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Hi there. Rebel is a 12 year old DSH spayed female was first seen in February, 2013. She was slightly underweight at 2.77kg, had fleas and severe flea allergy dermatitis, marked periodontal disease. A full chemistry panel, and urinalysis was normal, including T4, but she had: Hct=0.23 (0.29-0.45) platelets=37 (170-600), no clumping. WBC's were off a bit too, but have since corrected. She was treated with Revolution, and given a high-calorie diet. On March 26, she looked and was doing much better, had gained a little weight, and we updated her vaccines. Her CBC came back as: Hct=0.32 Plats=43, no clumping. We proceeded with: FeLV/FIV Elisa and RealPCR=neg, tick panel neg (anaplasma, bartonella, cytauxzoon, ehrlichia, candidatus) (Cornell FAVD). On April 26, clinically doing well, recheck CBC was: Hct=0.36 Plats=22 She was started on prednisolone at about 2.6mg/kg once daily (7.5mg) She is a tiny 2.9kg cat. May 10, she was up to 3.0kg, clinically well, recheck cbc: hct=.30 plats=63, marked clumping of platelets noted. No change in pred dose. May 29, up to 3.36kg and feeling great, recheck cbc: hct=0.29 plats=22, but small clot present no change in pred dose. June 27, up to 3.52kg, clinically great, recheck cbc: hct 0.29 plats=59, no clumping noted. So, it looks like she has responded to a degree (compatible with life), but not so much that I feel I can comfortably decrease pred at this point. I worry about staying at this dose long-term because of risk of diabetes, etc. SHould I start chlorambucil? Not sure where I should go from here. Thanks for help! ☼

Are the cbc's being run at a reference lab or in your hospital?

When was last estrus?

Hi there. Rebel is a 12 year old DSH spayed female was first seen in February, 2013. She was slightly underweight at 2.77kg, had fleas and severe flea allergy dermatitis, marked periodontal disease. A full chemistry panel, and urinalysis was normal, including T4, but she had: Hct=0.23 (0.29-0.45) platelets=37 (170-600), no clumping. WBC's were off a bit too, but have since corrected. She was treated with Revolution, and given a high-calorie diet. On March 26, she looked and was doing much better, had gained a little weight, and we updated her vaccines. Her CBC came back as: Hct=0.32 Plats=43, no clumping. We proceeded with: FeLV/FIV Elisa and RealPCR=neg, tick panel neg (anaplasma, bartonella, cytauxzoon, ehrlichia, candidatus) (Cornell FAVD). On April 26, clinically doing well, recheck CBC was: Hct=0.36 Plats=22 She was started on prednisolone at about 2.6mg/kg once daily (7.5mg) She is a tiny 2.9kg cat. May 10, she was up to 3.0kg, clinically well, recheck cbc: hct=.30 plats=63, marked clumping of platelets noted. No change in pred dose. May 29, up to 3.36kg and feeling great, recheck cbc: hct=0.29 plats=22, but small clot present no change in pred dose. June 27, up to 3.52kg, clinically great, recheck cbc: hct 0.29 plats=59, no clumping noted. So, it looks like she has responded to a degree (compatible with life), but not so much that I feel I can comfortably decrease pred at this point. I worry about staying at this dose long-term because of risk of diabetes, etc. SHould I start chlorambucil? Not sure where I should go from here. Thanks for help! ☼

Are the feathered edges examined, to ensure that there are no platelet clumps there?

I wonder if lancing the ear (like testing blood sugar in a diabetic) could yield enough blood to run a test?

Hi there. Rebel is a 12 year old DSH spayed female was first seen in February, 2013. She was slightly underweight at 2.77kg, had fleas and severe flea allergy dermatitis, marked periodontal disease. A full chemistry panel, and urinalysis was normal, including T4, but she had: Hct=0.23 (0.29-0.45) platelets=37 (170-600), no clumping. WBC's were off a bit too, but have since corrected. She was treated with Revolution, and given a high-calorie diet. On March 26, she looked and was doing much better, had gained a little weight, and we updated her vaccines. Her CBC came back as: Hct=0.32 Plats=43, no clumping. We proceeded with: FeLV/FIV Elisa and RealPCR=neg, tick panel neg (anaplasma, bartonella, cytauxzoon, ehrlichia, candidatus) (Cornell FAVD). On April 26, clinically doing well, recheck CBC was: Hct=0.36 Plats=22 She was started on prednisolone at about 2.6mg/kg once daily (7.5mg) She is a tiny 2.9kg cat. May 10, she was up to 3.0kg, clinically well, recheck cbc: hct=.30 plats=63, marked clumping of platelets noted. No change in pred dose. May 29, up to 3.36kg and feeling great, recheck cbc: hct=0.29 plats=22, but small clot present no change in pred dose. June 27, up to 3.52kg, clinically great, recheck cbc: hct 0.29 plats=59, no clumping noted. So, it looks like she has responded to a degree (compatible with life), but not so much that I feel I can comfortably decrease pred at this point. I worry about staying at this dose long-term because of risk of diabetes, etc. SHould I start chlorambucil? Not sure where I should go from here. Thanks for help! ☼

Although rebel may, in fact, be a petite cat, does she evidence of chronic disease, such as loss of adipose and/or muscle mass over the dorsal spinous processes?

Any history of collapse?

Hi there. Rebel is a 12 year old DSH spayed female was first seen in February, 2013. She was slightly underweight at 2.77kg, had fleas and severe flea allergy dermatitis, marked periodontal disease. A full chemistry panel, and urinalysis was normal, including T4, but she had: Hct=0.23 (0.29-0.45) platelets=37 (170-600), no clumping. WBC's were off a bit too, but have since corrected. She was treated with Revolution, and given a high-calorie diet. On March 26, she looked and was doing much better, had gained a little weight, and we updated her vaccines. Her CBC came back as: Hct=0.32 Plats=43, no clumping. We proceeded with: FeLV/FIV Elisa and RealPCR=neg, tick panel neg (anaplasma, bartonella, cytauxzoon, ehrlichia, candidatus) (Cornell FAVD). On April 26, clinically doing well, recheck CBC was: Hct=0.36 Plats=22 She was started on prednisolone at about 2.6mg/kg once daily (7.5mg) She is a tiny 2.9kg cat. May 10, she was up to 3.0kg, clinically well, recheck cbc: hct=.30 plats=63, marked clumping of platelets noted. No change in pred dose. May 29, up to 3.36kg and feeling great, recheck cbc: hct=0.29 plats=22, but small clot present no change in pred dose. June 27, up to 3.52kg, clinically great, recheck cbc: hct 0.29 plats=59, no clumping noted. So, it looks like she has responded to a degree (compatible with life), but not so much that I feel I can comfortably decrease pred at this point. I worry about staying at this dose long-term because of risk of diabetes, etc. SHould I start chlorambucil? Not sure where I should go from here. Thanks for help! ☼

Does she have a history of vomiting of food, fluid and/or hair?

Have you checked for ketones?

in general, what is the protocol for adjusting insulin after an overdose in a dog? i can give the details prn, but in general, just want to kow this: the dose that got the dog in trouble was 12 units...(18 lb dog: we had worked up slowly from 4 units at original diagnosis, and for the last 2 months, seems like 12 units was the best so far - based on signs and curves)...also, there was no insulin resitance issue that we all of a sudden treated such that now the insulin dose would work better, and perhaps too good... but something happened (owner swears not an iatrogenic overdose) so that the dose was now too much...no evidence of insulinoma (the dog became hyperglycemic), no sepsis changes, etc... went to ER with clinical tremoring and BG was 40...they provided dextrose, etc, and the BGs normalized in their care... and then back to us... i usually cut the dose in half following a clinical hypoglycemic issue, and start over from there... is that too much of a cut?...too conservative? my main question here is: ok, so we cut the dose in half to 6 units...(the dog had not received insulin in 36 hours post hypoglycemic episode - the BG had risen to over 250 by 12 hours into ER visit, but other doctor here did not recommence insulin until 24 hours later)... so, the AM we restarted the insulin the the BG was 275...we started 6 units in the AM, and did a curve mostly to see things didn't get too low...the BG rose slowly with no drop in BG at all...got to about 322 at discharge...owners instructed to stay with 6 units BID and check spot check in mid day next day to make sure not too low... so in mid day the next day, BG is 424... my question: should i continue to be conservative and keep at 6 units for 5-7 days and then perform curve before any change, OR should i not be a weenie, assume 6 units is not touching these BGs, and increase now, to 7 or 8 units...? i don't love the idea of keeping this dog hyperglycemic for the whole week until we do a curve, if i have a feeling the 6 units likely is not enough...but i know safe medicine (which i love) would be to keep at 6 units, as it may start working better in a couple days... thanks all.... kane, dvm

Can i see some of the previous bg curves?

What about pupillary light reflexes?

History: Rimmer is a 16 year old MN DSH that was first diagnosed and treated for diabetes by a colleague early March 2013. The cat was started on 2 U caninsulin BID. The cat subsequently developed a cat bite abscess that was treated with 4 weeks of antibiotics and cleared. Curve 2 weeks later was subsequently as follows: 830 29 10 20.1 12 20 2pm 21.4 4pm 26.1 The cat was subsequently increased to 3 U twice daily. The subsequent curve was as follows 10am 20.3 12 midday 12.9 3pm 18.2 The insulin was subsequently increased to 3 1/2 insulin units BID. The owner subsequently performed a glucose curve at home 2 weeks later: 730am before food 16.2 mmol/L 930 10.8 mmol/L 1130 5.9 mmol/L 130 4.5mmol/L 330 11.2 mmol/L 530 17.9mmol/L 730 13.2 mmol/L I subsequently saw Rimmer 4 weeks following this curve. The cat was doing very well and had gained weight (1kg since starting on insulin). All vitals were within WNL with mild tartar on the teeth. We discussed the current diet. The owner had been giving commercial senior dry food. I advised to swap slowly to d/m however the owner has another cat of which she cannot feed separately that has allergies to the components of d/m. We decided on a compromise of cutting out dry slowly and maintaining on moist diet with low carbohydrate, high protein high fat diet. 4 days later the cat presented with hypoglycaemia and a BG of 2.1. I subsequently admitted the cat for a BG curve of which found to remain low for the following 4 hours and after 2 x meals increased back to 20mmol/L in the evening . I subsequently sent the cat home on reduced dose of 1 U caninsulin BID and to maintain on the change of diet. The owner subsequently performed a blood glucose curve at home last week and it was as follows: 750 am (before food/insulin) 23.3 950 19.1 1150 16.1 150 17.5 350 9.1 550 26.4 750 18.5 Reluctant to increase the dose given the nadir of 9.1 at 350 however is elevated at both ends of the day. Should I increase slightly (1.5 U) BID, feel this cat is close to remission. Any suggestions would be much appreciated.

I don't sense that he's that close to a remission now, but it looks like we could possibly get one if we could get the carbs in the diet low enough....so tell me exactly what the cat is eating now---is it all canned?

Can you please return and fill in the weight for this cat in the signalment?

History: Rimmer is a 16 year old MN DSH that was first diagnosed and treated for diabetes by a colleague early March 2013. The cat was started on 2 U caninsulin BID. The cat subsequently developed a cat bite abscess that was treated with 4 weeks of antibiotics and cleared. Curve 2 weeks later was subsequently as follows: 830 29 10 20.1 12 20 2pm 21.4 4pm 26.1 The cat was subsequently increased to 3 U twice daily. The subsequent curve was as follows 10am 20.3 12 midday 12.9 3pm 18.2 The insulin was subsequently increased to 3 1/2 insulin units BID. The owner subsequently performed a glucose curve at home 2 weeks later: 730am before food 16.2 mmol/L 930 10.8 mmol/L 1130 5.9 mmol/L 130 4.5mmol/L 330 11.2 mmol/L 530 17.9mmol/L 730 13.2 mmol/L I subsequently saw Rimmer 4 weeks following this curve. The cat was doing very well and had gained weight (1kg since starting on insulin). All vitals were within WNL with mild tartar on the teeth. We discussed the current diet. The owner had been giving commercial senior dry food. I advised to swap slowly to d/m however the owner has another cat of which she cannot feed separately that has allergies to the components of d/m. We decided on a compromise of cutting out dry slowly and maintaining on moist diet with low carbohydrate, high protein high fat diet. 4 days later the cat presented with hypoglycaemia and a BG of 2.1. I subsequently admitted the cat for a BG curve of which found to remain low for the following 4 hours and after 2 x meals increased back to 20mmol/L in the evening . I subsequently sent the cat home on reduced dose of 1 U caninsulin BID and to maintain on the change of diet. The owner subsequently performed a blood glucose curve at home last week and it was as follows: 750 am (before food/insulin) 23.3 950 19.1 1150 16.1 150 17.5 350 9.1 550 26.4 750 18.5 Reluctant to increase the dose given the nadir of 9.1 at 350 however is elevated at both ends of the day. Should I increase slightly (1.5 U) BID, feel this cat is close to remission. Any suggestions would be much appreciated.

What's the current %carbs?

How much does she weigh?

History: Rimmer is a 16 year old MN DSH that was first diagnosed and treated for diabetes by a colleague early March 2013. The cat was started on 2 U caninsulin BID. The cat subsequently developed a cat bite abscess that was treated with 4 weeks of antibiotics and cleared. Curve 2 weeks later was subsequently as follows: 830 29 10 20.1 12 20 2pm 21.4 4pm 26.1 The cat was subsequently increased to 3 U twice daily. The subsequent curve was as follows 10am 20.3 12 midday 12.9 3pm 18.2 The insulin was subsequently increased to 3 1/2 insulin units BID. The owner subsequently performed a glucose curve at home 2 weeks later: 730am before food 16.2 mmol/L 930 10.8 mmol/L 1130 5.9 mmol/L 130 4.5mmol/L 330 11.2 mmol/L 530 17.9mmol/L 730 13.2 mmol/L I subsequently saw Rimmer 4 weeks following this curve. The cat was doing very well and had gained weight (1kg since starting on insulin). All vitals were within WNL with mild tartar on the teeth. We discussed the current diet. The owner had been giving commercial senior dry food. I advised to swap slowly to d/m however the owner has another cat of which she cannot feed separately that has allergies to the components of d/m. We decided on a compromise of cutting out dry slowly and maintaining on moist diet with low carbohydrate, high protein high fat diet. 4 days later the cat presented with hypoglycaemia and a BG of 2.1. I subsequently admitted the cat for a BG curve of which found to remain low for the following 4 hours and after 2 x meals increased back to 20mmol/L in the evening . I subsequently sent the cat home on reduced dose of 1 U caninsulin BID and to maintain on the change of diet. The owner subsequently performed a blood glucose curve at home last week and it was as follows: 750 am (before food/insulin) 23.3 950 19.1 1150 16.1 150 17.5 350 9.1 550 26.4 750 18.5 Reluctant to increase the dose given the nadir of 9.1 at 350 however is elevated at both ends of the day. Should I increase slightly (1.5 U) BID, feel this cat is close to remission. Any suggestions would be much appreciated.

Can you get glargine there?

What should he weigh?

Quick question about a diabetic I am treating. The dog is neutered male 7 year old Schnoodle 30 pounds. Diagnosed as a diabetic and started on Humulin N 7 units every 12 hours by another veterinarian. First glucose curve taken (5 blood gulcose curve readings taken every 2 hours) was the following: 443 mg/dL 1 hour post morning insulin 254 mg/dL 288 mg/dL 319 mg/dL 400 mg/dL Insulin was increased to 8 units every 12 hours. Owner reports the dog is doing well at home, urinating less frequenlty and eating better. Presents for next glucose curve 10 days later and here are the results: 614 mg/dL 1 hour post morning insulin 377 mg/dL 389 mg/dL 482 mg/dL 495 mg/dL I was shocked to see how much higher the blood glucose readings were compared to the previous curve. So at this point, I am trying to figure out what is the best course of action. Any input would be greatly appreciated. Thanks

Are they giving the insulin with the meal?

Is the owner able to measure and then inject insulin?

I have a bit of a difficult case and I was wondering if anybody could comment. I have a 5 yr FS Goldendoodle that is diabetic and is given lots of attention to get her to eat and I think she won't eat consistently for behavioral reasons. The owner is very frustrated and is my groomer so asks me about it almost daily. Bloodwork is otherwise normal including spec CPL, T4, chemistry, CBC, fructosamine, radiographs of the chest and abdomen (reviewed by radiologist just to be sure) are normal, glucose curve done at home when the patient does eat appears to have adequate control. The patient does get hypoglycemic with exercise and so the owner has stopped letting her run off leash at all because this has resulted in a seizure once and low blood sugar most of the time. No pu/pd on current dose of insulin (5.5 units NPH BID). Eating w/d for the most part, but owner has gotten desperate for patient to eat and has tried adding chicken and a/d and other dog foods to try to entice appetite, which normally works for a day or 2, then back to not wanting to eat. Just to try I put her on cyproheptadine a while ago without any obvious improvement and recently tried famotidine and metoclopramide and saw no change. What I am thinking of doing next is to try giving a basal dose of something like glargine or detemir and the regular insulin with each feeding if the patient eats. Does anybody have experience with this method of regulating the diabetes themselves? How does one go about getting dosages right for this type of treatment? Any help or insights would be appreciated. Thanks.

First...was she doing this reluctance to eat thing before she became diabetic?

Is aiha a concern at all since bilirubin is normal and no spherocytes are seen?

I have a bit of a difficult case and I was wondering if anybody could comment. I have a 5 yr FS Goldendoodle that is diabetic and is given lots of attention to get her to eat and I think she won't eat consistently for behavioral reasons. The owner is very frustrated and is my groomer so asks me about it almost daily. Bloodwork is otherwise normal including spec CPL, T4, chemistry, CBC, fructosamine, radiographs of the chest and abdomen (reviewed by radiologist just to be sure) are normal, glucose curve done at home when the patient does eat appears to have adequate control. The patient does get hypoglycemic with exercise and so the owner has stopped letting her run off leash at all because this has resulted in a seizure once and low blood sugar most of the time. No pu/pd on current dose of insulin (5.5 units NPH BID). Eating w/d for the most part, but owner has gotten desperate for patient to eat and has tried adding chicken and a/d and other dog foods to try to entice appetite, which normally works for a day or 2, then back to not wanting to eat. Just to try I put her on cyproheptadine a while ago without any obvious improvement and recently tried famotidine and metoclopramide and saw no change. What I am thinking of doing next is to try giving a basal dose of something like glargine or detemir and the regular insulin with each feeding if the patient eats. Does anybody have experience with this method of regulating the diabetes themselves? How does one go about getting dosages right for this type of treatment? Any help or insights would be appreciated. Thanks.

Can i see some of the bg curves?

A high fiber, low fat diet?

I have a bit of a difficult case and I was wondering if anybody could comment. I have a 5 yr FS Goldendoodle that is diabetic and is given lots of attention to get her to eat and I think she won't eat consistently for behavioral reasons. The owner is very frustrated and is my groomer so asks me about it almost daily. Bloodwork is otherwise normal including spec CPL, T4, chemistry, CBC, fructosamine, radiographs of the chest and abdomen (reviewed by radiologist just to be sure) are normal, glucose curve done at home when the patient does eat appears to have adequate control. The patient does get hypoglycemic with exercise and so the owner has stopped letting her run off leash at all because this has resulted in a seizure once and low blood sugar most of the time. No pu/pd on current dose of insulin (5.5 units NPH BID). Eating w/d for the most part, but owner has gotten desperate for patient to eat and has tried adding chicken and a/d and other dog foods to try to entice appetite, which normally works for a day or 2, then back to not wanting to eat. Just to try I put her on cyproheptadine a while ago without any obvious improvement and recently tried famotidine and metoclopramide and saw no change. What I am thinking of doing next is to try giving a basal dose of something like glargine or detemir and the regular insulin with each feeding if the patient eats. Does anybody have experience with this method of regulating the diabetes themselves? How does one go about getting dosages right for this type of treatment? Any help or insights would be appreciated. Thanks.

Has the owner's glucometer been checked for accuracy?

Could you post the films, and the u/s report?

I have a bit of a difficult case and I was wondering if anybody could comment. I have a 5 yr FS Goldendoodle that is diabetic and is given lots of attention to get her to eat and I think she won't eat consistently for behavioral reasons. The owner is very frustrated and is my groomer so asks me about it almost daily. Bloodwork is otherwise normal including spec CPL, T4, chemistry, CBC, fructosamine, radiographs of the chest and abdomen (reviewed by radiologist just to be sure) are normal, glucose curve done at home when the patient does eat appears to have adequate control. The patient does get hypoglycemic with exercise and so the owner has stopped letting her run off leash at all because this has resulted in a seizure once and low blood sugar most of the time. No pu/pd on current dose of insulin (5.5 units NPH BID). Eating w/d for the most part, but owner has gotten desperate for patient to eat and has tried adding chicken and a/d and other dog foods to try to entice appetite, which normally works for a day or 2, then back to not wanting to eat. Just to try I put her on cyproheptadine a while ago without any obvious improvement and recently tried famotidine and metoclopramide and saw no change. What I am thinking of doing next is to try giving a basal dose of something like glargine or detemir and the regular insulin with each feeding if the patient eats. Does anybody have experience with this method of regulating the diabetes themselves? How does one go about getting dosages right for this type of treatment? Any help or insights would be appreciated. Thanks.

(e.g. has one curve been done in the hospital, so that we can compare numbers on the owner's machine vs those on a machine that we know to be accurate in-house....not just once, but over the course of the day)?

Is this the highest it has been?

Any input on this case would be appreciated I saw a 9 year old DLH at the end of April for vomiting and lethargy. Her weight was 12.5 lbs down from 16.4 lbs the year before but the owners had been attempting weight loss She was depressed on exam and mildly dehydrated. Questionable pain in cranial abdomen Bloodwork: Glucose 255, Na 139 (slightly low), ALT 112 UA: Glucose 1000+ with 2+ protein and USG 1056, culture declined, trace ketones Fructosamine 426 (142-450) Abdominal ultrasound showed pancreatitis, sludge in the gallbladder and some cholangiohep She responded great to fluids, abx, single injection of Dex, Buprenex, Ursodiol, B vitamins, Cerenia and Vit E. She was home within 72 hours eating on her own Started on Duck and Potato based diet canned and DM. We had some problems getting her to eat canned at first BGs were periodically checked during her stay and were in the 300 and 400s I was thinking that she would be a transient diabetic that would respond to diet and resolving pancreatitis. May 11th: ALT 112 and glucose still in the 300s, Fructosamine 421. Owner say she isn't drinking very much 1 to 1.25 cups per day for two cats although they are adding water to diet and she is eating canned food May 25th: glucose is 337, ++glucose in urine and SG 1066 June 28th: weight 12.6lbs, doing great at home except that they came home to find her in plantigrade stance on all four legs. No pain and trying to jump on and off furniture. Acting comfortable in room. Rest of neurological exam wnl. No change in water consumption but they are not accounting for water being added to food. Eating canned DM, some canned duck and dry duck along with some tuna water. No vomiting or weight change Glucose 333, glucose 3+, USG 1019, sediment boring, Ketone negative Fructosamine 329..lowest that it has been ALT 312 (10-100) T4 2.7 (0.8 to 4.0) Lytes wnl along with CBC Started Lantus at 0.5 units BID and Ursodiol June 29 late pm: ruptured her left CCL and started on Buprenex Any thoughts on this case? I thought the Fructosamine was normal since she was such a new diabetic but I find it strange 3 months later to still be normal? I guess we don't always know why some cats get plantigrade and others don't

How is her current bcs?

Azathioprine would be an alternative but can we medicate this dog?

Any input on this case would be appreciated I saw a 9 year old DLH at the end of April for vomiting and lethargy. Her weight was 12.5 lbs down from 16.4 lbs the year before but the owners had been attempting weight loss She was depressed on exam and mildly dehydrated. Questionable pain in cranial abdomen Bloodwork: Glucose 255, Na 139 (slightly low), ALT 112 UA: Glucose 1000+ with 2+ protein and USG 1056, culture declined, trace ketones Fructosamine 426 (142-450) Abdominal ultrasound showed pancreatitis, sludge in the gallbladder and some cholangiohep She responded great to fluids, abx, single injection of Dex, Buprenex, Ursodiol, B vitamins, Cerenia and Vit E. She was home within 72 hours eating on her own Started on Duck and Potato based diet canned and DM. We had some problems getting her to eat canned at first BGs were periodically checked during her stay and were in the 300 and 400s I was thinking that she would be a transient diabetic that would respond to diet and resolving pancreatitis. May 11th: ALT 112 and glucose still in the 300s, Fructosamine 421. Owner say she isn't drinking very much 1 to 1.25 cups per day for two cats although they are adding water to diet and she is eating canned food May 25th: glucose is 337, ++glucose in urine and SG 1066 June 28th: weight 12.6lbs, doing great at home except that they came home to find her in plantigrade stance on all four legs. No pain and trying to jump on and off furniture. Acting comfortable in room. Rest of neurological exam wnl. No change in water consumption but they are not accounting for water being added to food. Eating canned DM, some canned duck and dry duck along with some tuna water. No vomiting or weight change Glucose 333, glucose 3+, USG 1019, sediment boring, Ketone negative Fructosamine 329..lowest that it has been ALT 312 (10-100) T4 2.7 (0.8 to 4.0) Lytes wnl along with CBC Started Lantus at 0.5 units BID and Ursodiol June 29 late pm: ruptured her left CCL and started on Buprenex Any thoughts on this case? I thought the Fructosamine was normal since she was such a new diabetic but I find it strange 3 months later to still be normal? I guess we don't always know why some cats get plantigrade and others don't

Was bilirubin normal?

Any chance of edta contamination?

Any input on this case would be appreciated I saw a 9 year old DLH at the end of April for vomiting and lethargy. Her weight was 12.5 lbs down from 16.4 lbs the year before but the owners had been attempting weight loss She was depressed on exam and mildly dehydrated. Questionable pain in cranial abdomen Bloodwork: Glucose 255, Na 139 (slightly low), ALT 112 UA: Glucose 1000+ with 2+ protein and USG 1056, culture declined, trace ketones Fructosamine 426 (142-450) Abdominal ultrasound showed pancreatitis, sludge in the gallbladder and some cholangiohep She responded great to fluids, abx, single injection of Dex, Buprenex, Ursodiol, B vitamins, Cerenia and Vit E. She was home within 72 hours eating on her own Started on Duck and Potato based diet canned and DM. We had some problems getting her to eat canned at first BGs were periodically checked during her stay and were in the 300 and 400s I was thinking that she would be a transient diabetic that would respond to diet and resolving pancreatitis. May 11th: ALT 112 and glucose still in the 300s, Fructosamine 421. Owner say she isn't drinking very much 1 to 1.25 cups per day for two cats although they are adding water to diet and she is eating canned food May 25th: glucose is 337, ++glucose in urine and SG 1066 June 28th: weight 12.6lbs, doing great at home except that they came home to find her in plantigrade stance on all four legs. No pain and trying to jump on and off furniture. Acting comfortable in room. Rest of neurological exam wnl. No change in water consumption but they are not accounting for water being added to food. Eating canned DM, some canned duck and dry duck along with some tuna water. No vomiting or weight change Glucose 333, glucose 3+, USG 1019, sediment boring, Ketone negative Fructosamine 329..lowest that it has been ALT 312 (10-100) T4 2.7 (0.8 to 4.0) Lytes wnl along with CBC Started Lantus at 0.5 units BID and Ursodiol June 29 late pm: ruptured her left CCL and started on Buprenex Any thoughts on this case? I thought the Fructosamine was normal since she was such a new diabetic but I find it strange 3 months later to still be normal? I guess we don't always know why some cats get plantigrade and others don't

Will the owners be pursuing surgery for her ccl rupture, or cage rest?

Which feet?

Hi all - could use some help with treating my first HAC dog (I'm a 2012 grad). Sorry for the long history. "Scrappy" is a 7yo C/M Yorkshire Terrier who initially presented to me in mid-January 2013 for a wellness exam. His owner reported PU/PD since around Christmastime, more recently with urinary accidents in the house, in spite of the owners being home at the time and the dog being taken o/s regularly 4-5x/day; he was also polyphagic and had generally been "not himself" for a few weeks. On PE his abdomen was tense but there was the suggestion of cranial organomegaly. We discussed BW to look for evidence of Cushing's dz or DM; o declined d/t cost constraints. Shortly thereafter, he re-presented for what turned out to be a severe sublingual laceration (his owner brought me a baggie of vomited frank blood, which we later determined he'd swallowed following the tongue laceration - we're talking a 1.5" linear laceration...Scrappy is quite the adventure). Bloodwork on 1/16/13 (the day of the tongue injury) showed mild anemia (Hct 31.1%), low platelets (142K), slightly decr'd TP (4.6, N=5.2-8.2), incr'd amylase (1751, N=500-1500), and incr'd BUN (45, N=7-27), and a mildly high BG (147, N=74-143); liver values were WNL (AlkP 98, N=23-212; ALT 73, N=10-100). Scrappy re-presented to one of my colleagues in late March 2013 for recheck following a CrCL injury, and his owner was concerned about continued PU/PD/polyphagia and progressive abdominal distension. On PE he was potbellied and had notably thin skin on his abdomen. He had also gained several pounds. Bloodwork on 3/29/13 revealed inc'r AlkP (187, N=5-131), incr'd ALT (161, N=12-118), and incr'd GGTP (23, N=1-12). The other bloodwork abnormalities noted in January had resolved; he did have a mild neutrophilia (10935, N=2060-10600) with normal total WBC. T4 was WNL at 1.5 (N=0.8-3.5). Urinalysis (voided sample) showed USG 1.023, protein 2+, trace blood, WBC 2-3/hpf, and RBC 2-3/hpf; neg for glucose. He was treated with Clavamox for a UTI and workup for Cushing's was discussed again. Scrappy remained PU/PD/PP with increased accidents in the house, panting and anxiety when crated, and continued to gain weight at home; I outlined a dx / tx plan with his owner for suspected Cushing's disease. She has fairly significant cost constraints (in nursing school, single mom) so we have tried to pursue testing and treatment without cutting corners, but we're not able to do as thorough a workup as I know would be ideal. LDDST was performed on 5/14/13 and results were as follows: Pre cortisol = 7.4 ug/dL 4hr Post = 2.6 ug/dL 8hr Post = 1.8 ug/dL Normal: Cortisol level 1.4 ug/dL 8hrs post-dex. Antech notes re: dx of hyperadrenocorticism: Cortisol level >1.4 ug/dL 8hrs post-dex. Scrappy was started on Vetoryl at 20mg (2 x 10mg capsules) PO once daily (wt at that point 8kg; starting dose 2.5mg/kg). During the initial week of tx, his owner switched his dosing from the PM to the AM (by "skipping" the PM dose and then restarting tx the following AM, in order to allow us to do a stim test during our normal hours). During treatment his owner reported no significant change in his signs at home. An ACTH stim test was performed on 6/7/13 and results were as follows: Pre cortisol = 3.6 (1.0-5.0) 1hr Post = 6.3 (8-17) LOW Antech note re: dogs on Trilostane: Pre & post cortisol levels between 1.5-9.1ug/dL indicate optimal control. Based on Scrappy's continued clinical signs at home I increased his Vetoryl dose to 30mg (1 x 30mg capsule) PO once daily; he's been taking this dose for almost a month. I'm concerned however as his owner reports that while his abdominal distension/potbelly have improved marginally, he remains PU/PD/PP. We have ordered more Cortrosyn and are planning a repeat ACTH stim test as soon as the drug arrives (should be early next wk). While his numbers look OK on paper, neither I nor his owner feel as though we've achieved optimal control. I used the 5 mcg/kg Cortrosyn dose, given IV; the drug had been reconstituted previously and had been stored frozen in our hospital freezer in a plastic syringe. For what it's worth, the dose of Cortrosyn I used was within a few weeks of hitting the "6-month" mark, hence ordering more this time around. I'm not sure if that may have skewed the last ACTH stim test results. Am I missing anything? I am leaning toward repeating a chemistry when we do the next ACTH stim test, but I'm not even sure in what timeframe to expect the liver values to return to normal, especially given the continued clinical signs at home. I don't want to wait to do another ACTH stim test until his clinical signs improve further, especially since there's not been much improvement over the past month, but his owner continues to be concerned about the cost of diagnostics. I'm hesitant to increase his dose further (based on his last weight, he's currently taking 3.6mg/kg/d of Vetoryl). Would it help to dose BID? I've read about using unequal doses (e.g. 30mg in AM, 10mg in PM) in order to avoid having to use compounded trilostane. I appreciate your time and consideration! --Jess

Is that the timing you used?

So feed the canned version of the purina dm diet or any of the many over-the-counter canned foods that are low enough in carbs---are you familiar with this list?

hello, The question is can glucagon stimulated by either CCK on the expectation of a treat or adrenalin just because of excitment cause a glucose jump during a glucose curve. I was doing a glucose curve today on a diabetic dog we are sharing with the IM department of the veterinary college This dog is very food (excited) motivated and knows i usually have treats in my pocket The glucose for the first 3 samples @2hr intervals was dropping and following an expected curve pattern Then we had 2 glucose measurements back close to the morning first sample The final glucose of the day was back to a level I would have expected based on the first three points on the curve of the day If not due to glucagon , I lack an explanation for the spike and as he has been a challenge to regulate( hence his referral to the IM people) is this an explanation for his less than stellar response to insulin? tyworden

So it sounds like you didn't actually give him the treats, right?

Vetsulin has to be vigorously shaken the first time the bottle is opened, then shaken enough each time the bottle is used to keep it looking milky...is this being done?

hello, The question is can glucagon stimulated by either CCK on the expectation of a treat or adrenalin just because of excitment cause a glucose jump during a glucose curve. I was doing a glucose curve today on a diabetic dog we are sharing with the IM department of the veterinary college This dog is very food (excited) motivated and knows i usually have treats in my pocket The glucose for the first 3 samples @2hr intervals was dropping and following an expected curve pattern Then we had 2 glucose measurements back close to the morning first sample The final glucose of the day was back to a level I would have expected based on the first three points on the curve of the day If not due to glucagon , I lack an explanation for the spike and as he has been a challenge to regulate( hence his referral to the IM people) is this an explanation for his less than stellar response to insulin? tyworden

Can you post the actual values for the bg curve?

How long do you usually treat with the antibiotics?

hello, The question is can glucagon stimulated by either CCK on the expectation of a treat or adrenalin just because of excitment cause a glucose jump during a glucose curve. I was doing a glucose curve today on a diabetic dog we are sharing with the IM department of the veterinary college This dog is very food (excited) motivated and knows i usually have treats in my pocket The glucose for the first 3 samples @2hr intervals was dropping and following an expected curve pattern Then we had 2 glucose measurements back close to the morning first sample The final glucose of the day was back to a level I would have expected based on the first three points on the curve of the day If not due to glucagon , I lack an explanation for the spike and as he has been a challenge to regulate( hence his referral to the IM people) is this an explanation for his less than stellar response to insulin? tyworden

Is the glucometer that you're using been checked lately for accuracy?

Which monitor is he using?

hello, The question is can glucagon stimulated by either CCK on the expectation of a treat or adrenalin just because of excitment cause a glucose jump during a glucose curve. I was doing a glucose curve today on a diabetic dog we are sharing with the IM department of the veterinary college This dog is very food (excited) motivated and knows i usually have treats in my pocket The glucose for the first 3 samples @2hr intervals was dropping and following an expected curve pattern Then we had 2 glucose measurements back close to the morning first sample The final glucose of the day was back to a level I would have expected based on the first three points on the curve of the day If not due to glucagon , I lack an explanation for the spike and as he has been a challenge to regulate( hence his referral to the IM people) is this an explanation for his less than stellar response to insulin? tyworden

Can i see a couple of previous curves?

Also could you give the owner link to owners of insulin treated pets?

Hi, Thanks again for help in Advance. I have an 11 year old Cockapoo that I'm currently treating. He's currently "well regulated" on his diabetes on WD and insulin. His concurrent diseases: Diabetes, Calcium Oxalate stones, new heart murmur, Hypertension (hemorrhages on fundic exam), suspect Cushing's disease (borderline LDDS and enlarged adrenal glands), dental disease, back pain, and now, borderline azotemia. phew.. So with the new azotemia, I'm wondering if there's a better diet for him? I'm going to do a "last dental" on him this month for his dental disease...his hypertension is well controlled on amlodipine currently. thanks so much, always ☼

Could you pass a bit more info?

They are using u-40 insulin syringes?

Hi, Thanks again for help in Advance. I have an 11 year old Cockapoo that I'm currently treating. He's currently "well regulated" on his diabetes on WD and insulin. His concurrent diseases: Diabetes, Calcium Oxalate stones, new heart murmur, Hypertension (hemorrhages on fundic exam), suspect Cushing's disease (borderline LDDS and enlarged adrenal glands), dental disease, back pain, and now, borderline azotemia. phew.. So with the new azotemia, I'm wondering if there's a better diet for him? I'm going to do a "last dental" on him this month for his dental disease...his hypertension is well controlled on amlodipine currently. thanks so much, always ☼

What is the weight and bcs of your patient, is it overweight/underweight/normal?

Can we see the films from the time of the chf diagnosis?

Hi, Thanks again for help in Advance. I have an 11 year old Cockapoo that I'm currently treating. He's currently "well regulated" on his diabetes on WD and insulin. His concurrent diseases: Diabetes, Calcium Oxalate stones, new heart murmur, Hypertension (hemorrhages on fundic exam), suspect Cushing's disease (borderline LDDS and enlarged adrenal glands), dental disease, back pain, and now, borderline azotemia. phew.. So with the new azotemia, I'm wondering if there's a better diet for him? I'm going to do a "last dental" on him this month for his dental disease...his hypertension is well controlled on amlodipine currently. thanks so much, always ☼

Are the stones still present or have they been removed?

How chronic/persistent have ketones been since april?

Hi, Thanks again for help in Advance. I have an 11 year old Cockapoo that I'm currently treating. He's currently "well regulated" on his diabetes on WD and insulin. His concurrent diseases: Diabetes, Calcium Oxalate stones, new heart murmur, Hypertension (hemorrhages on fundic exam), suspect Cushing's disease (borderline LDDS and enlarged adrenal glands), dental disease, back pain, and now, borderline azotemia. phew.. So with the new azotemia, I'm wondering if there's a better diet for him? I'm going to do a "last dental" on him this month for his dental disease...his hypertension is well controlled on amlodipine currently. thanks so much, always ☼

Have they been a problem with the w/d?

What's the high end of the normal range for creatinine?

Hi, Thanks again for help in Advance. I have an 11 year old Cockapoo that I'm currently treating. He's currently "well regulated" on his diabetes on WD and insulin. His concurrent diseases: Diabetes, Calcium Oxalate stones, new heart murmur, Hypertension (hemorrhages on fundic exam), suspect Cushing's disease (borderline LDDS and enlarged adrenal glands), dental disease, back pain, and now, borderline azotemia. phew.. So with the new azotemia, I'm wondering if there's a better diet for him? I'm going to do a "last dental" on him this month for his dental disease...his hypertension is well controlled on amlodipine currently. thanks so much, always ☼

(i assume dry?) and finally, what is the stage of ckd?

You thought our clients were smarter than this?

Hi, Thanks again for help in Advance. I have an 11 year old Cockapoo that I'm currently treating. He's currently "well regulated" on his diabetes on WD and insulin. His concurrent diseases: Diabetes, Calcium Oxalate stones, new heart murmur, Hypertension (hemorrhages on fundic exam), suspect Cushing's disease (borderline LDDS and enlarged adrenal glands), dental disease, back pain, and now, borderline azotemia. phew.. So with the new azotemia, I'm wondering if there's a better diet for him? I'm going to do a "last dental" on him this month for his dental disease...his hypertension is well controlled on amlodipine currently. thanks so much, always ☼

Any proteinuria?

Are the lytes normal?

Hi there, Chocho is a diabetic 10 yr old MN DSH. He was initially started on caninsulin at diagnosis in aug 2012 but did not regulate well. He had some serious hypoglycemic episodes. After spending a few days at our closest emerg/24 hour care clinic he was changed to glargine He was on 5 units glargine in november 2012. The owner does bg measurement at home and reported he had periods of hypoglycemia over christmas so she reduced his dose to 2-3 units bid. 2 weeks ago he went to a dental specialist to address the numerous teeth undergoing TR. On the first dental recheck exam, the owner informed me that he was getting 2 units bid, but his preinsulin bg was often 17 or so. She gave him 2.5 units once which dropped him to a bg of 1.3. As his requirement seems to be significantly less than it was 7 months ago, I got hopeful he may be going into remission. I suggested she do a full curve when on 2 bid then go to 1 bid and do a curve 7-10 days later. This is the info she brought back to me at his next dental recheck exam. June 27 am BG 14.4 gave 1 unit pm BG 25.9 gave 2 units June 28 am BG 14.4 gave 2 units pm BG 17.8 gave 2 units June 29 am BG 17.3 gave 2 units noon BG 9.6 mid aft BG 14.2 pm BG 9.8 gave 1 unit June 30 am BG 18.7 SKIP A DAY HAD COMPANY July 2 am BG 9.6 gave 1 unit (hot day, not eating well, slightly lethargic) noon BG 2.1 mid aft BG 14.9 pm BG 20.2 gave 1 unit July 3 am BG 24.7 gave 2 units (was very hungry) noon BG 19.0 gave another 1 unit early aft BG 5.2 mid aft BG 12.4 pm BG 13.8 gave 2 units July 4 am BG 13.6 gave 2 units mid aft BG 9.9 (just before coming to clinic for exam. I am uncertain how to advise her from here. He is doing great otherwise. His mouth has healed beautifully Any suggestions how to get him more stable? Thanks ☼

What diet is chocho eating?

What has her weight been doing?

Hi there, Chocho is a diabetic 10 yr old MN DSH. He was initially started on caninsulin at diagnosis in aug 2012 but did not regulate well. He had some serious hypoglycemic episodes. After spending a few days at our closest emerg/24 hour care clinic he was changed to glargine He was on 5 units glargine in november 2012. The owner does bg measurement at home and reported he had periods of hypoglycemia over christmas so she reduced his dose to 2-3 units bid. 2 weeks ago he went to a dental specialist to address the numerous teeth undergoing TR. On the first dental recheck exam, the owner informed me that he was getting 2 units bid, but his preinsulin bg was often 17 or so. She gave him 2.5 units once which dropped him to a bg of 1.3. As his requirement seems to be significantly less than it was 7 months ago, I got hopeful he may be going into remission. I suggested she do a full curve when on 2 bid then go to 1 bid and do a curve 7-10 days later. This is the info she brought back to me at his next dental recheck exam. June 27 am BG 14.4 gave 1 unit pm BG 25.9 gave 2 units June 28 am BG 14.4 gave 2 units pm BG 17.8 gave 2 units June 29 am BG 17.3 gave 2 units noon BG 9.6 mid aft BG 14.2 pm BG 9.8 gave 1 unit June 30 am BG 18.7 SKIP A DAY HAD COMPANY July 2 am BG 9.6 gave 1 unit (hot day, not eating well, slightly lethargic) noon BG 2.1 mid aft BG 14.9 pm BG 20.2 gave 1 unit July 3 am BG 24.7 gave 2 units (was very hungry) noon BG 19.0 gave another 1 unit early aft BG 5.2 mid aft BG 12.4 pm BG 13.8 gave 2 units July 4 am BG 13.6 gave 2 units mid aft BG 9.9 (just before coming to clinic for exam. I am uncertain how to advise her from here. He is doing great otherwise. His mouth has healed beautifully Any suggestions how to get him more stable? Thanks ☼

Now that i've written all of that, i realized i forgot to ask about his clinical signs during all of this?

Have you ever tried to make a casserole with just meat and fat?

I'll try to upload some pics of this cat. No allergy issues, but happens to be on grain-free limited antigen canned diet, prior to staring insulin. Reaction came on gradually over second year on insulin. Intense pruritus!!!

Is this can on lantus?

What diet was lily eating at the time of her diagnosis?

I think my brain has not returned from vacation and I need some additional help on this case. I feel something simple is staring me in the face and I am missing it. Joey is an 8 yo M/N beagle mix who started urinating on the kitchen floor about 3 weeks ago, He is a heavy guy and I thought immediately about diabetes mellitus but ruled it out quickly. A full panel of bloodwork run in March showed low normal HCT, slightly low RBC, all chemistries normal except for a slighty elevated ALKP - 278(23-212). He was not PU/PD at the time, at least he wasn't going in the house but he did has a weakness or seizure type episode then. Physical exam revealed only overweight and a chronic ear condition. Repeat chemistries reveal ALKP rising a little at 432. Urine SpG is 1.008 with a trace of protein, ph of 7 and no other abnormalities. Urine culture revealed no growth and ACTH stim test showed a presample at ,8(1-5) and post sample at 11.3(8-17). Should I be looking at a possible Addison's? I reae going back through these results I don't have recent electrolytes. On x-ray he has a few tiny stones in the bladder but no other abnormalities noted. Thanks for the time and brain power! ☼

Has this resolved along with this weakness/seizure behavior?

Is him eating the totality?

I think my brain has not returned from vacation and I need some additional help on this case. I feel something simple is staring me in the face and I am missing it. Joey is an 8 yo M/N beagle mix who started urinating on the kitchen floor about 3 weeks ago, He is a heavy guy and I thought immediately about diabetes mellitus but ruled it out quickly. A full panel of bloodwork run in March showed low normal HCT, slightly low RBC, all chemistries normal except for a slighty elevated ALKP - 278(23-212). He was not PU/PD at the time, at least he wasn't going in the house but he did has a weakness or seizure type episode then. Physical exam revealed only overweight and a chronic ear condition. Repeat chemistries reveal ALKP rising a little at 432. Urine SpG is 1.008 with a trace of protein, ph of 7 and no other abnormalities. Urine culture revealed no growth and ACTH stim test showed a presample at ,8(1-5) and post sample at 11.3(8-17). Should I be looking at a possible Addison's? I reae going back through these results I don't have recent electrolytes. On x-ray he has a few tiny stones in the bladder but no other abnormalities noted. Thanks for the time and brain power! ☼

Why are you thinking addison's?

Definitely don't want the potassium to be low...how low is it?

Get out your crystal ball, folks- I need some advice: JR is a 12 yr old Jack Russell terrier that has difficult-to-regulate Diabetes mellitus, rendering him blind from mature cataracts. He is at last (trying since December) managed nicely on Detemir/Levemir now. His Fructosamine level now is 351 but a recent urinalysis (asymptomatic pre-test for his surgery) revealed urine SG of 1.031 with a urine protein/Creatinine ratio of unfortunately 2.9. I am checking his blood pressure tomorrow and plan to start him on Enalapril but does it make sense to move forward with bilateral cataract surgery if he is in the beginning stages of a rapid decline? Protein sediment is benign and serum creat and BUN are well wnls. What kind of time frame should I predict with this kind of proteinuria? I believe we need to postpone surgery til we get his proteinuria down, correct? 5 grand is a lot to pay if he likely will not last more than a year. Thanks for any/all advice. ☼

I assume that this dog is not currently azotemic?

Any other confounding factors with diabetic regulation in this cat?

I just saw an 18 YO cat with acute onset irritation of the eyelids. The upper lids are more affected and it is the inner, non haired area. The left is worse and has some dark red tissue that looks like it may be traumatized. The cat is a well controlled diabetic. Yesterday was his first Adequan injection for arthritis. Could this be an allergic reaction? He was not cooperative for pics, so this is the only one we could get.

Were you able to do a conjunctival cytology in this kitty?

Do you think that the owner would be willing to do curves at home?

I just saw an 18 YO cat with acute onset irritation of the eyelids. The upper lids are more affected and it is the inner, non haired area. The left is worse and has some dark red tissue that looks like it may be traumatized. The cat is a well controlled diabetic. Yesterday was his first Adequan injection for arthritis. Could this be an allergic reaction? He was not cooperative for pics, so this is the only one we could get.

What other medications are being used for control of what i presume is djd?

Weight increasing or decreasing?

Gustave is a 2 year old neutered male cat belonging to one of our staff. Gustave has always been a very active food driven cat who since kittenhood will chew open bags and cupboard doors(yes!) to get to food items. He is very athletic, lean and has been trained to sit and give "high five". His owner had a consult with one of our doctors who is particularly interested in behavior medicine in October 2012, and he was thought to have primarily behavior iss. Gustave has also had episodes of inappropriate urination associated with "stress" as per owner(eg owner comes home late, cat pees by food bowl). June 20th (about two weeks ago) alprazolam was prescribed because the house was being reroofed and the pounding was causing some agitation. Use of alprazolam resulted in increased hyperactivity and agitation, so owner discontinued use. Gradually the owner became aware of more intense food drive and decreased social interaction over this two week period. The cat won't sit with them on the couch as per usual and dislikes being held. He is much more vocal. This became especially apparent around the 4th of July even early in the day before fireworks were heard by the owner and kept the owner awake the night of the 4th vocalizing and howling periodically throughout the night . In the exam room on July 5th, the cat would eat all treats and food offered including Hill's t/d without chewing and repeatedly jumped on and off the exam table, counter, and seating area. If food was withheld briefly the cat would try to bite fingers or swat to access the treat/kibble. There were no cranial nerve signs. Heart rate was ~160 and no thyroid nodule was palpated. While Gustave can run in a straight line at a walk there is a subtle change in hind limb function suggesting a slightly rolling gait or very mild ataxia. Proprioception & placing, though hard to assess due to hyperactivity, seem relatively normal. In the cage, Gustave paced continually knocking over food and water dishes. Since cat and owner were sleepless, we tried buprenorphine to no effect. Have not tried ace yet. Our local neurologist was consulted without any clear suggestions. A panel was submitted and revealed: WBC= 25,900 mature neutrophilia Albumin= 3.5 Globulin= 3.6 Creatine kinase= 1443 T4= 2.8 ALT= 154 AST= 99 We are in the process of collecting urine sample. The techs were hesitant to attempt a cysto on this hyperactive kitty! In February, by comparison, liver enzymes were normal and WBC was 20,990. Today the owner reports the kitty is still more vocal and whene ver he is moving around he is vocalizing. I will look up how to cross post to behavior as there are certainly strong behavioral components to this problem but it seems so extreme. Today, in the cage, Gustave is resting more quietly. Given the changes in the labwork it seems there may be a metabolic is as well as behavioral and I wondered about a brain lesion or dry form FIP. I couldn't find anything in the archives that exactly fit this case. I am very grateful for any feedback.

Has the kitty lost weight?

Have you seen the plantigrade stance in this kitty?

Hi, i have a quick question , Velvet is a 14 years old feline spayed female 8.7 lb that is on methimazole 2.5 mg bid . Now has developed or starting to develop Diabetes mellitus. Fuctosamine : 386 (191-349 umol) gLYCEMIC CONTROL : "GOOD " : 350-400 t4 : 3.1 (0.8-4.7 UG/DL ) FREE t4 ; 3.8 (0.7-2.6ng/dl : H) My question : staring a diet less then 8% carbohydrate ( DM wet ) + increasing dose of methimazole to 5 mg Bid ,and staring Lantus 1 unit BID will be the correct approach or should I wait for Lantus? Thanks a lot ☼

What dosing interval of prednisolone is this cat receiving for her asthmatic bronchitis?

How is the diabetic control doing?

Hi, i have a quick question , Velvet is a 14 years old feline spayed female 8.7 lb that is on methimazole 2.5 mg bid . Now has developed or starting to develop Diabetes mellitus. Fuctosamine : 386 (191-349 umol) gLYCEMIC CONTROL : "GOOD " : 350-400 t4 : 3.1 (0.8-4.7 UG/DL ) FREE t4 ; 3.8 (0.7-2.6ng/dl : H) My question : staring a diet less then 8% carbohydrate ( DM wet ) + increasing dose of methimazole to 5 mg Bid ,and staring Lantus 1 unit BID will be the correct approach or should I wait for Lantus? Thanks a lot ☼

What is this cat's serum glucose?

Over the next several weeks is when the diabetes goes away if it's going to....what dose is she currently on?

12 yo puggle, 13 kg but is very overweight. Diagnosed 2-3 years ago by a different vet and was started on 6 U of caninsulin BID. Last month had a dentistry with a few extractions, and O does change his diet on occasion (was science diet mini chunks, then W/D at our request for his weight and diabetic control, and more recently blue buffalo weight control bc he stopped eating W/D, although there is some suspicion that Grandma and dad was supplementing his kibble with egg or cheerios to ensure he would eat enough so they could give the insulin on time). Blind with cataracts bilaterally and is a very anxious dog so he is transported to and from the clinic multiple times a day for blood sampling. Anyways, in for a glucose curve this week. Clinically doing well and O says drinking and urinating is fine. They do think he has periods of hypoglycemia late afternoon as he will be slower and a bit ataxic on occasion and then as soon as he eat he is back to normal. 8 am: 30.7 then gave 13 U caninsulin. Did not finish all of his breakfast at home. 10 am: 22.8 12 pm: 17.3 2 pm: 14.3 4 pm: 9.1 Were unable to get another sample. FYI: Curve prior to dentistry, and food switches in Feb 2012 was: 8 am: 21.6, then gave 11 U caninsulin 10 am: 18.6 12 pm: 16.4 2 pm: 12.8 4 pm: 19.6 Was increased to 13 U after this. I am not sure what is going on. Worried about a somogyi effect with such a high glucose at the start of the curve. I wish I had another glucose after 4 pm to see if he goes high or continues to drop. I plan on offering a urine culture and not sure about the value of a fructosamine to see how he regulating overall. Should I reduce his insulin? Switch to another (NPH is the most convenient). Any suggestions?

Do you think there is a way the owner could learn how to do the glucose curves at home?

Crt, pulse quality changes?

12 yo puggle, 13 kg but is very overweight. Diagnosed 2-3 years ago by a different vet and was started on 6 U of caninsulin BID. Last month had a dentistry with a few extractions, and O does change his diet on occasion (was science diet mini chunks, then W/D at our request for his weight and diabetic control, and more recently blue buffalo weight control bc he stopped eating W/D, although there is some suspicion that Grandma and dad was supplementing his kibble with egg or cheerios to ensure he would eat enough so they could give the insulin on time). Blind with cataracts bilaterally and is a very anxious dog so he is transported to and from the clinic multiple times a day for blood sampling. Anyways, in for a glucose curve this week. Clinically doing well and O says drinking and urinating is fine. They do think he has periods of hypoglycemia late afternoon as he will be slower and a bit ataxic on occasion and then as soon as he eat he is back to normal. 8 am: 30.7 then gave 13 U caninsulin. Did not finish all of his breakfast at home. 10 am: 22.8 12 pm: 17.3 2 pm: 14.3 4 pm: 9.1 Were unable to get another sample. FYI: Curve prior to dentistry, and food switches in Feb 2012 was: 8 am: 21.6, then gave 11 U caninsulin 10 am: 18.6 12 pm: 16.4 2 pm: 12.8 4 pm: 19.6 Was increased to 13 U after this. I am not sure what is going on. Worried about a somogyi effect with such a high glucose at the start of the curve. I wish I had another glucose after 4 pm to see if he goes high or continues to drop. I plan on offering a urine culture and not sure about the value of a fructosamine to see how he regulating overall. Should I reduce his insulin? Switch to another (NPH is the most convenient). Any suggestions?

Has he lost any weight?

What have previous usgs been?

Hi everybody, I have a 10 years old MC Chesapeake Bay Retreiver thatis on Thyroid medication and have allergies. Dog is now diabete and is 45 Kg. I started the dog on NPH insuline. Dog is now at 29 units BID and I find the duration of insuline is really short. His last blood curve done on July 1 was: 7h55am 24.1 mmol/L 7h58 : 29 units of insuline 10h03: 19.3 12h04pm: 14.5 2h07 pm: 17.3 4h47: 20.8 6h37: 25.0 8h10: 26.3 8h12 pm: 29 units insuline If really find the insuline is short acting. I give you other curve so you guys can analyse better and at times, I find the curves are really weird (Suagr continu to increase after the insuline injection. Blood Curve May 18, 2013 Time Insulin/Reading 8:09 AM 19.1 mmol/L 8:11 AM 27 units 10:02 AM 20.1 mmol/L 12:01 PM 16.4 mmol/L 2:08 PM 12.3 mmol/L 4:01 PM 16.5 mmol/L 5:58 PM 13.7 mmol/L 8:07 PM 17.6 mmol/L 8:10 PM 27 units May 30 8h04am 17.1 8h07am 29 units 10h02am 17.3 11h47am 7.9 2h03pm 10.7 4h05pm 20.8 6h02pm 28.9 8h08pm 26.6 8h12pm 29 units Because of the high glucose reading and the low one and the sugar being really high at the end I was afraid of Symogy effect and decrease inuline again blood curve for 13/06/2013 Home (506) 350-0414 8:09 am 23.2 mmol/L 8:12 am 27 units of insulin 10:07 am 21.1 mmol/L 12:05 pm 25.7 mmol/L 2:02 pm 27.6 mmol/L 4:03 pm 22.2 mmol/L 6:02 pm 22.3 mmol/L 8:05 pm 21.3 mmol/L June 25 7:55 am 21.5 mmol/L 7:58 am 28 units of insulin 10:07 am 20.3 mmol/L 12:02 pm 23.2 mmol/L 2:03 pm 25.0 mmol/L 4:04 pm 16.4 mmol/L 5:47 pm 14.2 mmol/L 8:04 pm 20.3 mmol/L 8:07 pm 28 units of insulin 8:08 pm 27 units of insulin What do you guys think? For now I told O to increase to 30 units BID from the last curve done (the first one I post). Dog have have non-symptomactic for pancreatitis (strongly positive at the snap test The test was done because Amylase and Lipase were high for last time we did blood work and when I check in previous blood work in the past, those enzymes always been high, which is probably why dog is diabetic). Here is the last blood work that was done (march 19) Age: 10 Years Breed: Chesapeake Bay Retriever Test Results Reference Interval LOW NORMAL HIGH GLU 23.34 mmol/L 3.89 - 7.95 HIGH UREA 5.9 mmol/L 2.5 - 9.6 CREA 108 μmol/L 44 - 159 BUN/CREA 14 PHOS 1.42 mmol/L 0.81 - 2.20 CA 2.63 mmol/L 1.98 - 3.00 TP 66 g/L 52 - 82 ALB 31 g/L 22 - 39 GLOB 35 g/L 25 - 45 ALB/GLOB 0.9 ALT 97 U/L 10 - 100 ALKP 287 U/L 23 - 212 HIGH GGT 0 U/L 0 - 7 TBIL 9 μmol/L 0 - 15 CHOL 7.47 mmol/L 2.84 - 8.26 AMYL 2222 U/L 500 - 1500 HIGH LIPA 5321 U/L 200 - 1800 HIGH Na 149 mmol/L 144 - 160 K 4.6 mmol/L 3.5 - 5.8 Na/K 32 Cl 120 mmol/L 109 - 122 Osm Calc 315 mmol/kg Catalyst Dx (March 19, 2013 3:23 PM) TT4 32 nmol/L Diagnostic Interpretation for TT4 13 nmol/L Low 13 - 26 nmol/L Low Normal 13 - 51 nmol/L Normal > 51 nmol/L High 27 - 69 nmol/L Therapeutic Dogs with no clinical signs of hypothyroidism and results within the normal reference range are likely euthyroid. Dogs with low T4 concentrations may be hypothyroid or "euthyroid sick". Occasionally, hypothyroid dogs can have T4 concentrations that are low normal. Dogs with clinical signs of hypothyroidism and low or low normal T4 concentrations may be evaluated further by submission of freeT4 (fT4) and canine TSH. A high T4 concentration in a clinically normal dog is likely variation of normal; however elevations may occur secondary to thyroid auto antibodies or rarely thyroid neoplasia. For dogs on thyroid supplement, acceptable 4-6 hour post pill total T4 concentrations generally fall within the higher end or slightly above the reference range. SNAPshot Dx (March 19, 2013 3:33 PM) cPL Abnormal SNAPshot Dx (March 19, 2013 5:04 PM) Thanks for all feedback and I know this is a lot of informations to read. ☼

Is the owner generating the curves at home?

After that...?

I was hoping to get advice on a patient that is very pu/pd at home. This is a 13yo, MN chihuahua mix. The patient was seen Feb 2012 ADR, wt loss and pu/pd. BW at that time showed azotemia (BUN 81, creat 1.7), mild increase in ALP (132), thrombocytopenia (51,000 plt) and mild anemia (Hct 35). He was also positive for lyme on 4dx. US at the time showed some decreased corticomedullary distinction but no other changes. Kidney's normal size and shape. Long story short he was treated with Doxycycline and improved. Over the next few monthshHe regained the weight, all bloodwork returned to normal except a persistent increase in BUN (42). He remained pu/pd for the last 18 months. Since last year, the owner has been increasingly frustrated with the pu/pd as the dog is insatiable for water and urinating in the house. His BUN has increased to 72 and ALP has slowly gone back up (now 323) but creat remains normal at 1.0. Urine SG checked multiple times over last year and a half has always been 1.010-1.015 regardless of time of day. Urine culture is negative. ACTH stim was borderline (post 17.3) but LDDST was WNL (pre 3, 4 and 8 hr 0.7). We did a trial with Selegiline (never actually had it work but o is very frustrated so I thought I would try). It made no difference. I know there are renal changes on bloodwork but for some reason I am not convinced that is the full cause of his pu/pd, especially with the creatinine remaining normal. I am at a loss as to what to do next and the owner is at her wits end. Is a DDAVP trial worth it or is his SG too hi to be DI? Am I overthinking this and it is just CRF? Thanks for any advice,

Do you have sodium concentrations?

The owner can adequately and completely reconstitute the insulin?

I was hoping to get advice on a patient that is very pu/pd at home. This is a 13yo, MN chihuahua mix. The patient was seen Feb 2012 ADR, wt loss and pu/pd. BW at that time showed azotemia (BUN 81, creat 1.7), mild increase in ALP (132), thrombocytopenia (51,000 plt) and mild anemia (Hct 35). He was also positive for lyme on 4dx. US at the time showed some decreased corticomedullary distinction but no other changes. Kidney's normal size and shape. Long story short he was treated with Doxycycline and improved. Over the next few monthshHe regained the weight, all bloodwork returned to normal except a persistent increase in BUN (42). He remained pu/pd for the last 18 months. Since last year, the owner has been increasingly frustrated with the pu/pd as the dog is insatiable for water and urinating in the house. His BUN has increased to 72 and ALP has slowly gone back up (now 323) but creat remains normal at 1.0. Urine SG checked multiple times over last year and a half has always been 1.010-1.015 regardless of time of day. Urine culture is negative. ACTH stim was borderline (post 17.3) but LDDST was WNL (pre 3, 4 and 8 hr 0.7). We did a trial with Selegiline (never actually had it work but o is very frustrated so I thought I would try). It made no difference. I know there are renal changes on bloodwork but for some reason I am not convinced that is the full cause of his pu/pd, especially with the creatinine remaining normal. I am at a loss as to what to do next and the owner is at her wits end. Is a DDAVP trial worth it or is his SG too hi to be DI? Am I overthinking this and it is just CRF? Thanks for any advice,

If so, have they been low, high, or mid-range?

Maybe the owner could videotape an episode and you could post it?

I was hoping to get advice on a patient that is very pu/pd at home. This is a 13yo, MN chihuahua mix. The patient was seen Feb 2012 ADR, wt loss and pu/pd. BW at that time showed azotemia (BUN 81, creat 1.7), mild increase in ALP (132), thrombocytopenia (51,000 plt) and mild anemia (Hct 35). He was also positive for lyme on 4dx. US at the time showed some decreased corticomedullary distinction but no other changes. Kidney's normal size and shape. Long story short he was treated with Doxycycline and improved. Over the next few monthshHe regained the weight, all bloodwork returned to normal except a persistent increase in BUN (42). He remained pu/pd for the last 18 months. Since last year, the owner has been increasingly frustrated with the pu/pd as the dog is insatiable for water and urinating in the house. His BUN has increased to 72 and ALP has slowly gone back up (now 323) but creat remains normal at 1.0. Urine SG checked multiple times over last year and a half has always been 1.010-1.015 regardless of time of day. Urine culture is negative. ACTH stim was borderline (post 17.3) but LDDST was WNL (pre 3, 4 and 8 hr 0.7). We did a trial with Selegiline (never actually had it work but o is very frustrated so I thought I would try). It made no difference. I know there are renal changes on bloodwork but for some reason I am not convinced that is the full cause of his pu/pd, especially with the creatinine remaining normal. I am at a loss as to what to do next and the owner is at her wits end. Is a DDAVP trial worth it or is his SG too hi to be DI? Am I overthinking this and it is just CRF? Thanks for any advice,

Have you checked a blood pressure to see if the dog is hypertensive?

Sure that the vetoryl had been given with some food the morning of the test?

I typicly use Lantus as my first choice for newly diagnosed diabetic cats. Previously, I recommended the pens, as the individu cartridges were smler, and could be opened one at a time, saving money on wasted insulin. The insulin could be drawn up through the stopper on the cartridge. I'd heard a while back that the SoloStar cartridge style had changed, and you couldn't draw up insulin from them anymore, so I started prescribing 10 ml vis. Concerns regarding how long the insulin is stable once the vi is opened have been discussed ad nauseum, but even if the client doesn't adhere to the 28 day effectiveness rule, it's still getting precipitate in the vi before it's used up. I went to the Lantus SoloStar website, it seems like you could still draw up insulin from the pens - does anyone know if this is possible, especily for multiple uses? I know some people will have the client bring in the insulin pen, draw it up, and transfer it into a sterile red top tube for individu use - any liability issue with this, especily since the Feline Diabetes Message Board discourages it? On a separate note, I read a study indicating that the initi remission rate was higher for glargine than PZI insulin, but the sample size was sml. Anyone know of any more recent studies to corroborate or refute this? Thanks in advance.

Treatment of newly diagnosed diabetic cats with glargine insulin improves glycemic control.....j feline medicine and surgy?

Did the owner change to u40 syringes when he changed to the pzi?

Hello and thank you for your help. Last week I saw a 5 yr old 3.12 kg dmh girl called Daisy. She has lost 1/3 of her body mass since July 2011. (slow weight loss). Last week, Daisy presented for anorexia and diarrhea. glucose was 26.2 with normal upper range being 9.4. She had glucosurea. While waiting for fructosamine results, we gave one dose of 1 unit of caninsulin. By the end of the day, her glucose was 6.4 on a glucometer. Fructosamine came back at 388 (142-450). I went to this pet's home and we checked sugar levels at her house to find 18.8 on the glucometer and 363 on our istat machine. (both high with heska normal being 60-130) Her clinical signs resolved with only a transition to diabetic management food. ONe week later, she is vomiting more frequently and hiding. What kind of an insulin dose would you start this cat at? Are there any cats who need less than once a day? How long does it take for glucose to spill over into the urine with stress? What is truly normal for fructosamine of a non-diabetic cat? please see the attached min. data base for this cat. Feline leukemia and FIV were both negative. Thank you for your help.

Had pu/pd been noted at home?

Would it be true that the dog has a great appetite all the time?

Hello and thank you for your help. Last week I saw a 5 yr old 3.12 kg dmh girl called Daisy. She has lost 1/3 of her body mass since July 2011. (slow weight loss). Last week, Daisy presented for anorexia and diarrhea. glucose was 26.2 with normal upper range being 9.4. She had glucosurea. While waiting for fructosamine results, we gave one dose of 1 unit of caninsulin. By the end of the day, her glucose was 6.4 on a glucometer. Fructosamine came back at 388 (142-450). I went to this pet's home and we checked sugar levels at her house to find 18.8 on the glucometer and 363 on our istat machine. (both high with heska normal being 60-130) Her clinical signs resolved with only a transition to diabetic management food. ONe week later, she is vomiting more frequently and hiding. What kind of an insulin dose would you start this cat at? Are there any cats who need less than once a day? How long does it take for glucose to spill over into the urine with stress? What is truly normal for fructosamine of a non-diabetic cat? please see the attached min. data base for this cat. Feline leukemia and FIV were both negative. Thank you for your help.

What's her current bcs?

If we screen an apparently healthy older cat for hypertension and measure a high bp, will early intervention with drugs make any difference to that cat's morbidity or mortality?

Hello and thank you for your help. Last week I saw a 5 yr old 3.12 kg dmh girl called Daisy. She has lost 1/3 of her body mass since July 2011. (slow weight loss). Last week, Daisy presented for anorexia and diarrhea. glucose was 26.2 with normal upper range being 9.4. She had glucosurea. While waiting for fructosamine results, we gave one dose of 1 unit of caninsulin. By the end of the day, her glucose was 6.4 on a glucometer. Fructosamine came back at 388 (142-450). I went to this pet's home and we checked sugar levels at her house to find 18.8 on the glucometer and 363 on our istat machine. (both high with heska normal being 60-130) Her clinical signs resolved with only a transition to diabetic management food. ONe week later, she is vomiting more frequently and hiding. What kind of an insulin dose would you start this cat at? Are there any cats who need less than once a day? How long does it take for glucose to spill over into the urine with stress? What is truly normal for fructosamine of a non-diabetic cat? please see the attached min. data base for this cat. Feline leukemia and FIV were both negative. Thank you for your help.

Was she overweight to begin with?

What is the felv/fiv status?

Hello and thank you for your help. Last week I saw a 5 yr old 3.12 kg dmh girl called Daisy. She has lost 1/3 of her body mass since July 2011. (slow weight loss). Last week, Daisy presented for anorexia and diarrhea. glucose was 26.2 with normal upper range being 9.4. She had glucosurea. While waiting for fructosamine results, we gave one dose of 1 unit of caninsulin. By the end of the day, her glucose was 6.4 on a glucometer. Fructosamine came back at 388 (142-450). I went to this pet's home and we checked sugar levels at her house to find 18.8 on the glucometer and 363 on our istat machine. (both high with heska normal being 60-130) Her clinical signs resolved with only a transition to diabetic management food. ONe week later, she is vomiting more frequently and hiding. What kind of an insulin dose would you start this cat at? Are there any cats who need less than once a day? How long does it take for glucose to spill over into the urine with stress? What is truly normal for fructosamine of a non-diabetic cat? please see the attached min. data base for this cat. Feline leukemia and FIV were both negative. Thank you for your help.

Which clinical signs?

What was this patient's weight when you began the lantus and what diet is he eating?

Hello and thank you for your help. Last week I saw a 5 yr old 3.12 kg dmh girl called Daisy. She has lost 1/3 of her body mass since July 2011. (slow weight loss). Last week, Daisy presented for anorexia and diarrhea. glucose was 26.2 with normal upper range being 9.4. She had glucosurea. While waiting for fructosamine results, we gave one dose of 1 unit of caninsulin. By the end of the day, her glucose was 6.4 on a glucometer. Fructosamine came back at 388 (142-450). I went to this pet's home and we checked sugar levels at her house to find 18.8 on the glucometer and 363 on our istat machine. (both high with heska normal being 60-130) Her clinical signs resolved with only a transition to diabetic management food. ONe week later, she is vomiting more frequently and hiding. What kind of an insulin dose would you start this cat at? Are there any cats who need less than once a day? How long does it take for glucose to spill over into the urine with stress? What is truly normal for fructosamine of a non-diabetic cat? please see the attached min. data base for this cat. Feline leukemia and FIV were both negative. Thank you for your help.

The anorexia and diarrhea alone, or were there other signs?

Lepto serology?

Hello and thank you for your help. Last week I saw a 5 yr old 3.12 kg dmh girl called Daisy. She has lost 1/3 of her body mass since July 2011. (slow weight loss). Last week, Daisy presented for anorexia and diarrhea. glucose was 26.2 with normal upper range being 9.4. She had glucosurea. While waiting for fructosamine results, we gave one dose of 1 unit of caninsulin. By the end of the day, her glucose was 6.4 on a glucometer. Fructosamine came back at 388 (142-450). I went to this pet's home and we checked sugar levels at her house to find 18.8 on the glucometer and 363 on our istat machine. (both high with heska normal being 60-130) Her clinical signs resolved with only a transition to diabetic management food. ONe week later, she is vomiting more frequently and hiding. What kind of an insulin dose would you start this cat at? Are there any cats who need less than once a day? How long does it take for glucose to spill over into the urine with stress? What is truly normal for fructosamine of a non-diabetic cat? please see the attached min. data base for this cat. Feline leukemia and FIV were both negative. Thank you for your help.

How frequent of a vomiter has she been in the past?

Canned or dry?

Hello and thank you for your help. Last week I saw a 5 yr old 3.12 kg dmh girl called Daisy. She has lost 1/3 of her body mass since July 2011. (slow weight loss). Last week, Daisy presented for anorexia and diarrhea. glucose was 26.2 with normal upper range being 9.4. She had glucosurea. While waiting for fructosamine results, we gave one dose of 1 unit of caninsulin. By the end of the day, her glucose was 6.4 on a glucometer. Fructosamine came back at 388 (142-450). I went to this pet's home and we checked sugar levels at her house to find 18.8 on the glucometer and 363 on our istat machine. (both high with heska normal being 60-130) Her clinical signs resolved with only a transition to diabetic management food. ONe week later, she is vomiting more frequently and hiding. What kind of an insulin dose would you start this cat at? Are there any cats who need less than once a day? How long does it take for glucose to spill over into the urine with stress? What is truly normal for fructosamine of a non-diabetic cat? please see the attached min. data base for this cat. Feline leukemia and FIV were both negative. Thank you for your help.

Was any discomfort elicited on abdominal palpation?

Can you get that in canada yet?

Hello and thank you for your help. Last week I saw a 5 yr old 3.12 kg dmh girl called Daisy. She has lost 1/3 of her body mass since July 2011. (slow weight loss). Last week, Daisy presented for anorexia and diarrhea. glucose was 26.2 with normal upper range being 9.4. She had glucosurea. While waiting for fructosamine results, we gave one dose of 1 unit of caninsulin. By the end of the day, her glucose was 6.4 on a glucometer. Fructosamine came back at 388 (142-450). I went to this pet's home and we checked sugar levels at her house to find 18.8 on the glucometer and 363 on our istat machine. (both high with heska normal being 60-130) Her clinical signs resolved with only a transition to diabetic management food. ONe week later, she is vomiting more frequently and hiding. What kind of an insulin dose would you start this cat at? Are there any cats who need less than once a day? How long does it take for glucose to spill over into the urine with stress? What is truly normal for fructosamine of a non-diabetic cat? please see the attached min. data base for this cat. Feline leukemia and FIV were both negative. Thank you for your help.

Is she still hyperglycemic?

Are you certain owners are comfortable in handling and administering the insulin?

Hello and thank you for your help. Last week I saw a 5 yr old 3.12 kg dmh girl called Daisy. She has lost 1/3 of her body mass since July 2011. (slow weight loss). Last week, Daisy presented for anorexia and diarrhea. glucose was 26.2 with normal upper range being 9.4. She had glucosurea. While waiting for fructosamine results, we gave one dose of 1 unit of caninsulin. By the end of the day, her glucose was 6.4 on a glucometer. Fructosamine came back at 388 (142-450). I went to this pet's home and we checked sugar levels at her house to find 18.8 on the glucometer and 363 on our istat machine. (both high with heska normal being 60-130) Her clinical signs resolved with only a transition to diabetic management food. ONe week later, she is vomiting more frequently and hiding. What kind of an insulin dose would you start this cat at? Are there any cats who need less than once a day? How long does it take for glucose to spill over into the urine with stress? What is truly normal for fructosamine of a non-diabetic cat? please see the attached min. data base for this cat. Feline leukemia and FIV were both negative. Thank you for your help.

How have her glucose levels been since the diabetic diet was started?

I suspect a reactivation of toxo infection- is that a possiblity for this guy?

Hello and thank you for your help. Last week I saw a 5 yr old 3.12 kg dmh girl called Daisy. She has lost 1/3 of her body mass since July 2011. (slow weight loss). Last week, Daisy presented for anorexia and diarrhea. glucose was 26.2 with normal upper range being 9.4. She had glucosurea. While waiting for fructosamine results, we gave one dose of 1 unit of caninsulin. By the end of the day, her glucose was 6.4 on a glucometer. Fructosamine came back at 388 (142-450). I went to this pet's home and we checked sugar levels at her house to find 18.8 on the glucometer and 363 on our istat machine. (both high with heska normal being 60-130) Her clinical signs resolved with only a transition to diabetic management food. ONe week later, she is vomiting more frequently and hiding. What kind of an insulin dose would you start this cat at? Are there any cats who need less than once a day? How long does it take for glucose to spill over into the urine with stress? What is truly normal for fructosamine of a non-diabetic cat? please see the attached min. data base for this cat. Feline leukemia and FIV were both negative. Thank you for your help.

By the way, daisy is spayed, right?

Were able to assess his hydration status at that time?

Greetings, Your thoughts? Saw a kitty yesterday, first visit, 13 yr MN, with complaint of weight loss and good appetite. Nothing remarkable on PE, except fleas (owner using frontline...cats are indoors, believes flea infested friend infested his home when they brought laundry to his house to do). He has 4 cats, all indoors. Labs/CBC-CHEM/UA: Only abnormality was 30,200 WBC, with slightly increased lymphs (8,700) and very increased eos (8,400). Could this be just the fleas? He's eating well...not sure why the wt loss (of course I don't have a previous wt for the cat....he was 13 lbs yesterday). Fecal pending. Thanks,

How low was the t4 in this kitty?

Was the cat eating a chicken-based diet previous to the z/d?

In my little town there are two veterinarians; Me and Him. We get along well enough. We aren't drinking buddies or even "going for coffee" buddies. I suspect he considers me a "johnie-come-lately" infringing on his home-town territory (I bought this clinic three years ago) and I actually consider him a GP who just thinks he is a Boarded surgeon. He does just about everything: endoscopy, orthopedics, ultrasound and lots of stuff in-between. I suspect he is pretty good, but hardly experienced; the case load and the economomics of this isolated, depressed industrial town just does not lend itself to a huge case load of speciaed cases. I would bet that he repairs maybe three broken legs per year, yet his exceed that of most of the Boarded speciaed practices we have access to. I just cannot bring myself to refer orthopedics to him but, really, it is making me look like a small minded, incompetent jerk to the local community. My take on the subject is two-fold. While my colleague down the street remains truly a "colleague", he is also my only competition and by referring cases to him, by implication I am making myself look incompetent in comparison. It is like saying "here, go to the real veterinarian for the hard stuff". The issue is that he does not actually have more experience than I do: we graduated two years apart over 25 years ago and I have seen and done things in my mixed carreer that many veterinarians would blanche at. Specifically, with regards to orthopedics and endoscopy, I made an economic decision: I chose not to invest in expensive diagnostic and treatment modalities that would be rarely used and would never show profit to my small clinic. The decision was based wholly on economics rather than capability (I did both orthopedics and endoscopy for years in a more urban location with a heavier case load.) The other reason I refer more complex cases is the case load. If I send my orthopedics to a boarded surgeon, I am getting a surgeon who does three or four cases a working with a team that deals with orthopedics all the time. If I refer to my colleague down the street I am getting a guy that does three or four cases a year with his team of one technician and some helpful volunteers....at no cost savings. It just seems like bad business: my client gets rusty skill sets from a GP and it looks like "Dr.is incompetent". The problem I am running into is that my clients are all completely phobic of the big city and have steadfastly refused referrals most of the time. Sometimes it is the money (the impression being that it be cheaper here in the village...it NEVER is), sometimes it is the travel time (everybody here goes down to the big city on a routine basis for retail therapy), and often is is just the impression that my referrals are done purely out of personal prejudice rather than professional ethics. It makes me want to go and invest in orthopedics equipment again; ten to twenty thousand dollars in equipment I use maybe three times a year. I am coming to hate referrals altogether.

How you doing?

What do you suppose would happen if you put ~30 ml oxyglobin into a dehydrated, cold cat with glucose 800 and serum ketones?

Hi, My colleague saw a 10yo WHWT (FN) a month ago for PU/PD, slighty reduced appetite and some lethargy. NAD on physical. Prescribed 5d clav/amox and requested urine. UA - SG = 1.010, glucose +, NAD otherwise. Advised back for bloods, r/o DM. Blood result - Access Number : 3062115667 DAVID ID : LORD Lilly Bridge House Vet Surgery ASG : 10yo nf whwt Sherwood Hall Road Report Date : 25/06/13 Mansfield Request Date : 21/06/13 Nottinghamshire. NG18 2NH Standard Screen Full Blood Count WBC.................... L 5.5 x10^9/l 6.0 - 15.0 RBC.................... 7.95 x10^12/l 5.00 - 8.50 Haemoglobin............ H 18.9 g/dl 12.0 - 18.0 PCV.................... H 55.3 % 37.0 - 55.0 MCV.................... 69.6 fl 60.0 - 80.0 MCH.................... H 23.8 pg 19.0 - 23.0 MCHC................... H 34.2 g/dl 31.0 - 34.0 Platelets.............. 445 x10^9/l 200 - 500 % x10^9/l Range Neutrophils 70 3.8 3.0 - 11.5 Lymphocytes 23 1.3 1.0 - 4.8 Monocytes 5 0.3 0.0 - 1.3 Eosinophils 2 0.1 0.1 - 1.25 Basophils 0 0.0 % x10^9/l Range Film : Normal red cell morphology Platelet count appears normal in film Total Protein.......... 74.4 g/l 54.0 - 77.0 Albumin................ 36.7 g/l 25.0 - 37.0 Total Globulin......... 37.7 g/l 23.0 - 52.0 Sodium................. 153 mmol/l 139 - 154 Potassium.............. H 5.80 mmol/l 3.60 - 5.60 Sodium : Potassium..... L 26.38 27.00- 38.00 Chloride............... 111 mmol/l 105 - 122 Calcium................ 2.86 mmol/l 2.30 - 3.00 Phosphate.............. H 1.83 mmol/l 0.80 - 1.60 Urea................... 2.6 mmol/l 1.7 - 7.4 Creatinine............. 72 umol/l 20 - 100 Total Bilirubin........ 1.4 umol/l 0.0 - 16.0 ALP.................... H 393 u/l@37C 16 - 55 ALT.................... 28 u/l@37C 18 - 56 Gamma GT............... 1.0 u/l@37C 0.0 - 6.0 GLDH................... 6.0 u/l@37C 2.0 - 6.0 Bile Acids............. 0.0 umol/l 0.0 - 10.0 CK..................... H 1,316 u/l@37C 50 - 230 Cholesterol............ 6.5 mmol/l 3.8 - 7.0 Triglycerides.......... 1.02 mmol/l 0.56 - 1.69 Glucose - Random....... 4.5 mmol/l 2.0 - 5.5 Amylase................ 407 u/l@37 C 100 - 900 Lipase................. 37 u/l@37 C 0 - 250 Comment: Sample slightly haemolysed ________________________________________________________________________________ We've had two more USG and dips since, both negative for glucose, unremarkable dip stick and SGs of 1.015 and 1.005 so 2 isosthenuric and one hyposthenuric. The dog had a similar incident a year ago which was never diagnosed and went away. Had -ve ACTH stim at that time. My first thought was something fanconi like, eaten a dodgy beef jerky kind of thing. 2weeks clear of the 5d clav I took a cysto and submitted for C/S and took blood for lepto MAT testing. At this point the dog was still markedly PU/PD but well in herself. After taking the samples I gave two weeks clav. Urine C/S was -ve Lepto - BIOCHEMISTRY Leptospira MAT Screen............Pool 1: Negative Pool 2: POSITIVE Pool 3: POSITIVE Pool 4: Negative Pool 5: Negative Pool 6: Negative MICROBIOLOGY General bacteriology Sample............. Urine Microaerophilic Culture No growth ________________________________________________________________________________ No urinary tract pathogens isolated. Further results to follow. Further report: Positive leptospirosis MAT testing to pools 2 and 3. If you would like further information regarding the titre levels to the individual serovars within pools 2 and 3, please contact the reception. Susie Kenefick MA, VetMB, DipECVIM-CA, MRCVS Further information on the serovars in each pool: Leptospira - Pool 1 (L. canicola, copenhageni, ballum, icterohaemorragiae) Leptospira - Pool 2 (L. pomona, mozdok, tarassovi, grippotyphosa) Leptospira - Pool 3 (L. australis, bratislava, autumnalis) Leptospira - Pool 4 (L. hebdomadis, mini, sejroe) Leptospira - Pool 5 (L. javanica, bataviae, zanoni) Leptospira - Pool 6 (L. hardjo prajitno & hardjo bovis) Ruth Willis BVM&S, DVC, MRCVS, RCVS Recognised Specialist in Cardiology Clinical Pathologist: Je Ristic BVetMed, DSAM, Cert VC, MRCVS Phoned the lab to enquire about the test result, was expecting to get numerical titres. Lab said it is a qualitative test so only +ve or -ve, no numbers. Said the test measured IgM which is indicative of active infection not vaccinal interference and that this result means the dog is +ve for lepto. Is this correct? I plan to follow up the two weeks clav with 3 weeks doxy. Is this the current recommendation for treating lepto? Should I persue further diagnostics at this point or are we comfortable with the diagnosis? After 10d clav the dog is reportedly unchanged, still well but drinking loads. Any other thoughts? Many thanks in advance,

Do we have a vaccine history for dates?

Is the dog diabetic or hypoglycemic?

This case is regarding my own beloved dog Chance. He is an ~8yo castrated male black lab mix. He presented with gradual onset polyuria/polydipsia about 1 month ago. He then began having urinary incontinence while sleeping about 2 weeks ago. I have owned Chance for 6.5 years and he has never had a urinary accident before. I immediately started freaking out thinking "Cancer, it has to be cancer." Chance has never suffered from any major or related illnesses (occasional gastroenteritis, conjunctivitis). His only medication is Carprofen 75mg PRN given very rarely. His physical exam is generally unremarkable (iridial cysts, mild dental calculus, stifle arthritis). HX: He is able to void normally and has a normal stream. His is able to go about his normal marking routine outside and starts/stops his stream without any residual dribbling. He is only incontinent when asleep. I am not able to determine whether it is better or worse when bladder is full/empty (I have started taking him out at night 11am/3am/6am and he will still bedwet between 3-6). His urine output has definitely increase along with his water intake. PE: When he is relaxed enough to allow me to palpate his bladder, I would describe it as moderately full and not overly firm. After urinating, I am not able to feel a bladder, which leads me to believe he is able to empty his bladder. I do not palpate urethral abnormties rectally. My finger is not long enough to reach his prostate. ANS appears normal (normal PLR, normal rectal tone, normal HR), rest of neuro exam is normal. I am not able to express his bladder when awake. I am not sure which direction to head in next as far as diagnostics/therapies. So far I have run a CBC, Chemistry, UA and UCCR. The results are listed below. I am not sure if I should be looking at this as a primary incontinence issue or as a primary PUPD problem. -----CBC ------ HEMOGRAM RBC Count = 6.41 [4.48-8.53] Hemoglobin= 15.7 [10.5-20.1] Hematocrit = 43.2 [33.0-58.7] MCV = 67.3 [63.0-78.3] MCHC = 36.3 [30.8-35.9] *High* RCDW = 13.1 [11.9-18.1 Platelet = 385 [140-540] WBC Count = 10.5 [ 4.0-18.2] Seg Neut Abs # = 5.78 [2.50-15.70] Band Neut Abs # = 0.00 [0.00-0.20] Lymph Abs # = 3.05 [0.30-3.90] Act Lymph Abs # = 0.00 [0.00-0.90] Mono Abs # = 0.21 [0.00-1.40] Eos Abs # = 1.47 [0.00-1.30] *High* Bas Abs # = 0.00 [0.00-0.10] Other Abs # = 0.00 [0.00-0.00] Blast Abs # = 0.00 [0.00-0.00] Promyelocyte Abs # = 0.00 [0.00-0.00] Myelocyte Abs # = 0.00 [0.00-0.00] Metamyelocyte Abs # = 0.00 [0.00-0.00] DIFFERENTIAL Seg Neut = 55% Lymph = 29% Mono = 2% Eosin = 14% ------CHEM------ Glucose = 102 [74-145] AST = 17 [18-86] *Low* ALT = 37 [14-151] ALP = 20 [13-289] Total Bilirubin = 0.0 [ 0.0-0.5] Cholesterol = 234 [98-300] Total Protein = 5.8 [5.0-8.3] Albumin = 3.1 [2.6-4.0] Globulin = 2.7 [2.0-4.4] Urea N = 19 [8-30] Creatinine = 1.3 [0.4-2.0] Phosphorous = 3.1 [2.5-7.9] Calcium = 9.4 [8.7-12.0] Sodium = 146 [141-159] Potassium = 4.8 [3.4-5.6] Chloride = 113 [ 100-121] Bicarb = 23 [16-31] Anion Gap = 15 [17-28] *Low* GGT = 2 [3-19] *Low* A/G Ratio = 1.1 Urea/Creat Ratio = 15 Sodium/Potassium Ratio = 30 -------URINALYSIS------- USG = 1.015 [1.018-1.045] *Low* (This low USG has been repeatable with 3 samples, different times of day) pH = 6.0 [5.2-6.8] Prot = NEG Gluc = NEG Keto = NEG Uro = NORM Bili = NEG Bld = NEG Cytology = NSF -------CORT/CREAT RATIO-------- Urine Cortisol = 8.8 Urine Creatinine = 7.9 Cortisol/Creatinine Ratio = 1.1 [0.0-5.0] It would make me feel soooooo much better, if I could prove to myself that he is actually able to concentrate his urine, but I am terrified of the idea of water deprivation. When I look at the long list of causes for PUPD I can rule out many, but am not sure which to go after next. Thank you so much for your help!!!!

So, unless i missed it, he still lepto titers and cysto curine culture to complete his problem-specific database for pupd, right?

Acidosis is possible - can you run a blood gas and check for acidemia?

This case is regarding my own beloved dog Chance. He is an ~8yo castrated male black lab mix. He presented with gradual onset polyuria/polydipsia about 1 month ago. He then began having urinary incontinence while sleeping about 2 weeks ago. I have owned Chance for 6.5 years and he has never had a urinary accident before. I immediately started freaking out thinking "Cancer, it has to be cancer." Chance has never suffered from any major or related illnesses (occasional gastroenteritis, conjunctivitis). His only medication is Carprofen 75mg PRN given very rarely. His physical exam is generally unremarkable (iridial cysts, mild dental calculus, stifle arthritis). HX: He is able to void normally and has a normal stream. His is able to go about his normal marking routine outside and starts/stops his stream without any residual dribbling. He is only incontinent when asleep. I am not able to determine whether it is better or worse when bladder is full/empty (I have started taking him out at night 11am/3am/6am and he will still bedwet between 3-6). His urine output has definitely increase along with his water intake. PE: When he is relaxed enough to allow me to palpate his bladder, I would describe it as moderately full and not overly firm. After urinating, I am not able to feel a bladder, which leads me to believe he is able to empty his bladder. I do not palpate urethral abnormties rectally. My finger is not long enough to reach his prostate. ANS appears normal (normal PLR, normal rectal tone, normal HR), rest of neuro exam is normal. I am not able to express his bladder when awake. I am not sure which direction to head in next as far as diagnostics/therapies. So far I have run a CBC, Chemistry, UA and UCCR. The results are listed below. I am not sure if I should be looking at this as a primary incontinence issue or as a primary PUPD problem. -----CBC ------ HEMOGRAM RBC Count = 6.41 [4.48-8.53] Hemoglobin= 15.7 [10.5-20.1] Hematocrit = 43.2 [33.0-58.7] MCV = 67.3 [63.0-78.3] MCHC = 36.3 [30.8-35.9] *High* RCDW = 13.1 [11.9-18.1 Platelet = 385 [140-540] WBC Count = 10.5 [ 4.0-18.2] Seg Neut Abs # = 5.78 [2.50-15.70] Band Neut Abs # = 0.00 [0.00-0.20] Lymph Abs # = 3.05 [0.30-3.90] Act Lymph Abs # = 0.00 [0.00-0.90] Mono Abs # = 0.21 [0.00-1.40] Eos Abs # = 1.47 [0.00-1.30] *High* Bas Abs # = 0.00 [0.00-0.10] Other Abs # = 0.00 [0.00-0.00] Blast Abs # = 0.00 [0.00-0.00] Promyelocyte Abs # = 0.00 [0.00-0.00] Myelocyte Abs # = 0.00 [0.00-0.00] Metamyelocyte Abs # = 0.00 [0.00-0.00] DIFFERENTIAL Seg Neut = 55% Lymph = 29% Mono = 2% Eosin = 14% ------CHEM------ Glucose = 102 [74-145] AST = 17 [18-86] *Low* ALT = 37 [14-151] ALP = 20 [13-289] Total Bilirubin = 0.0 [ 0.0-0.5] Cholesterol = 234 [98-300] Total Protein = 5.8 [5.0-8.3] Albumin = 3.1 [2.6-4.0] Globulin = 2.7 [2.0-4.4] Urea N = 19 [8-30] Creatinine = 1.3 [0.4-2.0] Phosphorous = 3.1 [2.5-7.9] Calcium = 9.4 [8.7-12.0] Sodium = 146 [141-159] Potassium = 4.8 [3.4-5.6] Chloride = 113 [ 100-121] Bicarb = 23 [16-31] Anion Gap = 15 [17-28] *Low* GGT = 2 [3-19] *Low* A/G Ratio = 1.1 Urea/Creat Ratio = 15 Sodium/Potassium Ratio = 30 -------URINALYSIS------- USG = 1.015 [1.018-1.045] *Low* (This low USG has been repeatable with 3 samples, different times of day) pH = 6.0 [5.2-6.8] Prot = NEG Gluc = NEG Keto = NEG Uro = NORM Bili = NEG Bld = NEG Cytology = NSF -------CORT/CREAT RATIO-------- Urine Cortisol = 8.8 Urine Creatinine = 7.9 Cortisol/Creatinine Ratio = 1.1 [0.0-5.0] It would make me feel soooooo much better, if I could prove to myself that he is actually able to concentrate his urine, but I am terrified of the idea of water deprivation. When I look at the long list of causes for PUPD I can rule out many, but am not sure which to go after next. Thank you so much for your help!!!!

He's with you, right, so we know it's not seizure?

If the fructosamine level is elevated, it doesn't really answer many important question e.g. are we under-dosing the insulin?

Hello, I have a 16 year old spayed DSH with impressive hypernatremia I’m trying to sort out. In April 2012 I noticed she was losing weight and not eating as well. CBC/Chem/UA have a few mild abnormities but nothing major, FELV/FIV negative. Repeated BW a few times with nothing obvious to explain continued hyporexia and weight loss. GI panel in August had cobamin 517 (276-1425), folate 8.5 (8.9-19.9), fpl 3.2 (norm). By this time she was looking rely bad, BCS 3/9, totly anorexic, lethargic. Decided I didn’t want to do surgery for biopsies so we started her on prednisolone and B12 injections. She responded well and gained a pound over the next 9 months, was eating well, and acting happy. Over the last 2 months she’s been declining again, not eating as much, slightly lethargic and has lost hf a pound. She so meows in the early morning like she's confused (checked BP- norm). On CBC/chemistry, ALT 117 (28-100), BUN 90 (15-34), Creatinine 2.3 (1.8-2.3), Sodium 185 (147-156), chloride 142 (111-125), lymphocytes 684 (1500-7000). Rest of cbc/chem norm, Alb 3.8 (2.3-3.9), glob 4.7 (3-5.6). USG is now 1.018 (was 1.034 a year ago). I’m wondering what the de is with this hypernatremia. She acts thirsty and gets excited when I change the water bowl or put ice in her water but is a little weird when drinking- her chin gets wet and she makes smacking noises instead of sticking her tongue out and lapping up the water but she's done this for at least 6-12 months. I can post a video if that would help. Can prednisolone cause diuresis enough to cause a hypernatremia like this? I have noticed she twitches slightly every 10 seconds or so for about the last month but it’s subtle and she’s not acting rely “sick” with this hypernatremia so I’m wondering how aggressive I need to be about getting it down- hoping I can maybe figure out the cause and correct it rather than just treating the hypernatremia. Looking back at October 2012 chemistry, her sodium was 170 so it looks like it's been a slow but steady increase. Thanks,

Any other neurologic changes?

Do you have any chest radiographs?

I could use some help interpreting lab results and plan for further diagnostics/treatment. "Bowbay" is a 9 yr old FS poodle, initially presented several years ago for 2nd opinion for pruritis not responding to prednisone. She had one crusty lesion on her shoulder that scraped positive for Sarcoptes (surprise!). Treated her with Revolution (3 doses at 2 week intervals then kept on Revolution monthly to prevent reinfection, now on Frontline monthly as a preventative to scabies, fleas, & ticks). Skin lesion resolved, pruritus decreased but never entirely resolved, started food trials and is somewhat better on Hills z/d ultra, but still gets seasonal flareups, has always gotten some relief from periodic predisolone tapers and chlorpheneramine and owner has reported PU/PD while on pred but ok with it as long as patient got itch relief. (Also needs frequent anal gland expression and gets intermittant otitis externa, as is typical of allergic dogs). Last seen in April 2013 for itching and was dispensed pred and chlorpheneramine. Came in yesterday in need of itch relief again, but owner concerned that dog seems very PU/PD and has been off pred for about 3 weeks. No other clin signs reported, no weight loss, I will ask the owner specifically about appetite, vomiting, etc. but I think this owner would have mentioned it and the dog on PE was normal other than full anal glands. In-house UA showed USG=1.006, all else neg and no active sediment. Sent out Chem and CBC, results surprised (and baffled) me. I can post all results if that helps but will start with abnormals* and corresponding values. *ALT= 1126 (12-118 U/L) result verified AST= 46 (15-66) ALP= 114 (5-131) *GGTP= 24 (1-12) result verified T Bili= 0.1 (0.1-0.3) *BUN= 4 (6-31) Creat= 0.7 (0.5-1.6) *CPK= 48 (59-895) Rest of chem WNL including blood proteins Alb= 3.2 (2.7-4.4) Glob= 2.5 (1.6-3.6) Other than Platelet Count=457 (170-400) and Platelet EST= Increased, CBC was WNL. This does not look like steroid hepatopathy to me. Trying to put it together, ALT tells me hepatocyte injury, GGT either easily induced/falsely elevated or gall bladder obstruction, low BUN and CPK perhaps indicating muscle loss? I read that the low BUN may be a factor in medullary washout which may be the cause of the PU/PD and hyposthenuria? But I am having trouble putting this all together and with a dog that doesn't seem sick. I told owner common causes of PU/PD, Cushings (natural vs iatrogenic), renal, diabetes (ruled out by neg glucosuria), but none of these are reflected in the blood work. Never expected these results. Not sure where to go next. Pursue aggressively with abd ultrasound? Try a course of antibiotics and recheck ALT in 2 weeks to look for trending, since dog not acting sick? Deal with liver before dealing with PU/PD? The owner did ask about cyclosporine (Atopica) and would be willing to try that, but did not want to do anything until results were in. I did send chlorpheneramine with the dog as I thought that was pretty safe, warned the owner that it may not give a lot of relief on its own. Did not send pred. Also mentioned that I saw something about a new drug, Apoquel, a Janus kinase inhibitor that block the itch pathway (neuro component I think) but don't know yet if it's available or reviews on effectiveness. I can always post that question to derm tho. I appreciate any help you can give me with this case. Thank you.

Hepatic encephalopathy - worth a bile acids test given the elevation in alt and low bun - how does cholesterol and glucose and t bili look?

No chance of heating pad injury?

Since ouncing I am pregt, we had a staff turnover and a schedule change. With the new schedule, I technically on paper get an hour lunch but with the way appointments are scheduled, I often only have 10 minutes to quickly eat my food before I need to get to work again. I feel my stress level tremendously incsing at work and I am having anxiety at home. I have tried discussing this multiple times with the office manager who has taken no action to rectify the situation. I feel that I am being discriminated against though not in a blatant way. I want to know what recourse I can take, as I am feeling that the work environment is becoming so intolerable that I may need to quit. I can't find any direct law that protects me against not getting bks while pregt. I would like to know the best way to rectify the situation. We are owned by a corporation and so I would like to go above the office manager, but would like to have resources I can use to explain my position and protect myself against what I fear is going to become a forced termination.

Do all these circumstance you are going through apply to all staff members equally?

Why the ursodiol?

Since ouncing I am pregt, we had a staff turnover and a schedule change. With the new schedule, I technically on paper get an hour lunch but with the way appointments are scheduled, I often only have 10 minutes to quickly eat my food before I need to get to work again. I feel my stress level tremendously incsing at work and I am having anxiety at home. I have tried discussing this multiple times with the office manager who has taken no action to rectify the situation. I feel that I am being discriminated against though not in a blatant way. I want to know what recourse I can take, as I am feeling that the work environment is becoming so intolerable that I may need to quit. I can't find any direct law that protects me against not getting bks while pregt. I would like to know the best way to rectify the situation. We are owned by a corporation and so I would like to go above the office manager, but would like to have resources I can use to explain my position and protect myself against what I fear is going to become a forced termination.

The "10 minutes to eat my food" etc?

Any loss of anal tone or fecal incontinence?

Hello all, My colleague (a vet also) has a cat with multiple issues and we are looking for some suggestions on how manage him best, as he has multiple issues and has just been diagnosed with a protein losing nephropathy (low albumin on bloodwork and 3+ protein on urine - USG 1020, nothing else abnormal). Bear with us as this is a long history. We will try to summarize: Clovis is a 16 yo, MN, DSH with long-term issues with stress. He over-grooms, even on 10mg of Amitriptyline daily but his idiopathic cystitis has been stable at this dose. He has also had a history of crystalluria and urethral blockage which has been under control since the idiopathic cystitis has been under control. He has multiple allergies to foods and is currently eating Royal Canin Mobility/Fibre Formula mix wet and dry with water added, for arthritis and a fibre responsive diarrhea. In addition, he is on Cosequin which is helping the arthritis tremendously. He takes steroid (Prednisone 2.5mg) daily for feline asthma and to keep what she believes is stress induced flares of IBD under control (raging vomiting and diarrhea, sometimes diarrhea with blood) and this has been stable for 5 years with no flares since beginning the prednisone. 2 years ago, he developed strange, reverse-type sneezing episodes (history of herpesvirus-like flares of watery, erythemic eyes which resolve after a few days) which progressed this year to green nasal discharge and recently with blood when sneezing - she is unsure, but thinks this unilateral. Recently, the productive sneezing has been much more frequent prompting a need to choose antibiotic therapy (suspecting nasal polyp here) but of course, he gets raging diarrhea and vomiting with Clavamox, amoxicillin, cephalexin. The least traumatic seems to be a fluoroquinolone - he gets vomiting around day 10 of therapy usually. He has hyperthyroidism that seems unstable, dosages are needing to be increased every few months - currently on 5mg of Methimazole twice daily. His bloodwork has been fine except for hyperthyroidism and then two weeks ago, we noted Albumin was about 5 marks below low end of normal (sorry, don't have the bloodwork with me). In the last few weeks, she has noted Clovis also having head tremors - currently infrequently. Conditions in Summary: 1) Multiple food allergies 2) Multiple drug sensitivities 3) Idiopathic Cystitis and a history of crystalluria and urethral blockage 4) Severe Anxiety Issues 5) Fibre Responsive Diarrhea - suspect IBD 6) Arthritis 7) Hyperthyroidism 8) Feline Asthma 9) Protein-Losing Nephropathy 10) Possible Seizure activity. Currently Medicated with: 1) Cosequin 2) Methimazole 5mg q 12h 3) Prednisone 2.5mg q 24h 4) Amitriptylline 10mg q 24h Need to start treatment for green muco-purulent nasal discharge with blood and protein-losing nephropathy. We are wondering whether the seizures may be related to the Tapazole and Amitriptyline combination. Since a fluoroquinolone would be started for the nasal discharge, we are worried about the interaction with Tapazole, especially in light of the seizure activity, and are thinking of dropping the Tapazole dose. We have not taken his blood pressure yet, not having a time when the hyperthyroidism has been under control for long and suspecting when it is not, he would be high, especially in clinic as he is such a stressed cat. The questions we have are: 1) If dropping the Tapazole, how much of a drop would be appropriate (he was recently raised from 3/4 of tablet to a full tablet BID - hyperthyroid behavior was at home at 3/4 tablet bid)? 2) In starting the benazepril for the protein-losing nephropathy, beyond monitoring bloodwork and watching for syncope, is there anything else we should watch for given all the diseases on board and medications? We would be open to any other suggestions for managing this cat as managing him well is becoming much more complicated. Up until this year he has been really quite stable. Things began to deteriorate after his diagnosis of the hyperthyroidism. Thank you in advance for the consideration of this case. We have cross-posted to Feline Internal Medicine also.

What does that mean?

Female spayed?

Hello all, My colleague (a vet also) has a cat with multiple issues and we are looking for some suggestions on how manage him best, as he has multiple issues and has just been diagnosed with a protein losing nephropathy (low albumin on bloodwork and 3+ protein on urine - USG 1020, nothing else abnormal). Bear with us as this is a long history. We will try to summarize: Clovis is a 16 yo, MN, DSH with long-term issues with stress. He over-grooms, even on 10mg of Amitriptyline daily but his idiopathic cystitis has been stable at this dose. He has also had a history of crystalluria and urethral blockage which has been under control since the idiopathic cystitis has been under control. He has multiple allergies to foods and is currently eating Royal Canin Mobility/Fibre Formula mix wet and dry with water added, for arthritis and a fibre responsive diarrhea. In addition, he is on Cosequin which is helping the arthritis tremendously. He takes steroid (Prednisone 2.5mg) daily for feline asthma and to keep what she believes is stress induced flares of IBD under control (raging vomiting and diarrhea, sometimes diarrhea with blood) and this has been stable for 5 years with no flares since beginning the prednisone. 2 years ago, he developed strange, reverse-type sneezing episodes (history of herpesvirus-like flares of watery, erythemic eyes which resolve after a few days) which progressed this year to green nasal discharge and recently with blood when sneezing - she is unsure, but thinks this unilateral. Recently, the productive sneezing has been much more frequent prompting a need to choose antibiotic therapy (suspecting nasal polyp here) but of course, he gets raging diarrhea and vomiting with Clavamox, amoxicillin, cephalexin. The least traumatic seems to be a fluoroquinolone - he gets vomiting around day 10 of therapy usually. He has hyperthyroidism that seems unstable, dosages are needing to be increased every few months - currently on 5mg of Methimazole twice daily. His bloodwork has been fine except for hyperthyroidism and then two weeks ago, we noted Albumin was about 5 marks below low end of normal (sorry, don't have the bloodwork with me). In the last few weeks, she has noted Clovis also having head tremors - currently infrequently. Conditions in Summary: 1) Multiple food allergies 2) Multiple drug sensitivities 3) Idiopathic Cystitis and a history of crystalluria and urethral blockage 4) Severe Anxiety Issues 5) Fibre Responsive Diarrhea - suspect IBD 6) Arthritis 7) Hyperthyroidism 8) Feline Asthma 9) Protein-Losing Nephropathy 10) Possible Seizure activity. Currently Medicated with: 1) Cosequin 2) Methimazole 5mg q 12h 3) Prednisone 2.5mg q 24h 4) Amitriptylline 10mg q 24h Need to start treatment for green muco-purulent nasal discharge with blood and protein-losing nephropathy. We are wondering whether the seizures may be related to the Tapazole and Amitriptyline combination. Since a fluoroquinolone would be started for the nasal discharge, we are worried about the interaction with Tapazole, especially in light of the seizure activity, and are thinking of dropping the Tapazole dose. We have not taken his blood pressure yet, not having a time when the hyperthyroidism has been under control for long and suspecting when it is not, he would be high, especially in clinic as he is such a stressed cat. The questions we have are: 1) If dropping the Tapazole, how much of a drop would be appropriate (he was recently raised from 3/4 of tablet to a full tablet BID - hyperthyroid behavior was at home at 3/4 tablet bid)? 2) In starting the benazepril for the protein-losing nephropathy, beyond monitoring bloodwork and watching for syncope, is there anything else we should watch for given all the diseases on board and medications? We would be open to any other suggestions for managing this cat as managing him well is becoming much more complicated. Up until this year he has been really quite stable. Things began to deteriorate after his diagnosis of the hyperthyroidism. Thank you in advance for the consideration of this case. We have cross-posted to Feline Internal Medicine also.

What is the liver and kidney test enzymes?

Is he on the canned version of the dm?

I have my first diabetic cushinoid dog! Just wanted a second opinion on management. BooBoo is a 14 year old FS Bichon who came to me for a second option. **Been diabetic for a few years and on 5 units NPH BID. Eats well, not PUPD, no episodes of hypoglycemia. Most recent bloodwork in January shows glucose at 461 (75-106), at which point the insulin was changed from 4 units BID to 5 units BID. **Diagnosed Cushinoid with ACTH stimulation: Pre cortisol 11.6 (1-5), 4 hours 19.8 (1), 8 hours 7.5 (1). Was started on anipryl 10mg SID for treatment--never heard of this treatment. The owner cannot remember why they tested for cushings and so does not know if the dog is better now. It appears the previous veterinarian has been checking cushings with cortisol/creatinine ratio--last one 2.5 (8-24). **Has always been an itchy dog. Has been on food trials in the past. Currently has significant pyoderma on belly. On 25mg modified cyclosporine twice daily and the owner thinks there is no improvement. Looking back, was on actual atopica and well controlled at some point. Recommended basic bloodwork, urinalysis, and fructosamine to see where the dog is at. Started on Cephalexin for pyoderma. I am unfamiliar with this drug for Cushings, but the dog is not PUPD or panting and I am debating just keeping her on it? Would it be ideal to repeat an ACTH stimulation on this dog? Also, its a very high dose of cyclosporine--would you try switching to atopica name brand? Or add in ketoconazole?

Why was dog tested for cushings?

First, what brand is the glucometer?

I have my first diabetic cushinoid dog! Just wanted a second opinion on management. BooBoo is a 14 year old FS Bichon who came to me for a second option. **Been diabetic for a few years and on 5 units NPH BID. Eats well, not PUPD, no episodes of hypoglycemia. Most recent bloodwork in January shows glucose at 461 (75-106), at which point the insulin was changed from 4 units BID to 5 units BID. **Diagnosed Cushinoid with ACTH stimulation: Pre cortisol 11.6 (1-5), 4 hours 19.8 (1), 8 hours 7.5 (1). Was started on anipryl 10mg SID for treatment--never heard of this treatment. The owner cannot remember why they tested for cushings and so does not know if the dog is better now. It appears the previous veterinarian has been checking cushings with cortisol/creatinine ratio--last one 2.5 (8-24). **Has always been an itchy dog. Has been on food trials in the past. Currently has significant pyoderma on belly. On 25mg modified cyclosporine twice daily and the owner thinks there is no improvement. Looking back, was on actual atopica and well controlled at some point. Recommended basic bloodwork, urinalysis, and fructosamine to see where the dog is at. Started on Cephalexin for pyoderma. I am unfamiliar with this drug for Cushings, but the dog is not PUPD or panting and I am debating just keeping her on it? Would it be ideal to repeat an ACTH stimulation on this dog? Also, its a very high dose of cyclosporine--would you try switching to atopica name brand? Or add in ketoconazole?

Insulin resistance?

If female, is she spayed?

Hi, Rease is a 7 year old MN DSH. He presented for diabetes and was started on glargine 0.25u/kg bid and Hills m/d canned (no dry). His oral health is good. He had some low numbers (home measurement) so was reduced to 1/2 unit bid. His last curve was: 9:30 am 3.4. He was fed shortly after and given glargine 0.5 unit SQ 12:30 10.3 3:30 12.1 6:30 8.8 9:30 12.8, Fed and given insulin. This curve puzzles me a bit. Why is his morning reading so low? Is the length of action too long and it's overlapping? Would it be best to give him 0.5 unit once daily and repeat the curve in 7 days?

Should i continue him on 0.5 units bid and canned food only and recurve in 7 days?

Pe findings?

Hi, Rease is a 7 year old MN DSH. He presented for diabetes and was started on glargine 0.25u/kg bid and Hills m/d canned (no dry). His oral health is good. He had some low numbers (home measurement) so was reduced to 1/2 unit bid. His last curve was: 9:30 am 3.4. He was fed shortly after and given glargine 0.5 unit SQ 12:30 10.3 3:30 12.1 6:30 8.8 9:30 12.8, Fed and given insulin. This curve puzzles me a bit. Why is his morning reading so low? Is the length of action too long and it's overlapping? Would it be best to give him 0.5 unit once daily and repeat the curve in 7 days?

Or decrease to 0.5 units sid?

Their problem is that they don't tell you why the control is bad e.g. is it because of a too-short duration of insulin action?

Timon is a 16-month-old Siamese cat that got a blow to the head with a board (yikes!) when he was just a kitten. At that time he had a very pronounced anisocoria which has partially resolved. He also developed PU/PD that has not resolved. At the time of his neuter he had elevated WBC which caused a delay in the surgery for two weeks while he was on antibiotics (leukocytosis resolved.) He also has a raging appetite and will eat anything, according to the owners. On routine physical two weeks ago, he was in very good flesh (BCS 6-7/9), purring, very content, mild anisocoria. The owners complained he was drinking alot and peeing alot. We ran CBC and inhouse 12 chem panel; CBC unremarkable but BUN=37 and Cre=2.9; we could not get a urine. He had pretty bad gingivitis on the left side of his mouth...turns out there was a gemini tooth out of 207 that had been impacting ris. Started clindamycin for upcomnig COHAT. He came in yesterday and we repeated CBC, chem and got a cysto. The urine specific gravity was 1.008 and absolutely nothing on sediment. BUN and Creatinine were the same. He really really does not LOOK like a renal impairment kitty...well I put him on k/d anyway. I discussed the possibility of DI since trauma to the pituitary could surely influence the ADH levels. Would it be okay to do a trial of desmopressin? how do cats do with this? I can find nothing (so far) here about central feline diabetes insipidis. What other differentials should I be thinking about? Thanks in advance.

What do the kidneys palpate like?

Have the owners observed blood in the urine?

Here's my latest brain strain.. your wise words welcomed! 7 yr old female neutered Pomeranian, Pebbles, presented to me in 2012 for annual exam - doing very well at home, but since having her coat clipped the previous year, had grown back dry, rough and patchy. Her head was still soft and fluffy. Otherwise well, energetic, good appetite, V- D-, not PUPD. Nothing significant on abdominal exam apart from bilaterally luxated patellae, no pot-belly or sagging abdomen, no skin lesions, just a dry and rough coat. I was keen to rule out a possible endocrine issue due to her coat. Her owners wished to proceed slowly with investigations, so just ran a biochem panel. Creat was a bit low at 37 (44-159), GGT at 9 (0-7), everything else WNL. Two days later they dropped in a free catch urine sample: USG 1.024, nitrates +, pH 9, cocci 2-3 , bacilli 2, struvites +, all else negative. Urine cortisol creatinine ratio 18.9 (34). Since the sample was free catch, I had the patient come in for cystocentesis. Quick ultrasound of the bladder during cysto revealed no abnormalities. USG 1.037, pH 8, protein 1 , fat droplets 2 , all else negative. Sent for culture - came back as a proteus infection, resistant to amoxi only. Treated with Baytril x 4 weeks. Owners did not come back for the follow-up culture after treatment as recommended. More recently, I saw Pebbles for urinating when she sleeps, only during daytime naps. When she gets up her rear end is wet, and her urine so clear the owners were not sure it wasn't water. This never seems to happen through the night. They do not feel that she is polydipsic. Her heart rate on exam was only 90 (bradycardic for a small, excitable dog), but the rest of her exam was normal apart from her dry, brittle coat where she was groomed (head still fluffy). Urine by cysto had a USG of 1.005. pH 6-7, nothing else significant. Culture was negative. Hematology was normal. Full biochem was normal Free T4 was 7 (7.7-47.6), but TSH was only 0.07 (0-0.6). At this point my ddx were diabetes insipidus, hyperadrenocorticism despite normal ALP, psychogenic polydipsia, gonadal neoplasia? (She is spayed, could she have ectopic ovarian tissue or a remnant?) Am I correct in believing that hormonal-responsive urinary incontinence is not the real problem here, because the urine wouldn't be so dilute? Next I ran a low dose dex, which was normal (cortisol 94, 4 hrs post 11, 8 hrs post 10), and owners measured Pebbles' water intake, which was 50mls/kg/day. So it doesn't seem that she is polydispic. But how can she have such dilute urine and not be polydipsic without being horribly dehydrated? Her urine when I took the cysto was indeed as clear as water. A month later, Pebbles is still having urinary accidents when she sleeps. I have suggested an abdominal ultrasound as I do not have any more imagery than quick ultrasounds of the bladder during cysto. I'm really quite nervous about the idea of water deprivation tests. I suppose a more extensive workup of her urinary system (scope?) may also be warranted? Also I don't know what her poor coat quality has to do with all of this - maybe nothing? Some kind of telogen problem? Thanks in advance for your suggestions!

Did you know?

Is the kitty doing well on the hp?

Here's my latest brain strain.. your wise words welcomed! 7 yr old female neutered Pomeranian, Pebbles, presented to me in 2012 for annual exam - doing very well at home, but since having her coat clipped the previous year, had grown back dry, rough and patchy. Her head was still soft and fluffy. Otherwise well, energetic, good appetite, V- D-, not PUPD. Nothing significant on abdominal exam apart from bilaterally luxated patellae, no pot-belly or sagging abdomen, no skin lesions, just a dry and rough coat. I was keen to rule out a possible endocrine issue due to her coat. Her owners wished to proceed slowly with investigations, so just ran a biochem panel. Creat was a bit low at 37 (44-159), GGT at 9 (0-7), everything else WNL. Two days later they dropped in a free catch urine sample: USG 1.024, nitrates +, pH 9, cocci 2-3 , bacilli 2, struvites +, all else negative. Urine cortisol creatinine ratio 18.9 (34). Since the sample was free catch, I had the patient come in for cystocentesis. Quick ultrasound of the bladder during cysto revealed no abnormalities. USG 1.037, pH 8, protein 1 , fat droplets 2 , all else negative. Sent for culture - came back as a proteus infection, resistant to amoxi only. Treated with Baytril x 4 weeks. Owners did not come back for the follow-up culture after treatment as recommended. More recently, I saw Pebbles for urinating when she sleeps, only during daytime naps. When she gets up her rear end is wet, and her urine so clear the owners were not sure it wasn't water. This never seems to happen through the night. They do not feel that she is polydipsic. Her heart rate on exam was only 90 (bradycardic for a small, excitable dog), but the rest of her exam was normal apart from her dry, brittle coat where she was groomed (head still fluffy). Urine by cysto had a USG of 1.005. pH 6-7, nothing else significant. Culture was negative. Hematology was normal. Full biochem was normal Free T4 was 7 (7.7-47.6), but TSH was only 0.07 (0-0.6). At this point my ddx were diabetes insipidus, hyperadrenocorticism despite normal ALP, psychogenic polydipsia, gonadal neoplasia? (She is spayed, could she have ectopic ovarian tissue or a remnant?) Am I correct in believing that hormonal-responsive urinary incontinence is not the real problem here, because the urine wouldn't be so dilute? Next I ran a low dose dex, which was normal (cortisol 94, 4 hrs post 11, 8 hrs post 10), and owners measured Pebbles' water intake, which was 50mls/kg/day. So it doesn't seem that she is polydispic. But how can she have such dilute urine and not be polydipsic without being horribly dehydrated? Her urine when I took the cysto was indeed as clear as water. A month later, Pebbles is still having urinary accidents when she sleeps. I have suggested an abdominal ultrasound as I do not have any more imagery than quick ultrasounds of the bladder during cysto. I'm really quite nervous about the idea of water deprivation tests. I suppose a more extensive workup of her urinary system (scope?) may also be warranted? Also I don't know what her poor coat quality has to do with all of this - maybe nothing? Some kind of telogen problem? Thanks in advance for your suggestions!

Everything look o with the protein?

Do the owners want to learn how to generate curves at home?

Here's my latest brain strain.. your wise words welcomed! 7 yr old female neutered Pomeranian, Pebbles, presented to me in 2012 for annual exam - doing very well at home, but since having her coat clipped the previous year, had grown back dry, rough and patchy. Her head was still soft and fluffy. Otherwise well, energetic, good appetite, V- D-, not PUPD. Nothing significant on abdominal exam apart from bilaterally luxated patellae, no pot-belly or sagging abdomen, no skin lesions, just a dry and rough coat. I was keen to rule out a possible endocrine issue due to her coat. Her owners wished to proceed slowly with investigations, so just ran a biochem panel. Creat was a bit low at 37 (44-159), GGT at 9 (0-7), everything else WNL. Two days later they dropped in a free catch urine sample: USG 1.024, nitrates +, pH 9, cocci 2-3 , bacilli 2, struvites +, all else negative. Urine cortisol creatinine ratio 18.9 (34). Since the sample was free catch, I had the patient come in for cystocentesis. Quick ultrasound of the bladder during cysto revealed no abnormalities. USG 1.037, pH 8, protein 1 , fat droplets 2 , all else negative. Sent for culture - came back as a proteus infection, resistant to amoxi only. Treated with Baytril x 4 weeks. Owners did not come back for the follow-up culture after treatment as recommended. More recently, I saw Pebbles for urinating when she sleeps, only during daytime naps. When she gets up her rear end is wet, and her urine so clear the owners were not sure it wasn't water. This never seems to happen through the night. They do not feel that she is polydipsic. Her heart rate on exam was only 90 (bradycardic for a small, excitable dog), but the rest of her exam was normal apart from her dry, brittle coat where she was groomed (head still fluffy). Urine by cysto had a USG of 1.005. pH 6-7, nothing else significant. Culture was negative. Hematology was normal. Full biochem was normal Free T4 was 7 (7.7-47.6), but TSH was only 0.07 (0-0.6). At this point my ddx were diabetes insipidus, hyperadrenocorticism despite normal ALP, psychogenic polydipsia, gonadal neoplasia? (She is spayed, could she have ectopic ovarian tissue or a remnant?) Am I correct in believing that hormonal-responsive urinary incontinence is not the real problem here, because the urine wouldn't be so dilute? Next I ran a low dose dex, which was normal (cortisol 94, 4 hrs post 11, 8 hrs post 10), and owners measured Pebbles' water intake, which was 50mls/kg/day. So it doesn't seem that she is polydispic. But how can she have such dilute urine and not be polydipsic without being horribly dehydrated? Her urine when I took the cysto was indeed as clear as water. A month later, Pebbles is still having urinary accidents when she sleeps. I have suggested an abdominal ultrasound as I do not have any more imagery than quick ultrasounds of the bladder during cysto. I'm really quite nervous about the idea of water deprivation tests. I suppose a more extensive workup of her urinary system (scope?) may also be warranted? Also I don't know what her poor coat quality has to do with all of this - maybe nothing? Some kind of telogen problem? Thanks in advance for your suggestions!

Perhaps the low t4 is due to low tsh?

Would the client pursue abdominal ultrasound and biopsies (endoscopically, for example)?

I have a patient (K9) that appears on glucose curve to have about 8-10 hours of good glucose control with Humilin N. The owner is complaining of increased urination in the house and the above curve was done. Antibiotics were started for possible UTI at that time also. I mentioned to the owner that TID administration may be helpful based on the most recent curve numbers. Does anyone have any experience or suggestions for using Humilin N TID in dogs?

Can i see the actual curve numbers?

Can you post a recent curve or two?

This 7 yr old miniature schnauzer is being treated with NPH insulin for DM beginning 2 weeks ago. The dose was started at 3 units bid. She also had a uti and was treated with convenia. She came in for a glucose curve last week: 260, 176, 218, 482 (every 2 hrs) We increased the dose to 4 units bid. Also, we started proin because of excessive dribbling. Owner called this morning and reports she was lethargic all day yesterday and vomited this morning. Owner has not given insulin or proin since yesterday morning. Her abdomen is painful. Serum glucose: 483. We are doing anitemetics, fluids, analgesics and a gi panel at TAMU today. Could the proin be a part of the nausea problem? Thanks! Diane

Does she have ketones in the urine now?

What did the adrenals look like on the ultrasound?

This 7 yr old miniature schnauzer is being treated with NPH insulin for DM beginning 2 weeks ago. The dose was started at 3 units bid. She also had a uti and was treated with convenia. She came in for a glucose curve last week: 260, 176, 218, 482 (every 2 hrs) We increased the dose to 4 units bid. Also, we started proin because of excessive dribbling. Owner called this morning and reports she was lethargic all day yesterday and vomited this morning. Owner has not given insulin or proin since yesterday morning. Her abdomen is painful. Serum glucose: 483. We are doing anitemetics, fluids, analgesics and a gi panel at TAMU today. Could the proin be a part of the nausea problem? Thanks! Diane

Have you run a cbc/chem since she got sick?

As far as your food trial...what did you use?

This 7 yr old miniature schnauzer is being treated with NPH insulin for DM beginning 2 weeks ago. The dose was started at 3 units bid. She also had a uti and was treated with convenia. She came in for a glucose curve last week: 260, 176, 218, 482 (every 2 hrs) We increased the dose to 4 units bid. Also, we started proin because of excessive dribbling. Owner called this morning and reports she was lethargic all day yesterday and vomited this morning. Owner has not given insulin or proin since yesterday morning. Her abdomen is painful. Serum glucose: 483. We are doing anitemetics, fluids, analgesics and a gi panel at TAMU today. Could the proin be a part of the nausea problem? Thanks! Diane

Is she spayed?

Has the owner's glucometer been checked for accuracy?

This 7 yr old miniature schnauzer is being treated with NPH insulin for DM beginning 2 weeks ago. The dose was started at 3 units bid. She also had a uti and was treated with convenia. She came in for a glucose curve last week: 260, 176, 218, 482 (every 2 hrs) We increased the dose to 4 units bid. Also, we started proin because of excessive dribbling. Owner called this morning and reports she was lethargic all day yesterday and vomited this morning. Owner has not given insulin or proin since yesterday morning. Her abdomen is painful. Serum glucose: 483. We are doing anitemetics, fluids, analgesics and a gi panel at TAMU today. Could the proin be a part of the nausea problem? Thanks! Diane

Is she incontinent while awake, or just when resting/sleeping?

Is it glucosuric?

An 11 yo MN Border Collie cross presented for a second opinion after seeing being treated at another vet hospital for a hotspot last Thursday with an injection of Depo Medrol and topical spray (still awaiting records) The owner noted that the dog was having more difficulty getting around in his hindlimbs and seemed uncomfortable and not himself. They had called the local emergency clinic this weekend to see if could be due to steroid injection and were advised to give Pepcid and feed a bland diet which they said he ate readily. He is eating well and drinking excessively. The owner noticed an open hole on his leg this am and made an appointment here. We found several other holes through the skin along both legs. On physical examination he is BAR but nervous. He had several wounds through the skin exposing the muscle layers on the hindlimbs. His bloodwork is attached. Based on his time of presentation we cleaned up the wounds but elected to hold off on surgery until we get regulated. I have started him on antibiotics but have a lot of questions regarding treatment. Is it possible that the diabetes was caused by the steroid injection and if so would it be possible to expect that he may not remain diabetic long term? Should this affect the way that I monitor him and should I consider initially starting him on insulin in hospital? Since he is eating and drinking and not dehydrated, am I ok to start on NPH insulin? Any suggestions on how to proceed would be much appreciated. Thank you for your time.

Did he get anything besides the depo and the topical spray?

Is your patient normal, under or overweight?

An 11 yo MN Border Collie cross presented for a second opinion after seeing being treated at another vet hospital for a hotspot last Thursday with an injection of Depo Medrol and topical spray (still awaiting records) The owner noted that the dog was having more difficulty getting around in his hindlimbs and seemed uncomfortable and not himself. They had called the local emergency clinic this weekend to see if could be due to steroid injection and were advised to give Pepcid and feed a bland diet which they said he ate readily. He is eating well and drinking excessively. The owner noticed an open hole on his leg this am and made an appointment here. We found several other holes through the skin along both legs. On physical examination he is BAR but nervous. He had several wounds through the skin exposing the muscle layers on the hindlimbs. His bloodwork is attached. Based on his time of presentation we cleaned up the wounds but elected to hold off on surgery until we get regulated. I have started him on antibiotics but have a lot of questions regarding treatment. Is it possible that the diabetes was caused by the steroid injection and if so would it be possible to expect that he may not remain diabetic long term? Should this affect the way that I monitor him and should I consider initially starting him on insulin in hospital? Since he is eating and drinking and not dehydrated, am I ok to start on NPH insulin? Any suggestions on how to proceed would be much appreciated. Thank you for your time.

Can you post pictures?

Are you familiar with how to buy detemir (e.g. not the 10 ml bottle...buy the pens)?

Yellow cat is a 11lb dsh. He started on glarginine insulin 3 weeks ago. O just started bid dosing of 1 unit. His curves are not showing much response. He is consistently above 450. Urine culture neg. he is gaining weight, and pu/pd is still significant. He is on high prot, low carb. Should I just increase to 2 units bid?

He's not icteric, right?

Even if you didn't see fleas, i presume that you still recommended flea control on this cat?

Yellow cat is a 11lb dsh. He started on glarginine insulin 3 weeks ago. O just started bid dosing of 1 unit. His curves are not showing much response. He is consistently above 450. Urine culture neg. he is gaining weight, and pu/pd is still significant. He is on high prot, low carb. Should I just increase to 2 units bid?

Which diet is he on?

A lepto titer, ba stim and t4 level are often additional data i like to obtain, depending on the specific animal; did you do an abdo us?

Yellow cat is a 11lb dsh. He started on glarginine insulin 3 weeks ago. O just started bid dosing of 1 unit. His curves are not showing much response. He is consistently above 450. Urine culture neg. he is gaining weight, and pu/pd is still significant. He is on high prot, low carb. Should I just increase to 2 units bid?

Is it the canned only version?

And is the perceived anterior uveitis a prequel or sequel to the detachment?

Yellow cat is a 11lb dsh. He started on glarginine insulin 3 weeks ago. O just started bid dosing of 1 unit. His curves are not showing much response. He is consistently above 450. Urine culture neg. he is gaining weight, and pu/pd is still significant. He is on high prot, low carb. Should I just increase to 2 units bid?

Is the total amount for the day being measured and is it an appropriate amount for a cat this size?

Can you inject her in the car, if she's presumably still calm-ish?

Yellow cat is a 11lb dsh. He started on glarginine insulin 3 weeks ago. O just started bid dosing of 1 unit. His curves are not showing much response. He is consistently above 450. Urine culture neg. he is gaining weight, and pu/pd is still significant. He is on high prot, low carb. Should I just increase to 2 units bid?

The owner is able to accurately draw up and then inject the insulin?

How old is the dog?

Yellow cat is a 11lb dsh. He started on glarginine insulin 3 weeks ago. O just started bid dosing of 1 unit. His curves are not showing much response. He is consistently above 450. Urine culture neg. he is gaining weight, and pu/pd is still significant. He is on high prot, low carb. Should I just increase to 2 units bid?

Moving the insulin around on the cat's body every day?

What diet is she eating?

I have a 12 yo 10.7# happy bouncy otherwise healthy MN poodle who, likely since Dec 2012, is Cushenoid. He doesn't have a rat tail yet, he may (I saw it but everyone else told me I was nuts) be losing fur on his back. No pot belly yet (but it was coming!). The LDDST in December when he had a 3.3 ug/dL PRE and 0.6 ug/dL post at both 4 and 8 hour. Based on clinical signs I suspect the first test may have been rerun. Or maybe coincidence is that great. He's always been a slim critter with a finicky appetite but around that December range he became PU/PD/polyphagic. Great for us (easier to give him his meds) but completely not normal. He did have a moderate amount of bacteria in his urine and responded well to the antibiotics. The PU/PD mostly resolved as expected (perhaps drinking a little more than previously but greatly improved with the antibiotics) until late April when he started drinking bucketfulls and started looking fat (to me - everyone else complimented me for no longer starving the guy)! For the past 3 years he's had an ALT teetering slightly above the high URL but interestingly it went happily into normal range when he was on gabapentin for his back pain (lots of root signature pain). Everything else has always been fine. In 2011 he had one 1-2 mm diameter spot of calcium deposit just under the skin of his right thigh (where one might give a vaccine). Elected not to test for cushings at that time. Back to present, the urine culture was negative and the LDDST run in June (yes, I was slow to motivate) was 5.5 ug/dL (PRE) with a 1.1 ug/dL 4-hr post and 2.2 ug/dL 8 hr post consistent with PDH. The urine creatinine:cortisol was 7.8. We don't have an ultrasound. I started with TRILOSTANE 10 mg SID rationalizing that the extra # of body weight was water weight so a little low on the dosing. Clinical signs improved gradually (he's becoming more painful again which, for him, is a good sign that the steroids aren't there to help cover the back pain, but his appetite is still pesky and voracious, and he's drinking more than he should) but we're still, 20 days later, drinking a lot and not letting mom sleep until 7 am because we have to urgently pee at 6 am (while MUCH MUCH MUCH improved, we are FILLING 3 human oopsie pee pads daily). We also get up at 3 am and pee silently into our diaper for a little relief. It is getting better and I'm running an ACTH Stim today but.... Should I be anxious to jump to BID dosing? Or should I be patient? (I feel confused about BID vs SID dosing based on the one little dinky study I have that seems to imply that BID dosing is more riddled with side effects but SID dosing has a shorter mean survival time in incredibly small populations....) Should I be ordering vasopressin? Adding salt to food? Depriving him of water? Or just leaving this alone until controlled? Doing anything else? Thanks, Nat

How long has he been on the trilostane now---about 4-6 weeks?

Is the owner open to having more bg curves done?

I have a 12 year old diabetic domestic short hair that presented about a month and a half ago with a UTI. The cat has been regulated well on ProZinc. She is not PU/PD and overall is doing well except had just started urinating outside the litterbox. About a month before this p had a fructosamine test that was well regulated. The urinalysis showed an active sediment with no glucosuria. O declined culture and MIC due to fixed income. She was started on Clavamox and on follow up still had a UTI present, this time with mild glucosuria (on dipstick 100mg/dL). O declined glucose testing or fructosamine testing but reported they had spilled some of the Clavamox and aren't sure if they stored it correctly. Went back over how to medicate and store Clavamox and started again for 2 weeks. The insulin they have been giving was at that time about a month old, they have been storing it and using it appropriately. On recheck the UTI is resolved but the glucosuria is still present 100 mg/dL on dipstick. Convinced O to at least do a fructosamine. Results come back 495 (142-450) 500 = good regulation. I am concerned that the glucosuria will cause another UTI but am not sure if this is real or could she be spilling glucose into her urine due to stress when she comes to the clinic? She is very stressed while here so a glucose curve has never been reliable on her. Should I recommend O monitor with glucose strips at home? O is elderly and cannot bend down well to clean out litter box. They have 4 cats that share boxes and will not keep them separated so I don't know how to be sure it is her urine they would be testing. Any thoughts?

Is kitty losing any weight?

Calcium?

.

Do you see involvement of middle, inner ear?

Can you post a photo of the lesion sometime soon?

Hi, I have a ragamuffin breeder client who has a young cat with a congenital heart defect. Minnie is 1 year old and was born with a double outlet(aorta and pulmonary artery) from her right ventricle. She also has a vsd providing o2 to right ventricle outlet. She is doing well has grown to be a 6 pound cat on enalapril/pimobendan/and lasix. She is currently in heat and the breeder is worried about the stress of heat on her well being but she is not a safe anesthesia candidate for ohe. The breeder is interested in suppressing her cycle with progesterone or something but worried about potential side affects. Any suggestions Thanks

Are we sure that she is not an anesthetic candidate when managed by an anesthesiologist?

Was free t4 done via equilibrium dialysis?

"Jack" is a desexed male JRT that presented 1 1/2 weeks ago with vomiting & anorexia.2 days prior he had been fed pork bones-his normal diet never contains bones.He had a very painful abdomen -a Snap Spec cPl was +ve & he was treated for pancreatitis with antibiotics and NSAIDS and anti-emetics.48 hrs he was much improved ,eating and playing but then over the course of the week he gradually deteriorated again ,with a variable appetite and occasional vomiting. He was seen 2 days ago ,abdomen was no longer painful but he had lost 1kg in weight-a complete blood profile was taken this time .The main abnormalities are K=3.7(3.9-5.9) Cl=74(101-118)\ Bicarb=9(12-26) Glucose=21.2(3.3-6.8) Bilirubin=147(0-7) ALP=22330(1-150) ALP steroid Isoenzyme=5021 AST=498(18-80) ALT=1864(16-90) Cholesterol=31.7(3.5-9) Haematology WBC=24(4.5-17),Neuts =21.1(3.5-12),Monocytes=1.4(0-1.1) He has been admitted on fluid therapy ,ab's and anti-emetics,is Pu/Pd and whilst keen to eat he has vomited every night-today he is starting to look a little jaundiced. Should we be starting him on insulin?Could his episode of pancreatitis have resulted in diabetes already-I forgot to mention that his spec cPl is now normal. I know the liver has a remarkable ability to recover but those seem like huge nos to me -we are planning to repeat the bloods tomorrow.I realise that recovery would be prolonged but I don't really want to put the dog or the owners through a prolonged hospitalisation if the outcome is going to be terminal!! Many thanks for your help

Can you get an abd us?

The owner is neither over- nor under-shaking the insulin (we scare them so much sometimes about not over-shaking it that they fail to reconstitute it well and inject diluent); well, the label on vetsulin now requires us to vigorously shake it the first time the bottle is opened, then it should be shaken enough each time it's used to keep it looking continuously milky...is this being done?

"Jack" is a desexed male JRT that presented 1 1/2 weeks ago with vomiting & anorexia.2 days prior he had been fed pork bones-his normal diet never contains bones.He had a very painful abdomen -a Snap Spec cPl was +ve & he was treated for pancreatitis with antibiotics and NSAIDS and anti-emetics.48 hrs he was much improved ,eating and playing but then over the course of the week he gradually deteriorated again ,with a variable appetite and occasional vomiting. He was seen 2 days ago ,abdomen was no longer painful but he had lost 1kg in weight-a complete blood profile was taken this time .The main abnormalities are K=3.7(3.9-5.9) Cl=74(101-118)\ Bicarb=9(12-26) Glucose=21.2(3.3-6.8) Bilirubin=147(0-7) ALP=22330(1-150) ALP steroid Isoenzyme=5021 AST=498(18-80) ALT=1864(16-90) Cholesterol=31.7(3.5-9) Haematology WBC=24(4.5-17),Neuts =21.1(3.5-12),Monocytes=1.4(0-1.1) He has been admitted on fluid therapy ,ab's and anti-emetics,is Pu/Pd and whilst keen to eat he has vomited every night-today he is starting to look a little jaundiced. Should we be starting him on insulin?Could his episode of pancreatitis have resulted in diabetes already-I forgot to mention that his spec cPl is now normal. I know the liver has a remarkable ability to recover but those seem like huge nos to me -we are planning to repeat the bloods tomorrow.I realise that recovery would be prolonged but I don't really want to put the dog or the owners through a prolonged hospitalisation if the outcome is going to be terminal!! Many thanks for your help

Labs done in house or reference lab?

How has your patient's weight been?

"Jack" is a desexed male JRT that presented 1 1/2 weeks ago with vomiting & anorexia.2 days prior he had been fed pork bones-his normal diet never contains bones.He had a very painful abdomen -a Snap Spec cPl was +ve & he was treated for pancreatitis with antibiotics and NSAIDS and anti-emetics.48 hrs he was much improved ,eating and playing but then over the course of the week he gradually deteriorated again ,with a variable appetite and occasional vomiting. He was seen 2 days ago ,abdomen was no longer painful but he had lost 1kg in weight-a complete blood profile was taken this time .The main abnormalities are K=3.7(3.9-5.9) Cl=74(101-118)\ Bicarb=9(12-26) Glucose=21.2(3.3-6.8) Bilirubin=147(0-7) ALP=22330(1-150) ALP steroid Isoenzyme=5021 AST=498(18-80) ALT=1864(16-90) Cholesterol=31.7(3.5-9) Haematology WBC=24(4.5-17),Neuts =21.1(3.5-12),Monocytes=1.4(0-1.1) He has been admitted on fluid therapy ,ab's and anti-emetics,is Pu/Pd and whilst keen to eat he has vomited every night-today he is starting to look a little jaundiced. Should we be starting him on insulin?Could his episode of pancreatitis have resulted in diabetes already-I forgot to mention that his spec cPl is now normal. I know the liver has a remarkable ability to recover but those seem like huge nos to me -we are planning to repeat the bloods tomorrow.I realise that recovery would be prolonged but I don't really want to put the dog or the owners through a prolonged hospitalisation if the outcome is going to be terminal!! Many thanks for your help

Might recheck the values?

What type of diet?

Hello, I have a cat with a history of inappropriate urination that improved with 5 mg Clomipramine compounded capsule SID. His recent labwork is great, normal thyroid. He has been on this dose for years. He has started becoming more anxious and seems to not settle down as well. His coat is slightly unkempt and he has been losing a few ounces here and there for the last 3 years. He is now just underweight. Can I increase his dose further or do you recommend changing Rx? Feliway has not seemed to help either. He lives with a few other cats and several large dogs and there may be a child entering the picture soon. Thank you,

What is his age and weight?

Did the dog remain seizure free while having a normal glucose?

Mobius is a 10 year old indoor only cat who has lost a little over a pound in the past 6 mnths. Previous constipation has resolved completely with Miralax and previously chronic vomiting also decreased dramatically in frequency after starting Miralax. Now owner reports that patient has increased appetite and is very energetic despite weight loss. After consulting Dr. Google and diagnosing hyperthyroidism, owner called me for second opinion. T4 is 2 now and six months ago it was 2.1. fTotal and free T4 remain normal. There is no azotemia. Specfpl was normal 6 months ago, now 3.9- per IDEXX may indicate pancreatitis. All else was normal - no evidence of diabetes. 1. Can early hyperthyroidism present with normal - not even grey zone - T4 if polyphagia and weight loss are present? 2. Or, does this sound more suspicious for GI lymphoma (due to polpyphagia) 3. Or am I missing the boat and there is some other disease I should be considering?

Was there a palpable nodule?

Does this dog have any predisposing disease like cushings or diabetes?

I have a 6 month old MN Yorkie that we have done a somewhat extensive workup on for PU/PD with no real answers yet. CBC, Chem, Urinalysis, Urine Culture, Lepto titers were all completed with the only abnormality noted being a consistent specific gravity of 1.002-1.004. I have tried a desmopressin response test and after a week of administering 2 drops BID there is still no improvement in the isosthenuria. I know that the modified water deprivation test is typically not worth doing but we're kind of reaching at straws at this point. I believe I understand the procedure (and the risks) but my question is if you continue to feed during the test. I would assume so but just wanted to make sure since the 5% body weight loss is so important. I know that many recommend testing for other diseases such as Cushing's etc first but this dog has apparently drank tons of water and urinated every 15 minutes ever since getting the dog at 6 weeks of age. I had them measure water consumption over 5 days and he is averaging nearly 300 mL/kg/day. I'm assuming since it's a young dog and has always been this way, it's most likely something congenital but I'm planning to do the test as a last resort while he is here boarding for over a week. Thanks for the help!

Could this dog be a congenital nephrogenic di?

How are the cat's senses?

7 year old m/n DSH has chronic obstipation/ megacolon. UA: wnl CBC: wnl Chem: low P, CK and BUN from poor intake/poor absorption Newly acquired patient for us. History: was on high fiber diet - not working! Current: EN or I/D, Lactulose 2-3 mL TID, Cisapride 5 mg BID, Ranitidine 10 mg SID, Miralax 1/8 teasp SID and SQ fluids this week as was dehydrated Doing much better on above regimen though HATES the food. Any suggestions for improvement? (trying to optimize therapy so can best assess if a subtotal colectomy is their next step - not quite there yet I don't think) THANK YOU. Jen

What is the specific gravity of this patient?

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

7 year old m/n DSH has chronic obstipation/ megacolon. UA: wnl CBC: wnl Chem: low P, CK and BUN from poor intake/poor absorption Newly acquired patient for us. History: was on high fiber diet - not working! Current: EN or I/D, Lactulose 2-3 mL TID, Cisapride 5 mg BID, Ranitidine 10 mg SID, Miralax 1/8 teasp SID and SQ fluids this week as was dehydrated Doing much better on above regimen though HATES the food. Any suggestions for improvement? (trying to optimize therapy so can best assess if a subtotal colectomy is their next step - not quite there yet I don't think) THANK YOU. Jen

Does this cat need to be periodically hospitalized for enemas and ivf?

Assuming everything else was normal i.e. are the previously elevated liver values now normal?

15-yr old MN DSH. Chronic diarrhea (and subsequent inappropriate defecation) for > 8 years. Owners finally allowed ex. lap. 5/2013. Histopath interpretation: "Suspicious for alimentary lymphoma". Current treatment: Prednisolone 10-mg per day Chlorambucil 2-mg every 48-hours Budesonide 1-mg per day Vitamin B-12 250-mcg sc every other week Eagle Pack Holistic Selects Continues to have BMs the consistency of "gravy" with rare normal BM. Appetite is up & down. Still pooping out of litter box. Not as gassy as he used to be. Can I give Chlorambucil every day (so far, no myleosuppression); or is there something else I can try? Thank you!

Is this cat eating dry food only?

Was the wbc differential done in your lab or at the outside lab?