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Hello, My patient is a 16.2 lb (7.36 kg) FS JRT that is diabetic and recently diagnosed with cushing's syndrome. My question is regarding a starting dose of trilostane for this dog. It seems the consensus is to start at 2 mg/kg daily but his dog would require approximately 15mg. I want to use the Vetoryl capsules rather than have trilostane compounded. Would 10 mg daily be inappropriately low or 30 mg daily be inappropriately high for initial dosing? They are hoping they can administer 1 size capsule daily due to the high cost of the med. Thanks!

Lddst?

Insulin stored properly and 6 month old?

Hello, My patient is a 16.2 lb (7.36 kg) FS JRT that is diabetic and recently diagnosed with cushing's syndrome. My question is regarding a starting dose of trilostane for this dog. It seems the consensus is to start at 2 mg/kg daily but his dog would require approximately 15mg. I want to use the Vetoryl capsules rather than have trilostane compounded. Would 10 mg daily be inappropriately low or 30 mg daily be inappropriately high for initial dosing? They are hoping they can administer 1 size capsule daily due to the high cost of the med. Thanks!

Was the dog getting more than 1 unit per pound per administration of insulin to suggest insulin resistance?

Does the prostate palpate normally and non-painfully?

Hello, My patient is a 16.2 lb (7.36 kg) FS JRT that is diabetic and recently diagnosed with cushing's syndrome. My question is regarding a starting dose of trilostane for this dog. It seems the consensus is to start at 2 mg/kg daily but his dog would require approximately 15mg. I want to use the Vetoryl capsules rather than have trilostane compounded. Would 10 mg daily be inappropriately low or 30 mg daily be inappropriately high for initial dosing? They are hoping they can administer 1 size capsule daily due to the high cost of the med. Thanks!

Was an ultrasound performed to look at the adrenals?

/spanis she getting a topical ophthalmic steroid?

"Abbey" is a 12 yr of fs cranky cat, approx. 12 lb, who has been on prednisone for approx. 12 months, after symptoms consistent with inflammatory bowel disease (wt. loss, vomiting, and decreased appetite, with unremarkable blood test and urine results) responded very favourably to prednisone and ranitidine treatments. She presented again to our clinic (receives regular care at a different clinic but sees us for any emergency needs) on March 5, for symptoms of pu/pd, and the owner commented the urine was "sticky" when it started to dry on the floor. My first concerns were the cat could be diabetic, and an outpatient urinalysis supported this. (SG > 1.050, large glucosuria, minimal other changes, pH 6.5). Abbey's owner and I had a discussion tonight about alternatives to prednisone, I was wondering if budesonide (enterocort) was a viable alternative to address IBD without aggravating her diabetes further. Also: are other meds such as cyclosporine (atopica?) useful for this? My associate placed abbey on zeniquin although there was, at the time of the urinalysis, no hematuria recorded. We have also placed her on weight control (hill's) and d/m food (cans). Hope I picked the right folder, I suppose internal medicine might also be interested? Thanks for any input! ☼

The other question would be: how sure are we that this was ibd and if not, might this previous disease not be present anymore so that we can wean off the setroids and focus on diabetic control?

Are we sure that the cat is being injected properly and insulin is being handled properly?

Since I have some compliance issues, there may be little else to advise but I just wanted to see if any other advice was available. I have a 11 yr MN DSH (weight 11.5#) who has been a diabetic since June of 2012. He has been continuing to show signs of being unregulated, PU/PD, no further weight loss since dx and starting on Prozinc at 1 unit BID. They finally looked good about one month later on 3 units AM, 2 units PM. The results were at the time 358, 130, 70, 164, 144 (at 2 hr intervals). Since then he has had worsening rechecks with his values rarely getting lower than 300 and starting around 600-700 at the beginning of the day. The owner describes varying degrees of increased urine volumes. He is currently at 4 units BID of Prozinc. Here is my main question - when would I worry about insulin resistance? And my reasoning for this is two-fold. He has had a chronic cough, that the owner has only partially let us evaluate, apparently being present for years. She finally let us radiograph him and he has an area of soft tissue opacity in his right middle lung lobe that appears completely consolidated. He will cough some when here for the day, but the owner is really not concerned and has declined a further workup. The second concern is that this cat has had consistent leukopenia to the point of me recommending now for 3-4 years a bone marrow aspirate to evaluate further. Numerous clin path techs have called to have a path review on his CBC but to no avail as the owner also does not wish to evaluate more fully. My concern is not so much that my hands are tied in this case, but is there a point where I need to be concerned with the insulin dose if I can't treat or evaluate these two problems to lessen the stress on his diabetes. And i have fully made the owner aware that these process(es) could have resulted in his diabetes issues due to chronic stress on the body and yet she still does not wish to work up. BW results (CBC) follow: (sorry about the format but the lowest number under each heading is the earliest date - back to Dec 2010) But you can at least see the trend towards anemia and leukopenia/neutropenia worsening and the last part about path review is on each evaluation 4.66 6 - 10 M/µL 4 4.21 4.57 4.19 5.18 5.82 5.89 Hematocrit a 26.0 29 - 45 % 27.0 28.4 32.4 29.2 32.9 33.5 31.3 Hemoglobin 8.7 9.5 - 15 g/dL 8.5 8.7 9.6 8.7 10.1 10.6 11.0 MCV 61 41 - 58 fL 68 68 71 70 64 58 53 MCH 18.7 11.0 - 17.5 pg 21.3 20.7 21.0 20.8 19.5 18.2 18.7 MCHC 33.5 29 - 36 g/dL 31.5 30.6 29.6 29.8 30.7 31.6 35.1 % Reticulocyte 1.5 % 2.4 Reticulocyte 70 3 - 50 K/µL c 96 Reticulocyte Comment A reticulocyte count of greater than 50 K/uL of blood is considered evidence of bone marrow response to an increased peripheral demand. Depending on the degree of anemia, a reticulocyte count 50 K/uL may indicate an inadequate bone marrow response. Serial monitoring of the erythrogram and absolute reticulocyte count may be useful to evaluate bone marrow responsiveness over time. The following chart can be used as a guideline to determine appropriateness of regenerative response. Degree of bone marrow response (K/uL): Mild 50-75 Moderate 75-175 Marked >175 Please note: For information about our new reticulocyte reporting, please see the Diagnostic Update on Vetconnect.com or call the internal medicine consulting team at 1-888-433-9987, option 4, option 2. WBC b 1.1 4.2 - 15.6 K/µL 1.4 1.8 1.9 d 1.6 2.2 4 3.8 Neutrophil 0.319 2.5 - 12.5 K/µL 0.322 0.306 0.437 0.496 0.748 1.12 0.95 Band 11 0 - 300 /uL 14 36 Lymphocyte 0.638 1.5 - 7 K/µL 0.938 0.918 1.197 0.768 1.078 2.4 2.47 Monocyte 0 0 - 0.85 K/µL 0 0.018 0.019 0.016 0.132 0.12 0.038 Eosinophil 0.132 0 - 1.5 K/µL 0.126 0.468 0.247 0.32 0.242 0.36 0.342 Basophil 0 0 - 0.1 K/µL 0 0.054 0 0 0 0 0 Nucleated RBC 14 0 - 2 /100 WBC 11 29 1 19 6 Auto Platelet 215 170 - 600 K/µL 285 295 176 181 e 167 215 183 Platelet Comments PLATELET COUNT REFLECTS MINIMUM VALUE. PLATELET CLUMPS SEEN ON SLIDE. PLATELET COUNT AND ESTIMATE MAY BE FALSELY DECREASED. LARGE PLATELETS PRESENT PLATELET COUNT REFLECTS MINIMUM VALUE. LARGE PLATELETS PRESENT PLATELET COUNT REFLECTS MINIMUM VALUE. LARGE PLATELETS PRESENT SCANNING OF THE BLOOD SMEAR REVEALED ADEQUATE PLATELET NUMBERS. DUE TO CLUMPING AND/OR LARGE PLATELETS THE AUTOMATED PLATELET NUMBER CANNOT BE ACCURATELY DETERMINED. Polychromasia MODERATE MODERATE MODERATE MARKED Anisocytosis MODERATE MARKED MODERATE MARKED Remarks SLIDE REVIEWED MICROSCOPICALLY. WBC CORRECTED FOR PRESENCE OF NUCLEATED RBC'S SLIGHT HOWELL JOLLY BODIES REACTIVE LYMPHOCYTES PRESENT RESULTS REVIEWED BY SECOND TECHNOLOGIST, NO CHANGES MADE. SLIDE REVIEWED BY TECHNOLOGIST, SIGNIFICANT ABNORMALITIES PRESENT. SUGGEST PATHOLOGIST REVIEW. SLIDE REVIEWED MICROSCOPICALLY. WBC CORRECTED FOR PRESENCE OF NUCLEATED RBC'S REACTIVE LYMPHOCYTES PRESENT BASOPHILIC STIPPLING PRESENT NO FELINE HEMOTROPIC MYCOPLASMAS (FHM, formerly Hemobartonella) seen. IF FHM IS SUSPECTED, THE IDEXX RealPCR FOR FHM IS MORE SENSITIVE THAN BLOOD FILM REVIEW. UNIT CODE 1717. RESULTS REVIEWED BY SECOND TECHNOLOGIST, NO CHANGES MADE. SLIDE REVIEWED MICROSCOPICALLY. WBC CORRECTED FOR PRESENCE OF NUCLEATED RBC'S BASOPHILIC STIPPLING PRESENT REACTIVE LYMPHOCYTES PRESENT NO FELINE HEMOTROPIC MYCOPLASMAS (FHM, formerly Hemobartonella) seen. IF FHM IS SUSPECTED, THE IDEXX RealPCR FOR FHM IS MORE SENSITIVE THAN BLOOD FILM REVIEW. UNIT CODE 1717. RESULTS REVIEWED BY SECOND TECHNOLOGIST, NO CHANGES MADE. SLIDE REVIEWED BY TECHNOLOGIST, SIGNIFICANT ABNORMALITIES PRESENT. SUGGEST PATHOLOGIST REVIEW. SLIDE REVIEWED MICROSCOPICALLY. SLIGHT HOWELL JOLLY BODIES SLIDE REVIEWED MICROSCOPICALLY. REACTIVE LYMPHOCYTES PRESENT PLATELETS- CLUMPED LARGE PLATELETS PRESENT PLATELETS APPEAR ADEQUATE. SLIDE REVIEWED MICROSCOPICALLY. REACTIVE LYMPHOCYTES PRESENT PLATELETS- CLUMPED PLATELETS APPEAR ADEQUATE. NORMOCYTIC/NORMOCHROMIC BASED ON RBC INDICES SLIDE REVIEWED MICROSCOPICALLY. WBC CORRECTED FOR PRESENCE OF NUCLEATED RBC'S REACTIVE LYMPHOCYTES PRESENT PLATELETS APPEAR ADEQUATE. PLATELETS- CLUMPED LARGE PLATELETS PRESENT a MANUAL PCV PERFORMED. b WBC CORRECTED FOR PRESENCE OF NUCLEATED RBC'S

Felv/fiv negative?

Lab results?

Lantus insulin is becoming more and more expensive. Last time I checked it was over $160 for a 10ml bottle at a discount pharmacy. I have a cat who is getting 18units of Lantus BID and still gets glucose values close to 400. So I told the owners I'd look into trying a different insulin. I came across the compounded PZI insulin from BCP Pharmacy. It costs about half as much as Lantus for a 10ml bottle, although I'm not sure how many units they'll end up having to give. I don't know if this is the BEST option for this cat, but I want to consider it for a moment. You can have it compounded in either U-40 or U-100. This is where I'm confused. If someone suggests a starting dose for PZI at 0.5u/kg, is that for U-40 or U-100? Let's assume for a moment that that dose was calculated for U-40 insulin. What would it be for the U-100 version? If 10ml of U-100 PZI contains 1000 units, and 10ml of U-40 PZI contains 400 units... how much insulin is there in each unit? If you have a drug that is 5mg/ml, then there is 5mg per ml. If you change the concentration to 10mg/ml, you have 10mg/ml. If you want to give 1 mg, you'd give 0.2ml of the 5/mgml or 0.1ml of the 10mg/ml. Is this the same when we're talking about units of insulin? please someone help! ☼

Can you post more about what's been done to try to regulate this cat on the lantus?

Can you characterize these observed episodes for me?

Lantus insulin is becoming more and more expensive. Last time I checked it was over $160 for a 10ml bottle at a discount pharmacy. I have a cat who is getting 18units of Lantus BID and still gets glucose values close to 400. So I told the owners I'd look into trying a different insulin. I came across the compounded PZI insulin from BCP Pharmacy. It costs about half as much as Lantus for a 10ml bottle, although I'm not sure how many units they'll end up having to give. I don't know if this is the BEST option for this cat, but I want to consider it for a moment. You can have it compounded in either U-40 or U-100. This is where I'm confused. If someone suggests a starting dose for PZI at 0.5u/kg, is that for U-40 or U-100? Let's assume for a moment that that dose was calculated for U-40 insulin. What would it be for the U-100 version? If 10ml of U-100 PZI contains 1000 units, and 10ml of U-40 PZI contains 400 units... how much insulin is there in each unit? If you have a drug that is 5mg/ml, then there is 5mg per ml. If you change the concentration to 10mg/ml, you have 10mg/ml. If you want to give 1 mg, you'd give 0.2ml of the 5/mgml or 0.1ml of the 10mg/ml. Is this the same when we're talking about units of insulin? please someone help! ☼

What is she eating?

What was the most recent t4 just out of curiosity?

Lantus insulin is becoming more and more expensive. Last time I checked it was over $160 for a 10ml bottle at a discount pharmacy. I have a cat who is getting 18units of Lantus BID and still gets glucose values close to 400. So I told the owners I'd look into trying a different insulin. I came across the compounded PZI insulin from BCP Pharmacy. It costs about half as much as Lantus for a 10ml bottle, although I'm not sure how many units they'll end up having to give. I don't know if this is the BEST option for this cat, but I want to consider it for a moment. You can have it compounded in either U-40 or U-100. This is where I'm confused. If someone suggests a starting dose for PZI at 0.5u/kg, is that for U-40 or U-100? Let's assume for a moment that that dose was calculated for U-40 insulin. What would it be for the U-100 version? If 10ml of U-100 PZI contains 1000 units, and 10ml of U-40 PZI contains 400 units... how much insulin is there in each unit? If you have a drug that is 5mg/ml, then there is 5mg per ml. If you change the concentration to 10mg/ml, you have 10mg/ml. If you want to give 1 mg, you'd give 0.2ml of the 5/mgml or 0.1ml of the 10mg/ml. Is this the same when we're talking about units of insulin? please someone help! ☼

Is the owner doing blood glucose checks at home?

And as you pointed out...why look at a parameter in a dog when we don't even suspect the disease is there?

Indy is a 10 year old male neutered Miniature Schnauzer that has: Diabetes - diagnosed 12/6/10, on 7 units NPH bid and w/d dry dog food, last fructosamine 2/15/13 (poor control 477), last curve 12/27/12 (9:30 am 483, 11:30 am 159, 1:30 pm 163, 3:30 pm143) 4/6 left apical systolic murmur due to mild degenerative valve disease - on 5 mg enalapril bid, last echo 7/10/12 Consistent mild elevation in liver enzymes - on Urosidiol and Vitamin E (owner could not get pet to take Denamarin), abdominal ultrasound on 6/21/12 revealed urinary bladder stone and gall bladder sludging, chemistry done on 2/15/13 (alkp 2726, alt 162, ggt 18) Cataract surgery OU on 12/20/11 - on Flubiprufen QD and Optimmune BID Low dex suppress test on 2/18/13 was normal Prior to his diabetes diagnosis he had reoccurring hotspots around his neck that were treated with steroids and antibiotics. Starting last November, he started having them again. He has had 3 separate incidents in the past 4 months. They take a long time to heal with antibiotics (tried convennia, switched to cephalexin, then zenequin), chlorphenaramine and an ecollar to help prevent scratching. Is there anything that can be done to help prevent the recurrence of these or help speed the healing process? Thanks!!

Will cross post to derm -- allergies?

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

Hello, Ashley is a 13 y.o. female spayed pomeranian who has been a very difficult diabetic to regulate. She seems to be doing great at home but her last curve was concerning. She has a mucocele and severe dental disease as well. The owner is not going to treat either of these conditions :( Ashley's last curve was great-for her. The owner was giving a little less than 1 unit every 12 hours. Ashley had eaten at 7:30am and was given her dose. We have the owner feeding her several times a day to prevent hypoglycemia. The owner's father is elderly and is home with Ashley during the day. On the weekends the owner works late. She premeasures the evening insulin dose for her father to give. I told the owner that the insulin is likely out of solution and probably inactive for this dose. She does not have another choice so I'm not sure how this is affecting things. We try to do her curves toward the end of the week. 2-5-13 8:15 am = 372 10:15 am = 109 11:30 am ate Royal Canin Low fat. 12:15 pm =98 2:15 pm = 75 3:45 pm ate owner food 4:15 pm = 67 5:30pm= 214 I instructed the owner to give 1/2 unit every 12 hours. The owner is a nurse and we have reviewed her administration technique. This was her curve 3-13-13 The owner was still giving a little less than 1 unit every 12 hours at 7:30am and pm. She did not decrease to 1/2 unit. 8:00 am = 410 10:00 am = 65 fed Royal canin low fat canned- ate great. 11:00 am = 101 1:00 pm = 24, rechecked, 23- new sample-26, submitted to the lab (antech) to recheck-50. Ashley was not exibiting any signs of hypoglycemia. She was fed GI low fat and ate well. 1:20 pm = 88 2:20 pm = 270 4:20 pm = 254 I told the owner to decrease to 1/2 unit and to feed more at each meal. I have heard that the insulin can be diluted so that it is easier to measure but I don't know how to do that properly. Should we try a different insulin? Thank you for your help. ☼

What insulin are you giving?

Are the lesions few enough that you could use something like topical tacrolimus?

Hi, I recently saw an approx. 10 yr old CM DSH "Yoda" for severe pruritis and excoriated face.....Seems to itch and rip apart the lateral eye area/cheek....Indoor only cat...no other signs of illness...13.22 lbs BCS 6/9 On initial physical exam, the only abnormality was severely excoriated bilat cheeks....thickened....alopecia....bleeding....crusting... Sent home w/ D/D venison diet (dry and wet), Simplicef, Pred, and liquid Atopica....Cat liked D/D but now doesn't....Finished Simplicef and Pred on every other day day dose....Continuing to give Atopica but getting more difficult as the cat just holds the throat closed and lets liquid run out of mouth....E-Collar on.... Recheck exam: Skin well healed...mild scarring due to excoriations....E-Collar was on...No evidence of infection...Skin infection resolved... Took E-Collar off in exam room and went right for the face again...seems very itchy at face and ears...Looked in ears and no debris but simply pruritic... Sent home with Z/D diet...awaiting response for palatability....Finish off Pred, continue Atopica, keep e-collar on... What else can I do for this facial pruritis? Don't want the poor cat to have to live with E-Collar...owner has no money to see Dermatologist.... Thank you...☼

Is the cat on good flea control?

Any chance this dog is cushings too?

Hello! I have a 9 year old FS Daschund mix that presented to me about 3 weeks ago (2/25/13) for a possible UTI. Presenting complaint was PU/PD for 2 weeks duration. She had also gained almost 10# since her previous visit and had an increased appetite. Explained to owner that I did not think her dog had a UTI and my main rule outs were Cushing's dz, diabetes and renal dz. Owner had NO money (not even for exam), but since she was an established client I did a glucose (82 - WNL....better to check than to end up with a DKA case!) and told her to return later in the week for full BW/urine. Owner returned and allowed a Superchem/CBC/T4/UA. Abnormal results are as follows: ALT 251 (12-118), ALP 2172 (5-131), Ca 11.6 (8.9-11.4), Amyl 1164 (290-1125), Lipase 851 (77-695), T4 0.5 (0.8-3.5), Urine SG 1.012 (1.015-1.050). All other results were normal. I called owner and advised her that Cushing's Disease is now at the top of my list and want to do a LDDS. (Even though the Thyroid was low, I'm wondering if it is falsely decreased due to "sick euthyroid" or secondary to excessive steroids in the body because I'm pretty convinced it's Cushing's disease). She comes in for a LDDS and the results are as follows: Pre-sample 3.0, Post (4hr) 0.7, Post (8hr) 0.7. Soooo....it's not Cushings! She does not have the money to run a FT4 test to back-up the low T4 results (she wasn't able to pay for the LDDS test the same day either, even though I told her payment was due when we ran the test...sigh....), so I started the dog on Soloxine 0.5 mg 1/2 tablet BID. I advise the owner we will need to recheck they T4 levels in 3 weeks and owner will try to get the money together for that. Owner calls this past Saturday, still extremely PU/PD. Any advice on what to do next? (and remember, funds are practically non-existent) Any chance of it being DI? I read that Urine SG has to be below 1.008 for DI and hers was 1.012. Any other thoughts? Thanks! Jen

How about a hypercalcemia panel?

Do we know the distemper vaccination of all the dogs since birth?

I have an 11 year old MN Black Lab patient who is unable to do stairs and very wobbling in the back legs. He has crepitis in both knees and has a large "squishy" mass on the left rear inner thigh. And muscle wasting (mostly in hips and legs) So we dx degenerative joint disease and started Adequan injections (2mls every 4 days for a total of 8 injections). First injection gave 12/15/12, he weighed 98lbs. We ran bloodwork on 1/26/13: (his BW in 5/5/6/12 was completely normal) Chem: T4: 1.6 CBC: WNL Alk P 316 Alt 280 AST 130 CK 240 Chol 566 Gluc 549 Chloride 97 K 6.2 Na 135 Na/K 22 UA on 1/31/13 Free Catch Straw/Clear USG 1.046 Glucose +3 Ketones +1 ph 6.0 Protein Trace Dx Diabetes and put him on Humulin NPH This dog is VERY AGGRESSIVE and so the owners gave 11 units and brought him in 5 1/2 hours later and his BG was Hi (non registering) so we bumped it up to 15 units and recheck BG 8 hours after insulin the following day and his BG was 458 so then we increased his insulin to 17 units BID and check fructosamine level in 3 weeks. Well we were at 535 with Hemolysis index +1 so then we decided to go up to 19 units BID and recheck fructosamine level in 3 weeks. We are at 525 with Normal Hemolysis index. As far as clinical signs he is no longer pu/pd according to the owner and is not urinating in the house. However, his back legs are more "stable" and they have been taking him out more often. He is also on w/d since the diabetes dx. He now weighs 77.9lbs and he is on a 3 month schedule to receive his Adequan injection, which the next is due 4/16/13. How much insulin is too much insulin? Should I be changing insulin? Jen Loucks, DVM

Really need a curve to know what correct dose is -- can the owners perform at home?

All in all, i don't think you can change the dose of insulin at all.....how is the dog doing clinically?

12y FS DSH, history of "IBD" controled via diet, back in 09 was pu/pd w/ BG 360ish, fruct 450ish - previous doc changed to a lower carb diet and rechecked in 1m, BG/fruct WNL. Has done okay since other than dietary indiscretion. Presented most recently for V roughly 3 weeks, PU/PD. Activity level okay, appetite increased/good. New murmur. BG 380 at presentation; suspecting hyperthyroidism and given the cat was doing well we held off on insulin. V actually sounds to have been triggered by a diet change 3w prior (ran out of food, someone bought something else). Free T4 came back elevated. Obviously we're going to start treating the hyperthyroidism, and cat did fine over the weekend...I'm debating if I should go ahead and start glargine 1U q12h with the methimazole or leave it be as it will likely take care of itself with diet/T4 regulation. But then, I'm not sure how methimazole may hit the cat and I sure don't want to kick of a ketoacidotic episode...just not sure they'll reliably be able to monitor BG at home (willing, but skeptical) and I sure don't want to set of a hypoglycemic episode either. How would you handle this? And, would you have started glargine ASAP in this situation? Thanks! -☼

What was the t4 on this patient and were there elevations of liver enzymes, one (or both) palpable thyroid nodule(s), etc.?

If this is crf i'd be using calcitriol (familiar with this?) what's the current phosphorus level?

12y FS DSH, history of "IBD" controled via diet, back in 09 was pu/pd w/ BG 360ish, fruct 450ish - previous doc changed to a lower carb diet and rechecked in 1m, BG/fruct WNL. Has done okay since other than dietary indiscretion. Presented most recently for V roughly 3 weeks, PU/PD. Activity level okay, appetite increased/good. New murmur. BG 380 at presentation; suspecting hyperthyroidism and given the cat was doing well we held off on insulin. V actually sounds to have been triggered by a diet change 3w prior (ran out of food, someone bought something else). Free T4 came back elevated. Obviously we're going to start treating the hyperthyroidism, and cat did fine over the weekend...I'm debating if I should go ahead and start glargine 1U q12h with the methimazole or leave it be as it will likely take care of itself with diet/T4 regulation. But then, I'm not sure how methimazole may hit the cat and I sure don't want to kick of a ketoacidotic episode...just not sure they'll reliably be able to monitor BG at home (willing, but skeptical) and I sure don't want to set of a hypoglycemic episode either. How would you handle this? And, would you have started glargine ASAP in this situation? Thanks! -☼

Urinalysis?

Or back to what she was like before the diabetes?

Without going into extreme detail, I am treating a diabetic cat who has not been well controlled on either PZI or glargine and declines referral to specialist. This will be my first patient on detemir, and the owner does home curves on the cat. Some references say to dose the same as glargine, but I attended a talk that said how much more potent detemir is and recommended dividing dose by 4 when switching. This cat is 8 units glargine BID--should I start detemir at 2 units and work up slowly from there? Since owner doing home curves, cost of curve isn't a huge factor. First curve at 1 week or sooner? Thanks for your input, ☼

This kitty is eating a sufficiently low-carb canned diet, correct?

Absolutely sure that she's spayed?

9 yr old FS Siamese 7.3 kg cat has been having multiple skin lesions this winter, perhaps starting late fall. We've treated the superficial pyoderma, but the sores persist. We did a food trial w/ hypoallergenic diet (canned & dry), no change. We finally did a prednisone trial for suspected eosinophilic granuloma on tapering dosage, but with little effect. They were scheduled for visit with the dermatologist today, but came in yesterday with signs of DM. I had warned this owner about risks for DM just from the obesity alone, talked about diets, and the potential of steroids increasing that risk and thus the desire to taper as soon as possible "Mookie" was weaned off the prednisone 2-3 weeks ago. She'd had some increase in drinking, but not dramatic. Two days ago she stopped eating, has had some vomiting of bile and liquid. She has been drinking excessively and urinating large volumes just recently, but isn't drinking now. Her stools have been drier than normal. Last night she presented ~10% dehydrated. In-house CBC: WBC = 4,200 L Lymph = 45.1% Monos = 1% Grans = 53.9% RBC = 9.3M Hgb = 18.1 H Hct = 56.2% H Other parameters available if needed. Chemistry (serum very lipemic) ALB = 3.3 ALP = 30 ALT = 109 H AST = 84 H BUN = 31.9 Ca = 6.4 L Creat = 1.3 GGT = 15 H Glucose = 289 H IP = 1.7 L Lip = 215 H Mg = 2.5 Tbili = 0.2 TCHO = 333 H TG >500 H TP = 7.8 Amyl = 1476 Na = 137 L K = 3.2 L Cl = 97.0 L UA Light yellow USG = 1.051 WBC = 2+ (125) Ketone = 15 g/L Blood = 3+ (80) Urine glucose = 1000 g/L Bilirubin = 1+ Protein = 100 mg/dL Sediment: lots of course granular casts. 7 - 10 WBC /hpf, 20-30 lipid droplets /hpf, Occasional RBC, amorphous crystals, no distinct bacteria. Started cat on Normosol, 1.5 units glargine insulin. 10:30 p.m. cat seemed quite stressed, on her back (acted like a turtle during cystocentesis earlier, content to just stay on her back) and the cage was a mess: spilled water, urine in litter, rolled in her food, towels pushed away. She seemed a bit cyanotic, but I could not auscultate any unusual lung sounds. She vomited a large volume of thick foamy saliva, then settled down. I was worried about a hypoglycemic seizure that I'd just missed. Checked BG = 180. Gave Cerenia and adjusted fluid rate down. This a.m., Mookie is alert & seems stable. Well hydrated. No cyanosis or further vomiting. BG = 128, so no insulin given, but not eating either. Questions: How often do cats start off only needing SID insulin instead of BID? In cases where prednisone may play a role in tipping the DM dominoes, do these cats respond any quicker than other DM cats after withdrawal of pred? Might I be looking at pancreatitis instead of DM? Give me surgery cases any day. ☼

Just out of curiosity, did we culture the cat's urine?

The dog is only fed bid, at the time the insulin is given?

9 yr old FS Siamese 7.3 kg cat has been having multiple skin lesions this winter, perhaps starting late fall. We've treated the superficial pyoderma, but the sores persist. We did a food trial w/ hypoallergenic diet (canned & dry), no change. We finally did a prednisone trial for suspected eosinophilic granuloma on tapering dosage, but with little effect. They were scheduled for visit with the dermatologist today, but came in yesterday with signs of DM. I had warned this owner about risks for DM just from the obesity alone, talked about diets, and the potential of steroids increasing that risk and thus the desire to taper as soon as possible "Mookie" was weaned off the prednisone 2-3 weeks ago. She'd had some increase in drinking, but not dramatic. Two days ago she stopped eating, has had some vomiting of bile and liquid. She has been drinking excessively and urinating large volumes just recently, but isn't drinking now. Her stools have been drier than normal. Last night she presented ~10% dehydrated. In-house CBC: WBC = 4,200 L Lymph = 45.1% Monos = 1% Grans = 53.9% RBC = 9.3M Hgb = 18.1 H Hct = 56.2% H Other parameters available if needed. Chemistry (serum very lipemic) ALB = 3.3 ALP = 30 ALT = 109 H AST = 84 H BUN = 31.9 Ca = 6.4 L Creat = 1.3 GGT = 15 H Glucose = 289 H IP = 1.7 L Lip = 215 H Mg = 2.5 Tbili = 0.2 TCHO = 333 H TG >500 H TP = 7.8 Amyl = 1476 Na = 137 L K = 3.2 L Cl = 97.0 L UA Light yellow USG = 1.051 WBC = 2+ (125) Ketone = 15 g/L Blood = 3+ (80) Urine glucose = 1000 g/L Bilirubin = 1+ Protein = 100 mg/dL Sediment: lots of course granular casts. 7 - 10 WBC /hpf, 20-30 lipid droplets /hpf, Occasional RBC, amorphous crystals, no distinct bacteria. Started cat on Normosol, 1.5 units glargine insulin. 10:30 p.m. cat seemed quite stressed, on her back (acted like a turtle during cystocentesis earlier, content to just stay on her back) and the cage was a mess: spilled water, urine in litter, rolled in her food, towels pushed away. She seemed a bit cyanotic, but I could not auscultate any unusual lung sounds. She vomited a large volume of thick foamy saliva, then settled down. I was worried about a hypoglycemic seizure that I'd just missed. Checked BG = 180. Gave Cerenia and adjusted fluid rate down. This a.m., Mookie is alert & seems stable. Well hydrated. No cyanosis or further vomiting. BG = 128, so no insulin given, but not eating either. Questions: How often do cats start off only needing SID insulin instead of BID? In cases where prednisone may play a role in tipping the DM dominoes, do these cats respond any quicker than other DM cats after withdrawal of pred? Might I be looking at pancreatitis instead of DM? Give me surgery cases any day. ☼

Is she on antibiotics too?

Adrenals look ok on ultrasound?

I would love your opinions :) Two things: 1) Has anyone used the Purina Glucotest Feline Urinary Glucose Detection System for those cats that are somewhat in between needing insulin vs. needing just a diet? 2) Has anyone heard of any good OTC diets for cat diabetes? Someone mentioned Evo High Protein Canned food. Thanks for all your help!!

We like the glucotest granules when we're wondering if they've gone into a remission....what are this kitty's bg's looking like?

Has the owner noted any changes in appetite or eating pattern?

Mickey is a MC 5 yo miniature schnauzer who was diagnosed with diabetes in August 2012. He was started on 5 IU of Caninsulin BID. He then experienced some lows (via clinical signs, no BG levels) and so reduced his levels to 2.5 IU. Then September BG curve with 2.5 IU was 9:45am 22.4 mmol/L (the owner never comes in earlier even though we have asked repeatedly) 10:45 17.7 11:45 15.8 12:45 12.4 1:45 11.8 2:45 9.4 3:45 16.3 4:30 14.1 we increased to 3 IU BID Then client concerned that Mickey was off and so reduced back to 2.5 units in Oct and Nov. Owner was having difficulty testing at home during this time. End of November, PU/PD, recommended glucose curve. Came in a few weeks later for an exam. BG at the time was 25.6 (2.5 hours after giving 2.5 IU). She has been using the proper syringes as well. Cataracts were noted at this time. So now the owner wants surgery for the cataracts in Saskatoon but until we get him more regulated, he is at too high of a risk for the surgery. He has gone to the vet college but has had 1+ ketones and the surgery has been rescheduled. In February another BG on 3 1/2 units was consistently between 19 & 26. Owner was reluctant to increase insulin as much as we wanted so increased to 4 1/2 9:30 22.1 (insulin given at 8am) 11:30 23.4 1:30 18.6 3:30 20.1 4:30 16.2 owner was advised to increase to 6 IU but o QUITE reluctant to increase 1 week later @ 6 IU (results phoned in) 10am 17 12 25.2 2 25.2 increased to 7 units Owner called after giving 6.5 units over the next few days and spot checks were in the single digits except one HI result that was likely from the bread and honey fed! End of February - cataract surgery postponed again due to ketones. March 1st 7am 9.6 6.5 units given at 7:30 8:30 21.2 9:30 16.6 11:30 14.4 12:30 17.8 3:30 7.3 6pm 19.4 March 5 th 6.5 units given at 8am 8am 21.5 10 20.8 12pm 19.7 1:30 18.4 3:30 15.7 5:30 17.1 8pm 22 March 7th 10am 31.1 12pm 20.1 2pm 16.9 4pm 16.7 6pm 19.3 8pm 7.9 10pm 19.9 On March 12th, we did a urinalysis, upc and C&S. No ketones, neg on C&S and in the questionable range for the UPC. March 20th, we asked the owner to bring in the morning for a no charge curve. We gave the 7 IU of caninsulin from a new vial, administered ourselves and throughout the day, the levels were still in the high teens. We have Mickey on the RC Diabetic food and have cut out all the snacking (we hope) but we do not feel that we can get adequate control of his diabetes. Should we add on Lantus or Levemir or change to NPH? Please advise. There are 2 of us almost pulling our hair out over this case. Thank you

What time of day does the owner give the food/insulin in the am and pm?

Fructosamines?

I have been treating a cat with diabetes. Seamus is a 14 year old neutered male. He was diagnosed 10/30/2012. Started on lantus and M/D. He has controlled very well and as a matter of fact he is now only getting 1 unit BID and doing very well. The problem is that Seamus is also a chronic vomiter. His owner says that he vomits about once or twice a week. The diet change to M/D hasn’t made much of a difference. He gets both canned and dry M/D. Labs have always been pretty unremarkable and his abdomen palpates normally. He doesn’t have diarrhea and always has a good appetite and feels good. He has not been worked up for chronic vomiting but my feeling is that this is probably food intolerance or dysbiosis of some type. The question I have is which is more important the diabetes or the vomiting. I think the M/D is helping control his diabetes. If we try the hypoallergenic, novel protein or intestinal diets we may mess up his diabetes control. I was curious about other people’s opinions Thanks br/

Do you think the owner can feed just canned hypoallergenic diet?

Or both?

I have been treating a cat with diabetes. Seamus is a 14 year old neutered male. He was diagnosed 10/30/2012. Started on lantus and M/D. He has controlled very well and as a matter of fact he is now only getting 1 unit BID and doing very well. The problem is that Seamus is also a chronic vomiter. His owner says that he vomits about once or twice a week. The diet change to M/D hasn’t made much of a difference. He gets both canned and dry M/D. Labs have always been pretty unremarkable and his abdomen palpates normally. He doesn’t have diarrhea and always has a good appetite and feels good. He has not been worked up for chronic vomiting but my feeling is that this is probably food intolerance or dysbiosis of some type. The question I have is which is more important the diabetes or the vomiting. I think the M/D is helping control his diabetes. If we try the hypoallergenic, novel protein or intestinal diets we may mess up his diabetes control. I was curious about other people’s opinions Thanks br/

Is he actually losing weight?

Also, does the temaril contain steroids?

I suspect that my patient may have Addison's but the symptoms and results are affected by recent orthopedic surgery. It is a 6 yr old FS poodle mix weighing 6.9 lbs. She first presented 3/8/13 for a funny gait. She has a history of luxating patellas and had recently gained some weight. She appeared to be lame on her right rear and she would sit down rather than walk on it. Radiopgraphs demonstrated bilateral medially luxating patellas - very pronounced luxation. We tried Meloxicam for 5 days and discussed referral for surgical intervention should she not improve. She had not improved so we referred her for orthopedic repair. She had surgery on Tuesday 3/19 and the surgeon reported that these were the worse patellas he had ever dealt with. He did surgery on right knee. She went home Wednesday morning 3/20. She did drink for the owner but would not eat even when force fed. She called the surgery office and was told to recheck with us for possible dehydration. She was on Rimadyl 6.25mg bid, Cephalexin supsension bid and oral Buprenex from the ortho. She presented Thursday afternoon here. Quiet, weak - no weight bearing on either hindlimb. Temp 97.9, Bloodwork revealed a bunch of abnormalities including hypoglycemia, hyponatremia, hypochloremia, hyperphosphatemia, azotemia, hemoconcentration, Hematology Yesterday @ 3:11 pm RBC 6.61 5.5 - 8.5 M/μL Hematocrit 60.1 37.0 - 55.0 % H Hemoglobin 20.0 12.0 - 18.0 g/dL H MCV 90.9 60.0 - 77.0 fL H MCH 30.3 18.5 - 30.0 pg H MCHC 33.3 30.0 - 37.5 g/dL RDW 15.8 14.7 - 17.9 % % Reticulocyte 0.8 % Reticulocyte 55.2 10 - 110 K/μL WBC 10.98 5.5 - 16.9 K/μL % Neutrophil 73.7 % % Lymphocyte 9.1 % % Monocyte 13.7 % % Eosinophil 2.8 % % Basophil 0.7 % Neutrophil 8.09 2 - 12 K/μL Lymphocyte 1 0.5 - 4.9 K/μL Monocyte 1.51 0.3 - 2 K/μL Eosinophil 0.31 0.1 - 1.49 K/μL Basophil 0.07 0 - 0.1 K/μL Auto Platelet 155 175 - 500 K/μL L MPV 13.9 fL PDW 19.4 % Plateletcrit 0.22 % Chemistry Yesterday @ 3:12 pm Glucose 24 74 - 143 mg/dL L BUN 45 7 - 27 mg/dL H Creatinine 0.9 0.5 - 1.8 mg/dL BUN / Creatinine Ratio 50 Phosphorus 8.8 2.5 - 6.8 mg/dL H Calcium 9.2 7.9 - 12.0 mg/dL Sodium 142 144 - 160 mmol/L L Potassium 5.1 3.5 - 5.8 mmol/L Na / K Ratio 28 Chloride 108 109 - 122 mmol/L L Total Protein 6.9 5.2 - 8.2 g/dL Albumin 2.3 2.3 - 4.0 g/dL Globulin 4.6 2.5 - 4.5 g/dL H Alb / Glob Ratio 0.5 ALT 53 10 - 100 U/L ALP 327 23 - 212 U/L H GGT 0 0 - 7 U/L Bilirubin - Total 1.1 0.0 - 0.9 mg/dL H Cholesterol 252 110 - 320 mg/dL Osmolality 291 mmol/kg I know her ALKP elevation is likely from her recent orthopedic procedure. I don't know how much else can be explained by her anorexia and recent surgery. Now of course I am thinking back to her initial presentation and wondering if her exacerbated patellas was more from Addison's than her patellas themselves. (She had lived fine with crappy patellas for 6 years). Yesterday we started her on fluids and Dextrose. Got her body temp up and blood sugar normalized. When I checked on her in the evening she had some muscle fasiculations in her face. I gave her 1mg of Dexsp and talked to the owner about testing her today. My conundrum now is that I want to treat her but I don't want to do anything to compromise her healing from her orthopedic procedure. We did the ACTH stim test but won't get results until next week. Can I give her some Percorten even if she doesn't have Addison's? If so, do I give the recommended dose?

Did you use cortrosyn for the acth stim?

Another problem is that it sounds like the insulin isn't lasting long enough?

HI - I have a case I'm having trouble sorting out.. Storm is a 13.4lb Chihuahua MN, 6 yrs. He came to me on March 19th because he was painful when picked up. His owner was away for 2 weeks, she has been back for 2 weeks now, and since she returned he's been urinating in the house, huge quantities at one time (not frequent urination) and acting very quiet. He is overweight, and is on Satiety by Royal Canin. He was more overweight, has lost two pounds on the Satiety in 10 months. He also gets 'Gravy bones' as a treat. He was not dehydrated when I saw him, mild tartar, and clearly painful, abdomen/back - all over really. Temp was 40.2C. Bloodwork: Total Protein: 79 (50-74) HIGH Albumin 26 (27-44) g/L LOW Globulin 53 (16-36) g/L HIGH A/G Ratio 0.5 (0.8-2.0) Ratio LOW AST 241 (15-66) U/L HIGH ALT 601 (12-118) U/L HIGH ALP 1480 (5-131) U/L HIGH GGTP 23 (1-12) U/L HIGH Bilirubin total 6.9 (0.0-5.1) umol/L HIGH BUN 3.3 (2.1-11.1) mmol/L Creat 65 (44-141) umol/L BUN/Creat Ratio 51 Ratio Phos 0.78 (0.81-1.04) mmol/L LOW Glucose 14.6 (3.9-7.7) mmol/L HIGH Calcium 2.42 (2.23-2.85) mmol/L Magnesium 0.8 (0.7-1.3) mmol/L Sodium 148 (139-154) mmol/L Potassium 4.3 (3.6-5.5) mmol/L Sodium/Pot Ratio 34 (27-38) Ratio Chloride 114 (102-120) mmol/L Cholesterol 4.51 (2.38-10.0) mmol/L Triglycerides 1.49 (0.33-3.32) mmol/L Amylase 846 (290-1125) U/L Lipase 96 (77-695) U/L CPK 259 (59-895) U/L Comments: Hemolysis 2+, Lipemia 1+, no significant interference CBC: WBC 29.2 (4.0-15.5) 10^9/L HIGH RBC 5.5 (4.8-9.3) 10^12/L Hemoglobin 128 (121-203) g/L HCT 38 (36-60) % MCV 69 (58-79) fL MCH 23 (19-28) pg MCHC 337 (300-380) g/L Platelet Count 206 (170-400) 10^9/L Platelet Est: Adequate Differential: Neutrophils 21.61 74% (2.06-10.60) 10^9/L HIGH Bands 0.00 0% (0-0.3) 10^9/L Lymphs 5.84 20% (0.69 - 4.50) 10^9/L HIGH Monocytes 0.58 2% (0-0.84) 10^9/L Eosinophils 1.17 4% (0-1.20) 10^9/L Basophils 0.00 0% (0-0.15) 10^9/L Polychromasia Slight NRBC 8 (0-1) /100 WBC T4 7 (10-45) nmol/L Urinalysis Collection Method: catheter Color Yellow Appearance Cloudy *clear ABNORMAL Sp Grav 1.010 (1.015-1.050) LOW pH 7.0 (5.5-7.0) Protein Neg Neg Glucose 2+ Neg ABN Ketones Neg Neg Bilirubin 1+ Neg ABN Blood 2+ Neg ABN WBC 11-20 (0-3) HPF HIGH RBC 4-10 (0-3) HPF HIGH Casts None seen Crystals None seen Bacteria Rods 10-25 /HPF ABNORMAL Squamous Epithelials 2-3 HPF HIGH Culture: pending I treated the dog with a 0.1mg/kg dose of metacam, and started on Baytril and Clavamox orally. I discussed doing xrays and ultrasound, which client declined at that time. I recommended that we recheck the bloodwork in 3 days, or sooner if the dog was not feeling much better by the next morning. Called the next day, and the dog was BAR, eating well, seemed quite good. Repeat bloodwork: Total Protein: 84 (50-74) HIGH - has increased, was 79 Albumin 28 (27-44) g/L - now normal, was low 26 Globulin 56 (16-36) g/L HIGH - has increased, was 53 A/G Ratio 0.5 (0.8-2.0) Ratio LOW - same ALT 642 (12-118) U/L HIGH - has increased, was 601 ALP 1388 (5-131) U/L HIGH - has decreased was 1480 Bilirubin total 9.1 (0.0-5.1) umol/L HIGH - has increased, was 6.9 BUN 2.7 (2.1-11.1) mmol/L Creat 64 (44-141) umol/L BUN/Creat Ratio 42 Ratio Phos 1.20 (0.81-1.04) mmol/L LOW - now normal, was 0.78 Glucose 7.5 (3.9-7.7) mmol/L HIGH - now normal, was 14.6 Potassium 4.8 (3.6-5.5) mmol/L CBC: WBC 21.6 (4.0-15.5) 10^9/L Still High (was 29.2) improved RBC 5.7 (4.8-9.3) 10^12/L Hemoglobin 134 (121-203) g/L HCT 39 (36-60) % MCV 68 (58-79) fL MCH 24 (19-28) pg MCHC 344 (300-380) g/L Platelet Count 195 (170-400) 10^9/L Platelet Est - Adequate Differential: Neutrophils 16.63 77% (2.06-10.60) 10^9/L Still high, was 21.6 - improved Bands 0.00 0 % (0-0.3) 10^9/L Lymphs 3.24 15 % (0.69 - 4.50) 10^9/L - was high, now normal Monocytes 1.3 6 % (0-0.84) 10^9/L - now high, was normal Eosinophils 0.43 2% (0-1.20) 10^9/L Basophils 0.00 0% (0-0.15) 10^9/L NRBC 0.0 (0-1) /100 WBC - now normal, was high So, the WBC levels are improving, but the liver situation has not changed at all. The owner says that Storm is acting normal, and seems well and happy. I've once again recommended xray and ultrasound... she wants me to tell her immediately if the dog has something fatal! I initially wondered about Leptospirosis, as the dog has not been vaccinated for that, and the rods and urine, fever, etc. But this is a chihuahua who never gets walked, lives in a condo and uses pee pads. Is there something I'm missing from the bloodwork? I dont think this dog is diabetic, possible pancreatitis I suppose, with secondary cholangiohepatitis? Why do you think there were nucleated RBCs in this dogs blood initially when he was not anemic? I'm trying to get her to bring him in soon for the xrays at least, and I will keep you posted.. in the meantime, any thoughts? Thanks! Dr. ☼

Was the serum grossly icteric at this time?

Normal ica, tca and p values?

HI - I have a case I'm having trouble sorting out.. Storm is a 13.4lb Chihuahua MN, 6 yrs. He came to me on March 19th because he was painful when picked up. His owner was away for 2 weeks, she has been back for 2 weeks now, and since she returned he's been urinating in the house, huge quantities at one time (not frequent urination) and acting very quiet. He is overweight, and is on Satiety by Royal Canin. He was more overweight, has lost two pounds on the Satiety in 10 months. He also gets 'Gravy bones' as a treat. He was not dehydrated when I saw him, mild tartar, and clearly painful, abdomen/back - all over really. Temp was 40.2C. Bloodwork: Total Protein: 79 (50-74) HIGH Albumin 26 (27-44) g/L LOW Globulin 53 (16-36) g/L HIGH A/G Ratio 0.5 (0.8-2.0) Ratio LOW AST 241 (15-66) U/L HIGH ALT 601 (12-118) U/L HIGH ALP 1480 (5-131) U/L HIGH GGTP 23 (1-12) U/L HIGH Bilirubin total 6.9 (0.0-5.1) umol/L HIGH BUN 3.3 (2.1-11.1) mmol/L Creat 65 (44-141) umol/L BUN/Creat Ratio 51 Ratio Phos 0.78 (0.81-1.04) mmol/L LOW Glucose 14.6 (3.9-7.7) mmol/L HIGH Calcium 2.42 (2.23-2.85) mmol/L Magnesium 0.8 (0.7-1.3) mmol/L Sodium 148 (139-154) mmol/L Potassium 4.3 (3.6-5.5) mmol/L Sodium/Pot Ratio 34 (27-38) Ratio Chloride 114 (102-120) mmol/L Cholesterol 4.51 (2.38-10.0) mmol/L Triglycerides 1.49 (0.33-3.32) mmol/L Amylase 846 (290-1125) U/L Lipase 96 (77-695) U/L CPK 259 (59-895) U/L Comments: Hemolysis 2+, Lipemia 1+, no significant interference CBC: WBC 29.2 (4.0-15.5) 10^9/L HIGH RBC 5.5 (4.8-9.3) 10^12/L Hemoglobin 128 (121-203) g/L HCT 38 (36-60) % MCV 69 (58-79) fL MCH 23 (19-28) pg MCHC 337 (300-380) g/L Platelet Count 206 (170-400) 10^9/L Platelet Est: Adequate Differential: Neutrophils 21.61 74% (2.06-10.60) 10^9/L HIGH Bands 0.00 0% (0-0.3) 10^9/L Lymphs 5.84 20% (0.69 - 4.50) 10^9/L HIGH Monocytes 0.58 2% (0-0.84) 10^9/L Eosinophils 1.17 4% (0-1.20) 10^9/L Basophils 0.00 0% (0-0.15) 10^9/L Polychromasia Slight NRBC 8 (0-1) /100 WBC T4 7 (10-45) nmol/L Urinalysis Collection Method: catheter Color Yellow Appearance Cloudy *clear ABNORMAL Sp Grav 1.010 (1.015-1.050) LOW pH 7.0 (5.5-7.0) Protein Neg Neg Glucose 2+ Neg ABN Ketones Neg Neg Bilirubin 1+ Neg ABN Blood 2+ Neg ABN WBC 11-20 (0-3) HPF HIGH RBC 4-10 (0-3) HPF HIGH Casts None seen Crystals None seen Bacteria Rods 10-25 /HPF ABNORMAL Squamous Epithelials 2-3 HPF HIGH Culture: pending I treated the dog with a 0.1mg/kg dose of metacam, and started on Baytril and Clavamox orally. I discussed doing xrays and ultrasound, which client declined at that time. I recommended that we recheck the bloodwork in 3 days, or sooner if the dog was not feeling much better by the next morning. Called the next day, and the dog was BAR, eating well, seemed quite good. Repeat bloodwork: Total Protein: 84 (50-74) HIGH - has increased, was 79 Albumin 28 (27-44) g/L - now normal, was low 26 Globulin 56 (16-36) g/L HIGH - has increased, was 53 A/G Ratio 0.5 (0.8-2.0) Ratio LOW - same ALT 642 (12-118) U/L HIGH - has increased, was 601 ALP 1388 (5-131) U/L HIGH - has decreased was 1480 Bilirubin total 9.1 (0.0-5.1) umol/L HIGH - has increased, was 6.9 BUN 2.7 (2.1-11.1) mmol/L Creat 64 (44-141) umol/L BUN/Creat Ratio 42 Ratio Phos 1.20 (0.81-1.04) mmol/L LOW - now normal, was 0.78 Glucose 7.5 (3.9-7.7) mmol/L HIGH - now normal, was 14.6 Potassium 4.8 (3.6-5.5) mmol/L CBC: WBC 21.6 (4.0-15.5) 10^9/L Still High (was 29.2) improved RBC 5.7 (4.8-9.3) 10^12/L Hemoglobin 134 (121-203) g/L HCT 39 (36-60) % MCV 68 (58-79) fL MCH 24 (19-28) pg MCHC 344 (300-380) g/L Platelet Count 195 (170-400) 10^9/L Platelet Est - Adequate Differential: Neutrophils 16.63 77% (2.06-10.60) 10^9/L Still high, was 21.6 - improved Bands 0.00 0 % (0-0.3) 10^9/L Lymphs 3.24 15 % (0.69 - 4.50) 10^9/L - was high, now normal Monocytes 1.3 6 % (0-0.84) 10^9/L - now high, was normal Eosinophils 0.43 2% (0-1.20) 10^9/L Basophils 0.00 0% (0-0.15) 10^9/L NRBC 0.0 (0-1) /100 WBC - now normal, was high So, the WBC levels are improving, but the liver situation has not changed at all. The owner says that Storm is acting normal, and seems well and happy. I've once again recommended xray and ultrasound... she wants me to tell her immediately if the dog has something fatal! I initially wondered about Leptospirosis, as the dog has not been vaccinated for that, and the rods and urine, fever, etc. But this is a chihuahua who never gets walked, lives in a condo and uses pee pads. Is there something I'm missing from the bloodwork? I dont think this dog is diabetic, possible pancreatitis I suppose, with secondary cholangiohepatitis? Why do you think there were nucleated RBCs in this dogs blood initially when he was not anemic? I'm trying to get her to bring him in soon for the xrays at least, and I will keep you posted.. in the meantime, any thoughts? Thanks! Dr. ☼

Hemolysis or lipemia again?

Is the owner happy with how the dog is doing?

HI - I have a case I'm having trouble sorting out.. Storm is a 13.4lb Chihuahua MN, 6 yrs. He came to me on March 19th because he was painful when picked up. His owner was away for 2 weeks, she has been back for 2 weeks now, and since she returned he's been urinating in the house, huge quantities at one time (not frequent urination) and acting very quiet. He is overweight, and is on Satiety by Royal Canin. He was more overweight, has lost two pounds on the Satiety in 10 months. He also gets 'Gravy bones' as a treat. He was not dehydrated when I saw him, mild tartar, and clearly painful, abdomen/back - all over really. Temp was 40.2C. Bloodwork: Total Protein: 79 (50-74) HIGH Albumin 26 (27-44) g/L LOW Globulin 53 (16-36) g/L HIGH A/G Ratio 0.5 (0.8-2.0) Ratio LOW AST 241 (15-66) U/L HIGH ALT 601 (12-118) U/L HIGH ALP 1480 (5-131) U/L HIGH GGTP 23 (1-12) U/L HIGH Bilirubin total 6.9 (0.0-5.1) umol/L HIGH BUN 3.3 (2.1-11.1) mmol/L Creat 65 (44-141) umol/L BUN/Creat Ratio 51 Ratio Phos 0.78 (0.81-1.04) mmol/L LOW Glucose 14.6 (3.9-7.7) mmol/L HIGH Calcium 2.42 (2.23-2.85) mmol/L Magnesium 0.8 (0.7-1.3) mmol/L Sodium 148 (139-154) mmol/L Potassium 4.3 (3.6-5.5) mmol/L Sodium/Pot Ratio 34 (27-38) Ratio Chloride 114 (102-120) mmol/L Cholesterol 4.51 (2.38-10.0) mmol/L Triglycerides 1.49 (0.33-3.32) mmol/L Amylase 846 (290-1125) U/L Lipase 96 (77-695) U/L CPK 259 (59-895) U/L Comments: Hemolysis 2+, Lipemia 1+, no significant interference CBC: WBC 29.2 (4.0-15.5) 10^9/L HIGH RBC 5.5 (4.8-9.3) 10^12/L Hemoglobin 128 (121-203) g/L HCT 38 (36-60) % MCV 69 (58-79) fL MCH 23 (19-28) pg MCHC 337 (300-380) g/L Platelet Count 206 (170-400) 10^9/L Platelet Est: Adequate Differential: Neutrophils 21.61 74% (2.06-10.60) 10^9/L HIGH Bands 0.00 0% (0-0.3) 10^9/L Lymphs 5.84 20% (0.69 - 4.50) 10^9/L HIGH Monocytes 0.58 2% (0-0.84) 10^9/L Eosinophils 1.17 4% (0-1.20) 10^9/L Basophils 0.00 0% (0-0.15) 10^9/L Polychromasia Slight NRBC 8 (0-1) /100 WBC T4 7 (10-45) nmol/L Urinalysis Collection Method: catheter Color Yellow Appearance Cloudy *clear ABNORMAL Sp Grav 1.010 (1.015-1.050) LOW pH 7.0 (5.5-7.0) Protein Neg Neg Glucose 2+ Neg ABN Ketones Neg Neg Bilirubin 1+ Neg ABN Blood 2+ Neg ABN WBC 11-20 (0-3) HPF HIGH RBC 4-10 (0-3) HPF HIGH Casts None seen Crystals None seen Bacteria Rods 10-25 /HPF ABNORMAL Squamous Epithelials 2-3 HPF HIGH Culture: pending I treated the dog with a 0.1mg/kg dose of metacam, and started on Baytril and Clavamox orally. I discussed doing xrays and ultrasound, which client declined at that time. I recommended that we recheck the bloodwork in 3 days, or sooner if the dog was not feeling much better by the next morning. Called the next day, and the dog was BAR, eating well, seemed quite good. Repeat bloodwork: Total Protein: 84 (50-74) HIGH - has increased, was 79 Albumin 28 (27-44) g/L - now normal, was low 26 Globulin 56 (16-36) g/L HIGH - has increased, was 53 A/G Ratio 0.5 (0.8-2.0) Ratio LOW - same ALT 642 (12-118) U/L HIGH - has increased, was 601 ALP 1388 (5-131) U/L HIGH - has decreased was 1480 Bilirubin total 9.1 (0.0-5.1) umol/L HIGH - has increased, was 6.9 BUN 2.7 (2.1-11.1) mmol/L Creat 64 (44-141) umol/L BUN/Creat Ratio 42 Ratio Phos 1.20 (0.81-1.04) mmol/L LOW - now normal, was 0.78 Glucose 7.5 (3.9-7.7) mmol/L HIGH - now normal, was 14.6 Potassium 4.8 (3.6-5.5) mmol/L CBC: WBC 21.6 (4.0-15.5) 10^9/L Still High (was 29.2) improved RBC 5.7 (4.8-9.3) 10^12/L Hemoglobin 134 (121-203) g/L HCT 39 (36-60) % MCV 68 (58-79) fL MCH 24 (19-28) pg MCHC 344 (300-380) g/L Platelet Count 195 (170-400) 10^9/L Platelet Est - Adequate Differential: Neutrophils 16.63 77% (2.06-10.60) 10^9/L Still high, was 21.6 - improved Bands 0.00 0 % (0-0.3) 10^9/L Lymphs 3.24 15 % (0.69 - 4.50) 10^9/L - was high, now normal Monocytes 1.3 6 % (0-0.84) 10^9/L - now high, was normal Eosinophils 0.43 2% (0-1.20) 10^9/L Basophils 0.00 0% (0-0.15) 10^9/L NRBC 0.0 (0-1) /100 WBC - now normal, was high So, the WBC levels are improving, but the liver situation has not changed at all. The owner says that Storm is acting normal, and seems well and happy. I've once again recommended xray and ultrasound... she wants me to tell her immediately if the dog has something fatal! I initially wondered about Leptospirosis, as the dog has not been vaccinated for that, and the rods and urine, fever, etc. But this is a chihuahua who never gets walked, lives in a condo and uses pee pads. Is there something I'm missing from the bloodwork? I dont think this dog is diabetic, possible pancreatitis I suppose, with secondary cholangiohepatitis? Why do you think there were nucleated RBCs in this dogs blood initially when he was not anemic? I'm trying to get her to bring him in soon for the xrays at least, and I will keep you posted.. in the meantime, any thoughts? Thanks! Dr. ☼

Where is your crystal ball when you need it?

What do you thing is more likely and should i do next?

Hello, I was wondering if anyone out there could shed some light on which behaviour modification medication may be best for a dog I seen this week. I have only used behaviour modification drugs once and that client was lost to follow up! I have a 18 month, intact female, Boston Terrier that is approx 13.5 lbs. Owner has had her since 6 weeks of age and she has always had issues since this time. She said another puppy of this litter is the same. She barks and lunges at everyone who enters the home even her children. It takes her about 1 hour to calm down and during that time she is nipping (to the point of putting holes in clothing), jumping, barking and lunging. People are now avoiding the owners home and she cannot have children over. She cannot exercise her as when she tries to walk her she flips out on the leash, chews it and jumps/rolls all over the place. She is very attached to the female owner and will chew on the wall etc if she yells at her. In addition, she cannot give her balls/toys etc as the dog chews them up and eats them. Owner said she is scared of everything at home - music, will attack laundry baskets etc When I saw her the other day, I didn't even think I could touch her. She was lunging and barking in the room. Staying very close to mom. Eventually she calmed down enough not to bark, but if I came near she started to lunge again. I had the owner muzzle her and put her on the table. At this point she was actually not to bad and I was able to examine her. My impression is that she is that she has a combination of fear aggression and anxiety leading to re-driected behaviours. The owner has been rewarding these behaviours by petting her etc when she is barking etc. She thought by doing this she was calming her down. I had a long conversation about this! My plan includes trying a Thunder Shirt, Calm diet by RC +/- Zylkene (milk supplement by Vetoquinol that can help calm some dogs). I spoke to the owner in depth about not rewrding bad behaviour, obedience training (trying to find handouts on this etc), increasing exercise, enrichment toys (ie hide food etc). However, I think that this dog will need some type of stronger medication. Is there any behaviour drug that would be better than another for this dog? Also, do you think spaying would help? Thanks for any advice you have in advance. ☼

Can she be referred to a local dacvb for a comprehensive treatment plan?

Any chance there is cushings?

Roy is a 2 1/2 year old castrated male beagle who was adopted by his family in January as a rescue. The owner noted that he was very polyuric and polydipsic from the time he was adopted. Physical exam was within normal limits except that he was a bit thin. We did a mini panel, CBC and urinalysis, which was all normal except his urine SG was 1.002. The urine brought a first of the AM sample to recheck the SG and it was 1.005. I had the lab add a serum osmolality level, which was 326mOsm/kg (normal 280-305). I started him on a trial of DDAVP at 0.05mg BID, which we then increased to 0.1mg BID. Prior to starting DDAVP, he was having some nocturnal urinary incontinence, which has improved, but he's still pu/pd and his urine specific gravities have been 1.007 and 1.005 since starting meds. The owner is also concerned that he eats a ton and is still pretty thin. As of 3/14 he'd lost a pound from his initial visit with us. He's very active, but the owners feel that that can't keep up with his appetite. I rechecked a chemistry profile: Total Protein 5.9 g/dL 5.0 - 7.4 Albumin 3.0 g/dL 2.7 - 4.4 Globulin 2.9 g/dL 1.6 - 3.6 Albumin/Globulin Rat 1.0 Ratio 0.8 - 2.0 AST (SGOT) 22 U/L 15 - 66 ALT (SGPT) 27 U/L 12 - 118 Alk Phosphatase 34 U/L 5 - 131 GGTP 5 U/L 1 - 12 Total Bilirubin 0.2 mg/dL 0.1 - 0.3 Urea Nitrogen 23 mg/dL 6 - 31 Creatinine 0.8 mg/dL 0.5 - 1.6 BUN/Creatinine Ratio 29 Ratio 4 - 2 HIGH Phosphorus 2.8 mg/dL 2.5 - 6.0 GLUCOSE 106 mg/dL 70 - 138 Calcium 9.3 mg/dL 8.9 - 11.4 Corrected Calcium 9.8 Magnesium 1.5 mEq/L 1.5 - 2.5 Sodium 149 mEq/L 139 - 154 Potassium 3.6 mEq/L 3.6 - 5.5 Na/K Ratio 41 Chloride 114 mEq/L 102 - 120 Cholesterol 148 mg/dL 92 - 324 Triglycerides 60 mg/dL 29 - 291 ☼

The chemistry you posted is on ddavp or off of it?

Do you think that these pictures from cytology are transitional cells, and if so, are they concerning for tcc?

Roy is a 2 1/2 year old castrated male beagle who was adopted by his family in January as a rescue. The owner noted that he was very polyuric and polydipsic from the time he was adopted. Physical exam was within normal limits except that he was a bit thin. We did a mini panel, CBC and urinalysis, which was all normal except his urine SG was 1.002. The urine brought a first of the AM sample to recheck the SG and it was 1.005. I had the lab add a serum osmolality level, which was 326mOsm/kg (normal 280-305). I started him on a trial of DDAVP at 0.05mg BID, which we then increased to 0.1mg BID. Prior to starting DDAVP, he was having some nocturnal urinary incontinence, which has improved, but he's still pu/pd and his urine specific gravities have been 1.007 and 1.005 since starting meds. The owner is also concerned that he eats a ton and is still pretty thin. As of 3/14 he'd lost a pound from his initial visit with us. He's very active, but the owners feel that that can't keep up with his appetite. I rechecked a chemistry profile: Total Protein 5.9 g/dL 5.0 - 7.4 Albumin 3.0 g/dL 2.7 - 4.4 Globulin 2.9 g/dL 1.6 - 3.6 Albumin/Globulin Rat 1.0 Ratio 0.8 - 2.0 AST (SGOT) 22 U/L 15 - 66 ALT (SGPT) 27 U/L 12 - 118 Alk Phosphatase 34 U/L 5 - 131 GGTP 5 U/L 1 - 12 Total Bilirubin 0.2 mg/dL 0.1 - 0.3 Urea Nitrogen 23 mg/dL 6 - 31 Creatinine 0.8 mg/dL 0.5 - 1.6 BUN/Creatinine Ratio 29 Ratio 4 - 2 HIGH Phosphorus 2.8 mg/dL 2.5 - 6.0 GLUCOSE 106 mg/dL 70 - 138 Calcium 9.3 mg/dL 8.9 - 11.4 Corrected Calcium 9.8 Magnesium 1.5 mEq/L 1.5 - 2.5 Sodium 149 mEq/L 139 - 154 Potassium 3.6 mEq/L 3.6 - 5.5 Na/K Ratio 41 Chloride 114 mEq/L 102 - 120 Cholesterol 148 mg/dL 92 - 324 Triglycerides 60 mg/dL 29 - 291 ☼

Do you have a na+ from before ddavp?

Is she still ketotic?

Roy is a 2 1/2 year old castrated male beagle who was adopted by his family in January as a rescue. The owner noted that he was very polyuric and polydipsic from the time he was adopted. Physical exam was within normal limits except that he was a bit thin. We did a mini panel, CBC and urinalysis, which was all normal except his urine SG was 1.002. The urine brought a first of the AM sample to recheck the SG and it was 1.005. I had the lab add a serum osmolality level, which was 326mOsm/kg (normal 280-305). I started him on a trial of DDAVP at 0.05mg BID, which we then increased to 0.1mg BID. Prior to starting DDAVP, he was having some nocturnal urinary incontinence, which has improved, but he's still pu/pd and his urine specific gravities have been 1.007 and 1.005 since starting meds. The owner is also concerned that he eats a ton and is still pretty thin. As of 3/14 he'd lost a pound from his initial visit with us. He's very active, but the owners feel that that can't keep up with his appetite. I rechecked a chemistry profile: Total Protein 5.9 g/dL 5.0 - 7.4 Albumin 3.0 g/dL 2.7 - 4.4 Globulin 2.9 g/dL 1.6 - 3.6 Albumin/Globulin Rat 1.0 Ratio 0.8 - 2.0 AST (SGOT) 22 U/L 15 - 66 ALT (SGPT) 27 U/L 12 - 118 Alk Phosphatase 34 U/L 5 - 131 GGTP 5 U/L 1 - 12 Total Bilirubin 0.2 mg/dL 0.1 - 0.3 Urea Nitrogen 23 mg/dL 6 - 31 Creatinine 0.8 mg/dL 0.5 - 1.6 BUN/Creatinine Ratio 29 Ratio 4 - 2 HIGH Phosphorus 2.8 mg/dL 2.5 - 6.0 GLUCOSE 106 mg/dL 70 - 138 Calcium 9.3 mg/dL 8.9 - 11.4 Corrected Calcium 9.8 Magnesium 1.5 mEq/L 1.5 - 2.5 Sodium 149 mEq/L 139 - 154 Potassium 3.6 mEq/L 3.6 - 5.5 Na/K Ratio 41 Chloride 114 mEq/L 102 - 120 Cholesterol 148 mg/dL 92 - 324 Triglycerides 60 mg/dL 29 - 291 ☼

What route was the ddavp given?

The owner is using a detemir pen?

Roy is a 2 1/2 year old castrated male beagle who was adopted by his family in January as a rescue. The owner noted that he was very polyuric and polydipsic from the time he was adopted. Physical exam was within normal limits except that he was a bit thin. We did a mini panel, CBC and urinalysis, which was all normal except his urine SG was 1.002. The urine brought a first of the AM sample to recheck the SG and it was 1.005. I had the lab add a serum osmolality level, which was 326mOsm/kg (normal 280-305). I started him on a trial of DDAVP at 0.05mg BID, which we then increased to 0.1mg BID. Prior to starting DDAVP, he was having some nocturnal urinary incontinence, which has improved, but he's still pu/pd and his urine specific gravities have been 1.007 and 1.005 since starting meds. The owner is also concerned that he eats a ton and is still pretty thin. As of 3/14 he'd lost a pound from his initial visit with us. He's very active, but the owners feel that that can't keep up with his appetite. I rechecked a chemistry profile: Total Protein 5.9 g/dL 5.0 - 7.4 Albumin 3.0 g/dL 2.7 - 4.4 Globulin 2.9 g/dL 1.6 - 3.6 Albumin/Globulin Rat 1.0 Ratio 0.8 - 2.0 AST (SGOT) 22 U/L 15 - 66 ALT (SGPT) 27 U/L 12 - 118 Alk Phosphatase 34 U/L 5 - 131 GGTP 5 U/L 1 - 12 Total Bilirubin 0.2 mg/dL 0.1 - 0.3 Urea Nitrogen 23 mg/dL 6 - 31 Creatinine 0.8 mg/dL 0.5 - 1.6 BUN/Creatinine Ratio 29 Ratio 4 - 2 HIGH Phosphorus 2.8 mg/dL 2.5 - 6.0 GLUCOSE 106 mg/dL 70 - 138 Calcium 9.3 mg/dL 8.9 - 11.4 Corrected Calcium 9.8 Magnesium 1.5 mEq/L 1.5 - 2.5 Sodium 149 mEq/L 139 - 154 Potassium 3.6 mEq/L 3.6 - 5.5 Na/K Ratio 41 Chloride 114 mEq/L 102 - 120 Cholesterol 148 mg/dL 92 - 324 Triglycerides 60 mg/dL 29 - 291 ☼

Did they do usgs at home?

Has the dogs weight been stable?

Roy is a 2 1/2 year old castrated male beagle who was adopted by his family in January as a rescue. The owner noted that he was very polyuric and polydipsic from the time he was adopted. Physical exam was within normal limits except that he was a bit thin. We did a mini panel, CBC and urinalysis, which was all normal except his urine SG was 1.002. The urine brought a first of the AM sample to recheck the SG and it was 1.005. I had the lab add a serum osmolality level, which was 326mOsm/kg (normal 280-305). I started him on a trial of DDAVP at 0.05mg BID, which we then increased to 0.1mg BID. Prior to starting DDAVP, he was having some nocturnal urinary incontinence, which has improved, but he's still pu/pd and his urine specific gravities have been 1.007 and 1.005 since starting meds. The owner is also concerned that he eats a ton and is still pretty thin. As of 3/14 he'd lost a pound from his initial visit with us. He's very active, but the owners feel that that can't keep up with his appetite. I rechecked a chemistry profile: Total Protein 5.9 g/dL 5.0 - 7.4 Albumin 3.0 g/dL 2.7 - 4.4 Globulin 2.9 g/dL 1.6 - 3.6 Albumin/Globulin Rat 1.0 Ratio 0.8 - 2.0 AST (SGOT) 22 U/L 15 - 66 ALT (SGPT) 27 U/L 12 - 118 Alk Phosphatase 34 U/L 5 - 131 GGTP 5 U/L 1 - 12 Total Bilirubin 0.2 mg/dL 0.1 - 0.3 Urea Nitrogen 23 mg/dL 6 - 31 Creatinine 0.8 mg/dL 0.5 - 1.6 BUN/Creatinine Ratio 29 Ratio 4 - 2 HIGH Phosphorus 2.8 mg/dL 2.5 - 6.0 GLUCOSE 106 mg/dL 70 - 138 Calcium 9.3 mg/dL 8.9 - 11.4 Corrected Calcium 9.8 Magnesium 1.5 mEq/L 1.5 - 2.5 Sodium 149 mEq/L 139 - 154 Potassium 3.6 mEq/L 3.6 - 5.5 Na/K Ratio 41 Chloride 114 mEq/L 102 - 120 Cholesterol 148 mg/dL 92 - 324 Triglycerides 60 mg/dL 29 - 291 ☼

This was when compared to ddavp?

Can you post a few?

OK, so this is a moderately overweight 98lb 5yo FS Coonhound diagnosed with DM elsewhere in December. I have sketchy records. The first glucose curve shows no dose of insulin and BG never fell below 350. The last, and it appears to be second glucose, curve is below. The note says the owner has been giving 30 units because she was still PU/PD on 25 units. PD better on 30 units, eating well, on W/D, time of insulin administration NOT noted. 10am 387 12p 186 2pm 107 4pm 202 6pm 128 Owner showed up here because pet is PU/PD again, and has become avisual over the last month. A random mid-day urine showed a specific gravity of 1.038, which was unexpected. No evidence UTI. Blood work unremarkable except hypothyroid with low T4, FT4 and elevated TSH. Glucose curve below is after receiving 30 units of Novolin at 5:30am & fed W/D as usual. 8:15am 384 11am 182 1pm 151 3pm 100 5pm 173 So, it looks like the glucose is bottoming out around 9-10 hours. I obviously can't increase the dose or I'll get a Somogyi effect for sure (if I'm not getting one already). Any suggestions as to how to manage this girl? I've never used Novolin before and am not experienced with it. (I can post the Antech lab reports for the profile & thyroid if you need them) Thanks in advance!! ☼

Absolutely sure that she's spayed?

Does he have dark stools that could suggest a gi ulcer?

HI all, I have 9yo Mc Lab with possible myositis or MMM and a long confusing history. Patient is owned by a very good local breeder. 2 months ago, owner was away at show and patient suddenly showed signs typical of acute lyme disease (we live in MA)- painful joints, reluctant to move, wouldn't eat, etc and breeders husband started dog on appropriate dose of Doxycycline prescribed by house call vet. Patient was better within 24 hours. 3 weeks later, patient developed acute liquid projectile diarrhea along with lethargy & anorexia when breeder was away again for weekend. Tuesday, patient taken to regular clinic ( 1 hour away)- admitted for treatment. CBC/Chem/T4 and 4DX test were all wnl or negative. Patient given IVF for the day and discharged with metronidazole. Tuesday night, patient no better. House call vet visited and patient looked awful. HR-170, dry muddy mm, crt=4 sec, temp was normal, still anorexic with liquid diarrhea. She inserted IV catheter and bloused 1 liter of fluids Tues night, repeated bolus Wednesday am and PM with mild but short lived improvement. Thursday, patient presented me for ongoing care. Patient was shocky and weak on presentation, HR=170, muddy dry mm and patient seemed stiff with very mild grade 1 lameness LF, eating a little if hand fed, but dropping food from his mouth. Able to open his mouth wide with no apparent pain, nothing obvious in the oral cavity. Still having liquid diarrhea. Owner mentioned his temporal muscles were sunken slightly and this was a new finding. We admitted him for IVF, IV metronidazole, Pepcid, SQ Cerenia. Chest and abdominal rads- nsf, repeated CBC/Chem/Lytes- wnl with neg 4dx. He was improved in the afternoon except he remained tachycardic with HR=160 after nearly 2 liters of fluid. He ate for us, and limping was less, but by 5pm for discharge, he was much worse- he was acutely painful on all his limbs- grade 4/5 lame LF and RH with limb swelling and what seemed like joint effusions.

Is it still valuable to biopsy the muscle 18 days into pred therapy?

If so:   what brand is the owner's glucometer (and has it been checked for accuracy?)   what site does the owner use to collect the bg's?

HI all, I have 9yo Mc Lab with possible myositis or MMM and a long confusing history. Patient is owned by a very good local breeder. 2 months ago, owner was away at show and patient suddenly showed signs typical of acute lyme disease (we live in MA)- painful joints, reluctant to move, wouldn't eat, etc and breeders husband started dog on appropriate dose of Doxycycline prescribed by house call vet. Patient was better within 24 hours. 3 weeks later, patient developed acute liquid projectile diarrhea along with lethargy & anorexia when breeder was away again for weekend. Tuesday, patient taken to regular clinic ( 1 hour away)- admitted for treatment. CBC/Chem/T4 and 4DX test were all wnl or negative. Patient given IVF for the day and discharged with metronidazole. Tuesday night, patient no better. House call vet visited and patient looked awful. HR-170, dry muddy mm, crt=4 sec, temp was normal, still anorexic with liquid diarrhea. She inserted IV catheter and bloused 1 liter of fluids Tues night, repeated bolus Wednesday am and PM with mild but short lived improvement. Thursday, patient presented me for ongoing care. Patient was shocky and weak on presentation, HR=170, muddy dry mm and patient seemed stiff with very mild grade 1 lameness LF, eating a little if hand fed, but dropping food from his mouth. Able to open his mouth wide with no apparent pain, nothing obvious in the oral cavity. Still having liquid diarrhea. Owner mentioned his temporal muscles were sunken slightly and this was a new finding. We admitted him for IVF, IV metronidazole, Pepcid, SQ Cerenia. Chest and abdominal rads- nsf, repeated CBC/Chem/Lytes- wnl with neg 4dx. He was improved in the afternoon except he remained tachycardic with HR=160 after nearly 2 liters of fluid. He ate for us, and limping was less, but by 5pm for discharge, he was much worse- he was acutely painful on all his limbs- grade 4/5 lame LF and RH with limb swelling and what seemed like joint effusions.

Would it be ok to start imuran (with plan to taper pred) in a case where we have no confirmed diagnosis?

What does he currently weigh?

HI all, I have 9yo Mc Lab with possible myositis or MMM and a long confusing history. Patient is owned by a very good local breeder. 2 months ago, owner was away at show and patient suddenly showed signs typical of acute lyme disease (we live in MA)- painful joints, reluctant to move, wouldn't eat, etc and breeders husband started dog on appropriate dose of Doxycycline prescribed by house call vet. Patient was better within 24 hours. 3 weeks later, patient developed acute liquid projectile diarrhea along with lethargy & anorexia when breeder was away again for weekend. Tuesday, patient taken to regular clinic ( 1 hour away)- admitted for treatment. CBC/Chem/T4 and 4DX test were all wnl or negative. Patient given IVF for the day and discharged with metronidazole. Tuesday night, patient no better. House call vet visited and patient looked awful. HR-170, dry muddy mm, crt=4 sec, temp was normal, still anorexic with liquid diarrhea. She inserted IV catheter and bloused 1 liter of fluids Tues night, repeated bolus Wednesday am and PM with mild but short lived improvement. Thursday, patient presented me for ongoing care. Patient was shocky and weak on presentation, HR=170, muddy dry mm and patient seemed stiff with very mild grade 1 lameness LF, eating a little if hand fed, but dropping food from his mouth. Able to open his mouth wide with no apparent pain, nothing obvious in the oral cavity. Still having liquid diarrhea. Owner mentioned his temporal muscles were sunken slightly and this was a new finding. We admitted him for IVF, IV metronidazole, Pepcid, SQ Cerenia. Chest and abdominal rads- nsf, repeated CBC/Chem/Lytes- wnl with neg 4dx. He was improved in the afternoon except he remained tachycardic with HR=160 after nearly 2 liters of fluid. He ate for us, and limping was less, but by 5pm for discharge, he was much worse- he was acutely painful on all his limbs- grade 4/5 lame LF and RH with limb swelling and what seemed like joint effusions.

What is the chances that myositis affected the heart with the non-responsive tachycardia?

If female, is she spayed?

Hi there, We are updating our DKA protocol - we have been doing IM insulin, I have pulled together a lot of information from CPD/VIN/medicine books and I've come up with the following... - maintenance/replacement fluids 0.9% NaCl w KCl supplemented as determined by K+ levels-giving at approx 6ml/kg/hr to ensure that KCl does not exceed 0.5mmol/kg/hr - insulin(soluble) 0.1iu/kg/hour (10iu soluble insulin>>>100ml 0.9%NaCl=1iu per 10ml) - stop insulin infusion once BG is below 10mmol/l and restart if it starts creeping up towards 12-15mmol/l again - start glucose CRI if BG drops below 6mmol/l (10ml 50% glucose + 100ml 0.9%NaCl = 5%glucose solution) @2ml/k/hr Monitor electrolytes q 12hrs Monitor BG q 2hrs Monitor urine output Start on iv AB amoy-clav +/- analgesia/anti-emetics if indicated if no GI signs or indication to withhold food(ie concurrent pancreatitis) then after about 12-24hours if they are willing to eat start on BID insulin SC(caninsulin 0.25iu/kg) Continue monitoring K+ if nescessary - if eating hypokalemia should resolve on it's own but if showing clinical signs of hypokalemia supplement via CRI I have put this together from 4 protocols I have found - most of the problems I was having related to the fluids we stock... if some of the endo-guys would cast an eye over this and perhaps point out my inevitable errors that would be really helpful-as would any advice or tweaks! Also should we routinely be adding phosphate at start of treatment to anticipate hypophosphatemia or should that only be given if indicated on bloods? If giving it, is a sc inj ok or, do I need to calculate another CRI for phosphate also? If refusing to eat after 24hours should we be continuing on with ivf/insulin CRI and dextrose CRI for a few days or should we consider NG tube then? ☼

Why?

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

A 10 year old M/N DSH cat came into me early February for PU/PD. His blood glucose at the time was 463 (10 # cat). His globulin was also high at 5.3. Otherwise all else was normal (T4=1.6). The cat was started on Baytril and Lantus (1 unit bid). We increased the Lantus 1 unit at a time but he was persistently PU/PD even at 4 units bid. During this period, the owner described upper respiratory signs which we treated with Zithromax effectively but symptoms returned as soon as we stopped. Cerenia was started which the owner felt was controlling the UR signs pretty well. Recently, he developed pretty severe watery diarrhea. He came in last week and saw our relief vet. A fecal float and Crypto/Giardia was neg. Bloodwork was done and the blood glucose was 483 and fructosamine of 527. He is eating like a pig and losing weight. A urinalysis was done which was completely normal except for the glucose was 1000. He concentrated his urine well at 1.040 and no WBC or RBC's were observed on the microscopic exam. Radiographs were done and read out by a radiologist. (The report is pasted below) I started him on metronidazole which seems to be helping the diarrhea thus far. He had two days of normal stools but did have a blow out yesterday afternoon. I also started him back on Cerenia because the owner said the UR signs re-occurred when the cerenia was finished a week ago. To recap, I have a cat who is now on 5 units lantus bid, eating a ton, losing weight (3 pounds in the last 4 months), VERY pu/pd, normal U/A other than high glucose, has mild chronic UR signs, and watery diarrhea (maybe coming under control with flagyl. One other point, this cat does not look acromegalic. His jaw and teeth spacing are pretty normal. I think we have reached the point of looking into Insulin resistance. I don't think he is a symogi cat in that I started low and increased a unit at a time at 2 week intervals with the PU/PD never getter any better. However, a glucose curve has not been done to date. So, I think we need to do a glucose curve to see if Lantus is the product we should be using. Also, I need to address the diarrhea and chronic UR symptoms. Probably also need to due a urine C/S. Also considering a PLI to rule out pancreatitis. I wish I was at a university or specialty clinic where I go just go for it but I'm not and the owner is watching the pennies so I could use a little help to prioritize my approach to working up this cat. Any help would be greatly appreciated. I will also cross post with endocrine. ☼

Is this cat eating a sufficiently low-carb diet?

Is she on any nsaids?

A 10 year old M/N DSH cat came into me early February for PU/PD. His blood glucose at the time was 463 (10 # cat). His globulin was also high at 5.3. Otherwise all else was normal (T4=1.6). The cat was started on Baytril and Lantus (1 unit bid). We increased the Lantus 1 unit at a time but he was persistently PU/PD even at 4 units bid. During this period, the owner described upper respiratory signs which we treated with Zithromax effectively but symptoms returned as soon as we stopped. Cerenia was started which the owner felt was controlling the UR signs pretty well. Recently, he developed pretty severe watery diarrhea. He came in last week and saw our relief vet. A fecal float and Crypto/Giardia was neg. Bloodwork was done and the blood glucose was 483 and fructosamine of 527. He is eating like a pig and losing weight. A urinalysis was done which was completely normal except for the glucose was 1000. He concentrated his urine well at 1.040 and no WBC or RBC's were observed on the microscopic exam. Radiographs were done and read out by a radiologist. (The report is pasted below) I started him on metronidazole which seems to be helping the diarrhea thus far. He had two days of normal stools but did have a blow out yesterday afternoon. I also started him back on Cerenia because the owner said the UR signs re-occurred when the cerenia was finished a week ago. To recap, I have a cat who is now on 5 units lantus bid, eating a ton, losing weight (3 pounds in the last 4 months), VERY pu/pd, normal U/A other than high glucose, has mild chronic UR signs, and watery diarrhea (maybe coming under control with flagyl. One other point, this cat does not look acromegalic. His jaw and teeth spacing are pretty normal. I think we have reached the point of looking into Insulin resistance. I don't think he is a symogi cat in that I started low and increased a unit at a time at 2 week intervals with the PU/PD never getter any better. However, a glucose curve has not been done to date. So, I think we need to do a glucose curve to see if Lantus is the product we should be using. Also, I need to address the diarrhea and chronic UR symptoms. Probably also need to due a urine C/S. Also considering a PLI to rule out pancreatitis. I wish I was at a university or specialty clinic where I go just go for it but I'm not and the owner is watching the pennies so I could use a little help to prioritize my approach to working up this cat. Any help would be greatly appreciated. I will also cross post with endocrine. ☼

On the outside chance that the lantus vial is old : is the client using a vial that is older than four months?

Urinalysis otherwise quiet (no rbc or wbc)?

Hello Charlie is a 16 years old dog who was diagnosed with diabetes mellitus a few months ago. We have been running blood glucouse curves every 15 days in order to adjust insulin dose. Currently he is on 15 IU of caninsulin bid. Last glucose curve was performed last wednesday (20/03/13) and it was: 8.45 15 iu of caninsulin given -9.45 am - BG 26.7 -11.45 am - BG 13.7 -1.45 am - BG 8.4 -3.45 pm - BG 7.4 -5 pm - BG 8.5 -6pm - BG 7.7 On 6/03/13 he was on 13 IU of caninsulin bid and the blood glucose curve was: 8.25 am 13 iu of caninsulin given -10am - BG 27.1 -12pm - BG 21.9 -2pm - BG 14.4 -4pm - BG 23 -6pm - BG 20.1 We close at 7 pm so we cannot do a 24h glucose curve. This morning Charlie presented for diarrhoea, lack of appetite and weakness. According to the owner yesterday he was walking very unsteady and was shaking. He did not eat so he did not have the insulin in the evening. he passed diarrhoea overnight. This morning he looked very weak and he refused to eat his breakfast so he did not have any insulin. His blood glucose was 32. About 10 days ago he was sick after having the insulin and he was presented to us with hypoglycemia (BG 3.8). He was treated with glucose iv and he responded well. Last week I was quite happy with the blood glucose but now he looks very weak so I was wondering if I should go back to 13 iu. Any advise will be very well appreciated. Thanks ☼

When you say the bg is 32....i'm thinking that's in mmol/l, right?

How about quanitating water consumption?

Hello Charlie is a 16 years old dog who was diagnosed with diabetes mellitus a few months ago. We have been running blood glucouse curves every 15 days in order to adjust insulin dose. Currently he is on 15 IU of caninsulin bid. Last glucose curve was performed last wednesday (20/03/13) and it was: 8.45 15 iu of caninsulin given -9.45 am - BG 26.7 -11.45 am - BG 13.7 -1.45 am - BG 8.4 -3.45 pm - BG 7.4 -5 pm - BG 8.5 -6pm - BG 7.7 On 6/03/13 he was on 13 IU of caninsulin bid and the blood glucose curve was: 8.25 am 13 iu of caninsulin given -10am - BG 27.1 -12pm - BG 21.9 -2pm - BG 14.4 -4pm - BG 23 -6pm - BG 20.1 We close at 7 pm so we cannot do a 24h glucose curve. This morning Charlie presented for diarrhoea, lack of appetite and weakness. According to the owner yesterday he was walking very unsteady and was shaking. He did not eat so he did not have the insulin in the evening. he passed diarrhoea overnight. This morning he looked very weak and he refused to eat his breakfast so he did not have any insulin. His blood glucose was 32. About 10 days ago he was sick after having the insulin and he was presented to us with hypoglycemia (BG 3.8). He was treated with glucose iv and he responded well. Last week I was quite happy with the blood glucose but now he looks very weak so I was wondering if I should go back to 13 iu. Any advise will be very well appreciated. Thanks ☼

Uti (not simple cystitis but pyelonephritis)---is this an intact male (the antibiotic we're going to start empirically while awaiting the results will be different if he's intact)?

Has the cat recently become a poor groomer?

Hello Charlie is a 16 years old dog who was diagnosed with diabetes mellitus a few months ago. We have been running blood glucouse curves every 15 days in order to adjust insulin dose. Currently he is on 15 IU of caninsulin bid. Last glucose curve was performed last wednesday (20/03/13) and it was: 8.45 15 iu of caninsulin given -9.45 am - BG 26.7 -11.45 am - BG 13.7 -1.45 am - BG 8.4 -3.45 pm - BG 7.4 -5 pm - BG 8.5 -6pm - BG 7.7 On 6/03/13 he was on 13 IU of caninsulin bid and the blood glucose curve was: 8.25 am 13 iu of caninsulin given -10am - BG 27.1 -12pm - BG 21.9 -2pm - BG 14.4 -4pm - BG 23 -6pm - BG 20.1 We close at 7 pm so we cannot do a 24h glucose curve. This morning Charlie presented for diarrhoea, lack of appetite and weakness. According to the owner yesterday he was walking very unsteady and was shaking. He did not eat so he did not have the insulin in the evening. he passed diarrhoea overnight. This morning he looked very weak and he refused to eat his breakfast so he did not have any insulin. His blood glucose was 32. About 10 days ago he was sick after having the insulin and he was presented to us with hypoglycemia (BG 3.8). He was treated with glucose iv and he responded well. Last week I was quite happy with the blood glucose but now he looks very weak so I was wondering if I should go back to 13 iu. Any advise will be very well appreciated. Thanks ☼

Does he have ketones right now?

No history of recent infections?

Hello Charlie is a 16 years old dog who was diagnosed with diabetes mellitus a few months ago. We have been running blood glucouse curves every 15 days in order to adjust insulin dose. Currently he is on 15 IU of caninsulin bid. Last glucose curve was performed last wednesday (20/03/13) and it was: 8.45 15 iu of caninsulin given -9.45 am - BG 26.7 -11.45 am - BG 13.7 -1.45 am - BG 8.4 -3.45 pm - BG 7.4 -5 pm - BG 8.5 -6pm - BG 7.7 On 6/03/13 he was on 13 IU of caninsulin bid and the blood glucose curve was: 8.25 am 13 iu of caninsulin given -10am - BG 27.1 -12pm - BG 21.9 -2pm - BG 14.4 -4pm - BG 23 -6pm - BG 20.1 We close at 7 pm so we cannot do a 24h glucose curve. This morning Charlie presented for diarrhoea, lack of appetite and weakness. According to the owner yesterday he was walking very unsteady and was shaking. He did not eat so he did not have the insulin in the evening. he passed diarrhoea overnight. This morning he looked very weak and he refused to eat his breakfast so he did not have any insulin. His blood glucose was 32. About 10 days ago he was sick after having the insulin and he was presented to us with hypoglycemia (BG 3.8). He was treated with glucose iv and he responded well. Last week I was quite happy with the blood glucose but now he looks very weak so I was wondering if I should go back to 13 iu. Any advise will be very well appreciated. Thanks ☼

Is his blood pressure normal?

No hx of steroids, anticonvulsants, etc?

Hello Charlie is a 16 years old dog who was diagnosed with diabetes mellitus a few months ago. We have been running blood glucouse curves every 15 days in order to adjust insulin dose. Currently he is on 15 IU of caninsulin bid. Last glucose curve was performed last wednesday (20/03/13) and it was: 8.45 15 iu of caninsulin given -9.45 am - BG 26.7 -11.45 am - BG 13.7 -1.45 am - BG 8.4 -3.45 pm - BG 7.4 -5 pm - BG 8.5 -6pm - BG 7.7 On 6/03/13 he was on 13 IU of caninsulin bid and the blood glucose curve was: 8.25 am 13 iu of caninsulin given -10am - BG 27.1 -12pm - BG 21.9 -2pm - BG 14.4 -4pm - BG 23 -6pm - BG 20.1 We close at 7 pm so we cannot do a 24h glucose curve. This morning Charlie presented for diarrhoea, lack of appetite and weakness. According to the owner yesterday he was walking very unsteady and was shaking. He did not eat so he did not have the insulin in the evening. he passed diarrhoea overnight. This morning he looked very weak and he refused to eat his breakfast so he did not have any insulin. His blood glucose was 32. About 10 days ago he was sick after having the insulin and he was presented to us with hypoglycemia (BG 3.8). He was treated with glucose iv and he responded well. Last week I was quite happy with the blood glucose but now he looks very weak so I was wondering if I should go back to 13 iu. Any advise will be very well appreciated. Thanks ☼

What does the cbc and chem screen look like today?

Is there weight loss that accompanies these episodes?

Hi, I am looking for help with this glucose curve on a 5 year old male neutered poodle with diabetes. She started NPH insulin 4 untis BID on 3/5, couldn't get him on a consistent diet until the last 7 days- now has done a curve for 12 hours with a clinic calibrated Alpha trac. 5am 358 fed and then gave shot 7 308 9 177 11 274 1 215 3 96 5 378 fed and then gave shot His PU/PD is lessened but still increased over normal (owner's estimate) My question is with 96 reading at 3pm; do I decrease slightly? is this a rebound? Or is it safe to go up? Thanks in advance, these things always are difficult for me.

So the alphatrak has been checked against an in-hospital machine that we know to be accurate?

Can he handle the costs of managing a diabetic cat with frequent rechecks, blood glucose monitoring, etc.?

Hi, I am looking for help with this glucose curve on a 5 year old male neutered poodle with diabetes. She started NPH insulin 4 untis BID on 3/5, couldn't get him on a consistent diet until the last 7 days- now has done a curve for 12 hours with a clinic calibrated Alpha trac. 5am 358 fed and then gave shot 7 308 9 177 11 274 1 215 3 96 5 378 fed and then gave shot His PU/PD is lessened but still increased over normal (owner's estimate) My question is with 96 reading at 3pm; do I decrease slightly? is this a rebound? Or is it safe to go up? Thanks in advance, these things always are difficult for me.

The bg that rose at 11 am to 274 mg/dl, then fell again is suggestive that the owner may be giving the dog some food during the day?

Did you do a cysto urine culture?

Hi, I am looking for help with this glucose curve on a 5 year old male neutered poodle with diabetes. She started NPH insulin 4 untis BID on 3/5, couldn't get him on a consistent diet until the last 7 days- now has done a curve for 12 hours with a clinic calibrated Alpha trac. 5am 358 fed and then gave shot 7 308 9 177 11 274 1 215 3 96 5 378 fed and then gave shot His PU/PD is lessened but still increased over normal (owner's estimate) My question is with 96 reading at 3pm; do I decrease slightly? is this a rebound? Or is it safe to go up? Thanks in advance, these things always are difficult for me.

Any chance of that?

Energy levels?

Hi, I am looking for help with this glucose curve on a 5 year old male neutered poodle with diabetes. She started NPH insulin 4 untis BID on 3/5, couldn't get him on a consistent diet until the last 7 days- now has done a curve for 12 hours with a clinic calibrated Alpha trac. 5am 358 fed and then gave shot 7 308 9 177 11 274 1 215 3 96 5 378 fed and then gave shot His PU/PD is lessened but still increased over normal (owner's estimate) My question is with 96 reading at 3pm; do I decrease slightly? is this a rebound? Or is it safe to go up? Thanks in advance, these things always are difficult for me.

The food is only being given at mealtimes and the amount is being measured and is reasonable for a dog this size?

Does beep have a history of gi-related issues, such as vomiting, diarrhea, hyporexia/anorexia, etc.?

Hi, I am looking for help with this glucose curve on a 5 year old male neutered poodle with diabetes. She started NPH insulin 4 untis BID on 3/5, couldn't get him on a consistent diet until the last 7 days- now has done a curve for 12 hours with a clinic calibrated Alpha trac. 5am 358 fed and then gave shot 7 308 9 177 11 274 1 215 3 96 5 378 fed and then gave shot His PU/PD is lessened but still increased over normal (owner's estimate) My question is with 96 reading at 3pm; do I decrease slightly? is this a rebound? Or is it safe to go up? Thanks in advance, these things always are difficult for me.

Has he had a urine culture yet?

So the prednisone didn't resolve the periodic inappetance?

Hi, I am trying to figure out a proper diet for a case I have. Here's the background information: The patient is a 5 year / 6 month old spayed feline that weighs 4.8 lbs (BCS=1/5 or a 1/9....skin and bones). The o acquired the pet from an elderly relative who could not care for the pet. O brought the pet in within 1-2 weeks to figure out what is wrong with the pet. O stated that there is no previous medical/vx hx that she was given. O stated p's current diet is meow mix dry w/ friskies wet; unknown what previous diet was. O stated p eats well but seems to be losing weight. O feels that p is otherwise "normal" aside from being really thin and unkempt (p recently stopped grooming herself). O doesn't feel p has a "ravenous" appetite and is not PU/PD from o's given his; no c/s/v/d. O stated p's previous o said p has never used a litter box; o stated p currently stays in her kitchen by choice and just goes to the bathroom on the tile floor despite litter box availability. O did mention she has 2 other cats that "bully" pet. O's other pets are healthy w/ no symptoms. P presented 3/25/13 (sorry for the caps...I copied/pasted from record): MM PINK/TACKY, CRT 2 SEC, ~10-12% DEHYDRATED. EYES CLEAR. MODERATE BROWN EXUDATE AU. MODERATE DENTAL TARTAR/GINGIVITIS. HEART/LUNGS WNL-NO ABNORMALITIES AUSCULTATED (HR=200; RR=30). MATTED HAIR COAT W/ SEVERAL LIVE FLEAS. ERYTHEMA NOTED CRANIAL ASPECT OF RIGHT ANTEBRACHIUM AND RIGHT VENTRAL NECK (MOST LIKELY SELF TRAUMA DUE TO FLEAS). SOFT NON-PAINFUL ABDOMEN ON PALPATION; NORMAL SIZE BLADDER; FECES PALPATED IN COLON. DID NOT APPRECIATE ANY FOREIGN BODY OR MASSES ON ABDOMINAL PALPATION ATT. NO PAIN ELICITED ON ABDOMINAL PALPATION. NO OTHER SIGNIFICANT FINDINGS ATT. tx: IV fluids LRS bolus 100 ml then set @ 20 ml/hr tx: capstar 2-25# po tx: pyrantel 0.5 ml po dx: fecal (nos); ear swab (neg); felv/fiv/hwt (neg/neg/neg) dx: T4= 3.0, Normal=1.0-5.0, Borderline high=2.5-5.0, High >5.0 dx: u/a cysto (DARK HAZY YELLOW; GLUCOSE 50; pH=6.0; PROTEIN 300+++; SP GRAV > 1.050; only bacteria present on sediment, no crystals noted) dx: cbc/chem/lytes (GLU=196 mg/dL, RR=74-159; Na=185.3, RR=150-165; WBC=19.6, RR=5.0-19.5; RBC=4.39, RR=5.0-11.0; PLT=124, RR=200-500; MCH=18.88, RR=12.5-17.5; MCV=61.0, RR=39.0-50.0; REST WNL) ***recommended radiographs---o declined at this time and wanted to treat conservatively for now to see how pet does. Tx: convenia 80 mg/ml (0.5 ml sq) and working on rehydrating pet. So my differentials at this time are Hyperthyroidism, Neoplasia, Diabetes, GI dz, and Malnourishment. Am I missing any other differentials that I should be considering? I was planning on doing a trial therapy for hyperthyroidism since value was "borderline high", but want to make sure p is not diabetic. Currently treating uti and correcting dehydration. I am stuck on what diet to implement while continuing work up. I was thinking about doing a diabetic diet (i.e. m/d) just in case p turns out to be diabetic. I sent home some i/d and a/d for last night but stressed to the o to use a SMALL amount of the a/d to try and avoid too high of fat/protein intake to be on the safe side. Any other suggestions for diet? P is hospitalized today (3/26/13) just for iv fluid therapy to help correct dehydration; No changes on pe except dehydration is about 7-10% (slightly improved from yesterday). Thanks!!!

Are you sure about her age?

What is the body condition now at 11.75 lbs?

Hi, I am trying to figure out a proper diet for a case I have. Here's the background information: The patient is a 5 year / 6 month old spayed feline that weighs 4.8 lbs (BCS=1/5 or a 1/9....skin and bones). The o acquired the pet from an elderly relative who could not care for the pet. O brought the pet in within 1-2 weeks to figure out what is wrong with the pet. O stated that there is no previous medical/vx hx that she was given. O stated p's current diet is meow mix dry w/ friskies wet; unknown what previous diet was. O stated p eats well but seems to be losing weight. O feels that p is otherwise "normal" aside from being really thin and unkempt (p recently stopped grooming herself). O doesn't feel p has a "ravenous" appetite and is not PU/PD from o's given his; no c/s/v/d. O stated p's previous o said p has never used a litter box; o stated p currently stays in her kitchen by choice and just goes to the bathroom on the tile floor despite litter box availability. O did mention she has 2 other cats that "bully" pet. O's other pets are healthy w/ no symptoms. P presented 3/25/13 (sorry for the caps...I copied/pasted from record): MM PINK/TACKY, CRT 2 SEC, ~10-12% DEHYDRATED. EYES CLEAR. MODERATE BROWN EXUDATE AU. MODERATE DENTAL TARTAR/GINGIVITIS. HEART/LUNGS WNL-NO ABNORMALITIES AUSCULTATED (HR=200; RR=30). MATTED HAIR COAT W/ SEVERAL LIVE FLEAS. ERYTHEMA NOTED CRANIAL ASPECT OF RIGHT ANTEBRACHIUM AND RIGHT VENTRAL NECK (MOST LIKELY SELF TRAUMA DUE TO FLEAS). SOFT NON-PAINFUL ABDOMEN ON PALPATION; NORMAL SIZE BLADDER; FECES PALPATED IN COLON. DID NOT APPRECIATE ANY FOREIGN BODY OR MASSES ON ABDOMINAL PALPATION ATT. NO PAIN ELICITED ON ABDOMINAL PALPATION. NO OTHER SIGNIFICANT FINDINGS ATT. tx: IV fluids LRS bolus 100 ml then set @ 20 ml/hr tx: capstar 2-25# po tx: pyrantel 0.5 ml po dx: fecal (nos); ear swab (neg); felv/fiv/hwt (neg/neg/neg) dx: T4= 3.0, Normal=1.0-5.0, Borderline high=2.5-5.0, High >5.0 dx: u/a cysto (DARK HAZY YELLOW; GLUCOSE 50; pH=6.0; PROTEIN 300+++; SP GRAV > 1.050; only bacteria present on sediment, no crystals noted) dx: cbc/chem/lytes (GLU=196 mg/dL, RR=74-159; Na=185.3, RR=150-165; WBC=19.6, RR=5.0-19.5; RBC=4.39, RR=5.0-11.0; PLT=124, RR=200-500; MCH=18.88, RR=12.5-17.5; MCV=61.0, RR=39.0-50.0; REST WNL) ***recommended radiographs---o declined at this time and wanted to treat conservatively for now to see how pet does. Tx: convenia 80 mg/ml (0.5 ml sq) and working on rehydrating pet. So my differentials at this time are Hyperthyroidism, Neoplasia, Diabetes, GI dz, and Malnourishment. Am I missing any other differentials that I should be considering? I was planning on doing a trial therapy for hyperthyroidism since value was "borderline high", but want to make sure p is not diabetic. Currently treating uti and correcting dehydration. I am stuck on what diet to implement while continuing work up. I was thinking about doing a diabetic diet (i.e. m/d) just in case p turns out to be diabetic. I sent home some i/d and a/d for last night but stressed to the o to use a SMALL amount of the a/d to try and avoid too high of fat/protein intake to be on the safe side. Any other suggestions for diet? P is hospitalized today (3/26/13) just for iv fluid therapy to help correct dehydration; No changes on pe except dehydration is about 7-10% (slightly improved from yesterday). Thanks!!!

I suppose, no way of keeping them separated all the time to see if this might help with the cat's weight and grooming habits?

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, since vetsulin came back on the market, there's a new label requiring us to vigorously shake it the first time the bottle is opened, then shaken enough each time it's used to keep it looking continously milky...is this being done?

Hi, I am trying to figure out a proper diet for a case I have. Here's the background information: The patient is a 5 year / 6 month old spayed feline that weighs 4.8 lbs (BCS=1/5 or a 1/9....skin and bones). The o acquired the pet from an elderly relative who could not care for the pet. O brought the pet in within 1-2 weeks to figure out what is wrong with the pet. O stated that there is no previous medical/vx hx that she was given. O stated p's current diet is meow mix dry w/ friskies wet; unknown what previous diet was. O stated p eats well but seems to be losing weight. O feels that p is otherwise "normal" aside from being really thin and unkempt (p recently stopped grooming herself). O doesn't feel p has a "ravenous" appetite and is not PU/PD from o's given his; no c/s/v/d. O stated p's previous o said p has never used a litter box; o stated p currently stays in her kitchen by choice and just goes to the bathroom on the tile floor despite litter box availability. O did mention she has 2 other cats that "bully" pet. O's other pets are healthy w/ no symptoms. P presented 3/25/13 (sorry for the caps...I copied/pasted from record): MM PINK/TACKY, CRT 2 SEC, ~10-12% DEHYDRATED. EYES CLEAR. MODERATE BROWN EXUDATE AU. MODERATE DENTAL TARTAR/GINGIVITIS. HEART/LUNGS WNL-NO ABNORMALITIES AUSCULTATED (HR=200; RR=30). MATTED HAIR COAT W/ SEVERAL LIVE FLEAS. ERYTHEMA NOTED CRANIAL ASPECT OF RIGHT ANTEBRACHIUM AND RIGHT VENTRAL NECK (MOST LIKELY SELF TRAUMA DUE TO FLEAS). SOFT NON-PAINFUL ABDOMEN ON PALPATION; NORMAL SIZE BLADDER; FECES PALPATED IN COLON. DID NOT APPRECIATE ANY FOREIGN BODY OR MASSES ON ABDOMINAL PALPATION ATT. NO PAIN ELICITED ON ABDOMINAL PALPATION. NO OTHER SIGNIFICANT FINDINGS ATT. tx: IV fluids LRS bolus 100 ml then set @ 20 ml/hr tx: capstar 2-25# po tx: pyrantel 0.5 ml po dx: fecal (nos); ear swab (neg); felv/fiv/hwt (neg/neg/neg) dx: T4= 3.0, Normal=1.0-5.0, Borderline high=2.5-5.0, High >5.0 dx: u/a cysto (DARK HAZY YELLOW; GLUCOSE 50; pH=6.0; PROTEIN 300+++; SP GRAV > 1.050; only bacteria present on sediment, no crystals noted) dx: cbc/chem/lytes (GLU=196 mg/dL, RR=74-159; Na=185.3, RR=150-165; WBC=19.6, RR=5.0-19.5; RBC=4.39, RR=5.0-11.0; PLT=124, RR=200-500; MCH=18.88, RR=12.5-17.5; MCV=61.0, RR=39.0-50.0; REST WNL) ***recommended radiographs---o declined at this time and wanted to treat conservatively for now to see how pet does. Tx: convenia 80 mg/ml (0.5 ml sq) and working on rehydrating pet. So my differentials at this time are Hyperthyroidism, Neoplasia, Diabetes, GI dz, and Malnourishment. Am I missing any other differentials that I should be considering? I was planning on doing a trial therapy for hyperthyroidism since value was "borderline high", but want to make sure p is not diabetic. Currently treating uti and correcting dehydration. I am stuck on what diet to implement while continuing work up. I was thinking about doing a diabetic diet (i.e. m/d) just in case p turns out to be diabetic. I sent home some i/d and a/d for last night but stressed to the o to use a SMALL amount of the a/d to try and avoid too high of fat/protein intake to be on the safe side. Any other suggestions for diet? P is hospitalized today (3/26/13) just for iv fluid therapy to help correct dehydration; No changes on pe except dehydration is about 7-10% (slightly improved from yesterday). Thanks!!!

Rods, or cocci?

Using u40 syringes?

Hi, I am trying to figure out a proper diet for a case I have. Here's the background information: The patient is a 5 year / 6 month old spayed feline that weighs 4.8 lbs (BCS=1/5 or a 1/9....skin and bones). The o acquired the pet from an elderly relative who could not care for the pet. O brought the pet in within 1-2 weeks to figure out what is wrong with the pet. O stated that there is no previous medical/vx hx that she was given. O stated p's current diet is meow mix dry w/ friskies wet; unknown what previous diet was. O stated p eats well but seems to be losing weight. O feels that p is otherwise "normal" aside from being really thin and unkempt (p recently stopped grooming herself). O doesn't feel p has a "ravenous" appetite and is not PU/PD from o's given his; no c/s/v/d. O stated p's previous o said p has never used a litter box; o stated p currently stays in her kitchen by choice and just goes to the bathroom on the tile floor despite litter box availability. O did mention she has 2 other cats that "bully" pet. O's other pets are healthy w/ no symptoms. P presented 3/25/13 (sorry for the caps...I copied/pasted from record): MM PINK/TACKY, CRT 2 SEC, ~10-12% DEHYDRATED. EYES CLEAR. MODERATE BROWN EXUDATE AU. MODERATE DENTAL TARTAR/GINGIVITIS. HEART/LUNGS WNL-NO ABNORMALITIES AUSCULTATED (HR=200; RR=30). MATTED HAIR COAT W/ SEVERAL LIVE FLEAS. ERYTHEMA NOTED CRANIAL ASPECT OF RIGHT ANTEBRACHIUM AND RIGHT VENTRAL NECK (MOST LIKELY SELF TRAUMA DUE TO FLEAS). SOFT NON-PAINFUL ABDOMEN ON PALPATION; NORMAL SIZE BLADDER; FECES PALPATED IN COLON. DID NOT APPRECIATE ANY FOREIGN BODY OR MASSES ON ABDOMINAL PALPATION ATT. NO PAIN ELICITED ON ABDOMINAL PALPATION. NO OTHER SIGNIFICANT FINDINGS ATT. tx: IV fluids LRS bolus 100 ml then set @ 20 ml/hr tx: capstar 2-25# po tx: pyrantel 0.5 ml po dx: fecal (nos); ear swab (neg); felv/fiv/hwt (neg/neg/neg) dx: T4= 3.0, Normal=1.0-5.0, Borderline high=2.5-5.0, High >5.0 dx: u/a cysto (DARK HAZY YELLOW; GLUCOSE 50; pH=6.0; PROTEIN 300+++; SP GRAV > 1.050; only bacteria present on sediment, no crystals noted) dx: cbc/chem/lytes (GLU=196 mg/dL, RR=74-159; Na=185.3, RR=150-165; WBC=19.6, RR=5.0-19.5; RBC=4.39, RR=5.0-11.0; PLT=124, RR=200-500; MCH=18.88, RR=12.5-17.5; MCV=61.0, RR=39.0-50.0; REST WNL) ***recommended radiographs---o declined at this time and wanted to treat conservatively for now to see how pet does. Tx: convenia 80 mg/ml (0.5 ml sq) and working on rehydrating pet. So my differentials at this time are Hyperthyroidism, Neoplasia, Diabetes, GI dz, and Malnourishment. Am I missing any other differentials that I should be considering? I was planning on doing a trial therapy for hyperthyroidism since value was "borderline high", but want to make sure p is not diabetic. Currently treating uti and correcting dehydration. I am stuck on what diet to implement while continuing work up. I was thinking about doing a diabetic diet (i.e. m/d) just in case p turns out to be diabetic. I sent home some i/d and a/d for last night but stressed to the o to use a SMALL amount of the a/d to try and avoid too high of fat/protein intake to be on the safe side. Any other suggestions for diet? P is hospitalized today (3/26/13) just for iv fluid therapy to help correct dehydration; No changes on pe except dehydration is about 7-10% (slightly improved from yesterday). Thanks!!!

Does she not have unimpeded access to clean water?

Abd us?

Bo is a new patient to our clinic. Was diagnosed with Cushings at another vet and was started on Vetoryl. I do not have the history for the initial diagnosis. and the following history from other vets is sketchy at best, sorry. 11/2012 -potbellied appearance, sparse haircoat, overwght. for some reason (not clarified in history) it was recommended to stop Vetoryl for 2-3 days and start with a lower dose if symptoms return. recheck ACTH stim again if not excessively hungry and thirsty 12/22/12- was ravenous again. an ultrasound was recommened, or recommended considering treating again at a lower dose and see what happens. 12/26-ACTH, pre 4.5 ug/dl, Post 20.8 ug/dl. Origionally he was on 120 mg/day, at the time of the ACTH test it looked like he was on 60 mg/day. It was recommended to go to 90 mg once daily or may need to try 120 mg alternating with 60 mg. So, Bo came to see me in Feb, He was overweight, thinning coat, drinking normally. did have diarrhea at the time and appetite was down the previous 2 days but improved at the time of the visit. He just moved to the area. Discussed GI upset from stress, or due to Vetoryl dosing (was on 90 mg/day). declinded an ACTH stim at that time and just chose to monitor at home. Today he came in for ACTH stim for monitoring. He seems to be doing great, still slightly overweight but coat seems less thin. Eating/drinking normally according to owner. Results are Pre of 27.6 nmol/L and Post 233 nmol/L I am new to using Vetoryl, most of our patients are on Lysodren. The pre-sample seems low, but the post higher than ideal? The Stim was done about 11 hours after the dose of Vetoryl (he gives it at 9pm, he was dropped off for us at 8 am). Would he be better on a twice daily dosing? Thanks in advance and sorry again for the completely lacking and confusing prior history. :( /pp / DVM

How much does the dog weigh?

How is his bcs?

Bo is a new patient to our clinic. Was diagnosed with Cushings at another vet and was started on Vetoryl. I do not have the history for the initial diagnosis. and the following history from other vets is sketchy at best, sorry. 11/2012 -potbellied appearance, sparse haircoat, overwght. for some reason (not clarified in history) it was recommended to stop Vetoryl for 2-3 days and start with a lower dose if symptoms return. recheck ACTH stim again if not excessively hungry and thirsty 12/22/12- was ravenous again. an ultrasound was recommened, or recommended considering treating again at a lower dose and see what happens. 12/26-ACTH, pre 4.5 ug/dl, Post 20.8 ug/dl. Origionally he was on 120 mg/day, at the time of the ACTH test it looked like he was on 60 mg/day. It was recommended to go to 90 mg once daily or may need to try 120 mg alternating with 60 mg. So, Bo came to see me in Feb, He was overweight, thinning coat, drinking normally. did have diarrhea at the time and appetite was down the previous 2 days but improved at the time of the visit. He just moved to the area. Discussed GI upset from stress, or due to Vetoryl dosing (was on 90 mg/day). declinded an ACTH stim at that time and just chose to monitor at home. Today he came in for ACTH stim for monitoring. He seems to be doing great, still slightly overweight but coat seems less thin. Eating/drinking normally according to owner. Results are Pre of 27.6 nmol/L and Post 233 nmol/L I am new to using Vetoryl, most of our patients are on Lysodren. The pre-sample seems low, but the post higher than ideal? The Stim was done about 11 hours after the dose of Vetoryl (he gives it at 9pm, he was dropped off for us at 8 am). Would he be better on a twice daily dosing? Thanks in advance and sorry again for the completely lacking and confusing prior history. :( /pp / DVM

Male neutered?

Does the dog have underlying allergies such as flea, food or atopy?

Hi I have just been presented with a new client that came to our clinic for a second opinion on a new diagnosis of diabetes. Annie is a estimated 5-7 yr old Treeing Walker Coonhound. The dog was diagnosed at another local clinic with diabetes Feb 28th based on clinical signs of pu/pd and weight loss and BW. Weight at that visit was 85.7#. The notes on the record indicate a relatively normal PE other than early cataracts. Bloodwork and UA were done: *ALP 368 (10-150) *ALT 269 (5-107) *AST 84 (5-55) CK 103 (10-200) GGT 7 (0-14) Amylase 581 (450-1240) Lipase 604 (100-750) Alb 3.3 (2.6-4) T Prot 6.9 (5.1-7.8) Glob 3.6 (2.1-4.5) T bili .1 (0-.4) Direct bili .1 (0-.2) BUN 13 (7-27) Creat 1 (.4-1.8) Chol 275 (112-328) *Gluc 493 (60-125) Ca 10.2 (8.2-12.4) Phos 4.9 (2.1-6.3) *Cl 25 (17-24) K 5.1 (4-5.6) Na 142 (141-156) T4 1.3 (1-4) CBC WNL UA: USG 1.022, 3+ Gluc, 1+ Ketones, 1+ Blood, 2+ prot, 0-2 WBC pHpf, 2-5 RBC pHpf From the records it looks like NPH was started at 20U q12hr and diet was changed to Blue Buffalo Fish based diet. Annie returned to that clinic on 3/18/13 for recheck because she was acting very oddly after insulin that morning. 3rd eyelids elevated, acting unaware of surroundings and lethargic. Exam notes indicate PE WNL except slight elevation of 3rd eyelids and more mature cataracts. A glucose curve was performed. 20U NPH was given at 7am and the dog ate 1 1/4 cups of her food. BG 8:20am 530 BG 10:40am 562 BG 1:00pm 577 BG 3:00pm 491 From there the records indicate that the DVM would normally increase the insulin, but with the unusual behavior that morning, decided to keep it at 20U and recheck curve in 10days. Then the dog returned to that clinic on 3/25/13. Apparently dog seemed almost unresponsive that AM....lying on bed, finally responded to different family members voice. Completely blind now. Discharge from left eye. Did not eat that morning....o did not give am insulin but had given it the night before. Exam notes indicate BAR, mature cataracts, mucoid d/c OS BG 403 on Alphtrak Discontinued insulin with instructions to monitor at home. So, now on 3/26/13 they come to see us for a second opinion on what is going on. Annie weighs 83.8# and is completely blind due to mature cataracts. She does have a mild serous d/c from OS and mild episcleritis.(IOP OU wnl and flouroscein stain neg) Her abd is slightly pendulous and doughy, possibly enlarged liver or spleen, but nothing dramatic or obvious on palpation. Other than that, her PE is unremarkable. She has been off insulin for 2 days now and the owner feels her energy is much better. She continues to eat very well and is still pu/pd. I repeated BW (CBC/CHEM/4DXHW)and UA: BW all very normal except ALP 393 (23-212) BG 487 (74-143) I can post all results if you need them. UA: 2+ protein, pH 6, 3+ Blood, Trace ketones, 2% Gluc, USG 1.025. Sediment revealed 1-3 rbc pHpf, mild amount of struvite crystal fragments. I guess I just need a little guidance here. If I had not heard all of the hx and this dog came to me for the first time, I would also have started NPH but pably at a lower dose....like 10U q12hr. At this point, I am not sure if the dog was having hypoglycemic episodes? or is there something else going on. The owners are very reluctant to use NPH again. Would you recommend NPH lower dose and do a longer curve to really see what is happening? or possibly a different insulin? I have never used anything other than NPH in a dog. The owners were asking about Cushings Dz. I don't have a good enough feel for the clients yet to know how aggressive they want to be with testing etc. but can certainly talk to them about xrays, LDDS, urine c/s etc... Mainly I am wondering how to proceed with insulin in this case. Thanks for any help! br/

A guess i am a little confused the dog was on 20 units and showed high glu but the insulin was stopped and then want to start on lower dose?

Could she have bromide toxicity...did you take a sample for serum bromide level?

Hi I have just been presented with a new client that came to our clinic for a second opinion on a new diagnosis of diabetes. Annie is a estimated 5-7 yr old Treeing Walker Coonhound. The dog was diagnosed at another local clinic with diabetes Feb 28th based on clinical signs of pu/pd and weight loss and BW. Weight at that visit was 85.7#. The notes on the record indicate a relatively normal PE other than early cataracts. Bloodwork and UA were done: *ALP 368 (10-150) *ALT 269 (5-107) *AST 84 (5-55) CK 103 (10-200) GGT 7 (0-14) Amylase 581 (450-1240) Lipase 604 (100-750) Alb 3.3 (2.6-4) T Prot 6.9 (5.1-7.8) Glob 3.6 (2.1-4.5) T bili .1 (0-.4) Direct bili .1 (0-.2) BUN 13 (7-27) Creat 1 (.4-1.8) Chol 275 (112-328) *Gluc 493 (60-125) Ca 10.2 (8.2-12.4) Phos 4.9 (2.1-6.3) *Cl 25 (17-24) K 5.1 (4-5.6) Na 142 (141-156) T4 1.3 (1-4) CBC WNL UA: USG 1.022, 3+ Gluc, 1+ Ketones, 1+ Blood, 2+ prot, 0-2 WBC pHpf, 2-5 RBC pHpf From the records it looks like NPH was started at 20U q12hr and diet was changed to Blue Buffalo Fish based diet. Annie returned to that clinic on 3/18/13 for recheck because she was acting very oddly after insulin that morning. 3rd eyelids elevated, acting unaware of surroundings and lethargic. Exam notes indicate PE WNL except slight elevation of 3rd eyelids and more mature cataracts. A glucose curve was performed. 20U NPH was given at 7am and the dog ate 1 1/4 cups of her food. BG 8:20am 530 BG 10:40am 562 BG 1:00pm 577 BG 3:00pm 491 From there the records indicate that the DVM would normally increase the insulin, but with the unusual behavior that morning, decided to keep it at 20U and recheck curve in 10days. Then the dog returned to that clinic on 3/25/13. Apparently dog seemed almost unresponsive that AM....lying on bed, finally responded to different family members voice. Completely blind now. Discharge from left eye. Did not eat that morning....o did not give am insulin but had given it the night before. Exam notes indicate BAR, mature cataracts, mucoid d/c OS BG 403 on Alphtrak Discontinued insulin with instructions to monitor at home. So, now on 3/26/13 they come to see us for a second opinion on what is going on. Annie weighs 83.8# and is completely blind due to mature cataracts. She does have a mild serous d/c from OS and mild episcleritis.(IOP OU wnl and flouroscein stain neg) Her abd is slightly pendulous and doughy, possibly enlarged liver or spleen, but nothing dramatic or obvious on palpation. Other than that, her PE is unremarkable. She has been off insulin for 2 days now and the owner feels her energy is much better. She continues to eat very well and is still pu/pd. I repeated BW (CBC/CHEM/4DXHW)and UA: BW all very normal except ALP 393 (23-212) BG 487 (74-143) I can post all results if you need them. UA: 2+ protein, pH 6, 3+ Blood, Trace ketones, 2% Gluc, USG 1.025. Sediment revealed 1-3 rbc pHpf, mild amount of struvite crystal fragments. I guess I just need a little guidance here. If I had not heard all of the hx and this dog came to me for the first time, I would also have started NPH but pably at a lower dose....like 10U q12hr. At this point, I am not sure if the dog was having hypoglycemic episodes? or is there something else going on. The owners are very reluctant to use NPH again. Would you recommend NPH lower dose and do a longer curve to really see what is happening? or possibly a different insulin? I have never used anything other than NPH in a dog. The owners were asking about Cushings Dz. I don't have a good enough feel for the clients yet to know how aggressive they want to be with testing etc. but can certainly talk to them about xrays, LDDS, urine c/s etc... Mainly I am wondering how to proceed with insulin in this case. Thanks for any help! br/

Would suspect the dog needs more insulin ....did you think the dog was hypoglycemic and somogyi before?

What was the creatinine, and what was the urine sg when the bun was high?

Yet another cat with diarrhea. Mom is 11yr.old fs indoor cat. She lives with 9 other cats all of which are indoors. in November,2012 she was brought in because of episodes where she passes gas and runs to the litter and watery stool caomes. out. Her appetite at that time was normal and so was water intake activity etc. We treated her with metronodazole 25 mgs. sid for 14 dyas. Minimal improvement. Owners did refill the meds once. Didn't see her agian until 1/2013 still has diarrhea. Alos suffering from FBA. Treated the allergy with Steroids...told owner to monitor stool as this may help. Also discuused dietary intervention with Hills I/D and Forti-flora. Told owners probably should to further work-up . Heard from them in Feb..2013 same comlaint. At this time I told owners i didn't what I was treating and so we did CBC/CHEM. Which was normal. Felv/FIv neg. finally was able to do a GI PAnel and fromreading different threads i don't know if I know how to interpret the results and if they are valid. the cobalomine was normal I thought this should at least have been abnormal..and the folate was also normal. PLI fasting waselevated at 18 ( 0.1 to3.5)\ TLI fasting was 125.7 (12-82) I don't believe this gives me a whole lot of anythingto go on. At least I got a normal cobalomine (if was low I know how to treat that). Essentially the diet, and metronidazole. did't help. Thinking about z/d . I guess my question is when to do these Panels and the problem of inteeroretation.? Should I continue doing them on GI cases or just do Things I did before these tests were available( dinosaur ) ☼

Minimal improvement how much does she weigh?

So does this help?

Yet another cat with diarrhea. Mom is 11yr.old fs indoor cat. She lives with 9 other cats all of which are indoors. in November,2012 she was brought in because of episodes where she passes gas and runs to the litter and watery stool caomes. out. Her appetite at that time was normal and so was water intake activity etc. We treated her with metronodazole 25 mgs. sid for 14 dyas. Minimal improvement. Owners did refill the meds once. Didn't see her agian until 1/2013 still has diarrhea. Alos suffering from FBA. Treated the allergy with Steroids...told owner to monitor stool as this may help. Also discuused dietary intervention with Hills I/D and Forti-flora. Told owners probably should to further work-up . Heard from them in Feb..2013 same comlaint. At this time I told owners i didn't what I was treating and so we did CBC/CHEM. Which was normal. Felv/FIv neg. finally was able to do a GI PAnel and fromreading different threads i don't know if I know how to interpret the results and if they are valid. the cobalomine was normal I thought this should at least have been abnormal..and the folate was also normal. PLI fasting waselevated at 18 ( 0.1 to3.5)\ TLI fasting was 125.7 (12-82) I don't believe this gives me a whole lot of anythingto go on. At least I got a normal cobalomine (if was low I know how to treat that). Essentially the diet, and metronidazole. did't help. Thinking about z/d . I guess my question is when to do these Panels and the problem of inteeroretation.? Should I continue doing them on GI cases or just do Things I did before these tests were available( dinosaur ) ☼

Has an ova, parasites and giardia elisa been done yet on mom?

Have we done a ba to make sure the liver changes aren't from pheno?

Yet another cat with diarrhea. Mom is 11yr.old fs indoor cat. She lives with 9 other cats all of which are indoors. in November,2012 she was brought in because of episodes where she passes gas and runs to the litter and watery stool caomes. out. Her appetite at that time was normal and so was water intake activity etc. We treated her with metronodazole 25 mgs. sid for 14 dyas. Minimal improvement. Owners did refill the meds once. Didn't see her agian until 1/2013 still has diarrhea. Alos suffering from FBA. Treated the allergy with Steroids...told owner to monitor stool as this may help. Also discuused dietary intervention with Hills I/D and Forti-flora. Told owners probably should to further work-up . Heard from them in Feb..2013 same comlaint. At this time I told owners i didn't what I was treating and so we did CBC/CHEM. Which was normal. Felv/FIv neg. finally was able to do a GI PAnel and fromreading different threads i don't know if I know how to interpret the results and if they are valid. the cobalomine was normal I thought this should at least have been abnormal..and the folate was also normal. PLI fasting waselevated at 18 ( 0.1 to3.5)\ TLI fasting was 125.7 (12-82) I don't believe this gives me a whole lot of anythingto go on. At least I got a normal cobalomine (if was low I know how to treat that). Essentially the diet, and metronidazole. did't help. Thinking about z/d . I guess my question is when to do these Panels and the problem of inteeroretation.? Should I continue doing them on GI cases or just do Things I did before these tests were available( dinosaur ) ☼

What does she normally eat?

What stage of crd?

Yet another cat with diarrhea. Mom is 11yr.old fs indoor cat. She lives with 9 other cats all of which are indoors. in November,2012 she was brought in because of episodes where she passes gas and runs to the litter and watery stool caomes. out. Her appetite at that time was normal and so was water intake activity etc. We treated her with metronodazole 25 mgs. sid for 14 dyas. Minimal improvement. Owners did refill the meds once. Didn't see her agian until 1/2013 still has diarrhea. Alos suffering from FBA. Treated the allergy with Steroids...told owner to monitor stool as this may help. Also discuused dietary intervention with Hills I/D and Forti-flora. Told owners probably should to further work-up . Heard from them in Feb..2013 same comlaint. At this time I told owners i didn't what I was treating and so we did CBC/CHEM. Which was normal. Felv/FIv neg. finally was able to do a GI PAnel and fromreading different threads i don't know if I know how to interpret the results and if they are valid. the cobalomine was normal I thought this should at least have been abnormal..and the folate was also normal. PLI fasting waselevated at 18 ( 0.1 to3.5)\ TLI fasting was 125.7 (12-82) I don't believe this gives me a whole lot of anythingto go on. At least I got a normal cobalomine (if was low I know how to treat that). Essentially the diet, and metronidazole. did't help. Thinking about z/d . I guess my question is when to do these Panels and the problem of inteeroretation.? Should I continue doing them on GI cases or just do Things I did before these tests were available( dinosaur ) ☼

Any diet changes?

Maybe you have some of those brands/flavors there?

Yet another cat with diarrhea. Mom is 11yr.old fs indoor cat. She lives with 9 other cats all of which are indoors. in November,2012 she was brought in because of episodes where she passes gas and runs to the litter and watery stool caomes. out. Her appetite at that time was normal and so was water intake activity etc. We treated her with metronodazole 25 mgs. sid for 14 dyas. Minimal improvement. Owners did refill the meds once. Didn't see her agian until 1/2013 still has diarrhea. Alos suffering from FBA. Treated the allergy with Steroids...told owner to monitor stool as this may help. Also discuused dietary intervention with Hills I/D and Forti-flora. Told owners probably should to further work-up . Heard from them in Feb..2013 same comlaint. At this time I told owners i didn't what I was treating and so we did CBC/CHEM. Which was normal. Felv/FIv neg. finally was able to do a GI PAnel and fromreading different threads i don't know if I know how to interpret the results and if they are valid. the cobalomine was normal I thought this should at least have been abnormal..and the folate was also normal. PLI fasting waselevated at 18 ( 0.1 to3.5)\ TLI fasting was 125.7 (12-82) I don't believe this gives me a whole lot of anythingto go on. At least I got a normal cobalomine (if was low I know how to treat that). Essentially the diet, and metronidazole. did't help. Thinking about z/d . I guess my question is when to do these Panels and the problem of inteeroretation.? Should I continue doing them on GI cases or just do Things I did before these tests were available( dinosaur ) ☼

Raw meat fed?

Have we rechecked the dog's urine to see if ketones are still present?

Yet another cat with diarrhea. Mom is 11yr.old fs indoor cat. She lives with 9 other cats all of which are indoors. in November,2012 she was brought in because of episodes where she passes gas and runs to the litter and watery stool caomes. out. Her appetite at that time was normal and so was water intake activity etc. We treated her with metronodazole 25 mgs. sid for 14 dyas. Minimal improvement. Owners did refill the meds once. Didn't see her agian until 1/2013 still has diarrhea. Alos suffering from FBA. Treated the allergy with Steroids...told owner to monitor stool as this may help. Also discuused dietary intervention with Hills I/D and Forti-flora. Told owners probably should to further work-up . Heard from them in Feb..2013 same comlaint. At this time I told owners i didn't what I was treating and so we did CBC/CHEM. Which was normal. Felv/FIv neg. finally was able to do a GI PAnel and fromreading different threads i don't know if I know how to interpret the results and if they are valid. the cobalomine was normal I thought this should at least have been abnormal..and the folate was also normal. PLI fasting waselevated at 18 ( 0.1 to3.5)\ TLI fasting was 125.7 (12-82) I don't believe this gives me a whole lot of anythingto go on. At least I got a normal cobalomine (if was low I know how to treat that). Essentially the diet, and metronidazole. did't help. Thinking about z/d . I guess my question is when to do these Panels and the problem of inteeroretation.? Should I continue doing them on GI cases or just do Things I did before these tests were available( dinosaur ) ☼

Hunting of rodents?

Could this cat have any other confounding problem like uti, other occult infection, hypert4, renal insufficiency, or something that is affecting his response to insulin?

Yet another cat with diarrhea. Mom is 11yr.old fs indoor cat. She lives with 9 other cats all of which are indoors. in November,2012 she was brought in because of episodes where she passes gas and runs to the litter and watery stool caomes. out. Her appetite at that time was normal and so was water intake activity etc. We treated her with metronodazole 25 mgs. sid for 14 dyas. Minimal improvement. Owners did refill the meds once. Didn't see her agian until 1/2013 still has diarrhea. Alos suffering from FBA. Treated the allergy with Steroids...told owner to monitor stool as this may help. Also discuused dietary intervention with Hills I/D and Forti-flora. Told owners probably should to further work-up . Heard from them in Feb..2013 same comlaint. At this time I told owners i didn't what I was treating and so we did CBC/CHEM. Which was normal. Felv/FIv neg. finally was able to do a GI PAnel and fromreading different threads i don't know if I know how to interpret the results and if they are valid. the cobalomine was normal I thought this should at least have been abnormal..and the folate was also normal. PLI fasting waselevated at 18 ( 0.1 to3.5)\ TLI fasting was 125.7 (12-82) I don't believe this gives me a whole lot of anythingto go on. At least I got a normal cobalomine (if was low I know how to treat that). Essentially the diet, and metronidazole. did't help. Thinking about z/d . I guess my question is when to do these Panels and the problem of inteeroretation.? Should I continue doing them on GI cases or just do Things I did before these tests were available( dinosaur ) ☼

Any known vomiting?

Next questions are these the current labs, or the pretreatment (july) labs?

Yet another cat with diarrhea. Mom is 11yr.old fs indoor cat. She lives with 9 other cats all of which are indoors. in November,2012 she was brought in because of episodes where she passes gas and runs to the litter and watery stool caomes. out. Her appetite at that time was normal and so was water intake activity etc. We treated her with metronodazole 25 mgs. sid for 14 dyas. Minimal improvement. Owners did refill the meds once. Didn't see her agian until 1/2013 still has diarrhea. Alos suffering from FBA. Treated the allergy with Steroids...told owner to monitor stool as this may help. Also discuused dietary intervention with Hills I/D and Forti-flora. Told owners probably should to further work-up . Heard from them in Feb..2013 same comlaint. At this time I told owners i didn't what I was treating and so we did CBC/CHEM. Which was normal. Felv/FIv neg. finally was able to do a GI PAnel and fromreading different threads i don't know if I know how to interpret the results and if they are valid. the cobalomine was normal I thought this should at least have been abnormal..and the folate was also normal. PLI fasting waselevated at 18 ( 0.1 to3.5)\ TLI fasting was 125.7 (12-82) I don't believe this gives me a whole lot of anythingto go on. At least I got a normal cobalomine (if was low I know how to treat that). Essentially the diet, and metronidazole. did't help. Thinking about z/d . I guess my question is when to do these Panels and the problem of inteeroretation.? Should I continue doing them on GI cases or just do Things I did before these tests were available( dinosaur ) ☼

Did the steroid for the allergy (which one and how much?) help with the diarrhea?

Does the dog normally get the food/insulin at 9 am when she's home?

Yet another cat with diarrhea. Mom is 11yr.old fs indoor cat. She lives with 9 other cats all of which are indoors. in November,2012 she was brought in because of episodes where she passes gas and runs to the litter and watery stool caomes. out. Her appetite at that time was normal and so was water intake activity etc. We treated her with metronodazole 25 mgs. sid for 14 dyas. Minimal improvement. Owners did refill the meds once. Didn't see her agian until 1/2013 still has diarrhea. Alos suffering from FBA. Treated the allergy with Steroids...told owner to monitor stool as this may help. Also discuused dietary intervention with Hills I/D and Forti-flora. Told owners probably should to further work-up . Heard from them in Feb..2013 same comlaint. At this time I told owners i didn't what I was treating and so we did CBC/CHEM. Which was normal. Felv/FIv neg. finally was able to do a GI PAnel and fromreading different threads i don't know if I know how to interpret the results and if they are valid. the cobalomine was normal I thought this should at least have been abnormal..and the folate was also normal. PLI fasting waselevated at 18 ( 0.1 to3.5)\ TLI fasting was 125.7 (12-82) I don't believe this gives me a whole lot of anythingto go on. At least I got a normal cobalomine (if was low I know how to treat that). Essentially the diet, and metronidazole. did't help. Thinking about z/d . I guess my question is when to do these Panels and the problem of inteeroretation.? Should I continue doing them on GI cases or just do Things I did before these tests were available( dinosaur ) ☼

Has she been losing weight?

How old is the current bottle of insulin?

Yet another cat with diarrhea. Mom is 11yr.old fs indoor cat. She lives with 9 other cats all of which are indoors. in November,2012 she was brought in because of episodes where she passes gas and runs to the litter and watery stool caomes. out. Her appetite at that time was normal and so was water intake activity etc. We treated her with metronodazole 25 mgs. sid for 14 dyas. Minimal improvement. Owners did refill the meds once. Didn't see her agian until 1/2013 still has diarrhea. Alos suffering from FBA. Treated the allergy with Steroids...told owner to monitor stool as this may help. Also discuused dietary intervention with Hills I/D and Forti-flora. Told owners probably should to further work-up . Heard from them in Feb..2013 same comlaint. At this time I told owners i didn't what I was treating and so we did CBC/CHEM. Which was normal. Felv/FIv neg. finally was able to do a GI PAnel and fromreading different threads i don't know if I know how to interpret the results and if they are valid. the cobalomine was normal I thought this should at least have been abnormal..and the folate was also normal. PLI fasting waselevated at 18 ( 0.1 to3.5)\ TLI fasting was 125.7 (12-82) I don't believe this gives me a whole lot of anythingto go on. At least I got a normal cobalomine (if was low I know how to treat that). Essentially the diet, and metronidazole. did't help. Thinking about z/d . I guess my question is when to do these Panels and the problem of inteeroretation.? Should I continue doing them on GI cases or just do Things I did before these tests were available( dinosaur ) ☼

What were the actual b12 and folate levels?

Is this kitty eating well/normally?

Yet another cat with diarrhea. Mom is 11yr.old fs indoor cat. She lives with 9 other cats all of which are indoors. in November,2012 she was brought in because of episodes where she passes gas and runs to the litter and watery stool caomes. out. Her appetite at that time was normal and so was water intake activity etc. We treated her with metronodazole 25 mgs. sid for 14 dyas. Minimal improvement. Owners did refill the meds once. Didn't see her agian until 1/2013 still has diarrhea. Alos suffering from FBA. Treated the allergy with Steroids...told owner to monitor stool as this may help. Also discuused dietary intervention with Hills I/D and Forti-flora. Told owners probably should to further work-up . Heard from them in Feb..2013 same comlaint. At this time I told owners i didn't what I was treating and so we did CBC/CHEM. Which was normal. Felv/FIv neg. finally was able to do a GI PAnel and fromreading different threads i don't know if I know how to interpret the results and if they are valid. the cobalomine was normal I thought this should at least have been abnormal..and the folate was also normal. PLI fasting waselevated at 18 ( 0.1 to3.5)\ TLI fasting was 125.7 (12-82) I don't believe this gives me a whole lot of anythingto go on. At least I got a normal cobalomine (if was low I know how to treat that). Essentially the diet, and metronidazole. did't help. Thinking about z/d . I guess my question is when to do these Panels and the problem of inteeroretation.? Should I continue doing them on GI cases or just do Things I did before these tests were available( dinosaur ) ☼

How is the cat's current bcs?

Are you sure it is pu/pd and not incontinence issues?

Hi, My neighbor just came over and told me that she found her dog dead in their backyard. The dog is a 5 yr old intact female english mastiff. According to the owner she was bred 2 weeks ago but they did not know if she was pregnant. The owner said that the dog has been acting fine except for they noticed increased water consumption and a few accidents in the house about a week and a half ago. She also noted that the dog started smelling funny about 3 or 4 days ago. She called her vet and they recommended she be seen so she made an appointment for tomorrow. The owner told me she would have taken the dog sooner but she felt like the dog was acting normal otherwise so she wasn't really concerned. She assumed the increase water consumption was normal if the dog was pregnant. According to the owner there is no prior medical history. I asked her about vaginal discharge but she said they hadn't noticed any. The recent history of pu/pd and "smelling funny" makes me think of pyometra but could that cause sudden death if she did not have other signs (i.e. lethargy, inappetance, etc)? Is there anything to do with early pregnancy that can cause sudden death in a dog? I'm sorry I don't have any other information (other than what the owner told me) and am just looking for ideas. I would appreciate any input!

What did the necropsy show?

Any muscle wasting?

I have Fanci, an 8 y.o. S/F Fox Terrier. Has had increase liver enzymes on and off for the last few years - two US showed a liver that did not appear as steroid hepatopathy but there are a few lesions on the liver that have not yet been biopsied. She has responded to hepatosupport over the last few years and a few times her liver enzymes were actually normal. This week she came in PU/PD and her ALP is now over 3000, and ALT 1395 and GGT 33. Repeat US yesterday showed the same lesions as before with no change and other than an enlarged liver, not very exciting. Adrenals were NOT enlarged. I did have to sedate a bit with some IV torb for the US. She was also scheduled for a LDDST on the same day - so US with sedation and LDDST were done yesterday. She is now also diabetic, with a glucose of nearly 500. Started Humulin N this week, 3 units BID. OK so: Diabetic with a relatively unremarkable US (liver not biopsied yet, we are gonna do that next week) that has been repeatable. LDDST results as follows: Pre-sample: 7.5 (range 1-6) 4 hr post dex inj: 3.5 (less than 1.5) 8 hr post dex inj: 4.9 (less than 1.5) My concerns are: 1.) Should I repeat this LDDST instead of how I did it, i.e on the same day as a sedated US? 2.) To me this looks like real Cushing's based on liver changes, but the lack of enlargement of the adrenal glands is throwing me off. 3.) I hate trying to manage diabetics that are also cushinoid. ) Help! :) BTW, Fanci is relatively BAR, not DKA, but rather just "off" a bit. Owners will do just about anything I recommend, so trying to make good decisions here.

Do you have any physical exam findings that would suggest to you that the dog could have cushing's or is this strictly based on the increased liver enzymes and now pu/pd?

Any bleeding?

I have Fanci, an 8 y.o. S/F Fox Terrier. Has had increase liver enzymes on and off for the last few years - two US showed a liver that did not appear as steroid hepatopathy but there are a few lesions on the liver that have not yet been biopsied. She has responded to hepatosupport over the last few years and a few times her liver enzymes were actually normal. This week she came in PU/PD and her ALP is now over 3000, and ALT 1395 and GGT 33. Repeat US yesterday showed the same lesions as before with no change and other than an enlarged liver, not very exciting. Adrenals were NOT enlarged. I did have to sedate a bit with some IV torb for the US. She was also scheduled for a LDDST on the same day - so US with sedation and LDDST were done yesterday. She is now also diabetic, with a glucose of nearly 500. Started Humulin N this week, 3 units BID. OK so: Diabetic with a relatively unremarkable US (liver not biopsied yet, we are gonna do that next week) that has been repeatable. LDDST results as follows: Pre-sample: 7.5 (range 1-6) 4 hr post dex inj: 3.5 (less than 1.5) 8 hr post dex inj: 4.9 (less than 1.5) My concerns are: 1.) Should I repeat this LDDST instead of how I did it, i.e on the same day as a sedated US? 2.) To me this looks like real Cushing's based on liver changes, but the lack of enlargement of the adrenal glands is throwing me off. 3.) I hate trying to manage diabetics that are also cushinoid. ) Help! :) BTW, Fanci is relatively BAR, not DKA, but rather just "off" a bit. Owners will do just about anything I recommend, so trying to make good decisions here.

Was the liver hyperechoic?

Have we done a glucose curve on the cat in between uti/hypoglycemia episodes to ascertain whether or not the cat needs a lower dose all the time?

I have Fanci, an 8 y.o. S/F Fox Terrier. Has had increase liver enzymes on and off for the last few years - two US showed a liver that did not appear as steroid hepatopathy but there are a few lesions on the liver that have not yet been biopsied. She has responded to hepatosupport over the last few years and a few times her liver enzymes were actually normal. This week she came in PU/PD and her ALP is now over 3000, and ALT 1395 and GGT 33. Repeat US yesterday showed the same lesions as before with no change and other than an enlarged liver, not very exciting. Adrenals were NOT enlarged. I did have to sedate a bit with some IV torb for the US. She was also scheduled for a LDDST on the same day - so US with sedation and LDDST were done yesterday. She is now also diabetic, with a glucose of nearly 500. Started Humulin N this week, 3 units BID. OK so: Diabetic with a relatively unremarkable US (liver not biopsied yet, we are gonna do that next week) that has been repeatable. LDDST results as follows: Pre-sample: 7.5 (range 1-6) 4 hr post dex inj: 3.5 (less than 1.5) 8 hr post dex inj: 4.9 (less than 1.5) My concerns are: 1.) Should I repeat this LDDST instead of how I did it, i.e on the same day as a sedated US? 2.) To me this looks like real Cushing's based on liver changes, but the lack of enlargement of the adrenal glands is throwing me off. 3.) I hate trying to manage diabetics that are also cushinoid. ) Help! :) BTW, Fanci is relatively BAR, not DKA, but rather just "off" a bit. Owners will do just about anything I recommend, so trying to make good decisions here.

I assume these are focal lesions?

Owner unhappy with control?

Hello VIN, I have a trainwreck kitty I could use some help with. Bubba is 13 yrs, 13 lbs, M/N Siamese, indoor outdoor. He became sick, anorexic a week ago, owner brought him in 3 days into his bout of lethargy and anorexia. he is a hunter, and currently his asthma is controlled with a flovent inhaler, 2 puffs daily, with Albuterol as needed in rescue situations. He presented lethargis,1 lb wt loss in a 2 month time. His labs revealed an ALT of 642 (22-109), AST 308 (12-65), BG 308 (63-139), AlK Phos (16-71) t bili .3 (0-.2). His CBC revealed a severe leukopenia WBC 3.82 with a NE of 2.9. His red blood count was 9.09, and HCT 43.5 initially started him on 1 unit of lantis BID, 50 mg, metronidazole 50 mg BID and Baytril 30 mg SID, and initial fluids were plasmalyte 25/ hr, and he had 3 doses of sq vitamin K before undergoing anesthesia 3/27 for FNA of his liver and a feeding tube. We had to use the albuterol several times post anesthesia, and maintain him in oxygen for quite a while post anesthesia. He was ultrasounded and radiographed prior to anesthesia, and so far his imaging has been unremarkable as far as his abdoman, but pulmonary atelectasis from his asthma. HCO3 is elevated 32.8 (16-20), PCo2 43.1 (28-34), Ph 7.4 , base excess 9. His ALT today is improved at 332, and his AST is 61, BG this am 331, so I think his electrolyte abnormalities are doing him in. I am switching him to NACL, how much KCl should I add to his fluids? Thanks, ☼

Is his body weight changing?

Do you know why they are leaving you alone?

Hello VIN, I have a trainwreck kitty I could use some help with. Bubba is 13 yrs, 13 lbs, M/N Siamese, indoor outdoor. He became sick, anorexic a week ago, owner brought him in 3 days into his bout of lethargy and anorexia. he is a hunter, and currently his asthma is controlled with a flovent inhaler, 2 puffs daily, with Albuterol as needed in rescue situations. He presented lethargis,1 lb wt loss in a 2 month time. His labs revealed an ALT of 642 (22-109), AST 308 (12-65), BG 308 (63-139), AlK Phos (16-71) t bili .3 (0-.2). His CBC revealed a severe leukopenia WBC 3.82 with a NE of 2.9. His red blood count was 9.09, and HCT 43.5 initially started him on 1 unit of lantis BID, 50 mg, metronidazole 50 mg BID and Baytril 30 mg SID, and initial fluids were plasmalyte 25/ hr, and he had 3 doses of sq vitamin K before undergoing anesthesia 3/27 for FNA of his liver and a feeding tube. We had to use the albuterol several times post anesthesia, and maintain him in oxygen for quite a while post anesthesia. He was ultrasounded and radiographed prior to anesthesia, and so far his imaging has been unremarkable as far as his abdoman, but pulmonary atelectasis from his asthma. HCO3 is elevated 32.8 (16-20), PCo2 43.1 (28-34), Ph 7.4 , base excess 9. His ALT today is improved at 332, and his AST is 61, BG this am 331, so I think his electrolyte abnormalities are doing him in. I am switching him to NACL, how much KCl should I add to his fluids? Thanks, ☼

Have you started feeding him yet?

If she is spayed she might not remain a diabetic - was she in heat when she was diagnosed?

I'm tting a cat with hypercalcemia that we have not been able to determine the cause of. "Cha Chi" is a 16 year old MN DSH that has a history of chronic renal failure and constipation/poor colon motility. He has also been losing weight and his appetite has not been the best. Serial blood results are below. Throacic x-rays and abdominal ultrasound were declined so we started Fosamax, 10 mg, once weekly. It has been about 2 months since starting the Fosamax and the calcium levels are even futher elevated, however clinically Cha Chi is improved in his appetite and attitude. Any recommendations on how to proceed? Other current meds include Cisapride 7 mg twice daily, Aluminum hydroxide 128 mg once daily, Benefiber 1/2 tsp twice daily, Miralax 1/2 tsp twice daily, Mirtazapine 3.75 mg every 3 days, and Welactin supplement. 6/28/12 BUN 34 (15 - 34 mg/dL) CREATININE 2.7 (0.8 - 2.3 mg/dL) HIGH CHOLESTEROL 353 (82 - 218 mg/dL) HIGH CALCIUM 13.5 (8.2 - 11.8 mg/dL) HIGH PHOSPHORUS 4.3 (3.0 - 7.0 mg/dL) 7/9/12 IONIZED CALCIUM 1.44 (1.03 - 1.39 mmol/L) 12/27/12 ALK. PHOSPHATASE 13 (0 - 62 U/L) ALT (SGPT) 123 (28 - 100 U/L) HIGH AST (SGOT) 33 (5 - 55 U/L) ALBUMIN 3.4 (2.3 - 3.9 g/dL) TOTAL PROTEIN 7.6 (5.9 - 8.5 g/dL) GLOBULIN 4.2 (3.0 - 5.6 g/dL) BUN 47 (15 - 34 mg/dL) HIGH CREATININE 3.6 (0.8 - 2.3 mg/dL) HIGH CHOLESTEROL 336 (82 - 218 mg/dL) HIGH CALCIUM (1) 13.2 (8.2 - 11.8 mg/dL) HIGH PHOSPHORUS 5.0 (3.0 - 7.0 mg/dL) WBC 11.7 (4.2 - 15.6 K/uL) HCT 45.9 (29 - 45 %) HIGH ABSOLUTE NEUTROPHIL SEG 9454 (2500 - 12500 /uL) ABSOLUTE LYMPHOCYTE 1357 (1500 - 7000 /uL) LOW (remainder of CBC/Chem/T4 WNL) 12/31/12 PTH 0.1 (0.3 - 4.5 pmol/L) LOW IONIZED CALCIUM 1.44 (1.03 - 1.39 mmol/L) HIGH PARATHYROID RELATED PROTEIN 0.0 pmol/L 1/3/2013 IONIZED CALCIUM 1.32 (1.03 - 1.39 mmol/L) 3/26/2013 IONIZED CALCIUM1.56 (1.03 - 1.39 mmol/L)

Do you have a urinalysis and urine culture on this patient?

Did she have an ultrasound during the dka episode?

I'm tting a cat with hypercalcemia that we have not been able to determine the cause of. "Cha Chi" is a 16 year old MN DSH that has a history of chronic renal failure and constipation/poor colon motility. He has also been losing weight and his appetite has not been the best. Serial blood results are below. Throacic x-rays and abdominal ultrasound were declined so we started Fosamax, 10 mg, once weekly. It has been about 2 months since starting the Fosamax and the calcium levels are even futher elevated, however clinically Cha Chi is improved in his appetite and attitude. Any recommendations on how to proceed? Other current meds include Cisapride 7 mg twice daily, Aluminum hydroxide 128 mg once daily, Benefiber 1/2 tsp twice daily, Miralax 1/2 tsp twice daily, Mirtazapine 3.75 mg every 3 days, and Welactin supplement. 6/28/12 BUN 34 (15 - 34 mg/dL) CREATININE 2.7 (0.8 - 2.3 mg/dL) HIGH CHOLESTEROL 353 (82 - 218 mg/dL) HIGH CALCIUM 13.5 (8.2 - 11.8 mg/dL) HIGH PHOSPHORUS 4.3 (3.0 - 7.0 mg/dL) 7/9/12 IONIZED CALCIUM 1.44 (1.03 - 1.39 mmol/L) 12/27/12 ALK. PHOSPHATASE 13 (0 - 62 U/L) ALT (SGPT) 123 (28 - 100 U/L) HIGH AST (SGOT) 33 (5 - 55 U/L) ALBUMIN 3.4 (2.3 - 3.9 g/dL) TOTAL PROTEIN 7.6 (5.9 - 8.5 g/dL) GLOBULIN 4.2 (3.0 - 5.6 g/dL) BUN 47 (15 - 34 mg/dL) HIGH CREATININE 3.6 (0.8 - 2.3 mg/dL) HIGH CHOLESTEROL 336 (82 - 218 mg/dL) HIGH CALCIUM (1) 13.2 (8.2 - 11.8 mg/dL) HIGH PHOSPHORUS 5.0 (3.0 - 7.0 mg/dL) WBC 11.7 (4.2 - 15.6 K/uL) HCT 45.9 (29 - 45 %) HIGH ABSOLUTE NEUTROPHIL SEG 9454 (2500 - 12500 /uL) ABSOLUTE LYMPHOCYTE 1357 (1500 - 7000 /uL) LOW (remainder of CBC/Chem/T4 WNL) 12/31/12 PTH 0.1 (0.3 - 4.5 pmol/L) LOW IONIZED CALCIUM 1.44 (1.03 - 1.39 mmol/L) HIGH PARATHYROID RELATED PROTEIN 0.0 pmol/L 1/3/2013 IONIZED CALCIUM 1.32 (1.03 - 1.39 mmol/L) 3/26/2013 IONIZED CALCIUM1.56 (1.03 - 1.39 mmol/L)

Is the t4 appropriately low?

What other findings on voided u/a?

I'm tting a cat with hypercalcemia that we have not been able to determine the cause of. "Cha Chi" is a 16 year old MN DSH that has a history of chronic renal failure and constipation/poor colon motility. He has also been losing weight and his appetite has not been the best. Serial blood results are below. Throacic x-rays and abdominal ultrasound were declined so we started Fosamax, 10 mg, once weekly. It has been about 2 months since starting the Fosamax and the calcium levels are even futher elevated, however clinically Cha Chi is improved in his appetite and attitude. Any recommendations on how to proceed? Other current meds include Cisapride 7 mg twice daily, Aluminum hydroxide 128 mg once daily, Benefiber 1/2 tsp twice daily, Miralax 1/2 tsp twice daily, Mirtazapine 3.75 mg every 3 days, and Welactin supplement. 6/28/12 BUN 34 (15 - 34 mg/dL) CREATININE 2.7 (0.8 - 2.3 mg/dL) HIGH CHOLESTEROL 353 (82 - 218 mg/dL) HIGH CALCIUM 13.5 (8.2 - 11.8 mg/dL) HIGH PHOSPHORUS 4.3 (3.0 - 7.0 mg/dL) 7/9/12 IONIZED CALCIUM 1.44 (1.03 - 1.39 mmol/L) 12/27/12 ALK. PHOSPHATASE 13 (0 - 62 U/L) ALT (SGPT) 123 (28 - 100 U/L) HIGH AST (SGOT) 33 (5 - 55 U/L) ALBUMIN 3.4 (2.3 - 3.9 g/dL) TOTAL PROTEIN 7.6 (5.9 - 8.5 g/dL) GLOBULIN 4.2 (3.0 - 5.6 g/dL) BUN 47 (15 - 34 mg/dL) HIGH CREATININE 3.6 (0.8 - 2.3 mg/dL) HIGH CHOLESTEROL 336 (82 - 218 mg/dL) HIGH CALCIUM (1) 13.2 (8.2 - 11.8 mg/dL) HIGH PHOSPHORUS 5.0 (3.0 - 7.0 mg/dL) WBC 11.7 (4.2 - 15.6 K/uL) HCT 45.9 (29 - 45 %) HIGH ABSOLUTE NEUTROPHIL SEG 9454 (2500 - 12500 /uL) ABSOLUTE LYMPHOCYTE 1357 (1500 - 7000 /uL) LOW (remainder of CBC/Chem/T4 WNL) 12/31/12 PTH 0.1 (0.3 - 4.5 pmol/L) LOW IONIZED CALCIUM 1.44 (1.03 - 1.39 mmol/L) HIGH PARATHYROID RELATED PROTEIN 0.0 pmol/L 1/3/2013 IONIZED CALCIUM 1.32 (1.03 - 1.39 mmol/L) 3/26/2013 IONIZED CALCIUM1.56 (1.03 - 1.39 mmol/L)

Normotensive?

Does the owner go outside with the dog at night to verify outdoor elimination?

I'm tting a cat with hypercalcemia that we have not been able to determine the cause of. "Cha Chi" is a 16 year old MN DSH that has a history of chronic renal failure and constipation/poor colon motility. He has also been losing weight and his appetite has not been the best. Serial blood results are below. Throacic x-rays and abdominal ultrasound were declined so we started Fosamax, 10 mg, once weekly. It has been about 2 months since starting the Fosamax and the calcium levels are even futher elevated, however clinically Cha Chi is improved in his appetite and attitude. Any recommendations on how to proceed? Other current meds include Cisapride 7 mg twice daily, Aluminum hydroxide 128 mg once daily, Benefiber 1/2 tsp twice daily, Miralax 1/2 tsp twice daily, Mirtazapine 3.75 mg every 3 days, and Welactin supplement. 6/28/12 BUN 34 (15 - 34 mg/dL) CREATININE 2.7 (0.8 - 2.3 mg/dL) HIGH CHOLESTEROL 353 (82 - 218 mg/dL) HIGH CALCIUM 13.5 (8.2 - 11.8 mg/dL) HIGH PHOSPHORUS 4.3 (3.0 - 7.0 mg/dL) 7/9/12 IONIZED CALCIUM 1.44 (1.03 - 1.39 mmol/L) 12/27/12 ALK. PHOSPHATASE 13 (0 - 62 U/L) ALT (SGPT) 123 (28 - 100 U/L) HIGH AST (SGOT) 33 (5 - 55 U/L) ALBUMIN 3.4 (2.3 - 3.9 g/dL) TOTAL PROTEIN 7.6 (5.9 - 8.5 g/dL) GLOBULIN 4.2 (3.0 - 5.6 g/dL) BUN 47 (15 - 34 mg/dL) HIGH CREATININE 3.6 (0.8 - 2.3 mg/dL) HIGH CHOLESTEROL 336 (82 - 218 mg/dL) HIGH CALCIUM (1) 13.2 (8.2 - 11.8 mg/dL) HIGH PHOSPHORUS 5.0 (3.0 - 7.0 mg/dL) WBC 11.7 (4.2 - 15.6 K/uL) HCT 45.9 (29 - 45 %) HIGH ABSOLUTE NEUTROPHIL SEG 9454 (2500 - 12500 /uL) ABSOLUTE LYMPHOCYTE 1357 (1500 - 7000 /uL) LOW (remainder of CBC/Chem/T4 WNL) 12/31/12 PTH 0.1 (0.3 - 4.5 pmol/L) LOW IONIZED CALCIUM 1.44 (1.03 - 1.39 mmol/L) HIGH PARATHYROID RELATED PROTEIN 0.0 pmol/L 1/3/2013 IONIZED CALCIUM 1.32 (1.03 - 1.39 mmol/L) 3/26/2013 IONIZED CALCIUM1.56 (1.03 - 1.39 mmol/L)

Any chance for a cobalamin/folate in this kitty (send directly to tamu, which is less expensive than through the reference labs)?

Dm?

I have a 14 yr old 67 pound mixed breed dog who was diagnosed with diabetes in February of this year. He has always been an anxious dog but has recently developed signs of seperation anxiety. He doesn't tear things up in the house or hurt himself. But he cries continuously when dad leaves for work everyday (and mom works from home). He is restless inspite of anything mom does to consol him until dad comes home. When dad is home, he cries when dad moves from room to room. His diabetes seems to be well controlled with 7 units of NPH Humulin insulin. He also has had a history of elevated liver enzymes after recieving Rimadyl due to arthritis issues. He no longer recieves the Rimadyl and is recieveing Denamarin. His last labwork was ALT 164 (5-110) and ALP 667 (9-140). All other labwork WNL. I am unsure what to do about his separation issues. Dad is afraid of starting behavioral medicines as he believes they may change the dog's personality. I know most drugs affect diabetes regulation and liver enzymes. What are my options? ☼

Does the dog have cushings too that needs to be managed?

Has it been checked for accuracy?

"Colby" is a 14 y/o,NM,14.5lb Ragdoll who was diagnosed with DM in February (BG was 538). His BP was normal, CBC and rest of chem panel normal, UA unremarkable other than glucosuria, and a urine culture was negative. We started Glargine at 2 U bid and began a transition from dry food to canned (fancy feast). We did first recheck at 1 week, and his pu/pd had improved only slightly and BG was still 511, so we increased his Glargine to 3 U bid. I have been working on getting the owner proficient in using a human glucometer (I don't remember the brand off hand), which seems to read roughly 100 LOWER than my AlphaTrac. She is still having some trouble getting her samples, so her first attempt at a curve is not very complete. Gave 3 U at 8:55 BG as follows: 10:30 282 12:00 343 2:00 301 5:20 271 (her unit seems to run about 100 low) Colby has been on 3U bid for roughly 4 weeks now. He has gained about 1/4 lb. He is still somewhat pu/pd, but otherwise owner feels he is doing great. I feel like he needs more insulin, but I'm hesitant because 1) I don't know how accurate her meter is and 2) I don't have enough of a curve to find his nadir (and frankly, I really don't know if she'll be able to get a FULL curve done). I have only recently started trying to teach owners to do BG at home, and in the past have used in-house curves, fructosamine levels, and weight/clinical signs to guide my decisions. What do you suggest as next step? Thanks so much. ☼

Is the owner doing this?

Does she exhibit other historical findings of cognitive dysfunction (pacing, changes in interactions with family members, loss of house training, etc.) and the barking at night is one more symptom of this disease?

Kane is a 10 year old MN pit bull He has been a well controlled diabetic for the past 5 years. Over the past 2 weeks his appetite has slowly been declining. The owner would vary his diet and his appetite would improve, but it has slowly declined to just eating chicken. Abnormal lab values: BUN 33 Creat 3.3 USG 1.021 Urine culture positive for E.coli and proteus mirabilus Abdominal ultrasound bright corticomedularry junction potentially indicative of renal failure Lepto Titer pos 1:100 l.gryppo (vaccinated 1 year ago) He has been on oral antibiotics, sq fluids, Pepcid As he was becoming more lethargic and inappetant he was placed on IV antibiotics and fluids Does this sound like a pyelonephritis case? Is it typical to have this level of inappetance with this lab work? Any other thoughts welcome

Are you able to post the full cbc, chem, ua and culture for kane, including normals and reference ranges and the date the bloodwork is from?

Ps: could you complete the 5 minute diabetes treatment survey?

Kane is a 10 year old MN pit bull He has been a well controlled diabetic for the past 5 years. Over the past 2 weeks his appetite has slowly been declining. The owner would vary his diet and his appetite would improve, but it has slowly declined to just eating chicken. Abnormal lab values: BUN 33 Creat 3.3 USG 1.021 Urine culture positive for E.coli and proteus mirabilus Abdominal ultrasound bright corticomedularry junction potentially indicative of renal failure Lepto Titer pos 1:100 l.gryppo (vaccinated 1 year ago) He has been on oral antibiotics, sq fluids, Pepcid As he was becoming more lethargic and inappetant he was placed on IV antibiotics and fluids Does this sound like a pyelonephritis case? Is it typical to have this level of inappetance with this lab work? Any other thoughts welcome

;) has he just had this one set of bloodwork done since his initial presentation for inappetance?

Also, do the 'accidents' in the house consist of full urination, or just incontinence, with small urine spots?

Kane is a 10 year old MN pit bull He has been a well controlled diabetic for the past 5 years. Over the past 2 weeks his appetite has slowly been declining. The owner would vary his diet and his appetite would improve, but it has slowly declined to just eating chicken. Abnormal lab values: BUN 33 Creat 3.3 USG 1.021 Urine culture positive for E.coli and proteus mirabilus Abdominal ultrasound bright corticomedularry junction potentially indicative of renal failure Lepto Titer pos 1:100 l.gryppo (vaccinated 1 year ago) He has been on oral antibiotics, sq fluids, Pepcid As he was becoming more lethargic and inappetant he was placed on IV antibiotics and fluids Does this sound like a pyelonephritis case? Is it typical to have this level of inappetance with this lab work? Any other thoughts welcome

Is he serum and ketone negative?

Did you run a hw antigen test?

Kane is a 10 year old MN pit bull He has been a well controlled diabetic for the past 5 years. Over the past 2 weeks his appetite has slowly been declining. The owner would vary his diet and his appetite would improve, but it has slowly declined to just eating chicken. Abnormal lab values: BUN 33 Creat 3.3 USG 1.021 Urine culture positive for E.coli and proteus mirabilus Abdominal ultrasound bright corticomedularry junction potentially indicative of renal failure Lepto Titer pos 1:100 l.gryppo (vaccinated 1 year ago) He has been on oral antibiotics, sq fluids, Pepcid As he was becoming more lethargic and inappetant he was placed on IV antibiotics and fluids Does this sound like a pyelonephritis case? Is it typical to have this level of inappetance with this lab work? Any other thoughts welcome

How did the recent abnormal bloodwork compare to kane's historial values - has he ever had documented azotemia before?

Is this value correct?

Kane is a 10 year old MN pit bull He has been a well controlled diabetic for the past 5 years. Over the past 2 weeks his appetite has slowly been declining. The owner would vary his diet and his appetite would improve, but it has slowly declined to just eating chicken. Abnormal lab values: BUN 33 Creat 3.3 USG 1.021 Urine culture positive for E.coli and proteus mirabilus Abdominal ultrasound bright corticomedularry junction potentially indicative of renal failure Lepto Titer pos 1:100 l.gryppo (vaccinated 1 year ago) He has been on oral antibiotics, sq fluids, Pepcid As he was becoming more lethargic and inappetant he was placed on IV antibiotics and fluids Does this sound like a pyelonephritis case? Is it typical to have this level of inappetance with this lab work? Any other thoughts welcome

Any prior history of utis, or is this the first one?

Posted in message boards 1.0p/p/in reading more about ketones...i see (and i think i used to know) that the ketones are more an indication of something else going on in the body...?

Kane is a 10 year old MN pit bull He has been a well controlled diabetic for the past 5 years. Over the past 2 weeks his appetite has slowly been declining. The owner would vary his diet and his appetite would improve, but it has slowly declined to just eating chicken. Abnormal lab values: BUN 33 Creat 3.3 USG 1.021 Urine culture positive for E.coli and proteus mirabilus Abdominal ultrasound bright corticomedularry junction potentially indicative of renal failure Lepto Titer pos 1:100 l.gryppo (vaccinated 1 year ago) He has been on oral antibiotics, sq fluids, Pepcid As he was becoming more lethargic and inappetant he was placed on IV antibiotics and fluids Does this sound like a pyelonephritis case? Is it typical to have this level of inappetance with this lab work? Any other thoughts welcome

Do we have a recent fructosamine or bg curve from when he was feeling better to assess how tightly he has been controlled?

Hmm - any scar present?

Kane is a 10 year old MN pit bull He has been a well controlled diabetic for the past 5 years. Over the past 2 weeks his appetite has slowly been declining. The owner would vary his diet and his appetite would improve, but it has slowly declined to just eating chicken. Abnormal lab values: BUN 33 Creat 3.3 USG 1.021 Urine culture positive for E.coli and proteus mirabilus Abdominal ultrasound bright corticomedularry junction potentially indicative of renal failure Lepto Titer pos 1:100 l.gryppo (vaccinated 1 year ago) He has been on oral antibiotics, sq fluids, Pepcid As he was becoming more lethargic and inappetant he was placed on IV antibiotics and fluids Does this sound like a pyelonephritis case? Is it typical to have this level of inappetance with this lab work? Any other thoughts welcome

Any evidence of leukocytosis, left shift, toxic change or fever?

How many calories/meal does she currently get?

Kane is a 10 year old MN pit bull He has been a well controlled diabetic for the past 5 years. Over the past 2 weeks his appetite has slowly been declining. The owner would vary his diet and his appetite would improve, but it has slowly declined to just eating chicken. Abnormal lab values: BUN 33 Creat 3.3 USG 1.021 Urine culture positive for E.coli and proteus mirabilus Abdominal ultrasound bright corticomedularry junction potentially indicative of renal failure Lepto Titer pos 1:100 l.gryppo (vaccinated 1 year ago) He has been on oral antibiotics, sq fluids, Pepcid As he was becoming more lethargic and inappetant he was placed on IV antibiotics and fluids Does this sound like a pyelonephritis case? Is it typical to have this level of inappetance with this lab work? Any other thoughts welcome

What oral and then iv antibiotic were given for the e coli and proteus, and when were they started?

What do you think of these rads?

Kane is a 10 year old MN pit bull He has been a well controlled diabetic for the past 5 years. Over the past 2 weeks his appetite has slowly been declining. The owner would vary his diet and his appetite would improve, but it has slowly declined to just eating chicken. Abnormal lab values: BUN 33 Creat 3.3 USG 1.021 Urine culture positive for E.coli and proteus mirabilus Abdominal ultrasound bright corticomedularry junction potentially indicative of renal failure Lepto Titer pos 1:100 l.gryppo (vaccinated 1 year ago) He has been on oral antibiotics, sq fluids, Pepcid As he was becoming more lethargic and inappetant he was placed on IV antibiotics and fluids Does this sound like a pyelonephritis case? Is it typical to have this level of inappetance with this lab work? Any other thoughts welcome

Were the owners able to consistently get it into him given the decreased appetite prior to when he was hospitalized?

How much kcl/l are you putting in the fluids?

Kane is a 10 year old MN pit bull He has been a well controlled diabetic for the past 5 years. Over the past 2 weeks his appetite has slowly been declining. The owner would vary his diet and his appetite would improve, but it has slowly declined to just eating chicken. Abnormal lab values: BUN 33 Creat 3.3 USG 1.021 Urine culture positive for E.coli and proteus mirabilus Abdominal ultrasound bright corticomedularry junction potentially indicative of renal failure Lepto Titer pos 1:100 l.gryppo (vaccinated 1 year ago) He has been on oral antibiotics, sq fluids, Pepcid As he was becoming more lethargic and inappetant he was placed on IV antibiotics and fluids Does this sound like a pyelonephritis case? Is it typical to have this level of inappetance with this lab work? Any other thoughts welcome

How did the pancreas look on ultrasound?

Could you post the results in full please?

Kane is a 10 year old MN pit bull He has been a well controlled diabetic for the past 5 years. Over the past 2 weeks his appetite has slowly been declining. The owner would vary his diet and his appetite would improve, but it has slowly declined to just eating chicken. Abnormal lab values: BUN 33 Creat 3.3 USG 1.021 Urine culture positive for E.coli and proteus mirabilus Abdominal ultrasound bright corticomedularry junction potentially indicative of renal failure Lepto Titer pos 1:100 l.gryppo (vaccinated 1 year ago) He has been on oral antibiotics, sq fluids, Pepcid As he was becoming more lethargic and inappetant he was placed on IV antibiotics and fluids Does this sound like a pyelonephritis case? Is it typical to have this level of inappetance with this lab work? Any other thoughts welcome

Was there any pelvic dilation suggestive of pyelonephritis noted?

Are there other signs of cushing's?

Kane is a 10 year old MN pit bull He has been a well controlled diabetic for the past 5 years. Over the past 2 weeks his appetite has slowly been declining. The owner would vary his diet and his appetite would improve, but it has slowly declined to just eating chicken. Abnormal lab values: BUN 33 Creat 3.3 USG 1.021 Urine culture positive for E.coli and proteus mirabilus Abdominal ultrasound bright corticomedularry junction potentially indicative of renal failure Lepto Titer pos 1:100 l.gryppo (vaccinated 1 year ago) He has been on oral antibiotics, sq fluids, Pepcid As he was becoming more lethargic and inappetant he was placed on IV antibiotics and fluids Does this sound like a pyelonephritis case? Is it typical to have this level of inappetance with this lab work? Any other thoughts welcome

What are we doing currently for insulin in hospital when he's not eating?

Could the 11:30 be a lab error?

Kane is a 10 year old MN pit bull He has been a well controlled diabetic for the past 5 years. Over the past 2 weeks his appetite has slowly been declining. The owner would vary his diet and his appetite would improve, but it has slowly declined to just eating chicken. Abnormal lab values: BUN 33 Creat 3.3 USG 1.021 Urine culture positive for E.coli and proteus mirabilus Abdominal ultrasound bright corticomedularry junction potentially indicative of renal failure Lepto Titer pos 1:100 l.gryppo (vaccinated 1 year ago) He has been on oral antibiotics, sq fluids, Pepcid As he was becoming more lethargic and inappetant he was placed on IV antibiotics and fluids Does this sound like a pyelonephritis case? Is it typical to have this level of inappetance with this lab work? Any other thoughts welcome

What have the most recent bgs been looking like?

Were there any signs at 2.5u q12hr with respect to dm?

10 yo Fe/S Westie 16 pounds 3/15/13 Initial Glucose 459 Eating w/d canned aleady Started on 2 units NPH BID 3/22/13 0 hr 446 2 hr 373 4 hr 405 6 hr 551 Increase to 3 units BID 3/26/13 1 hr 331 3 hr 354 5 hr 253 7 hr 463 9 hr 364 Increased to 4 units BID 3/29/13 1 hr 260 3 hr 280 5 hr 444 7 hour 349 9 hr 407 Dog does get stressed here in hospital and hates the blood draws. Sample from ear is worse, not able to sample in home environment. It looks like were getting places with the first check and then her stress level rises. I was thinking of going up to 5 units and then maybe have the owner bring her in for the blood draws rather than her staying here in hospital. Should I stay with the 2 hour checks? ☼

Do you happen to know if the dog is being fed any food or treats in-between insulin injections?

What about transdermal methimazole?

Got a 14 yr old S/F Abysinian non-azotemic cat with recurrent hematuria and pyuria and several posative urine cultures (E.Coli) Also has intermittant neutophilias (like 22,000), Urine S/G (like 1.020) Been ultasounded 2X very accomplished ultasonographer/internist with no major serious findings! The cat always seems to respond to antibiotics. Question is: any reason NOT to place cats on a 'chronic low dose', AB similiar to the 1/3 dose, at night, on an empty bladder, as done in dogs? Thanx, br/

Can you provide us with some more information about how these utis have been diagnosed and treated previously?

While i realize we would expect a high iop with glaucoma, could it be possible this patient suffered for a long time from undiagnosed glaucoma (predisposing to retinal detachment), which resulted in decreased iop (i had read this on a vin thread)?

Got a 14 yr old S/F Abysinian non-azotemic cat with recurrent hematuria and pyuria and several posative urine cultures (E.Coli) Also has intermittant neutophilias (like 22,000), Urine S/G (like 1.020) Been ultasounded 2X very accomplished ultasonographer/internist with no major serious findings! The cat always seems to respond to antibiotics. Question is: any reason NOT to place cats on a 'chronic low dose', AB similiar to the 1/3 dose, at night, on an empty bladder, as done in dogs? Thanx, br/

(timeline of documented infections, what antibiotics have been used, duration of treatment, culture recheck schedule etc) does the kitty have clinical signs of uti each time (hematuria, stranguria, pollakuria, dysuria etc), or have some of these been asymptomatic infections being picked up on routine monitoring?

Makes sense?

Got a 14 yr old S/F Abysinian non-azotemic cat with recurrent hematuria and pyuria and several posative urine cultures (E.Coli) Also has intermittant neutophilias (like 22,000), Urine S/G (like 1.020) Been ultasounded 2X very accomplished ultasonographer/internist with no major serious findings! The cat always seems to respond to antibiotics. Question is: any reason NOT to place cats on a 'chronic low dose', AB similiar to the 1/3 dose, at night, on an empty bladder, as done in dogs? Thanx, br/

If clinical signs are present, do they resolve within a few days of starting antibiotics?

My question would therefore be: at this moment in time, is there pu/pd, is weight stable, is there polyphagia?

Got a 14 yr old S/F Abysinian non-azotemic cat with recurrent hematuria and pyuria and several posative urine cultures (E.Coli) Also has intermittant neutophilias (like 22,000), Urine S/G (like 1.020) Been ultasounded 2X very accomplished ultasonographer/internist with no major serious findings! The cat always seems to respond to antibiotics. Question is: any reason NOT to place cats on a 'chronic low dose', AB similiar to the 1/3 dose, at night, on an empty bladder, as done in dogs? Thanx, br/

Are we getting our cultures off cystocentesis-obtained samples?

Tracy -- a few thoughts: is this cat on a low-carb diet and how much does he weight?

Got a 14 yr old S/F Abysinian non-azotemic cat with recurrent hematuria and pyuria and several posative urine cultures (E.Coli) Also has intermittant neutophilias (like 22,000), Urine S/G (like 1.020) Been ultasounded 2X very accomplished ultasonographer/internist with no major serious findings! The cat always seems to respond to antibiotics. Question is: any reason NOT to place cats on a 'chronic low dose', AB similiar to the 1/3 dose, at night, on an empty bladder, as done in dogs? Thanx, br/

When infection is documented, what sort of cfu counts are we getting on quantitative culture, and is the antibiotic resistance profile of the e colis changing between infections?

Is the dog eating?

Got a 14 yr old S/F Abysinian non-azotemic cat with recurrent hematuria and pyuria and several posative urine cultures (E.Coli) Also has intermittant neutophilias (like 22,000), Urine S/G (like 1.020) Been ultasounded 2X very accomplished ultasonographer/internist with no major serious findings! The cat always seems to respond to antibiotics. Question is: any reason NOT to place cats on a 'chronic low dose', AB similiar to the 1/3 dose, at night, on an empty bladder, as done in dogs? Thanx, br/

Does the intermittent neutrophilia coincide with the times that the kitty has a documented uti?

Alleviation?