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Re: ANYBODY HERE 98-10-20 BOMBAYVET A DKA is a good case to start with but further info is needed to answer the questions: What? How much? How do we monitor? Since the diagnosis has been made, do we have access to full profile information and blood gases or did we get the diagnosis from DextroStix and AzoStix? Secondly, what is the weight of the patient? Need to know to set fluid rate. If this patient just came in, we got the quick diagnosis and sent out blood for CBC/Profile/UA with results in the morning, we would also need to know whether this dog will spend the night attended or left on a drip by himself overnight. Certainly, the more info we get, the better we can tailor the fluid therapy and discuss the physiology of our fluid therpy choices. If I knew nothing else but that he was an 8% dehydrated DKA and it was the end of a 12 hour day and he would be spending the night alone and fluid delivery would be by gravity and all I had was a drip set that delivered 10 drops/ml, I would figure his maintenance rate plus deficit, empty a bag of LRS to that level and add KCl to equal 20mEq/L, and try to sleep well so I would be ready to fix things in the morning. DKA's are great examples for fluid therapy discussions. If we set the parameters, this will be interesting.

Does this dog have an underlying probelm such as a uti or pyometra?

How much should she weigh?

Re: ANYBODY HERE 98-10-20 BOMBAYVET A DKA is a good case to start with but further info is needed to answer the questions: What? How much? How do we monitor? Since the diagnosis has been made, do we have access to full profile information and blood gases or did we get the diagnosis from DextroStix and AzoStix? Secondly, what is the weight of the patient? Need to know to set fluid rate. If this patient just came in, we got the quick diagnosis and sent out blood for CBC/Profile/UA with results in the morning, we would also need to know whether this dog will spend the night attended or left on a drip by himself overnight. Certainly, the more info we get, the better we can tailor the fluid therapy and discuss the physiology of our fluid therpy choices. If I knew nothing else but that he was an 8% dehydrated DKA and it was the end of a 12 hour day and he would be spending the night alone and fluid delivery would be by gravity and all I had was a drip set that delivered 10 drops/ml, I would figure his maintenance rate plus deficit, empty a bag of LRS to that level and add KCl to equal 20mEq/L, and try to sleep well so I would be ready to fix things in the morning. DKA's are great examples for fluid therapy discussions. If we set the parameters, this will be interesting.

Is that an ok start?

My questions, should i be concerned with the level of ddavp required?

Diabetic Cushingoid Dog 98-11-10 Petsdoc4 I have been treating a 12 yr old, mixed cocker that is both diabetic and Cushingoid. The Cushings seems to be under control with Lysodren. However, I am having trouble regulating the insulin. The dog was on Humilin N when she started coming to me where I diagnosed the Cushings. She's 10 kg and taking 33 units of insulin in the am and 19 at night and the glucose is hanging between 200-350mg. on glucose curves. Question, do I continue with the same insulin and keep increasing the dose? Or switch to a different type of insulin? If so which would be your choice? I am sure that the insulin is being administered correctly, the owner is extremely diligent and keeps better records than I do. Any help would be greatly appreciated. Thanks, Grif

Have you checked for other causes of insulin resistance besides cushing's -- any signs hypothyroidism?

Which antigens in asit?

Diabetic Cushingoid Dog 98-11-10 Petsdoc4 I have been treating a 12 yr old, mixed cocker that is both diabetic and Cushingoid. The Cushings seems to be under control with Lysodren. However, I am having trouble regulating the insulin. The dog was on Humilin N when she started coming to me where I diagnosed the Cushings. She's 10 kg and taking 33 units of insulin in the am and 19 at night and the glucose is hanging between 200-350mg. on glucose curves. Question, do I continue with the same insulin and keep increasing the dose? Or switch to a different type of insulin? If so which would be your choice? I am sure that the insulin is being administered correctly, the owner is extremely diligent and keeps better records than I do. Any help would be greatly appreciated. Thanks, Grif

Have you cultured the urine?

And needle emg?

Diabetic Cushingoid Dog 98-11-10 Petsdoc4 I have been treating a 12 yr old, mixed cocker that is both diabetic and Cushingoid. The Cushings seems to be under control with Lysodren. However, I am having trouble regulating the insulin. The dog was on Humilin N when she started coming to me where I diagnosed the Cushings. She's 10 kg and taking 33 units of insulin in the am and 19 at night and the glucose is hanging between 200-350mg. on glucose curves. Question, do I continue with the same insulin and keep increasing the dose? Or switch to a different type of insulin? If so which would be your choice? I am sure that the insulin is being administered correctly, the owner is extremely diligent and keeps better records than I do. Any help would be greatly appreciated. Thanks, Grif

Any signs other disease?

How long was the initial course of baytril?

ACTH Stim Test 98-11-22 Mrdr When can an ACTH test be run if a patient is currently on prednisone? I have a mess of a case. She's a 12 year old spayed Cairn with Cushings, Diabetes and horrible seasonal allergies. The only thing she responds to is pred. The last stim test was in 5/98 with pre and post a little be- low normal. I did lab work on her yesterday because she has lost some of her appetite, is losing weight and has been lethargic. When the pred was started for the allergies, there was no improvement in appetite, etc. The lab results were consistent with Cushings and Diabetes, some of which was due to the pred. Her Na:K ratio is 24 with the K normal and Na low. Rads are next on the diagnostic list. Suggestions? I'm not sure the ACTH test is indicated since there was no change when pred was given. But I'd still like to know timing of the test for future reference.

How is the dog's diabetic control?

Does she have any other dermatologic (pruritis, barbering, dermatitis, otitis etc) or gi (chronic vomiter) signs that could suggest a systemic allergy disorder?

ACTH Stim Test 98-11-22 Mrdr When can an ACTH test be run if a patient is currently on prednisone? I have a mess of a case. She's a 12 year old spayed Cairn with Cushings, Diabetes and horrible seasonal allergies. The only thing she responds to is pred. The last stim test was in 5/98 with pre and post a little be- low normal. I did lab work on her yesterday because she has lost some of her appetite, is losing weight and has been lethargic. When the pred was started for the allergies, there was no improvement in appetite, etc. The lab results were consistent with Cushings and Diabetes, some of which was due to the pred. Her Na:K ratio is 24 with the K normal and Na low. Rads are next on the diagnostic list. Suggestions? I'm not sure the ACTH test is indicated since there was no change when pred was given. But I'd still like to know timing of the test for future reference.

Is she ketotic?

Am i correct that you are giving a mix of these two foods?

ACTH Stim Test 98-11-22 Mrdr When can an ACTH test be run if a patient is currently on prednisone? I have a mess of a case. She's a 12 year old spayed Cairn with Cushings, Diabetes and horrible seasonal allergies. The only thing she responds to is pred. The last stim test was in 5/98 with pre and post a little be- low normal. I did lab work on her yesterday because she has lost some of her appetite, is losing weight and has been lethargic. When the pred was started for the allergies, there was no improvement in appetite, etc. The lab results were consistent with Cushings and Diabetes, some of which was due to the pred. Her Na:K ratio is 24 with the K normal and Na low. Rads are next on the diagnostic list. Suggestions? I'm not sure the ACTH test is indicated since there was no change when pred was given. But I'd still like to know timing of the test for future reference.

Any other signs?

But one acute dose, and how much can be in 28 pieces of gum anyway?

Re: Huge blocked cat 98-11-29 Dr

Just removing the obstruction and adding fluids will give his kidneys a chance to do their thing! my choice of fluids would probably be 5%dextrose in lrs, or 'piggy-backed' into plasmalyte (effectively 2.5%dextrose in 1/2 strength pl) through the same line -- does this make sense?

From the description i would think upper motor neuron disease (caudal fossa/cervical) vs tetanus (based on the stiff description?

Rottie down 98-12-26 HICKDOC Merry Christmas to all and to all..... Have a 7 year old male rot that came in comatose the other day with ketoacidosis from improperly controlled diabetes. His glucose was above 600 and apparently had acute pancreatitis to boot.....amylase and lipase both off the charts at Antech and in our in house lab as well. He has come around now trying to eat everyone as usual including the owners...oh why do they not make laws against these dogs...anyway the remaining problem is that the dog is, and apparently was when comatose, paralyzed in the back. He tries to get up and just drags his back legs...wouldnt walk the first day when we release him from the hospital but assumed them it was just pain and weakness. Any way I am hard pressed to associate his acute pancreatitis/dka with this neurological problem....I cannot examine this excuse for a pet as he is one that you cannot get into the same room with when he feels well. This was part of why his mobile vet hadnt gotten the insulin dose fine tuned I am sure. Any ideas here....gonna bite the bullet and xray the dog Monday if he is no better but dont relish the idea...I guess what I am looking for here is a disease that would be tied to his metabolic disease(s)....any thoughts? Thanks for your time, everyone. Happy Holidays...Jim PS back limbs are becoming edematous...I assume this is from being 'down' so long like downer cows. Just poor circulation but started me wondering about thromboembolism like the saddle block cats...never saw one of these get edematous but in a 100#+ dog it might be conceivable? Grasping for ideas I guess.

Perhaps the dog has a secondary problem?

Could this be a direct effect of the trilostane?

Re: Enalapril ,HCM, Renal dz 98-12-02 PDP1 Guess I don't think this cat needs any medication. If the cat is not having LA enlargement (not reported) then I don't think the cardiac disease is of significance. Happy to hear more details to convince me otherwise. I also don't think that 155/80 is hypertension worth treating in a cat. If you are getting repeatable systolic BP > 190 then I'd treat with amlodipine. This is somewhat complicated by us not knowing what effect the enalapril is having now -- and what will happen if we remove it. So are somewhat left with the option of status quo to not take a chance, add amlodipine and then remove enalapril, or stop enalapril and then add amlodipine. If there is no LA enlargement, I'd not be worried about considering some regimen of SQ fluids at home if azotemia continues to worsen and you are not sure the cat is drinking enough to keep up with losses. Does that help?

Do you have a baseline blood pressure on the cat?

Posted in message boards 1.0p/p/ -- why not the vmth at uc-davis?

Acromegaly and Constipation 98-12-10 K97527 Hi, I've a real management nightmare with this ty. An 11# 12yr FS DSH with acromegaly, pituitary tumor confrmed by MRI, and insulin resistant DM. Currently on 35u NPH BID. She was doing reasonably well until she developed a constipation problem. I have had to anesth. her and manually evacuate her entire colon on several occassions. Something I would really rather not do in a cat with a heart the size of a grapefruit. She is currently on Lactulose 3ml TID and Propulsid 7.5mg TID. I've been slowly increasing the dosages over the last 3 months, but feel I have maxed them out. I have also played with diet. W/D made things worse. Currently trying I/D and canned pumpkin and it seems to going ok so far. I'm curious about any thoughts you might have on the cause of the constipation. Basically I'm wondering if there is something I'm missing that could be addressed. I don't know if the constipation is an independent problem or if it could be related to the DM or Acromegaly. Is there any poss of a diabetic neuropathy affecting only the colon? Another crazy thought- could the pituitary tumor be affecting other pituitary functions like TSH production? I've seen constipation listed as a result of congenital hypothyroisism is cats. Are there any other therapeutic approaches you'ld recc. for the constipation? (The owners have declined radiation of the pituitary tumor and colectomy) This has been a really great case, but I don't know if there is anywhere to go from here. The owners aren't quite ready to give up yet. Thanks for the input. p

Regarding hypothryoidism?

Was the cholesterol high?

DKA Kitty 99-01-03 SAHDVM Spanky is a 14 month old cat that, of course, belongs to my technician. After boarding for about 10 days his appetite, which was never great while he was boarding, decreased. He continued to drink fairly well and urinate very well before my staff FINALLY told me that there was a problem. He was the most dehydrated kitty I have ever seen. His blood sugar was 417 with moderate ketones in his urine and 4+ glycosuria. I made a tentative diagnosis of DKA and started him on regular IM insulin injections, NaCl with 20 meq./liter of K+ at 2 x maint. IV fluid levels and antibiotics. His initial panel (12/31) PCV 33, wbc 13.2, neuts 12936, lymphos 264, sgot 170, sgpt 136, t bili 0.5 (not fractionated), choles 249, bun 133, creat 8.6, calcium 3.1, phos 10.4, Na 123, Cl 75, cpk 1922, triglycerides 904, osmol 323, FeLV, FIV negative. Cystocentesis urine spgr 1.020, pH 5.0, protein 2+, wbc 7-10, rbc 20-30. squamous 7-10. I started him on Humulin N, 2 units, (7.5# cat) SID after the regular insulin injections kept him in the 200-300 range for about 24 hours. He continued on fluids as above, 2 x maint. and antibiotics. He ate alittle, was force fed more and continued to drink and urinate very well. His labwork today (1/2) wbc 11.0, pcv 30, neuts 9570, lymphos 880, monos 110, eos 440, sgot 135, sgpt 176, t bili 0.7, sap 18, bun 89, creat 8.0, calcium 3.4 (unfortunately, I didn't address this three days ago-he is now on calcium gluconate), Na 139, Cl 91, triglycerides 101, cpk 4172, osmol 328, urine specific gravity 1.010, negative ketones, light glycosuria. The Humulin N seems to be keeping his BSL in the 160-240 range. He initially improved but was looking markedly worse last night. He has improved a tremendous amount since I started him on the calcium. Questions: I was expecting a low phosphorus, not a high level. I was also expecting a hyperosmolality. Does this look like diabetic ketoacidosis? Is the renal failure secondary to DKA (I think so) or could severe renal failure lead to a stress hyperglycemia...DKA? That doesn't seem particularly plausible. Where do the WBC and RBC in the urine fit in? I was certainly hoping that the creatinine was going to come down, should it already be lower? The increased bilirubin-is this probably secondary to hepatopathy? I guess one of my main concerns is how an apparently healthy cat can develop diabetes while boarding. My technician, who unlike my kennel staff, is very observant, says that he was not PUPD at home. No history of steroids. How fast does DKA develop? Any suggestions? Prognostications? Ts, Marti

Were these done in house?

Could there be a uti?

Multi Endo Cat 98-12-01 JODIDVM I have a 16 year old DSH male/N with a current vaccine history. We have done a CBC, CHem and Ua on him every 6 to 8 months for the last 4 years with normal results. In 5/98 the owner reported weight loss (1 lb. in 5 weeks) and vomiting. A blood screen revealed hyperthyroidism with a level of 4.6. He has maintained on 1 5mg Tapazole sid since with the T4 remaining around 2.5. On 11/4/98 he represented with a history of 3 days of PU/PD. His blood glucose at that time was 468, ALT 219, USG 1.016, 4+ glucosuria, no ketones and all other parameters normal. He was regulated on 4 iu of Humilin U and stayed well regulated for 3 1/2 weeks. His glucoses over this time ranged from 150 to 320 throughout the day. The owner is fanatical about charting water input and output and his PU/PD resolved over the last 2 weeks. He had what appeared to be a hypoglycemic attack yesterday and responded well to oral glucose. His glucose curve today (with 4 units) ranged from a high of 230 to a low of 38. He has had diarrhea over the last 72 hours of unknown cause. His bloodwork today reveals a ALP of 154, ALT of 809, Cholesterol of 291. The remainder of CBC,T4,and chem are normal. How would you recommend pursueing the elevated ALT. He is alert, happy and eating very well. Could a level this high be secondary to diabetes or hyperthyroidism. Could it be secondary to Tapazole? There is no history of toxin, etc.

If the cat was hypoglycemic, maybe that pissed the liver off and caused the elevation in alt?

How does the rest of the bloodwork look?

Multi Endo Cat 98-12-01 JODIDVM I have a 16 year old DSH male/N with a current vaccine history. We have done a CBC, CHem and Ua on him every 6 to 8 months for the last 4 years with normal results. In 5/98 the owner reported weight loss (1 lb. in 5 weeks) and vomiting. A blood screen revealed hyperthyroidism with a level of 4.6. He has maintained on 1 5mg Tapazole sid since with the T4 remaining around 2.5. On 11/4/98 he represented with a history of 3 days of PU/PD. His blood glucose at that time was 468, ALT 219, USG 1.016, 4+ glucosuria, no ketones and all other parameters normal. He was regulated on 4 iu of Humilin U and stayed well regulated for 3 1/2 weeks. His glucoses over this time ranged from 150 to 320 throughout the day. The owner is fanatical about charting water input and output and his PU/PD resolved over the last 2 weeks. He had what appeared to be a hypoglycemic attack yesterday and responded well to oral glucose. His glucose curve today (with 4 units) ranged from a high of 230 to a low of 38. He has had diarrhea over the last 72 hours of unknown cause. His bloodwork today reveals a ALP of 154, ALT of 809, Cholesterol of 291. The remainder of CBC,T4,and chem are normal. How would you recommend pursueing the elevated ALT. He is alert, happy and eating very well. Could a level this high be secondary to diabetes or hyperthyroidism. Could it be secondary to Tapazole? There is no history of toxin, etc.

Only worrisome thing is the diarrhea -- has that resolved?

Hmmm..how much does the dog weigh?

Re: unregulated diabetic cat 98-12-15 Doc Good job so far on working this cat up! what was the t4? if toward high end of normal, the cat could still be hyperthyroid and i would check a free t4. as far as insulin, unless you are going to get pzi from blue ridge pharmaceutical/idexx i wouldn't use it. pharmacists will compound it, but it is not consistent from vial to vial and that could account for some of the problems you were having. at this point the ultralente is unlikely to work, but you can go up as high as 8 u bid before giving up. if ultralente and pzi are out, i would use lente.

Bid pzi?

I'm attributing the leukocytosis and neutrophilia/monocytosis to the exogenous pred - is this a reasonable assumption?

Re: unregulated diabetic cat 98-12-15 Doc Good job so far on working this cat up! what was the t4? if toward high end of normal, the cat could still be hyperthyroid and i would check a free t4. as far as insulin, unless you are going to get pzi from blue ridge pharmaceutical/idexx i wouldn't use it. pharmacists will compound it, but it is not consistent from vial to vial and that could account for some of the problems you were having. at this point the ultralente is unlikely to work, but you can go up as high as 8 u bid before giving up. if ultralente and pzi are out, i would use lente.

Another bottle of pzi?

When he's coming in for these curves, how does the food/insulin timing in the am compare to what happens on a regular day at home?

Re: unregulated diabetic cat 98-12-15 Doc Good job so far on working this cat up! what was the t4? if toward high end of normal, the cat could still be hyperthyroid and i would check a free t4. as far as insulin, unless you are going to get pzi from blue ridge pharmaceutical/idexx i wouldn't use it. pharmacists will compound it, but it is not consistent from vial to vial and that could account for some of the problems you were having. at this point the ultralente is unlikely to work, but you can go up as high as 8 u bid before giving up. if ultralente and pzi are out, i would use lente.

Give up on pzi and go back to nph where at least clinically the cat seemed to be doing well?

It sounds like she has been a diabetic for a long time and recently became addisonian?

Re: unregulated diabetic cat 98-12-15 Doc Good job so far on working this cat up! what was the t4? if toward high end of normal, the cat could still be hyperthyroid and i would check a free t4. as far as insulin, unless you are going to get pzi from blue ridge pharmaceutical/idexx i wouldn't use it. pharmacists will compound it, but it is not consistent from vial to vial and that could account for some of the problems you were having. at this point the ultralente is unlikely to work, but you can go up as high as 8 u bid before giving up. if ultralente and pzi are out, i would use lente.

Also thinking maybe a bad bottle of pzi-does that happen?

Do we have a tbili on this panel?

Re: unregulated diabetic cat 98-12-15 Doc Good job so far on working this cat up! what was the t4? if toward high end of normal, the cat could still be hyperthyroid and i would check a free t4. as far as insulin, unless you are going to get pzi from blue ridge pharmaceutical/idexx i wouldn't use it. pharmacists will compound it, but it is not consistent from vial to vial and that could account for some of the problems you were having. at this point the ultralente is unlikely to work, but you can go up as high as 8 u bid before giving up. if ultralente and pzi are out, i would use lente.

Any thoughts?

How is this patient begin monitored?

DKA Kitty 99-01-03 SAHDVM Spanky is a 14 month old cat that, of course, belongs to my technician. After boarding for about 10 days his appetite, which was never great while he was boarding, decreased. He continued to drink fairly well and urinate very well before my staff FINALLY told me that there was a problem. He was the most dehydrated kitty I have ever seen. His blood sugar was 417 with moderate ketones in his urine and 4+ glycosuria. I made a tentative diagnosis of DKA and started him on regular IM insulin injections, NaCl with 20 meq./liter of K+ at 2 x maint. IV fluid levels and antibiotics. His initial panel (12/31) PCV 33, wbc 13.2, neuts 12936, lymphos 264, sgot 170, sgpt 136, t bili 0.5 (not fractionated), choles 249, bun 133, creat 8.6, calcium 3.1, phos 10.4, Na 123, Cl 75, cpk 1922, triglycerides 904, osmol 323, FeLV, FIV negative. Cystocentesis urine spgr 1.020, pH 5.0, protein 2+, wbc 7-10, rbc 20-30. squamous 7-10. I started him on Humulin N, 2 units, (7.5# cat) SID after the regular insulin injections kept him in the 200-300 range for about 24 hours. He continued on fluids as above, 2 x maint. and antibiotics. He ate alittle, was force fed more and continued to drink and urinate very well. His labwork today (1/2) wbc 11.0, pcv 30, neuts 9570, lymphos 880, monos 110, eos 440, sgot 135, sgpt 176, t bili 0.7, sap 18, bun 89, creat 8.0, calcium 3.4 (unfortunately, I didn't address this three days ago-he is now on calcium gluconate), Na 139, Cl 91, triglycerides 101, cpk 4172, osmol 328, urine specific gravity 1.010, negative ketones, light glycosuria. The Humulin N seems to be keeping his BSL in the 160-240 range. He initially improved but was looking markedly worse last night. He has improved a tremendous amount since I started him on the calcium. Questions: I was expecting a low phosphorus, not a high level. I was also expecting a hyperosmolality. Does this look like diabetic ketoacidosis? Is the renal failure secondary to DKA (I think so) or could severe renal failure lead to a stress hyperglycemia...DKA? That doesn't seem particularly plausible. Where do the WBC and RBC in the urine fit in? I was certainly hoping that the creatinine was going to come down, should it already be lower? The increased bilirubin-is this probably secondary to hepatopathy? I guess one of my main concerns is how an apparently healthy cat can develop diabetes while boarding. My technician, who unlike my kennel staff, is very observant, says that he was not PUPD at home. No history of steroids. How fast does DKA develop? Any suggestions? Prognostications? Ts, Marti

How well hydrated is the cat now?

Polyphagia?

DKA Kitty 99-01-03 SAHDVM Spanky is a 14 month old cat that, of course, belongs to my technician. After boarding for about 10 days his appetite, which was never great while he was boarding, decreased. He continued to drink fairly well and urinate very well before my staff FINALLY told me that there was a problem. He was the most dehydrated kitty I have ever seen. His blood sugar was 417 with moderate ketones in his urine and 4+ glycosuria. I made a tentative diagnosis of DKA and started him on regular IM insulin injections, NaCl with 20 meq./liter of K+ at 2 x maint. IV fluid levels and antibiotics. His initial panel (12/31) PCV 33, wbc 13.2, neuts 12936, lymphos 264, sgot 170, sgpt 136, t bili 0.5 (not fractionated), choles 249, bun 133, creat 8.6, calcium 3.1, phos 10.4, Na 123, Cl 75, cpk 1922, triglycerides 904, osmol 323, FeLV, FIV negative. Cystocentesis urine spgr 1.020, pH 5.0, protein 2+, wbc 7-10, rbc 20-30. squamous 7-10. I started him on Humulin N, 2 units, (7.5# cat) SID after the regular insulin injections kept him in the 200-300 range for about 24 hours. He continued on fluids as above, 2 x maint. and antibiotics. He ate alittle, was force fed more and continued to drink and urinate very well. His labwork today (1/2) wbc 11.0, pcv 30, neuts 9570, lymphos 880, monos 110, eos 440, sgot 135, sgpt 176, t bili 0.7, sap 18, bun 89, creat 8.0, calcium 3.4 (unfortunately, I didn't address this three days ago-he is now on calcium gluconate), Na 139, Cl 91, triglycerides 101, cpk 4172, osmol 328, urine specific gravity 1.010, negative ketones, light glycosuria. The Humulin N seems to be keeping his BSL in the 160-240 range. He initially improved but was looking markedly worse last night. He has improved a tremendous amount since I started him on the calcium. Questions: I was expecting a low phosphorus, not a high level. I was also expecting a hyperosmolality. Does this look like diabetic ketoacidosis? Is the renal failure secondary to DKA (I think so) or could severe renal failure lead to a stress hyperglycemia...DKA? That doesn't seem particularly plausible. Where do the WBC and RBC in the urine fit in? I was certainly hoping that the creatinine was going to come down, should it already be lower? The increased bilirubin-is this probably secondary to hepatopathy? I guess one of my main concerns is how an apparently healthy cat can develop diabetes while boarding. My technician, who unlike my kennel staff, is very observant, says that he was not PUPD at home. No history of steroids. How fast does DKA develop? Any suggestions? Prognostications? Ts, Marti

Was the serum lipemic or hemolyzed?

He's absolutely not getting any jerky treats?

Induction & Diabetic Cats 99-01-11 CUTNDOC Hi, What is the best/recommended pre-med/induction protocol for a stabilized DM cat. We have Diazpam, Ace, Butorphanol, isoflurane. I don't want to use Ketamine and we don't have any quick-acting barbituates. Thanks! Kris

Why no ketamine?

Are the accidents large or small?

Leflunomide and Etogesic pro 98-12-31 StClaraPet I have a 10year old,30 kg diabetic canine that has been diagnosed with systemic histiocytosis via skin biopsies. The dermatologist has started the dog on Leflunomide 20mg once a day. The dog also has degenerative joint disease that has been well controlled with Etogesic at 450mg once a day. I am aware of the potential for GI upset with both the luflunomide and etogesic and wonder if I should place this dog on GI protectants as well, or if there are any other interactions between these two drugs I should be aware of.

What type of medication is it?

It's not likely that nih is going to dole out money for this type of study, so what other options are available to the researchers?

DM and Cushings? 99-01-21 HMAH2100 Hi there, I have a 12 yr. old SF 18# mixed breed dog that presented originally on 1/9/99 for anorexia and one day duration of diarrhea. The bitch was very lethargic, almost lateral at that time and non-responsive. She was 10% dehydrated, had grade III periodontal disease and multiple lipomas...large, pot-bellied abdomen with hepatomegaly and possible splenomegaly. Bloodwork showed: Alk Phos: >4,000, ALT 254, BUN 86.6, CREA 4.45, GLU 612.8, PHOS >16.1. I could not obtain a urinalysis at that time. I started to diurese her and she perked up enough to begin drinking constantly. I started her on 6U NPH insulin BID and she began to eat the next day (we force fed her after the evening insulin injection). We continued the diuresis for 3 days after which time her renal values had returned to normal. Her glucose curve was going between 361 and 219 so we left it alone (she was up to 8U at that time). It is now two weeks later and the bitch is doing quite well at home. She is eating well, drinking less (but still drinking a great amount), has a voracious appetite and is much brighter. I saw her on a recheck today and her Alk Phos is still almost 4,000. Her BG was 219 on the panel and the rest of her values are WNL. My question is: How do you treat concurrent Cushingoid/diabetics? I am going to schedule her for an ACTH stim next week. I thought I had better treat her diabetes at the outset since she was so ill. Does the diabetes in these dogs improve once the Cushings is treated? I have had several dogs like this throught the years and have had several different opinions from internists as to what to treat first. This is the first dog I have successfully treated so she saw the sunrise from home again. How do you monitor the DM once you start Lysodren? Ts for all your help, it is greatly appreciated!!! Lisa Costello HMAH2100

Lisa does the dog look cushingnoid?

Uti?

DM and Cushings? 99-01-21 HMAH2100 Hi there, I have a 12 yr. old SF 18# mixed breed dog that presented originally on 1/9/99 for anorexia and one day duration of diarrhea. The bitch was very lethargic, almost lateral at that time and non-responsive. She was 10% dehydrated, had grade III periodontal disease and multiple lipomas...large, pot-bellied abdomen with hepatomegaly and possible splenomegaly. Bloodwork showed: Alk Phos: >4,000, ALT 254, BUN 86.6, CREA 4.45, GLU 612.8, PHOS >16.1. I could not obtain a urinalysis at that time. I started to diurese her and she perked up enough to begin drinking constantly. I started her on 6U NPH insulin BID and she began to eat the next day (we force fed her after the evening insulin injection). We continued the diuresis for 3 days after which time her renal values had returned to normal. Her glucose curve was going between 361 and 219 so we left it alone (she was up to 8U at that time). It is now two weeks later and the bitch is doing quite well at home. She is eating well, drinking less (but still drinking a great amount), has a voracious appetite and is much brighter. I saw her on a recheck today and her Alk Phos is still almost 4,000. Her BG was 219 on the panel and the rest of her values are WNL. My question is: How do you treat concurrent Cushingoid/diabetics? I am going to schedule her for an ACTH stim next week. I thought I had better treat her diabetes at the outset since she was so ill. Does the diabetes in these dogs improve once the Cushings is treated? I have had several dogs like this throught the years and have had several different opinions from internists as to what to treat first. This is the first dog I have successfully treated so she saw the sunrise from home again. How do you monitor the DM once you start Lysodren? Ts for all your help, it is greatly appreciated!!! Lisa Costello HMAH2100

What makes you think the dog has cushings besides the pu/pd?

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

DM and Cushings? 99-01-21 HMAH2100 Hi there, I have a 12 yr. old SF 18# mixed breed dog that presented originally on 1/9/99 for anorexia and one day duration of diarrhea. The bitch was very lethargic, almost lateral at that time and non-responsive. She was 10% dehydrated, had grade III periodontal disease and multiple lipomas...large, pot-bellied abdomen with hepatomegaly and possible splenomegaly. Bloodwork showed: Alk Phos: >4,000, ALT 254, BUN 86.6, CREA 4.45, GLU 612.8, PHOS >16.1. I could not obtain a urinalysis at that time. I started to diurese her and she perked up enough to begin drinking constantly. I started her on 6U NPH insulin BID and she began to eat the next day (we force fed her after the evening insulin injection). We continued the diuresis for 3 days after which time her renal values had returned to normal. Her glucose curve was going between 361 and 219 so we left it alone (she was up to 8U at that time). It is now two weeks later and the bitch is doing quite well at home. She is eating well, drinking less (but still drinking a great amount), has a voracious appetite and is much brighter. I saw her on a recheck today and her Alk Phos is still almost 4,000. Her BG was 219 on the panel and the rest of her values are WNL. My question is: How do you treat concurrent Cushingoid/diabetics? I am going to schedule her for an ACTH stim next week. I thought I had better treat her diabetes at the outset since she was so ill. Does the diabetes in these dogs improve once the Cushings is treated? I have had several dogs like this throught the years and have had several different opinions from internists as to what to treat first. This is the first dog I have successfully treated so she saw the sunrise from home again. How do you monitor the DM once you start Lysodren? Ts for all your help, it is greatly appreciated!!! Lisa Costello HMAH2100

Do you have serial bg's to make sure that the pu/pd is not from the diabetes?

The owner is moving the injections around on the dog's body every day?

PU/PD Puppies 99-01-25 Bleusmom A strange couple of puppies... Two littermate Rottweiler puppies, born 9-98, found their way to our clinic (independently...but with their individual owners ;-) Both initially presented for polydipsia/polyuria and 'leaking urine' when sleeping/napping. Both pups would leave their bedding urine soaked, and urinated frequently during the day. Appetites are good. I will try to be organized...sorry it's a long post. Pup #1: Originally presented before Christmas holiday. Since owner was leaving town, and signs were consistent with UTI, puppy was placed on Amoxicillin 10mg/# BID. (no urine available for cysto). Free catch sample collected after antibiotics: Sp.Gr.1.006 and bacteria observed neg or normal on all other values. Blood panel results: Alk Phos: 162 (10-150) CK: 325 (10-200) Phos: 9.2 (2.1-6.3) Potassium: 5.8 (4.0-5.6) Na/K ratio: 25 (27-40) WBC: 18,500 RBC: 5.06 HCT: 33.7 Absolute Lymph: 6290 Abs. Eosin: 4440 Abs. Baso: 185 target cells present Reticulocyte count 2.0 (0.5-1.5) Abs. Retic. count: 101200 Urine culture (by cysto): negative Water intake measured as approx. 2x normal (drank 1.5 liters water in 12 hours for 30# puppy) Original course of antibiotics had no effect. Puppy was dewormed with Panacur (3 days) and placed on Cephalexin 500mg BID for 2 weeks (despite negative culture). Also added Phenylpropanolamine which helped for 1 week only. Currently on Cephalexin. Problem of urinating frequently, drinking lots and 'leaking' during sleep is as bad as was originally. Pup #2 Presented for increased water consumption and urinary incontinence (during sleep). U/A: (morning urine--free catch) Sp. Gr. 1.010 Ph: 5 bacteria observed Panel results: Alk Phos: 276 (1-=150) ALT: 130 (5-60) CK: 470 (10-200) Alb: 2.5 (2.6-4.3) Phos: 9.7 (2.1-6.3) WBC: 25.2 RBC: 5.18 HCT: 35.4 Abs. Lymph.: 5040 Abs. Mono: 1764 Abs. Eosin: 10332 Urine cultuRe: >100,000 organisms/ml E.Coli MIC-sensitive to all Puppy dewormed with Panacur (3 days), placed on Clavamox and PPA. Water consumption measured at 3 times normal (drank 3 quarts of water from 4PM to 8AM for 31# puppy). Still leaking urine (soaking bedding) at night, PU/PD. Repeat culture after 10 days antibiotics was negative. Currently on Clavamox. WHEW. Both puppies have continued having PU/PD with NO improvement (except short term improvement with Pup #1 after PPA). They are otherwise alert and active, normal body temp, and good appetites/good body condition. Neither pup 'dribbles' urine or urinates submissively (both are somewhat nervous pups). Our next plan is to do an ACTH stim. on pup#1, and a bile acids on pup#2 as well as the ACTH stim. Any input or suggestions are welcome. We are not aware of any other pup in the litter having a problem, but the pups are from outside our immediate area (how they both ended up here we still haven't figured out :) Thanks in advance, p Ziemski Carol Iida

Were they checked for glucosuria to rule out primary renal glycosuria?

What form of acth did you use?

Trental 99-01-04 KimikoDVM Is there a reason not to use trental on chemo patients? Is anyone doing this regularly? It would seem that the TNF benefits, the increase in appeitie and well being would benefit these patients especially.

Could you elaborate a bit?

Any pu/pd, pot-belly, comedones, muscle wastage, fur changes, etc?

MCT in cat 99-01-16 Hypurr Gooooood morning! :-) Murphy is a 12year old DSH whose spleen I removed 2 years ago dt MCT. He has been stable on pred plus famotidine. Since Xmas he has been a little picky about food, but hasn't lost any weight. he is hunched in the back end and has remarkable crepitus of the LS region when I palpated his abdomen and when we temp'd him. He has a fever (40.7) As he is obes, hydration was difficult to assess, but even his mucous membranes were moist. Bloods...CBC inc wbc (17.9K) with acute inflammation (196 bands, moderate toxic change and occ doehle body)...mast cells seen. (Note: they have been seen over the years intermittently on his CBCs.) Chems: renal +/- prerenal azotemia (mild SC and BUN inc, usg 1.016) but trace glucosuria and hyperglycemia. (I never know how to interpret usg when there is possibility of diabetic polyuria....) I have requested fructosamine add on. Radiographs shown spondylolithisis of L3-4 and L7-S1 with possible flattening of the L femoral head. I have started him on cefalothin and metronidazole orally, SC fluids and we are supplementing his food intake. He is going for abdominal ultrasound. My Q to you is....is there anything I can use in place of the prednisolone as I am concerned about the apparent/possibility of insulin resistence? Anything else I should keep in mind? BTW....the cat I posted about in Nov 96 with intestinal MCT (as confirmed by Barb Powers) is holding his own on pred (5 mg po SID)and metronidazole (32 mg po SID) and famotidine. Thanks for your advice! Cheers! >M>

The question is, is the pred doing anything at this point or do we have multiple drug resistance?

Hav you c/s the urine?

MCT in cat 99-01-16 Hypurr Gooooood morning! :-) Murphy is a 12year old DSH whose spleen I removed 2 years ago dt MCT. He has been stable on pred plus famotidine. Since Xmas he has been a little picky about food, but hasn't lost any weight. he is hunched in the back end and has remarkable crepitus of the LS region when I palpated his abdomen and when we temp'd him. He has a fever (40.7) As he is obes, hydration was difficult to assess, but even his mucous membranes were moist. Bloods...CBC inc wbc (17.9K) with acute inflammation (196 bands, moderate toxic change and occ doehle body)...mast cells seen. (Note: they have been seen over the years intermittently on his CBCs.) Chems: renal +/- prerenal azotemia (mild SC and BUN inc, usg 1.016) but trace glucosuria and hyperglycemia. (I never know how to interpret usg when there is possibility of diabetic polyuria....) I have requested fructosamine add on. Radiographs shown spondylolithisis of L3-4 and L7-S1 with possible flattening of the L femoral head. I have started him on cefalothin and metronidazole orally, SC fluids and we are supplementing his food intake. He is going for abdominal ultrasound. My Q to you is....is there anything I can use in place of the prednisolone as I am concerned about the apparent/possibility of insulin resistence? Anything else I should keep in mind? BTW....the cat I posted about in Nov 96 with intestinal MCT (as confirmed by Barb Powers) is holding his own on pred (5 mg po SID)and metronidazole (32 mg po SID) and famotidine. Thanks for your advice! Cheers! >M>

By the way, is this kitty on chromium/vanadium (chromium fuel)?

Interesting case!  i would wonder if the dog has developed some pancreatitis, and if this is causing shutdown of normal and even the presumed neoplastic islet cells?

LSA in CR with neuro signs 99-01-22 FaVaAC I am treating a 4.5 year old intact female pug with lymphoma. It presented with respiratory disease attributable to large mandibular nodes and would be classified as at least a stage4b. (Some anemia too but no bone marrow aspirate) In any case I have used the VELCAP protocol from Tufts with few problems. The dog was in complete remission by week 5. After week seven had severe neutropenia with a fever (500wbc with 103+ F).The dog did well with supportive care and bounced back to 8000wbc. I had delayed the week 8 dose of elspar by a week . 3 days after the second dose of elspar the dog appears to have some loss of balance with some crab like walking. The odd thing is that she seems to work her way out of it over the course of the day. Appetite and thirst... appear unchanged. I have read a couple of previous posts (in '95 and'97) and am left with a couple of questions. Should I skip the last dose of elspar (scheduled for week 10)? Any evidence of intracranial bleed due to elspar in animals? Should I decrease the next dose of cytoxan by more than 25%? Thanks for any help Paul (The protocol I have used is the VELCAP short which ends after week 12(with alternatives depending on time of relapse). Week1-VCR and pred, Week2-Adria/VCR, Week3-VCR, Week4-Adria, Week7-VCR/CTX/elspar, Week8-elspar, Week10-elspar, Week12-VCR/CTX.)

Are you sure it was a neurologic problem and not generalized weakness?

Does this dog have an endocrine disease?

Poisoning 96-10-25 RASdvm Sig. 2 yr shep F/S Hx. seizure after one or two doses of Primor (for a paw lesion) so changed to Clav; one week later gets out, roams free for a few hours, comes back ataxic and dyspneic, improves greatly at emergency clinic over 24 hrs. so sent home Sunday (CBC/chem wnl); presents Monday w/ dyspnea, sl bradycardia (88 - 104 range) paresis, mild ataxia, mydriasis, mild hypersalivation, XR lat chest and abd. WNL, ALT 1400, AST >10000, CPK >10000, and hemoglobinuria with struvites (+/- hemoglobinemia or hemolyzed stick) but no anemia; started on LRS (susequently changed to saline .45% dex 2.5%) Cefazolin, metidazole, and lactulose; minimal response to atropine injections (with 2 PAM at first), toxiban by mouth, warm water enema then oral benadryl the next day; blood lead comes up 0, then cholinesterase comes out elevated 2 days ago (I realized the next day that probably RULED OUT OPtoxicity otherwise the level would have been low) so now we're back to supportive care for liver toxicity only (metidazole, 1/2 PSS 1/2 dex with B complex, lactulose K/D and Cefalexin for LUTD) with follow-up CBC/chem pending... Rosie was a little brighter, stger and maybe less dyspneic yesterday but it bugs me not having a specific dx so a more accurate Px can be offered... any ideas? (money not unlimited of course) thanks

How are the liver enzymes changing now?

How to confirm?

Poisoning 96-10-25 RASdvm Sig. 2 yr shep F/S Hx. seizure after one or two doses of Primor (for a paw lesion) so changed to Clav; one week later gets out, roams free for a few hours, comes back ataxic and dyspneic, improves greatly at emergency clinic over 24 hrs. so sent home Sunday (CBC/chem wnl); presents Monday w/ dyspnea, sl bradycardia (88 - 104 range) paresis, mild ataxia, mydriasis, mild hypersalivation, XR lat chest and abd. WNL, ALT 1400, AST >10000, CPK >10000, and hemoglobinuria with struvites (+/- hemoglobinemia or hemolyzed stick) but no anemia; started on LRS (susequently changed to saline .45% dex 2.5%) Cefazolin, metidazole, and lactulose; minimal response to atropine injections (with 2 PAM at first), toxiban by mouth, warm water enema then oral benadryl the next day; blood lead comes up 0, then cholinesterase comes out elevated 2 days ago (I realized the next day that probably RULED OUT OPtoxicity otherwise the level would have been low) so now we're back to supportive care for liver toxicity only (metidazole, 1/2 PSS 1/2 dex with B complex, lactulose K/D and Cefalexin for LUTD) with follow-up CBC/chem pending... Rosie was a little brighter, stger and maybe less dyspneic yesterday but it bugs me not having a specific dx so a more accurate Px can be offered... any ideas? (money not unlimited of course) thanks

What about bilirubin?

Do you have much lepto there?

Poisoning 96-10-25 RASdvm Sig. 2 yr shep F/S Hx. seizure after one or two doses of Primor (for a paw lesion) so changed to Clav; one week later gets out, roams free for a few hours, comes back ataxic and dyspneic, improves greatly at emergency clinic over 24 hrs. so sent home Sunday (CBC/chem wnl); presents Monday w/ dyspnea, sl bradycardia (88 - 104 range) paresis, mild ataxia, mydriasis, mild hypersalivation, XR lat chest and abd. WNL, ALT 1400, AST >10000, CPK >10000, and hemoglobinuria with struvites (+/- hemoglobinemia or hemolyzed stick) but no anemia; started on LRS (susequently changed to saline .45% dex 2.5%) Cefazolin, metidazole, and lactulose; minimal response to atropine injections (with 2 PAM at first), toxiban by mouth, warm water enema then oral benadryl the next day; blood lead comes up 0, then cholinesterase comes out elevated 2 days ago (I realized the next day that probably RULED OUT OPtoxicity otherwise the level would have been low) so now we're back to supportive care for liver toxicity only (metidazole, 1/2 PSS 1/2 dex with B complex, lactulose K/D and Cefalexin for LUTD) with follow-up CBC/chem pending... Rosie was a little brighter, stger and maybe less dyspneic yesterday but it bugs me not having a specific dx so a more accurate Px can be offered... any ideas? (money not unlimited of course) thanks

The markedly elevated sgot and cpk make me wonder about some muscle damage?

How is the dog doing?

Poisoning 96-10-25 RASdvm Sig. 2 yr shep F/S Hx. seizure after one or two doses of Primor (for a paw lesion) so changed to Clav; one week later gets out, roams free for a few hours, comes back ataxic and dyspneic, improves greatly at emergency clinic over 24 hrs. so sent home Sunday (CBC/chem wnl); presents Monday w/ dyspnea, sl bradycardia (88 - 104 range) paresis, mild ataxia, mydriasis, mild hypersalivation, XR lat chest and abd. WNL, ALT 1400, AST >10000, CPK >10000, and hemoglobinuria with struvites (+/- hemoglobinemia or hemolyzed stick) but no anemia; started on LRS (susequently changed to saline .45% dex 2.5%) Cefazolin, metidazole, and lactulose; minimal response to atropine injections (with 2 PAM at first), toxiban by mouth, warm water enema then oral benadryl the next day; blood lead comes up 0, then cholinesterase comes out elevated 2 days ago (I realized the next day that probably RULED OUT OPtoxicity otherwise the level would have been low) so now we're back to supportive care for liver toxicity only (metidazole, 1/2 PSS 1/2 dex with B complex, lactulose K/D and Cefalexin for LUTD) with follow-up CBC/chem pending... Rosie was a little brighter, stger and maybe less dyspneic yesterday but it bugs me not having a specific dx so a more accurate Px can be offered... any ideas? (money not unlimited of course) thanks

Could this dog have azoturia?

Pcv?

Poisoning 96-10-25 RASdvm Sig. 2 yr shep F/S Hx. seizure after one or two doses of Primor (for a paw lesion) so changed to Clav; one week later gets out, roams free for a few hours, comes back ataxic and dyspneic, improves greatly at emergency clinic over 24 hrs. so sent home Sunday (CBC/chem wnl); presents Monday w/ dyspnea, sl bradycardia (88 - 104 range) paresis, mild ataxia, mydriasis, mild hypersalivation, XR lat chest and abd. WNL, ALT 1400, AST >10000, CPK >10000, and hemoglobinuria with struvites (+/- hemoglobinemia or hemolyzed stick) but no anemia; started on LRS (susequently changed to saline .45% dex 2.5%) Cefazolin, metidazole, and lactulose; minimal response to atropine injections (with 2 PAM at first), toxiban by mouth, warm water enema then oral benadryl the next day; blood lead comes up 0, then cholinesterase comes out elevated 2 days ago (I realized the next day that probably RULED OUT OPtoxicity otherwise the level would have been low) so now we're back to supportive care for liver toxicity only (metidazole, 1/2 PSS 1/2 dex with B complex, lactulose K/D and Cefalexin for LUTD) with follow-up CBC/chem pending... Rosie was a little brighter, stger and maybe less dyspneic yesterday but it bugs me not having a specific dx so a more accurate Px can be offered... any ideas? (money not unlimited of course) thanks

(exertional rhabdomyolysis)?

Finally: is he eating canned or dry dm?

Poisoning 96-10-25 RASdvm Sig. 2 yr shep F/S Hx. seizure after one or two doses of Primor (for a paw lesion) so changed to Clav; one week later gets out, roams free for a few hours, comes back ataxic and dyspneic, improves greatly at emergency clinic over 24 hrs. so sent home Sunday (CBC/chem wnl); presents Monday w/ dyspnea, sl bradycardia (88 - 104 range) paresis, mild ataxia, mydriasis, mild hypersalivation, XR lat chest and abd. WNL, ALT 1400, AST >10000, CPK >10000, and hemoglobinuria with struvites (+/- hemoglobinemia or hemolyzed stick) but no anemia; started on LRS (susequently changed to saline .45% dex 2.5%) Cefazolin, metidazole, and lactulose; minimal response to atropine injections (with 2 PAM at first), toxiban by mouth, warm water enema then oral benadryl the next day; blood lead comes up 0, then cholinesterase comes out elevated 2 days ago (I realized the next day that probably RULED OUT OPtoxicity otherwise the level would have been low) so now we're back to supportive care for liver toxicity only (metidazole, 1/2 PSS 1/2 dex with B complex, lactulose K/D and Cefalexin for LUTD) with follow-up CBC/chem pending... Rosie was a little brighter, stger and maybe less dyspneic yesterday but it bugs me not having a specific dx so a more accurate Px can be offered... any ideas? (money not unlimited of course) thanks

Is there pain on palpation of the muscles?

Simultaneously we're keeping them hydrated and monitoring electrolytes and phosphorus closely, to correct all the abnormalities....how do her current numbers look?

Poisoning 96-10-25 RASdvm Sig. 2 yr shep F/S Hx. seizure after one or two doses of Primor (for a paw lesion) so changed to Clav; one week later gets out, roams free for a few hours, comes back ataxic and dyspneic, improves greatly at emergency clinic over 24 hrs. so sent home Sunday (CBC/chem wnl); presents Monday w/ dyspnea, sl bradycardia (88 - 104 range) paresis, mild ataxia, mydriasis, mild hypersalivation, XR lat chest and abd. WNL, ALT 1400, AST >10000, CPK >10000, and hemoglobinuria with struvites (+/- hemoglobinemia or hemolyzed stick) but no anemia; started on LRS (susequently changed to saline .45% dex 2.5%) Cefazolin, metidazole, and lactulose; minimal response to atropine injections (with 2 PAM at first), toxiban by mouth, warm water enema then oral benadryl the next day; blood lead comes up 0, then cholinesterase comes out elevated 2 days ago (I realized the next day that probably RULED OUT OPtoxicity otherwise the level would have been low) so now we're back to supportive care for liver toxicity only (metidazole, 1/2 PSS 1/2 dex with B complex, lactulose K/D and Cefalexin for LUTD) with follow-up CBC/chem pending... Rosie was a little brighter, stger and maybe less dyspneic yesterday but it bugs me not having a specific dx so a more accurate Px can be offered... any ideas? (money not unlimited of course) thanks

Especially epaxial muscles?

The marks on the graphs for 'unpaired meter value' are the times when we carated the machiine by taking a blood sample and measuring via glucometer, then inputting that data to the continous monitor?

Re: sweetie 99-01-09 MITCHSONG Beth: I agree with you and your thoughts as far as diagnostic tests etc. However, I would talk with the owner concerning the hypoallergenic diet. Even if the cat would need to go to another house it would be worth pursuing. p

What method did you use for your fungal culture?

Was the free t4 by equilibrium dialysis?

synotic 99-01-29 K9DOCS Has anyone had a problem with synotic causing diabetes. I realize if there was a tendency to become diabetic then anything is possible. The case in point is a 4yr.old min pin with what appeared to be an acral granuloma. Treatment consisted of oral antibiotics for the infection and topical synotic with banamine 1-2-3 drops twice a day. Treated 14 days. Owner called and reported the dog was drinking more,I told her to stop the synotic and if this persisted more than 2-3 days I needed to see her. Well, it did. Her blood glucose is 400, she is hyperlipidemic and her amylase and lipase are also elevated. Just wondering if my treatment was a problem. She is now started on insulin . Please advise Thankyou

Did you do any further bloodwork to see if the glucose stayed up that much above normal?

Which one is this kitty on?

diabetes/renal failure 99-01-02 HICKDOC Just a quick question to blast my stupidity all over the airways....I am taking care of a diabetic cat, 7 years old, he has apparently gone into renal faillure as his urine specific gravity is now 1.010 and his bun >140. His urine specific gravity was 1.037 in Sept and 1.047 in June. The only significant thing about his previous related medical problem is that he was on huge levels of insulin....humulin N 24 units bid....Monday we checked his glucose at peak insulin activity when he was dropped to board and it was 125....the first normal value we have had for him after adjusting him up time and time again since the summer. He had been 350-400 every time we checked until Monday....THe cat has lost no weight has felt normal at home until left here Monday. He ate well and acted his usual self the first 2 days but stopped eating after 2 days and then vomitted a couple times so we checked him out and found is bun >140 and glucose 35 temp 97 all over about a 48 hour period. I guess I am at a loss as to why the kidneys are failing. What is the relationship or is there one here between this cats two problems....I have seen several 12-14 year old cats this year who came in for polyuria/vomitting and in working them up found both glucosuria/hyperglycemia and azotemia/isothenuria but this cat isnt emaciated and isnt that old...(fwiw,.also worried about hepatic lipidosis coming ...seems a perfect candidate with all thats going on with him right now)....Anyway, I feel bad I cant explain to the owner the cause of what appears to be acute renal failure. Thanks for your help Jim

Once you have corrected the prerenal component, and have ascertained there is a renal component then the next question is acute or chronic?

Is the cat more manageable there?

Boxer w/ Incipient Failure? 99-01-23 DrShuf I'm treating an 8 yr old male boxer who has a history of 'seizures' that have been infrequent (q3-5 m). Dog was placed on phenobarb by another dvm. On physical the dog has a normal neuro exam, however, resting heart rate is 180 with occasional dropped beats. ECG reveals mild left atrial enlargement, sinus tachycardia w/ 3-6 vpcs per 100 beats. Echo values: (79# dog) diastole systole IVS 1.9cm 3.0 cm LVW 1.4cm 1.9 cm LV diameter 5.0 cm 3.2 cm LV volume 115ml 35mls Ejection fraction 70% Left Atrial diameter 2.6 cm Aortic Root diam 1.8 Ratio La/Ao 1.44 EPSS 1.2 cm There is mitral regurge on doppler When I run these numbers through the spreadsheet, looks like chamber size is enlarged in ventricle and atrium but wall thickness is approprite for the dilation. My theory is compensatory hypertrophy sec to mitral regurge? Is this dog likely to be an incipient cardiomyopathic? Would you put this dog on diltiazem or atenalol to reduce the heart rate. The dog is 'asymptomatic' but I suspect the 'seizures' may actually be syncopal episodes. Thanks for the input.

How was this measurement taken?

Is she spayed?

Re: Skinny cat with GI proble 99-01-21 SETSAIL728 John; Sounds like you've done everything. I've had a few cats like that over the years that have driven me crazy. But there's one in particular that 'I cured' after a huge work up. Seems the cat was loaded with tapeworms. We didn't know it at first because it wasn't passing segments and you know you almost never see tapeworm eggs in a fecal. Anyway this cat had the most god aweful intractable runny diarrhea that you can imagine. Cat looked like it spent a couple of years in a concentration camp. Nothing worked until we tapewormed it. Made a new cat out of it. Your post doesn't mention anything about intestinal parasites. I'd worm it 'empirically' whether you get a positive fecal or not. Can't hurt.

Why not get an abdominal u/s done?

Discontinue the otomax and start baytril otic with daily ear cleanings?

Re: Skinny cat with GI proble 99-01-21 SETSAIL728 John; Sounds like you've done everything. I've had a few cats like that over the years that have driven me crazy. But there's one in particular that 'I cured' after a huge work up. Seems the cat was loaded with tapeworms. We didn't know it at first because it wasn't passing segments and you know you almost never see tapeworm eggs in a fecal. Anyway this cat had the most god aweful intractable runny diarrhea that you can imagine. Cat looked like it spent a couple of years in a concentration camp. Nothing worked until we tapewormed it. Made a new cat out of it. Your post doesn't mention anything about intestinal parasites. I'd worm it 'empirically' whether you get a positive fecal or not. Can't hurt.

Have you tried pepto bismol for immediate relief?

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

Jemima the Diabetic 99-01-25 Rdvm I have a diabetic 6 year old Fe-Sp DSH that has been extremely difficult to regulate with insulin therapy. She has been in and out of the hospital for a couple months and finding the dosage that works for her has been a nightmare. She is in our hospital now and her blood glucose is around 380 with 1U regular insulin BID. She has not been eating very well and now she's icteric. My thought is to place a gastrotomy tube, however, how will I manage the diet with tube feeding? She is on LRS right now with KCL supplementation. What am I not considering? How can I best manage this cat at this stage of the game? HELP! Thank you in advance! Eileen Correa

Have you run bloods (cbc, diff, chems and lytes) plus a u/a to determine the cause of the bilirubinemia?

How many calories/day does he currently get?

Jemima the Diabetic 99-01-25 Rdvm I have a diabetic 6 year old Fe-Sp DSH that has been extremely difficult to regulate with insulin therapy. She has been in and out of the hospital for a couple months and finding the dosage that works for her has been a nightmare. She is in our hospital now and her blood glucose is around 380 with 1U regular insulin BID. She has not been eating very well and now she's icteric. My thought is to place a gastrotomy tube, however, how will I manage the diet with tube feeding? She is on LRS right now with KCL supplementation. What am I not considering? How can I best manage this cat at this stage of the game? HELP! Thank you in advance! Eileen Correa

Is (was) she obese?

Should i be instituting any anti-glaucoma therapy?

Jemima the Diabetic 99-01-25 Rdvm I have a diabetic 6 year old Fe-Sp DSH that has been extremely difficult to regulate with insulin therapy. She has been in and out of the hospital for a couple months and finding the dosage that works for her has been a nightmare. She is in our hospital now and her blood glucose is around 380 with 1U regular insulin BID. She has not been eating very well and now she's icteric. My thought is to place a gastrotomy tube, however, how will I manage the diet with tube feeding? She is on LRS right now with KCL supplementation. What am I not considering? How can I best manage this cat at this stage of the game? HELP! Thank you in advance! Eileen Correa

When you have perfoemed blood glucose curves on her, how have they looked?

Sounds like her calcium level was normal?

Jemima the Diabetic 99-01-25 Rdvm I have a diabetic 6 year old Fe-Sp DSH that has been extremely difficult to regulate with insulin therapy. She has been in and out of the hospital for a couple months and finding the dosage that works for her has been a nightmare. She is in our hospital now and her blood glucose is around 380 with 1U regular insulin BID. She has not been eating very well and now she's icteric. My thought is to place a gastrotomy tube, however, how will I manage the diet with tube feeding? She is on LRS right now with KCL supplementation. What am I not considering? How can I best manage this cat at this stage of the game? HELP! Thank you in advance! Eileen Correa

I am not clear what concern you have regarding managing her diet while using a tube?

What was the origin of each dog and how long has the owner had them?

Jemima the Diabetic 99-01-25 Rdvm I have a diabetic 6 year old Fe-Sp DSH that has been extremely difficult to regulate with insulin therapy. She has been in and out of the hospital for a couple months and finding the dosage that works for her has been a nightmare. She is in our hospital now and her blood glucose is around 380 with 1U regular insulin BID. She has not been eating very well and now she's icteric. My thought is to place a gastrotomy tube, however, how will I manage the diet with tube feeding? She is on LRS right now with KCL supplementation. What am I not considering? How can I best manage this cat at this stage of the game? HELP! Thank you in advance! Eileen Correa

Please fill us in with some more details so we can be of help?

He's no longer on the eyedrops that contain the steroids or topical steroids in any other form, right?

Glucose Curve 99-01-28 VetDude I'd like some help interpreting a glucose curve done by the owner at home using blood from ear pricks and a glucometer (kind =?). We started initially with humulin nph insulin but gave up as it never alleviated clinical signs and we ended with hypoglycemic crisis when on 7 units bid. We then changed to lente and the cat did great on 3 units bid but did have a possible hypoglycemic episode once. The owner has done two curves, the first after that episode. 2 curves are below: 10 am 99 (she did not give an injection that morning) 12 noon 252 2 pm 238 4 pm 265 6 pm 313 8 pm 215 ( injection given at 6:30) I didn't think I could tell anything from this so She did another: 8 am 411 (owner fed him and gave injection) 10 am 279 12 am 182 (ate again) 2 pm 340 4 pm 398 6 pm 407 8 pm 366 (injection and snack at 7:30) 9 pm 237 Can you determine anything from this? His latest fructosamine was 544 (349 )="" after="" 4="" weeks="" at="" 3="" units="" lente="" bid.="" he="" was="" doing="" great="" clinically="" (ie="" gaining="" wt),="" but="" now="" seems="" to="" be="" regressing.="" i'm="" a="" little="" nervous="" about="" trying="" 4="" units="" bid.="">/349> Thanks very much.

Have you ruled out concurrent infection that could be playing havoc with glycemic control (eg oral disease)?

Ua?

Diabetes and Renal Fail 99-01-28 FVC4 I'm treating a 13 year old M/N cat who has been on NPH insulin for 4 or 5 years. We recently switched to Euk Low Res from W/d due to obstipation problems and he's been doing very well for 3 to 4 months. The o brought Barney in for 24 hour hx of V & D and I we a panel, UA and Fecal. Fecal unremarkable Urine SG = 1.019, glu 2000 on dipstick, no ketones and no sediment. BUN=45/35, and Creat = 2.7/2.5. My question revolves around the physiology of the Urine SG. Which is the most powerful force: the osmotic effects of glucosuria or the need for increased urine concentration in the presence or mild azotemia? Most diabetics I've seen have Urine SG of 1.030 or a bit more. I also must consider the possibility that the BUN was due to GI bleed. Bottom line, can we diagnose renal failure in this cat? Thanks,

(as well, there is the medullary concentration gradient.) what is this point for the cat?

What did the original ldds look like?

Diabetes and Renal Fail 99-01-28 FVC4 I'm treating a 13 year old M/N cat who has been on NPH insulin for 4 or 5 years. We recently switched to Euk Low Res from W/d due to obstipation problems and he's been doing very well for 3 to 4 months. The o brought Barney in for 24 hour hx of V & D and I we a panel, UA and Fecal. Fecal unremarkable Urine SG = 1.019, glu 2000 on dipstick, no ketones and no sediment. BUN=45/35, and Creat = 2.7/2.5. My question revolves around the physiology of the Urine SG. Which is the most powerful force: the osmotic effects of glucosuria or the need for increased urine concentration in the presence or mild azotemia? Most diabetics I've seen have Urine SG of 1.030 or a bit more. I also must consider the possibility that the BUN was due to GI bleed. Bottom line, can we diagnose renal failure in this cat? Thanks,

Is it 1.007 ....or 1.013.....?

What diet is the dog on?

Diabetes and Renal Fail 99-01-28 FVC4 I'm treating a 13 year old M/N cat who has been on NPH insulin for 4 or 5 years. We recently switched to Euk Low Res from W/d due to obstipation problems and he's been doing very well for 3 to 4 months. The o brought Barney in for 24 hour hx of V & D and I we a panel, UA and Fecal. Fecal unremarkable Urine SG = 1.019, glu 2000 on dipstick, no ketones and no sediment. BUN=45/35, and Creat = 2.7/2.5. My question revolves around the physiology of the Urine SG. Which is the most powerful force: the osmotic effects of glucosuria or the need for increased urine concentration in the presence or mild azotemia? Most diabetics I've seen have Urine SG of 1.030 or a bit more. I also must consider the possibility that the BUN was due to GI bleed. Bottom line, can we diagnose renal failure in this cat? Thanks,

What happened to his bun and sc after you rehydrated him?

How has the cat been doing recently?

Diabetes and Renal Fail 99-01-28 FVC4 I'm treating a 13 year old M/N cat who has been on NPH insulin for 4 or 5 years. We recently switched to Euk Low Res from W/d due to obstipation problems and he's been doing very well for 3 to 4 months. The o brought Barney in for 24 hour hx of V & D and I we a panel, UA and Fecal. Fecal unremarkable Urine SG = 1.019, glu 2000 on dipstick, no ketones and no sediment. BUN=45/35, and Creat = 2.7/2.5. My question revolves around the physiology of the Urine SG. Which is the most powerful force: the osmotic effects of glucosuria or the need for increased urine concentration in the presence or mild azotemia? Most diabetics I've seen have Urine SG of 1.030 or a bit more. I also must consider the possibility that the BUN was due to GI bleed. Bottom line, can we diagnose renal failure in this cat? Thanks,

And there is glucosuria....is he diabetic with renal insufficiency?

What is palpable on digital rectal exam?

Diabetes and Renal Fail 99-01-28 FVC4 I'm treating a 13 year old M/N cat who has been on NPH insulin for 4 or 5 years. We recently switched to Euk Low Res from W/d due to obstipation problems and he's been doing very well for 3 to 4 months. The o brought Barney in for 24 hour hx of V & D and I we a panel, UA and Fecal. Fecal unremarkable Urine SG = 1.019, glu 2000 on dipstick, no ketones and no sediment. BUN=45/35, and Creat = 2.7/2.5. My question revolves around the physiology of the Urine SG. Which is the most powerful force: the osmotic effects of glucosuria or the need for increased urine concentration in the presence or mild azotemia? Most diabetics I've seen have Urine SG of 1.030 or a bit more. I also must consider the possibility that the BUN was due to GI bleed. Bottom line, can we diagnose renal failure in this cat? Thanks,

Care for more mud in the water?

Looks like there might be a delay in onset of insulin?

Geriatric Weight Loss 99-01-31

Have you cultured the urine?

Any clinical signs of hyperadrenocorticism?

Geriatric Weight Loss 99-01-31

How is his mouth?

How's the ua?

Dear Abbie - again 98-09-23 Wet Vet 41 Hey folks, this may take a little time as this case has been ongoing for a while. It's also my head tech's (and right hand lady's) dog and she's looking over my shoulders as I type this (-: Abbie is a 9.5 yr f/s Cocker. In 1/96 we ran a LDDS because she had her share of PU/PD and a health profile which was unremarkable revealed little. Her UA did show a sg of 1.005. The LDDS was normal. In 10/97 with the same cs but still doing ok, we repeated everything - still negative. In 12/97 we performed a modified water deprivation test. The urine sg went from 1.003 at 11 am to only 1.024 at 5 pm (I would have expected more). About 5/98 Abbie became incontinant on occasion so again we ran a repeat ua. Her SG was 1.014 (this was after 8 hrs of no water) in the AM then after she did drink some water it went to 1.000. We put her on 1mg DES twice weekly then once weekly which controlled the incont. and now she doesn't even need it at all. We repeated the profile with a T4 and she did have an elevated alkphos and decreased lymphs. So I'm figuring we got ourselves a cushings. We repeated the LDDS again (actually we waited 2 months because she was given a small dose of dex for some inflammatory bowels) and it too was negative. During this time she began developing some skin pyoderma with hair loss and poor regrowth. She has also been pruritic lately. This has been mildly reponsive to antibiotcs (keflex and dicural at high doses). In August we performed an ACTH stim and sent it to Dr Oliver at University of TN for the complete adrenal test of cortisol along with estrodials and andogens. The reults showed a normal cortisol response with a 'relative estrodiol/androgen imbalance which 'may' repond to methyltestosterone to restore the balance as per Kirk CVT XII pg 600. I'm not convinced that this is the sole problem. What about the urine SG? Where would you all go with this case from here? I'd greatly appreciate any suggestions and or advice. Abbie appears BAR but she is still absolutely PU/PP/PD and her skin still is poorly responsive to frequent baths and antibiotics. Help. Thanks,

What do you think?

Is she spayed?