nature. Seems to me that if I can pick up on a serious, correctable plem in even 1% of the cases, it may be justified. We would just have to be restrained in pursuing further diagnostics in those gray area cases. Thoughts? HM | Another question is - where do you draw the line? | Did you get a cytology on the transudate? |
Hi. I am interested to hear thoughts on whether offering an abdominal u/s as either part of a senior profile package or as a free standing senior service makes sense? My thought is to offer this service at a reduced fee. Basically scing the abdomen to look for masses, especially spleen/liver/adrenals/bladder. I am aware of the argument that if there are no clinical signs and there is a suspicion of an abnormality, that this may result in unwanted procedures (FNAs, biopsies, etc.). However, it would be nice to find a splenic mass before it ruptures, especially if it is benign. Recently I had a client who requested us to have her 14 yr old Dachshund sced (both echo and abd). Since we don't do echos, we called in a radiologist. The heart was fine. However, there was a rather large (1.5 mm) adrenal mass on the right side (next to, but not invading the vena cava). We are now working this dog up for cush vs. pheo. We are NOT a practice that pushes unnecessary procedures as a cash extraction. I think long and hard before I offer anything of this nature. Seems to me that if I can pick up on a serious, correctable plem in even 1% of the cases, it may be justified. We would just have to be restrained in pursuing further diagnostics in those gray area cases. Thoughts? HM | Why not radiographs on every patient? | Also, could you give the owner link to owners of insulin treated pets? |
Hi. I am interested to hear thoughts on whether offering an abdominal u/s as either part of a senior profile package or as a free standing senior service makes sense? My thought is to offer this service at a reduced fee. Basically scing the abdomen to look for masses, especially spleen/liver/adrenals/bladder. I am aware of the argument that if there are no clinical signs and there is a suspicion of an abnormality, that this may result in unwanted procedures (FNAs, biopsies, etc.). However, it would be nice to find a splenic mass before it ruptures, especially if it is benign. Recently I had a client who requested us to have her 14 yr old Dachshund sced (both echo and abd). Since we don't do echos, we called in a radiologist. The heart was fine. However, there was a rather large (1.5 mm) adrenal mass on the right side (next to, but not invading the vena cava). We are now working this dog up for cush vs. pheo. We are NOT a practice that pushes unnecessary procedures as a cash extraction. I think long and hard before I offer anything of this nature. Seems to me that if I can pick up on a serious, correctable plem in even 1% of the cases, it may be justified. We would just have to be restrained in pursuing further diagnostics in those gray area cases. Thoughts? HM | Why not a ct scan, or an mri? | Usually need furosemide to contol this? |
Roxy is a 9 year old FS Rottweiler (92lbs) that I daignosed several weeks ago with diabetes and started on 20 units of Novalin N bid. Injections are given at 6am and she is feed Blue Buffalo reduced calorie. Clinically she is doing well....especially the PU/PD is normal per owner. The first curve looked pretty good to me and since it was the first one after starting the insulin I had the owner keep the initial dose and I curved her 2 weeks later. Not sure what to think. There was no treats or food given during the day while the curve was goin on. Casn you comment on the curves. Thanks,
12/27
8am 309
11am 275
2pm 263
5pm 152
1/10
8am 340
11am 381
2pm 338
5pm 353 | It sounds like the curve was done in the hospital, not at home, right? | Would this suffice to screen/diagnose/grade kidney problems? |
Roxy is a 9 year old FS Rottweiler (92lbs) that I daignosed several weeks ago with diabetes and started on 20 units of Novalin N bid. Injections are given at 6am and she is feed Blue Buffalo reduced calorie. Clinically she is doing well....especially the PU/PD is normal per owner. The first curve looked pretty good to me and since it was the first one after starting the insulin I had the owner keep the initial dose and I curved her 2 weeks later. Not sure what to think. There was no treats or food given during the day while the curve was goin on. Casn you comment on the curves. Thanks,
12/27
8am 309
11am 275
2pm 263
5pm 152
1/10
8am 340
11am 381
2pm 338
5pm 353 | Is the owner feeding the same amount of food? | I'm a little confused about when he normally gets the am and pm food/insulin? |
Roxy is a 9 year old FS Rottweiler (92lbs) that I daignosed several weeks ago with diabetes and started on 20 units of Novalin N bid. Injections are given at 6am and she is feed Blue Buffalo reduced calorie. Clinically she is doing well....especially the PU/PD is normal per owner. The first curve looked pretty good to me and since it was the first one after starting the insulin I had the owner keep the initial dose and I curved her 2 weeks later. Not sure what to think. There was no treats or food given during the day while the curve was goin on. Casn you comment on the curves. Thanks,
12/27
8am 309
11am 275
2pm 263
5pm 152
1/10
8am 340
11am 381
2pm 338
5pm 353 | Measuring it? | Is the cat on good flea control? |
Roxy is a 9 year old FS Rottweiler (92lbs) that I daignosed several weeks ago with diabetes and started on 20 units of Novalin N bid. Injections are given at 6am and she is feed Blue Buffalo reduced calorie. Clinically she is doing well....especially the PU/PD is normal per owner. The first curve looked pretty good to me and since it was the first one after starting the insulin I had the owner keep the initial dose and I curved her 2 weeks later. Not sure what to think. There was no treats or food given during the day while the curve was goin on. Casn you comment on the curves. Thanks,
12/27
8am 309
11am 275
2pm 263
5pm 152
1/10
8am 340
11am 381
2pm 338
5pm 353 | Is it a reasonable amount for a dog this size? | What drugs are you most comfortable with?in other wors, what drugs were you thinking of using? |
Roxy is a 9 year old FS Rottweiler (92lbs) that I daignosed several weeks ago with diabetes and started on 20 units of Novalin N bid. Injections are given at 6am and she is feed Blue Buffalo reduced calorie. Clinically she is doing well....especially the PU/PD is normal per owner. The first curve looked pretty good to me and since it was the first one after starting the insulin I had the owner keep the initial dose and I curved her 2 weeks later. Not sure what to think. There was no treats or food given during the day while the curve was goin on. Casn you comment on the curves. Thanks,
12/27
8am 309
11am 275
2pm 263
5pm 152
1/10
8am 340
11am 381
2pm 338
5pm 353 | Can the owner accurately draw up and then inject the insulin? | Could you post the pre and post-lasix thoracic radiographs? |
Roxy is a 9 year old FS Rottweiler (92lbs) that I daignosed several weeks ago with diabetes and started on 20 units of Novalin N bid. Injections are given at 6am and she is feed Blue Buffalo reduced calorie. Clinically she is doing well....especially the PU/PD is normal per owner. The first curve looked pretty good to me and since it was the first one after starting the insulin I had the owner keep the initial dose and I curved her 2 weeks later. Not sure what to think. There was no treats or food given during the day while the curve was goin on. Casn you comment on the curves. Thanks,
12/27
8am 309
11am 275
2pm 263
5pm 152
1/10
8am 340
11am 381
2pm 338
5pm 353 | Is the owner neither over-shaking nor under-shaking the insulin? | Vetsulin should be vigorously shaken the first time the bottle is opened, then shaken enough each time it's used so that it looks continuously milky...is this being done? |
Roxy is a 9 year old FS Rottweiler (92lbs) that I daignosed several weeks ago with diabetes and started on 20 units of Novalin N bid. Injections are given at 6am and she is feed Blue Buffalo reduced calorie. Clinically she is doing well....especially the PU/PD is normal per owner. The first curve looked pretty good to me and since it was the first one after starting the insulin I had the owner keep the initial dose and I curved her 2 weeks later. Not sure what to think. There was no treats or food given during the day while the curve was goin on. Casn you comment on the curves. Thanks,
12/27
8am 309
11am 275
2pm 263
5pm 152
1/10
8am 340
11am 381
2pm 338
5pm 353 | Absolutely sure she's spayed? | Is she on the canned version of a high protein/low carb diet? |
My patient is a ten year old Labrador Retriever who recently developed symptoms of PU/PD and is urinating in the garage at night. Senior profile blood work was unremarkable except elevations in Alk Phos and GGT. The owner and I discussed the possibility of Cushing's disease and decided to run a Urine Cortisol Creatinine Ratio as a screening test rather than an ACTH stim test due to the expense. The owner is unlikely to pursue treatment due to the cost of meds and monitoring. The ratio came back at 75 which is consistent with, but of course, not diagnostic for Cushings Disease. The client asked if the ratio level correlated with likelihood of Cushings and does it tell us anything about how long the pet had been affected and/or the severity of disease. I know many factors other than Cushings disease can effect the UCCR and was not sure how to answer his questions. Can we make any assumptions based on the urine cortisol creatinine ratio results?
Thank you,
☼ | Is this a spayed female? | How much should she weigh? |
Hi there. I have been treating a 12 year old neutered male Beagle cross for diabetes and cushings disease. He weighs 30kg and we started him on 12 units NPH insulin BID and Vetoryl 60mg SID Dec. 8th. His glucose last week was 13.9 mml/L (only one done on this day), and his ACTH stim done yesterday 4-6 hours after morning Vetoryl was 4.5ug/dl 0 hour and was 15.7 ug/dl 1 hour post synacthen. What would your recommendation be for increasing the Vetoryl and should I be monitoring blood glucose more closely as we get the Cushings more under control.
Thanks
☼ | Can you tell us more about the details of how the cushing's was diagnosed? | You mean conn's syndrome? |
Hi there. I have been treating a 12 year old neutered male Beagle cross for diabetes and cushings disease. He weighs 30kg and we started him on 12 units NPH insulin BID and Vetoryl 60mg SID Dec. 8th. His glucose last week was 13.9 mml/L (only one done on this day), and his ACTH stim done yesterday 4-6 hours after morning Vetoryl was 4.5ug/dl 0 hour and was 15.7 ug/dl 1 hour post synacthen. What would your recommendation be for increasing the Vetoryl and should I be monitoring blood glucose more closely as we get the Cushings more under control.
Thanks
☼ | It sounds like it was diagnosed at the sametime as the insulin was started? | Why don't you feel she is a good candate for sx biopsy? |
Hi there. I have been treating a 12 year old neutered male Beagle cross for diabetes and cushings disease. He weighs 30kg and we started him on 12 units NPH insulin BID and Vetoryl 60mg SID Dec. 8th. His glucose last week was 13.9 mml/L (only one done on this day), and his ACTH stim done yesterday 4-6 hours after morning Vetoryl was 4.5ug/dl 0 hour and was 15.7 ug/dl 1 hour post synacthen. What would your recommendation be for increasing the Vetoryl and should I be monitoring blood glucose more closely as we get the Cushings more under control.
Thanks
☼ | Is this the first acth stim that was done after the vetoryl was started? | Noooo snacks during the day? |
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