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Pooh is a 13 year-old DSH FS who presented three days ago for constipation and recent weight loss. She was examined by a colleague at the practice where I now locum. She was found to be about dehydrated, mildly icteric, and constipated. BP by Doppler 145 mm Hg, HR 124 without arrhythmia or murmur, RR 34 bpm, T 37.3 C. Xrays showed copious fecal pellets in colon, a food-filled stomach, and slightly small kidneys. She was given an enema which cleared her colon, a SC fluid bolus, and started on Denamarin awaiting lab results. Biochemistry of June 8th on blood collected before any fluid therapy or treatments: hemolysis normal icterus +++ lipemia normal glucose 5.4 (4.0 - 8.0) BUN 11.0 (5.0 - 12.0) creatinine 110 (71 - 203) BUN/Creat ratio 25.1 sodium 150 (147 - 156) potassium 5.0 (3.0 - 5.3) Na/K ratio 30 chloride 112 (111 - 125) bicarb 19 (13 - 25) anion gap (24.0 (12 - 26) calcium 2.71 (2.00 - 2.90) phosphorus 1.48 (1.00 - 2.40) total protein 74 (59 - 85) albumin 27 (23 =- 33) globulin 47 (27 - 51) A/G ratio 0.6 (0.5 - 1.3) total bilirubin 130 (0 - 7) HIGH DIRECT BILIRUBIN 84 (0 - 3) HIGH ALP 370 (0 - 62) HIGH ALT 881 (28 - 76) HIGH AST 199 (5 - 55) HIGH GGT 3 (0 - 6) CK 90 (64 - 440) amylase 1631 (463 - 1833) lipase 54 (10 - 195) cholesterol 7.77 (2 - 6) HIGH calc osmolality 305 (285 - 314) CBC: WBCs 19.9 (4.2 - 15.6) HIGH RBCs 7.5 (6 - 10) Hb 121 (95 - 150) HCT 39% (29 - 45) MCV 52.3 (41 - 58) MC Hb 16 (11 - 17.5) platelets adequate, clumped RDW 21.3 (10 - 26) % reticulocytes 17 retic. count 12.8 (3 - 50) neutrophils 74% 14.726 (2.5 - 12.5) HIGH lymphocytes 15% 2.985 (1.5 - 7.0) monocytes 3% 0.597 (0 - 0.85) eosinophils 8.0% 1.592 (0 - 1.5) HIGH basophils 0.0 No blood parasites found on slide Spec fPL 4.7 (0 - 3.5) Increased, but in gray zone TT4 66.8 (10 - 60) HIGH probably even higher when corrected for euthyroid sick effect Negative for both FIV and FLV on ELISA U/A on cysto sample: SpGr 1.026 pH 6.5 urobilinogen 3.2 (3.2 - 16) blood ++ urine bilirubin +++ glucose negative ketones negative protein 1+ large amt. of bacteria seen WBCs 0-3/HPF moderate amount of bilirubin crystals urine culture and sensitivity pending. Once the results were discussed with owners, the cat was admitted for in-hospital IV fluids, ampicillin and metidazole, an injection of hemostam, and started on methimazole PO. She has not vomited and has been drinking a lot on her own and eating an adequate amount of food. Today I saw her for readmission and the second day of IV fluids/antibiotics. She was markedly pale and icteric, markedly prolonged skin tent, normal heart and lung sounds, only 30 grams weight gain in 24 hours, abdomen soft and non-painful with no palpable abnormalities except for possibly thickened colon. The concerning finding was a marked drop in PCV from 43% yesterday morning to 31% this morning, with stable total protein (9.1 yesterday vs. 9.0 today). I started her on a conservative rate of IV fluids at 3ml/kg/hr and increased to 4.5ml/kg/hr after two hours, having decided that she can handle some more hemodilution in the face of overwhelming icterus and a UTI which could be a pyelonephritis. So my main concern at this point are devising adequate fluid therapy rate while being mindful of increasing anemia and now evidence of hemolysis. There was evidence of marked gross hemolysis in the hematocrit tube this morning (and no hemolysis noted when blood was first collected), and the difference in PCV between yesterday and today seems alarming given that the cat has gained hardly any weight (only 30 grams, which may be simple scale error). Since no blood parasites were seen, I am at a bit of a loss at to the cause of the gross hemolysis. I cannot rule out leukemia lurking in the bone marrow and not picked up on ELISA of peripheral blood. She has an inflammatory/infectious process (UTI and hepatopathy), but is that enough to cause immune-mediated hemolysis? Could it be a reaction to any of the medications? Speaking of medications, I would have used ampicillin in combination with baytril but will not change her protocol until urine C+S results are in. I'm also considering adding a series of cobalamin injections. The owner has declined abdominal U/S but may agree to a repeat biochemistry. Any suggestions as to the cause(s) of illness and treatment for the cat would be greatly appreciated.

Do we have a palpable thyroid slip?

What should he weigh?

Pooh is a 13 year-old DSH FS who presented three days ago for constipation and recent weight loss. She was examined by a colleague at the practice where I now locum. She was found to be about dehydrated, mildly icteric, and constipated. BP by Doppler 145 mm Hg, HR 124 without arrhythmia or murmur, RR 34 bpm, T 37.3 C. Xrays showed copious fecal pellets in colon, a food-filled stomach, and slightly small kidneys. She was given an enema which cleared her colon, a SC fluid bolus, and started on Denamarin awaiting lab results. Biochemistry of June 8th on blood collected before any fluid therapy or treatments: hemolysis normal icterus +++ lipemia normal glucose 5.4 (4.0 - 8.0) BUN 11.0 (5.0 - 12.0) creatinine 110 (71 - 203) BUN/Creat ratio 25.1 sodium 150 (147 - 156) potassium 5.0 (3.0 - 5.3) Na/K ratio 30 chloride 112 (111 - 125) bicarb 19 (13 - 25) anion gap (24.0 (12 - 26) calcium 2.71 (2.00 - 2.90) phosphorus 1.48 (1.00 - 2.40) total protein 74 (59 - 85) albumin 27 (23 =- 33) globulin 47 (27 - 51) A/G ratio 0.6 (0.5 - 1.3) total bilirubin 130 (0 - 7) HIGH DIRECT BILIRUBIN 84 (0 - 3) HIGH ALP 370 (0 - 62) HIGH ALT 881 (28 - 76) HIGH AST 199 (5 - 55) HIGH GGT 3 (0 - 6) CK 90 (64 - 440) amylase 1631 (463 - 1833) lipase 54 (10 - 195) cholesterol 7.77 (2 - 6) HIGH calc osmolality 305 (285 - 314) CBC: WBCs 19.9 (4.2 - 15.6) HIGH RBCs 7.5 (6 - 10) Hb 121 (95 - 150) HCT 39% (29 - 45) MCV 52.3 (41 - 58) MC Hb 16 (11 - 17.5) platelets adequate, clumped RDW 21.3 (10 - 26) % reticulocytes 17 retic. count 12.8 (3 - 50) neutrophils 74% 14.726 (2.5 - 12.5) HIGH lymphocytes 15% 2.985 (1.5 - 7.0) monocytes 3% 0.597 (0 - 0.85) eosinophils 8.0% 1.592 (0 - 1.5) HIGH basophils 0.0 No blood parasites found on slide Spec fPL 4.7 (0 - 3.5) Increased, but in gray zone TT4 66.8 (10 - 60) HIGH probably even higher when corrected for euthyroid sick effect Negative for both FIV and FLV on ELISA U/A on cysto sample: SpGr 1.026 pH 6.5 urobilinogen 3.2 (3.2 - 16) blood ++ urine bilirubin +++ glucose negative ketones negative protein 1+ large amt. of bacteria seen WBCs 0-3/HPF moderate amount of bilirubin crystals urine culture and sensitivity pending. Once the results were discussed with owners, the cat was admitted for in-hospital IV fluids, ampicillin and metidazole, an injection of hemostam, and started on methimazole PO. She has not vomited and has been drinking a lot on her own and eating an adequate amount of food. Today I saw her for readmission and the second day of IV fluids/antibiotics. She was markedly pale and icteric, markedly prolonged skin tent, normal heart and lung sounds, only 30 grams weight gain in 24 hours, abdomen soft and non-painful with no palpable abnormalities except for possibly thickened colon. The concerning finding was a marked drop in PCV from 43% yesterday morning to 31% this morning, with stable total protein (9.1 yesterday vs. 9.0 today). I started her on a conservative rate of IV fluids at 3ml/kg/hr and increased to 4.5ml/kg/hr after two hours, having decided that she can handle some more hemodilution in the face of overwhelming icterus and a UTI which could be a pyelonephritis. So my main concern at this point are devising adequate fluid therapy rate while being mindful of increasing anemia and now evidence of hemolysis. There was evidence of marked gross hemolysis in the hematocrit tube this morning (and no hemolysis noted when blood was first collected), and the difference in PCV between yesterday and today seems alarming given that the cat has gained hardly any weight (only 30 grams, which may be simple scale error). Since no blood parasites were seen, I am at a bit of a loss at to the cause of the gross hemolysis. I cannot rule out leukemia lurking in the bone marrow and not picked up on ELISA of peripheral blood. She has an inflammatory/infectious process (UTI and hepatopathy), but is that enough to cause immune-mediated hemolysis? Could it be a reaction to any of the medications? Speaking of medications, I would have used ampicillin in combination with baytril but will not change her protocol until urine C+S results are in. I'm also considering adding a series of cobalamin injections. The owner has declined abdominal U/S but may agree to a repeat biochemistry. Any suggestions as to the cause(s) of illness and treatment for the cat would be greatly appreciated.

What dose of methimazole did we start at?

Were biopsies taken during the surgery?

Pooh is a 13 year-old DSH FS who presented three days ago for constipation and recent weight loss. She was examined by a colleague at the practice where I now locum. She was found to be about dehydrated, mildly icteric, and constipated. BP by Doppler 145 mm Hg, HR 124 without arrhythmia or murmur, RR 34 bpm, T 37.3 C. Xrays showed copious fecal pellets in colon, a food-filled stomach, and slightly small kidneys. She was given an enema which cleared her colon, a SC fluid bolus, and started on Denamarin awaiting lab results. Biochemistry of June 8th on blood collected before any fluid therapy or treatments: hemolysis normal icterus +++ lipemia normal glucose 5.4 (4.0 - 8.0) BUN 11.0 (5.0 - 12.0) creatinine 110 (71 - 203) BUN/Creat ratio 25.1 sodium 150 (147 - 156) potassium 5.0 (3.0 - 5.3) Na/K ratio 30 chloride 112 (111 - 125) bicarb 19 (13 - 25) anion gap (24.0 (12 - 26) calcium 2.71 (2.00 - 2.90) phosphorus 1.48 (1.00 - 2.40) total protein 74 (59 - 85) albumin 27 (23 =- 33) globulin 47 (27 - 51) A/G ratio 0.6 (0.5 - 1.3) total bilirubin 130 (0 - 7) HIGH DIRECT BILIRUBIN 84 (0 - 3) HIGH ALP 370 (0 - 62) HIGH ALT 881 (28 - 76) HIGH AST 199 (5 - 55) HIGH GGT 3 (0 - 6) CK 90 (64 - 440) amylase 1631 (463 - 1833) lipase 54 (10 - 195) cholesterol 7.77 (2 - 6) HIGH calc osmolality 305 (285 - 314) CBC: WBCs 19.9 (4.2 - 15.6) HIGH RBCs 7.5 (6 - 10) Hb 121 (95 - 150) HCT 39% (29 - 45) MCV 52.3 (41 - 58) MC Hb 16 (11 - 17.5) platelets adequate, clumped RDW 21.3 (10 - 26) % reticulocytes 17 retic. count 12.8 (3 - 50) neutrophils 74% 14.726 (2.5 - 12.5) HIGH lymphocytes 15% 2.985 (1.5 - 7.0) monocytes 3% 0.597 (0 - 0.85) eosinophils 8.0% 1.592 (0 - 1.5) HIGH basophils 0.0 No blood parasites found on slide Spec fPL 4.7 (0 - 3.5) Increased, but in gray zone TT4 66.8 (10 - 60) HIGH probably even higher when corrected for euthyroid sick effect Negative for both FIV and FLV on ELISA U/A on cysto sample: SpGr 1.026 pH 6.5 urobilinogen 3.2 (3.2 - 16) blood ++ urine bilirubin +++ glucose negative ketones negative protein 1+ large amt. of bacteria seen WBCs 0-3/HPF moderate amount of bilirubin crystals urine culture and sensitivity pending. Once the results were discussed with owners, the cat was admitted for in-hospital IV fluids, ampicillin and metidazole, an injection of hemostam, and started on methimazole PO. She has not vomited and has been drinking a lot on her own and eating an adequate amount of food. Today I saw her for readmission and the second day of IV fluids/antibiotics. She was markedly pale and icteric, markedly prolonged skin tent, normal heart and lung sounds, only 30 grams weight gain in 24 hours, abdomen soft and non-painful with no palpable abnormalities except for possibly thickened colon. The concerning finding was a marked drop in PCV from 43% yesterday morning to 31% this morning, with stable total protein (9.1 yesterday vs. 9.0 today). I started her on a conservative rate of IV fluids at 3ml/kg/hr and increased to 4.5ml/kg/hr after two hours, having decided that she can handle some more hemodilution in the face of overwhelming icterus and a UTI which could be a pyelonephritis. So my main concern at this point are devising adequate fluid therapy rate while being mindful of increasing anemia and now evidence of hemolysis. There was evidence of marked gross hemolysis in the hematocrit tube this morning (and no hemolysis noted when blood was first collected), and the difference in PCV between yesterday and today seems alarming given that the cat has gained hardly any weight (only 30 grams, which may be simple scale error). Since no blood parasites were seen, I am at a bit of a loss at to the cause of the gross hemolysis. I cannot rule out leukemia lurking in the bone marrow and not picked up on ELISA of peripheral blood. She has an inflammatory/infectious process (UTI and hepatopathy), but is that enough to cause immune-mediated hemolysis? Could it be a reaction to any of the medications? Speaking of medications, I would have used ampicillin in combination with baytril but will not change her protocol until urine C+S results are in. I'm also considering adding a series of cobalamin injections. The owner has declined abdominal U/S but may agree to a repeat biochemistry. Any suggestions as to the cause(s) of illness and treatment for the cat would be greatly appreciated.

Were we seeing rods, cocci or a mix on the urine sediment?

Urine ph?

Pooh is a 13 year-old DSH FS who presented three days ago for constipation and recent weight loss. She was examined by a colleague at the practice where I now locum. She was found to be about dehydrated, mildly icteric, and constipated. BP by Doppler 145 mm Hg, HR 124 without arrhythmia or murmur, RR 34 bpm, T 37.3 C. Xrays showed copious fecal pellets in colon, a food-filled stomach, and slightly small kidneys. She was given an enema which cleared her colon, a SC fluid bolus, and started on Denamarin awaiting lab results. Biochemistry of June 8th on blood collected before any fluid therapy or treatments: hemolysis normal icterus +++ lipemia normal glucose 5.4 (4.0 - 8.0) BUN 11.0 (5.0 - 12.0) creatinine 110 (71 - 203) BUN/Creat ratio 25.1 sodium 150 (147 - 156) potassium 5.0 (3.0 - 5.3) Na/K ratio 30 chloride 112 (111 - 125) bicarb 19 (13 - 25) anion gap (24.0 (12 - 26) calcium 2.71 (2.00 - 2.90) phosphorus 1.48 (1.00 - 2.40) total protein 74 (59 - 85) albumin 27 (23 =- 33) globulin 47 (27 - 51) A/G ratio 0.6 (0.5 - 1.3) total bilirubin 130 (0 - 7) HIGH DIRECT BILIRUBIN 84 (0 - 3) HIGH ALP 370 (0 - 62) HIGH ALT 881 (28 - 76) HIGH AST 199 (5 - 55) HIGH GGT 3 (0 - 6) CK 90 (64 - 440) amylase 1631 (463 - 1833) lipase 54 (10 - 195) cholesterol 7.77 (2 - 6) HIGH calc osmolality 305 (285 - 314) CBC: WBCs 19.9 (4.2 - 15.6) HIGH RBCs 7.5 (6 - 10) Hb 121 (95 - 150) HCT 39% (29 - 45) MCV 52.3 (41 - 58) MC Hb 16 (11 - 17.5) platelets adequate, clumped RDW 21.3 (10 - 26) % reticulocytes 17 retic. count 12.8 (3 - 50) neutrophils 74% 14.726 (2.5 - 12.5) HIGH lymphocytes 15% 2.985 (1.5 - 7.0) monocytes 3% 0.597 (0 - 0.85) eosinophils 8.0% 1.592 (0 - 1.5) HIGH basophils 0.0 No blood parasites found on slide Spec fPL 4.7 (0 - 3.5) Increased, but in gray zone TT4 66.8 (10 - 60) HIGH probably even higher when corrected for euthyroid sick effect Negative for both FIV and FLV on ELISA U/A on cysto sample: SpGr 1.026 pH 6.5 urobilinogen 3.2 (3.2 - 16) blood ++ urine bilirubin +++ glucose negative ketones negative protein 1+ large amt. of bacteria seen WBCs 0-3/HPF moderate amount of bilirubin crystals urine culture and sensitivity pending. Once the results were discussed with owners, the cat was admitted for in-hospital IV fluids, ampicillin and metidazole, an injection of hemostam, and started on methimazole PO. She has not vomited and has been drinking a lot on her own and eating an adequate amount of food. Today I saw her for readmission and the second day of IV fluids/antibiotics. She was markedly pale and icteric, markedly prolonged skin tent, normal heart and lung sounds, only 30 grams weight gain in 24 hours, abdomen soft and non-painful with no palpable abnormalities except for possibly thickened colon. The concerning finding was a marked drop in PCV from 43% yesterday morning to 31% this morning, with stable total protein (9.1 yesterday vs. 9.0 today). I started her on a conservative rate of IV fluids at 3ml/kg/hr and increased to 4.5ml/kg/hr after two hours, having decided that she can handle some more hemodilution in the face of overwhelming icterus and a UTI which could be a pyelonephritis. So my main concern at this point are devising adequate fluid therapy rate while being mindful of increasing anemia and now evidence of hemolysis. There was evidence of marked gross hemolysis in the hematocrit tube this morning (and no hemolysis noted when blood was first collected), and the difference in PCV between yesterday and today seems alarming given that the cat has gained hardly any weight (only 30 grams, which may be simple scale error). Since no blood parasites were seen, I am at a bit of a loss at to the cause of the gross hemolysis. I cannot rule out leukemia lurking in the bone marrow and not picked up on ELISA of peripheral blood. She has an inflammatory/infectious process (UTI and hepatopathy), but is that enough to cause immune-mediated hemolysis? Could it be a reaction to any of the medications? Speaking of medications, I would have used ampicillin in combination with baytril but will not change her protocol until urine C+S results are in. I'm also considering adding a series of cobalamin injections. The owner has declined abdominal U/S but may agree to a repeat biochemistry. Any suggestions as to the cause(s) of illness and treatment for the cat would be greatly appreciated.

Any chance we can do a saline slide agglutination test on some blood to see if we have autoagglutination?

What are the opthalmic steroids for?

I have a 15 yr old neut. male domestic longhair cat that is diabetic, hyperthyroid and has a lung mass. He has been on insulin, y/d and we have been monitoring the lung mass. He started getting hypoglycemic over the weekend and had a seizure. During his workup we determined that his kidney enzymes are now at 63 bun and creatnine at 2.4, with a specific gravity of 1.016. We ran a uricult with was no growth. His lung mass has grown quite a bit now also. Here is my question since we know we are on limited time. Would you discontinue the y/d? with the renal enzymes elevating.?

If possible, could you post some recent bloodwork (cbc, chem, fructosamine or bg curve, latest t4 on the y/d, last creat before the recent 2.4 value) and his insulin dose and type?

Any chance that the owner has the ability to generate bg's at home?

I have a 15 yr old neut. male domestic longhair cat that is diabetic, hyperthyroid and has a lung mass. He has been on insulin, y/d and we have been monitoring the lung mass. He started getting hypoglycemic over the weekend and had a seizure. During his workup we determined that his kidney enzymes are now at 63 bun and creatnine at 2.4, with a specific gravity of 1.016. We ran a uricult with was no growth. His lung mass has grown quite a bit now also. Here is my question since we know we are on limited time. Would you discontinue the y/d? with the renal enzymes elevating.?

How long has he been on the y/d?

Ckeck the vin database for infectious myocarditis/diaphragmitis, ok?

I have a 15 yr old neut. male domestic longhair cat that is diabetic, hyperthyroid and has a lung mass. He has been on insulin, y/d and we have been monitoring the lung mass. He started getting hypoglycemic over the weekend and had a seizure. During his workup we determined that his kidney enzymes are now at 63 bun and creatnine at 2.4, with a specific gravity of 1.016. We ran a uricult with was no growth. His lung mass has grown quite a bit now also. Here is my question since we know we are on limited time. Would you discontinue the y/d? with the renal enzymes elevating.?

Was methimazole ever tried, or was he initially put on diet and well controlled?

How controlled are the blood glucoses in this kitty?

I have a 15 yr old neut. male domestic longhair cat that is diabetic, hyperthyroid and has a lung mass. He has been on insulin, y/d and we have been monitoring the lung mass. He started getting hypoglycemic over the weekend and had a seizure. During his workup we determined that his kidney enzymes are now at 63 bun and creatnine at 2.4, with a specific gravity of 1.016. We ran a uricult with was no growth. His lung mass has grown quite a bit now also. Here is my question since we know we are on limited time. Would you discontinue the y/d? with the renal enzymes elevating.?

What is phosphorous currently?

Did you get a pli?

I have a 15 yr old neut. male domestic longhair cat that is diabetic, hyperthyroid and has a lung mass. He has been on insulin, y/d and we have been monitoring the lung mass. He started getting hypoglycemic over the weekend and had a seizure. During his workup we determined that his kidney enzymes are now at 63 bun and creatnine at 2.4, with a specific gravity of 1.016. We ran a uricult with was no growth. His lung mass has grown quite a bit now also. Here is my question since we know we are on limited time. Would you discontinue the y/d? with the renal enzymes elevating.?

How big was the lung nodule initially, and how much has it enlarged?

Did you check a schirmer tear test?

I have a 15 yr old neut. male domestic longhair cat that is diabetic, hyperthyroid and has a lung mass. He has been on insulin, y/d and we have been monitoring the lung mass. He started getting hypoglycemic over the weekend and had a seizure. During his workup we determined that his kidney enzymes are now at 63 bun and creatnine at 2.4, with a specific gravity of 1.016. We ran a uricult with was no growth. His lung mass has grown quite a bit now also. Here is my question since we know we are on limited time. Would you discontinue the y/d? with the renal enzymes elevating.?

Is it a single nodule, or are there multiples now?

What should he weigh?

I have a 15 yr old neut. male domestic longhair cat that is diabetic, hyperthyroid and has a lung mass. He has been on insulin, y/d and we have been monitoring the lung mass. He started getting hypoglycemic over the weekend and had a seizure. During his workup we determined that his kidney enzymes are now at 63 bun and creatnine at 2.4, with a specific gravity of 1.016. We ran a uricult with was no growth. His lung mass has grown quite a bit now also. Here is my question since we know we are on limited time. Would you discontinue the y/d? with the renal enzymes elevating.?

I'm guessing owner isn't interested in working this up further?

Can you post some recent u/a and glucose results?

I have a 15 yr old neut. male domestic longhair cat that is diabetic, hyperthyroid and has a lung mass. He has been on insulin, y/d and we have been monitoring the lung mass. He started getting hypoglycemic over the weekend and had a seizure. During his workup we determined that his kidney enzymes are now at 63 bun and creatnine at 2.4, with a specific gravity of 1.016. We ran a uricult with was no growth. His lung mass has grown quite a bit now also. Here is my question since we know we are on limited time. Would you discontinue the y/d? with the renal enzymes elevating.?

Did we identify a possible cause for the recent episode of hypoglycemia on workup?

Can you retropulse the eye normally back into the orbit?

I have a 15 yr old neut. male domestic longhair cat that is diabetic, hyperthyroid and has a lung mass. He has been on insulin, y/d and we have been monitoring the lung mass. He started getting hypoglycemic over the weekend and had a seizure. During his workup we determined that his kidney enzymes are now at 63 bun and creatnine at 2.4, with a specific gravity of 1.016. We ran a uricult with was no growth. His lung mass has grown quite a bit now also. Here is my question since we know we are on limited time. Would you discontinue the y/d? with the renal enzymes elevating.?

Is he maintaining body weight, or losing at all?

Although diabetics can have fungal/yeast cystitis as these organisms love the glucose, ir is possible that these are swollen cocci - what is the urine sg?

My Mother-in law's dog is a terrier mix, MN, DOB 7/2004. He was diagnosed with diabetes and chronic intermittent pancreatitis in 3/2011. He has been very difficult to stabilize with his diabetes. She feeds him W/D and gives NPH insulin 4.5 units BID. The owner is very diligent in treatment. This is the first month his BG curves were in a range below 200 and above 70. We have checked urine cultures regularly with only one positive since diagnosis with diabetes. Over the past 6 months he has been losing weight ( about 1 lb/week). He is now 19.7 lb BCS 3.5/9. BW 4/19: BUN 88, CREAt 2.0 ALKP 487 HCT 34.5, T4 0.5 UA: pH 5 , pt. 1+, sp.gr. 1.023 We started him on canned W/D and gave him Benazaril at 1/4 mg/kg SID BW 5/15: ALP 498, ALT 121 BUN 38, Cre 1.4, TP 5.4, HCT 43.8 Continued canned food, started Denamarin, Ursodiol, Metro (7.5 mg/kg BID), Clavamox for 2 weeks. With is meds his appetite decreased and weight loss continued. BW 5/30: Albumin 2.5, ALT 122, AlKP 529, BUN 55, cre 1.8, HCT 36 We decided to do a liver biopsy- full surgical wedge biopsy Microscopic findings: "Multiple pigment granulomas, increased arteriolar profiles, mild portal and cetrilobbular fibrosis and mild, diffuse vacuolar hepatopathy." The pathologist commented that this is nonspecific and could be due to chronic passive congestion from CHF (no heart murmur or lung changes on radiographs), high cortisol levels or cancer. Does anyone have any other ideas on how to diagnose this dogs weight loss, lethargy, low protein, and elevated liver enzymes I would greatly appreciate the help. I have tried to send her to an internist but she refuses.

Is the dog's clinical control good?

Bloodwork would be our next step?

15 yo dsh with diabetes (well controlled) that presented with LUTD clinical signs. The cat had been on a commercial kibble diet with high protein (not sure how much). Calculi were found and removed surgically. Urine culture was negative and the calculi were 100% struvite. I have recommended switching to canned food exclusively for treatment of the diabetes and struvite calculi. Is there a specific diet that you would recommend for this cat?

Is this kitty at ideal bcs, or currently overweight?

Bad ears?

15 yo dsh with diabetes (well controlled) that presented with LUTD clinical signs. The cat had been on a commercial kibble diet with high protein (not sure how much). Calculi were found and removed surgically. Urine culture was negative and the calculi were 100% struvite. I have recommended switching to canned food exclusively for treatment of the diabetes and struvite calculi. Is there a specific diet that you would recommend for this cat?

Do we have recent bloodwork and ua/usg/upc?

Is this cat a good and healthy weight?

Hi, Kristofur is a 13 year old MN DSH that is diabetic. He was handled by a colleague of mine, who had difficulty regulating him. Currently, he is at 5U NPH BID. We have not submitted a fructosamine on him to see if he is controlled yet. I saw him on 2 recent occasions for skin tears. He has very thin skin and he came in on 2 seperate occasions for these very large superficial lacerations with peripheral bruising. On the 2nd occasion, I discussed the possibilty of hyperadrenocorticism with them and they agreed to testing. The results of the LDDS are as follows: Pre-cortisol 7.5 (1-6) 4 hour post 3.6 8 hour post 3.3 Since he never fell below 1.0, are these values consistent with hyperadrenocorticism? Thanks for your help. ☼

Which dexamethasone dose did you use?

Why did you think overflow?

Here's the second photo

In addition, what are the doses of the medications?

Spayed?

I've lurked here for a long time learning things, but this is the first time I've posted. I have a five-year-old Dogo Argentino with two non-healing foot lesions that have been present unchanged for nearly three months. The dog has been to two other veterinarians, including the University of Florida. A summary of what has been done so far: Bacterial culture X 2: no growth DTM X 2: no growth Wedge biopsy with histopath: Pododermatitis, ulcerative, perivascular, suppurative with lymphocytes and plasma cells. Focally extensive, severe, with proliferation of granulation tissue in the ulcer bed maturing to stromal fibrosis in deeper tissue. No agents or foreign bodies. Acute thrombosis, s noted in the degenerating tissue and superficial granulation tissue, but there is no evidence of deeper vasculitis or thrombosis that might be causing the ulceration. Treatment so far: Ketoconazole Cephalexin Clindamycin Baytril Prednisone We've tried bandaging and keeping it unbandaged. The dog wears both a cone and a bite-not collar to keep him away from it. The lesions are virtually unchanged and he's still 3-legged lame. Anyone have any suggestions or ideas? I can't seem to post both photos, so I'll post the second one separately. Thanks, /pbie Cottrell DVM West End Animal Hospital Newberry, FL

Is bloodwork okay?

Have you watched how they're trying to get a pill down him?

I've lurked here for a long time learning things, but this is the first time I've posted. I have a five-year-old Dogo Argentino with two non-healing foot lesions that have been present unchanged for nearly three months. The dog has been to two other veterinarians, including the University of Florida. A summary of what has been done so far: Bacterial culture X 2: no growth DTM X 2: no growth Wedge biopsy with histopath: Pododermatitis, ulcerative, perivascular, suppurative with lymphocytes and plasma cells. Focally extensive, severe, with proliferation of granulation tissue in the ulcer bed maturing to stromal fibrosis in deeper tissue. No agents or foreign bodies. Acute thrombosis, s noted in the degenerating tissue and superficial granulation tissue, but there is no evidence of deeper vasculitis or thrombosis that might be causing the ulceration. Treatment so far: Ketoconazole Cephalexin Clindamycin Baytril Prednisone We've tried bandaging and keeping it unbandaged. The dog wears both a cone and a bite-not collar to keep him away from it. The lesions are virtually unchanged and he's still 3-legged lame. Anyone have any suggestions or ideas? I can't seem to post both photos, so I'll post the second one separately. Thanks, /pbie Cottrell DVM West End Animal Hospital Newberry, FL

Have you tried silver sulfadiazine cream?

The diarrhea didn't start after either cat was changed to the current diet?

76 lb labx female spayed diet:: call of the wild/blue buffalo up to 24 units q12h novolin urine culure negative low dex suppression to michigan diagnostic lab no evidence of cushings upc=1.5 fructosamine 741 blood glucose stays over 400 here and at home alpa trac what brand would you switch to?

Can you post a few bg curves?

Has anyone measured b12 on this cat?

I have a 9 1/2 yr old FS DSH that presented 3 weeks ago for hx of losing weight over a few weeks. Cat lives in house with 7 other cats and is indoor only. Still E/D fine, vomits once weekly- foam x several months, no C/S/D, eating Royal Canin Renal LP since other cats in house have renal dz, not on any supplements..., has lost 4# since last year. PE- mild tartar, mild tachycardia (HR- 240), no oral masses, mild L sided thyroid slip, no anal gland masses... CBC/Chem 17/Lytes: mild hypercalcemia- 12.4 (8.2- 11.8) mild hypophosphatemia- 1.8 ( 3.0- 7.0) TT4- 1.6 (0.8 - 4.7)- wnl's BG- 142 (70- 150)- wnl's UA (cysto): 3+ glucose 2+ blood ph 5.5 sp.gravity 1.025 No WBC's, crystals... The following was done 1 week later: Parathyroid Hormone- 0.1 (0.3- 4.5)- low (normal) mild increase Ionized Calcium- 1.77 (1.03- 1.39) Abdominal US: spleen appears slightly enlarged but normal echogenicity mild thickening of the duodenum FNA/Cytology of spleen: Three slides of FNA from an enlarged spleen seen on ultrasound. Slightly thickened duodenum and history of increased calcium. CYTOLOGICAL INTERPRETATION Nondiagnostic-see comments COMMENTS Slides consist of primarily peripheral blood with platelet lumps and fibrin clots and one slide having 3 small poorly preserved clumps of pink swirling material with remnant splenic stromal tissue suggested and a few scattered lymphocytes and blood associated leukocytes. Too little material is found here representing the spleen to be diagnostic. If you choose to reaspirate and resubmit for further cytologic evaluation, you may do so at a reduced rate with a test code 6500, and please include this initial accession numbers for reference. X-rays are as follows. What should I do next in order to try to determine cause of hypercalcemia? Try to re-aspirate the spleen to see if can get dx? Recommend exploratory/biopsies...? Check FeLV/FIV test? (was tested as a kitten)? At what point can a dx of idiopathic hypercalcemia be made? Thanks for your help. ☼

Is there a possible nodule in the l caudal lung field?

Did you culture his urine to determine no uti, or was that based on urine sediment?

I have a 9 yr old MC Bichon that was diagnosed with IMHA a few months ago. He was being treated with prednisone and Azathioprine. He has been doing well with IMHA- no longer anemic. He has been diagnosed with Diabetes mellitus about 1 month ago and pred was discontinued. He is currently on Azathioprine- 2 mg/kg 3 days/week + NPH 5 Units BID. He has had liquid diarrhea intermittently for 2-3 weeks so the owner was giving Metronidazole. No improvement on 2 weeks of metronidazole + fortiflora I saw the dog last week for vomiting x 2 days + liquid diarrhea + weight loss + lethargy + anorexia + continued PU/PD (diabetes still not under control). PE- temp 100.1, decreased/absent GI sound, 5% dehydrated Bloodwork revealed mild increase ALKP- 260, mod increase WBC/neutrophilia- 17, 260, PCV/TS- 50/9.0; Na/K- 21, negative ketones, Blood glucose: 268, no other abnormalities UA- 300 glucose, 15 ketones, no WBC/RBC/bacteria... Fecal-nps; Spec CPL: negative Baseline Cortisol: >10 Abdominal/Chest x-rays: mod amt of gas within intestines, no masses Abd US: dilalted loops of bowel, no thickening of bowel, no masses... Treated with IV fluids + Cerenia + famotidine + Pen G. Much better the next day- eating EN + no V/D. Discussed GI panel to rule out SIBO but owner declined. Started treatment with Tylan powder and Vitamin B12 injections + 5 U NPH + Pepcid + Azathioprine twice weekly + EN.... I am unsure what is causing the V/D at this time and the owner is maxed out on money. I know Azathioprine can cause anorexia and GI upste but would it be this delayed? Could it possibly be secondary to Azathioprine even on a decreased freqency? Recommend stopping all immunosuppressive drugs and monitor CBC closely? I am concerned about stopping all meds for IMHA because on initial treatment he needed a blood transfusion (concern for relapse). Any suggestions? Thanks. ☼

Albumin and globulin are fine?

After a 12-14 hour fast?

I am suspicious of the bengal polyneuropathy syndrome in "Harlem" a 5 month old male bengal. He was initially examined yesterday, given an enema due to moderate constipation observed, and a moderately full urinary bladder. (1 lateral radiograph was performed, no spinal abnormalities observed). My colgue Dr.also took a look at Harlem today, and mentioned she had heard about the polyneuropathy possibility. A felv/fiv/hw snap test was negative. We were pling on a referral examination for this kitten, and were looking to address the short term issues with bowel overfill and urinary stasis by evacuating the colon and passing a urinary catheter to empty the bladder. We were curious as to the prognosis and the expected time frame this may take to resolve. The limited information we were able to attain indicated that spontaneous recovery was the most likely outcome, but could not determine when this is likely to start happening. Your thoughts and opinions are always appreciated! We will definitely post an update. :) Thanks sincerely ☼

Would you agree that this sounds like the polyneuropathy of bengals?

Is the cat on insulin or any other therapy yet?

I am suspicious of the bengal polyneuropathy syndrome in "Harlem" a 5 month old male bengal. He was initially examined yesterday, given an enema due to moderate constipation observed, and a moderately full urinary bladder. (1 lateral radiograph was performed, no spinal abnormalities observed). My colgue Dr.also took a look at Harlem today, and mentioned she had heard about the polyneuropathy possibility. A felv/fiv/hw snap test was negative. We were pling on a referral examination for this kitten, and were looking to address the short term issues with bowel overfill and urinary stasis by evacuating the colon and passing a urinary catheter to empty the bladder. We were curious as to the prognosis and the expected time frame this may take to resolve. The limited information we were able to attain indicated that spontaneous recovery was the most likely outcome, but could not determine when this is likely to start happening. Your thoughts and opinions are always appreciated! We will definitely post an update. :) Thanks sincerely ☼

How long would you feel comfortable ving the urinary catheter in?

Is it the protein?

I am suspicious of the bengal polyneuropathy syndrome in "Harlem" a 5 month old male bengal. He was initially examined yesterday, given an enema due to moderate constipation observed, and a moderately full urinary bladder. (1 lateral radiograph was performed, no spinal abnormalities observed). My colgue Dr.also took a look at Harlem today, and mentioned she had heard about the polyneuropathy possibility. A felv/fiv/hw snap test was negative. We were pling on a referral examination for this kitten, and were looking to address the short term issues with bowel overfill and urinary stasis by evacuating the colon and passing a urinary catheter to empty the bladder. We were curious as to the prognosis and the expected time frame this may take to resolve. The limited information we were able to attain indicated that spontaneous recovery was the most likely outcome, but could not determine when this is likely to start happening. Your thoughts and opinions are always appreciated! We will definitely post an update. :) Thanks sincerely ☼

Would prazosin, bethanecol, alprazolam be helpful for the bladder?

What is his current diet?

I am suspicious of the bengal polyneuropathy syndrome in "Harlem" a 5 month old male bengal. He was initially examined yesterday, given an enema due to moderate constipation observed, and a moderately full urinary bladder. (1 lateral radiograph was performed, no spinal abnormalities observed). My colgue Dr.also took a look at Harlem today, and mentioned she had heard about the polyneuropathy possibility. A felv/fiv/hw snap test was negative. We were pling on a referral examination for this kitten, and were looking to address the short term issues with bowel overfill and urinary stasis by evacuating the colon and passing a urinary catheter to empty the bladder. We were curious as to the prognosis and the expected time frame this may take to resolve. The limited information we were able to attain indicated that spontaneous recovery was the most likely outcome, but could not determine when this is likely to start happening. Your thoughts and opinions are always appreciated! We will definitely post an update. :) Thanks sincerely ☼

Would cisapride be helpful for the colon?

Is the diabetes controlled?

I am suspicious of the bengal polyneuropathy syndrome in "Harlem" a 5 month old male bengal. He was initially examined yesterday, given an enema due to moderate constipation observed, and a moderately full urinary bladder. (1 lateral radiograph was performed, no spinal abnormalities observed). My colgue Dr.also took a look at Harlem today, and mentioned she had heard about the polyneuropathy possibility. A felv/fiv/hw snap test was negative. We were pling on a referral examination for this kitten, and were looking to address the short term issues with bowel overfill and urinary stasis by evacuating the colon and passing a urinary catheter to empty the bladder. We were curious as to the prognosis and the expected time frame this may take to resolve. The limited information we were able to attain indicated that spontaneous recovery was the most likely outcome, but could not determine when this is likely to start happening. Your thoughts and opinions are always appreciated! We will definitely post an update. :) Thanks sincerely ☼

I have read about using prednisolone, any thoughts if it helps 0.5 mg/kg bid?

There are medic apps?

I am suspicious of the bengal polyneuropathy syndrome in "Harlem" a 5 month old male bengal. He was initially examined yesterday, given an enema due to moderate constipation observed, and a moderately full urinary bladder. (1 lateral radiograph was performed, no spinal abnormalities observed). My colgue Dr.also took a look at Harlem today, and mentioned she had heard about the polyneuropathy possibility. A felv/fiv/hw snap test was negative. We were pling on a referral examination for this kitten, and were looking to address the short term issues with bowel overfill and urinary stasis by evacuating the colon and passing a urinary catheter to empty the bladder. We were curious as to the prognosis and the expected time frame this may take to resolve. The limited information we were able to attain indicated that spontaneous recovery was the most likely outcome, but could not determine when this is likely to start happening. Your thoughts and opinions are always appreciated! We will definitely post an update. :) Thanks sincerely ☼

How long?

Did you run a few samples on the one step and against your in-house machine?

I am suspicious of the bengal polyneuropathy syndrome in "Harlem" a 5 month old male bengal. He was initially examined yesterday, given an enema due to moderate constipation observed, and a moderately full urinary bladder. (1 lateral radiograph was performed, no spinal abnormalities observed). My colgue Dr.also took a look at Harlem today, and mentioned she had heard about the polyneuropathy possibility. A felv/fiv/hw snap test was negative. We were pling on a referral examination for this kitten, and were looking to address the short term issues with bowel overfill and urinary stasis by evacuating the colon and passing a urinary catheter to empty the bladder. We were curious as to the prognosis and the expected time frame this may take to resolve. The limited information we were able to attain indicated that spontaneous recovery was the most likely outcome, but could not determine when this is likely to start happening. Your thoughts and opinions are always appreciated! We will definitely post an update. :) Thanks sincerely ☼

I have read it can take 10-14 days to resolve but can reoccur for life as often as every couple months?

Before we change to benazepril, what's the current upc?

I am suspicious of the bengal polyneuropathy syndrome in "Harlem" a 5 month old male bengal. He was initially examined yesterday, given an enema due to moderate constipation observed, and a moderately full urinary bladder. (1 lateral radiograph was performed, no spinal abnormalities observed). My colgue Dr.also took a look at Harlem today, and mentioned she had heard about the polyneuropathy possibility. A felv/fiv/hw snap test was negative. We were pling on a referral examination for this kitten, and were looking to address the short term issues with bowel overfill and urinary stasis by evacuating the colon and passing a urinary catheter to empty the bladder. We were curious as to the prognosis and the expected time frame this may take to resolve. The limited information we were able to attain indicated that spontaneous recovery was the most likely outcome, but could not determine when this is likely to start happening. Your thoughts and opinions are always appreciated! We will definitely post an update. :) Thanks sincerely ☼

Is that your experience?

Age?

Hello, I have a 8 YO MC Lhasa Apso Poodle Mix dog was diagnosed DM in April 2013, BW is 10 KG. he was started on Caninsulin 10 IU BID and was doing good (no PU/PD, no weight loss and back to his normal self) due to owner's work schedule he couldn't keep going with BID and wanted SID. Up on advice of the Caninsulin manufacturer, I put him on 10 IU SID. now he started to have house accidents and his glucose is over 20 mmol/L. I wonder if the dose is good for him (0.5 IU SID) or should I increase it? and why the DM is not controlled on SID dose? Also is there a long acting insulin for dogs that is safe to use and how much is a starting dose would be for that patient? Thanks for your time. ☼

What exactly did the bg curves look like on 10 units bid?

And, a single bg (or fructosamine or glucose in the urine) tell us nothing about the kinetics of the urine (e.g. does it last long enough?

Hello, I have a 8 YO MC Lhasa Apso Poodle Mix dog was diagnosed DM in April 2013, BW is 10 KG. he was started on Caninsulin 10 IU BID and was doing good (no PU/PD, no weight loss and back to his normal self) due to owner's work schedule he couldn't keep going with BID and wanted SID. Up on advice of the Caninsulin manufacturer, I put him on 10 IU SID. now he started to have house accidents and his glucose is over 20 mmol/L. I wonder if the dose is good for him (0.5 IU SID) or should I increase it? and why the DM is not controlled on SID dose? Also is there a long acting insulin for dogs that is safe to use and how much is a starting dose would be for that patient? Thanks for your time. ☼

So, when exactly does the owner work?

Any other diagnosis?

Hi- Scooter is a 7 year old S/F who weighs 20 lbs - and has had the same weight for several years. She presented for what the owner thought was a UTI - but she also wasn't feeling well overall. She wouldn't jump up and was just feeling poorly in general - wouldn't go for walks. She had Glucosuria (1000 mg/dL) and her blood sugar was 196 - but she had no weight loss, very recent pu/pd. Looking back in her file, I found that in January 2011, she had a BG of 179 on pre-anesthetic blood work. (there was no mention of this high number in the record). Scooter was in for a dental prophy. Back in Feb 2010 - she had a BG of 128 (high normal is 125) on a pre-surg profile for a dental prophy. She also never had a urinalysis run, but she has been on Proin (ppa) since 2009. Urinalysis - all free catches caught here and processed quickly. 5/13/13 6/14 6/17 - just a dip stick USG 1.028 1.015 Prot + Glu 1000 500 50 Ketones - - bili - - uro - - Blood - - Sediment 5-8 WBC/hpf 0 Blood sugar 196? 113 She responded to antibiotics - but still had significant glucosuria, so I asked her to come in this morning for a BG check - I got the results after she had left. This morning was 113, and she only had 50 mg/dL of glucose in her urine. She isn't on any treats from China. Gen chem: 1-25-11 06-03-13 SAP (0-140) 39 46 ALT (0 - 120) 41 47 GGT (0-14) - 88 *blood very hemolyzed Alb (2.5 - 4.0) - 4.7 Total Pr (5.5-7.6) 6.1 7.4 Total bili (0.0-0.5) - 2.3 * BUN (9-29) 25.8 30.7 Cr (0.4-1.4) 1.0 1.0 Chol (120-310) - 202 Glu (75-125) 179 196 (166 on glucometer) Ca (9.0 - 12.4) - 11.2 Phos (1.9-5.0) - 3.6 WBC (4.2-15.6) 7.7 9.3 RBC (6.0-10.0) 8.33 7.94 HGB (9.5-15) 18.8 19.4 HCT % (29-45) 54.3% 51.3 MCV (41-55) 65.2 64.6 MCH (11-17.5) 22.6 24.4 MCHC (29-36) 34.7 37.7 Platelet (170-600) 239 313 Unfortunately, we don't have a BG on Friday when her urine was tested. Could she be a dog that has feline stress hyperglycemia? She developed diarrhea after both dental prophy's - could this be a stress response to anesthesia/waking up away from home? Her BG is normal today, and it was a couple of hours after eating her normal breakfast. Does that mean for sure she isn't a diabetic? Should I send this to Internal Med as well? Thank you for your assistance, ☼

As you say, it really rings the bell for the jerky treats (not just chicken but also reported with duck jerky)...does she get any treats?

Or doing ok?

Hi- Scooter is a 7 year old S/F who weighs 20 lbs - and has had the same weight for several years. She presented for what the owner thought was a UTI - but she also wasn't feeling well overall. She wouldn't jump up and was just feeling poorly in general - wouldn't go for walks. She had Glucosuria (1000 mg/dL) and her blood sugar was 196 - but she had no weight loss, very recent pu/pd. Looking back in her file, I found that in January 2011, she had a BG of 179 on pre-anesthetic blood work. (there was no mention of this high number in the record). Scooter was in for a dental prophy. Back in Feb 2010 - she had a BG of 128 (high normal is 125) on a pre-surg profile for a dental prophy. She also never had a urinalysis run, but she has been on Proin (ppa) since 2009. Urinalysis - all free catches caught here and processed quickly. 5/13/13 6/14 6/17 - just a dip stick USG 1.028 1.015 Prot + Glu 1000 500 50 Ketones - - bili - - uro - - Blood - - Sediment 5-8 WBC/hpf 0 Blood sugar 196? 113 She responded to antibiotics - but still had significant glucosuria, so I asked her to come in this morning for a BG check - I got the results after she had left. This morning was 113, and she only had 50 mg/dL of glucose in her urine. She isn't on any treats from China. Gen chem: 1-25-11 06-03-13 SAP (0-140) 39 46 ALT (0 - 120) 41 47 GGT (0-14) - 88 *blood very hemolyzed Alb (2.5 - 4.0) - 4.7 Total Pr (5.5-7.6) 6.1 7.4 Total bili (0.0-0.5) - 2.3 * BUN (9-29) 25.8 30.7 Cr (0.4-1.4) 1.0 1.0 Chol (120-310) - 202 Glu (75-125) 179 196 (166 on glucometer) Ca (9.0 - 12.4) - 11.2 Phos (1.9-5.0) - 3.6 WBC (4.2-15.6) 7.7 9.3 RBC (6.0-10.0) 8.33 7.94 HGB (9.5-15) 18.8 19.4 HCT % (29-45) 54.3% 51.3 MCV (41-55) 65.2 64.6 MCH (11-17.5) 22.6 24.4 MCHC (29-36) 34.7 37.7 Platelet (170-600) 239 313 Unfortunately, we don't have a BG on Friday when her urine was tested. Could she be a dog that has feline stress hyperglycemia? She developed diarrhea after both dental prophy's - could this be a stress response to anesthesia/waking up away from home? Her BG is normal today, and it was a couple of hours after eating her normal breakfast. Does that mean for sure she isn't a diabetic? Should I send this to Internal Med as well? Thank you for your assistance, ☼

Sounds like she had antibiotics without a urine culture?

Is the dog a reliable eater?

Hi- Scooter is a 7 year old S/F who weighs 20 lbs - and has had the same weight for several years. She presented for what the owner thought was a UTI - but she also wasn't feeling well overall. She wouldn't jump up and was just feeling poorly in general - wouldn't go for walks. She had Glucosuria (1000 mg/dL) and her blood sugar was 196 - but she had no weight loss, very recent pu/pd. Looking back in her file, I found that in January 2011, she had a BG of 179 on pre-anesthetic blood work. (there was no mention of this high number in the record). Scooter was in for a dental prophy. Back in Feb 2010 - she had a BG of 128 (high normal is 125) on a pre-surg profile for a dental prophy. She also never had a urinalysis run, but she has been on Proin (ppa) since 2009. Urinalysis - all free catches caught here and processed quickly. 5/13/13 6/14 6/17 - just a dip stick USG 1.028 1.015 Prot + Glu 1000 500 50 Ketones - - bili - - uro - - Blood - - Sediment 5-8 WBC/hpf 0 Blood sugar 196? 113 She responded to antibiotics - but still had significant glucosuria, so I asked her to come in this morning for a BG check - I got the results after she had left. This morning was 113, and she only had 50 mg/dL of glucose in her urine. She isn't on any treats from China. Gen chem: 1-25-11 06-03-13 SAP (0-140) 39 46 ALT (0 - 120) 41 47 GGT (0-14) - 88 *blood very hemolyzed Alb (2.5 - 4.0) - 4.7 Total Pr (5.5-7.6) 6.1 7.4 Total bili (0.0-0.5) - 2.3 * BUN (9-29) 25.8 30.7 Cr (0.4-1.4) 1.0 1.0 Chol (120-310) - 202 Glu (75-125) 179 196 (166 on glucometer) Ca (9.0 - 12.4) - 11.2 Phos (1.9-5.0) - 3.6 WBC (4.2-15.6) 7.7 9.3 RBC (6.0-10.0) 8.33 7.94 HGB (9.5-15) 18.8 19.4 HCT % (29-45) 54.3% 51.3 MCV (41-55) 65.2 64.6 MCH (11-17.5) 22.6 24.4 MCHC (29-36) 34.7 37.7 Platelet (170-600) 239 313 Unfortunately, we don't have a BG on Friday when her urine was tested. Could she be a dog that has feline stress hyperglycemia? She developed diarrhea after both dental prophy's - could this be a stress response to anesthesia/waking up away from home? Her BG is normal today, and it was a couple of hours after eating her normal breakfast. Does that mean for sure she isn't a diabetic? Should I send this to Internal Med as well? Thank you for your assistance, ☼

Which antibiotoic did you give and for how long?

The bg of 56 is strange, i agree - was that off an accucheck or sent in to a lab?

Hi- Scooter is a 7 year old S/F who weighs 20 lbs - and has had the same weight for several years. She presented for what the owner thought was a UTI - but she also wasn't feeling well overall. She wouldn't jump up and was just feeling poorly in general - wouldn't go for walks. She had Glucosuria (1000 mg/dL) and her blood sugar was 196 - but she had no weight loss, very recent pu/pd. Looking back in her file, I found that in January 2011, she had a BG of 179 on pre-anesthetic blood work. (there was no mention of this high number in the record). Scooter was in for a dental prophy. Back in Feb 2010 - she had a BG of 128 (high normal is 125) on a pre-surg profile for a dental prophy. She also never had a urinalysis run, but she has been on Proin (ppa) since 2009. Urinalysis - all free catches caught here and processed quickly. 5/13/13 6/14 6/17 - just a dip stick USG 1.028 1.015 Prot + Glu 1000 500 50 Ketones - - bili - - uro - - Blood - - Sediment 5-8 WBC/hpf 0 Blood sugar 196? 113 She responded to antibiotics - but still had significant glucosuria, so I asked her to come in this morning for a BG check - I got the results after she had left. This morning was 113, and she only had 50 mg/dL of glucose in her urine. She isn't on any treats from China. Gen chem: 1-25-11 06-03-13 SAP (0-140) 39 46 ALT (0 - 120) 41 47 GGT (0-14) - 88 *blood very hemolyzed Alb (2.5 - 4.0) - 4.7 Total Pr (5.5-7.6) 6.1 7.4 Total bili (0.0-0.5) - 2.3 * BUN (9-29) 25.8 30.7 Cr (0.4-1.4) 1.0 1.0 Chol (120-310) - 202 Glu (75-125) 179 196 (166 on glucometer) Ca (9.0 - 12.4) - 11.2 Phos (1.9-5.0) - 3.6 WBC (4.2-15.6) 7.7 9.3 RBC (6.0-10.0) 8.33 7.94 HGB (9.5-15) 18.8 19.4 HCT % (29-45) 54.3% 51.3 MCV (41-55) 65.2 64.6 MCH (11-17.5) 22.6 24.4 MCHC (29-36) 34.7 37.7 Platelet (170-600) 239 313 Unfortunately, we don't have a BG on Friday when her urine was tested. Could she be a dog that has feline stress hyperglycemia? She developed diarrhea after both dental prophy's - could this be a stress response to anesthesia/waking up away from home? Her BG is normal today, and it was a couple of hours after eating her normal breakfast. Does that mean for sure she isn't a diabetic? Should I send this to Internal Med as well? Thank you for your assistance, ☼

Absolutely sure she's spayed?

Oops meant to post this to the feline board, not to bother y'all any idea how to get this to them?

I have a 9-year old SF DSH who I diagnosed with diabetes mellitus in December 2012. She presented for PU/PD, had glucosuria (1000), a UTI, and elevated glucose on her blood work (351mg/dl). I started her on Prozinc insulin 2U BID SQ and treated her UTI with Clavamox. At her recheck a couple weeks later, the owner reported that she was doing much better, but her BG was 308. Her glucose curve was as follows: 8:17am 430 8:50am gave food and insulin 9:50am 417 10:54am 341 12:00pm 284 1:05pm 325 3:20pm 273 4:30pm 302 I increased her insulin dose to 3U in the AM and 2U in the PM. What I thought was strange about this glucose curve is how she went down into the 200's and then up again into the 300's. Her recheck of her urine in January showed that the infection itself had resolved, but still glucose present in the urine. We increased her insulin to 3U BID and put her on Gluco-Balance (supplement made by Natural PetRx). The owner was reporting that she was drinking a lot of water. She is on Purina DM and a grain free canned. On Feb 16th, she then presented very sick and in DKA. She was hospitalized and recovered. She was changed to Lantus insulin 2U TID, being given SQ fluids at home twice a week. She came back in for a recheck on Feb 25th and her BG was 445, but she was doing much better clinically! Owner was giving 3U Lantus at 7am, 1U @ 5pm, and then 2U @ 7:30pm. Fructosamine was 619 (ref 191-349). We have had the discussion with this owner about possible cancer or something else going on underlying the diabetes, but owner financially cannot do much in the way of diagnositcs/investigation. Rechecked this cat again in April and she was not doing well clinically again. She was PU/PD. She is still eating the diabetic food and is on K+ gluconate tablet AM and PM. The cat was still getting SQ fluids 1-2x week, which seems to give her a boost. Was on 3U BID of Lantus still. BG at this time was 494 and Fructosamine was 610. The cat is slightly overweight (BCS 6/9). We did do a chest x-ray because pet sounded a little wheezy, but didn't see anything exciting. I increased her insulin to 4U in AM and 3U in PM. I am very cautious about increasing these cats too quickly because of the symogy effect other veterinarians have warned me about, but maybe I'm being too cautious? We rechecked her again in May and her BG was 476 and fructosamine was 647 (which is an increase compared to the previous value). I then increased her insulin dose to 4U BID and put her on Whole Body Support (standard process whole food supplement). The owner is still doing SQ fluids 2xweek, which seems to help somewhat. She is still drinking and peeing a lot per owner. I just rechecked her again on June 15th and she is still PU/PD and her fructosamine is now 684 (even higher than the previous measurement). She is currently on 4U BID Lantus insulin, doing SQ fluids 2xweek, and on Whole Body Support. I recommended a UA and Chemistry 75, but the owner declined at this appointment and will do at her next recheck. I am going to call her with the results of the fructosamine today and try to encourage her to do the blood work and UA now because I really think something else is going on with this cat besides the diabetes. Should I increase her insulin? Any thoughts as to why this cat is not being well controlled? I was considering putting her back on the Prozinc because it looks like her glucose was better on that insulin, but then she went into DKA on it so that's making me hesitate. The Lantus does not seem to be doing much though. I would appreciate any help or advice with this case!

Do we know exactly what canned foods this cat is eating?

Recent lab work, including a t4, is wnl, except for the hyperglycemia, correct?

I have a 9-year old SF DSH who I diagnosed with diabetes mellitus in December 2012. She presented for PU/PD, had glucosuria (1000), a UTI, and elevated glucose on her blood work (351mg/dl). I started her on Prozinc insulin 2U BID SQ and treated her UTI with Clavamox. At her recheck a couple weeks later, the owner reported that she was doing much better, but her BG was 308. Her glucose curve was as follows: 8:17am 430 8:50am gave food and insulin 9:50am 417 10:54am 341 12:00pm 284 1:05pm 325 3:20pm 273 4:30pm 302 I increased her insulin dose to 3U in the AM and 2U in the PM. What I thought was strange about this glucose curve is how she went down into the 200's and then up again into the 300's. Her recheck of her urine in January showed that the infection itself had resolved, but still glucose present in the urine. We increased her insulin to 3U BID and put her on Gluco-Balance (supplement made by Natural PetRx). The owner was reporting that she was drinking a lot of water. She is on Purina DM and a grain free canned. On Feb 16th, she then presented very sick and in DKA. She was hospitalized and recovered. She was changed to Lantus insulin 2U TID, being given SQ fluids at home twice a week. She came back in for a recheck on Feb 25th and her BG was 445, but she was doing much better clinically! Owner was giving 3U Lantus at 7am, 1U @ 5pm, and then 2U @ 7:30pm. Fructosamine was 619 (ref 191-349). We have had the discussion with this owner about possible cancer or something else going on underlying the diabetes, but owner financially cannot do much in the way of diagnositcs/investigation. Rechecked this cat again in April and she was not doing well clinically again. She was PU/PD. She is still eating the diabetic food and is on K+ gluconate tablet AM and PM. The cat was still getting SQ fluids 1-2x week, which seems to give her a boost. Was on 3U BID of Lantus still. BG at this time was 494 and Fructosamine was 610. The cat is slightly overweight (BCS 6/9). We did do a chest x-ray because pet sounded a little wheezy, but didn't see anything exciting. I increased her insulin to 4U in AM and 3U in PM. I am very cautious about increasing these cats too quickly because of the symogy effect other veterinarians have warned me about, but maybe I'm being too cautious? We rechecked her again in May and her BG was 476 and fructosamine was 647 (which is an increase compared to the previous value). I then increased her insulin dose to 4U BID and put her on Whole Body Support (standard process whole food supplement). The owner is still doing SQ fluids 2xweek, which seems to help somewhat. She is still drinking and peeing a lot per owner. I just rechecked her again on June 15th and she is still PU/PD and her fructosamine is now 684 (even higher than the previous measurement). She is currently on 4U BID Lantus insulin, doing SQ fluids 2xweek, and on Whole Body Support. I recommended a UA and Chemistry 75, but the owner declined at this appointment and will do at her next recheck. I am going to call her with the results of the fructosamine today and try to encourage her to do the blood work and UA now because I really think something else is going on with this cat besides the diabetes. Should I increase her insulin? Any thoughts as to why this cat is not being well controlled? I was considering putting her back on the Prozinc because it looks like her glucose was better on that insulin, but then she went into DKA on it so that's making me hesitate. The Lantus does not seem to be doing much though. I would appreciate any help or advice with this case!

Is there a history of gi-related signs, especially hairball vomiting, in this cat?

Has he always been this way?

Hi everyone, I have a 3 year old DSH FS that has been diagnosed with idiopathic hypercalcemia.(PTH=0, iCa high) She did not respond to dietary changes and the client declined to try prednisolone because the cat had a previous episode of diabetes mellitus. When her calcium level went over 15 mg/dl with confirmed high iCa, I put her on Fosamax. She has now been on it for 1 month at 10 mg per week. The client mentioned that the cat has seemed weak the past two days. I drew blood today for an ionized calcium and ran a chemistry. Her potassium was 8.0!!! her albumin has also gone down to 2.0 mg/dL with no increase in globulin. Her total calcium is 10.8 mg/dl now. What endocrine nightmare is going on here? Is she likely low in ionized calcium? ☼

Hmmm...what's the na level?

And, how do the bg values on the client's glucometer match serum levels?

Hi everyone, I have a 3 year old DSH FS that has been diagnosed with idiopathic hypercalcemia.(PTH=0, iCa high) She did not respond to dietary changes and the client declined to try prednisolone because the cat had a previous episode of diabetes mellitus. When her calcium level went over 15 mg/dl with confirmed high iCa, I put her on Fosamax. She has now been on it for 1 month at 10 mg per week. The client mentioned that the cat has seemed weak the past two days. I drew blood today for an ionized calcium and ran a chemistry. Her potassium was 8.0!!! her albumin has also gone down to 2.0 mg/dL with no increase in globulin. Her total calcium is 10.8 mg/dl now. What endocrine nightmare is going on here? Is she likely low in ionized calcium? ☼

Were the 'lytes run in-house or at a commercial lab?

Is she on the canned-only version of a high protein/low carb diet?

Hi everyone, I have a 3 year old DSH FS that has been diagnosed with idiopathic hypercalcemia.(PTH=0, iCa high) She did not respond to dietary changes and the client declined to try prednisolone because the cat had a previous episode of diabetes mellitus. When her calcium level went over 15 mg/dl with confirmed high iCa, I put her on Fosamax. She has now been on it for 1 month at 10 mg per week. The client mentioned that the cat has seemed weak the past two days. I drew blood today for an ionized calcium and ran a chemistry. Her potassium was 8.0!!! her albumin has also gone down to 2.0 mg/dL with no increase in globulin. Her total calcium is 10.8 mg/dl now. What endocrine nightmare is going on here? Is she likely low in ionized calcium? ☼

What's the globulin and total protein?

Was the cat polyphagia/pu/pd/weight loss or facial pawing, eating well or anorexic?

Hi everyone, I have a 3 year old DSH FS that has been diagnosed with idiopathic hypercalcemia.(PTH=0, iCa high) She did not respond to dietary changes and the client declined to try prednisolone because the cat had a previous episode of diabetes mellitus. When her calcium level went over 15 mg/dl with confirmed high iCa, I put her on Fosamax. She has now been on it for 1 month at 10 mg per week. The client mentioned that the cat has seemed weak the past two days. I drew blood today for an ionized calcium and ran a chemistry. Her potassium was 8.0!!! her albumin has also gone down to 2.0 mg/dL with no increase in globulin. Her total calcium is 10.8 mg/dl now. What endocrine nightmare is going on here? Is she likely low in ionized calcium? ☼

How fast do you get the ionized calcium level back?

Is it always the same?

Hi everyone, I have a 3 year old DSH FS that has been diagnosed with idiopathic hypercalcemia.(PTH=0, iCa high) She did not respond to dietary changes and the client declined to try prednisolone because the cat had a previous episode of diabetes mellitus. When her calcium level went over 15 mg/dl with confirmed high iCa, I put her on Fosamax. She has now been on it for 1 month at 10 mg per week. The client mentioned that the cat has seemed weak the past two days. I drew blood today for an ionized calcium and ran a chemistry. Her potassium was 8.0!!! her albumin has also gone down to 2.0 mg/dL with no increase in globulin. Her total calcium is 10.8 mg/dl now. What endocrine nightmare is going on here? Is she likely low in ionized calcium? ☼

Is she making urine?

Has he been losing weight?

I have a 10.5 year old poodle mix that has been a skin nightmare for years. I tried to manage him medically and all the owner wanted was prednisone until he became diabetic. The diabetes is under good control by the way. He has been to 2 dermatologist, one is Cornell, has been on two different allergy vaccines, atopica, hypoallergenic diets, pentoxyphylline, revolution trials, and prozac. I have thrown the kitchen sink at him. It use to be the base of his tail and perianeal area that was the primary problem. Now he is getting methicillin resistant staff infections. One of the problems with this case is that the client is not compliant with the mediation and is willy nilly and does whatever she wants. it is a tough case all around. Short of yelling at her or putting Banjo down the only other solution I can think of is trying to keep him comfortable (he is scratching all the time and tearing his skin up) is manage the diabetes with prednisone on board. She is currently giving Prozac and baytril for the skin infection and ha diet and potato pleasers. Do you have any ideas? How bad is it to manage diabetes with prednisone on board?

Has this dog been on a good food trial?

Can you provide more details?

I have a cat which had stable CKD IRIS stage II (creat varying between 205 and 245 ug/L) nonproteinuric nonhypertensive for half a year, recently he is getting increasing hypercalcemia (tCa from 3,44 to today 3,85 mg/L in a month(ref 3,10), today iCa 1,65 (ref1,42; ABL where also he was mildly alkemic). He has been 100% healthy all the time, active outdoors cat, the only clinical sign was a temporary increased drinking half a year ago, rDVM has indicated leuco's 3+ on a dipstick so I assume he had a shot of antibiotics at the time though the owner does not know. His health puts concomitant idiopathic hypercalcemia high on my list of differentials (statistically) and it also makes it unlikely that we'll push for a full test for all possible differentials just now; the owner is leaving town for the summer 2 months and we just submitted PTH/PTHrp today. If they come back normal I am at square 1. 1. I'd prefer for him to stay on the kidney diet, but thought to add fibers since it does not harm if he eats it. Soluble fibers or insoluble fibers; one or both? Is there any research or experience on such an add-on approach? 2. I'd not consider the hypercalcemia a likely cause of his kidney problems since it appeared half a year later; though I wonder if Ca could fluctuate enough to play a role? 3. I'd prefer to avoid pred for concerns of UTI. Mark Paterson said at ACVIM this year that he usually skips pred because it does not work, and move on to alendronate directly. Does there exist experience or research in alendronate in CKD cats? I'd appreciate comments! yours, ☼

How old is the kitty?

Any evidence of cardiac disease?

I have a cat which had stable CKD IRIS stage II (creat varying between 205 and 245 ug/L) nonproteinuric nonhypertensive for half a year, recently he is getting increasing hypercalcemia (tCa from 3,44 to today 3,85 mg/L in a month(ref 3,10), today iCa 1,65 (ref1,42; ABL where also he was mildly alkemic). He has been 100% healthy all the time, active outdoors cat, the only clinical sign was a temporary increased drinking half a year ago, rDVM has indicated leuco's 3+ on a dipstick so I assume he had a shot of antibiotics at the time though the owner does not know. His health puts concomitant idiopathic hypercalcemia high on my list of differentials (statistically) and it also makes it unlikely that we'll push for a full test for all possible differentials just now; the owner is leaving town for the summer 2 months and we just submitted PTH/PTHrp today. If they come back normal I am at square 1. 1. I'd prefer for him to stay on the kidney diet, but thought to add fibers since it does not harm if he eats it. Soluble fibers or insoluble fibers; one or both? Is there any research or experience on such an add-on approach? 2. I'd not consider the hypercalcemia a likely cause of his kidney problems since it appeared half a year later; though I wonder if Ca could fluctuate enough to play a role? 3. I'd prefer to avoid pred for concerns of UTI. Mark Paterson said at ACVIM this year that he usually skips pred because it does not work, and move on to alendronate directly. Does there exist experience or research in alendronate in CKD cats? I'd appreciate comments! yours, ☼

For more information, see my last post on what's causing idiopathic hypercalcemia in cats?

How long has the cat been diabetic?

We have a client moved to our area/practice 12months ago with a 15.5yrs old neutered male Mandalay cat who is diabetic the cat is on Glargine insulin & has been for the past 2 years with the owner monitoring him every 2-3 days at home & presenting the resulting graphs/details to his formewr clinic & now to us.She usually can get 3-4 blood glucoses done per day each time she does them.The pattern is always erratic with some very normal;some very high & very occasionally he has "crashed" & ended up at the emergencyl clinic(twice in the last 1year)Urine glucose is always negative! We have tried changing insulins with no apparent effect or increased efficacy.A Fructosamine level says the diabetes is very uncontrolled. The cat appears in great health;eats regularly & well;is not losing weight;blood tests reegularly reveal a very mild increase in BUN & Creat but liver enzymes are normal.His insulin dose usualy varies between 4-5 IU depending on the blood glucoses then owner gets. Given his age & apparent "wellness" can anyone suggest what further tests/treatment we should be considering with thanks br/

What is his diet?

How are they measuring strange doses like 5.4 units?

We have a client moved to our area/practice 12months ago with a 15.5yrs old neutered male Mandalay cat who is diabetic the cat is on Glargine insulin & has been for the past 2 years with the owner monitoring him every 2-3 days at home & presenting the resulting graphs/details to his formewr clinic & now to us.She usually can get 3-4 blood glucoses done per day each time she does them.The pattern is always erratic with some very normal;some very high & very occasionally he has "crashed" & ended up at the emergencyl clinic(twice in the last 1year)Urine glucose is always negative! We have tried changing insulins with no apparent effect or increased efficacy.A Fructosamine level says the diabetes is very uncontrolled. The cat appears in great health;eats regularly & well;is not losing weight;blood tests reegularly reveal a very mild increase in BUN & Creat but liver enzymes are normal.His insulin dose usualy varies between 4-5 IU depending on the blood glucoses then owner gets. Given his age & apparent "wellness" can anyone suggest what further tests/treatment we should be considering with thanks br/

Is he eating only the canned version of a high protein/low carb diet?

Did you evalauate all affected areas specifically for yeast?

We have a client moved to our area/practice 12months ago with a 15.5yrs old neutered male Mandalay cat who is diabetic the cat is on Glargine insulin & has been for the past 2 years with the owner monitoring him every 2-3 days at home & presenting the resulting graphs/details to his formewr clinic & now to us.She usually can get 3-4 blood glucoses done per day each time she does them.The pattern is always erratic with some very normal;some very high & very occasionally he has "crashed" & ended up at the emergencyl clinic(twice in the last 1year)Urine glucose is always negative! We have tried changing insulins with no apparent effect or increased efficacy.A Fructosamine level says the diabetes is very uncontrolled. The cat appears in great health;eats regularly & well;is not losing weight;blood tests reegularly reveal a very mild increase in BUN & Creat but liver enzymes are normal.His insulin dose usualy varies between 4-5 IU depending on the blood glucoses then owner gets. Given his age & apparent "wellness" can anyone suggest what further tests/treatment we should be considering with thanks br/

Which one?

How many calories does he currently get?

14 year old MN DLH IRIS stage 2 CRD - for 1 year, Rx benazepril (2.5 mg BID PO) Feb 2013 DKA, now in diabetic remission Since May 2013 Chronic progressive anaemia, at least 2 episodes of melena, one spike in urea without associated increase creatinine, Recent TT4 WNL. reported current problems at home were mild PU/PD, two weeks of lethargy, depression and reduced activity. He has lost weight, but was reported to be currently stable (6.15kg and BCS 5/9, vs. 10 kg before!). Sleeping / resting respiratory rates at home were reported to be normal. The main abnormal findings on physical examination were depressed mentation, mildly reduced muscle mass, white mucous membranes, mild periodontal disease, a bilateral thyroid / parathyroid nodule, tachypnoea (40 breaths per minute, and this resolved with time), increased lung sounds, a grade 4/6 right parasternal systolic cardiac murmur, a grade 3/6 left parasternal systolic cardiac murmur, gallop rhythm with a heart rate of 200 beats per minute, diffuse hepatomegaly, bilateral mild renomegaly to normal sized kidneys, multiple small abdominal masses (lymph node / intestine suspected), and melena without diarrhoea. Systolic Doppler blood pressure was normal (140 mmHg). Haematology, biochemistry and urinalysis demonstrated a sever non-regenerative anaemia (PCV 0.12 L/L ref 0.3-0.45, 0.2 reticulocytes/100 RBC ref), azotaemia (urea 20.4 mmol/l ref 5.4-10.7, creatinine 0.19 mmol/l ref 0.07-0.16) likely renal and pre-renal in origin (USG 1.015), and reduced albumin (19 g/L ref 22-35, secondary to protein losing enteropathy and nephropathy). Serum glucose was normal. Urine dipstick and sediment exam was unremarkable. No glucosuria was noted. Urine culture is so far negative. Urine protein: creatinine ratio is increased (1.15 ref 0.4). During hospitalization, no insulin therapy was given and no glucosuria was noted. Serum glucose levels were monitored and have not been low, being either normal or slightly increased at values typical for stress. Abdominal ultrasound demonstrated bilateral renomegaly (50 mm right and 45 mm left, ref. 38-44 mm) with loss of corticomedullary definition, diffuse hyperechoic hepatomegaly with a single 8x mm hypoehcoic nodule in the left lateral liver lobe that distorted the liver margin, a focal thickening of at least 5 cm of small intestine with reduced layering definition and prominent muscularis later (4mm) and no evidence of obstruction, diffuse abdominal lymphadenomegaly, a small volume abdominal effusion (too small to aspirate), and was otherwise normal. Ultrasound guided aspirates of the liver, liver nodule, abdominal lymph node and jejunal intestinal mass were routinely collected without complication. Cytology of the liver and liver nodule were unremarkable, abdominal lymph node aspirates were reactive, and aspirates of the intestinal mass diagnostic for gastrointestinal lymphoma. Renal aspirates or bone marrow was not collected at this time given the severe anemia. Despite the cytology results, we suspect liver and abdominal lymph node involvement of his lymphoma. Renal and bone marrow involvement of his lymphoma is suspected. Subclinical cardiomyopathy (likely HCM) is suspected. Has IRIS stage 2 chronic renal disease with proteinuria. Given the melenea, the ACEi has been stopped for now, and omperazole (5 mg BID PO) started. Insulin therapy has been discontinued as felt to be in a diabetic remission. His severe anemia is likely due to bone marrow involvement of his lymphoma, compounded by gastrointestinal bleeding, renal disease / anemia of chronic disease. A typed (Group A) whole blood transfusion was given on the 19/6/13 without complications. Advice on an oncology protocol, remission rate and survival rates would be great.

You've been impressively thorough and concise in your report above, so i hate to ask for anything else - but is it possible to post the cytology report?

What should he weigh?

6 year old cat feeling great on insulin detemir insulin one unit twice a day. weighs 12 punds. lucky this owner checks glucoses at home:) ate ate 6 am and gave insulin check glucoses every two hours until 5 pm. all of them about 420 except the noon was 101. Should i increase even with the 101?

We can make better recommendations for you if we have a bit more information: diet that this patient is eating?

Sometimes it helps to get a better history -- what was dog doing?

6 year old cat feeling great on insulin detemir insulin one unit twice a day. weighs 12 punds. lucky this owner checks glucoses at home:) ate ate 6 am and gave insulin check glucoses every two hours until 5 pm. all of them about 420 except the noon was 101. Should i increase even with the 101?

How long has the cat been receiving insulin?

Has the cat seen exogenous steroids chronically?

6 year old cat feeling great on insulin detemir insulin one unit twice a day. weighs 12 punds. lucky this owner checks glucoses at home:) ate ate 6 am and gave insulin check glucoses every two hours until 5 pm. all of them about 420 except the noon was 101. Should i increase even with the 101?

What was the glucose at the time of diagnosis?

Have you done a ua and gotten urine sg also?

6 year old cat feeling great on insulin detemir insulin one unit twice a day. weighs 12 punds. lucky this owner checks glucoses at home:) ate ate 6 am and gave insulin check glucoses every two hours until 5 pm. all of them about 420 except the noon was 101. Should i increase even with the 101?

Any changes in insulin dosing to date?

How much insulin is she on (and what does she weigh?) and what do the current bg curves look like?

6 year old cat feeling great on insulin detemir insulin one unit twice a day. weighs 12 punds. lucky this owner checks glucoses at home:) ate ate 6 am and gave insulin check glucoses every two hours until 5 pm. all of them about 420 except the noon was 101. Should i increase even with the 101?

Bcs?

Has a urine culture been checked?

6 year old cat feeling great on insulin detemir insulin one unit twice a day. weighs 12 punds. lucky this owner checks glucoses at home:) ate ate 6 am and gave insulin check glucoses every two hours until 5 pm. all of them about 420 except the noon was 101. Should i increase even with the 101?

Any concurrent disease, including gingivostomatitis?

Does she have the finicky appetite primarily in the morning?

I have an after hours emergency hospital. I hired a vet about 2 years ago. The vet does most of the weekend and a weekday every other week. Of course I am happy to have this situation as it allows me to be off every weekend. This vet did come with a "history", but seems to be a decent vet and is good with clients. He has had run ins with almost every one on the staff including veterinars. The problem mainly being condescending to the staff and directly insulting one of the other doctors. He works another job which I believe affects his quality of work at times (ie. not promoting working, doing the minimum to "meet them and street them"). Despite this, his numbers are still good compared to others. I do have to say that out of all the doctors I have had he has had 2 board complaints and I now have a lawsuit pending from him. I don't believe he was at fault but maybe could have handled things a little better. Fast forward to the most recent problems. Over the last few months he has been spending time with other staff complaining and magnifying problems inherent in the emergency setting. I try to manage these problems, but I can't guarantee a 100% solution. I feel that these problems are blown way out of proportion. (ie. shit stirring). So this past weekend I came in to pick up my pet and he follows me out to the car to complain again about a doctor being late and drug inventory. No mention of any ill animals. The next evening one of my staff starts crying on the job. It turns out that he had, out of the blue, euthanized a cat we had had for 2 months and were waiting to place with a cat rescue. This was a bilateral cryptorchid orange tom with a fabulous personality who had been dumped in our waiting room. He was neutered and we were waiting for the urine smell to subside. He developed a skin problem probably from the plastic bowls and was having a reaction to the Baytril we were giving (vomiting and diarrhea). When the tech asked what to give him for the signs he said the cat had cancer and euthanized it. This cat was fine on Friday with his own suite in the back running and jumping around. He was FELV/FIV negative, normal CBC, and Chemistry with slight elevated phosphorous. And this vet can't be bothered with our 4 permanent resident cats (one who went into renal failure last week, a recently resolved diabetic with off and on cystitis, and my favorite with COPD/Asthma & Diabetes, and another with PU and intermittent bladder issues). This cat (actually my cat as I own the business) was neutered by this other vet he has had confrontations with and complained about. The vet had worked that day shift when the cat started having problems and blood drawn, and was relieved by this vet. I hate to think that this vet was just being vengeful or thought he had the authority to do something like this. In all of the years I have had this business nothing like this has EVER happened. I have been trying to reach this vet via phone for the past 3 days and he has not returned my calls. He is scheduled to work this weekend. Staff morale now is at an all time low. They are still in tears about this. I am already having to hire new people due to some moving on to other careers. What to do?

Is you life better or worse from having this vet around?

Has this been rechecked?

I have a 7 yr old MN DSh cat who presented in April for weight loss of 5 pounds. In the past few weeks prior to presenting cat's appetite had diminished but he was still eating for the owner. Physical examination was unremarkable but bloodwork revealed elevated ALKP 317 (14-111) ALT 456 (12-130 GGT 14 (0-1) and tbili 1.5 (0-0.7).. The cat was hospitalized on Iv fluids and treated supportively with antibiotics/flagyl and denamarin and cyproheptadine. The cat was eating well and bloodwork was repeated 48 hours later with ALKP 253 ALT 313 GGT 8 and Tbili 1. The cat was sent home with the owner. One week later the cat presented for vomiting and decreased appetite. Bloodwork at this time was ALKP 444 ALT 427 GGT 19 and tbili 0.9. An ultrasound was performed and an increase in echogenicity of the liver was found. Owner elected an exploratory with liver biopsy and placement of PEG tube. The biopsy came back as portal lymphocytic cholangitis. I am having a hard time finding out much about this disease. Some resources suspect it is immune-mediated and to treat with steroids and others say no treatment necessary but that it has a mean survival time of 3 years. We elected to treat with steroids but since this owner found she could not pill her cat we used Depomedrol injection 10 days after surgery. The cat is clinically doing well eating and gaining weight but when the bloodwork was checked 1 month after the Depo injection ALKP 313 ALT598 GGT 6 and tbili 0.8. The concern is with the increase in the ALT. The PEg tube was pulled 5 weeks after the surgery. The cat is scheduled to cme back in for bloodwork in 2 weeks. Should the Depo be discontinued? Any other thoughts on rteatment? Any input would be greatly appreciated. I have included an intra-operative picture of the liver.

Is there a history of gi-related signs, including the vomiting of food, fluid and/or hair in this patient?

Would 10-14 day bg curve be acceptable as well or should i check bg curve at 7 days after starting on the vetoryl?

I am writing in reference to a 12 yr old F/S overweight cat. She was diagnosed with diabetes in March 2011. Treated with glargine insulin until Jan 2012 when she reverted and no longer needed insulin. This cat was difficult to regulate in the beginning but finally did well for several months until she no longer needed insulin. She has done well ever since Jan, 2012. On her routine blood work, we have noticed her ALT being elevated for several years. 6-09 ALT 211 (28-100) Started denamarin 8-09 ALT 233 10-09 ALT 222 1-11 ALT 234 3-11 ALT 131 (diabetic at this time--BG 427) 4-11 ALT 144 6-11 ALT normal at 84 2-12 ALT 129 this is about the time that diabetes reverted to normal 2-13 ALT 184 4-13 ALT 180 Texas A/M digestive profile was normal I had an U/S done to look at liver. radiologist said that liver was hyperechoic with normal margination. Liver size was on large size of normal. No other lesions seen. Cytology of liver showed hepatic lipidosis. some groups of hepatocytes were mildly to markedly distended with lipid vacoules. At this time she is clinically normal. Needs no insulin and is on denamarin. Should I do anything else? Any thoughts? Thanks so much

Did the ultrasonographer get a good look at the pancreas of this kitty at the time of the exam?

E.g. 0.01 mg/kg iv?

I am writing in reference to a 12 yr old F/S overweight cat. She was diagnosed with diabetes in March 2011. Treated with glargine insulin until Jan 2012 when she reverted and no longer needed insulin. This cat was difficult to regulate in the beginning but finally did well for several months until she no longer needed insulin. She has done well ever since Jan, 2012. On her routine blood work, we have noticed her ALT being elevated for several years. 6-09 ALT 211 (28-100) Started denamarin 8-09 ALT 233 10-09 ALT 222 1-11 ALT 234 3-11 ALT 131 (diabetic at this time--BG 427) 4-11 ALT 144 6-11 ALT normal at 84 2-12 ALT 129 this is about the time that diabetes reverted to normal 2-13 ALT 184 4-13 ALT 180 Texas A/M digestive profile was normal I had an U/S done to look at liver. radiologist said that liver was hyperechoic with normal margination. Liver size was on large size of normal. No other lesions seen. Cytology of liver showed hepatic lipidosis. some groups of hepatocytes were mildly to markedly distended with lipid vacoules. At this time she is clinically normal. Needs no insulin and is on denamarin. Should I do anything else? Any thoughts? Thanks so much

Is there a history of vomiting of food, fluid and/or hair?

Can you post the concurrent urinalysis results along with all full culture/sensitivity profiles that were done so far, so we can see the cfu/ml count and mic breakpoints for the drugs?

I am writing in reference to a 12 yr old F/S overweight cat. She was diagnosed with diabetes in March 2011. Treated with glargine insulin until Jan 2012 when she reverted and no longer needed insulin. This cat was difficult to regulate in the beginning but finally did well for several months until she no longer needed insulin. She has done well ever since Jan, 2012. On her routine blood work, we have noticed her ALT being elevated for several years. 6-09 ALT 211 (28-100) Started denamarin 8-09 ALT 233 10-09 ALT 222 1-11 ALT 234 3-11 ALT 131 (diabetic at this time--BG 427) 4-11 ALT 144 6-11 ALT normal at 84 2-12 ALT 129 this is about the time that diabetes reverted to normal 2-13 ALT 184 4-13 ALT 180 Texas A/M digestive profile was normal I had an U/S done to look at liver. radiologist said that liver was hyperechoic with normal margination. Liver size was on large size of normal. No other lesions seen. Cytology of liver showed hepatic lipidosis. some groups of hepatocytes were mildly to markedly distended with lipid vacoules. At this time she is clinically normal. Needs no insulin and is on denamarin. Should I do anything else? Any thoughts? Thanks so much

Finally, is the kitty eating normally?

Does this seem like a good plan?

Jade is my 10 year old border collie service dog. She was treated for the past 5 months on low dose 500mg Amoxicillin at night for chronic UTI per a specialist in my area. She was asymptomatic for these past 5 months. 1 week after taking her off these medications she began drinking a lot of water, having accidents in the house and urinating frequently. I figured the UTI was back. Ran a complete CBC, Chem, Urine culture all were normal. Mild decrease in Cholesterol. Low normal RBC count, low normal Albumin. A Low dose dex test was normal. TSH- low and T4 was 0.6 and T4 by ED was slightly low. Chest X-ray is normal. 3 recent abdominal ultrasounds are all normal. She has dropped 2.5 pounds in 1 week on the same food and amount of food. She now has trouble walking, jumping and is falling down and missing the stairs. SHe is visibly muscle wasting. Today we are sending ACTH Stim test, Hormone panel to Tennessee, Fructosamine, Folate and B12. Is there anything else that we should/ should not be looking at? I'm concerned about DI but the polyphagia is not fitting. Jade is not having any diarrhea, normal stool. She has had an occassional epidode of vomiting but this is bile only and occurred 2 times in the past month. TLI and cPL? Thanks in advance!!!

Possible atypical cushing's?

The usgs that you have are first morning specifically?

Jade is my 10 year old border collie service dog. She was treated for the past 5 months on low dose 500mg Amoxicillin at night for chronic UTI per a specialist in my area. She was asymptomatic for these past 5 months. 1 week after taking her off these medications she began drinking a lot of water, having accidents in the house and urinating frequently. I figured the UTI was back. Ran a complete CBC, Chem, Urine culture all were normal. Mild decrease in Cholesterol. Low normal RBC count, low normal Albumin. A Low dose dex test was normal. TSH- low and T4 was 0.6 and T4 by ED was slightly low. Chest X-ray is normal. 3 recent abdominal ultrasounds are all normal. She has dropped 2.5 pounds in 1 week on the same food and amount of food. She now has trouble walking, jumping and is falling down and missing the stairs. SHe is visibly muscle wasting. Today we are sending ACTH Stim test, Hormone panel to Tennessee, Fructosamine, Folate and B12. Is there anything else that we should/ should not be looking at? I'm concerned about DI but the polyphagia is not fitting. Jade is not having any diarrhea, normal stool. She has had an occassional epidode of vomiting but this is bile only and occurred 2 times in the past month. TLI and cPL? Thanks in advance!!!

Do you like the hormonal panel and do you think you get good evidence for treatment?

Can you post the films?

We have been successfully managing a cat w/ IBD +/- presumptive GI lympoma for the last year w/ Pred 5mg BID Leukeran 2mg EOD Vit B injections He recently became more finicky, constipation issues and PU/PD. His Workup showed a Glucose of 375, 3+ glucosuria. My questions: 1. Could we blame this on pred and, although it would likely mean loss of control of his GI dz, would tapering off the pred and switching to something else (budesonide?) before starting insulin tx be worth a try and possibly resolve this? 2. I have treated many diabetic cats, but never tried to manage one with this type of situation. How problematic is it likely to be? Thanks, ☼

What diet does he usually eat?

How long has she been on the current dose?

We have been successfully managing a cat w/ IBD +/- presumptive GI lympoma for the last year w/ Pred 5mg BID Leukeran 2mg EOD Vit B injections He recently became more finicky, constipation issues and PU/PD. His Workup showed a Glucose of 375, 3+ glucosuria. My questions: 1. Could we blame this on pred and, although it would likely mean loss of control of his GI dz, would tapering off the pred and switching to something else (budesonide?) before starting insulin tx be worth a try and possibly resolve this? 2. I have treated many diabetic cats, but never tried to manage one with this type of situation. How problematic is it likely to be? Thanks, ☼

Any indication of renal disease, based on labwork (including urinalysis)?

Is it going on now?

Hi I am trying to get a diabetic dog regulated with Vetsulin He is a 6 yr 7 mo old 19.2 lb Cairn Terrier He saw Elsewhere Vet clinic on May 8th and they were told he was Diabetic - the O refused to treat with insulin (they own a health food store) and were convinced they could treat him with diet alone. They came to me on 5/21/13 for a "second opionion" for PU/PD And yes he is Diabetic and was then also Ketoacidotic but was still eating. He weighed 20.2 lbs at that time, gums were tacky and BG was 402 They FLAT OUT REFUSED to let me hospitae the dog. They also FLAT OUT REFUSED to let me do a cystocentesis for Urine culture. So I started him on 2 U Vetsulin BID ( WITH MUCH CONVINCING!!!) and some SQ fluids and Clavamox. They REFUSE to feed W/D but are feeding him now BID and have cut out his treats as he used to get a lot of people food peanut butter and snacks throughout the day. His food now is: Evo Senior (a weight loss food for sedentary life) Low fat, Canned Pumpkin, Chicken (boneless organic chicken breast) He had 2 BG Curves: they always bring him in at ~ 8AM but feed him at 6:45ish and I can NOT get them to give the insulin at home when they feed him for the life of me. 5/29 BG Curve: 8 AM 398 10 AM 560 12PM 534 2 PM 421 4 PM 250 5:30 PM 586 I increased Insulin to 3 U BID BG Curve 6/6: 8 AM 525 10 AM 485 12 PM 555 2 PM 563 4 PM 426 5:30 PM 389 Increase Insulin to 4 U BID Then as O was complaining about cost we did some spot BGs: 6/11 @ 11AM = 332 Increased to 5 U 6/15 @ 11:30 AM = 366 Increase to 6 U Told them next time we have to BG Curve which we did today 6/21/13: 8AM = 675 ( fed at 6:45 am Insulin given at 8:30) 10AM = 547 12 PM = 475 2 PM = 154 4 PM = 189 5:30 PM = 414 I am about to discharge this pet and am going to ask them to continue at 6 U BID but to please give the insulin at time of feeding and do a spot check early next week.... HELP ME I do not know where to go from here Thanks E

What explanation do they have for why they can't give him the insulin at the same time as the food?

Phosphorus is low?

Hello. Nash is a 4.5 yr M/N Min Schnauzer that I diagnosed with uncomplicated diabetes mell. in early March of this year. He was started on Caninsulin after diagnosis, screened for all possible plems (ie triglycerides, urine culture, PLI etc were all WNL). To make a lengthy history short, after diagnosis came to our clinic for weekly curves all through March, April and May gradually trying to get his blood glucose regulated. Nash is on a diet of Royal Canin GI Low Fat and I have been consiulting with Dr. Michelle Evason internist with Royal Canin regularly over his diabetic management. We had been getting gradually closer to good regulation, although our nadirs/cruve hadn't been quite where I was happy with them but due to financial concerns we decided since Nash was doing very well clinically -ie holding weight, no longer Pu/PD to back off in frequency of his monitoring to q 2 weeks as the owners were getting concerned for repeated costs of weekly curves (they have been one of my most compliant clients ever!). May 23 Nash was in for routine exam and vacc when I noticed the first incidence of cataracts.in the OD and they were very small/incipient to immature. I was very disappointed to see this (although I know it is inevitable) that the cataracts seemed to be having such an early onset despite our aggressive attempt to manage his diabetes. At this point our dose of Caninsulin is 7 units BID for Nash's weight of 20.6 lb. Two weeks after his routine vacc visit and first note of cataracts, Nash presented on June 5/13 for "going suddenly blind" and the owners were considering euthanasia as they had been alarm with changes in Nash's demeanor after the vision change. they also have a toddler at home and were concerned for his well being if Nash were to become more apprehensive of being approached. Upon exam June5 (I do not have any pictures of this visit) I somewhat relieved to note that Nash had uveitis, which although I cautioned the owners could be lens induced if cataracts had advanced, it may in fact be manageable and may not be a reason for euthanasia as I felt a lot of his behaviour and appetite changes were due to pain and discomfort from the uveitis.. My exam findings were as follows: OD - marked uveitis - could not see into anterior chamber at all -marked keratitis edema and, scleritis, conjunctivitis, perilimbal brush border of blood vessels 7-11 oclock, absent menace OS -mild keratitis, corneal edema and scleritis, conjunctivitits, mild aqueous flare, menace present but diminished -pupil miiotic and misshapen - could not evaluate cataract due to miotic pupil but what I could see through the pupil looked larger and more crystalline He also had mild mucopurulent discharge bilaterally. Corneal surface was smooth and moist and no blepharospasm so I did not evaluate STT or FLuorscein as trying to keep costs down for owner due to dwindling budget and do what is necessary. We have a schiotz but i am not very adept at it having only used it a handful of times in 8 yr of practice as I was accustomed to using a tonovet at other clinics I worked at. Since I was convinced of uveitis only clinically I did not see a huge reason for it at the time. We have an ophthalmologist 2 hr away but when I recommended to the owner they declined due to cost. So I initiated therapy for uveitis as follows: -Prednisolone acetate - 1 drop ou q 8 hr -Atropine ophth 1% - 1 drop ou q 12 hr x 3 d then 1 drop ou q 24 hr -Fucithalmic antibiotic ointment ou BID -Deramaxx 25 mg - 1/2 tab PO q 24 hr x 6 d We decided to postpone further BG curves until ocular plems under control as I felt it could affect the curve and he was doing well clinically at home as far as that went. I also cautioned owners the Pred topically could potentially interfere with his control but I felt the benefit of its use outweighed that risk for the moment. June 7/13 one week after starting uveitis therapy owners were incredibly happy, they said he was like himself again and although still bumping into things and not able to do stairs and find his food 100% on his own he was more like himself and trying to navigate around on his own. His appetite returned to normal. I found a 50-60% improvement in ocular symtoms. I could now see into the anterior chamber of the OD but found the menace was still absent and also could now see the pupil was miotic and misshapen in that eye. I could also note the cataracts seemed more crystalline from what I could see through the mioitc pupil. I advised owner to keep all treatments the same and requested a recheck in a week, initially pleased with progress June 14/13 Two weeks after starting therapy for uveitis I saw Nash for 2nd recheck. Overall 80-85% improvement in both eyes, however I was concerned that the OD globe looked very mildly' bupthalmic. I attempted Schiotz and

Should i be instituting any anti-glaucoma therapy?

The owner is only feeding at mealtimes, when the insulin is given, using a measuring cup and the amount is reasonable for a dog this size (sometimes when the weight is falling off of them they panic and start really over-feeding the dog---which means we have to chase after them with an ever-increasing amount of insulin) how many calories/day does he currently get?

Hello. Nash is a 4.5 yr M/N Min Schnauzer that I diagnosed with uncomplicated diabetes mell. in early March of this year. He was started on Caninsulin after diagnosis, screened for all possible plems (ie triglycerides, urine culture, PLI etc were all WNL). To make a lengthy history short, after diagnosis came to our clinic for weekly curves all through March, April and May gradually trying to get his blood glucose regulated. Nash is on a diet of Royal Canin GI Low Fat and I have been consiulting with Dr. Michelle Evason internist with Royal Canin regularly over his diabetic management. We had been getting gradually closer to good regulation, although our nadirs/cruve hadn't been quite where I was happy with them but due to financial concerns we decided since Nash was doing very well clinically -ie holding weight, no longer Pu/PD to back off in frequency of his monitoring to q 2 weeks as the owners were getting concerned for repeated costs of weekly curves (they have been one of my most compliant clients ever!). May 23 Nash was in for routine exam and vacc when I noticed the first incidence of cataracts.in the OD and they were very small/incipient to immature. I was very disappointed to see this (although I know it is inevitable) that the cataracts seemed to be having such an early onset despite our aggressive attempt to manage his diabetes. At this point our dose of Caninsulin is 7 units BID for Nash's weight of 20.6 lb. Two weeks after his routine vacc visit and first note of cataracts, Nash presented on June 5/13 for "going suddenly blind" and the owners were considering euthanasia as they had been alarm with changes in Nash's demeanor after the vision change. they also have a toddler at home and were concerned for his well being if Nash were to become more apprehensive of being approached. Upon exam June5 (I do not have any pictures of this visit) I somewhat relieved to note that Nash had uveitis, which although I cautioned the owners could be lens induced if cataracts had advanced, it may in fact be manageable and may not be a reason for euthanasia as I felt a lot of his behaviour and appetite changes were due to pain and discomfort from the uveitis.. My exam findings were as follows: OD - marked uveitis - could not see into anterior chamber at all -marked keratitis edema and, scleritis, conjunctivitis, perilimbal brush border of blood vessels 7-11 oclock, absent menace OS -mild keratitis, corneal edema and scleritis, conjunctivitits, mild aqueous flare, menace present but diminished -pupil miiotic and misshapen - could not evaluate cataract due to miotic pupil but what I could see through the pupil looked larger and more crystalline He also had mild mucopurulent discharge bilaterally. Corneal surface was smooth and moist and no blepharospasm so I did not evaluate STT or FLuorscein as trying to keep costs down for owner due to dwindling budget and do what is necessary. We have a schiotz but i am not very adept at it having only used it a handful of times in 8 yr of practice as I was accustomed to using a tonovet at other clinics I worked at. Since I was convinced of uveitis only clinically I did not see a huge reason for it at the time. We have an ophthalmologist 2 hr away but when I recommended to the owner they declined due to cost. So I initiated therapy for uveitis as follows: -Prednisolone acetate - 1 drop ou q 8 hr -Atropine ophth 1% - 1 drop ou q 12 hr x 3 d then 1 drop ou q 24 hr -Fucithalmic antibiotic ointment ou BID -Deramaxx 25 mg - 1/2 tab PO q 24 hr x 6 d We decided to postpone further BG curves until ocular plems under control as I felt it could affect the curve and he was doing well clinically at home as far as that went. I also cautioned owners the Pred topically could potentially interfere with his control but I felt the benefit of its use outweighed that risk for the moment. June 7/13 one week after starting uveitis therapy owners were incredibly happy, they said he was like himself again and although still bumping into things and not able to do stairs and find his food 100% on his own he was more like himself and trying to navigate around on his own. His appetite returned to normal. I found a 50-60% improvement in ocular symtoms. I could now see into the anterior chamber of the OD but found the menace was still absent and also could now see the pupil was miotic and misshapen in that eye. I could also note the cataracts seemed more crystalline from what I could see through the mioitc pupil. I advised owner to keep all treatments the same and requested a recheck in a week, initially pleased with progress June 14/13 Two weeks after starting therapy for uveitis I saw Nash for 2nd recheck. Overall 80-85% improvement in both eyes, however I was concerned that the OD globe looked very mildly' bupthalmic. I attempted Schiotz and

What are the tiny bubble like structures in the corneal stroma?

Any chance of this?

Hi guys- Just trying to make sense of a case I just stumbled into, so not sure I have ALL the relevant information, but I'm going to try to summarize. 2 YO male Sibe Husky presented on the 19th with weakness, lethargy, adr, anorexic, vomiting. PCV 36%, TP 6.0. Infested with ticks. Responded clinically somewhat to fluid administration. Bloodwork back (I have to type them, so abbreviated set): Not sure if they did the blood draw prior to fluids or not. BUN 261 H (6-31) Cre 25.3 H (0.5-1.6) Phos 22.5 H (2.5-8) Magnes 2.9 H (1.5-2.5) K 7.0 H (3.6-5.5) Na 142 (139-154) Na/K ratio 20 L HCT 35 (36-60) Neuts 11310 H (2060-10600) So, extreme azotemia, hyperphosphatemia, hyperkalemia, dehydration, slight anemia. USG (again, not sure timing relative to fluid admin, etc): 1.000 - in-house refractometer - calibrated with distilled water. Without the USG I would have just said ARF due to some sort of toxin, lepto, or other infection. With the USG of 1.000, to me this means that there's plenty of renal function, since to get urine that dilute requires tubule function. Is this correct? Unfortunately a full UA doesn't appear to have been done. After diuresis for a few days, BUN 291, Cre 25.5. I have trouble believing this level of azotemia solely due to dehydration. Is it possible that something like Diabetes Insipidus is causing these bloodwork results with this USG? Would we have seen correction of azotemia with DI if we didn't address the DI and only administered fluids? Can you see ARF with diluting ability in the kidneys? Let me know what you think! I'm cross-posting to IM as well. Thanks. ☼

Has the dog been pupd all along?

Got another cat, moved, etc)?

Hi guys- Just trying to make sense of a case I just stumbled into, so not sure I have ALL the relevant information, but I'm going to try to summarize. 2 YO male Sibe Husky presented on the 19th with weakness, lethargy, adr, anorexic, vomiting. PCV 36%, TP 6.0. Infested with ticks. Responded clinically somewhat to fluid administration. Bloodwork back (I have to type them, so abbreviated set): Not sure if they did the blood draw prior to fluids or not. BUN 261 H (6-31) Cre 25.3 H (0.5-1.6) Phos 22.5 H (2.5-8) Magnes 2.9 H (1.5-2.5) K 7.0 H (3.6-5.5) Na 142 (139-154) Na/K ratio 20 L HCT 35 (36-60) Neuts 11310 H (2060-10600) So, extreme azotemia, hyperphosphatemia, hyperkalemia, dehydration, slight anemia. USG (again, not sure timing relative to fluid admin, etc): 1.000 - in-house refractometer - calibrated with distilled water. Without the USG I would have just said ARF due to some sort of toxin, lepto, or other infection. With the USG of 1.000, to me this means that there's plenty of renal function, since to get urine that dilute requires tubule function. Is this correct? Unfortunately a full UA doesn't appear to have been done. After diuresis for a few days, BUN 291, Cre 25.5. I have trouble believing this level of azotemia solely due to dehydration. Is it possible that something like Diabetes Insipidus is causing these bloodwork results with this USG? Would we have seen correction of azotemia with DI if we didn't address the DI and only administered fluids? Can you see ARF with diluting ability in the kidneys? Let me know what you think! I'm cross-posting to IM as well. Thanks. ☼

Could this be acute on chronic?

What were the cat's labs initially?

I have a 12yr FS beagle that appears to use both us and another veterinarian (don't know why). She is on L-thyroxine (prescribed by the other vet), but came to us for routine bloodwork prior to a dental. On the bloodwork, her T4 was WNL, but her Alk Phos was about 750. The rest of the bloodwork was normal. The owner has not reported any PU/PD. We use IDEXX for our labwork, and their website says the Alk Phos can be elevated from Soloxine use. But I can't find any VIN posts or references to corroborate this. Any thoughts?

Did you call idexx directly and ask them?

Can you post the current cbc/chem/ua?

Hi all, I have Jess, a 10 year old neutered male bichon fries who was tentatively diagnosed with hyperadrenocorticism by a previous vet in January of this year. He was initially PU/PD, eating a lot, pot bellied appearance and hair loss. His labwork (chem/cbc/t4/u/a) 12/02/2012 revealed the following abnormalities: ALT 390 (12-118) ALK Phos 3039 (5-131) URINE 3+ protein 2+ blood sp gravity 1016 At this time denamarin was started and an abdominal u/s was done which revealed a tumor on the left adrenal gland. The recommendations were to consider adrenalectomy or ACTH stimulation test, low dose dex test. Jessie's owners decline further treatment/diagnostics at this time. I saw Jessie for a vaccine visit and examination 6-22-2013. The owners were very pleased, he had lost a small amount of weight (on purpose per owner), growing fur back and less pot bellied. His drinking and urination is more under control per owner. Labwork abnormalities today are as follows: WBC 28.5 (4-15.5) platelets 436 ( 170-400) neuts 22800 ( 2060-10600) bands 855 (0-300) monocytes 1995 ( 0-840) ALT 531 ( 12-118) ALK PHOS 6304 ( 5-131) GLUCOSE 191 ( 70-138) Urine sp. gravity 1014 3 + protein trace glucose RBC 4-10 Casts- course granular 0-1 Bacteria cocci and rods 26-40 I am hesitant to initiate insulin for diabetes being that the blood glucose is only mildly elevated. Ideally, I would like the owner to do a urine c/s, a urine protein/creatine ratio, recheck a fasted blood glucose, consider a recheck abdominal u/s. The owner's have limited funds, so I am trying to prioritize tests and treatments. If the owner declines any further testing I am planning to send Jessie home on Baytril and Clavamox, minimally recheck cbc/u/a and blood glucose in 2 weeks, fasted. I also am going to recommend w/d diet. My rule-outs are cushings vs adrenal tumor, diabetes mellitus, pyelonephritis (kidney values are normal), fanconi syndrome, neoplasia. Any thoughts or suggestions on Jessie would be much appreciated. Thanks in advance, ☼

Control cushing's if present....can i see the actual ultrasound report from december?

What's his current diet?

Hi, So have a cat with so many problems it seems laughable to ask about the alopecia but it is currently the owner's main concern. Jake is an 18 year old MN DLH who has been diabetic for at least 10 years. Currently well regulated on PZI insulin. Had an enucleation last year for non healing corneal ulcer. Has lung masses that are presumed to be neoplasia, but O. has opted not to have aspirate done. Cat also has HCM, low grade IBD and hypertension. Also anemic. He is on Dasuquin, FA, pednisilone benazepril, PZI, amlodipine. His most recent problem is hair loss over his shoulder blades with some crusting. SS-negative, skin cytology- normal, DTM- negative. For some reason this is the owner's primary concern at this time. I am attaching a picture. Any thoughts as to what I should do for this? Thanks! ☼

Is this an area where she applies flea control?

Is the owner moving the injections around on the cat's body every day?

Hey there. So I saw this dog for the first time a few days ago. Another vet was treating her and is now on maternity leave, so this little treat is all mine :) The patient is a 9yr MN yorkie that is very poorly controlled diabetic. He won't eat regularly, so when he presented to me he hadnt eaten for almost 48 hours and the o gave him 9 units of humulin that morning. I was expecting to treat a hypoglycemic crash but his initial BG was 346 at 2 hours post-insulin and 225 at 5 hours post insulin. The dog has a pendulous abdomen, pu/pd and panting all the time. Sure sounded cushingoid to me. Blood work also showed: ALKP 367 (23-212) Chol 468 (110-320) TBili 1.1 (0-0.9) Glob 5.3 (2.5-4.5) All else on CBC/Chem was wnl I ran an ACTH stim and the following results came back: Pre - 8.9 ug/dL Post- 19.2ug/dL I could use some help interpreting these results! Thanks! ☼

How much does he weigh?

Any known spinal issues?

Hey there. So I saw this dog for the first time a few days ago. Another vet was treating her and is now on maternity leave, so this little treat is all mine :) The patient is a 9yr MN yorkie that is very poorly controlled diabetic. He won't eat regularly, so when he presented to me he hadnt eaten for almost 48 hours and the o gave him 9 units of humulin that morning. I was expecting to treat a hypoglycemic crash but his initial BG was 346 at 2 hours post-insulin and 225 at 5 hours post insulin. The dog has a pendulous abdomen, pu/pd and panting all the time. Sure sounded cushingoid to me. Blood work also showed: ALKP 367 (23-212) Chol 468 (110-320) TBili 1.1 (0-0.9) Glob 5.3 (2.5-4.5) All else on CBC/Chem was wnl I ran an ACTH stim and the following results came back: Pre - 8.9 ug/dL Post- 19.2ug/dL I could use some help interpreting these results! Thanks! ☼

Does he have ketones today?

This seems high for a cat, is he overweight, what is his bcs?

I have an 11 year old FS basset hound who had a 1 year history of unresolved E. Coli UTI. At the time of the initial UTI, she had a several year seizure history and was seeing a neurologist and is currently on zonisamide, KBR, and Phenobarbital. The only abnormality on her PE was a hooded, recessed vulva. Her initial UA had rods and specific gravity of 1.017. After a few courses of antibiotics based on C&S, the infection was still present. August of 2012, she had abdominal radiographs which were normal, CBC and CHEM normal except increased ALP of 424 and abdominal ULT done by radiologist which found bilateral pyelectasia secondary to PU/PD or less likely pyelonephritis, urinary sediment (possible crystals, cells, blood). No bladder wall thickening or stones seen. Based on these findings a vulvoplasty was performed to repair her confirmation and she was sent home on zenequin for 1 month. At the recheck she cultured Klebsiella and urine specific gravity was 1.006 and the owner reported she was still extremely PU/PD. At this point a LDDS test was performed and she was placed on trimethoprim/sulfa (based on culture results). The LDDS was abnormal at pre 3.7, 4 hour 1.9 and post 2.4. She was started on vetoryl 60 mg SID. The recheck ACTH stim was done at 14 days and 1 month and 3 months. The last ACTH stim demonstrated good control at 2.8 pre, 7.8 post. However, the owner reported still PU/PD and urine culture was E. Coli again. She was started on simplicef based on C&S results and specific gravity of urine 1.006. The dog was not improving on the simplicef. I switched her Baytril and considering treating for concurrent diabetes insipidis by doing an at home trial with DDAVP. She was started on Desmopressin 0.2mg TID and the owner collected urine samples on day 12, 13 and 14 of treatment. The specific gravity was increased to 1.020 and the owner was happy because she was not waking them up at night to urinate and no accidents in the house. She was decreased on the Desmopressin 0.2mg BID and continued on the baytril for 30 days. This brings us to her recent recheck culture which still is positive for E.Coli :( Still at 100,000 colonies/ml. Again, the susceptibility as changed and it is not susceptible to baytril but is to simplicef! Please help. When I do a quick ultrasound myself her bladder is huge with sediment. I don't know what to do next to try to get this infection cleared. I was considering cystotomy to clean out sediment? Maybe bethanicol? Could she not be emptying out her bladder properly? It seems when I think I diagnose/treat an underlying issue that could be the cause it does not help.. Should I consider a simplicef/baytril combo for several months. It seems the susceptibility of the E.Coli changes with the antibiotic I have her on. Thanks for the advice. This case is driving me crazy.

What were size of adrenals on ultrasound?

How did the prostate look?

I have an 11 year old FS basset hound who had a 1 year history of unresolved E. Coli UTI. At the time of the initial UTI, she had a several year seizure history and was seeing a neurologist and is currently on zonisamide, KBR, and Phenobarbital. The only abnormality on her PE was a hooded, recessed vulva. Her initial UA had rods and specific gravity of 1.017. After a few courses of antibiotics based on C&S, the infection was still present. August of 2012, she had abdominal radiographs which were normal, CBC and CHEM normal except increased ALP of 424 and abdominal ULT done by radiologist which found bilateral pyelectasia secondary to PU/PD or less likely pyelonephritis, urinary sediment (possible crystals, cells, blood). No bladder wall thickening or stones seen. Based on these findings a vulvoplasty was performed to repair her confirmation and she was sent home on zenequin for 1 month. At the recheck she cultured Klebsiella and urine specific gravity was 1.006 and the owner reported she was still extremely PU/PD. At this point a LDDS test was performed and she was placed on trimethoprim/sulfa (based on culture results). The LDDS was abnormal at pre 3.7, 4 hour 1.9 and post 2.4. She was started on vetoryl 60 mg SID. The recheck ACTH stim was done at 14 days and 1 month and 3 months. The last ACTH stim demonstrated good control at 2.8 pre, 7.8 post. However, the owner reported still PU/PD and urine culture was E. Coli again. She was started on simplicef based on C&S results and specific gravity of urine 1.006. The dog was not improving on the simplicef. I switched her Baytril and considering treating for concurrent diabetes insipidis by doing an at home trial with DDAVP. She was started on Desmopressin 0.2mg TID and the owner collected urine samples on day 12, 13 and 14 of treatment. The specific gravity was increased to 1.020 and the owner was happy because she was not waking them up at night to urinate and no accidents in the house. She was decreased on the Desmopressin 0.2mg BID and continued on the baytril for 30 days. This brings us to her recent recheck culture which still is positive for E.Coli :( Still at 100,000 colonies/ml. Again, the susceptibility as changed and it is not susceptible to baytril but is to simplicef! Please help. When I do a quick ultrasound myself her bladder is huge with sediment. I don't know what to do next to try to get this infection cleared. I was considering cystotomy to clean out sediment? Maybe bethanicol? Could she not be emptying out her bladder properly? It seems when I think I diagnose/treat an underlying issue that could be the cause it does not help.. Should I consider a simplicef/baytril combo for several months. It seems the susceptibility of the E.Coli changes with the antibiotic I have her on. Thanks for the advice. This case is driving me crazy.

Secondly, is dog symptomatic for uti?

Did she have pancreatitis?

This is a 12 yr. old male neutered Yorkshire t. which has had a long hx of dermatitis that is antibiotic responsive but common reoccurences. The dogs haircoast is sparse on the truck of the body and lesions are diffuse subcorneal collarettes. Simplicef has typically been controlling, long term resolution has not been successful. During allergy seasons the dog has been treated with temaril p. In the feb. period of this year, 4 mos ago the dog was treated with atopica, which produce dermatological improvement, but the dog had chronic diarrhea and this treatment was discontinued two months ago. At that time the dog had an elevation of the BUN in comparison to the Cr, and this elevation was attributed to gi blood loss. The BUN since has returned to 35. At this same time the dog's urine protein/ Cr. was determined to be 8.2 and the dog was hypertensive with a BP of over 220. Norvasc was started and the BP did not decrease. Eventually Norvasc and benzapril were combined and still the BP was 300. I repeated the urine protein/cr ratio and it has increased to 11.2. With values so high for the BP I am wondering if this dog has a pheochromocytoma. Cushings seems very unlikely in that liver values are normal and the dog is puretic. It seems that the dx of pheochromocytoma is challenging and is by ultrasound by a good tech or urine catocholamines through Mayfield labs or perhaps a test through U.C. Davis. Should the dog be tested for cushing's, lddt, if it is puretic, and has normal liver values? The owner asked if the dog could just be treated for pheochromocytoma therapy, which appears to be beta-blockers. I did not know the answer; thus, I began to read on b-blockers. Would that be propranolol? This AM's search brought forward prazosin and phenxybenzamine , which was not my expectation. My first goal has been to control the dogs blood pressure and to reduce the proteinuria. I may be being drawn toward pheochromocytomas in correctly. Can you comment? ☼

Does this dog concentrate it's urine well?

Were the cortisols run at a commercial lab?

This is a 12 yr. old male neutered Yorkshire t. which has had a long hx of dermatitis that is antibiotic responsive but common reoccurences. The dogs haircoast is sparse on the truck of the body and lesions are diffuse subcorneal collarettes. Simplicef has typically been controlling, long term resolution has not been successful. During allergy seasons the dog has been treated with temaril p. In the feb. period of this year, 4 mos ago the dog was treated with atopica, which produce dermatological improvement, but the dog had chronic diarrhea and this treatment was discontinued two months ago. At that time the dog had an elevation of the BUN in comparison to the Cr, and this elevation was attributed to gi blood loss. The BUN since has returned to 35. At this same time the dog's urine protein/ Cr. was determined to be 8.2 and the dog was hypertensive with a BP of over 220. Norvasc was started and the BP did not decrease. Eventually Norvasc and benzapril were combined and still the BP was 300. I repeated the urine protein/cr ratio and it has increased to 11.2. With values so high for the BP I am wondering if this dog has a pheochromocytoma. Cushings seems very unlikely in that liver values are normal and the dog is puretic. It seems that the dx of pheochromocytoma is challenging and is by ultrasound by a good tech or urine catocholamines through Mayfield labs or perhaps a test through U.C. Davis. Should the dog be tested for cushing's, lddt, if it is puretic, and has normal liver values? The owner asked if the dog could just be treated for pheochromocytoma therapy, which appears to be beta-blockers. I did not know the answer; thus, I began to read on b-blockers. Would that be propranolol? This AM's search brought forward prazosin and phenxybenzamine , which was not my expectation. My first goal has been to control the dogs blood pressure and to reduce the proteinuria. I may be being drawn toward pheochromocytomas in correctly. Can you comment? ☼

Have we looked at several random first morning usg's?

Did we exclude a uti in this cat?

Went there. - ------------- "...and The Problem List will lead them"

Does pure unadulterated pln cause hypertension?

What diet is he eating?

Went there. - ------------- "...and The Problem List will lead them"

Or is it merely "associative" because many dogs with pln have interstitial nephropathies as well (that are undetected at the time of diagnosis), and has been misattributed to the pln by previous authors?

Guess i don't understand what you are saying/asking?

Hello; My associate found this tooth with a draining tract below the chin. She was afraid of bking the jaw trying to extract. o will not refer. Can this tooth be taken out safely? What is your technique to avoid mand fracture? Thanks,

What are the barriers?

Absolutely sure she's spayed?

Hello; My associate found this tooth with a draining tract below the chin. She was afraid of bking the jaw trying to extract. o will not refer. Can this tooth be taken out safely? What is your technique to avoid mand fracture? Thanks,

If you accept this case and the jaw does bk, are you prepared to deal with a fractured jaw?

Don’t you think that it is then time for the human behind that computer to engage in a bit of common sense thinking?

Hi, I have an 11 yr old MN, DMH, 7.44 kg, cat that has been having intermittent episodes of gastrointestinal irritation (i.e vom and /or diarrhea). In 2010, had many episodes that required IVF due to vom/dia. Once on z/d everything settled for 10 months, at which time, he had another episode of leth, vom/dia. Settled again and had another episode 12 months later 2012. His current episode has been unusual in the sense there has been no vom, but chronic diarrhea, bloods were all normal. Fecals were negative, cytologies were unremarkable. The feces varies from soft to liquid. Spread throughout the feces evenly are these small white dots like grains of coarse sand or salt. The owner and I discussed further diagnostics but they declined for financial reasons. He was wormed, treated with metronidazole and pred was tried (the pred helped for 3 days and then went back to the same). Does any one have any suggestions, should we try a diff food (hypo HP?). I told the owner we need an ultrasound but for now they can't afford. He was originally losing weight rapidly but now has put weight back on. He is now hungry all the time and complaining for food. Malassimilation? Malabsorptive? Vit B injections? Please, any suggestions? Thanks

Is he eating the dry z/d?

Sheri, do you have any suggestions?

Hi, I have an 11 yr old MN, DMH, 7.44 kg, cat that has been having intermittent episodes of gastrointestinal irritation (i.e vom and /or diarrhea). In 2010, had many episodes that required IVF due to vom/dia. Once on z/d everything settled for 10 months, at which time, he had another episode of leth, vom/dia. Settled again and had another episode 12 months later 2012. His current episode has been unusual in the sense there has been no vom, but chronic diarrhea, bloods were all normal. Fecals were negative, cytologies were unremarkable. The feces varies from soft to liquid. Spread throughout the feces evenly are these small white dots like grains of coarse sand or salt. The owner and I discussed further diagnostics but they declined for financial reasons. He was wormed, treated with metronidazole and pred was tried (the pred helped for 3 days and then went back to the same). Does any one have any suggestions, should we try a diff food (hypo HP?). I told the owner we need an ultrasound but for now they can't afford. He was originally losing weight rapidly but now has put weight back on. He is now hungry all the time and complaining for food. Malassimilation? Malabsorptive? Vit B injections? Please, any suggestions? Thanks

How much pred (prednisolone?

The owner can accurately measure and then inject the insulin--using u40 syringes?

Hi, I have an 11 yr old MN, DMH, 7.44 kg, cat that has been having intermittent episodes of gastrointestinal irritation (i.e vom and /or diarrhea). In 2010, had many episodes that required IVF due to vom/dia. Once on z/d everything settled for 10 months, at which time, he had another episode of leth, vom/dia. Settled again and had another episode 12 months later 2012. His current episode has been unusual in the sense there has been no vom, but chronic diarrhea, bloods were all normal. Fecals were negative, cytologies were unremarkable. The feces varies from soft to liquid. Spread throughout the feces evenly are these small white dots like grains of coarse sand or salt. The owner and I discussed further diagnostics but they declined for financial reasons. He was wormed, treated with metronidazole and pred was tried (the pred helped for 3 days and then went back to the same). Does any one have any suggestions, should we try a diff food (hypo HP?). I told the owner we need an ultrasound but for now they can't afford. He was originally losing weight rapidly but now has put weight back on. He is now hungry all the time and complaining for food. Malassimilation? Malabsorptive? Vit B injections? Please, any suggestions? Thanks

Prednisone?) and metronidazole was he treated with?

How was the urine sample obtained?

Hi, I have an 11 yr old MN, DMH, 7.44 kg, cat that has been having intermittent episodes of gastrointestinal irritation (i.e vom and /or diarrhea). In 2010, had many episodes that required IVF due to vom/dia. Once on z/d everything settled for 10 months, at which time, he had another episode of leth, vom/dia. Settled again and had another episode 12 months later 2012. His current episode has been unusual in the sense there has been no vom, but chronic diarrhea, bloods were all normal. Fecals were negative, cytologies were unremarkable. The feces varies from soft to liquid. Spread throughout the feces evenly are these small white dots like grains of coarse sand or salt. The owner and I discussed further diagnostics but they declined for financial reasons. He was wormed, treated with metronidazole and pred was tried (the pred helped for 3 days and then went back to the same). Does any one have any suggestions, should we try a diff food (hypo HP?). I told the owner we need an ultrasound but for now they can't afford. He was originally losing weight rapidly but now has put weight back on. He is now hungry all the time and complaining for food. Malassimilation? Malabsorptive? Vit B injections? Please, any suggestions? Thanks

Do his intestines feel very thickened?

When was the last stim?

Hi, I have an 11 yr old MN, DMH, 7.44 kg, cat that has been having intermittent episodes of gastrointestinal irritation (i.e vom and /or diarrhea). In 2010, had many episodes that required IVF due to vom/dia. Once on z/d everything settled for 10 months, at which time, he had another episode of leth, vom/dia. Settled again and had another episode 12 months later 2012. His current episode has been unusual in the sense there has been no vom, but chronic diarrhea, bloods were all normal. Fecals were negative, cytologies were unremarkable. The feces varies from soft to liquid. Spread throughout the feces evenly are these small white dots like grains of coarse sand or salt. The owner and I discussed further diagnostics but they declined for financial reasons. He was wormed, treated with metronidazole and pred was tried (the pred helped for 3 days and then went back to the same). Does any one have any suggestions, should we try a diff food (hypo HP?). I told the owner we need an ultrasound but for now they can't afford. He was originally losing weight rapidly but now has put weight back on. He is now hungry all the time and complaining for food. Malassimilation? Malabsorptive? Vit B injections? Please, any suggestions? Thanks

Any focal areas of thickening?

Potassium and renal parameters wnl?

Hi, I have an 11 yr old MN, DMH, 7.44 kg, cat that has been having intermittent episodes of gastrointestinal irritation (i.e vom and /or diarrhea). In 2010, had many episodes that required IVF due to vom/dia. Once on z/d everything settled for 10 months, at which time, he had another episode of leth, vom/dia. Settled again and had another episode 12 months later 2012. His current episode has been unusual in the sense there has been no vom, but chronic diarrhea, bloods were all normal. Fecals were negative, cytologies were unremarkable. The feces varies from soft to liquid. Spread throughout the feces evenly are these small white dots like grains of coarse sand or salt. The owner and I discussed further diagnostics but they declined for financial reasons. He was wormed, treated with metronidazole and pred was tried (the pred helped for 3 days and then went back to the same). Does any one have any suggestions, should we try a diff food (hypo HP?). I told the owner we need an ultrasound but for now they can't afford. He was originally losing weight rapidly but now has put weight back on. He is now hungry all the time and complaining for food. Malassimilation? Malabsorptive? Vit B injections? Please, any suggestions? Thanks

Do you think the owner would allow a maldigestion profile - tli/b12/folate +/- pli?

What was your bg curve?

Hi, I have an 11 yr old MN, DMH, 7.44 kg, cat that has been having intermittent episodes of gastrointestinal irritation (i.e vom and /or diarrhea). In 2010, had many episodes that required IVF due to vom/dia. Once on z/d everything settled for 10 months, at which time, he had another episode of leth, vom/dia. Settled again and had another episode 12 months later 2012. His current episode has been unusual in the sense there has been no vom, but chronic diarrhea, bloods were all normal. Fecals were negative, cytologies were unremarkable. The feces varies from soft to liquid. Spread throughout the feces evenly are these small white dots like grains of coarse sand or salt. The owner and I discussed further diagnostics but they declined for financial reasons. He was wormed, treated with metronidazole and pred was tried (the pred helped for 3 days and then went back to the same). Does any one have any suggestions, should we try a diff food (hypo HP?). I told the owner we need an ultrasound but for now they can't afford. He was originally losing weight rapidly but now has put weight back on. He is now hungry all the time and complaining for food. Malassimilation? Malabsorptive? Vit B injections? Please, any suggestions? Thanks

How is his current bcs?

Does the prostate palpate normally and non-painfully?

Pradah is a 12y3m FS 2.3kg Yorkie who was diagnosed with diabetes mellitus back in October 2012. She was started on 1 unit Humulin-N insulin and 3/8 cup RC Diabetic food q12h. On 6/12/13, pet received 2 units Humulin-N and the food in the AM @ 0700. BG: 0830 - 421 1030 - 366 1230 - 378 1430 - >500 discontinued curve at this point. Urine culture negative on this visit. Instructed owner to increase Humulin-N dose to 3 units q12h, come back in 1 week for recheck curve. This morning (6/26/13), pet received 3/8 cup of Diabetic food and 3 units Humulin-N sc @ 0730 BG 0830 - 120 0930 - 107 1030 - 94 1130 - 86 1245 - 90 1330 - 93 1430 - 93 1630 - 100 1830 - have not taken yet I'm wondering if i should be trying to back this pet off to 2.5 units q12h. None of these readings are technically low, but I'm worried about hypoglycemia after the next dose. Also, it can get a bit sketchy with clients trying to measure 1/2 unit on the U-100 needles. Thanks for any thoughts ☼

Do you have a bg curve on the initial dose of 1 unit bid?

What should she weigh?

I have recently taken over a young GRT (2yo male neuter) with juvenile DM. I have not had too much to do with the dog as it was stable. In recent weeks, he has had a couple of hypo episodes (collapsed on walk). The owner is pretty hands-on and has an alphatrak. Unfortunately, he is adjusting the insulin dose without veterinary input so I know I need to advise him against doing that! Dog is on Caninsulin (porcine lente) and Royal Canin dry food. Clinically, he looks very well and is in excellent body condition. It seems as if in the last few weeks, a previously stable dog has become unstable. Dog weighs around 25kg. The owner emailed me some blood results: Date Time Glucose Units Time of Injection 23-Jun 11:45 9.3 16 08:00 24-Jun 08:00 23.9 11:00 21.4 13:10 20.1 15:00 5.4 17:30 5.5 16 18:00 22:50 19.4 25-Jun 08:45 8.7 16 08:45 10:45 14.7 16:30 6.1 18:30 7.3 16 18:30 20:00 13.9 26-Jun 08:30 9.1 16 08:30 10:30 23.4 18:00 22.9 16 18:00 20:30 8.5 27-Jun 08:30 34.4 17 08:30 17:00 17.6 17 17:30 19:00 7.4 23:00 12.2 So, the first thing that strikes me is that he isn't injecting every 12 hours! Sometimes as short as 9.5 hours. I also get the impression that the insulin is lasting quite a long time but perhaps I can't say that if he isn't injecting every 12 hours. My thought was to keep him on 17 units twice daily for 4-5 days with o injecting q12h then get o to generate 2h blood glucose curve for the day at home. Is that a reasonable plan? Other comments much appreciated! Many thanks ☼

His appetite hasn't fluctuated recently?

What antibiotic is the dog currently on?

I have recently taken over a young GRT (2yo male neuter) with juvenile DM. I have not had too much to do with the dog as it was stable. In recent weeks, he has had a couple of hypo episodes (collapsed on walk). The owner is pretty hands-on and has an alphatrak. Unfortunately, he is adjusting the insulin dose without veterinary input so I know I need to advise him against doing that! Dog is on Caninsulin (porcine lente) and Royal Canin dry food. Clinically, he looks very well and is in excellent body condition. It seems as if in the last few weeks, a previously stable dog has become unstable. Dog weighs around 25kg. The owner emailed me some blood results: Date Time Glucose Units Time of Injection 23-Jun 11:45 9.3 16 08:00 24-Jun 08:00 23.9 11:00 21.4 13:10 20.1 15:00 5.4 17:30 5.5 16 18:00 22:50 19.4 25-Jun 08:45 8.7 16 08:45 10:45 14.7 16:30 6.1 18:30 7.3 16 18:30 20:00 13.9 26-Jun 08:30 9.1 16 08:30 10:30 23.4 18:00 22.9 16 18:00 20:30 8.5 27-Jun 08:30 34.4 17 08:30 17:00 17.6 17 17:30 19:00 7.4 23:00 12.2 So, the first thing that strikes me is that he isn't injecting every 12 hours! Sometimes as short as 9.5 hours. I also get the impression that the insulin is lasting quite a long time but perhaps I can't say that if he isn't injecting every 12 hours. My thought was to keep him on 17 units twice daily for 4-5 days with o injecting q12h then get o to generate 2h blood glucose curve for the day at home. Is that a reasonable plan? Other comments much appreciated! Many thanks ☼

The amount of exercise hasn't fluctuated recently?

I am not sure what to make of the toxoplasma titers....are these high values for your lab?

Hi all! Working through a PU/PD case that is confusing me. Hoping for some help. This is an 11 year old male/neutered maltese. The farthest history I have is 9/2011. Presented for routine exam. No PU/PD, Routine CBC/Chem done for dental cleaning purposes. Tbili = 0.9 (.0.1-0.8) rest within normal Had dental 3/28/12 Little lethargic, seems a little uncomfortable when touched on sides per owner. Normal PE. CBC/Chem done BUN = 29 (4-26) Calcium = 11.3 (9-11.1) Put on a renal support supplement. Sigh. 7/24/12 Renal panel BUN = 15 Creat 0.6 Caclium 10.9 phos 5.4 all normal. supplement worked! I saw him on 6/19. Weight stable. Fairly normal PE (benign sq masses and mild dental dz). Again owner notes cries out sometimes when touched on sides. owner notes PU/PD. 4DX test - negative CBC/Chem/T4 and U/A by cysto T4= 4.4 (1-4) BUN = 35 Creat = 2.0 (0.4-1.5) Calcium - 11.2 (9-11.1) Phosphorus- 6.4 (2.2-6.1) Nucleated RBC 1 (1) USG = 1.003 - this is first a.m. sample done the following day - 6/20 NSF sediment Urine culture in house is negative Baseline cortisol - 10.6 - ruled out addison's PTH and ionized calcium pending Questions: Should I be thinking about the hypercalcemia as a primary cause that may have lead to renal damage and azotemia or is the degree of hypercalcemia not high enough for that to be likely? I'm thinking abdominal ultrasound is the next logical step. Seems like a long time frame for lepto, but should suggest titers. Here are my rule outs from here forward: hypercalcemia - malignancy, idiopathic, hyperparathyroidism Chronic renal disease central diabetes insipidis Should I be considerintg that there are multiple conditions going on concurrently or can all of my findings be explained with one? Thank you for the help!

Was the dog dehydrated?

What should she weigh?

Hello! Question about my own cat. Simon is a 15 year old m/c siameese/abbysinian cross. He had a bout of vomiting in December and seemed to be loosing weight. I Ran a CBC/ Chemistry/ T4 and TLI, Cobalamin and Folate on him. Results were normal except for a Cobalamin of 154 ng/L (290-1499). His T4 was 2.5 and Glucose was 80. I changed his diet to mostly canned food (Iams chicken or Iams turkey pate) and started him on weekly Cobalamin injections for a month then every other week for a month then monthly. His vomting pretty much went away and he seemed to be doing great. Fast forward to several weeks ago, I found myself cleaning out his litterbox more often than usual and he seemed hungry all of the time though he seemed to be loosing weight. Took him into the clinic yesterday and repeated the labwork as well as a u/a. He weighed 10lbs in December and now weighs 8 lbs!! Labwork indicates a UTI with 3+ glucosuria, Glucose is now 255, T4 1.9. Rest of the labwork is normal again. I did not repeat Cobalamin, TLI or folate this time. I changed his diet to Purina canned DM and started him on antibiotics for the UTI. I plan to purchase a glucometer to measure glucose levels at home because he is so stressed --cries, vomits, diarrhea, urinations in crate during the car ride to the clinic. I am wondering if I should go ahead and start insulin at the glucose level of 255 or if I should try just changing his diet to DM and see what happens with his glucose levels? Any input would be greatly appreciated. This is my 9 year old daughter's buddy so I want to do anything for him I can. Thanks! ☼

I'd run a couple more bg's on him....do you think you could bring home a glucometer so he'd be less stressed?

The owner moves the injections around on his body every day?

Hello! Question about my own cat. Simon is a 15 year old m/c siameese/abbysinian cross. He had a bout of vomiting in December and seemed to be loosing weight. I Ran a CBC/ Chemistry/ T4 and TLI, Cobalamin and Folate on him. Results were normal except for a Cobalamin of 154 ng/L (290-1499). His T4 was 2.5 and Glucose was 80. I changed his diet to mostly canned food (Iams chicken or Iams turkey pate) and started him on weekly Cobalamin injections for a month then every other week for a month then monthly. His vomting pretty much went away and he seemed to be doing great. Fast forward to several weeks ago, I found myself cleaning out his litterbox more often than usual and he seemed hungry all of the time though he seemed to be loosing weight. Took him into the clinic yesterday and repeated the labwork as well as a u/a. He weighed 10lbs in December and now weighs 8 lbs!! Labwork indicates a UTI with 3+ glucosuria, Glucose is now 255, T4 1.9. Rest of the labwork is normal again. I did not repeat Cobalamin, TLI or folate this time. I changed his diet to Purina canned DM and started him on antibiotics for the UTI. I plan to purchase a glucometer to measure glucose levels at home because he is so stressed --cries, vomits, diarrhea, urinations in crate during the car ride to the clinic. I am wondering if I should go ahead and start insulin at the glucose level of 255 or if I should try just changing his diet to DM and see what happens with his glucose levels? Any input would be greatly appreciated. This is my 9 year old daughter's buddy so I want to do anything for him I can. Thanks! ☼

Can you get the purina glucotest granules to sprinkle in his litter?

That is hair loss, pot belly, thin skin, etc?

Hello! Question about my own cat. Simon is a 15 year old m/c siameese/abbysinian cross. He had a bout of vomiting in December and seemed to be loosing weight. I Ran a CBC/ Chemistry/ T4 and TLI, Cobalamin and Folate on him. Results were normal except for a Cobalamin of 154 ng/L (290-1499). His T4 was 2.5 and Glucose was 80. I changed his diet to mostly canned food (Iams chicken or Iams turkey pate) and started him on weekly Cobalamin injections for a month then every other week for a month then monthly. His vomting pretty much went away and he seemed to be doing great. Fast forward to several weeks ago, I found myself cleaning out his litterbox more often than usual and he seemed hungry all of the time though he seemed to be loosing weight. Took him into the clinic yesterday and repeated the labwork as well as a u/a. He weighed 10lbs in December and now weighs 8 lbs!! Labwork indicates a UTI with 3+ glucosuria, Glucose is now 255, T4 1.9. Rest of the labwork is normal again. I did not repeat Cobalamin, TLI or folate this time. I changed his diet to Purina canned DM and started him on antibiotics for the UTI. I plan to purchase a glucometer to measure glucose levels at home because he is so stressed --cries, vomits, diarrhea, urinations in crate during the car ride to the clinic. I am wondering if I should go ahead and start insulin at the glucose level of 255 or if I should try just changing his diet to DM and see what happens with his glucose levels? Any input would be greatly appreciated. This is my 9 year old daughter's buddy so I want to do anything for him I can. Thanks! ☼

If i could go back, i'd have cultured the urine (then you could start an antibiotic while awaiting the results), as we want to use the 'smallest gun' antibiotic that will work, for at least 4 weeks, then culture when off for 1 week, then 1 month later, then once every 4-6 months for the long haul (via cysto, 'automatically', even if the sediment is quiet....now it's not too clear whether we need to do all of that?

Is the cat only on the canned version of a high protein/low carb diet?

Hi, 2days ago I was presented with a very thin ~10yo FN DSH. Owner's complaints - dramatic weight loss over a couple of weeks, PU/PD for a longer period, perhaps months, past 24hrs very subdued, poor appetite, vomited once. The cat was in very poor condition, tachypnoeic, otherwise nothing detected. Spot BG = 16.7, urine - SG = 1.041, glucose +++, ketone +++, blood +, protein +, bilirubin -ve, poss cocci in sediment. Blood was sent out, urine sent for C/S. Diagnosis of DM/DKA +/- other dependent on further work up. Lengthy discussion culminated in trialling treatment as outpatient. Gave convenia, s/c fluids and started glargine 1 unit BID (2.2kg cat), low CHO diet. Recheck 24hrs, advised hospitalization unavoidable if inappetance. BIOCHEMISTRY Fructosamine........... 413 umol/l Fructosamine reference limits in non diabetic patients 160-350(Canine) 175-400(Feline) Fructosamine reference for monitoring diabetics Fair Control Less than 450(Canine) Less than 500(Feline) Poor Control More than 450(Canine) More than 550 (Feline) Investigative Profile Feline Intestinal Screen Full Blood Count WBC.................... H 21.8 x10^9/l 4.0 - 15.0 RBC.................... 7.76 x10^12/l 5.50 - 10.00 Haemoglobin............ 12.0 g/dl 8.0 - 15.0 PCV.................... 34.1 % 27.0 - 50.0 MCV.................... 43.9 fl 40.0 - 55.0 MCH.................... 15.5 pg 13.0 - 17.0 MCHC................... H 35.2 g/dl 31.0 - 34.0 Platelets.............. 582 x10^9/l 200 - 600 % x10^9/l Range Neutrophils 93 H 20.3 2.5 - 12.5 Bd Neutrophils 0 0.0 0.0 - 0.3 Lymphocytes 5 L 1.1 1.5 - 7.0 Monocytes 2 0.4 0.0 - 0.8 Eosinophils 0 0.0 0.0 - 1.5 Basophils 0 0.0 % x10^9/l Range Film : Occasional platelet clumps in film - true count may be higher than shown Normal red cell morphology Total Protein.......... H 83.3 g/l 54.0 - 78.0 Albumin................ 32.4 g/l 21.0 - 39.0 Total Globulin......... 50.9 g/l 15.0 - 57.0 Comment: Sample lipaemic Urea................... 9.2 mmol/l 6.0 - 10.0 Creatinine............. 71 umol/l 60 - 170 Total Bilirubin........ 6.2 umol/l 0.0 - 10.0 ALP.................... H 42 u/l@37C 0 - 40 AST.................... H 108 u/l@37C 0 - 69 ALT.................... H 138 u/l@37C 0 - 20 Gamma GT............... 0.0 u/l@37C 0.0 - 27.0 GLDH................... H 20.0 u/l@37C 0.0 - 10.0 CK..................... H 585 u/l@37C 0 - 152 Bile Acids............. 4.5 umol/l 0.0 - 15.0 Cholesterol............ H 8.7 mmol/l 1.9 - 3.9 Triglycerides.......... H 36.70 mmol/l 0.22 - 1.24 Lipase................. 160 u/l@37 C 0 - 200 Glucose - Random....... No oxf received Sodium................. 143 mmol/l 120 - 155 Potassium.............. 4.00 mmol/l 3.60 - 5.60 Sodium : Potassium..... 35.75 Chloride............... L 96 mmol/l 112 - 129 Calcium................ 2.52 mmol/l 1.60 - 3.00 Phosphate.............. 1.51 mmol/l 1.40 - 2.60 B12/Folate B12.................... Less than 111 pmol/l (220 - 500) Folate................. 28.8 nmol/l 19.0 - 37.0 ________________________________________________________________________________ C/S pending Seen again this am - eating much better so elect continue as outpatient, recheck Monday. So - rock bottom cobalamin => GI disease. My working assumption is IBD/LSA and concurrent pancreatitis underlying the diabetic state. What do you think? I'm hopeful we can work through the DKA without hospitalization, seems that way just now. Should I start preds for the GI disease (after receiving urine culture)? I don't recall having treated a diabetic with steroids before. Thanks, ☼

Any chance for ultrasound in this kitty?

If that wasn't the case, then maybe the owner's observations were incorrect?

Hi! I am looking for help in managing a difficult diabetic. Paris is a 6 Year old spayed female Min Pin that was diagnosed with dm in February. The vet then started her on 2 units of NPH BID. Her first curve was done 3/4/13. Insulin was given at 7:30 am and at this time the dog was eating W/D. BG 9:30 am =328 mg/dl BG 11:30 am = 297 BG 1:30 pm =276 BG 3:30 =279 BG 5:30 =283 The insulin dose was increased to 3 units BID at this time. A spot check of the BG was done at 2:15 pm on 3/19/13 and was 370. At this point the dog was no longer eating the W/D and the owner did not wish to try any of the other diabetic diets. I first saw the dog on 5/9/13 for a checkup. BG was 491 mg/dl and Fructosamine was 535 still on 3 units NPH BID. Insulin was increased to 4 units BID, and a BG curve was performed on 5/16/13. Insulin was given at 6 am. BG 9:05 am = 233 mg/dl BG 10:10 am = 259 BG 11:30 am = 310 BG12:55 pm = 332 BG 2 pm = 286 BG 4:20 pm = 381 At this point it seemed to me the NPH insulin was only lasting about 4 hours, so I recommended changing the pet to Vetsulin at the same dose. Curve on the first day of Vetsulin with 4 units given at 7 am was: BG 9:05 am =300 BG 10 am =244 BG 11 am =287 BG 12 pm =410 Since no hypoglycemia was observed, I instructed the owner to continue at this dose and to recheck a curve and fructosamine in 2 weeks. BG curve on 6/6/13. Fructosamine was 592 (still high). Insulin given at 7 am BG 9am 225 BG 10 am 204 BG 11 am 197 BG 12 pm 229 BG 1 pm 303 BG 3 pm 377 Here it looked like we were getting a slightly longer duration of action, but still not long enough. I had the owner increase insulin to 4.5 U Vetsulin BID and told her we might have to switch to a longer acting product. 6/27/13 Fructosamine 450 (fair control). Insulin at 7 am. BG 9am 101 BG 10 am 100 BG 11:15 am 168 BG 12:45 pm 271 BG 2:45 pm 371 It looks like we're on the right track, but I think we still need a longer acting insulin. My question, since I have not used these in dogs, would be which one should I use and how should I begin dosing it? Thanks in advance for your help. /p DVM

How much does she weigh?

Other tests?